PECS Related Research
Adkins, T. & Axelrod, S. (2002). Topography‐versus selection‐based responding: Comparison ofmand acquisition in each modality. The Behavior Analyst Today, 2, 259‐266.
Abstract: This study examined the acquisition of a mand repertoire by one child with pervasive
developmental disorder and ADHD. The subject was taught to request preferred items using
American Sign Language (a topography-based response form) and the Picture Exchange
Communication System (a selection‐based form). There were four types of sessions: (1) training
session for PECS, (2) training session for sign language, (3) test for generalization of the PECS
words, and (4) test for generalization for the sign words. The number of trials to meet criterion
and the occurrence of spontaneous emissions of the taught words was recorded. Also, thesame word was taught for five days in both the PECS and the sign session and the results wererecorded. It was found that the selection‐based verbal response technique (PECS) was more
effective in all areas. This finding contradicts the results of previous studies, suggesting thatfurther research is needed. (http://www.behavior‐analyst‐online.org)
Agius, M. & Vance, M. (2015). A comparison of PECS and iPad to teach requesting to preschoolers with autistic spectrum disorders. Augmentative and Alternative Communication, Nov
20, 1-11.
Abstract: Few studies have compared the efficacy of the Picture Exchange Communication
System (PECS) and iPads used as speech generating devices (SGDs), and none have targetedpreschoolers. This study compares the relative efficacy of PECS and an iPad/SGD with threepreschool-aged children with autism spectrum disorder and limited functional speech who lived
in Malta. The study utilized an adapted alternating treatment design embedded in a multiple
baseline design, with requesting of reinforcers as the dependent variable. Visual analysis of theresults indicated that all participants required more prompted trials and sessions for the
iPad/SGD condition. All participants learned a three-step navigational sequence on the iPad.
Participant preference probes were inconclusive and were not linked to speed of acquisition ofrequesting skills. Results suggest that both PECS and an iPad could be appropriate for teaching
requesting skills to beginning communicators.
Almeida, M., Piza, M., & LaMonica, D. (2005). Adaptation of the picture exchange
communication system in a school context (original title: Adaptações do sistema decomunicação por troca de figuras no contexto escolar) Pró‐Fono Revista de AtualizaçãoCientífica, Barueri (Spanish), 17, 233‐240.
Abstract: Background: alternative communication. Aim: to evaluate the efficacy of the adapted
PECS and Picture Communication Symbols (PCS) in the communication of a child with cerebral
palsy. Method: the participant of this study was a 9 year and 10 months old girl, with athetoid
quadriplegia. All stages of the adapted Pecs were applied (Walter, 2000), using the PCS pictures(Johnson, 1998), associated with the functional curriculum proposed by LeBlanc (1991). An
experimental AB Design was used in order to test the procedures. Results: the subject was able
to pass through all of the adapted Pecs phases and to use her communication board in school
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activities. Conclusion: the adapted Pecs proved to be effective in improving the subject’s
communication abilities.
Alsayedhassan, B., Banda, D. & Griffin-Shirley, N. (2020). Training parents of children with
autism to implement the picture exchange communication intervention. Clinical Archives ofCommunication Disorders, 5, 31-41.
Abstract: Background: Autism spectrum disorder impacts social communication. Picture
Exchange Communication System is one of the methods to improve communication skills inindividuals with autism. In spite of numerous studies on the effectiveness of Picture Exchange
Communication System, no studies were conducted to examine the perceptions of practitioners
who used the strategy. Method: An online survey was conducted with 120 practitioners (44teachers and 76 therapists; 80.8% 20–49 years old; 80.8% graduate education) who used thePicture Exchange Communication System with children with autism. Using rating scales,
practitioners reported their knowledge of Picture Exchange Communication System and theirperceptions about importance, benefits, and barriers of utilizing Picture Exchange
Communication System.
Results: Practitioners reported they were confident when implementing Picture Exchange
Communication System and considered integrating Picture Exchange Communication System atschool to be important. Also, the practitioners indicated that Picture Exchange Communication
System was easy to use and effective to develop communication skills in children with autism.
However, they found that using Picture Exchange Communication System was time consuming.
Conclusion: It is important to hear the viewpoints of practitioners concerning the use of Picture
Exchange Communication System for individuals with autism spectrum disorder. This study
found Picture Exchange Communication System is a useful strategy but has some barriers
concerning its use. Future research is needed to confirm the current findings with a larger
sample.
Alsayedhassan, B., Lee, J., Banda, D. Kim, K. & Griffin-Shirley, N. (2019): Practitioners’
perceptions of the picture exchange communication system for children with autism.
Journal of Disability and Rehabilitation, 41.https://DOI:10.1080/09638288.2019.1620878.
Abstract: Purpose: We investigated the effects of behavioral skills training package withparents to use picture exchange communication system (PECS) with their children with autism
spectrum disorder (ASD) to develop communication skills. Methods: Two parents and theirchildren with ASD (one child per family) participated in this study. A multiple baseline design
was used during the parents’ training, and a changing criterion design was used during parents’
implementation of PECS with children. Results: Results indicated that both parents
implemented PECS intervention with their children with high procedural integrity and required
minimal feedback through Bug-in-Ear at the end of the intervention. Moreover, both children
acquired independent picture exchanges with their parents who implemented PECS training
and generalized and maintained the skills. Conclusions: The findings suggest that when parents
receive appropriate training and feed-back, they can train their children to use PECS to
independently request desired items or activities. The current study extends existing research
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on PECS by teaching parents as the primary PECS trainers to implement the strategy with theirchildren.
Alzrayer, N. (2020). Transitioning from a low- to high-tech Augmentative and Alternative
Communication (AAC) system: effects on augmented and vocal requesting. Augmentative andAlternative Communication, https://doi.org/10.1080/07434618.2020.1813196.
ABSTRACT: A considerable number of studies have demonstrated that augmentative andalternative communication (AAC) is effective in increasing speech production in some children
with autism spectrum disorder (ASD). Thus, this study aimed to (a) investigate the effects of a
Picture Exchange Communication System (PECS) Phase IV protocol on the acquisition of
spontaneous augmented requests, (b) evaluate the impact of progressive time delay andsynthetic speech output on the development of vocal requests, and (c) determine theparticipants’ preferences for each modality after reaching mastery. A multiple-baseline design
across four children with ASD was used to measure the acquisition of augmented and vocal
requests during the transition from low-tech to high-tech AAC systems. During a natural
condition (i.e., playtime), a modified PECS Phase IV protocol was applied to teach theparticipants to request by producing multisymbol messages (e.g., I WANT þ names of apreferred item) using an iPad as well as vocalizations. After mastery, the participants’
preference for using the modified PECS Phase IV app or the communication book was assessedby comparing the response allocations. The preliminary results suggest that the modified PECS
protocol can be used to transition from a low to high-tech communication modality.
Anderson, A., Moore, D. & Bourne, T. (2007). Functional Communication and Other Concomitant
Behavior Change Following PECS Training: A Case Study. Behaviour Change, 24, 1–8.
Abstract: The Picture Exchange Communication System (PECS) is widely used to teach children
with language delays, including those with autism, functional language. A feature of PECS is thatit incorporates principles deemed by some to be pivotal, leading to broader behaviour change. In
this study, a 6‐year‐old child with autism was taught functional language using PECS. Along withmeasures of language gains, concomitant changes in nontargeted behaviours (play and TV
viewing) following PECS training were observed. Results show increases in manding, initiations
and cumulative word counts, as well as positive changes in the nontargeted behaviours.
Angermeier, A., Schlosser, R., Luiselli, J., Harrington, C., & Carter, B., (2008). Effects of iconicity
on requesting with the Picture Exchange Communication System in children with autism
spectrum disorder. Research in Autism Spectrum Disorders, 2, 430–446.
Abstract: Research on graphic symbol learning suggests that symbols with a greater visual
resemblance to their referents (greater iconicity) are more easily learned. The iconicity
hypothesis has not yet been explored within the intervention protocol of the Picture Exchange
Communication System (PECS). Within the PECS protocol, participants do not point to a symbol
but exchange the symbol for an object. The purpose of this study was to examine whether
children learn to request more readily with PECS when the symbols involved are highly iconic
versus symbols that are low in iconicity. An adapted alternating treatments design combined
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with a multiple baseline design across subjects was used to evaluate the effectiveness andefficiency of symbol learning under two conditions: high iconicity and low iconicity. Four
students with autism or pervasive developmental disorders between the ages of six and nine
years participated. Results indicated that students learned to request desired objects underboth conditions, lending further support for the effectiveness of PECS. There was little to nodifference, however, in the effectiveness and efficiency of requesting between the two
conditions during Phases I and II of PECS training. Thus learners do not benefit from symbols
that bear more resemblance with their referents during the first two phases of PECS
instruction.
Avagyan, A. (2019). Picture Exchange Communication System (PECS) as a connected speech
development tool for children from immigrant families in Armenia The Journal of theInternational Association of Special Education, 19, 37-44.
Abstract: Alternative methods of communication skill development, such as Picture Exchange
Communication System (PECS), are often used in speech therapy. PECS has been widely used
for communication development in children with autism and has proven its efficacy in a large
number of studies. PECS is used with people displaying a variety of communication disorders. A
review of the literature over the past decade revealed little systematic activity to document or
improve PECS intervention services for bilingual children. This study evaluates the effects of
PECS intervention with bilingual children from immigrant families in Armenia. PECS could serveas an alternative tool to improve connected speech in bilingual children from immigrantfamilies, thus enhancing their socialization. The study was conducted with nine Armenian
children for whom Arabic or Russian was a native language, and Armenian was a second
language. These children did not have a good command of the Armenian
Barbosa, R., de Oliveira, A., de Lima Antão, J., Crocetta, T., Guarnieri, R., Antunes, T., Arab, C.,
Massetti, T., Bezerra, I., de Mello Monteiro, C. & de Abreu, L. (2018). Augmentative andalternative communication in children with Down’s syndrome: a systematic review. BMC
Pediatrics, 11, doi: 10.1186/s12887-018-1144-5.
Abstract: Background: The use of technology to assist in the communication, socialization,
language, and motor skills of children with Down’s syndrome (DS) is required. The aim of thisstudy was to analyse research findings regarding the different instruments of ‘augmentative
and alternative communication’ used in children with Down’s syndrome. Methods: This is asystematic review of published articles available on PubMed, Web of Science, PsycInfo, and BVS
using the following descriptors: assistive technology AND syndrome, assistive technology AND
down syndrome, down syndrome AND augmentative and alternative communication. Studies
published in English were selected if they met the following inclusion criteria: (1) study ofchildren with a diagnosis of DS, and (2) assistive technology and/or augmentative andalternative communication analysis in this population. Results: A total of 1087 articles wereidentified. Thirteen articles met the inclusion criteria. The instruments most used by the studies
were speech-generating devices (SGDs) and the Picture Exchange Communication System(PECS). Conclusion: Twelve instruments that provided significant aid to the process of
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communication and socialization of children with DS were identified. These instruments
increase the interaction between individuals among this population and their peers,
contributing to their quality of life and self-esteem.
Barlow, K., Tiger, J., Slocum, S. & Miller, S. (2013). Comparing acquisition of exchange‐based
and signed mands with children with autism. The Analysis of Verbal Behavior, 29, 59-69.
Abstract: Therapists and educators frequently teach alternative‐communication systems, suchas picture exchanges or manual signs, to individuals with developmental disabilities who
present with expressive language deficits. Michael (1985) recommended a taxonomy foralternative communication systems that differentiated between selection‐based systems inwhich each response is topographically identical (e.g., card selection and exchange systems)
and topography‐based systems in which each response is topographically distinct (e.g., signed
language). We compared the efficiency of training picture exchanges and signs with 3
participants who presented with severe language deficits; all participants acquired the picture‐exchange responses more readily.
Barnes, C., Dunning, J. & Rehfeldt, R.A. (2011). An evaluation of strategies for training staff toimplement the picture exchange communication system. Research in Autism Spectrum
Disorders, 5, 1574–1583.
Abstract: The picture exchange communication system (PECS) is a functional communication
system frequently used with individuals diagnosed with autism spectrum disorders who
experience severe language delays (Frost & Bondy, 2002). Few empirical investigations haveevaluated strategies for training direct care staff how to effectively implement PECS withclients. Using a multiple probe design, the current investigation evaluated staff training
procedures for teaching three direct care staff to implement phases 1–3 of PECS for 3 adults
with autism. Training with verbal instructions and an instructional video resulted in little
improvement from pretest scores, underscoring the limited utility of workshops andinstructional videos alone in teaching paraprofessional staff important clinical skills.
Battaglia, D. & McDonald, M. (2015). Effects of the Picture Exchange Communication System(PECS) on maladaptive behavior in children with Autism Spectrum Disorders (ASD): A Review of
the Literature. Journal of the American Academy of Special Education Professionals, Winter, 8-20.
Abstract: This paper provides an overview of the literature investigating the functional
relationship between the use of the Picture Exchange Communication System (PECS) andmaladaptive behavior (i.e., aggression, tantrums) in individuals with autism spectrum disorders(ASD). Digital searches were conducted to identify single subject design studies publishedbetween 1994 and 2012. While nine studies were identified, only three explicitly addressed thecollateral effects of PECS training on reduction of maladaptive behavior. Of the seven participants
across these three studies, four demonstrated an inverse relationship between PECS exchange
and reduction of maladaptive behavior. Results are promising in terms of functional
communication. However, the authors suggest caution due to limited number of publications to
date.
5PECS Related Research (Updated: October 2020)

Bazain, D. & Bari, S. (2017). Communicating by using PECS for Children with Rubinstein-Taybi
Syndrome. Journal of Research and Development of Extraordinary Education, 4, 29-31.
(Malaysia)
Abstract: This study discusses communication aid using the Picture Exchange Communication
System (PECS) to children with Rubinstein Taybi Syndrome (RTS). RTS’s children suffer mental
retardation, have the – the autistic, can not speak and can not manage themselves well. The
aim of this study was to determine the effectiveness of using PECS and RTS students canimprove their language to communicate better to all. Based on the theory of constructivism
introduced by Gagne that emphasizes learning system must start from the simple to thecomplex. The study design is a case study of a child suffering from Rubinstein-Taybi syndrome.
In conclusion, the PECS implemented is expected can help children’s RTS and improve theiracademic performance.
Beck, A., Stoner, J., & Bock, S. (2008) Comparison of PECS and the use of a VOCA: A Replication.
Education and Training in Developmental Disabilities, 43 (2), 198‐216.
Abstract: This study compares use of the Picture Exchange Communication System (PECS) and a
Voice Output Communication Aide (VOCA) with four preschool children who were either
nonspeaking or limited in their ability to speak and did not use an AAC system to communicate
functionally. An alternating treatment single subject design was used to measure participants’
preferences for each system and the verbalizations of the participants during system use.
Results indicated that participants learned PECS in a relatively short time period, preferences
for one mode of communication are not predictable, and the influence of the communication
systems on each participant’s verbalizations varied.
Bock, S.J., Stoner, J. B., Beck, A. R., Hanley, L., & Prochnow, J. (2005). Increasing functional
communication in non‐speaking preschool children: Comparison of PECS and VOCA.
Education and Training in Developmental Disabilities, 40(3), 264‐278.
Abstract: Education and Training in Developmental Disabilities, 40(3), 264‐278.o have complex
communication needs and for the interventionists who work with them, the collection of
empirically derived data that support the use of an intervention approach is critical. The
purposes of this study were to continue building an empirically derived base of support for, andto compare the relative effectiveness of two communication intervention strategies (i.e., PECS
and the use of VOCA) with preschool children who have complex communication needs.
Specific research questions were (a) Which communication strategy, PECS or VOCA, results in amore rapid rate of acquisition of requesting skills for preschool children?, and (b) To what
extent do communication behaviors utilizing PECS and VOCA generalize from a pull‐out setting
to the classroom setting? Results are discussed and clinical implications given.
Boesch, M., Wendt, O., Subramanian, A. & Hsu, N. (2013). Comparative efficacy of the Picture
Exchange Communication System (PECS) versus a speech‐generating device: Effects onrequesting. Research in Autism Spectrum Disorders, 7, 480‐493.
Abstract: An experimental, single‐subject research study investigated the comparative efficacy
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of the Picture Exchange Communication System (PECS) versus a speech‐generating device (SGD)
in developing requesting skills for three elementary‐age children with severe autism and little
to no functional speech. Results demonstrated increases in requesting behavior for allparticipants across intervention phases with both augmentative and alternative communication(AAC) intervention strategies; however, difficulties were observed with picture discrimination.
The Wilcoxon signed pair test did not reveal significant differences between PECS and the SGD
for any participant. Findings suggest PECS and SGD are equally appropriate for developing initial
requesting skills. Based on the current findings, successful implementation of either AAC
strategy is achievable when appropriate instructional strategies are used.
Bondy, A. & Battaglini, K. (2006). Application of the Pyramid Approach to Education Model in a
Public-School Setting. In J. Handleman & S. Harris (Ed.) School‐age education programs forchildren with autism (pp. 163‐193). Austin: TX. Pro‐Ed Inc.
Bondy, A. & Battaglini, K. (2007). Application of the Pyramid Approach to Education Model in a
Preschool School Setting. In J. Handleman & S. Harris (Ed.) Pre‐school education programs forchildren with autism 3rd Edition). (pp. 283‐308). Austin: TX. Pro‐Ed Inc.
Bondy, A. & Frost, L. (1998). The picture exchange communication system. Seminars in Speechand Language, 19, 373–389.
Abstract: The Picture Exchange Communication System (PECS) was developed as a means toteach children with autism and related developmental disabilities a rapidly acquired, self‐
initiating, functional communication system. Its theoretical roots combine principles fromapplied behavior analysis and guidelines established within the field of alternative andaugmentative communication. This approach has several potential advantages relative toimitation‐based strategies (both vocal and gestural) and symbol selection strategies. The
system begins with the exchange of simple icons but rapidly builds “sentence” structure. The
system also emphasizes developing the request function prior to developing responding tosimple questions and commenting. The development of requesting with a sentence structure
also permits the rapid development of attributes more traditionally taught within a receptive
mode. The relationship between the introduction of PECS and various other behavioral issues(i.e., social approach and behavior management) as well as its relationship to the codevelopment of speech are reviewed.
Bondy, A. & Frost, L. (2001). The Picture Exchange Communication System. Behavior
Modification, 25, 725‐744.
Abstract: The Picture Exchange Communication System (PECS) is an alternative/augmentative
communication system that was developed to teach functional communication to children withlimited speech. The approach is unique in that it teaches children to initiate communicativeinteractions within a social framework. This article describes the advantages to implementing
PECS over traditional approaches. The PECS training protocol is described wherein children aretaught to exchange a single picture for a desired item and eventually to construct picture‐based
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sentences and use a variety of attributes in their requests. The relationship of PECS’s
implementation to the development of speech in previously non‐vocal students is reviewed.
(http://www.sagepub.com)
Bondy, A. & Frost, L. (2003). Communication strategies for visual learners.
In O.I. Lovaas (Ed.). Teaching Individuals with Developmental Disabilities: Basic Intervention
Techniques (pp. 291‐303). Austin, TX: Pro‐Ed. [Book chapter].
Bondy, A. & Frost, L. (2008). Autism 24/7: A Family Guide to Learning at Home and in theCommunity. Baltimore, MD: Woodbine House.
Bondy, A. & Frost, L. (2009). Generalization Issues Pertaining to the Picture Exchange
Communication System (PECS). In C. Whalen (Ed.) Real Life, Real Progress for Children with
Autism Spectrum Disorders: Strategies for Successful Generalization in Natural Environments.
Baltimore, MD: Paul Brookes Publishing Company.
Bondy, A. & Frost, L. (2009). The Picture Exchange Communication System: Clinical andResearch Applications. In P. Mirenda & T. Iacono (Eds.) Autism Spectrum Disorders and AAC.
Baltimore, MD: Paul Brookes Publishing Company. Pp. 279‐302.
Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today, 2, 127– 132.
Abstract: The Picture Exchange Communication System (PECS) is an augmentative/alternative
communication strategy for those who display little or no speech. The rationale for PECS and its
training sequence is described. Each phase of training is associated with specific behavior
analytic teaching strategies. Skinner’s analysis of Verbal Behavior forms the basis for teachingparticular skills at specific points in the training sequence and also provide guidelines for how
best to design the teaching strategies. Common problems and potential solutions are offeredfor various levels of training. The relationship between PECS and the co‐development ofspeech, as well as its impact upon other behaviors (e.g., behavior management concerns, social
orientation, etc.) is briefly reviewed.
Bondy, A. (2012). The unusual suspects: Myths and misconceptions associated with PECS.
The Psychological Record, 62, 789‐816.
Abstract: The Picture Exchange Communication System (PECS) is an alternative/augmentative
communication protocol designed to help children and adults with autism and related
disabilities to engage in functional communication. The protocol was developed over a numberof years and was based on Skinner’s analysis of verbal behavior. Publications about theapplication and effectiveness of PECS have grown steadily. However, there also are many
misconceptions about the protocol and its implementation. This paper reviews some of theresearch associated with PECS, describes several myths and misconceptions, and attempts toclarify many of the issues raised.
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Bondy, A. (2019). Issues related to AAC and SGD use by adolescents and adults with Autism
Spectrum Disorder. Advances in Neurodevelopmental Disorders, 3, 351-362.
Abstract: The use of technology, especially speech-generating devices (SGDs), has generated agreat deal of attention. In order to assess the quality and effectiveness of such strategies, many
issues related to terminology and teaching require careful attention. The first section begins
with a discussion about functional communication, including long-term goals, from a behavioral
perspective. Key issues will include speaker vs. listener distinctions, functional units, and factors
related to expanding communication repertoires. The next section reviews SGDs, their
popularity, and concerns such as distinguishing between toy use vs. communication device andthe role of the audio output. Next, factors related to demonstrations that a user knows themeaning of words in different modalities will be considered. There follows a look at someresearch examples related to both SGD and picture use by adolescents and adults with ASD
regarding functional communication. This section includes examples of studies that appear tohave overestimated functional outcomes as well as noting the overall paucity of researchdemonstrating a robust gain in repertoire size and complexity. Lastly, suggestions are offeredassociated with determining how clinicians can assure that efforts to teach functional
communication to individual teenagers and adults will result in effective outcomes.
Bondy, A., & Frost, L. (1993). Mands across the water: A report on the application of thepicture exchange communication system in Peru. The Behavior Analyst, 16, 123–128.
Abstract: This report describes the introduction of the Picture‐Exchange Communication
System (PECS) to the Ann Sullivan Center, a program for developmentally disabled children andadults in Lima, Peru. PECS was developed in the Delaware Autistic Program, a public school
program in the United States with a strong behavior‐analytic orientation for children with
autism. We will briefly describe PECS, its advantages with people with language disabilities, andour efforts to work with the staff of the Ann Sullivan Center to implement the system.
(http://www.abainternational.org)
Bondy, A., & Frost, L. (1994). The picture exchange communication system. Focus on Autistic
Behavior, 9, 1–19.
Abstract: A variety of strategies have been used to help children with autism acquire functional
communication skills. The Picture Exchange Communication System (PECS) is a uniquecommunication training program that was developed as a means of circumventing someshortcomings associated with these strategies. A description of the steps within PECS isprovided. Long‐term group data have indicated that a large proportion of children started on
PECS as preschoolers acquire speech. Individual and group data supporting the use of PECS areprovided. (http://www.proedinc.com)
Bondy, A., & Frost, L. A. (1993). Mands across the water: A report on the application of thepicture exchange communication system in Peru. The Behavior Analyst, 16, 123–128.
Abstract: This report describes the introduction of the Picture‐Exchange Communication
System (PECS) to the Ann Sullivan Center, a program for developmentally disabled children and
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adults in Lima, Peru. PECS was developed in the Delaware Autistic Program, a public school
program in the United States with a strong behavior‐analytic orientation for children with
autism. We will briefly describe PECS, its advantages with people with language disabilities, andour efforts to work with the staff of the Ann Sullivan Center to implement the system.
(http://www.abainternational.org)
Bondy, A., Esch, B., Esch, J. & Sundberg, M. (2010). Questions on Verbal Behavior and its
application to individuals with autism: An interview with the experts. The Behavior Analyst
Today, 11, 186‐205.
Abstract: A note about the interviews from the editors: The use of Skinner’s Verbal Behavior(VB) classification system has been increasingly applied to learners with autism. We asked
several of the best known behavior analysts to answer some key questions regarding thispractice, the state of research regarding the advantages of this approach, and the confusionthat exists regarding the application of VB to this population of learners. We structured the
responses to follow each question separately, indicating the responder in each case. At the endof the interviews, you will find relevant references from each responder.
(http://www.baojournal.com/BAT%20Journal/VOL‐11/BAT%2011‐3.pdf)
Bondy, A., Horton, C. & Frost, L. (2020). Promoting functional communication within the home.
Behavior Analysis in Practice https://doi.org/10.1007/s40617-020-00439-6
Abstract: Functional communication skills are essential for all learners and must be promoted
within all environments, including the home. During this time of home confinement, manyfamilies will need to look at opportunities for their children to use existing functional
communication skills or even to acquire new skills. This article describes a set of 9 criticalcommunication skills and provides a variety of examples of how families can improve the use of
these important skills. Some of these involve speaker (expressive) skills, whereas others involve
listener (receptive) skills.
Bondy, A., Tincani, M. & Frost, L. (2004). Multiply controlled verbal operants: An analysis andextension to the Picture Exchange Communication System. The Behavior Analyst, 27,247‐261.
Abstract: This paper presents Skinner’s (1957) analysis of verbal behavior as a framework forunderstanding language acquisition in children with autism. We describe Skinner’s analysis ofpure and impure verbal operants and illustrate how this analysis may be applied to designingcommunication training programs. The Picture Exchange Communication System (PECS) is a
training program influenced by Skinner’s framework. We describe the training sequence
associated with PECS and illustrate how this sequence may establish multiply controlled verbal
behavior in children with autism. We conclude with an examination of how Skinner’sframework may apply to other communication modalities and training strategies.
(http://www.abainternational.org)

