issues and considerations in teaching social skills to individuals with autism

Issues and considerations in Issues and considerations in teaching social skills to teaching social skills to individuals with autismindividuals with autism

Mary Jane WeissMary Jane Weiss

September, 2008September, 2008

State of intervention………..State of intervention………..

Social deficits remain the most resistant to Social deficits remain the most resistant to intervention effortsintervention efforts

Social skill difficulties include problems with Social skill difficulties include problems with responsiveness and initiationsresponsiveness and initiations

Deficits also include problems in the Deficits also include problems in the functional availability of social responsesfunctional availability of social responses

ABA: A DefinitionABA: A Definition

““Applied Behavior Analysis is the science in which Applied Behavior Analysis is the science in which tactics derived from the principles of behavior are tactics derived from the principles of behavior are applied systematically to improve socially applied systematically to improve socially significant behavior and experimentation is used to significant behavior and experimentation is used to identify the variables responsible for behavior identify the variables responsible for behavior change.”change.”

Cooper, Heron, & Heward, 2007Cooper, Heron, & Heward, 2007

Critical elements of the definitionCritical elements of the definition

Improve Improve socially significantsocially significant behavior behavior– What does this mean?What does this mean?

Identify variables responsible for behavior Identify variables responsible for behavior changechange– Why is this challenging in the teaching of social Why is this challenging in the teaching of social

skills? How can this be done?skills? How can this be done?

Why is it harder to teach these Why is it harder to teach these skills? Diagnostic criteria reviewskills? Diagnostic criteria review

1. Impairment in social interaction1. Impairment in social interaction– Multiple nonverbal behaviorsMultiple nonverbal behaviors– Peer relationshipsPeer relationships– Sharing enjoymentSharing enjoyment– Social/emotional reciprocitySocial/emotional reciprocity

2. Impairments in Communication2. Impairments in Communication– ConversationConversation– Make-believe or social imitative playMake-believe or social imitative play

Why else is it harder to teach these Why else is it harder to teach these skills?skills?

Multi-element skillsMulti-element skills Involve social judgment as well as skill Involve social judgment as well as skill

masterymastery– Judgment is made more difficult by the myriad Judgment is made more difficult by the myriad

possibilities that exist in natural interactionspossibilities that exist in natural interactions

Topics for discussionTopics for discussion

When are we targeting social skills?When are we targeting social skills? What are the qualitative aspects of social What are the qualitative aspects of social

responding that are most clinically relevant?responding that are most clinically relevant? How do we build social “comprehension” or How do we build social “comprehension” or

more elaborate social responses?more elaborate social responses? Is ABA really well-suited to teach social Is ABA really well-suited to teach social

skills?skills? What about joint attention and TOM?What about joint attention and TOM?

When does social skill training When does social skill training begin?begin?

What are early targets of instruction?What are early targets of instruction?– MandingManding– ImitationImitation– Play skillsPlay skills

Examples of mands that occur in Examples of mands that occur in social contextssocial contexts

Pointing to a video game that another Pointing to a video game that another student is playing withstudent is playing with

Asking a friend for the glue stickAsking a friend for the glue stick Asking a friend to open your soda canAsking a friend to open your soda can Asking a friend to do something funny (e.g. Asking a friend to do something funny (e.g.

make a silly noise) againmake a silly noise) again

Questions on mandingQuestions on manding

How can manding become a long-term How can manding become a long-term curricular progression?curricular progression?

How can we take data on manding?How can we take data on manding?

Critical Issues in Social SkillsCritical Issues in Social Skills

InitiationsInitiations ResponsivenessResponsiveness Qualitative aspects of social behaviorsQualitative aspects of social behaviors

Social initiations and responsesSocial initiations and responses

How are these taught?How are these taught?– Social validity of items taught Social validity of items taught

What are the challenges in teaching these What are the challenges in teaching these skills?skills?

-# learning opportunities vs. natural contexts-# learning opportunities vs. natural contexts

-how should we determine mastery?-how should we determine mastery?

Qualitative aspects of social Qualitative aspects of social behaviorsbehaviors

ClarityClarity AppropriatenessAppropriateness Independence Independence EnduranceEndurance LatencyLatency

How do we address these How do we address these issues?issues?

