The Picture Exchange Communication System is a form of augmentative and
alternative communication produced by Pyramid Educational Consultants, Inc.
While the system is commonly used as a communication aid for children with
autism spectrum disorder, it has been used with a wide variety of learners,
from preschoolers to adults, who have various communicative, cognitive, and
physical impairments, including cerebral palsy, blindness, and deafness. PECS has
been the subject of much academic research, with currently over 85
PECS-related publications. PECS was developed in 1985 at the
Delaware Autism Program by Lori Frost and Andy Bondy. They noted that
traditional communication techniques, including speech imitation, sign
language, and picture point systems, relied on the teacher to initiate social
interactions and none focused on teaching students to initiate
interactions. Based on these observations, Frost and Bondy created a
functional means of communication for individuals with a variety of
communication challenges. Overview
PECS is designed to teach functional communication skills with an initial
focus on spontaneous communication. It has been and continues to be implemented
in a variety of settings and contexts so users have the skills to communicate
their wants and needs. PECS does not require complex or expensive materials
since it uses picture symbols as the modality. PECS is a method to teach
young children or any individual with a communication impairment a way to
communicate within a social context. Research has shown that many
preschoolers using PECS also begin developing speech. Based on the current
evidence base, PECS has been described as an emerging treatment shown to
increase communication skills for individuals with ASD.
Philosophy The training protocol is based on the
principles of applied behavior analysis. The goal of PECS is spontaneous and
functional communication. Verbal prompts are not used during the early phases,
thus building immediate initiation and avoiding prompt dependency. PECS begins
with teaching a student to exchange a picture of a desired item with a
teacher/communicative partner, who immediately honors the request. After
the student learns to spontaneously request for a desired item, the system
goes on to teach discrimination among symbols and then how to construct a
simple sentence. In the most advanced phases, individuals are taught to
respond to questions and to comment. Additionally, descriptive language
concepts such as size, shape, color, number, etc. are also taught so the
student can make their message more specific. For example, I want big yellow
ball. PECS Protocol
After a preparation, the PECS Protocol occurs in six phases:
Reinforcer Inventory: Before implementing the PECS protocol, the
teacher develops an inventory of which items the learner likes. This way, no
verbal prompting is needed to ask the child what they want. The chosen
reinforcers should be consistently motivating to the user.
Phase 1: How to Communicate During Phase I, the focus is on teaching the student
to initiate social communication. The student is taught to approach the
communicative partner with a picture of a desired object or food item and place
the picture in the trainer's hand, in order to receive the desired reward.
This exchange is taught using one picture, selected by the trainer. Within
Phase I, two trainers are utilized. One trainer acts as the student's
communicative partner, and the other trainer acts as the physical prompter,
who prompts the student to reach towards the communicative partner with the
picture in exchange for the student's reward.
Phase 2: Distance and Persistence During Phase 2, the student is taught to
initiate social interaction when the communicative partner is not nearby and
waiting. The student is taught to persevere if the reward is not
immediately provided, to communicate over longer distances whether it be
across a larger table or walking farther distances to reach his/her communicative
partner, and initiate spontaneous communication. Teaching the child
persistence is comparable to a typically developing child raising his/her voice
to gain attention when initial attempts are not recognized by the communication
partner. Training should progress across different settings, with different
communicative partners, and different types of reinforcing items to assist in
the generalization of PECS usage. Phase 3: Discrimination Between Symbols
During this phase, the student is taught discrimination of symbols and how to
select the symbol which depicts a desired item.
Once the student demonstrates mastery with pairings of preferred and
non-preferred pictures, discrimination between two preferred pictures is
introduced.The picture array is increased until the child can
discriminate among all the pictures in the picture book. Frost and Bondy's
4-Step Error Correction Procedure is used to correct mistakes. For children
who have difficulty with picture discrimination, mini objects can be used
followed by a gradual shift to pictures. Students progress to this step after
they can reliably request their favorite items from a variety of people. Pyramid
Educational Consultants markets an app designed to reinforce Phase 3
instruction. Phase 4: Using Phrases During Phase 4,
the student is taught sentence structure in order to make requests by using
expressions such as "I want ____ ". Another skill targeted in this phase is
commenting as it is learned at the same time as requesting among typically
developing children. The requests consist of a sentence starter and a
picture of the desired activity or item on a sentence strip. The communicative
partner reads back the sentence after it has been exchanged by the student. A
delay between the sentence starter and the activity/reward is often used to
encourage speech and/or vocalizations. Speech/vocalizations are rewarded by
providing the student with a greater amount of the reinforcer to encourage
the student to use a picture and speech rather than a picture exchange alone to
request activities and items. Teaching children using PECS to create a sentence
using expressions such as "I want ___" is a way to increase the complexity of
their communicative exchanges. Phase 5: Answering a Direct Question
During Phase 5, the student is taught to respond to the prompt, "What do you
want?" The goal of this phase is for the child
to respond "I want ___ " regardless of whether the item is present. This phase
adds upon already established skills and a desired item is still used to motivate
the user to respond. A delayed prompting procedure is used in which the question
and prompt are initially presented at the same time and later a delay is
established between the question and gestural prompt. Ultimately, the student
should answer the question before additional prompts are provided.
