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General Implementation What do I need to prepare for each person prior to beginning PECS? The most critical element to the success of PECS is identifying a set of potent reinforcers. When potent reinforcers are identified, the first couple of Phases of PECS tend to be very easy to teach and for the person to learn. Once reinforcers have been identified, those items will need to be carefully monitored so the person does not have free access to them. If these items are available at all times, they will not prove to be highly motivating during your initial PECS lessons. Icons will need to be developed prior to your first PECS session. The symbol set does not matter in the early stages of PECS. We recommend you identify a symbol set that is easy for you to reproduce and maintain. If changes in the symbol set are needed, those will be made in Phase III. The person I am thinking about for PECS is not able to match. Should we postpone the introduction of PECS until these skills have been mastered? PECS begins by teaching the important communication skills of “how to communicate” and “how to be persistent with communication.” We begin by using single icons in the first two Phases of PECS. These important skills are taught using one icon at a time to parallel typical language development. Very young children are able to communicate long before they develop their first words. In a similar fashion, we teach the “art of communication” via PECS first and then focus on building a vocabulary in Phase III. Therefore, matching skills are not necessary prior to beginning PECS. Specific teaching strategies are utilized in Phase III to teach discrimination of the icons. These teaching strategies have been effective with children who previously were not able to master a variety of match-to-sample lessons. What about imitation, especially verbal imitation? Imitation is an extremely important skill. Many children with autism and related disabilities demonstrate very poor imitation abilities. Imitation may involve body actions (i.e., clapping hands), manipulating objects (i.e., bouncing a ball), or vocal acts (i.e., sounds, words, or phrases). If a child does not imitate one of these behaviors, it is very important to teach the skill. One of our primary premises is that it is not necessary to be able to imitate a word in order to effectively communicate. Many of the children with whom we have worked have acquired important functional communication skills via PECS while they have improved their imitation skills, including vocal imitation. For many of these children, when their vocal imitation skills significantly improved, they have been able to imitate the words corresponding to the phrases they construct via the sentence strip. However, in our view, during the period of time that these children were acquiring imitation skills they still were not able to communicate in a functional manner via speech. Therefore, we strongly suggest that while children are taught PECS, parents and staff continue to put an emphasis upon teaching imitation skills. However, it is best to teach one skill per lesson. Therefore, PECS and verbal imitation lessons should not be merged. Requests via PECS will be honored as a legitimate form of communication. Opportunities to engage in imitation should be offered at other times throughout the day. Many staff and parents work on vocal imitation within activities during which communication is not necessary (i.e., during free play when the child has unlimited access to toys). Many staff conduct a morning-circle routine to promote imitation of words/sounds, sometimes within a song or other established routines. In short, there is no conflict between PECS and imitation training, nor is it an either/or decision. Should we use individual systems or classroom-based systems? Each student should have his/her own communication system that goes with him/her wherever he/she goes. The system is treated as if it is part of the child (like a wheelchair or orthopedic shoe) and the child must learn to be responsible for it. It should not be up to the teacher or parent to carry the book from setting to setting. Menus or room-based systems are extremely useful, too. These can be boards that contain vocabulary specific to the location. For example, in the bathroom, there might be a board containing pictures of soap, towel and bath toys (as long as these icons represent reinforcers or vocabulary that has been taught within a routine). Additionally, multiple icons should only be presented once a person has mastered Phase III (discrimination). On the refrigerator, you could keep pictures of various food items. At school in the motor area there might be a board containing pictures of the equipment. What is important to remember is that the student needs a system that he can take with him when he leaves the home or classroom where the location –specific boards are located. This typically means that much of the vocabulary on those boards will need to be replicated in the child’s communication book. One strategy we have found helpful in homes is to use pages within the communication binder as the “menu” boards that will be posted around the house. This way, when you leave the house, you merely have to collect the pages and snap them back in the book, and you’re on your way! What types of children and adults are appropriate candidates for PECS? Currently, we do not have a formal evaluation for folks who might be good candidates for PECS. However, a couple of basic questions may help guide your thinking.
