PEC: Picture Exchange Communication

Given my and Ellie's frustration with Ellie's difficulty communicating, we recently started using the PEC or Picture Exchange Communication system.

What is PEC?  
The Picture Exchange Communication is a system that helps individuals with difficulty speaking communicate to get their needs met.  It is exactly as it sounds--pictures of everyday items such a food, toys, people, etc are used to communicate a message.  For instance, the child would take a picture of a banana and present it to "the listener".  The listener would then give the child a banana in exchange for the picture.  Eventually, the system can be expanded so that the child can make choices between pictures (i.e. cracker vs. banana).

In order for this system to be successful, the child must understand the concept of "taking turns". That is knowing to hand off the picture to another person to receive the item in the photo.

Why PEC?
As you know, Ellie has great difficult making sounds.  She also has trouble signing (this is related to poor motor planning).  Her signs are very gross approximations that only those closest to her may understand.  Yet even then, sometimes Andrew and I have no idea what she is signing.  Many of her signs look exactly alike--duck, milk, orange.  This frustration leads to SCREAM.  We do not like SCREAM in our household so J, our developmental therapist suggested adding PEC to our bag of tricks.

I must admit that I was bit skeptical at first given the fact that we tried this months ago and Ellie just could not grasp the concept of exchanging photos for items.  She would just hold onto the picture, play with it, mouth it.  I was also wary due to Ellie's propensity to mouth everything.  What if she just mouthed the picture the whole time? This was one of our biggest problems when we tried to use PEC previously.

Where to start?
First, it is important to find out what motivates your child.  For Ellie, I presented her with a variety of toys and looked to see which were the top three toys she typically gravitated towards.  I then started to place those toys high up or in difficult to open containers so that she would have to "ask" for them.  Her favorite items: the iPad (which I already kept out of reach), her blocks, and her nesting cups.  I took pictures of these three items. Placing velco on the backs of the pictures, I then attached them to a small poster board.  This poster board is kept within Ellie's reach and can be easily carried from room to room.  Eventually I hope to get a binder that will hold all of the pictures.

PEC Board

Implementing PEC.
We started the PEC system when J was here for a therapy session.  We corralled Ellie and secured her into her high chair so that she couldn't escape.  She is feisty like that.  We presented only ONE picture to her.  We were trying to teach her about "turn taking".  I used the iPad picture.

Mmmm.  Technology

Of course she mouthed it.

Here Mom!  Give me the iPad.  NOW!

Then she wanted the iPad so bad that she handed the picture to me.  Now, very stoically, I handed her the iPad while saying in a neutral tone of voice "iPad".  We repeated this for a while and guess what, the mouthing decreased.  She got it!  She knew that in giving me the picture of the iPad, she would be rewarded with the iPad.

Next, we introduced 2 pictures.  I gave her the iPad picture and the block picture.  Ellie, of course, mouthed the new picture because you know, it might taste different than the iPad one.  Ellie then chose the blocks.  Same thing as the iPad.   You calmly take the picture while handing her a few blocks and say "blocks".

I am shocked that it is working.  Soon we are going to move into food items.  Ellie still doesn't recognize that she can go to the poster board, grab the photo of the desired object off of it, and present it to me, but I have hope it will happen soon.  We are still going to use signs with her, but the PEC is a nice adjunct to the signing.  Am I still frustrated?  Yes, at times.  Is Ellie?  Of course. Yet the PEC now allows Ellie to express some of her wants.