Developing Meaningful Relationships among Adolescents and Young Adults with ASD and their Peers

Wesley H. Dotson, Ph.D., BCBABurkhart Center for Autism Education and Research

Texas Tech University

Acknowledgements: The participants, staff, and families of the KU

Social Skills groups Jim Sherman and Jan Sheldon Andrea Courtemanche Justin Leaf Faculty, staff, and students of Department of

Applied Behavioral Science at University of Kansas

Goals for today’s session Discuss current state of affairs/importance of

developing friendships and other meaningful relationships

Describe issues encountered in doing so Provide suggestions for characteristics of

support programs Provide an opportunity for questions and

discussion

Something to think about: As talk proceeds, keep these two young men

in mind

Kenny and Zane Both 15-yr-old boys with autism Both participated in after-school social skills

group for adolescents with autism and typically-developing peers

Both easily mastered social skills taught during formal instruction with graduate and undergraduate teachers

Kenny: Regularly generalized skills to interactions with

peers in social skills group Added all participants in group to Facebook,

called several regularly, and invited them to outside social events (movies, bowling, etc.)

On last day of group, insisted on having picture taken with all participants and staff

Zane: Rarely generalized skills to interactions with

peers in group Never attended outside events, no interaction with

peers outside group meetings Dropped out of group before end of program

Part 1: Context for discussion Social skills deficits are core feature of

receiving a diagnosis on the Autism Spectrum (DSM IV-TR, 2000)

What does the literature say about adolescents and young adults with autism, social skills, and building relationships?

Orsmond, Krauss, & Seltzer, 2004 Interviewed 235 families with adolescent or

young adult with autism Majority (>80%) in inclusive setting or employed in

community Only 24% had relationship with same-aged peer

involving social meetings or activities outside of work or classroom

46% had NO relationships with same-aged peers Significant predictor of presence of relationships

with same-aged peers was level of social skills development

Longitudinal study from Office of Special Education Programs (2005) Explored post-secondary and social experiences

< 20% with ASD reported interacting with friend once weekly 40% belonged to community or social group of some kind For most, over 75% of social interactions with family members

and paid care givers

Involvement in organized groups strongly correlated with positive outcomes Enrollment in post-secondary education Increased independence

Few students with autism (~25%) attend any kind of post-secondary educational institution

Less than 25% of those who attend earn a degree within 6 years

Recent study suggests most common reason for dropping out is failure to develop friendships and “fit in” with peers (Barnard-Brak, Lechtenberger, & Lan, 2010)

Failure to develop social relationships also associated with: Increased anxiety about social situations with

peers (e.g., Browning, Osbourne, & Reed, 2009) Other anxiety disorders (e.g., Farrugia & Hudson,

2006; White & Robertson–Ney, 2009) Depression (e.g., Stewart, Barnard, Pearson,

Hasan, & O’Brien, 2006)

Conclusions: Few adolescents and young adults with

autism develop friendships with same-aged peers

Quality of life and successful independence closely tied to development of relationships

Ability to develop meaningful relationships is linked with level of social skills

An important point about friendships for people with autism: People with disabilities report that their friends have

several characteristics (e.g., Carrington, Templeton, & Papinczak, 2003; McVilly, Stancliffe, Parmenter, & Burton-Smith, 2006): Shared interests Loyalty Helping when it is requested Spending time together

Exact same characteristics typically developing peers use to identify their friends

Part 2: Interventions Describe common interventions to teach

social skills Describe interventions to develop positive

relationships

Teaching Social Skills A number of interventions used to develop

social skills, including: Video modeling Script fading Peer mediated strategies Teaching Interactions Virtual reality

All have successfully taught social skills

Recent reviews suggest generalization of outcomes remains a problem. Matson, Matson, & Rivet, 2007 Rao, Beidel, & Murray, 2008 Tse, Strulovitch, Tagalakis, Meng, & Fombonne, 2007 Williams White, Koenig, & Scahill, 2007

Generalization most likely when peers involved, training is in natural environment, or training is carefully structured to promote generalization

Fewer studies explore teaching social skills to older learners relative to younger children

Skills targeted for intervention with older learners: Conversation Self-Advocacy Recreation skills Dating/Relationship skills

May require different instructional arrangements and considerations versus more basic social skills More sensitive issues More complex discriminations

