is composed of the therapist giving an instruction (i.e., "Look at me", "Do this", "Point to", etc.), in reference to an object, color, simple imitative gesture, etc., which is followed by a prompt (verbal, gestural, physical, etc.). The concept is centered on shaping the child to respond correctly to the instructions throughout the trials. Should the child fail to respond to an instruction, the therapist uses either a "partial prompt" (a simple nudge or touch on the hand or arm) or a "full prompt" to facilitate the child to successfully complete the task. Correct responses are reinforced with a reward, and the prompts are discontinued as the child begins to master each skill. The intervention is often used in conjunction with the Picture Exchange Communication System (PECS) as it primes the child for an easy transition between treatment types. The PECS program serves as another common intervention technique used to conform individuals with autism. As many as 25% of autistic individuals have no functional speech. The program teaches spontaneous social communication through symbols or pictures by relying on ABA techniques. PECS operates on a similar premise to DTT in that it uses systematic chaining to teach the individual to pair the concept of expressive speech with an object. It is structured in a similar fashion to DTT, in that each session begins with a preferred reinforcer survey to ascertain what would most motivate the child and effectively facilitate learning. Effectiveness Limited research shows DTT to be effective in enhancing communication, academic and adaptive skills, as many studies are of low quality research design and there needs to be more larger sample sizes. Society and culture In media A 1965 article in Life magazine entitled Screams, Slaps and Love has a lasting impact on public attitudes towards Lovaas's therapy. Giving little thought to how their work might be portrayed, Lovaas and parent advocate Bernie Rimland, M.D., were surprised when the magazine article appeared, since it focussed on text and selected images showing the use of aversives, including a close up of a child being slapped. Even after the use of aversives had been largely discontinued, the article continued to have an effect, galvanizing public concerns about behavior modification techniques. United States cost In April 2002 treatment cost in the U.S. was about US$4,200 per month ($50,000 annually) per child. The 20–40 hours per week intensity of the program, often conducted at