My son is almost four years old and I would class him as non-verbal. Unfortunately we have seen a number of regressions in relation to speech, we have periods where he has used a few single words but generally there is no speech. At 2.5 he was diagnosed with autism but it was aged 2 that we started to engage with speech and language as it was clear he was delayed.
Our speech and language therapist was great (we were lucky), she explained that our son needed an alternative method of communication as it may be some time before his speech develops (assuming he will eventually speak). The two most commonly used methods for children with autism are PECs and Makaton:
PECs – Picture Exchange Communication System: A functional communication system based on applied behaviour analysis (ABA) used for people with difficulties relating to speech and language. It uses pictures which are exchanged with ‘communicative partners’ and teaches how to communicate what they need before moving through different phases of functional communication.
Makaton: A system of signs and symbols combined with speech to assist hearing people with communication or learning difficulties. Signs from British Sign Language (BSL) are used, however BSL is different to Makaton as it is a language for the deaf community in the UK and is naturally evolving language with its own grammar and word order. Makaton is what Mr Tumble uses on the Cbeebies show Something Special.
I think Makaton is brilliant and I had already tried lots of baby signing with my son, however he was really struggling with eye contact / looking directly at people, attention and social contact so our speech and language therapist recommended PECs.
PECs has been in our lives now for 15 months, I’m not going to lie it has been really hard at times but it has made so much difference. The fact that my son can tell me what he wants and we have a method of communication that we both understand is invaluable. Throughout this post I will refer to the PECs student as ‘child’ this is simply because my experience has been with my child, many PECs students are adults.
What is PECs / Picture Exchange Communication System
PECs is very simply using the exchange of pictures to communicate, having said that it there is a very specific process to follow in order to teach the method of functional communication. It is very easy to confuse visual aids and PECs but they are two very different things (we can talk about that in a minute).
You can get a lot of information on PECs from their website – Pyramid Education Consultants UK. There are also some great videos on YouTube. Initially PECs can be a bit overwhelming, there is lots of terminology – ‘reinforcers’, ‘communicative partners’, ‘ error correction’ and ‘prompting’ to name a few and if you are like me you may already be overwhelmed with autism terminology to learn along with trying to manage a toddler who is struggling with many things.
PECs is a very well established, evidence based method of teaching communication it includes teaching strategies with error correction, using the specific teaching method ensures you are setting a solid foundation for communication with the student /child. At times I felt like most of the information on PECs was very much geared towards teachers and speech and language therapists, however stick with it and give yourself time, you don’t need to be an expert at the beginning. Hopefully you have a supportive speech and language therapist (that has done proper PECs training), focus on the first step and worry about the next stage when you get there.
Initially PECs begins with learning to exchange a single picture, as you move through the phases you teach new elements of functional communication. I remember being quite sceptical at first, I had never heard of PECs and I assumed that he would start speaking at some point. I am so pleased that I persisted with PECs, his speech has been up and down and as I mentioned currently non-existent, PECs has enabled us to communicate and now we are at a point where he can create three part sentences with PECs e.g. ‘I want orange juice’, ‘I want peppa pig puzzle’, and ‘I see small dog’.
If you have a non-verbal child that has autism (or is going through social communication difficulties) I strongly recommend using PECs and sticking with it, some days it will go well and other days it won’t but finding a communication method that works makes all the difference to you and your child. Don’t wait and see – get started, if you are considering PECs I imagine your child is ready, my son was 2 and a half when we started but I’m sure we could have started much earlier.
What are the six phases of PECs?
PECS Phase 1 Communicate / Exchange
PECS Phase 2 Distance and Persistence
PECS Phase 3 Picture Discrimination
PECS Phase 4 Sentence Structure
PECS Phase 5 Responding to “what do you want”
PECS Phase 6 Commenting
Attributes is not a set phase but once you get to phase 4 you can begin to introduce them.
What do I need to start PECs?
First thing you need is some help – hopefully this is a speech and language therapist or someone that has some PECs experience. You definitely need two people to implement phase one correctly, this was a bit of a sticking point for me as I was home alone with my son (and his younger brother) most of the time and only saw my speech and language therapist once a week (after much complaining to the council to get seen once a week but that’s another story). To ensure the exchange is taught correctly you need two people, having said that the majority of time I did it alone being both the communicator and prompter – it is not ideal but it is better than not doing it at all. However do make sure you have someone with you when you introduce PECs initially, use support as much as possible but the more you do it the more likely your child will get the hang of it so doing it alone means they get more practice but just remember to stick to the correct method as best you can.
You need to know what your reinforcers are, so before you start with PECs you should do a reinforcer assessment – what does this mean I hear you shout! A reinforcer is an item that the child wants such as food or toys but it can be something like music or tickles, it just needs to be something they want and may want to ask for more of. I remember constantly being asked what my son liked and drawing a blank, at the time he was quite content and wasn’t attempting to communicate at all, it was really hard to find motivating items as he just wanted to avoid any communication and would regularly just turn his back on me if I tried to communicate with him.
