Transcript Slide 1
strengthening social comptence in children and youth with autistic spectrum disorders luke moynahan, Børge Strømgren & Mickey Keenan 2004
social competence
• persons demonstrate social competence when they – initiate and sustain reciprocal interpersonal relationships with members of their intimate and effective social networks – attain personal goals with high probability and contribute effectively to attaining collective goals – satisfy culturally determined explicit rules and implicit norms for conduct in accordance with established fundamental human rights, – result in positive evaluation by others.
markers
• social competence is a behavioural competence that cannot be fully understood independent of contextual demands • it can not be defined solely with respect to the capacity or behavioural dexteritey of the individual • from a teaching perspective it is useful to take account of both contextual and developmental … – social arenas • family, school, community, work • dyads, groups and larger systems – age – developmental transitions • skill complexity • subtlety of contextual stimuli
positive consequences
• research within developmental social psychology (Durkin, 1995) • social and clinical psychology (Seligman, ; Barlow & Durand, 1996) • reveals that children who demonstrate high levels of social competence … – improved physical health, higher school achievement, larger social networks and higher degree of perceived social support, higher probability of employment
costs of non-competence
• children who demonstrate low social competence reveal increased vulnerability to … – poor physical health – educational under achievement – family dysfunction including high levels of family stress factors, – social isolation and weak social networks, – increased risk of conduct disorders, aggressive and anti social behaviour – increased risk of susbtance abuse – underemployment and unemployment • (Andrews; Dodge; Farrington; Loeber; Patterson; Ogden; Svedhem)
autism
inability to initiate and maintain social behaviour according to context • autism is particularly devastating in its effects upon the family – parental cohesion, sibling relations • autism can have deleterious effects on family members participation in extrafamilial activities – school, leisure, work, friendships, community engagement
autism & sc
• autistic children will not acquire sufficient mere exposure to the contingencies of normal life.
• neither will they acquire reporoires comparable to their non-autistic peers through provision of standard education • they require specialized systematic educational services as early as possible • they may require flexible specialized habilitation services throughout their lives autism men must focus on the child’s family and Carr et al, 2000)
programmes for teaching social competence
young children-play
• a lack of varied spontaneous make believe play is a defining feature of autism. It si also one of the most reliable early signs ogf autism. (Boucher & Wolfberg, 2003) • cooperative play provides a rich source of tasks and challenges that can be used to strengthen social competence – fair play, turn taking, delay of gratification, rule governed play, choice taking, decision making, cooperation in teams, leadership.
play – norwegian studies • teaching children with autism to initiate and sustain cooperative play
(Jahr, Eldevik & Eikeseth, 2000; Jahr & Tryggestad, 2001?) • the methods chosen were – modelling and multiple exemplars – observation with and without verbal description – participation in cooperative play – initiation of play with novel partners without instruction or prompts
markers
• children had participated in Løvaas Early Intensive Behavioural Intervention • could engage in simple play by themselves. • could describe simple play responses • multiple exemplars – differing forms of play – increasing complexity • description of the behaviour of the models – in contrast to Meichenbaum (1977) modelling av self-instructions
results
junior school –senior school
schoolbased programmes
• Prepare Curriculum (Goldstein, 1988, 1999) – skillstreaming (ineterpersonal skills) – situational perception training – problem solving training – stress management training – anger control training – cooperation training – understanding and using groups – empathy training – moral reasoning training – recruiting pro-social support
PEACE CURRICULUM
• Cuuriculum developed by Sara Salmon and colleagues as ”extended ART” at peace4allkids, Center for Safe Schools and Communities • P – Parental empowerment • E – Empathy training • A – Aggression management • C – Character education • E – Essential social skills
Aggression Replacement Training
• developed with multi- problem, delinquent youth in youth correctional facilities in north eastern USA by Arnold Goldstein, Barry Glick & John Gibbs (1988; 1998) • based on social learning analysis of aggression (Bandura, 1973), stress innoculation training (Meicenbaum, Novaco & Feindler) and Moral Development paradigm (Kohlberg, 1968).
