Understanding and Developing

Interventions to Support the Social-

Emotional Needs of Children with ASD
 What are “social skills?”
 Brainstorming activity create a list social skills &
behaviors that may be impaired in children with ASDs:
Examples of social skills & behaviors that may be
impaired in students with ASDs:
 Initiations
 Joint attention
 Eye contact
 Imitation skills
 Perspective taking
 Theory of mind difficulty
 Problem solving skill
challenges
 Difficulty with inferential,
abstract thinking
 Pretend/imaginative play
Asking questions/seeking
social information
 Conversation skills
 Relationship difficulties
Initiate, maintain interaction

 Recognizing & responding to
social cues of others
 Lack of understanding of social
rules
 Friendship management
 Cooperative play skills
 Conflict management
 Assessment of social skills
 Observe child in his/her natural environment to see
specifically what they are doing & what they are not
able to do

 Determine why s/he is or is not performing skills similar to

those of their same-aged peers

 Different functions = different approaches & strategies

Skill acquisition deficit vs. skill performance
deficit
 Skill acquisition deficit:
 Absence of particular skill or behavior
 Something child cannot do (has not yet acquired)

 Skill performance deficit:

 Skill or behavior is present but is not consistently used
 Something the child won’t do (reliably across contexts)

 To determine where impairment is ask

 Is this part of their social skill repertoire (i.e., is this something s/he
has learned to do)?
 “Can the child perform this task/behavior with multiple people &
across multiple settings?”
 Review: Deficits in Social Interaction in
DSM-IV and DSM-V
 DSM-IV – Social functioning is one of three areas of impairment:
 Marked impairment in use of multiple nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction;
 Failure to develop peer relationships appropriate to developmental level
 Lack of spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., by a lack of showing, bringing, or pointing out objects of interest); and
 Lack of social or emotional reciprocity
 DSM-V – Persistent deficits in social communication & social interaction:
 Deficits in social emotional reciprocity, ranging, for example, from abnormal social
approach and failure of normal back-and-forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or respond to social interactions
 Deficits in nonverbal communicative behaviors used for social interaction, ranging,
for example, from poorly integrated verbal & nonverbal communication; to
abnormalities in eye contact and body language or deficits in understanding and use
of gestures; to a total lack of facial expressions and nonverbal communication
 Deficits in developing, maintaining, and understanding relationships, ranging, for
example, from difficulties adjusting behavior to suit various social contexts; to
difficulties in sharing imagine play or in making friends; to absence of interest in peers
 Social-Emotional Development

 Child’s capacity to “experience and express a

variety of emotional states, to regulate emotional
arousal, to establish secure and positive
relationships, and to develop a sense of self as
distinct from others” (Prizant & Wetherby, 1990)

Prelock (2006)
 Social-Emotional Development in
Children Without Disabilities
 Infancy:
 Neurotypical (NT) infants socially motivated from earliest days of life
 Early infancy: use facial expressions & EC & social smile to interact
 3mo: distinguish b/w different emotions in others; regulate some emotions
 1st year of life:
 Differentiate caregiver from others; preference for or bond with caregivers
 Reach for children; direct looks, vocalizations, & smiles in direction of other infant
 Simple imitation of both peer & adult behavior
 2nd year of life:
 Coordinate behavior with others
 Toddlerhood
 Parallel play; often expanded to sharing of materials & commenting on behavior
 Preschool years
 More skilled at coordinating & cooperating with adults & peers, imitation improves
 Rudimentary perspective-taking as early as age 2
 Read, interpret, & adjust behavior to facial expressions & body language of others
 Earliest forms of friendship typically during toddler & preschool
Prelock (2006)
 Social-Emotional Development in
Children With ASD
 Infancy:
 Lack of reciprocal eye contact, infrequent or absence of social smile, less
interest in human face
 Early childhood:
 Less pleasure from physical contact, less likely to reach for or seek comfort
 Despite apparent lack of interest, can form attachments (develop more slowly)
 Look at others in environment less frequently
 Less consistently respond to own name
 Marked preference for objects over social interaction
 Prefer solitary activities
 Display more limited range of facial & body expressions
 Difficulty reading others & perspective-taking
 Absence of spontaneous seeking to share & comfort, & share enjoyment
 Cooperative play uncommon
 Throughout childhood, social relationships w/adults, rather than peers
 Adolescence: may be increased interest in relationships, but difficulty
with reciprocal social exchanges Prelock (2006)
 Key areas of impairment in the
social-emotional area
 Several components of social-emotional development
in which children with ASD demonstrate specific
challenges:
 Jointattention
 Face perception & emotion recognition

 Gesture & imitation

 Theory of mind

 Executive function

 These impairments might help to explain overall

social functioning
Prelock (2006)
 Impact of Deficits in Arousal & Attention

 Arousal modulation and attention deficits in children with ASD

affect the development of attachment, emotional expression, and
coordination of affective expression
 Difficulty in these areas often distorts the information being

processed, which is critical to making early emotional connections &

coordinating feelings with expressions of those feelings
 Failure to attend or respond to shared interest will interfere with

the ability of children with ASD to share social experiences &

sustain face-to-face interactions

Prelock (2006)
 Profile of Social-Emotional Strengths & Challenges:
Joint Attention & Imitation
 Joint attention: whether child demonstrates JA & in what contexts
 Does the child observe other children’s or adults activities?
 Does the child follow others’ visual line of regard?

 Does the child communicate (verbally or nonverbally) to establish

JA by commenting & providing or requesting info?
 Does the child respond to the signals of others to establish JA?

