10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-09

What is PECS and how does it actually work?

PECS stands for Picture Exchange Communication System. Andy Bondy and Lori Frost developed it in 1985 at the Delaware Autism Program, and it remains one of the most studied augmentative and alternative communication (AAC) approaches in existence ^[1]. The core idea is simple. Instead of waiting for a child to develop verbal speech before communicating, you teach them to hand a picture to another person in exchange for what they want. The exchange is physical and social from the very first lesson.

That "exchange" piece matters more than it sounds. Other picture-based systems sometimes involve pointing at a board or pressing a button in isolation. PECS specifically requires the child to approach a communication partner and give them something. That social initiation is baked into every phase, which is one reason researchers think it transfers to spoken language more often than passive pointing systems do ^[2].

The system uses Velcro-backed picture cards (line drawings, photographs, or symbols) organized in a binder or communication book. Cards represent objects, actions, people, places, and feelings. Over time, the child builds multi-card strips that work like short sentences: "I want + [item]" or "I see + [object]".

PECS is not a therapy brand that requires expensive proprietary materials, though the Pyramid Educational Consultants group (founded by Bondy and Frost) does sell official training and materials. The protocol itself is documented in peer-reviewed literature and can be run by any trained speech-language pathologist (SLP).

Who is PECS designed for?

PECS was originally designed for young autistic children with little or no functional speech. Its use has widened a lot since. The American Speech-Language-Hearing Association (ASHA) lists PECS as an evidence-based practice for autism ^[3], and clinical guidance from the American Academy of Pediatrics (AAP) supports AAC for children who are minimally verbal ^[4].

Candidates who typically benefit most:

• Children under age 6 who are nonverbal or have fewer than 10 consistent functional words
• Children with autism who struggle with verbal imitation
• Older children and adults who have not responded to verbal-only approaches
• Children with other diagnoses (Down syndrome, apraxia, cerebral palsy) who understand far more than they can say

There is no minimum cognitive level required to start PECS. The protocol reaches learners at very early developmental levels by using highly motivating items and errorless teaching from the start ^[1].

One thing parents worry about: will PECS stop my child from trying to talk? The short answer is no. A 2010 systematic review in the American Journal of Speech-Language Pathology found that PECS intervention was associated with gains in speech production in most participants, and did not suppress vocalization in any of the studies reviewed ^[2]. That finding has held up in later reviews. ASHA's guidance says the same, noting that AAC does not hinder speech development. Individual results still vary, so an SLP who knows your child should decide whether PECS is the right starting point or one tool among several.

What are the 6 phases of PECS?

PECS follows a precise six-phase sequence. Each phase has specific mastery criteria before the child moves on. Jumping ahead is one of the most common implementation mistakes, so understanding what each phase actually looks like matters.

Phase I: How to communicate The child learns to pick up a single picture card and hand it to a communication partner to get a desired item. Two adults are needed: one acts as the communicative partner, the other physically prompts the child from behind without speaking. The goal is that the child initiates the exchange with zero verbal prompting. Mastery is typically defined as 80% independent exchanges across two or three different items and two or more communicative partners ^[1].

Phase II: Distance and persistence The child learns to travel to their communication book, retrieve a card, then travel to find a partner. This phase builds the understanding that communication can happen across space, not only when someone is sitting right in front of you.

Phase III: Picture discrimination The child learns to choose between two or more pictures to request the item they actually want, rather than handing over any card. This is where the vocabulary starts to grow. Errorless learning techniques reduce frustration during this phase.

Phase IV: Sentence structure The child learns to build a sentence strip using an "I want" card followed by a picture of the desired item. This is the phase where most people first see the sentence structure PECS is known for. Children begin to construct multi-word messages.

Phase V: Answering questions The child learns to respond to the question "What do you want?" using their sentence strip. Earlier phases focused entirely on spontaneous requesting. This phase adds responding as a skill.

