A survey was conducted to examine the perceptions of parents who use the Picture Exchange Communication System (PECS) to help improve the communication abilities of their children with autism spectrum disorder and/or other developmental disabilities.
This online survey gathered demographic information and employed a scale that parents could use to rate their perceptions of PECS in four areas: their knowledge of PECS, the usefulness of PECS, the benefits of PECS, and barriers to the implementation of PECS. The responses of 40 parents were analyzed.
The results revealed that parents with higher levels of education reported more knowledge of PECS and integrated PECS into their home lives to a greater degree than did parents with lower levels of education. However, both groups reported that PECS was easy to use and effective in developing the communication abilities of their children with autism.
Parents’ perceptions are important to building strong, collaborative relationships between parents and professionals who work with children with ASD. Current findings show that parents found PECS to be effective in improving their children’s communication skills. Future research is recommended to further examine parents’ perceptions of PECS.
Autism spectrum disorder (ASD) is a disability that limits an individual’s ability to develop skills in social communication and social interaction [
PECS is a means of aided augmentative alternative communication (AAC) that consists of six phases. In the first phase, children with ASD learn to exchange a picture for an item or activity they desire instead of pointing to a symbol to obtain that item or action. Over the course of the six phases, the child is taught to initiate communication by requesting items through discrimination, to respond to questions like “What do you want?”, and, ultimately, to make social comments (e.g. statements of the form “I see+object”). The PECS process helps individuals with communication difficulties to engage in spontaneous communication [
Several literature reviews reveal that PECS has been widely used to develop the functional communication skills of individuals with ASD and other developmental disabilities and that PECS is both appropriate and effective for individuals of different ages and ethnicities and with different communication abilities [
Although several intervention studies have investigated PECS and ASD, no study to date has examined parents’ perceptions of PECS. However, several studies have examined families’ perceptions of AAC in general, and these have used survey, interviews, and focus groups [
Five studies reported a need for families to collaborate with professionals in using their native languages with AAC [
Goldbart and Marshall [
Another study, conducted by McNaughton et al. [
Five other studies [
Herzroni [
Calculator [
While most of the studies described above examined AAC in general, no studies have specifically examined parents’ perceptions of PECS, even though PECS is popular and widely used. However, numerous intervention studies in which individuals with ASD were taught to use PECS questioned the social validity and usefulness of PECS; this provides only an individual perspective on parents’ views of PECS. To understand the impact and usefulness of PECS and barriers to its implementation, however, a comprehensive parental view of PECS is necessary. For this reason, this study examined the perceptions of parents on the use of PECS to enhance the communication skills of individuals with ASD and/or other developmental disabilities. It answered the following questions: a) “What do parents know about PECS?” b) What are parents’ perceptions of PECS?”, and c) “What benefits and barriers do parents attribute to PECS?”
Approval from the Human Research Protection Program was obtained before this study was conducted. An email that included a description of, a link to, and access information regarding a survey was sent to administrators of several organizations in the United States, Canada, and Europe. These organizations included professional organizations, parent organizations, and private agencies serving individuals with autism and developmental disabilities. The administrators were asked to forward the email to their membership list of parents and professionals they served who cared for children with ASD and other developmental disabilities. Clicking the survey link, reading the consent page, and accessing the survey implied consent. In addition, individuals who accessed the survey were encouraged to forward it to additional participants. Because this study focused solely on parents’ perceptions of PECS, participants had to have experience with PECS.
Once an initial draft of the survey had been created, four experts in PECS evaluated its content validity. These experts were asked to comment on the clarity and importance of each item and the extent to which the survey avoided words that could generate bias on the basis of gender, race, culture, or ethnicity. The survey was then sent to 20 professionals and parents who used PECS. They were asked to complete the survey and to relay any concerns that they may have had regarding the clarity of the items. The investigator then revised the survey in response to the participants’ concerns. Next, a link to the survey was distributed via an online software platform (Qualtrics®) to several agencies and organizations. Potential participants were informed that the survey would take approximately 10–15 minutes to complete. The survey instrument obtained demographic information and measured four factors: participants’ knowledge of PECS, their use of PECS, the benefits they perceived in using PECS, and barriers they perceived to using PECS.
The demographic items obtained each participant’s age, educational level, employment status, and income. Additional items obtained information on individuals with autism and/or developmental disabilities, including demographic information (e.g. their age and gender) and other information (e.g. their diagnosis).
Each parent rated their
Each parent rated the
Descriptive statistics were used to summarize the demographic characteristics of the parents and their responses to the survey items. The parents were grouped according to education level, annual income, and the phase of PECS their child was currently using. Bivariate tests were then performed to determine whether the groups differed in their knowledge of PECS, their use of PECS, or their perceptions of the benefits of and barriers to using PECS. A chi-square or Fisher’s exact test was then used to compare the groups’ responses to the categorical items, and a
Forty parents of children with autism and/or developmental disabilities (37 mothers and 3 fathers) participated in the study.
