Thoughts from an adult with Aspergers

(Look me in the eye by John Elder Robison)

Teaching Social Interaction Skills to Students with ASD

Presented by the MNPS Autism Team

My conversational difficulties highlight a problems Aspergians face every day. A person with an obvious disability-for example, someone in a wheelchair-is treated compassionately because his handicap is obvious. No one turns to a guy in a wheelchair and says Quick! Lets run across the street! And when he cant run across the street, no one says, Whats his problem? They offer to help him across the street.

Thoughts continued
With me, though, there is no external sign that I am conversationally handicapped. So folks hear some conversational misstep and say What an arrogant jerk! I look forward to the day when my handicap will afford me the same respect accorded to a guy in a wheelchair. And if the respect comes with a preferred parking space, I wont turn it down.

Why be Concerned?!?!

70% of people with Autism are unemployed The higher the functioning, the higher the unemployment! (Belini, 2007)

Objectives
1. 2. 3.

Social Interaction Skills

By definition (Gresham & Elliot, 1995) Socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses.

to understand the common social difficulties associated with autism to understand an appropriate means of evaluating social skills gain ideas for using these interventions in classroom activities/groups

Autism Documentary

Social Interaction Skills

Early Social Skills

Turn taking Eye contact Sharing Parallel play Cooperative play Imitation Joint attention: gestural and communicative Sharing affect Proximity Following simple commands Responding Rejecting appropriately Requesting help

Joint Attention
ability to share attention with another person while both are paying attention to the same object Can be gestural or conversational

Later Social Skills

Empathy Compliments Sharing interests Interpreting and using facial expressions Initiate, terminate, and maintain interactions Conversation topics and amount of info Lacks tact: appears rude or nave Interpreting figurative language, Comments Feelings Community rules Self monitoring Critical thinking Dating/sexual etiquette Grooming Respecting authority Problem solving Difficulty understanding jokes Social anxiety and withdraw

Understanding why this happens

Repetitiveness and restricted interests Interpret literally Theory of Mind: difficulty understanding another persons perspective or that they have thoughts and feelings different from their own Difficulty imitating Difficulty problem solving Pragmatics: form (syntax, morphology, phonology) and content (semantic) encodes differently in ASD from early interactions

Consequences of Poor Social Skills: 70% of those on the spectrum are unemployed

Poor Academic Performance Peer Failure Rejection Isolation Anxiety Depression Substance Abuse Suicidal Thoughts Violence Towards Self or others.

Bellini/2007

Activity 1
Stand Up!! What were the communication difficulties you experienced?

Social Interaction Skills

Evaluation and Planning

Pragmatic Assessments
Formal Assessments Test of Pragmatic Language Clinical Evaluation of Language Fundamentals: Pragmatic Profile Social Emotional Evaluation Pragmatics Language Skills Inventory Comprehensive Assessment of Spoken Language Social Skills Rating system

Pragmatic Assessment
Informal Assessment Language Sample Observations: Parent/Teacher Report Social Language Checklist

Informal Assessment: Observations

What are you looking for?

Informal Assessment
What is keeping the student from establishing and maintaining social relationships? Rate social competence: interviews and rating scales Take date: during recess observe # of social initiations, # of social responses, and amount of social engagement time Conversations skills: Initiations, responses, maintenance, closure of social interactions (various settings) Cooperative play skills: joining in, taking turns, sharing, losing, games Friendship skills: proximity, appropriate topics, helping, rules, bullies, grooming Emotions: understanding emotions, problem solving skills Empathy Conflicts: anger, respect, NO,

Proximity: appropriate space Object/body use Requests Initiations Responses Behaviors: do they interfere Transitions Participation in routine or novel situations

www.cpsinstitute.org
PATHWAYS INVENTORY (Rev. 6/23/07) Child's Name ___________________________ Date _______

Determine: Skill Acquisition Deficit or Performance Deficit

Skill Acquisition Deficit: skill is absent (will need to teach) Performance Deficit: skill is in repertoire but the child does not use the skills (enhance performance) Can the student do the skill with different people in different settings?

