Social Interaction Groups For Children with Autism: Visual Strategies

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Social Interaction Groups For Children with Autism: Visual Strategies Elizabeth (Liz) Delsandro, M.S., CCC-SLP Clinical Assistant Professor in Speech-Language Pathology

1 Social Interaction Groups For Children with Autism: Visual Strategies Elizabeth (Liz) Delsandro, M.S., CCC-SLP Clinical Assistant Professor in Speech-Language Pathology Graduate Students and Clinicians in Speech-Language Pathology Teryn De Haan Shay Gallagher Sarah Mayefsky Amanda Miller ASHA Convention, Atlanta, Georgia Friday, November 16, 2012

2 Disclosure Statement Elizabeth Delsandro is Clinical Faculty at the University of Iowa, specifically at the Wendell Johnson Speech and Hearing Clinic in Iowa City. She has no relevant financial or nonfinancial relationships to disclose related to ASHA or this presentation. Teryn De Haan, Shay Gallagher, Sarah Mayefsky, and Amanda Miller are all 2 nd year Master s students in the Speech Language Pathology Program at the University of Iowa. They have no relevant financial or nonfinancial relationships to disclose related to ASHA or this presentation.

3 General Overview of the Program 9-session program in Spring 2012 Concentration on social understanding (social cognition) and social doing (social interaction) One, 60-minute session weekly (in the evening) Four, early elementary-age children with Autism Spectrum Disorders were enrolled in the program Four graduate student clinicians in the speechlanguage pathology program were assigned to work with the children (1:1) with supervision from one clinical supervisor Held at the Wendell Johnson Speech and Hearing Clinic (University of Iowa) Family-referred

4 Parent Involvement: To Help Promote Generalization Parents were welcomed to observe all program sessions. The clinical supervisor provided in-time explanations for parents regarding strategies and supports (e.g., while parents were observing the sessions). Some mini-lessons with follow-up were provided by the clinical supervisor (e.g., writing Social Stories ). Homework assignments were sent home with the children on a weekly basis (e.g., written explanation of a Friend File, an activity originated by Michelle Garcia Winner and how to make one; information about the Incredible 5-Point Scale originated by Kari Dunn Buron & Mitzi Curtis )

5 Identifying Need: A More Formal Measure The Autism Social Skills Profile (Bellini, 2006) may be used. Parents and others (e.g., teacher, para-educator) can complete the profile. It is a 49-item profile of which each social behavior is rated as never or almost never (N), sometimes or occasionally (S), often or typically (O), or very often or always (V) exhibited. Team members are encouraged to prioritize 3-4 skills to target.

6 Identifying Need: Informal Measures Parents were asked to prioritize and identify 3-4 social behaviors that they deemed most important for their child to gain. Student clinicians and the clinical supervisor observed the children interact in both structured and unstructured activities (e.g., play) to contribute to information for developing individual goals for the children in the program.

7 Sample Skills Targeted 1: The child will increase his ability to take turns in conversation 2: The child will increase his ability to initiate interactions with his peers 3: The child will increase his ability to pay attention as a listener

8 Progress Monitoring: Data Collection Date Theme: Activity Description Amount & Type of Prompting/ Support for Initiation Amount & Type of Prompting for Paying Attention to Peer(s) Number of conversation turns 2/15/12 Listening to friends Free play with blocks and animals 2/22/12 Having a conversation Talking about pictures with a peer 2/29/12 Teamwork Building block towers with a peer

9 Schedule of a Typical Session (TEACH, COACH, GENERALIZE,& REVIEW) Activity Focus 1. Jobs To assign jobs to children (the jobs were designed to promote social interaction). 2. Check-In To check in and communicate emotions through the Incredible 5-Point Scale. 3. Lesson To teach, model, and build understanding of a targeted skill. 4. Group or Partner Activity To practice the targeted skill with coaching from the graduate student clinicians. 5. Free Play To generalize skills. 6. Snack To provide another structured opportunity to promote interaction with peers. 7. Check-Out & Homework To review skill(s) with parents.

