Experimental evaluation of the training structure of the Picture Exchange Communication System (PECS)

The Picture Exchange Communication System (PECS) is a picture-based alternative communication method that is widely accepted and utilized with individuals with disabilities. Although prior studies have examined the clinical efficacy of PECS, none have experimentally evaluated its manualized training structure. We experimentally evaluated the effects of training during each of the 6 phases of PECS with 7 children with developmental or language disorders. For all 7 participants, PECS responses consistently increased only after training was completed for each of the first 4 phases, but increases in PECS responses occurred during tests of Phases 5 and 6 as soon as training was completed in Phase 4. Consistent with prior research, PECS was taught in a short period of time and required few prerequisite skills. However, 3 of the 7 participants had difficulty with some aspects of training and were able to acquire the targeted skills only after procedural modifications were made.     

Using an adapted form of the Picture Exchange Communication System to increase independent requesting in deafblind adults with learning disabilities

The current study assessed the effectiveness of an adapted form of the Picture Exchange Communication System (PECS) in increasing independent requesting in deafblind adults with learning disabilities. PECS cards were created to accommodate individual needs, including adaptations such as enlarging photographs and using swelled images which consisted of images created on raised line drawing paper. Training included up to Phase III of PECS and procedures ensuring generalizations across individuals and contexts were included. The effects of the intervention were evaluated using a multiple baseline design across participants. Results demonstrated an increase in independent requesting with each of the participants reaching mastery criterion. These results suggest that PECS, in combination with some minor adaptations, may be an effective communicative alternative for individuals who are deafblind and have learning impairments.     

Brief report: increasing communication skills for an elementary-aged student with autism using the Picture Exchange Communication System

The purpose of this study was to examine the effects of the Picture Exchange Communication System (PECS) on the spontaneous communication skills of a 6-year-old girl with autism across her home and school environments. The effects of the PECS were also examined for social interaction. Results indicated increases in spontaneous language (i.e., requests and comments) including use of the icons and verbalizations across those settings in which PECS was implemented. Intelligible verbalizations increased in two of three settings, and changes in peer social interaction were noted in one of the two school settings.     

Effects on Communicative Requesting and Speech Development of the Picture Exchange Communication System in Children with Characteristics of Autism

Few studies on augmentative and alternative communication (AAC) systems have addressed the potential for such systems to impact word utterances in children with autism spectrum disorders (ASD). The Picture Exchange Communication System (PECS) is an AAC system designed specifically to minimize difficulties with communication skills experienced by individuals with ASD. The current study examined the role of PECS in improving the number of words spoken, increasing the complexity and length of phrases, and decreasing the non-word vocalizations of three young children with ASD and developmental delays (DD) with related characteristics. Participants were taught Phases 1-4 of PECS (i.e., picture exchange, increased distance, picture discrimination, and sentence construction). The results indicated that PECS was mastered rapidly by the participants and word utterances increased in number of words and complexity of grammar.     

Brief Report: Randomized Test of the Efficacy of Picture Exchange Communication System on Highly Generalized Picture Exchanges in Children with ASD

A randomized control trial comparing two social-communication interventions in young children with autism examined far-transfer of the use of picture exchange to communicate. Thirty-six children were randomly assigned to one of two treatment conditions, one of which was the Picture Exchange Communication System (PECS). All children had access to picture symbols during assessments. Post-treatment measurement of the number of picture exchanges in a far-transfer, assessment context favored the PECS intervention. These findings were interpreted as support for the hypothesis that the PECS curriculum can successfully teach a generalized means of showing coordinated attention to object and person without requiring eye contact to children with ASD.     

Maintenance and generalization of skills acquired through picture exchange communication system (PECS) training: a long-term follow-up

ABSTRACT

Purpose: To conduct a follow-up assessment of the maintenance of communication skills of a 7-year-old child with autism spectrum disorder, 3 years 7 months post PECS training; and investigate the effects of environmental adaptations on the child’s PECS and vocal communications.

