A synthesis of six related TEACCH-based outcome studies for Autism Spectrum Disorders (ASD)

Paul Probst, Department of Psychology, University of Hamburg

Symposium paper presented at the XXX International Congress of Psychology, Capetown, South-Africa, 22-27 July, 2012

Symposium "Evidenced-based interventions for Autism Spectrum Disorders (ASD): International concepts and outcomes (Convener: Paul Probst)

update: 28.11.2012, probst@uni-hamburg.de , Homepage: http://www1.uni-hamburg.de/Paul.Probst/ Email: probst@uni-hamburg.de

Symposium paper presented at the XXX International Congress of Psychology, Capetown, South-Africa, 22-27 July, 2012

[Symposium "Evidenced-based interventions for Autism Spectrum Disorders (ASD): International concepts and outcomes", Convener: Paul Probst]

Autism-Spectrum Disorders (DSM 5/ ICD-11-Draft, 2010)

Deficits in Social Communication and Interaction

Restricted Patterns of Behavior, Interests, and Activities

Onset in early childhood (1-3 yr.)

Etiology: Neurodevelopmental disorder with strong genetic component influencing early brain development;

Prevalence: total: 0.4 % [conservative estimation]

Tertiary prevention: i. e. preventing disability progression and associated suffering by alleviating behavioral symptoms and strengthening compensatory abilities;

1. State-of-the-art autism concept

THEORETICAL BACKGROUND

DEMANDS & STRESSORS

Caregiver Adaptive

RESSOURCES

APPRAISAL of

Stressors

2. Caregiver-Stress-Coping- Tertiary Prevention Model (adapted from Pakenham et al., 2005; Antonovsky, 1993: "Sense of Coherence"/ SOC)

Caregiver COPING:Problem-/Emotion-Focused

Family/ Classroom/

Group home/ Workshop/

FUNCTIONING

INDIVIDUAL with ASD:

* Enhancing abilities

* Reducing obstruct. deficits

TERTIARY INTERVENTION:

Individual (ASD)-Focused (Need for SOC)

Caregiver-Focused (Need for SOC )

3. CONCEPT of TEACCH

Structured Teaching, & Educational Guiding

Visually structuring (e. g. visual schedules, choice boards)

Clear verbal and nonverbal directions/ instructions

Prompting and behavior shaping

Consequence-based interventions (natural reinforcements, mild punishments, such as strict "No")

Social-communicative, self-management and daily living skills training

Professional-Caregiver Cooperation

International Program Dissemination professional training;

Can key components of the TEACCH program be generalized to the situation of individuals with ASD in German-speaking countries in terms of effectiveness and social acceptance

Participants: children, adolescents and adults with ASD; parents teachers and educators als cargivers

Instruments: behavioral observation, questionnaires, interviews

Data analysis : quantitative and qualitative procedures

AIMS OF THE SYNOPSIS STUDY:

METHODS

RESULTS: Study 1

- Topic- Topic

- Design- DesignSingle subject social communication training study Single subject social communication training study in a residential home. - Pre (baseline)-Post-design, in a residential home. - Pre (baseline)-Post-design,

ParticipantsParticipants - 7-yr-old girl (L) with ASD and severe intellectual - 7-yr-old girl (L) with ASD and severe intellectual disability, averbal, self-injuring behaviors (PICA);disability, averbal, self-injuring behaviors (PICA);

- TEACCH-trained therapist (master's student)- TEACCH-trained therapist (master's student)

Aims of Aims of interventionintervention

(1) Enhancement of social communication; (2) (1) Enhancement of social communication; (2) Reduction of challenging behavior; (3) teaching a Reduction of challenging behavior; (3) teaching a valid autism disability concept to caregiversvalid autism disability concept to caregivers

InterventioIntervention methods n methods

(1) 12-session-communication training using (1) 12-session-communication training using structured teaching methods (schedule, choice-structured teaching methods (schedule, choice-board management; (2) oral discussions with board management; (2) oral discussions with caregiverscaregivers

Outcome Outcome measurememeasurementnt

(1) video-based systematic behavior observation; (1) video-based systematic behavior observation; (2) Behavior Problems Inventory (BPI); (2) Behavior Problems Inventory (BPI); (3) qualitative interview data analysis(3) qualitative interview data analysis

Pictorial Schedule for L

1= Foto & Name-Card for L

2= Go-to-your-Work- Place-Card

3= Recreation-Card= "Go to your Choice-Board!"

