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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


Participants

Participants

  • 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)


Participants1

Participants

  • 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


Results

Results

  • 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)


References

References

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.


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