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Bridge, D. & Carter, S. (2007). A personal account of using the Picture Exchange
Communication System (PECS) with a child with autism. In J. Sigafoos & V. Green (Eds.)
Teaching and Technology, pp. 183‐193. Nova Science Publishers, Tasmania.
Abstract: This chapter describes the use of the Picture Exchange Communication System(PECSTM) (Frost & Bondy, 2002) with a child with autism. It explains the PECS system and offerssome examples of how this communication technology was used with the child (Thomas), his
parents and teachers in his early learning at home and in his classroom. Through this case someof the strengths of this technology are identified, and Thomas’ experiences are linked toresearch in the area. Some issues related to using such a program are considered.
Busch, L., Koudys, J. (2017). Evidence-based practices for individuals with autism spectrum
disorder: Recommendations for caregivers, practitioners, and policy makers. Resource
document. Ontario Association for Behavior Analysis. https://www.ontaba.org/pdf/ONTABAOSETT-ASD REPORT WEB.pdf
Cagliani, R., Ayres, K., Whiteside, E. & Ringdahl, J. (2017). Picture Exchange Communication
System and Delay to Reinforcement. Journal of Developmental and Physical Disabilities, 29,925-939.
Abstract: Picture Exchange Communication Systems (PECS) is a form of augmentative andalternative communication (AAC) frequently used by individuals with autism spectrum disorderand intellectual disability when speech development is delayed or does not develop (Bondy andFrost 1994 in Focus on Autism and Other Developmental Disabilities, 9, 1–19; Sunberg andPartington 1998). Researchers have previously evaluated variations of PECS as a means for
vocalization development (Ganz and Simpson 2004 in Journal of Autism and Developmental
Disorders, 34, 395–409; Tincani et al. 2006 in Education and Training in Developmental
Disabilities, 41, 177–184). The current study investigated delay to reinforcement and anincrease in response effort when utilizing PECS on the development of intelligible word
vocalizations with four elementary aged students. Three participants transitioned fromprimarily requesting using PECS at Phase IIIb to using independent vocalizations (i.e., spoken
words). This research provides further evidence for the use of PECS not only as a tool for
functional communication, but also as a resource for assisting individuals in the development of
vocalizations with slight variations in the parameters of reinforcement including response effort
and delay of reinforcement.
Campos de Jesus, J., Oliveria, T. & Vieira de Rezende, J. (2017). Generalization of Mands
Learned by PECS (Picture Exchange Communication System) in Children with Autism. Trends in
Psychology / Temas em, 25, 531-543. (Brazil)
Abstract: Verbal training with the use of alternative communication is a tool for improving thesocial interaction of children with Autism Spectrum Disorder (TEA). The aim of this study was topromote generalization of trained mands through the Picture Exchange Communication System(PECS). Trained mands comprise the exchange of pictures with visual stimuli by the items
themselves. There were 4 autists aged between 6 and 12 years old, who took part in the study.
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After the PECS training, the teacher and the mothers were instructed to take notes of themands performed in school and home settings. Results have shown that 3 children met thelearning criterion for PECS and that there was a generalization for other settings. The need for
greater control of the variables that interfere with mand acquisitions and the children planningfor generalization of environment, people and different items have been discussed.
Cannella‐Malone, H., Fant, J., & Tullis, C. (2010). Using the Picture Exchange Communication
System to Increase the Social Communication of Two Individuals with Severe Developmental
Disabilities. Journal of Developmental and Physical Disabilities, 22, 149‐163.
Abstract: The purpose of this study was to examine the effectiveness of the PECS with Peers
protocol developed by Garfinkle and Schwartz (1994), which uses The Picture Exchange
Communication System (PECS) as a means of increasing social communication between
individuals with disabilities and their peers. Two females with severe communication delays anddevelopmental disabilities served as participants and one male with developmental disabilities
and one female without disabilities acted as their peers. A multiple baseline across behaviors(i.e., greetings, requests, and responses) design was used to assess the effectiveness of PECS on
social communication as well as to examine whether using PECS led to increases in theparticipants’ verbal communication. Both participants increased their social interactions using
PECS with their peer and also demonstrated a general preference for verbal communication.
Social validity questionnaires indicated that teachers and parents found the social
communication skills to be important and that this intervention was helpful.
Carr, D. & Felce, J. (2006). Increase in production of spoken words in some children with autism
after PECS teaching to Phase III. Journal of Autism and Developmental Disabilities, 37. 780‐787.
Abstract: The context for this work was an evaluation study (Carr & Felce, under review) of theearly phases of the Picture Exchange Communication System [PECS] (Frost & Bondy, 1994;
2002). This paper reports that 5 of 24 children who received 15 hours of PECS teaching towards
Phase III over a period of 4‐5 weeks, showed concomitant increases in speech production,either in initiating communication with staff or in responding, or both. No children in the PECS
group demonstrated a decrease in spoken words after receiving PECS teaching. In the control
group, only 1 of 17 children demonstrated a minimal increase and 4 of 17 children
demonstrated a decrease in use of spoken words after a similar period without PECS teaching.
Carr, D. & Felce, J. (2007). The effects PECS teaching to Phase III on the communicativeinteractions between children with autism and their teachers. Journal of Autism andDevelopmental Disabilities, 37, 724‐737.
Abstract: The study investigated the impact of mastery of the Picture Exchange Communication
System (PECS) to Phase III, on the communications of children with autism. Children aged
between 3 and 7 years, formed a PECS intervention group and a non‐intervention control
group. The intervention group received 15 h of PECS teaching over 5 weeks. Three 2‐hclassroom observations recorded communications between the children and their teachers.
These occurred: 6 weeks before teaching; during the week immediately prior to teaching;
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during the week immediately following teaching. For the control group, two 2‐h observations
were separated by a 5‐week interval without PECS teaching. Communicative initiations anddyadic interactions increased significantly between the children and teachers in the PECS groupbut not for the control group.
Carre A., Le Grice, B., Blampied, N., & Walker, D. (2009). Picture Exchange Communication(PECS) Training for young children: Does training transfer to school and to home? Behaviour
Change, 26, 54‐65.
Abstract: The limited communicative abilities of young children with autism and developmental
disabilities may be enhanced by augmentative communication systems such as the Picture
Exchange Communication System (PECS). Both children and adults can learn to use PECS, but
research is inconsistent in establishing the degree to which PECS training transfers reliably fromthe training setting to other settings, for example, regular classrooms, and home. Three 5–6year‐old children, diagnosed as autistic and/or developmentally disabled, were given 1:1 PECS
training at school, structured to enhance generalisation and transfer. Concurrent observations
were made in their regular classroom and at home to probe the extent of generalisation. All
three acquired the ability to request a preferred object or activity by exchanging a picture
symbol with a communicative partner. In tests of transfer and generalisation, a multiple‐
baseline across subjects design showed no use of PECS symbols either in the classroom or athome prior to training, with spontaneous initiations of picture exchange (transfer) occurring toa slight to moderate degree in the classroom and to a slight degree at home. Even with PECS
training structured to enhance transfer, functionally significant degrees of generalisation oftraining may be difficult to achieve and cannot be assumed to occur.
Carson, L., Moosa, T., Theruer, J. & Cardy, J.O. (2012). The Collateral Effects of PECS Trainingon Speech Development in Children with Autism. Canadian Journal of Speech‐Language
Pathology and Audiology, 36, 182‐195.
Abstract: Research suggests that 25 to 61% of children with autism will use little or nofunctional speech to communicate. For these children, many speech‐language pathologists willteach the use of the Picture Exchange Communication System (PECS). Studies have reported
some children go on to develop functional speech after using PECS. What remains unclear is (i)which children will begin to use functional verbal abilities, and (ii) why this occurs for some andnot others. The purposes of this study were to: (a) measure changes in speech production inchildren with autism after PECS use, and (b) explore whether these changes could be related tochildren’s pre‐intervention characteristics, including adaptive functioning, symbolic
representation, motor imitation and receptive and expressive language skills. Three malechildren with autism spectrum disorder aged 2–3 years participated in this study, which
followed a single‐subject, changing‐criterion design. At study outset, speech skills and pre‐intervention characteristics were assessed. Parents were then trained to use PECS with theirchild during weekly clinic and home visits across a five‐month period. Speech production data
were collected during monthly probes and at post‐intervention, then analyzed and compared topre‐intervention characteristics. Results showed changes to speech occurred for Participants 1
13
PECS Related Research (Updated: October 2020)and 3. Comparison of pre‐intervention characteristics revealed imitation as the only skill areathat was different between children, with Participant 3 demonstrating higher motor and verbal
imitation scores. These preliminary results suggest that stronger imitation skills may increase
the likelihood that a child with autism will develop functional speech after PECS use.
Chaabane, D.Ben , Alber‐Morgan, S., & DeBar, R. (2009). The effects of parent‐implemented
PECS training on improvisation of mands by children with autism. Journal of Applied Behavior
Analysis, 42, 671‐677.
Abstract: The present study examined the extent to which mothers were able to train theirchildren, 2 boys with autism, to exchange novel pictures to request items using the picture
exchange communication system (PECS). Generalization probes assessing each child’s ability tomand for untrained items were conducted throughout conditions. Using a multiple baseline
design, results demonstrated that both children improvised by using alternative symbols when
the corresponding symbol was unavailable across all symbol categories (colors, shapes, andfunctions) and that parents can teach their children to use novel pictorial response forms.
Chambers, M. & Rehfeldt, R. (2003). Assessing the acquisition and generalization of two mand
forms with adults with severe developmental disabilities. Research in Developmental
Disabilities, 24, 265‐280.
Abstract: The purpose of this study was to determine whether manual sign or the Picture
Exchange Communication System (P.E.C.S.) (Frost and Bondy, 1994) would be more effective inteaching mand skills to adults with mental retardation in the severe and profound range. Fourparticipants were taught to mand for four reinforcing items using both communication
modalities, in an alternating treatments design. Three of four participants demonstrated
criterion performance across all four mands using P.E.C.S. first. Two of those three participants
later demonstrated criterion performance for the mands using manual sign. The fourthparticipant was removed from the study during training due to illness, but her progress
indicated greater acquisition with P.E.C.S. Generalization probes conducted at participants’respective residences showed that three participants demonstrated generalization acrosssettings using P.E.C.S., and two participants demonstrated generalization across settings using
manual sign. Participants were also more likely to mand for reinforcing items not present using
P.E.C.S. than using manual sign. (www.sciencedirect.com/science/journal/08914222)
Charlop, M., Malmberg, D., & Berquist, K. (2008). An application of the Picture Exchange
Communication System (PECS) with children with autism and a visually impaired therapist.
Journal of Developmental and Physical Disabilities, 19, 509‐515.
Abstract: The Picture Exchange Communication System (PECS) (Bondy and Frost, Focus on
Autistic Behavior 9:1–19, 1994) is a visually‐based alternative and augmentative
communication system that is considered appropriate for many special populations. However, avariety of challenged populations, such as people with visual impairments, would initially beconsidered unable to communicate with PECS users. In the present study, a multiple baseline
reversal design across children was used to explore the viability of a Braille‐modified PECS
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system for use between a visually impaired therapist and three children with autism. The PECS
cards were slightly modified with the addition of Braille labels so that the visually impaired
therapist would be able to understand and respond to the requests of the children with autism.
Results indicated that the addition of Braille labels allowed children with autism and the visually
impaired therapist to communicate with each other using PECS. In addition, children had
ancillary decreases in problem behaviors during work sessions with the Braille‐modified PECS.
This study demonstrated the versatility of PECS and its potential for use with non‐sighted
populations, increasing opportunities of visually impaired persons in the job market.
Charlop‐Christy, M.H., Carpenter, M, Le, L., LeBlanc, L, & Kelley, K. (2002). Using the Picture
Exchange Communication System (PECS) with children with autism: Assessment of PECS
acquisition, speech, social‐communicative behavior, and problem behaviors.
Journal of Applied Behavior Analysis, 35, 213‐231.
Abstract: The picture exchange communication system (PECS) is an augmentative
communication system frequently used with children with autism (Bondy & Frost, 1994; Siegel,
2000; Yamall, 2000). Despite its common clinical use, no well‐controlled empirical investigations
have been conducted to test the effectiveness of PECS. Using a multiple baseline design, thepresent study examined the acquisition of PECS with 3 children with autism. In addition, thestudy examined the effects of PECS training on the emergence of speech in play and academic
settings. Ancillary measures of social‐communicative behaviors and problem behaviors wererecorded. Results indicated that all 3 children met the learning criterion for PECS and showedconcomitant increases in verbal speech. Ancillary gains were associated with increases in social‐communicative behaviors and decreases in problem behaviors. The results are discussed interms of the provision of empirical support for PECS as well as the concomitant positive side
effects of its use.
Chua, B. & Poon, K. (2018). Studying the implementation of PECS in a naturalistic special
education school setting. Education and Child Psychology, 35, 60-75.
Abstract: Aims: This study sought to investigate the predictors of spontaneous Picture
Exchange Communication System (PECS) use in a naturalistic school setting. Method: The study
recruited 44 students (36 boys and eight girls), aged between 6 to 18 years and their teachers(26 teachers and two teaching assistants). Teaching staff completed measures of student’s
communicative ability, autism symptomology and PECS abilities. Teachers also provided
information of their PECS training history and PECS teaching experience. Findings: Stepwise
Multiple Regression Analysis revealed that: (1) teacher’s intentional pre-planning of PECS; (2)context in which PECS is used; (3) PECS phase level; and (4) the number of months of PECS
teaching experience teachers had significantly predicted spontaneous PECS use. Childdependent variables such as the severity of student’s autism symptomology and level ofstudent’s mastery and age did not significantly predict spontaneous PECS use. Limitations: The
limitations of this study are the small sample size, teachers’ self-reported bias, and the lack of
exploring other potential factors. Conclusions: The findings of the study highlight theimportance for professionals, such as Educational Psychologists (EPs), to consider
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implementation factors that will impact the efficacy of intervention. In this study, it was theorchestration of how PECS is taught that had significantly predicted better PECS spontaneoususe, rather than within-child factors. This suggests that PECS is suitable for a wide range of ASD
learners. Additionally, it provides new insights for EPs to emphasise certain components overothers during PECS teachers’ trainings.
Conklin, C. & Mayer, G.R. (2010). Effects of implementing the Picture Exchange Communication
System (PECS) with adults with developmental disabilities and severe communication deficits
Remedial and Special Education (Online First) 2011 32 155‐166.
Abstract: The purpose of this study is to evaluate the effects of Picture Exchange
Communication System (PECS) training, using a multiple baseline design on the independent
initiations of three adults with developmental disabilities and severe communication deficits.
All participants increased their independent initiations, although at different levels of quality
and quantity throughout PECS training. Results demonstrate a functional relationship between
the teaching of PECS and the increase of independent initiations, and these independent
initiations continued to improve after initial training. In addition, problem behaviors (off‐task
and tantrum behaviors) were monitored to assess the collateral effects of PECS training. Resultsof data collection on untreated problem behaviors showed marked decreases, especially in thelast half of PECS training, and remained below baseline levels during follow‐up. The results ofthis study suggest that participants taught via PECS increased their initiation of requests,
thereby increasing their independence and choice making, which also appears to have collateraleffects on problem behaviors. This study extends the literature on PECS training with adults
with developmental disabilities and severe communication deficits by demonstrating that atleast one of the participants learned all six phases. This study also demonstrates collateralchanges in untreated problem behaviors in this adult population.
Cooper, L. (2017). Using the Picture Exchange Communication System with families of children
with autism. Learning Disability Practice, 20, 22-25. http://doi: 10.7748/ldp.2017.e1842
Abstract: Children with autism experience difficulties with communication and interaction, andthese impairments are most problematic for children who are non-verbal. The Picture Exchange
Communication System (PECS) is an intervention strategy that aims to improve communication
for people with autism. Using PECS in the family environment can be challenging in the initialstages. The specific needs of individual families should be considered and a whole family
approach adopted. With appropriate support and a consistent approach, using PECS can help toimprove communication and reduce challenging.
Cummings, A., Carr, J. & LeBlanc, L. (2012). Experimental evaluation of the training structure of
the Picture Exchange Communication System (PECS). Research in Autism Spectrum Disorders, 6,32‐45.
Abstract: The Picture Exchange Communication System (PECS) is a picture‐based alternative
communication method that is widely accepted and utilized with individuals with disabilities.
Although prior studies have examined the clinical efficacy of PECS, none have experimentally
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evaluated its manualized training structure. We experimentally evaluated the effects of training
during each of the 6 phases of PECS with 7 children with developmental or language disorders.
For all 7 participants, PECS responses consistently increased only after training was completed
for each of the first 4 phases but increases in PECS responses occurred during tests of Phases 5
and 6 as soon as training was completed in Phase 4. Consistent with prior research, PECS wastaught in a short period of time and required few prerequisite skills. However, 3 of the 7participants had difficulty with some aspects of training and were able to acquire the targetedskills only after procedural modifications were made.
Danov, S., Hartman, E., McComas, J., & Symons, F. (2010). Evaluation of two communicative
response modalities for a child with autism and self‐injury. The Journal of Speech‐Language
Pathology and Applied Behavior Analysis, 5, 70‐79.
Abstract: There is little empirically replicated guidance from the research literature on selecting
a communication response modality when implementing functional communication training(FCT). In this study, two forms of communicative responding (verbal speech and picture cards)
were evaluated during FCT treatment of self‐injury for a three‐year‐old boy with autism. The
functional analysis indicated the self‐injury was maintained by positive reinforcement in theform of access to preferred items. Findings indicated (1) SIB was eliminated during FCT sessions,and (b) independent picture cared (but not verbal speech) were used in all evaluation sessions.
Results are discussed in relation to the clinical issue of choosing among different possible
communication response modalities to effectively compete with severe problem behavior.
Dionesius, A. R., Esti, W. & Wahidyanti, R. (2017) Effect of PECS (Picture Exchange
Communication System) on social interaction development in autistic children. Nursing News,2, 801-810. (Indonesian)Abstract: Picture Exchange Communication System (PECS) is an approach to train social
interaction by using symbols such as pictures. PECS is not limiting Children to interact withanyone. Everyone can easily understand symbols PECS so that children with autism can interact
with others not only by his own family. Research Objective is to know the Influence ofApplication of PECS Method (Picture Exchange Communication System) on Social Interaction
Development of Autistic Children in Bahakti Luhur Foundation Malang. This research method is
Pre experimental design using the form one group pretest/posttest. The population study is
autistic children in Yayasan Bhakti Luhur Malang, amounting to 22 people, The sample study
consists of respondents who met the inclusion criteria as many as 14 people, Samplingtechnique used is Purposive sampling. Data collection techniques used were observation sheet.
Data analysis method used is Wilcoxon matched pairs. The results showed that of the 14
respondents’ children with autism it can be seen that all of the respondents (100%) to ableinteract socially well after 8 treatments using PECS method. Obtained results of calculations Pvalue= 0.000 < α (0.05). So it can be concluded there is influence application of Pecs Method(Picture Exchange Communication System) Against Development Social Interaction In Autism
Children In Bakti Luhur Foundation Malang. Is expected that teachers and caregivers can
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provide a method of Pecs in a little longer with the media varies so that children with autism
can interact very well.
Dogoe, M., Banda, D & Lock, R. (2010). Acquisition and Generalization of the Picture Exchange
Communication System Behaviors across Settings, Persons, and Stimulus Classes with Three
Students with Autism. Education and Training in Autism and Developmental Disabilities, 45,
216‐229.
Abstract: A brief narrative description of the journal article, document, or resource. This study
examined the acquisition and generalization of requesting behaviors learned through PECS withthree children with autism. A single‐subject multiple baseline across participants design wasused to determine the effects of PECS. Results indicated that all three participants acquired
PECS skills for requesting and generalized the skills across settings and persons. However, only
two of the three participants met criterion on the generalization across stimulus class probes.
Implications and suggestions for future research are discussed. This study provides preliminary
data on generalization of PECS across stimulus classes by persons with autism.
Doherty, A., Bracken, M. & Gormley, L. (2018). Teaching children with autism to initiate andrespond to peer mands using Picture Exchange Communication System (PECS). Behavior
Analysis in Practice, 11, 279-288. https://doi: 10.1007/s40617-018-00311-8
Abstract: We evaluated the effects of systematic prompting plus reinforcement on listeners’
independent responses to peer mands and on speakers’ peer-directed mands using the picture
exchange communication system (PECS) in two studies. In Study 1, three PECS users with adiagnosis of autism were trained to direct PECS exchanges toward peers, whereas in Study 2,
three peers with autism were taught to accept a PECS card, select the requested item from anarray of three items, and place it in front of their peer. Study 1 showed an increase in peer PECS
mands that generalized to novel trained peers for all participants. Results of Study 2
demonstrated an increase in correct independent responses to PECS exchange for allparticipants, a response that readily generalized across peers and settings for two out of threeparticipants. These results suggest that this intervention protocol may be an effective way toincrease interactions between peers with autism.
Dooley, P., Wilczenski, F. & Torem, C. (2009). Using an activity schedule to smooth schooltransitions. Journal of Positive Behavioral Interventions, 3, 57‐61.
Abstract: Functional assessment of a preschool child’s aggressive and disruptive behaviors
identified antecedent conditions associated with difficulties during transitions from one activity
to another at school. Antecedent conditions and functional communication were addressed in
the behavior plan using a schedule board based on the Picture Exchange Communication
System. A dramatic decrease in aggression and increase in cooperative behavior in theclassroom was observed.

