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

Introduction

Background

Autism spectrum disorder (ASD) is one of the most common developmental disorders, affecting approximately 1–2.5% of children. According to the World Health Organization (WHO), 1 in 100 children in the world have ASD and may require intensive care due to other comorbid conditions such as intellectual disability (1). Males are 3 to 4 times more likely to have ASD than are females (2). To ensure an individual with ASD can cope with various life demands, it is essential that interventions that lead to greater independence, social integration, and a higher quality of life are implemented. With the increasing prevalence of ASD among children, effective education and therapeutic interventions for ASD are in high demand. Education intervention aims to foster social, personal, adaptive, and communication skills while addressing academic difficulties (3). The National Institutes of Health and Autism Speaks have supported the development of several psychosocial and educational interventions, including animal-assisted therapy, applied behavior analysis (ABA), and relationship development intervention (RDI), among others (4). Despite numerous studies and interventions aimed at addressing the symptoms of ASD, there is currently no golden standard treatment for supporting children with ASD due to the complexity of its etiology and pathogenesis (5-7).

Study rationale

Unlike other conventional treatments, the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) program proposed by Schopler et al. (8) emphasizes providing a structured and systematic educational environment that aims to address the unique learning needs of individuals with ASD through visual learning while addressing challenges in attention, social communication, and executive function (9). The TEACCH program focuses on several aspects: (I) organization, by providing a physical environment that is well prepared with visual cues, boundaries, and minimum distraction; (II) proper arrangements, which could visually inform individuals with ASD of the location and time to follow the designated schedule or routine; and (III) the development of a physical or visual work and activity system, which allows the individual with ASD to visually understand what tasks or activities need to be performed without distraction and thus fosters independence (10). It is important to note that the end goal of structured teaching is to provide visual and organizational support that can be used to address the behavioral and academic issues caused by ASD symptoms, thereby aiding individuals with ASD to be more productive and independent (10). TEACCH has been implemented on a global scale, with a previous survey suggesting that approximately 15.7% of ASD families were using TEACCH and 14.9% had a history of using it (11).

Research indicates that TEACCH demonstrates moderate effectiveness in enhancing communication, adaptive skills, and self-management abilities among children with autism, yet its cross-cultural implementation faces significant challenges (12). In Western societies, TEACCH emphasizes parents’ role as “cogoverning partners”, prioritizing parental training and home-school collaboration. Conversely, within Asia’s collectivist cultures, families often rely on multigenerational caregiving, with parents tending to depend on professionals or avoiding openly seeking assistance (12). Compounded by the societal stigma surrounding autism, some families remain hesitant to engage in interventions (13). Furthermore, in China, Japan, and other Asian nations, insufficient professional training, uneven resource distribution, and high intervention costs substantially constrain program sustainability and accessibility (14,15). Empirical evidence supports TEACCH’s feasibility within Asian contexts; for instance, a Hong Kong study (12) indicated that culturally adapted TEACCH significantly enhances adaptive behaviors in preschool children; additionally, research from Japan and China indicated improvements in social and communication skills postintervention. However, these studies also highlighted limitations in parental engagement and inadequate teacher training (14,15). Thus, successful implementation of the TEACCH program in Asia necessitates careful consideration of cultural values, family structures, and differences in educational systems. Future research should prioritize large-scale randomized controlled trials (RCTs) and long-term follow-up to establish a more robust, culturally informed, and evidence-based foundation.

The flexibility of TEACCH allows for interventions to be conducted in different settings and populations, with varying intensities and durations. The literature suggests that TEACCH yields small-to-moderate improvements in adaptive outcomes and is highly scalable in schools and community settings (16-19); however, the evidence base from RCTs is smaller and more heterogeneous as compared to that for intensive ABA and other early interventions (4,14,20,21). Selecting TEACCH over other interventions is justifiable when the clinical priorities (functional independence, classroom participation, and family acceptability), service constraints (limited specialist hours, school setting), or ethical preferences favor environmental or visual supports and family training—or when a blended approach is planned.

