Headstart for Life

Using PECS for Children with Persisting Speech Difficulties


As a Speech and Language Therapist, I have used PECS (PICTURE EXCHANGE COMMUNICATION SYSTEM) on many occasions with my students in HeadStart for Life.  I did have some resistance to it as parents thought the child might have to use PECS for life. But I found out that once parents realised that in using PECS the child would have to listen to the language spoken (e.g The sentence: Cookie? I want cookie), there is more acceptance for this AAC (Augmentative and Alternative Communication). I found that children using PECS are more motivated to use sounds to request for something. Could it be that they like the attention given to them? Or they start paying more attention to the words? Let me present a case study for you.


Jansen (not his real name) is 3 years old. He is a sweet little boy who is very much loved by his extended family (parents and grandparents).   He can mainly say open vowels in his speech sounds like the sound [a] and has a limited repertoire of gestures to communicate his needs. He points at things that he wants or pulls his mum to the item that he needs. He is physically mobile and thus he can access whatever things that he wants.  He attends child care daily but is not on any Early Intervention Services (EIPIC).

Jansen’s parents started to be very concerned about his lack of communication when he was refused entry to a childcare. They were perplexed and decided to see a pediatrician. They were told that their child needed a specialized form of service, which a mainstream education will not be able to provide.

They started speech therapy for their child as Jansen’s speech difficulties were very obvious. Speech therapy started with the therapist assessing the child. The therapist suggested that speech sounds can be elicited using PROMPT (PROMPTS for Restructuring Oral Muscular Phonetic Targets, is a multidimensional approach to speech production disorders) and advising them to use an alternative form of communication, PECS. PECS is needed in order to elicit interaction and a spontaneous form of communication in a structured situation.


Jansen’s parents were devastated to learn that their child needed PECS. They insisted that all Jansen needed was to get his speech going. The speech therapist was quick to explain in detail the rationale in introducing PECS, at the same time reassuring them that speech sounds will be a priority in working with Jansen.  Picture Exchange Communication System (PECS) is a learning system that allows children with little or no verbal ability to communicate using pictures. PECS can be used at home, in the classroom or in a variety of other settings. A therapist, teacher or parent helps the child to build a vocabulary, and to indicate desires, observations or feelings by using pictures consistently. The PECS program starts by teaching the child how to exchange a picture for an object.  Although PECS is based on visual tools, verbal reinforcement is a major component, and verbal communication is encouraged. This aspect of PECS was emphasised to the parents.  Jansen’s family was very supportive and decided that the whole family would use PECS to communicate with Jansen.  The speech therapist was able  to reassure the parents that speech sounds will be elicited using PROMPT and play.


Perhaps a review of the research on PECS might shed some light on its usefulness. A systematic review of the PECS research by Tien (2008) found that PECS is effective in enhancing functional communication skills of individuals with Autism Spectrum Disorders (ASD). PECS is allowing children with ASD a means to communicate with others that they did not have before starting on PECS. But does it lead to better speech output for the child? Apparently there is no evidence to suggest that PECS hinders speech production but might actually aid in increased speech production (Schwartz et al. 1998).

So let’s try PECS and give it a chance. We can move on to high tech AAC such as PROLOQUO TO GO, TOUCH CHAT if needed. We can even give it up once the child starts using sentences on their own. Talk to your therapist on how to make it work. We at HeadStart for Life are here for you and your child.


K.C. TIEN (2008). Effectiveness of the Picture Exchange Communication System as a Functional Communication Intervention for Individuals with Autism Spectrum Disorders: A Practice-Based Research Synthesis,  Education and Training in Developmental Disabilities, 2008, 43(1), 61–76

Schwartz, I. S., Garfinkle, A. N., & Bauer, J. (1998). The Picture Exchange Communication System: Communicative outcomes for young children with disabilities. Topics in Early Childhood Special Education, 18, 144 –159.

"All the information on this site is for educational purposes only and does not replace the assessment and intervention of a registered speech-language pathologist, occupational therapist or any other medical or education professional."

About Zunaida

Zunaida likes to browse through websites looking for more background information on her favourite topics such as speech difficulties and pragmatic skills disorders. She has more than 10 years of experience working with children with special needs in Singapore.

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