Overview of Social Skills Interventions for Autism in Occupational Therapy

Introduction

Social skills interventions are designed to address barriers in social skills for clients with autism spectrum disorder (ASD). These social skills interventions can be facilitated by the occupational therapist or educator and may involve training peers to interact with those who have ASD to improve their social skills. Furthermore, social skills training may be individual or group based. In terms of environment, it an take place within a school, at home, or anywhere really where the client can benefit from, such as social situations in public.

Those with ASD may experience social trauma and PTSD as a result of their difficulties in understanding and interpreting social cues, body language, and emotions. This can lead to negative experiences such as bullying, isolation, and rejection.

Some examples of social traumas that individuals with ASD may experience include:

  • Being bullied or bullied by peers in school or in community settings
  • Being rejected or excluded by peers
  • Being misunderstood or misinterpreted by others
  • Being the target of harassment or discrimination
  • Having difficulty making and maintaining friendships
  • Being misunderstood or misdiagnosed by healthcare professionals.
  • Being more vulnerable to being taken advantage of (personally, physically, psychologically, sexually((Brown-Lavoie, S.M., Viecilli, M.A., Weiss, J.A.: Sexual knowledge and victimization in adults with autism spectrum disorder. J. Autism Dev. Disord. 44, 2185–2196 (2014). doi:10.1007/s10803-014-
    2093-y)), financially, socially, etc.)

Brown-Lavoie et. al found that adults with ASD are 3 times more likely to experience unwanted sexual contact, 2.7 times more sexual coercion, and 2.4 times more likely to experience rape compared to the control group.((Brown-Lavoie, S.M., Viecilli, M.A., Weiss, J.A.: Sexual knowledge and victimization in adults with autism spectrum disorder. J. Autism Dev. Disord. 44, 2185–2196 (2014). doi:10.1007/s10803-014-
2093-y))

Individuals with autism spectrum disorder (ASD) may have difficulty processing and expressing their emotions, so they may not always be able to communicate or express that they have been traumatized or abused. It’s important to be mindful and sensitive of this, and to provide appropriate support and resources to help them cope with any negative experiences they may have had.

There is a growing body of evidence to support social skills interactions for occupational therapy, such as for youth with ASD. Social skills training includes many types and more are emerging with evidence. Notable interventions that have been used include:

  • Peer mentoring(( Laushey K, Heflin L. Enhancing social skills of kindergarten children with autism
    through the training of multiple peers as tutors. J Autism Dev Disord 2000;30:
    183–93.))((Tichenor, K. (2016). The Effects of Peer Mentoring on Students with Autism Spectrum Disorder. Inquiry:
    The University of Arkansas Undergraduate Research Journal, 20(1). Retrieved from
    https://scholarworks.uark.edu/inquiry/vol20/iss1/8 ))
  • Social skills groups
  • Video modeling
  • Social stories
  • Picture books

Peer Mentoring

Peer mentoring is a form of therapy that involves pairing individuals with autism with typically developing peers for social and emotional support. This can be done in a one-on-one or group setting and is often used as an adjunct to other therapies such as occupational and speech therapy. Peer mentoring can provide individuals with autism the opportunity to practice and improve their social skills in a natural and less formal setting. These mentors can serve as positive role models for individuals with autism, helping them to learn how to navigate social interactions and build relationships. Peer mentoring can provide individuals with autism with increased social opportunities and exposure to typically developing peers, which can be beneficial for their social and emotional development.

Another benefit is that these mentors can help individuals with autism develop self-esteem and confidence by providing them with positive social experiences and the opportunity to be successful in social interactions. And it works both ways. The reciprocal benefit of peer mentoring is that it mentors can learn from those with autism as well. In other words, can also help the peers themselves to be more understanding, empathetic and accepting of people with autism, which can contribute to a more inclusive society.

