a review of son-rise and teacch christina slaten

A Review of Son-Rise and TEACCH

Christina Slaten

Sources www.theautismtreatmentcenter.org

www.option.org

http://www.asatonline.org

Hogan., W. & Hogan, B. K. The Son-Rise Program Developmental Model: Understanding the Importance of Social Development & Creating a Curriculum for Your Child’s Social Growth. (2007) The Option Institute and Fellowship

Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books.

PsycInfo

Peer-reviewed “Son-Rise” and “Autism” “Son-Rise”

3 Survey/questionnaires

Son-Rise PrinciplesLimitless potential

Autism is a relational, interactional disorder NOT a behavioral disorder

Motivation is the key to all learning

Stereotypic behaviors (“isms”) have meaning and value

www.autismtreatmentcenter.org

“The Core of What We Teach”

“Many of us have heard of the popular psychological model of

stimulus-response. The dog barks, I get scared. My friend compliments me, I feel happy. This model has helped spawn a

culture where we see our emotions and experiences as being caused by people and

events around us. As a result, we often try to change our

circumstances and the people around us so that we can feel

good or, at least, not feel bad.”

www.option.org

"This approach leaves most of us feeling like victims. We

believe that, if we could just get our loved ones to treat us right, or our finances to increase, or the roads to be traffic-free, we would feel better. But there's always something else. Even without major life events such as divorce, bankruptcy, illness or loss of a loved one, many of

us experience deep distress and discomfort.”

www.option.org

“The Option Institute modifies the stimulus-response paradigm

with a simple twist. We introduce a third component: BELIEF. Every stimulus that

elicits a response from us is first filtered and processed by one or

more beliefs. As our beliefs change, so do our responses and experiences. This simple

shift changes everything in our lives, moving us from the passenger's seat into the

driver's seat.”

J. Gundacker (personal communication, June 10, 2011)

Principles continuedThe parent is the child’s best resource

The right environment is needed for progression

Parents/professionals most effective when Confortable with childOptimistic about progressHopeful about future


Can be combined with….Complimentary Therapies:Bio-Medical InterventionsDietary InterventionsAuditory Training ProgramsSensory Integration InterventionsCranial Sacral TherapyThe Handle Program Massage Therapy HomeopathyThe Listening Program®Neuro FeedbackThe Fast ForWord® Program Therapeutic Horseback Riding Supplemental Interventions: Vitamins, minerals, probiotics, essential fatty acids, etc. Enzyme Therapy - Highly recommend enzymes by Enzymedica® www.enzymedica.com The Defeat Autism Now ProtocolThe Alert Program www.alertprogram.com Not ABA video - ABA


Son-Rise vs. ABA http://www.youtube.com/watch?

v=N6CWf9H7F8k&playnext=1&list=PLD335F5C4D1153771

http://www.youtube.com/watch?v=2VGbdl-LHSM&feature=autoplay&list=PLD335F5C4D1153771&index=2&playnext=2

The Son-Rise Program®Developmental Model

Hogan., W. & Hogan, B. K. The Son-Rise Program Developmental Model: Understanding the Importance of Social Development & Creating a Curriculm for Your Child’s Social Growth. (2007) The Option Institute and Fellowship

Eye-contact and Non-verbal

Communication

Most obvious deficit

Encourage to “want” to look into the eyes of other vs. “be pushed to” look in order to get a desired item

Benefits of eye contactLearn facial expressionsLearn to speakPay attention longerSee the love that we feel for them- most important


Verbal CommunicationFocus on transition from inappropriate

communication methods (e.g,. crying, tantrums) to spoken word

Single word expanded content conversation loops conversational skills


Verbal CommunicationCommunication goals

Desires/DislikesHow they feelWhat they care about Interactive games and situationsConversation


Interactive Attention SpanIncrease engagement with others

Examples: Look at othersTake turnsCommunicate in a variety of ways

Decrease solitary/non-interactive activities


FlexibilityNecessary to develop and

maintain friendships


The Son-Rise Program®

Developmental ModelEach stage is rated every 4 – 8 weeks

Emerging or acquired “IMPORTANT: No child will demonstrate all of the

above skills (in the fundamental assessment) 100% of the time. Remember to use common sense.”

