Free The effectiveness of Picture Exchange Communication System (PECS) Dissertation Example

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The effectiveness of Picture Exchange Communication System (PECS)

Category: Communication

Subcategory: Design

Level: University

Pages: 22

Words: 6050

The Effectiveness of Picture Exchange Communication System (PECS)
Student’s Name:
University Affiliation:
Date:
Abstract
The following study aims at examining the efficiency of PECS training on the communicating conduct of learners with severe language disability in early years. Qualitative interview timetables will be carried out with partakers from both settings. The study will examine the efficacy of PECS for students with autism and its importance to their communication abilities. Qualitative interviews will be utilized to address the research interviews for the following reason. The participants will be currently employed teachers in an autism particular kindergarten and presently working staff members in a normal preschool, with autistic children attendance. The sample population will comprise of ten teachers. The participant’s age group will range from 23 years to 34 years of age. The experience of the population will vary from level six childcare qualifications to stage eight Bachelor degrees. The investigators will obtain written permission from the administration, and from the educator and assistant demanded in the study. Purposeful sampling will be utilized in choosing the participants in relation the rationale of the case study, which is to get insight into the awareness of teachers concerning PECS.
Keywords: PECS, language disability, Training, communication, phenomenological study, Autism, changing criterion method, Qualitative interview, Students, teachers
The effectiveness of Picture Exchange Communication System (PECS)
Introduction
Communication and daily human interactions are deeply intertwined. Language is defined as any behavior reinforced by another person or organism’s mediation in the verbal community. In the overall sense, language allows an individual the authority to influence other people’s actions in her/his surroundings. From a life-long viewpoint, it also can affect an individual’s ability to traverse the social world successfully. Language is especially important during education in early childhood. Each day, active pre-schools fill up with chatter among teachers, pupils, and other staff members. The children in pre-school share information by talking with those around them, unfortunately, some children have less command of language than others do. Such kids need to be supported more in language using specialized interventions and others require assistive technology equipment to allow them to take part fully in the early childhood school setting (Beth, Hoffman, Catherine, Andrew, Lori, and Frost, 2009). This research, thus, aims at investigating the efficiency of PECS training on the communication conducts of children who have serious language problems in their early years.
Assistive Technology for Communication
These laws have allowed people with disabilities higher access to technology that can better assist them to take part in daily life, community, and school. A child who has difficulty producing vocal speech may not participate fully as they lack the means of conveying ideas and needs (Lerna, Esposito, Conson, and Massagli, 2014). The technology type known as assistive or augmentative communication (ACC) can help individuals with the problem of producing vocal speech by speaking for them. According to Mirenda (2003), the ACC is categorized into two: aided ACC and Unaided ACC. The unaided one involves the use of alternative modes of communication that do not necessitate creating a message using an external device. This encompasses miming, gestures, and manual signs. Aided ACC, on the other hand, is when a person needs an external device to help them in conveying their message. Examples of aided ACC include languages such as line drawings, words in print form, and photographs (Mirenda, 2003). Voice output devices, computers as well as micro-switches are also other examples. When devices like these are used alongside behavioral interventions, people with communication deficits see positive outcomes (Myles, 2007). To be specific, functional communication training is a form of technology that boosts effective responses in communication to show needs or wants to replace challenging behavior (e.g., hitting and hurling things). (Travis, & Geiger, 2010).
Picture Exchange Communication System
Bondy and Frost (1994) argue that the common proper additional responses chosen in the process of functional communication training are a vocal speech response. Nevertheless, the use of ACC as a response topography is also common. As mentioned in previous contexts, symbols, voice output devices, and sign language have all been used for communicative responses. The PECS can also be viewed as an ACC or an assistive technology device. In 1994, Bondy and Frost came up with the PECS procedures, which approach the acquisition of language through the Skinnerian perspective of developing verbal behavior. The method was fashioned with the aim of examining efficient means for autism children to acquire speech skills.
The system first trains children on how to request for something (Bondy & Frost, 1994). The premise of this notion is that children who have autism may not be as sensitive to social consequences as children who are developing normally. While using PECS, a concrete, preferred outcome is coupled with social interaction. The child learns how communication can be used in altering another person’s behavior to attain a specific goal (Flippin, Reszka, & Watson, 2010). As the learner carries on through the six PECS stages, they become more social and less direct. Upon completion, the child gains the ability to describe the events or items in their surrounding by using a word strip or picture.
