An Introduction to Autism
Autism is a neurodevelopmental disorder characterized by impaired social interaction and communication and by restricted and repetitive behaviour (American Psychiatric Association, 2000). These signs begin all during the childhood. The first systematic description of autism was made by the psychiatrist Leo Kanner (1943). The dominant and special features of the eleven clinical cases studied by him were the absence of social awareness and often lack of interest about the others. To describe more precisly these children, he introduced the word autism, which derives from the Greek word "self", that refers to the person who is disconnected from his environment and others; and the main symptom is the self-absorption. The social disability of people with autism remains even after 60 years of research and clinical practices as the main characteristic that separates autistics from other categories of people with disabilities and perhaps is the only behaviour that is less understood (Lord, 1993). Autism is characterized by three impairments, (referred to as the "triad"):Â a) absence or impairments of social interaction, b) difficulty in communication and c) hardship in developing imagination (Frith, 1989; Mesibov et al, 1997). These three impairments are shown in a wide variety of ways, but the underlying similarities are recognizable. Since the disorder of autism affects many areas of a child's development, behaviour is manifested as the child grows. In the most classical form, some features such as lack of imaginative play and avoid eye contact are critical predictors of autism from the age of 18 months (Baron-Cohen et al, 1996; Osterling & Dawson, 1994).
The TEACCH Approach
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The approach most widely associated with autism is known as
TEACCH (Treatment and Education of Autistic and related Communication handicapped CHildren). It was developed by the Department of Psychiatry, School of Medicine, in the University of North Carolina, USA during the 1960s. The TEACCH is an alternative education program for children with autistic spectrum disorders (ASD), which includes visual materials, daily schedules, work systems and task organisation. Language, imitation, social and cognitive skills are emphasized. The TEACCH method is not considered an actual therapy but rather a therapeutic tool to help autistic individuals understand their surroundings. The TEACCH method provides the individual with structure and organization.
The Structured Teaching
The Structured Teaching is the main teaching approach used by
the program TEACCH (Treatment and Education of Autistic and related Communication handicapped CHildren). This approach is one of the prevailing educational approaches in the field of autism, based on the principles of theories of learning and build upon the findings of cognitive psychology for the specific cognitive characteristics of students with autism (Mesibov et al, 2005). It is a strategy that helps a person with autism to develop his autonomy. It consists of the reconstruction of learning environment with basic method the visual organization, which has emerged as an appropriate approach to teaching and social integration of children and adults with autism (Hodgdon, 1995; Mesibov & Howley, 2003; Quill, 1995). The Structured Teaching is an approach specifically designed for students with autism and can be applied in conjunction with the main teaching approaches in special education, such as direct teaching, work analysis, etc. (Mavropoulou, 2006) An important part ofÂ the T.E.A.C.C.H. program concerns the teaching skills for independent work through the visual organization of the environment (Schopler & Mesibov, 1995). The structured environment best suits people's autism thinking. When the functions of each
space environment are clear, then the requirements are more easily understood from those invited to respond to it. Moreover, the
organized environment is predictable and easier for people with autism to
adapt. The students learn to be responsible for their daily program, which has a form that shows them the space to perform each activity and the supervision or assistance given by the teacher. There is always a need to teach students with autism different activities, in order to make them capable of operating in situations that are not so clear structured. The Structured Teaching is also applied for the visual organization of adults' life both in their everyday life and in their professional employment (Faherty, 2003).
The principles of The Structured Teaching
The principles of the Structured Teaching are:
Always on Time
Marked to Standard
The consistency, the stability and predictability of a class environment.
The visually structured education can dramatically affect the behaviour of students with autismÂ (Peeters, 2000). This is achieved mainly through the repetition and the daily routine of each individual program- regardless of its form- which will reduce the uncertainty and the anxiety of the studentÂ (Peeters 2000, Faherty 2003).
Full exploitation of the interests of the student.
The detailed assessment helps teachers to confine students' interests.Â Thus, most of the activities are based on their own interests and consequently, their performance is increasedÂ (Peeters, 2000).
The introduced activities must have a specific meaning to the students with autism.
Usually students with autism can understand, learn and
remember what isÂ relevant to their particular interests since these are meaningful for them. Teachers need to test several different types of educational programs and activities to find the most effective and appropriate for each student (Faherty, 2003).
