Picture Exchange Communication System

Last updated
Example of basic PECS communication board Snack PECS.pdf
Example of basic PECS communication board

The Picture Exchange Communication System (PECS) is an augmentative and alternative communication system developed and produced by Pyramid Educational Consultants, Inc. [1] PECS was developed in 1985 at the Delaware Autism Program by Andy Bondy, PhD, and Lori Frost, MS, CCC-SLP. [2] The developers of PECS noticed that traditional communication techniques, including speech imitation, sign language, and picture point systems, relied on the teacher to initiate social interactions and none focused on teaching students to initiate interactions. Based on these observations, Bondy and Frost created a functional means of communication for individuals with a variety of communication challenges. [2] Although PECS was originally developed for young children with autism spectrum disorder (ASD), its use has become much more widespread. Through the years, PECS has been successfully implemented with individuals with varying diagnoses across the aged span. PECS is an evidence-based practice that has been highly successful with regard to the development of functional communication skills.

Contents

Philosophy

The training protocol is based on the principles of applied behavior analysis. [3] The goal of PECS is spontaneous and functional communication. [3] The PECS teaching protocol is based on B. F. Skinner's book, Verbal Behavior , such that functional verbal operants are systematically taught using prompting and reinforcement strategies that will lead to independent communication. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency. PECS begins with teaching a student to exchange a picture of a desired item with a communicative partner, who immediately honors the request. After the student learns to spontaneously request for a desired item, the system goes on to teach discrimination among symbols and then how to construct a simple sentence. In the most advanced phases, individuals are taught to respond to questions and to comment. Additionally, descriptive language concepts such as size, shape, color, number, etc. are also taught so the student can make their message more specific. For example, I want big yellow ball.

PECS protocol

Reinforcer inventory: Prior to implementing the PECS protocol, it is highly recommended that the teacher, parent, or caregiver develops an inventory of items such as toys, books, and edibles that the learner enjoys. Preferred items are presented to the learner to determine which one(s) they want. This preference assessment is completed throughout the day in a variety of activities. Once the desired item or activity is determined, the communicative partner will entice the student with the item(s) by holding or showing the item. This way, no verbal prompting is needed. [3] The chosen reinforcers should be assessed to ensure they are consistently motivating to the user. [4]

The PECS Protocol occurs in six phases:

Phase 1 – how to communicate: During phase I, the focus is on teaching the student to initiate social communication by exchanging a picture of a desired item. [2] This exchange is taught presenting one picture, selected by the trainer based on the student's observed preferences. Within Phase 1, two trainers are utilized. One trainer acts as the student's communicative partner, and the other trainer acts as the physical prompter, who prompts the student after he makes an initiation towards the desired item. The student is taught to pick up the picture through the use of hand over hand techniques [5] and reach towards the communicative partner with the picture, in exchange for the requested item. [6]

Phase 2 – distance and persistence: During phase 2, the student is taught to expand the initiated social interaction by creating motivation for the student to seek out the communicative partner even when he or she is not nearby and waiting. [2] The goal of this phase is to have the student generalize his or her requests across places and people and to increase the likeliness of spontaneous communication. The student is taught to communicate over longer distances whether it be across a table or going to another location to find a communicative partner, and initiate spontaneous communication. Training should progress across different settings, with different communicative partners, and different types of highly motivating and preferred items to assist in the generalization of PECS usage. [6]

Phase 3 – discrimination between symbols: As soon as the student has demonstrated distance and persistence in multiple settings with multiple communicative partners, they are ready to be introduced to phase 3A – visual discrimination. During structured training sessions, the student will begin to work on discriminating between highly preferred and non-preferred items. During other times throughout the day, the learner should continue to generalize phase 2 skills. The next step is to teach discrimination between two items that are both contextually relevant 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. is taught discrimination of symbols and how to select the symbol which depicts a desired item. If students have difficulty with discrimination, there are systematic ways of incorporating error correction and alternative strategies. [7] The ECS phase 3 App created by Pyramid Educational Consultants provides an easy way for teachers to practice picture discrimination with one or several learners within a single session.

