Therapy Guide
$100–$160/hour (SLP-delivered); PECS materials kit: $400–$600 initial cost
Typical Cost
2–5 sessions per week during initial training phases; ongoing generalization support
Frequency
18 months and up (no upper age limit)
Age Range
4
Provider Types
PECS is covered under OAP core clinical services, typically delivered by speech-language pathologists (CASLPO-registered) or BACB-certified behaviour analysts. Both interim one-time funding and childhood budgets can be used for PECS training and materials.
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 attract 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.
PECS has one of the strongest evidence bases among augmentative communication approaches for autism. The 2010 systematic review by Flippin, Reszka, and Watson in the American Journal of Speech-Language Pathology found that PECS effectively increases communication acts in autistic children. A 2012 randomized controlled trial by Howlin et al. in the Journal of Child Psychology and Psychiatry, involving 84 children across 15 schools, demonstrated that PECS training significantly increased communication initiations.
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.
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.
Commitment to Accuracy: Our data is verified against official government reports (FAO, MCCSS), peer-reviewed scientific literature, and accessible public records. Last updated: March 24, 2026.
Verified Facts
Early Start Denver Model (ESDM) delivered to children aged 18–30 months produced significant gains in IQ, adaptive behaviour, and autism severity — some children no longer met diagnostic criteria at follow-up
Cochrane systematic review finds evidence that early intensive behavioural intervention (EIBI) may produce positive effects on adaptive behaviour and communication for young children with ASD (low certainty of evidence)
WHO recommends accessible, community-based early interventions for children with autism — timely evidence-based psychosocial interventions improve communication and social engagement
88,175, children are registered in the Ontario Autism Program
23.4%, Only 20,666 children have active funding agreements () — less than one in four