News and Knowledge

This article is reprinted with permission from the September-October 2005 issue of the Autism Asperger’s Digest, a bimonthly national magazine offering practical, functional information on autism spectrum disorders. More information about the publication is available on their website.

John is 3 years old, with very limited language skills. When his parents try to sit and play with him he focuses on lining up play letters on the floor, virtually ignoring his parents. They call his name and he does not respond. They show him other toys and he ignores them. His older sister tries to engage him in a game of peek-a-boo and he shows no interest.

Karen is 12 years old with Asperger’s Syndrome. Her intellectual and language skills are excellent; she is very articulate and understands most anything someone says to her. Often, when she has a project in school, she either refuses to do it or refuses to compromise with peers or teachers on how to do the project. Her teachers and parents explain to Karen that she needs to compromise if she wants to develop friendships with peers and that she needs to do the school work if she wants to graduate and get a job later in life. She explains that she has no interest in making friends or ever having a job, and thus there is no need to do the work or compromise with others.

Although very different in their levels of functioning, both John and Karen are not motivated to learn social skills. Efforts to teach them how to relate to others will be frustrating for their parents and teachers until the issue of motivation is addressed. The table below summarizes some methods of motivating students to learn social skills and many other skills.

The table categorizes different methods of motivating students in terms of the language ability of the students (preverbal versus verbal reasoner) and the locus of motivation (external/contrived versus internal/naturalistic). Preverbal reasoners are students who may have some language but are not yet able to understand If–Then statements (e.g., “If you play this with me, then you can have a snack.”). Verbal reasoners can understand If–Then statements and thus could respond to the use of verbal reasoning as a motivational method (e.g., “If you do your math with me, then we can play afterwards.”). External/contrived motivation refers to providing students with a reward that may be unrelated to the activity or response they are making. For example, if a student is able to greet others when prompted, an external reward might be a special snack or access to a toy. The reward here is not logically related to the response (i.e., greeting) and is not naturally built into the situation (i.e., the instructor must provide the reinforcement). Internal motivation refers to situations in which the student’s behaviors naturally provide them with rewards because the activity itself is rewarding or the student’s response brings its own rewards. For example, if a child enjoys playing follow the leader, then playing the game is itself rewarding and there is no need to provide another reward. Similarly, if a student learns to request a toy from others and receives the toy, then the request naturally leads to its own reward, receiving the toy.

Motivational Strategies for Non-verbal Reasoners

The methods listed for non-verbal reasoners are those strategies often associated with “early intervention.” The goals are often to build crucial skills that are prerequisites for later learning in school and social settings. These skills include: joint attention (attending to others and attending to what others point out), the ability to label objects, request objects, follow simple directions, and answer simple questions. The interventions associated with applied behavior analysis (ABA) have been subjected to the most rigorous controlled evaluations of outcome and demonstrate excellent results in about 50% of autistic students in terms of intellectual, language, adaptive and early social skills.

ABA approaches include Discrete Trial Intervention (DTI) (Lovaas, 2003), Natural Language Paradigm (and its more recent cousin Pivotal Response Training; Koegel & Koegel, 2005), and Verbal Behavior Training (Sundberg and Parrington, 1998). Although all these approaches share a basic structure of teaching behavior through cueing, prompting and rewarding students, they differ in their emphasis on teaching in natural environments, and utilizing internal/naturalistic versus external/contrived motivational systems.

A discrete trial has five components: a cue, prompt, the student’s response, a reward and data collection. Early DTI interventions often emphasized compliance and labeling of objects. For example, if a child was learning colors, the child might get a cue, “Point to the blue car.” Then the instructor might prompt the student to touch the blue car. If the child responded correctly he might then get a favored reward, such as a piece of candy. Here the reward is not naturally related to the response. Earlier DTI approaches have been shown effective in improving students’ ability to respond to adult cues, but not always as successful in increasing students’ spontaneous language or generalizing skills to natural settings.
In contrast, Verbal Behavior Training and Pivotal Response Training occur in more natural settings and capitalize more on the students’ own interests. In the first phase of verbal behavior training, the emphasis is on teaching children to spontaneously request, utilizing the students’ own interest in activities, food, objects, wanting a break or wanting attention while in a more natural play environment. As such, the students are typically highly motivated as their responses lead to naturally rewarding consequences (i.e., getting what they requested). Similarly, Pivotal Response Training begins with assessing what the student is interested in and then beginning a discrete trial centered on that interest. For example, if a youngster shows an interest in playing with a car, the adult might hold the car out and cue “What color is the car?” If the youngster says “car”, the adult might cue and prompt, “What color is the car? Is it blue?” And when the child says “blue car”, the child would get to play with the car.

Greenspan’s “Floortime” approach, one segment of his DIR (Developmental, Individual-Difference, Relationship-Based) model, also capitalizes on the student’s own interests. It emphasizes following the lead of the youngster as the adult plays with the student in an effort to target various developmental skills (Greenspan & Wieder, 1998). Although there are some semi-structured play activities in this model, cues, prompts and rewards are not used in the same systematic way as in ABA methods.