Study 1-Figure 1

Two Element-Pictorial Schedule for L [see bottom line]

* Listening-to-Favourite-Music-Card; * Flapping-Glove-Card (favourite activity)

Study 1-Figure 2

CommunicatioCommunication trainingn training

Improved autonomous and spontaneous Improved autonomous and spontaneous management of picture schedule and management of picture schedule and choiceboard, compared with baselinechoiceboard, compared with baseline

Challenging Challenging behaviors behaviors (Pre-Post)(Pre-Post)

(1) Reduced problems in BPI-Full-Scale (1) Reduced problems in BPI-Full-Scale (2) Reduction in BPI-item "Pica" from "daily" to " (2) Reduction in BPI-item "Pica" from "daily" to " monthly "; monthly "; (3) Reduction in BPI-Item "Biting/ Cruel" from (3) Reduction in BPI-Item "Biting/ Cruel" from "weekly" to "monthly" "weekly" to "monthly"

Social Social acceptance by acceptance by caregiverscaregivers

Positive evaluation of the 12-session training Positive evaluation of the 12-session training intervention as helpful and relieving: (a) child less intervention as helpful and relieving: (a) child less aggressive, more predictable and communicative; aggressive, more predictable and communicative; (b) better understanding of functional aspects of (b) better understanding of functional aspects of challenging behaviorschallenging behaviors

RESULTS: Study 1-continued: OUTCOMES

-Topic Topic

- Design- DesignOutcomes of a 3 -year TEACCH-based intervention in a Outcomes of a 3 -year TEACCH-based intervention in a residential-vocational setting residential-vocational setting Pre-Post [retrospective]-designPre-Post [retrospective]-design

ParticipantsParticipants - Three male adults with ADS and intellectual disability;- Three male adults with ADS and intellectual disability;- TEACCH-trained staff supervisor and educators- TEACCH-trained staff supervisor and educators

Aims of Aims of interventionintervention

(1) Reduction of disruptive behaviors and enhancement (1) Reduction of disruptive behaviors and enhancement of social communication abilities; (2); social acceptance of social communication abilities; (2); social acceptance of the TEACCH approach by residential-vocational staffof the TEACCH approach by residential-vocational staff

InterventioIntervention methods n methods

(1) Implementation of TEACCH components (e. g. (1) Implementation of TEACCH components (e. g. schedules, work systems) for individals with ASD; (2) schedules, work systems) for individals with ASD; (2) Education, training & supervision of staff members Education, training & supervision of staff members

Outcome Outcome measurememeasurementnt

(1) Matson Evaluation of Social Skills [...] (MESSIER)(1) Matson Evaluation of Social Skills [...] (MESSIER)(2) Developmental Behaviour Checklist f. Adults (DBC-A(2) Developmental Behaviour Checklist f. Adults (DBC-A(3) BPI, (4) TEACCH evaluation caregiver interview(3) BPI, (4) TEACCH evaluation caregiver interview

RESULTS: Study 2

Study 2: Figure 1: Individualized Work system for person T:

T follows a Left-to-Right Routine: (1) Taking working materials from the shell on the left (organized in a Top-Down-Order); (2) carrying out the task (e. g. matching picture cards) on the desk; (3) putting the completed task to the box to his right

Study 2: Figure 2: Typical matching task for T

Disruptive and Disruptive and Challenging Challenging behaviors behaviors (Pre-Post)(Pre-Post)

