Effects of TEACCH on social functioning in individuals with autism spectrum disorders: a systematic review and meta-analysis

Abstract

Objective

To investigate the effects of Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) on social functioning in individuals with autism spectrum disorders (ASD).

Methods

Relevant studies on TEACCH intervention in ASD individuals were systematically searched in PubMed, The Cochrane Library, Embase, CNKI, and Wanfang from inception to March 2024. The main outcome measures were social, cognitive performance, fine motor, communication, daily living, imitation, and cognitive verbal skills. Data were meta-analyzed using R studio (4.1.2).

Results

Eleven studies involving 701 ASD individuals were included in this study. The TEACCH group had significantly higher socialization score [MD = 0.6, 95% CI(0.2, 1.0)], Cognitive Performance Scale score [MD = 1.34, 95% CI(0.09, 2.58)], and fine motor score [MD = 0.7, 95% CI(0.4, 1.0)] but significantly lower Autism Behavior Checklist score [MD = -1.57, 95% CI(-2.11, -1.02)], Childhood Autism Rating Scale score [MD= -0.7, 95%CI(-1.0, -0.3)], and Autism Treatment Evaluation Checklist score [MD= -0.7, 95% CI(-1.0, -0.3)] compared to the control group. There were no significant differences in other outcome measures.

Conclusion

TEACCH is a promising intervention for improving the social skills, cognitive performance, and fine motor functions of ASD individuals. However, further studies are warranted to confirm the effectiveness of TEACCH on ASD core symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-025-05921-0.

Introduction

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by mild to severe social communication impairment and restrictive repetitive behaviors [1]. ASD has a broad range of presentations, extending from intellectual disability and limited language proficiency to significantly above-average intellectual and language capacities alongside social challenges. The complexity and heterogeneity of ASD have been shown to be associated with developmental factors (e.g., age and intelligence quotient) and environmental factors (e.g., availability of personalized educational services and verbal, language, and behavioral interventions) [2]. In addition to intellectual and language impairment, ASD is often accompanied by other medical and psychiatric conditions such as epilepsy, sleep problems, anxiety, and depression [3, 4].

At present, the global prevalence of ASD is 0.6% [5]. A 2020 survey estimated that ASD is found in 1 in 36 eight-year-old children (about 4% of boys and 1% of girls), which is higher than previous estimates by the Autism and Developmental Disabilities Monitoring (ADDM) network from 2000 to 2018 [6]. The higher annual incidence of ASD may be related to changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness [7, 8]. ASD is a highly heterogeneous disease that poses a heavy health burden worldwide. Therefore, it is urgent to explore effective treatment methods for ASD. However, a meta-analysis of autism interventions in younger children showed that none of the intervention types significantly influenced ASD outcomes when effect estimates were limited to randomized controlled trials (RCTs) without detection bias [9].

Increased interest in ASD has led to significant advances in ASD management over the past six decades. There is mounting evidence supporting the effectiveness of behavioral interventions for ASD [10].Of the many ASD interventions currently available, Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is a program specifically designed for children with ASD. This program takes into account the characteristics of ASD and aims to minimize children’s challenges through structured and ongoing intervention, environmental adaptation, and enhanced communication. The key principles of TEACCH include improved adaptability, parental collaboration, evaluation of individualized therapy, structured teaching, skill enhancement, cognitive and behavioral therapy, and generalist training. Previous studies demonstrated that the TEACCH program is strikingly distinct from most other treatments due to its multidisciplinary nature, which relies on interactions among service staff, professionals, communities, and families. Engaging parents in intervention strategies for children with autism can enhance the children’s skills and reduce stress for both parents and children [11]. TEACCH is also one of the most widely used methods in the school setting. However, there is still a large gap between current scientific knowledge and the help and support needed by ASD individuals and their families. The pressing issue of how to effectively support each family with ASD requires immediate attention [12].

Categories of intervention approaches that were too sparsely represented in the existing literature to allow summary effect estimation for autistic children between birth and 8 years old. Given these interventions like TEACCH are frequently prescribed for and used by this population, there is a need for more rigorous research evaluating the efficacy of such approaches [9, 13]. A 2013 meta-analysis showed that TEACCH has minimal impact on perceptual, motor, language and cognitive skills, as well as minimal to negligible influence on communication, daily living and motor function [14].

