Picture Exchange Communication System and Autism Ranking: Strong positive evidence

Picture Exchange Communication System card The Picture Exchange Communication System (PECS) is a form of augmentative and alternative communication in which a child is taught to communicate with an adult by giving them a card with a picture on it.

PECS is based on the idea that children who are non-verbal or with limited functional speech can be taught to communicate using pictures.

The adult begins by teaching the child to exchange a picture of an item he wants. For example, if the child wants a drink, he will give a picture of a drink to the adult who will then give him a drink.

The adult will then teach the child progressively more difficult skills, such as using pictures to make whole sentences or to express preferences.

The Picture Exchange Communication System was originally designed to help non-verbal autistic children but it has also been used with adolescents and adults who have a wide range of communicative, cognitive and physical difficulties.

The Picture Exchange Communication System is a key element in many multi-component programmes and approaches - such as the SPELL approach and the TEACCH programme.

Our Opinion

There is a very small amount of high quality research evidence (five controlled trials) and a small amount of low quality research (19 single-case design studies with three or more participants) into the use of PECS for autistic  individuals.

This research suggests that PECS may be an effective way to increase the social communication skills (particularly requesting) of some young autistic children who are non-verbal or who have limited functional speech. 

There is insufficient evidence to determine if PECS provides any benefits in other areas (such as a reduction in challenging behaviours) to young autistic children.

There is insufficient evidence to determine if PECS provides any benefits to autistic adolescents and adults.

There is a need for more research into PECS which uses scientifically robust, experimental methodologies with larger numbers of more diverse participants.  That research should investigate whether PECS is more or less effective than other interventions designed to improve social communication skills (in particular requesting and speech) and whether specific individuals are more likely to benefit from PECS than other individuals.

PECS is a straightforward and positive approach, cost effective and not overly time consuming to implement.  There is, however, much confusion regarding the correct use of PECS and it should only be implemented by appropriately trained individuals.


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17 Jun 2022
Last Review
01 Sep 2017
Next Review
01 Dec 2023