1. Social Implications for Students with Autism Spectrum Disorders
Presented by
Marrea Winnega, Ph.D. Licensed Clinical Psychologist
Consultant on Autism Spectrum Disorders February 22, 2011

2. Why are people with Autism or Asperger’s Disorder different?
Brain is wired differently
Object area of brain is more developed than people area
Not wired to be social
How?
Genetic/starts in utero before born
Likely to be a genetic/environment interaction
NOT caused by bad parenting

3. Different Perspectives
Wicked
The 3 Pigs from the Wolf’s perspective
Slumdog Millionaire
Breakfast Club, Grease, High School Musical, etc.

4. Different points of view
Car accidents
Sister has Columbus Day off
She works 2 half days per week
Should she get the day off?
Perspective of vacation – secretaries vs. educational staff
Asking, “How are you?”

5. Evidence-based Interventions
Use the National Standards as your guide
Note: The results support behavioral interventions – because that is where the research is

6. National Standards www.nationalautismcenter.org
The National Autism Center is a nonprofit organization dedicated to supporting effective, evidence-based treatment approaches for Autism Spectrum Disorders (ASD) and to providing direction to families, practitioners, organizations, policy-makers, and funders.

7. Treatment Divisions
11 “Established” Treatments: treatments that produce beneficial outcomes and are known to be effective for individuals on the autism spectrum. The overwhelming majority of these interventions were developed in the behavioral literature (e.g., applied behavior analysis, behavioral psychology, and positive behavior support).

8. Treatment Divisions
22 “Emerging” Treatments: treatments that have some evidence of effectiveness, but not enough for us to be confident that they are truly effective. Need more research
5 “Unestablished” Treatments: treatments for which there is no sound evidence of effectiveness. There is no way to rule out the possibility these treatments are ineffective or harmful.

9. Examples of Methods
Communication – Speech production; Picture Exchange Communication System; Sign Language; Assistive Technology (All 3 are Emerging Treatments) – therefore find the one the student prefers
Social Stories/Social Skills/Peer training (All Established)
Circle of Friends and Integrated Play Groups
Joint Attention/Self-management – Established
Pragmatic Language - Emerging

10. Methods
Relationship Development Intervention/Floor Time or DIR (home based vs. school based) – both are Emerging
Music Therapy – Emerging
Exercise – Emerging
Sensory Integration is Unestablished

11. Autism Spectrum Disorders
Also known as the Pervasive Developmental Disorders
Under this umbrella are:
Autistic Disorder
Asperger’s Disorder
Pervasive Developmental Disorder Not Otherwise Specified
Girls fly under the radar
Educationally: All of these
fall under Autism

12. Autism Defies Generalization
Social
Interaction
Aloof
Active but Odd
Measured IQ
Severe
Gifted
Communication
Non-Verbal
Highly Verbal
Motor Skills
Awkward
Agile
Gross
Fine
Uncoordinated
Coordinated
Sensory
Hyposensitive
Hypersensitive

13. The Iceberg: Understanding Autism
Behavior - Tip Below the water line: Reciprocal Social Interactions Communication and Play Restricted Repetitive Behaviors/ Need for Sameness Sensory Processing Learning Style

14. Impairments in Reciprocal Social Interactions
Marked impairment in the use of multiple nonverbal behaviors to regulate social interactions
Eye contact, gestures, facial expressions (social smile/range), body posture; joint attention
Failure to develop peer relationships appropriate to developmental level
Response; interest; imaginative play; group play; Age 10 and over – friendships

15. Impairments in Reciprocal Social Interactions
Marked impairment in spontaneous seeking to share enjoyment, interests or achievements
Showing/directing attention; offering to share; sharing one’s enjoyment
Lack of social or emotional reciprocity
Comfort; inappropriate facial expressions; quality of social response and overtures; socially awkward; social perspective taking

16. Impairments in Communication
Delay or lack of development of spoken language
Marked impairment in ability to initiate or sustain a conversation
Stereotyped or repetitive use of language
Lack of varied, spontaneous make-believe play or social imitative play

17. Note: Impact of Communication Impairments
Sequencing information
Difficulties retelling a story
Describing routine events
Brushing teeth, washing hands
Describing nonroutine events
A trip to Great America or a recent vacation

18. Restricted, Repetitive Behaviors
Encompassing preoccupations
Circumscribed interests
Nonfunctional routines and rituals
Preoccupation with parts of objects
Repetitive motor mannerisms

19. Theory of Mind Deficits
Inability to perceive feelings and thoughts of others
Insensitivity to other people's feelings
Do not appear embarrassed
Inability to read intentions of others
Inability to read listener's level of interest in one's speech
Not knowing what the listener needs to know 

20. Theory of Mind An Aspie Perspective Jean-Paul Bovee
All communication takes two people.
We have our own things that embarrass us.
Odd or repetitive behaviors, etc. have a reason for existing.
“There is not a shared understanding of how the world works.”
There are not shared beliefs.

