Running head: ANNOTATED BIBLIOGRAPHY
Annotated Bibliography: Social-Communicative Interventions
for Children with Autism
Jessica C. Alcantara
University of California, Merced
Author Note
This is the Annotated Bibliography Final Draft assignment completed IRU0LU]D]DGHK¶V
Writing 101 Section 7 class, due on April 2nd, 2013.
References
Charlop-­Christy, M., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the 1
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picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-­communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35(3), 213-­231. doi: 10.1901/jaba. 2002.35-­213 Charlop-­&KULVW\ &DUSHQWHU /H /H%ODQF .HOOHW¶V VWXG\ H[DPLQHG WKH
effectiveness of the Picture Exchange Communication System (PECS), an intervention commonly used for the intervention of autism to increase speech, communication and social interactions. Three boys, ages 3, 5 and 12, participated twice a week in PECS sessions. All participants displayed severe deficits in language in comparison to their age, little to no spontaneous speech, lack of eye contact with communication limited to gestures such as pointing, prior to the intervention. Programs consisted of free play sessions where opportunities were given to produce either spontaneous or imitative speech, communication increased with physical exchange of pictures Findings
indicated that all three children met the learning requirements for PECS. Spontaneous
verbal speech and imitation increased. Disruptive behaviors decreased, sociocommunicative skills (previously lacking) like joint attention, eye contact increased as
well.
This article is important to my research because it revealed PECS as an effective
intervention strategy that increases speech and skills such as requesting, initiating and
joint attention, all important aspects of social-communicative acquisition. In addition,
high structure found in the program, visual representations and reinforcement were key
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the achievement of other skills, this suggests that interventions should not limit to one
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skill but many such as this study did. Strength of this research was the introduction of
novel trainers and stimuli in various settings to promote generalizability. Although this
study did have many positive outcomes it was limited in other areas. One very
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participants. Future studies with a greater sample size may not show the same results,
thus being unreliable. Validity of this study can be questioned because the research
design failed to provide a control group for comparison. There were also no strong
causal links between increased social and communication abilities and the PECS
intervention, because it may have the result of natural occurrences outside of the study. Ganz, J., & Simpson, R. (2004). Effects on communicative requesting and speech development of the picture exchange communication system in children with characteristics of autism. Journal of Autism and Developmental Disorders, 34(4), 395-­409. doi:10.1023/ B:JADD.0000037416.59095.d7 *DQ]DQG6LPSVRQ¶VUHVHDUFKH[SORUHGWKHUROHRI3(&6DVDVWUDWHJ\Ior improving the number of words spoken, while increasing the complexity and length of phrases. Three young children, one girl age 5 and two boys ages 3 and 7 with autism participated in the study. Participants were taught to communicate through exchange of pictures representing their wants, then expressing their wants in the form of sentences. For example, the participant would hold up a picture containing markers and then learn WRVD\³,ZDQWPDUNHUV´5HVXOWVGHPRQVWUDWHGWKDWDOOFKLOGUHQPDGHSURJUHVV in PECS system and displayed huge gains in mean number of words per trial. Participants with a beginning production of 1-­word sentences completed the program with a mean of 3 to 4 Running head: ANNOTATED BIBLIOGRAPHY
4
words phrases, sentences were also more varied and became more complex (such as the use of adjectives to describe objects) in communication. This study is useful to my literature review because results indicated that PECS LQFUHDVHG SDUWLFLSDQW¶V DPRXQW RI ZRUGV XVHG DQ LPSRUWDQW IRXQGDWLRQ IRU PRUH
complex vocal communication and interactions with others. Some features that may be responsible for its success is using preferred items as motivators to the child, as noted in Charlop-­Christy et al. (2002) research, using visuals such as pictures or symbols made it easier for learning. In addition, having participants request early on in the study might have been more internally motivating for the child in comparison to having a child comment on an item. Some strengths of this research was the quick mastery of skills within 2 months and generalization through various adults. Limitations to the study were identifying what particular aspects or combination of things (within phases 1-­4) were significant for these changes. This was also a single-­group study with no control group, leading tR QR LQWHUQDO YDOLGLW\ 7KH VWXG\¶V VPDOO VDPSOH VL]H RI WKUHH
cannot indicate if results are reliable if replicated. Similar results would verify generalizability across different settings, not just in the classroom. Goldstein, H., Kaczmarek, L., Pennington, R., & Shafer, K. (1992). Peer-­mediated Running head: ANNOTATED BIBLIOGRAPHY
