by Veronica McKibbin, Child & Family Counselor, LIH Olivia’s Place Shanghai
Jamie, now 8 years old, has moved to Shanghai with his parents and younger siblings. Jamie was diagnosed at age 3, with what was then known as Asperger Syndrome (now grouped into the DSM-V’s broader category of Autism Spectrum Disorder) by a team of specialists in his home country. Jamie is a sensitive and often funny young boy, who has, over time, had many special interests. Upon arriving in Shanghai he developed an enthusiasm for architecture, in particular tall buildings. Jamie has strong expressive verbal language skills and cognitive development. However, he also shows marked weakness in his social communicative learning. He can talk at length about the height and facts about famous landmarks, however pays little attention to if the ‘listener’ is engaged or even participating in the conversation. He also finds some academic areas difficult, particularly written expression where he is required to interpret information about what people are thinking or feeling. Organizational skills are especially challenging for him. He also found the social emotional demands of moving to a new school and city overly taxing on a system already stretched to capacity, and his family noticed he was now having frequent and intense emotional outbursts. One of the recommendations for Jamie from his class teacher was that he attends a “social skills” group.
Teachers, parents, doctors, or therapists refer children to a “social skills” group for a variety of reasons. Sometimes the child is perceived as shy or anxious around their peers; they may feel the child has difficulty initiating or maintaining friendships. Referrers often feel the child would benefit from some pragmatic social language instruction, that is, learning specifically about how to use language appropriately in social situations. Often children (such as Jamie) have particular challenges in managing their behavior in an expected and socially accepted way for their age in relation to their peers.
LIH Olivia’s Place currently offers social skills groups based on the social cognition program developed by Michelle Garcia Winner, known as “Social Thinking.” The Social Thinking program is not designed to cover all “social skill” difficulties. Rather, it is designed to be most effective for Emerging Social Communicators, with the goals of the group to help children improve in the areas of: Joint Attention, Perspective Taking, Developing Reciprocity, Communicative Intent, and Using Language to relate to others. Social Thinking is a language-based learning approach, and so to benefit from this approach, children require solid to advanced verbal language skills.
The conceptual framework of social cognition is based on the core theories reported in the literature as critical for those with social issues. These include: Theory of Mind (Flavell, 2004), Central Coherence Theory (Happe and Frith, 2006) and Executive Functioning (Hill, 2004). The model attempts to help children develop skills across the following domains:
I = Initiating communication in unfamiliar or more stressful social communicative contexts.
L = Listening with eyes and brain: syncing auditory processing with non-verbal communication cues to process and respond more sufficiently to a message.
A= Abstracting and inferencing to predict and glean meaning from language and non-verbal and contextual cues.
U = Understanding perspective which is key to participation in any type of group, weakness in perspective taking is a significant aspect of autism spectrum disorder and other social cognitive deficits.
G = Gestalt processing / Getting the “Big Picture.” Social thinkers intuitively determine the underlying concept being discussed without being distracted by the details or being overly tangential in their social relations.
H = Humor and human relatedness. Relating and responding to other people’s emotions as well as their own, Social Thinking endeavors to help children feel the enjoyment that arises through mutual sharing, and is critical to the development of all other aspects of social development.
How does an Emerging Social Communicator (ESC) present?
Garcia-Winnner describes the emerging social communicator as having “a weak social radar system;” they are not highly in tune with what is happening around them. They may have relatively weak eye contact, be poorly attuned to context of situational and physical cues (such as gestures, body language, eye gaze, and intent), often they have difficulties in recognizing their own and others’ emotions. Garcia-Winner finds that Emerging Social Communicators usually desire social interaction but struggle to relate to peers of their own age without facilitation, instead they will seek out interactions with adults. Often ESCs will have difficulty (due to awareness or language related concerns) at tracking what others are talking about and making related comments or asking questions (staying on the path of the conversation).
Emerging Social Communicators have difficulty paying attention in classroom-size groups and often have difficulty even in very small groups, usually benefiting from increased support and extra time to process and respond to social information. These children benefit from the Social Thinking curriculum and the embedded language-based cognitive skills as they typically have weak self-awareness of what is considered unexpected social behavior and other’s social behavior. In early development, these children often lack the natural development of sustained and mutually fulfilling joint attention and affect. They often benefit from explicit intervention to understand that others have thoughts that are different from their own.
