Newsletter
Volume 30 | 2007 | Number 3
Social and Interpersonal Skills Interventions for Children with Autism
By Dr. Marjorie H. Charlop-Christy, Claremont McKenna College and Clarement Autism Center
Deficits in social behavior are a core feature of children with autism. The literature is replete with various applications of behaviorally oriented social skills programs. However, many programs are limited to acquisition of isolated social behaviors, or small changes in such, without pervasive generalization and maintenance effects. This paper will focus on those newer interventions that have been empirically verified, and have shown promise in terms of generalization and maintenance of social behaviors. These interventions include Video Modeling, Naturalistic Teaching Strategies, Incidental Teaching, and Photo Chaining. These interventions are perhaps successful because they focus on teaching children with autism using motivational techniques, facilitators of generalization, and rely on the visual strengths that are often present in a child with ASD’s repertoire. Thus, treatment programs that are “learner friendly” are of maximum importance.
As well, we believe that there are certain social and interpersonal behaviors that are “key behaviors” for intervention. Such key behaviors will allow the child with ASD easier access to reinforcers in the social world. These key behaviors can affect others in the same response classes and perhaps enable a child with autism to enter the social realm and possibly generalize their responses to others in the same response class and thus increase or maintain social behavior and/or other skills. Among the key areas that we have identified in our work, and clearly there may be many more, are play, social initiation (including verbal and nonverbal), turn taking and other reciprocal behaviors (i.e. coordinated joint attention) and communication. Page constraints provide for only a cursory discussion and necessitate the omission
of communication.
There are a number of variables that also need to be considered before beginning social skills interventions and these variables will vary depending on each child, as each child may be in a different circumstance, at a different point on the spectrum, have a different behavioral repertoire, and/or be a different age. We need to consider the child’s developmental age as well as the chronological age. For example, while we may not want a 12 year old boy playing with a fluffy stuffed animal because it isn’t “age appropriate,” we also may want to consider what reinforcers there are for this boy and what will motivate him to learn. Making him “look good” (without his stuffed animal) at the cost of learning may not be the best choice. Trade-offs sometimes need to be made. We need to understand contextual and cultural differences and standards as well. In some cultures, quietness and solitude are revered. However, if a child is nonverbal, we need to convey the importance of expressive language and teach the importance of initiations.
Play
Play is considered a key social behavior for many reasons. First, all children play. Play phases occur in developmental stages that typically developing children go through, so play is not only for fun, but for purpose. Children learn through play. They learn about social interaction and about language through play.
Research has found that this is true for children with autism as well. It has been shown that there is a positive relationship between the level of symbolic play in children with autism and their mental age. We have also seen in the literature that play is related to the increase in language for children with autism, as it is for typically developing children (Ungerer & Sigman, 1981).
Further effects of play as a key behavior can be seen in an example from our program evaluation and follow-up study of The Claremont Autism Center. Child 1 illustrates a common theme; the finding that as play increases, stereotypy decreases (See Figure 1 at the end of the article). This finding has been demonstrated for short experimental conditions (e.g. Favell, 1973), and now for long periods of time (years). While we present Child 1 as an example of a finding common of many children who passed through our program, we do note that it is an association that may be explained other ways. Another finding of interest is that the children made the most gains in play if they started the program below the age of six years; whereas the children who started the program six years and older made most of their gains in speech. This too may be suggestive of play as a prerequisite or facilitator of speech.
Recently, video modeling techniques have shown promise as an effective intervention for a wide variety of behaviors, and are particularly good to teach play (e.g. Charlop-Christy, Le, & Freeman, 2002). Briefly, video modeling involves filming “models” engaged in appropriate play activities. We have found that video modeling has been effective for teaching cooperative play, independent play, and make-believe play skills to children with autism. The effect of video modeling has been replicated often (e.g. Matson and Sweezy, 1998). Learning tends to occur after few presentations of the videos, so video modeling is quick and efficient. As well, the literature has shown promising generalization and maintenance effects.
The efficacy of video modeling may be due to its visual presentation format. Indeed, treatment research for children with autism has been moving towards programs that incorporate visual stimuli and take advantage of the children’s visual strengths such as picture activity schedules (McClannahan & Krantz, 1999) and PECS (the Picture Exchange Communication System) (Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002).
