The Picture Exchange System: A Method of Communication For Children With Autism


Words often escape individuals, especially children with Autism. Social interaction and communication are often trouble areas. Where we don’t think twice about asking someone to hand us a specific item, people with Autism find this seemingly simple task to be almost impossible, or at the very least, highly difficult.

The Picture Exchange Communication System, or PECS, focuses on a child’s ability to communicate using methods other than speech. As it’s name suggests, PECS utilizes photos on cards to prompt children to demonstrate, or hand the item of their desire to their facilitator to express what they want.

Picture exchange is typically taught in 6 sections or “Phases”.  In most cases, these phases should be taught in order, however, there may be some instances in which phases may need to be switched or reversed depending on the child’s specific needs.

Phase I – The first phase of PECS is when the child is conditioned, or introduced to the system. As an exercise, parents, teachers, therapists, etc. determine items that the individual child may want. For example, if the child likes chocolate, it would be considered a desired item that he or she may request or choose from a group of other cards. During this phase, the “leader” or parent usually, entices the child with an item that he or she may want. In our example above, we used chocolate, so we’ll go with that.

The first adult, or parent entices the child while the 2nd adult stands behind the child and assists him or her when they reach for that item’s photo on the table. When the child gives the adult the card, the child is rewarded immediately.

Phase II – Phase two is similar to phase I, the major difference is that the child is usually requested to go a further distance to deliver the card to the adult. Whereas in Phase I the child may have just needed to reach across the table, in Phase II he or she may need to walk a short distance.

Phase III – In Phase III, the child is introduced to discrimination; that is, choosing between two objects. “Which one do you want?” may be asked. Then, the child is to choose only one of the cards, deliver it, and be rewarded.

Phase IV: This phase begins to focus on sentence structure. The child is asked to maybe choose a card symbolizing “I want”, and then the item(s) that he or she wants.

Phase V: In this phase, the child should move from “I want Chocolate” to  “I want 2 pieces of red M and M’s.” He or she should be able to choose from a series of groups of cards and form complete sentence structure using the cards.

Phase VI: Phase 5 and 6 go hand in hand and are often done together. Specifically, in Phase VI, the child is introduced to phrases such as “I feel”, “I hear”, “I want”, “I need”, etc.

The PECS system is a handy and inexpensive system for assisting socially and communication challenged children how to communicate effectively without learning a whole new language. While sign language is also a commonly utilized method, this is difficult when the child comes in contact with someone who doesn’t know the language. PECS is universally known and is solely based on the child’s understanding to make a sentence and express needs, wants, and desires using photographs or images.

The Reward System: A Behavior Modification Technique for Autism


The behavior of Autistic children can be a very challenging thing to handle. From temper tantrums, to self-injury, to repetitive, destructive behavior, parents often don’t know where to turn to for behavior modification techniques. When “No!” doesn’t work, and time outs are ineffective, it almost seems as though it’s a lost cause. Behavior Modification Therapy focuses on these outbursts and trains the Autistic mind to relate good behavior with good feelings.

In the shoes of an Autistic Child…

If every day you went to work, did your 8 hours, and didn’t get paid, would you continue to do go to work? If you started a new diet, and it claimed that maybe someday you would be healthy, would you continue to do it? Life is all about the reward system: if you do something correctly, then you receive a reward. What the reward might be is relative to the situation, but if you seek value in that reward, you’re sure to do what is required in order to get it.

If you went to work late everyday, sat around and did nothing and still collected a paycheck, would you continue to go to work? If you were on a diet that allowed you to eat as much candy as you wanted, but promised that you’d lose weight rapidly, would you remain on the diet? Probably. Life is also about consequences. If your reward isn’t taken away when you do something against policy, then you never learn right from wrong. How are you to know that going to work late is wrong, or that eating candy is bad, if you’re not given a consequence to your action?

You Need To Say Exactly What You Want To Get Exactly What You Want

For this to be a structured approach, it’s important that you identify three main ideas to the new method:
1) What exact behavior are you looking for from the child.
2) How long do you wish for the child to apply this behavior?
3) Under what circumstances should the behavior be preformed.

For example, if you are having an issue with your child throwing a temper tantrum every time you try to put their shoes on, this can surely become a great hassle. In this situation, the behavior you’re looking for might be to calmly sit on the sofa, and allow his/her shoes to be put on. The  duration of the action may be for 2 minutes or until the shoes are on and tied. The circumstances would be when it’s time to go outside and you have to wear shoes. The goal here would be for the child to learn the idea that “When it’s time to go outside and put on shoes, I have to sit on the sofa for 2 minutes until my shoes are tied”.