If your answer to any of these questions is “NO,” then your student is a likely candidate for PECS, given he or she has the motor skills to exchange a picture. How long should a training session last? Very simply put, as long as you have the student’s interest. You can conduct one trial or you can conduct 20 trials as long as you student continues to initiate. Once your student is no longer interested in what you have to offer (i.e., doesn't reach for the item or begin the exchange), you have two alternatives:
The tricky bit about beginning PECS sessions is to end the session PRIOR to satiation or boredom. The point of the lesson is to learn to communication when motivation is high, not “learn this new skill because I want to teach it.” The second course of action listed above creates a dilemma when one of the trainers is a speech/language pathologist conducting a “traditional” speech/language session. “Traditional” sessions typically last 20-30 minutes and if cut short, the result is that other people have to adjust their schedules. For this, and other reasons, we feel that the best “service delivery” model for speech/language pathologists conducting PECS training is an integrated model where the therapist is available to conduct one trial whenever the opportunity arises and isn’t committed to interacting with the student for any minimum amount of time. In a setting where speech/language services are integrated, the therapist typically is actively involved in the daily classroom schedule and, consequently, is interacting with the students throughout regular classroom activities. Since two trainers are necessary for Phase I sessions/training, another constraint will be the availability of two trainers. Sometimes sessions must be cut short because the second trainer must leave. Once the session has ended, the icons should be put away until another training opportunity can be arranged. How many pictures do you introduce in Phase I? The number of pictures is dependent upon the reinforcer assessment and the number of trials/sessions, etc. needed for the student to master Phase I. We have seen many children and adults learn the first Phase in fewer than 10 trials, so only one picture was introduced. For students who need more time, the number of pictures is determined by the number of strong preferences and how they relate to activities occurring when Phase I training is conducted. If, during your reinforcer assessment, you identified 5 highly preferred items, then these 5 items should all be introduced in Phase I (one-at-a-time, along with the corresponding icon). If, on the other hand, you only identified 2 or 3 items then you would only introduce those corresponding pictures. Should I just use the pictures in one setting such as snack when I first start teaching the program? The very first trials within Phase I training typically take place in a very structured format. The student might be removed from ongoing activities initially to teach Phase I. If Phase I mastery is not reached the first day of training, it is important to conduct training in a variety of settings. REMEMBER: it is very important to have two trainers available to do this training! We have been working on Phase I for quite some time, and the child is not independently exchanging the icon. What could be the problem? The following areas may need to be addressed to help skill acquisition in this Phase.
Identify potential problem areas and adjust your teaching. Note: some children have a very slow learning profile. If the student you are working with typically learns skills at a very slow pace, then PECS may also be learned quite slowly. However, when we get the reinforcers right-the pace or learning will generally pick up! Remember, these MUST be reinforcers from the child’s perspective, not ours. I don’t want my students getting up out of their seats throughout the school day, however I realize that persistence is an important skill to teach. How can I reconcile these issues? Children who use speech as their functional communication system have a variety of ways to get our attention (i.e., raising hands, calling out to us, coming over to us and tapping us on the shoulder). Our children who use PECS should be taught some of the same strategies as a means of gaining our attention when they need us. If we do not teach socially acceptable ways for them to meet these needs, they will certainly find other ways to do so, or they will simply not try to get our attention and become passive about communication. While we recognize that order is an important aspect of all classrooms, we may need to identify times of the day when Phase II can be taught with minimal interruption to the rest of the class (i.e., playground, free