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Evidence-Based Communication Assessment

and Intervention
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information:
http://www.tandfonline.com/loi/tebc20

Picture Exchange Communication System

(PECS) may facilitate communicative
behaviors between individuals with
developmental disabilities and their peers,
but further replications are necessary
a a
Kate Simpson & Deb Keen (Commentary authors)
a
Faculty of Education , Australian Catholic University , Brisbane, Australia
Published online: 17 Jan 2011.

To cite this article: Kate Simpson & Deb Keen (Commentary authors) (2010) Picture Exchange
Communication System (PECS) may facilitate communicative behaviors between individuals with
developmental disabilities and their peers, but further replications are necessary, Evidence-Based
Communication Assessment and Intervention, 4:4, 188-191, DOI: 10.1080/17489539.2010.544094

To link to this article: http://dx.doi.org/10.1080/17489539.2010.544094

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 Evidence-based Communication Assessment and Intervention
2010, 4(4), 188–191
Treatment

Picture Exchange Communication System (PECS)

may facilitate communicative behaviors between
individuals with developmental disabilities and
their peers, but further replications are necessary1
Kate Simpson & Deb Keen (Commentary authors)
Faculty of Education, Australian Catholic University, Brisbane, Australia
.............................................................................................................
Downloaded by [University of Tasmania] at 13:32 28 November 2014

Q (1) communication
Can older children with developmental disabilities be taught to engage in social
with peers?
(2) Will participants increase their use of spoken communication or manual signing
with continued use of picture exchange communication system (PECS)?

METHODS
According to the authors, this order
was based on the protocol used in the
Design: Multiple-baseline design
social skills training package PECS with
across three behaviors: greetings,
PEERS by Garfinkle and Schwartz
requests, and responses. Behaviors
(1994).
were presented in the same order for
both participants. A minimum of three Blinding: Unblinded; the training,
baseline sessions were recorded across intervention, and data collection were
behaviors prior to implementing the conducted by a trainer who was not
intervention. Maintenance data were blind to the purpose of the study.
gathered on the three behaviors using Videotape data were randomly
the baseline procedures one month selected for scoring by researchers
following the cessation of the interven- who were not blind to the purpose of
tion for one participant. Generalization the study.
was not assessed.
Study duration: Prior to intervention
Allocation: The two participants both both participants received 13 sessions
received the same assessment, training, of PECS training. Baseline, interven-
and intervention. As this study was a tion, and maintenance sessions were of
single-case design, allocation to the 15-min duration. This was conducted
intervention was not required. Behaviors over 18 sessions for one participant
were presented in the following and 20 sessions for the other partici-
order: greetings, requests, responses. pant. The period of time over which the
study was conducted was not stated.
Setting: The study was conducted
.................................................... within the classroom setting for one
1
Abstracted from: Cannella-Malone, H. I., Fant, J. L., & Tullis,
participant, and in the home environ-
C. A. (2009). Using the picture exchange communication system
to increase the social communication of two individuals with ment for the second participant.
severe developmental disabilities. Journal of Developmental and
Physical Disabilities, 22, 149–163.
Participants: There were two female
Source of funding and disclosure of interest: No source of funding participants with a diagnosis of
reported, and the original authors of this research report no an autism spectrum disorder and
conflicts of interest. impairments in communication.
For correspondence: E-mail: [email protected]

ß 2011 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/EBCAI DOI: 10.1080/17489539.2010.544094
 TREATMENT 189

Each participant was assigned a peer. and responding behaviors. If the par-
Tulla was 14 years old and had ticipant did not demonstrate the appro-
Pervasive Developmental Disorders- priate response within 15 s, a hierarchy
Not Otherwise Specified (PDD-NOS) of least-to-most prompts was used.
and Mood Disorder-NOS. She did not Naturally occurring opportunities for
reliably use a communication system, peer interaction were provided; how-
although she was able to use verbal ever, if this did not occur within 5 min,
utterances when prompted. Tulla’s the researcher engineered an interac-
peer was an 11-year-old boy who tion opportunity. Sessions were video-
was a classmate and communicated taped for data collection. Treatment
using speech characterized by poor integrity was at a mean of 98.3%
articulation. London was 6 years old
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Outcomes: Preference assessments

with autism and used manual signs,
yielded seven preferred items or activ-
short phrases, and an AAC device
ities for each participant, of which the
when communicating with adults. Her
top two items were used during PECS
peer was her typically developing
and social skills intervention. The cri-
3-year-old sister. Both participants
terion for PECS training was 100%
had previous exposure to PECS inter-
responding on three consecutive ses-
vention, but neither participant used
sions. During baseline and intervention
this as their primary form of commu-
data were collected on the frequency
nication. When interaction with peers
and form of communicative acts.
occurred, it was generally character-
Accepted forms of communication
ized by avoidant or aggressive
included PECS, verbal communication,
behavior.
American Sign Language (ASL), or a
Intervention: Both participants were combination. Social validity was
taught greeting, request, and response assessed using a questionnaire com-
behaviors. The study began with a pleted by the parents and teachers.
preference assessment to determine The mean interobserver agreement
individual reinforcers. A communica- was 83.8%.
tion book was developed using photo-
Attrition: Both participants completed
graphs or Picture Communication
the assessment and intervention com-
Symbols (Mayer-Johnson, 1981) of
ponents of the study. Due to time
greetings, responses, and preferred
restraints, maintenance data were col-
items. Initial baseline data on the
lected on only one participant.
three behaviors were collected during
a group activity. Prior to intervention,
participants received training in PECS.
The two peers were provided with
MAIN RESULTS
training to learn appropriate responses
to participants’ greetings and requests. Tulla’s greeting behaviors initially increased,
Greeting behavior with peers was but then decreased when intervention com-
taught first by removing and reintrodu- menced with the second behavior (requests).
cing the participant to the setting at Results for request behavior were variable,
regular intervals. The number of ranging from 2 to 8 requests. An increase in
opportunities was faded to natural Tulla’s response behaviors occurred while
levels when the second behavior, requesting behaviors were targeted and
requesting, was introduced. Using pre- response behaviors were still in baseline.
ferred items or activities, teaching pro- Response behaviors following intervention
cedures were the same for requesting
remained at pre-intervention levels.
 190 TREATMENT

