B E YO N D B E H A V I O R - Social Skills
Social Skills Interventions for Students With Asperger Syndrome and High-Functioning Autism: Research Findings and Implications for Teachers
CHRISTOPHER B. DENNING, UNIVERSITY OF VIRGINIA
More than a decade ago, Asperger syndrome (AS) was added to the Diagnostic and Statistical Manual – 4th Edition (DSMIV) (American Psychiatric Association [APA], 1994). Although there is much debate over the differentiation between high-functioning autism (HFA) and AS, social skills deficits are a hallmark of both disorders (Klin, 2000). These impairments have lifelong implications and have been linked to depression,
limited job success, and poor relationships (Bernard, Harvey, Potter, & Prior, 2001; Gutstein & Whitney,
2002; Klin, Volkmar, & Sparrow, 2000; Venter, Lord, & Schopler, 1992). There is a great need for
research-based practices and for placing this research into the hands of educators. Guidelines are also needed to ensure that effective practices are used. According to the National Research Council (2001, as
cited in Sweeney & Hoffman, 2004), “Some approaches have been greeted with great enthusiasm initially, but have relatively quickly faded, in part because of their failure to demonstrate worthwhile effects” (p. 304). Numerous techniques have been shown to be effective for students with HFA and AS, and these studies begin to show teachers how to instruct students with HFA and AS in order to provide the best chance for social and lifelong success. This article examines the available research in social skills instruction as it relates to HFA and AS, and recommends practices to educators.
Overview Definition
The DSM-IV defines the social impairment for autism and AS in four different areas and requires that an individual exhibit two of these to qualify (APA, 1994). These include
- (a) a marked impairment in the use of multiple nonverbal behavior,
- (b) a failure to develop peer relationships,
- (c) a lack of spontaneous seeking to share enjoyment with other people, and
- (d) a lack of social or emotional reciprocity (APA, 1994, p. 77).
difficulties include unusual voice— cadence, pitch, and volume; a tendency to discuss topics of interest without regard for the listener; difficulty following the rules of games or with losing games; and problems with
change or an insistence on routine.Finally, the “hidden curriculum” or the subtleties that other children seem to
pick up naturally can be problematic (Myles & Simpson, 2001). Students with AS or HFA may need to be explicitly taught many of the skills teachers or parents expect students to understand. All of these issues can create problems during general social engagement.
Recent Research
Recent research has focused obiological and cognitive differences in individuals with AS and HFA related to early social impairments (Dawson, Meltzoff, Osterling, Rinaldi, & Brown, 1998; Dawson et al., 2004),
joint attention (Mundy & Burnette, 2005; Mundy & Crowson, 1997), and theory of mind differences (Klin,
2000). Dawson et al. (2004) found that children with autism failed to orient to all stimuli and that their orientation to social stimuli was “much more extreme” (p. 479) when compared with typical peers or children with Down syndrome. Other signs that point to an early lack of social connectedness include
- (a) a failure to smile by 6 months;
- (b) a failure to share sounds or facial expressions by 9 months; and
- (c) a failure to babble, point, show, wave, or reach by 12 months (Painter, 2003).
repeated practice, children with AS or HFA can remain relatively isolated unless someone intervenes.
Outcomes
Although the outcomes for individuals with HFA and AS are generally considered more favorable than for individuals with more typical autism, there are still concerns with employment, personal relationships,and independence (Bernard et al., 2001; Gutstein & Whitney, 2002; Klinet al., 2000; Venter et al., 1992). Bernard et al. (2001) conducted a study in the United Kingdom that interviewed the parents of 450 individuals with autism spectrum disorders. More than 70% of the individuals were identified as medium to very high functioning and nearly 50% had a diagnosis of AS. The results showed that 70% of parents felt that their children would not be able to live independently without support, only 12% of high-functioning adults had full-time employment, 56% S P R I N G 2 0 07 17 BB BeyondBehavior B Social Skills had depression, “only 28% have had any access to social groups for people with autism or Asperger syndrome” (p. 7), and finally 82% of the parents “believed their children would benefit from social skills training, but only 44% had received any” (p. 21). Clearly, work is required to increase support and involvement for students before they enter adulthood to improve these outcomes.
