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Asperger*, Asperger syndrome, Asperger’s syndrome, ASD, autis*, autism spectrum disorder*, PDD, PDD-NOS, and pervasive developmental disorder*, augmentative communication, alternative communication, AAC, augmentative and alternative communication, Picture Exchange Communication System, and PECS.


Purpose: This systematic review aims to compare the efficacy of the Picture Exchange Communication System (PECS) to other forms of Augmentative and Alternative Communication (AAC) in increasing social communication skills in children with Autism Spectrum Disorder (ASD).

Methods: A systematic review of the literature on PECS and other forms of AAC written between 2007 and 2018 was conducted. Studies were selected based on the established inclusionary and exclusionary criteria. The inclusionary criteria incorporated subjects with a formal diagnosis of ASD under the age of 18. Exclusionary criteria included individuals with severe sensory, motor, and/or other medical conditions that may have affected their use of PECS. 25 articles of varying study designs were critically appraised for validity and reliability to minimize bias.

Results: Results suggest that both PECS and other forms of AAC are conducive to improving social communication in children (<18 >years) with ASD. Advancements in conversation initiation, requesting behaviors and joint attention were noted, resulting in a global increase in communication interactions. However, studies demonstrated mixed results with specific consideration of rate of acquisition, modality preference, and overall effectiveness of the system.

Conclusion: Synthesis of results from the 25 studies suggest that both PECS and other AAC systems show favorable outcomes for encouraging social-communicative behavior. The clinical implications of these results suggest the implementation of an AAC system may be client dependent. Single design designs were included in this review due to the lack of research in the areas of ASD and AAC. Further research of this comparison should be conducted on larger populations of children with ASD to improve clinical decision making to target social communication and increase generalizability.


Nancy Gauvin, EdD, CCC-SLP

Systematic Review: Comparative Efficacy of the Picture Exchange Communication System (PECS) to Other Augmentative Communication Systems in Increasing Social Communication Skills in Children with Autism Spectrum Disorder