Teaching social skills: Focusing on individuals with autism and Asperger syndrome Ireland November 2005 katarina.larss

1. Teaching social skills: Focusing on individuals with autism and Asperger syndrome Ireland November 2005 katarina.larsson@misa.se

2. Introduction • Misa • Autism and Asperger syndrome • In the workplace • Social stories • Reward systems • Other methods - Solution focused therapy - Aggression Replacement Training (ART)

3. Presentation Facts • Founded in 1994 • 7 units in Stockholm • Turn over ~3.5 million Euro/year • 70 employees • Offer support to 200 individuals • Cooperates with over 150 workplaces SL 2005-04-20 3

4. Presentation Our name • M ethod development • I ndividual Support • S ociety Orientation – social integration • A ctivity – job oriented activity in worksettings SL 2005-04-20 4

5. We know… … that individuals with disabilities are able to participate in working life with the right kind of support! SL 2005-04-20 2

6. Presentation We take for granted • Normalisation • Integration • Self determination Supported Employment/ISA • Job-matching • Misa staff learn the worktasks • 100% level of support – to be faded when possible • Real assignments • Work colleagues • Importance of participation in working life SL 2005-04-20 9

7. Presentation Our clients • Municipalities within and around the city of Stockholm • Regional social insurance offices • Unemployment offices • Employers SL 2005-04-20 14

8. Autism and Asperger syndrome

9. Autism and Asperger syndrome bild

10. Autism Autism and Asperger syndrome

11. Flexibility of thought • (imagination) • Difficulty with: • Empathy • Generalisation • Coping with changes in routine • Language and communication: • Difficulty processing and retaining verbal information • Difficulties understanding: • Jokes and sarcasm • Social use of language • Literal interpretation • Body language, facial expression and gesture • Social and emotional • Difficulties with: • Friendships • Managing unstructured • parts of the day • Working co-operatively Asperger syndrome

12. Asperger syndrome - Quote ”Suppose you’re colourblind and can’t differ between red and green. You’re in a room with other people where everyone has normal sight. No one, not even you, know that you’re colourblind. Everyone gets a list of instructions. They’re printed in red against a green background. Everyone except you know what to do. They can’t understand why you just sit there. The sheet of paper looks blank to you and you can’t understand how all the others can know what to do. Imagine how you would feel, especially if the others stared, whispered or laughed at you.

13. Fitting in Structuring the day Managing breaks and lunchtime Appropriate topics of conversation Obsessions and rituals Clothing In the workplace

14. People with AS learn social skills cognitively and analytically rather than intuitively Teaching social skills

15. Ways of teaching social skills: role playing, social stories, videotape social situations. To make situations: less intimidating, uncomfortable and unpredictable - reduce stress. To increase: the understanding of the social world – promote social inclusion. Teaching social skills

16. Marc Segar – A survival guide for people with Asperger Syndrome. “ This is a book designed to make you aware of the many unwritten rules which most people instinctively know and take for granted. When people disobey these unwritten rules, sometimes they get away with it, but usually they who break informal rules are made to suffer informal punishments. These punishments may include being laughed at, being treated as a less important person or being isolated” Teaching social skills

17. Distortions of the truth Sarcasm is when someone says one thing but means the opposite. For example, in response to hearing someone burp, someone else might say "how polite". The easiest way of picking up on sarcasm is by listening to tone of voice. You may need to defend yourself against sarcasm at times and this will be covered in following chapters. (Segar, p. 8) Teaching social skills

18. Teaching social skills From “Asperger’s…What Does It Mean To Me”, Faherty, 2000

19. Social stories What is a social story? • Developed by Carol Gray • Presents appropriate social behaviour in the form of a story. • Can be individualized to incorporate the specific needs of the person for whom the story is written

20. Social stories Social stories can • Deal with compulsions and feelings such as fear, aggression, obsessions, fixations etc. • Clarify rules, changes, norms, time etc. • Explain social situations • Make abstract social situations and theoretical knowledge more concrete

21. Describe situations in a realistic manner Describe the individual´s reactions Describe other peoples´ reactions Teach appropriate behaviour by giving alternate strategies to deal with situations Should be individualized Should be written in first-person Social stories

22. Social stories Sentence types • Descriptive sentences • Directive sentences • Perspective sentences • Control

23. Social stories Additional sentence types • Cooperative sentences • Affirmative sentences

24. What do you need? General knowledge about the disability Specific knowledge about the individual Specific knowledge about the situation/context for which the story is written Social stories

25. Social stories Individualizing the story • What to keep in mind - length of story - level of reasoning - language: avoid overload, concrete, length of sentences - context - theme • Check comprehension

26. Social stories

27. Clothing in the workplace The clothes I wear influence what people think about me. This means that wearing particular clothing make people hold certain expectations about me. For example, if I wear skimpy clothing to work, such as a very short skirt and a top with low cleavage it can attract unwanted attention from men and might make them think I am not serious about my work. It is a good idea to try to wear clothes that cover up my body and avoid bright clashing colours. Why does this not work? Social stories– what can go wrong?

