Picture Exchange Communication System
Pre-Assessment
Pre-Assessment
What makes PECS unique from other graphic augmentative alternative communication
(AAC) systems of communication?
Select an answer for question 204
Before beginning training with PECS, it is important to assess the learner's . . .
Select an answer for question 205
Verbal prompts are allowed in any phase of teaching PECS.
Select an answer for question 206
During Phase 3 of PECS training, the learner is taught to make a request from more
than one picture or symbol. What is this called?
Select an answer for question 207
When conducting pre-PECS teaching reinforcement sampling, how are preferred items
confirmed? By...
Select an answer for question 208
PECS has been shown to increase what abilities in children with whom it has been
implemented long-term?
Select an answer for question 209
Overview
A key characteristic of autism spectrum disorders (ASD) is that many individuals have
difficulty developing and using verbal speech to communicate with others. The Picture
Exchange Communication System (PECS) has been used to help children and youth
with ASD develop a system for communicating with teachers, parents, and peers. PECS
was initially developed at the Delaware Autistic Program (Bondy & Frost, 1994) as an
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alternative communication system and has since been demonstrated in the research
literature to promote speech development and production (Charlop-Christy, Carpenter,
Le, LeBlanc, & Kellet, 2002). An updated version of the original procedures is now
available (Frost & Bondy, 2002).
This module will define PECS, outline the steps to effectively implement it, and provide
specific examples for its use across settings and age groups. It is not intended,
however, to take the place of training and resources on PECS provided by Pyramid
Educational Consultants, Inc., (www.pyramidproducts.com). Further, the strategies
described in this resource should be implemented under the supervision of a trained
professional. PECS can be used across age ranges, starting in preschool, to help
individuals with ASD communicate with others.
What is PECS?
PECS falls into the category of augmentative and alternative communication (AAC)
systems and is considered an aided technique (Mirenda, 2003). AAC systems are
included in a larger grouping of systems and methods that are used to help individuals
who do not have typical verbal skills to communicate with others. Examples of
commonly used AAC systems include sign language and picture boards. PECS is
another type of AAC system that was designed to teach children with limited functional
communication skills to initiate communicative exchanges and interactions within a
social context.
According to the developers of PECS, it is a behaviorally-based intervention that
teaches the learner to use visual-graphic symbols to communicate with others (Bondy &
Frost, 1994; Frost & Bondy, 2002). With PECS, learners are taught to give a picture or
graphic symbol of a desired item to a communicative partner in exchange for the actual
item. PECS is the system of communication, not to be confused with how PECS is
taught and used (e.g., behavioral principles).
There are six phases of PECS instruction, each building on the last. The phases include
the following:
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teaching the physically assisted exchange
expanding spontaneity
simultaneous discrimination of pictures
building sentence structure
responding to "What do you want?"
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commenting (initially in response to a question and later spontaneously)
Unlike other graphic systems of communication, the individual using PECS hands the
symbol depicting a desired item to the communicative partner. After learners
understand that PECS can be used to make requests (e.g., demands), it can be
extended to other communicative functions (e.g., labeling, questioning) and to other
contexts (e.g., home, community).
Each of the phases will be explained more in depth throughout the module. It is
essential that the phases are taught sequentially.
Why Use PECS?
Children and youth with ASD may not use words the way most typically developing
children do. In fact, impairment of communication skills is a core feature of autism
spectrum disorders (American Psychiatric Association, 2000). Some children with ASD
do not use or have limited use of eye contact, vocalizations of any type, or gestures to
communicate with others. Instead, children and youth with ASD sometimes learn and
use other means (at times inappropriately) to gain the attention of others and to obtain
desired objects/outcomes.
Early intervention is a well-established and supported practice (Thompson, 2007) and is
critical for helping children and youth with ASD develop communication skills as early as
possible. For children who do not develop typical verbal and nonverbal communication
skills, learning to express wants and needs can be challenging. Delays in developing
these skills can cause frustration for both the child and the caregiver and may lead to
behavioral challenges. AAC systems such as PECS can be highly effective tools in
helping to decrease challenging behaviors and increase the use of appropriate
functional communication.
Who can use PECS and where can it be
used?
While any professional, parent, or caregiver may use PECS procedures, it is
recommended that those interested in doing so receive professional training. Training is
available from the individuals who developed and market the PECS system through
Pyramid Educational Consultants, Inc. (For more information, see
www.pyramidproducts.com). The information in this module is intended to provide a
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detailed overview of how PECS may be successfully implemented and to supplement
training for parents and paraprofessionals working with a child or youth with ASD in a
variety of educational and community-based settings. PECS can be implemented
anywhere communication is desired or needed and across a variety of home, school,
and community settings (see evidence-base reference list in the Resources section).
With what ages is PECS most effective?
Research has shown that PECS is effective with preschool and elementary children
across a variety of home, school, and community settings (e.g., Howlin, Gordon, Pasco,
Wade, & Charman, 2007; Yoder & Stone, 2006). For more information about the
evidence base for PECS, see the reference list in the Resources section. While most of
the research in this area has been completed with younger children, there is some
evidence that it also works with students in middle school (Charlop-Christy, Carpenter,
Le, LeBlanc, & Kellet, 2002). Additional research supports the effectiveness of PECS
with adult learners (Chambers & Rehfeldt, 2003; Rehfeldt & Root, 2005; Stoner et al.,
2006).
What assessments should be conducted
prior to using PECS?
If you are considering using PECS for a student with ASD, some assessments probably
have been completed already. These assessments often include formal intelligence
tests and tests of adaptive behavior/functioning, including social interactions and
communication skills. However, teachers should conduct two additional assessments
prior to implementing PECS training. First, a checklist should be completed to determine
the student's current communication skills. For example, it would be helpful to know
whether the student is currently requesting, what kinds of directions are needed to
complete a task (e.g., visual, oral), and how the student transitions between activities.
Such information can help teachers determine target skills for PECS training (e.g.,
requesting, initiating interactions) as well as the types of prompts that can be used to
facilitate communicative exchanges (Frost & Bondy, 2002).
In addition to the communication assessment, a reinforcer sampling should be
conducted. A "reinforcer sampling" is an informal inventory of items and activities that
are of particular interest to the learner. There are a number of options for completing
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reinforcer sampling; however, for children and youth with limited communication skills,
the following steps are suggested (Fisher et al., 1992):
1. Gather a selection of items that may be favorable to the individual. These
items can be identified by asking caregivers and observing the individual.
2. Present the learner with pairs of choices, being sure to match each item at
least once with the other items being sampled (this is to determine relative
preference). Also, vary left and right presentation throughout to minimize the
effects of a side preference on the part of the learner.
3. Document the items chosen most often, least often, or that produce a notable
response (e.g., learner tastes something and spits it out, learner throws item
after choosing it).
From this informal assessment, a selection of favorite items to be used during PECS
training is created. These reinforcing items will help to increase student motivation as
well as promote acquisition of effective communication skills.
Implementing PECS
Once an adequate number of desired reinforcers has been identified and gathered,
picture/symbol cards are created. The number of reinforcers and picture cards will vary
for each individual; however, the goal is to provide enough choices to keep the learner
engaged and motivated. Cards can be created by using simple drawings or pictures
taken with a digital camera. The decision to use photos versus pictures or line drawings
is based on the skills of the individual with whom you are using them. Resources are
also available for creating cards at no cost. Please see the Document section of
RESOURCES for more information.
Other factors to address prior to beginning PECS instruction include the following:
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Training Environment. One important goal of PECS is that it should be used
across all natural environments. In the early phases of teaching, the setting for
training remains structured and consistent (described in each phase of training). As
the student becomes more proficient at using PECS, the learning environment is
more relaxed to promote generalization of skills.
