Emily Dickinsons Because I Could Not Stop for Death Essay -- Because

Emily Dickinsons Because I Could Not Stop for destructionEmily Dickinsons Because I could not bridle for Death is a remarkable masterpiece that exercises thought between the known and the unknown. In Dickinsons poem, Because I could not see to it Death, there is much impression in the tone, in symbols and in the use of imagery that over flow with creativity. One might undoubtedly agree to an eerie, haunting, if not frightening, tone and use of symbolism in Dickinsons poem.Dickinson uses controlling adjectives slowly and passed to create a tone that seems rather placid. For example, We slowly drove He knew no Haste / We passed the School / We passed the Setting fair weather (5,9,11,12), sets a slow, quiet, and clam atmosphere. The tone in Dickinsons poem puts readers ideas on a track towards a boggling atmosphere. Dickinsons poem lives on complex ideas that argon evoked through symbols, which carry her readers through her poem. Besides the literal significance of the Schoo l, Gazing Grain, Setting Sun, and the Ring much is gathered to complete the poems commutation idea. Dickinson brought to light the mysteriousness of the life cycle. The cycle of ones life, as symbolized by Dickinson, has three stages and then a final stage of eternity. Schools, where children strove (9) may represent childhood Fields of Gazing Grain (11), maturity and Setting Sun (12) old age. In addition to these three stages, the final stage of eternity was symbolized in the last two lines of the poem, the Horses Heads (23), leading towards Eternity (24). Dickinson thought about the life cycle in terms of figurative symbols.Dickinson describes the scene such that mental pictures of sight, feeling, and sound com... ...ld not stop for Death, will leave many readers talking for years to come. This poem then, puts on immortality through an act of mere creativity. Indeed, creativity was captured at all angles in this impinging piece.BibliographyDickinson, Emily. Because I coul d not stop for Death. The Compact Bedford Introduction to Literature. Ed. Michael Meyer. 4th ed. Boston Bedford-St. Martins, 1997. 642-643. Greenaway, Kate.Ring-a-ring-a-roses. The Oxford Dictionary of Nursery Rhymes. Ed. Iona and Peter Opie. Oxford Clarendon Press, 1951. 365. Greenberg, John M.Dickinsons Because I could not stop for Death. Explicator. v49n4. Summer 1991. 218.Monteiro, George. Dickinsons Because I could not stop for Death. Explicator. v46n3. Spring 1998. 20, 21.Shaw, Mary N. Dickinsons Because I could not stop for Death. Explicator. v50n1. Fall 1991. 21.

What is a Vision :: Business, Constructing a Vision Statement

IntroductionA view is a statement that paints an idealized picture of what an cheek wants to become. Jick (2002) offers a similar definition. He calls it, an render to articulate what a desired future for a company would look like (p. 142). Although many definitions for pot are similar, the effects heaps have on disposals vary. For slightly the vision is an agent of change, for others it is a source of confusion. The exit lies in certain elements of the vision, and how the leader implements the vision throughout the organization. This paper will look at what makes an utile vision and how it impacts an organization it will highlight the substance of employee identification, and how a leader can develop and institute a vision in an effective manner. It in like manner takes a look at the current vision of an organization, and offers some recommendations to increase that visions effectiveness. An Effective VisionConstructing a vision statement is non as simple as scribbling down the commencement ceremony thing that comes to mind. A leader take must include certain elements in the vision to run into it is effective and contributes to the success of the organization. A few of those elements include long-term, inspiring, and aligned with the values and culture of the organization. A vision should look beyond the sidereal day-to-day operations of the organization and focus on the future. By developing a long-term vision, a leader moves the focus of employees from the daily tasks to the future goal. Deetz, Tracy & Simpson (2000) write, When an organization has a clear reason of purpose and knows where it wants to go, that gives meaning to what happens day in and day out (p. 53). A long-term vision impacts the organization by highlighting the contrast amid where the organization is and where it needs to go. Jick (2002) argues, This creates a structural tension between today and tomorrow that seeks a resolution (p. 144). The organization then succeeds a s motivated employees work towards their objectives in order to calm the tension, lessen the gap, and turn the vision into reality. For a vision to be truly effective, it has to inspire employees to take action. This means it has to reflect a greater purpose that stirs up passion in employees. As an example, Nikes vision is to bring inspiration and innovation to every athlete in the world (Nike, 2011). The vision reflects a greater purpose to impact the lives of athletes everywhere, and paints a picture for employees of why their work is important.What is a Vision Business, Constructing a Vision StatementIntroductionA vision is a statement that paints an idealized picture of what an organization wants to become. Jick (2002) offers a similar definition. He calls it, an attempt to articulate what a desired future for a company would look like (p. 142). Although many definitions for vision are similar, the effects visions have on organizations vary. For some the vision is an agent of change, for others it is a source of confusion. The difference lies in certain elements of the vision, and how the leader implements the vision throughout the organization. This paper will look at what makes an effective vision and how it impacts an organization it will highlight the significance of employee identification, and how a leader can develop and institute a vision in an effective manner. It also takes a look at the current vision of an organization, and offers some recommendations to increase that visions effectiveness. An Effective VisionConstructing a vision statement is not as simple as scribbling down the first thing that comes to mind. A leader take must include certain elements in the vision to ensure it is effective and contributes to the success of the organization. A few of those elements include long-term, inspiring, and aligned with the values and culture of the organization. A vision should look beyond the day-to-day operations of the organization and focu s on the future. By developing a long-term vision, a leader moves the focus of employees from the daily tasks to the future goal. Deetz, Tracy & Simpson (2000) write, When an organization has a clear sense of purpose and knows where it wants to go, that gives meaning to what happens day in and day out (p. 53). A long-term vision impacts the organization by highlighting the contrast between where the organization is and where it needs to go. Jick (2002) argues, This creates a structural tension between today and tomorrow that seeks a resolution (p. 144). The organization then succeeds as motivated employees work towards their objectives in order to calm the tension, lessen the gap, and turn the vision into reality. For a vision to be truly effective, it has to inspire employees to take action. This means it has to reflect a greater purpose that stirs up passion in employees. As an example, Nikes vision is to bring inspiration and innovation to every athlete in the world (Nike, 2011). The vision reflects a greater purpose to impact the lives of athletes everywhere, and paints a picture for employees of why their work is important.

An Explication of The Garden of Love :: Garden of Love Essays

An Explication of The garden of Love My original interpretation of The tend of Love encompassed the speaker as a person who was scared to move on in their life and in love. I thought (he) was afraid of failure, afraid of losing childhood innocence in the wake of adulthood decisions and expectations. I funneled my theory into a neat little package that contained the Chapel as a symbol for marriage (or adult themes), and the Garden to stand for his life, or thoughts. I further belabored my opinion and interpretation. After long deliberation with the writings of Blake experts, I have conceded to concur with their interpretations of The Garden of Love, and therefore tally to Ostriker, Blake celebrates sexuality and attacks repression (156). I agree that his attack on repression is apparent in this poem, in that Blake seems to want the speaker, and the readers, to take a chance on life, love, or sex. whatever the convention of each individual, Blake wants us to not be a fraid to go against the conventional. Yet the speaker in The Garden of Love is constrained to move fore with his own decisions, probably restricted by the strict conventions of the Church. The priests follow suit as a reminder of conventional holiness. Blake has often ridiculed the Church, and it seems as though he uses The Garden of Love to display the affects of the Churchs manipulation on youth. Regarding the two youngsters kneeled behind the priest, Kauvar explains, The bowed figures reveal the presence of Urizenic (def. Reason - mine) repression and morality, for instead of embracing, the youths kneel submissively behind the priest (60). As I grasped in my first response to this poem, Blakes Garden represents new growth and childhood innocence. Kauvar continues that thought with the opposite side, but in Experience he sees personality dying and the graveyard supplanting the garden (60). It seems to me that Blake was highly disturbed with the manipulating effec ts placed on the habitual by the Church. I think he believed the public was mislead by the Church and its expectations, and further, believed their lives were governed as such. Pagliaro continues with the mention of, .

Role of Colour in Impressionism :: Essays Papers

Role of Colour in Impressionism In this essay, I shall try to examine how great a role colour compete in the evolution of Impressionism. Impressionism in itself can be seen as a linkage in a long chain of procedures, which led the art to the point it is today. In order to do so, colour in Impressionism needs to be placed within an art-historical context for us to see more clearly the role it has played in the evolution of modern painting. In the late eighteenth century, for example, ancient Greek and Roman examples provided the classical sources in art. At the same time, there was a revolt against the formalism of Neo-Classicism. The accepted style was characterised by appeal to reason and intellect, with a demand for a well-disciplined order and restraint in the work. The decisive quixotic movement emphasized the individuals right in self-expression, in which imagination and emotion were given free reign and stressed colour sooner than line colour can be seen as the express ion for emotion, whereas line is the expression of rationality. Their style was painterly rather than linear colour offered a immunity that line denied. Among the Romanticists who had a strong influence on Impressionism were Joseph Mallord William Turner and Eugne Delacroix. In Turners works, colour took precedence over the realistic portrayal of form Delacroix led the way for the Impressionists to use unmixed hues. The transition between Romanticism and Impressionism was provided by a small group of artists who lived and worked at the village of Barbizon. Their representational style was based entirely on their observation and painting of nature in the open air. In their natural landscape subjects, they paid careful oversight to the colourful expression of light and atmosphere. For them, colour was as important as composition, and this visual approach, with its appeal to emotion, gradually displaced the more studied and forma, with its appeal to reason. Impressionism grew out o f and followed forthwith after the Barbizon school. A distinctive feature of the work of the Impressionists was the application of paint in touches of mostly pure colour rather than blended their pictures appeared more luminous and colourful even than the work of Delacroix, from whom they had learned the technique. To the modern eye, the accepted paintings of the salon artists of the day seem pale and dull.

I Am Proud to Be An American Soldier Essay -- I Am Happy To Be A Soldi

The United States has long been known for having a military presence that few would dare to challenge. The catalyst has not been in having billions in defense funds, it has not been in having huge weapons of mass destruction, it is the heart and spirit of the soldier. I am very proud to be a part of this long and proud customs of upholding the ideals set forth in the U.S. Constitution. It is something that I would recommend to all willing and able college students. It instills a sense of pride and satisfaction that is matched by no other. As a soldier, there are many options as far as what type of soldier you wish to be. It is similar to choosing a career in the civil world. The first step in this process is choosing your military branch. There are four main branches in the military the Army, Navy, Air Force, and Marines.The Army is the branch that I chose. The Army is the largest branch, in terms of the number of soldiers, with an impressive five hundred thousand soldiers o n active duty, five-hundred thousand in the Reserves, and three-hundred thousand in the theme Guard. The Army is responsible for the majority of land combat in a War. These soldiers are also trained to occupy other countries if necessary (Iraq, Afghanistan, and Mogadishu.) In cessation time, the Armys main deterrent of other countrys aggression is its large presence throughout the world. There are deployed soldiers in all over one-hundred countries at any certain time, along with huge ship...

