When working with children with disabilities there often comes a time when you realize that a child may be very delayed in acquiring verbal language or that a child may not develop verbal communication skills. At that time we debate about how this child will communicate his or her want and needs. Parents and clinicians often debate whether to use a picture based system or an AAC device.


Picture Exchange Communication System (PECS): PECS is a picture based communication system that includes 6 phases to learning/teaching children to use photos to gain their wants and needs.


Pros: Picture exchange is relatively simple to learn and use. Children are able to get their basic wants and needs met once they grasp the concept that pictures represent objects/actions.


Cons: As a child’s language grows, so does the number of pictures that the child and/or parent has to manage. Managing the number of pictures becomes a lot of work and the child may want to say something new that there is not a picture to represent. Pictures often represent 2 words (i.e. I want), which may confuse children to thinking that the 2 words are 1 unit of language. Additionally, PECS does not have voice output for the child to communicate over a crowd or to call attention in case of an emergency.  


Augmentative/Alternative Communication Device (AAC): AAC devices includes apps on tables/phones and/or devices dedicated to communication.


Pros: Children are often drawn to technology, so a device may be of more interest to a child than pictures. Voice output allows children to communicate in a way that other people understand, and it allows children communicate over a crowd. It also allows children to alert others in emergency situations. One device stores and manages all of the words needed.


Cons: There can be technical issues, which may leave a child without a communication system. The communication system may not be able to go to places such as the pool.


The Take Away: Clinician’s will often start with pictures to introduce children to the concept that a picture represents an object action. This is a fine place to start, but children should be transitioned to an AAC device as soon as possible secondary to the many benefits stated above. If a child is unwilling to use picture communication, a device should still be trialed as a child may have a greater interest in a voice output device. While devices may need repairs at times, most if not all of the big name communication device companies will send a loaner while the AAC device is being repaired.