From play dates to romantic dates: Social skills training for individuals with autism…

From play dates to romantic dates: Social skills training for individuals with autism…


>So we have a very large group that makes
all of our work possible, so I just wanted to quickly acknowledge them. In terms of the presentation, I’m going to
very briefly go over the social deficits that are commonly seen in individuals with ASE,
as well as the consequences of some of these social challenges, so how it impacts our day
to day functioning. From there Irquote m going to talk about
the peers method, which is the social skills intervention program that we use, and it was
developed at UCLA. And then I’ll be talking about our three groups. So we have a preschooler group, an adolescent
group, and a young adult group. And then from there Irquote m going to wrap
up by talking about the research that we have conducted, looking specifically at adolescents
with ASD. And then for those of you commissions who
are in the audience, really focusing on some resources that might be of interest to you. So let’s start off by just talking about some
of the social deficits that are commonly seen in adolesce
nts and youth with ASD. And so overall what we see is that these children
tend to have, or make fewer social initiations, meaning they are entering peer interactions
less frequently or even initiating those play interactions. When they do when they are involved
in play interactions, they tend to engage more in parallel playing, meaning they are
playing next to each other, not really interacting much. And we see this even in our adolescent groups
and in young adults as well. So it’s something that stays with them over
the course of the lifespan. And overall they tend to have less interactive
play and less imaginative play. We see that they tend to exhibit poorer social
motivation, meaning that they are less engaged with peers their age. They are seeking out the peer contact less
frequently. And they also seem to have poorer social awareness,
meaning they have difficulty understanding social cues. So, being able to pick up on verbal and non-verbal
signs, and maybe their friends aren’t interested in talking about time over and over again. Or knowing that if somebody is looking away
and yawning, that might be a sign of disinterest. So they have difficulty picking up on those
cues. They tend to have poorer social communication,
meaning that they have difficulty initiating and sustaining reciprocal social conversations. So not only beginning conversations, but being
able to talk about things that are shared interests with their partner, being able to
draw in o ther people by asking questions, elaborating
on the other person’s statements. And we also see poorer social cognition. So this is an overall difficulty understanding
the perspectives of others. So what another person might feel like, what
they might be thinking, and being able to integrate into that their interactions. Now, the consequences of these social deficits
are actually quite pervasive and persistent across development. And what we know is that despite the cognitive
functioning of ind ividuals with ASD and despite their language
abilities, we do see broad challenges in their social functioning. And what we also know is that these social
challenges, they worsen as social demands and expectations increase with age. And so it’s really important that we are providing
them with appropriate skills as they go their different developmental periods. Consequences of these social challenges is
that they are often rejected by their peers. And this means they are actively rejected. So they are trying to initiate, they might
be trying to join conversations with people, but they are being actively pushed away. Some of them are overlooked, so they are socially
neglected. So these may be the teens or the young children
that maybe are on the periphery of the playground, periphery of the lunch area. They are not being actively rejected by their
peers, but they are not being sought out as well. As a result, they tend to have fewer reciprocal
friendships. And what we also know is that they tend to
report increased loneliness and increased feelings of isolation. Now, this came out of a study that was conducted
back in 2000 by Dr. KASRI, who really looked at the quality of these relationships. And we oftentimes in the past I think we assumed
that individuals with ASD or kids with ASD enjoyed being by themselves, right? That they were seeking that solitude. But what it turns out is they were actually
able to report and describe feel significant loneliness in light of all of their social
challenges. We see that these children and teens, they
are at higher risk for developing mood and anxiety symptoms. So they tend to have anxiety disorders, depressed
mood, because of these social challenges, and that they not only experience academic
problems during childhood adolescence, but this continues into difficulties with employment
later on. There are a lot of different types of interventions
out there for youth with ASD. And when we are looking specifically at social
skills in our intervention, there tends to be a greater focus on early intervention. And early intervention is a grey area to be
working in. Because we know that if we intervene earlier,
our hope is to be able to put our children on a different trajectory in terms of their
development. However, even with this focus on early intervention
programs, there isn’t a specific focus within these programs on teaching social skills. So broadly, oftentimes they are targeting
language development, for example, or targeting behavior management flexibility and not specifically
social skills. And what we know also of other existing social
skills treatments is that they arenrquote t tailored for individuals with ASD who donrquote
t have an intellectual disability. Now, it’s important to think about this group. I think oftentimes they are overlooked, because
cognitively they are functioning comparable to their peers. But we see them struggling. If you see them in the playground, if you
see them at lunch. And oftentimes they face different social
challenges.>So we have a very large group that makes
all of our work possible, so I just wanted to quickly acknowledge them. In terms of the
presentation, I’m going to very briefly go over the social deficits that are commonly
seen in individuals with ASE, as well as the consequences of some of these social challenges,
so how it impacts our day to day functioning. From there Irquote m going to talk about
the peers method, which is the social skills intervention program that we use, and it was
developed at UCLA. And then I’ll be talking about our three groups. So we have a preschooler
group, an adolescent group, and a young adult group. And then from there Irquote m going
to wrap up by talking about the research that we have conducted, looking specifically at
adolescents with ASD. And then for those of you commissions who are in the audience, really
focusing on some resources that might be of interest to you.
So let’s start off by just talking about some of the social deficits that are commonly seen
in adolesce nts and youth with ASD. And so overall what
we see is that these children tend to have, or make fewer social initiations, meaning
they are entering peer interactions less frequently or even initiating those play interactions.
When they do endash when they are involved in play interactions, they tend to engage
more in parallel playing, meaning they are playing next to each other, not really interacting
much. And we see this even in our adolescent groups and in young adults as well. So it’s
something that stays with them over the course of the lifespan.
