Abstract
Individuals diagnosed with autism spectrum disorder (ASD) have qualitative impairments in social behavior. These impairments can range from intolerance of peers to a failure to develop meaningful prosocial relationships. Failure to develop appropriate social behaviors can result in some serious negative outcomes such as depression, loneliness, being bullied, and thoughts of suicide, while the development of appropriate social behavior correlates with positive outcomes such as better school performance, developing friendships, and a higher quality of life. Thus, it is important for researchers to evaluate ways to assess social behavior, measure social behavior displayed by individuals diagnosed with ASD compared with their peers, and evaluate interventions that improve social behavior. This handbook was developed to address these areas (i.e., assessment, evaluation, and intervention) of social behavior as it relates to individuals diagnosed with ASD. The introductory chapter goes over the importance of social behavior, resistance in addressing social behavior, and describing what information is included in the handbook.
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In 1943, Leo Kanner wrote a paper describing 11 individuals exhibiting behaviors we now know are distinctive features of a diagnosis of autism spectrum disorder (ASD). Within his description, Kanner (1943) outlined social deficits that were commonly displayed by the 11 individuals whom he was observing. For several years, ASD has been included in the Diagnostic and Statistical Manual of Mental Disorders (currently in its fifth edition; DSM-5, American Psychiatric Association [APA], 1980, 2000, 2013). Although there have been changes to the diagnostic criterion of ASD over time, a consistent hallmark of the diagnosis has been a lack of appropriate social behavior (e.g., APA, 1980, 2000, 2013; Yaylaci & Miral, 2017). Furthermore, some professionals have stated that the lack of appropriate social behavior is the primary diagnostic feature (e.g., Soto-Icaza, Aboitiz, & Billeke, 2015).
What is known today is there is a wide range of deficits observed in social behavior for individuals diagnosed with ASD (APA, 2013). These deficits include social language (Tager-Flusberg, 1981), emotional behavior (Baron-Cohen & Wheelwright, 2004), play skills (Taubman, Leaf, & McEachin, 2011), and a failure to develop meaningful friendships and prosocial relationships (Bauminger & Shulman, 2003). It is also known that there is an increasing prevalence in the number of individuals who will be diagnosed with ASD (Centers for Disease Control and Prevention [CDC], 2006; Newschaffer, Falb, & Gurney, 2005). This increasing prevalence makes it even more important for researchers to conduct studies which evaluate social deficits, identify the best ways to assess social behavior, and evaluate efficacious intervention strategies to improve social behavior of individuals diagnosed with ASD. The increasing prevalence of ASD will also make it imperative for practitioners to implement the most effective interventions to help improve the social behavior of individuals diagnosed with ASD.
For several years, my colleagues and I have strived to disseminate the importance of teaching social skills for individuals diagnosed with ASD and conduct research on social behavior as it relates to individuals diagnosed with ASD (e.g., Cheung, Schulze, Leaf, & Rudrud, 2016; Kassardjian et al., 2013; Oppenheim-Leaf, Leaf, Dozier, Sheldon, & Sherman, 2012). We have accomplished this through conducting workshops (e.g., Leaf & Streff, 2009; Taubman, Leaf, McEachin, & Leaf, 2012), presenting at conferences (e.g., Leaf, 2015; Milne, Leaf, Townley-Cochran, Leaf, & Oppenheim-Leaf, 2015), and authoring curriculum books (e.g., Taubman et al., 2011). Unfortunately, we have encountered resistance from parents and professionals for prioritizing social skills interventions as part of a comprehensive curriculum for individuals diagnosed with ASD. A common statement we typically hear is, “students with autism are not social.” In my clinical and research experience , it is not that individuals diagnosed with ASD are not social or that individuals diagnosed with ASD do not desire to be social with their peers. Rather, it is that individuals diagnosed with ASD do not display appropriate social behavior (e.g., Leaf et al., 2016), and these deficits should be specifically targeted as part of comprehensive intervention.
