Mastering PECS: A Step-by-Step Guide to Picture Exchange Communication System

The Picture Exchange Communication System (PECS) is an augmentative and alternative communication (AAC) system developed in 1985 by Lori Frost, MS, CCC/SLP and Andy Bondy, PhD. It’s primarily designed for individuals with autism spectrum disorder (ASD) and other communication challenges. PECS focuses on initiating communication by teaching individuals to exchange pictures for desired items or activities. Unlike some other AAC methods, PECS prioritizes teaching functional communication from the very beginning, rather than relying on pre-linguistic skills or complex technology. This guide provides a comprehensive, step-by-step explanation of how to implement PECS effectively.

Why Choose PECS?

PECS offers several advantages, making it a valuable tool for promoting communication skills:

• Emphasis on Initiation: PECS actively teaches individuals to initiate communication, rather than passively responding to prompts. This fosters independence and autonomy.
• Focus on Functional Communication: From day one, individuals learn to communicate their wants and needs, leading to immediate and tangible reinforcement.
• Relatively Low-Tech: PECS relies on readily available materials, making it accessible and cost-effective. While technology can be incorporated later, it’s not essential to get started.
• Versatile and Adaptable: PECS can be adapted to various settings and individuals, regardless of age or cognitive ability.
• Foundation for Language Development: While PECS is a communication system in itself, it can also serve as a foundation for developing spoken language or other communication methods.
• Reduces Frustration: By providing a clear and reliable means of communication, PECS can significantly reduce frustration and challenging behaviors often associated with communication difficulties.

Who Can Benefit from PECS?

PECS is most commonly used with individuals diagnosed with:

• Autism Spectrum Disorder (ASD)
• Developmental Delays
• Cerebral Palsy
• Down Syndrome
• Apraxia of Speech
• Other communication impairments

However, anyone who struggles to communicate effectively can potentially benefit from PECS. It’s important to note that PECS is not a replacement for spoken language; rather, it’s a tool to facilitate communication and potentially encourage language development.

The Six Phases of PECS

PECS is structured around six distinct phases, each building upon the previous one. It is crucial to master each phase before moving on to the next. Rushing through the phases can hinder progress and lead to frustration. Each phase requires patience, consistency, and positive reinforcement.

Phase 1: How to Communicate

The primary goal of Phase 1 is to teach the individual to exchange a single picture of a desired item for that item. This phase establishes the fundamental concept of communication through picture exchange.

Materials Needed:

• Highly Preferred Item: Choose an item or activity the individual finds extremely motivating (e.g., a favorite snack, toy, or activity). It’s important to have a variety of highly preferred items available to avoid satiation.
• PECS Picture: A clear, realistic picture of the preferred item. The picture should be approximately 2″x2″ or 3″x3″ in size. Laminating the picture will increase its durability.
• Helper: A helper is necessary to physically prompt the individual to exchange the picture.
• Communication Partner: The communication partner sits directly across from the individual.
• Flat Surface: A table or desk provides a stable surface for the exchange.

Steps:

1. Set the Stage: Sit with the individual at a table or desk. Place the preferred item within sight but out of reach. The PECS picture should be placed directly in front of the individual.
2. Initiate the Exchange: The helper sits slightly behind the individual and provides a gentle physical prompt by guiding their hand to pick up the PECS picture.
3. Help with Reaching: As the individual reaches for the desired item (guided by the helper), the communication partner immediately takes the picture from their hand and simultaneously gives them the preferred item.
4. Verbal Reinforcement: The communication partner should immediately provide verbal praise, such as “Great job asking! Here you go!”
5. Fade Physical Prompts: Gradually reduce the physical prompting from the helper. Start by lessening the pressure applied to the hand and eventually fade to a gesture or verbal cue. The goal is for the individual to independently pick up the picture and reach for the communication partner.
6. Practice Repeatedly: Repeat this process multiple times throughout the day, using different preferred items. Keep sessions short and engaging.

Key Considerations for Phase 1:

• Error Correction: If the individual reaches for the item without the picture, gently redirect them to the picture. Do not give them the item until they exchange the picture.
• Avoid Verbal Prompts: Do not ask the individual to “give me the picture” or “what do you want?” The focus is on teaching the physical exchange, not verbal labeling.
• Consistency is Key: Ensure that everyone working with the individual follows the same procedures.
• Positive Reinforcement: Make the exchange a positive and rewarding experience. Use enthusiastic praise and genuine excitement.
• Prompt Fading: Prompt fading is critical. The goal is for the student to initiate the exchange without assistance.

Phase 2: Distance and Persistence

In Phase 2, the individual learns to generalize the picture exchange across different environments and distances. They also learn to be persistent in their communication attempts.

Materials Needed:

• Same materials as Phase 1 (preferred items, PECS pictures, helper, communication partner).
• Communication Book: A binder or notebook with Velcro strips to hold the PECS pictures. This will become the individual’s primary communication tool.

