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Connect:A Social Skills Support Group
For College Students With Asperger’s Syndrome:
Insights and Lessons Learned
Deborah Wright, Ph.D. and Hannah Bush, M.Ed.University of Missouri - Columbia
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True Confessions
Learning Objectives!!!
1. Four areas that could be of benefit 2. Three social skills 3. Three group norms/guidelines 4. Two lessons learned
You don’t know what you don’t know
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Overview
Prior Experience and Impetus A bit about Treatment for ASD Structure, Content and Process Case Study Evolution, Insights and Lessons Learned
Goal: To leave you with a sense that you were a fly
on the wall during this group.
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Impetus
Assessment and Consultation Clinic
Thompson Center for Autism and Neurodevelopmental Disorders
Student Health Center Crisis walk-in Campus Judicial Hearing
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Research Findings: Asperger’s Syndrome
Most helpful resources: The Complete Guide to Asperger’s Syndrome (Tony Attwood, Ph.D.) Cognitive-Behavioral Treatment of Asperger’s Syndrome (Valerie Gaus,
Ph.D.) Preparing for Life (Jed Baker, Ph.D.)
Areas of clinical presentation that can be addressed: Reading nonverbal behaviors Social inference/Knowledge of Social Norms/Social Reciprocity Emotion regulation Executive functioning (e.g., problem-solving, time management)
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This Emotional Life clip (PBS)
http://www.youtube.com/watch?v=QWY3ntr3sdI
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Research Findings: Treatment
Process Therapy in short intervals Structured, skills-focused Need time to process When overwhelmed, teach deep breathing Provide autonomy on choice of topics Skills-streaming: Didactic, Model, Role play…
Practice, practice, practice!
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Research Findings: Treatment
Content Focus on increasing instrumental skills, fund of
knowledge about social norms, and social cognition Social skills menu: Starting a conversation, maintaining a
conversation, deepening friendships, etc Cognitive-behavioral therapy as treatment of choice
for co-occurring mood and anxiety
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Connect: Treatment Goals
1. Improve Social Skills
2. Improve Emotion Regulation
3. Increase Support Network
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Materials
Developed detailed handouts on: Conversation Skills Emotion Management Social Norm Descriptions
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Conversation Skills
Compliments Disclosure: including disclosure of diagnosis Forming friendships Expressing and reading welcoming and unwelcoming
cues Greetings and farewells Starting conversations Sarcasm versus genuine expressions Attending, Asking and Telling Conversation Repair
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Emotion Management
“How to Deal” Handouts: Anxiety Frustration Sadness/Depression Cognitive Distortion Lists Asking for what you need Problem-solving
Diaphragmatic breathing
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Social Norm Descriptions
“Unwritten Codes” Roommates and Res Hall Advisors Developing friendships Dating Working in groups Misunderstandings and disagreements
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Group Format
One hour, 9-week course Basic structure:
Small talk Mindfulness Meditation Didactic Practice in small group or dyad Individual work time Group discussion Mindful Meditation at closing
Blackboard System
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Interventions/Techniques
Meditation/Diaphragmatic breathing HRV Biofeedback Slowwwww the process! Allow time to write out thoughts Prompting when they give non-verbal cues Identifying relevant content Modeling Use of Humor Playful games
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Social Norms/Guidelines
Confidentiality Respect Participation
At individual pace Manage monologuing
Peace sign
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Recruitment
Office of Disability Services Student Services Coordinator
Screening Length of time No formal diagnosis
FS: N=5, SS: N=7 Age: 18-28 Dropout
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Case Study, Insights and Lessons Learned
Summary: Didactic, skills-building versus interpersonal
Experiential Anxiety Content/Process Connection
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Group 1: FS 2010
Topic: Deepening relationships
Intervention: Didactic
Disclosing personal information Compliments
Group Discussion
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Observations
High anxiety They came anyway! Called a “spectrum” for a reason Facilitators “getting caught up in their own
thoughts” Theme: interpersonal skills are complicated!
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Group 2 and 3: FS 2010
Topic: Meeting new people Managing Anxiety
Intervention Didactic, Modeling, Thought logs, Dyad discussions
Blackboard Introduced possibility of having small group
discussions at next group
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Observations
Stuck in rumination (blackboard example)
Facilitators’ anxiety
“I found it really difficult, but I also think it was useful.
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Group 4: FS 2010
Topic: Thought logging with emphasis on disputing and active listening skills
Intervention Individual logging Modeled active listening Group game
Blackboard Robust discussion regarding disclosing ASD diagnosis
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Observations
Games and humor reduced anxiety
They were engaged in a genuine, authentic way
Need for flexibility
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Group 5 and 6: FS 2010
Topic: What is it like to have ASD?
