1. Asperger’s Disorder & Social Skills Jom Choomchuay,M.D.,M.Sc.(Merit) Child and Adolescent Psychiatrist Samitivej Srinakarin Hospital

2. Asperger’s Disorder AACAP,52 nd Annual meeting, Toronto, Canada, October 22 nd,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

3. What are Social Skills? Definition: (Wagner, 1999) Social skills are skill that: Allow appropriate initiation of contact Enable one to maintain positive relationships Facilitate peer acceptance Enable one to cope and adapt to social environment

4. Basic Assumptions about Social Skills: Learned skills Made up of behaviors that can be explicitly taught Can be systematically taught with considerations for generalization

5. 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

6. Social Skill Development Techniques Two Dominant Types Instrumental Social Skills Relationship Building Skills Models Individual Interventions Group Work

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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

14. Other Techniques Social Autopsies SOCCSS Situation-Options-Consequences-Choices-strategies- Stimulation Thermometer Role Play Video Modeling

15. 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

16. 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

17. 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

18. 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