What actually happens in Social Thinking Lessons? You are a Social Detective – Thinking with our Eyes
The following is an example of the activities in the group that help ESC’s learn the core skills of joint attention and develop their social communication skills.
For a lot of the children who come to the group, “thinking with their eyes” will be and may continue to be their biggest challenge. A lot of children who have been “trained” in social skills will have been told – “look at me when I’m speaking,” or “look a person in the eyes when they talk to you.” But, for many children, particularly those on the autism spectrum this is not something that comes intuitively to them. As children are often best engaged through play, this ‘lesson’ of thinking with our eyes is reinforced over many lessons through different engaging games. One such activity is as follows:
Look at something very obviously, such as the clock or a watch, and ask the students if they can guess what you are looking at. If they guess correctly ask them if they can guess what you might be thinking about. You may need to provide a lot of cues, making it very obvious what you are looking at. If the students are unable to track your eye gaze, they will be unable to even begin to make smart guesses about what you are thinking about, and so this needs to be the starting point for the intervention into shared attention and social communication.
Activities to facilitate eye gaze tracking:
- Show students that eyes can point, and that you can look at where a person’s eyes are pointing to see what they are looking at.
- You can use pictures, props such as glasses with arrows or take turns with the students who can track eye gaze by playing eye spy and continue to look at the object you are “spying.”
- Once students are familiar with eye gaze tracking, have all the students close their eyes and give them vague instructions like “look over there and see what is on that wall,” or “who is that?”
- Ask them what it is you are talking about or who you are talking to each time.
- Ask them to describe why they don’t know the answer (because they can’t see to what or whom the comments refer).
LESSON – Can you read my plan?
This builds on the work of eye gaze tracking and understanding that others have thoughts about what they are looking at.
- The joint attention activity for this session can be a game of charades. Begin with very simple charades that the children will easily be able to act out and guess. Use a children’s charades game, or just make some before the group with a combination of activities, animals, or feelings.
- After the game of charades, review thinking with your eyes and re-read social stories as needed, and then introduce the new content of “Can you read my plan?”
- Beginning with maximal cues look at the clock or your watch, move towards the door, or reach for an object then FREEZE just before you touch the object. Ask the students if they can “read” your plan. They should easily be able to guess what you might do next. From here you may also be able to introduce the idea that they can make a “smart guess” about what you are thinking. You could look at the clock, rub your tummy and hopefully they will be able to guess that you are looking at your watch and you might be thinking, “What time is it,” or “I’m hungry – it’s time for lunch.”
- Give them a few examples with maximal cues. You could put a glass of water nearby, stare at it, and rub your throat. Or, put a jumper nearby, look at it, rub your arms. Stare at the light switch and see if they can “guess your plan” to turn the lights off/ on.
- Encourage them to use their eyes, ears, and brain to make a “smart guess” about figuring out someone’s plan.
- Then have the students take turns “doing an action,” but stopping short of what they were about to do by freezing their bodies. Help them understand that they are not supposed to try and trick others but instead are trying to help others guess. If others guess correctly then they are being a good teacher!
The Social Thinking program is designed to help individuals recognize their own and other’s social minds, develop their understanding to adjust their behavior to achieve more rewarding social outcomes, and learn to adapt to people and surroundings across contexts. Many children will be most successful learning the skills taught in the social thinking curriculum in a variety of settings, for example in speech and language therapy, behavioral therapy, the classroom, working with an aide or teaching assistant, and at home. Then the group can provide a safe and supportive testing ground for practicing the skills they have been working on. Groups naturally will be a mirror for reflecting and noticing the difficulties a child has in social communication that may otherwise go unnoticed in individual therapy. For this reason, social skills group work is a nice addition to ongoing therapy that is also addressing social and language concerns. It is rarely (if ever!) the complete answer to address all the needs a child with social communication learning challenges may have.
Reference: The Social Thinking-Social Communication Profile™ – Levels of the Social Mind. Michelle Garcia Winner, Pamela Crooke and Stephanie Madrigal.
Further information on Social Thinking is available at www.socialthinking.com