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This research was embarked upon to help children with autism communicate their needs and desires nonverbally using the Picture Exchange Communication System (PECS). To achieve the above objective, the researcher used a single-subject experimental research design. A variation of single-subject experimental design adopted was the A-B-A-B design with one treatment. Data was collected using three instruments: concrete objects, a display board and treatment evaluation instruments. Data collected was analyzed using simple percentage and t-test. Four nonverbal autistic children from the Model Teaching Center constituted the sample used for the study. Following the analysis, the result showed that with the use of PECS, children with autism could satisfy their needs without resorting to violence. It was also found that there was a significant difference between the baseline and the achievements of children with autism using PECS. Based on the results of the research, its implication is that if PECS is adopted for children with autism, it will be an effective way for developing nonverbal communication.
Introduction
One feature of children with autism is delayed speech and language skills (Charlop & Haymes, 1994). The right to communicate is both a basic right and the means by which all rights are realized.
PECS is a modified Applied Behavior Analysis program designed for early nonverbal symbolic communication training (Frost & Bondy, 1994). It is a method that uses a picture symbol and in place of it a real object or item contained in the picture card, which is immediately honored (Bondy & Frost, 1994b).
PECS is not a program designed to teach speech, although the latter is encouraged indirectly and some children begin to spontaneously use speech while on the PECS program (Frost & Bondy, 1996). It is for this reason that the researcher strongly feels that, with PECS, children can be helped to communicate.
Problem
Several strategies have been used in an effort to help children with autism overcome their communication difficulty. These include facilitated communication, argumentative and alternative communication, and picture cards. The ineffectiveness of these methods gave rise to the need for determining an alternative intervention strategy for helping children with autism acquire functional communication skills.
One major flaw of these strategies was that most were inefficient in developing communicative competence that children with autism need in order to communicate their desires. The problem that this research sought to address was to determine if by using PECS, children with autism can develop nonverbal communication. The purpose of the present study was to empirically assess the utility of PECS with children with autism using a single-subject design. The research question was to determine the progress of each child during picture exchange intervention. A hypothesis stated that there was no significant difference between the baseline and treatment achievements of children with autism when given intervention using PECS.
Method
Participants
Four children diagnosed with autism (two boys and two girls) participated in this study during weekly sessions at an after-school behavior treatment program. All of the children had an extensive history of verbal speech training that had been ineffective in teaching them to communicate. These children were chosen for the study because they were the only children with autism in the Model Teaching Center in Jos, Nigeria, where this research was carried out. The study lasted for 12 weeks.
The ages of the children were child A: 7 , Child B: 9, Child C: 11 and Child D: 15. The age of the children was not considered as a factor because the normal age of language acquisition is two and half years. That meant that the children who participated in this study had attained the required age of language acquisition (whether verbal or nonverbal).
PECS Materials
Picture Symbols: These pictures/drawings (15 cm by 23 cm) were used as communication material to teach PECS. This treatment intervention instrument contained major activities for each day and sub-activities classified into six areas. They were classified into preferred and non-preferred.
These picture cards were carefully drawn and colored to attract and sustain the attention of each child. The treatment materials were selected based on the experiences and interests of the children. Available in the literature are preferences of such children as identified by Kanner (1973), Wing (1995), Jordan (1997), Bondy & Frost (1993) and Okwudire (1999). The selection and inclusion of the items were done in collaboration with the classroom teachers, parents and the children themselves. The items were then subjected to the scrutiny of experts - child psychologists, educational technologists, behavior therapists - to judge the representativeness and adequacy of the items for the children as well as the suitability and clarity of nonverbal language expression. The items were categorized into preferred and non-preferred.
The validity and reliability of this instrument was established through pre-testing.
Concrete Objects: These are real objects of preferred items drawn on the picture card. These objects were either bought or prepared by the researcher. Each child was given a concrete object in exchange for the picture card of his or her choice.
Display Board: The instrument was designed by the researcher and constructed by a carpenter according to specifications. It was made in such a way that the picture cards were hung lightly on it. This was to allow the child to remove a picture card with ease and present it in exchange for the concrete item he/she wants.
Settings
The researcher set up a simulation laboratory where intervention was carried out at the Model Teaching Center, after which the researcher embarked on collecting baseline data from the individual child.
