PECS: Fair exchange

Children who have communication difficulties are learning to express their needs with a deceptively simple, progressive system of picture cards. Mary Evans reports

Imagine you are Daniel. You are four years old and have been playing all morning. Now you are thirsty, but you are unable to communicate, so you cannot ask for the drink you need. Think how frustrated, anxious and cross you would get as you try to express your need for that drink. Perhaps you would grab one of the adults near you and lead them to where the drinks are kept. Maybe you could point to a mug. Probably, if someone did set down a tray of drinks, you would have to push past the other children and snatch one quickly.

Consider how much easier it would be if you could give an adult a picture to swap for the drink. That is what Daniel and the children at the Rainbow Children's Centre, a special needs nursery in Queen's Park, London, are learning to do. The centre had used the Picture Exchange Communication System (PECS) in a basic way with a few children, but after Sarah Nottingham, the centre's speech and language therapist, went on a course last October, she led staff training sessions to launch it nursery-wide.

Wait for it

PECS begins with teaching pupils to give a picture of a desired item to a teacher, who immediately honours the request. For example, if they want a drink, they will give a picture of 'drink' to an adult who directly hands them a drink. Verbal prompts are not used, to keep everyone from becoming dependent on them. Miss Nottingham says, 'To train the other staff we used videos and had practical sessions. At Christmas the staff had to make a picture exchange to get a mince pie.'

The system was developed in the United States over 12 years ago as an alternative, augmentative training package for children and adults with autism and other communication difficulties .

PECS was introduced to the Rainbow centre's children at snack time. Miss Nottingham says, 'It is a structured time which happens twice a day, every day. Most of our children have autistic spectrum disorder and learning difficulties. Food and drink are very good motivators.

'Snack times used to be chaotic. There would be a whole group of children reaching for drinks and they could become anxious and upset. Now they wait with their symbols to exchange. It has reduced their anxiety, because they know they are going to get their drinks, crisps or biscuits, or whatever symbols they have. They know it is going to happen. They can predict, and it helps their waiting.'

Picture collection

PECS is labour-intensive and time- consuming at first, as two adults work with a child on each exchange: one to encourage the child to take the card, and the other to receive it and hand over the desired object. The PECS user then learns to discriminate between pictures. If he hands over a symbol of a biscuit he is given a biscuit, but if he trades a picture of an apple he is handed an apple. Gradually the support is reduced so the child has to take the relevant picture and find an adult with whom to make an exchange.

The child builds up a collection of pictures in a folder and begins to make a sentence strip starting with the symbol 'I want' - which is drawn as a pair of hands reaching for a box - and adding the desired object, for example a ball. The child gradually learns to use symbols expressing concepts like colour and size, such as 'I want the big, red ball', as well as expressions such as 'I see' and 'I feel.'

The adult says the name of the object. As the child progresses he may imitate the adult and repeat the name, but he is never forced to verbalise and the picture exchange is always promptly honoured.

Sandra Gee, the SENCO and senior practitioner at the centre, says, 'We have found that this is a great way of beginning communicative intent. The children have to ask for something they really want. We have to be aware all the way through the stages that autistic children can find it painful to communicate with anyone and therefore we have to be sensitive to their needs. We have mostly found that since the children have been able to make themselves understood, they have shown less frustration and seem to be much more content.'