Our Version of the Picture Exchange Communication System (PECS) in Action!

by Tim on April 27, 2008

I promised this post a while back. Sorry I’m just now getting around to it.

For kids who have severe speech delays and are unable for whatever reason to sign, some variation of the Picture Exchange Communication System (PECS) – known more around here as the ‘picture board’ – is a great way to get some sense of what your child wants. The fundamental principle – any kind of communication is good communication. (You can also read the Wikipedia article, though I couldn’t readily find an easy-to-read description of it.)

I use “some variation of” in the above paragraph because the PECS inventors have a specified way of doing it, and I imagine we ain’t following it to the letter. But that’s OK. This is working for us so far and I’ll tell you how we do it.

Standard disclaimer: Again, this is how we do it and isn’t intended to tell you how you should do it (or even whether you should do it) for your child. We’ve worked on adapting this to work for J-Man in concert with his speech therapist. Your speech therapist will be your best resource in developing a plan for your child.

That said, I think this is worth trying out if you aren’t getting communication by voice or sign. It’s worked well for us, and it comes highly recommended for kids with autism, apraxia, and other severe speech delays.

OK, here’s the picture board. Obviously, the board focuses on food. I’ll tell you why in a second.

Food_Picture_Board1.jpg

[Top row – crackers and puree; middle – tea and chicken nuggets; bottom row – cheese toast and puffed veggie sticks]

It’s a simple piece of dark poster board (so the pictures show up better), tacked on to the wall with double-sided sticky stuff. Underneath the pictures are velcro dots, with the opposite part of the velcro on the back of the picture. The pictures were taken with a digital camera, printed on our home printer, and laminated. They can be detached from the board as needed to swap out pictures or use them for something else.

At first we pretty much moved him over to the board, took his hand, touched it to a picture, then handed him that food item. We repeated this routine for a while, but to our excitement he picked it up pretty quickly. We started with just 2-3 pictures and worked our way up to the current six. You definitely want to keep the choices few and simple at first.

The next breakthrough came when he essentially would punch the picture of what he wanted on his own (first big want – corn chips…) and then he would get it from us. He didn’t make a vocal noise to go with it, but he got his point across and everyone was happy.

Even better was when he’d reach for something and we’d say, “use your pictures!” then he would go touch the picture of that something and come back to us to get it. I’ve even seen him hand me something he wanted, go completely across the downstairs to touch the picture, and then come back to get it!

Lately it’s gotten really good. He’s giving us his words (or word approximations) while pointing (we’re tickled stupid when he points with his index finger) to the picture. This nearly knocked us flat the first time he did it. We still sometimes have to prompt him to point to the picture even if we know what he wants. We want to keep reinforcing the pictures, and so far that’s worked very well. In all likelihood, this will be our most effective form of communication for a good while, though clearly we’re seeing great verbal improvement as well.

So we usually get:

(All caps means the stress is on that syllable.)

  • Points to tea -> “KUH kuh” (for ‘cup’ – he makes these syllables longer in duration for ‘cup’, which is important since he uses ‘k’ sounds a lot)
  • Points to chicken nuggets -> “NUH nuh” (for ‘nuggets’)
  • Points to cheese toast -> “CO co” (his word for ‘toast’ since he substitutes ‘c’ sounds in for ‘t’ sounds)
  • Points to veggie sticks -> “keh keh” or “k-k” (like two, breathy ‘k’ sounds said quickly – hard to describe – which is what he does to several words that end in ‘k’ or ‘ks’ like ‘socks’)

It’s hard to describe what a miracle this is.

Minor variations – for cheese toast, he may do the above and then go to the toaster, reach for it, then say “coco” again. For nuggets, he may do the above, go to the microwave, reach for it, and say “nuh nuh” again.

He’s not been into crackers lately, so that one’s been ignored for a while. When he was on a cracker binge, he pointed to it a lot, I think largely because he was so excited that he could actually say ‘cracker’.

I promised I’d say why we focus on food and not toys and other stuff. The main issue we’re facing is that the pictures represent something literal to him. With food, what’s on the picture is what he gets. It’s a literal representation of that food. Except for one. Bonus question – which one doesn’t work very well and why?

With toys, a picture of a book means I want THAT book, not just any book. This means that if he’s faced with choices on the toy board of a few things he really doesn’t want to play with, he won’t pick any of them. We have a toy board, but it has been a flop so far compared to the food board. The food board has the advantage of that he only will eat a half-dozen actual foods. So literally everything he eats can be captured on that board. Still, we are staying at it on the toy board. Someday it’ll click.

