IMAGE

EXCHANGE COMMUNICATION SYSTEMSPECS

(Picture Exchange Communication System)
Catherine B. Coleman, MS CCC-SLP
Speech Language Pathologist
George Mason Middle and High School
INOVA VNA Home Health Therapy
(h) 703-934-0303
(w) 703-248-5550 ext. 4017
email [email protected]
INTRODUCTION: Information for Parents
Pyramid Educational Consultants, Inc.
Andrew S. Bondy Ph.D.
Lori A. Frost, MS, CCC/SLP
5 Westbury Drive, Cherry Hill NJ 08003 tel. (609) 489-1644

Children with autism, especially very young ones, often have great difficulty using
expressive language. Up to 80% of children with autism who enter public schools at age 5 or
younger do not display any useful language. For these children and others who may have some
speech but rarely use it to their advantage, intensive, highly structured interventions will be
necessary if language is ever to develop. Another major difficulty faced by young children with
autism is how they react to social situations. These children rarely initiate interactions with adults
and usually do not maintain them, even when initiated by adults. Of course, most of our social
interactions involve language, so these children face a double problem.
Many parents and professionals have tried to teach their silent children to talk. Such
training often begins with trying to teach the child to look directly into the adult's face or eyes.
Although this type of teaching works, it takes many weeks, or months. The child is then taught to
make various sounds and eventually to imitate them. This step also takes a lot of time. Finally,
the child is taught to blend sounds into words--words often selected by adults. During all this time
of learning, the child continues without having a calm and useful means of communicating with
other people.
Some people have tried ALTERNATIVE communication systems - that is,
communication styles that do not involve speech. Sign language is one of them, as is the
language of images and other visual symbols. Several factors contribute to making these
systems relatively slow to acquire. For example, sign language requires imitation, which is not
easy for children with autism. Imaging systems (at least so far) involve pointing (pointing with
your finger) at images. However, pointing is often confusing for both the child and the adult
because the child does not always have the adult's attention or see that the picture is a picture
of…., or the child repeatedly hits one or more pictures.
We developed the Picture Exchange Communication System (PECS) because of our
difficulty over the years trying to train with other communication programs (Bondy and Frost
1994). The system has been used with 85 children in Delaware who were 5 years old or younger
and were non-verbal by the time they entered school. Of the 66 children who used PECS for
more than a year, 44 already use independent language and 14 more use it aided by picture
systems (or written words). Seven of those children are no longer educationally identified as
autistic and more than 30 have been placed in classrooms for children with mild disabilities.
Therapists enthusiastically support and use the system and parents have used the system at
home or in the community. PECS is acquired very quickly; many children learn the fundamental
exchange on the first day of training. An important aspect of PECS is that children are the
initiators (they are the ones who start the interaction). They do not learn to wait or depend on
adults to communicate. They immediately express their needs to adults who can satisfy them.
Learning PECS has also had a dramatic effect in reducing concerns about managing these
children's behavior both at school and at home.
PECS begins by finding things that appeal to the child (that is, things the child wants).
These objects can be food, drinks, toys, books, or anything that the child consistently seeks out
and likes to have. After the adult (therapist or parent) knows what the child wants by observing it,
then a picture (color photograph or black and white line drawing) is made of that object. Suppose
the child likes raisins. As the child reaches for the raisins, one therapist physically assists the
child in taking the picture of the raisins and placing it in the open hand of the second therapist -
the one holding the raisins. As soon as the picture is placed in the hand, the therapist says "OH,
you want a raisin!" (or something similar) and immediately gives the raisins to the child. The child
is NOT asked what he (she) wants. The child is NOT asked to take the picture. The therapist
says NOTHING until the child has placed the picture in the open hand. Slowly, over time, the
physical assistance in taking the image is discarded, as is the assistance in leaving it in the other
therapist's hand. After several interactions, the child begins the interaction, taking the image and
giving it to a therapist.

