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Picture Exchange Communication System (PECS)

What is PECS?
The Picture Exchange Communication System (PECS) is a type of augmentative or alternative communication intervention which prompts a child to exchange a picture of a desired item with their “communicative partner” who will immediately honor their request accompanied with social reinforcement.1 Although the PECS program focuses on communication, it is not designed to teach speech. However, speech is encouraged indirectly and some children do begin to spontaneously use speech as they progress through the PECS program.2 The Picture Exchange Communication System materials are inexpensive and simply include pictures, icons, and a communication binder equipped with VELCRO®. A benefit of the PECS program is that the programs only prerequisite is that the individual can clearly indicate (reach for an item).3 The Picture Exchange Communication Program was developed in 1985 by Andy Bondy, PhD., and Lori Frost, M.S. CCC/SLP who established Pyramid Educational Consultants, Inc., which is the exclusive home of the PECS and the Pyramid Approach to Education.4

The Picture Exchange Communication System is divided into 6 different phases that encourages the participant to become a more effective communicator as the program progresses. Pyramid Educational Consultants, Inc.1 lists the 6 phases of PECS as follows:

  • Phase I: How to Communicate

The first phase of PECS teaches students to exchange single pictures for an item the student desires. For this example we shall use a piece of candy. The first phase requires two adults to be present. One adult is the “communicative partner”, who shows the student the reinforcer, or the favored item, and waits for the child’s natural response to reach for the piece of candy, otherwise known as first initiation.5 The second adult, known as the “physical prompter”, leads the student towards the communicative behavior for receiving the piece of candy by physically guiding the student’s hand to a picture of the piece of candy, then guiding the student’s hand to give the picture to the communicative partner, and then guides the student in releasing the picture into the hand of the communicative partner. At this point, the communicative partner will immediately relinquish the piece of candy to the student as if the student had verbally asked for the item and then rewards the student with an “animated social reinforcement.” The student is then given time to enjoy the item before the process is repeated. This training process “continues until the child independently picks up the picture, reaches for the communicative partner, and puts the picture in [their] hand without prompting or assistance.”5 To help the student to communicate with a wide array of people, the physical prompter and communicative partner should switch places or insert two new individuals to fill these roles.

  • Phase II: Distance and Persistence

The second phase of PECS builds up the student’s ability to communicate by having the communicative partner distance themselves from the student forcing the student to put forth more effort to engage in the communication process. The student is given a communication book with one interchangeable picture. The student is required to locate their communication book and travel to their communicative partner across the room at which point the student will hand the communicative partner the picture in exchange for the desired object.6 Accommodations can be made for students with mobility issues through the use of a “call switch”. The student will be taught to hit the call switch to indicate that the communicative partner should approach the student so the student can exchange the picture for the reinforcer.8 The goal of Phase II is “to teach the child to communicate with a variety of people, in different settings, and for a variety of items.”9 Students will require that pictures of desired items are readily available to them as they increase their vocabulary and become more adept to the PECS process.

  • Phase III: Picture Discrimination

In Phase III of PECS the student is asked to disseminate between multiple pictures of desired and non-desired objects placed on their communication book. Consistent with the previous phases of PECS, the student is to select a picture and hand it to their communicative partner. If the student selects the picture of the desired item, then they are presented the actual desired item coupled with social reinforcement. When a student responds incorrectly, error correction strategies, such as the 4-Step Error Correction Procedure10, are introduced to help the student realize his/her error. More pictures and objects are introduced as the student succeeds in consistently choosing the correct desired object. The student is ready to proceed to Phase IV once he/she can consistently discriminate between all the objects on the front of their communication book.

  • Phase IV: Sentence Structure

In this phase of the PECS program, the student is provided a new picture with the command “I want” that is to precede the picture of the object on the student’s communication book. The “I want” icon/picture is attached to a sentence strip on the communication book. The student is taught to find the picture of the desired object within the communication book, place it on the strip next to the “I want” picture, then the student will remove the entire sentence strip, and hand it to the communicative partner. The communicative partner then turns the strips toward the student and recites the “I want” phrase before handing the student the desired object.6

  • Phase V: Answering Questions

The reason that the communicative partner must use the command “I want” as the precursor to the desired object in phase IV is that the communicative partner is preparing the student for the answering questions phase of the PECS program. This phase focuses on answering the question “What do you want?” and the student should be able to spontaneously request a variety of items.7

  • Phase VI: Commenting

In the final phase of the PECS program the student learns to make up sentences starting with “I see”, “I hear”, “I feel”, etc.1 This way the student learns to comment on the environment around him/her. The communicative partner creates pictures for these expressions and can create opportunities for the student to express themselves by making comments such as “I like ice cream. What do you like?”7 The communicative partner should still utilize the child’s pictures for this exercise.

