Picture symbols: for professionals and students

This page provides information on a particular intervention/approach and any research connected with it; it is not a recommendation. The outcome of any approach will depend on the needs of the individual, which vary greatly, and the appropriate application of the intervention. An intervention that may help one individual may not be effective for another. It would therefore not be appropriate for the NAS to recommend any one particular practice or therapy.

Introduction

The triad of behaviours that underpins autism spectrum disorder includes difficulty with social communication. Communication consists of exchanging messages between people: expressing needs; sharing thoughts, ideas and feelings. Communication often, but not always involves the use of language either spoken or written. Human beings use communication in social settings and derive pleasure from sharing conversation.

Children with autism spectrum disorder (ASD) have difficulty in discovering the power and pleasure of social communication. They tend to engage less in day-to-day exchanges with their carers and are often slower to develop language. They may also have learning difficulties that interfere with learning language.

However, people with autism tend to be visual learners, and visual means of communication can help them to understand and use the process of communication thus encouraging the development of spoken language and of appropriate social communication.

Temple Grandin (an American animal scientist who has autism) describes how she thinks in pictures and how words are like a second language for her (Grandin, 1995). Visual thinkers can be helped by visual support and the Treatment and Education of Autistic and related Communication handicapped Children (TEACCH) approach encourages the use of visual structure to reduce stress and promote learning for people with autism by making their environment more easily understood. Visual aids can help people with autism to make sense of the world and of other people, including the process of communication.

Visual ways to enhance and facilitate communication

There are various visually based ways to help communication in people with autism. Visual means can be used to accompany or augment the spoken word to help the person with autism understand spoken information. They can also be used to help the pre-verbal person learn to express their needs by requesting what they want.

Object, photograph or symbol?

Objects, photographs, picture symbols and written words can all be helpful to accompany speech and the choice will depend on the needs of the individual. Traditionally, the use of objects of reference was considered most suitable for an early developmental stage, followed by the use of photographs and only later that of symbols.

Picture symbols (line drawings which are usually accompanied by the written word) are one way of enhancing (or augmenting) the spoken word to help visual learners communicate. However, as with many aspects of development, in autism the normally developing progression from object to photo to symbol may not be appropriate indeed, sometimes the person with autism finds a symbol line drawing less confusing than a detailed photograph. People with autism tend to perceive details more powerfully than the whole (they may be unable to see the wood for the trees) and they can become confused or distressed if the photograph used (e.g. that of a particular brand of sweet or of a certain playground) does not exactly match the real life object or place to which it refers.

Some people with autism are able to recognise written words more easily than spoken words (hyperlexia) so it advisable to always use picture symbols with an accompanying (lower-case) written word. This may assist the person with autism and will also help other people to understand the symbol. Picture symbols are easily understood by the general public (especially if used in association with the written word) and are becoming more easily available with the advent of computer generated systems in addition to the master picture sets available from educational suppliers.

Labelling: understanding names for things and places

Picture symbols should first be associated with the thing that they represent by labelling: attaching a symbol to the object or place that it represents (eg biscuit or toilet). Once the person with autism has begun to associate the symbol with the real thing (or place), then an identical symbol can be introduced a little distance away from the actual thing, allowing the parent or carer to show the symbol whilst telling the person with autism what to get, or where to go. Thus the symbol becomes portable and can be used away from the thing that it represents.

The rate at which new symbols can be introduced will vary from person to person but it will be important to use symbols first to refer to things which are motivating for the person with autism and to wait for clear signs of understanding before introducing a new symbol.

Learning to request: to exchange a symbol for a desired object

People with autism have difficulty in learning how communication works. Their mind-blindness increases their problems in figuring out how communication works. If you lack the understanding that another person may not know what you want, why make the effort to communicate that want? To help the person with autism learn how communication works, it can be very helpful to teach them to exchange a symbol for a desired object.

The Picture Exchange Communication System (PECS) was developed by Bondy and Frost to help young children with autism learn to initiate requests and communicate their needs. PECS uses a behaviourally based programme to teach the child to exchange a picture card for something the child likes and wants. Objects, pictures or symbols may be used, according to the childs developmental level but many young children with autism find the less detailed line drawing of a symbol easier to understand, especially if this is accompanied by the written word. A picture cut out from a certain packet of crisps may be refused by the child with autism for use with any other type (or brand!), whereas the more general outline of a symbol will be accepted as referring to all crisps.