Another reason we have found that social behavior is commonly not prioritized as part of comprehensive intervention is a heavy focus on other skills such as language development (Sundberg & Michael, 2001), reduction of aberrant behavior (Wunderlich & Vollmer, 2015), and academic priorities (e.g., Stasolla et al., 2016). Within many clinical settings, one of the primary goals is determining the function of an individual’s aberrant behavior and reducing these aberrant behaviors (e.g., Santiago, Hanley, Moore, & Jin, 2016). Although we agree that interventionists should address aberrant behavior as part of comprehensive program, especially when aberrant behavior interferes with learning (Koegel, Firestone, Kramme, & Dunlap, 1974) or will result in missed opportunities for social interaction (Taubman et al., 2011), this should not preclude teaching social behavior . Within many clinical settings, another common target is improving language. Although we agree that it is important to improve language for individuals diagnosed with ASD, this also should not impede teaching social behavior.
We commonly encountered the desire for professionals, and sometimes parents, to teach academic skills (e.g., math facts) at the expense of teaching social behavior. The tendency to focus on other skills (e.g., language, aberrant behavior, and academic skills) in clinical settings parallels the trends observed within the research. For example, research on functional behavioral assessment/functional analysis and reducing aberrant behavior is one of the most commonly studied methodologies today (e.g., Hanley, Iwata, & McCord, 2003). There is also a tremendous amount of research on developing and improving language (e.g., Johnson, Kohler, & Ross, 2017). Finally, there are several studies that have focused on improving academic behaviors (e.g., Kelly, Axe, & Allen, 2015). Although there has been an increase in the number of studies teaching and evaluating social behavior as it relates to ASD (e.g., Matson, Matson, & Rivet, 2007), the amount of studies are far fewer compared with the areas mentioned above.
My colleagues and I understand the parental desire for their children to learn the language and academic skills that their peers are learning. We also understand the tremendous pressure that teachers and school administrators are under to ensure that students meet individual educational plan objectives and state standards. However, it remains unclear why these skills are consistently prioritized within interventions over social behavior. In our opinion, social behavior can lead to meaningful outcomes, and it is unclear if prioritizing academic goals will lead to the same meaningful outcomes (Ayres, Lowrey, Douglas, & Sievers, 2011). As Dr. Peter Gerhardt commonly informs professionals, we have to ensure that we teach functional skills that will lead to meaningful outcomes for individuals diagnosed with ASD, especially as they become adults (Gerhardt, 2016).
Another common argument for not targeting social behavior for individuals diagnosed with ASD is the potential to destroy that student’s individuality (Devita-Raeburn, 2016). Many believe that by teaching social behavior, we minimize uniqueness, alter personalities, and force conformation of societal norms (Devita-Raeburn, 2016). We acknowledge that every individual is unique and we want them to grow up to be comfortable with who they are; however, this does not mitigate the need to teach social behavior.
Ultimately, individuals diagnosed with ASD often do not realize what opportunities they may miss through a lack of social skills. Moreover, individuals diagnosed with ASD often cannot provide assent for the direction of programming. As such, a parent or guardian provides consent. Deciding not to prioritize and develop social skills can lead to life-altering negative consequences. Alternatively, learning these social skills can lead to life-altering positive consequences . Without being able to make an informed choice, it could be deemed unethical for a professional to not teach important social behaviors. Once an individual can provide assent, that individual may determine if he or she should engage in the appropriate social behavior.
Another rationale we commonly encounter for not targeting social behavior is parents saying, “We are not social ourselves. Why does our child have to be?” Often, when I hear this type of excuse I think, “Well, you are social enough to be in a relationship” and “You were social enough to have a child.” Although I would not recommend saying this to a parent, it does illustrate that parents can assent to electing to not be social, while sometimes individuals diagnosed with ASD cannot. If a parent elects to stay at home and watch TV as opposed to inviting others over to her/his house, they can identify the missed social opportunities. Parents also know the positive and negative side effects that occur by choosing not to engage in these social opportunities. As stated above, individuals diagnosed with ASD often cannot provide assent. Thus, this excuse should not be a reason why we do not teach social behavior to individuals diagnosed with ASD.
