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Pre-Assessment
Pre-Assessment What makes PECS unique from other graphic augmentative alternative communication (AAC) systems of communication? Select an answer for question 204
Before beginning training with PECS, it is important to assess the learner's . . . Select an answer for question 205 Verbal prompts are allowed in any phase of teaching PECS. Select an answer for question 206 During Phase 3 of PECS training, the learner is taught to make a request from more than one picture or symbol. What is this called? Select an answer for question 207 When conducting pre-PECS teaching reinforcement sampling, how are preferred items confirmed? By... Select an answer for question 208
PECS has been shown to increase what abilities in children with whom it has been implemented long-term? Select an answer for question 209
Overview
A key characteristic of autism spectrum disorders (ASD) is that many individuals have difficulty developing and using verbal speech to communicate with others. The Picture Exchange Communication System (PECS) has been used to help children and youth with ASD develop a system for communicating with teachers, parents, and peers. PECS was initially developed at the Delaware Autistic Program (Bondy & Frost, 1994) as an 1
alternative communication system and has since been demonstrated in the research literature to promote speech development and production (Charlop-Christy, Carpenter, Le, LeBlanc, & Kellet, 2002). An updated version of the original procedures is now available (Frost & Bondy, 2002). This module will define PECS, outline the steps to effectively implement it, and provide specific examples for its use across settings and age groups. It is not intended, however, to take the place of training and resources on PECS provided by Pyramid Educational Consultants, Inc., (www.pyramidproducts.com). Further, the strategies described in this resource should be implemented under the supervision of a trained professional. PECS can be used across age ranges, starting in preschool, to help individuals with ASD communicate with others.
What is PECS?
PECS falls into the category of augmentative and alternative communication (AAC) systems and is considered an aided technique (Mirenda, 2003). AAC systems are included in a larger grouping of systems and methods that are used to help individuals who do not have typical verbal skills to communicate with others. Examples of commonly used AAC systems include sign language and picture boards. PECS is another type of AAC system that was designed to teach children with limited functional communication skills to initiate communicative exchanges and interactions within a social context. According to the developers of PECS, it is a behaviorally-based intervention that teaches the learner to use visual-graphic symbols to communicate with others (Bondy & Frost, 1994; Frost & Bondy, 2002). With PECS, learners are taught to give a picture or graphic symbol of a desired item to a communicative partner in exchange for the actual item. PECS is the system of communication, not to be confused with how PECS is taught and used (e.g., behavioral principles). There are six phases of PECS instruction, each building on the last. The phases include the following:
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teaching the physically assisted exchange expanding spontaneity simultaneous discrimination of pictures building sentence structure responding to "What do you want?" 2
Unlike other graphic systems of communication, the individual using PECS hands the symbol depicting a desired item to the communicative partner. After learners understand that PECS can be used to make requests (e.g., demands), it can be extended to other communicative functions (e.g., labeling, questioning) and to other contexts (e.g., home, community). Each of the phases will be explained more in depth throughout the module. It is essential that the phases are taught sequentially.
detailed overview of how PECS may be successfully implemented and to supplement training for parents and paraprofessionals working with a child or youth with ASD in a variety of educational and community-based settings. PECS can be implemented anywhere communication is desired or needed and across a variety of home, school, and community settings (see evidence-base reference list in the Resources section).
reinforcer sampling; however, for children and youth with limited communication skills, the following steps are suggested (Fisher et al., 1992): 1. Gather a selection of items that may be favorable to the individual. These items can be identified by asking caregivers and observing the individual. 2. Present the learner with pairs of choices, being sure to match each item at least once with the other items being sampled (this is to determine relative preference). Also, vary left and right presentation throughout to minimize the effects of a side preference on the part of the learner. 3. Document the items chosen most often, least often, or that produce a notable response (e.g., learner tastes something and spits it out, learner throws item after choosing it). From this informal assessment, a selection of favorite items to be used during PECS training is created. These reinforcing items will help to increase student motivation as well as promote acquisition of effective communication skills.
Implementing PECS
Once an adequate number of desired reinforcers has been identified and gathered, picture/symbol cards are created. The number of reinforcers and picture cards will vary for each individual; however, the goal is to provide enough choices to keep the learner engaged and motivated. Cards can be created by using simple drawings or pictures taken with a digital camera. The decision to use photos versus pictures or line drawings is based on the skills of the individual with whom you are using them. Resources are also available for creating cards at no cost. Please see the Document section of RESOURCES for more information. Other factors to address prior to beginning PECS instruction include the following:
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Training Environment. One important goal of PECS is that it should be used across all natural environments. In the early phases of teaching, the setting for training remains structured and consistent (described in each phase of training). As the student becomes more proficient at using PECS, the learning environment is more relaxed to promote generalization of skills. Teachers/Adults. Initially, two adults are involved in training: one is identified as the "helper" and the other as the "communicative partner." These two adults can 5
trade roles throughout PECS. Finally, PECS should be used across all natural settings to assist in creating a functional communication system that children and youth with ASD can use to communicate with a variety of communication partners including same-age peers.
