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Article Review. Comparative efficacy of the Picture Exchange Communication System (PECS) versus a Speech-Generating Device: Effects on Social-communicative Skills and Speech Development. Presented by: Anna Gill April 7, 2014. Questions being investigated.

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article review

Article Review

Comparative efficacy of the Picture Exchange Communication System (PECS) versus a Speech-Generating Device: Effects on Social-communicative Skills and Speech Development

Presented by: Anna Gill

April 7, 2014

questions being investigated
Questions being investigated
  • What comparative effects are there between PECS and an SGD on enhancing:
    • Social communication skills?’
      • Eye contact
      • Physical orientation
      • (social) smiling
    • Natural speech production?
      • Verbalizations
      • Word approximations
      • Does not include vocal stereotypy (squealing, raspberries), jargon or echolalia
  • School-aged children
  • All participants had a diagnosis of Autism
  • Childhood Autism Rating Scale (CARS) scores indicated at least moderate to severe range of Autism
    • No 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)
  • Christian: 6 y.o., Caucasian, English-speaking
    • Speaks 8 single words, 7 manual gestures
  • Nadia: 7 y.o., Hispanic, English and Spanish at home
    • Non-verbal
    • Previous exposure to pictures (not PECS)
    • 3 manual gestures
  • Zeth: 10 y.o., Caucasian, English at home
    • Non-verbal
    • 4 manual gestures
treatment conditions
Treatment conditions
  • Picture Exchange Communication System (PECS):
    • Protocol by Bondy & Frost (1994)
    • Examined Phases I – III
  • Speech-Generating Device (SGD):
    • Logan ProxTalker
    • Up to 5 buttons on which picture cards can be attached
    • Activation is by pressing down on the picture card
    • Device was set on the table for each of the sessions
preference assessment
Preference assessment
  • 3 stages to determining preferred items
    • Parent interview
    • Trial assessment
    • Forced choice
  • Authors created 2 ranked lists of food reinforcers for each participant
    • One list to be used during the PECS condition
    • Other list for the SGD condition
treatment duration
Treatment duration
  • Participants 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 phases
Treatment phases
  • Baseline
  • Phase I
  • Phase II
  • Phase III (5 subphasesbut later modified)
  • Follow-up
  • Maintenance
  • Mastery Criterion: Child must independently request reinforcers in at least 80% of the opportunities, in both treatment conditions, over 2 consecutive sessions
  • Authors 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 study
Limitations of this study
  • Authors had 3 behaviours for participants to demonstrate social communication skills
    • Apparently 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 study1
Limitations of this study
  • What 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 messages
Take home messages
  • Be 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 AAC
    • i.e., evidence of SOME spoken language at onset of treatment is a strong predictor for later speech development

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


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 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.