And overall they tend to have less interactive play and less imaginative play. We see that
they tend to exhibit poorer social motivation, meaning that they are less engaged with peers
their age. They are seeking out the peer contact less frequently. And they also seem to have
poorer social awareness, meaning they have difficulty understanding social cues. So,
being able to pick up on verbal and non-verbal signs, and maybe their friends aren’t interested
in talking about time over and over again. Or knowing that if somebody is looking away
and yawning, that might be a sign of disinterest. So they have difficulty picking up on those
cues. They tend to have poorer social communication, meaning that they have difficulty initiating
and sustaining reciprocal social conversations. So not only beginning conversations, but being
able to talk about things that are shared interests with their partner, being able to
draw in o ther people by asking questions, elaborating
on the other person’s statements. And we also see poorer social cognition. So
this is an overall difficulty understanding the perspectives of others. So what another
person might feel like, what they might be thinking, and being able to integrate into
that their interactions. Now, the consequences of these social deficits
are actually quite pervasive and persistent across development. And what we know is that
despite the cognitive functioning of ind ividuals with ASD and despite their language
abilities, we do see broad challenges in their social functioning. And what we also know
is that these social challenges, they worsen as social demands and expectations increase
with age. And so it’s really important that we are providing them with appropriate skills
as they go their different developmental periods. Consequences of these social challenges is
that they are often rejected by their peers. And this means they are actively rejected.
So they are trying to initiate, they might be trying to join conversations with people,
but they are being actively pushed away. Some of them are overlooked, so they are socially
neglected. So these may be the teens or the young children that maybe are on the periphery
of the playground, periphery of the lunch area. They are not being actively rejected
by their peers, but they are not being sought out as well.
As a result, they tend to have fewer reciprocal friendships. And what we also know is that
they tend to report increased loneliness and increased feelings of isolation. Now, this
came out of a study that was conducted back in 2000 by Dr. KASRI, who really looked at
the quality of these relationships. And we oftentimes in the past I think we assumed
that individuals with ASD or kids with ASD enjoyed being by themselves, right? That they
were seeking that solitude. But what it turns out is they were actually able to report and
describe feel significant loneliness in light of all of their social challenges. We see
that these children and teens, they are at higher risk for developing mood and anxiety
symptoms. So they tend to have anxiety disorders, depressed mood, because of these social challenges,
and that they not only experience academic problems during childhood adolescence, but
this continues into difficulties with employment later on. There are a lot of different types
of interventions out there for youth with ASD. And when we are looking specifically
at social skills in our intervention, there tends to be a greater focus on early intervention.
And early intervention is a grey area to be working in. Because we know that if we intervene
earlier, our hope is to be able to put our children on a different trajectory in terms
of their development. However, even with this focus on early intervention programs, there
isn’t a specific focus within these programs on teaching social skills. So broadly, oftentimes
they are targeting language development, for example, or targeting behavior management
flexibility and not specifically social skills. And what we know also of other existing social
skills treatments is that they arenrquote t tailored for individuals with ASD who donrquote
t have an intellectual disability. Now, it’s important to think about this group. I think
oftentimes they are overlooked, because cognitively they are functioning comparable to their peers.
But we see them struggling. If you see them in the playground, if you see them at lunch.
And oftentimes they face different social challenges. So there’ s a greater push for
inclusion, greater push to put these students in a mainstream classroom, but we are not
giving them the right supports to be able to interact with their peers in that inclusive
setting. There are overall few treatments for teens
and adolescents, because there is such a focus on the early, the early years. And most programs
do not include a parent as an active part of treatment or teachers.
Now, teachers are seeing the children for many hours during the day, and then parents
are there oftentimes to be able to follow through with that coaching, but most programs
don’t incorporate teachers and parents. So something that we are very passionate about
in the peers program. And overall, we see generally a limited generalization
of treatment gains over time, as well as across various treatment settings. So with many existing
social skills interventions, we will see them being able to demonstrate the skill, join
the gro up, during the 12, 13, 14 weeks of treatment. But we are not seeing them being
able to maintain those skills outside of the treatment setting or outside of the or the
course of treatment, and be able to use that, you know, with their peers and being able
to develop meaningful relationships. And when we look at various social skills interventions,
there are a lot of different types of social skills. So you can focus on conversation skills,
you can focus on grooming, table manners, eating. So it’s
really important that there are specific programs focused on friendship development. Now, there
are various evidence-based methods of social skills instruction, and these are the methods
that we use in the peers program. So as we go through these different methods, I’ll talk
about how we incorporate them in our program. So it’s really important to have a small group
format. I know sometimes social skills is taught one-on-one. And in certain scenarios,
that may be more appropriate. If, for example, the adolescent needs more repetition of instruction,
perhaps if there’s an intellectual disability that might be interfering or that might make
it difficult for them to be a group setting. If you have had teens that maybe are not cognitively
delaye d, you might use a one-on-one setting. But
generally you want to have a small group format, so they can practice the skills with each
other. And as much as possible, this offers a setting where they can practice the skills
in a naturalistic way. So in our group we start off all of our groups with about 10
adolescents, about 10-11, same four-hour, young adult, and our preschooler groups. Okay?
And it’s really important to have structured, didactic lessons. So there are a lot of different
groups out there, and some of them are social recreational groups, meaning they are not
teaching specific skills each week. But what they are doing is having children come together
or teens come together And that’ s great, but they are not teaching them specific skills
to be using in those settings. And so it’s really important that we teach concrete rules
and steps of social etiquette. So what to do if your goal, for example, is to join a
conversation with somebody. How do you do that? If you want to have a get together,
you want to invite somebody to hang out, how do you do that? We go over these concrete
rules and steps, and our goal is to play our families with a road map. So if you are in
this situation, this is what you can do. And these are the four or five steps to be able
to accomplish that goal. Okay? And we focus on ecologically balanced skills,
meaning not what we as adults, as treatment providers, want teens, children, young adults
to be doing, but really what their peers are naturally doing on their own to be making
and keeping friends. So we pulled from the research to see how other teens are initiating
conversations. We are breaking down those skills and sharing them with the families.