The objectives of The Structured Teaching
The Structured Teaching is a method that is primarily intended
to help students with autism to understand the world around them
and to behave in a more appropriate way. It is an organization system of educational materials that facilitates learning and promotes the autonomy of students. It builds on the preferences and special interests of children with autism and is useful in the classroom, at home, in leisure time and also in the professional world. In addition, it helps the child with autism to be calm, to focus on what is most important to him andÂ to obtain a more appropriate behaviour (Faherty, 2003). Briefly, the Structured Teaching can provide the student with autism:
Consistency and predictability of events resulted to a more illustrated
environment without uncertainty and anxiety.
Reduction of difficulties concerning behaviour and time, so as
the student with autism to understand what he does and manages betterÂ his time.
Stability and simpler situations. It helps the child with autism
to understand, and focus on the basic meaning of a situation without beingÂ "lost" in the details.
Increase of theÂ autonomy. The understanding of the environment
increases the student's abilityÂ to controlÂ his environment and become more independent in many areas of his life.
It is essential the structure of the environment to remain unchanged even after the child has understood it. As he grows, the structure is being adapted to his needs. At each case, the basic structure of the environment in which he lives, works or is trained will be of particular importance, such as a person with visual impairments needs always to wear glasses in order to be autonomous.
The key elements of The Structured Teaching
The Structured Teaching has four important components: a) the
physical structure and organisation of the room's environment, b) the structure of the daily program, c) the individual work systemÂ and d) the structured learning activities (Schopler et al, 1995). More specifically:
Structuring the room: The term refers to howÂ the furniture and
educational materials are placedÂ at school, at home or in the working area of aÂ child or adult with autism. A significant matterÂ is the reduction and containment, if possible, of the auditory and visual impairements when these impairements disrupt the person with autism (Faherty, 2003). The main areas of instruction in a class of students with autism are:
the room forÂ 'one-to-one' teaching
the room for group activities
the space for free or structured play and recreation and
the area of transition from one activity to another.
By using spacers - which can be shelf, dashboard or simply paperboard - each student has its own place to study, that clearly distinguishes him from other students with autism. Moreover, weÂ signal individually these placesÂ with pictures or words in order to have full clarity about their use. By signalling these places, teachers show to the children the functionality of the place and also help to reduce children's behavioral problems caused by the "chaotic" environment.
Structuring the individual daily program: The main objective ofÂ the
program is to assist the student with autism to understand the organization of the school life and to participate actively in it. Essentially what the student is taught through the program is an expressive and organized way of his life. A simple program has two activities: work comes first and game follows - never vice versa. With such a program, information is given to children with autism about what proceeds and what follows. When the child is familiar with this series of activities, then the teacher can enrich the program with other step by step activities and thereby reduce any inconvenience caused toÂ children with autism. It should be noted that each child with autism needs to learn to follow a routine and do all the activities - even those with a short duration - at each classroom. Also, there has to be a good distribution of teaching time in each teaching area. To develop a personalized daily program, the teacher shall proceed as follows:
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Evaluate the cognitive level of the student, in order to establish a program with elements that can be easily understood by the student with autism.
Select the format of the program, which may consists of: objects,
pictures, designs and symbols, designs and words, only words or combination
of these. AnyÂ form of the program the teacher will use, should reflect at least
one of the followings: the place of activity, the teaching materialsÂ that will be used, theÂ person with whom the student will work.
To determine the number of program activities: Based on the
assessment the teacher will decide if the student's program will be daily or hourly. Usually, theÂ favourite activities or routines of the student are placed in the program as a reward.
DecideÂ on the use of the program: The teacher selects how the
student will use the program and then teaches himÂ how to do it. For example, he may simply tick the activities done if the program is written on a sheet of paper or a calendar. Another way is to put in a file those cards that showÂ the activities which are already performed.
Structuring the individual working system: The working system is
always placed in a specific area of autonomous work or in any other place that is chosen upon a teacher's consideration. With that system, the student
"builds" a working method based on autonomy. An appropriate working
system must provide the following information to the student:
how many activities has to be done.
which activities he will make
how will he know that is done, and
what will he do afterwards?
To develop a system of individual work, the teacher has to select:
the position of the working system
the form of the working systemÂ
a concept (i.e. a symbol) which shows that the work is done
Depending on the cognitive level of students there are different working systems. The simplest systems areÂ consisting of items that teacher puts in a specific order (from the top to the bottom or from the left to the right) on each student's desk. Other working systems are based on colours matches,Â shapes, numbers or letters. Finally, in some more complex working systems, the activities are depicted with pictures and words, with words or proposals only, or with a combination of all the above.
