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Newsletter

Volume 31 | 2008 | Number 3

A Clear Picture: The Use and Benefits of PECS

By Dr. Andy Bondy, Pyramid Educational Consultants, Inc.

The Picture Exchange Communication System (PECS) is an alternative/augmentative communication system that was developed about 20 years ago in a behaviorally oriented public school setting serving students with autism (Bondy & Frost, 1994; Frost & Bondy, 2002).  It was developed and refined over the years by a behavior analyst (Bondy) and a speech/language pathologist (Frost) and relies upon the analysis of language provided by Skinner’s seminal work, Verbal Behavior (1957). It begins by addressing the heart of verbal behavior- do something to someone else who in tern mediates access to reinforcement.  The immediate goal is to teach functional communication skills. Of course, when children do not speak, we hope that speech will develop. We will return to the relationship between PECS use and speech after we clarify what PECS is all about.

The initial lessons teach users to exchange (pick up, reach, and put into the hand of a communicative partner) a single picture for an offered reinforcer. Discrimination skills are not a prerequisite, nor is the presence of eye-contact or imitative skills. In fact, the only prerequisite is the clear identification of a powerful reinforcer.

Before briefly describing the various lessons within PECS, it should first be emphasized that functional communication skills cannot be effectively taught without using the teaching strategies developed within the broad field of behavior analysis. We organize the many factors that are necessary to create effective educational environments by a visual structure that we call The Pyramid Approach to Education (Bondy & Sulzer-Azaroff, 2002). The organizational system separates issues related to ‘why’ behavior occurs and changes as it does, ‘what’ should we teach, and ‘how’ can we arrange for effective lessons. Without a strong understanding of these principles and research-based practices, then progress with PECS is unlikely to occur.

The protocol used to teach PECS addresses a number of important issues. First, because an imitative repertoire is not a prerequisite, we can begin with spontaneous requests (mands within Skinner’s nomenclature) and thus minimize the risk of prompt dependency. We begin with requests because of the power and availability of the reinforcers for this communication function. Later in the system, we will aim at teaching comments (tacts) which may be more difficult to acquire for some children who are relatively insensitive to social reinforcers, which maintain this type of communication. (For a complete description of the PECS protocol in terms of Skinner’s analysis, please see Bondy, Tincani & Frost, 2004).

Within the first lesson, we use 2 teachers- one who controls the reinforcer- the communicative partner- and one who provides and eliminates the prompts. The exchange of a single picture without the use of any prompts is the goal of the first lesson and is often achieved within the first teaching session. The second phase focuses on expanding particular issues regarding generalization- increasing the number of items that can be requested, increasing the number of communicative partners and settings in which requesting will occur, and expanding the distance between the user and the partner as well as to the picture itself.

The third phase of training addresses issues associated with discrimination between pictures. We strongly suggest starting with two pictures that are distinct in terms of their association with reinforcement- that is, one item is a powerful reinforcer while the other item is non-reinforcing (a distracter). Once this simple discrimination is demonstrated, then conditional discrimination training is introduced.

The next step within the protocol is to teach users how to construct simple sentences. In essence, we maintain the same request function previously established by introducing an icon depicting “I want.” This step is introduced here in anticipation of teaching other sentence starters with other functions. (It should be noted that other languages use different syntax and thus may require ‘sentence enders’ to serve the same function.)  Once this simple sentence structure is acquired a number of steps can be taken.

While the primary goal of PECS may not involve the acquisition or expansion of speech, it is an important long-term goal. Once simple sentence structure can be used, we introduce several strategies that are aimed at increasing the likelihood of speech development and growth. For example, the communicative partner begins to introduce a pause between reading “I want” and naming the referent part of the sentence. By using this delayed prompt strategy, should the child vocalize, the item would be provided immediately plus the communicative partner would use differential reinforcement in an attempt to further strengthen vocalizations. These strategies appear to be successful as indicated by research showing a marked increase in vocalizations within this phase of PECS training (Carr & Felce, 2006; Ganz & Simpson, 2004; Tincani, Crozier, & Alazetta, 2006).

