ORI GI NAL PAPER

The Home TEACCHing Program for Toddlers with Autism

Aurelie Welterlin

Lauren M. Turner-Brown

Sandra Harris

Gary Mesibov

Lara Delmolino
Published online: 13 December 2011
Springer Science+Business Media, LLC 2011
Abstract The study evaluated the efcacy a parent
training intervention for children with autism based on the
TEACCH model. Twenty families were randomly assigned
to the treatment or waitlist group. All families were com-
pared at pre- and post-treatment on formal dependent
measures. Direct measures of behavior were compared
across six matched pairs using a multiple baseline probe
design. The results of the multiple baseline design showed
robust support for improvement in child and parent
behavior. Due to the sample size and short time frame,
results of a repeated measures analysis of variance did not
reach signicance.
Keywords Autism Early intervention TEACCH
Home-based intervention
Introduction
Children with autism exhibit three main clusters of symp-
toms: qualitative impairment in social interaction, impair-
ment in communication, and narrow and stereotyped
patterns of behavior and interests (APA 2000). By deni-
tion, these features must develop before 3 years of age.
There is no known cure for autism spectrum disorders
(ASDs), however, a growing number of interventions exist
that increase functioning and quality of life for these
individuals (Dawson et al. 2010; Smith et al. 2000), with
some evidence that intervention begun at very early ages
showing particular promise (McGee et al. 1999; Dawson
et al. 2010). Unfortunately, only a small body of research
exists on the efcacy of comprehensive intervention pro-
grams, and many of the studies that do exist have not used
conventional standards of research design and methodol-
ogy (Odom et al. 2010; Gresham et al. 1999). This lack of
research leaves families at risk of placing their children in
programs that may not be benecial, as some research has
begun to demonstrate that different child characteristics are
associated with different responses to intervention (Carter
et al. 2011; Yoder and Stone 2006). The present study
evaluated the efcacy of a comprehensive home-based
early intervention program for young children with autism
based on the TEACCH methodology and uses a novel
research design that meets many of the current research
standards.
Treatment of autistic and related communication hand-
icapped children (Division TEACCH), has emphasized
professionals working together with parents since its
inception (Schopler 1994). A substantial body of research
demonstrates that parent training programs provide a
number of benets for both children with autism and their
families (Kasari et al. 2010; Aldred et al. 2011; Schertz and
Odom 2007; Diggle et al. 2003), though results have not
always demonstrated strong positive effects for all children
(Carter et al. 2011; Green et al. 2010). One potential benet
is decreased parent stress. A large body of research indi-
cates that stress levels among parents of children with
autism are elevated compared to parents of typically
developing children and those with other clinical condi-
tions (e.g. Sanders and Morgan 1997; Sivberg 2002; Weiss
2002). It is well recognized that stress can lead to a number
of deleterious effects on the well-being of individuals
A. Welterlin (&) L. M. Turner-Brown G. Mesibov
University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
e-mail: Dr.Welterlin@gmail.com
A. Welterlin S. Harris L. Delmolino
The Graduate School of Applied and Professional Psychology,
Rutgers University, Piscataway, NJ, USA
1 3
J Autism Dev Disord (2012) 42:18271835
DOI 10.1007/s10803-011-1419-2
experiencing stress, and it can have negative effects on
those who interact or depend on the individual. Robbins
et al. (1991), for example, found a signicant negative
correlation between maternal stress level and child devel-
opmental progress. Parent training programs that result in
reducing parent stress, therefore, are clearly warranted.
Division TEACCH has nine regional centers located
across North Carolina, and serves children and adults of all
ages who have or are suspected of having autism. The aim
of Division TEACCH is to use general characteristics of
learning in autism plus highly individualized approaches to
help individuals with autism both learn skills and use
visual, organizational, and structured adaptations to their
environment to function as independently and effectively
as possible in society (Schopler 1994). Structured teaching,
the methodological framework of TEACCH, is a series of
cognitive, developmental, educational and behavioral
strategies that involve using assessments to create highly
individualized curricula, visual work systems and teaching
tasks, and positive routines that are based on the unique
learning styles of children with autism (Mesibov et al.
1994).
