Solomon SocialSkills

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Cover

Teaching Social Skills toTeaching Social Skills to

Children with PervasiveChildren with Pervasive

Developmental DisordersDevelopmental Disorders

Marjorie Solomon, Ph.D.,

Assistant clinical Professor

U.C. Davis Health SystemM.I.N.D. Institute

Elwyn

March 2007

22q11.2 Deletion Syndrome

Conference


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Presentation OutlinePresentation Outline

1. Individuals with Pervasive DevelopmentalDisorders

Diagnostic characteristics

Other similar disorders

2. Features of PDDs Social and Emotional Characteristics (Emotion and

Face Processing), Theory of Mind

Cognitive Characteristics (Executive Functions)

3. Remediation Strategies Research and Practice Academics

Social Functioning

Teaching teens social skills with movies


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Impairments in Social Interaction

Impairments in Verbal and Nonverbal

Communication

Restricted and Repetitive Patterns of

Behavior

DSM-IV-TR: Core Features inDSM-IV-TR: Core Features in

Autistic Disorder andAutistic Disorder and ASDsASDs


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Social Symptoms in PDDSocial

Symptoms in PDD

poor regulation of social interaction through eye

contact, facial expression, gesture, posture,

intonation

failure to develop age-appropriate peerrelationships

limited social-emotional reciprocity

empathy

aloofness


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Communication Symptoms in PDDCommunication

Symptoms in PDD

repetitive or idiosyncratic language

echolalia (including delayed)

neologisms overly formal or pedantic language

poor conversational abilities

difficulty taking listeners perspective

limited reciprocity


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Repetitive Behavior Symptoms inRepetitive Behavior Symptoms in

PDDsPDDsencompassing preoccupations

unusual topics

focus on details, difficulty differentiatingrelevant from irrelevant information

insistence on sameness, ritualistic behavior

stereotyped body movements

preoccupation with parts or sensory aspects

of objects


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Autistic DisorderAutistic Disorder

the most common PDD

> 6 symptoms from DSM-IV-TR list 2 social

1 communication

1 restricted/repetitive behavior onset before age 3


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AspergerAspergers Disorders Disorder

ruled out if criteria for autism met

< 6 symptoms from DSM-IV 2 social

1 restricted/repetitive behavior

normal IQ (> 70)

no history of language delay


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Pervasive Developmental DisorderPervasive Developmental Disorder

Not Otherwise Specified (PDDNOS)Not Otherwise Specified (PDDNOS)

used when criteria for other PDDs not met

subthreshold

number of symptoms

pattern of symptoms

severity

atypical

age of onset

uncommon symptoms


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WhatWhats in a Name?s in a Name?

NLDNLD NLD is a term coined by neuropsychologists who

interested in brain hemisphere laterality

Some, but not all, children with ASDs have NLDcognitive profiles

The typical pattern in children with autism is actuallyPIQ>VIQ

This information about relative strengths and

weaknesses is useful for educational and treatmentplanning

Not all children meeting the criteria for NLD havesocial deficits that are as pronounced as childrenwith ASDs


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Semantic Pragmatic DisorderSemantic Pragmatic Disorder

Rapin & Allen (1983) coin the term semanticpragmatic disorder syndrome

They have trouble understanding discourseThechildren usually have an intact or superior auditorymemory and are fluent. They may repeat wholesentences verbatim or recite TV comercials their

speech (has) a loose, tangential or somewhatinappropriate quality

A subcategory of PDDNOS? A bridge betweenlanguage impairment and autism (Bishop, 2000)


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Sensory Integration DysfunctionSensory Integration Dysfunction

Parents of many children with ASDs report thattheir children experience sensory stimuli in atypicalways

Parents of many children with general behavioraldysregulation also report their children havesensory issues

Many parents of children with ASDs report that OTis extremely helpful for their children

Empirical work about sensory issues in childrenwith ASDs and OT treatment efficacy is needed

(see Baranek, 2002; Stackhouse et al., 2003)


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Deficits in Emotional Awareness andDeficits in Emotional Awareness andUnderstandingUnderstanding

Emotion perception and comprehension (Downs & Smith,

2004; Hobson, 1986; Fein, Lucci, Braverman &

Waterhouse, 1992)

Experiencing relationship-based emotions (Hobson, 1993,

2002, 2005).

