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(Treatment and Education of Autistic and Related Communication Handicapped Children)

Founded in 1972 at the University of North Carolina1, the Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) is an intervention that focuses on building a structured learning program around an individual’s skills, interests, and needs through well-defined educational goals. Developed by Eric Schopler and Robert J. Reichler, the TEACCH program can be effectively utilized by parents for home-based teaching, for adults in residential care settings, and, most commonly, for children in a classroom setting. 2 The elements of the TEACCH program can be effectively combined with a number of other treatment interventions.3 Three key aspects of the TEACCH program are early intervention and assessment, parental collaboration, and structured teaching.4 This section will discuss the TEACCH program in detail, how the intervention improves the lives of those on the autism spectrum, the research regarding the program, and what one can expect from a TEACCH treatment provider.

What is TEACCH?
The TEACCH method of learning is based on understanding the “culture of autism”. The culture of autism refers “to the relative strengths and difficulties shared by people with autism that are relevant to how they learn.”5 These general strengths include the proclivity for processing visual information (pictures over words) and frequent attention to details. When considering the weaknesses related to the culture of autism, TEACCH is referring to difficulties with combining ideas, difficulties with attention, communication problems, and difficulties organizing ideas, materials, and activities.6 The TEACCH intervention focuses on strengthening these weaknesses in order to realize the primary goal of reaching the individual’s maximum ability by the time he/she reaches the adult age and for he/she to be an independent member of the community.3 The TEACCH method does not follow the standard method of curricula, but instead focuses on developing the specific language, social, and adaptive skills.7

The TEACCH intervention implements an approach known as “structured teaching”, which “increases the learning of new skills but also serves to increase independence and self-esteem, reducing behavior problems that result from confusion, anxiety, and over-stimulation.”8 Structured teaching, the principle technique of the TEACCH program, requires the classroom or learning environment to be structured physically in scheduling and in teaching methods to ensure continuity for the child.9 According to the Texas Guide for Effective Teaching TEACCH, the four main components of the structured teaching process are:

  • Physical organization: Physical structure refers to the arrangement of the classroom or teaching environment. Arranging furniture in a way that dictates where the student should sit, play, or work is one example of a physically structured learning environment. The physical structure of the learning environment should also reduce “environmental sources of distraction or overstimulation by seating a student facing away from a door or window.”11 Each student is provided their own private work station where they can individually complete their activities or work in small groups.

  • Scheduling: Scheduling helps individuals on the autism spectrum who have difficulties with sequential memory and organization of time.20 The students should simultaneously follow their own individual schedule and the general overall classroom schedule. Utilizing these schedules can lessen anxiety, help with transitioning from activity to activity, and can motivate students to conquer more challenging tasks if they realize a more pleasurable activity is on the schedule’s horizon.20

  • Work Systems: Work systems help teach independent behavior, organization, and task completion.7 Lesson leaders should observe what motivates their students to complete activities. For example, a student may enjoy playing with a specific toy. The teacher should arrange the work times so that the toy will be available after the student works, which will hopefully motivate the student to complete their tasks.

  • Task organization: Tasks should be organized and presented to students in ways that they can understand. The “[d]irections for tasks and the use of prompts and reinforcers should be organized and systematic in order to build success experiences for students.”20 Tasks can be better understood if visual cues are used to help aid direction, which limits verbal confusion.

How does TEACCH make a Difference for People on the Autism Spectrum?
The educational approach of TEACCH is designed to teach individuals of all ages on the autism spectrum how to function independently and responsibly in a community setting. The TEACCH method aims to develop the appropriate behaviors necessary to accomplish this goal. The TEACCH program is founded on the principle that every child can develop and learn. After an initial assessment of skills, the student is provided their own individualized lesson plan that includes a personal work station and schedule.9 As the student progresses in the lesson plan special “attention is paid to communication, self care, vocational, and recreational skills.”7 This adaptive approach includes the use of prompts, visual cues, and social reinforcement to guide students towards the appropriate behaviors. The general educational goals of the TEACCH program are designed to help the student to find meaning and order in their world, understand the concept of cause and effect, and enhance their communication skills in order to achieve the program’s overall goal of developing the meaningful skills that are needed to assist the individual in their independent adult life.6

