Effectiveness of the Picture Exchange Communication System as a Functional Communication Intervention for Individuals with Autism Spectrum Disorders: A Practice-Based Research Synthesis

This research synthesis verifies the effectiveness of the Picture Exchange Communication System (PECS) for improving the functional communication skills of individuals with autism spectrum disorders (ASD). The research synthesis was focused on the degree to which variations in PECS training are associated with variations in functional communication outcomes (Dunst, Trivette & Cutspec, 2002). The communication consequences of PECS were examined in 13 studies, which included 125 participants with ASD who had been identified as having limited or no functional communication skills. Claims that PECS is an effective intervention for improving functional communication skills appeared to be supported by the available research evidence. The purpose of this practice-based research synthesis was to verify the effectiveness of the Picture Exchange Communication System (PECS) for improving the functional communication skills of individuals with autism spectrum disorders (ASD). The synthesis focused on the degree to which variations in the PECS training are associated with variations in functional communication consequences. In general terms, a practice-based research synthesis differs from more traditional meta-analyses by systematically examining and unpacking the characteristics of practices that are related to differences in outcomes or consequences. Specifically, this type of analysis focuses more on understanding how the same or similar characteristics exert the same or similar observable effects and not solely on statistical or observation-based relationships between or among these variables. The reader is referred to Dunst et al. (2002) for a detailed explanation of this framework. Individuals diagnosed with ASD share significant deficits in communication (American Psychiatric Association, 2000). In order to address the communication challenges of children with ASD, behavior analysts, speech-language pathologists, and special educators increasingly have turned to augmentative and alternative communication (ACC) (Frea, Arnold, & Vittimberga, 2001). The Picture Exchange Communication System (PECS) is one of such augmentative communication system designed to increase functional communication skills and potentially provide a bridge to speech acquisition. The Picture Exchange Communication System been supported by a small number of case studies and a large body of anecdotal literature (Charlop-Christy, Carpenter, Le, LeBlanc, & Kellet, 2002; Magiati & Howlin 2003; Mirenda, 2001; Mirenda & Erickson, 2000). Thus few published experimental studies have specifically investigated the effectiveness of PECS for children with ASD or other developmental disabilities. Furthermore, the majority of the anecdotal literatures reviewing the effectiveness of PECS were contributed by its developers, Andy Bondy and Lori Frost. Bondy and Frost’s first published article (1993) on PECS detailed its use with children and adults with developmental disabilities. Specifically, they described the procedures Correspondence concerning this article should be addressed to Kai-Chien Tien, University of Kansas, 4227 Wimbledon Dr., Lawrence, KS 66047. Education and Training in Developmental Disabilities, 2008, 43(1), 61–76 © Division on Developmental Disabilities Functional Communication Intervention / 61 used to train school-based staff in Peru to use the system over a five-month period. Although no formal data were collected, the school reported that of the 74 students who received the PECS training, at the end of a 3-month period, 28 were working on mastering Phase I, 28 were working on mastering Phases II, and 18 were working on mastering Phase III of the PECS training protocol. In another study, Bondy and Frost (1994) reported outcomes for 85 noncommunicative preschool children with ASD aged 5 years or younger. While children’s cognitive abilities were not assessed, they were estimated as ranging from near-normal to profoundly disabled. Over 95% learned to use two or more pictures within the exchange format; almost all learned at least one picture within one month of starting the PECS. For the 66 children who used PECS for more than a year, 41 were able to use speech independently, whereas the remaining 25 children were using a combination of pictures or symbols and speech. All children mastered using pictures or symbols to communicate, although not all reached the highest levels of PECS. Bondy and Frost (1994) also presented anecdotal data from a number of single-case and small-group studies. Most indicated encouraging results in terms of increased spontaneous communication and speech and, in some case, decreased behavioral problems. The impact of PECS on problem behaviors was also examined in several studies beyond that of Bondy and Frost. For example, PECS was reported as an effective intervention for a 4-year-old with autism to decrease aggressive behavior in a general education preschool classroom (Frea et al., 2001). Dooley, Wilczenski, and Torem (2001) reported a dramatic decrease in problem behaviors and increase in compliance during transitions following PECS on a 3-year-old boy with a diagnosis of pervasive developmental disorders (PDD). Description of PECS Practice Developed in 1985 by Andrew Bondy and Lori Frost, PECS originally was primarily used for preschool-age children with ASD and other social communicative disorders who displayed no functional or socially acceptable speech (Frost & Bondy, 2002, pp. 46). The rationale behind PECS is that the exchange of a picture for a reinforcing item parallels the communicative exchange that takes place in typical conversation (Bondy & Frost, 1993, 1994). The PECS training is based on research and practice in the principles of applied behavior analysis. Thus, distinct teaching strategies, reinforcement strategies, error correction strategies and generalization strategies are essential for teaching each skill (see Frost &