And with the ecologically valid skills, we target dos and donrquote t, meaning what
should we not be doing, as well as what we should be doing instead. Okay?
Now, after the lesson its really important to also have our families practice. And so
we will have the teens, children and a young adults so first will model the skill. So we
do this through role play demonstration. So the group leader, and we also have behavioral
coaches who are oftentimes graduate students college students. They will actually model
the behavior that we are hoping to teach. Now, they also demonstrate the inappropriate
behavior. And there has been oftentimes been a discussion of not modeling the inappropriate
behavior, because we donrquote t want to be encouraging our teens and young adults
to be doing inappropriate behavior, you’ re right.
So the way that we do this is, we start off by showing an inappropriate role play, and
we use that as a teaching opportunity. So we never tell our teens, if you want to join
a conversation, this is how you do it. We will have our coaches, for example, role play
what not to do. So that’s the inappropriate role play. And then we will have our teens-young
adults then generate what they should be doing instead based on those errors.
So that’s really using a Socratic method, and I’ll talk and show you guys how we do
that through our groups. So you want to do an inappropriate role play,
and also utilize an appropriate role play. And after that, we have our teens a
nd young adults practice the skills. And as they are practicing with each other, we are
providing them performance feedback in the moment. So we are giving them little tips,
feedback on how they might want to use the skills in the future. Okay?
And we also provide homework assignments each week, meaning we provide several assignments
for our teens-young adults to be practicing the skills during the week in their naturalistic
setting, whether it’s at school, at work, in whatever social group or extracurricular
activity that they are in. And then we also have a very big component in terms of parents
social coaching. So parents are actively involved throughout the entire program. They come each
week, and they are involved for the entire session.
Some brief background around peers. It is a program that has been used internationally,
so it’s been translated into six languages. It has been used in over a dozen countries.
The NICE identified it as a best example of an evidence-based social skills intervention
for youth with ASD. And a recent COCHIN report said it was one of five evidence-based social
skills interventions for youth that can actually be obtained. So there are a lot of evidence-based
programs out there, but you are not able to access them, because they are used primarily
for research. So it’s really important that we are able to then provide or give families
and treatment providers access to these types of evidence-based interventions.
And it is evidence-based for our adolescent and young adult group, and we are starting
to collect data on our preschooler group. So for our preschooler group, this is a 16-week,
manualized social skills intervention. And at this point we are offering this group to
children between the ages of four-six years with ASD who did not have
an intellectual disability. And the way that we teach the lessons is we
actually have a live puppet show each week, where we have puppets roll play the skills
with each other, and then the kids will come up and practice the skills with the puppet.
So it’s a lot of repetition of instruction. And then we set of two activities where the
children will practice that skill. And they are activities that most children will see
in their preschool or kindergarten s etting, like red light-green light, what time
is it, Mr. fox, red rover, mother may I. But we adapt the game each week to focus on that
specific skill. We teach ecologically valid friendship skills, and Irquote ll show you
which skills those are. And it’s a parent-assisted intervention. So while the children are in
one room, we have parents down the hall in a separate room talking to us about how the
children did and using the skills during the week. And we really focus on really basic
behavior management strategies, so that parents can be applying those to the play dates that
the children are having during the week. And parents are acting as social coaches,
both during sessions and outside of sessions. So tthe first hour of the group, the parents
and children are separated, each learning their own lesson. But the last 20-30 minutes
of the group, we actually reunify the families, and we set up mock play dates. This is where
we assigned two kids to play with each other. They will bring a board game or some kind
of structured activity from home. We will have the parents social coach their children
on that specific skill. And at the same time, we have our treatment team standing behind
the parent whispering in the parent’s ears and giving them coaching on their social coaching.
So it’s a trickle down approach that we are using. We are really taking advantage of this
parent training model. In terms of the curriculum, these are all
the skills that we address. The skill in why join the game is a clinical example that I’ll
be showing you. But as you see, we will go over listen and following directions the reason
why we start off with this lesson is even though most of our children are able to do
this quite well, it’s actually it can be drawing, that first day of groups, for a lot of our
kids. So it’ s a nice way to orient them to the structure of the program. And from there
we talk about greeting friends, meeting and greeting friends. So saying hi, how do you
ask for names. We talk about how to play with our peers, by sharing and giving a turn, asking
for a turn, but also keeping cool. So we can follow all the right skills, but our friends
might still say no if we ask for a turn. So it’s really important that our kids know how
to keep cool in the moment. And what else can they do? They can keep on playing, or
they can choose to find another game, right? We talk about how to be a good sport, how
to show and tell during play. This is a great way to increase reciprocity during the play
interaction, so it’s not so much a parallel play interaction. And we also go over how
to ask a friend to play, how to join an ongoing game.
So if you see, you know, a group of friends playing, how can you join that game? The skills
are slightly different there. As well as how to play something different, which really
means if you get bored playing with your friends and you want to play a new activity, instead
of just walking away, how do you introduce, or how do you suggest playing a new activity
to your peer? And then from there we talk about how to help
friends, maintaining appropriate body boundaries, and how to use an inside voice. So we are
not talking too loudly or too quietly. For the study, we just completed an RCT. We
did have using polite words as a lesson, but we actually replaced that for our current
clinical groups. And we replaced that with don’t be bossy, meaning how to be more cooperative.