 Imitation
 Although not consistent deficit, examine imitation in context of social
experiences (imitation of actions, vocalizations, verbalizations)
 Note any evidence of social orientation (e.g., gaze checking, affect
sharing, communicating verbally) when they accompany imitations
Prelock (2006)
 Profile of Social-Emotional Strengths & Challenges:
Social Responsiveness
 Consider social behaviors that characterize social impairment in ASD:
 Attempts to avoid social interaction
 Responds selectively to social opportunities
 Responds differently in complex environments
 Reacts to different levels of stimulation
 Avoids social encounters in unfamiliar or unpredictable contexts
 Consider Strengths:
 Do respond to others who have made active attempts to engage them
 Do demonstrate attachment
 Look for attempts to engage other children & consider the social context, including the
environment, its predictability & familiarity, interactive partners, & level of stimulation
 Differences in manner & frequency with which children w/ASD initiate
 Consider current means used to initiate interaction & success of initiations
 Examine social communicative interactions in variety of contexts with familiar
communication partners to establish features of the interaction that enhance the
child’s social communicative competence
Prelock (2006)
 Profile of Social-Emotional Strengths & Challenges:
Pivotal Response Behaviors
1) Motivation
 During assessment, identify real & potential intrinsic & extrinsic motivators
 Social motivation: e.g., preference to be alone or in proximity of others, attempts to bring
attention to themselves, response to social games & routines, tendency to orient visually &
shift their gaze to connect with others, attempts to direct acts of others
2) Self-management/Self-regulation
 Arousal (level of alertness), attention (sustained focus), affect (emotional response), and
activity (level of movement appropriate for the situation)
3) Initiation
 Consider unconventional attempts to initiate & opportunities for initiation to occur
4) Empathy
 Are caregivers used for security of emotional support?
 What emotions do children display through their facial expressions?
 Are children’s facial expressions appropriate to the situation?
 Do children appropriately respond to others’ facial expressions
5) Social interaction
 Familiar & unfamiliar peers & adults, structured & unstructured situations, small & large groups
Prelock (2006)
Pivotal Response Training (PRT)

 Pivotal Skills
 Those skills that, once strengthened, result in
positive changes in other areas of functioning and
improvements in subsequent learning

Motivation
Language
Pragmatics

Academics

 Interventiontargeting one response in a cluster

affects other related responses
Koegel et al., (1989); Pierce & Schreibman (1995)
Assessment of Pivotal Response Behaviors

Pivotal Behaviors Context Describe Intervention

Observations Suggestions
(include examples)
Motivation
•Extrinsic motivators
•Intrinsic motivators
Self-Regulation
•Arousal
•Attention
•Affect
•Activity
Self-initiation
Empathy
Social Interaction
Figure 6.2; Prelock (2006)
 Profile of Social-Emotional Strengths & Challenges:
Peer Interactions & Friendship Behaviors
 Less time interacting with peers due to: lack of opportunity, lack of familiarity &
experience, and lack of needed social skills
 Examine friendship behaviors (ability to share, show affection, suggest play ideas,
assist others, sustain encounters, and engage in reciprocal social interaction) of child
with ASD and potential peer buddy (Figure 6.2)
 Differentiate between social behavior (individual action of one child directed to
another), social interaction (reciprocal exchange among two or more children), social
goals (intended outcomes), and behavioral strategies (social behaviors used to
achieve goals)
 System for Observation of Children’s Social Interactions (SOSCI; Brown et al., 1996)
assesses 15 behavioral strategies used by children to achieve 12 different social goals.
Considers outcome of social interaction,
 Assessment of Social & Communication Skills for Children with Autism (Quill, 2000) for
profiling social & communication skills across several contexts
 Social Skills Rating System (SSRS; Gresham & Elliot, 1990); five social skills subscales:
cooperation (helping others, sharing, complying), assertion (initiation), responsibility
(communicating with adults and having regard for work & property), empathy (concern and
respect for others’ feelings), and self-control (response to situations with and without conflict)
Prelock (2006)
Brown, Odom, & Holcombe, (1996)
Brown, Odom, & Holcombe, (1996)
 Assessment of Friendship Behaviors
Friendship Context Describe Intervention
Behaviors Observations Suggestions
(Strain, 2001) (include examples)
Sharing
Showing Affection
Suggesting Play
Ideas
Assisting Others
Sustaining
Encounters
Engaging in
Reciprocal Social
Interaction

Figure 6.2; Prelock (2006)

 Profile of Social-Emotional Strengths & Challenges:
Theory of Mind & Executive Function
 Impairments in ToM present several challenges for children with ASD:
 Inferring mental states
 Predicting behavior
 Adjusting one’s own behavior to accommodate particular situation
 Establishing JA
 Taking turns & creating communicative circles
 Playing symbolically
 Recognizing & understanding emotions
 Using pragmatic language skills
 Recognizing character goals in stories
 Recognizing false beliefs
 Understanding deception
 Differential performance for children of varying ages & cognitive abilities; first-
order and second-order false beliefs
 Executive Function:
 Assess the flexibility with which children with ASD approach tasks and investigate their
ability to transition from one task to another, inhibit inappropriate responses, develop a
plan for completing tasks, and monitor their own behavior
Prelock (2006)
 Social-Emotional Assessment Across
Impairment, Activity, & Participation
1) Record review
2) Interview
3) Observation in clinical or natural environments
4) Use of standardized & nonstandardized tools

Prelock (2006)
Assessing Social Behavior:
McGee Study
 Norms for social behavior
 How often is “typical”?

