PECSPERTS: Evaluating Telehealth and Hybrid Caregiver Training Models for Teaching Caregivers How to Implement the Communication System

Roughly 30% of children diagnosed with autism do not develop functional speech. For these children, augmentative and alternative communication systems (AAC) may be used to help develop functional communication systems. One such system is the Picture Exchange Communication System (PECS). Prior research has established professional-delivered PECS as an evidence-based AAC. However, few studies have assessed the efficacy of parent training on caregiver PECS use and there is limited research on the use of telehealth technology when implementing PECS caregiver training. This dissertation reports on two studies designed to expand our understanding of PECS caregiver training using both telehealth and in-person applications of behavioural skills training (BST) and generalized case training (GCT).

Study one evaluated the feasibility as well as caregiver outcomes of the PECSperts Caregiver Training package. Six caregivers participated in a two-week telehealth training in which they were taught how to implement the first four phases of PECS (phases 1-3b) using BST and GCT. Caregivers were taught to implement PECS with the use of structured scenarios and demonstrated their skill through roleplay with a trained mediator. Following the conclusion of the 2-week training, all caregivers had met the mastery criteria for all four phases. Caregivers maintained these treatment gains at 1- and 2-month follow-up.

Study two evaluated a second iteration of the PECSperts Caregiver Training package and included an evaluation of child outcomes and child characteristics (e.g., cognitive level) and their relations to child PECS outcomes. Nine caregivers participated in a 4-week hybrid (online and in-person) training. Participants were evaluated on their ability to implement the first four phases of PECS (phases 1-3b) with their children and their children were evaluated on their independent PECS use across five timepoints. Overall, there was a significant improvement in both caregiver PECS teaching accuracy and child PECS use accuracy between baseline and the end of intervention. Caregivers and children maintained their treatment gains at both 1- and 3-month follow-up. Baseline child characteristics were not significantly associated with PECS outcomes at the end of the intervention; however, parents reported a significant decline in autism symptom severity over the course of the intervention.