Predictors of Picture Exchange Communication System (PECS) outcomes.
Higher mental age, matching skill, and added generalization drills push autistic preschoolers further in PECS.
01Research in Context
What this study did
Koudys and her team watched the preschoolers with autism or developmental delay learn PECS.
They tracked how far each child got in six months.
Before training started they tested mental age, matching skill, and daily-living scores.
They also noted if the program later added generalization lessons outside the therapy room.
What they found
Kids who had higher mental age, could match identical objects, and had better self-care scores reached Phase IV or higher twice as often.
Even children with severe behaviors made it if they got extra generalization practice.
Without that extra practice, only the highest-scoring kids moved past simple requests.
How this fits with other research
Hartley et al. (2015) showed that color photos work better than line drawings for minimally verbal children.
Koudys’ results line up: the kids with lowest language needed the clearest pictures to keep going.
Hsieh et al. (2014) used eye-tracking and found autistic children look at faces in picture symbols the same way typical peers do.
That supports Koudys: attention to pictures is not the roadblock; cognitive and matching skills are.
Girard et al. (2023) found early visual skills predict later IQ.
Koudys shows a similar pattern: early visual matching predicts PECS success, not just IQ.
Why it matters
You can forecast which learners will fly through PECS in the first month.
Give extra generalization trials to kids with lower mental or matching scores; the study shows it closes the gap.
Pick color photos over black-and-white icons for children who speak little or not at all.
These quick checks let you set realistic goals and avoid stall-outs at Phase III.
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02At a glance
03Original abstract
Although the Picture Exchange Communication System (PECS) has been demonstrated to be an effective intervention to teach people diagnosed with autism spectrum disorder a functional communication system, the research indicates variability in PECS outcomes across people and studies. Therefore, the purpose of the current study was to explore child characteristics and treatment variables that may explain the variation in, and potentially predict, PECS outcomes. A total of 22 children and youth diagnosed with autism or a related developmental disorder, all of whom scored substantially below average on standardized measures of cognitive and adaptive abilities, participated in a PECS intervention. Participants who achieved high phases of PECS (≥PECS phase IIIb) differed significantly from those who mastered lower PECS phases (≤PECS phase IIIa) in terms of overall, verbal, and nonverbal mental age, matching abilities, and adaptive behavior level. Stimulus generalization was also associated with significant variation in PECS outcome. PECS outcomes could be predicted with good accuracy using a combination of these child characteristics and treatment variables. The findings from the current study suggest that children with relatively higher cognitive and adaptive skill levels are more likely to achieve higher phases of PECS; further, approaches to generalization training also play a role. Factors such as autism symptom severity and parental ratings of maladaptive behavior were not associated with significant differences in PECS outcomes. However, more research is needed. Gaining a better understanding of predictors of PECS outcomes is important to inform intervention, provide more accurate outcome expectations for families, and guide PECS teaching procedures. Although participants were more likely to achieve higher phases of PECS if they had a higher mental age, adaptive skill level, and matching skills, the average scores for these measures were well below those expected for same age peers. These results indicate that PECS is appropriate for use with children with clinically significant deficits in cognitive and/or adaptive abilities. Further, results suggest that even children who demonstrate more severe symptoms of autism and exhibit more challenging behavior can achieve higher phases of PECS.
Autism & Developmental Language Impairments, 2023 · doi:10.1177/23969415231221516