Presentation on theme: "Social Implications for Students with Autism Spectrum Disorders"— Presentation transcript:
1 Social Implications for Students with Autism Spectrum Disorders Presented byMarrea Winnega, Ph.D. Licensed Clinical PsychologistConsultant on Autism Spectrum Disorders February 22, 2011
2 Why are people with Autism or Asperger’s Disorder different? Brain is wired differentlyObject area of brain is more developed than people areaNot wired to be socialHow?Genetic/starts in utero before bornLikely to be a genetic/environment interactionNOT caused by bad parenting
3 Different Perspectives WickedThe 3 Pigs from the Wolf’s perspectiveSlumdog MillionaireBreakfast Club, Grease, High School Musical, etc.
4 Different points of view Car accidentsSister has Columbus Day offShe works 2 half days per weekShould she get the day off?Perspective of vacation – secretaries vs. educational staffAsking, “How are you?”
5 Evidence-based Interventions Use the National Standards as your guideNote: 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 Divisions11 “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 Divisions22 “Emerging” Treatments: treatments that have some evidence of effectiveness, but not enough for us to be confident that they are truly effective. Need more research5 “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 MethodsCommunication – Speech production; Picture Exchange Communication System; Sign Language; Assistive Technology (All 3 are Emerging Treatments) – therefore find the one the student prefersSocial Stories/Social Skills/Peer training (All Established)Circle of Friends and Integrated Play GroupsJoint Attention/Self-management – EstablishedPragmatic Language - Emerging
10 MethodsRelationship Development Intervention/Floor Time or DIR (home based vs. school based) – both are EmergingMusic Therapy – EmergingExercise – EmergingSensory Integration is Unestablished
11 Autism Spectrum Disorders Also known as the Pervasive Developmental DisordersUnder this umbrella are:Autistic DisorderAsperger’s DisorderPervasive Developmental Disorder Not Otherwise SpecifiedGirls fly under the radarEducationally: All of thesefall under Autism
12 Autism Defies Generalization SocialInteractionAloofActive but OddMeasured IQSevereGiftedCommunicationNon-VerbalHighly VerbalMotor SkillsAwkwardAgileGrossFineUncoordinatedCoordinatedSensoryHyposensitiveHypersensitive
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 interactionsEye contact, gestures, facial expressions (social smile/range), body posture; joint attentionFailure to develop peer relationships appropriate to developmental levelResponse; 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 achievementsShowing/directing attention; offering to share; sharing one’s enjoymentLack of social or emotional reciprocityComfort; 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 languageMarked impairment in ability to initiate or sustain a conversationStereotyped or repetitive use of languageLack of varied, spontaneous make-believe play or social imitative play
17 Note: Impact of Communication Impairments Sequencing informationDifficulties retelling a storyDescribing routine eventsBrushing teeth, washing handsDescribing nonroutine eventsA trip to Great America or a recent vacation
18 Restricted, Repetitive Behaviors Encompassing preoccupationsCircumscribed interestsNonfunctional routines and ritualsPreoccupation with parts of objectsRepetitive motor mannerisms
19 Theory of Mind Deficits Inability to perceive feelings and thoughts of othersInsensitivity to other people's feelingsDo not appear embarrassedInability to read intentions of othersInability to read listener's level of interest in one's speechNot 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 objectsLevel 2:Cause for emotions; respects personal spaceLevel 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 PitfallsNot socially aware – varies from nonverbal to verbal studentsSocial misperceptions“They are laughing at ME!”Not knowing social norms or the “hidden curriculum”How to act in different social situationsWhich 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 commentsIt smells in here!Speaking their minds or not knowing about little white liesYou smell…well, then, your cologne smells.Teasing and BullyingFabricating 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 smartestYet cannot tolerate getting a math problem wrong and throws a tantrum if doesKnows peers will not do this when they get one wrong
29 Story of MattIdentified with Asperger’s about 3 years ago; now a 4th graderVery verbal and brightExcellent gross motor skills and good at soccerVery competitiveSwears on the soccer field – only one who does
30 Processing Real Drama I’m not (might not) play this. This is a big disappointmentI hope I get to play next yearI’m never going to play soccer againI suck at soccerIt’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 misbehaviorA 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 othersLimited peer relationshipsPossible 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 doMay not understand first this then thatDoes not understand what you wanthim/her to doDoes not know when it will endInterventions: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 SitWalkQuietWorkStand upClean upClassroom rulesStop/Think/Make a Choice
44 Problem Behavior/Speech Issues and using visuals Visuals* can be distracting (power struggles)Requests are keyWrite a sentence and have student read = “Use your words”:I want a Reese’s cupLack 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’sTell your student what you want him/her to do:Sit downWalk with meOpen the doorHold the doorHands on kneesHands 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 TakingFour Steps of CommunicationI 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 usStep 2: Establishing a physical presenceStep 3: "Thinking with our eyes"Step 4: Using language to relate to othersIt is not all about talking!
