Last updated 2026-07-09
TL;DR
Communication cards are low-tech visual tools, pictures, symbols, or words on paper or card stock, that let nonverbal and minimally verbal autistic children (and adults) express wants, needs, feelings, and choices without spoken language. Research supports picture-based systems as effective AAC from as young as 12 to 18 months. Free printable sets exist, and paid options run roughly $20 to $150.
A communication card is exactly what it sounds like: a picture, symbol, or word a child can point to, hand over, or exchange instead of saying something out loud. No batteries, no app, no Wi-Fi to wait on. That's really the whole idea.
The format ranges widely, from a laminated photo of a child's own cup to commercial symbol sets like Boardmaker's PCS (Picture Communication Symbols) to something a parent sketched at the kitchen table five minutes ago. What all of these share is that the picture carries the message when speech can't. For a lot of autistic children, that fits naturally with how they process information: visual input stays put and can be looked at again, while spoken words vanish the second they're said. A card can be carried back to a parent and understood on the spot, and that moment of being understood matters more than people realize.
This falls under what speech-language pathologists call AAC, or augmentative and alternative communication. The American Speech-Language-Hearing Association defines AAC as "all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas," covering both unaided forms like sign language and aided forms like picture cards and devices [1]. Communication cards sit in the low-tech, aided end of that category. You'll hear them called picture cards, PECS cards, visual communication cards, choice cards, or symbol cards, depending on who's talking, but they're variations on the same basic tool.
Where cards fit between verbal and nonverbal communication
Autism affects communication across a wide range, and the line between "verbal" and "nonverbal" is blurrier than most people assume. The CDC estimates that around 25 to 30 percent of autistic individuals are minimally verbal, meaning they use fewer than 30 functional words consistently [2]. "Minimally verbal" is the more current clinical term; "nonverbal" is still common among families and still accurate for many people. Both groups can benefit from cards. What often gets missed is that verbal autistic children frequently have nonverbal communication differences too. Eye contact, gesture, facial expression, and pointing can all develop on a different timeline. A child who says "juice" clearly might not point toward the fridge for something else, or might not wave goodbye unprompted. Cards can help there as well, filling in gestural gaps while speech keeps developing.
Some parents worry that introducing cards will delay talking. The research says otherwise. A review published in the American Journal of Speech-Language Pathology found "no evidence that AAC impedes speech production" and reported that AAC use was linked to gains in natural speech for many participants [3]. That review is now over a decade old, and nothing since has overturned it. If your child's speech-language pathologist raises concerns about starting cards "too early," it's worth a real conversation, because the evidence doesn't support waiting; more on this under early intervention.
The main types of communication cards
The choices can feel like a lot when you're starting out, so here's a plain breakdown.
Real photographs of a child's actual cup, person, or place tend to mean more to a 2-year-old than any generic drawing. They're easy to make and update, and often the best starting point for very young children or those with strong visual processing needs.
Clip art and simple line drawings are what most people picture when they hear "communication cards." Sites like Do2Learn (do2learn.com) and Teachers Pay Teachers offer thousands of free and low-cost printable sets. Quality is uneven, but simple, high-contrast images are generally easier to process than detailed illustrations.
Boardmaker PCS (Picture Communication Symbols) is the standard in most schools and therapy rooms, with over 45,000 symbols sharing a consistent visual language. The software runs $499 a year for a single license, steep for one family, but many SLPs and schools already have access and can print cards for you.
PECS-specific cards come from the Picture Exchange Communication System, a structured protocol developed by Bondy and Frost. The cards aren't proprietary, but the training program is. PECS is one of the most studied picture-based AAC systems; a Cochrane review found it produced improvements in communication for some autistic individuals, though evidence quality varied [4].
Core vocabulary boards work differently: instead of request-only cards ("I want cookie"), they give access to high-frequency words used across all communication, like more, stop, go, help, no, want, and don't. The evidence behind core vocabulary instruction is strong. ASHA's clinical resources note that roughly 80 percent of what we say day to day draws from a set of about 400 core words [1].
Feelings and social-emotional cards name emotions or social situations, and tend to help older children and teens who struggle to identify what they're feeling. They pair well with social stories.
| Type | Best for | Approximate cost | Where to get |
|---|---|---|---|
| Real photos | Toddlers, very concrete learners | $0 (print at home) | Your own camera |
| Clip art cards | Most children, home use | $0-$15 | Do2Learn, TPT |
| Boardmaker PCS | School settings, therapy | $499/yr software | boardmakershare.com |
| PECS cards | Structured request training | $0-$30 (cards only) | Printable online |
| Core vocabulary boards | Broadening communication | $0-$80 | ASHA, Tobii Dynavox |
| Feelings cards | Age 4+, emotional regulation | $10-$25 | Amazon, TPT |
How PECS actually works
PECS is the most structured of the picture card systems, and it's worth spelling out because families often assume every card system works the same way. It doesn't.