Outside of the classroom, the TEACCH regional centers offer free evaluations to children, adolescents, and adults on the autism spectrum for individuals who live in North Carolina. 12 TEACCH also offers a Supported Employment program. Located at the Chapel Hill and Greensboro TEACCH Centers, the Supported Employment program “helps individuals with ASD to become as independent as possible by assisting them in obtaining and maintaining meaningful and stable employment in predictable and rewarding work environments.”13 The principles of TEACCH are to extend beyond the classroom into the home as the program encourages parents and clinicians to work together to “create effective programs for their child at home, at school and in the community.”14
To this end, the greatest feature of the National Autism Network is the HIPAA-secure private network which allows our parent users to create a private network for their child and invite the various providers and caregivers to be a part of that network. From here they can easily share important progress reports, treatment session updates, schedules, videos, files, and more.

What Can You Expect from TEACCH Treatment Providers?
Professionals within the classroom setting conduct an assessment of the student, create an individualized work station based on that assessment, schedule tasks, and develop visual cues that can enhance the student’s ability to understand direction. TEACCH research members have developed two assessment instruments that “provide a starting point for individualized plans for teaching and supporting emerging skills.”11 The Psychoeducational Profile (PEP-3) is designed for individuals on the autism spectrum aged 6 months to 7 years and “graphically charts uneven and idiosyncratic development, emerging skills, and autistic behavioral characteristics.”15 The TEACCH Transition Assessment Profile (T-TAP) is designed for adolescents and adults and can “help providers identify the individual’s principle transition goals, strengths, and weaknesses.”16

Work Systems are a major proponent of the TEACCH program and rely heavily on the educator understanding the individual partaking in the intervention. After the initial assessment, educators should let the student’s needs dictate what activities in which he/she partakes. The work system should reflect this notion, and “may consist of written lists of activities, word cards, picture cards, number or color cards, or left to right basket systems, depending on the level of conceptual understanding of each individual.”17 After a work system is constructed, staff members should instruct the student on how to use the work system, and facilitate the student to eventually complete the activity independently without the use of prompts.18 Educators should apply a data collection system to assess the student’s progress and performance to determine if the student requires additional teaching or if they need to modify their work system strategy.18-19

The lesson plan for each student should be systematic and routine “in order to build success experiences for students.”20 The Teaching Materials Section of the TEACCH program provides books describing structured teaching activities, tasks created by parents and professionals for individuals on the autism spectrum preschool to adult, and home teaching kits for parents interested in implementing the TEACCH structured teaching principles at home.21 The student will get the most out the TEACCH intervention if “parents and professionals work together as co-therapists to extend lessons and techniques seamlessly across all environments.”2

Who is qualified as a TEACCH treatment provider?
The outcomes of the TEACCH program, like most autism treatment interventions, depend on the educator’s ability to implement the intervention effectively. There is no certification process necessary to implement the TEACCH program as an educator. The TEACCH program does offer training workshops at their Regional Centers. All seven of the TEACCH program’s regional centers are located in North Carolina. Their services include training for individuals working with all types of people on the autism spectrum. Professionals, educators, and parents can find an abundance of training programs focused on teaching the elements of the TEACCH program throughout North Carolina. Training sessions focus on adolescents and adults, early intervention, behavior management, structured TEACCHing, and more. The TEACCH program offers parent support and education that aims to teach them “about their child’s unique learning style and effective strategies that will enhance learning at home.”22 The TEACCH site provides specific Teaching Materials for families and teachers interested in implementing the principles of the TEACCH method.

Where do TEACCH Treatment Providers Work?
The TEACCH program network is limited to North Carolina. Visitors are welcomed from around the country and overseas to the TEACCH regional centers. Each center accommodates scheduled observational learning experiences that are individualized to meet the interests of visiting groups.23 TEACCH also provides on-site consultation, training, and workshops for groups all over the world.24 As a result of these consultations there are schools that implement the TEACCH program all over the globe.

