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SYMMETRY GROUP

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Handbook Of Social Skills And Autism Spectrum D...


This handbook identifies the various social deficiencies widely associated with children and youth diagnosed with autism spectrum disorder (ASD). It discusses possible causes as well as the lifelong effects if these deficiencies are not addressed. The handbook presents current behavioral and curriculum-based methods for assessing social deficits. Chapters examine the various interventions that have been used to improve social skills and behavior, including video modeling, peer-mediated interventions, and script fading. Chapters also assess various interventions using empirically based procedures, evaluate the research of each of these procedures, provide guidelines for treatment planning, and offer clinical recommendations. The handbook concludes with future directions for the development of both social behavior and clinical social skills interventions.




Handbook of Social Skills and Autism Spectrum D...



Children with ASD have difficulty with social interaction behaviors, including establishing and maintaining relationships, reciprocating social interaction, and communicating with others.2 Lack of social skills may have lifelong implications for children with ASD, affecting their family/community interactions, academic skills, self-worth, and independence. Reports on social skills in ASD indicate that these skills are extremely difficult to learn5 and that educational objectives should be focused on developing social skills because they have lifelong implications.6 Therefore, there is a need for effective interventions targeting social outcomes in children with ASD who have differing levels of functioning and abilities.


Although musical stimuli provide a clear time-based structure, music exploration is also inherently flexible, as musical improvisations can use different tonalities, harmonies, melodies, phrase lengths, motives, and structure. For example, the use of strict structure can be provided to help with anticipation of a back-and-forth communication, while improvisation within a certain modality (ie, major or minor key) and the use of different melodic themes on a pitched instrument allow for creativity. Within this experience, rhythm may be held constant in order to promote the anticipation and timing of musical communication, supporting the overall social interaction. This musical experience, wherein the client and therapist may be passing musical phrases back and forth, provides a means for practicing social interaction within a structure that provides accommodations to promote success. For example, this experience could be completed with school-aged children with ASD who have little to no verbal language, providing a nonverbal means for practicing social engagement, turn taking, joint attention, and other fundamental social skills.


Music therapy interventions are indicated to have positive effects on social skills, including increased engagement behavior,36 increased emotional engagement,37 and improved social interaction.38,39 Researchers have also indicated that music therapy can increase social greeting routines,40 joint attention behaviors,21,22 peer interactions,41 communication skills,15,17,42 and cognitive social skills.43 These studies provide evidence that music therapy can promote measurable changes in the social behaviors of children with ASD.


One difficulty in assessing social skills in children with ASD is that many of the nonmusical assessment tools that are readily available consist of subjective scales of behavior (such as the CARS). Other scales may be training or time prohibitive (such as Autism Diagnostic Observation Schedule). Therefore, in order to determine whether gains are being made as a result of music therapy treatment, the music therapy professional may use a combination of assessment tools, including parent-report scales (such as the Autism Treatment Evaluation Checklist), clinician-based observation scales (such as the Functional Emotional Assessment Scale), clinical session data documentation, interview, or observation of the client across different settings. As many music therapists are members of a larger interdisciplinary treatment team,48 observations from other professionals may inform the music therapist as to the generalization of skills in other settings.


Music therapists also use musical materials in order to assess nonmusical functioning, including social skills. As a form of alternative communication and play, assessment in music interactions may show social reciprocity, social engagement, responsiveness, and verbal/nonverbal interactions.49 Because many children with ASD are attracted to musical stimuli, music can be used to further assess core characteristics of ASD.49,50 There are also two music-based assessments that have been developed and tested for validity and reliability.


Researchers have demonstrated that persons with ASD often have unique attraction to music and may have enhanced musical abilities.31,69,70 This attraction to music can be used to engage children with ASD in musical experiences that can facilitate social skills. In these experiences, engagement is promoted through interactions with musical stimuli but also with the music therapist who is crafting musical stimuli that will engage the child. Peers (with ASD or neurotypical) or parents are often involved in the sessions to promote social skills within the family or peer group. Several types of music therapy interventions and approaches have demonstrated increased social engagement, including improvisational music therapy and neurological-based group music therapy.


Although the specific approach in each of these afore-mentioned music therapy interventions varies, the unifying factor is the use of engaging musical experiences to help promote social engagement. Along with the musical stimuli, the interactions are at the core of each of these experiences. Musical engagement may be essential for the improvement of social skills, as simply introducing musical materials has not been shown to increase social engagement.41 Further, simply presenting music in the environment has not been shown to have an effect on engagement of children with ASD.76 Therefore, the combination of clinically selected music within a social experience is needed for increased social engagement.


Music therapy clinicians developing musical experiences for joint attention must consider many factors of the experience, including the age of the clients, level of ASD, and presenting behaviors. Unique to music therapy treatment, the clinician must consider the type of music that will be used, as the style and/or complexity of the music may affect responses. For example, Kalas77 found that more complex music was the most effective musical stimulus for eliciting joint attention in children with mild/moderate ASD. Conversely, children with severe ASD demonstrated greater joint attention with less complex music. Therefore, the role of the music therapist is to determine what type of music and music materials promotes joint attention skills and then to use those materials within social experiences that provide the person with ASD the opportunities to practice joint attention.


Musical materials and experiences have been shown to be superior to nonmusical materials in the promotion of joint attention.21,22 In one study, children with ASD were engaged in music-making experiences that promoted joint engagement with a peer with ASD. Researchers coded for triadic joint attention that was receptive or initiated. Music therapy experiences included playing instruments, where triadic joint attention was between two child peers and an instrument. The music therapist provided structure using an original song that contained lyrics for the steps of joint attention to the peer and the instrument. In this case, the instrument is a desired object and the reference to another person/participation in musical play continues the engagement with an item and another person in the room. The musical experience is rewarding and can therefore be used to promote or reinforce the desired social skill. The researchers noted that in the play group, the observational data indicated that the children spent more time occupied with the tools in the room (such as game pieces) than referencing their peer as a part of the social experience.22 Therefore, the clinically intentioned music adds a scaffold for the desired behavior and that structure can be faded as the children gain intended skills.


In this video a behavioural psychologist explains how techniques like role-play and social scripts can help autistic children learn social skills. You can use these techniques to teach greetings and other skills that help children in daily life.


Social skills training can help your autistic child develop social skills in a structured way. For example, the Westmead Feelings Program teaches emotions and social skills in individual or group therapy sessions. The Program for the Education and Enrichment of Relational Skills (PEERS) is a program for young children who have difficulty with making friends and interacting with peers.


In this video, a behavioural psychologist explains how to use social stories to help autistic children learn social skills and get ready for challenging situations. The psychologist also explains how breathing exercises, muscle relaxation and imagery can help children manage anxiety related to social situations.


Beaumont, R., & Sofronoff, K. (2008). A multi-component social skills intervention for children with Asperger Syndrome: The Junior Detective Training Program. The Journal of Child Psychology and Psychiatry, 49, 743-753. doi: 10.1111/j.1469-7610.2008.01920.x.


Karkhaneh, M., Clark, B., Ospina, M., Seida, J.C., Smith, V., & Hartling, L. (2010). Social stories to improve social skills in children with autism spectrum disorder: A systematic review. Autism, 14(6), 641-662. doi:


Koegel, L.K., Park, M.N., & Koegel, R.L. (2014). Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1055-1063. doi: 10.1007/s10803-013-1956-y. 041b061a72


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