Do people still use the Picture Exchange Communication System (PECS)? This was once a popular evidence-based communication intervention but it seems to be a thing of the past. But don’t throw away your PECS manual! There may be a student who still needs this approach. In this post, our Speech and Language Pathologist, Carol Dittoe, will give her feedback on the use of PECS.
As the speech pathologist on the Autism and Low Incidence Coaching Team (ACT), Isometimes asked about my thoughts on the use of PECS. I want to be clear that PECS is a specific and trademarked system that follows a very detailed protocol that requires training from a Pyramid Educational Consultant. I have been through the formal training but I have also adapted it when needed (so I can no longer officially call it PECS). For more information visit the official PECS website In today's Communication Corner, I will provide my thoughts about the use of PECS which are based on many years of experience and observations.
PECS is more than just using Pictures. PECS is the use of picture EXCHANGE. The E in PECS means exchange. Sometimes when you start with an AAC device, especially a dynamic device, the student focuses on the technology only and does not acknowledge the communication partner. If the learner is able to see and manipulate a picture, they can develop joint attention by exchanging the picture with a partner to gain the desired item. If they love technology, use picture exchange to request the iPad.
PECS is not always my first option for Augmentative and Alternative Communication (AAC). It is not a prerequisite of AAC. It depends on the needs of the learner. If the learner has good joint attention and is already showing some use of pictures to communicate, I will move on to an AAC device or a static picture-supported communication system that is much more robust. If the learner does not demonstrate joint attention and does not engage with pictures for communication, PECS is a great way to teach these foundational skills.
The first phase of PECS is to teach the initiation of a picture exchange. I love the focus on initiation and feel it is important to avoid developing prompt dependency. You are not supposed to use any verbal prompting. You are to entice the learner rather than prompt them. The use of a second person acting as the physical prompter during Phase 1 is not the same as facilitated communication (if you are doing it correctly). Some people have expressed concern that having a physical prompter is taking away the learner’s autonomy. In my experience with PECS, I am following the lead of the learner by watching for their initiated reach and using physical prompting to shape the reach for an item down to the picture to facilitate the picture exchange. Typically, I only need to use physical prompting for the first few requests before the learner understands how to give the picture to the communication partner to obtain the desired item. The goal is to fade any prompting as quickly as possible.
Typically, when using PECS, I focus on the first 3 phases to focus on the development of joint attention, initiation, persistence, and picture discrimination. Here are the first 3 phases of PECS:
Teaching the exchange with a single picture
Teaching the exchange with a single picture, adding distance, and generalizing the skill across people and environments
Teaching picture discrimination between 2 or more pictures (I spend a lot of time at this phase to continue generalizing across settings and people for a variety of items)
The strategies in these first 3 phases will make sure the learner takes the responsibility of exchanging the request with the right communication partner. Have you seen a student using a device and repeatedly hitting the button without getting the attention of anyone? It’s almost as if they think it is a magical button that will get them what they want (who needs people?) Even if a team is not using PECS, I may refer them to some of the strategies from PECS to teach initiation, joint attention, and traveling. Traveling is when the learner must travel to get the picture and then travel to give the picture to the right person. This is an important skill weather your student is using pictures or a device. You want to make sure the student is exchanging information with a partner and not just interacting with a device.
When teams are struggling to teach picture discrimination, I often refer them to the PECS manual Phase 3 for some great ideas for teaching, assessing, and reinforcing picture discrimination. Picture discrimination is critical if you plan to use any kind of picture-supported communication.
 |
| Amy D'amico Learning Center North, MCESC |
 |
| Watts Middle School, Centerville |
Phase 4 of PECS is sentence structure. This is where you add the “I want__”. Once I have developed strong joint attention and the learner can discriminate between many pictures across environments, I may start to transition to other more robust systems and introduce core words.
 |
| Sara Moore Bell Creek Intermediate, Bellbrook |
While I am a big fan of teaching core words, some students need to start with more concrete language using highly motivating nouns for exchange. The first 3 phases of PECS will focus on the use of highly preferred items. These nouns are considered fringe words (ball, chip, iPad) and are used in a very concrete way to teach the power of pictures for communication. Core words are introduced in phases 4-6 and can be more abstract but are used more frequently in our language and can be combined to have many different meanings. (I, want, see). Descriptive words are also introduced in Phase 4.
If you believe your student needs more of a Gestalt language approach, you can use the strategies of PECS to teach the foundational skills (exchange, initiation, traveling, discrimination) while introducing core words. I like the use of Aided Language Stimulation, a strategy that focuses on the frequent modeling of words on a core board without expecting the learner to respond. This can be done on a static core board or an AAC device. This combination goes against the PECS protocol but if you are not formally using PECS, you can still use many of the PECS strategies to meet the needs of your student.
Remember, any approach you take to developing functional communication must meet the specific and unique needs of the learner. Get to know your student and ask yourself the following questions to determine if your student would benefit from the strategies of PECS:
Do they struggle with joint attention and initiation?
Are they highly distracted by technology only focusing on the device and not the partner?
Are they destructive by often throwing or pounding on a device?
Are they unable to use pictures in a meaningful way or discriminate between pictures?
Do they rely on others to initiate the use of the device and travel with the device to get the message to the right person?
There are so many factors to consider when choosing the communication mode and strategies to try. Collaboration between the classroom team, SLP, family, and outside therapy is needed. The most important thing is that you try something! You can visit these resources to get more information and assistance when assessing your student’s communication and AAC needs:
PECS is an evidence-based practice. Here is a link to ASHA’s AAC Evidence Map and PECS Evidence-Based Practice Review