We have learned from our study, that our kids need a little bit more help being more cooperative,
not being so self directed during play in terms of telling their friends what to do
and how to do it. Okay? All right. So this is the format that we use
in teaching the skills. And so for all the skills, we use very short buzzwords or buzz
phrases to highlight the main components of each skill. So we tell our kids, you know,
if you want to join a game so if you see your friends playing ball, for example, and you
want to join, you say you first have to watch the game, right? So you have to watch the
game, and you have to figure out what they’re playing and determine if you know the rules.
You can’t just barge in because you want to play. And we say actually if you don’t know
the rules, you kind of have to just wait and see if you can pick
up the rules, or at that point find another activity to play. If you do know the rules,
we say you can then move a little bit closer, and then you can ask to play. And the way
you ask to play is by looking at your friend, smiling at your friend, you know, saying can
I play using names. And these are repetitive themes throughout the program, is to look
at your friends with your eyes, smile with your mouth. It’s really important to use names.
And then we say if a friend says yes, great. Join the game. But if your friends say no,
then you keep your cool endash it was a previously taught skill, and then you find something
else to do. Okay. So let me go over the results for our open
trial. We are still analyzing our results from our randomized control trial. So when
we were looking at their scores, their severity schools on the ADOS, what we see pre is on
the left side and post is on the right side. We see that our children, they are moving
from a moderate range of impairment or severity to a low range. And for our randomized control,
we had a smaller group. Just wanted to make sure that the intervention and curriculum
was feasible. And so we had a group of five at that time. And so we were under
powered, but we are seeing a nice trend. And our initial analyses of our randomized control
trial, we are seeing the same results. So itrquote s very encouraging to see.
In regards to the social responsiveness scale, which is a parent questionnaire, and it looks
at their social communicative behaviors. So we are looking at overall social communication
impairments, and then we look at social awareness, social cognition, social communication, motivation,
then repetitive behaviors and restricted interests. And for this, higher scores indicate more
impairment. So we want to see scores go down from pre to post treatment. And so pre is
the dark blue, and then post is the light blue. And so we see our pre, they are pretty
much in the moderate range across the domains. And at post we see them go down to the mild
range or even though the mild range. So they are in the average range in regards to how
interfering those social communication impairments are.
We also administered the social skills improvement scales. And this taps into overall social
skills, as well as overall problem behaviors as reported by parents. And here, higher scores
indicate better social skills. And so we see at pre, which is the darker blue, that they
are below the average range at pre. But at post treatment endash so, after 16 weeks
of intervention, we see them fall into the average range. Now, intervention for our preschooler
group, as well as other groups, is once a week for 90 minutes. So it’s not a lot of
intervention, right? It’s really the parents who are learning to be effective social coaches,
who are coaching the children during the week so that we can see these types of meaningful
gains. And then on the right side, those are the
subscal es of the SSIS, when it gets to the social
domain. And here, again, we see want to see higher scores, because higher scores indicate
improvement social skills. And across all the sub domains in terms of communication,
cooperation, assertion, responsibility, empathy, engagement, self control, we are seeing slight
improvements. So again, this is just with, you know, a group of five. But we are seeing
good, you know, changes moving in the right direction. And the social skills, the SSIS
also looks at problem behaviors. And again, dark blue is before treatment, light blue
is after treatment. Now, they are in the average range at pre post. But what we are seeing
is that they are decreasing in the problem behaviors, right?
And then we are seeing the same trend when it comes to the subscales, which is externalizing
behavior, internalizing behaviors. Bullying is going up a little bit, that means they
are bullying their peers. But I wonder if it might be a consequence of being more assertive,
in a way. So we will need to look at that a little bit more. And we are seeing decreased
hyperactivity and decreased ASD-like symptoms. Now, we also looked at level of overall social
engagement, and this is a measure that was developed in our clinic and we have been using
in all of our various studies, is a quality of play questionnaire.
So this is where we have parents identify how many play dates they have had that they
were hosting, that they were hosting themselves, and how many play dates t
hey have that they were invited to. And this is really getting at the reciprocity. So we
see that on the very left side, it’s overall number of get together or play dates, that
before treatment, they were having a little bit less than two play dates. After treatment,
they were having, what, three and a half? And in terms of specifically hosting and attending
a get together, they were hosting less than one play date, but then they were having almost
two play dates that they were hosting at the end of treatment. And in terms of being invited
as a guest to a play date, that stayed around the one-two. And this is within a month, right?
So the number of play dates they are having in a month.
Right. So moving along to our adolescent program, this is also a parent-assisted program. This
one meets for 14 weeks. And again, it’s 90-minute weekly intervention. And we have concurrent
parent and teen sessions. So the teens are in one room, and we have all the parents down
the hall in the separate room. And this one also has a published Korean manual,
which I’ll talk about the research around that for a little bit, in a little bit. And
there is also a school version of this which recently came out, and it is again based on
research, where the school version, itrquote s a teacher facile model, and it’s a 16-week-long
curriculum. For this one, parents arenrquote t involved.
But there is a very comprehensive parent handout. And the way that this is laid out is that
itrquote s daily lessons that could be sche duled, somewhere between 30-50 minutes, depending
on the class schedule. And the teachers would spend like the first day reviewing this, their
practice during the week, second day going over the skills and practicing with each other
through the role play demonstrations, and then having the kids practice together. So
it’ s laid out quite nicely. Now with peers, we focus specifically on friendship
skills. So, you know, how to identify appropriate friends, where we can meet them, how to get
to know them better. but we also go over strategies related to handling peer conflict and rejection.
So some of our teens unfortunately come into our program having experienced significant
peer rejection, peer neglect. Or, as they become more socially engaged, you know, they
experience some teasing. It happens to all of us. So itrquote s really important that
we teach, that we share those skills with our teens.
And again, we focus on ecologically valid skills. So for our teen and adolescent group,
these are the friendship skills that we focus on. So we talk about where to find appropriate
friends and how to identify or start to assess whether or not these friends are appropriate.
