Caregivers’ Perceptions of Picture Exchange Communication System with Children with Autism Spectrum Disorder: A Systematic Review

Abstract

Background: Autism Spectrum Disorder (ASD) affects a child’s ability to communicate with others and the development of social skills. Picture Exchange Communication System (PECS) is one of the behavioural and communication interventions to help children with ASD with minimally verbal communication. While many previous studies were conducted on the effectiveness of PECS, only a few examined the perceptions of caregivers who implement PECS as the intervention. This study aims to fill the gap to examine the attitudes and perceptions of caregivers towards implementation of PECS and the factors leading to the attitude. Methods: This is a systematic review of published articles available on PsycINFO, Medline, ERIC, Scopus, and Web of Science, with the following descriptors: autism spectrum disorder AND picture exchange communication system AND parents OR teachers. Studies published in English are included if they met these criteria: (1) studies of children with a clear diagnosis of ASD, (2) studies related to PECS, and (3) studies of the caregivers’ perceptions. Results: A total of 188 articles were identified in which 18 articles met the inclusion criteria. The caregivers mostly hold a positive attitude towards PECS. Many of the respondents from the included studies are satisfied with the implementation regarding the ease of use and from the improvements observed through the intervention. However, the cost of training and preparation work, and the logistic problem to carry the PECS book are factors that hinder the confidence of caregivers of the implementation of PECS. Conclusion: Caregivers’ attitude and perception have long been neglected in the literature. The current study found PECS is welcomed by majority of caregivers. Although there existed some barriers concerning its implementation, results support that PECS is not only effective but also well perceived by caregivers of children with ASD. Results of this study also suggest that there is a need to examine the wellbeing of participants and practitioners during the intervention.