Communication Pictures/Symbols and Book. In the early phases of instruction, only a few pictures/symbols are used. It is important to have a designated communication book in which commonly used pictures/symbols are stored. Frost and Bondy (2002) recommend using small three-ring binders with Velcro strips placed on the cover and inside the book and attaching pictures organized by theme, making it as functional as possible. Many teachers organize books by vocabulary categories such as food, toys, places, people. Others organize by activities of the day (e.g., snack time, library time, play time). Additional pages can be added as needed. As the learner begins to use PECS across settings and with varying communication partners, a second copy of the book as well as extra pictures/symbols should be created for use in the home setting. One common practice is to create a CD with a PDF file of pictures that can be quickly printed out for replacement pictures. See the Resources section for more detailed information about how to create and set up communication systems for individual children.
Monitoring Individual Student Progress. In each phase of the training process it is essential that individual student progress is monitored so that teachers and other professionals can make informed decisions about when to fade prompts as well as when to move on to the next phase. Frost and Bondy (2002), the developers of PECS, recommend multiple communication training opportunities spread across the day, with training continuing within each phase until the child has reached 80% or greater proficiency for a minimum of three days before moving on to the next 6
phase. Throughout this module, the methods that can be used to monitor student progress in all of the phases will be discussed. To access existing progress monitoring forms and checklists, you will need to purchase the Picture Exchange Communication System Training Manual (Frost & Bondy 2002) at http://www.pyramidproducts.com. Once the key players (e.g., learner, helper, partner), reinforcers, and initial materials have been identified and developed, PECS training can begin. The six phases of instruction are outlined below.
Training Environment
The training environment includes opportunities for both structured and unstructured learning (Frost & Bondy, 2002). In the structured training environment, the student with ASD may be seated across from the communication partner, with a helper seated behind or beside him or her to assist in developing the desired actions (e.g., reaching, picking up). It is not necessary for the learner to be seated. Some learners with ASD may find learning PECS easier if they are allowed to move about the room. At the beginning of the training session, one of the highly preferred items identified through the reinforcer sampling is on the table and out of reach of the learner. The picture or symbol of that item is on the table between the learner and the item.
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PECS training also can occur during more unstructured learning activities such as during free play or on the playground. Teachers and other classroom staff must be vigilant to ensure that PECS training takes place across daily routines and activities. For example, if a student on the playground seems interested in swinging with peers, the teacher and helper should stop what they are doing, grab the communication book with a picture of a swing, and help the child request a turn from a peer. This learning opportunity will help the child generalize the use of newly acquired skills across settings, activities, and people (Frost & Bondy, 2002).
Communicative Exchange
The physically assisted communicative exchange is prompted by physically interrupting the learner's reach toward the actual, desired item, and redirecting the learner to pick up the picture/symbol instead. It is important at this stage to use NO VERBAL PROMPTS, as this helps the student become more independent and less reliant upon others during communicative exchanges. Once the learner grasps the picture/symbol, the assistant helps him to place it in the open hand of the communication partner. Once the picture/symbol is in the hand of the communication partner, s/he responds by saying the name of the item/activity.
Reinforcers
If the learner does not indicate an interest in the available reinforcer (e.g., does not reach for the item), the communication partner presents the reinforcing item again while maintaining silence (i.e., NO VERBAL PROMPTS). To gain the attention/interest of the learner, the communication partner may use other cues such as showing the object or playing with the object in front of the child. It is imperative that neither the helper nor the 8
communication partner says anything until the picture has been received from the learner and is in the communication partner's hand.
Teaching Strategies
Two teaching strategies are used during Phase 1 and are critical in helping students with ASD acquire the basic communicative exchange skills. They include (a) fading physical assistance and (b) fading open-hand prompt. Fading Physical Assistance Initially, total physical assistance (i.e., hand-over-hand) is used to help the learner navigate and practice successful exchanges; however, this must be gradually reduced so that the child can initiate and complete an exchange with few or no prompts. Backward chaining is a common strategy that can be used to fade and eliminate the physical prompts used by the helper. With backward chaining, the helper assists through to the final step of the exchange and then gradually fades assistance as the student becomes more independent. Sometimes it is helpful to move from the full physical assist (i.e., hand-over-hand) to a touch or gesture prompt as fading begins. It is important to note, however, that the communication partner continues to show an open hand whenever the child reaches for the picture while the helper's prompts are faded. While the goal of PECS is independent communication, some learners may not reach complete independence. The level of independence may vary according to student needs and abilities. This should not discourage you from using PECS with learners having physical or other limitations (Frost & Bondy, 2002). Fading Open-Hand Prompt As physical assistance is decreased and as students become more independent during communicative exchanges, the communication partner can begin to fade the open-hand prompt. Some learners may continue to need some physical guidance (e.g., mild touch, gesture prompts) while others may need no prompt assistance to participate in exchanges. The goal is for the learner to initiate the handing of the picture/symbol before the communication partner opens his/her hand to receive the item.