10 Supports and Strategies Used Common Areas of Need Organization Social Understanding Following Directions Participation and Attention Emotional Regulation Support or Strategy Schedules; First-Then Boards; Step-by-Step Instructions; Name Tags Social Stories (Carol Gray); Video Modeling (Tom Buggey); Social Skills Picture Books (Jed Baker); Social Thinking Vocabulary and Concepts (Michelle Garcia Winner) Lanyards with Cue Cards; Step-by-Step Instructions; Dry-Erase Boards Scripted Language or Social Scripts; Fidgets; Hands-On Materials Incredible 5-Point Scale (Kari Dunn Buron & Mitzi Curtis)

11 Technology and Applications Used in the Groups SMART Board TECHNOLOGY USE To display and teach the targeted lesson, and promote engagement and participation (Another option is using an LCD projector and laptop). SMART Notebook software Boardmaker software (Mayer-Johnson Company) To create customized SMART Board activities for the targeted lesson. To create multiple visual supports and to include graphics or symbols in social narratives, for example.

12 Technology and Applications Used in the Groups PowerPoint TECHNOLOGY USE To create electronic stories. Video camera To create videos and embed them in PowerPoint stories. Digital camera Time Timer To take still pictures (enhanced with thought bubbles and talking bubbles ) to promote perspective taking. To designate time for play or other activities. (

13 Planning and Structuring the Sessions with Consideration to Structured Teaching 4. Structure Tasks 3. Establish Routines 2. Put a Visual Schedule in Place 1. Structure the Physical Environment (Modified from work from TEACCH: Treatment and Education of Autistic and Communication Related Handicapped Children,

14 Planning and Structuring the Sessions with Consideration to Structured Teaching 4. Structure Tasks 3. Establish Routines 2. Put a Visual Schedule in Place 1. Structure the Physical Environment (Modified from work from TEACCH: Treatment and Education of Autistic and Communication Related Handicapped Children,

15 Structure the Physical Environment Multiple locations to promote change of scenery and movement which positively impacted the children s attention to task. Station-like approach to setting up activities or tasks. Designated areas for the check-in and check-out, lesson, yoga or warm-up, snack, break (e.g., bean bag), play, etc. Visual boundaries (e.g., assigned seats with nametags, tape on the floor, blanket on the floor, arrangement of furniture) to set expectations. The preferred behaviors for a specific activity were posted in activity locations to promote successful participation.

16 Planning and Structuring the Sessions with Consideration to Structured Teaching 4. Structure Tasks 3. Establish Routines 2. Put a Visual Schedule in Place 1. Structure the Physical Environment (Modified from work from TEACCH: Treatment and Education of Autistic and Communication Related Handicapped Children,

17 Put a Visual Schedule in Place Jobs Check-in Story Time-Lesson Play Snack Review Check-out

18 Details of the Schedule The schedule provided structure to assist the children in anticipating the flow of the session. Large visual schedule used for the whole group. Constructed with Boardmaker symbols. The schedule was interactive in that children (e.g., the Schedule Helper) took off schedule pictures upon completion of activities and announced upcoming activities to peers. A great tool to redirect children back to the task!

19 Planning and Structuring the Sessions with Consideration to Structured Teaching 4. Structure Tasks 3. Establish Routines 2. Put a Visual Schedule in Place 1. Structure the Physical Environment (Modified from work from TEACCH: Treatment and Education of Autistic and Communication Related Handicapped Children,

20 Establishing Routines and Structuring Tasks or Activities Job Routine * Check-In Routine * Lesson Routine * Play Routine Snack Routine Check-Out Routine * Details will be provided regarding these routines

21 Job Routine Each child was given a job, and each job was designed to promote interaction between the children. Folders providing visual step-by-step instructions to complete the jobs were reviewed with the children. Children referred to the job folders during their assigned job with assistance from clinicians as needed. Over time, most of the children became familiar with the job routines, thus no longer needing the support.

