A Look at TEACCH - An Intervention System for Autism

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" Healing Autism: No Finer a Cause on the Planet "

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A Look at TEACCH - An Intervention System for Autism

Thursday, September 30, 1999

[Another in an ongoing series of FEAT's Parent Education Project.

Excerpted from TARGETING AUTISM: What We Know, Don't Know, and Can Do to

Help Young Children with Autism and Related Disorders, by Shirley Cohen,

University of California Press, 1998. Shirley Cohen is Professor of Special

Education at Hunter College of the City University of New York. Our thanks

to Steve Apollo on the FEATList. ]

http://www.unc.edu/depts/teacch/

[From page 104:]

TEACCH, which stands for Treatment and Education of Autistic and

Related Communication-Handicapped Children, is a statewide comprehensive

intervention system that provides a variety of services to autistic

individuals and their families across all age periods. Since 1972 the system

has operated out of the department of psychiatry of the University of North

Carolina, Chapel Hill, with state funding. It has an extensive training

program for professionals and is also in use in other areas of the country

as well as other parts of the world. Furthermore, Schopler, the

long-term (recently retired) director of the TEACCH system, has been a very

influential figure in the autism field for many years.

The primary educational goal of TEACCH is to increase the student's

level of skill. Recovery is not a term used in this system. While the Lovaas

program is based on the premise that the child must overcome his autistic

characteristics so as to adapt to the world around him, in TEACCH the child

is provided with an environment designed to accommodate the characteristics

of autistic children.

A TEACCH classroom makes use of many visual organizers or cues because

visual processing is a strength of so many autistic children. Areas for

special activities have clear boundaries. There are picture or picture-word

schedules for individual children and for the class. Individual work systems

are organized to maximize independent functioning and capitalize on the

child's affinity for routines. Spontaneous functional communication is the

language goal of TEACCH, and alternative modes of communication such as

pictures, manual signs, and written words are used when speech is

particularly difficult for the child. Such strategies neutralize or

deemphasize deficits common in children with autism and minimize behavioral

problems. While the TEACCH model uses individual instruction for some new

skills, group instruction is a major format.

So, parents may ask, what's the bottom line? How effective is a TEACCH

approach? This is not an easy question to answer. Unlike the Lovaas Young

Autism Project, which served a small and select group of autistic children,

TEACCH is open to all autistic children in the state of North Carolina and

also serves students with communication problems who are not autistic. In

addition, the TEACCH model is implemented in different settings such as

mainstream classrooms and special classes. Over the years TEACCH has used a

variety of measures to evaluate its effectiveness, including parent reports

and rate of institutionalization. This latter measure was appropriate in the

1970s when the TEACCH model began; today, in the face of over fifteen years

of deinstitutionalization, it is no longer a relevant outcome variable.

Another outcome measure is parent satisfaction. A survey conducted by TEACCH

in the late 1970's found that most parents were very satisfied with the

services provided to their children and families. But the outcome measures

that parents want to know about today are indices of children's performance.

Given the long number of years that TEACCH has been in operation, the

influence that this model has had in the area of treatment, and the major

role that Schopler played as a critic of the outcome data presented by

Lovaas, it is surprising that TEACCH has not pursued comprehensive studies

of child performance outcomes.

The data that are available on children served by TEACCH come largely

from studies focused on stability of IQ (e.g., Lord and Schopler 1989a,

1989b) rather than on the effects of treatment per se. Based on these

studies, Lord and Schopler report that substantial increases in IQ are

common among children first evaluated at ages three or four, with the

largest change found among children who were nonverbal and had IQ scores in

the 30-50 range. These three-year-olds gained a mean of 22-24 points by age

seven, while the four-year-olds gained an average of 15-19 points by age

nine. However, most of these children still had IQ's in the range considered

to indicate mental retardation (Lord and Schopler 1994, 102), and the

increases found in IQ between earlier and later test results may reflect

differences the tests themselves as well as changes in the children (1989a).

Moreover, while a substantial number of children had increases of 20 points

or more in IQ, decreases of this magnitude were found with equal or greater

frequency among children first assessed after age 3.

When asked, at the 1995 conference of the Autism Society of America,

how many autistic children treated in TEACCH recovered, Schopler, its

long-term director, replied: " We have had some children who have become

dissociated with the label of autism and others who have gone on to

college. " This was not quite the kind of answer parents were looking for.

One major difference in overall strategy separating Lovaas-type

programs and TEACCH is the different values assigned by these approaches to

accommodating the child's autistic characteristics or waging an all-out war

against them. This is not a one-time decision. Decision points on this issue

continue to present themselves throughout the child's educational treatment.

[And from page 117:]

A funny thing seems to be happening out there in the world of

educational/therapeutic treatment of autistic children. Common elements are

appearing in approaches that were considered very different, even

antagonistic, as programs learn and borrow from each other. People seem more

willing to acknowledge that maybe they haven't had all the right answers.

The director of a school that describes its goal as recovery and its

approach as applied behavioral analysis told me: Maybe it's time to think of

a TEACCH model for some children who show few signs of movement toward

recovery after a year or two. The more gentle and loving hand long espoused

by programs based on a developmental approach seems to be creeping into

programs derived from the Lovaas framework; and the principal theorist of

developmental intervention, Stanley Greenspan, is talking about combining

behavioral and developmental approaches to better fit the needs of some

children.

What Lovaas does better than anyone else is document outcomes, both

short-term and long-term. (He should soon have data from his replication

sites.) Very few other programs carefully collect outcome data. While there

are many justifications for this lack - it's time consuming and expensive to

measure outcomes and follow-up on children, for example - this is

information that parents feel they need in making decisions that may

significantly affect their children's futures. It's one of the major reasons

why parents are flocking to programs using Lovaas-based approaches. Parents

who have options are no longer willing to take the word of a high-status

professional that his or her approach works. Nor are they satisfied with

research that only provides narrowly based short-term data. They are saying,

" Show me. My child's whole future is at state, and it's too precious to

entrust to some professional's say-so. What data do you have to support your

claim of effectiveness? "

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editor: Lenny Schafer east coast editor: , Ph.D.

schafer@... CIJOHN@...

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