The effectiveness of TEACCH-based interventions in improving adaptive skills in children with autism spectrum disorders: a systematic review and meta-analysis

Background: The Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) intervention has been adopted globally for children with autism spectrum disorder (ASD). Although previous studies have investigated the effectiveness of TEACCH-based interventions for children with ASD, the impact of various experimental designs and participants' characteristics remains unclear. To address this, a systematic review and meta-analysis were conducted to examine the effectiveness of TEACCH-based interventions in improving different skills, reducing ASD severity, and decreasing parental stress across different study designs and children's characteristics.

Methods: A literature search of the PubMed, Embase, MEDLINE, APA PsycInfo, Scopus, and Web of Science databases was conducted. Studies were included if the following criteria were met: (I) a diagnosis of ASD based on professional diagnostic criteria or school report; (II) an age <= 18 years; (III) studies conducted with TEACCH-based interventions explicitly described as based on the TEACCH approach, with structured teaching and environment tailored to ASD children being emphasized; (IV) changes in outcomes reported with at least one well-developed measurement; and (V) a primary study type of randomized controlled trials (RCTs) or nonrandomized controlled studies (NRSs), with pretest-posttest studies only included in the systematic analyses and not in the final meta-analysis. Data were extracted and analyzed via meta-regression and subgroup analysis, and publication bias and quality were assessed. From 1,019 initially included studies, 20, comprising 920 children, were ultimately used in the meta-analysis.

Results: This analysis revealed significant improvements in communication skills (g=0.21), daily living skills (g=0.40), motor skills (g=0.19), and social skills (g=0.76) among children with ASD. Subgroup analyses highlighted the positive influence of school age (6-12 years) and parental involvement in strengthening TEACCH-based intervention outcomes. TEACCH interventions also significantly reduced ASD symptom severity (g=-0.91), improved cognitive functioning (g=0.30), and reduced parental stress (g=-0.4).

Conclusions: This study demonstrates that TEACCH-based interventions can significantly enhance a range of developmental skills in children with ASD. By comparing intervention settings, durations, and levels of parental involvement, and identifying the specific conditions under which TEACCH yields the greatest benefits-namely, structured clinical environments, medium-term implementation periods, and intentional parent participation. These findings provide actionable evidence on how to optimize TEACCH-based programs in practice and emphasize the importance of context-specific adaptation and high-fidelity delivery when applying these interventions across diverse populations and service settings.