Developing Meaningful Relationships among Adolescents and Young Adults with ASD and their Peers

1. Developing Meaningful Relationships among Adolescents and Young Adults with ASD and their Peers Wesley H. Dotson, Ph.D., BCBA Burkhart Center for Autism Education and Research Texas Tech University

2. Acknowledgements: • The participants, staff, and families of the KU Social Skills groups • Jim Sherman and Jan Sheldon • Andrea Courtemanche • Justin Leaf • Faculty, staff, and students of Department of Applied Behavioral Science at University of Kansas

3. Goals for today’s session • Discuss current state of affairs/importance of developing friendships and other meaningful relationships • Describe issues encountered in doing so • Provide suggestions for characteristics of support programs • Provide an opportunity for questions and discussion

4. Something to think about: • As talk proceeds, keep these two young men in mind

5. Kenny and Zane • Both 15-yr-old boys with autism • Both participated in after-school social skills group for adolescents with autism and typically-developing peers • Both easily mastered social skills taught during formal instruction with graduate and undergraduate teachers

6. Kenny: • Regularly generalized skills to interactions with peers in social skills group • Added all participants in group to Facebook, called several regularly, and invited them to outside social events (movies, bowling, etc.) • On last day of group, insisted on having picture taken with all participants and staff

7. Zane: • Rarely generalized skills to interactions with peers in group • Never attended outside events, no interaction with peers outside group meetings • Dropped out of group before end of program

8. Part 1: Context for discussion • Social skills deficits are core feature of receiving a diagnosis on the Autism Spectrum (DSM IV-TR, 2000) • What does the literature say about adolescents and young adults with autism, social skills, and building relationships?

9. Orsmond, Krauss, & Seltzer, 2004 • Interviewed 235 families with adolescent or young adult with autism • Majority (>80%) in inclusive setting or employed in community • Only 24% had relationship with same-aged peer involving social meetings or activities outside of work or classroom • 46% had NO relationships with same-aged peers • Significant predictor of presence of relationships with same-aged peers was level of social skills development

10. Longitudinal study from Office of Special Education Programs (2005) • Explored post-secondary and social experiences • < 20% with ASD reported interacting with friend once weekly • 40% belonged to community or social group of some kind • For most, over 75% of social interactions with family members and paid care givers • Involvement in organized groups strongly correlated with positive outcomes • Enrollment in post-secondary education • Increased independence

11. Few students with autism (~25%) attend any kind of post-secondary educational institution • Less than 25% of those who attend earn a degree within 6 years • Recent study suggests most common reason for dropping out is failure to develop friendships and “fit in” with peers (Barnard-Brak, Lechtenberger, & Lan, 2010)

12. Failure to develop social relationships also associated with: • Increased anxiety about social situations with peers (e.g., Browning, Osbourne, & Reed, 2009) • Other anxiety disorders (e.g., Farrugia & Hudson, 2006; White & Robertson–Ney, 2009) • Depression (e.g., Stewart, Barnard, Pearson, Hasan, & O’Brien, 2006)

13. Conclusions: • Few adolescents and young adults with autism develop friendships with same-aged peers • Quality of life and successful independence closely tied to development of relationships • Ability to develop meaningful relationships is linked with level of social skills

14. An important point about friendships for people with autism: • People with disabilities report that their friends have several characteristics (e.g., Carrington, Templeton, & Papinczak, 2003; McVilly, Stancliffe, Parmenter, & Burton-Smith, 2006): • Shared interests • Loyalty • Helping when it is requested • Spending time together • Exact same characteristics typically developing peers use to identify their friends

15. Part 2: Interventions • Describe common interventions to teach social skills • Describe interventions to develop positive relationships

16. Teaching Social Skills • A number of interventions used to develop social skills, including: • Video modeling • Script fading • Peer mediated strategies • Teaching Interactions • Virtual reality • All have successfully taught social skills

17. Recent reviews suggest generalization of outcomes remains a problem. • Matson, Matson, & Rivet, 2007 • Rao, Beidel, & Murray, 2008 • Tse, Strulovitch, Tagalakis, Meng, & Fombonne, 2007 • Williams White, Koenig, & Scahill, 2007 • Generalization most likely when peers involved, training is in natural environment, or training is carefully structured to promote generalization

18. Fewer studies explore teaching social skills to older learners relative to younger children • Skills targeted for intervention with older learners: • Conversation • Self-Advocacy • Recreation skills • Dating/Relationship skills