Many parents notice signs of depression and withdrawal during the teenage years. It seems that adolescents
become more aware of their differences and their lack of friends, despite their repeated attempts at interaction, and become frustrated by this difficult reality. Others may struggle with instances of being picked on or being actively rejected by peers (Myles & Simpson, 2001).
Interventions - Social Stories
What does the research say?
The studies using Social Stories™ begin to illustrate that they can be used to increase appropriate behaviors
and decrease inappropriate behaviors. The advantage of Social Stories seems to be their ability to address
social understanding and to provide behavioral solutions to the student in a concrete and portable form. Some studies have examined ways for students to access them independently, and for the busy classroom teacher, they are relatively easy to implement. One limitation is that the research has not clearly shown the necessary components or that teachers need to follow the guidelines presented by Gray (1993, 2004).
Sansosti, Powell-Smith, and Kincaid (2004) performed a research synthesis of Social Stories and concluded that the empirical evidence was limited. The authors found that “due to a lack of experimental controls, weak treatment effects, and confounding treatment variables in the reviewed studies, it was difficult to determine if Social Stories alone were responsible for durable changes in important social behaviors” (p.200). Another area of concern was the fading of Social Stories. Since they are intended to produce long-term change, removing Social Stories should not result in a complete return to baseline levels for behaviors. More recently,
Reynhout and Carter (2006) conducted a meta-analytic review of Social Stories and found that the studies showed considerable variability, that the overall change in behavior did not indicate the intervention was effective, and that there was little evidence to indicate that Social Stories were more effective if they conformed to Gray’s (2004) guidelines (see below). In fact, Social Stories that included more control
sentences than recommended were more effective. Scattone, Wilczynski, Edwards, and Rabian (2002) developed a program for three participants and created a Social Story for each that was read before engaging in the target activity. The results showed that each participant had markedly reduced levels of inappropriate behaviors. Thiemann and Goldstein (2001) developed an intervention for five students that combined Social Stories, comic strip conversations, and video modeling. The intervention focusedon social communication skills such as “(a) securing attention, (b) initiating comments, (c) initiating requests, and
(d) contingent responses” (p. 429). Results showed increased and more consistent rates of the targeted social behaviors, but limited generalization and maintenance. The authors hypothesized that results might have
improved if training had continued for a longer time period and if prompts had been faded more gradually.
Another study that was implemented at home involved a single subject (Lorimer, Simpson, Myles, &
Ganz, 2002). Two Social Stories were written for the target behavior of tantrums: “talking with adults” to
address his need for attention when others are talking, and “waiting.” The behaviors decreased dramatically
during the intervention phase. Bledsoe, Myles, and Simpson (2003) developed a program to use with a 13-year-old subject and targeted his lunchtime behavior. The story addressed both using a napkin to wipe his face and spilling food and drink. Results showed that spills decreased and wipes increased. The authors hypothesized that the behaviors improved the longer the story was used, and that the participant may have required additional practice to master the skills. Some studies trained or involved parents in implementing Social Stories (Adams, Gouvousis, VanLue, & Waldron, 2004; Ivey, Heflin, & Alberto, 2004; Rogers & Myles, 2001; Smith, 2001; Sofronoff, Leslie, & Brown, 2004). Interventions occurred in both home
and school settings. Results showed that the majority of the participants reported that it was enjoyable, practical, and effective. Adams et al. (2004) noted that both parents and teachers reported that the Social
Stories seemed to reduce frustration of a 7-year-old participant and helped him understand how to ask for help. Finally, Ivey et al. (2004) reported that - The advantage of Social Stories seems to be their ability to address social understanding and to provide behavioral solutions to the student in
a concrete and portable form .
18 BEYOND BEHAVIOR all three participants said that they enjoyed the Social Stories and would like to use them again. In addition, the parents reported that the story created the opportunity for their children to
ask questions about and comment on the upcoming events.
How is it done?
