Sunday, February 26, 2012

Addressing Social Deficits



The following is from the DSM –V and describes the social deficits necessary to receive a diagnosis of Autism Spectrum Disorder:

A) Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1.deficits in social-emotional reciprocity
2. deficits in nonverbal communicative behaviors used for social interaction
3.deficits in developing and maintaining relationships


 ABA therapy seeks to strengthen a child’s deficits so children can function better at home, at school, and in the community. There is an emphasis on intensive instruction and teaching (direct or incidental), and unfortunately social skills can sometimes be placed on the backburner or viewed as not as important. Actually social skills are quite important. Communication and social skills are closely linked, in that a child who cannot communicate and has limited receptive language will have little interest in socializing. Also typical peers will have little interest in interacting with a child who communicates mainly through problem behaviors. Communication deficits can dramatically affect social performance.

For most of us, developing skills such as eye contact, parallel play, and social gaze didn’t need to be explicitly taught. We picked them up from our environment and learning occurred when these behaviors were socially reinforced. Social Learning Theory explains that behaviors are learned through observation, imitation, and modeling. For a child with Autism social learning will either be minimal or nonexistent. I could visit a client every week and smile and wave at her when I arrive, but that does not mean she will imitate my behavior and  greet me. It may take repeated instruction and reinforcement to get that child to smile  back at me and wave.  Just like academic skills, social skills need to be part of an instructional plan when you are dealing with children who have Autism. If you want to see improvement in the area of socialization, then teach it.

For some reason there's a misconception that if a child with Autism just spends time with NT peers that they will “catch” appropriate behaviors. The problem with that belief is part of being Autistic means having a diminished ability to learn from social cues. Therefore it doesn’t make sense to expect an inclusive environment to solve all social deficit problems.


Social skills are much more than being able to play with peers. Social skills can include:

  • Eye contact, reading facial expressions, smiling, knowing and using good manners, appropriate physical touch, proximity to others/personal space, hygiene, profane language, attending, listening skills, waiting, requesting or accepting help, story telling, humor/sarcasm, group instruction, asking questions and answering questions, sexually aggressive behaviors, lack of empathy, public speaking, sharing, emotion regulation, voice modulation, public masturbation, and joint attending.

Social skills are a broad concept that basically covers any skill or behavior that involves others or affects others. When you think of it in those terms it’s easy to see how critical social skill deficits are.


So how do you teach social skills?

There are many curriculum guides, computer software programs, and books out there that describe exactly how to teach social skills. Two teaching tools I personally find very helpful are Social Stories  developed by Carol Gray, and Social Skill Builder a computer software program.  However it isn’t necessary to buy a specific book or software program to begin teaching social skills to your child. Below are a few recommendations:

  1. If the child is pre-school age: Create situations where you can observe the child around other children. It is often easier for an adult to get a child to engage than for another child to do so. For this reason, you cant assume that because the child will share with you that they would share with another child. Watch them with their peers  as well as children much younger and older than them. This is important because sometimes a child will completely ignore peers, but will interact with children much younger in age. You are looking to see how the child interacts socially compared to other children. Pay attention to eye contact, attending, initiating play or communication, sharing, and proximity to others. Once you have identified the social deficits, that is your starting point to begin teaching.
  2. If the child is school age: In addition to observing the child with other children, you need to observe  in the classroom setting. Pay attention to off- task behaviors, transitions, down time, independent and group instruction times, and attending to the teacher. Much of classroom instruction requires good social skills. Even a very bright child who does well academically will face serious social disapproval if they exhibit incorrect or odd social behaviors. Think about the Aspergers teenager who stares intently at peers in the classroom, and follows children around that he wants to befriend. That child will face ridicule and possibly bullying if that inappropriate behavior isn't corrected. Once you have identified the social deficits, that is your starting point to begin teaching.
  3. From the selected deficits create clear and measurable goals: If you observe that the child avoids being near other children and reacts with anger  if touched by another child, a great social goal would be “When given the opportunity, Stacie will sit appropriately with the class during Circle Time for 15 seconds”. A poor choice for a social goal would be “When given the opportunity, Stacie will play nice with her sister and not hit”. The second one is a poor goal because its not clear what "play nice" means.
  4. Work closely with your BCBA or Lead Therapist to write programs to address the social skill deficits: If you do not have a Consultant or Lead Therapist who is writing the ABA programs, ask one of your child’s teachers for help. The curriculum planning and objective writing that teachers do is very similar to the program writing that ABA therapists do.
  5. Understand that most social skill goals are taught using an adult model first: This is because typically it is hard to get a child to participate for the necessary repeated trials of learning, and also children are usually less aggressive with adults than peers. In other words, your child may find it easier to learn to share with you first, than with another child. Once you have some success teaching the social skill using an adult, at that point you can introduce a peer. Once you have success with a peer, then you can teach the social skill in a group of peers.
  6. Stay true to ABA methodology: Use positive reinforcement to teach and strengthen social skills, collect and analyze data to track progress, and plan for generalization of the social skills that have been taught. For example, if you teach the child to make eye contact and say “Hello” to people who visit the house, you also need to teach the child to exhibit these skills at the park, at Uncle David’s house, at daycare, etc.
  7. Do not expect a child to exhibit a skill they have not learned yet:  I usually explain that to parents by saying “If the behavior is inconsistent, or consistently poor, then we have to believe the child doesn’t know what to do”. If you know your child has poor social skills don’t be surprised if she hits her brother because she doesn’t want to share. Don’t be surprised when she refuses to give Grandma a hug, and don’t be surprised if her teacher complains to you about excessive tantrums during recess. Expect that your child will need help being appropriate in social situations in addition to structured ABA instruction.




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