Assessment is part of the child or adult’s initial evaluation, and also continues beyond that point. The purpose of assessment is to identify the person’s strengths, weaknesses, interests, learning style, and emerging skills from a variety of perspectives. Our ultimate goal is to use the assessment information to develop appropriate individualized goals and intervention strategies and to continue to evaluate their effectiveness over time.

Utilizing information from parents, teachers, and the individual with ASD, individualized teaching goals are developed based on the perceived needs and weaknesses in different settings. Respect for the individual with ASD necessitates choosing goals and objectives based on recognition of the child or adult’s specific wants and interests. Emerging skills identified through the assessment process are used to form developmentally appropriate and achievable goals. Emerging skills are those skills that the child or adult is showing a beginning or partial understanding of but has not yet mastered the concept. For a young child, he/she may be starting to sort by color recognizing one or two colors but not consistently putting like colors together. For an adolescent learning to care for his/her own needs, he/she may be able to hold a broom correctly and make the sweeping motion, but does not yet have the concept of how to sweep an entire area. Part of the assessment process includes assessing the parent’s interests, needs, and skills as they are essential collaborators in this process. Carefully listening to parents is perhaps the most valuable assessment skill one can have (Morrell and Palmer 2006). Taking the time early on and throughout one’s relationship with a family to hear their story and to recognize their greatest concerns and needs creates a foundation that is essential to the ongoing collaboration.

A second aim of the assessment process is to identify the person’s learning style in order to individualize the teaching strategies and behavioral interventions. Knowing the person’s strengths—whether he/she is good at matching or decoding objects, pictures, letters, numbers or words—is the beginning step to Structured Teaching. The TEACCH approach has always been to utilize the strengths of the individual to help compensate for areas he/she is not yet ready to learn. Along with identifying strengths, defining the unique interests of the client is a very important aspect of the assessment process. Motivating individuals on the autism spectrum can be challenging especially if we make the erroneous assumption that what is meaningful to us is meaningful to them. Intense and atypical interests are defining features of autism spectrum disorders. As will be discussed shortly, Structured Teaching utilizes the clients’ special interests to increase their engagement, appropriate attention, and motivation to complete tasks.

Ongoing assessment is an important aspect of any intervention or educational program. Taking data on either the acquisition of a skill or the frequency of occurrence of a negative behavior helps us to determine whether or not the goal is being achieved. When targeting high frequency or high intensity negative behaviors one may actually have a successful behavior plan but subjectively not recognize progress without objective data that is regularly analyzed and charted. Data on teaching goals helps us determine when the intervention plan is working or not working and may provide information on how to refine the teaching method.

The Psychoeducational Profile (PEP 1971) was originally developed at a time when children with autism were often thought to be “untestable” (Alpern 1967; Marcus and Baker 1986). Standardized tests often require an inflexible, language based administration that does not fully reflect the uneven profile of children with autism. A developmental measure, the Psychoeducational Profile (PEP) was designed to assess the functioning of children whose communication deficits may impair their ability to understand what is being asked of them on a more language based standardized test.

The PEP-3 (Schopler et al. 2005), the most recent update of this measure, includes both a direct assessment of the child’s skills and behaviors as well as a caregiver questionnaire. The direct assessment scale is comprised of six developmental subtests and four maladaptive scales. Developmental items range from 7 to 81 months. In general, the test is best utilized with children whose cognitive ability is younger than 6 years of age. The six developmental subtests include cognitive verbal/preverbal, expressive language, receptive language, fine motor, gross motor, and visual motor imitation. Each item is scored as a 2, 1, or 0 with 2 being a passing skill that the child can do without extra demonstration or teaching; 1 is an emerging skill where the child demonstrates some ability to perform the skill or needs extra demonstration or teaching to be successful; or 0 is a failure indicating an inability to complete any aspect of the task. These scores are totaled to yield developmental ages and percentile ranks for each area.

The Maladaptive Behavior subtests include items related to Affective Expression; Social Reciprocity, Characteristics Motor Behaviors, and Characteristic Verbal Behaviors. Lower scores represent atypical or autistic behaviors.