22 Examples of Different Jobs in the Session Clinician s Names Children s Names

23 Example of a Job Folder

24 Check-In & Check-Out Routine with The Incredible 3-Point Scale This was a way for the children to communicate their emotions. This is based on the work of Kari Dunn Buron and Mitzi Curtis.

25 Check-In & Check-Out 1. Each child and clinician had a clothespin with his or her name on it. 2. The Check-In/Check-Out Helper (a child) asked each person, (Friend s Name), how are you feeling? 3. Each child and clinician responded to the question and placed the clothespin (with his or her name) on the scale. 4. The clinician modeled and provided an explanation of why she was at a certain number. The children gradually started to include that information as well.

26 Using Scripted Language Within a Routine Designing activities to promote safe and predictable exchanges between the children.

27 Lesson Routine The lesson was typically comprised of two components, (1) a learning activity to promote social understanding and (2) practice activities to promote social doing. A variety of tools or strategies (e.g., social narratives, talking and thinking bubbles, video modeling, role-playing) were used during the learning activity.

28 A Strategy Used in Lessons: Social Narratives Social skills often need to be explicitly taught to children with ASD. Social narratives like Social Stories (Carol Gray) were used in sessions to build understanding of targeted social skills using a story format. The social narratives provided short, straightforward, and accurate descriptions of a social situation. The social narratives were a way of priming the children before having them practice the social skill within the session. Social narratives were also sent home for review.

29 Themes of Social Narratives: Based on Observation of Children s Needs Teamwork Theme Getting someone s attention Listening to friends Taking turns Specific concepts and vocabulary Description Working together and directly interacting with each other. Initiating interactions with others. Attending to others. Taking turns in conversation and in play. Teaching targeted vocabulary from Social Thinking (Michelle Garcia Winner)

30 How Social Narratives Were Integrated Into Our Sessions: Created the stories using PowerPoint Embedded graphics, photos and videos that were meaningful to the children Presented the stories on a SMART Board

31 Sample Page of a Social Narrative Topic: Having a Conversation

32 When Creating Social Narratives: Keep the language positive and appropriate for children s level. Helpful Hint #1

33 When Creating Social Narratives: Make the story interactive. Have fill-in-the blank areas or build in questions for children to answer to promote active participation. Helpful Hint #2

34 When Creating Social Narratives: Keep it short. Keep it simple. Helpful Hint #3

35 A Strategy Used in Lessons: Interactive Visual Charts This strategy was used to promote positive social behavior. Children were shown photos of the clinicians acting in a social situation in a preferred or non-preferred way on a poster or on the SMART Board. One column represented preferred behavior while the other column represented non-preferred behavior (Michelle Garcia Winner of Social Thinking has critical vocabulary related to this). Children took turns moving the photos to the column (e.g., on the SMART Board) that they thought it belonged to.

36 Interactive Visual Chart (Topic Maintenance) Talking about the same thing Talking about different things This work is influenced by Michelle Garcia Winner s Social Behavior Mapping (Social Thinking ) and Jed Baker s Social Skills Picture Books.

37 Strategies Used in Lessons: Live-Modeling and Role-Playing Clinicians acted out targeted social skills (livemodeling). While viewing the performance, the children provided feedback or voted regarding the behaviors they observed. Clinicians engaged in role-playing with the children to act out the positive social behavior. By initially pairing an adult with a child, the child was provided with a strong model.

38 A Strategy Used in Lessons: Video Modeling Video modeling or instruction was used to teach positive social behaviors and to supplement the information that was provided through social narratives. They were short video clips. The actors were the graduate student clinicians. The video clips kept the children engaged in learning. The children seemed to enjoy seeing the graduate student clinicians acting out the scenes. The children actively participated in voting to provide feedback regarding social behavior in the video clips.

