Social Skills
& Children
with ADHD Dr. Aubrey H. Fine
& Learning
Disabilities
Hallmark of ADHD
• Social Problems
– Serious interpersonal difficulties
– Peer rejection
• Associated feelings of loneliness
• Unhealthy self-esteem
• Poor school work
• Possibly school drop out
Negative Peer Feedback
• Don’t recognize or respect social boundaries
• Can act intrusively at times
• May appear to be annoying to others
• May cause irritation to peers
• Boisterousness
• Lack of awareness on others
• Stubbornness
• Inflexibility
• Aggression
• Bullying
Verbal Skills
• Selection of right
topic to talk about
• Use of
appropriate modes
of speaking
depending on the
social situation
Non-Verbal
Skills
• Problem
resolution skills
• Turn taking
• Internal ability to
conceptualize
social cues and
feedback
Social Skill Deficits
• Begin because of perception,
understanding, or interpreting
environmental cues
• Encoding and perceiving social
cues in the environment
• Limited behavior repertoire
Social
Performance
Deficit
• Behave appropriately
• Unable to consistently apply skills in
everyday interactions
Performance
Deficit
• Disengaged
• Reclusive
Social Skills Deficit
Refers to the
presence of social
skills in a
behavioral
repertoire, but
failure to perform
these behaviors at
an acceptable level
in specific
situations.
Review of Literature
• Why children who have
LD and ADHD
Have Social Skill Deficits?
Snapshot of Research as it Pertains to
Social Skills and LD
• Baum et al. (1998): studied the prevalence of
social dysfunction among students with learning
disabilities in the public schools of Iowa. Their
results found that 38% of students with learning
disabilities were in need of social skills training.
• Bryan (1998): Reported that students with learning
disabilities demonstrated less effective
communicative competence. They were found to
be less tactful in most situations as well as being
less persuasive in arguing their point of view.
• Bryan (1974): In her pioneer study provided
evidence that youngsters with learning disabilities
(when compared with their mainstream
contemporaries) were less well accepted and often
socially rejected.
• Bryan (1974): Suggested that many children with
LD are rejected by their peers.
Snapshot of Research as it Pertains to
Social Skills and LD– con’t
• Carlson (1987): Noted that children with LD have
been found less skilled than their NLD
contemporaries in the quantity of strategies chosen
for hypothetical social situations.
• Conte and Andrews (1993): Concluded that the
absence of limiting conditions in definitions of
learning disabilities makes it difficult to exclude any
particular skills or type of knowledge from falling
with the bounds of the definition.
• Flicek (1992): Reported that the combination and
quality of ADHD along with LD was associated with
the greatest risk of social status problems.
• Kavale and Forness (1966): Suggested that 75% of
children with learning disabilities manifest social
skill deficits. The perceptions one how one does in
school may have great bearing on the rejection that
the student’s face.
Snapshot of Research as it Pertains to Social
Skills and LD– con’t
• Kavanaugh and Truss (1988): Recommended that
the definition of learning disabilities should be
changed to include social skills disorders as one of
the challenges.
• Kistner and Gatlin (1989): Pointed out that close to
60% of children with learning disabilities
experience social problems and that many are
rejected and ignored by their peers.
• Levine (2002): Discussed social language as a
potential obstacle for optimal social development.
He noted that children with language challenges
have trouble regulating their tone of voice, may
have week greeting skills, poor verbalization of
feelings, may have trouble alternating their speech
with various groups (code-switching), the prosody
of the speech, and their overall ability to convey
what exactly they mean may also be hampered.
Some of these children may also have a lot of
difficulties perceiving what others are actually
trying to convey.
Snapshot of Research as it Pertains to
Skills and LD– con’t
Social (2001): Identified several other common
• Levine
skill deficits that some children may also display.
These children may struggle with the use of humor
and have difficulty asking for things, as well as
knowing what to talk about and when.
• Margalit (1994): Reported that children with LD are
more likely to experience loneliness and engage in
more solitary activities.
