By definition, children with Asperger’s Syndrome (AS) have problems with social skills. Books and programs teach a wide variety of social skills, everything from greetings to compromising on play dates, giving a compliment to accepting criticism. There are many reasons why these programs face uphill challenges.
In their book, “Helping the Child Who Doesn’t Fit In (1992),” Stephen Nowicki and Marshall P. Duke cite a critical study showing that 55% of emotional meaning is found in facial expression, posture and gesture, and another 38% of meaning is communicated through tone of voice. They state, “Only 7% of emotional meaning is actually expressed in words.” Most AS children have neuropsychological profiles of a nonverbal learning disability; they miss nonverbal cues. As a result, they don’t “get” what’s going on: who’s friendly and who’s not, what’s appropriate and what’s not. They misperceive the behavior and intentions of others because they miss the vital cues that convey meaning. AS children often over-react to their perceptions of the behavior of others, often getting into trouble and alienating instead of engaging their peers.
Additionally, AS children are black and white thinkers, so they make judgments about what’s right and wrong. Theory of mind, or understanding that others have a unique (and different) point of view, is a weakness for these children, so it is difficult for them to recognize that others might perceive situations differently from themselves. They tend to think that their perception is the only way of understanding or behaving. It’s challenging to get an AS child to budge from an opinion. These limitations can make it hard for AS children to know how and when to use the social skills they learn and sometimes, to feel that using these skills makes sense.
The complaint about social skills programs is that the skills learned “don’t generalize” to everyday situations. Just as an AS child might not recognize an academic problem if it’s framed differently, he might not recognize a social situation if it’s presented differently. Unfortunately, social situations are complex, rapid and multi-dimensional, and even similar situations present somewhat differently each time. The child must integrate information and shift sets according to different situations. He must stay in control, and monitor the accuracy of his perceptions as well as the way his behavior affects others. Social skills, therefore, involve the behavioral executive functions of inhibition, emotional self-control and shifting, as well as metacognitive functions such as initiation, planning and self-monitoring in order to function smoothly and transfer from training to real life.
Working with children (and young adults) with AS on social skills therefore means that in addition to teaching skills, one must teach social cognition and address a broad range of executive functions; one has to address perception of social situations, cognitive flexibility and awareness of the perspective of others. For the clinician or parent, this is a much more complicated task than teaching a child how to introduce himself.
Over 15 years of teaching social skills to children, Maureen Foley, LCSW, CCC-SLP and I developed a conceptual framework for teaching social skills that includes all of these elements. We defined six “building blocks” that underlie social skills. These building blocks are in play simultaneously. Unfortunately, social situations do not present themselves in discrete categories; however, understanding this framework can point to how to initiate an intervention and focus on one salient area, later moving on to a second “block” and a third. It’s always important to take on one area at a time to avoid overwhelming a child, and to accept gradual progress.
The building blocks incorporate executive functions, social cognition and social skills into a fairly simple framework that can easily be communicated to parents and children. The six blocks are:
- Awareness (of self and others)
- Emotional Self Control
- Big Picture Thinking
- Predicting Outcomes
- Social Resiliency
Self-awareness is the most basic building block, and also one of the most challenging for children. It addresses the metacognitive function of self-monitoring, and the typical deficits of understanding nonverbal cues. Children with good self-awareness know how they look to others and how to use both nonverbal and verbal behaviors to send the right message to make friends. Awareness also includes awareness of others, especially of nonverbal behaviors that give critical feedback in social interaction.
Emotional self-control is critical to responding appropriately and effectively in social situations. Most AS children don’t plan what they’ll do in social situations; they simply react. They may be just responding to how they feel – usually angry, hurt or anxious. The child who immediately cries is often teased, and the child who lashes out gets in trouble. Unfortunately, it’s fun for other kids to get a reaction, and often it’s the child who reacts who gets blamed. It is vital that children learn, and practice regularly, those skills that help them maintain emotional control.
“Getting the Big Picture” is the third building block. Big picture thinking requires taking into account all the w’s: who, what, where, when and why. If we understand how the parts of a social situation fit together, we know better how to react. The child has to read verbal and nonverbal cues, stay calm, think about perspectives other than his own, and use past experience to understand how all of this fits together. This kind of synthesis, seeing how the parts add up to a whole, is social cognition, and is very challenging for being able to put social behavior in context. Often this critical aspect of social skillfulness is overlooked when children are taught specific behaviors, but not how to judge when to use them. One must teach and model this kind of social processing.
Adaptability involves having a repertory of responses, like a toolbox filled with skills a child can use. This is where much of traditional social skills training come into play, and it is vital to create this repertory of skills. If a child is aware, in control, and sees the “big picture,” he can better choose an appropriate skill to use in the situation. Groups can be very helpful in giving children the opportunity to role play and practice skills, but usually it’s important to have an adult shaping appropriate skills through prompting in ongoing situations.
Anticipating the outcomes of social situations is a key skill. Children need to learn to ask themselves, “What might happen if I do this?” They need identify the outcome that they really want, so they can choose from their “toolbox” wisely. They need to know when to act, and that not doing something can also be a plan. The challenge of anticipating outcomes is that it requires multiple executive functions: planning, shifting and flexibility to think forward and backward, and monitoring to consider the perspectives of others. Most social dilemmas happen over and over, so there’s plenty of experience to rely on and to use educationally. It’s not hard to teach children how to think through what they want to have happen, what they do or don’t like, and how to make a situation work best.
The sixth building block, social recovery, helps children become more socially resilient. Everyone makes mistakes, but socially skillful children know how to bounce back and move on. Resiliency is a critical part of adaptability, and requires self-control and flexibility. Certain skills, like apologizing, taking responsibility and using humor can go a long way towards mending a relationship and making a better impression. Often AS children feel that they shouldn’t apologize if they feel they didn’t intend anything wrong. They need to learn that we can say, “I’m sorry” even when they haven’t meant to hurt someone, which expresses concern for the fact that someone else felt hurt. Similarly, just because someone provoked you doesn’t “make” you react.
The keys to using recovery skills bring us back to self-control, seeing the big picture, adaptability based on having a reparatory of tools, and being able to predict the outcome of different choices of behavior.
It is impossible to expect children to learn and implement such a broad range of skills independently; therefore, it is important that 1:1 social “coaching” help a child process situations in “real time,” especially in unstructured situations such as hallways, cafeteria, recess and the bus at school, and in play dates and social situations at home. This supplements a group situation where children can practice skills and, as they’re older, process situations. As any clinician who works with AS children knows, these skills are long term gradual projects, but the advantage of the “building block” model is that it helps to pinpoint which skills need to be the focus of intervention and priorities.
Dr. Marcia Eckerd is a licensed psychologist in private practice for 28 years, specializing in evaluating, treating and consulting on children with social disorders such as NLD and Asperger’s Syndrome. Dr. Eckerd is on the professional boards of Smart Kids with LD and CT Assoc for Children with LD, is a resource professional on Asperger.com and NLDline.com, and writes a blog, “People Skills,” for Psychology Today (www.psychologytoday.com/blog/people-skills).