play, choice time, etc.). We might also design lessons where getting out of seats in order to communicate is the focus and is an acceptable alternative to other not-so-socially-appropriate behavior. The message is, be flexible and try to identify perhaps more than one way to teach your students to be persistent. Certainly, moving across the room is one way to be persistent with communication, raising a hand and waiting for a communicative partner is another option (keep in mind that raising a hand will only be effective when the communicative partner notices that the hand is raised). Another bit to remember is that the child in this scenario should have his communication book with him at all times. This will decrease the amount of movement necessary across the day. However, we do recommend specific lessons that teach him to locate his communication book when it is not nearby as well. If you are worried about your student “running away,” when he gets out of his seat, and this is a behavior you are targeting, one strategy to try is keeping the student’s book in a location on the opposite side of the classroom from the door or any other area to which he typically runs. This way, if he gets out of his seat, you will be able to assess very quickly whether he is heading in the correct direction (toward his book) or is running away. What about the child with mobility difficulties? How can he be persistent with this communication system? We teach the same skill (persistence with communication) in a slightly different manner to children who are not able to traverse distances to his/her communication book and communicative partner. These children should have access to their communication boards or books at all times. Depending upon their motor planning skills, the communication book may be hung on the back of the wheelchair or to the side. We must insure that the communication book does not further inhibit mobility though. Then, we must adapt the ways in which these students access their communicative partners. We have used a variety of call switches to teach this skill. We must change the teaching protocol a bit and will still rely upon the physical prompter. The child will be taught to first hit the switch (that will call the communicative partner) and then WAIT for the communicative partner before exchanging the icon. Initial wait intervals should be very short and will only be extended once the child is successful with these initial intervals. Some teams have used bells and other signaling devices. When these are used, be certain that you will be able to tolerate them in your classrooms/homes once they have been mastered. How do you determine when to begin the discrimination level (Phase III)? Because Phase II should continue throughout all of PECS training, there obviously will be some overlap between Phase II and Phase III. For example, if a child has learned to go to the communicative partner to give the picture, but is still learning to go get his picture it is okay to begin discrimination training. But remember, only one lesson should be taught at a time. When you are actively working on a new level of discrimination in Phase III, then the student should traverse no distance. Other lessons that focus on Phase II should be scheduled throughout the school day. What is important to remember is that Phase II never ends. The crucial component of PECS is that the student be a persistent communicator-one who nags rather than one who waits to be prompted to communicate. Handing the student his communication book or going to the student to receive a picture are cues on which the student may come to depend. We begin discrimination training once the student has 6-12 pictures in his repertoire during Phase II. Remember, these have ONLY been presented one-at-a-time and have been changed as preferences change across the day. How do you decide when to introduce new vocabulary? New vocabulary is added when the frequently conducted reinforcer assessment shows the need. The number of pictures used in Phase I and II is unlimited as long as only one picture at a time is presented. Again, in Phase III, all of the same pictures are used, but at the discrimination level at which the child is working. We find it helpful to conduct the reinforcer assessment and to use a vocabulary selection worksheet (one can be found in the PECS Training Manual). Once question answering and commenting have been introduced, new vocabulary can be added as quickly as the student can learn it. My student is stuck on Phase III and discrimination seems hopeless. Do I have any alternatives? Before offering alternative strategies, may we suggest that the team assess the training procedures that have been used to teach Phase III.