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Teachers/Adults. Initially, two adults are involved in training: one is identified as
the "helper" and the other as the "communicative partner." These two adults can
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trade roles throughout PECS. Finally, PECS should be used across all natural
settings to assist in creating a functional communication system that children and
youth with ASD can use to communicate with a variety of communication partners
including same-age peers.
Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
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Communication Pictures/Symbols and Book. In the early phases of instruction,
only a few pictures/symbols are used. It is important to have a designated
communication book in which commonly used pictures/symbols are stored. Frost
and Bondy (2002) recommend using small three-ring binders with Velcro strips
placed on the cover and inside the book and attaching pictures organized by theme,
making it as functional as possible. Many teachers organize books by vocabulary
categories such as food, toys, places, people. Others organize by activities of the
day (e.g., snack time, library time, play time). Additional pages can be added as
needed. As the learner begins to use PECS across settings and with varying
communication partners, a second copy of the book as well as extra
pictures/symbols should be created for use in the home setting. One common
practice is to create a CD with a PDF file of pictures that can be quickly printed out
for replacement pictures. See the Resources section for more detailed information
about how to create and set up communication systems for individual children.
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Monitoring Individual Student Progress. In each phase of the training process it
is essential that individual student progress is monitored so that teachers and other
professionals can make informed decisions about when to fade prompts as well as
when to move on to the next phase. Frost and Bondy (2002), the developers of
PECS, recommend multiple communication training opportunities spread across the
day, with training continuing within each phase until the child has reached 80% or
greater proficiency for a minimum of three days before moving on to the next
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phase. Throughout this module, the methods that can be used to monitor student
progress in all of the phases will be discussed. To access existing progress
monitoring forms and checklists, you will need to purchase the Picture Exchange
Communication System Training Manual (Frost & Bondy 2002) at
http://www.pyramidproducts.com.
Once the key players (e.g., learner, helper, partner), reinforcers, and initial materials
have been identified and developed, PECS training can begin. The six phases of
instruction are outlined below.
Phase 1: Teaching the Physically
Assisted Exchange
The outcome of Phase 1 is for the learner to look at, reach for, pick up, and hand the
picture/symbol to his/her communication partner. These are the basic skills needed to
effectively communicate using PECS (Frost & Bondy, 2002). To achieve this, the
following factors must be taken into account:
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training environment
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communicative exchange
reinforcers
teaching strategies
progress monitoring
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Training Environment
The training environment includes opportunities for both structured and
unstructured learning (Frost & Bondy, 2002). In the structured training
environment, the student with ASD may be seated across from the
communication partner, with a helper seated behind or beside him or her to
assist in developing the desired actions (e.g., reaching, picking up). It is not
necessary for the learner to be seated. Some learners with ASD may find
learning PECS easier if they are allowed to move about the room. At the
beginning of the training session, one of the highly preferred items identified
through the reinforcer sampling is on the table and out of reach of the learner.
The picture or symbol of that item is on the table
between the learner and the item.
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Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
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PECS training also can occur during more unstructured learning activities such
as during free play or on the playground. Teachers and other classroom staff
must be vigilant to ensure that PECS training takes place across daily routines
and activities. For example, if a student on the playground seems interested in
swinging with peers, the teacher and helper should stop what they are doing,
grab the communication book with a picture of a swing, and help the child
request a turn from a peer. This learning opportunity will help the child generalize
the use of newly acquired skills across settings, activities, and people (Frost &
Bondy, 2002).
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Communicative Exchange
o
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Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
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The physically assisted communicative exchange is prompted by physically
interrupting the learner's reach toward the actual, desired item, and redirecting
the learner to pick up the picture/symbol instead. It is important at this stage to
use NO VERBAL PROMPTS, as this helps the student become more
independent and less reliant upon others during communicative exchanges.
Once the learner grasps the picture/symbol, the assistant helps him to place it in
the open hand of the communication partner. Once the picture/symbol is in the
hand of the communication partner, s/he responds by saying the name of the
item/activity.
Reinforcers
If the learner does not indicate an interest in the available reinforcer (e.g., does not
reach for the item), the communication partner presents the reinforcing item again while
maintaining silence (i.e., NO VERBAL PROMPTS). To gain the attention/interest of the
learner, the communication partner may use other cues such as showing the object or
playing with the object in front of the child. It is imperative that neither the helper nor the
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communication partner says anything until the picture has been received from the
learner and is in the communication partner's hand.
Teaching Strategies
Two teaching strategies are used during Phase 1 and are critical in helping students
with ASD acquire the basic communicative exchange skills. They include (a) fading
physical assistance and (b) fading open-hand prompt.
Fading Physical Assistance
Initially, total physical assistance (i.e., hand-over-hand) is used to help the learner
navigate and practice successful exchanges; however, this must be gradually reduced
so that the child can initiate and complete an exchange with few or no prompts.
Backward chaining is a common strategy that can be used to fade and eliminate the
physical prompts used by the helper. With backward chaining, the helper assists
through to the final step of the exchange and then gradually fades assistance as the
student becomes more independent. Sometimes it is helpful to move from the full
physical assist (i.e., hand-over-hand) to a touch or gesture prompt as fading begins. It is
important to note, however, that the communication partner continues to show an open
hand whenever the child reaches for the picture while the helper's prompts are faded.
While the goal of PECS is independent communication, some learners may not reach
complete independence. The level of independence may vary according to student
needs and abilities. This should not discourage you from using PECS with learners
having physical or other limitations (Frost & Bondy, 2002).
Fading Open-Hand Prompt
As physical assistance is decreased and as students become more independent during
communicative exchanges, the communication partner can begin to fade the open-hand
prompt. Some learners may continue to need some physical guidance (e.g., mild touch,
gesture prompts) while others may need no prompt assistance to participate in
exchanges. The goal is for the learner to initiate the handing of the picture/symbol
before the communication partner opens his/her hand to receive the item.
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Monitoring Student Progress
Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
In Phase 1, progress monitoring focuses on student participation in the training process.
Specifically, teachers and other professionals collect data on the skills used during the
communicative exchange (i.e., picking up, reaching, releasing). Teachers also record
what types of prompts were needed to complete the communicative exchange (e.g., full
physical, partial physical). This information will help teachers and other professionals
make decisions about when to move on to Phase 2 (Frost & Bondy, 2002).
Phase 1 data collection forms may be found on pages 370-371 of the PECS Manual
(Frost & Bondy, 2002).
Phase 2 can begin as soon as students have acquired the basic skills outlined in Phase
1 (e.g., reaching for the high-interest item, picking up the picture/symbol of the item,
handing the picture/symbol to the communication partner, acquiring the high interest
item). There will continue to be many opportunities for the learner to practice these skills
in a variety of settings with highly desirable reinforcers.
Tips for Implementing Phase 1
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The outcome of Phase 1 is for the learner to look at, reach for, pick up, and hand
the picture/symbol to the communication partner as independently as possible.
During Phase 1, two individuals (i.e., helper, communication partner) are required to
assist the learner.
Verbal prompts (e.g., "What do you want?") should not be used. The goal is for the
desired item to serve as a visual cue by being placed slightly out of reach.
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o
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At the beginning of Phase 1, the helper fully assists (i.e., hand-over-hand) the
physical exchanges (e.g., pick up, reach, release).
Physical assistance is faded by moving to touch and gesture prompts, before fading
out physical prompts completely.
Immediate access to the requested item is provided with each successful
exchange.
"Open-hand" cues are faded only after the helper's assistance has been faded.
Each successful exchange is reinforced by using items known to be highly
motivating to the student.
Many opportunities are provided for practice and exchanges should be fun for the
student.
