January 18, 2011 Features

Social Communication Strategies for Adolescents With Autism

see also

The social journey through adolescence has always been complex, confusing, and in some ways counter to the interaction style needed for survival in the social world of adulthood. In adolescence, the rules of communicating are often subtle and unspoken—but breaking those rules can have far-reaching ramifications. The mechanisms of social communication during these years are finely tuned and nuance-based, and yet most adolescents have the ability to figure out intuitively how to get by.

In her theoretical model, Seltzer (2009) describes the neurotypical adolescent as living in a "peer arena." She postulates that adolescents seek to learn from one another in this arena by what she describes as "peership" rather than friendship. By exploring different peer relations, teens learn about friendship, loyalty, and individual differences. She describes this stage of development as marked by constant comparison and competition. Those who don't earn high marks in this abstract competition may retreat socially.

Adolescents also appear increasingly disrespectful and defiant to adults as they become more intensely involved in the peer arena. At the same time, teens also struggle with the growing complexities of curricula, homework, critical thinking, and executive functioning. Play and academics, which were easier when they were less nuance-driven, are now more difficult to master for all students. The process is complex and painful not only for adolescents, but also for the adults (including speech-language pathologists) with whom they interact. Interestingly, most of us understand the physical, social, and communicative stages in young children, but many of us are not as aware of the constantly evolving social, emotional, and critical thinking demands of the adolescent, especially for those with social learning challenges such as autism spectrum disorders (ASDs).

ASDs include the diagnostic labels of Asperger syndrome (AS), high-functioning autism (HFA), autism, and pervasive developmental disorder-not otherwise specified (PDD-NOS), all of which describe conditions that typically involve some form of social learning challenge. Schools are identifying more students with ASDs who have "normal" language and cognition; these students are then placed in mainstream classrooms where there is a need to define and refine treatments (White, Keonig, & Scahill, 2007). This "high-functioning" group is the fastest-growing segment of those diagnosed with ASDs (Rao, Beidel, & Murray, 2008), but it is unclear whether mainstreaming assures that peers will include the individual in social interactions (Chamberlain, Kasari, & Rotheram-Fuller, 2007). Recent reports have postulated that a social learning deficit clearly has an impact on social skill development and a possible effect on academic development (Arick, Krug, Fullerton, Loos, & Falco, 2005; Rao, Beidel, & Murray, 2008).

To complicate matters, adolescents with social learning challenges, regardless of higher cognition and language, reportedly experience difficulty transitioning into adulthood and sustaining activities such as employment, relationships, and skills for independent living (Zager & Alpern, 2010). In addition, the literature is expanding on the impact of social challenges on mental health (Reaven, Blakeley-Smith, Nichols, Dasari, Flanigan, & Hepburn, 2009; Pine, Guyer, Goldwin, Towbin, & Leibenluft, 2008). Given the complexity of social and academic issues facing adolescents with ASDs, many SLPs are finding themselves on the front line battling social learning problems that are inextricably linked with language-based learning problems and academic issues.

Social Learning and Social Thinking 

The term "social thinking" (Winner, 2000) was coined while working with higher-functioning students who were expected to blend in with their peer group by producing more nuanced social responses. The theory views social skills as dynamic and situational, not as something that can be taught and then replicated across a school campus. Instead, social skills appear to evolve from one's thinking about how one wants to be perceived. It appears that the decision to use discrete social skills (e.g., smiling versus "looking chill," standing casually versus formally, swearing/speaking informally versus speaking politely) is not based on memorizing specific social rules (as often taught in social skills groups), but instead is based on a social decision-making tree of thought that involves dynamic and synergistic processing.

Perhaps students' multidimensional social learning needs could be better understood by exploring the many different aspects of social information and related responses expected from anyone in order to be considered as having "good social skills" (Winner, 2000; 2007). For example, the use of perspective-taking skills is critical for social engagement. This concept also provides information to demonstrate the link between one's social learning abilities and the related ability or inability to process and respond to the school curriculum requiring the use of the social mind (e.g., reading comprehension of literature or some aspects of written expression). These research-based ideas related to teaching social thinking are the conceptual foundation for developing treatments for those with social challenges. Winner and colleagues (in press) argue that individuals who share a diagnostic label (e.g., Asperger syndrome) nonetheless exhibit extremely different social learning traits or social mind profiles and should have unique treatment trajectories, such as those based in cognitive-behavioral therapy (CBT).

The CBT approach, which began in the mental health community, is steadily gaining support as a viable treatment method for individuals with ASDs who have strong language communication abilities (Lopata, Thomeer, Volker, & Nida, 2006; Reaven, Blakeley-Smith, Nichols, Dasari, Flanigan, & Hepburn, 2009). CBT provides a concrete method through which students and providers can discuss social expectations (perceptions, thoughts, and emotions) and then define social-behavioral adaptations, better known as "social skills."

