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Assisting Students with ASD to Form and Sustain Friendships 
 
Autism Spectrum Disorder (ASD)
For students to qualify for special education services under the eligibility of ASD, they need  to exhibit Impairments in communication, social interactions, restricted  repetitive and stereotypic patterns of behavior, interests, and activities, and  impairments in sensory integration. Further these characteristics need to be inconsistent and documented over time and intensity.
Consequently, social deficits can be seen as one of the cornerstones of Autism. These social deficits may be exhibited or seen in the following ways: 
  • Challenges in developing and maintaining friendships that are developmentally appropriate lack of joint attention, i.e. independent sharing of enjoyment with others
  • Unable to predict social outcomes from cues  in the environment and from others around them
  • Lack of social reciprocity; prefers to engage with others on their own terms, i.e. only wishing to talk  about their favorite topics
  • Prefers to be with self or objects, rather than peers
  • May desire friendships, but unable to understand their peers’ feelings, thoughts, ideas, motivations, or desires
  • Play and social behaviors may appear immature
  • May have challenges with making “small  talk” and holding appropriate conversations
  • Difficulty making or maintaining eye contact
  • Inability to read other’s facial expressions, gestures, and other body language and adjust behavior accordingly
  • May isolate oneself or have difficulty entering social situations or play with others
  • Play may lack imaginative and novel schemes  and may appear to be scripted and repetitive in nature
  • May not understand why certain social rules, norms, and/or etiquette  are in place, and therefore may not be aware if they  have been offensive or insulting to others

Other Factors
In conjunction with the above stated  characteristics, social skills deficits may be exacerbated by other factors such as:
  • Anxiety
  • Social Isolation
  • May further impair existing social skill deficits
  • Poor peer interactions
  • Rejection from peers
  • Isolation
  • Depression

As a result of their disability and it’s  social deficits, many individuals with ASD struggle with developing and maintaining meaningful relationships. For some children with ASD, they may retreat into their areas of intense interest or absorption which are often solitary activities or hobbies. Once the child becomes engrossed into these patterns of behavior, it becomes very difficult to change.

These unique and complex social difficulties faced by children with ASD pose distinct challenges to educators and their families. According to the 
National Research Council (2001), play and social instruction with peers is rated amongst the top interventions that should receive priority in educational 
programs for children with ASD.

Assessing Social Function
Before implementing social skills instruction, an assessment of the students current level of social skills  functioning needs to be established. The evaluation should consist of the  following elements:
  1. Information about the students strengths and areas of weakness.
  2. Inclusion of standardized measures such as behavioral checklists, social skills measures, etc.
  3. Information collected from a variety of sources that encompasses observations, both structured and non-structured environments such as recess or lunchtime, etc.
  4. Information collected from individuals that  know the child well, such as parents/guardians, teachers, support staff, etc.
  5. For older children, with High Functioning Autism or Asperger Syndrome have them self-evaluate their own social skills and/or provide input on their social skills struggles and strengths. 

Communication Assessment Tools 
Below are a few example assessment tools that can be used as a starting point. Instruments may have multiple uses  and functions. Some assessments may used to determine current communication levels and others may help identify supports needed to address the disability.  There are many others. 
  • Bishop, D. (2003). Children's Communication Checklist (CCC-2), Second  Edition. San Antonio, TX: Harcourt Assessment.
  • Constantion, J. (2005). Social Response Scale (SRS). Los Angeles,  CA: Western Psychological Services.
  • Prizant, B., Wetherby, A., Rubin, E., Laurant, A. and Rydell, P. (2005). The SCERTS Model, Comprehensive Approach for children for Children with Autism Spectrum Disorders. Baltimore, MD: Brookes Publishing Co.
  • Quill, K. (2002). Do-Watch-Listen-Say, Social and Communication Intervention for Children with Autism. Baltimore, MD: Brookes Publishing Co.
  • Skowron-Gooch, A., Jordan, K., Schmeltzer,  K., Hass, T., McFerron, C., (2005). Adjusting the Image, A Comprehensive Guild to Teaching  Social-Cognitive Skills to Students with Asperger’s Syndrome.

Developing an Intervention Program
  • Once weak areas are identified and prioritized as areas of most concern, then these items can serve as a starting point for writing individualized educational plans (IEP) goals.
  • When developing goals make sure to include: * Skills and performance deficits  * A plan to address skills deficits
  • A skills deficit is when the child is not able to perform a skill across several settings or with multiple individuals.
  • A plan to address performance deficits
  • Performance deficits are when the child does have the skills but fails to use them.
  • It may be as a result of a lack of motivation, anxiety or sensory sensitivity.
  • It is also important to look at existing skills and utilizing them as a scaffold to support areas of struggle.