The next step involves moving the therapist away, so that the child has to make an
effort to reach him. Several people must now be involved in receiving the images--but only with
the image of the raisins at this point! Once the child is taught to use one picture with several
people, then more pictures of things he likes will be added. However, at this point, the child is
presented with one image at a time. After spending some time using several images, one by
one, then the therapist can put 2 images on a board, then three, four, etc.
A child using the system at this point, while seemingly doing only a few things, has
learned some extremely important skills. When a child wants something, he or she will go to the
picture board, pick a picture, go to an adult, put the picture in the adult's hand, and wait to
receive what they have requested. The child will calmly go to an adult to get something, rather
than trying to get the object while ignoring everyone else. The importance of the child
INITIATING the interaction cannot be overstated. The child is NOT dependent on adults.
The PECS system will then teach the child to create simple statements, such as "I
want"….."cookie", using various pictures and a "sentence strip". The child must continue to
deliver the sentence to an adult. The PECS system then teaches the child the difference
between requesting (asking) and simple comments such as "I have" or "I see" or "There is a…."
For some children, this step is difficult and will require some "fine tuning." PECS continues to
expand the number of pictures per utterance and the number of concepts the child can
communicate about. In our experience, children who use 50 to 100 pictures often begin to talk
while handling the pictures. (Some children begin to talk much earlier, while other children must
continue to rely on pictures.)
We are very pleased with the extraordinary success we have seen with children taught
to use PECS. We have controlled studies supporting the use of PECS in many states across the
United States, South America, and Canada, from toddlers to adults, and with children with
autism and other severe communication disabilities. All of the children we have worked with in
Delaware and New Jersey have learned at least the first aspect of PECS--exchanging a picture
(or visual representation) for a desired object. A very high proportion of these children learn to
speak within a year or two of starting PECS.
PECS is easy to learn and use by therapists, staff and parents. It does not involve
complex materials or highly technical training. It does not involve expensive equipment,
sophisticated testing or expensive staff or parent training. It is helpful both in the classroom, at
home and in the community. Children who have already learned other communication systems
have quickly switched to PECS and expanded their communication skills. Children in PECS are
highly motivated to learn the system, because they can get exactly what they want. We
understand that very young children with autism will not usually try to make us happy or please
us with their achievements. Through PECS they can learn the importance of having other people
to help them and they can learn to trust that people will respond to their delivered messages
calmly. With the right system and proper training a picture is surely worth a thousand words.

BASIC PREMISES
Children using PECS are taught to approach and give a picture (photo) of a desired object to
their interlocutor in exchange for the object.
By doing this, the child initiates a communicative act, to obtain a concrete result in a social
context.
The Keys to Getting Started
1 .- Prepare a Symbol System
Black and white line drawings
Line drawings in color
Commercial photos
Personal photographs
Album for pictures/photos

2 .- Images (photos) must be easily available during training.

Wear a carpenter apron with pictures (photos)
Have a well-organized box of pictures (photos)

3 .- Use Velcro widely

Stick evenly on the images and on the support surface

4 .- Have a place in the room or house where the pictures and/or boards are available to
the student

5 .- Throughout the training, the student should NEVER hear the words "NO" or "I don't
have any of that"

Set Reinforcements
What is highly desired by the student?
• Interview family, teachers, friends
• Reinforcement Assessment
(An object is said to be preferred if the student safely reaches it within 5 seconds or if it is
selected by the student 3 times.)

Problems when starting

1 .- Is there a motor disability that inhibits the child from actively reaching?
2 .- Don't limit your options at this stage

