The document discusses using behavioral strategies to improve social skills in children and adolescents with autism spectrum disorder. It describes various intervention methods including scripting, video modeling, social stories, and games based on special interests. The goal is to provide structured opportunities to practice social skills through direct instruction and interaction with peers.

1. Using Behavioral Strategies to Improve
Social Skills in Children & Adolescents
with Autism Spectrum Disorder
Moira Lewis, M.S. CCC-SLP
Health Education Workshop
Summer 2010

2. Overview
• Introduction & Overview of current research
in social skills training
• Intervention methods
• Behavioral Basis for group interventions
• Peer tutor information
• Questions & Answers

3. Criteria for ASD
• Impairment in socially reciprocal behavior
• Impairment in communication
• Restricted and repetitive behaviors and/or
interests

4. Subtypes
• Autism
• Asperger’s Disorder
• Childhood Disintegrative Disorder
• Rett’s Disorder
• Pervasive Developmental Disorder ‐‐ not otherwise
specified

5. Social Skills Training for
children on the autism spectrum

6. Social Skills Groups: A Growing Trend
• Research and evidence‐based programs have not
caught up with the popularity and number of
social skills groups, clinics, and materials at this
point in time
• We know there is a need for both intervention and
additional evidence
• Children and adolescents with ASD do desire and
deserve friendships and long lasting relationships
• Do we know what works best?

7. Social Skills Groups: A Growing Trend
• Pre‐planned lessons and social skills instruction
books are widely available and used, and continue
to be published
• Are worksheets and pre planned lessons
addressing individual skills from week to week the
most effective way to teach?
• What is a more effective way for children to learn
& practice
Consider this:
• Allow individual needs of the children to dictate the
lessons and activities

8. Growing too fast?
• No single approach will be successful with everyone,
especially in a group setting
• Parents and teachers are eager to find an effective way to
improve a child’s ability to interact and lead to successful
relationships
• Providers have been pushed to employ multiple methods
to address social skills intervention
• A majority have not been empirically tested
• Good news: research is being conducted as we speak
• Bad news: Difficult area of research to implement well.

9. Why so difficult?
• We need programs with empirical support for
efficacy
• Randomized clinical trials are difficult to do
especially in school and clinical settings
• We need social outcome measures to assess subtle
changes/improvement in social skills and
behavior
• Most social skill programs rely on curriculum that
is anecdotally based, not systematically tested
• Future directions currently being ‘tested’

10. Social Delays: across the spectrum…
• Lack of interest in interaction
• Poor eye contact
• Little use of nonverbal communicative means
• Lack of social or emotional reciprocity
• Deviant or absent language
• In those with speech, inability to sustain a conversation
• Cognitive impairment

11. Components of Successful Social
Behavior: Varied & Complex
To name a few….
• Imitation
• Learning give and take
• Perspective taking
• Regulating reactions
• Opportunities for interactions over time
• ‘Personal History’
• Verbal and nonverbal communication
• Understanding non literal language and sarcasm
• Problem solve simple conflicts with peers

12. Within Autism….
• Children with ASD often miss out on the
incidental learning opportunities for these
social skills
• Decreased levels of motivation and interest
in others
• Difficulty interpreting subtle social cues
• Interactions and social rules constantly
change
• Varied learning styles

13. How can we accommodate social behaviors and
weaknesses unique to autism in a group setting?
• Incorporating ‘discussion’ of social skills among
learners is not likely to always be successful
• Verbal learning=often a weakness of children with
ASD
• Most children require a great deal of practice,
repetition, and reinforcement to be able to :
• Learn a skill + apply it flexibly
• Being told what to do in a social situation vs.
applying or performing the behavior flexibly in the
correct setting
• Real interaction is CRITICAL

14. In Vivo Socialization
• It is not the activities alone that help
children learn social skills
• It is the EXPERIENCE of carrying out the
activity, with facilitation from adults and
with peers
• Acceptance and responsiveness should be
consistently promoted so that members
come to feel they ‘belong’
• May promote self esteem, a sense of
accomplishment, a sense of friendship, a
motivation to pursue successful peer
relationships

