A Picture's Worth: PECS and Other Visual Communication Strategies in Autism.

Bondy A, Frost L. Bethesda, MD 20817, Woodbine House, 2001, paperback, 170 pp, illus, ISBN: 0-933149-96-4, $16.95.

This book is written primarily for parents and professionals who provide services and support to children with autism. The text is written in lay terms that are easily understood by parents and uses real-life case studies to help parents and professionals apply the Picture Exchange Communication Systems (PECS) techniques described in the text.

The first 2 chapters of this 8-chapter text focus on verbal communication development in children who are not autistic. The chapters focus on the types of communication used by children at different ages and how these types are used for different purposes. The presentation is very simplistic with examples given through case scenarios. Chapters 3 and 4 explore why some children do not develop communication skills and, in particular, how children with autism experience communication difficulties. The authors discuss the relationship between the child's inability to express himself or herself and the frustration levels that can lead to many undesirable behaviors that are seen in children with autism. Augmentative and alternative communication (AAC) systems, which can be used to decrease frustrations in children who do not speak, are covered in chapter 5. Two types of augmentative and alternative communications systems--nonelectronic or "low tech" and electronic or "high tech"--are described in detail.

The PECS--a "low tech," visual communication program that uses pictures developed by the authors of the text--is presented in detail in chapters 6 through 8. The goals of PECS are to have the child: (1) initiate communication, (2) find a communicative partner and approach that partner, and (3) use a single picture to communicate and avoid confusion about the intent of the message. The book provides real-life case studies, along with a series of lessons from beginning PECS techniques to more advanced techniques.

The text is well written, and the content is important for those parents, educators, and therapists who work with children with autism. However, because of the intended audience, very little information on the efficacy of the approach is presented. References are given at the end of the chapters on the PECS, but text contains little discussion of research outcomes. I also found that the issues of communication dysfunctions in children with autism were too superficially discussed to be of benefit to most physical therapists. The "Resource Guide" at the end of the book was limited and primarily focused on the certification process that is available for people who wish to carry out the PECS approach.

In conclusion, this book has value primarily for parents, educators, and speech-language pathologists who work with children with autism. For physical therapy practitioners, the book may be of interest to whose who work with children with autism and who wish to gain more insight into communication strategies.

Barbara H Connolly, PT, EdD, FAPTA
University of Tennessee Health
Sciences Center
Memphis, Tenn

Dr Connolly is Professor and Chair of the Department of Physical Therapy. She currently teaches in the area of pediatrics and research. In addition, she holds a faculty appointment at the University of Indianapolis and is President of the Pediatric Section of the APTA.