Phase 4 – using phrases: Within phase 4, the student learns to construct simple sentences on a detachable sentence strip making requests such as "I want ____ ". The requests consist of a sentence starter, "I want", and a picture of the desired activity or item. The communicative partner reads back the sentence after it has been exchanged by the student. After the student has learned to construct the sentence and point to the pictures, a delay between "I want" and the picture of the desired item is inserted as a way to encourage vocalizations. Speech/vocalizations are celebrated by providing the student with a greater amount of the requested item/activity and additional preferred items as a way to promote speech on future exchanges. It is important to note that speech/vocalizations are never demanded, just encouraged through the use of the delay. Teaching PECS users to create a sentence using expressions such as "I want ___" is the first step in developing more complex sentence structures. After the student learns the basic sentence structure, descriptors such as color, shape, size, number are taught so that learner can make their preferences more specific, such as "I want 3 cars". [3]

Phase 5 – answering a direct question: During phase 5, the student is taught to respond to the question, "What do you want?" The goal of this phase is for the learner to respond "I want ___ " after being asked some form of the "what do you want" question. This phase adds upon the already established skill of building a sentence while still using the desired item to motivate the user to respond. [3] A delayed prompting procedure is used in which the question and gestural prompt are initially presented at the same time and later a delay is established between the question and gestural prompt. [3] Ultimately, the student should answer the question before additional prompts are provided. [3]

Phase 6 – commenting: The student can now make spontaneous requests and respond questions such as "What do you want?" by building the sentence "I want ___" [3] Within phase 6, the student is taught to respond to commenting questions as well as to spontaneously comment on items, people, or activities present in his or her environment. In this phase, the student is also taught the meaning of sentence starters to differentiate between appropriate responses to the questions "What do you see?", which results in a social outcome and "What do you want?" which results in a tangible outcome [3] The teacher should structure the environment to give the student plenty of opportunities to have a variety of communication opportunities that encompass all of their communication skills. [8]

Depending on the age and cognitive level of the user, the time to master PECS will vary. One study found that it takes an average of 246 trials for users to master all six phases of PECS. [9]

Effectiveness

There is evidence that PECS is easily learned by most students, with its primary benefit being a means of communication for children and adults who have limited or no speech due to autism or other communication disorders. With regard to the intervention setting for AAC training, there is evidence that PECS is most readily learned when instruction takes place in a general education setting. [10] Evidence also indicated that learners initiate a higher number of picture exchanges when PECS is taught in a single setting versus multiple settings. [11] Research also advocates for the use of PECS training by non-professional implementers such as camp workers, counselors, or volunteers in their respective naturalistic settings, to better communication outcomes for those with complex communication needs. [12]

The consensus among most researchers is that "PECS is recommended as an evidence-based intervention for enhancing functional communication skills of individuals with ASD." [13] On the other hand, the 2009 National Standards Report from the National Autism Center lists PECs among emerging treatments that do not have sufficient evidence of effectiveness. [14]

An initial concern was that PECS might delay or inhibit speech development. However, a recent review of several peer-reviewed studies found that "there is no evidence within the reviewed studies to suggest that PECS inhibited speech; to the contrary, if any effect was observed, it was facilitative rather than inhibitory." [15] When difficulties do arise, it is often due to a lack of powerful reinforcers and/or trainer error. [16] A systematic review of interventions for children with autism spectrum disorder reported that use of PECS resulted in short-term improvement in word acquisition, but the effects were not maintained over time. [17]

Evidence from meta-analyses indicate that PECS does not result in equal communicative outcomes for all children with ASD. PECS training appears to have the most beneficial effects for younger learners. [18] Research also relays that the use of PECS as a communication intervention may yield more effectiveness in children that have challenges with sustaining joint attention. [19] In addition, evidence of maintenance and generalization effects of functional communication gains achieved through PECs training has been mixed. [20] Research indicates that "PECS is probably best used as an initial intervention to teach manding and the basic elements of what is a communicative exchange," and is not the best selection "for a long-term intervention as it does not address question asking and may be better implemented as part of a multimodal system for when picture communications are more socially appropriate." [21]

Additional applications

There is emerging research that suggests adults with developmental disabilities and severe communication deficits may benefit from the implementation of PECS. [22] Others tried to combine PECS training with video modeling. [23] Research conducted by David F Cihalk Et al. combined the use of PECS and video modeling to increase independent communicative initiations in preschoolers with autism and developmental delays. The founding of the study indicated that the use of video modeling facilitated student’s ability to become proficient in using PECS. [24]

See also

Related Research Articles

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).

