Some Basic Information about TEACCH
Why do we think TEACCH is a good model to follow
What is TEACCH?
What is done at TEACCH?
Discussions about TEACCH
Where to get more information about TEACCH
BIBLIOGRAPHY ON TEACCH
What differenciate TEACCH from pure Behavior modification programs
Behavior Problems Management
Some personal comments about Lovaas
TEACCH is starting to be well known all over the world for the excellent services provided to autistic people and is often used as a model as a result. However several misconceptions have been spread and it seems to be good to give some basic information that will hopefuly give a faithful description of the TEACCH Program.
First of all, TEACCH is not a single approach and even less a method. It is a state program that tries to respond to the needs of autistic people using the best available approaches and methods known so far for educating them and to provide the maximum level of autonomy that they can achieve.
If some people have ported successfully out of North Carolina and even out of the United States some elements of this program, the only complete implementation of TEACCH as a State Program remains the one of North Carolina. For the sake of my European friends, I should add that we were quite lucky in porting some of the TEACCH program in Europe thanks to Theo Peters, a Belgium professional who received training in N.C. and helped a lot of European professionals and parents get up to speed with modern views on autism. The program in Antwerpen is pretty near to most of the achievements of those in N.C. and constitutes a closer reference for visits in Europe...
Before I go any further along a description of how TEACCH Program functions, I will give a few of the considerations that lead us to chose this program as a model:
As parents quite involved in the autistic society activities, we have explored hundreds of methods, going from "recipes" to full blown country wide systems...
TEACCH is one of the two programs for autistic people that met our quality criteria the other one being the UK National Autistic Society (NAS) based School system for autistic children which is good but not as comprehensive as TEACCH.
Here are the considerations that were decisive in our choice of TEACCH versus other approaches of autism:
So, now to answer the question on what TEACCH is, I hope that every one will by now realize what stunt this attempt represents... :-)
TEACCH cannot be reduced to a technique, not even to a set of techniques, not even to a method. It is a complete program of services for autistic people which makes use of several techniques, of several methods in various combination depending upon the individual person's needs and emerging capabilities.
TEACCH (note that this is not a spelling error) stands for Treatment and Education of Autistic and Communication Handicapped Children, is a Public Health Program available in North Carolina. The new director is Dr Gary Mesibov. The head office is located in Chapell Hill, N.C. and TEACCH has a research section at U.N.C. Hospital.
There are several other offices and facilities all over North Carolina,
with a good geographical coverage.
Services provided go from diagnostic and early counselling for parents and
professionals, to adult community based centers, with all the intermediate
steps in between: psychological assessment, classes, teachers programs,
etc...
The TEACCH Program supervises about 130 Classes for autistic children. Several centers for adolescents and adults with varying degrees of mainstreaming according to the capabilities of each person are installed either in rural areas or in town. Depending upon preferences expressed by autistic people and their families, country or town setting will be proposed.
There are few programs in the world that can claim thirty years of experience with autistic people. TEACCH keeps evolving, they are continuously refining their approach, challenging old beliefs, adding new research results. They tend to be cautious there not to introduce techniques that are not proven on a large scale.
Unlike AIT, VT, Holding and other approaches the TEACCH program doesn't use a single technique or method. You wont find anybody at TEACCH telling you that they are going to "cure" autism.
The main goal of TEACCH for autistic children is to help them grow up to a maximum autonomy at adult age. This includes helping them understand the world that surround them, acquiring communication skills that will enable them to relate to other people and giving them as much as possible the necessary competence to be able to make choices concerning their own lives.
The major thrust is toward improving communication skills and autonomy to the maximum of the child potential, using education as a means to achieve that goal. Educational programs are being revised frequently, according with the child maturation and progress, since there are no good predictor of a child evolution and early assessment could prove misleading.
Educational strategies are established individually on the basis of a detailed assessment of the autistic person learning abilities, trying to identify potential for acquisitions rather than deficits.
The assessment called PEP, Psycho Educational Profile tries to identify areas where the person "passes", areas where the skill isn't there yet, and areas where the skill is emerging. These domains are then put in an education program for the person. This assessment is multi dimensional. This is a must since there is a great variability of skills, even in the same autistic person, from one domain of competency to the other. (I have also expended on that subject of assessment on the list earlier)
As opposed to behavior modification, these strategies do not work on the behavior directly but on underlying conditions that will foster learning experiences. They also make use of recent cognitive psychology research results about some differences in particular areas of brain processing in autistic people versus other people.