A main focus of the TEACCH programs is to teach
parents how to assess and implement individualized sup-
ports for their children. The Home TEACCHing Pro-
gram is an outreach model designed to serve the early
intervention needs of 2- to 3-year-old children with autism
and their families. The program runs for 12, 90-min ses-
sions in which a clinician provides hands on training to
parents on the structured teaching methodology of
TEACCH. Over the course of the program, parents begin to
take on an increasingly active role in teaching their chil-
dren, while under the supervision of the clinician, so that
upon completion of the program, parents are able to con-
duct sessions independently. Sessions cover a range of
topics from structuring the home to teaching pre-academic
skills, communication, and self care.
The body of literature supporting the efcacy of TEA-
CCH methods and programs is growing; however, many
programs still lack empirical support (Panerai et al. 2002).
To date, no studies have examined the efcacy of the
TEACCH early intervention programs, and only a few
studies have examined TEACCH parent training programs
in general (Marcus et al. 1978; Short 1984; Ozonoff and
Cathcart 1998a, b).
One study by Ozonoff and Cathcart (1998a, b) examined
the effectiveness of a TEACCH home based intervention
with 11 children with autism by comparing them to a
matched no-treatment control group. Parents were
instructed on how to teach cognitive, academic, and pre-
vocational skills to their preschool children. Measures on
the Psychoeducational Prole-Revised (PEP-R; Schopler
et al. 1990) were collected before treatment and after a
4 month period on both groups of children who were
matched according to age and pretest PEP-R scores, time
to follow-up, and severity of autism. The results indicated
that the experimental group demonstrated signicantly
more improvement than the control group on the imitation,
ne motor, and cognitive subtests of the PEP-R as well as
on the total subtest score. The use of a control group was a
considerable strength in the study, however, participants
were not randomly assigned to groups, and those who
administered measures of the dependent variable were not
blind to group assignment. Furthermore, treatment delity
measures were missing, and no measures were taken of
parent behavior.
Research on comprehensive early intervention methods
for individuals with ASDs as a whole is limited compared to
other child mental health or behavioral issues due to meth-
odological challenges in autism research (Lord et al. 2005).
According to a NIMHsupported working group charged with
developing guidelines for designing research studies of
interventions for individuals with ASDs, no single research
design can deal with all methodological challenges (Smith
et al. 2007). Although conducting RCTs continues to be
a priority given its robust design, other research designs and
statistical methods are also regarded as important to innovate
(Lord et al. 2005). Single subject designs, for example, have
advantages including close monitoring of treatment effects
and the need for less time and resources compared to group
studies. The limitations of single subject designs include the
small number of participants, difculty generalizing results to
larger populations, measuring overall outcomes, and some
subjectivity in the interpretation of the results.
The current study aimed to examine the efcacy of the
Home TEACCHing program using a dual approach to
assessment that combines the advantages of single subject
design and those of a group design. We hypothesized that
the Home TEACCHing program would lead to changes in
both parents and children relative to a waitlist condition.
Specically, we hypothesized that parents would learn to
implement structured teaching with their child and that
stress would decrease. For children, we hypothesized that
there would be positive effects on observed child behavior
during sessions and on developmental outcome measures in
comparison to a waitlist control group. This is the rst
study of the TEACCH program to (1) examine program-
ming exclusively for children 3 years of age and younger,
(2) utilize a waitlist control group with random assignment,
(3) include systematic measurement of treatment delity
and a treatment manual that allows for reliable training and
replication (Kasari 2002), and (4) ensure that assessors and
video coders were blind to group assignment. It is also the
rst study to use a combination single case design and
group design as a method of assessing an early intervention
treatment in individuals with ASDs.
1828 J Autism Dev Disord (2012) 42:18271835
1 3
Methods
Participants and Setting
Twenty 23 year old children with autism and their parents
participated. Families were paired based on chronological
and mental age (e.g., within 6 months for each) and then
randomly assigned to the treatment (Home TEACCHing
Program; HTP) or waitlist (WL) group. Families in the WL
group were told that they would receive treatment after the
12 week wait period. Six families (e.g., three pairs) com-
pleted the multiple baseline single-subject design phase of
this study. The other 14 completed baseline and post-
intervention assessments only. Children were recruited
from the Chapel Hill and Raleigh TEACCH Centers in
central North Carolina. Inclusion criteria included a chro-
nological age of less than 42 months and a clinical diag-
nosis of autism.