Baseline is conducted via observation and initial rating

Social curriculum goals are then created Kept for at least 1 month until another fundamental re-

assessment is completed Children will have different skill levels in different areas

Clear and specific program goals written/posted/shared with all involved


Examples of Program Goals

Eye contact: "Inspire John to look at us when he shows an interest in what we are doing”

Communication: “Encourage John to answer questions about the past and future events”

Interactive Attention Span: “Invite John to interact with you 5 times per hour or more (when he gives you ‘Green Lights’)”

Flexibility: Strongly encourage John to verbally participate in the interaction”

No clear/consistent strategies given on how to teach specific goals as outlined in Developmental Curriculum.


VideoBackground

Introduction to principles

3 Cornerstone Techniques

Demonstration

Kaufman, B. M. (Producer). (2008). Autism Solution: Getting Started with the Son-Rise Program [DVD]

InterviewEmpirical study coming out soon?

The resources of the non-profit group has been focused on helping children rather than on research

Emphasis on shift in attitude and commitment

Claimed no language 5 word phrases in 6 months

Typical program 2 – 4 years depending on level of intensity – suggest 40 hrs a week for maximum benefit

No data on number of individuals who no longer meet the diagnostic criteria for ASD


Research No peer-reviewed, empirical research conducted

Heavy reliance on anecdotal data from families

“Empirical Research Supporting the Son-Rise Program”Literature review on topics such as:

Hyper-arousal to sensory imputSocial orienting“Attentional functioning”


Empirical Research Supporting the Son-Rise Program. (2006). Retrieved from: http://www.autismtreatmentcenter.org/ files/supportive_research.pdf

Surveys Conducted

1. The Son-Rise programme intervention for autism: prerequisites for evaluation –

Questionnaires and interview data family demographics implementation patternsperceived treatment fidelity gathered three times over the course of a year from

families who had attended a Son-Rise initial training course.

Findings - Children ranged in age from 2 to 12 at the outset of intervention, with the majority of children aged under 6 years. The most common diagnosis was autism.

Treatment fidelity large concern – concurrent treatment, drift from specific procedures

Avg 21 hours a weekWilliams, K. the Son-Rise program intervention for autism: Prerequisites for evaluation. Autism, 10, 1, 86- 102.

Surveys Conducted

Williams, K., and Wishart, J. (2003). The Son-Rise program intervention for autism: An investigation into family experiences. Journal of Intellectual Disability Research, 47, 4-5, 291 – 299.Williams, K., and Wishart, J. (2001). Combining school attendance with home-based interventions for autism. Journal of Research in Educational Special Needs, 1, 1.

2. The Son-Rise Program intervention for autism: An investigation into family experiences.•Included 87 families with children with autism•Found that family involvement led to more drawbacks than benefits, however, family stress levels did not rise in all cases

3. Combining school attendance with home-based interventions for autism•Found that families use the Son-Rise techniques in conjunction with school-based interventions

Red Flags?High success rate

Easy to administer

Rapid effects

Emotional appeals

Testimonials

Any others?

ConclusionsEmpirical, peer-reviewed research needed

“untested”

http://www.asatonline.org/intervention/treatments/sonrise.htm

Any Questions?

TEACCH - Sources www.teacch.com

www.asatonline.org

National Autism Center


Handleman, J.S. (2008). Preschool education programs for children with autism (3rd ed.). Austin, TX: Pro-Ed

Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. Mahwah, NJ: Lawrence Erlbaum.