Steps:

1. Increase Distance: Gradually increase the distance between the individual and the communication partner. Start by having the communication partner stand a few feet away, then move to across the room, and eventually to different rooms.
2. Introduce the Communication Book: Place the PECS picture in the communication book. Teach the individual to remove the picture from the book and hand it to the communication partner.
3. Persistence: If the individual hesitates or gives up, the helper can provide a minimal physical prompt to encourage them to complete the exchange. Gradually fade this prompting as they become more confident.
4. Vary Environments: Practice the exchange in different locations, such as at home, at school, or in the community.

Key Considerations for Phase 2:

• Generalization: The goal is for the individual to understand that they can use PECS to communicate in any environment.
• Persistence: Encourage the individual to keep trying, even if they encounter obstacles.
• Communication Book Management: Teach the individual to care for and maintain their communication book.

Phase 3A: Picture Discrimination

Phase 3A introduces the concept of picture discrimination. The individual learns to select the correct picture from an array of two or more pictures to request their desired item.

Materials Needed:

• Same materials as Phase 2 (preferred items, PECS pictures, communication book, helper, communication partner).
• Distractor Picture: A picture of a non-preferred item.

Steps:

1. Introduce the Distractor Picture: Place the picture of the preferred item and the distractor picture in the communication book.
2. Positioning the Pictures: Position the preferred picture and distractor picture with considerable space in between on the page.
3. Ask a Question (Optional and Fading): You can start by asking, “What do you want?” but immediately fade this prompt. The emphasis should be on spontaneous selection.
4. Simultaneous Presentation: Present both pictures simultaneously.
5. Prompting: Initially, the helper may need to provide physical prompts to guide the individual’s hand to the correct picture. Gradually fade these prompts.
6. Error Correction: If the individual selects the incorrect picture, gently redirect them to the correct picture. Do not give them the incorrect item.
7. Increase the Number of Pictures: Gradually increase the number of pictures in the communication book, always including the picture of the desired item.

Key Considerations for Phase 3A:

• Picture Clarity: Ensure that the pictures are clear and easily distinguishable.
• Equal Opportunity: Give each picture an equal opportunity to be selected. Rotate the position of the pictures in the communication book.
• Prompt Fading: Gradually fade the physical prompts as the individual becomes more proficient.

Phase 3B: Conditional Discrimination

Phase 3B builds upon Phase 3A by teaching the individual to select the correct picture based on a question or instruction, even when the desired item is not immediately visible. This introduces the concept of requesting unseen items.

Materials Needed:

• Same materials as Phase 3A (preferred items, PECS pictures, communication book, helper, communication partner).

Steps:

1. Hidden Items: The desired item is not visible. It is hidden in a bag or container, or in another room.
2. Ask a Question: Ask the individual, “What do you want?”
3. Picture Selection: The individual selects the correct picture from the communication book.
4. Provide the Item: The communication partner retrieves the item and gives it to the individual.

Key Considerations for Phase 3B:

• Understanding the Question: The individual must understand the question “What do you want?” This may require additional teaching and practice.
• Generalization: Practice requesting unseen items in different environments.
• Patience: This phase can be challenging. Be patient and provide plenty of positive reinforcement.

Phase 4: Sentence Structure

Phase 4 introduces the use of a sentence strip to create simple sentences. The individual learns to construct phrases such as “I want [desired item].”

Materials Needed:

• Same materials as Phase 3B (preferred items, PECS pictures, communication book, helper, communication partner).
• Sentence Strip: A strip of Velcro that attaches to the communication book.
• “I Want” Picture: A picture that says “I want.”

Steps:

1. Introduce the Sentence Strip: Attach the sentence strip to the communication book.
2. “I Want” Picture Placement: Place the “I want” picture on the sentence strip.
3. Constructing the Sentence: Teach the individual to place the “I want” picture on the sentence strip, followed by the picture of the desired item.
4. Reading the Sentence: Point to each picture on the sentence strip as you read the sentence aloud: “I want [desired item].”
5. Handing Over the Strip: The individual removes the sentence strip and hands it to the communication partner.
6. Providing the Item: The communication partner reads the sentence strip aloud again and provides the desired item.

Key Considerations for Phase 4:

• Sentence Strip Placement: Ensure that the sentence strip is easily accessible.
• Reading the Sentence: Always read the sentence aloud as you point to each picture.
• Consistency: Be consistent with the sentence structure.

Phase 5: Answering “What do you want?”

Phase 5 expands on sentence structure by teaching the individual to answer the question “What do you want?” with a complete sentence.

Materials Needed:

• Same materials as Phase 4 (preferred items, PECS pictures, communication book, helper, communication partner, sentence strip, “I want” picture).

Steps:

1. Ask the Question: Ask the individual, “What do you want?”
2. Sentence Construction: The individual constructs the sentence “I want [desired item]” on the sentence strip.
3. Handing Over the Strip: The individual removes the sentence strip and hands it to the communication partner.
4. Providing the Item: The communication partner reads the sentence strip aloud and provides the desired item.

Key Considerations for Phase 5:

• Delayed Prompting: Use delayed prompting to encourage the individual to answer the question independently. For example, wait a few seconds after asking the question before providing a prompt.
• Gradual Fading: Gradually fade the prompts as the individual becomes more proficient.

