Michelle Winner conference
“Understanding Social Cognitive Deficits across the school and Home day”
Labels for social cognitive deficits:
· High Functioning Autism (HFA)
· AS
· Semantic Pragmatic Disorder
· Non-verbal Learning Disorder
· Pdd-nos
· Hyperlexic
· Tourette’s?....Fragile X….
· ADHD = OCD = AS?
· Where does bi-polar fit in?
Michelle Winner explained that all of these labels are used for kids who have
“social cognitive deficits.” She says the labels are subjective. Some day
soon there may be brain imaging to help dx each “label” correctly, however,
that doesn’t change that the help they need is often the same.
Michelle says, “Persons with significant social skills deficits HAVE academic
learning problems.” We need to realize that social skills happen EVERYWHERE.
There is not a single lesson that is taught outside of a social environment.
Classrooms are “mini societies.”
· If a child cannot be social, he cannot learn.
· These kids do not realize they are part of a larger group.
· These kids need direct social teaching.
Current education is teaching to the “standards” (NCLB act) But what is the
ultimate purpose of education? Does your school have a mission statement?
Read it. Use it! Ask them how this child will be able to fulfill the mission
statement without direct social teaching? Where are these kids going as
adults? How do we prepare them to be adults?
Many tests do not reveal social cognitive deficits.
Executive functioning IS social communication. The only time we don’t use
Executive functioning is during testing!
College is about self-advocacy. We need to start to prepare kids for
self-advocacy in middle school at the latest. They need problem solving goals in
the IEP by middle school. They are not good personal problem solvers.
Biggest issues they face are organization and initiation of communication.
· K-2 is about rote learning and kids tend to do okay
· High 3rd/4th grade begins critical thinking, abstract connections and
social groups
· 5th and 6th grade – aspies usually hit “the wall” due to problems with
organization and working with so many different teachers.
· They begin to have motivational and personality problems
Unfortunately, these kids usually do not grow out of needs, they grow into
needs
The rigidity of the educational system does not help.
Most restrictive environment becomes “mainstreaming” because it does not
allow for change.
Many kids start to need more restrictive settings to get help
Problems change with age
· Self stims are more discreet with age
· Attention is better directed with age
· Increased self-awareness
· Interests are more acceptable
· More flexible to some degree
· Sullen attitude is considered “normal” by others
Causes of Autism à affects cognitive functioning à affects behavior
You cannot just look at behavior and fix behaviors. You need to teach
strategies and cognitive skills.
The goal of treatment is to use each person’s strengths to teach increasingly
abstract ideas. The goal is not to “cure”
Social skills are the way we express our “social intelligence.” Teaching
social skills is not the total solution – we need to teach the “why”.
Social Thinking is demonstrated by:
Effective communication
Personal problem solving/organizational skills
Michelle has come up with what she calls the “I LAUGH” method of
communication and problem solving.
I = INITIATING
L=LISTENING WITH EYES AND BRAIN
A=ABSTRACTING/INFERENCING
U= UNDERSTANDING PERSPECTIVE
G= GETTING THE BIG PICTURE (GESTALT)
H = HUMOR
She then went through each step of her method –
INITIATION
Kids have difficulty with initiation - both physical and communicative. It
is hard to start a behavior that is not routine for them.
Main idea is to learn that what you do impacts other people’s emotions
Does he ask for help? Why not?
· Does not want to call attention to himself
· He was told not to interrupt and takes that literally
· He thinks he is too smart to need help
First you have to create the expectation for initiation
Build initiation into routines
Teach with social stories, scripting and comic conversations
Give child grading system for asking for help (he might appreciate the
significance of initiating if it is graded/i.e. something to work towards)
LISTENING:
Do not ask children, “What is your favorite…?” Our kids take this literally
and then cannot answer the question because they cannot pick their absolute
favorite.
Teach the kids that communication is speedy and sloppy
Teach the children scripting, that you can predict what words will be used in
many instances
Listening is a challenge and not an excuse
· Problems listening – weak CAPD
o
Delayed responders – CAPD
o
DO NOT ACCOMMODATE CAPD, you simply create more problems
o
Teach the children strategies to work through their delays such as
written notes, picture icons, checking comprehension, have them write out the
instructions
· Difficulty gaining information with eyes
· Blurting
o
Teach to hold up hand
· Quirky attention span
o
“magnet brains” teach them that they DO have control over their
brains by using visual supports and timers
o
stuck on topics – set parameters, give them specific time to talk
about subject, then must stop
o
Magnet brains have problems with motivation and are using magnets as
an avoidance tactic.
All kids have boring moments. We should teach them how to be bored. They
should realize that life is not “all about having fun” and that it is okay to
be bored.
SERIOUS SOCIAL PROBLEMS à Affects reading comprehension. Kids will
comprehend reading at their social level, not reading level.
Teach kids to “listen with your eyes” à they should look at what they are
thinking about and are thinking about what they are looking at.
ABSTRACT AND INFERENTIAL:
People who are very concrete do not like the unknown. This is why they
prefer routines.
They have difficulty inferencing (hate to guess)
· Must teach guessing skills to the kids
· Have to teach them the “smart” guess vs. “whacky guesses”
They have poor interpretation of figurative language (idioms and metaphors)
· Be wary of vocabulary
· Say it another way if the child has a problem with a specific word
· Work on teaching synonyms
· Must tell school that teaching synonyms is more than what they cover in
regular curriculum.