(1)(1) DBC-A-Disruptive: significant decrease for all DBC-A-Disruptive: significant decrease for all three individuals: M-RCI (Reliable Change three individuals: M-RCI (Reliable Change Index) = 2.43; (p <0.05)Index) = 2.43; (p <0.05)

(2)(2) DBC-A-Total-Problem-Behavior: significant DBC-A-Total-Problem-Behavior: significant decrease (M-RCI= 2,55); decrease (M-RCI= 2,55);

Evaluation by Evaluation by caregiverscaregivers

Overall, positive evaluation: (a) report enhanced Overall, positive evaluation: (a) report enhanced communication between caregivers and clients communication between caregivers and clients with ASD; (b) more independence and autonomy with ASD; (b) more independence and autonomy of clients; (c) less aggressive beahviors in T. of clients; (c) less aggressive beahviors in T.

(d) criticism: possibility of reduced flexibility (d) criticism: possibility of reduced flexibility

RESULTS: Study 2-continued: OUTCOMES

- Topic- Topic

- Design- DesignOutcomes of education and skills group parent Outcomes of education and skills group parent training for ASD training for ASD Pre-3-mo-Follow-up-designPre-3-mo-Follow-up-design

ParticipantsParticipants (1) 24 parents (83% mothers) of 23 children with ASD (1) 24 parents (83% mothers) of 23 children with ASD (M-age= 8.9); trainer and assistant trainer with (M-age= 8.9); trainer and assistant trainer with TEACCH /ABA expertiseTEACCH /ABA expertise

Aims of Aims of interventionintervention

(1) Teaching an adequate concept of ASD ; (2) (1) Teaching an adequate concept of ASD ; (2) Enhancing parents' emotional and social experiences Enhancing parents' emotional and social experiences by parent-to-parent communication; (3) Teaching by parent-to-parent communication; (3) Teaching structured educational strategies & skillsstructured educational strategies & skills

Intervention Intervention methods methods

(1) 3-session small group training (in total 24 h); (1) 3-session small group training (in total 24 h); teaching methods included lectures, group discussion, teaching methods included lectures, group discussion, video and in-vivo modelling; role play, assignment of video and in-vivo modelling; role play, assignment of homework;homework;

Outcome Outcome measuresmeasures

(1) 23-item-Parent Evaluation of Training Effects on (1) 23-item-Parent Evaluation of Training Effects on Daily Family Life Questionnaire; (2) Home Diary Daily Family Life Questionnaire; (2) Home Diary Experience Questionnaire (Follow-up)Experience Questionnaire (Follow-up)

RESULTS: Study 3

RESULTS: Study 3-continued-a: Figure 1

86%76%

68% 72%84%

97%

74%

0%10%20%30%40%50%60%70%80%90%

100%

Improved parental skills

Improved Parent health

Improved fam

ily climate

Autism concept helpful

Practical training helpful

Parents as teachers helpful

Transfer to support team

Effects of parent group training on family life

Results of the follow-up "Parent Evaluation of Training Effects on Daily Family Life Questionnaire"

Note: The y-coordinate describes the percentage of parents evaluating the effects of the parent group training as "moderately" or "strongly positive" (with scores of 2 or 3 on the 3-point Likert scale); the x-coordinate includes seven categories of reported effects on daily family life

Parent Parent Evaluation of Evaluation of Traing Effects Traing Effects QuestionnaireQuestionnaire

The great majority of parents (about 70-90%) The great majority of parents (about 70-90%) report report improved parental skills in daily family life improved parental skills in daily family life improved mental health of parentsimproved mental health of parents improved family climateimproved family climate positive effects of exchanging experiences with positive effects of exchanging experiences with other parents other parents (parents-as-teachers concept) (parents-as-teachers concept) experienced helpfullness of both theoretical experienced helpfullness of both theoretical (autism disability (autism disability concept) and practical parent training concept) and practical parent training componentscomponents beneficial transfer of training elements to child beneficial transfer of training elements to child support teamsupport team