As is shown in
Similarly, parents with lower incomes and whose children were in earlier phases of PECS perceived greater barriers to using PECS (
This study examined parents’ perceptions of PECS, specifically the knowledge they perceived themselves to have about PECS, the degree to which they perceived themselves to use PECS, the benefits they perceived of using PECS, and the barriers they perceived to using PECS. The results revealed that parents who had earned higher levels of education and/or attained more knowledge of PECS integrated PECS into the home lives of their children to a greater degree than did parents who had earned lower levels of education and/or attained less knowledge of PECS. All of the parents said that PECS was effective in developing the communication skills of their children with ASD and that it was easy to use.
The results agree with those of previous studies that have reported increases in the independence of children who use aided AAC [
The results revealed that the parents with a graduate-level education or more reported more knowledge of and greater use of PECS than did the parents with a college education or less. The parents with a graduate-level education or more also reported greater success in improving the communication abilities of their children with ASD when they integrated PECS into their home lives. In addition, the parents of children who were in Phase IV or a higher phase expressed greater knowledge of PECS than did the parents of children who were in Phase III or a lower phase, perhaps because the children in more advanced phases had used PECS for longer. These findings are similar to those of Goldbart and Marshall [
The results also revealed that the parents with higher incomes reported more knowledge and use of PECS than did the parents with lower incomes. In addition, they revealed that the parents with higher incomes reported better communication abilities on the part of their children (including in requesting and commenting) than did the parents with lower incomes. However, parents with relatively less education and/or higher incomes and parents whose children were in more advanced phases of PECS perceived greater benefits in using PECS. These results may have been due to the costs of purchasing PECS and attending trainings in PECS.
In general, the parents perceived barriers to using PECS, including the need to carry the PECS book, the amount of time required for training, the costs involved, and the need for a communication partner with whom to use PECS. Some of the barriers that this study identified—the need for training and the costs—were similar to the barriers identified by Bailey et al. [
The majority of the participants in this study were mothers, and the majority of their children were males younger than 10 years old. This is consistent with previous studies conducted to assess parents’ perceptions of AAC. Many of these studies included only mothers [
The limitations of this study include its small sample size, and the education and income levels of the participants. Also, the participants had to have internet access to participate in the study. In addition, this study was internet-based and did not include follow-up interviews to further probe parents’ perceptions; employing methods other than self-administration—such as interviews or focus groups—may have resulted in different responses [
Although a significant body of research has investigated PECS interventions for individuals with ASD, little is known about how parents perceive PECS. However, parents’ perceptions are important to building strong, collaborative relationships between parents and professionals who work with children with ASD. The results of this study suggest that parents find PECS to be effective in improving their children’s communication skills. However, additional research could further support this conclusion.
Length of PECS use, by education level, annual income, and phase.
Level of knowledge, by education level, annual income, and phase.
Level of knowledge, by education level, annual income, and phase. Benefits1, Easy to use PECS; Benefits 2, Better comm by using PECS; Benefits 5, Speech increasing with using PECS; Benefits 10, PECS is useful for all ages.
Level of barriers, by education level, annual income, and phase. Barrier 1, the need to carry a communication book with limited vocabulary choices; Barriers 2, the lack of training opportunities; Barrier 4, the amount of time training took; Barrier 5, necessary modifications required to use PECS; Barrier 6, the cost involved; Barrier 7, the need for a communication partner to implement PECS.
Demographic characteristics of study sample
Variable | n | % |
---|---|---|
Relationships to the child with autism | ||
Father | 3 | 7.5 |
Mother | 37 | 92.5 |
| ||
Age | ||
20–29 | 3 | 7.5 |
30–39 | 18 | 45.0 |
40–49 | 12 | 30.0 |
50–59 | 5 | 12.5 |
60+ | 1 | 2.5 |
Missing | 1 | 2.5 |
| ||
Highest educational level | ||
Some high school | 1 | 2.5 |
High school degree | 1 | 2.5 |
Some college (Bachelor or community college) | 11 | 27.5 |
College or College degree (Bachelor or community college) | 14 | 35.0 |
Some graduate school | 5 | 12.5 |
Graduate school or professional degree (master or doctoral) | 8 | 20.0 |
| ||
Employment status | ||
Full time | 15 | 37.5 |
Part time | 10 | 25.0 |
Stay home parent | 14 | 35.0 |
Retired | 1 | 2.5 |
| ||
Total family income ($) | ||
15,000–19,999 | 2 | 5.0 |
20,000–39,999 | 10 | 25.0 |
40,000–59,999 | 5 | 12.5 |
60,000–79,999 | 4 | 10.0 |
80,000–99,999 | 5 | 12.5 |
100,000–120,999 | 6 | 15.0 |
121,000+ | 7 | 17.5 |
Missing | 1 | 2.5 |
| ||
Child’s age (n=41) | ||
<5 | 8 | 19.5 |
5–9 | 17 | 41.5 |
10–14 | 5 | 12.2 |
15–19 | 4 | 9.8 |
20+ | 3 | 7.3 |
Missing | 4 | 9.8 |
| ||
Child’s gender (n=41) | ||
Male | 30 | 73.2 |
Female | 9 | 22.0 |
Missing | 2 | 4.9 |