Transcript Folie 1

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
update: 25.07.2012,
Author's note: Due to severe family health problems, this
presentation is going to be completed not before the middle of
August, 2012; [email protected] , Homepage:
http://www1.uni-hamburg.de/Paul.Probst/
THEORETICAL BACKGROUND
1. State-of-the-art autism concept
 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
influencing early brain development;
component
 Prevalence: total: 0.4 % [conservative estimation]
 Tertiary prevention: i. e. preventing disability progression and associated suffering
by alleviating behavioral symptoms and strengthening compensatory abilities;
2. Caregiver-Stress-Coping- Tertiary Prevention Model (adapted from Pakenham
et al., 2005; Antonovsky, 1993: "Sense of Coherence"/ SOC)
INDIVIDUAL with ASD:
TERTIARY INTERVENTION:
* Enhancing abilities
 Individual (ASD)-Focused (Need for SOC)
* Reducing obstruct. deficits
 Caregiver-Focused (Need for SOC )
DEMANDS &
STRESSORS
Caregiver
Adaptive
RESSOURCES
APPRAISAL
of Stressors
Caregiver
COPING:
Problem-/
EmotionFocused
Family/ Classroom/
Group home/
Workshop/
FUNCTIONING
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;
AIMS OF THE SYNOPSIS STUDY:
Can key components of the TEACCH program be generalized to Germanspeaking countries in terms of effectiveness and social acceptance
METHODS
 Participants: children and adults with ASD; parents; teachers and educators
 Instruments: behavioral observation, questionnaires, interviews
 Data analysis : quantitative and qualitative procedures
 Selective outcomes of four autism intervention studies are reported
RESULTS: Study 1
- Topic
- Design
Single subject social communication training study in a residential
home. - Pre (baseline)-Post-design,
Participants
- 7-yr-old girl (L) with ASD and severe intellectual disability, averbal,
self-injuring behaviors (PICA);
- TEACCH-trained therapist (master's student)
(1) Enhancement of social communication; (2) Reduction of
challenging behavior; (3) teaching a valid autism disability concept to
caregivers
(1) 12-session-communication training using structured teaching
methods (schedule, choice-board management; (2) oral discussions
with caregivers
(1) video-based systematic behavior observation;
(2) Behavior Problems Inventory (BPI);
(3) qualitative interview data analysis
Aims of
intervention
Intervention
methods
Outcome
measurement
Study 1-Figure 1
Pictorial Schedule
for L
1= Foto & Name-Card for L
2= Go-to-your-WorkPlace-Card
3= Recreation-Card=
"Go to your Choice-Board!"
Study 1-Figure 2
Two ElementPictorial Schedule
for L [see bottom
line]
* Listening-to-Favourite-Music-Card;
* Flapping-Glove-Card (favourite activity)
RESULTS: Study 1-continued: OUTCOMES
Communication
training
Improved autonomous and spontaneous management of picture
schedule and choiceboard, compared with baseline
Challenging
behaviors (PrePost)
(1) Reduced problems in BPI-Full-Scale
(2) Reduction in BPI-item "Pica" from "daily" to " monthly ";
(3) Reduction in BPI-Item "Biting/ Cruel" from "weekly" to
"monthly"
Positive evaluation of the 12-session training intervention as
helpful and relieving: (a) child less aggressive, more predictable
and communicative; (b) better understanding of functional
aspects of challenging behaviors
Social acceptance
by caregivers
RESULTS: Study 2
-Topic
- Design
Participants
Aims of
intervention
Intervention
methods
Outcome
measurement
Outcomes of a 3 -year TEACCH-based intervention in a residentialvocational setting
Pre-Post [retrospective]-design
- Three male adults with ADS and intellectual disability;
- TEACCH-trained staff supervisor and educators
(1) Reduction of disruptive behaviors and enhancement of social
communication abilities; (2); social acceptance of the TEACCH approach
by residential-vocational staff
(1) Implementation of TEACCH components (e. g. schedules, work
systems) for individals with ASD; (2) Education, training & supervision of
staff members
(1) Matson Evaluation of Social Skills [...] (MESSIER)
(2) Developmental Behaviour Checklist f. Adults (DBC-A
(3) BPI, (4) TEACCH evaluation caregiver interview
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 TopDown-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
RESULTS: Study 2-continued: OUTCOMES
Disruptive and
Challenging
behaviors (PrePost)
(1)
DBC-A-Disruptive: significant decrease for all three
individuals: M-RCI (Reliable Change Index) = 2.43; (p <0.05)
Evaluation by
caregivers
Overall, positive evaluation: (a) report enhanced communication
between caregivers and clients with ASD; (b) more independence
and autonomy of clients; (c) less aggressive beahviors in T.