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Dyer, K., Sulzer‐Azaroff, B., & Bondy, A. (May, 2006). Teaching Picture Discrimination toChildren with Autism: “Traditional Match‐to‐Sample” Training vs. “Naturalistic PECS” Training.
Poster presented at the 32nd Annual Association for Behavior Analysis Convention, Atlanta, GA.
Abstract: Picture discrimination, essential to any picture‐based communication program, often
is taught through “match‐to‐sample” (MTS) requests for object‐picture pairings. We comparedthat method to the match‐to‐sample approach inherent in the Picture Exchange
Communication System (PECS). In the traditional MTS condition, we showed the children apicture and asked them to match it to one of a set of objects. Correct matches were rewarded
with an item preferred by the child, but unrelated to the sample stimulus; errors were followedwith an error correction procedure. In the “naturalistic PECS” condition, a child‐preferred and anon‐preferred item were displayed. Next, s/he was shown two pictures, each of whichcorresponded to the items. When s/he handed one of the pictures to the therapist, s/hereceived the matching item. If the child chose a picture representing an item known to be non‐preferred, an error correction procedure followed. Four of 5 children required fewer trials tocriterion in the “naturalistic PECS” condition than the “MTS” training condition.
Ferreira, C., Bevilacqua, M., Ishihara, M., Fiori, A., Armonia, A. & Perissinoto, J. (2017).
Selection of words for implementation of the Picture Exchange Communication System – PECS
in non-verbal autistic children. Codas. 9;29. (Brazil).
Abstract: Purpose: It is known that some autistic individuals are considered non-verbal, since
they are unable to use verbal language and barely use gestures to compensate for the absenceof speech. Therefore, these individuals’ ability to communicate may benefit from the use of the
Picture Exchange Communication System – PECS. The objective of this study was to verify themost frequently used words in the implementation of PECS in autistic children, and on acomplementary basis, to analyze the correlation between the frequency of these words and therate of maladaptive behaviors. Methods: This is a cross-sectional study. The sample wascomposed of 31 autistic children, twenty-five boys and six girls, aged between 5 and 10 years
old. To identify the most frequently used words in the initial period of implementation of PECS,
the Vocabulary Selection Worksheet was used. And to measure the rate of maladaptive
behaviors, we applied the Autism Behavior Checklist (ABC). Results: There was a significant
prevalence of items in the category “food”, followed by “activities” and “beverages”. There wasno correlation between the total amount of items identified by the families and the rate ofmaladaptive behaviors. Conclusion: The categories of words most mentioned by the families
could be identified, and it was confirmed that the level of maladaptive behaviors did notinterfere directly in the preparation of the vocabulary selection worksheet for the children
studied.
Fillipin, M., Reszka, S. & Watson, L. (2010). Effectiveness of the Picture Exchange
Communication System (PECS) on communication and speech for children with autism
spectrum disorders: A Metanalysis. American Journal of Speech‐Language Pathology. (Online
version).
Abstract: Purpose: The Picture Exchange Communication System (PECS) is a popular
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communication training program for young children with autism spectrum disorders (ASD). Thismetanalysis reviews the current empirical evidence for PECS in impacting communication andspeech outcomes for children with ASD. Methods: A systematic review of the literature on PECS
written between 1994 and June 2009 was conducted. Quality of scientific rigor was assessed
and used as an inclusion criterion in computation of effect sizes. Effect sizes were aggregatedseparately for single subject and group studies for communication and speech outcomes.
Results: Eight single‐subject experiments (18 participants) and three group studies (95 PECS
participants, 65 in other intervention/control) were included. Results indicated PECS is
promising, but not as yet established evidenced‐based intervention for facilitating
communication for children with ASD ages 1–11 years. Small to moderate gains incommunication were demonstrated following training. Gains in speech were small to negative.
Conclusions: This metanalysis synthesizes gains in communication and relative lack of gains
made in speech across the PECS literature for children with ASD. Concerns about maintenanceand generalization are identified. Emerging evidence of potential pre‐intervention childcharacteristics are discussed. Phase IV was identified as a possibly influential program
characteristic for speech outcomes.
Finkel, A., Weber, K., & Derby, K. (2005). Use of a Braille Exchange Communication System toimprove articulation and acquire mands with a legally blind and developmentally disabled
female. Journal of Developmental and Physical Disabilities, 16, 321‐336.
Abstract: This research examined the effectiveness of a Braille Exchange Communication
System (BECS) on a legally blind adult with developmental disabilities to determine the effects
on word articulation and acquisition of mands. The procedures used a multiple baseline design
across four sets of words in a three‐phase experiment. Phase one measured word articulation.
Phase two measured acquisition of vocal mands. Phase three analyzed the exchange forcommunication component. Results for phases one and two showed that with verbal prompts
and fading procedures, verbal responding increased dramatically. For phase three, using BECS
was effective in improving communication exchanges through the use of physical promptingwith fading procedures. An additional unique feature of having a third person score IOA data
was included to ensure vocal response integrity.
Fleury, V., Trevors, G. & Kendeou, P. (2019). Public perception of Autism treatments: The roleof credibility and evidence Journal of Autism and Developmental Disorders, 49(5), 1876-1886.
Abstract: We explored the influence of credibility and evidence on public perceptions of ASD
treatments using survey methodology. Participants (N = 379) read texts about different ASD
treatments. The text presentation was based on a 2 × 2 within-subjects factorial design withtreatment status [evidence based practices (EBP) vs. non-EBP] and source credibility in the text
(credible vs. non-credible) as the independent variables. An instructional manipulation
condition served as a between subjects factor. Respondents were more familiar with non-EBPs
than EBPs, but viewed EBPs as being more credible and were more likely to endorse themcompared to pseudoscientific practices. Interactions between source credibility andinstructional manipulation were found on ratings of credibility and recommendation of both
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EBP and non-EBP texts. Implications of these findings are discussed. [Included PECS as an
example of EBP.]
Frea, W., Arnold, C. & Vittimberga, G. (2001). A demonstration of the effects of augmentative
communication on the extreme aggressive behavior of a child with autism within an integrated
preschool setting Journal of Positive Behavior Intervention, 3, 194‐198.
Abstract: Research in the area of behavior support has repeatedly demonstrated the positiveeffects of learning more effective and efficient communication on the challenging behaviors ofindividuals with developmental disabilities. More recently, augmentative and alternative
communication strategies have been receiving increased attention as primary teaching goals
for young children with autism. Use of picture exchange and choice‐making opportunities has
been reported to facilitate speech acquisition and/or result in increased communicative
attempts across daily routines. The case study discussed in this article examines the effects ofpicture exchange on the severe aggressive behavior of a preschooler with autism who was at
risk of losing his integrated school placement. Picture exchange was introduced within two playroutines in the classroom. The effects of picture exchange on the student’s aggression were
evaluated within a multiple baseline design. Results indicated that the student’s aggressive
behavior was eliminated in a brief amount of time when picture exchanges were in place. Thesefindings are discussed in terms of integrating augmentative communication into behavioral
support planning and future research in this area. (http://www.proedinc.com)
Frost, L. & Bondy, A. (2006). A common language: Using B.F. Skinner’s Verbal Behavior forassessment and treatment of communication disabilities in SLP‐ABA. The Journal of Speech andLanguage Pathology ‐ Applied Behavior Analysis, 1, 103‐110.
Abstract: Professionals in the field of speech‐language pathology (SLP) and applied behavior
analysis (ABA) share a common goal in the treatment of communication disorders. The two
fields, however, do not share a common language. Skinner’s definition of verbal behavior andhis classification of verbal operants provide interventionists with a valuable tool for classifying
verbal behavior based on controlling variables. An understanding of the primary verbal
operants and operants under multiple control are essential for planning efficient verbal
behavior intervention. This paper presents a primer on B.F. Skinner’s 1957 publication, Verbal
Behavior, a description of the primary verbal operants, verbal operants under multiple control,
and a discussion of using this taxonomy for writing precise communication goals for effective
intervention.
Frost, L. (2002). The Picture Exchange Communication System. Perspectives on Language
Learning and Education, 9, 13‐16.
Fujimoto, Y. & Isawa, S. (2007). The practical study on approach to secondary disorders instudent with autistic disorder at school for children with mental retardation: Effect ofindividualized schedule and applied PECS. Hattatsu Shinri Rinsyo Kenkyu, 13, 129‐135.
Abstract: The subjects in this study was a student (CA:17‐0, DA:1‐11, SA:2‐5) with autistic
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disorder at school for children with mental retardation. He presented states such as secondary
disorders and “Persistence to opening or closing of a door” “sleeplessness” “overeating” from it
was thought with an environmental change of department of high school from department ofjunior high school. The making the environmental that the student is easy to understand thathe should perform “when” “what” “how long” and training mand based on applied PECS (The
Picture Exchange Communication System) to express his demands were conducted. This study
was aimed at examining the process and effect of that support. We discussed reason of theprocess of and effect and considered ideal method of support in department of school ofchildren for mental retardation.
Ganz, J. & Simpson, R. (2004). Effects on communicative requesting and speech developmentof the Picture Exchange Communication System in children with characteristics of autism.
Journal of Autism and Developmental Disabilities, 34, 395‐409.
Abstract: Few studies on augmentative and alternative communication (AAC) systems haveaddressed the potential for such systems to impact word utterances in children with autism
spectrum disorders (ASD). The Picture Exchange Communication System (PECS) is an AAC
system designed specifically to minimize difficulties with communication skills experienced byindividuals with ASD. The current study examined the role of PECS in improving the number ofwords spoken, increasing the complexity and length of phrases, and decreasing the non‐word
vocalizations of three young children with ASD and developmental delays (DD) with relatedcharacteristics. Participants were taught Phases 1–4 of PECS (i.e., picture exchange, increased
distance, picture discrimination, and sentence construction). The results indicated that PECS
was mastered rapidly by the participants and word utterances increased in number of words
and complexity of grammar.
Ganz, J., Earles‐Vollrath, T., Heath, A., Parker, R., Rispoli, M. & Duran, J. (2012). A Meta‐
Analysis of Single Case Research Studies on Aided Augmentative and Alternative
Communication Systems with Individuals with Autism Spectrum Disorders. Journal of Autism
and Developmental Disorder, 42, 60‐74.
Abstract: Many individuals with autism cannot speak or cannot speak intelligibly. A variety of
aided augmentative and alternative communication (AAC) approaches have been investigated.
Most of the research on these approaches has been single‐case research, with small numbersof participants. The purpose of this investigation was to meta‐analyze the single case researchon the use of aided AAC with individuals with autism spectrum disorders (ASD). Twenty‐four
single‐case studies were analyzed via an effect size measure, the Improvement Rate Difference(IRD). Three research questions were investigated concerning the overall impact of AAC
interventions on targeted behavioral outcomes, effects of AAC interventions on individual
targeted behavioral outcomes, and effects of three types of AAC interventions. Results
indicated that, overall, aided AAC interventions had large effects on targeted behavioral
outcomes in individuals with ASD. AAC interventions had positive effects on all of the targetedbehavioral outcome; however, effects were greater for communication skills than othercategories of skills. Effects of the Picture Exchange Communication System and speech‐
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generating devices were larger than those for other picture‐based systems, though picture‐
based systems did have small effects.
Ganz, J., Goodwyn, F., Boles, M., Hong, E., Rispoli, M., Lund, E. & Kite, E. (2013). Impacts of a
PECS instructional coaching intervention on practitioners and children with autism. AAC:
Augmentative and Alternative Communication, 29, 210‐221.
Abstract: There is a growing research literature on the potential benefits of augmentative andalternative communication (AAC) for individuals with autism; however few studies haveinvestigated implementation of AAC within real‐life contexts. Thus, the purpose of this study
was to investigate the impact of training for practitioners in implementation of aided AAC, andto examine implementation of Picture Exchange Communication System (PECS) in real‐life
contexts. In particular, this study involved the implementation of instructional coaching toincrease opportunities offered by behavioral therapists for their preschool‐aged clients to use
PECS to make requests. Results indicated increases in therapist implementation of AAC andclient use of AAC in trained contexts, with limited generalization to untrained contexts.
Ganz, J., Heath, A., Rispoli, M. & Earles‐Vollrath, T. (2010)., Impact of AAC versus verbal
modeling on verbal imitation, picture discrimination, and related speech: A pilot investigation.
Journal of Developmental and Physical Disability, 22, 179‐196.
Abstract: Delays in or lack of language development are a primary characteristic of autism.
Thus, teachers, families and researchers face the challenge of determining which teachingstrategies are most effective and efficient in addressing these communication deficits. This
study attempts to add to the literature regarding this issue. A multi‐treatment/multi‐measuresingle‐case design was used to compare the effects of the Picture Exchange Communication
System (PECS) with a verbal modeling intervention on four communicative behaviors: (a)picture requests, (b) imitated verbalizations, (c) picture discrimination, and (d) any related
speech for a 3 year old child with autism. Results indicated that the PECS training led toincreases in picture requests and these results were maintained during the verbal modelingintervention phase. No change in imitated verbalizations was observed following either
intervention. With respect to both picture discrimination and related speech, no significant
results were achieved following PECS training or verbal modeling. However, during the verbal
modeling phase the participant demonstrated a small increase in both picture discrimination
and any related speech for both the PECS and verbal modeling item sets.
Ganz, J., Hong, E. & Goodwyn, F. (2013). Effectiveness of the PECS Phase III app and choice
between the app and traditional PECS among preschoolers with ASD. Research in Autism
Spectrum Disorders, 7, 973‐983.
Abstract: We investigated the efficacy of a tablet‐computer‐based Picture Exchange
Communication System (PECS) application for use with three preschoolers with ASD andinvestigated participant preference for the app versus traditional PECS (i.e., with a physicalcommunication book) once the participants demonstrated minimal levels of mastery of both.
We implemented a single‐case multiple baseline design to determine the efficacy of the app.
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Results indicated that participants rapidly demonstrated above‐chance level mastery of theapp. Following mastery, two participants demonstrated a preference for the app, while theother preferred the traditional PECS communication book.
Ganz, J., Mason, R., Goodwyn, F., Boles, M., Heath, A., & Davis, J. (2014). Interaction ofparticipant characteristics and type of AAC with individuals with ASD: A meta-analysis.
American Journal on Intellectual and Developmental Disabilities, 119, 516-535.
Abstract: Individuals with autism spectrum disorders (ASD) and complex communication needs
often rely on augmentative and alternative communication (AAC) as a means of functional
communication. This meta-analysis investigated how individual characteristics moderate
effectiveness of three types of aided AAC: the Picture Exchange Communication System (PECS),
speech-generating devices (SGDs), and other picture-based AAC. Effectiveness was measured
via the Improvement Rate Difference. Results indicated that AAC has small to moderate effects
on speech outcomes, and that SGDs appear to be most effective when considering any
outcome measure with individuals with ASD without comorbid intellectual/developmental
disorders (IDD). PECS appears to be most effective when considering any outcome measurewith individuals with ASD and IDD. SGDs and PECS were the most effective type of AAC forpreschoolers, when aggregating across outcome measures. No difference was found between
systems for elementary-aged and older individuals.
Ganz, J., Parker, R. & Benson, J. (2009). Impact of the picture exchange communication systemand collateral effects on maladaptive behavior. Augmentative and Alternative Communication,
25, 250‐261.
Abstract: Many children with autism require intensive instruction in the use of augmentative oralternative communication systems, such as the Picture Exchange Communication System(PECS). This study investigated the use of PECS with three young boys with autism to determine
the impact of PECS training on use of pictures for requesting, use of intelligible words, andmaladaptive behaviors. A multiple baseline‐probe design with a staggered start was
implemented. Results indicated that all of the participants quickly learned to make requests
using pictures and that two used intelligible speech following PECS instruction; maladaptive
behaviors were variable throughout baseline and intervention phases. Although all of theparticipants improved in at least one dependent variable, there remain questions regarding
who is best suited for PECS and similar interventions.
Ganz, J., Rea Hong, E., Goodwyn, F., Kite, E. & Gilliland, W. (2015). Impact of PECS tablet
computer app on receptive identification of pictures given a verbal stimulus. Developmental
Neurorehabilitation, 18, 82-87.
Abstract: Objective: The purpose of this brief report was to determine the effect on receptive
identification of photos of a tablet computer-based augmentative and alternative
communication (AAC) system with voice output. Methods: A multiple baseline single-caseexperimental design across vocabulary words was implemented. One participant, a preschoolaged boy with autism and little intelligible verbal language, was included in the study. Results:
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PECS Related Research (Updated: October 2020)

