MAKING (& KEEPING)
FRIENDS:
A MODEL FOR SOCIAL SKILLS INSTRUCTION
by Dr. Scott Bellini, Research Associate, Indiana
Resource Center Autism
“I am not asking for my child to be the life of
the party, or a social butterfly. I just want her to be happy and
have some friends of her own. She is a wonderful kid, and I hope
someday others can see that.”
Social Skill Deficits in autism Spectrum Disorders
Indeed, many parents of children with Autism Spectrum Disorders (Autism Spectrum Disorder) echo this sentiment concerning
their child’s social functioning. They know that their child has
many wonderful qualities to offer others, but the nature of their
disability, or more precisely, their poor social skills, often preclude
them from establishing meaningful social relationships. This frustration
is amplified when parents know that their children want desperately
to have friends, but fail miserably when trying to make friends.
Often, their failure is a direct result of ineffectual
programs and inadequate resources typically made available for social
skills instruction. For most children, basic social skills (e.g.,
turn taking, initiating conversation) are acquired quickly and easily.
For children with Autism Spectrum Disorder, the process is much
more difficult. Whereas, many children learn these basic skills
simply by exposure to social situations, children with Autism Spectrum Disorder often need to be taught skills explicitly. The present
article addresses social skill deficits in children and adolescents
with Autism Spectrum Disorder by providing a five stage model for
social skills instruction, with particular emphasis placed on an
emerging intervention strategy, videotaped self-modeling (VSM).
Lack of “Know-How” Versus Lack of Social Interest
Impairment in social functioning is a central
feature of Autism Spectrum Disorder and is well documented in the
literature (Attwood, 1998; Rogers, 2000). Typical social skill deficits
include difficulties with: reciprocity, initiating interactions,
maintaining eye contact, sharing enjoyment, empathy, and inferring
the interests of others (APA, 1994). The cause of these skill deficits
varies, ranging from inherent neurological impairment (e.g., limbic
system dysfunction) to lack of opportunity to acquire skills (e.g.,
social withdrawal). Most important, these social skill deficits
make it difficult for the individual to develop, and keep meaningful
and fulfilling personal relationships.
The long held notion that individuals with Autism Spectrum Disorders lack an interest in social interactions is often
inaccurate. Many individuals with Autism Spectrum Disorder do indeed
desire social involvement, however, these individuals typically
lack the necessary skills to interact effectively. One young man
I worked with illustrates this point quite well. Prior to my visit,
the school staff informed me of his inappropriate behaviors and
his apparent “lack of interest” in interacting with other children.
After spending the morning in a self-contained classroom, Zach was
given the opportunity to eat lunch with the general school population
(a time and place that produced many of the problem behaviors).
As he was eating lunch, a group of children to his right began a
discussion about frogs.
As soon as the conversation began, he immediately
took notice. So too did I. As he was listening to the other children,
he began to remove his shoes, followed by his socks. I remember
thinking, “Oh boy, here we go!” As soon as the second sock fell
to the ground, Zach flopped his feet on the table, looked up at
the group of children and proclaimed, “Look, webbed feet!” The other
children (including myself) stared in amazement. In this case, Zach
was demonstrating a desire to enter and be a part of a social situation,
but he was obviously lacking the necessary skills to do so in an
appropriate and effective manner.
This lack of “know-how” could also lead to feelings
of social anxiety in some children. Many parents and teachers report
that social situations typically evoke a great deal of anxiety from
their children. Individuals with Autism Spectrum Disorder often
describe an anxiety that resembles what many of us feel when we
are forced to speak in public (increased heart rate, sweaty palms,
noticeable shaking, difficulties concentrating, etc.). Not only
is the speaking stressful, but just the thought of it is enough
to produce stomach-gnawing butterflies. Imagine living a life where
every social interaction you experience was as anxiety provoking
as having to make a speech in front of a large group!
The typical coping mechanism for most of us is
to reduce the stress and anxiety by avoiding the stressful situation.