 Proximity to children

 Receipt of social bids from children

 Focus of engagement on children

McGee, G.G., Feldman, R.S., & Morrier, M.J. (1997). Benchmarks of social
treatment for children with autism. Journal of Autism and Developmental
Disorders, 27, 353-364.
 McGee Study

Social Behavior Autism Typical

Proximity 62% 80%

Receipt 3% 10%

Focus 3% 11%

*The importance of establishing benchmarks for treatment goals based

on the behavior of typical children
 Peer Intervention Strategies
 Proximity
 placing typical peers who are socially competent with children with disabilities
and directing them to play together without specific training
 Prompting & reinforcing
 socially competent peers are trained first to prompt child with disabilities to play
& then to reinforce child’s responses
 Antecedent prompting
 child with ASD paired with socially competent peer who is instructed to remain in
proximity to child with ASD
 teacher provides periodic prompts to child with ASD to engage in social
interaction
 Teacher initially waits for response and, if there is none, provides physical prompt
 Peer initiation
 Typical peers are trained to make social initiations to children with disabilities
(e.g., sharing, suggesting play ideas, showing affection, providing assistance)
 Peer Tutoring
 Children with ASD work in dyads with socially competent peers Prelock (2006)
 Peer-Mediated Techniques
Teach typical peer to initiate an interaction with child w/ASD –
Using peers as trainers
 Peer-Modeling: A situation in which peers, rather than teachers
or therapists, model behaviors to peers with ASD
 Peer-Monitoring: When typically developing peers teach
students with ASD how to self-monitor (self-control)
 Peer-Reinforcement: When peers rather than adults reinforce
learned social skills through the use of rewards
 Peer-Tutoring: When peers work with students with ASD in small
groups and teach each other information as a means to acquire
knowledge of facts as well as more appropriate skills and
behavior
 Peer Network Intervention

 5 typical peers per student

 SocialSkills (e.g., initiating & responding, conversing,
sharing, giving instructions, saying nice thing) modeled
by experimenter with role-play practice & feedback
 Students with autism received training in
augmentative communication
 Results: Increased social interaction & use of ACC
& peer nominations of student

Garrison-Harrell et al., 1997

 Peer-Mediated Intervention: LEAP
(Strain et al., 1996)

 Teaches 5 key social skills:

 Getting friend’s attention
 Sharing a toy
 Requesting a toy
 Suggesting play ideas
 Complimenting what friend is doing
 Intervention around each skill involves 4 basic steps:
 Introduce skill to typical peer
 Demonstrate skill for typical peer
 Typical peer rehearses skill with interventionist
 Typical peer practices skill with another child (another
typical peer and ultimately target child with ASD)
Prelock (2006)
 Example Intervention Goals for
Facilitating Peer Interactions
 Child will accept an object from another child by taking
that object and using it to play
 Child will offer an object to another child
 Child will respond to an idea for play from a peer
 Child will suggest an idea for play with a peer
 Child will allow a peer to help him complete a task
 Child will help a peer to complete a task
 Child will accept affection (e.g., patting, hugging, holding
hands) from a peer
 Child will show affection toward a peer
 Child will respond with appropriate affect to statements of
praise from a peer
 Child will make appropriate statements of praise to a peer
Prelock (2006)
Research on Peer-Mediated Interventions

 Typical peers as young as 3 years old can be

taught to engage with socially withdrawn peers
 Peer mediation leads to immediate effects
(indicating that some of the poor social abilities of
children with ASD can be a result of unresponsive
educational contexts)
 No negative outcomes have been reported for

typical peers participating in peer-mediated

interventions – instead, improvements in their
social relationships with other children
Prelock (2006)
 Cognitive Behavioral Interventions

 Interpersonal problem-solving
 Facilitate child’s ability to attend to both internal (e.g.,
feelings) and external (e.g., facial expressions) social cues,
as well as gain knowledge about different ways to respond
in social situations & consequences of the particular
behavior selected
 Affective education
 Enhance children’s recognition of their own as well as others’
emotions, linking particular social situations with emotions
elicited
 Training can begin with simple emotions, teaching rules
about the emotion and how to identify it
Prelock (2006)
 Affective Behavior
 Teaching contextually appropriate affect (happy, sad,
surprised, etc.) - scenarios

