Sometimes parents ask, if he doesn't talk how is speech therapy going to help? Speech pathology is more than just "speech", it's about communication. Communication is tricky for kids with ASD, whether they can speak or not. Let's look at PECS (picture exchange communication system) which is very valuable for kids with limited or no speech and for some that do have some speech as well. So what is PECS and how is it useful for kids?
Picture exchanging helps children to develop communication by giving an immediate reward for an attempt to communicate. Children learn how to communicate an inner desire, helping them to see the value of communication. The success in having their desires met is usually very motivating and results in children wanting to communicate more. Their frustration is also reduced, allowing them to concentrate on the model provided to them by their communication partner.
A picture exchange communication system (PECS) is a form of augmentative and alternative communication (AAC) that uses pictures to support words, to help children communicate.PECS was originally designed especially for children with autism who have delays in speech development, however is used very effectively for children with a range of communication difficulties.
PECS works well with children who don't speak at all or have very limited speech. It reduces frustration and teaches communication. Many children then begin to speak quite quickly, but for those who take longer, or who don't learn to speak, being able to communicate is still very valuable.
PECS also works well for children who "speak" but don't communicate very well. Some children with autism for example may echo what others say, or use randon words out of context, or label things they see but not know how to ask for things they want. PECS helps these children learn the meaning and usefulness of communicating with another person to get their needs met. Because these children can say words they often quickly transfer this ability to communicate with pictures into more meaningful use of spoken words.
When first learning to use PECS, the child is given a set of pictures of favourite foods or toys. When the child wants one of these items, he gives the picture to a communication partner (a parent, therapist, caregiver, or even another child). The communication partner then hands the child the food or toy. This exchange rewards the child’s communication attempt. As the child begins to understand the usefulness of communication, the hope is that he will then begin to use natural speech. It is important the child receives the requested item quickly after making a request, so be careful in the items you select (e.g. you may wish to avoid lollies, chocolate, soft drink etc).
The items used need to be highly motivating for the child because they need to want the item and be prepared to work to get it. For chidlren with autism, toys related to their special interest, or toys related to sensory experinces they enjoy often work well.
PECS may also help improve social interactions in children who experience difficulties in this area. Because the child is in charge of approaching the communication partner, the child learns how to make the first move. For children with communication difficulties, approaching another person socially can be difficult. However, with the support of a PECS system the child has the support of the picture to assist him communicate his needs, so the initial approach may be less intimidating.
There are no known negative effects of PECS. Some parents have been concerned that their child will become dependent on PECS and not move on to develop natural speech. However, this view is not supported by research studies. In fact, there is evidence that children who have learned to use PECS develop speech more quickly than those who have not been trained in PECS.
There are several well-designed research studies showing the usefulness of PECS. In one study of 18 preschool children with language delays, some of whom were diagnosed with autism, PECS generalized across communication partners and environments. Further, almost half of these children stopped using PECS and started using natural speech within a year. One parent commented that "PECS turned on the light for communication" in her child. Similar results were found for two smaller, but still well-designed studies.
Research is fine but what do parents have to say? We asked some Talking Matters families how PECS worked for their child.
Brooke, mother of a three year old with autism said "In the beginning I did have my doubts about the program as I didn't want my child to use cards instead of words. The program has helped my son and he is communicating not just with his PECS cards, he is also verbally saying what he wants. My advice to people who have their doubts is just to try it, a little communication is better than none."
Christine, mother of James aged 4 who also has autism said "With the PECS cards, I was a bit unsure of them, as I wanted my son to talk and not rely on the cards to talk for him. We were so amazed that he picked it up so quickly and it gave him a voice for the very first time, even though he didn't use words. He showed us what he wanted and it took away some of the frustration. Now he is starting to come out with new words".
So how is it done? PECS is usually taught in phases:
Phase One: The adult makes a list of the child's favourite items (often beginning with foods). One of these items is selected for the first training session, and a picture of the item is made. That item can be placed under a clear container, so the child can see it, but not get it. If the child looks interested in the item, one adult gives the child the picture card. Then the child is prompted (usually by holding his/her hand and guiding it) to hand the picture card to the other adult. Once the communication partner receives the card, the request is spoken aloud ("Oh, you want the cookie! You can have it!"). At this point, the requested item is given to the child.
Phase Two: The adult moves slightly away from the child so that the child has to move towards the adult to place the picture card in his/her hand.
Phase Three: The child is given more than one picture card. Now the child must choose which one represents a desired object, and then give this card to the adult. At this point, the child may be using a communication board or a binder in which to hold the cards.
Phase Four: The child is given a card with the phrase "I want ____" on it. This card now must be used with the picture card showing what is desired. The idea is that the child will learn how to communicate using complete sentences. Even children who cannot yet read can learn to recognize the words as symbols on the cards.
Phase Five: Before this point, the child has never been asked directly, "What do you want?" In this phase, the communication partner asks the child this direct question, and waits for the child to hand him/her a picture card. This builds the foundation for future communication when a parent needs to know the desires of his or her child.
Phase Six: Once the child can usePECS with fluency and has generalized the system to more than one communication partner, the child is taught how to comment on something s/he observes. The communication partner holds up an interesting object, asking the child, "What do you see?" at the same time pointing out the "I see ____" card. The child is then prompted to place the picture card representing the object next to the "I see ____" card. The parent then comments on the cards ("Yes! I see the airplane too"). In this way, the child learns how to communicate his or her observations and experiences to others.
Many children who are using PECS to get their communication started will not need to move beyond Phase Three. Some children for whom we use PECS initially will begin to use more words and no longer need the additional support that PECS provides. Some children will however move on through the following phases.
PECS pictures can be made at home or with the help of the speech pathologist. Pictures may include:
Digital photos, particularly of children doing preferred activities
Pictures cut from magazines and glued on to card
Labels from food or items
PICS for PECS or Boardmaker symbols (these are programs some speech pathologists and schools use)
The pictures need to be accessible to the child and families may have different ways of using the cards in their home. Some suggestions include:
Velcro the pictures to the fridge door in easy reach
Keep the pictures in a box, basket or on a shelf that the child can access easily
On a key ring the child can carry with them
In a small notebook or photo folder
To find out more about how PECS can help your child visit the PECS webpage. To find out more about how the
Related Blog Posts
If you liked this post you may also like: