Picture Exchange Communication System (PECS) is a great tool in helping non verbal children and non verbal children with autism communicate without words. PECS are used in a variety of ways – starting with pictures – to allow the child to make choices and communicate needs. When children can communicate and express their needs often behaviors can be minimal zed and you have a much happier child.
PECS can be used in several ways to have the ASD child communicate to you and for you to provide visual schedules and communicate with them in a way that is easy to understand and organize. PECS typically will start with pictures of desired objects (such as food, places, people) and move over time to pictures with sentence strips (for example; I want cookies) then move from pictures to words. PECS can also be used to create schedule boards for providing a visual schedule of the child’s day. For a more detailed description please see the PECS web site.
PECS can be created using a digital camera taking pictures of familiar items or using cartoon or available pictures where the Internet. Laminating pictures and words can make these useful items for durable. There are also PECS picture web sites and software products that have libraries of photos to work with.
For our family PECS was a life saver. By giving my non-verbal son the tools to communicate he was much more calm and behaviors that were 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 NON VERBAL and diagnosed with autism at 2 ½ years old. The first things we introduced to help him were PECS, speech therapy, ABA (Applied Behavorial Analysis,) Occupational therapy, Gluten free/casein free diet (yeast free, soy free, corn free) diet, vitamin supplements and within a year he had 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 happened 1 year after implementing PECS.
- Site reading over 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 was beginning 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.
Books & Web resources:
Visual Strategies for Improving Communication by Linda A. Hodgdon -
This is an EXCELLENT book for understanding how and why are kids are so visual and how they can learn - This is a must have book
Activity Schedules for Children With Autism : Teaching Independent Behavior
(Topics in Autism) by Lynn E. McClannahan, Patricia J. Krantz (Paperback - March 1999
This is an EXCELLENT book for understanding why schedules are so important. It makes our kids feel more "grounded" and in understanding their day. It helps limit frustration.
The Picture Exchange Communication System (PECS) Training Manual - from www.pyramidproducts.com.
This is another EXCELLENT resource for understanding all the who, what, when where whys AND HOW to do PECS.
Main Web site for info is www.pecs.com
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. 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 has in store for him (i.e. there is a picture of every therapist, activity (eating, naps, play time / free time, speech, parks, pools, stores, all activities, etc.) The schedule board was available for him to create what he wants to do on Saturday and Sunday afternoons which gave him some control.
3) PECS board is especially important in therapy. He can choose between play toys and choose between tough drills. It is truly important that the child feels they have some control in his life.
4) The PECS communication book and schedule boards start with PICTURES and then move to WORDS over time. Later in the program, children will learn to build 5-8 word sentences using his communication book (see the pyramid products web site for pictures.)
5) Communicating out of the home is just as important has in the home. Make sure to have a travel PECS book for communicating outside the home. (This is so important it appears twice!)
6) After using cartoon based pictures, it is recommended to move to digital photos of real objects. Since technology is always getting better in quality and lower in price it is worthwhile to buy an inexpensive digital camera and cataloged hundreds of pictures on our computer. Then you can print them all at home off a $150 color printer. We use 8 1/2 X 11" lamination sheets from an office supply store that are easy to use and make picture or PECS card indestructable. Supplies to start in building your PECS 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 using packing tape as an inexpensive laminator.
7) If you don’t have a camera to take pictures, your speech therapist and some school have a software product called “Board Maker” which can make cartoon like pictures used for PECS.
8) Some of our kids are “visual thinkers” and can easily understand pictures with words vs. voiced commands. This was a key decision point for us to implement PECS for some 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 until speech is possible. It seems counter intuitive but having children have a way to communicate – like using PECS or an alternative communication device can help speech come along.
10) Make sure the parents and therapists have been properly trained on PECS! I have seen many families have too much of a variation on the people working with the child or have an improper interpretation of the PECS material. It is important to give yourself and the child the tools to be successful!
11) In most situations, PECS is not a life time way of communication. Typically PECS is introduced and faded over time. And of course, this varies by child.
