strengthening social comptence in children and youth with autistic spectrum disorders

luke moynahan, Børge Strømgren & Mickey Keenan

2004

social competence

• persons demonstrate social competence when they– initiate and sustain reciprocal interpersonal

relationships with members of their intimate and effective social networks

– attain personal goals with high probability and contribute effectively to attaining collective goals

– satisfy culturally determined explicit rules and implicit norms for conduct in accordance with established fundamental human rights,

– result in positive evaluation by others.

markers

• social competence is a behavioural competence that cannot be fully understood independent of contextual demands

• it can not be defined solely with respect to the capacity or behavioural dexteritey of the individual

• from a teaching perspective it is useful to take account of both contextual and developmental …– social arenas

• family, school, community, work• dyads, groups and larger systems

– age – developmental transitions • skill complexity• subtlety of contextual stimuli

positive consequences

• research within developmental social psychology (Durkin, 1995)

• social and clinical psychology (Seligman, ; Barlow & Durand, 1996)

• reveals that children who demonstrate high levels of social competence …– improved physical health, higher school

achievement, larger social networks and higher degree of perceived social support, higher probability of employment

costs of non-competence

• children who demonstrate low social competence reveal increased vulnerability to …– poor physical health– educational under achievement – family dysfunction including high levels of family stress

factors,– social isolation and weak social networks, – increased risk of conduct disorders, aggressive and anti-

social behaviour– increased risk of susbtance abuse– underemployment and unemployment

• (Andrews; Dodge; Farrington; Loeber; Patterson; Ogden; Svedhem)

autism

• Autism is defined primarily in relation to the inability to initiate and maintain social relations and to pervasive failure to vary behaviour according to context

• autism is particularly devastating in its effects upon the family– parental cohesion, sibling relations

• autism can have deleterious effects on family members participation in extrafamilial activities – school, leisure, work, friendships, community

engagement

autism & sc• autistic children will not acquire sufficient

repertoires of academic, social or vocational skills by mere exposure to the contingencies of normal life.

• neither will they acquire reporoires comparable to their non-autistic peers through provision of standard education

• they require specialized systematic educational services as early as possible

• they may require flexible specialized habilitation services throughout their lives

• such services must not only target the individual with autism men must focus on the child’s family and effective social network (Dunst, 1994; Powers, 1990; Carr et al, 2000)

programmes for teaching social competence

young children-play

• a lack of varied spontaneous make believe play is a defining feature of autism. It si also one of the most reliable early signs ogf autism. (Boucher & Wolfberg, 2003)

• cooperative play provides a rich source of tasks and challenges that can be used to strengthen social competence– fair play, turn taking, delay of gratification, rule

governed play, choice taking, decision making, cooperation in teams, leadership.

play – norwegian studies

• teaching children with autism to initiate and sustain cooperative play (Jahr, Eldevik & Eikeseth, 2000; Jahr & Tryggestad, 2001?)

• the methods chosen were – modelling and multiple exemplars– observation with and without verbal

description– participation in cooperative play– initiation of play with novel partners without

instruction or prompts

markers

• children had participated in Løvaas Early Intensive Behavioural Intervention

• could engage in simple play by themselves.

• could describe simple play responses • multiple exemplars

– differing forms of play– increasing complexity

• description of the behaviour of the models– in contrast to Meichenbaum (1977) modelling

av self-instructions

results

junior school –senior school

schoolbased programmes

• Prepare Curriculum (Goldstein, 1988, 1999) consists of 10 programmes– skillstreaming (ineterpersonal skills)– situational perception training– problem solving training– stress management training– anger control training– cooperation training– understanding and using groups– empathy training– moral reasoning training– recruiting pro-social support

PEACE CURRICULUM

• Cuuriculum developed by Sara Salmon and colleagues as ”extended ART” at peace4allkids, Center for Safe Schools and Communities

• P – Parental empowerment• E – Empathy training• A – Aggression management• C – Character education• E – Essential social skills

Aggression Replacement Training

• developed with multi- problem, delinquent youth in youth correctional facilities in north eastern USA by Arnold Goldstein, Barry Glick & John Gibbs (1988; 1998)

• based on social learning analysis of aggression (Bandura, 1973), stress innoculation training (Meicenbaum, Novaco & Feindler) and Moral Development paradigm (Kohlberg, 1968).

• Comprises three components …• skillstreaming• anger control training• moral reasoning training

skillstreaming

skillstreaming

basic training method (group)• 2 trainers demonstrate the chosen skill twice *• discussion of the relevance of the skill to students own

lives, similar experiences etc are briefly discussed• role play – step by step replay of the modelled skill,

trainers provide and rapidly fade specific prompts in order for the students to attain fluent use of the skill *

• feedback – response specific feedback to the main actor is provided by the co-actor and the group. Video is used to highlight important details *

• homework and transfer training tasks are planned

“transfer training"

• laminated skill cards highlight the major steps and rules for use, trainers may use fotoflows* (self-modelling) as well as booster training in natural settings

• overlearning – the group design ensures several repititions of the skill (multiple exemplar training) homework tasks also ensure further trials

• identical elements – roleplays are made as lifelike as possible – shift of training to actual locations

“transfer training"

• stimulus variation – invite other trainers, students to session, train in several locations at different times, creative use of homework

• use of reinforcement contingencies – students are trained in self-reinforcement *, contrived external reinforcement contingencies may be planned with parents other teachers etc, group contingencies and toekn economies may be established to ensure vicarious reinforcement

skillstreaming

• adjustments to skillstreaming – selection of skills based upon functional

assessment by child, parents and teachers– simultaneous and delayed imitation training – microtraining – fluency training of microskill

elements with rapid, response specific feedback

– use of video in training of self-evaluation of performance (reflexive feedback)

