Social Communication and autism spectrum disorder Erica Howell, Ph.D.

Welcome! Are you pumped to learn a variety of free and easy-to- implement strategies that support your students’ social understanding and involvement?

Table of Contents Theory of Mind The Impact of TOM on the Educational Setting Social Interventions The Hidden Curriculum SODA Social stories Social Scripts Comic Strip Conversations Power Cards This lecture will introduce you to the social underpinnings of ASD and teach you about some interventions that are effective for individuals with ASD

What is Theory of Mind and why is it important? I. Theory of Mind (TOM) What is Theory of Mind and why is it important?

Theory of Mind Theory of Mind (ToM) is the ability to infer the mental states of others in relation to their knowledge, intentions, beliefs, desires and the ability to use this information to interpret what another says, make sense of the behavior and predict what he or she will do next Depending on the researcher or interventionist, ToM may also be referred to as perspective taking, social thinking, social cognition, or empathy Sis in law----tattoo example

Theory of Mind cont. ToM is hypothesized to be the core, central impairment of autism Functions as a continuum of impairment with some individuals with autism exhibiting more theory of mind impairment than others ToM is CRUCIAL to social, interpersonal, and communicative relationships Mistakes in understanding and interpreting social interactions can have serious implications for relationships with others.

Theory of Mind cont. Social Challenges may impact the following: Joint attention Emotion recognition and sharing Understanding knowledge Deception Humor Teasing Mental state language (e.g. know, think, feel, guess)

How does a Theory of Mind develop?

Theory of Mind Development Typical developing children have “theory of mind” by the age of three or four, but it develops as early as infancy with behaviors such as Pointing or vocalizing to direct another’s attention toward an object (establishing joint attention) Learning what an item is like based on positive or negative reactions from an adult (social referencing)

Theory of Mind Development cont. Theory of mind also affects how children understand emotions: by the age of three, children should understand that a situation affects emotion By the age of four, children can take into account someone’s desires and beliefs, predict how they will feel

II. The Impact of TOM on the Educational Setting Why is ToM an important construct for general and special educators to understand?

Importance of ToM With the impact of IDEA and NCLB, the inclusion of students with autism spectrum disorder and testing results hold higher importance for general educators than previous years Teachers must learn to examine the relationship between ToM, behavior, classroom instruction, and educational content

School and Classroom Navigation A typical school day requires repeated social navigation and can be exhausting for the student with ASD. Classroom interactions that occur between the teacher and student, peer work groups, and sharing space are examples of common scenarios where a ToM is needed to interact.

School and Classroom Navigation Cont. For example, one middle school student with high- functioning autism I worked with was distressed whenever a classmate sneezed. Upon seeing or hearing the action, she would exclaim in a loud voice how disgusting the “sneezer” was. Her impaired ToM prevented her from interpreting her classmates’ snickers and facial expressions as a response to HER inappropriate behavior. Another student often exclaimed, “I’m bored!” during his teacher’s instruction.

School and Classroom Navigation Cont. Everyday school activities such as recess or PE hold social challenges for our students on the spectrum Recess/PE: Typically consists of a large unstructured area where kids run around, engage in group games without explicit rules, and use social language. How overwhelming! Teach recess and PE skills explicitly! Most of these students want to be part of a group, but don’t know how to.

III. Social Interventions Now that you have background knowledge on what TOM is and why it is important, let’s learn about some interventions that facilitate social understanding

The “Hidden Curriculum” of Schools Implicit or unstated social rules make up a “hidden curriculum” When these rules are violated, an individual may be teased, bullied or ostracized e.g. boys don’t wear “pretty” shirts, a teenager playing “detective” around the neighborhood will be mistaken for a stalker The hidden curriculum differs according to age, gender, groups of people, and culture The movie “Elf” demonstrates this perfectly!

The Hidden Curriculum Cont. Our students on the autism spectrum need these rules explicitly taught to them When I was an elementary school teacher, my young male students with autism continually violated the hidden curriculum of using the bathroom . Neuro-typical peers would often tattle that my students dropped their pants all the way down to their ankles when using the urinals.

Can you think of the hidden curriculum of a Birthday Party? *Hint: Don’t blow out the candles on the birthday kid’s cake!

Stop, Observe, Deliberate, Act (SODA) SODA is a tool for interpreting behavior and problem solving how to respond Typically used with individuals with Asperger Syndrome in order to promote social interaction skills and helps guides students on how to act in novel situations

Stop This component helps the student develop a framework for a specific situation that requires social interactions. When the student enters a novel situation, she uses self-questioning to decide what to do. The first question guides the student to develop an organizational schema for the setting (i.e., Where should I go to observe? What is the room arrangement?). The student identifies a place to stand to observe and learn about the social situation.

