Michelle Garcia Winner and Chris Abildgaard
There is a tendency when exploring treatment options to build walls and think in the black and white. As we have moved from developing treatment with people with classical autism to exploring and developing treatments for the entire autism spectrum and related disabilities, we have to shift from thinking there is one way to treat by embracing a range of approaches to better meet the range of challenges our students and adults experience across the “spectrum.”
One’s language and cognitive abilities matter greatly when exploring methods of intervention or “treatment”. The huge shift in discussing treatment for those with “Autism” to those on the “Autism Spectrum” is really about understanding how to design programs for students with different abilities in language, cognition, sensory and perspective taking abilities.
As we now have caseloads filled with ASD students with reasonable to advanced verbal intelligence scores and spontaneous expressive and receptive language abilities we have had to move into a more sophisticated treatment approach. The treatments chosen are not only rooted in language based explanations (e.g. Social Stories®) but also need to teach more nuance and sophistication as this new generation of those we now call high functioning “ASD” are expected to merge and adapt into the neurotypical world of functioning in adulthood. Furthermore, our teaching methods need to also address a multitude of issues ranging from sensory needs to compelling mental health issues that coexist and impact the majority of our “brighter” students.
As we strive, collectively, to develop models of intervention that serve our diverse population of folks with ASD, I hope we are slowly taking down the walls and arguments about whether to use Applied Behavior Analysis (ABA), Social Thinking, Floortime®, SCERTS®, mental health supports, etc.. and instead take the best all of these programs have to offer to decide which to use and how to use them together to form a meaningful “intervention plan” that is individualized to the needs of each of our students/clients.
The SCERTS® model is a holistic treatment program that considers all aspects of the child and how best to serve the child given many different factors. As its name suggests, it explores treatment for social communication and emotional regulation by providing transactional supports. In keeping an eye on all factors that impact a student, methods of intervention and teaching approaches need to be multifaceted. Social Thinking, sensory integration, relationship development, structured teaching, use of some principals of ABA, etc to better help support and teach a student can all be considered for an individual within the bandwidth of this SCERTS model.
As we use those visible and invisible “transactional supports” within one’s environment we can explore how our programs overlap as most of the strong treatment programs now being developed for our brighter and language rich students share common tentacles. Let’s take, for example, ABA and Social Thinking. While philosophically these treatments have different core tenants upon which these treatment models differ, the actual application of these teachings for this higher functioning group are blending.
What is the first thing that comes to mind when thinking ABA? Lovaas, tokens, discrete trials? Well, you would be right…but there is more. Applied Behavioral Analysis (ABA) is the science in which procedures derived from the principles of behavior are systematically applied to improve socially significant behavior to a meaningful degree. Through systems of reinforcement, punishment and contingencies, a target behavior can be shaped, strengthened or decreased to improve one’s level of functioning. As one’s behavioral goal is met it is hoped that the external means of producing the behavior can be faded out.
A core tenant of Social Thinking is learning to acquire a new social behavior is part of a larger process. The process begins with recognizing what people think and feel about each other in different situations, and then determining the expected desired behaviors to keep others around you accepting you in their presence. The motivation for this learning comes from the desire to be socially validated (socially included) by others.
Treatments of ABA and Social Thinking Merge
As the treatment for students with social learning challenges broadened from those with classical autism to those with more nuanced social learning challenges, so have our treatment approaches.
For those who are higher functioning the everyday aspects associated with the hidden curriculum, social language peers use and most recently with the advent of various social networking sites, social roadblocks appear out of no where. With the intention of helping our students to recognize when those roadblocks are coming and how to navigate in day to day interactions without apparent road blocks, we continue to develop and implement ideas to help those who appear more neurotypical to blend into society. To do this, our guys/gals have to utilize their social thinking skills to uncover the “what, how and why” of the social behaviors that exist in certain situations. Understandably then, our treatments have had to shift to focus on more subtle and sophisticated lessons. Most notably, our treatments need to teach a process through which we engage in social decision making to choose our social behaviors; thereby teaching the students how to use various tools across their day.
Hence, our students need more explanation of social expectations and how those expectations are driven by what we think and feel about each other every minute we are in the presence of others. The core of this thinking is in the treatment approach developed by this author (Michelle G Winner) and referred to as Social Thinking®. Carol Gray’s creation of Social Stories® helped to forge this pathway as well as the work of Dr. Tony Attwood. Social Stories are included in what I describe as teaching tool within the Social Thinking.
Enlightened behaviorists, who notice that the more traditional reward system are not being as easily accepted by this more verbal and at times argumentative group, also notice that by explaining expectations to our students makes sense to them. Hence this language based approach to nuanced social behavioral intervention that encourage social thinking as part of the reason to modify one’s behavior are commonly added to the tool bag of most behaviorists working with higher functioning students. As our clever students ask why they should care about others or why it matters to others how they behave, the answers will not be found in the teachings of reward systems (e.g., if you sit quietly then you get a sticker) but more in the discussion of how we think and feel about each other and how that impedes or encourages the development of a relationship.
Yet at the same time, our younger students with social learning challenges or some of our older behaviorally challenged students need incentives for practicing what they are taught either in a small group or individual setting. They are not yet mature enough to recognize the implicit reward associated with successful social relations. Hence, the use of basic reinforcements systems helps to build motivation.
But even while providing token rewards another key is to also help the student to see how his or her positive behaviors help people to interpret him in a positive light, making them feel better about his participation. For example, if a child gets a point for coming into the classroom quietly and taking out his work, he should also be given a detailed compliment such as, “Justin, you did such a great job entering the class and getting to work, it makes me feel good when you do it that way.” In doing this we are providing verbal reinforcement in a way that will shift students towards exploring natural social emotional consequences of their actions.