In Phase 1, progress monitoring focuses on student participation in the training process. Specifically, teachers and other professionals collect data on the skills used during the communicative exchange (i.e., picking up, reaching, releasing). Teachers also record what types of prompts were needed to complete the communicative exchange (e.g., full physical, partial physical). This information will help teachers and other professionals make decisions about when to move on to Phase 2 (Frost & Bondy, 2002). Phase 1 data collection forms may be found on pages 370-371 of the PECS Manual (Frost & Bondy, 2002). Phase 2 can begin as soon as students have acquired the basic skills outlined in Phase 1 (e.g., reaching for the high-interest item, picking up the picture/symbol of the item, handing the picture/symbol to the communication partner, acquiring the high interest item). There will continue to be many opportunities for the learner to practice these skills in a variety of settings with highly desirable reinforcers.
The outcome of Phase 1 is for the learner to look at, reach for, pick up, and hand the picture/symbol to the communication partner as independently as possible. During Phase 1, two individuals (i.e., helper, communication partner) are required to assist the learner. Verbal prompts (e.g., "What do you want?") should not be used. The goal is for the desired item to serve as a visual cue by being placed slightly out of reach. 10
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At the beginning of Phase 1, the helper fully assists (i.e., hand-over-hand) the physical exchanges (e.g., pick up, reach, release). Physical assistance is faded by moving to touch and gesture prompts, before fading out physical prompts completely. Immediate access to the requested item is provided with each successful exchange. "Open-hand" cues are faded only after the helper's assistance has been faded. Each successful exchange is reinforced by using items known to be highly motivating to the student. Many opportunities are provided for practice and exchanges should be fun for the student. The communication partner and helper include a variety of individuals to prevent the learner from becoming "stimulus dependent" on any one person. For learners who are echolalic (e.g., repeat what is said to them), the phrase, "I want ______," may be used instead of "You want _______" when acknowledging and reinforcing the exchange. However, it may be simpler to just say the name of the requested object.
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Communicative Partners
During Phase 2, the learner must have many opportunities to engage in picture exchanges with a variety of communication partners. Partners are chosen from individuals with whom the child interacts on a regular basis, including parents, siblings, family members, classroom or building staff, peers, and therapists. While verbal prompts should be avoided, it is sometimes helpful for the communication partner to interact with the preferred item in front of the learner, which will encourage him or her to request the item. For example, the partner may be eating a preferred food item or interacting with a favorite toy or object as the learner enters the teaching setting. The purpose of this activity is to motivate the student to engage in a communicative exchange.
Environments
In order to promote generalization of the learned communicative exchange using the PECS system, instruction should take place in a variety of natural environments (e.g., home, school, community) and should occur during natural events and activities that take place throughout the course of a typical day (e.g., meals, snacks, play time, teaching time, playground opportunities). By mixing it up, the learner begins to experience the immediacy of the reward for communicating and learns that the same exchange system is effective across people, places, and activities.
Traveling
Traveling is an important component of Phase 2 because it requires the student to seek out the communication book in order to request items or activities from a partner. Two types of traveling activities are used to expand the spontaneity of communicative 12
exchanges (a) increasing the distance to the communication partner and (b) increasing the distance from the communication book. Increase Distance to the Communication Partner In Phase 1 the partner was readily available (e.g., within arm's reach, across the table) to the learner and waited expectantly for the exchange to occur. In Phase 2, the partner gradually increases distance and positioning from the learner so that the student learns to access the picture/symbol, move within proximity of the desired communication partner, and gain the partner's attention before making the request. When transitioning from Phase 1 to Phase 2, the helper is available to provide nonverbal prompts or assistance when students begin to navigate the steps and the distance. The "expectant look" often is used to facilitate student initiations. For example, the communication partner raises his/her eyebrows while also hunching shoulders and raising arms to convey the message, "What do you want?" This often is enough to elicit a communicative exchange between student and partner. As before, prompting, including the expectant look, is faded as quickly as possible (Frost & Bondy, 2002). Increase Distance From the Communication Book As the learner accomplishes the steps required in traveling from a point of origin to make a request of a communication partner, the distance is increased between the learner and the pictures/symbols on the communication book. This increase in distance is gradual and encourages the learner to actively seek the specific picture/symbol needed for the communicative exchange (Frost & Bondy, 2002).
