An intervention system for autism

Excerpted from TARGETING AUTISM: What We Know, Don’t Know, and Can Do to Help Young Children with Autism and Related Disorders, [From page 104:] 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.

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, Eric 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 de-emphasize 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 de-institutionalization, 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 Eric 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 l 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, Eric 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 stake, 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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