Social Stories attempt to accurately describe the situation in which a behavior occurred, describe the perspective of those involved, and provide guidelines for what the student should do in the future (Gray
& Garand, 1993). They have been used to prepare students for a new activity, to teach appropriate behaviors, and to focus on inappropriate behaviors. The basic format can be implemented with minimal teacher effort. Based on the reviewed research, some components appear to make the technique more
effective; these include
- (a) involving the parents,
- (b) using the approach in multiple settings,
- (c) receiving input from the student,
- (d) focusing on a limited number of specific behaviors,
- (e) using additional reinforcements with the story,
- (f) writing on the students receptive language level,
- (g) reading before engaging in the activity,and
- (h) including comprehension questions to ensure that the student understands the expectations and alternative behaviors.
different sentence types (descriptive, perspective, cooperative, directive, affirmative, and control) and a formula that states there should be twice as many descriptive sentences as directive or control sentences combined. The research, however, does not indicate whether this or any other formula is more effective. illustrations are also discussed in the guidelines (Gray, 2004), including the use of drawings, photographs, objects, and children’s illustrations, but again the research is unclear about what is more effective or whether pictures need to be used. Minimizing pictures may make it easier for teachers to use the technique quickly as the need arises. Another option is to have students create their own illustrations, which may help them connect more with the story. Prewritten stories are also available and may save teachers and parents time when addressing common concerns, such as raising your hand or getting ready for school (Gray, 1993;
2000). See Figure 1 for an example of a Social Story. Cue Card/Written Script
What does the research say?
A cue card or script is similar to a Social Story and may hold promise as an intervention because it is portable and concrete. Scripts have been used in two different ways: to teach appropriate conversational skills (Charlop & Milstein, 1989; Charlop-Christy & Kelso, 2003); and to teach appropriate behaviors (Keeling, Myles, Gagnon, & Simpson, 2003). Both methods have produced positive results. Charlop and Milstein (1989) and Charlop-Christy and Kelso (2003) used scripts and video-modeling to teach conversational skills to three boys. Scripted conversations were created that the boys practiced and then viewed on a video or had access to on a cue card. Results showed that the boys were able to learn the scripts and acquired subsequent scripts more rapidly. Generalization probes also showed success across
different persons, topics, settings, stimuli, abstract conversations, and maintenance at a 15-month follow-up.
Keeling et al. (2003) developed an intervention called a Power Card that combined elements of Social
Stories, special interests, reinforcement, scripts, and a portable card to teach appropriate social behaviors. They developed a script about playing games for one student that centered on her interest in the Power Puff
Girls, and created a card that listed how to act if she lost or won a game. Results showed that her screaming
and whining was reduced to near zero during the intervention and that she was able to generalize the skill to the playground when she had the Power Card with her. Because only one study has demonstrated the effectiveness of the Power Card strategy, additional research is needed to make a recommendation.
How is it done?
The use of a cue card or script may lend itself well as an addition to an existing social skill support plan. The
written format is concrete, portable, and relatively easy to implement. The above studies used scripts that were seven lines long, and generally included a statement and question within each response. Scripts could be practiced with a parent, teacher, or sibling, should focus on either an area of interest or a Social Skills
Figure 1 JOHN’S MORNING ROUTINE STORY
When I get to school in the morning there are many things I need to do. All of the children in my class need to do these things too. If I need help I can watch the other children or ask my teacher, Mrs. Smith. Sometimes it’s hard to remember what I need to do. I can use my schedule to help me remember. First I need to unpack my backpack. I put all my things where they belong. Then I give my journal to Mrs. Smith and move my lunch clip. This will let Mrs. Smith know what I want to eat. The last thing I do is hang up my backpack. Everyone will be happy when I get done and I will be ready for school. Yeah!!
S P R I N G 2 0 07 19 BB BeyondBehavior B topic that is typical for the age group, and should be written on the student’s reading level. Practice sessions could follow a sequence that includes practicing with the script present, practicing without the script, and then practicing the script in another setting with a different partner. Based on the criterion of Charlop-Christy and Kelso (2003) students should be able to complete the entire conversation in two consecutive trials before they would try the conversation in another setting or with another partner. Some students may need more time and as many as 20 trials to be successful (Charlop &
Milstein, 1989). Lastly, praise or small reinforcers such as stickers or food could be used in the initial training
stages to create motivation. See Figure 2 for an example of a social script.
Social Skills Groups
What does the research say?
