Picture Exchange Communication System (PECS) for Autism in Ontario

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 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 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.