solomon socialskills
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Cover
Teaching Social Skills toTeaching Social Skills to
Children with PervasiveChildren with Pervasive
Developmental DisordersDevelopmental Disorders
Marjorie Solomon, Ph.D.,
Assistant clinical Professor
U.C. Davis Health SystemM.I.N.D. Institute
Elwyn
March 2007
22q11.2 Deletion Syndrome
Conference
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Presentation OutlinePresentation Outline
1. Individuals with Pervasive DevelopmentalDisorders
Diagnostic characteristics
Other similar disorders
2. Features of PDDs Social and Emotional Characteristics (Emotion and
Face Processing), Theory of Mind
Cognitive Characteristics (Executive Functions)
3. Remediation Strategies Research and Practice Academics
Social Functioning
Teaching teens social skills with movies
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Impairments in Social Interaction
Impairments in Verbal and Nonverbal
Communication
Restricted and Repetitive Patterns of
Behavior
DSM-IV-TR: Core Features inDSM-IV-TR: Core Features in
Autistic Disorder andAutistic Disorder and ASDsASDs
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Social Symptoms in PDDSocial
Symptoms in PDD
poor regulation of social interaction through eye
contact, facial expression, gesture, posture,
intonation
failure to develop age-appropriate peerrelationships
limited social-emotional reciprocity
empathy
aloofness
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Communication Symptoms in PDDCommunication
Symptoms in PDD
repetitive or idiosyncratic language
echolalia (including delayed)
neologisms overly formal or pedantic language
poor conversational abilities
difficulty taking listeners perspective
limited reciprocity
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Repetitive Behavior Symptoms inRepetitive Behavior Symptoms in
PDDsPDDsencompassing preoccupations
unusual topics
focus on details, difficulty differentiatingrelevant from irrelevant information
insistence on sameness, ritualistic behavior
stereotyped body movements
preoccupation with parts or sensory aspects
of objects
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Autistic DisorderAutistic Disorder
the most common PDD
> 6 symptoms from DSM-IV-TR list 2 social
1 communication
1 restricted/repetitive behavior onset before age 3
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AspergerAspergers Disorders Disorder
ruled out if criteria for autism met
< 6 symptoms from DSM-IV 2 social
1 restricted/repetitive behavior
normal IQ (> 70)
no history of language delay
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Pervasive Developmental DisorderPervasive Developmental Disorder
Not Otherwise Specified (PDDNOS)Not Otherwise Specified (PDDNOS)
used when criteria for other PDDs not met
subthreshold
number of symptoms
pattern of symptoms
severity
atypical
age of onset
uncommon symptoms
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WhatWhats in a Name?s in a Name?
NLDNLD NLD is a term coined by neuropsychologists who
interested in brain hemisphere laterality
Some, but not all, children with ASDs have NLDcognitive profiles
The typical pattern in children with autism is actuallyPIQ>VIQ
This information about relative strengths and
weaknesses is useful for educational and treatmentplanning
Not all children meeting the criteria for NLD havesocial deficits that are as pronounced as childrenwith ASDs
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WhatWhats in a Name?s in a Name?
Semantic Pragmatic DisorderSemantic Pragmatic Disorder
Rapin & Allen (1983) coin the term semanticpragmatic disorder syndrome
They have trouble understanding discourseThechildren usually have an intact or superior auditorymemory and are fluent. They may repeat wholesentences verbatim or recite TV comercials their
speech (has) a loose, tangential or somewhatinappropriate quality
A subcategory of PDDNOS? A bridge betweenlanguage impairment and autism (Bishop, 2000)
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WhatWhats in a Name?s in a Name?
Sensory Integration DysfunctionSensory Integration Dysfunction
Parents of many children with ASDs report thattheir children experience sensory stimuli in atypicalways
Parents of many children with general behavioraldysregulation also report their children havesensory issues
Many parents of children with ASDs report that OTis extremely helpful for their children
Empirical work about sensory issues in childrenwith ASDs and OT treatment efficacy is needed
(see Baranek, 2002; Stackhouse et al., 2003)
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Deficits in Emotional Awareness andDeficits in Emotional Awareness andUnderstandingUnderstanding
Emotion perception and comprehension (Downs & Smith,
2004; Hobson, 1986; Fein, Lucci, Braverman &
Waterhouse, 1992)
Experiencing relationship-based emotions (Hobson, 1993,
2002, 2005).
