Documente Academic
Documente Profesional
Documente Cultură
elayed development of language is an early and persistent marker of autism (Lord, Risi, & Pickles, 2004).
Although estimates vary, approximately 25% of children with autism do not develop functional speech (Volkmar,
Lord, Bailey, Schultz, & Klin, 2004). Thus, the need for early
and effective communication training for children with autism
is clear. However, given the myriad communication-training
strategies available, it is difficult for clinicians to choose the
most effective intervention for an individual child with autism
spectrum disorders (ASD). Variability in language outcomes
for children with ASD makes it difficult to predict which
children will go on to develop speech and which children will
require augmentative and alternative communication. In addition, differential response to intervention for individual
children with ASD makes it difficult for clinicians to identify
the best method of communication training for any one particular child. Given the heterogeneous nature of ASD, variability
178
American Journal of Speech-Language Pathology Vol. 19 178195 May 2010 A American Speech-Language-Hearing Association
II
III
IV
VI
Description
Training begins on a single picture of highly desired item.
Student picks up picture of desired item and releases into
communicative partners hand in exchange for desired
item. Communicative partner gives the item to the child
while naming the item (e.g., car ). Two adults (i.e., the
communicative partner and a physical prompter) are used
during this phase.
A communication book is introduced, and increased distance
is placed between the child and communicative partner.
Child is required to get picture from her communication
book and travel to communicative partner to request item.
To increase spontaneity and persistence, placement of
picture symbol is varied in the book. Also, generalization
across a variety of trainers, contexts, and reinforcers is
introduced at this phase.
Child is required to discriminate between two picture
symbols (highly desired vs. nondesired item to gradually
multiple desired items). Correspondence checks are
done to ensure that child is truly requesting preferred
item.
Child uses a sentence starter (I want) to make a request by
building and exchanging a 2-picture-sequence sentence
strip with I want symbol plus picture symbol for preferred
item. Communicative partner provides verbal model I
wantI and pauses before labeling the requested item
and handing sentence strip and requested item back to
child. Communicative partner differentially reinforces
any vocal attempt.
Communicative partner introduces the verbal prompt What
do you want? Over time, a delay is inserted between
the verbal prompt and an additional gesture prompt
toward the I want picture symbol. The child begins
answering the question before her communicative
partner uses the gestural prompt.
Comments are trained as child exchanges sentence strips
to respond to partners communicative questions (i.e.,
What do you see? What do you want? What do
you have?).
Note. From PECS Training Manual (Frost & Bondy, 2002). Adapted
with permission.
179
syntheses of the evidence for PECS, they do not provide assessments of the quality of the studies included, or quantitative analyses of results.
In contrast, Schlosser and Wendt (2008) employed both
quality assessment and quantitative analyses in their systematic review of the effects of augmentative and alternative
communication intervention on communication and speech
production for children with autism. Although the independent
variables examined in that review were not limited to PECS,
articles that met criteria for review included seven studies (six
single-subject experiments and one group design) in which
PECS was the independent variable. The authors proposed that
PECS was highly effective for teaching requesting to children
with autism. In contrast, the authors reported mixed results
for speech outcomes, with two studies yielding percentage of
nonoverlapping data (PND) considered highly effective for
promoting speech, one study ineffective, and one study mixed
(highly effective for one participant and ineffective for another);
however, effect sizes (ESs) were not aggregated. Furthermore, since the publication of that review, several additional
group and single-subject experiments have been published
that add to the evidence base for the PECS approach. Most
recently, Preston and Carter (2009), in their examination of
the efficacy of PECS in 10 single-subject and three group designs, reached similar conclusions to Schlosser and Wendt
(2008) that PECS is effective in providing a means of communication for individuals with little or no speech but that the
data are not as clear for speech outcomes following PECS
training. Assessment of quality and calculation of ESs were
completed for individual studies in that review; however, participant criteria were not limited to children with a diagnosis
of autism, and independent variables were not limited to
standard PECS protocol. Rather, the review included studies
with participants ranging in age from early childhood to adulthood, studies of participants with comorbid diagnoses (e.g.,
autism and attention deficit/hyperactivity disorder [ADHD],
blindness, and deafness), and studies that involved modifications of the PECS approach. Thus, despite the contributions
of these systematic reviews of literature, to date no metaanalysis has examined the effectiveness of the standard PECS
protocol on communication and speech outcome variables
for children with ASD.
