The Picture Exchange Communication System (PECS) was designed by Andrew Bondy and Lori Frost of The Delaware Autistic Program. It was designed for children who are not yet initiating communication to express their needs or interests. Using PECS, a child learns to exchange a picture of a desired object in return for that object. In handing the picture to another person to request the object, the child’s communication becomes more social and intentional.

A speech-language pathologist must always make the decision concerning the use of this approach with a particular child and how to implement it.

PECS has six phases to expand children’s communication skills. The six phases are described below to provide a general understanding of the approach:

Phase One — Requesting an Item or Activity

• Identify food/toy/activity of preference (must be highly motivating and available in small portions throughout the day).
• Make a picture representation of the desired item using a photo, magazine clipping, line drawing, picture symbol, or label from an item’s packaging.

Teaching the Exchange:

• Two adults are usually required during the first teaching session. One sits directly across from the child to receive the picture. The other is behind the child to prompt the exchange.
• Place the desired item (e.g., a cracker) and the picture of it in front of the child.
• Do not ask the child what he wants.
• As the child reaches for the item, the adult behind physically assists the child to pick up the picture and hand it to the other adult’s open hand.
• Provide the child with the desired object immediately and say, “Oh, you want the _____.”
• Gradually provide less physical prompting. For example, hand-over-hand assistance may be required at first and eventually just a touch on the child’s elbow is all that is necessary.

Move to phase two when the child can independently and consistently pick up the picture and hand it to the adult in exchange for the item.

Phase Two — Spontaneously Requesting an Item

• Individually introduce two more pictures of desired items (from different categories such as food, toys, activities) using the same method as in phase one.
• Once the child can successfully request each of the new pictures when presented individually, place one picture at a time on a board with Velcro or tape.
• The child should be encouraged to glance at the adult during this phase before exchanging the picture.
• The adult gradually moves away from the child.
• The child learns to get the picture from the board and initiate communication with an adult.
• More than one adult should use the exchange system at this point.
• The adult should verbally reinforce the child for exchanging the picture by saying, “Oh, you want the ____.”

Move to phase three when the child is able to go to the communication board, pull off the picture, and take it to an adult to request an item.

Phase Three — Discriminating Between Pictures

• Place two pictures on the board that include one picture of a desired item and one picture of an undesired item. Rotate the pictures on the board so that the child is not just reaching for a specific location.
• If the child reaches for the picture of the undesired object, the adult says, “No, we don’t have that”, and gestures toward the picture of the desired item.
• If the child tries to take an item that does not correspond to the picture that was exchanged, the adult says, “You asked for _____”, and points to the item.
• Continue the above steps until the child has between twelve and twenty pictures, organized on a board, or in a book.

Phase Four — Building Sentence Structure

• Arrange the child’s pictures into categories such as food, toys, and activities. If using a binder, place each category on a different page.
• Print the phrase, “I want ____”, and teach the child to request a desired object from the communication board by placing its picture on the “I want ____” strip.
• The child learns to request a variety of items from various people.
• Items being requested should sometimes be out of sight.

Phase Five — Responding to Verbal Questions/Prompts

The child uses the sentence strip “I want ____” in answer to the adult’s verbal question “What do you want?”, even when the item is not present.

Phase Six — Commenting

• Phrases such as “I see ____”, or “I have ____” are used to teach the child to name items.

The Picture Exchange Communication System provides children with direct training in how to initiate communication. This training is important for those children who would prefer to go and get what they need or want instead of requesting it from another person. Without this training, some children learn how to respond to questions but are unable to ask for something. Through structured training, children progress from requesting one item to using a sentence strip to make comments. Some children also begin to use the spoken word to request items through PECS as the spoken word is consistently paired with the picture. For children who are nonverbal, the system allows for progression from using a single word to using a few words to request, respond, or comment.

References:

Based on “An Overview of the Picture Exchange Communication System (PECS)” from Geneva Centre, January 1996.