– commentator (simultaneous descriptor) and director (functional instruction) training

Anger control training

1. INTRODUCTION, ABC’s of anger

2. TRIGGERS; external triggers and internal triggers

3. ANGER CUES (signals); muscle tightening, clenched fists, pounding heart; ANGER REDUCERS; deep breathing, backwards counting, pleasant imagery

4. POSITIVE REMINDERS; self-instructional statements

STEPS WEEK BY WEEK 5. SELF-EVALUATION; self-rewarding

statements

6. THINKING AHEAD, figure out the C (consequence) in the ABC-model

7. ANGRY BEHAVIOR CYCLE; what do YOU do to make others angry

8. REHEARSAL OF FULL SEQUENCE; steps 1-7 + social skill

9. REHEARSAL OF FULL SEQUENCE; hassle log review

10. OVERALL REVIEW; full sequence

anger control training

• adjustments– fluency training in identification of anger

signals, interne and externe triggers – extension of anger reducers – mindfulness

procedures– regaining of self control– transformation of response functions– turning point and bubble talk techniques– magic remote control– response specific feedback group and reflexive

variations with use of video

moral reasoning training

• dilemma discussion methods

dilemma discussion –method 1

• the goal is to create conflict (cognitive dissonance) – perturb students immature or dogmatic moral stance

• group composition and dynamics are vital – trainers must ensure that the group comprises both stage 1 & 2 reasoners

• rules must ensure active participation, respect for each others opinions and the right to disagree

• discussion starts with the trainer who presents the dilemma, copies are given to each student

• trainer asks for opinions from each member and leads discussion.

dilemma discussion –method 1

• trainers encourage differences of opinion• when level 1 reasoners are confronted by level 2

reasoners whom they like and respect the level 1 reasoners experience a dilemma that is uncomfortable (dissonance)

• trainers adjourn discussion until the next meeting• level 1 reasoners often seek out level 2 reasoners

and seek further clarification (why did you say that? why do you mean that? – between session change

dilemma discussion – method 2

• the goal is to help the group arrive at a more mature moral reasoning level

• 1 – a written dilemma is provided to each member and is read out loud by the trainer or group members

• 2 – trainers lead a summary of the dilemma (with use of flipover)

• 3 – trainers then elicit opinions, suggestions and solutions form each member

• 4 – trainers then conduct a polling of support for each suggestion etc

dilemma discussion – method 2

• 5 – group is divided into two smaller groups• 6 – each trainer helps her/his smaller group

refine their arguments • 7 – a spokesperson is chosen to present the

opinions and arguments of the smalle group • 8 – the larger group reconvenes – arguments

from both smaller groups are written up on the flipover

• 9 – the group debates the newer arguments • 10- debate continues until consensus is

obtained or that members agree that they are satisfied with own presentation

moral reasoning training

• adjustments– presentation of dilemmas in role play

format where trainees assume roles in continuation of role play

– use of triple dance and four step method to encourage flexibility of social perspective and empathy

– coorespondence training – verbal behaviour as guide for motoric performance

results – individual and family applications

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Vold. Trusler Uaksept. Sosial atferd Uhensiktsmessig sosial atferd

Etter ART Etter ART Etter ART Etter ART

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Vold. Trusler Uaksept. Sosial atferd Uhensiktsmessig sosial atferd

Slagslag m/ gjenstandSparkDytting/skubbingKasting av gjenstander

Truer m/ gjenstandDirekte verbal trusselIndirekte verbal trusselSkinnangrep

Spytter på nær.pSpytter på fremmedeSmeller i dørerBanningHøylytt nektingKnuser/ødelegger gjennstanderBrøler/roper

Overdreven klemmingIkke ønsket berøringoppsøker nabo ubedtTar kontakt med fremmede

Bergsmarksetra Movie 1

Bergsmarksetra Movie 1

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Reg.arkMistet?

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Red Yellow Green

A B1 B2 B3 B4

Per

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Successive Weeks

Kim

Distribution Behaviors 200 and 2001

classroom and whole school applications

projects

• Larvik Municipality and Røyken Rural Community

• establishment of community wide ART PEACE

• initiated by single referrals of ASD pupils• joint experimental cooperation

– all participants are researchers – analyste are temprorary members of the

change network• social competence training that works for

ASD will also work and be valued by normal peers

three phases

• interventive assessment and collective analysis– data that means something – dat that functions as MOm for headmasters,

teachers , parents and pupils

• strengthening competence and connecting– proactive and preventative– connecting to new actors, activities and arenas

• consolidation

• Larvik - over 500 pupils have participated in ART– 180 teachers, child welfare workers,

nurses and youth psychiatric professionals have been trained as ART practitioners to ICART standards

• family ART- Berg Junior School pilot project begins may 2004

• Røyken – all schools in the community will partcipate– public council commitment by local politicians

to reduce and prevent anti – social and aggressive behaviour in schools

– parent and family mobilization – joint experimental cooperation

• all interventions are data based• all participants are committed to collection and

analysis of data – celeration charts, quality of school life surveys, frequency registration of positive interactions in classroom, corridors, schoolyard + to and from school

summary

skillstreaming-

• selection of skills according to functional value– test battery, existing competence behavioural

observation, increased reinforcement, reduced punishment, aversive stimulation

• fluency training methods, microtrainig• behaviour specific feedback• Arne Scheie (commentator) – Steven

Spielberg (director)

anger control training

• expansion of anger reducers– regaining self-control– mindfulness skills

• transformation of response functions• fluency procedures

– anger signals, bubble talk

• turning point• graded exposure (GEARS)

moral reasoning training

• presentation of dilemmas in role play format

• use of triple dance, 4 step,

• correspondence training – say - do