The picture exchange communication system, or PECS, is a teaching system that can help an autistic child or another individual with speech difficulties improve their communication skills. We take a look at PECS’ role in ABA therapy and unpack how it works.

Picture Exchange Communication System and its use in ABA Therapy

Many autistic children have difficulties communicating verbally. PECS is one of the many tools we use in ABA therapy to help them increase their independence and improve their outcomes. Join us as we further unpack PECS, how it works, the benefits it offers, and more.

What is PECS?

The picture exchange communication system, or PECS, is a communication system that was developed in the USA in 1985 by Andy Bondy, Ph.D., and Lori Frost, M.S., CCC-SLP, the founders of Pyramid Educational Consultants, Inc. It is based on the book “Verbal Behavior” by B. F. Skinner. 

This augmentative or alternative communication system was first used to assist autistic preschool students who were part of the Delaware Autism Program. It is now also used to help people of all ages with communication difficulties that are caused by many conditions. 

How PECS works

One of the downsides to other programs and methods designed to help those with communication issues, such as sign language and picture point systems, is that they rely on the teacher to initiate communication with a student. This creates a situation where the student learns to only respond in communication and to never initiate it themselves. The main goal of PECS is to help address this by teaching students to communicate more spontaneously using specific prompting and reinforcement strategies and avoiding verbal prompts, as well as improving their functional communication skills. 

Implementing PECS

Regardless of whether you are using the PECS program for autism or other causes of communication-related challenges, it has a specific process that you need to follow.

Complete reinforcer sampling

Before the PECS protocol is implemented, it’s important to first complete “reinforcer sampling.” Reinforcer sampling simply refers to the creation of an inventory of activities, toys, or other items that the student likes so that these items can be used as motivators during PECS. 

This inventory is created using an assessment process that can be completed in numerous ways, such as asking caregivers, observing the student and what they choose most and least often, and presenting the learner with pairs of options to see what they like the most. The reinforcers that are chosen will need to be consistently appealing to the learner in order to assist with PECS.

The six phases of PECS

Phase 1: How to communicate

In phase one, the student learns to initiate communication by exchanging pictures for things they really want or activities they want to take part in with a second trainer, who is the student’s communicative partner. (These desirable items and activities were identified during the complete reinforcer sampling stage.)

Phase 2: Distance and persistence

During phase two, the student learns to use this skill of exchanging a picture to get something they want in different places. They learn to do this by seeking out their communicative partner. They are also taught to initiate communication with other communicative partners using the same system. This is accomplished using different desirable items and activities. 

Phase 3: Picture discrimination

During phase three, the student is now tasked with asking for two or more of their favorite things, using multiple pictures. These images are stored in a PECS Communication Book, which allows for easy removal and return of images used by the student.

Phase 4: Sentence structure

In phase four, the student learns to complete basic sentences using what are known as Sentence Strips. These strips begin with an “I want” picture, with the student adding the picture of the item they desire to the strip from the PECS Communication Book. Once the student has demonstrated the ability to make this request, additional detail is added to these statements using descriptors, including the number, color, shape, or size of the object that they want.

Phase 5: Responsive requesting

Phase five asks the student to engage with the question “What do you want?” and to respond using the skills and tools they learned in phase four. When asked this question, the student must use the Sentence Strips and pictures from their PECS Communication Book to provide an answer.

Phase 6: Commenting

In the final phase of PECS, the student learns to answer other questions such as “What do you see?”, “What do you hear?” and “What do you smell?”. This is done by teaching them to use additional phrases such as “I see,” “I hear,” and “I smell” on their sentence strips, expanding their requests beyond “I want.”

The benefit of PECS

There are many benefits to teaching using PECS. Here are some of the advantages that it offers to autistic children:

• Helps make communication a more understandable process
• Improves the initiation of communication
• Can decrease problem or negative behaviors
• Can help improve social skills and allow students to build relationships
• Easy to learn for a student’s partner
• Increases the use of speech in some learners

Find out more about Lighthouse Autism Centers and how we use PECS

At Lighthouse Autism Center, we provide PECS for autism treatment and to help our students achieve better outcomes. We also provide autism resources so that you can better navigate this spectrum disorder and more insight into our Lighthouse Fusion® ABA therapy program and how it can help your child.

Augmentative and alternative communication, or AAC, is a way for people who struggle with speech, or lack the ability to speak entirely, to communicate their needs, wants, and desires. We unpack what AAC is, the types of AAC devices that you can use, their benefits, and more.

Understanding AAC and the Use of AAC Devices

As a parent, guardian, or relative of someone with autism, you may have heard about AAC devices and wondered what they were. Read to discover what AAC is, what these devices do, the different types of AAC available, the benefits they provide, and more.

