Autism and changing your ways

Pamela Crooke, PhD, CCC-SLP

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For most of us, the drive to change our own behavior emerges on or around January 1st with the dawn of a new year and new possibilities for self improvement. Lose a little weight, stop smoking, exercise more, and eat leafy greens seem to be among the favorites. Most of us are pretty conservative and only select 1 (maybe 2) goals to tackle each year. After all, we are only human and it takes a lot of thinking to change a pattern or ingrained routine. If you’re diligent and work hard, you might see a change but for most of us….it’s an exercise in futility by the time March 1st comes along. Why does that happen? How do we lose our “oomph” and why do we slip back into our old, familiar ways? Why can’t we learn to change our ways? These are all questions that we ought to be asking, but rarely do. Instead, we wait until the following year and begin the process all over again. Why?

Because changing a behavior is REALLY hard, even when we’re highly motivated to do so.

If changing behavior is so tough for us…consider for a moment the number of IEP goals your child or student currently has. Most of the IEPs I’ve been involved with have no less than 2-3 goals per target area resulting in anywhere from 7 to 15 goals. But wait! There are often 2-3 objectives as part of each goal area and each and every one requires some level of behavior change. To be fair, a goal to improve math skills may have sorting as an objective and it is routinely “met” without any knowledge on the part of the learner that s/he was able to do this task with 80% accuracy. Likewise, a written language goal for a 3rd grader may include generating paragraphs which might be easily tackled by just being an active learner in the classroom or resource room. But learning about social skills and the underlying thinking is a whole new ballgame. For many, social learning is something that doesn’t just happen by being exposed in a classroom to what he or she “should do.”

Before we can change behavior, help develop it, or expand it, we need to understand its origins.

What do we know about how kids learn information? There are literally thousands of research articles, books and websites dedicated to demystifying how children develop early skills. Social development starts before a child is born and continues to burst forth with new skills throughout the early years. Children as young as three days old are distinguishing between facial expressions, within the first they are starting to point to engage others in their thinking, and by the age of three are really quite brilliant in their use of social information. That is, if the child is developing in a “neurotypical” (NT) fashion. For those learners on the autism spectrum or who struggle with social learning, moving from recognizing facial expressions to pointing to understanding others’ intentions can be a lifelong learning process. This is an important point to consider given that our IEPs are written on a school year cycle and we routinely hope that a student will make several years worth of behavior shift over the course of one year. I don’t think I could do this…could you?

For example, think about an eight-year-old child who has no idea that his eyes can help him understand that teachers often look at the person to whom they are asking a question. Because of this, he routinely blurts out the answer to every question because he doesn’t use his eyes to gather this information. Would we really make a time sensitive (school year) goal to target talking to peers when this child should be working on using his eyes to understand the point of reference (joint attention)…something that babies are perfecting in the crib? But let’s say the goal is written on the child’s IEP. We’ve now asked this child to gain 6+ years of skills over the course of two semesters. What about the 9-year-old who can talk and talk and talk but never seems to be talking to anyone in particular? Why are we so persistent in having “maintaining a conversation” as the focus goal of his behavior change regime when the bigger issue is that he has no idea how to get his body into a group…a prerequisite to having a conversation?

We DO know that social learning forms the basis for so many important later developing skills. Recent advances in brain science confirm the complexity of the social brain, something most of us who have NT development simply take for granted. We know that the social brain is developing so rapidly that by four years of age, children are able to talk about understanding what other people are thinking. Kids this age are beginning to use something we call mental state words like “guess” and “know” and “think” in their everyday language. By the time a child is having his sixth birthday, he is learning how to lie and trick others; something we refer to as mental manipulation. We may not like to think of it, but understanding and using mental manipulation is one of life’s critical survival skills. If you don’t know when you are being tricked, you will likely wind up at the mercy of someone who is up to no good. Likewise, the spouse who doesn’t know when to say something tastes good when it may not is bound to find himself or herself in the proverbial doghouse.

The reality is that all of early social learning forms the basis not only for social participation and play but also for more abstract concepts such as problem solving, understanding people’s communicative intentions, written expression and reading comprehension. Not coincidentally, social knowledge and abstract social language and communicative interpretation are a distinct part of our academic curriculums. One of the great assumptions of students entering kindergarten is that they are equipped with an active social operating system; students are expected to understand they are part of a group and how to learn in a group (Winner, 2005). And, as our kids move through the school system a number of educational standards related to language arts tax a child’s ability to think socially. This means that students with social learning challenges aren’t simply struggling with “conversation” and “making friends” but are likely having issues understanding the motive and intentions of characters in fiction as well as others on the playground.

What else should I know about changing behavior?