For individuals with Autism Spectrum Disorder, it often results
in the avoidance of social situations, and subsequently, the development
of social skill deficits. When a child continually avoids social
encounters, she denies herself the opportunity to acquire social
interaction skills. In some individuals, these social skill deficits
lead to negative peer interactions, peer rejection, isolation, anxiety,
depression, substance abuse, and even suicidal ideation. For others,
it creates a pattern of absorption in solitary activities and hobbies;
a pattern that is often difficult to change.
A Five Step Model
• Identify Social Skill Deficits
• Distinguish Between Skill Acquisition and Performance
Deficits
• Select Intervention Strategies
• Implement Intervention
• Assess and Modify Intervention as Necessary.
The following section will summarize the proposed
“Five Step Model” of social skills instruction. Before implementing
social skills instruction, it is important to begin with a thorough
assessment of the individual’s current level of social skills functioning.
Once the assessment is complete, the next step is to discern between
skill acquisition deficits and performance deficits. Based on this
information, the selection of intervention strategies takes place.
Once intervention strategies are implemented, it is then imperative
to evaluate and modify the intervention as needed.
Although I use the term “Steps,” it is important
to note that the model is not perfectly linear. That is, in real-life
applications social skills instruction will not follow a lock-step
approach from step one to step five. For instance, it is not uncommon
for me to identify additional social skill deficits (step one) while
I am in the middle of the implementation process (step four). In
addition, I am continually assessing and modifying the intervention
as additional information and data is accumulated.
Identify Social Skill Deficits
The first step in any social skills training program
should be to conduct a thorough evaluation of the individual’s current
level of social functioning. The evaluation should detail both the
strengths and weakness of the individual related to social functioning.
The assessment should involve a combination of observation (both
naturalistic and structured), interview (e.g., parents, teachers,
playground supervisors), and standardized measures (e.g., behavioral
checklists, social skills measures). I have developed a social skills
profile to assist in the identification of typical social skill
deficits in individuals with Autism Spectrum Disorder. Kathleen
Quill (2000) also provides an excellent social skills checklist
for parents and professionals in her book, Do-Watch-Listen-Say.
It is important for the child’s team to ascertain
current level of functioning and effectively intervene at the child’s
area of need. For instance, if the evaluation reveals that the child
is unable to maintain simple one-on-one interactions with others,
then the intervention should begin at this level and not at a more
advanced group interaction level. After a thorough assessment of
social functioning is complete, the team should then determine whether
the skill deficits identified are the result of skill acquisition
deficits or performance deficits.
[Author’s Note: A detailed description of social
skills assessment is beyond the scope of this article. If you would
like more information on this topic, including a copy of the social
skills profile form that I currently use, please contact me at the
IRCA via email at sbellini@indiana.edu].
Skill Acquisition versus Performance Deficits
Social skills training programs typically focus
on one of two areas: skill acquisition deficits and/or performance
deficits (Gresham, 1995). A skill acquisition deficit refers to
the absence of a particular skill or behavior. For example, a child
with an Autism Spectrum Disorder may not know how to effectively
initiate a conversation with another person; therefore, he/she will
often fail to initiate interactions (can’t do). A performance deficit
refers to a skill or behavior that is present, but not used.
To use the same example, a child may have the
skill (or ability) to initiate a conversation, but for some reason,
chooses not to do so (won’t do). Careful consideration should be
used to discern between a skill acquisition deficit and a performance
deficit. A good rule of thumb is to ask the question, “Can the child
perform the task with multiple persons and across multiple settings?”
For instance, if the child only initiates interactions with mom
at home and not with his peers at school, then you should address
the initiation difficulty as a skill acquisition deficit. I hear
the statement a lot from school personnel, “The child interacts
fine with me, so it must be a performance deficit, right?” Not quite.
In my experience, children with Autism Spectrum Disorder tend to
interact better and more easily with adults, because adults typically
make it easy for them; the adults do most of the conversational
“work” for the child.
To use a baseball analogy, just because Tommy
can hit Dad’s soft, underhand pitches at home, doesn’t mean he has
mastered the skill well enough to hit pitches thrown by his peers
on the playing field. Sometimes adult interactions with children
with Autism Spectrum Disorder are similar to throwing a child a
soft, underhand pitch. Although they are positive and well intended,
they do not adequately prepare the child for more difficult peer-to-peer
interactions.
