Article ReviewComparative efficacy of the Picture Exchange

Communication System (PECS) versus a Speech-Generating Device: Effects on Social-

communicative Skills and Speech Development

Presented by: Anna GillApril 7, 2014

Questions being investigatedWhat comparative effects are there between

PECS and an SGD on enhancing:1) Social communication skills?’

- Eye contact- Physical orientation- (social) smiling

2) Natural speech production?- Verbalizations- Word approximations- Does not include vocal stereotypy (squealing,

raspberries), jargon or echolalia

ParticipantsSchool-aged children

All participants had a diagnosis of Autism

Childhood Autism Rating Scale (CARS) scores indicated at least moderate to severe range of AutismNo other diagnoses mentioned

None of the participants were using a formal communication system or receiving any other type of intervention at the time of the study

Language assessment at baseline: MacArthur-Bates Words and Gestures Communication Development Inventory (CDI)

ParticipantsChristian: 6 y.o., Caucasian, English-speaking

Speaks 8 single words, 7 manual gestures

Nadia: 7 y.o., Hispanic, English and Spanish at homeNon-verbalPrevious exposure to pictures (not PECS)3 manual gestures

Zeth: 10 y.o., Caucasian, English at homeNon-verbal4 manual gestures

Treatment conditionsPicture Exchange Communication System

(PECS):Protocol by Bondy & Frost (1994)Examined Phases I – III

Speech-Generating Device (SGD):Logan ProxTalkerUp to 5 buttons on which picture cards can be

attachedActivation is by pressing down on the picture cardDevice was set on the table for each of the sessions

Preference assessment3 stages to determining preferred items

Parent interviewTrial assessmentForced choice

Authors created 2 ranked lists of food reinforcers for each participantOne list to be used during the PECS condition Other list for the SGD condition

Treatment durationParticipants were seen 2-3 times/week

Sessions took place in the clinic (Nadia and Zeth) or home (Christian)

Sessions were structured, mainly taking place at a table, with participant in a chair (except Phase II)

Sessions were approximately 15 minutes long

Period of study approximately 5 months

Treatment phasesBaselinePhase IPhase IIPhase III (5 subphases but later modified)Follow-upMaintenance

Mastery Criterion: Child must independently request reinforcers in at least 80% of the opportunities, in both treatment conditions, over 2 consecutive sessions

ResultsAuthors noted that all participants

demonstrated “increased social-communicative behaviours” during Phase II PECS

No increase in speech production across participants in either treatment condition

Limitations of this studyAuthors had 3 behaviours for participants to

demonstrate social communication skillsApparently each behaviour was recorded separately

but the data was coded under only ONE umbrella term (“social-communicative behaviours”)

One social-communication behaviour was “physical orientation”; Think – what is Phase II PECS??

Christian had very marginal speech skills (but was functionally non-verbal); Nadia and Zeth were reported to have had no speech skills – no wonder there was no increase in speech production noted!

Limitations of this studyWhat about other SGDs?

Icon size a factor?

Did the participants have other diagnoses (e.g., DD)?

One of the authors (Anu Subramanian) is apparently an S-LP Why wasn’t there a more thorough comparison of

language skills prior to and following the study?Authors not verify parent responses on the

MacArthur-Bates Words and Gestures CDI before or after intervention(see report of parent responses for Zeth)

Take home messagesBe careful how you define and measure “social

skills”

Social-communication skills need to be explicitly taught by other approaches; not sure PECS is the best

Current research regarding use of AAC and increase in speech often (but not always) depends on child’s skills BEFORE implementation of AACi.e., evidence of SOME spoken language at onset of

treatment is a strong predictor for later speech development

(Schlosser & Wendt, 2008; Ganz & Simpson, 2004)

ReferencesBoesch, M. C., Wendt, O., Subramanian, A., & Hsu, N. (2013). Comparative efficacy of the Picture Exchange Communication System (PECS) versus a speech-generating device: effects on social-communicative skills and speech development. Augmentative and Alternative Communication, 29(3), 197-209.

Boesch, M. C., Wendt, O., Subramanian, A., & Hsu, N. (2013). Comparative efficacy of the Picture Exchange Communication System (PECS) versus a speech-generating device: Effects on requesting skills. Research in Autism Spectrum Disorders, 7(3), 480-493.

Ganz, J., Parker, R., & Benson, J. (2009). Impact of the picture exchange communication system: Effects on communication and collateral effects on maladaptive behaviors. Augmentative and Alternative Communication, 25, 250-261.

Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism.: A systematic review. American Journal of Speech-Language Pathology, 17, 212-230.