Autism communication cards: what they are and how to use them

Last updated 2026-07-09

A communication card is a physical or digital image, word, or symbol a child can point to, hand over, or exchange to say something. A child who can't yet say "I want juice" can hand you a card with a picture of juice on it, and that counts as real communication. The brain is still doing the work of turning an intention into an expression, which is the loop underneath all language.

The American Speech-Language-Hearing Association defines augmentative and alternative communication (AAC) as "all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas" ^[1]. Communication cards sit at the low-tech end of that spectrum, with speech-generating devices and apps further along it. For autistic children in particular, visual supports tend to land better than spoken words. Many autistic learners process what they see more reliably than what they hear, so a card sitting on the table has staying power a spoken word doesn't: it isn't gone the instant it's said. The child doesn't have to hold language in working memory while also figuring out how to respond. The message just sits there, waiting.

Cards themselves can take several forms: laminated photos of the child's actual belongings, illustrated symbols (PCS symbols from Mayer-Johnson are the most widely used set), or typed words for children who read. Which one works depends on the child's cognitive level, vision, and motor control, so it's worth asking your speech-language pathologist before you print fifty cards that end up in a drawer.

The right format also depends on what the child is trying to say and where they are developmentally. Real photographs, of the child's actual juice box or their own bed, tend to work well early on because the image is concrete rather than something the child has to generalize from a cartoon. Picture Communication Symbols (PCS), simple line-drawn icons developed by Mayer-Johnson and now part of the Boardmaker suite, are the set most commonly used in U.S. schools and clinics, covering thousands of items paired with printed words. PECS cards are a bit different: Picture Exchange Communication System is a specific intervention rather than a card style, developed by Frost and Bondy in 1994, with six structured phases starting with physically handing over a card and building up to full sentence strips ^[2]. The early phases really do need a trained PECS implementer overseeing them.

Core word cards take a different approach, carrying high-frequency words like "more," "stop," "go," "want," and "help" instead of labeling objects. Core vocabulary makes up roughly 80 percent of what people actually say day to day, and it transfers across settings in a way that words like "banana" or "swing" don't ^[3], which is why AAC specialists lean toward core-focused systems more and more. Emotion cards, showing faces or characters expressing happy, sad, angry, scared, or tired, show up often in social-emotional learning and help kids who can ask for what they want but struggle to name how they feel. First-then boards ("first shoes, then iPad") are technically visual supports rather than communication cards, but families tend to use them alongside expressive cards since making a sequence visible cuts down on transition meltdowns. Here's how the main formats stack up:

Almost every parent's first worry about AAC is that cards will stop a child from talking, and the research points the other way. A 2006 meta-analysis in the American Journal of Speech-Language Pathology found AAC use did not suppress natural speech and, in many cases, was tied to gains in spoken language ^[4]. ASHA's position agrees: giving a child AAC doesn't lower their motivation to speak. The worry makes intuitive sense, but communication isn't a fixed resource that runs out if you spend it on a card. Getting a need met through any channel reinforces the act of communicating itself. The child learns that expressing something makes something happen, and that feedback loop is what builds toward more communication, spoken or otherwise.

What cards won't do is teach articulation or phonology. They're not a stand-in for speech therapy aimed at motor speech skills; think of them as running in parallel, giving the child a way to communicate right now while therapy builds oral skills over time. The American Academy of Pediatrics recommends a full communication assessment for children with autism, with AAC considered when speech is significantly delayed or absent ^[5]. That doesn't mean cards are only for children who don't speak at all. Plenty of partially speaking kids use them to fill gaps, manage frustration, or get through noisy, stressful moments when speech isn't working.

Where to find free printable cards

You don't need to spend money to get started. Do2Learn (do2learn.com) is one of the longest-running free libraries of picture communication symbols online, with thousands of cards covering routines, emotions, food, school, and social skills, plus social stories and visual schedules. Boardmaker's software runs about $300 a year, but Boardmaker Share is a community library where educators and SLPs upload free boards and card sets you can download without a subscription. Teachers Pay Teachers isn't autism-specific, but plenty of SLPs and special education teachers post free AAC boards and PECS starter cards there if you search for them. Autism Speaks has downloadable visual support cards in its tool kit section, especially for transitions and daily routines ^[6], and Widgit Symbols is a UK-based set, different in style from PCS but recognized internationally, with some free downloads.

