Last updated 2026-07-10
TL;DR
PECS (Picture Exchange Communication System) has 6 phases that move from handing over one picture to building sentences. Parents can teach phases 1 through 3A at home with printed symbols, a Velcro binder, and a second helper. Startup cost runs under fifteen dollars. Phases 4 through 6 add complexity where an occasional SLP check-in helps, but the daily practice always happens at home.
PECS stands for Picture Exchange Communication System, and the whole idea is that a child hands a picture to someone in exchange for what they want. No pointing first, no eye contact required. Andy Bondy and Lori Frost built it in the late 1980s while working with preschoolers with autism in Delaware's public schools, and the early research reached the peer-reviewed literature in the following years [1]. The exchange itself is what builds communication intent, from the ground up.
Parents end up teaching it at home mostly because of math: a therapy session is usually one hour a week, which leaves 167 other hours where nothing happens unless someone makes it happen. PECS sticks through repetition in real places: the kitchen, the bedroom, the backyard. A therapist can train you in the method, but you're the one running it during breakfast, bath time, and every snack in between.
One thing worth settling before you start: PECS isn't a substitute for a speech-language evaluation. ASHA recommends that AAC choices, PECS included, come out of a broader communication assessment [2]. If your child hasn't been evaluated yet, it's worth reading about early intervention and requesting one through your school district or state program. Starting PECS at home while you wait doesn't cause harm, and the research supports doing exactly that.
Does it actually work?
The evidence holds up, with honest limits. A 2010 meta-analysis by Flippin, Reszka, and Watson reviewed 14 studies and found PECS produced reliable gains in functional communication for children with autism, strongest in phases 1 and 2 [3]. A separate systematic review reached similar conclusions but flagged that evidence for speech development beyond PECS use itself is more mixed [4].
So: PECS reliably teaches kids to start communicating, which is the hardest skill to teach. Whether it grows spoken words depends on the child. Some gain speech alongside PECS, some don't, and nobody has clean data on exactly who gets the speech boost. The closest studies suggest children who already have some vocalizations are more likely to see speech climb [9].
For kids working through echolalia or living with apraxia of speech, PECS runs a parallel channel that doesn't compete with speech practice. It's not either-or, and if your child eventually outgrows paper pictures, AAC devices and dedicated apps are the natural next step. PECS is a bridge, not a ceiling.
What you actually need to get started
You need less than you'd think: a set of picture symbols, a way to carry them, and a willing partner (you).
Pyramid Educational Consultants sells the official PECS materials at prices that vary by package [8], but for home use, many families print low-cost symbols or just photograph the actual items in the house. Real photos of your child's specific snacks and toys often work better than generic clipart, especially early on.
For carrying them, a three-ring binder with Velcro strips on each page does the job. You attach pictures with Velcro so the child can pull them off and hand them over. A 1-inch binder costs under five dollars, a roll of Velcro tape runs two to four dollars, and you don't need an expensive pre-made PECS binder to start. Once you reach phase 4, you'll also want a small cardstock sentence strip with Velcro where the child lines up pictures in order. And for phases 1 and 2, you need a second person: a physical prompter who sits behind the child. A partner, grandparent, or older sibling who understands the role all work fine. Total cost to start runs five to fifteen dollars if you print your own symbols. The official PECS starter kit runs roughly sixty to one hundred dollars, and the PECS Level 1 Training manual is priced separately [8]. Buy the manual if you can afford it: it explains the physical prompting procedures in detail, and skipping it means filling the gaps with guesswork.