At present, the overall effectiveness of these approaches in children and adolescents with ASD is currently unclear due to the scarcity of studies. Given the frequent application of TEACCH in this population, more rigorous studies are warranted to evaluate the effectiveness of these methods [13]. The present study aims to provide a meta-analysis of the latest findings on the effectiveness of TEACCH in ASD patients in order to provide guidance for healthcare professionals, clinicians and families.

Methods

This study was conducted in compliance with the PRISMA statement [15] and has been registered on PROSPERO (CRD42024526825).

Eligibility criteria

Inclusion criteria

(1) RCT, cohort study; (2) Studies published in Chinese or English; (3) Individuals with ASD, regardless of age, sex, type of onset and nationality; (4) Intervention is TEACCH or TEACCH in combination with other interventions.

Exclusion criteria

(1) Review, books, editorials, comments, case reports, meta-analysis, unpublished studies; (2) Inaccessible full text or nonextractable outcome measures; (3) Duplicate publication; (4) Less than 10 participants; (5) The intervention measures or group method or outcome measures not met; (6) Intervention duration < 3 months.

Outcome measures

Primary outcome measures were communication, social, cognitive, motor, daily living, imitation, and gross and fine motor skills. Secondary outcome measures were Autism Behavior Checklist (ABC) score, Childhood Autism Rating Scale (CARS) score, Autism Treatment Evaluation Checklist (ATEC) score, eye-hand integration, and perception.

Search strategy

Relevant studies were systematically searched in Chinese National Knowledge Network (CNKI), Wanfang Data (Wanfang Data), PubMed, The Cochrane Library, Embase and other Chinese and English databases from inception to March 2024 using subject headings and keywords. The Chinese search terms included autism, TEACCH, and structuralization. The English search terms were “TEACCH”, “treatment and education of autistic”, and “treatment and education of autistic and communication handicapped children”.

Literature screening and data extraction

Literature screening and data extraction were performed independently by two researchers, and any disagreement was resolved by a third researcher. Data extracted included: (1) General study characteristics (author, publication year, patient age, and diagnostic criteria for ASD); (2) Intervention program (intervention method, frequency, and duration); (3) Quality assessment (randomization method, blinding method, selective reporting, and completeness of results); (4) Outcome measures.

Risk of bias assessment

The quality of the included RCTs was assessed independently by two researchers using the risk of bias tool for randomized trials (RoB 2) [16]. The evaluation included random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and other bias. Each domain was scored as high, low, or unclear risk. The quality of cohort and case-control studies was evaluated using the Newcastle-Ottawa scale (NOS) in cohort study. Studies with a score of 6 or higher are considered to be of high quality. Any disagreements were discussed and resolved by a third reviewer.

Statistical analysis

Meta-analysis was performed using R studio (4.1.2). The outcome measures examined in this study were all continuous variables, and the pooled values were expressed as mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI). Heterogeneity was evaluated by the I² statistic. A P > 0.1 and I² < 50% indicates no or little heterogeneity among studies, and a fixed effects model was used for meta-analysis; otherwise, a random effects model was adopted [17]. The sources of heterogeneity were also examined by sensitivity and subgroup analyses. Publication bias was evaluated for the outcomes reported in three or more articles through funnel plots and egger’s test method. A P < 0.05 was considered statistically significant.

Results

Literature search

The literature search process is described in Fig. 1. We initially identified 417 articles, including 377 in English and 40 in Chinese. The articles were imported into Endnote to remove duplicates. After abstract and title screening, a full text review was performed on 38 articles, and 21 ineligible studies were eliminated. A final total of 11 articles were included, encompassing 6 English articles [18–23] and 5 Chinese articles [24–28].

Fig. 1.

Literature screening process

General study characteristics

The 11 included RCTs involved 701 children and adolescents with ASD aged 2–18 years. There were 344 participants in the experimental group and 315 in the control group. General information of the RCTs are summarized in Table 1.

Table 1.