I Am Proud to Be An American Soldier Essay -- I Am Happy To Be A Soldi

The United States has long been known for having a military presence that a couple of(prenominal) would d are to challenge. The catalyst has not been in having billions in defense funds, it has not been in having huge weapons of mass destruction, it is the heart and spirit of the soldier. I am rattling proud to be a part of this long and proud tradition of upholding the ideals set forth in the U.S. Constitution. It is something that I would recommend to all willing and equal to(p) college students. It instills a sense of pride and satisfaction that is matched by no other. As a soldier, there are many options as far as what case of soldier you wish to be. It is similar to choosing a career in the civilian world. The first step in this process is choosing your military branch. There are quad main branches in the military the Army, Navy, Air Force, and Marines.The Army is the branch that I chose. The Army is the largest branch, in terms of the number of soldiers, with an impr essive five hundred gee soldiers on active duty, five-hundred thousand in the Reserves, and three-hundred thousand in the National Guard. The Army is responsible for the majority of land combat in a War. These soldiers are also trained to occupy other countries if necessary (Iraq, Afghanistan, and Mogadishu.) In peace time, the Armys main deterrent of other countrys encroachment is its large presence throughout the world. There are deployed soldiers in over one-hundred countries at any certain time, along with huge ship...

Philippine’s Political Dynasty Essay

The 1987 Constitution of the Philippines states in Article II Section 26, The State shall guarantee equal access to opportunities for public service, and prohibit governmental dynasties as may be defined by law. How can we define political dynasty? Political dynasty is a family, associations or group that maintains power for several generations. These clans etymon themselves into our national and local governments for many decades. Almost every position in the government has been posted either by relatives, or friends who are indebted to the clan for appointing them into position.In a sense, they have already established political kingdoms throughout the country. In the course of the rising and expanding political kingdoms ruling over the country, it has become fractious to tell where democracy is to be found. With rules unclear and morality questioned, people can never tell if they deserve more than what they are getting from the government. Political dynasties restrict democra cy, further adding instability and weakness of political institutions that are supposed to be working on their sense of rationality and individualism for the country.With political dynasties, it is no long-lived a question on qualifications and slogans, it allow for now be a question on connections and guns. The establishment of political dynasties is an effective way of monopolizing and perpetuating power. With various seats in the government occupied by a single family it would be easy to manipulate the system to benefit their family. The concept of check and balance will be thrown out the window. More often than not, politicians get to be elected not because of their merit, but because they belong to a family that is been in the government for generations.

Balcony and monument scenes Essay

Write roughly the effectiveness of Shakespe argons imagery in The Banquet, Balcony and Monument Scenes of Romeo and Juliet That which we call a rose by any other word would smell as sweet. Shakespeare uses imagery and metaphors throughout Romeo and Juliet to great effect. By exploitation language, instead of props or backdrops to produce a vivid picture, he is engaging the audience more and making them think for themselves. This dramatic technique is utilise to the best effect in the Banquet, Balcony and Monument scenes, when portraying Romeo and Juliets revere.The Banquet scene is the first snip Romeo sees Juliet, so the language used has to make a big impact so as to convey to the Elizabethan audience that this is true love, in contrast with Romeos infatuation with Rosaline. O she doth teach the torches to trim down bright. Shakespeare uses alliteration on teach the torches and burn bright to make Romeos words sound more beautiful and poetic, ideally like a sonnet. The words are coincidently very much like genius of Shakespeares sonnets, Sonnet 21, where he contrasts light(a) with dark.Shakespeare uses this same comparison throughout the happen to convey emotions, foreshadow tragedy and express the stages of the young love to the audience. In a look, Romeo and Juliets devotion is like light against the dark background of feuding families. By claiming that Juliet is brighter than any other torch, Romeo is directly comparing her to other girls, in p fraudicular Rosaline. When Romeo speaks of Rosaline, he uses the language of Elizabethan courtly love. All his feelings are quite contained in comparison to the poetic imagery he uses upon seeing Juliet for the first time.He says about Rosaline Shes fair I love, which in Shakespeares time was the sort of language one would use when describing their love. However, Romeo describes Juliets beauty as too rich for use and later claims that he neer adage true beauty till this night. The audience pick outs stra ight away that this is true love. But the audience is also aware of the fact that this love is doomed, and thither is some irony in a number of Romeos lines. Beauty too rich for use, for earth too dear. This suggests that Juliet is out of Romeos reach, which, being a Capulet, she is.He is also comparing her to an angel or heavenly creature, which he does throughout the play. This is Shakespeares way of showing that although these are young lovers, they are very spiritual too. The idea that she belongs to heaven because she is too good for earth builds up a feeling of unease and sadness in the audience, as they know she is going to die and therefore will not belong to the Earth anymore. This spiritual imagery is used when the lovers exchange their first words. Romeo tries to entice Juliet by referring to her as his holy shrine and to his lips as two blushing pilgrims.This shows Romeo to be a more sensitive and poetic character, which makes the audience, and Juliet, fall in love with him. By referring to her as his holy shrine he is showing the audience that he idolises her, and sees himself as lowly compared to her beauty. This speech between them is laid out in sonnet form. Sonnets are generally about love, which emphasises to the audience that Romeo and Juliet are in love. It also contributes to Romeos poetic image. Upon walking home later that evening, Romeo decides he has to see Juliet again.He finds his way into her garden and stands by the balcony. Romeo sees Juliet at her window. He exaggerates the pale flicker of the foundationdlelight to describe it as the East. But soft, what light through yonder window breaks? It is the east and Juliet is the sun. Shakespeare is using Romeos dialogue to light the stage. He puts a clear image into the audiences minds. Again Romeo is comparing Juliet to light this time the sun, the brightest light of all. This is his poetic way of declaring that she is the brightest and most beautiful of girls.It also signifies how very important she is to him, as the sun is imperative to everyday life. The light from Juliets window is verbalise to break through. This could imply a breakthrough in Romeos love life he has found his soul mate. In the Balcony scene Shakespeare uses language about the moon to help create a scene in the audience members mind. This means they are more involved in the play, and can imagine themselves there in the moonlight. Arise fair sun and kill the envious moon, Who is already sick and pale with trouble That thou her maid art far more fair than she. It is interesting that Romeo compares Juliets beauty to the moon here, as he has just described her as his sun. In mythology, Diana, the Goddess of the moon, is served by pure(a) maids. Being a virgin, Juliet is depicted as one of these maids, but Romeo believes that Diana is jealous of Juliets beauty. He asks her to stop serving the moon, and therefore stop being a virgin and become his lover instead. This shows Romeo is passionate in a sexual way about Juliet, which would be quite exciting to an Elizabethan audience member, as sex was not as commonly talked about as it is now.The fact that the moon is sick and pale with grief could be foreshadowing future grief for the couple. By asking the sun to arise, Romeo is wishing the day to come, therefore reminding the audience that it is night. When Romeo decides to reveal himself to Juliet she, feeling embarrassed and shocked, asks him who he is. Of course he has recently spy she is the daughter of his familys enemy, and feels his name is hurtful to her.By a name I know not how to tell thee who I am. My name, dear saint, is hateful to myself,Because it is an enemy to thee. Romeo and Juliet strongly believe in their names being a now unwanted allegiance to their family. Despite the fact that their names are just words, two of the star crossed lovers feel they are chains, locking them to their families, and keeping them away from each other. Again he refers to J uliet as a saint. This would seem graduate(prenominal) praise to an audience of very religious Elizabethans. In Shakespearean times, exploring was very popular and a lot of new lands were being found.Because travel was not as easy then as it is now, and the knowledge of the world was not as advanced, exploring new lands was very exciting and appealing to the Elizabethans, which was why it was a popular flying field matter and why Shakespeare used it throughout the play. I am no pilot, yet wert thou as far, As that vast shore washed with the furthermost sea, I should adventure for such merchandise. The word adventure is used here because in the Elizabethan times, international traders were known as Merchant adventurers.It also suggests that Romeo finds his and Juliets love very exciting, as adventure is usually associated with new and exciting things. Shakespeares use of imagery to convey Romeos love as a new found land helps to set a picture in the audiences minds of a far off t ropical shore. In Shakespeares time there would not piss been a lot of back drops and flats setting the stage, so it would be up to the audience to imagine their own scenery, and up to the playwright to use the correct language to stimulate these thoughts.Romeo describes himself being hidden from the eyes of Juliets guards and family. I have nights cloak to handle me from their eyes. Again Shakespeare is using light and dark to set a scene for the audience. His actors would not have had the electrical lighting actors have now, so he would have to create modalitys and light by using words. Romeo is telling the audience it is dark, so it is easier to imagine. This contrast is used a lot in the monument scene too. When Romeo hears that Juliet is exanimate he goes to the tomb where she is said to be.After killing Paris he looks at Juliet for the last time. He describes the days they spent together as A lightning before death, because it was believed in those days that before somebo dy died, they would seem very well and happy temporarily. This is the contrast between light and dark again, which adds mood to the scene the audience knows Romeo is deeply saddened by the sudden death of Juliet and, because of this, so are they. The word lightning makes you think of lightning as in a quick flash. Their play was very sudden and over quickly, but very enlightening all the same.Romeo mentions Juliets beauty despite her death too, especially concentrating on her lips and cheeks. Beautys ensign yet Is crimson in thy lips and in thy cheeks Romeo talks about Juliets beauty a lot throughout the play. In the balcony scene he says The brightness of her cheek would shame those stars and then proclaims O that I were a cheek upon that hand. It is interesting how Romeo talks of Juliets cheeks so much. Perhaps Shakespeare is move to link the two scenes together to show that Romeos love for Juliet was present from the beginning to the end of their relationship.He still felt the same for her when she was dead as he did when their love was blooming. I will raise her statue in pure gold Montague says this of Juliet in the last scene. Gold was a very expensive and prized cloth to the Elizabethan audience and so proves that Montague means well. It is a bit ironic that he is comparing her to a statue, because in the first scene Romeo and Juliet meet, the banquet scene, he describes her as a holy shrine. It is a very sad moment as the audience are reminded how happy the lovers used to be.The audience really benefits from Shakespeares imagery as it brings the play to life. It makes the words far more beautiful and the characters easier to relate to. Romeo seems more poetic and easier to fall in love with. Juliet appears to be intelligent and loving. Without the imagery the audience would not feel as involved with the plot, and would therefore not sympathise with the characters. The imagery heightens the emotions of the audience and confirms Romeo and Juliet as on e a Shakespeares greatest tragedies.