Gena, A., Krantz, P. J., McClannahan, L. E., & Poulson, C. L. (1996). Training and generalization of affective
behavior displayed by youth with autism. Journal of Applied Behavior Analysis, 29(3), 291.
 Example of Social Skills Group
using CBT: PEERS
 Didactic instruction (psychoeducation)
 EXAMPLE: Peer Entry
 (1) watch & listen, (2) identify topic, (3) wait for pause in conversation, (4) move
closer, (5) join by saying something on topic
 Socratic questioning (e.g., “What do you think we are watching & listening for?’)
 Modeling & Role-play demonstrations
 Cognitive strategies
 Social perception (reading social cues)
 “Did it seem like the group wanted to talk to me?” “How could you tell?”
 Social cognition (perspective-taking)
 “What do you think that was like for the other people?” “What do you think
they thought of me?” “Are they going to want to talk to me again?”
 Social problem-solving
 Behavioral rehearsal exercises
 Performance Feedback
 Homework assignments & review
 Parent involvement Laugeson & Park (2014)
 Pivotal Response Training
 Teach children with ASD “pivotal” behaviors that are central
to a child’s day-to-day functioning, with the ultimate goal of
facilitating generalized improvements across contexts
 Pivotal behaviors
 Motivation
 Responsivity to multiple cues
 Stimulusoverselectivity: failure to respond to a variety of
environmental cues (failure to use all the information in their
environment to learn and respond in social contexts)
 Self-initiation
 Empathy
 Self-regulation
 Social interaction Prelock (2006)
 How to Teach Pivotal Behaviors
 Points to Remember
I. The Question/Instruction/Opportunity to Respond should:
1. Be clear, uninterrupted, and appropriate to the task
2. Be interspersed with maintenance tasks
3. Be chosen by the child
4. Include multiple components
II. Reinforcers should be:
5. Continent upon the behavior
6. Administered following any attempts to respond
7. Related to the desired behavior
Koegel, R. et al. (1988). How To Teach Pivotal
Behaviors to Children with Autism: A Training Manual.
 Teaching Pivotal Behaviors
 Provide opportunity for child to respond
 Interspersing maintenance trials in novel task
 Offer the child choices (shared control)
 Use multiple cues
 Capitalize on child’s motivators or interests
 Reinforcing child’s behavior
 Reinforcement should be immediate, appropriate, and
contingent (dependent) on child’s actual behavior
 Reinforce attempts (all goal-directed attempts at responding
to questions, instructions, or opportunities to respond)
 Natural reinforcement

 Incorporate self-management Prelock (2006)

 Cartooning & Thought-bubble Activities
 Cartooning: use of sketches or simple drawings to:
 Enhance social understanding & interpretation of difficult social situations
 Teach recognition & understanding of the thoughts, feelings, perspectives of
others
 Thought-bubbles: using pictures of social situations with thought
bubbles that serve as visual cues representing the thoughts, feelings,
perspectives of others during common interactions
 Useful way of helping the child to identify & communicate their own
thoughts/feelings during situations & interactions
 Visually represent important elements of interactions (e.g., facial
expression, postures, emotions) to make them more concrete
 Comic Strip Conversations:
 Effective visual strategy used to:
 Facilitate social skill instruction
 Convey important information about social situations
 Understanding perspectives, feelings, ideas of others during interactions/social activities
 Teach problem-solving & conflict resolution strategies

 Common elements:
 Description of event or problematic situation
 Feelings & thoughts of everyone involved
 Possible solutions to problem, ideas on how to avoid it in future
 Use of appropriate symbols (as per symbol dictionary you create with child)
 Stick figures, thought bubbles, use of color to express different feelings

 Helpful hints:
 Child should play pivotal role in creating his/her own comic strip conversation
increases likelihood of using these strategies in future
 Create a book of different comic strips that child can use on their own as needed
 Comic Strip Conversations
 Simple drawings to illustrate an ongoing conversation
while providing visual support for students with ASD who
have difficulty understanding rapid exchange of info
 Used to work through a problem that student with ASD
has experienced & identify solutions
 Anecdotal support,
but no empirical research

Prelock (2006)
An overview of Comic Strip Conversations:

 Set of 8 symbols used to represent basic conversational

skills

 Color is used to represent emotional content of statements,

thoughts, questions

 Incorporate simple figures & symbols in comic strip format

 Social Stories

 Short stories written from perspective of student

that provide instruction on positive appropriate
social behaviors
 Prompting strategy using pictures/audio/video
 Describe social situations, highlight important cues,
and give examples of ways in
which individual could respond
 Describes feelings and
reactions of others
Social Stories™
 Topics commonly addressed:
 Difficult
situations already encountered, or that may be
encountered in future
 Provides individual with information he/she may be lacking
regarding perspective taking; social cues; behavior
expectations in social situations
 Areas of difficulty
 Hidden curriculum
 Trouble expressing & perceiving emotions
 Misreading/misinterpreting social situations
 Preparingfor upcoming event/transition/change/activity
 Acknowledging achievement
 Half of all stories should be “affirmation” stories
 How to write a Social Story™
 Individualized general format-depending on child’s level
of comprehension (pictures; simple sentences; articles;
newspaper column)
 Length of each story is typically short
 Straightforward, concrete descriptions of situations &
expectations
 Written in 1st person for younger children; 3rd person for
adolescents & adults
 Present-tense
 Overall positive tone
 Use “positive language”
 Points to remember…
 Social Stories are NOT scripts detailing appropriate behaviors
 Use simple, concrete terms & descriptions the child can easily
understand
 Make it easy, enjoyable, reinforcing (not perceived as “work”)
 Limit the use of “negative language”
 When describing an interfering or inappropriate behavior, avoid using 1st
person
 Instead, use 3rd person or general statements
 E.g., “sometimes kids get upset and might cry” vs “sometimes I get upset and might cry.”

 Avoid absolute or definitive phrases

 Replace “I can” and “I will” with “I will try” or “I will work on” in
directive sentences
 “Usually” and “sometimes” should be used instead of “always” in
perspective & descriptive sentences
Points to remember…
 Everyone working with child should have copy of story
& be encouraged to read it with child & refer to it
often, to promote generalization of skills
 Maintain consistent schedule for reviewing story
 Recommended that it is read once a day with child
(preferably in non-demanding, relaxed environment)-
gradually faded
 Create a personalized “social stories library” for
each child
Different ways to present your Social Story™

 Pictures & Symbols

 Actual photos, boardmaker pictures, drawings made by adult or child
depicting him with others in social situation
 Ensure images aren’t too complex or cluttered