Phase 6: Commenting

Phase 6 is the final phase of PECS and introduces commenting and responding to questions beyond simple requests. The individual learns to use PECS to make comments, ask questions, and engage in more complex communication.

Materials Needed:

• Same materials as Phase 5 (preferred items, PECS pictures, communication book, helper, communication partner, sentence strip, “I want” picture).
• Additional Pictures: Pictures related to activities, people, and places. Pictures for feelings (happy, sad, angry). Pictures for colors, sizes, and other attributes.
• Question Pictures: Pictures for “I see,” “I hear,” “What do you see?” “What do you hear?”

Steps:

1. Introduce Commenting Pictures: Add pictures to the communication book that allow the individual to make comments about their environment. For example, pictures of people, objects, and actions.
2. Modeling: Model how to use PECS to make comments. For example, point to a dog and say, “I see dog.” Then, have the individual repeat the process.
3. Answering Questions: Ask the individual simple questions and encourage them to answer using PECS. For example, “What do you see?” or “What do you hear?”
4. Expanding Vocabulary: Continuously expand the individual’s vocabulary by adding new pictures to the communication book.

Key Considerations for Phase 6:

• Relevance: Choose pictures that are relevant to the individual’s interests and experiences.
• Variety: Provide a variety of communication opportunities throughout the day.
• Naturalistic Settings: Encourage the use of PECS in naturalistic settings.

Troubleshooting Common Challenges

While PECS is a highly effective communication system, you may encounter some challenges during the implementation process. Here are some common issues and possible solutions:

• Lack of Motivation: If the individual is not motivated to participate, re-evaluate the preferred items. Make sure they are truly highly motivating. You might need to rotate items frequently to maintain interest.
• Picture Discrimination Difficulties: If the individual struggles to discriminate between pictures, ensure that the pictures are clear and distinct. Reduce the number of pictures in the communication book and gradually increase them as the individual progresses.
• Prompt Dependency: If the individual becomes too reliant on prompts, gradually fade the prompts. Use delayed prompting and provide opportunities for independent communication.
• Challenging Behaviors: If the individual exhibits challenging behaviors during PECS training, try to identify the underlying cause. It could be frustration, anxiety, or a lack of understanding. Modify the training approach to address the specific needs of the individual. Make sure the sessions are short, positive, and focused on success.
• Resistance to the Communication Book: Some individuals may resist using the communication book initially. Make it engaging and personalize it with pictures that are meaningful to them. Gradually introduce the book and associate it with positive experiences.
• Lack of Generalization: If the individual is only using PECS in specific settings, actively promote generalization by practicing PECS in various environments and with different communication partners.

Tips for Successful PECS Implementation

Here are some additional tips to help you implement PECS successfully:

• Start Early: The earlier you start PECS training, the better.
• Be Consistent: Consistency is key to success. Ensure that everyone working with the individual follows the same procedures.
• Be Patient: PECS training takes time and patience. Don’t get discouraged if you don’t see results immediately.
• Make it Fun: Make PECS training enjoyable for the individual. Use positive reinforcement and celebrate their successes.
• Track Progress: Keep track of the individual’s progress and adjust the training approach as needed.
• Seek Professional Guidance: Consult with a speech-language pathologist (SLP) or other qualified professional for guidance and support. An SLP can help you develop a personalized PECS training program and address any challenges you may encounter.
• Involve Family and Caregivers: Ensure that family members and caregivers are actively involved in the PECS training process. This will promote consistency and generalization across all environments.
• Celebrate Successes: Acknowledge and celebrate even the smallest successes. This will help to motivate the individual and reinforce their communication efforts.

Beyond the Six Phases

Once the individual has mastered the six phases of PECS, there are many ways to continue expanding their communication skills. You can introduce new vocabulary, teach more complex sentence structures, and encourage them to use PECS in a wider range of situations. You might also explore transitioning to other forms of AAC, such as speech-generating devices, if appropriate.

Resources for Learning More

• Pyramid Educational Consultants: The official website of PECS, offering training, resources, and materials.
• Speech-Language Pathologists: Consult with a qualified SLP for personalized guidance and support.
• Online Forums and Support Groups: Connect with other parents and professionals who are using PECS.

Conclusion

PECS is a powerful tool that can empower individuals with communication challenges to express themselves and connect with the world around them. By following the step-by-step instructions outlined in this guide and seeking professional guidance when needed, you can help individuals unlock their communication potential and achieve greater independence and fulfillment. Remember that patience, consistency, and positive reinforcement are key to successful PECS implementation. The journey may have its challenges, but the rewards of seeing an individual develop effective communication skills are immeasurable.

This comprehensive guide provides a solid foundation for understanding and implementing PECS. Remember to adapt the strategies to the individual’s specific needs and abilities, and to celebrate every step of progress along the way.

Disclaimer: This article is intended for informational purposes only and does not constitute medical advice. Always consult with a qualified professional for personalized guidance and treatment.