Social Skills Development, Assessment, and Programming in School-Aged Speakers with Autism Spectrum Disorders

by Rhea Paul, Ph.D., CCC-SLP Prof., Southern CT State U. Yale Child Study Center Rhea.Paul@yale.edu

Preparation of this Presentation was supported by:

Research Grant P01-03008 funded by the National Institute of Mental Health STAART Center Grant U54 MH66494 funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), the National Institute of Environmental Health Sciences (NIEHS), the National Institute of Child Health and Human Development (NICHD), the National Institute of Neurological Disorders and Stroke (NINDS), MidCareer Development K24 HD045576 funded by National Institute of Deafness and Other Communication Disorders National Alliance for Autism Research

Seminar Overview
Typical

social communication development: school age Role of SLP in social skills intervention Assessing social skills Programming for social skills development

Typical Development of SocialCommunication: School Age

Pragmatic Domains

Communicative functions

Intents Frequency Turns topics

Discourse management

Register variation

Politeness Social roles Grices maxim of Quantity mind-reading

Presupposition

Pragmatic Development: School Age

Communicative functions

Increase in range of functions Narration Persuasion/negotiation Increase in decontextualized talk

Discourse management

Requires less support from adults; still needs some Longer turns; more turns/topic Increased topic maintenance, fewer unrelated utterances Smooth transitions; Decline in abrupt shifts Greater coherence

Pragmatic Development: School Age, cont.

Register variation New polite forms: permission requests, permission directives, some indirect requests 4-7: hints Ability to use motherese Language of power, social negotiation Presupposition attending to listener needs informativeness

Pragmatic Development in Later Childhood and Adolescence

Discourse

Genres

Narration Persuasion/negotiation Exposition Ambiguity/sarcasm

Register

variation

Slang Figurative language Presupposition

Cohesive devices

Pragmatic Development in Adolescence: Discourse Management

Stay on topic longer Has extended dialogues Makes greater number of relevant, factual, new contributions to topic Shifts gracefully from one topic to another Adjusts the content and style of speech to thoughts and feelings of others.

Pragmatic Development in Adolescence: Persuasion

Adjusts to listener characteristics (e.g., social status, familiarity States advantages to the listener as a reason to comply Anticipates and replies to counterarguments Uses positive strategies such as politeness and bargaining Gives up negative strategies such as whining and begging Generates a number and variety of arguments Controls discourse assertively

Pragmatic Development in Adolescence: Negotiation

Takes social perspective of another Shows awareness of needs, thoughts, feelings of others Reasons with words (verbal reasoning) Uses cooperative an d collaborative strategies Shows concern for group welfare Shows concern for long-term implications of conflict Shows willingness to compromise

Differences in Language Development in ASD

Some speakers w/ ASD show SLI pattern Pronoun reversals Idiosyncratic word use Use of immediate and delayed echolalia (communication strategy) Limited comprehension of verbal and gestural forms of communication

Overselectivity Gestalt learning Rote learning; associative learning Difficulty in generalization

Atypical voice and prosodic features

Impairments in Pragmatic Skills in ASD

Reduced topic management skills

appropriate topic termination Responding to cues to change topic Commenting contingently; say something relevant

Reduced presuppositional skills due to theory of mind (ToM) deficits

Poor ability to share topics infer others informational state

Obsessive, circumscribed interests Sparse conversation OR overly talkative about special interests Gaze and prosodic deficits persist

Language in ASD: Overview

Generally,
Some

syntax is on par with mental age

speakers w/ ASD show SLI pattern

In

general phonology is also on par with MA

But tendency for residual speech errors

Apart

from some idiosyncratic word use, semantics is at expected level Prosody also shows high rates of impairment Pragmatics, social communication is most impaired area

The SLPs Role

Pragmatics vs. Social Skills

Pragmatics = Conversational skills Social skills include: Pragmatics Paralinguistics Prosody Gaze Gestures Proximity Social behaviors Conventional Gestures Wave Handshake Facial Expressions Avoiding socially unacceptable Nose-picking

behaviors

What is the Role of the SLP in Social Skills Development?

Once basic language skills are acquired, pragmatic skills are the greatest area of deficit for speakers with ASD.
Pragmatic communication is the domain of the SLP. Therefore, improving conversational skills in speakers with ASD is within the scope of practice of the SLP. No other professional fulfills this role.

