Using PECS for Language Delayed Toddlers

Many young children need another way to communicate before they learn to talk. Speech-language pathologists often recommend that parents introduce pictures to help give a child an additional way to express his wants and needs. The most popular method for beginning to teach children to communicate with pictures is The Picture Exchange Communication System, commonly called PECS.

There are lots of myths and misconceptions concerning PECS. First of all, just because you’re using pictures doesn’t necessarily mean you’re using PECS. PECS is a very specific and systematic protocol for teaching a child to request items that he wants using pictures. This program was authored by Bundy, an applied behavioral analysis psychologist, and Frost, a speech-language pathologist in 1985. This program began as a way to teach autistic children to communicate, but it’s been expanded and used in a wide variety of populations and ages.

PECS consists of 6 very distinct phases based on the principles from the fields of applied behavioral analysis (ABA) and speech-language pathology.

If you’re just placing pictures out in front of your child and letting him choose which one he wants, you’re not using PECS. If your SLP is encouraging you to take digital pictures and hang them on the fridge in hopes that your child will point to what he wants, you’re not using PECS. If you are showing him a picture to help him understand what comes next in his day, you’re not using PECS. These are all very valid methods for using pictures to communicate and process language, but they are not PECS.

PECS is a very specific program outlined in its latest version in 2002 in a training manual that’s helpful for both clinicians and parents. You can get more information on ordering this system at the website at www.pecs.com. I highly recommend that parents who want to begin to use PECS with their children should order the manual and read it from cover to cover. It’s an easy read and very parent-friendly. Don’t depend on your SLP to teach you or to implement the program in the way it was intended. Read it yourself so that you know exactly how to introduce each phase. Using the phases just as they were intended is the quickest and easiest way to successfully implement this sytem for your child. Don’t cheat! Do it correctly, the first time!

(Just a quick note – I have also purchased additional used copies from e-bay. It’s cheaper than new, but you may get a highlighted, dog-earred, or stained copy, but that’s usually okay for me and the parents of children on my caseload!)

This information about PECS is directly from their website –

“PECS begins with teaching a student to exchange a picture of a desired item with a communicative partner, who immediately honors the request (a mand within Skinner’s terminology). Rather than verbal prompts we use our unique 2-Person Prompting Procedure, building immediate initiation while avoiding prompt dependency. The system goes on to teach discrimination of symbols and the development of simple sentences. In the most advanced Phases, individuals learn to respond to statements and questions (i.e., intraverbals) as well as learn to comment about common items and activities (i.e., tacts). Many preschoolers using PECS also begin developing speech.”

In real-life parent language, this means that you first select items that you KNOW your kid is going to want and take pictures of these. Things I always use with kids are snacks (think junk foods not green beans) or highly preferred toys. You can use PECS or Boardmaker pictures (colored drawings similar to cartoons), but I do usually take pictures witha phone or a digital camera, print them, and then laminate them so they are EXACT visual representations of what the child wants and can stand up to attempts to throw, tear, and eat them! Kinkos laminates pictures cheaply, or you can go the really cheap route and use clear shelf-liner paper or clear packing tape to cover your pictures. If you think you are going to use PECS for a while, go ahead and invest in a $30 laminator from an office supply place or WalMart. It’s worth the money.

Initially I don’t enourage parents to spend lots of money on supplies other than the a way to take and laminate the pictures. If a parents doesn’t own a smart phone, get a digital camera (which most people have or can borrow).  Places like WalMart and Walgreens are cheap alternatives for printing pictures if a family doesn’t already have a decent printer. Don’t rush out and buy the velcro or a special notebook until you know you’re going to be using this system for a while.

I actually also loan parents my copy of the PECS manual to read initially, then they buy their own when we decide this is a method we’re going to use for a while. But again, if your SLP isn’t providing you a copy of the real thing, go ahead and purchase the manual yourself. You may have to end up letting her (or him) borrow your copy to learn how to do it correctly!

Also remember that PECS takes two adults to implement. One adult is the one who “prompts” the child to by holding the item the child wants to entice him to trade his picture for the item and then holding out the other hand to accept the picture. The second adult is the “helper” who sits behind or beside the child and physically helps him pick up the picture and give it to the other adult. You MUST have 2 adults to use PECS initially. This is a deal breaker if you don’t. Wait to practice until Dad comes home, Grandma is there, or during therapy time. I have trained older siblings as young as 6 or 7 to help too.

One other word of caution – This is supposed to be mostly a nonverbal cueing system, meaning that children are supposed to learn to trade pictures for items they want WITHOUT LOTS OF VERBAL INSTRUCTION. This is HARD for some parents. If you are saying too much during the initial phases, you’re defeating the whole purpose of PECS. I have had parents who repeatedly say, “Give me the card! Where’s your picture? You have to give it to me. I’m not giving you this until you pick up the card, etc…..” Don’t do this! Prompt in just the way the PECS manual says!