Labeling and explaining their own emotions (Capps,

Yirmiya, & Sigman, 1992), and those of other children

(Yirmiya, Sigman, Kasari, & Mundy, 1992)

Individuals experience jealousy, but understanding is lesscomplex and nuanced than typically developing children

(Bauminger, 2004)

Predicts difficulty in developing affective closeness and

intimacy.


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Deficits in Emotional Awareness andDeficits in Emotional Awareness andUnderstanding: Face ProcessingUnderstanding: Face Processing

Mixed results in the literature; simple versuscomplex emotion distinction; role of VIQ (Robins,Tracy & Solomon, in preparation)

Bias towards visual-verbal over visual-affectiveinformation when processing facial expressions ofemotion (Grossman, Klin, Carter, & Volkmar,2000)

Non-typical neural recruitment in face perception

(Boucher & Lewis, 1992; Critchely, Daley,Bullmore et al., 2000; Pierce, Muller, Ambrose,Allen, & Courchesne, 2001; Schultz et al., 2003)

Abnormal eye tracking patterns (Klin, Jones,

Schultz, Volkmar, & Cohen, 2002)


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Deficits in Theory of Mind:Deficits in Theory of Mind:What is TOM?What is TOM?

Being able to infer the full range of mental states(Beliefs, desires, intentions, imagination, emotions,etc.) that cause action. In brief, to be able to reflecton the contents of ones own and others minds.(Baron-Cohen, 2000)

The ability to represent others mental states anduse social cues as a key to interpreting behavior(Casari & Rotheram-Fuller, 2005)

The capacity to understand and manipulate themental states of others and to thereby alter their

behavior (Frith & Frith, 1999)

Also known as mentalizing, perspective taking,

introspective awarenessempathy


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Deficits in Executive Functions:Deficits in Executive Functions:

What are Executive Functions?What are Executive Functions? Skills required to prepare

for and execute complex

behavior

Inititiation

Planning

Inhibition

Organization

Self-monitoring

Mental representation

of tasks and goals

Cognitive Flexibility

Set Shifting


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Deficits in Executive Functions:Deficits in Executive Functions:NeuropsychologyNeuropsychology

EF established as an influential theory of autism (Ozonoff,

Pennington, & Rogers, 1991)

Progression through the 1990s to affirm that autism

involves a specific versus a generalized deficit (Chapman

& Chapman, 1978) and to document which component

processes are impaired using clinical neuropsychologyand cognitive neuroscience methods.

Impaired are: Planning as assessed by Tower Task

(Ozonoff, Pennington, & Rogers, 1991); Set shifting as

assessed by WCST and other cognitive flexibility tasks;

visual attention shifting Spared are: Working memory, inhibition

Some also argue that autism involves spared simple

information processes, but impaired complex processing

(Minshew & colleagues)


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Deficits in Executive Functions:Deficits in Executive Functions:

Real-Life-Type Problem SolvingReal-Life-Type Problem Solving

Getting stuck on the wrong details of a problem or

stimulus overselectivity (Ozonoff, 1998)

Difficulty shifting from ineffective to effective strategies(Twachtmann-Cullen, 2000)

AS children impaired in recounting the pertinent facts,

generating possible high-quality solutions, and selecting

optimal, preferred, and socially appropriate solutions

(Channon, Charman, Heap Crawford, & Rios, 2001)

Difficulty with concept formation versus concept

identification (Minshew, Meyer, & Goldstein, 2002)


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A few disclaimersA few disclaimers

We are further behind in the developing ofempirically supported interventions for older highfunctioning children with PDD

Empirically supported is a very high bar

Good intervention should involve: assistance withsocial cognition, verbal and nonverbalcommunication, increased engagement inappropriate developmental activities, academic

skills, fine and gross motor skills, reduction ofproblem behaviors, independent organization skills(Filapek, Steinberg-Epstein, & Book, 2006)

This will be a review of best practices and recentresearch


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Problem Solving for Parents

Child Characteristics Problems

Oppositionality ? Rigidity

Hyperactivity ? Introversion ? Extraversion

Anxiety Autism Spectrum Disorder Deficits Cognitive Endowment Developmental Level

Executive

Function/

Problem Solving Goal direction Motivation Organization

Theory of Mind Perspective taking

Empathy

Emotion Awareness

and Recognition Knowing ones own

feelings Knowing

those of others


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Preparing Students forPreparing Students for

Change/Social StoriesChange/Social Stories

My Social Story about RecessTime Change

Most days we have recess at12:00. Tomorrow will be aspecial day because the blacktopis being fixed. Tomorrow wewill have recess at 11:00. Thismeans we will skip music timefor one day. Recess time will be

the same as always. Mrs. Joneswill be with us. Our class andthe 3rd grade will be together.We will still have all the sameequipment.


