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Overview of Social Skills

OverviewThe most complicated part of any person's day can be dealing with social situations. Different environments or relationships bring a variety of rules and actions.

o Should I shake her hand or give her a hug? o Can I tell that joke here? o Why can't we play a different game?

Social skills have been defined as "socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses" (Elliott, Racine, & Busse, 1995, p. 1009). Effective social skills allow individuals to elicit positive reactions and evaluations from peers as they perform socially approved behaviors (Ladd & Mize, 1983). Social skills are distinguished from social competence, in that social skills represent behaviors that must be learned and performed, and social competence represents judgment of those behaviors by others (Gresham, 2002). Adequate social competence ensures effective social engagement and reciprocity in the social environment.

Case Study: Rachel

Rachel, a high school junior with Asperger Syndrome, is called to her resource teacher's classroom. Mrs. Boyd tells her to sit down and asks her about a conversation Rachel had with Miss Reed earlier that day. Rachel tells Mrs. Boyd that she had watched a

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makeover show on television over the weekend and that she thought about Miss Reed as she watched the show. Rachel said she couldn't wait for Monday so she could tell Miss Reed what clothes to wear so she wouldn't look so fat and not to put on so much blusher and especially not to line her lips with that dark lip liner pencil. Mrs. Boyd asked Rachel how she thought Miss Reed felt about the discussion. Rachel said Miss Reed cried like the lady on the show did when she was so happy she looked better. Mrs. Boyd realized she had to work with Rachel about the different things crying can mean and on what she could tell other people about their appearances. Mrs. Boyd also needed to tell Miss Reed about Asperger Syndrome and social misunderstandings.

What makes "social" difficult for persons with ASD? Social interactions involve verbal and non-verbal communication, personal space, humor, topic flow, and many other facets that are usually deficit areas for people on the spectrum. In The Oasis Guide to Asperger Syndrome (2001), the authors state that up to 90% of communication is nonverbal and only 10% is the spoken words. If most of a person's attention is on the spoken word, it is easier to see how conversations with others can be misunderstood by those on the spectrum, and then add to that a possible sensory overload and anxiety to make social really hard. This module will further explain how social competence and social skills are exhibited in persons with ASD and what supports can increase positive interactions.

Pre-AssessmentPre-AssessmentWhat is the primary purpose of social skills assessment?

Select an answer for question 564

Why is it important to interview the child or adolescent himself if possible?

Select an answer for question 565

Which of the following best represent criteria for quality social objectives?

Select an answer for question 566

What is a skill acquisition deficit?

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Select an answer for question 567

What is a performance deficit?

Select an answer for question 568

Why is it important to determine whether an area of challenge is due to a skill acquisition deficit or a performance deficit?

Select an answer for question 569

Which of these statements best describes priming?

Select an answer for question 570

Which of the following strategies can be used to prime social cognitions and behaviors?

Select an answer for question 571

What is generalization?

Select an answer for question 572

What is meant by the term social accommodation?

Select an answer for question 573

Common Social Skill Difficulties

According to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (American Psychiatric Association, 2000), essential diagnostic criteria in the social

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domain include "(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction; (b) failure to develop peer relationships appropriate to developmental level; (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people; and (d) lack of social and emotional reciprocity" (p. 75).

Social skill deficits may be separated into four broad categories of social functioning: nonverbal communication, social initiation, social reciprocity, and social cognition. Each category will be discussed on the following pages.

Nonverbal Communication

Successful social skills require the ability to read and understand the nonverbal cues of others and to clearly express thoughts, feelings, and intentions through facial expressions, gestures, and body language. In many ways, nonverbal communication is more meaningful than verbal communication. Difficulty reading body language or nonverbal cues of others is a common problem for individuals with ASD. Some fail to look for nonverbal cues and are virtually oblivious to nonverbal communication. Others may look for nonverbal cues, but interpret them incorrectly or fail to understand the intended message. Understanding nonverbal communication requires that we recognize the body language of others and infer the meaning of the nonverbal communication. This is done by integrating all the available nonverbal and contextual cues in the environment.

Case Study: George

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George is between classes at college, so he decides to go to the student center. He sits at a table with a group of girls and says hi. Before the girls can respond, George starts talking about how cool fire engines are and how many fire stations are in their city and how many different kinds of trucks each station has and how many fires there were in the last year. The girls are looking at each other and some are giggling. One girl tries to interrupt George, but he keeps on talking. The girls start getting up and walking away. George is confused about what is happening. He feels very upset. He talks to his parents that night about the girls and the talking and the walking away. His parents remind him of the service his college offers to help him learn about social situations, conversations, and reading nonverbal signs. George says he might stop in to see the coordinator tomorrow.

