All social interaction and social problems involve at least two people. Social difficulty can be defined as both a skill deficit for the student with a social disability and a problem of acceptance of that student by peers or the community. Thus, intervention must focus on teaching skills for both the student with a disability and typical peers. All too often we strive to “fix” the child with the disability and virtually overlook the “typical” peers who may be ignoring, teasing or rejecting the student. Moreover, including typical peers as a focus for intervention may yield results much sooner, as typical peers may learn to be understanding of the student with a disability more quickly than the child with a disability can learn to interact more appropriately with peers. We might begin to target peers at the age that many students enter school environments and typically begin to interact with peers, by about age 3 to 4 years old.
Consistent with this view, I believe effective social skills training for individuals with autism spectrum disorders (ASD) and their peers consists of at least the following four components:
1. Skills training lessons to teach explicitly the social skills that do not come naturally for ASD students
2. Activities to promote generalization of skills in the situations where they are needed
3. Sensitivity training lessons for others to be more accepting and engaging of students with ASD
4. Activities to promote generalization of sensitivity to ASD students
Although most of these components are relevant for all ages, the focus of this article is on students age 3 through adulthood who have developed some basic receptive language skills and show some joint attention skill, that is, the ability to, at least briefly, attend to another person or to attend to what another person is showing a student. Joint attention and language skills are important prerequisites for later learning, as you have to be able to attend to and understand others to learn from others. To address these crucial early prerequisite skills, the interested reader should look at popular Applied Behavioral Analysis (ABA) programs like discrete trial methodology (Lovaas, 2003) and verbal behavior training methods (Sundberg and Partington, 1998) or non-behavioral methods such as Greenspan’s Floortime methods (Greenspan and Weider, 1998). The methods described below are appropriate for students with some capacity for joint attention and some very basic receptive language ability.
Skill lessons include a variety of strategies geared to the students’ cognitive/language functioning. For those students who can understand verbal instructions, we might break down a skill into its component steps, explain it, model it, and role-play it until he or she can demonstrate the skill and understands why it is important. Let’s say a student with good verbal skills always wants to do things his way and that conduct gets in the way of developing peer relations. We decide to teach him 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 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 straightforward 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 (Baker, 2003).
For the student with less ability to understand verbal explanation, we have translated a subset of those skills into picture form (Social Skills Picture Book, Baker, 2002). Instead of explaining skill steps with words, we first show a picture sequence. Thus, for a skill like “compromise,” the pictures demonstrate a student asking to play a game with another student 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 with both looking upset. Of particular benefit is making your own picture books using pictures of your students, so that they see pictures of themselves engaged in the right (or wrong) way to demonstrate a skill. After the pictures are shown, students should still role-play the skill so that they can actually go through the motions of the skill steps.
A strategy called cognitive picture rehearsal utilizes cartoon-like drawings on index cards combined with positive reinforcement principles (Groden and Lavasseur, 1995). Cognitive picture rehearsal always includes drawings or pictures of three components: the antecedents to a problem situation, the targeted desired behavior, and a positive reinforcer. The pictures are displayed on index cards. On the top of each card (or on the back of the card) is a script describing the desired sequence of events. Children are shown the sequence of cards until they can repeat what is happening in each picture. The sequence is reviewed just before the child enters the potentially problematic situation.
For example, a cognitive picture rehearsal was created for Matt, a 7-year-old who would throw tantrums when his teacher told him to get off the computer. Cards 1 and 2 illustrated the antecedent to the problem situation: Matt is playing at the computer and then the teacher tells him it is time to get off the computer. Cards 3 and 4 showed Matt engaged in the desired target behavior: thinking that the teacher will be happy if he gets off the computer and give him a chance to use the computer later, he then says, “Okay, I’ll get off the computer.” Cards 5 and 6 show the positive rewards of engaging in the desired behavior: Matt receiving a point on a reward chart and the teacher letting Matt use the computer again later because he had cooperated earlier.
Social Stories™, developed by Carol Gray and colleagues (Gray et al., 1993), uses stories written in the first person to increase students’ understanding of problematic situations. Beginning with the child’s understanding of a situation, a story is developed describing what is happening and why, and how people feel and think in the situation. While the story contains some directive statements (i.e., what to do in the situation), the focus is on understanding what is happening in the situation.