General characteristics of included studies

Study		Number of subjects (experimental group/control group)	Age (year)	ASD diagnostic criteria	Intervention		Intervention frequency and duration	Outcome measures
					experimental group	control group
Sally Ozonoff et al. 1998 [18]	11/11		2–6	DSM-IV, ADOS, ADI-R	TEACCH	conventional rehabilitation	8–12 sessions for 4 months	①②
Simonetta Panerai et al. 2009 [19]	13/10		6–12	ADI-R, CARS	TEACCH	conventional rehabilitation	Six months	①⑤
Lidia D’Elia et al. 2014 [20]	15/15		2–6	ADOS, DSM-IV	TEACCH	conventional rehabilitation	4 h/day for 6 months	①⑤⑦⑨
Lauren Turner-Brown et al. 2019 [21]	32/17		≤ 3	ADOS, DSM-V	TEACCH	conventional rehabilitation	90 min/session for 6 months	⑧⑨⑩
M. Mazza et al. 2021 [22]	37/26		12–18	ADOS-2	TEACCH	BEI	4 h/day, 5 days/week for 12 months	⑥
Hongling Zeng et al. 2021 [23]	30/30		3–6	DSM-V	TEACCH + DTT	DTT	30 min/session, 5 times/week for 6 months	①
Zhang Feilin et al. 2022 [24]	45/45		4–7	-	TEACCH + ABA	conventional rehabilitation	5–6 h/day, 5 days/week for 6 months	①③
Zhang Lan et al., 2019 [27]	50/50		2–6	-	TEACCH + Family rehabilitation training	TEACCH	4 h/session, 5 times/week for 6 months	③④
Beibei Li, et al., 2020 [26]	30/30		2–8	CARS, DSM-V	TEACCH + ABA	TEACCH	4 h/session, 5 times/week for 3 months	④
Lin Xiaoqin, et al., 2019 [25]	30/30		2–3	DSM-V	TEACCH + ABA	TEACCH	4 h/session, 5 times/week for 6 months	①② ③
Zhang Zhenlin et al. 2020 [28]	51/51		2–6	-	TEACCH + ABA	TEACCH	4 h/session, 5 times/week for 6 months	②③④

ADI-R Autism Diagnostic Interview-Revised, ADOS Autism Diagnostic Observation Schedule, PEP-R Psycho Educational Profile-Revised, VABS Vineland Adaptive Behavior Scales, ABC Aberrant Behavior Checklist, CARS Childhood Autism Rating Scale, ATEC Autism Treatment Evaluation Checklist, C-PEP Psychoeducational Profile, PSI Parenting Stress Index, CBCL Child Behaviour Checklist, VABS-II Vineland Adaptive Behaviour Scale-Second Edition, PIA-CV Parent Interview for Autism-Clinical Version, PSI-SF Parenting Stress Index: Short Form, RAND-36: a widely used health-related quality of life (HRQoL) survey instrument, BEI Behavioural Educational Intervention

①PEP/PEP-R/C-PEP/CPEP-3; ② CARS;③ABC; ④ATEC; ⑤VABS; ⑥VABS-II; ⑦CBCL; ⑧PIA-CV; ⑨PSI-SF; ⑩RAND-36

For ASD diagnosis, eight studies reported the use of at least one or more ASD diagnostic criteria such as DSM-V, ADOS, or ADI-R, while three studies did not specify the method of diagnosis [24, 25, 28]. As for interventions, TEACCH [18–22] or TEACCH in combination with other methods, including Discrete Trial Teaching (DTT) [23], Applied Behavior Analysis (ABA) [24, 26, 28] or family training [25], was utilized in the experimental group, while conventional rehabilitation [18–21, 24], behavioral and education intervention (BEI) [22], DTT [23] or TEACCH [25–28] was applied in control group.

The interventions were mostly performed in family- and center-based settings. Family-based settings included delivery of intervention in home settings by trained parents or trained professionals [18–21]. Center-based settings encompassed schools, centers, and hospitals [22–25, 27, 28]. In addition, a combination of the two has also been reported in some studies, such as 2 h at home and 2 h at school [19, 20, 26].