Social skills groups are becoming more popular and recommended as a training tool for individuals both at schools and in private settings. Unfortunately, only two of the studies were conducted within a school setting
(Kamps et al., 1992; Williams, 1989), so it is difficult to make recommendations for school personnel. Although results from studies have generally been positive, the outcome data relied heavily on anecdotal information and should be interpreted with caution. The studies consistently reported concerns with generalization of skills to other settings, limited changes in interactions with peers, and limited or no improvement in understanding of how others may feel. Mesibov (1984) conducted a social skills group with 15 older adolescents and adults who ranged in age from 14 to 35. The group met for 10–12 weeks for 1 hour and had a 1:1 staff to participant ratio. Each meeting consisted of a group discussion, listening and talking, role-playing, and an appreciation of humor. The author felt that the group met the goal of providing positive peer-related social experiences, and there were anecdotal reports that skills had generalized back
to the home and community. Williams (1989) attempted to replicate Mesibov’s social skills group. The group consisted of 10 students between the ages of 9 and 15 who attended a separate school, and lasted for 4 years. Results of a social behavior questionnaire indicated that they all exhibited gains in social skills, and anecdotal reports showed the participants were more likely to volunteer in groups, talk to peers, and use appropriate facial expressions. The lack of a control, lack of entry data, and extended length of the intervention make it difficult to pinpoint specific causes of improvement. Kamps et al. (1992) assessed the
effects of a classwide social skills group on three participants. Groups contained four peers and one student with HFA. The class was instructed in areas such as initiating an interaction, giving compliments, helping others, and including others in activities. During free time students received stars on a monitoring form when they were engaged in a social interaction at 1- minute checks. The results showed that social interaction increased in duration and frequency, and that appropriate behaviors occurred more frequently.The authors felt that training the whole class was effective and that “the groups were more successful when focusing on fewer behaviors with more practice opportunities for those basic skills” (p. 287). Barry et al. (2003) created an outpatient clinic-based group with four elementary students that lasted for eight sessions. Seven typically
developing peers were taught about autism and were trained to use strategies, such as ignoring inappropriate
behaviors and providing a suggestion during a monologue, to assess whether the students could apply the skills they had learned. Weekly groups used a structured format, behavior chart, an assessment period, and parent training to review skills and make suggestions for use at home, and taught new skills through scripts and role-play. Results showed that participants had significant improvements in greetings and play, and showed a trend for improvement in conversation. Skills that were not targeted did not increase and there was
limited generalization to other settings, according to parent reports. Webb, Miller, Pierce, Strawser, and
Jones (2004) created a social skills group that focused on teaching adolescents to use the SCORE Skills Strategy.
In the program, students needed to
- (a) share ideas,
- (b) compliment others,
- (c) offer help or encouragement,
- (d) recommend changes nicely, and
- (e) exercise selfcontrol.
SAMPLE CONVERSATION
Teacher: What did you do over the weekend?
Student: I went swimming. What did you do?
Teacher: I went for a walk in the woods. What else did you do?
Student: I ate pizza at a restaurant. Do you like pizza?
Teacher: I do. What’s you favorite topping?
Student: I like cheese. What do you like?
Teacher: Everything!
20 B E YO N D B E H A V I O R for “share ideas.” Working in the study did not change the participants’
opinion about working in small groups with classmates at school. The authors also expressed concerns
that the students would not be able to generalize the skills, and additional research may need to focus on this area. Finally, Solomon, Goodlin-Jones, and Anders (2004) created a group that trained parents to use problem-solving strategies to deal with inappropriate behaviors and taught skills to students with autism spectrum disorders. Eighteen boys were in the group, and a control group was used to compare results. Parents were taught how temperament and intelligence interact with core autism deficits to create problem behaviors, and used a behavior log to brainstorm problemsolving strategies. Mothers reported statistically fewer problems and increased satisfaction in their dealing with these behaviors. Two groups developed in the social skills group and differences were noted in how each responded to information. Boys with higher verbal skills seemed to rely more on verbal information, and those with higher visual-spatial skills relied more on nonverbal skills to gain information. This suggests that there may be a difference in how children respond to
information. As with other studies, the participants failed to achieve significant gains in their ability to understand others’ perspective or in generalizing skills to other settings.
How is it done?
The best results were achieved when the lessons focused on teaching specific skills for the students to use,
involved modeling and role-play, were connected with home so the skills could be practiced in multiple settings, and involved the participation of peers.