The Caregiver Report provides information about the parents’ perceptions of their child’s current developmental level, diagnostic categories, problem behavior, personal self-care, and adaptive behavior. Parent estimates of current child functioning in communication, motor, social, self help, thinking, and overall skills are generally accurate and broadly sensitive to developmental difficulties (Glascoe and Sandler 1995). They are also an excellent gauge of likely parent reactions to the feedback from the assessment.

Overall, analysis of reliability and validity indicate that the PEP-3 demonstrates sound psychometric properties (Schopler et al. 2005). It was developed using data collected during 2002 through 2003 in a normative sample comprised of 407 children and adolescents with ASDs and 148 children with typical development from across the United States. Both groups were similar to the general U.S. population as measured by 2001 Census data on the characteristics of race, family income, and parent educational attainment. The gender of the typically developing sample was also similar to the general population, while the gender of the sample with ASD (4:1 males to females) was similar to reported prevalence rates for autism. Coefficient alphas were calculated for all subtests and composites from the sample of individuals with ASDs at 11 age intervals (ages 2 through 12 years); average coefficients indicated high reliability and for the Developmental subtests ranged from .92 to .97, for the Maladaptive Behavior subtests ranged from .90 to .93, for the Caregiver Report subtests ranged from .84 to .90, and for the Composites ranged from .97 to .99. Test-retest reliability was assessed over a period of two weeks in a subsample of 33 children with ASDs. Raw scores were used to calculate correlation coefficients for each subtest and all indicate high reliability: Developmental subtest correlation coefficients ranged from .97 to .99, Maladaptive Behavior subtest correlation coefficients ranged from .94 to .98, and Caregiver Report subtest correlation coefficients ranged from .98 to .99.

Validity was evaluated in a series of studies correlating scores from the PEP-3 with scores from other developmental and behavioral assessments used to measure similar constructs, including the Vineland Adaptive Behavior Scales, the Childhood Autism Rating Scales, and the Autism Behavior Checklist–Second Edition. Overall, the vast majority of correlations were large (.50 and above) and in the expected direction, thus supporting the validity of the PEP-3 as a measure of development and autism characteristics (Schopler et al. 2005).

The PEP-3 can be used to identify a starting point for designing both teaching goals and Structured Teaching intervention strategies for a preschool child with autism. For developing teaching goals for home or a school IEP, the emerging skills in each development area combined with the information about parents’ greatest area of concerns typically provides an ideal starting point. The observations of the child’s strengths, and responses to the different teaching strategies utilized within the test administration, give valuable insights into the child’s learning style and where to start in developing the visual strategies discussed later in this chapter.

TEACCH Transition Assessment Profile–Second Edition (TTAP; Mesibov et al. 2007) is a criterion referenced assessment tool developed to assist in the assessment of skills and development of goals for older children and adolescents as they transition to adulthood. It is also useful for assessing and developing goals for many adults on the autism spectrum. Originally developed as the Adolescent and Adult Psychoeducational Profile (AAPEP; Mesibov et al. 1988), this second edition has been expanded to include more high functioning skills in recognition of the increasing incidence of high functioning autism diagnoses. The interrater reliability for the total score of the original APPEP was .865, and the validity of the AAPEP was established by comparing the recommendations generated by the AAPEP with those already in the client’s IEPs or IHPs. Ratings by independent, blind observers rated the recommendations based on the AAPEP as superior to those on the current IEP (Van Bourgondien and Mesibov 1989). The reliability and validity studies for the new edition, TTAP, are currently in progress. Also added to the TTAP is an informal community-based assessment to assist in the transition to adult life by evaluating the individual in a variety of vocational and living situations. The Individuals with Disabilities Education Act (IDEA) of 1997 and the reauthorization of IDEA in 2004 require that an evaluation be made and a transition plan be put into place by age 16 years at the latest.