“Skill” may look different based on who the social partner is OR who the person with autism WANTS the social partner to be

Class, status, and personality type also influence topography of skills (e.g., self-advocacy with a friend vs. a principal vs. a police officer)

Personal preference plays larger role

Developing positive peer relationships requires a different set of social skills than other social domains Manners and politeness versus having an

uncomfortable conversation with a friend Conversation in the hallway with platonic friends

versus conversation with potential dating partner

Teaching programs can still target more complex skills successfully Programming must account for increased

complexity Discrimination and generalization programs

become focal point of intervention

Building Relationships: In addition to teaching social skills it is

important to explore how and why positive relationships form:

Assumptions about formation and maintenance of relationships: Positive reinforcement is a privilege, not a

right. People choose to deliver positive things to others

Relationships are governed by concept of reciprocity.

Both parties must give and receive in a healthy relationship

Value of a relationship is a direct function of amount of reinforcement people receive. Relationships are strongest when people reinforce

each other on a regular basis

Goal is to create relationships that involve the regular, voluntary exchange of reinforcers between both people

Teaching Family Model Groups of adolescents live in homes with a “family”

who is responsible for providing social support and structured teaching

Constant embedded and formal teaching Widely replicated and successful teaching

procedures Most teaching focused on developing social skills

and helping adolescents build positive relationships with adults

Provided measures of relationship strength between residents and teaching family Proximity during free time Joking Asking staff opinion about things without

prompting Smiles, laughs when staff member present

Methods to develop positive relationships between staff and clients Work suggests that there are ways to

systematically foster relationships Research involving staff and clients in

Teaching Family Model homes for clients with DD

Steps to building positive relationships Step 1: Staff member provides non-

contingent access to preferred items Approaches client and offers access to known

preferred items “for free” Waits longer before approaching client each time

to set the occasion for client to approach staff member

Step 2: Staff member begins shaping specific approach and request responses using preferred items as reinforcers Initially requires client to approach before

delivering item Shapes an approach response (e.g., tap on

shoulder) Shapes a request response (e.g., sign for “drink”

or “toy”)

Step 3: Staff member shapes reciprocity by placing increasingly effortful demands on client before delivering preferred item Following a request response, asks client to do something

before preferred item delivered Initial demands small and highly likely (“Come over

here…”) Move to larger demands “equivalent” to value of

reinforcer being requested (“Please unload the dishwasher first”)

Results: Clients spent more time in proximity with staff

members Clients more compliant with demands from staff

members

Discussion: Social skills can be taught Involving peers in teaching can increase

likelihood of generalization Positive relationships can be systematically

built Next steps: further explore programs to build

relationships and extend to peers (as both targets of relationships and teachers)

Part 3: Suggestions, Issues, and Discussion Developing relationships between adolescents

and young adults with ASD and their peers: What, then, do we do?

How do we approach programming?

Back to Kenny and Zane What do you think were some of the

differences between the two cases?

Motivation: Adolescents more likely to build relationships with

preferred people Kenny liked peers and shared many interests with them Zane didn’t share interests with peers and thought they

weren’t “cool” Engagement:

Adolescents more willing to participate when learning environment fun/preferred

Kenny enjoyed group social games and enjoyed sports Zane did not like many games selected and did not like

playing sports

Relevance: Adolescents more willing to engage in target behaviors

which they see as functional and important When teaching adolescents how to ask and answer

questions to get to know a friend better: Kenny saw skills as helping him be friends with peers

in group Zane “Why should I do this, I don’t even like these

people anyway?”

Implications for programming: What, if anything, could we have done

differently with Zane?

Setting Skills Teaching Approach Ownership

Summary: Few adolescents and adults with autism develop and

maintain meaningful peer relationships The ability to develop relationships is closely tied to

social skills development Both social skills and relationship-building skills can

and have been taught Active involvement of participant and compatibility

with peers and social environment are key to achieving generalized and meaningful outcomes

Thus: Intervention and support services for adolescents and

young adults with autism should: Focus on developing the complex social skills needed to

navigate various kinds of adult relationships Provide/identify opportunities for increased participation

in community activities Teach/work where peer relationships are most likely to

form for that person Involve the person directly in their own program to

increase likelihood of compatibility with goals, target peers, and desired outcome

Thanks for coming!