54 I LAUGH ModelI: 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 behaviorSelf-Monitoring and Rating SheetsFriendshipsBeing part of a groupExploring language conceptsDeveloping effective communication
56 Worksheets! for Teaching Social Thinking and Related Skills Understanding and interpreting emotionsPerspective takingMaking plans to be with othersProblem solving and dealing with responsibilitiesPoster handouts
57 Strategies for Organization Daily individual scheduleMonthly or long-term scheduleIndividual work systemSchedules within schedulesListsColor coding – folders, books, spiral notebooksContainers for colored hanging filesExpanding file foldersPhysical structure of building
58 Strategies for Organization Assignment booksTeach what is most important to doTeach how to manage deadlinesWho writes in it?Erasable highlighters; highlighting tapeAdjust the level of spoken languageUse shorter sentences for directionsEnhance oral directions with written informationTeach 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 othersCultivate social awareness - of self and others
60 Foundation Social Skills Joint AttentionRequestingSpeaking in 2 to 3 word meaningful phrases with 1 word being a verbTolerating 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 peersLevel 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, ByeSaying, “Please” and “Thank you”Giving ComplimentsRespondingInitiating
63 MotivationIs there a peer the student with an autism spectrum disorder gravitates towards?Give peer something the student with autism wantsTeach the names of his/her classmates
64 Teaching to say “Hi” Written on a strip: Hi <person’s name> Modeling/Verbal cuingSocial 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 questionsInitiate greetings, social interactions, or topicsMaintain a conversation:Make commentsListen and ask questions/make commentsStay on topicLet peer make a comment or ask a questionEnd graciously (e.g., talk to you later)
67 Conversation Start with area of interest and teach skills Teach concept of a topicTeach 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 ProximityLookingParallel PlaySharingAssociative PlayTurn Taking Cooperative PlayFollowing Rules
71 Basic Social Skills Tolerate peers Appropriate touching Appropriate social distanceMaking choicesSharingEye contactTurn takingRelinquishing one’s turnLosing graciouslyParticipating in class group activities
72 Interventions with Peers Circle of FriendsPeer buddiesPeer mentor (Student on the autism spectrum teaches about his interest)
73 Strategies Model Prompt Provide picture or written cues Coach FacilitateOrchestrateTask Analysis – break skill down and teach each partCreate a list of the steps of the skill or use a schedule (next slide)
74 Social Skills Solutions Uses ABAChecklist:3 Levels9 Modules
75 Social Skills Checklist MODULES:Joint Attention/AttendingGreetingsSocial PlayAbility to Calm SelfConversationsPerspective TakingProblem SolvingAdvanced LanguageFriendshipsCommunity/Home
76 Joint Attention From Social Skills Solutions Level 1:Follows eye gaze, point or gesture by others; looks/orients/responds to objects presentedLevel 2:Can sit and listen to group stories; shows others objects with intent to shareLevel 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 objectsLevel 2:Cause for emotions; respects personal spaceLevel 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 picturesLevel 2:Retells events of that day/yesterday; retells short stories without visualsLevel 3:Asks for clarification; makes predictions; interprets idioms
79 Friendships From Social Skills Solutions Level 1:Sits next to same peer consistently; shares with peerLevel 2:Gives others compliments; helps others when asked; apologizesLevel 3:Introduces self to others; invites friends over; beginning sexuality - privacy
80 Video ModelingScott Bellini & Jennifer Akullian – Meta-Analysis of 16 single subject design studies (49 participants) in Council for Exceptional Children, 2007:Promotes skill acquisitionSkills acquired are maintained over timeSkills transferred across persons and settingMeets criteria for evidence-based practice
81 Video Modeling Possible Skills to Teach Motor behaviorsSocial skills (e.g., initiations, responses, play)*Communication (e.g., conversation)*Self-monitoringFunctional skills (e.g., purchasing, hygiene)*Vocational skillsAthletic performanceEmotional regulationBehavioral 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 ModelingChoose 1 skillModels are similar to the childModel is successfulModel is reinforcedScripted***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 KnowGuessLearnDecideTopicIdeaWonderUnderstandSupposeConfuseExpectHopeAnticipateOpinionForgetBelieve
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 byListening and watchingImitationParticipate in group time byLooking at/listening to a bookMaking choices of activitiesDiscussing the topic
86 Layered Groups Everyone – lively songs with music Smaller Group Routine actionsCountingConcrete – objects to holdSmaller GroupCalendar or Weatherwith visual supportsSmallest GroupLanguageSocial SkillsCurrent Events
87 Working in GroupsProvide explicit group instructions – roles for each student in the group/who is responsible for what aspect of the projectSome 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 cueTeach and Practice while calmand with the picture presentPractice in one settingGeneralize to other settings***This becomes a new routine***Relaxation Visual System:
89 ResourcesThe TEACCH Approach to Autism Spectrum Disorders (www.autismsociety-nc.org)Teach Me Language (www.autismbooks.com)Social Skills Solutions; A Work in Progress; The Verbal Behavior Approach (www.difflearn.com)Educate Toward Recovery (www.amazon.com)Peer play and the autism spectrum: The art of guiding children’s socialization and imagination (Integrated Play Groups Field Manual) by Pamela Wolfberg (www.asperger.net)Wolfberg website:Michelle Garcia Winner:
90 ResourcesFrom : 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