Recently, a new play or social skills intervention has been designed at our Center that is heavily based on visual learning strategies called Steps to Social Success (Daneshvar, 2006). In this program, social behaviors were broken down into components and individual steps that led to a desired social behavior and were chained together (e.g., paying attention, making eye contact, initiating with a person). Steps for Social Success included provisions to take advantage of the visual preferences in children with autism by using photographs of the children themselves engaging in each step of a target behavior. A Rolodex was used to present the photograph chaining of each step of the social behaviors to the children. The Steps for Social Success is considered a Naturalistic Teaching Strategy (Charlop-Christy, Carpenter, & LeBlanc, 1999) because: 1) motivation was enhanced by incorporating child preferred toys or activities, 2) functional behaviors that would likely mand reinforcers were used, and 3) facilitators of generalization were used by incorporating teaching into a child’s daily routine (Charlop-Christy, et al., 1999; Stokes & Baer, 1977). An example of a child’s data for Steps for Social Success compared with the use of Social Stories (Garand and Gray) is in the second figure.
Social Initiation
It is important to teach children with autism both verbal and nonverbal social initiations. While much of the research is with verbal children, nonverbal behaviors such as a smile, wave, hug and joint-attention are key to the development of social interaction skills. It is far easier to teach a child with autism to respond than to initiate. However, if we are to teach just responders, who will be the initiators?
Multiple Incidental Teaching Sessions (MITS) was developed to combine some of the effective components of DTT (rapid acquisition) with components of incidental teaching (generalization facilitation) to treat children with autism. MITS incorporates the aspects of DTT that aid in the rapid acquisition of target behaviors such as multiple trials. It capitalizes on the effectiveness of the traditional incidental procedure by providing teaching in the natural setting, thus increasing the likelihood of generalizing the target behavior (Charlop-Christy & Carpenter, 2000; Hart & Risley, 1975). This blend of DTT and incidental teaching to form MITS occurs when with each incidental teaching episode, two additional rehearsal or “practice” trials of the behavior are presented. Non-verbal initiations such as waves, high fives, head nods have been taught with MITS (Charlop-Christy & Berquist, 2007) as well as verbal initiations (Charlop-Christy & Carpenter, 2002).
Turn-taking and Joint Attention
Coordinated joint attention is generally defined as a child looking at a person, shifting gaze at a desired item, and then returning gaze to the person within 10 seconds of the presentation of the stimulus. This is an early step in play for typically developing babies and is also a form of non-verbal language. Importantly, it is the sharing of an experience and the understanding that the experience was shared. It is the inclusion of another into one’s world. Whereas turn-taking is the active process of participating with another, the other person can be regarded or disregarded. The other person can be a computer or a gaming machine. The inclusion of the other into the activity is a huge step for a child with autism. He/she is taught interaction, reciprocity, dependency, and cooperation. All of these are social behaviors, but all of these can be executed without much regard for the other person. It is joint attention that is the quintessential interpersonal behavior.
Figure 1: Play before, during, and upon conclusion of treatment.
References
Charlop-Christy, M. H., & Carpenter, H. M. (2000). Modified incidental teaching sessions: A procedure for parents to increase spontaneous speech in their children with autism. Journal of Positive Behavior Interventions, 2(2), 98-112.
Charlop-Christy, M. H., Carpenter, H. M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35, 213-231.
Charlop-Christy, M. H., LeBlanc, L. A., & Carpenter, H. M. (1999). Naturalistic teaching strategies (NATS) to teach speech to children with autism: Historical perspective, development, and current practice. The California School Psychologist, 4, 30-46.
Favell, J. (1973). Reduction in stereotypies by reinforcement of toy play. Mental Retardation, 11(4), 21-23.
Hart, B., & Risley, T. R. (1975). Incidental teaching of language in the Figure 1: Play before, during, and upon conclusion of treatment.preschool. Journal of Applied Behavior Analysis, 8, 411-420.
Stokes, T. F. & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10(2), 349-367.
Ungerer, J. A., & Sigman, M. (1981). Symbolic play and language comprehension in autistic children. Journal of the American Academy of Child Psychiatry, 20(2), 318-337.