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How to Develop an Evidence Base to Support Intervention Use

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How to Develop an Evidence Base to Support Intervention Use

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1. Evidence/research must serve as the main influence of decision-making related matters and strives to improve outcomes.

Flippin et al. (2010) evaluated the effectiveness of the PECS intervention in the increasing of communication and speech outcomes for children under 18 with ASD through the meta-analysis of 11 studies.

Ganz et al. (2012) results from meta-analysis within 13 PECS intervention studies conveyed that PECS can improve functional communication such as initiating requests across age and disability types.

2. The intervention is either listed in Wong et al. 2014, NPDC, or meets ABA criteria.

Picture Exchange Communication (PECS) is a technique/intervention used in ABA. PECS may also fall under "AAC supports" in the NPDC criteria.

3. The evidence is relevant and consistent. It is also peer reviewed.

Research consistently highlights the listed phases of the PECS intervention: phase 1 includes the physical picture exchange through prompting, phase 2 includes implementing distance in order for the individual to approach the conversational partner to exchange the picture, in phase 3 the individual(s) learn to distinguish between multiple pictures, and sentences are constructed in the 4th phase through the combination of pictures (Flippin et al., 2010), (Preston et al., 2009).

Research is consistent in terms of outcomes (provides a means of communication for the ASD population or individuals with little or no functional speech).

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The target population of this intervention includes children and adults with Autism Spectrum Disorder (ASD) and with limited to no functional speech.

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The target location for the utilization of this intervention can take place in any environment in which communication occurs.
However, research suggests that the implementation of the Picture Exchange Communication Systems intervention (PECS) take place within clinical or school settings (Flippin et al., 2010).

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The skills developed in this intervention will include expressive communication through the targeting of requests, and initiating conversation to limit the dependence on conversational partner(s).

PECS is used to teach individuals to approach and give a picture of a desired item/action to a communicative partner in exchange for the item/action or response from the partner.

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In order to collect information to support this intervention, one must determine whether the intervention is evidence based. To be considered evidence-based the evidence should include:

1. Evidence/research must serve as the main influence of decision-making related matters and strives to improve outcomes.
2. The intervention is either listed in Wong et al. 2014, NPDC, or meets ABA criteria.
3. The evidence is relevant and consistent. It is also peer reviewed.

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Although this intervention targets both adults and children with ASD and/or limited functional speech, PECS is advised to be implemented when the individual is a child. Therefore, this intervention would require a lifetime commitment being that it is introduced to the individual as a child.

Flippin et al. (2010) advises that, "Children with relatively limited skills begin exchanging picture symbols to request preferred items immediately starting the first phase of PECS" (p. 179).

Preston et al. (2009) suggests the same in that PECS, "...helps young children with autism acquire functional communication skills. PECS...avoids difficulties inherent in other systems by requiring very few prerequisites" (p. 1471).

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While research is limited in this area of intervention usage, PECS can be argued to be a somewhat less financially demanding as the insert pages range from $4-35 on the official website. Pictures can be printed for free online. A digital version of PECS on the Apple App Store is $34.99.

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Flippin et al. (2010) emphasizes the ease of implementing PECS for both children and interventionists. For children, they are not required to master any prerequisite skills such as eye contact, gestures, and verbal imitation prior to beginning PECS training. It is also motivational in that reinforcers are used to shape communication. For interventionists, Flippin et al. reports of little training needed for trainers.

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The design of PECS consists primarily of requests. Flippin et al. (2010) notes this and addresses how PECS does not include self- initiated comments. Instead, the comments are responses to the interventionist's prompts.

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If the design of PECS consists primarily of requests, then it may be helpful to utilize the PECS intervention in various different settings (school, home, community, etc.) in order to further increase the intervention's ability for increasing self-initiation and generalization techniques among the target population.

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The Picture Exchange Communication System (PECS) is similar to the Voice Output Communication Aids intervention (VOCAs) in that both are augmentative alternative communication systems (AACs). Additionally, both interventions target populations with complex communication deficits and limited functional speech (Beck et al., 2008). Both interventions can be utilized digitally and/or physically through a booklet/own device.

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Special educators who use the PECS intervention must have access to a PECS booklet and allot time to use the intervention with the student(s) who need it. Pictures should be chosen carefully to reflect student needs and be individualized.

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Clinically speaking, Flippin et al. (2010) suggests that concerns arise for these stakeholders in terms of the maintenance of communication and speech gains for children with ASD as participants of PECS. It is crucial for clincians to know ehther the intervention can be continued without continued support from the clinician/ABA therapist.

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Families as stakeholders in the PECS intervention would most likely involve the trial of this intervention themselves at home with their child. PECS could be applied at home through the same technology/materials. Additionally, PECS can serve as a method of communication between the individual and family members or even as a means of scheduling the individual's day and fostering independence.

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Administrators within a school setting would be responsible for potentially supplying such an intervention and take cost factors and method of PECS (app or booklet) into consideration. Additionally, administrators would be responsible for ensuring that the educators implementing this intervention are able to do so effectively and hold accountability for that.

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Beck, A.R., Stoner, J.B., Bock, S.J., and Parton, T. (2008) "Comparison of PECS and the use of VOCA: A Replication." Education and training in Developmental Disabilities. 43(2). 198-216.

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Flippin, M., Reska, S.S., and Watson, L.R. (2010). "Effectiveness of the Picture Exchange Communication System (PECS) on Communication and Speech for Children with Autism Spectrum Disorders: A Meta-Analysis." American Journal of Speech-Language Pathology. 19. 178-195.

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Ganz, J.B., Davis, J.L., Lund, E.M., Goodwyn, F.D., and Simpson, R.L. (2011). "Meta-analysis of PECS with Individuals with ASD: Investigation of Targeted Versus Non-Targeted Outcomes, Participant Characteristics, and Implementation phase." Research in Developmental Disabilities. 33(2). 406-418.

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Preston, D., and Carter, M. (2009). "A Review of the Efficacy of the Picture Exchange Communication System Intervention." Journal of Autism Development Disorder. 39. 1471-1486.