Social Skills Training for Students with Autism: A Review of Literature

By Shari Coplin

Some students with autism spectrum disorder (ASD) may be characterized as displaying behavioral challenges and have difficulties with communication and social skills in the inclusion classroom setting (Majoko, 2016). These students struggle when faced with new routines, new individuals and social events, peer to peer interactions and daily activities that their non-disabled peers complete with ease (Fitzpatrick, Srivorakiat, Wink, Pedapati, & Erickson, 2016). ASD is a neurological development disorder that affects an individual’s ability to effectively communicate and socialize with peers (Jagan, & Sathiyaseelan, 2016). However, studies and research have shown that individuals diagnosed and treated at an early age have greater success with communication skills later in life (Jagan, & Sathiyaseelan, 2016). Early intervention includes exposing students to social situations, body language, verbal and non-verbal language, at home, in school, throughout the community and in the clinical settings. These are areas many individuals with autism struggle with on a daily basis (Jagan & Sathiyaseelan, 2016). Studies in autism have shown males are more likely to be diagnosed with autism than females. Males with autism have the same developmental sensors in their brains as females with autism, however the receptive parts of the male brain that reacts to decision making, differs from males to females (Hall et al., 2012). This issue of NASET’s Autism Spectrum Disorder series was written by Ms. Shari Coplin and will cover the topic of social skills training for students with autism.

Introduction

Some students with autism spectrum disorder (ASD) may be characterized as displaying behavioral challenges and have difficulties with communication and social skills in the inclusion classroom setting (Majoko, 2016). These students struggle when faced with new routines, new individuals and social events, peer to peer interactions and daily activities that their non-disabled peers complete with ease (Fitzpatrick, Srivorakiat, Wink, Pedapati, & Erickson, 2016). ASD is a neurological development disorder that affects an individual’s ability to effectively communicate and socialize with peers (Jagan, & Sathiyaseelan, 2016). However, studies and research have shown that individuals diagnosed and treated at an early age have greater success with communication skills later in life (Jagan, & Sathiyaseelan, 2016). Early intervention includes exposing students to social situations, body language, verbal and non-verbal language, at home, in school, throughout the community and in the clinical settings. These are areas many individuals with autism struggle with on a daily basis (Jagan & Sathiyaseelan, 2016). Studies in autism have shown males are more likely to be diagnosed with autism than females. Males with autism have the same developmental sensors in their brains as females with autism, however the receptive parts of the male brain that reacts to decision making, differs from males to females (Hall et al., 2012)

Struggles with Inclusive Practices

More schools are opting for inclusive education for students with special needs to ensure they are meeting the social and emotional needs of the child (Dagli & Oznacar, 2015). To accomplish this successfully, schools are including special needs students in general education classes with non-disabled peers during both social and academic times throughout the school day (Dagli & Oznacar, 2015). In a study conducted by Majoko, (2016) qualitative methodology was utilized to interview 21 general education teachers regarding inclusive practices for students with ASD in their classes between the ages of six and twelve. During the study, in-depth interviews of the selected teachers, including nine males and twelve females with at least three years of primary teaching experience, regarding the barriers faced while teaching students with ASD in the inclusion setting.  The interviews took place over the course of 10 months comparing and contrasting students with ASD to their non-disabled peers, the difficulties students with ASD face in the classroom and the type of support children with ASD may need in the inclusion classroom. The findings revealed students with ASD face social rejection, communication impairments and behavior challenges when interacting with peers in the inclusion classroom. These barriers affect the education of the special education students as well as the general education students in the inclusion classroom. Participants concluded support for students with ASD was necessary in the inclusion classroom as well as professional development in the areas of ASD, communication and behavior modification, are necessary to successfully assist students with ASD in the inclusive setting.