Another avenue that is introduced once simple sentence structure is used involves the use of attributes (tacts) to further specify the requested reinforcers. Users have been taught to use modifiers such as color, size, shape, texture, number, etc. to clarify which particular items is requested. Marckel, Neef, & Ferreri, (2006) observed that children with autism could use such descriptors to improvise requests in situations when a specific picture of a corresponding item was not available. Furthermore, since the skills of a ‘speaker’ are independent of the skills of a ‘listener’ (more commonly viewed as expressive vs. receptive skills) it is not necessary for a PECS user to demonstrate matching-to-sample skills with particular attributes prior to successful use within the requesting function.

The next phase of PECS teaches users to respond to the simple question, “What do you want?” It is important at this point to demonstrate that users can continue to be spontaneous at times while responding to this question at other times.

Within the last phase of the PECS protocol, users are taught to comment (tact) about common items and events (and their various properties). Initially the focus in on responsive commenting to questions such as, “What do you see?” or “What do you hear?” Next, we attempt to eliminate such questions to promote spontaneous comments.

The initial reports about PECS were published in 1994. There has been a dramatic increase in publications regarding PECS internationally (involving about a dozen countries) during the past few years, with at least 18 publications since 2004. PECS has been identified as very popular within the United States (Stahmer, Collings, & Palinkas, 2005) and in the UK where its social validity with parents has been noted (Mills, & Wing, 2006). Research designs have included single-case methodology with multiple-baselines (Charlop-Christy, Carpenter, Le, LeBlanc, & Kelley, 2002) to large group designs (Howlin, Gordon, Pasco, Wade, & Charman, 2007; Yoder & Stone, 2006a, 2006b).  While PECS was developed with children with autism, research has demonstrated its effectiveness with teenagers and adults, as well as with a number of other types of language related disabilities. Furthermore, various studies have noted positive side-effects, including improvement in speech, social interactions, and reductions in behavior management problems.

As with anything that becomes popular, many misconceptions and myths have arisen associated with the use of PECS. For example, some may say that the use of any picture is PECS, including the use of visual schedules. PECS may involve pictures but how they are used defines whether PECS is used. Schedules are useful for us when we are ‘the listener’ but PECS focuses on speaker skills. Some imply that PECS is only useful for those who have no speech. That suggests that the benefits of PECS are limited to alternative uses and ignores the issue of augmentative effects. A system is augmentative when its use helps in the production of another modality- whether that effect is between PECS and speech, sign and speech, PECS and sign, or whatever two modalities are involved. Skinner (1957) was adamant that verbal behavior is defined independently of the modality involved. He wrote, “In defining verbal behavior as behavior reinforced through the mediation of other persons, we do not, and cannot, specify any one form, mode, or medium. Any movement capable of affecting another organism may be verbal (p. 14).” Thus, PECS may often be helpful to individuals who have some speech but whose speech improves (in terms of repertoire size, complexity, initiation or understandability by others) when given access to PECS.

Some people seem to believe that PECS can only be used to request items, but as we’ve indicated it should be used to comment about things using any of the senses. Sentence structure should go beyond simple “I want…” constructions to promote vocabulary expansion via attributes and other modifiers.  Some folks suggest that every time a person uses PECS to request something, that we must honor that request! While it is important to maintain a high rate of reinforcement for communication via PECS early in training, just as with users of speech or sign, users of PECS must learn that they cannot get everything they want when they want it! They must learn to cope with real world issues involves learning to wait, understanding what ‘later’ means or ‘unavailable’ and even learn to tolerate the occasional ‘no!’

Of course the biggest fear associated with PECS (or any alternative/augmentative system) relates to concerns about the impact upon speech acquisition, development or inhibition. Within the broad field of AAC, there is over 40 years of research without any evidence that any system interferes with the development or continuation of speech. There is no evidence that any one modality- PECS, sign, voice-output-systems- is universally superior with regard to speech acquisition for children with autism. As noted, there have been several studies showing a positive correlation between PECS use and speech development. Of course, more research in this area is sorely needed.  We need to continue to look at the best teaching strategies for all of the lessons within PECS as well as look at strategies that best promote the acquisition and expansion of speech for those using PECS. Our field is best known for its emphasis upon the analysis of the functional relations between behavior and environment rather than a focus upon the topography of responses. Continuing with that tradition will yield ongoing improvements in teaching strategies for those in need functional communication skills.

References