What is AAC?

AAC stands for “augmentative and alternative communication.” It refers to the wide range of systems and tools used to help people who struggle with speech and those unable to speak at all. This includes people with autism, brain trauma, down syndrome, degenerative diseases, and other conditions. AAC helps these individuals connect and navigate a world where speech is often the primary way of communicating with others. 

In order to better understand AAC, it’s important to unpack what the terms augmentative and alternative mean in this communication system. Augmentative communication systems support or assist someone’s ability to speak. Alternative communication systems, on the other hand, are used in place of someone’s ability to speak.

Different types of AAC

There are two different types of AAC, namely, unaided and aided. We explore the differences below.

Unaided AAC

Unaided AAC refers to a type of communication system or strategy that doesn’t use any additional tools or materials. Examples of unaided AAC are facial expressions, gestures, body language, sign language, and vocalizations.

Aided AAC

Aided AAC refers to a type of communication system or strategy that does use additional tools or materials. Examples of aided AAC are communication boards, choice cards, speech-generating devices, and even apps on mobile devices.

Aided AAC is where AAC devices come in.

What are AAC devices

AAC devices are specific tools used to communicate when an individual is unable to express themselves using spoken or written language. 

The different types of AAC devices

There are two categories of AAC devices: low-tech (non-electronic) and high-tech (electronic). Some common AAC devices that fall into either of these categories are:

• Low-tech AAC devices: Symbol boards, alphabet boards, communication books, and choice cards. The user may select images, words, or phrases if they are able to do so. If they have physical limitations, gestures, light pointers, gaze, or a head-mouth stick might also be used, or they might use another way to communicate yes or no, such as nodding their head, as someone reads through the options available to them.
  
• High-tech AAC devices: Speech-generating devices (SGDs) or voice output communication aids (VOCAs), devices with pre-programmed messages and apps on tablets and smartphones. How a user interacts with high-tech AAC devices varies greatly, depending on its capabilities and the user. For example, some SGDs are operated by hand or using eye-tracking technology.

Depending on the cause of the communication impairment, devices from either the low-tech or high-tech category may be better suited to address an individual’s needs than others. However, while some people may need either a low-tech or high-tech device most of the time, situations may arise where they need a device that they normally don’t use. 

For example, someone who uses symbol boards may have difficulties communicating if they’re in a poorly lit room. Another person who uses a device like an iPad to communicate may find themselves unable to do so if they are outdoors and caught in the rain. This is why it is important that people have access to both low- and high-tech AAC devices where possible. 

Both low-tech and high-tech devices are further broken down into three categories, depending on the type of communication system they use. These three categories are:

Single-meaning pictures

A single image has a single meaning. Users are taught what each image means and how they can communicate by gesturing at the word or selecting it, depending on the type of AAC device. Some limitations of these systems are that they may require thousands of images before they can be used meaningfully; or that it could be difficult for them to communicate more abstract words like “help”, “stop,” or “mine”.

Alphabet systems

Alphabet systems require some level of literacy. Communication takes place with the user pointing at or selecting each letter to spell out the word they are trying to communicate, or choosing from complete words. An example of this would be words printed on cards or displayed on a digital device.

Semantic compaction

Multiple images are used in a sequence to communicate. A single image has multiple meanings – but these meanings may change depending on the combination of symbols. Users are taught the meanings of each image and how to construct sequences with specific patterns that affect meaning.

The benefits of AAC devices for autism and other speech-impeding conditions

For someone with autism, apraxia, traumatic brain injury or other conditions which affect their speech and who struggle with verbal or written communication, AAC devices provide numerous benefits. These benefits can include:

• Empowering users to become independent
• Improving the user’s ability to connect with others
• Improving a user’s speech and written communication skills
• Improving a user’s overall quality of life by reducing negative factors in their life such as stress, vulnerability, and loneliness.

How to choose an AAC device

Even if you have the best intentions, going in without the requisite knowledge of AAC devices and systems may leave you with a device that is poorly suited at best – or completely unfit for use at worst. This is why it’s important to work with a professional when deciding on which AAC devices to use. Whether it’s a speech-language pathologist (SLP), an occupational therapist (OT), psychologist, or other suitably qualified individual, they will be able to help you choose the best solution that meets the needs of the individual. 

Learn more about our approach to ABA therapy

Whether your autistic child uses an AAC device or not, we can help them develop and reach their goals with ABA therapy. Take a look at our autism resources to help you better understand autism. You can also learn more about our Lighthouse Fusion® ABA therapy program to find out how we can help autistic children improve their outcomes.

Learn how assistive communication technology is used in ABA to improve social communication and behavior in autistic people.