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The communication partner and helper include a variety of individuals to prevent
the learner from becoming "stimulus dependent" on any one person.
For learners who are echolalic (e.g., repeat what is said to them), the phrase, "I
want ______," may be used instead of "You want _______" when acknowledging
and reinforcing the exchange. However, it may be simpler to just say the name of
the requested object.
Phase 2: Expanding Spontaneity
The outcome of this phase is to increase the learner's spontaneity and generalization of
the picture exchange. That is, adults create opportunities for students to increase their
ability to initiate the communicative interaction, including gaining the attention of the
communication partner and being persistent in seeking the desired outcome. Much of
the routine remains the same as in Phase 1 with the most critical aspect being the
exchange sequence of the learner picking up the picture/symbol for the desired item,
handing it to the communication partner, and receiving the desired object with the verbal
confirmation of the name of the item. While the helper has faded the prompts, s/he
remains available to assist as necessary. As in Phase 1, no verbal prompts are used,
and only one picture/symbol is used at a time.
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Requests, Communicative Partners,
Environments, and Traveling
Requests
In Phase 2, the number and variety of reinforcer items is increased. A balance of food,
activities, and tangible items should be available for the learner to request through the
exchange process. As with any teaching program that uses reinforcing consequences,
there is always a danger of reinforcer satiation (i.e., the learner growing tired of the
reinforcer), which can hamper the effectiveness of the training. Therefore, it is essential
that multiple items are used during communicative exchanges to maintain student
motivation.
Communicative Partners
During Phase 2, the learner must have many opportunities to engage in picture
exchanges with a variety of communication partners. Partners are chosen from
individuals with whom the child interacts on a regular basis, including parents, siblings,
family members, classroom or building staff, peers, and therapists. While verbal
prompts should be avoided, it is sometimes helpful for the communication partner to
interact with the preferred item in front of the learner, which will encourage him or her to
request the item. For example, the partner may be eating a preferred food item or
interacting with a favorite toy or object as the learner enters the teaching setting. The
purpose of this activity is to motivate the student to engage in a communicative
exchange.
Environments
In order to promote generalization of the learned communicative exchange using the
PECS system, instruction should take place in a variety of natural environments (e.g.,
home, school, community) and should occur during natural events and activities that
take place throughout the course of a typical day (e.g., meals, snacks, play time,
teaching time, playground opportunities). By mixing it up, the learner begins to
experience the immediacy of the reward for communicating and learns that the same
exchange system is effective across people, places, and activities.
Traveling
Traveling is an important component of Phase 2 because it requires the student to seek
out the communication book in order to request items or activities from a partner. Two
types of traveling activities are used to expand the spontaneity of communicative
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exchanges (a) increasing the distance to the communication partner and (b) increasing
the distance from the communication book.
Increase Distance to the Communication Partner
In Phase 1 the partner was readily available (e.g., within arm's reach, across the table)
to the learner and waited expectantly for the exchange to occur. In Phase 2, the partner
gradually increases distance and positioning from the learner so that the student learns
to access the picture/symbol, move within proximity of the desired communication
partner, and gain the partner's attention before making the request. When transitioning
from Phase 1 to Phase 2, the helper is available to provide nonverbal prompts or
assistance when students begin to navigate the steps and the distance. The "expectant
look" often is used to facilitate student initiations. For example, the communication
partner raises his/her eyebrows while also hunching shoulders and raising arms to
convey the message, "What do you want?" This often is enough to elicit a
communicative exchange between student and partner. As before, prompting, including
the expectant look, is faded as quickly as possible (Frost & Bondy, 2002).
Increase Distance From the Communication Book
As the learner accomplishes the steps required in traveling from a point of origin to
make a request of a communication partner, the distance is increased between the
learner and the pictures/symbols on the communication book. This increase in distance
is gradual and encourages the learner to actively seek the specific picture/symbol
needed for the communicative exchange (Frost & Bondy, 2002).
Monitoring Student Progress
Phase 2 progress monitoring focuses on the traveling process. For example, teachers
record whether the student traveled to the communication partner and/or
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communication book as well as the distance traveled. It is also noted whether prompting
was necessary during the communicative exchange.
Phase 2 data collection forms may be found on pages 372-374 in the PECS Manual
(Frost & Bondy, 2002).
Phase 3 training can begin once students are independently traveling to and from the
book to a communication partner to initiate an exchange on a consistent basis and
requesting at least four different items (Frost & Bondy, 2002).
Tips for Implementing Phase 2
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The outcome of Phase 2 is for the learner to engage in communicative exchanges
that involve increasing distances between the learner and the communication book,
as well as between the learner and the communication partner to promote
generalization and persistence.
Both the communication partner and the helper still are necessary to provide
assistance if needed.
The learner travels to and from the communication book during communicative
exchanges.
The learner travels to gain the attention of communication partners.
Physical prompts and subtle visual cues are faded.
No verbal prompts are provided throughout Phase 2.
Highly preferred items are used to encourage communicative exchanges.
The pool of reinforcers is increased and varied to increase communicative
competence.
Many opportunities per day (20-30) are provided across a variety of settings,
partners, and activities.
Phase 3: Simultaneous Discrimination of
Pictures
In this phase, the learner is ready to choose from more than one picture during
communicative exchanges. At this stage, the learner must closely attend to the
pictures/symbols in order to be able to discriminate between them (Frost & Bondy,
2002). The following components should be included in Phase 3 training: (a)
discriminating between two pictures, (b) teaching discrimination through correction
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procedure, (c) increasing pictures in the display, (d) conducting a correspondence
check, and (e) monitoring student progress.
Discriminating Between Two Pictures
Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
In early discrimination training, the communication book includes only two
pictures/symbols. One picture is a known, highly reinforcing item or an item appropriate
to the situation, and the other is a non-preferred or unrelated item. For example, if the
learner is being read to and the communication partner stops reading, the learner would
reach for and give the picture for a book to the partner. If the learner gives the picture of
an unrelated item (e.g., shirt), the communication partner gives the learner the shirt
without any social reaction (Frost & Bondy, 2002). If the learner persists, note his or her
reaction to receiving the unrelated item. Then continue teaching with an alternate
scenario using other preferred items and pictures/symbols. A critical feature of
discrimination training is to reinforce the selection of the correct picture as soon as it
happens (i.e., as soon as the learner's hand touches the picture). This may be done
with verbal praise such as "Yes," "That's right," "Uh-huh," or "Good choice."
Teaching Discrimination Through
Correction Procedures
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Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
Some individuals easily learn to discriminate between pictures and make the connection
between the items pictured and the actual items/activities. Others do not learn this skill
as readily and will need specific instruction. Steps for implementing this procedure are
included below (reprinted from The PECS Training Manual, 2nd edition, 2002, pp.127128 with the authors' permission).
Alternative strategies that increase the contrast between the picture/symbol being
taught and other pictures include the following:
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Make the picture of the relevant object larger than the picture of the non-preferred
object
Use color pictures of relevant/desired objects to contrast with black-and-white
pictures of non-preferred/irrelevant objects
Highlight the desired picture by outlining it with a magic marker
Use a blank card as the other picture in the display
Make the desired picture 3-dimensional by attaching it to a poker chip or block
Place the desired picture closer to where you are holding the desired object
Successful use of these or any strategies for discrimination training depends upon
correct use of error-correction procedures. Furthermore, once the learner is able to
discriminate among pictures, enhanced features (e.g., using large pictures or
highlighting certain aspects) should be gradually eliminated.
Note that the official PECS distributors and trainers have developed several DVDs on
discrimination training: PECS Discrimination Training Alternatives DVD, Modules 1, 2,
and 3; they are available at www.pyramidproducts.com.
