Communication is the key for understanding all that goes on around us. It is important educationally, socially and vocationally. Communication is essential whether or not we have a disability. According to the Diagnostic and Statistical Manual, fourth edition, Text Revision (DSM-IV-TR), difficulty with communication is one of the core deficits of Autism Spectrum Disorders (ASD). The range of communication challenges is as varied as those who are identified with an ASD. The one fact that we all know from working with children on the autism spectrum is that no two are alike — each is unique and strategies that work for one student might not work for another. Even in the same environment, strategies that work one day might not work for the same student the next day.
Researchers recently determined that PECS is an effective evidence-based practice for teaching students with autism how to initiate communication using pictures within a social context.
Therefore, how do we help a student with autism learn to communicate? Each month we seem to read about new practices, but which of these is evidence-based and which will be most effective with our students? With the increase in autism, there also appears to be a similar increase in the number of different treatments or interventions. It is critical that these various interventions undergo research to determine if they meet the appropriate criteria and enhance outcomes for our students.
Researchers at the National Professional Development Center on Autism Spectrum Disorders have investigated practices to use with children with autism, from early childhood through grade 12. The purpose of their investigations was to determine whether practices being implemented with children with autism were effective or were harmful to children. The NPDC on ASD has currently identified 24 practices that research supports to be effective with children on the autism spectrum; four of those practices relate to communication. This article is the first in a series on evidence-based practices (EBP) for students with ASD and will focus on just one of the four EBPs in communication researched by the NPDC on ASD. The series will focus on choosing the EBP that is most appropriate for a student’s communication needs and implementing the practice effectively.
The Picture Exchange Communication System (PECS)
Many of you reading this might be thinking that PECS is not new — you’ve known about it for years. You’re correct; PECS was developed in the mid ’90s by Andrew Bondy and Lori Frost — who were then at the Delaware Autism Program — to teach young children to initiate communication using pictures within a social context. However, only recently have researchers determined that PECS is indeed one of the EBPs that is effective for some students with autism. To become recognized as an EBP the methodology must undergo rigorous scrutiny by researchers through either the NPDC on ASD or the National Autism Center’s National Standards Project. Because PECS has met the criteria for an EBP by the NPDC on ASD and is recognized as an Emerging Practice by the National Standards Project, it is important to know the critical features of this particular communication system so that you can implement it with fidelity. Using PECS in the way it was designed could make a difference as to whether or not it is a successful communication intervention for some of your students.
So, what is PECS? PECS is a way to make communication visible. According to the NPDC on ASD, “learners are taught to give a picture of a desired item to a communication partner in exchange for the item.” For example, if a young student wants to blow bubbles, he would give a picture of bubbles to the communication partner (e.g., teacher, therapist or parent) and the partner would give the young student the jar of bubbles. While this might sound easy, it isn’t. Because of the complexity of teaching communication to students with autism, you must implement the strategy with validity so that the student makes maximum progress. According to the research by the NPDC on ASD, the use of PECS is valid for children ages 3 through 12 and it can be used in a variety of settings, such as school, home and therapy sessions. The PECS process has six phases, beginning with teaching the child how to “request,” moving through increasing expectations and ending with teaching the child how to “comment.”
A key component to the success of PECS is the use of a reinforcer. Prior to teaching the PECS, you must determine what items or activities are reinforcing to the student by conferring with the family and assessing what are his highly preferred and non-preferred items or activities at school. Teachers often say, “Nothing motivates him.” By observing and assessing the student, you might learn that he has different interests than his neuro-typical peers. For example, he might like playing with string, drawing telephone poles or clapping his hands.
After determining some of the student’s preferences and selecting the reinforcer, implementation of “Phase I: Teaching the Physically Assisted Exchange” begins. Through systematic teaching, the student learns to pick up a picture, place it in the communication partner’s hand and then receive the item or begin the activity he requested. In “Phase II: Expanding Spontaneity,” the distance increases between the student and the communication partner so that the student has to make an effort to pick up a picture, find the partner and place the picture in the partner’s hand, then receive the item or begin the activity. “Phase III: Simultaneous Discrimination of Pictures” teaches the student to discriminate between two, and then among several, pictures to make sure that he is choosing the preferred item or activity. As PECS is implemented, it is important to note that sometimes the preferred reinforcer changes from day to day and what is reinforcing one time might not be as reinforcing the next time the practice session occurs.
During “Phase IV: Building Sentence Structure,” the student learns how to request items using the carrier* phrase, “I want ____.” The student chooses the desired picture, places it on a pre-made sentence strip next to a picture which depicts “I want,” then gives the entire sentence strip to the communication partner. In “Phase V: Responding to ‘What do you want?’” the student learns to respond to the question, “What do you want?” by spontaneously giving an appropriate picture using the sentence strip throughout the daily activities. Finally, in “Phase VI: Commenting in Response to Questions,” the student learns to respond to different questions such as “What do you see?” or “What do you have?” by using carrier phrases such as “I see ___.” or “I have ____.” (Frost & Bondy, 2002). Interestingly, some, but not all, students begin to spontaneously use spoken language at some point during the PECS process. Contrary to what one might think, using this EBP does not prohibit students from learning to speak.
As mentioned earlier, this process seems relatively easy, but for a student with autism who does not understand the process of communication, the PECS process can take time. The motivating reinforcer is critical. Along the way the teacher or partner might need to give the student a physical, gestural or verbal prompt or assist. It is important to know when and how to fade the prompts. You also must be aware of what errors the student might make and quickly use an error-correction procedure so that the skill is not learned incorrectly. To assure that the practice is implemented with fidelity, NPDC on ASD gives all of the steps for implementation of each phase along with error-correction procedures. During the process of teaching PECS, many communication partners use pictures, such as Picture Communication Symbols, which are available through software at the Mayer-Johnson Co. Also, many use digital cameras to take pictures, or search Google Images.
At this time, the results of five studies demonstrate that PECS is an effective communication practice to teach students with autism ages 3 through 12. To learn more about PECS and to participate in a training session, visit the Autism Internet Modules. There you can register for free and learn about PECS in greater detail.
*A carrier phrase is a short phrase that you use consistently in which the last word in the sentence is the one on which you are focused.
Frost, L.A. & Bondy, A.S. (2002). PECS: The Picture Exchange Communication System training manual (2nd edition). Newark, DE: Pyramid Educational Consultants, Inc.
The National Professional Development Center on Autism Spectrum Disorders (2009). Evidence-based practices. Retrieved from http://autismpdc.fpg.unc.edu/content/evidence-based-practices
A personal reflection
As a personal note, I recently had the wonderful opportunity to meet with one of my former students. I first worked with him when he started preschool and at the time he was nonverbal. At kindergarten age he entered an autism program and, during the first year, the teacher and I implemented PECS after we visited the Delaware Autism Program and learned about the system from one of its developers, Andrew Bondy. This young student made continued progress through the PECS phases. When he reached Phase IV, we taught his parents how to implement PECS at home. It was during this phase that he started talking and he eventually progressed through all six phases.
During elementary school he became much more verbal and was included in general education classes with his peers, with support from the autism program. Once he started talking fluently, he continued to carry his PECS book with him, “just in case” he ever needed it. He recently graduated from high school with a standard diploma and would like to work with students with disabilities. When I met with him, we talked about his learning PECS and about his book. He revealed that he still has his PECS book and that it is still important to him, although its current home is in his closet. For me, hearing about this former student’s success with PECS and how he learned to communicate by using, it was no longer a reflection, but a fulfilled dream.