Eﬀec%veness of Picture Exchange Communica%on System (PECS) Versus Speech-‐
Genera%ng Devices (SGDs) for Children with Au%sm Julia Cabal, B.S. & Abbie Olszewski, Ph.D., CCC-‐SLP University of Nevada, Reno CLINICAL SCENARIO RESULTS I am a graduate student clinician at the University of Nevada, Reno (UNR) Authors Speech and Hearing Clinic who is assigned to work with a 4-‐year 6-‐month Research Design old male diagnosed with auPsm spectrum disorder (ASD). The client has Flippin, Reszka, & Watson (2010) no funcPonal means of communicaPon; thus, the driving goal of therapy is Meta-‐analysis to increase his expressive communicaPon skills-‐-‐speciﬁcally in regard to requests-‐-‐so that the he can eﬀecPvely communicate his needs. Based on my coursework readings and notes, I would like to implement an AugmentaPve and AlternaPve CommunicaPon (AAC) device. I am seeking knowledge as to which AAC device, the Picture Exchange CommunicaPon System (PECS) or a speech-‐generaPng device (SGD), signiﬁcantly increases the frequency of requests. Descrip%on of Par%cipants / Inclusion Criteria • 
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CLINICAL/PICO QUESTION For children with auPsm spectrum disorder (ASD), does the Picture Exchange CommunicaPon System (PECS) signiﬁcantly increase the frequency of requests more than speech-‐generaPng devices (SGDs)? Ganz et al. (2011) Meta-‐analysis • 
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INTRODUCTION •  Approximately 25% of children diagnosed with ASD do not develop funcPonal communicaPon (Flippin, Reszka, & Watson, 2010). •  FuncPonal communicaPon training is beneﬁcial for children with ASD. •  AAC devices are implemented as funcPonal communicaPon training strategies. •  PECS is one AAC opPon, and SGDs are another. •  Both PECS and SGDs are empirically supported treatments that have demonstrated improvement in the frequency of requests for children with ASD (Ganz et al., 2011). •  It is unknown which of these devices would provide a greater increase in the frequency of requests. METHODS The following search terms Au6sm Spectrum Disorder, Picture Exchange Communica6on System, Speech-‐Genera6ng Devices, and Augmenta6ve and Alterna6ve Communica6on Device were used in the PsycINFO electronic database. Ten research arPcles were appraised with an 8-‐point CriPcal Appraisal of SystemaPc Review or Meta-‐Analysis (CASM) form or an 11-‐point CriPcal Appraisal of Treatment Evidence (CATE) form. Each arPcle was evaluated for validity and importance. Each arPcle had an achieved interrater reliability of 100%. Five studies were used to make an evidence based pracPce (EBP) decision. REFERENCES Flippin, M., Reszka, S., & Watson, L. R. (2010). EﬀecPveness of the picture exchange communicaPon system (PECS) on communicaPon and speech for children with auPsm spectrum disorders: A meta-‐analysis. American Journal of Speech-‐Language Pathology, 19, 178-‐195. Retrieved from hnp://ajslp.pubs.asha.org/ Ganz, J. B., Earles-‐Vollrath, T. L., Heath, A. K., Parker, R. I., Rispoli, M. J., & Duran, J. B. (2011). A meta-‐analysis of single case research studies on aided augmentaPve and alternaPve communicaPon systems with individuals with auPsm spectrum disorders. Journal of Au6sm and Developmental Disorders, 42, 60-‐74. doi: 10.1007/s10803-‐011-‐1212-‐2 Ganz, J. B., Mason, R. A., Goodwyn, F. D., Boles, M. B., Heath, A. K., & Davis, J. L. (2014). InteracPon of parPcipant characterisPcs and type of aac with individuals with asd: A meta-‐analysis. American Journal on Intellectual and Developmental Disabili6es, 119(6), 516-‐535. doi: 10.1352/1944-‐7558-‐119.6.516 Gillam, S. & Gillam, R. (2008). Teaching graduate students to make evidence-‐based intervenPon decisions: ApplicaPon of a seven step process within an authenPc learning context. Topics in Language Disorders, 28(3), 212-‐228. Retrieved from hnp://journals.lww.com/topicsinlanguagedisorders/pages/default.aspx SPll, K., Rehfeldt, R. A., Whelan, R., May, R., & Dymond, S. (2014). FacilitaPng requesPng skills using high-‐tech augmentaPve and alternaPve communicaPon devices with individuals with auPsm spectrum disorders: A systemaPc review. Research in Au6sm Spectrum Disorders, 8, 1184-‐1199. Retrieved from hnp://ees.Elsevier.com/RASD/default.asp Van Der Meer, L., Kagohara, D., Roche, L., Sutherland, D., Balandin, S., Green, V. A., O’Reilly, M. F., . . . Sigafoos, J. (2013). Teaching mulP-‐ step requesPng and social communicaPon to two children with auPsm spectrum disorders with three aac opPons. Augmenta6ve and Alterna6ve Communica6on, 29(3), 222-‐234. doi: 10.3109/07434618.2013.815801 • 
