In the latest episode of the Autism Little Learners podcast, we tackle an important and evolving topic in autism communication: the Picture Exchange Communication System, or PECS. PECS has long been a prominent tool for helping autistic children communicate, yet recent insights have sparked meaningful—and sometimes controversial—discussions about its effectiveness and limitations.
Joining the conversation are speech-language pathologists Paulina Elias and Amanda Blackwell from Natural Communication, who bring their expert perspectives on PECS, Augmentative and Alternative Communication (AAC), and the move toward child-led, autonomy-focused approaches. From encouraging kids to say ‘no' to empowering communication beyond simple requests, this episode is packed with fresh perspectives for parents, educators, and anyone who supports autistic children.
Meet Amanda and Paulina: Multilingual AAC Experts Dedicated to Inclusive Communication
Tara: Can you introduce yourselves and your background in speech-language pathology?
Paulina: I am a speech language pathologist. One of the key characteristics of my identity is that I'm multilingual. I love languages! I was born in Guatemala, and thanks to a German immersion school and later living in Canada, I learned multiple languages: Spanish, German, English, and French. This multilingual background drives my work in supporting clients in their native languages.
Amanda: I'm Amanda Blackwell, a speech-language pathologist from the U.S., living in Guatemala for the past 11 years. My passion for learning and teaching led me to pursue a clinical doctorate (SLPD) and a doctorate in education (EdD), with the goal of creating a postgraduate program for speech-language pathologists in Central America. We founded an association here with nearly 80 members, offering workshops with bilingual SLPs globally to improve local services. I'm also fortunate to travel and receive invitations to share knowledge.
We realized the challenge here isn't a lack of interest or desire to learn, but a lack of access to information, especially for those who don't speak or read English. Most of the latest evidence-based practices and articles are in English, so we're expanding to French and Portuguese to make this knowledge accessible globally, ensuring it's adapted and ecologically valid for different regions. We're passionate about advancing knowledge beyond English-speaking countries.
What Is PECS?
Tara: When I began as an SLP, the gold standard for AAC was the Picture Exchange Communication System. But now, PECS has lost favor and receives criticism on social media. Could you explain what PECS is and why it’s no longer widely recommended for autistic kids?
Paulina: PECS, created in 1985, is a structured protocol where a person is trained to exchange a picture or symbol to communicate, often to request something. It’s based on B.F. Skinner’s behavioral theories and applied behavior analysis (ABA), which is very structured and focused primarily on requests.
Tara: I think that's why it's fallen out of favor is that the behavioral methodology is based in ABA off of Skinner's work.
Amanda: We're focused on staying objective and differentiating light tech AAC, which is valuable and useful, especially for families with limited resources. We're not disregarding light tech AAC; as Paulina said, it's important to distinguish between behavior-based exchange systems and using visual supports, a proven and effective strategy.
Why PECS Faces Criticism Today
Tara: In my 25 years working with young autistic kids, my first AAC training was through PECS with Pyramid. I remember feeling unsure how to implement it effectively in a classroom setting with limited staff and resources. Many of us couldn't follow it as precisely as we were taught, but it was our only guidance for supporting communication.
For some, PECS remains a go-to because robust AAC isn’t accessible—whether due to budget constraints or district policies. Even in a well-funded district, I saw AAC devices unavailable for kids; I often had to help families obtain them independently. In the meantime, we relied on various visuals, but how they're used is crucial. “Model without expectation” is essential as we shift from PECS, which emphasizes hand-over-hand prompting and requesting, leading to automatic language patterns like “I want.”
This approach can be particularly limiting for Gestalt language processors, who may echo phrases automatically rather than genuinely request something. This outdated method of hand-over-hand prompting no longer aligns with best practices in supporting autistic children’s communication. Could you elaborate on why this is the case?