Home Diary Home Diary Experience Experience QuestionnaireQuestionnaire

12 of 16 responding parents (75%) reported one 12 of 16 responding parents (75%) reported one or more implementation of structured teaching or more implementation of structured teaching methods ( picture schedules, physical structure, methods ( picture schedules, physical structure, task organization)task organization)

RESULTS: Study 3-continued-b: OUTCOMES

-- TopicTopic

- Design- Design

-Outcomes of a TEACCH-based teacher training program for Outcomes of a TEACCH-based teacher training program for ASDASD-- Pre-Post/ Follow-up design- Pre-Post/ Follow-up design

ParticipaParticipantsnts

- - 10 special school teachers teaching students with 10 special school teachers teaching students with intellectual disabilities and ASD in a contained classroom intellectual disabilities and ASD in a contained classroom settingsetting

- 10 special school students with ASD, mean age = 10 yrs.- 10 special school students with ASD, mean age = 10 yrs.

Aims of Aims of interventiinterventionon

-Child-related effects: reduction of child behavioral symptoms Child-related effects: reduction of child behavioral symptoms in classroomin classroom- Teacher-related effects: (a) Reduction of teachers' stress Teacher-related effects: (a) Reduction of teachers' stress level; (b) Implementing structured learning strategies in level; (b) Implementing structured learning strategies in classroomclassroom

InterventiInterventionon

Three half-day teacher group training plus individualized Three half-day teacher group training plus individualized teacher support in classroom (average amount of support: teacher support in classroom (average amount of support: 3h). Training was carried out within two small group settings3h). Training was carried out within two small group settings

Outcome Outcome measuremeasurementment

- Classroom Child Behavioral Symptom Questionnaire; - Classroom Child Behavioral Symptom Questionnaire; School Situation Q. (Barkley, 1987); Classroom Teachers' School Situation Q. (Barkley, 1987); Classroom Teachers' Stress Reaction Q.; Implementing Structured Learning Stress Reaction Q.; Implementing Structured Learning Strategies in Every School Life Q.Strategies in Every School Life Q.

RESULTS: Study 4

48-Item-Classroom Child Behavioral Symptom Questionnaire: 48-Item-Classroom Child Behavioral Symptom Questionnaire: Pre-Post outcomes: mean overall scorePre-Post outcomes: mean overall score

979899

100101102103104105106

Classroom Child BehavioralSymptom Scale

Pre

Post

Pre-Post effect size d = 0.66

T- test for repeated measures, p<0.05

RESULTS: Study 4 continued-a: Figure 1

48-Item-Classroom Child Behavioral Symptom Questionnaire: Pre-48-Item-Classroom Child Behavioral Symptom Questionnaire: Pre-Post outcomes on item levelPost outcomes on item level

Behavioral SymptomsBehavioral Symptoms Pre-Post effect sizes Pre-Post effect sizes (d) [t-test](d) [t-test]

““Child does not do as he or she is told Child does not do as he or she is told and does not accept rules and respect and does not accept rules and respect limits" limits"

1.28 [p<0.01]1.28 [p<0.01]

“ “ ... has little motivation to find out or do ... has little motivation to find out or do something new "something new "

0.69 0.69 [p<0.05][p<0.05]

“ “ ... plays with light switches" ... plays with light switches" 0.63 0.63 [p= 0.05][p= 0.05]

RESULTS: Study 4 continued-b: Table 1

16-Item School Situation Questionnaire (SSQ, Barkley, 1987): Overall Intensity score16-Item School Situation Questionnaire (SSQ, Barkley, 1987): Overall Intensity score

0

0,5

1

1,5

2

2,5

3

School Situation Questionnaire

Pre

Post

[5-point Likert scales: 1= "situation (e.g., "group work", "gym" or "toilet")= not problematic", 5= "... is highly problematic"]

Effect size d= 0.54, t-test: p= 0.10, (=5!)

