Social Issues Faced by Those with…

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Facts About Autism from theAutism Society

• About 1 percent of the world population has autism spectrum disorder. (CDC, 2014)• Prevalence in the United States is estimated at 1 in 68 births. (CDC, 2014)• More than 3.5 million Americans live with an autism spectrum disorder. (Buescher et al., 2014)• Prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68). (CDC, 2014) Autism is the fastest-growing

developmental disability. (CDC, 2008)• Prevalence has increased by 6-15 percent each year from 2002 to 2010. (Based on biennial numbers from the CDC)• Autism services cost U.S. citizens $236-262 billion annually. (Buescher et al., 2014)• A majority of costs in the U.S. are in adult services – $175-196 billion, compared to $61-66 billion for children. (Buescher et al., 2014)• Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention. (Autism. 2007 Sep;11(5):453-63; The economic consequences of

autistic spectrum disorder among children in a Swedish municipality. Järbrink K1.)• 1 percent of the adult population of the United Kingdom has autism spectrum disorder. (Brugha T.S. et al., 2011)• The U.S. cost of autism over the lifespan is about $2.4 million for a person with an intellectual disability, or $1.4 million for a person without

intellectual disability. (Buescher et al., 2014)• 35 percent of young adults (ages 19-23) with autism have not had a job or received postgraduate education after leaving high school. (

Shattuck et al., 2012)• It costs more than $8,600 extra per year to educate a student with autism. (Lavelle et al., 2014) (The average cost of educating a student is about

$12,000 – NCES, 2014)• In June 2014, only 19.3 percent of people with disabilities in the U.S. were participating in the labor force – working or seeking work. Of those, 12.9

percent were unemployed, meaning only 16.8 percent of the population with disabilities was employed. (By contrast, 69.3 percent of people without disabilities were in the labor force, and 65 percent of the population without disabilities was employed.) (Bureau of Labor Statistics, 2014)

• Last updated: August 26, 2015• Autism Society | 4340 East-West Hwy, Suite 350 | Bethesda, Maryland 20814 | 1(800) 328-8476 • The Autism Society improves the lives of all affected by autism through

education, advocacy, services, research and support.

Autism is a Developmental Disorder Characterized by:

1. Deficits in social communication and interaction.2. The presence of restricted/repetitive patterns of behaviors, interests or activities.3. Onset occurs during early childhood and is lifelong.4. Symptoms limit and impair everyday functioning (Boutot, Myles,Gonzalez, and Cassel, 2011)

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Common Socialization Deficits in Autism

Impaired Use of Non-Verbal Behaviors/ Communication

• Eye to eye gaze• Facial expression• Body/ posture/ gestures

Failure to Develop Peer Relationships• Social Initiation Skills• Social CognitionLack of Spontaneous Seeking to Share

• Enjoyment• Interests• Achievements• By pointing, bringing or showing items

Lack of Social or Emotional Reciprocity (Gonzalez, Cassel, Boutot,

Myles 2011)

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Prerequisite Skills for Appropriate Social Interaction

• Language• Complian

ce

• Play Skills• Motor

Skills

(LRC, 2015)

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To Teach

Social Communication SkillsUsing gesturesResponding to othersTalking about how you feel with someoneSpeaking with someone and maintaining the topicMaking friendsKeeping friendsTaking turns

Examples of Skills

To Teach

Social Initiation SkillsGreetings: Meeting a peer at the door Looking at a peer Greeting a peer Inviting a peer inside Offering a peer the choice of activities

Good – Bye: Walking a peer to the door Looking at a peer Saying “Good Bye”, etc.…

Examples of Skills

To Teach

Social Reciprocity SkillsConversation skills: Being able to converse with and individual and go back and forth in a conversation. Showing an interest in interacting with another individual

Examples of Skills

To Teach

Social Cognition SkillsExecutive Functioning Skills: Organization skills Being able to plan things Problem solving skills

Joint Attention Skills: Being able to share a common focus with someone Shared gaze at something

Emotional Regulation Skills: Doing things in a timely fashion Controlling aggression Controlling anxiety

Examples of Skills

Eye Contact

• In response to a teacher or therapist’s request

• In response to name being called• In response to a peer’s vocalization• When speaking to an individual• When pointing to items• When someone else points to

something

Imitating and Following• When an individual learns to

imitate an individual, they will learn from that individual.