Peer Coaching/Tutoring
What does the research say?
Involving peers in the process of teaching social skills has produced positive results in a variety of studies.
Kamps et al., (1998) conducted a study measuring the social validity of peermediated programs by assessing peer opinions after participating in these interventions. Their findings suggest that these programs can make a
difference in active social participation as long as the programs include peer training and are structured by the
teacher or parent. Peers generally reported positive comments about the programs and were excited to participate. Handlan and Bloom (1993) trained peers through two phases: the first provided education about disabilities, and the second provided modeling to assist with interactions. Minimal change was noted in peer interactions after the education phase; however, peer interactions increased from an average of 2 or 3 per class to as many as 18 after they received support through modeling and coaching. In addition, parents reported increased contact with peers, and the parents of the nondisabled students reported that they were more likely to talk about their peers with disabilities. Kamps, Barbetta, Leonard, and Delquadri (1994) used a classwide peer tutoring (Greenwood, Delquadri, & Carta, 1988) program in a second grade classroom. All students were trained for three 45-minute sessions. Components included reading of passages, feedback
from peers, correction of errors, and a public posting. Tutors were instructed to provide positive and corrective feedback, were monitored by teachers, and received bonus points for appropriate interactions.
Results showed that all 3 students with HFA and 11 out of 13 of the peers had significant improvements in
reading comprehension during both intervention phases when compared to baseline. Although social interactions increased, there are two main limitations. The authors assessed the length of the interactions, but not the quality. In addition, these interactions account for only between 10% and 16% of the total free time. To be truly integrated in the class, these students need to engage more frequently. Barry et al. (2003) recruited and trained peers to interact with students with autism during a social skills group. Finally, Bauminger (2002) developed a program that used aspects of other previously discussed techniques (i.e., training and modeling for peers, teachers, and parents). The intervention involved 15 participants with a mean age of 11 and included
- (a) instruction in prerequisite concepts such as what a friend is or how we listen to a friend,
- (b) affective education in teaching emotions, and
- (c) social–interpersonal problemsolving.
home. In addition, parents helped students meet with peers at home, suggested social activities, and assisted
with phone calls. Results showed that participants demonstrated growth in positive social interactions through
interest in other students, improved eye contact, an increase in sharing experiences, an increase in functional
behavior, and a reduction in repetitive or ritualistic behavior. Although it was difficult to assess whether this
translated into interactions with other peers, parent and teacher reports showed improvements in overall social skills, assertiveness, interactions with peers, and the ability to cooperate in a group. The study shows promise in its ability to integrate the program across settings, intimately involve parents as agents of change, and connect the participants closely with another peer. It also provided ongoing times to practice the skill that may be much more effective than the isolation seen from a social skills group or another intervention that is only connected with a single setting.
How is it done?
Peer coaching and training has been effective on both an individual and classwide basis. The research seems to show that interactions increase Social Skills S P R I N G 2 0 07 21 BB BeyondBehavior B between students with disabilities and peers when a structured activity is created, such as tutoring or a structured
play time. Peers should be trained in specific techniques, such as positive reinforcement through modeling,
and be provided information about disabilities and differences. More research is needed to isolate how
specific components affect results, and teachers would benefit from the use of protocols that outline how to create peer tutoring programs.
Parent Training
What does the research say?
Parental involvement has been examined in eight studies and consistently correlated with improved outcomes. Results showed improved outcomes and generalization to other settings when parents were involved in the process and when the activities were used in the home (Adams et al., 2004; Bauminger, 2002; Charlop-Christy & Kelso, 2003; Ivey et al., 2004; Lorimer et al., 2002; Smith, 2001; Sofronoff et al.,2004; Solomon et al., 2004). Sofronoff et al. (2004) developed a controlled study to assess the effects of parent training. Fifty-one parents with children recently diagnosed with AS were instructed in Social Stories, comic strip conversations, behavior management techniques, anxiety management, and educated about the disability. Parents involved in either training session group reported significant improvement in number of problem behaviors, intensity of problem behaviors, and social skills. Parents from the individual session group reported greater use of strategies, while those in the waitlist control group did not report a significant improvement on any outcome measure.
How is it done?
