TEACCH The TEACCH Autism Program is a therapeutic approach developed in the early 1970s at the University of North Carolina. One of the core principles of the treatment is “structured TEACCHing.” TEACCH Representative: One reason why structure is so important is that people with autism kind of lack a compass. They are, you could use the phrase, ‘They’re lost in time and space.’ They have trouble making decisions. They have trouble understanding the concept of when something is finished. They have difficulty with sequencing and organization. They have difficulty with time concepts, with generalization. They all have cognitive learning issues. Structure addresses all of those elements, and when properly done, it helps ground the person, helps them understand what is expected, helps them be calm, helps them focus their attention better. The structured teaching involves careful organization of the environment, predictable ordering of activities and events, and strong reliance on visual supports. JALEN, 4 years old Susan Boswell: Interestingly enough, Jalen’s only been with us for eight days this summer, four hours a day, and we are noticing that as he is becoming comfortable in the environment and is picking up on all the structured tools that we’ve placed there and are teaching him to use, we are seeing some really unusual skills starting to emerge. He’s looking at the letter and she’s presenting the picture as well and giving him these words; and as he learns them in a highly structured setting, I think they will start coming out communicatively. That’s what we usually find. Teacher with Jalen: All done. Time. Susan Boswell: Eye contact is a very misunderstood diagnostic feature of autism. Jalen uses eye contact almost never; very, very rarely. We see it emerging. There has been more, at least glancing into someone’s face as if, as if to say, ‘Are you looking at me? Are you paying attention?’ In the long run, maybe another week from now, he would actually be turning and looking at the person beside him. That would be our goal, is that he learns to do that. Teacher: Just when he’s engaging in an activity, sometimes you’ll hear a word come out, but you don’t see consistency with those words. Training Program for Therapists and Educators (visuals) Susan Boswell: As we’ve taught him the structure, we’re seeing a child who can communicate a bit more and who can connect a bit more. Teacher with Jalen: A budding artist, aren’t you. Susan Boswell: Communication involves shared affect, gesture, and that word is all integrated, and that’s what we’re looking for. BRUCE, 6 years old Susan Boswell: Let’s take Bruce, for example. His teacher will feel obligated to teach him the first grade curriculum. Well, what will keep Bruce from learning that first grade curriculum? Well, it won’t be his I.Q. points, but it’s his autism, his difficulties with coping skills, understanding social feedback, and communication; those will be the things that will keep him from accessing the academic curriculum. Teacher with Bruce: Hey, friends, what vacation do you like? I like beach. I like the beach, too. That was fun. Susan Boswell: So visuals are great for keeping someone focused and reminding them of things they need to know, those figurative language pieces. Last week she introduced him to a little card system where he can read about ‘frustrated, happy, and sad.’ Teacher: So we put ‘Sounds like. . .’ and give him the words he can use to describe his emotions. So when he’s sad, he has words, not only do ‘I feel sad,’ but ‘I need a hug,’ or ‘I need a break.’ And frustrated is one he encounters a lot in his school career. I don’t prompt him by saying, ‘Oh, Bruce, I think you’re frustrated.’ I say, ‘How are you feeling?’ And he looks down and checks which one am I feeling, and then he’ll open to the right thing. Susan Boswell: He, even though he’s quite young, has a pretty decent reading vocabulary, and he’s very interested in any kind of visual instructions. He looks for visuals; he can become very absorbed with visuals. As a matter of fact, sometimes he becomes overly absorbed with visuals. Susan Boswell with Bruce: He’s pretty good playing by himself there. Feel free to observe him. Susan Boswell: He’s over-focused on a little piece of plastic that had Play-Doh stuck to it. Teacher with Bruce: Bruce, can I clean it for you, that Play-Doh stuff? It’s all clean. Susan Boswell: He needed to get every molecule of that Play-Doh off. Teacher with Bruce: I’ll clean it. Thank you. Now you can get your biscuit. No, no. Susan Boswell: Starting with a small problem, and it becomes a huge problem. Teacher with Bruce: I’ll clean it. No (screaming and crying). Bruce, just relax. No. Come on. O.K. Susan Boswell: He pitched himself into the floor, and he just fell on the floor crying. Teacher with Bruce: I feel. Frustrated. O.K. What can we do to solve the problem? Susan Boswell: How did his teacher solve that problem? She recognized that this is a teachable moment for him. Teacher with Bruce: You know what helps me feel better. What’s my favorite? Which one’s my favorite? What’s my favorite? Sometimes a couple of nice, calm, structured activities, meaning more relaxed, or check schedule. Check schedule. Susan Boswell: And within a couple of minutes he was able to get himself under control and come back and address his work again. Teacher with Bruce: There’s something in there. I think he goes ‘oink, oink.’ Pig. You’re right. It’s a pig. That’s funny. I got a smile. Susan Boswell: Language is here and gone. You say a word, you hear it, and it’s gone. And the visual is there for you, and it makes the process easier for you to remember. Teacher with Bruce: Can I have the marbles. Yes, you can. Susan Boswell: That seems to be really key, both for learning new skills and for accessing old skills. Another of TEACCH’s core principles is that families are equal partners in the treatment process. In this session, therapists work with both a mother and her son at the same time. WILL, 4 years old Linda Varblow: Um, Will is a little boy that I saw for his intake, when he was, um, when his parents were first concerned that he might have autism, and this, he’s four years old now, he was two then. Linda Varblow with Will: Wah. Check your schedule. See where you’re going to go. Put it in the pocket. Wait. Will, put it in this pocket. This pocket. Right. Therapist observing with Will’s Mother: What I think is, one of the things that Linda was using with Will today just to let him know how much, what sequence of activities he was going to be participating in, was the visual schedule that he has on the wall. Linda Varblow: Kids with autism do like routines, and so using a functional routine instead of something that he might invent on his own that might not be functional, is a really good thing. Linda Varblow with Will: Take the bus. You want to take the bus? O.K. Give me the cars first. I like this one too. O.K., I’ll hold this one. I want to hold this one. Will. Will’s Mother: One of the things we try to do, you know, he’s so obsessed with cars, is to get him to do other things. Linda Varblow with Will: O.K. We’re going to put the bus right here so you can see it. Therapist observing with Will’s Mother: And so, instead of trying to just take it from him, which would be difficult for him, and he wouldn’t necessarily understand why, one of the strategies that’s really helpful is just to let him bring that with him and then have a place where it can stay. Linda Varblow with Will: Uh, huh. I like the bus. Leave the bus here. I want to see. O.K., we need to get your, we need to go get your work. I play with this. O.K., but you have to go get your work. Linda Varblow: That’s pretty much a hallmark of, you know, what autism is all about. They have interests and they do those interests. That doesn’t always help them towards learning new things or becoming independent. Linda Verblow with Will: Alright. Therapist observing with Will’s Mother: Linda was getting him engaged in the next activity so that he can begin to work. The other thing that’s really helpful is just the routine of putting things in the finished basket, so when he’s finishing with an activity, she’s having him put it finished and labeling it that way. Linda Varblow with Will: Now go look for this one. Linda Varblow: We would take some organizational activities. . . Linda Varblow with Will: Push. Good. Here. Now do another one. Linda Varblow: Language activities. . . Linda Varblow with Will: And this one, this one spells BOY, B – O – Y. Boy. That’s right. Linda Varblow: And just kind of throw them out there to see where his strengths and weaknesses lie. And I think it was amazing, you know, considering I had never worked with him how well he did work and his mom was excited to see how well he could sit at the table. Will’s Mother: And I’ve seen him play games like this. Linda Varblow with Will: O.K., push hard. Push. Therapist observing with Will’s Mother: And she’s working on looking at some of his play activities, play skills. Linda Varblow with Will: I make. I think this is finished. Next, we are going to look at pictures. Linda Varblow: Children on the spectrum, one of the things that is often a struggle for them is reading people’s facial expressions, body language, and things like that. So a place to start with them is through the use of photographs. Linda Varblow with Will: Some of the pictures are happy people, and some of the people are not happy. O.K. Linda Varblow: Will’s little sister is probably just going to know this, you know, she will look at her peers and know whether they’re happy or know whether they’re unhappy. But Will probably doesn’t have that ability, and needs to be taught in order to have that ability. Linda Varblow with Will: So can you tell me, are they happy or not happy? This is happy. You’re good at this. Will’s Mother: When we first got the diagnosis of autism, I almost looked at it as like a death sentence, like what does this mean? He’s never going to be normal, they