Social Implications for Students with Autism

Spectrum Disorders

Presented byMarrea Winnega, Ph.D.

Licensed Clinical Psychologist Consultant on Autism Spectrum Disorders

February 22, 2011

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 socialHow?• Genetic/starts in utero before born• Likely to be a genetic/environment interaction• NOT caused by bad parenting

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Different Perspectives

WickedThe 3 Pigs from the Wolf’s perspectiveSlumdog MillionaireBreakfast Club, Grease, High School Musical,

etc.

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Different points of view

Car accidentsSister 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?”

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Evidence-based Interventions

Use the National Standards as your guideNote: The results support behavioral

interventions – because that is where the research is

National Standardswww.nationalautismcenter.org

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.

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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).

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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.

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Examples of MethodsCommunication – 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 – EstablishedPragmatic Language - Emerging

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MethodsRelationship Development Intervention/Floor

Time or DIR (home based vs. school based) – both are Emerging

Music Therapy – EmergingExercise – EmergingSensory Integration is Unestablished

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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 Educationally: All of these fall under Autismfall under Autism

Autism Defies Generalization

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SocialInteraction

Aloof

Active but Odd

Communication

Non-Verbal

Highly Verbal

SensoryHyposensitive Hypersensitive

Motor SkillsAwkward

AgileGross

Fine Uncoordinated Coordinated

Measured IQ

Severe Gifted

The Iceberg: Understanding Autism

Behavior - TipBelow the water line:

Reciprocal Social InteractionsCommunication and Play

Restricted Repetitive Behaviors/Need for SamenessSensory Processing

Learning Style

1313www.teacch.com

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

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

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

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

Restricted, Repetitive Behaviors

• Encompassing preoccupations– Circumscribed interests

• Nonfunctional routines and rituals• Preoccupation with parts of objects• Repetitive motor mannerisms

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

Theory of MindAn 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.

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.”

Perspective TakingFrom 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

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.

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

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”

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.

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

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

Story of Matt• Identified with Asperger’s about 3 years

ago; now a 4th grader• Very verbal and bright• Excellent gross motor skills and good at

soccer• Very competitive• Swears on the soccer field – only one who

does

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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

Difficulty DisclosingChild 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.

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

The Iceberg: Understanding Autism

Behavior - TipBelow the water line:

Reciprocal Social InteractionsCommunication and Play

Restricted Repetitive Behaviors/Need for SamenessSensory Processing

Learning Style

3333www.teacch.com

Does not follow classroom directions

Below the water line:Does not process language in groups or

subtleties of languageSocial – does not know that she

is part of “everyone”Possible interventions:Teach that she is included in group directionsAsk indirectly

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Thinks everyone is laughing at himBelow the water line:

Limited social reciprocity/Limited understanding of the perceptions of othersLimited 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

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Social MisperceptionsBelow the water line:

Lack of social reciprocityLimited peer relationshipsPoor communication skills

Possible interventions:Teach other perspectives on the situation; teach

purposeful behavior vs. accidents (being bumped into)

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Argumentative StudentBelow 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?)

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Will not do homework at homeBelow 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 hallsShorten assignmentsAlso give frequent movement breaks or breaks from

sensory and social input.

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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)

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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 thisIf makes sounds, try to teach when can make

sounds; give alternatives such as lollipops

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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 thatDoes not understand what you want

him/her to doDoes not know when it will end

Interventions:Build additional motivation into the task;

Clarify how much work (perhaps visually)

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Aggressive – hits, slapsBelow the water line:

Lack of social emotional reciprocityLimited 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

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Visuals for Understanding

• Sit• Walk• Quiet• Work• Stand up• Clean up• Classroom rules• Stop/Think/Make a Choice

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.

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

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Social ThinkingMichelle Garcia Winnerwww.socialthinking.com

• 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).”

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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!).

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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.

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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.

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Social Thinking Interventions

• Four Steps of Perspective Taking• Four Steps of Communication• I LAUGH

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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.