The frequency of TEACCH intervention was either not specified [18, 19] or performed 5 times per week at 30 min [23], 90 min [21], 3 h [26], 4 h [20, 22, 25, 27, 28] or 5–6 h [24] per session. Duration of intervention was 6 months in 9 studies [19–25, 27, 28], 3 months in 1 study [26], and 4 months in 1 study [18].

Quality assessment

Of the 11 included studies, 10 were RCTs [18, 19, 21–28], and one was a cohort study [20]. Two RCTs [21, 23] reported allocation concealment and blinding or assessor, with a low risk of selective reporting. The risk of bias assessment of the included articles is shown in Fig. 2. The quality evaluation scores of all articles were greater than or equal to 6 points. The quality of the the included studies was considered to be relatively high.

Fig. 2.

Risk of bias assessment of the included studies

Meta-analysis

Social skills

Three studies [19, 20, 22] involving 116 participants reported social skill scores. There was no heterogeneity among the studies (P = 0.25, I² = 28%), and a fixed effects model was utilized. Meta-analysis showed that social skill scores were significantly higher in the experimental group than in the control group [MD = 0.6,95% CI (0.2,1.0), P < 0.05] (Fig. 3A).

Fig. 3.

Forest plots of the effectiveness of TEACCH in ASD individuals. A Social skill; B Cognitive performance; C Sensitivity analysis of cognitive performance; D Fine motor

Cognitive performance

Cognitive performance scores were examined in 3 studies [18, 19, 24] with 135 participants. Heterogeneity was present across the studies (P < 0.01, I² = 90%) but was eliminated after excluding 1 study [24] (P = 0.03, I² = 0%). Upon review, the heterogeneity may be attributed to the use of different assessment scales, leading to bias in selection and implementation. The pooled results showed that cognitive performance scores were significantly higher in the experimental group than in the control group [MD = 1.34, 95% CI (0.09,2.58), P < 0.05] (Fig. 3B and C).

Fine motor

Fine motor score was examined in 4 studies [18, 19, 23, 24] with 195 participants. There was no heterogeneity among studies (P = 0.33, I² = 13%). Our findings demonstrated that fine motor score was significantly higher in the experimental group than in the control group [MD = 0.7,95% CI (0.4,1.0), P < 0.05] (Fig. 3D).

Imitation and cognitive language verbal skills

Imitation scores were reported in 5 studies [18, 19, 21, 23, 24] involving 244 participants. Heterogeneity was present across the studies (P < 0.01, I² = 90%) but was eliminated after excluding 1 study [24] (P = 0.03, I² = 0%). Upon review, the heterogeneity was likely caused by the use of different assessment scales, leading to bias in selection and implementation. Our data showed no significant difference in imitation scores between the experimental and control groups [MD = 0.82,95% CI (0.00,1.64), P > 0.05] (Fig. 4A and B).

Fig. 4.

Forest plots of the impact of TEACCH on imitation and cognitive verbal skills of ASD individuals. A Imitation skills; B Sensitivity analysis of imitation skills; C Cognitive verbal skills; D Sensitivity analysis of cognitive verbal skills

Cognitive verbal scores were recorded in 4 studies [18, 19, 23, 24] with 195 participants. Heterogeneity was present across the studies (P < 0.01, I² = 87%) but was eliminated after excluding 1 study [24] (P = 0.38, I² = 0%). The source of heterogeneity was likely the use of different assessment scales, leading to bias in selection and implementation. The pooled results showed no significant difference in cognitive verbal scores between the experimental and control groups [MD = 0.60,95% CI (−0.16,1.37), P > 0.05] (Fig. 4C and D).

Communication, motor, gross motor, and daily living skills

Communication scores were reported in 3 studies [19, 20, 22] with 116 participants. Motor skill was assessed in 2 studies [19, 20] with 53 participants (Fig. 5A). Gross motor skill was evaluated in 4 studies [18, 19, 23, 24] with 195 participants (Fig. 5B). Daily living skills were reported in 2 studies [19, 20] with 53 participants (Fig. 5E). A fixed effects model was used for the meta-analysis of communication (P = 0.60, I² = 0%) and daily living skills (P = 0.16, I² = 49%). However, further sensitivity analysis was performed due to significant heterogeneity for motor skills (P = 0.06, I² = 72%) and gross motor skill (P = 0.16, I² = 49%). Meta-analyses revealed no significant differences in communication [MD = 0.2, 95% CI (−0.2, 0.6), P > 0.05], motor skills [MD = 0.0, 95% CI (−1.1, 1.0), P > 0.05], gross motor skills [MD = 1.09, 95% CI (−0.2, 2.39), P > 0.05], and daily living skills [MD = 0.3, 95% CI (−0.2, 0.9), P > 0.05) between the two groups (Fig. 5).