Methods: An alternating-treatments design enabled comparison of the effects of two treatment conditions (an environmental adaptation to increase need and opportunities for communication, versus a continuation of baseline procedures) on the child’s PECS and vocal communications in the child’s home.

Results: Baseline data demonstrated decreased levels of PECS and vocal communication at follow-up, compared to post PECS training 3 years 7 months prior. The environmental adaptation had no observable effect on the participant’s use of PECS, but vocal manding increased in this condition.

Conclusion: These results suggest ongoing need for motivating environments with ample opportunities to practice post PECS training. Implications and directions for future research are discussed.     

Teaching Young People who are Blind and have Autism to Make Requests Using a Variation on the Picture Exchange Communication System with Tactile Symbols: A Preliminary Investigation

This study used a single-subject multiple baseline across participants design to evaluate the effectiveness of a modified picture exchange communication system (PECS) teaching protocol with tactile symbols. Three students (two male, one female) aged 12-17 years who had autism and were blind participated in the study. The instructional program involved three phases. First, each participant learned to exchange a tactile symbol with his/her communication partner to request a preferred item/activity. Second, the distance between the communication partner and the participant was increased. Third, the participants were required to discriminate between two dissimilar tactile symbols. One out of three participants completed all phases of the instructional program. Although the other two participants did not complete the program, they demonstrated improvement from baseline responding rates. This study provided preliminary results that using tactile symbols with strategies from PECS may be an effective method to teach requesting to youth who are blind and have autism.     

Effects of different social partners on the discriminated requesting of a young child with autism and severe language delays

We examined the effects of two adult social partners on the requesting repertoire of a young child with autism and severe language delays. We used a multiple-schedule design (Kazdin, 1982) to evaluate the request topography that the participant emitted relative to each social partner's contingent differential reinforcement for specific requesting forms. The contingencies associated with each adult were reversed after the participant reached a preestablished criterion of discriminated responding. The participant learned to request in a discriminated manner in the presence of each social partner. Implications of these results are discussed.     

Comparative efficacy and safety of oxcarbazepine versus divalproex sodium in the treatment of acute mania: A pilot study

ObjectiveThis study compared the efficacy and safety of oxcarbazepine and divalproex sodium in acute mania patients.Subjects and methodsIn this 12 week, randomized, double-blind pilot study, 60 patients diagnosed with acute mania (DSM-IV) and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexibly dosed oxcarbazepine (1000–2400 mg/day) or divalproex (750–2000 mg/day). The mean decrease in the YMRS score from baseline was used as the main outcome measure of response to treatment. A priori protocol-defined threshold scores were ≤12 for remission and ≥15 for relapse. Number of patients showing adequate response and the time taken to achieve improvement was compared. Adverse events were systematically recorded throughout the study.ResultsOver 12 weeks, mean improvement in YMRS scores was comparable for both the groups including the mean total scores as well as percentage fall from baseline. There were no significant differences between treatments in the rates of symptomatic mania remission (90% in divalproex and 80% in oxcarbazepine group) and subsequent relapse. Median time taken to symptomatic remission was 56 days in divalproex group while it was 70 days in the oxcarbazepine group (p = 0.123). A significantly greater number of patients in divalproex group experienced one or more adverse drug events as compared to patients in the oxcarbazepine group (66.7% versus 30%, p < 0.01).ConclusionOxcarbazepine demonstrated comparable efficacy to divalproex sodium in the management of acute mania. Also the overall adverse event profile was found to be superior for oxcarbazepine.     

Comparative efficacy of antipsychotics in the treatment of schizophrenia: a critical assessment

