Promoting Social Skills among Children with Asperger Syndrome (ASD)

These notes provide a summary of the nature of social deficits among children with ASD, plus a collating of advice from a range of sources concerning how to enhance social skill development and to reduce anxieties or communicative disabilities which stand in the way of positive interaction.

Promoting Social Skills Among Children with Asperger Syndrome (ASD)

Introduction - The Nature of Asperger Syndrome

It is entirely to be expected that objectives planned for children diagnosed with Asperger Syndrome or ASD would include or even emphasise social skill development given the very nature of the condition.

Converging definitions or descriptions refer to three core features - the autistic "triad" - by which ASD or Asperger Syndrome is diagnosed ( even if there is still some debate whether Asperger Syndrome is simply a relatively mild form of "classic" autism or whether it is a separate condition in its own right ).The triad comprises :

• Inhibited peer interactions or social relationships ..... the children may appear solitary, preferring their own company, even resisting any "invasion" of their space by others. They may seek interaction but are uncertain how to approach other children, fail to give out or read the appropriate social signals, and do not appreciate how behaviour may need to vary according to circumstances. They may appear actively anti-social.
• Limited communication ..... vocabulary knowledge and articulatory skills may be adequate but there is poor use of language, and communication may be one-sided and eventually break down altogether. There may be an obsessive repetition of the same questions or, at least, an insistence on focusing upon one topic. Understanding is often literal with an inability to understand humour or idioms. Tone of voice tends to be monotonous, the face may remain expressionless, and there is minimal use or understanding of non-verbal signals (including when the other person is becoming irritated).
• A lack of imaginative play or flexible thinking ..... there is a common lack of true interactive play with other children so that the children with Asperger Syndrome may focus upon individual activities and appear obsessed with some particular object or set of objects. They may seek to impose their choice of games upon others and may not be able to take part in "pretend" games.

Much of the behavioural style may be explicable in terms of a lack of " Theory of Mind ".The children with ASD or Asperger Syndrome commonly fail to appreciate how other people may have opinions, attitudes, or knowledge which differ from their own. They are likely to assume, instead, that others share their perspective and will be able immediately to become attuned to what they say and to understand the topic without the need for introduction.

This characteristic may underlie a failure to establish joint attention and, subsqequently, to establish a meaningful interaction. If there is no awareness of what someone else might be thinking or feeling, it will not be possible to make sense of that person's actions or to anticipate their reactions to a given situation or event.

Additional difficulties may include a resistance to change and anxiety at the prospect of an interruption to routines ( or distress/anger if someone makes any change in the way toys or belongings have been set out ). There is a preference for sameness.

Further, some of the children concerned may show awkward motor skills, a clumsiness, and impaired ability to run or throw or catch.

Finally, some children may show an exaggerated response to touch or sound, or display a sensory defensiveness.

So, what is observable about higher-functioning ASD or Asperger Syndrome is, at its very heart, a matter of social disability as much as, or more than, anything else. It is the absence of social interaction or its short-lived or one-sided nature, or even the apparent lack or extinction of a wish to establish interaction, which may provide the initial diagnostic clues. Diagnosis often occurs at about the time the child is beginning to attend group settings such as a nursery or playgroup but when (s)he remains outside any interactive play or shared activities.

It is also relevant to note evidence for some damage or dysfunction in those parts of the mid-brain which are involved both in emotional arousal and in thinking or problem solving.  The implication is for some lack of capacity to attach any personal feelings to what is observed ; autistic thinking remains objective and not subjective so that learning loses personal meaningfulness. The individuals with ASD may not be able to look beyond the actual information given, to make links between different bits or sources of information, or to perceive similarities and differences between their own views and those of other people.

It is stressed that these autistic difficulties may co-exist with other difficulties, such as attention deficit ; and the number or severity of the symptoms will show wide variation within any given sample of children sharing the diagnosis so that there is an implication for individual planning.

However, it is likely that the majority of children with Asperger Syndrome will be placed in mainstream schools where they can probably cope at least adequately with the academic demands and may achieve very well in certain areas like Science or Maths ; but it is the social or group nature of school life that may prove very difficult or threatening to many of these children.

Further, these children may show a kind of innocence in not recognising teasing but a tendency to comply with being told to perform some unacceptable or silly action and then fail to comprehend why the other children laugh at them.

( The present writer's own study [2000], involving the self reports of comprehensive school experience among children with Asperger Syndrome, highlighted a consistent anxiety about how to occupy the long lunch-break period ). 

In respect of anxiety ....... the technique involving " Social Stories " may be very helpful in individual work with a given child to reduce his or her anxiety over some identified activity or circumstance during the school day, with the implication that, if the negative thoughts and anticipations can be largely eliminated, the child will no longer feel the need to set him/herself apart or avoid significant parts of the school experience.

For example, in the initial description of the use of Social Stories, Gray (1995) refers to a child who is intimidated by the general noise in the dining hall but is encouraged to recognise that there is no need for anxiety so that (s)he can take join peers in what is a particularly important, socially-speaking, part of the school day.

Further research has confirmed that this approach is very useful for the ASD child given its visual format, the use of simple language, the explicitness, and availability for repeated usage.