Fig. 5.

Forest plots of the effect of TEACCH on communication, motor, gross motor, and daily living skills of ASD individuals. A Communicate skills; B Motor skills; C Gross motor skills; D Sensitivity analysis of gross motor skills; E daily living skills

Hand-eye coordination and perception

Hand-eye coordination was assessed in 2 studies [18, 19] with 45 participants. There was no significant heterogeneity between studies (P = 0.95, I² = 0%) and no significant difference in hand-eye coordination between the experimental group and the control group [MD = −0.3, 95% CI (−0.3, 0.9), P > 0.05] (Fig. 6A).

Fig. 6.

Forest plots of the effect of TEACCH on hand-eye coordination and perception of ASD individuals. A Hand-eye coordination; B Perception

Perception was reported in 3 studies [18, 19, 24] involving 135 participants. Heterogeneity was present across the studies (P < 0.01, I² = 93%) but was eliminated after excluding 1 study [24] (P = 0.16, I² = 0%). The identified heterogeneity was likely attributed to the use of different assessment scales, leading to bias in selection and implementation. Our data indicated no significant difference in perception between the two groups [MD = 1.19, 95% CI (−0.28, 2.67), P > 0.05] (Fig. 6B and C).

ABC, CARS and ATEC

ABC scores were reported in 3 studies [25, 27, 28] with 262 participants. Heterogeneity was present across the studies (P = 0.03, I² = 72%) but was eliminated after excluding 1 study [25] (P < 0.01, I² = 0%). The heterogeneity was potentially attributed to the study design and implementation process, leading to bias in selection and implementation. The pooled results showed that the experimental group had significantly lower ABC scores than the control group [MD = −1.57, 95% CI (−2.11, −1.02), P < 0.05] (Fig. 7A and B).

Fig. 7.

Forest plots of the effect of TEACCH on the ABC, CARS, and ATEC scores of ASD individuals. A ABC score; B Sensitivity analysis of ABC score; C CARS score; D ATEC score

CARS scores were reported in 2 studies [27, 28] with 162 participants. There was no significant heterogeneity between studies (P = 0.62, I² = 0%). The experimental group had a significantly greater decrease in CARS scores after intervention compared to the control group [MD = −0.7, 95% CI (−1.0, −0.3), P < 0.05] (Fig. 7C).

ATEC was evaluated in 2 studies [26, 27] with 160 participants. No heterogeneity was detected between studies (P = 0.89, I² = 0%). Our findings revealed that the experimental group had a significantly greater decrease in ATEC scores after intervention compared to the control group [MD = −0.9, 95% CI (−1.2, −0.6), P < 0.05] (Fig. 7D).

Publication bias

The publication bias was visually evaluated through funnel plots for socialization, fine motor, cognitive performance, imitation (Fig. 8), and ABC (Fig. 9). The Egger’s test was further used to quantify publication bias. It was found that the P values were all greater than 0.05, suggesting that there was no significant publication bias. The quantitative assessment results of publication bias of each outcome are shown in Table 2.

Fig. 8.

Funnel plots of TEACCH on the socialization, fine motor, cognitive performance and imitation scores of ASD individuals. A Socialization; B Fine motor; C Cognitive performance; D Imitation

Fig. 9.

Funnel plots of TEACCH on the ABC score of ASD individuals

Table 2.

Quantitative assessment results of publication bias of outcome indicator

Outcome indicator	The number of articles	P egger
Socialization	3	0.42
Cognitive performance	3	0.11
Fine motor	4	0.54
Imitation	5	0.78
ABC	3	0.88

Grade evidence classification

The evidence levels of the primary outcome measures included in the meta-analysis were evaluated. The results showed that the quality of evidence for two outcome measures, namely socialization and fine motor was high. The quality of evidence for three outcome measures, including cognitive performance, imitation, and ABC, was moderate. The quality of evidence for communication, daily living skills and gross motor was low (Table 3).