Sainato, Morrison, Jung, Axe and Nixon, (2015) conducted research, using empirical research and data collection, on kindergarten students with autism in the inclusive setting. The team compared model classrooms in a non-public, non-private, school geared towards inclusion practices specifically for students with ASD, to a public school setting where kindergarten students with ASD participated in inclusion classrooms. During this study 41 students identified with ASD or pervasive developmental disorder- not otherwise specified (PDD-NOS), by the age of five, participated in a general education classroom for 28 hours per week over a period of four school years (Sainato, et al., 2015). During the study classrooms were identified as model, the classrooms in the school geared towards ASD inclusion, and comparison, the classrooms in the public school setting. Researchers studied a new set of students each year in the two separate locations, in a total of seven different classrooms over the four years. The identified model classroom had an equal or lesser number of typically developing students to students with ASD, while the comparison classroom in the public school was not controlled by the researchers as students were placed by school district guidelines and personnel. Researchers trained the general education teachers for the model classroom before and during the study on how to implement a comprehensive intervention for the students in their class with ASD. The students attended kindergarten from 9am to 3pm, Monday through Thursday and 9am to 1pm on Fridays, for the duration of the study. Each student in the study was given a comprehensive clinical assessment by psychologists before and after the study. The assessments given, showed the students had relatively the same baseline skills both socially and academically before entering kindergarten. Once the study concluded and students were reassessed, the students that participated in the model classroom consistently tested higher than students in the comparison classroom, specifically looking at areas of academics and adaptive behavior (Sainato, 2015). The study concluded inclusion practices, when implemented appropriately, can indeed be successful for students with ASD.  

Many frustrations faced by regular education teachers of students with autism are the struggles to modify the student’s behavior in a positive manner, without disrupting class instruction and without isolating the student from non-disabled peers. For students with autism who display behavior difficulties, creating goals that target the specific behavior is essential to successful behavior modification (Ruble, 2001). For example, providing a student within the classroom visuals of acceptable classroom behavior, a schedule and a visual reminder of the behavior goal they are working towards, the students are more susceptible to acknowledging the modification necessary to correct the targeted behavior. The teacher should also frequently verbally remind the student of classroom and behavioral expectations, while maintaining consistent documentation on the student’s progress towards his behavior goals (Ruble, 2001).

To measure the targeted student behavior and interactions, teachers utilize a number of different tools in the classroom. Studies have shown the quality of peer interactions is best measured through looking at the interactions students share in and outside of the classroom. How students interact during unstructured times and outside of the school venue, says more about the quality between those students (Jones, Pickles & Lord, 2017). During this study, researchers utilized the Penn Interactive Peer Play Scale (PIPPS) method to measure the quality of peer interactions of 107 students. These students were studied, through observations and self-report for five years. At the ages of nine and 13 teachers administered the PIPPS in the school setting, while clinicians and care-givers administered diagnostic and cognitive assessments and the Autism Diagnostic Interview-Revised (ADI-R), respectively, at the age of nine. Throughout the study, teachers, parents and care-givers observed, interviewed, modeled behavior and provided opportunities to display appropriate social skills in the home and school settings. The study concluded, by assessment reports from both teacher and care-givers, that students with more access to “typically developing peers” displayed more socially appropriate interactions with peers. Whereas students who spent more time in special education classes, that were also more severe on the autism spectrum and less verbal, displayed fewer social interaction capabilities, although they were exposed to the same behavior modeling and assessments as their peers (Jones, et al., 2017).

Comorbid Disabilities and HFASD

Along with verbal communication comes non-verbal communication and body language. Individuals with autism do not typically understand non-verbal cues, facial expressions, voice intonation and sarcasm. Teaching these students through role play and skills based social skills will also positively influence the modification of the targeted behavior. However, when the child has a co-occurring disability of emotional disturbance or intellectual disability, the approach must be significantly different. In a study conducted by Zimmerman et al., (2007) researchers studied the prevalence of children with ASD, emotional disturbance (ED) and intellectual disabilities (ID), to understand the impact of these disorders on communication of children with ASD. To do so, the team observed 1,667 eight year old students born between January 1, 1994 and December 31, 1994 in three counties within a Utah suburb. The children selected had a diagnosis of ASD as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth text revision (DSM-IV TR, 2002), and one other co-occurring disability, either ED, ID or communication disorder (CD), as classified by the special education standards of their school district. Both male and female students were observed in the school setting during the study and all of the children were given psychometric testing by school clinicians. The results of the study found there was a higher prevalence of males with ASD than females with a ratio of 1:8. Among that ratio four percent of the males also had a co-occurring communication and ID disorder (Zimmerman, et al., 2007).

