TEACHING SOCIAL SKILLS
Parents often wonder why it appears to be so effortless for typically developing children to learn to enjoy playing together and interacting while it appears so difficult for their child with Autism. Children diagnosed on the Autism Spectrum differ among one another quite significantly so there is no "one" answer that will be relevant for all. Instead, it is important to view each child individually to determine the nature of the social difficulty.
Before using the strategies discussed in this section, the child should have basic language competencies including the ability to use language to request objects, actions and information, label ongoing and past objects and events, intraverbally respond to questions and imitate multiple sequences of actions.
While we are focusing on the child with Autism, it is important to recognize that social interactions are never "one sided". The problem sometimes lies, not in a skill deficit of the child, but in the reactions of "typical" individuals to the child. These reactions may be inadvertent due to a lack of understanding and experience about Autism or may be deliberate. Many people who are not diagnosed with Autism have social skills deficits also! For this reason, the author is highly supportive of integrated programs that will allow all children to learn to recognize and respect the differences between people as well as teaching approaches that emphasize "social skills" for all children.
As related to this, it is important for parents to have a clear understanding of exactly what it is they feel is important for their child to learn from a social perspective. We all vary in our desires to be with and spend time with other people and generally choose to be around people who are reinforcing. Parents should consider their child as an ito teach him to behave in ways that the child does not find reinforcing or it is unlikely that these behaviors will be maintained in the natural environment. Instead, it is recommended that parents teach the child to enjoy the things he already finds reinforcing with others who are reinforced by similar activities.
The following lists of problems and solutions are provided as a "starting point" when determining what particular set of skills a child needs to learn in order to improve social skills.
Language- It is difficult, if not impossible to be "social" without language. The function of the language used frequently depends on the nature of the activity in which the children are engaged.
Teaching Social Skills to
Many pre-school activities can be conducted with peers. Instructors can set up situations that create the need for children to request (mand) items or activities from each other with prompting as needed. The previous section discussed the importance of pairing peers with reinforcement so be sure the activities chosen are those enjoyed by the child with Autism. As in all teaching interactions, be sure to specify the target behavior clearly, prompt the child to use the target behavior and reinforce heavily for independent use of "new" skills. Some examples may include:
Have two children create the same painting. Give each child two colors of paint, along with the corresponding brushes to create a need to request from each other. Each child takes turns deciding and telling the other what to add to the painting next.
If the child has a favorite toy or activity, make it a "rule" that the child has to ask another child to participate in the activity in order to engage in it.
Give each child a puzzle to complete but give the pieces to the "friend" so each has to request from the other.
Put two children on the computer. Allow one to control the mouse while the other tells him what to "click". Take turns in each role.
Give each of the children a "Mr. Potato Head" toy. Give all the eyes, ears and noses to one and all the mouths, arms and feet to the other. The children tell each other which parts they want to add next.
Play "Simon Says", allowing different children to take turns being "Simon" and telling the other children what to do.
Give the children a picture to color but only give 1 marker of a different color to each child. The children request the markers from each other in order to complete the picture.
Play ball games where the children can request that the ball be thrown, rolled or bounced to each other.
Create "marble runs" or block creations where each child takes turns deciding what to add to the structure next. These are often good opportunities to teach the children that people can have different "ideas" some of which work and some that don't! Teach the child the language of reinforcing and their peers such as "That's a good idea!" or "That worked!".
Make identical bead necklaces. Give different colored beads to each child and prompt them to take turns deciding what color of beads to put on next.
Rule Based Games
Some rule based games such as board games may be quite easy mediums to use to teach the child with Autism to interact with peers. The games are predictable which is often comforting to the child with Autism. Turn taking games are often good opportunities to generalize the teaching of pronouns, turn taking and other important "group interaction" skills. Choose very easy games at first that require a minimum of language and gradually increase the complexity of the play.
Other "rule based" games such as baseball, kickball or tag may be more difficult to teach. Often these games have rules that are less consistent or direct. In addition, the sensory stimulation during these types of activities may be overwhelming for some children. Finally, if the child with Autism does not have strong motor coordination skills, they may tend not to be appreciated as team members which does not lend to good peer interactions. Many typically developing children and adults can tell you the negative peer experiences from their involvement in team sports!
If the child does enjoy sports, there is no reason not to allow them to participate in these types of activities. Just be sure to explicitly teach the child the rules of the game, providing extra stimulus prompts as necessary. Spend a great deal of time on the skills needed for the game in order to insure the child is successful when participating with the team. Also teach the child the language involved in team sports, including any "jargon" involved. For example, other children will be reinforced if you directly teach the budding baseball player, "Hey batter, batter!", "Nice hit!" or "You really smacked that one!" to cheer their teammates on.