If your child gets special education services, your school's SLP is legally required to provide materials that match their IEP goals, which often means communication boards at no cost to you. One thing worth knowing: free printables vary a lot in quality, since some come from experienced SLPs and others from well-meaning parents without clinical training. Run any set past your child's therapist before committing to it. The exact symbol style matters less than consistency: pick one system and keep it the same across home, school, and therapy so your child isn't relearning symbols every time the setting changes.

Introducing cards for the first time

Start with something the child wants badly, not something you think they should want. What do they reach for, cry for, or fall apart over losing? That's your first vocabulary target.

Put the card where the thing usually lives or where the exchange usually happens. If the child loves crackers, tape the cracker card to the pantry door at their eye level. When they approach the pantry, model handing you the card or pointing to it before you hand over the cracker. Do this every single time; consistency is the whole intervention.

Keep the early set small, two to five cards is plenty. Any more than that and the child spends their energy hunting for the right symbol instead of communicating. Grow the set gradually, once what's already there is being used reliably.

Model the cards yourself. When you want something, point to the card and say the word. When you're offering a choice, hold up both relevant cards. This is called aided language stimulation, and it's one of the better-supported strategies in AAC ^[7]. Doing this shows the child the cards are a real way to talk, not a task you're making them perform.

Skip the drilling. Holding up a card and demanding "what is this?" is a test, not communication. Real communication starts because someone has a need, so set up situations where the child actually has one: put the favorite toy slightly out of reach, or offer a spoonful of yogurt and wait with the "more" card in view.

Expect some mess. A child new to cards might throw them, ignore them, or grab the wrong one. That's part of learning it. Stay calm, model the right card, and don't turn the wrong choice into a big moment.

Families who want a guided way to build this at home sometimes use the Little Words app, which includes an AI companion that helps parents practice aided language input and tracks which vocabulary the child is responding to, so you're not guessing.

What is PECS, and how is it different from just using picture cards?

PECS stands for Picture Exchange Communication System, and the important word is "exchange." Instead of pointing to a card on a board, PECS teaches a child to physically pick up a card and hand it to another person. That handoff is the communication itself.

The system, developed by Lori Frost and Andrew Bondy ^[2], runs through six phases. The first teaches the physical exchange using something the child really wants. The second stretches that exchange across distance and different people. The third adds telling symbols apart. The fourth builds sentence structure with a strip that combines "I want" with an item card. The last two bring in answering questions and commenting on things.

The order isn't arbitrary. A child who jumps straight to sentence strips without mastering that first simple exchange hasn't learned that communication gets things done. They've just learned to move paper around.

There's solid evidence behind PECS for building intentional communication in minimally verbal autistic children ^[2]. A 2011 randomized controlled trial in the Journal of Child Psychology and Psychiatry found that children who received PECS training made significant gains in communication acts compared to controls, and it's listed as an evidence-based practice by the National Autism Center.

It only works, though, if it's taught correctly. If you're trying this at home without guidance, the early phases especially need a trained person in the room. Ask your child's SLP whether they're PECS-trained and can coach you through running it at home.

PECS isn't the only evidence-based option. A child who already points or has some speech might do better with a core word board or an aided language stimulation approach. Your child's own communication profile should decide the starting point, not a one-size-fits-all recommendation from the internet, this article included.

How many communication cards should a child start with?

Fewer than you'd guess: two to five cards for an early communicator. Seriously.

The instinct is to print a huge set so you feel covered. What actually happens is the child learns that nothing about the system is stable, and stops using it. A small set used successfully dozens of times a day beats a binder of 200 cards used twice.

AAC practitioners generally suggest starting with the child's top motivators plus "no" and "more." That might look like juice, cracker, swing, no, and more, five cards used constantly across every relevant moment for two to four weeks before anything new gets added.