RESULTS: Study 4 continued-c: Figure 2

48-Item-Classroom Teachers' Stress Reaction Questionnaire: Pre-Post-48-Item-Classroom Teachers' Stress Reaction Questionnaire: Pre-Post-Outcomes: M-overall-scoreOutcomes: M-overall-score

82

84

86

88

90

92

94

96

98

Classroom Teachers' Stress ReactionScale

Pre

Post

Pre-Post effect size d = 0.67 [t-test, p<0.05]

RESULTS: Study 4 continued-d: Figure 3

48-Item-Classroom Classroom Teachers' Stress Reaction 48-Item-Classroom Classroom Teachers' Stress Reaction Questionnaire: Pre-Post outcomesQuestionnaire: Pre-Post outcomes

Teacher stress reactions related to Teacher stress reactions related to behavioral symptomsbehavioral symptoms

Pre-Post effect sizes Pre-Post effect sizes (d) [t-test](d) [t-test]

““Child does not do as he or she is told Child does not do as he or she is told and does not accept rules and respect and does not accept rules and respect limits" limits"

0.75 [p<0.05]0.75 [p<0.05]

“ “ ... requires a teacher only for him- or ... requires a teacher only for him- or herself during class"herself during class"

0.63 0.63 [p= 0.05][p= 0.05]

“ “ ... does not show any interest for the ... does not show any interest for the world around him or her" world around him or her"

0.63 0.63 [p= 0.05][p= 0.05]

RESULTS: Study 4 continued-e: Table 2

Implementing Structured Learning Strategies in Everyday School Life Implementing Structured Learning Strategies in Everyday School Life Questionnaire: OutcomesQuestionnaire: Outcomes

Semi-structured questionnaire with open-ended response sections

Results:

9 of 10 teachers applied ≥ 1 structured learning strategy [over period of > 2 months]

M= 1.8 strategies [SD= 1.5]

RESULTS: Study 4 continued-f: Figure 4

- - TopicTopic

- Design- Design

-Outcomes of a TEACCH-based social communication Outcomes of a TEACCH-based social communication enhancement intervention for individuals with ASDenhancement intervention for individuals with ASD-- Descriptive-observational study- Descriptive-observational study

ParticipantsParticipants - 3 individuals with ASD and Intellectual Disability (2 3 individuals with ASD and Intellectual Disability (2 boys, both aged 12.; 1 woman, aged 25); - 3 student boys, both aged 12.; 1 woman, aged 25); - 3 student training facilitators (1 B.Sc.-level/Psychol., 2 BA-level/ training facilitators (1 B.Sc.-level/Psychol., 2 BA-level/ Ed.); - 3 parents (mothers) ; - program supervisor (PP)Ed.); - 3 parents (mothers) ; - program supervisor (PP)

Aims of Aims of interventionintervention

-Enhancing social-communicative functioning during Enhancing social-communicative functioning during programmed play activitiesprogrammed play activities-- Social acceptance of the program's goals, methods and - Social acceptance of the program's goals, methods and effects by parentseffects by parents

Social- Social- Comm. Comm. InterventionIntervention

Comprising 21 centre-based weekly one-hour sessions Comprising 21 centre-based weekly one-hour sessions including both small group and one-to-one settings. : including both small group and one-to-one settings. :

Component 1: Using Component 1: Using Structured TeachingStructured Teaching (e.g. visually (e.g. visually structuring the individuals environment, such as structuring the individuals environment, such as delivering schedules)delivering schedules)

RESULTS: Study 5

Social- Social- Communicative Communicative InterventionIntervention

Component 2: Using Component 2: Using play activitiesplay activities including including closed-ended functional play (e. g. puzzles); closed-ended functional play (e. g. puzzles); open-ended functional play (e.g. playing a rhythm open-ended functional play (e.g. playing a rhythm instrument); instrument); closed-ended cooperative play (e.g. Picture Lotto)closed-ended cooperative play (e.g. Picture Lotto) open-ended cooperative play (e.g. improvising in open-ended cooperative play (e.g. improvising in playing instrument)playing instrument) symbolic play (e.g. talking with toy animals)symbolic play (e.g. talking with toy animals)