Phase VI: Commenting The child learns to comment on the environment using phrases like "I see," "I hear," or "I feel." This moves communication beyond requests into a richer social function. Many autistic children need explicit instruction to comment, because social commenting is not naturally reinforced the way requesting is.

Progress through the six phases typically takes months to years depending on the child, the intensity of practice, and how consistently adults respond across settings ^[1][3].

What does the research actually say about PECS outcomes?

PECS has more randomized controlled trial (RCT) evidence behind it than most AAC approaches. That is a genuine strength, though the evidence base is still imperfect and honest reviewers say so.

A 2006 RCT by Yoder and Stone, published in the Journal of Consulting and Clinical Psychology, compared PECS to RPMT (Responsive Education and Prelinguistic Milieu Teaching) in 36 toddlers with autism ^[5]. Children who started with low levels of object exploration showed greater gains in spoken communication after PECS. Children with higher initial object exploration did better with RPMT. The takeaway: PECS is not universally the best choice, but it outperforms alternatives for a specific subgroup.

A 2010 systematic review by Flippin, Reszka, and Watson examined 13 studies and concluded that PECS "appears to be effective" for increasing functional communication and showed a positive association with speech development, though the authors called the evidence base "preliminary" given small sample sizes in many studies ^[2].

A 2007 group RCT by Howlin, Gordon, Pasco, Wade, and Charman, published in the Journal of Child Psychology and Psychiatry, followed 84 children and found that PECS training increased the rate of spontaneous communication, though gains in speech were modest and variable ^[6]. The authors noted that teacher training quality had a large effect on outcomes.

What this adds up to: PECS reliably increases the rate of functional communication. It frequently co-occurs with more spoken words or vocalizations. It does not reliably produce spoken language on its own. For children whose primary goal is any reliable form of communication, the evidence is strong. For families hoping PECS will be the thing that "unlocks" speech, the picture is more mixed.

Nobody has good data yet on exactly which child profiles predict the speech-emergence response. The closest predictors identified in the literature are higher initial imitation skills and younger age at start ^[5][6].

How does PECS compare to other AAC options?

Parents and clinicians often weigh PECS against several alternatives. Here is an honest comparison based on what the evidence actually shows.

PECS has a specific practical advantage over SGD-first approaches for families with limited resources. A basic starter set of cards costs almost nothing to make at home using printed images and Velcro, while SGD devices can run $1,000 to over $8,000 ^[7]. The flip side: PECS relies on a physical communication book that can be lost, forgotten, or left behind in community settings where a tablet-based SGD might already be present.

PECS is frequently used as a bridge to SGD use rather than a lifetime system. Many SLPs introduce PECS first because the physical exchange teaches the social-communicative intent, then transition to a device once that intent is established.

For more on device-based options, see our guide to alternative augmentative communication devices for autism.

How do you start PECS at home?

You do not need to be a trained therapist to run PECS practice at home, but you do need to understand the protocol well enough to dodge the common errors that stall progress. The single most important step before starting: get at least one consultation with an SLP who has PECS training. Most families can then run daily sessions after that initial guidance.

Here is what home implementation looks like in practice.

Step 1: Identify highly motivating items Spend a week noticing what your child reaches for, stares at, or melts down about when it disappears. Those become your first picture cards. A card for something the child is lukewarm about will not teach communication. Motivation is the engine of the entire system.

Step 2: Make or order your starter cards Real photographs of actual items work well for young or lower-support-needs learners. Line drawings (like Boardmaker symbols or the free Mulberry symbols) travel better across contexts. Print them at roughly 2 x 2 inches, laminate them, and add Velcro to the back and to your communication book.

Step 3: Phase I practice with two people You need two adults for Phase I. One holds the desired item within sight. The other sits behind the child and physically guides the hand to the card and then to the communication partner. No verbal prompting during the exchange. The partner hands over the item right away with warm, natural language: "Oh, you want the cracker! Here you go!"

Step 4: Practice across many opportunities daily Research suggests that 20 to 30 exchange opportunities per day produces faster progress than fewer massed trials ^[1]. Spread them across snack time, play time, and daily routines. Variety beats long single sessions.

