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Picture Exchange Communication System (PECS)

PECS is one of my absolute favourite interventions! So what is it and what is it not? And more importantly will it help your child? Stick with me and find out...


(Disclaimer: these are my own personal opinions and experiences as a clinician)


What is PECS?

PECS is an augmentative and alternative communication system - it can help children who are finding it hard to communicate using typical methods such as speech, body language or eye contact. It was developed for children with autism but has been successfully used for other children and adults.


PECS is not just using picture cards! This is my absolute pet peeve when people say they are using PECS with a child when actually they are just using picture cards to support communication. Whilst this is admirable if it is helping the child, it is not PECS and should never be confused with PECS.


How do I use it in my practice?

I use PECS to teach a child to initiate communication and to make requests. This is a skill that does not come naturally to some autistic kiddos. Very often when I meet families for the first time, their little one is not always aware of other people as communication partners. They might not understand that they can communicate with another person to get something that they want.


For example, a child might be frustrated that they cannot reach something they really, really want but not have developed the skills to:


(a) get another person's attention,

(b) direct their attention to the thing they want, and

(c) ask for the thing they want


It's all pretty complicated when you break it down like this. And when the skills are not there and frustration is high this can make everyone feel pretty sad!




The phases of PECS

PECS has 6 phases. Phase 1 is all about learning to exchange a picture card for a highly desirable item. It is always lots of fun trying to find the most motivating toy/item/activity for a particular child. If it is not motivating enough then the child will quite frankly not be bothered to work for it! My most recent PECS session at the weekend involved the child requesting me to tip a bag of coloured, plastic cotton reels from a height onto the wooden floor. Absolute hilarity ensued as the cotton reels made an awesome noise and bounced across the room in all directions - so much fun! This little boy absolutely loves the visual and auditory stimulation of this activity. There was then a quick scramble from me to put all the cotton reels back in the bag so he could request it again. It was a physical workout!



Phase 1 requires two people initially: one to physically prompt the child to pick up the picture and make the exchange; and one to be the communication partner holding the desired item. In my experience some children pick this up super quickly within one session and others can take a few weeks of daily practice. The moment when the child independently picks up the picture and makes the exchange for the first time always, always makes the hairs on my neck stand up - it's just so powerful and emotional for everyone. For parents this is often the very first time their child has made a clear and purposeful request with them!


Sometimes PECS is not right for a child - either it's the wrong time or the wrong approach. For example, if a child dislikes being touched the physical prompting required for phase 1 can be too stressful for them. I will never persevere with PECS when it is clear that it is not right for the child. However, sometimes trying again in a few months or a year can make all the difference.


Phase 2 teaches the child how to seek an adult out to make a request, whilst phase 3 teaches discrimination - how to choose the right picture from a choice of two or more! Once a child reaches this stage it opens up so many possibilities. Sometimes I leave a family's home when we have just introduced this phase and when I come back the following week they tell me how their child has suddenly started bringing them pictures to ask for things all over the house! Of course, this then brings up the subject of how to say 'no' to the twentieth request for a biscuit...


After phase 3 there are options to make sentences to request and introduce all sorts of interesting language such as "I want a big, red sweet" or "I see a fluffy, yellow chick". There is really so much potential.


Does PECS stop speech developing?


One important step in PECS is to always, always say the name of the object/activity that the child is requesting as soon as the picture is exchanged. Often the child quickly learns to associate the word with the object or activity and starts to use the word independently.


Overall PECS can be a real springboard for communication development - which is why I love it so much. There are downsides to all interventions but experienced clinicians will always be able to explain why they are suggesting one particular approach over another.

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