• Martlew and Hodson (1991): Acknowledged that
children with mild learning disabilities were
teased/bullied more and made fewer friends than
mainstream children.
• Pearl and Bay (1999): Identified that many children
with LD “are less accepted, more rejected, or more
neglected than their nondisabled classmates.”
Although academic concerns appear to be a
priority, children with learning challenges face
disproportionate levels of rejection than their
mainstream friends.
Snapshot of Research as it Pertains to
Social Skills and LD– con’t
• Pearl and Bay (1999): In their review of the
psychosocial correlates of learning disabilities
found numerous studies highlighting the fact that
many of these children have deficits in interpreting
social displays, especially understanding nonverbal
emotional expressions. Furthermore, youngsters
with learning disabilities had definite deficits in
social insight, which included their ability to
evaluate realistically their social status.
• Schachter et al. (1991): Examined the prevalence
of emotional problems among children with
learning disabilities. The children displayed a broad
spectrum of behavioral problems.
• Strain (1981): Suggested that children with LD do
not generally employ reinforcing behaviors (e.g.,
verbal compliments) and, as a result, are rarely
sought out for social interactions by others.
Snapshot of Research as it Pertains to Social Skills
LD– con’t
and Swanson and Malone (1992): Found that social skill
•
difficulties may not be due to social inefficiency, but
rather to the inability to learn more positive social
behaviors. It is important to emphasize that children
with NVLD may have a hard time distinguishing
what a person is trying to say when there is a
contradiction between verbal and nonverbal
messages.
• Vaughn et al. (1993): Reported that there is
extensive research documenting that children with
learning disabilities have tremedous difficulty
forming and maintaining relationships.
• Wiener (1987): Reviewed 25 studies that compared
the peer status of children with learning disabilities
and students without learning challenges. The
findings suggested overwhelmingly that children
and adolescents with learning disabilities were
lower in peer status than their mainstream peers.
Academic failure may have much to do with peer
status and how one is accepted.
ADHD: Snapshot into the
Literature on Social Skills
• Bagwell (2001): Reported that children with ADHD
were, as a group, more rejected by their peers in
their teenage years than those teens without ADHD.
• DeWolfe et al. (2000): Suggested that for some
school-age children with ADHD, negative social
situations will ultimately result in social rejection by
their peers. Furthermore, these disruptive and
intrusive behaviors may eventually receive
tremendous negative sanctions from parents and
teachers, as well as their own peers.
• Dodge and Coie (1987): Identified that early
aggressive reactions are a viable predictor to later
social impairments.
• Fine (1993): Reported that although children with
ADHD seem to know the correct answer to social
dilemmas in real-life situations, there appears to be
significant difficulty generating solutions to their own
difficulties.
ADHD: Snapshot into the Literature on
Social Skills
• Fine (1993): Identified that children with ADHD have
difficulty adapting their behavior to situational
demands. They do not seem as cognizant to the
social cues.
• Flicek (1992): Pointed out that beyond aggression,
the traits of off-task behaviors, distruptiveness,
defiance, and the inability to exhibit self-control were
other features that seem to dramatically impact
social acceptance.
• Levine (2001): Identified several traits that children
who are impulsive and hyperactive may display. The
following lists some of the issues presented:
Problematic conflict resolution skills, poor social
predicting, failure to self-monitor social behavior
accurately, and aggressiveness.
• Martlew and Hodson (1991): Suggested that children
with MLD or ADHD tend to be bullied/teased more
by peers and are subjected to increase amounts of
teasing as they get older.
ADHD: Snapshot into the Literature on
Social Skills
• O’Moore and Hilley (1989): In their study of Dublin
schools, found that children with ADHD or MLD were
bullied twice as much as nonremedial children.
• Salmon et al. (2000): Found that the most common
disorder associated with bullying was conduct
disorder, with ADHD being the most common
comorbid disorder.
• Stormont (2001): Pointed out that children with
ADHD often misread subtle social cues that can
easily lead to teasing/bullying or being ostracized by
peers.