28. What clothes to wear in the office When working in the office it is appropriate to dress in business casual clothing. If I wear other types of clothing my colleagues might stare at me. That would make me feel uncomfortable and insecure. Business casual clothing for women is either casual trousers or a skirt. The skirt should come at least to the knees while standing. If the skirt comes to just below the knee, a slit to just above the knee might be acceptable. Tailored shirts or blouses, tailored knit sweaters and sweater sets are appropriate business casual choices for women. The top should cover the bosom. The colours of the clothes and shoes should be neutral like for example black, grey, brown, white or beige. I will try to choose clothes according to these guidelines. I will also try to make sure that my clothes are clean and wrinkle-free. If I try to dress in this way people will think that I dress nicely and that I am professional and serious about my work. This will make me feel more confident at work and when socializing with my colleagues. If I am unsure about how to dress I can ask a colleague or someone that I trust. Social stories - individualizing

29. Social stories What to wear? Have look in a magazine and write the story together.

30. Social stories Carmen • 45 years old • South America • High-functioning autism • Co-existence of obsessions and compulsions • Special interest: chess

31. Social stories What I should think about when I eat lunch in the restaurant When I eat I use a fork and knife. (descriptive) This shows that I am eating in the correct manner. I will try to eat slowly. (directive) Eating slowly will make me less stressed, which is good for my stomach. I want my tray to look nice. This shows that I have good tablemanners. When I am finished I put my tray in the traycart. This will make the staff happy because it makes it easier for them. I put the chair back in its place when I leave. The staff is happy when they see that I behave appropriately (perspective).

32. Rewards systems Basic principles • This method is all about rewards • Realistic goal • Clear instructions

33. Rewards systems Basic principles: • What is being rewarded has to be concrete and specific. • All of the people involved have to agree on adhering to the reward system point by point. • It has to put across what the individual should do, not what he/she should not do.

34. There is a difference between a reward and a bribe Reward systems

35. Reward system Carmen’s shop Every morning after I have taken the dishes out of the dishwasher and set the table before the coffeebreak I get: 1 point If I put my dirty dishes in the dishwasher I get: 1 point If I go to the restaurant without my jacket on, eat in the correct manner and keep my plates on my tray I get: 3 points

36. Reward system Carmen’s shop If I refrain from talking about my compulsions I get: 1 point a.m. 1 point p.m. What I can use my points for: 15 points 15 min conversation with the staff 20 points 1 lunch coupon 25 points 1 extra hour on the internet 30 points 100 credits for mobile phone

37. Contract This contract is between XXXXXX and Katarina Larsson The aim of this contract is that XXXX will practice being on time at her workplacement in Topshop. This contract is valid between the 050812 – 051012. The working day begins at 9.00 and ends at 14.00 on Monday - Wednesday. XXXXX will meet Katarina outside of the staff entrance at 9.10 at the latest. Bonus points If XXXXXX is on time between 9.00-9.10 1 point will be awarded. 3 points is the maximum number of points to be awarded per week. 1 point = 30 minutes off 4 points = one cinema ticket 8 points = 1 day off Reward system

38. Important! It is not possible to use bonus points to get time off in the morning. No points will be awarded if XXXX arrives at work after 9.10 no matter the circumstances. XXXX and Katarina´s watches have been syncronized on 050812. Stockholm 050812 XXXXXXXXXX Katarina Larsson Reward system

39. Solution focused therapy Keeping things positive • Focusing on failures and inadequacies can make people feel worse rather than better. • The solution-focused way of thinking is based on the assumption that it is easier and more rewarding to create solutions instead of solving problems.

40. The solution-focused therapy method offer “tools” that you can use when conversing with the client. Ask questions about: the client’s behaviour; how people around the client react to the client’s behaviour. Solution focused therapy

41. Solution focused therapy Three basic principles • If it’s not broken - don’t fix it • When you know what works - do more of it • When it doesn’t work - do something different

42. Solution focused therapy Keep in mind • Emphasize what is healthy, the things that work • Here and now and the future • Change is always present and an unavoidable process

43. Solution focused therapy Keep in mind • Use the individual’s own way of looking at life • Cooperation • Be curious • The individual chooses what the problem is

44. Solution focused therapy Example questions 1st session • What is important for you that we talk about today? • 2. Suppose a miracle happens- what is the first thing that would be different tomorrow? • 3. When did part of those things happen last time? What was different then? Look for exceptions – i.e. situations where the problem is absent or at least not as great.

45. Solution focused therapy • On a scale of 0 - 10: • Where are you today? What has happened that made you go from 0 to X? • b. What is the least you can do to move one step further? (small goal) • c. How willing are you to do something to get to the next step on the scale (0-10)? • d. How realistic is it?

46. ART Aggression Replacement Training

47. Aggression Replacement Training Component 1: Skillstreaming • Teaching skills that serve to displace destructive out-of-control behaviour with constructive prosocial behaviour. • An intervention in which a 50-skill curriculum of prosocial behaviours is taught.

48. Aggression Replacement Training Skillstreaming - Curriculum • Beginning social skills • Advanced social skills • Skills for dealing with feelings • Alternatives to aggression • Skills for dealing with stress • Planning skills

49. Aggression Replacement Training Component 2: Anger Control Training • Each person is required to bring to each session a description of a recent anger-arousing experience, which they record in a binder. • For 10 weeks they are trained to respond to their hassles with a chain of behaviours that include:

50. Aggression Replacement Training Anger Control Training – Curriculum • Identifying triggers • Identifying cues • Using reminders • Using reducers • Using self-evaluation