“For people with autism, the best predictor of quality of life is employment, and for children with autism, the best predictor for future employment is attaining independent living skills.” Those words of Dr. Laura Klinger, Executive Director of the TEACCH Autism Program at The University of North Carolina (UNC), guided my recent return to train at TEACCH after twelve years. I have incorporated TEACCH principles and strategies into behavior support, teaching daily living skills, parent counseling, and in professional development workshops ever since my first TEACCH trainings at UNC in 2000, 2003, and 2005. After these many years, I am pleased to share information in this article about how the TEACCH principles and program components are as effective as ever for parents, professionals and, most of all, for children and adults with autism on any level of the spectrum.
In 1965, Dr. Eric Schopler and North Carolina parents created TEACCH, the acronym for Treatment and Education of Autistic and related Communication Handicapped Children. In 1972, North Carolina funded TEACCH, which became the first state-wide program of autism services in the U.S., achieving the highest rate of employment for people with autism of any state. One of the pillars of TEACCH that was as prominent and meaningful over the past fifty years as it is today was Schopler’s commitment to grounding TEACCH in the principle that parents/families are co-therapists and co-teachers. He, as much as any professional I ever met, understood that “family engagement” and “parent-school collaboration” are not euphemisms, but values and practices that all professionals must be guided by and live by every minute. This grew out of first-hand experiences as a social work graduate student that were so formative for Dr. Schopler that they became the foundation for the TEACCH approach known as Structured TEACCHing.
As a social work student, Eric Schopler was assigned to the infamous Orthogenic School in Chicago run for decades by the equally infamous Bruno Bettelheim. Bettelheim promoted the then-common belief that parents, particularly “refrigerator mothers,” caused autism due to their inability to love their child. Schopler witnessed Bettelheim’s so-called treatment of children with autism by isolating them from their parents and most of the staff with a treatment of climbing on stone statues. Schopler remained horrified by this, and went on to obtain a PhD in psychology and to direct research on the stress of parents of children with psychosis, which at that time included autism and autistic psychopathy, a term for Asperger syndrome that unfortunately lingers today. Years later, Eric Schopler and TEACCH dedicated themselves to validating the traumas and duress that the Bettelheim parents and their children had endured, by producing a documentary and honoring them.
Over the years, TEACCH expanded to be the first and only source of autism programming/support in many U.S. school districts and countries. In the 1970s, TEACCH was endorsed by the NY State Health Dept. as an evidence-based approach for preschoolers with autism and communication disabilities. In 2003, the landmark book, Educating Children with Autism, was regarded as the gold standard for educational evaluation of programs for autism. TEACCH was one of the programs to be cited as a model program that met the National Research Council’s rigorous criteria. In 2005, when I was at TEACCH to train and participate in Dr. Schopler’s 40th anniversary, I recall asking Dr. Catherine Lord, co-editor, if the National Research Council would publish a badly needed series of similar books of best practices guides for middle and high school. She explained that when completing this book in the midst of a changing presidential administration, it was all that they could do to get it published.
Through the decades, and today, families, researchers, educators, and therapists continue to face these ubiquitous challenges to institute and expand best practices in schools and community settings. Of note, among her extensive credentials as a renowned researcher and academician, Dr. Lord completed a clinical internship at TEACCH. While TEACCH may not be as familiar to many as other evidence-based methods of positive behavior support and training, TEACCH has the advantage of having stood the test of over 50 years of research, and remains a client-friendly, practical approach that complements and blends with other approaches, including discrete trial and other forms of behavior analysis. It is designed to teach and support a child or adult in the classroom as well as in natural settings at home, recreation, community, pre-vocational, and employment settings.