Single Subject Design
Data were collected monthly by videotaping parent/child
teaching sessions in the home. Videotaped sessions for
both the treatment and waitlist groups consisted of video-
taping parents setting up a teaching area and conducting
5 min of direct teaching. Videotapes were collected prior
to the rst (pre-treatment) treatment session and approxi-
mately after the fourth, eighth and twelfth (post-treatment)
treatment sessions for the treatment group. Videotapes for
the waitlist group were collected at the same intervals as
the treatment group while in the waitlist and again at the
same intervals during their treatment phase.
During videotaping, the HTP and WL parents were
provided with a rug, a shelf, small table, small chair, large
2 9 3 9 2 ft. basket, and a home teaching kit. The home
teaching kit was comprised of a 57 self-contained tasks
designed to teach children with autism a variety of ne
motor, cognitive, play, problem-solving, and communica-
tion skills. A research assistant directed the parent to
complete a 5-min work session using a standardized
instruction. The research assistant then began videotaping,
stepped away from the parent/child dyad, and provided
minimal interaction during the videotaping. Materials were
removed after videotaping, though the treatment families
had access to their own set of materials during their par-
ticipation in the program.
All 5-min work session segments were scored by an
undergraduate research assistant blind to the hypotheses of
the study and to group assignment. Using tapes from pilot
families the research assistant was trained by the primary
investigator, to reliably use the coding and scoring system.
Data from training tapes were not included in the nal
results. Reliable use of the system was dened as 80%
reliability on observed occurrences with the primary
investigator over at least two, 5-min work session video-
tape segments. Videotapes used for data analysis were
identied by numbers provided in random order to ensure
the research assistant could not identify dates or the
sequence of videotaped sessions in any way. Order effects
were controlled by counterbalancing pre-treatment/waitlist
and post-treatment/waitlist videotapes. The research assis-
tant collected partial interval data and point-by-point data
on paper and pencil data sheets. Tapes were scored
according to operational denitions of dependent measures
and to specic scoring methods (See Table 1). For reli-
ability purposes, 35.8% of work sessions were also scored
by the primary investigator.
Two coding systems were used. First, the percentage of
10-sec intervals that the parent and child were engaged in
targeted behaviors was calculated using a partial-interval
coding system. Parent behavior variables included (a) total
effective prompts, and (b) total ineffective prompts. The
child behavior variable was independent functioning. Sec-
ond, a point by point coding system was used to track a third
parent behavior: parent set-up behavior. It was used to cal-
culate the percentage of individual components present from
a checklist of 16 items indicating correct placement of fur-
niture and teaching activities. Brief operational denitions
are provided in Table 1. Additional information about the
behavior codes can be obtained from the rst author.
A research assistant also collected treatment integrity data
to ensure that the treatment protocol was being followed.
The clinician was unaware of when the delity checks were
being conducted. Treatment delity checks were scored as
the number of applicable steps correctly performed. Addi-
tional information about the behavior codes and treatment
delity checks can be obtained from the rst author.
A multiple baseline probe design across HTP and WL
family pairs was used. Baseline videotaping of each family
within the pair began simultaneously, and the treatment was
introduced sequentially to evaluate its effects on child and
parent behavior. It was hypothesized that parents ability to
successfully set up the teaching environment and activities
and parent prompting would improve in response to treat-
ment, and that child independent functioning would increase.
Interobserver Agreement and Treatment Integrity
Two independent observers collected data during 35.8% of
sessions. Reliability ranged from an average of 84.999.0%
across all target behaviors. Treatment integrity data were
collected by a research assistant who used a procedural
checklist of treatment steps to assess correct implementation
by a clinician who was unaware of being observed and not
part of the research team. Data showed the treatment was
implemented with a range of 87.5100.0% accuracy.
J Autism Dev Disord (2012) 42:18271835 1829
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Group Design
The group study was a randomized pre-post treatment
design. Child outcome was measured using the Mullen
Scales of Early Learning (MSEL; Mullen 1995) and Scales
of Independent Behavior-Revised (SIB-R; Bruininks et al.