 Social Stories on Tape

 Can be used in conjunction with actual book
 Video
 Film of child & peers acting out scenes from situation
 Story boxes
 Use small action figures to act out scenes from story in “shoe box set”
 Behavioral rehearsal
 Social Stories

 Elements of Social Story

 Descriptive sentences: info about the setting, people,
or activities (what’s about to happen)
 Directive sentences: gives students instructions of how
to behave (what you must do)
 Perspective sentences: provides info about how other
people think and feel (reason for these instructions)
 Control sentences: identify strategies he or she might
use to recall info in a social story
 One directive sentence for every 2-5 descriptive, perspective,
or control sentences
Social Stories: Example

How to behave in the cafeteria

 pic1) At my school, students each lunch in cafeteria
 pic2) The cafeteria can be very crowded at lunch
 pic3) When I go to the cafeteria I get my tray & I
wait in line
 pic4) When I wait, I can think of other things; I can
think of my favorite book
 pic5) Soon, it will be my turn, and I can choose my
lunch
 pic6) Waiting in line is hard but I try to be calm.
Everyone feels good when people wait their turn.
The Power Card Strategy:
 Scripts:
 Teacher developed, written at child’s level of comprehension
 Details problem situation or target behavior/skill
 Describes the behavior & how special interest addresses that social
challenge
 This solution is generalized back to child & actual situation

 Power Card:
 Visual cue-small card that has a picture of the special interest
or hero & a brief summary of solutions or strategies child can
use
 Portable so child can bring it with them
 Motivating way to provide direct instruction & reminders of strategies
Sample Power Card Strategy
Example: Bev, a 9 yr. old girl with ASDs has lots of difficulty when losing a game. This happens
at school & home. A Power Card was created for her featuring the Power-Puff Girls (her
special interest)
Sample Script:
The Power-Puff Girls Play a Game
The Power-Puff Girls like to play games. Sometimes they win the game.
When they win games the Power Puff Girls feel happy. They might smile, give
each other a high five or say "yea!" But sometimes they lose the game.
When they lose games the Power-Puff Girls might not feel happy. They
might take a deep breath, say "good job" to their friend or say, "maybe next
time.“
The Power-Puff Girls" want every one to have fun playing games. They
want you to remember these three things when playing games the Power-Puff
way:
1. Games should be fun for everyone.
2. If you win a game you can; smile, give a high five, or say, "yea!"
3. If you lose a game you can: Take a deep breath, say, "good job" to your
friend or "maybe next time."
Other Interventions Used to
Teach Social Skills
 Incidental teaching
• Teaching child about social situation as it is occurring
(rather than in structured lesson or group)
• Aim is to amplify the social environment as it is unfolding in
real-time
– Highlighting relevant & important social cues, rules,
expectations, perspectives of others involved in specific
situation

• Adult serves as coach in situation

– Prompting, reminding, reinforcing
Describe how incidental teaching could be used
to address the following scenarios:
 Jon gets extremely angry when someone bumps into him as
he walks in the hallway between classes. He typically
responds with aggression directed to the person that he
believes bumped into him deliberately, resulting in a number
of altercations with peers, as well as numerous office referrals
& detention.
Describe how incidental teaching could be
used to address the following scenarios:
 Hailey has a difficult time initiating interactions with her
peers. Instead of asking them if she could play them
when they are in the building center, she typically runs
over and knocks down their blocks. This behavior has
resulted in her peers getting angry and not inviting her to
join their games.
Describe how incidental teaching could be
used to address the following scenarios:
 Corey has several sensory sensitivities, particularly to
certain smells and tastes. When he smells something he
does not like, he usually has an extreme response in
which he loudly vocalizes his displeasure for both the
smell as well as for the person he believes is responsible
for the “offense!” As a result, many people have been
embarrassed and feel uncomfortable when they are with
him (especially in situations where “pungent” food is
present).
Direct Instruction and Modeling

Video: Conversation Training Clip

 Use of Scripts

 Written sentences (script) and/or verbal directions that

instruct kids with ASD how to interact with others
 Example: “Johnny do you want to use one of my pens?”
 Teach child with ASD to initiate conversation with
another child
 Promotes peer-peer interaction
 Increase in # of initiations child with ASD makes
 Other children respond to these initiations
 Over time, child may begin to go “off-script”—
behavior is generalizing
Task Analysis for Social Skills Training

 Social interaction
training
 More naturalistic
responses
 Usedmultiple
exemplar training
 Successful in
teaching children
with autism to
interact with peers
Gaylord-Ross et al. (1984)
 Role playing & behavior rehearsal
• Role playing: acting out various social interactions or skills
• Behavior rehearsal: practicing how to do specified
behavior or skill
• These techniques are usually used prior to an actual
situation to help prepare the child for various social rules
& expectations they may encounter:
– What may occur in the situation
– How they are expected to behave
– What skills or strategies they may need to use
– How others may react or respond to them
Cue cards & conversation scripts
 Visually represent the “how to…” of conversations
 Initiating, asking questions, ending interactions
 We should act as coaches in naturally occurring
opportunities to interact with peers
 Cue cards can list procedures, reminders of “what to do when…”
 We need to provide each child with appropriate levels of
support to ensure success
 Not too direct, but not letting them flounder & fail
 Examples of ways to foster social interactions using more
indirect methods:
 Conversation starters
 Posing questions to remind or cue an interaction
 Offer suggestions
Video Modeling

 Using video or audio to teach social skills or

identifying emotions
 Video tape of two children having a normal
interaction
 e.g., modeling turn taking
 Videotaped self-modeling
• Social skills are largely acquired via learning that involves
observation, modeling, & feedback (coaching &
reinforcement)

• Use of video-tape to teach social skills has been found to

be extremely effective
– Child learns by observing themselves performing the targeted
skill
• Visual-based strategy of support
• Highly motivating they get to watch themselves on TV
 Videotaped self-modeling

 Child plays pivotal & direct part in the instruction process

 Starring role in video
 Watch themselves on video to acquire & practice target skill

 Videotape is an excellent way to collect objective data!