21. A Reinterpretation of Theory of Mind
We have our own perspective.
Not every person thinks alike.
It is not the fault of the individual with ASD – both parties have a problem.
“We are people and we are different.”

22. Perspective Taking From Social Skills Solutions
Level 1:
Labels emotions in pictures, other people, on self; looks for and finds hidden objects
Level 2:
Cause for emotions; respects personal space
Level 3:
Interprets body language; identifies nice vs. mean vs. teasing

23. Who knows what? From Carol Gray
First page: My name is _______. Sometimes, I like to think about _______, _______, or _______. I think about other things, too. Second page: (My mom, dad, grandparent, teacher, sibling, friend) thinks, too. S/he sometimes likes to think about _______, _______, or ________. S/he thinks about other things, too. Illustrate each page.

24. Think about: A lack of social understanding is not misbehavior
A lack of social understanding makes students on the autism spectrum vulnerable to being set up by peers

25. Social Pitfalls
Not socially aware – varies from nonverbal to verbal students
Social misperceptions
“They are laughing at ME!”
Not knowing social norms or the “hidden curriculum”
How to act in different social situations
Which way do you stand when you ride an elevator? Why?
Not knowing what is “cool”

26. Laughing (Social Story)
People like to laugh. The kids and teachers in my class laugh a lot. Sometimes I don’t know why they are laughing. I will try to stay calm and ask them why they are laughing. Then I can laugh, too.

27. Social Pitfalls Asking inappropriate questions
Why do you color your hair?
Making inappropriate comments
It smells in here!
Speaking their minds or not knowing about little white lies
You smell…well, then, your cologne smells.
Teasing and Bullying
Fabricating stories

28. Socially Inappropriate Comments
“Your idea is crap.”
Tell soccer coaches and other players what they are doing wrong (days later told a student he was awesome at the game).
I am the smartest
Yet cannot tolerate getting a math problem wrong and throws a tantrum if does
Knows peers will not do this when they get one wrong

29. Story of Matt
Identified with Asperger’s about 3 years ago; now a 4th grader
Very verbal and bright
Excellent gross motor skills and good at soccer
Very competitive
Swears on the soccer field – only one who does

30. Processing Real Drama I’m not (might not) play this.
This is a big disappointment
I hope I get to play next year
I’m never going to play soccer again
I suck at soccer
It’s my mom’s fault I’m not playing soccer

31. Difficulty Disclosing
Child brought legos home from school:
T: Did you take something home?
C: Is that bright green or yellow?
T: Tell me something. Did you take something home?
C: Yes (showed legos)
T: Cannot take without asking. What happens if adults take something?
C: Call Police. And so this color is bright green or yellow.

32. Discussion Do these points make sense? Do you agree?
A lack of social understanding is not misbehavior
A lack of social understanding makes students on the autism spectrum vulnerable to being set up by peers

33. The Iceberg: Understanding Autism
Behavior - Tip Below the water line: Reciprocal Social Interactions Communication and Play Restricted Repetitive Behaviors/ Need for Sameness Sensory Processing Learning Style

34. Does not follow classroom directions
Below the water line: Does not process language in groups or subtleties of language Social – does not know that she is part of “everyone” Possible interventions: Teach that she is included in group directions Ask indirectly

35. Thinks everyone is laughing at him
Below the water line:
Limited social reciprocity/Limited understanding of the perceptions of others
Limited peer relationships
Possible interventions:
Teach concept of humor and different ideas that students think are funny (e.g. slapstick vs. puns vs. play on words

36. Social Misperceptions
Below the water line: Lack of social reciprocity Limited peer relationships Poor communication skills Possible interventions: Teach other perspectives on the situation; teach purposeful behavior vs. accidents (being bumped into)

37. Argumentative Student
Below the water line: Lack of social emotional reciprocity esp. social perspective Need for sameness (certain pair of shoes) Concrete/logical Possible interventions: Don’t argue – once starts, we have lost; pause and think about student’s request and how to modify your request; ask indirect questions (could you take your seat please?)

