NONVERBAL AUTISM
PECS (Picture Exchange Communication System)
PECS, the Picture Exchange Communication System, is a structured approach to teaching children to communicate using pictures. Developed in the United States in 1985 by Andy Bondy and Lori Frost and first used with autistic preschoolers, it starts by teaching children to exchange a picture card for a desired item, then builds toward more complex communication. A 2010 meta-analysis found small to moderate gains in communication for autistic children ages 1 to 11, and described PECS as promising but not yet an established evidence-based intervention.
We are not doctors. We are advocates. PECS implementation should involve a trained professional. This content is for informational purposes.
The Six Phases of PECS
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Phase I: The Physical Exchange: The child is taught to pick up a picture of a desired item and hand it to a communication partner to receive the item. This phase requires two people, one to prompt the child physically, one to receive the picture and give the item. The goal is to establish the concept that pictures can be exchanged for things.
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Phase II: Distance and Persistence: The child learns to travel to find their communication book, retrieve the correct picture, and seek out a communication partner, even if that partner is not immediately in front of them. Communication becomes purposeful and self-initiated rather than prompted.
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Phase III: Picture Discrimination: The child learns to select from two or more pictures to request a specific item. This phase establishes that different pictures represent different things, a critical step in building a meaningful picture vocabulary.
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Phase IV: Sentence Structure: The child learns to build a simple sentence by combining an "I want" card with a picture of the desired item. This introduces the structure of communication and moves beyond single-word requests toward phrase-level expression.
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Phase V: Responding to Questions: The child learns to respond to the question "What do you want?" by building a sentence. This phase introduces the concept of responding to social communication rather than only initiating.
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Phase VI: Commenting: The child learns to make comments in addition to requests, "I see...", "I hear...", "I feel..." expanding communication beyond requesting to genuine conversational exchange.
PECS vs High-Tech AAC
PECS and high-tech AAC are not competing approaches, they serve different functions and many children use both. Some key differences:
→PECS requires no technology and is low-cost relative to dedicated AAC devices
→High-tech AAC has larger vocabulary capacity and generates speech, which PECS does not
→PECS requires fine motor skills for handling small cards; high-tech AAC requires different motor skills (tapping a screen)
→Many speech-language pathologists recommend starting with PECS to build the understanding that pictures represent objects, then transitioning to high-tech AAC
→Both approaches require consistent implementation across settings, school, home, and community, to be effective
Practical Notes for Families
Consistency across settings
PECS only works if it is used consistently at home, at school, and wherever the child spends time. A child who uses PECS at school but whose communication book stays at school does not have access to communication at home. Every setting needs the materials.
Protect communication books
Physical PECS materials, books, cards, velcro boards, are the child's voice. Treat them with the same care and priority you would give any essential medical equipment.
Training for communication partners
PECS implementation has specific protocols. Ideally, the adults implementing it should receive formal PECS training. At minimum, read the PECS manual and work closely with the implementing speech-language pathologist.
Sources
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