Phases of PECS Training
Phase 1: Communication Techniques
In this phase, a child discovers how to choose a photo through the communication partner and selects the picture. In the initial stage, two trainers teach the skill (Pasco & Tohill, 2011). The instructor acts as the communication partner standing in front of the child and the other teachers standing either behind or beside them directs on physical prompts. Verbal cues are not utilized all through the teaching. The communication instructor gives an item; the physical assistant observes the learner’s behavior to reach for the piece and then offers the learner a physical prompt instantly. The time allowed for the child to take an action assists in developing spontaneity with a less possibility of prompt-reliance.
Phase 2: Distance and persistence
The second phase involves teaching students to reach for the communication book, take one card from the book cover and head towards the communication partner. Teaching these skills is a gradual process that involves increasing the proximity between the communication partner, the book, and the child slowly. Just like phase one, there is no use of verbal prompts in the second phase.
Phase 3: Picture Discrimination
There are two sub-phases involved in teaching picture discrimination. The learner first differentiates between a picture of an item he highly prefers and another one that is neutral. The communication partner starts the process by putting the pictures of the items on the communication book cover. Social reinforcement is achieved when the communication instructor praises the child decides on reaching and selecting the preferred picture. When he touches the picture of the neutral item, no social reinforcement is delivered to them. The strategy of correcting the error involves:
Model – The trainer points at the preferred item pic to model the right response.
Prompt – The child is prompted to exchange the preferred picture. In reinforcing the correct exchange, social praise is used.
3. Switch – The process is paused briefly, or a non-related skill is performed in one trial.
4. Repeat – the child is given another opportunity to request.
The error-correction procedure prevents prompted responses from being reinforced by calling for a proper response before the desired item can be delivered and can be repeated up to five times until the learner masters the required skill.
Phase 4: Sentence structure
The skill is taught by backward chaining and involves the learner knowing how to use the phrase “I want” and arranging various items on a sentence strip. The icon “I want” is included on the sentence strip from the beginning. The learner starts off by giving the communication partner one card and then he receives the prompt from placing the card on the strip and interchange the sentence strip. He is then taught how to arrange the card labeled “I want” and the picture of the item on the strip. This way a child learns how to identify every picture on the strip after the exchange. Verbalization is encouraged through a time delay method with differential corroboration. The child is given more of the reinforcer if he gets to verbalize. It is however not a requirement as he will still be given reinforcement without verbalizing. The next step after learning how to merge icons on the sentence strip is to learn how to request for specific items through attributes. The child learns how to differentiate between attributes that are highly and least preferred. The error correction process explained in the third phase is used again to teach the item discrimination. In the end, the learner will master the use of various attributes and their application to many preferred items.
Phase 5: Responding to “What do you want?”
Besides instinctively requesting items, learners know how to respond to the question “what do you want?” by exchanging the strip with the trainer. A progressive-time delay is a technique used to teach the skill. The student receives multiple opportunities to make requests spontaneously.
Phase 6: Commenting
The most common questions that the learner is expected to answer in this phase are:
What is it?
What do you have?
What do you hear?
What do you see?
First, the environment is set in such a way that it gives an interesting thing that can be commented on. For instance, the learner and the trainer can look through a preferred photo album. The learner will first learn to give a response to one question without any form of discrimination. The trainer poses the target question, and this prompts the student to organize the sentence strip with the icon “it is a” and the corresponding item. The exchange is socially reinforced and does not involve presenting the learner with the item. It is essential to employ only social reinforcement since the skill is more of a comment than a request.
Literature Review
Literature determines the efficiency of PECS training on the communicating behavior of children with severe language disability in their early years. Tien (2008) did a review of thirteen research studies with 125 participants who had ASD. He then concluded that comprehensive research designs, generalization, treatment conformity, and components of maintenance of the studies endorsed PECS as an intervention.