Despite the widespread use of the TEACCH program, the research on this approach remains relatively limited, with most studies producing broad findings without a focus on specific populations or key outcomes. A previous meta-analysis [2013] reported that the TEACCH program has a moderate-to-large positive impact on the overall development of individuals with ASD and highlighted the importance of early intervention, particularly the potential benefits of the structured teaching approach used in TEACCH (4). Additionally, a systematic review [2023] found that the TEACCH approach is particularly effective in improving communication skills and reducing the challenging behaviors in individuals with ASD (22). Although these studies have examined the effectiveness of TEACCH from various aspects, certain deficiencies remain. Methodologically, previous studies have failed to examine the impact of varying experimental designs on the effectiveness of the TEACCH approach, potentially resulting in either an overestimation or underestimation of its efficacy in managing ASD. Moreover, these studies did not address the potential influence of study characteristics or differences in participant demographics on the evaluation of the TEACCH program’s effectiveness.

Objectives

To address the limitations of previous research, this study aimed to assess the effectiveness of the TEACCH approach in improving adaptive skills, ASD symptoms, and social function among children with ASD. Moreover, we examined the potential factors, including participant and study characteristics, that may influence the effectiveness of the TEACCH intervention. Rigorous subgroup analyses were conducted to determine the impact of factors such as age, country, and parental involvement. Narrative analysis was employed to investigate the components of the TEACCH methodology and intervention processes reported in previous studies. By critically evaluating TEACCH’s effects in children with ASD, we sought to provide a stronger foundation for future clinical applications of TEACCH-based interventions. We present this article in accordance with the PRISMA reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-466/rc).

Methods

The protocol for this study was registered in PROSPERO (No. CRD42024554992).

Study search and selection

A search was conducted of the PubMed, Embase, MEDLINE, APA PsycInfo, Scopus, and Web of Science databases for literature published from database inception to May 10, 2024, according to the participants, intervention, comparison, outcome, and study design (PICOS) framework. The databases were searched using keywords based on two main concepts: ASD and TEACCH (Appendix 1). Studies were included if (I) the participants were diagnosed with ASD based on professional diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), DSM-IV Text Revision, or DSM-V) or school reports; (II) the participants were ≤18 years old; (III) intervention studies were explicitly conducted based on the TEACCH approach, with structured teaching and environments tailored to ASD children being emphasized; (IV) the outcomes changes were reported with at least one well-developed measurement; and (V) the primary types of studies included were either RCTs or nonrandomized controlled studies (NRSs), with the pretest–posttest studies only included in the systematic analyses and not in the final meta-analysis.

Further details of the selection criteria are presented in Appendices 2,3.

Data extraction and coding

All studies were screened systematically, and J.L., M.C. and R.C.F.C. extracted data including publication characteristics (author names, regions, and year of publication), participant characteristics (age, gender, sample size, and diagnostic criteria), type of intervention (research design, duration, and frequency), and outcome measures (changes in ASD symptoms and adaptive skills based on established measurements). Any discrepancies were resolved through discussion with L.W. (corresponding author), and a kappa coefficient of 0.83 was found for the agreement between the reviewers.

The results were recorded as the mean and standard deviation for each condition and timepoint (pre- and postintervention). When the mean and standard deviation were unavailable, we recorded the data as the mean change with standard deviation or as mean difference with the 95% confidence interval (CI). If the data could not be retrieved from the published study, we contacted the authors to request the missing information. The code and data used for analysis can be found on the Open Science Framework (https://osf.io/eync2/?view_only=85423648552448439afe60e9a3c208bc).

Quality assessment

To ensure the quality of the included studies, J.L. and M.C. researchers assessed each study using the Physiotherapy Evidence Database Scale (PEDro) (23), with the methodological quality of RCTs and NRSs being evaluated. Literature was rated from 0 to 10 according to 11 criteria related to eligibility, randomization, allocation, blinding (participants and experimenters), intention-to-treat analysis, between-group comparisons, and point measures.

