Picture Exchange Communication System® (PECS®) Use in a Community Setting: A Preliminary Investigation

Abstract

Communication deficits are one of the core symptoms of autism spectrum disorder (ASD). As such, individuals diagnosed with ASD are often taught to communicate using augmentative and alternative communication (AAC) systems. One of the most commonly used AAC systems is the Picture Exchange Communication System ® (PECS ® ). Despite the prevalent use of PECS within clinical and educational settings, there exists little empirical information about the use of PECS in community settings, such as summer camps. The present preliminary investigation explored the nature of participants' PECS use in a community setting using various sources of data from multiple respondents. Fidelity of PECS implementation was also examined. Twenty-two children and youth, the majority of whom scored substantially below average on standardized measures of cognitive and adaptive abilities and in the "severe" range of ASD symptomatology, were taught to use PECS within a therapeutic summer camp. Overall, results indicate that participants were reported to use PECS to request a diverse array of reinforcing items, across a variety of activities and environments. Increased PECS use and appropriate communicative behavior was observed, as well as reductions in contextually inappropriate behavior. Results were reported by parents to generalize to the home environment. Further, PECS was implemented with adequate fidelity by community implementors. Implications for communication training within community settings are discussed.

Predictors of Picture Exchange Communication System (PECS) outcomes

“…These results suggest that even children who demonstrate more severe symptoms of autism and those who exhibit more challenging behavior can achieve higher phases of PECS. This is an important finding given the established connection between the acquisition of a functional communication system and the prevention or reduction in maladaptive behavior (Koudys et al, 2021;Tiger et al, 2008).…”

“…Study participants were the same 22 children/youth who were involved in the companion study (Koudys et al, 2021). Participants included three girls and 19 boys and ranged in age from 2 years, 3 months to 15 years, 0 months (M = 6 years, 6 months; additional participant details are included in Table 1; Reprinted, as modified, from [2021] Koudys et al, 2021). These participants were recruited from a community organization serving people on the autism spectrum.…”

“…As is expected in any clinical study, there are several limitations which must be considered when interpreting the findings. As thoroughly discussed in Koudys et al ( 2021 ), the study did include a small sample that may not be representative despite best efforts during the recruitment process. The sample size limits the statistical power for analysis, meaning we may not have been able to detect some differences or effects that would have emerged in a larger sample (possible for treatment intensity, for example).…”

“…An exploration of the literature reveals significant differences in treatment duration and intensity, with some studies conducting training over a limited number of sessions and a limited number of trials ( Anderson et al, 2007 ; Cannella-Malone et al, 2010 ; Carré et al, 2009 ; Ganz & Simpson, 2004 ; Ganz et al, 2008 ; Greenberg et al, 2012 ; Jurgens et al, 2009 ; Yoder & Stone, 2006a , 2006b ), while other studies report on outcomes over longer periods, with unlimited trials spread over the course of the entire day ( Koudys et al, 2021 ; Magiati & Howlin, 2003 ; Schwartz et al, 1998 ; Webb, 2000 ). Teaching practices targeting generalization also vary considerably, with some conducting training in a single, controlled teaching environment, such as a clinic ( Greenberg et al, 2012 ; Yoder & Stone, 2006a ), while others conduct teaching in multiple natural settings and/or activities, including the child's home and/or classroom ( Carr & Felce, 2006 , 2007a , 2007b ; Koudys et al, 2021 ; Kravits et al, 2002 ; Schwartz et al, 1998 ). These discrepancies are not surprising when variations in staff training are explored.…”

“…In fact, the results of our initial research that explored the nature of 22 participants’ PECS use in a community setting revealed similar variability. Specifically, although there was significant overall improvement in PECS phase acquisition following PECS training, some participants only mastered one PECS phase while others mastered up to five PECS phases ( Koudys et al, 2021 ). To better understand the outcome variability in the original sample of 22 participants, the present companion study was designed to explore both the child characteristics and treatment factors that may explain the variation in, and potentially predict, PECS outcomes.…”