Search Strategy
Studies were identified for inclusion in this meta-analysis
through a three-step process. First, searches were conducted
to identify conceptual and empirical articles related to PECS
published between 1994 and June 2009 that included at least
one child participant (18 years or younger) with ASD, in
the following databases: PsycInfo, ERIC, Academic Search
Premier, and Cumulative Index to Nursing and Allied Health
Literature (CINAHL). Table 2 describes the search terms and
yields. Search terms used were Picture Exchange Communication System, autism, PECS, and Bondy and Frost. Reverse
searches were then conducted to identify articles that cited the
seminal article on PECS (Bondy & Frost, 1994). Second, results were cross-referenced with articles listed on the research
page of the official PECS Web site (www.pecs.com/research.
htm). Finally, reference lists were examined from three relevant literature reviews (Preston & Carter, 2009; Schlosser &
Wendt, 2008; Sulzer-Azaroff et al., 2009) to identify additional
studies that were not captured through previous searches. The
systematic search returned 54 articles. Of the 54 articles identified, only empirical studies (single-subject experiments or
Academic Search
Premier
ERIC
CINAHL
Search strategy
(DE Picture Exchange Communication System)
(DE Picture Exchange Communication System AND DE autism)
(DE Picture Exchange Communication System OR DE PECS)
(DE Picture Exchange Communication System OR DE PECS
AND DE autism)
(DE PECS)
(DE PECS AND DE autism)
(Reverse search for articles citing Bondy & Frost, 1994)
(DE Picture Exchange Communication System)
(DE Picture Exchange Communication System AND DE autism)
(DE Picture Exchange Communication System OR DE PECS)
(DE Picture Exchange Communication System OR DE PECS
AND DE autism)
(DE PECS)
(DE PECS AND DE autism)
(Reverse search for articles citing Bondy & Frost, 1994)
Yield (references)
48
45
154
51
150
45
98
36
24
3,295
71
3,141
28
32
Revised search
added AND autism
added OR PECS
added AND autism
added AND autism
added OR PECS
added AND autism
added AND autism
added AND autism
33
24
82
81
76
23
52
48
192
56
188
49
13
Note. DE = descriptor; ERIC= Education Resources Information Center; CINAHL= Cumulative Index to Nursing and Allied Health Literature.
181
Quality of Evidence
The quality of evidence for the PECS approach was evaluated via the use of rating scales adapted from guidelines by
Horner et al. (2005) and Wolf (1978) for single-subject designs (see Appendix A) and by Gersten et al. (2005) for group
designs (see Appendix B). Quality indicator items were assigned a rating of adequate, partially adequate, or inadequate/
unknown and a score of 2, 1, or 0 points, respectively. Each
article was independently coded for quality assessment by
the first two authors. Interrater reliability was calculated via
point-to-point agreement on the 11 included articles and
ranged from 84.2% to 100%. Composite scores were tallied
as a percentage of points assigned out of total possible points
for each article. Scores at 90% and above were considered
to be strong quality of evidence. Scores ranging from 75% to
90% were considered to be adequate quality of evidence, and
scores of 74% and below were considered to be inadequate
quality of evidence.
Overall, the quality of evidence for PECS was considered
to be adequate (see Tables 36). Quality assessment ratings
of group studies ranged from strong to inadequate levels of
evidence (one study of strong quality and two of inadequate
quality) for the effectiveness of PECS on communicative and
speech abilities of children with autism. For group designs,
the quality of evidence for PECS would be strengthened by
improved measurement and reporting of treatment fidelity.
For example, in two of the three group studies in this metaanalysis, treatment fidelity was not reported. Without measures
of treatment fidelity, it is difficult to know whether PECS was
delivered in the appropriate manner and dosage; thus, it is
difficult to demonstrate a functional relationship between the
intervention and the communication and speech outcomes.
