Picture Exchange Communication System (PECS)

Note: The PECS program was not responsive to the CEBC's inquiry. The following information was obtained from publicly available sources.

About This Program

Target Population: Nonverbal individuals including preschool students diagnosed with autism

Program Overview

PECS is a unique alternative/augmentative communication system designed for preschool students diagnosed with autism. PECS is used with learners of all ages who have various cognitive, physical and communication challenges. Specific prompting and reinforcement strategies that are designed to lead to independent communication are used throughout the protocol. The protocol also includes systematic error correction procedures to promote learning if an error occurs. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency.

PECS consists of six phases and begins by teaching an individual to give a single picture of a desired item or action to a "communicative partner" who immediately honors the exchange as a request. The system goes on to teach discrimination of pictures and how to put them together in sentences. In the more advanced phases, individuals are taught to use modifiers, answer questions and comment.

The primary goal of PECS is to teach functional communication.

Logic Model

The program representative did not provide information about a Logic Model for Picture Exchange Communication System (PECS).

Manuals and Training

Publicly available information indicates there is a manual that describes how to deliver this program, and there is some training available for this program.
See contact info below.

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Yoder, P., & Stone, W. (2006a). Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 74(3), 426–435. https://doi.org/10.1037/0022-006X.74.3.426

Type of Study: Randomized controlled trial
Number of Participants: 36

Population:

  • Age — Parents: Not specified; Children: 21-54 months (Mean=33.6 months)
  • Race/Ethnicity — Parents: Not specified; Children Not specified
  • Gender — Parents: Not specified; Children: Not specified
  • Status — Participants were children with a diagnosis of autistic disorder or pervasive developmental disorder not otherwise specified (PDD-NOS).

Location/Institution: A university-based clinic

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to compare the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT]) and the Picture Exchange Communication System (PECS) on spoken communication in preschoolers with autism spectrum disorders (ASD). Participants were randomly assigned to either PECS or RPMT. Each treatment was delivered to children for a maximum total of 24 hours over a 6-month period. Measures utilized include the Autism Diagnostic Observation Schedule (ADOS), the Mullen Scales of Early Learning, the Developmental Play Assessment, and a turn-taking measure. Results indicate PECS was more successful than RPMT in increasing the number of nonimitative spoken communication acts and the number of different nonimitative words used at the posttreatment period. Considering growth over all 3 measurement periods, an exploratory analysis showed that growth rate of the number of different nonimitative words was faster in the PECS group than in the RPMT group for children who began treatment with relatively high object exploration. In contrast, analogous slopes were steeper in the RPMT group than in the PECS group for children who began treatment with relatively low object exploration. Limitations include the examiners and coders were not blind to treatment assignment.

Length of postintervention follow-up: None.

Yoder, P., & Stone, W. (2006b). Randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49(4), 698–711. https://doi.org/10.1044/1092-4388(2006/051)

Type of Study: Randomized controlled trial
Number of Participants: 36

Population:

  • Age — Parents: Not specified; Children:18-60 months (Mean=2.7–3.1 years)
  • Race/Ethnicity — Parents: Not specified; Children: 69% Caucasian, 22% African American, and 8% Other
  • Gender — Parents: Not specified; Children: 86% Male
  • Status — Participants were children with a diagnosis of autistic disorder or pervasive developmental disorder not otherwise specified (PDD-NOS).

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Yoder and Stone (2006a). The purpose of this study was to compare the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture Exchange Communication System (PECS) in preschoolers with autism spectrum disorders. Participants were randomly assigned to either PECS or RPMT. Measures utilized include the Autism Diagnostic Observation Schedule (ADOS), an abridged version of the Early Social Communication Scales (ESCS), unstructured free play with examiner (UFPE), turn taking, and parent-child free play. Results indicate the RPMT facilitated the frequency of generalized turn taking and generalized initiating joint attention more than did the PECS. The latter effect occurred only for children who began treatment with at least some initiating joint attention. In contrast, the PECS facilitated generalized requests more than the RPMT in children with very little initiating joint attention prior to treatment. These effect sizes were large. Limitations include examiners were not blind to child’s treatment assignment, small sample size, lack of follow up, and sample made up largely of boys.

Length of postintervention follow-up: None.

