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

A synthesis of six related TEACCH-based outcome studies for Autism Spectrum Disorders (ASD). Paul Probst , Department of Psychology, University of Hamburg.

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

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  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, 2012Symposium "Evidenced-based interventions for Autism Spectrum Disorders (ASD): International concepts and outcomes (Convener: Paul Probst) 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

  2. 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 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;

  3. 2. Caregiver-Stress-Coping- Tertiary Prevention Model (adapted from Pakenham et al., 2005; Antonovsky, 1993: "Sense of Coherence"/ SOC) • TERTIARY INTERVENTION: • Individual (ASD)-Focused (Need for SOC) • Caregiver-Focused (Need for SOC ) INDIVIDUAL with ASD: * Enhancing abilities * Reducing obstruct. deficits Caregiver Adaptive RESSOURCES Caregiver COPING: Problem-/ Emotion-Focused Family/ Classroom/ Group home/ Workshop/ FUNCTIONING DEMANDS & STRESSORS APPRAISAL of Stressors

  4. 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-CaregiverCooperation • InternationalProgramDissemination professional training;

  5. AIMS OF THE SYNOPSIS STUDY: 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 METHODS • Participants: children, adolescents and adults with ASD; parents teachers and educators als cargivers • Instruments: behavioral observation, questionnaires, interviews • Data analysis : quantitative and qualitative procedures

  6. RESULTS: Study 1

  7. Study 1-Figure 1 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!"

  8. Study 1-Figure 2 Two Element-Pictorial Schedule for L [see bottom line] * Listening-to-Favourite-Music-Card; * Flapping-Glove-Card (favourite activity)

  9. RESULTS: Study 1-continued: OUTCOMES

  10. RESULTS: Study 2

  11. 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

  12. Study 2: Figure 2: Typical matching task for T

  13. RESULTS: Study 2-continued: OUTCOMES

  14. RESULTS: Study 3

  15. RESULTS: Study 3-continued-a: Figure 1 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

  16. RESULTS: Study 3-continued-b: OUTCOMES

  17. RESULTS: Study 4

  18. RESULTS: Study 4 continued-a: Figure 1 48-Item-Classroom Child Behavioral Symptom Questionnaire: Pre-Post outcomes: mean overall score Pre-Post effect size d = 0.66 T- test for repeated measures, p<0.05

  19. RESULTS: Study 4 continued-b: Table 1 48-Item-Classroom Child Behavioral Symptom Questionnaire: Pre-Post outcomes on item level

  20. 16-Item School Situation Questionnaire (SSQ, Barkley, 1987): Overall Intensity score RESULTS: Study 4 continued-c: Figure 2 [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!)

  21. RESULTS: Study 4 continued-d: Figure 3 48-Item-Classroom Teachers' Stress Reaction Questionnaire: Pre-Post-Outcomes: M-overall-score Pre-Post effect size d = 0.67 [t-test, p<0.05]

  22. RESULTS: Study 4 continued-e: Table 2 48-Item-Classroom Classroom Teachers' Stress Reaction Questionnaire: Pre-Post outcomes

  23. Implementing Structured Learning Strategies in Everyday School Life Questionnaire: Outcomes RESULTS: Study 4 continued-f: Figure 4 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]

  24. RESULTS: Study 5

  25. RESULTS: Study 5-continued-a

  26. 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.;

  27. RESULTS: Study 5-continued-d

  28. RESULTS: Study 5-continued-c: Figure 2 Mean percentage of Social-Communicative Behaviours 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

  29. 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]

  30. RESULTS: Study 5-continued-e

  31. RESULTS: Study 6

  32. RESULTS: Study 6-continued-a: OUTCOMES

  33. 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 alsopracticable in German-speaking countries, and compatible with local health careinterventions • Further research is urgently needed, in particular for controlled replication studies

  34. Thank you for your attention! Email: probst@uni-hamburg.de • 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) 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

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