Friday, May 05, 2017

101 Ways to Teach Social Skills - Neurodiversity Comments (Activities 1-21)

Recently I posted a list of neurodiversity-friendly ways to teach an autistic kid. Later, I came across this list of 101 activities for a social skills group, and was inspired to write up comments on how to modify those activities to be more respectful of neurodiversity and overall more useful to the children.

First, a few general principles:

It's important to keep in mind remediation, compensation and accommodation. If a child struggles with a certain skill, there are three main ways to help them. You can target weak skills directly, target strengths in alternative skills to accomplish the same purpose, or teach them to modify their environment or use an external tool to help them get around that skill they lack. It's important not to overemphasize remediation alone.

Secondly, self-advocacy is crucial, especially if the child needs accommodation. It's important to build their confidence and feelings of self-worth, and to help them understand what they need and how to communicate that to others.

Thirdly, examine the reasons behind a behavior. Sometimes, it's simply that the child hasn't learnt the typical behavior (eg, a child might grab objects because they don't know how to ask nicely). But other times, the kid has a very pressing reason to act the way they do, such as compensating for a sensory issue (eg overload triggered by eye contact), a motor problem (eg poor balance can cause strange posture), or other issue. If a Deaf child insisted on you looking at them while talking to them, it would be pretty easy to understand why. Just because neurological differences are harder to understand doesn't make the needs that result any less real.

Lastly, we tend to think of poor social skills as a generalized difficulty with all things involving figuring out other people. However, my reading of the research suggests that there are a pile of separable skills under that general category. Among adults with brain injuries, distinctions can be found between theory of mind and social perceptual skills, between cognitive theory of mind (inferring what someone believes by their experiences) and emotional theory of mind (inferring how someone feels by their experiences), between facial expressions, body posture, gestures and vocal cues, between reading emotions in the forehead versus the mouth, and even between specific emotions such as sadness, fear and anger.

Although studies of autistic people as a group find difficulties in all of those areas, this doesn't necessarily mean each individual autistic person has the same level of difficulty in each area. When we look at other developmental disabilities, they definitely don't have uniform difficulty in all of those areas. This uneven performance is useful for compensation strategies, since we could build on their strengths.

Lastly, keep an eye on the future. What's fine for an 8 year old may not be fine for a 16 year old. Conversely, some things are not really necessary for adults but may be expected of children (eg, eating what someone else tells you to eat). Children who are slower to learn social skills will also be slower to adapt to changes. And there's no real point in teaching a child something you'll have to un-teach later, especially if it's something they find really difficult.

And now, I'll start discussing each activity.

Section 1: Communicating

Activities 1, 2 and 3 sound like great activities. They focus on helping kids show off to the group what makes them unique - sharing interests, values and strengths with the group. All of these activities are great as they are, but activity #1 could be made even better if you worked in a body positivity exercise (sadly, body image concerns are extremely common even in young children) by asking them to list appearance traits they like about themselves, rather than choosing appearance traits at random. Be prepared to help a child if they have a lot of difficulty finding good things to say about themselves.

Activity #4 teaches polite greeting. This one is problematic because it requires eye contact. As I found in my recent survey, a substantial subgroup of autistic people have problems with eye contact, ranging from increased difficulty concentrating while making eye contact to feeling anxious even when someone else looks at them. Impairing one child's ability to concentrate or causing them acute anxiety isn't worth the benefits of making eye contact while greeting someone new. Therefore, eye contact should be optional.

If you notice a child avoiding eye contact in this activity, explore with them whether they can handle looking elsewhere on the person's face (such as at their mouth). My Mom and I tested it out, and at a normal conversational distance, she couldn't tell if I was looking at her eyes or her mouth. However, some kids can't handle even looking at someone's face, and that should be respected. One warning, though: adolescent boys who struggle with eye contact should be warned to avoid looking at a girl's chest instead!

In addition, activity #4 mentions the option of a handshake. This can be a problem for kids with tactile sensitivity. If you choose to suggest handshakes, model how a child can politely refuse to shake hands while still offering a friendly greeting.

As the first activity with sensory concerns, it would be a good idea to take this time to introduce the idea that you want them to tell you if you ask them to do something they aren't comfortable with. It's possible you may be helping children who have previously been pressured into ignoring sensory needs for the sake of appropriate behavior, so some children may assume they have no option but to do it regardless of the discomfort it causes.

Activity #5 revolves around having each child introduce themselves to the class so they can learn each other's names. I see no major problems with this activity, but it's important to remember that for children with prosopagnosia or other similar difficulties, learning to recognize classmates by name may not be a realistic expectation. In severe cases, prosopagnosic individuals can fail to recognize immediate family members, or even their own reflection. Even in milder cases, it can take years of regular interaction before a prosopagnosic child can reliably recognize an individual.

It may be useful to give the child advice on compensatory strategies such as noticing hair, movement patterns or voices. They could learn to listen for a person being called by name and take note of who responds and what they are wearing. For milder prosopagnosia, taking a little extra time to study a person right after being introduced can help, so you could ask the child, after putting their name on the board, to pause and wait for a moment in front of the class. (Although some children might find being the center of attention anxiety-provoking, so flexibility is important.) Nametags can be a big help, though some children may have sensory issues with wearing nametags. Assigned seating can also be helpful.