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Difficulty handling transitions, shifting from one mindset or task to another (shifting cognitive set) Difficulty doing things in a logical sequence or prescribed order Poor sense of time Difficulty reflecting on multiple thoughts or ideas simultaneously Difficulty maintaining focus for goal-directed problem-solving Difficulty considering the likely outcomes or consequences of actions (impulsive) Difficulty considering a range of solutions to a problem Difficulty expressing concerns, needs, or thoughts in words Difficulty understanding what is being said Difficulty managing emotional response to frustration so as to think rationally (separation of affect) Chronic irritability and/or anxiety significantly impede capacity for problem-solving Difficulty seeing the grays/concrete, literal, black-and-white, thinking Difficulty deviating from rules, routine, original plan Difficulty handling unpredictability, ambiguity, uncertainty, novelty Difficulty shifting from original idea or solution/difficulty adapting to changes in plan or new rules/possibly preservative or obsessive Difficulty taking into account situational factors that would suggest the need to adjust a plan of action

What if you are thinking?

I dont think I should modify or make excuses for these kids. I know they can do it! Saying that they know how to do something is only DECLARATIVE KNOWLEDGE. I can teach mostly anyone the facts necessary to learn how drive a stick shift car. But, being able to say how to do something does not mean you can do it. What often keeps a child from being successful are skills we often do not teach Its a continuum that requires PROCEDURAL KNOWLEDGE.

Doing

Thinking

Feeling

Bellini/2007

Being able to say how to do it doesnt mean you can do it! We can bridge the gap with visual support, practice, and meaningful activities

How to start planning and begin instruction?

5 Steps Identify and assess areas of need Discern between skill acquisition deficits and performance deficits Select appropriate intervention strategies Implement intervention strategies Evaluate program and modify as needed
*Source: Bellini, 2007

Goal Selection
Goals should be functional and applicable to success in life Ensure goals are appropriate for cognitive levels Goals should be positive Goals should be realistic and represent a challenge Set criteria based on baseline data

The Hidden Curriculum

by Brenda Smith Myles, Melissa L. Trautman, and Ronda L. Schelvan

Teachers Hidden Curriculum

Teacher Expectations
What students should do when the bell rings How to travel from class to class in the most direct way. The administrative structure. Which teachers will tolerate lateness Which teachers give homework. Which teachers place value on final exams.

Refers to the set of rules that everyone in the school knows, but that no one has been directly taught:
How to dress What type of backpack to carry How to greet a peer Where to hang out between classes What games are acceptable to play Who to ignore Others?

Some more thoughts from John

Many descriptions of autism and Aspergers describe people like as not wanting to contact with others or preferring to play alone. I played by myself because I was a failure at playing with others. I was alone as a result of my own limitations, and being alone was one of my bitterest disappointments of my young life. The sting of those early failures followed me long into adulthood, even after I learned about Aspergers. Look me in the Eye by John Elder
Robison

Social Interaction Skills

Understanding and Decreasing Anxiety

Some more thoughts on Anxiety

by Jerry Newport Your Life Is Not a Label
As far back as I remember, I was like a little bird on a wire, ready to flee from the next embarrassment at a moments notice. No matter how hard I tried to obey all the rules, spoken by parents with frustration and siblings with sarcasm, I knew I would eventually screw up and tread water in another sea of laughter. So, my stress and perhaps yours, came from many sources: frustration, neurological overload, and social humiliation to name a few. There is nothing more frustrating than the lifelong accumulation of scars that result from trying to be like normal people and failing daily. It is especially hard when your disability is invisible like mine.

Fear and Anxiety are common feelings for people with ASD.

Stress in Persons with Aspergers

Aggression
Verbal / physical 1. 2. 3.

