Implementation of the Teacch Approach on Repetitive Behavior and Limited Interest in Children with Autism

Abstrak : One of the main disorders in children with autism is repetitive behavior and limited interest. The purpose of this study was to describe 1) planning, 2) implementation and 3) evaluation of the implementation of the TEACCH approach on behavior and limited interests in children with autism. The research method uses a qualitative research design with a case study approach. Data were obtained through observation and documentation, open questionnaires and discussions with therapists and caregivers at the Autism Therapy Unit of Bhkati Luhur in Malang. Results: 1) Planning: there is training to find out the TEACCH approach, recurrent disorders in children with autism, the impact and handling of strategies, 2) the implementations are; Structuring the environment, assessment, making visual programs and schedules, regular and structured and collaborative intervention 3) Evaluation: Children with autism are more organized, more independent, increased in receptive communication, more focused, control emotions, and are confident. Some children with severe disabilities are still need some assistance.


INTRODUCTION
Every year the prevalence of children with autism continues to increase. According to the WHO in 2013, epidemiological data estimated the global prevalence of children with autism at 1:160, accounting for more than 7.6 million children. These estimates are representative of average figures, and reported prevalence varies substantially across studies. The results of the study in the capital city of Oslo showed an increase in prevalence of 1:166 at the age of 0-10 years and 1:125 at the age of 11 years. In addition, other national researchers found that 1 in 192 men and 1 in 695 women are between the ages of 1-16 years, so that it is estimated to have doubled from 2012 to 2016 (Özerk, 2018). While in the United States, the prevalence is between 1 in 50 children (about 1.7%) have autism disorders (Hyman et al., 2020). In Indonesia, there are no real data on the number of children with autism. However, according to the Directorate of Mental Health, Ministry of Health of the Republic of Indonesia, since 2010, the number of children with autism has reached 112,000 at the age of 5-19 years. This figure comes from the prevalence of 1.68 per 1000 children under the age of 15 years, while the number of children in Indonesia is 66 million. (El Fath, 2015; : (Sunandar et al., 2019 ). Based on these data, it can be found that the prevalence of the number of children with autism globally has increased tremendously from year to year so that it requires serious attention from all parties.
In addition to the increasing prevalence, the developmental disorders experienced are complex or varied disorders that occur in the central nervous system (neurodevelopmental disorders) that affect several domains. Repetitive behaviour and limited interest are typical and are one of the core symptoms besides social communication disorders (DSM-5, 2013) but they can affect each other. For example, when the child is busy with repetitive behaviour and limited interest, he or she is not interested in what is happening in his or her environment, he or she is not interested in getting involved, not interested in imitating. The opportunity to learn new things becomes a significant difficulty that affects social communication and task completion.
This problem will become bigger, more complex and difficult if it is not handled as early as possible. For example, they will have difficulty learning new things because their orientation is only on repetitive behaviour and interest or interest in certain objects or activity They will get angry if there is a change in their daily routine or the object that is their obsession is gone. As you get older, of course it gets harder to deal with. This has an impact on the child himself and his parents or anyone who lives with a child with ASD However, they have advantages on the other hand, such as visual or visual learning by students (Tissot & Evans, 2003: Venker et al., 2012 so that we can compensate by utilizing. In addition, autistic children are also very patterned and structured so that the Treatment and Education of Autistic Children and Related Communication Handicapped (TEACCH) approach is proven to be effective in managing repetitive behaviour and limited interest.

METHODS
This study uses a qualitative research design with a case study approach. Qualitative research method is a research procedures that is generates data in the form of sentences or texts, that the end result is a written report that is influenced by the views, thoughts, and knowledge of researchers. Case studies is one of the ways of qualitative research methods that explore a particular case by collecting sources of information (K. Ranjit, 2011). Data collection in this qualitative research method is observation, open questionnaires through google form, documentation and discussions by google meet about the TEACCH approach to repetitive behaviour and limited interest at Autism Therapy Unit of Bhakti Luhur in Malang. Researchers chose to use this method to obtain an in-depth overview of information and experiences from teachers and parents or caregivers when using the TEACCH approach for repetitive behaviour and limited interest in autistic children.

