The Picture Exchange Communication System (PECS) PECS Resources for a Child with Autism Phases 1 – 6 1 Contents Pages 3 – Phase One: How to Communicate Page 5 – Phase Two: Distance and Persistence Page 6 – Phase Three: Discrimination Between Symbols Page 8 – Phase Four: Using Phrases Page 9 – Phase Five: Answering a Direct Question Page 10 – Phase Six: Commenting Page 11 – Recommended Reading 2 Using the Picture Exchange Communication System (PECS) for a child with Autism PECS is a visual form of communication that can be employed to help children who have communication difficulties obtain functional communication. Phase One: How to Communicate Two adults are required at this stage, one who acts as a physical prompter and one communicative partner, who provides the prompts (Bondy and Frost, 2001, p.728). Phase one is designed to teach a physical behavior that is considered to be a communicative act. Before starting PECS, you need to know the type of things that motivate the child you are working with, determining which items the child persistently wants. This can be achieved by talking to the child’s parents and observations of the child’s interests; i.e. looking out for specific items the child: reaches towards; looks towards; or takes. When a variety of items the child appears to like have been identified, it is then time to determine the order of preferences. During this phase the child will learn to ‘pick up a picture of a desired item, reach to the communicative partner, and release the picture into the communicative partner’s hand. Resource In the phase one folder, you will see one picture of a snack for break/snack time and one of a toy, to play with. Activity The communicative partner sits opposite the child on the other side of the table, while the physical prompter sits behind the child. The communicative partner shows a picture of a snack that he/she knows is the most desirable snack to the child. Initially the physical prompter may need to guide the child’s hand to the picture, but after this initial task the child should reach for the picture him/herself. When the child reaches for the picture, the adult who is sat directly behind the child (the physical prompter), provides physical assistance to pick up the picture, reach to the communicative partner, and release the picture into the communicative partner’s hand. The communicative partner then immediately hands the item to the child to consume while naming it (i.e. “Raisin”), if it is a snack, or play with for a few seconds if it is a toy. It is recommended that you start these tasks with a snack, as a toy will need to be taken away, and this may be distressing for the child. The physical prompter gradually reduces assistance to encourage the child to exchange the picture for the desired item independently. 3 Once the child consistently picks up the picture and reaches towards the communicative partner’s open hand, the communicative partner deliberately waits increasingly longer before extending her/his hand to receive the picture. This task should be repeated throughout the day with different staff, using different motivators, to avoid the child relating this task to particular members of staff or one particular motivator. A child has achieved phase one when he/she consistently and independently picks up the picture of the desired item, reaches toward the communicative partner, and releases the picture into his/her hand to obtain the desired item. P Level/s – English - Listening/Receptive Communication - P2(i) – Pupils begin to respond consistently to familiar people events and objects. NB: The PECS symbols/pictures I have created were images that were available at www.google.co.uk/images. Your school/child may use slightly different symbols/pictures, and the child may have different preferences (desired items). Therefore you may have to adapt pictures, or use/create different pictures/symbols to suit the child’s needs with whom you are working. 4 Phase Two: Distance and Persistence During phase two, the child is taught to persist and travel increasingly longer distances to the communicative partner. Resource In the phase two folder you will see additional pictures as well as the initial pictures and a PECS binder. Activity In this phase you will need to help the child understand that the activity is not just done on a certain table, and that they can move around. The picture should already be in place stuck to the front of the book with Velcro and the child should be prompted to pull it off. Encourage the child to reach farther, or travel (walking increasingly greater distances), to reach the hand of the communicative partner, and to be consistent at delivering the picture even when the communicative partner has his/her back turned to the child. Encourage the child to go to that person, even if that person is in another room, and encourage the child to approach different staff, requesting a variety of different desired items, across all daily activities, and in a variety of contexts. This will further increase spontaneity. Initially the physical prompter may need to stand the child up, and guide the child to move to the communicative partner with the picture. The child needs to learn that the pictures do not magically appear, therefore in subsequent lessons the child should be encouraged to go and get the picture when they need/want to communicate. (By this time the child’s own PECS binder has been created with the picture that is currently in use placed on the front cover, and additional pictures placed within the binder). It is important at this stage to also use other cues such as, visual, slight gestural and eye gaze cues to direct a pupil to initiate communication. The child has achieved phase two when they independently get up and get the picture, and move around spontaneously with the picture to reach/find the communicative partner. P Level/s – English - Listening/Receptive Communication – P2(ii) – Pupils begin to be proactive in their interactions. They communicate consistent preferences. NB: The PECS symbols/pictures I have created were images that were available at www.google.co.uk/images. Your school/child may use slightly different symbols/pictures, and the child may have different preferences (desired items). Therefore you may have to adapt pictures, or use/create different pictures/symbols to suit the child’s needs with whom you are working. 