The benefit of using a skill acquisition/performance
deficit model is that it guides the selection of intervention strategies.
Most intervention strategies are better suited for either skill
acquisition or performance deficits. The intervention selected should
match the type of deficit present. That is, you would not want to
deliver an intervention designed for a performance deficit, if the
child was mainly experiencing a skill acquisition deficit. For instance,
in the example above, if Tommy has not mastered the skill of hitting
(skill acquisition deficit), all the reinforcement in the world
(including pizza!) will not help Tommy hit the ball during the game.
If we want him to be a skilled hitter, we need to provide Tommy
additional instruction on the mechanics of hitting a baseball.
The same is true for social skills. If we want
a child to be socially fluent, then we need to deliver effective
social skills instruction. In contrast, if Tommy does have sufficient
hitting skills, but lacks the motivation to “do his best,” then
the reward of cheese and pepperoni may be all he needs to excel
on the playing field. Too often, social skill deficits and inappropriate
behaviors are wrongly conceptualized as performance deficits. In
my experience, the vast majority of social skill deficits in individuals
with Autism Spectrum Disorder can be attributed to skill acquisition
deficits. Therefore, it is essential to focus on skill development
when implementing social skills instruction.
Once a thorough social profile is completed and
the team is able to attribute the social difficulties to either
skill acquisition or performance deficits, social skills instruction
is ready to begin. There are a variety of strategies that can be
delivered to children with Autism Spectrum Disorder. The most important
thing is that the strategies being delivered are appropriate to
the unique needs of the child and that a logical rationale can be
provided for using the intervention.
The following strategies provide a sampling of
techniques that can be implemented to teach successful social interaction
skills to children and adolescents with Autism Spectrum Disorder.
Many of the strategies listed below are designed to address skill
acquisition deficits. However, some of the strategies (in particular,
videotaped self-modeling) work equally well in addressing performance
deficits. In addition, it is imperative that the child be reinforced
continually for his effort and participation in the program.
Selecting and Implementing the Intervention
Accommodation and Assimilation
When selecting intervention strategies, it is
important to consider the notion of accommodation versus assimilation.
Accommodation, as it relates to social skills instruction, refers
to the act of modifying the physical or social environment of the
child to promote positive social interactions. Examples of this
include: training peer mentors to interact with the child throughout
the school day, autism awareness training for classmates, and signing
your child up for various group activities, such as little league,
or Boy or Girl Scouts. Whereas accommodation addresses changes in
the environment, assimilation focuses on changes in the child. Assimilation
refers to instruction that facilitates skill development that allows
the child to be more successful in social interactions. The key
to a successful social skills training program is to address both
accommodation and assimilation. Focusing on one and not the other
sets the child up for failure. For instance, one family that I worked
with did a wonderful job of structuring playgroups for their child,
and keeping their child active in social activities. However, they
were becoming increasingly frustrated with the fact that their son
was not making friends on his own and still having negative peer
interactions. The problem was that they were putting the cart before
the horse. They provided their child with ample opportunity to interact
with others, but they weren’t providing him the skills necessary
to be successful in those interactions. Similarly, providing skill
instruction (assimilation) without modifying the environment to
be more accepting of the child with autism also sets the child up
for failure. This happens the moment an eager child with autism
tries out a newly learned skill on a group of non-accepting peers.
The key is to teach skills and modify the environment. This ensures
that the new skill is received by peers with both understanding
and acceptance.
Social Skills Strategies
As stated previously, social skills often need
to be taught explicitly to children and adolescents with Autism Spectrum Disorder. Traditional social skills strategies (such as
board games about friendships and appropriate classroom behavior)
tend to be too subtle for many children with Autism Spectrum Disorder.
For instance, a school counselor was frustrated with the progress
she was making with a student with autism. She stated that the program
was showing positive results with “other kids in the group,” but
the student with autism didn’t seem to “get it.” Indeed, he was
not “getting it!” The reason was quite apparent. The school counselor
was attempting to teach the students about the concept of “friendship.”