Once use is reliable, add vocabulary in small batches of two or three cards. Favor core words like "help," "want," "stop," "go," and "again" over specific object names, because core words generalize. A child who can use "want" can pair it with almost anything; a child who only has a "banana" card is stuck the moment you're out of bananas.

There's no ceiling for a child who keeps progressing. Some AAC users eventually have thousands of symbols available on a device. But nobody gets there by starting with thousands. They get there by building competence one step at a time.

Should communication cards be used the same way at school and at home?

Yes, and this is one of the most common places the whole system falls apart.

Consistency across settings isn't optional. If the child uses PCS symbols at school and real photographs at home, they're effectively learning two different symbol systems, which doubles the cognitive load and cuts generalization in half. Pick one symbol set, share materials between school and home, and coordinate vocabulary targets with the school SLP.

The Individuals with Disabilities Education Act (IDEA) requires that a child's IEP address the need for assistive technology, AAC included, across every setting the child participates in ^[8]. If the school is using a communication system, they're required to send materials home or train you to use the same approach. If that isn't happening, ask, and put it in writing.

One practical move: photograph the school communication board and recreate it at home with matching vocabulary. Ask the teacher for a weekly word list so you know what's being targeted, and if the school uses a specific AAC app or device, ask for training so you can use it during homework and daily routines too.

The goal is that "I want help" means the same thing in the kitchen, the classroom, and the grocery store. That's really the whole point.

When should you move from cards to a speech-generating device?

Move to a device when the card system starts limiting what the child can say, not because a calendar says they should be talking by now. Cards are cheap, durable, hard to break, easy to customize, and never need batteries, but they do have real limits.

A card system gets cumbersome once vocabulary grows past what fits in a portable format: carrying a 200-card binder just isn't practical. Cards also can't produce novel sentences the way a capable AAC device or app can. A child who needs to say "I'm scared because the dog is loud" needs more than a symbol board can easily offer.

The typical path runs from simple card exchange to a small core board to a larger dynamic display device (tablet-based AAC like Proloquo2Go, TouchChat, or LAMP Words for Life). That path isn't universal, and it isn't one-way; some children keep using both a device and physical cards depending on the situation.

Speech-language pathologists run a formal AAC evaluation to work out device candidacy, looking at motor skills, vision, cognition, language level, and communication needs across settings. Insurance, including Medicaid, often covers AAC devices once an SLP documents medical necessity. The process takes time, but devices that can cost $5,000 to $8,000 retail are usually covered in the end.

Our guide to AAC devices for autism covers the full range of options in more depth.

There's no timeline here that should make you feel behind. The card system earns its retirement when the child outgrows it, and not a day sooner.

How does early intervention affect how well communication cards work?

Earlier is better, but there's no hard deadline that should send you into a panic. Research on early AAC intervention consistently shows that children who get communication support before age 3 have better long-term communication outcomes than those who start later ^[9]. The brain is more plastic in those early years, and building a reliable way to communicate early on heads off the behavioral problems that tend to show up when a child can't express what they need.

The federal early intervention program under IDEA Part C provides free evaluation and services, speech and language included, for children under age 3 with developmental delays ^[8]. If your child is under 3 and you're worried, call your state's early intervention program. You don't need a diagnosis to request an evaluation, and you don't even need a pediatrician's referral, though it doesn't hurt.

Once a child turns 3, school districts take over under IDEA Part B. Again, an autism diagnosis isn't necessarily required to qualify for communication services; a documented delay is often enough on its own.

Starting cards after age 3 isn't a failure. Kids learn to use AAC at 5, at 10, at 15. Adults with autism who never had communication support as children can and do learn AAC systems later in life. A later start just means the easiest window has passed, not that the door is closed. If you're navigating the IDEA Part C process, our article on early intervention speech and language therapy walks through it in detail.

What does a speech therapist add that a parent can't do alone?

Parents can do a lot with cards on their own. You don't need a therapist standing over your shoulder every time you hold up a card at snack time. That's the point: the system lives in daily life, and you're the one who's there for daily life.

