Social-communicative effects of the Picture Exchange Communication System (PECS) in Autism Spectrum Disorders

Anna Lerna, Dalila Esposito, Massimiliano Conson, Luigi Russo, Angelo Massagli

Research output: Contribution to journalArticlepeer-review


Background: The Picture Exchange Communication System (PECS) is a common treatment choice for non-verbal children with autism. However, little empirical evidence is available on the usefulness of PECS in treating social-communication impairments in autism. Aims: To test the effects of PECS on social-communicative skills in children with autism, concurrently taking into account standardized psychometric data, standardized functional assessment of adaptive behaviour, and information on social-communicative variables coded in an unstructured setting. Methods & Procedures: Eighteen preschool children (mean age = 38.78 months) were assigned to two intervention approaches, i.e. PECS and Conventional Language Therapy (CLT). Both PECS (Phases I-IV) and CLT were delivered three times per week, in 30-min sessions, for 6 months. Outcome measures were the following: Autism Diagnostic Observation Schedule (ADOS) domain scores for Communication and Reciprocal Social Interaction; Language and Personal-Social subscales of the Griffiths' Mental Developmental Scales (GMDS); Communication and Social Abilities domains of the Vineland Adaptive Behavior Scales (VABS); and several social-communicative variables coded in an unstructured setting. Outcomes & Results: Results demonstrated that the two groups did not differ at Time 1 (pre-treatment assessment), whereas at Time 2 (post-test) the PECS group showed a significant improvement with respect to the CLT group on the VABS social domain score and on almost all the social-communicative abilities coded in the unstructured setting (i.e. joint attention, request, initiation, cooperative play, but not eye contact). Conclusions & Implications: These findings showed that PECS intervention (Phases I-IV) can improve social-communicative skills in children with autism. This improvement is especially evident in standardized measures of adaptive behaviour and measures derived from the observation of children in an unstructured setting.

Original languageEnglish
Pages (from-to)609-617
Number of pages9
JournalInternational Journal of Language and Communication Disorders
Issue number5
Publication statusPublished - Sep 2012


  • autism
  • intervention
  • Picture Exchange Communication System (PECS)
  • social and communicative skills

ASJC Scopus subject areas

  • Speech and Hearing
  • Linguistics and Language
  • Language and Linguistics
  • Medicine(all)


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