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intervention: Attending to, commenting on, and acknowledging the behavior of preschoolers with autism. Journal of Applied Behavior Analysis, 25(2), 289-­305. doi:10.1901/jaba.1992.25-­289. Goldstein, Kaczmarek, Pennington, & Shafer (1992) investigated peer-­mediated interventions that focused on peer interaction to increase socialization skills. Five preschool boys with autism ages 3 to 7 were paired with two normal functioning peers ages 3 to 5 (5 boys, 5 girls). The oldest target child could say simple sentences, two used single words, and two were non verbal. They were taught to pay attention to peer behaviors, to comment for clarification or request information and acknowledge the behavior of other classmates. Results found increase rates of communication and social interaction among the target group, especially during play activities, for four out of five children with autism. This study was first of its kind to deliver a well rounded package of learning opportunities for children with autism. This work is important to my research because not only did it increase aspects of socialization like paying attention and recognizing behaviors, but also on aspects of communication such as commenting and requesting. Participants were paired with two and not just one peer, this may also be useful to the effectiveness of the research. The significance of introducing multiple skills in a program as each skill facilitates the possibility of another is also something worth trying in future studies. Several limitations to this study were the small sample size of five, gender limitations and no control group, all these weaknesses affect the overall reliability of the experiment, since results may not be the same if replicated. Sessions were conducted in classrooms, future studies should explore using new settings to Running head: ANNOTATED BIBLIOGRAPHY
6
externalize validity so behaviors can be generalized in any setting like home or unfamiliar places. Howlin, P., Gordon, R., Pasco G., Wade, A., & Charman, T. (2007). The effectiveness of
picture exchange communication system (PECS) training for teachers of children with
autism: A pragmatic group randomized controlled trial. Journal of Child Psychology and Psychiatry, 48(5) 473-481. doi:10.1111/j1469-7610.2006.01707.x
+RZOLQ*RUGDQP3DVFR :DGH&KDUPDQ¶VDLPRIWKHVWXG\ZDVWRWHVWWKH
effectiveness of PECS by training teachers of children with autism spectrum disorder (ASD) with a 2-­day PECS workshop. The experiment consisted of a controlled trial of three groups: immediate treatment, delayed treatment, and no treatment. Participants were 84 elementary school children with autism, with a mean age of 6.8 years. The purpose of treatment was to increase communicative initiations and speech in the classroom. Findings indicated modest effectiveness of PECS teacher training. Rates of SXSLOV¶LQLWiations and use of symbols however did increase in the classroom, although there was no evidence of improvement in other areas of communication such as increase in speech production. This article is useful for my literature review because it reveals that larger studies are possible, promising more reliable results. Although modest effectiveness was found in initiations, researchers could devise a large controlled-­ trial study and combine the methods of smaller studies that have been found to be effective in increasing speech. The strengths of this research is that this study is the largest randomized intervention trial for autism to measure the impact of teacher training on increased communication in children with autism. The limitations to this study were that observations were Running head: ANNOTATED BIBLIOGRAPHY
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limited to snack times, behaviors could be highly motivated by reinforcements (food) and researchers were unable to observe students in their classroom or home environment. Therefore it was hard to distinguish if better treatment outcomes could be achieved by more training or more time for observation. This study did display high reliability as the amount of participants (84 children) was very high in comparison to the majority of studies that investigate behavioral interventions with autism. However external validity was lacking as participants were only observed in one environment, results could easily be different elsewhere. Jones, E. A., Feeley, K. M., & Takacs, J. (2007). Teaching spontaneous responses to young children with autism. Journal of Applied Behavior Analysis, 40(3), 565-­570. doi: 10.1901/jaba.2007.40-­565 Jones, Feeley, & Takacs¶ study explored the effectiveness of an intensive
behavioral intervention in establishing spontaneous verbal responses in two 3-year-old
boys diagnosed with autism, referred by their teachers due to their lack of spontaneous
vocalizations. The program was held at a preschool and interventions were not just
exclusive to increasing communication but also to help cognitive and motor skills. The
intervention included discrete-trial training, where a stimulus like a sneeze or vocalized
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DSSURSULDWHUHVSRQVHOLNH³EOHVV\RX´RU³DUH\RXRND\"´7KHVWLPXOXVZDVILUVWJLYHQ
and the appropriate response was then immediately prompted the children
independently were able to respond as well as to generalize these responses to new
settings and individuals. Results at end of the sessions for both children showed
mastery in their targeted spontaneous responses.