Quality assessment ratings of the single-subject experiments ranged from strong to adequate (three studies of strong
183
IIV
IIII
IIII
IIV
IIV
IIII
IIII
PECS
phases
Treatment
fidelity (Y/N)
% independent mands
Spontaneous language
(icons and
verbalizations)
% independent mands
% independent PECS
exchanges
% independent PECS
exchanges
% accuracy PECS
exchanges
% independent PECS
exchanges
Dependent variables
Results reported
S (93)
S (93)
A (76)
A (82)
A (83)
A (78)
S (90)
Quality rating
(% scores)
98.4
100
64.8
0.34
0.30
0.16
0.71
64.4
1.04
ES
93.7
PND (%)
NR
NR
NR
G/M
24 PECS,
17 control
26 immediate,
28 delayed,
29 control
17 PECS,
19 RPMT
3;98;9
5;29;5
5;110;0
3;07;0
3;07;0
Ages
( years;months)
RCT
Group
(nonrandom;
nonmatched)
RCT
Design
IVI
NR
IIII
PECS
phases
Treatment
fidelity (Y/N)
Requesting
Initiations;
PECS usage
Initiations
Dependent
variables
Results reported
S (100)
I (45)
I (50)
Quality rating
(% scores)
NR
G/M
0.65
0.95
ES
Note. I = inadequate quality of evidence; RCT = randomized controlled trial; RPMT = Responsive Education and Prelinguistic Milieu Teaching; JA = joint attention. Dash indicates incalculable
from data presented.
Participants
Reference
TABLE 4. Summary of communication outcomes and quality ratings for group designs.
Note. PND = percentage of nonoverlapping data points; ES = effect size; G/M = generalization or maintenance measures included; S = strong quality of evidence; NR = not reported;
A = adequate quality of evidence. Dash indicates incalculable due to absence of baseline phase.
10;2, 11;9
Tincani et al.
(2006; Study I)
6;0
5;10, 6;8
Tincani (2004)
Changing criterion
Alternating treatments
and multiple baselines
across participants
Alternating treatments
Design
NR
(3 preschoolers)
Ages
( years;months)
Angermeier et al.
(2008)
Reference
TABLE 3. Summary of communication outcomes and quality ratings for single-subject designs.
IIV
IIII
IIV
IIV
IIII
IIII
PECS
Treatment
phases fidelity (Y/N)
Results reported
Vocal approximations
Word vocalizations
Dependent variables
Note. Dash indicates incalculable due to absence of baseline phase. MLU = mean length of utterance.
Multiple baselines
across participants
5;10, 6;8
10;2
Alternating treatments
Tincani et al.
(2006; Study I)
Multiple baselines
across participants
Multiple baselines
across participants;
multiple baselines
across settings
(home, centers,
journal)
Changing criterion
NR
Alternating treatments
(3 preschoolers)
Ages
(years;months)
Charlop-Christy
et al. (2002)
Reference
TABLE 5. Summary of speech outcomes and quality ratings for single-subject designs.
S (93)
S (93)
A (80)
A (82)
A (83)
A (78)
12
100
6.5
NR
NR
1.45
NR
0.26
0.01
NR
0.05
59.4
G/M
NR
ES
Quality rating
(% scores) PND (%)
185
26 immediate,
28 delayed,
29 control
17 PECS,
19 RPMT
Participants
Reference
3;98;9
5;29;5
5;110;0
3;07;0
Ages
(years;months)
RCT
RCT
Design
IVI
NR
PECS
phases
TABLE 6. Summary of speech outcomes and quality ratings for group designs.
Treatment
fidelity (Y/N)
Nonimitative
words;
nonimitative
spoken acts
Frequency
of speech
Dependent
variables
No significant change in
frequency of words
Results reported
S (100)
I (45)
Quality rating
(% scores)
0.57
0.05
ES
G/M
quality and five of adequate quality). Quality of the singlesubject experiments would be strengthened by inclusion of
measures of maintenance, generalization, and social validity.
Follow-up measures to assess maintenance and generalization were reported in only 50% of the single-subject studies,
and social validity was measured in only two of the eight
single-subject designs. Failure to measure maintenance, generalization, and social validity in the PECS single-subject
literature is consistent with other single-subject investigations
in the autism literature. For example, Odom and colleagues
(2003) reported that only 35% of single-subject intervention
experiments with individuals with ASD measured maintenance and only 41% reported generalization measures. Knowing whether speech and communication gains made during the
PECS program are maintained after stopping PECS intervention is important for clinicians in deciding on a communicationtraining approach for children with autism.
Analysis Procedures
For group designs, ESs for posttest group differences were
reported as given or calculated from published data. For one
study that reported results using the nonparametric Mann
Whitney U statistic (Carr & Felce, 2007a, 2007b), an equivalent of Cohens d was calculated as outlined by Rosnow
and Rosenthal (2008). The dequivalent metric represents the
value of d analogous to the result for an exactly normally
distributed outcome with N/2 units in each group (Rosnow
& Rosenthal, 2008, p. 382). For another study (Howlin et al.,
2007), Cohens d was calculated from the published odds
ratios as outlined by Chinn (2000). Standard interpretation
of Cohens d (Cohen, 1988) was used to consider the strength
of evidence for group design studies (i.e., <0.2 = trivial;
0.20.5 = small; 0.50.8 = moderate; >0.8 = strong).