Facilitated communication (FC), or supported typing, is a scientifically discredited technique that claims to allow non-verbal people, such as those with autism, to communicate. The technique involves a facilitator guiding the disabled person's arm or hand in an attempt to help them type on a keyboard or other such device which they are unable to properly use if unfacilitated.

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Reading for special needs has become an area of interest as the understanding of reading has improved. Teaching children with special needs how to read was not historically pursued due to perspectives of a Reading Readiness model. This model assumes that a reader must learn to read in a hierarchical manner such that one skill must be mastered before learning the next skill. This approach often led to teaching sub-skills of reading in a decontextualized manner. This style of teaching made it difficult for children to master these early skills, and as a result, did not advance to more advanced literacy instruction and often continued to receive age-inappropriate instruction.

Discrete trial training (DTT) is a technique used by practitioners of applied behavior analysis (ABA) that was developed by Ivar Lovaas at the University of California, Los Angeles (UCLA). DTT uses mass instruction and reinforcers that create clear contingencies to shape new skills. Often employed as an early intensive behavioral intervention (EIBI) for up to 25–40 hours per week for children with autism, the technique relies on the use of prompts, modeling, and positive reinforcement strategies to facilitate the child's learning. It previously used aversives to punish unwanted behaviors. DTT has also been referred to as the "Lovaas/UCLA model", "rapid motor imitation antecedent", "listener responding", errorless learning", and "mass trials".

High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.

<span class="mw-page-title-main">Augmentative and alternative communication</span> Techniques used for those with communication impairments

Augmentative and alternative communication (AAC) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. AAC is used by those with a wide range of speech and language impairments, including congenital impairments such as cerebral palsy, intellectual impairment and autism, and acquired conditions such as amyotrophic lateral sclerosis and Parkinson's disease. AAC can be a permanent addition to a person's communication or a temporary aid. Stephen Hawking, probably the best-known user of AAC, had amyotrophic lateral sclerosis, and communicated through a speech-generating device.

The following outline is provided as an overview of and topical guide to autism:

<span class="mw-page-title-main">Autism therapies</span> Therapy aimed at autistic people

Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.

Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that was pioneered by Robert Koegel and Lynn Kern Koegel. PRT advocates contend that behavior hinges on "pivotal" behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. In 2005, Richard Simpson of the University of Kansas identified pivotal response treatment as one of the four scientifically based treatments for autism.

Social Stories were devised as a tool to help individuals with ASD better understand the nuances of interpersonal communication so that they could "interact in an effective and appropriate manner". Although the prescribed format was meant for high functioning people with basic communication skills, the format was adapted substantially to suit individuals with poor communication skills and low level functioning. The evidence shows that there has been minimal improvement in social interaction skills. However, it is difficult to assess whether the concept would have been successful if it had been carried out as designed.

Tact is a term that B.F. Skinner used to describe a verbal operant which is controlled by a nonverbal stimulus and is maintained by nonspecific social reinforcement (praise).

Tangible symbols are a type of augmentative and alternative communication (AAC) that uses objects or pictures that share a perceptual relationship with the items they represent as symbols. A tangible symbol's relation to the item it represents is perceptually obvious and concrete – the visual or tactile properties of the symbol resemble the intended item. Tangible Symbols can easily be manipulated and are most strongly associated with the sense of touch. These symbols can be used by individuals who are not able to communicate using speech or other abstract symbol systems, such as sign language. However, for those who have the ability to communicate using speech, learning to use tangible symbols does not hinder further developing acquisition of natural speech and/or language development, and may even facilitate it.