Another promising approach is Relational Development Intervention (RDI) (Gutstein & Sheely, 2002). RDI outlines a systematic set of activities that create opportunities for “shared experiences.” At the heart of RDI is motivating the child to feel the intrinsic delight in connecting to another human being, so that they want to engage in social interaction because of the joy in the activity – not because of a contrived/external reward for interacting. Early activities to build joint attention might include imitation games like follow the leader, or “follow my eyes to the prize,” where students have to look at an adult’s eyes to find where the adult hid a prize in the room (the adult is looking in the direction of where the prize is hidden). Although these activities have not yet been empirically tested, the concepts behind RDI are reasonable: engage students in activities that limit over-stimulation. require attending to others as part of the instructional format, and teach children to look to other people as information sources to understand the world around them.

Motivational Strategies for Verbal Reasoners

Verbal reasoners understand If – Then statements. For example, “if you learn how to stand in line, you can order your favorite hamburger at McDonalds” or “if you learn good interview skills for a job, you might get that job you want.” External motivational strategies that have proven effective in helping verbal reasoners involve finding meaningful incentives (rewards, privileges) for practicing new skills.
Token or point systems are examples of external motivational strategies. Here a child earns a token or point each time he exhibits the appropriate behavior being learned. A pre-determined number of points or tokens can be exchanged for short and long-term rewards. Note: as with pre-verbal learners, the reward is not necessarily logically related to the behavior. For instance, a child may agree to practice ‘sharing skills’ in order to earn time to play computer video games by himself. Each token provides a measure of motivation in itself. Furthermore, points or token are usually kept track of on a visual behavior chart, which provides further motivation. Token systems can be used with young children to learn simple skills. They are equally effective in teaching a child delayed gratification and using a combination of skills to achieve a social behavior goal.

While language abilities can often be highly functional in this segment of the autism population, parents and teachers should recognize that often the child’s perspective-taking abilities will not be on par with their language skills, and should be taken into account when choosing motivational strategies to use in teaching social skills. A verbal reasoner may still need very basic external motivators in learning certain skills. Mix and match as is appropriate.

For many verbal reasoners, however, external/contrived rewards are not necessary, and internal/naturalistic motivational strategies that are closely aligned with their goals and desires work well. These are sometimes the children who feel a strong desire to connect with their peers, but lack the ‘how to’ component of social adeptness. Josh often was eager to play with his elementary school peers, so eager that he would barge right into their play group in a disruptive manner. It was obvious he wanted to join his classmates in their activity. He just lacked the social know-how to approach them appropriately and ask if he could play. If students want friends, good grades, a job, or to be able to engage in an activity (sports, clubs, or a social event), then linking social skills lessons to these goals is an effective motivation in developing the crucial skills needed. However, what do we do for the student like Karen who wants no friends, no job and seems to have no goals? Anxiety, depression and withdrawing from the social world entirely are common reactions to the tremendous efforts often required of our kids. Their impaired social understanding and limited perspective-taking usually result in more social failures than social successes… none of us enjoy that experience. Such students may need to deny any need for skills training. It takes a modicum of self-esteem to tolerate thinking about what one’s difficulties one has. One way around such resistance is through counseling that allows them to expand their sense of their talents and strengths before targeting areas that need improvement. For most students, it is helpful to have someone else point out two to three strengths for every difficulty that is highlighted. The student can be asked directly what talents and strengths they have and then the counselor can add or refine that lists of strengths before suggesting areas in need of improvement. For example, during group sessions, I will ask each member to talk about their special talents and I corroborate these positive descriptions. Then I might say “There are some minor issues I want to address with you guys so you can continue to do as well as you are doing now.” Keep it positive; keep it honest, but keep it light, too. No one wants to feel they need to be constantly ‘fixed’.

Another method involves having students create picture books (see discussion below), videos or live skits, so that they can demonstrate the skills to other students. As such, they can learn a skill in order to “help others” without having to acknowledge that they themselves needed to learn it.

Skill Lessons

Skill lessons include a variety of strategies geared to the student’s cognitive/language functioning. For verbal reasoners we might break down a skill into its component steps, explain it, model it, and role-play it until the youngster can demonstrate the skill and understands why it is important. Marty is a student with good verbal skills, however he always wants to do things his way. His behavior gets in the way of developing peer relations. We decide to teach Marty how and why to compromise. We teach him how to ask what others want, say what he wants, and to offer to do a little of both. We explain that when you do a little of both (i.e., compromise) the other person will be happy and may want to play with you again or be your friend. Using this straight-forward approach, we have broken down into simple steps over 70 such social skills related to play, conversation, emotion management and empathy in a manual on social skills training for children with social-communication problems (see Baker, 2003).
For very young students (3 and under) with very little language or ability to attend to others, we might begin with one of the early intervention strategies previously described (Discrete Trial Intervention, Verbal Behavior Training, Pivotal Response Training, Floortime, or RDI). For students who have developed some language but still have difficulty understanding verbal explanations, I have translated a subset of the skills that appear in the manual (Baker, 2003) into picture form (see the Social Skills Picture Book, Baker, 2001). Instead of explaining skill steps with words, they are illustrated through a picture sequence. For a skill like compromising, the pictures demonstrate a student asking to play a game with another youngster who says he wants to play another game. We show them pictures of the students compromising and playing a little of both games with both looking happy. Then we show them pictures of the same people not compromising, not playing with each other and both looking upset. Making your own picture books comprised of pictures of your child or student engaged in the right (or wrong) way to demonstrate the skill is especially motivating.