Table 3.

GRADE evidence grading assessment form

Certainty assessment							№ of patients		Effect		Certainty	Importance
№ of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Intervention	Control	Relative (95% CI)	Absolute (95% CI)
Socialization
3	randomised trials	not serious	not serious	not serious	not serious	none	65	51	-	SMD 0.6 SD higher (0.2 higher to 1 higher)	⨁⨁⨁⨁ High	Key
Cognitive performance
3	randomised trials	not serious	seriousa, b	not serious	not serious	none	69	66	-	SMD 1.3 SD higher (0.1 higher to 2.6 higher)	⨁⨁⨁◯ Moderatea, b	Key
Fine motor
4	randomised trials	not serious	not serious	not serious	not serious	none	99	96	-	SMD 0.7 SD higher (0.4 higher to 1 higher)	⨁⨁⨁⨁ High	Important
Imitation
5	randomised trials	not serious	seriousa, b	not serious	not serious	none	131	113	-	SMD 0.8 SD higher (0 to 1.6 higher)	⨁⨁⨁◯ Moderatea, b	Important
ABC
3	randomised trials	not seriousa	not serious	seriousb	not serious	none	131	131	-	SMD 1.6 SD lower (2.1 lower to 1 lower)	⨁⨁⨁◯ Moderatea, b	Key
Communication
3	randomised trials	seriousb	very seriousb	not serious	seriousb	none	65	51	-	SMD 0.2 SD higher (0.2 lower to 0.6 higher)	⨁◯◯◯ Very lowb	Important
Gross motor
2	randomised trials	seriousa, b	very seriousa, c	seriousc	seriousc	none	28	25	-	SMD 1.09 SD higher (0.2 lower to 2.39 higher)	⨁◯◯◯ Very lowa, b,c	Not important
Daily living skills
2	randomised trials	seriousa, c	seriousc	not serious	seriousc	none	28	25	-	SMD 0.3 SD higher (0.2 lower to 0.9 higher)	⨁◯◯◯ Very lowa, c	Important

CI confidence interval, SMD standardised mean difference 

^aOne study had high overall risk of bias; ^bThe intervention measures are different; ^cThe assessment scales are inconsistent

Discussion

All the articles included in this study had quality evaluation scores greater than or equal to 6 points, and the literature quality was considered relatively high. Only two RCTs mentioned the allocation concealment and evaluator blinding method, with a relatively low risk of selective reporting bias. The blinding design needs to be further improved in future studies. In the GRADE evidence grading, the quality of evidence for two outcome measures was high, providing credibility for the evidence that the TEACCH method improved the ability of socialization and fine motor. The quality of evidence for three outcome measures was moderate. The quality of evidence for three outcome measures was low. After sensitivity analysis, heterogeneity still existed, which might have an impact on the reliability of the conclusions. In addition, the risk of bias of all outcome measures decreased by one level, which might be related to the inconsistent assessment scales and the non-standard intervention measures. Therefore, future studies should standardize the experimental design and strictly implement the process.

Despite the limited number of included studies, our meta-analysis indicated that TEACCH can improve social skills, cognitive performance, and fine motor skills of ASD individuals. However, TEACCH was ineffective for enhancing imitation skills, cognitive language verbal skills, hand-eye coordination, perception, communication skills, motor skills, gross motor skills, and daily living skills.

Australia has recently revised its national guidelines for supporting ASD children and their families, incorporating a framework for ethical support recommendations. The framework emphasizes that support should be reasonable (effective and evidence-based), practical (locally feasible), desirable (aligns with child and family priorities) and justifiable (benefits outweigh costs for positive long-term outcomes) [29]. In line with this framework, physicians are advised to steer families towards evidence-based interventions that optimize outcomes while integrating seamlessly into the child’s healthcare and family routines, enhancing rather than disrupting daily life.

