Picture Exchange Communication System (PECS)

July 7th, 2010

Picture Exchange Communication System (PECS) is a great tool in helping all nonverbal children with or without autism communicate without words. PECS is used in a variety of ways–starting with pictures–to allow the child to make choices and communicate his/her needs. When children can communicate and express their needs, behaviors often can be minimalized resulting in a much happier child.

PECS can be used in several ways: to help an ASD child communicate with you, and for you to provide visual schedules and communicate with them in a way that is easy to understand and organized. PECS typically will start with pictures of desired objects (such as food, places, and people) and progress over time to pictures with sentence strips (for example: I want cookies) and then, finally move from pictures to words. PECS can also be used to create schedule boards for providing a visual schedule of the child’s day.

PECS can be created by using a digital camera to take pictures of familiar items or by using cartoons and/or other available pictures from the Internet. Laminating pictures and words can make these useful items more durable. There are also PECS picture websites and software products that have libraries of photos available for use.

For our family, PECS was a lifesaver. By giving my non-verbal son the tools to communicate, he was much more calm and behaviors that had been escalating over time were minimized quickly just a few weeks after the introduction of PECS.

Some Personal Background

My son did not point and was completely NONVERBAL when he was diagnosed with autism at 2.5 years old. The first things we introduced to help him was PECS, speech therapy, ABA (Applied Behavioral Analysis), occupational therapy, a gluten free/casein free diet (yeast free, soy free, corn free) diet, and vitamin supplements. Within a year, he had made TREMENDOUS progress in his goals. It is my belief that PECS played an important part of that success.

Some successes are (at the time – my son was 5 years old):

  • Jeff can say over 1,000 words
  • Jeff spontaneously creates speech, which began 1 year after implementing PECS.
  • Jeff can site read more than 500 words
  • He has been using PECS and a SCHEDULE board for communication when he cannot find the words. (This was critical early on when he had no words.)
  • While implementing PECS he began to points to things he wants (this is incredible to us, he never pointed before.)
  • You can introduce and learn tough concepts using PECS – then the pictures are faded after the concept is learned
  • And many other successes!

Early after my son’s diagnosis, he began to get very frustrated and a little aggressive (no too much, but the starting of this new behavior scared me. I had to do whatever I could to help Jeff communicate needs so he could curb his frustration.) We implemented the above mentioned therapies and PECS and the major behaviors melted away.

Important Notes for PECS Implementation

1. PECS must be done EVERYWHERE – in school, in therapy and at home. Our kids NEED and thrive on consistency and structure. Traveling with a portable PECS book while at the store or on other outings is more than helpful, it should be a requirement.

2. While using PECS, we had PECS schedule boards EVERYWHERE! Early in the program, we had one in the bathroom to remind him the order of going to the potty and washing his hands. We had another in the kitchen for food choices and to present what the day had in store for him (i.e., there was a picture of every therapist and every activity (eating, naps, play time/free time, speech, parks, pools, stores, all activities, etc.) The schedule board was available for him to create whatever he wanted to do on Saturday and Sunday afternoons, which gave him the feeling of control.

3. The PECS board was especially important in his therapy. He could choose between play toys and between tough drills. It is truly important that the child feels they have some control in his/her life.

4. The PECS communication book and schedule boards start with PICTURES and then transition to WORDS over time. Later in the program, children will learn to build 5-8 word sentences using the communication book (see the PECS website for pictures).

5. Communicating out of the home is just as important as it is in the home. Make sure you have a travel PECS book for communicating outside the home. (This is so important that it appears twice!)

6. After using cartoon-based pictures, it is recommended to start using digital photos of real objects. Since technology is always improving in quality and decreasing in price (sometimes!), it is worthwhile to buy an inexpensive digital camera and catalog hundreds of pictures on your computer. Then, you can print them all at home from a $150 color printer. My family also used 8 1/2 X 11” lamination sheets from an office supply store that are easy to use and make picture or PECS card indestructible. Supplies for building our PECS picture library was about $400 and worth every penny.

Notes:

  • You can start cheaper by sharing pictures with other families. It is important to get the pictures personalized over time.
  • Some families I know used packing tape as an inexpensive laminator.

7. If you don’t have a camera to take pictures, your speech therapist and some schools may have a software product called “Board Maker”, which can create cartoon-like pictures that can be used for PECS.

8. Some kids are “visual thinkers” and can easily understand pictures with words vs. voiced commands. This was a key decision point for many parents who then decided to implement PECS for their children.

9. Starting PECS does not mean you are giving up on speech for your child. It means you are looking for alternative ways of communicating with you child until speech is possible. It seems counter intuitive, but giving children another way to communicate using PECS or an alternative communication device can help speech eventually develop someday.