So we know when you are younger, your parents kind of dictate who your playmates are, right?
What we want to do is to help our teens and young adults really develop their own independent
ability to assess the quality of those friends. And we are really looking at reciprocity of
friendships, not just me reaching out to my friends, but also friends reaching back out
to me. It’s something that we are constantly focusing on in the groups. From there we talk
about and when it comes to choosing friends, we also go over the importance of common interests.
And that’s really, you know, interests that are mutually
shared between you and your friends. Because those interests the foundation of friendships.
So I want you to think about your friendships. I’m assuming that probably your stronger friendships
are those friendships where you have more common interests, because you have more things
to do together, more things to talk about, in addition just to overall compatibility.
So we do focus on common interests with our teens and young adults. From there we talk
about conversation skills, how to trade information in a very reciprocal way, so we are not taking
over the conversation, we are not monopolizing the conversation, but also to avoid being
too passive. So we talk about asking follow up questions,
open-ended questions. We talk to our teens about not being a conversation hog. We talk
to them, our teens and young adults about not being a policer during conversations,
and those are teens that maybe point out errors that their friends make or say you can’t do
this, or that’s not right, you shouldn’t do that. They are constantly correcting their
friends. Nobody likes to be corrected. And so we talk about not being a policer during
conversations. That’s one of the skills that we go over. I’ ll show you guys an example
of how we teach our teens to start a conversation with their peers, as well as how to exit conversations.
And we actually teach them three different ways to exit a conversation. Again, we are
providing them a road map, right? We don’t say if you are not interested, just go ahead
and leave. We say, you know, if you join a conversation, you may never be accepted. You
could do everything right, but they may never accept you, for whatever reason. In that case,
you want to exit the conversation by looking, turning and walk away all in the same direction,
right? We also say sometimes you might join a conversation,
you might be initially accepted but then excluded. So this happens to all of us, where they will
invite you in, but then they will kind of kick you out of the conversation
by saying whatever, and they turn their body, right we have all experienced. And the strategies
are a little bit different. Because you can’t just walk away at that point, because they
have talked to you, they have acknowledged you.
So in that case you actually have to give a brief cover story for leaving. You have
to give a reason for leaving. Because if you just walk away, they will notice you walked
away and they will think well, where did she go? That was kind of weird, right? So a brief
cover story might be something like, got to go, right? See you later. Brief cover story.
And then we talk about if you are fully accepted into a conversation, how do you exit that
conversation? In that situation you give them more specific cover story. You can’t just
say see you to your friends, because they might be confused. They will say where are
you going, right? So in that case, you say oh, my ride is here. I have got to go to soccer,
I have tutoring now. You give them more specific cover story. So we, as much as possible, try
to break down these various scenarios. And again, these concrete rules and steps.
We talk about electronic communication, which is the, I would say the most prominent way
that teens are communicating these days, right? So we go over rules related to texting, snap
chat, whatever it is that they are using, how to use it safely if they choose to. We
also go over rules regarding telephone skills. And I know it’ s a dying art, and our teens
always make a point to tell us that. But at this point, there is still no form of technology
to replace a telephone. So we still go over those strategies.
We talk about get togethers, which really is the strongest and best way to strengthen
a friendship. And that’s hanging out with your peers outside of school, outside of club.
So it’s really hanging out with your friends outside those rearranged settings. And for
a young adult group, we go over dating etiquette. We go over how to let somebody know that you
like them, how to ask somebody out on a date. So how to flirt with them, how to ask them
out on a date, as well as how to organize a date, general dos and don’ts when it comes
to dating, how to take no for an answer. So how to accept rejection, as well as how they
can politely turn somebody down if they don’t want to date them.
And that’s a running them through our program, is friendship is a choice, and dating is a
choice, meaning I don’t get to be friends with everybody, but also not everybody gets
to be friends with me, right? So really our teens and young adults get to choose who their
friends are. When it comes to managing conflict and rejection,
we go over the skills related to handling arguments, so how you can resolve an argument
to be able to sustain that friendship. How to handle verbal teasing and embarrassing
feedback, as well as how to manage chronic bullying. Now for a teen group, we focus on
physical bullying. In our adult group, we don’y focus on physical bullying, but we do
talk about, you know, if people are being, if its more like workplace bullying or classroom-type
bullying that happens. We talk about what to do if you are the target
of rumors and gossip, as well as how to handle cyber bullying. And we go over the strategies
for changing your reputation, if that’s something that you want to do.
And for our adult group, we go over of the strategies related to handling peer pressure.
So how to say no, for example, if your friends are pressuring you to do something that you
donrquote t want to do, whether it’s alcohol, drugs, staying out past your curfew, whatever
it is, how to say no to your friends but still be able to maintain that friendship. Okay?
So I’m going to go over clinical example. This is actually where I would love to have
you guys participate. So what are most teens told to do when trying to meet a new group
of people? What are well intentioned adults oftentimes telling teens to do to go meet
new people? What do we say? What do we say?>>Join a group.
>>But how do you join a group?>>Or join a club.
>>Right. But then once you get there, we say how do you then talk to those people?
What do we say? We say hi, right? Can you imagine being a teen, going up to a group,
and just saying hi, right? Or hi, I’m MINA. What are they going to do? They are going
to stare at you and they are going to think you’re weird. But we are giving them this
advice. So it’s really important that we give them the right advice.
So what are other teens doing to join these conversations, okay? Now let’s also think
about what are the common social errors made by teens with ASD when they are trying to
join group conversations? What do they tend to do?
>>Jump right in.>>They will barge right in, right? And when
they barge right in, what do they talk about? Their restricted interests. So itrquote s
really important that we know go over not only what to do, but also what not to do.
par So, we again introduce all of our skills by typically doing a role play first. So we
never give them the skills. We want them to be part of the process. It’s very organic.
