1. SOCIAL INTERVENTION FOR
CHILDREN WITH AUTISM
Kathleen Ann Quill, Ed.D. BCBA-D
Autism Institute
Massachusetts, USA

2. Autism is defined by 3 social differences
Social, communication & restricted, repetitive behavior
Integrate Developmental and Behavioral (ABA) treatment
Autism is defined by 3 social differences: different way of interacting with others, a different way of communicating with others, and a tendency to engage in restricted, repetitive patterns of behavior.
My work has been to try to translate the body of research on social differences in autism and translate that into guidelines for intervention.
Degrees Developmental Psychology, Early Childhood Development, Education of Students with Behavior Disorders and Applied Behavior Analysis gives me a unique perspective on intervention –
We need to combine what we know about child development, what we know about autism, and what we know about the science of applied behavior analysis to plan intervention
Intervention must be systematic, data driven and individualized

3. Webinar Goals Define social behavior
Understand how to plan intervention that teaches meaningful social behavior
Recognize the complexity of this process

4. 1. What is Social Behavior?

5. Sample Social Skills Use familiar materials to create something new
Watch others play and ask to join in
Imitate teacher’s expressions or intonations during a song, story or finger play
Offer to share materials with other children
Cooperate with other children during play
Young children demonstrate social skills by:

6. Sample Communication Skills
Use details to share personal experiences
Ask questions to understand something, such as, “How does that work?”
Listen to others to acquire new knowledge
Talk about an object or experience
Respond to questions about shared information
Young children demonstrate effective communication by

7. Sample Expressions of Relationship
Express sympathy to a friend who is feeling sad
Asks someone for help to carry a heavy basket of blocks
Ask for a toy before grabbing it
Say “I’m sorry” when she/he bumps into another child or causes a toy to fall
Begin to negotiate conflicts that arise using words, “Give me back my toy” before seeking help
Young children demonstrate emotional understanding, friendships, relationships by
Notice that the absence of communication creates a “reason” for problem behavior

8. Autism is a broad spectrum
of social differences
Rose Age 2
Social: Isolates herself with Restricted interests
Communication: Single words
Social Rituals: lines up objects and screams when they are touched
Communication Rituals: Echolalia – repeats same words from favorite cartoon repeatedly without social intent
Carlos Age 9
Social: Socially motivated but awkward – follows peers around the school playground asking the same question about “the color of their car”
Communication: Highly verbal – one-sided conversations
Social Rituals: Insistence on routines/same outcome – must always win a game, must always get an A on a school test
Communication Rituals: Incessant questioning
Jon – age 16
Social – Communication A teen who talks non-stop about his favorite birds;
Who loves to read about birds and other animals;
Rituals gets easily upset when his schedule changes;
A teen who is afraid to make a mistake.
Social differences – absent skills, social frustration, and anxiety trigger challenging behaviors – the focus of most parents and teacher’s attention
Many challenging behaivors are the child’s different way of interacting and communicating needs
Thus, intervention that focuses on teaching social behavior and communication skills is central to our work

9. Autism
The severity of autism is defined by the degree to which generalization of social and communication skills does not naturally occur after direct instruction.
Another reason why systematic intervention across all settings – parents, teachers, therapists – essential to success

10. 2. Plan intervention that teaches meaningful social behavior
Assess What to Teach
Plan How to Teach:
Use Evidence-based Practices
Assessment can take the form of developmental checklists OR ecological inventories of specific situations
How to Teach: Verbal Behavior, Discrete Trial Training, Pivotal Response Training, Naturalistic Teaching, Incidental Teaching, and variations!!!
Monitor Functional Use
Support Families – Social Communication and Behavioral Control is every families #1 and 2 priorities – I have never had a family ask me to teach their young child to match pictures
Monitor Generalization and
Functional Use

11. Assess Social Development
FOUNDATION
Attend - Watch
Imitate
Motivation
SOCIAL
Social Play and Leisure
School Skills
Community Skills
Emotional Understanding
Friendships
COMMUNICATION
Messages for Basic Needs
Messages for Social-emotional
Conversational Skills
EMOTIONAL REGULATION
ASSESS IMPORTANCE TO FAMILY
Foundation to building interaction and relationships
Watch others
Imitate others
Understand others
Expand interests and motivators (pair new with familiar) example – 50 play activities that use an interest in animals, or spinning or ABCs
Focus on GENERALIZATION AND FUNCTIONAL USE OF SKILLS
Compare closed-ended & open-ended activities
Parallel play that requires no sharing
Parallel play that requires sharing
Structured interactive play with clear roles
Open-ended interactive play
Group:
Listening
Following directions
Taking turns
Waiting
List settings important to family and conduct an ecological inventory of the setting
Sample Settings:
Restaurant
Holiday Events
Birthday Parties
Photographer
Doctor & Dentist
Other
ReBasic Functions
Requests for personal needs
Requests for information
State negation
Comment on events
Social-emotional Functions
Express feelings
Pro-social statementsquests for information
Pro-social statements
Initiate
Terminate
Repair (relative to comprehension)
Maintain (relative to comprehension)

12. Use Evidence-based Practices
Plan How to Teach:
Use Evidence-based Practices

13. Quality Program Indicators
Providers with measurable competencies
Individualized student planning
Evidence-based teaching methods
Evidence-based behavioral support strategies
Systematic means to track child progress
Effective communication between school, clinic and family