When behavior problems occur, they are not treated directly either. The approach calls for efforts to understand the underlying reasons for this behavior problem: anxiety, physical pain, difficulty with the task, unpredictable changes, boredom, etc... The idea is two folds:
A/ By giving the person means to understand better his/her environment, it (the environment) becomes more predictable and less anxiety generator. This may require proposing a simpler environment in the early phases of development and progressively reintroducing complexity as the child progresses towards more and more autonomy.
B/ By giving means of communication to the person the comprehension and expression capabilities will enable him/her to understand better what is being told/asked and to express his/her needs and feelings by other means than behavior problems.
Direct Behavior Modification isn't completely ruled out. It is reserved for those behaviors that endanger the person and for which the above strategy didn't work, at least so far. This is very rare.
I'll reproduce here an answer I made to a parent, who is also a psychiatrist, following his question:
(Begin quote)
> Is there any risk that such a program could become a > closed system, like, say, orthodox psychoanalysis--purporting > to explain everything from one point of view?
Indeed there is always such a risk with any approach. My wife and I often asked the question to ourselves. We have been fighting very hard the Psychoanalytic current in France on the basis that it became a closed system, not capable of following the new results of Neuro Psychology.
We often dread the time when we may be the "old timers" incapable of adapting to newer research results...
For the moment, though, the people working at TEACCH and the ones working in programs inspired from TEACCH are continuously trying to merge new research results into their program and discard no longer valid approaches.
As an example, recent trends have been in the area of finding ways to foster spontaneous communication and incidental learning to extend the reach of structured education which was the main thrust of TEACCH.
(End of quote)
If you want to learn a little more about TEACCH, a fairly extensive bibliography is provided below. If you want to know a lot more, get in touch with the program TEACCH:
Division TEACCH
School of Medicine
310 Medical School Wing E, 222H
Chapel Hill, N.C. 27514
TEACCH also runs clinics
that are opened to professionals and parents, this may be another
possibility for learning more.
Paul Trehin
There is often a confusion between the goals of a program such as TEACCH and Pure Behavior Modification Approaches. Behavior modification approaches are often getting parents approbation as they make sense, at least at first sight, they offer bounded programs of intervention, and they work fairly well in the early phases of the program.
Here is a typical comment that we often get about behavior modification versus other approaches:
> What Behavior Modification does have is step-by-step > programs that spans several years. > I haven't seen this from either Sundburg, > Schoppler, Mesibov, Freeman or others.
Here is an answer that I gave:
I don't know about Sundburg or Freeman, but for Schopler and Mesibov who run the TEACCH program, if you haven't seen a "step-by-step program that spans several years" it is because such long term programs are considered too limiting for the children, considering the continuous evolution of their capabilities. Educational programs keep being updated.
There is indeed a long term individualized strategy for each child. That strategy keeps being adjusted throughout the evolution of the child, according to the progress made in each domain of development. It continues on at adult age.
In order to have a reliable assessment of these progress, Schopler Reichler and Lansing devised an evaluation scheme called PEP (Psycho Educational Profile) and have prolonged this scheme for Adolescents and Adults: the AAPEP. These schemes give a lot of information to the teachers and to the parents with regard to what is the appropriate level that can be successfully taught in each domain of development at the present time for the child.
Again, I really think that this is where TEACCH and pure Behavior modification differ. Teaching a specific behavior ceases to be the main goal of the teachers endeavor. Rather than teaching the behavior directly, prerequisites skills to that behavior emergence are being evaluated and if missing they are being taught. The appropriate behavior comes naturally then.
This is done by placing the child in an environment that fosters such learning: structured space and time, teaching methods that take into account the differences of individual learning styles.
Sure, this may take longer than classical behavior modification, but here the skills are really understood. In a classical behavior modification program some fairly advanced skills may be learned rather fast, but the generalization of these skills to other environments will be much more difficult later on.
