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Picture Exchange Communication System (PECS)

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Picture Exchange Communication System (PECS)

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PECS is a low-tech system in which individuals are taught to select pictures and exchange them to communicate wants and needs. PECS is used with students who are nonverbal or who have limited speech. This system can be helpful when a student is not able to communicate.

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Phase 1 is "How to Communicate". A single picture is exchanged for an item or activity the student wants.  Phase 2 is "Distance and Persistence". Single pictures are still used, but with more than one communication partner and in different places to promote generalization. Phase 3 is "Picture Discrimination". Students learn to choose between 2 or more pictures to ask for their favorite things. Phase 4 is "Sentence Structure". Students learn to build a sentence by using sentence strips that start with "I want". Phase 5 is "Answering a Direct Question". The student uses PECS to answer the question, "What do you want?". Phase 6 is "Commenting". Students learn to comment on their feelings and respond to multiple questions.  

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PECS would be determined effective when a student is able to progress through all 6 phases and there is a reduction in disruptive behaviors. 

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Gesturing is an important part of communication. Individuals with autism often have difficulty imitating gestures and making connections. This low-tech strategy may require explicit instruction in both gestural production and gestural comprehension.

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Individuals with ASD often do not naturally pick up gestures and must be taught. Some strategies to teach gestures to students with ASD are: 1. Use Visual Supports. Picture cards can help students understand and use gestures. 2. Modeling and Prompting. Teachers, caregivers and therapists can demonstrate gestures and prompt the student to imitate. 3. Social Stories: Creating social stories that use hand gestures in various scenarios can help students with ASD learn how to use them. 4. Use Positive Reinforcement. Reinforce accurate use of gestures through praise or rewards. 

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If a student can reciprocate to a communication partner by using a gesture, this would be considered progress. In the memoir, "The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism", by Naoki Higashida, Higashida (an individual with ASD), writes about the act of waving goodbye (2016). He learned to imitate this gesture when he was young, but it was not until his teenage years when he realized he was supposed to turn his hand outward instead of facing himself. He noted that he felt silly when he realized that he had essentially been waving to himself. This experience of Higashida is a reminder of the importance of the explicit teaching of gestures. 

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30+ Gestures in Nonverbal Communication Examples

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Explore the power of unspoken words! Learn the art of Gestures in Nonverbal Communication for impactful interactions. 🤝🔍

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Sign language is a low-tech system that supports communication for individuals with ASD. There are two common forms of sign language used in the United States among individuals with ASD: American Sign Language (ASL); and Signed Exact English (SEE). ASL is the preferred choice for students who will likely remain nonverbal whereas SEE mirrors the English language and is useful for students who have the goal of achieving verbal communication.

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Some strategies for implementing ASL or SEE are to use visual aids to aid in comprehension, involve all stakeholders to develop consistency, and to integrate signing into every day activities. It is also important to develop a plan for the student. Focusing on 2 or 3 signs per week would create a solid base for functional communication. 

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Gauging the effectiveness of using ASL or SEE can be determined by observing students with ASD. Are they attempting to sign in natural environments (classroom, cafeteria, playground, etc.)? Are they communicating wants and needs by signing? 

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One of the most common symptoms of autism is difficulty with speech and language. Autism spectrum disorder is, well, a spectrum, so these difficulties may look very different for each autistic child. Some can speak fluently, while others will always be nonverbal.

As a parent, you desperately want to communicate with your child-to understand their needs, wants, and emotions. This is harder when your child can't speak out loud, but not impossible. There are a range of ways for autistic people to communicate non-vocally, including sign language.

What is sign language?

Sign language uses hand gestures, facial expressions, and body movements to express words and phrases. It's the primary language for most Deaf and hard-of-hearing people, though plenty of hearing people use it, too.

Sign language isn't the same everywhere-American Sign Language (ASL) is the standard in the United States and Canada, but different places have their own versions. For example, although hearing Brits and Americans both speak English, British Sign Language and American Sign Language are so different they're not considered to be in the same language family!

Using sign language for autism

If your child with ASD struggles with speech, it's important to access early intervention services. This will give them the best chance of achieving functional communication later on. That said, your speech therapist may decide that Augmentative and Alternative Communication (AAC) is the right option. Augmentative and Alternative Communication includes many different methods, from a picture exchange communication system (PEC), to flash cards, to sign language.