Planning Implementation of TEACCH on repetitive behaviour and limited interest in autistic children.
Regarding planning implementation, the Therapy Autism Unit conducts training for therapists, parents and social workers to improving the qualifications of therapists. All therapists and several parents in the Bhakti Luhur Malang have received training from the Bhakti Luhur Malang Therapy Service Unit who had attended training on Management of Autism Children at the Autism Association of Western Australia in the framework of sister state cooperation between the East Java Province Government and the Australian Government. West (Western Australia) in Perth in 2013, as well as through the East Java Autism Care Forum where Bhakti Luhur is one of the members of the Autism Care Forum. The training is related to the TEACCH approach, repetitive behaviour disorder and restricted interest, impacts and treatment strategies for children with autism. (Dis/Question/Doc/T, CG/F1 19-6-2021) The application of the TEACCH approach to the behaviour of autistic children.
To implement TEACCH, the important thing to do is structure the environment. This is done as much as possible by Autism Service Unit of Bhakti Luhur among others by labelling and giving boundaries for each room and task analysis. In addition, there are structured visual schedules. Visual schedules were given to Wisma Bhakti Luhur and parents as a follow-up to be trained at home. Yes..all children in the service unit have their own visual schedule. This visual is placed in every room and is used according to its function and is used routinely every day as well as collaboration between the therapists and parent (Dis/ Question/Dok/T, CG/F1 19-6-2021. In order for TEACCH to be effective in its implementation, teachers or therapists and caregivers carry out assessments. Furthermore, a program is prepared taking into account the abilities and characteristics of each child considering that each child is unique and has different abilities. These programs are prioritized starting from what the children can do, focusing on what has been prioritized. In order to focus on the task, it is necessary to make a task analysis, namely small steps arranged in the form of drawings and short writings that make it easier for children to read pictures if they cannot read written text. However, some autistic children can read without being specifically taught. Visually it can also help teachers and parents in conducting evaluations or assessments. Evaluation can occur at the beginning, during the intervention and at the end of the treatment. (Dis/Questionnaire/Doc/T, CG/F2 19-6-2021)

Evaluation
Based on the results of observations, open questionnaires, discussion results and document studies, it is said that children with autism have made significant progress. In general, within one year, they already independent in taking responsibility and completing tasks according to task analysis. Visual behaviour is more organized, understands social rules such as queuing, waiting for their turn, and greeting. In addition, children with autism also showed significant communication improvements such as understanding simple one-step instructions, becoming more independent, more focused and more confident. As for children who have severe abilities, some still need help. …They increase their independence and self-confidence, orderly and can control their emotions or are calmer, more focused and concentrated on tasks and understand simple routine instructions… (Dis/ Questionnaire/Doc/T, CG/F3/Doc. 19-6-2021) Another advantage that can be obtained from the TEACCH approach to repetitive behaviour and limited interests is that children can slowly control themselves such as being able to taking turn in activities with friends, social workers are helped because children with autism can do it independently. On the other hand, they make good progress in verbal and non-verbal communication, socializing better. By TEACCH approach We can teach children obedience in carrying out daily routines, more quickly understand the instructions and the following tasks to be done (Dis/ Questionnaire/Doc/T, CG/F3 19-6-2021).

Preparation Application of the TEACCH approach to repetitive behaviour and limited interest in autistic children. Training
To apply the TEACCH approach effectively, the first thing to do is to increase the knowledge and understanding of teachers and parents or social workers about what and how to apply TEACCH to repetitive behaviour and restricted interests in autistic children. Teacher professional development invests in effective strategies to achieve teacher performance in enhancing student learning. This will not be achieved unless there is a transfer of teacher learning so that it has an impact in the classroom (McDonald, 2011). Teacher, parent and social workers should be trained and have knowledge so they will put into practice how to dealing repetitive behaviour and limited interest into the functional activities by using TEACCH method and improve student learning if they are in the school or at home. However, this cannot happen unless there is a transfer of learning from the teacher so that it has an impact in the classroom.

