Social Implications for Students with Autism Spectrum Disorders

1. Social Implications for Students with AutismSpectrum Disorders Presented by Marrea Winnega, Ph.D.Licensed Clinical Psychologist Consultant on Autism Spectrum DisordersFebruary 22, 2011

2. Why are people with Autism or Asperger’s Disorder different? • Brain is wired differently • Object area of brain is more developed than people area • Not wired to be social How? • Genetic/starts in utero before born • Likely to be a genetic/environment interaction • NOT caused by bad parenting

3. Different Perspectives • Wicked • The 3 Pigs from the Wolf’s perspective • Slumdog Millionaire • Breakfast Club, Grease, High School Musical, etc.

4. Different points of view • Car accidents • Sister has Columbus Day off • She works 2 half days per week • Should she get the day off? • Perspective of vacation – secretaries vs. educational staff • Asking, “How are you?”

5. Evidence-based Interventions Use the National Standards as your guide • Note: The results support behavioral interventions – because that is where the research is

6. National Standardswww.nationalautismcenter.org The National Autism Center is a nonprofit organization dedicated to supporting effective, evidence-based treatment approaches for Autism Spectrum Disorders (ASD) and to providing direction to families, practitioners, organizations, policy-makers, and funders.

7. Treatment Divisions • 11 “Established” Treatments: treatments that produce beneficial outcomes and are known to be effective for individuals on the autism spectrum. The overwhelming majority of these interventions were developed in the behavioral literature (e.g., applied behavior analysis, behavioral psychology, and positive behavior support).

8. Treatment Divisions • 22 “Emerging” Treatments: treatments that have some evidence of effectiveness, but not enough for us to be confident that they are truly effective. Need more research • 5 “Unestablished” Treatments: treatments for which there is no sound evidence of effectiveness. There is no way to rule out the possibility these treatments are ineffective or harmful.

9. Examples of Methods • Communication – Speech production; Picture Exchange Communication System; Sign Language; Assistive Technology (All 3 are Emerging Treatments) – therefore find the one the student prefers • Social Stories/Social Skills/Peer training (All Established) • Circle of Friends and Integrated Play Groups • Joint Attention/Self-management – Established • Pragmatic Language - Emerging

10. Methods • Relationship Development Intervention/Floor Time or DIR (home based vs. school based) – both are Emerging • Music Therapy – Emerging • Exercise – Emerging • Sensory Integration is Unestablished

11. Autism Spectrum Disorders • Also known as the Pervasive Developmental Disorders • Under this umbrella are: • Autistic Disorder • Asperger’s Disorder • Pervasive Developmental Disorder Not Otherwise Specified • Girls fly under the radar Educationally: All of these fall under Autism

12. Active but Odd Aloof Severe Gifted Measured IQ Social Interaction Non-Verbal HighlyVerbal Communication Gross Awkward Agile Motor Skills Uncoordinated Coordinated Fine Sensory Hyposensitive Hypersensitive Autism Defies Generalization

13. The Iceberg: Understanding Autism Behavior - Tip Below the water line: Reciprocal Social Interactions Communication and Play Restricted Repetitive Behaviors/ Need for Sameness Sensory Processing Learning Style www.teacch.com

14. Impairments in Reciprocal Social Interactions • Marked impairment in the use of multiple nonverbal behaviors to regulate social interactions • Eye contact, gestures, facial expressions (social smile/range), body posture; joint attention • Failure to develop peer relationships appropriate to developmental level • Response; interest; imaginative play; group play; Age 10 and over – friendships

15. Impairments in Reciprocal Social Interactions • Marked impairment in spontaneous seeking to share enjoyment, interests or achievements • Showing/directing attention; offering to share; sharing one’s enjoyment • Lack of social or emotional reciprocity • Comfort; inappropriate facial expressions; quality of social response and overtures; socially awkward; social perspective taking

16. Impairments in Communication • Delay or lack of development of spoken language • Marked impairment in ability to initiate or sustain a conversation • Stereotyped or repetitive use of language • Lack of varied, spontaneous make-believe play or social imitative play

17. Note: Impact of Communication Impairments • Sequencing information • Difficulties retelling a story • Describing routine events • Brushing teeth, washing hands • Describing nonroutine events • A trip to Great America or a recent vacation