For single-subject experiments, two methods of calculating
ES were used, as there is not currently an established metric
for ES in single-subject experiments (Beretvas & Chung, 2008).
In the first analysis, data from published graphs were entered
and analyzed using the software program ITSACORR (Crosbie,
1993). ITSACORR conducts an analysis of the single-subject
data by fitting least-squares trend lines to baseline and treatment phases while controlling for autocorrelation and short
data sets (Maughan et al., 2005). ITSACORR was chosen
over other methods of ES calculation (e.g., standardized difference approach) because of the validity of this approach
for graphs with zero slope in the baseline phase (Huitema,
2004) and undefined standard deviations (i.e., less than two
data points in baseline or all baseline data points equal to zero;
Beeson & Robey, 2006; Kratochwill, Stoiber, & Gutkin,
2000). ITSACORR provides an F statistic as well as tests of
change in intercept and change in slope. The y-intercept
t statistic given by ITSACORR and the number of data points
per phase were used to calculate ESs as Glasss delta, as
outlined by Maughan et al. (2005).
In addition to the ITSACORR method of data analysis for
single-subject designs, the studies were also analyzed using
the PND method, in which the highest data point in baseline
phase was identified and the percentage of data points during
intervention exceeding this level was calculated (Scruggs,
Mastropieri, & Castro, 1987). PND could not be calculated
Synthesized Results
Findings were synthesized to evaluate the effectiveness of
the PECS approach on communication and speech outcomes
for children with autism. Results are reported separately for
single-subject studies and group designs, as ESs from singlesubject experiments tend to be inflated when compared with
those of group designs (Swanson & Sachse-Lee, 2000), and
there is no method to combine ESs from different experimental
designs (Kavale et al., 2000).
Communication Outcomes
Communication outcomes examined in the PECS literature include the frequency of PECS exchanges, requests
(Angermeier et al., 2008; Beck et al., 2008; Ganz & Simpson,
2004; Ganz, Simpson, & Corbin-Newsome, 2008; Howlin
et al., 2007; Kravits, Kamps, Kemmerer, & Potucek, 2002;
Tincani, 2004; Tincani et al., 2006), and initiations (Carr &
Felce, 2007a, 2007b; Howlin et al., 2007). Increases in communication outcomes following PECS training were demonstrated across both single-subject and group studies. Overall,
for the single-subject experiments, the mean weighted ES
was 0.51. The confidence interval did not include zero, 95% CI
[0.04, 0.67]; therefore, the assumption can be made that
PECS treatment had a significant impact on communication
outcomes. The mean PND of 84.3%, 95% CI [68.4%, 100.1%],
indicates that PECS is a fairly effective treatment for improving communication for young children with autism. However, evidence of the maintenance and generalization of
communication gains made through PECS intervention is
limited in the single-subject literature. In fact, maintenance
of communication gains was measured in only one of the
seven single-subject studies that examined communication
outcomes. In that study, Angermeier and colleagues (2008)
reported that all three participants maintained mastery level
of communicative exchanges at the Phase II level of PECS
immediately after completing Phase II training. Furthermore,
Speech Outcomes
Although the developers of the program describe PECS as
an augmentative communication system and are careful not
to claim that PECS improves speech for children with ASD,
speech is a frequently measured outcome variable in the
PECS literature. Clinicians and parents alike desire information regarding the effectiveness of PECS in influencing speech
outcomes for young children with autism. Speech outcomes
were measured broadly across the PECS studies and included
the general measures of spontaneous speech (Charlop-Christy
187
Joint Attention
Joint attention refers to three-point, systematic sharing
of attention between (a) an individual, (b) an object or event,
and (c) another individual (Tomasello, 1995). Evidence from
one group design study suggests that PECS may be a more
effective communication intervention than RPMT for children with initially low rates of joint attention. In Yoder and
Stones study (2006a, 2006b), exploratory analysis of pretreatment variables revealed that initial rates of joint attention were a strong predictor of whether a child made greater
communication (i.e., requesting) gains from either PECS or
RPMT. Initiating joint attention was operationally defined
as an intentional communication act about an object that
attempts to get the adults to comment, laugh, smile, show attention, or give a label (Yoder & Stone, 2006b, p. 430). For
children who began an intervention with initially lower frequencies of joint attention (i.e., one instance or less of initiating joint attention across two assessment procedures), PECS
was the more successful approach in targeting communication outcomes. Joint attention also emerged as a potentially
influential preintervention characteristic in a single-subject
experiment by Charlop-Christy and colleagues (2002), which
documented that the largest overall gains in both speech
and communication were made by the youngest participant,
who began the study with no spontaneous speech, and relatively weaker social communicative behaviors (i.e., joint attention, eye contact, and toy play). Thus, joint attention may
be one child characteristic to be explored as a moderating
variable of main effects in group designs and as a preintervention characteristic to describe for participants in single-subject
experiments.