What Research is there to Support the TEACCH Intervention?
Currently, the TEACCH research staff is conducting three studies that are dedicated to discovering the long-term adult outcomes of TEACCH, if the methods of TEACCH can reduce anxiety, and how individuals with ASD learn and attend to the world. This section will provide a synopsis of some specific past research results on each of these measures accompanied with additional research resources.

One of the first research studies conducted on the efficacy of TEACCH was completed in 1971 by Eric Schopler and Robert J. Reichler. The study focused on the benefits of structured conditions for education. The study found that “children responded better to structured than unstructured conditions, and that children with lower developmental functions became more disorganized the less structure they had.”17 The limitations of this particular study include the fact that the study was conducted by members of the TEACCH program staff, and also that the study lacked a control group.11

A 2002 study determined to evaluate the efficacy of the TEACCH program compared to a special education program in a public school setting. The study monitored 2 groups of 8 children who shared similar ASD diagnosis, one group underwent the TEACCH program while the other group attended regular classrooms. Each group was evaluated with the Psycho-Educational Profile-Revised and the Vineland Adaptive Behavior Scale twice, once before and once after a one-year interval.25 The results found that the “scores of the experimental group increased more than the control group scores. Statistically significant differences were obtained in both groups because of the differences in the two approaches.”25

A study published in 2003 evaluated how the TEACCH program can benefit adults living in a residential program. The study observed adults living at the Carolina Living and Learning Center who “experienced an increase in structure and individualized programming in the areas of communication, independence, socialization, developmental planning, and positive behavior management compared to participants in control settings.”26 Also, the families of these individuals were more satisfied as the use of the TEACCH methods resulted in a reduction of difficult behaviors.26

A 2007 study concluded that work systems, an element of the TEACCH program, had a beneficial and lasting impact on individuals with ASD. The study collected data on three participants and found that “all students showed increases in on-task behavior, increases in the number of tasks completed or play materials utilized, and reduction of teacher prompts. The results were maintained through the 1-month follow-up.”27 A study published in 2006 was conducted on 34 children in Hong Kong, 18 of which were on the autism spectrum and 16 were in the control group. The study evaluated over 15 different skills after 6-month and 12-month exposures to the TEACCH intervention. The results found that children in the experimental group “showed better outcomes at post-test. They also showed progress in different developmental domains over time. The study provided initial support for the effectiveness of using the TEACCH program with Chinese children.”28 Another longitudinal study published in 2000 examined 7 men placed in a group home that used the TEACCH intervention for a 2.5 year period. The results of study found “improvements in interpersonal behavior, leisure skills, vocational behavior and independent functioning. However of the 18 areas assessed, 12 showed no significant changes from the beginning to the end of the study. ”29

It must be pointed out that, although there is some research indicating TEACCH as an effective intervention for individuals with ASD, there is still a need for further research on the subject. The Texas Guide for Effective Teaching TEACCH includes a number of research study abstracts detailing the outcomes of TEACCH related studies. The National Standards Project classified the use of a structured teaching intervention, such as the TEACCH Model, as an “emerging treatment.”30 A behavioral treatment is considered “emerging” if there are one or more studies that show that the treatment has some beneficial qualities, but additional high quality studies must be conducted before the treatment can be considered to be “established.”30

Where can I find a TEACCH Treatment Provider?
The TEACCH program has been employed all over the world, but the TEACCH network is located throughout 7 regional centers located solely in North Carolina. North Carolina families will be interested to learn that the TEACCH program is offering free autism evaluations utilizing the Autism Diagnostic Observation Schedule (ADOS) and The Childhood Autism Rating Scale – 2nd Edition (CARS2) for people of all ages.12 Families interested in learning more about TEACCH programs in their area or the TEACCH program in general should visit TEACCH Autism Program.