Parent-Parent-professional professional discussion discussion groupgroup

Comprising 3 two-hour sessions with parents, Comprising 3 two-hour sessions with parents, facilitators and program supervisor. Activities included facilitators and program supervisor. Activities included Presentation of the program in terms of aims and Presentation of the program in terms of aims and methods; methods; Exchange of autism-related information and Exchange of autism-related information and experiences; experiences; Presentation of selected video sequences showing Presentation of selected video sequences showing childrens' activities during program followed by childrens' activities during program followed by discussion on practical applicability of Structured discussion on practical applicability of Structured Teaching and some play activitiesTeaching and some play activities

RESULTS: Study 5-continued-a

RESULTS: Study 5-continued-b: Figure 1

Example of delivery of "visually structuring": picture schedule for S. [woman with ASD and severe intellectual disability, aged 25]

Note: The picture schedule, attached in the small group room is to be followed vertically from top to bottom. The schedule includes: (1) name card and (2) photo indicating the participant S of this schedule; (3) a (coloured) card containing table and chair symbolizing a request for movement: "Go with your facilitator to the one-to-one-room"; (4), (5) and (6) three cards in the colours of red, green and blue (shown as grey/white, white, grey) indicating three different play activities to be performed together with her facilitator. S finds the play materials in three boxes on which corresponding and identical coloured symbol cards have been attached; (7) the next (yellow) card with the smiley symbol directs S to a box containing her favourite play activities from which she can select one; (8) the last card functions as a directive for movement ("transit card") and tells S to go to the small group room and participate in musical activities there (singing popular songs accompanied by guitar). The corresponding identical card is attached on the outside of the group room door. (9) The movable arrow indicates what play task (4 to 7) is now active.;

Outcome Outcome measuresmeasures

Systematic Child behavioral observationsSystematic Child behavioral observations (based on videotaped therapy sessions; using (based on videotaped therapy sessions; using "partial interval time-sampling method") for 4 "partial interval time-sampling method") for 4 variables: Cooperative Behavior (including, for variables: Cooperative Behavior (including, for example, behavioral criteria such as "Participant example, behavioral criteria such as "Participant follows directions", "participates in social routines follows directions", "participates in social routines and games"; "acts together with another person and games"; "acts together with another person with sharing common focus"); (2) Non-Cooperative with sharing common focus"); (2) Non-Cooperative Behavior (e.g. "shows challenging behavior"); (3) Behavior (e.g. "shows challenging behavior"); (3) Spontaneous Communication ("initiates Spontaneous Communication ("initiates communicative situation by verbal expression or communicative situation by verbal expression or nonverbal expression, such as taking hands of nonverbal expression, such as taking hands of facilitator); (4) Responsive Communication ("reacts facilitator); (4) Responsive Communication ("reacts to another person verbally or nonverbally")to another person verbally or nonverbally")

Parent Program Evaluation QuestionnaireParent Program Evaluation Questionnaire (adapted from Mattejat & Remschmidt, 1998): (adapted from Mattejat & Remschmidt, 1998):

RESULTS: Study 5-continued-d

RESULTS: Study 5-continued-c: Figure 2

Mean percentage of Social-Communicative Behaviours

0,00%10,00%20,00%30,00%40,00%50,00%60,00%70,00%80,00%

small group

one-to-one

Note: Percentage (%) of 15-second observation intervals in which participants showed (1) Cooperative, (2) Non-Cooperative Behaviours ; (3) Spontaneous (Verbal / V or Nonverbal/ NV) Communication ; (4) Responsive (V or NV ) Communication