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7KLVVWXG\¶VVWUHQJWKZDVLWVJHQHUDOL]DWLRQexpanded with different settings as well as through different instructors however those generalizations are limited. This study was limited due to a small sample size of of only 3 children, gender were also limited therefore having low reliability. There was no control group to compare results, or to reveal if effectiveness of the treatment was due in fact to the intervention or of other naturally occurring events leading to low internal validity. Also, once the child was able to appropriately give the appropriate response but failed to after two tries the instructor ZRXOG ³VD\ QR´ 7KHUHIRUH LW¶V XQVXUH ZKHWKHU WKH DYRLGDQFH RI ³QR´ RU WKH SRVLWLYH
reinforcement contributed to the targeted response. However this research is important to my topic because regardless of other factors, it increased level of communication in children with rare spontaneous vocal utterances in the beginning of the intervention. Specifically, this research has demonstrated that spontaneous verbal responses is an important component of communication necessary for acquiring a wider scope of communication. Lerna, A., Esposito, D., Conson, M., Russo, L., Massagli, A. (2012) Social-communicative
effects of the picture exchange communication system (PECS) in autism spectrum
disorders. International Journal of Language and Communication Disorders, 47(5),
609-617. doi:10.1111/j.1460-­6984.2012.00172.x /HUQD(VSRVLWR&RQVRQ5XVVLRQ0DVVDJOL¶VSXUSRVHRIVWXG\ZDVWRWHVWWKH
effects of PECS on social-communicative skills on such as, spontaneous communication, socializations skills, joint attention, requests and initiations. Eighteen children with
autism were assigned to either PECS or Conventional Language Therapy (CLT) groups.
Participants were of the mean age of 3 and were instructed three times a week for 30-
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minute sessions throughout a period of months. For the first phase no initial difference
was found within groups, however for the second trial the PECS group showed
significantly higher improvements in social communicative abilities like joint attention,
request, initiation, and cooperative play in comparison to the CLT group.
This article is useful for my literature review because it demonstrated that PECS is
overall more effective at achieving social-communicative skills like joint attention and
requesting than CLT. PECS effectiveness, is significant because it shows that the
interactive exchange of visuals promotes higher rates of learning, thus incorporating
visuals in interventions plans may be beneficial. The strengths of this study was that it
used two different intervention techniques to assess effectiveness and results were also
generalized through unstructured and structured settings. Reliability was achieved by
having two independent individuals analyzing and coding observational results, this
ensured results were interpreted consistently in an objective matter. Limitations of this
study consisted of lack of randomization of participants to treatments thus decreasing
internal validity. The small sample size of 18 participants, although larger than most
other studies assessing PECS, was also an issue that limited generalizability.
Tsao, L., Odom, L. S. (2006) Sibling-­mediated social interaction intervention for young children with autism. Topics in Early Childhood Special Education, 26(2), 106-­123 doi: 10.1177/02711214060260020101
Tsao & Odom (2010) investigated the effectiveness of a sibling-mediated intervention
for four children with autism in supporting social behaviors. The participants were all
boys, ages 3, 6 and 7 with little to no speech production, limited to gestures, and lack of
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eye contact and preferred to be on their own. The intervention taught normal
developing siblings ways to socially engage their brothers with autism through play like
turn taking, and providing verbal feedback, and asking questions. Home settings were
typically where the intervention sessions took place but siblings also were introduced to
other environments such as the neighborhood park or the school playground. Results
indicated modest and positive changes in social behaviors like joint attention, initiations
and interactions for 3 out of 4 participants.
This article is important to my research because it provides a moderately effective
more assessable method of peer-mediated approaches. Traditional peer-mediated
interventions pair the child with autism with a peer from a classroom, however having
the child be taught by a sibling is both easier and may produce better results since
siblings are around each other for longer periods of time throughout a period of many
years. Learning more social behaviors, such as interaction and initiations. The strengths
of this research is that the results found more increases in social behaviors than
anticipated, such as joint attention. This may have been due to siblings playing the role
of peer mediators and since they are around their autistic sibling more often, studies
should investigate further the advantages. Several limitations to the study was the lack
of external validity to settings other than home (e.g. school playground), in increased
interactions. This study was a single-subject designed, which consisted of a very small
sample size that produced results that may not be reliable when replicated with more
participants.
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a
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picture communication with vocal results. Infants & Young Children, 24(2) 174-192.