It needs also to be remembered that the child with ASD or Asperger Syndrome may experience a range of negative emotions but not be able to label them or to express them to other people. The implication is for some help in recognising anxiety, in establishing some message or signal by which the child can make clear when anxiety or stress or anger is building up, and taking time to explore the reasons behind the feelings.

It is likely that a significant source may be the apparent unpredictability of the world, with the child with ASD developing rituals by which to increase feelings of stability.  Everything must remain in a certain place ; activities must be followed in the same sequence ... and the "free" social and play activities of various groups of children during school break times may be a particular source of the perceptions of unpredictability and feelings of insecurity, with the child motivated by a wish to escape from this setting.

Strategies for Enhancing Social Interaction

• The direct teaching of social rules or conventions which guide interactions and which most children learn without direct input. These might include how to greet somebody, how to initiate a conversation, taking turns in a conversation, and maintaining appropriate eye contact.
• Modelling of social skills such as the above for the target child to observe ; or shared viewing and discussing of a video-tape of two people talking or playing, including reference to any non-verbal messages which can be discerned.
• Providing specific and structured activities which are to be shared with one or two selected classmate(s). These might range from some jobs to be completed in the school during break or lunch time, games involving turn-taking (board games based on logic or spatial intelligence such as Chess rather than games based on inference-making like Cluedo, simple card games ), tasks or mini-projects to be completed on the computer ( eg preparing large print labels for work to be displayed around the classroom or having the major responsibility for printing a class newsletter ).
• Identifying particular skills in the target child and inviting him/her to offer some help to another child who is less advanced ( eg with the use of the computer ).
• Encouraging his or her participation in school clubs or organised/structured activities during the lunchtime.
• Direct advice about when and for how long the child may go on about a favourite topic, perhaps with the use of a signal by which to indicate when to stop ( or not to start ! ).

Murray (1997) emphasises the value of computers in facilitating shared activites and shared attention.  She notes how the size of monitor plus the use of cursor to highlight the focus of attention enhances the opportunity for " joining in ".  Further, computer-based activities do reduce the level of stimuli to manageable levels, are context free, allow for safe error-making, and provide a structured step by step approach, thus increasing predictability. Certainly, computer activities and games are more predictable than playground games, especially when one recognises the difficulties with pretend play among children with ASD who may be unable to cope with the " as if " element of such play

Recognising the Views/Feelings of Other People

• In the classroom setting, instructions should be very precise with no opportunity to misunderstand what is expected. It may be necessary to follow up group instructions with individual instructions rather than assuming that the target child has understood what is needed or can learn "incidentally" from watching what other children do.
• Direct teaching about social situations such as how to recognise when someone is joking or how to recognise how someone else is feeling. This latter might begin with a series of cartoon faces with clearly drawn expressions indicating anger, amusement, etc., with the target child helped to identify the various feelings and guess what caused them.
• Games or role play to focus upon the viewpoint of another person. This might include simply looking at pictures of children or adults interacting or working together or sharing some activity, and asking what is happening or what a given individual is doing, and what he might be thinking.
• Direct teaching of what to do ( or what not to do ) in certain situations, such as when the teacher is cross either with the individual child or with the whole group.

Avoiding Social or Communicative Breakdown

• Helping the child to recognise his/her own symptoms of stress or distress, with a "script" by which to try relaxation strategies ; or having in place a system where it is acceptable for the child briefly to remove him/herself from the class as necessary.
• The establishment of a "buddy" system or a system where the child in question is encouraged to observe how other children behave in particular situations. 
• Having selected peers specifically model social skills. The buddy might also be encouraged to be the partner of the ASD child in games, showing how to play, and offering or seeking help if the child is teased.
• The use of the " Circles of Friends " approach designed to identify (social) difficulties, and to set targets and strategies by which other children in the class can be helpful and supportive, with the long term aim of increasing social integration and reducing anxiety.
• The availability of a regular time slot for support from an adult in terms of feedback concerning (social) behaviour, discussing what is going well and less well, and why ; and enabling the child to express concerns or versions of events.
• A clarity and explicitness of rules in the classroom to minimise uncertainty, and to provide the basis for tangible rewards.
• Reminders about conversation rules ; and using videos of TV programmes as a basis for observing appropriate interaction.
• In a group setting, adopting the circle time strategy of limiting verbal contributions to whomsoever is in possession of some object (while ensuring that the object circulates fairly among the whole group).
• Using a video of a situation to illustrate behaviour that is inappropriate in, for example, causing irritation to other children, then and discussing why ; making a video of the target child him/herself and discussing where there are incidents of good social behaviours.
• In respect of repetitive questioning or obsessive topics of conversation ......... :
  • Provide a visual timetable plus bulletins of any innovations so there is no uncertainty about the day's routine.
  • Make it clear that one will respond to the question only when a given task has been completed.
  • Agree a later time for responding to the question.
  • Specify one particular place, such as the playground, where the question will be answered.
  • Say that the question is boring, but invite a discussion about something else.
  • If obsessive talking appears to mask some anxiety, seek to identify its source, or teach general relaxation techniques.
  • Specify times when the obsessive topic can be introduced, or allow an opportunity as a reward for finishing a piece of work.
  • Provide time and attention, and positive feedback, when the child is not talking about the given topic.
  • Agree with the child and his classmates a signal to be used by those classmates when they are tired of the topic.
• Allow some practice of talking at a reasonable volume, with an agreed signal to be given if it is too loud ; or tape-recording speech so that the child can evaluate the volume him/herself.