10. Make sure parents and therapists have been properly trained on PECS!  I have seen many families practice too much of a variation from the people working with their child or have an improper interpretation of the PECS material. It is important to give yourself and the child the right tools and information to be successful!

11. In most situations, PECS is not a lifetime form of communication. Typically, PECS is introduced and slowly faded away over time. And of course, how long varies by child.

Augmentative Communication Devices

There are augmentative communication devices available that are “electronic PECS”, which offer many ASD children the next step in communication. There are many augmentative communication devices available. This section outlines experience with one of these devices from DynaVox. The device used was called “Dynamyte”, and was about 5 lbs in size and a very durable electronic device. Read more information on the DynaVox website.

The DynaVox device graduates a child from PECS when the child can build a sentence using pictures and or words, then, plays it back. Playing the sentence back is when the device actually SAYS the sentence in a young male, young female, or adult voice. Everything about this device is customizable.

In addition, using an electronic augmentative communication device is an excellent way to eliminate the need for printing photos and laminating them. These devices are highly customizable with the ability to integrate real photos and customized text.  These devices can also be backed up on a computer for safe-keeping and management.

The Dynamyte device also starts with a simple screen with a field of 4-6 choices and can greatly expand to 12, 24 or more choices.  Menus and sub-headings can be created by managing the many aspects of communication including social skills, requests for food, play, and schedules.

For my son, over time he REPEATED the sentence each time the Dynamyte played it back. It was highly motivating for him and allowed him to practice language with a visual display and a “cause and affect” outcome. He began to talk after being silent for two years! The DynaVox devices are an excellent next step graduation AFTER PECS is mastered in a traditional form!

In Southern California, there is an augmentative communication company, Assistive Technology Exchange Center (ATEC), who is affiliated with Goodwill Industries and offers people with disabilities consultation and assessment services, equipment trial, equipment loan and reuse and support in learning how to use assistive technology equipment.

ATEC allowed my family to preview some of the latest models, have our son try out some of the devices, and even had a 30-day evaluation program. In addition, they offer complete assessments, training and follow-up for obtaining these tools for your child.

Contact information:

ATEC/GIOC
200 North Fairview
Santa Ana, CA  92703
(714) 547-6301 or 6308
Ask for Penne Rieger at ext. 397  or Faride Gonzalez at ext. 390 for service info.

Please note some important follow information for device evaluation

A) The DynaVox is not the only augmentative communication device provider. There are many providers – this is why a complete evaluation is so important.

B) Counter to what many think (myself included) these devices ENABLE speech to happen and ENCOURAGE non verbal kids to speak. An augmentative communication device was truly a wonderful experience for our family and should be considered for a child who lacks verbal communication.

C) School districts, early intervention centers like state agencies, or health insurance providers are all options for evaluating and paying for these devices. If you choose to have your district or state agency pay for an evaluation and possible device, you need to call an IEP/IFSP (Individualized Education Plan/Individualized Family Service Plan) meeting to request the next steps.

Nonverbal Children & Possible Biomedical Issues

Speech, or lack thereof, is a very complex issue for children on the autism spectrum. Lack of speech or loss of speech may be caused by many things such as apraxia, third cranial nerve damage, yeast/parasite/bacterial issues, stool and digestive/gut problems and not just neurological issues. A careful evaluation by a qualified treating physician can look at the possible biomedical issues unique to each child.

For my family, autism and my son’s lack of speech was both an oral/motor planning issue and a complex biomedical issue. His needs had to be addressed biomedically as well as with hundreds of hours of speech therapy, occupational therapy, and behavioral training. Those hours of speech therapy and OT would not have helped WITHOUT biomedical intervention.

Some suggestions for reviewing this complex area for your child include:

a) Find a good DAN! (Defeat Autism NOW!) doctor to start the biomedical journey with your child. Check the Provider Directory or the Autism Research Institute wesite. These resources provide a comprehensive list of many different types of doctors.

b) Read the Art of Managing Professionals. This is important so you can plan next steps, interview questions so you can make the decision

c) Read Medical Testing information

d) Read information from the latest medical conference featuring Dr. Jerry Kartzinel.

Your ASD Child is Still Not Speaking – What To Do?

If you have investigated a variety of biomedical options (such as a GFCF/SF diet and supplements such as TMG, P5P, Omega 3s, and flax), performed a variety of treatments, applied speech and other various therapy services and find that speech is still not developing for your child–please have your speech pathologists evaluate your child for APRAXIA. A good website about apraxia and other helpful ideas is www.apraxia-kids.org.

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