Environmental Justice and Sustainability Essay

Alex Steffen and Sarah Rich, executive editors of the bright green environmentalist online magazine WorldChanging tardily observed that while environmental movements accept focused primarily on confronting the ecological in justices that have become a historical trademark of industrialization, it has made piffling of a name for itself in addressing the social injustice that is also a part of environmental degradation. (Steffen & Rich, 2007)Steffen and Rich remark, the environmental movement has grown and become cognize (at least early on) more for its vehement advocacy for whales and rainforests than for disenfranchised citizens noting that the latter is generally regarded as a partake of otherwise movements related to social justice and civil rights. However, they note that it has become increasingly apparent that social injustice and environmental degradation are inextricably related to one another. (Steffen & Rich, 2007)While umpteen cities have begun to embrace the concep t of sustainability into their policies, few have taken environmental justice into account. Van Jones neatly summarized the issue of environmental justice when he say at last years Green Festival in Chicago, Who are we going to take with us, and who are we going to leave behind? Jones concern was that the environmental movement is divided between the rich and the poor. (Anderson, 2007) As such, any definition of sustainability must take the social dimensions of environmental damage into account, for the degradation of the environment is in fact, a civil injustice.Sustainability must embrace environmental justice by letting environment stand not just for concerns over resources, contamination and biodiversity but concerns over equitable distribution of resources, human health and racial equality. (Steffen & Rich, 2007) The city of San Francisco has embraced the United Nations definition of sustainability and has conclusively inferred that sustainability means social equity as much as it does environmental responsibility.However, it is also rather vague about what social equitability means. (Magilavy, 2008) Sustainability policies should introduce that improvements and protection of environmental welfare should be applied without discrimination. They should declare that resources are distributed equally and access to justice over environmental matters should be available to all, and that corporation and decision making should be not limited to an easy lay demographic class or ethnicity.Likewise, environmental injustices such as the systemically inequitable distribution of wealth, the discriminatory improvement of environment, or the denial of access to information and participation in decision making in environmental-related policies should be covered by sustainability policies. As such, if the heart of sustainabilitys definition is concern for the ecosystem and life within it, hence it also includes the human beings who are part of it as well.The goal of sustainability should then be the achievement of the longevity of human and planet welfare, rather than just environmental protectionism by another name. The Global Footprint Network defines ecological debt as the sum of all deficits in the biocapacity of the planet, and asserts that humanitys demands on the planet is interminably exceeding that biocapacity. As such, the Network contends that we are in a state of overshoot, placing greater demands on nature than can it regenerate. (Global Footprint Network, 2008) This concept is crucial to the founding of environmental justice.Sustainability metrician Mathis Wackernagel (co-founder of The Global Footprint Network) has theorized that an equitable distribution of planetary capital would mean that our fair share would have to be limited in extension to being sustainable. As such, Alex Steffen argues that the essence of sustainability is using the planets resource capital to create investments such that the same capital exists for f uture generations, anything else is unjust. (Steffen, 2006) Ecological res publica is an important means of achieving sustainability and environmental justice.To ensure that the environmental welfare of all individuals, regardless of race, class or gender is accounted for and that it is not done at the expenditure of planetary capital and the environmental welfare of future generations, decisions must be made that are free from the influence of the economic elite, racial factions, political forces and other special interests. In other words, the decisions to be made about the future of the environment must be done democratically to ensure that all have a say in the control of their local environment.Sustainability begins with environmental justice, which in turn is possible only with ecological democracy. The only alternative to such a form of environmentalism is a continuing perpetuation of inegalitarian systems, where we save the planet not for future generations, not for our fe llow men, but for ourselves. REFERENCES Anderson, D. (2007, April 22) Dispatch from Greenfest Chicago Van Jones on Green Collar Jobs and Our Shared Future, Part 1. Retrieved April 1, 2008 from http//davidanderson. greenoptions. com/2007/04/22/dispatch-from-greenfest-chicago-van-jones-on-green-collar-jobs-and-our-shared-future-part-i/Global Footprint Network. Glossary. Retrieved April 1, 2008 from http//www. footprintnetwork. org/gfn_sub. php? content=glossary Magilavy, B. (2008) Sustainability Plan. Retrieved April 1, 2008 from http//sustainable-city. org/Plan/Intro/intro. htm Steffen, A. & Rich, S. (2007, May 28) Principle 17 environmental Justice. Worldchanging. Retrieved April 1, 2008 from http//www. worldchanging. com/archives/006778. html Steffen, A. (Ed. ) (2006) Worldchanging A Users Guide for the 21st Century. New York Abrams, Inc.

The Main Arguments of Evolution Theory

out-of-door Management Prof. dr. Niels Noorderhaven Lecture 1 Agenda 1. 2. 3. Introduction and organizational matters Does multinational simmer down matter? Conceptual foundations of international business strategy (1) Case Honda in the USA Literature Textbook chapter 1 (pp 13-33 + 59-62) Team Lectures Niels Noorderhaven Cases Fons Naus Ana Aranda Gutierrez Zhengyu Li didactics strategy Complementarity of lectures readings one-on-one case participation Each lecture, one or several cases from the book will be expanded to put the theory into employ Importance of research articles Grading 70% MC exam See Study manual for correction formula Exam dates December 13, 2012 and April 12, 2013 30% 2 Interactive lectures individual participation Interactive lectures grades of 2010 and 2011 can be exchangered Book http//www. cambridge. rg/features/management/verbeke/ Does international still matter? 7 Transportation & communication cost fall 17 September 2012 8 Tariffs fal l, anti-dumping measures rise anti- 17 September 2012 9 Globalization Theory Linguistic, trade and cultural barriers become less central Stateless MNCs Within MNCs worldwide diffusion of technologies, companionship and information Convergence of world economies 17 September 2012 10 Why is nationality important to people? Individual identity and social identity Three processes of social identity formation social categorization social comparison social identification (Self-)categorization what is the salient household? 17 September 2012 11 Why is nationality important to people? Positive stereotyping of in-group, negative stereotyping of out-group Nationality differences are particularly salient when people have no ordinary history Nationality then becomes a source for ones own identity and for the ascribed identity of the other 7 September 2012 12 Does international still matter? Yes, because . Cultural , institutional and language differences persist Leading to diff erences in (business) decision making Nationality forms an important basis for social categorization processes Leading to shortcuts the like cultural attribution and stereotyping With the effect that doing business across borders is different than domestic business 13 Conceptual foundations of international business strategy 4 interpretation of international business strategy International business strategy means effectively and efficiently matching a multinational enterprises (MNEs) privileged strengths (relative to competitors) with the opportunities and challenges found in geographically dispersed environments that cross international borders. Such matching is a precondition to creating value and satisfying stakeholder goals, both domestically and internationally. 15 TABLE OF circumscribe (1) Introduction and overview of the books frame achievement Part one Core concepts (1) Conceptual foundations of international business strategy (2) The critical portion of firm-specifi c advantages (3) The nature of home country location advantages (4) The problem with host country location advantages (5) Combining firm-specific advantages and location advantages in an MNE network 16 TABLE OF CONTENTS (2) Part two Functional issues (6) (7) (8) (9) (10) International innovation International sourcing and exertion International finance International marketing Managing managers in the multinational enterprise 7 TABLE OF CONTENTS (3) Part three Dynamics of global strategy (11) Entry mode kinetics 1 foreign distributors (12) Entry mode dynamics 2 strategic alliance partners (13) Entry mode dynamics 3 mergers and acquisitions (14) The role of emerging economies (15a) International strategies of corporate social responsibility (15b) International strategies of environmental sustainability 18 The seven concepts of the unifying framework Internationally transferable (or non-location bound) firmspecific advantages (FSAs) Non-transferable (or location-bound) FSAs L ocation advantages Investment in and value creation through recombination Complementary resources of external actors bounded rationality Bounded reliability The MNEs unique resource base Physical resources (natural resources, buildings, plant equipment). Financial resources (equity and loan capital) Human resources (individuals and teams, entrepreneurial and operational skills). upriver knowledge (sourcing knowledge, product and process-related technological knowledge). Downstream knowledge (marketing, sales, distribution and after sales service). Administrative knowledge (organizational structure, culture and systems). Reputational resources (brand names, reputation for honest business dealings). International transferability of FSAs? Paradox If the FSA consists of easily codifiable knowledge (i. e. , if it can be articulated explicitly, as in a handbook or blueprint), then it can be inexpensively transferred abroad, but it can also be easily imitated by other firms.Thou gh expensive and time-consuming to transfer tacit knowledge across borders, the benefit to the MNE is that this knowledge is also difficult to imitate. It is often a key source of competitive advantage when doing business abroad. Some FSAs are not transferable abroad location-bound locationFSAs (1) quaternion main types Stand-alone resources linked to location advantages (privileged retail locations). Local marketing knowledge and reputational resources, such as brand names (may not be relevant to a host country context, or valued to the same extent). Local best practices (i. e. routines), such as incentive systems or buyer-supplier relations (may not work abroad). Domestic recombination capability (may not work in foreign markets e. g. , because co-location of resources is needed). Some FSAs are not transferable abroad location-bound locationFSAs (2) Even if transferability of the relevant resources were technically possible, this does not mean potential for profitable deplo yment, i. e. the resource bundles that may be transferable from a technical perspective (e. g. , the way n which a product is marketed at home), do not constitute an FSA abroad. Location advantages Entire set of strengths of a location, and accessible by firms in that location. Should always be assessed relative to the strengths of other locations. implemental to FSAs Motivations for foreign expansion Natural resource seeking Verbeke physical, financial or human resources Market seeking Strategic resource seeking e. g. , knowledge, finance force seeking E. g. , low labor cost Case Honda in the USA Background Prior to 1970s exports of motorcycles and cars Drivers of foreign production Rising value of the yearn against US$ Fear of import restrictions The Clean Air Act in the US First oil crisis Motivation for expansion (natural resource, market, strategic resource, efficiency seeking? ) Hondas approach After four-year decision process Honda of America Manufacturing established in Marysville, Ohio, in 1978 Top priority attain Japanese-level quality and efficiency plectron of employees Training program Fly in managers and workers from Japan Develop lean supplier network Upgrade supplier quality level 1980 start production of cars Present 9 production plants in USA Hondas FSAs Non-location bound FSAs Know-how four-strike engines with optimal power-to-weight ratio Management principles Quality systems Employee selection processes Training and knowledge transfer routines Manufacturing expertise Supplier management approach Location-bound FSAs in the host country High demand for specific products Resource recombination Use four-strike engines in many products (motorcycles, thin cars, generators, ) Design and manufacturing skills + knowledge of consumer preferences in USA Melding existing and new resources through management exchange program Exploit new capabilities worldwide Complementary resources of external actors Opportu nity to study American way of production at Ford Extensive use of American experts and consultants (especially for selecting location) Critical role of suppliers Bounded rationality issues leave out of knowledge topical anaesthetic conditions Suppliers lack of familiarity with Honda New employees lack of familiarity with The Honda Way Bounded reliability issues Moral hazard/adverse selection employees American managers have local priorities Deliberate strategy? Agenda for next lecture 1. 2. 3. 4. Four types of MNEs Recombination Bounded rationality & reliability Firm-specific advantages (FSAs) Cases 3M & IKEA Literature Textbook chapter 1 (pp 33-76) + chapter 2 NB var. will be in SZ 31

K+12 Program in the Philippines : Necessary or Not?