Because of their broader spectrum of efficacy and lower risk of short- and long-term motor side-effects in comparison to first generation 'typical' antipsychotics (FGAs), second generation 'atypical' antipsychotics (SGAs) are rapidly becoming the standard of antipsychotic pharmacotherapy. It is unclear, however, as to how different SGAs compare in efficacy since the multitude of studies and integrative reviews seemingly provide discrepant information in this regard. To address this issue, we critically review three distinct approaches to analysis of data from randomized controlled clinical trials of the efficacy of SGAs in the treatment of schizophrenia and schizoaffective disorder: (i) comparing average improvement in symptomatology with different SGAs; (ii) comparing average improvement observed with different SGAs relative to haloperidol; and (iii) head-head trials comparing one SGA to another. We discuss the strengths and limitations of each approach with reference to the reports in which it was applied to assess comparative antipsychotic efficacy. We conclude that the most informative picture is obtained by using each of these strategies, looking at all available data, and then putting all the results together. Data thus far do not support claims of differential efficacy among SGAs with the singular exception of clozapine possibly still being the gold standard of antipsychotic efficacy in otherwise treatment-refractory schizophrenia. Dosing appears to be a critical variable in optimizing efficacy.     

The efficacy of integrated cognitive behavioral therapy (CBT) and acupressure versus CBT for insomnia: a three-arm pilot randomized controlled trial

ObjectivesThis pilot study aimed to examine the efficacy of integrated cognitive behavioral therapy (CBT) and acupressure in treating insomnia and its daytime impairments in a Chinese adult population.Methods40 eligible participants with insomnia were randomly assigned to either the integrated CBT and acupressure (CBTAcup) group (n = 14), the CBT group (n = 13), or the waitlist control (WL) group (n = 13). Participants in the CBTAcup group attended a 2-hour integrated CBT and self-administered acupressure group treatment once per week for six consecutive weeks, while participants in the CBT group attended six weekly 2-hour CBT for insomnia. Sleep, mood, daytime impairments, quality of life, and treatment credibility and adherence were assessed at baseline, immediate post-treatment (Week 7), and 4-week post-treatment (Week 11).ResultsLinear mixed-effects models showed that both the CBTAcup and CBT groups had significantly lower insomnia severity (d = −1.74 and d = −2.61), dysfunctional beliefs related to sleep (d = −2.17 and −2.76), and mental fatigue (d = −1.43 and −1.60) compared with the WL group at Week 7. The CBTAcup group provided additional benefits in reducing total fatigue (d = −1.43) and physical fatigue (d = −1.45). Treatment credibility was found to be improved in the CBTAcup group from baseline to Week 7.ConclusionsIntegrated CBT and acupressure demonstrated comparable efficacy to pure CBT in treating insomnia symptoms, with additional advantages to improve fatigue symptoms and acceptability in the Chinese population. Further methodologically rigorous studies on a larger scale and longer follow-up are warranted to confirm these findings.     

Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized,double-blind trial of olanzapine versus haloperidol

OBJECTIVE: Few long-term studies have compared the efficacy and safety of typical and atypical antipsychotic medications directly in patients with a first episode of psychosis who met the criteria for schizophrenia or a related psychotic disorder. This study compared the acute and long-term effectiveness of haloperidol with that of olanzapine in patients with first-episode psychosis in a large, controlled clinical trial. METHOD: Patients with first-episode psychosis (N=263) were randomly assigned under double-blind conditions to receive haloperidol or olanzapine and were followed for up to 104 weeks. Domains measured included psychopathology, psychosocial variables, neurocognitive functioning, and brain morphology and metabolism. This report presents data from clinical measures of treatment response and safety data from the 12-week acute treatment phase. RESULTS: Haloperidol and olanzapine were associated with substantial and comparable baseline-to-endpoint reductions in symptom severity, which did not differ significantly in last-observation-carried-forward analyses. However, in a mixed-model analysis, olanzapine-treated subjects had significantly greater decreases in symptom severity as measured by the Positive and Negative Syndrome Scale total score and negative and general scales and by the Montgomery-Asberg Depression Rating Scale but not as measured by the Positive and Negative Syndrome Scale positive scale and by the Clinical Global Impression severity rating. Olanzapine-treated patients experienced a lower rate of treatment-emergent parkinsonism and akathisia but had significantly more weight gain, compared with the haloperidol-treated patients. Overall, significantly more olanzapine-treated subjects than haloperidol-treated subjects completed the 12-week acute phase of the study (67% versus 54%). CONCLUSIONS: As expected on the basis of previous studies, both olanzapine and haloperidol were effective in the acute reduction of psychopathological symptoms in this group of patients with first-episode psychosis. However, olanzapine had several relative advantages in therapeutic response. Although the nature of adverse events differed between the two agents, retention in the study was greater with olanzapine. Retention in treatment is important in this patient population, given their risk of relapse. Longer-term results are needed to determine whether treatment with atypical antipsychotics results in superior outcomes for a first episode of schizophrenia.     