PECS was developed by speech-language pathologist Lori Frost and behavior analyst Andrew Bondy in the late 1980s at the Delaware Autistic Program. It teaches communication through six phases, beginning with the child physically handing a card to a communication partner in exchange for something they want. That physical exchange is deliberate: it creates an intentional, functional communication act from the very first session.
In Phase 1, the child picks up a picture of a desired item and hands it to an adult, who gives the item right away. Phase 2 has the child seek out a communication partner rather than handing the card to whoever happens to be nearby. Phase 3 introduces discrimination between two or more pictures. Phase 4 builds a sentence strip ("I want ___"). Phase 5 has the child respond to "What do you want?" Phase 6 moves into answering questions and making comments.
Training is meant to be delivered by trained practitioners, and official PECS workshops cost roughly $300 to $600 per person. Families don't need to pay for a workshop just to use picture cards at home, though; understanding and applying the principles with guidance from a child's SLP works fine. One common mix-up is skipping the exchange step and just pointing to pictures on a board. That's a valid approach too, but it's a different method with different mechanics, and staying clear with your child's team about which one you're using keeps everyone consistent.
At what age should you start using communication cards with an autistic child?
As early as 12 to 18 months if there are concerns about communication development. That's not a guess, it matches current early intervention guidance. The American Academy of Pediatrics recommends developmental surveillance at every well-child visit and formal screening at 18 and 24 months, with immediate referral if a child is not using any words by 15 months or not combining two words by 24 months [5]. If a child hits those markers and still isn't talking, waiting to see what happens is the option most likely to cost time you can't get back.
For children already diagnosed with autism, the real question isn't when to start cards, it's why you haven't already. Communication cards are harmless, cheap or free, and can only help. Introduce them too early and the worst that happens is the child ignores them for a few weeks.
For toddlers, start small: one to three cards, maybe "more," "help," and a favorite food or toy. Add cards as the child reliably uses what's already there. Handing a 2-year-old a 50-card binder gets you nothing but a mess on the floor.
For older children and teens who've never used AAC, it's not too late either. The field has mostly dropped the idea that there's a critical window after which AAC stops helping. Plenty of autistic adults use communication cards and boards every day. The age ceiling people imagine just isn't there.
Making communication cards at home, no software required
You need a printer, cardstock or a laminator, and pictures. That's really it.
The fastest free route is Google Image Search: find a clear, simple image of the object or concept, drop it into a Word document or Google Slides, size it to roughly 3x3 inches, add a text label underneath, and print. Laminating pouches run about $15 for a 100-pack at any office supply store, and a cheap laminator costs $25 to $35. Add velcro dots (about $6 for 200) and you've got a full system for under $60.
If you want something more polished without paying for Boardmaker, a few free resources hold up well: Do2Learn (do2learn.com) offers thousands of free picture cards sorted by category, with single sheets or custom boards; Smarty Symbols has a free tier plus a paid tier around $5 to $8 a month for full access; Tobii Dynavox's symbol stix show up on some free platforms if you know where to look; and ASHA's public resources page links to several free symbol libraries through its AAC evidence maps.
A few things that make homemade cards work better: use real photos for the things your child cares about most (their specific blanket, their specific snack), keep backgrounds clean, make the text label bigger than feels necessary, and laminate everything, because toddlers are hard on paper. One thing worth doing differently: don't spend the first week making 40 cards. Make five or six, see which ones your child responds to, and build from there. Parents tend to over-invest in making cards and under-invest in teaching them.
Teaching card use, and what to do when a child ignores them
Teaching card use is mostly about your behavior, at least at the start, not your child's.
The core technique is called aided language stimulation. You model the card every time you say the word it represents. Want juice? Touch the juice card as you say "juice." Offering a choice? Touch both cards as you name them. Children learn what cards mean by watching an adult use them consistently and seeing that communication actually gets a result.
The biggest reason cards fail at home is inconsistency. If they live in a drawer most of the day, they won't get used. They need to be present at the moments communication actually happens: meals, playtime, transitions, bath and bedtime. Clip a small ring of cards to a bag strap or keep a board on the fridge. Out of sight really is out of mind.