Creating a reward system and sticking to it

Why should your child put their shoes on? Of course it prevents mommy and daddy from going nuts from all of the screaming, but what does the child get out of the deal? If there’s no reason or reward for them to do it, then why in the world should they?

It is our own natural defense mechanism to avoid pain and gravitate to good. If you don’t know the difference, then how do you know which direction to go? Behavioral Modification creates a reward system for desired behavior, and enables the child to create healthy behavioral patterns. If they do the right thing, they receive a reward. Whether it be a hug, a high five, 5 minutes to play a video game, the key is to make the reward be something that the child wants. If you try giving a child who doesn’t like ice cream and ice cream cone, that’s not considered a reward.

In our shoe example, let’s assume that the child loves hugs and sandboxes.In this case, we may want the child to think “When it’s time to go outside and put on shoes, I have to sit on the sofa for 2 minutes until my shoes are tied, and then I get to go outside and play in the sandbox and get a big hug from Mommy”.

You Might Need a Little Help…

Unless you have your PhD in Behavioral Health hanging in your office, you probably aren’t completely sure on where to begin. There are plenty of specialists available who can help get you and your family on the right track to behavioral modification. True to form, you as the parent should keep your eye on the reward:

A happier, healthier child. This is probably above all, the best reward we could offer.

Horse Therapy May Be Effective In The Treatment Of Autism

Horse Therapy Shown to Be a Beneficial Therapy Treatment (via)
Horse Therapy Shown to Be a Beneficial Therapy Treatment (via)

Every form of Autism is unique. There are many cases of Autism that are similar – similar symptoms, similar patterns, similar family background. However, it all boils down to the fact that people are different – so each Autism case will be different. Each and every story is very inspiring. Alexis Diaz’s story is no different.

Alexis is ten years old and has severe autism that prevents her from speaking and doing independent tasks that we often take for granted. She is unable to feed or bathe herself, and in addition she lost one of her eyes due to cancer.

Last year, Alexis was enrolled in the Therapeutic Riding of Texas (TROT) program, and made significant progress. The local news stations banded together and paid $700 for Alexis to attend the sessions.

Horse Therapy has been around for quite some time and there have been benefits noted in children with ADD and Autism. The mere act of being around a horse can change brainwave patterns — people feel more calm, at ease, and focus less on the past or negative events – so it’s a very enjoyable experience for them. Children with ADD/Autism Disorder have benefited as they are often unable to effectively communicate with other people and express themselves. Even those who are more aggressive and have severe behavioral issues have shown positive benefits from horse therapy. Even being around the horse has made these people much calmer, and more willing to communicate and be receptive.

How and Why Does Horse Therapy Work?

Horses behave in a way that is a direct reflection of how they’re being spoken to. They’re an animal of prey so they want to feel safe. If they’re being spoken to an an aggressive, angry or demanding way, the horse will become fearful. If the horse is spoken to calmly, smoothly and by making requests, they’ll be very receptive and obey such requests.

Children are ideal candidates to work with horses because with just a little insight on how to communicate with the horse, the child can learn how to change or control his/her behavior and see the effects from it. The child is more likely to consider this more of “making a relationship” with the horse rather than trying to dominate the situation and be in constant control.

After Alexis’ great outcome from her last TROT visit, she was very excited to head back this March. This year, however, the charity wasn’t sure if they would have the funds available to send Alexis back to the program. Alexis’ family is also on a limited income as her mother, Tammy Stewart, is a single mother who is unable to work due to Alexis’ need for 24 hour care.

Her attending the TROT program was almost definitely out for this year due to funding.

This past week, an anonymous letter was sent to Duncanville Outreach Ministry. Inside the letter was a $700 donation that was to go toward Alexis’ registration to this year’s TROT program. The donation was in the form of a Money Order with no return address. It simply said: “Sincerely, a Duncanville citizen who wishes to remain anonymous.”

Autism’s logo – a puzzle peice — is all too appropriate. Autism itself is a puzzling disorder. It comes in so many different forms, with many different symptoms.  There are many treatments available, and twice as many opinions about these treatments. It boils down to what methods and treatments work for your child.

Over the course of this blog, we’ve taken a look at a lot of different treatment options. Something we pride ourselves in is making you aware of everything that’s out there, so you can have the information necessary to make decisions based on what’s best for you and your situation.