Phase 2 progress monitoring focuses on the traveling process. For example, teachers record whether the student traveled to the communication partner and/or
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communication book as well as the distance traveled. It is also noted whether prompting was necessary during the communicative exchange. Phase 2 data collection forms may be found on pages 372-374 in the PECS Manual (Frost & Bondy, 2002). Phase 3 training can begin once students are independently traveling to and from the book to a communication partner to initiate an exchange on a consistent basis and requesting at least four different items (Frost & Bondy, 2002).
The outcome of Phase 2 is for the learner to engage in communicative exchanges that involve increasing distances between the learner and the communication book, as well as between the learner and the communication partner to promote generalization and persistence. Both the communication partner and the helper still are necessary to provide assistance if needed. The learner travels to and from the communication book during communicative exchanges. The learner travels to gain the attention of communication partners. Physical prompts and subtle visual cues are faded. No verbal prompts are provided throughout Phase 2. Highly preferred items are used to encourage communicative exchanges. The pool of reinforcers is increased and varied to increase communicative competence. Many opportunities per day (20-30) are provided across a variety of settings, partners, and activities.
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procedure, (c) increasing pictures in the display, (d) conducting a correspondence check, and (e) monitoring student progress.
In early discrimination training, the communication book includes only two pictures/symbols. One picture is a known, highly reinforcing item or an item appropriate to the situation, and the other is a non-preferred or unrelated item. For example, if the learner is being read to and the communication partner stops reading, the learner would reach for and give the picture for a book to the partner. If the learner gives the picture of an unrelated item (e.g., shirt), the communication partner gives the learner the shirt without any social reaction (Frost & Bondy, 2002). If the learner persists, note his or her reaction to receiving the unrelated item. Then continue teaching with an alternate scenario using other preferred items and pictures/symbols. A critical feature of discrimination training is to reinforce the selection of the correct picture as soon as it happens (i.e., as soon as the learner's hand touches the picture). This may be done with verbal praise such as "Yes," "That's right," "Uh-huh," or "Good choice."
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Some individuals easily learn to discriminate between pictures and make the connection between the items pictured and the actual items/activities. Others do not learn this skill as readily and will need specific instruction. Steps for implementing this procedure are included below (reprinted from The PECS Training Manual, 2nd edition, 2002, pp.127128 with the authors' permission). Alternative strategies that increase the contrast between the picture/symbol being taught and other pictures include the following:
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Make the picture of the relevant object larger than the picture of the non-preferred object Use color pictures of relevant/desired objects to contrast with black-and-white pictures of non-preferred/irrelevant objects Highlight the desired picture by outlining it with a magic marker Use a blank card as the other picture in the display Make the desired picture 3-dimensional by attaching it to a poker chip or block Place the desired picture closer to where you are holding the desired object
Successful use of these or any strategies for discrimination training depends upon correct use of error-correction procedures. Furthermore, once the learner is able to discriminate among pictures, enhanced features (e.g., using large pictures or highlighting certain aspects) should be gradually eliminated. Note that the official PECS distributors and trainers have developed several DVDs on discrimination training: PECS Discrimination Training Alternatives DVD, Modules 1, 2, and 3; they are available at www.pyramidproducts.com. 16
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As the learner reliably demonstrates the ability to discriminate between a picture of a highly preferred item and the picture of a contextually inappropriate or undesired item, the next step is to teach discrimination between two items that are both appropriate and desirable to the learner. This is done with correspondence checks to ensure that the learner is requesting and taking the item for which he or she is asking. A simple way to do this is to present two preferred items and have pictures of both available on the communication book. When the learner presents the communication partner with one picture, do not give the item and do not name the item. Offer both items and say, "Go ahead," "Show me," "Here," or something similar. If the learner takes the item that corresponds with the picture presented, allow access, provide praise, and name the item. If the learner reaches for the other item, block access and begin an errorcorrection sequence for the picture that corresponds to the item reached for by the learner.
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The goal of progress monitoring in Phase 3 is to determine whether the learner can accurately discriminate between three or more pictures. Data are collected throughout the discrimination process. Once a learner is discriminating between 12 to 20 pictures independently and can travel to and from the communication book to initiate an exchange, Phase 4 instruction can begin.
Once a learner is discriminating between 12 to 20 pictures independently and can travel to and from the communication book to initiate an exchange, Phase 4 instruction can begin.
