02/04/2020, by Julie Roberts, M.S., CCC-SLP
The Picture Exchange Communication System (PECS®) created by Andy Bondy, PhD and Lori Frost, M.S., CCC-SLP is an AAC system based on rewards and compliance. PECS® requires a non-speaking child to give a picture to a communication partner (trainer) in order to receive a concrete outcome (high-value reinforcer), (Bondy & Frost, 1994). Applied Behavioral Analysis (ABA) is embedded throughout PECS® because the system is based upon the work of behavioral scientist B.F. Skinner’s 1957 Verbal Behavior framework of language training curricula for persons with severe developmental disabilities[1]. Specifically, PECS® uses Operant Conditioning, which is a behavior technique that can be used to target and increase a behavior by pairing performance of the target behavior with a positive or rewarding outcome.[2] Per Andy Bondy, inventor of PECS®, “Skinner’s analysis of Verbal Behavior forms the basis for teaching particular skills at specific points in the training sequence and also provides guidelines for how best to design the teaching strategies.[3]” PECS® uses picture-based prompting and reinforcement tied to error correction in order to teach language skills. The method allows the trainer to artificially cause frustration through the withholding of highly desired objects or food until the targeted behavior is achieved, even if the communicator becomes upset or angry. It is not a natural or nice way to teach language.
PECS® is low-tech Augmentative and Alternative Communication (AAC). There are six phases:
- Phase one: Trainer identifies what motivates the child the most, a “highly desired item. “The trainer teaches the child that by handing a card to the trainers, only then will he or she will be able to receive the desired object/food in return. This phase requires two trainers: Communicative Partner and Prompter. The communicative partner is the one who will entice the child by withholding a highly valued object or food. The physical prompter will prompt or physically manipulate the child to pick up, reach, release. If the child makes an error, the “Backstep” error correction is used. Example: the child picks up the picture and drops it before putting in the communicative partner’s hand. Physical prompter goes back to the last step performed correctly and prompts from that point through end of task
- The second phase – Expands the use of pictures. The child must come to the trainer to request objects/food by handing cards in exchange for highly desired objects/food.
- Third phase: The child now makes choices between available pictures and receives the desired food/object.
- Fourth phase: The child learns to make simple sentences to make requests: “I want…” The child gets the desired food/object when they make the sentence.
- Fifth phase: The child learns to respond to “What do you want?” Unlike earlier phases, in the fifth phase, the desired object does not need to be physically present.
- Sixth phase: In addition to responding to “What do you want?” the child will learn to differentiate between this and similar questions, such as “What do you have?” and “What do you see?” The child should begin to be able spontaneously to distinguish between the questions and respond with the appropriate carrier phrases learned in phase IV: “I want ____,” “ I see ______,” “I hear _____,” etc.[4]
In 1967, Noam Chomsky, the father of modern linguistics and a founder of the field of cognitive science, in a critique of B. F. Skinner’s Verbal Behavior said, “… the controlling variables are to be described completely in terms of such notions as stimulus, reinforcement, deprivation, which have been given a reasonably clear meaning in animal experimentation. In other words, the goal of the book (Verbal Behavior) is to provide a way to predict and control verbal behavior by observing and manipulating the physical environment of the speaker.[5] Chomsky goes on to say, “Skinner’s thesis is that external factors consisting of present stimulation and the history of reinforcement (in particular, the frequency, arrangement, and withholding of reinforcing stimuli) are of overwhelming importance, and that the general principles revealed in laboratory studies of these phenomena provide the basis for understanding the complexities of verbal behavior.”[6]
The functions of human communication include so much more than requesting or responding to the withholding of highly favored objects and food, but PECS® is based exactly on this – the communicator receives a tangible reinforcement (“a highly desired item/food”) in exchange for a picture, or the communicator uses the picture to request. The problem is, most communication attempts are not always, or even generally about requesting a tangible object or food.
