Predicting progress in Picture Exchange Communication System (PECS) use by children with autism (summary)



The Picture Exchange Communication System (PECS) is a communication system designed mainly for use by non-verbal children with autism. It has generally been found to have positive outcomes in a range of areas, including social communication skills, decrease in challenging behaviour and possible increases in the use of spoken language. However there is limited information available to support professionals to make predictions about the amount of progress individuals might make using PECS.

PECS is broken down into six phases, from the exchange of a single symbol for a desired object with support to spontaneous requesting and commenting using symbols.

It has been suggested that the cognitive levels of individual children might influence their ability to progress through the levels of PECS.

This study investigated this further.

What did they do?

The authors used retrospective analysis to look into whether children’s scores on the Psycho-Educational Profile-Revised (PEP-R) before intervention could predict the progress children aged 5 to 6 with autism made in PECS use. They used an achievement of level 3 PECS (discrimination between an array of symbols) as the point of differentiation between most and least progress.

The PEP-R assessment gives a Total Developmental Age (TDA) score which provides an estimate of an individual’s overall ability level. 

23 children took part in the study. All had had PECS intervention in school. The children were assessed to find the highest PECS phase they had achieved and where then allocated to one of two groups; group A had mastered PECS level 3 group B had not.

What did they find?

The children in group A were found to have had significantly higher PEP-R TDA scores at the start of intervention than those in group B. All in group a scored at an age equivalent of 16 months or above, all but on in group B scored below 16 months.

The authors suggest that awareness of developmental age could offer professionals a way of setting realistic and achievable targets for children.


An assessment of the developmental level of children with autism who are being considered for the introduction of PECS might give useful information about the likely degree of progress.


There are a number of limitations to this paper. As a retrospective study the participants were not matched or preselected in any way.  There was no baseline assessment other than the

PEP-R, and no independent confirmation of the children’s diagnoses. The study was relatively small and the assessment of PECS levels was not carried out by an independent person. There was also a lack of information about the way in which PECS was implemented by school staff.


Things you may want to look into:

The Effects of PECS Teaching to Phase III on the Communicative Interactions between Children with Autism and their Teachers

Long-term effects of PECS on social–communicative skills of children with autism spectrum disorders: a follow-up study

A Communication-Based Intervention for Nonverbal Children With Autism: What Changes? Who Benefits?

Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis

The Picture Exchange Communication System (PECS) What Do the Data Say?

The Picture Exchange Communication System

A pilot evaluation study of the Picture Exchange Communication System (PECS) for children with autistic spectrum disorders

 Added to site June 2016