Okay, let's talk about PECS
I hear this question from parents, educators, and other service providers all the time: "Should we start with PECS before we try a device?"
Short answer: nope. I don't recommend PECS instead of or before a high-tech device trial. And I promise this isn't AAC snobbery. I used PECS for years! Then I learned more, and when you know better, you do better.
So grab your coffee (or your cold coffee, I see you) and let's walk through my three big reasons. Then we'll look at what the research from the last five years actually says.
Reason #1: PECS is built around requesting (and our kids have SO much more to say)
PECS starts by teaching a child to hand over a picture of something they want, and the adult gives it to them. Requesting is the backbone of the whole program. Later phases add "I want" sentence strips, answering "What do you want?", and simple comments like "I see" or "I hear" (Pyramid Educational Consultants).
And look, requesting matters! I want every kiddo to be able to ask for juice, a break, or the iPad. But that's not the finish line.
Our real goal is for kids to say what they want, when they want, to whoever they want. Think about everything you said today that wasn't asking for something:
Greetings: "Hi!" "Bye!" "See you later!"
Exclamations: "Whoa!" "Uh oh!" "Yuck!"
Questions: "Where's Daddy?" "Why?"
Comments: "That's funny." "I don't like that."
Protesting: "Stop!" "No!" "All done!"
Feelings, jokes, stories, and plain old chit-chat
If we only ever teach "I want ___," we're teaching kids that communication is a vending machine. Picture in, snack out. They deserve the whole language buffet.
A robust high-tech system (one with core words like go, stop, more, not, like, help, what, you) gives kids access to all of those functions from day one. They don't have to wait until Phase VI to make a comment.
Reason #2: "Prove it with pictures first" is gatekeeping
Here's an old-school reason I used to hear (and, honestly, used to say): "Let's start with PECS so they can show us they're ready for a device."
Friends, this is gatekeeping at its peak. Nobody should have to prove anything to be allowed to communicate. You didn't have to pass a test before your parents started talking to you. Babies hear millions of words before they say their first one.
The AAC field settled this a long time ago. Back in 1988, Kangas and Lloyd reviewed the research and concluded that withholding AAC until a child shows certain "prerequisite" skills isn't supported. ASHA adopted a "no prerequisites" stance in 2001 (SpeechPathology.com). The National Joint Committee's Communication Bill of Rights says the same thing: communication is a basic right for every person (Brady et al., 2016).
And here's the thing nobody tells parents: some kids respond way better to a device than to paper. The light-up screen. The voice that says the word out loud every single time. The instant feedback. For a lot of kiddos, that voice output is the hook. Making them master laminated squares first can mean months of waiting for the tool that actually clicks for them.
Autistic adults who use AAC are saying this too. In one study, speaking autistic adults urged families and professionals to treat all communication as equal and to give kids access to AAC "without delay and without stigma" (Donaldson et al., 2021).
Reason #3: Two adults, one child, and a lot of physical prompting
To run PECS the way it's designed, the first phases need two adults for one child. One adult (the "communicative partner") sits in front holding the yummy thing. The other (the "physical prompter") sits behind the child and physically guides them to pick up the picture, reach, and let go into the partner's hand (PECS USA). In real classrooms, that often looks like hand-over-hand.
First, the practical problem. How many classrooms have a spare adult to do this, consistently, all day? A 2024 review of 49 PECS studies found that heavy adult staffing, staff turnover, and lack of time were common barriers. It also noted that the second trainer can be impractical in real-world settings (Paris et al., 2024).
Second, the part that matters most to me. When we move a child's body to make the "right" answer happen, we're teaching them that adults get to control their body. Every child needs to learn they have the right to say no. That includes no to being touched. Hand-over-hand quietly teaches the opposite: you must allow this in order to learn.
The field is moving away from this. AAC clinicians increasingly name both body autonomy (a person may not want their body controlled) and communication autonomy (pulling away is itself a message) as reasons to be careful with physical prompts (USSAAC). There are gentler ways to teach, and we'll get to them in a sec.
So what does the recent research say?
The short version: kids learn to request about equally well with pictures or a device, many kids prefer the device, and the device opens doors that picture exchange keeps closed for a long time.
Study
What they found
Why it matters
Pak et al., 2023 (meta-analysis, 19 studies, 66 young kids)
Kids learned to request equally well with devices and picture exchange. Devices beat manual sign.
Almost every study only measured requesting. So PECS "tied" on its home turf. Nobody's showing PECS wins on comments, questions, or jokes.
Aydin & Diken, 2020 (meta-analysis, 21 studies)
35 of 44 autistic participants preferred the device. 7 preferred PECS. 1 preferred sign.