Problem Behaviors are often a source of exclusion for many autistic people. Their management isn't easy, however, great improvements can be achieved though good approaches:
One of the strategies used by behavior modification is:
> Don't reward negative behavior and reward positive > behavior. Not rewarding doesn't mean hitting, slapping, > or yelling - IT MEANS IGNORING|
This is obviously a valid strategy. It is being used as a last resort approach, when the above teaching approach isn't producing the desired effects, at least during the early phases. But Ignoring the behavior is OK only if we have analyzed its potential communicative content. Never forget that a behavior problem is very often caused by a physical pain and since the autistic person doesn't know how to communicate her pain, she does it through a behavior problem.
The main difference again between TEACCH attitude and pure behavior modification is that most of the undesirable behavior can be dealt with without requiring behavior modification, just by providing the autistic person with the skills that will permit an easier understanding of the "world" and to make sense of other people behaviors. For example, in the situation of a behavior problem caused by a lack of means to express pain, having taught the child how to signal pain would have avoided the behavior problem all together...
In fact, the modern, non aversive behavior management techniques apply very good principles. These techniques are being used when Behavior Problems persist, even in a favorable learning environment.
There are however some categories of behavior problems that resist all regular approaches, being the educative one (TEACCH) or the Behavior Modification one. These are of two sorts:
1/ Hyper sensitivity to certain stimuli, such as described so well by Temple Grandin. These provoke unbearable pains for those people and require completely different approaches, mainly centered around avoiding the painful stimuli situation.
2/ Some specific disorders that intrinsically create self abuse and violent behavior, Lech Nihan Syndrom for example.
Trying to extinguish such behavior problems via behavior modification, especially aversive ones, is criminal, and I weight my words. Management methods for such problems, specifically the second type, are beyond the means that can be expected from regular intervention. They require the help of specialists that will try to solve the problem, but always with great difficulty and not always with great success. (very sad)
The situations that I addressed in the first part are obviously less tragic. For them Education remains the best solution, in combination with non-aversive behavior modification to cope with behavior problems that persist.
Very often the name of Lovaas comes as a behavior modification expert. He certainly qualifies for that. In the past however he did push the behavior modification techniques to extremes, including fairly painful treaments of autistic people as a way to teach them what behavior were undesirable. These are often refered as "Aversive Behavior Modification".
Recently, there have been reports telling that Lovaas programs have changed for the better, and I will be the first to say that I am happy of that change. There are however still some programs that claim to be based upon Lovaas theories where the "strong aversive" methods are instituted as a valid approach, not only of severe behavior problems but as teaching methods in general.
Don't misunderstand me here, I do not approve of "strong aversive" in any
case, not even for severe behavior problems. In fact, I am glad to see
that in the "Lovaas new version" even problem behaviors < This is obviously better than before and I am sure that it is effective,
at least with some autistic children. I consider, however, that it is
possible to go beyond behavior modification, be it for behavior problems
or for other general learning purpose.
Behavior modification is inspired by "Behaviorist psychology" which was
indeed a progress compared with the earlier theories. One of the basic
element of that theory was that it was enough to look at the visible
behavior as a response to a stimuli. What ever was happening in the brain
was considered happening in the "black box" and as being beyond real
investigation. The psychologist observes that a specific stimuli provokes
a specific response, that's all.
Operand conditioning, which is the root of behavior modification, hence
does not take in account other psychological phenomenons that are taking
place "IN the black box".
Recent progress in psychology and in neuro psychology, (In fact starting in
the late sixties, early seventies) have started to unveil some of the mystery
of the "black box" which are key to our understanding of autism, even
partly, but more importantly, to propose more adapted treatments of autism
than the pure behavior modification.
This is not to say that behavior modification techniques have been thrown
out completely, but that they are now integrated in a more comprehensive
education program.
So I believe statements like << every parent who has tried Lovaas has
seen significant improvement in the behavior, language, socialization,
problem solving and motor skills of their child.>>
It has even been shown that behavior modification "Lovaas style"
tends to have faster short term effects that other education methods
but that this is only true in the short term.
I also believe that equivalent visible progress would have been seen in a
program like the TEACCH program in North Carolina, albeit in a longer
period, but beyond that, long term effects such as generalization of
learning capability to adapt to new situations have a better prospect in
a program like TEACCH, or also in the programs proposed in the English
schools managed by the N.A.S. (UK National Autistic Society).