Set up your classroom to increase relaxation

Be mindful of stress in your students Establish a relationship with your students so they can come to you for help and support Create means to cope within the classroom (break area, yoga, system for help, organize areas, visual supports) Incorporate social skills in lessons, centers, as a designated area in the classroom, bulletin boards Facilitate relationships in your classroom through character building activities Celebrate uniqueness often

Withdrawal / Shut down Increased Obsession Increased Stress / Anxiety

4.

5.

Anxiety
6.

Triggers

Atwood, 1999

5 Point Scale
Kari Buron and Mitzi Curtis
tool which provides a visual representation of stressors, inappropriate behaviors, rules, etc.. Allows children the ability to connect internal issues to a visual support Encourages problem solving, self monitoring and independence in resolving issues www.5pointscale.com

Examples

Developing a Plan
Identify stressors Recognize behaviors leading up to aggression or shut down Create supports, area, or a plan with the student

Relaxation Plans
1. Help students regulate stress- teach student to request a break, include breaks in schedule, create break area in classroom, coping strategies specific to situations 2. Use self-monitoring- 5 point scale, checklists, power cards 3.Tension release and breathing exercises yoga, deep breathing cards,

In the public school setting, children with autism are often integrated into the general education classroom with the hope that social skills will be absorbed through proximity to normal socialization. Instead, direct instruction of specific skills combined with an awareness of appropriate models is required.

Social Interaction Skills

Intervention Strategies

The Effectiveness of an Interview Template in Children with Autism: Structured Peer Interview to Facilitate Peerpeer Interactions Crooke, Pamela J. (2005)

Why is this important?

Teaching social skills should become a priority in our classrooms Decreases anxiety Encourages relationships and support through peers and teachers Allows for problem solving directly in the classroom

Promote Skill Acquisition

Role-playing Teach perspective taking, social rules, problem solving, and mind reading Discrete trial Reciprocal strategies Social narratives Social Skills Picture Stories

Incidental Teaching Sabotage Power Cards Structured Teaching Self-Monitoring Prompting Video modeling Cartooning

Role-Play
The students act out the skills in the appropriate order. The teacher acts as a hands on coach. Use scripted and unscripted Keep it fun Let the students pick scenarios or practice use units from class readings or other subjects

Role-Playing: acting out and practicing newly learned skills

Teaching students to: 1. Read nonverbal cues 2. Conversation skills 3. Social rules (interrupting, eye contact, gaining attention, amount of information, etc) 4. Sequence interactions

Conversation Skills
Conversation webs (www.do2learn.com) break down skills into individual pieces as needed: initiation, turn taking, appropriate topics, endings using visual supports Comments: Appropriate vs. inappropriate

Teaching Nonverbal Cues

Explain importance and use of gestures (cartoons with volume down, magazine pictures, charades Teach understanding and interpretation of facial expressions (start with cartoons, then move to photos as line drawings are easier for children with ASD to identify, magazines, software, websites www.cccoe.net/social) Teach tone, volume, proximity (5 point scale, videos, tapes, etc) Later social skills will need to focus on conduct with the opposite sex, rules at work, etc.

Specific skills to Target during Role-Play

Gaining/Securing Attention: indirectly requests attention or acknowledgment from peers (e.g., Hey!, See this?, Look.), calls a peers name, taps peer on the shoulder, Greetings, Inviting others to play Requests for Actions/Objects: requests an action (e.g., Can I have a turn?), requests an object (e.g., Can I have a marker?), tells a peer what action to do or not to do (e.g., Stop it, Put it in there.) Commenting: express an opinion (e.g. I think we should start.), response to a peers action (e.g. Youre done.), express enjoyment or frustration (e.g. Oh no!)
Thiemann, K. & Goldstein, H. (2004). Effects of Peer Training and Written Text Cueing on Social Communication of School-Age Children With Pervasive Developmental Disorder. Journal of Speech, Language, and Hearing Research, 47, 126-144.