Another review by Lancioni and colleagues (2007) consisted of studies published between 1992 and 2006 which likened the effectiveness of VOCAs and PECS. Their search generated thirty-seven studies that appraised either PECS or VOCA or made direct comparisons between VOCA and PECS for educating twenty-five partakers about requests. From the review, there were no perceptible variations between the rates of acquisition between the systems, predilection by participants, or day-to-day use. In the discussion, the authors mentioned that it would not have been possible to reveal the differences because the number of requests was small. Also, apparent preferences for a given modality against another would not have been demonstrated because there were fewer participants whose motor abilities were also the same. Suppose impairment in motor skills was considered as a factor, the participants would have selected VOCA. In closing, the researchers posited that if honestly, the two systems had a slight difference or none at all to the participants, the preferences of the caregiver may be used to select communication devices.
Tincani and Devis (2011) meta-analyzed sixteen single-subject studies on PECS. A total of forty-four participants took place in the reviews. Their evaluation was based on requests using speech and PECS. It was also a requirement for the studies to cite the PECS guiding method (Frost & Bondy, 1994). The unit of analysis used to treat the effects for each participant was PND. In total, forty-one PNDs were considered because some participants had incomplete sets of data. The outcomes of the research showed that both females and males learned PECS’ requests at a relatively equal rate. According to the statistical analysis done there was no variation in learning twenty-eight rates for gender, diagnosis, or the setting of training. There was no aggregation in the effect sizes of vocalization. Each study had a unique set of definitions as well as speech acquisition. Only seven studies reported treatment fidelity and other studies did not cover the level of rigor for evaluating accuracy. In general, the mean from the PND analysis was 80.1. The authors recommended further research for Phases V and VI since there were fewer studies that evaluated the advanced phases of PECS. Over fifty percent of those who took part in the meta-analysis were diagnosed with other conditions besides autism and PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified). This caused the researchers to make a tentative suggestion that PECS may prove effective with other populations. Although some of the players did not show any speech gains, others gained moderately and modestly. It was thus noted that PECS intervention was not solely meant for increasing and results that showed a lack of speech gains were not enough to discredit the methods. The researchers then went ahead to a accentuate that the studies reviewed included only forty-four participants and advised against being too conclusive based on such a small sample.
Generalization Studies
Stoner et al., (2006) endeavored to examine the efficiency of PECS in enhancing communication skills in mentally disabled adults. The participants included one female and four males aged between twenty-two and thirty. The sessions took place in the group homes of the participants. The design used was the modified ABAB model. A total of forty-four data sets were collected through event recording and direct observation on the right number of PECS’s exchanges. The data sets were after that converted to a proportion of proper exchanges per every opportunity in every session. Baseline conditions had the partakers seated at a table with actual and preferred items in front of them. The preferred item was placed a bit out of reach. The researcher drew an open hand towards one participant after the other without providing any prompt or error correction. Each participant was allowed ten chances to request an item. As they underwent treatment, the first three PECS phases were taught to the participants with criteria for mastery set at ninety percent accuracy for three days consecutively. They took a break between the third and fourth phase during a summer recess. The fourth phase started in the fall and before that those taking part in the PECS process went through another baseline condition with similar procedures as the first baseline condition. The participants received training in the fourth phase.
The Bondy and Frost (1994) procedures provided guidelines for teaching the PECS phases. Visual inspection was used in the graphing and analysis of data. The results showed that three out of five of those who participated had acquired PECS’s requests successfully up to the fourth phase. The participants who were unsuccessful at acquiring phase III skills were hindered by health conditions and difficulties in motor skills. The conclusion made by the researchers was that PECS was less effective as a modality for communication for the participants. The participants who were successful at acquiring all the phases the conclusion made was that PECS was effective. The participants were able to utilize PECS while engaging in community activities like ordering food at a diner. One strength of this research is that it occurred over a long time. The results permanence was backed up by the ability of the participants to use forty-five PECS even after they broke for summer. The weakness is that no data was gathered on treatment integrity.
Summary of the Literature
The review by Tien (2008) also acknowledged PECS as an evidence-based practice for those who have Autism Spectrum Disorder due to the general value of the single-subject literature. Comparisons of reviews between VOCA and PECS showed that there was no significant variation between the rates of acquisition and those of adoption of one modality of communication over the other (Lancioni et al., 2007). When likened to sign language, training through PECS is more effective acquiring requests. Comparing it to VOCA however, the rate of requests acquisition through PECS’s training was the same. (Ganz, Simpson, & Lund, 2012) established that devices for generating speech and PECS were efficient at enhancing communication; however, other systems that were mostly picture-based were less efficient. Howlin et al. (2007) carried a study that disclosed that only fifteen hours of participating in the PECS teaching yielded a considerable rise in the number of productive unorganized initiations of interactions made by children with ASD. The findings by Howlin et al., (2007) demonstrated the effectiveness of the PECS training on the rate of using PECS. The effects however dissipated in the course of a ten-month follow-up.
