VelcroTM strip can be placed on the back of each picture to hold it in place on the front

The child is then prompted to place the picture card representing the object next to the "I see ______" card. The parent then comments on the cards ("Yes! I see the airplane too"). In this way, the child learns how to communicate his or her observations and experiences to others.What is the theory behind it?The direct Rosetta Stone Korean reinforcement that comes from immediately getting what you want is the key to PECS. Without having to use spoken words, a child is able to turn an inner desire into an external reward. It is thought that tangible rewards are more reinforcing to children with autism than social rewards, at least during the first steps of communication learning. However, if these rewards are too difficult to receive - that is, if it is very difficult for the child to form words - then the point of communication may, at first, be lost on these children. This can result in tantrums and other undesirable behavior, because the child cannot clearly communicate what s/he wants. However, when children with autism are trained in PECS, problem behaviors often subside as the benefits of communication become more tangible (1, 4, 5).PECS may also help improve social interactions in children with autism. Because the child is in charge of approaching the communication partner, the child learns how to make the first move. For children with autism, approaching another person socially can be difficult. However, in this case, the child is not expected to speak, so the initial approach may be less intimidating (1, 4).Does it work?There are several well-designed research studies showing the usefulness of PECS. In one study of 18 preschool children with language delays, some of whom were diagnosed with autism, PECS generalized across communication partners and environments (6). These children were able to use PECS to communicate throughout their school days, not just during the training sessions. Further, almost half of these children stopped using PECS and started using natural speech within a year (6). One parent commented that "PECS turned on the light for communication" in her child (6). Similar results were found for two smaller, but still well-designed studies (5, 7).Recently, a comparison was made between PECS and another popular AAC technique, Responsive Education and Prelinguistic Milieu Training (RPMT). The results showed that children with autism trained in PECS were more verbal than those for whom the RPMT approach was used (8). Overall, the evidence supports the use of PECS as a tool for developing natural communication in children with autism, especially when it is taught before the child is six years old (3).Is it harmful?There are no known negative effects of PECS. Some parents have been concerned that their child will become dependent on PECS and not move on to develop natural speech. However, this view is not supported by research studies. In fact, there is evidence that children with autism who have learned to use PECS develop speech more quickly than those who have not been trained in PECS (see "Does it work?") (2, 4).CostThe materials used in PECS are relatively inexpensive. A binder for storing PECS Rosetta Stone Portuguese pictures can be made from a 3-ring binder. A VelcroTM strip is attached to the front cover to hold the picture(s) currently being used. Each picture can be drawn by a parent, cut out of a magazine, or made from an actual photograph of the object glued onto a card. A VelcroTM strip can be placed on the back of each picture to hold it in place on the front cover of the binder when it is being used. Each picture can be hole-punched for storage in the binder (1).A more expensive alternative is to purchase a PECS binder and several commonly used pictures (see Resources). However, even if you purchase these ready-to-use PECS systems, you will have to create your own pictures of preferred items that are unique to your child.The more expensive side of PECS can be the expertise involved in PECS training. However, PECS can be covered in speech therapy under IDEA (see Resources). Also, PECS training manuals are available for $40-70 for parents and other caregivers (see Resources).ResourcesAutism is a condition covered under the Individuals with Disabilities Education Act (IDEA), and PECS Services covered by IDEA include early identification and assessment and speech language pathology (speech therapy). For nonverbal children, this can often include PECS. This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21 (U.S. Department of Education Web site, http://www.ed.gov/index.jhtml). Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). School districts will coordinate special services for children 3-21 years old.Many PECS resources, including commonly used pictures and PECS binders can be found at: http://www.pecs.com/WhatsPECS.htm.Three books that might be helpful in learning about and using PECS are:EMPOWER! Book CD by Beth A, Soeder, M.A., SLP-CCC and Catharine M. Critz, Ph.D., CPNP, 2003.A Pictures Worth by Andy Bondy, Ph.D., and Lori Frost, M.S., CCC/SLP, 2002.PECS Training Manual, 2nd Edition by Lori Frost, M.S., CCC/SLP and Andy Bondy, Ph.D., 2002.ReferencesBondy, A.S., and L. Frost. 1994. "The Picture Exchange Communication System." Focus on Autistic Behavior 9(3):1-19. Bondy, A.S. 2001. "PECS: Potential benefits and risks." The Behavior Analyst Today 2:127-132. Mirenda, P. 2001. "Autism, Augmentative Communication, and Assistive Technology: What Do We Really Know?" Focus on Autism and Other Developmental Disabilities 16(3):141-151. Bondy, A.S., and L. Frost. 2001. "The Picture Exchange Communication System." Behav Modif. 25(5):725-744. Charlop-Christy, M.H., et al. 2002. "Using the Picture Exchange Communication System (PECS) With Children With Autism: Assessment of PECS Acquisition, Speech, Social-communicative Behavior, and Problem Behavior." J Appl Behav Anal. 35(3):213-231. Schwartz, I.S., et al. 1998. "The Picture Exchange Communication System: Communicative Outcomes for Young Children with Disabilities." Topics in Early Childhood Special Education 18(3):144-159. Ganz, J.B., and R.L. Simpson. 2004. "Effects On Communicative Requesting And Speech Development Of The Picture Exchange Communication System In Children With Characteristics Of Autism." J Autism Dev Disord. 34(4):395-409. Yoder, P., and W.L. Stone. 2006. "A Randomized Comparison of the Effect of Two Prelinguistic Communication Interventions On The Acquisition of Spoken Rosetta Stone Spanish Communication In Preschoolers With ASD." J Speech Lang Hear Res.

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