Topographical disorientation in a patient who never developed navigational skills: the (re)habilitation treatment

Although many cases of topographical disorientation are described in the literature, very few attempts have been made to rehabilitate this deficit, most likely because it is a multi-faceted syndrome in which different patients are affected by different topographical deficits. Therefore, it is not easy to develop a single rehabilitation programme to improve all types of topographical disorders. We describe the rehabilitation of a young woman with selective and pervasive topographical disorientation who never developed navigational skills due to a cerebral malformation bilaterally involving the retrorolandic regions. During treatment, the patient was trained to explore her surroundings carefully, to orient herself and then to move in the environment using a language-based strategy. At the end of the treatment, the patient was able to navigate in the environment by adopting several cognitive strategies useful for orientation. This result was maintained at the one-year follow-up, at which time the patient was also able to reach locations she had never been to alone. These results suggest that even patients who have never developed the ability to orient themselves in the environment can still achieve very good functional recovery if they are accurately assessed and submitted to a specific rehabilitation intervention.     

Communication Deficits and the Motor System: Exploring Patterns of Associations in Autism Spectrum Disorder (ASD)

Many children with autism spectrum disorder (ASD) have notable difficulties in motor, speech and language domains. The connection between motor skills (oral-motor, manual-motor) and speech and language deficits reported in other developmental disorders raises important questions about a potential relationship between motor skills and speech-language deficits in ASD. To this end, we examined data from children with ASD (n?=?1781), 2–17 years of age, enrolled in the Autism Speaks—Autism Treatment Network (AS-ATN) registry who completed a multidisciplinary evaluation that included diagnostic, physical, cognitive and behavioral assessments as part of a routine standard of care protocol. After adjusting for age, non-verbal IQ, Attention Deficit Hyperactivity Disorder (ADHD) medication use, and muscle tone, separate multiple linear regression analyses revealed significant positive associations of fine motor skills (FM) with both expressive language (EL) and receptive language (RL) skills in an impaired FM subgroup; in contrast, the impaired gross motor (GM) subgroup showed no association with EL but a significant negative association with RL. Similar analyses between motor skills and interpersonal relationships across the sample found both GM skills and FM skills to be associated with social interactions. These results suggest potential differences in the contributions of fine versus gross motor skills to autistic profiles and may provide another lens with which to view communication differences across the autism spectrum for use in treatment interventions.     

Ear acupuncture in the treatment of migraine attacks: a randomized trial on the efficacy of appropriate versus inappropriate acupoints

Ear acupuncture can be a useful mean for controlling migraine pain. It has been shown that a technique called the Needle Contact Test (NCT) can identify the most efficacious ear acupoints for reducing current migraine pain through just a few seconds of needle contact. The majority of the points were located on the antero-internal part of the antitragus (area M) on the same side of pain. The aim of this study was to verify the therapeutic value of area M and to compare it with an area of the ear (representation of the sciatic nerve, area S) which probably does not have a therapeutic effect on migraine attacks. We studied 94 females suffering from migraine without aura, diagnosed according to the ICHD-II criteria, during the attack. They were randomly subdivided into two groups: in group A, tender points located in area M, positive to NCT were inserted; in group B, the unsuitable area (S) was treated. Changes in pain intensity were measured using a VAS scale at various times of the study. During treatment, there was a highly significant trend in the reduction of the VAS value in group A (Anova for repeated measures: p < 0.001), whereas no significance was observed in group B. VAS values were significantly lower in group A than in group B at 10, 30, 60 and 120 min after needle insertion. This study suggests that the therapeutic specificity of auricular points exists and is linked to the somatotopic representation of our body on the ear.