Picture Exchange Communication System (PECS) for Children with Autism

Published Nov 6, 2009, last updated Jan 2, 2010

What is it?

A picture exchange communication system (PECS) is a form of augmentative and alternative communication (AAC) that uses pictures instead of words to help childrencommunicate. PECS was designed especially for children with autism who have delays in speech development.

When first learning to use PECS, the child is given a set of pictures of favorite foods or toys. When the child wants one of these items, he gives the picture to a communication partner(a parent, therapist, caregiver, or even another child). The communication partner then hands the child the food or toy. This exchange reinforces communication (1-4).

PECS can also be used to make comments about things seen or heard in theenvironment. For example, a child might see an airplane overhead, and hand a picture of an airplane to his or her parent. As the child begins to understand the usefulness ofcommunication, the hope is that he will then begin to use natural speech (5).

What's it like?

A child can be trained in PECS by a parent, caregiver, or therapist who has learned about the method (see Resources). An applied behavior analysis (ABA) approach is used, in which prompts are given to guide the picture exchange. Further, in the early phases ofPECS training, the child chooses a picture of a desired food, and receives the food in exchange for the picture. Getting the food is the positive reinforcement for using the picture to communicate.

PECS is usually taught in six phases (6, 7):

  • Phase One: The communication partner makes a list of the child’s favorite items (usually beginning with foods). One of these items is selected for the first training session, and a picture of the item is made. That item can be placed under a clear container, so the child can see it, but not get it. If the child looks interested in the item, the communication partner gives the child the picture card. Then the child is prompted (usually by holding his/her hand and guiding it) to hand the picture card back to the communication partner. Once the communication partner receives the card, the request is spoken aloud (“Oh, you want the cookie! You can have it!”). At this point, the requested item (which has become the reinforcer) is given to the child.
  • Phase Two: The communication partner moves slightly away from the child so that the child has to move towards the communication partner to place the picture card in his/her hand.
  • Phase Three: The child is given more than one picture card. Now the child must choose which one represents a desired object, and then give this card to the communication partner. At this point, the child may be using a communication board or a binder in which to hold the cards.
  • Phase Four: The child is given a card with the phrase "I want ____" on it. This card now must be used with the picture card showing what is desired. The idea is that the child will learn how to communicate using complete sentences. Even children who cannot yet readcan learn to recognize the words as symbols on the cards.
  • Phase Five: Before this point, the child has never been asked directly, "What do you want?" In this phase, the communication partner asks the child this direct question, and waits for the child to hand him/her a picture card. This builds the foundation for futurecommunication when a parent needs to know the desires of his or her child.
  • Phase Six: Once the child can use PECS with fluency and has generalized the system to more than one communication partner, the child is taught how to comment on something s/he observes. The communication partner holds up an interesting object, asking the child, "What do you see?" at the same time pointing out the "I see ____" card. The child is then prompted to place the picture card representing the object next to the "I see ____" card. The parent then comments on the cards ("Yes! I see the airplane too"). In this way, the child learns how to communicate his or her observations and experiences to others.

What is the theory behind it?

The direct reinforcement that comes from immediately getting what you want is the key toPECS. Without having to use spoken words, a child is able to turn an inner desire into an external reward. It is thought that tangible rewards are more reinforcing to children withautism than social rewards, at least during the first steps of communication learning. However, if these rewards are too difficult to receive – that is, if it is very difficult for the child to form words – then the point of communication may, at first, be lost on these children. This can result in tantrums and other undesirable behavior, because the child cannot clearly communicate what s/he wants. However, when children with autism are trained inPECS, problem behaviors often subside as the benefits of communication become more tangible (1, 4, 5).

PECS may also help improve social interactions in children with autism. Because the child is in charge of approaching the communication partner, the child learns how to make the first move. For children with autism, approaching another person socially can be difficult. However, in this case, the child is not expected to speak, so the initial approach may be less intimidating (1, 2).

Does it work?

There are several well-designed research studies showing the usefulness of PECS (8). In one study of 18 preschool children with language delays, some of whom were diagnosed with autism, PECS generalized across communication partners and environments (6). These children were able to use PECS to communicate throughout their school days, not just during the training sessions. Further, almost half of these children stopped usingPECS and started using natural speech within a year (6). One parent commented that "PECS turned on the light for communication" in her child (6). Similar results were found for two smaller, but still well-designed studies (5, 7).

A larger study of school-aged children found significantly increased use of PECS whenadults trained in the use of PECS were in the classroom. The study involved 6 half-days ofPECS intervention per month for 5 months. While use of PECS by the children increased, there was no significant increase in verbal language use (9). The children's use of PECSdiminished after classroom visits by the trained adults were stopped (9).


Recently, a comparison was made between PECS and another popular AAC technique,Responsive Education and Prelinguistic Milieu Training (RPMT). The results showed that children with autism trained in PECS were more verbal than those for whom the RPMTapproach was used (10).

Overall, the evidence supports the use of PECS as a tool for developing naturalcommunication in children with autism, especially when it is taught before the child is six years old (3, 8).


In my experience, PECS has a number of advantages over other methods of addressing communication:

  • Each exchange is clearly intentional and readily understood. When a child hands you a picture or sentence strip, the request or comment is quickly determined. The child is given an effective avenue for swiftly and easily meeting his needs.
  • From the start, communication is initiated by the child. Children are not drilled in rote responses to specific phrases or instructions, rather they are encouraged to independently seek out communication partners in naturally occurring settings.
  • Communication is meaningful and highly motivating. Reinforcement for communication is natural and strongly rewarding.
  • Materials are cheap, easy to prepare, and portable. A PECS symbol can be as simple as a hand-drawn picture, or a snapshot.
  • With PECS, the child has an essentially unlimited pool of potential communicative partners. Anyone willing to accept a picture is available, not just those who understand sign language or who are familiar enough with the child to understand him despite his articulation or motor planning difficulties. Children are able to generalize communication to a wide circle of people very quickly.

I know that the decision between PECS and sign language as an augmentative means of communication is often a source of concern for people dealing with non-verbal individuals or those with very limited verbal ability. Personally, I love the concrete and consistent visual nature of PECS and the fact that it doesn't require the more difficult motor planning that many signs do. I like, too, that PECS symbols are often very quickly acquired, and that they can be rapidly generalized across many aspects of the child's life, without having to teach staff, family, and peers a number of signs along with the child. Have  seen it use by speech therapist and have rewarding effect on develop speech.