London’s greeting behaviors initially natural settings with individuals with

increased for three sessions, then declined developmental disability and peers.
to pre-intervention levels when request Research of this nature is important
behaviors were introduced. Results for because encouraging social communica-
request behaviors were variable, ranging tion with peers is a significant challenge
from 0 to 14 requests. As for Tulla, an for children with autistic spectrum disor-
increase in London’s response behaviors ders, their parents, and professionals.
occurred while requesting behaviors were Furthermore, one of the participants in
being targeted and response behaviors were this study was 14 years old, and the
still in baseline. Response behaviors follow- inclusion of an older child is a positive
ing intervention were variable and ranged element in this type of research, which
Downloaded by [University of Tasmania] at 13:32 28 November 2014

from 1 to 5 responses. When assessed at often targets much younger children.

follow-up, London’s frequency of greeting Any conclusions and interpretations of
and response behavior was similar to baseline the data from this study must be made
data, while request behavior was variable. with caution. A multiple-baseline-across-
Both participants used a combination of behaviors design relies on achieving a
communication forms. Tulla predominantly stable baseline for each behavior prior to
used spoken forms, or ASL plus speech, while intervention in order to demonstrate
London used PECS plus speech, speech, and experimental control (Kennedy, 2005).
PECS. Social validity was assessed, and the This was not achieved for one of the
intervention was viewed as appropriate and three behaviors for each of the partici-
important by the teachers and parent. pants, and therefore it has not been
demonstrated unequivocally that the
intervention was responsible for any of
AUTHORS’ CONCLUSIONS the outcomes attained. In addition, the
The authors concluded that the PECS proto- intervention data were highly variable,
col provided an initial intervention to facil- and in the case of one participant
itate social communication between (London) the intervention did not achieve
individuals with developmental disability a sustained increase in greeting behavior
and their peers. It was concluded that this beyond baseline levels.
study extended previous research supporting Both participants used a range of
the use of PECS to facilitate language acqui- communicative forms during the interven-
sition. The decrease in greeting behavior was tion, particularly Tulla, who used speech
explained by the reduced opportunities to independent of PECS. This raises ques-
demonstrate these behaviors. The authors tions about the role PECS may have
suggested that the baseline increase in played in facilitating social communica-
responding behaviors that coincided with tion with peers, particularly for Tulla, and
the introduction of the requesting interven- it would have been helpful to understand
tion might have been due to response the rationale for the selection of PECS as
modeling provided by the peers. a communication system for this partici-
pant. The use of a variety of communica-
tion modes by participants highlights the
COMMENTARY need to consider individual preferences
his study examined how PECS could when selecting communication systems.

T be used to enable peers to facilitate

communicative exchanges in
It would also be helpful to have further
information about the criteria used by the
 TREATMENT 191

authors when they collected data on the them could have made a useful
frequency of communicative acts. It is not contribution.
clear whether communicative acts were There are a number of considerations
prompted or unprompted. An increased for future replication of this study. The
frequency of speech was observed for one unintended increase in response behav-
participant, and, while encouraging, iors during baseline while intervention
information on whether there was an was targeting request behaviors warrants
associated increase in the participant’s further investigation, as it may have
vocabulary would have been useful. implications for the generalization of
The authors identified a number of training across behaviors. The choice of
limitations to their study. These included behaviors targeted for intervention is also
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the modest results, the small number of worthy of further consideration. Of the
participants, lack of generalization behaviors chosen for this intervention,
probes, the limited assessment of main- greeting was socially reinforced, while
tenance, and the lack of stable baseline request and response behaviors were
prior to commencing intervention with reinforced by tangibles (activities,
some behaviors. Additional limitations objects). Individuals with ASD often show
can be noted. The frequency of commu- a preference for tangible rather than
nicative behaviors was dependent on the social stimuli. In light of this it would be
number of opportunities in a session. of interest to consider whether the order
These opportunities were not controlled of introducing target behaviors and the
type of reinforcer impacted on the
for and varied across sessions. It may
outcomes.
have been desirable to display the data
using a measure of the percentage of
correct responses to opportunities rather
Declaration of interest: The commentary
than as a frequency. For example, the
authors report no conflicts of interest and are
authors stated that when request behavior
solely responsible for the content of this
was introduced, greeting behavior was
structured abstract.
faded to naturally occurring opportunities
when the child arrived or departed. It is
therefore possible that a frequency of two REFERENCES
greetings was the maximum possible in
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this behavior had declined from levels integrated preschool. Paper presented at the meeting
achieved in earlier intervention sessions. of The Association for the Severely Handicapped,
In relation to greeting behaviors, San Francisco, CA.
Kennedy, C. H. (2005). Single-case designs for educational
these were described as either initiation research. Boston, MA: Pearson Education.
or response, and a further breakdown Mayer-Johnson (1981). Picture Communication Symbols.
of the data to distinguish between Stillwater, MN: Author.