14. Continuum of Methods to Enhance Social and Communication
Families can be overwhelmed by the large number of intervention options
It is recommended that decisions about intervention be driven by research that reports outcomes
In the US, we rely on documents that summarize the research – named “evidence-based best practices” – the last report was 2014
NEXT SLIDE

15. Evidenced-Based Practices

16. Evidence-based (2014) Interventions Discrete Trial Training (DTT)
Naturalistic Intervention (NET)
Parent Implemented Intervention
Peer mediated instruction
Pivotal Response Training
Structured Play Groups
Accommodations
PECS
Scripting
Social Narratives
Video Modeling
Visual Supports
27 practices – many derived from priniciples of ABA
Important to understand that ABA encompasses a wide range of practices
DTT in a 1:1 teaching situation is only 1 example of how ABA can be used to teach skills

17. Monitor Functional Use
Accountability: Document family success and child progress (Families want to interact, socialize and communicate with their child)
Generalization: Implement best practices across all settings - home, school/center, community

18. Measure Social Progress
Skills generalized to natural contexts
Functional communication
Friendships
Emotional well-being
Behavior change
Family expectations met
Keeping in mind that most research is measuring success for academic performance and development of adaptive skills.
How often does a parent tell you at an IEP meeting that his vision for his son or daughter is to improve his math scores in the next year.
As a parent, I can tell you that my child’s social relationships and emotional well-being is always a first priority.
Prioritize IEP goals according to the wishes of the family
Measured outcomes
For example, The majority of social intervention programs occur in schools,
A review of 55 research studies on school-based social skills programs found them to be minimally effective (Bellini, 2008) - treatment in naturalistic settings versus pull-out groups appeared to be more effective
- biggest challenge was the lack of generalization to home

19. Functional Use is the Goal
Generalization does NOT occur automatically
Teach skill across a
variety of familiar adults,
siblings and peers?
variety of natural contexts?

20. DATA on Generalization and Functionality (measure socially meaningful skills)

21. Authentic Measures of Family Mental Health
Measure child’s active participation in his family and community
Measure child’s acquisition of skills that are valued by the family.
Measure child’s ability to communicate with his family and friends.
For one family, it is
A child who hugs mom
A child who laughs with siblings and peers
A child who sleeps through the night
A child who attends church with her family without disruption

22. 3. Recognize the complexity of autism and the process of teaching social behavior
We need to consider individual Profiles rather than the diagnosis when prescribing treatments

23. The Process of Intervention
is Equally Complex
A = Autism is a spectrum of disorders
U = Understand and apply research
T = Transdisciplinary intervention
I = Individualized treatment
S = Services for child and family
M = Managed care to measure success
First, let’s look at how we can bridge the gap between research(the volumes of information that is written about “what to do” and educational practices, as educators and therapists work day to day.
Article written for Autism Spectrum Quarterly – vision for autism community
6 ISSUES – ACRONYM FOR AUTISM
READ SLIDE

24. A = Autism is a spectrum of disorders
Autism is continuum of complex social and behavioral issues associated with:
A wide range of developmental differences (cognitive, language, motor)
A wide range of mental health challenges (anxiety, mood disorders, ADHD)
A wide range of other medical challenges

25. U = Understand and Apply Research
The U in autism reminds us to understand and apply the research.
There is a lot of research on treatments. But, The majority of research
does not clarify the Subgroups of children who were
Studied, does not tell us the characteristics of those that benefit from a particular intervention versus those who do not benefit from the treatment.
So, I preface this look at applying best practices with the realization of the limitations of existing research

26. T = Treatment uses 27 Evidence Based Practices
Autism Evidence-Based Practice Review Group Frank Porter Graham Child Development Institute University of North Carolina at Chapel Hill by Samuel L. Odom
OCALI internet modules
Autism Ontario webinars
National Professional Development Center on ASD (NPDC) –
READ SLIDE
Within the Autism community, varied initiatives are in place to improve educational services for students with ASD. There are innovative tools being used to disseminate information about evidence-based best practices.).
Examine the list of practices
While ABA is absolutely the science of choice, educators
And families need guidance to understand how ABA looks in school,
At home, in the community, in inclusive classrooms – it is
So much more that IBI 1:1 skill practice in isolation –
it is the use off positive behavior supports, and systematic teaching in natural settings

27. I = Individualized intervention for each student and family
ONE SIZE
DOES NOT FIT ALL
The I in Autism
Maybe we need to truly individualize a plan to teach the student by a critical analysis of the current research relative to the child’s specific profile

28. S = Services for the child and the family
Link school, community, mental health and medical services to maximize social success
Simplify system of communication across all providers
The S in autism stands for Services that we give to the family
The Family Is Experiencing Overwhelming Challenges
Apply what we know through better communication
Across providers – coordinated care and speak
A common language

29. Every Family & Child is Different

30. M = Managed Care Family Medical Child School Community
The M in autism is for Managed Care
READ SLIDE
Social skills needed to communicate pain, feel comfortable at the doctor’s office

31. Help Families with Social Behavior at Home
Nurturing Relationships
Intensive Intervention
Consistency across providers
Understand the relationship between challenging behavior, the social skills of the specific child, the reason why behaviors occur, and how to use evidence-based support strategies This understanding allows for the authentic development of social skills

32. Time to Say “Thank you”
This feels like a random list of ideas – I ask that you take one of them and consider how you can apply it to your life or your work with a person with autism or another related disability.
Thank you