Moving from Hand-Over-Hand to Hand-Under-Hand Support
Paulina: Hand-over-hand prompting often raises concerns, even for parents who may feel uneasy taking their child's hand to point or grab something. Many parents, especially those whose children have been in ABA, find their kids start relying on others' hands to communicate or request.
This realization can be eye-opening for parents, highlighting that hand-over-hand prompting may limit a child’s ability to communicate independently. PECS, for instance, focuses on requests, but communication is about much more—including the ability to protest or reject, which isn't part of that system.
We've discussed with families and autistic individuals how a hand-under-hand approach is a more respectful alternative. This method provides support without taking control, allowing the person to keep autonomy. They can seek our hand if needed but remain in control, as they can remove their hand anytime, unlike with hand-over-hand prompting.
Encouraging Autonomy in AAC
Tara: Great point. Dr. Diamond Rashad, an occupational therapist, emphasizes why we should replace hand-over-hand prompting with hand-under-hand. With hand-over-hand, you control the child’s hand, blocking them from breaking away. Hand-under-hand, however, allows them to pull away if uncomfortable, preserving autonomy.
A colleague I worked with would say, “If it feels yucky, don’t do it.” Many kids dislike being controlled or touched and may pull away if prompted by hand-over-hand. Forcing this can cause meltdowns and dysregulation, teaching only that someone else is in control. Looking back, I’m glad we’re moving away from this practice.
Amanda: PECS was developed 40 years ago, and we've since learned so much about autism, especially through insights from autistic people. We can’t stay stuck in one system. The data shows that PECS doesn't lead to substantial overall communication gains. A 2010 study found only minimal to negative gains, raising concerns about maintenance and generalization.
While PECS emphasizes moving from requesting to commenting, communication is far more complex. PECS often leads to prompt dependency, with children stuck on requesting. True communication should be spontaneous and versatile, not just about asking for things.
Tara: Right and PECS is also situational. Kids may use it at snack time, but not during play, and I’ve never seen autistic adults using PECS in the community. None of my former students who used PECS as kids are still using it as adults, which suggests it’s not sustainable.
Another issue is that PECS encourages moving pictures around, disrupting the user’s muscle memory. It’s like when you accidentally move an app on your phone and can’t easily find it again—this disruption affects efficiency. Instead, maintaining a consistent layout, like in a communication book with designated pages for requests, comments, etc., supports muscle memory, helping kids and adults communicate more easily and effectively.
So, are all communication books problematic? If not, how can they be modified to avoid the limitations of PECS?
Empowering Independent Communication with Customizable AAC Tools
Amanda: We often discuss the difference between autonomous and independent communication. Autonomous communication means someone can express whatever they want, whenever they want, and however they want. It doesn't always mean full independence, though—someone may still need support, like having a communication book held up for them.
The concern with communication books is that they can limit autonomy. If we're controlling what symbols are available, we control what the individual can express. For example, if a “no” symbol isn't included, they can't say no. While communication books aren't inherently bad, they can restrict what someone can communicate if they're not provided with enough words or symbols.
That's why high-tech AAC is beneficial—it offers access to thousands of words and can be personalized. If using communication books, the goal should be to offer as many options as possible to avoid limiting autonomy and ensure the individual can express themselves fully.
Tara: Great point! Often, we don't consider giving people a way to protest, but it's crucial for communication. If a student pushes something away, that's their way of protesting, and we should acknowledge it. For safety, it's important to teach individuals they can say no, as not doing so can put them at risk.
When a student rejects an activity, instead of pushing through, we can model a response like, “I don't want that,” and pivot. It's about honoring their choice, not forcing compliance. Sometimes, offering a break or a different activity can lead to success later, but it’s our responsibility as adults to adapt.
With PECS, I’ve been guilty of asking a child to use their book when I already know what they want. It’s like asking someone to text when you already understand their words. The shift is simple: accept multimodal communication and model AAC, but don’t make it a requirement.