In a study conducted among adults with ASD and comorbid disorders, researchers found there is a higher incidence of negative behaviors in the adults with comorbid disorders than those with ASD alone (Matson, Fodstad & Rivet, 2009). In this study Matson et al., (2009) studied the relationship between social skills and adults with ASD and ID. The research took place in a residential facility with 257 adults with a diagnosis of ASD alone or ASD and ID, with a range of severities. Researchers utilized the DSM-IV-TR as their guide for diagnoses and clinical and medical information on each participant to ensure their ability to participate in the study. Researchers trained direct care staff to administer the Matson evaluation of social skills for individuals with severe intellectual disabilities and the Autism Spectrum Disorder-Behavior problems for adults (ASD-BPA) screener. Each screener was presented in a one-on one interview style with each participant and a direct care giver they had been familiar with for at least six months. The Matson evaluation displayed the participants’ social skill strengths and weaknesses, while the ASD-BPA measured the participants’ severity of problem behaviors based on four empirically derived subscales: aggression/destruction, stereotypy, self-injurious behavior, and disruptive behavior (Matson et al., 2009). The research resulted in participants with ASD only, displaying a higher set of social skills, as well as more aggressive/destructive and disruptive behaviors, than the participants with diagnoses of ASD and ID. The researchers concluded, although the individuals with ASD and co-occurring disabilities had higher prevalence of problem behaviors, the behaviors of participants with ASD only, were more aggressive, disruptive and stereotyped, correlating with behaviors of higher functioning individuals with ASD who are more socially aware and susceptible to social skills (Matson et al., 2009).

Research has shown that individuals with autism respond to social interactions differently than non-disabled individuals; and differently based on their capabilities on the autism spectrum. For instance, a higher functioning student with autism is going to perceive social interactions differently that a student that is lower functioning on the spectrum. A higher functioning student may be able to verbalize what they do not understand, how it makes them feel and if they have seen the non-verbal interactions before; while a lower functioning student may not acknowledge the non-verbal cue at all (Scheeren, Koot, & Begeer, 2012). Scheeren et al., (2012) studied the qualitative differences between 156 children between the ages of six and 19 with high functioning autism spectrum disorder (HFASD). The Wing Subgroups Questionnaire was utilized to determine their interaction style, taking into consideration the students’ severity of autism and comorbid behavior disorders, psychosocial health and executive functioning skills. The study found the higher functioning the student was on the autism spectrum the more appropriate and unprompted their social interactions; while students with comorbid disruptive behavior disorders and those more severe on the spectrum were less likely to display quality peer to peer interactions as measured by the Wing Subgroup Questionnaire.

In a study conducted by Just et al., (2014) researchers studied how social concepts are altered in ASD. 17 adults with high functioning ASD participated in fMRI scans while thinking about 16 social interactions, based on the matching machine controls they had previously been shown. The scans revealed biological complexities when participants were presented with images of self-representation, finding it difficult to interpret the emotion behind the non-verbal visuals. Due to the lack of understanding in non-verbal communication, individuals with autism do not appropriately match responses to actions or overly respond to non-verbal cues by others (Just, et al., 2014). For student with ASD, non-verbal classroom interactions from peers and teachers may be confusing. The students may over react by yelling, crying or becoming aggressive when they feel frustrated and does not know why or how to express these feelings.

Aside from communication disorders, autism can come with other comorbid disorders. Many students with autism experience speech, mobility, feeding, focus or over activity, physical and motor skills issues. These issues can affect how the student interacts with others, display themselves as defiance, ADHD/ADD, or other disorders, effects how students receive and interpret academics, and how they access academics in the general education setting (Dadgar et al., 2017). These difficulties can restrict a student’s access to inclusionary classes and time with non-disabled peer during the school day, limiting their exposure to age appropriate social and coping skills from peers. While not all students with autism experience the same difficulties or experiences, it is important for these students to be included in their least restrictive environment where appropriate. A student’s over-activity not only affects their learning but that of others. Maintaining on task behavior is another facet of social skills training that can be taught in the classroom setting for practice and skills based usage. Studies have shown, boys with autism that display lower reactive aggression are capable of reciprocating task demands and remaining on task for periods of time with skills training, at an older age (Kaartinen et al., 2017), thus defending the adage of early intervention.  When students with autism are taught social skills in a controlled clinical setting at an early age, preschool to preadolescents, the students are more likely to understand, accept and model what they have learned. However, when students are taught to generalize real world situations, in general, uncontrolled settings it is difficult for the student to generalize these learned skills to the school setting with non-disabled peers and teachers.  

