PECS: A Communication System for Children on the Autistic Spectrum

The Picture Exchange Communication System (PECS) is an augmentative communication system developed to encourage spoken language in individuals with autism and related spectrum disorders. Augmentative communication is an alternative way to help clients with language disorders develop both expressive and receptive language. This system uses a behavioral approach to develop language that is self-initiated, rather than imitative. PECS also follows the typical steps of speech and language development as the client moves through the different levels of the program.

The basic premise of PECS is that by teaching a child to exchange a picture for an object they find to be highly desirable, gaps in communication skills can be bridged. The child is asked to give the picture to the person working with him/her, who is called a communication partner. The child is then given immediate gratification by granting the child the specific request, while also giving them verbal praise. As the stages of PECS continue, the linguistic tasks become increasingly complex. PECS is composed of five stages. This article will briefly discuss the stages and what you can expect your child to gain from mastering each phase.

Phase I does not require the youngster to be able to discriminate between picture cards. The goal of this phase is "initiation" – so the student must "go first." The therapist or communication partner shows the child the reinforcer (highly desired object) and a second therapist or communication partner prompts the child to pick up the corresponding picture. Hand over hand prompting is used to make the exchange of picture for object. These prompts are eventually faded out as the child progresses to greater success.

Phase II is entitled "Distance and Persistence." The goal of this phase is to have the picture cards or communication book further from the child and for the child to become increasingly motivated to find the pictures and bring them to the communication partner and to initiate this exchange. The pictures may, at first, only be a few inches from the child. This will increase to a foot, several feet, being across the room, etc. The child learns to navigate to the therapist/communication partner when they are highly motivated to ask for a desired object.

Phase III is broken down into Phases IIIA and IIIB. The goal of this phase is for the student to learn to discriminate between the picture cards. Phase IIIA helps the child learn the difference between preferred and non-preferred items. For example, the child would be shown a picture of a paperclip and of a Koosh ball. If the child chooses to exchange the picture of the paperclip, the theory is that they will learn this is not the object they desire. They will then choose the Koosh ball by default, therefore learning the meaning of this picture card. Phase IIIB focuses on discriminating between preferred items. We informally call this phase "teach to the reach" – the student reaches out to exchange an icon, we then immediately give them the item that corresponds with the picture card. They are unable to get this exchange "wrong" – this is also known as "errorless learning." Phases IIIA and IIIB typically take the longest to master, as with children on the spectrum, it is often difficult for them to learn to discriminate between the pictures and to understand the concept of navigating through a variety of pictures to complete the exchange. However, because this is "errorless learning", the student does not experience frustration and/or have negative feelings towards the treatment protocol. Very specific data is taken to ensure the child has reached mastery of this phase.

Phase IV introduces the idea of a sentence strip. The child learns the meaning of the "I want" icon, for instance. It is placed on the strip in conjunction with a preferred item. The child then removes the sentence strip and exchanges the entire strip with the communication partner. The sentence is then modeled for the child and immediately reinforced. For example, the child places an "I want" icon next to a "ball" icon. He or she then gives the entire sentence to the therapist. The therapist models "I want the ball!" – and immediately gives the child the ball. Enthusiastic verbal praise is given immediately, as well. It is not necessary, but encouraged, for the child to repeat or imitate the sentence verbally. Over time, many children learn to say these words in conjunction with the therapist.

Finally, Phase V introduces attributes or descriptive words to the sentence strip. Rather than saying "I want the ball," the child would create a sentence such as "I want the red ball." Eventually the child will learn to use PECS for commenting, particularly by using an "I see" icon. For example, "I see the dog." Other comments could include "I smell," "I have," and "I like."

While PECS can be a time-consuming process for many children on the autism spectrum, it has been proven to be one of the most highly effective ways to promote communication and initiation of language for these youngsters. As a child increases his or her ability to go through the phases of PECS, research shows a positive correlation with the number of spoken words they will have acquired throughout this time. Generalization and carry-over of these skills have also been shown to increase over time within various environments and settings and with different communication partners. Thus, The PECS approach to teaching language to those on the autistic spectrum is an excellent technique for developing receptive-expressive vocabulary, grammatical structure and for facilitating interaction with others.