K+12 Program in the Philippines Necessary or Not? Education is the most powerful weapon which you can use to change the world. (Mandela,2010). This quote states that upbringing develops our world to to a greater extent powerful. This is one of a undercoat why others necessity the K+12 program on the Philippines. Some ar not in favor of this because they say that it is not the longer statement is the solution and it is the improving of quality of education. Some say that K+12 in the Philippines is not obligatory while I as a scholarly person agree for this program.There are many reasons why I agree to have a K+12 Program in our country precisely thither are three things that I think the most significant. First is to elevate the quality of education. This important because we all get laid that we have poor quality of education compared to the other countries. According to Isagani Cruz(2010)The poor quality of basic education is reflected in the low achievement scores of Filip ino students. One reason is that students do not get adequate instructional time or time on task. He said that our current number of long time in school are not enough to fulfill the main objective of the lessons in school. We can see that some are graduated in high school but they still not ready to take their college life. Longer years of education can increase the preparedness of students on their career. Second is to inspire the students to study harder. external test results consistently show Filipino students lagging way behind practically everybody else in the world.In the 2008 mathematics exam, for example, we came in dead last. (Cruz,2010). Some students graduated good forgets what they have learned from their teachers. When they are ask by their younger family member or friend they fail to recall what the answer or if its a numerical problem they already forgot how to solve it. Longer years in school can help us to not to be embarrassed when someone is enquire things tha t we have studied. Third is according to Joe Padre Most graduates are too young to enter the labor force. He said that most of our graduates is not on their right age to work. Some cannot find a job suited for him. If we will have a K+12 Program the problem active age will be disappeared and it can be easy for them to find a good job. These reasons why K+3 program in the Philppines is necessary can be a great help in improving our knowledge about it. For me it is necessary in the philippines even though we will throw off much more money for this.Money is not a reason to refuse this program, time will come after I graduated from college I know that I will have a good life. Many people refuse this program, most of them tell that it is the quality of education not the longer years in school but how can we have good quality of education if the years in school are not enough for what they want to have. K+12 program is necesary in our country because it is the only way to improve the qu ality of education in our country. Now, we will have a more productive people in the Philipppines.