Interventions Lily Group Discussion
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Lily: Comfort Dog
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Observations
Histories of bullying Level of pain and trauma related to bullying Genuine desire and ability to connect Feeling misunderstood Humor helps alleviate anxiety Genuine, empathic connection during this group
B’s quote
Facilitators were totally confused
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Group 7, 8, 9: FS 2010
Topic: Clarifying and maintaining conversations Interventions
Group game Ambiguous statements Pointed out assumptions
Individual work Writing how they would say to professor and a friend
Themes: Clear safety and trust was established
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Group 1 and 2: SS2011
Topic: Introductions and Emotional Bids Interventions
Mindful observer exercise Dyads Didactic re: CBT Group discussion
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Group 3: SS2011
Topic: SFBT Intervention
Started with longer meditation Group discussion
Theme Facilitators slowed the process Decreased anxiety More disclosure
Blackboard More disclosure on blackboard this week
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Observations
Affect appropriate to content Eye contact Facing facilitators Subtle nonverbals Slow process Most poignant Great depth of sharing All were clearly touched
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Group 4: SS2011
Topic: Relaxation Intervention
Autogenics Exercise Group discussion
Theme Autogenics was useful for most
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Group 5: SS2011
Topic: Connecting Intervention
Brief Autogenics exercise Individual writing Dyads Group discussion
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Group 6 and 7: SS2011
Topic: Self-exploration and connection Intervention
Autogenics Exercise Mini-SPIN MBTI-type inventory Didactic Dyads
Theme Connection
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Observations
Hitting the balance of content and process
Giving them something meaningful to discuss
Controlling anxiety
More time for information processing
Highly engaged!
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Group 8: SS2011
Topic: Stress management Intervention
HRV Biofeedback Group discussion Reminder closing Blackboard
Theme
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Lesson Learned #1
Managing anxiety is key. Interferes with information processing and response
time. Facilitators need to manage high level of anxiety.
Interventions Starting and ending with mindful meditation Autogenics HRV
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Lesson Learned #2
Balance between process and content is encouraged by: Slowing the process Responding to nonverbals Using mindful meditation and other relaxation skills
during the group Offering some ideas for relevant discussion:
Disclosing ASD diagnosis MBTI Bullying
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Lesson Learned #2
Use of various modalities Individual time to reflect and write Dyads Group Games within group and humor Role play by facilitators
The balance of process and content helped with meaningful social skill practice of: Disclosures Showing verbal/nonverbal empathy Turn taking, mutual dialogue
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Lesson Learned #3
Be flexible: Remember, it is a spectrum.
Tailor content to feedback from group members Blackboard Within group
Need for facilitators to take risks
No expectations for change: embrace them for all of their wonderful uniqueness
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Lesson Learned #4
Blackboard is an important tool Specific problem-solving assistance Building safety Getting to know each other Reduced anxiety: Online practice
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Lesson Learned #5
Genuine desire for authentic connection in tolerable doses Willingness to self-disclose Willingness to tolerate very high levels of anxiety Enormous capacity for empathy
Exceptionally rewarding professionally
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Most Useful Skills Learned
Controlling breathing rate has as large effect on stress level Breathing—deeply and slowly (learned through biofeedback) and thought-
logging The biofeedback exercise was beneficial. Biofeedback-Relaxation skills, importance of heart rate variability,
visualization meditation (forgot the name) Sleep does not equal relaxation Ways to respond to social engagement gave me a different perspective for
thinking about social interaction I learned how to better judge the motivations of others, how to open up more,
and how to react appropriately in society. I got better at asking questions when talking with someone, I learned how to
breathe to relax me more, and I have gotten better at carrying on a conversation
Ask questions,, just because I think of something to say doesn’t mean I have to say it every time
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Most Beneficial
The games aimed at clarifying and practice conversations. The small group size: I was more comfortable. Blackboard part of it was very helpful. Support from group members and leaders Being asked our preference and made sure to accommodate us. I loved the discussions we had in session and thought the
teaching was excellent as well.
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Most Beneficial
I really appreciated doing the Myers-Briggs personality inventory. I have heard many social skills group try to “change” participants and make them be more social…so I thought the acknowledgment of the different personalities, some more introverted than others, was excellent!!
Any time we got a chance to talk amongst ourselves (typically during the 1-on-1’s)
Also blackboard helped me talk to people. Also just the one on one talking with someone helped me improve my speaking skills.
Some of the group talk sessions got me to open up more It was a relaxing break from the hardships of school and it was just
fun to just listen to other people’s stories
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Least Beneficial
Hmm…hard to say. One of the interactions that was more staged – we were in dyads – felt a little forced. Although I think I was out of my comfort zone so not necessarily that it wasn’t helpful.
The length of the group. Longer sessions Longer group meeting Maybe 1.5 to 2 hour sessions just because they
always seemed to end quickly.