When we ask kids (by watching what they choose), most pick the talker.
Muharib, Walker & Dunn, 2023 (meta-analysis)
Tablet-based device interventions improved communication for autistic individuals.
iPads and dedicated devices aren't a "maybe someday." They work now.
Pope, Light & Laubscher, 2024 (systematic review)
Naturalistic play-based therapy plus aided AAC led to better language outcomes than the therapy alone.
Modeling on a device during play and routines is a winning combo.
Paris et al., 2024 (review of 49 PECS studies)
Staffing, turnover, time, and the two-trainer setup were common barriers. Only about half the studies reported fidelity.
Even when PECS works in a study, it's hard to run well in a busy classroom.
Donaldson et al., 2021 (autistic adults who use AAC)
Adults asked that all communication be treated as equal, with AAC offered early and without stigma.
Listen to the people who actually use AAC.
And for the parent who's worried a device will stop their child from talking: the research has never shown that. Studies going back decades find AAC supports speech rather than replacing it (AssistiveWare).
So what do I do instead?
I start with a high-tech device trial with a robust vocabulary, and I bring the whole team along. Here's the recipe:
Model, model, model. We touch the words on the device while we talk, during play, snack, and routines. No pressure for the child to copy. (This is called aided language modeling, and it's how kids learn any language: by hearing it first.)
Let them babble. Kids pushing random buttons is exploring, not "misusing." Toddlers babble with their mouths. AAC users babble with their fingers.
Honor every message. If they say "no" or "stop," that counts. We respond like it's real communication, because it is.
Skip hand-over-hand. Try waiting, pointing to the word, or modeling it yourself. If a child truly needs physical help to reach the screen, use a light touch under the hand, with permission, and let them pull away.
Keep a paper backup. A low-tech core board is great for bath time, the pool, or a dead battery. It's a backup, not a hoop to jump through.
Let me be fair to PECS for a sec
PECS isn't evil, and the people who use it care about kids. It has decades of research behind it for teaching requesting. And one recent analysis found that kids who preferred picture exchange learned faster with it (Pak et al., 2023).
That's actually my whole point: preference matters. We can't know a child's preference until they've had a real shot at a device. So I don't start with PECS, and I never make it the gate. If a child tries both and clearly loves their picture book? Awesome. We follow the kid.
Because at the end of the day, the best AAC system is the one that lets your child say what they want, when they want, to whoever they want.
Want to get the whole team on the same page (literally)? Grab the free one-page handout here, print a stack, and hand it out at your next meeting.
Melba Acey, MSP, CCC-SLP AAC Adventure · Rocket City Speech Therapy
References
Aydin, O., & Diken, I. H. (2020). Studies comparing augmentative and alternative communication systems (AAC) applications for individuals with autism spectrum disorder: A systematic review and meta-analysis. Education and Training in Autism and Developmental Disabilities, 55(2), 119–141. ASHA Evidence Map summary
Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., Paul, D., Romski, M. A., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121–138.
Donaldson, A. L., corbin, e., & McCoy, J. (2021). "Everyone deserves AAC": Preliminary study of the experiences of speaking autistic adults who use augmentative and alternative communication. Perspectives of the ASHA Special Interest Groups, 6(2), 315–326. https://doi.org/10.1044/2021_PERSP-20-00220
Kangas, K., & Lloyd, L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4(4), 211–221.
Muharib, R., Walker, V. L., & Dunn, W. (2024). Effects of interventions involving tablet-based speech-generating devices for individuals with ASD: A meta-analysis. Journal of Autism and Developmental Disorders, 54(12). https://doi.org/10.1007/s10803-023-06173-6 (published online 2023)
Pak, N. S., Bailey, K. M., Ledford, J. R., & Kaiser, A. P. (2023). Comparing interventions with speech-generating devices and other augmentative and alternative communication modes: A meta-analysis. American Journal of Speech-Language Pathology, 32(2). https://doi.org/10.1044/2022_AJSLP-22-00220
Paris, A., Denne, L. D., Grindle, C. F., et al. (2024). Facilitators and barriers to the implementation of the picture exchange communication system (PECS): A systematic review. Frontiers in Education, 9, 1206410. https://doi.org/10.3389/feduc.2024.1206410
Pope, L., Light, J., & Laubscher, E. (2024). The effect of naturalistic developmental behavioral interventions and aided AAC on the language development of children on the autism spectrum with minimal speech: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders. RERC on AAC summary
Pyramid Educational Consultants. (2020). PECS brief description. PECS USA
Galvin-McLaughlin, D. (n.d.). Physical prompting in AAC. USSAAC SpeakUp Blog. USSAAC