Labeling and explaining their own emotions (Capps,
Yirmiya, & Sigman, 1992), and those of other children
(Yirmiya, Sigman, Kasari, & Mundy, 1992)
Individuals experience jealousy, but understanding is lesscomplex and nuanced than typically developing children
(Bauminger, 2004)
Predicts difficulty in developing affective closeness and
intimacy.
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Deficits in Emotional Awareness andDeficits in Emotional Awareness andUnderstanding: Face ProcessingUnderstanding: Face Processing
Mixed results in the literature; simple versuscomplex emotion distinction; role of VIQ (Robins,Tracy & Solomon, in preparation)
Bias towards visual-verbal over visual-affectiveinformation when processing facial expressions ofemotion (Grossman, Klin, Carter, & Volkmar,2000)
Non-typical neural recruitment in face perception
(Boucher & Lewis, 1992; Critchely, Daley,Bullmore et al., 2000; Pierce, Muller, Ambrose,Allen, & Courchesne, 2001; Schultz et al., 2003)
Abnormal eye tracking patterns (Klin, Jones,
Schultz, Volkmar, & Cohen, 2002)
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Deficits in Theory of Mind:Deficits in Theory of Mind:What is TOM?What is TOM?
Being able to infer the full range of mental states(Beliefs, desires, intentions, imagination, emotions,etc.) that cause action. In brief, to be able to reflecton the contents of ones own and others minds.(Baron-Cohen, 2000)
The ability to represent others mental states anduse social cues as a key to interpreting behavior(Casari & Rotheram-Fuller, 2005)
The capacity to understand and manipulate themental states of others and to thereby alter their
behavior (Frith & Frith, 1999)
Also known as mentalizing, perspective taking,
introspective awarenessempathy
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Deficits in Executive Functions:Deficits in Executive Functions:
What are Executive Functions?What are Executive Functions? Skills required to prepare
for and execute complex
behavior
Inititiation
Planning
Inhibition
Organization
Self-monitoring
Mental representation
of tasks and goals
Cognitive Flexibility
Set Shifting
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Deficits in Executive Functions:Deficits in Executive Functions:NeuropsychologyNeuropsychology
EF established as an influential theory of autism (Ozonoff,
Pennington, & Rogers, 1991)
Progression through the 1990s to affirm that autism
involves a specific versus a generalized deficit (Chapman
& Chapman, 1978) and to document which component
processes are impaired using clinical neuropsychologyand cognitive neuroscience methods.
Impaired are: Planning as assessed by Tower Task
(Ozonoff, Pennington, & Rogers, 1991); Set shifting as
assessed by WCST and other cognitive flexibility tasks;
visual attention shifting Spared are: Working memory, inhibition
Some also argue that autism involves spared simple
information processes, but impaired complex processing
(Minshew & colleagues)
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Deficits in Executive Functions:Deficits in Executive Functions:
Real-Life-Type Problem SolvingReal-Life-Type Problem Solving
Getting stuck on the wrong details of a problem or
stimulus overselectivity (Ozonoff, 1998)
Difficulty shifting from ineffective to effective strategies(Twachtmann-Cullen, 2000)
AS children impaired in recounting the pertinent facts,
generating possible high-quality solutions, and selecting
optimal, preferred, and socially appropriate solutions
(Channon, Charman, Heap Crawford, & Rios, 2001)
Difficulty with concept formation versus concept
identification (Minshew, Meyer, & Goldstein, 2002)
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A few disclaimersA few disclaimers
We are further behind in the developing ofempirically supported interventions for older highfunctioning children with PDD
Empirically supported is a very high bar
Good intervention should involve: assistance withsocial cognition, verbal and nonverbalcommunication, increased engagement inappropriate developmental activities, academic
skills, fine and gross motor skills, reduction ofproblem behaviors, independent organization skills(Filapek, Steinberg-Epstein, & Book, 2006)
This will be a review of best practices and recentresearch
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Problem Solving for Parents
Child Characteristics Problems
Oppositionality ? Rigidity
Hyperactivity ? Introversion ? Extraversion
Anxiety Autism Spectrum Disorder Deficits Cognitive Endowment Developmental Level
Executive
Function/
Problem Solving Goal direction Motivation Organization
Theory of Mind Perspective taking
Empathy
Emotion Awareness
and Recognition Knowing ones own
feelings Knowing
those of others
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Preparing Students forPreparing Students for
Change/Social StoriesChange/Social Stories
My Social Story about RecessTime Change
Most days we have recess at12:00. Tomorrow will be aspecial day because the blacktopis being fixed. Tomorrow wewill have recess at 11:00. Thismeans we will skip music timefor one day. Recess time will be
the same as always. Mrs. Joneswill be with us. Our class andthe 3rd grade will be together.We will still have all the sameequipment.