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Group Exercise: Writing a SocialGroup Exercise: Writing a Social

StoryStory

Please divide into 3 teams

Write the following stories: Going to a play

Why it is important not to belch and fart in

public

Going to a birthday party


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Remediation Techniques: ImprovingRemediation Techniques: Improving

Emotional Understanding and AwarenessEmotional Understanding and Awareness

Emotion thermometers

Bouncing off the walls

Body language charades

Fun with the digital

camera

Emotion matching games

Role plays


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Remediation Techniques:Remediation Techniques:Theory of MindTheory of Mind

Social skills group setting (Ozonoff & Miller,1995)

Teaching Children with Autism to Mind Read(Howlin, et al., 1999)

Training on emotion, belief, and pretend play(Hadwin, et al., 1996, 1997)

Provide action and emotional cues (Bowler &Stromm, 1998)

Thoughts are like pictures in the head & thoughtbubbles (Swettenham, 1996;McGregor, 1998;Gomez et al., 1996)

Training in EF actually improves TOM! (Fisher &Happe, 2005)


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Remediation Techniques: TeachingRemediation Techniques: Teaching

Theory of Mind at M.I.N.D.Theory of Mind at M.I.N.D.

Stress the Golden Rule

Introductory song w/

personal information

Always highlight different

perspectives

Using teachable

moments Friendship party

Group name and logo


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Remediation Techniques: TeachingRemediation Techniques: Teaching

Conversation SkillsConversation Skills

Tennis ball conversations

Recipe for a coversation = 1 starter + 1 comment+1 statement of your own + 1 pass.

Follow the Rules (an adaptation of Grice, 19 )

Share the Air!

Stay on the Same Page Be honest..


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Remediation Techniques:Remediation Techniques:

Executive Functions DeficitsExecutive Functions Deficits

Contingency based self-management programs (Quinn,

Swaggart, & Myles, 1994)

Metacognitive strategies that enhance observing ego so

childen can grapple with their maladaptive behaviors (for

ADHD see Wasserstein & Lynn, 2001)

Goal Management Training-- 5 steps to self-monitor results

of actions (Levine & Robertson, et al., 2000) Teach external compensatory strategies

Flexibility Training (see Sohlberg & Mateer, 2002)


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Remediation Techniques: Real-Life-Remediation Techniques: Real-Life-

Type Problem SolvingType Problem Solving

Points system

Wicked witch visual

template

Leaders and followers

Cognitive flexibility games

Use of visual template

Graduation projects

Running commentary on

cause and effect


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Teaching Social Skills WithTeaching Social Skills WithMoviesMovies


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Group AgendaGroup Agenda

I. Beginning Circle

II. Game or OutsideTime

Lesson Time/Movie

Time/Snack Time

Joke Time


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Teen Group: The BeginningTeen Group: The Beginning

Circle -- MechanicsCircle -- Mechanics

News or

announcements

The Questions

Discussion of Social

Experiment

Discussion of PhoneCalls

Use of Group Mascot


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Teen Group: The BeginningTeen Group: The BeginningCircleCircleThe QuestionsThe Questions

Questions progress along with the group and

ideally relate to topic under study or group

stage related phenomena.

Beginning questions: What do you like?

What kinds of ice cream/ foods/ pizza/

amusement park rides do you like?

What are you like? (Options given)

What is your personality like? (Options given)


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Beginning Circle: Mid GroupBeginning Circle: Mid Group

QuestionsQuestions

o Tell us about a friendshipthat youve had. What are

two importantcharacteristics in a friend?

o What are you like in newsituations? What are youlike as a friend?

o What is a problem youvehad and how did you dealwith it?

o Have you ever beenbullied. What did you do?