• Prompt (verbally or visually) for the individual to copy:

Actions with objects Actions with their body Words Gestures Facial Expressions

(Photography by Nancy Harris-Kroll, 2011)

Play Skills - • Parallel (e.g.,

playing next to each other)

• Interactive (e.g., playing ball together)

• Pretend Play (e.g., “kitchen” or dressing up

• Figure/Doll Play• Organized Game

Play (e.g., board games, UNO, kickball, etc.…)

(Photography by Nancy Harris-Kroll, 2011)

Routines and Transition Times1. Independence in following teacher / therapist directions2. Lining up at school3. Retrieving and putting materials where they belong – clean up4. Moving between activities smoothly

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ConversationTopic Based(Non-

perseverative)

Initiating a

conversation

Maintaining a

conversation

Transitioning in a

conversation

Exiting a conversat

ion

FLEXIBILITY – Theory of Mind

• Playing a game that a peer chooses

• Talking about a peer’s preferred topic

• Accepting another’s ideas

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Social Skills Assessment Tools

Checklist for Autism in Toddlers (CHAT) The CHAT was designed as a screening measure for individuals ages 18 months to 24 months. It presents questions for parents and medical personnel to answer regarding the client. It takes approximately 10 minutes to complete. Primary skills being measured by the CHAT are joint attention and pretend play, according to Baron-Cohen et. al., 2000. Specifically, the CHAT measures: Pretend Play, Protodeclarative Pointing, Following a Point, Pretending, Producing a Point, Rough and Tumble Play, Social Interest, Motor Development, Social Play, Protoimperative Pointing, Functional Play, Showing, Eye Contact, Tower of Bricks. (Hall, 2013)(Double click on black rectangle to play video “Screening Toddlers for Autism”)

Childhood Rating Scales (CARS)The CARS is an assessment tool that was developed in 1988 by Schopler, Reicher and Renner as part of the TEACCH program at the University of North Carolina, Chapel Hill. There is now a 2nd version the CARS2-ST to be used with clients under the age of 6 or those over six with an IQ score of 79 or below. Scores from this measure generate a classification of “nonautistic, autism spectrum – mild to moderate level of behaviors, and autism spectrum – severe level of behaviors.” (Hall, 2013)

(Double click on black rectangle to play video “EDUC 622 Lydia & Lynn CARS-2”)

Vineland Social-Emotional Early Childhood Scales (Vineland SEEC)The Vineland Social- Emotional Early Childhood Scales is completed in an interview with an adult who is familiar with the client. It is used to assess anindividual’s adaptive behavior in the following areas: Interpersonal Relationships, Play and Leisure Skills, and Coping Skills. It also yields a comprehensive social emotional score. This tool takes approximately 20 minutes to administer. (Perry et. al., 2009)

(Picture – Pearson Educational , 2016)

Diagnostic Interview for Social and Communication Disorders (DISCO)

How do we reach you to communicate?

(Graphic – clip art Microsoft Office, 2010)

This measure is an interview that is conducted with a client’s parent(s) or caregiver to determine the prevalence of autism-PDD. The DISCO has three sections. Section one deals with family and medical history, section two with the first two years of life and section three various developmental skills. These skills range from self-help skills to cognitive skills. There is required training to administer this assessment. This assessment takes 2-3 hours to complete. (Hall, 2013)

Autism Diagnostic Observation Schedule (ADOS)The ADOS has 4 modules that are administered based on the client’s language level. Levels 1 and 2 are for those with language levels of less than 48 months. Levels 3 and 4 are designed to assess older individuals with varying degrees of fluent language. The ADOS is designed to yield a score that delineates the level of autism possessed by the client. The ADOS is an interesting assessment in that it contrives actual scenarios and situations that the examiner observes and discusses with the client as part of the assessment. The ADOS takes approximately 60 minutes to administer. (Akshoomoff et al., 2006)

(Double click on black rectangle to play video “Autism Diagnostic Observation Scale”)

Self Monitoring Strategies

Student Performance Monitoring• Student performance monitoring as a way self- monitoring can

be used in a classroom setting. It is effective with individuals identified as having a handicapping condition such as autism, ADHD or simply to assist typical peers with their day to day organization and functioning in the classroom environment. For instance, a student may need assistance with math. Perhaps they can’t remember the steps to a math problem. Self-monitoring could be a valuable tool for that student. The teacher could sequence the steps and write them down in a checklist format. They could use visuals next to the steps to further assist the student in remembering the process. As the student does the math problem they would check off the step as they completed it.

Visual Checklists• Students with autism often find a visual

checklist helpful when they are trying to remember what to do in class. They can use a self-monitoring checklist to target the “problem areas” identified in their assessment, and use the checklist as a reminder and a way of reflecting on their day. What follows on the next slide is an example of a self-monitoring technique that a student might use in this situation.