15. Evidence-based Approaches to
Social Skills Programming

16. Scripting and Fading
(McClannahan & Krantz, 2005)
• Construct scripts:
• Choose phrases that gain access to favorite objects
and activities (“Tickle me!”)
• Select scripts that contain different words
• Use fully grammatical forms
• Make scripts age‐appropriate
• Start w/ 1‐2 scripts, increase as
mastered
• Record scripts
• Use model to introduce use of scripts
• Teach script sequence
• Increase number of scripts used
• Fade portions of scripts

17. Scripting Social Skills
• Provide explicit written script of interaction, e.g.,
– Walk up to a classmate
– Make eye contact
– Say, “Hi ____________”
• Practice script w/ clinician
• Practice w/ peer
• Script Fading: Cut off increasingly large parts of script,
until client can do the scene independently

18. Scripting with Peer Training
Peers taught 5 facilitative skills w/o target child
present:
1. Look, wait, and listen
2. Answer questions
3. Start talking
4. Say something nice
5. Keep talking
Target children given written scripts for social
interaction
(“Can I play checkers with you?”)

19. Incidental Teaching
(McGee et al., 1999)
• Materials are controlled so that target
child must interact to obtain needed
objects and complete favored activities
• Interactions are ‘engineered,’:
• Child is assigned to complete puzzle
• Peer holds all puzzle pieces and is told to
hold them until asked
• Child must ask for each piece to complete
task
Creating communication temptations and
barriers.

20. Peer Group Entry
(Beilinson & Olswang, 2003)
• Lead Child is assigned a role to establish
group membership
• Child is prompted to initiate interactions
• Child is given highly valued objects,
game, or ‘prop’
• Target child is taught five‐step sequence
for entering group, using Visual Schedule

21. Peer Group Entry
1. Walk over to your friend.
2. Watch your friend.
3. Get a toy like your friend is using.
4. Do the same thing as your friend.
5. Tell an idea.

22. Buddy Time
(English et al., 1997)
• 20 min. period during school day
• Each child assigned a buddy
• Buddies rotate
• Class or peers are taught ‘buddy’ rules sequentially
• Both buddies receive reward if follow rules for entire
buddy period:
1. STAY
2. PLAY
3. TALK: say name, talk about the play,
respond to partner, repeat then say more
about it, ask a Question

23. Direct Instruction, con’t.
The “Conversation Can” (Brinton, Robinson &
Fujiki, 2005):
• Brainstorm a list of topics classmates might want to discuss
• Write each on a slip of paper
• Put slips in can
• Take turns pulling out a topic
• Start conversation:
– Think first: What should I say
– Say two things about the topic
– Ask interlocutor a question about the topic
– Listen while interlocutor answers

24. Social Stories
(Gray, 2000)
• Descriptive sentences: statements of fact
– Many children play on the playground during recess.
• Perspective sentences: refer to internal states
– Some children like to make a lot of noise.
• Affirmative sentences: express a common value
– One child goes down the slide at a time.
– This is a safe thing to do.
• Control sentences: identify personal strategies
– When I have to wait my turn on the slide, I can count the
people in front of me to make the time go faster.
• Cooperative sentences: what others can do to help.
– The teacher can help me if I feel impatient. She can talk
to me while I wait.

25. Example Social Story

26. Quirmbach, 2008 Review
• Reviewed 52 studies using Social Stories
• Studies aimed a variety of ages and ability levels
• ALL used case study methodology
• 60% reported positive outcomes
– On a range of behaviors
– Most target reducing inappropriate behaviors
• Data on increasing pro‐social behaviors is less abundant

27. Comic Strip Conversations
• Use ‘think’ and ‘word’ bubble cartoons
• Provide a visual tool to show conversation and
thinking
Sam doesn’t know
Sam, I saw a as much as I do
cowcatcher on an old‐ about trains. I will
fashioned train find out if he knows
yesterday. Do you what the
know what that is? cowcatcher does
before I tell him
about the one I saw

28. Games Based on Special Interests
(Baker et al., 1998)
Develop social games based on special
interests of target child
• Involve target child in development of materials and rules
• Have target child teach game to peer
• Set up special opportunities to play game
• Take turns choosing games to play during interactive game
time
• Use favorite games as a method of developing an
interaction‐ naturally motivating!

