Asperger’s Disorder & Social Skills

Jom Choomchuay,M.D.,M.Sc.(Merit)

Child and Adolescent Psychiatrist

Samitivej Srinakarin Hospital

Asperger’s Disorder

AACAP,52nd Annual meeting,

Toronto, Canada, October 22nd ,2005

Martin J. Lubetsky, M.D.

John J. Mcgonigle, Ph.D.

Melissa Smiley Jacobson, M.S.W.,L.C.S.W.

Center fo Autism and Developmental Disorders,

Western Psychiatric Institute and Clinic (WPIC),

University of Pittsburgh Medical Center

What are Social Skills?

Definition: (Wagner, 1999) Social skills are skill that:

Allow appropriate initiation of contactEnable one to maintain positive relationshipsFacilitate peer acceptanceEnable one to cope and adapt to social

environment

Basic Assumptions about Social Skills:

Learned skills Made up of behaviors that can be explicitly

taught Can be systematically taught with

considerations for generalization

Why Social Skill development is difficult for those with Asperger’s

Lack of “Theory of Mind” Central Coherence Deficits Failure to develop “an Experiencing Self” Executive Functioning Deficits

Social Skill Development Techniques

Two Dominant Types Instrumental Social Skills Relationship Building Skills

Models Individual Interventions Group Work

Instrumental Social Skills

Teaching social rules and behaviors that support ability to function

How to cope with day to day problems & situations Eye contact Waiting your turn Smiling Appropriate topics of conversation

Instrumental Social Skill Teaching Techniques

Direct Instruction Adult & Peer Mediated Strategies Social Stories & Scripts Comic Strip Conversations Social Autopsies SOCCSS Thermometer Role Play Video Modeling

Direct Instruction

First: identify social goal Second: identify the steps the child needs to

learn to reach the goal Third: Teach these sequential steps through:

Modeling Multiple opportunities to practice behaviours Prompts ( verbal, visual) Reinforcement

Adult & Peer Mediated Strategies

AS child paired with typical peer in socially supportive setting

Typical peer is instructed to remain close to the AS child & participate in activities with AS child

Adult remains close to the children giving prompts when needed if interaction successful, adult provides reinforcement

Social stories & scripts (Carol Gray)

Explicitly describes the process of social situation

Includes 3 types of sentences: Descriptive: who what where why Perspective: persons thoughts, feelings, mood Descriptive: a desired positive response

Example: Social Story“Learning to play fair”

Descriptive It is a good idea to play fair with my friends. Sometimes my friend may win the game we are playing.

Perspective I will try to stay calm if my friend wins a game

Directive & Perspective mix: If my friend wins a game, I may ask them to play again. (D) Asking to play again is a friendly thing to do. (P) It is good to play fair when playing games. (D) That way friends may want to play again. (P)

Comic Strip Conversations(Carol Gray)

Visually illustrates aspects of conflict Actions+ Feelings + thoughts +Intentions

Word Bubbles: what was actually said Thought Bubbles: child perception of what

others were thinking Colors used to represent feelings Helps to identify misunderstanding or

misinterpretations

Other Techniques

Social Autopsies SOCCSS

Situation-Options-Consequences-Choices-strategies-Stimulation

Thermometer Role Play Video Modeling

Instrumental Social Skills- Information for Coaches:

Treatment goals made collaboratively with AS child

Must explain theory behind rules/scripts Must explain exceptions to “social rules” Goal should parallel existing social

opportunities Parents should be involved to promote

learning process

Relationship Building Skills(Gutstein & Sheely)

Goal To target deficits in Experience-Sharing in a systematic

manner, resembling stages of development To teach “ a new way to observe the social environment.”

Desired outcome Creation and deepening of emotional connections Shared excitement and joy Collaboration in novel problem solving Reaching shared goals Cooperation in joint creative efforts

Learning Process

Careful assessment of social skill level Systematic layering of skills Facilitated by Relationship coach Address core deficits regarding:

Theory of mind Sense of “experiencing Self” Central Coherence

Focus on: Skills more adaptable Teaches importance of understanding and reacting to

others perspectives

Helpful Hints

Teaching Environment/setting Balance Directive and Facilitative Interactive

Style Don’t rely solely on verbal communication Keep your objective simple Activities should be Motivating Goals should be meaningful to child