1. Picture Exchange Communication System (PECS) Hannah Coles Speech and Language Therapist Camden Language and Communication Service (CLCS) Camden ASD Provisions

2. What is PECS? A visual communication system It is a form of Augmentative & Alternative Communication (AAC) Uses object cards to express/communicate desires A picture of the desired object is given to a communication partner in exchange for that item

3. What does PECS aim to achieve? It enables non-verbal children with autism and other communication deficits to initiate communication with others. PECS focuses on the initiation of communication and aims to develop the basic skills for communication, including language, social skills as well as reciprocal communication It can be used in a variety of settings Enables non-verbal children to request/choose High rate of success in teaching spoken communication

4. PECS and the Triad PECS can be used to address the Triad of Impairments…  Social and Emotional Understanding: Teaches that communication needs a person, a topic and another person to ‘hear’ about the topic  Communication & Language: It gives a clear and easy means of communicating with or without language  Flexibility of Thought & Behaviour: By using PECS symbols, situations can be negotiated and information shared

5. Who should PECS be used with? The approach was specifically devised to meet the needs of young children with ASD However, the system has been successful with adolescents and adults who have a wide array of communication, cognitive and physical difficulties. Now also able to be used with  Difficulty with speech or intelligibility  Poor initiators  To develop sentence structure and length

6. How to get started Motivation – it is essential to start with what engages the student Establish a motivation hierarchy, most preferred to neutral to non preferred items. Update as preferences change Determine whether student can understand symbols Preferably 2 people:  Child aims to communicate with adult 1.  Adult 2 sits behind/beside child to assist.

7. Phase 1 – THE PHYSICAL EXCHANGE Set-up: Picture of motivator on table in between adult 1 and student. Adult 1 holds the motivator in one hand and has their other hand open Student reaches/points to motivator Adult 2 guides student’s hand to pick up picture and place it in open hand of Adult 1 Adult 1 shows the student the picture and exchanges it for the motivator Adult 1 may add verbal praise

8. Phase 2 (1) – DISTANCE & PERSISTENCE Set-up: Adult 1 has motivator in hand and picture is attached with velcro to a communication board/book. Student practises taking picture off the board/book and giving it to adult 1 Then, the distance is increased between the adult and student:  Adult 1 moves away so student has to reach to give picture  Adult 1 moves further away so student has to move out of chair to give picture  Adult 1 has their back turned so student has to be persistent to give picture

9. Phase 2 (2) – DISTANCE & PERSISTENCE Then, distance is increased between student and picture/book/board  Adult 1 is beside book and student stands to get picture  Adult 1 stands away from picture and student reaches for picture and reaches to give picture  Adult 1 stands away from picture and student stands to get picture and reaches to give picture  Student has to stand to get picture and walk to give picture to adult 1  Student independently gets book/board form where it is kept and gives picture to adult 1.

10. Phase 3 - DISCRIMINATION Set-up: 2 pictures on communication book/board (1 x motivator and 1 x irrelevant). Ensure the student can see the motivator Student selects picture of motivator and adult 1 gives the item and verbal praise If student gives picture of irrelevant item, adult 1 gives the motivator and points to the correct picture. When student consistently gives the picture of motivator increase number of pictures to 3,4,5...

11. Phase 4 – SENTENCE CONSTRUCTION Set-up: Choice of pictures and a sentence strip on board/book. Initially the motivator is in view. Student places picture on the sentence strip and give the sentence strip to adult 1 (adult 2 may need to prompt this) Adult 1 reads the strip while pointing and showing student ‘I want’ picture is put on book/board. Student puts ‘I want’ on sentence strip (adult 2 may need to prompt this) Motivator moved out of sight, repeat as above.

12. Phase 5 – WHAT DO YOU WANT? Set-up: Choice of pictures, ‘I want’ and a sentence strip on board/book. Motivator is in sight Adult 1 asks ‘What do you want?’ and points to the ‘I want’ picture at the same time. Adult 1 asks ‘What do you want?’ and delays pointing to ‘I want’ picture Adult 1 asks ‘What do you want?’ Student independently sequences ‘I want’ & picture on sentence strip and gives to Adult 1

13. Phase 6 (1) - COMMENTING Set-up: Choice of pictures, ‘I want’, ‘I see’ and a sentence strip on board/book. Adult 1 is holding a neutral item Adult 1 asks ‘What do you see?’ and points to the ‘I see’ picture at the same time Student places ‘I see’ on sentence strip (adult 2 may need to prompt this) and a picture If student sequences the correct picture, Adult 1 says ‘Yes you see a…’ and gives a small reward not related to neutral item. Adult 1 asks ‘What do you see?’ and delays pointing to ‘I see’ picture Adult 1 asks ‘What do you see?’ and student sequences ‘I see’ & picture on sentence strip and gives to Adult 1 Adult 1 randomly asks ‘What do you want?’ & ‘What do you see?’ and student responds appropriately to each question.

14. Phase 6 (2) - COMMENTING Set-up: Choice of pictures, ‘I want’, ‘I see’, ‘I have’ and a sentence strip on board/book. Adult 1 has a neutral item. Adult 1 gives the student the neutral item and asks at the same time ‘What do you have?’ Student places ‘I have’ on strip (adult 2 may need to prompt this) and picture of neutral item. If the student puts correct picture, Adult 1 says ‘Yes you have a…’ and gives a small reward not related to neutral item. Adult 1 asks ‘What do you have?’ and delays pointing to ‘I have’ picture Adult 1 asks ‘What do you have?’ Student independently sequences ‘I see’ & picture on sentence strip and gives to Adult 1 …‘What do you smell?’, ‘What is it?’ & ‘What do you hear?’

15. Things to Remember It is important that the child exchanges the picture Give small quantities of the motivator if it is food/drink Let the student have the toy/activity only for a short amount of time Alternate the communication partner/adult 1 so the child is able to communicate with a range of people Ensure the picture has the written word at bottom Make sure the picture all the same size Keep the communication book/board in the same place and where the student can access it

16. Contact Details Camden Language and Communication Service Monday & Tuesday – 020 7388 6506 Camden ASD Provisions Wednesday & Thursday – 020 7530 4336 Friday – 020 7539 2658 Hannah.Coles@islingtonpct.nhs.uk