New iPhone app aims at helping children with autism

When your child is diagnosed with autism, a million questions begin running through your mind. “How do I help him/her?” “How do I find a doctor that I know is qualified” “How am I going to pay for this?” “How can I effectively help my child in their development?” Many of these answers are dependent a variety of different factors and the nature of your specific situation.

Nowadays, whenever a “how-to” question is posed, typically one of two answers are given; A) ‘Google That’ or B) ‘There’s an app for that.”. The latter of course is referring to Apple’s revolutionary iPhone and iPod, both of which feature download-able applications (“apps”). There are apps available that assist you in a variety of tasks ranging from getting a cocktail recipe to ordering movie ticks and booking a hotel room. Even more impressive is the possibility that there will soon be an app available targeted to help children with autism.

Lisa Domican lives in Dublin, Ireland and is the mother of two children with Autism; Liam (11) and Grace (9). With both Liam and Grace, Lisa has practiced Picture Exchange Communication, also known as PECS which is an alternative form of communication that enables children to use pictures instead of words to create sentences and communicate.

“You are constantly having to replace loose cards and make new ones,” said Ms Domican. So out of that came the idea to develop an iPhone application that would make the process more efficient. Coincidentally, the application was created under the name “Grace”, her 9 year old daughter.

“With the iPhone, the screen looks like a Pecs book. It’s ok to have a four-year-old walking around with a Pecs book; it’s not ok for a 10 or 12-year-old. They’re very personal to the kids; it’s their voice. The [Pecs books] really stand out, whereas the iPhone is discreet and always there.”

Domican collaborated with Steven Troughton-Smith, a software developer for the iPhone who has created a number of bestselling applications. The application is backed by O2 Ireland who supplied the devices and testing for the application while it was in development stage. Domican’s daughter, Grace has become so comfortable with the device that she adds her own pictures to the PECS library with her iPhone Camera.

The application is still undergoing testing at a few schools to see if parents, students and teachers can use the application easily. Once approved, it will be sent to the Apple iPhone application store.

The Earlier The Better When It Comes To Autism Diagnosis

autism-boyCountless children are sent to the principal’s office or given detention for their poor behavior or lacking social skills. It’s always assumed that these are “problem children” who come from “problem families” or who are never taught the proper way to act.

These are classic symptoms of Autism. Children with Autism often lack the social skills needed to maintain well behavior. This disorder and inability to develop skills is often noticeable in children younger than four years old.

Toddlers with Autism often do not respond as a child normally would to social situations. Typically at the age of 2 or 3, children begin to make friends. Autistic children often to not develop this social skill and seem a bit stand offish. Additionally, they may not respond to being hugged or shown affection from a parent or caregiver.

Autistic children also may develop a seemingly “obsessive” series of habits. For example, having to arrange things in a specific order and checking to make sure it remains that way several times. They also may have a slower speech progression. Autistic children sometimes have a limited vocabulary characterized by repeating the same words over and over again.

It’s worth mentioning that you may have a child who is simply shy, or who just takes a liking to a certain word and chooses to repeat it. There are even some children who are just naturally slower when it comes to developing speech. It’s usually when it’s a combination of these things that flags are raised.

If your child does develop a few of these common autism symptoms, or others such as unnatural attachment to objects, repetitive physical movements, or general lack of affection, it is strongly suggested that you bring it up with your physician as soon as you begin to notice it.

It’s often said that mother are the best diagnosticians – they can sense something is wrong at a very young age. It’s also recommended that you keep a video or photo diary of your child’s questionable behaviors or habits to show to your doctor.

In a recent study, it was found that there were a variety of improvements in those children who were diagnosed and treated for Autism at a younger age. There are many new and experimental treatments being used to treat the disorder, and these treatments might not always be available to all autistic children. It all depends on their geographical location.

As long as parents and caregivers can recognize the symptoms of Autism, it’s likely that an effective treatment schedule can be developed.

A Sibling’s Take on Autism

Brothers AutismAdam and Dean Aviram are best friends – more than that, they’re brothers. At 9 and 10 years old respectively, Adam and Dean brag that they’re building a time machine together. Though he’s the younger of the two, Adam looks out for Dean and enjoys spending as much time playing with him as possible. They work as a team many times, especially because Dean has a wonderful memory so Adam loves that he doesn’t have to remember things.

Though alike in the traditional last name and DNA departments, Adam and Dean’s differences are many. Adam prefers to play soccer and Wii. Dean has a fascination with history and loves to have intelligent conversations about world leaders with anyone who is interested. Though you might not be able to tell by simply looking at them, Adam and Dean’s biggest difference is that Dean has Asperger’s Syndrome and Adam does not.

