1. Research Based Communication Strategies

2. Picture Exchange System
A functional Communication System
A way for students without verbal or limited verbal skills to communicate
Developed to help people with Autism and other developmental disabilities
Can be used in conjunction with a voice output system
Trainer Note:
Add Activity Details
Include Methodology
Time Taken etc
Note: Glossary is linked to a word document

3. What is PECS
PECS was developed by Lori Frost, a certified Speech-Language Pathologist, and Andrew Bondy, PhD., at the Delaware Autistic Program. 
Using the PECS, the student learns to spontaneously initiate communicative exchanges. People using PECS are taught to approach and give a picture of a desired item to a communicative partner in exchange for that item. Using PECS, students learn to gain the attention of the communication partner in order to make a request.

4. Pyramid approach
Start with basic communication and work your way up! Words first, and then sentences.
Strongly correlated to Skinner’s behavioral theory (operant conditioning) involving an object and reinforcement
Population served: PECS can be used with children or adults who are not yet initiating requests, comments, etc.

5. Benefits It’s Visual!!! Pictures are universally understood
May assist a verbal child in organization of language
Follows a systematic approach
Progresses through several “phases”
Can be transferred into a variety of settings

6. Picture Symbols
Three main “types” of pictures are used to exchange depending on the level the student is at
Actual Pictures (digital camera of specific items/objects)
TOBI’s (True Object Based Icons)
May be a picture of a sucker, but is cut in the same shape of the actual object
Boardmaker, or other line drawings
Can be done with objects

7. Words It is beneficial to have words underneath pictures
Transition to words for students needing assistance with organization or structure (and are “readers”)

8. Preparing for PECS Participants Reinforcers
Student
Communication Partner
Physical Prompter
Reinforcers
How to determine items of interest
Variability
Supplies (
Book with velcro
Pictures with velcro (Boardmaker)

9. Phases of PECS
Follows the pyramid format on one stage building upon another.
Stages 1-6
Each stage has objectives and specific procedural guidelines

10. Phase 1 “How” to Communicate
Terminal Objective: Upon seeing a highly preferred Item, the student will pick up the picture of the item, reach toward the communication partner, and release the picture into the partner’s hand

11. Phase 1 No verbal prompting One picture at a time
Two trainers required to teach initiation
Allow for request opportunities per day
Pictures can be any size as long as they match student motor skills

12. Phase 1 Procedure: Communicative partner sits facing student
Picture is placed between student and trainer
“First one is free!”
Student is enticed by desired item
Student reaches for desired item
Hand-over-hand to assist student in giving the picture to the trainer’s open hand
Trainer says “I want….”
Trainer gives desired object within ½ second
Trainer puts the picture back in place
If objects is a toy, trainer takes back the object to initiate another cycle of requesting
Pointing to pictures is discouraged as pointing does not require interaction with a person.

13. Phase 1 Fading Fade physical assistance Fade open-hand cue
Move to phase 2 if goal is met

14. Phase 1: Practical Application
Communicative Partner’s Responsibilities
Entice the student
Reinforce the student’s Exchange (with the item)
Time the open hand appropriately
Physical Prompter’s Responsibilities
Wait for the student’s initiation
Physically prompt the student to exchange the picture
Systematically fade prompts

15. Phase 1 of 6 Spontaneously Requesting Items or Activities
Choose a favorite toy or item that student will want to ask for
Necessary to have two “teachers” (can be a parent, sister, etc.)
The first teacher shows student item they really want, second assists child in taking picture and exchanging it…give item immediately
First adult “confirms” request with “Oh, you want an orange.”
The second teacher fades away until the child independently reaches for the picture and hands it to the second teacher.
DON”T ask the student what they want or tell them they should want something…goal is to spontaneously initiate conversation

16. Phase 2 Distance and Persistence
Terminal Objective: The student goes to his/her communication board/book, pulls the picture off, go to the communication partner, and release the picture into the partner’s hand.

17. If object exchange is to be used, collect the items the child will use as the representative sample. The following suggestions may assist in gathering these items:
1. A plastic cup to request a drink.
2. A few pieces of the child's favorite snack taped to a piece of cardboard.
3. A few pieces of the favorite food inside a clear cassette case taped shut.
4. A sample of the favorite item inside a clear video case box.

18. Phase 2: Introducing Variables
Listener factors
Distance to communicative partner
Variety of communicative partners
Expectant look
Enticement style
Eye contact
Body orientation
Taking picture from room to room to find communication partner
Environmental Factors
Distance to book
Variety of rooms
Variety of reinforcers
Variety of activities (lessons)
Sitting vs. standing vs. “on the move”
Furniture

19. Phase 2 This stage may last a long time. No verbal prompting
Use a variety of communication partners
Get the student to travel.
Allow for spontaneous requesting throughout the day
Use a communication book to attach the picture to.

20. Phase 2: Practical Application
Communicative Partner’s Responsibilities
Plans for student to have a communication book
Arranges and positions trainers and environment
Entices appropriately
Gradually increases distance between student and communication book
Teaches student to cross room to reach communication book
Reinforces appropriately
Turns away from student without body cues
Teaches student to travel room to room
Does not insist on speech
Physical Prompter’s Responsibilities
Waits for initiation
Prompts removal of picture from book if necessary
Physically guides student to trainer if necessary
Physically guides student to communication book if necessary
Does not interact socially with the student
Uses backstepping if necessary

21. Phase 2 of 6
Child has mastered independently making a request with one item, now child is required to move a greater distance to get to the first teacher.
After this is accomplished begin using system in different settings and with different people
Can use other reinforcing items as well
Still only offering one item
Still have two teachers to guide when moving
Have 10 successful trials before changing people

22. Phase 3: Picture Discrimination
Terminal Objective: The student requests desired items by going to a communication book, selecting the appropriate picture from an array, going to a communication partner, and giving the picture.

