Picture Exchange Communication


What is Picture Exchange and what is it for?

Picture exchange is an assistive technique that allows children to communicate.  Systems like PECS are called augmentative communication systems- sign language is another example.  I like to teach PECS over sign language for two reasons; it doesn't limit children to their ability to imitate motor movements(often a deficit area for kids with autism) and it can be used to communicate with anyone, including peers. If we teach sign language we are teaching the child to communicate with the select people in his life who know sign language.  If we teach pecs the child can bring a picture to anyone at all and they can understand what he is asking.  The key to PECS is that it not only gives the child vocabulary they don't otherwise have, but it teaches them to initiate communicative exchanges and interactions. This is something children with autism often don't know how to do. For instance, they might be able to say a word, but they don't know how to turn to a person and use that same word to ask for the item when they want it.   In order to successfully teach the initiation piece, the way you prompt and use PECS is very important. 

The stages of Picture Exchange

PECS is taught in 6 stages..  You don't need to memorize these, but it helps to have an understanding of where we are going with things.   

  • Teaching the exchange with one picture
    • this stage takes two people, one to be the communicative partner and one to be what's called the "ghost" prompter.  It's very important at this stage that the communicative partner NOT prompt, or else that initiation piece is not being taught. 
  • Distance and persistance 
    • getting to the point where the child will get the book on their own and travel distance to the person that has the item to use the card to ask for it
  • Discriminating pictures 
    • Being able to choose from many pictures the specific item the child wants
  • Building Sentence structure
    • going from using one picture to ask for something to creating sentences like "I want a hug"   (This is what the red strip on the bottom of the book is for) 
  • Responding to "what do you want" 
  • Commenting 
    • Saying phrases like "I see a plane!" 

Phase One

Phase one looks like this:  https://www.youtube.com/watch?v=eNbucDWEfpg


Here's the really important thing to remember in phase 1

  • The person that has access to the item the child wants is the communicative partner- there job is to "entice" the child to ask for the item.  They should NOT prompt the exchange.  Don't point to the book, don't hold at your hand, don't ask "what do you want".  If it's a toy make that toy look really fun.  If it's snack go ahead and munch on a cracker.  
  • The second person is the "ghost prompter"  They should NOT communicate with the learner!  Their job is to be a ghost- as invisible as possible.  Don't talk.  Wait for the learner to reach for the item.  THEN and only then does your job start- take the learner's hand and provide only as much support as necessary to guide the learner to pick up the picture and hand it to the communicative partner.   Don't do this before the learner reaches for the item, that is basically putting words in the child's mouth.  We don't want to prompt the learner to ask for something unless they actually want the item, so them reaching for that item is our cue. 


Roles in phase one

  • Ghost prompter is usually the
    1:1 assistant
  • Communicative partner would usually be
    The general ed teacher, assistant, or another student
  • Ghost prompter should say
  • Communicative Partner should say
    comments to entice the child to request the item, "mmm I have yummy crackers"
  • Communicative Partner should prompt the student by
    TRICK QUESTION- The communicative partner should not prompt the student
  • Has the items the child might ask for easily available
    The communicative partner

Beyond Phase one

  • I'm not going to go over each phase specifically right now.  Just know that once the child learns to hand a card themselves the "ghost prompter" is faded.  After phase one, it's okay for the the communicative partner to give tiny prompts like pushing the book towards the child or making the sure the book is nearby. 
  • After phase one you want to create situations where the child has to go some distance to obtain the book or the item.  If the child can only ask for something when the book is placed directly in front of them and they are seated at the table that's not super functional.  If you are holding each block and the child is asking for them, scoot away a few feet and see if they child can move towards you to hand you the picture.  If that works scoot a little further.  Maybe get up and assist another child(still holding the blocks in view). 
  • Treat the book like you would a child's backpack or coat, don't carry it around for them.  At first they will need a little prompting to pick it up and bring it with them but you want to fade that as fast as possible. 


Common mistakes/ things to remember

Common Mistakes

  • Don't use the book only for food.  Sometimes it's harder to think of other items the child might ask for, but be creative and ask for new pictures if you think of good ideas. 
  • Don't take away vocabulary from a learner when it is not available.  A typically developing peer can ask for ice cream 400 times if they want to.  A child can use his book the same way.   If it's not available, just say  "you want ice cream, we don't have any ice cream, sorry!"   It's okay to take the picture off the front and put it inside the book just to shift the focus, but if they want to dig in the book and ask for it let them. 
  • There is ZERO reason why a child should ever not have access to their book.  Taking a child's book away is like duct-tapping a verbal child's mouth shut.  
  • Do not over prompt the learner.  Don't point to specific pictures, don't ask what do you want three times.  Use the same level of prompting you would use with a verbal child. 
  • I know you will see ten professionals/specialists/speech therapists do this, but please do not teach "more" at this early communication stage.   There is very clear research that tells us not to do this.  Typically developing children do not learn to say the word more before learning more specific words like "milk or mama".   When we teach more we do not help the child communicate their specific wants and needs, we just start ourselves a guessing game of what they want "more" of.   Children at this stage often get stuck with this "more" if taught and have trouble moving to more specific words. 

Tips and things to remember

  • With an early learner, make it easy at first.   If he asks for a cracker, and it's not snack time, go ahead and give him a piece of cracker if you can.  This is one place where you might deviate from how you would respond to typically developing children. Later we can work on waiting and appropriate times, but at the beginning stages you want as many successful attempts as possible. 
  • With an early learner, look for ways to increase the opportunities to practice.  Have him ask for each puzzle piece one at a time, at snack break the cracker into small pieces and give him one each time.  At the same time, don't push the child too far.  If they ask for ten pieces of the puzzle and then get worn out give them the rest of the pieces and let them take a break. Give them this break when you first see signs of fatigue, not when they are screaming for the puzzle piece.  Learning a new skill is hard work, think about how many calculus problems you would be willing to do in a row. 
  • Look for opportunities to have a learner ask from multiple people, can you recruit a peer to play a game and hold the items, while the child asks the peer for them?

Review Questions

True or False

  • If they use PECS the child may not bother learning to speak

True or False

  • Only give the child pictures for things that you have available.

True or False

  • It's okay to not allow the child to have a book for some activities like circle.

True or False

  • You should try to move to full sentences as fast as possible.