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Group Exercise: Writing a SocialGroup Exercise: Writing a Social
StoryStory
Please divide into 3 teams
Write the following stories: Going to a play
Why it is important not to belch and fart in
public
Going to a birthday party
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Remediation Techniques: ImprovingRemediation Techniques: Improving
Emotional Understanding and AwarenessEmotional Understanding and Awareness
Emotion thermometers
Bouncing off the walls
Body language charades
Fun with the digital
camera
Emotion matching games
Role plays
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Remediation Techniques:Remediation Techniques:Theory of MindTheory of Mind
Social skills group setting (Ozonoff & Miller,1995)
Teaching Children with Autism to Mind Read(Howlin, et al., 1999)
Training on emotion, belief, and pretend play(Hadwin, et al., 1996, 1997)
Provide action and emotional cues (Bowler &Stromm, 1998)
Thoughts are like pictures in the head & thoughtbubbles (Swettenham, 1996;McGregor, 1998;Gomez et al., 1996)
Training in EF actually improves TOM! (Fisher &Happe, 2005)
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Remediation Techniques: TeachingRemediation Techniques: Teaching
Theory of Mind at M.I.N.D.Theory of Mind at M.I.N.D.
Stress the Golden Rule
Introductory song w/
personal information
Always highlight different
perspectives
Using teachable
moments Friendship party
Group name and logo
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Remediation Techniques: TeachingRemediation Techniques: Teaching
Conversation SkillsConversation Skills
Tennis ball conversations
Recipe for a coversation = 1 starter + 1 comment+1 statement of your own + 1 pass.
Follow the Rules (an adaptation of Grice, 19 )
Share the Air!
Stay on the Same Page Be honest..
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Remediation Techniques:Remediation Techniques:
Executive Functions DeficitsExecutive Functions Deficits
Contingency based self-management programs (Quinn,
Swaggart, & Myles, 1994)
Metacognitive strategies that enhance observing ego so
childen can grapple with their maladaptive behaviors (for
ADHD see Wasserstein & Lynn, 2001)
Goal Management Training-- 5 steps to self-monitor results
of actions (Levine & Robertson, et al., 2000) Teach external compensatory strategies
Flexibility Training (see Sohlberg & Mateer, 2002)
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Remediation Techniques: Real-Life-Remediation Techniques: Real-Life-
Type Problem SolvingType Problem Solving
Points system
Wicked witch visual
template
Leaders and followers
Cognitive flexibility games
Use of visual template
Graduation projects
Running commentary on
cause and effect
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Teaching Social Skills WithTeaching Social Skills WithMoviesMovies
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Group AgendaGroup Agenda
I. Beginning Circle
II. Game or OutsideTime
Lesson Time/Movie
Time/Snack Time
Joke Time
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Teen Group: The BeginningTeen Group: The Beginning
Circle -- MechanicsCircle -- Mechanics
News or
announcements
The Questions
Discussion of Social
Experiment
Discussion of PhoneCalls
Use of Group Mascot
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Teen Group: The BeginningTeen Group: The BeginningCircleCircleThe QuestionsThe Questions
Questions progress along with the group and
ideally relate to topic under study or group
stage related phenomena.
Beginning questions: What do you like?
What kinds of ice cream/ foods/ pizza/
amusement park rides do you like?
What are you like? (Options given)
What is your personality like? (Options given)
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Beginning Circle: Mid GroupBeginning Circle: Mid Group
QuestionsQuestions
o Tell us about a friendshipthat youve had. What are
two importantcharacteristics in a friend?
o What are you like in newsituations? What are youlike as a friend?
o What is a problem youvehad and how did you dealwith it?
o Have you ever beenbullied. What did you do?
