Connect:A Social Skills Support Group

For College Students With Asperger’s Syndrome:

Insights and Lessons Learned

Deborah Wright, Ph.D. and Hannah Bush, M.Ed.University of Missouri - Columbia

True Confessions

Learning Objectives!!!

1. Four areas that could be of benefit 2. Three social skills 3. Three group norms/guidelines 4. Two lessons learned

You don’t know what you don’t know

Overview

Prior Experience and Impetus A bit about Treatment for ASD Structure, Content and Process Case Study Evolution, Insights and Lessons Learned

Goal: To leave you with a sense that you were a fly

on the wall during this group.

Impetus

Assessment and Consultation Clinic

Thompson Center for Autism and Neurodevelopmental Disorders

Student Health Center Crisis walk-in Campus Judicial Hearing

Research Findings: Asperger’s Syndrome

Most helpful resources: The Complete Guide to Asperger’s Syndrome (Tony Attwood, Ph.D.) Cognitive-Behavioral Treatment of Asperger’s Syndrome (Valerie Gaus,

Ph.D.) Preparing for Life (Jed Baker, Ph.D.)

Areas of clinical presentation that can be addressed: Reading nonverbal behaviors Social inference/Knowledge of Social Norms/Social Reciprocity Emotion regulation Executive functioning (e.g., problem-solving, time management)

This Emotional Life clip (PBS)

http://www.youtube.com/watch?v=QWY3ntr3sdI

Research Findings: Treatment

Process Therapy in short intervals Structured, skills-focused Need time to process When overwhelmed, teach deep breathing Provide autonomy on choice of topics Skills-streaming: Didactic, Model, Role play…

Practice, practice, practice!

Research Findings: Treatment

Content Focus on increasing instrumental skills, fund of

knowledge about social norms, and social cognition Social skills menu: Starting a conversation, maintaining a

conversation, deepening friendships, etc Cognitive-behavioral therapy as treatment of choice

for co-occurring mood and anxiety

Connect: Treatment Goals

1. Improve Social Skills

2. Improve Emotion Regulation

3. Increase Support Network

Materials

Developed detailed handouts on: Conversation Skills Emotion Management Social Norm Descriptions

Conversation Skills

Compliments Disclosure: including disclosure of diagnosis Forming friendships Expressing and reading welcoming and unwelcoming

cues Greetings and farewells Starting conversations Sarcasm versus genuine expressions Attending, Asking and Telling Conversation Repair

Emotion Management

“How to Deal” Handouts: Anxiety Frustration Sadness/Depression Cognitive Distortion Lists Asking for what you need Problem-solving

Diaphragmatic breathing

Social Norm Descriptions

“Unwritten Codes” Roommates and Res Hall Advisors Developing friendships Dating Working in groups Misunderstandings and disagreements

Group Format

One hour, 9-week course Basic structure:

Small talk Mindfulness Meditation Didactic Practice in small group or dyad Individual work time Group discussion Mindful Meditation at closing

Blackboard System

Interventions/Techniques

Meditation/Diaphragmatic breathing HRV Biofeedback Slowwwww the process! Allow time to write out thoughts Prompting when they give non-verbal cues Identifying relevant content Modeling Use of Humor Playful games

Social Norms/Guidelines

Confidentiality Respect Participation

At individual pace Manage monologuing

Peace sign

Recruitment

Office of Disability Services Student Services Coordinator

Screening Length of time No formal diagnosis

FS: N=5, SS: N=7 Age: 18-28 Dropout

Case Study, Insights and Lessons Learned

Summary: Didactic, skills-building versus interpersonal

Experiential Anxiety Content/Process Connection

Group 1: FS 2010

Topic: Deepening relationships

Intervention: Didactic

Disclosing personal information Compliments

Group Discussion

Observations

High anxiety They came anyway! Called a “spectrum” for a reason Facilitators “getting caught up in their own

thoughts” Theme: interpersonal skills are complicated!

Group 2 and 3: FS 2010

Topic: Meeting new people Managing Anxiety

Intervention Didactic, Modeling, Thought logs, Dyad discussions

Blackboard Introduced possibility of having small group

discussions at next group

Observations

Stuck in rumination (blackboard example)

Facilitators’ anxiety

“I found it really difficult, but I also think it was useful.

Group 4: FS 2010

Topic: Thought logging with emphasis on disputing and active listening skills

Intervention Individual logging Modeled active listening Group game

Blackboard Robust discussion regarding disclosing ASD diagnosis

Observations

Games and humor reduced anxiety

They were engaged in a genuine, authentic way

Need for flexibility

Group 5 and 6: FS 2010

Topic: What is it like to have ASD?