Clarity and AppropriatenessClarity and Appropriateness– Use shapingUse shaping– Use differential reinforcement Use differential reinforcement

IndependenceIndependence– Guard against prompt dependencyGuard against prompt dependency– Program for generalizationProgram for generalization

Addressing enduranceAddressing endurance

Focus on duration as a dimension of Focus on duration as a dimension of responseresponse– Length of time in play/leisure contextsLength of time in play/leisure contexts– # conversational exchanges# conversational exchanges

Addressing Issues of LatencyAddressing Issues of Latency

Focus on latency as an aspect of Focus on latency as an aspect of respondingresponding– Measure it and work to reduce itMeasure it and work to reduce it– Include it as part of criteria for masteryInclude it as part of criteria for mastery

Achieve Fluency through Rate BuildingAchieve Fluency through Rate Building– What is Fluency: “The fluid combination of What is Fluency: “The fluid combination of

accuracy plus speed that characterizes accuracy plus speed that characterizes competent performance.” (Binder, 1996)competent performance.” (Binder, 1996)

When does latency have social When does latency have social consequences?consequences?

Social responsivenessSocial responsiveness Responding in a group environmentResponding in a group environment

Long latencies to respond and slow Long latencies to respond and slow response rates lead to missed response rates lead to missed

opportunities for interaction and opportunities for interaction and participationparticipation

Characteristics of Fluent Characteristics of Fluent BehaviorBehavior

AutomaticAutomatic Low response effortLow response effort FlowingFlowing FunctionalFunctional ExpertExpert

Using rate-building to achieve fluent Using rate-building to achieve fluent respondingresponding

How is timed practice for social skills done?How is timed practice for social skills done?

What aims do we use?What aims do we use?– Are published aims appropriate?Are published aims appropriate?

A review of why we might choose to A review of why we might choose to do rate-buildingdo rate-building

Non-fluent responses may not be available Non-fluent responses may not be available when neededwhen needed

Non-fluent responses may be laborious and Non-fluent responses may be laborious and difficult, and may interfere with the social difficult, and may interfere with the social exchangeexchange

Issues in Non-fluency with Issues in Non-fluency with ConversationConversation

Verbal behaviorVerbal behavior– Occurs at great speedOccurs at great speed– Is easily and rapidly emittedIs easily and rapidly emitted

Speed deficits affectSpeed deficits affect– ComprehensionComprehension– Conversational outputConversational output

Necessary rate: what aim to use?Necessary rate: what aim to use?

Performance StandardPerformance Standard 150 to 250 words per minute (Conversation)150 to 250 words per minute (Conversation)

– Commonly used list compiled by Rick Kubina: Commonly used list compiled by Rick Kubina: 150-200 per minute150-200 per minute

– Clay Starlin: 150 to 250 per minuteClay Starlin: 150 to 250 per minute– Speaking and listening rateSpeaking and listening rate

Verbal response must occur at same rate to remain Verbal response must occur at same rate to remain effective in conversationeffective in conversation

Performance standardPerformance standard

150 to 250 WPM may be a powerful 150 to 250 WPM may be a powerful performance standardperformance standard

Questions Regarding the Questions Regarding the Performance StandardPerformance Standard

Is this rate applicable to all ages?Is this rate applicable to all ages? Is this rate applicable to students with Is this rate applicable to students with

ASD’s?ASD’s?

What other elements of social What other elements of social skill training are commonly skill training are commonly

discussed as clinical challenges?discussed as clinical challenges? Following social rulesFollowing social rules Emitting complex social responsesEmitting complex social responses

Understanding social rules and Understanding social rules and what is expected …….what is expected …….

What do people use to teach these skills?What do people use to teach these skills?– Social StoriesSocial Stories– Rule cardsRule cards– Feedback on performance Feedback on performance – Role playsRole plays– Video instructionVideo instruction

Social StoriesSocial Stories

Developed by Carol GrayDeveloped by Carol Gray Can be used with modifications such as Can be used with modifications such as

pictures to assist with comprehensionpictures to assist with comprehension Can be used for multiple purposesCan be used for multiple purposes

– multi-element tasksmulti-element tasks– addressing fearsaddressing fears– addressing challenging behaviorsaddressing challenging behaviors

Writing Social StoriesWriting Social Stories

Carol Gray Recommends:Carol Gray Recommends:

A 1:2-5 ratioA 1:2-5 ratio DescriptiveDescriptive PerspectivePerspective DirectiveDirective ControlControl

Social stories: Data?Social stories: Data?