Technology and ABA

Applied Behavior Analysis (ABA) is an indispensable tool used in the treatment of Autism Spectrum Disorder (ASD). Thus, it stands to reason that ABA therapy is inextricably linked to technological advancements that improve the quality of ABA for therapists and patients alike. 

Assistive communication devices for autism

Figuring out how to improve social communication skills in autism sits at the heart of ABA therapy. Many practitioners and patients often turn to technology for solutions. 

The development of assistive communication devices for autism has tracked the rise of technology, and these have been employed with great success in recent times. Here are some of the most innovative new developments in the technological dimension of ABA, focusing on assistive communication technologies and devices for autism. 

Augmented Reality (AR)

Studies have shown that Augmented Reality (AR) technology provides an enjoyable and stimulating environment, which reduces boredom in autistic people while increasing enjoyment and motivation. 

AR also improves social skills and communication in patients with an increased interest in the education process through participation.

In early experiments with Google Glass, the camera would interpret facial expressions of people for the patients and display a corresponding emoji. This provided therapists with a deeper understanding of the link between social situations and the behavior of autistic people. Additionally, the use of AR role-playing and interactive autism games for social skills significantly boosted the recognition of social cues. 

Virtual Reality (VR)

Although virtual reality (VR) has been around for a long time, it has only recently become more accessible and affordable. Head-mounted displays (HMDs) like Google’s Cardboard, which houses a smartphone loaded with a VR autism app, have demonstrated remarkable improvements in autistic people – especially with social functioning, emotion recognition, speech, and language. 

Video-modeling

Incorporating video into ABA is largely based on Albert Bandura’s social learning theory (1977). This simply means people learn by watching and copying each other. 

Video-modeling, according to modern parlance, is less threatening to autistic children than face-face modeling and seems to be more motivating. It also allows patients to focus on one or two skills at a time without overwhelming them. 

Mobile apps

There has been a surge in the development of applications or apps to turn our mobile devices, like tablets and phones, into assistive communication devices for autism. Here are a few apps that have successfully dealt with communication and behavioral issues in autistic patients.

Language and Cognitive Therapy for Children (MITA)

Operating System – Android and iOS

This app delivers an almost unlimited number of cognitive exercises for autistic children with speech delays. Having passed clinical studies, MITA (which stands for Mental Image Therapy for Autism) uses simple vocabulary with higher forms of language and adaptive activities specifically for early intervention. Other features include playtime rewards and offline viewing.

Symbotalk

Operating System – Android and iOS

Symbotalk helps autistic children to communicate verbally through flexible boards and sub-boards, as well as augmentative and alternative communication (AAC) systems. 

The app helps children associate symbols and pictures with audio. It also allows you to upload your own images and record your own voice to make it easier for the child. 

Proloquo2Go

Operating System – iOS

This is not a free app but has won awards for innovation in giving a voice to children who can’t speak. Autistic children who find speech and communication difficult are able to communicate complexity through a highly intuitive interface. 

Parents and therapists can configure grammar, while core words can be learned through associated movement. 

Leeloo

Operating System – Android and iOS

Based on augmentative and alternative communications (AAC) as well as picture exchange communication systems (PECS), Leeloo uses cards to match words and phrases to images. 

Once a card is selected, Leeloo reveals a list of words and phrases associated with that image, then reads out the word or phrase the child selects in up to 10 different voices. 

Otsimo

Operating System – Android and iOS

Otsimo improves both speech development and behavior in autistic children and adults. 

With over 50 games, the app supports ABA interventions through the provision of progress reports as well as the ability to personalize each game to the needs of the individual child.

ABC Autismo

Operating System – Android 

ABC Autismo focuses on enhancing learning in autistic children through the use of over 40 interactive activities that promote attention and focus. Therapists and psychologists also use it as an evaluation tool to assist in diagnosing autism and other mental disorders.

Autastico II

Operating System – Android 

Autastico II focuses on improving cognitive skills, attention, and motor coordination through activities, sound, and music. Unlike other apps that are primarily functional, Autastico II also emphasizes entertainment and fun through engaging content and striking graphics. 

Dino Tim

Operating System – Android 

Dino Tim is a fun learning app for autistic children. The app follows the storyline of Dino Tim and his family, who are kidnapped by witches. Children are then required to become heroes to rescue them from the witches by conquering over 100 puzzles and activities that boost motor skills and increase attention and concentration. 

Wearable assistive technologies (WAT)

Wearable assistive technologies (WAT) are making it possible for autistic people to re-enter classrooms and other clinical environments to learn and even venture into real-world social situations through the use of real-time feedback. 

As the technologies mature, autistic people can navigate social interaction using WAT like smartwatches with haptic responses, augmented reality headsets like Google Glass, and almost invisible hearing aids. 

