Picture Exchange Communication System and Autism Ranking:

Current Research

Study characteristics

We have identified more than 30* studies of the Picture Exchange Communication System used as an as an intervention for autistic people which were published in English-language, peer-reviewed journals and which included three or more participants. 

• These studies included a total of more than 400 autistic individuals aged from two years old to adult. The majority of these studies were on pre-school children or primary school children. There was only one study on secondary school children and only one study on adults. 
• The majority of the studies we identified included children who were non-verbal or with limited functional speech.
• The majority of the studies investigated PECS to stage 3. Very few studies investigated PECS from stage 4 to stage 6.  
• Some of the studies compared PECS to other forms of augmentative and alternative communication (such as voice output communication aids).  
• Some of the studies compared PECS to combined, multi component interventions (such as pivotal response training or responsive education and prelinguistic milieu teaching).

* Please note: 

• Because there are so many studies on this topic we have not included those studies with fewer than three participants in this section. However, you can find details of some of those studies, and other publications on PECS, in our publications database.
• Some of the studies appeared several times in different journals. For example, the following papers all report on the same study:  McDuffie et al. (2012); Yoder and Stone(2006a); Yoder and Stone ( 2006b); Yoder and Lieberman (2010). 

Study outcomes

• The majority of studies reported that PECS lead to an increase in requesting, via the exchange of picture cards, in the majority of participants.
• Some of the studies reported an increase in speech or other forms of social communication in many of the participants.
• Only one of the studies (Charlop-Christy et al, 2002) reported decreases in problem behaviours.
• The studies which compared PECS with voice output communication aids reported that both were equally effective but the results of these studies were limited and inconsistent.
• The study which compared PECS to responsive education and prelinguistic milieu teaching (Yoder and Stone, 2016) reported that PECS was more effective in teaching young children to make requests than responsive education and prelinguistic milieu teaching.
• The study which compared PECS to pivotal response training (Schreibman and Stahmer, 2014) reported that PECS was as effective as PRT in teaching young children to speak. 

Updated

17 Jun 2022

Last Review

01 Sep 2017

Next Review

01 Dec 2023