Social InitiationDifficulties with initiating interactions are common among individuals with ASD (Hauck, Fein, Waterhouse, & Feinstein, 1995). Many children fall into one of two initiation categories: those who rarely initiate interactions with others, and those who initiate frequently, but inappropriately. Children in the first category often demonstrate fear, anxiety, or apathy regarding social interactions. It was once believed that the vast majority of children on the autism spectrum fit into this category. In fact, many social skill interventions have been designed with the express goal of increasing social initiations. However, in recent years an increasing number of children have been found to fit within the latter category. These children initiate interactions frequently, but their initiations are often ill timed and ill conceived. For example, they may interrupt or talk over someone. They may ask repetitive questions or questions that only pertain to their own interests or they may talk with others in settings that require silence, such as a library or church. For these children, the goal of social skills training is not to get them to initiate more frequently but to get them to initiate more appropriately.

Case Study: John

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John, a six foot ninth grader with ASD, is on a community trip to the local mall. He has a picture schedule to follow and a photo shopping list for one store. He appears happy to be at the mall; he is smiling, laughing, and making what the staff recognize as happy noises. To regulate his sensory system, John needs a lot of large muscle input. Before he left for the trip, he walked several laps with a weighted backpack and jumped on a mini-trampoline. John's class is walking down the hall when he suddenly runs ahead, leaping and landing with loud footsteps near a group of mall employees. One girl yells and a man moves out of the way as John stops right next to them. John's teacher approaches the group and explains John is trying to say hi. The teacher hands the group cards that have a definition of autism and a website they can visit to learn more (John's parents agreed to the card being handed out on community trips if needed to educate others). John's teacher reminds him about "space" as he puts his arm out to demonstrate how much space to leave between yourself and someone else. John needs further instruction on how to initiate greetings with strangers.

Social ReciprocitySocial reciprocity refers to the give-and-take of social interactions. Successful social interactions involve a mutual, back-and-forth exchange between two or more individuals. Many individuals with ASD engage in one-sided interactions in which they are either doing all the talking or fail to respond to the social initiations of others and to build on conversations with others. Individuals with ASD may continually derail conversations by changing the subject to fit their self-interests. They may also fail to respond to the initiations of others.

Case Study: Jamie

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Jamie, an eleventh grade student with high functioning autism, was eating her lunch in the cafeteria when a classmate, Amy, sat down across from her. Jamie and Amy greeted each other and were eating their lunches. Amy asked Jamie if she had any plans for the weekend. Jamie answered for the next ten minutes straight about everything she was doing over the weekend, including an elaboration about going to a museum to see a glass exhibit which happens to be her current special interest area. Amy tried to comment on Jamie's plans and tell about what she would be doing for the weekend, but Jamie never stopped talking to give her a turn.

Social CognitionSeveral social skill difficulties exhibited by children and adolescents with ASD may be attributed to the manner in which they process social information, or social cognition (Baron-Cohen, 1989). Social cognition involves understanding the thoughts, intentions, motives, and behaviors of ourselves and others (Flavell, Miller, & Miller, 1993). As such, it impacts the success of social functioning. Knowing and understanding social norms, customs, and values is essential to healthy social interactions and is influenced by our social cognition (Resnick, Levine, & Teasley, 1991). Within the social-cognitive domain, three processes are particularly important in social functioning: knowledge (know-how), perspective taking, and self-awareness. Individuals with ASD often experience difficulties in all these areas.

Case Study: Rose

Rose, a fifth grade student with ASD, has trouble waiting in the lunch line. As her classroom gets ready for lunch, she always wants to be first in line. When the class gets to the cafeteria, Rose yells and pushes in past anyone else who is waiting. Rose is not following spoken directions from her teacher, the cafeteria workers, or other students. To try to help, Rose's teacher makes a photo of each student and puts them in order on a Velcro board. She teaches the students to line up in the order of the photo board. (The pictures get changed periodically so each student can be the leader.) In the

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hallway by the cafeteria, Rose's teacher places contact paper handprints on the wall. Each student places their hand on the handprint to wait until they are told to go in and get their food. Rose learns to take her place in line at the classroom and to wait with her hand on the wall for lunch. It works so well, the cafeteria workers add enough handprints so all students can use the system as they wait for lunch. This system helped Rose understand the social norms of waiting in line and taking turns as the leader.