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Increasing Pictures in the Display
As the learner becomes more competent at discriminating between two pictures,
additional pictures/symbols are introduced so s/he can begin to request from numerous
options. Initially, both highly and less preferred items are included. As training
progresses, symbols of equally desirable items are added. Ample opportunities for the
learner to practice discriminating among pictures/symbols are provided. This is
accomplished by slowly increasing the number of new pictures. If the learner appears to
be confused or loses the ability to discriminate, decrease the number of pictures to the
last known success point. Provide the learner with an opportunity to practice at that
level before the number of pictures is increased again.
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Conducting Correspondence Check
Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
As the learner reliably demonstrates the ability to discriminate between a picture of a
highly preferred item and the picture of a contextually inappropriate or undesired item,
the next step is to teach discrimination between two items that are both appropriate and
desirable to the learner. This is done with correspondence checks to ensure that the
learner is requesting and taking the item for which he or she is asking. A simple way to
do this is to present two preferred items and have pictures of both available on the
communication book. When the learner presents the communication partner with one
picture, do not give the item and do not name the item. Offer both items and say, "Go
ahead," "Show me," "Here," or something similar. If the learner takes the item that
corresponds with the picture presented, allow access, provide praise, and name the
item. If the learner reaches for the other item, block access and begin an errorcorrection sequence for the picture that corresponds to the item reached for by the
learner.
Monitoring Student Progress
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The goal of progress monitoring in Phase 3 is to determine whether the learner can
accurately discriminate between three or more pictures. Data are collected throughout
the discrimination process. Once a learner is discriminating between 12 to 20 pictures
independently and can travel to and from the communication book to initiate an
exchange, Phase 4 instruction can begin.
Once a learner is discriminating between 12 to 20 pictures independently and can travel
to and from the communication book to initiate an exchange, Phase 4 instruction can
begin.
Tips for Implementing Phase 3
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The outcome of Phase 3 is for the learner to (a) select the picture associated with
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the object s/he wants from a display of pictures, (b) approach a communication
partner, and (c) give the communication partner the picture to access the object
desired.
During discrimination training, the placement of pictures in the communication
book/board should be varied. Please see photo in PECS Manual (Frost & Bondy,
2002) on page 131.
No verbal prompts are used during this phase.
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Ample exchange opportunities are offered throughout the day and across
settings/people/activities.
Helpers and communication partners avoid saying "No" when the child makes a
mistake during discrimination training. Instead, respond by giving the child what he
has requested even if you know it is not the desired item (i.e., natural
consequences).
Ongoing documentation of items used as reinforcers as well as those that have lost
reinforcing value is an important part of the PECS training.
Phase 4: Building Sentence Structure
In this phase, the learner is taught to place an "I want" symbol with one of the pictures
already successfully used onto a sentence strip and then use it during the
communicative exchange. Sentence structure is taught for two specific reasons. First, a
framework is established for teaching other communicative functions in the future by
visually defining requesting with the "I want" symbol. Second, the use of the sentence
strip may provide the structure to elicit spoken words. The outcome of Phase 4 is for the
learner to spontaneously request using simple sentence structure (Frost & Bondy,
2002). Other factors involved in Phase 4 include: (a) introducing sentence structure, (b)
promoting verbalization, and (c) monitoring student progress.
Introducing Sentence Structure
When introducing the use of the sentence strips, the "I want" symbol is placed on the
left side of the sentence strip. When the learner begins to take a picture off the board,
the helper immediately guides the learner to (a) place the picture next to the "I want"
symbol on the sentence strip, (b) take the entire strip off the book, and (c) give it to the
communicative partner. The communication partner then reads the sentence ("I want
____.") as s/he points to the symbols on the strip while also giving the learner the item
requested. The helper or the communication partner places the sentence strip and
symbols back on the communication book (or assists the learner to do so). The helper
gradually fades physical guidance until the learner is able to place the symbol next to
the "I want" symbol on the sentence strip by using the backward chaining strategy
outlined in Phase I and gives it to the communication partner with minimal assistance.
Once the sentence strip has been introduced, the learner uses it for all requests
throughout the day.
20
Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
The next step is to have the learner place the "I want" symbol before placing the
picture/symbol of the desired item. In doing so, the "I want" symbol is placed in the
upper left-hand corner of the cover of the communication book. When the learner puts
the picture of the desired item on the sentence strip, the helper physically prompts him
or her to put the "I want" symbol in front of it on the strip. As in previous phases, these
physical prompts are quickly faded as the learner independently places all symbols on
the sentence strip. At this point, the helper begins to prompt the learner to point to the
symbols on the strip as the communication partner reads it. Although eye contact is not
directly taught in PECS, it is often a positive outcome of many successful
communicative exchanges using the system. It is helpful for the adult partner to hold the
sentence strip near his or her face while reading the sentence. If the learner is not
directing his gaze to or making eye contact with the communication partner, a return to
the two-person training system may help the child become more persistent in getting his
partner's attention (i.e., face-gazing/eye contact). The communication partner should not
automatically look at the child when he approaches with his sentence strip, but rather
put his head down. The prompter can help the child tap the partner's shoulder to get his
attention. The communication partner should then look up and respond ("Oh, it's
learner's name") and respond to the request. After repeated trials, physical assistance is
faded.
Promoting Verbalization
Once the learner is able to point to the symbols as the communication partner reads the
words "I want _____," it is appropriate to promote vocalization of the word for the
desired object. To do this, the communication partner adds a pause after reading "I
want" and before naming the requested item. Individuals who are able to vocalize may
begin to complete the sentence with a vocalization, a word, or a word, approximation.
Any attempt to vocalize during this pause should be immediately reinforced with the
learner obtaining the requested item, even if he is unable to properly say the word. Even
if the learner cannot vocalize, it is important to honor the request.
21
Monitoring Student Progress
In Phase 4, progress monitoring focuses on the use of the "I want" symbol as well as
the prompting that is needed to complete the communicative exchange. Teachers also
should conduct correspondence checks once the student is able to point to the pictures
on the sentence strip independently (Frost & Bondy, 2002).
Phase 4 progress monitoring forms may be found on pages 377-378 of the PECS
Manual (Frost & Bondy, 2002).
Tips for Implementing Phase 4
o
Physical prompts are used initially and quickly faded.
o
Verbal prompts are not used at any time during Phase 4.
Frequent requesting is maintained in a variety of environments.
It is easiest to begin sentence structure training in a one-to-one session with the
communication book and a communication partner in close proximity.
Once the sentence strip is introduced, it is used for all requests.
Requesting vocabulary continues to be expanded.
Correspondence checks are continued.
o
o
o
o
o
22
o
o
o
o
When reading the sentence strip, continue to provide opportunities for vocal/verbal
requesting by pausing.
During initial training, pictures of items are placed on the front cover of the book.
As the learner becomes accustomed to using the sentence strip, the pictures are
kept on the inside pages according to the category to which they belong.
Both at home and at school, the communication book is kept in a designated place
that is accessible to the learner.
Phase 5: Responding to What Do You
Want?
By this time, most learners are spontaneously requesting a variety of objects or
activities. Phase 5 instruction encourages initiation and teaches the learner to answer
the question, "What do you want?" Using the strategies presented in previous phases,
the question "What do you want?" is introduced by using a delay method, followed by
fading the prompt cue (Frost & Bondy, 2002). This can be implemented using the
strategies of zero-second delay, increasing delay interval, fading pointing cue, and
monitoring student progress, as outlined below.
Zero-Second Delay
The communication partner begins by simultaneously pointing to the "I want" card and
asking "What do you want?" (i.e., zero-second delay). The goal is for the learner to
complete the sentence strip with the "I want" picture and follow through with the
exchange (Frost & Bondy, 2002).