Even the animals communicate for reasons other than responding to withheld reinforcing stimuli. In fact, “Prairie dogs appear to have one of the most extensive vocabularies in the animal world. Not only can they use words to tell each other about an approaching threat, but they can also add in descriptive language to communicate the type of threat, including size, shape and even advancing speed.”[7]
When infants and then toddlers begin to develop language, they learn to label common nouns such as Mama and Daddy, ball, cookie, dog. They greet and take leave. They ask for help. They protest, a lot. Young communicators make comments and share information. As their language develops, young communicators begin to ask and answer Who?” “What?” “Where?” and “Why?” questions all day long, much to the chagrin of parents. Young communicators share their feelings when they are “sad,’ “happy,” “mad,” or “excited.” They are silly with their communication. Young communicators are playful. And as language abilities increase, young communicators begin to predict and answer “What would happen if …” or “Why do you think …” questions. Between two and three years of age, a typically developing child acquires a 400-word vocabulary.[8] To be limited to responding to or making requests for Scooby snacks is not true language development, nor is withholding a favored object or food until someone complies, treating that person with dignity. Children are not rats; we should not train them like rats.
Some other reasons PECS® is problematic:
By “only targeting requesting, the frequency of requesting increases which leads to more opportunities for denials to these requests triggering more externalizing problems (Nugai et al. 2017). This can lead to the cycle of requesting and externalizing problems as discussed in Dorney, K. E., & Erickson, K. (2019) Transactions Within a Classroom-Based AAC Intervention Targeting Preschool Students with Autism Spectrum Disorders: A Mixed-Methods Investigation. Exceptionality Education International, 29, 42-58.” – Kathryn E. Dorney, M.A., CCC-SLP
A PECS® system is expensive, both for the initial training, and the purchasing of cards. The expense is ongoing. The cost to maintain and grow a PEC system is more expensive than the cost of many AAC apps on an iPad. Additionally, there are even free AAC applications available, like LetMeTalk.
Many communicators benefit from the benefits of motor planning on a familiar board. When a board is used over and over, the communicator memorizes exactly where pictures/words are located.
With PECS®. there may not be immediate access to the card a child needs, and there may not be PECS® cards at all to communicate the kind of message a child may want to communicate. In order for a child to use PECS® to communicate with another person, there must always be access to a communication notebook. Pictures can be lost or damaged.
PECS® is an extremely cumbersome way to communicate. Additionally, it is time-consuming. The trainer must constantly adjust the binder or picture board holding the picture cards (Communication Notebook). Binders must go everywhere with the user.
PECS® does not respect body-autonomy, as the child is physically prompted or manipulated to comply with card requests. This operant conditioning method rejects communicative attempts that do not comply with the compliance training’s goals, such as looking at, grabbing for or trying to reach a highly desired object or food. It violates human dignity by ignoring the child.
The Picture Exchange Communication System (PECS®) is a trademarked AAC system that includes training, on-site consultation, and products. The PECS® method is operant conditioning. Operant conditioning is ABA. The PECS® cards are used in conjunction with tangible reinforcement. Reinforcement is withheld until the child complies with exchanging the card. PECS® is not the same as a therapist or parent using laminated picture cards to model language as they acknowledge any total communicative attempts made by the child. If an adult knows a child wants something (they’ve brought it to you, pointed, looked in that direction, made any attempt to communicate their desire for a highly favored item or food), why would the adult artificially cause frustration by withholding it until the child complies with the method in which the adult wants them to communicate? Not acknowledging someone else’s communicative attempts, even if the communication is through behavior from a non-speaking child, is controlling and cruel.
Therapist Neurodiversity Collective does not recommend PECS® as an AAC system. We have strong ethical concerns and philosophical differences pertaining to the use of Applied Behavioral Analysis (ABA) on human beings, including ABA-derived therapy models. We do not force compliance through the earning of snacks, checkmarks, behavior charts, stickers, access to favorite toys, activities or similar. The fundamental goal of ABA is compliance with the will of the person in the position of authority; this is completely counter-intuitive to self-advocacy, self-determination, and upholding human rights and dignity. Therapist Neurodiversity Collective advocates for communication choice that is free from coercion and/or compliance. We are advocates for removing both access and opportunity barriers to communication. Robust AAC, including access to core language, is our first and primary choice for aided communication.