And so we say and in this situation tell us what jasmine
is doing wrong to enter this conversation. And so then we will say great, time out. Tell
us, what did jasmine do wrong trying to join that conversation? And they will let us know.
They can point it out when other people are doing it, but it’s hard for them to kind of
catch themselves in the moment, right? And so that’s why really that practice is so important.
All right. So then we will.so then we will, after each role play, bad and good, we will
ask some perspective-taking questions. Because we really want to strengthen their perspective
taking skills, right? So we will ask them, so I’m ask will you guys, too, what was it
like for the group when jasmine tried to just barge in? What was it like for the group?
>>Awkward, right? They will say annoying. What did the group think of jasmine?
Yeah, weird. They will say weird, right? And will the group want to talk to jasmine again?
Probably not. We asked them the same three questions after
every single role play, because they really want them to start thinking about their interactions
in this way, right? So after we do a bad role play, then from there we take the information
they provide us about what they did wrong, and then we provide the skills of what to
do. So we will say you guys are right. We shouldn’t
be barging into conversations. Instead what we should first do is we should watch and
listen, right? So what are we doing? We are watching from a distance, but we don’t want
to make it obvious that we are watching or eavesdropping, right? So we say have a prop.
We all look at our phone. When we are looking at something, we will look at our phone, we
might, like, look up again and we will look back down. We all do this.
If you are at school, you can pull out a book, for example. But you want to have a prop as
you are watching. And we want them to be listening. And what they are really listening for is
a topic, and seeing if they can identify any of those common or mutual interests.
You know, we want them to assess, OH, can I join this conversation and meaningfully
contribute to it if not, I shouldn’t be joining that conversation, right?
We want them to make periodic eye contact. So look up once in a while from their prop.
And we say if you know somebody in that group, it makes it easier to join that conversation.
Why? Why is it easier if you are kind of familiar
with somebody in the group? Connection, yeah. They vouch for you. We do clarify, though,
it’s somebody that you have a bad reputation with, you don’t want to join that group. Again,
we do a lot of clarifying in our groups, okay? And then you also want to make sure that they
are talking nicely. So if they are arguing, you probably donrquote t want to join that
group. Or if they are being mean to each other, probably donrquote
t want to join that group, because most likely they will be mean to you, too. Right?
So once you have watched and listened and you decided I want to join this group, I know
what they are talking about, I can talk about it too, then we say you actually have to wait.
So you can’t just join, you still have to wait for some type of pause or some type of
acknowledgment. Now if you are waiting there by a group, people will sometimes notice and
look at you. That’s a great time to join the group, too. And then we say when you join,
you want to move closer, but you are still about an armrquote s length away. You are
not completely joining the group. Because if you are still about an armrquote
s length away, if you need to exit the conversation, it makes
it that much easier to do. And then we say you join by making an on-topic comment, question,
or complimenting them on whatever they were talking about.
So if they are talking about their new phone, you can compliment them on their new phone,
for example. Right? So do you guys endash thinking about your interactions, do you guys
do this too, when you are joining conversations? You guys will notice this. You will start
to break down interactions in this way. par So now let me show you the right way
to join a conversation. All right. So then we do repetition of instruction, and we say
okay, so what did jasmine do right this time in joining the conversation? We have them
those steps, right? Again, it’s very repetitive, but that’ s the level of repetition needed
for them to really take in information. And if they say all of them, we will say great,
which ones, and we have them tell us which skills they were.
And again, we follow through with those pers pective-taking questions, right? So what was
that like this time for the group, when jasmine followed the steps? What do you guys think
they will say? They will say fine. They are not going to say it was great, right? But
it was fine. She wasn’t disrupting, she wasn’t interrupting them. What do you think the group
thought of jasmine? They will say okay, she was fine, she was cool, she seemed cool, right?
Do you think they will want to talk to her again? Maybe, probably. It’s definitely not
a no, which was the case for the first time, right? So again, we are just helping them
to enter these conversations in a seamless way.
par So let me move on to a young adult example. So letrquote s talk about dating. We have
three weeks that we spend on dating in the young adult group. So what are most people
with ASD told to do, or anybody told to do, to let somebody know that you like them romantically?
What type of advice do we give to people? Nobody wants to say.
[Laughter] Okay. So, well, what do you guys think? What
are people told to do?>>Start talking to them
>>To start talking to them, say you like them or you might be interested in them, right?
Hang out where they are hanging out, right? What do you think people with ASD are often,
what they often do to let somebody know that they like them? They will just tell them.
I like you. Or they won’ say anything, and they will think that person is their partner
because of that perspective taking, right? They are thinking, well, I like you. So then,
I’m going to assume then you like me too. So we need to break things down for them.
So we go over how to flirt. We teach young adults how to flirt. And this is really fun.
And what we do is we say when you flirt I know you guys are all laughIng, because we
all do this you say we first make eye contact, right?
So you will look at somebody, you look at somebody, you give a slight smile and we do,
again, clarify, you don’t want to give a big smile, you donrquote t want to show a lot
of teeth. Why not? It’s very aggressive, right? So we just say just give a very slight smile.
And then we say so you look, slight smile, then you look away, right? And then what do
you have to do? Repeat it, right? So you have to look back at the person.
The reason why you have to repeat is because if you did it just once, it might have been
a coincidence, right? But if you did a repeat and they are also looking at you, it’s more
likely that they are also interested in you, too. Okay?
