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

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Presentation on theme: "Social Implications for Students with Autism Spectrum Disorders Presented by Marrea Winnega, Ph.D. Licensed Clinical Psychologist Consultant on Autism."— Presentation transcript:

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 2

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

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?” 4

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 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. 6

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). 7

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. 8

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 9

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 10

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 12 Social Interaction Aloof Active but Odd Communication Non-Verbal Highly Verbal Sensory HyposensitiveHypersensitive Motor Skills AwkwardAgile Gross Fine UncoordinatedCoordinated Measured IQ SevereGifted

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 13

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 4 th grader Very verbal and bright Excellent gross motor skills and good at soccer Very competitive Swears on the soccer field – only one who does 29

30 Processing Real I’m not (might not) play this. This is a big disappointment I hope I get to play next year Drama 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 33

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 34

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 35

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) 36

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?) 37

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. 38

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) 39

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 40

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) 41

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 42

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 45

46 Social Thinking Michelle Garcia Winner 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).”perspective-taking 46

47 Social Thinking – Core Philosophies 1.We “think with our eyes” to figure out other people’s thoughts, intentions, emotions, plans, etc. 2.Our thoughts and emotions are strongly connected. How we think affects how we feel, how we behave affects how others think and feel. 3.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!). 47

48 Social Thinking – Core Philosophies 4.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.” 5.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. 6.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. 48

49 Social Thinking – Core Philosophies 7.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. 8.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. 9.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. 49

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

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. 51

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. 52

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! 53

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 54

55 Worksheets! for Teaching Social Thinking and Related Skills* 1.Learning about our own behavior 2.Self-Monitoring and Rating Sheets 3.Friendships 4.Being part of a group 5.Exploring language concepts 6.Developing effective communication

56 Worksheets! for Teaching Social Thinking and Related Skills 7.Understanding and interpreting emotions 8.Perspective taking 9.Making plans to be with others 10.Problem solving and dealing with responsibilities 11.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 57

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 58

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 60

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 61

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

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 63

64 Teaching to say “Hi” Written on a strip: Hi Modeling/Verbal cuing Social Story 64

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. 65

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) 66

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 67

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? 68

69 Social Interaction Schedule 1.Say, “Hi ” (Check box or draw line through the activity) 2.Review schedule. 3.Ask, “What did you have for dinner last night?” 4.Listen to the response. 5.Listen to question. 6.Answer. 7.Select a game to play. 8.Play game. 9.Say “Goodbye, ” 10.Go back to class.

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

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 71

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

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) 73

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 Level 1: 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 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 – 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: 88

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

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