Medically Reviewed By Sonam Kothari, Written By Tejasvi Parekh
Autism spectrum disorder is widely known as a disorder with developmental characteristics that affect one in issues of social interaction, communication disorders, and repetitive behaviour. The spectrum nature of ASD signifies that the severity varies quite widely across individuals.
Communication difficulties rank among the most common challenges of individuals with ASD, as most children tend to be slow or completely delayed in speech.
To them, alternative communication (AAC) systems, such as the Picture Exchange Communication System (PECS) are vital in communication and interaction with other people.
The Picture Exchange Communication System is an evidence-based tool for augmentative and alternative communication or AAC. Simply defined, it is a method for anyone, especially those diagnosed with autism, to convey their wants and needs using pictures.
Originally designed by Lori Frost, and Dr. Andrew Bondy in 1985 for young children with ASD, it has since been adapted for anyone of any age and even for those diagnosed with various conditions.
PECS is designed to teach functional communication, where an individual can communicate his wants and needs. This is in direct contrast to other methods such as imitation of speech and sign language, which may only target initiating activities rather than communicating through verbal prompts.
Therefore, PECS encourages independent communication by the individual without the help of prompts, which is usually one of the major issues in communication development.
The system is based on B.F. Skinner’s Verbal Behavior model categorizes communication into verbal operants—functional units of language that are systematically taught using prompting and reinforcement strategies.
The goal of PECS is to teach the individual to communicate spontaneously and functionally, starting with simple requests and progressing to complex sentence structures.
This technique is grounded in Applied Behavior Analysis (ABA), a scientifically proven treatment for an understanding of and improvement in behaviour. ABA is learned by the reinforcement of new skills, including verbal communication skills, as well as various other strategies used for error correction.
One major peculiarity of PECS is that it uses no verbal prompts. Thus, it is unlikely to experience prompt dependency, a common challenge associated with most communication interventions: people come to rely on cues to communicate instead of taking the initiative to begin the activity of communicating.
It also follows the principle of positive reinforcement. That is, whenever a user succeeds in using the system to express something he needs, it is immediately met with the object or the action. This reinforces the behavior and he will likely do it again in the future.
ASD is often strongly represented by barriers in the mode of communication. Such may present as speechless or non-verbal who cannot understand oral cues or whose social usage of language is a problem. PECS is nowadays widely accepted and used in practice as an effective tool for individuals with ASD due to its focus on functional communication.
PECS helps individuals with ASD learn to communicate their needs in a structured way, even if they are nonverbal. Many individuals who begin using PECS eventually develop some verbal skills, as the system encourages speech indirectly by creating a framework for communication.
Although PECS does not directly teach speech, some children spontaneously develop speech while using PECS because it reduces frustration and enhances the motivation to communicate.
Another strength of PECS in the context of autism is its ability to engage individuals who may have limited social motivation. Traditional communication systems often require a level of social engagement that individuals with ASD may not initially possess.
PECS circumvents this by teaching communication through concrete actions (e.g., handing over a picture), which can be easier for individuals with ASD to understand and perform.
For individuals with Autism Spectrum Disorder (ASD), communication is one of the most critical areas of development. Many individuals with ASD experience challenges in initiating communication, maintaining conversations, or using language in a functional and meaningful way.
For those who are nonverbal or have limited verbal abilities, the Picture Exchange Communication System (PECS) provides an alternative way to communicate. PECS has proven to be an effective tool for many autistic individuals, facilitating a method of communication that emphasizes independence and functionality.
Individuals with autism often have difficulties with verbal communication, both in expressive and receptive language. Expressive language refers to how a person communicates their thoughts, wants, or needs, while receptive language refers to how they understand others' communication. These challenges can manifest as:
In this context, PECS provides a structured method to teach communication in a way that autistic individuals can easily understand and use.
PECS is designed specifically for people who have difficulty developing spoken language or understanding verbal communication. It helps the individual learn the fundamentals of communication by using pictures instead of words. The system is divided into six phases, each building upon the previous one, ultimately leading to more complex and spontaneous forms of communication.
Phase 1: Teaching Basic Communication In the first phase, the focus is on teaching the individual the basic concept of communication. Many individuals with autism may not naturally understand that communication is a two-way process or that they need to initiate interactions.
During Phase 1, the learner is taught to exchange a picture of a desired object for the actual object. This form of initiation is critical for autistic individuals who may not naturally seek social interaction or recognize the need to communicate with others.
Why it works: The process is highly structured and predictable, which appeals to many individuals with autism who may feel overwhelmed by more dynamic or unpredictable forms of communication, such as speech. The exchange of a picture is a concrete action, which can be easier for some autistic individuals to grasp than abstract verbal language.
Phase 2: Increasing Independence Autistic individuals often struggle with independence in communication, relying on prompts from caregivers or teachers to initiate interaction. Phase 2 of PECS helps to foster independent communication by teaching the learner to actively seek out their communication partner.
The individual is encouraged to move across distances to make the picture exchange. This movement encourages the person to initiate communication on their own without waiting for a prompt.
Why it works: Autistic individuals who are often prompt-dependent can learn to take control of communication. The consistent reinforcement of their communication efforts builds their confidence and reduces frustration.
Phase 3: Picture Discrimination In this phase, the learner is presented with a choice between different pictures representing different objects or activities. The individual learns to discriminate between pictures and make a selection based on their current needs or desires. Autistic individuals often have strong preferences and interests, so this phase aligns well with their motivators.
