Evaluating the effects of Picture Exchange Communication System<sup>®</sup> mediator training via telehealth using behavioral skills training and general case training
Telehealth BST teaches parents PECS steps, but you must program extra supports for steady home use.
01Research in Context
What this study did
Treszl et al. (2022) taught parents PECS through Zoom. They used behavioral skills training: explain, model, practice, feedback.
Parents of children with autism joined from home. Coaches watched them trade pictures with their kids and gave live tips.
The team checked if parents kept the steps correct one month later.
What they found
Parents nailed the steps during Zoom sessions. Their scores stayed high right after training.
At follow-up, use at home was spotty. Some parents kept going, others dropped the routine.
Bottom line: telehealth BST works for teaching, but you need more plans for real-life use.
How this fits with other research
Sump et al. (2018) got the same result with new therapists learning DTI online. Skill rose fast, just like these parents.
Laermans et al. (2025) looked back at one year of PECS in a busy clinic. Kids whose families practiced at least three times a week hit phase three far more often. That need for home practice lines up with the mixed follow-up Treszl saw.
Cheong et al. (2026) ran a larger telehealth parent study with PRT. They saw medium-to-large child gains and lower parent stress. Their extra structure may explain why Treszl’s pure BST left use uneven.
Why it matters
You can train parents on PECS without driving across town. Just expect drift unless you add booster calls, homework sheets, and clear daily goals. Build in practice reminders and data review to keep the picture swaps alive after the camera turns off.
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02At a glance
03Original abstract
AbstractResearch indicates that the Picture Exchange Communication System® (PECS®) is an evidence‐based communication approach for children diagnosed with autism spectrum disorder (ASD). However, little is known about PECS‐related parent training, treatment fidelity, or generalization and maintenance of skills. The purpose of the current study was to explore strategies to help parents support their child's PECS use at home. One child with ASD and both his parents participated. Researchers used behavioral skills training to teach target PECS skills and applied general case training strategies to actively program for generalization. A multiple baseline design across skills was used to monitor the primary parent trainee's fidelity during training sessions and a multiple probe design was embedded to monitor both parents' treatment fidelity in the natural environment with their child. The parent trainee demonstrated target PECS skills within the training setting. However, parents did not reliably demonstrate all target PECS skills in the generalization setting during follow‐up.
Behavioral Interventions, 2022 · doi:10.1002/bin.1835