Interventions Lily Group Discussion

Lily: Comfort Dog

Observations

Histories of bullying Level of pain and trauma related to bullying Genuine desire and ability to connect Feeling misunderstood Humor helps alleviate anxiety Genuine, empathic connection during this group

B’s quote

Facilitators were totally confused

Group 7, 8, 9: FS 2010

Topic: Clarifying and maintaining conversations Interventions

Group game Ambiguous statements Pointed out assumptions

Individual work Writing how they would say to professor and a friend

Themes: Clear safety and trust was established

Group 1 and 2: SS2011

Topic: Introductions and Emotional Bids Interventions

Mindful observer exercise Dyads Didactic re: CBT Group discussion

Group 3: SS2011

Topic: SFBT Intervention

Started with longer meditation Group discussion

Theme Facilitators slowed the process Decreased anxiety More disclosure

Blackboard More disclosure on blackboard this week

Observations

Affect appropriate to content Eye contact Facing facilitators Subtle nonverbals Slow process Most poignant Great depth of sharing All were clearly touched

Group 4: SS2011

Topic: Relaxation Intervention

Autogenics Exercise Group discussion

Theme Autogenics was useful for most

Group 5: SS2011

Topic: Connecting Intervention

Brief Autogenics exercise Individual writing Dyads Group discussion

Group 6 and 7: SS2011

Topic: Self-exploration and connection Intervention

Autogenics Exercise Mini-SPIN MBTI-type inventory Didactic Dyads

Theme Connection

Observations

Hitting the balance of content and process

Giving them something meaningful to discuss

Controlling anxiety

More time for information processing

Highly engaged!

Group 8: SS2011

Topic: Stress management Intervention

HRV Biofeedback Group discussion Reminder closing Blackboard

Theme

Lesson Learned #1

Managing anxiety is key. Interferes with information processing and response

time. Facilitators need to manage high level of anxiety.

Interventions Starting and ending with mindful meditation Autogenics HRV

Lesson Learned #2

Balance between process and content is encouraged by: Slowing the process Responding to nonverbals Using mindful meditation and other relaxation skills

during the group Offering some ideas for relevant discussion:

Disclosing ASD diagnosis MBTI Bullying

Lesson Learned #2

Use of various modalities Individual time to reflect and write Dyads Group Games within group and humor Role play by facilitators

The balance of process and content helped with meaningful social skill practice of: Disclosures Showing verbal/nonverbal empathy Turn taking, mutual dialogue

Lesson Learned #3

Be flexible: Remember, it is a spectrum.

Tailor content to feedback from group members Blackboard Within group

Need for facilitators to take risks

No expectations for change: embrace them for all of their wonderful uniqueness

Lesson Learned #4

Blackboard is an important tool Specific problem-solving assistance Building safety Getting to know each other Reduced anxiety: Online practice

Lesson Learned #5

Genuine desire for authentic connection in tolerable doses Willingness to self-disclose Willingness to tolerate very high levels of anxiety Enormous capacity for empathy

Exceptionally rewarding professionally

Most Useful Skills Learned

Controlling breathing rate has as large effect on stress level Breathing—deeply and slowly (learned through biofeedback) and thought-

logging The biofeedback exercise was beneficial. Biofeedback-Relaxation skills, importance of heart rate variability,

visualization meditation (forgot the name) Sleep does not equal relaxation Ways to respond to social engagement gave me a different perspective for

thinking about social interaction I learned how to better judge the motivations of others, how to open up more,

and how to react appropriately in society. I got better at asking questions when talking with someone, I learned how to

breathe to relax me more, and I have gotten better at carrying on a conversation

Ask questions,, just because I think of something to say doesn’t mean I have to say it every time

Most Beneficial

The games aimed at clarifying and practice conversations. The small group size: I was more comfortable. Blackboard part of it was very helpful. Support from group members and leaders Being asked our preference and made sure to accommodate us. I loved the discussions we had in session and thought the

teaching was excellent as well.

Most Beneficial

I really appreciated doing the Myers-Briggs personality inventory. I have heard many social skills group try to “change” participants and make them be more social…so I thought the acknowledgment of the different personalities, some more introverted than others, was excellent!!

Any time we got a chance to talk amongst ourselves (typically during the 1-on-1’s)

Also blackboard helped me talk to people. Also just the one on one talking with someone helped me improve my speaking skills.

Some of the group talk sessions got me to open up more It was a relaxing break from the hardships of school and it was just

fun to just listen to other people’s stories

Least Beneficial

Hmm…hard to say. One of the interactions that was more staged – we were in dyads – felt a little forced. Although I think I was out of my comfort zone so not necessarily that it wasn’t helpful.

The length of the group. Longer sessions Longer group meeting Maybe 1.5 to 2 hour sessions just because they

always seemed to end quickly.