PsycInfo

Peer-reviewed “TEACCH” and “Autism”

92 results (large majority survey-based, reviews) “TEACCH”

102 results (large majority surveys, reviews)

What is TEACCH?Treatment and Education of Autistic and

Communication-related Handicapped Children

Est. early 1970s – Eric Schopler and colleagues

Chapel Hill, North Carolina CLLC- Carolina Living and Learning Center

Can be combined with ABA

2 priorities Structured teaching Cultivating strengths and interests vs. sole focus on

remediation of deficits

www.teacch.com Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. Mahwah, NJ: Lawrence Erlbaum.

Goals of TEACCHAttempt to understand autism and individuals with

autism

Develop appropriate structures

Promote independent work skills

Emphasizes strengths and interests

Foster communication, as well as social/leisure interests and opportunities

Integrate services and provider networks over lifespan

Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. Mahwah, NJ: Lawrence Erlbaum. Pg., 225

Goals of TEACCH “To effectively teach autistic students a teacher

must provide structure, i.e., set up the classroom so that students understand where to be, what to do, and how to do it, all as independently as possible.”

To enable individuals with autism to function as meaningfully and as independently as possible in the community

To provide exemplary services throughout North Carolina to individuals with autism and their families and those who serve and support them

As a member of the University community, to generate knowledge; to integrate clinical services with relevant theory and research; and to disseminate information about theory, practice, and research on autism through training and publications locally, nationally and internationally

www.teacch.com

Structured TeachingOrganization of the physical environment

Predictable sequence of activities with flexibility incorporated

Visual schedules

Work-activity systemsWhat task/activity am I supposed to do?How much work/how long will activity last?How can I see that I am making progress/almost

done?What will happen next?

Visually structured activities

Shea, V., and Mesibov, G. (2006). The TEACCH approach to school-age children. In S.L Harris and J.S. Handlemann, eds. Preschool education programs for children with autism. (pp. 221 – 248).Austin, TX: Pro-Ed.

Classroom GoalsCognitive

Fine motor

Eye/hand integration

Organizational skills

Self-help skill

Receptive/expressive language

Social interaction


Other ComponentsStudent: teacher ratio unlimited in preschool

program, restricted 6:1 for school-age program

Functional Analysis

Time-out

Multiple settingsSchoolHomeCommunityVocational


What Does TEACCH Look Like?

“Introduction to TEACCH”

Take a tour of a TEACCH classroom

http://www.youtube.com/watch?v=PxLfIHPWlTA&feature=related

http://www.youtube.com/watch?v=ddGLJ2r4rcw&feature=related

ResearchVery little empirical research conducted

Reliance on surveys and other indirect observations

Other confounds…

Effectiveness of a Home Program Intervention for Young Children with Autism

Sally Ozonoff and Kristina Cathcart2 matched groups of parents/preschoolers diagnosed

with autism

Compared treatment vs. no treatment group

Independent Variable Parents taught how to work with children in home

setting – weekly meetings (over 10 week period) with two therapists in clinic One therapist demonstrating tasks and modeling

teachingOne therapist with parent behind 2-way mirror,

explaining techniques/providing emotions/other supportParents encouraged to spend 30 min daily working with

childParents would demonstrate what was going on @ home

feedback providedFocus on cognitive, academic, & prevocational skills

Approximately 4 months of home programming

Ozonoff, S. & Cathcart, K (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28, 1, 25 – 32. doi:10.1023/A:1026006818310

Effectiveness of a Home Program Intervention for Young Children with Autism

Sally Ozonoff & Kristina Cathcart (1998)

Dependent variable Pre/posttest Psychoeducational Profile – Revised (PEP-R) – not

widely considered sufficient as stand alone assessment does not measure behavior

Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books. Ozonoff, S. & Cathcart, K (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28, 1, 25 – 32. doi:10.1023/A:1026006818310

Concerns


PEP-R does not look at behavior

PEP-R not considered sufficient when used in isolation

Two different sets of researchers assessing the different groups

Benefits of the treatment and education of autistic and communication handicapped children(TEACCH) programme as

compared with a non-specific approach Panerai, S. Ferrante, L. & Zingale, M. (2002)