Review of the Efficacy of the Picture Exchange Communication

J Autism Dev Disord (2009) 3914711486 DOI 10. 1007/s10803-009-0763-y ORIGINAL PAPER A Review of the Ef? cacy of the stamp Exchange conversation System Intervention Deborah Preston ? Mark Carter Published online 3 June 2009 O Springer Science+Business Media, LLC 2009 Abstract The go out Exchange Communication System ( pectoralis) is a discourse chopine that has become widely apply, especi on the wholey with children with autism. This paper reports the results of a review of the confirmable literature on pectoral. A descriptive review is pass ond of the 27 studies identi? d, which allow in randomized controlled trials (RCTs), former(a) group designs and hit thing studies. For 10 appropriate sensation subject designs the constituent of nonoverlapping selective information (PND) and percentage exceeding median(prenominal) (PEM) metrics were examined. age on that come in argon few RCTs, on balance, useable research provides preliminary evidence that musculus pectoralis is readily learned by just about affairicipants and provides a means of communicating for individuals with little or no functional saving. Very limited info suggest some(prenominal) positive picture on both socialcommunicatory and ch aloneenging behaviors, while effects on vocabulary development remain un effloresce.Directions for future research ar discussed including the priority need for further organized RCTs. Key actors line supply exchange communication system A Augmentative and alternative communication A Autism Introduction Serious de? cits in communication form part of the primary diagnostic criteria for autism (American Psychiatric Association 2000). It has been estimated that around D. Preston A M. Carter (&) Macquarie University Special Education Centre, Macquarie University, Sydney, NSW 2109, Australia e-mail mark. emailprotected edu. au cardinal-third to one-half of children and adults with autism do not hold up unctional speech (Mirenda 2003). Such indiv iduals may show altogether pre- flavourional communication, such as r separatelying for a desired item, or communication may demonstrate intent through behaviors such as alternating eye gaze, and conventional gestures such as pointing (Yoder et al. 2001). Communication may also take the form of challenging behaviors (Mirenda 1997). When speech does develop it may be limited mainly to unusual or echolalic communicatoryizations (Paul 2005). Individuals with serious developmental disabilities other than autism may also fail to develop speech and language skills (Westling and Fox 2004).In order to help develop communication skills, various forms of augmentative and alternative communication (AAC) have been developed. These include the utilization of manual signs (e. g. , Layton 1988 Yoder and Layton 1988), region output communication devices (VOCAs) (reviewed by Lancioni et al. 2001), and various picture-based systems (Keen et al. 2001 Sigafoos et al. 1996). The estimate Exchange C ommunication System ( pectoral) is a picturebased system developed by Bondy and freeze (1993, 1994) to help junior children with autism acquire functional communication skills. pectoralis appears promising for several reasons.First, it avoids dif? passionies inherent in other systems by requiring truly(prenominal) few prerequisites in fact the only prerequisite is that the individual can clearly indicate (e. g. , by reaching for an item) what he or she wants, in a way that can be wrought into exchanging a physical symbol such as a picture (Bondy and icing the puck 2002). Other skills such as eye contact, motor or verbal imitation skills, the ability to sit quietly in a chair, match-to-sample skills, picture discrimination, or the ability to follow verbal prompts atomic number 18 not necessary (Bondy and rime 1994, 2002), at to the lowest degree at the earliest program stage. 23 1472 J Autism Dev Disord (2009) 3914711486 Second, the ? rst skill taught in pectoral medallio n is requesting. Requesting has often been targeted in early knowledge of individuals with developmental disabilities due to motivational considerations (Reichle and Sigafoos 1991). In relation to pectoral medallion, it is argued that individuals with autism in particular atomic number 18 slight likely to be motivated by the social consequences of labeling or commenting (Bondy and Frost 1995) and more than likely to be motivated by requesting and conterminously obtaining a speci? c, typically concrete, desired item (Bondy and Frost 1994).Third, PECS systematically addresses the get it on of spontaneity, which has often been describe as problematic in individuals with autism spectrum disorders (ASD) (Chiang and Carter 2008 Koegel 2000). Rather than being dependent on a partner to establish a communicative exchange, or requiring a partner to watch for the learner to point to a picture board or generate a manual sign, which could easily be missed, PECS speci? cally teaches the individual to approach the partner and gain their attention by putting a picture symbol into their hand. quaternth, picture symbols can be highly iconic, tight resembling their referents (Ganz and Simpson 2004 Mirenda 2003). Consequently, they may be easily recognized by the learner (Ganz and Simpson 2004) and are more recognizable by communicative partners than some other systems, such as manual signs (Lancioni et al. 2007). The PECS communications protocol begins with a reinforcer assessment through which the trainer determines an ordered list of reinforcers for the individual (Bondy and Frost 1998). This is followed by six phases, which are brie? overviewed in display panel 1. For each phase, the measuring for successful completion is 80% or more trials successful without prompting in a 10-trial block (Charlop-Christy and Jones 2006). The randomized control trial (RCT) is recognized as providing the gold touchstone for evaluating clinical encumbrances in areas such as medici ne and education (Evidence-Based Medicine Working conclave 1992 What Works Clearinghouse 2006) and ideally paygrades would be limited to such evidence (Carter and Wheldall 2008).Such designs, however, are coitusly rare in educationrelated areas (Carter and Wheldall 2008) for a variety of reasons and clinicians mustiness often front to a second line of evidence to inform decision- fashioning. Single subject quasi observational designs employ perennial measures of the dependent covariant over cartridge clip with a star or small enumerate of participants. Although not offering the standard of evidence of RCTs, the best of these designs are considered capable of trenchantly controlling major threats to internal hardihood and strong conclusions about causal inference can be drawn (Campbell and Stanley 1963 Horner et al. 005). Similarly, high spirit quasi-experimental group designs, speci? cally those involving non-equivalent groups with pre-test matching, are everydayly con sidered to be interpretable (Flay et al. 2004). The weakest take aim of evidence is provided by pre-experimental designs, such as single group pre-testpost-test studies, where few threats to internal rigorousness are controlled and causal inference cannot be inferred with any grad of con? dence (Campbell and Stanley 1963). Early papers on PECS were largely descriptive with limited selective information (e. . , Bondy and Frost 1993, 1994, 1995, 1998), or impersonateed outcome info without control (e. g. , Schwartz et al. 1998). In recent geezerhood, however, a sum of interpretable group studies (e. g. , Yoder and lapidate 2006b) and single subject studies (e. g. , Charlop-Christy et al. 2002 Tincani 2004) have been published. Lancioni et al. (2007) reviewed the use of PECS and VOCA (voice output communication aids) for request making in individuals with developmental disabilities. In addition to studies following the PECS protocols of Frost and BondyTable 1 Summary PECS stage s Phase Teaching target I II Make requests through picture exchange Persistence in initiating communication Discrimination between symbols Introduction of sentence structure Answering headspring with a request Commenting verbal description Second person acts as a prompter from behind learner when learner reaches for the desired item, physically prompts to exchange picture prompts worn out(p) as quickly as possible Communicative partner moves gradually further external picture is also gradually moved further away number of communicative partners adjoin Communication book is introduced range of items requested is growing, further only one picture and item is available at a time Initially, two pictures are presented (highly favored and neutral or disliked) more pictures are added subsequent, more than one preferred item is offered at a time periodic correspondence checks are carried out to check accuracy at discrimination Taught to use a sentence strip, placing an I want as so undly as the symbol requests can also be expanded with attributes such as color or size, e. g. I want red playdough Taught to answer header What do you want? Taught to respond to other simple questions such as What do you see? gradually, more spontaneous commenting is developed III IV V VI 123 J Autism Dev Disord (2009) 3914711486 1473 (1994, 2002), they also included studies employing any conventional use of pictorial material as a way of making requests for preferred items (p. 4).Thus, studies that did not follow PECS protocols, and in which the participants pointed to a picture alternatively than actually exchanging it, were included (e. g. , Dyches et al. 2002 Keen et al. 2001). In addition, no attempt was made to determine the data obtained from the studies to evaluate either the overall ef? cacy or effectiveness of the approach or the effect of relevant inconsistent quantitys on outcomes. To date, no comprehensive review of falsifiable literature speci? cally examining the PECS approach of Frost and Bondy (1994, 2002) appears to have been published. The present paper looks speci? cally at studies of PECS hinderance as describe by Frost and Bondy (1994, 2002).In the absence of a substantial number of gold-standard RCT studies that would allow a conventional meta-analysis, a broader approach to evaluation of the research was undertaken. This review is intended to examine the extant empirical research on PECS, with speci? c consideration of the research designs employed and, consequently, the strength of conclusions that can be drawn. excluded (e. g. , Son et al. 2006). One article in which previously taught communication utilise the PECS program was analysed to facilitated communication (Simon et al. 1996) was excluded because there was no PECS intervention during the admit. The study of Rosales and Rehfeldt (2007), in which the ? rst three phases of PECS was taught prior to the experiment, was lso excluded because no data on the results of th e PECS rearing was provided. Analysis A summary of each study was prepared including participants, research design, give-and-take and duration of study, outcomes investigated, setting, PECS reading material and phases implemented, and a summary of the outcomes, as well as inter-observer and procedural dependableness, social validity, support and generalization data. maturates of participants were coded into 5, 58, 917, or over 18 long time. Four categories of dependent variable were identi? ed PECS exchanges (number or percentage of supreme exchanges), speech or vocalization, social-communicative behaviors, and unwanted behaviors.As the absolute majority of studies employed single subject designs, they were coded for quality using an adaptation of the guidelines for single subject research presented by Horner et al. (2005). These indicators addressed several areas adequacy of participant and setting verbal descriptions dependent variables independent variables service line experimental control/internal validity external validity and social validity. A sum of money of 10 points were allocated to each area with the exception of external validity, which was allocated 5 points in recognition of the inherent limitations of single subject designs in this pick up. Thus, studies were rated on a scale from 0 to 65, with high scores indicating greater quality.Details of the criteria are included in the Appendix. Traditionally, single subject studies have been interpreted by ocular inspection of graphed data (Reynhout and Carter 2006). More recently, attempts have been made to quantify results of these studies objectively, and to provide reliable data summaries for evaluating evidence-based interventions (Parker et al. 2007). The most commonly apply of the resulting statistical indices is the percentage of non-overlapping data (PND) (Scruggs et al. 1987). The PND is the percentage of interposition data points that are above (or to a lower place when behav ior decrease is targeted) the highest (or lowest) baseline data point.Scruggs and Mastropieri (1998) provided guidelines for the interpretation of PND scores between 91 and 100 indicate highly effective interventions, between 71 and 90 effective interventions, between 51 and 70 questionable interventions, and 50 or below ineffective interventions. Whilst PND has been criticized on a number of grounds (e. g. , Allison and Method Search Strategy Empirical studies using PECS were identi? ed through computerized searches of A? Education, British Education Index, ERIC, Expanded Academic ASAP, Linguistic and Language Behavior Abstracts, PsycINFO, PubMed and ScienceDirect, using the descriptors PECS or Picture Exchange Communication System. In addition, manual searches of the reference lists of articles identi? ed were carried out to locate further studies.Studies were included if they (1) (2) were journal articles in English from 1992 to July 2007 used PECS (Bondy and Frost 1994 Frost an d Bondy 1994, 2002) as whole or part of an intervention strategy as indicated by reference to program documentation and description of capital punishment presented group or individual data on the results of the intervention. (3) Articles that referred to PECS but did not follow Frost and Bondys protocol were excluded. For example, Dooley et al. (2001) used a PECS-based schedule board (p. 58) but no actual picture exchange. In addition, articles that used a picture exchange system but did not speci? cally state that the PECS protocols (Bondy and Frost 1994 Frost and Bondy 1994, 2002) were employed were 123 1474 J Autism Dev Disord (2009) 3914711486 Gorman 1993 Salzberg et al. 1987 White 1987), it is nevertheless the most widely used statistic for quantifying data from single subject studies (e. g. Bellini and Akullian 2007 Erion 2006 downwind et al. 2007 Reynhout and Carter 2006 Xin et al. 2005). A particular disadvantage of PND is that if any baseline data point has reached the c eiling or ? oor level of the measurement scale, the mensurable PND is 0%, even if visual inspection indicates a treatment effect (Ma 2006). Ma (2006) has suggested an alternative, the percentage of data points exceeding the median (PEM). The PEM is the percentage of treatment data points that are above (or below when behavior decrease is targeted) the median baseline data point. There is also evidence that PEM may correlate better with author judgments of program ef? cacy than PND (Ma 2006).Nevertheless, PND is by removed the most widely used metric for summarizing single subject studies and comparative data are available on a range of interventions. The application of the PEM statistic is very limited to date but, given its potential advantages, it was decided to calculate both PEM and PND determine in the current review. It has also