- To understand the world around them.
- To acquire communication skills in order to communicate with others.
- To gain the necessary competence to make choices about their own lives.
The driving force of the programme is the improving of communication skills using education as a means to achieving these goals.
TEACCH Research Evidence.
In 2003 a report for the National Foundation for Educational Research (NFER) found that there was a surprisingly limited amount of evidence for the effectiveness of TEACCH considering its ‘widespread influence on practice’, (Fletcher-Campbell 2003). The NFER report pointed out that although there is some evidence (Mesibov, 1997) of parental satisfaction with TEACCH, most of the follow-up studies were in fact unconvincing, without control groups and took no account of policies that affected the way in which the pupils were accepted into mainstream life. They also maintained that the majority of reports tended to be internal documents, of Division TEACCH, that did not use comparisons with other interventions.
Only a small number of treatment outcome studies to date have investigated the effectiveness of TEACCH. Schopler, Mesibov, and Baker (1982), for example gathered data from 348 families whose pupils were currently or had previously been registered with the programme. Those who were involved ranged in age from 2 to 26, and cognitively from ‘severe mental retardation to normal intellectual functioning’, (Schopler et al 1982). The widely held view of respondents to the study was that the programme was supportive and helpful and certainly worth undertaking. Furthermore the study went on to emphasise that the number of participants that were subsequently institutionalised was reduced to 7%, compared with the rates of 39% to 75% that had been reported previously, (De Mayer, Portius, Norton, Barton, Allen & Steele, 1972). However in his study of 1996, Smith points out that this study is marked by some weaknesses: not all participants had a diagnosis of autism, the absence of control conditions, and the lack of standardised and independent assessment measures. In addition the comparison of Schopler et al to the rates of institutionalisation in their study with the 1960s data of De Mayer et al, is probably misleading as again in his study Smith (1996), notes that changes to policy during the 60’s and 70’s reduced rates of institutionalisation in general and should therefore not be used as evidence of success in isolation.
A more up to date study sample by Ozonoff and Cathcart (1998) tested the effectiveness of TEACCH specifically in home-based instruction for pupils with autism. Parents were asked to focus on areas of cognitive, academic, and prevocational skills related to school success. This group was composed of 11 preschool pupils with autism who received four months of home based studies. The group were appraised before and following the four month programme using the Psycho Educational Profile (PEP), (Schopler, Reichler, Bashford, Lansing & Marcus, 1990), which provides detailed assessment of the pupils and helps to classify how pupils respond to learning. The results were compared with those from a group of pupils not on the TEACCH programme. These results showed that the pupils receiving TEACCH tutoring developed appreciably in the areas of replication, fine-motor, gross-motor, reaction to change and nonverbal abstract skills; an improvement of 3-4 times greater than the control group. Moreover, the treatment group showed an increased developmental gain after the 4-month intervention. Although this study provides some support for the TEACCH programme, the results are affected by some limitations, including the lack of randomised control conditions, the small sample size, the lack of group description and that the original study was not designed to test the effectiveness of TEACCH but rather to assess the TEACCH-based home programme as a supplement to the child’s normal day, (Emergency Care Research Institute, 2001).
Prior to the above, Short (1984) used a small sample of twenty pupils acting as their own control group. All the pupils had outcome measures taken at the end of a pre-treatment control phase and then again after the control phase had finished. The outcome of this trial was measured for four main variables: parental guidance, appropriate child behaviour, inappropriate child behaviour and stress. The results of these outcomes were reported to be that the effectiveness of TEACCH was significant in its improvement in these areas. These results were similarly recorded by Sines (1996) in his study in Northern Ireland. However, in their critique of 2001, the Emergency Care Research Institute (ECRI) point out that in this sample there was a high drop out rate of 25% which could question the validity of the results, poor sample description and the use of ‘medicated’ pupils in the sample. The ECRI also criticised the work of Paneria, Ferrante and Caputo (1997), who failed to describe their methodology in a study of 18 pupils’ with autism who were on the TEACCH programme. Paneria et al also failed to exclude medicated pupils, did not provide information on the diagnostic criteria used and used non-validated measures in their research.
