strengthening social comptence in children and youth with autistic spectrum disorders

1. strengthening social comptence in children and youth with autistic spectrum disorders luke moynahan, Børge Strømgren & Mickey Keenan 2004

2. 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.

3. 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

4. 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

5. 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)

6. 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

7. 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)

8. programmes for teaching social competence

9. 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.

10. 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

11. 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

12. results

13. junior school –senior school

14. 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

15. 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

16. 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

17. skillstreaming

18. 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

19. “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

20. “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

21. 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

22. 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

23. 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

24. 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

25. moral reasoning training • dilemma discussion methods

26. 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.

27. 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

28. 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

29. 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

30. 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

31. results – individual and family applications

34. Bergsmarksetra Movie 1

35. Bergsmarksetra Movie 1

40. classroom and whole school applications

41. 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

42. 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

43. 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

44. 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

45. summary

46. 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)

47. 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)

48. moral reasoning training • presentation of dilemmas in role play format • use of triple dance, 4 step, • correspondence training • say - do