Restricted accessResearch articleFirst published online 2025-9
Adapted Picture Exchange Communication System (PECS) to Teach Tangible Symbol Use to Students With Multiple Disabilities and Visual Impairments: A Replication Study
Introduction: Learners with multiple disabilities and visual impairments (i.e., blindness or low vision) stand to benefit from accessible augmentative and alternative communication such as tangible symbols, but currently no evidence-based practices exist to guide intervention decisions. This study is a replication of previous research on Phase 1 of the Picture Exchange Communication System (PECS) adapted to teach students with multiple disabilities to exchange a tangible symbol for a preferred item. Methods: A multiple-probe single-case research design was used with three participants. Data were also collected to assess generalization, maintenance, and social validity. Results: A functional relation was observed, and all three participants achieved mastery criteria within 7–15 sessions. Although limited, generalization and maintenance data were promising. Social validity data showed families and professionals alike generally perceived the procedures and outcomes positively. Discussion: Results contribute to the growing body of evidence that adapted PECS Phase 1 is effective to teach students with multiple disabilities to use tangible symbols for basic requesting. Length of time to attain mastery criterion was longer for participants who were nonambulatory. Implications for practitioners: Practitioners should use efficiency data to plan for adequate time to support skill development, which will require collaboration and embedding opportunities into natural routines.
AliE.MacFarlandS. Z.UmbreitJ. (2011). Effectiveness of combining tangible symbols with the picture exchange communication system to teach requesting skills to children with multiple disabilities including visual impairment. Education and Training in Autism and Developmental Disabilities, 46(3), 425–435. https://www.jstor.org/stable/23880596
BeukelmanD.LightJ. (2020). Augmentative and alternative communication: Supporting children and adults with complex communication needs (5th ed.). Paul H. Brookes.
4.
BrackenM.RohrerN. (2014). Using an adapted form of the picture exchange communication system to increase independent requesting in deafblind adults with learning disabilities. Research in Developmental Disabilities, 35(2), 269–277. https://doi.org/10.1016/j.ridd.2013.10.031
5.
BruceS. (2005). The impact of congenital deafblindness on the struggle to symbolism. International Journal of Disability, Development and Education, 52(3), 233–251. https://doi.org/10.1080/10349120500252882
6.
BruceS.IvyS.BrumC. (2024). Severe and multiple disabilities. In KauffmanJ. M.HallahanD. P.PullenP. C. (Eds.), The handbook of special education (3rd ed., pp. 327–359). Routledge.
7.
FrostL.BondyA. (2002). The Picture Exchange Communication System training manual (2nd ed.). Pyramid Educational Consultants.
8.
HumeK.SteinbrennerJ. R.OdomS. L.MorinK. L.NowellS. W.TomaszewskiB.SzendreyS.McIntyreN.Yücesoy-ÖzcanS.SavageM. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 51(11), 4013–4032. https://doi.org/10.1007/s10803-020-04844-2
9.
IvyS. E.HattonD. D.HooperJ. D. (2014). Using the picture exchange communication system with students with visual impairment. Exceptional Children, 80(4), 474–488. https://doi.org/10.1177/0014402914527239
10.
IvyS.HanlineM. F.RobbinsA. (2024). Teaming to design tangible symbol communication systems for children with multiple disabilities. Young Exceptional Children, 27(2), 63–77. https://doi.org/10.1177/10962506241248758
11.
IvyS.RobbinsA.KerrM. G. (2020). Adapted picture exchange communication system using tangible symbols for young learners with significant multiple disabilities. Augmentative and Alternative Communication, 36(3), 166–178. https://doi.org/10.1080/07434618.2020.1826051
12.
LedfordJ. R.GastD. L. (eds.) (2018). Single case research methodology: Applications in special education and behavioral sciences (3rd ed.). Routledge.
13.
LundS. K.TrohaJ. M. (2008). 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. Journal of Autism and Developmental Disorders, 38(4), 719–730. https://doi.org/10.1007/s10803-007-0439-4
14.
ParkerA. T. (2009). Measuring an adapted form of Picture Exchange Communication Systems (PECS) for young children with visual impairments and developmental disabilities [Doctoral dissertation, Texas Tech University]. http://hdl.handle.net/2346/15685
Parker, A., & Ivy, S. (2014). Communication development of children with visual impairments: A synthesis of intervention research. International Review of Research in Developmental Disabilities: Current Issues in the Education of Students with Visual Impairments, 46, 101–143. https://doi.org/10.1016/B978-0-12-420039-5.00006-X
17.
RobbinsA.IvyS. (2024, February 15-17). Scoping review of AAC interventions: Considerations for VI/DHH/motor disabilities [Poster session]. Conference on Research Innovations in Early Intervention, San Diego, CA, USA.
18.
RocheL.SigafoosJ.LancioniG. E.O’ReillyM. F.GreenV. A.SutherlandD.van det MeerL.SchlosserR. W.MarschikP. B.EdrisinhaC. D. (2014). Tangible symbols as an AAC option for individuals with developmental disabilities: A systematic review of intervention studies. Augmentative and Alternative Communication, 30(1), 28–39. https://doi.org/10.3109/07434618.2013.878958
19.
Trief, E., Cascella, P. W., & Bruce, S. B. (2013). A field study of a standardized tangible symbol system for learners who are visually impaired and have multiple disabilities. Journal of Visual Impairment & Blindness, 107(3), 180–191. https://doi.org/10.1177/0145482X1310700303
20.
Zhang, Y., Zhang, J., Zhang, J., Sutherland, M., & Huang, S. (2023). Teaching requesting skills to children with visual impairment and intellectual disability by using picture exchange communication system combined with tangible symbols. International Journal of Disability, Development and Education, 71(7), 1152–1172. https://doi.org/10.1080/1034912X.2023.2295911
