Objective To explore the efficacy of group language training combined with the picture exchange communication system (PECS) on core symptoms and rehabilitation outcomes in children with autism spectrum disorder (ASD), in order to provide theoretical reference for clinical intervention. Methods A total of 86 children aged 2 - 6 years with ASD, treated at Dongguan Maternal and Child Healthcare Hospital from July 2023 to April 2025, were recruited in this study.They were randomly assigned to experimental group and control group, with 43 cases in each group.Both groups underwent rehabilitation training for 1 hour per day, 5 days per week, for a total duration of 6 months.The control group received conventional one-on-one speech rehabilitation.The experimental group received a combined intervention of PECS and group language training.Assessments included the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Gesell Development Diagnosis Scales(GDDS) before and after intervention. Results Finally 80 children completed the intervention,with 40 cases in control group and 40 cases in experimental group.Post-intervention analysis showed no statistically significant differences in ABC or CARS scores between the two groups (P>0.05).However, both groups demonstrated significant improvements in language and personal-social developmental quotients (DQ) (control group: language DQ t=7.42, P＜0.001, personal-social t=6.96, P＜0.001; experimental group: language DQ t=15.29, P＜0.001, personal-social t=11.43, P<0.001).Notably, the experimental group exhibited significantly greater improvements in language DQ (t=6.61, P<0.001) and personal-social DQ (t=5.44, P<0.001) compared to the control group. Conclusions The combination of group language training and PECS is superior to conventional language training in enhancing language and personal-social development in children with ASD.However, its effects on core symptoms remain inconclusive and warrant further investigation.
Key words
autism spectrum disorder /
group language training /
picture exchange communication system /
combination intervention
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References
[1] Shaw KA, Williams S, Patrick ME, et al.Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years - autism and Developmental Disabilities Monitoring network, 16 sites, United States, 2022[J].MMWR Surveill Summ, 2025,74(2):1-22.
[2] Zhou H, Xu X, Yan W, et al.Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years[J].Neurosci Bull, 2020,36(9):961-971.
[3] Menezes M, Mazurek MO.Associations between domains of health-related quality of life and comorbid emotional and behavioral problems in youth with autism spectrum disorder[J].Res Autism Spectr Disord, 2021,82:101740.
[4] Leader G, O'Reilly M, Gilroy SP, et al.Comorbid feeding and gastrointestinal symptoms, challenging behavior, sensory issues, adaptive functioning and quality of life in children and adolescents with autism spectrum disorder[J].Dev Neurorehabil, 2021,24(1):35-44.
[5] Oakley BF, Tillmann J, Ahmad J, et al.How do core autism traits and associated symptoms relate to quality of life? findings from the Longitudinal European Autism Project[J].Autism, 2021,25(2):389-404.
[6] Lord C, Elsabbagh M, Baird G, et al.Autism spectrum disorder[J].Lancet,2018,392 (10146):508-520.
[7] Castillo MA, Urdaneta KE, Semprun-Hernandez N, et al.Speech-stimulating substances in autism spectrum disorders[J].Behav Sci (Basel), 2019,9(6):60.
[8] Boucher TQ, Lukacs JN, Scheerer NE, et al.Negative first impression judgements of autistic children by non-autistic adults[J].Front Psychiatry, 2023,14:1241584.
[9] Anderson DK, Lord C, Risi S, et al.Patterns of growth in verbal abilities among children with autism spectrum disorder[J].J Consult Clin Psychol, 2007,75(4):594-604.
[10] Tamanaha AC, Olivatti D, Silva S, et al.Picture exchange communication system (PECS) implementation program for children with autism spectrum disorder[J].Codas, 2023,35(4):e20210305.
[11] Safi MF, Alshamsi M, Opoku MP.Parenting children with autism spectrum disorder in the united arab emirates: exploring perceptions towards using the picture exchange communication system to enhance the development of children with autism spectrum disorder[J].BMC Psychol, 2022,10(1):229.
[12] Santos PA, Bordini D, Scattolin M, et al.The impact of the implementation of the picture exchange communication system-PECS on understanding instructions in children with autism spectrum disorders[J].Codas, 2021,33(2):e20200041.
[13] Koudys J, Perry A, Magnacca C, et al.Predictors of picture exchange communication system (PECS) outcomes[J].Autism Dev Lang Impair, 2023,8:1616162572.
[14] Wannapaschaiyong P, Vivattanasinchai T, Wongkwanmuang A.Predictors of successful picture exchange communication system training in children with communication impairments: insights from a real-world intervention in a resource-limited setting[J].BMJ Paediatr Open, 2025,9(1):e003282.
[15] Ferreira C, Bevilacqua M, Ishihara M, et al.Selection of words for implementation of the picture exchange communication system-PECS in non-verbal autistic children[J].Codas,2017,29 (1):e20150285.
[16] Fortea-Sevilla MS, Escandell-Bermudez MO, Castro-Sanchez JJ, et al.Early development of language in small children with autism spectrum disorder using alternative systems[J].Rev Neurol, 2015,60 (Suppl 1):31-35.
[17] Ogletree BT, Morrow-Odom KL, Westling D.Understanding the brain-behaviour relationship in persons with ASD: Implications for PECS as a treatment choice[J].Dev Neurorehabil, 2015,18(2):88-96.
[18] Schreibman L, Stahmer AC.A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism[J].J Autism Dev Disord, 2014,44(5):1244-1251.
[19] 赵雪.两种干预模式结合图片交换沟通系统对孤独症儿童语言沟通能力影响的对比分析[D].新乡:新乡医学院,2024:000462.
Zhao X.A Comparative analysis of the effects of two intervention models combined with picture exchange communication system on the language and communication skills of children with autism[D].Xinxiang: Xinxiang Medical University,2024:000462.(in Chinese)
[20] 柳茵茵,周晓博,韩惠惠.图片交换沟通系统训练结合引导式教育应用于孤独症谱系障碍患儿的效果[J].医学理论与实践,2024,37(24):4307-4309.
Liu YY, Zhou XB, Han HH.The effect of picture exchange communication system training combined with conductive education on children with autism spectrum disorder[J].Medical Theory and Practice,2024,37(24):4307-4309.(in Chinese)
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