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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
www.autismtreatmentcenter.org
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
www.autismtreatmentcenter.org
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
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
Verbal CommunicationFocus on transition from inappropriate
communication methods (e.g,. crying, tantrums) to spoken word
Single word expanded content conversation loops conversational skills
J. Gundacker (personal communication, June 10, 2011)
Verbal CommunicationCommunication goals
Desires/DislikesHow they feelWhat they care about Interactive games and situationsConversation
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
Interactive Attention SpanIncrease engagement with others
Examples: Look at othersTake turnsCommunicate in a variety of ways
Decrease solitary/non-interactive activities
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
FlexibilityNecessary to develop and
maintain friendships
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
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
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
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.
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
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
J. Gundacker (personal communication, June 10, 2011)
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”
Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books.
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
Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books.
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
Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books.
Other ComponentsStudent: teacher ratio unlimited in preschool
program, restricted 6:1 for school-age program
Functional Analysis
Time-out
Multiple settingsSchoolHomeCommunityVocational
Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books.
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
Freeman, S. K. (2007). The complete guide to autism treatments: A parent’s handbook. Lynden, WA: SKF Books.
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
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
Results
Increased
Imitation
Perception
Fine-motor
Eye-hand coordination
Gross motor
Cognitive functioning
Insignificant change Communication
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
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
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.)
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
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
ProcedureBaselines conducted 6 months and 1 month
prior to entering CLLC
Assessments at 6 months and 12 months after entering CLLC
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
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
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
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
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
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?