Object Exploration
A second potential preintervention variable that may moderate the effects of PECS on speech outcomes is object exploration. Differential response to treatment based on a childs
initial levels of object exploration was documented by Yoder
and Stone (2006a, 2006b). In their study, Yoder and Stone defined
object exploration as the number of different toys a child
touched during a play assessment. For children with initially
higher levels of object exploration (+1 SD above the group
mean), PECS was shown to be a more effective treatment than
RPMT in increasing the frequency of nonimitative speech at
posttest. Initial levels of object exploration were also shown to
be important in maintaining gains in speech made through PECS.
In fact, only children with high object exploration maintained
speech gains at the 6-month follow-up, relative to the alternate
treatment group. Thus, object exploration may be a variable
that moderates speech outcomes achieved by children with
autism through the use of PECS, but this finding has not yet
been replicated across studies or by independent researchers.
Imitation
Imitation is a third potential preintervention characteristic
that may influence both speech and communication outcomes
for children participating in PECS intervention. Motor imitation
was examined as a preintervention characteristic that influenced
the acquisition and effectiveness of PECS in a single-subject
study comparing the effectiveness of sign language and PECS
on the training of requests. In that study, Tincani (2004) examined the pretreatment ability of two participants to imitate
27 hand, arm, and finger movements, similar to those required
to communicate via sign language. As was predicted by the
author, sign language was more effective than PECS in facilitating independent requests for a participant with relatively
higher motor imitative ability. In contrast, PECS was the more
effective treatment for improving communication for a participant with relatively lower motor imitative ability. With regard to speech outcomes, however, sign language was the
more effective intervention for both participants, regardless
of initial levels of motor imitation.
Verbal imitation has also emerged as a potentially influential preintervention child characteristic. Charlop-Christy
and colleagues (2002) described the three participants in their
study, who each made gains in both communication and
speech through PECS, as having some ability to verbally imitate before beginning PECS training. The authors postulate
that participants baseline level of verbal imitation may have
accounted for the ability to produce spontaneous speech during and after training. Assessment measures of preintervention verbal imitation were not described, however. It is important
to emphasize that results from these two single-subject experiments may not generalize to the overall population of
children with ASD. Nevertheless, motor and verbal imitation
may be a variable of interest in future studies of the effectiveness of PECS on communication and speech outcomes
for children with autism. In fact, given that early imitation
skills have been shown to be a strong predictor of later speech
development in children with autism (Charman et al., 2003;
Toth, Munson, Meltzoff, & Dawson, 2006), it is interesting
models, the use of time delay, or some combination of strategies that may contribute to an increase in speech production
during PECS Phase IV. Alternatively, it may be that those
children who reach the criterion of 80% mastery in Phases IIII
are the same children who are likely to go on to develop
speech. There is some support in the PECS literature for the
impact of time delay on increased speech production (CharlopChristy et al., 2002; Tincani, 2004; Tincani et al., 2006). For
example, after the introduction of a 4-s delay of reinforcement,
one child in Tincanis study (2004) increased percentage of
word vocalizations from a low of 30.1% during PECS Phase III
training to an average of 90%. Tincani and colleagues (2006)
further documented the effectiveness of using a 35-s delay
in an alternating treatment design, with one participant who
demonstrated greater use of speech during those phases that
employed a delay versus baseline phases. Thus, there is some
limited evidence that the verbal modeling, time delay, or some
combination introduced during Phase IV of PECS may play
a role in the acquisition of spontaneous speech for those children who go on to develop speech through the PECS program,
but few studies have addressed these questions, limiting the
evidence available. Further research to determine whether including verbal models and time delay strategies earlier in the
PECS program results in an earlier speech gains would have
important clinical implications.