• Comprises three components … • skillstreaming • anger control training • moral reasoning training
skillstreaming
skillstreaming
basic training method
(group)
• 2 trainers demonstrate the chosen skill twice * • discussion of the relevance of the skill to students own lives, similar experiences etc are briefly discussed • role play – step by step replay of the modelled skill, trainers provide and rapidly fade specific prompts in order for the students to attain fluent use of the skill * • feedback – response specific feedback to the main actor is provided by the co-actor and the group. Video is used to highlight important details * • homework and transfer training tasks are planned
“transfer training"
• laminated skill cards highlight the major
steps and rules for use, trainers may use fotoflows* (self-modelling) as well as booster training in natural settings
• overlearning – the group design ensures
several repititions of the skill (multiple exemplar training) homework tasks also ensure further trials
• identical elements – roleplays are made as
lifelike as possible – shift of training to actual locations
“ transfer training"
• stimulus variation – invite other trainers,
students to session, train in several locations at different times, creative use of homework
• use of reinforcement contingencies –
students are trained in self-reinforcement *, contrived external reinforcement contingencies may be planned with parents other teachers etc, group contingencies and toekn economies may be established to ensure vicarious reinforcement
skillstreaming
• adjustments to skillstreaming – selection of skills based upon functional assessment by child, parents and teachers – simultaneous and delayed imitation training – microtraining – fluency training of microskill elements with rapid, response specific feedback – use of video in training of self-evaluation of performance (reflexive feedback) – commentator (simultaneous descriptor) and director (functional instruction) training
Anger control training
1. INTRODUCTION, ABC’s of anger tightening, clenched fists, pounding backwards counting, pleasant imagery
STEPS WEEK BY WEEK
5. SELF-EVALUATION; self-rewarding statements 7. ANGRY BEHAVIOR CYCLE; what do YOU do to make others angry 8. REHEARSAL OF FULL SEQUENCE; steps 1-7 + social skill 9. REHEARSAL OF FULL SEQUENCE; hassle log review 10. OVERALL REVIEW; full sequence
anger control training
• adjustments – fluency training in identification of anger signals, interne and externe triggers – extension of anger reducers – mindfulness procedures – regaining of self control – transformation of response functions – turning point and bubble talk techniques – magic remote control – response specific feedback group and reflexive variations with use of video
moral reasoning training
• dilemma discussion methods
dilemma discussion –method 1 • the goal is to create conflict (cognitive dissonance) – perturb students immature or dogmatic moral stance • group composition and dynamics are vital – trainers must ensure that the group comprises both stage 1 & 2 reasoners • rules must ensure active participation, respect for each others opinions and the right to disagree • discussion starts with the trainer who presents the dilemma, copies are given to each student • trainer asks for opinions from each member and leads discussion.
dilemma discussion –method 1
• trainers encourage differences of opinion • when level 1 reasoners are confronted by level 2 reasoners whom they like and respect the level 1 reasoners experience a dilemma that is uncomfortable (dissonance) • trainers adjourn discussion until the next meeting • level 1 reasoners often seek out level 2 reasoners and seek further clarification (why did you say that? why do you mean that? – between session change
dilemma discussion – method 2
• the goal is to help the group arrive at a more mature moral reasoning level • 1 – a written dilemma is provided to each member and is read out loud by the trainer or group members • 2 – trainers lead a summary of the dilemma (with use of flipover) • 3 – trainers then elicit opinions, suggestions and solutions form each member • 4 – trainers then conduct a polling of support for each suggestion etc
dilemma discussion – method 2
• 5 – group is divided into two smaller groups • 6 – each trainer helps her/his smaller group refine their arguments • 7 – a spokesperson is chosen to present the opinions and arguments of the smalle group • 8 – the larger group reconvenes – arguments from both smaller groups are written up on the flipover • 9 – the group debates the newer arguments • 10- debate continues until consensus is obtained or that members agree that they are satisfied with own presentation
moral reasoning training • adjustments
– presentation of dilemmas in role play format where trainees assume roles in continuation of role play – use of triple dance and four step method to encourage flexibility of social perspective and empathy – coorespondence training – verbal behaviour as guide for motoric performance
results – individual and family applications
500 450 400 350 300 250 200 150 100 50 0 1000 950 900 850 800 750 700 650 600 550 Etter ART Vold.
