Children with Down syndrome typically have more developed receptive than expressive language skills, which often limits their ability to convey wants and needs verbally. Left unaddressed, this gap can trigger frustration and tantrum behavior. This study describes the process and outcomes of implementing Phase 1 of the Picture Exchange Communication System (PECS) as an effort to shift weak verbal communication toward more functional visual communication in a girl with Down syndrome at SLB Sumber Dharma, Malang, Indonesia. A qualitative single descriptive case study design (N-1) was used. Data were collected through participatory observation across five intervention sessions, parent interviews, and document review (child data form and planning matrix), then analyzed descriptively and thematically. Results revealed an uneven prompt-fading pattern across three PECS Phase 1 sub-behaviors: reaching toward the communication partner reached independence by the fourth session, handing over the picture card reached independence by the fifth session, while independently taking the card had not yet been achieved by the final session. Post-school fatigue, device distraction, and sensory sensitivity were identified as factors affecting the consistency of the child's performance. These findings underscore the need to report PECS outcomes at the sub-behavior level rather than only as global phase-mastery status, particularly for the Down syndrome population, whose literature base remains comparatively limited relative to the autism population.
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