The point of a reinforcer assessment is to try out different items with the child to see what they go for and what may be highly motivating items, this will be different for every child but the ones that consistently worked at the start for us were chocolate buttons, cookies, bubbles, balloons, stickers and light up / sound toys. Some items may be highly motivating on some days and not others but that is natural for all of us. Food is often a good place to start as most people have particular foods they like, I probably gave my son lots more chocolate and cookies than I would have planned to at 2 and a half years old but it got us started and was worth it in the long run. Don’t be disheartened if you can’t find many reinforcers, just keep trying different things – you will get there. Great reinforcers for PECs are those that the child needs help with, for example bubbles – they need the adult to blow them.
PECs cards – you don’t need many to get started as you are only at phase one. Once you have identified a few reinforces make up some cards. The cards I use are 4cm squared and I use symbols, it is recommended that you use symbols rather than photos as they allow for more generalisation. Having said that we did initially start with photos of the objects and my son was happy when we transitioned from photos to symbols but this can be hard for some children. There are tons of cards on the internet that you can use for phase one, just google ‘PECs cards’ and look at the images that come up. You can worry about what process to use or buying any packages later on, I strongly recommend laminating the cards. Most speech and language therapists will be able to give you some cards or reach out to local children’s centres or autism / special needs charities / support groups hopefully someone will have some they can give / lend you to get started. Don’t worry too much about the cards at first, many children won’t even really look at it or take in the picture at phase one as it is the exchange we are teaching here.
Phase one – how to communicate
The objective for phase one as set out in the PEC’s training manual (2nd edition) is: Upon seeing a ‘highly preferred’ item, the student will pick up a picture of the item, reach toward the communicative partner, and release the picture into the communicative partner’s hand.
PICK UP –REACH – RELEASE
So there should be two of you to get started, one of you will be the ‘communicative partner’ and the other is the ‘physical prompter’. Using the two person prompting means shouldn’t get any errors at this stage.
Select one reinforcer and have that and the PECs card available (which should have be placed in front of the child either on the floor or table), choices will be introduced at a later phase. Have a couple of reinforcers on hand in case they lose interest but only one out / visible.
Make sure you have a clear environment, try to have as much put away and out of reach so the child has few distractions (trust me just a scratch on the floor can be used as a distraction when a child wants to avoid doing something you are trying to teach them). Make sure noise is limited – no TV / radio and avoid having other kids in the room to start with.
You want the child to enjoy communicating, make it as fun as you can. To get the child interested you can let them have a go with the reinforcer first so if you are using cookies (break them into little pieces) let them have the first piece for free – this is to entice them. If they are definitely not interested use a different reinforcer.
Ok so the ‘communicative partner’ is the one who interacts with the child, they have the reinforcer, play with it / show it off – make it enticing for the child. The ‘physical prompter’ should be silent and stand behind the student – they are simply there to physically aid the child to do the exchange and as the child progresses fade this prompt away until they are not needed. All verbal prompting should be avoided from both of you.
You are now waiting for the child to show you they want the reinforcer (if you are anything like me this will be the tough bit – but give them time and lots of it). Any sign that the child wants the reinforcer such as sound or reaching for the item is the cue for the physical prompter. You need to make sure that the child is initiating the exchange – they are indicating they want the item, if this is not happening the reinforcer may be wrong, you may not be giving them enough time or you are not enticing them enough.
As soon as the child has indicated they want the item the physical prompter lays their hand over the child’s hand and guides them to pick up the PECs card for the reinforcer. They guide the child’s hand to the ‘communicative partner’, who will have used the indication that the child wants the item as their cue to show the child their open hand (ready to accept the PECs card), the physical prompter will guide and assist the child to release the PECs card into the ‘communicative partner’s’ hand. As soon as the ‘communicative partner’ has the card they hand over the reinforcer immediately, as you hand over the item label it ‘bubbles’ / ‘chocolate’ and be consistent with the word used on the card.
Remember to praise the child for doing what you want as they do it. It sounds easy and some students will get this straight away. Personally I found this the hardest phase, it was very difficult to entice my son and the physical prompting was the key for him, initially the physical prompter was really doing the whole exchange after my son had indicated he wanted the reinforcer. It took time but we were able to phase out the prompts step by step until he had mastered the exchange of the card for the item. There were times he would start the exchange and then get distracted or drop the card and not complete the exchange, if this happens just put the card back and wait for them to initiate again. There were days my son loved PECs and really enjoyed himself, there were others he really resisted and would be angry, I would push him to continue within reason and I’m glad I did as he needed this persistence from me but every child will be different and see what works for you. Patience, time and persistence were the most important things for us. Once phase one is mastered you are ready to move onto phase two, also try to ensure you are giving your child opportunities for exchanges regularly throughout the day, it is very easy to just do PECs sessions with speech and language or just use it at snack times, whilst it is likely this is how you will start off the more you use it throughout the day, every day the more beneficial it will become.
What is the difference between PECs and visual aids?
Visual aids can be real objects, photos, pictures or written words, they are used to support an individual’s understanding. They can be more reliable than speech and are less open to interpretation. Young children with delays in speech and language can rely on visual clues to grasp what is going on around them, visual aids can make a big difference for them. Visual aids I use include schedules, now and next boards and signing.
So how is this different to using a picture with PECs? It took me a while to get my head around why they are totally different things, it becomes clearer as you move through the phases of PECs (also going on the PECs official training course made a big difference to me). The main thing to remember initially is PECs is for the child / student to communicate with you while the use of a visual aid is you communicating to the child what is happening / going to happen or how to do something.
Good luck if you are starting with PECs, I hope it works for you too.