Autism: Play, Social Behavior, and Friendships

* Disclaimer:  The following is notes and reflections written during a county-wide series of autism workshops for educators.  I am not an expert on Autism Spectrum Disorder.  I am a general education teacher.  I hope the information is helpful.  I refer to copyrighted materials whenever it is mentioned.

Today we talk about play and social behavior.  Hurrah.  I've wanted this class all year.  The play behavior is a huge puzzle.  Social interactions are a core challenge for many kiddos on the autism spectrum.  It is part of the disability because the part of the brain that organizes social interactions is impacted by autism.  And yet in schools, we tend to focus on academics and behavior modification.  So we are seeing big deficits in older children and young adults as they grow without being taught core skills.

Again, if they got the idea through natural context, they would.  At the same time, we are not inclined to teach social interactions in a overt way.

Play for the youngest kids involved joint attention, imitation, and emotional responsiveness.  In social play, we start seeing solitary play.  Then in preschool we start to see orientation/onlooker play.  So I may watch you playing with blocks.  Then starts parallel play, where I play with blocks near you.  This moves to common focus, where we both play with blocks.  Then a common goal, oh, let's build a city together.  This moves to Peer Group Entry- can I play blocks with you?

The goal is not to change a person on the autism spectrum.  The goal is not to make them be more typical.  The goal is to give them the tools to access social opportunities if they want to.  The goal is to give them the skills for job interviews, a workplace, pursuing areas of interest, meeting and interacting with people in a positive way.

The challenges for kiddos (and adults, too, probably), are a lack of joint attention, inability to play with peers spontaneously, and a lack of social competence.  By having these challenges, it creates a cycle with kiddos around them to start excluding or neglecting that peer (probably without even a conscious decision).  We can think about how we react when someone approaches us that doesn't follow the natural flow of interaction.  We may step back or think of excuses, somewhere we suddenly need to go, in order to avoid or limit interaction with that person.

Play is the work of childhood.  It should be fun, spontaneous, voluntary, and involve active engagement.

For children with ASD (Autism Spectrum Disorder), their play is often self-stimulatory and repetitive.  These tasks may help with self regulation.  So the calming effect of taking apart and putting together can make the play rewarding for kiddos.  It's all about how to connect the natural inclinations to another person.

In a typically developing child, they move from sensory play to functional play to symbolic/pretend play by 2-3 years old.

For ASD kiddos, the play continuum is very different.  They often stay in the sensory play for a much longer time (never leave), the exploring, banging, tasting of toys.  Their play scripts are very different.  They may line up trains over and over without deviating from that script at all.  Their games may not involve novelty or generative thinking or planning.

Of course, everyone with ASD is different.  They may have strengths in areas of social interaction and play.  Again, these are generalized patterns that may or may not apply to someone on the spectrum.  The most important thing about loving or working with anyone with disability is to first learn about the world through their eyes, then how to help them live their best life.

Typical Play:

• Spontaneous progression on developmental continuum
• Sensory exploration
• Functional play from simple to complex
• Symbolic play progresses from simple to complex, transforming objects, self and others in made up roles and situations

ASD Play:

• Atypical progression on developmental continuum
• High rates of sensory motor exploration with limited variation
• Spontaneous functional play is uncommon
• Spontaneous symbolic play is uncommon

There are formal and informal assessment for social development.  Many times language assessments can be helpful, because so much about interaction  involves language.  Other assessments can be Developmental Inventories and Social Communication Questionnaires.

It is important to use multiple assessments, and use different people for assessments so you see a complete picture of a child's world.

Here's something I would like to do- Structured Observations, really watching specific behaviors and patterns.  Keeping records of observations.  These provide specific tasks like building puzzles, then noting behaviors during that task.

Natural observations are unstructured activities- free play, recess, etc.  It would be best to have multiple observers on multiple days.

Parent collaboration is a key ingredient for skill-building. It's important to have time with parents outside of IEP meetings.  Developing that relationship can make a huge difference for the student.

To develop an effective program for students, it is very helpful to have a Developmental Assessment, a Speech and Language Assessment, and an Autism Diagnostic Observation Scale.

For informal assessment, having observations, checklists, and interviews.

Using this information, you can develop a program that identifies areas of need, prioritizes needs and writes specific goals, determines strategies and methods for implementation, determines a level of needed support, and collects data to evaluate progress towards goals.

We can teach play-based behaviors with deliberate teaching strategies, teaching a specific skill that chains to other skills.  The key element is how to help the student generalize that skill into the world and how to take it everywhere.