immediately gave us a whole list of resources. They taught us key phrases to use with Will. He’s still going to make progress, and it’s just a little bit slower than other children, but he’s doing really, really well. The TEACCH approach focuses on understanding the perspective of the person with autism, and creating an individualized program which emphasizes a individual’s strengths, as well as weaknesses. JULIAN, 16 years old Training Participant with Julian: Put your hat here. Put your hat here while you work. Mindy Govan: So I met Julian a little over a year ago, and I had him come into the clinic and we worked, just working with him so I could see what his particular learning style was. Mindy Govan with Julian: What’s mine. Um. I like Mulan. Mulan is made possible by a grant from the Corporation for Public Broadcasting. Do I sound like it? Oh, yeah. Oh, yeah. Kick it. Kick it. Can I say kick it? The show’s over. Working? Uh, huh. Mindy Govan: Julian is a character with very uneven skill development. Training Program for Therapists and Educators (visuals) Training Participant with Julian: Well, White Harrison Avenue. Can you make eight? How many is that? Fourteen. Is eight more or less? More. More than fourteen. Yes. Eight is less. Less. How do we make it less? Mindy Govan: If we put the visual structure in place for him, he’s driven to follow it, and he’s very good at following it. Training Participant with Julian: How do we put the mail in? Do you have a hammer? Do you have a hammer? No. Mindy Govan: He can read, he can understand what he’s reading, but his speech, although he’s very, very talkative, he’s not communicative. Training Participant with Julian: Can you introduce yourself to the people first? Hi, Robert. Hi, Melanie. Hi, Joanne. Mindy Govan: Realistically, he not going to not talk for very long. But if you redirect by pointing to this, that’s why it’s going to disappear. He’s going to hide it, because he doesn’t want to not talk. Mindy Govan with Julian: Do you know what I like. No. I like it when you sing Diana Ross. Will you sing me Diana Ross? ‘Don’t lose your way with each passing day. You’ve come so far, don’t throw it away.’ Light green is recycling? I like that. You have a hammer? Are you a hammer? Yeah. No, you’re not a hammer. You’re a boy. Don’t hit. Have you seen Hammer Strong? No, but are you going to hammer your leg? Yes. No. Mindy Govan: All the speech that he does keeps him off-task and I think will get in the way of his future employment possibilities unless we can get him to stay focused on task longer. Mindy Govan with Julian: Let’s finish. We’ve got to finish. Like Children’s Television Workshop? Uh, huh. Fold them? Mindy Govan: If you notice when you’re watching Julian, if he gets very distressed or confused or doesn’t know what he’s supposed to do, you’ll hear a lot more of the repetitive questioning. Mindy Govan with Julian: And fold. Nice. Look at that. Ha, ha, ha. Oh, that was nice. Am I Tony Bennett? Can you put it in? Am I Tony Bennett? Are you working? I’m Tony Bennett. Are you working? No, I’m not. You did great. Ha, ha, ha. Excuse me. Ha, ha, ha, ha, ha. Mindy Govan: We’re working with Julian only a short period of time, and the model behind TEACCH is to train in the family, um, as co-therapists so that they can learn the strategies that we’re using and understand why we’re using the strategies, because the task itself is not as important as the why, the why and the how. Training Participant with Julian: That’s your turn. You like counting clothes? Yes. Perfect. Am I Miami Bollard? So have a cup of flour and it has to be just right. There you go. You scraped it off good. Just right. It’s just right. Very good. Mindy Govan: He has great vocational potential. I think what I’m learning about Julian is that for him, he will need a task that is predictable, but yet changes. Mindy Govan with Julian: I want to be a police officer (whistling like siren). Do I look like it? Yes. Ta daa. What does it mean? It means you’re finished. You have the channel? Mindy Govan: I think Julian has another two years in school, two to three, um, and I think he’s going to be employable and then will work more on the independence with vocation skills. TEACCH Representative: So the question that often comes up when we see a family or an individual for the first time when they are older such as fourteen, fifteen into their twenties or thirties, the question is, ‘Is it too late to get started?’ And I’m a strong believer that it is never too late to get started, that the information you get at that point can be put to use right away, and the changes you make can help that person right away. I’m also a strong believer in, I think there’s supporting evidence that says that people with autism are lifelong learners, and some of them may be because of neurological maturation, some of it may be cumulative experience, some of it may be getting into the right program at a certain point in time. But people with autism continue to learn.