With the advances in functional brain imaging we now know so much more about what happens when we are working on changing our own behaviors. Remember the January 1st goal to lose some weight? Our brains are pretty resistant when it comes to changing something we’ve done for awhile or something we find pleasurable. In fact, a professor from Stanford recently published a book on willpower and describes the brain as something that operates on the levels of “I will”, “I won’t”, and “I want” (McGonigal, 2012). If you think about behavior change in your own life, this makes a lot of sense. The “I want” part of our brains, or the midbrain, is actively seeking our desires while the front part of our brain tells us to “cool it” and stay on target. If you think about it this way you realize that your brain is having a bit of a spat with itself whenever you are working on changing your ways. An even more alarming statistic is that more than 40% of the things we do over the course of the day are rooted in habit, not thoughtful and deliberate decisions (Duhigg, 2012).

Wow. This adds a whole new spin on how we should be thinking about teaching behavior change, including social. We need to spend more time on getting our kids to have an awareness of what they are doing or not doing in order to kick their brains into the “I will” actions. This is one of the key tenets of Social Thinking (more on this later). And, like any new learning or behavior change it isn’t quick and it’s not based on the school year calendar. Social learning happens over the course of our lives and it changes based on our age and the context.

Okay. This child/student has social learning issues so who is responsible to help?

This is the moment where we imagine a circle of professionals pointing to one another with both hands crossed in a “he went that-a-way” sort of Laurel and Hardy spoof which happens right after pointing to the parents who are firing an index digit back at professionals. The truth is that there is no single profession trained to fully understand and develop treatment programs related to a child with social cognitive challenges. This is confusing to many school staff and parents. After all, isn’t this the job of speech-language pathologists (SLPs)? The simple answer to this is yes but no. The right answer is that SLPs should be involved along with every other person across the home and school day. While most SLPs have training in pragmatic language, few are highly trained in understanding the nuanced social and academic issues of the highly verbal ASD student (along with those who have ADHD, Nonverbal Learning disorder, emotional and mental health issues). Remember, social learning is the foundation for academic success! So, we all attend workshops to try to fill in the missing links between social learning, behavior, academics, and problem solving. The bottom line is that all of us must play a role in actively addressing these issues. It’s just too complex!

But it’s on the IEP!

One of the most powerful tools to guide instruction and intervention for children with learning issues of any sort is the Individualized Education Plan (IEP). It’s the roadmap for how and what we focus on for a particular individual. As professionals, we take a class or have a lecture about the process in college but nothing really prepares us for the mountain of paperwork that will ensue for each child. Parents also feel the cognitive fog that comes around each year when his or her child’s future is under a microscope. It’s actually mind-numbing for everyone involved, but a pivotal and crucial cog in the process.

I’ve found that many IEPs start on a positive note while discussing goals and objectives related to teaching how to add double digit numbers but may take a dramatic shift when the discussion changes to getting the child to “make friends.” Who will be in charge of that and what will the goal and objectives look like? As I look back on all of my coursework, I see nothing that prepared me, as an SLP, to select other children to form friendships for those on my caseload. I also know from years in the schools that putting kids into “friendship” groups didn’t equal friends. And yet, I understand the need for us as professionals (and the wishes of parents) to connect their children to others – after all we are all human and making connections with others is what we do (and also helps to keep the species around).

So, I tried for years to make the ever important social goals make sense based on my behavioral training. If I could just teach the child a rule for when and where to use his social skill, then he would be able to call upon that skill when needed. I taught many, many children with ASD how to greet by saying “hello” and I even taught many to shake hands in conjunction with the greet. When the IEP rolled around, I was proud to report that the child was 80-90% accurate in saying “hello” to others. Success, right? I thought so until I realized that my students were not only greeting and greeting and greeting, but they were shaking hands with new peers on the playground, walking away from the group and then greeting again and again. I taught the rule…”when you see someone in your class, say hello” and “when you meet someone new, shake his hand.” Oops.

I actually think that every professional and parent should try writing an IEP for his or her own behavior change. Write no more that two goal areas and no more than three objectives per goal area which results in only six things you need to change. Only six – this is fewer than what we typically ask of our students. Your brain will fight you and your habits will get in the way but you’ll have a better understanding of what we ask our children to do every year for about 12 years while in school. Several years ago I tried this and found that I performed at a 20-30% rate which falls in the UNMET category which means I will have the same objective for the next IEP - and the next -and the next.

With the realization that my skill-based approach seemed to be missing some depth, I went in search of something that would help me tackle the complex social issues of these children. I stumbled across the work of Michelle Garcia Winner and Social Thinking®. I remember my relief in finding a novel way to teach social skills. It wasn’t a cookbook of what to do, but instead helped me start to understand that I needed to shift away from simply teaching a social skill and instead begin to teach the thinking that underlies doing the social skill. For my high level kids with ASD, ADHD, and many others this provided the logic for why we do what we do socially. My IEPs began to change to reflect teaching WHY we use the social skills we do at the time and in the place that we use them. This made some sense to me. I like to know why I’m being asked to do something too.

