Evaluation of the Effectiveness of the TEACCH Program  

This paper evaluates the effectiveness of the TEACCH (Treatment and Education of Autistic and related Communication handicapped CHildren) program for preschoolers with autism spectrum disorder (Mesibov, Shea, & Schopler, 2006). A literature search was conducted using the terms “TEACCH,” “preschool children,” “autism,” and “treatment” in ERIC (EBSCOhost), MEDLINE, and PubMed databases. The article, “A Longitudinal Study of the Teacch Program in Different Settings: The Potential Benefits of Low Intensity Intervention in Preschool Children with Autism Spectrum Disorder” composed by D’Elia et al. (2013), discussed the TEACCH program being used in home and school settings. This article was recapped and analyzed for its effectiveness of the TEACCH program for preschoolers with autism spectrum disorder.

TEACCH was created in 1966 at the University of North Carolina by Dr. Eric Schopler (Schopler & Reichler, 1971). TEACCH is a multidisciplinary program that has both professionals and families working together to help improve the child’s social, behavioral, and communication skills (D’Elia et al., 2013). Autism not only affects the child, but also the child’s family, so it is essential to use a program that incorporates both the child and family. It is crucial to look at the effectiveness of the TEACCH program so therapists can implement a program that will support and improve the child’s success. The TEACCH program will be used on a preschool child diagnosed with autism spectrum disorder. The child will receive medium- intensity therapy, meaning the child will receive eight hours of therapy in the home setting and eight hours of therapy in the school setting per week.

Study Summary and Critique

Children with autism spectrum disorder experience deficiencies in social interaction, communication skills, and behavior patterns (D’Elia et al., 2013). Many interventions have been used to help improve a child’s behavioral concerns or social skills in the school and home settings. What set aside the TEACHH program from other interventions was that it involved a multidisciplinary team, including parents, teachers, and other professionals (D’Elia et al., 2013). According to a study by Schopler (1994), the TEACHH program was aimed at enhancing the child’s abilities while reducing the parent’s worries. The authors of this study stated that there was an insufficient amount of high-intensity intervention studies, so this specific study used a low-intensity intervention, meaning the children received less than 20 hours of therapy per week (D’Elia et al., 2013). TALK ABOUT PREVIOUS STUDIES AND WHAT THEY FOUND? NECESSARY? The author’s main goal was “to assess changes in the severity of autism, adaptive behavior, and language skills in these children compared to children with ASD following a non-specific approach” (as cited in D’Elia et al., 2013, p. 617). The authors anticipated that the parents involved in the TEACCH program would have reduced stress levels concerning their child’s diagnosis and therapy than the group receiving typical treatment (D’Elia et al., 2013).

There were 30 participants in this study, 15 for the experimental group and 15 for the control group. This study took place in Italy, meaning the children and the parents involved in this study spoke mainly Italian. The participants were “between the chronological ages of 2;0 and 6;11, all either recognized with Autistic Disorder or Pervasive Developmental Disorders- Not Otherwise Specified (DSM-IV TR, APA 2000), did not have any other major medical diagnoses, and participated in the intervention for two years” (as cited in D’Elia et al., 2013, p. 617). The parents chose if their child was going to participate in the experimental group or the control group, so they were not randomly assigned to a particular group (D’Elia et al., 2013). As seen in Table 1, children in the experimental group were paired with children in the control group for age, gender, diagnosis, and ADOS scores (ADOS; Lord, Rutter, Di Lavore, & Risi, 1999). The children received this treatment and were observed for two years. A group of neuropsychiatrists, speech-language pathologists and child psychologists, that were uninformed to the child’s therapy type, evaluated the children four times, at baseline (T0), after six months (T1), after 12-15 months (T2) and after 24 months (T3) (D’Elia et al., 2013). The authors of this study chose to perform a longitudinal study, meaning they studied the same group of children over a two year period.

The children were assessed four times throughout the study, using mostly the same tests at each phase. The first step of the study was to evaluate each child at baseline (T0). To establish that there were no meaningful variations between the experimental and control groups, the authors used the Griffith Mental Developmental Scales for ages 2-8 (GMDS-ER 2-8; Luiz et al., 2006) exclusively at baseline. The Autism Diagnostic Observation Schedule (ADOS; Lord et al., 1999) was used at baseline, T1, and T3 to measure the extremity of autism for each child (D’Elia et al., 2013). Other tests that were administered at T0, T1, T2, and T3 were the Vineland Adaptive Behavior Scales (VABS; Sparrow, Balla, & Cicchetti, 1994), the Child Behavior Checklist (CBCL .5-5; Achenbach, 1991), the Communication Developmental Inventory (CDI; Fenson, Pethick, Renda, & Cox, 2000) to measure expressive and receptive language, and the Parenting Stress Index (PSI-SF; Abidin, 1999) to see what the parents were specifically stressed about. Additionally, the experimental group was administered the Psychoeducational Profile-Third Edition (PEP-3; Schopler, Lansing, Reichler, & Marcus, 2005) to “identify idiosyncratic learning patterns” (as cited in D’Elia et al., 2013, p. 619).