38. Will not do homework at home
Below the water line: Lack of social emotional reciprocity – bound to rules; concrete thinker: “Homework is school work. I do it at school. I have other work to do at home.” At school, socially overwhelmed/senses are overwhelmed – exhausted when arrives home Possible interventions: Complete during day/study halls Shorten assignments Also give frequent movement breaks or breaks from sensory and social input.

39. Manipulative*
Below the water line: Lack of social emotional reciprocity Does not understand instructions Poor expressive communication skills (has concerns) Possible interventions: Help express concerns and problem solve *True manipulation takes forethought and planning (team going to 31 Flavors vs. Dairy Queen)

40. Disruptive Student – too talkative vs. makes sounds
Below the water line: Lack of social emotional reciprocity Poor expressive communication skills Lack of awareness of social situations Possible interventions: If blurts out or interrupts: Teach when can talk; use Social Stories to understand this If makes sounds, try to teach when can make sounds; give alternatives such as lollipops

41. Will not do what you want him/her to do when you want
Below the water line:
More interested in what s/he wants to do
May not understand first this then that
Does not understand what you want
him/her to do
Does not know when it will end
Interventions:
Build additional motivation into the task; Clarify how much work (perhaps visually)

42. Aggressive – hits, slaps
Below the water line: Lack of social emotional reciprocity Limited social skills Poor expressive communication skills Functions: Escape, attention, tangible Possible interventions: What is the cause of the aggression? When is it occurring? Teach to ask for a break Give student frequent motor breaks

43. Visuals for Understanding
Sit
Walk
Quiet
Work
Stand up
Clean up
Classroom rules
Stop/Think/Make a Choice

44. Problem Behavior/Speech Issues and using visuals
Visuals* can be distracting (power struggles)
Requests are key
Write a sentence and have student read = “Use your words”:
I want a Reese’s cup
Lack of spontaneous speech:
Expand the sentence: write “May I have a cookie?”
*Objects, photographs, Boardmaker drawings,
written words, etc.

45. State/Teach the Behavior You Want
Do directions > don’t do/no’s
Tell your student what you want him/her to do:
Sit down
Walk with me
Open the door
Hold the door
Hands on knees
Hands on desk/table

46. Social Thinking Michelle Garcia Winner www.socialthinking.com
Social Thinking is required before social skills; aka Social Cognition
“Successful social thinkers consider the points of view, emotions, thoughts, beliefs, prior knowledge and intentions of others (this is often called perspective-taking - considering the perspectives of others).”

47. Social Thinking – Core Philosophies
We “think with our eyes” to figure out other people’s thoughts, intentions, emotions, plans, etc.
Our thoughts and emotions are strongly connected. How we think affects how we feel, how we behave affects how others think and feel.
We think about people all the time, even when we have no plans to interact with them. We adjust our own behavior based on what we think the people around us are thinking. (This is how we drive our cars!).

48. Social Thinking – Core Philosophies
As part of our humanity, each of us is on a daily quest to avoid each other’s “weird thoughts.” We … adjust our behavior to help people have “normal thoughts about us.”
Most of the core social thinking lessons operate BELOW the level of cultures, meaning that all people engage in these thoughts and social behavioral adjustments.
How we adapt our behavior changes as we age and are in different situations and cultures. The nuance and sophistication of our behaviors is constantly evolving.

49. Social Thinking – Core Philosophies
Social thinking is something all of us do every day, all day, even when we are alone in our homes. To understand a TV drama/sitcom/novel one has to think about the character’s emotions, thoughts, reactions.
Social thinking, therefore, plays into our academic world, requiring us to think about the motives and intentions of people we read about in literature and history.
Social thinking affects us in adulthood. To hold a job, most of us have to adapt our own social behavior based on the perceived thoughts of the people we work and live with.

50. Social Thinking Interventions
Four Steps of Perspective Taking
Four Steps of Communication
I LAUGH

51. Four Steps of Perspective Taking
Imagine you are in an elevator: Step One: When you come into my space, I have a little thought about you and you have a little thought about me. Step Two: I wonder “why are you near me?,” “what is your purpose for being near me?” “Is it because you are just sharing the space, do you intend to talk to me or do you intend to harm me?” I have to consider all these things in order to keep me safe around people as well as to predict what will happen next.

52. Four Steps of Perspective Taking
Step Three: Since we have thoughts about each other, I wonder what you are thinking about me. Step Four: To keep you thinking about me the way I would like you to think about me, I monitor and possibly modify my behavior to keep you thinking about me the way I want you to think about me.

