Tuesday, 29 March 2011

Why teaching 'social skills' doesn't work in autism

This is quite a long post, about the equivalent of 2.5 sides of A4 so you might want to get a cup of tea............

I have an article published in the UK’s SEN Magazine (issue 51) entitled ‘Adapt and Thrive’ where I put the case for prioritising the development of flexible, adaptive thinking in children with autism.  In it I share something that was shared with me recently by an older adult with autism – that his biggest challenge in life has been responding adaptively to the myriad of interpersonal challenges related to navigating the world on a daily basis.
Janine Collins from the University of Maine recently wrote a paper called ‘Socially skilled or socially adaptive – there is a difference.’  She asks a question about the transferability of ‘social skills’ that are taught as a discrete set of rules of behaviour and highlights that people without autism are able to learn and then apply rule-based ‘social skills’ because they ‘acquire ‘social capacity’ incidentally as part of growing up’.
The ‘social capacity’ that she is referring to is, of course, the dynamic intelligence that is developed in the early years via the interpersonal engagement between child and caregiver.
So – when we try to ‘teach’ social skills to people with autism, often they are able to learn the rules but then they fail to put them into practice….they don’t generalise the skills.  It would seem that learned rules of behaviour in isolation from the ability to adapt the response to the changing needs of a social situation, just don’t cut the mustard.
It’s not possible to learn alternative rules for every single variation that could occur in a social encounter – it’s probably not even possible to predict the nature of the many possible variations that could occur.  Collins tellingly states ‘It seems to be assumed that the application and adaptation will simply happen so long as the skill has been learned’.

Temple Grandin makes a similar point in her book ‘Unwritten rules of social relationships: Decoding social mysteries through the unique perspectives of autism’.  In her discussion of interventions for autism, she says ‘many programmes with a social or behavioural basis teach good/bad behaviour and expect behaviour conditioning to produce social understanding’.

And therein, for me, lies the crunch.  We know that autism is classed as a developmental disorder.  Surely the definition of a developmental disorder is that development is disordered??  If so, what would happen if we re-ordered it to facilitate the development of social understanding?  It never ceases to amaze (and frustrate) me that our approach to supporting people with autism doesn’t take account of the developmental steps that have been missed.

Over the past couple of years, I’ve noticed that there has been much more emphasis on autism research that looks at developing joint attention in children with autism.  That is definitely a good thing and a step in the right direction, but still misses out all the developmental steps that are the foundations for joint attention.

You’ll remember we looked at joint attention in a previous blogpost entitled ‘Why we need guided participation in autism education’ (11 Jan 2011).  Joint attention involves the child looking at an external object (e.g. a toy) and then looking to the partner to share their reaction to the toy.

I have a theory that the Pre-School Autism Communication Trial (PACT) (the largest ever randomised controlled autism research trial in the UK to date) didn’t achieve the outcomes that were anticipated because it looked at joint attention in isolation from all the preceding developmental steps.  Dr Gutstein once gave a good analogy about this ‘don’t run before you can walk’ approach – we can’t expect anyone to be able to solve a calculus problem without first having taught them to add and subtract.

The foundations that underpin joint attention include social referencing, role co-ordination, co-regulation, experience-sharing – all competencies (rather than ‘skills’ – I really don’t like that description) that are developed during interpersonal engagement in the early years.  In order for these competencies to be developed, the child needs to be in the right framework – the guided participation relationship (GPR).   We know (from studying the interaction of children with autism) that if the right framework isn’t in place, the interpersonal engagement can’t take place and the competencies do not develop.

That’s not to say that parents of children with autism don’t try to put the GPR in place - in autism, the child is unable to give the parents the feedback that they need to make the GPR work. When the framework that facilitates the interpersonal engagement leading to the development of flexible thinking and social understanding breaks down, it leads to a kind of domino effect where subsequent developmental steps are also then missed.

Generally speaking, humans start to talk around the age of 2 years.  However, what has preceded the development of language is thousands of hours of non-verbal communication – working on reciprocity, social understanding and paving the way for the development of perspective-taking.

Here’s a great clip of twin brothers who have taken part in a GPR, having a non-verbal ‘conversation’ (with thanks to Laura who brought this clip to my attention via facebook).