Individuals are taught that thinking about the social world can help them to choose more effective behaviors in an increasingly proficient manner. The adept use of social skills requires dynamic and synergistic processing and quick responses to social information. Of course, the complexity of this process stumps all of us from time to time, and most readers likely have had a social gaffe or a social misperception. How, then, do we teach the nuanced social thinking and related social behaviors to adolescents with ASDs who are expected to blend in with the neurotypical world?

 Social Thinking Strategies  

For the adolescent with advanced cognitive and language skills, a discussion about the "why" underlying the skill production becomes crucial. Teaching scaffolds have been developed (Winner, 2007) to encourage students to explore how "we all get along" with one another, even when relating to someone we don't know well. One construct clinicians often use with adolescents is the notion of social thinking/social psychology. Students are asked whether or not they understand that at the heart of social interactions is a core emotional understanding of what we want/expect from each other. Clinicians can encourage students to think about this in the following sequence:

  • We all want others to have good or reasonable thoughts about us. When people don't have positive or benign thoughts, they tend to have "uncomfortable" or "weird" thoughts.
  • It is likely that all people are a bit worried others don't like them or their ideas, although they may not admit it. In general, people don't want others to have persistent "weird" thoughts.
  • All people have to try to make those around them feel reasonably okay based on the first two items. So all of us attempt to monitor how other people are thinking and feeling by reading others' intentions or motives or guessing how others have read our intentions.
  • Based on the information above, we adjust our behavior to continue the reasonable or positive thoughts others have about us.

In discussing these concepts, it is interesting to observe adolescents' responses. Many haven't thought about their own personal desire to have people feel okay or reasonably good about them, nor have they realized how actively we all try to figure out one another, even if we are just sitting near another person but not talking. Behavioral regulation stems from adjusting one's own behavior to help influence how others are thinking about him or her.

With social thinking, treatment does not begin by teaching students to change their behavior to please others. Instead, we emphasize that people should consider what they expect others to do for them to keep them feeling calm and safe. For students, the foundation of social thinking is the systematic understanding of the process through which they are expected to engage with others. Social skills are the behavioral output of our social minds, and clinicians need to help students build stronger social minds as the first step in treatment.

A treatment sequence referred to as "The Four Steps of Communication" (Winner, 2007) was designed to make the abstract concept of face-to-face communication more concrete. The sequence, oversimplified here, has helped many students learn that communication is not simply talking to another person, but involves a whole body and mind experience.

Four Steps of Communication 

Step 1: Think about the person with whom you may communicate.  

Ask yourself: What do I know about him/her (based on prior experiences or consideration of the current context)? Clinicians can help students recognize that hanging out or chatting requires thinking about the person even before we approach him/her. Consider:

  • What do I remember about the person, if I've met him before? (Many students will say they remember nothing.)
  • Teach students to infer what they may know or could guess about the person, even if they have never spoken to the person. For example, if the student attends the same school, then the other person likely lives in the same community, takes some of the same classes, may know some of the same people, etc.

Step 2: Establish physical presence

Physically approach the person and establish appropriate physical distance, as well as a relaxed stance, arm gestures, posture, etc. Clinicians can emphasize that a person's body is typically relaxed when sharing space with others. If someone is overly stiff, has his or her body subtly turned away from the communicative partners, or doesn't fully enter the group, then that person will have difficulty engaging with the group.

Although it is tempting to tell students to use "the one-arm rule" when determining how far away to stand from another student, physical presence requires more nuanced use of the body. For example, a student can stand one arm's length away from others and still have his shoulders or head awkwardly turned from the group.

Step 3: Think with your eyes

Observe the communicative partner's face and other situational cues to help determine what he or she is thinking or feeling, may already be discussing, or even if the student's approach is welcomed.

As the student "thinks" with his or her eyes, the communicative partner is also noting that the student is thinking about the partner, which affirms the student's intent to communicate. If a student enters a group or approaches another person and establishes physical presence, but does not use his or her eyes to think about the potential communicative partner, the communicative partner may be confused about the student's intention.

These are the three primary steps needed for students to "hang" successfully with teenage peers. Often adolescents aren't involved in deep conversations, but are instead listening to music, texting others, or playing video games while standing in a group. Clinicians may need to help their teenage students learn how to "hang" by co-existing and not constantly trying to find something to talk about. However, there is still a need to consider how to teach social language.

Step 4: Finally, use language to relate to others. 

Connect with others in the group by using language. Clinicians can help the student learn that at times
we all do "the social fake"—act as if we're interested when we're not. Although this strategy may sound disingenuous, the social-emotional process of friendship/classroom behavior is not about saying/doing what you want. It's more about gauging what should be said (or not) to keep others thinking neutral or calm thoughts.

