Connect: A Social Skills Support Group For College Students With Asperger’s Syndrome:

1. Connect: A Social Skills Support Group For College Students With Asperger’s Syndrome: Insights and Lessons Learned Deborah Wright, Ph.D. and Hannah Bush, M.Ed. University of Missouri - Columbia

2. True Confessions Learning Objectives!!! • 1. Four areas that could be of benefit • 2. Three social skills • 3. Three group norms/guidelines • 4. Two lessons learned You don’t know what you don’t know

4. Overview • Prior Experience and Impetus • A bit about Treatment for ASD • Structure, Content and Process • Case Study • Evolution, Insights and Lessons Learned Goal: To leave you with a sense that you were a fly on the wall during this group.

5. Impetus • Assessment and Consultation Clinic • Thompson Center for Autism and Neurodevelopmental Disorders • Student Health Center • Crisis walk-in • Campus Judicial Hearing

6. Research Findings: Asperger’s Syndrome • Most helpful resources: • The Complete Guide to Asperger’s Syndrome (Tony Attwood, Ph.D.) • Cognitive-Behavioral Treatment of Asperger’s Syndrome (Valerie Gaus, Ph.D.) • Preparing for Life (Jed Baker, Ph.D.) • Areas of clinical presentation that can be addressed: • Reading nonverbal behaviors • Social inference/Knowledge of Social Norms/Social Reciprocity • Emotion regulation • Executive functioning (e.g., problem-solving, time management)

7. This Emotional Life clip (PBS) • http://www.youtube.com/watch?v=QWY3ntr3sdI

8. Research Findings: Treatment • Process • Therapy in short intervals • Structured, skills-focused • Need time to process • When overwhelmed, teach deep breathing • Provide autonomy on choice of topics • Skills-streaming: Didactic, Model, Role play…Practice, practice, practice!

9. Research Findings: Treatment • Content • Focus on increasing instrumental skills, fund of knowledge about social norms, and social cognition • Social skills menu: Starting a conversation, maintaining a conversation, deepening friendships, etc • Cognitive-behavioral therapy as treatment of choice for co-occurring mood and anxiety

10. Connect: Treatment Goals 1. Improve Social Skills 2. Improve Emotion Regulation 3. Increase Support Network

11. Materials • Developed detailed handouts on: • Conversation Skills • Emotion Management • Social Norm Descriptions

12. Conversation Skills • Compliments • Disclosure: including disclosure of diagnosis • Forming friendships • Expressing and reading welcoming and unwelcoming cues • Greetings and farewells • Starting conversations • Sarcasm versus genuine expressions • Attending, Asking and Telling • Conversation Repair

13. Emotion Management • “How to Deal” Handouts: • Anxiety • Frustration • Sadness/Depression • Cognitive Distortion Lists • Asking for what you need • Problem-solving • Diaphragmatic breathing

14. Social Norm Descriptions • “Unwritten Codes” • Roommates and Res Hall Advisors • Developing friendships • Dating • Working in groups • Misunderstandings and disagreements

15. Group Format • One hour, 9-week course • Basic structure: • Small talk • Mindfulness Meditation • Didactic • Practice in small group or dyad • Individual work time • Group discussion • Mindful Meditation at closing • Blackboard System

16. Interventions/Techniques • Meditation/Diaphragmatic breathing • HRV Biofeedback • Slowwwww the process! • Allow time to write out thoughts • Prompting when they give non-verbal cues • Identifying relevant content • Modeling • Use of Humor • Playful games

17. Social Norms/Guidelines • Confidentiality • Respect • Participation • At individual pace • Manage monologuing • Peace sign

18. Recruitment • Office of Disability Services • Student Services Coordinator • Screening • Length of time • No formal diagnosis • FS: N=5, SS: N=7 • Age: 18-28 • Dropout

19. Case Study, Insights and Lessons Learned • Summary: • Didactic, skills-building versus interpersonal • Experiential • Anxiety • Content/Process • Connection

20. Group 1: FS 2010 • Topic: Deepening relationships • Intervention: • Didactic • Disclosing personal information • Compliments • Group Discussion

21. Observations • High anxiety • They came anyway! • Called a “spectrum” for a reason • Facilitators “getting caught up in their own thoughts” • Theme: interpersonal skills are complicated!

22. Group 2 and 3: FS 2010 • Topic: • Meeting new people • Managing Anxiety • Intervention • Didactic, Modeling, Thought logs, Dyad discussions • Blackboard • Introduced possibility of having small group discussions at next group

23. Observations • Stuck in rumination (blackboard example) • Facilitators’ anxiety • “I found it really difficult, but I also think it was useful.