From PECS to Multimodal AAC: Embracing Flexible Communication Strategies
Amanda: In my AAC graduate class, we use light-tech boards for a full class period. I throw random scenarios at students, and they quickly realize their boards lack essential words for basic communication, like asking questions or commenting. Even though they created these boards, they see how limited they are without access to a full range of vocabulary. It’s a powerful moment that highlights the importance of having comprehensive vocabulary to communicate authentically.
Tara: That’s a powerful activity, and it would be impactful to do with paraprofessionals in a staff meeting. It reminds me of a student I had years ago, a three-year-old with a robust AAC device. Despite meeting none of the old-school prerequisites, he explored the device and, to my surprise, formed the sentence, “This is boring.” I wasn’t sure if it was intentional, but I acted as if it was and switched the activity. It was a great moment of authentic communication!
Paulina: We often focus on our own goals and agendas, but this can lead to frustration because we place expectations and have a set way of doing things. It's important to remember that the person we're supporting should take the lead. Instead of creating low-tech communication boards, we should observe and listen to how they communicate and what interests them. Building a connection starts by focusing on their needs and interests, creating trust, and avoiding imposing our own expectations. Understanding what they're noticing and feeling is key to supporting them effectively.
Tara: Neurotypical toddlers go through a phase where “no” is their answer to everything, which is a normal developmental stage. However, our students often aren't given the opportunity to say “no.” One key takeaway is to ensure your students have a way to protest. If they start by pushing something away, model it with a picture or AAC device—this is a valuable tool you can give them.
Paulina: While high-tech AAC systems are effective for many, they aren’t always accessible due to factors like affordability or safety concerns. Low-tech options, such as communication boards, can be a great alternative. Assistive Wear, for example, offers a printable communication board that’s easy to access and use, serving as a strong starting point for modeling without expectation. Other resources offer multilingual support, which is especially important for the families we serve.
Why Building Trust and Relationships Matters in AAC Implementation
Tara: There's so much free material out there, but having a curated list can help avoid overwhelm, especially for parents and educators. Google can be overwhelming, leading to indecision and returning to old methods. Thank you for providing that list—it will be really helpful.
Also, taking the time to build relationships with students is crucial. Whether you're a parent, paraprofessional, or educator, getting on the floor with the child, understanding their interests, and connecting with their world makes a big difference. Once you build that connection, progress follows. I've had students who, after building trust, invited me to join them, which was a huge sign of progress. The connections we make are often more important than what we teach.
Amanda: We wrote an article with Marge Blanc on Gestalt language development, highlighting the lived experiences of autistic individuals. A key takeaway was the importance of trust and connection. Establishing safety and trust is essential for genuine relationships, not just transactional ones. This is especially true for autistic clients, who need to feel safe before authentic connections can be formed.
Tara: That resonates deeply with me. As a new teacher, I ran a communication-based classroom, wearing many hats. Without much guidance, I relied on my gut to connect with kids. Giving ourselves grace and time to truly understand students can improve behavior and cooperation. Building relationships honors who they are and makes a huge difference.
Tara: I'm so glad I found both of you! I'm excited to dive deeper and share your Gestalt Language Processing crash course in multiple languages. It's incredibly valuable and needed. Thank you for all you do and for joining the show!
Listen to the podcast version: Episode 96
Watch it on YouTube:
Connect with Paulina & Amanda:
English website (for free resources, our parent and professional courses, professional development events, and individual consultations info)
Instagram (English)
Instagram (Spanish)
Resources:
- ASHA Journal Article
- Playground AAC board
- PRC Saltillo core
- GRID core board
- Avaz core board
- Assistiveware core boards in different languages
- Project Core boards
- Smarty Symbols Core
If you use visual supports in your classroom or home, you are going to want to sign up for this free Visual Supports Starter Set ASAP! Click here to have one sent to your inbox. Also, be sure to read more about visual supports and how they can help autistic children here.
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