Magiati et al., 2003

Study DescriptionInterventionInclusion/Exclusion
Criteria/Population
Baseline MeasuresOutcomes
Author: Magiati et al., 2003

Country:
UK

Practice setting:
Academic

Intervention setting:
School
Enrollment period: NR
Funding:
Agency: Three Guineas Trust, UK
Author industry relationship disclosures:
NR
Design:
Prospective case series
Intervention:
Picture Exchange Communication system (PECS). Assessment carried out in the 2 month period prior to training with rates of change measured during 2 month periods over 6 months following training ( time1/BL, time2, time3, time 4)

Assessments:
Teachers completed initial measures of children’s communicative ability 2 mos before onset of PECS training; same assessments completed immediately after PECS workshop and at 2 monthly intervals thereafter

ASQ, VABS, ATEC

Parental information on child’s general level of functioning and severity of autistic symptoms prior to onset of PECS training

Groups:
G1a: Initially using little/no speech
G1b: Vocabulary of > 10 words when training began

Provider:
Teachers

Measure of treatment fidelity reported:
No

Co-interventions held stable during treatment:
NR

Concomitant therapies:
None

N at enrollment:
G1a: 18
G1b: 16
Inclusion criteria:
  • Diagnosis of Autism
  • Special schools with a full dedicated provision for children with ASD
  • No or minimal prior experience of PECS
Exclusion criteria:
  • Very well developed verbal skills
  • Any increase of Behavioral difficulties
  • See inclusion criteria
Age, mean/yrs ± SD (range):
Both groups: 7.66 ± 2 (5–12)
Mental age: NR
Gender:
M, n (%): 29 (85.3)
F, n (%): 5 (14.7)

Race/ethnicity:
NR

SES:
Maternal education: NR

Household income: NR

Diagnostic approach:
In Study/Referral: Referral

Diagnostic tool/method:
ADI-R

Diagnostic category, n (%):
Autism : 34 (100)
G1a: 18
G1b: 16
Vineland scores:
Age equivalent, mean/yrs:mos ± SD, (range):

Communication: 1:6 ± 7, (0:8–2:8)
Daily living skills: 2:7 ± 7, (1:4–3:9)
Socialization: 1:6 ± 7, (0:7–2:10)
PECS, mean ± SD:
Level: 0.91 ± 1.26
Vocabulary: 0.85 ± 1.18
Frequency: 1.65 ± 1.89
Number of signs: 1.18 ± 1.31
Number of words: 2.53 ± 2.19
Number of phrases: 1 ± 1.58
Overall level of spontaneous communication: 5.91 ± 2.02

Rimland Autism Treatment Evaluation Checklist, mean ± SD:
Total score: 74.9 ± 20.98
Communication: 19.50 ± 5.43
Socialization: 16.02 ± 8.05
Sensory/cognitive: 22.58 ± 6.37
Physical/mood: 16.76 ± 7.38
Vineland scores:
NR
PECS, mean ± SD:
Level: 4.58 ± 1.26
(P = 0.001)
Vocabulary: 4.31 ±1.12
(P = 0.001)
Frequency: 4.71 ±1.59
(P = 0.001)
Number of signs: 1.62 ± 1.56
(P = 0.01)
Number of words: 3.21 ± 2.01
(P = 0.001)
Number of phrases: 1.53 ± 1.98
(P = 0.02)
Overall level of spontaneous communication: 7.38 ±1.47
(P = 0.001)

Rimland Autism Treatment Evaluation Checklist, mean ± SD:
Total score: 65.11 ± 20.89
Communication: 17.29 ± 5.45
Socialization:13.97 ± 7.13
Sensory/cognitive: 19.00 ± 7.97 (P < 0.01)
Physical/mood: 14.85 ± 7.1

Harms:
NR

Modifiers:
Changes according to initial language level:
Baseline vs. Follow up, mean ± SD:
N at follow-up:
G1a: 18
G1b: 16
Other characteristics, n (%):
Hyperactivity: 1 (2.9)
Non-verbal: 10 (29.4)
Single words: 10 (29.4)
Phrase speech: 14 (41.2)
G1a: PECS Level:
1.3 ± 1.13 vs. 4.0 ± 1.14
Vocabulary: 1.05 ± 0.87 vs. 4.06 ± 0.94
Frequency: 2.4 ± 1.76 vs. 4.4 ± 1.61
[all 3 P < 0.01]
Overall level of spontaneous communication:
4.94 ± 1.55 vs. 6.39 ± 1.14 P < 0.001
Number of signs:
P < 0.03
Number of words:
P = 0.001
G1b:
PECS Level: <1 vs. 5.3
P < 0.001
Pictures used: <1 to 21–50
P < 0.001
Frequency of PECS use <1 to 11–20 symbols P < 0.001
Number of words
P = NS
Number of phrases
P = NS
Number of signs:
P = NS
Overall level of spontaneous Communication:
6.9 ± 2.01 vs. 8.47 ± 0.91
P < 0.001
Prior exposure to PECS:
experienced group vs. naïve group:
Experienced:
PECS Freqs :
baseline vs. follow-up
P = NS

PECS vocabulary:
P = 0.02
Naïve group:
PECS level, freq, vocabulary all rose significantly between times 1 & 4 (P < 0.001)

School differences:
pupils in schools with little or no prior experience of PECS actually reached higher PECS levels at follow-up than pupils in schools where PECS was already established

From: Appendix C, Evidence Tables

Cover of Therapies for Children With Autism Spectrum Disorders
Therapies for Children With Autism Spectrum Disorders.
Comparative Effectiveness Reviews, No. 26.
Warren Z, Veenstra-VanderWeele J, Stone W, et al.

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