RESULTS: Study 5-continued-d: Table 1

Results of the 11-item Parent Program Evaluation Questionnaire [selected items], 4-point Likert scale [0= I strongly disagree, 4= I totally agree]

ItemItem M (SD)M (SD)

(1) Overall , the program was helpful for my child(1) Overall , the program was helpful for my child 2.7 (.58)2.7 (.58)

(2) The facilitator who implemented the program (2) The facilitator who implemented the program expressed empathy for the problems of my daughter/ son expressed empathy for the problems of my daughter/ son and the resulting demands on the familyand the resulting demands on the family

4.0 (.00)4.0 (.00)

(8) I felt sufficiently involved in the program(8) I felt sufficiently involved in the program 4.0 (.00)4.0 (.00)

(10) I have got a deeper understanding of my child's (10) I have got a deeper understanding of my child's abilities and deficits through contacts with the facilitatot abilities and deficits through contacts with the facilitatot by discussion and watching video samples of program by discussion and watching video samples of program sessionssessions

2.7 (.58)2.7 (.58)

(11) Overall, I am satisfied with the program(11) Overall, I am satisfied with the program 3.7 (.58)3.7 (.58)

Child-Child-related related OutcomesOutcomes

-Overall, the results (see Figure 2) suggest that beneficial Overall, the results (see Figure 2) suggest that beneficial settings were established in the social communication settings were established in the social communication enhancement program which enabled the individuals with enhancement program which enabled the individuals with autism to show more social-cooperative and autism to show more social-cooperative and communicative behaviours than they communicative behaviours than they usuallyusually show within show within the family, and thus substantially exceeding the parent-the family, and thus substantially exceeding the parent-reported informal baseline.reported informal baseline.- All three clients showed a wide range of social All three clients showed a wide range of social communicative behaviours, participating (a) in functional, communicative behaviours, participating (a) in functional, social and symbolic play of different kind and level, and social and symbolic play of different kind and level, and (b) in social routines of following schedules and visually (b) in social routines of following schedules and visually structured learning system (cf. Figure 1). structured learning system (cf. Figure 1).

Parent-Parent-related related outcomesoutcomes

Parent-Professional Relationship quality was very Parent-Professional Relationship quality was very positive, with a mean of 3.9, the Effectiveness of the positive, with a mean of 3.9, the Effectiveness of the program intervention was also evaluated positively, but to program intervention was also evaluated positively, but to a lesser extent (a lesser extent (MM = 2.6). The Global evaluation of the = 2.6). The Global evaluation of the program was clearly positive, with a mean of 2.9. The program was clearly positive, with a mean of 2.9. The high program satisfaction is reflected by the mean rating high program satisfaction is reflected by the mean rating of 3.7 (item 11).of 3.7 (item 11).

RESULTS: Study 5-continued-e

- - TopicTopic

- Design- Design- Outcomes of a TEACCH-based child-parent in-home - Outcomes of a TEACCH-based child-parent in-home training training - Descriptive Pre-Post-Follow-up single subject study- Descriptive Pre-Post-Follow-up single subject study

ParticipantsParticipants 5-yr-old boy with ASD, averbal, normal visuospatial 5-yr-old boy with ASD, averbal, normal visuospatial intelligenceintelligence

Aims of Aims of interventionintervention

(1) Enhancement of functional communication; (2) (1) Enhancement of functional communication; (2) Reduction of challenging behavior (aggression, temper Reduction of challenging behavior (aggression, temper tantrums; (3) Promotion of elementary verbal skills tantrums; (3) Promotion of elementary verbal skills (naming); (4) parent education & training; (5) teacher (naming); (4) parent education & training; (5) teacher support; (5) broad-spectrum parent supportsupport; (5) broad-spectrum parent support