been argued that con? dence in ? ndings from analysis of single subject studies may be strengthened if multiple approaches to synthesis converge on similar conclusions (Smoot et al. 1990). PND and PEM statistics were calculated for all single subject studies with graphed data including a baseline and intervention phase. Changing conditions (i. e. , PECS phase changes), were coded as part of the intervention phase.Metrics were initially calculated for treatment data only and then for all intervention data, including treatment, maintenance and generalization phases. The PND statistic was calculated for each study using the pooled number of non-overlapping data points across all subjects and categories of dependent variable (PECS exchanges, speech/ vocalization, social-communicative behaviors, undesirable behaviors). In addition, a PND statistic was calculated for each participant and for each category of dependent variable within relevant studies. Similarly, PEM statistics were calculated using the pooled number of data points exceeding, or below when appropriate, (i. e. , for undesirable behavior) the baseline median.In cases w here the exact value of data points on a graph was dif? cult to determine, a copy of the graph was obtained from a Portable Document Format copy of the article or a good quality digital scan. Subsequently, numeric data were extracted using the Digitizelt (Bormann 2003) computer software. Inter-Rater reliableness PND and PEM determine were independently calculated by the ? rst and second authors for ? ve arbitrarily selected single subject studies (50% of studies for which enumeration was possible). Values were calculated for each graph that included a baseline and time-series data. Where more than one panel was shown on the aforementioned(prenominal) graph (e. g. multiple baseline, alternating treatments), a value was calculated for each panel. For each panel, dependability was calculated by dividing the lower percentage value by the higher percentage value and multiplying by 100 (i. e. , if both raters agreed on the percentage value, the reliability was 100%). The same ? ve st udies were independently rated for quality indicators by the ? rst and second authors. Inter-rater reliability was calculated by dividing the number of agreements by the total of agreements and disagreements, and multiplying by 100. Inter-rater reliability for both PND and PEM was 100% for 54 panels and over 90% for the remaining three panels with an overall mean agreement of 99. 8%.There were discrepancies in only three graphs the majority of these related to determining how many data points were present in very small ? gures. Inter-rater reliability for quality indicators was 97. 5%. Results A summary of the participants, research design, comprehension of maintenance or generalization data, PECS phases taught, and outcomes examined is presented in Table 2. Research Design The early studies (Bondy and Frost 1993, 1994, 1998 Schwartz et al. 1998) were all reports or program evaluation data without adequate experimental control, as were two later studies (Liddle 2001 Webb 2000). Mal andraki and Okalidou (2007) used a case study.Magiati and Howlin (2003), in their pilot study, used a pre-PECS treatment measure positivistic three measures over time, with data mainly from teacher ratings. All of these studies can be considered pre-experimental. Of the 14 single subject studies, 4 used alternating treatments. Adkins and Axelrod (2001), domiciliate and Rehfeldt (2003) and Tincani (2004) compared PECS and manual signing, while Bock et al. (2005) compared PECS and VOCA (voice output communication aid). Four studies (Charlop-Christy et al. 2002 Rehfeldt and Root 2005 Tincani et al. 2006, Study 1 Yokoyama et al. 2006) used a multiple baseline across participants, while two (Frea et al. 2001 Kravits et al. 2002) used a multiple baseline across settings, one (Marckel et al. 006) used a multiple baseline across descriptors taught, and one (Cummings and Williams 2000) used a multiple baseline across activities. Two studies ( swayr et al. 2006 Tincani et al. 2006, Study 2) used an ABAB design, while one (Ganz and Simpson 123 Table 2 Summary of Studies Ages Dependent variable Research design Maintenance (M) PECS or generalization (G) Phases data IIII IIII IIII IIV IIII IIII IIII IVI III Picture exchange, sign Picture exchange, VOCA Picture exchange Picture exchange, speech Picture exchange, speech speech Social/communicative Picture exchange, sign language Speech, social, behavior (variation) Authors Participants DiagnosisAdkins and Axelrod (2001) 35 Autism Autism Autism Autism Autism 1 autistic characteristics Autism 2 autism, 3 PDD 35 years Single-subject (multiple baseline) 312 years Single-subject (multiple baseline) M,G 1940 years Single-subject (alternating treatment) G 37 years 37 years Non-equivalent control group Non-equivalent control group G 32 months Program evaluation 6 years Program evaluation 6 years adult Program evaluation 4 years Single-subject (alternating treatment) G 1 PDD 7 years Single-subject (alternating treatment) G Bo ck et al. (2005) 6 Bondy and Frost (1993) 74 Bondy and Frost (1994) 85 Bondy and Frost (1998) 1 J Autism Dev Disord (2009) 3914711486 Carr and Felce (2007a) Carr and Felce (2007b) 10 41 chamber and Rehfeldt (2003) 4 Charlop-Christy et al. (2002) 3Cummings and Williams (2000) Autism Autism Autism Autism 14 ASD Autism or ASD Autism Autism 16 autism/PDD-NOS 36 years 2231 years 2034 years 45 years 10 years Case study Single-subject (multiple baseline) Single-subject (multiple probe) Program evaluation Single-subject (ABAB) Single-subject (alternating treatment) 911 years Single-subject (multiple baseline, ABAB) 512 years Single group School Program evaluation 6 years Single-subject (multiple baseline) 37 years 411 years Single-subject (changing criterion RCT G M G M G G G G G 4 years Single-subject (multiple baseline) 5 Picture exchange, other IIII IIV IVI IIII IVI IVI IVI Extension IIII IIV IIV IIII IIV Picture exchange, behavior Picture exchange, speech Picture exchange, speech, ADOS-G Picture exchange, speech, social Picture exchange Picture exchange, speech, other Picture exchange Picture exchange (improvised requests) Picture exchange, other Picture exchange, speech, other Picture exchange Picture exchange Picture exchange, sign, speech PECS, speech 1475 Frea et al. (2001) 1 Ganz and Simpson (2004) Howlin et al. (2007) 3 84 Kravits et al. (2002) 1 Liddle (2001) 21 Magiati and Howlin (2003) 34Malandraki and Okalidou (2007) 1 Marckel et al. (2006) 2 Rehfeldt and Root (2005) 3 Schwartz et al. (1998) 31 Stoner et al. (2006) 5 Tincani (2004) Autism 2 1 autism, 1 PDD-NOS 56 years 123 Tincani et al. (2006) 3 1476 J Autism Dev Disord (2009) 3914711486 Maintenance (M) or generalization (G) data M,G 2004) used a within subjects changing criterion design. In several studies, a changing criterion was included, re? ecting the PECS phase changes but it was secondary to the main design (Bock et al. 2005 Chambers and Rehfeldt 2003 Cummings and Williams 2000 Rehfeldt an d Root 2005 Stoner et al. 2006 Tincani 2004 Tincani et al. 2006 Yokoyama et al. 2006).Comparative group designs were employed in ? ve papers. Yoder and Stone (2006a, b) used random assignment to PECS or Responsive Education and Prelinguistic Milieu Teaching (RPMT) intervention groups, while Howlin et al. (2007) used random assignment of classes to immediate treatment, lasted treatment or no treatment with PECS groups. Carr and Felce (2007a, b) used a quasiexperimental group design whereby PECS intervention and control groups were chosen by geographical location, and included both within subjects and between group measures. Pre-test equivalence of the groups was established. Participants Picture exchange, speech PECS Phases IVI IVI G IVI G Single-subject (multiple baseline)) IIV Picture exchange, speech Dependent variable Speech Social In total, there were 456 participants in the 27 studies of these, 394 (86%) received PECS intervention and 62 (14%) were in non- or alternative-inter vention groups. Of the total, 377 (83%) were draw as having ASD. Ages of participants ranged from 20 months to 40 years and there were 198 males (43%) and 38 (8%) females with the gender of 220 (48%) of participants unstated. Where the same or a subgroup of participants were reported in multiple studies (Carr and Felce 2007a, b Yoder and Stone 2006a, b), they were counted only once. The group experimental (Howlin et al. 007 Yoder and Stone 2006a, b) or quasi-experimental (Carr and Felce 2007a, b) studies involved a total of 161 participants (35% of the total sample) 98 in PECS intervention groups and 92 in control or other treatment groups. The Delayed Treatment Group in the Howlin et al. (2007) study was used as both control and intervention at different times. All these children were described as having autism or PDD-NOS and little or no speech. They ranged in age from 20 months to 11 years at study commencement. These studies all provided information on the initial abilities of the participants based on standardized tests. The single subject studies involved a total of 42 participants (9% of the total sample) and all provided information on diagnosis, age and gender.Only a minority provided information on the diagnostic instrument or protocol used to identify ASD (Ganz and Simpson 2004 Marckel et al. 2006 Yokoyama et al. 2006), described the degree of autism or provided standardized assessment data or a description of general ability for all participants (Chambers and Rehfeldt 2003 Frea et al. 2001 Kravits et al. 2002 Rehfeldt and Root 2005 Stoner et al. 2006 Research design Program evaluation 5570 months RCT 2154 months Autism/PDD 36 Yoder and Stone (2006a) 2053 months Autism/PDD Yoder and Stone (2006b) 36 RCT Diagnosis Participants 6 Table 2 Summary of Studies 123 Yokoyama et al. (2006) Authors Webb (2000) 3 Autism 5 ASD 57 years Ages J Autism Dev Disord (2009) 3914711486 1477 Yokoyama et al. 2006).Most researchers did document initial communication ski lls, either using standardized test results or a description of functional skills, although some descriptions were minimal. Participants were almost entirely described as non-verbal or having little or no functional speech, or in some cases no functional communication. The participants in the Marckel et al. (2006) study were able to use PECS independently to make requests at the start of the research. Participants in three studies were explicitly identi? ed by researchers as having challenging behavior (Adkins and Axelrod 2001 CharlopChristy et al. 2002 Frea et al. 2001). Interobserver and Procedural reliableness Interobserver reliability was reported for 20 of the 27 papers reviewed. Papers in which interobserver reliability was not reported included ? e earlier program evaluations (Bondy and Frost 1993, 1994, 1998 Liddle 2001 Webb 2000) and one single subject study (Adkins and Axelrod 2001). Reliability ranged from 80. 3 to 100% calculated on between 10 and 100% of data. Three stu dies (Howlin et al. 2007 Kravits et al. 2002 Malandraki and Okalidou 2007) estimated reliability on less than a minimal standard of 20% of total sittings. In contrast, procedural reliability was reported for only 7 of the 27 studies (Bock et al. 2005 Cummings and Williams 2000 Marckel et al. 2006 Tincani 2004 Tincani et al. 2006 Yoder and Stone 2006a, b) and discussed but not formally calculated in one other (Stoner et al. 2006). Where reported, procedural reliability ranged from 96 to 100%.In two papers (Yoder and Stone 2006a, b) less than 20% of sessions were used for the estimate. Social Validity Formal measures of social validity were reported in only quatern papers (Magiati and Howlin 2003 Marckel et al. 2006 Tincani 2004 Yoder and Stone 2006a). Settings Fourteen studies were conducted in a special school, special preschool or special classroom setting. Remaining studies were conducted in a variety of settings including an integrated preschool, regular classroom, homes, clini cs, day treatment facilities, and combinations of these settings. Ef? cacy and dominance of PECS Of the total group of 394 individuals who received PECS intervention, only one child was reported as being nsuccessful at mastering at least phase I (Liddle 2001), and one adult had dif? culty with the motor and cognitive demands of the training and failed to progress past phase I (Mike, Stoner et al. 2006). Carl, from Tincanis (2004) study, was more successful with manual signs than PECS, but, the great majority successfully mastered at least some phases of PECS. Outcome data will now be considered further, initially focusing on pre-experimental designs, then single subject designs, quasi-experimental group designs and ? nally RCTs. This will be followed by a more little consideration of maintenance and generalization. Pre-data-based Studies some(prenominal) studies used pre-experimental designs.Bondy and Frost (1993) reported data on the implementation of PECS and erect change ma gnitude communicative initiations and use of pictures. Bondy and Frost (1994, 1998), Schwartz et al. (1998), Webb (2000), and Liddle (2001) also presented data on PECS implementation and reported increases in spoken language following PECS training. Schwartz et al. fix that children were able to acquire communication with PECS training and there was evidence of generalization across pragmatic function. These studies, however, insufficiencyed adequate experimental control, and especially given the young age of the children involved in at least four studies, it is unknown how communication would have developed without the intervention.In their pilot study, Magiati and Howlin (2003) used a pre-treatment measure and three teacher ratings over time. They found signi? slant increases in PECS level (d = 2. 91),1 frequency of spontaneous use (d = 1. 75), and number of symbols used (d = 3. 01) over the 6 months following teacher training in PECS and its subsequent introduction. These are very large effect sizes by educational standards. They also found smaller but still statistically signi? cant increases in the number of signs (d = 0. 31), words (d = 0. 32) and phrases (d = 0. 30) used, and in the overall level of spontaneous communication (d = 0. 83). Outcomes were, however, measured mainly through teacher rating scales.The results must be treated with caution as they are likely to have been in? uenced by expectations and the research design was very weak. 1 For pre-test post-test designs, effect sizes were calculated by subtracting the pretest mean from the post-test mean and dividing by the pooled standard deviation. For studies involving a simile group, effect sizes were calculated by subtracting the mean of the control or alternate treatment group from the mean of the PECS intervention group and dividing by the pooled standard deviation. 123 1478 J Autism Dev Disord (2009) 3914711486 Single Subject Studies PND and PEM statistics were calculated for the 10 sin gle subject studies that provided baseline and intervention data.Initially, calculations were conducted on treatment data alone and then on all intervention data, including treatment, maintenance and generalization. When compared, the overall mean differences in favor of the treatment alone data were very small, only 0. 4% in the case of PND and 0. 8% for PEM. It was considered that the inclusion of all intervention data provided the best indicator of the ef? cacy of the overall package and these data were used for the remaining analysis. Results are provided in Table 3. Calculations were not possible for the four additional single subject studies (Adkins and Axelrod 2001 Cummings and Williams 2000 Ganz and Simpson 2004 Rehfeldt and Root 2005). These studies either lacked baseline data (e. g. alternating treatment design without baseline) or lacked baseline data that corresponded directly to that collected in intervention. The overall mean PND was 78. 