PROGRAM PHASES
(Phases 1-4 are directly based on the work of Andrew Bondy and Lori Frost; Ryan, Bondy and
Finnegan (1990), Frost & Bondy (1992) and Bondy & Frost (1994).
Phase 1: Physically Stimulated Exchange
Aim:
Upon seeing a highly preferred object, the individual will select the object symbol, approach the
therapist, and place the symbol in the therapist's hand.
Note:
1. Verbal incitement will not be used to carry out the exchange.
2. Once the exchange has occurred, the therapist or interlocutor immediately says the
name of the symbol and provides the requested object.
3. More than one preferred object may be used in this phase, although each object should
 be presented individually. (one by one).
4. The symbol may be initially presented on a display board, or on the cover of a book, or
held in front of the individual.
5. Provide opportunities for multiple requests for the same object in one activity. For
example, give the child small portions of a desired food or repeatedly remove the desired
activity from the child to elicit more requests.
6. Don't do all your training in an "orderly" way. If possible, arrange at least 30 opportunities
throughout the day for the individual to apply.
7. For phase one, it is helpful to have two people available for training. One person sits
behind the child and provides the physical stimuli, the other person holds the hand in an
open palm position and provides verbal reinforcement and the requested object.
Phase 1 Steps:
A. A FULLY STIMULATED (INCITED) EXCHANGE:
As the individual reaches for the object, the teacher physically assists the student to pick
up the symbol, reach out, and place the symbol into the open hand of that therapist.
Once the symbol is placed in the therapist's open hand, the therapist verbally reinforces
the child (Oh, you want the ______________________________) and immediately
gives the student the requested object.
B. WITHDRAWING PHYSICAL ASSISTANCE:
Removing physical assistance for the student to take the symbol and reach the teacher's
open hand. Continue to show the student your open hand as soon as the student
reaches for either the object or the symbol. Continue this step until the individual, seeing
the therapist's open hand, takes the symbol, approaches the therapist, and places the
symbol in his or her open hand. Immediately give the individual the object and verbally
praise him.
C. COVER UP THE "OPEN HAND KEY"
Do this by waiting longer and longer to show your open hand, until the student is able to
take the symbol, walk over to the adult, and drop it into the teacher's hand.
Common problems:
1. The individual is not interested in the object and shows no interest in achieving it. The
object may not be motivating. Explore other activities and objects.
2. The individual does well for a few sessions and clearly demonstrates independent
sharing to obtain desired objects. After a few sessions, the individual is less interested
and it becomes very difficult to achieve an exchange even for objects that are known to
be of high interest. Some individuals seem to learn that they can wait, and once the
master is gone, they know they can get whatever they want anyway. These individuals
will need a great deal of environmental adaptation to be consistent with the exchange.
This tends to happen when PECS is taught within a more traditional therapy model, i.e.
one hour of therapy each week.
3. The individual sees a highly preferred object and immediately throws a tantrum or
initiates a repertoire of behaviors that has been effective in achieving his or her goals in
the past. The therapist needs to provide immediate physical assistance to help the
individual exchange the symbol and obtain the desired object, before the behavioral
response becomes more severe (tantrums increase).
4. The individual goes from one activity to another and never concentrates on one for a long
period of time. You may need to make symbols for objects as the individual switches
 from one activity to another, so have blank cards available for this purpose. You will also
need to find other highly motivating activities for the individual.
Phase 2:
Increasing Spontaneity and Search/Locate Behaviors and Persistence
Aim:
The individual goes to the communication board, selects the symbol, goes to his interlocutor, and
leaves the symbol in the interlocutor's open hand.
Note:
1. Verbal prompting or encouragement is not used to achieve exchange.
2. Continue teaching a variety of symbols – presented one at a time.
3. Continue to re-evaluate and introduce new reinforcements constantly.
4. Use a variety of therapists, adults and if possible children as interlocutors.
5. In addition to structured training trials, create 30 opportunities for spontaneous
solicitation during functional activities each day.
6. Vary the position and number of symbols on the communication board until
discrimination is perfected.
Phase 2 Steps:
A. INCREASE THE DISTANCE BETWEEN STUDENT AND TEACHER.
The individual begins the exchange, takes the symbol and approaches the adult. As the
student approaches the therapist, the therapist leans back so that the student has to
stand up to reach him. Once the exchange is completed (the symbol is left in the adult's
open hand) the individual is verbally reinforced and given access to the object. Continue
training in this manner, gradually increasing the distance between the student and the
therapist. Continue training in this manner, gradually increasing the distance between the
student and the therapist. Maintain close proximity between the student and the symbol.
The therapist should initially increase his distance from the student in very small
increments (literally inches/centimeters). Depending on the student's success in
approaching the adult, the increases should be greater. Continue to reinforce the student
upon achievement, not after the exchange has been completed.