Observe The second step, Observe, helps the student become more aware of social cues other people use in the setting. In this step, the student should pay attention when she can hear other people’s conversations. She can also note how others conduct themselves (formal vs. informal language), length of conversations, conversation topics, whether individuals stay in groups or move from group to group, etc. However, the student should be careful not to eavesdrop on people’s private conversations or be seen as suspicious by loitering. During this step, the student seeks to understand the roles of various social cues and the meaning of typical phrases or behaviors used in the setting (i.e., When people say, “Where have you been?” you are not supposed to name all of the places you have visited). Thus, the goal of the Observe step is to identify what others are doing.

Deliberate The overarching question that should be asked during this stage is, “What do I need to do to successfully participate in this setting?” This component helps the student decide what to say and how other people will perceive her. The student can ask herself, “What would I like to do?” and “How will other students react if I say this?” The secondary issue to be addressed during this stage is to identify particular aspects of the event that might be problematic and identify strategies to address these. For example, if the situation is loud and the student is sound sensitive, she may need to remind herself to wear her earplugs or immediately create a plausible excuse that will allow her to leave the situation quickly.

Act The final step guides the student in how to interact with others. The student identifies people with whom she wants to interact in the specific setting and acts according to the plan she developed during the Deliberate stage.

Social Narratives The rest of the social interventions we are going to focus on are under an umbrella term of “social narratives”. Social narratives are visually represented stories that describe social situations and socially appropriate responses or behaviors to help individuals with autism spectrum disorder (ASD) acquire and use appropriate social skills. These are similar in how they address social strategies, but differ in the procedures that are used. These can be used after a social error has occurred, prior to encounter a social situation or as an intervention to reduce existing behaviors.

Social Stories A social story is an individualized story from the perspective of a person with ASD They can be created in a variety of formats, including pictures with words, text alone, audiotapes, videotapes, PowerPoint, etc.

Who is Line Leader? My name is Andrew. I am in the first grade. Sometimes, the children in my class form (one, two, three, etc.) lines. www.graycenter.org

The children in my class stand in a line when we are getting ready to go to another part of the school. Children do move a little when they stand in a line. Children may move to scratch, or fix their shirt, or their shoe. Sometimes, because they are standing close together, children may touch one another. Many times, it is an accident when children touch one another in line. They were not planning to touch another child.

Usually, children stand and walk in lines for a short period of time Usually, children stand and walk in lines for a short period of time. Once the children reach their destination, their teacher often doesn't need them to stay in the line anymore.

Sometimes, I may be the Line Leader Sometimes, I may be the Line Leader. This means that the other children in my class will walk behind me.

Sometimes, I may be second, or third, or fourth, or another position.

Many children in my class like to be the Line Leader Many children in my class like to be the Line Leader. My teacher knows who should be first in line. Teachers know about being fair, and try to make sure each child is Line Leader now and then.

It's important to follow directions about who is Line Leader It's important to follow directions about who is Line Leader. My turn to be Line Leader again gets closer every time the children in my class walk in a line!

Social Story Formula - The Four Basic Sentences Descriptive sentences - answer “wh” questions, truthful, opinion & assumption free statements of fact, only required sentence of the four basic sentences Ex: At work we bag the breadsticks. Perspectives sentences - describe feelings, beliefs, thoughts, motivation of social situation -Ex: Eric likes working in the cafeteria.

The Four Basic Sentences (continued) Directive sentences - offer or suggest response or choice to a social concept or situation, based on a student’s effort Ex: I will try to walk to the cafeteria. Affirmative sentences - used to stress an important point, refer to a rule or law, or reassure the individual, often express a socially agreed upon value or opinion Ex: Most people eat dinner before dessert.

Social Story Ratio For every directive sentence, there needs to be at least two to five descriptive, affirmative, or perspective sentences in the story. This ratio ensures a descriptive quality to the social story.

Essential Elements of a Social Story Written from the perspective of the student Answers “wh” questions Written in positive language Has an introduction, body, and conclusion Is literally accurate Uses language matching ability Can be adapted by using pictures, illustrations, audio and video

Going to get a pole

My name is Keira Howell. Sometimes I go to the hospital to get medicine.

After I arrive at the hospital and go to my room, the nurses ask me to put some medicine in my mouth. Sometimes I don’t like this!

When it is time to take the medicine in my mouth, I can sip the medicine or swallow it quickly. Fancy Nancy likes taking medicine that tastes like grape, bubble gum, or cherry.

Next, the nurses use soda. POP Next, the nurses use soda *POP* because it helps my arm not hurt when the needle goes in. Soda pop is loud! Mom can help by covering my ears.

Now it is time to put the needle in my arm Now it is time to put the needle in my arm. This is how the medicine gets inside my body. The medicine helps my body feel good and stay healthy.