What a speech-language pathologist brings is assessment, judgment, and troubleshooting. Assessment means figuring out which symbol set fits your child's visual processing, which vocabulary makes sense developmentally, and what's actually getting in the way of communication, whether that's motor skills, cognition, sensory issues, or a lack of partner training. Get that wrong at the start and you can lose months.

Clinical judgment is knowing whether a child who seems stuck needs a new strategy or just more time with the current one. It's recognizing that a child throwing cards across the room isn't necessarily misbehaving; they might have a fine motor difficulty that makes handling small cards genuinely hard.

Troubleshooting is where a lot of parent-led systems break down. The child used cards fine for two weeks and then suddenly refuses. An experienced speech therapist has seen that pattern before and has ideas worth testing. On your own, you're mostly guessing.

The other thing a good therapist does is train you. Research on parent-implemented AAC shows that parent training is one of the strongest predictors of whether a child succeeds with AAC ^[10]. A therapist who spends most of a session coaching you, rather than working only with your child, is doing it right. If your child's SLP never gives you homework or feedback on how you're doing it, that's worth bringing up. For families who can't get in-person therapy, online speech therapy has grown a lot and now includes plenty of SLPs who specialize in AAC and autism.

How do you make communication cards sturdy enough for daily use?

Cards that fall apart get abandoned, so it's worth setting them up right the first time. Laminate everything. A basic home laminator runs $25 to $40, or an office supply store will laminate by the page for about $1 to $2. Laminated cards survive spills, chewing, and being thrown across the room, none of which is rare with kids.

Put velcro on the back. Hook-and-loop dots on the cards and on a backer board (foam core, a clipboard, a simple wallet) let you swap and rearrange quickly, and velcro backer boards are the most common format for portable systems anyway.

Size matters too. Cards that are too small are hard to pick up for a child with motor difficulties, and cards too large are a pain to carry around. About 2 by 2 inches works well for younger children, while older kids and adults often go smaller so they can fit more vocabulary onto one board.

Color-coding by category helps a child find what they need faster once the set grows. Many systems, including Boardmaker, follow the same scheme: yellow for people, green for verbs, blue for descriptors, orange for nouns, pink for social words.

Where you keep the cards matters as much as how you build them. A binder your child can't open alone isn't really a communication system, it's just a binder. A small ring clipped to a belt loop, a wallet in a pocket, or a board mounted at standing height on the wall all work better, because the child can start a conversation without asking an adult to open anything first. Independence is really the whole point. If you're building out a fuller home system, our guides on pediatric speech therapy and speech therapy for kids cover how to carry what a therapist teaches into everyday routines.

What does the research actually say about which approach works best?

Nobody has clean data comparing every card system head-to-head in a randomized trial with autistic kids specifically. The evidence we do have is real, just imperfect. Here's what can be said with reasonable confidence.

PECS has the most controlled trial evidence for building intentional communication in minimally verbal autistic children ^[2], and it's listed as an evidence-based practice by the National Autism Center and the National Professional Development Center on ASD.

Aided language stimulation, which just means modeling AAC use while you talk, has strong support across multiple studies for expanding vocabulary and sentence length in AAC users ^[7]. It isn't a card system on its own, more a teaching strategy layered on top of whatever card or device system the child already has.

Core vocabulary approaches have growing evidence and wide support among practitioners, but large randomized trials specifically in autism are still limited as of 2024. The case for core vocabulary is strong on theoretical and clinical grounds; the research is still catching up to the practice.

As for real photographs versus PCS symbols, a small number of studies suggest real photos are easier for very early communicators to recognize at first, and kids often move to symbols faster than people assume ^[11]. In practice that means starting with whatever the child already recognizes, then shifting to symbols later if you want something more portable and scalable.

The honest bottom line is that the specific symbol set matters less than consistent use, a vocabulary that's actually big enough, and a communication partner who responds every single time. A perfectly chosen system used inconsistently will fail. A merely decent system used the same way, everywhere, every day, will work.