SLPs Role
Other social skills may be targeted BUT primary role is in treating pragmatic conversational skills; i.e.: Increasing overall rate of communication Encouraging expression of range of communicative functions Teaching management of turns and topics in conversation Increasing flexibility of forms available to convey various functions Politeness Using language flexibly Encouraging the use of mind reading in conversational settings to gauge what is appropriate to say when and to whom

Assessment of Pragmatic and Social Skills

Assessment: School-Age
Childrens

Communication Checklist (Bishop, 2003) Pragmatic Rating Scale (Landa et al., 1992) Pragmatic Rubric Pragmatic Protocol (Prutting & Kirchner, 1984) Social Skills Rating System (Gresham, 1990) Pragmatic Language Skills Inventory Gilliam & Miller, 2006)

Experimental Investigations of ASD Children at Developing and Advanced Levels: Pragmatic Communication
Yale

Pragmatic Rating Scale (YPRS) Based on ADOS videotaped interview Modified from Landa et al. (1992) 30 categories of pragmatic behaviors 10 3 minute time samples analyzed Yale in vivo Pragmatic Protocol (YiPP) 20 minute interview containing 24 probes for specific behaviors

YPRS Coding Categories

1. Inappropriate / absent greeting
2. Strikingly candid 3. Overly direct or blunt 4. Inappropriately formal 5. Inappropriately informal 6. Overly talkative 7. Irrelevant / inappropriate detail 8. Out of sync content / unannounced topic shifts 9. Confusing accounts 10. Topic preoccupation / perseveration 11. Unresponsive to examiners cues 12. Little reciprocal to-and-fro exchange 13. Terse 14. Odd Humor 15. Insufficient background information 16. Failure to reference pronouns, terminology 17. Inadequate clarification 18. Vague 19. Scripted, stereotyped language 20. Awkward expression of ideas 21. Indistinct speech / mispronunciations 22. Rate of speech is too rapid / slow 23. Intonation is unusual 24. Volume is inappropriate (note too loud/soft) 25. Unusual timing of responses, reformulations 26. Unusual rhythm, such as stuttering 27. Physical distance 28. Gestures 29. Facial Expressions 30. Eye Gaze (e.c., or to help identify referent)

Yale Adaptation of the Pragmatic Rating Scale (Y-PRS)

Subject _______________

ITEM 1. Inappropriate / absent greeting 2. Strikingly candid 3. Overly direct or blunt 4. Inappropriately formal 5. Inappropriately informal 6. Overly talkative 7. Irrelevant / inappropriate detail 8. Out of sync content / unannounced topic shifts 9. Confusing accounts 10. Topic preoccupation / perseveration 11. Unresponsive to examiners cues 12. Little reciprocal to-and-fro exchange 13. Terse 14. Odd Humor 15. Insufficient background information 16. Failure to reference pronouns, terminology 17. Inadequate clarification 18. Vague Speech and Language Behaviors 19. Scripted, stereotyped sentences or discourse 20. Awkward expression of ideas 21. Indistinct speech / mispronunciations 22. Rate of speech is too rapid / slow 23. Intonation is unusual 24. Volume is inappropriate (note too loud/soft) 25. Unusual timing of responses, reformulations 26. Unusual rhythm of speech such as stuttering Other Communicative Behaviors 27. Physical distance 28. Gestures 29. Facial Expressions 30. Eye Gaze (e.c., or to help identify referent) Rating Scale 0 = occurs almost never 1 = occurs sometimes 2 = occurs almost always

Block 1

Block 2

Block 3

Block 4

Block 5

Block 6

Block 7

Block 8

Block 9

Block 10

cnr = could not rate n/o = no opportunity to rate

Means for Items That Differentiated ASD Group From TD

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
t De l ai ut O -o nc y f-S o n nf io I t a rd er g v e Bk rs e P n ue io t g na Va o t In e az G

Norm Lang ASD

HFA vs. AS Pragmatic Differences

YPRS Summary
(Chuba et al., 2003)

25%

of PRS items distinguish ASD from TD

Misuses are inconsistent, not constant (except for intonational differences) # of errors distinguished groups:
All

TDs had <5 errors All ASDs had >8 errors

Most robust differences=intonation, gaze; lower in HFA than AS Remaining differences center on ability to share topics, infer others informational state