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Game Time/Game Time/Outside TimeOutside Time

Vote on What to Do Indoor or outdoor

Goals: To practice skills required to play simple games

To generate enthusiasm for the group and motivation forinteracting with others

To facilitate smaller group social interaction between

different group members Used as a setting to observe group members in

social situations

Every week different members volunteers to bring

in music to play during game time


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Game Time/Game Time/

Outside TimeOutside Time

Members pair or group together

Leaders monitor and assist in conversations, andfade out of interactions

Positive behavior reinforced

Socially inappropriate or unacceptable behavior

used as teaching points Balls and playground equipment used

Opportunity to experience non-threatening athletics(football, races, the worm)


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Lesson Time: General Progression ofLesson Time: General Progression of

Lesson TopicsLesson Topicso Understanding your own feelings

o Understanding the feelings and perspectives ofothers

o First impressionso The meaning of friendship

o Conversation skills

o Irony, sarcasm, metaphors, figurative language,

and subjective vs. objective informationo Problem solving

o Team Building


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Lesson Time/Movie TimeLesson Time/Movie Time

Primary teaching vehicle for first 16 weeks are10-20 minute film clips

These provide a starting point for discussion of

focal issues in the lesson and others that arise General progression of topics is the same during

groups, however, flexibility is built in so thatindividual groups and chosen film clips can be

tailored to member needs and interests Popcorn is served!


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Lesson Time/Movie Time: SampleLesson Time/Movie Time: Sample

ThemesThemes First impressions and how they

develop (Harry Potter)

The meaning of friendship (Holes, StarWars)

Social hierarchies (Holes)

Appropriate male/female behavior(Dodge Ball)


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Lesson Time/Movie Time:Lesson Time/Movie Time:

Sample Themes -2Sample Themes -2

Different Kinds of Comedy (Take the Money

and Run; Monty Python & the Holy Grail)

Team skills and why teams do and do not

work (Miracle, October Sky)

Coaches and Bosses (Miracle, Remember the

Titans)


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Friendship; empathyBeing a team/group;

family not in literal

terms

Being a friend; going

against authority; problem

solving

Teaching Point

Caveman and Zero climb

mountain; 6min. 41 sec;

Chap. 19 on DVD Zero

confesses to Caveman. 4 min36 sec; Chap. 21 on DVD

Players approach coach

about replacing them;

team/family theme;

Christmas dinner. Chap. 10on DVD; 8min 27 sec

Roommate wants to be an

actor; new guy

unsupportive. Discuss

new guys introversion.3min 29 sec; 47 min 05

sec into tape

Scene Summary

Social hierarchy; impressions;

bullying

Working as a team;

emotions; leadership

First impressions;

friendship; personality

traits; emotions

Teaching Point

Caveman finds lipstick case;

older boy claims to have

found it and gets the day off

without dispute. 6min 26 sec;

Chap. 11 on DVD

Friction between players in

bar and on the ice, Coach

uses to bring team together.

5min 58 sec.; Chap. 4

New guy meets his

roommate and his friends;

roommate and father.

4min. 18 sec; 7min 18 sec

into tape

Scene Summary

HolesMiracleThe Dead Poets SocietyMovie


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Teaching Point

Scene Summary

Movie

Phony friends; personality;

motivation

First impressions;

assumptions

Humor; personality traits

Girls croquet game; girl

talking with parents;

convenience store. 4min. 56

sec; 21 minutes into tape

Battle of wits over which

cup is poisoned. 5min. 12

sec; 30min 03 sec into tape

Buddy the elf goes to

work with Dad and in

mailroom; Dad takes an

important conference call.

Chap. 11 on DVD

HeathersThe Princess BrideElf

Also watched: Harry Potter and the Sorcerers Stone; Monty Python

and the Holy Grail; Dodgeball; Star Wars; Radio; Billy Elliott; The

Breakfast Club; and Lord of the Rings


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Joke TimeJoke Time Goals:

To teach jokes and scaffold

the development of sense of

humor

To continue teaching about

irony, sarcasm, metaphors,

and figurative language

Members can volunteer to

share a joke or read from

our books

Safe place for feedback


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AcknowledgementsAcknowledgements For your attention

To the teens and parentswho participate in ourgroups

To our wonderfulvolunteers Julia Hales,Neil Cummings, PetrinaKaluzhny and many others,as well as my colleagues

Beth Goodlin-Jones, JohnBrown, Mary BethSteinfeld, Erin Roseborowho work on social skills

Documents

Solomon SocialSkills