Based on the available research, teachers should actively seek ways to involve parents through training in
both understanding the characteristics of the disorder and implementing the interventions, encourage parents to provide support and motivation to their children, and provide weekly updates on the status of the program. Parents are able to follow up on strategies and plans outside of the school to ensure their use in multiple settings. In addition, the added knowledge may be helpful in areas other than social skills, and may positively affect the overall atmosphere of the home.
Conclusion
According to the research reviewed, seven components are common across successful social interventions for students with AS or HFA:
- teaching specific skills, such as how to initiate a conversation;
- modeling skills demonstrated by the interventionist, using a scripted conversation or scripted lines, or by presenting an example of a response to a situation (e.g., asking to play a game);
- practicing the skills after observing a demonstration;
- using positive reinforcement, such as praise, food, or stickers;
- involving parents in the intervention and giving specific responsibilities so that the student could continue to practice the skills at home;
- involving peers as the intervention agents or in the practice and play sessions; and
- including written information and pictures to create a readily accessible and more concrete format.
interventions to create long-term change. Table 1 lists the studies analyzed and illustrates whether the
interventions were effective. Scripts, peer support, and parental involvement appeared to produce the best results in generalizing behaviors to other settings. Future research should also focus on ways to improve the quality and frequency of interactions. The research also illustrates the benefits for individuals with HFA and AS when effective instructional techniques are used. Since social skills deficits create lifelong difficulties related to employment, independence, and personal happiness, it is crucial that teachers find ways to improve the social interactions and social behavior of students with AS and HFA.
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Table 1 PUBLISHED RESEARCH ON SOCIAL SKILLS INTERVENTIONS FOR
HFA AND ASPERGER SYNDROME
Author Year N Design Intervention(s) Results Adams et al. 2004 1 ABAB Social storiesParent training Behaviors improved Ivey et al. 2004 3 ABAB Social stories Parent training Increased participation
skills
Solomon et al. 2004 18 Pre-post Social skills group Parent training Parent reported success, but limited
generalization
Webb et al. 2004 10 Multiplebaseline Social skills group Skills improved, but not generalized to school
Barry et al. 2003 4 Pre-post Social skills group Peer coaching Skills improved, but limited generalization
Bledsoe et al. 2003 1 ABAB Social stories Decreased spills and increased mouth wipes Charlop- Christy &
Kelso 2003 3 Multiple baseline Cue card Parent training Improved conversational speech Keeling et al. 2003 1 Multiple baseline Cue card Reduced inappropriate behaviors and results generalized Bauminger 2002 15 Pre-post Social skills group Peer coaching Parent training Skills improved; parents and teachers noted social skills gains Lorimer et al. 2002 1 ABAB Social stories Parent training Reduced tantrums and
interruptions Scattone et al. 2002 3 Multiple baseline Social stories Reduced levels of inappropriate behaviors Rogers & Myles 2001 1 Case study Social stories Anecdotal reports of improved behaviors Smith 2001 15 Case study Social stories Parent training Parent reports positive,results anecdotal
Thiemann & Goldstein 2001 5 Multiple baseline Social stories Targeted behaviorsimproved
Kamps et al. 1998 2 ABAB Peer tutoring Increased interactions,but quality not assessed
Kamps et al. 1994 3 Multiple baseline Peer coaching Interactions increased,but quality not assessed
Handlan & Bloom 1993 3 Multiple baseline Peer coaching Increased interactions and positive parent report
Kamps et al. 1992 3 Multiple baseline Social skills group Peer coaching Social interactions and behavior improved
Charlop & Milstein 1989 3 Multiple baseline Written script Conversations improved and results generalized
Williams 1989 10 Pre-post Social skills group Positive anecdotal reports
Mesibov 1984 15 Pre-post Social skills group Positive anecdotal reportsSocial Skills S P R I N G 2 0 07 23 BB BeyondBehavior B
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Kamps, D. M., Leonard, B. R., Vernon, S., Dugan, E. P., Delquadri, J. C., Gershon, B., et. al. (1992). Teaching social skills to students with autism to increase peer interactions in an integrated first-grade
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Journal of Applied Behavior Analysis, 25, 281–288. Keeling, K., Myles, B. S., Gagnon, E., &
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