Selecting Intervention Strategies

There are a multitude of strategies  that can be used with students with ASD. The following are a sampling of techniques that are designed to address skills acquisition deficits. These are only a sampling, the most important thing to remember is that the strategies  being used are appropriate to the needs of the child.

Instruction Strategies Examples

Direct Instruction:
Direct instruction refers to teaching social skills in a purposeful and meaningful manner. It should include the following components:

Rational: Why the information is important to the student. How the student can use the information and where they can use the information that they will be learning.

Presentation: 
How the information is presented to the students. Consideration needs to be given to active participation that is both visual and auditory in format.

Modeling: 
With emphasis being placed on the desired behavior verses what we do not want. Further, making sure that it occurs often and takes place in the context that it will be used.

Verification: 
Checking in frequently to ensure that the student understands. This is especially critical with students that do not ask for support when they do not understand, or students who have a flat affect that does not change to indicate concern or lack of understanding.
 
Evaluation: Use a variety of means to assess student understanding. Further, have the student also take part in self evaluation of concepts learned.
Generalization: 
Provide opportunities for the students to practice newly learned skills across a variety of setting, both structured and unstructured. 

Social  Narratives: A methodology that provides visual supports and instruction for students with ASD by describing  social cues, appropriate responses to social behavior and teaching new social  skills. Social narratives are written by instructional staff for the student using the student’s perspective and uses language at the student’s level. It  frequently uses pictures or photographs to confirm content. There are two types of social narratives: Social stories and scripts. 

Social StoriesTM  (Gray, 1995, 2000; Gray & Gerand, 1993) is the most often used social narrative. Social StoriesTM were created to describe social 
situations specific to individuals and their circumstances. When developing social stories consideration needs to be given to the following:
  • Picturing a goal,
  • Gathering information
  • Tailoring text,
  • Teaching with the title

More information about Carol Gray and Social Stories can be found at:
http://www.thegraycenter.org/
 

Scripts: Scripts provide pre-taught language for specific situations. They may include conversation starters, responses and ideas to connect conversations or change the topic. Social Scripts may help to reduce the stress associated with social interactions. Further they can assist the student with understanding the perspective of others. They may be used to help teach informal language, slang or child-specific language or terms (Kamps et al., 2002).

Care needs to be taken when using Social Scripts because they are not appropriate in every  situation. There is a risk in making children sound too rehearsed or scripted in their response. In addition, students with ASD struggle with generalization of skills, and may use a script in a wrong social situation.

The  Power Card Strategy: The Power Card Strategy is a visual aid that incorporates the child’s special interest to teach appropriate social interactions, including  routines, behavioral expectations and the hidden curriculum. Hidden curriculum  refers to unspoken social rules or norms that are often missed by individuals  with ASD.

Many children with ASD often have a highly developed special interest. This strategy utilizes the students special interests in connection with a power card. There are two components to this strategy: a script and the  Power Card. First, a short script detailing how the hero solves the problem using the child’s language level is one side of the card. On the back of the  card there is a recap of the strategies used by the Super Hero to solve the  problem. Following the initial reading of the scenario, the child is given the  Power Card to keep with them. The card can be carried , placed in a notebook or locker for the child to refer to as needed. This strategy can also help with generalization of skills taught (Gagnon, 2001).

Comic Strip Conversations TM: Comic Strip Conversations TM is a cartooning strategy developed by Gray (1994). The technique involves illustrating conversations through the use of simple drawings. This strategy helps the student identify what other people say and or do with emphasis being placed upon what other people were thinking. By drawing a short conversation with thinking and thought bubbles that help the student learn how to general conversation occur. When using this technique the following information needs to be gathered (Gray, 1994):
  • Where are you? (Student draws a person)
  • Who else is here? (Student draws a person)
  • What are you doing? (Student draws relevant  items and/or actions)
  • What happened? What did the other people do? (Student draws relevant items and or actions.)
  • What did you say? (Use conversation bubbles)
  • What did other people say? (Use conversation bubbles)
  • What did you think when you said that? (Use  thought bubbles)
  • What did other people think when they said that/did that? (Use thought bubbles)

This strategy can also be used to address upcoming situations or future events.

This link contains a fact sheet about comic strip  conversations:
http://www.autismspectrum.ilstu.edu/resources/factsheets/comicstrip.shtml

Conversation Starters: Conversation starters are helpful strategies for addressing initial conversations between children with ASD and their peers. One example of a conversation starter is a Conversation Map (Bellini, 2006).The Conversation Map is a sequential framework that illustrates important elements of a potential conversation, such as:
  • the conversation partner
  • topics
  • interests
  • scripted initiation
  • practice

Because visual cues are generally effective for children with ASD, textual or visual scripts or cue cards are also effective for initiating and maintaining 
conversations (Sarokoff,  Taylor, & Poulson, 2001). 