Multimodal Multimodal interventionsinterventions

(1) 20 in-home child and parent sessions (à 3h= 60h) (1) 20 in-home child and parent sessions (à 3h= 60h) over 22 mo; (2) Broad-spectrum parent counselling over 22 mo; (2) Broad-spectrum parent counselling (10h); (3) classroom visits (15h); (4) interactions with (10h); (3) classroom visits (15h); (4) interactions with community agencies (10h, e. g. therapist expert community agencies (10h, e. g. therapist expert reports); reports);

Outcome Outcome measuremenmeasurementt

Video-based Behavioral observations; behavioral Video-based Behavioral observations; behavioral observation inventories, questionnaires, standardized observation inventories, questionnaires, standardized tests (Peabody Picture Vocabulary Test)tests (Peabody Picture Vocabulary Test)

RESULTS: Study 6

ChildChild (1) Improved functional communication (nonverbal and (1) Improved functional communication (nonverbal and verbal, e.g. requesting, rejecting); (2) acquisition of low-verbal, e.g. requesting, rejecting); (2) acquisition of low-level verbal abilities (e. g. naming, expression of 2-3-level verbal abilities (e. g. naming, expression of 2-3-word phrases, enhanced verbal comprehension); (3) word phrases, enhanced verbal comprehension); (3) improved behavioral functioning (less aggressive, less improved behavioral functioning (less aggressive, less vocal stereotypies, more on-task behavior in vocal stereotypies, more on-task behavior in preacademic and play activities); (4) successful preacademic and play activities); (4) successful transition from preschool to primary school, attending an transition from preschool to primary school, attending an inclusive class with full-time aide;inclusive class with full-time aide;

ParentParent (1) Implementation of structured teaching in daily life; (1) Implementation of structured teaching in daily life; (2) enhanced quality of the parental autism disability (2) enhanced quality of the parental autism disability concept; (3) positive evaluation of in-home trainingconcept; (3) positive evaluation of in-home training

TeacherTeacher (1) Implementation of structured teaching in classroom; (1) Implementation of structured teaching in classroom; (2) enhanced quality of the teacher autism disability (2) enhanced quality of the teacher autism disability conceptconcept

CommuniCommunityty

(1) Provision of social support (e. g. social welfare (1) Provision of social support (e. g. social welfare benefits); (2) assisting parents in school placement and benefits); (2) assisting parents in school placement and transition issues; (3) allocation of classroom aide ; transition issues; (3) allocation of classroom aide ;

RESULTS: Study 6-continued-a: OUTCOMES

CONCLUSIONS

Overall, the results of all six studies indicate evidence for positive outcomes of TEACCH-based interventions across multiple individuals, ages, settings and outcome measures

Limitations: (1) threats to internal validity (sample size, lack of control groups); (2) threats to external validity (selective samples, single-study)

Overall, TEACCH-based interventions: (1) lead to clinically and

educationally relevant effects across different settings; (2) show sufficient social validity across different caregivers; (3) support the assumption that they are also practicable in German-speaking countries, and compatible with local health care interventions

Further research is urgently needed, in particular for controlled replication studies

Thank you for your attention!

Acknowledgement to Collaborators: Tobias Leppert, Ph.D; M.S; Florian Jung, M.S; Jan Micheel, M.S; Iain Glen, M.S; Petra Steinborn, M.Ed.

Petia Gewohn, M.S; Christoph Faecks, M.S; Stefanie Brakemeier, M.S; Marzena Radzij, M.S; Julia Spreitz, MS;

Parents, teachers, and educators (participants)

Children, adolescents and adults with ASD (participants)

Email: probst@uni-hamburg.de

For related publications see:

Probst & Leppert (2008): Brief report: Outcomes of a teacher training program [...]. Journal of Autism & Dev.elopmental Disorders, 38, 1791-1796.

Probst, Jung, Micheel & Glen (2010). Tertiary prevention [...]. Life Span and Disability, 13 (2), 129-167

Probst & Glen (2011). TEACCH-based interventions for families [...]. Life Span & Disability, 14 (2), 111-138.

See Homepage: http://www1.uni-hamburg.de/Paul.Probst/ for download