If Phase IIIa (the first level of Discrimination Training) was implemented properly, and progress has not been documented, then alternative strategies should be explored. Any alternative you use will involve changing some part of the lesson (i.e., how we present the choices). These changes are often in the form of prompts that we put into the lesson to help the student succeed. Once we note success, those prompts should be faded. Refer to your handout packet from the 2-Day Workshop or the PECS Training Manual for a refresher on some Discrimination Training Alternatives. Is it okay if my student puts the reinforcer icon on the sentence strip before he puts the “I want” icon on the strip, but gets them in the correct order? At this stage of training, we accept this response as correct as long as the child continues to “read” or point to the sentence strip in the correct order. Pay careful attention to this behavior later in the training protocol (attributes and beyond) when the child is using more than two icons. It will continue to be important to put the pictures on the strip in the right order. If the child loses sight of this order as he adds more and more pictures to the strip, then he will need to be taught to put the pictures on the strip starting with the sentence starter icon. Remember, this is a sequential error and will require a Backstep Error Correction Procedure. Some children use both hands to create the sentence-they will pull the “I want” icon with one hand and the reinforcer icon with the other hand, but at the same time. They then add them to the sentence strip at the same time. This too, is acceptable. In fact, it saves the child time and helps him to get the sentence strip into his communicative partner’s hand that much more quickly! Who takes the pictures off of the sentence strip and puts them back on/in the book? Initially, the communicative partner should take the pictures off of the sentence strip, and return them and the strip to the communication book so that it is ready for the next use. Requiring the PECS user to do so unnecessarily slows the communicative response for him or her. Some children insist on being the ones to put their pictures back, though! This is fine! Essentially, as students become integrated into community activities, they will need to learn to take the sentence strip back from the “lay communicative partner,” so that pictures and sentence strips don’t get lost. When teaching this skill, we recommend the use of physical prompts or gestures instead of verbal prompts (i.e., “Put your pictures away”). The physical prompts or gestures you insert into this lesson should be much easier to fade than verbal prompts and will promote independence as quickly as possible with this new skill. My student inconsistently vocalizes while constructing the sentence strip or while I am “reading” it to him. I want him to vocalize EVERY time! How can I encourage speech without demanding it? We rely upon differential reinforcement to encourage speech during Phase IV training and beyond. We will sometimes hear vocal approximations or clearly articulated words at this Phase of PECS. The delayed prompting strategy gives students an opportunity to use their developing speech skills. When we do hear those approximations or words, we will provide more of the reinforcer or a longer amount of time with the item. The message to the child is that speech is GREAT, but his or her functional communication system will continue to work even on those days where the words are not as easy for them to produce. When should I introduce attributes? Attributes should be introduced after Phase IV has been mastered (i.e., when the child can independently construct sentences “I want” + _____ and exchange the sentence strip with a communicative partner). At this point the team should start to identify reinforcers that are important from the child’s perspective based upon a particular attribute. Color, size and shape are the areas we typically introduce first. At the same time, lessons related the responding to questions (Phase V) should be arranged. While these lessons will be separate from the attribute lessons you plan, it will be important to continue with the rest of the PECS protocol while attributes are a focus. I have a student who is so adept at spontaneous requests that I am not able to ask the question “What do you want?” quickly enough. How can I teach the skill of responding to this question when this occurs? This is a common occurrence and we will attempt to change the learning environment slightly in order to teach this skill. While we often recommend that the icons related to the lesson be placed on the front of the communication book for initial training sessions in many of the PECS Phases, this may indeed promote the type of behavior you are describing. Try placing all of the child’s icons inside of the communication book, including the “I want” icon. This will create a bit of a delay to the icons and may allow you the opportunity to ask the question and provide the delayed prompting strategy for the child to open the communication book, which is essentially the beginning of constructing the sentence. Be sure to provide opportunities for the student to request spontaneously across the day as well! Will all students make it to Phase VI? When a team assesses that socially based reinforcers are not important for a child, they may decide to postpone Phase VI lessons. For many children and adults, the ability to request their most powerful reinforcers both spontaneously and in response to questions is a tremendous achievement and allows them a calm way to access those things they want most. Moving into commenting allows us many opportunities to teach a variety of new vocabulary words and concepts; however, this may not match a person’s most critical