Will PECS Help Children Speak?

In this month’s blog, Julia Hoffman, MS, CCC-SLP, answers one of our most commonly asked questions: “Will PECS help children speak?”

How many people have either heard this question or asked it themselves?  It’s worth asking!  Isn’t speech the goal?  And could the Picture Exchange Communication System (PECS) actually help nonspeaking individuals start talking?

I’m a Speech Language Pathologist (SLP) and in my first job, I worked with lots of young people who didn’t speak.  Some did speak a little but not at the level they needed to really communicate well.  The first thing with any learner was to check if the child was “stimulable” for speech.  I tried to get them to copy the words I said.  Some children could do it so I spent hours of therapy time with them working to increase the number of words they could say.  I said the word, they said the word. It felt like a real accomplishment tallying up the number of words being said – never mind I usually had to say it first, or “pull” it from the learner with a question.  I really thought the presence of speech was THE goal and it honestly never occurred to me to actively eliminate all the prompting I was doing to help them use the speech they had independently.

One day, a supervisor observed and asked me to come see her later.  When we talked, she reminded me my job title at the center was “Communication Therapist” and we talked about changing the sole focus from speech development to communication development.  This meant introducing Augmentative & Alternative Communication (AAC) systems of some sort.

The center where I worked provided sign classes for staff so we could teach it to the children.  I did try doing that but if the learner wasn’t good at imitation, it just didn’t achieve great results.  When talking with other SLPs from that time, we seem to all tell the same story.  Speech first, sign language if speech isn’t forthcoming.  I’m not sure how many of us were actually looking up research studies to support our decisions!  But we now have plenty of research that supports the use of PECS to teach functional communication.  As of January 2023, there are nearly 250 PECS-related publications. For the most up-to-date list, please refer to our research tab.

This was the late 1980s and technology was nothing like it is now. Also, PECS wasn’t widespread like it is today.  I often wish for a time machine to go back to those early years of my career.  Knowing what I know now about AAC, especially PECS, I would do so much differently.

The first thing I’d do is share information about AAC systems to family and team members who might be worried about using PECS.  It seems logical that if you give the child a way around talking, they’ll take it as the path of least resistance and won’t be motivated to speak.  We can look to the body of research that’s been done over the years to put everyone’s minds at ease.  Introducing AAC to someone with little or no speech will NOT inhibit speech development.  In addition, we have research showing that teaching PECS may well result in speech development for our PECS users!  The research, specifically including gold-standard Randomized Control Trial (RCT) studies, shows not only the effectiveness of the PECS protocol for communication development, but also socially-significant gains in related areas such as speech development.

If you’ve had the PECS training, you’ll remember that we say the name of whatever the learner is asking for with their picture as we deliver it to them. This means they’re hearing the labels of all their favorite people, things, and actions repeatedly.  Some learners start saying words as early as Phase I in the PECS protocol.

Once the learner is exchanging the sentence strip in Phase IV, we start modeling the full phrase “I WANT BUBBLES”, etc. We also start leaving a 3-5 second delay after saying “I WANT” to encourage the learner “fill the gap” by attempting to say the final word themselves. Lots of PECS users start talking at this point in the PECS protocol!

We never insist on speech but if the learner talks or tries to talk along with their sentence strip, we basically have party!  PECS alone = a regular sized serving.  PECS with speech = a much bigger serving!!

Since speech is ideal if it’s possible for the person, we also recommend continuing speech therapy separate from their use of PECS.  Some people will fully transition to speech.  If you’ve taught them to use PECS, the chances of speech actually go up.  And if they don’t end up moving to speech, you’ll know you taught them the functional communication skills that are truly the goal for everyone, regardless of the modality!


Additional Support

 Ready to start PECS? Visit our training schedule! Register for a PECS Level 1 Training so you can see first-hand the 6-phase protocol backed by research.

For ongoing support with communication skills, AAC implementation, the PECS protocol, and the Pyramid Approach, join our online community on Facebook. Search “PECS User Support” on Facebook and request to join. This active group of over 30,000 professionals, parents, and caregivers is monitored by our Pyramid Consultants from around the globe daily!

Written By Julia Hoffman, MS, CCC-SLP

© Pyramid Educational Consultants, LLC. 2023