When typically developing children begin playing together, it always involves language. Children don't typically ask each other many questions while playing but they do use language to "script" ongoing pretend play schemes. They may take on the roles of different characters as their "play script" evolves. When children play together, sometimes one will be the "leader" in determining the evolution of these play scripts and other times they will take turns.
So, if we want our children to learn the "language of play", we have to teach it! It is important to remember that the language of "play" is often quite different than the language of "learning". While both are important, we should not exclude the teaching of one for the other.
The language of play typically involves a great to labeling (tacts) of ongoing actions as well as many requests (mands) between the participants. Emotions are often exaggerated, much to the chagrin of parents who see themselves in their children's play!
One technique the author has found helpful is to use "play scripts" centering around favorite toys. The script may not be written out but the same "routine" occurs over and over, at least initially, to allow the child multiple opportunities to practice the language involved. The child is often given some control over determining the direction the script will take by offering choices as to what should happen next. The role of the instructor is to act both as "playmate" and "teacher", prompting the child to respond as necessary, demonstrating confusion and requiring clarification when the child's play appears to get "off track", and providing the "words" the child might use to request or label based on the behaviors exhibited.
As soon as the child has learned the "script", it is important that the instructor begin changing parts or insisting on taking some turns in determining the course of the play so that the child does not become "stuck" in having to conduct the play the same way each time.
Once the child has mastered the play script with an adult, use the same toy but bring in another child. The child should ideally be at the same language level as the child with Autism even if their ages are not the same.
Narrated Free Play/Early Conversations
Much of what children "say" when they are playing involves narration (tacts). Children narrate both when playing together and when playing alone. Teach the child to say "Whoa! I'm going high!" while swinging or "Wee! This slide is fast!". Many of these spontaneous tacts are really mands (requests) for attention because the intent is to have others notice what they are doing. Be sure when teaching children to mand for attention in this manner that reinforcement, rather than demands follow the behavior. For example, say "Wow! I've never seen anyone go so high!" rather than asking questions.
Also teach children to produce contingent comments based on what others say. Contingent comments are often the first forms of "conversations" engaged in between peers. The children may not be showing a great deal of interest in their conversational partner by manding information from each other but clearly are "conversing" about the same topic! For example:
Child 1 Child 2
I have a dog. I have a cat.
My dog has white fur. My cat is spotted.
I saw my dog catch a bird. My cat caught a bird once.
I bet my dog could catch your cat! I bet by cat can scratch your dog!
In order for adults to obtain strong social skills, it is necessary that they recognize and respond to both their own emotions and the emotions of others. We often explain our behaviors as they relate to our emotional state (ex: "I'm really distracted today because I didn't get much sleep.) and modify our behaviors based on the emotional state of others. It doesn't take long for most typically developing children to learn to recognize when it might not be a good time to ask the teacher or parent for something!
Children with Autism often have a much more difficult time learning emotions. Like other "abstract concepts" discussed previously, emotions are not "concrete". We cannot see them directly but can only observe the co- occurring behaviors we have learned to associate with different emotions. This makes them difficult to teach but also a very important part of teaching social interactions.
While we can certainly empathize and model tacts of emotions when we see our child exhibiting associated behaviors, some difficulties come into play when teaching the child to label (tact) their own emotions. First, as mentioned above, emotions involve "internal stimulation", so we cannot be sure exactly what emotion the child is feeling. Children with Autism might not display behaviors typically associated with emotions or may display them in atypical or magnified ways. For example, a child may display behaviors associated with rage when they are actually feeling anxious. In addition, we cannot always assume we know how a child feels based on what we would feel in a similar situation. Finally, teaching the child to label anything may be difficult when they are sick or really angry! It's tough to get a response let alone reinforce appropriately without also reinforcing negative behaviors.
Instead, we can teach the child to tact their emotions by associating them with objects or activities that have a history of evoking specific emotions. Start with the "basics" such as "happy", "sad" and "angry" then teach the child to differentiate degrees of these emotions. The author has experienced success with using "Emotion Books" as described by Tony Attwood. Basically, the instructor and child create books about each emotion. The books contain pictures of objects the child associates with the emotions as well as objects or activities that other important people in their life associate with the emotions. At the end of the book a "gauge" is presented to specify degrees of the emotion felt. Finally, the books contain suggested activities the child can engage in when experiencing a given emotion.
It is also important to teach the child to learn to recognize the emotions of others. The child can be taught to look at specific facial features or body postures as well as other non-verbal communications such as tone of voice or inflection to assist them in "reading" the emotions of others.