Although a functional relation between the intervention and the dependent variable was notestablished, the intervention did appear to result in mild improvement for two of the threevocabulary words selected. Conclusion: The authors recommend further investigations of thecollateral impacts of AAC on skills other than expressive language.
Ganz, J., Sigafoos, J., Simpson, R., & Cook, K. (2008). Generalization of a picture alternative
communication system across instructors and distance. Augmentative and Alternative
Communication, 24, 89‐99.
Abstract: Nonverbal individuals with autism spectrum disorders (ASD) often require the use of
picture based, aided augmentative and alternative communication (AAC) systems. Such systems
are used widely, but little research has investigated the generalization of these devices to avariety of communicative partners and under a variety of conditions. We investigated use of amodified Picture Exchange Communication System (PECS) protocol to teach AAC supported
functional communication skills to a 12‐year‐old boy with autism. Results indicate that theparticipant was able to generalize his communication skills across a variety of instructors and touse functional non‐verbal strategies to respond to communication obstacles.
Ganz, J., Simpson, R. & Corbin‐Newsome, J. (2008). The impact of the Picture Exchange
Communication System on requesting and speech development in preschoolers with autism
spectrum disorders and similar characteristics. Research in Autism Spectrum Disorders, 2, 157–
169.
Abstract: By definition children with autism spectrum disorders (ASD) experience difficulty
understanding and using language. Accordingly, visual and picture‐based strategies such as thePicture Exchange Communication System (PECS) show promise in ameliorating speech andlanguage deficits. This study reports the results of a multiple baseline across participants
investigating the implementation of the PECS with three preschool children with characteristics
of ASD. The first four phases of PECS were taught to the participants: basic picture exchange,
increasing distance use of PECS, discriminating among a variety of pictures, and communicating
in sentences composed of pictures. Relative to the impact of PECS’s implementation inproviding the participants with a functional communication system, word approximations, andintelligible word and phrase use, results indicated that two of the three participants mastered
PECS. However, participants did not significantly increase in use of word approximations andintelligible words.
Ganz, J., Simpson, R. & Lund, E. (2012). The Picture Exchange Communication System (PECS): A
Promising Method for Improving Communication Skills of Learners with Autism Spectrum
Disorders. Education and Training in Autism and Developmental Disabilities, 47, 176–186.
Abstract: Children and youth with autism spectrum disorders (ASD) and other developmental
delays frequently experience deficits in functional communication. Identifying and using
suitable communication enhancement and augmentative and alternative communication
supports is essential to achievement of positive outcomes for these learners. This article
discusses the use of the Picture Exchange Communication System (PECS), a commonly used and25
PECS Related Research (Updated: October 2020)

utilitarian AAC system for children and youth who lack sufficient functional communication
skills. Particular attention is given to practitioners’ use of this promising tool.
Ganz, J.B., Cook, K.E., Corbin‐Newsome, J., Bourgeois, B., & Flores, M. (2005). Variations on
the Use of a Pictorial Alternative Communication System with a Child with Autism andDevelopmental Delays. TEACHING Exceptional Children Plus, 1(6) Article 3.
Abstract: As aberrant behavior is often recognized as the number one form of communication,
it becomes imperative that as parents, teachers, and educators we must address andsystematically teach or provide all children with an effective means of communication. While
many augmentative and alternative communication systems such as manual sign language and
the Picture Exchange Communication System (Frost & Bondy, 1994) have shown tremendous
success, some students with developmental disabilities students unique needs require moreindividually tailored communication training that necessitates empirical inquiry and use ofcollective expertise. Doing so may facilitate the acquisition of skills and behaviors that improve
communication skills through independent appropriate means for meeting students’ personalneeds and desires. This article systematically provides a variation of the Picture Exchange
Communication System (PECS) including materials, resources, and methodology necessary.
(http://escholarship.bc.edu/education)
Gilroy, S., Leader, G. & McCleery, J. (2018). A pilot community‐based randomized comparisonof speech generating devices and the picture exchange communication system for children
diagnosed with autism spectrum disorder Autism Research, 11 https://doi: 10.1992/aur.2025
Abstract: A pilot community‐based randomized controlled trial was conducted to compare theeffects of the Picture Exchange Communication System (PECS) to a teaching sequence using ahigh‐tech Speech Generating Device (SGD) to teach social communication behaviors. The two
approaches were compared to evaluate the effectiveness of the newer, more high‐techintervention using technology to improve social and communicative behavior of children
diagnosed with Autism Spectrum Disorder. A total of 35 school‐age children were randomized
to either a high‐tech (SGD device) or low‐tech (PECS cards) form of Augmentative andAlternative Communication (AAC). Study participants received 4 months of communication
training delivered in their classrooms, and the primary outcome measures of the trial wereseveral functional communication skills emphasized in the PECS teaching sequence. Results
indicated that both high‐tech and low‐tech AAC approaches resulted in significant
improvements in communication, and that these improvements did not differ significantly
between the two approaches. These findings support the use of high‐tech AAC and highlightthe need for evidence‐based guidelines for its use as well as evaluation with individuals with arange impairments and disabilities. Autism Res 2018. © 2018 International Society for Autism
Research, Wiley Periodicals, Inc. Lay Summary This study compared the effectiveness of a free
and open‐source app for teaching social and communicative behavior to children with autism
spectrum disorder (ASD) to traditional picture card approaches. Thirty‐five children with ASD
were randomized to a picture card or app‐based intervention and both treatment approaches
resulted in significant improvements in social and communicative behavior. These data
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indicated that both “high‐tech” and “low‐tech” interventions were effective for improving
behavior and that there was not a significant difference between the two approaches.
Gilroy, S., McCleery, J. & Leader, G. (2017). Systematic Review of Methods for Teaching Social
and Communicative Behavior with High-Tech Augmentative and Alternative Communication
Modalities Review Journal of Autism and Developmental Disorders, 4, 307-320.
Abstract: A systematic review was conducted to analyze the scope and breadth of the existing
training protocols for establishing social and communicative behavior using high-tech,
touchscreen devices. This review aimed to determine the degree to which studies evaluating
high-tech communication aides have established procedures to extend, or completely replace,traditional low-tech communication training methods (e.g., Picture Exchange Communication
System). Individual studies were evaluated based on the range of social and communicativeskills targeted. The PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) methodology was utilized (Prospero: No. CRD42017055541) and systematic searches
included the Scopus, PsycINFO, ScienceDirect, and SpringerLink databases. Studies were
included in the review if their methods utilized high-tech devices as a vehicle for establishingsocial and/or communicative behavior. Single-case and group-design studies including children
and adults were included in the review if participants were diagnosed with either autism
spectrum disorder and/or other developmental disabilities. Fifty-six studies were included andthe results of this review indicated that the existing support for high-tech communication aides
has focused predominantly on a narrow band of social and communicative behavior (e.g.,
requesting) and that substantial research is warranted for establishing more advanced forms ofsocial behavior, beyond requesting alone, using these new high-tech methods.
Gopalan, RT & Piking, ET. (2016). The Effectiveness of the Picture Exchange Communication
System (PECS) in autism. Imperial Journal of Interdisciplinary Research, 2, 455-461. (Malaysia).
Abstract: The purpose of this study was to determine the effectiveness of the use of the
Picture Exchange Communication System (PECS) on the improvement of functional
communication skills among children with autism. Method: Case study design with pre and post
assessment was used. A four year old child diagnosed to have autism was participated in the
study. In the study only two of the six PECS phases (the Physical Exchange and Distance andPersistence) were selected to teach the child because of lack of language ability. Result: Thedata from this study indicates that in terms of the PECS acquisition data in phase 1 and 2, and
the PECS did improve the participant’s functional communication skills, especially the ability torequest edibles, toys or activities, given choice and greeting. Conclusion: A visual inspection of
the data collected revealed that overall the participant in the study had improved somefunctional communication skills that would allow him to appropriately communicate his basic
wants and needs which indicate that PECS is effective.

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Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P. & Charman, T. (2011). A
communication‐based intervention for nonverbal children with autism: What changes? Whobenefits? Journal of Consulting and Clinical Psychology, 79, 447‐457.
Abstract: Objective: This article examines the form and function of spontaneouscommunication and outcome predictors in nonverbal children with autism following classroom‐
based intervention (Picture Exchange Communication System [PECS] training). Method: 84
children from 15 schools participated in a randomized controlled trial (RCT) of PECS (P. Howlin,
R. K. Gordon, G. Pasco, A. Wade, & T. Charman, 2007). They were aged 4–10 years (73 boys).
Primary outcome measure was naturalistic observation of communication in the classroom.
Multilevel Poisson regression was used to test for intervention effects and outcome predictors.
Results: Spontaneous communication using picture cards, speech, or both increased
significantly following training. Spontaneous communication to request objects significantly
increased. Only the effect on spontaneous speech persisted by follow‐up (9 months later). Less
severe baseline autism symptomatology was associated with greater increase in spontaneous
speech and less severe baseline expressive language impairment, with larger increases inspontaneous use of speech and pictures together. Conclusion: Overall, PECS appeared toenhance children’s spontaneous communication for instrumental requesting using pictures,speech, or a combination of both. Some effects of training were moderated by baseline factors.
For example, PECS appears to have increased spontaneous speech in children who could talk alittle at baseline.
Greenberg, A., Tomaino, M. & Charlop, M. (2013). Adapting the Picture Exchange
Communication System to Elicit Vocalizations in Children with Autism Journal of Developmental
and Physical Disabilities, DOI 10.1007/s10882‐013‐9344‐2.
Abstract: Little is known about the relationship between PECS training and vocalizations inchildren with limited verbal abilities (e.g., children who are unable to verbally imitate simple
phrases). Study 1 used a multiple baseline design across children to examine the vocalizationsof four children with autism during and after PECS training. At follow‐up, three of theparticipants demonstrated higher frequencies of vocalizations than at baseline. Further, two ofthese participants used both PECS and vocalizations to mand at different times but did not pairthe two modalities. Study 2 was then conducted to determine if children with limited verbal
abilities could be taught to pair PECS with spontaneous vocalizations using time‐delay andverbal prompting procedures. By the end of Study 2, both participants made a spontaneous
vocalization every time that they used PECS. Findings support the potential use of PECS as acomponent of a treatment package leading to verbal speech. 13.5
Greenberg, A., Tomaino, M.A.E. & Charlop, M. (2012). Assessing Generalization of the Picture
Exchange Communication System in Children with Autism. Journal of Developmental andPhysical Disabilities, 24, 539‐558.
Abstract: Since its introduction to the field, a growing body of research on the Picture Exchange
Communication System (PECS) has demonstrated its efficacy for children with autism inresearch settings. However, knowledge of PECS generalization remains limited and mixed. The
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PECS Related Research (Updated: October 2020)

present study explored a train and probe technique of assessing generalization after each phaseof PECS training. Four children with autism were taught PECS in treatment rooms with atherapist at their behavioral treatment program. Generalization was assessed in a playroom
with a therapist, at home with a therapist and parent, and in the community with a stranger.
Results indicated that all four participants generalized PECS use across settings and people andmaintained PECS use at follow‐up. Findings provide support for the utility of a train and probe
technique to assess generalization when using PECS with children with autism.
Greenburg, A., Tomaino, M., & Charlop, M. (2014). Adapting the Picture Exchange
Communication System to elicit vocalizations in children with autism. Journal of Developmental
and Physical Disabilities, 26, 35-51.
Abstract: Little is known about the relationship between PECS training and vocalizations inchildren with limited verbal abilities (e.g., children who are unable to verbally imitate simple
phrases). Study 1 used a multiple baseline design across children to examine the vocalizationsof four children with autism during and after PECS training. At follow-up, three of theparticipants demonstrated higher frequencies of vocalizations than at baseline. Further, two ofthese participants used both PECS and vocalizations to mand at different times, but did not pairthe two modalities. Study 2 was then conducted to determine if children with limited verbal
abilities could be taught to pair PECS with spontaneous vocalizations using time-delay andverbal prompting procedures. By the end of Study 2, both participants made a spontaneous
vocalization every time that they used PECS. Findings support the potential use of PECS as acomponent of a treatment package leading to verbal speech.
Haramaki, S. & Bondy, A. (2007). Behavior analytic approach to Asperger Syndrome.
Nippon Rinsho, 65, 516‐21.
Abstract: We describe the behavior analytic approach to helping people with Asperger
syndrome regarding social interaction and communication issues. In the behavior analytic
approach, the cause of maladaptive behavior is not attributed to the disability itself.
Maladaptive behaviors are viewed as a function of the interaction between an individual andthe environment. Therefore, we assess these functional relationships and intervene bymodifying aspects of the environment. Functional assessment is one of the most effective
methods to evaluate the cause of problem behaviors and helps in the selection of anintervention strategy. We teach students functionally equivalent alternative behaviors that aresocially appropriate and yet met the needs of the individual. Furthermore, we discuss theimportance of teaching individuals with Asperger syndrome critical skills, including
communication skills, self‐management skills, and how to deal with anxiety.
Hart, S. & Banda, D. (2009). Picture Exchange Communication System with individuals with
developmental disabilities: A meta‐analysis of single subject studies. Remedial and Special
Education (Online First), XX, 1‐13.
Abstract: Picture Exchange Communication System (PECS) is a picture‐based communication
strategy used to teach communication skills to persons with developmental disabilities
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PECS Related Research (Updated: October 2020)

including autism. This article systematically reviews 13 published single subject studies to
examine the effectiveness of PECS, the effects of PECS on speech and problem behaviors,
generalization beyond training conditions, and social validity of the intervention. The authors
also calculated percentage of non‐overlapping data points for all participants to quantify,
compare, and analyze results. Results indicate that PECS yielded increases in functional
communication in all but 1 participant. Additionally, PECS decreased problem behaviors andincreased speech in some individuals. A theoretical framework, analyses of methodologies, andimplications for researchers and practitioners are discussed.
Heneker, S. & Page, L.M. (2003). Functional Communication: the impact of PECS. Speech &Language Therapy in Practice, 12‐14.
Abstract: The Picture Exchange Communication System (PECS™) aims to teach individual users
to initiate communication. The effectiveness of introducing this approach to whole classes
within a school for autistic spectrum disordered children was investigated in two groups. Class
staff and parents attended a formal PECS training course and the impact on the amount,functions and method of communication and the level of adult support required wererecorded. Observations were carried out in four different contexts: free play, snack, swimmingand structured teaching. For group 1 children, aged 6 to 8, the amount of communication
increased in all activities apart from swimming. Requesting was the most frequent function at
both base‐line and follow‐up. The most frequently used method of communication at base‐line
was by symbols. At follow‐up symbols was the main method for snack and structured teachingand physical communication was predominant for free‐play and swimming. The presence of an
object/event was the main level of stimulus to which children responded for all activities. For
Group 2 children, aged 9‐10 years, total communicative acts increased for all activities apartfrom structured teaching, where the decrease may have been due to their being taught more
independent skills of commenting for the first time. Requesting remained the most frequentfunction of communication, and more formal means of communication were observed. The
presence of an object/event remained the main stimulus for snack and swimming, but more
independent responses were seen in free‐play, with the presence of a listener becoming thelevel of cue required to initiate communication. At follow‐up, children involved in the study
appeared to show less frustration, were able to accept that their requests might not always be
met, and could wait patiently for adult attention.
Hill, D. & Flores, M. (2014). Comparing the Picture Exchange Communication System and the
iPad™ for communication of students with autism spectrum disorder and developmental delay
TechTrends, 58, 45-53.
Abstract: Both picture exchange, a low-tech picture based communication system, andtechnology based interventions, such as the iPad™ with communication application, areemerging treatments for students with autism spectrum disorder (ASD), according to the
National Autism Center (2009). Recently, investigations regarding the use of the Apple iPad™ tocommunicate have been conducted with mixed results. The authors used a single-subject
alternating treatment design during an extended school year (ESY) program for students with
30
PECS Related Research (Updated: October 2020)disabilities to compare the independent use and effectiveness of the two approaches (low-tech
picture-based versus iPad™ equivalent) for three pre-school and two elementary students with
ASD and developmental delay (DD). The authors concluded that teaching low-tech picture
exchange prior to introducing the iPad™ may be effective progression in teachingcommunication reciprocity skills for some students with ASD/DD. Limitations and strengths ofboth technologies are discussed. NOTED: “The authors recommend that PECS™ phases I-III be
mastered before the iPad™ is introduced, to ensure the students master these prerequisite
skills since they are more difficult to scaffold (break into smaller units for teaching and thenbuild additional skills) using the iPad™.
Hill, D., Flores, M., & Kearley, R. (2014). Maximizing ESY services: Teaching pre-service teachers
to assess communication skills and implement picture exchange with students with autism
spectrum disorder and developmental disabilities. Teacher Education and Special Education:
The Journal of the Teacher Education Division of the Council for Exceptional Children, 37, 241254.
Abstract: The authors supervised and trained pre-service teachers while conducting extended
school year (ESY) services for pre-kindergarten and elementary students with autism spectrum
disorder (ASD) and other developmental disabilities (DD). Each classroom was responsible for
conducting communication assessments and developing interventions focused on increasing
functional communication. One intervention, the Picture Exchange Communication System(PECS™), was taught to three pre-service teachers and staff who implemented PECS™ with four
students who lacked functional communication skills. The teachers were mentored as they
implemented the appropriate level of PECS™ and developed communication books for the
students to use in school, home, and other settings.
Homlitas, C., Rosales, R. & Candel, L. (2014). A further evaluation of behavioral skills training
for implementation of the Picture Exchange Communication System. Journal of Applied
Behavior Analysis, 47, 198-203.
Abstract: We evaluated the effectiveness of a behavioral skills training package to teachimplementation of Phases 1, 2, and 3A of the picture exchange communication system (PECS)
to teachers employed at a therapeutic center for children with autism. Probes in the naturalenvironment and follow-up were conducted with children who were assigned to work with theteachers in their own classrooms. Results provide additional support for the efficacy of
behavioral skills training to each implementation of PECS.
Howlin, P., Gordon, R.K., Pasco, G., Wade, A. & Charman, T. (2007). The effectiveness ofPicture Exchange Communication System (PECS) training for teachers of children with autism: apragmatic, group randomised controlled trial. Journal of Child Psychology and Psychiatry, 48,
473‐481.
Abstract: Objective: To assess the effectiveness of expert training and consultancy for teachersof children with autism spectrum disorder in the use of the Picture Exchange Communication
System (PECS). Method: Design: Group randomised, controlled trial (3 groups: immediate
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PECS Related Research (Updated: October 2020)

