Autism and the Picture Exchange Communication System

How do you communicate with a person who has no ability to talk or use sign language? Many people with autism communicate using picture cards. Whether cut from magazines, printed out from the Internet, or purchased as a set, picture cards offer autistic individuals the ability to communicate needs, desires, and even ideas without the need for spoken language.

Woman looking at flash cards
Tina Stallard / Getty Images

Since many people on the autism spectrum tend to learn visually, it makes good sense to start communicating with images. Just as important, images are a universal means of communication, and they are just as understandable by strangers or young peers as by parents or therapists.

The Picture Exchange Communication System (PECS)

Within the autism community, the term PECS (usually pronounced "pex") has become synonymous with picture cards of any type. And, just as "Kleenex" has come to mean the same thing as "tissue," PECS has lost much of its brand association. But PECS is actually a trademarked program of Pyramid Educational Products, a small corporation founded in the 1980s by Lori Frost and Andrew Bondy.

Pyramid Products does produce a fair number of picture cards, though they're by no means the largest collection of images available. The company also produces Velcro-lined books designed to hold Velcro-backed pictures; but, again, these are not the most attractive or comprehensive picture card products on the market.

Much more significant to the PECS philosophy is not the specific picture cards or their holders, but rather the process by which nonverbal children (and adults) are taught to use these cards. Over time, claim the makers of PECS (and their claims are backed by experience and research), children who use PECS build independent communication skills. At the same time, apparently as a by-product, many children also gain significant spoken language.

The PECS Approach

If you choose to use PECS (as opposed to just offering picture cards as a tool for communication) you must be trained through Pyramid Products. The company’s training program prepares you to work with a learner through the following six phases:

  • In phase one, the trainer (that's you) works with the learner and their caregivers to figure out what might be most motivating to that individual learner (a ball, toy, food, etc.). Cards have created that picture that motivating item and a pair of trainers helps the learner discover that, by handing over the card, they can get the desired object.
  • In phase two, the trainer moves farther away from the learner, so that the learner must actually come toward the trainer and hand over the card. This is a life skill lesson in seeking and obtaining another person's attention.
  • Phase three requires the learner to discriminate among multiple pictures when requesting an item. For some learners this is easy; for others, it's tougher. Some learners learn best with photos, and others with graphic images that approximate the appearance of an object.
  • Phase four starts learners in the process of building sentences through "sentence strips." Instead of a single picture, they may drop an "I want" starter on the strip to create the sentence: "I want a ball."
  • Phase five challenges learners to build questions using sentence strips, starters, and pictures.
  • In phase six, learners are taught to comment on the world around them by responding to questions such as "What do you hear?" and "What do you see?" They learn to use descriptors ("the big green ball") and more complex pictorial language.

This learning process may take weeks, months, or years to complete. Throughout, learners are encouraged to use PECS in various different settings and with different partners.


Picture-based communication is nearly free. All you need is a magazine full of pictures, a pair of scissors, a loose-leaf notebook and some Velcro. PECS, on the other hand, can be quite pricey: several hundred dollars for the initial training, hundreds more for ongoing consultations, and so forth. Is it worth it?

According to Pyramid Products, the difference between the PECS approach and simple picture-based communication is considerable. Most importantly, the difference lies in providing the learner with the tools to communicate spontaneously and independently. In addition to simply making communication smoother, the process can also:

  • Decrease negative behaviors that were caused by frustrations
  • Increase availability for learning and interaction
  • Increase relatedness and emotional closeness
  • Build spoken language skills (this is not a direct outcome of PECS but seems to occur as PECS skills increase)
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Frost L, Bondy A. A Common Language: Using B.F. Skinner’s Verbal Behavior for Assessment and Treatment of Communication Disabilities in SLP-ABA. The Journal of Speech - Language Pathology and Applied Behavior Analysis. 2006;1, 103-110.

  • Rehfeldt RA, Root SL Establishing derived requesting skills in adults with severe developmental disabilities. Journal of Applied Behavior Analysis. 2005;38, 101-105.

  • Yokoyama K, Naoi N, Yamamoto J. Teaching verbal behavior using the Picture Exchange Communication System (PECS) with children with autistic spectrum disorder. Japanese Journal of Special Education. 2006;43, 485-503.

By Lisa Jo Rudy
Lisa Jo Rudy, MDiv, is a writer, advocate, author, and consultant specializing in the field of autism.