The outcome of Phase 3 is for the learner to (a) select the picture associated with the object s/he wants from a display of pictures, (b) approach a communication partner, and (c) give the communication partner the picture to access the object desired. During discrimination training, the placement of pictures in the communication book/board should be varied. Please see photo in PECS Manual (Frost & Bondy, 2002) on page 131. No verbal prompts are used during this phase. 19
Ample exchange opportunities are offered throughout the day and across settings/people/activities. Helpers and communication partners avoid saying "No" when the child makes a mistake during discrimination training. Instead, respond by giving the child what he has requested even if you know it is not the desired item (i.e., natural consequences). Ongoing documentation of items used as reinforcers as well as those that have lost reinforcing value is an important part of the PECS training.
The next step is to have the learner place the "I want" symbol before placing the picture/symbol of the desired item. In doing so, the "I want" symbol is placed in the upper left-hand corner of the cover of the communication book. When the learner puts the picture of the desired item on the sentence strip, the helper physically prompts him or her to put the "I want" symbol in front of it on the strip. As in previous phases, these physical prompts are quickly faded as the learner independently places all symbols on the sentence strip. At this point, the helper begins to prompt the learner to point to the symbols on the strip as the communication partner reads it. Although eye contact is not directly taught in PECS, it is often a positive outcome of many successful communicative exchanges using the system. It is helpful for the adult partner to hold the sentence strip near his or her face while reading the sentence. If the learner is not directing his gaze to or making eye contact with the communication partner, a return to the two-person training system may help the child become more persistent in getting his partner's attention (i.e., face-gazing/eye contact). The communication partner should not automatically look at the child when he approaches with his sentence strip, but rather put his head down. The prompter can help the child tap the partner's shoulder to get his attention. The communication partner should then look up and respond ("Oh, it's learner's name") and respond to the request. After repeated trials, physical assistance is faded.
Promoting Verbalization
Once the learner is able to point to the symbols as the communication partner reads the words "I want _____," it is appropriate to promote vocalization of the word for the desired object. To do this, the communication partner adds a pause after reading "I want" and before naming the requested item. Individuals who are able to vocalize may begin to complete the sentence with a vocalization, a word, or a word, approximation. Any attempt to vocalize during this pause should be immediately reinforced with the learner obtaining the requested item, even if he is unable to properly say the word. Even if the learner cannot vocalize, it is important to honor the request.
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In Phase 4, progress monitoring focuses on the use of the "I want" symbol as well as the prompting that is needed to complete the communicative exchange. Teachers also should conduct correspondence checks once the student is able to point to the pictures on the sentence strip independently (Frost & Bondy, 2002). Phase 4 progress monitoring forms may be found on pages 377-378 of the PECS Manual (Frost & Bondy, 2002).
Physical prompts are used initially and quickly faded. Verbal prompts are not used at any time during Phase 4. Frequent requesting is maintained in a variety of environments. It is easiest to begin sentence structure training in a one-to-one session with the communication book and a communication partner in close proximity. Once the sentence strip is introduced, it is used for all requests. Requesting vocabulary continues to be expanded. Correspondence checks are continued. 22
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When reading the sentence strip, continue to provide opportunities for vocal/verbal requesting by pausing. During initial training, pictures of items are placed on the front cover of the book. As the learner becomes accustomed to using the sentence strip, the pictures are kept on the inside pages according to the category to which they belong. Both at home and at school, the communication book is kept in a designated place that is accessible to the learner.
Zero-Second Delay
The communication partner begins by simultaneously pointing to the "I want" card and asking "What do you want?" (i.e., zero-second delay). The goal is for the learner to complete the sentence strip with the "I want" picture and follow through with the exchange (Frost & Bondy, 2002).
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In Phase 5, teachers and other staff collect progress monitoring data that focus on the delay interval used and whether or not the student "beat" the prompt. Correspondence checks also are conducted as students progress to determine students' understanding of the phrase "I want" (Frost & Bondy, 2002). Phase 5 progress monitoring forms may be found starting on page 379 in the PECS Manual (Frost & Bondy, 2002). As the learner demonstrates the ability to complete the sentence strip and the exchange, the communication partner increases the time interval, encouraging the learner to complete the exchange prior to the point prompt (Frost & Bondy, 2002).
This is one of the easiest steps of PECS! The outcome of Phase 5 is for the child to answer the question, "What do you want?" and spontaneously request a variety of items. Spontaneous requesting should be alternated with responding to the verbal request "What do you want?" Numerous opportunities continue to be provided each day for the learner to request during functional, meaningful activities across settings and with a variety of communication partners.