• Stormont (2001): Suggested that children with ADHD
are less popular among their peers and that
aggression toward peers is strongly associated with
peer rejection.
• Stormont (2001): Suggested that children with ADHD
have a bias toward aggressive solutions and are less
desirable to work with.
ADHD: Snapshot into the Literature on
Social Skills
• Stormont (2001): Found that teachers are
often negative when interacting with children
with ADHD and may influence how the
teacher interacts with the entire class.
• Stormont (2001): Pointed out that one of the
most pervasive problems for children with
ADHD is aggression. It appears that children
with ADHD start more fights and arguments
as compared to non-ADHD children.
• Wolfe et al. (2000): Pointed out that
preschool children with ADHD were rated by
their parents as being more aggressive,
noncompliant, demanding, and less adaptive
and socially competent than their peers.
Assessing Social Skill Deficits
(Gresham 1993; 1998)
Three types of measures to consider in
planning social skill interventions
• Social validity
• Observations of the child’s behavior
in the natural environment
• Measure component skills
Social Validity
• Predicts long-term outcomes important
to society
• Measures
– Peer acceptance
– Friendship status
– Parent and teacher judgments
– Archival data
• School attendance
• Disciplinary referrals
• School suspension
Observations
in Natural
Environment
• Objective
observations
– Direct
observational
recording
Observations in Natural
Environment – con’t
• Did the child’s behavior change in a
predicted direction?
• Objective observations in the natural
setting indicates if the behavior did or
did not change
Measure of
Component Skills
• Least socially valid measure. This is a measure
of how the child does in the following categories:
• Role-playing tests
• Problem-solving measures
• Measures of cognition
Social Skills Training
• Four Main Objectives
a) Promoting skill
acquisition
b) Enhancing skill
performance
c) Reducing or removing
competing behaviors
d) Facilitating generalization
and maintenance
Strategies for
Social Skills
training
programs to
generalize
beyond their
therapeutic
settings
(Stokes, Osnes 1989)
Current Functional
Contingencies
• Connect behavior to the natural
consequences
• Teach the child to “go after” the natural
consequences
• At least temporarily stop the reinforcement
for inappropriate behaviors.
• Aggressively reinforce any occurrence of
generalization.
Train Diversely
• Train in multiple settings with
multiple trainers
• Vary the antecedents of the
behaviors as much as possible.
• Create multiple responses to the
behavior.
• Vary the schedule and intensity of
consequences.
Generalization Strategies – Con’t
–Some social skills either
are not learned or
performed because of the
presence of stronger,
competing, or interfering
problem behaviors.
Generalization Strategies – Con’t
– Temporarily interrupting the
contingency of peer attention by
extinguishing disruptive behavior and
reinforcing appropriate behavior
strengthens the appropriate
behavior.
Functional Mediators
• Incorporate the “look” of the natural
environment in the training.
• Incorporate relevant people in the
training.
• Incorporate a tangible
prompt/reminder that he can take
with him.
• Incorporate self-mediated verbal
reminders/prompts.
Generalization Strategies – Con’t
• Social skills can also be viewed from a
competing behaviors framework
– Interfering problem behaviors include
behaviors that are internalizing or over
controlled (e.g., anxiety, fear, social
withdraw) and those that are
externalizing or under controlled (e.g.,
aggression, disruption, impulsivity). For
example, one might recruit the
cooperation of peers in the child’s
classroom to ignore disruptive behavior
and reinforce the child for appropriate
behavior.
Generalization Strategies – Con’t
• Emphasize Training Diversity
– The more similar the training setting is
to the natural environment the more
likely the stimuli from training will elicit
the trained response.
– If there are peers from the child’s
classroom in the social skills training
group, they will help increase the
likelihood the child will respond with
learned responses in the natural
environment with the peers present.
Generalization Strategies – Con’t
– The more similarities to the natural
setting that can be presented in the
clinical setting the greater the
probability of these stimuli prompting
appropriate social behavior.
