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A Systematic Review of Picture Exchange Communication System Interventions for Children and Adolescents on the Autism Spectrum in Mainland China

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Abstract

The picture exchange communication system (PECS) is an evidence-based intervention used to improve communication for people on the autism spectrum. Little is known, however, about the extent to which PECS is currently used with Chinese-speaking persons. Our systematic review identified 13 single-case design studies reporting on PECS interventions with a total of 22 participants. The results indicated that PECS increased non-vocal communication behavior for 19 participants, increased speech for six participants, and decreased problem behavior for five participants. Five studies reported social validity, three studies programmed for generalization, and nine studies reported maintenance effects. According to Reichow’s (2011) evaluation standards, thirteen studies met only weak criteria indicating that they did not provide good evidence for the effectiveness of PECS in Chinese-speaking persons on the autism spectrum. Implications for future research and practice are discussed.

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References

* Denotes studies included in the review

  • Agius, M. M., & Vance, M. (2016). A comparison of PECS and iPad to teach requesting to pre-schoolers with autistic spectrum disorders. Augmentative and Alternative Communication, 32(1), 58–68. https://doi.org/10.3109/07434618.2015.1108363

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., Welch, K., & Pickles, A. (2007). Patterns of growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75(4), 594–604. https://doi.org/10.1037/0022-006X.75.4.594

  • Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today, 2(2), 127–132. https://doi.org/10.1037/h0099924

    Article  Google Scholar 

  • Bondy, A. S., & Frost, L. A. (1994). The picture exchange communication system. Focus on Autistic Behavior, 9(3), 1–19. https://doi.org/10.1177/108835769400900301

    Article  Google Scholar 

  • Brodhead, M. T., Durán, L., & Bloom, S. E. (2014). Cultural and linguistic diversity in recent verbal behavior research on individuals with disabilities: A review and implications for research and practice. The Analysis of Verbal Behavior, 30(1), 75–86. https://doi.org/10.1007/s40616-014-0009-8

    Article  PubMed  PubMed Central  Google Scholar 

  • Chang, C. F. (2002). Yiwei zibizheng ertong de yuyan fazhan licheng- Liangnian zongguan yanjiu de faxian [A study of language development of a child with autism-two years longitudinal study]. Teshu Jiaoyu Yanjiu Xuekan, 22, 27–47.

  • *Chen, J. (2019). iPad yingyong ruanjian dui zibizheng ertong goutong xingwei de ganyu yanjiu [Intervention research of iPad on communication behavior for children with autism] (Publication No. 1020005316) [Master’s Thesis, Shanxi Normal University]. CNKI Master Theses Database. http://www.cmfd.cnki.net/dejournals/#/cmfd/engineering2

  • *Chen, X. M., Xie, X. C., Li, C. X., Huang, R. Y., Yang, J. H., Lin, W. M., & Chen, J. M. (2020). Jiyu shipin shifan jishu de PECS jiaoxue dui zibizheng ertong zhudong goutong ji qingxu xingwei de ganyu yanjiu [An intervention study of video modeling-based pecs teaching in autistic children’s spontaneous communication behavior and emotional behavior]. Zhongguo teshu Jiaoyu, 9, 45–52. https://doi.org/10.3969/j.issn.1007-3728.2020.09.008

  • DeLeon, I. G., Fisher, W. W., Rodriguez-Catter, V., Maglieri, K., Herman, K., & Marhefka, J. M. (2001). Examination of relative reinforcement effects of stimuli identified through pretreatment and daily brief preference assessments. Journal of Applied Behavior Analysis, 34(4), 463–473. https://doi.org/10.1901/jaba.2001.34-463

  • Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the picture exchange communication system (pecs) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19(2), 178–195. https://doi.org/10.1044/1058-0360(2010/09-0022)

    Article  PubMed  Google Scholar 

  • Friedman, L., Sterling, A., DaWalt, L. S., & Mailick, M. R. (2019). Conversational language is a predictor of vocational independence and friendships in adults with ASD. Journal of Autism and Developmental Disorders, 49(10), 4294–4305. https://doi.org/10.1007/s10803-019-04147-1

    Article  PubMed  PubMed Central  Google Scholar 

  • Frost, L. A., & Bondy, A. S. (2014). The Picture exchange communication system training manual (Chinese version) (Q. X. Bian, Trans.). Pyramid Educational Consultants. (Original work published 2002).