Increasing Delay IntervalMonitoring
Student Progress
23
In Phase 5, teachers and other staff collect progress monitoring data that focus on the
delay interval used and whether or not the student "beat" the prompt. Correspondence
checks also are conducted as students progress to determine students' understanding
of the phrase "I want" (Frost & Bondy, 2002).
Phase 5 progress monitoring forms may be found starting on page 379 in the PECS
Manual (Frost & Bondy, 2002).
As the learner demonstrates the ability to complete the sentence strip and the exchange, the
communication partner increases the time interval, encouraging the learner to complete
the exchange prior to the point prompt (Frost & Bondy, 2002).
Fading Pointing Cue
Once the learner demonstrates that s/he is able to beat the prompt, the opportunities for
spontaneous requesting and responding to "What do you want?" are varied. The goal is
for the child to both request and respond without prompting.
Tips for Implementing Phase 5
o
o
o
o
This is one of the easiest steps of PECS!
The outcome of Phase 5 is for the child to answer the question, "What do you
want?" and spontaneously request a variety of items.
Spontaneous requesting should be alternated with responding to the verbal request
"What do you want?"
Numerous opportunities continue to be provided each day for the learner to request
during functional, meaningful activities across settings and with a variety of
communication partners.
Phase 6: Commenting
PECS training to this point has focused on the communicative function of requesting,
i.e., asking for and getting what you want. The purpose of Phase 6 is to teach a new
communicative function: labeling or naming things. This initially involves listening and
responding to another person's request for information (Frost & Bondy, 2002). This is an
important step in the development of communication skills and is often difficult for
children and youth with ASD. The later part of this phase aims to eliminate the question
so that the learner can begin to use spontaneous comments. Important components of
Phase 6 include (a) preparation, (b) introducing commenting in response to a question,
24
(c) teaching differentiated responses to questions, (d) teaching spontaneous
commenting, and (e) monitoring student progress.
Preparation
A number of items the learner already has in his or her requesting vocabulary are
gathered along with the pictures associated with the items and a new symbol to
represent the concept "I see." These items should be familiar to the learner but should
not be the most highly desired objects. The "I see" symbol is placed on the cover of the
learner's communication book.
Introducing Commenting in Response to
a Question
The adult holds one of the training items, then places the "I
see" symbol, the picture representing the item, and the
sentence strip on the communication book. The adult holds up
the item and asks "What do you see?" and points to the "I see" symbol on the book. If
the learner does not pick up the "I see" symbol, the adult physically guides him/her to
pick it up and place it on the sentence strip. The adult then waits for five seconds to see
if the learner will pick up the picture of the item s/he is holding and place it on the
sentence strip. If the learner assembles the sentence strip and gives it to the adult, the
adult responds with "Yes, you see a "___," and gives the learner a reinforcer unrelated
to the item she is holding. If the learner does not assemble the strip, the adult guides
him to do so and responds as above. The adult then holds up another item (having
placed the corresponding picture on the book) and again asks, "What do you see?"
using the same procedure. The adult fades cues as quickly as possible until the learner
is able to assemble and use the "I see" symbol to respond to the question. It is very
important that the item being commented on is NOT used as the reinforcer when
teaching a response to "What do you see?" This is to help the learner to distinguish
between the labeling function being taught and the previously taught requesting
function.
Gradually increase the pictures and items so that the learner must discriminate among
pictures, assemble the sentence strip, and respond to "What do you see?" New
vocabulary items may be added and taught in this manner. Training in responding to
25
"What do you see?" should take place during defined training sessions until the learner
is able to respond reliably with a variety of symbols. After that, the process may be used
across settings, activities, and communication partners (Frost & Bondy, 2002).
Teaching Differentiated Responses to
Questions
Graphic courtesy of Pyramid Educational Consultants, Inc. (www.pyramidproducts.com)
Once the learner is able to respond reliably to "What do you see?," the adult begins to
intermix the question "What do you see?" with "What do you want?" in order to teach
differentiated responses. At this point the "I see" symbol is placed below the "I want"
symbol in the upper left-hand corner of the communication book. The adult gives the
learner the requested item when s/he uses "I want ___," and verbally acknowledges this
while providing alternative reinforcement when s/he uses "I see ___." If possible,
progress from tangible to social reinforcement for the learner's correct responses to
"What do you see?" That is, verbal reinforcement for identifying the correct item is
gradually provided without offering another tangible or edible reinforcer. Responses to
these questions should be generalized to a variety of communication partners and
environments (Frost & Bondy, 2002).
The outcome of Phase 6 is for the learner to appropriately answer randomly asked
questions, including "What do you want?" "What do you see?" "What do you hear?"
"What do you have?" and even spontaneously comment without being asked a
question.
Teaching Spontaneous Commenting
As the learner demonstrates commenting in response to a question, the goal is to
promote commenting independent of questioning. In order to do that it is important to
continue to create interesting environmental events and eliminate any questions. A
26
chart on page 230 of the PECS Training Manual (Frost & Bondy, 2002) illustrates how
to remove the question.
27
Monitoring Student Progress
Teachers and other professionals gather data on learners' use of spontaneous
commenting. For example, progress monitoring data are collected during structured
training sessions and during daily routines and activities to determine whether learners
spontaneously comment about meaningful objects, people, and events (Frost & Bondy,
2002).
Phase 6 data collection forms may be found starting on page 380 in the PECS Manual
(Frost & Bondy, 2002).
Tips for Implementing Phase 6
In Phase 6, you begin to teach commenting through labeling, a new communicative
function.
o
Teaching responses to a question begins with familiar, but not highly desired items.
o
The item you are asking the learner to label should not be used as the reinforcer for
a correct response. This may confuse the learner in terms of the function of what he
is learning to do.
o
Responses to a question are taught and practiced during a training session, then
generalized to other environments.
Materials that are interesting to learners should be used when teaching them to
comment on what they see. Examples include:
o making different stuffed animals appear from behind a screen
o using lift-the-flap books (e.g., the Spot series) where the pictures are hidden
under flaps in the book
o putting familiar objects in sealed, clear containers and then putting them inside
a cloth bag
o pulling a container out of the bag, showing it to the learners, and asking, "What
o
o
o
do you see?"
hanging objects of interest from the ceiling
going on a walk and asking learners what they see in the school hallway or
outdoors
Next Steps
28
Once learners have progressed through all six phases of PECS training, they are fairly
proficient in seeking their communication book, discriminating among pictures,
constructing sentence strips, finding a communication partner, and completing the
exchange. Logical next steps for post-PECS instruction include:
o
o
o
o
o
o
o
continuing to add new pictures to the learner's communication book.
developing multiple copies of the learner's communication book for use across
settings (e.g., home, community).
continuing to provide multiple and varied opportunities for communicative
exchanges across settings, people, times, and items.
introducing others with whom the learner may interact to PECS (e.g., store and
community workers, extended family, peers).
providing opportunities without questions to promote spontaneous commenting.
introducing attributes and modifiers to provide the learner with specificity in
requests (e.g., "I want the blue blocks," "I'd like a large piece of cake"). This is an
important aspect of language development and should not be overlooked,
particularly with learners who respond to and learn PECS quickly. The full PECS
training includes details on how to fully incorporate this into regular PECS use.
applying the picture symbol system to a voice output device if the learner is not
showing progress in vocalizations.