Specific skills to Target during Role-Play

Complimenting: child reinforces a peer for winning a game (e.g., You did it!), reinforces peer for personal performance (e.g. nice try.) Responding: commenting about events in an activity, greeting, when others invite child to play, when others request, when others ask questions Nonverbal cues: Understanding facial expressions (e.g. eyebrows raised mean surprised), Understanding body language (e.g. arms crossed when angry
Thiemann, K. & Goldstein, H. (2004). Effects of Peer Training and Written Text Cueing on Social Communication of School-Age Children With Pervasive Developmental Disorder. Journal of Speech, Language, and Hearing Research, 47, 126-144.

Reciprocal Strategies (learning

back and forth exchanges) Conversation game: supply visuals as prompts, provide topic, provide scripts if necessary Eden Conversation program

Reciprocal Questions
Newspaper Reporter (give child simple questions to ask peer in order to get your student asking questions and increasing interactions) Eden Asking Questions program

Activities to teach perspective, problem solving, social rules, and mind reading
Label and recognize emotions: through cartoons, magazines, pictures, videos, break down into features of the face if needed Understand emotions (Why is he feeling that way, what is he thinking) Prediction of consequences (What will happen next? What happened before?) Selection of alternative behaviors (sarcasm, understanding situation to interpret behaviors) Thought bubble activities

Thought Bubble Activity

Activities to teach perspective taking, social rules, problem solving, mind reading Interest inventories
(list of possible peer interest that could be used for conversation topics)

Mind reading activities (Howlin) If-then statements to infer the thoughts and interests of others Software programs (Simon BaronCohen, do 2 learn) Social scenarios ( what has happened)

Discrete Trial

Cue Prompt (if necessary) Response (behavior) Consequence (reinforcement)

Example from Eden Curriculum

SD your turn Procedure
Model activity Model activity again and give SD Same procedure as steps 1-2 Randomize activities Continue procedure with other activities Generalize responses to various teachers in various settings

Social Narratives
Written in first person and describes how people feel and think in certain situations. Uses directive statements to show students how to act in those situations Read repeatedly until the child over learns it and rereads before problematic situation. Should be written at childs instructional level for self awareness, self calming, self management

Activities include
Passing ball Banging drum Jack-in-the-box Stacking rings Pegs Hi fives Turning pages Sandbox with shovel and pail Jumping Making sandwhich

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Social Skill Picture Stories

The depiction of various social skills the correct way to act with accompanying text that explains what the children are doing.

Incidental Teaching
Teaching as the situations occur rather than in structured settings.
Example a teacher points out (at recess) to the student with ASD that a peer looks physically hurt. She coaches the student with ASD to stop playing and ask the other student if he is OK. (The teacher is amplifying the cue (someone is hurt) so that the student with ASD reacts and does not remain oblivious.)

Sabotage
Setup the environment/activity so that the child will be unsuccessful. This will require the child to communicate

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Power Cards
help change an unwanted or inappropriate behavior by capitalizing on the special interests that characterize children and youth with AS. A brief, motivational text related to a special interest or a highly admired person is combined with an illustration and made into a bookmarkor business card-sized POWER CARD that the student can refer to whenever necessary. For younger children the special interest or hero is worked into a brief story.

Power card
Front of power card has the logo on it. Back of power card The contestants on Survivor think everyone should have fun playing games. They also want you to remember three things when playing games with other people: Games should be fun for everyone. If you win a game, you can: Smile, give high fives, or say, "Alright!" If you lose a game, you can: Take a deep breath and say, "Good job" to the opponent or say, "Maybe next time."

Structured Learning

The A-Team thinks everyone should be respectful to their teachers. They want you to remember 3 things when you are in class: 1.Raise your hand if you have a question 2.If you need a break tell your teacher 3.Use kind words like please and thank you.