  • Ganz, J. B., & Simpson, R. L. (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. https://doi.org/10.1023/b:jadd.0000037416.59095.d7

  • *Geng, H. (2019). Tupian jiaohuan goutong xitong dui guduzheng puxi zhang ai ertong goutong xingwei de ganyu yanjiu [Effects of PECS on the communication behavior for a child with autism] (Publication No. 1019056657) [Master’s Thesis, Liaoning Normal University]. CNKI Master Theses Database. http://www.cmfd.cnki.net/dejournals/#/cmfd/engineering2

  • Gu, L. (2019). Fenxi gongneng goutong xunlian he tupian jiaohuan goutong xitong dui zibizheng ertong wenti xingwei de yingxiang [Analysis of the effects of functional communication training and picture exchange communication systems on problem behaviors in children with autism]. Shenzhou jiaoyu, 9, 85–86. https://doi.org/10.3969/j.issn.1009-5071(s).2019.09.070

  • Hansen, S. G., Frantz, R. J., Machalicek, W., & Raulston, T. J. (2017). Advanced social communication skills for young children with autism: A systematic review of single-case intervention studies. Review Journal of Autism and Developmental Disorders, 4(3), 225–242. https://doi.org/10.1007/s40489-017-0110-8

  • Hart, S. L., & Banda, D. R. (2009). Picture exchange communication system with individuals with developmental disabilities: A meta-analysis of single subject studies. Remedial and Special Education, 31(6), 476–488. https://doi.org/10.1177/0741932509338354

    Article  Google Scholar 

  • He, S. J., & Li, W. G. (2020). Jinshinian tupian jiaohuan goutong xitong ganyu zibizheng renshi de guoji yanjiu zongshu [A review of the international studies in the past decade on the intervention of picture exchange communication system( PECS) for people with autism]. Xiandai teshu jiaoyu: Gaodeng jiaoyu yanjiu, 391(16), 50–57. https://doi.org/10.3969/j.issn.1004-8014.2020.16.009

  • Helland, W. A., Lundervold, A. J., Heimann, M., & Posserud, M. B. (2014). Stable associations between behavioral problems and language impairments across childhood – the importance of pragmatic language problems. Research in Developmental Disabilities, 35(5), 943–951. https://doi.org/10.1016/j.ridd.2014.02.016

  • Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33, 61–135. https://doi.org/10.1017/S0140525X0999152X

    Article  PubMed  Google Scholar 

  • *Hu, X., & Lee, G. (2018). Effects of PECS on the emergence of vocal mands and the reduction of aggressive behavior across settings for a child with autism. Behavioral Disorders, 44(4), 215–226. https://doi.org/10.1177/0198742918806925

  • Huang, B. Y. (2016). Litan zibizheng ertong yuyan jiaowang zhangai de kangfu xunlian [Rehabilitation of language communication disorders in autistic children]. Xiandai teshu jiaoyu, 9, 64–65. https://doi.org/10.3969/j.issn.1004-8014.2016.05.027

  • Huang, W., Lee, G. T., & Zhang, X. (2023). Current dimensions of applied behavior analysis in Mainland China: A review of 20 years of research. Behavior Analysis in Practice, 16, 437–449. https://doi.org/10.1007/s40617-022-00751-3

    Article  PubMed  Google Scholar 

  • Lan, W. (2016). Qiantan zibizheng ertong yuyan xunlian [An introduction to language training for children with autism]. Kecheng jiaoyu yanjiu, 26, 224. https://doi.org/10.3969/j.issn.2095-3089.2016.26.265

