Picture Exchange Communication System (PECS) Implementation Program for children with autism spectrum disorder.

The team ran a 24-session PECS program in a public clinic.

They worked with 17 minimally verbal autistic children .

Each child got one hour of PECS training twice a week over the study period.

Staff tracked how far kids moved through the six PECS phases.

Fourteen kids (a large share) reached phase IV — they could hand over a picture to ask for items.

Only five kids reached phases V and VI — they learned to build full sentences.

Parents reported kids used more words and showed fewer problem behaviors.

No child lost skills during the program.

Galuska et al. (2006) showed kids can go beyond basic PECS. They taught children to add color and shape words so they could ask for items even when the exact picture was missing. ADiemer et al. (2023) did not teach this extra step, which may explain why fewer kids reached the later phases.

Allen et al. (2001) used functional communication training instead of PECS. Both studies cut problem behavior, but D et al. did it in preschool classrooms with teacher-led FCT. This tells us PECS and FCT both work — you can pick the tool that fits your setting.

Perez et al. (2015) used telehealth to coach parents in FCT and saw a meaningful improvement in problem behavior. ADiemer et al. (2023) got smaller gains with clinic-only PECS. The difference hints that adding parent coaching or telehealth might boost PECS outcomes too.

If you run a clinic and need a clear PECS roadmap, this 24-session plan is ready to use. Track phase mastery weekly and add improvisation training from Galuska et al. (2006) if kids stall at phase IV. Consider brief parent coaching calls to match the big gains seen in telehealth FCT studies.