Three additional studies have been conducted to document outcome data of pupils who received TEACCH services (Lord, 1991; Venter, Lord & Schopler, 1994 and Lord & Schopler, 1989) and these studies indicate substantial increases in IQ scores. Pupils accessing TEACCH services beginning at the age of three, who were non-verbal and had IQ scores ranging from 30 - 50, demonstrated a 22 to 24 point increase in IQ scores by the age of seven (Lord & Schopler, 1989). In each of these studies, gains were most significant in very young pupils who were non-verbal prior to intervention (Lord & Schopler, 1994).
According to Schopler (1989), over 250 research studies have been conducted by or in collaboration with Division TEACCH since 1965. These relate to the nature of autism, structured teaching, working with families, assessment, language and communication, independence, vocational skills, social and leisure skills, and behaviour management. However, this extensive research includes few peer-reviewed studies of outcome replications conducted by researchers not affiliated with TEACCH.
Finally, a study carried out by Jocelyn, Casiro, Beattie, (1998), which researched the treatment of pupils with autism in a controlled trial to evaluate the caregiver-based intervention programme, found no direct evidence against TEACCH but found that the effectiveness of TEACCH was not proven.
The critics of TEACCH research do not go unanswered though and in addressing the difficulty in substantiating the effectiveness of TEACCH Gary Mesibov points out that:
"Demonstrating the effectiveness of a large and complex programme such as Division TEACCH is difficult. The problem is compounded by the organic basis of autism, and the focus of Division TEACCH on lifelong adaptation, which do not lend themselves to superficial cures or clearly defined milestones" (Mesibov, 1998, ).
Additionally, research conducted by TEACCH and anecdotal reports suggest that TEACCH shows promise (Lord, 1991; Lord & Schopler, 1989; Lord & Schopler, 1994), but this has not been objectively substantiated as effective by independent researchers. This is confirmed by other researchers, (Haramaki, Hull, Jones & Jordan, 2001), who maintain that there is still a need for larger, independently evaluated and controlled studies, to be completed that directly compare pupil’s performance in the TEACCH programme to that of other programmes.
In the opinion of this author the work of Ludwig & Harstall (2001) and the comments of Jordan & Powell (1997) exemplify the current situation with regard to the TEACCH programme. These authors noted that while there have been studies that demonstrate the effectiveness of TEACCH it is in individual components and not its entirety where the favourable evidence lies. Therefore if we take the evidence provided above at face value it would be quite appropriate to ask; ‘Why is TEACCH so popular with so many practitioners and parents?’
Accepting that the availability of short training courses is widespread, the most understandable explanation for its success may be that TEACCH concentrates on making available an environment and structure that is in accord with the particular needs and difficulties of pupils with autism. Additionally, structured classroom organisation can be set up in any teaching setting and class management can be maintained in surroundings that are favourable to all pupils with autism.
Taking these issues into consideration it was the communicating of information by visual rather than verbal teaching, concentration on structure to reduce distractions and sustain routine; with classes that are signposted, task defined and with the use of work stations and systems that were the characteristics of TEACCH that appealed to our staff when considering a suitable intervention for one pupil in our care. The staff were convinced that the pupil in question would benefit greatly from being helped in his work, being shown what to do, reducing language input and by concentrating on visual teaching.
Case Study
It is not possible to identify an intervention that meets all the needs of a pupil with autism, (Jordan & Jones, 2001). However there have are a number of interventions specifically intended to help pupils with ASD. The decisions that were made concerning the pupil in this case study were reinforced by the knowledge and understanding of how a particular intervention would link to the three areas of communication, social understanding and flexibility of thought and behaviour. Everything that we had read, seen and been told concerning the TEACCH intervention led us to believe that this was the most appropriate choice for our pupil.