Directly teaching with explicit language the social expectations, how a behavior (positive or negative) makes another person feel and how they could adapt their behavior to forge a more positive thought/emotion is central to learning nuanced social behavior. As social rules and expectations become more sophisticated with age, so should the focus of our reward systems shift from artificial (token based) to naturalistic. Keep in mind that parents are not permitted to call their young adult child’s boss or University professor to tell them to put their child on a behavior plan. If a child has not figured out by then how to sustain expected social behaviors in all aspects of the community, they will find the community is not as welcoming.
As students age up into upper middle school, high school and beyond they need to be strongly encouraged to learn to evaluate how their behaviors make others think and feel. Hence we need to transition them from powerful token rewards to encouraging them to understand that when they help to keep others feeling good, they tend to feel good themselves. We start by teaching students to be social detectives or spies in their own world. To tune into what makes them feel good or bad around others.
As with any good social thinking- behavioral program, as the reward shifts towards internal monitoring of their own thoughts and emotions as one begins to recognize how subtle shifts in their behavior can shift people’s acceptance of them. To sustain social behaviors well across settings means to actively monitor how people are thinking and feeling in those settings.
Observe your own social thinking and related behaviors you will notice the social behavioral choices you make are hinged on how you want people to think about you. The positive thoughts or at least not receiving a negative thought/emotion from another person is the reward we appear to seek and helps t to sustain our behavior regulation across adulthood. Monitor this within yourself.
The power of another’s attention focused on each, of us is an incredibly intoxicating reward. Whether people pay positive or negative attention to a child, especially for students who receive little attention at all, the fact that someone is paying attention to the student provides that student with social validation. Hence, as we work with our students we have to be highly aware that our paying attention to their inappropriate or unexpected behaviors serves as a strong social reward and can easily, accidentally reward dysfunction perpetuating the behavior we are trying to eliminate. If the student can do it wrong and receive a lot of attention, what is the point of doing it correctly and receiving little notice? They are much more validated that someone noticed they were in the room if they do it wrong!
The problem is that often our students don’t understand that getting attention in the moment for something that is unexpected/inappropriate, may work against them in the future. People have strong social emotional memories, how they choose to interact with a person over time is strongly based on whether they remember positive or negative feelings associated with the individual they are thinking about. For example, we see this a lot when Unthinkables like “Was Funny Once” creep into the brains of our guys (Superflex Curriculum by Madrigal and Winner, 2008). For the student who is receiving a lot of attention for dysfunctional behavior, they may not realize the consequences are so negative (e.g., people thinking, what a dork or that joke was funny the first time) given the power of the immediate social reward (e.g., people continue to laugh. However they laugh “at” him and not “with” him). As they sense their rejection from their peers, teachers, etc. mental health problems of anxiety and depression can creep in, exacerbating treatment further.
As social behavioral expectations shift over time, all of our social teachings have to also shift. As our students merge into adulthood they are no longer “forgiven” for their mistakes because they are children. If they are to work and live in our communities they are expected to adapt their behaviors accordingly.
Providing increased opportunities for naturalistic rewards, extinguishing negative behaviors while providing encouragement and reinforcement of positive social behaviors is the focus of all skilled care providers and should not be seen as belonging to one treatment camp or the other. It is common sense; it should be our common treatment goal. How to arrive at this goal requires consideration of a variety of factors as discussed above.
As social thinking and applied behavior analysis join forces, we have to recognize that looking deeper into the antecedents for what we construe as “inappropriate behaviors” to locate the cognitive misinterpretations a student may be experiencing is key. Treatment needs to begin at the root, helping them to better grasp the social thinking concepts associated with behavioral outcomes.
It is the reward of positive human attention and how it impacts us in the long run that ultimately is central towards developing social behaviors that help one to co-exist with others into their adulthoods. Chris Abildgaard, a consultant and behaviorist from Connecticut, and I consider thought that a Reeses Peanut Butter® is a good analogy for the shared process of social thinking and behaviorism. Social Thinking is the middle of the peanut butter cup and the chocolate on the outside represents the rewards we receive for engaging well in the total process.
So rather than argue whether a student should receive ABA or Social Thinking, instead we should continue to explore how we can merge the best ideas from both treatments into one intervention approach for our higher functioning students and continue to create new ideas in treatment for our population as it ages. Inspired behaviorists are becoming social thinkers, and vice a versa while all of us also have an eye on sensory integration, relationship development, stage of development, and mental health issues. Hence educational and clinical intervention team needs to be multifaceted. Teams need to operationally define those target social thinking behaviors and reinforce our students for using what they are taught. We can integrate these philosophies when we start to think about things like:
- What does the student do or fail to do cognitively and behaviorally that leads us to recognize his social thinking strengths and weaknesses?
- What language can be targeted as a means of teaching the core concepts of social thinking skills?
- How do core deficits in one’s social thinking impact his social behavioral skills? For example if a student is very literal, he may misinterpret another’s actions which will lead to a different behavioral outcome than had he interpreted it correctly.
- What social behaviors need to be taught in association with the social thinking concepts that are targeted?
- What motivates your student to participate in a social behavioral treatment program ?
- How frequently are we reinforcing a student for using their expected social thinking skills and related social behaviors?
- What types of visuals can we use to help remind our student of the social thinking concepts?
Let’s avoid overly simplistic explanations and decisions about providing treatment to students with complex minds. While the research data may struggle to account for these complex factors in the treatment process, that does not mean we can discount the complexity of what we call “teaching social skills” simply because it is difficult to measure.
Courtesy of Social Thinking | Source: AutismSupport Network