The 6 phases, and what each looks like at home
Parents can usually handle phases 1 through 3 on their own. Phase 4 onward gets easier with SLP check-ins, but daily home practice stays your job either way.
| Phase | Name | What the child does | Realistic home timeline |
|---|---|---|---|
| 1 | Physical exchange | Picks up one picture and hands it to a partner | Days to weeks |
| 2 | Distance and persistence | Goes to the book, gets the picture, finds the partner, hands it over | Weeks to months |
| 3A | Picture discrimination | Chooses the correct picture from two or more options | Weeks to months |
| 3B | Choosing from an array | Selects from a larger set of pictures | Weeks to months |
| 4 | Sentence structure | Places "I want" plus item picture on a strip and hands it | Months |
| 5 | Responding to "What do you want?" | Answers a direct question | Months |
| 6 | Commenting | Uses pictures to comment, not only to request | Months to longer |
In phase 1, you sit across from your child while a physical prompter sits behind them. You hold something your child wants (a favorite snack, a toy) at eye level. The prompter guides the child's hand to pick up the picture and move it toward you. The instant the picture touches your hand, you take it, say the word with real enthusiasm ("Cookie!"), and hand over the item. No extra talking, no "say cookie": the exchange is the whole point. Repeat ten to twenty times per session. Five minutes is plenty.
Phase 2 moves you a little further away. The communication book is nearby but not in the child's hand, so the child has to get up, go to the book, grab the picture, find you, and hand it over. This teaches that communication takes effort and travels across distance, which is the whole foundation of real-world requesting.
In phase 3A, put two pictures on the book: one the child wants, one they clearly don't (pick something obviously undesirable at first). When they hand you the wrong one, give them that item with a neutral face. Getting something they didn't want usually nudges the child to look more carefully next time. Skip the verbal correction.
Phase 4 adds the sentence strip, which has an "I want" symbol fixed on the left. The child puts the item picture next to it, pulls the strip off, and hands you the whole thing. You read it back ("Oh, you want cracker!") and then hand over the cracker. This phase tends to take the longest for most children.
Phases 5 and 6, answering questions and commenting, get more abstract. If you have access to speech therapy at any point, these are good phases to work on with a professional.
Picking the right pictures
Start with three to five items your child genuinely wants, not things you think are good for them. Skip vegetables at phase 1. The item needs to be something your child would work for: something they reach toward, point at, or melt down over losing.
Common first picks include a specific snack (crackers, chips, a juice box), a preferred toy (a spinning top, a certain car, bubbles), or a sensory item (a squeeze toy, a fidget). Bubbles are a classic phase 1 choice because the child has to request more after each turn and you control the supply.
Take real photos when you can. A photo of your child's exact goldfish cracker bag says more than a generic cracker symbol. Print at 2 by 2 inches, laminate with self-laminating pouches (under ten dollars for a pack), and stick Velcro on the back.
As the child moves through the phases, expand the picture set to include more foods, activities, places, and people, but don't add pictures faster than the child can tell them apart. More pictures aren't better if the child can't pick the right one reliably.
How do you prompt without creating prompt dependence?
Prompt dependence is the real risk with any picture system. If your child only exchanges pictures when you hover nearby, you haven't taught communication, you've taught compliance.
The PECS manual is specific here: physical prompts come from behind, never from the front. You, as the communication partner facing the child, never reach forward to help. Whoever is prompting stays behind the child and out of their line of sight, guiding the hand from there. The reason matters: the child needs to see you as the target of communication, not the helper.
Fade prompts on a set path: full physical (hand over hand), then partial physical (a touch at the wrist), then gestural (a point toward the picture), then nothing. Drop to a lighter prompt as soon as the child completes the step two or three times without the heavier one. If your child stalls, back up one prompt level rather than waiting it out, and skip verbal prompts like "do you want it?" or "give me the picture." Those turn into crutches fast.
For children with childhood apraxia of speech, the physical exchange often feels more natural than attempting speech. Let that be the main channel while speech therapy works the motor planning separately.
How many sessions a day actually move the needle?
More is better, but quality beats quantity. Short, high-motivation sessions beat one long forced sit-down. Aim for thirty to fifty exchange opportunities a day across all contexts.