<span class="mw-page-title-main">Video modeling</span> Teaching method

Video modeling (VM) is a mode of teaching that uses video recording and display equipment to provide a visual model of the targeted behaviors or skill. In video self-modeling (VSM), individuals observe themselves performing a behavior successfully on video, and then imitate the targeted behavior. Video modeling has been used to teach many skills, including social skills, communication, and athletic performance; it has shown promise as an intervention for children with autism spectrum disorders (ASD). Important practical and theoretical questions remain largely unanswered about video modeling and other forms of video-based intervention. Video modeling has theoretical roots in the social learning theory work of Bandura (1969), which called attention to the ability to learn through observation.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulty with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

The rapid prompting method (RPM) is a pseudoscientific technique that attempts to aid communication by people with autism or other disabilities to communicate through pointing, typing, or writing. Also known as Spelling to Communicate, it is closely related to the scientifically discredited technique facilitated communication (FC). Practitioners of RPM have failed to assess the issue of message agency using simple and direct scientific methodologies, saying that doing so would be stigmatizing and that allowing scientific criticisms of the technique robs people with autism of their right to communicate. The American Speech-Language-Hearing Association has issued a statement opposing the practice of RPM.

Autism is characterized by the early onset of impairments in reciprocal social interaction and communication and restricted repetitive behaviors or interests. One of the many hypotheses explaining the psychopathology of autism, the deficit in joint attention hypothesis is prominent in explaining the disorder's social and communicative deficits. Nonverbal autism is a subset of autism spectrum where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5, are still nonverbal 10 years later.

Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by significant difficulties in the social use of verbal and nonverbal communication. Individuals with SPCD struggle to effectively engage in social interactions, interpret social cues, and use language appropriately in social contexts. This disorder can have a profound impact on an individual's ability to establish and maintain relationships, navigate social situations, and participate in academic and professional settings. Although SPCD shares similarities with other communication disorders, such as autism spectrum disorder (ASD), it is recognized as a distinct diagnostic category with its own set of diagnostic criteria and features.

<span class="mw-page-title-main">Social narrative</span> Learning tool for people with disabilities

A social narrative is an evidence-based learning tool designed for use with people with autism spectrum disorder (ASD) and other associated disabilities. Social narratives often use personalized stories to teach a skill, identify a situation, or tell a narrative; some examples of social narratives may cover topics such as getting along with others, interacting with others, or experiencing a new place or activity. It is referred to as a story or a written explanation that tells the learner not only what to do but also what the situation is, with the goal of addressing the challenge of learners finding social situations confusing. Social narratives have been found effective for learners ages Preschool-High School in several areas such as social, communication, joint attention, behavior, adaptive, play, and academic.

Rhea Paul is an American clinical language scientist known for her work in the field of speech-language pathology. She was Founding Chair in the Department of Speech-Language Pathology in the College of Health Professions at Sacred Heart University and a research scientist and affiliate of Haskins Laboratories at Yale University.