Phase 6: Commenting
PECS training to this point has focused on the communicative function of requesting, i.e., asking for and getting what you want. The purpose of Phase 6 is to teach a new communicative function: labeling or naming things. This initially involves listening and responding to another person's request for information (Frost & Bondy, 2002). This is an important step in the development of communication skills and is often difficult for children and youth with ASD. The later part of this phase aims to eliminate the question so that the learner can begin to use spontaneous comments. Important components of Phase 6 include (a) preparation, (b) introducing commenting in response to a question, 24
(c) teaching differentiated responses to questions, (d) teaching spontaneous commenting, and (e) monitoring student progress.
Preparation
A number of items the learner already has in his or her requesting vocabulary are gathered along with the pictures associated with the items and a new symbol to represent the concept "I see." These items should be familiar to the learner but should not be the most highly desired objects. The "I see" symbol is placed on the cover of the learner's communication book.
"What do you see?" should take place during defined training sessions until the learner is able to respond reliably with a variety of symbols. After that, the process may be used across settings, activities, and communication partners (Frost & Bondy, 2002).
Once the learner is able to respond reliably to "What do you see?," the adult begins to intermix the question "What do you see?" with "What do you want?" in order to teach differentiated responses. At this point the "I see" symbol is placed below the "I want" symbol in the upper left-hand corner of the communication book. The adult gives the learner the requested item when s/he uses "I want ___," and verbally acknowledges this while providing alternative reinforcement when s/he uses "I see ___." If possible, progress from tangible to social reinforcement for the learner's correct responses to "What do you see?" That is, verbal reinforcement for identifying the correct item is gradually provided without offering another tangible or edible reinforcer. Responses to these questions should be generalized to a variety of communication partners and environments (Frost & Bondy, 2002). The outcome of Phase 6 is for the learner to appropriately answer randomly asked questions, including "What do you want?" "What do you see?" "What do you hear?" "What do you have?" and even spontaneously comment without being asked a question.
chart on page 230 of the PECS Training Manual (Frost & Bondy, 2002) illustrates how to remove the question.
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Teaching responses to a question begins with familiar, but not highly desired items. The item you are asking the learner to label should not be used as the reinforcer for a correct response. This may confuse the learner in terms of the function of what he is learning to do. Responses to a question are taught and practiced during a training session, then generalized to other environments. Materials that are interesting to learners should be used when teaching them to comment on what they see. Examples include: o making different stuffed animals appear from behind a screen o using lift-the-flap books (e.g., the Spot series) where the pictures are hidden under flaps in the book o putting familiar objects in sealed, clear containers and then putting them inside a cloth bag o pulling a container out of the bag, showing it to the learners, and asking, "What
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do you see?" hanging objects of interest from the ceiling going on a walk and asking learners what they see in the school hallway or outdoors
Next Steps
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Once learners have progressed through all six phases of PECS training, they are fairly proficient in seeking their communication book, discriminating among pictures, constructing sentence strips, finding a communication partner, and completing the exchange. Logical next steps for post-PECS instruction include:
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continuing to add new pictures to the learner's communication book. developing multiple copies of the learner's communication book for use across settings (e.g., home, community). continuing to provide multiple and varied opportunities for communicative exchanges across settings, people, times, and items. introducing others with whom the learner may interact to PECS (e.g., store and community workers, extended family, peers). providing opportunities without questions to promote spontaneous commenting. introducing attributes and modifiers to provide the learner with specificity in requests (e.g., "I want the blue blocks," "I'd like a large piece of cake"). This is an important aspect of language development and should not be overlooked, particularly with learners who respond to and learn PECS quickly. The full PECS training includes details on how to fully incorporate this into regular PECS use. applying the picture symbol system to a voice output device if the learner is not showing progress in vocalizations.
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accessing the things she wants or needs in their home. Alex's parents agree to keep trying to implement PECS and Ms. M assures that Alex is making excellent progress on the system at school. From Phase 1, Alex transitioned smoothly to picking up the pictures herself. During Phase 2, Ms. M and the educational assistant move the communication book with pictures to a bookshelf near the table where they have been teaching Alex. During the training trials, Ms. M will now move from the table to her desk or to another area of the room so that Alex will have to walk over to her to give her the picture. Everyone is delighted when Alex begins to go through the communication book to find pictures of items she wants. This means that Ms. M does not have to teach her to discriminate from a variety of pictures. Occasionally, Alex will be in a hurry to get an item and will not look carefully at the pictures. This is sometimes the case with pictures of favorite story books. However, when Ms. M takes the picture and verbally confirms, "You want name of book," Alex will make the correction if it is the wrong book by pointing to the correct book or going to get the correct picture of the book and switching it for the wrong picture.
has repeated practice and learns to place the "I want" symbol without help, other helpers are added. This is also an excellent opportunity for other students in the classroom to practice their reading skills. While Alex progresses rapidly in this phase, her parents are disappointed to learn that she is not initiating verbalizations during Step 9 of Phase 4. (i.e., Communicative partner pauses after reading, "I want" from the sentence strip, before saying the name of the pictured item). Ms. M tries to encourage Alex's parents by telling them that Alex may pick up the verbalizations in time. She also comments on how anxious, and sometimes impatient, Alex is to complete the exchange. In time, perhaps she will learn that if she says the word she will get the item faster.
questions, and to everyone's delight, in general. She clearly understands the difference between labeling and requesting.