Ultimately, one of the main reasons social behavior may not be a priority is teaching appropriate social skills is very difficult. Social behaviors are nuanced with many variables that an individual must respond to within a social interaction. For example, when teaching someone to join into an ongoing game, the individual must identify which game and with what peers to join, ask to join into that game in a way that will lead to acceptance by their peers, identify how to respond if their peers accept them into the game, and how to respond if the peers do not accept them into the game. As evident from this one example, there are a multitude of variables to consider even within a basic social skill. The amount of variables multiply with more complicated skills, such as friendship development. This can be highlighted by Jim Parson’s character, Dr. Sheldon Cooper, attempting to make friends in the “Friendship Algorithm” episode of The Big Bang Theory (Lorre, Molaro, & Cendrowski, 2009).
Simply put, teaching social behavior is very complex, especially compared with teaching less complex skills like requesting (e.g., Brodheard, Higbee, Gerencser, & Akers, 2016), matching (e.g., Farber, Dube, & Dickson, 2016), or receptive labeling (e.g., Grow & Van Der Hijde, 2017). The complexity of teaching social behavior makes evaluating interventions to improve social behavior more difficult within research, as it could result in less functional/experimental control. This difficulty could also result in professionals and parents departing from teaching social behavior within clinical settings.
Regardless of how difficult teaching social behaviors can be, or the reasons why social skills are not made a priority, it is imperative to teach social behaviors to individuals diagnosed with ASD for several reasons. For one, teaching social behavior may promote more natural language. When we make teaching social behavior with individuals diagnosed with ASD a priority, it increases the likelihood of fostering appropriate social interaction, and, therefore, could lead to more opportunities to communicate with their peers. In our clinical practice, we have seen that by teaching social behavior we simultaneously promote natural language.
Another rationale for teaching social behavior with individuals diagnosed with ASD is that research has shown that when students have positive social relationships, they enjoy and do better in school (Ladd, Birch, & Buhs, 1999). Thus, by teaching social behavior, the individuals we serve may gain collateral skills with no additional time or cost. If the argument is that academic skills or language development must be made a priority over social skills, it would be inconsistent with the research on the benefits of teaching social behavior.
Teaching social behavior may lead to higher rates of peer approval for individuals diagnosed with ASD as well as the development of meaningful friendships. We do not teach social behaviors such as joint attention (e.g., Taylor & Hoch, 2008), observational learning (DeQuinzio & Taylor, 2015), joining in (e.g., Leaf et al., 2012), or winning graciously (e.g., Leaf et al., 2012) just so that the individual can display these skills. We teach these skills, and other social behaviors, to increase the likelihood that the individual has positive, prosocial relationships and friendships (Bauminger & Shulman, 2003).
When an individual, with or without a diagnosis of ASD, does not engage in appropriate social behavior, it may lead to a lack of meaningful friendships or prosocial relationships. Unfortunately, this can lead to serious negative consequences such as loneliness (Bauminger, Shulman, & Agam, 2003), depression (e.g., Hurley, 2008), and thoughts of suicide or attempting/committing suicide (Dodd, Doherty, & Guerin, 2016; Mayes, Gorman, Hillwig-Garcia, & Syed, 2013). Research shows that individuals diagnosed with ASD are more susceptible to these negative outcomes (Mayes et al., 2013). The potential for these negative consequences solidifies the rationale for why teaching social behaviors to individuals diagnosed with ASD should be prioritized.
Ultimately, the reason why it is imperative to teach social behavior is to improve the quality of life for individuals diagnosed with ASD (Taubman et al., 2011). If you were to ask most, if not all, parents what they would want for their child it would be for them to have a high quality of life. If you were to ask most professionals why they went into the human service field or why they decided to work with individuals diagnosed with ASD, one would hope their answer would include to help improve the lives of those they serve. In reality, most individuals diagnosed with ASD can live high quality of lives without knowing advanced math facts, all of the U.S. presidents, or cursive handwriting. However, it is my and my colleagues’ contention that you cannot have a high quality of life if you do not have meaningful friendships. Therefore, teaching social behaviors with individuals diagnosed with ASD MUST be made a priority.