B. INCREASE THE DISTANCE BETWEEN THE INDIVIDUAL AND THE SYMBOLS.
Begin by systematically increasing the distance between the individual and the symbols,
so that the individual has to go to the symbol and then go to the adult to complete the
exchange. Continue reinforcing as described above.
C. PERSISTENCE IN TEACHING.
Allow the individual to bring the symbol to the adult, but let the adult pretend not to be
paying attention. The individual can be taught (physically stimulated) to touch the adult to
get attention and then exchange the symbol.
Phase 3 Steps:
A. DISCRIMINATION :
Follow the sequence below when starting discrimination testing. Evaluate a starting site
with each student. Some students will learn to discriminate quickly. It is not necessary to
go through all the steps with each student.
 a. A "high preference" symbol and a "blank" card.
b. A "high preference" symbol and a "meaningless" symbol.
c. A "high preference" symbol and a "low preference" symbol.
d. One "high preference" symbol and 2,3, or 4 "low preference" symbols.
e. Multiple "low preference" symbols with one "high preference" symbol - the
individual discriminates and selects the high preference symbol and exchanges
them.
f. Multiple "high preference" symbols present - the individual searches,
discriminates, and selects (from five to ten symbols present) and exchanges the
highly desired object regardless of where it was placed in the selections offered.
B. REVIEWS OR CORRESPONDENCE CHECKS:
Once the individual is demonstrating discrimination between symbols, do a matching
check by having the individual request a particular object and then…. Gesturing, "Go
ahead and take what you asked for." The individual must select the appropriate object. If
not, the student is not using the symbol correctly.
C. REDUCING SYMBOL SIZE:
Once the individual is able to discriminate between 8 to 10 symbols on the
communication board in a given time, gradually begin reducing the size of the symbols.
Reduction in symbol size can wait until phase 5 when a number of symbol-organized
events have to be taught.
Common Problems:
1. The individual takes all the symbols and exchanges them. This is quite common.
Physically encourage the individual to take only the symbol that you think the individual
wants.
2. The individual does not discriminate between symbols. Ex. He doesn't look at the board
or grab the nearest symbol. Try using highly preferred foods versus less preferred ones.
Ex. sweet vs. onion. Try changing the symbol type, Eg. switch from a simple drawing to a
photograph or colored symbol backgrounds. Try enlarging the size of the symbols.
3. The individual inconsistently discriminates between symbols. The environment must be
modified to the needs of the individual so that he can make the exchanges to obtain
everything. Visual search skills need to be stimulated.
4. There are some individuals who may not be able to discriminate between symbols. For
these individuals, move the symbol close to its referent (real object) but at the same time
do not allow easy access to the same referent. The individual will go to the real object
through visual and location cues, but still needs to locate the symbol and exchange it
with his interlocutor to play or interact with the object. This is an extension of the "Hand
and Help" gesturing program described by Pein & McGibbon-Klein (1989).
Phase 4 Sentence structure:
Objective: The individual requests present and non-present objects using the symbol "I want",
putting it on a sentence strip, taking the symbol of what he or she wants, putting it on the
sentence strip, taking the sentence strip from the communication board or book, approaching the
interlocutor and exchanging the statement with the individual. At the end of this phase the
student typically has 20-50 symbols on the board/book communicating with a wide variety of
interlocutors.
Grades:
 1. Verbal prompts are not used while the exchange is taking place.
2. Continue with periodic "correspondence" reviews.
3. Provoke at least 20 opportunities (preferably 30-50) per day.
4. A sentence strip (board card approx. 2 inches) Attached with Velcro to the front of the
book or communication board.
Phase 4 Steps:
A. STATIONARY SYMBOL "I WANT":
The "I want" symbol is attached to the left of the sentence strip. When the student wants
a single item, physically guide the individual to place the symbol on the sentence strip
next to the "I Want" symbol. Then guide the student to give the prayer strip to the teacher
(now containing "I Want" and a single symbol). Over time, gradually decrease
assistance. Mastery is achieved when the student is able to attach the symbol of the
desired object to the sentence strip (which already contains the "I Want" symbol),
approach an interlocutor, and deliver the entire sentence strip without any prompting.
B. MOVE THE "I WANT" SYMBOL:
Move the "I Want" symbol to a location in the communication book/board. When the
individual desires an object/activity, guide the student to pick up the "I want" symbol,
stand on the left side of the sentence strip they pick up and place the desired symbol
next to it on the sentence strip, walk over and hand the sentence strip to the speaker.
Over time, I covered up all traces. Mastery of this phase must occur without physical or
verbal prompting between at least 3 therapists/interlocutors.
C. REFERENCES NOT IN SIGHT:
Begin by creating opportunities for the student to request objects/activities that are not in
plain sight. Start by putting something away immediately after the student has requested
it and it has been given to them. Over time, the student will need to learn to request
objects that he or she knows about but cannot see.
D. TRAIN THE INDIVIDUAL TO REMOVE THE SYMBOLS:
After the exchange and delivery of the requested object, physically encourage the
student to take the strip and the symbols to return them to the book.