Howlin, P., Gordon, R. K., Pasco, G., Wade, A., & Charman, T. (2007). The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: A pragmatic, group randomised controlled trial. Journal of Child Psychology and Psychiatry, 48(5), 473–481. https://doi.org/10.1111/j.1469-7610.2006.01707.x

Type of Study: Randomized controlled trial
Number of Participants: 84

Population:

  • Age — Parents: Not specified; Children: Mean=73.1–86.6 months
  • Race/Ethnicity — Parents: Not specified; Children: Not specified
  • Gender — Parents: Not specified; Children: 73 Male and 11 Female
  • Status — Participants were children with autism spectrum disorder.

Location/Institution: Greater London and Southeast England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to assess the effectiveness of expert training and consultancy for teachers of children with autism spectrum disorder in the use of the Picture Exchange Communication System (PECS). Participants were randomly assigned to one of three groups: PECS immediate treatment group (ITG), PECS delayed treatment group (DTG), or no treatment group (NTG). Measures utilized include the Expressive One Word Picture Vocabulary Test (EOWPVT), the British Picture Vocabulary Scales (BPVS), the Autism Diagnostic Observation Schedule-Generic (ADOS-G), rates of communicative initiations, use of PECS, and speech in the classroom. Results indicate controlling for baseline age, developmental quotient (DQ) and language; rates of initiations and PECS usage increased significantly immediately posttreatment of being in a higher ordinal rate category. There were no increases in frequency of speech, or improvements in ADOS-G ratings or language test scores. Limitations include intervention only last two school terms, relied on only one measurement point at each assessment period for each child, and primary measures were restricted to relatively brief periods of time. 

Length of postintervention follow-up: 10 months (PECS ITG only).

Yoder, P., & Lieberman, R. (2010). Brief report: Randomized test of the efficacy of Picture Exchange Communication System on highly generalized picture exchanges in children with ASD. Journal of Autism and Developmental Disorder, 40, 629–632. https://doi.org/10.1007/s10803-009-0897-y

Type of Study: Randomized controlled trial
Number of Participants: 36

Population:

  • Age — Parents: Not specified; Children: 18-60 months (Mean=2.7–3.1 years)
  • Race/Ethnicity — Parents: Not specified; Children: Not specified
  • Gender — Parents: Not specified; Children: Not specified
  • Status — Participants were young children with autism.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Yoder and Stone (2006a). The purpose of this study was to compare two social-communication interventions in young children with autism and examine far-transfer of the use of the Picture Exchange Communication System [PECS] to communicate and Responsive Education and Prelinguistic Milieu Teaching (RPMT). Participants were randomly assigned to one of two treatment conditions, PECS or RPMT. Measures utilized include the Early Social Communication Scales-Abridged (ESCS-Abridged) the Autism Diagnostic Observation Schedule (ADOS), and the Mullen Scales of Early Learning. Results indicate posttreatment measurement of the number of picture exchanges in a far-transfer, assessment context favored the PECS intervention. Limitations include small sample size and lack of follow up. 

Length of postintervention follow-up: None.

Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P. & Charman, T. (2011). A communication‐based intervention for nonverbal children with autism: What changes? Who benefits? Journal of Consulting and Clinical Psychology, 79(4), 447–457. https://doi.org/10.1037/a0024379 

Type of Study: Randomized controlled trial
Number of Participants: 84

Population:

  • Age — Parents: Not specified; Children: 4–10 years (Mean=6.8 years)
  • Race/Ethnicity — Parents: Not specified; Children: Not specified
  • Gender — Parents: Not specified; Children: 73 Males
  • Status — Participants were children with a formal clinical diagnosis of autism.

Location/Institution: Greater London or the southeast of England

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Howlin et al. (2007). The purpose of this study was to examine the form and function of spontaneous communication and outcome predictors in nonverbal children with autism following classroom-based intervention, Picture Exchange Communication System (PECS), training. Participants from 15 schools were randomly assigned into one of three intervention groups: The PECS immediate treatment group (ITG); five class groups, 26 children), the PECS delayed treatment group (DTG; six class groups, 30 children), or the no-treatment group (NTG; six class groups, 28 children). Measures utilized include Module 1 of the Autism Diagnosis Observation Schedule (ADOS) and the Classroom Observation Schedule for Measuring Intentional Communication. Results indicate spontaneous communication using PECS picture cards, speech, or both increased significantly following training. Spontaneous communication to request objects significantly increased, but spontaneous requesting for social purposes did not. Only the effect on spontaneous speech persisted by follow-up. Less severe baseline autism symptomatology was associated with greater increase in spontaneous speech and less severe baseline expressive language impairment, with larger increases in spontaneous use of speech and PECS pictures together. Limitations include lack of systematic information on family variables such as ethnicity and other background factors that might also be related to differential outcome, lack of measures of fidelity, and a sample made up largely of boys.

