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

Abstract

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is a family-centered program to assist children and adults with autism. TEACCH assists people of all skill levels in school, personal, and work settings. The approach involves extensive clinical expertise and is backed by empirical research. Its founder, Eric Schopler, made a bold departure from accepted conceptualizations of autistic children as suffering from an emotional disorder caused by emotionally distant parenting.

Overview

In 1971, Eric Schopler, a professor of psychiatry at the University of North Carolina at Chapel Hill (UNC), founded the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) program at the university’s School of Medicine. Schopler was seeking to help parents and their children cope with the challenges of autism. The first statewide education program for autistic children, it would become the model for other states and nations. In the United Kingdom, for example, the Northamptonshire County Council Autism Family Advisory Team has adopted the TEACCH model.

TEACCH, according to the UNC website, promotes "the concept of the ‘Culture of Autism’ as a way of thinking about the characteristic patterns of thinking and behavior seen in individuals with autism spectrum disorders." The mission statement is "The University of North Carolina TEACCH Autism Program creates and cultivates the development of exemplary community-based services, training programs, and research to enhance the quality of life for individuals with Autism Spectrum Disorders (ASD) and their families."

TEACCH offers a professional certification training program, which is available to educators, psychologists, and social workers at seven regional centers in North Carolina and nationwide, by way of online courses and webinars. Other services include a detailed diagnostic evaluation, using assessment instruments that have been empirically verified: the Childhood Autism Rating Scale (CARS) and the Autism Diagnostic Observation Schedule (ADOS). For parents of preschool and elementary-school children, in-home early intervention services and parent–child teaching sessions are available throughout North Carolina; group sessions can also be scheduled. Psychoeducational interventions for adults on the autism spectrum offer an opportunity to discuss matters of personal concern involving relationships or work. Central to the TEACCH philosophy is involvement of family members; parental support is ongoing and workshops are available.

Further Insights

The word autism came into the lexicon when Leo Kanner, a professor at Johns Hopkins University used it to describe a group of boys exhibiting unusual social behaviors in his seminal 1943 paper, "Autistic Disturbances of Affective Conduct." Over the ensuing decades, most professionals and laypeople alike would have the erroneous impression that autism was a rare condition characterized by highly disturbed, poorly functioning children. After World War II, Kanner promulgated the theory that autism was the result of "toxic parenting," parents who, like the children he described, were extremely emotionally detached.

Another psychoanalyst, Bruno Bettelheim, who ran the University Orthogenic School at the University of Chicago, popularized this idea in his 1967 book The Empty Fortress. Though the book was critically acclaimed, an increasing number of parents did not accept the idea they were to blame for children’s autism; they decided they needed to advocate for themselves. That same year, the National Society for Autistic Children (NSAC) was born. Two years later, NSAC held its First Annual Congress in Washington, DC. Among the speakers Eric Schopler.

Schopler’s interest in autism went back to the early 1960s, when he was a University of Chicago graduate student under Bettelheim. Though at first Schopler shared his mentor’s excitement in "solving the puzzle" of autism, his own experience of working with these parents convinced him that they were not emotionally cold. In fact, he said, Bettelheim "became a ‘negative role model’ for me" (Mesibov, Shea & Schopler, 2010). Upon earning his doctorate in 1964, Schopler left the University of Chicago and joined the faculty at UNC to embark on empirical research to replace the psychoanalytic theories he deemed misleading with a workable service program.

Through his research, Schopler sought to demonstrate that autism was not an emotional disorder (and one caused by emotional shortcomings in child rearing), but rather a sensory processing (perceptual) disorder, combined with unusual ways of thinking and understanding, challenges in social interactions, and narrow interests. Any unusual maternal behavior, he claimed, was in response to and not the cause of her child’s autism. Furthermore, both conditions could be ameliorated through a sound education program, laying the foundation for TEACCH. What Schopler needed, however, was a valid and reliable instrument to diagnose autism and differentiate it from other developmental and intellectual disabilities. This came in 1980, in the form of the Childhood Autism Rating Scale (CARS). The seven-point scale also rated the degree of autism each child presented, which would be reflected in the autism spectrum, a term coined by Lorna Wing.

In 1944, Hans Asperger, a Viennese physician, described a syndrome in which people on the autism spectrum, despite exhibiting the repetitive behaviors and social interaction challenges associated with autism, exhibited a very high degree of cognitive ability, through academic achievement or exceptional feats of memory. In his classic description, Asperger called his patients "little professors." Asperger’s paper first appeared only one year after Kanner’s description of autism.

A major component of the TEACCH Autism Program is the concept of the "Culture of Autism," a perspective on the characteristic patterns of cognition and behavior in children and adults with ASD. In addition, the program involves replacing the standard curriculum and developing a plan that is both person- and family-centered for each adult or student. Visual supports are used within a structured environment to make everyday activities understandable and predictable.

Viewpoints

As with any program, there are misconceptions with TEACCH. The program is for people with ASD of all ages, not just children. In addition to schools, TEACCH has been well proven in residential and vocational programs for adults with ASD. It even has applications in various counseling for personal, marital, vocational, and academic issues. As such, TEACCH is not only for persons with intellectual disabilities but also for individuals on all parts of the spectrum, including those with a high degree of academic achievement.