The key principles of the TEACCH program focus on addressing the needs of children with ASD. These strategies include creating an environment that minimizes distractions, establishing structured daily activities through visual schedules, and arranging materials and tasks to facilitate independent learning without constant adult supervision. Such approaches may contribute to the reported improvements in social skills, cognitive performance, and fine motor skills, as well as reductions in symptom severity among ASD individuals associated with TEACCH.

TEACCH is an educational model that enhances individuals’ ability to acquire, understand and apply knowledge across various contexts. TEACCH leverages the learners’ visual processing capabilities to organize space and activities, adapting to the physical environment and using visual structures to support understanding and independence. Through this adaptive process, TEACCH is anticipated to yield favorable outcomes for learners in perceptual tasks and activities that require visual and motor coordination. The TEACCH framework is grounded in several fundamental principles aimed at supporting ASD individuals. While standardized assessments and traditional clinical research methods are integral components of this program, TEACCH also focuses on improving key areas of ASD individuals, such as daily living, communication, language, and social skills. Acquiring skills in these areas have been shown to greatly improve the intellectual capacity, reduce problematic behaviors, and enhance environmental adaptation of ASD individuals. However, the results of our study indicate that TEACCH does not improve imitation skills, cognitive verbal skills, hand-eye coordination, or perception of ASD individuals. No improvement in these areas may be attributed to the methodology, components, frequency and duration of TEACCH, participant characteristics (age, diagnosis, pre-intervention function), assessment methods used, and study design used, each of which may influence the quantity and quality of empirical evidence supporting TEACCH implementation. At present, there is no unified standard for TEACCH, and the application sites and frequencies of the intervention are also different. Motor skills, gross motor skills and fine motor skills are assessed by different scales respectively. Hence, researchers form a more unified standard in the future, so that it can be applied more scientifically and accurately in clinical practice.

There are still some limitations in this study. Firstly, the number of included studies was small and the sample size was low. The information such as intervention measures, the places where the intervention was applied, and the frequency of TEACCH intervention among the included studies was not detailed enough and inconsistent, which to a certain extent affected the credibility of the results. Secondly, we only retrieve Chinese and English publications, which may pose a risk of incomplete retrieval. Finally, there were many deficiencies in the included studies in randomization, blinding, and the implementation of allocation concealment, which increased the possibility of risk of bias. More high-quality research is needed in the future.

Conclusion

TEACCH can improve the social skills, cognitive performance, and fine motor skills of ASD individuals while reducing the severity of the condition. However, TEACCH is ineffective for enhancing imitation skills, cognitive verbal skills, hand-eye coordination and perception, communication skills, motor skills, gross motor skills and daily living capability of ASD individuals. However, several limitations must be considered in this study, including bias in the design and implementation of some studies, variations in assessment scales and intervention methods, small sample size, and lack of follow-up assessment. Therefore, further multi-center, large-cohort RCTs with longer intervention duration and follow-up are warranted to verify the effectiveness of TEACCH in ASD patients.

Abbreviations

TEACCH

Treatment and Education of Autistic and Related Communication Handicapped Children

RCTs

Randomized controlled trials

ASD

Autism spectrum disorder

ADDM

Autism and Developmental Disabilities Monitoring

ABC

Autism Behavior Checklist

CARS

Childhood Autism Rating Scale

ATEC

Autism Treatment Evaluation Checklist

CNKI

Chinese National Knowledge Network

DTT

Discrete Trial Teaching

ABA

Applied Behavior Analysis

BEI

behavioral and education intervention

Authors’ contributions

All authors contributed to the study conception and design. Writing - original draft preparation: [Shanshan Shi, Shuang Song, Huitong Wang]; Writing - review and editing: [Xiaoying Zhang]; Conceptualization: [Shanshan Shi, Shuang Song, Huitong Wang]; Methodology: [Shanshan Shi, Shuang Song, Huitong Wang]; Formal analysis and investigation: [Shanshan Shi, Shuang Song, Huitong Wang]; Funding acquisition: [Shanshan Shi, Shuang Song, Huitong Wang]; Resources: [Pengfei Li，Xiaoying Zhang]; Supervision: [Pengfei Li，Xiaoying Zhang], and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

This work was supported by the Science and Technology Development Project of Beijing Rehabilitation Hospital, Capital Medical University (grant number 2022-025).

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author (Xiaoying Zhang) on reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.