[1] Investigating the Acquisition, Generalization, and Emergence of Untrained Verbal Operants for Mands Acquired Using the Picture Exchange Communication System in Adults With Severe Developmental Disabilities https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779930/
[2] Domjan, M. (2010). Principles of Learning and Behavior, 6th Edn. Belmont, CA: Wadsworth/Cengage.
[3] PECS: Potential benefits and risks. https://www.researchgate.net/publication/26455606_PECS_Potential_benefits_and_risks
[4] Car Autism Roadmap – PICTURE EXCHANGE COMMUNICATION SYSTEM™. https://www.carautismroadmap.org/picture-exchange-communication-system/
[5] A Review of B. F. Skinner’s Verbal Behavior by Noam Chomsky. In Leon A. Jakobovits and Murray S. Miron (eds.), Readings in the Psychology of Language, Prentice-Hall, 1967, pp. 142-143 https://chomsky.info/1967____/
[6] Ibid.
[7] Irish Examiner: Appliance of Science – Can animals communicate with each other? https://www.irishexaminer.com/lifestyle/features/appliance-of-science-can-animals-communicate-with-each-other-460987.html
[8] http://www.healthofchildren.com/L/Language-Development.html
She is a frequent speaker, educator, and trainer who delivers high-energy presentations that challenge audiences to re-examine their beliefs about Autism and re-access outdated and damaging therapy and education practices.
Julie’s work focuses on professional, and public education about empathetic evidence-based therapy alternatives to ABA and behavioral therapy models that are non-trauma inducing and respectful of autistic social communication differences, social justice, and human rights. Her articles and educational resources have reached well over three-quarters of a million people and are frequently cited in other presentations and articles.
- IEPs, Ableist Goals and Parents’ Rights - April 1, 2023
- SLPs directly contribute to autistic outcomes of trauma and suicidality through social skills training - March 16, 2023
- Toxic Social Skills Training Goals, “Be yourself, but not like that.” - February 22, 2023
The Therapist Neurodiversity Collective’s goal is not to debate with ABA practitioners, but rather to inform our therapists and family followers about empathetic and respectful practice models, as well as to inform about ABA derived therapy models we believe to be objectionable, because they may cause trauma, violate body autonomy, self-determination, and human dignity. In the past three years, it’s become clear that such a debate is futile.
The Therapist Neurodiversity Collective flat out does not practice ABA derived therapy models. One of our executive board members is Julia Bascom, Executive Director at Autistic Self Advocacy Network. She and Kieran Rose, Autism Campaigner and International Public Speaker are our mentors for all things neurodivergent and ABA.
Of course, ABA works – at least initially – but at what cost to the client? Loss of body-autonomy, self-determination, loss of self-esteem secondary to masking, or to their emotions and sensory differences and preferences being ignored, or having to earn access to favorite items, foods, and activities? Compliance training is not speech therapy or occupational therapy. We honor all communication attempts, including behavior. There is no reason to debate.
Indeed. BF Skinner’s experiments on autistics proved that physical abuse can make people temporarily compliant. Huh Who would’ve thought. It’s rape culture if ever; how often in the USA ABA is pushed on people, especially with autism. Every person can benefit from understanding the principles of ABA and behavior itself. Reinforcement, Pavlov’s Bell, etc. But it’s only truly beneficial to individual people as long as you consider them AS an individual and take care to teach effective communication and common sense of unacceptable behavior (which it’s sad to think of needing ABA therapy for this). It’s being mindful of yourself and of the individual. Motivation and rewards. The way it’s implemented all too often is “Do what I say now” and “you will no longer be in discomfort”. Sounds like torturing someone in many ways. And it can feel that way to someone with SPD, or something causing them to feel extreme distress that they CANNOT communicate. Not because they don’t want to. I fully support professionals willing to take a stand against the blind conglomeration of enforcing such a lack-of-intuitive self-guidance as well as a lack of choice when it comes to effectively communicating.