One could summarise much of the classroom-based issues in this area by emphasisng how there will be problems in dealing with implications rather than simple facts, or when the purpose behind some task is not immediately clear, and when the transfer of previous knowledge is assumed rather than spelled out. A risk exists that the fast moving curriculum in a mainstream school, delivered across a range of subject areas, and involving group discussion and a reliance on at least some incidental learning, will be threatening to the child or young person with ASD or Asperger Syndrome. 

This point is underlined by the evidence for difficulties among children with ASD in planning or organising their response. Information processing may be relatively slow and the child may be left behind. The outcome may be that of spending increasing time in his/her own secure world of familiar topics and activities and being all the more unavailable to respond to attempts at communication or to classroom interchange.

Peer Awareness

 A common theme in much of the foregoing or in research findings generally about social skills in the child with ASD or Asperger Syndrome is that the work intended to help the child needs to involve other children to at least some extent. If the focus is upon peer interaction, there is little logic in seeking to improve performance by using only one to one sessions.

This being so, it would be desirable for perhaps two or three non-ASD peers to participate in the activities or video watching so that there could be a shared discussion subsequently and an actual practice of the skills by the children in various permutations and not simply by target child and adult. This latter arrangement risks being somewhat abstract when evidence suggests the value of working on social skills within a social context.

Further, if peers are involved in the training strategies and share the same rules, the greater predictability of the situation may reduce stress upon the ASD child and increase the rate at which (s)he internalises the targeted behaviours.

There is a consensus in the research literature that simply placing a child with ASD in a mainstream class will not suffice for that child to develop socially appropriate behaviours. There needs to be direct teaching or modelling of the behaviours, and it is likely that the number of such behaviours needs to be limited to one or two at a time if true learning and consolidation is to take place.

Peer tutoring, in sum, takes three forms ..... The proximity approach where the target child is placed within a group of peers whose positive social skills will be modelled constantly and where it has been made clear to the ASD child what to observe and imitate ; the training approach involves peers being shown how to prompt some particular response from the child with ASD and then to offer praise when the child acts appropriately ; and the peer-initiated approach involves showing peers how to talk with the ASD child and how to invite him or her to respond.

There is evidence that involving all children in the development of social skills has more benefits than working with the targeted child(ren) only ; there is also the point that this approach avoids singling out the child with the ASD characteristics which might otherwise introduce a further disadvantage before one even begins !  There is a similar risk in a constant pairing of the ASD child with a support assistant in that a dependency may be established, and any need or motivation to interact with other children is reduced.

A further implication behind all this is that there will be benefits in providing some sensitive awareness-raising among classmates of the nature of ASD characteristics and behaviours. There is evidence ( eg Roeyers 1996) that giving peers this kind of information can improve the frequency and quality of social interaction between the ASD child and classmates ; and that it can increase empathy towards the ASD individual whose idiosyncracies become more understandable and are not seen as provocative or awkward.

In conclusion, one might stress that, if a problem is "social", then the action needs to be "social".  The major point of inclusion of children with special needs within a mainstream school is to have he opportunity to interact with and learn from the other children who may deliberately or unwittingly provide positive models of behaviour and communication.  In fact, it is increasingly being recognised that a significant but untapped or under-used source of support for the child with special needs is the presence and involvement of the peer group.

M.J.Connor          September 2002

REFERENCES

It is stressed that this paper does not offer any new perspectives or information but is  largely a matter of bringing together findings and advice from a number of sources which are acknowledged as follows :

Attwood T. 1993   Why Does Chris Do That? London : NAS

Cohen S.  1998 Targeting Autism. Los Angeles : University of California Press

Connor M.J. 2001  Autism : Current Contents 16 Unpublished  Research Notes.  Surrey EPS : Kingston upon Thames

Connor M.J 2001 Autism : Current Contents 20>Unpublished  Research Notes.  Surrey EPS : Kingston upon Thames

Connor M.J. 2000 Asperger Syndrome and the self reports of comprehensive school students.  Educational Psychology in Practice 16(3)  285-296

Gray C.  1995 Teaching children with autism to read social situations.  In Quill A. (Ed)  Teaching Children with Autism.  New York : Delmar

Howlin P. 1998 Children with Autism and Asperger Syndrome.   Chichester : Wiley

Leicester City Council and Leicestershire County Council   1998 Asperger Syndrome - Practical Strategies for the Classroom.   London : NAS

Powell S. and Jordan R. 1997  Autism and Learning. London : Fulton.
(With particular reference to the chapter by Murray D. on autism and information technology )

Roeyers H. 1996   The influence of non-handicapped peers on the social interaction of children with a pervasive developmental disorder.   Journal of Autism and Developmental Disorders 26  307-320