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Social and Interpersonal Skills Interventions for Children with

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					Social and Interpersonal Skills Interventions for Children with Autism Marjorie H. Charlop-Christy, Ph.D. Claremont McKenna College and Claremont Autism Center

Deficits in social behavior are a core feature of children with autism. Social skills have been defined as specific, identifiable skills that form the basis of social competency, such as the contextually appropriate application of motor, cognitive, and affective behaviors. The literature is replete with various applications of behaviorally oriented social skills programs. However, many programs are limited to acquisition of isolated social behaviors, or small changes in such, without pervasive generalization and maintenance effects. This paper will focus on those interventions that have been empirically verified, and have shown the most promise in terms of generalization and maintenance of social behaviors for children with autism. These interventions include Naturalistic Teaching Strategies, Incidental Teaching, Video Modeling, and Photo Chaining. These interventions are perhaps successful because they focus on teaching children with autism using motivational techniques, facilitators of generalization, and rely on the visual strengths which are often present in a child with ASD’s repertoire. that are “learner friendly” are of maximum importance. As well, we believe that there are certain social and interpersonal behaviors that are “key behaviors” for intervention. Such key behaviors will allow the child with ASD easier access to reinforcers in the social world. These key behaviors are essentially response classes that enable Thus, treatment programs

a child with autism to enter the social realm and possibly generalize their responses to others in the same response class and thus increase or maintain social behavior and/or other skills. Among the key areas that we have identified in our work, and clearly there may be many more, are play,

social initiation (including verbal and nonverbal), turn taking and other reciprocal behaviors (i.e. coordinated joint attention) and communication. Page constraints provide for only a cursory discussion and necessitate the omission of communication. There are a number of variables that also need to be considered before beginning social skills interventions and these variables will vary depending on each child, as each child may be in a different circumstance, at a different point on the spectrum, have a different behavioral repertoire, and/or be a different age. We need to consider the child’s developmental age as well as the chronological age. For example, while we may not want a 12 year old boy playing with a fluffy stuffed animal because it isn’t “age appropriate, we also may want to consider what reinforcers are there for this boy and what will motivate him to learn. Making him “look good” (without his stuffed animal) at the cost of learning may not be the best choice. We need to understand contextual and cultural differences and standards as well. In some cultures, quietness and solitude are revered. However, if a child is nonverbal, we need to convey the importance of expressive language and teach the importance of initiations. While we may generate many different answers, in terms of social skills, I suggest we start with play. Play Play is considered a key social behavior for many reasons. First, all children play, regardless of age, so this is a behavior that is typically found in the behavioral repertoires of all children. To teach play to children with autism is to teach them skills that other typically developing children have and give them a common ground, a common language to engage with others. Play phases occur in developmental stages that typically developing children go through, so play is not only for fun, but for purpose. Children learn about the world through play. They learn about social interaction through play. They learn about language through play.

Research has found that this is true for children with autism as well. It has been shown that there is a positive relationship between the level of symbolic play in children with autism and their mental age (Wing,1977). Even when play is ritualistic and stereotyped, children who engage in such have been found to have intelligence quotients on both verbal and non-verbal tests in the mildly retarded or normal ranges, and appeared to have a better prognosis for achieving some degree of independence as adults (Tilton, 1964). We have also seen in the literature that play is related to the increase in language for children with autism, as it is for typically developing children (Ungerer & Sigman, 1981). Further effects of play as a key behavior can be seen in an example from our program evaluation and follow-up study of The Claremont Autism Center. Child 1 illustrates a common theme; the finding that as play increases, stereotypy decreases. While this finding has been shown before, it has only been shown within the short experimental condition, and not for long periods of time (years)(e.g. Favell, 1973). Of interest is that we had no real procedure to decrease stereotypy in effect except using it as a reinforcer (Charlop, Kurtz, & Casey, 1990), which did show concomitant decreases in stereotypy, and DRO. While we present Child 1 as an example of a finding common of many children who passed through our program, we do note that it is an association that may be explained other ways. An additional finding from this program evaluation is the tendency for the children with autism the make the most gains in play if they started the program below the age of six years; whereas the children who started the program six years and older made most of the gains in speech, and relatively few gains in speech. This too may be suggestive of play as a prerequisite or facilitator of speech (Charlop and Kelso, 1992).

Recently, video modeling techniques have shown promise as an effective intervention for a wide variety of behaviors, but is particularly good to teach play (e.g. Charlop-Christy, Le, & Freeman, 2002). Video modeling involves filming "models" engaged in appropriate play activities. We generally use adults as models since this is effective and more cost-efficient for the videos, and we follow a protocol that was established in an earlier study for conversational skills (see Charlop & Milstein, 1989). We have found that video modeling has been effective for teaching cooperative play (Charlop, Milstein, & Moore, 1989), independent play (Charlop, Spitzer, & Kurtz, 1990), and make-believe play skills (Allen, 1994) to children with autism. The effect of video modeling has been replicated often (e.g. Matson and Sweezy, 1998). Learning tends to occur after few presentations of the videos, so video modeling is quick and efficient. As well, the literature has shown promising generalization and maintenance effects. While it had been hypothesized that the efficacy of video modeling was perhaps due to the novelty of the training stimulus, and the ability to zoom in on the relevant aspects of the behavior and highlight them, we now may also attribute some of its effectiveness to the medium of which it uses; visual presentation. Treatment research for children with autism has been moving towards programs that incorporate visual stimuli and take advantage of the children’s visual strengths such as picture activity schedules (McClannahan & Krantz, 1999; MacDuff et al., 1993) and PECS (the Picture Exchange Communication System) (Bondy & Frost, 1994; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002). Recently, a new play or social skills intervention has been designed at our center, that is heavily based on visual learning strategies, called Steps to Social Success (Daneshvar, 2006). In

