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A communication-based intervention for nonverbal children with autism : what changes ? Who benefits ? OBJECTIVE This article examines the form and function of spontaneous communication and outcome predictors in nonverbal children with autism following classroom-based intervention ( Picture Exchange Communication System [ PECS ] training ) . METHOD 84 children from 15 schools participated in a randomized controlled trial ( RCT ) of PECS ( P. Howlin , R. K. Gordon , G. Pasco , A . Wade , & T. Charman , 2007 ) . They were aged 4-10 years ( 73 boys ) . Primary outcome measure was naturalistic observation of communication in the classroom . Multilevel Poisson regression was used to test for intervention effects and outcome predictors . RESULTS Spontaneous communication using picture cards , speech , or both increased significantly following training ( rate ratio [ RR ] =1.90 , 95 % CI [ 1.46 , 2.48 ] , p < .001 ; RR = 1.77 , 95 % CI [ 1.35 , 2.32 ] , p < .001 ; RR = 3.74 , 95 % CI [ 2.19 , 6.37 ] , p < .001 , respectively ) . Spontaneous communication to request objects significantly increased ( RR = 2.17 , 95 % CI [ 1.75 , 2.68 ] , p < .001 ) , but spontaneous requesting for social purposes did not ( RR = 1.34 , 95 % CI [ 0.83 , 2.18 ] , p = .237 ) . Only the effect on spontaneous speech persisted by follow-up ( 9 months later ) . Less severe baseline autism symptomatology ( lower Autism Diagnosis Observation Schedule [ ADOS ] score ; C. Lord et al. , 2000 ) was associated with greater increase in spontaneous speech ( RR = 0.90 , 95 % CI [ 0.83 , 0.98 ] , p = .011 ) and less severe baseline expressive language impairment ( lower ADOS item A1 score ) , with larger increases in spontaneous use of speech and pictures together ( RR = 0.62 , 95 % CI [ 0.44 , 0.88 ] , p = .008 ) . CONCLUSION Overall , PECS appeared to enhance children 's spontaneous communication for instrumental requesting using pictures , speech , or a combination of both . Some effects of training were moderated by baseline factors . For example , PECS appears to have increased spontaneous speech in children who could talk a little at baseline .
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Intervention_Educational
communication-based intervention
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Intervention_Psychological
classroom-based intervention ( Picture Exchange Communication System [ PECS ] training )
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Intervention_Psychological
PECS
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Outcome_Mental
naturalistic observation of communication
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Outcome_Mental
intervention effects and outcome predictors
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Outcome_Mental
Spontaneous communication using picture cards , speech , or both
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Outcome_Mental
Spontaneous communication to request objects
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Outcome_Mental
spontaneous speech
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Outcome_Mental
severe baseline autism symptomatology ( lower Autism Diagnosis Observation Schedule [ ADOS ] score
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Outcome_Mental
spontaneous speech
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Outcome_Mental
severe baseline expressive language impairment
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Outcome_Mental
spontaneous use of speech and pictures together
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Participant_Age
children
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Participant_Age
children
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Participant_Condition
autism
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Participant_Sample-size
84
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Participant_Age
children
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Participant_Age
4-10 years
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Participant_Sample-size
73
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Participant_Sex
boys