In addition, children with prosopagnosia should be taught to warn others when it's likely that they might need to recognize them. For example, if they're planning to meet someone in a public place, or are being introduced to someone they will probably meet again. I've found that warning people I will have trouble recognizing them makes things go a lot more smoothly.

Activity #6 involves each person greeting the person next to them and giving a detail about themselves. It has handshakes and eye contact, which as described above should be optional. It could also be extremely challenging for a prosopagnosic child. Consistent seating will help a great deal here.

Activities 7 & 8, which both involve figuring out stuff about other children, both look great to me. I have no concerns with them.

Activities 9 & 10, giving and receiving compliments, are mostly fine, except for the mention of appearance. There are a number of problems with appearance compliments. First, for children with body image issues, receiving or overhearing appearance compliments can potentially be triggering. Secondly, once children reach adolescence, complimenting the opposite sex on appearance is considered inappropriate in non-intimate circumstances (especially a boy complimenting a girl). Complimenting secondary sexual characteristics such as breasts is especially inappropriate. Even if children are nowhere near adolescence, it's better not to teach a behavior you'll have to un-teach later on.

Section 2: Nonverbal Communication

Activity #11 focuses on tone of voice. This is generally a good activity, however for some children, this will be an insurmountable challenge. It may be useful for a child to learn to warn people that they have trouble reading tone of voice. In addition, if a child has a particular weakness in reading tone of voice, but other nonverbal cues are easier, it may be more effective to focus practice on their strongest nonverbal cue reading, because most messages are communicated multimodally. Just like Deaf people learn to focus on facial expressions, and blind people on tone of voice, people with specific difficulties with certain nonverbal cues may learn to compensate.

Activity #12 looks good, but actually controlling the volume of their voice may take a lot of intensive one-on-one practice in realistic contexts for some kids.

Activity #13, teaching eye contact, is terrible. Instead, children who struggle with eye contact should be taught to look elsewhere on their face if possible, or if not possible (do not pressure the child!) they should be taught other ways to show they are paying attention, such as nodding or saying ‘uh huh’ periodically, and to respond to requests for eye contact with self-advocacy. In addition, some children may find eye contact from others uncomfortable, so the activity of having someone stare nonstop at them may provoke intolerable anxiety even if they aren't looking back. Tying eye contact to caring could be emotionally damaging if the child needs to avoid eye contact for their own well-being. Essentially, to be appropriate for children who avoid eye contact, this activity would have to be modified to the point of being unrecognizable.

Activity #14 is mostly good, but looking at their face should be optional. Some children can follow facial expressions with brief glances or peripheral vision, so training them on facial expressions is still beneficial. Some individuals find even looking at pictures of eyes anxiety-provoking (in this Wrongplanet thread, one respondent found the Mind in the Eyes test stressful for this reason). However, cartoon faces are probably fine for the majority of kids with eye contact issues.

As described above, some kids may also find this insurmountably difficult. Children with prosopagnosia may be especially likely to have face-specific emotion recognition issues, since facial identity recognition and facial expression recognition are controlled by closely interconnected brain systems. For these kids with general face processing issues, it may be useful to teach them to focus on non-facial cues a lot more.

Activity #15, teaching children to recognize common gestures, looks completely fine to me.

Activity #16, focusing on the concept of personal space, looks good. Keep in mind that children with tactile sensitivity may need a larger personal bubble (and self-advocacy skills regarding their bubble). In addition, children with depth perception difficulties may not be able to judge their distance from another person. They could use external cues such as floor tiles or wall fixtures (make sure to teach generalization for multiple situations), or else simply avoid “chasing” if the person moves away.

Activity #17, teaching children when it's okay to touch others and when it's not, looks great. I especially like the questionnaire on the accompanying worksheet, which could be quite educational for understanding a child with tactile issues. I would prefer if this activity also included some instruction on how the children can defend their boundaries if touched in a way that makes them uncomfortable. Not only is this a valuable self-advocacy skill for children with tactile issues, it's also an important sexual abuse prevention strategy for all children. Since children with disabilities are at higher risk of abuse, this is a very important lesson to learn.

Activity #18, teaching children the meaning of various postures, looks fairly good. However, it's important to remember that hypotonia, balance problems and other motor difficulties are common among kids with social disabilities, and can make certain posture uncomfortable or unsustainable for the child. Remind the class to let you know if certain poses are a problem for them, and work with them to find an alternative that conveys the same message. If you can't find something workable, it's time to teach self-advocacy skills.

Activity #19 discusses body language in general. I have concerns about telling children that "93% of communication is nonverbal". Firstly, I seriously doubt that's true - if a person is unable to speak (or doesn't share a common language with their communication partner), does it seem likely that they could get across 93% of their message anyway? And more importantly, for a child who knows they struggle with nonverbal communication, telling them that is very disheartening.

Activity #20 reviews the various ways that people communicate emotions nonverbally. It's a great activity, and since you call upon children to provide each component, you could strategically call upon any child with significant skill scatter in these skills so they get to show off their strengths rather than their weaknesses.

Activity #21 discusses clothing choices. It's good information to know, but it's important to note that sensory issues (particularly tactile sensitivity) and motor issues (fine motor struggles, needing shoes they can walk safely in, needing to cross their legs or lift them up, etc) can constrain clothing choices as well. It may be useful to discuss these practical concerns in class.

That marks the end of section 2. I'm going to take a break now. The next post will start with section 3: being part of a group.


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