5 Phase Three: Discrimination Between Symbols During phase three, the child learns to discriminate between two pictures. Resource In the phase three folder you will see I have added more pictures of specific items. These items are non desirable to the child. Activity Place one picture of a highly desired item and one picture of a nondesired item on the front of the PECS binder, if the child hands you the picture of the desired item, give the child that item along with some spirited social praise. However, if the child hands you the picture of the nondesired item, give the child that item. If the child displays a negative reaction then you will need to try again, by using ‘an error correction sequence’; to demonstrate making the correct selection (via tapping or other visual cues), prompting the child to pick the desired item. If the child then chooses the desired item, praise him/her, but do not give the child that item until you repeat the choice to see if the child gives you the desired item again. If the child does, then give the child that item. As soon as the correct picture is touched, show the child that he/she has done well by giving: the thumbs up sign; another reinforcement sign; or by altering your tone of voice. When the child is reliably picking the desired item each time, change the pictures so they are equal in desirability. This makes it more difficult to establish whether the child has picked the item that is wanted as he/she may be quite happy to play with the other item, as this is also desirable. For example there could be a picture of a ball and some toy cars. To see if the child has really chosen the picture of the item they want to play with, show the child both items, one in each hand and say “take it.” This neutral statement, ‘take it’ rather than ‘take the ball’ or ‘take the cars’ ‘helps assure that the child is making a visual discrimination rather than an auditory discrimination’ (Bondy and Frost, 2001, p.733). If the child takes the toy that matches the picture they have chosen they may play with that toy, but if the child chooses the toy that does not match the picture he/she has chosen, then do not let them have the toy and proceed with the error correction sequence, similar to that above. Continue with this training, gradually increasing the number of pictures (to five or six) on the front of the binder, hence increasing the number of items to choose from. Then encourage the child to also look inside the binder for more pictures of desirable items. The child has achieved phase three when he/she knows what the pictures are and can consistently discriminate between the pictures. 6 P Level/s – English - Listening/Receptive Communication – P3(i) – Pupils begin to communicate intentionally; they sustain concentration for short periods; they observe the results of their own actions with interest; they remember learned responses. NB: The PECS symbols/pictures I have created were images that were available at www.google.co.uk/images. Your school/child may use slightly different symbols/pictures, and the child may have different preferences (desired items). Therefore you may have to adapt pictures, or use/create different pictures/symbols to suit the child’s needs with whom you are working. 7 Phase Four: Using Phrases During phase four the child learns to request items by constructing sentences. Resource In the phase four folder you will see a sentence strip, with sentence starters such as, “I want,” and “I see”, and desirable items. Activity Through demonstration and prompting teach the child how to: construct a two-picture sentence; place on a sentence strip; remove the strip from the binder and hand it to a communicative partner in exchange for a desired item. Initially in this phase, start by just using the ‘I want’ sentence starter, as it is a request, thus more motivating to the child than a comment. When the child hands you the constructed sentence, turn the sentence strip back to the child so he/she can see it, direct the child’s finger to the pictures/symbols and read “I want” to the child, pause for a second, move the child’s finger to “raisins”, say the word at the same time, and also deliver the requested item at the same time as saying “raisins”. The child has achieved phase four when he/she can independently construct a sentence of a request, placing the “I want” symbol and a desired item from the binder onto the sentence strip, and hand the sentence strip to the communicative partner. P Level/s – English - Listening/Receptive Communication – P3(ii) – Pupils can remember learned responses over increasing periods of time; they apply potential solutions systematically to problems, for example, constructing the sentence strip and giving it to an adult. NB: The PECS symbols/pictures I have created were images that were available at www.google.co.uk/images. Your school/child may use slightly different symbols/pictures, and the child may have different preferences (desired items). Therefore you may have to adapt pictures, or use/create different pictures/symbols to suit the child’s needs with whom you are working. 