This is acceptable for some children, but for
children with Autism Spectrum Disorder it tends to be a too subtle
form of instruction. That is, instead of spending countless hours
teaching the child about “friendship,” the instruction should have
focused on skills the child could use to make and keep friends.
Experience tells me that the concept of friendship is much easier
to understand once you have a friend or two! The following section
summarizes various social intervention strategies that have been
designed to promote social interaction skills in children with Autism Spectrum Disorder, including peer-mediated instruction, thinking-feeling
activities, reciprocity instruction, social stories, role-playing,
and video-taped self-modeling.
Peer Mentors
The use of peer mentors is one example of an effective
strategy for children with Autism Spectrum Disorders. Peer mediated
interventions have been frequently used to promote positive social
interactions among peers (Strain & Odom, 1986; Odom & McConnell,
1993). Peer mediated instruction allows us to structure the physical
and social environment in a manner to promote successful social
interactions. In this approach, trained peers participate in the
intervention by making social initiations or responding promptly
and appropriately to the initiations of children with Autism Spectrum Disorder during the course of their school day.
Peer mentors should be classmates of the child
with Autism Spectrum Disorder, have age-appropriate social and play
skills, have a record of regular attendance, and have a positive
(or at least neutral) history of interactions with the child with
Autism Spectrum Disorder. Peer mentors should also be made aware
of the behaviors associated with autism in a manner that is respectful
and developmentally appropriate for the age group. The use of peer
mentors allows the teacher and other adults to act as facilitators,
rather than participate as active playmates. That is, instead of
being a third wheel in child-child interaction, the teacher prompts
the peer buddies to initiate and respond appropriately to the child
with Autism Spectrum Disorder. The use of peer mentors also facilitates
generalization of skills by ensuring that newly acquired skills
are performed and practiced with peers in the natural environment.
Thoughts and Feelings Activities
Recognizing and understanding the feelings and
thoughts of self and others is often an area of weakness for individuals
with Autism Spectrum Disorder and is essential to successful social
interactions. For instance, we continually modify our behavior based
on the non-verbal feedback we receive from other people. We may
elaborate on a story if the other person is smiling, looking on
intently, or showing other signs of genuine interest. On the other
hand, if the other person repeatedly looks at her watch, sighs,
or looks otherwise disinterested, we may perhaps cut the story short
(I said perhaps!). Individuals with Autism Spectrum Disorder often
have difficulty recognizing and understanding these non-verbal cues.
Because of this, they are less able to modify their behavior to
meet the emotional and cognitive needs of other people.
Picture cards can be used to ascertain the child’s
level of awareness concerning the feelings of others. The pictures
should portray characters participating in various social situations
while emoting various feelings. The child is asked to identify how
the characters are feeling based on facial expressions, posture,
and the situation portrayed in the picture. This requires the child
to make inferences based on the context and cues provided in the
picture. Once mastery is achieved on the picture cards, move to
video footage of social situations (make sure your machine pauses
with a clear picture). A thought bubble activity can also be used
to infer the thoughts of others. The idea is to teach the child
that we can often determine what others are thinking by listening
to what they are saying.
For instance, if Michael is talking about basketball,
he is probably thinking about basketball as well. During the sessions,
the child is read statements (similar to the one just described)
and asked to fill in the thought bubble for the character. For instance,
for the one example above, the child would write the word “basketball”
in a thought bubble to describe what Michael was thinking. In addition,
if-then statements can be used to infer the interests of others.
For instance, if Michael is talking about basketball and thinking
about basketball, then he probably likes basketball as well. Recognizing
the interests of others is extremely important for initiating interactions
and ultimately developing friendships. Patricia Howlin’s book Teaching
Children with autism to Mind-Read offers helpful information and
resources in this area of instruction. In addition, there are a
number of software programs on the market that address both emotions
and perspective taking abilities.
Facilitating Reciprocal Interactions
Another area of concern for individuals with Autism Spectrum Disorder is lack of reciprocal interactions. Individuals
with Autism Spectrum Disorder often engage in one-sided interactions
that lack give and take. In conversations, these children rarely
ask questions of others, or rarely talk about the interests of others.