Case Study: Alex
Case Study: Alex
Alex (short for Alexandra) is a 5-year-old girl with ASD enrolled in an inclusive
kindergarten classroom. Alex's teachers and parents have been working with her to
develop behavioral, communication, and social skills that will enable her to succeed in
first grade without one-on-one instructional support. It has become evident to everyone
that Alex needs a way to initiate her wants and needs. Alex is mostly nonverbal. To this
point, she has utilized a combination of gestures, vocalizations, and idiosyncratic signs
to indicate her desires. Most often, Alex waits for others to interact with her before
attempting to communicate. Her educational support team has decided to implement
PECS as a means of teaching her some consistent communication skills, with an
emphasis on initiating. Alex's parents are hopeful that PECS training will encourage her
to begin to use verbal language.
29
Case Study: Alex - Reinforcer Sampling
After talking to Alex's parents and observing her in the classroom, her teacher, Ms. M,
gathers some of Alex's favorite toys, books, and snacks along with some new items.
She spends a few minutes sitting with Alex and offering her items, two at a time, being
sure to switch between left and right presentation across trials. After repeating this
process on another day, Ms. M feels that she has identified enough desired items to
begin PECS training.
Case Study: Alex - Pre-Training Tasks
Ms. M prepares for Alex's PECS training by taking digital pictures of the items identified
as highly motivating from the reinforcer sampling. She prints out multiple copies of the
pictures on her computer, organizing two sets and backup copies into two binders. One
binder will be used as Alex's at-school communication book. The other will be sent
home for Alex's parents to use there. Because Ms. M knows that Alex has a younger
brother who is very active, she includes a CD with copies of the pictures with the book.
This allows Alex's parents to print out new pictures if the old ones are lost or destroyed.
After going over the PECS procedures with Alex's current one-on-one educational
assistant, identifying times throughout the school day during which PECS trials can be
implemented, and setting up a table in the corner of the room at which to begin the
training, Ms. M is ready to begin training.
PECS Phases 1-3
Case Study: Alex - PECS Phase 1
Alex makes excellent progress learning the communication exchange taught in PECS.
She quickly learns the advantage of handing the picture to her teacher or educational
assistant to have a book read to her or to get a taste of a favorite snack food. Alex also
enjoys the extra attention she is receiving with the two-person training. Alex's
classmates also are intrigued by the PECS training. Soon, they are asking if they can be
involved. Ms. M thanks them for their interest and tells them that they will be able to
communicate with Alex this way in the near future.
Case Study: Alex - PECS Phase 2
Ms. M is pleased with how quickly Alex learned the physically assisted exchange in
Phase 1. They have been able to quickly fade the physical assist and open-hand
prompt. Alex's parents report that while they have had some success in using the PECS
system at home, it is difficult to find the time to do it as Mom and Dad are rarely home
and unoccupied at the same time. They also comment on how independent Alex is at
30
accessing the things she wants or needs in their home. Alex's parents agree to keep
trying to implement PECS and Ms. M assures that Alex is making excellent progress on
the system at school. From Phase 1, Alex transitioned smoothly to picking up the
pictures herself. During Phase 2, Ms. M and the educational assistant move the
communication book with pictures to a bookshelf near the table where they have been
teaching Alex. During the training trials, Ms. M will now move from the table to her desk
or to another area of the room so that Alex will have to walk over to her to give her the
picture. Everyone is delighted when Alex begins to go through the communication book
to find pictures of items she wants. This means that Ms. M does not have to teach her to
discriminate from a variety of pictures. Occasionally, Alex will be in a hurry to get an
item and will not look carefully at the pictures. This is sometimes the case with pictures
of favorite story books. However, when Ms. M takes the picture and verbally confirms,
"You want name of book," Alex will make the correction if it is the wrong book by
pointing to the correct book or going to get the correct picture of the book and switching
it for the wrong picture.
Case Study: Alex - PECS Phase 3
Much to everyone's surprise, Alex has not only led the way to adding new pictures to
her book (e.g., bringing an item to the teacher, pointing to the book indicating that she
would like it in the book), she has also initiated bringing new people into the training
scenario. Like her classmates, Alex wants other children to be involved. Ms. M has
responded to this request by having Alex's peers participate in the training trials across
the day. For example, during story time, when it is Alex's turn to choose a book, Ms. M
invites a classmate to interact with Alex to determine which book she would like read.
This has been so successful that Alex's school friends are now volunteering to take the
communication book to inclusive classes like art and music, as well as to the lunchroom
and playground. This is all timely, as during Phase 3, one of the goals is to increase
opportunities for requesting. Also, throughout the PECS training, it is important to
generalize across stimuli, settings, and people.
PECS Phases 4-6
Case Study: Alex - PECS Phase 4
During Phase 4, Ms. M is working with Alex to use sentence strips by placing an "I
want" picture on the left side of the strip and an already learned picture request card to
the right. Initially, Ms. M and the educational assistant do this training with Alex. Ms. M
is concerned that if too many people are involved, Alex may become confused. As Alex
31
has repeated practice and learns to place the "I want" symbol without help, other
helpers are added. This is also an excellent opportunity for other students in the
classroom to practice their reading skills. While Alex progresses rapidly in this phase,
her parents are disappointed to learn that she is not initiating verbalizations during Step
9 of Phase 4. (i.e., Communicative partner pauses after reading, "I want" from the
sentence strip, before saying the name of the pictured item). Ms. M tries to encourage
Alex's parents by telling them that Alex may pick up the verbalizations in time. She also
comments on how anxious, and sometimes impatient, Alex is to complete the
exchange. In time, perhaps she will learn that if she says the word she will get the item
faster.
Case Study: Alex - PECS Phase 5
Ms. M decides to make a game out of Phase 5 (i.e., responding to "What do you
want?") and has a small group of students sit around a circular table with a pile of
pictures in the middle. She goes around the table, asking, "What do you want?" The
students have the option of finding a picture with the desired item on it and using a
sentence strip like Alex or of answering verbally. When it is Alex's turn, Ms. M uses the
sentence strip and points to the "I want" card, asking "What do you want, Alex?" Alex
uses the picture cards on the table to complete the sentence and receive the desired
item. All of the children enjoy this activity and frequently ask if they can do it. Ms. M
incorporates it into snack time and free time on a regular basis.
Case Study: Alex - PECS Phase 6
During this phase of instruction, Ms. M is working toward teaching Alex to answer
questions and label. This is difficult for Alex because she wants to receive each item
she labels, and it is important for her to learn the difference between answering a
question and asking for something. Initially, some exchanges end in tantrums when Ms.
M does not give Alex the item that she labels after being asked, "What do you see?" Ms
M talks to Alex's mom, and together they identify some activity reinforcers that will make
Alex happy and help to prevent a tantrum. These activities include Alex going for a short
walk to say hi to another teacher in the building, listening to music on headphones for a
minute, taking a drink of a preferred juice, and looking briefly at a picture of Mom and
Dad. These are all preceded by Ms. M praising Alex for her work (e.g., "Nice job, Alex,
that is a ______. Let's go say hi' to Ms. K.") In a short while, Alex is able to use the
sentence strip on her communication book to answer the question, "What do you see?"
with the "I see" symbol and a picture. Now Ms. M feels comfortable alternating these
questions with request for items. Alex's tantrums have subsided during the labeling
32
questions, and to everyone's delight, in general. She clearly understands the difference
between labeling and requesting.
Next Steps
For Alex, PECS training has been a huge success. In just a little over a month, she has
learned to answer labeling questions and to initiate when she wants something. She is
ready for first grade with a solid start on a systematic means of communicating with
adults and peers. While Alex still needs a significant amount of one-on-one educational
support, she will be able to work independently for short periods of time and to interact
with peers without much assistance. An important next step for Alex is to continue to
build her vocabulary with pictures in her book. Another next step might be to begin to
incorporate some symbol pictures (e.g., simple line drawings) into the collection of
photographs. Being able to use symbols, rather than photos, might broaden Alex's
vocabulary and help her generalize newly acquired skills to other objects, people, and
settings. Finally, teachers should continue to build the expectant pause into reading
sentence strips, "You want [pause] __________" because Alex's parents still would like
her to develop verbal skills. As Alex continues to use PECS to communicate with sameage, nondisabled peers, she may learn to verbalize her wants and needs.
