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Individuals with autism spectrum disorder (ASD) display a multitude of deficits in social functioning along with deficits in communication and social skills and patterns of repetitive and stereotyped behaviors. Historically, however, social development, especially within behavioral treatment approaches, has received the least amount of attention in treatment. The unfortunate result is limited ability and reduced opportunities to participate in the social world, often leading to loneliness, isolation, and depression for persons with ASD. Limited social skills can have a devastating effect on overall quality of life, yet intervention, programming, and teaching focused on social skills and their development tend to lag well behind treatment efforts in other skill domains. Some earlier attempts to use ABA procedures for establishing social competencies tended to involve social targets that were limited and often involved rote, stiff and rigid social responses. Today, a growing range of approaches are being used to systematically teach social skills in individual and group arrangements, while preserving their authentic social nature and intent which also have strong research support (e.g., teaching interactions, video modeling, pivotal response training, and discrete trial teaching). These interventions are rooted in ABA and many find their origins in Ivar Lovaas’s UCLA Young Autism Project and Mont Wolf’s (Kansas) Teaching Family Project.
Social skills are perhaps the most critical skills that a child can learn. Learning these skills is important for a number of reasons. First, these skills strongly influence the quality of life. When all is said and done, it doesn’t matter how smart a person is or how many facts he or she knows; rather, what is most critical is whether the individual has at least one meaningful friendship. Is there someone the person spends time with, can talk to, and enjoy life with? When people don’t have meaningful friendships, passions, and hobbies, that emptiness all too often results in boredom, isolation, and eventually depression. Tragically, in the world of ASD, social skills are all too often not a priority. Home programs generally concentrate on developing language, and schools focus on academic skills. Although these skills are certainly helpful to children, by themselves they are not nearly enough.
The contemporary ABA approach to social skills and relationship development treatment illustrated in the video is designed to focus on building more than simple social responses. This ABA approach, shown in a group setting, is intended to capture the essence of authentic social competence and genuine relationship development while remaining systematic and analytic.
One teaching approach that has been used with children and adolescents with ASD with great success for many years, and that has a growing body of research support, is the Teaching Interaction (TI) procedure. Discrete Trial Teaching (DTT), including the use of the Cool versus Not Cool procedure, has also been shown to be effective in promoting social skill growth. Together these methods, along with motivational arrangements like token economies, can be a very effective way to teach a wide range of numerous social skills at home, at school, in the community, and in teaching settings ranging from one-on-one instruction to large groups.
The first step of the teaching interaction procedure is to label and identify the social skill that is being targeted. In the second step, the teacher provides a meaningful rationale, or reason why the learner should engage in the social behavior. In the third step, the teacher first describes the behavior by breaking the targeted skill into smaller behavioral parts, and then demonstrates the desired behavior. In the fourth step, the learner has the opportunity to practice or role-play the desired social behavior with the teacher. In the fifth step of the TI, the teacher provides specific feedback based on the learner’s practice of the skill during role- plays. In the sixth and final step, the learner is provided with an external consequence or reinforcement (e.g., points on a token system) based on his or her performance of the skill as well as the overall level and quality of his or her “learning how to learn” behaviors (e.g., compliance, attention, engaged effort) during the TI process.
Discrete Trial Teaching can be used to teach social skills to individuals whose language, interactional, or cognitive deficits preclude their participation in Teaching Interactions. DTT involves simplifying instruction (trials of learning that include an instruction, brief opportunity for response and clear and concise feedback, along with a faded assist or prompt as necessary) and breaking down skills to learnable levels and systematically expanding their complexity and promoting their usage in everyday life. Among the DTT methods utilized to teach social skills to individuals with ASD at all functioning levels is the Cool versus Not Cool procedure.
The Cool-Not Cool discrimination procedure is used to help an individual with ASD tell the difference between “Cool” (appropriate/correct) and “Uncool” (inappropriate/incorrect) versions of a social skill or its parts (e.g., body posture, voice intonation, facial expression). During the procedure, the teacher provides examples of the forms of the behavior (e.g., in vivo, pictorially, through video modeling), and the student learns to correctly identify the category of the skill (e.g., Cool or Not Cool, polite or impolite, bored or interested etc.).
The social skills intervention group presented in this video includes two neuro-typical children.
Children with ASD do not readily pick up social skills merely through exposure to others with those competencies. It is also the case that ongoing guidance, facilitation, and assistance (prompts or help that is never faded) do not produce independent social growth. This holds true for all individuals with ASD no matter their functioning level. What children need is careful and systematic instruction to build social behavior, whether simple or complex. Further, and perhaps most critical, growth in the social area cannot be expected to broadly and generally occur when work happens only once or twice a week (or even once or twice a day!) in isolated groups. The same is true for the development of actual, reciprocal relationships.
Necessary ingredients for social skills groups typically include the following:
Whether in individual, play date, or social skills group settings, addressing social skills through the use of a social skills taxonomy may prove helpful in identifying needs, developing curriculum and establishing skills and relationships.
The following social skills taxonomy has been developed to help organize, categorize, and direct thinking and efforts. Fairly intuitive in structure and concept, it is designed so that most social skills would be covered by at least one of the domains of the taxonomy. There can be overlap between the areas, and the skills in the various areas are often interrelated. Such is the nature of social skills.
