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Dave from North Carolina writes to ask "TEACCH v. Lovaas?"
Dear Mr. Wright:
Thank you for doing such an excellent job informing parents about IDEA.
You may remember that I consulted with you several years ago about my autistic son. We followed your advice which allowed him to receive the necessary services from our school system in Virginia.
We recently moved to Chapel Hill, NC. Our son is a TEACCH based classroom in the public school. I mention this because your latest newsletter suggests that only ABA programs have achieved success as early intervention for children with autism.
In fact, there is a great deal of research conducted here at UNC using the TEACCH method that finds it to be effective in the long term treatment of autism.
When the state of NC instituted the TEACCH program state-wide, the institutionalization rate of adult autistics dropped to about 5%. This compares quite favorably with other methods.
Actually, there are a number of adult autistics who are outspoken opponents of the ABA/Lovaas method. (In particular, Jerry Newport speaks frequently at autism conferences about his personal experiences with this method.)
However, the techniques have changed over the years and I don't know if their criticisms are the same. I hope this information is useful to you and keep up the good work defending the rights of children.
We respond to Dave's letter:
Of course we remember you. We're very glad you wrote.
Re: the TEACCH - ABA debate. First, the early childhood regs deal with educational issues for children who are under 3 years of age. What we are seeing is school districts that place two and three year old autistic children in "class-based" programs for 9-12 hrs a week (typically 3 hrs a day, 3-4 days a week) - and that's it. In these group programs, these very young children make little or no progress. Many actually lose skills.
Pam worked in North Carolina for about 10 years - this was during the time when UNC was developing TEACCH programs. At the time, people were very excited about the TEACCH programs.
Previously, most autistic children ended up in institutions. Mothers were blamed for "causing" autism. When North Carolina began closing their mental institutions, the state legislature had UNC develop a program for the young autistic people who would have no place to go (this process began before the special ed law was passed)
The result was TEACCH, which is a school-based program. The basic TEACCH model places several children in small self-contained classes, usually with one teacher and one aide. There are variations but this is the basic TEACCH program.
TEACCH also provides the child's family with education and support. The parents are not blamed for the child's autism. When these autistic children grow up, many end up in sheltered workshop programs, etc.
I understand that some have criticized Dr. Lovaas for using "aversives." As you say, ABA or Lovaas therapy has gone through changes and fine-tuning over the years. We have no cases where aversives are used. A sharp "No" from the parent or therapist is strongest aversive.
Our "take" on this is that autism is a medical-neurological condition. Over time, new treatments will be developed to improve the prognosis for children who have this disorder. More than twenty years ago, UNC developed TEACCH. More recently, Dr. Lovaas and others developed the ABA/Lovaas form of treatment. As with any medical-neurological condition, new programs will evolve, just as new treatments evolve for other medical conditions.
It is a mistake for people to become emotionally wedded to one program if this blinds them to the possibility that new treatments and improvements will be made over time.
We are heartened by the fact that in 1997, NIH launched research programs at several university medical centers around the country. Their objective is sift through the claims being made and identify the most appropriate ways to treat children with this diagnosis, how to diagnose more accurately, etc.
The problem with TEACCH is that it seems to be static. In our cases, TEACCH experts have testified that TEACCH programs are successful because surveys show that parents feel supported. These experts are not producing hard evidence to document that the children's symptoms improve.
Children in TEACCH programs may improve. We don't know.
TEACCH programs may be good for some children, or older children. We don't know.
We would like to see decisions being made from objective research, not anecdotal observations, beliefs and emotions.
But - speaking of anecdotal observations - last weekend, we had house guests, including a 7 year old child. At age 3, the child was diagnosed with autism. After about 2.5 years of ABA therapy, he "lost his label."
Last year, he completed first grade in a regular class. His first grade teacher did not know that he had been diagnosed with autism. We would not have known. Yet, we've seen the earlier evaluations. We've seen videos of his ABA/Discrete Trial therapy sessions. Until a year or two, he was autistic. Today, he shows no overt signs or symptoms of autism. What happened?
Thanks for your letter. Keep in touch.
Pete and Pam Wright
Dave wrote back:
Great to hear from you. I'm sure you will get a number of replies on both sides of the issue. It does seem to stir up people's emotions. By the way, I should have mentioned that the school system here has responded to gentler pushes than I used in Virginia. That experience has made me a great record keeper (thanks to Pete) which helps prevent most problems before they start.
We were lucky enough to get our son in a speech therapy program at UNC this summer which ran 3 days a week and overlapped with ESY.At first I was told that he could not attend ESY the other two days. It only took one letter and one phone call to arrange this "impossible" placement.
Again, thanks for all your help and keep up the good work.