Autistism; modifying behaviours 1; Picture Exchange Communication System; Evaluation Flashcards
1
Q
Evaluation; Effectiveness/supporting evidence
A
- Marjorie Charlop-CHristy et al (2002) investigated the effects of a PECS programme on the development of speech in three boys ASD. All had been through speech training programmes that had been inneffective and all had virtually and all had virtually non-existent spontaneous speech. The researchers used the authorised PECS protocol in two 15 minute sessions every week.
- They found that all three children made significantly more spontaneous speech utterances after PECs training than they did before.
- For instance, one child improved from 28% spontaneous utterances pre training to 100% afterwards, and this level was maintained in a follow up after 12 months. Eye contact and joint attention also improved significantly, and there was a marked reduction in problem behaviours including tantrums and disruptions.
- The findings support three central claims of PECS; that it is highly effective in helping children with ASD acquire spontaneous speech, that it can be learned quickly and relatively easily by children with ASD; and that the acquired communication skills can be generalised to non training situations.
- The findings also confirm that PECS can have additional benefits in terms of reducing problem behaviours.
2
Q
Effectiveness; Ease of use
A
- The study by Charlop-Christy et al indicated that the participants progressed through PECS training very rapidly, in a mean time of 170 minutes for all six stages.
- This suggests that PECS is relatively easy to implement and use.
- Michelle Flippin et al (2010) attribute the widespread popularity of PECS (especially in the USA) to this very factor.
- Unlike many other communication training programmes, PECS does not require children with ASD to possess skills such as eye contact before training begins. This means they can swift progress as soon as they start to exchange pictures despite having limited skills.
- This straightforward nature, in which children with no spontaneous communication can make quick and immediate progress, gives PECS an attractive face validity for parents and professionals, increasing its acceptance in the ASD community.
3
Q
Limited support from meta analysis.
A
- Flippin et al reviewed research studies published between 1994 and 2009.
- they also evaluated the scientific quality of each study and included only those that reached an acceptable standard. Eight experiments (a total of 18 participants) and three group studies (with 95 participants receiving PECS and 65 controls) were included in their analysis.
- The findings offered only limited support for PECS . On the positive side they found that PECS is a fairly effective method of improving communication in children with ASD. There was some support for claims regarding spontaneous initiation with ‘small to moderate’ gains. However, there was no reliable evidence that improvements are maintained over time.
- In some cases speech was negatively impacted by PECS.
- most disappointingly, gains in spontaneous speech usage were at best small. in some cases speech was negatively impacted.
4
Q
Ethical implications; Ethical benefits of PECS
A
- One aspect of PECS in particular has potential ethical benefits: the pre programme preparation that involves identifying the reinforcers the child finds most motivating.
- In line with behaviourist principles, this increases the likelihood that the programme will be successful. This means PECS offers the families of children with ASD the prospect of achieving improvements which they have not seen from other training programmes.
- Experiencing the rapid progress promised by PECS allows the child to feel better about themselves and their abilities (i.e maintain and develop their self esteem) because they are less likely to experience the failures which they may be used to. An added benefit is that this also reduces stress within the family.
5
Q
Ethical Implications; Ethical criticisms of PECS
A
- Although not directly targeted at PECS, Simon Baron-Cohen (2009) is critical of any treatment programme for ASD that relies on the application of external rewards, as is the case for any behaviourist method.
- Ethical questions arise over for example stage 1, which involves the teacher withholding a much coveted and enjoyed object (eg a ball) until the child has exchanged a picture. The ball is being used as an Extrinsic Reward when it could be argued that the child should be free to play with the object as they wish.
- This is why Baron- Cohen prefers methods that tap into an interest that the child with ASD already has. and that they find intrinsically rewarding, so there is no need to apply or withhold external rewards in such as situation.
6
Q
Social implications; financial costs of PECS
A
- PECS is a trademarked and branded training programme belonging to an organisation called Pyramid Educational consultants. They produce PECS materials such as high quality picture cards and a mobile app for practising symbol discrimination in stage 3.
- The organisation also insists that PECS practitioners should be trained and qualified in a programme that only they are eligible to provide.
- These commercially available resources can be very expensive. The costs usually come from the budgets of cash strapped public sector organisation such as the health service and local authorities.
- The lack of research support questions the justification for such expenditure by our society.
7
Q
Social Implications; Financial benefits of PECS?
A
- Such considerations have to be balanced against the costs of alternative treatments that may be even less effective in improving the functional communication skills of children with ASD.
- Ultimately, successful training may well contribute to their greater independence as adults, perhaps improving their skills to the point where they are able to work and earn a living.
- This in turn is likely to lower the costs to wider society of social care and welfare benefits.