Step 5: Fade prompts systematically Fade the physical prompt from behind as fast as the child's accuracy allows. The goal is independent initiation. Keeping prompts too long is one of the top errors in home implementation.

If your child already works with an SLP, ask them to train you specifically in PECS Phase I procedures rather than just letting you watch sessions. Parent-implemented PECS has good evidence, but training quality drives outcomes ^[6].

What does PECS training cost, and is it covered by insurance?

Costs break down across three buckets: the materials, the professional training for therapists, and the therapy sessions themselves.

Materials: A DIY set costs $5 to $30 for laminating pouches and Velcro. A premade PECS starter kit from Pyramid Educational Consultants runs roughly $150 to $250. Boardmaker software for symbol creation costs about $400 per year for a school license, though many SLPs already have access ^[7].

Professional PECS training: A two-day PECS Level 1 workshop through Pyramid runs around $250 to $350 per attendee (prices fluctuate; verify at pyramidebp.com). School districts and therapy practices sometimes cover this for staff.

Therapy sessions: If your child qualifies, early intervention speech and language therapy through the IDEA Part C program is free for children under age 3 in the US. The Individuals with Disabilities Education Act (IDEA), 20 U.S.C. § 1432, requires states to provide early intervention at no cost to families when a child has a developmental delay or established risk condition ^[8].

For children over 3, school-based speech services under IDEA Part B are available at no cost if the child qualifies through an IEP. Private therapy sessions cost $100 to $300 per hour out of pocket depending on geography.

Insurance: Medicaid covers AAC evaluations and devices in most states under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which requires coverage of medically necessary services for children under 21 ^[9]. Private insurance coverage for PECS specifically varies widely. Many plans cover speech therapy sessions that happen to use PECS as the method, even if they will not reimburse for materials.

Telehealth speech therapy has widened access a lot. Online speech therapy can lower the per-session cost and let families in rural areas reach PECS-trained SLPs.

How does PECS fit into a broader autism speech therapy plan?

PECS is almost never the only thing happening in a child's communication plan. It is one approach within a broader autism spectrum speech therapy framework that might also include naturalistic developmental behavioral interventions (NDBIs), social communication therapy, and language-rich routines at home.

An SLP working with an autistic child will usually complete a full communication assessment before recommending PECS. That assessment looks at receptive language, expressive language, oral motor function, imitation skills, play skills, and sensory factors that might affect communication. PECS may be the right starting point, or an SGD might be a better fit, or a combined approach might make the most sense.

For children who are late talkers without an autism diagnosis, PECS is less commonly used because the communication profile is different. A speech delay without the social initiation challenges of autism often responds well to more naturalistic language facilitation. Your SLP is the right person to draw that line, not a communication system chart.

Children using PECS also benefit from parallel work on:

• Joint attention skills (looking at an object and then at a partner)
• Play-based language opportunities
• Literacy-rich environments
• Family training so communication is supported everywhere, not only in therapy

If your child is approaching school age, their pediatric speech therapy plan should coordinate with preschool or kindergarten staff so the communication book travels with them and staff know how to respond correctly. Inconsistent responding from adults is one of the fastest ways to erode progress.

Can PECS help an autistic child develop spoken speech?

This is the question most parents are really asking, and it deserves a straight answer: sometimes yes, sometimes no, and we cannot predict with certainty which outcome your child will have.

The evidence for speech emergence alongside PECS is real. The 2007 Howlin et al. RCT found increases in spontaneous vocalizations and some spoken words in children who received PECS training ^[6]. The 2010 review by Flippin and colleagues found that across 13 studies, PECS was positively associated with speech production in the majority of participants ^[2]. The American Journal of Speech-Language Pathology has published multiple studies showing vocalization rates rise during PECS exchanges even before formal speech emerges.

