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What happens during PECS sessions?
During PECS sessions a speech and language therapist teaches a child to communicate by handing over picture cards to request what they want, progressing through six gentle phases from a single exchange to building sentences and commenting. Sessions are playful and led by the child's motivation. AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional.
When words are hard to find, a single picture handed to someone you love can become your child's very first 'I want that' — and that is where real communication begins.
In short
During PECS sessions, a speech and language therapist gently teaches your child to communicate by handing over a picture card to ask for something they want. It starts with simple exchanges — giving a picture of a favourite snack or toy to receive it — and grows, step by step, into building short sentences and commenting on the world. Sessions are warm, playful and led by what motivates your child, so communication feels rewarding from the very first exchange.
What happens in a session
PECS is taught in six gentle phases, and a session focuses on whichever phase your child is ready for:
- Phase 1 — The exchange. Your child learns the core idea: pick up a picture of something they want, hand it to a person, and receive that item. Two therapists often help at first — one beside your child to guide, one to receive the card.
- Phase 2 — Distance and persistence. Your child learns to travel to their picture book and to a communication partner, building independence.
- Phase 3 — Choosing. Your child learns to pick the right picture from several, discriminating between options.
- Phase 4 — Building sentences. Using an "I want" card plus a picture, your child begins forming simple sentence strips.
- Phase 5 — Answering questions. Your child learns to respond to "What do you want?"
- Phase 6 — Commenting. Your child moves beyond requesting to sharing — "I see", "I hear" — true conversation.
Throughout, the therapist follows your child's motivation, keeps pressure low, and rewards every attempt. Importantly, PECS does not stop speech — research suggests it can actually encourage spoken words to emerge alongside the pictures.
Who PECS can help
PECS is often introduced for children who are minimally verbal or pre-verbal, including many autistic children, where reaching for a clear, reliable way to express needs reduces frustration. Your therapist will judge whether PECS, another communication approach, or a blend best fits your child after observing how they currently connect.
The Pinnacle way
AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional — never from an app or online form. Our speech therapy team uses your child's AbilityScore® profile to decide if PECS suits them and to set joyful, achievable goals. Explore how we support communication and language at every step.
Trusted sources
American Speech-Language-Hearing Association (ASHA) guidance on augmentative and alternative communication; CDC "Learn the Signs. Act Early." resources; American Academy of Pediatrics (HealthyChildren.org) on supporting early communication.
Next step — Curious whether PECS could help your child find their voice? Book a communication assessment with a Pinnacle clinician.
This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.
What to notice
Watch for whether your child can show you what they want — by pointing, leading you by the hand, or reaching — and whether frustration rises because they cannot make needs understood; these signal that a structured communication support like PECS may help.
In everyday life
Keep a few pictures of your child's favourite snacks or toys handy at home, and encourage them to give you the picture before they receive the item — turning everyday wants into joyful communication practice.
Questions families ask
Does PECS stop my child from learning to talk?
No. PECS is designed to support communication, and research suggests it often encourages spoken words to emerge alongside picture use rather than replacing speech. Many children begin to vocalise as they exchange cards.
How many phases are there in PECS?
PECS is taught in six phases — from the first picture exchange, through travelling to the communication book, choosing the right picture, building sentences, answering questions, to finally commenting on the world. A therapist focuses each session on the phase your child is ready for.
Is PECS only for autistic children?
No. PECS is often used with autistic children, but it can help any child who is minimally verbal or pre-verbal and needs a clear, reliable way to express their wants and needs. A clinician will decide if it suits your child.
How does PECS start in the very first session?
It begins with a simple exchange: your child learns to pick up a picture of something they really want, hand it to a person, and immediately receive that item. Two therapists often help at first to make this first success easy and rewarding.
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Sources & further reading
- ASHA — Augmentative and Alternative Communication (AAC)
- CDC — Learn the Signs. Act Early.
- AAP — HealthyChildren.org
References are those supplied with this answer. A general organisation website is a route to further reading, rather than evidence of an independent review of this page.
Content attribution in the source record: SETU Consortium · Pinnacle Blooms Network.
KEEP EXPLORING
Your next question may be here.
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Read the answer AnswerWhat is the Picture Exchange Communication System (PECS)?
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Read the answer AnswerWhat techniques are used in the Picture Exchange Communication System (PECS)?
Read the answerGeneral information supports a conversation with an appropriately qualified professional. Advice, goals and support depend on the individual child.