A study by Kasari et al., (2016) supports the premise that students, not specified by age or gender, are more likely to transfer what they learned to peers interactions when social skills are taught in the clinical setting, rather than the school setting. In this study students were randomized and placed in mixed groups that consisted of students with varying exceptionalities along the ASD spectrum. Among the two different groups, two different interventions, skills based social skills and engagement based social skills- including role play and interactive lessons, were used to teach social skills to the groups. After an eight week, 16 session period, students who participated in the skills based group increased their peer to peer interactions and age appropriate social interaction. This finding aligns with the goal of social skills training, to teach student the necessary skills to interact with their peers, adults and individuals they may come into contact with in uncontrolled settings. Another randomized style study of children with ASD was conducted in Germany and concluded similar findings. Freitag et al., (2016) studied patients between the ages of eight and 20 at six different German university clinics for children and adolescents with ASD. At the beginning of the study participant groups were randomized by an age gap of no more than four years and ability levels. Parents of the selected individuals completed parent-rated Social Responsiveness Scales to measure the participants’ baseline social skill set before beginning the groups. During the study patients received 90 minute afterschool group sessions for a total of 14 weeks. During each session a specific social goal was identified for each participant, and the sessions were highly structured. Researchers utilized a comprehensive social skills program that combined experimental, operant behavioral and cognitive techniques, computer-based social learning and teaching methods at each session. The sessions also followed a systematic sequence from beginning to end each week: greeting, opening group round, group rules, results of homework, session-specific individual goals, introducing and practicing the session-specific topic, games, homework, closing round with feedback (Freitag et al., 2016). The curriculum for the study was sequential and became increasingly difficult to strengthen student tolerance and skill set. At the end of the study parents again completed the Social Responsiveness Scale on their participant. Researchers found the students made significant growth in all areas of the study including social awareness and peer related interactions (Freitag et al., 2016). After three months researchers conducted a follow up on these same participants and found the social skills training to have long term effects as the participants continued to grow in assessed areas.

As students with ASD age, it is increasingly important to learn to network with and connect with peers and adults. A study conducted by Gardner et al., (2014) with two high school students with high functioning autism, looked at the importance of facilitating social interactions with students sooner than later to enhance the overall educational experience. The study utilized peer facilitated social skills interactions and networking opportunities. Non-disabled peers initiated social interactions with the two peers with ASD in the school setting, assisting the students with peer to peer and student to adult interactions. The study concluded interactions and relationship building were more effective when the interventions were peer-mediated rather than adult to student facilitated. Other important factors when considering peer to peer social interactions is the severity of the student’s autism.  The higher functioning a student is, the more likely the student is to accept, model and generalize the skills taught. This is important for venturing into adulthood and into a society that is not always understanding of differences.

Conclusion

In conclusion, according to findings, social skills are most helpful for high functioning students with ASD, as well as their typically developing peers. While skills based social skills in the clinical setting have shown to deliver more effective results than engagement based (Kasari et al., 2016), early intervention and diagnosis are the ultimate key to success when implementing behavior modification and skills generalization. When younger children are given the opportunity to participate in social skills training in controlled settings, they are more likely to generalize what they have learned and maintain the information as they grow and develop later in life (Jagan, & Sathiyaseelan, 2016). Peer to peer interactions evolve for students as they age as well and without prior exposure to appropriate social interactions, students will struggle in this area (Gardner et al., 2014). With the early implementation of strategies to handle social events, interactions including disappointments and undesired responses, students will be better equipped to handle difficult, unplanned and unstructured interactions in and out of school.

References

(All articles retrieved from FIU library catalog/e-books and peer-reviewed journals)

Cunningham, A. (2012). Measuring change in social interaction skills of young children with autism. Journal of Autism & Developmental Disorders, 42(4), 593-605. doi:10.1007/s10803-011-1280-3

Dadgar, H., Rad, J. A., Soleymani, Z., Khorammi, A., McCleery, J., & Maroufizadeh, S. (2017). The relationship between motor, imitation, and early social communication skills in children with autism. Iranian Journal of Psychiatry, 12(4), 233-237.

Dagli, G., & Öznacar, B. (2015). An evaluation on mainstreaming practices of primary schools according to the views of school administrators, teachers, and parents. Educational Sciences: Theory and Practice, 15(5), 1317-1332.

Fitzpatrick, S. E., Srivorakiat, L., Wink, L. K., Pedapati, E. V., & Erickson, C. A. (2016). Aggression in autism spectrum disorder: presentation and treatment options. Journal ofNeuropsychiatric Disease & Treatment, 121525-1538. doi:10.2147/NDT.S84585.