1996). Both scales have demonstrated good reliability and
validity. The Parenting Stress Index-3rd edition (PSI;
Abidin 1995) was used to assess parent stress. Assessments
were performed either in the home or in the clinic. During
the post-assessments, the number of hours children spent in
non-project interventions such as speech and occupational
therapy were collected via interview from 50% of parents
to allow comparison between groups regarding uptake of
community services.
Treatment Procedure
Once initial baseline assessments were completed, families
were randomly assigned to either the HTP or the WL
condition. Those assigned to the HTP group began meeting
with a clinician 1.5 h a week for 12 sessions. Each treat-
ment session consisted of several 510 min teaching times
in which parents were trained to work with their child.
These teaching times consisted of the clinicians teaching
specic cognitive, ne motor, and language skills to the
child while modeling appropriate prompting behavior to
the parents, and how to set up the teaching environment. As
children began learning the activities, the clinician sys-
tematically faded their prompts until the children were
completing tasks independently. Parents were also pro-
vided with 30 min of education about autism and inter-
vention strategies. At the end of each session, parents were
assigned written homework and asked to apply new skills
learned between treatment sessions. After the 8th treatment
session, parents took an active role in teaching time, with
the clinician providing coaching and feedback on teaching
procedures and on how they set up the teaching environ-
ment. A standardized treatment manual was used with each
family; however, individualization was also built into the
Table 1 Operational denitions of parent and child behaviors
Work session set up: dened as the placement of the following items/objects in the proper arrangement according to the following criteria
before the child is transitioned to the work area:
1. Auditory distractions and visual distractions are minimized
2. Work table: table set up in location with no other movable items/objects within 3 ft
3. Chair placement: facing one side of the table
4. Chair placement: pulled out 12 ft away from the tables edge for easy access to child
5. Shelving: located no more than 6 inches from the table
6. Shelving: located catty corner left of the chair, lengthwise along the table
7. Shelving: edge of shelf is located within childs reach
8. Finished basket: located catty corner right of the chair (across from shelves)
9. Finished basket: edge of basket is touching edge of table
10. Task arrangement: tasks are placed on the shelf side-by-side
11. Task arrangement: tasks are not stacked
12. Task arrangement: at least 1 task is located within the childs reach on the shelf
13. Task arrangement: 1 task located in front of the child, on table, within 3 in. of reach
14. Rug is placed to dene the play area within 36 ft from work table
15. Toy basket: located on rug or within 1 ft of rug
16. Toy basket: all toys are stored in the basket
Effective Prompt: any instance of the parent providing a clear verbal, visual, gestural, or model instruction to the child that results in
compliance with instruction within 3 s of prompt. An effective prompt is limited to approximately 3 consecutive prompts and includes
prompts for orienting or attending behavior (e.g. Are you ready?). Does not count if the child does not change behavior due to prompt. (e.g.,
parent says come here when child is already moving in his/her direction)
Ineffective Prompt: any physical prompt (taking a childs body part to engage in an instruction) or any verbal, visual, gesture or model
guidance provided to the child that does not result in compliance by the child within 3 s of prompt or any instruction that is repeated
consecutively more than approximately 3 times
Child Independent functioning: dened as one or more of the following actions:
the child initiates or reaches for tasks on the shelf without prompting (without prompting excludes when helped due to inability to reach task
due to size, though initiation must be unprompted)
the child places tasks on the work table or on the oor in front of his/her body without prompting
the child completes tasks for more than 3 s without prompting
the child pushes/throws tasks toward or places them in the nished basket without prompting
1830 J Autism Dev Disord (2012) 42:18271835
1 3
program. For example, the presentation, difculty, and
layout of tasks were based on assessment of the childs
skills and learning style. After waitlist families were
assessed on post-treatment measures, they had the oppor-
tunity to participate in the program. Additional information
about the treatment can be obtained from the rst author.
Results
Single Subject Results
Six families participated in the multiple baseline design
study. These families included three pairs of families,
randomized within each pair to the HTP or WL groups.