Case Study: Joe
Case Study: Joe
Joe is a sixth-grade student with ASD who attends an inclusive middle school. Joe has
limited verbal abilities (i.e., he frequently vocalizes); however, it is very difficult to
understand him unless the person with whom he is speaking knows him well and is able
to use a communication book with a limited number of symbols. While Joe is not easy to
understand when he does attempt to vocalize, it has been noted that he is somewhat
echolalic in his speech. Joe participated in PECS training as a young child, but it was
discontinued when his family moved to another school district. Historically, Joe has
been very passive in terms of communicating with others. Though he will respond (with
limited choices) to a question from another individual, rarely will Joe begin the
interaction or seek out a communication partner. Joe's IEP team has set a goal for him
to learn how to initiate communicative interactions with a greater number of people.
They feel that a return to PECS may equip Joe with the initiation skills he needs, while
broadening his vocabulary and helping him gain confidence in interacting with people he
does not know well.
33
Case Study: Joe - Reinforcer Sampling
Mr. L is Joe's case manager and also acts as the transition coordinator for the school
district that Joe attends. Prior to beginning PECS training, Mr. L observes Joe across
the school day and talks with his mom and brother, Lee, who is three years older, and
with whom Joe is very close. Lee enjoys the kinds of things that Joe likes to do, wear,
eat, listen to and watch. From this information Mr. L constructs a list of possible
reinforcers, adding to the list other options that come to mind. He then conducts a
reinforcer sampling, being sure to alternate left and right presentation and pairing old
known reinforcers with new ones. From the notes he takes during the sampling, Mr. L
identifies 10 items that can be used during the PECS training.
Mr. L prepares for PECS training by gathering symbols of the reinforcing items identified
through a reinforcer sampling. Because Joe already uses some symbols, Mr. L decides
to use symbols rather than photographs. He prints out multiple copies of the symbols on
his classroom computer, organizing two sets and backup copies into two binders. One
binder will be used as Joe's at-school communication book. The other will be sent home
for Joe's mom and brother to use. Because Mr. L knows that Joe spends time at his
grandparents' house, he gives his mom a CD with copies of the symbols. This way,
Joe's family can print out new pictures if the old ones are lost or left at his grandparents'
house. After going over the PECS procedures with the two educational assistants who
are available to help Joe during the school day, identifying times throughout the school
day during which PECS trials can be implemented, and setting up a table in the school
library, Mr. L is ready to begin training.
PECS Phases 1-3
Case Study: Joe - PECS Phase 1
Because Joe already uses a communication book with three to five symbols by pointing
to indicate a choice, Mr. L is careful about teaching the physically assisted exchange.
He explains to Joe that with the symbols, Joe must hand the card to Mr. L rather than
point. The educational assistant provides a hand-over-hand (i.e., full physical) prompt to
begin. During this part of the PECS training, the use of Joe's communication book is
stopped, to avoid confusing Joe. Initially, Joe does not like the physical assist. Once he
understands that he is to pick up the card rather than point to it, it is easy to fade out the
physical prompt. The teacher has no trouble fading the open-handed prompt either.
Because Joe does at times echo words that are spoken to him, Mr. L says, "I want
________" rather than "You want _____" during the communicative exchange. Soon
34
Joe is readily exchanging symbol cards for desired items. The challenge with Joe is that
the teacher and educational assistants have to refresh the reinforcer pool on a regular
basis because Joe is easily bored with his choices. They suspect this is because his
grandparents spoil him on the afternoons he stays with them.
Case Study: Joe - PECS Phase 2
Joe enjoys coming to the library for the PECS training, so Mr. L continues training there
for the time being. To promote Joe's use of the communication book and to expand his
ability to persist in seeking to communicate, Mr. L works with the school librarian to
develop an in-school job for Joe. Joe helps the librarian to re-shelve books during study
hall. The goal is for Joe to use his communication book to initiate interactions with the
librarian to indicate that he is ready for another book and to ask for a break (which he
does frequently). In order to do this, Joe must go to the table where his book is kept,
find the symbol he wants, and take it to the librarian for the exchange. Over time, Joe
learns to do this quite well and naturally begins to take his communication book with him
from place to place in the library. Other training that still involves two people (i.e., Mr. L,
an educational assistant) occurs during home room and across the classes Joe attends
throughout the day.
Case Study: Joe - PECS Phase 3
Because of Joe's limited use of the communication book, Mr. L had anticipated that Joe
would have trouble learning to discriminate among three or more symbols. Mr. L does
repeated trials using the discrimination correction procedure. This gives Joe practice in
matching the desired symbol with the appropriate item. Within the PECS instruction, Mr.
L. incorporates some symbols of non-desired items that are in black and white rather
than color. This is done to help Joe further discriminate among a variety of symbol
options. Finally, just to be certain that Joe knows what he is asking for, Mr. L conducts a
periodic correspondence check. To do this, he accepts the symbol that Joe offers and
responds with, "You want ______, go ahead and take it." Mr. L makes a note of whether
or not Joe takes the item that matches the symbol he presented. After Joe reaches 80%
accuracy during this phase of training and maintains it for four days, Mr. L proceeds to
Phase 4.
PECS Phases 4-6
35
Case Study: Joe - PECS Phase 4
Mr. L introduces Joe to the sentence strip, fashioning it after Joe's old communication
book. Joe learns to place the "I want" symbol on the strip with only a touch prompt
because he did not like the full physical prompt; however, this is quickly faded. After he
learns to also place the picture of the desired item, Joe intently watches as Mr. L reads
the strip to him, "I want [expectant pause] ______." Because Joe occasionally
verbalizes, Mr. L accurately predicted that Joe would say the name of the item he
wanted before Mr. L. Mr. L is quick to reinforce him with the presentation of the
requested item and with verbal praise for talking. However, because of Joe's
unintelligibility when speaking, it is not a goal for him to rely fully on speech for
communicating with others.
Case Study: Joe - PECS Phase 5
This phase of training is easy for Joe because he has used a communication book to
respond to questions in the past. During the early trials of being asked, "What do you
want?," Joe has to be reminded to use the sentence strip to construct "I want" with a
symbol of a desired object rather than simply pointing to what he wants or to its symbol.
Over time, Joe gets in the habit of using the sentence strip to answer as well as initiate.
Case Study: Joe - PECS Phase 6
Again, because of his experience with a communication book, Joe quickly advances
through labeling items in response to the question, "What do you see?" Once Joe is
able to consistently use "I see ____," he gets to engage in a favorite activity (e.g.,
listening to his headphones, playing his finger drum, having a TicTac), but not
experience the item just labeled. Joe has come to enjoy the interactions and treats it like
a game. Sometimes he turns the tables on Mr. L and hands him the sentence strip and
a symbol card to put together. When Mr. L labels the item verbally, Joe allows him to
listen to his headphones or tap out a drum beat on his finger drum. Rarely does he offer
to share his candy though. Mr. L is careful to use the first person so that if Joe does
echo, he imitates saying "I" instead of "You." After several weeks of labeling practice,
Mr. L reintroduces the "What do you want?" question and provides many opportunities
for Joe to practice this skill throughout the day and across school and community
settings. Joe has really warmed up to the PECS training and seems to be increasingly
comfortable with initiating communicative interactions as well as responding to them.
