Addressing Social Deficits

The following is from the DSM –V and describes the social deficits necessary to receive a diagnosis of Autism Spectrum Disorder:

A) Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1.deficits in social-emotional reciprocity
2. deficits in nonverbal communicative behaviors used for social interaction
3.deficits in developing and maintaining relationships

 ABA therapy seeks to strengthen a child’s deficits to improve overall functioning across the lifespan. There is an emphasis on intensive instruction and teaching (direct or incidental), and unfortunately social skills can sometimes be placed on the back burner or viewed as not as important. 

Actually social skills are quite important. 

Communication and social skills are closely linked, in that a child who cannot communicate and has limited receptive language might have little interest in socializing. Also typical peers may avoid interacting with a child who communicates mainly through problem behaviors. Communication deficits can dramatically impact social performance.

Note that I am saying SOCIAL SKILLS, and not "friendship". Do ABA providers force Autistic children to make friends? No. Some people for various reason just aren't interested in forming or maintaining *BFF* style friendships. And that's ok.

BUT, if you plan to live on Earth you do need to socially interact with others: at school, in public, in your family, on the job, etc.

For most of us, developing skills such as eye contact, parallel play, and social gaze didn’t need to be explicitly taught. We picked them up from our environment and learning occurred when these behaviors were socially reinforced. Social Learning Theory explains that behaviors are learned through observation, imitation, and modeling. For a child with Autism social learning may be minimal or nonexistent. I could visit a client every week and smile and wave at her when I arrive, but that does not mean she will  spontaneously imitate my behavior and start greeting me. It may take repeated instruction and reinforcement to return my greeting.  Just like academic skills, social skills should be part of an instructional plan. 

For some reason there's a misconception that if children with social deficits will magically “catch” appropriate behaviors just from being near peers. The problem with that belief is physical closeness does not equal ability to learn or understand social cues. Therefore it doesn’t make sense to expect an inclusive environment to solve all social deficits if intentional intervention does not also occur.

Social skills are much more than being able to play with peers. Social skills can include:

• Eye contact, reading facial expressions, smiling, knowing and using good manners, appropriate physical touch, proximity to others/personal space, hygiene, profane language, attending, listening skills, waiting, requesting or accepting help, story telling, humor/sarcasm, group instruction, asking questions and answering questions, sexually aggressive behaviors, lack of empathy, public speaking, sharing, emotion regulation, voice modulation, public masturbation, and joint attending.

Social skills are a broad concept that basically covers any skill or behavior that involves others or affects others. When you think of it in those terms it’s easy to see how broad social skill deficits can be.

So how do you teach social skills?

There are many curriculum guides, computer software programs, and books out there that describe exactly how to teach/improve upon social skills.
It often isn’t necessary to buy a specific book or software program to begin teaching social skills.

Below are a few recommendations:

1. If the child is pre-school age: Create situations where you can observe the child around other children. It is often easier for an adult to get a child to engage than for another child to do so. For this reason, you can't assume that because the child will share  a toy with you that they would share with another child. Watch them with their peers  as well as children much younger and older than them. This is important because sometimes a child will completely ignore peers, but will interact with children much younger in age. You are looking to see how the child interacts socially compared to other children. Pay attention to body orientation, attending, initiating play or communication, sharing, and proximity to others. Once you have identified the social deficits, that is your starting point to begin teaching.
2. If the child is school age: In addition to observing the child with other children, you need to observe  in the classroom setting. Pay attention to off- task behaviors, transitions, down time, independent and group instruction times, and attending to the teacher. Much of classroom instruction requires complex social skills. Even a very bright child who does well academically will face serious social disapproval from peers if they exhibit unexpected social behaviors. Once you have identified the social deficits, that is your starting point to begin teaching.
3. From the selected deficits create clear and measurable goals: If you observe that the child avoids being near other children and reacts with anger  if touched by another child, a great social goal would be “When given the opportunity, Stacie will sit appropriately with the class during Circle Time for 15 seconds”. A poor choice for a social goal would be “When given the opportunity, Stacie will play nice with her sister and not hit”. The second one is a poor goal because its not clear what "play nice" means.
4. Work closely with your BCBA or Lead Therapist to write programs to address the social skill deficits: If you do not have a Consultant or Lead Therapist who is writing the ABA programs, ask one of your child’s teachers for help. The curriculum planning and objective writing that teachers do is very similar to the program writing that ABA professionals do.
5. Understand that most social skill goals are taught using an adult model first: This is because typically it is hard to get a child to participate for the necessary repeated trials of learning, and also children are usually less aggressive with adults than peers. In other words, your child may find it easier to learn to share with an adult first, than with another child. Once you have some success teaching the social skill using an adult, at that point you can introduce a peer. Once you have success with a peer, then you can teach the social skill in a group of peers.
6. Do not expect a child to exhibit a skill they have not learned yet:  I usually explain that to parents by saying “If the behavior is inconsistent, or consistently poor, then we have to act as if the child doesn’t know what to do”. If you know your child has poor social skills don’t be surprised if she hits her brother because she doesn’t want to give up a toy. Don’t be surprised when she refuses to give Grandma a hug, and don’t be surprised if her teacher complains to you about excessive tantrums during recess. Expect that your child will need help being appropriate in social situations in addition to structured ABA instruction.