To address this, I created an activity called, “Newspaper Reporter.”
For this activity, the child is required to play the role of a newspaper
reporter and ask questions of others. The form consists of rather
simple questions, including a person’s name and age, hobbies and
interests, and favorite foods.
The goal is simply to get the child in the habit
of asking questions, thereby increasing the give and take of conversations.
Later in the sessions, the child should be encouraged to ask additional
probing questions to gain more information from the other person
(in the spirit of great investigative journalism!). This often becomes
a favorite activity for children, as they often ask for extra forms
to take home. A chess timer can also be used for verbal individuals
with Autism Spectrum Disorder to facilitate give-and-take in interactions.
In this activity, the person with Autism Spectrum Disorder is instructed
to ask another person a question, and then press the chess timer
(or similar device). After answering the question, the other person
then poses a question to the person with autism and then presses
the timer herself. This back-and-forth interaction proceeds for
a specified time period with the goal of eliminating the timer from
the interaction altogether. This activity tends to be quite difficult
for even the most verbally fluent adolescents.
Social Stories
A Social Story is a frequently used strategy to
teach social skills to children with disabilities. A Social Story
is a non-coercive approach that presents social concepts and rules
to children in the form of a brief story. This strategy could be
used to teach a number of social and behavioral concepts, such as
making transitions, playing a game, and going on a field trip. Carol
Gray (1995) outlines a number of components that are essential to
a successful Social Story, including: the story should be written
in response to the child’s personal need; the story should be something
the child wants to read on her own (depending upon ability level);
the story should be commensurate with ability and comprehension
level; and the story should use less directive terms such “can,”
or “could,” instead of “will” or “must.”
This last component is especially important for
children who tend to be oppositional or defiant (i.e., the child
who doesn’t decide what to do until you tell him to do something...then
he does the opposite!). The Social Story can be paired with pictures
and placed on a computer to take advantage of the child’s propensity
towards visual instruction and interest in computers. I have found
that children with Autism Spectrum Disorder learn best when Social
Stories are used in conjunction with Role-Playing. That is, after
reading a Social Story, the child then practices the skill introduced
in the story. For instance, immediately after reading a story about
raising your hand before speaking, the child would practice raising
his hand to be called on (for more comprehensive guidance on creating
a Social Story, see Gray, 1995).
Role Playing/Behavioral Rehearsal
Role-playing is used primarily to address basic
interaction skills. Often times, individuals with Autism Spectrum Disorder have great difficulty initiating social interactions and
getting other children to engage in activities with them. They are
often dependent on the advances of other children; which can be
infrequent. Many children with Autism Spectrum Disorder only engage
in activities with other children if the other child initiates the
interaction. Role-playing consists of acting out various social
interactions that the child would typically encounter.
During the role-play scenarios, the child could
be required to initiate a conversation with another person as the
other person is engaged in a separate task. He would then have to
ask to join in, or ask the other person to join him in another activity.
The latter typically proves to be most difficult for children with
Autism Spectrum Disorder. During the first few sessions, it is not
uncommon for the child to get “stuck” in conversations and interactions,
often for minutes without knowing what to say or how to proceed.
During the early sessions, the child should be given ample time
to process and respond to the role-play scenarios. As the sessions
progress, speed and proficiency should gradually increase.
Videotaped Self-Modeling
Social skills are primarily acquired through learning
that involves observation, modeling, coaching, social problem solving,
rehearsal, feedback, and reinforcement-based strategies. Videotaped
self-modeling (VSM) is one means of instruction that allows the
interventionist to use this entire range of strategies to promote
skill acquisition, enhance skill performance, and remove interfering
problem behaviors. VSM is an intervention where individuals learn
skills by observing themselves performing the targeted skill. A
strength of VSM is that it allows the individual to learn, both
through observation and through personal experience. The use of
video taped self-modeling (VSM) has been shown to be effective in
treating children with a variety of disorders including: selective
mutism, attention deficit/hyperactivity disorder (ADHD), social
anxiety, aggressive/disruptive behavior, motor problems, and Autism Spectrum Disorders (Buggey, 1999; Harvey, 2000).