These pairs are described in detail below, as pair 1 which
includes the parent/child dyad assigned to Home TEAC-
CHing (HT-C1/HT-P1) and the parent child dyad assigned
to the waiting list (WL-C1/WL-P1), pair 2 (HT-C2/HT-P2
and WL-C2/WL-P2) and pair 3 (HT-C3/HT-P3 and WL-
C3/WL-P3). Demographic characteristics of these three
pairs of parentchild dyads are presented in Table 2.
Results for child behavior are presented in Fig. 1.
Treatment was associated with clear increases in levels of
independent functioning across two of the three pairs of
dyads. HT-C2 showed a reversal of treatment effects dur-
ing the nal two probes, whereas the waitlist control
showed a clearer response to treatment. HT-C1 increased
from a baseline of 10.7% to a mean of 40.0% (range,
31.046.6%) and WL-C1 increased from a mean of 26.9%
(range, 23.334.4%) to 62.5% (range, 53.367.1%) only
after the treatment was implemented. HT-C2 showed an
initial response to treatment, and then a reversal, with
overall stable rates of independent functioning, from 23.3%
to a mean of 21.4% (range, 10.037.5%) and WL-C2
increased from a mean of 1.6% (range, 0.03.3%) to 16.7%
(range, 0.030.3%). HT-C3 showed a clear treatment
response, from 23.3% to a mean of 45.6% (range,
36.750.0%) and WL-C3 increased from a mean of 8.8%
(3.316.6%) to a mean of 19.2% (range, 00.040.0%) after
treatment was implemented.
Results for parent setup behavior are presented in Fig. 2.
Visual inspection of the graphs and comparison of means
indicates that treatment was associated with a clear increase
Table 2 Single subject design
participant demographic
characteristics
Chronological Age Child gender Child ethnicity Parent
Pair 1 HT 30 months Male Caucasian Father
WL 30 months Female Latina Mother
Pair 2 HT 28 months Male Caucasian Mother
WL 24 months Male Caucasian Mother
Pair 3 HT 32 months Male Caucasian Mother
WL 39 months Male African American Mother
0
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HT-C1
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Pre WL 3 WL 6 WL Sess.
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Fig. 1 Child independent functioning
J Autism Dev Disord (2012) 42:18271835 1831
1 3
in parent set up behavior across all three family pairs. Results
for parent prompt behavior are presented in Fig. 3. Treatment
effects for increases in effective prompts and decreases in
ineffective prompts were supported across all three family
pairs. A moderate change in levels of effective prompting for
WL-P1 (mean of 61.4% (range, 53.770.0%) to a mean level
of 77% (range, 65.288.2%)), taken together with a clear
change in levels of effective prompting for HT-P1 (37.5%to a
mean of 81.5% (range, 8084.6%), provides evidence for
treatment effects. Decreases in ineffective prompting across
HT-P1 and WL-P1 also provides evidence for treatment
effects. HT-P2 showed moderate increases in mean effective
prompting (58.3% to a mean of 71.8%) and decreases in
ineffective prompting (41.6% to a mean of 28.2% (range,
0.053.8%), despite an apparent reversal of effects during the
second probe. The parent reported that their child was ill
during the time that the second probe was conducted. WL-P2
showed a delayed (hypothesized to be due to the parents
Fig. 2 Parent setup behavior
Fig. 3 Parent effective and ineffective prompts
1832 J Autism Dev Disord (2012) 42:18271835
1 3
need to practice and take a hands-on role for greater learning)
but moderately strong treatment effect for effective prompt-
ing (mean of 16.3% (range, 0.032.1%) to a mean of 35.5%
(range, 13.665.5%)) and ineffective prompts (mean of
83.7% (range, 67.9100.0%) to 64.5% (range, 34.586.4%)).
HT-P3 showed support for treatment effects on both behav-
iors, with effective prompting increasing from 66.7% to a
mean of 89.1% (range, 81.295.0%) and total ineffective
prompting decreasing from36.3%to a mean of 10.8%(range,
5.118.2%), while WL-P3 did not verify the treatment effects
until the nal treatment probe. This also may have been due to
the parent needing more practice and hands on training to
develop their skills.
Group Comparisons
Demographics of the total Home TEACCHing Program
(HTP) and Waitlist (WL) groups are presented in Table 3.
