O impacto da implementação do Picture Exchange Communication System - PECS na compreensão de instruções em crianças com Transtorno do Espectro do Autismo
The Impact of the Implementation of the Picture Exchange Communication System – PECS on Understanding Instructions in Children with Autism Spectrum Disorders
Patricia de Almeida Santos, Daniela Bordini, Monica Scattolin, Graccielle Rodrigues da Cunha Asevedo, Sheila Cavalcante Caetano, Cristiane Silvestre Paula, Jacy Perissinoto, Ana Carina Tamanaha
Resumo
Objetivo: O objetivo deste estudo foi analisar o impacto da implementação do Picture Exchange Communication System – PECS na compreensão de instruções de crianças com Transtorno do Espectro do Autismo (TEA). Método: Trata-se de estudo longitudinal. A amostra foi constituída por 20 crianças com TEA não verbais, sendo 15 meninos e 5 meninas, na faixa etária de 6 a 12 anos, avaliadas e diagnosticadas por equipe multidisciplinar, segundo os critérios do DSM-5. Para avaliação da compreensão de instruções foram aplicadas 8 instruções visuais e 8 instruções orais, em dois momentos do Programa de Implementação do PECS: no início das fases II e IV. O programa foi composto por 24 sessões de terapia fonoaudiológica individual com a presença do familiar e obedeceu às seis fases propostas originalmente pelo Manual de Treinamento do PECS. Resultados: Houve aumento expressivo na compreensão de todas as instruções, na comparação entre os dois momentos do estudo; sendo que em seis das instruções orais (p=0,001) e cinco das instruções visuais (p=0,002), esse aumento foi estatisticamente significante. Conclusão: Foi possível observar o impacto positivo do uso do PECS na compreensão de instruções tanto visuais quanto orais, mostrando que esse sistema não apenas fornece uma ferramenta de comunicação aumentativa ou alternativa para a criança se expressar, mas também promove melhora significativa na compreensão das informações contextuais.
Palavras-chave
Abstract
Purpose: The purpose of this study was to analyze the impact of the implementation of Picture Exchange Communication System (PECS) on the comprehension of instructions for children with Autism Spectrum Disorder (ASD). Methods: This is a longitudinal study (N° 0809/2018). The sample consisted of 20 children with nonverbal ASDs, 15 boys and 5 girls, aged 6 to 12 years, evaluated and diagnosed by a multidisciplinary team, according to the DSM- 5. For assessment of the comprehension of instructions, we used 8 visual instructions and 8 oral instructions were applied at two points in the PECS Implementation Program: early phases II and IV. The program consisted of 24 individual speech therapy sessions with the presence of the family member and obeyed the six phases originally proposed by the PECS Training Manual. Results: There was an expressive increase in the comprehension of all the instructions, in the comparison between the two moments of the study; and in six of the oral instructions (p=0.001) and five visual ones (p=0.002), this increase was statistically significant. Conclusion: It was possible to observe the positive impact of the use of PECS in the comprehension of both visual and oral instructions, showing that this system not only provides an augmentative or alternative communication tool for the child to express himself, but also promotes a significant improvement in the understanding of information contextual.
Keywords
Referências
1. American Psychiatric Association. Manual Diagnóstico e Estatístico de Transtornos Mentais – DSM-5. Porto Alegre: Artmed; 2014.
2. Klin A, Jones W. An agenda for 21st century neurodevelopmental medicine: lessons from Autism. Rev Neurol. 2018;66(S01):S3-15. http://dx.doi. org/10.33588/rn.66S01.2018039. PMid:29516447.
3. Tamanaha AC, Perissinoto J. Transtornos do Espectro do Autismo – implementando estratégias para a comunicação. 1. ed. Ribeirão Preto: BookToy; 2019.
4. Tamanaha AC, Chiari BM, Perissinoto J. A eficácia da intervenção terapêutica fonoaudiológica nos Distúrbios do Espectro Autístico. Rev CEFAC. 2015;17(2):552-8. http://dx.doi.org/10.1590/1982-021620156314.