Tichenor and Whitby (2016) studied the effects of peer mentoring on students with autism. Target students and peer mentors were matched based on skill level, age, and preferences; the students participated in a variety of activities throughout a week-long day camp. Peer mentors were taught how to interact with students, and behavior technicians were trained to facilitate these interactions. Findings indicate that peer mentor characteristics and the characteristics of the target student
contribute to the success of a peer mentoring intervention.((Tichenor, K. (2016). The Effects of Peer Mentoring on Students with Autism Spectrum Disorder. Inquiry:
The University of Arkansas Undergraduate Research Journal, 20(1). Retrieved from
https://scholarworks.uark.edu/inquiry/vol20/iss1/8))

Social Skills Groups

In a traditional social skills group, approximately 4 or 5 children with ASD participate in social skills lessons taught by a teacher or therapist. These groups usually meet at the child’s school along with other classmates, or in an outpatient clinic setting with other youth with ASD from the broader community. Session topics might include greeting others, being friendly, joining or initiating play with others, reading nonverbal cues, and starting and maintaining conversations.((Bohlander, A. J., Orlich, F., & Varley, C. K. (2012). Social skills training for children with autism. Pediatric clinics, 59(1), 165-174.))

Some examples of topics for social skills groups include:

  • Getting to know someone
  • Body talk (nonverbals)
  • Dealing with emotions
  • Conversation
  • Making impressions
  • Teasing vs humor
  • Friendship tips((Toth K, Orlich F. Social skills interventions in children and teens with HFA, in Intervention Manual. Seattle (WA): Seattle Children’s Research Foundation; 2009.))
  • Meeting new people/asking questions
  • Using body talk
  • Using body signals to express and understand emotions
  • Being positive
  • Keeping the conversation going/active listening
  • Teen obstacles
  • Sharing opinions

Video Modeling

With video modeling, children with ASD watch videos showing themselves or peers demonstrating specific social skills, and then practice the skills. Research has widely supported video modeling as an effective intervention for children and adolescents with ASD to learn many types of skills, including social skills.((Reichow B, Volkmar F. Social skills interventions for individuals with autism: evaluation for evidence-based practices within a best evidence synthesis framework. J Autism Dev Disord 2010;40:149–66.))(( Bellini S, Akullian J. A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Coun Exc Child 2007;73:264–87.))

Stories of people who have grown up who are on the spectrum include the use of video modeling with multimedia that has been accessible. Two most popular forms include TV shows and movies. Those on the spectrum learn how people interact with the conversation, non-verbal communication, behaviors, or narration of thoughts in their head. So although this is not official evidence, it video modeling has been around and been used outside of research and official therapy.

One study examined the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders. Both peer-mediated and video-modeling (mean = 1.22, 95% CL = 0.65–1.78, N = 5) of social skills were shown to improve the social performance of children with ASD.((Wang, S. Y., Cui, Y., & Parrila, R. (2011). Examining the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders: A meta-analysis in single-case research using HLM. Research in Autism Spectrum Disorders, 5(1), 562-569.))

Social Stories and Picture Books

Social stories are brief, individualized stories written to teach a social skill or behavior, or about a concept or event. The stories are written in simple language and often include illustrations to help the individual understand the situation. Social stories can be used to teach a wide range of skills, including communication, social interactions, self-care, and daily living tasks. They can also be used to help individuals with ASD understand and cope with changes in routines or new situations. Social stories can be helpful for individuals of all ages and can be adapted for use in different settings such as in-person, teletherapy and online.

Example: The Social Skills Picture Book: Teaching Communication, Play and Emotion buses comics to teach children how to perform social skills, along with thought bubbles explaining how the children perform the
skill, and why.

Conclusion

With social skills training, occupational therapists can help to use a variety of techniques to help a client with autism. Occupational therapy can be used to teach a wide range of social skills, including communication, social interactions, self-care, and daily living tasks. It can be adapted for use in different naturalsettings of the client. Each client has their own strengths so no one technique is considered to be the best. In fact, a combination of techniques such as peer mentorship, video modeling, social stories, and groups may be more effective than isolation for improvements in socialization.

Above all, while socialization according to societal “norms” may often be the goal of parents, the needs of the client (often a child) should not be ignored. This is why some techniques such as ABA are more controversial than those used by an occupational therapist as they often are focused on changing the client and are less client-centered.