Picture Exchange Communication System (PECS)

Introduction

Communication is a fundamental human need that many of us take for granted. For individuals with autism spectrum disorder (ASD), developmental delays, or other communication challenges, expressing basic wants and needs can be a significant hurdle. The Picture Exchange Communication System, commonly known as PECS, has emerged as a transformative intervention that bridges this communication gap through visual supports and systematic teaching.

Developed in 1985 by Andy Bondy, Ph.D., and Lori Frost, M.S., CCC-SLP, PECS has grown from an innovative concept to an evidence-based practice implemented worldwide. According to the National Autism Center, PECS is considered an established intervention for individuals with ASD, with research demonstrating its effectiveness across diverse populations and settings.

In this comprehensive guide, we'll explore what PECS is, how it works, the scientific evidence supporting its use, and practical implementation strategies for families and professionals seeking to enhance communication skills in children and adults with communication challenges.

What is the Picture Exchange Communication System (PECS)?

The Picture Exchange Communication System is a unique augmentative/alternative communication intervention designed to help individuals with limited speech develop functional communication skills. Unlike some communication systems that focus primarily on speech imitation or sign language, PECS begins by teaching the communicative exchange itself—the social aspect of communication.

At its core, PECS involves exchanging a picture or symbol for a desired item or activity. This simple yet powerful concept allows individuals with limited verbal abilities to initiate communication independently, express preferences, and interact socially with others in their environment.

PECS follows a structured, six-phase protocol that systematically builds communication skills from basic requesting to forming sentences and commenting. What sets PECS apart from other visual systems is its emphasis on initiation—teaching individuals to approach a communication partner and initiate the interaction, rather than waiting to be prompted.

According to data from Pyramid Educational Consultants, the organization founded by Bondy and Frost, PECS has been implemented in over 60 countries and translated into more than 15 languages, highlighting its universal applicability and effectiveness across cultural contexts.

The Six Phases of PECS Implementation

PECS implementation follows a systematic, evidence-based protocol consisting of six distinct phases, each building upon skills mastered in previous phases:

Phase I: Physical Exchange

The first phase focuses on teaching the physical exchange—literally placing a picture into someone's hand to request a desired item. This foundational skill establishes the basic communicative exchange without requiring verbal prompts like "What do you want?" or "Show me."

Research indicates that approximately 95% of learners successfully master Phase I within an average of 11 training sessions, often spanning just a few days with consistent practice.

Phase II: Expanding Spontaneity

Once the basic exchange is mastered, Phase II expands the physical distance between the learner, their communication book, and the communication partner. This phase teaches persistence in communication—reaching further, traveling longer distances, and overcoming obstacles to make requests.

This phase also typically introduces the communication book—a portable display where pictures are stored and organized for easy access.

Phase III: Picture Discrimination

Phase III introduces choice-making by teaching learners to select the specific picture that matches their desired item from an array of options. This critical discrimination skill allows for more precise communication and preference expression.

Studies show that approximately 90% of learners successfully master picture discrimination, though this phase often requires more systematic teaching than previous phases.

Phase IV: Sentence Structure

Phase IV introduces the sentence strip and the "I want" picture, teaching learners to construct simple sentences by combining the "I want" card with a picture of their desired item. This phase marks the transition from single-picture communication to more complex linguistic structures.

Phase V: Responding to "What do you want?"

While earlier phases focus on spontaneous requesting, Phase V teaches learners to respond to the direct question, "What do you want?" This phase bridges the gap between initiated communication and responsive communication.

Phase VI: Commenting

The final phase expands beyond requesting to include commenting on the environment. Learners are taught to respond to questions like "What do you see?" and "What do you hear?" and to use sentence starters like "I see," "I hear," and "I feel."

According to a comprehensive review published in the Journal of Autism and Developmental Disorders, approximately 70% of individuals using PECS eventually develop some degree of speech, with many progressing to Phase VI and beyond.

Evidence-Based Outcomes of PECS Implementation

The efficacy of PECS has been well-documented through numerous peer-reviewed studies and meta-analyses. Here are some key findings regarding PECS outcomes:

Communication Improvements

A meta-analysis published in the Journal of Speech, Language, and Hearing Research examined 16 single-subject studies involving 44 participants and found that PECS intervention resulted in significant improvements in functional communication for 76% of participants.

Additionally, a randomized controlled trial published in the Journal of Child Psychology and Psychiatry involving 84 children with autism found that those receiving PECS training showed significant increases in initiations and picture use compared to control groups.