39 Video Modeling: Listening to Friends

40 Video Modeling Listening to Friends

41 Video Modeling: Helpful Hints Keep language developmentally appropriate Keep clips short to maintain attention Keep video clips free of distracting elements to help children focus on relevant components of the social behavior Use actual clinicians in the videos Consider sending copies of video clips to families to view with their children

42 A Strategy Used in Lessons: Modeling Through Digital Photos Modeling through digital photos was used to promote positive social behavior. It consisted of photos of clinicians modeling both the preferred social behavior and non-preferred social behavior. Talking bubbles were included to demonstrate the spoken words of others in specific social situations. Thought bubbles were included to help build the children s understanding of others potential thinking in specific social situations. This work is influenced by Michelle Garcia Winner s Social Behavior Mapping (Social Thinking ) and Jed Baker s Social Skills Picture Books.

43 Modeling Through Digital Photos Teamwork

44 Modeling Through Digital Photos Teamwork

45 Modeling Through Digital Photos Teamwork

46 Modeling Through Digital Photos: Helpful Hints Keep photos simple. Use thought bubbles to narrate thoughts of the characters in the photos. Use talking bubbles to illustrate what the characters are saying in the scene. Use actual clinicians or familiar people in the photos. Eventually, include the children in the process (e.g., photographing the children engaging in the positive social behaviors).

47 SOCIAL DOING When planning the framework of our sessions, we knew we wanted to incorporate some sort of opportunity for structured practice (Social Doing) of the session s theme immediately following the lesson (Social Understanding). To make this practice more appealing and more relevant to the children s daily interactions, we tried to make these practice opportunities fun and interactive.

48 The Children Participating in a Lesson

49 Social Doing Activities: Theme: Listening to a Friend Activity: Simon Says This activity focused on showing others that you are listening and ready to participate, as well as how to get a conversational partner s attention so that they are ready to listen to you.

50 Social Doing Activities: Theme: Listening to a Friend Activity: Show & Tell The activity focused on how to show a conversational partner that you are ready to listen to them. In this activity, the children were encouraged to show others that they were listening while one child was sharing about their object. The children were encouraged to show the speaker that they were thinking and caring about what the speaker had to say. To practice showing that they were thinking and caring about what the speaker had to say, the children were encouraged to ask questions about their peer s object.

51 Social Doing Activities: Activity: Partner Puzzle Theme: Teamwork This activity focused on two pieces of teamwork: working together and doing the same thing. The children were paired up and given a small puzzle to complete, and were encouraged to work together to fix the puzzle.

52 Social Doing Activities: Activity: Tower Building Theme: Teamwork The activity continued the focus on two pieces of teamwork: working together and doing the same thing. In one activity, the children were paired up and provided large foam blocks, as well as a picture of a tower to replicate. They were prompted to use teamwork to build the tower together.

53 TEAMWORK

54 Social Doing Activities: Activity: Body Spelling Theme: Teamwork In another activity, the children were each assigned a letter to form with their body Once the children had practiced forming their letters with their bodies, they were directed to line up, spelling the word IOWA. Take home message for the children: Each person might only make 1 letter, but together, they can form a whole word.

55 Teamwork I O W A

56 A variety of take-home activities were sent home, like this script, to involve parents in the learning process and to promote generalization. Take-home Activities

57 What Worked? Keeping it simple. Considering and incorporating children s high interests. Establishing solid routines for the children. Keeping it visual, and not bombarding children with lots of extra words. Communicating clear expectations for the children. Priming children for upcoming activities and expectations.

58 Breaking down social interactions into discrete steps and teaching repeat modeling. Providing choices to children whenever possible. Using a variety of strategies for promoting social understanding and social doing. Embedding use of social vocabulary across activities (Social Thinking critical vocabulary from Michelle Garcia Winner) Integrating technology. Understanding and respecting the children s perspectives. Being flexible.