doi:10.1097/IYC.0b013e31820d95ff 2VWU\Q :ROIH¶V SXUSRVH RI WKH VWXG\ ZDV WR LQYHVWLJDWH DQG GHPRQVWUDWH
whether a non vocal child with autism, lacking question asking could learn to ask, ³:KDW¶VWKDW"´WKURXJKD3(&6SURJUDP7KHSDUWLFLSDQWVZHUHDOOER\VDJHVDQG
4, enrolled in preschool. The experimenter would look into a bag or box with a hidden REMHFWDQGDVN³ZKDW¶VWKDW´ZKLOHSRLQWLQJWRWKHSKUDVHRQDFDUGZLWKDpicture of a child pointing out of view and the hidden object. Training was done within one to two GD\V5HVXOWVUHYHDOHGVXFFHVVIXODVNLQJRI³:KDW¶VWKDW"´E\DOOWKUHHSDUWLFLSDQWV This article is relevant and important to my research because it provides an effective LQWHUYHQWLRQSODQWRLQFUHDVHFRPPXQLFDWLRQWKDWLVPRUHFRPSOH[LQQDWXUHVLQFHLW¶V
not focusing on the child expressing a simple mand but asking questions about things of interest. The concept of asking questions and receiving an answer or having the child see the object may play an important role in its effectiveness, since children will typically mand for an object and get it, reinforcers play a slightly different role. This study was one of the first to teach children to ask questions using visual representations commonly used in PECS. Another strength was that participants learned to ask questions within one to two days, the incorporation of visuals may be significant to fast learning. Limitations to this study was limiting generalization of settings, to just the school environment. A small sample and no control group made it difficult to understand if increased behaviors of asking questions was the result of the intervention or other outside factors, therefore the technique cannot be deemed internally valid. Replication of the study should be further investigated however results may not be Running head: ANNOTATED BIBLIOGRAPHY
12
FRQVLVWHQW EHFDXVH DOWKRXJK WKH UHVHDUFK ZDV IRXQG WR EH HIIHFWLYH LW¶V PHWKRG
LPSDLUHGWKHVWXG\¶VUHOLDELOLW\ Travis, J., & Geiger, M. (2010). The effectiveness of the picture exchange communication
system (PECS) for children with autism spectrum disorder (ASD): A south african pilot
study. Child Language Teaching & Therapy, 26(3), 383-384. doi:10.1177/02656590093
49971
Travis & Geiger (2010) investigated the effects of introducing PECS to two 9-year old
South African children with autism, to increase in frequency to request, comment, and
length of spoken words. Requests could be made to the instructor and comments related
to objects. The participants displayed some spoken language but encountered problems
with inadequate use for communication purposes. Results indicated effective treatment
for increasing requesting in both children as well as increased commenting and length of
phrases but not as much. This suggests that further training should be done to increase
comments and words amounts to a level equivalent to that of requesting.
This research is important to my literature review because it indicaWHV 3(&6¶ SRVLWLYH
results in increased communicative behavior for children with autism in another country.
This is significant because it demonstrates that techniques can be applied to children from
many different backgrounds. Also a strength of this study was the incorporation of
increasing a variety of skills like *ROGVWHLQ.DF]PDUHN 3HQQLQJWRQ 6KDIHU¶V study that increased behaviors of requesting and commenting as well as Ganz & 6LPSVRQ¶V VWXG\ ZKLFK LQFUHDVHG VSRNHQ ZRUGV 7KLV GHPRQVtrates that interventions can be effective by looking to increase many different communication behaviors. However a major weakness found in this study, like many other single-subject
designs was the small sample size, which cannot generalize to larger numbers of children
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affected with autism. Also, Hawthorne could have affected the results because
participants received higher than average amounts of attention and reinforcement.
Yoder, P., & Stone, W. L. (2006). Randomized comparison of two communication interventions
for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 74(3), 426-435. doi: 10.1037/0022-006X.74.3.426
Yoder & Stone (2006) conducted a randomized group experiment to compare the
effectiveness two communication interventions Responsive Education and Prelinguistic
Milieu Teaching (RPMT) and the Picture Exchange Communication System (PECS).
Participants were 36 preschoolers with autism spectrum disorders, 19 participants with
the mean age of 3 were placed in the PECS group while 13 participants with a mean age
of 2.7 were in the RPMT group. Participants were in sessions for three times a week, in
20-min sessions, for six months. The results showed that PECS was more effective at
increased initiations for joint attention, turn taking and requests, for children previously
lacking in these abilities than the RRMT treatment.
This article is useful to my literature review bHFDXVH LW¶V RQH RI D IHZ VWXGLHV WKDW
compare effectiveness of PECS with other interventions such as RPMT, the results suggest that PECS was more effective in increasing joint attention and requests. The visual nature of PECS may have had an advantage over 5307WHFKQLTXHVVLQFHWKH\¶UH
more verbal than visual in instruction. Having participants attend to others and turn take incorporates aspects of social behavior as well as communicative skills. When requesting from instructors, both social and communicative abilities in conjunction facilitate better learning. The strength of this study was that participants were randomly assigned to different treatment groups, this produces high reliability. One of the weaknesses of the Running head: ANNOTATED BIBLIOGRAPHY
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study however is that there was no control group, participants that were not introduced to any treatments to ensure that findings were the results of either interventions and not of other factors.