The formal assessment aspect of the TTAP assesses six functional areas across three different contexts. The six areas assessed are vocational skills, vocational behaviors, independent functioning, leisure skills, functional communication, and interpersonal behaviors. The Direct Observation Scale provides a skill based observation and evaluation of the client by the examiner. The Home scale and the School/Work scale each complement the information gathered in the direct assessment with information from the caregiver and from either the teacher or a work supervisor. The information from these interview scales provide valuable information about a larger range of strengths and weaknesses, the generalization of skills across different contexts, and the individual’s ability to flexibly use his/her skills.

The scoring system is the same as used in the PEP-3 with a pass, emerge, or fail. In addition to the scores in each functional area across the three contexts, the TTAP formal assessment section also includes a Structure Checklist that helps to identify the environmental accommodations the individual needs to be most successful. The TTAP directly assesses the individual’s ability to benefit from the different types of schedules, work systems, and visual instructions described later in this chapter.

An added feature of the TTAP is its informal assessment components. Best practices indicate that effective transitions are facilitated by a combination of both formal and informal assessment tools (Mesibov et al. 2007). The Cumulative Record of Skills (CRS) and additional TTAP forms provide information on a greater variety of skill sets that can be assessed, taught, and re-evaluated within the job site. With its comprehensive list of skills, it goes beyond an assessment tool to become both a curriculum of skills needed in community environments and a potential record/resume of skills acquired during multiple community interventions.

The next step in this process is to implement the teaching activity and to observe the success of this effort. Every teaching opportunity is also a chance to reassess not just the individual’s skill, but also the learning style and what teaching strategy works best. Restructuring our teaching activities is a fundamental aspect of the Structured Teaching philosophy. By carefully observing the child or adult’s response to our teaching efforts, we learn what works best for him or her. Ultimately, through this dynamic process of teaching and restructuring, the individual achieves mastery of the concept and independence in performing the skill (see Fig. 5.1).

TEACCH’s predominant intervention methodology is Structured Teaching, a set of teaching principles and intervention strategies based on our understanding of the culture of autism as well as the unique needs, skills, interests, and preferences of each individual with ASD (Mesibov et al. 2005). Given the neurological basis of the culture of autism, Structured Teaching emphasizes both teaching new skills as well as developing compensatory strategies and environmental supports, much as a cognitive remediation program seeks to improve and/or compensate for cognitive deficits arising from brain dysfunction (Ozonoff et al. 2005b). Structured Teaching emphasizes the use of visual and organizational supports and can be applied in flexible ways in a variety of settings for individuals of all ages and all abilities levels. Structured Teaching can be used to develop or improve skills in communication, social interaction, academic achievement, daily living and self-help, leisure, and vocation. It can also be used to help prevent behavior problems (Van Bourgondien et al. 2003) and adapt interventions focusing on mental health issues (DeRamus and Naftel 2008). Although Structured Teaching draws heavily from behavioral and cognitive behavioral principles, it is most closely aligned with cognitive–social learning theory in that it emphasizes the importance of recognizing the client’s thoughts, expectations, and understanding when designing interventions to change behavior and teach new skills (Mesibov et al. 2005). The effectiveness of visual systems as an intervention technique has been documented in numerous studies with children and adults in a variety of settings (Bryan and Gast 2000; Dettmer et al. 2000; Francke and Geist 2003; Hume and Odom 2007; Mesibov 1997; Mesibov et al. 2002; Mesibov and Shea 2010; Mesibov et al. 2005; Panerai et al. 1998; Panerai et al. 2002; Panerai et al. 2009; Persson 2000; Probst et al. 2010; Probst and Leppert 2008; Quill 1997; Short 1984; Van Bourgondien et al. 2003; Vaughn and Horner 1995).

The primary goals of Structured Teaching are to (1) create an organized and predictable environment that enables individuals with ASD to move beyond fragmented details and begin to understanding meaningful connections in the world around them, and (2) teach skills that are functional and help promote personal independence at whatever level the individual is capable of (Mesibov et al. 2005). The basic elements of Structured Teaching include (1) organization of the environment and physical space, (2) visual schedules, (3) structured work and activity systems, and (4) visually structured activities. Each is discussed in the following section.