Self Monitoring: Visual Checklist

(Pinterest 1/10/16, pediastaff.com, Jessica Kingsley Publisher: London)

Self Monitoring for a Specific Skill• Self-monitoring to assist in the writing process can be

very helpful as a “check” and as a learning tool. A visual/verbal checklist is a good beginner’s checklist for proofreading one’s work. This particular checklist on the next slide, works well for individuals having reading problems and also those needing a visual prompt in order to understand what is being asked.

• Other versions of the proofreading checklist might be more advanced for older students. They might not require a visual. A straightforward traditional checklist format would be more appropriate for those students.

Student Proofreading

(Pinterest 1/10/16 free from www.teacherspayteachers.com)

Self Monitoring Behavior A visual chart developed for the purpose of self-monitoring one’s behavior is sometimes very useful for students. • They can choose how they are feeling and then find

a corresponding facial expression to match that feeling.

• The facial expression can have Velcro on it and be put on the chart.

• Once the student identifies the way they are feeling, they can look at a choice board or a menu of the things they can pick from to do during a “break”.

• The “break” is used as a “calm down” period. What follows is an example of a chart a younger student, or a student with cognitive impairment might use to monitor their behavior and their feelings.

Student Behavior

(https://www.pinterest.com/pin/401031541789599392/)

How Can Teachers and Therapists Help?

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Establish Reinforcement as a Social Scenario

• Establish something that both the student and peer both want to earn

• Establish the target skill that must be performed in order to earn reinforcement

• Set up a token economy system for both individuals

• Both individuals receive reinforcement for performance of the target skill

(LRC, 2015)

Prompting a Student

SYSTEM OF LEAST PROMPTS – Sequencing help from independent to more assistance.

Prompt the student as discretely as possible.Use a quiet voice and whisper to the student.Use indirect prompts, nonverbal, when possible. (LRC, 2015)

SYSTEM OF MOST PROMPTS – Prompting a student with maximum assistance and removing the prompts as they progress. We are always striving for independence.Do not sit between the student and a peer.Sit behind the student.Prompt the student to observe their peer.Use pivotal phrases such as, “I really like the way _____ is siting quietly.” (LRC, 2015)

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Prompting a Peer• Sometimes the peer

may not respond to the student’s ideas.

• Use a natural verbal prompt to re-direct the peer so the student will receive reinforcement.

“Wow, Michael had a great idea!”

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Guidelines for Teachers to Facilitate Peer Participation

• Minimize verbalization to the student• Redirect the student or the peer to respond to

each other• Minimize reinforcing the student • Redirect the student and the peer to reinforce

each other• Be sure to watch and listen for the student• Prompt the student, as needed, to watch and

listen to the per in order to maintain the play situation

• Make sure you have the student and peer engage in fun games and conversations that promote social behavior

(LRC, 2015)

What are Social Skills and How do We Get Them?

Social SkillsSocial skills are a way of communicating with one another. The communication can be made up of our words, gestures, our body language, our tone of voice, and our volume.

There are many different methods to teach social skills…

A few of them are:Prompting Social ScriptingNatural Environment Teaching Social Problem SolvingAntecedent Based Interventions Social StoriesTime Delay Video ModelingVideo Self-Modeling Differential ReinforcementSelf Management Task AnalysisDiscrete Trial Teaching Peer Mediated InterventionNaturalistic Interventions(Hall, 2013)Pivotal Response TrainingFunctional Communication Training

For this presentation our focus will be on the following three methods listing pros and cons to each: Social Scripting, Video Modeling and Social Problem Solving.

Social ScriptingPROS• Can be used to help individuals with autism know what to say in social situations

such as playing or talking to others.• Parent or teacher writes a script, with pictures, that could be used to prompt a

student when presented with that situation.• Can reduce anxiety if the individual knows what to say or do first.• Can teach specifics like: greetings, exiting a conversation, and starting a

conversation.• Research indicates, Hall 2013, that social scripting can lead to increases in social

conversation.

CONS • Can produce stilted conversation.• Need to do a fading technique so that the skill will generalize.

( Loveland and Tunali, 1991)

Social Scripting – Examples(Both examples below are downloaded from www.pinetrest.com)

Social Problem Solving - Example

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Video Modeling

• Video Modeling Example(Right click and click “Open Hyperlink” to play video)

PROS – • Involves a student watching a

video of someone modeling a behavior or a social skill.