It is good to snuggle my mom and stay calm It is good to snuggle my mom and stay calm. If I kick and move, the nurses and mom have to hold me still. I don’t like when they do this. If I start to get scared, I can: Let my mom hold me Remember that God will keep me strong, and Know that it will be over very fast!

Cousin Brooke thinks it is very cool that I can take my medicine in my mouth and stay still while the needle goes in my arm!

Sometimes the medicine makes me sleepy Sometimes the medicine makes me sleepy. That’s good because mommy loves when I snuggle her! Mommy and I can put on a movie, watch it together, and I can fall asleep on my mom if I’m tired.

When I wake up, I can play with toys if it is not already time to go home. There are a lot of fun activities to do at the hospital.

Once all the medicine is in my body, it is time to take the needle out Once all the medicine is in my body, it is time to take the needle out. Sometimes, the tape hurts. It is good if I let the nurse or mommy use the alcohol wipes to take the tape off. This will help it not hurt so much.

Once the needle is out, I am all done Once the needle is out, I am all done! I get to pick a special prize for being such a brave girl!

It was a long day! My family is so proud of me for getting the medicine that helps my body stay healthy!

Social Scripts Social scripts provide an individual with statements, comments and questions to use in specific social scenarios that they may have difficulty navigating on their own. Social scripts can reduce the stress of social interactions that individuals on the spectrum can experience. Social scripts can include conversation starters, responses to common questions, or even appropriate phrases to change the topic of conversation. The script gives the individual the language they need to participate appropriately in an identified social situation. Scripts can also offer suggested phrases for use in a particular type of situation such as asking to join in a game, or inviting someone to play or initiating a conversation with a peer. Scripts cannot be used in all situations, however, and their overuse can make the individual appear too rehearsed. An important part of using a social script successfully is practicing the script with the child so that different responses to the scripted language can be identified and the individual can be taught to respond appropriately. For example, if an individual uses his script to ask to join in a game expecting the answer to be "yes" and the answer is "no", the script must anticipate that possibility and include appropriate responses and actions for that answer.

Social Script: Ordering at McDonald's When I go to McDonald's I like to order a Quarter Pounder with cheese and nothing else on it. When the person taking the order at McDonald's says: "Can I help you?" I say: "I want a Quarter Pounder with cheese only on it. No onion, no tomato, no lettuce and no mayonnaise." They usually say "Quarter Pounder, cheese only?" And I say: "Yes, please." The person taking my order usually says: "Do you want fries?" And I say, "Yes, please, medium fries and a medium Sprite to drink." The person behind the counter then asks me if that will be all, and I say: "Yes, thank you." I give the person my money and they give me my change. I take one step to the side at the counter so the person behind me can give their order while I wait for my order to be put on the counter. Antonio, a 12-year old, sixth grader enjoys going out to eat. Antonio's favorite place to eat out is McDonald's: he likes the Quarter Pounderwith cheese and nothing else. His mother developed the following Script for him to use when ordering at McDonald's. www.autisminternetmodule.net

Comic Strip Conversations Steps to creating a CSC: Engage in small talk Draw about a given situation Provide structure or sequence Present perspective Provide sequence or structure Summarize the cartoon Identify solutions Utilizes simple drawings to illustrate what people say, do, and think

Power Cards Power cards are visuals that incorporate a child's special interest in a brief scenario that deals with a situation that is difficult for the child. They are written in the first person from the perspective of a child's hero and describe how the hero solves the problem. A small card recaps how the child can use the same strategy to solve a similar problem of her own. Power Cards are visual aids that incorporate a child's special interest to help promote an understanding of social situations, hidden curriculum items, routines, organizational skills and transitions. The Power Card strategy consists of a script paired with a Power Card. In the first paragraph the hero or role model attempts to solve a problem and experiences success. The second paragraph encourages the student to try a new behavior, which is broken down into 3-5 manageable steps. The Power Card: The Power Card is the size of a trading card, bookmark, or business card. It contains a small picture of the special interest and the solution to a problem broken into 3-5 steps. www.autisminternetmodules.org

Wow! I can’t believe how much I learned! YOU DR. HOWELL Wow! I can’t believe how much I learned! That’s right! It’s so cool that all this information is at your fingertips. After listening to this lecture, you have the knowledge to socially support students with ASD in multiple ways. I encourage you to continue developing your “tool box” of interventions. Don’t be afraid to use your tools to help a student with ASD!

Recommended Resources www.autisminternetmodules.org Free online training modules addressing a variety of topics pertinent to ASD www.autismspeaks.org Loads of resources, videos, assessment information www.socialthinking.com Michelle Winner’s website www.uctv.tv Free videos and podcasts from leading researchers www.tinsnips.org Great website for teachers of students with ASD

Contact information Erica Howell, Ph.D. Assistant Professor Department of Special Education Cal State University, Fullerton ehowell@fullerton.edu