January 18, 2011 Features

Social Communication Strategies

for Adolescents With Autism
by Michelle Garcia Winner & Pamela J. Crooke

SEE ALSO

 References

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.

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