When a child ignores the cards, check a few things. Do the cards represent things the child actually wants? A "broccoli" card gets ignored if the child hates broccoli. Is the card physically reachable? A nonverbal 3-year-old won't climb to get to a board. Have you tried real photos instead of symbols? Some kids take to symbols right away; others need six months of photos first. And if you've been consistent for four to six weeks with no response, bring in a speech-language pathologist, not because you've done anything wrong, but because they can observe what's happening and adjust the approach.
Patience isn't just a nice sentiment here. Some children take three or four weeks of adult modeling before they touch a card on their own. That's normal. Keep going.
If your child also uses repeated phrases or scripted language, it's worth reading about echolalia and how it connects to communication. It might reframe what you're seeing.
Cards versus AAC devices and apps
These aren't competitors, they're different tools on the same spectrum. Low-tech cards cost nothing to replace, never need charging, and don't ask a child to navigate a touchscreen. For a child just beginning to grasp symbolic communication, cards are often the better starting point, since picking up and handing over a card is a more concrete act than tapping a screen.
High-tech AAC devices, including dedicated speech-generating devices and apps like Proloquo2Go or TouchChat, offer far bigger vocabularies, synthesized voice output, and the ability to combine words in ways cards can't really match. Proloquo2Go runs about $249.99 as an iPad app. Dedicated devices like Tobii Dynavox systems cost roughly $5,000 to $14,000, though Medicaid covers them for eligible children under IDEA and related federal policy [6].
Research doesn't clearly favor one type over the other. Both work. The right choice depends on the child's motor skills, cognitive profile, vision use, and what their daily environment supports. Plenty of children use both: a core vocabulary app on a tablet for most of the day, plus a simple feelings card at school or a first-then board at home during routines. Nobody says you have to pick one and stick with it forever. The Little Words app, for instance, is built as a lightweight daily practice companion rather than a full AAC replacement, and it works alongside whatever else a family already uses.
For families also managing motor planning issues, apraxia of speech and childhood apraxia of speech are worth reading about, since motor access to cards and devices matters a great deal for those children.
What the research actually says about picture systems
The evidence base is real, if imperfect. The most cited synthesis of PECS specifically, a review in the Journal of Autism and Developmental Disorders, found moderate to large effects on communication frequency, with gains in spontaneous speech in some participants [7]. The authors were upfront that most studies were small and methodologically limited. Large randomized trials are genuinely hard to run with children who are minimally verbal.
A broader Cochrane review of behavioral interventions for autism that included picture-based systems found improvements in communication but flagged the overall low quality of evidence across the AAC literature, pointing to small samples and little long-term follow-up [4].
What's less contested: visual supports as a category, which includes communication cards, have strong backing in the autism intervention literature. The National Autism Center's 2015 National Standards Project rated visual supports as an "established" treatment, meaning the evidence is sufficient to conclude they produce positive outcomes [8]. That's a meaningful rating.
For children who have motor speech difficulties alongside autism, the research overlap between AAC, autism spectrum speech therapy, and apraxia keeps growing. The tools intersect even when the diagnoses don't.
Nobody has great long-term data on kids who use communication cards from toddlerhood into adulthood. That gap is real. What we have are retrospective reports and case series, suggestive but not conclusive, and honest practitioners will tell you exactly that.
If your child has an IEP and uses picture cards, the school is required to document and support that under IDEA (20 U.S.C. § 1400 et seq.) [6]. If the school isn't following through, that's worth raising with the IEP team directly, and it may point to a bigger conversation about the plan itself. Most school SLPs know their way around PECS, core vocabulary boards, and symbol systems. What's inconsistent is whether the rest of the classroom staff, teachers and paras included, actually get trained to use them. This matters more than people realize: research on implementation shows that cards used only by the SLP twice a week produce far weaker results than cards used all day by every adult around the child [7]. Consistency across settings is the strongest single predictor of whether a picture system actually works. A few things help here. Ask to sit in on an SLP session so you can watch exactly how the cards get presented and how the therapist responds to your child's attempts. Request a home version of the same board or card set used at school. Kids don't transfer skills between contexts automatically, so matching symbols at home makes a real difference. Ask directly which classroom staff have been trained. If the answer is "just the SLP," say something. And keep a simple log of what's working: a note like "used the 'help' card three times during dinner this week" is exactly the kind of information SLPs find useful. For families who can't get to in-person speech therapy easily, online speech therapy is a real option, and it often comes with parent coaching on AAC systems built in. There are a handful of mistakes that come up again and again, and the research and SLP guidance are fairly consistent about what they are. The biggest one is requiring speech before accepting the card. If a child hands you the "cookie" card and you respond with "now say it," you've turned communication into a negotiation the child can lose. The entire point of the card is that it works without speech. Accept it, hand over the cookie, let the communication succeed on its own terms. Speech