Finally, PECS has been examined concerning other alternative modalities of communication with the most common comparison being the VOCA. The study by Adkins & Axelrod (2001) showed that it is easier to acquire PECS than sign language. The observation has also been made for older populations. According to Chambers and Rehfeldt, (2003), three out of four participants acquired mands faster using PECS than they did use sign language. Also, all the four participants often used PECS to request for items that weren’t in sight than they used sign language.
Gaps in articles
The supporting journal articles give evidence that PECS was successful in improving public communication abilities and language in young children in comparison to other language interventions. Rebutting articles offer evidence that PECS did not extensively improve public communication abilities or language in comparison to other language treatments and therapies. Mixed articles offer proof that there might be abilities those children may possess before treatments that will enhance the probability that a child may get better social communication skills or language.
Methodology
Previous researchers proposed that young people with fewer communicating skills are more probable to participate in difficult behavior. Purposely, children with autism might use difficult behavior as a way to demand or decline (Bondy, 2012). One method to improve such behavior is through practical communication teaching. In 1994, Bondy and Frost produced the PECS. Nevertheless, coherent with principles of the National Autism Center, the use of PECS is still viewed as a promising application for people with serious language abilities. As a result, the underlying principle of this study is to investigate the efficiency of PECS training on the communication techniques of learners with severe language disability in early years. This chapter describes the participants, settings, treatments, and processes used for collecting data in this study. A changing principle design will be used to scrutinize the effectiveness of PECS’s teaching on children with disabilities who are lacking verbal skills and attending a preschool classroom.
Research Questions
The central question for his study is;
What are broad education teachers’ attitudes of training autistic children mainstreamed in their class?
What barriers affect teacher’s aptitude to distinguish tutoring in their class?
What schemes do teachers recognize would ease the procedure of providing specialized teaching in their class for children diagnosed with ASD?
Qualitative Interviews
Qualitative interviews will be utilized to address the research interviews for the following reason. First, qualitative study will facilitate both aspect and depth concerning reactions, rather than searching to contain the respondent’s experiences in prearranged responses. It is established that qualitative design techniques are not only clear, although are the most efficient in studying multifaceted issues, such as training on the communication behaviors of students with serious language disability in early years. In this study, I will use a qualitative phenomenological research model to scrutinize the skill of education tutors and their opinion concerning teaching autistic children in a mainstreamed classroom. Creswell (2003) stated that a qualitative researcher should be in a position of an unreal lens. He or she acts as the device in the collection of data. The researcher works as the lens in a qualitative research to inspect research problems questioning into the significance of groups attributed to a human difficulty. Creswell (2013) confirms that a phenomenological research offers perceptiveness into a matter or difficulty experienced by everyone involved. In this research, I will focus on the attitudes of education tutors in a public school who educate autistic children in mainstreamed classrooms. I will analyze information from general education tutors who are teaching autistic students in kindergarten through eighth grades. Data will be collected from general education teachers in person, semi-structured interrogation guide. I will code all answers from the teachers and identify rising themes. The research findings can later be utilized by executives at the school setting in the district agency regarding in-services for the broad education tutors.
Materials
The following research will be conducted using interview schedules. Earlier in the interviews, some questions will be developed as a basis for the investigator to operate from. The data will be recorded with a mobile device and recorded on paper.
Participants
The participants will be currently employed teachers in an autism particular kindergarten and presently working staff members in a normal preschool, with autistic children attendance. The sample population will comprise of ten teachers. The participant’s age group will range from 23 years to 34 years of age. The experience of the population will vary from level six childcare qualifications to stage eight Bachelor degrees. The amount of expertise teaching children with autism will vary from one month to four years. More data on the participants are explained in the interview questions. All the participants will be operating with no less than one child with an autism spectrum disorder (ASD).