53. Four Steps of Communication
Step 1: Thinking about others and what they are thinking about us
Step 2: Establishing a physical presence
Step 3: "Thinking with our eyes"
Step 4: Using language to relate to others
It is not all about talking!

54. I LAUGH Model
I: Initiation of Communication L: Listening with Eyes and Brain A: Abstract and Inferential Language/Communication U: Understanding Perspective G: Gestalt Processing/Getting the Big Picture H: Humor and Human Relatedness

55. Worksheets! for Teaching Social Thinking and Related Skills*
Learning about our own behavior
Self-Monitoring and Rating Sheets
Friendships
Being part of a group
Exploring language concepts
Developing effective communication

56. Worksheets! for Teaching Social Thinking and Related Skills
Understanding and interpreting emotions
Perspective taking
Making plans to be with others
Problem solving and dealing with responsibilities
Poster handouts

57. Strategies for Organization
Daily individual schedule
Monthly or long-term schedule
Individual work system
Schedules within schedules
Lists
Color coding – folders, books, spiral notebooks
Containers for colored hanging files
Expanding file folders
Physical structure of building

58. Strategies for Organization
Assignment books
Teach what is most important to do
Teach how to manage deadlines
Who writes in it?
Erasable highlighters; highlighting tape
Adjust the level of spoken language
Use shorter sentences for directions
Enhance oral directions with written information
Teach length of time – use stopwatches and timers

59. Fundamental Social Interventions
Instruct them on how to interact socially (changes every year)
Teach in small groups (one or two other students)
Facilitate social interactions on the playground, in the lunchroom or gym, etc.
Teach feelings and how to read the facial expressions and body language of others
Cultivate social awareness - of self and others

60. Foundation Social Skills
Joint Attention
Requesting
Speaking in 2 to 3 word meaningful phrases with 1 word being a verb
Tolerating the close proximity of peers

61. Joint Attention From Social Skills Solutions
Level 1: Follows eye gaze, point or gesture by others; looks/orients/responds to objects presented; passes item to peers
Level 2: Orients toward person when speaking/listening; shows others objects with intent to share; follows other’s eye gaze to objects; follows basic nonverbal commands (stop, point-look, come here)
Level 3: Uses gestures to communicate

62. Social Language Greetings Saying, “Please” and “Thank you”
Hi, Bye
Saying, “Please” and “Thank you”
Giving Compliments
Responding
Initiating

63. Motivation
Is there a peer the student with an autism spectrum disorder gravitates towards?
Give peer something the student with autism wants
Teach the names of his/her classmates

64. Teaching to say “Hi” Written on a strip: Hi <person’s name>
Modeling/Verbal cuing
Social Story

65. Saying Hi to My Friends (Social Story)
Sometimes other students talk to me. This may mean they want to be my friend. I will try to say “Hi” when another student says hi to me. Maybe students will talk to me more if I talk to them.

66. Task Analysis of a Conversation
Response to peers greeting or questions
Initiate greetings, social interactions, or topics
Maintain a conversation:
Make comments
Listen and ask questions/make comments
Stay on topic
Let peer make a comment or ask a question
End graciously (e.g., talk to you later)

67. Conversation Start with area of interest and teach skills
Teach concept of a topic
Teach alternative topics – what are peers’ interests?
Try using a topic chart

68. Shoebox Sample Questions
What is your favorite movie?
Where do you like to eat?
What is your favorite food?
What is your favorite TV show?
What is your favorite video game?
What did you do over winter break?
What do you like to think about?
What should you say when you meet someone for the first time?

69. Social Interaction Schedule
Say, “Hi <therapist>” (Check box or draw line through the activity)
Review schedule.
Ask <therapist>, “What did you have for dinner last night?”
Listen to the response.
Listen to <therapist’s> question.
Answer.
Select a game to play.
Play game.
Say “Goodbye, <therapist>”
Go back to class.

70. Levels of Social Comfort
Proximity
Looking
Parallel Play
Sharing
Associative Play
Turn Taking  Cooperative Play
Following Rules

71. Basic Social Skills Tolerate peers Appropriate touching
Appropriate social distance
Making choices
Sharing
Eye contact
Turn taking
Relinquishing one’s turn
Losing graciously
Participating in class group activities

72. Interventions with Peers
Circle of Friends
Peer buddies
Peer mentor (Student on the autism spectrum teaches about his interest)

73. Strategies Model Prompt Provide picture or written cues Coach
Facilitate
Orchestrate
Task Analysis – break skill down and teach each part
Create a list of the steps of the skill or use a schedule (next slide)