"Rules of Conduct"
Children with Autism often need to be directly taught the specific rules of interaction in given situations. Carol Gray has published many excellent products outlining strategies of using social stories and comic strip conversations to teach these skills. It is important to remember that these types of techniques involve the use of "contingency specifying stimuli". In other words, the stories or comic strips are presented before the behavior actually occurs and change the function of the stimuli present later to serve as discriminative stimuli that evoke certain behaviors. In order for the behaviors to be evoked, not only must the child have a learning history of "rule following behavior" but also must be reinforced when the desired behavior is actually exhibited. Merely "giving information" about what is expected is not enough to teach the desired skills.
Social stories can be written about any social situation in which the child typically has difficulty. There are general guidelines regarding the use of social stories which include:
Must include introduction, body and conclusion.
Answers "Wh" questions including who is involved, where and when a situation occurs, what is happening, how it happens and why.
Is written from a first person perspective as though the person with Autism is the describing the event.
Is written in positive language with positively written descriptions of responses and behaviors. (Says what "to do" rather than what "not to do")
Contains up to 4 different types of sentences including descriptive, perspective, affirmative and directive. It is suggested that the following ratios of sentence types be used. 0-1 partial or complete directive sentences for every 2-5 partial or complete descriptive, perspective and/or affirmative sentences.
Is literally accurate with the use of qualitative words like "usually" and "sometimes" to ensure accuracy.
Uses concrete, easy to understand text with the use of picture prompts as needed.
Comic strip conversations are frequently used to "illustrate" an ongoing discussion of difficult social situation or a specific event in which the child has exhibited difficulty. Stick figures are used to illustrate the people involved. Colors are taught to be associated with specific emotions (i.e. red= anger, green= happy, blue= sad, yellow= frightened, orange = confused, brown = comfort). Word bubbles are used to depict specific things that were said while "thought bubbles" are used to illustrate what people may have been thinking. Comic strip conversations are frequently written in sequential squares, similar to the frames in comic strips.
Another strategy for teaching the "rules of conduct" in particular social situations involves the use of role playing. This allows the instructor to give immediate reinforcement of desired behaviors as well as multiple opportunities to "practice" new skills before they are actually needed in a social situation. Again, it is important to also reinforce the use of the skills in the actual social situation in most cases in order for the behaviors to generalize across settings.
Many parents have reported an increased in use of appropriate behaviors in new social situations with the use of these teaching strategies, especially for children who often are typically anxious in new situations.
Other, more general "rules" can also be taught to help children exhibit appropriate social skills. For example, children can be taught the "rules" of beginning a conversation, joining in a conversation, ending a conversation, asking for help, and offering help to other people.
Lynn and Robert Koegel describe ways of teaching children to monitor themselves in the use of specific skills taught. Self monitoring skills are often quite helpful in insuring that skills are generalized in across relevant settings.
Some suggest that the reason so many children with Autism lack strong social skills is because of their inability to determine the "knowledge" of another person or to understand that people don't have the same thoughts, knowledge or emotions that they do. Terms often used to describe this weakness include "mind blindness" or a lack of "theory of mind".
Rather than attributing the cause of difficulty to be within the individual, behaviorists choose to view and treat these difficulties from a "stimulus control" perspective. In other words, what stimuli in the environment allow us to determine what another person knows and doesn't know? Which of these stimuli is the child not responding to? The benefits of this focus is that it allows us to determine exactly what to teach rather than just explaining the "cause" of the problem within the child. Specific stimuli to teach the child to respond to may include:
Facial expressions, body language and intonation patterns associated with various emotions and degrees of emotion.
Desire based, thought or belief based, and reality based emotions.
The presence of absence of a person in a room to determine if they can see the same thing as you.
The use of pronouns only after the "referent" has been established in a conversation.
Starting conversations by stating the main idea of what you want to discuss.
It is important to constantly consider the unique ways the individual child experiences sensory stimuli when determining the skills the child needs in particular social situations. When able, the child should be taught to be "proactive" and state his sensory preferences as ways to explain his behaviors or tell others what he needs. In the meantime, it will be important for instructors to be able to interpret behaviors that may have a sensory base and modify the environment as well as desensitize the child to a variety of sensory stimuli whenever possible.
In order for children to have the opportunity to benefit from social situations, it is important to appropriately deal with negative behaviors from very early on. An ongoing use of a functional analysis to determine the nature of any negative behaviors exhibited so that the correct procedures can be used to extinguish the negative behaviors and teach replacement behaviors will be necessary to avoid removing the child from learning situations that include interactions with typically developing peers.