Hearing aids

Modern hearing aids have become so advanced that they can assess the acoustics of a room or environment and then remove sounds that it doesn’t recognize as speech. 

Even more impressive is that some hearing aids can simulate high-definition sound for music and speech. Better still is that they can be configured and controlled using mobile devices like phones and tablets. 

Neural command

Neural command makes it possible for people to control devices simply by using their brainwaves. Not unlike common software that converts text to speech on our mobile phones, neural interfaces (although still in their infancy) are being developed to integrate with speech-generating devices that allow people with severe speech impediments to “talk” using their thoughts and specially designed headsets.

Robotics

Advances in robotics aid in teaching autistic children social skills while keeping them focused during their therapies.

A recent study using NAO, a robot created by SoftBank robotics, also showed that with appropriate software, robots can be used to assess autism in children through observing play and interaction.

Artificial Intelligence (AI) and machine learning

It has recently been established that machine learning models can help predict ABA treatment programs for children with ASD and significantly assist ABA practitioners in prioritizing resources for the management of ASD from diagnostics through to intervention. 

Lighthouse Autism Center

Lighthouse Autism Center is the Midwest’s leading autism therapy institution, with world-leading autism resources and a ground-breaking Lighthouse Fusion® ABA Therapy program that fuses the best practices of ABA and speech therapy into a one-of-a-kind clinical model that delivers better outcomes for children with autism.

The holidays are generally a period to look forward to for most children, but they can be stressful for children with autism due to their change in routine and potential for sensory overload. We have five quick tips to help you and your autistic child have a good time and enjoy the holidays.

5 Quick Tips for Celebrating Holidays with an Autistic Child

The holidays are a break to look forward to for most kids, but this time of year can be both exciting and overwhelming for children, especially those with an autism diagnosis. Whether it’s due to an unexpected change in schedule, overstimulation, or just the stress of the holiday season, this time of year can be challenging for autistic children.

Below, we have compiled a list of holiday tips to help your autistic child (and all children really!) manage the stress of the season so that your family can focus on what’s most important, enjoying time together.

1. Preparing to Support Your Autistic Child During the Holidays

The first thing you should do if you are planning a holiday trip, event, or gathering is ensure that your autistic child understands what might happen. Autistic children may not deal with change well, so it’s important to give them the tools to cope with the change to routine they might experience during this time of year. You can do things like, take them to visit somewhere before the event. For example, if a sibling is in a holiday program, you might take your child to visit the space before the day of the program several times, and explain to them what will take place. You can do that by showing them photos, and talking to your child about what to expect. Additionally, you can read them books about similar situations or show them photos of a place you plan to visit beforehand. 

2. Communication with others and your child is important

During the holidays, we often see family or friends that we haven’t seen for some time. Your family and friends may not be aware of your child’s unique needs or may not have an understanding or awareness of autism more broadly. Be sure to communicate to your family and friends ahead of a gathering or event, letting them know how to best communicate with your child, and what to expect in terms of your child’s needs.

You should also make them aware of how your child can react to certain situations so that if your child reacts in a way that your friends and family are not used to, they are not caught off guard or take offense. You can also teach your family members how to assist if a meltdown occurs, or at least let them know what you, as the parent, will do to manage the situation. For example, a child who is overstimulated may walk away to avoid the stimulus, which may be confusing to those who don’t know this is how your child will react.

3. Plan or take part in autism-friendly events and activities

Many holiday events can be crowded, loud, bright, and overall overstimulating for a child with autism. Seek opportunities for sensory friendly events that might better meet the needs of your child and family. If autism friendly events are not available, try to attend an event early, or avoid peak periods so that the event is quieter and easier to manage for your child and family. Devices like earplugs or noise-canceling headphones can also be helpful during large events.

4. Plan an “easy escape” to give your child a break from the stimulation

There may be certain holiday events that are difficult to decline or change to suit your child’s needs, such as religious services. If you are attending an event like this with an autistic child, make sure to seat yourself and your child near an exit. If your child becomes overstimulated, you can temporarily leave the event to give them the time and space they need to engage in a calming activity. If a meltdown is taking place, being seated near an exit will allow you to leave the event entirely without causing too much disruption.

5. Have fun!

Remember the holiday season is about enjoying time with family. Try to avoid feeling the pressure to do what others are doing. Do what works for you and your family, whatever that may look like, as long as you are having fun!

Learn more about autism and our Lighthouse Fusion® program

We hope these tips have made navigating autism and the holidays easier for you and your child. Two more ways to help you and your child navigate through life are our autism resources and Lighthouse Fusion ABA therapy program. Explore these materials and learn about all the ways Lighthouse Autism Centers can assist you and your loved one.