 Monitor student’s progress
 Determine areas in need of further intervention & instruction
Videotaped self-modeling:
 Positive Self-Review (“catch me being good!”)
 Child views themselves successfully engaging in target behavior or activity
 Videotape child engaging in activity/demonstrating skills or behavior as it occurs
(with prompting or multiple steps if needed) edit out prompting
 Video Feed-Forward (“putting it all together”)
 Child is videotaped as s/he is engaging in each skill; segments are spliced
together to form the proper (fluent) sequence
 Learn how to put the various components together to form the appropriate
(target) social skill/activity
 Peer video-modeling (“let’s see how it is done”)
 View peers demonstrating target skill/activity to learn how others perform the
behavior/skill
 Self-Management Training
 Children with ASD taught to discriminate between
appropriate and inappropriate behavior
 May be taught to monitor and record his own behavior and
give himself points for appropriate behavior
 Examples of things that can be self-managed:
 Appropriate facial expression and affect
 Nonverbal mannerisms
 Perseveration on a topic
 Intensity of voice volume
 Eye gaze
Social Skills (Training) Groups

 How to initiate social

interaction/reaction/continuation
 How to continue a conversation
 Turn-taking
 Helping others and asking for help
 Example of Social Skills Group
 Treatment targets included:
 Instruction & therapeutic activities targeting social skills
 Face-emotion recognition
 Interest expansion
 Interpretation of non-literal language
 Treatment delivered using:
 Direct instruction
 Modeling
 Role-play
 Performance feedback
 Response cost
 Results:
 Significantly higher posttreatment scores for treatment group on measures of
knowledge of target social skills & understanding of idioms
 Parent reported improvements in treatment group
 Children were also positive about the program, although their ratings were
somewhat lower than the parent & staff ratings Thomeer et al. (2012)
Social Skills Training

 The “Hidden Curriculum”

 Teach things people “just know” (but aren’t
normally aware of)
 e.g., men’s room situation
The Hidden Curriculum

 The set of unwritten rules that no one has been

directly taught, but everyone knows
 Violation of these rules can make individual a social outcast
 Hidden Curriculum differs across age, who you
are with, gender, culture
 Example (age): what does a 6-year-old boy do to let a
girl know that he likes her?
 What happens if he does that when he is 17?
 Example (gender): Women get together to do what? Men
get together to do what?
 Do men change topics? Does more than one man talk at once?
Dr. Brenda Smith Myles (2015)
Example of Hidden Curriculum: Dating

 What is the difference between trying to get to know

someone and stalking her?
 If a man asks out a woman, does a woman often turn
him down directly?
 No, she often comes up with an excuse
 Man with ASD might wait 3 hours and then call again
 How many times can he call before it becomes
inappropriate?
 Zero. Maybe 1.
 Can he stop by her apartment if she has not picked up
the phone to make sure her phone is working?
 Can he look inside her window to see if there is
something that they might share in common to discuss?
Dr. Brenda Smith Myles (2015)
Examples of Hidden Curriculum Items

 When you are with classmates/coworkers you don’t know very

well and you are at the center of attention, do not pick your
nose, pass gas, or scratch an itch of a private body part.
 A compliment is almost always a good thing, but know which body parts
can be complimented.
 When you are taking a shower in a group setting, do not sustain eye
contact for very long or watch other people taking their shower
 You should talk to teachers in a pleasant tone of voice because they will
respond to you in a more positive manner. They also like it if you smile.
 The goal of social skills is generally to make others feel good about
themselves; it is not to make you feel good.
 When hearing someone speak using incorrect grammar, do not correct him
every time, especially in a critical manner.
 When somebody asks if you like her new outfit, impolite to say no, even if
it’s the truth. Better to make positive comment on some Dr.
aspect of the outfit .
Brenda Smith Myles (2015)
Example of Hidden Curriculum:
The social context of urinals…

1 2 3 4 5

•Where should 1st guy who enters bathroom go?

•Where should 2nd guy go?
Brenda Smith Myles (2015)
Interventions Used to Increase
Social Motivation
Teaching Social Communication Skills

 Attempts to teach children with ASD to

request desired objects or activities are
often more successful than efforts to teach
communication skills that are socially
motivated

Durand (2014)
Review of Interventions Addressing
Social Impairment in Autism
 Moderate to large effects were found for
interventions targeting joint attention/joint
engagement and peer relationships, with mixed
effects on interventions targeting social skills
knowledge (Kasari & Patterson, 2012)
 Review of GSSIs: important to consider gains in both
social knowledge (ie, knowing a social skill cognitively)
and social performance (ie, applying that social skill
appropriately) (McMahon, Lerner, & Britton, 2013)
Review: Kasari & Patterson (2012);
Updated Review: Kasari, Shire, Factor, & McCracken (2014)
 Building Social Motivation &
Social Relationships
 Social Relationships
 Attachment

