Training Parents of Children with Autism to Implement the Picture Exchange Communication Intervention by Using Bug-in-Ear
Alsayedhassan, Batool Taleb
The Centers for Disease Control and Prevention Autism and Developmental Disabilities Monitoring Network has reported that 1 in 68 children have been diagnosed with autism spectrum disorder (ASD), which is one of the fastest growing disability categories. Social communication disorder is considered one of the main characteristics of individuals with autism, influencing development and social outcomes across the lifespan. Interventions are needed to replace unconventional communicative behavior in children with ASD. Augmentative and alternative communication (AAC) is a system that has been used with individuals with autism who subsequently have demonstrated effective communication skills. The AAC system consists of unaided interventions that do not require any external equipment beside parts of the body (e.g., sign language, gestures, and manual signs) and aided interventions that require external materials such as pictures and electronic devices. One of the AAC strategies found to be effective for persons with autism is the Picture Exchange Communication System (PECS). PECS is a low-tech system that has been used to develop communication skills in different settings such as home, school, and clinical centers. This study intends to investigate the effects of parents’ training and the use of PECS to help their children with ASD develop communication skills while the investigators provide parents with immediate feedback using Bug-in-Ear (BIE) technology. Specifically, this study sought to find out: (1) Do parents acquire mastery of PECS stages after training? (2) Does the use of BIE for training parents reduce errors during PECS implementation with their children with autism? (3) Do children with autism acquire communication skills by using PECS with their parents? (4) Do participants with ASD maintain the acquired skills over time? and (5) What is the perception of parents regarding PECS as measured by the Treatment Acceptability Rating Form-Revised (TARF-R)? Two parents and their children with ASD (one child per family) were recruited for this study. A multiple baseline design across participants was used during the parents’ training, and a changing criterion design was used for the children with ASD. Parents were trained using BIE to implement PECS with their children with ASD. An interobserver agreement, procedural integrity, and social validity were also assessed during the study. Results indicated that both parents implemented the PECS process accurately within 90% and above through the use of BIE. Moreover, both children successfully acquired independent picture exchanges along with their parents who implemented PECS training. Also, both children with autism generalized PECS skills to another setting; they also maintained the acquired skills over one month. These findings extend the existing evidence on PECS by training parents as primary implementers of PECS. The study provides practitioners with insight into the feasibility and necessity of parent-implemented PECS training.