Recent research suggests great promise for the
use of video-modeling in social skills instruction for children
with Autism Spectrum Disorder. Alcantara (1994) used a video priming
technique to teach children with autism how to purchase items from
a store. The use of video instruction increased both the effectiveness
and efficiency of the children’s purchasing behaviors, and generalized
to other stores not portrayed on the videotape. Buggey and colleagues
(1999) used VSM to increase responding behaviors in preschool children
with Autism Spectrum Disorder. The children in the study viewed
videotapes of themselves answering questions while engaging in play
activities. Although answering questions was a low frequency behavior
for these children, the videos were edited to portray the children
as fluent in their responses. Charlop-Christy et al. (2000) found
that video-modeling was more effective than live modeling in teaching
daily living skills to children with Autism Spectrum Disorder. In
addition, the children viewing the video model demonstrated better
generalization of skills across settings.
Similarly, Sherer et al., (2001) demonstrated
that video modeling was an effective way to teach conversation skills
for some children with Autism Spectrum Disorder. In a recent article,
Charlop-Christy and Daneshvar (2003) used video modeling to teach
perspective taking to three children with Autism Spectrum Disorder
between the ages of 6 and 9. The researchers concluded that the
video modeling intervention was a quick and effective procedure
for teaching perspective taking and promoting generalization of
newly acquired skills.
The use of VSM has many benefits for individuals
with Autism Spectrum Disorder. First and foremost, VSM allows us
to capitalize on the individual’s propensity towards visual learning
by presenting a visual representation of the target skill instruction
(i.e., showing the child during social interactions). In addition,
personal experience suggests that watching videos is often a highly
desired activity for many children with Autism Spectrum Disorder,
thereby, increasing motivation and better attention to the instructional
task.
Another strength of VSM is that it lessons our
reliance on “Social Autopsies,” where we dissect and analyze a social
encounter with a child after it has already taken place. Instead,
VSM allows the individual to examine and analyze a social situation
as it is taking place on the video (with the luxury of pause and
rewind). Finally, VSM allows us to implement a social problem solving
intervention. Social problem solving is beneficial in addressing
the various social information processing deficits present in individuals
with Autism Spectrum Disorder and can easily be incorporated into
the VSM intervention.
VSM interventions typically fall within two categories:
positive self-review (PSR) and video feed-forward (Dowrick, 1999).
PSR refers to individuals viewing themselves successfully engaging
in a behavior or activity. PSR can be used with low frequency behaviors
(i.e., a behavior that the individual can sometimes do, but with
some difficulty) or behaviors that were once mastered, but are no
longer. In this case, the individual is simply videotaped while
engaging in the low frequency behavior, or videotaped while receiving
assistance to complete the task.
An example of PSR can be applied to my miserable
golf game (which, by the way, can be characterized as a skill acquisition
deficit). To implement the intervention, I can videotape myself
hitting the ball 10 times, with the hopes that I will hit at least
one good shot (low frequency behavior). After editing the tape,
the positive self-review intervention would involve me repeatedly
watching that one good shot. The goal would be for me to learn from
what I did right, not from what I did wrong. PSR works well for
individuals who need additional assistance to complete tasks successfully.
For instance, the child could be videotaped interacting with peers
while an adult provides assistance through cueing and prompting.
The cueing and prompting could then be edited out so that when the
child views the videotape, she sees herself as independent and successful.
Video feed-forward is another category of VSM
interventions. Video feed-forward interventions are typically used
when the individual already possesses the necessary skills in her
behavioral repertoire, but may not be able to put these skills together
to complete an activity. For instance, the child may have the ability
to get out of bed, brush her teeth, get dressed, and comb her hair
(morning routine), but can not perform these skills in the proper
sequence. A video feed-forward intervention would videotape her
engaging in each of these tasks and then splice the segments together
to form the proper sequence. The same can be done with typical social
interaction sequences. For instance, the child could be videotaped
demonstrating three different skills: initiating an interaction,
maintaining a reciprocal interaction, and appropriately terminating
the interaction. The three scenes could then be blended together
to portray one successful, and fluent social interaction.