189
uncover trends in the composite data that are not readily apparent by visual inspection and narrative review. These results
also provide information on some preintervention child characteristics and program characteristics that may be influencing speech and communicative outcomes for children with
autism undergoing PECS training, but studies addressing
these questions are currently few in number.
Despite the overall adequate quality of evidence for the
effectiveness of the PECS approach and the potentially clinically useful identification of child and intervention characteristics for examining which children are most likely to have
favorable speech and/or communication outcomes through
PECS, several concerns and questions remain. One important concern is the lack of measurement and reporting of
treatment fidelity for two of the three group studies of PECS
and four of the eight single-subject experiments. Without
clear documentation of how PECS was implemented, including descriptions of personnel training and measurement of
adherence to the manualized PECS protocol, the functional
relationship between the intervention and communication
and speech outcomes at both posttest and during generalization is unclear. In addition, there is insufficient evidence to
determine whether PECS results in generalization and longterm maintenance of communication and speech gains for
children with ASD. Two group studies raised concerns regarding the maintenance of communication and speech gains
made through PECS, and only a few single-subject studies
reported maintenance or generalization measures. Clinically,
this is a concern, as it is important for interventionists to know
whether gains made in PECS can be maintained without continued support, across varying contexts. Furthermore, given
that there is only one published group design comparing
PECS with a specific alternative treatment, it is still unknown
whether the PECS approach results in better communication
and speech outcomes than other available autism interventions. Thus, several concerns and questions remain about the
overall effectiveness of PECS for communication and speech
outcomes for children with ASD.
Questions also remain regarding the influence of moderators on the effectiveness of PECS and the identification of
pretreatment characteristics of children who are more likely to
respond to PECS. Given the small number of studies providing
the relevant pretreatment data on participants, the evidence
is inconclusive regarding which of the currently identified
factors (i.e., joint attention, motor and verbal imitation, and
object exploration) contribute the most to the relative effectiveness of PECS on speech and communication outcomes.
In addition, the three preintervention characteristics described
in this synthesis likely do not exhaust the possible initial characteristics of children with ASD influencing response to PECS.
Finally, Phase IV of PECS and two strategies introduced
in that phase (i.e., verbal modeling and time delay) were
discussed as possible influences on speech acquisition for
those children who went on to develop speech through PECS
training. It is still unclear, however, as to whether the documented increases in spontaneous speech in Phase IV are
related to the introduction of verbal modeling, time delay, or
some combination, or whether those children who are able to
achieve success in Phases IIII are simply more likely to go
on to develop speech. Also unclear is whether introducing
Acknowledgment
The authors thank Necdet Karasu for his advice on calculating
effect sizes in single-subject research.
References
References marked with an asterisk indicate studies included in
the meta-analysis.
Adkins, T., & Axelrod, S. (2002). Topography versus selectionbased responding: Comparison of mand acquisition in each
modality. The Behavior Analyst Today, 2, 259266.
*Angermeier, K., Schlosser, R. W., Luiselli, J. K., Harrington, C.,
& Carter, B. (2008). Effects of iconicity on requesting with
the Picture Exchange Communication System in children with
autism spectrum disorder. Research in Autism Spectrum Disorders, 2, 430446.
*Beck, A. R., Stoner, J. B., Bock, S. J., & Parton, T. (2008).
Comparison of PECS and the use of VOCA: A replication. Education and Training in Developmental Disabilities, 43, 198216.
Beeson, P. L. M., & Robey, R. R. (2006). Evaluating singlesubject treatment research: Lessons learned from the aphasia
literature. Neuropsychology Review, 16, 161169.
Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and
adolescents with autism spectrum disorders. Exceptional Children, 73, 264287.
Bellini, S., Peters, J. K., Benner, L., & Hopf, A. (2007). A metaanalysis of school-based social skills interventions for children
with autism spectrum disorders. Remedial & Special Education,
28, 153162.
191
Appendix A (p. 1 of 2)
Quality Indicators for Single-Subject Research
193
Appendix A (p. 2 of 2)
Quality Indicators for Single-Subject Research
Appendix B
Quality Indicators for Group Research
195
Copyright of American Journal of Speech-Language Pathology is the property of American Speech-LanguageHearing Association and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print, download, or email
articles for individual use.