PECS

Also called Picture Exchange Communication System, Picture exchange

The Picture Exchange Communication System: handing a picture to a person to ask for something, taught in six phases, and what it is and is not.

What it is

PECS is a way of teaching a person to communicate by handing over a picture. The person wants a biscuit; they pick up the picture of the biscuit, put it into your hand, and get the biscuit. The exchange is the point, and the name says it: a picture is given, not pointed at, so from the first moment the person is doing the thing that communication is, getting someone's attention and giving them a message.

It was developed in the mid-1980s by Andy Bondy, a psychologist, and Lori Frost, a speech and language pathologist, in the Delaware Autism Program, and it is owned and taught by Pyramid Educational Consultants. The method is built on behavioural teaching: it starts with two adults, one prompting from behind, and fades the prompts as the person takes over.

PECS is a teaching protocol with six phases, from a single picture to sentences and comments. Many settings use the name loosely for any picture card, and that is not what it means; a wall of laminated symbols with velcro is not PECS unless someone is running the phases.

Who it can help

It was designed for young autistic children who had no functional way to ask for things, and that is still where the evidence is strongest: it reliably teaches requesting, and for a child who has never initiated communication that is a real gain. It has since been used with children and adults with a range of conditions, wherever the first problem is that the person does not yet approach anyone to ask.

It is not for everyone, and honesty about that matters. The strong version of the critique, from autistic adults and from many speech and language therapists, is that PECS teaches asking for things and little else, that the reward structure can make communication feel like a transaction, and that a person can spend years in the early phases handing over pictures of snacks while a core vocabulary board would have given them words like no, go, help and more on day one. The evidence that PECS leads on to speech is weak either way; it neither delays it nor reliably brings it.

The reasonable position is that PECS is a good way to teach the act of exchange to someone who does not yet have it, and a poor place to stop.

How it works

Two adults and a motivating object. The person reaches for the thing; the second adult, behind them, guides their hand to the picture and helps them put it in the first adult's open hand; the first adult says the word and gives the thing at once. Over repetitions the guiding hand fades until the exchange is independent. That is Phase 1.

The later phases add distance and persistence, telling pictures apart, building a sentence on a strip, answering the question of what they want, and commenting on what they see. The materials are a communication book with velcro pages, a sentence strip, and pictures in whatever set the setting uses, since PECS is a method and not a symbol set.

Training in the protocol is a two-day course from Pyramid, and the fidelity of the method, doing the phases as written, is what the evidence is about.

Getting started

If the person does not yet approach anyone to ask for anything, PECS Phase 1 is something a family can start this week with a printed picture of one favourite thing, two adults and ten minutes at a time, and the Pyramid website describes it. Keep it to things the person really wants, and give the thing every single time the picture arrives in your hand.

At the same time, put a core board on the table and point to words on it as you talk, so that the person meets a vocabulary as well as an exchange. The two do not conflict.

If the person has been at Phase 3 for a year, ask why, and ask what would happen if they were given a fuller vocabulary now. That question is the one a good therapist welcomes.

Where to get help

Pyramid Educational Consultants owns the method, runs the training and sells the materials. The National Autistic Society describes PECS among other approaches for autistic children. For an independent view of whether PECS or another route suits a particular person, Communication Matters and your speech and language therapist, via referring to speech and language therapy. The Health A-Z entry on autism covers the diagnosis side.