When autistic children learn to communicate, it helps to reduce behavior issues, personal frustration, and meltdowns. However, many of these children never develop functional speech. Despite the various language-related interventions, research shows that one-half of all autistic children still cannot talk. One of the most popular methods for improving nonverbal communication is the Picture Exchange Communication System (PECS). While the idea of visual aids existed before Dr. Andrew Bondy and Lori Frost created PECS, their system uses pictures in a specific and systemic way.
What is PECS?
The PECS program uses verbal behavior and visual techniques common to many language therapies, but it emphasizes that interaction comes from the child’s request rather than parental prompting. While prompts do play an initial role in teaching what’s expected, the program design relies on children independently handing someone a picture or drawing of an item they want or need. The person receiving the picture exchanges it for the requested item.
Children who generally enter the PECS program are classified as nonverbal, but that includes those who struggle to talk and can utter a few sounds as well as those who don’t attempt communication at all. The program divides into six specific divisions with each major stage introducing different activities and skills to help a child move towards independence:
Communication begins: PECS training starts by teaching the child to pick up a picture sitting in front of him, hand it to another person close by, and release it. This first stage uses only a single picture. Hand-over-hand training and prompts by a parent or second adult may be necessary until the child understands the process and can do it independently. Reinforcement is given.
Physical exchange: This stage uses a picture attached to a board that sits further away from the child. The person working with the child also sits further away. The child must reach for the picture, hand it to the other person, and release it. In return, the child receives reinforcement. While still working with one picture at a time, different pictures, people, locations, and reinforcements test the child’s ability to use the communication technique in a more general way.
Picture discrimination: Child begins using more than one picture at the same time. At this point, the idea is to establish motivation for the child to use the right picture among several possibilities in order to receive what he wants. Reinforcement is the item the picture represents. The wrong picture gets the child the undesired item pictured on the card.
Composing simple sentences: With the help of sentence strips, the child learns to create a sentence by combining a picture card that represents “I want” with a picture of what he desires. Mastery of this step requires the child to compose the sentence on the strip, and then bring the entire strip to someone else. It teaches the child the benefit of making specific requests. Additional activities at this stage involve the parent reading the sentence to the child, but placing a deliberate pause after the words “I want” and the picture item. The hope here is that the child will vocally provide the name of the item he wants during the delay.
Learns to answer a question: The child learns to answer the question: “What do you want?”
Answers additional queries: Once the child understands how to answer questions, parents add additional questions: “What do you see?” “What do you have?” “What do you hear?” “What do you feel?” The child must learn to discriminate between sentence-starter phrases such as “I see” and answering a question.
Once the child masters these six stages, the PECS program attempts to transition the child from pictures to regular speech. A handout published by Pyramid Educational Consultants claims verbal speech is a benefit of following the PECS program, but how likely is that to happen?
PECS Program Benefits and Disadvantages
One of the goals of the PECS program is to achieve meaningful communication, rather than simple labeling. While general visual strategies first concentrate on teaching autistic children to use pictures as symbols and then help them label items in their environment, Bondy and Frost weave communication techniques into their first steps of intervention. Like other relationship therapies, PECS utilizes motivation to drive learning. It strives to create functional communication through eliminating prompts and imitation, and teaching useful communication skills such as child requests instead.
Research, assessments, and corresponding study reviews agree. The PECS program works to improve communication skills for many children, and researchers often describe it as “promising.” Researchers support that it helps reduce the child’s frustration level, improves behavior, and decreases problems that come from a lack of communication. However, research does not back up the claim that PECS can teach an autistic child to talk.
While research has found small to moderate gains from using pictures to communicate, improved verbal speech saw little to no improvement. They did find that PECS works best for children who enter the program with some type of limited speech already; however, that doesn’t mean the child will never talk. Anecdotal evidence is as real as scientific evidence when it comes to finding autism therapies and programs that work. What it means is that among the children studied so far, few have moved from PECS to speech.
Many parents of autistic children and speech-language therapists do not use or recommend PECS. They prefer to use a variety of teaching methods instead, such as sign language, picture pointing, and labeling. Disadvantages of PECS lean towards the same types of problems as other picture communication systems. While it works well initially, eventually the child’s picture book will become too large and heavy to carry around. In addition, there’s no way to communicate with the child if he is in a swimming pool, jumping on a trampoline, or has forgotten his book at home.
Although PECS’ popularity has caused many misconceptions among parents using other picture strategies, it is a very specific program. According to Dr. Bondy, parents need to follow the plan as outlined in the PECS Training Manual (entitled PECS: The Picture Exchange Communication System, and available at bookstores). Deviations that fall outside his program are not allowed. If parents purchase a starter kit, picture package, sentence board, and notebook from his website, but first teach their child to understand symbolism rather than requiring the child to initiate interaction immediately, they are not doing PECS. The distinction is small but one that Bondy is adamant about.
Autistic children are individuals and each child has different needs. While the PECS program as created and designed has been a successful therapy for many autistic children, parents should strive to implement all home-based therapies in a way that matches the personality and needs of their child. Sometimes that means a program such as PECS needs a little tweaking to work best. Programs don’t have to carry a popular name; they just have to work.