Case Study: DarrellDarrell is sitting at the lunch table with his seventh grade classmates. He is talking and laughing with them. One of his classmates tells him if he stands on the table and yells out a swear word that everyone will think he is funny and will want to be his friend. Darrell jumps up on the cafeteria table and yells a swear word. His classmates are laughing! Darrell thinks, "My friend was right, this is funny." He yells another swear word as the principal walks up to the table and says to follow him to his office. Darrell tries to high five his classmates as he gets down, but they turn their backs to him and stop laughing. The principal asks Darrell to explain what was going on, so Darrell tells him everything. The principal calls the speech and language therapist to the office and asks him to do some cartooning with Darrell to help him understand what happened and maybe write a Social Story TM about the situation. Darrell sees two of his classmates in the office as he leaves. They sarcastically say, "Thanks a lot Darrell." Darrell answers, "You're welcome." The speech therapist notices the exchange and decides he will have many things to review with Darrell about his classmates and how to recognize friends.

Skill Acquisition Deficits vs. Performance DeficitsSocial skill deficits are often seen from a skill acquisition/performance deficit model.

o A skill acquisition deficit refers to the absence of a skill or behavior. For example, a young child may not know how to effectively join in activities with peers. If we want this child to join in activities with peers, we need to teach her the skills to do so.

Case Study: Joette

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It's recess time and a group of kindergarten students are playing Duck, Duck, Goose. Joette, a student with Asperger Syndrome, is watching the game. A teacher notices Joette watching and takes her over near the students. She whispers to Joette to ask if they will let her join in the game. The other students welcome her. Joette sits down to play and the teacher walks away. When the kids say, "Duck" and tap Joette on the head, she is really upset she is not the goose. Finally, she is tapped as the goose. Joette doesn't understand the game and runs around the whole playground instead of just the circle. When the tapper catches Joette and touches her, Joette says the child hit her and runs to the teacher. The teacher tells the tapper she knows he just touched her, but to Joette it felt like a hit. Both the tapper and Joette settle down. The teacher then has Joette watch the game as she explains it to her. Joette tries again. She plays it the right way and the kids tap her very lightly.

o A performance deficit refers to a skill or behavior that is present but not demonstrated or performed. To use the earlier example, a child may have the skill (or ability) to join in an activity but for some reason fails to do so. In this case, if we want the child to participate, we would not need to teach her to do so (since she already has the skill). Instead, we would need to address the factor that is impeding performance of the skill, such as lack of motivation, anxiety, or sensory sensitivities.

Case Study: Ben

Ben can dance! He loves music and loves to move to it. Ben's friends want him to come to the school dance on Friday, but he isn't sure about going to the dance. It's in the gym and there will be really loud, loud music and strobe lights in the large, dark room. Other people might bump into him while they are all dancing. His friends tell him he can wear his ear buds from his music device to lessen the noise and that they will help keep other

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kids from bumping into him. They tell him he'll look cool if he wears his sunglasses to the dance so the strobe lights won't be so bright. Ben tells them he'll think about it. He isn't sure his sensory system is up to that much action.

A skill acquisition/performance deficit model guides the selection of intervention strategies. Most intervention strategies are better suited for either skill acquisition or performance deficits. The selected intervention should match the type of deficit present (Gresham, Sugai, & Horner, 2001). That is, you would not want to deliver a performance enhancement strategy if the child was mainly experiencing a skill acquisition deficit. It is important to note that these two categories are not mutually exclusive. Some strategies are capable of both teaching a new skill and enhancing the performance of existing skills (e.g., video modeling, Social StoriesTM, prompting, self-monitoring).

Assessment of Social SkillsThe first step in social skills training programs should consist of conducting a thorough evaluation of the child's current level of social functioning (Bellini, 2006). The purpose of the social skills assessment is to identify skills that will be the direct target of the intervention and to monitor the outcomes of the social skills program. The evaluation details both the strengths and needs of the individual related to social functioning. The assessment often involves a combination of observation (both naturalistic and structured), interview (e.g., parents, teachers, playground supervisors), and social skill rating forms (parent, teacher, and self-reports). Social skills assessment involves the direct assessment of social skills (via systematic observation) and the evaluation of social competence (via interview and rating scales). Information gathered from the assessment allows us to develop quality IEP and treatment objectives.

Purpose of Social Skills Assessment

o To identify skills to teacho To monitor progress

Case Study: Miki

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Miki, a kindergartener with autism, has significant expressive communication deficits and exhibits severe aggressive behavior with peers. She is primarily echolalic and seldom uses her language spontaneously with classmates and teachers. Miki is extremely fearful of social situations and often avoids social interactions. Consequently, Miki spends the vast majority of her playground time by herself with little peer interaction. When peers initiate, Miki often responds with physical aggression. A social skills assessment was conducted. Staff observed Miki on the playground, in the cafeteria, and during gym class. The psychologist on the team also completed a rating scale with Miki's parents. The team concluded that she has significant skill deficits in responding to the initiations with peers. It was hypothesized that Miki was engaging in aggressive behaviors because of her difficulties with social responsiveness. Social skills programming was implemented to teach Miki how to effectively initiate and respond to the initiations of peers.