The following situation provides an example of a situation in which Social StoriesTM may help an individual with autism deal with a social problem. Peter was a 13-year-old who frequently got into fights at lunchtime because he believed that other students in the cafeteria were teasing him. He said that several other boys who sat on the other side of the cafeteria always laughed at him. He would give them “the finger” and then they would start a fight with him. When Peter was observed at lunch, it was apparent that the other boys were laughing, but not at him. They were at least 50 feet from Peter, not looking at him, and laughing with each other, presumably about some joke or discussion they were having.
We developed the following social story for Peter starting with his perspective that others might be laughing at him:
When I am in the cafeteria, I often see other boys laughing and I think they are laughing at me. Lots of students laugh during lunchtime because they are talking about funny things they did during the day, or funny stories they heard or saw on TV, movies, or books they read. Sometimes students laugh at other students to make fun of them. If they are making fun of other students, they usually use the student’s name, or look and point at that student. If the other students are laughing, but they do not look or point at me, then they are probably not laughing at me. Most students do not get mad when others are laughing, as long as they are not laughing at them. If they do laugh at me, I can go tell a teacher rather than give them the finger.
Like cognitive picture rehearsal, Social Stories™ are read repeatedly to children until they have overlearned them, and are then read again just prior to the problematic situation.
Generalization refers to the ability of an individual to use a new skill in situations beyond the training session, and hopefully to use the new skill spontaneously without prompting from others. To achieve this level of fluidity with a new skill, individuals must practice and repeat the skill steps a great deal. As a result, it is unrealistic to think one can generalize many new skills at once. In my experience, true generalization occurs when individuals are reminded about or rehearse no more than one to three new skills every day for several months. Although individuals can learn the concept of many more skills during skill lessons, they may only be able to generalize one to three new skills at a given time. Generalization of a skill involves three steps: priming before the situation in which the skill is needed; frequent facilitated opportunities to practice the skill; and review of the skill after it is used.
Priming involves some reminder to the individual of what the skill steps are “just prior” to needing the skill. For example, just before going on a job interview, an individual might go over how to answer anticipated questions. Or just prior to starting a frustrating task at school or at work, the individual might review options for dealing with frustrating work. Priming can be verbal and/or supplemented by a visual aide. Verbal priming involves someone verbally explaining the skill steps prior to the situation in which they will be needed. Cue cards, behavior charts, copies of skill lessons (Baker, 2003), Social StoriesTM, cognitive picture rehearsals, and social skill picture books can serve as visual aides that depict the skill steps.
If students want to change their behavior but can’t remember the skill steps, then cue cards or copies of the skill lessons may be ideal. We might write one to three skills on an index card and laminate it. Then we might ask a parent, teacher, or employer or the student him or herself to review the skill steps prior to the situation in which it will be needed. Although it is ideal for the student to see the skill steps immediately prior to the situation in which they need to use the skill, this may not always be practical. Instead the parent, teacher, employer, or student might review the skill once in the morning prior to school or work, once at lunch and then again at the end of the day so that the student at least has to think about the skill three times per day.
If a student has not fully agreed to try a new skill and thus is lacking in “intrinsic” motivation to perform the skill, then the behavior chart can be used as a reward chart in which external rewards are contingent on demonstrating certain targeted skills.
In order to practice the new skills, students need opportunities. Facilitated opportunities involve creating daily situations in which the skills can be practiced and coached. Sometimes those opportunities are naturally built into the day. For example, a student learning to deal with frustrating work may always have his or her share of challenging work to do during the day. Other times, the practice opportunities need to be carefully planned or created. 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.
After situations have occurred in which skills were needed, the student’s performance can be reviewed to increase awareness of the skill. If a student’s progress is tracked through a reward chart, the reason why the student received the reward (or not) should be reviewed with him or her to enhance learning.
Sometimes students with ASD are ignored, yet often they are actively teased or bullied. Students with ASD may do nothing to deserve such teasing and other times they may provoke such reactions with unintentionally “irritating” behaviors like perseverating on a topic, making loud noises, or having angry meltdowns. When students are harassed, teased, or rejected because they look or behave differently, it is crucial to explain to others the unintentional nature of their behaviors and how others can help. We often talk with peers not only about the unintentional nature of the difficult behaviors of someone with ASD, but also the person’s strengths and talents as well as presenting examples of successful, famous figures who may also have had an ASD.
We ask peers to do three things to help their ASD peers and each other: (1) include others who are left out; (2) stand up for those who are teased; and (3) offer help to those who are upset. To help these kind behaviors generalize into the daily routines of the students, we might create a lunch buddy program, where peers volunteer to eat and hang out with the ASD student on a fixed rotating schedule. We might also introduce a reward program to recognize and reward “kind” behaviors towards fellow students. We may also train peers in how to engage ASD students in play, including how to get their attention and what kinds of games to initiate (i.e., games the ASD student can play).