The proposed mechanism is straightforward. PECS establishes communicative intent and a clear exchange structure. Once a child understands that handing over a "cookie" card produces a cookie, pairing the card exchange with a spoken model creates a natural opening for the child to attempt the word. Therapists are trained to build this pairing deliberately in later phases.

However. The size of speech gains varies enormously. Some children move to mostly verbal communication within a year of starting PECS. Others use PECS or an SGD as their primary communication mode long-term. Both outcomes are valid. A child who communicates reliably using PECS has achieved something genuinely important, not a consolation prize.

Age at start matters. Children who begin PECS before age 5 show better speech outcomes on average than children who start later, though later starters still make meaningful gains in total communication ^[5][6]. This is one reason the AAP keeps pushing early identification of communication delays.

What are the most common PECS mistakes parents make at home?

Implementation fidelity determines outcomes more than almost any other variable in the PECS research. A well-designed 2007 study found that teacher training quality strongly moderated intervention outcomes ^[6]. Here are the errors that come up most often in the literature and in clinical practice.

Verbal prompting during Phase I exchanges Saying "give me the card" or "what do you want?" during Phase I teaches the child to wait for a verbal cue rather than initiate on their own. Phase I should be silent from the communication partner.

Skipping the physical prompter in Phase I Phase I requires two adults. Running it alone means you end up verbally or gesturally prompting the child instead of using the behind-the-child physical prompt. One adult trying to manage both roles almost always introduces the wrong kind of help.

Using cards for low-preference items If the child doesn't really want the item, they won't work for it. Motivation is not optional. A card for "apple" means nothing if the child would rather have bubbles.

Not fading prompts Keeping physical prompts too long creates prompt dependence. The child learns to wait for the prompt rather than initiate independently. Systematic prompt fading schedules are part of the protocol for a reason.

Treating the book as a static display The communication book should go everywhere the child goes. If it lives on a shelf in the therapy room, the child learns that communication only happens there.

Inconsistent responding from partners Every adult in the child's world needs to respond to a card exchange the same way: immediately, warmly, with the actual item. Inconsistent or delayed responses weaken what the exchange is worth.

If you are running home sessions and progress has stalled, an honest conversation with your child's SLP about implementation fidelity beats adding new cards or jumping to the next phase early.

How do you know if PECS is working?

Progress in PECS is measurable, which is one of the things that makes it useful for tracking and adjusting. You should not have to guess whether it is working.

Signs of progress within a phase:

• Increasing independence (fewer physical prompts needed)
• Shorter delay between seeing the desired item and initiating the exchange
• Generalization to new partners and new settings
• Generalization to new vocabulary items not specifically trained

Signs that something may be off:

• The child only initiates with one specific adult
• The child grabs for items without using cards after weeks of Phase I practice
• No new spontaneous vocalizations over months of practice
• Consistent refusal to engage with the book

Formal progress monitoring should happen at every therapy session. ASHA guidelines recommend that SLPs document measurable communication goals and track data against those goals ^[3]. If you are not seeing data sheets or progress summaries from your child's therapist, ask for them.

For parents tracking at home, a simple frequency count works: how many times did the child independently initiate a card exchange today without any prompt from an adult? If that number is not growing over two to three weeks of consistent practice, something in the implementation needs to change.

Some families find that a daily communication log shared with the SLP between sessions catches problems faster. Smartphone apps that let parents log communication attempts in real time have gotten more practical in recent years. The Little Words app, for example, is built to support speech practice at home with guidance calibrated to your child's current communication level, which can sit alongside formal PECS sessions run by an SLP.

If you have not yet had a formal speech evaluation, that is the right starting point. Find out what speech therapy for kids looks like at your child's developmental level before committing to any single approach.

What happens after PECS: transitioning to a speech-generating device or verbal speech

PECS is not necessarily a permanent system. For many children, it is the bridge to either verbal speech or to a high-tech AAC device, and planning for that transition is part of a well-designed communication program.

