The Development of PECS
Over a dozen years ago, we were working on communication skills with a young boy with autism who was not successful at vocal imitation or pointing to pictures. We had tried teaching him to point to a picture among an array of pictures that corresponded to things he liked. However, we encountered a number of problems with this approach. First, in part due to his young age, he had difficulty reliably using just one finger to touch one picture. In addition, at times he would touch a picture when his eyes were focused on something happening outside. We weren't sure if he really wanted what he was pointing to, if he wanted what he was looking at outside the window, or if he simply liked the sound of his finger tapping on the picture board.

We were also concerned about our observation that some children with autism had been taught to point to pictures when they wanted something but had not been taught to approach someone. That is, they could be sitting in the back of the room pointing to a picture on their communication board, but unless someone happened to be looking at them, their pointing would be ineffective. They had learned to point to pictures, not to communicate with people.

Finally, we were concerned about the strategy traditionally used to teach children to point to pictures. Like others in the field, we had tried to teach children to match a picture with an object that we displayed. We would hold up an item, such as a ball, issue a simple instruction (i.e., "match" or "find the same"), and teach the child to point to the corresponding picture. Many professionals advised that prior to teaching matching pictures to objects, we had to be sure that the child could match objects to objects. In each of these types of matching lessons, it was the teacher who started the interaction, not the child. Some children would only point to a picture when we began the sequence by holding up an item or using a spoken instruction. Therefore, these children were dependent upon various prompts from adults to communicate and could not initiate an interaction.

Since the boy we were working with could not reliably imitate our actions, we had to devise a method to teach him to functionally communicate without imitating us. We thought this might be possible based on our knowledge that very young children typically learn to communicate independent of imitating others. That is, they learn to approach adults and engage in actions that are communicative, but are not refined or formalized messages. (For example, an eighteen-month-old girl might look at her mother and simultaneously reach toward her ball that fell onto the floor).

Given these concerns, we decided to teach this child to give us a single picture that corresponded to the item he currently desired. As with typical communication, he would need to approach us to give us his picture (message). We started by making a line drawing of a pretzel, which was something we knew he enjoyed eating. With one of us enticing him with pretzels and the other one helping him with hand-over-hand guidance, we gradually taught him to give this picture in exchange for the pretzel. Over time, we reduced the physical prompting and added pictures of other items and activities he desired to his vocabulary. Eventually we taught him to place several pictures in a row to construct a sentence.

We started using this same method to teach other young children with autism to communicate, and in time, named our method the Picture Exchange Communication System (PECS). Our hope was that this method would accomplish several things:
1) The child would initiate the communication (rather than depend on a cue from the adult).
2) The child would find a communicative partner and approach that partner.
3) The child would use a single picture and avoid confusion about the intent of the message.

We also hoped that this method of communication would avoid certain potential problems:
1) The child would not have to depend on prompts from the adult.
2) The child would not need to have learned to imitate actions or words prior to starting this lesson.
3) The child would not have to learn to make eye contact on demand prior to starting this lesson.
4) The child did not have to learn to sit quietly in a chair prior to starting this lesson.
5) The child would quickly learn to communicate rather than initially learning to match pictures to objects.

Of course, ultimately it is important for children to learn to imitate actions, sounds, and words, to sit attentively in a chair, and to look at someone on request. However, these are not prerequisites for a child to learn to functionally communicate her wants and desires. To functionally communicate, it is necessary for a child to approach someone and then deliver a message. And this is something that PECS most definitely enables many children (and adults) with autism to do.

In this chapter, we will describe the basic sequence of training in the initial steps of the Picture Exchange Communication System (PECS) in some detail. Many of these teaching strategies are very effective in teaching children with autism other AAC techniques or speech. The next chapter will cover more advanced and complex lessons.

What Are the Prerequisites for Starting PECS?
The primary factor to consider before beginning PECS is what your child does (e.g., reaches for, moves toward something) to indicate what is reinforcing to her. If a child reaches for snacks, toys, trinkets, or other small items, then we are confident that we can teach her to reach for a picture instead of reaching for the item.

Your child does not need to have wonderful fine motor skills. If she has trouble picking up small items, the picture can be modified so that it is easier to manipulate. For example, the picture can be glued to a wooden or foam block or a dowel, to aid in picking it up. The size of the picture can be modified as well to help in manipulation.

Neither does your child have to know the meaning of the picture before starting PECS. Our aim in the first part of PECS is to teach the child to initiate an interaction with another person, so there is no reason to precede teaching the exchange by trying to teach the meaning of the picture. Not until the third phase of PECS training (covered later in this chapter) do we focus on assuring that users are able to select distinct messages.

We are not aware of any cognitive prerequisites indicated by scores on a standardized developmental test. That is, children do not have to reach a minimum developmental age before they can successfully learn PECS. Instead, it is critical to observe that the child can clearly indicate (such as by reaching for a toy) what is reinforcing to her in a form that can ultimately be modified to manipulating a physical symbol, such as a picture.

Skills such as eye-to-eye contact, sitting quietly in a chair, responding to a series of simple instructions, or being able to match pictures to objects or other pictures are not prerequisites for PECS.

Finally, a child does not have to be nonverbal to benefit from PECS. The primary focus during the first phase of PECS is on teaching communicative initiation. Therefore, while PECS is frequently used with children who have no spoken words, it has also been used effectively with children who say some words but do not initiate with those words.

What Are the Phases of Teaching PECS?
We've broken the sequence of steps to learn in PECS into six phases. In the first phase, children are taught to initiate communication. The second phase expands the use of pictures to other people, places, and rewards. In the third phase, making specific choices between pictures is addressed. The fourth phase teaches the child to construct simple sentences. At this point, we also begin to teach children to be more specific about what they want by teaching them how to use attributes to qualify their requests. The fifth phase assures that children can respond to the direct question, "What do you want?" while the sixth phase teaches children to comment about various items and activities. This chapter covers Phases One through Four, and Chapter 7 continues with Phases Five and Six.