To PECS or not to PECS?

PECS is the most common and best-researched intervention for children with communication differences. All the research clearly shows that it is also one of the most efficient. At the same time, I met many parents who said, “PECS doesn’t work for my child.” And now, the NHS has started to move away from PECS. So, what is wrong here? Where do these contradictions come from? Let’s have a closer look.

What is PECS?

The Picture Exchange Communication System (PECS) is an aided AAC (Augmentative and Alternative Communication) intervention that gained widespread use in the last decade of the twentieth century and remains the most popular communication system for children with communication differences. AACs aim to permanently or temporarily compensate for the communication limitations of individuals with significant speech and language challenges. Aided ACC means that the intervention uses external tools—pictures, in this case, photographs or symbols.

Developed in 1985 by Andy Bondy and Lori Frost, a clinical psychologist and a speech pathologist, PECS consists of six stages of learning: from handling a single picture to requesting an item to constructing complex sentences and making comments. By the end of PECS training, the student is expected to locate his PECS book, navigate through it, find the appropriate images, arrange them in sentence format on a sentence strip, hand the strip to a communication partner, and point to each image while optionally verbalizing them.

PECS has been widely used, well-known, and well-researched for forty years. So, why was there no controversy earlier? And why is it emerging now? The answer is simple: autistic people now have the Internet, their own platforms on social media, and finally, a voice. Many of them have expressed that being forced to learn PECS was a traumatic part of their childhood.

What is traumatic about picture exchange?

Nothing. Picking up a picture from a book and handing it to an adult to request a biscuit—what can be traumatic about it? In fact, for many children, it is their voice, an empowering form of communication, the way they can express their needs and wants and have them fulfilled. No more frustration of being thirsty, hungry, or misunderstood. The trauma doesn’t come from the pictures. It comes from the teachers and the methods used to teach them.

The methods – ABA

Both Andy Bondy and Lori Frost are behaviourists, and they designed the PECS protocol based on ABA – Applied Behavioural Analysis. ABA is a controversial therapy still widely used in the USA (and Poland) and funded by their government and medical system. In most European countries, however, it is discouraged, less prevalent, and the subject of ongoing ethical debate. In short, ABA seeks to modify behaviour—often targeting core autistic traits like stimming—through conditioning. The method involves “discrete trials training”: focusing the child’s attention, presenting a stimulus, and expecting a specific behavioural response. If the correct behaviour occurs, the child receives a tangible reinforcement, such as a small toy or a favourite treat. In practice, it looks exactly like a dog’s training – a trainer shows a dog a treat and says “sit”; the dog sits and receives its treat. In early years, if the child didn’t present expected behaviours, the teachers used “negative reinforcement”, a euphemism for punishment, often physical. Children undergoing 20–40 hours of these drill-like conditioning each week frequently suffer from sensory overload, physical and emotional exhaustion, stress, and long-term side effects like prompt dependency, low self-esteem, passive communication styles, failure in social relationships, and even PTSD. Moreover, teaching obedience as a core value is dangerously disempowering and makes children even more vulnerable to any form of abuse. Many autistic adults who endured this approach now refer to themselves as “ABA survivors.”

How our first PECS lesson turned into a disaster

Let’s be clear: PECS is based on ABA principles, but it is not ABA therapy. Still, many of the techniques used to teach PECS remain ethically questionable—for example, using food as reinforcement or employing hand-over-hand support with children who dislike physical touch.

Here’s my personal experience. I first heard about PECS from an NHS Speech and Language Therapist. As we all know, the NHS prioritizes cost-saving, and therapists’ time is limited. The therapist gave me a brief explanation and handed me a leaflet. The plan was as follows: I would sit my child at a small table, opposite me, with my husband seated behind him. I would place a bowl of raisins (my son’s favourite) in front of me and a picture of raisins in front of him. When he reached for the raisins, my husband was to take his hand, guide it to the picture, and drop the picture in my open palm. I would then say, “I want raisins,” and give him some. This would be repeated until the raisins were gone. Ok. We sat at the table; I put a picture in front of my son and raisins in front of me; my son reached for the raisins, my husband grabbed his hand, and… it all fell apart. My son screamed, pulled away, and did everything he could to escape and grab the raisins.

I guess this is the point where many sensible parents stop and conclude: “PECS doesn’t work for my child”. Let’s unpack what went wrong. The setup had all the hallmarks of ABA: forced sitting face-to-face, which can be emotionally overwhelming; hand-over-hand prompting, which can feel like an invasion for children with sensory sensitivities; and finally, offering and then refusing food, sweets, or favourite toys to children who do not understand the reason. These elements can result in anxiety, stress, and a profound loss of control—conditions ripe for trauma. We stopped immediately. Many practitioners don’t.

These is not PECS

So, should we abandon the method that gives children a voice? Absolutely not. However, we must abandon the outdated and harmful teaching methods associated with it. The solution is straightforward: child-centred education always works best. Make a child in control of the teaching and learning process. If you observe signs of stress or discomfort, stop. Learning should be joyful and engaging—a shared game, not a test of compliance. Having a happy time together guarantees that no trauma will happen. And with this approach, we can start teaching picture exchange. From this point onward, I will stop referring to this intervention as “PECS,” since that is a proprietary term. The original PECS protocol is strict, and its creators insist that only methods following the official structure be called PECS. Instead, I will refer to it as “picture exchange”.

I received classic PECS training from Pyramid of Education, a PECS representative for the UK. I have been delivering PECS for many years, both at school and to my own child. However, the classic PECS approach has never worked for any of my learners. Every child is different, with different cognitive abilities and learning styles. To deliver a successful lesson that will not cause any stress, we need to learn our students’ ways first.

How our next picture exchange lesson turned into communication

Back to my experience: after the failed attempt, I tried something new. I created laminated pictures with screenshots of my son’s favorite nursery rhymes. He had no tablet, so I played the songs from my computer. I gave him the pictures and observed. At the time, he was very into lining things up. So, he lined up the images in a neat row. I played the first song in the line. Whenever he lined up his pictures, I played him the first song in the line.

Then, I noticed that he was always lining up the same song first. He started to make his first requests. Then, he began to position three of his favourite songs in first, second and third place. Then, he started putting pictures of songs he wanted to listen to next to the computer. Then, he began bringing pictures to me, looking for me around the house if necessary. At that point, he had learned to discriminate pictures and travel with them to his communication partner. I made him his first picture book. Since that time, he learned like a storm. I put symbols of all his toys in the book, and he loved discovering what the symbols represented. He kept giving me picture after picture to check what I would bring him. Not long after, he began forming full sentences like, “I want square biscuit,” or “I want mummy read Zog book.” And then, he abandoned the pictures as he started to use his verbal language to communicate.

I used a similar approach with my students. No, they didn’t line up pictures like he did, but by observing how they interacted with visuals, what they liked to do, and how they liked to learn, I tailored the process to their style.

Conclusion

In my opinion, every child can learn picture exchange. But instead of violent training, when the child must adjust to the teaching method, training that causes stress and sometimes even trauma, we need to adapt our strategies to suit the child and give our learners a leading role. What we don’t want is to deprive children of their voices while neglecting to provide them with the communication tools that we have.