*3.8.1. Purpose of the technique*

the task at hand, learning development can occur. TEACCH is considered to be a multi-disciplinary approach, focused on collaboration between a variety of service providers, including

The TEACCH program was developed in 1972 by Eric Schopler, Ph.D. at the University of North Carolina at Chapel Hill [66]. The program focuses on utilizing structure in a manner that encourages learning. According to Mesibov and Shea, structure in TEACCH comprises four components: physical structure, timing structure, task structure, and work/activity system structure [66]. Physical structure requires that the environment be set up in order to focus learning. This includes offering visual cues in the environment. Timing structure incorporates the use of a schedule, including scheduling cues. Organizing the task into manageable chunks is part of the task structure, this includes offering explicit directions. Finally, work/activity system structure involves synthesizing smaller tasks into a complete activity. By controlling these four structural elements, care providers can create an environment that maximizes func-

Along with utilizing TEACCH in a school or clinic setting, it is recommended that a home TEACCH program be developed for carry-over by parents/caregivers [67]. Ideally, the home TEACCH program would provide training and clinician supervision to parents/caregivers to assist them in structuring the home environment in order to support teaching skills in self-

As TEACCH was developed and has training facilities housed within the University of North Carolina at Chapel Hill, there are researchers embedded in the program who have worked to establish a strong research base. When analyzing efficacy, it is important to identify potential bias that might occur by reviewing studies conducted only by researchers working where the technique was developed. To avoid that bias, a number of studies from within and outside the

A meta-analysis of intervention studies using TEACCH (level 1 evidence) was conducted by Virues-Ortega, Julio, and Pastor-Barriuso in 2013 [68]. This meta-analysis utilized 13 studies, with a combined sample of 172 children diagnosed with ASD, assessing perceptual and motor skills, adaptive behaviors, and language and cognition. Results indicated that TEACCH had a small magnitude impact on perceptual, motor, verbal and cognitive skills, a negligible impact on communication, activities of daily living, and motor functioning, and moderate to large gains in social behavior and maladaptive behavior. The overall effect of the TEACCH program on all the outcomes measured in the meta-analysis was moderate, with effects in older children being higher than those in younger children. The authors cautioned that while these findings indicate success with TEACCH, the small number of studies and sample size should be considered.

D'Elia and associates conducted a longitudinal study of low-intensity TEACCH in preschool aged children [65]. The study followed a sample of 30 children, aged 2–6.11 years,

teachers, therapists, family, and community [65].

14 Occupational Therapy - Therapeutic and Creative Use of Activity

tional capabilities of the child with ASD.

care, academics, and communication [67].

University of North Carolina at Chapel Hill were reviewed.

*3.7.3. Review of literature*

*3.7.2. Overview of the technique*

The Cognitive Orientation to Occupational Performance (CO-OP) is a task-oriented, problemsolving approach that uses cognitive skills to improve occupational performance. It is typically a verbally based approach that emphasizes teaching clients to incorporate self-talk and problem-solving to address difficulty with the execution of various motor skills [69]. According to Missiuna and associates, elements of CO-OP include concepts related to problem-solving, learning theory, motor learning theory, cognitive strategies, client-centered practice, goal setting, and motivation [69]. CO-OP has been observed to be highly individualized, starting with clinician generated verbal guidance, followed by the development of client internal selfdialog, and finally independent application of problem-solving strategies ([70], p. 190).

Missuana and associates identified that the three main objectives addressed by CO-OP are: (1) skill acquisition in client-chosen goals/tasks, (2) cognitive strategy development, and (3) generalization of subsequently learned skills and strategies to a variety of contexts. Specifically, in the CO-OP process the client is learning a new motor skill or improving performance on one that has not yet developed sufficiently to be functional [69].

pre and post-intervention assessment [78]. Specifically, moderate to significant improvement was noted on the caregiver subjective scale using the Canadian Occupational Performance Measure, Performance Quality Rating Scales and the Vineland Adaptive Behavior Scales.

Occupational Therapy's Role in the Treatment of Children with Autism Spectrum Disorders

http://dx.doi.org/10.5772/intechopen.78696

17

Overall, the CO-OP approach for children and adolescents with ASD has yielded positive findings, enhancing function and participation in meaningful activities as a part of activities of daily living and instrumental activities of daily living and supports its use in clinical prac-

Behavioral treatment approaches to ASD incorporate components of operant conditioning in order to manipulate behavior to create positive outcomes. When considering ASD, the primary behavioral treatment approach used is Applied Behavior Analysis (ABA), which is applied in a variety of forms (school-based, clinic-based, home-based, discrete trial training, Lovaas therapy, inclusive programs). Generally, occupational and physical therapists will follow an ABA approach if the child is currently enrolled in a program that specifically uses ABA, or if the child is learning a discrete skill that would benefit from an ABA approach (e.g.

The purpose of Applied Behavior Analysis (ABA) is to teach discrete skills by modifying the environment in order to manipulate behavior [79]. To teach these skills, therapists utilize the "ABC technique" to determine why a behavior is occurring: *antecedent*, *behavior*, *consequence* [63]. Antecedent refers to what is happening prior to the behavior. The *antecedent* prompts the behavior to occur. The *behavior* is what the child does in response to a stimulus (antecedent). Finally, the *consequence* is what the child receives as a response to the behavior. The consequence can perpetuate or extinguish the behavior. Once therapists have determined the "ABC," then they can create a structured plan that addresses each component to create an

Based on principles developed by B.F. Skinner in the 1950s, Clinical Psychologist O. Ivar Lovaas created ABA as a behavior modification program for use in children with ASD [63]. The program is intended for use across a variety of instructional formats, including both group and individual sessions, which allows for independent and observational learning [80]. In ABA programming, once a functional behavior assessment has determined the ABC (antecedent, behavior, consequence), the therapist will determine the target behavior and how the environment will be modified to achieve that behavior. Additionally, the therapist will determine what reinforcement to use and the reinforcement schedule. Reinforcement is a critical component of ABA, and determining appropriate reinforcers is crucial for program success. Often people are tempted to use edible reinforcers (candy, chips). This practice is

tice, yet more research needs to be conducted using more robust designs.

**3.9. Behavioral treatment approaches**

**3.10. Applied behavior analysis (ABA)**

*3.10.1. Purpose of the technique*

toileting, shoe-tying).

optimal outcome.

*3.10.2. Overview of the technique*

In CO-OP, a client-centered approach is used to encourage clients to select their own goals for the intervention plan. The CO-OP cognitive strategies are used to influence skill acquisition. Generalization and transfer of skills is supported through the use of an executive, or problem-solving, strategy that trains the child to monitor his performance and self-evaluate the outcome [69].

Rodger et al. have argued that in order for clients with ASD to be successful in taking part in CO-OP, therapists need to ensure they have accommodated the language and communication needs of the clients, given that the technique relies heavily on language and communication [71]. The goal of CO-OP is to create a process to teach clients how to think, instead of what to think.