Environmental Arrangement
So that students can accommodate information during learning activities, it is necessary to modify or structuring the environment to facilitate the organization of tasks both by teachers and by autistic children themselves related to the learning process. A structured and organized environment is one of the requirements for the TEACCH approach or method. TEACCH class setting are visually organized to promote engagement and learning (Hyman et al., 2020)) it means that the class setting in the TEACCH method is visually arrange to support interaction and learning. Thus, a TEACCH specialist will make sure that everything is organized the learning environment and process to facilitate the acquisition of learning objectives based on individual programs. The learning structure consists of the environment and individual activities must be organized in a variety of ways that can optimize the learning process and situations that cause stress in children. One way to minimize the situation is to use structured visuals. Grandin (1995), a writer despite having a disorder with autism he explained: "I think in picture. Words are like second language to me. I translate both spoken and written words into full colour movies, complete with sounds, which run like a VCR tape in my head. When someone talking to me, his voices are instantly translated into pictures". So, Grandin explains that his way of thinking is an image. and this is the most important thing to him. Words are like a second language to him. So that when someone else speaks he instantly translates it into an image. That is why children with ASD are called visual learners or learn by seeing. (Gordon et al., 2011)R. K. Gordon, G. Pasco, A. Wade, & T. Charman, 2007& (Beukelman, David R, 2020 Application of TEACCH "Establishment based assessment of cognitive, communicative and other skills prepare some significant information for both diagnostic and program planning for children with autism and related condition" (Gordon et al., 2011)R. K. Gordon, G. Pasco, A. Wade, & T. Charman, 2007. Meaning that assessments based on the development of cognitive, communication and other skills provide important information for diagnosis and program planning for children with autism or with similar conditions. To improve the performance of students or children with autism, an assessment is also needed to recognize and find out the needs and abilities of each child or student as a consideration for the preparation of development programs (Matson, 2017). From the two opinions above, it can be conclude that we can make a program as good as any but if it is not based on the results of the assessment, the program is not useful for a student or child with autism or related. Functional assessment, identification of strong interests and variables that are beneficial to individuals with ASD, utilizing parental support and framing children's characteristics to focus on positive aspects of behaviour can influence child outcomes by integrating interventions and changing attitudes of parents, teachers, therapists, care givers.
From the results of the assessment, exercise steps are made in a structured manner and with visual assistance. There are several important factors in the application of TEACCH (Rao & Gagie, 2004). An environment that is consistently organized for the needs of children, namely by modifying and structuring the room by paying attention to; a) Safety is the needs to be prioritized, b) Structure, because children with autism are very patterned and prefer routine and, c) Peace. A calm and comfortable environment really helps children with autism to be calm and focused. d) Stimulation: Provide opportunities that give sensory input or stimulation to children to experience.
Visuals are a great way to help children with autism and get the most attention, which can be applied in homes, schools, workplaces and communities. The importance of a visual schedule, among others; 1) Visuals are part of everyone's communication system, 2) Visuals can attract and retain attention, 3) allow students to focus on messages and reduce anxiety, 4) make abstract concepts concrete for students (Rao & Gagie, 2004) The schedule that has been made is a general schedule or can be said to be a title. From this large schedule, of course there is task analysis. Task analysis is a very detailed process; including breaking down a specific task into sequential basic steps, components or skills required to complete the task, and then evaluating after the intervention.

Evaluation of TEACCH implementation on repetitive behaviour and limited interests.
According to (Istiqomah, 2019) explains that the TEACCH approach is used to increase the desired behaviour with a visual-based communication system in which the environment that must be adapted specifically for children with autism to minimize children's difficulties in adapting to the environment and in communicating. TEACCH applies a work system for children with autism which will result in an environmental setting that is equipped with visual support so that children know their tasks, what to do, the number of tasks that must be completed and when the task ends.
The effects of TEACCH on the repertoire of adaptive behaviour including communication, daily living activities and motor function are in the range of negligible to diminished. In addition, TEACCH also helps children with autism organize their tasks, namely planning, implementing, how to manage emotions and evaluation in a nutshell, which can be said to be effective in improving executive function. (Rao & Gagie, 2004 ;Abshirini et al., 2020) CONCLUSSION TEACCH is a structured teaching approach to increase the desired behaviour using a visual-based system in which the environment must change, and applying a work system so that children know what the task is, how to do it, the number of tasks to be completed and when the task ends. Therefore, it is necessary to develop competence for teachers, parents and care-givers through trainings. Skills that have been trained are transferred directly to children with autism, then visually structure the environment, conduct assessments, determine programs, make training steps accompanied by visuals (task analysis) and apply the TEACCH approach routinely and collaboratively as well as evaluate sustainable for better development This study was conducted to determine the implementation of TEACCH on repetitive behaviour and limited interest in the Bhakti Luhur Autism Service Unit Malang. For other domains in relation to the application of TEACCH, further research needs to be done.