8 Phase Five: Answering a Direct Question During phase five continue to build on the child’s current skills, constructing more sentences, and adding adjectives and other words to the child's repertoire to help him/her further refine his/her requests. For example, the child could move on from “I want the ball”, to “I want the red ball”, and even “I want the big, red ball”. Resource In phase five folder you will see more items/activites to make requesting sentences that answer the direct question. Activity At the onset of phase five, start with a requesting sentence, such as, “What do you want?” rather than a commenting sentence, as this still gives the child access to a desired item. Use a delayed prompting procedure for this, for example, present the question and gestural prompt toward the “I want” icon at the same time, then gradually delay the prompt. In time, the child should begin to answer the question before you use the prompt. The child has achieved phase five when he/she is independently answering a direct question. P Level/s – English - Listening/Receptive Communication – P4 – Pupils understand some simple adjectives related to their own experience of the world, for example, hot, cold; they respond appropriately to simple requests which contain one word, sign or symbol in familiar situations; they answer questions; they apply potential solutions systematically to problems. NB: The PECS symbols/pictures I have created were images that were available at www.google.co.uk/images. Your school/child may use slightly different symbols/pictures, and the child may have different preferences (desired items). Therefore you may have to adapt pictures, or use/create different pictures/symbols to suit the child’s needs with whom you are working. 9 Phase Six: Commenting During phase six continue to build on the child’s current skills, constructing more sentences and incorporating commenting sentences. Resource In phase six folder you will see some more sentence starters with a more abstract concept such as, “I see”, “I hear”, “I feel”, etc. This will enable the child to comment on elements of his/her environment. Activity When you feel the child is ready to make a comment try using the sentence strip for him/her to make a comment. You may need to demonstrate this yourself. For example, look at a ball, using the sentence strip, put on the corresponding symbols and say ‘I see a ball’, this could be extended to “I see a green ball”. This may encourage the child to use the sentence strip for different communication purposes other than just requesting. Although, for a child with an autistic spectrum disorder (ASD), teaching spontaneous commenting is often difficult and according to Bondy and Frost (2001), Bondy, Ryan and Hayes found it to be ‘more effective to teach commenting initially in response to a simple question (i.e. “What do you see?”)’ (Bondy and Frost, 2001, p.735). The child has achieved phase six when he/she can respond to a question with a comment, and initiate spontaneous comments. P Level/s – English - Listening/Receptive Communication – P5 – Pupils respond to questions about familiar events or experiences by vocalising, signing or using symbols; they follow requests and instructions containing at least two key words, signs or symbols. NB: The PECS symbols/pictures I have created were images that were available at www.google.co.uk/images. Your school/child may use slightly different symbols/pictures, and the child may have different preferences (desired items). Therefore you may have to adapt pictures, or use/create different pictures/symbols to suit the child’s needs with whom you are working. 10 Recommended Reading – for more information about PECS and its phases. Bondy, A. and Frost, L. (2001) ‘The Picture Exchange Communication System’ in Behavior Modification. Vol 25 (5) pp.725-744. Bondy, A. and Frost, L. (2002) Topics in Autism: A Picture’s Worth: PECS and Other Communication Strategies in Autism. United States of America: Woodbine House Inc. Magiati, I. And Howlin, P. (2003) ‘A Pilot Evaluation of the Picture Exchange Communication System (PECS) for Children with Autistic Spectrum Disorders’ in Autism. Vol 7. (3) pp.297-320. QCA (2007) Performance – P Level-Attainment Targets. QCA. Available at: http://www.qcda.gov.uk/resources/assets/Performance-pscales-attainment_targets.pdf (Accessed 10/07/10). Sulzer-Azaroff, B., Hoffman, A. O., Horton, C. B., Bondy, A., Frost, L. (2009) ‘The Picture Exchange Communication System (PECS): What Do the Data Say?’ in Focus on Autism and Other Developmental Disabilities. Vol 24. (2) pp89-103. Special Communication Needs - available at: http://callcentre.education.ed.ac.uk/SCN/scn.html -The CALL Centre (Communication Aids for Language and Learning) provides specialist expertise in technology for children who have speech, communication and/or writing difficulties, in schools across Scotland. This website provides information, guidance and resources on how Information and Communication Technology (ICT) can make a major impact on the education of children and people with disabilities or special educational and communication needs. Wallin, J. Teaching Children With Autism – This is a resource for parents, professionals, or anyone interested in teaching children with autism or other related developmental disorders. Available at: http://www.polyxo.com/ It was developed by Jason Wallin to encompass a variety of instructional techniques and philosophies. 11