Another myth is that TEACCH is used only in self-contained classrooms. Because the TEACCH approach works with autistic children of all intellectual abilities, the program is equally well suited to inclusive settings, both regular-education classrooms and "specials" such as art, music, and physical education. Moreover, TEACCH can be used in settings beyond classrooms, such as children’s private homes, adult residential programs in a variety of settings, in sheltered workshops, and at employment sites. In fact, TEACCH supports language development in all the aforementioned settings.

Most important, TEACCH focuses on independence, establishing it as a priority for individuals. It should be noted that independence does not mean isolating people on the autism spectrum who may already be lonely. An important part of independence for individuals with ASD is enhancing the ability to partake in and enjoy social interactions, something many people with this condition would not otherwise be able to enjoy.

Structured TEACCHing, as the program is called, is supported by research. A low-intensity application of TEACCH program was effective in reducing autistic symptoms in preschool children with autism. Reducing parental stress is also important to enhance their involvement in the program (D’Elia et al., 2014). In addition, the use of TEACCH methods can help beyond the classroom, for example, among children and adults with autism before and during a doctor or dentist visit, leading to notably greater patient compliance and reduced need of medical sedatives (Orellana, Martinez-Sanchis & Silvestre, 2014).

One area of controversy is the medicalization, or the use of a medical model of disability, for conditions such as ASD. Autism advocates and self-advocates claim that such a perspective treats the condition as a pathology, a departure from the "normal," with negative implications for a person’s self-identity. In the late 1990s, the term neurodiversity was coined to denote the view that neurological conditions such as autism are normal variations in the human genome, genetic differences that are part of who we are. Two noteworthy books appeared in 2015, endorsing the idea that, in fact, autism is primarily a different way of perceiving the world and expressing it. Although the TEACCH method is part of the UNC School of Medicine, it does (as part of its Culture of Autism philosophy) have as a goal the independence of people on the autism spectrum, fostered by support services, including teaching and training.

The other widely used program to assist children and adults with ASD is Applied Behavior Analysis (ABA). ABA involves analyzing socially significant behaviors and applying of the principles of learning and motivation to solve them. Both approaches are popular and widely used; both are highly effective in enhancing social skills (Callahan et al., 2010). Two other well-regarded programs are the Learning Experiences and Alternate Program for Preschoolers and their Parents (LEAP) and the Social Communication, Emotional Regulation and Transactional Support (SCERTS). The LEAP model, created by the Association for Science in Autism Treatment, involves assisting young children in inclusive settings with their typically developing peers and enlisting them as partners in interacting (Strain & Bovey, 2011). The SCERTS model focuses on the significant challenges people with ASD face, namely social communication, emotional regulation, and transactional support. School districts across the United States and more than a dozen countries have adopted SCERTS (Prizant, 2015).

Terms & Concepts

Adaptive Behavior: The ability to perform cognitive and physical skills of daily living independently.

Asperger Syndrome: Named for Hans Asperger, a Viennese physician, this syndrome has been used to classify people on the autism spectrum who, despite exhibiting the repetitive behaviors and social interaction challenges associated with autism, exhibit a very high degree of cognitive ability, through academic achievement or exceptional feats of memory. In his classic description, Asperger called his patients "little professors." Asperger’s paper first appeared in 1944, only one year after Kanner’s description of autism. However, the paper would remain virtually unknown in the English-speaking world until it was translated in 1991. The term was dropped as a standard classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and included as part of the autism spectrum.

Autism: A developmental disability that affects verbal and/or nonverbal communication and a person’s ability to interact socially. These signs usually manifest themselves by age 3. In addition, a person with autism may exhibit stereotyped or repetitive behavior and movements, which can be present in the person’s speech. Most people with ASD dislike changes in routine or unexpected sensory stimuli.

Autism Spectrum Disorders: An umbrella term for a range of disorders that include Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.

Child Autism Rating Scale (CARS): The first research-based instrument used by TEACCH to evaluate and diagnose children and adults who may have ASD. A Second Edition was released in 2010. The other diagnostic instrument is the Autism Diagnostic Observation Schedule (ADOS).

Developmental Delay: A term denoting the absence or late presence of cognitive (intellectual), physical, social and emotional, communication, or adaptive behavior abilities, as measured by established instruments.

Diagnostic and Statistical Manual of Mental Disorders (DSM): A reference published by the American Psychiatric Association providing a standardized common language and criteria for mental disorders. The first edition was published in 1952; the most recent edition, the DSM-5, appeared in 2013. The global equivalent is the International Statistical Classification of Diseases and Related Health Problems, issued by the United Nations World Health Organization.

Intellectual Disability: The presence of well below average intellectual functioning, occurring with sharply reduced adaptive behavior.

Medicalization: The concept of defining or treating (or both) of a condition such as ASD as a medical condition or in medical or clinical terms. It is also sometimes called the medical model of disability.

Neurodiversity: The concept that neurological conditions, especially in persons on the autism spectrum, are an aspect of one’s genetic makeup and should not be considered abnormal, but rather as a different way of thinking and perceiving the world (Silberman, 2015; Prizant, 2015).