Small body of literature existsSmall body of literature existsReview study has been published (Reynhout Review study has been published (Reynhout

& Carter, 2006)& Carter, 2006)Not all studies reported cognitive levelNot all studies reported cognitive levelEffect sizes highly variableEffect sizes highly variableMethodology highly variable and often Methodology highly variable and often

not following protocolnot following protocolNo effect of more descriptive No effect of more descriptive

sentencessentences

More on social storiesMore on social stories

Consequence statements may be very importantConsequence statements may be very important Many aspects unclear in terms of impactMany aspects unclear in terms of impact

– Frequency of reviewFrequency of review– Comprehension activitiesComprehension activities– Access to storyAccess to story

Often, social stories are used as Often, social stories are used as one componentone component of an intervention package that includes more of an intervention package that includes more direct interventionsdirect interventions– PromptingPrompting– ReinforcementReinforcement

More on social storiesMore on social stories

Global evaluationGlobal evaluation– Data not robust that social stories facilitate Data not robust that social stories facilitate

behavior changebehavior change– Maintenance and generalization are largely Maintenance and generalization are largely

unaddressedunaddressed Critical issue for this populationCritical issue for this population

Social stories: AppealSocial stories: Appeal

Clinical popularityClinical popularity– Ease of implementationEase of implementation– Touted as applicable to a wide range of Touted as applicable to a wide range of

behaviorbehavior

Clinical guidelinesClinical guidelines– If used, should be used in combination with If used, should be used in combination with

direct behavior change proceduresdirect behavior change procedures– HOW ARE WE EVALUATING IMPACT????HOW ARE WE EVALUATING IMPACT????

Rule cardsRule cards

Helpful in teaching students to follow social rules Helpful in teaching students to follow social rules associated with a particular activityassociated with a particular activity

A rule card clearly states the behavioral A rule card clearly states the behavioral expectations for a specific activityexpectations for a specific activity

Can be textual or picture-based, or bothCan be textual or picture-based, or both Should be briefShould be brief

– enhances portabilityenhances portability Can be used in combination with in vivo behavioral Can be used in combination with in vivo behavioral

rehearsal rehearsal

Rehearsing Appropriate BehaviorRehearsing Appropriate Behavior

In combination with rule cardsIn combination with rule cards

Role PlaysRole Plays

Video InstructionVideo Instruction

Role PlaysRole Plays

Can be used to target nuances of interactionCan be used to target nuances of interaction Format can be individualized to maximize Format can be individualized to maximize

successsuccess Can be done with characters, puppets, or Can be done with characters, puppets, or

peoplepeople

Video ModelingVideo Modeling

Has also been shown to be effective in Has also been shown to be effective in building a variety of skillsbuilding a variety of skills– PlayPlay– ConversationConversation

Probably under-utilized given the empirical Probably under-utilized given the empirical supportsupport– High response effortHigh response effort– Need to program variabilityNeed to program variability

Which of these strategies have Which of these strategies have empirical support?empirical support?

Video modeling (e.g. Charlop & Milstein, Video modeling (e.g. Charlop & Milstein, 1989; Taylor et al, 1999)1989; Taylor et al, 1999)– Can include targets such as playing with others, Can include targets such as playing with others,

conversationconversation– Can be used to teach identification of Can be used to teach identification of

appropriate behaviorappropriate behavior– Can be used to provide reinforcement and Can be used to provide reinforcement and

corrective feedbackcorrective feedback

What about some hot topics?What about some hot topics?

Are social skills better addressed through a Are social skills better addressed through a non-ABA approach, such as RDI?non-ABA approach, such as RDI?– Conceptual issues Conceptual issues – Lack of operational definitionsLack of operational definitions– Absence of evidence of effectivenessAbsence of evidence of effectiveness

More hot topicsMore hot topics

What about Joint attention? Perspective What about Joint attention? Perspective taking/TOM? taking/TOM? – Critical question is not whether such skills can Critical question is not whether such skills can

be taught, at least to some individuals on autism be taught, at least to some individuals on autism spectrum, but whether these skills generalize spectrum, but whether these skills generalize into the natural environment.into the natural environment.

And let’s revisit non-vocal And let’s revisit non-vocal communicators and social skill communicators and social skill

developmentdevelopment

What is the same?What is the same? What is different?What is different? How do we train the listener community How do we train the listener community

better?better?– Especially peersEspecially peers

Peer understanding of ASD’sPeer understanding of ASD’s Peer training approachesPeer training approaches

Social skill trainingSocial skill training

Probably an area in which we are least Probably an area in which we are least guided by theory or evidence, and most guided by theory or evidence, and most guided by ritualguided by ritual

We need to think more clearly conceptually We need to think more clearly conceptually about what we are teaching and how we are about what we are teaching and how we are teachingteaching

We need to design better studies with We need to design better studies with controls in place to effectively evaluate controls in place to effectively evaluate social interventionssocial interventions

Social skill trainingSocial skill training

For individual students, we need to For individual students, we need to – focus on the demonstration of meaningful and socially focus on the demonstration of meaningful and socially

significant changesignificant change– Use data to guide decisions about instructionUse data to guide decisions about instruction– Conduct component analyses of package interventionsConduct component analyses of package interventions

For consumers, we need toFor consumers, we need to– Educate them about the evidence (and the lack of Educate them about the evidence (and the lack of

evidence) that exists for different interventionsevidence) that exists for different interventions