Statistical analysis

Effect size calculations were conducted with STATA version 18.0 (StataCorp., College Station, TX, USA). To combine the effect sizes across studies, the Hedges method was employed for calculating standardized mean differences (SMDs). This method is advantageous due to its correction for small sample bias, providing a more accurate estimate of effect size. Heterogeneity across studies was assessed with the Q and I² statistics. The Q statistic tests the null hypothesis that all studies are evaluating the same effect, with a significant Q (P<0.05) indicating the presence of heterogeneity (24). The I² statistic quantifies the proportion of total variation across studies that is due to heterogeneity rather than chance, with values of 25%, 50%, and 75% typically representing low, moderate, and high heterogeneity, respectively (25). A random-effects model was used in this meta-analysis to determine the variability both within and between studies, thus accounting for potential differences in study characteristics and populations (26). The statistical significance of the effect size was assessed through P values, with a P value <0.05 being considered statistically significant and indicating that the observed effect is unlikely to be due to chance. CIs were also calculated for each SMD, providing a range within which the true effect size is expected to lie with 95% confidence. The formulas for calculating the SMD are provided in the Appendix 4. A CI that did not cross zero was considered to further support the statistical significance of the effect size.

Meta-regression and subgroup analysis

Meta-regression analysis was conducted to further examine the source of heterogeneity between studies and to examine the effect of individuals variables on effect size (Table S1). The meta-regression models analyzed each variable separately to assess the impact of various participants’ and study characteristics on the results. Variables included in the meta-regression were selected based on their relevance and potential to explain variation in effect size (27).

We also conducted subgroup analyses to examine the potential differences in effect size between participant characteristics (e.g., the mean age of participants and country of publication) and study characteristics (e.g., RCT or NRS design and intervention duration), and the results of subgroups that included fewer than three studies are not reported or discussed. By categorizing studies into subgroups, we aimed to identify patterns or factors that may influence the effect size.

Sensitive analysis and publication bias

Sensitivity analyses were conducted to ensure the robustness of the results, with the leave-one-out method being used to determine if any single study disproportionately influenced the findings. Publication bias was assessed via funnel plots and the Egger test (28) based on the adaptive skill-related outcome, with asymmetry suggesting the potential for publication bias.

Results

Study characteristics

The initial search identified 1,522 articles, and after the removal of 503 duplicates, 1,019 titles and abstracts were screened. Of the 19 full texts screened, an additional article from other similar reviews that met the current criteria was included; thus, the final review consisted of 20 studies published from 1998 to 2023 consisting of 920 participants (mean age ranging from 2.5 to 15.15 years; sample size ranging from 10 to 198) were included. The participant characteristics are presented in Table 1, and the details of the analysis for the included studies are presented in Table S2.

The included studies were conducted in various regions, including Asia (n=6), Europe (n=9), and the United States (n=5). Among the 20 included studies, 4 studies incorporated single group pretest–posttest designs, 8 were RCTs, and 8 were NRSs; thus, only 16 were included during statistical analysis. A detailed description of the selection process is presented in Figure 1.

Figure 1 Study flowchart. TEACCH, Treatment and Education of Autistic and Related Communication Handicapped Children.

Summary of results

The meta-analysis included findings from 16 studies investigating TEACCH interventions for children with ASD. Across the studies, 12 studies reported significant positive effects of TEACCH on various outcomes such as communication skills, adaptive behavior, and social interaction. These improvements were consistent across different settings and intervention durations. However, three studies reported nonsignificant effects, primarily attributing this to methodological variations or small sample sizes. Notably, the study by Tsang et al. diverged from others, emphasizing substantial gains in self-help skills but with limited generalizability due to the absence of follow-up data (12). Overall, while TEACCH interventions have demonstrated robust efficacy in enhancing developmental outcomes for children with ASD, the variability in study results underscores the need for standardized protocols and larger-scale RCTs to validate and refine intervention practices. More narrative analyses of all included studies and the systematic analysis can be found in Table S3.

Quality assessment

For methodology quality, the overall quality of studies included in the systematic review and meta-analysis was deemed to be fair, with a mean score of 5.05 (range, 2–8). All included studies had clear recruitment criteria based on professional diagnostic reports or followed well-established diagnostic criteria and maintained a high retention rate. However, it is important to note that only a few studies incorporated blinding to assessors, therapists, or participants. In addition, only two studies incorporated intent-to-treat analysis. A detailed description of the quality assessment is presented in Table S4.

