重度聽障兒童要面對的不只是聽力喪失，還要因應後續造成的溝通障礙。重度聽障兒童常有口語、手語及書面語皆詞不達意的現象，相較於聽障成人更容易發生「溝通中斷」的情形。當聽者無法有效接收其表達時，重度聽障兒童可以改變其他的溝通形式來修補溝通。本研究採用單一受試跨受試、多試探、多基線研究法，在遊戲情境中探討PECS對重度聽障兒童溝通行為之影響。在基線期與PECS使用期分析三位國小學生之表達完整性、溝通次數、使用詞彙數及溝通管道。在PECS訓練前期三位參與者完整學習PECS六個階段。結果指出PECS強化參與者之表達完整性與建立圖片交換溝通系統(PECS)與重度聽障兒童溝通行為之功能關係。但是在溝通次數與使用詞彙數並無一致的改變，溝通形式則因為使用PECS而擴增。PECS在重度聽障生學習快速且成為溝通修補策略。討論研究之成效與重度聽障生學習PECS的特性，並提出未來研究之方向和建議。

Children with severely hearing disability need to adjust not only with their hearing loss, but also with the difficulty in communication. Those children often express themselves with incomplete speech、sign or text resulted in communication breakdown which happened more than adults with hearing disability. However, those children might benefit from other forms of communication (e.g., Picture Exchange Communication System, aka PECS) to repair the breakdown when listeners fail to comprehend their expressions.
In the present study, we used single subject, multiple probe design across participants to investigate the effects of the PECS on facilitating communication behaviors for children with severely hearing disability in play activities. In the baseline phase, three elementary students were analyzed of their expression integrity、 the number of communication 、the number of words used and the form of communication. In the PECS pre-training phase, they were taught to use the PECS till mastery criterion according to the manual. The results indicated that the PECS facilitated the students’ expression integrity and a functional relationship was established. However, the effects on number of communication and the number of words used showed no consistent change. For participants with severely hearing disability, the forms of communication had been expanded to use the PECS. PECS was acquired quickly as a repair strategy to children with severely hearing disability. The strengths of the study and the characteristics of participants in learning PECS were discussed. Clinical implications and future research directions were also provided.

參考文獻:
一、 中文文獻:
王瓊珠 (2012)：台灣中文字詞教學研究之文獻回顧與展望。教育心理學報，44(2)，253-272。 doi:10.6251/bep.20111109
孔逸帆、劉馨憶、楊熾康(2013)：輔助溝通系統介入方案對一位國中重度聽障學生語句表達成效之初探。東華特教，49，1-7。
李芃娟(2012)：國立臺南大學特殊教育中心特教叢書第56 輯:聽覺障礙。臺南:國立台南特殊教育中心。
杜正治(2006)：單一受試研究法。臺北:心理。
王文科(2003)：單一受試者研究:在教育與臨床情境中的研究。台北:濤石。
林寶貴(1994)：語言障礙與矯治(265-266頁)。臺北:五南。
林寶貴(1994)：聽覺障礙教育與復健(6-7頁)。臺北:五南。
林寶貴(2004)：溝通障礙理論與實務。臺北:五南。
林玉霞(2015)：聽覺障礙幼兒的早期讀寫概念發展（上）。雲嘉特教期刊，22， 4-10。
林淑莉、胡心慈、趙玉嵐、邱滿艷 (2012)：圖卡兌換溝通系統訓練對一位多重障礙兒童之功能性溝通行為的改變。特殊教育季刊，122， 1-12。
林桂如,鍾雅婷(2017)：帶得走的溝通技巧聽覺障礙學童溝通修補教學策略手冊(21-26頁)。臺北市：心理。
宣崇慧、林寶貴 (2002)：學前聽障及聽常兒童讀寫萌發情形與口語發展能力之探究。特殊教育與復健學報，10， 35-57。
張蓓莉(1989)：聽覺障礙學生之語言能力研究。特殊教育研究學刊，5，165-204。
陳美琍(2006)：手語大師1單形篇。台北：現代經典。
黃玉枝(2007)：促進聽障學生批判思考的教學。屏師特殊教育，15，46-53。
Bondy, A. S., & Frost, L. A.(2002):圖片交換溝通系統培訓手冊第二版。金字塔公司。
錡寶香(2011)：聽力損失幼童的早期讀寫萌發與支持。國小特殊教育，52 ，1-14。
錡寶香(2015)：度障礙學生的溝通服務與支持。台北：國立台北教育大學特殊教育中心。
翁素珍、洪儷瑜、林寶貴(2006)：聽障違抗兒童之溝通互動能力研究。特殊教育研究學刊，30， 155-180. doi:10.6172/bse200603.3001008
劉秀丹、曾進興、劉俊榮(2009)：自然手語與文法手語的詞彙記憶廣度比較。 特殊教育研究學刊，34(3)， 25-45。
蔡淑苓(2004)：遊戲理論與應用：以幼兒游戲與幼兒教師教學(24-31頁)。臺北：五南。
特殊教育法施行細則(1999)：中華民國一0二 年 七 月 十二 日臺教學(四)字第1020097264B號 令發布。
身心障礙學生支持服務辦法(2013)。中華民國102年9月27日教育部臺教學(四)字第 1020139818B號令修正發布。
 
