Monday, July 18, 2011

Social Skills classes are not the answer for students with ASD

For information on assessment and treatment programs offered by Dr. Jim Roche, a Registered Psychologist in British Columbia, please see his web page at www.relatedmindsbc.com or www.relatedmindsbc.com/autism.

Again a school district wanted to know about social skills training for kids with ASD (actually, Asperger's Disorder or high functioning autism as some people would call it).This request came three minutes after writing an email to another school psychologist who wanted to know about social skills evaluation programs for students with ASD. I suspect that both these programs are being managed by someone with little or no experience in autism, or any real theoretical background for that matter. Suggesting that ASD students, students on the autism spectrum, need social skills training is clearly a sign they are lost in the mae of terminology or don't understand the nature of ASD.

Sure, kids with ASD (autism) have some strange social skills at times. They come across in a strange way, and this deficit causes problems between them and staff, other students and even their friends. But the issue isn't one of social skills. A social skills program (like Skills Streaming by Research press, a GREAT social skills program) simply doesn't address their deficit.  These students with autism have a deficit of perspective taking. Their problem is seeing things from the other persons point of view. It's a deficit of social reciprocity.

all the social skills training in the world will not teach your child reciprocity and perspective taking. Often, when working with teens with ASD I get, " Yeah, but it really doesn't matter....I did the right thing" as an answer to why they did some behaviour, said some statement  or behaved a certain way in spite of what the social results were.

I'll just give the the bluntest situation, and one that I hear about a lot. A student passes gas, farts, in class. Then when another student makes a comment he gets in a prolonged argument. " It's a natural process..." "I had to do it, everyone does, it's natural." Because of the student's rigidity of thinking and inability to accept the viewpoint of others he ends up socially isolated and often picked on. Social skills training is NOT what this student needs.

Working from the perspective of "social learning" we address this student's deficit in social reciprocity, in perspective taking. The student needs to understand that his actions cause people to react a certain way, and from observing others we learn to understand how we are doing - socially. Mitchell Winner has a program called "social behaviour mapping" in which we engage the student in a process of understanding how others feels and respond by asking new questions. One set of formal questions we ask is: "Was that an expected behaviour, or unexpected?"  Unexpected behaviours make people anxious, nervous and want to avoid you. Expected behaviours are more familiar, and we don't avoid those.

Sometimes other processes are used, such as social stories, drawings, mapping out the situation visually. This method of intervention addresses the key deficit that is causing the child difficulty: a lack of social understanding. In a social skills class you are unlikely going to get a student to engage in the social behaviour you want because it simply doesn't make sense to them. Often they already know the proper social skill, and make the choice not to engage in it because it makes no sense to them. Out job is to teach this skill of social reciprocity.

If your school is trying to put your child with ASD (autism, Asperger's Disorder of NVLD) into a "social skills" group they are setting your child up for more social failure because they are not addressing the real issue. Perhaps they understand and are using the wrong terms? If that's so, make sure and correct them. I also don't want people thinking that children with ASD simply lack social skills .... that often leads to a rejecting and punitive environment.  Check out what your school is up to. And for more information feel free to contact me, or look up the work of Mitchell Winner on the web.





Tuesday, July 5, 2011

New Research: Environmental Factors found in Autism

Click here to read the New York Times article: http://www.nytimes.com/2011/07/05/health/research/05autism.html
 For more details from the original article, click here: http://archpsyc.ama-assn.org/cgi/content/full/archgenpsychiatry.2011.76

A new study implicates environmental factors in the cause of autism (ASD, Asperger's and related disorders). By "environmental factors" they mean conditions for the fetus while in the womb.  These conditions, the researchers say, are as at least as important as overall genetic factors.

Researchers say that, "This is a very significant study because it confirms that genetic factors are involved in the cause of the disorder....but it shirts the focus to the possibility that environmental factors could also be really important."

This was a twin study. 192 pairs of identical twins were drawn from California data bases.  At least one twin in each pair had the classic form of autism, extreme social withdrawal, communications problems and repetitive behaviours. Identical twins share 100 percent of their genes. The study found that autism occurred in both children 77 percent of the time when they were males and 36 percent with females.  Mathematical models suggest only 38 percent of the cases could be attributed to genetic factors, compared with 90 percent from previous studies. Even more surprising, shared environmental factors appeared to be at work in 58 percent of the cases.

The rate of autism occurring in siblings who are not twins is much lower, suggesting that the conditions the twins shared in the womb, rather than what they were exposed to after birth ( vaccines... again show not to be a cause) contributed to the development of autism.

There was a second study that showed an elevated risk of autism in children whose mothers took a popular type of antidepressant during the year before delivery. The authors assure mothers that the risk is still very low.  Speak with your doctor directly if you have concerns.