Scripted planning  procedures can speak to initial encounters and meaningful conversations in a predictable, controlled, and less stressful manner. 
Conversation starters may be  used in educational settings during social skills training as a way of enhancing communication planning and problem solving. Specific skills related to a child’s challenging areas may be embedded into conversation planning. In addition to school settings, these strategies can be used at home or in community settings  when parents or adults are provided with guidelines and materials for planning  conversations.

The following are steps/guidelines for using a Conversation Map (Bellini, 2006):

  1. Select a child to play with. In order to begin a meaningful conversation, a child should select a conversation partner to interact with.
  2. Determine reason for playing with child. The child understands the purpose of interacting with the conversation partner.
  3. Identify other child s interest. It is important to know the interest of the other child to ensure the conversation will be meaningful for both 
    participants.Select topic of planned conversation . For a conversation to  maintain, the content is important. The child has to decide a topic or theme to have a conversation about.
  4. Develop scripted initiation and expected response . Based on  the selected topic, a series of anticipated statements/questions is listed to prepare for the initiation.
  5. Select best setting to initiate conversation . To promote more  natural social interaction, the child must be aware of the location where the  conversation takes place.
  6.  Practice. After completing the conversation scripts, the child rehearses how to perform the conversation.

Video Modeling: Many Individual with ASD learn from visual presentation rather than auditory ones. They need to see what they are trying to learn, either through words or pictures. Video modeling is a teaching method used to promote desired behavior and interactions. Using this approach, the student observes a video of a peer, adult, or himself  engaging in a targeted behavior. Video modeling is also very useful when the student has mastered individual skills but does not know how to combine them in real life situations. This strategy can be used across many areas, such as self-help skills, communication skills, social behaviors, or academic behaviors.

The basic concept of video modeling is learning through observation. One of its benefits is that a student can learn without actually being in the various situations. Examples of video modeling  include:
  • Purchasing items at a store
  • Communication skills (e.g., complimenting,  greeting, or socially initiating words)
  • Washing hands
  • Playing with others
  • Getting lunch
  • Using an electric appliance (e.g. microwave oven, blender, DVD, etc.)
  • Following a teacher’s directions
  • Making a sandwich

 The following steps are used when  implementing video modeling:
  • Determine the target behavior
  • Decide who should demonstrate the behavior on the video – self, adult, or peer
  • Set up the scenario to be videotaped
  • Videotape the scene
  • Show the video to the student and discuss the behavior portrayed
  • Encourage the student to practice the behavior she saw on the videotape

Resources:

Model Me Kids: http://www.modelmekids.com/video-modeling.html
This is a resource page for learning about and ordering commercial videos for video modeling.

 Self-Awareness: Self –awareness includes the ability to read and self-monitor both positive and negative reactions. Individuals with ASD have difficulty interpreting their emotions and social well being. Thus it is important to address emotional regulation when addressing social skills.
 
Emotional Regulation: Being aware of their emotions is important for students with ASD to help them deal with difficult  situations and to prevent meltdowns. The Incredible 5-Point Scale (Buron &  Curtis, 2003) helps students understand themselves and manage their emotions and behavior as consequences of the emotion. By rating themselves on these visual  scales, students can learn to identify and label their own emotions. 

The  Incredible 5 Point Scale: The goal of the Incredible 5-Point Scale is to help students with ASD become aware of their emotions, such as anger, fear, or pain, and the stage of the emotion. One-to-one instruction is suggested as the best condition for introducing this strategy to the student.

Using the scale, the student rates his emotions or status of a condition or situation. This in turn allows him to:
      (a) provide information to the teacher about how  he is feeling,
      (b) manage his thinking process, or     
      (c)  implement the desired behavior as a proactive approach. 

Talking in numbers instead of describing or naming their emotional or mental status helps students with ASD think efficiently in order to make a right decision under a given set of circumstances. Buron and Curtis (2003) suggest that a story, narrative, or memo written along with the scale can be very useful in providing information about the purpose of the scale.

Building Community in the Classroom
While teachers cannot create friendships among students, they can create classroom and conditions that will  give students opportunities to strengthen social relationships. Some example activities or curriculum that cultivate community include:
  • Cooperative learning
  • Conflict resolution
  • Games
  • Class meeting
  • Cross and same age tutoring
  • Social Justice Education 

Circle of Friends

The “Circle of friends” intervention is a useful and practical tool for promoting inclusion of students with special needs into the school community. 

The Circle of Friends intervention is a peer-based approach, that parallels inclusive education policies of encouraging students with special needs to get involved in the school community by engaging in peer groups and practicing social skills. A circle is formed by a group of volunteers, usually peers and 
classmates, a  student with social difficulties as “the focus child,” and an adult facilitator.  The circle works as a team to :
  1. discuss the challenges that the focus child faces in terms of social interaction,
  2. set up goals and targets to improve peer relationships,
  3. brainstorm strategies to reach the goals.

