From a very young age, neurotypical children learn social, cognitive, and communicative abilities from their primary caregivers by listening to speech and looking at faces. Recognizing and interpreting familiar faces allows infants to identify socially important people and understand others’ internal mental states (Baron-Cohen et al., 1994). In fact, when a mother simply establishes eye contact and communicates with her child, she helps activate specific regions in her child’s brain, which support social, cognitive, and communication development. When these regions in the brain develop slowly or function atypically, the global effects on a child can be profound, often leading to social impairments and language disorders, for example.
According to the American Psychiatric Association, Autism Spectrum Disorder is defined by the presence of social impairments and language disorders, accompanied by stereotyped and repetitive behaviors (American Psychiatric Association, 1994). According to current research, children with ASD tend to display different neuro-anatomical characteristics such as low activity in their fusiform gyri when viewing human faces (Kanwisher et al., 1999;Pierce et al., 2001, 2004; Bolte et al., 2006). As a result, children with ASD often have deficits in processing human faces, interpreting non-verbal social cues, or understanding humor.
At the Center for Social Dynamics (CSD), we use an evidence-based approach that treats the social-emotional affects associated with the medical diagnosis of ASD. The following is an outline of treatment areas, targeted in the social skills groups.
Social Communication – the main goal is to increase the functional use of language and communication in all natural settings.
Emotional Regulation – the focus here is to expand an individual’s capacity to manage his/her responses to internal and/or external stimuli by using cognitive behavioral techniques. Other communication-related target areas may involve improving an individual’s ability to recognize and label facial expressions.
Theory of Mind (ToM): Children on the autism spectrum tend to display deficits in a key skill area called Theory of Mind, which is a system for inferring the full range of mental states from behavior (Baron-Cohen, 1995). Within CSD social skill groups, trained clinicians design treatments which target this area of functioning.
Improving Problem Behavior through Effective Social Communication – to address this, CSD uses visual supports, role-play, and high-interest activities to teach individuals two important concepts: 1) how their behavior affects other people, and 2) what choices people may make based on the behavior they encounter.
Modifying Social Environments or Using Techniques to Increase Communication – this may involve teaching parents, caregivers, or teachers concepts such as communicative temptations, which entice a child to ask for help or initiate a communicative interaction.
Multimodal Supports – these are tools such as visuals, icons, picture schedules, or modified communication styles, all of which appeal to the child’s interests and assist in learning.
Learning and Playing with Peers – within group-based instruction, SLPs, Behaviorists, and OTs collaborate, facilitate and/or teach skills, which allow children with ASD to interact naturally with their peers through play or other developmentally functional activities.
Goals – all goals must be functional, family oriented, developmentally appropriate, and measurable.
Meaningful and Purposeful Activities – skill-based tasks (matching, motor imitation, etc.) frequently fail to address what children with ASD encounter in their natural environments. Activities that do not take into account what is meaningful for a child may exacerbate behavior problems and prevent the individual from generalizing what he/she has learned into multiple environments. Activities should be integrated into a child’s routines – that is, he or she should be able to use skills learned in a natural setting. Further, activities should have a natural sequence, with clear beginnings and endings — offering some flexibility where needed (games, art, etc.)
Planned Activities – these are intended to teach specific skills, such as following eye gaze or reading facial expressions, by using multiple learning opportunities whose eventual aim is to instruct independent mastery.
Engineered Activities and Environments – these may not occur naturally in a child’s environment, but they are designed to provide familiar, consistent, and predictable formats for addressing treatment goals. The goal of these activities is to provide routines that allow the child to practice and maintain skills.
Modified Natural Activities and Environments – these provide a student an opportunity to apply new skills in different contexts; this is an important step toward generalizing skills.
Naturally Occurring Events and Environments – this aspect of intervention largely involves parent training. Parents can then help their children demonstrate new communication skills within the community (introductions, eye gaze, body language, etc.).
Communicative Temptations – these techniques, developed by Wetherby and Prizant (1989), encourage communication. Most importantly, CSD clinicians teach parents how to use these techniques at home.
Balanced Turn-Taking – this involves a child and an adult or peer participating in a balanced, back-and-forth fashion to increase the length of attention and engagement. (Greenspan, 1997).
Playful Construction/Obstruction – in this approach, clinicians seek to transform a child’s solitary play into a social interaction.
Playful Negotiation – during problem-solving activities, clinicians encourage back-and-forth interactions during problem-solving situation.
The Function or Purpose of the Communicative Behavior: All autism-focused social communication groups seek to increase each patient’s communicative and social behavior by improving the following areas:
Expressive language skills involve abilities such as talking or writing – essentially what a person produces to communicate.
Receptive language skills determine how, and to what degree, a person understands language. These abilities include reading and listening.
Pragmatic skills, as defined by the American Speech-Language Hearing Association (ASHA), involve the following:
i. using language for different purposes such as greeting, informing, or demanding;
ii. changing language according to the needs of the listener or situation by talking or speaking differently;
iii. following communication rules for conversations and storytelling – such as maintaining a topic under discussion and reading body language for non-verbal communication.
Communicative Competence/Social-Behavioral Improvement – CSD groups treat social behavior by improving communication skills.