Transitioning to verbal speech: As children begin producing consistent vocalizations alongside card exchanges, SLPs typically introduce expectant pausing. They complete the exchange, then wait a beat after giving the item to see if the child attempts the word. Over time, the card exchange is required less as the spoken word becomes reliable. This transition usually happens naturally in Phase IV and V, and good SLPs plan for it from the start.

Transitioning to SGDs: Many children who complete PECS through Phase VI are good candidates for a speech-generating device. They already understand requesting, commenting, and building sentences. They just need to transfer that knowledge to a different output format. The PECS binder and the SGD are often used in parallel during the transition period, phasing out the physical cards as device use becomes fluent.

Medicare and Medicaid classify SGDs as durable medical equipment, and CMS has specific coverage criteria requiring documented functional communication need and evaluation by an SLP ^[9]. Private insurance follows varying standards. An SLP can write a funding letter documenting why a specific device is medically necessary for your child.

For more detail on device options after PECS, see our overview of alternative augmentative communication devices for autism.

Adults who use AAC, including PECS-derived systems, have different goals and a different evidence base than children. Speech therapy for adults with autism or acquired communication differences has its own specialized literature worth reviewing if your child is transitioning to adult services.

Frequently asked questions

At what age should a child start PECS?

PECS has been used successfully with children as young as 18 months. The AAP recommends referral for speech evaluation any time a child under 2 has fewer than 10 words or lacks pointing and joint attention. Earlier starts are associated with better speech outcomes on average, but children who begin PECS at older ages still make meaningful communication gains. There is no upper age limit.

Can PECS be used for children who are not autistic?

Yes. PECS was developed for autism but has worked well with children who have Down syndrome, apraxia of speech, cerebral palsy, and other conditions that affect expressive language more than receptive language. The core requirement is that the child understands cause and effect and has at least some social awareness of communication partners. An SLP can tell you whether the profile fits.

Does my child need an autism diagnosis to access PECS therapy?

No diagnosis is required to use PECS as a communication approach. A diagnosis may affect insurance reimbursement and access to school-based services, though. Under IDEA Part C (children under 3), services are based on developmental delay, not a specific diagnosis. Under IDEA Part B (ages 3 to 21), an IEP team decides eligibility based on educational need.

How many PECS sessions per week does a child need to make progress?

Research suggests that 20 to 30 exchange opportunities per day produce faster progress than massed weekly sessions. Those can be spread across snack, play, and routine activities at home. Formal therapy sessions with an SLP typically run one to three times per week, but parent-implemented daily practice drives the bulk of learning. Frequency matters more than session length.

Can a parent run PECS at home without a therapist?

Parents can run daily practice, but should not start without at least one consultation with a PECS-trained SLP. Implementation fidelity, especially avoiding verbal prompts in Phase I and fading physical prompts correctly, strongly affects outcomes. One study found teacher training quality was a significant moderator of results. A brief training session with a therapist prevents the most common errors.

What is the difference between PECS and other picture card systems?

The defining feature of PECS is the physical exchange: the child must hand the card to a partner. Other systems, like visual schedules or pointing boards, do not require this social initiation. PECS also follows a specific six-phase protocol with defined mastery criteria and systematic prompt fading. Generic picture cards used without the protocol structure are not PECS.

Will using PECS prevent my child from learning to talk?

No. Multiple studies, including a 2010 systematic review in the American Journal of Speech-Language Pathology, found that PECS was associated with increases in speech production and did not suppress vocalization. ASHA's official position is that AAC does not hinder speech development. PECS often co-occurs with more vocalizations, likely because it establishes the communicative intent that speech requires.

How much does PECS therapy cost without insurance?

Out-of-pocket speech therapy sessions in the US run $100 to $300 per hour depending on geography. A starter PECS materials kit costs $150 to $250 from Pyramid Educational Consultants, or under $30 to make yourself. For children under 3, IDEA Part C provides free early intervention. School-age children may receive PECS-based speech services through a school IEP at no family cost.

What pictures should I start with in PECS Phase I?