Speech Development

Contrary to concerns that picture-based communication might inhibit speech development, research suggests the opposite. A study in Focus on Autism and Other Developmental Disabilities followed 66 children who used PECS and found that 65% developed independent speech after PECS implementation.

The largest study to date, conducted by Schwartz, Garfinkle, and Bauer (1998), tracked 31 preschool children using PECS and found that 59% developed speech as their primary communication system within two years of PECS introduction.

Reduction in Problem Behaviors

Research consistently shows that as communication skills improve through PECS, challenging behaviors often decrease. A study in Behavior Modification documented an average 80% reduction in disruptive behaviors following PECS implementation across 18 students with developmental disabilities.

This correlation makes intuitive sense—when individuals gain effective means to express their needs, the frustration that often leads to problem behaviors diminishes.

Social Communication Benefits

Beyond functional requesting, PECS has demonstrated positive effects on social communication. A 2006 study in the Journal of Autism and Developmental Disorders found increases in social-communicative behaviors, including joint attention and turn-taking, following PECS training.

Who Can Benefit from PECS?

While PECS was originally developed for children with autism spectrum disorder, its applications have expanded significantly. PECS has been successfully implemented with individuals with:

Autism Spectrum Disorder
Developmental delays
Intellectual disabilities
Multiple disabilities
Cerebral palsy
Childhood apraxia of speech
Traumatic brain injuries
Other complex communication needs

According to statistics from the Centers for Disease Control and Prevention (CDC), approximately 1 in 36 children in the United States is diagnosed with autism spectrum disorder, representing a significant population that may benefit from PECS.

Additionally, the American Speech-Language-Hearing Association estimates that 2 million Americans have a communication disorder severe enough to require an augmentative or alternative communication system like PECS.

PECS is appropriate for both children and adults, with documented success stories of implementation with individuals ranging from 18 months to adulthood. The system requires no prerequisites—individuals do not need to demonstrate specific cognitive abilities, imitation skills, or attention spans before beginning PECS.

Implementing PECS: A Practical Guide

Successful PECS implementation requires careful planning, appropriate materials, and consistent application of teaching procedures. Here's a practical guide for educators and families:

Getting Started: Essential Materials

Pictures/Symbols: These can be photographs, line drawings, or symbols from communication software. Ideal pictures are clear, simple, and meaningful to the learner.
Communication Book: Typically a ring binder with Velcro strips where pictures can be stored and organized.
Sentence Strip: A Velcro strip where multiple pictures can be placed in sequence to form sentences.
Reinforcers: Highly preferred items or activities that motivate the learner to communicate.

Key Implementation Strategies

Preference Assessment

Before beginning PECS, conduct a systematic preference assessment to identify items and activities that are highly motivating to the learner. These preferred items become the initial communication targets.

Research in the Journal of Applied Behavior Analysis suggests that preference assessments should be conducted regularly, as preferences may change over time.

Creating a Communication-Rich Environment

Arrange the environment to create numerous opportunities for communication throughout the day. A study in Focus on Autism and Other Developmental Disabilities found that learners who had at least 30 communication opportunities daily progressed through PECS phases significantly faster than those with fewer opportunities.

Consistency Across Settings

Ensure consistency in PECS implementation across different environments (home, school, community) and with different communication partners. Research indicates that generalization of PECS skills improves when the system is used consistently across multiple settings.

Data Collection

Systematic data collection is essential for monitoring progress and making informed decisions about when to move to subsequent phases. Track:

Number of independent exchanges
Variety of items requested
Distance traveled to communicate
Discrimination accuracy

Common Implementation Challenges and Solutions

Challenge: Picture Selection Difficulties

Solution: Begin with highly contrasting pictures (different colors, sizes, shapes) and gradually introduce more similar items as discrimination skills improve.

Challenge: Dependency on Prompts

Solution: Use backward chaining and systematic prompt fading to promote independence. Research shows that physical prompts are more effective than verbal prompts for teaching PECS.

Challenge: Limited Generalization

Solution: Practice PECS across multiple settings, with different communication partners, and for various functions. A study in the Journal of Positive Behavior Interventions found that planned generalization strategies improved PECS use in novel settings by 78%.

Challenge: Transitioning to Electronic Systems

Solution: Once basic PECS skills are established, some learners benefit from transitioning to electronic communication systems or apps. Maintain consistent teaching procedures during this transition.

PECS and Technology: Digital Adaptations

As technology has evolved, so too have applications of PECS principles to digital platforms. Speech-generating devices (SGDs) and communication apps now offer dynamic display options that build upon the foundation of picture exchange.

According to a survey published in Augmentative and Alternative Communication, approximately 45% of individuals who begin with PECS eventually transition to electronic communication systems.

