“I don’t want to use PECS because I’m scared my child will never learn to talk”  is a common reaction from parents when PECS is introduced for the first time.

It is often questioned why a child who is non-verbal should see a Speech Pathologist who is not teaching them to use speech to “talk” in a way that is conventional. The truth of the matter is, delivering a message is far more complex than just using sounds and words to make sentences. Communication can be verbal (spoken) as well as symbolic including gestures and signs or in this case, a Picture Exchange Communication System. (PECS).

What is PECS?
PECS is a form of Augmentative and Alternative Communication (AAC) intervention which has been practiced since 1985 for individuals with communication difficulties. PECS is most commonly used for children with Autism Spectrum Disorder  however can also be implemented with children and adults of all ages presenting with various other communication, cognitive and physical impairments.
Through picture exchanges, individuals are given a “voice” and may use words and/or pictures to create simple key word phrases to complex, detailed sentences. In this way, PECS can be used for a variety of communicative purposes including:
•   Requesting for desired actions, items and activities (e.g. I want____, More! Up! Open!)
•   Sharing feelings (e.g. I feel___)
•   Making comments and observations (E.g. I see___, I hear____, I have____)
•   Asking questions and participating in social interactions (e.g. Can I have____? Can I Play? My turn!)

Picture Exchange Systems can be developed and individually tailored to match a child’s needs, preferences and communication skills through a variety of formats and devices. PECS can be implemented through:
•   Choice boards or folders including:
→ Generic cartoon images from such computer programs as PICS for PECS or Board Maker
→ Real photos for children who require more realistic representations
→ Written words and phrases
•   Electronic speech generating devices including iPad applications such as “TapToTalk” and “Proloquo2go”.

PECS can also be easily implemented across all environments of a person’s life including home, preschool, school and work places.

Why should I use PECS with my child with Autism?

PECS is most commonly used in early intervention for children with autism. There are no research studies to support any negative effects of using PECS. Studies instead have shown children who communicate with the support of a picture exchange system develop speech, language and social skills faster than children who have not been trained in PECS.

It is an efficient mode of communication for children who are non-verbal and children who “speak” but have difficulties being understood by others. In this way a child’s pictures act as their “words” while speech and language is still developing, in turn reducing a child’s frustration and behaviours associated with communication breakdowns.

Using PECS has numerous positive effects on a Child with Autism’s development of communication skills. PECS promotes:
•   Positive Social Interactions: During the initial stages of teaching PECS, children learn through a quick exchange of a picture item they will immediately receive access to a highly reinforcing reward (toy, food item, activity etc). Children develop a positive association with people, increasing the likelihood that they will seek out others and initiate social interactions in future.
•   Independence: Unlike spoken words, caregivers and therapists are able to provide hand on hand prompts to help a child complete picture exchange requests. PECS allows children to rely on visual cues rather than their communication partner’s verbal cues (e.g. “What do you want?” “Say ____” etc) to initiate requests independently. Visual prompts are particularly useful for children with echolalia to initiate communication rather than repeating others.
•   Confidence and Motivation: PECS is useful for children who are unintelligible to unfamiliar people or children who can ‘speak’ but rarely initiate communication verbally. Picture exchanges encourage children who are unintelligible to continue to practise using vocal approximations but still ensures communication partners understand the message. PECS is also a less demanding and intimidating mode of communication for children who are shy or resistant to use their words, particularly in community settings such a preschool.
•   Vocabulary Building: Particularly for children who have some functional words and phrases, PECS WILL NOT stop or replace speech and language. PECS will in fact promote vocabulary development as picture items are paired with verbal word labels, helping children to understand and use new words.
PECS can also help develop word association skills, being able to categorise, locate and use items from a variety of word groups (e.g. locations, food, toys).
•   Sentence Building: PECS allows children to correctly structure and build upon sentences, increasing in length and complexity depending on a child’s ability through words and/ or pictures (e.g. I want car, I want to play with my red car).

How can I use PECS in my child’s everyday life?
There are so many ways you can use PECS to promote language development in your child’s life. Be creative and manipulate the environment to set up situations where your child will need to use picture exchanges to communicate.
It is important to ensure your child’s PECS choice items are in sight to provide visual prompts and in a location easily accessible for the child. Examples include:
•   Lock your child’s favourite food in a cupboard or high shelf. Place the PECS book nearby or have a poster suck on the cupboard/ fridge displaying food options they may request for.
•   Stick your child’s favourite backyard activities (e.g. swing, trampoline) on back door so they must request before the door is unlocked and they are directed to preferred activities.
•   Stop/ pause activities (e.g. movie/iPad game paused, piggy back ride stopped) so your child is required to request for continuation or different actions (e.g. up, more, turn on, push etc)
•   Stand back and wait for your child to approach you and request for assistance during everyday activities (e.g. ‘open’ – door, chip packet; ‘I need help’ when dressing etc).
•   Ensure your child’s PECS system is easily comprehensible and accessible. Consider picture/ font sizes and group similar items (e.g. page of food items, toys etc) to increase the efficiency of picture exchanges.
•   Immediately respond to all initiations of communication using PECS by immediately providing the child with the item they are requesting for or at least acknowledging the request and offering alternate choices when this is not possible.