Predictors of successful Picture Exchange Communication System training in children with communication impairments: insights from a real-world intervention in a resource-limited setting.
Six clinic sessions plus three home practices a week lift PECS success in low-resource settings.
01Research in Context
What this study did
The team tracked 46% of kids who reached PECS phase 3 after one year in a Thai clinic.
They asked: who moves forward when money, staff, and time are tight?
Lower autism severity, ≥6 sessions a year, higher family income, and home practice ≥3 times a week predicted success.
What they found
Kids with milder communication delays moved faster.
Six or more clinic visits plus lots of home practice doubled the odds of hitting phase 3.
Money mattered: richer families could buy extra pictures and travel.
How this fits with other research
Eisenhower et al. (2006) warned that untrained staff skip steps; Laermans et al. (2025) now show that low session count hurts kids the same way.
Treszl et al. (2022) taught parents PECS on Zoom, yet home use faded without extra cues; the Thai data echo this—practice frequency beats simply knowing the steps.
Pickard et al. (2025) found provider fidelity helps parents use strategies; P et al. add that family-level factors—cash and daily practice—still decide child success.
Why it matters
You can’t change a family’s income, but you can control dose and coaching.
Schedule at least six PECS visits a year and build a cheap home kit with printed icons.
Add a weekly text reminder: “Practice 3× today.” These two moves lift success rates even when funds are low.
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02At a glance
03Original abstract
<h4>Background</h4>Children with communication impairments-such as autism spectrum disorder or global developmental delay-face significant challenges affecting their emotional and behavioural development. The Picture Exchange Communication System (PECS) is an augmentative communication tool designed to enhance their skills. However, its effectiveness can vary in resource-limited settings. This study aimed to identify predictors of successful PECS training among children with communication impairments in such environments.<h4>Methods</h4>This retrospective study analysed records of 61 children with communication impairments who underwent PECS training at Siriraj Hospital in Bangkok, Thailand, from 2020 to 2023. Success was defined as achieving PECS phase 3 proficiency and a Clinical Global Impression-Improvement score of 1-3 after 1 year. Logistic regression identified predictors of successful outcomes based on demographic, clinical, family and training-related factors.<h4>Results</h4>After 1 year, 46% (28 out of 61) of the children achieved successful PECS outcomes. Significant predictors of success were lower severity of communication impairment (Clinical Global Impression-Severity ≤4; adjusted OR= 15.24, p = 0.002), higher frequency of PECS sessions (>6 times per year; OR = 9.11, p = 0.010), higher family income (≥20,000 baht per month; OR = 9.83, p = 0.024) and frequent home practice (≥3 times per week; OR = 7.02, p = 0.066).<h4>Conclusions</h4>In resource-limited settings, factors such as severity of impairment, intensity of intervention, socioeconomic status and caregiver involvement significantly influence the success of PECS training. Tailored interventions and strategic resource allocation are crucial to optimise communication outcomes for these children.
, 2025 · doi:10.1136/bmjpo-2024-003282