Staff Discussion
Prior to our decision to introduce the TEACCH programme we held a series of staff meetings in order to assess the potential use of TEACCH with the pupil. We examined the strengths of the programme and whether these would be appropriate for our pupil and this provided us with a starting point. We also looked at the use of structure and the benefits that could be gained from visual cues, the use of independent learning and the concentration on the pupil’s strengths and weaknesses offered by the TEACCH approach.
As a team we next considered some of the critical questions that arise from the use of the TEACCH programme. Specifically we examined the possible reduction in interaction and communication associated with TEACCH, the nature of the independent work that would be given to the pupil, the possible transfer of the programme into the home setting and the elements of TEACCH that the pupil would benefit from, (Jones, 2002).
Background
T is an eleven year old boy who has a diagnosis of ‘Moderate Autistic Spectrum Disorder’. T followed a normal development pattern until he was about 2 years old but after this period he gradually lost the early language skills that he had acquired. T was referred for speech and language therapy and received several sessions of therapy.
T was originally placed at a ‘First School’ (age range 5-7) where he progressed through the Special Education Needs assessment procedure. Finally, he was placed at a Primary school (age range 7-11) with access to a specialist base for pupils with Autistic Spectrum Disorder (ASD).
It was at this base that I observed T, as preparation for his secondary transfer, in a playground situation where he coped well with a semi-structured ‘aerobics’ lesson. He copied the movements as necessary and appeared to enjoy himself. In the classroom I noticed that T communicated very little verbally, and co-operated within his highly structured routine – T was not partaking in the TEACCH programme at this stage. Throughout the day I was unable to persuade T to collaborate with any activities beyond sitting beside me for the timetabled periods and during these sessions I observed that his definition of ‘work’ was to copy out passages from reading books.
In interview with his parent it was reported that in the home T occupies himself for hours with repetitive activities, for example ‘cutting, sticking and stencilling’. He watches television and uses the home computer but is rarely spontaneously communicative, this was stressful for his mother and siblings and they were struggling to cope with T’s difficulties. T’s mother had observed some imaginary play and she stated that his listening and attention skills were improving.
T is 12 years of age and reads and spells at a level far beyond his chronological age but his comprehension is some 5 years below these levels
T is now placed within a specialist provision for autism in a mainstream school. He follows a structured timetable, in a small group or individual classroom setting and receives additional speech and language support and one-to-one support from a Learning Support Assistant (LSA).
The approach with T, within the specialist provision, incorporates the use of a TEACCH classroom structure, to reduce over stimulation (see above), with an individual work station and work schedules, (Mesibov, 1997). Initially within this setting T showed extreme rigidity and responded badly to any change that occurred. His adverse reactions could be delayed owing to poor sequential functioning, (Mesibov 2004), and could occur some days later. Thus it was at times difficult to identify the triggers for this behaviour. When T was upset he became aggressive and could lash out at staff and other pupils. Since the introduction of the TEACCH programme staff have observed improvements in many areas (see below) which now enable T to integrate within mainstream classes while still accessing the provision when necessary.
Physical structure in the classroom
The TEACCH philosophy refers to physical structure as ‘the way of arranging furniture, materials and general surroundings of the classroom’, (Mesibov & Howey, 2003).
In order to reduce the auditory and visual distractions of the classroom adaptation was seen as an essential component in our programme as over stimulation has been found to distract some pupils with ASD, (Siegel, 2003). The fundamentals of this approach are that by making the environment more predictable the pupil will be less confused and problems will be reduced (Mesibov, 1997; Seach, 1998).
