Are Pictures Worth a Thousand Words? Testing the Validity and Reliability of the Pictorial Infant Communication Scale

Background: The Pictorial Infant Communication Scale (PICS; Delgado, Mundy, Venezia & Block, 2003) is a brief (16-item) parent-report questionnaire designed to assess the nonverbal communication of infants and toddlers. To improve parental understanding of the specific behaviours being measured (e.g., joint attention), pictures are presented next to each item on the questionnaire depicting the behaviour.

Objectives: To assess the cross-time reliability and concurrent validity of two versions of the PICS, one with pictures (PICS) and one without pictures (NPICS), among typically developing children.

Methods: The participants included 70 typically developing infants and one of their parents at the time of enrollment into the study. The infants were randomly divided into two groups. The PICS with pictures was administered to one group (PICS group) and the PICS without pictures to the other group (NPICS group). The parents were asked to fill out the PICS when their child was about 12 and 18 months old.  To obtain a direct clinical measure of the child’s nonverbal social communication skills, the Early Social Communication Scale was completed when the child was about 12 and 18 months old. To obtain a parent-report measure of the child’s language development, parents were asked to complete the short-form versions of the MacArthur Communication Development Inventory (MCDI) when the child was about 12, 18, and 24 months old.  To obtain a direct clinical measure of the child’s language development, the Mullen Scales of Early Learning- Expressive and Receptive Language Scales (MSEL-ERL) were completed at about 18 and 24 months old. Cross-sectional and longitudinal correlations among scores on the PICS, MCDI, ESCS and MSEL-ERL were assessed for both groups.
Results: Cross-time reliability from 12 to 18 months (r(30) = .45, p =.012) was found for the PICS, but only marginally for the NPICS (r(30) = .35, p =.056).
At 12 months old the PICS Total, Initiating Joint Attention (IJA)and Initiating Behaviour Requests (IBR) scores were significantly positively correlated with ESCS IJA and IBR scores, but only the NPICS IJA scores were significantly positively correlated with ESCS IJA scores. Both the PICS and NPICS at 12 months were marginally positively correlated with MCDI scores.
At 18 months old both the PICS and the NPICS scores were marginally positively correlated with ESCS scores. The PICS RJA score was marginally positively correlated with MCDI scores and Mullen Receptive scores but not the NPICS.
With regard to longitudinal correlations, the PICS scores at 12 months were marginally positively correlated with MCDI and Mullen Receptive scores at 18 and 24 months old. The NPICS scores at 12 months were marginally positively correlation with MCDI scores only at 24 months old and Mullen Expressive scores at 18 and 24 months old.   
Conclusions: Overall, both versions of the PICS show promising properties as a parent report measure to assess nonverbal communication among infants as young as 12 months old. The inclusion of pictures seems to improve parents reporting, especially at 12 months old. The examination of the PICS among infants at risk for autism would be beneficial.