During conversational exchanges, neurotypical individuals often look as though they are really happy and interested, when one or both partners may be bored or disinterested. Most people stay engaged in a social relationship because of the social-emotional connection, not because of knowledge gained through the discussion. Most of us would have few friends or successful marriages if we didn't fake it socially on a regular basis. Our students are often very relieved to hear this; they literally thought that because we look so happy together we must always be happy!

There are many more issues and strategies related to adolescents with social learning challenges. When working with adolescents with advanced cognitive and language skills, clinicians should not assume that they understand even basic social interaction concepts. Students with social learning challenges can have large gaps in their social knowledge and related social thinking and skills.

As communication specialists, SLPs can continue to explore ways to add to this theory-driven practice simply by becoming better observers of the social world and by using that knowledge to make the abstract social world more concrete for students. The next time you're working with an adolescent with language-based learning problems, consider the concepts related to social thinking/social psychology and the four steps of communication. Teaching this more explicitly may help you guide your students along the bumpy road of adolescence.  

Michelle Garcia Winner, MA, CCC-SLP, is director of The Center for Social Thinking in San Jose, Calif. She specializes in working with students with social cognitive deficits. Contact her at michelle@socialthinking.com.

Pamela J. Crooke, PhD, CCC-SLP, is on the clinical faculty at San Jose State University and is a senior clinician at The Center for Social Thinking. Her research focuses on treatment efficacy in social and relational therapies for individuals with social-cognitive challenges. Contact her at pcrooke@socialthinking.com.

cite as: Winner, M. G.  & Crooke, P. J. (2011, January 18). Social Communication Strategies for Adolescents With Autism. The ASHA Leader.

References

Arick, J., Krug, D., Fullerton, A., Loos, L., & Falco, R. (2005). School-Based Programs. In F. Volkmar, R. Paul, A. Klin & D. Cohen (Eds.) Handbook of Autism and Pervasive Developmental Disorders. Volume Two: Assessment, Interventions and Policy, 3rd edition (pp.1103–1028). John Wiley and Sons, Inc. Hoboken, New Jersey.

Buron, K. D., & Curtis, M. (2004). Incredible 5-Point Scale: Assisting Students with Autism Spectrum Disorders in Understanding Social Interactions and Controlling Their Emotional Responses. Autism Asperger Publishing Company: Shawnee Misson, Kansas. www.asperger.net

Buron, K. D. (2007). A 5 Is Against the Law! Social Boundaries Straight Up! Autism Asperger Publishing Company, Inc. Shawnee Mission, Kansas.

Chamberlain, B., Kasari, C., & Roterham-Fuller, E. (2007). Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders, 37, 230–242.

Green, S., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: Is there a causal relationship? Journal of Autism and Developmental Disorders. Published online April 10, 2010. DOI 10.1007/s10803-010-1007-x.

Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M.-L., Ebeling, H., Pauls, D. L., & Moilanen, I. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38(9), 1697–1709.

Lopata, C., Thomeer, M. L., Volker, M. A., & Nida, R. E. (2006). Effectiveness of a cognitive-behavioral treatment on the social behaviors of children with Asperger disorder. Focus on Autism and Other Developmental Disabilities, 21(4), 237–244.

Pine, D., Guyer, A., Goldwin, B., Towbin, K., & Leibenluft, E. (2008). Autism spectrum disorder scale scores in pediatric mood and anxiety disorders. American Academy of Child and Adolescent Psychiatry, 47(6), 652–661.

Rao, P., Beidel, D., & Murray, M. (2008). Social Skills Interventions for Children with Asperger Syndrome or High Functioning Autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353–361.

Reaven, J., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive behavioral group treatment for anxiety symptoms in children with high functioning autism spectrum disorders: A pilot study. Focus on Autism and Other Developmental Disorders, 24(1), 27–37.

Seltzer, V. (2009). Peer-Impact Diagnosis and Therapy: A handbook for successful practice with adolescents. New York, NY: New York University Press.

White, S., Keonig, K., & Scahill, L. (2007). Social Skill Development in children with autism spectrum disorder: A review of intervention research. Journal of Autism and Developmental Disorders, 37, 1858–1868.

Winner, M. (2000). Inside Out: What makes a person with social cognitive deficits tick?, San Jose, CA: Think Social Publishing.

Winner, M. (2007). Thinking about you, Thinking about me. San Jose, CA: Think Social Publishing.

Winner, M. G. (2003, September 23). Asperger Syndrome Across the Home and School Day. The ASHA Leader.

Winner, M., Crooke, P., & Madrigal, S. (in press). Understanding the Social Mind using the Social Thinking-Social Communication Profile. San Jose, CA: Think Social Publishing.

Zager, D., & Alpern, C. (2010). College Based Inclusion Programming for Transition-Age Students with Autism. Focus on Autism and Other Developmental Disabilities, 25(3), 151–157.



  

Advertise With UsAdvertisement