Sometimes, AAC is meant to help guide your child on their journey to speech. A 1979 study titled Teaching autistic children to use sign language: some research issues explored this topic. It found that a combination of sign language and ongoing speech therapy (called "simultaneous communication") can stimulate language development in children with autism.

However, the study also found that completely nonverbal children weren't likely to gain spoken words through simultaneous communication. Sign language could end up being your child's primary or only way to communicate-and that's okay! Nonverbal people with autism can still live happy, fulfilled lives.

Pros of sign language for children with autism

Signing has a number of benefits for autistic kids, besides the obvious one that they'll be able to express themselves.

More spontaneous communication: children will be more likely to communicate without prompting

Better social skills: they may pay more attention to the social cues of others

Less aggression and meltdowns: these behaviors are often caused by frustration at being unable to communicate

Less depression and anxiety: likewise, kids with autism are likely to be happier when they can make themselves understood

Less reliance on auditory processing: this skill is hard for many autistic children, so signing may be easier to understand

Cons of sign language for children with autism

Signing isn't for everyone. Depending on your child's strengths and weaknesses, these features could present problems:

Extensive use of motor skills: signing involves careful use of hands and arms, but some children with autism struggle with motor skills

Focus on facial expressions: ASL often uses facial expressions to convey more nuanced conversation. This could be hard for kids who have trouble interpreting faces

Eye contact: many autistic people don't enjoy prolonged eye contact, but this is a common part of ASL etiquette, especially when interacting with Deaf signers

Stimming could distract others: Self-stimulatory behavior isn't a bad thing, but if your child uses their hands to stim, it could confuse or distract a conversation partner

Types of sign language

American Sign Language is the United States' most common form, but not the only one. There is also Signed Exact English (SEE).

American Sign Language

This method wasn't created by a single person or organization; like spoken languages, it developed organically over centuries. Today, 250,000-500,000 people in the U.S. claim ASL as their native language.

It has its own grammar, vocabulary, and syntax that doesn't always align with verbal English.

Signed Exact English

SEE, which was invented in 1972, bases many of its signs on ASL, but it's more directly modeled on English. It follows English sentence structure and adds prefixes, endings, and tenses in order to be an exact visual representation of English.

Which should you use?

Many professionals recommend teaching SEE to children with autism, especially if the goal is to achieve verbal communication. That way, the child is still learning the rules of English even while using signs. Parents who have no experience with ASL may also find it easier to learn SEE. And because SEE replicates English words, it doesn't rely as heavily on facial expressions to convey exact meaning.

However, many people find SEE clunkier and slower than ASL. There is also a much smaller community of adults who know SEE-people who are fluent in a sign language are most likely to know ASL, meaning that SEE is less useful for speaking with the broader world. If it looks like your child will be permanently nonverbal, ASL could be a better choice.

All children with autism are unique, so talk to your speech therapist about your options.

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Tips for learning sign language

If the child uses signs, that means the parents will have to learn, too! This may seem intimidating, but your speech therapist should guide you to resources. Here are a few tips to keep in mind:

Find the right teacher

You can learn how to sign through private tutors, online courses, or local classes. Ask your speech therapist for any recommendations, and find a way that works for your schedule and learning style.

Learn the finger alphabet

This is crucial when you first start using signs. ASL comes with its own alphabet, so if you forget certain signs, you can always spell them!

Learn vocabulary that's important to your family

When prioritizing which signs to memorize, focus on things that you and your child with autism use most often.

Set specific goals

Give yourself daily, weekly, or monthly benchmarks to help you stay on track. For example, you might decide to learn three new signs every day.

Other alternative and augmentative communications

Today, there are countless AAC options for kids with autism. Other than sign language, you may consider...

Every child is different, so no method is universally better than another. Some people with autism find signing effective and enjoyable, while others get more out of something else. Using different methods for different contexts is also possible. Consult with professionals and pay attention to your child's reactions so you can make the best choice.

In conclusion

The journey to functional communication can be tough, but resources are out there. Research has shown that sign language may help children with autism develop speech. If not, it's still a valid, useful tool for connecting with the people around them.
References
Brooks, R. (2018, May 10). A Guide to the Different Types of Sign Language Around the World. The Language Blog.