The PECS approach starts with many brief opportunities spread through the day rather than formal sessions at a table [8]. Thirty to fifty sounds like a lot until you build it into meals, snacks, play, and transitions. Then it adds up fast: breakfast alone can give you ten (cereal, milk, spoon), snack time another five to ten, play another ten to fifteen. You don't need a therapy room for any of it. Track your data, even roughly. A tally mark on a sticky note works. Data tells you when to move up a phase and when something is off; without it you're guessing. The official PECS system includes data sheets, or you can make a simple grid on paper with the date, the target picture, and whether the exchange happened independently or with prompting.
If progress has flatlined for three weeks with no change in your data, that's your signal to consult a speech-language pathologist, even for one session. Online speech therapy has made those consults far easier to reach for families where local SLPs are thin on the ground.
The mistakes parents make most often
Talking too much during exchanges tops the list. Phase 1 asks for almost no talking from you. The classic mistake is narrating: "Good job! You gave me the picture! Do you want the cracker?" All of that delays the exchange and piles on noise the child has to filter through. Say the name of the item, give the item, move on.
Using PECS as a quiz is another one. Holding up a picture and asking "what's this?" isn't PECS. PECS is always child-initiated: the child wants something and acts to get it. Drilling pictures without motivation kills the whole system.
Adding too many pictures too fast feels like progress, but if the child can't tell them apart reliably, you've just made the system harder for no gain. Add one new picture at a time and test it against a clearly different picture before adding more.
Leaving the book behind is a quiet killer. The communication book has to be as available as your phone. If it sits on a living room shelf while your child needs something in the kitchen, the system is dead. Keep the book, or a small set of pictures, wherever your child spends time.
And don't skip the other caregivers. Grandparents, daycare workers, and siblings all need the basics. A child who exchanges pictures at home but gets things handed over without any exchange at school is getting mixed signals. One page of instructions and a quick demonstration usually trains another adult well enough.
When to move from PECS to a speech-generating device
PECS is a strong start, but paper pictures have hard limits. You can only carry so many. They get wet, torn, and lost. As vocabulary grows, hunting for the right picture slows communication down. Most speech-language pathologists suggest looking at an AAC device or app once the child requests reliably across phases 3 and 4, uses thirty or more concepts regularly, and shows interest in talking about things beyond the immediate want. Those signs mean the child's drive to communicate has outgrown what a small binder can hold.
The move doesn't mean starting over. The concepts carry across: the child already knows symbols stand for things and that handing over a symbol gets a result. A device just holds a bigger symbol set and adds voice output.
For families weighing what comes next, Little Words has a quiz at /start that helps match the right communication support to your child's current profile, whether that's PECS, a device, or something else. For autistic children specifically, the autism spectrum speech therapy page has a wider look at communication options across different profiles.
Does PECS only work for autistic children?
No. PECS was built with autistic children, but the research includes other diagnoses: Down syndrome, cerebral palsy, apraxia of speech, global developmental delay, and other conditions affecting speech output have all been studied with PECS.
The real test is a gap between what the child understands and what they can say out loud. If a child follows language but can't or doesn't produce functional speech, PECS targets that expressive gap directly.
ASHA's stance on AAC is plain: no individual should be denied the opportunity to access AAC based on age, motor ability, or cognitive level [2]. PECS is one form of AAC, so the same principle covers it.
Children with apraxia of speech often find PECS useful during the stretch before speech becomes functional, since picking up and handing over a picture asks far less of the motor system than the planning speech demands.
How do you know if your child is ready for PECS?
PECS has almost no prerequisites. The original research was clear on this: it doesn't require eye contact, imitation skills, or any existing communication [1]. That's one of its real advantages over older approaches.
What the child does need is some ability to reach or move toward wanted objects, plus enough fine motor control to pick up and let go of a card. Most children over eighteen months can manage this. Younger children, or those with significant motor impairment, may need adapted materials: larger cards, a magnetic board, or a modified exchange movement.