Timing and Perspective

Many adolescents who never wanted to learn social skills while in elementary school suddenly find themselves strongly motivated to learn certain skills in an effort to help them find a date. While some motivation is better than no motivation, parents and teachers do children with ASDs a grave error by ‘waiting’ until some intrinsic form of motivation appears before making social skills training a priority. Social skills are a function of everyday life at all ages, and as such, priority should be given to teaching social skills in a structured manner from a young age. Certain social skills form a foundation without which children will remain alienated from developing meaningful relationships with others. These include skills like sharing, social conversation skills, good manners/etiquette, learning to ask for help, accepting ‘no’ for an answer, compromising, asking someone to play/join in a group, accepting mistakes and moving on, etc. These global skills are needed in early life in developing friends and surviving in school and in later life in the workplace and forming meaningful personal relationships. These ‘social functioning skills’ should not be overlooked in the desire to teach ‘social relatedness.’

At a younger age, parents can use external motivation strategies to teach children mastery of the core social functioning skills, especially if the skills are taught in a fun manner. As children move into elementary school, as much as possible begin weaving more naturalistic motivational strategies into the mix, as these also reinforce cause-and-effect concept formation in the child.

Generalizing Skills into Real Life

Keep in mind that no matter what the motivational strategy used, repeated practice of emerging social skills in “real situations” is necessary. In order to practice the new skills, students need opportunities – and lots of them. Facilitated opportunities involve creating daily situations in which the skills can be practiced and coached. Sometimes these opportunities are naturally built into the day. For example, a student learning to deal with frustrating work may already have his or her share of challenging work to do during the day. Other times the practice opportunities need to be carefully planned or orchestrated. For example, a student who never initiates conversation with anyone may be asked to call someone on the phone once per day or join others for lunch and initiate conversation once during that period.

If it is necessary to use external motivators, it is important to conduct a rewards/ reinforcement assessment periodically to maintain motivation in children with ASD. We recommend about once a month, especially when using external motivators. A child’s interests change over time; rewards must too.

Lastly, keep in mind that it is possible to understand many new skills quite rapidly, but to actually use skills in real life, it is necessary to limit the number of skills targeted to two or three themes over several months. Focusing on fewer skills intensely (e.g., through daily activities) for several months leads to better generalization than targeting too many skills in a short period of time.

Teaching children with ASD social skills and social relatedness is paramount in assuring they grow up with the ability to be functioning and contributing members of society. Using a variety of motivational strategies (both meaningful external and intrinsic rewards) and creating frequent opportunities to practice are key factors in achieving success.

References

Baker, J. E. (2001). Social skill picture books. Arlington, TX: Future Horizons, Inc.

Baker, J. E. (2003). Social skills training for students with Aspergers syndrome and related social communication disorders. Shawnee Mission, Kansas: Autism Aspergers Publishing Company.

Baker, J.E. (In press). Social skills training for the transition from high school to adult life. Arlington, TX: Future Horizons, Inc.

Baker, J.E. (In press). Social skill picture book for teens and adults. Arlington, TX: Future Horizons, Inc.

Greenspan, S. I. and Wieder, S., (1998). The child with special needs: Encouraging intellectual and emotional growth. Addison-Wesley, Reading, MA

Gutstein, S. E. & Sheely, R. K. (2002). Relationship development intervention with children, adolescents and adults: Social and emotional development activities for asperger syndrome, autism, PDD, and NLD. London: Jessica Kingsley Publishers Ltd.

Koegel, R. L., & Koegel, L.K. (Eds.) (2005). Pivotal response treatments for autism: Communication, social, and academic development. Brookes Publishing Co., Inc.

Lovaas, O.I. (2003) Teaching Individuals with Developmental Delays: Basic Intervention Techniques. PRO-ED, Inc., Austin, Texas

Sundberg, M.L. and Parrington, J. W. (1998). Teaching language to children with autism or other developmental disabilities. Behavioral Analysts, Inc.

Jed Baker, Ph.D., is the director of the Social Skills Training Project in Maplewood, N.J., and a behavioral consultant for several New Jersey school systems, where he provides social skills training for students with Pervasive Developmental Disorders and learning disabilities. He lectures nationally on social skills topics, and is the author of The Social Skills Picture Book (2001, Future Horizons) and Social Skills Training For Children and Adolescents with Asperger Syndrome and Social-Communication Problems (2003, Autism Asperger Publishing Company). Click here for more information about Jed Baker and the Social Skills Training Project.