What Research is has been Conducted on PECS?
The National Professional Development Center (NPDC) on Autism Spectrum Disorder (ASD) has qualified PECS as one of 24 evidence-based practices based on peer-reviewed research.11 There have been over 100 PECS-related publications that have produced some positive results in support of the efficacy of the PECS program.12 Many studies have found that the PECS program is effective in nonverbal children with autism. However, a 2009 descriptive review of 27 studies found that the bulk of interpretable data on PECS comes from single subject studies, which can have several limitations, including low external validity.3 The efficacy of the Picture Exchange Communication System has not been tested through very many randomized controlled trials (RCT). A randomized controlled trial “is a study in which people are allocated at random to receive one of several clinical interventions.”13 The empirical literature related to PECS found that there were only 3 RCTS reported to date and found that the “nature and quantity of data arising from RCTs at this point in time is insufficient to draw from conclusions regarding PECS interventions.”3 Despite the need for more randomized controlled studies in peer-reviewed publications, the current research “indicates that PECS is clearly an effective functional communication system for individuals with communication difficulties.”10

The National Standards Project (NSP), a project similar to that of the NPDC in that they both reviewed scientific literature to determine the most efficacious treatments for ASD but only with different criteria, concluded that the evidence level for PECS was “emerging.”14 According to the National Standards Project, a treatment is deemed emerging when there are one or more studies that suggest the treatment can produce beneficial results, but additional high quality studies are needed before a firm conclusion can be drawn.14 The NSP reviewed 13 studies before labeling PECS as an emerging treatment.

How Does PECS make a Difference for Individuals on the Autism Spectrum?
The Picture Exchange Communication System can benefit both non-verbal and verbal individuals on the autism spectrum. The program has been used to assist individuals with communication impairments from 14 months to 85 years of age.14 Other known benefits of the program include increases in social behaviors and decreases in problem behaviors. A 2002 study on the efficacy of PECS on 3 children with autism found that a “70% or greater reduction was observed for 10 of 12 behaviors, and four behaviors were eliminated.”15 Although not everybody who uses the PECS program will develop verbal communication, they can develop an effective way to communicate with a variety of people in their world.16

What Do PECS Treatment Providers Do?
PECS requires two treatment providers for the first two phases of the program. One treatment provider will act as the “communicative partner” while the other will act as the “physical prompter”. The communicative partner shows the student the desired item and waits for him/her to reach for the item. The physical prompter then guides the student’s hand to the picture of the desired object, places the picture in the student’s hand, guides the student’s arm to the communicative partner, and then drops the desired item in the communicative partner’s hand.5 At this point, the communicative partner rewards the student with the actual desired item and strong social reinforcement. It is important for the student to hand over the picture first, so that they are the ones initiate the communication.17 Physical prompters and communicative partners should switch places or implement new instructors to teach the student how to interact with numerous individuals. In the later phases of the PECS program the physical prompter is not necessary, but the communicative partner should continue their methods of strong social reinforcement when the student successfully completes a communicative behavior.

Who is Qualified as a PECS Treatment Provider?
Professionals who work with children with ASD, teachers, and parents are able to learn the Pyramid Approach methods of teaching the Picture Exchange Communication System by attending workshops available throughout the United States and in many countries around the world. These workshops include a 2-day basic training workshop, advanced training workshops, and more in-depth workshops that focus on subjects like critical communication skills, behavior intervention, Asperger syndrome, and parent training.

Where do PECS Treatment Providers Work?
PECS Implementers and Supervisors can be found in schools, hospitals, and the many offices of Pyramid Education Consultant, Inc. located around the globe.

How Can I Find a PECS Treatment Provider or Receive More Information?
Pyramid Education Consultants, Inc. has an extensive directory of PECS Implementers and Supervisors available in over 20 states and 15 countries.18 The webcasts series found on the Pyramid Education Consultant, Inc. site provides viewers with an in-depth summation of B.F. Skinner’s Verbal Behavior (the basis for the PECS teaching protocol), the uses and benefits of the PECS program, and how to utilize the Pyramid Approach for parents and professionals alike.19