  • Li, H., & Du, Z. (2016). Tupian jiaohuan goutong xitong dui xueqian zibizheng ertong zhudong goutong xingwei de ganyu yanjiu [An intervention study of the picture exchange commuication system in aultistic preschool children’s spontanious behaviors]. Zhongguo teshu jiaoyu, 7, 44–51. https://doi.org/10.3969/j.issn.1007-3728.2016.07.007

  • Liao, Y., Dillenburger, K., He, W., Xu, Y., & Cai, H. (2020). A systematic review of applied behavior analytic interventions for children with autism in Mainland China. Review Journal of Autism and Developmental Disorders, 7(4), 333–351. https://doi.org/10.1007/s40489-020-00196-w

    Article  Google Scholar 

  • *Ling, Z. (2020). Yunyong tupian jiaohuan goutong xitong gaishan zibizheng ertong zhudong goutong nengli de ge an yanjiu [A case study of using a picture exchange communication system to improve the initiative communication skills of children with autism]. In guangdong jiaoyu xuehui (Eds), Guangdong jiaoyu xuehui 2019-2020 niandu xuehui chengguoji (pp. 354–361). CNKI. https://kns.cnki.net/knavi/conferences/proceedings/JIAO202012008/detail?uniplatform=NZKPT

  • Liu, W. Y. (2008). Tigao gaogongneng zibizheng ertong yuyan yingyong nengli de ge an yanjiu [A case study on improving language ability of a high-functional autistic child]. Suihua xueyuan xuebao, 5, 12–14. https://doi.org/10.3969/j.issn.2095-0438.2008.05.005

  • Lu, J. P., Yang, Z. W., Shu, M. Y., & Su, L. Y. (2004). Ertong guduzheng liangbiao pingding de xindu xiaodu fenxi [Reliability and validity analysis of the Childhood Autism Rating Scale]. Zhongguo xiandai yixue zazhi, 14(3), 119–123. https://doi.org/10.3969/j.issn.1005-8982.2004.13.037

  • Ma, S., Luo, M., He, H., Qiao, Y., & Li, M. (2021). Liangzhong banben PECS dui zibizheng ertong qingqiu xingwei de ganyu xiaoguo yanjiu [The effect of two versions of picture exchange communication system on the request behavior of children with autism spectrum disorder]. Zhongguo teshu jiaoyu, 11, 43–51. https://doi.org/10.3969/j.issn.1007-3728.2021.11.008

  • *Mao, X. (2017). Tupian jiaohuan goutong xitong dui zibizheng ertong zhudongxing goutong xingwei de xiaoguo yanjiu. [Effectiveness of the picture exchange communication system (PECS) on initiative communication behavior for children with autism spectrum disorders] (Publication, No. 1017196058) [Master’s Thesis, Hangzhou Normal University]. CNKI Master Theses Database. http://www.cmfd.cnki.net/dejournals/#/cmfd/engineering2

  • Miller, L. E., Burke, J. D., Troyb, E., Knoch, K., Herlihy, L. E., & Fein, D. A. (2017). Preschool predictors of school-age academic achievement in autism spectrum disorder. The Clinical Neuropsychologist, 31(2), 382–403. https://doi.org/10.1080/13854046.2016.1225665

    Article  PubMed  Google Scholar 

  • National Development and Reform Commision. (2022). Shisiwu guomin jiankang guihua [14th Five-Year National Health Plan]. https://www.ndrc.gov.cn/fggz/fzzlgh/gjjzxgh/202206/t20220601_1326725.html. Accessed 2 Mar 2023

  • Norrelgen, F., Fernell, E., Eriksson, M., Hedvall, A., Persson, C., Sjolin, M., Gillberg, C., & Kjellmer, L. (2015). Children with autism spectrum disorders who do not develop phrase speech in the preschool years. Autism, 19(8), 934–943. https://doi.org/10.1177/1362361314556782

    Article  PubMed  Google Scholar 

  • O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2014). Functional assessment and program development for problem behavior: A practical assessment handbook (3rd ed.). Cengage Learning.