Another misconception about PECS is that it is only for nonverbal children. While it can be used it this way, it can also be used to teach interacting/social skills for a child who is verbal but doesn’t communicate very well. For example, some children talk, such as labeling pictures or quoting from their favorite movies, but they don’t understand how to initiate a request to ask for that they want. PECS teaches children how to approach another person and begin interaction by systematically training these skills using pictures.

Initially requesting is targeted in PECS, but later phases also work on responding to questions and commenting (I see, I hear, etc….)

In the middle phases of PECS you’re also going to be teaching picture discrimination so that you can be sure your child can tell the difference between pictures. This is helpful because sometimes children select pictures with no real communicative intent. PECS eliminates this because you’ll be using a picture of an item your child doesn’t want. What a lesson to learn! If you give mommy the wrong picture, you get the wrong item! It’s a very tough lesson to learn, but how else can you be sure your child is really choosing? Many parents want to skip this phase and begin to offer choices for pictures too soon. They give two pictures for things their child may really want, so he never learns to look at the pictures and “choose.” This approach teaches this important skill like no other method I’ve ever used. When children master this phase, they are purposefully choosing and discriminating between pictures for items. That’s communicating!

One other great skill PECS teaches is helping kids learn to seek out other people to communicate. It requires that children lean across a distance or walk across the room  to trade a picture for an item they want. Again, this approach teaches this skill in a very concrete way. Once children learn to do this, they almost always begin to “lead” their parents to what they want (if they haven’t done this already!).

Some parents are afraid that using pictures to teach their child to communicate may mean that their child will never learn to talk. Let me beg you to change your mind! Using PECS (or another alternative method like sign language) actually INCREASES the likelihood that a child will become a verbal communicator! Research has confirmed this with PECS. For more information on these studies visit the PECS site. In my opinion, a child who isn’t going to talk for a long time absolutely needs to learn another way to communicate. As his parent, you should want that for him to save yourself some frustration and heartache!

m4s0n501

Comments

  1. courtney says

    Laura,
    I have seen your website through the Ivillage message board, but have never asked for your feedback directly. my daughter is Sydney (3 yr old dx apraxia, sev. phonological disorder) I have also posted some video clips of her speech on you tube. She has newly transitioned and the therapists in both school districts, in addition to her EI therapist all agree we should begin implementing PECS then possibly AAC depending on how she responds to PECS. It seems they are not as concerned with doing the “official” system, or at least they have not voiced it to me. But have asked to make a list and or photograph relevant subjects, and they have offered to laminate them. If I am going to initiate it (PECS) I would like to do so in the most effective way, as Sydney definitely needs more functional language, particularly when entering preschool in the near future. My question is, do I start with the most common requests/needs, even though i can understand her verbal attempts for these things? For example, she signs and approximates “drink”, I then ask her what she wants, and usually the answer is her approximation for “chocolate milk”. Are these common requests a good place to start, even though I can understand her in context well enough?

    Thanks!
    Courtney

  2. Laura says

    Courtney – Thanks for the great question! I think it is so important to give kids a supplemental way to help others understand their speech, even when Mom is doing okay.

    My caution to start directly from the beginning with PECS is especially for children who don’t know how to initiate requests. From what you’ve said, Syndney knows how to initiate and ask, she’s just not understood. Introducing a picture system to her should be pretty easy, so that’s probably why your therapists don’t think starting from square one with PECS is necessary.

    At home I would certainly start with common requests to be sure she understands the task of requesting with pictures to supplement her speech. If her receptive language is age-appropriate, I think you can instruct her with something like, “Sometimes Mommy doesn’t know what you want when you tell me. I have made you some pictures so you can show me, especially when I can’t understand your words.”

    Then you can introduce the pictures and “practice” some fun requests. Start with the 1:1 trade – you have the chocolate milk and hold it out saying, “What do you want?” Then she gives you the picture and says, “chocolate milk.” Be sure that she keeps telling you what she wants too, so her verbal speech & language skills don’t diminish during this time. It’s also a great way to practice speech without so much pressure since she’s going to be focused on the new task -giving you the picture.

    Once she’s got that, you can give her some “choices” by having her select what she wants from a couple of different pictures. If you think she can’t discriminate pictures (choose one she really wants vs. a non-preferred choice), then back up and do the discrimination training phase, but my guess is that she’ll get it pretty quickly and won’t need specific practice with this phase.

    I would also suggest that you do the “proximity” trading part of PECS so she learns to take you the picture when you’re across the room, which is definitely a skill she’ll need at preschool. Somtimes a teacher will take the time to stand and ask and then wait on a specific request, but if it’s possible, help Sydney learn how to use the pictures efficiently and independently so that they can be as effective as possible for her at school.

    I think introducing pictures at home now is a great way to make sure she’s familiar enough with them to transition this to preschool when it’s time for her to go. The pictures may even help you too for things you don’t get on her first couple of tries verbally. Right before school starts you can say something like, “You can take your pictures to school too. You can show your teacher what you want to help her know what you’ve said.”

