Monday, March 7, 2016

Teaching Social Skills to Children on the Autism Spectrum



Impairment in social communication and interaction is a core feature of autism spectrum disorder (ASD). Social skills deficits include difficulties with initiating interactions, maintaining reciprocity, taking another person’s perspective, and inferring the interests of others.  Unfortunately, many children with ASD do not receive consistent and intensive social skills programming in school. This is problematic, especially considering social impairments may result in negative outcomes, such as poor academic achievement, social failure, isolation, and peer rejection, which often leads to co-occurring (comorbid) anxiety and depression. 
Because social skills are critical to successful social, emotional, and cognitive development and long-term outcomes, best practice indicates that social skills instruction should be an integral component of educational programming for all children with ASD. Research evidence suggests that when appropriately planned and systematically delivered, social skills instruction has the potential to produce positive effects in the social interactions of children with ASD. Both the National Professional Development Center on Autism (NPDC) and the National Autism Center (NAC) have identified social skills training/instruction as an evidence-based intervention and practice. Social skills training is typically offered as small-group instruction with a shared goal or outcome of learned social skills in which participants can learn, practice, and receive feedback. These interventions seek to build social interaction skills in children and adolescents with ASD by targeting basic responses (e.g., eye contact, name response) to complex social skills (e.g., how to initiate or maintain a conversation). 

Most often, schools are expected to assume the responsibility of delivering social skills training programs to children with social skills deficits, because these impairments significantly interfere with social relationships and have an adverse effect on academic performance. Although equipped to teach social skills, implementing social skills programming can be challenging for school personnel (teachers, counselors, psychologists, social workers), who often have limited time and resources. Recent meta-analysis research suggests that the effectiveness of social skills training can be enhanced by increasing the quantity (or intensity) of social skills interventions, providing instruction in the child’s natural setting, matching the intervention strategy with the type of skill deficit, and ensuring treatment integrity (fidelity). In order for students to learn, practice, and maintain expected social behavior, educators must teach social skills within the context of the various school settings that students encounter each day (i.e., classroom, special subject areas such as art and music, cafeteria, and playground). 
The following are recommended when developing a social skills intervention strategy:
  • Avoid a "one size fits all" approach and adapt the intervention to meet the needs of the individual or particular group. 
  • Employ primarily positive strategies and focus on facilitating the desirable social behavior as well as eliminating the undesirable behavior. 
  • Emphasize the learning, performance, generalization, and maintenance of appropriate social behaviors through modeling, coaching, and role-playing
  • Provide social skills training and practice opportunities in a number of settings with different individuals in order to encourage students to generalize new skills to multiple, real life situations. 
  • Use assessment strategies, including functional assessments of behavior, to identify children in need of more intensive interventions as well as target skills for instruction. 
  • Enhance social skills by increasing the frequency of an appropriate behavior in "normal" or typical environments to address the naturally occurring causes and consequences. 
  • Include parents and caregivers as significant participants in developing and selecting interventions (they can help reinforce the skills taught at school to further promote generalization across settings).
The type of skill deficit (performance deficit versus skill deficit) should also be considered when developing a social skills intervention plan. A performance deficit refers to a skill or behavior that is present but not demonstrated or performed, whereas a skill acquisition deficit refers to the absence of a particular skill or behavior. School professionals should make an intensive effort to systematically match the intervention strategy to the type of skill deficit exhibited by the child. For instance, if the child lacks the skills necessary to join in an interaction with peers, an intervention strategy should be selected that promotes skill acquisition. In contrast, if the child has the skills to join in an activity but regularly fails to do so; a strategy should be selected that enhances the performance of the existing skill.
Social relationship skills are critical to successful social, emotional, and cognitive development and to long-term outcomes for students. Thus, systematic social skills instruction should be considered a critical component of treatment for children with autism. Teaching social skills can have both preventive and remedial effects that can help reduce the risk for negative outcomes not only for children on the autism spectrum, but for all children. 

Adapted from Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London and Philadelphia: Jessica Kingsley Publishers.


Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Wednesday, March 2, 2016

Improving Maternal Mental Health After a Diagnosis of Autism Spectrum Disorder

Improving Maternal Mental Health After a Diagnosis of Autism

Parents worldwide often experience a range of emotions when their child is first diagnosed with autism, including shock, sadness and grief, anger, and loneliness. Mothers, in particular, appear to face unique challenges that potentially have an impact on their mental health and wellbeing. This includes high levels of psychological distress, depressive symptoms, and social isolation. Almost 40% of mothers report levels of clinically significant parenting stress and between 33% and 59% report significant depressive symptoms following a diagnosis of autism spectrum disorder (ASD). The prevalence of psychological distress among mothers of children with ASD suggests a need to address parental mental health during the critical period after the child’s autism diagnosis and when parents are learning to navigate the complex system of autism services.
Research

A study published in the journal Pediatrics examined whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child’s diagnosis of ASD. A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs. Participants were mothers of 122 young children who recently received a diagnosis of ASD. The intervention group received PSE, a manualized cognitive behavioral intervention delivered in six 30-minute individualized sessions. The usual care group mothers received the services specified in the child’s Individualized Family Service Plan or Individualized Educational Plan (IEP) which typically includes speech and language therapy, occupational therapy, and social skills training. Neither specifically includes parent-focused mental health services.
The results indicated that at a 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance; however, the reduction in mean depressive symptoms was statistically significant. The findings demonstrate evidence of PSE’s short-term efficacy and potential to reduce clinically significant psychological distress during this critical juncture—when parents first learn of an ASD diagnosis and must navigate a complex service system on their child’s behalf.
Implications

The findings have implications for clinical practice. Practitioners need to be aware that parents experience a myriad of emotions when receiving a diagnosis of ASD and many go through stages of grief. Likewise, professionals working with families of children with an ASD should be aware of negative effects of stress and anxiety and assist in offering services that directly address parental needs and support maternal mental health. Strengthening maternal problem-solving skills might serve as a buffer against the negative impact of life stressors and thereby reduce parental stress and attenuate depressive symptoms in the months immediately following a child’s ASD diagnosis. Future research is needed to examine the effect of intervention over a longer follow-up period and to assess whether the intervention worked differently among subgroups of mothers, which could help better identify those who are most likely to benefit from the intervention.
Reference

Improving Maternal Mental Health After a Child’s Diagnosis of Autism Spectrum Disorder: Results From a Randomized Clinical Trial. Emily Feinberg, CPNP, ScD; Marilyn Augustyn, MD; Elaine Fitzgerald, DrPH; Jenna Sandler, MPH; Zhandra Ferreira-Cesar Suarez, MPH; Ning Chen, MSc; Howard Cabral, PhD; William Beardslee, MD; Michael Silverstein, MD, MPH. JAMA Pediatrics. doi:10.1001/jamapediatrics.2013.3445
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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