The explanation of skills training so far may seem pretty straightforward if not for the fact that we are teaching actual people with their own agendas, desires, and wishes that may not correspond with the well-meaning wishes of their parents or social skill therapists. For example, take the student described earlier who may be quite verbal and always wants to do things his way. We decide to teach him how and why to compromise. We explain how compromise helps others to be happy so they may want to play with him again or be his friend. And then he turns around and says, “I do not want any friends, and I do not want to play with anyone, I don’t want to compromise. I just want to do what I want to do.”
Clearly, one of the major challenges of skills training is motivation to socialize. For many ASD students, socializing has never been that pleasurable and so they retreat into their world of objects, facts, and routines that provide more stability and comfort.
For students with good verbal reasoning skills, generating motivation is about building a rationale for the importance of social skills training. Motivation may come from an individual’s insight into his or her own pattern of strengths and weaknesses. Many students with special needs deny or otherwise resist any mention of weakness or difficulty. It takes a modicum of self-esteem to tolerate thinking about one’s difficulties.
One way around such resistance is through counseling that allows them to explore and experience their talents and strengths. Targeting weaker areas that need improvement must come after first identifying strengths. For most students, it is helpful to have someone else point out two to three strengths for every weakness that is highlighted. The student can be asked directly what talents and strengths they have and then the counselor can add or refine that list of strengths before suggesting areas in need of improvement. For example, during group sessions, I will ask each member what their special talents are and 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.” Then comes the lesson on a skill topic.
There are several more ways to motivate engagement for skill lessons, including: linking skill lessons to real-life goals, using entertaining role-plays, linking skill lessons to fun group activities or projects, and creating skill lessons to teach others. This last method of reducing resistance to learning new skills is to have students participate in the teaching of skills to others. By creating picture books, videos, or live skits, students can demonstrate the skills to others. As such, they can learn a skill without having to acknowledge that they themselves needed to learn it.
For students without good verbal reasoning skills, increasing motivation cannot involve verbal reasoning. Instead, we may enhance motivation by insuring that our social activities with the student are enjoyable. That may mean we have to make sure the student is not overstimulated by too many people and complicated activities. We might decide to meet one-on-one in a quiet room with little distractions and introduce interactive activities that the student can understand. Researcher Steve Gutstein (2002) has compiled a series of activities from simple to more advanced to help students enjoy social interaction while truly interacting rather than retreating into their own self-stimulation worlds. 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 concept is reasonable; engage students in activities that limit overstimulation and complexity while focusing on attending to others.
With some motivation to socialize, skills can be more easily taught and generalized. By an additional focus on peer training, we can enhance both sides of the social interaction and create an accepting atmosphere for individuals with ASD to attend school or an employment setting.
Baker, J. E. (2003). 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.
Gray, C., Dutkiewicz, M., Fleck, C., Moore, L., Cain, S.L., Lindrup, A., Broek, E., Gray, J., and Gray, B. (Eds.). (1993). The Social Story Book. Jenison, MI. Jenison Public Schools.
Greenspan, S. I. and Wieder, S., (1998). The Child with Special Needs: Encouraging Intellectual and Emotional Growth. Addison-Wesley, Reading, MA
Grodon, J., and LeVasseur, P. (1995). “Cognitive Picture Rehearsal: A System to Teach Self-Control.” In K. A. Quill (Ed.), Teaching Children with Autism. (pp.287-306) Albany, NY: Delmar Publishing.
Gutstein, S. E. and 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.
Lovaas, O.I. (2003) Teaching Individuals with Developmental Delays: Basic Intervention Techniques. PRO-ED, Inc., Austin, Texas.
Sundberg, M.L. and Partington, 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. Dr. Baker has been a clinical psychologist since 1992. He is on the professional advisory board of ASPEN (an information network for parents of children with Asperger Syndrome). He is 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 directs and supervises social skills training for students at Millburn Public Schools. In addition, he writes, lectures, and provides training across the country on the topic of social skills training for individuals with Asperger Syndrome and related Pervasive Developmental Disorders. He has published both a manual on social skills training for children with Asperger Syndrome and a social skill picture book to aid in social skills training.
For more information about Jed Baker, Ph.D. and the Social Skills Training Project, please visit www.socialskillstrainingproject.com/.
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