Start with three to five items your child consistently reaches for, stares at, or cries about losing. Common first cards include a favorite snack, a preferred toy, bubbles, a beloved video, or a comfort object. Motivation is the entire engine of Phase I. Real photographs of the actual items in your home often work better than generic clip art for young children just starting out.

Is PECS the same as an AAC device?

No, though they overlap. PECS is a specific low-tech protocol using physical picture cards. AAC (augmentative and alternative communication) is the broader category that includes PECS, speech-generating devices, sign language, and other systems. Many children use PECS as a starting point and move to a high-tech SGD later. The two can also be used together during a transition period.

How do I get PECS covered by insurance?

Most plans cover speech therapy sessions regardless of the specific method used. For PECS materials (the communication book and cards), coverage is less common. Medicaid covers AAC evaluations and devices as medically necessary equipment under the EPSDT benefit for children under 21. An SLP can write a letter of medical necessity if a speech-generating device is the next step. Check your state Medicaid plan for specifics.

What is the success rate of PECS for autistic children?

Defining success depends on the goal. Studies consistently show PECS increases functional communication in most participants, often reported in the 70 to 90 percent range. Speech emergence alongside PECS occurs in a meaningful subset, with one 2007 RCT showing measurable spoken word gains in children who started with low-baseline vocalizations. PECS reliably produces some communication gain. It does not reliably produce spoken language in every child.

Can PECS be used in a classroom setting?

Yes, and it should be. Generalization across settings is a core goal of PECS, and school is one of the most important communication environments. Teachers and classroom aides need basic PECS training to respond correctly. Under IDEA, a child's IEP can specify AAC supports, including PECS, as part of the school day. Coordination between the school SLP and family keeps vocabulary and phases consistent.

What should I look for in a PECS-trained speech therapist?

Look for an SLP (M.S. or M.A., CCC-SLP credential through ASHA) who has completed formal PECS Level 1 or Level 2 training through Pyramid Educational Consultants or equivalent. Ask how many children they have run PECS with and whether they use data-based progress monitoring. A good therapist will also train you to run home sessions, more than run sessions while you watch.

Sources

1. Flippin M, Reszka S, Watson LR. Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders. American Journal of Speech-Language Pathology, 2010.: Systematic review of 13 studies found PECS positively associated with speech production and did not suppress vocalization in any included study
2. American Speech-Language-Hearing Association (ASHA), Evidence-Based Practice in Communication Disorders: ASHA lists PECS as an evidence-based practice for autism and states AAC does not hinder speech development
3. American Academy of Pediatrics, Autism Spectrum Disorder clinical guidance: AAP guidelines support AAC approaches for minimally verbal children with autism and recommend early speech evaluation for children under 2 with fewer than 10 words
4. Yoder P, Stone WL. Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 2006.: RCT of 36 toddlers found children with low object exploration showed greater spoken communication gains after PECS versus RPMT; age at start predicted speech outcomes
5. Howlin P, Gordon RK, Pasco G, Wade A, Charman T. The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial. Journal of Child Psychology and Psychiatry, 2007.: RCT of 84 children found PECS training increased spontaneous communication; teacher training quality significantly moderated outcomes; speech gains were modest and variable
6. Tobii Dynavox, AAC device pricing overview: Speech-generating devices range from approximately $1,000 to over $8,000 depending on model and features
7. U.S. Department of Education, IDEA Part C Early Intervention Program: IDEA, 20 U.S.C. § 1432, requires states to provide early intervention services at no cost to families for children under 3 with developmental delays or established risk conditions
8. Centers for Medicare and Medicaid Services (CMS), Medicaid EPSDT benefit: Medicaid EPSDT benefit requires coverage of medically necessary services including AAC devices and evaluations for children under 21
9. National Institute on Deafness and Other Communication Disorders (NIDCD), Autism Spectrum Disorder: Communication Problems in Children: NIDCD documents that many children with ASD are minimally verbal and benefit from AAC approaches including picture-based systems