What do you mean by Social Thinking?

Michelle Garcia Winner coined the term “Social Thinking” after spending several years with students who were considered to function “higher” on the autism spectrum; those with average to way above average language skills, but demonstrated significant social issues. Her clinical observations and knowledge of the research related to those with ASD (as well as others with social challenges) led her to develop the ILAUGH Model of Social Thinking (Winner, 2000). This model was (and is) a way to help professionals and parents more efficiently understand the core challenges associated with those with social issues. The ILAUGH model also helps link the relationship between social interaction, problem solving and the ability to interpret and respond to aspects of the academic curricula to create more efficient treatment programs while also respecting the complexity involved with teaching social learning to persons not intuitively born to these skills. (There are a number of books and articles related to this model which can be explored on the Social Thinking website, www.socialthinking.com ).

A very quick summary of the ILAUGH acronym is listed below:

I = Initiation of Language Initiation of communication and language is the ability to use one’s skills to seek assistance or information. A student’s ability to talk about his own interests can be in sharp contrast to how he communicates when he needs assistance. Many of our students do not ask for help or clarification. While a student may talk frequently in class about his own knowledge and ideas, he may not be proficient at using his sizable language skills to communicate effectively with others when he doesn’t know what to do next.

L= Listening with Eyes and Brain Most persons with social learning challenges have difficulty with auditory comprehension. However, listening requires more than just taking in the auditory information. It also requires the integration of information the student sees and hears to understand the deeper concept, or to make an educated guess about what is being said when the message cannot easily be literally interpreted. This can also be referred to as “active listening” or “whole body listening.” All teachers and parents realize that seeing leads to knowing; when they ask their students to listen they expect them to look. Through the Social Thinking approach we teach students to more actively “think with their eyes” in order to help them logically deduce the meaning of verbal and non-verbal cues.

A = Abstract and Inferential Language/Communication Communicative comprehension depends on one’s ability to recognize that most language or communication is not intended for literal interpretation. For example, a speaker might say “that was hot” but the listener can only interpret what this means by observing the speaker’s intentions within a context, which includes analyzing who the speaker is, who they are addressing and the context in which the message was spoken. The phrase would be interpreted differently if the speaker sees someone touching a metal chair sitting out in the sun verses the speaker observing a very interesting phenomenon.

U = Understanding Perspective As students evolve through the elementary and middle school years, great advances are made in the neurotypical child’s ability to interpret other people’s perspective at a level of increasing nuance and sophistication. Perspective taking is not black and white, and it continues to strengthen across our lifetimes. Those with a strong understanding and response to other people’s thoughts and minds across different contexts are those we celebrate as mature in our younger years and “wise” in our older years.

G = Gestalt Processing/Getting the Big Picture Information is conveyed through concepts, not just facts. For example, when having a conversation participants intuitively determine the underlying concept being discussed. When reading a book, the reader has to follow the overall meaning (concept) rather than just collect a series of details. When writing the student has to crystallize his or her ideas for others to follow and understand. Organizational skills for doing homework, written expression, cleaning our homes and work environments require us to “see the big picture” and assess what needs to be done before plugging in the details that will help us develop a systematized process to accomplish our goals.

H= Humor and Human Relatedness Many individuals with social challenges have a good sense of humor, but feel anxious since they miss the subtle cues which would help them understand how to participate more successfully with others in a social context. At the same time, many use humor inappropriately and candid lessons about when humor is funny versus inappropriate are often mandated by middle to later childhood. Emotional processing is also at the heart of human relatedness. Students with social learning challenges are developmentally weak at flexibly relating across a variety of people. While the majority of higher functioning persons on the autism spectrum have social motivation to establish and maintain relationships, their social mis-steps can serve as large barriers toward success. Social challenges directly impact our emotional processing which is central to our mental health.

Wow. Once I had a chance to digest this information I realized that social learning is REALLY complicated. No wonder people struggle to teach it and others struggle to learn it. I have to say that once I found this information it truly changed the way I thought about where my students might be having issues. I needed to shift gears and develop lessons around these areas of difficulty by using my students’ biggest area of strength - language. This is where the Social Thinking Vocabulary© came into play.

Break it down, break it down, break it down!

Many of our students are considered “bright” and even gifted when it comes to learning factual information, but struggle with the most basic social skills. Because our students often have strong cognitive skills, we tend to think that social learning should be as easy as other subjects. In fact, I’ve heard many say, “he’s so smart…why won’t he just do it?” Well, the fact remains that social learning is very difficult and must be broken down into smaller parts – much simpler than we might expect on most occasions. Social Thinking uses a core set of terms (Social Thinking Vocabulary©) that are friendly to both parents and professionals and provide a common language across home and school. There are many, many terms but for the purposes of this article, I’ve included a very general look at four.