59 Finale! The Freeze Dance

60 Questions? Thank you!

61 References Baker, J. (2001). The social skills picture book: Teaching play, emotion, and communication to children with autism. Arlington, Tx: Future Horizons, Inc. Baker, J. (2003). Social skills training for children and adolescents with asperger syndrome and socialcommunication problems. Shawnee Mission, KS: Autism Asperger Publishing Company. Baker, J. (2006). The social skills picture book for high school and beyond. Arlington, Tx: Future Horizons, Inc. Bellini, Scott (2006). Building social relationships: A systematic approach to teaching social interaction skills to children and adolescents with autism spectrum disorders and other social difficulties. Shawnee Mission, KS: Autism Asperger Publishing Company.

62 Buggey, T. (2009). Seeing is believing: Video self-modeling for people with autism and other developmental disabilities. Bethesda, MD: Woodbine House Buron, K. & Curtis, M. (2003). The incredible 5-point scale: Assisting students with autism spectrum disorders in understanding social interactions and controlling their emotional responses. Shawnee Mission, KS: Autism Asperger Publishing Company. Gray, C. (1994). Comic strip conversations: Illustrated interactions that teach conversation skills to students with autism and related disorders. Gray, C. (1994). The new social story book: Illustrated edition. Arlington, TX: Future Horizons, Inc.

63 McClannahan, L.E. & Krantz, P.J. (2005). Teaching conversation to children with autism. Bethesda, MD: Woodbine House. Winner, M.G. (2005). Think social! A social thinking curriculum for school-age students. San Jose, CA: Think Social Publishing, Inc. Winner, M.G. (2007). Social behavior mapping: Connecting behavior, emotions, and consequences across the day. San Jose, CA: Think Social Publishing, Inc.

64 Helpful Resources: Grouped by Type VISUAL SUPPORTS Hodgdon, Linda (1995). Visual Strategies for Improving Communication: Practical Strategies for Home and School. QuirkRoberts Publishing. Hodgdon, Linda (1999). Solving Behavior Problems in Autism: Improving Communication with Visual Strategies. QuirkRoberts Publishing. SOCIAL NARRATIVES Gray, Carol (2010). The New Social Stories Book: 10 th Anniversary Edition. Future Horizons.

65 VIDEO MODELING Buggey, Tom (2009). Seeing Is Believing: Video Self-Modeling for People with Autism and Other Developmental Disabilities. Woodbine House. Model Me Kids: EXPECTED BEHAVIORS-UNEXPECTED BEHAVIORS Baker, Jed (2001). The Social Skills Picture Book: Teaching Play, Emotion, and Communication to Children with Autism. Future Horizons. Baker, Jed (2006). The Social Skills Picture Book: For High School and Beyond. Future Horizons. Garcia Winner, Michelle (2005). Think Social! A Social Thinking Curriculum for School-Age Students. Social Thinking.

66 COMMUNICATING AND REGULATING EMOTIONS Dunn Buron, Kari & Curtis, Mitzi (2003). The Incredible 5-Point Scale: Assistive Students with Autism Spectrum Disorders With Autism Spectrum Disorders in Understanding Social Interactions and Controlling Their Emotional Responses (2003). Autism Asperger Publishing Company. TEAM-BUILDING ACTIVITIES Jones, Alanna (1998). 104 Activities That Build: Self-Esteem, Teamwork, Communication, Anger Management, Self-Discovery, Coping Skills. Rec Room Publishing. Jones, Alanna (1999). Team-Building Activities for Every Group. Rec Room Publishing.

Rachel Stotts, M.S., CCC-SLP Assistant Professor/Clinical Supervisor

Rachel Stotts, M.S., CCC-SLP Assistant Professor/Clinical Supervisor A Puzzle~ This section will be a crash course on creating supports to increase success for individuals with ASD in the home, community