treatment, delayed treatment, no treatment). Participants: 84 elementary school children,
mean age 6.8 years. Treatment: A 2‐day PECS workshop for teachers plus 6 half‐day, school‐
based training sessions with expert consultants over 5 months. Outcome measures: Rates of:communicative initiations, use of PECS, and speech in the classroom; Autism Diagnostic
Observation Schedule‐Generic (ADOS‐G) domain scores for Communication and Reciprocal
Social Interaction; scores on formal language tests. Results: Controlling for baseline age,developmental quotient (DQ) and language; rates of initiations and PECS usage increased
significantly immediately post‐treatment (Odds Ratio (OR) of being in a higher ordinal ratecategory 2.72, 95% confidence interval 1.22–6.09, p < .05 and OR 3.90 (95%CI 1.75–8.68), p <.001, respectively). There were no increases in frequency of speech, or improvements in ADOSG
ratings or language test scores. Conclusions: The results indicate modest effectiveness of PECS
teacher training/consultancy. Rates of pupils’ initiations and use of symbols in the classroom
increased, although there was no evidence of improvement in other areas of communication.
Hu, X. & Lee, G. (2018). Effects of PECS on the emergence of vocal mands and the reduction of
aggressive behavior across settings for a child with Autism, Behavioral Disorders, 44, 112. https://doi.org/10.1177/0198742918806925
Abstract: Effective strategies to address communication and behavior challenges are critical inearly intervention programs. The purpose of this study was to investigate the effects of the
Picture Exchange Communication System (PECS) on vocal mands and aggressive behavior
displayed by a child with autism in China. One 4-year-old boy with autism participated in thisstudy. The experimental design was a multiple baseline across three settings. The PECS
intervention involved the first three phases described in the PECS manual. The results indicatedthat PECS effectively increased vocal mands and decreased aggressive behavior maintained byaccess to preferred items in all three settings. The results also suggested that vocal mands werepotentially controlled by pictures in the PECS book. One week following the completion of theintervention, the child maintained the PECS exchanges at a high level with increased vocal
mands. His aggressive behavior remained at almost zero occurrences. Results of this study haveimportant implications to early intervention educators working with children with autism.
Hughes-Lika, J. & Chiesa, M. (2020). The picture exchange communication system and adults
lacking functional communication: A research review. European Journal of Behavior Analysis,
https://doi.org/10.1080/15021149.2020.1815507.
ABSTRACT: PECS training for children with Autism Spectrum Disorder and Intellectual
Disabilities has been extensively evaluated. In contrast, there is a dearth of literature on
outcomes of PECS training for adults lacking functional communication skills. A literature search
produced five empirical studies involving PECS training with 18 adults. The participants involved
presented with a wider range of intellectual and physical challenges than those typically foundin child-related research. Where noted, severity of diagnoses ranged from mild to profound andincluded participants with single, dual and triple diagnoses, the majority with dual diagnoses.
Each of the studies shows results in line with child-related research. While the amount ofresearch is limited, the outcomes of these few studies are profound in their implications for
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adults with a variety of intellectual disabilities and physical challenges. Implications for bothchildren and adults are considered.
Ivy, S., Hatton, D. & Hooper, J. (2014). Using the Picture Exchange Communication System withstudents with visual Impairment. Exceptional Children, 80, 474-488.
Abstract: Students with visual impairment (VI) were taught to request using the Picture
Exchange Communication System (PECS) and tangible symbols. Participants were four maleswith additional disabilities, 5 to 11 years old, who had little to no functional vision. A functional
relation between PECS Phase 1 and requesting was established using a multiple baseline single
subject design. All students learned to request independently within 7 to 14 sessions in Phase 1.
Students maintained requesting above criterion for 1 to 5 months. All students generalized
requesting to a new communication partner (CP); however, only two students reached criterion
during generalization sessions. Two students learned to seek out a CP 5 feet away to request;
however, no functional relation was established for Phase 2. More research is needed toestablish PECS as an evidence-based practice for children with VI.
Isshiki, M., Ishiyama, A., Yoshida, S., Hisatake, Y., & Terada, S. (2008). A complex effect of
PECS and cognition intervention for autism spectrum disorder Bulletin of the Faculty of
Education, Kochi University, 68, 73‐82.
Abstract: We introduced interventions of both the Picture Exchange Communication System(PECS) and the cognition to four participants with autism Spectrum disorder who use few words
and have poor communication skills. As a result, the participants improved in each phases of
the PECS, and acquired a spontaneous demand skill to use the PECS in the intervention setting.
We also improved the PECS intervention to their daily lives, therefore they showed aspontaneous demand skill in a non‐structured setting in the daily living. Simultaneously, wetaught cognitive tasks to the participants. We found that the levels of cognitive tasks
correspond to the PECS phases. Accordingly, it was suggested that the psychological operationacquired by the cognitive intervention, work as the base for the necessary operation in the
PECS intervention.
Jurgens, A., Anderson, A. & Moore, D. (2009). The effect of teaching PECS to a child with
autism verbal behaviour, play, and social functioning. Behaviour Change, 26, 66‐81.
Abstract: The Picture Exchange Communication System (PECS) is a widely used intervention
strategy designed to teach communication skills to children with developmental delays,
including autism. The Picture Exchange Communication System incorporates the teaching ofmand initiations that are thought to be pivotal response behaviours, and have been
demonstrated to lead to generalised improvements in other nontargeted behaviours. The aimof the present study was to assess the acquisition of PECS with a 3‐year‐old boy with autism
using the established PECS training program, and to evaluate concomitant changes in spoken
language, social–communicative behaviours, and functional play. Results indicated that theparticipant rapidly acquired the criterion behaviours for Phases 1 to 3 of the PECS program.
Although PECS exchanges were rarely observed in the generalization settings, clear increases
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were evident in verbal mands and other initiations in both home and kindergarten
generalisation settings. Increases in spoken vocabulary and in the length of comprehensible
spoken utterances in free‐play were observed, as were gains in time spent in developmentally
appropriate play. Implications of these results and directions for future research are discussed.
Jurgens, A., Anderson, A. & Moore, D. (2012). Parent‐implemented Picture Exchange
Communication System (PECS) training: An analysis of YouTube videos. Developmental
Neurorehabilitation, 15, 351‐360.
Abstract: Purpose: To investigate the integrity with which parents and carers implement PECS
in naturalistic settings, utilizing a sample of videos obtained from YouTube. Methods: Twenty‐
one YouTube videos meeting selection criteria were identified. The videos were reviewed for
instances of seven implementer errors and, where appropriate, presence of a physicalprompter. Results: Forty‐three per cent of videos and 61% of PECS exchanges contained errors
in parent implementation of specific teaching strategies of the PECS training protocol. Vocal
prompts, incorrect error correction and the absence of timely reinforcement occurred mostfrequently, while gestural prompts, insistence on speech, incorrect use of the open hand
prompt and not waiting for the learner to initiate occurred less frequently. Conclusions: Results
suggest that parents engage in vocal prompting and incorrect use of the 4‐step error correction
strategy when using PECS with their children, errors likely to result in prompt dependence.
Jurgens, A., Anderson, A. & Moore, D. (2018). Maintenance and generalization of skills
acquired through picture exchange communication system (PECS) training: a long-term followup. Journal of Developmental Neurorehabilitation, 22, 338347. https://doi.org/10.1080/17518423.2018.1503619
Abstract: Purpose: To conduct a follow-up assessment of the maintenance of communication
skills of a 7-year-old child with autism spectrum disorder, 3 years 7 months post PECS training;
and investigate the effects of environmental adaptations on the child’s PECS and vocal
communications. Methods: An alternating-treatments design enabled comparison of the effectsof two treatment conditions (an environmental adaptation to increase need and opportunities
for communication, versus a continuation of baseline procedures) on the child’s PECS and vocal
communications in the child’s home. Results: Baseline data demonstrated decreased levels of
PECS and vocal communication at follow-up, compared to post PECS training 3 years 7 months
prior. The environmental adaptation had no observable effect on the participant’s use of PECS,
but vocal manding increased in this condition. Conclusion: These results suggest ongoing needfor motivating environments with ample opportunities to practice post PECS training.
Implications and directions for future research are discussed.
Jusob, W. & Majid, R. A. (2017). Using the Picture Exchange Communication System to improve
speech utterance among children with Autism. Journal of ICSAR, 1, 1-4. [Malaysia]
Abstract: Picture Exchange Communication System is a common augmentative communication
system used on children with Autism Spectrum Disorder (ASD), which is one of the categories ofdevelopmental problems in social interaction, communication and behavior patterns. The aim
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of this study is to see an increase in the utterance of the word by students with autism using
PECS. This study is an action research using quantitative descriptive on data collection.
Observations were implemented over a period of four weeks to see the effectiveness of PECS
using cartoon picture cards and cards real pictures to enhance the utterance of two primaryschool autism students. From the result shown, the application of PECS successfully stimulates
utterance among the students. This study is expected to enhance the communication and social
interaction development of children with autism and other children who have difficulty
mastering the language.
Jusob, W. & Majid, R. A. (2017). Using the Picture Exchange Communication System to improve
speech utterance among children with Autism. Journal of ICSAR, 1, 1-4. [Malaysia]
Abstract: Picture Exchange Communication System is a common augmentative communication
system used on children with Autism Spectrum Disorder (ASD), which is one of the categories ofdevelopmental problems in social interaction, communication and behavior patterns. The aimof this study is to see an increase in the utterance of the word by students with autism using
PECS. This study is an action research using quantitative descriptive on data collection.
Observations were implemented over a period of four weeks to see the effectiveness of PECS
using cartoon picture cards and cards real pictures to enhance the utterance of two primaryschool autism students. From the result shown, the application of PECS successfully stimulates
utterance among the students. This study is expected to enhance the communication and social
interaction development of children with autism and other children who have difficulty
mastering the language.
Kern, L., Gallagher, P., Starosta, K., Hickman, W. & George, M. (2006). Longitudinal outcomesof functional behavioral assessment–based intervention. Journal of Positive Behavior
Interventions, 8, 67–78.
Abstract: A critical measure of intervention effectiveness is durability over time. Still, few
studies have examined the long‐term outcomes of support derived from a functional behavioral
assessment as well as enablers and barriers that contribute to or impede successful outcomes.
In the current study, a functional behavioral assessment was conducted with a 10‐year‐old boy
with developmental disabilities who engaged in high‐rate aggression. Based on the assessment
results, a comprehensive support plan was developed and implemented, which resulted in adecrease in aggression and increase in activity engagement. His subsequent progress wasfollowed for 3 consecutive school years. This longitudinal follow‐up indicated that componentsof the plan remained effective; however, illness and implementation lapses resulted indecrements in progress.
Khoiriyah, K. (2016). The Picture Exchange Communication System: An approach to optimize
communication ability of autistic children. International Conference on Education, 1, 237247. (Indonesia.)
Abstract: The communication barrier is a disorder condition that is often found among theautistic children. Therefore, we need an approach to optimize the communication ability of the
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autistic children. PECS is very effective to help the autistic children to communicate and tocontrol their emotions. PECS can be used as a starting point to build the interactions during the
instruction both between autistic students and their teachers, and between their classmates
and the environment more effectively. The Picture Exchange Communication System (PECS) is aunique alternative communication intervention method for individuals with autism. It is anapproach to practice communication ability using non-verbal symbols. PECS is primarily an
attempt to stimulate the children’s communication ability spontaneously. The use of visuallanguage instead of verbal language is an initial mediation effort towards the communication
process appears to be more complicated. The process of visual communication in turn triggers
verbal expressions. PECS can be considered as efforts to provide visual stimuli. The process canbe done in several phases. In the first phase the children are introduced to the non-verbal
symbols. The different phases show the ability levels and the children’s development. To apply
PECS, it is required to use a behavior modification. By using the behavior modification, it will becovered up the children desire. The objects desired will enforce the children to communicate
through the pictures exchange, in which in the final phase the use of PECS approach makes thechildren motivated to speak
Kodak, T., Paden, A., & Dickes, N. (2012). Training and generalization of peer‐directed mands
with non‐vocal children with autism. The Analysis of Verbal Behavior, 28, 119‐124.
Abstract: The current investigation evaluated the effects of extinction and prompts on training
and generalization of peer‐directed mands for preferred items using a picture exchange
communication system with 2 children diagnosed with autism. Results showed thatindependent mands with a peer increased during treatment for both participants, generalized
to a novel peer without explicit training for 1 participant and following training for the second
participant, and maintained in a more naturalistic setting that simulated a free‐play activity in aclassroom. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363405/
Koita, H. & Sonoyama, S. (2004). Communication training using the Picture Exchange
Communication System (PECS): Case study of a child with autistic disorder. Japanese Journal of
Behavior Analysis, 19, 161‐174.
Abstract: The purpose of this study was to examine the effect of training with the Picture
Exchange Communication System (PECS) on the acquisition of functional communication skills.
Participants were a child with autism who did not speak, and his mother. Intervention was
conducted with the changing conditioning design, including 6 phases and follow up. The PECS
training was implemented by the participant’s mother in his home. In the home, intervention
was implemented using backward chaining and other methods, the child’s mother taught him
to give her icons in order to make requests and answer questions. Measures were thepercentage of correct responses in the PECS training, the frequency of spontaneous requestingwith using the PECS, and the form and the initial time of speech after the intervention has
begun. As a result, the boy learned the PECS in a comparatively short period, and spontaneous
requesting using the PECS increased. After the intervention, some speech appeared, but its
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frequency was low. Although the PECS training could be effectively implemented by the motherin home, the procedures for commenting need to be examine further.
Koita, H., Sonoyama, S., & Takeuchi, K. (2003). Communication Training With the Picture
Exchange Communication System (PECS) for Children With Autistic Disorder: The Training
Program and Current and Future Research. Japanese Journal of Behavior Analysis, 18, 120-130.
(Japanese)
Abstract: This review article would be one of the first studies to be published in Japan on the
PECS. The PECS was developed by Frost and Bondy as a means to teach children with autistic
disorder and related developmental disabilities a self‐initiating, functional communication
system that could be rapidly acquired. Its theoretical roots combine principles from applied
behavior analysis and guidelines established within the field of augmentative and alternative
communication. The PECS training manual was first published in 1994, and revised in 2002. In
the PECS training protocol, children are taught to exchange a picture for a desired item andeventually learn to construct picture‐based sentences and use a variety of attributes in theirrequests. The system emphasizes developing the request function prior to developing
responding to simple questions and commenting. In the present article, we described the PECS
procedure, summarize effects of communication training by PECS, and comment on the futureof PECS.
Kravits, T. R., Kamps, D.M., & Kemmerer, K. (2002). Brief report: Increasing communication
skills for an elementary‐aged student with autism using the picture exchange communication
system. Journal of Autism and Developmental Disorders, 32, 225‐230.
Abstract: Communication and interactions with others are a few of the hardest tasks for an
autistic child. This study showed how the gap may be bridged by using a system called thePicture Exchange Communication System (PECS). A 6‐year‐old girl named Molly showed much
improvement in both her verbalizations and socialization skills using this method which gives
promise to execution of these programs. (http://www.springerlink.com/content/104757)
Kuma, H., Takeuchi, Y., Hara, Y., Naoi, N., Yamamoto, J., Takahashi, K., Iijima, K., Saito, U.,
Watanabe, S., Haramaki, S., & Bondy, A. (2009). On Current Research and Practice on Autism
and Communication in Japan. Japanese Journal of Behavior Analysis, 24, 82‐101.
Abstract: The present symposium was conducted at a seminar on and communication held on
July 12, 2008, at Hosei University in Tokyo. First, a comprehensive program for teachingcommunication skills to autistic children at Keio University was presented. Second, a family‐
support program provided by the University of Tsukuba to teach an autistic child using PECS athome was introduced. Third, a family and school support program based on functional
communication training provided by a private clinic (TASUC Ltd.) was described. Finally, thediscussant, Bondy, commented on each presentation on the basis of his expertise in providing
communication training for teachers and parents working with children with autism.

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Kuramitsu, A. Tyou, K. & Sonoyama, S. (2008). Shaping Mand Behavior by Home‐based
Communication Training Using PECS for a Child with Pervasive Developmental Disorder.
Japanese Journal of Disability Science, 32, 159‐171.
Abstract: In this study, we conducted Picture Exchange Communication System (PECS) training
for one non‐speaking child with pervasive developmental disorder, and examined the effect of
the acquisition and expansion of functional communication skills. An ecological assessment was
implemented to establish a training environment so as to encourage the child as regards mand
behaviors. The mother carried out the PECS training for the child as a home trainer. For the
training procedure, a series of actions required in daily life were grouped into a set of tasks byusing PECS. A task analysis was conducted with mand behavior using a picture card and asentence seat view to making each task group easy for the child to acquire. As a result the childquickly acquired mand skills with PECS. In addition, the mand skills using PECS were
demonstrated to the child’s father who was not a trainer, or in a non‐training setting at home.
It was suggested that an issue will remain related to an examination of the generalization ofmand skills by PECS in a setting other than meal times at home.
Lancioni, G., O’Reilly, M., Cuvo, A., Singh, N., Sigafoos, J. & Didden, R. (2007). PECS and VOCAs
to enable students with developmental disabilities to make requests: An overview of theliterature. Research in Developmental Disabilities, 28, 468‐488
Abstract: This paper provides an overview of the literature dealing with the use of the Picture
Exchange Communication System (PECS) and voice output communication aids (VOCAs) for
promoting the performance of requests by students with developmental disabilities.
Computerized and manual searches were carried out to identify the studies published during
the last 15 years (i.e., the period between 1992 and 2006 during which PECS and VOCA
approaches became popular). Thirty‐seven studies were identified and then divided into threegroups concerning the use of the PECS or equivalents, the use of VOCAs or equivalents, and thecomparison of both these approaches, respectively. Of the 173 students involved in studies
using the PECS or equivalents only three could be considered failures, while a fourth one did
not progress in the program due to illness. Similarly, of the 39 students who used VOCAs or
equivalents only three could be considered failures, while one was partly successful. Finally, ofthe 11 students involved in the comparisons between PECS and VOCAs none could be classified
as a failure. The results are very encouraging but methodological concerns and the relatively
limited use of the systems in terms of request items and request opportunities suggest caution.
Caution may also be needed in interpreting the reported similarities between the two systems
in usability and effectiveness.
Landa, R, & Hanley, G. (2016). An evaluation of multiple-schedule variations to reduce highrate requests in the picture exchange communication system. Journal of Applied Behavior
Analysis, 49, 1-6.
Abstract: Using procedures similar to those of Tiger, Hanley, and Heal (2006), we compared two
multiple-schedule variations (S+/S– and S+ only) to treat high-rate requests for edible items in
the Picture Exchange Communication System (PECS). Two individuals with autism participated,
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after they showed persistent requests for edible items after PECS training. Stimulus control wasachieved only with the multiple schedule that involved presentation of a discriminative stimulus
during reinforcement components and its removal during extinction components (S+ only).
Discriminated requests were maintained for the 1 participant who experienced schedulethinning.
lbis, J. & Reed, F. G. (2012). Modified stimulus presentation to teach simple discrimination
within Picture Exchange Communication System Training. Journal of Speech‐Language
Pathology and Applied Behavior Analysis, 5, 42‐46.
Abstract: Previous research has documented the effectiveness of the Picture Exchange
Communication System (PECS) to teach functional communication. These studies havegenerally focused on evaluating the PECS curriculum as it is written, but questions regarding
how best to modify stimulus materials to teach individuals with deficits in simple discrimination
remain unanswered. The present study examined the effectiveness of modified stimulus
presentation on the percentage of trials the preferred edible/icon was selected within a picture
exchange communication training program. Using an A‐B case study design, findings revealed
that modified stimulus presentation improved performance above baseline levels. Performance
was maintained three weeks post‐training. Limitations associated with the design of this study
are noted in the discussion, together with recommendations for further research.
Lerna, A., Esposito, D., Conson, M., Russo, L. & Massagli, A. (2012). Social– communicative
effects of the Picture Exchange Communication System (PECS) in Autism Spectrum Disorders.
International Journal of Language and Communication Disorders, 47, 609‐617.
Abstract: The Picture Exchange Communication System (PECS) is a common treatment choicefor nonverbal children with autism. However, little empirical evidence is available on theusefulness of PECS in treating social–communication impairments in autism. Aims: To test theeffects of PECS on social–communicative skills in children with autism, concurrently taking into
account standardized psychometric data, standardized functional assessment of adaptive
behaviour, and information on social–communicative variables coded in an unstructured
setting. Methods & Procedures: Eighteen preschool children (mean age = 38.78 months) wereassigned to two intervention approaches, i.e. PECS and Conventional Language Therapy (CLT).
Both PECS (Phases I–IV) and CLT were delivered three times per week, in 30‐min sessions, for 6
months. Outcome measures were the following: Autism Diagnostic Observation Schedule(ADOS) domain scores for Communication and Reciprocal Social Interaction; Language andPersonal–Social subscales of the Griffiths’ Mental Developmental Scales (GMDS);
Communication and Social Abilities domains of the Vineland Adaptive Behavior Scales (VABS);and several social–communicative variables coded in an unstructured setting. Outcomes &Results: Results demonstrated that the two groups did not differ at Time 1 (pre‐treatment
assessment), whereas at Time 2 (post‐test) the PECS group showed a significant improvementwith respect to the CLT group on the VABS social domain score and on almost all the social–communicative abilities coded in the unstructured setting (i.e. joint attention, request,
initiation, cooperative play, but not eye contact). Conclusions & Implications: These findings
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showed that PECS intervention (Phases I–IV) can improve social–communicative skills inchildren with autism. This improvement is especially evident in standardized measures ofadaptive behaviour and measures derived from the observation of children in an unstructured
setting.
Lerna, A., Esposito, D., Russo, L. & Massagli, A. (2009). The efficacy of the PECS for improving
the communicative, relational and social skills in children with autistic disorder: Preliminary
results. European Psychiatry, 24, Supplement 1.
Abstract: The aim in the current study was to investigate the efficacy of the PECS (Picture
Exchange Communication System) in a sample of children with Autistic Disorder (AD) in thedevelopment of the communication, alternating gaze and pointing in children with Autistic
Disorder (AD). The sample included 5 children diagnosed with AD (DSM‐IV‐TR), no verbal
language, followed by the team of the Rehabilitation Centre belonging to Scientific Institute “E.
Medea”, Association “La Nostra Famiglia” Branch of Ostuni (Italy). The children were tested on
their ability with neuropsychiatric, psycholinguistics and psychological assessment at the preand post of the trial. The treatment PECS has gone on for two years with a frequency of threetimes a week (45 minutes each one). The results show a significant increase in the number of
spontaneous requests, in the capacity of alternating gaze, pointing, vocalizing and verbalizing
on imitation. Finally the PECS seems to allow not only to develop a functional communication inAD, but also to increase social communicative behaviors of children with AD. Neverthelessfurther studies are necessary.
Liddle, K. (2001). Implementing the Picture Exchange Communication System (PECS).
International Journal of Language and Communication Disorders, 36, 391‐395.
Abstract: PECS was developed in Delaware, USA over 10 years ago by Bondy and Frost (1994a).
Over the last two years PECS has been introduced to this country and has raised a great deal ofinterest in people working in the field of autistic spectrum disorders (ASD). This paper willaddress some of the issues that arose during the establishment of PECS in one special school.
Changes seen in 21 children with severe learning difficulties who have been taught to use PECS
are reported and the use of PECS with children who do not have an ASD is discussed.
(http://www.tandf.co.uk/journals)
Lund, S.K. & Troha, J.M. (2007). Teaching Young People who are Blind and have Autism to
Make Requests Using a Variation on the Picture Exchange Communication System with Tactile
Symbols: A Preliminary Investigation. Journal of Autism Developmental Disorders, 38, 719‐730.
Abstract: This study used a single‐subject multiple baseline across participants design toevaluate the effectiveness of a modified picture exchange communication system (PECS)
teaching protocol with tactile symbols. Three students (two male, one female) aged 12‐17 years
who had autism and were blind participated in the study. The instructional program involved
three phases. First, each participant learned to exchange a tactile symbol with his/hercommunication partner to request a preferred item/activity. Second, the distance between thecommunication partner and the participant was increased. Third, the participants were40
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required to discriminate between two dissimilar tactile symbols. One out of three participants
completed all phases of the instructional program. Although the other two participants did notcomplete the program, they demonstrated improvement from baseline responding rates. This
study provided preliminary results that using tactile symbols with strategies from PECS may be
an effective method to teach requesting to youth who are blind and have autism.
Magiati, I. & Howlin, P. (2003). A pilot evaluation study of the Picture Exchange
Communication System (PECS) for children with autistic spectrum disorders. The International
Journal of Autism, 7(3): 297‐320.
Abstract: A pilot study was conducted to evaluate the effects of training teachers of children
with autistic spectrum disorders (ASDs) in the use of the Picture Exchange Communication
System (PECS). Thirty‐four children with ASDs (29 boys and 5 girls) were selected from eightspecialist schools. Teaching staff attended a 2 day PECS workshop and received six half‐day
visits from PECS consultants. Data on the children’s use of PECS, spontaneous communication,
and adaptive behaviour were collected before the study and at set times following theworkshop. Significant, rapid increases were recorded in the level of PECS attained by thechildren, in their PECS vocabulary, and in their frequency of PECS use over time. Improvementsin children’s general level of communication were slower to occur. The majority of participants
showed improvements in their ability to use PECS. The results are discussed in relation to themethodological and practical difficulties that arose during the project.
(http://www.sagepub.co.uk/home.nav)
Maglione, M., Gans, D., Das, L., Timbie, J. & Kasari, C. (2012). Nonmedical interventions forchildren with ASD: Recommended guidelines and further research needs. Pediatrics, 130, 169‐
178.
Abstract: OBJECTIVE: To use the findings of a systematic review of scientific evidence todevelop consensus guidelines on nonmedical interventions that address cognitive function andcore deficits in children with autism spectrum disorders (ASDs) and to recommend priorities for
future research. METHODS: The guidelines were developed by a Technical Expert Panel (TEP)
consisting of practitioners, researchers, and parents. A systematic overview of research findings
was presented to the TEP; guideline statements were drafted, discussed, debated, edited,reassessed, and presented for formal voting. RESULTS: The strength of evidence of efficacy
varied by intervention type from insufficient to moderate. There was some evidence that
greater intensity of treatment (hours per week) and greater duration (in months) led to better
outcomes. The TEP agreed that children with ASD should have access to at least 25 hours per
week of comprehensive intervention to address social communication, language, play skills, andmaladaptive behavior. They agreed that applied behavioral analysis, integrated
behavioral/developmental programs, the Picture Exchange Communication System, and various
social skills interventions have shown efficacy. Based on identified gaps, they recommend that
future research focus on assessment and monitoring of outcomes, addressing the needs of
pre/nonverbal children and adolescents, and identifying the most effective strategies, dose,and duration to improve specific core deficits. CONCLUSIONS: The creation of treatment
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guidelines and recommendations for future research represents an effort by leading experts toimprove access to services for children with ASDs while acknowledging that the research
evidence has many gaps. There is scientific evidence (from controlled trials and observational
studies) of the effectiveness of the Picture Exchange Communication System (PECS) in
increasing child‐to‐adult initiated communication, primarily requesting communication acts.
Studies range in length from 3 months to 2 years. At least half the studies did not reportintensity; in the studies that did report intensity, intensity ranged from 20 minutes, 3 times per
week, to a total of 15 hours per week. Guideline: Individuals with ASDs who have limited verbal
language, or those who do not respond to multiple interventions aimed at improving
communication, should be offered the opportunity to use the PECS. Monitoring and ongoingintervention are recommended to maintain gains in communication. Rating: B (80%)(http://pediatrics.aappublications.org/content/130/Supplement_2/S169.full.pdf+html)
Marckel, J.M, Neef, N.A. & Ferreri, S.J. (2006). A preliminary analysis of teaching improvisation
with the picture exchange communication system to children with autism. Journal of Applied
Behavior Analysis, 39, 109‐115.
Abstract: Two young boys with autism who used the picture exchange communication systemwere taught to solve problems (improvise) by using descriptors (functions, colors, and shapes)
to request desired items for which specific pictures were unavailable. The results of a multiple
baseline across descriptors showed that training increased the number of improvised requests,
and that these skills generalized to novel items, and across settings and listeners in the naturalenvironment.
Martocchio, N. & Rosales, R. (2016). An Evaluation of Pyramidal Training to Teach
Implementation of the Picture Exchange Communication System: Pyramidal training PECS.
Behavioral Interventions, 31, 265-282.
Abstract: The pyramidal training or train-the-trainer model is a method of training in which a
professional teaches a skill to a small group of individuals who then teach that skill to anotherset of individuals. This model has demonstrated efficacy to teach several behavioral
intervention techniques to parents, teachers, and direct care staff in a timely manner. The
purpose of the present study was to extend the literature on pyramidal training to teachimplementation of the first four phases of the Picture Exchange Communication System (PECS)
to university students working with a confederate learner. We used a multiple baseline acrossparticipants design (Tier 1 and 2) and a non-concurrent multiple baseline design (Tier 3) todemonstrate the efficacy of this model. Results replicate and extend the literature on pyramidal
training. Discussion focuses on implications and limitations to be addressed in future work.
McCleery, J. (2015). Comment on technology-based intervention research for individuals on theautism spectrum. Journal of Autism and Developmental Disorders, 45, 3832-3835.
Abstract: The purpose of this letter to the editor is to comment on several review papers
recently published in the current Journal of Autism and Developmental Disorders, Special Issue
on Technology: Software, Robotics, and Translational Science. These reviews address a variety
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of aspects relating to technology-aided intervention and instruction for individuals with Autism
Spectrum Disorders (ASDs). Here, I comment on and evaluate the overall status of research anddevelopment in this area, including reflection on current challenges in this area in the context
of previous challenges and resolutions in behavioral intervention research. From these reviews
and the current evaluation, I further discuss important next steps for the field which may be
critical for guiding progress toward meaningful impacts upon individuals with ASD.
McCleery, J., Elliott, N., Sampanis, D. & Stefanidou, C. (2013). Motor development and motor
resonance difficulties in autism: relevance to early intervention for language andcommunication skills. Frontiers in Integrative Neuroscience, 7,1‐20.
Abstract: Research suggests that a sub‐set of children with autism experience notabledifficulties and delays in motor skills development, and that a large percentage of children with
autism experience deficits in motor resonance. These motor‐related deficiencies, whichevidence suggests are present from a very early age, are likely to negatively affect social‐communicative and language development in this population. Here, we review evidence fordelayed, impaired, and atypical motor development in infants and children with autism. We
then carefully review and examine the current language and communication‐based
intervention research that is relevant to motor and motor resonance (i.e., neural “mirroring”
mechanisms activated when we observe the actions of others) deficits in children with autism.
Finally, we describe research needs and future directions and developments for earlyinterventions aimed at addressing the speech/language and social‐communication
development difficulties in autism from a motor‐related perspective.
McCoy, A. & McNaughton, D. (2018). Training education professionals to use the Picture
Exchange Communication System: a Review of the literature Behavior Analysis in Practice, 11,
1-10. https://doi.org/10.1007/s40617-018-00296-4
Abstract: The Picture Exchange Communication System (PECS) is a popular augmentative andalternative communication strategy. Like many communication interventions, the successful
use of PECS is dependent on the skills of the communication partner. This article provides asystematic review of the published research on teaching education professionals (EPs) to use
PECS. Training of EPs was usually conducted during individual or small group sessions andincluded a description of the PECS strategy, practice on implementation of PECS, and feedbackon performance. Instructional activities typically resulted in an immediate increase in thequality and/or quantity of PECS opportunities provided by the EP; however, mixed findings arereported for maintenance and generalization. Implications for future research and practice are
discussed.
McDonald, M., Battaglia, D. & Keane, M. (2015). Using fixed interval-based prompting toincrease a student’s initiation of the Picture Exchange Communication System. Behavioral
Development Bulletin, Oct 5.
Abstract: This report describes an AB case study in which a fixed interval-based prompting
procedure was used to support a child’s spontaneous approach to a Picture Exchange
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Communication System (PECS) book for selecting icons to request preferred items. The
participant was a 6-year-old student with autism spectrum disorder. Preferred items were
determined through formal preference assessments prior to the onset of the study.
Performance was monitored based on the percentage of spontaneous approaching andrequesting behaviors emitted during 10-min intervals throughout each day. Results revealed anincrease in requesting of preferred items from a mean of 12% during baseline to 43% during
intervention and 83% at a 6-month follow-up.
Mirenda, P. (2003). Toward functional augmentative and alternative communication forstudents with autism: Manual signs, graphic symbols, and voice output communication aids.
Language, Speech, and Hearing Services in Schools, 34, 203‐216.
Abstract: Many individuals with autism are candidates for augmentative and alternative
communication (AAC) systems, either to supplement (i.e., augment) their existing speech or toact as their primary (i.e., alternative) method of expressive communication. The purpose of thisarticle is to summarize research and directions for future research with regard to two questions
related to the delivery of AAC supports to these individuals: (a) What AAC modality ispreferable to use? And (b) What do we know about the use of voice output communication aidswith people with autism? (http://www.asha.org)
Montanari, S. Using picture exchange communication system with autistic children in a day
hospital: two years after training. Perspectives Psychology, OCT/DEC., 1-8. (France)
Abstract: Introduction: We had realized a study two years previously concerning the evaluationof the skills in communication of five autistic children during their learning of the picture
exchange communication system.
Objective: We suggest here reporting the evolution of these five children two years after theformation and to review the use of this method. Material and method: We proceeded toconversations semi-structured with nursing concerning the clinical evolution of the children,
their progress from the point of view of the communication as well as on the use which wasmade by the picture communication system at the day hospital. Results: On five children of theinitial search, three of them don’t use the picture exchange communication system anymore.
For the two other children, the use of the picture exchange communication system continues
but without emergence of verbal language or other visible progress on the big functions ofcommunication. The picture exchange communication system is especially used on the groupsof life and at the lunch time, the session of learning being difficult to set up. Conclusion: The
picture exchange communication system seems to constitute a foot adapted to the difficulties
of representation and abstraction of the autistic children. However, the children who use
perfectly the method but do not reach the verbal language shows its limits and the necessity ofexperimenting other approaches.