2 groups of 8 subjects (all living in Italy)Matched by gender, chronological age, and

diagnosis Control Group – Public school program with

support teacherExperimental group – TEACCH (lived at residential

school, home every other weekend)Assessed twice with one-year interval between

The Psycho-Educational Profile-RevisedVineland Adaptive Behavior Scale

Dependent VariablePre/post-assessment using Psychoeducational Profile-

Revised (PEP-R) Panerai, S. Ferrante, L. & Zingale, M. (2002). Benefits of the treatment and education of autistic and communication handicapped children (TEACCH) programme as compared with a non-specific approach. Journal of Intellectual Disability Research, 4, 4, 318 - 327. doi: 10.1046/j.1365-2788.2002.00388.x

TEEACH

Individual education program

Environmental adaptation

Alternative communication training

Control Group

Support teacher

Outpatient treatment Physical therapy Speech therapy

No structured teaching

No specific teaching method for children with autism

Panerai, S. Ferrante, L. & Zingale, M. (2002). Benefits of the treatment and education of autistic and communication handicapped children (TEACCH) programme as compared with a non-specific approach. Journal of Intellectual Disability Research, 4, 4, 318 - 327. doi: 10.1046/j.1365-2788.2002.00388.x

Results

Panerai, S. Ferrante, L. & Zingale, M. (2002). Benefits of the treatment and education of autistic and communication handicapped children (TEACCH) programme as compared with a non-specific approach. Journal of Intellectual Disability Research, 4, 4, 318 - 327. doi: 10.1046/j.1365-2788.2002.00388.x

Longitudinal study – Hong Kong 12 months

34 children with autism

Compared TEACCH to other types of individualized teaching

Pretest, Posttest1 (6 months) and Posttest 2 (12 months)

Experimental group -7 hrs of TEEACH during week (Heep Hong Society)

Control group – Varied, non-TEEACH intervention within a variety of settings (Special Child Care Center, public kindergartens, integrated child care centers) with additional hours of non-TEACCH intervention as needed.

Tsang, S.,K., M., Shek, D., T., L, Lam, L., L., Tang, F., L., Y., & Cheung, P.,M., P. (2007). Brief report: Application of the TEACCH program on Chinese pre-school children with autism – does culture make a difference? Journal of Autism and Developmental Disorders, 37, 390 – 396. doi: 10.1007/s10803-006-0199-6

Brief Report: Application of the TEACCH Program on ChinesePre-School Children with Autism––Does Culture Make a

Difference? Sandra K. M. Tsang, Daniel T. L. Shek, Lorinda L. Lam, Florence L. Y. Tang, Penita M. P.

Cheung (2007)

Results


Results

Increased

Imitation

Perception

Fine-motor

Eye-hand coordination

Gross motor

Cognitive functioning

Insignificant change Communication


Effects of a Model Treatment Approach on Adultswith Autism

Mary E. Van Bourgondien, Nancy C. Reichle, and Eric Schopler (2003)

Evaluated effectiveness of a residential program using TEACCH (CLLC- Carolina Living and Learning Center)

32 adults/adolescents with autism

Dependant variables Environmental Rating Scale – measures

environmental adaption5 conceptual sub-groups

Van Bourgondien, M., E., Reichle, N. C. Schople E. (2003). Effects of a model treatment approach on adults with autism.Journal of Autism and Developmental Disorders 2003;33(2):131-140.

Dependent VariablesEnvironmental Rating

Scale (ERS)

Measures environmental adaption 5 conceptual sub-groups

Communication, structure, social and leisure skill development, developmental assessment and planning, behavior management

Research assistants scored based on semi-structured caregiver interviews and tours of residential setting (1 – 5)

32 items (scale 1 – 5)

Global Rating Form

1 – 5 scale (1 = no programming, 5 = excellent programming)

Completed by research assistants following each residential visit

Indicated feelings about how it would be to live in that setting

Van Bourgondien, M., E., Reichle, N. C. Schople E. (2003). Effects of a model treatment approach on adults with autism.Journal of Autism and Developmental Disorders 2003;33(2):131-140

Dependent Variables (cont.)