PECS first assesses the childs preferences, for a small number of food items and some toys. The child is then taught, in a carefully graded pattern of small steps, to exchange a symbol representing one of these wanted items for the item itself. At first, two adults are needed so that the child can be physically (but not verbally) prompted to exchange the symbol, rather than grab the wanted item. One item (and its symbol) is worked on at a time. No verbal prompts are given the first speech the child hears will be the name of the item, said by the adult offering it, as the exchange is made. The second adult stands behind the child, offering a physical prompt to encourage the child to exchange the symbol, but never speaking. Once the child learns to give the symbol, this second adult is no longer needed.

The six phases of PECS are carefully structured to enable the child to:

learn the picture exchange
actively find someone to give a symbol to as a request
discriminate between several symbols
use a portable communication book
construct simple sentences, both requests and comments.

The child gradually becomes independent of adult prompting and learns that communication is a two-way process which can achieve desired needs.

PECS has been shown to facilitate the development of spoken words, and establishes the basics of communication in advance of the hoped-for emergence of speech. Children learn to communicate with PECS because they are highly motivated to request a wanted item and because PECS teaches visually explicit skills, using only physical prompts which can be gradually faded, thus avoiding the child becoming prompt dependent. PECS is easy to use and does not involve expensive equipment, testing or training although training courses for professionals are available, together with a video.

Making choices

Picture symbols can also be used to introduce the idea of choices for instance with food. If the understanding (and exchange) of symbols for a variety of foods has been established then these symbols can be used to show the choices available and the person with autism can be encouraged to communicate their preferred choice. Choice boards can also be used for play or leisure activities, encouraging the person with autism to choose an available activity (rather than remaining passive or persisting in one activity repetitively).

Visual structure

People with autism, whether non-verbal or verbal, may also benefit from the use of picture symbols on timetables (or schedules) showing the sequence of daily routines. Using picture symbols in this way can avoid tantrums or a build up of anxiety and encourages the development of independence in skills such as dressing. Symbol timetables can be adapted for use at home, at school, in the workplace, or in an independent living environment. This use of visual structure helps the person with autism understand the world around them, and develop independence skills. Picture symbols can help make their environment organised and predictable, encouraging calm behaviour.

Symbols can also be used to help the person with autism understand available choices of activity, or to reinforce the concept that something is finished and show the person with autism what will happen next. When one activity has been selected and completed the person with autism can (if desired) be taught to place the symbol for the completed activity in a container labelled finished and to move on to another activity.

This use of visual structure is part of the TEACCH approach and can be modified for use throughout the life of the person with autism, if necessary.

References

Bondy, A.S. and Frost, L.A. (1994) The Picture Exchange Communication System. Focus on Autistic Behaviour, Vol. 9(3), pp. 1-19.

Grandin, T. (1996) Thinking in pictures and other reports from my life with autism. New York: Vintage Books.
Available from the NAS Publications Department

Further information

Do to Learn
A source of picture symbols and suggestions for their use available from: email: do21earn@do2learn.com; website: www.dotolearn.com

ISPEEK
Dixon J. (2007) ISPEEK at home: over 1300 visual communication images. London: Jessica Kingsley.

Dixon J. (2007) ISPEEK at school: over 1300 visual communication images. London: Jessica Kingsley.

Obtaining picture symbol resources
A range of picture symbol resources can be obtained from: Winslow, Goyt Side Road, Chesterfield, Derbyshire, S40 2PH; tel: 0845 230 2777; fax: 01246 551195; email: sales@winslow-cat.com; website: www.winslow-cat.com

Obtaining picture symbol software
Software for a range of picture symbols is available from: Widgit Software Ltd, 26 Queen Street, Cubbington, Leamington Spa, Warwickshire, CV32 7NA; tel: 01926 333680; fax: 01926 885293; email: sales@widgit.com; website: www.widgit.com

PECS
Further information about PECS is available from: Pyramid Educational Consultants UK Ltd., Pavilion House, 6 Old Steine, Brighton, BN1 1EJ; tel: 01273 609555; fax: 01273 609556; email: pyramid@pecs.org.uk; website: www.pecs.org.uk

TEACCH
The National Autistic Society has a factsheet about TEACCH that is available from the NAS Information Centre, or on the NAS web site: http://www.autism.org.uk/006197

Further information on interventions is available on the Research Autism website at www.researchautism.net

Research Autism is the only UK charity exclusively dedicated to research into interventions in autism. The interventions section of their website provides information about a wide range of interventions, including what they are, what they are supposed to achieve and whether there is any supporting scientific evidence behind them.

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Last updated: February 2009