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Montanari, S., Vandromme, L. & Perot, JM. (2015). Perspective Psychology, Jul/Sep., 1-9.
(France).
Abstract: Introduction Among the interventions focused on the communication for the autistic
children, the Picture Exchange Communication System seems to lack the support of numerous
institutions and speech therapists although few fundamental studies and case studies reallyshow its efficiency. Within the framework of the introduction of the Picture Exchange
Communication System in a day hospital in Picardy, we were able to follow the implementationof this method. Objective: We wished to study the contributions of this new method on theskills in communication of five autistic children. Method: We estimated the skills incommunication of these five children thanks to the M Guidetti and C Tourette’s Early Social
Communication Scale and to the Schopler’s Childhood Autism Rating Scale at six months
interval. Results: Our results show progress for five children as regards the level of Picture
Exchange Communication System. Besides, we note a preservation or a progress in the resultsin the early Social Communication Scale for five children. The observed progress concerns threedomains of the seule (social interaction, joint attention and regulation of the behavior).
Conclusion: This preliminary study could be widened in a research on several day hospitals andpursued over time to evaluate if the use of the Picture Exchange Communication System indeed
has a long-term interest for the children.
Nam, S. & Hwang, Y. (2016). Acquisition of Picture Exchange-Based vs. Signed Mands and
Implications to Teach Functional Communication Skills to Children with Autism. Journal ofSpecial Education Apprenticeship, 5, 1-15
Abstract: A literature review was conducted to describe important concepts involved infunctional analysis of verbal behavior as well as to evaluates empirical research findings on
acquisition of picture exchange-based vs. signed mands to suggest instructional implications forteachers and therapists to teach functional communication skills to children with autism.
Research findings indicate that children with autism acquire picture exchange responses tomand for reinforcing items more easily and rapidly than signed responses. There is also a strong
relation between motor imitation, matching skills and sign language acquisition. It is suggested
that both motor imitation and matching skills be examined to teach manual signs to children
with autism. Speech is the most common response form, but writing, typing, signs, pictures,
gestures, or eye gaze should also be considered for manding. A decision making process is
proposed to determine a proper communicative form considering abilities and environmental
conditions of a child concerned.
Ninci, J., Rispoli, M., Neely, L. & Guz, S. (2018). Transferring picture exchange requests toreceptive identification for children with ASD. Developmental Neurorehabilitation, 21, 178-187.
Abstract: The purpose of this study was to evaluate a procedure to transfer stimulus control
from picture exchange requests to receptive identification. Three children with autism
spectrum disorder (ASD) and absent receptive identification repertoires participated. An
adapted alternating treatment design was used. During intervention, two high-preferred andtwo low-preferred targets were available during picture exchange requesting sessions.
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Participants requested primarily for one or both high-preferred targets. During receptive
identification instructional sessions, one participant acquired one high-preferred target, one
participant acquired all targets, and one participant demonstrated no improvements.
Generalization to novel examples of targets was assessed pre- and post-intervention andprogrammed if necessary. One participant generalized his acquired high-preferred target
without programming. Another participant generalized a high-preferred and a low-preferredtarget without programming and acquired a high-preferred target with programming. Potential
benefits of this intervention and suggestions for future research are presented.
Ogletree, B., Morrow‐Odom, K.L. & Westling, D. (2013). Understanding the brain-behaviour
relationship in persons with ASD: Implications for PECS as a treatment choice. Developmental
Neurorehabilitation, early online, 1‐9.
Abstract: This article presents emerging neurological findings in Autism Spectrum Disorders(ASD) with particular attention to how this information might inform treatment practices
addressing communication impairments. Methods: The article begins with a general discussionof the brain–behaviour relationship and moves to the presentation of recent research findings
related to ASD. There is particular attention to individuals with autism who are either nonverbal
or present emergent verbal abilities. Results/Discussion: A specific communication treatment,
the Picture Exchange Communication System (PECS), is presented as an example of anintervention that addresses the learner needs of many individuals with ASD. The success of
PECS is discussed within the context of its fit with brain‐based learner characteristics.
Okalidou, A., & Malandraki, G. (2007). The application of PECS in children with autism anddeafness: A case study. Focus on Autism and Other Developmental Disabilities, 22, 23‐32.
Abstract: The subject of this study is a 10‐year‐old non‐verbal Greek boy, who has been
diagnosed with both bilateral sensory‐neural profound hearing loss and autism. The Picture
Exchange Communication System (PECS), with some modifications and extensions, was applied
for a 4‐month intensive intervention period. His original communication and behavioral status
as well as the PECS application process are presented along with the communicative, language
and psychosocial outcomes following the entire intervention program. In addition, follow‐up
data are presented six months post‐intervention.
Ostryn, C., Wolfe, P. & Rusch, F. (2008). A Review and Analysis of the Picture Exchange
Communication System (PECS) for Individuals with Autism Spectrum Disorders Using a
Paradigm of Communication Competence. Research & Practice for Persons with Severe
Disabilities, 33, 13–24.
Abstract: Research related to the use of the Picture Exchange Communication System (PECS)
with individuals having autism spectrum disorders (ASDs) was examined using a communicationcompetence paradigm detailed by J. C. Light (1988, 1989, 2003). Communication components
were operationalized based on skills identified in ASD research. A review was conducted to
examine general PECS outcomes and outcomes related to communication competence
including generalized, spontaneous, and joint attention abilities, and maintenance. Results
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PECS Related Research (Updated: October 2020)

indicated that there were few empirical studies related to the PECS. Of note, the reported
studies indicated generally positive outcomes for individuals with ASDs, particularly related to
manding and generalization. When the communication competence paradigm was applied,
results indicated that, in its present form, the PECS needs to be used as a part of a multimodal
communication system. Results suggest that training related to the PECS includes joint
attention and question asking. Recommendations for the use of PECS and future research withindividuals having ASDs are outlined.
Overcash, A., Horton, C. & Bondy, A. (2010). The Picture Exchange Communication System:
Helping individuals gain functional communication. Autism Advocate, 3, 21‐24. Implementing
PECS in the home, community and generalizing PECS across settings and people.
Paden, A., Kodak, T. Fisher, W., Gawley‐Bullington, E. & Bouxsein, K. (2012). Teaching children
with autism to engage in peer‐directed mands using a picture exchange communication system.
Journal of Applied Behavior Analysis, 45, 425‐429.
Abstract: We evaluated differential reinforcement of alternative behavior (DRA) plus prompting
to increase peer‐directed mands for preferred items using a picture exchange communication
system (PECS). Two nonvocal individuals with autism participated. Independent mands with apeer increased with the implementation of DRA plus prompting for both participants. In
addition, peers engaged in brief social interactions following the majority of mands for leisureitems. These results suggest that teaching children to use PECS with peers may be one way toincrease manding and social interactions in individuals with limited or no vocal repertoire.
Park, J.H. (2009). The effects of mother‐implemented Picture Exchange Communication Systemtraining on spontaneous communicative behaviors of young children with autism spectrum
disorders. Doctoral Dissertation, Ohio State University.
Abstract: The current study examined whether mothers could be taught to implement the
picture exchange communication system (PECS) training with their child and investigated theeffects of the mother‐implemented PECS training on the spontaneous communication of young
children with autism spectrum disorders. Three mothers were trained to teach their child PECS
Phases 1 through 3B and subsequently were asked to train their child to use PECS as a way ofrequesting a preferred item or activity. Results on mother’s accuracy of implementing PECS
training showed that all three mothers taught their child PECS with high integrity. A changing
criterion design was used to demonstrate the effects of mother‐implemented PECS training onchildren. Results indicated that all three children successfully acquired independent picture
exchanges along with the mother‐implemented PECS training. Moreover, not only did all threechildren generalize PECS skills to an untrained communication partner, they also maintained
the acquired skills over one month. Word vocalizations increased for one child, though no or
limited improvement was observed for the other two. These findings extend the existing
evidence on PECS by training mothers as primary implementers of PECS training and provide
practitioners with insight into the feasibility and necessity of parent‐implemented PECS
training.
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PECS Related Research (Updated: October 2020)

Park, J.H., Alber‐Morgan, S. & Cannella‐Malone, H., (2011). Effects of Mother‐Implemented
Picture Exchange Communication System (PECS) Training on Independent Communicative
Behaviors of Young Children With Autism Spectrum Disorders Topics in Early Childhood Special
Education, 31, 37‐47.
Abstract: This study examined the effects of mother‐implemented Picture Exchange
Communication System (PECS) training on the independent communication of three young
children with autism spectrum disorders. Three mothers were trained to teach their child PECS
Phases 1 through 3B, which they did with high integrity. Moreover, all three children
successfully acquired independent picture exchanges that were generalized to a different
communication partner and maintained for at least 1 month. Vocalizations across participants
showed limited or no improvement. These findings systematically extend previous PECS
research by training mothers to be the primary implementers of PECS training. In addition, thisresearch provides practitioners with insight into the feasibility and necessity of parent‐
implemented PECS training.
Parker, A.T. (2009). Measuring an adapted form of Picture Exchange Communication System(PECS) for young children with visual impairments and developmental disabilities. Doctoral
Dissertation, Texas Tech University.
Abstract: The Picture Exchange Communication System (PECS) has been shown to build theexpressive communication skills for students with autism and those with developmental
disabilities. Traditional PECS teaching strategies rely upon an intact visual sense for accessing
pictures, line drawings, gestures or other visual supports from a communication partner torequest items, or make choices about desired objects in the environment. The use of 3‐D partsof objects may be useful in adapting the PECS protocol for individuals with visual impairments
and additional disabilities. This study examined the effects of an adapted form of PECS on thecommunication skills for three students with visual impairments and developmental delays.
Pasco, G. & Tohill, C. (2011). Predicting progress in Picture Exchange Communication System(PECS) use by children with autism. International Journal of Language and Communication
Disorders, 46, 120-125.
Abstract: Background:The Picture Exchange Communication System(PECS) is a widely usedcommunication intervention for non-verbal children with autism spectrum disorder. Findings
for the beneﬁts of PECS have almost universally been positive, although there is very limited
information about the characteristics of PECS users that determine the amount of progress thatthey are likely to make. Aims: To explore the utility of using children’s developmental age topredict the subsequent degree of progress using PECS. Methods & Procedures: In a
retrospective study, 23 non-verbal 5- and 6-year-old children with autism spectrum disorderattending a special school were assessed to determine their highest level of PECS ability. They
were then allocated to one of two groups depending on whether or not they had mastered
PECS phase III. All participants had been assessed using the Psycho-Educational Proﬁle—Revised (PEP-R) on entry to the school and before being introduced to PECS. Total
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developmental age scores were examined to determine whether they accurately predicted
membership of the two PECS ability groups. Outcomes & Results: All the 16 children who hadmastered PECS phase III had total developmental age scores of 16 months or above, whilst sixof the seven children who had not progressed beyond phase III scored below 16 months—theother child had a score of 16 months. Conclusions & Implications: The assessment of thedevelopmental level of potential PECS users may provide valuable predictive information forspeech-and-language therapists and other professionals in relation to the likely degree ofprogress and in setting realistic and achievable targets.
Peirats-Chacón, J. & Vidal-Esteve, I. (2016). Introducing PECS to overcome the communicative
limitations in a case of West syndrome, Journal of Psychology, 34, 71-80. (Spain)
Abstract: This case study tackles the intervention in a four year-old student schooled in a
specific class at an ordinary school who was recently diagnosed with West syndrome. Applying
during a quarter in a Hearing and Speech classroom The Picture Exchange Communication
System (PECS) was applied over a period of an academic quarter in the school’s Hearing andSpeech classroom with the goal of helping the student overcome the serious communicative
limitations associated with the syndrome. A mixed methodological procedure is used, withresearch techniques consisting of the application of standardized tests, interviews,
questionnaires, observations, records and document analysis. From the initial assessment of
the case, established by the test, the program is implemented and data are recorded daily, in
addition to interviewing the family and analysing documents and questionnaires filled out by
the teachers involved. The results show that while the reluctance of some teachers suggests theneed to improve coordination, this wasn’t an obstacle to the achievement of certain benefits interms of student interaction, request and eye contact, essential for communicative
achievement.
Peterson, S., Bondy, A., Glassberg, M. & Neef, N. (2002, May). The relationship of matchOgelto‐sample to visual discrimination skills utilized within PECS. Paper presented at the Annual
Association for Behavior Analysis Convention, Toronto, CA.
Peterson, S., Bondy, A., Vincent, Y. & Finnegan, C. (1995). Effects of alternating communicative
input for students with autism and no speech: Two case studies. Augmentative and Alternative
Communication, 11, 93‐100.
Abstract: Individuals with autism and severe mental retardation typically display deficits in bothcommunicative input and communicative output skills. Comprehension of spoken input may beparticularly challenging for individuals with autism, for a number of reasons. This paper
presents two case studies examining the impact of varying the form of communicative input on
behavior management targets as well as performance on an object identification task. Bothcases involved students with autism and no speech. One student responded with poor task
performance and high frequencies of self‐injury to spoken communication but not to gestures
alone or gestural plus spoken communication. The other student displayed a similar pattern oftask performance and showed an increased tendency toward disruptive behavior in response to
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spoken or spoken plus gestural communication only in high‐stress situations. Programmodifications (changes in the communication approaches of these students’ communicative
partners) are described. It is suggested that the impact of spoken communicative input on task
performance and behavior management targets of individuals with autism be probed in cases
where more straightforward programming issues have been addressed with only limited
success.
Peterson, S., Glassberg, M., Neef, N. & Bondy, A. (2002, May). PECS acquisition: Patterns ofskill development across four young children. Paper presented at the Annual Association for
Behavior Analysis Convention, Toronto, CA.
Preissler, M.A. (2008). Associative learning of pictures and words by low‐functioning children
with autism. Autism, 12, 231‐248.
Abstract: This research investigates whether children with autism learn picture, word andobject relations as associative pairs or whether they understand such relations as referential. In
Experiment 1, children were taught a new word (e.g. ‘whisk’) repeatedly paired with a novel
picture. When given the picture and a previously unseen real whisk and asked to indicate awhisk, children with autism, unlike typically developing peers matched on receptive language,associated the word with the picture rather than the object. Subsequent experiments
respectively confirmed that neither a bias for selecting pictures nor perseverative responding
accounted for these results. Taken together, these results suggest that children with autism
with cognitive difficulties are learning picture–word and picture–object relations via an
associative mechanism and have difficulty understanding the symbolic nature of pictures.
Preston, D, & Carter, M. (2009). A review of the efficacy of the Picture Exchange
Communication System Intervention. Journal of Autism and Developmental Disabilities, 39,
1471‐1486.
Abstract: The Picture Exchange Communication System (PECS) is a communication programthat has become widely used, especially with children with autism. This paper reports theresults of a review of the empirical literature on PECS. A descriptive review is provided of the 27
studies identified, which included randomized controlled trials (RCTs), other group designs andsingle subject studies. For 10 appropriate single subject designs the percentage of nonoverlapping data (PND) and percentage exceeding median (PEM) metrics were examined. While
there are few RCTs, on balance, available research provides preliminary evidence that PECS isreadily learned by most participants and provides a means of communication for individuals
with little or no functional speech. Very limited data suggest some positive effect on both social
communicative and challenging behaviors, while effects on speech development remain
unclear. Directions for future research are discussed including the priority need for further well‐conducted RCTs.