This is really fun to do, because we actually have them do this with our coaches. So we
will have both a male or female coach, and we will let them choose which coach they want
to use to practice the skills. And they will actually practice flirting with one of our
coaches. All right. We say another way to let somebody know that
you like them is to speak to a mutual friend. And I know this seems very junior high, high
school-ish, but we all still do this, meaning, you know, pick a mutual friend and ask if
that person is dating anybody. Are they seeing anybody? You might want to ask if they are
interested in you, if they might go out with you. You might casually mention that you like
them. But we always end by saying, but don’t told them I said anything. But you know your
mutual friend is going to go to that friend and say something, right?
[Laughter] So there’ s a formula to all of this. So again,
not only do you flirt, but you want to speak to a mutual friend. You can also give compliments.
But the types of compliments have to be specific. So the way you compliment is very specific.
And when you actually are getting to know somebody, we say you don’t want to provide
very specific compliments. So you don’t , sorry, you actually do want
to give specific compliments to people you don’ t know well. So if they said a funny
joke, you say oh, that was a funny joke, or that was really interesting . but for people
n once you have gotten to know them better, then you can provide more general comments,
like oh, you are so funny, right? Oh, you are so smart.
The reason why you want to be specific when you don’ t know somebody quite well is if
you give a general compliment, it might come across as not being very genuine, or you just
trying to win them over, right? So you want to be very specific at first. We say you do
want to avoid giving a lot of physical compliments. And again, it gets around that perspective
taking. It might take the person feel uncomfortable, right? They might think yourquote re interested
in them only for a specific reason. So we say not too many physical compliments.
And when you do give physical compliments, try to focus on neck up.
[Laughter] So we do clarify. All right.
So how do you then ask somebody out on a date? This is how you do it. First you trade information
with them, right? So you are trading information. You try to mention your common interests,
see if they also are interested in those things. And then you kind of casually
ask what they are doing. Maybe some time this weekend, for example. If they seem interested,
you say you want to use that common interest as a cover story to go out.
Because if you were just to say hey, do you want to go out, do you want to go on a date,
that again can be very aggressive or assertive, right? And it’s also difficult to kind of
save face if that person says no. Whereas if you are using a common interest as a cover
story, it could have been that you were just asking us to hang out as a friend. Okay?
If they are interested, then you would choose a general day and time to go out, exchange
contact information, then finalize those plans, maybe like two days before the date. If they
are not interested, we tell young adults to abort mission, right? You kind of keep your
cool at that moment, casually say okay, and then you change the subject. So it’s not awkward.
So for the dating etiquette, we just say practice if you are actually interested in somebody.
Don’t go out and just start practice dating and flirting with everybody.
[Laughter] Because some of them are so eager, they will
just flirting with random people. Okay? All right.
So let’s get into the evidence-based our program. And by the way, that was Dr. LAGESON. She
is a CO DEVELOPER of the peers intervention as well as a director of the clinic. So these
are some of the studies that we have done really looking at the effectiveness of the
peers intervent ion. And so the top two studies are looking
at our adolescent group. On the bottom right side, or bottom side, we are looking at peers
in the classroom setting. And this was deployed in a non-public school setting.
And then we also have a study on the young adults. And we have also had some great collaborators.
And on the top, itrquote s at MARQUETTE with Dr. van ECKE’s group. And what they looked
at is not only how social anxiety changes as a function of the peers intervention, so
they found that the ir teens actually decreased significantly
in social anxiety after going through the group. But as well she found the first biomarker
really looking at how there are changes in their EEG pre and post treatment. So that’s
been really exciting to see. And then we also have a study there where peers was translated
into Korean, and it was a cultural adaptation of peers in Korea.
What I want to do is present on our long-term follow up study. And this is really one of
our most exciting studies. And what this did is follow families one-five years after treatment.
So we contacted families after they participated in our group. And out of the 82 families that
we reached, we were able to get information from 53 of those families. We did run some
analyses, and there were no differences in between the responder and non-responder groups
in terms of the follow up data. The mean age at follow up endash and this
is only for our teen group endash was 17.5 years. And on average for our teen groups,
the mean age is 14 years. So, 9 grade, 14 years old. And the average time to follow
up was about a little bit, two and a half years.
So what we are going to see here is time one is preintervention. Time two is post intervention.
So, 14 weeks after the program, after going through the program. And then time three is,
again, about two years after they left the program.
And what we are seeing here is improvement in their social skills. So here, greater scores
indicate better social skills. So we are seeing across the three time points, the teens are
consistently increasing in their social skills, and all these results were clinically significant.
So they are going from the below average range to the average range in their social skills.
When it comes to their problem behaviors, we are seeing similar results. But this time
we want problem behaviors to go down. And what we see here is at preintervention at
time one, they were just below the elevated range when it came to problem behaviors, and
that has gone down across post intervention and the follow up time points. Again, this
was all statistically significant. These are the subscales for the social skills
domain. And what you see here is, again, you want the scores to go up. It indicates better
social skills. So we are seeing them improve in cooperation, assertiveness, empathy, and
self control. And then for internalizing-externalizing,
which are those problem behaviors, we want to see those go down. And we are seeing that
same trend across those two problem behavior subdomains. Okay?
Now, this is the SRS. Again, thatrquote s a measure of social communication impairments.
What we are seeing at time one is that our teens were in the severe range in terms of
their social impairments, social communication impairments. At time two, they are in the
mild to moderate range, right? And at time three, they are staying in the mild to moderate
range. So we are not, you know, curing autism, but
we are pulling them down from a severe to a mild-moderate range in regard to their ASD
symptoms. And that was statistically significant. And when we are looking at the subscales,
again, we are seeing a trend in that they are again improving in their social awareness,
social cognition, communication, motivation and autistic mannerisms that really gets to
repetitive behaviors and restricted interests. And we are seeing autism that improve over
the three time points. And when we look at the quality of the number
of get togethers, we are seeing that at time one, they are having about two get togethers
a month, right? At time two so after the group nthey are having about, per parent report,
which is blue, parents are reporting about four get togethers a month. Our teens are
reporting about almost six get togethers a month. And at time three, which is about two
years after treatment, they are reporting four get togethers a month.