Evaluation of Social Skills

Direct observation of social behaviors should follow the interviews and administration of rating scales. Two traditional methods of observation may be used to assess the social functioning of children with ASD, naturalistic and structured. The purpose of both is to observe the child's social performance across settings, persons, and social contexts. Naturalistic observation involves observing and recording the child's behavior in real-life social settings, such as the school playground and cafeteria, or in various social settings at or near the child's home. Structured observations involve observing social behavior in

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a structured play group or structured social group. The child with ASD is grouped with one or two non-disabled peers in a setting that is rich in social opportunities (games, toys, and other age-appropriate play objects).

Evaluation of Social Competence

Evaluations of social competence are typically conducted through the use of interviews or rating scales. Interviews are a valuable method for obtaining information regarding social functioning in a relatively short time by allowing us to collect and synthesize information from a variety of respondents, representing a wide range of settings. That is, they allow the evaluator to make decisions regarding the direction and focus of the program.

Rating scales are indirect assessment tools that provide information across a variety of functioning areas. These measures range from informal checklists to standardized rating scales and may be administered to parents, teachers, and the child. Rating scales can measure social functioning, anxiety, self-concept and self-esteem, and behavioral functioning. A major advantage of rating scales is their ability to quickly and efficiently obtain large quantities of information regarding social behavior from a variety of sources and across a variety of settings.

Social ValiditySocial validity refers to the social significance of the treatment objectives, the social significance of the intervention strategies, and the social importance of the intervention results (Gresham & Lambros, 1998). It involves ensuring that the consumers believe that the selected treatment objectives are indeed important for the child to achieve. Social validity influences treatment fidelity; that is, to the degree to which the intervention was implemented as intended. The measurement of treatment fidelity, in part, allows us to determine whether an ineffectual intervention is due to an ineffective intervention strategy or to poor implementation.

Case Study: Mrs. Cohn

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Mrs. Cohn, a seventh grade science teacher, was using a Social Story TM about how to work with your peers on a group project with Sam, one of her students who has Asperger Syndrome. Mrs. Cohn reported at a team meeting that it wasn't working because Sam still wasn't cooperating with his classmates. The team members looked at the Social Story TM and found it was written according to the formula. They asked Mrs. Cohn when she was using the story, and discovered she would hand it to Sam after he became upset when trying to work with a group. The team explained that the story was meant to be used prior to the social situation and recommended Mrs. Cohn read the story with Sam the day before group work was to begin, and also to send home a copy so Sam's parents could review the story with him too. Mrs. Cohn tried using the story this way and found Sam was able to improve his social behaviors as listed in the Social Story TM.

Social ObjectivesSkills identified by the social skills assessment should be targeted in the development of IEP and treatment objectives.

Social objectives should:

o Define short-term, immediate behaviorso Be connected directly to the intervention strategieso Describe specific levels of performance

Examples of possible social objectives:

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o Scotty will join in play activities with peers in a structured playgroup a minimum of 5 times per session.

o Scotty will respond to the social initiations of peers on the playground with a minimum response ratio of 70%.

o Scotty will raise his hand before answering questions during classroom discussions (90% of questions answered).

Bellini, 2006

Summary of Social Skill Intervention Strategies

Social skills training refers to instruction or support designed to improve or facilitate the acquisition and/or performance of social skills. Social skills training programs address three primary objectives: promote skill acquisition, enhance the performance of existing skills, and facilitate the generalization of skills across settings and persons. Most children acquire social skills through learning that involves observation, modeling, coaching, social problem solving, behavior rehearsal, feedback, and reinforcement-based strategies (Gresham & Elliot, 1990).

Social skills training can be delivered across a variety of settings (e.g., home, community, classroom, resource room, playground, and therapeutic clinic) and with multiple persons (e.g., family members, teachers, counselors, speech and language pathologists, social workers, occupational and physical therapists, psychologists, physicians, case managers). In addition, social skills can be taught in an individual, group, or class-wide format. Successful social skills training programs promote cooperation between parents (and other family members and caregivers) and professionals.

One final consideration for teaching social skills is to address both social accommodations and social assimilation (Bellini, 2006). Social accommodation involves modifying the physical or social environment to promote positive social interactions.

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Examples of social accommodations include training peer mentors and conducting autism awareness training. Social assimilation refers to instruction that facilitates skill development or fundamental changes in the child that allows the child to be more successful in social interactions. Examples of social assimilation include social skill intervention strategies that are child specific, such as video modeling, social stories, self-monitoring, and so on.