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Game Time/Game Time/Outside TimeOutside Time
Vote on What to Do Indoor or outdoor
Goals: To practice skills required to play simple games
To generate enthusiasm for the group and motivation forinteracting with others
To facilitate smaller group social interaction between
different group members Used as a setting to observe group members in
social situations
Every week different members volunteers to bring
in music to play during game time
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Game Time/Game Time/
Outside TimeOutside Time
Members pair or group together
Leaders monitor and assist in conversations, andfade out of interactions
Positive behavior reinforced
Socially inappropriate or unacceptable behavior
used as teaching points Balls and playground equipment used
Opportunity to experience non-threatening athletics(football, races, the worm)
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Lesson Time: General Progression ofLesson Time: General Progression of
Lesson TopicsLesson Topicso Understanding your own feelings
o Understanding the feelings and perspectives ofothers
o First impressionso The meaning of friendship
o Conversation skills
o Irony, sarcasm, metaphors, figurative language,
and subjective vs. objective informationo Problem solving
o Team Building
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Lesson Time/Movie TimeLesson Time/Movie Time
Primary teaching vehicle for first 16 weeks are10-20 minute film clips
These provide a starting point for discussion of
focal issues in the lesson and others that arise General progression of topics is the same during
groups, however, flexibility is built in so thatindividual groups and chosen film clips can be
tailored to member needs and interests Popcorn is served!
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Lesson Time/Movie Time: SampleLesson Time/Movie Time: Sample
ThemesThemes First impressions and how they
develop (Harry Potter)
The meaning of friendship (Holes, StarWars)
Social hierarchies (Holes)
Appropriate male/female behavior(Dodge Ball)
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Lesson Time/Movie Time:Lesson Time/Movie Time:
Sample Themes -2Sample Themes -2
Different Kinds of Comedy (Take the Money
and Run; Monty Python & the Holy Grail)
Team skills and why teams do and do not
work (Miracle, October Sky)
Coaches and Bosses (Miracle, Remember the
Titans)
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Lesson Time/Movie TimeLesson Time/Movie Time
Friendship; empathyBeing a team/group;
family not in literal
terms
Being a friend; going
against authority; problem
solving
Teaching Point
Caveman and Zero climb
mountain; 6min. 41 sec;
Chap. 19 on DVD Zero
confesses to Caveman. 4 min36 sec; Chap. 21 on DVD
Players approach coach
about replacing them;
team/family theme;
Christmas dinner. Chap. 10on DVD; 8min 27 sec
Roommate wants to be an
actor; new guy
unsupportive. Discuss
new guys introversion.3min 29 sec; 47 min 05
sec into tape
Scene Summary
Social hierarchy; impressions;
bullying
Working as a team;
emotions; leadership
First impressions;
friendship; personality
traits; emotions
Teaching Point
Caveman finds lipstick case;
older boy claims to have
found it and gets the day off
without dispute. 6min 26 sec;
Chap. 11 on DVD
Friction between players in
bar and on the ice, Coach
uses to bring team together.
5min 58 sec.; Chap. 4
New guy meets his
roommate and his friends;
roommate and father.
4min. 18 sec; 7min 18 sec
into tape
Scene Summary
HolesMiracleThe Dead Poets SocietyMovie
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Lesson Time/Movie TimeLesson Time/Movie Time
Teaching Point
Scene Summary
Movie
Phony friends; personality;
motivation
First impressions;
assumptions
Humor; personality traits
Girls croquet game; girl
talking with parents;
convenience store. 4min. 56
sec; 21 minutes into tape
Battle of wits over which
cup is poisoned. 5min. 12
sec; 30min 03 sec into tape
Buddy the elf goes to
work with Dad and in
mailroom; Dad takes an
important conference call.
Chap. 11 on DVD
HeathersThe Princess BrideElf
Also watched: Harry Potter and the Sorcerers Stone; Monty Python
and the Holy Grail; Dodgeball; Star Wars; Radio; Billy Elliott; The
Breakfast Club; and Lord of the Rings
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Joke TimeJoke Time Goals:
To teach jokes and scaffold
the development of sense of
humor
To continue teaching about
irony, sarcasm, metaphors,
and figurative language
Members can volunteer to
share a joke or read from
our books
Safe place for feedback
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AcknowledgementsAcknowledgements For your attention
To the teens and parentswho participate in ourgroups
To our wonderfulvolunteers Julia Hales,Neil Cummings, PetrinaKaluzhny and many others,as well as my colleagues
Beth Goodlin-Jones, JohnBrown, Mary BethSteinfeld, Erin Roseborowho work on social skills