needs at that point in his/her education or life. My student is able to comment under highly structured situations, but no matter how creative my lessons are, he is not commenting spontaneously. Is it okay to end with commenting in response to a variety of commenting questions? This is similar to the question above and we typically find this happening with folks who are not particularly motivated by social reinforcers. The team will have a wealth of opportunities to teach new vocabulary and concepts via commenting under structured situations. And who knows, at some point in the future, those social reinforcers might very well become important and spontaneous commenting may result. Remember, plan for a variety of commenting lessons in a variety of settings to teach the student that commenting is a skill that can be used in many situations, not just highly predictable situations. You’ve heard about PECS, but do you really know what it is? Amanda Reed, Director Over the past ten years or so, PECS has become an acronym that is well recognized in the field of autism intervention. While many people have heard of PECS, though, there are a lot of myths and misconceptions about what the Picture Exchange Communication System (PECS©) really is. Outlined below are some of the most common myths. If we’re using pictures of any kind, we’re using PECS. PECS does use pictures, but it is a specific protocol for teaching expressive use of pictures for an individual to communicate wants and needs, and to comment about the world. The protocol involves 6 distinct phases of teaching, as well as strategies for introducing attributes (e.g. colour and size) into the individual’s language. It combines knowledge from the fields of applied behaviour analysis and speech-language pathology to produce an effective and efficient method for teaching functional communication. The teaching protocol was developed by Andy Bondy, PhD, and Lori Frost, SLP/CCC, in 1985 and is now described, in its most up-to-date version, in the Picture Exchange Communication System Training Manual – 2nd Edition (Bondy & Frost, 2002). This training manual is recognised by professionals in the fields of communication and behaviour analysis as an effective and practical guide to one of the most innovative systems available. We’re using a visual schedule, so we’re using PECS. PECS is an expressive communication system for the individual with severe communication impairment. Visual schedules are about receptive understanding. The Pyramid Approach to Education, of which PECS is a part, will make use of visual schedules, but they are not PECS per se. PECS is only for people who don’t speak at all. PECS can provide a very effective functional communication system to individuals with no verbal communication, but it can also teach important skills to those who talk. The PECS protocol emphasises teaching a person to approach others to initiate a communication interaction. Some people may talk, but don’t understand that need for a social approach – they may talk to an empty room or to the fridge. These individuals may be able to learn about the social approach through PECS. Other people may talk, but will only do so if asked a question or told to use their words. These individuals may be able to learn about spontaneous, self-initiated communication through PECS. PECS can be an alternative communication system for those who don’t speak or an augmentative communication system for those who do. PECS is only for young children. PECS has been used around the world with people aged from 14 months to 85 years. While the learning process may be different for people at different ages or with different types of communication impairment, PECS can be an effective functional communication system right across the age range. PECS just teaches people to request. Requesting is the first skill taught in PECS, but the protocol’s final phase focuses on teaching commenting (e.g. I see, I hear, I smell). PECS is not about a person just getting his/her needs and desires met, but about communicating with other people in his/her world. If we use PECS, the person using the system won’t learn to speak. As with any other alternative communication system, the use of PECS will increase the likelihood that a person will become a verbal communicator. Research has been carried out looking at the emergence of speech in PECS users, and the results indicate that speech may well be an outcome of PECS. What we also know, though, is that even if a person doesn’t start to speak with PECS, that person will have an effective way of communicating with lots of different people in his/her world. PECS is only for people with autism. PECS was developed at the Delaware Autism Program in the United States and did therefore have its origins in the field of autism intervention. What has been discovered over the 20 years since the inception of PECS, though, is that it can serve as an effective communication system for a range of individuals with communication impairment. PECS is being used with individuals with autism, Down syndrome, Cri-du-Chat, Angelman’s syndrome, developmental delay, language disorder, developmental verbal dyspraxia, head injury … and the list goes on. In summary … The Picture Exchange Communication System (PECS©, Bondy & Frost, 2002) is a unique augmentative/alternative communication training protocol that has received worldwide recognition for focusing on the initiation component of communication. PECS does not require complex or expensive materials. It was created with educators, resident care providers and families in mind, and so is readily used in a variety of settings. The system has been successful with individuals who have a wide array of communicative, cognitive and physical difficulties. |
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