The Picture Exchange Communication System - Research Paper Example

? The Evidence-Base for the Effectiveness of Picture Exchange Communication System (PECS) for Children and Learners with Autism of the Name of the School/ Institution The Evidence-Base for the Effectiveness of Picture Exchange Communication System (PECS) for Children and Learners with Autism Introduction “The picture exchange communication system (PECS) is a pictorial system developed for children with social-communication deficits” (Charlop-Christy, Carpenter, Le et al, 2002, p.213). This method developed by Bondy and Frost (1993, 1994), assists young children with autism acquire functional communication skills, using pictures both black-and-white and color drawings as the sources for creating communication. According to Preston and Carter (2009), different types of augmentative and alternative communication (AAC) have been developed, to promote communication skills in children with autism. These include the use of manual signs, voice-output communication devices, and different picture-based systems such as the PECS. The Picture Exchange Communication System (PECS) employs fundamental behavioral principles and techniques such as shaping, differential reinforcement, and transfer of stimulus control through delay. The child with autism uses velcro to mount the pictures on a PECS board, known as a notebook. The pictures help the child in learning to communicate. For making a request, the child is taught to use the pictures on the PECS board to create a ‘sentence’ by selecting picture cards such as ‘I want’ card plus ‘juice’ card. This request is then delivered to a communicative partner. The PECS thus teaches a child to take the initiative in making a request for both seen and unseen items, to respond to questions such as “what do you want?”, and to make social comments such as “I see a book” or other object (Charlop-Christy et al (2002). Thesis Statement: The purpose of this paper is to examine the evidence for effectiveness of the Picture Exchange Communication System (PECS) for children and learners with autism. The Significance and Effectiveness of Employing the PECS for Children with Autism A characteristic feature of children with autism is deviant or delayed speech and language skills. More than 50 percent of children with autism remain mute, despite the use of behavioral interventions such as discrete-trial procedures, incidental teaching, delay procedures, and pivotal response training. For this reason, interventions such as the Picture Exchange Communication System which focus on alternative communication strategies, have been developed, for children who do not develop speech. These programs involve nonvocal methods of communication, “and include sign language, picture-point systems, electronic devices, and other picture-communication systems”, state Charlop-Christy et al (2002, p.213). Further, the Picture Exchange Communication System is valuable for children with autism because most of them have high levels of visual memory, they are visual thinkers, and are able to memorize by rote easily, besides being able to “process a greater amount of material at a very fast pace, and are meticulous in performing tasks to the point of perfection”, state Heflin and Alaimo (2007). Individuals with insufficient language skills as a result of various disabilities or disorders, including autism spectrum disorders, are benefited by interventions using the Picture Exchange Communication System (PECS), a visually based communication system. One of its greatest benefits is that it requires that attention be given to the message recipient using a behavior that does not require eye contact. “Showing attention to the message recipient as part of the communication act is a critical distinction between intentional action and intentional communication” (Yoder & Lieberman, 2010, p.629), and increases the probability of potentially communicative behavior being responded to, by mothers or other care givers of autistic children. An important element promoting the functional use of a communication system is the generality of the system, which facilitates its use in situations that may differ in several aspects from the training environment (Yoder & Lieberman, 2010). Charlop-Christy et al (2002) conducted research using a multiple baseline design, on 3 children with autism. They investigated the acquisition of Picture Exchange Communication System (PECS); and examined the effects of PECS training on the emergence of speech in play and academic settings on their 3 subjects. Additional measures of social-communication behaviors and problem behaviors were also recorded. The evidence reveals that all the 3 children achieved the learning criterion for PECS, and showed concurrent increases in verbal speech. Collateral gains were achieved in the form of improvements in social-communicative behaviors, and reduction in problem behaviors. “Although the demonstration of the efficacy of PECS is important in and of itself, the increase in speech is perhaps