二、 外文文獻:
Baker, S., Baker, K., & ERIC Clearinghouse on Disabilities and Gifted Education, R. V. (1997). Educating children who are deaf or hard of hearing: bilingual-bicultural education. ERIC Digest #E553.
Bates, E., Thal, D., Whitesell, K., Fenson, L., & Oakes, L. (1989). Integrating language and gesture in infancy. Developmental Psychology, 25(6), 1004-1019.
Blaylock, R. L., & Scudder, R. R. (1995). Repair behaviors used by children with hearing loss. Language, Speech & Hearing Services in Schools, 26(3), 278.
Bondy, A. S., & Frost, L. A. (1994). The picture exchange communication system. Focus on Autistic Behavior, 9(3), 1.
Bracken, M., & Rohrer, N. (2014). Using an adapted form of the picture exchange communication system to increase independent requesting in deafblind adults with learning disabilities. Research In Developmental Disabilities, 35(2), 269-277. doi:10.1016/j.ridd.2013.10.031
Caselli, M. C. , Vicari S. & Longobardi E.(1998).Gesture and words in early development of children with Down Syndrome. Journal of speech, language and hearing research, 41, 1125-1135.
Charlop-Christy, M. H., Carpenter, M., Loc, L., LeBlanc, L. A., & Kellet, K. (2002). Using the Picture Exchange Communication System (PECS) with children swith Autism: Assessment of PECS acqusiton, speech,
social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35(3), 213.
Ciocci, S. R., & Baran, J. (1998). The use of conversational repair strategies by children who are deaf. American Annals of the Deaf, 143(3), 235-245.
Cohen, E. T., Heller, K. W., Allgood, M. H., & Castelle, M. (2001). Use of picture dictionaries to promote written communication by students with hearing and cognitive impairments. AAC: Augmentative & Alternative Communication, 17(4), 245-254.
Conklin, C. G., & Mayer, G. R. (2011). Effects of implementing the Picture Exchange Communication System (PECS) with adults with developmental disabilities and severe communication deficits. Remedial and Special Education, 32(2), 155-166. doi:10.1177/0741932510361268
Courtin, C. (2000). The impact of sign language on the cognitive sevelopment of deaf children: The case of theories of mind. Journal of Deaf Studies and Deaf Education, 5(3), 266-276.
Dromi, E., & et al. (1996). Characteristics of pre-linguistic communication in deaf children. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=ED397616&lang=zh-tw&site=ehost-live
Elfenbein, J. L. (1992). Coping with communication breakdown: A program of strategy development for children who have hearing losses. American Journal Of Audiology, 1(3), 25-29. doi:10.1044/1059-0889.0103.25
Halle, J., Brady, N. C., & Drasgow, E. (2004). Enhancing socially adaptive communicative repairs of beginning communicators with disabilities. American Journal of Speech-Language Pathology, 13(1), 43-54.
Higginbotham, D. J. , & Baker, B. M.(1979). Social participation and cognitive play differences in hearing-impaired and normal hearing preschoolers. researchgate.net
Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71(2), 165-179.
Ivy, S. E., Hatton, D. D., & Hooper, J. D. (2014). Using the picture exchange communication system with students with visual impairment. Exceptional Children, 80(4), 474-488. doi:10.1177/0014402914527239
King, A. M., & Fahsl, A. J. (2012). Supporting social competence in children who use augmentative and alternative communication. TEACHING Exceptional Children, 45(1), 42-49.
Knoors, H., & Marschark, M. (2012). Language planning for the 21st century: revisiting bilingual language policy for deaf children. The Journal of Deaf Studies and Deaf Education, 17(3), 291-305. doi:10.1093/deafed/ens018
Lee, Y., Jeong, S.-W., & Kim, L.-S. (2013). AAC intervention using a VOCA for deaf children with multiple disabilities who received cochlear implantation. International Journal Of Pediatric Otorhinolaryngology, 77(12), 2008-2013. doi:10.1016/j.ijporl.2013.09.023
Malandraki, G. A., & Okalidou, A. (2007). The application of PECS in a deaf child with autism: A case study. Focus on Autism and Other Developmental Disabilities, 22(1), 23-32.
Reichow, B., Volkmar, F. R., & Cicchetti, D. V.(2008).Development of the evaluative method for evaluating and determining evidence-based practices in autism.Journal of Autism and Developmental Disorders, 38, 1311-1319.
Samuelsson, S., & Ronnberg, J. (1993). Implicit and explicit use of scripted constraints in lip-reading. European Journal of Cognitive Psychology, 5(2), 201-233.
Sigafoos, J., Drasgow, E., Halle, J. W., O'Reilly, M., Seely-York, S., Edrisinha, C., & Andrews, A. (2004). Teaching VOCA use as a communicative repair strategy. Journal of Autism & Developmental Disorders, 34(4), 411-422.
Thistle JJ & Wilkinson KM (2015).Building evidence-based practice in AAC display design for young children: Current practices and future directions.Augmentative and Alternative Communication 31:124-36.
Von Tetzchner S., & Martinsen H. (2000). Introduction to augmentative and alternative communication. 2nd edition. London:Whurr.
Wang, Hui-Ting. (2017). Utilizing primary tier intervention to enhance reciprocal turn-taking of children with Autism in Taiwan. Education and Training in Autism and Developmental Disabilities, 52(1),64-76.
Westby, C., & Wilson, D. (2017). Using pretend play to promote foundations for text comprehension: examples from a program for children who are deaf and hard of hearing. Topics in Language Disorders, 37(3), 282-301.
World Health Organization(2007).International classification of functioning, disability, and health: Children & youth version: ICF-CY.Geneva, Switzerland:Author.
Wong, C., Odom, S. L., Hume, K. A., Cox, C. W., Fettig, A., Kurcharczyk, S., et al. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-014-2351-z
Ye, J., Peng, A., Lu, A., Tian, H., Hong, X., Yi, H., . . . Lan, Y. (2016). Attachment, loneliness, and social anxiety: A comparison of deaf and hearing Chinese adolescents. Social Behavior and Personality: an international journal, 44(6), 1033-1042.