5% (range 50 100), placing the PECS intervention in the effective range (Scruggs and Mastropieri 1998). The overall mean PEM was 89. 1% (range 72. 3100). Quality indicator scores are also presented in Table 3, and ranged from 30. 6 to 55. 7 out of a possible 65 points. Correlation between Quality Indicator scores for each study and their associated study PND was not signi? cant (rs = -0. 05, p = 0. 87). For PEM there was a trend toward weaker studies producing higher effect sizes but this did not reach signi? cance (rs = -0. 44, p = 0. 19).MannWhitney U tests or KruskalWallis one-way ANOVAs were used to compare PND and PEM values across participant and study characteristics and these data are presented in Tables 4 and 5. No signi? cant difference in PND was found for age, gender, setting, inclusion of maintenance or generalization data, or research design. A signi? cant difference was found for PND scores for outcome variables, with studies addressing picture exchange only having a higher mean PND than those that included other dependent variables (i. e. , speech, social, behavioral, with or without picture exchange). A signi? cant difference was also found between PND values for participant diagnosis.Post hoc comparison showed that PND for children identi? ed with autism (i. e. , autistic disorder) were signi? cantly lower than for the other two groups, but these groups were not signi? cantly different from each other. No signi? cant difference was found between PEM values for any of the study or participant characteristics although participant diagnosis approached signi? cance (p = . 06). Four of the single subject studies included data speci? cally relating to speech development from which PND and PEM values could be calculated (Charlop-Christy et al. 2002 Tincani 2004 Tincani et al. 2006 Yokoyama et al. 2006). The mean calculated PND was 49. % (range 19. 5 100) and PEM 54. 2% (range 25. 0100). These values are in the non-effective or at best very mildly effective range but with wide va riation. Charlop-Christy et al. (2004) found increases in speech during PECS training. Tincani (2004) examined independent word vocalizations during PECS and sign language training. The addition of a Table 3 Single subject studies PND and PEM results study quality results Study PND PEM Study quality (Maximum 65) Picture Speech Social Behavior Overall Picture Speech Social Behavior Overall exchange exchange Adkins and Axelrod (2001) Bock et al. (2005) Chambers and Rehfeldt (2003) Charlop-Christy et al. 2002) Cummings and Williams (2000) Frea et al. (2001) Ganz and Simpson (2004) Kravits et al. (2002) Marckel et al. (2006) Rehfeldt and Root (2005) Stoner et al. (2006) Tincani (2004) Tincani et al. (2006) Yokoyama et al. (2006) Mean SD 92. 1 100. 0 100. 0 87. 7 97. 3 77. 5 90. 6 98. 6 68. 7 90. 0 10. 9 59. 8 100. 0 20. 0 19. 5 49. 8 38. 4 86. 8 86. 8 n/a 26. 0 0 13. 0 18. 4 92. 1 100. 0 55. 6 50. 0 87. 7 97. 3 77. 5 95. 3 70. 5 58. 6 78. 5 18 . 8 92. 1 100. 0 100. 0 87. 7 100. 0 90. 1 90. 6 98. 6 89. 9 94. 3 5. 2 65. 7 100. 0 25. 0 26. 0 54. 2 36. 0 95. 95. 6 n/a 85. 0 100. 0 92. 5 10. 6 90. 1 95. 3 72. 3 76. 7 89. 1 10. 6 92. 1 100. 0 76. 3 100. 0 87. 7 100. 0 30. 6 55. 7 43. 8 52. 4 32. 9 42. 4 35. 3 50. 4 49. 6 43. 8 50. 3 48. 2 45. 7 50. 3 45. 1 7. 6 123 J Autism Dev Disord (2009) 3914711486 Table 4 Means, standard deviations and MannWhitney U test results for PND and PEM scores of study and participant characteristics Variable N PND M (SD) Quality indicators C50 50 PECS only Includes other Yes No 5 74. 3 (16. 6) 5 82. 6 (21. 7) 5 90. 9 (8. 9) 5 66. 0 (18. 0) 3. 0 0. 94 84. 6 (7. 5) 93. 5 (12. 0) 3. 0 1. 98* 94. 0 (5. 7) 84. 1 (12. 6) 7. 0 1. 14 5. 0 1. 6 U z PEM M (SD) U z Research design Multiple baseline Alternating treatments ABAB Age Under 5 58 2. 0 1. 56 76. 5 (0. 3) 92. 2 (9. 4) 4. 0 1. 04 87. 9 (11. 2) 93. 9 (8. 7) 6. 0 1. 27 89. 9 (12. 2) 11. 0 0. 21 88. 5 (10. 5) 8 8. 5 (12. 5) 52. 0 0. 46 92. 5 (11. 2) 6. 0 0. 52 2. 0 1. 56 917 18? Diagnosis Autism PDD-NOS/autistic characteristics Other Setting Special school/ preschool Clinic Integrated preschool Home Combination 10 1 1 9 8 90. 1 (12. 5) 3. 87 79. 3 (n/a) 50. 0 (n/a) 74. 3 (30. 4) 82. 3 (21. 8) 2 57. 1 (2. 1) 8 83. 8 (17. 0) 9 8 3 9 13 85. 0 (17. 0) 2. 58 73. 1 (31. 2) 72. 2 (21. 4) 87. 9 (18. 5) 69. 8 (25. 9) 7. 68* 93. 8 (7. 3) 84. 4 (11. 4) 75. 4 (18. 8) 93. 5 (11. 1) 6 3 1 70. 0 (19. 0) 3. 82 95. 8 (4. 0) 77. 5 (n/a) 479 Table 5 Descriptive statistics and KruskalWallis One-Way ANOVA results of PND and PEM scores of study and participant characteristics Variable N PND M (SD) H PEM M (SD) H 85. 5 (12. 3) 1. 62 95. 8 (4. 0) 90. 1 (n/a) 6. 74 Outcome variables Maintenance data included Generalization data included Yes 8 80. 9 (17. 8) No Yes No Gender Male Female 2 68. 9 (26. 7) 4 88. 8 (12. 4) 6 71. 6 (20. 0) Procedural reliability data 83. 7 (13. 2) 5. 59 100. 0 (0) 92. 8 (9. 8) 90. 4 (11. 8) 2. 29 79. 3 (n/a) 100. 0 (n/a) 87. 8 (13. 1) 89. 2 (13. 4) 2 100. 0 (0) 14 89. 2 (15. 2) 25 78. 9 (23. 9) 40. 5 1. 12 5 92. 5 (11. 2) Note * Indicates signi? cant result at 0. 05 level for two-tailed test reinforcer delay in phase IIIb resulted in increased in word vocalizations. Tincani et al. 2006) examined word vocalizations and vocal approximations during PECS training, and found a decrease during phases I-III before dramatic increases in phase IV. In a second experiment, expression at phase IV only, a higher percentage of word vocalizations was found with the reinforcement delay procedure than without. Yokoyama et al. (2006) examined frequency and intelligibility of vocalization during PECS training in phases I-IV these authors also found an increase with the time delay procedure. Several other studies provided data on speech development, which was not suitable for calculation of PND or PEM values. Kravits et al. (2002) found an increase in frequency of intelligible speech but not in range of spoken vocabulary.Ganz and Simpson (2004) found that words per trial increased noticeably during phase IV or phases III and IV of PECS training, in particular, simultaneously with delayed word modeling. Charlop-Christy et al. (2002) provided the only appropriate data for calculation of PND and PEM values for social outcomes. From this very small amount of data, the PND of 86. 8% and PEM of 95. 6% suggest an effective or highly effective intervention. Variables that increased in this study were eye contact, pin attention, cooperative play, and frequency of initiations and requests including but not limited to PECS requests. Initiations and requests Note * Indicates signi? cant result at 0. 05 level for two-tailed test ncreased the most, and say attention also increased in all three children. It has been suggested that a direct positive relationship exists between joint attention and communication in children with autism, with improvement in one potentially stimu lating an increase in the other (CharlopChristy et al. 2002). Kravits and colleagues (2002) reported some increase in duration of social fundamental interaction with peers although these data were not suitable for calculation of PND or PEM as only the mean level in each phase was presented. PND and PEM scores were calculated for data from only two studies for behavioral variables (CharlopChristy et al. 2002 Frea et al. 2001). The mean PND was 13. 0% while the mean PEM was 92. %, but, examination of graphed data showed treatment effects, indicating that decreased problem behaviors occurred in conjunction with increased communication skills through PECS training. Two studies compared sign language to PECS interventions (Chambers and Rehfeldt 2003 Tincani 2004) and one compared a VOCA to PECS (Bock et al. 2005). For each of these studies PND and PEM were equal, and a higher value was found for PECS than for the alternative intervention. For Tincani (2004) calculated values were 95. 3% for PECS and 92. 3% for sign, for Chambers and 123 1480 J Autism Dev Disord (2009) 3914711486 Rehfeldt (2003) values were 100% for PECS, and 65. 7% for sign, and for Bock et al. 2005) values were 92. 1% for PECS and 79. 7% for VOCA. Quasi-Experimental Group Studies Carr and Felce (2007b) found signi? cant improvement in several aspects of communicative interaction between children and staff following 15 h of PECS training (Phases I-III). Signi? cant increases were found for total child-toadult initiations, linguistic initiations, the percentage of adult response, the percentage of child response, and signi? cant decrease in adult-to-child interactions with no opportunity for child response. These differences were found in comparison to both a pre-intervention measure over time and to a non-intervention and non-equivalent control group.Examining a subset of this group, who used at least one word during observations, Carr and Felce (2007a) reported that over 6 weeks training in PECS p hases I-III, 3 of the 24 children in the PECS group increased their spoken words. A further 2 who did not speak at pretesting did so at post-testing, while there was a marginal increase in speech for one child in the control group. RCTs Only three RCT studies were located. Yoder and Stone (2006a) conducted an experimental study of 36 children with autism, aged 2154 months, who were randomly assigned to PECS or RPMT intervention groups. They found that the PECS group showed a signi? cantly greater increase in frequency of speech (d = 0. 3) and in number of different words used (d = 0. 50) after 6 months of intervention, but by 6 months post-intervention the difference was no longer evident. Interestingly, they also found differing effects consort to pretreatment characteristics children who were low in initial object exploration bene? ted more from the RPMT intervention, while those who were higher bene? ted more from PECS, these effects being evident 6 months post-intervention. Ove rall, there was a signi? cant increase in non-imitative spoken acts over 1 year. The actual increases were from a mean of 0. 25 nonimitative spoken acts in a 15-min session to a mean of 5. 5, and from a mean of 0. 7 different non-imitative words to a mean of 3. Given the young age of the children, the fact that their initial verbal mental age averaged 11. 9 months (range 719 months), just at the stage when verbal language is likely to develop naturally, it bets quite possible that this increase could be attributed to maturation. In a second article, Yoder and Stone (2006b) examined the effect of the interventions on the three major types of intentional communication used prior to speech development, (i. e. initiating joint attention, requesting, and turn-taking). They found that, overall all three communicative functions increased signi? cantly, but RPMT increased turn-taking more than PECS.Children who were higher in initiating joint attention before treatment had greater increase s in both initiating joint attention and requesting following RPMT intervention, while those who were initially lower in initiating joint attention had greater increases following PECS intervention. Howlin et al. (2007) conducted a group RCT of 84 children with autism, examining the effect of teacher training and consultancy in PECS. It should be stressed that this study examined the effectiveness of a consultancy model to deliver PECS, rather than the ef? cacy of PECS per se. Thus, the study was notepricey in that it appears to be the only research to examine effectiveness (i. e. , outcomes under clinical rather than optimal conditions). Howlin et al. ound that rates of communicative initiations and PECS usage were signi? cantly increased immediately following intervention, but that these effects were not well-kept once the intervention ceased. They found no signi? cant increase in frequency of speech. Howlin et al. also examined ADOS-G (Lord et al. 2000) domain scores for communic ation and reciprocal social interaction. They found no increase in most ADOS-G ratings, with the exception of a decrease in the severity score for the Reciprocal Social Interaction domain at the 10 month followup. Unfortunately, no data was provided on the ? delity of implementation of the PECS program, or indeed on the ? delity of the teacher training.Maintenance and Generalization Only ? ve studies provided data on maintenance. Two of the RCT studies included long-term follow-up. Yoder and Stone (2006a) found that differences in speech variables were not maintained 6 months post-intervention, while Howlin et al. (2007) found that for the 26 children assessed at a 10-month follow-up, the increased rate of communicative initiations and PECS usage found immediately post-intervention was not maintained. Two single subject studies and one case study measured maintenance of skills 610 months postintervention (Charlop-Christy et al. 2002 Malandraki and Okalidou 2007 Yokoyama et al. 2006) . Charlop-Christy et al. ound that speech and socio-communicative behaviors had been maintained or continued to increase for one participant followed up 10 months post-training. Yokoyama et al. found maintenance of PECS skills both in the training room and at home, 68 months after training for the three participants in their study. Malandraki and Okalidou in their study of one child found maintenance of skills 6 months after the main intervention. speckle the difference was not signi? cant and the number of studies was low, for the single 123 J Autism Dev Disord (2009) 3914711486 1481 subject studies both PND and PEM were lower for studies that included maintenance data (Table 4).Fifteen of the 27 studies included some data on generalization of PECS skills. The great majority of these were positive, with skills generalizing to different settings, people and stimuli. For some studies, generalization was an integral part of the way data were collected (CharlopChristy et al. 2002 Yode r and Stone 2006a, b). For others, generalization to untrained situations was speci? cally probed (e. g. , participants in Stoner et al. s (2006) study generalized their skills to use in fast food restaurants). Several studies show generalization to the classroom teacher or to home. In a small number of instances, generalization was unimpressive or absent.For example, in the Adkins and Axelrod (2001) study, tests for generalization simply postulate the child to mand for an object without immediately prior prompted trials. Carl, from Tincanis (2004) study, failed to generalize PECS skills to classroom teachers, preferring to use sign language. Discussion The PECS program was originally designed to provide a method of communication for children with autism, particularly those who do not use functional speech. PECS appears to be a popular intervention (Howlin et al. 2007) but, unfortunately, popularity of a given treatment does not necessarily re? ect actual ef? cacy (Green et al. 200 6 Reynhout and Carter 2006). Only three RCTs have been reported to date. The studies of Yoder and Stone (2006a, b) compared PECS to RMPT.PECS was superior for some children but the study was designed to compare two treatments and, consequently, did not include a control arm. Thus, no conclusions can be drawn about the relative superiority of either intervention to a non-treatment control. Howlin et al. (2007) provided the only effectiveness study conducted. They found signi? cant effects on communicative initiations but this was not maintained once the intervention ceased. Thus, further examination of approaches to the delivery of PECS in clinical settings is needed. Con? dence in the Howlin et al. study is somewhat weakened by the lack of any data on treatment ? delity, which is a critical feature in study quality (Gersten et al. 2005).The nature and quantity of data arising from RCTs at this point in time is insuf? cient to draw ? rm conclusions regarding the PECS interventions. T hus, probably the highest priority for research in this area is the conduct of further RCTs examining both ef? cacy and effectiveness in employ settings. In the absence of an adequate body of RCTs, clinicians still need to make informed decisions regarding interventions and may need to look to the second line of evidence. Evidence backup the PECS intervention was provided by the well-designed quasi-experimental studies of Carr and Felce (2007a, b), which incorporated a non-equivalent control group with demonstration of pre-test equivalence between groups.Arguably, the bulk of interpretable data on PECS comes from single subject studies. For the relevant studies, the overall, mean PND (78. 