Primary outcomes

For primary outcomes, 12 studies reported a significant but small positive effect for communication skills (K=12; g=0.21; 95% CI: 0.03–0.39; P=0.02) with low heterogeneity (Q=26.3; I²=35.4%; P=0.07). Eight studies reported a significant positive but small effect for daily living skills (K=8; g=0.39; 95% CI: 0.04–0.75; P=0.03) with moderate heterogeneity (Q=17.47; I²=54.2%; P=0.03). Nine studies reported a significant positive but small effect for motor skills (K=9, g=0.19; 95% CI: 0.00–0.38; P=0.05) with moderate heterogeneity (Q=51.85; I²=51.8%; P<0.001). 11 studies reported a significant moderate positive effect for social skills (K=11; g=0.75; 95% CI: 0.32–1.18; P=0.001) with high heterogeneity (Q=58.38; I²=79.4%; P<0.001). All the results for the primary outcomes are shown in Figure 2.

Figure 2 Forest plot of the adaptive skill-related outcomes. (A) Communication skills. (B) Daily living skills. (C) Motor skills. (D) Social skills. CI, confidence interval; SMD, standardized mean difference.

Secondary outcomes

ASD symptoms

Six studies reported a significantly large suppression effect on ASD symptom severity (K=6; g=–0.89; 95% CI: –1.61 to –0.17; P=0.04) with low heterogeneity (Q=42.49; I²=88.2%; P<0.001).

Cognition

Five studies reported a significant but small positive effect on cognitive function (K=6; g=0.30; 95% CI: 0.06–0.53; P=0.01) with low heterogeneity (Q=7.83; I²=0%; P=0.65).

Parental stress

Four studies reported a significant but small suppression effect on parental stress in ASD families (K=4; g=–0.40; 95% CI: –0.74 to –0.06; P=0.02) with low heterogeneity (Q=1.63; I²=0%; P=0.65). All the results for the secondary outcomes are shown in Figure 3.

Figure 3 Forest plot of secondary outcomes. (A) ASD symptom. (B) Cognitive function. (C) Parental stress. ASD, autism spectrum disorder; CI, confidence interval; SMD, standardized mean difference.

Subgroup analysis

The analysis of subgroups of different participants and study characteristics for primary outcomes was conducted. The detailed results are presented in Table 2.

Communication skills

Regarding communication skills, studies published from Europe demonstrated a small but significant effect, and nonsignificant training effects were evident from the studies from Asia and the United States. Eight studies included a significant but small effect from the clinical setting intervention, while the home setting and school setting interventions produced nonsignificant training effects.

Daily living skills

Regarding daily living skills, six studies examined children of school age reported a significant moderate effect. The nonsignificant training effects were evident from the study on children of preschool age. Six studies published in Europe had a significant but small effect, while a study from Asia included nonsignificant training effects. Five studies demonstrated significant moderate effects from parents participating in the intervention, with low heterogeneity, and a study without parent participation in the intervention had nonsignificant training effects.

Motor skills

Regarding motor skills, 12 studies on children of school age showed a significant moderate effect, while nonsignificant training effects were evident from a study on children of preschool age. Six studies demonstrated a significant but small effect for TEACCH on gross motor skills, while nonsignificant training effects were evident from the study measuring eye-hand coordination, fine motor skills, and integrated motor skills. Four studies showed a significant small effect for the TEACCH intervention with a duration of 6 to 12 months, while nonsignificant training effects were evident from interventions with a duration of less than 6 months or more than 12 months. Thirteen studies showed a significant moderate effect of parents participating in intervention, while nonsignificant training effects were evident from a study without parent participation. Fifteen studies demonstrated a significant small effect for a clinical setting, while home and school settings exerted nonsignificant training effects.

Social skills

Regarding social skills, seven studies examining children of school age showed a significantly large effect, while nonsignificant training effects were evident from a study on children of preschool age. Four studies demonstrated a significantly large effect for TEACCH interventions with a duration of less than 6 months, while nonsignificant training effects were evident from interventions with a duration of 6–12 months or longer than 12months. Nine studies indicated a significant moderate effect with the group TEACCH intervention, while nonsignificant training effects were evident from a study that used individual intervention.