Augmentative Communication Devices
There are augmentative communication devices also available that are “electronic PECS” which for many ASD children offer a 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 “Dynamte” which was about 5 lbs in size and a very durable electronic device.
Information on Dynavox systems is available at www.dynavoxsys.com
The Dynavox device graduates PECS where the child could build a sentence using pictures and or words, then play it back. Playing it back is when the device actually SAYS the sentence in a boy, girl or adult voice. Everything about this device is customizable.
In addition using an electronic augmentative communication device is an excellent way to element the need of printing photos and laminating them. These devices are highly customizable with the ability to integrate real photos and customized text. In addition these devices can be backed up to a computer for safe keeping and management.
The Dynamyte device also starts with a simple screen of a field of 4-6 choices and can greatly expand to 12, 24 or more choices. In additional menus and sub headings can be created in managing many aspects of communication including social skills, requests for food, play, and schedules.
For my son, over time he REPEATED the sentence each time it played off the Dynamyte. 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 AFTER PECS is mastered in a traditional form!
In Southern California there is an augmentative communication company affiliated with Goodwill Industries for such devices like the Dynamyte.
ATEC allowed us 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 talk. 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 Regional Center or health insurance are all options for evaluating and paying for these devices. If you choose to have your district or regional center pay for an evaluation and possible device you need to call an IEP/IFSP meeting to request the next steps.
Non Verbal Children & Possible Biomedical Issues
Speech and lack thereof is a very complex issue for children on the autism spectrum. Lack of speech or loss of speech could be many things, apraixa, third cranial nerve damage, yeast/parasite/bacterial issues, stool and digestive/gut problems not just neurological issues. A careful evaluation by a qualified treating physician can look at the possible biomedical issues unique to the 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, occupational therapy, and behavioral training. These hours of speech therapy and OT could not have helped WITHOUT biomedical intervention.
Some suggestions to reviewing this complex area for your child include:
a) Find a good DAN (Defeat Autism NOW) doctor to start the biomedical journey with your son. All resources are on the TACA web site. They would not be on the web site if 2 or more TACA families did not love them. To find a resources click here or for a national list click here. These resources provide a comprehensive list of many different types of doctors.
b) A good article to read about resources - management of professionals - click here
This is important so you can plan next steps, interview questions so you can make the decision
c) Recommended medical testing, please click here
d) Latest medical conference featuring Dr. Jerry Kartzinel, please click here for the notes.
ASD Child is still not speaking – what to do?
If you have investigated a variety biomedical options, performed a variety of treatments, applied speech and therapy services and speech is still not occuring for your child – please sure your speech pathologists evaluates your child for APRAXIA. A good web site on Apraxia and helpful ideas is www.apraxia-kids.org.
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I had Christian when I was 19 years old. For the first year of his life I couldn’t imagine anything being wrong with my baby. He smiled; he laughed; he rolled, crawled and walked on time. At age one he had a massive overload for his little immune system. He had two ear infections, a high fever, back to back treatment of major antibiotics and he was given his MMR, varicella and HIB vaccines while he was still very sick. Christian faded away for the next 6 months.
At age two he was diagnosed with full syndrome Autism. I met an amazing mother who introduced me to the group Talk About Curing Autism. Before I found out about TACA, I had no clue that there was hope for my child. From that day on I knew that it was my job to get my son back and undue what had been done to him.
It has been three years since Christian was diagnosed with Autism. I had taken what I had learned from TACA, found wonderful therapists, began a diet, found a DAN! Doctor, and took control of my child’s health. I heard his first word when he was 38 months old, and let me tell you, it was worth the wait.
Today Christian attends a typical private preschool. He is the only child in the class with a diagnosis…and none of the other parents know that. He speaks clearly, has friends, reads, pretends on the playground and even knows what he wants to be when he grows up (which of course changes weekly).
I can honestly say, if I had not found that mom (you know who you are), and not been introduced to TACA, I don’t know where Christian would be today and I don’t know if I would ever have been able to help other parents starting this journey. Thank you TACA, thank you my hero mom, and thank you Christian for fighting this with me. I love you.
Chelsi, Washington State