Structuring of the educational activities: The structured approach
involves the design and development of educational activities with visual
organization and visual instructions, which should be very clear, in orderÂ the
child with autism to understand the requirements of each activity. The activities based solely on oral instructions are likely to have fewer learning benefits. According to the structured approach, the parameters for the development of educational activities for children with autism are based on:
The visual organization of the material which intends to limit the
The visual instructions given toÂ the student, to know how to perform an activity.
The visual clarity, so asÂ the student to understand the meaning of
and how to deal with the material activity.
A critique of the Structured Teaching
Significant enhancement in appropriate behaviour and
communication is the main advantage of the structured teaching. The structure helps young people and childrenÂ with autism to make sense of their surroundings and to focus appropriately on tasks without frustration and anxiety, which couldÂ lead to behaviour problems in fewer structured circumstances. Structured teaching is improving the visual abilities of children with autism, hence minimizing the potential negative effects on learning from deficits in areas such as auditory processing difficulties in students' behaviour and to increase students' adaptation and independent performance In 2003, Van Bourgondien and his colleagues found some support for using TEACCH approaches in residential program treatment for adolescents and adults with both mild to severe autism and cognitive delay. Also, it has been found that TEACCH methods resulted in higher family satisfaction. However, they were not perceived to increase children's acquisition of skills. In other researches studying the results of other related home-based treatments (Ozonoff & Cathcart, 1998) and residential program treatments have supplied some support to the TEACCH approach. (Van Bourgondien et al, 2003In a quasi-experimental study conducted by Ozonoff & Cathcart in 1998, home-based treatment concentrating on training parents in TEACCH approaches was associated to important gains in cognitive and developmental abilities such as motor skills, and cognitive performance. However, the children who took part did not score much higher after the intervention than the control group on perception and a cognitive verbal test. Additional study using the TEACCH method in Italian schools found that students with autism and disability improved in scores on perception, hand-eye coordination, motor skillsÂ and cognitive performance when using the TEACCH approach versus the control group, which made an enhancement only in hand-eye coordination. (Panerai et al, 2002). A more recent study ofÂ 5 andÂ 6 year-old students with autism, as well as a 22 year-old student, established gains and maintenance of on-task behaviour and work completion.Â Â Â (Hume & Odom, 2007). To conclude, our critique can be
seen in the table below:
Â ADVANTAGES OF TEACH.
DISADVANTAGES OF TEACH.
Often funded by public schools
The experts of TEACCH do not appear to produce empirical evidence, which prove that the children's symptoms are gettingÂ improved with their method
Recognizes the need for lifetime support from early childhood to adulthood
Social interaction and verbal communication are not emphasized
Includes parents as co-therapists, thereby increasing confidence
The children do not promote interaction with their peers
Facilitates autonomy at all levels of functioning
From its start as a research project in the mid-1960's, the
TEACCH approach has been developed, delivered and continues to provide exemplary services to people with autism and their families in North Carolina while inspiring concepts and approaches throughout the world. While TEACCH is well distributed, especially within special education classrooms and group homes, there has been done a limited empirical research of the approach. Additionally, its applicability to the inclusive school environment is discerned as obscure. Investigators on TEACCH have pointed out the limited classroom research as well as the absence of sufficient control for threats to internal and external validity (Gresham et al, 1999). Parents can acquire worthwhile information from school psychologists and other educational experts by discussing the different available approaches to facilitate the social and cognitive ability of children with autism. Intervention policies may vary relying on each child's specific strengths and challenges, the aims of parents, and the home and school surroundings. School psychologists and other experts who might be participating in helping a child with autism may facilitate communication and cooperation with parents. Given the huge amount of challenges confronted by children with autism, intervention strategies should be fitted to the individual child's specific needs and aims. School psychologists must be capable of providing enlightening assessments of the child's abilities (e.g., communication and social interaction) and the presence of stereotyped behaviours or limited interests (Happe, 1994). As stated by Potter, and Whittaker (2001), overall, an optimal treatment strategy for autism will study the results of a comprehensive assessment and contain a behavioural and psychoeducational treatment plan based on the child's specific needs, whether superior aims comprise developing functional communication skills, improving social and play skills, or increasing positive behaviours.