Meta-regression on adaptive skill-related outcomes

The meta-regression analyses revealed that age significantly predicted improvements in communication (coefficient =0.386; SE =0.182; 95% CI: 0.000–0.772; P=0.05), motor skills (coefficient =0.402; SE =0.188; 95% CI: 0.014–0.791; P=0.04), and social skills (coefficient =1.083; SE =0.397; 95% CI: 0.208–1.957; P=0.02), with children of school age receiving greater benefit. The country of the study was significantly associated with communication outcomes (coefficient =–0.300; SE =0.089; 95% CI: –0.488 to –0.112; P=0.004), while the setting of intervention was significantly associated with motor skill outcomes (coefficient =–0.339; SE =0.110; 95% CI: –0.565 to –0.113; P=0.005). No significant predictors were found for daily living skills, although age was non-significantly associated (coefficient =0.659; SE =0.348; 95% CI: –0.165 to 1.482; P=0.10). Intervention duration demonstrated a nonsignificant association with social skills (coefficient =–0.501; SE =0.249; 95% CI: –1.049 to 0.047; P=0.07), suggesting a potential influence. These findings point to age and setting as key factors affecting heterogeneity in TEACCH-based interventions. The full results of the meta-regression are shown in Table S1.

Publication bias and sensitivity analysis

Publication bias for studies reporting adaptive skill-related outcomes was assessed via the Egger test, with the related funnel plots being shown in Figure S1. Significant publication bias was only detected for motor skill outcomes (intercept =–0.4606; SE =0.2724; 95% CI: –0.995 to 0.073; t=2.26; degrees of freedom =24; P=0.03). To address this bias, the trim-and-fill method was applied to the motor skill outcomes. The observed effect size for motor skills was 0.19 (95% CI: 0.00–0.25). After adjustment, the effect size was –0.02 (95% CI: –0.21 to 0.17), indicating that the initial observed effect might have been overestimated due to publication bias. The detailed results are shown in Tables S5,S6.

A sensitivity analysis was conducted via the leave-one-out method for all outcomes. This analysis revealed that one or more studies significantly influenced the heterogeneity in each outcome. However, the combined SMD remained consistent in direction, with no positive or negative changes observed. These findings suggest that the overall results are robust and stable despite the presence of certain influential studies affecting heterogeneity. The results of sensitivity analysis are shown in Figure S2.

Discussion

Principal findings

This systematic review and meta-analysis offers insights into the use of the TEACCH program, especially its effectiveness in improving the adaptive skills of children with ASD, including communication, daily living skills, motor skills, and social skills. The findings suggest that the TEACCH method can significantly improve the adaptive skills of children with ASD. It was further found that parental involvement is a key component of the TEACCH approach, yet inconsistent training quality affects its efficacy. Further details regarding these findings can be found in Appendix 5.

Strengths and limitations

Our analysis suggested that the TEACCH method can significantly benefit the adaptive skills of children with ASD. The findings constitute a comprehensive overview of the TEACCH intervention and offer valuable guidance for policymakers and researchers for its implementation among children with ASD. However, the several limitations should be noted: (I) the inclusion of NRSs might have introduced selection bias, reducing overall paper quality. (II) The lack of consistency in assessment methods and diagnostic criteria across studies could have affected how changes in certain aspects of ASD symptoms were evaluated. (III) Given the small number of studies that incorporated the TEACCH intervention and the small sample size, future studies with larger sample sizes are warranted to better ascertain the effectiveness of the TEACCH intervention, which can generate more reliable results. (IV) The description of intervention procedure in included studies was not clear, and thus future research should prioritize the standardization of intervention protocols to minimize variability and enhance the generalizability of these positive effects.

Comparison with similar work

In our review, the majority of the effect sizes in the included studies were positive but relatively small, which is similar to previous reviews (45). Moreover, the findings suggest that the use of the TEACCH intervention could significantly ameliorate ASD severity, improve cognitive function, and decrease parental stress. Moreover, compared to other reviews, our study provides a more comprehensive analysis of the effectiveness of TEACCH-based interventions in improving various skills in children with ASD.

Interpretation of findings

The effect of the TEACCH-based intervention on primary outcomes

Our meta-analysis demonstrated that TEACCH-based interventions have significant positive effects on communication, daily living, and motor and social skills in children with ASD, although the outcomes vary across contexts and factors.