Freitag, C. M., Jensen, K., Elsuni, L., Sachse, M., Herpertz-Dahlmann, B., Schulte-Rüther, M., & … Cholemkery, H. (2016). Group-based cognitive behavioural psychotherapy for children and adolescents with ASD: the randomized, multicentre, controlled SOSTA – net trial. Journal of Child Psychology & Psychiatry, 57(5), 596. doi:10.1111/jcpp.12509

Gardner, K. F., Carter, E. W., Gustafson, J. R., Hochman, J. M., Harvey, M. N., Mullins, T. S., & Fan, H. (2014). Effects of peer networks on the social interactions of high school students with autism spectrum disorders. Research and Practice for Persons with Severe Disabilities, 39(2), 100-118. doi:10.1177/1540796914544550

Hall, J., Philip, R., Marwick, K., Whalley, H., Romaniuk, L.,  McIntosh, A.,  Santos, I., Sprengelmeyer, R.,  Johnstone, E., Stanfield, A., Young, A., Lawrie, S. (2012). Social cognition, the male brain and the autism spectrum. Public Library of Science. Published: December 26, 2012 https://doi.org/10.1371/journal.pone.0049033

Jagan, V., & Sathiyaseelan, A. (2016). Early intervention and diagnosis of autism. Indian Journal of Health & Wellbeing, 7(12), 1144-1148.

Jones, R. M., Pickles, A., & Lord, C. (2017). Evaluating the quality of peer interactions in children and adolescents with autism with the Penn Interactive Peer Play Scale (PIPPS). Molecular Autism, 81-9. doi:10.1186/s13229-017-0144-x

Just, M. A., Cherkassky, V. L., Buchweitz, A., Keller, T. A., & Mitchell, T. M. (2014). Identifying Autism from Neural Representations of Social Interactions: Neurocognitive Markers of Autism. Public Library of Science ONE, 9(12), 1-22. doi:10.1371/journal.pone.0113879

Kaartinen, M., Puura, K., Pispa, P., Helminen, M., Salmelin, R., Pelkonen, E., Skuse, D. H. (2017). Associations between cooperation, reactive aggression and social impairments among boys with autism spectrum disorder. Autism, 136236131772641. doi:10.1177/1362361317726417

Kasari, C., Dean, M., Kretzmann, M., Shih, W., Orlich, F., Whitney, R., King, B. (2015). Children with autism spectrum disorder and social skills groups at school: a randomized trial comparing intervention approach and peer composition. Journal of Child Psychology and Psychiatry, 57(2), 171-179. doi:10.1111/jcpp.12460

Majoko, T. (2016). Inclusion of Children with Autism Spectrum Disorders: Listening and Hearing to Voices from the Grassroots. Journal of Autism & Developmental Disorders, 46(4), 1429-1440. doi:10.1007/s10803-015-2685-1

Matson, J. L., Fodstad, J. C., & Rivet, T. T. (2009). The relationship of social skills and problem behaviors in adults with intellectual disability and autism or PDD-NOS. Research In Autism Spectrum Disorders, 3258-268. doi:10.1016/j.rasd.2008.07.001

Pinborough-Zimmerman, J., Satterfield, R., Miller, J., Bilder, D., Hossain, S., & McMahon, W. (2007). Communication Disorders: Prevalence and Comorbid Intellectual Disability, Autism, and Emotional/Behavioral Disorders. American Journal of Speech-Language Pathology, 16(4), 359-367. doi:10.1044/1058-0360(2007/ 039)

Ruble, L. A. (2001). Analysis of Social Interactions as Goal-Directed Behaviors in Children with Autism. Journal of Autism & Developmental Disorders, 31(5), 471

Sainato, D. M., Morrison, R. S., Jung, S., Axe, J., & Nixon, P. A. (2015). A Comprehensive Inclusion Program for Kindergarten Children With Autism Spectrum Disorder. Journal of Early Intervention, 37(3), 208-225. doi:10.1177/1053815115613836

Scheeren, A., Koot, H., & Begeer, S. (2012). Social Interaction Style of Children and Adolescents with High-Functioning Autism Spectrum Disorder. Journal of Autism & Developmental Disorders, 42(10), 2046-2055. doi:10.1007/s10803-012-1451-x

About the Author

Shari Coplin is a behavior specialist for students in Pre-K through 12th grades in Northwest Tennessee. When she is not creating visuals, in her free time Shari enjoys listening to music, dancing, travel, trying new eateries and spending time with family and friends.