Popular digital adaptations include:

Dedicated Communication Devices: Purpose-built devices like Tobii Dynavox systems or PRC devices that incorporate PECS principles.
Communication Apps: Applications like Proloquo2Go, TouchChat, and LAMP Words for Life that allow for customization of symbols and vocabulary.
PECS Phase IV+ App: Developed by Pyramid Educational Consultants, this official PECS app maintains fidelity to the original protocol while offering digital advantages.

Research in the International Journal of Developmental Disabilities indicates that learners with established PECS skills often transfer these abilities successfully to digital platforms, suggesting that starting with the physical exchange remains valuable even when the ultimate goal is electronic communication.

Integrating PECS with Other Interventions

PECS is often most effective when implemented as part of a comprehensive communication intervention plan. Research supports combining PECS with:

Speech-Language Therapy

Speech-language pathologists often integrate PECS with traditional articulation and language therapy. A study in the American Journal of Speech-Language Pathology found that simultaneous implementation of PECS and speech therapy resulted in greater gains in spoken language than either intervention alone.

Applied Behavior Analysis (ABA)

The principles underlying PECS align closely with ABA methodology, making these approaches highly compatible. Data reported in the Journal of Applied Behavior Analysis indicates that combining PECS with other ABA-based interventions leads to improved communication outcomes and faster acquisition of skills.

Visual Supports and Structured Teaching

PECS complements other visual support systems, including visual schedules, first-then boards, and structured work systems. Research from the University of North Carolina's TEACCH program demonstrates that comprehensive visual support systems enhance understanding and independence.

Supporting Families Implementing PECS

Family involvement is crucial for successful PECS implementation. Research published in Topics in Early Childhood Special Education found that children whose families implemented PECS at home showed 2.5 times greater communication gains than those who received PECS only in educational settings.

Key strategies for supporting families include:

Parent Training

Structured parent training programs significantly improve implementation fidelity. A study in the Journal of Positive Behavior Interventions found that parents who received six hours of direct PECS training implemented the protocol with 85% accuracy compared to 43% accuracy for those who simply observed professional implementation.

Home-School Collaboration

Regular communication between home and school ensures consistency across environments. Effective strategies include:

Communication logs tracking reinforcers and vocabulary across settings
Regular team meetings to discuss progress and challenges
Shared picture libraries with identical symbols used at home and school

Customizing PECS for Family Routines

Identify family routines that present natural communication opportunities, such as:

Mealtime choices
Leisure activities
Community outings
Bedtime routines

A study in the Journal of Early Intervention found that embedding PECS opportunities within existing family routines resulted in greater maintenance of skills and family satisfaction with the intervention.

Future Directions in PECS Research and Practice

As PECS approaches its fourth decade of implementation, researchers continue to refine and expand the protocol. Current areas of innovation include:

Cultural Adaptations

Researchers are examining how PECS can be adapted for diverse cultural contexts while maintaining fidelity to the core protocol. A promising study in the International Journal of Developmental Disabilities demonstrated successful cultural adaptations of PECS in six countries across three continents.

Long-Term Outcomes

Longitudinal studies are beginning to document the long-term communication outcomes for individuals who began using PECS in early childhood. A 10-year follow-up study published in Autism Research found that 64% of early PECS users developed functional speech by adolescence.

Telepractice Implementation

The COVID-19 pandemic accelerated research into remote PECS training and implementation. Early findings published in the Journal of Autism and Developmental Disorders suggest that telehealth-delivered PECS coaching for families can be effective, particularly for maintenance and generalization phases.

Conclusion

The Picture Exchange Communication System represents a pivotal advancement in supporting individuals with complex communication needs. Through its systematic, evidence-based approach, PECS has opened channels of communication for countless individuals who might otherwise remain unable to express their basic wants, needs, and observations.

The strength of PECS lies in its accessibility—requiring no expensive equipment to begin, no prerequisites to start training, and offering a clear, well-researched protocol that can be implemented across diverse settings. Its emphasis on initiation and functional communication aligns with our understanding that effective communication is not merely about producing words but about engaging in meaningful exchanges with others.

As research continues to validate and refine PECS implementation, and as technology offers new platforms for applying these principles, the fundamental exchange at the heart of PECS remains unchanged: communication is about connection, and everyone deserves the opportunity to connect.

For families, educators, and clinicians supporting individuals with communication challenges, PECS offers not just a technique but a philosophy—one that presumes competence, respects individual differences, and recognizes that the desire to communicate is universal, even when the means to do so must be thoughtfully taught.