My question is how stress ties into social interactions.  I know students who are brilliant problem-solvers in a quiet room with a few kids.  Yet you add the rest of the class, a teacher that is constantly being distracted so they cannot intervene or problem-solve effectively, and the learned behaviors spiral into melt down.  I suppose we need to build the skills so they sink beyond the mental-thinking-reactions into a intuitive, reflexive reaction.  But isn't that wanting to change the core challenge of the disability itself?  Hmm . . .  Maybe it will be addressed later, how stress impacts learning social behaviors.

For more Direct Trial Teaching programs and Pivotal Response programs, see the links at the end of the notes.

There are obviously a lot of different approaches to teach the same skills.  We can have directed teaching, which controls all aspects of the situation towards a specified goal or skill, to naturalized settings where we react to behaviors in context and teach the desired skills and goals.

For us, it may be more challenging to write play and leisure goals because we are not used to seeing play and leisure as directed lessons, or to be given equal weight to academic or behavior goals.  And yet (and I have said this forever in my teacher career) those social skills are huge for lifelong success in the world.

The foundation of friendships is play-skills, leading to social skills.  Our world is a social world.  So we need to learn how to get along.  "Trying to teach children teh obvious and unspoken rules of social relationships is a long-term project that will span all the years of their lives." -Temple Grandin

There in an entire unwritten curriculum happening in schools.  It's a hidden curriculum that most people learn through natural context.  There are so many rules in context and interaction that can be a huge challenge.  There is an app for the iphone/touch that helps parents teach this hidden curriculum:  click here for the link.  Looks like a cool way to discuss/teach the unstated lessons that happen at school. There is also a book and interactive DVD, even a daily calendar. Links are at the end along with a fun book to share perspectives on life with ASD.

The diagnostic criteria for autistic disorder: deficits in reciprocal social interaction:

• Trouble looking others in the eye
• Little use of gestures when speaking
• Few or unusual facial expression
• Trouble know how close to stand to others
• Unusual intonation or voice quality
• Deficits in using nonverbal behaviors to regulate social interactions

We have to be careful not to bring too many assumptions to people with ASD.  It can be easy to think that highly verbal, highly intelligent people are choosing not to have positive social interactions.  Not true.  Especially kids.

There is also failure to develop age-appropriate peer relationships:

• Few or no friends
• Relationships only with kids much older or younger or with family members
• Relationships primarily based on special interests
• Trouble interacting in groups and following cooperative rules of games

And little sharing of pleasure, achievements, or interests of others

• Enjoys favorite activities, television shows, toys alone, without trying to involve other people
• Does not try to call others' attention to activities, interests, or accomplishments
• Little interest in or reaction to praise

Lack of social or emotional reciprocity

• Does not respond to others: "appears deaf"
• Not aware of others: "Oblivious" to the existence
• Does not notice when others are hurt or upset; does not offer comfort

Phew, a lot happens in our incidental interactions.  What a lot of work for these kiddos to try and think their way through a thousand interactions a day.

ASD may show these interaction styles: Aloof (withdrawn or avoiding peers), Passive (indifferent, but may easily be led into social situations.  Rarely initiates but can be responsive), and Active-Odd (shows interest in interacting but attempts in odd or peculiar ways).

One thing that challenges ASD students is humor.  Understanding humor is a pretty tricky.  For kids, there can be challenges with discriminating mean teasing and friendly teasing.  They can also have a hard time know when to stop a joke.  Or when humor is appropriate.  Or what makes kids laugh.

It isn't being mentioned, but I've seen sarcasm being difficult, too.  Probably because it depends on inflection and facial expression to communicate an opposite meaning.  It expects a lot.

So many things need to be explicitly taught.  A little overwhelming.  A lot overwhelming, actually.

Social comics, games, and curriculum at socialthinking.com

A strategy with high-functioning kids is to create a graphical organizer with Expected/Unexpected responses and behaviors.

Part of me wonders how our society is changing expectations for these kids, for their role in society.  I think in past generations, people were odd.  They were eccentric. Did we give more room for eccentric behaviors?  Curious.  I wonder about history and ASD.  I think in the past that many people just dropped out of mainstream society.  I wonder what the future holds.  Is there a middle ground where we integrate our various perspectives on the world?

What does that look like?

Curious.

Anyway, back to notes.  Social scripts may be needed for all students, even students with a strong vocabulary.  They need the structure to learn positive behaviors.  We can use modeling and role play to help.  Video modeling can be very powerful because of the strengths in visual learning.

The main message of the day is not to take social skills for granted.  In many cases, they need to be explicitly taught and broken down into attainable steps.  As for success, what does that look like?

I suppose that returns to the student or the person with ASD.  There is no one journey through this life.  There are no true correct answers.  Just lots of questions :)

I hope to hear lots of different answers.  From all sorts of perspectives.