tends to show up alongside that success, not because it was demanded. Another common one is moving too fast: handing a child who's never used AAC a binder with 60 cards isn't a communication system, it's just clutter. Start with the words that matter most in that child's actual day, then expand slowly. Along the same lines, cards that only come out during a scheduled "therapy time" don't help much, because communication doesn't happen on a schedule. Kids need access to their cards in the real moments: wanting a snack, needing help, choosing between two toys, hitting a wall of frustration. If the cards live in a drawer the rest of the day, the child never learns to reach for them outside of a structured sit-down. Modeling gets skipped a lot too. If you want your child to use the "all done" card, they need to watch you pick it up and say "all done" every single time that moment comes up. That repetition is the actual teaching. And then there's timing: most kids need four to eight weeks of steady adult modeling before they start initiating card use themselves. Giving it two weeks and deciding it doesn't work is one of the most common reasons these systems get abandoned too early. It's rarely the cards that failed, it's just not enough time. If you feel stuck, a consultation with an AAC-specialized SLP is worth it, not as an admission of failure but because an outside eye often catches the one adjustment that changes everything. As for where to actually get cards: Do2Learn (do2learn.com) has the largest free symbol library online, searchable and printable with no email required. Boardmaker Share (boardmakershare.com) has community-uploaded boards, free and otherwise, with quality that varies but some genuinely good finds. Teachers Pay Teachers (teacherspayteachers.com) turns up hundreds of results if you search "free communication cards autism" and filter to free items. ASHA's Evidence Maps for AAC link out to evidence-based tools, some of them free. And Tar Heel Reader (tarheelreader.org), from UNC Chapel Hill, offers free symbol-supported books that double nicely as communication supports. For families who want a structured daily practice tool alongside whatever cards they're using, Little Words has a guided quiz at littlewords.ai/start that helps identify a starting point based on your child's current communication level. If you're willing to pay a little, Smarty Symbols runs about $5 to $8 a month and includes a large library plus a customizable card maker; Symbolstix Prime sits at a similar price and shows up often in school systems. On Amazon, searching "autism communication cards" and sorting by rating turns up plenty of pre-made laminated sets in the $12 to $30 range, good if you want something ready to use immediately. Worth being honest about: no free set will be perfectly matched to your child. The cards that work best are the ones built around what your specific kid actually wants and does day to day, so even a strong commercial set usually needs a few photos from your child's own life mixed in.Frequently asked questions
Can communication cards replace speech therapy for an autistic child?
No, and they were never meant to. Communication cards are a support tool, not a stand-in for working with a speech-language pathologist. What they do is give a child a way to communicate while therapy continues alongside it. Research consistently shows that picture-based AAC doesn't prevent speech development and may actually support it. An SLP can help you figure out which cards, which system, and how to teach their use effectively.
Do communication cards work for autistic adults too?
Yes, there's no age ceiling on communication cards or AAC in general. Adults who are minimally verbal, or who lose speech under stress (sometimes called situational mutism or speech shutdown), use communication cards, boards, and AAC apps effectively. The same principles apply: start with what matters most in daily life, model use consistently, and expand vocabulary over time.
What's the difference between PECS and just using picture cards?
PECS (Picture Exchange Communication System) is a specific six-phase protocol where the child physically hands a picture to a communication partner in exchange for a desired item, with a structured training sequence behind it. "Picture cards" is a broader term covering any visual symbol used for communication, including pointing to a board. PECS is one structured way to use picture cards, not the only way.
Will using communication cards stop my child from learning to talk?
This worry is understandable and very common, but the evidence says no. A review in the American Journal of Speech-Language Pathology found no evidence that AAC impedes speech development, and many studies show AAC use is associated with increases in natural speech. Holding back communication support while waiting for speech to develop on its own isn't backed by research.
How many cards should I start with for a toddler?
Three to five is a reasonable starting point: a favorite snack, a beloved toy, and a functional request like "more" or "help." Add cards only once the child reliably uses the ones they already have. Handing a toddler 30 cards at once is overwhelming and works against you. The goal is communication that actually gets used, not a large system that sits in a drawer.
What symbols or pictures work best for autistic children?
This varies by child. Many young children and concrete thinkers respond better to real photographs of actual objects than to line drawings or symbols. For children who are ready for symbols, simple, high-contrast images with a text label work better than detailed illustrations. When in doubt, start with photos and move to symbols once the child understands that pictures represent objects and requests.
Are communication cards covered by insurance or Medicaid?
Low-tech cards themselves (paper and laminate) usually aren't billed through insurance since the cost is negligible. High-tech AAC devices that sometimes accompany a card-based system can be covered under Medicaid for children who meet eligibility criteria, and under private insurance in some states, but an SLP has to document medical necessity and conduct a formal AAC evaluation first. The cards themselves are something parents buy directly.