Some examples of a
Generalization Plan
Target Behavior: Questioning an individual in a
rude and aggressive manner.
• Connect • PLAN- Teach
behavior to the diplomatic verbal
natural statements likely to
consequences. be positively
perceived and
reinforced by
teachers.
Some examples of a
Generalization Plan – Con’t
• Teach the • PLAN- Have the
child to “go student track their
after” the use of tactful
natural questions and share
consequences. with the teacher.
Train the student to
praise the teacher
for answering his
question.
Reviewing Social Skills
Programs
1) How are social skill deficits
assessed
2) How is treatment matched
to deficits
3) How to encourage
generalization of new skills
Social Skills Programs: How to
Develop Intervention
• Social skills programs take a “One size
fits all” approach
– Highly inefficient
– Does not recognize the individual needs of
the child
• Implementing a social skills program
should always start with a functional
analysis
– Of the nature of the child’s current social
skill deficits
Social Skills Programs: How to
Develop Intervention– con’t
• Program should then determine type of
deficit
– Does the child lack the knowledge to
execute particular social skills or fail to
discriminate when certain social behaviors
are appropriate?
– Is there a performance deficit?
– Is the social skill within his repertoire, but
he fails to perform those behaviors at
acceptable levels in specific situations?
– Is the social skills deficit one of fluency?
Social Skills Programs: How to
Develop Intervention– con’t
• Develop strategies
–Most effective strategies combine:
• Modeling
• Coaching
• Reinforcement procedures
–Weaknesses include:
• Failure to generalize beyond the
therapeutic setting
(Gresham, 1998; Dupaul & Eckart, 1994; Mathur & Rutherford, 1996;
Stokes & Baer, 1997; Stokes & Osnes, 1986)
Taxonomy of Social Skills
• Communication Skills
– Introducing oneself
– Beginning a conversation
– Sustaining a conversation
– Utilizing proper nonverbal behaviors
– Ending a conversation
– Speaks in an appropriate tone
– Learning to evaluate how you sound to
others (e.g., friendly or unfriendly)
– Matching your language style to the
group you are speaking to
Taxonomy of Social Skills – con’t
• Friendship Skills
– Giving compliments
– Accepting compliments
– Sharing
– Inviting others to play
– Coping with not always getting one’s way
– Listening
– Saying nice things to others
– Asking others if you can play
– Asking for favors and doing a favor
– Demonstrating kindness
Taxonomy of Social Skills – con’t
• Friendship Skills – con’t
– Monitoring activity level
– Playing fairly
– Being assertive
– Helping others
– Controlling talking
– Dealing with teasing
– Taking turns
– Follows rules of a game
– Recognizing how you behavior impacts
others
Taxonomy of Social Skills – con’t
• Friendship Skills – con’t
– Being patient
– Joins activities
– Being a good sport
– Dealing with embarrassment
– Coping with losing
– Monitoring how you are doing with others
– Being able to call a friend on the phone
– Demonstrates compassion and concern
for others
– Conflict management skills (avoiding
fights and using positive solutions
Taxonomy of Social Skills – con’t
• Friendship Skills – con’t
– Avoiding arguments
– Apologizing
– Handling criticism
– Dealing with losing or not getting
your way
– Negotiating and problem solving
– Learning how to interact with more
than one person (do not dominate)
Taxonomy of Social Skills – con’t
• Skills for dealing with your feelings
– Identifying various feelings
– Recognizing the feelings of others
(both verbally and nonverbally)
– Demonstrating an awareness of
how other’s feel
– Regulating one’s anger
– Dealing with fears and novel
situations
– Controlling temper in conflict
situations
Examples of Social Skills
Programs
• Get Along
Gang
• The Magic
Within You
Taxonomy of Social Skills
focused in the Get Along Gang
• Communication Skills
– Introducing oneself
• Friendship Skills
– Accepting compliments
– Saying nice things to others
• Skills for Dealing with Your Feelings
– Dealing with fears and novel situations
Other Individual Strategies:
Toolbox of Social Skills
Guidelines for Helping Children with
ADHD and LD Demystify and meet
their challenges
• Encourage children to always ask for
help when something is difficult.