Hello Julie. You are the 1st SLP that I have read about that doesn’t practice ABA and I applaud that! Now, having said that how do I help my four-year-old son, who is uttering more words here and there learn to speak at home if all there is out there being taught is ABA?
Thanks much!
Aaron Shuck
PECS is what is being prioritized vs speech which is bothersome. Yes it ties into ABA. Which is also being pushed on people. It’s disturbing to say the least. Some therapists have not rewarded our child for speaking words, and have told her she needs to use her PECS/AAC instead which makes me livid. I realized they were stuck in their ways and said no more. We have a therapist that listens (isn’t burnt-out?) and cares and will move on with the activity or whatnot when our child approximates the word(s). Simple enough you wouldn’t think it’d be so dang hard to find a professional who understands how vital THAT reinforcement is. We have a handful of “PECS” (DIY) for (toilet/water/ need help) in case our child is in a hectic space mentally and needs to revert to that. But it works for us. We use her AAC Proloquo, and some ASL (had an ASL vocab of 8 at 2 years old) but we ALWAYS prioritize speech and teach her that that’s the quickest and most effective way to communicate. I re-discovered the keyboard function on Proloquo (an “advanced speak and spell”) ; as she more consistently reads and learns to spell we are practicing typing. Since she does not prefer to speak many times and has issues annunciating; if she would type her words out it would open a whole new world of choices for her! I’d suggest anyone to try that if/when their child is ready to start learning words and letters even. (If we had though about it during that phase I would’ve been doing that every day).
I’m relieved we got out child out of public school years ago but it’s still been a lot of work to obtain and keep a good therapy team that does not blindly accept all ABA and PECS practices. We saw our child regress every time we tried actual ABA therapy (vs implementing basic behavior-awareness models of reinforcement, etc). Even at the Charter school we use they tried to push inexperienced and awful “therapists” onto us, but we fought back. Now our team is wonderful barring one “meh” OT. Also they pushed ESY onto us every year since our child started school (in Pre-school). We finally said no last year, had our first no-school, no therapy summer (at home we still of course practiced therapeutics etc.). So much less stress on all of us and our child didn’t regress as much during the Summer as in the past with being too overwhelmed. Doesn’t make sense to us that someone especially not NT should not get a break that NT kids usually do. Maybe works for some but for us it’s one of the best decisions we have made this last year when it comes to our child’s education. Ironic considering it took less “traditional” instruction to better educate our child. Hmmm… Best of luck to you. God bless.
Also we were told NOT to combine various forms of communication yet since she was a baby she used (a little) speech and ASL…We were told many things that did not work for us. We blindly believed “professionals” way too many times vs our own guts as parents. I regret it but live and learn.
Exchanging a picture as a means of communication – just fine.
Picture Communication Exchange System (PECS) – not fine.
PECS incorporates an ideology, the core of ABA, operant conditioning, nasty anti-autistic programming. Reward(for NT)/Punishment(for Autistic). Unseen coercives. Forced compliance. Nagged to anxiety. Neverending frustration as a ‘breaking-in’ tool. Demanded conformity. The message of ‘defective’.
Hi Julie,
I find this approach really, really intriguing and I’m glad I’m not the only one feeling that some of the methodology for teaching language seems a bit punitive! As someone with little AAC experience-though I did take the intro to PECS course two years ago-could you direct me to any podcasts, videos, books, articles, that might add to my knowledge. I’d love to see what one of your sessions looks like, or to watch someone who is a member of this collective.
Thanks.
Jessica
Hi Jessica, I would suggest you start with this video: https://www.youtube.com/watch?v=OZ9_gxgEkMs&ab_channel=TheAACCoach
Kate McLaughlin, M.S., CCC-SLP is the AAC Chair for the Therapist Neuordiversity Collective. Her work is wonderful.