More

frequent errors in AS than HFA

Yale in vivo Pragmatic Probe (YiPP): Sample Items

Greeting : During interview, an adult knocks on the door and comes in to get something from room. Examiner introduces adult to subject, waits for subject to greet. If subject does not greet, adult greets and waits for a response. Request Object: When examiner gives subject form to fill out (above), doesnt provide pencil Express Denial / Comment on object: Examiner gives subject a choice of magazines to read, at a mid-point in the Examiner gives a different magazine from the one selected Comment on action: Examiner goes into closet to get something, and knocks objects down Topic Initiation: Examiner pauses during conversation and waits for subject to re-initiate

Critical Observations for Speakers with ASD

Prosodic Deficits Deficits in Reciprocity Communicative initiations Deficits in Presupposition/ToM Topic stickiness; ability to appropriately maintain, shift topics Communicative efficiency Ability to elaborate; relate new and relevant information Ability to detect and elaborate theme of story Ability to understand internal states of characters

Evidence-based Approaches to Social Skills Programming

Evidence-based Practices: School-Age

Scripting and fading (Theimann & Goldstein, 2004; McClannahan & Krantz, 2005) Incidental teaching (Milieu Communication Training; McGee et al., 1999) Peer group entry (Beilinson & Olswang, 2003) Incidental teaching (McGee et al., 1999) Buddy time (English et al., 1997) Peer and target training (McGrath et al., 2003) Direct instruction (Coe et al., 1990; Chin & Bernard-Opitz, 2000) Social stories and Comic Strip Conversations (Gray, 2000) Games based on special interests (Baker et al., 1998) Video modeling (Nikopoulos & Keenan, 2003) Cognitive Behavioral Approaches (Timler et al., 2005) Social Skills Groups (Bellini et al., 2007) Peer Support Networks (Haring & Breen, 1992)

Scripting and Fading

(McClannahan & Krantz, 2005)

Construct scripts:

Choose phrases that gain access to favorite objects and activities (Tickle me!) Select scripts that contain different words Use fully grammatical forms Make scripts age-appropriate Start w/ 1-2 scripts, increase as mastered

Record scripts Use model to introduce use of scripts Teach script sequence Increase number of scripts used Fade portions of scripts

Script #
1

Gets card
+

Plays tape
+

Approaches and Orients

+

Says script
+

2
3 4
Script #: 1: want up 2: play horsie 3: tickle me 4: open please

+
+ +

+
+ +

+ +

+ -

Scripting Social Skills

Provide explicit written script of interaction, e.g.,

Walk up to a classmate Make eye contact

Say, Hi ____________

Practice script w/ clinician Practice w/ peer Script Fading: Cut off increasingly large parts of script, until client can do the scene independently

Scripts and Script Fading: Social Skills

Provide

topic lists, guide students to write and fade their own scripts Use favored topics to bridge to new ones

trainsdining car food

Have

students choose a strip to talk with a teacher/clinician Fade scripts with adult Encourage student to repeat with peer partner

Scripting with Peer Training

Peers taught 5 facilitative skills w/o target child present:
1. 2. 3.

4.
5.

Look, wait, and listen Answer questions Start talking Say something nice Keep talking

Target children given written scripts for social interaction (Can I play checkers with you?)

Incidental Teaching
(McGee et al., 1999)

Materials are controlled so that target child must interact to obtain needed objects and complete favored activities Interactions are engineered,:

Child is assigned to complete puzzle Peer holds all puzzle pieces and is told to hold them until asked Child must ask for each piece to complete task

(Beilinson & Olswang, 2003)

Child

Peer Group Entry

is assigned a role to establish group membership Child is prompted to initiate interactions Child is given highly valued prop Child is taught five-step sequence for entering group, using Visual Schedule

Peer Group Entry

Walk over to your friend. Watch your friend. Get a toy like your friend is using.

Do the same thing as your friend.

Tell an idea.

Buddy Time (English et al., 1997)

20 min. period during school day Each child assigned a buddy Buddies rotate Class is taught buddy rules sequentially Both buddies receive reward if follow rules for entire buddy period:

STAY PLAY TALK: say name, talk about the play, respond to partner, repeat then say more about it, ask a Q

Peer and Target Training

(McGrath et al., 2003)

Peer Training: Learn to play new game (e.g., Ring around the Rosy, Hide and Seek) Learn initiation strategies: Tap T on shoulder Say Ts name Say, Would you like to play.. name once choice while pointing to appropriate card

Target (T) Child Training: Learn new game Learn response strategies: Say yes to peer Look at card Look at peer Play game 8 sessions prompted 8 sessions w/out prompts

Direct Instruction
(Coe et al., 1990)

Make conversation:

Go up to person. Say hello. Smile. Listen to what s/he says. Respond.