    Good luck and keep me up to date on her progress! I love hearing the day-to-day stuff because it helps me know what other info I need to share on the site as well as help my little friends on my own caseload! Laura

  3. Angela says

    My son is 2;2 with an expressive language delay. He currently has 6 words and 10 signs. I am just not sure if I should introduce PECS as well as signs…

  4. Laura says

    Angela – Sorry it’s taken me so long to respond. As I’m sure you’ve read, we’ve had website problems. Before I say anything, let me ask you, what does his SLP think? Is she pleased with his new words and signs and feels that he’s making progress, or does she think he’s “stuck” and needs more help communicating his wants and needs? Does he seem increasingly frustated that he can’t communicate more complex and different messages than he has words or signs for, or is he hanging in there and making the most of what he is able to do? All of these factors determine when/if I introduce PECS for a child.

    I will tell you that generally I use PECS as a last resort when words and signs AREN’T coming, but this decision really is child-specific. Your SLP may feel the same way. Some SLPs introduce everything, words/signs/pics at once. You’ll want to see what your SLP thinks and WHY she feels that way about your son’s specific situation. I also introduce PECS when a child doesn’t seem to understand requesting, and it sounds like your child might already have “communicative intent.” If you’d like to send me some more details, I’d be happy to help walk you thru more of the decision making process I’d use for him. Again, sorry for the delay in responding. Thanks for the question! Laura

  5. Angela says

    He is just starting group therapy in a multidisciplinary program, so the therapists are just getting to know him. I do feel that he is progressing learning signs. He learned 3 new signs in the last week, and I must share some of the credit for this progress with you! I was utilizing the ideas I found on your website, so thank you.
    You are right that my son does understand requesting. He requests both items (water, food) actions (sleep, bath, change diaper etc.)and people (mom & dad). I am tying to model pointing and labeling so that he will comment as well.

  6. Laura says

    Angela – I’d stick with signs and words for now since he is making progress and already understands requesting. You also didn’t indicate that he’s becoming more frustrated. If you’d said that I probably would lean toward starting PECS, but if not, stick with what you’re doing. Since it sounds like you’re only getting group services in a center, I’d strongly encourage you to start your own therapy play sessions with him at home every day several times a day. Kids who make the most progress are the ones with moms who tackle this problem head on and become their own child’s therapist. It sounds like you’re already doing this since you’ve implemented ideas you’ve read here on the site, and it’s working for him since he’s learned 3 new signs!! Congratulations Mom!!! Keep up the good work! Laura

  7. Tamara says

    Laura,
    I have a 3 1/2 yr old child with Down Syndrome. He has been in speech therapy services for approx 2 yrs now, beginning with early intervention as well as private services. He was transitioned into the school system at 3 and began services with the speech therapist while at Head Start, but continues to have two alternative private services as well. His private services show constant slow improvement. He is communicating with both sign and verbal approximations. However, the school’s therapist cannot get him to respond, sign, vocalize, or interact with her. The school system has decided to implement the use of a “picture-voice” board. I’m unsure as to the exact product they intend, just that it will give an option of 2 pictures (to begin with) that will vocalize the request when he presses it. Ex: press the book and it will speak “I want the book”
    My question is, is this really necessary? My husband and I are concerned that this will encourage our son to not speak. Why teach him how to use this instead of teaching him how to speak? His private SLP’s are unsure if this would be an appropriate approach – but our son signs and vocalized for them where he doesn’t for the school.
    What are your suggestions?

  8. Laura says

    Tamara – I never think that alternative communication systems prevent kids from talking, so I don’t think I’d necessarily restrict them from following through with this recommendation.

    However, I think school may be missing the bigger picture here. Knowing that he can and does sign and approximate words and vocalize in speech and at home would mean something totally different to me. I’d actually push him even harder! If he can do it in one place, then he needs to be signing & talking everywhere. Do they think that he needs a way to express messages that he can’t yet say/sign even at home?

    Regardless of the intent for the system, if I were you, I’d pay for one of your private SLPs to visit school and meet with his SLP or better yet, accompany him during one of his speech sessions so she can show the school SLP what works for him. If this isn’t possible, videotape the session with your private SLP, call an IEP meeting and have your school team view it with you. Your private SLPs may be using approaches that your school folks haven’t tried. Shifting the focus to what he currently can already do is ALWAYS appropriate with the goal of getting those signs and words to generalize to school.

    Let me know how this turns out for you! Laura

    Is there another SLP at his school that can see him besides the one who’s had no success? This is also something I’d pursue.

  9. Laura says

    Tamara – One more question – does he sign and talk for you at home? If he doesn’t then this is also something I’d heavily pursue. He needs to be performing and more importantly COMMUNICATING with you at home even more so than in speech sessions. Laura

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