Procedures
The teachers will be informed verbally concerning the study and they will also be invited to take part in the process. Interviews will be arranged for ready participants at a specific time and location that will accommodate them. During the interviews, the teachers will be asked to sign a written approval form to accept their participation in the study. It will also delineate ethical matters like the opportunity to pull out from the study. All the teachers offered to partake and no compensation will be made. The time for the interviews will range from 10-25 minutes. The data will be recorded on a mobile device. The researcher will transcribe all the interviews and store the information in a safe USB disk. The analysis of the interview will be done with paper and pen. The usage of paper and pen means carefully analyzing the recorded interviews and highlighting related topics.
Ethics
Discussion on ethical concern that is pertinent to this case study entails the procedures utilized in the enlisting of players because such procedures were communicated by numerous ethical values important to the accomplishment of the research. It is essential to mention that study is a two-way activity concerning the researcher and the responders and, consequently, must be conducted with equality and honesty between parties. Additionally, involvement must be charitable without any uneasiness about the possible penalty for not taking part. It is probable for investigators to determine this matter by instructing about the type of the study to the respondents, such as the objectives and processes of the study and explicating how the findings from the research will be utilized. Some probes that the investigator must respond before involving the players in a study include if the partaker has provided his or her communicated approval to be incorporated in the study, if they have has willingly accepted to participate, and whether the partaker is completely informed of possible risks and reimbursement of the study. In other words, partakers need to be conscious of the type and objective of the study and must give their permission with no form of intimidation.
Safeguarding Respondent Privacy
Concerning the idea of communicated permission, maintaining partaker’s privacy while introducing detailed explanations of the experiences of the partakers is vital. The authority to privacy is essential to the implementation of moral investigation. It will be impossible to guarantee the participants’ full anonymity since exact quotes will be utilized in this study. Nevertheless, some steps will be taken to protect the privacy, such as refraining from using real names when marking the audio clips interviews and making sure that every one credential concerning to the research will be securely stored. In sum, these steps will be taken to guarantee privacy:
The personality of the partakers will be kept private. Their real names will not be used to defend their identity.
Copies of the interviews will be kept for about five years, in which they will be deleted and the copies destroyed.
Extracts from the interviews will be incorporated in the thesis only with the consent of the partakers. Adequate concern will be taken to defend the personality of the responders and all those who will take part in the interviews.
The information collected from the study will be offered to any third party.
Any personal data that might cause the recognition of the responders will be excluded from this thesis.
Consent form
A teacher’s viewpoint on the usage of PECS for children with autism
My name is (write your name), and I am carrying out the study that researches the effectiveness of PECS training on the communication conducts of children who have serious language problems in their early years. We are inviting you to participate in this research, and the engagement involves an interview that will be scheduled to take place approximately 40 minutes.
Involvement is charitable, and therefore you are not compelled to join in. In case you participate, and you feel that any of the interviews are difficult or private, you can skip the questions, and carry on with the interview.
Participation in this study is private. In any case, you would like to remove your interview from the record after the completion of the interview; this can be admitted up to when the study has been published. The question and every associated certification will be stored securely on a password confined USB disk.
It is vital that you recognize that by carrying out and presenting the interview that you are accepting to partake in the research.
For any other further information concerning the research, please get in touch with Grace (your name and email)
Thank you for taking part in this research.
Participant Signature:………………………………….Date:…………………………………
Demographics form:
Sex:
Age:
Qualifications:
Work experience with children:
Work experience with Autism:
Work title:
Interview Questions:
1. Do you have any training exclusively for Autism?
2. Concerning training students with Autism, is there a specific teaching syllabus for the children with Autism?
3. What are the behaviors recognized in Autistic that you do not observe in typically developing students?
4. How do you handle these diverse behaviors?
5. Have you undergone training to take care of such behaviors?
6. Do you take not such conducts? If so, please explain how?
7. In case you experience a tough behavior to handle is there someone or organization you can speak to concerning the matter? How responsive is your support system?
8. Is coping with behaviors a challenge when teaching Autistic children?
9. Are there any other challenges you experience?
10. How do you handle an Autistic child if he/she is non-verbal?
11. Are there any other communication techniques that you utilize to supplement the child?
12. Do you utilize other visuals aids in the class?
13. Concerning the behaviors as discussed before, how would an Autistic child understand what is required of them? Your visuals? Or words?