Some children with autism might babble as toddlers, but it’s more than likely that they babble to themselves, rather than babbling in a reciprocal way with a partner.  What’s great about this clip is that whilst the toddlers aren’t talking, they are communicating really well.   Toddler A babbles to toddler B, who is entranced by the babble and looks intently at his twin.  Toddler A uses intonation to emphasise different parts of his ‘conversation’.  He also uses body proximity, gesture and, I’m guessing  - although we can’t see it as his back is turned away from the camera - facial expression.

Toddler B waits for toddler A to get to the end of his babble and then does a mighty chuckle.  He also responds to toddler A’s babble with his own babble (including intonation for emphasis), gestures and facial expression. 

You can almost feel what’s happening between these two – it’s as if one of them shares something profoundly amusing and the other responds by acknowledging the hysterical nature of what has been shared and then takes it, builds on it and shares it right back with his twin to magnify their shared experience.  The sum of what they have created together is much more powerful than what they contribute singly.

These toddlers have not been ‘taught’ to respond to each other in this beautiful reciprocal way.  They have been taking part in a ‘communicative dance’ since they were born, initially with their parents.  Now they are at the stage where they can begin to communicate reciprocally with each other and have a really meaningful exchange without ever saying a word.

It’s the reciprocity and co-creation that stand out for me in this clip. 

Clearly, neither of these toddlers is consciously applying a set of rules to govern or guide their behaviour or responses.  They have developed the competence to adapt to (and build on) their partner’s social overtures.

We have come full circle back to where we started with Janine Collins.  She states ‘Social encounters are dynamic occurrences that require spontaneity, flexibility, adaptation’.

Research that has taken place in the school setting also reveals that being successful in school requires a combination of social, emotional, and academic competencies. A new analysis of more than 200 school-based social and emotional learning programs has found that such programs improve students' attitudes and behaviours, and in some cases, even boost academic performance.
"The findings highlight the value of incorporating well-designed and carefully conducted social and emotional learning programs into standard educational practice," according to Joseph A. Durlak, emeritus professor of psychology at Loyola University Chicago, the study's lead author. "Such programs do not detract from but can enhance academic achievement, while providing students with stronger skills in areas that are important to their daily lives and future functioning."
A meta-analysis of 55 published research studies reveals programs designed to teach social skills to children with autism are failing to meet their goals. The study, conducted at Indiana University, found that outcomes for social skills training were poor overall, but programs held in normal classroom settings were more likely to result in positive changes than programs held in other environments.
In terms of interventions/care programmes/support for our children and adults with autism, the way forward must surely be to re-create the conditions that enable them to become socially adaptive. This is what we (my family) are doing with our use of the intervention Relationship Development Intervention (RDI - see footage and text in previous blogposts) - helping our son, Philip to have greater flexibility in his thinking (and therefore, in his behaviour) and helping him to improve his social understanding and reciprocal communication.   

I think most of us would want to enable our kids with autism to be able both to share experience and to co-create experiences like the twins in this clip.  Without that, our emotional landscape would be pretty grey.

To learn more about RDI, please visit http://www.rdiconnect.com/


  1. Hi Zoe
    Thanks for the post, I really enjoyed reading it! Those tots are too cute for words, quite sad really to watch them and know that my child didn't do any of that! Although he is starting to do it now!! :))

  2. Wow, Zoe...

    You set the bar high! What an amazing blog.
    Is it sad that reading back through your writing it's like discovering a box of chocolates you didn't know you had...?

    I have always avoided 'social skills groups' here, thinking they seemed like a bunch of bogus promises... you just gave me a much more articulate response!



  3. Hello Valerie

    What lovely feedback - thank you.

  4. great post Zoe I saw this clip on a few peoples facebook and thought I would make a blog about it too..at some point ha..great clip!!

  5. This was a wonderful, complete, and well-articulated post!! THIS is exactly what I have been thinking for quite some time, and have struggled to get people to understand... So thank you!!!

  6. @ Kathy - great, look forward to reading your blog. Good to have a different perspective on the clip - am sure you'll spot things that I didnt :)

    @ Pia - thanks for your kind feedback. I guess I've been thinking about those issues over the last few years, talking to others about them and collecting bits of evidence along the way. Somehow it all came together yesterday. Watch out though, you might have to wait another 4 years for my next blogpost!!

  7. Hi- I came to your blog through Jane on Facebook- really interesting post....having tried other approaches, I'm really interested in starting RDI.

    Love the cute babies- I have twins too, although mine weren't quite like this as one has asd.

    I blog about autism too :)

  8. Hi Rachel

    What is the URL of your blog?

    I always wanted twins myself - must be great fun, though lots of work I imagine!