the most important finding” (Charlop-Christy et al, 2002, p.227). The researchers advocate the use of PECS for initiating communication among children with autism, also resulting in positive side effects. The emergence of vocal as well as pictorial communication is attributed to several features of the PECS, including the teaching of practical communication behaviors using strong reinforcers that can be used in natural environments. An emphasis on mands or verbal operants initiates verbal behavior. The development of speech also arises from the pairing of the phrase spoken by the adult, such as “I want juice”, with the pictorial communicative act of handing a PECS sentence strip to a communicative partner. Thus, with the simultaneous presentation of vocal and pictorial mands, the two responses are reinforced concurrently, and the child begins to imitate the vocalizations in the later phases of PECS (Charlop-Christy et al, 2002). These results are supported by the evidence from research undertaken by Ganz and Simpson (2004), to study the effects of Picture Exchange Communication System (PECS) on communicative requesting and speech development in children with characteristics of autism. The authors state that few research studies on “augmentative and alternative communication (AAC) systems have addressed the potential for such systems to impact word utterances in children with autism spectrum disorders (ASD)” (Ganz & Simpson, 2004, p.395). The Picture Exchange Communication System (PECS) is an AAC system particularly developed to reduce difficulties with communication skills experienced by individuals with ASD. Ganz and Simpson (2004) explored the function of PECS in improving the number of words spoken, also while increasing the complexity and length of phrases, and reducing the nonword vocalizations of three young children with autism spectrum disorder and developmental delays, with associated features. The children in the research sample were taught Phases 1 to 4 of PECS, including picture exchange, increased distance, picture discrimination, and sentence construction. The evidence from the study demonstrates that “PECS was mastered rapidly by the participants and word utterances increased in number of words and complexity of grammar”, state Ganz and Simpson (2004, p.395). A meta-analysis carried out by Flippin, Reszka and Watson (2010) using recent research on the use of PECS on communication and speech for children with autism spectrum disorders, supports the view that the technique is useful, and has positive effects on children’s learning, communication, and speech (Flippin et al, 2010). Further, the use of delay, an integral part of the PECS protocol, also contributes to promoting speech. Significantly, the emergent speech produced by the children in this study by Charlop-Christy et al (2002, p.228), occurred with “with novel persons, in two nontraining settings, and with stimuli not directly included in the training settings”. Thus, the PECS is found to promote generalization of its use in natural environments. Generalization is enhanced by the use of child-selected reinforcers, several settings, and interactions with multiple trainers in the daily routine of training with PECS, similar to naturalistic teaching strategies (Charlop-Christy et al, 2002). Yoder and Stone (2006) conducted an experiment using two communication interventions for preschoolers with autism spectrum disorders. This randomized group research compared the effectiveness of the Picture Exchange Communication System (PECS) with Responsive Education and Prelinguistic Milieu Teaching (RPMT), among 36 preschoolers with autism. “Each treatment was delivered 3 times per week, in 20-min sessions, for 6 months” state Yoder and Stone (2006, p.426). Evidence from the research indicates that the RPMT enabled the frequency of generalized turn taking and generalized initiating joint attention, more than the PECS did. The generalized initiating of joint attention was an effect that was found only for children who had started with at least some initiating joint attention at the beginning of the treatment with Responsive Education and Prelinguistic Milieu Teaching (RPMT). On the other hand, the Picture Exchange Communication System (PECS) promoted generalized requests more than the RPMT, in children with low levels of initiating joint attention prior to treatment. These effect sizes were significantly substantial (Yoder & Stone, 2006). The findings from research conducted by Ganz, Simpson and Corbin-Newsome (2008) reiterate that requesting and speech development in preschoolers with autism spectrum disorders was significantly improved with the help of the PECS technique. Further, the application of PECS for blind youth with autism (Lund & Troha, 2008), and for a deaf child with autism (Malandraki & Okalidou, 2007) have been examined. The research results in both cases indicated the development of positive communication outcomes on blind and deaf children, using PECS. In the study undertaken by Ali, MacFarland and Umbreit (2011), four students aged 7 to 14 years with multiple disabilities including visual impairment, were taught requesting skills using PECS to which tangible symbols were added. First, the preferred/ reinforcing and non-preferred items were determined for each participant, by means of conducting an assessment. This was followed by a multiple probe design across participants, to assess the efficacy of the adapted training technique. Data were collected at baseline, during training, maintenance conditions, and generalizatio probes were conducted at intervals, throughout all conditions. The outcome of the study indicates that “all four participants learned requesting skills, generalized these skills to their classrooms, and maintained the skills after training” (Ali et al, 2011, p.425). The use of adapted PECS with other Augmented and Alternative Communication (AAC) systems is considered as potentially beneficial, and is required to be investigated in future research. Paden, Kodak, Fisher et al (2012) used the Picture Exchange Communication System (PECS) to assess differential reinforcement of alternative behavior (DRA) and prompting, to increase peer-directed mands for preferred items (Paden et al, 2012). Two nonvocal children with autism, participated in the study. The evidence indicates that independent mands with a peer increased with the implementation of the differential reinforcement of alternative behavior, together with prompting for both participants in the study. Further, peers engaged in short durations of social interactions in response to the majority of mands for leisure items. The findings reveal that “teaching children to use PECS with peers may be one way to increase manding and social interactions in individuals with limited or no vocal repertoire” (Paden et al, 2012, p.425). Deficits in functional communication occur frequently among children and youth with autism and other developmental delays. Ganz, Simpson and Lund (2012) find that the PECS is a commonly used, valuable, augmentative and alternative communication (AAC) system, which is useful for children and youth lacking adequate communication skills. Tincani (2004) reports from his study comparing PECS and sign language training for children with autism, that the acquisition of picture exchange and sign language may vary according to individual child’s characteristics, particularly motor imitation skills before administration of the techniques. However, optimal procedures for teaching both modalities to students with communication deficits, are required to be determined through future research (Tincani, 2004). Jurgens, Anderson and Moore (2012, p.351) “investigate the integrity with which parents and carers implement PECS in naturalistic settings”, utilizing a sample of twenty-one videos which fulfilled selection criteria, obtained from YouTube. The videos were reviewed for the occurrence of seven implementer errors, and the presence of a physical prompter where relevant. 43% of videos and 61% of PECS exchanges had errors in parent’s carrying out of specific teaching strategies of the PECS training protocol. The errors that appeared most frequently were vocal prompts, incorrect error correction, and the absence of timely reinforcement; and those errors that occurred less frequently were “gestural prompts, insistence on speech, incorrect use of the open hand prompt, and not waiting for the learner to initiate” (Jurgens et al, 2012, p.351). The researchers concluded that the outcome of the parents’ errors and incorrect use of the 4-step error correction strategy when using PECS with their children, are likely to result in prompt dependence by the children with autism, and consequent inability to speak autonomously. Conclusion The Picture Exchange Communication System or PECS method has been found to be effective overall, for achieving enhanced communication outcomes among children with autism spectrum disorders. PECS is found to be promising for numerous reasons. First, the technique requires very few prerequisites, and avoids the difficulties integral to other systems. The only prerequisite is that the individual can clearly indicate what he wants, by reaching for an item, which forms the first step towards exchanging a physical symbol such as a picture. Second, the first skill of requesting taught in PECS is highly suitable for individuals with autism, who feel motivated to develop speech skills. Third, PECS promotes spontaneity which is a feature lacking in children with autism. Fourth, picture symbols used in this approach closely resemble the objects they refer to, hence they are easy for the learner to recognise. Preston and Carter (2009) reiterate that they are more easily recognised by the communication partner also, unlike manual signs and other alternative systems. The generalizability of the PECS technique for easy adaptation to the real life environment, helps the child achieve desired outcomes with ease. Research evidence pertaining to positive speech outcomes by Phase IV of the PECS programme, is now