By Matt Harrington, BCBA · Behaviorist Book Club · Clinical decision guide
One of the most consequential decisions a behavior analyst makes is not just what intervention to use, but how to approach the clinical question in the first place. For pecs, the difference between an evidence-based, individualized approach and a traditional, protocol-driven one can significantly impact outcomes.
This guide lays out the key factors side by side to support your clinical decision-making.
| Factor | Evidence-Based Approach | Traditional Approach |
|---|---|---|
| Motor skill requirements | PECS: requires the ability to pick up and hand a card; accessible to learners with limited fine motor skills | Sign language: requires fine motor precision and hand shape differentiation; may be challenging for some learners |
| Partner communication demands | PECS: any partner who can receive a picture card and provide the item can understand the communication | Sign language: requires that communication partners know sign vocabulary; limits communication to trained partners |
| Portability | PECS: requires a communication book or binder that must be available in all environments; can be lost or forgotten | Sign language: learner carries their communication system at all times; no materials required |
| Vocabulary flexibility | PECS: vocabulary is limited to available pictures; adding new vocabulary requires creating and adding picture cards | Sign language: vocabulary can be expanded rapidly through new sign learning; no physical materials needed |
| Speech development evidence | PECS: literature includes studies showing speech increases; mechanism may be via mand training under natural MOs | Sign language: motor speech literature suggests some learners benefit from motor-to-vocal transfer; evidence is mixed |
| Best learner profile | PECS: learners with limited fine motor skills, those in environments with varied communication partners, and those beginning communication training | Sign language: learners with adequate fine motor skills, consistent communication partners who can learn sign vocabulary, and those who have failed to acquire PECS discrimination |
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Use this framework when approaching pecs in your practice:
Does the data support a need for intervention? Is there a meaningful impact on the individual's quality of life, safety, or access to reinforcement?
YES → Proceed to assessment NO → Document reasoning, monitor
A functional assessment should guide intervention selection. Avoid defaulting to standard protocols without individual analysis. Consider environmental variables, setting events, and private events.
YES → Select evidence-based approach matched to function NO → Complete assessment first
Goals should be co-developed. Assent and informed consent are ethical requirements. The individual's preferences and values matter in selecting both goals and methods.
YES → Proceed with collaborative plan NO → Engage in shared decision-making
This course covers the clinical and ethical dimensions in detail with structured learning objectives and CEU credit.
PECS — ABA Courses · 1 BACB General CEUs · $0
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Research-backed educational guide
Research-backed answers for behavior analysts
All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.