this program, social behaviors were broken down into components and individual steps that led to a desired social behavior were chained together. (e.g., paying attention, making eye contact, initiating with a person). Steps for Social Success included provisions to take advantage of the visual preferences in children with autism by using photographs of the children themselves engaging in each step of a target behavior. A Rolodex was used to present the photograph chaining of each step of the social behaviors to the children. The Steps for Social Success is considered a Naturalistic Teaching Strategy (Charlop-Christy , Carpenter, & LeBlanc, 1999) because motivation was enhanced by incorporating child preferred toys or activities (e.g., Charlop, Kurtz, & Casey, 1990) and teaching functional behaviors that would likely mand reinforcers were used, and facilitators of generalization were used by incorporating teaching into a child’s daily routine (Charlop-Christy et al., 1999; Stokes & Baer, 1977). An example of a child’s data for Steps for Social Success compared with the use of Social Stories (Garand and Gray) is in the second figure. Social Initiation It is important to teach children with autism both verbal and nonverbal social initiations. While much of the research is with verbal children, nonverbal behaviors such as a smile, wave, hug and joint-attention are key to the development of social interaction skills (Ricks & Wings, 1975; Loveland & Landry, 1986). It is far easier to teach a child with autism to respond than to initiate. However, if we are to teach just responders, who will be the initiators? Modified Incidental Teaching Sessions (MITS) was developed that combines the effective components of DTT (rapid acquisition) with components of incidental teaching (generalization facilitation) to treat children with autism. MITS incorporates the aspects of DTT that aid in the rapid acquisition of target behaviors such as multiple trials. In addition, the increase in training

trials capitalizes on the effectiveness of the traditional incidental procedure by providing extra opportunities for the child to practice in the natural setting, thus increasing the likelihood of acquiring the target behavior (Charlop-Christy & Carpenter, 2000). Furthermore, MITS integrates the components of incidental teaching and the mand-model technique that augment generalization, motivation and maintenance, such as child initiated sessions and the use of reinforcer items found in the natural environment (Charlop-Christy & Carpenter, 2000; Hart & Risley, 1975; Rogers-Warren & Warren, 1980). As with incidental teaching, all teaching episodes occur within the natural environmental context. However, with each teaching episode, two rehearsal trials of the behavior are practiced before the reinforer is provide. Non-verbal initiations such as waves, high fives, head nods have been taught with MITS (Charlop-Christy & Berquist, 2007) as well as verbal initiations (Charlop-Christy & Carpenter, 2002), Turn-taking and Joint Attention Coordinated joint attention is generally defined as a child looking at a person, shifting gaze at a desired item, and then returning gaze to the person within 10 seconds of the presentation of the stimulus (Carpenter, 2003). This is an early step in play for typically developing babies and is also a form of non-verbal language. Importantly, it is the sharing of an experience and the understanding that the experience was shared. It is the inclusion of another into one’s world. Whereas turn-taking is the active process of participating with another, the other person can be regarded or disregarded. The other person can be a computer or a gaming machine. The inclusion of the other into the activity is a huge step for a child with autism. He/she is taught interaction, reciprocity, dependency, and cooperation. All of these are social behaviors, but all of these can be executed without much regard for the other person. Eye contact can be faked. It is joint attention that is the purest form of interpersonal behavior.

References

Carpenter, H. M. (2003). Using naturalistic teaching strategies (NaTS) to promote coordinated joint attention and gestures in children with autism. Unpublished doctoral dissertation, Claremont Graduate University, Claremont, California. Charlop, M.H., & Milstein, J.P. (1989). Teaching autistic children conversational speech using video modeling. Journal of Applied Behavior Analysis, 22, 275-285. Charlop-Christy, M. H., & Carpenter, H. M. (2000). Modified incidental teaching sessions: A procedure for parents to increase spontaneous speech in their children with autism. Journal of Positive Behavior Interventions, 2(2), 98-112. Charlop-Christy, M.H., Carpenter, H.M., Le, L., LeBlanc, L.A., & Kellet, K. (2002). Usinng the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35, 213-231. Charlop-Christy, M. H., LeBlanc, L. A., & Carpenter, H. M. (1999). Naturalistic teaching strategies (NATS) to teach speech to children with autism: Historical perspective, development, and current practice. The California School Psychologist, 4, 30-46. Favell, J. (1973). Reduction in stereotypies by reinforcement of toy play. Mental Retardation, 11(4), 21-23. Hart, B., & Risley, T.R. (1975). Incidental teaching of language in the preschool. Journal of Applied Behavior Analysis, 8, 411-420.

Stokes, T. F. & Baer, D. M. (1977). An implicit technology of generalization. Journal of applied Behavior Analysis, 10(2), 349-367. Tilton, J., & Ottinger, D. (1964). Comparison of the toy play behavior of autistic, retarded, and normal children. Psychological Reports, 15, 967-975. Ungerer, J. A., & Sigman, M. (1981). Symbolic play and language comprehension in autistic children. Journal of the American Academy of Child Psychiatry, 20(2), 318-337. Warren, S.F., McQuarter, R.J., & Rogers-Warren (1984). The effects of mands and models on the speech of unresponsive language-delayed preschool children. Journal of Speech and Hearing Disorders, 49, 43-52. Wing, L., Gould, J., Yeates, S., & Brierley, L. (1977). Symbolic play in severely mentally retarded and in autistic children. Journal of Child Psychology and Psychiatry, 18, 167178.

Figure 1: Play before, during, and upon conclusion of treatment.

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