There are number of important questions to consider when selecting social skill strategies, including the following:

1. Does the strategy target the skill deficits identified in the social assessment?

2. Does the strategy enhance performance?

3. Does the strategy promote skill acquisition?

4. Does the strategy facilitate generalization? If not, what is the plan for facilitating generalization?

5. Is there research to support its use? If not, what is your plan to evaluate its effectiveness with the child?

6. Is it developmentally appropriate for the child?

Skill Acquisition StrategiesThe strategies on the following pages will assist individuals with ASD in acquiring the skills necessary to engage in social situations. We will discuss Social Stories TM, Video Modeling, Social Problem Solving, Pivotal Response Training, and Social Scripting.

Social Stories TMA Social StoryTM (Gray, 2000) is a frequently used strategy to teach social skills to children with ASD. A Social Story presents social concepts and rules to children in the form of a brief story and may be used to teach a number of social and behavioral concepts, such as initiating interactions, making transitions, playing a game, and going on a field trip. Gray emphasizes that the story should be written in response to the child's personal need and that it should be something the child wants to read on her own (depending upon ability level). She also stresses that the story should be commensurate with the child's ability and comprehension level. Sansosti, Powell-Smith, and Kincaid (2004) conducted a research synthesis of eight Social Story intervention

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studies. The researchers concluded that Social Stories is an effective intervention strategy in addressing the social, communication, and behavioral functioning of children and adolescents with ASD.

Case Study: Social Story TM Example

What Happens with Art When it Travels from My Mind to My Project?My name is Catherine. I go to Sunshine Academy. Sometimes at my school we have art.

Sometimes, when children do art projects they discover that their project doesn't look EXACTLY like it does in their mind. My mind may be able to create things, but my fingers are still learning how to create those same things. So, until my fingers catch up with what my mind can do, it's important to be patient.

Patience is important in art. If a child can stay calm, they will be able to make a project that is closer to the one in their mind.

The neat thing about art is that it doesn't have to be "right" or "exact." If a child makes it, and tries their best, and follows the general directions, the way art works, what that child makes is okay!

Many great artists practice many years to learn how to match what they create with their fingers with the ideas and pictures in their mind. If I can learn to stay calm and continue to practice, I, too, will be able to make projects with my fingers that are closer to the ideas in my mind, too! It just takes time. This is okay.

Retrieved from http://www.thegraycenter.org 12/3/10

Video Modeling and Video Self-Modeling

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Video modeling involves demonstrating desired behaviors through active video representation of the behaviors. A video modeling intervention typically involves an individual watching a video demonstration and then imitating the behavior of the model. Video self-modeling (VSM) is a specific application of video modeling, where the individual learns by watching her own behavior. Results of a recent meta-analysis of 23 peer-reviewed studies suggest that video modeling and VSM are highly effective intervention strategies for addressing social-communication skills, behavioral functioning, and functional skills in children and adolescents with ASD (Bellini & Akullian, 2007). Video modeling and VSM effectively promote skill acquisition. Further, skills acquired via video modeling and VSM are maintained over time and transferred across persons and settings.

Social Problem Solving (SPS)Many children with ASD have difficulties interpreting and analyzing social situations. This is due to a number of factors, including lack of self-awareness, failure to read nonverbal and contextual cues, difficulties with perspective taking, and failure to understand social rules. It is also due to the fact that they lack the necessary skills and strategies to analyze social situations. Social Problem Solving includes activities to help the individual learn how to make sense of social interactions and situations. Research has demonstrated that social problem solving can be taught to children with ASD (Bernard-Opitz, Sriram, & Nakhoda-Sapuan, 2001). A meta-analysis conducted by Beelman, Pfingsten, and Losel (1994) found that SPS strategies were effective in increasing performance on social problem tasks. However, a major limitation noted by the researchers was that increases in social problem-solving ability had no carryover effect to other areas of social functioning, such as specific social behaviors or skills.

Six Steps of Analyzing Social Situations

1. Describe the social scenario, setting, behavior, or problem (What's happening or what has happened?).

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2. Recognize the feelings/thoughts of participants (How does he/she/you feel? What is he/she thinking?).

