Using the picture exchange communication system (PECS) with children with autism: assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior.

Three autistic children learned to trade pictures for items they wanted.

The team used a multiple-baseline design. They waited, then taught each child one by one.

Sessions happened at a table. Adults gave the pictures, then waited for the child to hand one back.

Every child learned to swap pictures. They also began to say the item name out loud.

Problem behavior dropped during teaching. Social smiles and eye contact went up.

Gains stayed when new adults or new places were added.

Heinicke et al. (2012) took the next step. They showed you can teach the same picture trades, but have the child hand the picture to a peer instead of an adult.

Szempruch et al. (1993) used photo schedules years earlier. Parents taped picture steps to the fridge. Kids stayed busy and calm, hinting that pictures can guide autistic children before PECS was even sold.

Ashley et al. (2025) tried peer PRT at recess. They also saw more talking, but play skills stayed flat. The PECS study got speech plus calmer behavior at the table; Ashley’s team got speech on the playground. Different tools, same spoken bonus.

You can start PECS even if the child has no words. The same lessons that build picture trades also spark first spoken requests and cut tantrums. Try it during snack or play. Have peers nearby? Blend in Heinicke et al. (2012) and let classmates be the picture partners.