74. Social Skills Solutions
Uses ABA
Checklist:
3 Levels
9 Modules

75. Social Skills Checklist
MODULES:
Joint Attention/
Attending
Greetings
Social Play
Ability to Calm Self
Conversations
Perspective Taking
Problem Solving
Advanced Language
Friendships
Community/Home

76. Joint Attention From Social Skills Solutions
Level 1:
Follows eye gaze, point or gesture by others; looks/orients/responds to objects presented
Level 2:
Can sit and listen to group stories; shows others objects with intent to share
Level 3:
Repeats and performs 4-5 step directions; follows and completes large group instructions

77. Perspective Taking From Social Skills Solutions
Level 1:
Labels emotions in pictures, other people, on self; looks for and finds hidden objects
Level 2:
Cause for emotions; respects personal space
Level 3:
Interprets body language; identifies nice vs. mean vs. teasing

78. Critical Thinking Skills (Level 1) Problem Solving (Levels 2 & 3) From Social Skills Solutions
Ability to follow a schedule; understands first/then; can sequence 4 pictures
Level 2:
Retells events of that day/yesterday; retells short stories without visuals
Level 3:
Asks for clarification; makes predictions; interprets idioms

79. Friendships From Social Skills Solutions
Level 1:
Sits next to same peer consistently; shares with peer
Level 2:
Gives others compliments; helps others when asked; apologizes
Level 3:
Introduces self to others; invites friends over; beginning sexuality - privacy

80. Video Modeling
Scott Bellini & Jennifer Akullian – Meta-Analysis of 16 single subject design studies (49 participants) in Council for Exceptional Children, 2007:
Promotes skill acquisition
Skills acquired are maintained over time
Skills transferred across persons and setting
Meets criteria for evidence-based practice

81. Video Modeling Possible Skills to Teach
Motor behaviors
Social skills (e.g., initiations, responses, play)*
Communication (e.g., conversation)*
Self-monitoring
Functional skills (e.g., purchasing, hygiene)*
Vocational skills
Athletic performance
Emotional regulation
Behavioral functioning (e.g., decreased problem behaviors, off-task/on-task behaviors)*
*All part of Bellini & Akullian meta-analysis

82. ***Make sure there are no extraneous details***
Video Modeling
Choose 1 skill
Models are similar to the child
Model is successful
Model is reinforced
Scripted
***Make sure there are no extraneous details***

83. Adapted Games Matching games Modified Candyland
Card games – start with Disney and transfer to “Bicycle” playing cards. Then teach a new card game with the Disney cards.

84. Social Story Dictionary Define terms related to thoughts
Know
Guess
Learn
Decide
Topic
Idea
Wonder
Understand
Suppose
Confuse
Expect
Hope
Anticipate
Opinion
Forget
Believe

85. Group Skills Observe group activity from a distance
Stay during a short activity then to the completion of an activity (10 min)
Participate in circle-time songs or games by
Listening and watching
Imitation
Participate in group time by
Looking at/listening to a book
Making choices of activities
Discussing the topic

86. Layered Groups Everyone – lively songs with music Smaller Group
Routine actions
Counting
Concrete – objects to hold
Smaller Group
Calendar or Weather
with visual supports
Smallest Group
Language
Social Skills
Current Events

87. Working in Groups
Provide explicit group instructions – roles for each student in the group/who is responsible for what aspect of the project
Some students with ASD control the group; others do not attempt to be part of it; others do both depending on the group

88. Teaching how to use a relaxation system:
Select a picture cue
Teach and Practice while calm
and with the picture present
Practice in one setting
Generalize to other settings
***This becomes a new routine***
Relaxation Visual System:

89. Resources
The TEACCH Approach to Autism Spectrum Disorders (
Teach Me Language (
Social Skills Solutions; A Work in Progress; The Verbal Behavior Approach (
Educate Toward Recovery (
Peer play and the autism spectrum: The art of guiding children’s socialization and imagination (Integrated Play Groups Field Manual) by Pamela Wolfberg (
Wolfberg website:
Michelle Garcia Winner:

90. Resources
From : Super Skills: A Social Skills Group Program for Children with Asperger Syndrome, High-Functioning Autism and Related Challenges The Hidden Curriculum by Brenda Smith Myles Power Cards, Incredible 5 point Scale Navigating the Social World by Jeanette McAfee Social Skills Training; Social Skills Picture Book by Jed Baker Exploring Feelings: Cognitive Behavior Therapy to Manage Anger by Tony Attwood Exploring Feelings: Cognitive Behavior Therapy to Manage Anxiety by Tony Attwood