The purpose is to include all students to establish friendships and encourage peer interactions with the student with ASD or other disability.  Many students with ASD can benefit from this intervention, particularly in the area of social integration, peer interaction, and decreased anxiety. Research  has shown improvements in empathy, problem solving, communication skills,  emotion expressions, and awareness of individual ability (Barrett & Randall,  2004; Interventions Whitaker, Barratt, Joy, Potter, & Thomas, 1998).

The following steps may be used to  establish a circle of friends (Taylor, 1997):
  1. Establishing prerequisites. A suitable school environment is selected and a commitment of the necessary resources is obtained (30-40 minutes  of teacher time to facilitate meetings).The parents and the focus child are also contacted.
  2. A discussion with the class or tutor group. A meeting is  conducted with class members to discuss the strengths and challenges of the focus child and to encourage peers to build experiences of friendships with the  child. At the end of the meeting, volunteers are selected from the class to form the circle. The volunteered group members are socially competent peers with positive attitudes towards the focus child. They are told to be continually  assisting the focus child in the areas that have been discussed.
  3.  Establishing a circle. The circle includes six to eight  volunteers, the focus child, and an adult facilitator. The circle group meets  and works 
    collaboratively with practical adjustments using a problem-solving approach. That is, the objectives are subject to change according to the  progress of the focus child.
  4.  Weekly meetings of the circle. The circle group and school  staff meet weekly to review progress, identify difficulties, and present  solutions 

Extracurricular Activities 
Participation in extracurricular activities is another option for keeping kids with ASD involved, busy, and feeling like they belong. Additionally, it also provides social learning situations outside of the regular academic school day. When a good match is made, a students strengths and or areas of special interest can be matched to an  activity or club. To establish a successful match consideration needs to be given to the following:
  1. Match the student with an activity he or she  is interested in.
  2. Align the student with an adult who understands the child’ needs and is willing to work with him.
  3. Provide necessary supports for the adult in charge of the extracurricular activities.
  4. Coach the student on appropriate behaviors and expectations.
  5. Use existing friends such as from the “circles program” to support the student within extracurricular activities.
  6. Provide ongoing feedback to the student with ASD, peers and or supporting adult(s).

References

Bellini, S. (2006). Building Social Relationships, A  Systematic Approach to Teaching Social Interaction Skills to Children and  Adolescents With Autism Spectrum Disorders and Other Social Difficulties. Kansas: Autism Asperger Publishing Co.

National Research Council. (2001) Educating children with autism. Committee on educational interventions for children with autism, Division 
of Behavioral and Social Science and Education. Washington, DC:  National Academy Press.

Garcia-Winner, M. (2000). Inside Out: What Makes a Person With Social Cognitive Deficits Tick? California: Think Social Publishing.

Garcia-Winner, M. (2007). Thinking about You Thinking about Me, Teaching perspective taking and social thinking to persons with Social Cognitive Learning Challenges. California: Think Social Publishing, Inc.

Gray, C. (1994). Comic strip conversations: Illustrated interactions that teach conversation skills to students with autism and related disorders. Arlington, TX: Future Horizons, Inc.

Kluth, P. (2003). “You’re Going to Love This Kid” Teaching  Students with Autism in the Inclusive Classroom. Maryland: Brooks  Publishing Co.

Moyes, R. (2006). Incorporating Social Goals in the Classroom, A Guild for Teachers and Parents of Children with High-Functioning Autism and Asperger Syndrome. Great Britain: Athenauem Press. 

Myles, B. (2005). Children and Youth with Asperger  Syndrome, Strategies for Success in Inclusive Settings. California: Corwin  Press. 

National Research Council. (2001) Educating children with autism. Committee on educational interventions for children with autism, Division of Behavioral and Social Science and Education. Washington, DC: National Academy Press.

Sarokoff, R.A.,Taylor, B.A., & Poulson, C. L.  (2001).Teaching children with autism to engage in conversational exchanges:  Script fading with embedded textual stimuli. Journal of Applied Behavior  Analysis, 34, 81-84.

Schlieder, M. (2007) With Open Arms, Creating School Communities of Support for kids with Social Challenges Using Circle of  Friends, Extracurricular Activities, and Learning Teams. Kansas: Autism  Asperger Publishing Co.

Taylor, G. (1997). Community building in schools: Developing a ‘circle of friends.’ Educational and Child Psychology, 14, 45-50.

Texas Statewide Leadership for Autism. (2009) TARGET: Texas  Autism Resource Guide for Effective Teaching. Retrieved 06/14/10 from 
  http:http://www.txautism.net/manual.html

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