increasingly available, with more studies focusing on this aspect. Further, PECS may be more beneficial for promoting speech in children with a specific developmental profile such as low joint attention, low motor imitation, and high object exploration, than some of the alternative approaches, at least as a short-term outcome. Flippin et al (2010) suggests further investigation of generalizability of speech and communication gains following PECS, and the examination of specific child characteristics causing variations in outcomes. Hence, it is essential for researchers to include measures for treatment fidelity, maintenance and generalization, in future studies of PECS. Further, additional studies are required to examine the effectiveness of PECS on speech and communication outcomes for children with autism spectrum disorder, as compared to other techniques. Moreover, the evidence base for PECS will be increased with studies on the potential influence of moderators and preintervention variables of the participants with respect to attention, exploration, and imitation. A stronger evidence base will increasingly help “clinicians to make informed treatment decisions for individual children with ASD” (Flippin et al, 2010, p.190), and will promote evidence-based practice. References Ali, E., MacFarland, S.Z., & Umbreit, J. (2011). Effectiveness of combining tangible symbols with the Picture Exchange Communication System to teach requesting skills to children with multiple disabilities including visual impairment. Education and Training in Autism and Developmental Disabilities, 46(3), 425-435. Bondy, A.S., & Frost, L.A. (1993). Mands over the water: A report on the application of the picture-exchange communication system in Peru. The Behavior Analyst, 16, 123-128. Bondy, A.S., & Frost, L.A. (1994). The picture exchange communication system. Focus on Autistic Behavior, 9, 1-19. Charlop-Christy, M.H., Carpenter, M., Le, L., Leblanc, L.A., & Kellet, K. (2002 Fall). Using the Picture Exchange Communications System (PECS) with children with autism: Assess- ment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35(3), 213-231. Flippin, M., Reszka, S., & Watson, L.R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19, 178-195. Ganz, J.B., & Simpson, R.L. (2004). Effects on communicative requesting and speech development of the picture exchange communication system in children with characteristics of autism. Journal of Autism and Developmental Disorders, 34(4), 395-409. Ganz, J.B., Simpson, R.L., & Lund, E.M. (2012). The Picture Exchange Communication System (PECS): A promising method for improving communication skills of learners with autism spectrum disorders. Education and Training in Autism and Developmental Disabilities, 47(2), 176-186. Ganz, J., Simpson, R.L., & Corbin-Newsome, J. (2008). The impact of the Picture Exchange Communication System on requesting and speech development in preschoolers with autism spectrum disorders and similar characteristics. Research in Autism Spectrum Disorders, 2, 157-169. Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P., & Charman, T. (2011). A communication-based intervention for nonverbal children with autism: What changes? Who benefits? Journal of Consulting and Clinical Psychology, 79(4), 447-457. Heflin, J.L., & Alaimo, D.F. (2007). Students with autism spectrum disorder: Effective instructional practices. Upper Saddle River, NJ: Pearson Publications. Jurgens, A., Anderson, A., & Moore, D.W. (2012). Parent-implemented Picture Exchange Communication System (PECS) training: An analysis of YouTube videos. Developmental Neurorehabilitation, 15(5), 351-360. Lund, S.K. & Troha, J.M. (2008). Teaching young people who are blind and have autism to make requests using a variation on the Picture Exchange Communication System with tactile symbols: A preliminary investigation. Journal of Autism and Developmental Disorders, 38, 719-730. Malandraki, G.A., & Okalidou, A. (2007). The application of PECS in a deaf child with autism: A case study. Focus on Autism and Other Developmental Disabilities, 22, 23-32. Paden, A.R., Kodak, T., Fisher, W.W., Gawley-Bullington, E.M., & Bouxsein, K.J. (2012). Teaching children with autism to engage in peer-directed mands using a picture exchange communication system. Journal of Applied Behavior Analysis, 45(2), 425-429. Preston, D., & Carter, M. (2009). A review of the efficacy of the Picture Exchange Communication System intervention. Journal of Autism and Developmental Disorders, 39, 1471-1486. Tincani, M. (2004). Comparing the Picture Exchange Communication System and Sign Language training for children with autism. Focus on Autism and Other Developmental Disabilities, 19(3), 152-163. Yoder, P.J., & Lieberman, R.G. (2010). Brief report: Randomized test of the efficacy of picture exchange communications system on highly generalized picture exchanges in children. Journal of Autism and Developmental Disorders, 40, 629-632. Yoder, P., & Stone, W.L. (2006). Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 74(3), 426-435. Read More