Given the importance of teaching social behavior to individuals diagnosed with ASD and the growing literature on social behavior (Matson et al., 2007), it is imperative for professionals to have a resource dedicated to social behavior as it relates to individuals diagnosed with ASD. It is for these reasons that this handbook was created. The handbook should be used as a tool for professionals, academics, practitioners, as well as parents and family members. My goal for editing this book is that consumers have a useful resource that can guide them through the literature on social assessment , social behavior, and interventions to teach social behavior for individuals diagnosed with ASD. By having this book as a guide, it is my hope that this handbook can help practitioners in their everyday work with individuals diagnosed with ASD.
To help write this book, top professionals and leaders in the field of ASD and behavior analysis were recruited to write chapters on their area of expertise. All authors have many years of research and clinical experience. It is without a doubt that the authors of each chapter are recognized as experts on the subject matter provided within each of the chapters. It is my hope that having so many experts contributing to this handbook will result in an important informational guide for researchers, academics, students, clinicians, and parents.
1.1 Four Sections of This Book
1.1.1 Section One: Social Skills Deficits
The first section is meant to inform consumers of the social behaviors and social deficits commonly displayed by individuals diagnosed with ASD. The second chapter of this handbook was written by Volkmar and Vander Wyk, who describe the social nature of individuals diagnosed with ASD, specifically reviewing the clinical manifestations and the neuroscience of the social deficits. The third chapter was written by Sturmey who outlines perilous behaviors commonly displayed by individuals diagnosed with ASD including symptoms of depression, anxiety, loneliness, and suicide. The fourth chapter, written by Zweers, Scholte, and Didden, provide information on the serious issue of bullying as it pertains to individuals diagnosed with ASD. This chapter specifically discusses the prevalence of bullying, role of the environment, causes, and prevention/intervention. The fifth chapter of this handbook was written by Bauminger-Zviely and Kimhi, and it describes friendships as they pertain to individuals with ASD. Specifically, the chapter describes the characteristics of friendships, how friendships are displayed across the life span, and future directions .
1.1.2 Section Two: Assessment
The second section of this book provides information on various ways to assess social behavior for individuals with ASD. The sixth chapter of the book written by Freeman and Cronin describes various social skills assessments that can be used to evaluate social behavior. This chapter describes the assessments, the strengths of various assessments, and the limitations of various assessments. The next chapter was written by Cronin and Freeman and describes assessments used to evaluate adaptive behavior. In this chapter, the authors describe methodological concerns when measuring adaptive behavior as well as commonly used assessments such as the Vineland Adaptive Behavior Scales (Sparrow, Cicchetti, & Saulnier, 2016) and the Behavior Assessment System for Children (Reynolds & Kamphaus, 2015). The eighth chapter, written by Romanczyk, Wiseman, and Morton, describes curriculum-based assessments and how these assessments can be used to help with selecting appropriate social targets for individuals diagnosed with ASD. Within this chapter, the authors describe various assessments such as the Assessment of Basic Language and Learning Skills (Partington, 2006) and the Hawaii Early Learning Profile (Wheat & Baker, 2010) .
1.1.3 Section Three: Social Skills Interventions
The bulk of this handbook is dedicated to the third section, which describes various interventions that can be used to help improve the social behavior of individuals diagnosed with ASD. The section begins with a chapter written by DiGennaro Reed, Novak, Henley, and Brand. The authors discuss the importance of evidence-based interventions. This chapter is critical to the handbook as it can help consumers identify what constitutes evidence-based interventions. This is important because there are numerous pseudoscientific, antiscientific, nonevidence-based, and not scientifically supported procedures promoted for individuals diagnosed with ASD. The tenth chapter was written by Weiss, Hilton, and Russo who describe how discrete trial teaching can be used to teach social behavior. Weiss and colleagues describe how discrete trial teaching can be used to teach more than just simple skills (e.g., matching, imitation, receptive labeling). The next chapter, written by Ala’i-Rosales, Toussiant, and McGee, provides an overview of incidental teaching procedures and how they can be used to make meaningful social gains for individuals diagnosed with ASD. The authors of this chapter provide detailed examples of how the procedures can be implemented effectively.