We have been unable to generalize the objects in the pictures, though that’s the long-term goal. Eventually, the idea is to have a picture of just about any food mean “I’m hungry” with the next step being a way to choose what specific food he wants using specific pictures. This creates a sort of decision tree that could be consolidated into a book if need be.

You might be able to see where a system like this starts breaking down. If you need a literal picture for everything your child might want, you could end up with hundreds of them over time spread over picture boards all over the house. You can put them into a ‘picture book’ (basically a portable photo album), but you need to get to some way to work through it without flipping pages all day.

Our therapists have described the eventual goal in these steps: 1) Child picks a broad category of want (food, drink, toy, book, person, etc.), 2) Parent or child flips to the section that shows individual pictures related to that category (let’s keep with food for this example), 3) Child picks specific want from the pictures in the food section (e.g., toast).

It’s step 1 that we can’t get past yet, and that would probably be the case for most anyone starting out with this. J-Man doesn’t generalize from a picture of any food or a picture of any drink to “I’m hungry” or “I’m thirsty.” Choosing a picture means “I want that.”

In addition to those goals, the idea is to transition to other representations of the objects rather than just photos. This could include more cartoonish drawings or even line drawings. Obviously the primary goal is to get him to communicate well verbally, but again, any communication is good communication. If this helps him communicate his needs until speech can someday catch up better, then we’re all for it.

Answer to the bonus question – the puree. Because puree could mean any puree (applesauce, pears, sweet potatoes, whatever), so it’s not literal. Therefore, he pretty much never picks it because it’s too vague a choice.

Someday I’ll try to get a video of this. Whenever we pull out a camera, he either hams it up or stops doing whatever he was doing, so we’ll need to be subtle about it.

In the meantime, if you have questions about how we do it, feel free to ask. We’d love to hear from anyone else using this approach as well. Thanks!

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{ 8 comments… read them below or add one }

JB April 28, 2008 at 6:56 pm

Wow — I cannot wait to see the video! This is really exciting.

And next time I’m at your house, I’m putting up a picture of enchiladas. 😉

asha December 15, 2008 at 5:17 pm

wow good idea ,I will try this with bella, she never ever asks or points to anything .Hope it works for me too.Thank you.You could print pamphlets and distribute to drs, this material is awesome .

Phil Schwarz December 28, 2008 at 3:52 am

So eventually the thing he’ll want is to make his picture system *extensible*. That’s what letters and knowledge of the sounds they make (at least from other people’s lips and larynx) are good for. Even if he can’t *utter* sounds, he should be learning the letters (leverage that autistic rote memory to master a 26-member set, over time!) and the sounds they make… basic preliteracy skills… so that one day, when he wants something not in the set of pictures, he’ll be able to begin to tap out sequences of letters that make *invented spellings* (phonetic soundings-out) of what he wants. So there should be a keyboard page in his picture-book. Good to get him used to where things live on a QWERTY keyboard.

Tim December 29, 2008 at 9:18 pm

We have a couple of posts that talk about his recent letter and reading skills. (Try here and here.) We’ve been meaning to give a more complete update on his incredible progress, but the holidays have kept us busy.

We’ve been exploring a number of picture methods lately with the challenge being that his reading skills seem to leap by the day, which makes us stop and rethink what system really would work best for him. It’s like trying to hit a flying receiver 40 yards downfield. He’s too fast for us lately!

They use a very elaborate picture system at school for schedules, identifying centers and tasks, filling in sentences for wants and needs (e.g., the “I Want ____” board, which I also keep meaning to write about), structuring activities that are hard to structure (like assembling lego blocks), and all sorts of activities.

At the moment, we’re transitioning into a hybrid picture-word system, where the picture of the item has the accompanying word under it. The goal there is to transition to some combination of very simple pictures with the accompanying word or just word cards with no pictures. This should help with extensibility, but an analog system of cards has its limits to be sure.

Like I said, this is like hitting a moving target at this point. He could be ready to read novels for all we know right now. As I posted in my reply to your other comment, keyboards – and most anything with buttons – are a perseverative and highly overstimulating thing right now for him. We are revisiting it on a regular basis in hopes of integrating it more into his communication routine. He can certainly find anything he wants on a QWERTY keyboard since he knows all of his letters now.

Which leads to another thing we’re about to start working on more intentionally – spelling. We plan to start with having him try filling in a letter of words he knows well. (e.g., ‘ r_d’ and have him add the ‘e’ – via flash card of ‘e’, one of those magnetic letters, or whatever – to make ‘red’) I think that would really move us along toward communication by keyboard or other letter system, among other skills.

