Why do we communicate?
• To express needs and wants
• To develop social closeness
• To exchange information
• To fulfill social etiquette routines
Light 1988
Challenges
• An estimated 1/3 to 1/2 of children and adults
with autism do not use speech functionally.
(National Research Council, 2001)
Non-Functional Speech Difficulties
Frustration
Loss of
Confrontation, independence
Tantrums reliance on
others
Learned Lack of control
helplessness over decisions
What is PECS?
• Developed by Andy Bondy, Ph.D. & Lori Frost, M.S., CCC-
SLP in 1985
• Teaches functional communication that is immediately
useful by exchanging visual symbols for communication
purposes
• Based on principles of Applied Behavior Analysis and on
B.F. Skinner’s 1957 book, “Verbal Behavior”
• Fields of applied behavioral analysis + speech-language
pathology = effective method of teaching functional
Bondy & Sulzer-Azaroff 2002
communication
What does the child learn?
What does the Child Learn?
• Initiation: child learns to be spontaneous and act
without prompting, more control over self-expressions
• Concrete Outcomes: receiving a tangible, desired
item teaches the child to value the act of communicating
with others and is a powerful motivator to drive learning
• Social Context: skills generalized in order to be used
in a variety of environments
Components
• Participants
• Reinforcer
• Velcro book
How does PECS Work?
phrases Target Skill
Phase 1 Physical exchange of picture
Phase 2 Distance and persistence
Phase 3 Picture discrimination
Phase 4 Building Sentences and Attributes
Phase 5 Answering “What do you want?”
Phase 6 Responsive and spontaneous commenting
Possible PECS Candidate?
Is the student using functional communication?
NO YES
Is the student’s
PECS may be communication
appropriate understandable to
unfamiliar listeners?
NO YES
PECS may be Is the student initiating
appropriate communication?
NO YES
PECS may be
appropriate
Are the student’s mean length of
utterance and vocabulary size
adequate?
NO YES
PECS may be PECS is NOT
appropriate appropriate
PECS Popularity
• Clear and intentional
• Requires few motor movements
• Meaningful and motivating
• Inexpensive and portable
• Large number of communicative partners
Myths
PECS is only used for people who don’t speak at all
• System targets initiation and purpose
PECS only teaches the child to learn to request using
single words
• Requesting is the first skill taught
• Progresses to using sentence structure, answering
questions, and finally expands to commenting.
Myths
If PECS is used, the learner won’t learn how to speak.
• Research conducted over the past 30 years has demonstrated that
augmentative and alternative communication strategies do not inhibit
the development of speech. Many researchers have reported a
facilitation of speech when AAC strategies are used.
• Schwartz, Garfinkle, and Bauer (1998) children who initially had a
limited spontaneous vocal repertoire continued to have increases in
spontaneous language following PECS training.
Myths
If the child is starting to speak, stop PECS immediately
• No evidence to support that taking away pictures will promote
more speech
• Anecdotal information shows the opposite effect
• If you take away skills (by taking away pictures) that is unethical
Cognitive Basis of Autism: Profile of Cognitive
Strengths/Weaknesses
(Minshew, Goldstein & Siegel, 1997; Williams, Goldstein & Minshew, 2006)
Intact abilities Cognitive weakness
Attention Complex sensory
Sensory perception Complex motor
Elementary motor Complex memory
Simple memory Complex language
Rule-learning Complex formation
Visiospatial processing
Implications for Language Intervention
Visually based supplementation increases understanding by:
•Making concepts more understandable
•Making material is stable over time
• Creating an “eye-catcher” for capturing and maintaining attention
•Prompting the student
•Helping minimize anxiety
(Twachtman-Cullen 1998)
Speech Development
Charlop-Christy et al. (2004);
• Increases in speech during PECS training
Tincani et al. (2006);
• Dramatic increase in Phase IV
Yokoyama et al. (2006);
• Increase in frequency and intelligibility of vocalizations during PECS training phases I- IV
Ganz & Simpson (2004);
• Increase in words per trial during phases III & IV
Howlin et al. (2007);
• Little to no effect on speech
Yoder & Stone (2006a);
• PECS groups showed significantly greater increase in frequency of speech and in number
of different words used verses Responsive Prelinguistic Mileu Teaching intervention
Socio-Communication Functions
Charlop-Christy et al. (2002);
• Requesting and initiations were proven to increase the most, occurring on an average of
2.8 times per session at baseline to 27 times
• Joint attention and eye contact increased from 30% from baseline to 60% post treatment
Kravits and Colleagues (2002);
• Increase in duration of social interaction with peers
Ticani et al., (2006);
• Increases in manding (requesting) from 0% at baseline to approximately 55% post
treatment
Yoder & Stone (2006b);
• Those higher in initiating joint attention before treatment showed greater increases in
initiating joint attention and requesting following RPMT intervention, however those that
were Initially lower in initiating joint attention showed greater increases following PECS
intervention
Behaviors
Charlop-Christy, et al., (2002);
• 70% reduction in 10 of the 12 behaviors after implementation of
PECS, and four of the behaviors were completely eliminated from
the child’s everyday actions
• Tantrums and getting out of their seat without permission during
sessions decreased from about 20% to 7% after training
Granz & Simpson, (2004);
• In a 4 year old preschool classroom, PECS was used to decrease
autistic children’s aggressive behavior and was successful
Conclusion
• A functional communication system allows someone to
express himself
• PECS can be the first step in the path of social interaction
• Using a low tech AAC system, such a PECS, to begin
provides functional communication to teaching a person
“how” to communicate
• When mastered, consider other methods for developing
communication