If a child has practiced daily for two to three months and is still stuck in phase 1, the most useful next step is a formal evaluation. It can tell you whether the system needs tweaking, whether a different AAC approach fits better, or whether sensory or motor issues need attention first. Connect with an SLP through your school district (under IDEA, children ages 3 to 21 qualify for evaluations at no cost to families) [5], or through your state's early intervention program for children under three [6].
What to do when your child throws the pictures or won't engage
Thrown pictures usually mean one of three things: the item isn't motivating enough, the prompt is too heavy, or the child is swamped by how many pictures sit on the board.
Strip the book down to one picture of the single most-wanted item and make the exchange trivially easy to pull off. Use a lighter prompt or none at all, then see if the child tries it alone when the item is in view. Sometimes backing up two steps in the prompt hierarchy is the right call even when it feels like going backward.
Refusal during a session is information too. It can mean the session ran too long, the timing was off, or the child isn't regulated enough to learn right now. A dysregulated child won't get anything out of the session no matter how cleanly you run the technique, so ten minutes after a meltdown is not the moment to practice.
Some children do better with motivating activities than objects. If your child loves being chased around the room, a picture for "chase" works as well as one for "cookie." Match the exchange to what actually reinforces the child right now, not what seems appropriate on paper.
If you keep hitting walls and want a structured home program, an early intervention coordinator or a consulting SLP can run one or two coaching sessions to watch your technique and adjust it. That targeted help often beats ongoing weekly sessions, since you're the one running the program day to day.
Some children pick up phase 1 of PECS in days, others need several weeks. Studies usually define mastery as independent exchanges across three straight sessions, but the real timeline depends on the child, on how motivating the chosen items are, and on how consistently the prompting gets applied. If a month of daily practice hasn't produced any movement, the items themselves are probably the problem: they're not motivating enough. You don't need to buy official materials to get started. Real photos of your child's favorite things, images pulled from a search engine, or free symbol libraries online all work fine. The Pyramid Educational Consultants manual is worth the money because it lays out the prompting procedures in real detail, but the cards themselves can be homemade. A binder and some printed photos will run you under fifteen dollars total. PECS can work with toddlers under two. Research settings have used it with children as young as fourteen to eighteen months, and the main thing a child needs is enough fine motor control to pick up and release a card. For very young children, go with larger cards, lighter lamination, and Velcro that holds but still lets a small hand pull free. Keep sessions to two or three minutes and stick to items your child really wants. A lot of parents worry PECS will stop their child from talking, but there's no research behind that fear. The 2010 review by Flippin and colleagues found no evidence that PECS reduces vocalizations, and some studies actually showed speech attempts increasing alongside PECS use. ASHA's position is the same: AAC supports natural speech rather than replacing it. Keep reacting with real enthusiasm to any sound your child makes during an exchange. It's common for kids to just grab items early on, skipping the picture altogether. The fix is controlling access so the exchange becomes the only reliable way to get what they want: keep snacks out of reach, put favorite toys in containers they can't open on their own, and wait for the exchange before handing anything over. Don't stretch the wait out too long, though. You're aiming for a brief pause that makes the exchange the easy path, not a test of patience. PECS also works fine alongside whatever speech a child already has. If your child says "ba" for ball sometimes but not reliably, PECS gives them something steady to rely on while speech keeps developing. Respond to the picture exchange and to any vocalization with the same enthusiasm. Many children eventually start pairing sounds or approximations with their exchanges, which is worth noticing and reinforcing when it happens. The size of the book changes as skills build. Phase 1 is one picture, one item, nothing more. Phase 2 stays at one to three pictures since it's about distance, not choosing between options. Phase 3A introduces two pictures, one the child wants and one they clearly don't. Phase 3B grows to six to ten pictures once discrimination looks solid. From phase 4 on, the book can hold as many pictures as the child manages well, often ten to thirty for kids using PECS at home, sorted by category with divider tabs. Grandparents, babysitters, and other caregivers can absolutely help, and getting