The next chapter of the book, written by Vernon, describes pivotal response training (PRT) and how it can be effectively used to improve social behavior. Throughout the chapter, Vernon describes the key components to PRT and how they can be used to improve social behavior. This chapter is followed by a description of another comprehensive program to improve the overall quality of individuals diagnosed with ASD known as the Early Start Denver Model (ESDM) . This chapter, written by Rogers, Vivanti, and Rocha, describes the ESDM model as well as the research supporting that model to teach social behavior.
This topic is followed by a chapter written by Ayres, Travers, Shepley, and Cagliani who describe video-based instruction. In this chapter, the authors provide a rationale for using video-based instruction to improve social behavior, considerations for using video-based instruction, how video-based instruction can be used to teach a wide variety of skills, and areas for future research. The next chapter of the book, written by Higbee and Sellers, focuses on visual learning strategies (e.g., activity schedules and social scripts). This chapter provides a thorough description of the procedures, clinical implications, and research implications of visual learning strategies.
Kamps, Mason, and Heitzman-Powell provide a chapter on peer-mediated interventions. The authors define what constitutes peer-mediated interventions and provide a key summary of the research. This is followed by a chapter written by Casagrande and Ingersoll describing parent-mediated interventions. In this chapter, the authors provide a detailed description of the various research procedures and a discussion of future areas of research.
The next two chapters are dedicated to interventions that use demonstration and role-playing as part of the intervention to teach social behavior. In a chapter written by Cihon, Weinkauf, and Taubman, the authors describe the teaching interaction procedure (TIP) . Within the chapter, the authors describe the historical roots of the TIP and how the procedure has an emerging literature base demonstrating its effectiveness for teaching social behavior for individuals diagnosed with ASD. Miltenberger, Zerger, Novotny, and Livingston describe a similar procedure known as behavioral skills training (BST) . Within this chapter, the authors describe the various components of BST as well as the research demonstrating the effectiveness of the procedure .
Ellingsen, Bolton, and Laugeson’s chapter describes the benefits of social skills groups for teaching social behaviors to individuals diagnosed with ASD. So often, interventions are implemented in a one-to-one instructional format, and it is critical to ensure that teaching also occurs within a group instructional format. This chapter describes the importance of and how to implement social skills groups.
The next chapter, written by Ross, describes how matrix training procedures can be used to improve social behavior for individuals diagnosed with ASD. In this chapter, the author thoroughly describes matrix training and how it can be applied in a clinical setting.
This is followed by a chapter written by Leaf and Ferguson, which reviews a commonly implemented procedure, Social Stories™. In this chapter, the authors describe the guidelines of Social Stories™, describe the variations of Social Stories™, and provide a critical analysis of the research on Social Stories™. The final chapter in this section was written by Wieckowski and White. In this chapter, the authors describe various interventions that have an emerging research base but may be implemented with individuals diagnosed with ASD. It may be the case that in 5–10 years some of these procedures may have a robust amount of research available and would no longer be considered emerging interventions .
1.1.4 Section Four: Future Directions
The final section of the handbook looks to the future of teaching social behavior as it relates to ASD. Leaf, Oppenheim-Leaf, and Weiss write about future directions as it pertains to research evaluating social behavior, social assessment(s), and interventions to help improve social behavior. The authors provide numerous suggestions that future researchers should consider when conducting future methodological evaluations. Taubman and Ferguson provide the final chapter that describes how clinicians should proceed when teaching social behavior to individuals diagnosed with ASD. Within this final chapter the authors describe a progressive approach for teaching social behavior.
1.2 Conclusion
This handbook covers a wide variety of topics as they relate to social behavior and individuals diagnosed with ASD. From deficits, to assessment, to interventions, and to future directions, this handbook can be used as a guide for any person (professional or nonprofessional) working or living with individuals diagnosed with ASD. We hope that this handbook will help guide clinical practice, will be used as a resource to gain knowledge about areas related to social behavior for individuals diagnosed with ASD, and help guide future research. If these goals can be reached, it will no doubt improve social behavior and the lives of individuals diagnosed with ASD.
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Leaf, J.B. (2017). An Introduction to the Handbook. In: Leaf, J. (eds) Handbook of Social Skills and Autism Spectrum Disorder . Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-319-62995-7_1
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