Next Steps
For Alex, PECS training has been a huge success. In just a little over a month, she has learned to answer labeling questions and to initiate when she wants something. She is ready for first grade with a solid start on a systematic means of communicating with adults and peers. While Alex still needs a significant amount of one-on-one educational support, she will be able to work independently for short periods of time and to interact with peers without much assistance. An important next step for Alex is to continue to build her vocabulary with pictures in her book. Another next step might be to begin to incorporate some symbol pictures (e.g., simple line drawings) into the collection of photographs. Being able to use symbols, rather than photos, might broaden Alex's vocabulary and help her generalize newly acquired skills to other objects, people, and settings. Finally, teachers should continue to build the expectant pause into reading sentence strips, "You want [pause] __________" because Alex's parents still would like her to develop verbal skills. As Alex continues to use PECS to communicate with sameage, nondisabled peers, she may learn to verbalize her wants and needs.
Joe is readily exchanging symbol cards for desired items. The challenge with Joe is that the teacher and educational assistants have to refresh the reinforcer pool on a regular basis because Joe is easily bored with his choices. They suspect this is because his grandparents spoil him on the afternoons he stays with them.
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Next Steps
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The biggest accomplishment for Joe during the PECS training is that he is much more likely to initiate interactions with others. This is important because he soon will transition to high school and adult life. Also, as he moves from class to class in a larger school setting, he will need to communicate with others independently. A valuable next step is to arrange for an assessment to determine the need for an electronic communication device such as a "TuffTalker Plus," "Hand Held Voice," or a "Say It Sam." With an AAC device such as these, Joe will be able to use the skills learned through PECS to both initiate and respond to others. The sky will be the limit with his ability to quickly learn new symbols!
Summary
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Deficits in communicative ability are a defining feature of ASD. Deficits in communication can sometimes lead to or contribute to behavioral difficulties. PECS can be effectively used to increase communicative initiations of individuals with ASD. PECS has the potential to increase vocalizations of individuals with ASD. PECS can be used across settings and with a variety of communication partners. Effective implementation of PECS involves careful preparation of training materials, identification of multiple reinforcers, involvement of others to act as helpers and communication partners, many opportunities for communication exchanges, and monitoring of learner progress across the six phases.
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NOTE: First five questions from the Interactive Collaborative Autism Network website (ICAN, retrieved Jan. 24, 2008, from Picture Exchange Communication System: FAQs)
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Question. Why can't I ask, "What do you want?" when teaching a child to use PECS? Answer. One of the unique aspects of PECS is that from the very beginning the child is taught to initiate communication. If the child were to give the picture to his partner after the partner said "What do you want?," he would be responding to the question. When the child puts the picture in his partner's hand, he is, in a 37
sense, the first one to "talk." This is called initiating a request and is very different from responding to a question. Another reason for not asking the child what he wants is that the question often becomes a verbal cue. It is common for children and youth with ASD to become dependent on cues used by teachers and parents to teach them things. Prompts are a very useful teaching strategy and, when used effectively, often speed up the learning process significantly. It is important when using prompts to fade them as quickly as possible so the learner does not develop dependence. You will know a learner has developed a prompt dependency if he tends to sit and wait until either told or given some other cue before doing something. In PECS, physical prompts (guiding the child's hand to pick up a picture) or visual prompts (pointing to a picture in the child's communication book) are used rather than verbal prompts (verbally telling the child what to do) because verbal prompts are much more difficult to fade. It is much easier to go from totally guiding the child's hand, to giving the arm an initiating nudge to no physical contact than it is to go from telling the child "What do you want, pick up the picture, give it to me" to silence. Question. What is the difference between pictures and symbols? Can you use both? Answer. Pictures are just what you would expect--they may be photographs or drawings of objects. They leave no question as to what is being requested. Symbols are more representational; individuals must be able to look at a symbol, interpret what it means, and then generalize and apply it to an actual situation. It is important to individualize according to the child's learning style. Some begin training with photos because they are so specific, then move on to more general symbols when they learn how to use descriptors. Also, some individuals respond better to color pictures while others respond more readily to black-and-white line drawing symbols. Computer programs are available that provide photos and symbols to print out for use with PECS books. Pictures and symbols can be used together. Professionals who are trained in the system regularly evaluate and make changes to promote success. Question. What size pictures or symbols should I use for the learner I am working with? Answer. It depends on the child. During the initial stages of PECS it is very important that the child is able to pick up the picture or symbol as easily as possible so you may want to begin with pictures that are 2-3 inches square. The child's fine-motor abilities are a factor as are visual discrimination skills. As the 38