3. Understand the feeling of participants (Why is he/she/you feeling/thinking that way? Ask child to provide evidence).

4. Predict the consequences (What do you think will happen next? What will be the consequences of this behavior?).

5. Select alternative behaviors (What could he/she/you have done differently).

6. Predict the consequence for alternative behaviors.

Bellini, 2006, p. 157

Pivotal Response TrainingBased on the principles of applied behavioral analysis, Pivotal Response Training (PRT) (Koegel & Koegel, 2006) is utilized in natural environments where it capitalizes on the availability of naturally occurring reinforcers. PRT targets so-called pivotal behaviors (behaviors that lead to widespread changes in other behaviors), which facilitates transfer of skills to multiple settings and collateral improvements in non-targeted behaviors. PRT directly targets behaviors related to initiation and responding to environmental cues. PRT targets four pivotal areas: responsivity to multiple cues, initiation, motivation, and self-management. PRT teaches children to attend and respond to multiple cues in the environment. Intervention in this area PRT teaches the child to select cues that are relevant in a given context or situation. Intervention in the initiation area teaches the child to effectively initiate interactions with others. Intervention in the motivation area addresses the child's lack of motivation related to social situations. Intervention includes giving the child a choice in activity, using natural reinforcers, and reinforcing reasonable attempts at interacting. Finally, interventions in self-management teach the child to be more independent and less reliant on prompts from others Based on research synthesis of 13 studies that investigated the effectiveness of PRT, Humphries (2003) concluded that PRT is an effective strategy for addressing the behavior, communication, and social functioning of children with ASD. For more information, click here to see the AIM on Pivotal Response Training.

Social Scripting and Script Fading

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Scripting involves presenting a structured "script" to the child that provides an explicit description of what the child will say or do during a social interaction (Mayo & Waldo, 1994). The script may provide a narrative of what to say during a conversation or what to do during an activity. It may contain the entire sequence of the interaction or only the initiation. For instance, the child might be taught a script for initiating an interaction with a peer who is also taught to respond in a scripted fashion. The benefits of scripting for individuals with ASD has been demonstrated in research involving both conversational scripts (Loveland & Tunali, 1991) and play scripts (MacDonald, Clark, & Garrigan, 2005). A major limitation of scripting is that the child may become over-reliant on the script, and be unable to engage in spontaneous, unscripted interactions. Script fading is a research-based practice designed to address this limitation (Krantz & McClannahan, 1998). Script fading involves introducting of script to facilitate an increase in social interactions and then a systematic fading of the script over time to promote maintenance, generalization, and elaboration of the interaction. For more information, click here to see the AIM on Social Narratives.

Strategies to Enhance Performance of Existing SkillsIn this section, we will share strategies that can assist individuals with ASD to carry out skills they already possess. We will review Priming, Prompting, Self-Monitoring, and Peer Mediated Interventions.

PrimingPriming is used to provide a person with information and answers before they are presented with an activity or before they enter a social situation. Priming refers to the "incidental activation of knowledge structures" (Bargh, Chen, & Burrows, 1996, p. 230), which facilitates memory recall or behavioral performance. The positive effects of priming to facilitate social behavior is supported by researchers, who used priming to increase the social initiations of preschool children with ASD (Zanolli, Daggett, & Adams, 1996) and to decrease problem behaviors in the classroom (Koegel, Koegel,

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Frea, & Green-Hopkins, 2003). Video priming has been used to reduce problem behaviors during transitions for children with ASD (Schreibman, Whalen, & Stahmer, 2000). The researchers selected transitions in settings deemed most problematic by the children's parents. The researchers then videotaped the settings to show the environment just as the child would see it (moving through the store, getting ready in the morning, etc.). Social cognitions and social behaviors can be primed by presenting cognitive or behavioral "primes" just prior to performance of the skill or behavior in the natural environment.

Case Study: Larry

Larry, a 26-year-old man with autism, had been working in the print shop for six years. Now that the print shop was moving to a new location, his supervisor, George, was concerned about how Larry would handle the change. George remembered that when Larry first started working at the print shop, his job coach took pictures of everywhere in the shop that Larry would need to walk through and work in, including the bathroom and lunch room. The job coach included text explaining what social behaviors were expected in each area. George decided to go to the new print shop location and take pictures of everywhere Larry would need to access when they moved. George made up a book about the move using the pictures, including text explaining expected social behaviors, and even made Larry a calendar showing when they were relocating. Larry looked at the book every day and asked George questions about the move. When the print shop relocated, Larry was ready and knew what social behaviors were expected at the new shop.

PromptingPrompts are highly effective in facilitating child-adult and child-child interactions in children with ASD (McConnell, 2002; Rogers, 2000). Prompts are supports and assistance provided to help the child acquire skills and successfully perform behaviors. Prompts may be used to teach new social skills (in the case of physical and modeling prompts) and to enhance performance of previously acquired skills. In addition, they may be used with novice or advanced performers; in individual sessions or in group

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sessions; with verbal children or with nonverbal children; and with preschoolers or with adults. Finally, prompts may be delivered by adults or by other children. A limitation of prompting strategies is that the child with ASD may limit social interactions to only instances in which prompting is provided. As such, a prompt-fading plan needs to be implemented to systematically fade prompts from most to least supportive.