14. Do you experience these behaviors degenerate or develop over time?
15. In general, do you believe from earlier experiences that Autistic children fit into your class?
16. What is your perfect method of teaching children with Autism?
References
Top of Form
Bottom of Form
Beth Sulzer-Azaroff, Anne O. Hoffman, Catherine B. Horton, Andrew Bondy, Lori, Frost. (March 23, 2009). The Picture Exchange Communication System (PECS): What Do They Say? 24 (2), 89-103 https://doi.org/10.1177/1088357609332743
Bondy, A. a. (2012). The Unusual Suspects: Myths And Misconceptions Associated with Pecs. Psychological Record, 62(4), 789-816.
Bondy, A. S., & Frost, L. A. (1994). The picture exchange communication system. Focuson Autism and Developmental Disabilities, 9(3), 1-19.
Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods.approaches (2nd ed.) Thousand Oaks, CA: Sage Publications.
Creswell, J. W. (2013). Qualitative inquiry and research design. Choosing among fiveapproaches. Thousand Oaks, CA: Sage.
Flippin, M., Reszka, S., & Watson, L. R. (May 01, 2010). Effectiveness of the Picture Exchange Communication System (PECS) on Communication and Speech for Children with Autism Spectrum Disorders: A Meta-Analysis. American Journal of Speech-Language Pathology, 19, 2, 178-195.
Friman, Patrick. (2010). Cooper, Heron, and Heward’s Applied Behavior Analysis (2nd Ed.): Checkered Flag For Students And Professors, Yellow Flag For The Field. Journal of Applied Behavior Analysis. 43. 10.1901/jaba.2010.43-161.
Ganz, J. B., Simpson, R. L., & Lund, E. M. (2012). The Picture Exchange Communication System (PECS): A Promising Method for Improving Communication Skills of Learners with Autism Spectrum Disorders. Education And Training In Autism And Developmental Disabilities, 47(2), 176-186.
Howlin, P. p., Gordon, R. K., Pasco, G., Wade, A., & Charman, T. (2007). The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial. Journal Of Child Psychology & Psychiatry, 48(5), 473-481. doi:10.1111/j.1469-7610.2006.01707.x
Lancioni, G. E., O’Reilly, M. F., Cuvo, A. J., Singh, N. N., Sigafoos, J., & Didden, R. (2007). PECS and VOCAs to enable students with developmental disabilities to make requests: An overview of the literature. Research in DevelopmentalDisabilities, 28, 468–488.
Lerna, A., Esposito, D., Conson, M., & Massagli, A. (2014). Long-term effects of PECS on social-communicative skills of children with autism spectrum disorders: a follow-up study. International Journal Of Language & Communication Disorders, 47(5), 609-617. doi:10.1111/1460-6984.12079
Mirenda, P. (2003). Toward Functional Augmentative and Alternative Communication for Students with Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids. Language, Speech, And Hearing Services In Schools, 34(3), 203-16.
Myles, B. S. (2007). Autism spectrum disorders: A handbook for parents and professionals. Westport, Conn: Praeger.
Pasco, G., & Tohill, C. (2011). Predicting progress in Picture Exchange Communication System (PECS) use by children with autism. International Journal Of Language & Communication Disorders, 46(1), 120-125. doi:10.3109/13682822.2010.484851
Stoner, J. B., Beck, A. R., Bock, S. J., Hickey, K., Kosuwan, K., & Thompson, J. R. (2006). Remedial and Special Education, 27(3), 154-165.
Tien, K. C. (2008). Effectiveness of the picture exchange communication system as a functional communication intervention for individuals with autism spectrum disorders: A practice-based research synthesis. Education and Training in Developmental Disabilities, 43(1), 61-76.
Tincani, M., & Devis, K. (2011). Quantitative synthesis and component analysis of single-participant studies on the picture exchange communication system.Remedial and Special Education, 32(6), 458-470.
Travis, J. j., & Geiger, M. (2010). The effectiveness of the Picture Exchange Communication System (PECS) for children with autism spectrum disorder (ASD): A South African pilot study. Child Language Teaching & Therapy, 26(1), 39-59. doi:10.1177/0265659009349971

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