learner develops a vocabulary of 25-30 symbols and becomes proficient in manipulating the symbols, it may be a good idea to reduce the size of the symbols to 1-inch square. Reducing the size of the symbols makes it easier for the learner to find the symbol she is looking for, as the small size allows for fewer pages in the book and/or more space between the symbols on a page. Question. My child doesn't want to use PECS. He just goes and gets what he wants. What do I do? Answer. Children with ASD who do not have a communication system are often very determined and persistent in getting what they want by themselves. Their parents and caregivers often learn to "read the signs" of the child's behavior and know what the child wants without the child actually communicating anything. By introducing PECS, you are basically changing the rules, and that can be very uncomfortable in the beginning. It takes effort on the part of parents and teachers to make sure that a few highly desired items are available to the child only during PECS training to make this initial learning as quick and easy as possible. Once the child learns how quickly he can go tell the important people in his life what he wants, it becomes much easier to use the system. Question. Won't my child become dependent on using symbols? Will my child ever learn to talk? Answer. There are many factors involved in learning to use spoken language and functional communication. One major factor is a child's ability to produce a variety of vocalizations even if she is not using words. Another factor is the child's understanding that her vocalizations can have meaning to another person. A third factor is the child's cognitive abilities. One or all of these may be significantly affected in young children with ASD. It is impossible to predict the rate of progress in any of these factors when a child is very young. What is known, however, is that the earlier a communication system is taught to the child, the more practice she will get in successfully communicating with and learning from others. Many children who began to communicate using PECS start to say words and begin talking. These children tend to gradually use their communication books less and less and become more skilled in communicating with spoken language. A few children never develop the verbal skills needed for spoken language. For these children PECS continues to be an effective way to communicate. There is no evidence that use of PECS prevents children from developing spoken language. 39
Question. The learner I am working with is continually losing his PECS symbols when he is not at school. How can I expect his family to use the system when they are unable to keep track of his symbols and book? Answer. Keeping track of symbols and communication books at home can be a challenge for some families, especially if they have young children. One strategy that you can use to support PECS use at home is to provide the family with a CD of the child's symbols in PDF format. Assuming they have a computer and printer (preferably color), they can easily and affordably replace symbols as needed. Question. The young girl that I am working with has done quite well with PECS until recently. Now she no longer seems interested in participating in the training sessions. She often gets up and walks away. What can we do? Answer. The first thing to check is your supply of reinforcing items. She may simply be bored (i.e., satiated) with the limited number of items you are using for the exchange. It pays to continually update your supply of reinforcers and to regularly rotate their use. Question. Is it okay to use reinforcing items that are known self-stimulation objects (e.g., a playing card that is used for flapping)? Answer. This is a question best answered by those who know the individual the best. For some individuals, access to a stimulation item will deter further progress in the training for that session. For others, the highly motivating object will support faster learning and use of the exchange system. Consideration should also be given to behavior support plans that may be in place to minimize self-stimulating behavior. Question. When implementing the four-step discrimination training procedure, why, in Step 3, do I not give the learner the object shown in the picture? I find this step a bit confusing and don't see how it is relevant to the training. Answer. This step is necessary as the goal of the discrimination training is to confirm that the learner understands the association between the picture and the object and that he can choose the picture of the desired object from more than one picture. By acknowledging what the picture represents and then "distracting" the learner with a simple, non-related request, you can be confident that the next time he hands you the picture, he knows what he is asking for.
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Post-Assessment
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Post-Assessment What makes PECS unique from other graphic augmentative alternative communication (AAC) systems of communication? Select an answer for question 210 Before beginning training with PECS, it is important to assess the learner's. . . . Select an answer for question 211 Verbal prompts are allowed in any phase of teaching PECS. Select an answer for question 212 During Phase 3 of PECS training, the learner is taught to make a request from more than one picture or symbol. What is this called? Select an answer for question 213 When conducting pre-PECS teaching reinforcement sampling, how are preferred items confirmed? By... Select an answer for question 214 PECS has been shown to increase what abilities in children with whom it has been implemented long-term? Select an answer for question 215
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