29. Video Modeling
(Nikopoulos & Keenan, 2003)
• Use commercial material such as My School Day
(http://www.modelmekids.com/)
• Video tape peers conducting interactions such as
greeting, negotiating, etc.
• Use video clips from TV shows to exemplify
interactions (may use negative interaction)
• Rehearse with written scripts first
• Verbal rehearsal

30. Video Modeling
• View video, discuss reactions
• View video, attend to focused cue, discuss what
was noticed or what changed
• Re‐enact scene on video with clinician
• Re‐enact with peer
• DESCRIBE VERBALLY
while watching
• Improvise similar situation

31. Social Cognitive Skills Training (Timler
et al., 2005)
Role play social scripts in peer group
• Situation paragraph read to group
• 4‐5 situations/ 2 hour session
• 6 weeks of 2 sessions/week
Guide role play to identify what they know about situation
from their own and other’s perspective (thinking about
thinking)
Ask Questions, identify a range of response strategies by
• selecting goal,
• stating alternative strategies to reach goal
• Evaluating consequences after response

34. Social Skills Groups
• Can use commercial curricula, such as
• Navigating the Social World (McAfee, 2001)
• Skillstreaming the Adolescent (Goldstein &
McGinnis, 2000)
• Provide consistent group structure
• Check‐in, greet
• Review last meeting’s skill
• Introduce new skill
• Model and role play new skill
• Snack, social time
• Activity that allows real‐life practice of new skill
• Summary

35. Peer Support Networks
(Haring & Breen, 1992)
• Select 2‐5 peers to serve as social
support for student with ASD
• Assign each support peer a 20 minute period/day to
structure activities for student with ASD, e.g.:
– Lunch: use Prompt and Praise to engage with others
at table
– Recess: teacher or clinician creates scripts for
entering games; peer support and target student
practice in private, then on playground

36. Meta-analysis of Social Skills Interventions:
Bellini et al., 2007
• Most effective when
• Deficits of child are systematically matched to
intervention strategy
• Ex.: If child lacks skills to enter peer group, teach
those; if child can enter but cannot participate and
maintain participation, teach those skills
• Targeting social‐cognitive skills; use meta‐
linguistic and meta‐cognitive strategies
• Done in classroom settings
• As opposed to settings contrived for the purpose

37. Principles of Pragmatic Intervention
Strategies: Involve the SLP
• SLPs have a legitimate role in assessing and
developing social/pragmatic skills
• Students with ASD will not acquire social skills
from exposure; they require mediated experiences
• Verbal, written and graphic supports are effective
• Peer involvement is an essential element
– Peers need training, but it is not extensive

38. Effective Techniques: Social Skills
Training
(Timler et al., 2007)
• Teacher Redirects
• Prompting children to play with one another
• Rephrasing or restating one child’s statement for
another
• Praising children for playing together
• Direct instruction in social language
• Modeling and practice with explicit cues
• Role play with prompting
• Corrective feedback
• Authentic contexts (peer involvement)
• Self‐monitoring for older students

39. Treatment & Goal Planning
• Group leaders should learn what behaviors are of
most concern to parents and teachers and note
what behaviors the child exhibits that indicate
poor social understanding and interaction
• Initial observation is critical
• Standard assessments can also be incorporated