5. Ferreira C, Bevilacqua M, Ishihara M, Fiori A, Armonia A, Perissinoto J, et al. Selection of words for implementation of the Picture Exchange Communication System - PECS in non-verbal autistic children. CoDAS. 2017;29(1):e20150285. http://dx.doi.org/10.1590/2317-1782/20172015285. PMid:28300954.
6. Bondy A, Frost L. Manual de treinamento do sistema de comunicação por troca de figuras. Newark: Pyramid, 2009.
7. Fortea-Sevilla MS, Escandell-Bermudez MO, Castro-Sanchez JJ, MartosPérez J. Early development of language in small children with autism spectrum disorder using alternative systems. Rev Neurol. 2015;25(60, Suppl. 1):S31-5. PMid:25726821.
8. Ogletree BT, Morrow-Odom KL, Westling D. Understanding the brain behavior relationship in persons with ASD: implications for PECS as a treatment choice. Dev Neurorehabil. 2015;18(2):88-96. http://dx.doi.org/ 10.3109/17518423.2013.833995. PMid:24063565.
9. 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 Autism Dev Disord. 2014;44(5):1244-51. http://dx.doi.org/10.1007/s10803-013-1972-y. PMid:24272416.
10. Ganz JB, Hong ER, Goodwyn F, Kite E, Gilliland W. Impact of PECS tablet computer app on receptive identification of pictures given a verbal stimulus. Dev Neurorehabil. 2015;18(2):82-7. http://dx.doi.org/10.3109/ 17518423.2013.821539. PMid:23957298.
11. Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil. São Paulo, SP: ABEP ; 2018. pp. 1-6. [citado em 2020 Fev 29]. Disponível em: www.abep.org
12. Krug D, Arick J, Almond P. Autism Screening Instrument for Educational Planning- ASIEP-2. Austin, Texas: PRO-ED; 1993.
13. Marteleto MRF, Pedromônico MRM. Validity of Autism Behavior Checklist (ABC): preliminary study. Rev Bras Psiquiatr. 2005;27(4):295-301. http:// dx.doi.org/10.1590/S1516-44462005000400008. PMid:16358111.
14. Tellegen PJ, Laros JA, Jesus GR, Karino CA. SON-R 21/2-7 [a] Manual do Teste Não Verbal de Inteligência. São Paulo: Hogrefe; 2015
15. Sparrow SS, Balla D, Cicchetti D. Vineland Adaptive Behavior Scales. Expanded Edition. Circle Pines, MN: American Guidance Service; 1984.
16. Doherty A, Bracken M, Gormley L. Teaching children with autism to initiate and respond to peer mands using Picture Exchange Communication System. Behav Anal Pract. 2018;11(4):279-88. http://dx.doi.org/10.1007/ s40617-018-00311-8.
17. Landa R, Hanley GP. An evaluation of multiple schedule variations to reduce high rate request in the PECS. J Appl Behav Anal. 2016;49(2):388- 93. http://dx.doi.org/10.1002/jaba.285. PMid:26814152.
18. Agius MM, Vance M. Vance M. A comparison of PECS and Ipad to teach requesting to preschollers with autistic spectrum disorders. Augment Altern Commun. 2016;2(1):58-68. http://dx.doi.org/10.3109/07434618.2015.11 08363. PMid:26586580.
19. Thiemann-Bourque K, Brady N, McGuff S, Stump K, Naylor A. Picture Exchange Communication System and Pals: a peer-mediated augmentative and alternative communication intervention for minimally verbal preschoolers with autism. J Speech Lang Hear Res. 2016;59(5):1133-45. http://dx.doi. org/10.1044/2016_JSLHR-L-15-0313. PMid:27679841.
20. Homlitas C, Rosales R, Candel L. A further evaluation of behavioral skills training for implementation of the Picture Exchange Communication System. J Appl Behav Anal. 2014;47(1):198-203. http://dx.doi.org/10.1002/jaba.99. PMid:24435619.
Submetido em:
29/02/2020
Aceito em:
18/05/2020
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