Phase 5: Responding to "What do you want?"

Aim:
The student can spontaneously request a variety of objects and can respond to the question,
"What do you want?"

Preparation:
Have the communication board with the "I want" picture, the Velcro strip (sentence line), and
photographs (images) of objects available. Have multiple reinforcement items available but
inaccessible (hidden)

Steps:
A. Zero second delay:
With a desired object present, and the "I want" card on the communication board, the
therapist simultaneously points to the "I want" card and asks, "What do you want?" The child
must then take the "I want" picture and complete the exchange.
B. Increasing the delay interval:
Start by increasing the time between asking "What do you want?" and pointing to the "I want"
card.
 C. Don't give him any clue to point out:
Once the student has consistently mastered the command "What do you want?", then
systematically mix in opportunities for spontaneous request and response.
Phase 6: Spontaneous response and comment
Aim:
The student responds appropriately to "What do you want?", "What do you see?", "What do you
have?" and other similar questions when they are asked randomly.

Preparation:
Have the communication board available with the “I want” image, the “I see” image, and the “I
have” image. Also have available several pictures of less preferred objects for which the student
has already learned the picture.

Steps:
TO. "What do you see?"
B. "What do you see? Vs. "What do you want?"
C. ´See´ vs. 'Want' vs. have

FAQ:

1 .- How many images should I enter during Phase 1?

The number of images depends on the reinforcement rating and the number of
attempts/sessions required by the student to master phase 1.

2 .- Should I only use images of a single topic such as a snack when I start teaching the student
the program?
Early training attempts in Phase 1 typically take place in a highly structured format. The student
may initially be removed from ongoing activities to teach Phase 1.

3 .- How do you decide when to introduce new vocabulary?

New vocabulary is introduced when the need for reinforcement is minimal. The number of
images used in Phases 1 and 2 will be unlimited, as long as they are entered one at a time.

4 .- How do you determine when it is appropriate to start Phase 3?

There may be some overlap between achieving Phase 2 and Phase 3 mastery. For example, if a
student has learned to go to his interlocutor to give him the picture, but is still learning to go and
take the pictures, in this case, it would be correct to start discrimination training. It's important to
remember that Phase 2 is never really over. The crucial component of PECS is that the student
be a persistent communicator, one who "teases" rather than one who has to be prompted to
communicate.

5 .- Do you use individual systems or systems based on collective classrooms?

Each student must have THEIR own communication system that can travel with them. The
system is treated as if it were an "appendage" of the child, [like a wheelchair or an orthopedic
shoe] and the child must learn to take responsibility for it. It should not be the therapist or the
relative who carries the book from one place to another. Group classrooms or home-based
systems are extremely useful as well. These can be "menu" boards containing specific
vocabulary. For example, in the bathroom, there can be a board containing pictures of soap,
towel, bath toys, etc.

6 .- How do you determine the number of symbols to be used during an activity?