  • Ostryn, C., Wolfe, P. S., & Rusch, F. R. (2008). A review and analysis of the picture exchange communication system (PECS) for individuals with autism spectrum disorders using a paradigm of communication competence. Research and Practice for Persons with Severe Disabilities, 33(1–2), 13–24. https://doi.org/10.2511/rpsd.33.1-2.13

  • Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), 89. https://doi.org/10.1186/s13643-021-01626-4

    Article  PubMed  PubMed Central  Google Scholar 

  • *Qi, H., & Zhao, B. (2018). Tupian jiaohuan goutong xitong ganyu zibizheng you er goutong xingwei de ge an yanjiu [A case study of picture exchange communication system intervenes autism without spoken language children’s spontaneous communication behaviors]. Xiandai teshu jiaoyu: Gaodeng jiaoyu yanjiu, 1, 59–64. https://doi.org/10.3969/j.issn.1004-8014.2018.02.012

  • *Qian, X. (2016). Tupian jiaohuan goutong xitong gaishan gaogongneng zibizheng xuqiu biaoda ji neng de ge an yanjiu [A case study of picture exchange communication system on high-functioning children’s requirement expression skill]. Suihua xueyuan xuebao, 36(1), 109–112. https://doi.org/10.3969/j.issn.2095-0438.2016.01.029

  • Reichow, B. (2011). Development, procedures, and application of the evaluative method for determining evidence-based practices in autism. In B. Reichow, P. Doehring, D. Cicchetti, & F. Volkmar (Eds), Evidence-based practices and treatments for children with autism (pp 25–39). Springer. https://doi.org/10.1007/978-1-4419-6975-0_2

  • Scruggs, T. E., Mastropieri, M. A., Cook, S. B., & Escobar, C. (1986). Early intervention for children with conduct disorders: A quantitative synthesis of single-subject research. Behavioral Disorders, 11, 260–271. https://doi.org/10.1177/019874298601100408

    Article  Google Scholar 

  • Scruggs, T. E., Mastropieri, M. A., & Casto, G. (1987). The quantitative analysis of single-subject research methodology: Methodology and validation. Remedial and Special Education, 8, 24–33. https://doi.org/10.1177/074193258700800206

    Article  Google Scholar 

  • Sun, H., Zhou, C., Huang, X., Liu, S., Lin, K., Yu, L., Huang, K., Chu, J., & Yang, Z. (2013). Correlation between the linguistic affinity and genetic diversity of Chinese ethnic groups. Journal of Human Genetics, 58(10), 686–693. https://doi.org/10.1038/jhg.2013.79

    Article  PubMed  Google Scholar 

  • Tao, J. L. (2015). Qianxi zibizheng ertong goutong nengli fazhan de ge an yanjiu [A case study of the development of communication skills in children with autism]. Xiaoxue jiaoxue cankao, 6, 87–88. https://doi.org/10.3969/j.issn.1007-9068.2015.18.075

  • Tincani, M., & Devis, K. (2010). Quantitative synthesis and component analysis of single-participant studies on the picture exchange communication system. Remedial and Special Education, 32(6), 458–470. https://doi.org/10.1177/0741932510362494

  • Tincani, M., Crozier, S., & Alazetta, L. (2006). The picture exchange communication system: Effects on manding and speech development for school-aged children with autism. Education and Training in Developmental Disabilities, 41(2), 177–184.

    Google Scholar 

  • Wang, L. (2021). Tigao guduzheng ertong yuyan biaoda nengli de ge’an yanjiu [A study of improving the expressive language skills of children with autism]. Xiandai teshu jiaoyu, 23, 73–75. https://doi.org/10.3969/j.issn.1004-8014.2021.23.023

  • Wang, Y., Wang, Y., Huang, B., & Li, X. (2019). Woguo zibizheng kangfu jigou ganyu fangfa ji yingxiang yinsu yanjiu [Research on the application and influence factors of intervention methods and assistive teaching devices in autism rehabilitation agencies]. Canjiren Yanjiu, 2, 50–55. https://doi.org/10.3969/j.issn.2095-0810.2019.02.007

    Article  Google Scholar 

  • Wei, S. H., & Xu, J. (2007). Zibizheng ertong zhudong kouyu goutong xingwei ganyu de ge an yanjiu [A case study on intervention for the spontaneous verbal communication behavior of a child with autism]. Zhongguo teshu jiaoyu, 12, 58–62.

