Academic journal article The Journal of Rehabilitation

Intervention for Adults with Autism

Academic journal article The Journal of Rehabilitation

Intervention for Adults with Autism

Article excerpt

The treatment program for adults with autism grew out of the work with younger children in the first statewide program for the Treatment and Education of Autistic and related Communications Handicapped CHildren (TEACCH). In 1972, North Carolina legislators established TEACCH as the permanent state agency mandated to serve children with autism and their families. Based on this early experience and the outcome data, we learned that through interventions applied with close parent/professional collaboration most of the children improved. Some did so dramatically, and the majority improved only partly (Schopler, in press). Based on the recognition that autism is a long-term disability, TEACCH's mandate was expanded in 1979 to include service to adolescence and adults and their families.

Over the years, the basic TEACCH philosophy (Schopler, in press) has been adapted and applied to the work with adolescents and adults. The purpose of this article is to first briefly summarize the TEACCH philosophy as it applies to adults with autism. The areas of diagnosis and assessment will then be discussed as prerequisites for developing an appropriate individualized treatment program. Finally, the article examines four primary treatment components - structured teaching, communication training, leisure and social skill development, and stress reduction. Each of these treatment components affects the adaptation of the adults across residential, vocational, and recreational settings.

TEACCH Philosophy

The program's early emphasis on parents and professional working together to optimize the outcome for the children with autism has continued in TEACCH's approach to working with the adults and their families (Mesibov, Schopler & Sloan, 1983). As the person with autism enters vocational, residential, or other community settings, their families continue to play a crucial role. They are still the experts who have valuable information about their children to share with future job coaches, caregivers, or other treatment providers. As advocates, they often have the best perspective on their children's long term needs. The exact role of the family in the lives of the adults with autism varies depending on the needs and resources of the family (Van Bourgondien & Schopler, 1990). Some families continue a very active involvement in all aspects of the adult's life, others change their role as the needs of other family members are addressed.

Recognizing the heterogeneity of individuals with autism, an individualized approach to treatment that is based on a careful assessment of the adult's skills is an essential part of the approach (Schopler, 1994). The TEACCH philosophy also emphasizes a positive, proactive approach to helping an individual learn new skills and when autism related deficits impede to accommodate the environment to that deficit (Schopler, 1994). This two factor approach involves the direct teaching of functional skills that the individual shows a readiness to learn, and at the same time adapting the environment to enable the individual to utilize his/her strengths to compensate for areas of deficit. Structured teaching is the basis of this two factor approach.

Structured teaching is both an educational strategy and a method for preventing behavior problems in individuals with autism (Mesibov, Schopler, & Hearsey, 1994; Schopler, Mesibov, & Hearsey, 1995). Based on the needs, skills and deficits of autism, it is a system of organizing the physical environment, developing appropriate activities, and helping individuals of all ages understand what is expected of them and how to function independently. Visual skills and routines are utilized to create meaningful environments that people with autism can understand and within which they can be successful.

Behavioral difficulties are assumed to be the result of an individual's inability to understand and successfully cope with their environment. …

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