Evidence review in progress · May be OAP-covered
Direct answer
Flippin, Reszka & Watson (2010) · Howlin et al. (2007) · Charlop-Christy et al. (2002) · Verified 2026-08-20
Quick summary
In brief
PECS, Quick Summary
- This page is general information, not an individualized treatment recommendation.
- Evidence labels summarize the page sources and should not replace clinical judgment.
- Confirm provider credentials, coverage, goals, monitoring, alternatives, and fees before starting.
General information only, not a diagnosis, treatment plan, crisis service, or individual estimate. Confirm your next step with the linked source or a qualified professional.
At a glance
- Evidence level
- Evidence review in progress
- OAP funding
- Eligible under OAP core clinical services
- Typical cost
- Provider fees vary by setting; request a current written quote
- Typical frequency
- Individual plan varies; confirm the schedule with a qualified clinician
- Target age range
- Age suitability varies; confirm fit with a qualified clinician
OAP Coverage Note
OAP eligibility depends on current program rules, the funded service category, and the provider's credentials. Confirm coverage with AccessOAP or your service coordinator before committing to care.
Who provides this therapy
- Provider credential check
- Ask any prospective provider which of these credentials they hold, and confirm the credential with the relevant regulatory college before starting.
- Credentials listed for this therapy
- Speech-language pathologists (CASLPO-registered)
- Board Certified Behavior Analysts (BCBA)
- PECS-certified trainers
- Registered Behaviour Technicians under supervision
The Six Phases of PECS
PECS training follows a structured six-phase protocol. Phase I teaches the physical exchange: the child learns to pick up a picture and hand it to a communication partner to receive a desired item. Phase II builds persistence and distance: the child learns to travel across the room and get a partner's attention. Phase III introduces picture discrimination: choosing between multiple pictures to request specific items.
Phase IV introduces sentence structure using a "sentence strip" where the child constructs "I want" + [item picture] requests. Phase V addresses the responsive question "What do you want?" and Phase VI teaches commenting — responding to questions like "What do you see?" or "What do you hear?" Each phase has clear mastery criteria before advancing.
In Ontario, PECS training is most commonly delivered by CASLPO-registered speech-language pathologists, often in combination with other communication strategies. Many school boards also implement PECS in classroom settings, making coordination between private therapy and school programming particularly important.
Research Evidence and Outcomes
PECS has one of the strongest evidence bases among augmentative communication approaches for autism. The 2010 review by Flippin, Reszka, and Watson found that PECS can increase communication acts in autistic children. A 2007 pragmatic group-randomized trial by Howlin et al., involving 84 children across 15 schools, reported more communication initiations after PECS training.
Importantly, research by Charlop-Christy et al. (2002) found that PECS did not inhibit speech development — in fact, some children developed spoken language alongside or after PECS training. This addressed a common parental concern and solidified PECS as a complementary rather than competing approach to speech development.
Evidence and sources
Flippin, Reszka & Watson (2010)
Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19(2), 178-195.
Howlin et al. (2007)
The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: A pragmatic, group randomised controlled trial. Journal of Child Psychology and Psychiatry, 48(5), 473-481.
Charlop-Christy et al. (2002)
Using the Picture Exchange Communication System (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35(3), 213-231.
Before you commit
- Questions worth asking any provider
- What certification or regulatory college licenses you to deliver this therapy, and can I verify it?
- How will you measure progress, and how often will you share results with our family?
- What does a typical session look like, and can we observe one before committing?
- How does this approach get adjusted if it is not working after a few months?
- What happens to our data, our schedule, and our funding if you leave or the practice closes?
- Signs to slow down
- The provider cannot name a regulatory college or certifying body, or asks you not to check it.
- You are asked to sign a long-term contract before seeing a session or meeting the therapist.
- Progress is described only in general terms, with no way to see or measure it over time.
- The provider discourages you from getting a second opinion or asking about other approaches.
- Fees, cancellation terms, or what OAP funding covers are unclear or change after you sign up.
Frequently asked questions
No. Research consistently shows that PECS does not inhibit speech development. Studies by Charlop-Christy et al. (2002) found that many children actually increased spoken language after starting PECS. PECS provides a functional communication bridge that reduces frustration and can support emerging verbal skills.
PECS-related services or materials may be eligible depending on the provider, treatment goals, funding stream, and current OAP rules. Confirm the expense with AccessOAP before purchasing or booking care.
There is no single age rule for PECS. A speech-language pathologist should assess the persons communication needs and recommend an appropriate system without delaying access to functional communication.
Where the waitlist stands
Families navigating autism services in Ontario face a documented multi-year wait. Here is the Ontario data — and a two-minute way to push back, when you are ready.
- Official provider list — snapshot of registered OAP providers. Ontario Autism Program (oapproviderlist.ca)
- Ontario Autism Program guidelines for Core Clinical Services and supports. Government of Ontario (2026)
Verified references and sources
Official Organizations
- [2025]Autism Spectrum Disorders Fact Sheet (updated September 17, 2025)World Health Organization (WHO) • Official • 2025-09-17
Peer-Reviewed Research
- [2010]Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver ModelDawson G, Rogers S, Munson J, et al. (Pediatrics) • Academic • 2010-01-01
- [2018]Early intensive behavioural intervention (EIBI) for young children with autism spectrum disorders (ASD)Reichow B, Hume K, Barton EE, Boyd BA (Cochrane Systematic Review) • Academic • 2018-05-09
About this page
Check the author’s context, review method, and how to report an error.