Didactic instruction (explanation of the skill steps) Modeling of skill steps Role-playing skills with feedback Practice in and outside the group

Didactic Instruction
The instructor explains the steps of a particular skill, using a visual of the skill steps
Why is it important to compliment others? What can you compliment others about? Why should you use a nice voice tone when complimenting others?

Cartooning
Using simple pictures and text as a whole or in strips to understand a situation description of the event that caused the problem feelings and thoughts of everyone involved a solution to the problem and ideas on how to avoid it in the future reinforcement appropriate symbols (stick figures, smiley faces, thought bubbles) colors used to express feelings (green-happy, blue-sad, black-angry

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Promote Social Performance

Peer sensitivity training Reinforcement/mo tivation Priming Modifications Game playing Increase opportunities (practice) Peer Mentoring Self-Monitoring Relaxation plans Prompting Video modeling Social narratives

Self-Monitoring
Teaching child to be aware of behavior
1. 2. 3. 4. 5. 6. 7.

Identify behavior, emotion, or skill Define behavior, emotion, or skill Introduce/teach behavior, emotion, skill Select self-monitoring procedure Teach self-monitoring strategy Implement Provide feedback
Source: Bellini, 2007

Prompting
Supports used to help students learn new skills and successfully perform behaviors Have a plan for fading immediately Determine a prompt hierarchy with the team

Level of Prompting will Vary

When requesting a physical response: Gesture gesture to indicate the correct response Partial Physical hand over hand assistance to initiate response, the student completes on his own. (tap the elbow to get him to pick something up, tap the shoulder to get him to sit down) Full Physical hand over hand assistance to perform the entire response.

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Prompts continued
VERBAL CUES Visual a written cue that elicits a
response

Video Modeling
Includes videos that depict appropriate target behaviors and/or videos of themselves performing the desired behavior One Key reason for the success of video modeling is that it increases the childs attention to the television, or computer screen. And if you do not have attention, you will not have learning.

Partial Verbal stating part of/or the initial sound of the verbal response you are expecting. (What time is it? It is _____.) Full Verbal stating the entire verbal response. (What time is it? It is 2:00.)

Courtesy of Indiana University

Bellini, S., akullian, J., & Hopf, A. (2007). Increasing social engagement in young children with autism spectrum disorders using video self-modeling. School Psychology Review, 36, 80-90 Bellini, S. & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73, 261-284.

http://modelmekids.com/autism-videosamples.html

Promote Social Performance

Reinforcement/Motivation
Increases desired behaviors Forces us to monitor students behavior Provides feedback to student

Reinforcement/Motivation
should receive praise and social reinforcers, even when receiving a more tangible reinforcer. The type of reinforcer must be appropriate and natural to the activity the student is doing and to the level of student understanding. Reinforcement can include a variety of items or activities. Give the student CHOICES. The teacher needs to make sure the reinforcing consequence immediately follows the behavior or skill being learned or increased so that the relationship between the two is clear to the student. However, be careful to not interrupt a social interaction.

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Priming
Priming Preparing the student for the upcoming task.
Not Teaching. Preparing Cognitive Priming: use visual and/or verbal Behavioral Priming: practicing skill right before having to perform in natural setting

Modifications
Are necessary modifications in place? Consider students sensory deficits

Game Playing
Games require social interaction but are structured. Most children interact not just during conversation but during activities. Use popular games Teach child how to play

Practice
Increase social opportunities. The students should be given opportunities to practice skills with peers in other settings. Feedback from the student, peers, adults as to how the opportunity was successful or not Select activities that are appropriate for practicing (student preferred activities) Use other strategies for practicing (e.g. roleplaying)

Peer Sensitivity Training

Child specific or general overview Celebrate differences Allow the children to be involved in the training