Back in 2000-2005, when I attended the week-long TEACCH trainings, these were times when, even more than now, we were searching for family- and teacher-friendly evidence-based approaches that could effectively combine teaching communication, self-regulation, organization, and activities of daily living – no simple achievement then and now. Today, we live in an era where social emotional learning (SEL) is emphasized for all young children as the essential foundation for lifelong problem solving. Parents worry that their children with learning disabilities keep falling behind. Teachers feel taxed with pressure to shepherd delayed learners and diverse learners along. Since its creation, Structured TEACCHing (ST) has specifically addressed these demands by designing learning, play, and independent activity systems that allow a child or adult with autism to process, organize and problem solve information at their own pace. The key element of assessing each individual is identifying their unique learning styles. As an example of person focus, ST trains us to assess “learning styles” as opposed to deficits and challenging behaviors. ST practitioners understand that people with autism are susceptible to confusion, stress, and dysregulation. Dr. Klinger described ST as an Antecedent System. They find that the large percentage of what teachers and parents would report to be challenging behaviors are eliminated when the activity and system for using it are designed to match the child’s or adult’s learning style. In other words, by implementing ST, we can prevent and address the pitfalls that would otherwise cause and reinforce repetitive behaviors, rigid adherence, isolating, dysregulation, overstimulation, sensory overload, etc. When needed, they draw on Functional Behavior Assessment, Pivotal Response, PBIS, and other forms of behavior analysis.
TEACCH does not replace speech therapy and discrete trial. Rather, professionals and families can integrate its assessment and organizing systems with other approaches for a preschooler, school-age children, teen, or adult with ASD, as well as for children and adults with related executive functioning needs. TEACCH fits under the broad umbrella of evidence based approaches for applied behavior analysis that require assessment, data collection, progress monitoring, reassessment, and research.
Having previously trained at TEACCH with Adolescents, Level Two, and Invitational topics, my recent trip was for TEACCH Early Childhood Training with 4, 5, 6, and 7 year olds who were verbal and nonverbal. True to form, as trainees, we experienced a parallel process of Structured TEACCHing ourselves, using a physical environment and curriculum that were intentionally structured for sequential, visual, and experiential practice of all the elements that we learned. An array of visual materials and containers were available as we worked in small groups, observed the students, and assessed each child’s learning styles. Next, we were given specific tasks to create a new activity or expand on a child’s skill using a familiar activity. We implemented the activity with the child, and then we were asked to reassess, restructure where needed, and retry the activity.
For people less acquainted with Structured TEACCHing and the research that supports it, questions sometimes arise about overreliance on visual schedules, lack of flexibility, and applications in inclusive settings. Actually, hallmarks of ST are teaching transition, flexibility, generalization, and independence. This is achieved by building these elements into a child’s or adult’s daily program in all assessments, tasks, activity/work systems, and schedules. Knowing what to do, where to do it, when an activity is finished, and knowing what to do next, are always made visually and spatially explicit. Regardless of level of functioning, amount of language a person possesses, and delays in processing and attention, people with autism receive clear permanent information that enables them to complete meaningful tasks and meaningful transitions.
One of the benefits of TEACCH has been to bring back a multitude of photos of the tasks (activity systems), work areas, schedules, and visuals that they create. Recently, when I showed my photos to a group of teachers, they were amazed at how efficiently very small spaces and everyday materials were used to organize areas and tasks for teaching, independent work, and a relaxation station. After all, everyone can benefit from a relaxation station. For more information with articles by TEACCH practitioners and about training, consult www.TEACCH.com.
Dr. Kappenberg is a long-time member of AHA and serves on our Professional Advisory Board. She is a co-founder of Westbrook Preparatory School and served as their Clinical Director. Currently, she directs the Long Island Early Childhood Direction Center at the Center for Community Inclusion, LIU-Post at Faith.Kappenberg@liu.edu. Her offices for psychotherapy and consultation are in St. James and Glen Cove at Kappenberg@aol.com.
© 2017 AHA Association. Further reproduction of this article is prohibited without express written permission of AHA. This article was reprinted with permission and was originally published in the Fall 2017 issue of AHA Association’s On The Spectrum. For more information, visit www.ahany.org.