Testing the Validity of the Pictorial Infant Communication Scale in Preschool-Aged Children with Autism Spectrum Disorder

Background: Joint attention is a crucial milestone in the development of communication and a notable area of deficit in children with autism spectrum disorder (ASD; Sigman & Ruskin, 1999).  While valid parent-report measures of communicative abilities are available, assessment of joint attention is primarily limited to semi-structured, examiner-led interactions, which are time consuming and laborious to score. The Pictorial Infant Communication Scale (PICS; Delgado, Mundy, Venezia, & Block, 2003) addresses the need for an efficient parent-report measure of joint attention. The PICS is a brief (sixteen item) parent-report measure of nonverbal communication for use with infants and toddlers.  Pictures are presented next to each item to aid parents' understanding of the specific behaviors of interest. While preliminary analyses suggest strong construct validity and reliability with ASD samples (Ghilain et al., 2014), associations with established measures of joint attention and language skills have not yet been evaluated.

Objectives:  To investigate the concurrent validity of the PICS, a parent-reported measure of joint attention abilities, in preschool-aged children with ASD.

Methods:  Participants included 197 children with ASD who were recruited as part of a larger study examining the comparative efficacy of public school-based intervention models for preschoolers with ASD (Boyd et al., 2014). Children were between the ages of 3 and 5 years (M = 47.60 months, SD= 7.49 months) at enrollment, and were assessed twice during the school year (pre- and post-test). Parents completed the PICS at pre-test. The PICS yields subscale scores for Initiating Joint Attention (IJA), Initiating Behavioral Requests (IBR), and Responding to Joint Attention (RJA), as well as a Total Score. To obtain a direct clinical measure of child joint attention and language skills, a subset of children (n = 25) were administered the Early Social Communication Scales (Mundy et al., 2003), the Mullen Scales of Early Learning (MSEL; Mullen, 1995), and the Preschool Language Scale, Fourth Edition (PLS-4; Zimmerman, Steiner, & Pond, 2002) at pre-test. Pearson r correlations among scores on the PICS and ESCS, and the PICS and PLS-4 and MSEL were calculated.

Results:  PICS Total, IJA and RJA scores were significantly and positively correlated with ESCS RJA (ps < .01; see Table 1). In addition, PICS IJA scores were significantly associated with ESCS IBR scores (p < .05). Additional analyses indicated that Total Score on the PICS was significantly and positively correlated with both receptive and expressive language scores on the PLS-4 and the MSEL (ps < .05; see Table 2). Language scores were strongly correlated with PICS IJA and RJA scores (ps < .01) but not IBR scores.  

Conclusions: Taken together with previous reports of strong psychometric properties (Ghilain et al., 2014), findings suggests that the PICS is a valid tool for measuring joint attention skills in preschool-aged children with ASD. Future research examining the PICS' ability to distinguish between children with and without ASD may be useful in clarifying its role in screening and/or treatment efforts.