According to Bondy and Frost, skills developed in Phase 5 are acquired
quickly because sentence construction is familiar to the student and they are
motivated to answer. In this phase, the student is also taught descriptives so
that he or she can indicate preferences within desired reinforcers.
Phase 6: Commenting During this phase, the student is taught to respond to
questions as well as to spontaneously comment on items, people, or activities
present in his or her environment. The student can now respond to the question
"What do you want?" with "I want ___" In this phase, the student is also
taught to differentiate between appropriate responses to the questions
"What do you see?" and "What do you want?" The teacher should structure the
environment to the give the student plenty of opportunities to make
spontaneous comments. The teacher can sabotage the environment to elicit
comments from the student. Functional communication skills the student should
now have developed include being able to make spontaneous requests, responsive
requests, and responsive and spontaneous comments.
Depending on the age and cognitive level of the user, the time to master PECS
will vary. One study found that it takes an average of 246 trials for users to
master all six phases of PECS. Effectiveness
There is evidence that PECS is easily learned by most students, with its
primary benefit being a means of communication for children and adults
who have limited or no speech due to autism or other communication disorders.
With regard to the intervention setting for AAC training, there is evidence that
PECS is most readily learned when instruction takes place in a general
education setting. Evidence also indicated that learners initiate a
higher number of picture exchanges when PECS is taught in a single setting
versus multiple settings. The consensus among most researchers is
that "PECS is recommended as an evidence-based intervention for
enhancing functional communication skills of individuals with ASD." On the
other hand, the 2009 National Standards Report from the National Autism Center
lists PECs among emerging treatments that not have sufficient evidence of
effectiveness. An initial concern was that PECS might
delay or inhibit speech development. However, a recent review of several
peer-reviewed studies found that "there is no evidence within the reviewed
studies to suggest that PECS inhibited speech; to the contrary, if any effect
was observed, it was facilitative rather than inhibitory." When difficulties do
arise, it is often due to a lack of powerful reinforcers and/or trainer
error. A systematic review of interventions for children with autism
spectrum disorder reported that use of PECS resulted in short-term improvement
in word acquisition, but the effects were not maintained over time.
However, evidence from meta-analyses indicate that PECS does not result in
equal communicative outcomes for all children with ASD. PECS training appears
to have the most beneficial effects for younger learners. In addition, evidence
of maintenance and generalization effects of functional communication
gains achieved through PECs training has been mixed. Research indicates that
"PECS is probably best used as an initial intervention to teach manding
and the basic elements of what is a communicative exchange," and is not the
best selection "for a long-term intervention as it does not address
question asking and may be better implemented as part of a multimodal
system for when picture communications are more socially appropriate."
Additional applications There is emerging research that suggests
adults with developmental disabilities and severe communication deficits may
benefit from the implementation of PECS as well. Others tried to combine PECS
training with video modeling. References
Bibliography Bondy, A.S. 2001. "PECS: Potential
benefits and risks." The Behavior Analyst Today 2:127-132.
Mirenda, P. 2001. "Autism, Augmentative Communication, and Assistive Technology:
What Do We Really Know?" Focus on Autism and Other Developmental Disabilities
16(3):141-151. Hart, S., and Banda, D.R. 2010. "Picture
Exchange Communication System With Individuals With Developmental
Disabilities: A Meta-Analysis of Single Subject Studies." Remedial and Special
Education. 31(6) 476–488. Vicker, B. 2011. "What is the "Picture
Exchange Communication System" or PECS?" Autism Support Network. Retrieved from:
ange-communication-system-or-pecs-223321 External links
What is PECS? from the Official PECS USA website