Icons are image cards that help people who have difficulties with spoken expression communicate in a different way. The person exchanges small picture cards for items or creates full sentences to express themselves.
Toddlers, children, teens and adults can all use icons. Icons are suitable for a variety of diagnoses and abilities. Different factors will impact how quickly a person learns how to use icons.
Most will use icon communication as a stepping stone towards spoken communication. Some people will continue with icons their whole lives. Others switch over to more advanced Augmentative and Alternative Communication(AAC) programs like Proloquo2Go.
What are PECS
The Picture Exchange Communication System (PECS) is a specific program that uses icons. Not all neurodivergent people use the traditional PECS system. It is critically important that the neurodivergent person’s strengths and needs are considered before choosing traditional PECS or a more informal icon system. Informal use of icons typically follow some of the following phases with more flexibility than PECS would allow.
PECS Phases
Phase I: How to Communicate
The child learns to exchange a single picture card for an item or activity they really want. Only have one card available during this phase. One adult may need to start the process by putting the card in the child’s hand. Then they move the child’s hand to the other adult who has the item or activity ready to reward the person with. Over time the child will begin to grab the card themselves and hand it to the adult for the item or activity.
Phase II: Distance and Persistence
Still using the single card the adult slowly begins to get further away from the child. First they start across the room, then in another room and encourage the child to continue bringing the card over for the item. Next the adult can expand the environmental conditions. When learning to use PECS at the library, park or store, start with being close together and slowly get further away just as they did at home. Once this is solidly in place it’s time to introduce other adults and even older children as the communication partner. It’s important that you explain the process to the new communication partner and show them what it should look like.
Phase III: Picture Discrimination
In phase III, give the child two picture cards to choose from. It is helpful to start with one picture card that you know the child wants and the other as a silly item you know they do not want i.e. a food they hate or a box of tissues. The goal is to get the child to look at both picture cards and select the one they want. With time more cards can be added to a PECS communication book. Eventually the silly cards will not be necessary and the book can be filled with a variety of items and activities the child enjoys.
Phase IV: Sentence Structure
In this phase, the sentence strip is added to the communication book. Sometimes this a portable strip but it can also be the cover of the book. Start with the “I want” card and have the child put the item or activity on the end of the sentence strip. Add in adjective, verb and preposition cards. This lets the child create more robust sentences like “I want more cereal” or “I want to play outside”.
Phase V: Answering Questions
Now the child is ready to create a sentence in response to the question “what do you want”. An adult asks the question verbally and prompts the child to look at their communication book and create a sentence strip.
Phase VI: Commenting
In this final phase the adult asks a variety of questions that require the child to use different verbs in their response. You could ask “what do you see?”. The child is taught to answer the question with their sentence strip starting with the correct cards for “I see”.
Are all the phases necessary
This is a tricky question. The first three phases are crucial for the system to work in its most basic form. Many toddlers and preschoolers will only use the first three phases and then transition into using spoken communication. It is fine if you never get to the sentence phases. Others will need to continue with the phases into childhood, adolescence or even adulthood. It is nearly impossible to tell which path a child will take so it’s best to follow the early phases as closely as possible so that a solid foundation is created.
That being said, some kids will “catch on” quicker than others and they may naturally understand the concept. It is still important to teach each phase, it just may be a fairly short lesson. Big Brother “BB” took nearly 6 months to learn the first two phases. Little Brother “LB” instantly did these two phases without any training and was therefore ready for the third phase after one session.
But I want my child to talk…why do any of this?
It can seem very discouraging to accept that a child may need an alternative form of communication. The important thing to remember is that for your child this is their “normal”. They do not know any difference and in many cases it can be a temporary thing! The goal is to make sure the child feels heard and validated which supports healthy emotional development. Giving a person the opportunity to communicate reduces behavioral problems and tantrums.
There are a variety of ways that picture cards can be used to support spoken communication. Once you have had success with phase one, you can put your mouth in the child’s line of sight and say the word as they exchange the card. Alternatively, cards can be used to pairs sounds with they already know. For example, if I child naturally says “babababa” you can show them the card for “ball” while saying “baba—ball”. You may be surprised to hear your child say “ball” while handing you the card one day!