Types of prompts (from least to most supportive):1. Natural: saying or doing what would typically happen before a behavior

2. Gestural: pointing to, looking at, moving, or touching an item or area to indicate a correct response

3. Verbal: providing a verbal instruction, cue, or model

4. Modeling: the acting out of a target behavior with the hope the child will imitate

5. Physical: moving the child through the behavior; can be full, which is doing the whole behavior, or partial, such as just touching the hand

Self-MonitoringSelf-monitoring strategies have demonstrated considerable effectiveness for teaching children with and without disabilities to both monitor and regulate their own behavior (Carter, 1993). Self-monitoring may be considered both a skill acquisition strategy because it teaches the child to monitor her own behavior and a performance-enhance technique because through self-monitoring, the child is able to enhance the performance of an existing skill. Self-recording of behavior can be used during the behavioral performance or after the performance (or both). Strategies can target a number of externalizing behaviors, such as time-on-task, work completion, and disruptive behaviors, as well as internal processes, such as thoughts (self-talk) and feelings (both positive and negative affect). Self-monitoring strategies may involve having the child record occurrences (whether the behavior was performed), duration (for how long), and frequencies of behaviors (how frequently it was performed) as well as the quality of the behavioral performance (how well the behavior was performed). Self-monitoring strategies have been used effectively to address the social and behavioral

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functioning of children with ASD (Coyle & Cole, 2004; Shearer, Kohler, Buchan, & McCullough, 1996). Shearer et al. used self-monitoring to increase the social interactions of preschool children with ASD. Coyle and Cole used self-monitoring in combination with video self-modeling (positive self-review) to decrease off-task behavior in school-aged children with ASD. Finally, self-monitoring strategies support generalization of skills because they teach children to independently monitor their own behavior.

Case Study: Nate

Nate's mom and dad wanted him to start independently initiating interactions with people in the community when they went to a store, the local gym, or a restaurant. Nate and his parents decided on a couple of goals a week for him to target. They found an application on his cell phone that allowed Nate to track how often he independently started a social interaction with people in the community, which was always one goal, and then one other target goal. Every Saturday, Nate would review with his mom and dad who he talked to, what they talked about, and how he was feeling during the conversation. Nate really liked tracking his progress on the weekly goals and it helped him start to increase how often he initiated interactions with people in the community.

Peer-Mediated Interventions

Peer-Mediated Instruction and Intervention (PMII) is an effective and strategy for facilitating social interactions between young children with ASD (and other disabilities) and their nondisabled peers (Laushey & Heflin, 2000, Sasso, Mundschenk, Melloy, & Casey, 1998; Odom, McConnell, & McEvoy 1992; Strain & Odom, 1986). In PMII

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programs, nondisabled children are selected and trained to be "peer buddies" for a child with ASD. As such, the nondisabled peers participate in the intervention by making social initiations or responding promptly and appropriately to the initiations of children with ASD during the course of their school day. PMII allows children with ASD to perform social behaviors through direct social contact and by modeling the social behaviors of peers. PMII enables us to structure the physical and social environment so as to promote successful social interactions. PMII may be used in naturalistic settings (classroom and playground), and also in structured settings (structured play groups). For more information, click here to see the AIM on PMII.

Facilitating GeneralizationA critical aspect of all social skills programs is to develop a plan for generalization, or transfer of skills across settings, persons, situations, and time. The ultimate goal of social skills training is to teach the child to interact successfully with multiple persons and in multiple natural environments.

From a behavioral perspective, the inability to generalize a skill or behavior is a result of too much stimulus control. That is, the child only performs the skill or behavior in the presence of a specific stimulus (person, prompt, directives, etc.). For instance, the child may respond to the social initiations of other children, but only if his mother is there to prompt him. If Mom is not there, he does not respond. Or the child might initiate with her special education teacher, but with nobody else. Generalization is particularly important for children with ASD who often have pronounced difficulties transferring skills across persons and settings.

