Therapy and received several sessions of therapy

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.

Autism is a lifelong developmental disorder that affects, often severely, a person’s ability to communicate and socially interact with others. It is four times more prevalent in males than females and currently, autism is believed to affect 1 in every …

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 …

Hippotherapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input. Opi: Derived from the Greek hippos (horse), “hippotherapy” literally refers to …

These were the results of the handgrip test. You can see that the strength in my arm has actually increased. I did the handgrip test and the average after the training sessions is higher than the average before. Training sessions I started …

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