18. Restricted, Repetitive Behaviors • Encompassing preoccupations • Circumscribed interests • Nonfunctional routines and rituals • Preoccupation with parts of objects • Repetitive motor mannerisms

19. Theory of Mind Deficits • Inability to perceive feelings and thoughts of others • Insensitivity to other people's feelings • Do not appear embarrassed • Inability to read intentions of others • Inability to read listener's level of interest in one's speech • Not knowing what the listener needs to know

20. Theory of MindAn Aspie PerspectiveJean-Paul Bovee • All communication takes two people. • We have our own things that embarrass us. • Odd or repetitive behaviors, etc. have a reason for existing. • “There is not a shared understanding of how the world works.” • There are not shared beliefs.

21. A Reinterpretation of Theory of Mind • We have our own perspective. • Not every person thinks alike. • It is not the fault of the individual with ASD – both parties have a problem. • “We are people and we are different.”

22. Perspective TakingFrom Social Skills Solutions • Level 1: Labels emotions in pictures, other people, on self; looks for and finds hidden objects • Level 2: Cause for emotions; respects personal space • Level 3: Interprets body language; identifies nice vs. mean vs. teasing

23. Who knows what?From Carol Gray First page: My name is _______. Sometimes, I like to think about _______, _______, or _______. I think about other things, too. Second page: (My mom, dad, grandparent, teacher, sibling, friend) thinks, too. S/he sometimes likes to think about _______, _______, or ________. S/he thinks about other things, too. Illustrate each page.

24. Think about: • A lack of social understanding is not misbehavior • A lack of social understanding makes students on the autism spectrum vulnerable to being set up by peers

25. Social Pitfalls • Not socially aware – varies from nonverbal to verbal students • Social misperceptions • “They are laughing at ME!” • Not knowing social norms or the “hidden curriculum” • How to act in different social situations • Which way do you stand when you ride an elevator? Why? • Not knowing what is “cool”

26. Laughing(Social Story) People like to laugh. The kids and teachers in my class laugh a lot. Sometimes I don’t know why they are laughing. I will try to stay calm and ask them why they are laughing. Then I can laugh, too.

27. Social Pitfalls • Asking inappropriate questions • Why do you color your hair? • Making inappropriate comments • It smells in here! • Speaking their minds or not knowing about little white lies • You smell…well, then, your cologne smells. • Teasing and Bullying • Fabricating stories

28. Socially Inappropriate Comments • “Your idea is crap.” • Tell soccer coaches and other players what they are doing wrong (days later told a student he was awesome at the game). • I am the smartest • Yet cannot tolerate getting a math problem wrong and throws a tantrum if does • Knows peers will not do this when they get one wrong

29. Story of Matt • Identified with Asperger’s about 3 years ago; now a 4th grader • Very verbal and bright • Excellent gross motor skills and good at soccer • Very competitive • Swears on the soccer field – only one who does

30. Processing Real Drama I’m never going to play soccer again I suck at soccer It’s my mom’s fault I’m not playing soccer • I’m not (might not) play this. • This is a big disappointment • I hope I get to play next year

31. Difficulty Disclosing Child brought legos home from school: T: Did you take something home? C: Is that bright green or yellow? T: Tell me something. Did you take something home? C: Yes (showed legos) T: Cannot take without asking. What happens if adults take something? C: Call Police. And so this color is bright green or yellow.

32. Discussion Do these points make sense? Do you agree? • A lack of social understanding is not misbehavior • A lack of social understanding makes students on the autism spectrum vulnerable to being set up by peers

33. The Iceberg: Understanding Autism Behavior - Tip Below the water line: Reciprocal Social Interactions Communication and Play Restricted Repetitive Behaviors/ Need for Sameness Sensory Processing Learning Style www.teacch.com

34. Does not follow classroom directions Below the water line: Does not process language in groups or subtleties of language Social – does not know that she is part of “everyone” Possible interventions: Teach that she is included in group directions Ask indirectly

35. Thinks everyone is laughing at him Below the water line: Limited social reciprocity/Limited understanding of the perceptions of others Limited peer relationships Possible interventions: Teach concept of humor and different ideas that students think are funny (e.g. slapstick vs. puns vs. play on words

36. Social Misperceptions Below the water line: Lack of social reciprocity Limited peer relationships Poor communication skills Possible interventions: Teach other perspectives on the situation; teach purposeful behavior vs. accidents (being bumped into)

37. Argumentative Student Below the water line: Lack of social emotional reciprocity esp. social perspective Need for sameness (certain pair of shoes) Concrete/logical Possible interventions: Don’t argue – once starts, we have lost; pause and think about student’s request and how to modify your request; ask indirect questions (could you take your seat please?)