Family Satisfaction Measures

Families filled out questionnaire at end of study

8 items Overall satisfaction with

placement, individual’s general well-being, physical environment, direct care staff, administrative staff

1 – 5 scale ( 1 = very dissatisfied, 5 = very satisfied)

Participant’s Skills

Adolescent and Adult Psychoeducational Profile (AAPEP) - Mesibov, Schopler, Schaffer, & Landrus, (1988) Direct assessment and

caregiver interviews Vocational skills,

independent functioning, leisure skills, vocational behavior, functional communication, interpersonal behavior

Rated as passing, emerging, or failing


Dependent Variables (cont.)

Participant Behaviors

Autism Behavior Inventory (Van Bourgondien & Mesibov, 1989) Rate frequency of each

behavior and the degree to which it is considered a problem

The Vineland Maladaptive Domain Negative behaviors rated

0 – 4

Direct observation by research assistants20 minute observation

in 3 settings10 second whole-

interval sample used to code score/code occurrences of target behaviors


ProcedureBaselines conducted 6 months and 1 month

prior to entering CLLC

Assessments at 6 months and 12 months after entering CLLC


Results

Van Bourgondien, M., E., Reichle, N. C. Schople E. (2003). Effects of a model treatment approach on adults with autism. Journal of Autism and Developmental Disorders 2003;33(2):131-140

Results


Effects of an Individual Work System on the IndependentFunctioning of Students with Autism

- Hume & Odom (2007)

Effects of work system developed by TEACCH on the independent work and play skills of students with autism

Single-subject withdrawl with replication across 3 participants

IV – individual work system (visual info about task, amount of work to be completed, signal that work is finished, instructions for next activity in schedule)

DV – on-task behavior, increases in # of tasks completed/play materials utilized, reduction of teacher prompts

Hume, K., & Odom, S.(2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and Developmental Disorders, 37, 1166-1180. doi: 10.1007s10803-006-0260-5

Independent Work System

Hume, K., & Odom, S.(2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and Developmental Disorders, 37, 1166-1180. doi: 10.1007s10803-006-0260-5

Hume, K., & Odom, S.(2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and Developmental Disorders, 37, 1166-1180. doi10.1007s10803-006-0260-5

Concerns

“Mulick, James A. (2009). Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice (Kindle Locations 7695-7702). LEA. Kindle Edition.

“The TEACCH program as implemented in North Carolina is a lifelong, integrated, and comprehensive program supported by a legislative mandate by the state of North Carolina. To the best of our knowledge, no other state in the United States has a similar mandate. Thus, in our experience in Ohio, the programs implemented by school districts as TEACCH programs are not in any way comparable to the TEACCH program as implemented via the University of North Carolina at Chapel Hill in North Carolina. School programs do not provide multiagency integrated services, often do not integrate parents, often do not provide for implementation in the home and the community outside of school, and do not provide for follow-up past the specific school program. Rather, school programs tend to incorporate facets of the methods used in TEACCH classrooms in isolation and then claim that they are providing a TEACCH program. They are not.”

ConcernsAutism as a “culture”

Generalization away from visual cues and highly structured environment?

Communication and social skills?

Problematic behavior?

Reliance on PEP-R

World-wide dissemination a goal, prior to large body of solid research

ConclusionsConsidered “Emerging” and “untested”

Additional empirical, peer-reviewed studies needed

National Autism Center.. (2009), National Standards Project: Findings and Conclusions – Addressing the Need for Evidence-Based Practice Guidelines for Autism Spectrum Disorders. Randolph, M.A: Author.http://www.asatonline.org/intervention/treatments/teacch.htm

Red Flags?Measurement

Easy to administer

Any others?

Any Questions?

a review of son-rise and teacch christina slaten

Documents

orgthe option institute

review of son

aba video aba

stimulusresponse paradigm

protocolthe alert program

defeat autism

autism treatments

aba http