The control group and experimental group received the same number of treatment hours each week for two years. Children in the experimental group received two hours of the TEACCH program in the home and two hours of the TEACCH program at school per week (D’Elia et al., 2013). Children in the control group received conventional therapy for autism that the Italy National Health Service used, involving two hours of psychomotor therapy and two hours of speech therapy (D’Elia et al., 2013). Psychomotor therapy covered “emotional, physical, cognitive, and symbolic responses and reactions in the body” (as cited in D’Elia et al., 2013, p. 617). Speech therapy worked on expressive or receptive language, depending on the child’s struggles. The parents and teachers of the children in the control group played no part in their child’s intervention (D’Elia et al., 2013). Treatment for each child in the experimental group was differentiated to fit each child’s unique goals. Even though each child had a different IEP, they all followed five common themes:

1. An organized environment to help facilitate the child’s activity and compliance with rules and limits.
2. Individualized communication such as gestures, pictures, signs or words to provide functional communication.
3. Scheduling (by using visual schedules to help the child anticIpate future events).
4. Precise routines to facilitate the child’s independence.
5. Individualized material to promote greater independence in performing tasks”.

The TEACCH program was done in two settings, the home and school, to help promote generalization. In the home setting, the therapist would work with the child while the parent would observe. The therapist would give the parents homework and encourage the parents to work with their child for one hour each day and track data using the data-sharing sheet (D’Elia et al., 2013). Giving the parents homework allowed them to have more independence from the therapist and take on a bigger part in their children’s lives (D’Elia et al., 2013). Should reword somehow and add in this paragraph: monthly regular meeting with multidisciplinary team and parents, and every 3 months a senior trainer met with team and parents to evaluate performance

All the children receiving the TEACCH therapy were in mainstream schools. The therapist and teachers collaborated to make therapy goals that targeted emotional control, language, and self-help skills (D’Elia et al., 2013). Therapy in the classroom was aimed at “teaching the children the process of learning and applying skills, breaking down complex skills, adapting the classroom to the needs of the children by creating one work station according to the concept of environmental adaptation, and promoting integration between the autistic child and his classmates” (as cited in D’Elia et al., 2013, p. 620).

Interrater reliability was achieved by the team that evaluated the children at each phase because they were all blinded to the children’s progress due to intervention (D’Elia et al., 2013). Intrarater reliability was accomplished because the team went through training for working with children with autism and on the TEACCH program (Larsen, 2011).

Statistical analysis was done to assess the effect of TEACCH treatment compared to the control group. The authors stated that they “analyzed the mean scores from T0, T1, T2, and T3 using a two way repeated measure ANOVA” (as cited in D’Elia et al., 2013, p. 620). Normality was evaluated with the Shapiro-Wilk normality test and to determine changes in ADOS scores the authors used the Cochran-Mantel-Haenszel Chi squared test (D’Elia et al., 2013). A score of Before receiving the intervention, the experimental group and the control group’s cognitive functioning, language skills, behavioral functioning, parental stress, and psychopathological comorbidity were measured and the results showed no significant distinctions between the groups (D’Elia et al., 2013). Intervention caused positive changes in most areas in both groups, but the results did not display that one group outperformed the other. ADOS scores lowered in both groups, exhibited in Table 3 (D’Elia et al., 2013). Language skills (measured using the CDI) for both groups increased throughout the two years, but the experimental group had more improved scores. Adaptive functioning (VABS) scores revealed progress for communication, socialization, daily living, and motor skills for both groups (D’Elia et al., 2013).

The experimental group showed slightly higher scores than the control group. Psychopathological comorbidity (CBCL) (emotionally reactive, withdrawal, attention problems, anxiety problems, pervasive developmental, ADHD, internalizing problems, and externalizing problems) mean scores for both groups reduced over the two years and the experimental group had lower mean values (D’Elia et al., 2013). Parental stress (PSI) diminished in both groups. The subscores for parent-child difficult interaction and parental distress in the experimental group decreased compared to the control group whose scores did not lower. For the experimental group, skills and behavior (PEP 3) scores for all subsections, except receptive language and personal care, increased over the two years of treatment (D’Elia et al., 2013).

The authors noted four limitations regarding this specific study. The biggest limitation was that the study was not randomized, meaning parents picked if they wanted their child to receive the TEACCH intervention or not. Although the authors stated that the two groups showed no meaningful differences, the study would have been stronger if randomized. Second, the sample size was small, having only 15 children in each group. Smaller sample sizes may possibly skew the results of the study. Next, the children’s cognitive levels were only assessed at baseline and not as an outcome (D’Elia et al., 2013). Finally, no other interventions were mentioned in this study, so the authors could not compare the TEACCH program results to another intervention’s results (D’Elia et al., 2013). Some other concerns with this study were that it was a low-intensity intervention, which could have been why there were no noteworthy distinctions between the experimental group and control group. These children only received four hours of therapy a week, whereas a medium or high-intensity intervention might have led to noticeable differences between the two groups.