Carr E. G. (1979). Teaching autistic children to use sign language: some research issues. Journal of autism and developmental disorders, 9(4), 345-359. https://doi.org/10.1007/BF01531444

Edelson, S. M. (n.d.). SIGNED SPEECH OR SIMULTANEOUS COMMUNICATION. Synapse. http://www.autism-help.org/communication-sign-language-autism.htm

Lingvano. (n.d.). 15 tips for learning American Sign Language. Lingvano. https://www.lingvano.com/asl/blog/15-tips-for-learning-american-sign-language/

Miller, J. (2010, September 7). The difference between ASL and English signs. Signing Savvy. https://www.signingsavvy.com/blog/45/The+difference+between+ASL+and+English+signs

NIDCD. (2019, May 8). American Sign Language. National Institute on Deafness and other Communication Disorders. https://www.nidcd.nih.gov/health/american-sign-language

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Sign language for autism has a number of benefits for children on the spectrum, besides the obvious one that they'll be able to express themselves.

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For individuals who are literate or able to draw, using paper and pencil can provide an avenue for communicating. Writing is a low tech strategy that can enhance communication for individuals with autism.

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Students with ASD can often learn the mechanics of writing. One approach suggested by occupational therapist, Desiree Gapultos, is to introduce pre writing skills (Autism Speaks, n.d.). Give students the opportunity to draw on multiple surfaces (white board, easel, chalkboard) and with a variety of tools (marker, crayon, pencil). Another approach to writing is the use of an alphabet board. For this approach, the student sits with another person and points to the letters they want to use while the other scribes for them. 

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The effectiveness of written communication is determined by the clarity of shared responses. 

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A "First...Then" communication board is a low tech strategy that can teach students with autism the order of activities. For example: first we complete the math worksheet, then we play with kinetic sand.

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A first-then board is often used to show a less preferred activity (first) followed by a preferred activity (then). The "then" should be something that is a strong reinforcer for the student. Involving the student in choosing the preferred activity can increase the likelihood of success. When using a first-then board, it is important to ensure the student is capable of completing the first task. If the goal is to have the child complete a math worksheet, and math is difficult,  a good starting point could be: first complete 5 problems, not the entire worksheet.

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A student will likely require support and prompting when using a first-then board in the beginning stages. Eventually, prompting can fade and tasks can become more difficult and the student more independent. Pictures, words, and symbols can be used to illustrate the "first" and "then". 

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First Then Visual Schedule for Kids -Premium Durable Plastic -32 Communication Cards -Autism Learning Materials -Special Education Classroom (English)

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Perfect for helping to smooth transitioning from one activity to another, this A4 board is the perfect size to be clearly visible when sat on a desk/on the wall, but also to easily to carry around to refer to. With space for 3 symbols on the board at any one time, it visually labels the current ...

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NovaChat is a speech generating device from Saltillo. There are different sizes available and vocabulary files are preloaded. Colorful wraps are easy to swap out and the device has a handle for easy carrying. The newest model (NovaChat 8 Active) also comes with easy grip side handles that aid in positioning during use.

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Implementation of an AAC device should be approached as a team. Often the Speech-Language Pathologist (SLP) is knowledgeable about the best device to suit the student. Working with the Statewide Alternative Augmentative Assistive Communication (SWAAAC) coordinator is also imperative in order to access devices and receive training on how to best utilize them. The student, families, service providers, and (sometimes) peers should be knowledgeable about the device in order to best facilitate communication. The use of the assistive technology (AT) framework, Human Activity Assistive Technology (HAAT) , is valuable when determining the most appropriate AT for an individual. The HAAT model considers the purpose of the AT in relation to the person using it. The four components that comprise HAAT are the target activity (leisure, productivity, self-care), the abilities of the person using the device (physical and cognitive), the environment in which the device is used, and the most suitable device (programming specifications, output/input) for the individual (Elsahar, Hu, Bouazza-Marouf, Kerr, & Mansor, 2019). 

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The success of an AAC device is determined if the student is using it and it is effective at being the students "voice". Frustration and disruptive behaviors should decrease. The use of the device should also increase in complexity; from aiding in functional communication to being able to participate in daily life activities with more independence. This, of course, is determined by the ability of the student. 

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The NovaChat 12 has a 12.2 inch LCD display- the largest in the Chat line of products. It is a speech-generating device that offers the well-known Chat Software on an Android™ platform. Like all Chat devices, NovaChat 12 offers a durable yet sleek, portable design, with features that include a built-in camera, single or dual switch scanning, Social Chat, IVONA speech synthesizer, and many other exciting features.