• Be careful not to explain the disorder
or disability in a way that suggests
they are incapable of something, have
no responsibility for their behavior, or
it somehow excuses them.
• Remember to point out individuals as
models who have overcome their
challenges or excelled.
Guidelines for Helping Children with
ADHD and LD Demystify and meet
their challenges – con’t
• Answer your child’s questions at the
appropriate developmental level.
• Be willing to share your own experiences if
you also have struggled with similar
challenges.
• Involve your child in support groups or
create the opportunity for your child to
meet other children who are struggling with
similar challenges.
• Be sensitive to your child’s emotional state.
Guidelines for Helping Children with
ADHD and LD Demystify and meet their
challenges – con’t
• Anticipate some of the negative
experiences that children may have and
help them learn how to respond.
• Help your child understand that labels
such as ADHD are for the purpose of
allocating resources.
• Help them to know how, when, and
whom they can go to if they need help.
Guidelines for Helping Children with
ADHD and LD Demystify and meet
their challenges – con’t
• Be aware of situations that are a
challenge for your child and try
never to become frustrated, angry,
or disappointed.
• Established realistic expectations
and make those the challenge.
U. C. I. Child
Developmental
Center
Department of
Pediatrics
Social Skills Program
Multicomponent Program
• Structured School
Program
• Daily Social Skills
Training
• Parent Training
• Multiple Family Group
Structured
School System
• Token System
• Frequent Positive Feedback
• Low Student / Teacher Ratio
Combined Clinical and Teaching Staff
• Three half time psychologist
• Two social skills counselors
• Three teachers
• Two behavior specialists per
class
Classroom Token System
• 2 POINTS - GETTING STARTED
• 4 POINTS - FOLLOW DIRECTIONS
• 4 POINTS - FOLLOWING RULES
• 4 POINTS - COMPLETING TASKS
• 4 POINTS - RELATIONSHIPS
• 2 POINTS - CLEAN-UP AND
TRANSITION
•
•
•
•
•
•
•
•
•
•
DAILY REINFORCEMENT
(LAST TWENTY MINUTES OF THE DAY)
• 90 % - 100 % = RED PATROL
• 80 % - 89 % = YELLOW PATROL
• 79 % OR BELOW = BLUE PATROL
90 % - 100 % = RED PATROL
• PLAY OUTSIDE WITH STAFF
• PLAY COMPUTER GAMES
• SPECIAL ART PROJECTS
• LEGOS
•
•
•
80 % - 89 % = YELLOW PATROL
• WATCH RED PATROL ACTIVITIES
• PUZZLES
• CARD GAMES
• PLAY BOARD GAMES
• USE ART SUPPLIES
70 % AND BELOW = BLUE PATROL
• READ A BOOK
• DRAW WITH PAPER AND
PENCIL
• REST AT YOUR DESK
• LISTENING CENTER
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WEEKLY REINFORCER
FUN DAY FRIDAY
(90% OF POINTS FOR THE WEEK)
• POP CORN AND MOVIE
• WATER PLAY DAY
• FIELD TRIP
• TRANSPORTATION DAY
Transitional Page
DAILY SOCIAL SKILL
(ONE HOUR PER DAY)
• COMBINE TEACHING AND CLINIC
STAFF
• INTEGRATED THROUGHOUT THE
DAY
• INTEGRATED INTO THE HOME
PROGRAM
Transitional Page
SOCIAL SKILLS
CURRICULUM
• IGNORING PROVOCATION
• ASSERTION
• ACCEPTING
• GOODSPORTSMANSHIP
• PROBLEM SOLVING
SOCIAL SKILLS SESSION
• FEELING TIME
• GOAL SETTING
• ROLE PLAY SOCIAL SKILL
• PLAY GAME SOCIAL SKILLS
GAME
• CONTINUOUS FEEDBACK
Transitional Page
Transitional Page
GROUP SOCIAL SKILLS
CONTIGENCY
• GOOD SPORT PIZZA -
GROUP SHOWING GOOD
SPORTSMANSHIP
(PIZZA PARTY)
• BIG DEALS
INDIVIDUAL STUDENTS
EARN FOR THE CLASS
(FIESTA)
Transitional Page
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LEVEL SYSTEM
• LEVEL 1
• LEVEL 2
• LEVEL 3
• LEVEL THREE 3.1 - 3.10
Transitional Page
U.C.I. Outpatient
Social Skills
Program
• Another of Group Therapy
Generalization Strategies
• Principle 1: Exploitation of
current functional
contingencies – con’t
– Another approach is to program
opportunities for the child to
come into contact with
environmental settings, which
may naturally prompt and
reinforce appropriate social
skills.