T has a number of strong points in many areas of the curriculum. However, he struggled at first with the number of class changes moving to secondary school entailed. This manifested itself primarily in T not being aware of where to sit in each classroom thus causing stress and confusion. After discussion it was agreed that T should be able to sit in the same place or position in each of his classes whether this was in the main school or during his lessons in the provision; normally in front of the teacher’s desk. As a consequence we have now provided T with seating plans which illustrate (pictorially) where he should sit in each of his classes, resulting in structure that has helped his unease. This approach supports the evidence offered by Short in his 1984 study. Surprisingly though this unease does not arise during lunchtime in the school canteen and T insists on eating his lunch in the melee of sounds and smells that arise. This could explain some of the difficulties in finding concrete evidence for the effectiveness of TEACCH (see Mesibov above) as pupils tend not respond in the same way to every situation.
Further, attention was given to the planning of the rooms within the provision. While it is pleasant to display details of work and posters in the walls of the department it was decided that these should be kept to a minimum and if possible under eye level to reduce distractions and over stimulation.
We have also worked with T to overcome the potential barriers to learning that come about simply because of the physical structure of the working environment. As the National Curriculum specifically provides for an adapted environment and requires teachers to remove barriers to learning (DfEE/QCA 1999: 34) we felt no reluctance in doing so.
Visual Schedules
The use of visual schedules have long been in use throughout education. These usually take the form of written timetables which focus the pupil’s attention on their daily classes. The most common types of schedules in the TEACCH approach are objects, written words with icons, pictures, photographs or written schedules, (Mesibov & Howey, 2003).
When providing a schedule for T we considered and modified his standard timetable so that it was better suited for his use. One consideration was the level of the schedule and it was decided that as T had little difficulty in understanding the written word that this was the best form of structure for him although we were equally conscious of the need to focus the schedule at the most meaningful level that addressed T’s needs on his most difficult days. Therefore even though he reads very well we have provided a written schedule with icons, (Mesibov 2004). Another consideration was the length of the schedule. As we knew that T could follow a sequence of activities using the visual clues given in the schedule we completed a schedule that contained more than one item, up to half a day, that lead T through the day thus; ‘first….then…..then’. T has now been issued with a pupil’s journal that has been customised for his needs. The journal allows the schedule to be simplified with room numbers, teachers’ names and a plan of the building. Changes to the schedule are documented within the provision on a whiteboard that allows all pupils in the department to update their journals at the start of the day, break and lunch. All pupils find these reminders reassuring and we believe that they enhance autonomy. The use of cover or supply teachers can also be tracked using this system and we have found that this reduces the element of change and thus stress for the pupils and is in support of the findings of Ozanoff and Cathcart (1998).
Overall the use of the journal results in a better understanding of the sequence of the school day for T and we have found, again in support of Ozanoff and Cathcart, that this allows him access to a wider range of lessons, skills and activities in the mainstream school.
Work Systems
As visual processing is strong point of so many pupils with autism, (Attwood, 1998) the classrooms within our provision make good use of many visual cues. T has an individual work system organised and signposted to maximise his independent functioning and capitalise on his affinity for routines.
T studies in both the mainstream school, supported by a LSA, and attends 1:1 lessons within the specialist provision. The rationale behind these lessons is to reinforce the work from the mainstream, to secure skills and to extend concentration and attention span. Before these structured TEACCH lessons, T was not spontaneously verbal, co-operated only within his highly structured routine and his fine motor (handwriting) skills were impaired. The use of dedicated LSA guidance, work schedules and the structure of the classroom in addition to these structured lessons have resulted in a more appropriate learning environment in which he contributes and integrates into school life. These improvements support the evidence provided by Ozanoff and Cathcart (1998).
T keeps his work in plastic wallets and writes the teachers’ instructions into his journal. The combination of schedule and system of work is being used in the provision, in support of Schopler (1991), in order to encourage T to become as independent as possible within school and in other situations. T now has the added incentive of being provided with decision making and choice opportunities and we are endeavouring to adapt these systems for T to make them more flexible to circumstances external to school and to enable them to be adapted to adult life.