38. Will not do homework at home Below the water line: Lack of social emotional reciprocity – bound to rules; concrete thinker: “Homework is school work. I do it at school. I have other work to do at home.” At school, socially overwhelmed/senses are overwhelmed – exhausted when arrives home Possible interventions: Complete during day/study halls Shorten assignments Also give frequent movement breaks or breaks from sensory and social input.

39. Manipulative* Below the water line: Lack of social emotional reciprocity Does not understand instructions Poor expressive communication skills (has concerns) Possible interventions: Help express concerns and problem solve *True manipulation takes forethought and planning (team going to 31 Flavors vs. Dairy Queen)

40. Disruptive Student – too talkative vs. makes sounds Below the water line: Lack of social emotional reciprocity Poor expressive communication skills Lack of awareness of social situations Possible interventions: If blurts out or interrupts: Teach when can talk; use Social Stories to understand this If makes sounds, try to teach when can make sounds; give alternatives such as lollipops

41. Will not do what you want him/her to do when you want Below the water line: More interested in what s/he wants to do May not understand first this then that Does not understand what you want him/her to do Does not know when it will end Interventions: Build additional motivation into the task; Clarify how much work (perhaps visually)

42. Aggressive – hits, slaps Below the water line: Lack of social emotional reciprocity Limited social skills Poor expressive communication skills Functions: Escape, attention, tangible Possible interventions: What is the cause of the aggression? When is it occurring? Teach to ask for a break Give student frequent motor breaks

43. Visuals for Understanding • Sit • Walk • Quiet • Work • Stand up • Clean up • Classroom rules • Stop/Think/Make a Choice

44. Problem Behavior/Speech Issues and using visuals • Visuals* can be distracting (power struggles) • Requests are key • Write a sentence and have student read = “Use your words”: I want a Reese’s cup • Lack of spontaneous speech: • Expand the sentence: write “May I have a cookie?” *Objects, photographs, Boardmaker drawings, written words, etc.

45. State/Teach the Behavior You Want • Do directions > don’t do/no’s • Tell your student what you want him/her to do: • Sit down • Walk with me • Open the door • Hold the door • Hands on knees • Hands on desk/table

46. Social ThinkingMichelle Garcia Winnerwww.socialthinking.com • Social Thinking is required before social skills; aka Social Cognition • “Successful social thinkers consider the points of view, emotions, thoughts, beliefs, prior knowledge and intentions of others (this is often called perspective-taking - considering the perspectives of others).”

47. Social Thinking – Core Philosophies • We “think with our eyes” to figure out other people’s thoughts, intentions, emotions, plans, etc. • Our thoughts and emotions are strongly connected. How we think affects how we feel, how we behave affects how others think and feel. • We think about people all the time, even when we have no plans to interact with them. We adjust our own behavior based on what we think the people around us are thinking. (This is how we drive our cars!).

48. Social Thinking – Core Philosophies • As part of our humanity, each of us is on a daily quest to avoid each other’s “weird thoughts.” We … adjust our behavior to help people have “normal thoughts about us.” • Most of the core social thinking lessons operate BELOW the level of cultures, meaning that all people engage in these thoughts and social behavioral adjustments. • How we adapt our behavior changes as we age and are in different situations and cultures. The nuance and sophistication of our behaviors is constantly evolving.

49. Social Thinking – Core Philosophies • Social thinking is something all of us do every day, all day, even when we are alone in our homes. To understand a TV drama/sitcom/novel one has to think about the character’s emotions, thoughts, reactions. • Social thinking, therefore, plays into our academic world, requiring us to think about the motives and intentions of people we read about in literature and history. • Social thinking affects us in adulthood. To hold a job, most of us have to adapt our own social behavior based on the perceived thoughts of the people we work and live with.

50. Social Thinking Interventions • Four Steps of Perspective Taking • Four Steps of Communication • I LAUGH