• Student observes video then is taught to imitate the behavior seen in the video.

• Video Self Monitoring is when the child watches himself in a video.

• Combines visual with the verbal• Can be used to teach a wide

variety of skills such as social skills, communication skills, appropriate behavior, and self help skills.

• Video modeling has been shown to generalize across environments and across situations over time.

CONS - • Need to be proficient at

technology (Bellini and Akullian, 2007)

Example of child using video modeling to help himlearn how to tie his shoes. (2015, Pinterest.)

Social Problem SolvingPROS – • Can be used with individuals with autism to help them figure out social

situations and socialproblems. • Involves visuals and words or just visuals.• The teacher or parent teaches the skill.

CONS - • The student needs to recognize there is a problem and decide on a strategy

to use.• This strategy has not been shown to generalize to other situations. (McClure

et al., 1978)

Teachers Can Use Proactive Strategies to Support Social Interaction

• Anticipate antecedent events and use proactive strategies to set the stage for success and reinforce that success.

• Have reinforcers readily available.

• Use a token economy system

• Allow student control at first (sit in choice chair, etc.…)

• Student can earn breaks for desired behavior (LRC, 2015)

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Ways Teachers Can Initiate Social Interaction

• Use structured teaching to teach specific social skills through: modeling, role play, and verbal prompting.

• Set up “play dates” within the classroom for students to practice what you have taught them.

• Develop a peer mentoring program.• Set up situations in which the student has to

interact with others.

ReferencesBooks:Hall, L. (2013). Building Social Skills and Social Relationships. In Autism Spectrum Disorder From Theory to Practice (pp. 192-221). Pearson.Boutot, E., & Myles, B. (2011). Overview of Autism Spectrum Disorders. In Autism spectrum disorders: Foundations, characteristics, and effective strategies. Boston: Pearson. Boutot, E., & Myles, B. (2011). Teaching Students with Autism to Communicate. In Autism spectrum disorders: Foundations, characteristics, and effective strategies. Boston: Pearson. Articles:Ozonoff, S., & Miller, J. (1995). Teaching theory of mind: A new approach to social skills training for individuals with autism. Journal of Autism and Developmental Disorders, 25(4), 415-433. Bellini, S., & Akullian, J. (2007). A Meta-Analysis of Video Modeling and Video Self-Modeling Interventions for Children and Adolescents with Autism Spectrum Disorders. Exceptional Children, 73(3), 264-287. Mcclure, L., Chinsky, J., & Larcen, S. (1978). Enhancing social problem-solving performance in an elementary school setting. Journal of Educational Psychology, 7D(4), 504-513. Loveland, K. A., & Tunali, B. (1991) Social scripts for conversational interactions in autism and down syndrome. Journal of Autism and Developmental Disorders, 21, 177-186.Beelman, A., Pfingsten, U., & Losel, F. (1994). Effects of training social competence in children: A meta-analysis of recent evaluation studies. Journal of Clinical Child Psychology, 213, 260-271

Websites:Autism Facts | Autism Society. (n.d.). Retrieved November 29, 2015, from https://www.autism-society.org/what-is/ "What is a Social Communication Disorder? How is it Treated?" (n.d.). Retrieved November 29, 2015, from https://www.autismspeaks.org/Pinterest. (n.d.). Retrieved December 13, 2015, from https://www.pinterest.com/ Leven, M. (n.d.). Video Modeling for Autism - Cate. Retrieved December 13, 2015, from https://youyube.comNickel, Tom (n.d.). Autism Diagnostic Observation Scale. Retrieved January 18, 2016, from https://youtube.comLydia and Lynn (n.d.). EDUC 622 – CARS2. Retrieved January 18, 2016, from https://youtube.comLee Memorial Health System (n.d.). Screening Toddlers for Autism. Retrieved January 18, 2016, from https://youtube.com

Manual:Harris-Kroll, N. (2015). Learning Resource Center Manual (2015 ed.). Virginia Beach, Virginia: Self Published.

Photographs:Unknown (Photographer). (2015, November). Royalty Free Stock Photograph. Retrieved from http://www.123rf.comHarris-Kroll, N. (Photographer). (2011). Maxie and Friends [photograph]. Virginia Beach, VirginiaHarris-Kroll, N. (Photographer). (2011). Maxie [photograph]. Virginia Beach, VirginiaPhotograph. Retrieved from http://www.pearsonclinical.com

Graphic:Microsoft (Graphic Art) (2010) Head With Ladder (graphic). Retrieved from Clip Art Microsoft Office 2010.

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