In order to incorporate the TEACCH principles into an overall philosophy of best practice, it was also important to include parental involvement at all stages of planning and implementation. Parental feedback is encouraging and ongoing and it is reported that many of the stresses, previously reported by T‘s parent and siblings, have reduced and the programme is ‘without doubt worth doing’; a parental comment that supports the work of Schopler et al (1982).
Interventions, we believe, should be driven by an ongoing assessment of effectiveness. While at the same time, the programme ought to be individualised and based on appropriate activity-based interventions that address pupils’ needs. Moreover transitions are particularly difficult and should be addressed for each pupil throughout the day. Structure can also help to provide a practical response to the question of what is the best educational environment for each pupil with autism. One possible answer, and one that was successful for us, seems to consist of establishing multi-methodology classrooms which utilise communicative, academic, social and environmental supports, thus finding ways of translating our world into comprehensible segments for pupil’s with autism.
Finally, although the TEACCH approach has resulted in benefits for our pupil we also understand that the approach is broad-based and takes into account all aspects of the lives of people with autism and their families. Although independent skills are emphasised, it is also recognised that life is not all work and that communication, social and leisure skills can be learned by people with autism and can have an important impact on their well being. An important part of any TEACCH curriculum therefore is developing communication skills, pursuing social and leisure interests, and encouraging people with autism to pursue more of these opportunities. It is this cultivating of strengths and interests, rather than dwelling solely on areas of deficit that is another important priority we are working towards in our provision. It is our goal to offer a curriculum within our department that provides breadth and balance while also reacting to the particular and appropriate learning needs of the pupils in our care and it is our belief that the TEACCH programme, with structured teaching used to enhance the development of pupils with ASD, will help us to achieve this goal.
References
Attwood, T. (1998) Aspergers Syndrome: a guide for parents and professionals, London, Kingsley.
De Mayer, M., Portius, W., Norton, J., Barton, S., Allen, J. and Steele, R. (1972) Parental Priorities and Innate Activity in Normal, Autistic and Brain Damaged Infants, Journal of Autism and Schizophrenia, 2, pp49-66.
DFEE/QCA (1999) The National Curriculum Handbook for Secondary Teachers in England, London, DfEE/QCA.
Emergency Care Research Institute (2001) Comprehensive Programs for the Treatment of Children with Autism. Plymouth Meeting, ECRI Report 2000.
Fletcher-Campbell, F. (2003) Review of the Research Literature on Educational Interventions for Pupils with ASD. National Foundation for Educational Research, London.
Gresham, F.M., Beebe-Frankenberger, S. and MacMillan, D.L. (1997) Autistic Recovery? An Alalysis and Critique of the Empirical Evidence on the Early Intervention Project. Behavioural Disorders, 1997, 22(4), pp 185-201.
Haramaki, T., Hull, A., Jones, G. and Jordan, R. (2001) Curriculum and Approaches for children with autism: Treatment of autistic related communications handicapped children (TEACCH), Unit 5 Module 1105505/1111470 School of Education University of Birmingham, distance Learning Materials.
Howlin, P. and Rutter, M. (1987) Treatment of Autistic Children, Chichester, Wiley.
Jocelyn, L.J., Casiro, O.G. and Beattie, D. (1998) Treatment of Children with autism: a randomised controlled trial to evaluate a care-giver based intervention program in community day-care centres. Journal of Developmental Behaviour Pediatric, 19(5), pp326-334.
Jones, G. (2002) Educational Provision for Children with Autism and Asperger Syndrome: Meeting their needs, London, Fulton.
Jordan, R. and Connick, M. (2000) Social Education Needs of Children with Autism, Unit 5 Challenging Behaviour, Module 1111457505542, University of Birmingham School of Education, Distance Learning Materials.
Jordan, R. and Jones, G. (2001) Curriculum and Approaches for children with autism: Educational interventions in ASD, Unit 2 Module 1105505/11114470, School of Education, University of Birmingham, Distance Learning Materials.