23. Phase 3 If trouble discriminating:
Vary sizes of different pictures to contrast each other
Place pictures further apart
Make both pictures larger
Make a blank picture card to compare with one with a picture
Arrange pictures to correspond with actual objects
Place pictures onto actual items
By the end of stage 3, student should have a book of items that they can discriminate

24. Phase 3: Practical Application High vs. Distracter discrimination
Communicative Partner’s Responsibilities
Kim
Arranges effective training environment
Entices with both items
Socially reinforces as soon as student touches correct picture
Appropriate reinforcement with requested item
Uses a variety of distracter items anda variety of target pictures
Conducts error correction
Moves pictures around on book
No insistence on speech
Physical Prompter’s Responsibilities
Kim
Blocks student from taking items
May assist in some hand-over-hand if student becomes frustrated

25. Phase 3 of 6
Teacher asks child to choose between several items on a board and request item
First start with a preferred and non preferred item
May begin by asking “What do you want?” but should be QUICKLY faded
If child can’t pick between 3 or 4 only give 1 or 2 then add on.

26. Phase 3: Practical Application Multiple Preferred discrimination
Physical Prompter’s Responsibilities
Blocks student from taking items
May assist in some hand-over-hand if student becomes frustrated
Communicative Partner’s Responsibilities
Arranges effective training environment
Entices with both items
Conducts error correction
Moves pictures around on book (diagonal, vertical, horizontal)
Teaches 3, 4, 5-way discrimination
Uses a variety of target pictures in the 2-, 3-, 4-, or 5-way mix
Teaches looking inside book
No insistence on speech

27. Phase 4: Sentence Structure
Terminal Objective:
The student requests present and non-present items using a multi-word phrase by going to the book, picking up a picture/symbol of “I want,” putting it on a sentence strip, picking out the picture of what is wanted, putting it on the sentence strip, removing the strip from the communication board, approaching the communicative partner, and giving the sentence strip to him.
By the end of this phase the student typically has twenty or more pictures on the communication board and is communicating with a variety of partners.

28. Phase 4 The student must be able to request AND comment
The sequence to teach:
Get book
Remove “I Want” icon from book
Put “I want” icon on sentence strip
Remove reinforcer picture from book
Put reinforcer picture on sentence strip
Remove sentence strip
Give sentence strip to communicative partner
(Use time-delay strategy while reading sentence strip to encourage student’s speech. 3-5 seconds)
(Student can eventually request multiple items)

29. Phase 4: Practical Application
Communicative Partner’s Responsibilities
Waits for initiation
Physically guides student to put picture on strip and exchange
Fades physical guidance to put picture on strip and exchange
Verbal praise and turns strip around and reads sentence
Use backward chaining to teach the sentence strip (work through the seven steps backwards)
Reinforces new behavior within ½ second
Reinforces with tangible item

30. Phase 4: Practical Application
Communicative Partner’s Responsibilities
Uses physical assistance to teach student to point while strip is being read
Uses delay (3-5 seconds) in reading strip
Reinforces if student speaks
Avoids verbal prompting
Conducts error correction for incorrect picture sequence
Organizes communication book appropriately
Does not insist on speech imitation/drill during PECS
Create opportunities throughout the day for spontaneous requesting
Simplify some aspects of the lesson while teaching new behaviors, then reincorporate

31. After Phase 4
At the same time, add more vocabulary and progress to Phase 5.
Attributes are excellent to incorporate into a student’s vocabulary. They can be included in the sentence strip.

32. Phase 4 of 6
After student can quickly and easily choose between pictures and make spontaneous requests with different people can focus on Sentence Strips.
Start with “I want”
Attach pictures to sentence strip and exchange entire strip
May need to give hand over hand assistance at first
Students with verbal skills may begin to give structure to language

33. Phase 3
By stage 3, student should be socially using pictures to harness the power of communication
No verbal prompts
Use a variety of trainers
Create opportunities for functional communication throughout the day
Vary positions of 2 pictures on the board/book until discrimination is mastered
Highly preferred vs. non-preferred
Highly preferred vs. highly preferred

34. Phase 5 and 6 Occur simultaneously
Focus on different extensions of words being added
Add more pictures to book
Use more items, “I see,” “I hear,” “I feel,” “I smell,” etc.
Extending requests into all environments

35. Phase 5 Responding to, “What do you want?”
Terminal Objective: The student spontaneously requests a variety of items and answers the question, “What do you want?”

36. Phase 5
Continue to verbally and tangibly reinforce each correct response
Use “delayed prompting” during this phase
Create opportunities to answer “What do you want” and to spontaneously request
Continue creating multiple communicative opportunities throughout the day.

37. Phase 5: Practical Application
Communicative Partner’s Responsibilities
Uses delayed prompting to teach “What do you want?”
Uses differential reinforcement if student “beats” the second prompt
Reinforces new behavior within ½ second
Creates multiple opportunities for spontaneously requesting AND answering, “What do you want?” within the same lesson.

38. Phase 6 Commenting
Terminal Objective: The student answers “What do you want?” “What do you see?” “What do you have?” “What do you hear?” and “What is it?” and spontaneously requests and comments.

39. Phase 6 Reinforce each communicative act appropriately
Use delayed prompting to train responses to each new question during this phase
Use discrimination training to teach discrimination between sentence-starter icons
Create at least 30 opportunities per day for the student to request or comment during functional activities

40. Phase 6 Practical Application
Communicative Partner’s Responsibilities
Facilitate communication
Think of some activities that can involve special sets of PECS pictures
Make use of PECS as natural as possible