    Google Scholar 

  • Xu, W. F. (2015). Zibizheng ertong anli ji ganyu fangfa yanjiu [A study of autistic children’s cases and intervention methods]. Keji jingji shichang, 3, 107. https://doi.org/10.3969/j.issn.1009-3788.2015.03.079

  • Xu, Y. (2017). Xueqian ertong zibizheng anli fenxi ji jiaoyu tujing [Case study of autism in preschool children and educational approaches]. Xin kecheng, 14, 5. https://doi.org/10.16071/j.cnki.cn51-1650/g4.2017.05.250

  • Yang, H. (2017). Zibizheng ertong goutong he yuyan nengli de duoyangxing peiyang [Diversity in the development of communication and language skills in children with autism]. Heihe Jiaoyu, 6, 81–82. https://doi.org/10.3969/j.issn.1002-1647.2017.06.040

    Article  Google Scholar 

  • Ye, Z. P., & Zhang, B. Y. (2020). Yili wuyuyan ganyu youer fuzhu goutong ganyu shijian [Augmentative and alternative communication for a non-verbal preschool child with autism: An intervention in practice]. Shanxi xueqian shifan xueyuan xuebao, 36(1), 69–72. https://doi.org/10.11995/j.issn.2095-770X.2020.01.011

  • *Zhang, C. H. (2015). Jiyu iPad de PECS jiaoxue fang an ganyu zibizheng ertong goutong xingwei zhi yanjiu [The study of using iPad-based PECS training protocol to promote the communication behavior of autistic children] (Publication No. 1015323371) [Master Thesis, Chongqing Normal University]. CNKI Master Theses Database. http://www.cmfd.cnki.net/dejournals/#/cmfd/engineering2

  • Zhang, X., & Zuo, R. Y. (2015). Xueqian zibizheng ertong yuyan kangfu ge an yanjiu [A case study of language rehabilitation training for preschool children with autism]. Chongqing Di Er Shifan Xueyuan Xuebao, 3, 163–166. https://doi.org/10.3969/j.issn.1008-6390.2015.03.039

    Article  Google Scholar 

  • Zheng, R., & Li, X. (2017). Wuyu zibizheng ertong biaoda xuqiu xunlian xiaoying de ge an yanjiu [A case study on training effect of a speechless autistic child’s expression of demand]. Lingnan shifan xueyuan xuebao, 38(2), 37–44. https://doi.org/10.3969/j.issn.1006-4702.2017.02.007

  • Zhou, H., Xu, X., Yan, W., Zou, X., Wu, L., Luo, X., Li, T., Huang, Y., Guan, H., Chen, X., Mao, M., Xia, K., Zhang, L., Li, E., Ge, X., Zhang, L., Li, C., Zhang, X., Zhou, Y., … LATENT-NHC Study Team. (2020). Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years. Neuroscience Bulletin, 36(9), 961–971. https://doi.org/10.1007/s12264-020-00530-6

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhou, Z., & Cheng, Q. (2016). Tupian jiaohuan goutong xitong dui guduzheng puxi zhang ai ertong shejiao ji yuyan gongneng kangfu xiaoguo de xitong pingjia [Effect of picture exchange communication system on social communication and speech in children with autism spectrum disorder: A systematic review]. Zhongguo Kangfu Lilun Yu Shijian, 22(9), 1075–1079. https://doi.org/10.3969/j.issn.1006-9771.2016.09.020

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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by The Fundamental Research Funds for the Central Universities (2020ECNU-HLYT054, PI: Sheng Xu) and The National Social Science Foundation of China (19XSH020, PI: Sheng Xu).

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Li, Y., Lee, G.T., Qi, Y. et al. A Systematic Review of Picture Exchange Communication System Interventions for Children and Adolescents on the Autism Spectrum in Mainland China. Rev J Autism Dev Disord (2024). https://doi.org/10.1007/s40489-024-00442-5

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