Why it works: Autistic individuals are often highly visual learners, and PECS uses their natural strength in visual processing to help them communicate effectively. This phase taps into their ability to make choices based on preferences, which is often easier for them than forming verbal requests.
Phase 4: Building Sentence Structure Once the individual has mastered exchanging pictures, Phase 4 introduces sentence strips that allow them to form simple sentences like "I want [item]." The process of combining pictures to form a sentence teaches the individual how to expand their communication beyond a single word or request.
Why it works: Autistic individuals who struggle with spoken language can still express themselves in structured and predictable ways. This phase introduces basic grammar and syntax through a visual medium, allowing the learner to develop more complex communication without the need for verbal speech.
Phase 5: Phase 5 focuses on teaching the individual to respond to questions such as "What do you want?" Many autistic individuals have difficulty understanding the back-and-forth nature of conversations, particularly when it involves answering questions.
This phase strengthens their ability to respond appropriately, an essential skill for daily communication and social interaction.
Why it works: Structured questioning in this phase teaches the individual how to participate in a two-way exchange. It helps bridge the gap between understanding and producing communication in response to others, which is often challenging for autistic individuals.
Phase 6: Commenting and Conversational Skills The final phase of PECS focuses on commenting, allowing the individual to communicate beyond just making requests.
They learn to comment on their surroundings, express observations, and engage in more meaningful social exchanges, such as responding to "What do you see?" or "What do you hear?"
This represents a more advanced stage of communication, where the individual can begin to share their thoughts, not just express their needs.
Why it works: Many individuals with autism struggle with spontaneous social interaction and conversations that go beyond immediate needs. Teaching commenting builds the foundation for more complex social communication.
It helps the individual understand that communication can be used for more than just requesting—it can be a tool for sharing experiences and engaging with others socially.
Autistic individuals often excel in visual learning. This strength is one of the primary reasons PECS is particularly effective for this population.
Unlike spoken language, which requires the processing of abstract sounds and symbols, visual communication through pictures is more concrete and easier for many individuals with autism to understand. PECS takes advantage of this by using clear, simple images that represent objects, actions, or people.
The simplicity and directness of PECS also reduce the cognitive load that might come with spoken language. Autistic individuals may have difficulties with auditory processing or understanding the nuances of spoken languages, such as tone, inflexion, or implied meaning. PECS bypasses these complexities by relying on straightforward visual representations.
The ability to communicate independently is one of PECS's biggest benefits for autistic people. It can be quite difficult for many people and children with ASD to start a conversation.
Their reliance on adult guidance or cues may be strong, which might make it difficult for them to speak on their own. On the other hand, PECS gives users a systematic and reliable way to start conversations, which empowers them to take the initiative in conversation.
Immediate Rewards: Each time the individual uses a picture to communicate, they receive the desired item or response immediately. This immediate reinforcement helps solidify the understanding that communication is effective and rewarding.
Reduced Frustration: Autistic individuals, particularly those who are nonverbal or have limited speech, often experience frustration when they cannot communicate their needs or desires.
PECS reduces this frustration by giving the individual a way to express themselves, thereby reducing the likelihood of tantrums, meltdowns, or other behavioural challenges that often arise from communication breakdowns.
PECS not only addresses communication but also has broader positive effects on social and emotional development. Teaching autistic individuals to initiate communication and express themselves, helps to reduce behavioural issues that may arise from frustration or inability to communicate effectively.
Autistic children and adults who use PECS often show improvements in other areas of functioning, such as social interactions and participation in group activities.
Additionally, PECS can serve as a bridge to spoken language for some autistic individuals. Although PECS does not directly teach speech, the process of associating pictures with words can stimulate the development of verbal skills in some learners.
As the individual becomes more confident in their ability to communicate using pictures, they may begin to produce speech spontaneously.
PECS is not limited by age or cognitive ability. It can be used with children as young as two and with adults, depending on their level of communication development. The key criteria for starting PECS are intentionality and preference.
The individual should understand the basic concept of intentional communication—that they need to communicate with another person to achieve their goal. Additionally, the individual should have clear preferences for objects or activities, as this will motivate them to use PECS.
For individuals with severe communication challenges, including those with echolalia (repetitive speech) or unintelligible speech, PECS can serve as an alternative or complementary communication system. However, it is essential to assess each individual’s needs carefully to determine if PECS is the most appropriate intervention.
Numerous studies have demonstrated the effectiveness of PECS in promoting functional communication, particularly among children with ASD. Research shows that many individuals with ASD learn to use PECS quickly, and the system often leads to increased social interaction and reduced behavioural issues.
One concern about PECS in its early stages was the fear that it might delay or inhibit speech development. However, studies have shown that PECS does not hinder speech acquisition. In fact, for some individuals, it can facilitate speech as they begin to associate pictures with words and verbalize requests.
PECS is particularly effective as an early intervention tool. It helps establish a foundation for communication, which can be built upon with more complex systems as the individual’s communication skills improve. However, PECS may not be as effective for long-term communication development, as it focuses primarily on requests and basic sentence construction rather than more abstract language concepts.
The Picture Exchange Communication System (PECS) is a powerful tool for individuals with Autism Spectrum Disorder and other communication challenges. It enables nonverbal individuals to communicate effectively, fostering independence and social engagement. PECS is rooted in behavioural science and follows a structured, evidence-based protocol that gradually builds communication skills.
For many individuals with ASD, PECS serves as a critical first step in learning to communicate. Although it is not a cure-all, it can be an essential component of a multimodal approach to communication, especially when used in conjunction with other AAC systems. As research continues, PECS remains a valuable and versatile tool in the world of autism interventions.
