Let's Talk About PECS

I want to dive into a topic I get so many questions about: Picture Exchange Communication System (PECS).

If you’re wondering whether PECS is the best option for your kids, keep reading. I’ve got some thoughts.

PECS is an AAC (Augmentative and Alternative Communication) system, and it’s been around for a while. 

I can’t even tell you how often I get calls from parents saying, “We’re using PECS, but our therapist doesn’t think my child is ready for anything else.” 

And that’s the thing—I feel like PECS is often presented as the only option, when it’s really not.

Before we dive deeper, let's clear something up. PECS is NOT the same as using visuals. 

A lot of professionals may say, “Oh, I use PECS in my sessions,” but really they’re just using visual supports. Visual supports, like symbols in a book, are awesome, but they’re not PECS. 

Let’s not mix those two up.

First things first, let me walk you through what PECS actually is. It’s broken down into six phases:

Phase 1: Hand-over-hand. The child picks up a picture and hands it to an adult to request something. Think: “I want this toy; here’s a picture of it.” You’re teaching the child to make an exchange.

Phase 2: The child has to go to their communication book, get the picture, and then bring it to you.

Phase 3: Here’s where they start learning to choose between a preferred item (like bubbles) and something they don’t want (like a shoe).

Phase 4: Now, we start sentence structure. They build sentences like, “I want bubbles.”

Phase 5: Answering questions! Like, “What do you want?” They pick a picture and respond.

Phase 6: Commenting! This is where we teach kids to say things like “I see a dog” or “I hear a car.”

So, what’s the issue? 

Here are my top reasons why PECS might not be the best fit for neurodiversity-affirming therapy. 

I’m going to break it down because, honestly, there are a few big reasons that PECS might not serve our kids as well as some therapists think it does.

Hand-Over-Hand (Eek!)

This is a biggie. One of the foundational phases of PECS is hand-over-hand prompting, where you’re physically guiding a child’s hand to pick up and hand over a picture. In the world of neurodiversity-affirming practices, hand-over-hand is a big no-no. We’re all about bodily autonomy, and forcing a child to do something with their body? Not great. And yes, some people use hand-under-hand, which is better, but it’s still a key component of PECS that doesn’t align with giving kids control over their own bodies.

It’s Labor-Intensive!

PECS can be A LOT of work. Think about it—every time your kid gets into something new, you have to print a new picture, cut it out, laminate it, and slap some Velcro on it. Compare that to a robust AAC device where you can add a new symbol in seconds. It’s just not practical when you need immediate access to new vocabulary on the fly. Printing, cutting, and Velcro-ing takes time—time we often don’t have in the middle of a session (or at home!).

PECS Isn’t a Long-Term Solution

A lot of therapists tell parents, “We’ll use PECS until your child is ready for a device.” But here’s the truth: there are NO prerequisites for AAC devices! We have kids in my clinic who are two years old and already using AAC on iPads. PECS doesn’t have to be a stepping stone. Devices are ready whenever your child is ready. Period.

It’s All About Requests

PECS heavily focuses on requesting, and while asking for things is important, language is so much more than just making requests! Imagine if you could only communicate by asking for things: “I want this. I want that.” Boring, right? Language is about connection—about sharing, commenting, expressing thoughts and feelings. PECS often stalls kids at the request phase, and they don’t move beyond that.

It Doesn’t Support Gestalt Language Processors

If you’re working with a Gestalt language processor, PECS is definitely not ideal. PECS focuses on single words (think: “I want”), but our Gestalt language processors thrive on phrases. Plus, if we focus too much on single-word requests, these kids can get stuck on those words and struggle to move on to longer phrases and sentences.

So, what should you do?

Look, I get it—PECS was created with good intentions. And I’ve used it myself back in the day before I knew better. But now that we have more dynamic, neurodiversity-affirming AAC options, I just don’t see PECS as the go-to choice anymore. 

Our kids deserve communication systems that respect their autonomy, offer flexibility, and support the way they naturally learn language.

The key takeaway? PECS is not the only AAC option. There are so many robust, dynamic AAC systems out there that can grow with your child and meet their individual needs. 

Let’s move past the outdated idea that PECS is a stepping stone and give our kids the tools they need right now.

And if you want to hear more about why I don’t recommend PECS, check out this episode of our live show: Let's Talk About PECS, Making the Shift for Autistic Kids, Ep. 84