Jordan, R., Jones, G. and Murray, D. (1998) Educational Interventions for Children with Autism: a literature review of recent and current research. DfEE Research Report 77, London, DfEE.
Jordan, R. and Powell, S. (1997) Autism and Learning: A Guide to Good Practice, London, Fulton.
LaGreca, A. M. and Mesibov, G. B. (1981) Facilitating Interpersonal Functioning with Peers in Learning Disabled Children. Journal of Learning Disabilities, 14, pp197-199.
Lord, C. (1991) A cognitive behavioural model for the treatment of social-communicative deficits in adolescents with autism. In: McMahon, R. and Peters, R. (eds), Behaviour Disorders of Adolescence, pp 155-174, New York, Plenum.
Lord, C. and Scholpler, E. (1989) The role of age at assessment, developmental level and test in the stability of intelligence scores of young autistic children, Journal of Autism and Developmental Disorders, 19(4), pp483-499.
Lord, C. and Scholpler, E. (1994), TEACCH services for pre-school children. In: pre-school education programs for children with autism pp87-106, Austin, TX, PRO-ED.
Ludwig, S. and Harstall, C. (2001) Intensive Intervention Programs for Children with Autism, Alberta Heritage Foundation for Medical Research, Alberta, Canada.
Mesibov, G. B. (1988) Diagnosis and assessment of autistic adolescents and adults, New York, Plenum.
Mesibov, G. (1997) Formal and informal measures of the effectiveness of the TEACCH program. Autism: The International Journal of Research and Practice, 1, pp 25-35.
Mesibov, G. (1998) ‘Why TEACCH? (WWW) , 13th January 2004, WWW.
Mesibov, G. (2004) Seminar and Workshop on the TEACCH Provision. The Royal Pharmaceutical Society, London, 25th – 27th February 2004.
Mesibov, G. and Howey, M. (2003) Accessing the Curriculum for Pupils with Autistic Spectrum Disorders: Using the TEACCH programme to help inclusion, London, Fulton.
Moore, K. (1998) Diagnostic Scoping Report for University of Ulster, University of Ulster.
National Autistic Society (2003) (WWW). (1st December 2003).
Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28, 25–32.
Paneria, S., Ferrante, L. and Caputo, V. (1997) The TEACCH strategy in mentally retarded children with autism: a multidimensional assessment, pilot study, Journal of Autism and Developmental Disorders 27(3) pp345-347.
Schopler, E. (1989) TEACCH. In Reynolds, C. and Mann, L. (eds) Encyclopaedia of Special Education, pp1536-1537, New York, Wiley.
Schopler, E. and Mesibov, G. (1995) Structured Teaching in the TEACCH Approach: Learning and Cognition in Autism, New York, Plenum.
Schopler, E., Mesibov, G. & Baker, A. (1982) Evolution of Treatment for Autistic Children and their Parents, Journal of American Academy of Child Psychiatry, 21, pp262-267.
Schopler, E., Reichler, R. J., Lansing, M. and Waters, L. (1980) Individualized Assessment and Treatment of Autistic and Developmentally Disabled Children. Volumes I, II, III & IV, New York, Plenum.
Schopler, E., Reichler, R. J., Bashford, A., Lansing, M. D., Marcus, L. M. (1990). Individualized assessment and treatment for autistic and developmentally disabled children (Vol. 1): Psychoeducational profile revised. Austin, TX: PRO-ED.
Seach, D. (1998) Autistic Spectrum Disorder: Positive Approaches for Teaching Children with ASD. NASEN.
Seach, D., Lloyd, M. & Preston, M. (2002) Supporting Children with Autism in Mainstream School, Birmingham, Question Publishing
Short, A. (1984) Short Term Treatment Outcomes Using Parents as Co-Therapists for their own Children. Journal of Child Psychology and Psychiatry, 25(3), pp443-458.
Siegel, B. (2003) Helping Children with Autism Learn, New York, Oxford University Press.
Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 45–59). Austin, TX: PRO-ED.