A number of strategies may be used to facilitate generalization of social skills across settings, persons, situation, and time, including:

1. Reinforce the performance of social skills in the natural environment

2. Train with multiple persons and in multiple settings

3. Ensure the presence and delivery of natural reinforcers for the performance of social skills

4. Practice the skill in the natural environment

5. Fade prompts as quickly as feasible

6. Provide multiple examples of social rules and concepts

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7. Train skills loosely (i.e., vary the instruction, directives, strategies, and prompts used during skill instruction)

8. Teach self-monitoring strategies

9. Provide "booster" sessions (i.e., provide follow-up training after initial instruction has been discontinued)

Case Study: Carl

Carl is a 13-year-old boy with Asperger Syndrome. His teachers report that Carl engages in many "socially inappropriate" behaviors when in the presence of peers, such as inappropriate touching and mimicking the behavior of peers. In particular, Carl often stands behind other children in the hallway and repeats everything they say. An interview with teachers revealed that Carl has no friends but frequently expresses an interest in making friends. A social skills assessment revealed significant difficulties in social initiations, including joining in interactions with peers. A social skill intervention was implemented to teach Carl how to effectively join in activities with peers. First, it was taught by his teacher in the classroom. Then, an aide used the same intervention in the cafeteria. Also, Carl's mom tried the intervention when he was going to swim team practice at the local pool. Carl started approaching small groups and was able to join in their activities.

Summary

Gaining social competence through the teaching of social skills and the application of interventions gives individuals with autism spectrum disorder a better chance at getting along with others, making friends, and being able to obtain and sustain a job. Learning how to initiate, reciprocate, and think about social interactions is key to decreasing the

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challenges persons with ASD experience. People on the spectrum need to be assessed and have an individualized program developed for them to move them towards a higher level of social competence. There are many interventions described in this module to assist with teaching how to interact socially.

Discussion Questions[ Export PDF with Answers | Export PDF without Answers ]

1. Describe common social skill deficits in individuals with ASD.

A correct response would include:

"(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction; (b) failure to develop peer relationships appropriate to developmental level; (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people; and (d) lack of social and emotional reciprocity." (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (American Psychiatric Association, 2000, p. 145.)

2. Why is it important to teach social skills to individual with ASD?

A correct response would include:

Effective social skills allow children to elicit positive reactions and evaluations from peers as they perform socially approved behaviors (Ladd & Mize, 1983).

3. How are social skills and social competence evaluated?

A correct response would include:

Evaluations of social competence are typically conducted through the use of interviews or rating scales. Interviews are a valuable method for obtaining information regarding social functioning in a relatively short time by allowing us to collect and synthesize information from a variety of respondents, representing a wide range of settings.Rating scales are indirect assessment tools that provide information across a variety of functioning areas. These measures range from informal checklists to standardized rating scales and

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may be administered to parents, teachers, and the child. Rating scales can measure social functioning, anxiety, self-concept and self-esteem, and behavioral functioning.

4. Distinguish between a skill acquisition deficit and performance deficits. How is this dichotomy important to intervention?

A correct response would include some of the following information:

A skill acquisition deficit refers to the absence of a skill or behavior. For example, a young child may not know how to effectively join in activities with peers. If we want this child to join in activities with peers, we need to teach her the skills to do so.

A performance deficit refers to a skill or behavior that is present but not demonstrated or performed. To use the earlier example, a child may have the skill (or ability) to join in an activity but for some reason fails to do so. In this case, if we want the child to participate, we would not need to teach her to do so (since she already has the skill). Instead, we would need to address the factor that is impeding performance of the skill, such as lack of motivation, anxiety, or sensory sensitivities.

A skill acquisition/performance deficit model guides the selection of intervention strategies. Most intervention strategies are better suited for either skill acquisition or performance deficits. The selected intervention should match the type of deficit present (Gresham, Sugai, & Horner, 2001).

5. What social skills training strategies are available to teach social skills to individuals with ASD?

A correct response would include:

Social Stories (TM), Video modeling and Video self-modeling, Social problem-solving, and Pivotal Response training, social scripting and script fading, priming, prompting, self monitoring, and Peer Mediated Instruction.

Post-AssessmentPost-Assessment

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What is the primary purpose of social skills assessment?

Select an answer for question 574

Why is it important to interview the child or adolescent himself if possible?Select an answer for question 575

Which of the following best represent criteria for quality social objectives?

Select an answer for question 576

What is a skill acquisition deficit?

Select an answer for question 577

What is a performance deficit?

Select an answer for question 578

Why is it important to determine whether an area of challenge is due to a skill acquisition deficit or a performance deficit?Select an answer for question 579

Which of these statements best describes priming?Select an answer for question 580

Which of the following strategies can be used to prime social cognitions and behaviors?

Select an answer for question 581

What is generalization?

Select an answer for question 582

What is meant by the term social accommodation?Select an answer for question 583

Submit Post-Assessment

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Citation and ReferencesCitationIf included in presentations or publications, credit should be given to the authors of this module. Please use the citation below to reference this content.

Bellini, S. (2011). Overview of Social Skills Functioning and Programming (Columbus, OH: OCALI). In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, www.autisminternetmodules.org. Columbus, OH: OCALI.

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