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Putri, C., Hastuti, W. & Adi, E. (2018). The influence the Picture Exchange Communication
System method toward the communication ability of Autistic child, Journal of ICSAR, 2, 1-6.
[Indonesia]
Abstract: Children with autism have some very complex developmental disorders including
communication, social interaction, emotions, and interest in certain behaviors. They needcertain tools and methods for developing communication and language skills, especially in
speaking skills. One of the methods is the Picture Exchange Communication System method.
This research was conducted by using the Single Subject Research method with A-B-A design.
Data collection was conducted in 20 sessions. The results of this study indicated that the effectof PECS method towards communication ability of children with autism. This was evidenced byan overlap percentage of 0%. The conclusion showed that PECS method has an effect towards
the communication ability of autistic children.
Rahman, F., Kayani, A. & Hanif, M. (2019). Digital embodiment of adapted version of the
Picture Exchange Communication System (PECS) for autistic children in Pakistan. Academic
Research International, 10, 101-105.
Abstract: In 1984 Lori Frost and Dr. Andrew Bondy developed PECS. PECS basically aids autistic
people in developing verbal language; moreover, it reduces grumpiness and anomalous
behaviors which results in increased socialization. By implementing the heuristic framework,
the researcher adapted pictures which were traditionally sensitive for Pakistan within the PECS.
The current experimental research aimed to utilize digital advancements for implementing theadapted version of PECS for autistic children in Pakistan to facilitate their communication andpersonification in the world. An experimental study on a sample of 5 autistic children was
conducted for the digital embodiment of adapted PECS. The sample of the research study
comprised of one experimental group. Convenience sampling technique was administered inorder to make the precise and accurate results. A paired t-test on sample and digital adapted
PECS showed significant results. Statistical package for social sciences (SPSS Version, 22.0) fordata analysis. As the study was experimental, so the main objective of the study was tohighlight the effectiveness and implementation of digital embodiment of adapted pictures
within the PECS. This study has produced a well-adapted digitally embodied PECS, suitable for
implementation for Pakistani Autistic Children. Results of this study confirmed that digital
embodiment of adapted PECS enhanced the perceptual and sensory skills of the autistic
children. The high level of correct identification percentage of adapted PECS through ipad,
depicts that no response percentage was lesser in digitally adapted PECS as compared to theadapted PECS on hard copy.
Rahman, F., Najmussaqib, A. & Kiani, A. (2016), Adaption of Picture Exchange Communication
System (PECS) for children with autism spectrum disorder: A case study of Pakistan. Science
International, 28, 451-454. (Pakistan).
Abstract: Management of Autism has been the subject of much academic research around theglobe in recent times. Autism affects the child’s communication, socialization and cognition.
From many decades Picture Exchange Communication System (PECS) has been successfully
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used for autistic children and evidenced significant positive results respectively. The present
study was aimed at exploring the awareness of the application of this system for autistic
children, to check the cultural appropriateness and comprehensibility of (PECS) in Pakistan. For
this purpose, a questionnaire and a focus group discussion was conducted with 150 participantsfrom special education institutions of five provinces i.e. Punjab, Baluchistan, Sindh,
Khyberpakhtunkha and Azad Jammu Kashmir of Pakistan. Results indicated that 50% of theparticipants are not aware of the system. Results also showed that there is a 100% need toadapt this system in Urdu language. Results are discussed in a cultural context proposing a needfor the adaptation of PECS for children with autism spectrum disorder in Pakistan.
Rauch, J., McLaughlin, T., Derby, K.M. & Rinaldi, L., (2012). Teaching a Non‐Verbal PreschoolStudent to Use a Modified Picture Exchange Communication System: Effects of Fading Prompts
on Rate of Communication and Generalization to a Communication Board. International Journalof Basic and Applied Science, 1, 320‐330.
Abstract: The purpose of this study was to evaluate the effects of a Picture Exchange
Communication System (PECS) and fading prompts to increase rate of communication and toteach generalization to a full communication board. One non‐verbal preschool student withmultiple developmental delays served as our participant. A combination ABCDEF single caseand multiple baseline experimental design was used. A refers to baseline or no intervention andthe additional letters evaluate the various interventions that were employed. This study
demonstrated that PECs and fading prompts was shown to be responsible for increasing bothspontaneous, independent communication and correct responses.
(http://www.insikapub.com/Vol‐01/No‐02/19IJBAS%281%29%282%29.pdf)
Rehfeldt, R. & Root, S. (2005). Establishing derived requesting skills in adults with severe
developmental disabilities. Journal of Applied Behavior Analysis, 38, 101‐105.
Abstract: This project examined whether a history of reinforced relational responding would
result in derived requesting skills in three adults with disabilities. Participants were first taught
to request preferred items using pictures [with PECS]; they were then taught conditional
discriminations between pictures and their dictated names and dictated names and theircorresponding text. Finally, requests for preferred items using corresponding text were
evaluated. All three participants demonstrated derived requesting skills.
Rosales, R. & Rehfeldt, R.A. (2007). Contriving transitive conditioned establishing operations toestablish derived manding skills in adults with severe developmental disabilities. Journal ofApplied Behavior Analysis, 40, 105-121.
Abstract: The purpose of this study was to demonstrate derived manding skills in 2 adults withsevere developmental disabilities and language deficits by contriving transitive conditioned
establishing operations. Specifically, we evaluated whether a history of reinforced conditional
discrimination learning would ultimately result in a derived mand repertoire, in which
participants manded for items that were needed to complete chained tasks. After mastering
the first three phases of the picture exchange communication system (PECS), participants were52
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taught to mand for the needed items by exchanging pictures of the items for the items
themselves. They were then taught to conditionally relate the dictated names of the items to
the corresponding pictures of the items and to relate the dictated names to the corresponding
printed words. We then tested, in the absence of reinforcement, whether participants would
mand for the items needed to complete the chained tasks using text rather than pictures. Bothparticipants showed the emergence of derived mands and some derived stimulus relations as aresult of this instruction. Some of the derived relations were shown to be intact at 1‐monthfollow‐up, and scores on derived mand probes were higher at follow‐up than before training. In
addition, the 2 participants vocally requested the needed items on maintenance test probes, askill that was never trained and was not previously in their repertoires. These results suggestthat a history of reinforced relational responding may facilitate the expansion of a number of
verbal skills and emphasize the possibility of a synthesis of Skinner’s (1957) analysis of verbal
behavior and derived stimulus relations into language‐training efforts for persons withsignificant disabilities.
Rosales, R., Stone, K. & Rehfeldt, R. A. (2009). The effects of Behavioral Skills Training on theimplementation of the Picture Exchange Communication System. Journal of Applied Behavior
Analysis, 42, 541‐9.
Abstract: The effectiveness of a behavioral skills training (BST) package to teach theimplementation of the first three phases of the Picture Exchange Communication System (PECS)
was evaluated with three adults who had no history teaching any functional communication
system. A multiple baseline across participants design was used to evaluate the effectiveness ofthe training package, which consisted of a video, written and verbal instructions, modeling,rehearsal, and feedback. Results showed significant improvements relative to baseline in ashort amount of training time, and that skills generalized to a learner with a severe
developmental disability. Skills were maintained at one-month follow‐up for one participant.
Schreibman, L. & Stahmer, A. (2014). A randomized trial comparison of the effects of verbal
and pictorial naturalistic communication strategies on spoken language for young children with
autism. Journal of Autism and Developmental Disorders, 44, 1244-1251.
Abstract: Presently there is no consensus on the specific behavioral treatment of choice fortargeting language in young nonverbal children with autism. This randomized clinical trial
compared the effectiveness of a verbally-based intervention, Pivotal Response Training (PRT) toa pictorially-based behavioral intervention, the Picture Exchange Communication System (PECS)
on the acquisition of spoken language by young (2–4 years), nonverbal or minimally verbal (≤9words) children with autism. Thirty-nine children were randomly assigned to either the PRT or
PECS condition. Participants received on average 247 h of intervention across 23 weeks.
Dependent measures included overall communication, expressive vocabulary, pictorialcommunication and parent satisfaction. Children in both intervention groups demonstrated
increases in spoken language skills, with no significant difference between the two conditions.
Seventy-eight percent of all children exited the program with more than 10 functional words.
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Parents were very satisfied with both programs but indicated PECS was more difficult toimplement.
Schreibman, L. & Stahmer, A. C. (2013). A Randomized Trial Comparison of the Effects of
Verbal and Pictorial Naturalistic Communication Strategies on Spoken Language for YoungChildren with Autism. Journal of Autism and Developmental Disabilities, DOI
10.1007/s10803013‐1972‐yAbstract: Presently there is no consensus on the specific behavioral treatment of choice fortargeting language in young nonverbal children with autism. This randomized clinical trial
compared the effectiveness of a verbally‐based intervention, Pivotal Response Training (PRT) toa pictorially‐based behavioral intervention, the Picture Exchange Communication System (PECS)
on the acquisition of spoken language by young (2–4 years), nonverbal or minimally verbal (B9words) children with autism. Thirty‐nine children were randomly assigned to either the PRT or
PECS condition. Participants received on average 247 h of intervention across 23 weeks.
Dependent measures included overall communication, expressive vocabulary, pictorialcommunication and parent satisfaction. Children in both intervention groups demonstrated
increases in spoken language skills, with no significant difference between the two conditions.
Seventy‐eight percent of all children exited the program with more than 10 functional words.
Parents were very satisfied with both programs but indicated PECS was more difficult toimplement.
NOTE: Words produced (MacArthur CDI raw number of words)
Pretreatment
PECS 5.3
PRT 11.9
83.2

Post Treatment (6 mn)
88.7
113.3

Follow‐up (3+ mn)
129.8

Both groups showed substantial increases in spoken word production for children with ASD with
10 or fewer spoken words at the start of training.
Schreibman, L. (2008). One Size Does Not Fit All: Developing individualized treatment protocols
for children with autism. The Association for Behavior Analysis Newsletter, 31 (3), 40‐43.
Schwartz, I. S., Garfinkle, A. N., & Bauer, J. (1998). Communicative outcomes for young
children with disabilities. Topics in Early Childhood Special Education, 18, 144–159.
Abstract: The Picture Exchange Communication System (PECS) has become a widely known andused augmentative system for teaching functional communication skills and potentiallyproviding a bridge to speech acquisition. Unfortunately, although there is a great deal of
anecdotal clinical evidence about the PECS, there is little empirical information about its
efficacy. We present two studies documenting the use of PECS for preschool children with54
PECS Related Research (Updated: October 2020)

severe disabilities. The first study analyzed the PECS acquisition data for 31 preschool children
and demonstrated that young children with severe communication delays and disorders canlearn to use PECS quickly and efficiently. The second study followed 18 preschool PECS users fora year. The results of language samples taken at snack time and during free‐choice activities
indicated that PECS use generalizes to untrained settings and may have concomitant effects on
untrained language functions. Directions for future research are discussed.
(http://www.proedinc.com)
Schwartz, J. & Nye, C. (2006). Improving Communication for Children with Autism: Does Sign
Language Work? Evidence Based Practice Briefs, 1,1‐17.
Summary: This review spotlights the glaring shortage of high quality research needed to informany discussion of the merits of teaching sign language to children with autism. In theintervening 18 years since Yoder and Layton (1988) called for experimental research on this
topic, little appears to have been accomplished. Thus, clinicians’ use of a sign language
approach to enhance the communicative competence of children with autism must be
considered in light of (a) the absence of conclusive group experimental design evidence tocorroborate the single subject design findings, and (b) the absence of a discussion ofintervention fidelity in all studies reviewed. From a programmatic and policy implementation
point of view, the single subject research offers limited support for the use of sign language forchildren with autism. Considering the overall quality of the available research we would suggestthat there are insufficient data to advocate for the use of sign language either alone on in
combination with oral language as a method for substantially improving communication inchildren with autism. Evidence‐Based Practice Recommendation: Evidence‐based practicerequires clinicians to integrate the scientific, objective, and quantifiable data available in the
research literature into the clinical decision‐making process. Evidence‐based practice should
allow professionals to consider a variety of sources of information in light of the client’s needs
and the situation of the individual being treated. In this review, the evidence on the use of sign
language with children with autism provides limited support for its concentrated application forchildren with autism, as there is little compelling evidence that sign language provides
substantial improvements in either oral or sign language communication. The modest effects
reported by single subject studies coupled with the absence of even a few well controlled groupstudies only serves to suggest that either (a) the research community views this area ofintervention as having limited usefulness, or (b) the clinical community has not found sign
language to be of a substantial a value so as to press for more and better research. This review
indicates that there is a need for high quality primary research that will provide the scientificbasis for the effective clinical application of sign language intervention for children with autism.
Sigafoos, J., Ganz, J., O’Reilly, M., Lancioni, G., & Schlosser, R. (2007). Assessing
correspondence following acquisition of an exchange‐based communication system. Researchin Developmental Disabilities, 28, 71–83.
Abstract: Two students with developmental disabilities were taught to request six snack items.
Requesting involved giving a graphic symbol to the trainer in exchange for the matching snack
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item. Following acquisition, we assessed the correspondence between requests andsubsequent item selections by requiring the student to select the previously requested snack
item from an array containing all six items. The effects of acquisition training were evaluated ina multiple‐probe across subjects design. Acquisition was achieved in from 9 to 29 trials per
item. Following acquisition, Jason showed a high level of correspondence between requestingand selecting, but Ryan required additional training to achieve correspondence. These data
support the use of exchange‐based communication systems, but suggest that some students
may require explicit correspondence training.
Sigafoos, J., Green, V., Payne, D., Son, S., O’Reilly, M. & Lancioni, G. (2009). A comparison of
picture exchange and speech‐generating devices: acquisition, preference, and effects on social
interaction. Augmentative and Alternative Communication, 25, 99‐109.
Abstract: Augmentative and alternative communication (AAC) includes picture exchange (PE)and speech‐generating devices (SGD), but these two systems have rarely been compared. We
therefore conducted three studies comparing PE and SGD for an adolescent boy with adevelopmental disability. Study 1 compared acquisition of a PE‐and SGD‐based requesting
response and monitored the effects on social interaction. For Study 2, both communication
modes were made simultaneously available and the child could choose to use either PE or the
SGD. For Study 3, only PE intervention continued, with the distance between the child andtrainer systematically increased to prompt social interaction. The results showed equally rapid
acquisition of the PE‐and SGD‐based requesting response, but only the distancing manipulation
had any positive effect on social interaction. We conclude that PE and SGD are equally viable
modes of communication, but acquisition of an initial PE‐or SGD‐based requesting response
may not be sufficient to promote social interaction.
Simacek, J., Pennington, B., Reichle, J. & Parker-McGowan, Q. (2017). Aided AAC for people
with severe to profound and multiple disabilities: A systematic review of interventions andtreatment intensity Advances in Neurodevelopmental Disorders, 2, 100-115.
https://link.springer.com/article/10.1007/s41252-017-0050-4
Abstract: Given the limited evidence, along with a rapidly evolving state of technology, researchis needed to drive effective and efficient communication intervention for people with severe toprofound and multiple disabilities. The purpose of the current review was to synthesize andevaluate the state of the aided, augmentative and alternative communication (AAC)
intervention literature for this population from 1997 to 2016. Results synthesized findings from25 studies (n = 59) on the extracted participant characteristics, intervention, and dosage
parameters from the studies. Results included an under-reporting of sufficient dosage
parameters in addition to implications for future directions in the areas of maintenance,
generalization, and discriminated use of skills, and bridging aided low and high-tech AAC
interventions.