the skill to generalize across different people is part of the goal rather than a complication. What matters is a short training session covering the physical prompt procedure and the reminder not to talk too much during exchanges; a one-page visual guide taped up in the kitchen helps everyone stay consistent, since uneven implementation across caregivers really does slow things down. If your child already points, that doesn't tell you which phase to start at. Pointing is a communication behavior, but it isn't PECS. Run the actual phase 1 test: does your child independently pick up a picture and hand it to someone without being prompted? If not, start at phase 1 regardless of what else they can do. If they pass that on their own, move to assessing phase 2, and so on. A full assessment takes thirty to sixty minutes and tells you exactly where to begin. As for cost, the materials themselves (a binder, some pictures) are cheap enough that insurance rarely gets involved. Parent training in PECS may be covered if a speech-language pathologist bills it under a therapy benefit. Schools are required under IDEA to provide communication supports, including AAC, at no cost when it's written into a child's IEP, and Medicaid waivers in many states cover AAC evaluation and materials too. For children under three, your state's early intervention program is the place to start. People sometimes mix up PECS with picture schedules, but they do different jobs. A picture schedule shows a child what's coming next in the day: it's receptive, helping them read the environment. PECS is expressive: the child initiates a request to get something they want. Both are useful, often run side by side, and a child can benefit from both at the same time. PECS builds initiation; schedules build predictability and smoother transitions. If PECS is working at home but not at school, that's a generalization gap, and it's a common one. Write up your home procedure for the school team: which pictures are in the book, what prompt level you're using, what motivates your child. Ask the school to use the same book and the same procedure. If your child has an IEP, PECS should appear in it as a communication support with implementation details spelled out, and you can request an IEP meeting to line everything up at any time.Sources
- Bondy AS, Frost LA. The Picture Exchange Communication System. Behavior Modification, 2001: PECS was developed by Andy Bondy and Lori Frost and published with early research in the peer-reviewed literature describing the six-phase system
- American Speech-Language-Hearing Association, AAC position statement: ASHA states no individual should be denied AAC access based on age, motor, or cognitive level and recommends AAC decisions be part of a broader communication assessment
- Flippin M, Reszka S, Watson LR. Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis. American Journal of Speech-Language Pathology, 2010: Meta-analysis of 14 studies found PECS produced reliable increases in functional communication, with strongest effects in phases 1 and 2, and no evidence that PECS reduced vocalizations
- Tien KC. Effectiveness of the Picture Exchange Communication System as a Functional Communication Intervention for Individuals with Autism Spectrum Disorders. Education and Training in Developmental Disabilities, 2008: Systematic review confirmed PECS reliably teaches communication initiation but found evidence for speech development beyond PECS use is more mixed
- U.S. Department of Education, Individuals with Disabilities Education Act (IDEA) overview: Under IDEA, children ages 3 to 21 are eligible for evaluations and services including AAC at no cost to families through the public school system
- U.S. Department of Health and Human Services, Administration for Children and Families, early childhood programs: Children under age three with developmental delays can receive early intervention services including speech-language services through Part C of IDEA administered by states
- American Academy of Pediatrics, autism patient care resources: AAP supports use of augmentative and alternative communication strategies including picture-based systems for children with autism who have limited spoken communication
- Pyramid Educational Consultants, PECS official training and materials: Official PECS starter materials and Level 1 Training manuals are available commercially; the system includes six phases with specific prompting and data collection procedures
- Ganz JB, Davis JL, Lund EM, Goodwyn FD, Simpson RL. Meta-analysis of PECS with individuals with ASD: investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase. Research in Developmental Disabilities, 2012: Meta-analysis confirmed PECS produced positive outcomes for communication initiation and found children with existing vocalizations more likely to show speech increases alongside PECS use
- National Institute on Deafness and Other Communication Disorders (NIDCD), assistive devices for speech and language disorders: NIDCD describes picture-based AAC systems as evidence-supported tools for individuals with speech and language disorders, including children with autism