 Bonding

 Affection

 Friendship

 Reflects social motivation, not just

social skills (i.e., behavior)
Motivation
 Children with autism typically lack
motivation to respond to
environmental stimuli
 Interventions should use motivation-
enhancing techniques
 Motivation to communicate  Critical
treatment component
 Links Between Joint Attention &
Motivation for Social Behaviors
What is Joint Attention?
 Two people share attentional focus on an
object or event
 Form: e.g., gaze alternation, pointing, etc.
 Function: motivation to socially interact – show
enjoyment in sharing object or event
 FORM of Joint Attention
 Responding
 Following direction of adult’s gaze, head turn,
pointing, etc.
 Initiating
 Directing the adult to adopt child’s attentional focus
 Nonverbal: gaze alternation, pointing, showing, etc.
 Verbal: vocalizations to direct adult’s attention
FUNCTION of Joint Attention

 Requesting
 Function:to obtain an object or assistance
 Reward: Nonsocial

 Joint Attention/Commenting
 Function: to obtain social interaction (showing,
sharing attention or enjoyment)
 Reward: Social
 J.A. in Children with Autism
 They’re relatively good at requesting &
protesting, but not gaze shifts, shared
positive affect, gestures, & J.A.
 Deficit in J.A.
 One of earliest symptoms of autism
 Discriminates autism from other developmental
disabilities (DD)
 Related to social & language development

 Developmental Changes
 May learn to respond more than initiate
Pivotal Response Training (PRT)

 Pivotal Skills
 Those skills that, once strengthened, result in
positive changes in other areas of functioning and
improvements in subsequent learning

Motivation
Language
Pragmatics

Academics

 Interventiontargeting one response in a cluster

affects other related responses
Koegel et al., (1989); Pierce & Schreibman (1995)
Examples of Pivotal Skills

 Motivation
 Responsiveness to social & academic stimuli
 Responsivity to Multiple Cues
 Children with ASD respond to overlimited portion of
cues in environment or respond on basis of
irrelevant component of complex stimulus
 Self-Management
 Self-regulatory behavior
 Self-Initiations
 e.g., asking questions
Joint Attention
as a Pivotal Skill
 J.A. may be a pivotal skill
 J.A. reflects cardinal feature of autism
 J.A. facilitates other areas of
development often impaired in ASD
 J.A., symbolic play, & receptive language
are predictors of long-term outcome
 Joint Attention Interventions
(had been used with children with DDs, but not with ASD)

 Milieu or Incidental Teaching

 Arranging environment to elicit desired responses
(e.g., commenting)
 Novel activities; variations in routines; sabotaging
objects/events
 Expectant Waiting
 Teaching within social routines
 Following child’s attentional lead
 Use child’s current focus of interest  Motivation
PRT: Child Choice/Preference

 Preferred Objects/Activities motivate child to

engage in J.A. & interact
 Increase child’s interest & engagement
 Stimulus Novelty (new)
 Variety of Preferred Items (different)
 Salience (interesting, exciting)
 PRT: Natural Consequences
 Consequences that are functionally related
to the target behavior
Teaches child that there is a direct relation
between his response & reinforcement
Behavior: Joint Attention  Natural Consequences: Social Interaction

 Idiosyncratic forms of social attention may be

highly reinforcing for children with ASD (e.g.,
silly voice, funny face, tickles)
 PRT: Activity Interspersal
 Motivating interest in more
difficult activities by interspersing
easier activities between the
difficult ones

 

Child listens to music Child engages in J.A. Natural Social Consequences

Example:
Teaching J.A. Using PRT Techniques
 Adult points to or turns head to look at preferred
object/event (e.g., child’s choice: bubbles)
 Child’s response: alternating gaze between
bubbles and adult (joint attention)
 Natural consequence: Idiosyncratic social
interaction (e.g., excited “Wow!”)
 Activity Interspersal: more bubble play
Multiple Effects of Joint Attention
Intervention for Children with Autism
Jones, Carr, & Feeley (2006)

 Study 1: Effectiveness of multicomponent

intervention with teachers
 Discrete Trial Instruction
 Pivotal Response Training strategies

 Study 2: Extend skills to children’s interactions

with their parents using naturally occurring joint
attention stimuli in the home & community
 Study 3: Examine pivotal nature of joint attention
and social validity of the intervention
 Responding to Joint Attention
SD Response Prompt Consequence

In presence of Child Say child’s Adult meets

interesting alternates name child’s gaze,
object or event gaze OR trace provides
(activated toy), (looks at visual path idiosyncratically
adult turns, object, with reinforcing
looks, back at adult, reinforcer social response,
points at & back at smiles, comments,
object/event, object) and looks back at
and makes (Joint Attention) object of J.A.
exclamatory (Natural Consequences)
Verbalization
The child & adult
engage in activity
related to the
object/event
(Activity Interspersal)
 Initiating Joint Attention
SD Response Prompt Consequence

Interesting Child Say child’s Adult meets

object present alternates name OR child’s gaze,
or event occurs gaze and trace visual provides
(activated toy) points path w/ idiosyncratically
that evokes (Joint Attention) reinforcer reinforcing
child’s attention social response,
Model point smiles, comments,
OR and looks back at
form child’s object of J.A.
(Natural Consequences)
hand into a
point
The child & adult
engage in activity
related to the
object/event
(Activity Interspersal)
 Conclusions

 Study 1: Intervention Effectiveness with Teachers (N=5)