Peer Mentoring
Select age-appropriate sensitive peer Peer must willing Can pair during difficult times such as transitions Peer must be given specific instructions on how to increase communication success (e.g. if student w/ASD needs simple direct instructions) Alternate peers

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Considerations for Social Interaction

Match Social Interaction Programs to Students' Needs and Settings. Establish Reasonable Social Interaction Expectations Be Sensitive to Local Social Interaction Norms and Conditions Program for Interaction Quality As Well As Quantity Recognize That Not All General Education Students Will Be Suited to Social Interaction Programs

Continued
Reduce Aberrant Behaviors Prior to Initiating Social Interaction Programs Provide Ongoing Instruction and Monitoring Task Analyze Social Interaction Skills Consider the Importance of Setting and Material Variables Consider Social Validity in Programming Prioritize Social Interaction Skills Tailor Reinforcement to Meet Individual Needs

Continued
Educate Tutors and Others About Autism Facilitate Initial Interactions Make Data-Based Program Decisions Generalize Social Skills Maintain Acquired Social Skills

Social Skills Groups

When first beginning make sure the level of understanding is commensurate with all students
Review the purpose of the group Establish group rules and reinforcement/consequences Get to know each other through discussion and/or worksheet inventories Game or snack time

Social Skills Groups Cont.

Set and display a schedule for the group:
Talk Time Skill Time Game Time Snack All Done

Social Skills Groups Cont.

Prepare a visual of the agreed upon group rules
Listen to each other (wait for a pause to talk during a conversation, raise your hand and wait to be called on during skill time). Talk nicely to each other (do not yell, tease, or insult). Keep hands and feet to yourself (do not push, hit, kick, pinch, or grab others).

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Social Skills Groups Cont.

When getting to know each other -Use various prompts and visuals to help the students focus on each other prompt them to respond or ask follow-up questions.

Social Skills Groups

Humor: incorporate humor through jokes, charades, newspaper cartoons, silly stories, etc.

Include all communication systems

A Last Thought from John

I may look and act pretty strange at times, but deep down I just want to be loved and understood for who and what I am. I want to be accepted as part of society, not an outcast or outsider. I dont want to be a genius or freak or something on display. I wish for empathy and compassion from those around me, and I appreciate sincerity, clarity, and logicality in other people. I believe most people-autistic or not- share this wish. I hope youll keep those thoughts in mind the next time you meet someone who looks or acts a little strange.
Look me in the Eye by John Elder Robison

References
Bellini, S., akullian, J., & Hopf, A. (2007). Increasing social engagement in young children with autism spectrum disorders using video self-modeling. School Psychology Review, 36, 80-90 Bellini, S. & Akullian, J. (2007). A meta-analysis of video modeling and video selfmodeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73, 261-284. The Effectiveness of an Interview Template in Children with Autism: Structured Peer Interview to Facilitate Peer-peer Interactions Crooke, Pamela J. (2005) Thiemann, K. & Goldstein, H. (2004). Effects of Peer Training and Written Text Cueing on Social Communication of School-Age Children With Pervasive Developmental Disorder. Journal of Speech, Language, and Hearing Research, 47, 126-144. Buschbacher, P. & Fox, L. (2003). Understanding and Intervening With the Challenging Behavior of Young Children With Autism Spectrum Disorder. Language, Speech, and Hearing Services in Schools, 34, 217-227. Teacher's Toolbox. "Teacher's Toolbox." . . . 11 September 2007. <http://www.ttoolbox.com/help.htm>. Susan Klein. "Model Me Kids." . 2004. Model Me Kids, LLC.. 11 September 2007. <http://www.modelmekids.com/index.html>. Fovel, T. (2002). The ABA Program Companion. Bashe, P. & Kirby B. (2001). The Oasis Guide to Asperger Syndrome-Revised.

www.speakingofspeech.com www.usevisualstrategies.com www.do2learn.com www.thegraycenter.org www.tinsnips.com www.teacch.com www.mrsriley.com

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