How do I get my child's school to use the same communication cards we use at home?
Request it in writing as part of the IEP process. Under IDEA, schools must provide supports necessary for a child to receive a free appropriate public education. If your child already uses a communication system at home, you can ask the school to use the same symbols and vocabulary. Bring examples of what you use, ask the SLP to observe, and get what you're requesting written into the IEP meeting notes.
Can communication cards help with autism meltdowns and emotional regulation?
Yes, sometimes directly and sometimes indirectly. Many meltdowns start with a child unable to communicate a need or feeling before frustration builds. Feelings cards, "I need a break" cards, and visual first-then boards showing what comes next can cut down the uncertainty that triggers dysregulation. They won't prevent every meltdown, but giving a child more ways to communicate consistently reduces the frustration that feeds into them.
What is the core vocabulary approach to communication cards?
Core vocabulary is the small set of high-frequency words that make up most of what people say across contexts: words like more, stop, help, go, want, I, you, like, no, yes. Core vocabulary boards prioritize these over object-specific (fringe) vocabulary. Research suggests teaching core words gives children a broader communication foundation than systems built only around specific wants.
Are there communication cards specifically for nonverbal adults with autism?
Yes. Adults who are nonverbal or minimally verbal use communication cards, topic boards, and AAC apps built for adult vocabulary and social situations, including phone-based apps like Proloquo4Text (text-based) or CommunicoTool. The Autistic Self Advocacy Network has published resources on AAC for autistic adults. The principles of card-based communication stay the same; it's the vocabulary and topics that are age-appropriate.
How long does it take for a child to start using communication cards on their own?
Usually four to eight weeks of consistent adult modeling before a child starts initiating card use on their own, though this varies a lot. Some children pick it up in days; others take several months. Consistency matters more than anything else: if adults model the cards every time a relevant moment comes up throughout the day, children learn faster. Limiting practice to one session a day stretches that timeline out considerably.
Sources
- American Speech-Language-Hearing Association (ASHA), Augmentative and Alternative Communication: ASHA defines AAC as all forms of communication other than oral speech used to express thoughts, needs, wants, and ideas, and states that roughly 80 percent of daily communication uses approximately 400 core words
- CDC, Data and Statistics on Autism Spectrum Disorder: Approximately 25 to 30 percent of autistic individuals are minimally verbal, meaning they use fewer than 30 functional words consistently
- Schlosser & Wendt (2008), American Journal of Speech-Language Pathology, 'Effects of augmentative and alternative communication intervention on speech production in children with autism': Systematic review found no evidence that AAC impedes speech development and that AAC use was associated with growth in natural speech for many participants
- Ospina et al. (2008), Cochrane Database of Systematic Reviews, Behavioural and developmental interventions for autism spectrum disorder: Cochrane review found improvements in communication from picture-based systems including PECS but flagged low overall quality of evidence due to small sample sizes
- American Academy of Pediatrics, Developmental Surveillance and Screening Policy Statement: AAP recommends developmental screening at 18 and 24 months with immediate referral if a child has no words by 15 months or no two-word combinations by 24 months
- Individuals with Disabilities Education Act, 20 U.S.C. § 1400: IDEA mandates that schools provide communication supports including AAC as part of a free appropriate public education; Medicaid covers speech-generating devices for eligible children
- Flippin, Reszka & Watson (2010), Journal of Autism and Developmental Disorders, 'Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders': Review found moderate to large effects of PECS on communication frequency; implementation fidelity across the full day predicted stronger outcomes than clinic-only use
- National Autism Center, National Standards Project Phase 2 (2015): Visual supports, including communication cards, are rated as an 'established' treatment for autism, meaning sufficient evidence exists to conclude they produce positive outcomes
- Bondy & Frost (1994), Focus on Autistic Behavior, 'The Picture Exchange Communication System': Original description of the PECS six-phase protocol developed at the Delaware Autistic Program, emphasizing physical card exchange as the foundational communicative act
- Tobii Dynavox, AAC device pricing and Medicaid coverage information: Dedicated speech-generating devices range from approximately $5,000 to $14,000; Medicaid covers them for eligible children when medical necessity is documented by an SLP
- UNC Center for Literacy and Disability Studies, Tar Heel Reader: Free accessible symbol-supported books available for use as communication supports, produced by the University of North Carolina
- ASHA, Evidence Map for Augmentative and Alternative Communication: ASHA evidence map documents the research base for picture-based AAC systems across age groups and diagnosis categories including autism spectrum disorder