For a fuller picture of where communication cards fit into a broader plan, see our article on autism spectrum speech therapy. Parents who want a structured way to track what their child responds to, and to practice the right kind of language input between sessions, can also try the Little Words app.

Frequently asked questions

Are communication cards the same as AAC?

Communication cards are one form of AAC (augmentative and alternative communication). AAC is the broader category that includes any communication method beyond natural speech: cards, boards, speech-generating devices, apps, sign language, and even facial expressions and gestures. ASHA defines AAC as all non-oral forms used to express thoughts and needs. Cards are the low-tech, no-battery end of the AAC spectrum.

Can a child who already has some words still benefit from communication cards?

Yes. Many partially speaking children use cards to fill gaps when speech breaks down under stress, in noisy environments, or for complex ideas they can't yet express verbally. Cards also expand vocabulary access. A child who can say five words but can communicate 50 concepts via cards has significantly more communicative power. Speech and cards work in parallel, not in competition.

What age should you start using communication cards with an autistic child?

As early as a communication concern is identified, which can be 12 to 18 months. Federal early intervention programs (IDEA Part C) serve children from birth to age 3. You don't need a formal autism diagnosis to start using visual communication supports at home. Most AAC specialists say there is no child too young or too cognitively impaired to benefit from some form of supported communication.

Do communication cards work for nonspeaking autistic adults?

Yes. AAC, including card-based systems, is used by nonspeaking and minimally speaking autistic people across all ages. Adults may start with cards and transition to more capable device-based systems. ASHA guidelines explicitly support AAC for adults. There is no age cutoff for communication intervention. Some adults learn to use full AAC systems in their 20s, 30s, and beyond with good outcomes.

How do I get the school to use the same communication cards my child uses at home?

Request an IEP meeting and ask specifically that the child's communication system be addressed in the IEP under assistive technology. IDEA requires the IEP team to consider whether the child needs assistive technology devices and services. Bring a copy of your home cards to the meeting. Ask the school SLP to document which symbol set and vocabulary targets will be used consistently across school and home environments.

How much do communication cards cost?

Free printable sets are available from Do2Learn, Boardmaker Share, and Autism Speaks, so starting costs can be essentially zero beyond paper and lamination. A home laminator runs $25 to $40. Commercial symbol libraries like Boardmaker cost roughly $300 per year for the full subscription. PECS starter kits retail for around $40 to $60. Speech-generating devices that go beyond cards range from $100 for simple apps to $5,000 to $8,000 for dedicated devices, often covered by insurance.

What is the difference between a communication board and communication cards?

A communication board is a static display, usually a sheet or binder page, where multiple symbols are arranged together. Communication cards are individual symbols the child can pick up and exchange or point to one at a time. Boards are good for giving the child access to many options at once. Individual cards are better for PECS-style exchange, for building a sentence strip, or for a portable wallet the child carries. Many systems use both.

My child ignores the communication cards. What am I doing wrong?

Usually one of three things: the vocabulary isn't motivating enough (start with what the child desperately wants, not what seems useful), the cards aren't accessible enough (the child has to ask an adult to bring them out, which defeats the purpose), or you haven't modeled using them yourself often enough. Aided language stimulation, where you point to the card and say the word while doing activities, is the most evidence-supported way to build a child's interest in using the system.

Are there apps that work like communication cards?

Yes. Apps like Proloquo2Go, TouchChat, and LAMP Words for Life are essentially digital communication boards on a tablet. They use the same symbol sets (PCS or custom photos) but allow access to far more vocabulary without carrying a binder. Some free or low-cost apps like LetMeTalk (Android, free) and Snap Core First (subscription) serve as entry points. An SLP should guide the choice of app based on the child's motor, cognitive, and language profile.

Will insurance or Medicaid cover communication cards or AAC devices?

Medicaid is required in most states to cover medically necessary AAC devices under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children under 21. Private insurance coverage varies by plan and state law. An SLP's written report documenting medical necessity is the key document for any insurance claim. Simple communication card materials are generally not covered because the cost is low, but speech-generating devices and apps often are.

What is the first word or phrase a child should learn to communicate with cards?