Expected and Unexpected: We stray away from the terms “appropriate” and “inappropriate” because things really aren’t that black and white. After all, yelling the name of another to get attention is probably unexpected in the library or classroom, but perfectly expected on the playground. So, instead we say that social behaviors are either expected or unexpected based on the context/situation and teach that these behaviors are linked to others’ thoughts and emotions.

Think with your eyes, ears and brain: We use our eyes to figure out what non-verbal messages others are sending as well as what they might be thinking about. Teaching this concept provides more information than just telling the student to “use good eye-contact” or “look at me.”

Whole body Listening: The idea is the whole body (eyes, ears, mouth, hands, feet, bottom and brain) needs to be focused on others in order to listen and to show you are listening.

People Files: People files are the way we organize information about people in our brains. When we meet someone we are supposed to remember some things about him/her so we can remember what that person may want to talk about the next time we meet. However, not all files are “friendly.” Sometimes we have to remember when someone is not safe to be around! Opening the files simply means that once you store the information you have to call it up when you see the person.

Now what? Where do I start?

This article isn’t meant to say that we can’t change our ways but instead encourage all of us to think differently about behavior change. Not to simplify this process – because it’s truly a huge task. I’ve included five key ideas for each parent/professional/advocate/individual to consider when talking about helping our children increase, decrease, improve, eliminate, or just plain change something related to social learning.

1. Be thoughtful about how hard social learning is for many of our kids. It’s not like learning a math fact or memorizing a spelling word. For many, it means changing a behavior that may be very ingrained and that means it will take time. Sometimes it takes a very, very long time and doesn’t always align with a school year.

2. Educate yourself about the new “CORE” academic standards to be a part of all 50 states and that will guide the direction of many of our IEPs in the upcoming years. These core standards are meant to provide some unity across states and are deeply, deeply connected to social learning. Things like working in groups, analyzing others’ perspectives, talking about topics on grade level are among the many that will be expected during the school day. The academic day is based in social learning and Social Thinking!

3. As a team, take the time to thoughtfully consider the actual number of “things” we are asking this child to learn or change over the next year and truly consider whether or not it is reasonable. You may want to also consider the use of rubrics (rather than percentages) to measure progress over the course of the quarter or semester. In other words, it’s very hard to measure whether or not a student asked for help 80% of the time (what does that mean anyway?) but it might be more accurate to use a 4-point rubric like the one listed below:

1 = student waits for a teacher or peer to approach and ask if he needs help. Student does not initiate a request for help when it is clear that he/she does not understand the task.

2 = student asks for help in highly motivating situations which may or may not be academic (e.g., may ask how to navigate through a computer game or help in selecting book).

3= student initiates a request for help on non-motivating or motivating activities through the use of a “strategy card” or other visual tool occasionally throughout the day.

4=student consistently initiates a request for help, clarification, or further information from peers or adults.

In this way, a parent and professional can have a clear picture of where the child is starting (beginning of year =level 1) and where he or she is during the next IEP update (level 2). The goal isn’t always to get to the highest point on the rubric in one year – it depends on the child. Remember…changing a behavior is hard. Some kids just need a strategy to improve while others may work for an entire year on shifting up one number on the rubric.

4. TALK! Professionals – we need to talk about how to make our goals and objectives realistic given the fact that our more verbal kids with social learning issues need to learn how to “think” about “why” they should do something that may not be intuitive. Parents, we need to talk about making goals/objectives realistic given the exact same reasoning above.

5. Most importantly, we all need to work on helping our kids learn this really challenging information across the home, school and community day in a humane and positive way without pointing and blaming one another. Wait….maybe we should put this on our own behavior change plans.

References
All information cited from Winner along with other core concepts and blogs/free articles about social learning and Social Thinking can be found at www.socialthinking.com

McGonigal, K. (2012). http://kellymcgonigal.com/willpowerinstinct/

Duhigg, C. (2012). http://charlesduhigg.com/

Dunn Buron, K. & Curtis, M. (2004). The Incredible 5-Point Scale. www.asperger.net

Gray, C. Social Stories: Multiple Publications on the topic. www.thegraycenter.org

BIO
Dr. Pamela Crooke is a speech-language pathologist and senior therapist at the Social Thinking Center in San Jose, CA. She has an active caseload of children, teens and adults with social learning challenges. The co-author of four books related to Social Thinking, Dr. Crooke consults/trains school programs locally and around the US, and presents on Social Thinking topics as part of the Social Thinking Training and Speakers Collaborative. She has served on the clinical faculty of three universities, worked as a school SLP for 15 years, and published a study on the effectiveness of using Social Thinking vocabulary in the schools. Learn more about her at www.SocialThinking.com.

Courtesy of Socialthinking.com