5%) and PEM (89. 1%) ? gures support the preliminary conclusion that PECS may be an effective intervention, at least when implemented under research conditions. There was a signi? cant difference between the PND results for studies that only looked at picture exchange outcome variables and those that included other collateral variables, such as speech, social, or challenging behavior. This indicates that, unsurprisingly, PECS training appears to be most effective in providing a successful means of communication through picture exchange.Nevertheless, it should be acknowledged that the number of studies remains relatively low and single subject designs have several limitations, including low external validity. While these studies contribute to our knowledge and give us a preliminary indication of the ef? cacy of PECS, they are not a substitute for well-conducted large scale RCTs. A substantial number of the extant studies were preexperimental in nature, particularly the early research. As such, they are not able to provide convincing demonstrations of experimental control. Hence, these studies offer no interpretable evidence on the ef? cacy of PECS. The effect of PECS training on speech development remains unclear.Research into various forms of AAC suggests they may have the potential to kick upstairs speech development (Cress and Marvin 2003 Millar et al. 2006 Romski and Sevcik 2005) although results have sometimes been inconsistent (Carter 1999 Millar et al. 2006). Several of the studies reviewed in this paper reported increases in speech following PECS training, but others, including Howlin et al. (2007), reported little or no effect. Where speech increased, this has often occurred concurrently with phase III or IV of PECS, and in particular when a time delay was introduced. A related question, for which there is as yet no empirical evidence, is whether PECS training affects comprehension.Brady (2000) found increased comprehension skills with the use of VOCAs and it would be worth investigating whether PECS would have a similar effect. In comparison with other AAC systems, better overall results were obtained with PECS in the studies reviewed here (Adkins and Axelrod 2001 Bock et al. 2005 Chambers and Rehfeldt 2003 Tincani 2004). Nevertheless, there was variability in the results depending on initial imitation skills and, possibly, participant preference. It has been argued that individuals with ASD may bene? t from visually cued instruction (Quill 1997) and further examination of this issue would seem warranted. In addition, existing 123 1482 J Autism Dev Disord (2009) 3914711486 application of PECS appears to have been exclusively limited to graphic symbols.There are distinct advantages to the use of three-dimensional palpable symbols, including decreased cognitive load and high iconicity (Rowland and Schweigert 1989, 1990 Turnell and Carter 1994). The exploration of the use of PECS with tangible symbols, especially with individuals who are low functioning, would seem warranted. Only 5 of the 27 studies provided data on maintenance of PECS skills or other dependent variables. It is worthy of note that maintenance was problematic in both RCTs (Howlin et al. 2007 Yoder and Stone 2006a) that examined the issue. Overall, availab le evidence is mixed but there is certainly suf? cient doubt to indicate that maintenance should be formally and systematically monitored in the clinical application of PECS programs.Fifteen studies provided data on generalization of skills, the vast majority of these found that generalization did occur, but what was described as generalization varied greatly. There were several methodological limitations and issues in the research examined that warrant comment. In general, participant descriptions were poor, making it dif? cult to assess whether the intervention is best suited to individuals with particular characteristics. While nearly all studies provided a diagnosis, few speci? ed the diagnostic protocol or criteria. Further, when participants were diagnosed with ASD, few researches attempted to quantify the degree of autism.Noting the range of behaviors and symptom severity possible within individuals presenting with autistic disorder, and even greater variation in the broader autism spectrum, this would seem to be relevant, if not critical, information. Few researchers provided standardized assessment data or a detailed functional description of general ability, but probably re? ecting the aim of the intervention, most did provide some description of initial communication skills. While the number of studies was clearly insuf? cient to reach ? rm conclusions, PND data suggest that individuals with PDD-NOS or showing autistic traits made more progress with PECS than those with autistic disorder.It is unclear whether this is because the PECS protocol is better suited to them, or because they would do better with any treatment. Without further clear and consistent quanti? cation of the degree of autistic symptomatology, it is impossible to evaluate further this variable in relation to the ef? cacy of the PECS intervention. In addition, there was insuf? cient data on reason functioning to enable analysis of any relationship to PND or PEM. It is recommended t hat, in future studies, standardized psychometric data, standardized functional assessment of adaptive behavior, and clear information on initial communicative abilities should be provided.In addition, where a diagnosis of autism is provided the level of autistic symptomatology should be quanti? ed. Procedural reliability data were very limited, with data only meeting the conventional minimum standard in 5 of the 27 studies. Because of the absence of this data, it is not possible to determine in many cases whether what was being implemented was in fact the PECS program as designed. PECS is a complex and multi-component intervention making the veri? cation of treatment integrity even more critical. The absence of such information in research studies is somewhat dif? cult to understand given that the PECS manual (Frost and Bondy 2002) gives explicit and speci? criteria for assessing the integrity of training during each phase. Nevertheless, research on PECS is not alone in this regard and lack of procedural reliability data has been reported as a problem in other recent intervention reviews in the area of autism (e. g. , Bellini and Akullian 2007 Reynhout and Carter 2006). The calculated PND (88. 8%) and PEM (89. 9%) ? gures for studies that did meet the standard for reporting procedural reliability, are at the high end of the effective intervention range (Ma 2006 Scruggs and Mastropieri 1998), suggesting that monitoring of procedural integrity should be a key feature in research as well as clinical applications of PECS. A signi? ant component of the present review was the application of PND and PEM metrics to the relevant data. PND and PEM values were in most cases very similar, with lower variability for PEM (see Table 4). An exception was found for data relating to behavioral variables (CharlopChristy et al. 2002 Frea et al. 2001), where high baseline variability and ? oor effects occurred, often causing the calculated PND for affected graphs to be low, while the PEM was high. For example, visual inspection of the graphed data in Frea et al. (2001) shows a clear treatment effect of the PECS intervention on disruptive behavior. Nevertheless, the calculated PND for these data was 0%, while the PEM was 100%.The discrepancy between the clear treatment effect seen in the graphed data and the PND value indicates that PEM may be a more appropriate metric for challenging behavior, where variability is likely to be high. Further, the advantages of using multiple methods of calculating effect sizes for single subject research are highlighted. As previously noted, PECS is a complex multi-component intervention program. Consequently, the question arises as to which of the components are most critical to its ef? cacy. For example, reinforcer assessment is formally and systematically incorporated into PECS and this may well be a owing(p) factor in program ef? cacy. The use of picture exchange with a partner (rather than touching or pointing to a sym bol) is a key distinguishing feature of PECS, but it is unclear whether exchange per se is essential to ef? cacy.The issue of developing spontaneity is addressed in an unusually systematic way in the PECS program (Chiang and Carter 2008) but extant research 123 J Autism Dev Disord (2009) 3914711486 1483 provides only limited information on the circumstances under which communication occurs. Thus, there would appear to be considerable scope for examination of how speci? c components contribute to the overall ef? cacy of PECS. In addition, there has been only limited comparison of PECS to alternative interventions and this stands as a priority for future research. Several limitations of the current review must be acknowledged. Many of the earlier studies were descriptive and clear experimental control was not established.While later studies were of higher quality, only a limited number of RCTs have been conducted and much of the available interpretable data comes from second line of e vidence single subject studies. Analysis of PND and PEM was only possible for a subset of the relevant single subject studies examined and analysis of speci? c study and participant characteristics were based on low numbers. In addition, very few studies provided adequate procedural reliability data so the extent to which PECS was appropriately implemented often remained unknown. Conclusion On balance, the studies reviewed provide preliminary evidence that PECS may be ef? cacious for children and adults with ASD and other developmental disabilities, who have little or no speech. Primary bene? s appear to be evident in communication by picture exchange. Identi? cation of the core aspects of the program that are important to its success, the individuals to whom it is best suited, and its relationship to other interventions remain to be substantively investigated. PECS stands as a promising intervention with some empirical support but many questions remain. The conduct of further RCTs into the ef? cacy and effectiveness of PECS stands as a high research priority. Appendix See Table 6. Table 6 Quality criteria for single subject research adapted from Horner et al. (2005) Area Indicator Description of participants Participants are described with suf? ient detail to allow others to select individuals with similar characteristics and settings (e. g. , age, gender, disability, diagnosis). One point awarded for each of the following (maximum of 5) 1. Statement of diagnosis such as autism, ASD, Asperger syndrome, intellectual disability (with or without indicating diagnostic source), age and gender 2. Diagnostic instrument speci? ed (e. g. , WISC, AAMR diagnostic criteria, DSM-IV criteria, ADOS). Must provide if ASD or 0 awarded 3. If ASD, degree of autism speci? ed either with reference to symptoms (DSM-IV) or instrument like CARS. If not ASD, award point 4. Standardized assessment data (e. g. IQ, developmental scale, adaptive behavior) OR detailed functional descripti on of general ability. Disability range (e. g. , moderate) acceptable for intellectual disability 5. Communication skills documented by means of standardized test results OR description of functional skills The process for selecting participants is described with replicable preciseness. MUST describe the process used to select participants, not just describe the participants or their needs. This would generally include the criteria the participants must meet (e. g. , 35 years, less than 5 spoken words, diagnosis of autistic disorder) and or the process of selecting participants (e. g. , the ? rst 5 children on the waiting list).Essentially, authors must explicitly state HOW/WHY participants were selected Critical features of the physical setting are described with suf? cient precision to allow replication Dependent variables All dependent variables are described with operational precision Each dependent variable is measured with a procedure that generates a quanti? able index The me asurement process is described with replicable precision Dependent variables are measured repeatedly over time Data are collected on the reliability or inter-observer agreement (IOA) associated with each dependent variable, and IOA levels meet minimal standards (i. e. , IOA = 80% Kappa = 0. 60).Must be on minimum of 20% of sessions to be acceptable Independent variables Independent variable is described with replicable precision Independent variable is systematically manipulated and under the control of the experimenter Overt measurement of the ? delity of implementation for the independent variable. MUST be measured on a minimum of 20% of sessions to be acceptable 123 1484 Table 6 continued Area Baseline Indicator J Autism Dev Disord (2009) 3914711486 A baseline phase provides repeated measurement of a dependent variable and establishes a pattern of responding that can be used to predict the pattern of future performance if introduction or manipulation of the independent variable d id not occur. Should include a minimum of 3 stable data points.High variability is acceptable if intervention effects are unambiguous The procedural characteristics of the baseline conditions should be described operationally Experimental control/internal The design provides at least three demonstrations of experimental effect at different points in time. Effects of validity alternating treatments may be added, as main comparison is not with baseline. AB designs may not be added as they do not demonstrate intervention at different times when comparing to baseline The design controls for common threats to internal validity (e. g. , permits elimination of rival hypotheses). Acceptable designs include multiple baseline, ABAB and alternating treatment with counterbalancing.Unacceptable designs include AB, ABA, and changing criterion External validity Social validity Experimental effects are replicated across participants, settings, or materials to establish external validity. At least t hree participants, settings or materials must be apparent The dependent variable is socially important Implementation of the independent variable is practical and cost effective (must be measured) Social validity is enhanced by implementation of the independent variable over extended time periods, by typical intervention agents, in typical ph