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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.

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Four Steps of Communication

Step 1: Thinking about others and what they are thinking about usStep 2: Establishing a physical presenceStep 3: "Thinking with our eyes"Step 4: Using language to relate to others

• It is not all about talking!

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I LAUGH Model

I: Initiation of CommunicationL: Listening with Eyes and BrainA: Abstract and Inferential Language/CommunicationU: Understanding PerspectiveG: Gestalt Processing/Getting the Big PictureH: Humor and Human Relatedness

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Worksheets! for Teaching Social Thinking and Related Skills*

1. Learning about our own behavior2. Self-Monitoring and Rating Sheets3. Friendships4. Being part of a group5. Exploring language concepts6. Developing effective communication

Worksheets! for Teaching Social Thinking and Related Skills

7. Understanding and interpreting emotions8. Perspective taking9. Making plans to be with others10.Problem solving and dealing with

responsibilities11.Poster handouts

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

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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

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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

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

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Joint AttentionFrom 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

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Social Language

• Greetings– Hi, Bye

• Saying, “Please” and “Thank you”• Giving Compliments• Responding• Initiating

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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

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Teaching to say “Hi”

• Written on a strip: Hi <person’s name>• Modeling/Verbal cuing • Social Story

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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.

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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)

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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

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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?

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Social Interaction Schedule1. Say, “Hi <therapist>” (Check box or draw line through the

activity)2. Review schedule.3. Ask <therapist>, “What did you have for dinner last night?”4. Listen to the response.5. Listen to <therapist’s> question.6. Answer.7. Select a game to play.8. Play game.9. Say “Goodbye, <therapist>”10. Go back to class.

Levels of Social Comfort

• Proximity• Looking• Parallel Play• Sharing• Associative Play• Turn Taking Cooperative Play• Following Rules

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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

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Interventions with Peers

Circle of Friends Peer buddiesPeer mentor (Student on the autism spectrum

teaches about his interest)

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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)

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Social Skills Solutions

• Uses ABA• Checklist:– 3 Levels– 9 Modules

Social Skills Checklist

MODULES:• Joint Attention/ Attending• Greetings• Social Play• Ability to Calm Self• Conversations

• Perspective Taking• Problem Solving• Advanced Language• Friendships• Community/Home

Joint AttentionFrom 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

Perspective TakingFrom 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

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

FriendshipsFrom 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

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

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

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***

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.

Social Story DictionaryDefine terms related to thoughts

• Know • Guess• Learn• Decide• Topic• Idea• Wonder• Understand

• Suppose • Confuse• Expect• Hope• Anticipate• Opinion• Forget• Believe

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

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

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

Teaching how to use a relaxation system:

Select a picture cueTeach 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: www.littlefriendsinc.org8888

ResourcesThe TEACCH Approach to Autism Spectrum Disorders (

www.autismsociety-nc.org)Teach Me Language (www.autismbooks.com) Social Skills Solutions; A Work in Progress; The Verbal

Behavior Approach (www.difflearn.com)Educate Toward Recovery (www.amazon.com)Peer play and the autism spectrum: The art of guiding

children’s socialization and imagination (Integrated Play Groups Field Manual) by Pamela Wolfberg (www.asperger.net)

Wolfberg website: http://coe.sfsu.edu/coe/faculty/moreinfo/wolfberg.php

Michelle Garcia Winner: www.socialthinking.com

ResourcesFrom www.asperger.net :Super Skills: A Social Skills Group Program for Children

with Asperger Syndrome, High-Functioning Autism and Related Challenges

The Hidden Curriculum by Brenda Smith MylesPower Cards, Incredible 5 point Scale Navigating the Social World by Jeanette McAfeeSocial Skills Training; Social Skills Picture Book by Jed

BakerExploring Feelings: Cognitive Behavior Therapy to

Manage Anger by Tony AttwoodExploring Feelings: Cognitive Behavior Therapy to

Manage Anxiety by Tony Attwood