Next Steps
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The biggest accomplishment for Joe during the PECS training is that he is much more
likely to initiate interactions with others. This is important because he soon will transition
to high school and adult life. Also, as he moves from class to class in a larger school
setting, he will need to communicate with others independently. A valuable next step is
to arrange for an assessment to determine the need for an electronic communication
device such as a "TuffTalker Plus," "Hand Held Voice," or a "Say It Sam." With an AAC
device such as these, Joe will be able to use the skills learned through PECS to both
initiate and respond to others. The sky will be the limit with his ability to quickly learn
new symbols!
Summary
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Deficits in communicative ability are a defining feature of ASD.
Deficits in communication can sometimes lead to or contribute to behavioral
difficulties.
PECS can be effectively used to increase communicative initiations of individuals
with ASD.
PECS has the potential to increase vocalizations of individuals with ASD.
PECS can be used across settings and with a variety of communication partners.
Effective implementation of PECS involves careful preparation of training materials,
identification of multiple reinforcers, involvement of others to act as helpers and
communication partners, many opportunities for communication exchanges, and
monitoring of learner progress across the six phases.
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Frequently Asked Questions (FAQ)
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NOTE: First five questions from the Interactive Collaborative Autism Network
website (ICAN, retrieved Jan. 24, 2008, from Picture Exchange Communication
System: FAQs)
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Question. Why can't I ask, "What do you want?" when teaching a child to
use PECS?
Answer. One of the unique aspects of PECS is that from the very beginning the
child is taught to initiate communication. If the child were to give the picture to his
partner after the partner said "What do you want?," he would be responding to
the question. When the child puts the picture in his partner's hand, he is, in a
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sense, the first one to "talk." This is called initiating a request and is very different
from responding to a question. Another reason for not asking the child what he
wants is that the question often becomes a verbal cue. It is common for children
and youth with ASD to become dependent on cues used by teachers and parents
to teach them things. Prompts are a very useful teaching strategy and, when
used effectively, often speed up the learning process significantly. It is important
when using prompts to fade them as quickly as possible so the learner does not
develop dependence. You will know a learner has developed a prompt
dependency if he tends to sit and wait until either told or given some other cue
before doing something. In PECS, physical prompts (guiding the child's hand to
pick up a picture) or visual prompts (pointing to a picture in the child's
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communication book) are used rather than verbal prompts (verbally telling the
child what to do) because verbal prompts are much more difficult to fade. It is
much easier to go from totally guiding the child's hand, to giving the arm an
initiating nudge to no physical contact than it is to go from telling the child "What
do you want, pick up the picture, give it to me" to silence.
Question. What is the difference between pictures and symbols? Can you
use both?
Answer. Pictures are just what you would expect--they may be photographs or
drawings of objects. They leave no question as to what is being requested.
Symbols are more representational; individuals must be able to look at a symbol,
interpret what it means, and then generalize and apply it to an actual situation. It
is important to individualize according to the child's learning style. Some begin
training with photos because they are so specific, then move on to more general
symbols when they learn how to use descriptors. Also, some individuals respond
better to color pictures while others respond more readily to black-and-white line
drawing symbols. Computer programs are available that provide photos and
symbols to print out for use with PECS books. Pictures and symbols can be used
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together. Professionals who are trained in the system regularly evaluate and
make changes to promote success.
Question. What size pictures or symbols should I use for the learner I am
working with?
Answer. It depends on the child. During the initial stages of PECS it is very
important that the child is able to pick up the picture or symbol as easily as
possible so you may want to begin with pictures that are 2-3 inches square. The
child's fine-motor abilities are a factor as are visual discrimination skills. As the
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learner develops a vocabulary of 25-30 symbols and becomes proficient in
manipulating the symbols, it may be a good idea to reduce the size of the
symbols to 1-inch square. Reducing the size of the symbols makes it easier for
the learner to find the symbol she is looking for, as the small size allows for fewer
pages in the book and/or more space between the symbols on a page.
Question. My child doesn't want to use PECS. He just goes and gets what
he wants. What do I do?
Answer. Children with ASD who do not have a communication system are often
very determined and persistent in getting what they want by themselves. Their
parents and caregivers often learn to "read the signs" of the child's behavior and
know what the child wants without the child actually communicating anything. By
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introducing PECS, you are basically changing the rules, and that can be very
uncomfortable in the beginning. It takes effort on the part of parents and teachers
to make sure that a few highly desired items are available to the child only during
PECS training to make this initial learning as quick and easy as possible. Once
the child learns how quickly he can go tell the important people in his life what he
wants, it becomes much easier to use the system.
Question. Won't my child become dependent on using symbols? Will my
child ever learn to talk?
Answer. There are many factors involved in learning to use spoken language
and functional communication. One major factor is a child's ability to produce a
variety of vocalizations even if she is not using words. Another factor is the child's
understanding that her vocalizations can have meaning to another person. A
third factor is the child's cognitive abilities. One or all of these may be significantly
affected in young children with ASD. It is impossible to predict the rate of
progress in any of these factors when a child is very young. What is known,
however, is that the earlier a communication system is taught to the child, the
more practice she will get in successfully communicating with and learning from
others. Many children who began to communicate using PECS start to say words
and begin talking. These children tend to gradually use their communication
books less and less and become more skilled in communicating with spoken
language. A few children never develop the verbal skills needed for spoken
language. For these children PECS continues to be an effective way to
communicate. There is no evidence that use of PECS prevents children from
developing spoken language.
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Question. The learner I am working with is continually losing his PECS
symbols when he is not at school. How can I expect his family to use the
system when they are unable to keep track of his symbols and book?
Answer. Keeping track of symbols and communication books at home can be a
challenge for some families, especially if they have young children. One strategy
that you can use to support PECS use at home is to provide the family with a CD
of the child's symbols in PDF format. Assuming they have a computer and printer
(preferably color), they can easily and affordably replace symbols as needed.
Question. The young girl that I am working with has done quite well with
PECS until recently. Now she no longer seems interested in participating in
the training sessions. She often gets up and walks away. What can we do?
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Answer. The first thing to check is your supply of reinforcing items. She may
simply be bored (i.e., satiated) with the limited number of items you are using for
the exchange. It pays to continually update your supply of reinforcers and to
regularly rotate their use.
Question. Is it okay to use reinforcing items that are known self-stimulation
objects (e.g., a playing card that is used for flapping)?
Answer. This is a question best answered by those who know the individual the
best. For some individuals, access to a stimulation item will deter further
progress in the training for that session. For others, the highly motivating object
will support faster learning and use of the exchange system. Consideration
should also be given to behavior support plans that may be in place to minimize
self-stimulating behavior.
Question. When implementing the four-step discrimination training
procedure, why, in Step 3, do I not give the learner the object shown in the
picture? I find this step a bit confusing and don't see how it is relevant to
the training.
Answer. This step is necessary as the goal of the discrimination training is to
confirm that the learner understands the association between the picture and the
object and that he can choose the picture of the desired object from more than
one picture. By acknowledging what the picture represents and then "distracting"
the learner with a simple, non-related request, you can be confident that the next
time he hands you the picture, he knows what he is asking for.
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Post-Assessment
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Post-Assessment
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What makes PECS unique from other graphic augmentative alternative
communication (AAC) systems of communication?
Select an answer for question 210
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Before beginning training with PECS, it is important to assess the learner's. . . .
Select an answer for question 211
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Verbal prompts are allowed in any phase of teaching PECS.
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Select an answer for question 212
During Phase 3 of PECS training, the learner is taught to make a request from
more than one picture or symbol. What is this called?
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Select an answer for question 213
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When conducting pre-PECS teaching reinforcement sampling, how are preferred
items confirmed? By...
Select an answer for question 214
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PECS has been shown to increase what abilities in children with whom it has
been implemented long-term?
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Select an answer for question 215
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