Communication skills showed modest improvements, with European studies reporting consistent benefits. In contrast, studies from Asia and the United States reported nonsignificant results, possibly due to cultural and implementation differences (46). The results related to parental involvement on outcomes were mixed, while those related to interventions without parental participation indicated significant improvement, suggesting that TEACCH’s structured approach can be effective independent of parental involvement. However, inconsistent training and support in studies with parental involvement might have reduced the effectiveness of the TEACCH method, highlighting the need for high-quality parent training (37). Daily living skills were notably improved in school-aged children, with European studies demonstrating consistent benefits and low heterogeneity. Parental involvement further enhanced outcomes, reinforcing the transfer of skills into everyday contexts, whereas interventions lacking parent engagement did not yield significant effects. Motor skill development showed significant improvements, particularly in gross motor skills, with medium-term interventions (6–12 months) proving most effective. Studies conducted in clinical settings demonstrated superior results, emphasizing the importance of structured environments for intervention success (12,47). Social skills also benefited significantly from TEACCH-based interventions, especially through short-term, group-based programs. Group settings fostered peer interactions and social modeling, resulting in moderate-to-large effect sizes, although individual interventions did not consistently achieve statistical significance (12). Variability in outcomes across studies was linked to differences in implementation fidelity, participant characteristics, and intervention designs. Overall, TEACCH-based interventions effectively improve multiple skills in children with ASD, with optimal results achieved through structured clinical environments, medium-term durations, and targeted parental involvement. These findings highlight the importance of context-specific adaptations and high-fidelity implementation in maximizing the benefits of TEACCH-based programs across diverse settings and populations.

The effect of TEACCH-based intervention on secondary outcomes

This meta-analysis also examined the effect of the TEACCH intervention on ASD symptom severity, cognition, and parental stress to determine the additional benefit from the implementation of TEACCH. Individuals with ASD typically exhibit multiple delays in cognitive development, including executive function, attention, and initiation (48). The individualized approach of the TEACCH intervention involves structured teaching that emphasizes visual information processing while mitigating challenges in social communication, attention, and executive function (6). The results of our analysis further confirmed that ASD severity, cognition, and parental stress could be improved through the TEACCH intervention.

Caring for children with ASD on a daily basis presents numerous challenges that impact parent-child relationships, caregiving capabilities, and the family’s overall ability to raise these children (49). Due to the delayed development of social and communication skills, parents of children with ASD often experience stress, which can affect the quality of life in both parents and children with ASD (50,51). TEACCH intervention offers structured teaching to parents for assessing and providing individualized support for their children (14) and provides psychoeducation on ASD. Previous studies have demonstrated the effectiveness of parents’ involvement in TEACCH, which could reduce mother’s depressive symptoms and improve family interaction (10). In summary, TEACCH-based interventions demonstrate various benefits by improving cognitive function, reducing ASD symptom severity, and alleviating parental stress. These outcomes highlight the multifaceted impact of structured interventions on children with ASD and their families, consistent with the broader literature on autism interventions.

Implications and actions needed

This systematic review and meta-analysis supports the effectiveness of TEACCH-based interventions in children with ASD, as it can improve various skills and cognitive function, ameliorate ASD symptoms, and reduce parental stress; meanwhile, we further identified critical areas for future research. Parental involvement is a key component of the TEACCH approach, yet inconsistent training quality affects its efficacy. Future studies should prioritize standardized and consistent parental training. Clinical settings emerged as more effective environments for TEACCH-based interventions, offering structured and well-designed conditions. Further research is needed to delineate the specific elements that enhance intervention outcomes in clinical versus home settings. Additionally, the evidence suggests that TEACCH interventions are particularly beneficial for school-aged children. Future investigations should examine the factors contributing to this age-specific efficacy.

The small number of studies and limited sample sizes in the research underscore the need for more robust investigations to fully realize the potential of TEACCH-based interventions. Longitudinal studies are particularly necessary to establish causality, identify potential influencing factors, and evaluate the long-term effectiveness of TEACCH in addressing ASD-related challenges. These efforts will provide a more comprehensive understanding of how to optimize the TEACCH approach for a diversity of populations and settings.

Conclusions

This systematic review and meta-analysis provided crucial insights into the implementation and effectiveness of the TEACCH approach and TEACCH-based interventions. The results of this study suggest that the use of a structured approach in a clinical setting within 6 to 12 months for school-aged children with parental involvement might produce optimal benefit for ASD children’s various skills and their family. Given the limitations of this study, further investigations are warranted to further determine the effectiveness of TEACCH approaches and to generate more reliable results.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the PRISMA reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-466/rc

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-466/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-466/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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(English Language Editor: J. Gray)