A variety of vocabulary configurations allows you to tailor the device to meet your needs. The NovaChat includes thousands of SymbolStix© symbols, and PCS© symbols can be added. The ability to use your own photos permits even further customization.

Whether you are a child, teen, or adult, the Ivona© synthesizer offers a voice that can be manipulated to your liking. It includes a child, teen, and numerous American, British English and Australian adult options. Additionally, Acapela™ voices are available for NovaChat 12 as an option. Your voice will definitely be heard as the encased amplifier produces sound clarity beyond that of any portable speech generating device of its size.

NovaChat 12 comes with a 12.2" screen and weighs only 2.85 lbs. The capacitive touchscreen is accessible by finger touch or an included stylus.

Saltillo has updated the user interface of their Chat software. Included are features for sharing text with other applications and social networks. This Social Chat feature allows text generated by Chat pages to be sent to Facebook, Twitter or other social networks with the touch of a button.

NovaChat 12 features a 12.2" screen, which is accessible with the touch of a finger or an included stylus. It is very lightweight compared to traditional speech generating devices, weighing in at a mere 2.85 lbs.
Pre-Loaded Vocabulary:
Various page sets targeting individuals with different communication needs are included in the NovaChat:

The NovaChat 12 dimensions are 12" x 8.38" x 1.25", which makes it easy to hold. A stand and handle are also built into the design and strap attachments are available for hands-free transporting.

A colorful rubberized protective shield preserves the system while giving it an appealing style. No need to choose just one color, as four colorful shields are provided with each system. Blue, green and purple offer lively options while gray provides a more sophisticated look.

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The NovaChat 12 has a 12.2 inch LCD display- the largest in the Chat line of products. It is a speech-generating device that offers the well-known Chat Software on an Android™ platform. Like all Chat devices, NovaChat 12 offers a durable yet sleek, portable design, with features that include a built-in camera, single or dual switch scanning, Social Chat, IVONA speech synthesizer, and many other exciting features.

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The Via Pro is a speech generating device by Saltillo. A choice of the communication apps Lamp Words for Life, TouchChat, or Dialogue (or a combination of all three) are available during the order process. The device is less than 3 pounds and has a 5 year warranty. It also meets the requirements to be classified as durable medical equipment, which can aid in funding.

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Introduction to Via Air or Via Pro   TouchChat

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TD Snap offers a suite of page sets, all eye gaze, touch and switch-enabled, to meet different communication needs. It is a flexible software offering professionals and families a choice of AAC solutions. It comes with a set of powerful tools and resources to empower people with speech and language disabilities to communicate.

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TD Snap is a flexible software offering a choice of AAC solutions to help people with communication disabilities. With a number of page sets to explore, professionals and families will find the right solution to meet their needs. TD Snap comes with several page sets developed by Tobii Dynavox, including Core First, Motor Plan, Text, Scanning and Aphasia, while page sets created by third parties such as PODD and Gateway are available via in-app purchase. All TD Snap Page Sets are accessible via touch, eye gaze or switch, offering clear speech output. They also offer integrated access to a suite of powerful tools, such as intuitive search and editing, behavioral supports and Google Assistant. TD Snap is compatible with all Tobii Dynavox  devices and is also available to purchase as a standalone app for iPad and Windows devices.

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TD Snap is a flexible software offering a choice of AAC solutions to help people with communication disabilities. With a number of page sets to explore, professionals and families will find the right solution to meet their needs.

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Available through AbleNet, the QuickTalker Freestyle comes with a five year warranty and the support of the AbleNet team. There are 2 sizes available and the iPadOS is the operating system. An AbleNet funding team is dedicated to the finding process and can guide families and providers through needed documentation, speech evaluations, and insurance guidelines.

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Explore the QuickTalker Freestyle’s device details, including robust features, customizable options, and comprehensive support for effective communication.

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The ProSlate series has a variety of devices in different sizes, ranging from a 13 inch screen to one that can fit in your pocket. Operating systems are iOS based. ProSlate also offers an eye gaze device.

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ProSlate™ Series and AAC Apps: Highlighting Proloquo2Go

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The ProSlate™ Series from Forbes AAC are iOS-based speech generating devices that can run almost any AAC app on the market using iOS-based software.