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Simacek, J., Pennington, B., Reichle, J. & Parker-McGowan, Q. (2017). Aided AAC for people
with severe to profound and multiple disabilities: A systematic review of interventions andtreatment intensity. Advances in Neurodevelopmental Disorders, 2, 100115. https://doi.org/10.1007/s41252-017-0050-4
Abstract: Given the limited evidence, along with a rapidly evolving state of technology, researchis needed to drive effective and efficient communication intervention for people with severe toprofound and multiple disabilities. The purpose of the current review was to synthesize andevaluate the state of the aided, augmentative and alternative communication (AAC)
intervention literature for this population from 1997 to 2016. Results synthesized findings from25 studies (n = 59) on the extracted participant characteristics, intervention, and dosage
parameters from the studies. Results included an under-reporting of sufficient dosage
parameters in addition to implications for future directions in the areas of maintenance,
generalization, and discriminated use of skills, and bridging aided low and high-tech AAC
interventions.
Simon, E., Whitehair, P., & Toll, D. (1996). A case study: Follow‐up assessment of facilitatedcommunication. Journal of Autism & Developmental Disorders. 26 (1), 9‐18.
Abstract: A 6‐month follow‐up of an individual reported to engage in validated facilitatedcommunication (FC) is presented. Three main issues are addressed: the current status of theindividual’s FC use, the effect of food reinforcers on his communicative ability, and acomparison of FC to the Picture Exchange Communication System (PECS). Results indicated thatthe individual did not engage in any validated FC, that performance was equivalent on food andnonfood trials, and that PECS was the preferred mode of communication, yielding 100%
accuracy in a message‐passing, object identification task. Implications of these findings are
discussed in the context of an individual’s right to communicate by objectively validated
methods.
Smith, J., Hand, L., & Dowrick, P. (2014). Video feedforward for rapid learning of a picturebased communication system. Journal of Autism and Developmental Disorders, 44, 926-936.
Abstract: This study examined the efficacy of video self modeling (VSM) using feedforward, toteach various goals of a picture exchange communication system (PECS). The participants were
two boys with autism and one man with Down syndrome. All three participants were nonverbal with no current functional system of communication; the two children had long histories
of PECS failure. A series of replications, with different length baselines, was used to examine
whether video self modeling could replace the PECS method of teaching to achieve the same
goals. All three participants showed rapid learning of their target behavior when introduced totheir self modeling videos, and effects generalized without the need for further intervention.
We conclude that VSM, using feedforward, can provide a fast, simple way of teaching the use ofa picture-based communication system without the need for prompts or intensive operant
conditioning. VSM may provide an accessible, easy-to-use alternative to common methods ofteaching augmentative and alternative communication systems.
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Stahmer, A. & Ingersoll, B., (2004). Inclusive programming for toddlers with autism spectrum
disorders: Outcomes from the Children’s Toddler School. Journal of Positive Behavior
Interventions, 6, 67‐84.
Abstract: The passage of the Individuals with Disabilities Education Act of 1990 mandated theprovision of interventions for young children with autism spectrum disorders (ASD) under theage of 3 years. Although Strain, McGee, and Kohler (2001) suggested that children with autism
benefit from inclusive programming, inclusive early intervention programs are rare. In thecurrent study, the authors used a quasi‐experimental design to analyze the outcomes for 20
young children with ASD in an inclusive program for children under age 3. Both outcomes on
standardized assessments and functional outcomes were compared at program entry and exit.
Significant increases in standard scores were found for the standardized assessments fromintake to exit, with 37% of the children functioning in the typical range at exit, compared to
11% at entry. Significant improvements in performance on functional measures were also seen.
At intake, 50% of the study participants had no functional communication skills, whereas atexit, 90% used a functional communication system. Social and play behaviors also increased
substantially. Use of augmentative communication systems and a combination of research‐based programming are discussed. (NOTE: see pages 76‐77 in particular re: PECS‐“Two of thechildren on the PECS system began to use spoken language consistently, and they discontinued
use of the PECS system. The use of an augmentative system thus did not appear to impair theacquisition of spoken language for these children, as has been previously suggested (McGee etal., 1999).
Stahmer, A., Schreibman, L. & Cunningham, A. (2010). Toward a technology of treatment
individualization for young children with autism. Brain Research, 1380, 229‐239.
Abstract: Although the etiology of autism spectrum disorders (ASD) and early development of
the ASD are not yet well understood, recent research in the field of autism has heavily
emphasized the importance of early intervention (i.e. treatment before the age of 4 years).
Currently, several methods have been demonstrated to be efficacious with some children
however no treatment completely ameliorates the symptoms of ASD or works for all children
with the disorder. The heterogeneity and developmental nature of the disorder make it unlikelythat one specific treatment will be best for all children, or will work for any one childthroughout his or her educational career. Thus, this paper examines early research validating
different technologies for individualizing treatment. A discussion of current research on
pretreatment characteristics associated with differential outcomes in treatment, includingchild, family, and practitioner variables; and how specific intervention techniques address eachof those pre‐treatment characteristics is provided. The ultimate goal of this line of research is toenable practitioners to prospectively tailor treatments to specific children and increase theoverall rate of positives outcomes for children with autism. Research that furthers
understanding of how to match clients with efficacious treatments will decrease the outcome
variability that characterizes early intervention research at present, and provide for the mostefficient allocation of resources during the critical early intervention time‐period. This type of
research is in its infancy, but is imperative if we are to determine a priori which treatment
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method will be most effective for a specific child. Section involving PECS research: “A recent
study evaluated the differential effectiveness of two communication training strategies
commonly used to teach early communication skills to nonverbal and minimally verbal young
children with ASD (Cunningham et al., 2008). Specifically, this randomized trial addressed thedifferential effects of a language‐based approach (PRT) and a visually based approach (thePicture Exchange Communication System, PECS; Bondy and Frost, 2001) on the communication,social, and cognitive functioning of 34 very young (i.e., 2–4 years‐old), minimally verbal children
with ASD. Both programs were found to result in substantial spoken language gains forapproximately 50% of the children. While early word use was highly predictive of verbal gains inboth treatment conditions, it was not predictive of augmentative communication gains.
Children with some words (i.e. 1–9 words at intake) were equally likely to develop verbal
communication skills in PECS or PRT. Children entering treatment with no words were unlikely
to develop spoken language. However, over 80%of the PECS participants developed substantial
augmentative communication skills. These preliminary results indicate that word use at intake
may be an important and parsimonious child variable to consider when deciding between
verbal and augmentative communication programs for very young children with ASD.” p. 225
Stoner, J., Beck, A., Bock, S., Hickey, K., Kosuwan, K., & Thompson, J. (2006). The effectivenessof the Picture Exchange Communication System with nonspeaking adults. Remedial and Special
Education, 27, 154‐165.
Abstract: Picture Exchange Communication System (PECS) training was implemented with 5
nonspeaking adults with mental retardation who were not currently using any type offunctional communication system. A modified ABAB, single‐subject design was used to assess
the effectiveness of PECS in enhancing the functional communication skills of these individuals.
Three individuals progressed through 4 PECS training phases relatively quickly and developed
functional skills that they were able to display in home and community settings. Two otherindividuals demonstrated limited progress, and the PECS training did not meaningfully alter
their level of communicative competence. Implications for teaching functional communication
skills to nonspeaking adults are discussed, and recommendations for future research areprovided.
Suchowierska, M., Rupinska, M. & Bondy, A. (2013). Picture Exchange Communication System(PECS): A short “tutorial” for doctors. Postępy Nauk Medycznych, t. XXVI, nr 1. 95‐92.
Abstract: Summary: One area of persistent difficulties for children with autism iscommunication, with about 25% of individuals with autism not developing spoken language atall. In light of this information, it is of paramount importance to have means of teaching thoseindividuals how to pass to others information about their needs and wants in a sociallyappropriate and easily understood manner. Picture Exchange Communication System (PECS) isan empirically validated alternative and augmentative communication method. In the present
article we will provide a brief tutorial on PECS that may be of help to health care professionals
who in their work come across children with autism. In conclusion, PECS is a method that has
been created specifically for individuals who have language development difficulties. It is based
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on applied behavior analysis and thus is supported by strong theoretical foundation – mainly
Skinner’s analysis of verbal behaviour – and empirical research. The system itself has been
evaluated in a number of separate studies as well as few meta‐analyses. The overall conclusion
is that PECS is an effective, evidence‐based method that teaches children how to communicate
effectively and efficiently. It also reduces rates of problem behavior and for some children isassociated with speech development. For interested individuals, more information on PECS canbe found at: www.pecs.com.
Sulzer‐Azaroff, B., Hoffman, A., Horton, C., Bondy, A., & Frost, L. (2009). The Picture Exchange
Communication System (PECS): What Do the Data Say? Focus on Autism, 24, 89-103.
Abstract: Originally designed to enable young children with autism lacking functional
communication to initiate requests and to describe what they observed, the Picture Exchange
Communication System (PECS) has been the subject of an ever‐expanding body of research anddevelopment. Thirty‐four peer‐reviewed published reports on PECS are analyzed in this article
with documentation of research questions, methodology, and results. Findings suggest that
PECS is providing people around the globe who have no or impaired speech with a functional
means of communication. Refinements in methodology and additional questions that might be
addressed in future research are discussed.
Tincani, M. (2004). Comparing the Picture Exchange Communication System and sign language
training for children with autism. Focus on Autism and Other Developmental Studies, 19, 152‐
163.
Abstract: This study compared the effects of Picture Exchange Communication System (PECS)
and sign language training on the acquisition of mands (requests for preferred items) ofstudents with autism. The study also examined the differential effects of each modality on
students’ acquisition of vocal behavior. Participants were two elementary school students with
autism enrolled in a suburban public school. Training sessions involved presentations ofpreferred items, prompting and prompt fading procedures. Probes were conducted to evaluate
the generalization of learned mands to classroom teachers. For one participant, sign language
training produced a higher percentage of independent mands. PECS training produced a higher
percentage of independent mands for the other participant. For both participants, sign
language training produced a higher percentage of vocalizations during training. Mands learned
with the experimenter generalized to classroom teachers. The results of the study suggest that
acquisition of picture exchange and sign language may vary as a function of individual student
characteristics, specifically, motor imitation skills prior to intervention. However, further
research is needed to determine the optimal procedures for teaching both modalities tostudents with communication difficulties. (http://www.proedinc.com)
Tincani, M., Crozier, S. & Alazetta, L. (2006). The Picture Exchange Communication System:
Effects on manding and speech development for school‐aged children with autism. Education
and Training in Developmental Disabilities, 41, 177–184.
Abstract: We examined the effects of the Picture Exchange Communication System (PECS; Frost
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& Bondy, 2002) on the manding (requesting) and speech development of school‐aged children
with autism. In study 1, two participants, Damian and Bob, were taught PECS within a delayed
multiple baseline design. Both participants demonstrated increased levels of manding after
implementation of PECS. Only Damian demonstrated any measurable speech during study 1.
His speech development occurred primarily during phase IV of PECS. Because of the positive
relationship between Phase IV and increased speech for Damian, study 2 was conducted toconfirm a functional relationship between phase IV procedures and speech development for an
additional participant. Carl received phase IV training procedures in two conditions,administered in an ABAB design. In condition A, no reinforcement was provided for
vocalization; in condition B, reinforcement was provided for vocalization after a delay of 3‐to
5s. The vocal reinforcement procedures in phase B differentially increased Carl’s speech.
Results are discussed in terms of research on augmentative and alternative communication andspeech development for children with autism.
Tien, K‐C. (2008). Effectiveness of the Picture Exchange Communication System as a functional
communication intervention for individuals with Autism Spectrum Disorders: A practice‐based
research synthesis. Education and Training in Developmental Disabilities, 43, 61‐76.
Abstract: This research synthesis verifies the effectiveness of the Picture Exchange
Communication System (PECS) for improving the functional communication skills of individuals
with autism spectrum disorders (ASD). The research synthesis was focused on the degree towhich variations in PECS training are associated with variations in functional communication
outcomes (Dunst, Trivette & Cutspec, 2002). The communication consequences of PECS were
examined in 13 studies, which included 125 participants with ASD who had been identified ashaving limited or no functional communication skills. Claims that PECS is an effective
intervention for improving functional communication skills appeared to be supported by theavailable research evidence.
Tincani, M. & Devis, K. (2010). Quantitative synthesis and component analysis of single‐
participant studies on the Picture Exchange Communication System. Remediation and Special
Education (Online First), 1‐13.
Abstract: The Picture Exchange Communication System (PECS) has emerged as theaugmentative communication intervention of choice for individuals with autism spectrum
disorder (ASD), with a supporting body of single‐participant studies. This report describes ameta‐analysis of 16 single‐participant studies on PECS with percentage of non‐overlapping data
(PND) as the metric of effect size. Results suggest that PECS was moderately effective inestablishing mands (PND = 80.1) for 41 participants up to Phase IV of the system. Higher levelsof manding were found when PECS was taught to individuals without ASD diagnoses versus
those with ASD diagnoses and in single settings versus multiple settings; however, thesedifferences were not statistically significant. For a smaller subset of participants for whom
vocalizations were recorded, PECS appeared to facilitate speech, though considerable variabilityin speech acquisition was evident. While these results support PECS as an evidenced‐based
communication intervention, they indicate that more research is needed on speech with PECS,
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to establish the efficacy of PECS when implemented across settings and communicative
partners, and to confirm efficacy of Phases IV, V, and VI.
Travis, J. & Geiger, M. (2010). The effectiveness of the Picture Exchange Communication
System (PECS) for children with autism spectrum disorder (ASD): A South African pilot study.
Child Language Teaching and Therapy, 26, 39‐59.
Abstract: This study investigated the effects of introducing the Picture Exchange
Communication System (PECS) on the frequency of requesting and commenting and the lengthof verbal utterances of two children with autism spectrum disorder (ASD) who presented withsome spoken language, but limited use of language in communicative exchanges. A mixed
research design was used, including a quantitative component — a single‐subject multiple‐
baseline design (MBD) across three behaviours, repeated with two participants — and aqualitative component. Data was collected in the PECS pre‐training, training, post‐training andfollow‐up stages, in both structured and unstructured settings. The quantitative data wasvisually represented and analysed to determine the effectiveness of the PECS. The qualitative
component investigated the impact of the PECS on other areas (e.g. communication profile,
speech complexity and pragmatic skills), and included parent and educator perspectives. Bothparticipants benefited from the introduction of PECS. The findings indicated highly effective
treatment for requesting and mixed results for commenting and length of verbal utterances.
There were considerable increases in intentional communicative acts (ICAs) for bothparticipants, with marked increases in requesting (function) and the development of forms ofcommunication (from augmentation of speech with pictures to speech only utterances).
Clinical, educational and research implications were raised.
Tincani, M. & Devis, K. (2011). Quantitative synthesis and component analysis of single‐
participant studies on the Picture Exchange Communication System. Remedial and Special
Education, 32, 458‐470.
Abstract: The Picture Exchange Communication System (PECS) has emerged as theaugmentative communication intervention of choice for individuals with autism spectrum
disorder (ASD), with a supporting body of single‐participant studies. This report describes ameta‐analysis of 16 single‐participant studies on PECS with percentage of nonoverlapping data
(PND) as the metric of effect size. Results suggest that PECS was moderately effective inestablishing mands (PND = 80.1) for 41 participants up to Phase IV of the system. Higher levelsof manding were found when PECS was taught to individuals without ASD diagnoses versus
those with ASD diagnoses and in single settings versus multiple settings; however, thesedifferences were not statistically significant. For a smaller subset of participants for whom
vocalizations were recorded, PECS appeared to facilitate speech, though considerable variabilityin speech acquisition was evident. While these results support PECS as an evidenced‐based
communication intervention, they indicate that more research is needed on speech with PECS,
to establish the efficacy of PECS when implemented across settings and communicative
partners, and to confirm efficacy of Phases IV, V, and VI.
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Turan, M., Moroz, L. & Paquet-Croteau, N. (2012). Comparing the effectiveness of errorcorrection strategies in discrete trial training. Behavior Modification, 36 (2), 218-234.
Abstract: Error-correction strategies are essential considerations for behavior analysts
implementing discrete trial training with children with autism. The research literature, however,is still lacking in the number of studies that compare and evaluate error-correction procedures.
The purpose of this study was to compare two error-correction strategies: Independent Probeand Delay across learners with autism in an intensive intervention program. Two studies wereconducted. The first study compared the two procedures across receptive tasks for 3
individuals, and differential effects were seen across learners. The second study compared thetwo procedures across tact trials with two of the same learners and found that individual
differences were noted, but in addition, the more effective error-correction strategy wasconsistent across the two verbal operants (i.e., receptive in Study 1, tacts in Study 2). These
combined studies suggest the effectiveness of error-correction strategies may be
individualized to the learner but may generalize across operants
Thiemann-Bourque, K. Brady, N., McGuff, S., Stump, K & Naylor, A. (2016). Picture Exchange
Communication System and Pals: A Peer-Mediated Augmentative and Alternative
Communication Intervention for Minimally Verbal Preschoolers With Autism. Journal of Speech,
Language, and Hearing Research, 59, 1133–1145.
Abstract: Purpose: This study was conducted to investigate the effectiveness of a social
intervention that integrates peer-mediated approaches and the Picture Exchange
Communication System (PECS).
Method: Effects were evaluated using a series of A-B designs replicated across 4 children withsevere autism and limited verbal skills. Seven peers without disabilities were trained to use
PECS and facilitative social skills. Measures of changes included rates of communication
behaviors, modes, functions, and engagement.
Results: Outcomes revealed an intervention effect for 1 child with autism, and this effect was
replicated across 3 other children. All children improved in peer-directed communication, withgreater increases for 2 children during snack time. For each child with autism, the primarycommunication behavior was to initiate with picture symbols to request; the peer’s primarycommunication was to respond. Two children increased communicative functions to commentand to share, and all 4 children showed improved social engagement. All peers increased theircommunication with the children with autism.
Conclusions: These findings add to the limited research on the benefits of teaching typicallydeveloping peers to be responsive listeners to preschoolers with autism by learning to use
PECS. These results invite further investigation of teaching peers other augmentative andalternative communication approaches and how to increase children’s communication withpeers for different purposes.

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Travers, J., Tincani, M, Thompson, J. & Simpson, R. (2016). Picture Exchange Communication
System and Facilitated Communication: Contrasting an Evidence-Based Practice with a
Discredited Method, in Bryan G. Cook , Melody Tankersley , Timothy J. Landrum (ed.)
Instructional Practices with and without Empirical Validity (Advances in Learning and Behavioral
Disabilities, Volume 29) Emerald Group Publishing Limited, pp.85 – 110
Abstract: Learners with autism require specialized education and supports to ensure acquisition
and mastery of various communication skills. This is particularly true for individuals whose
disability significantly impacts their language development. Without functional communication,these individuals often engage in severe behavior, have reduced self-determination, andexperience diminished quality of life. Accordingly, researchers in special education and related
fields have sought ways to improve the communication skills of learners with autism who needspecialized language and communication interventions. Although the Picture Exchange
Communication System (PECS) is well-established in the empirical literature and has helped
countless individuals learn to communicate, the method known as facilitated communication(FC; which also is being called “supported typing” and “rapid prompting method”) has become
increasingly popular in recent years. Few methods in special education have been as thoroughly
discredited as FC and perhaps none are as dangerous. This chapter contrasts the thoroughly
debunked FC and its pseudoscientific characteristics with those underpinning PECS. A brief
historical account of each method is provided along with key scientific and pseudoscientificfeatures that distinguish science from pseudoscience. Ultimately, our intent is to further clarify
how FC is not an augmentative or alternative communication method and why PECS is.
Webb, T. (1999). Look who’s talking! Special Children, April/May.
Abstract: The author who is a teacher at Avalon Special School, Street, Somerset, introduced
PECS to a class of 6, 4/5 year old children, with severe communication difficulties, and of whom
5 have autistic spectrum disorders. The work started mid‐September 1998 and within weeks all
children who were previously at a pre‐verbal level, were verbalising, and now five months on
are using spoken language to communicate spontaneously with and without the use ofsymbols/words.
Webb, T. (2000a) Can children with autism be taught to communicate using PECS? Good Autism
Practice (GAP), 1, 29‐43.
Abstract: This paper reports one of the first studies to be conducted in the UK on the impact of
PECS on children with an autism spectrum disorder and severe learning difficulties. Teresa
Webb is a teacher at a special school for children with severe and multiple learning difficulties.
In September 1998, she introduced PECS to a class of six children aged between 4 and 6 years.
All, but one, had an ASD and all had severe communication difficulties. In her opinion, PECS has
had a major effect on the children’s skills and behaviour and has also influenced how staff
work. The parents too report big improvements in their child’s communication skills and visitors
to the school have been impressed by what they see. Clearly, the conclusions that can be drawn
from the study are limited in that there was no comparison group of children who did not
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receive PECS or who were engaged in a different intervention and so further research is
required. http://www.corelearning.co.uk/gap/index.asp
Webb, T. (2000b). The talking goes on ‐The Picture Exchange Communication System. Special
Children, June/July 2000.
Abstract: This article reviews the progress of a group of children 19 months after being
introduced to PECS which was reported in Special Children 1999. The group have progressedfrom using 3‐5 word sentences incorporating attributes to spontaneously requesting andcommenting both with and without PECS. As speech developed the teacher continued to use
PECS as a framework for teaching further communicative functions and a range of curriculum
subjects. The familiar framework enabled the assimilation of new concepts and ideas moreeasily, and they were able to ask and respond to a range of questions. They progressed to moreadvanced requesting and commenting lessons and used the conjunction ‘and’ and theindefinite article ‘a’ within 13 word sentences. There was increasing evidence of generalisation
as the taught structures were used spontaneously at home, which underlines the importance ofensuring the same vocabulary is available in all environments. Gradually, the children wereobserved using commenting spontaneously both with and without PECS, and the skill extended
into narrative and description. The author used PECS right across the day, which enabledlanguage to be integrated with the social and environmental context and enabled the mappingof language onto experiences. The development of functional communication impacted on
reducing contextually inappropriate behaviours. In fact it also raised the question of whose
behaviour changed the most, the children’s or the staff? Staff found that by using PECS they
could eliminate prompts, allow time to observe, facilitate children to respond and self‐correct,
and as a result peer interaction and independence was able to develop.
Webb, T., Baker, S. & Bondy, A. (2005). Picture Exchange Communication System. In L.
Wankoff (Ed.) Innovative Methods in Language Intervention. (pp. 111‐139). Austin, TX: Pro‐Ed
Inc.
Abstract: Book chapter, based on work by Teresa Webb and Sue Baker in a class in the UK.
Wendt, O., Hsu, N., Simon, K., Dienhart, A. & Cain, L. (2019). Effects of an iPad-based speechgenerating device infused into instruction with the Picture Exchange Communication System foradolescents and adults with severe autism spectrum disorder. Behavior Modification, 43 (6),898-932.
Abstract: This study used a multiple baseline, single-subject research design to investigate theefficacy of an iPad®-based speech-generating device (SGD). The iPad was equipped with the
SPEAKall!® application to function as a SGD. SGDs are a form of aided augmentative andalternative communication (AAC) allowing a user to communicate using digitized and/or
synthesized speech. Instruction followed a modified version of the intervention phases fromthe Picture Exchange Communication System (PECS). This modified PECS protocol was
implemented with two adolescents and one young adult between the ages of 14 and 23. All
three participants were diagnosed with severe autism spectrum disorder and little to no65
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functional speech. Dependent measures included the ability to request for edible and tangible
items as the primary measure, and the ability to engage in natural speech production as anancillary measure to determine simultaneous, additive effects on speech acquisition. Results
indicated increases in requesting behaviors for all three participants across intervention andmaintenance phases. Once participants mastered requesting of edible items, they were able togeneralize the skill to tangible items. However, mixed results were found when targeting
natural speech production. Based on the current findings, the infusion of an iPad-based SGD
into PECS instruction may be effective in increasing initial requesting skills; however, afacilitative effect on increasing speech acquisition cannot necessarily be expected for every
participant.
Whitby, P., Kucharczyk, S. & Lorah, E. (2019). Teaching object exchange for communication toa young girl with autism spectrum disorder and visual impairment. Journal of Visual Impairment
and Blindness, 113, 372-380.
Abstract: AAC systems such as the Picture Exchange Communication System (Frost & Bondy,
2002) are found in evidence-based literature for learners with ASD. Adapting such systems forlearners with comorbid conditions extends access of these practices to children and youths who
could benefit and extends the research literature. Overall, object exchange was an effective
intervention for Laura and her family.
Wood, A. L. Luiselli, J. K. Harchik, A. E. (2007). Training Instructional Skills with
Paraprofessional Service Providers at a Community‐Based Habilitation Setting. Behavior
Modification, 31, 847‐855.
Abstract: The present study evaluates a training program with paraprofessional service
providers at a community‐based habilitation setting. Four staff were taught to implement
alternative and augmentative communication instruction with an adult who had autism andmental retardation through a combination of instruction, demonstration, behavior rehearsal,
and performance feedback. Training was conducted under natural conditions at the adult’sgroup home residence. Three of the four staff were able to maintain near‐100% instructional
accuracy following initial training. The results add to the limited research literature concerning
community‐based training of direct‐care personnel.
Yoder, P. & Lieberman, R. (2010). Brief Report: Randomized Test of the Efficacy of Picture
Exchange Communication System on Highly Generalized Picture Exchanges in Children with
ASD. Journal of Autism and Developmental Disorder, 40, 629‐632.
Abstract: A randomized control trial comparing two social‐communication interventions inyoung children with autism examined far‐transfer of the use of picture exchange tocommunicate. Thirty‐six children were randomly assigned to one of two treatment conditions,one of which was the Picture Exchange Communication System (PECS). All children had accessto picture symbols during assessments. Post‐treatment measurement of the number of picture
exchanges in a far‐transfer, assessment context favored the PECS intervention. These findings
were interpreted as support for the hypothesis that the PECS curriculum can successfully teach66
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a generalized means of showing coordinated attention to object and person without requiring
eye contact to children with ASD.
Yoder, P. & Stone, W. (2006). Randomized comparison of the effect of two prelinguistic
communication interventions on the acquisition of spoken communication in preschoolers With
ASD. Journal of Speech, Language, and Hearing Research, 49, 698‐711.
Abstract: This randomized group experiment compared the efficacy of 2 communicationinterventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture
Exchange Communication System [PECS]) on spoken communication in 36 preschoolers with
autism spectrum disorders (ASD). Each treatment was delivered to children for a maximum
total of 24 hr over a 6‐month period. Spoken communication was assessed in a rigorous test ofgeneralization at pretreatment, post‐treatment, and 6‐month follow‐up periods. PECS was
more successful than RPMT in increasing the number of nonimitative spoken communicationacts and the number of different nonimitative words used at the post‐treatment period.
Considering growth over all 3 measurement periods, an exploratory analysis showed thatgrowth rate of the number of different nonimitative words was faster in the PECS group than in
the RPMT group for children who began treatment with relatively high object exploration. In
contrast, analogous slopes were steeper in the RPMT group than in the PECS group for children
who began treatment with relatively low object exploration.
Yoder, P. & Stone, W. (2006). Randomized comparison of two communication interventions forpreschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 74,
426‐35.
Abstract: This randomized group experiment compared the efficacy of 2 communicationinterventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture
Exchange Communication System [PECS]) in 36 preschoolers with autism spectrum disorders.
Each treatment was delivered 3 times per week, in 20‐min sessions, for 6 months. The results
revealed that the RPMT facilitated the frequency of generalized turn taking and generalized
initiating joint attention more than did the PECS. The latter effect occurred only for children
who began treatment with at least some initiating joint attention. In contrast, the PECS
facilitated generalized requests more than the RPMT in children with very little initiating joint
attention prior to treatment. These effect sizes were large.
Yokoyama, K., Naoi, N., & Yamamoto, J. (2006). Teaching verbal behavior using the Picture
Exchange Communication System (PECS) with children with autistic spectrum disorder.
Japanese Journal of Special Education, 43, 485‐503.
Abstract: The Picture Exchange Communication System (PECS) is widely used with non‐verbal
children with autistic disorders as an Augmentative and Alternative Communication (AAC).
Most of the participants in prior research on that method, although referred to as non‐verbal,
had initial vocal repertoires of at least a few words. The purpose of the present study was to
examine whether 3 elementary‐school‐age children with autistic disorders whose vocal
repertoires were severely limited, such as only a few phonemes, could acquire elementary
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communication skills using PECS. The present study incorporated task analysis, in which asequence of picture‐exchanging behaviors was divided into 4 components. The results
demonstrated that all 3 children acquired the basic components of PECS within a short period.
Data from the task analysis revealed that, with increased use of PECS, their prior mode ofcommunication (grabbing, reaching, or crying) was gradually replaced, thereby indicating thereinforcing value embedded in PECS. In addition, the present data suggest that PECS training
produced collateral behavioral changes, such as an emergence of intelligible vocalization, evenin students who had previously had severely limited vocal repertoires.
Ziomek, M. & Rehfeldt, R.A. (2008) Investigating the acquisition, generalization, andemergence of untrained verbal operants for mands acquired using the Picture Exchange
Communication System in adults with severe developmental disabilities. The Analysis of Verbal
Behavior, 24, 15‐30.
Abstract: This study compared the total amount of training time and total number of trial
blocks for individuals with severe developmental disabilities to acquire mands under control of
unconditioned establishing operations and mands under control of transitive conditioned
establishing operations for manual sign and for the Picture Exchange Communication System(PECS). Also examined was the generalization of mands across settings and communicative
partners, as well as the emergence of untrained tacts and intraverbals for mands acquired using
PECS. Mands for preferred items and for items needed to complete a chained task wereacquired more rapidly and in fewer training blocks for PECS than for manual sign. Moreover,mands established using PECS generalized across settings and communicative partners. Finally,
untrained tacts and intraverbals using PECS were shown to emerge for some of the participants
following PECS training. These results suggest that PECS may be a viable alternative
communication system for adults with severe developmental disabilities who have little or no
history of systematic instruction and limited imitative repertoires.

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