Whether the student is in Phase 1 or Phase 2 of training, no more than one symbol should be
presented at a time. It is up to the therapist to determine, based on effort assessment and
natural routines, which image should be available at each point in the activity. If the child is in
Phase 3 of training, the number of symbols will be determined by the student's current ability to
discriminate them. Beyond Phase 3, all images must be available to the student.

7 .- What do you do with a child who has not been identified as having reinforcements?
Without potential reward, there is no potential for communication. Therefore, we must continue to
determine what objects and events would be rewarding to the learner. Sometimes this will
require careful observation of the student's preferences, such as observing the student who
stands at a window, who frequently sits in a rocking chair, who puts a cheek on cool surfaces,
etc. Each of these preferences can be used as a potential reward and therefore, as an object or
activity to request.

PECS in the Classroom

1. This program was initially developed and implemented in a variety of classrooms
throughout the state of Delaware.
2. The program works well with a "consultation model" where one person is available to
provide intensive support (making symbols, obtaining motivators, implementing the
program in a classroom, and training classroom staff).
3. Determine the priority. If the priority is communication, then other classroom goals and
routines will need to be modified for a period of time to try to support student
communication.
4. Some changes will be needed in the classroom. Keep in mind that many of the students
for whom PECS is appropriate have narrow or unusual interests and that unique
motivators for each student may not be readily available.
5. For most students to learn the power of communication, they will initially need to be able
to have highly motivating activities immediately upon request. This should only be
necessary for a few weeks. Once you delay getting requested activities or motivators
available at specific times of the day, be sure to have a symbol-based calendar system
so the student can predict daily activities.
6. Even if you may not be able to make changes in the classroom to create opportunities for
communication, you may be able to use PECS during snack time or mealtime.
7. If you have a classroom with multiple PECS users, each student will need to have their
own book and a specific place to keep it. Do not try to introduce all students to PECS at
the same time. Pick one student and develop the program with that student before
moving on to the next. It is important to teach each student to replace symbols in the
book after they have already been used.
8. Please remember that for students to gain the most benefit from this program, they must
communicate spontaneously 30 or more times throughout the school day.
Educational Considerations for Children with Autism
1. Early and intensive intervention can result in significant developmental change in some
children with autism.
2. Communication/social skills are the most important a child can learn. Particularly when
80% of pre-schoolers and 50% of school-aged children show no functional speech or
have limited communication.
3. Increasing control over the environment is the primary goal of instruction.
4. Functional Skills are taught in their natural context. Pre-academic and academic skills
may also be important for the young child.
 5. Instructional priorities come from the individual and his or her environment.
6. Parent involvement is a crucial component of the instructional process.
7. Integration or Inclusion may not be effective without active and direct programming. It is
my opinion that the "dump and hope" model of inclusion is often not effective. There may
be prerequisite skills that the child must acquire in order to benefit substantially from
Integration. I believe that some young children with autism need to have an effective
communication system and be able to learn it before they could benefit from inclusion
environments.
8. Children need structured and predictable learning environments centered on visual
programs/schedules.
9. Challenging behaviors can be best managed using a functional analysis of behavior.
(behaviors may be the result of tasks being too difficult, frustrating, too boring, or the
need for specific sensory input.)
10. Children need their teachers to have high expectations and provide a positive learning
environment.
Sample objectives involving symbol-based approaches:
1. Facilitating 30 or more opportunities daily, the student will use words, symbols, and/or
language to communicate a variety of functions in a variety of settings throughout the
day.
The student will be provided with physical assistance if required.
Therapists and classroom staff will assess the use of PECS daily using the worksheets
and charts.
2. The student will use a personal schedule to start and complete activities, and when
switching from one activity to another throughout the day.
The student will be given full access to the schedule (program) and, if necessary,
physically encouraged to do so. The student will use his/her personal schedule a
minimum of 12 times during the day between his/her activities.
Progress will be measured based on observation/documentation made by the therapist
and classroom staff once a week.
3. The student will prepare a simple snack for the class following a symbol/word
instructional routine.
The student will demonstrate 100% capacity in all steps of the task analysis for which
assistance level has been given in 5/8 days.
Daily information will be collected by staff working with the student using a planned
homework routine.