Generalization Strategies
• Principle 1: Exploitation of
current functional
contingencies
– In selecting a target behavior to
change, one could choose
behaviors that are highly unlikely
to be reinforced in the natural
setting each time they are
exhibited. Also know as trapping
(Stokes & Baer, 1977).
Generalization Strategies – Con’t
• Principle 2: Social skills can also be viewed
from a competing behaviors framework
– Interfering problem behaviors include
behaviors that are internalizing or over
controlled (e.g., anxiety, fear, social
withdraw) and those that are
externalizing or under controlled (e.g.,
aggression, disruption, impulsivity). One
must help the child by perhaps
scheduling consequences that maintain
inappropriate behaviors so that more
appropriate behaviors can be
developed. For example, one might
recruit the cooperation of peers in the
child’s classroom to ignore disruptive
behavior and reinforce the child for
appropriate behavior.
Generalization Strategies – Con’t
• Principle 2: Social skills can
also be viewed from a
competing behaviors
framework
–Some social skills either
are not learned or
performed because of the
presence of stronger,
competing, or interfering
problem behaviors.
Generalization Strategies – Con’t
• Principle 2: Social skills can also
be viewed from a competing
behaviors framework – con’t
– Temporarily interrupting the
contingency of peer attention by
extinguishing disruptive behavior and
reinforcing appropriate behavior
strengthens the appropriate
behavior.
Generalization Strategies – Con’t
• Principle 3: Emphasizes training
diversity
– When the goals and procedures of
training are more widespread so are
the outcomes widespread.
– The more similar the training setting is
to the natural environment the more
likely the stimuli from training will elicit
the trained response.
– If there are peers from the child’s
classroom in the social skills training
group, they will help increase the
likelihood the child will respond with
learned responses in the natural
environment with the peers present.
Generalization Strategies – Con’t
• Principle 3: Emphasizes training
diversity – con’t
– The more similarities to the natural
setting that can be presented in the
clinical setting the greater the
probability of these stimuli prompting
appropriate social behavior.
– Another strategy in training diversity is
to allow a variety of conditions of
training so that the child will not readily
discriminate performance to a
particular set of circumstances.
Generalization Strategies – Con’t
• Principle 4: The use of functional
mediators
– A mediating stimulus is usually one that
can be carried easily by the child to a
diversity of conditions to facilitate
generalization.
– One strategy is to incorporate salient
physical stimuli; physical items common
and obvious in natural and relevant
generalization environments are
incorporated into the training. For
example, a simple report card targeting
specific social skills taught in the weekly
clinical sessions could be used in the
school setting to prompt the use of
these skills in school. The report card
itself serves as a cue to use appropriate
social skills.
Generalization Strategies – Con’t
• Principle 4: The use of functional
mediators – con’t
– A strategy that incorporates many
of the generalization strategies
reviewed earlier is incidental
learning. Incidental learning takes
advantage of the naturally
occurring behavioral incidents or
events to teach social behavior.
Reviewing Social Skills
Programs
1) How are social skill deficits
assessed
2) How is treatment matched
to deficits
3) How to encourage
generalization of new skills