 Multicomponent intervention (discrete trial + pivotal response)
effective in development of J.A. skills, both respond & initiate
 J.A. taught in natural environment by natural intervention agents
 Generalized & maintained
 Study 2: Clinical Extension with Parents (N=2)
 Natural agents (parents), natural settings (home & community) &
natural stimuli (routines; e.g., reading books)
 Greg & David acquired J.A. more quickly in Study 2 than Study 1
 Study 3: Collateral Effects & Social Validity (N=4)
 Collateral Effects: Increased spontaneous vocalizations & social-
communicative behaviors
 Social Validity: videotapes validated by other children’s mothers
Early Social Engagement Intervention
for Young Children with ASD & Parents
 Parents taught to create reinforcing social activity by embedding
social interaction into child-preferred non-social interests

a) Parent set up social-communicative learning opportunity by presenting SD

(e.g., providing verbal prompt or enticing child with reinforcer)
b) Child make an appropriate verbal attempt
c) Child’s verbal attempt was reinforced with motivating social interaction
Vernon, Koegel, Dauterman, & Stolen (2012)
 Effects of Incorporating PRT
Motivational Procedures
 ↑ imitative verbalizations & generalization to spontaneous
verbalizations than DTT alone (Koegel et al., 1987)
 When reinforced for attempts, made more rapid &
consistent progress than when only reinforced for correct
responses (Koegel et al., 1988)
 ↑ acquisition of target sounds when motivational
procedures incorporated into DTT (Koegel et al., 1998)
 ↑ interest, enthusiasm, happiness (Koegel et al., 1988)
 ↓ in disruptive behavior (Koegel et al., 1992)
 ↑ in social play  ↑ social behavior & ↓ in ritualistic
behavior (Baker, Koegel, & Koegel, 1998)
 Incorporating stereotypic or ritualistic behavior  ↑ in
appropriate behavior & ↓ in problem behavior (Charlop-Christy &
Haymes, 1996)
Quality of Rapport
Magito McLaughlin & Carr (2005)

 P.B. more likely to occur in presence of non-

preferred staff members than preferred staff
members
 Strategies to Promote Rapport
 Establish adults as Generalized Reinforcers
(e.g., pair with positive things)
 Responsivity Training (encourage greater
responsivity to communicative attempts)
 Strengthen Reciprocity (i.e., turn-taking, built around
shared reinforcers)
 Establishing Adult as a
Generalized Reinforcer
 Noncontingent presentation of positive
reinforcers
 Pairing staff member w/wide variety of highly
preferred reinforcers;
 Deliver daily reinforcer & positive feedback
 After 3-4 sessions, staff member approach
in order to prompt an approach response
 If not approach, then prompt (verbal cue, then
visual/gestural cue)
 Prompt-fading sequence to strengthen approach
response
 Occasional reinforcers (activities, 2 x a week)
 Responsivity Training
 3-A Rule
1. Acknowledge all communicative
attempts
2. Assess functions of communicative
attempts
3. Address need/request

“Joan, you’re opening “Let’s get a small snack

& closing the doors” “Are you hungry?” because we don’t want to
(acknowledge) (assess) spoil your dinner”
(address)
 Reciprocity
 Teach turn-taking in context of mutually
preferred activity
 E.g., Task-Analysis:
10 steps for “Getting Dessert at Friendly’s”
• Before intervention: Alex grabbed keys, money, took
his own jacket from closet, without involving Joan; no
interaction

• During 1st intervention session, Alex took his jacket

from closet & asked Joan to get her jacket from closet

• During 4th intervention session, Joan got both of their

jackets, while Alex got the van keys and money; Joan
put on her jacket and gave Alex his jacket
 Measures of Task Performance
(Intervention Phase)

Baseline Intervention

100
80
60
40
20 Joan
0

Demand Sessions High Rapport Staff

Low Rapport Staff
 Figure 3. Measures of Task Performance (Intervention Phase)

Baseline Invervention
Measures of task performance (intervention phase)

100
80
Percentage of Task Steps Completed

60
40
20 Joan
0
100
80
60
40
20 Steve
0
100
80
60
40
20 John
0
Demand Sessions
High Rapport Staff Low Rapport Staff

(Note: Symbols for high rapport staff have been slightly displaced for ease of reading).
 RESULTS: Quality of Rapport

 Study 1: Assessment
 Problem Behavior
Poor Rapport: 28 out of 30 sessions terminated
Good Rapport, 4 out of 30 sessions terminated
 Task Completion
Poor Rapport: complete 2 out of 30 sessions
Good Rapport: complete 26 out of 30 sessions
 Study 2: Intervention
 Problem Behavior
Less P.B. after Intervention for all three dyads
 Task Completion
BL: only 8% of task steps completed, 0 out of 15 sessions
PT: 87% of task steps completed, more than half sessions task completion
 Friendship Intervention
(adapted from Natural Ties model)
1) Match the person with disability & the friend
 At least one interest or hobby in common
2) Provide friend with background information
 Info on disabilities & problem behavior
3) Initial Meeting
 Enjoyable setting (e.g., pizzeria, bowling alley)
 Facilitator present (family or staff member)
4) Schedule time together
 Once per week, for 2 hours at a time
5) Introduction to other friends
6) Identifying organizations that have potential for long-
term inclusion Kaarin Anderson Ryan
 Outcomes of Friendship Intervention
 Fewer symptoms of depression after 1 yr
 Compared to activities with staff members, activities with
friends:
 Lasted longer
 Were preferred by the person with disabilities
 Provided the person with disabilities opportunities to meet
more friends without disabilities
 Provided the person with disabilities more opportunities for
inclusion into social groups & organizations
 Provided the person with disabilities with more activities that
were social (not routine errands)
 Tended to elicit fewer episodes of P.B.
Kaarin Anderson Ryan