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Picture Exchange Communication System - Lumiere Children’s Therapy Chicago

Our previous post, Learning to Talk, outlined the typical development pattern for expressive language. Expressive language is the ability for one to communicate wants and needs, socialize, and interact with their environment through words, gestures, and nonverbal communication. For children with a language delay or an expressive language disorder secondary to an underlying diagnosis, a picture exchange system may assist in the development of expressive language. The picture exchange system can offer a bridge between communicating with gestures or signs to verbal communication. It may also help a child develop the necessary skills to operate a high tech Augmentative Alternative Communication Device (AAC).

Picture Exchange Communication System, often referred to as PECS, is a program of picture representations for common objects, actions, and thoughts. A person can initiate conversation using PECS to communicate their wants and needs without verbally speaking. It allows children to communicate with others even if they do not have the necessary verbal skills.



What is Picture Exchange Communication System?

Picture Exchange Communication System (PECS) was developed by Andy Bondy, PhD, and Lori Frost, MS, CCC-SLP in 1985 as a system used with preschool students diagnosed with autism. The goal of the program was to teach children how to self-initiate functional communication. Based on the success of the program, it is used with many learners with various communicative, cognitive, and physical difficulties of all ages. PECS is a six phase program that emerges from single word requests to building of sentence structures. There have been several studies that confirm that implementing PECS can help children develop verbal language, as well as decrease negative behaviors associated with language delays.



Who would be appropriate for PECS?

PECs is an approach used for nonverbal children. If your child consistently uses words, although limited, this system may not be the first choice in treatment. The following would indicate if your child would be a good candidate for a picture exchange system. 

  • Intentional communicator: In order to effectively use a communicate exchange, a child needs to want to communicate with others either through pointing, gestures, bringing caregivers to desired objects, or communicate through facial expression. 

    • Example: Jenny wants a chocolate chip cookies, so she directs dad into the kitchen and points to the cabinet with cookies. 

    • If a child does not involve the caregiver when trying to obtain an object, they may not be ready for a picture exchange program. The first step in this scenario would be to gain joint attention. Joint attention is when the child and caregiver are actively focused on the same object/activity. 

  • Preferences/motivation.  In order to understand the power of a picture exchange system, the child needs to be fully motivated for what they are receiving in return. When first teaching PECs, food, favorite toys, and motivating activities (slide, swing, etc) are most frequently used as motivation to communicate through pictures.

    • Example: Eric loves to build with legos. Parent will hold box of legos and give Eric one lego after every request. Eric is motivated to continue to use PECS to get more lego pieces. 

    • If a child has weak or no preferences, then PECs may not be appropriate. Preferences can be determined through trial and error of different foods, toys, and activities.

  • Discrimination of picture. Although picture discrimination is not a definite prerequisite of picture exchange system, it can enhance progress. As PECs continues to be implemented into daily routines, children will begin to learn which pictures correspond with the matching toys, food, activities, etc. If a child advances quickly with PECS, they may be more appropriate for an AAC high tech device. 



How is PECS implemented?

PECs is taught by a certified, trained speech language pathologist (SLP) but involves a caregiver or teacher as part of the team. The SLP becomes certified in PECS by attending a two day training. The SLP will be the primary PECS program coordinator for a child but it can be beneficial if caregivers attend the two-day training as well. Caregivers may include parents/family members, classroom teachers, and classroom assistants. Here is a list of training workshops available across states. PECS can be taught by the SLP in a therapy clinic, home setting with early intervention, and/or school or daycare. As the child and parent progresses in their knowledge and training of PECs, it should be used in all activities in their everyday activities. During phase stage, the goal is approximately 80 picture exchanges each day. 



Stages of PECS: 

In the early stages of PECs, there are three people in the training situation. The child, the person who receives the pictures (mom or teacher), and the facilitator who assists the child (speech therapist). Eventually, the facilitator is phased out of the training. 

  • PECS PHASE I: How to Communicate 

The first phase lays the foundation for exchanging single pictures for desired toys or activities. Receiver entices the child with the preferred object or food. As the child reaches for the desired object, the facilitator can assist the child to pick up the picture and hand to the receiver. The receiver does not say anything until receiving the picture. Once they receive the picture, they can say “ball, you want ball”.

  • PECS PHASE II: Distance and Persistence 

Phase II continues to target single pictures but in a variety of places, communication partners, and at greater distances from their field of view. It also teaches the child to become more persistent and consistent with communicating wants and needs. The facilitator is still present, and intervenes when necessary, but the child should be more independent in this stage.

  • PECS PHASE III: Picture Discrimination 

In this phase, two or more pictures are used at a time. The caregiver would present two or more pictures for a child to choose their desired object. The pictures are compiled into a communication book such as a ring binder for easy access by the child. 

  • PECS PHASE IV: Sentence Structure

The child learns to construct simple sentences with a sentence strip using “I want” picture with desired picture following.

  • PECS PHASE V: Answering Questions 

At this point, the child can learn to use PECS to answer questions such as “What do you want to play?” or “What do you want to eat”. 

  • PECS PHASE VI: Commenting 

The final phase of PECS is using pictures to make comments or respond to questions in their environment. They learn to create sentences starting with functional phrase strips I see, I hear, I feel, It is a, etc. 



How does PECs help develop verbal language?

In the previous post, Learning to Talk, a list of seven prerequisites to verbal language were described with at-home strategies. Three of the prerequisites align with the foundation of a picture exchange system. 

  1. Adequate attention and joint attention. Joint attention is when a child is focused on the same item or activity as the communicator or parent.

    1. Joint attention is necessary for a child to understand the concept of PECs. PECs requires the child to establish joint attention between the communication partner and their desired object or action. 

  2. Understands words and commands. 

    1. Before a child can effectively use verbal language, they need adequate receptive language skills. Receptive language is the ability to understand and comprehend language. Receptive language involves the identification of pictures. PECs encourages children to identify an action or object with a corresponding picture. It increases the child’s recognition and labeling of common objects and actions, improving one’s receptive language skills. 

  3. Communicates wants and needs with gestures and/or pointing. Children learn to communicate and engage with caregivers before verbal language typically emerges. Children may smile when they get something they want, point towards desired objects, or carry toys to caregiver. These are all forms of expressive language. PECs helps facilitate non-verbal expressive language by giving the child resources to communicate wants and needs to caregivers. It teaches the concept that requesting for an object/action results in receiving desired item. PECS encourages the concept of cause and effect. 



As a child develops these necessary skills through a picture exchange system, they are reinforcing the development of communicating for wants and needs. The caregiver is modeling the verbal production of each picture exchange providing more opportunities for modeling. For example, if Noah brings a picture of a ball to his mom, mom will state “ball, want ball”. Noah is receiving verbal modeling of the word ball to picture multiple times. 

If you feel your child would be an appropriate candidate for a picture exchange system, contact Lumiere Children’s Therapy. At Lumiere Children’s Therapy, we have therapist certified in the program to help your child communicate their wants and needs across all environments.




References:

“Picture Exchange Communication System (PECS)® |.” Pyramid Educational Consultants, pecsusa.com/pecs/.

“The Picture Exchange Communication System (PECS).” The Picture Exchange Communication System (PECS), www.nationalautismresources.com/the-picture-exchange-communication-system-pecs/.

Vicker, B. (2002). What is the Picture Exchange communication System or PECS? The Reporter, 7(2), 1-4, 11.