Frekvensregistreringer av målatferd. August.2002 - Juli.2003
Etter ART Etter ART Etter ART Trusler Uaksept. Sosial atferd Uhensiktsmessig sosial atferd
130 120 70 60 50 40 30 20 110 100 90 80 10 0 Slag slag m/ gjenstand Spark Dytting/skubbing Kasting av gjenstander Vold.
Frekvensregistrering av målatferder August 2003 - 2004
Truer m/ gjenstand Direkte verbal trussel Indirekte verbal trussel Skinnangrep Spytter på nær.p
Spytter på fremmede Smeller i dører Banning Høylytt nekting Knuser/ødelegger gjennstander Brøler/roper Overdreven klemming Ikke ønsket berøring oppsøker nabo ubedt Tar kontakt med fremmede Trusler Uaksept. Sosial atferd Uhensiktsmessig sosial atferd
Bergsmarksetra Movie 1
Bergsmarksetra Movie 1
Reg. Positivt samspill, 15 min. intervall. 22.11.02 - 31.05.03
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Positivt samspill med 30 min. intervall 01.06.2003 til 30.09.2003
100 % 90 % 80 % 70 % hjemme hos Mor&Far ferie med personal Reg.ark
Mistet?
Sommerferie med Mor og Far 60 % 50 % 40 % reg. helg Mor&Far Reg.P
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Poly. (Reg.H) Poly. (Reg.P) 30 % 20 % 10 % 0 % 01 .0
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Positivt samspill med 30 min. intervall. 01.10.2003 - 28.02.2004
100 %
A B1
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B2 Distribution Behaviors 200 and 2001 B3 B4
40 % 20 %
Kim
0 % U ke 1 0 U ke 1 2 U ke 1 4 U ke 1 6 U ke 1 8 U ke 2 0 U ke 2 2 U ke 2 4 U ke 2 6 U ke 3 1 U ke 3 3 U ke 3 9 U ke 4 1 U ke 4 3 U ke 4 5 U ke 4 7 U ke 4 9 U ke 5 1 U ke 1 U ke 3 U ke 5 U ke 7 U ke 9 U ke 1 1 U ke 1 3 U ke 1 5 U ke 1 7 U ke 1 9 U ke 2 1 U ke 2 3
Successive Weeks
Red Yellow Green
classroom and whole school applications
projects
• Larvik Municipality and Røyken Rural • establishment of community wide ART PEACE • initiated by single referrals of ASD pupils • joint experimental cooperation – all participants are researchers – analyste are temprorary members of the change network ASD will also work and be valued by normal
three phases
• interventive assessment and collective analysis – data that means something – dat that functions as MOm for headmasters, teachers , parents and pupils • strengthening competence and connecting – proactive and preventative – connecting to new actors, activities and arenas • consolidation
• Larvik - over 500 pupils have participated in ART
– 180 teachers, child welfare workers, nurses and youth psychiatric professionals have been trained as ART practitioners to ICART standards
• family ART- Berg Junior School pilot project begins may 2004
• Røyken – all schools in the community will partcipate – public council commitment by local politicians to reduce and prevent anti – social and aggressive behaviour in schools – parent and family mobilization – joint experimental cooperation • all interventions are data based • all participants are committed to collection and analysis of data – celeration charts, quality of school life surveys, frequency registration of positive interactions in classroom, corridors, schoolyard + to and from school
summary
skillstreaming-
• selection of skills according to functional value – test battery, existing competence behavioural observation, increased reinforcement, reduced punishment, aversive stimulation • fluency training methods, microtrainig • behaviour specific feedback • Arne Scheie (commentator) – Steven Spielberg (director)
anger control training • expansion of anger reducers
– regaining self-control – mindfulness skills
• transformation of response functions • fluency procedures
– anger signals, bubble talk
• turning point • graded exposure (GEARS)
moral reasoning training
• presentation of dilemmas in role play format • use of triple dance, 4 step, • correspondence training – say - do