Now, I know that might seem low, but that is a significant increase from time one. But
also at the end of groups, we recommend that our families continue to have one get together
a week, which is what they are doing. So they are following our recommendation.
You guys might wonder in time two why thererquote s a discrepancy between parent and teen report.
We kept them with our teens, and our teens said they were hanging out with their friends
and not telling their parents, which is actually pretty cool. So we want to be seeing that.
Okay. par And then finally, this is just a measure
that we us e just to make sure our teens have learned
the material. And what we see is that at time one, they were about 50/50 in knowing ecologically
valid social skills. At time two, they learned about 80% of the material that we presented
to them. And at time three, about two years, they still maintained about 70% of information,
which is actually great. And it’s not just because they were in a fourteen-week-long
program, right? We are a very short-term. Itrquote s really the parents. The parents
are continuing to social coach them, to have get togethers, and they are coaching them
in all these different strategies and skills. So the parent piece, it really is critical
component of this intervention. Okay? par Now just for other resources. For our
peers clinic, we do run three groups. We run a lot of groups during the week. So we have
our preschooler group on Tuesdays. At this time it’s limited to children between the
ages of four-six, and only with ASD. For our adolescent groups, it’s not by age necessarily,
but more about social landscape. So it’s for our teens who are in middle school and high
school. So we have teens as young as 10 in that group,
but also as old as 18, within one group. And the reason why we can do that is that we tell
our teens, yourquote re not here to make friends with each other. We actually don’t
allow our teens to hang out with each other during the course of the program. We say you
are here just to learn the skills. If you guys want to hang out after the program is
over, you guys can definitely do that. And so we have an ASD-specific group, but
we also have a general clinic group for our adolescent group. So this is where we might
see teens who ASD but look more neurotypical. And we also, in that group we have teen
s with ADHD, depression, anxiety, or maybe in disorder but they are just struggling socially.
And then we have a young adult group, which we are serving young adults between the ages
of 18-30. So you have to graduated from high school to be in this group. And even though
it says it’s limited to ASD, we actually take in young adults without an ASD diagnosis.
So depression, anxiety, that’s appropriate. In terms of those of you interested training
or using this intervention in your clinical work, this is a published manual, so you can
purchase this manual. There is also the school-based manual here that has all of our recent modifications
that we have made. But there is also a certified training, which you don’ t have to attend
to use the manual, but it is available to you. It’s a three or four-day long training
that is held at UCLA. We also have several training resource scholarships, for those
of you who maybe are interested in doing this as part of your dissertation or master’s level
research work. You could apply for a research scholarship. And we give about two-three for
each training. So thatrquote s something to think about if you are interested. And
this is our school-based manual, talked about this a little bit. Again, for middle school-high
school students, 16 weeks long. And it’s a daily lesson plan. But it’s really flexible,
so it depends on how you are able to implement it into your school setting. And it is teacher
facilitated, but parents can be involved if the teacher if the parents were willing to
maybe come to a separate group once a week. That would be ideally how peers would be implemented
in the school setting. Again, we go over those friendship skills, peer conflict skills, and
you have the comprehensive parent handouts. And a newest one of the newer resources is
this parent book, which is a translation of our peers manual that we use. And Dr. LAGESON
wrote this, because there were teens or families who weren’t able to access our program, because
they lived too far away, but also because the teens were not motivated to be in the
program. Now, that is also what makes us different from other social skills groups out there,
in that if the teen says they are not motivated or they are here because their parent is making
them come, the school is making them come, the doctor is making them come, they actually
do not allow them to join into the group. The teen has to say they are at some level
motivated to either make new friends or change something in their friendships.
So again, that’s also why this program works. It’s because we do have a motivated population
that we are getting to work with, and they are a delight to work with when you get to
work with such a motivated group of teens. So in this parent book we go over all the
same strategies. There’s a parent section, and it goes over the lessons, as well as specific
social coaching tips. And each parent section is followed by a section for teen and young
adults to read. So it kind of breaks down the information a little bit more. It goes
over various homework assignments that they want to practice. And at the end the book
there’s actually a companion DVD. So the DVD, the role play videos that you
saw here, it’s actually part of a DVD that is in that book. And so they can look at,
watch the skills, and see what it looks like. And this was also developed in conjunction
with an app that we created. And that was part of a virtual coach research study. The
app is called friendmaker. And we developed this app to see if having this extra level
of support would be helpful to teens and young adults.
Because oftentimes, parents aren’t there, nor should they be there when they are hanging
out with their friends necessarily. Or if they are at school, they want to join a conversation
and they forgot the skills, they can pull it up on their phone to see all the steps.
If they are able to, they can watch a quick video. So that’s an extra resource. It’ s
called friendmaker. It’s only available on apple platform, but itrquote s 99 cents,
so its a great resource to have for our teens and young adults.
Okay. So thanks for listening. If you have any questions, you can always contact our
clinic there. Facebook is a great way. It helps to, I think, make us as a treatment
team very human to our teens and young adults. So if you have ]if you are interested in doing
this, it’s a great way to kind of get to know our clinic more.>The UC Davis MIND Institute was created
in 1998 with a promise to find cures for neurodevelopmental disorders. Every day our physicians and researchers
come closer to fulfilling that promise. Their groundbreaking research on autism, fragile
X syndrome, chromosome 22Q11.2 deletion syndrome, ADHD, and other brain disorders are helping
children achieve their fullest potential. Please visit our website to find out more
about current studies, upcoming events, and how you can help make a difference.

Author: Kennedi Daugherty

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