Most AAC specialists recommend starting with the child's single strongest motivator (a specific food, a toy, an activity) plus the word "more" and the word "no." "More" and "no" are power words: they let the child extend an experience or stop something unwanted, which means they have real communicative payoff immediately. Starting with these three concepts before adding any others tends to build faster, more confident card use.

How is PECS different from other communication card approaches?

PECS is a structured six-phase intervention, more than a card format. It specifically teaches the child to physically hand a card to a communication partner, building the initiation of communication rather than just responding to prompts. It has strong randomized controlled trial evidence for minimally verbal autistic children. Other approaches like core word boards or aided language stimulation don't require the physical exchange. A trained implementer should oversee PECS phases 1 and 2 especially.

Can siblings or other family members use the communication cards too?

They should. Every person who regularly interacts with the child should know how to use the cards and should respond to the child's use of them. If only one parent knows the system, the child's communication opportunities are cut in half at minimum. Run a short training session for siblings, grandparents, and anyone who provides regular care. It doesn't need to be formal: show them the cards, demonstrate how to model and respond, and ask them to use the system every time the child initiates.

Sources

1. ASHA, Augmentative and Alternative Communication overview: ASHA defines AAC as all forms of communication other than oral speech used to express thoughts, needs, wants, and ideas
2. Frost L, Bondy A. The Picture Exchange Communication System Training Manual, 2nd ed. Pyramid Educational Consultants, 2002; also National Autism Center evidence review: PECS has six structured phases and is listed as an evidence-based practice by the National Autism Center
3. Beukelman D, Mirenda P. Augmentative and Alternative Communication (4th ed.), Brookes Publishing; core vocabulary frequency research cited therein: Core vocabulary accounts for approximately 80 percent of words used in everyday conversation
4. Millar DC, Light JC, Schlosser RW. The impact of AAC on natural speech development. American Journal of Speech-Language Pathology, 2006: AAC use does not suppress natural speech development and was associated with gains in spoken language in many cases
5. American Academy of Pediatrics, Identification and Evaluation of Children with Autism Spectrum Disorder (clinical report): AAP recommends full communication assessment and consideration of AAC for autistic children with significantly delayed or absent speech
6. Autism Speaks, Visual Supports Tool Kit: Autism Speaks provides downloadable visual support cards and schedules for transitions and daily living routines
7. Romski M, Sevcik RA, et al. Randomized comparison of augmented and nonaugmented language interventions. Journal of Speech, Language, and Hearing Research, 2010: Aided language stimulation (modeling AAC use while speaking) is evidence-supported for expanding vocabulary and sentence length in AAC users
8. U.S. Department of Education, Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq.: IDEA Part C provides free evaluation and services for children under age 3; Part B requires IEP teams to consider assistive technology including AAC in all settings
9. Yoder PJ, Stone WL. Randomized comparison of two communication interventions for preschoolers with ASD. Journal of Consulting and Clinical Psychology, 2006: Children who receive communication support before age 3 have better long-term communication outcomes
10. Kaiser AP, Hancock TB. Teaching parents new skills to support their young children's development. Infants and Young Children, 2003; subsequent AAC parent-training literature: Parent training is one of the strongest predictors of child AAC success in parent-implemented AAC research
11. Schlosser RW, Sigafoos J. Augmentative and alternative communication interventions for persons with developmental disabilities. Research in Developmental Disabilities, 2006: For very early communicators, real photographs may be easier to recognize initially; children generalize to symbols more quickly than often assumed
12. Centers for Medicare and Medicaid Services, EPSDT benefit for children under 21: Medicaid is required in most states to cover medically necessary AAC devices under EPSDT for children under 21
13. National Institute on Deafness and Other Communication Disorders (NIDCD), Autism Spectrum Disorder: Communication Problems in Children: NIDCD notes that some autistic children benefit from AAC methods, including picture symbols and speech-generating devices, to support communication
14. Centers for Disease Control and Prevention (CDC), Autism Spectrum Disorder: Treatment and Intervention: CDC identifies communication and language interventions among the recommended approaches for children with autism spectrum disorder