(d) criticism: possibility of reduced flexibility
(2)
DBC-A-Total-Problem-Behavior: significant decrease (MRCI= 2,55);
RESULTS: Study 3
- Topic
- Design
Outcomes of education and skills group parent training for ASD
Pre-3-mo-Follow-up-design
Participants
(1) 24 parents (83% mothers) of 23 children with ASD (M-age= 8.9);
trainer and assistant trainer with TEACCH /ABA expertise
Aims of
intervention
(1) Teaching an adequate concept of ASD ; (2) Enhancing parents'
emotional and social experiences by parent-to-parent communication;
(3) Teaching structured educational strategies & skills
Intervention
methods
(1) 3-session small group training (in total 24 h); teaching methods
included lectures, group discussion, video and in-vivo modelling; role
play, assignment of homework;
Outcome
measures
(1) 23-item-Parent Evaluation Questionnaire; (2) Home Diary
Experience Questionnaire
RESULTS: Study 3-continued: OUTCOMES
Parent Evaluation
Questionnaire
Parents report (1) "improved parental skills in daily family life"
(86%) , (2) "improved mental health" (76%), (3) "positive effects
of exchanging experiences with other parents" (100%);
Home Diary
Experience
Questionnaire
12 of 16 responding parents (75%) reported one or more
implementation of structured teaching methods ( picture
schedules, physical structure, task organization)
RESULTS: Study 4
- Topic
- Design
- Outcomes of a TEACCH-based child-parent in-home training
- Descriptive Pre-Post-Follow-up single subject study
Participants
5-yr-old boy with ASD, averbal, normal visuospatial intelligence
Aims of
intervention
(1) Enhancement of functional communication; (2) Reduction of
challenging behavior (aggression, temper tantrums; (3) Promotion of
elementary verbal skills (naming); (4) parent education & training; (5)
teacher support; (5) broad-spectrum parent support
(1) 20 in-home child and parent sessions (à 3h= 60h) over 22 mo; (2)
Broad-spectrum parent counselling (10h); (3) classroom visits (15h); (4)
interactions with community agencies (10h, e. g. therapist expert reports);
Video-based Behavioral observations; behavioral observation inventories,
questionnaires, standardized tests (Peabody Picture Vocabulary Test)
Multimodal
interventions
Outcome
measurement
RESULTS: Study 4-continued: OUTCOMES
Child
Parent
Teacher
(1) Improved functional communication (nonverbal and verbal, e.g.
requesting, rejecting); (2) acquisition of low-level verbal abilities (e. g.
naming, expression of 2-3-word phrases, enhanced verbal comprehension);
(3) improved behavioral functioning (less aggressive, less vocal stereotypies,
more on-task behavior in preacademic and play activities); (4) successful
transition from preschool to primary school, attending an inclusive class
with full-time aide;
(1) Implementation of structured teaching in daily life; (2) enhanced quality
of parent autism concept; (3) positive evaluation of in-home training
(1) Implementation of structured teaching in classroom; (2) enhanced
teacher autism concept
Community (1) Provision of social support (e. g. social welfare benefits); (2) assisting
parents in school placement and transition issues; (3) allocation of
classroom aide ;
CONCLUSIONS
 Overall,
the results of all four small-scale 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, control groups); (2) threats to
external validity (selective samples, single-study)
 Cautiously viewed, 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 tertiary 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
 Florian Jung, M.S.
 Jan Micheel, M.S.
 Iain Glen, M.S
 Petia Gewohn, M.S, Christoph Faecks,
M.S, Stefanie Brakemeier, M.S, Marzena
Radzij, MS, Julia Spreitz;
 Petra Steinborn, M.Ed
 Parents, Teachers, and Educators
 Children, adolescents and adults with ASD
Email: [email protected]
 Probst, Jung, Micheel & Glen (in print).
Tertiary prevention [...]. Life Span and
Disability, xx,
 Probst & Leppert (2008): Brief report:
Outcomes of a teacher training program
[...]. Journal of Autism & Dev.elopmental
Disorders, 38, 1791-1796