An independent-samples t-tests was used to examine
whether any signicant differences in means existed
between groups at pre-test on time spent in occupational
and speech therapy, and no group differences were found,
p = .840 and p = .819 respectively. Group comparisons
examined whether there were any signicant differences in
developmental gains or parent stress over the 3 month
period of the HTP between HTP and WL groups. Repeated
measures analysis of variance for the Mullen Scales of
Early Learning, SIB, and PSI did not reach signicance.
Within-group effect sizes are reported in Table 4 to dem-
onstrate that participants in the HTP made considerable
gains over the 3 month time period, particularly in
expressive language, as measured by both the Mullen
Scales of Early Learning and the SIB expressive language
domain. These results also show similar changes in the WL
group. Effect sizes for the HTP group were medium and
large for this domain. Results suggest that this study was
underpowered to demonstrate signicant intervention
effects, and also suggest that the 12-week timeframe may
be too short for these global developmental measures.
Parent stress, as measured by the PSI, decreased slightly
between pre- and post-test for participants in the HTP, but
increased slightly for parents in the WL group. Group
differences were not statistically signicant.
Discussion
The current results support the feasibility of this home
based program using structured teaching methods. Results
suggested that participation in the HTP led to improvement
in childrens independent work skills and parents ability to
structure the environment for learning and effectively
prompt their children during teaching sessions. While this
study was underpowered, within-group effect sizes for
improvements in child developmental and adaptive skills,
and decreases in parent stress were encouraging and sug-
gest future study is warranted. The combined approach of a
detailed multiple baseline study and randomized group
design makes this a unique study of a comprehensive early
autism intervention program.
These preliminary results, if replicated, could carry
important implications. First of all, with regard to
improvement in childrens independent work skills, the
structured teaching methodology focuses on teaching chil-
dren to engage in positive work routines as independently as
possible (Mesibov et al. 2005). Work routines consist of a
behavior chain of taking, completing, and putting away
activities in a left to right sequence. Once this behavior
chain is learned, it can be generalized to a wide variety of
activities and settings, which can facilitate broad learning
and independence. Learning this behavior chain also avoids
over-reliance on adult prompts for on-task behavior.
Secondly, the results showed that parents could learn to use
physical structure of the environment as an antecedent inter-
vention. The structured teaching approach promotes using
physical structure, includingthe use of furniture andboundaries
and organization of materials, to provide visual cues that are
thought to increase on-task behavior, reduce behavior chal-
lenges, and increase independence (Mesibov and Shea 2011).
Future studies could manipulate aspects of physical structure
used in the home program to examine both the inuence of
different aspects of physical structure and the presence versus
absence of physical structure on child behavior.
Third of all, the results suggested that the treatment
program increased effective prompting behavior in parents.
Providing effective prompts is a pivotal skill needed for
Table 3 Demographic characteristics for group comparison
Home TEACCHing
(n = 10)
Waitlist
(n = 10)
Age in months
Mean (s.d.) 30.5 (3.6) 30.5 (4.3)
Range 2437 2439
Mullen DQ
Mean (s.d.) 57.1 (15.6) 53.7 (24.5)
Range 3586 2189
Gender (% male) 90% 90%
Ethnicity (% Caucasian) 90% 70%
Maternal education
(% some college or more)
90% 90%
Mean (s.d) hours
in occupational therapy
4.8 (6.6)* 5.6 (5.6)*
Mean (s.d) hours
in speech therapy
8.4 (5.4)* 9.3 (5.4)*
*n = 5 per group
J Autism Dev Disord (2012) 42:18271835 1833
1 3
parents to ensure responding and learning from their chil-
dren. Effective prompting also results in conservation of
time and resources. Parents were taught to rely on visual
prompts versus verbal prompts which is in line with the
goals of the TEACCH program. Given that many individ-
uals with autism tend to be visual learners (Quill 1997), an
emphasis is placed on relying on visual prompts and cues,
or at least supplementing verbal prompts and cues with
visual ones (Mesibov et al. 2005) to match children with
autisms learning style and to decrease prompt dependence
thereby increasing independence. Less use of ineffective
prompts is important as it may contribute to decreased
behavioral challenges in children.