Tim December 29, 2008 at 10:03 pm

Asha – Funny you should mention that. There are plans in the works to publish materials for parents. Stay tuned!

ROSE ANNE NEPA April 1, 2010 at 2:30 pm

i WORK WITH AUTISTIC KIDS, MY QUESTION IS THIS, ONE OF MY STUDENTS,
IS MORE PHYSICALLY HANDICAPPED, 90 PERSCENT BLIND, HOW CAN YOU MAKE A PICTURE EXCHANGE, AS HE DOES NOT HAVE LANGUAGE, IN BRAIL?
ANY IDEAS….OR MAYBE GET THE CRICKET MACHINE, HAVE RAISED SHAPES IN WHAT YOU ARE TRYING TO CONVEY. CAN YOU LET ME KNOW?
DOES ANY ONE HAVE A COMMUNICATIONS BOARD, THAT THEY DO NOT WANT? WE WANT TO HELP THIS BOY AT OUR CHURCH, BUT FAMILY IS MINIMAL IN MONEY, I COULD PAY FOR SHIPPING. LET GOD LEAD YOU.
LOVE,
ROSE ANNE

Tim April 16, 2010 at 9:50 pm

Rose Anne,

Many apologies for the delay in response. I’m not only perpetually behind on everything, I’ve been digging around trying to find an answer to your question. I asked around some, though because we’re on break from school there are some people I won’t be able to reach for a while. You’ve asked a fantastic and challenging question. This is a very inadequate response, and I apologize. I just don’t know enough about this to be particularly useful.

A blogger I’ve talked to has a child who is visually-impaired in one eye. They use a device from Prentke Romich that’s been modified to fit his needs. I’m assuming one of their technicians worked with her to set up the device so he could use it. The downside is, devices like that are incredibly expensive and likely well outside your price range.

One alternative I guess is to use regular picture board pics but add Braille or texture to them. Teaching Braille obviously would take time and adds another layer of communication issues to work through. I’d imagine you’d quickly run out of different textures to use, but perhaps if you could just get a few ‘pictures’ into his communication vocabulary, you’d at least get a start. If there was any way to make those textures in some way correlate to the object in the picture (soft texture for ‘blanket’, for example) I’d do that. It might cause problems later if a child learns to associate things too literally that don’t really go together very well.

Another possibility is to add miniature versions of the actual objects and attach them somehow to a choice board. This would provide some 3-dimensional objects to understand by feel. This might work OK for things like food and such as there are plenty of small versions of those in the toy sections of stores. There are obvious limitations to this approach, but it might also be a way to get started.

I’d be reluctant to use raised shapes. My son can be very literal about things, and equating a raised circle with, for example, a car might mean that he’d associate circles with cars always rather than generalizing that circles exist in other places. I’m not saying it wouldn’t work, but I’m pretty sure it wouldn’t work for us.

[Note: The following assumes living in the U.S.]

For everyone living in the U.S. (don’t know enough about other countries, but feel free to comment if anyone does), I strongly suggest contacting your county agencies and schools for assistance and advice. Children under 3 can get help under Early Intervention, the contact info for which you should be able to get from a phone book or a local pediatrician. Over age 3, evaluations, services, and educational instruction go through the local school system. All of them have special education contacts, so start there. In your case, your student would most definitely qualify, and you have a federally protected and mandated right in the U.S. to services appropriate to your child’s educational needs.

Many places also have independent agencies that serve those who need assistive communication devices. It varies from place to place, but someone with a county agency or the local schools should be able to point you to any that are near you. Around here, we can get devices on loan to try out and professional advice on what would be most appropriate to our child. However, these organizations don’t exist everywhere. Also ask any local organizations that assist those with visual impairments. If that doesn’t help, go to the national organizations.

Also, if the child qualifies for Medicaid – which can be done because of disability rather than income – a communication device might be covered by insurance.

The American Speech-Language-Hearing Association (ASHA) has a lot of smart people working for and with them. It’s very likely someone at ASHA would know the answer to your questions. I suggest going to their site and contacting them.

I’ll ask around and see what else I can find out. I’m sorry I couldn’t provide more specific (or timely for that matter) information.

Michael Rosa May 13, 2015 at 12:46 pm

Rose Anne,

Another possible avenue would be “Tactile Signing” this is used with individuals who are blind as a communication system.
I would also follow Tim’s advice about looking for support from county and local agencies and your states dept. of social and health services. They should have resources to help the family
Mike

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