Assess and Modify the Intervention
Although “Assess and Modify” is listed as the
last stage in the intervention process, it certainly is not the
least important. In addition, it also is not the last thing to think
about when designing a social skills program. Typically, as soon
as I am able to identify the social skill deficits to be addressed,
I begin to develop the methods for evaluating the efficacy of the
intervention. To use a basic example, if the target of the intervention
is social initiations, then I might take baseline data on the frequency
of initiations with peers and adults. I would then continue to collect
data on social initiations throughout the implementation stage.
Accurate data collection is essential in evaluating the effectiveness
of the intervention. It allows us to determine whether the child
is benefiting from the instruction, and how to modify the program
to best meet the child’s needs. In school settings, accurate data
collection is a legal imperative. When I work with school teams,
the focus is on integrating the social skills program with the child’s
behavioral and social objectives. As such, Stage 5 is typically
a very important aspect of IEP development, implementation, and
integrity.
Case Example
The following case study illustrates the use of
VSM for a young girl diagnosed with autism. “Kelly,” was a 6-year-old
girl with low average verbal ability. Although her vocabulary was
in the average range for children her age, she seldom used her language
spontaneously with classmates and teachers. She spoke only when
asked direct questions and interacted only when others initiated
the interactions. Consequently, Kelly spent the majority of her
playground time by herself, with little peer interaction. A social
skills assessment concluded that she had significant skill deficits
in initiating interactions, and maintaining interactions with peers.
A social skills intervention was designed to increase the frequency
and length of social interactions with peers. Data on peer interactions
(initiations and responses to peers) were collected in both a structured
playgroup, and during recess.
Two peers mentors were selected to participate
in a structured playgroup with Kelly. The peers were instructed
to initiate and to respond promptly to Kelly’s initiations. The
peers were also provided developmentally appropriate information
regarding autism and Kelly’s behaviors, which included hand-flapping.
Also prior to the playgroup, Kelly was read a social story related
to initiating social interactions. Each time the story was read,
Kelly was given the opportunity to practice initiation skills via
a role-playing procedure. The children participated in a playgroup
three days a week for two weeks. During the playgroups, Kelly was
prompted to initiate interactions with the peers, and she was prompted
to respond promptly and appropriately to the peers when they initiated
interactions with her.
The playgroups were videotaped over the two-week
time period. The video footage was then edited to exclude the continual
prompting and coaching provided to Kelly. The edited tapes portrayed
Kelly fluently interacting with her peers. The tapes were shown
to Kelly in 5-minute increments for two weeks. For Kelly, the VSM
procedure facilitated immediate increases in initiations and responses
to peers in both the play setting and on the playground. By the
end of the school year, Kelly had developed relationships with two
other children, friendships that continue to this day.
The purpose of this article is not to provide
an all-inclusive list of social skills strategies available for
children with Autism Spectrum Disorder. Instead, the present article
presents a social skills training model that assists families and
professionals in the delivery of social skills instruction. In addition,
not all programs are appropriate for every child. Great care and
planning needs to be put forth to ensure that the strategies used
in the program meet the individual needs of the child. Therefore,
a multi-dimensional intervention strategy that addresses the individual
characteristics (both strengths and weaknesses) of the child is
imperative.
In the example above, Kelly received weekly social
skills instruction, in addition to speech and occupational therapy.
Kelly needed a full compliment of strategies to be successful socially.
As her mother told me, Kelly may never be the life of the party
or a “social butterfly.” However, with the delivery of an effective
social skills program, Kelly has been given an opportunity to develop
the skills necessary to develop meaningful personal relationships.
And the rest of us have been given the opportunity to meet a truly
wonderful child.
References
Alcantara, P. R. (1994). Effects of videotape
instructional package on purchasing skills of children with autism.
Exceptional Children, 61, 40-55.
American Psychiatric Association. (1994). Diagnostic
and statistical manual of mental disorders (4th ed.). Washington,
DC: Author.
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