Wannapaschaiyong Prakasit, Vivattanasinchai Thitaporn, Wongkwanmuang Awassada
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMJ Paediatr Open. 2025 Mar 13;9(1):e003282. doi: 10.1136/bmjpo-2024-003282.
Children with communication impairments-such as autism spectrum disorder or global developmental delay-face significant challenges affecting their emotional and behavioural development. The Picture Exchange Communication System (PECS) is an augmentative communication tool designed to enhance their skills. However, its effectiveness can vary in resource-limited settings. This study aimed to identify predictors of successful PECS training among children with communication impairments in such environments.
This retrospective study analysed records of 61 children with communication impairments who underwent PECS training at Siriraj Hospital in Bangkok, Thailand, from 2020 to 2023. Success was defined as achieving PECS phase 3 proficiency and a Clinical Global Impression-Improvement score of 1-3 after 1 year. Logistic regression identified predictors of successful outcomes based on demographic, clinical, family and training-related factors.
After 1 year, 46% (28 out of 61) of the children achieved successful PECS outcomes. Significant predictors of success were lower severity of communication impairment (Clinical Global Impression-Severity ≤4; adjusted OR= 15.24, p = 0.002), higher frequency of PECS sessions (>6 times per year; OR = 9.11, p = 0.010), higher family income (≥20,000 baht per month; OR = 9.83, p = 0.024) and frequent home practice (≥3 times per week; OR = 7.02, p = 0.066).
In resource-limited settings, factors such as severity of impairment, intensity of intervention, socioeconomic status and caregiver involvement significantly influence the success of PECS training. Tailored interventions and strategic resource allocation are crucial to optimise communication outcomes for these children.
患有沟通障碍的儿童，如自闭症谱系障碍或全面发育迟缓，面临着影响其情感和行为发展的重大挑战。图片交换沟通系统（PECS）是一种旨在提高他们沟通技能的辅助沟通工具。然而，在资源有限的环境中，其效果可能会有所不同。本研究旨在确定在这种环境下，沟通障碍儿童成功进行PECS训练的预测因素。
这项回顾性研究分析了2020年至2023年在泰国曼谷诗里拉吉医院接受PECS训练的61名沟通障碍儿童的记录。成功的定义是在1年后达到PECS第3阶段熟练程度，且临床总体印象改善评分在1至3分之间。逻辑回归根据人口统计学、临床、家庭和训练相关因素确定成功结果的预测因素。
1年后，46%（61名中的28名）的儿童取得了成功的PECS训练结果。成功的显著预测因素包括沟通障碍严重程度较低（临床总体印象严重程度≤4；调整后的比值比=15.24，p=0.002）、PECS训练课程频率较高（每年>6次；比值比=9.11，p=0.010）、家庭收入较高（每月≥20,000泰铢；比值比=9.83，p=0.024）以及在家中频繁练习（每周≥3次；比值比=7.02，p=0.066）。
在资源有限的环境中，障碍严重程度、干预强度、社会经济地位和照料者参与度等因素会显著影响PECS训练的成功。量身定制的干预措施和战略资源分配对于优化这些儿童的沟通结果至关重要。