Within-group effect sizes for the HTP group were
medium to large for developmental and adaptive skills as
well as for parent stress. However, results revealed no
statistically signicant differences between the HTP and
WL groups. The effect sizes were encouraging for a
12-week parent-mediated program, and suggest that future
study with a larger sample size could be important. Results
also suggest that a longer, or more intensive, intervention
may be better suited for examination of change in global
developmental skills. Decreased parent stress during the
initial months after a child is diagnosed with ASD could be
quite important given the high stress often seen in these
parents during the preschool years (Estes et al. 2009).
There were several limitations in the current study. Only
one baseline probe was collected for treatment families. An
extended baseline of at least three probes to show baseline
stability would have allowed for stronger conclusions to be
made about treatment effects, however, the shortened
baseline period used in the study was necessary to avoid
delaying access to treatment. Also, the overall limited
number of probes that were collected during treatment
sessions is a limitation, and may have masked the strength
of treatment effects. Finally, we only collected information
on the other interventions for 50% of participants, which
could make it challenging to interpret the group-level
analyses as it is possible that the WL group sought more
intensive services while on the waiting list, however, we did
not see a signicant difference in number of hours of out-
side intervention between groups for half of the participants
and believe this trend to be true for all participants.
In summary, the current study represents an initial
piloting of a home based intervention based on the TEA-
CCH model. The target behaviors analyzed in the current
study reect some of the core concepts of the structured
teaching methodology. Future studies may want to directly
examine the effects of the strategies on other pivotal
behaviors such as nonverbal communication skills, imita-
tion, and joint attention, as these skills enable children to
access further learning from their environment and are vital
goals of early intervention programs (Rogers and Vismara
2008). Also, future students may want to consider testing
this program when conducted over a longer period of time.
Finally, future research could break apart components of
the home program to demonstrate which aspects of the
program are responsible for change, and whether increased
or decreased intensity would make a difference in both
child and parent outcomes.
Table 4 Effect sizes for HTP
and WL
Baseline Post-test Baseline to post-test
Mean SD Mean SD t p d
Home TEACCHing
Mullen developmental quotient 57.1 15.6 63.7 17.4 -2.4 0.0 0.4
RL quotient 53.2 23.1 60.9 26.1 -1.8 0.1 0.3
EL quotient 46.2 23.5 58.0 21.9 -2.6 0.0 0.5
PSI total stress 254.1 48.5 242.4 41.5 1.3 0.2 -0.3
SIB social interaction 11.8 6.1 18.4 7.3 -6.1 0.0 1.0
SIB language comprehension 9.9 4.4 12.0 4.7 -2.6 0.0 0.5
SIB language expression 11.4 5.7 16.2 7.1 -4.6 0.0 0.8
Waitlist
Mullen developmental quotient 53.7 24.5 58.1 25.0 -2.1 0.1 0.2
RL quotient 49.4 33.8 58.1 30.8 -2.5 0.0 0.3
EL quotient 47.4 25.3 62.4 32.6 -3.5 0.0 0.5
PSI total stress 244.5 32.8 256.2 70.0 -.7 0.5 0.2
SIB social interaction 12.1 4.2 16.0 5.0 -3.2 0.0 0.9
SIB language comprehension 7.3 4.2 10.9 4.8 -3.0 0.0 0.9
SIB language expression 10.2 7.5 14.2 7.1 -3.1 0.0 0.6
1834 J Autism Dev Disord (2012) 42:18271835
1 3
Acknowledgments We wish to thank the participating families and
the team that made this program and research possible including Ron
Faulkner, Susan Boswell, Lindsey Schumacher, Devon Hartford,
Johanna Lima, Mandy Benson, and Nadette Welterlin-Hugg. Their
contributions were invaluable to the completion of this project. Part of
this project was the doctoral dissertation of the rst author. Dr. Wel-
terlin was supported, in part, by the Harris Fellowship Award and the
2007 Graduate Research Grants Program Award. Dr. Turner-Brown
was supported by Division TEACCH, by the National Institutes of
Child Health and Human Development T32-HD40127 and P30
HD03110, and by grant R40 MC22648 through the U.S. Department of
Health and Human Services, Health Resources and Services Admin-
istration, Maternal and Child Health Research Program
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