These two articles are considered "game changers" and will redirect studies to what is going on in terms of prenatal and perinatal factors with respect to autism susceptibility.

As the "fear factor" of the anti-science and conspiracy crowd around individuals like Jenny McCarthy and the former Dr. Wakefield  (see :http://www.sciencebasedmedicine.org/index.php/anti-vaccine-warriors-vs-research-ethics/)  lose their credibility with the public, more important and actual science based research can now become the focus of the publics attention. There may be environmental factors, but they are not what we have been told. We urgently need to refocus research efforts and monies, but this time lets let scientist guide the direction of the inquiry rather  than a former model, a movie comedian and a defrocked MD.

For  information on autism treatment your welcome to view my web page at: http://www.relatedmindsbc.com/autism or at http://www.relatedmindsbc.com/  General information about my practice can be found at: http://www.bcpsychologist.org/users/jimroche or at http://Therapists.Psychologytoday.com/70682

Sunday, July 3, 2011

Teaching Autistic Teens To Make Friends

Teaching Autistic Teens To Make Friends

Can the skills of making friends really be taught? The answer seems to be yes. In a study appearing in the April edition of the Journal of Autism and Developmental Disorders, UCLA clinical instructor of psychiatry Elizabeth Laugeson and colleagues report that in comparison with a control group, the treatment group taking the class significantly improved their overall social skills and interactions with their peers. "Although, typically, developing teens often learn basic social rules through observation of peer behavior and specific instruction from parents," Laugeson said, "adolescents with autism spectrum disorders often require further instruction. You can read more about this study by clicking above.

"It's hard enough to be a teenager," she said, "but it's harder still for adolescents with autism because they typically lack the ability to pick up on all the social cues most of us take for granted — things like body language, hand gestures and facial expressions, along with speech inflections like warmth, sarcasm or hostility. "Lack of these basic social skills may lead to rejection, isolation or bullying from their peers. And sadly, that isolation can carry into their adult life."

Many of these skills need to be directly taught. Preferably in a group context where teens with autism spectrum disorder / Aspergers can practice and observe others practicing these skills (and do it in a protected environment) or individually. If the teen needs to work on these skills one-to-one because there are no groups or they have difficulty working in a group, there is still that option. If, however, individual training is used it is critical that parents become involved in knowing what skills are being taught, how they are cued, and how they can help with homework...using these new skills in a wide variety of environments. That's how they become part of your child's daily lives.

In this group study Laugeson and her colleagues developed a social skills class called PEERS (Program for the Education and Enrichment of Relational Skills), to give high-functioning teens with ASD a set of specific social skills. In it they worked on issues such as: "How do you have a successful get-together with someone? How do you go up to a group of teens and join their conversation? What do you say as a comeback when someone teases you? Without these core social skills, it becomes very difficult for teenagers to make and keep friends."

In the study, 33 teens with ASD — 28 males and five females — attended the PEERS classes. All the participants had a previous diagnosis of high-functioning autism, Asperger's Disorder or Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS). The teens met once a week for 12 weeks; each session lasted 90 minutes. Instruction was conducted in a small-group format, with seven to 10 teens, using established strategies for teaching social skills to adolescents with ASD. How could you get a class like this going in your school? First, contact the school's support teacher. If that doesn't work, go to the principal. Failing there many lower mainland districts have ASD or "Autism Teams." Ultimately, if your school doesn't have the skills or ability to put together such a program you should ask for a consultation with the "POPARD Partner," this is the individual who works with the Provincial Outreach Program for Autism and Related Disorders (POPARD). They often provide training, support and consultation to schools and individual teachers in developing these "social learning" groups. Here in BC we are more likely to call such a group a "social learning" group as the issue at hand isn't simply not knowing a specific social skill (although our student most likely doesn't), instead it's a matter of understanding the nature of social reciprocity. The give and take of language and communication involving emotion and meaning. (See books by Michelle Winner on "Social Learning" through my website at http://www.relatedminds.com/autism or directly through Amazon.ca

As part of the study this article is about parents were required to attend separate, concurrent sessions where they were provided direct instruction and guidance to support their child's development. Honestly, if someone is treating your child for deficits in social awareness and not seeing you on a regular basis to review and teach skills...something is missing in the program.

"Parental involvement was mandatory and important," said Laugeson, associate director of the UCLA Parenting and Children's Friendship Program and director of the Help Group–UCLA Autism Research Alliance. "Other research has shown us that parent involvement can have significant positive effects upon children's friendships, both in terms of direct instruction and supervision, as well as supporting a child's development of an appropriate peer network."

Please, take a moment to read the article. One of the problems in the field of autism/ASD/Aspergers is that we really don't have solid research proving that what we do brings about change. Often it is obvious to those doing the work, but it's good to see some basic science going on to back up our day to day practice in the field.