Social Skills Interventions Used With Autism Spectrum Disorders

Does your child who is diagnosed with an autism spectrum disorder receive Social Skills? What are Social Skills? What interventions are used for Social Skills and how effective are they? (This is a short paper I did in a graduate course at Johns Hopkins in 2005.)




Social Skills Interventions Used With Autism Spectrum Disorders


Abstract
Social skills for autism spectrum disorders (ASD) are the most prolific problem that overwhelms the individual and others around them. Being able to communicate and get a long with others is vital in being able to achieve to their fullest potential. It is therefore essential and required that this be taught. How to address this problem and teach social skills for ASD is easier said than done. This paper will discuss briefly the interventions used with social skills and their effectiveness in teaching individuals with ASD.


Social Skills Interventions Used With Autism Spectrum Disorders
Children diagnosed with autism spectrum disorders (ASD) have deficits in understanding and effectively using social skills to interact and communicate with others. Studies have confirmed that children diagnosed with ASD often display a lack of eye contact and misunderstand social cues such as body language, gestures, and facial expressions. Due to their misunderstanding of certain social cues, children with ASD may behave inappropriately. They maybe become aggressive toward or withdraw from others, demonstrate self-injurious behaviors, and loose control altogether (Adams, Gouvousis, VanLue, & Waldron, 2004).

Children with ASD show an inability to understand complex rules of social interaction; are naïve; are extremely egocentric; may not like physical contact; talk at people instead of to them; do not understand jokes, irony, or metaphors; use monotone or stilted, unnatural tone of voice; use inappropriate gaze and body language; are insensitive and lack tact; misinterpret social cues; cannot judge “social distance”; exhibit poor ability to initiate and sustain conversation; have well-developed speech but poor communication; are sometimes labeled “little professor” because speaking style is so adult-like and pedantic; are easily taken advantage of (do not perceive that others sometimes lie or trick them); and usually have a desire to be part of the social world (Williams, 2001).


Targeting Interventions
The standard interventions for ASD conditions in childhood are behavioral (Applied Behavioral Analysis: ABA), speech therapy, and special education. A meta-analysis of treatment effects suggest that no one approach is better than another, but that interventions are most successful when they start early, are intensive and are highly structured (Baron-Cohen, 2004).


Social Skills Groups
Social skills groups are an intervention used for ASD to provide an opportunity to learn and practice a range of social abilities. Social skills groups can be both educational and entertaining. The duration of each session or course will vary accordingly to the ability levels and rate of progress of the participants. They can be a component of speech and drama classes or a separate program run by specialists in ASD. The group may comprise students with ASD who attend different schools and can also include several ordinary children. The number or participants in the social group must be small to allow for individual tuition and minimal disruption. Prior to the sessions, a profile is prepared on strengths and weaknesses for each participant (Attwood, 1998).

One such study by Barnhill, Cook, Tebbenkamp, and Myles (2002) to determine the effectiveness of social groups found two positive outcomes. This social group was led by three trainers in the field of ASD during Saturday afternoons, lasting for an eight week period. Even though the social group met for such a short period of time, it resulted in social growth among the participants. First, some social relationships were developed and maintained even after the training had ended. The second outcome of note was the ability of many participants to read the nonverbal communication of others following intervention. Also, participants appeared to be more aware of the importance of eye contact.


Social Stories
Carol Gray has developed a technique called social stories to help a child with ASD understand cues and actions for specific social situations. Social stories are an effective method of providing both guidance and direction to promote self-awareness, self calming, and self-management in responding to social situations. The technique involves creating a short story that describes the situation and includes appropriate actions and expressions. By creating a short story, the situation is described in terms of relevant social cues, anticipated actions and information on what is occurring and why. The stories are written according to specific guidelines based on Gray’s extensive use of this technique. The story is customized for the individual and their circumstance (Attwood, 1998).

Adams et al. (2004) found that social story intervention decreases a variety of undesirable behaviors exhibited by children diagnosed with ASD. Results of their study support the notion that social story intervention is a useful too in decreasing inappropriate behaviors. Although the problem behaviors decreased, the participant’s use of oral language to express his needs/concerns increased. Furthermore, this study demonstrated that multiple behaviors serving one function can be successfully addressed in a single social story. Using one story instead of four stories to address behaviors appears to be more efficient and effective.


Comic Strip Conversations
Gray developed another intervention called comic strip conversations that was designed to illustrate and interpret social situations and provide support to students who struggle to comprehend the quick exchange of information, which occurs in a conversation. Comic strip conversations promote social understanding by incorporating simple figures and other symbols in a comic strip format. Speech, thought-bubble symbols, and color are used to help the individual with ASD see and analyze a conversation. Comic strip conversations allow the child to analyze and understand the range of messages and meanings that are natural part of conversation and play. Many children with ASD are confused and upset by teasing or sarcasm. The speech and thought-bubble as well as choice of colors can illustrate the hidden messages that the child is missing. Educators can also draw a social situation to facilitate understanding or assist students in doing their own illustrations (Myles & Simpson, 2001). Comic strip conversations have been found to change behavior and were most effective in helping the ASD to interpret social situations. It is reported that they enjoy using comic strip conversations and will request their use from others at school and home (Rogers & Myles, 2001). Research is needed to validate whether and under which circumstances social stories and comic strip conversations are effective.