24. Group 4: FS 2010 • Topic: Thought logging with emphasis on disputing and active listening skills • Intervention • Individual logging • Modeled active listening • Group game • Blackboard • Robust discussion regarding disclosing ASD diagnosis

25. Observations • Games and humor reduced anxiety • They were engaged in a genuine, authentic way • Need for flexibility

26. Group 5 and 6: FS 2010 • Topic: What is it like to have ASD? • Interventions • Lily • Group Discussion

27. Lily: Comfort Dog

28. Observations • Histories of bullying • Level of pain and trauma related to bullying • Genuine desire and ability to connect • Feeling misunderstood • Humor helps alleviate anxiety • Genuine, empathic connection during this group • B’s quote • Facilitators were totally confused

29. Group 7, 8, 9: FS 2010 • Topic: Clarifying and maintaining conversations • Interventions • Group game • Ambiguous statements • Pointed out assumptions • Individual work • Writing how they would say to professor and a friend • Themes: Clear safety and trust was established

30. Group 1 and 2: SS2011 • Topic: Introductions and Emotional Bids • Interventions • Mindful observer exercise • Dyads • Didactic re: CBT • Group discussion

31. Group 3: SS2011 • Topic: SFBT • Intervention • Started with longer meditation • Group discussion • Theme • Facilitators slowed the process • Decreased anxiety • More disclosure • Blackboard • More disclosure on blackboard this week

32. Observations • Affect appropriate to content • Eye contact • Facing facilitators • Subtle nonverbals • Slow process • Most poignant • Great depth of sharing • All were clearly touched

33. Group 4: SS2011 • Topic: Relaxation • Intervention • Autogenics Exercise • Group discussion • Theme • Autogenics was useful for most

34. Group 5: SS2011 • Topic: Connecting • Intervention • Brief Autogenics exercise • Individual writing • Dyads • Group discussion

35. Group 6 and 7: SS2011 • Topic: Self-exploration and connection • Intervention • Autogenics Exercise • Mini-SPIN • MBTI-type inventory • Didactic • Dyads • Theme • Connection

36. Observations • Hitting the balance of content and process • Giving them something meaningful to discuss • Controlling anxiety • More time for information processing Highly engaged!

37. Group 8: SS2011 • Topic: Stress management • Intervention • HRV Biofeedback • Group discussion • Reminder closing Blackboard • Theme

38. Lesson Learned #1 • Managing anxiety is key. • Interferes with information processing and response time. • Facilitators need to manage high level of anxiety. • Interventions • Starting and ending with mindful meditation • Autogenics • HRV

39. Lesson Learned #2 • Balance between process and content is encouraged by: • Slowing the process • Responding to nonverbals • Using mindful meditation and other relaxation skills during the group • Offering some ideas for relevant discussion: • Disclosing ASD diagnosis • MBTI • Bullying

40. Lesson Learned #2 Use of various modalities • Individual time to reflect and write • Dyads • Group • Games within group and humor • Role play by facilitators • The balance of process and content helped with meaningful social skill practice of: • Disclosures • Showing verbal/nonverbal empathy • Turn taking, mutual dialogue

41. Lesson Learned #3 • Be flexible: Remember, it is a spectrum. • Tailor content to feedback from group members • Blackboard • Within group • Need for facilitators to take risks • No expectations for change: embrace them for all of their wonderful uniqueness

42. Lesson Learned #4 • Blackboard is an important tool • Specific problem-solving assistance • Building safety • Getting to know each other • Reduced anxiety: Online practice

43. Lesson Learned #5 • Genuine desire for authentic connection in tolerable doses • Willingness to self-disclose • Willingness to tolerate very high levels of anxiety • Enormous capacity for empathy Exceptionally rewarding professionally

44. Most Useful Skills Learned • Controlling breathing rate has as large effect on stress level • Breathing—deeply and slowly (learned through biofeedback) and thought-logging • The biofeedback exercise was beneficial. • Biofeedback-Relaxation skills, importance of heart rate variability, visualization meditation (forgot the name) • Sleep does not equal relaxation • Ways to respond to social engagement gave me a different perspective for thinking about social interaction • I learned how to better judge the motivations of others, how to open up more, and how to react appropriately in society. • I got better at asking questions when talking with someone, I learned how to breathe to relax me more, and I have gotten better at carrying on a conversation • Ask questions,, just because I think of something to say doesn’t mean I have to say it every time

45. Most Beneficial • The games aimed at clarifying and practice conversations. • The small group size: I was more comfortable. • Blackboard part of it was very helpful. • Support from group members and leaders • Being asked our preference and made sure to accommodate us. • I loved the discussions we had in session and thought the teaching was excellent as well.

46. Most Beneficial • I really appreciated doing the Myers-Briggs personality inventory. I have heard many social skills group try to “change” participants and make them be more social…so I thought the acknowledgment of the different personalities, some more introverted than others, was excellent!! • Any time we got a chance to talk amongst ourselves (typically during the 1-on-1’s) • Also blackboard helped me talk to people. Also just the one on one talking with someone helped me improve my speaking skills. • Some of the group talk sessions got me to open up more • It was a relaxing break from the hardships of school and it was just fun to just listen to other people’s stories

47. Least Beneficial • Hmm…hard to say. One of the interactions that was more staged – we were in dyads – felt a little forced. Although I think I was out of my comfort zone so not necessarily that it wasn’t helpful. • The length of the group. • Longer sessions • Longer group meeting • Maybe 1.5 to 2 hour sessions just because they always seemed to end quickly.