If I were to pose the question “What is Austism?”, I can only assume that you would head right to Google or WebMD and find the most technical and informative definition. Though it would be certainly accurate, your definition may differ from that of an Autistic child’s parent or even more, an autistic child’s brother or sister. The siblings of autistic children are undoubtedly intelligent and some of the best people to ask about the disease to get an honest, accurate description of what Autism looks like and means to them.

When Adam was asked what Asperger’s was, he answered, “Asperger’s is a type of autism and it’s hard for people to have a good conversation with other people.” His answer was not filled with technical words, however it was very accurate. He was also asked if his friends could notice that something was different about his brother, Dean. Adam answers an honest “Yes.” but says that they are not disrespectful towards his brother. He does go on to say that his friends wonder why he sits with other Autistic children at lunch time. Adam says that he tell his friends that he’s helping people and he’s interested in other people with Autism because of his brother’s Asperger’s.

Not only does Adam go above and beyond for his own brother, but he is a true advocate for the Autistic community by reaching out to others.

Some researchers are concerned with the effect of Asperger’s and Autism on the other children in the household. Do they grow up craving attention? Do they form a resentment for the illness and for their sibling for their mental disorder? Do they develop anger issues and are they more likely to have anxiety disorders as young adults? All of these scenarios and more are being studied, and we’ll surely see reports and statistics released at some point. However, in the case of Adam and Dean and surely in many other cases out there we have a chance to see that when subjected to Asperger’s in their home, children learn the lessons of respect, compromise, tolerance and patience at a much younger age than many other children. These are lessons and skills that many of us live our entire lives trying to learn and perfect.

Facilitated Communication – A Controversy

A few weeks ago, we took a look at Carly, a young girl who has Autism. She is FCnon-verbal however she independently communicates via keyboard to her family, friends, Twitter Followers and Facebook Friends. She often fields questions from followers and she answers them herself. Once in a while her father has been known to send out a message just making a general request. Recently, for example, Carly’s father sent a message out kindly asking that people use Twitter to communicate with Carly as opposed ro Facebook. This was simply because Carly prefers Twitter over Facebook. Other than these once-in-a-while instances, Carly communicates everything herself with near no assistance.

As common as  individual communication methods have become, there are still some non-verbal people who are unable to successfully use a keyboard.  Hand-eye coordination is required to be able to utilize the keyboard method and many people lack this skill, especially if they have Autism. There are alternative methods of communication that have opened the doors of possibility for those who are non-verbal and lack the hand-eye coordination to successfully use a keyboard. One method in particular is known as Facilitated Communication or FC. In this method, specifically targeted to those who cannot type, there are two people involved; the communicator, (whom is often autistic, deaf, mute, etc) and the Facilitator. The facilitator is responsible for conveying the message of the communicator by assisting them in finding the right key, easing their hand to the desired letter, or pressing they key down that the communicator indicates.

Despite the numerous success stories that have come from this method, it is still under much controversy and has been for years.  In 1977, Rosemary Crossley claimed to have successfully used facilitated communication with a group of non verbal children. In 1989, the Facilitated Communication Institute was founded by Douglas Bilkin at Syracuse University in New York. The school was designed to educate families who were exploring such a method.

Facilitated Communication has had its advances over the years, but both medical and psychology experts claim that there is not enough hard evidence to prove the success of FC. In the 1990’s the American Medical Association and the American Psychological Association issued statements that opposed the use and validity of FC. Their main criticism being that the facilitator had influence over what the communicator was attempting to say.

In 1997, Diane Twatchman-Cullen, the editor-in-chief of the Autism Spectrum Quarterly journal published “A Passion to Believe: Autism and the Facilitated Communication Phenomenon. ” In the book, Twatchman-Cullen takes a look at the conditions that led parents, teachers and others to depend on FC.

Also featured in the book is an examination of the study that Twatchman-Cullen conducted in 1990 of three adults with non-verbal, non functioning Autism.  All three people spent their educational and informative years in institutions so they had no real external exposure. With a facilitator, however, all three were able to communicate ideas about the outside world.

“I don’t think that the vast majority of people were deliberately typing their own messages,” she said. “I really don’t believe that, but I do believe there was unconscious facilitation.”

Though rare, there have also been a few cases in which individuals have graduated from using FC to independent communication.

It is estimated that there are about 700 – 1,000 people worldwide who communicate using FC.