When I first meet parents whose young child was newly diagnosed with ASD, most suffer in saying the same thing: “It is very difficult to engage my child,” “I can’t get my child to pay attention to me.” And, if parents are able to “connect,” the connection is often fleeting.
While the literature is replete with considerations for developing social skills (Gates, Kang, & Lerner, 2017), little attention is given to the formation of social awareness. Social awareness as a critical domain in early intervention for children with autism is concerned with establishing the relevance of others so that children regard their comings and goings, doings, gestures, attention (gaze, point), location, mistakes, and perspective. There are a variety of platforms and strategies that can be employed to fortify social awareness so that children act and learn in relation to US; to enhance learning as a function of increased engagement. In this article, a few illustrative examples and strategies will be offered.
A Basic Strategy: Avoiding the “Explicit Reference Trap”
Much of early intensive behavioral intervention (EIBI) is directed toward establishing language abilities (Leaf & McEachin,1999; Lovaas OI. 1987, Taylor & McDonough, 1996) with an emphasis on teaching children to use and respond to specific linguistic referents (e.g., “Get the red ball”, “Put the car under the table”). While this is essential, it overlooks the need to have children also learn to use and respond to non-specific linguistic referents.
When intervention routinely incorporates and intersperses non-specific referents, as it should since this is a fundamental aspect of our linguistic practice, children are forced to consider the person speaking and not just their words.
Exercises that utilize Selection-Based Imitation (SBI) (Lund, 2004, Lund and Schnee, 2018) leverage the use of deictic terms in order to fortify social awareness. SBI can also be used to strengthen other language abilities, memory, executive function and shared and shifting attention. Below is one example of how it may be used.
Fortifying Social Awareness: Shifting Between Instruction Modalities
(this is a modified version of an exercise found in Lund and Schnee, 2018)
Setup: Pictures are placed on a wall(s). Matching pictures are placed on the child’s desk and corresponding items are distributed around the room. Child is seated at the desk; instructor is standing by the wall.
Procedure 1: Point to a picture on a wall. Present random instructions:
- “What’s this?” (Pointing to picture on the wall)
- “Touch same” (Pointing to picture on the wall child touches matching item on their desk)
- “Touch this and this” (Point to two pictures on the wall consecutively, child touches matching items on their desk)
- “Bring me this” (Point to picture on the wall, child retrieves it)
- “Bring me the (ball)” (No point)
- “What color is the car” (Pointing to car on wall)
- “What color is this?” (Pointing to item on wall)
Procedure 2: Same set-up as in procedure 1 except pictures are now placed on two different walls and items are also placed inside and outside of the room.
The exercise above includes layered demands on attention (to task and to others), working visual memory, executive function and serves to fortify social awareness. Children are required to attend to the instructor; to that which the instructor attends and to is required to track the instructor as they move about the room. By mixing instructions, children learn to switch flexibly between different kinds of instructions.
Fortifying Social Awareness: Using Ambiguous Point
The use of deictic terms can be used also to intentionally confound children in order to ensure that they learn to ‘check back’… to ‘check in’ with us in order to obtain more information. This can be achieved with the use of an ‘ambiguous point’ as illustrated in the example below:
Setup: Place several of the same items (e.g. two-three cars) very close to each other, a few feet away from the child. Stand next to the child.
Procedure: Point toward the array of cars and say, “Bring me that car.” At first the child will likely select one of the cars. When they do, say something like, “No.” We say this in order that the child will stop what they are doing and turn back to us in order get more information. This exercise requires that children learn to ‘check back’ with us in order to select the item that ‘we have in mind.’ Linguistic targets which ‘fall out’ under these circumstances might include teaching children to learn to ask, “Which one?” when confronted with such ambiguity.
Fortifying Social Awareness: Using Sequential Matching
(this is a modified version of an exercise found in Lund and Schnee, 2018)
Once a child has learned to match, we can leverage this basic ability to foster social awareness using sequential matching.
Set up: An assortment of items is placed within arms reached of the child. These items correspond to an array of pictures on the table in front of the child.
Procedure: The child is instructed to match the items with the corresponding pictures. The instructor “sabotages” the child’s ability to complete the task by removing some of the items. This forces the child to ask the adult for the matching item. (We do not use this exercise to introduce ‘requesting,’ only to bring other abilities into further use.) Thus, once the child asks for the needed item, additional abilities are ‘folded in.’
Therefore, when a child asks for the item, we can direct the child to get it by pointing to its location:
- “It’s over there.”
- “It’s under that table.”
Or we can direct them to other persons:
- “Alan has it.”
- “Mommy has it.”
- “She has it.”
Thus, we can see how various social dimensions are packed into a simple matching exercise so that children are required to refer to our point or to seek other persons out.
Fortifying Social Awareness: Spatial Considerations
Common EIBI programs such as “bring me” or “give to” can be employed to fortify social awareness and social pragmatics. For example, to fortify the relevance of others in a simple ‘bring me’ exercise, we can move from the location from which the instruction was given. This can be exaggerated so that children are forced to find us, if we conceal our location (partially or completely; concealed behind a wall or piece of furniture or even if we leave the room). Also, if you refer back to the first exercise, “Shifting instruction modalities,” the purpose of placing items on two walls in Procedure 2 is so that children are forced to track our movements stressing social awareness.
Summary
A variety of strategies and platforms can be employed to establish and fortify the relevance of others in the lives of children with autism and should be considered a critical domain for intervention. Common exercises can be used as vehicles in this effort. This article touched on only a few things to consider, but much more can be done to effectively foster social awareness in children with ASD.
Alan Schnee, PhD, BCBA-D has been treating children with autism for almost 30 years and is co-author of Early Intervention for Children with ASD: Considerations. For questions or comments, contact Dr. Schnee at as@nexusais.com. For more information go to www.nexusais.com.
References
Gates, Jacquelyn A, Kang, Erin, & Lerner, Matthew D. (2017). Efficacy of social skills intervention for youth with autism spectrum disorder: A systematic review and meta-analysis. Clinical Psychology Review, 52, 164–181.
Howard, Jane S., Sparkman, Coleen R., Cohen, Howard G., Green, Gina, & Stanislaw, Harold. (2005). A Comparison of Intensive Behavior Analytic and Eclectic Treatments for Young Research in Developmental Disabilities, 26, 359–383 Children with Autism.
Leaf, R. B., & McEachin, J. (1999). A Work in Progress: Behavior Management Strategies and a Curriculum for Intensive Behavioral Treatment of Autism. DRL Books.
Lund SK. (2004). Selection-based imitation: a tool skill in the development of receptive language in children with autism. The Behavior Analyst Today. 5, 27–38.
Lund, S. K., & Schnee, A. (2018). Early Intervention for Children with ASD: Considerations. Infinity Publishing.
Lovaas OI. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
Taylor B.A, McDonough K.A. (1996). Selecting teaching programs. In: Maurice, C., Green, G., & Luce, S. C. (Eds.) Behavioral Intervention for Young Children with Autism: A Manual for Parents and Professionals. (pp. 63–177). Pro Ed.