Length of postintervention follow-up: 9 months (PECS ITG only).

Schreibman, L., & Stahmer, A. (2014). A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism. Journal of Autism and Developmental Disorders, 44, 1244–1251. https://doi.org/10.1007/s10803-013-1972-y

Type of Study: Randomized controlled trial
Number of Participants: 39

Population:

  • Age — Parents: Not specified; Children: Mean=28.9–29.5 months
  • Race/Ethnicity — Parents: Not specified; Children: Not specified
  • Gender — Parents: Not specified; Children: 84.2–90% Male and 10–15.8% Female
  • Status — Participants were children with a diagnosis of Autistic Disorder.

Location/Institution: Two university-based autism research programs

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to compare the effectiveness of a verbally based intervention, Pivotal Response Training (PRT) to the Picture Exchange Communication System (PECS) on the acquisition of spoken language by young nonverbal or minimally verbal (B9 words) children with autism. Participants were randomly assigned to either the PRT or PECS condition. Measures utilized include the Vineland Adaptive Behavior Scales (VABS), the Mullen Scales of Early Learning (MSEL), the Autism Diagnostic Observation Schedule (ADOS), the Expressive One-Word Picture Vocabulary Test (EOWPVT), the MacArthur Communicative Developmental Inventory (CDI), a parent–child observation, and a parent satisfaction survey. Results indicate children in both the PECS and PRT groups demonstrated increases in spoken language skills, with no significant difference between the two conditions. Seventy-eight percent of all children exited the program with more than 10 functional words. Parents were very satisfied with both programs but indicated PECS was more difficult to implement.

Length of postintervention follow-up: 3 months.

Gilroy, S., Leader, G., & McCleery, J. (2018). A pilot community‐based randomized comparison of speech generating devices and the Picture Exchange Communication System for children diagnosed with autism spectrum disorder. Autism Research, 11(12), 1701–1711. https://doi.org/10.1002/aur.2025

Type of Study: Randomized controlled trial
Number of Participants: 35

Population:

  • Age — Parents: Not specified; Children: 5–13 years (Mean=8.7 years)
  • Race/Ethnicity — Parents: Not specified; Children: Not specified
  • Gender — Parents: Not specified; Children: Not specified
  • Status — Participants were children formally diagnosed with autism spectrum disorder (ASD). 

Location/Institution: Ireland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to compare the effects of the Picture Exchange Communication System (PECS) to a teaching sequence using a high-tech Speech Generating Device (SGD) to teach social communication behaviors. Participants were randomly assigned to either a high-tech (SGD device) or low-tech (PECS cards) form of Augmentative and Alternative Communication (AAC). Measures utilized include the Childhood Autism Rating Scale, Second Edition-Standard Form (CARS2-S), the Adaptive Behavior Assessment System, Third Edition, (ABAS-3), and the Behavioral Communication Assessment (BCA). Results indicate that both high-tech and low-tech (PECS cards) AAC approaches resulted in significant improvements in communication, and that these improvements did not differ significantly between the two approaches. Limitations include small sample size, length of intervention, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today, 2(2), 127–132. https://doi.org/10.1037/h0099924

Bondy, A. S., & Frost, L. A. (1998). The Picture Exchange Communication System. Seminars in Speech and Language, 19(4), 373–389. https://doi.org/10.1055/s-2008-1064055

Contact Information

David Battista
Agency/Affiliation: Pyramid Educational Consultants
Website: www.pecsusa.com
Email:
Phone: (888) 732-7462
Fax: (302) 368-2516

Date Research Evidence Last Reviewed by CEBC: March 2021

Date Program Content Last Reviewed by Program Staff: June 2021

Date Program Originally Loaded onto CEBC: June 2021