Ganz et al. (2014) Meta-‐analysis • 
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S%ll et al. (2014) SystemaPc Review Van der Meer et al. (2013) Single-‐subject design, alternaPng treatments • 
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N = 11 8 single-‐subject; 3 group Age: <18 Diagnosis of auPsm, ASD, or pervasive developmental disorder-‐
not otherwise speciﬁed (PDD-‐NOS) Independent variable (IV): implementaPon of one or more of the six manualized PECS phases Dependent variables (DVs): communicaPve behaviors and speech or vocalizaPon N = 24 Diagnosis of ASD (i.e., any of the PDD diagnoses in the DSM-‐IV-‐TR) IV: aided AAC systems DV of one or more of the following: social skills, adapPve behavior, challenging behavior, communicaPon, or academic skills N = 35 Diagnosis of a PDD (i.e., auPsPc disorder, Asperger syndrome, or PDD-‐NOS) IV: of aided AAC systems DV: academic skills, challenging behavior, communicaPon, and/or social skills Purpose of Study Dependent Variable(s) Examine the eﬀecPveness of PECS on Frequency of requests both communicaPve and speech outcomes speciﬁcally for young children with ASD Frequency of requests Single-‐subject PND: 84.3% (moderately-‐eﬀecPve) Eﬀect Size (ES): 0.51 (moderate) Group design ES (aggregated) : not calculated InvesPgate the eﬀecPveness of aided AAC systems (PECS and SGDs) on communicaPon for children with ASD Behaviors Improvement Rate Diﬀerence (IRD) = 0.99 (large) PND: 76% (moderately eﬀecPve) PECS /SGDs IRD for the use of PECS = 0.99 (large) IRD for the use of SGDs = 0.99 (large) Speech outcomes Some speech at outset: IRD = 0.55 (moderate) Nonspeaking at outset: IRD = 0.43 (small) PECS/SGDs PECS: IRD = 0.68 (moderate) SGDs: IRD = 0.74 (large) Reques%ng skills ParPcipants’ requesPng skills either increased from baseline or were successfully acquired with at least one communicaPon system. On examinaPon of the prevalence of each mode of communicaPon, the use of SGDs was frequent (16 studies). Reques%ng skills across SGDs and PE ParPcipant 1 PND Interven6on: SGD = 53% (minimally eﬀecPve); PE = 67% (minimally eﬀecPve) PND Follow-‐up: SGD = 71% (moderately eﬀecPve), PE = 100% (highly eﬀecPve) ParPcipant 2 PND Interven6on 2: SGD = 8% (ineﬀecPve); PE = 79% (highly eﬀecPve) PND Follow-‐up: SGD = 4% (ineﬀecPve), PE = 25% (ineﬀecPve) Behaviors PECS/SGDs InvesPgate how individual characterisPcs Speech outcomes moderate eﬀecPveness of three types of aided AAC: PECS, SGDs, and other picture-‐based AAC for children with ASD PECS/SGDs N = 16 Review the research published within the last 15 years on empirical studies using high-‐tech devices to teach funcPonal communicaPon skills to children with ASD N = 2 Compare the acquisiPon of mulP-‐step RequesPng skills across SGDs and PE requesPng and social communicaPon across three AAC opPons: manual signing (MS), picture exchange (PE), and speech-‐generaPng devices (SGDs) for young children with ASD Age: <16 Diagnosis of ASD IV: a portable, electronic AAC DV: a funcPonal requesPng skill Required selecPon-‐ or topography-‐
based responding •  Age: <18 •  Diagnosis of ASD •  Very limited or no communicaPon skills as determined by an age equivalency of 2.5 years or less •  No auditory or visual impairments •  Suﬃcient motor skills Results RequesPng skills DISCUSSION •  External Evidence: Aper evaluaPng the outcomes, I concluded that neither PECS nor SGDs demonstrated a greater eﬀect in regard to increasing the frequency of requests. •  Internal Evidence to Client/Caregiver: Aper presenPng the external evidence to the client’s parents, they preferred to implement PECS. •  EBP Decision: IntegraPng external evidence and internal evidence to the client/caregiver, I decided to implement PECS with my client.