40. Steps for evaluating social behavior in
preparation for goal planning
1. Observe the child
2. Identify positive pro social behaviors, strengths,
weaknesses, and problem behaviors
3. Conduct a functional analysis of the behavior
4. Hypothesize about what motivates the behavior
5. Observe each child’s approach to the group as a whole‐
do they assume a certain role? Are they ambivalent about
joining? Provocative? Are they completely silent? Do they
take on a clowning role? Are they less mature or more
mature than other group members?
6. Target goals for change‐ ( Aim to )Eliminate problem
behaviors and teach/practice/develop new, pro‐social
behaviors

41. Treatment and Goal Planning: your
contribution
• Note positive and negative behaviors displayed
• Note strengths, weaknesses, interests, and
communicate about favorite games and activities
• Document, for negative behaviors: the setting,
events, antecedents, consequences, possible
motivating factors

42. Preparation
• These observations and notes can be
formally organized into a functional
assessment of behavior
• Which is then used to develop and guide a
treatment plan
• Refer to Applied Behavior Analysis for a detailed discussion
of functional behavior assessment.

43. Sample Treatment Plan
Reinforcement/ Competing Strategies for prevention/
Prosocial teaching strategies behaviors* replacement behaviors
target
behaviors
(example)
1. Joining 1a. Special star chart with 1a. Insisting on 1a. Ignoring
stars for joining in each drawing
activities with activity, a lot of praising, 1b. Insisting on 1b. Asking peers if they are
Peers 1b. Working in dyads, showing others how interested
conversation games good he is at art
2. Becoming 2a. Stars for being okay with 2a. Rigid about the 1a. Ignoring/redirecting
changes agenda 1b. Asking peer tutors for
Flexible and feedback “Do you want to
plans & rules 2b. Games on flexibility have a friend who tells you
negative things about you all
the time?”
3. Monitor 3a. Stars for ‘Body Still 3a.Flapping habit 3a. Hand signal from group
3b. Encouraging him to 3b. Gets very close as a reminder
body monitor peers who are still to peers to speak 3b. Encourage peer tutor to
position/ notice the behavior
space

44. Friends Group
Visual schedule 1.
Greeting
for group 2.
Rules!
therapy
3.
Planet Game
sessions
4.
Snack
5.
Quiz Show
6.
Closing

45. Peer Tutors as Social Models
• Boys & Girls
• No clinical concerns or outstanding
behavior issues
• Natural ‘helpers’
• Recruited from other classrooms
• Given a general overview and specific
instructions for tutoring, prompting,
or modeling each week

46. Peer tutor worksheet, example
Children with Autism Spectrum Disorders can:
• Have trouble understanding language, especially if sentences are
complicated
Keep language simple
• Have trouble understanding things they can’t see, like ‘yesterday’ or ‘next
week’
Use pictures to teach things that are hard to think about abstractly
• Have difficulty knowing whether their voice is too loud or too soft
Tell the child directly that they are speaking too loudly or too softly
• Have trouble with touching other children when they should keep their
hands to themselves
Tell the child the rule “keep your hands on your own body”

47. Things to remember:
Advocate for your child
• Consider your child’s learning style
• Provide input regarding social ‘successes and messes’ outside of
school
• Recruit and incorporate typical peers and buddies‐ use other kids
as a resource
• Ask about generalization of skills and communication across
teachers and settings (i.e. classroom, playground,
paraprofessionals,etc.)
• Social Skills instruction can be kept simple
• Average standardized testing can be deceiving
• Support can always be ‘backed off’
• Avoid “cookbook” techniques
• Always ask!

48. Critical Components
Activities designed
to learn and practice Pare
Part nt
appropriate icipa
tion
Interaction
Typically
Developing
Peers
Functional
assessment
of behavior
Group therapy
experience:
focus on
process

49. Important to consider
• Children can be agents of change for each
other
• Children with autism can actively
experience interactions through games and
activities that are socially motivating
• ….While receiving continual reinforcement
for appropriate behavior
• If the children enjoy interacting with each
other = a positive experience = reinforcing
in its own right

50. Thank you!
• A special acknowledgement to Kathy Koenig and the clinicians and
investigators at the Yale Child Study Center, and their work thus far
with the Social Skills Development Program
Questions?