19. May require different instructional arrangements and considerations versus more basic social skills • More sensitive issues • More complex discriminations • “Skill” may look different based on who the social partner is OR who the person with autism WANTS the social partner to be • Class, status, and personality type also influence topography of skills (e.g., self-advocacy with a friend vs. a principal vs. a police officer) • Personal preference plays larger role

20. Developing positive peer relationships requires a different set of social skills than other social domains • Manners and politeness versus having an uncomfortable conversation with a friend • Conversation in the hallway with platonic friends versus conversation with potential dating partner

21. Teaching programs can still target more complex skills successfully • Programming must account for increased complexity • Discrimination and generalization programs become focal point of intervention

22. Building Relationships: • In addition to teaching social skills it is important to explore how and why positive relationships form:

23. Assumptions about formation and maintenance of relationships: • Positive reinforcement is a privilege, not a right. • People choose to deliver positive things to others • Relationships are governed by concept of reciprocity. • Both parties must give and receive in a healthy relationship

24. Value of a relationship is a direct function of amount of reinforcement people receive. • Relationships are strongest when people reinforce each other on a regular basis

25. Goal is to create relationships that involve the regular, voluntary exchange of reinforcers between both people

26. Teaching Family Model • Groups of adolescents live in homes with a “family” who is responsible for providing social support and structured teaching • Constant embedded and formal teaching • Widely replicated and successful teaching procedures • Most teaching focused on developing social skills and helping adolescents build positive relationships with adults

27. Provided measures of relationship strength between residents and teaching family • Proximity during free time • Joking • Asking staff opinion about things without prompting • Smiles, laughs when staff member present

28. Methods to develop positive relationships between staff and clients • Work suggests that there are ways to systematically foster relationships • Research involving staff and clients in Teaching Family Model homes for clients with DD

29. Steps to building positive relationships • Step 1: Staff member provides non-contingent access to preferred items • Approaches client and offers access to known preferred items “for free” • Waits longer before approaching client each time to set the occasion for client to approach staff member

30. Step 2: Staff member begins shaping specific approach and request responses using preferred items as reinforcers • Initially requires client to approach before delivering item • Shapes an approach response (e.g., tap on shoulder) • Shapes a request response (e.g., sign for “drink” or “toy”)

31. Step 3: Staff member shapes reciprocity by placing increasingly effortful demands on client before delivering preferred item • Following a request response, asks client to do something before preferred item delivered • Initial demands small and highly likely (“Come over here…”) • Move to larger demands “equivalent” to value of reinforcer being requested (“Please unload the dishwasher first”)

32. Results: • Clients spent more time in proximity with staff members • Clients more compliant with demands from staff members

33. Discussion: • Social skills can be taught • Involving peers in teaching can increase likelihood of generalization • Positive relationships can be systematically built • Next steps: further explore programs to build relationships and extend to peers (as both targets of relationships and teachers)

34. Part 3: Suggestions, Issues, and Discussion • Developing relationships between adolescents and young adults with ASD and their peers: • What, then, do we do? • How do we approach programming?

35. Back to Kenny and Zane • What do you think were some of the differences between the two cases?

36. Motivation: • Adolescents more likely to build relationships with preferred people • Kenny liked peers and shared many interests with them • Zane didn’t share interests with peers and thought they weren’t “cool” • Engagement: • Adolescents more willing to participate when learning environment fun/preferred • Kenny enjoyed group social games and enjoyed sports • Zane did not like many games selected and did not like playing sports

37. Relevance: • Adolescents more willing to engage in target behaviors which they see as functional and important • When teaching adolescents how to ask and answer questions to get to know a friend better: • Kenny saw skills as helping him be friends with peers in group • Zane “Why should I do this, I don’t even like these people anyway?”

38. Implications for programming: • What, if anything, could we have done differently with Zane?

39. Setting • Skills • Teaching Approach • Ownership

40. Summary: • Few adolescents and adults with autism develop and maintain meaningful peer relationships • The ability to develop relationships is closely tied to social skills development • Both social skills and relationship-building skills can and have been taught • Active involvement of participant and compatibility with peers and social environment are key to achieving generalized and meaningful outcomes

41. Thus: • Intervention and support services for adolescents and young adults with autism should: • Focus on developing the complex social skills needed to navigate various kinds of adult relationships • Provide/identify opportunities for increased participation in community activities • Teach/work where peer relationships are most likely to form for that person • Involve the person directly in their own program to increase likelihood of compatibility with goals, target peers, and desired outcome

42. Thanks for coming!