These two interpretive techniques developed by Gray appear to hold promise for children and youth with ASD. They directly address an area of challenge seen in person with ASD; interpreting social situations that are primarily verbal and that offer little reflection time. Both techniques are also potentially important because they are adult and student friendly and are designed to be used in the classroom, home, and community settings with no need for expensive tools or specially constructed environments. (Rogers & Myles, 2001).


Social Autopsies
Social autopsies have been successful with ASD individuals and are particularly well suited to interpret social and behavioral situations. Rick Lavoie developed this intervention to help students with severe learning and social problems understand social mistakes, a social skills autopsy is used to dissect social incidents so that individuals learn from their mistakes. When a social mistake occurs, the individual meets with a teacher, counselor, or parent. Together, in a non punitive fashion, they identify the mistake and determine who was harmed by it. Then the student develops a plan to ensure that the error does not reoccur. Because of the visual strengths, problem-solving deficits, and language-processing problems of the student with ASD, social skills autopsies may be enhanced by using written words or phrases or pictorial representations to illustrate each of the stages (Myles & Simpson, 2001).


SOCCSS
Another social skills intervention that has been successful with ASD is the SOCCSS (Situation, Options, Consequences, Choices, Strategies, Simulation). SOCCSS strategy was developed by Jan Roosa to help students with social interaction problems put social and behavioral issues into a sequential form. The strategy helps students understand problem situations and lets them see that they have to make choices about a given situation and that each choice has a given consequence (Myles & Simpson, 2001).


SODA
SODA is a social behavioral learning strategy that can enhance the social interaction skills of individuals with ASD. SODA helps the ASD guide their thinking strategies by replacing their own inflexible and ineffective social interaction rules with SODA.

SODA provides them with a set of rules that help them attend to relevant social cues (both verbal and non-verbal), ponder their relevance and meaning, and select an appropriate response during novel social interactions. It has four components: Stop, Observe, Deliberate, and Act. Each component contains an icon and three to five questions or statements. These should be individualized to meet the specific needs and level or each student. The visual strategy format of SODA serves as an ongoing cueing system and each SODA component can be shrunk to fit on a one by three inch card that can be laminated and inserted in a visual strategy container. The effectiveness of using SODA is still ongoing, but has shown promise that it does help ASD successfully navigate new social situations (Bock, 2001).


Games
To teach pragmatic language that the ASD have tremendous problems with, educators may do this through direct modeling and games. Games can address initiation of communication, response initiation, and topic maintenance. During the game, the educators should address body language, facial cues, and gestures, along with recognition and interpretation of voice qualities during social skills groups. (Falk-Ross, Iverson, & Gilbert, 2004).

The most effective way for individuals with ASD to learn and retain social skills is to practice them in authentic contexts and certain activities. Several board games have come out on the market that may provide prerequisite knowledge or reinforce previously learned skills. The Idiom Game and What’s Up? are two such games that may prove invaluable for this population (Ganz, 2001).

While The Idiom Game and What’s Up? cannot replace structured social skills programs, they may provide students with information and practice that make navigation social situations easier. Such activities can serve as compliments to practice in using and understanding non-literal phrases and social interactions in applied situations (Ganz, 2001).


Virtual Environments
Single user virtual environments (SVEs) are done on a computer to provide an opportunity for users with ASD to learn social interaction skills in a safe environment, which they can visit as many times as they like. The use of game-like tasks can provide an incentive and can also be used to guide the user through progressive learning states. Collaborative virtual environments (CVEs) allow several users to interact simultaneously within the virtual environment, each talking different perspectives or role play characters. The use of computer technology may be specifically advantageous to the ASD community. The virtual environments offer a secure environment in which they can learn rules of social interaction without having to deal with others face to face. Users can also examine alternative outcomes and can move progressively though levels. Using this intervention for social skills has been advantageous and more studies are needed to assess user interpretation of virtual environments with respect to the real world (Cobb, Beardon, et al., 2002).


Conclusion
Since each individual with ASD is different and will respond differently to interventions, one must be open to new ideas and be willing to try alternative methods. Such methods can result in increased appropriate responding, but they vary in their effectiveness among children and the results have not always generalized to performance in real-life settings.

As with any technique or service, the effectiveness of any social skills intervention depends upon the ASD individual and the person working with them. Without proper training in ASD and in the proper implementation of the intervention, the effectiveness is greatly altered as well. Frequent checks on the improvements in the ASD individual’s social skills is needed to see if the intervention is beneficial and if it should be continued or changed. Further research and studies are needed to see what is successful and utilized this knowledge in designing and implementing social skills intervention.