Listen. Think about what the person says. Talk about the same thing. Keep quiet and listen. Wait until the person pauses. Say, Lets talk about something else. How about?

Maintain topic:

Change topic:

Direct Instruction, cont.

The Conversation Can (Brinton, Robinson & Fujiki, 2005):

Brainstorm a list of topics classmates might want to discuss Write each on a slip of paper Put slips in can Take turns pulling out a topic Start conversation:

Think first: What should I say Say two things about the topic Ask interlocutor a question about the topic Listen while interlocutor answers

Social Stories
(Gray, 2000)

Descriptive sentences: statements of fact

Many children play on the playground during recess. Some children like to make a lot of noise. One child goes down the slide at a time.

Perspective sentences: refer to internal states

Affirmative sentences: express a common value Control sentences: identify personal strategies

This is a safe thing to do.

Cooperative sentences: what others can do to help.

When I have to wait my turn on the slide, I can count the people in front of me to make the time go faster.

The teacher can help me if I feel impatient. She can talk to me while I wait.

Comic Strip Conversations

Use think and word bubble cartoons

Sam, I saw a cowcatcher on an old-fashioned train yesterday. Do you know what that is? Sam doesnt know as much as I do about trains. I will find out if he knows what the cowcatcher does before I tell him about the one I saw

Games Based on Special Interests

(Baker et al., 1998)

Develop

social games based on special interests of target child

Involve target child in development of materials and rules Have target child teach game to peer Set up special opportunities to play game Take turns choosing games to play during interactive game time

(Nikopoulos & Keenan, 2003)

Video Modeling

Use commercial material such as My School Day

(http://www.modelmekids.com/)

Video tape peers conducting interactions such as greeting, negotiating, etc. Use video clips from TV shows to exemplify interactions (may use negative interaction) Rehearse with written scripts first Verbal rehearsal Focus attention on one cue at a time:

Tone of voice Facial expression Proximity Loudness Verbal content

Video Modeling
View video, discuss reactions View video, attend to focused cue, discuss what was noticed Re-enact scene on video with clinician Re-enact with peer DESCRIBE VERBALLY Improvise similar situation

Using Video Modeling

Use video modeling and role playing to become aware of listener cues

Looking at watch Taking a breath Looking toward door Yawning

Use role playing to practice giving and perceiving these cues

Social Cognitive Skills Training

(Timler et al., 2005)

Role play social scripts in peer group

Situation paragraph read to group 4-5 situations/ 2 hour session 6 weeks of 2 sessions/week

Guide role play to identify what they know about situation from own and others perspective Ask Qs identify a range of response strategies by

selecting goal, stating alternative strategies to reach goal Evaluating consequences after response

Social Skills Groups

Can use commercial curricula, such as

Navigating the Social World (McAfee, 2001) Skillstreaming the Adolescent (Goldstein & McGinnis, 2000) Check-in, greet Review last meetings skill Introduce new skill Model and role play new skill Snack, social time Activity that allows real-life practice of new skill Summary

Provide consistent group structure

Most effective when

Targeting social-cognitive skills Done in school settings

Peer Support Networks

(Haring & Breen, 1992)

Select

2-5 peers to serve as social support for student with ASD Assign each support peer a 20 minute period/day to structure activities for student with ASD, e.g.:
Lunch: use Prompt and Praise to engage with others at table Recess: teacher creates scripts for entering games; peer support and target student practice in private, then on playground

Principles of Pragmatic Intervention Strategies

SLPs have a legitimate role in assessing and developing social/pragmatic skills Students with ASD will not acquire social skills from exposure; they require mediated experiences Verbal, written and graphic supports are effective Peer involvement is an essential element

Peers need training, but it is not extensive

Effective Techniques: Social Skills Training

(Timler et al., 2007)

Teacher Redirects Prompting children to play with one another Rephrasing or restating one childs statement for another Praising children for playing together Direct instruction in social language Modeling and practice with explicit cues Role play with prompting Corrective feedback Authentic contexts (peer involvement) Self-monitoring for older students