The social skills taxonomy consists of five areas, each containing basic, intermediate, and advanced skills:
Evidence-Based research on ABA:
A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: A randomized trial in kindergarten and first grade.1Researchers randomized 95 kindergarten students to either a two-year social communication intervention or a control group that did not receive the intervention. In the intervention group, two neuro-typical peers rotated with each child with ASD to form a triad (2 peers to one focus child). Peers were selected based on teacher recommendation of children who had (1) good school attendance, (2) high social status (liked by majority of classmates), (3) age-appropriate social skills, and (4) willingness to participate. Pairs of peers rotated from one child to another each day. In addition, about 3 times a week, social groups were assembled to teach social and communication skills using games and age-appropriate table-top play activities (e.g., card games, popular board games). Skills taught in the groups included (a) requests and sharing, (b) comments about one’s own play activities, or personal actions on objects, (c) comments about others’ play activities, or peer actions on objects, (d) niceties such as saying please and thank-you, and giving compliments, and (e) ideas about setting up games and rules (‘‘Ways to Play’’). Sessions started with an adult-led discussion about the target social communication skill, practice of the target skill using written and picture cues, and child-peer practice with adult feedback. These discussions were followed by play/game activities with peer prompting of skill use, and then five-minute teacher reinforcement and feedback of skill use.Children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment observation. Treatment session data showed significant growth in total communications over baseline levels for the children in the intervention group. Children in treatment also showed more growth in language and adaptive communication. Finally, teachers’ ratings of prosocial skills revealed significantly greater improvements for the intervention group. highly structured one-on-one treatment for children on the autism spectrum that was developed at UCLA in the 1980s by Ivar Lovaas. Based on the results of this technique, which deconstructs every human social behavior into sequences of tiny steps and seeks to teach children the steps using behavioral therapy tools, Lovaas claimed that nearly half of the children who received this therapy in its full form recovered. The claim created considerable controversy, and examination of the treatment and Lovaas’ data identified a number of problems. More recent case studies, and two systematic reviews of those studies, have shown that although a certain percentage of individuals with the diagnosis do recover (have successful, functional lives), the rate of recovery may not be higher among individuals who underwent ABA or other intensive behavioral-based therapies than among those who received much less intensive types of therapy. The article follows 5 young people and their families from birth through their diagnoses and treatment; 4 of the 5 have recovered. The fifth, a young man, never learned to speak and now resides in a group home, in spite of intensive one-on-one therapy, yet another is a popular and accomplished honor student in his senior year of high school, in spite of no intensive therapy. Nothing in the studies seems to suggest what might predict whether any one child will benefit more from intensive therapy or even outgrow the diagnosis on his or her own.
Impact of social communication interventions on infants and toddlers with or at-risk for autism: A systematic review.2Morgan and colleagues conducted a systematic review of studies on social communication interventions for children age three years or younger, with or at risk for ASD. The review included seven group studies and nineteen single-subject studies (enrolling a total of 427 children, ranging in age from 10 to 36 months). Interventions varied widely, including Early Start Denver Model, reciprocal imitation training, pivotal response training (PRT), and video modeling. The studies reported primarily positive effects of the interventions on social communication skills in terms of both growth rates and gain scores but not emerging language and language-related cognitive skills. Maintenance of skills after the interventions ended varied by the types of skills, and reporting of generalization results was limited. Problems with research design were noted for both single-subject (e.g., lack of assessor blinding to treatment) and group studies (e.g., use of convenience sampling).
Parent-implemented social intervention for toddlers with autism.3Researchers randomized parents of 82 toddlers with autism spectrum disorders (ASD) to two types of parent training for the Early Social Interaction (ESI) Project. One group of parents were offered individual training 2 or 3 times per week at home or in the community, while the other group was offered group training once per week in a clinic. All ESI trainings taught parents how to embed strategies to support their child’s social communication throughout everyday activities. The ESI intervention, based on the manualized Social Communication, Emotional Regulation, and Transactional Supports (SCERTS) curriculum, lasted nine months. Parents were expected to employ the techniques with the child at least 25 hours per week.
Standardized validated measures were used to assess autism symptoms, social-communication skills, behavior, motor skills, and language. Individual-ESI was statistically superior on six child outcomes, including significantly greater improvement on social components of communication and receptive language. However, children in both groups displayed worsening in restricted repetitive behavior and both groups failed to progress in motor skills compared to norms. The authors conclude that findings support the efficacy of individual-ESI compared with group-ESI on child outcomes.
1 Kamps D, Thiemann-Bourque K, Heitzman-Powell L, et al. A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: A randomized trial in kindergarten and first grade. Journal of Autism & Childhood Schizophrenia. June 2015, Volume 45, Issue 6, pp 1809-1824.
2 Morgan LJ, Rubin E, Coleman JJ, Frymark T, Wang BP, Cannon LJ. Impact of social communication interventions on infants and toddlers with or at-risk for autism: A systematic review. Focus on Autism and Other Developmental Disabilities 2014;29(4):246-56.
3 Wetherby AM, Guthrie W, Woods J, Schatschneider C, Holland RD, Morgan L, et al. Parent-implemented social intervention for toddlers with autism: an RCT. Pediatrics. 2014;134(6):1084-93.