References

  1. ↑ "Welcome to Pyramid Educational Consultants, Inc.!". Pyramid Educational Consultants, Inc. Retrieved 26 December 2013.
  2. 1 2 3 4 Overcash, A., & Horton, C. (2010). The picture exchange communication system: Helping individuals gain functional communication. Autism Advocate, 3, 21-24
  3. 1 2 3 4 5 6 7 8 9 Bondy AS, Frost LA (1994). The Picture Exchange Communication System. Focus on Autism and Other Developmental Disabilities, Vol. 9, No. 3, 1-19 (1994)
  4. ↑ Bondy, A.S., and L. Frost. 2001. "The Picture Exchange Communication System." Behav Modif. 25(5):725-744.
  5. ↑ https://resources.leicestershire.gov.uk/sites/resource/files/field/pdf/2018/4/16/PECS-autism.pdf
  6. 1 2 http://www.corwin.com/upm-data/2675_10bmod01.pdf#page=58 [ bare URL PDF ]
  7. ↑ Frost, Lori A. (2002). The Picture Exchange Communication System training manual. Pyramid Educational Consultants. ISBN   9781921751097. OCLC   704265241.
  8. ↑ Frost, L., & Bondy, A.(2002) The Picture Exchange Communication System training manual, 2nd ed. Pyramid Educational Consultants, Inc.
  9. ↑ Charlop-Christy, M.H., Carpenter, M., et al. (2002). Using the picture exchange communication system (PECS) with children with autism: assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavioral Analysis, 35(3): 213-231.
  10. ↑ Ganz et al. (2013) Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: An aggregate study of single-case research with individuals with ASD.
  11. ↑ Tincani, M., & Devis, K. (2011). Quantitative Synthesis and Component Analysis of Single-Participant Studies on the Picture Exchange Communication System. Remedial & Special Education, 32(6), 458-470.
  12. ↑ Koudys, Julie; Perry, Adrienne; McFee, Kristen (2021-11-19). "Picture Exchange Communication System® (PECS®) Use in a Community Setting: A Preliminary Investigation". Journal of Developmental and Physical Disabilities. 34 (5): 829–852. doi:10.1007/s10882-021-09826-5. ISSN   1056-263X. S2CID   244432273.
  13. ↑ Tien, K-C. (2008). Effectiveness of the Picture Exchange Communication System as a functional communication intervention for individuals with Autism Spectrum Disorders: A practice-based research synthesis. Education and Training in Developmental Disabilities, 43, 61-76.
  14. ↑ National Autism Center. (2009).National Standards Report Archived 2013-07-24 at the Wayback Machine page 76.
  15. ↑ Tincani, M. & Devis, K. (2010). Quantitative synthesis and component analysis of single-participant studies on the Picture Exchange Communication System. Remediation and Special Education (Online First), 1-13.
  16. ↑ Horton, C., Matteo, J. A., Waegenaere, J., & Frost, L. (2008). Pecs: Fact and fiction. Presentation delivered at the 2008 ASHA Convention. Retrieved from www.asha.org/Events/convention/handouts/2008/1528_Frost_Lori/
  17. ↑ Warren, Z., Veenstra-VanderWeele, J., et al. (2011). Therapies for Children With Autism Spectrum Disorders. Comparative Effectiveness Review No. 26. Agency for Healthcare Research and Quality (AHRQ) Publication No. 11-EHC029-EF.
  18. ↑ Ganz, J. B., Davis, J. L., et al. (2012). Meta-Analysis of PECS with Individuals with ASD: Investigation of Targeted Versus Non-Targeted Outcomes, Participant Characteristics, and Implementation Phase. Research in Developmental Disabilities, 33(2), 406-418.
  19. ↑ Lerna, Anna; Esposito, Dalila; Conson, Massimiliano; Russo, Luigi; Massagli, Angelo (September 2012). "Social-communicative effects of the Picture Exchange Communication System (PECS) in Autism Spectrum Disorders: Social-communicative effects of PECS in ASD". International Journal of Language & Communication Disorders. 47 (5): 609–617. doi:10.1111/j.1460-6984.2012.00172.x. PMID   22938071.
  20. ↑ Flippin, M., Reszka, S., et al. (2010). Effectiveness of the Picture Exchange Communication Systems (PECS) on Communication and Speech for Children with Autism Spectrum Disorders: A Meta-Analysis. American Journal of Speech-Language-Pathology, 19, 178-195.
  21. ↑ Ostryn, C., Wolfe, P. S., et al. (2008). A Review and Analysis of the Picture Exchange Communication System (PECS) for Individuals with Autism Spectrum Disorders Using a Paradigm of Communication Competence. Research & Practice for Persons with Severe Disabilities, 33(1-2), 13-24.
  22. ↑ Conklin, C. G. (2011-03-01). Effects of implementing the picture exchange communication system (PECS) with adults with developmental disabilities and severe communication deficits.(Report). Remedial and special education, 32(2), 155-166.
  23. ↑ Cihak, David; Smith, C. C.; Cornett, A.; Coleman, M. B. (12 March 2012). "The Use of Video Modeling With the Picture Exchange Communication System to Increase Independent Communicative Initiations in Preschoolers with Autism and Developmental Delays". Focus on Autism and Other Developmental Disabilities. 27 (3): 3–10. doi:10.1177/1088357611428426. S2CID   145196243.
  24. ↑ Cihak, David F.; Smith, Catherine C.; Cornett, Ashlee; Coleman, Mari Beth (2012). "The Use of Video Modeling With the Picture Exchange Communication System to Increase Independent Communicative Initiations in Preschoolers With Autism and Developmental Delays". Focus on Autism and Other Developmental Disabilities. 27 (1): 3–11. doi:10.1177/1088357611428426. ISSN   1088-3576. S2CID   145196243.

Bibliography

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.