Bibliography

Boyd, B., et al. (2014). Comparative efficacy of LEAP, TEACCH and non-model-specific education programs for preschools with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(2), 366–380. Retrieved January 2, 2016 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=93922120&site=ehost-live

Callahan, K., et al. (2010). ABA versus TEACCH: The case for defining and validating comprehensive treatment models in autism. Journal of Autism and Developmental Disorders, 40(1), 74–88. Retrieved January 2, 2016 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=47626177&site=ehost-live

D’Elia, L., et al. (2014). A longitudinal study of the TEACCH program in different settings: The potential benefits of low-intensity intervention in preschool children with autism spectrum. Journal of Autism and Developmental Disorders, 44(3), 616–626. Retrieved January 2, 2016, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=94344400&site=ehost-live

Ichikawa, K., et al. (2013). TEACCH-based group social skills training for children with high-functioning autism: A pilot randomized controlled trial. BioPsychoSocial Medicine, 7(14). Retrieved January 2, 2016 from http://link.springer.com/article/10.1186/1751-0759-7-14#/

Mesibov, G., Howley, M., & Naftel, S. (2015). Accessing the curriculum for learners with autism spectrum disorders: Using the TEACCH programme to help children. (2nd Ed.). London, UK: Routledge.

Mesibov, G., Shea, V., & Schopler E. (2010). The TEACCH approach to autism spectrum disorders. New York, NY: Springer Science & Business Media.

Orellana, L., Martinez-Sanchis, S., & Silvestre, F. (2014). Training adults and children with autism spectrum disorder to be compliant with a dental assessment using a TEACCH-based approach. Journal of Autism and Developmental Disorders, 44(4), 776–785. Retrieved January 2, 2016 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=94772599&site=ehost-live

Schopler, E., & Reichler, R. (1971). Parents as co-therapists in the treatment of psychotic children. Journal of Autism and Childhood Schizophrenia, 1(1), 87–102.

Silberman, S. (2015). NeuroTribes: The legacy of autism and the future of neurodiversity. New York, NY: Avery.

Virues-Ortega, J., & Julio, F., & Pastor-Barriuso, R. (2015). The TEACCH program for children and adults with autism: A meta-analysis of intervention studies. Clinical Psychology Review, 33(8), 940–953. Retrieved January 2, 2016, from ScienceDirect. http://www.sciencedirect.com/science/article/pii/S0272735813000937

Welterlin, A., et al. (2012). The home TEACCHing program for toddlers with autism. Journal of Autism and Developmental Disorders, 42(9), 1827–1835. Retrieved January 2, 2016, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=79293702&site=ehost-live

Suggested Reading

Benton, L., & Johnson, H. (2014). Structured approaches to participatory design for children: Can targeting the needs of children with autism provide benefits for a broader child population? Instructional Science, 42(1), 47–65. Retrieved January 2, 2016 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=94081445&site=ehost-live

Faherty, C. (2010). Communication: What does it mean to me? Arlington, TX: Future Horizons.

Faherty, C. (2014). Autism: What does it mean to me? Arlington, TX: Future Horizons.

Howley, M. (2015). Outcomes of structured teaching for children on the autism spectrum: Does the research neglect the bigger picture? Journal of Research in Special Education Needs, 15(2), 106–119. Retrieved January 2, 2016 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=101893534&site=ehost-live

Lum, J., & Hogdson, K. (2013). Developmental continuum (principles of TEACCH). In Volkmar, F., (Ed.). Encyclopedia of Autism Spectrum Disorders. New York: Springer. (pp. 884–885).

Marcus, L., & Grinstaff, J. (2013). Multidisciplinary training (TEACCH component). In Volkmar, F., (Ed.). Encyclopedia of Autism Spectrum Disorders. New York: Springer. (p. 1948–1953).

Mesibov, G., & Shea, V. (2010). The TEACCH program in an era of evidence-based practice. Journal of Autism and Developmental Disorders, 40(5), 570–579. Retrieved January 2, 2016 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=49444537&site=ehost-live

Mesibov, G., & Shea, V. (2011). TEACCH. In Kreutzer, J., & DeLuca, J. (Eds.). Encyclopedia of Clinical Neuropsychology. New York: Springer. (pp. 2472–2477).

Nasoudi Gahreh Bolagh, R., Zahednezhad, H., & Vosoughillkhnchi S. (2013). The effectiveness of treatment-education methods in children with autism disorders. Pocedia—Social and Behavioral Sciences, 84(9), 1679–1683. Retrieved January 2, 2016 from ScienceDirect. http://www.sciencedirect.com/science/article/pii/S1877042813018855

Prizant, B. (2015). Uniquely human: A different way of seeing autism. New York, NY: Simon & Schuster.

Schopler, E., et al. (Eds.) (2001). The research basis for autism intervention. New York, NY: Springer.

Strain, P., & Bovey, E. (2011). Randomized, controlled trial of the LEAP model of early intervention for young children with autism spectrum disorders. Topics in Early Childhood Special Education, 31, 133–154.