To collect data, each of the children was invited into the laboratory and observed on a one-to-one basis. The child was then left to make contact with the treatment materials and the researcher. The researcher proceeded to collect data. After collecting the first baseline data, each child was exposed to the PECS intervention. Then, the second baseline data was collected before the second treatment took place. In both the first and second treatment periods, the scoring was done by ticking good (√ ) for the correct number of exchanges the child made using PECS.
Design
The study adopted a single-subject experimental design, which involves analyzing the effects of an intervention on one or more learning outcomes on an individual.
The variation of single-subject experimental design used was A-B-A-B design with one treatment. The symbolic representation of this design is:
A B A B
First First Second Second
Baseline Treatment Baseline Treatment
Period Period Period Period
In the diagram above, the first A represents the initial baseline that was collected through observation before treatment started. The first B represents initial treatment using PECS, while the second A represents the second baseline period after initial treatment. By returning to the second B, treatment was instituted again.
Data Analysis
Data collected was analyzed using simple percentage and a t-test to test the hypothesis. The percentage was used to answer the research question, while the t-test was used to test the null hypothesis and a bar chart was also used to present the results.
Presentation and Analysis of Data
To answer the research question, what was the progress of each child during picture exchange intervention?, figures 1-4 were used. The null hypothesis was tested at α = 0.05 level, using a two-tailed test.
Results
Acquisition of PECS
What was the progress of each child during picture exchange intervention?
When the first baseline data was collected, each child had a zero baseline. Under the first treatment phase, each child made some good exchanges following the introduction of treatment. A downward trend was recorded when treatment was suspended and the second baseline data was collected. As soon as treatment was reinstated, each child made tremendous progress again. It was interesting to note that under the first and second treatment phases, each child made progress during picture exchange intervention. However, the majority of the children made better progress during the second treatment in almost all of the activities and sub-activities, with the exception of one case where a better score was earned during the second baseline period. For example in figure 4, Child D made higher scores during the second baseline. This was attributed to the unpredictable nature of autism. From the same baseline, it was noticed that the child made as low as 4% and progressed to make up to 74% exchanges during the second treatment period.
This result has shown that the four children that participated in the study could communicate their needs and desires nonverbally using PECS. The number of exchanges made within the 12 weeks the intervention lasted was a laudable achievement for these children with autism. This was an indication that although children with autism had very little expressive language, they communicated their needs and desires using picture symbols and had a high degree of intact language functional abilities.
The implication of this finding was that Nigerian children with autism would, to a large extent, benefit from the use of PECS as a means of communicating their needs and desires. Yamall (2000) investigated the effectiveness of introducing PECS to children with autism and found out that requesting was the most frequent function at both baseline and follow-up. At follow-up, the researcher concluded that all of the children involved in the study showed fewer frustrations, were able to accept that their requests might not always be met and could wait patiently for adult attention.
This result confirmed the findings from the studies of Schwartz, Garfickle, & Bauer (1998) and Frost & Bondy (1996), who found that children with autism developed the ability to communicate with adults and peers while using PECS. They further maintained that some of the children also developed unprompted, non-echolalia spoken communication. In a related study, Magiati & Howlin (2003) discovered that PECS increased children’s vocabulary and the frequency of picture use over time. On the contrary, they found that improvements in children’s general level of communication were slower to occur in children with autism.
In another research study, Bondy & Frost (1994); Peterson, Bondy, Vincent, & Finnegan (1995); and Frost & Bondy (2004) observed that children using PECS improved in their communicative abilities. In addition, there were decreased behavior outbursts, increased initiation behavior, increased meaningful use of symbols to communicate, decreased problem behavior and improved social behavior. In a related study, Siegel (2000) and Yamall (2000) discovered that PECS had become a popular communication strategy used for children with autism and other disorders.
Conclusion
From the finding, it was evident that significant differences existed between baseline and intervention achievements of the research participants. It also showed that nonverbal communication was another way to express or perceive any symbol system used as a medium of communication by individuals without speech (Bondy & Frost, 1994).
Based on the data analysis, the research question and hypothesis were answered in the affirmative. This was because PECS had proven to be an efficient way of communicating with children with autism who did not use verbal language. The researcher concluded that:
PECS had a significant effect on children with autism.
Significant differences existed between baseline and treatment achievements of children with autism who used PECS.
Learning Objectives:
Content Area: Communication
Anne Nwanyieze Okwudire, Ph.D.
Alvan Ikoku Federal College of Education