· Teach literal vs. figurative (idioms)
· Teach prediction and inference, making “smart” guesses
Difficulty with non-verbal communication skills
SCHOOL IS AUTISM!
· One curriculum fits all
· Bell schedule
· Seating charts
· Switch from one topic to another for no logical reason
· Inflexible adherence to routine
UNDERSTANDING PERSPECTIVE:
Perspective taking is the ability to consider your own and other people’s
· Thoughts an emotions
· Motives and intentions
· Prior knowledge experiences
· Beliefs
· Personality
We monitor this all the time when we are communicating with other people
Perspective taking is the marriage of Theory of Mind with Executive
Functioning
Kids with social cognitive deficits have problems with perspective taking.
They have problems with
· Physical presence
· Can not read people’s plans (physical and mental)
· Does not anticipate by following the plans
· Lack of social curiosity
· Inability to visualize what other people are talking about
· They do not wonder – must teach imagination
· Must teach “reading a plan” (this improves written expression)
· Kids do not know what we want from them so they end up just pleasing
themselves.
Perspective taking has four immediate steps:
I think about you
I think about WHY you are near me/what is your intent?
You think about what I am thinking about you
I monitor you and modify my behavior to keep you thinking about me the way I
want you to think about me
Impressions: we need to teach how you make impressions by how you look/what
you say/what you do.
Kids with Social cognitive deficits have trouble understanding their own
feelings and other people’s feelings. They have limited understanding of
emotional words
Teach perspective taking even to the very young
· Develop sense of self – that child expects something of others
· Develop sense of others – what do others expect?
· Explore rule-based social skills from the place of “WHY?” do we do them
Creating conversations is based on perspective taking. You must:
· Think what you know about the other person
· Think about what the other may want to talk about based on what you know
· Must think of questions that relate to what they want to talk about
GESTALT – GETTING THE BIG PICTURE
These kids will often over focus on the details and not see the big picture
They do not account for contextual cues
Do not see how what they do in one place relates to another
Weak ability to organize/prioritize
Poor time management
Organization is a HUGE issue for these kids. This is not specifically taught
in school. Organization is a large part of gestalt thinking. Without
organizational skills, you cannot be educated.
Strategies:
· You need to start teaching the child by what they know. Go back until you
find where they are at and start teaching from that point.
· Use academic planners
· Show schedules with pictures or words
· Practice breaking down a task and putting it back together
· Use graphic organizers
She gave an example of what to teach when the child wants to get a job:
Getting, keeping and having a job
· Hygiene
· Applying for SSI #
· Knowing what to do at the interview
· Doing the job expected
· Asking questions on the job
· Getting transportation to work
· Keeping track of schedule
· Getting a work permit
Disorganization is the biggest major barrier to going to college for many of
these kids.
See web page “ www.stepuptowriting.com ”
Organization is necessary in order to activate reading comprehension and
written expression.
HUMOR/HUMAN RELATEDNESS:
· Figure out what makes people laugh
· When it is okay to be funny, when it is not.
· Use goofy props to teach social skills (pass the chicken to visual
conversational skills or chicken on the shoulder to recognize a mistake.
IEP Ideas:
IEP should reflect specific learning needs including those not curriculum
based
If behavior or attentional problems are being targeted, goals should be
written specifically to describe the treatment approach
Not only have relevant goals but consider environmental accommodations
(longer test taking time, use of word processor, etc.)
IEP should not attempt to cure autism. Goals that say, “Joe will pay
attention for 45 minutes” are not helpful.
Each goal/objective should:
· State a purpose
· State a strategy
· Be measurable
Top 11 worst IEP goals:
11. Lori will interact with staff and students in a positive and productive
manner in structured settings. (IOW, Lori will BEHAVE)
10. Joey will not hit other children more than 3 times per day (children
will never rise to low expectations)
9. Fred will pay attention in class, 90% of the time.
8. Draco will converse for 10 minutes with a peer (this is an Executive
functioning task – break it down!)
7. Vivian will converse with a peer: 3-5 times a day in the next 3 months
5-10 times a day by the next 6 months
10 – 15 times a day by the end of the school year
(should really strive for 1- 2 quality interactions)
6. Chad will keep track of all his assignments and tell the teacher when he
needs hel, 90% of the time. (this is an initiating goal. We need strategies
to teach skills. We need to prioritize skills to teach.)
5. Joe will solve problems with 90% accuracy
4. Booky (who is 12 years old) will produce “r” in sentences 90% of the
time (prioritize needs!)
3. Billy will list the main idea and 3 supporting details
2. Fred will use an “I” statement when he is in a conflict with a peer
1. George will no longer act autistic, 90 % of the time (this one is a joke
but it is written in various forms on many IEPs)
Instructional Aides:
Aide is not the total solution. Be careful of over-dependency on the aide
when we want to facilitate independence.
Discuss the purpose for the aide:
Academic need or behavioral?
Let the aide and the child know the purpose for the aide.
Aide should be guided by the speech therapist or special ed teacher.
Aide should use a clip board which will contain:
IEP goals
Simple behavior plan and behavior tracking sheets
Checklist journal related to IEP goals
Diagnostics:
She said that when she walks into a room and goes to shake the hand of child
with social cognitive deficits and they cannot shake hands or turn their body
away while shaking hands, she knows the child has a serious social deficit.
Testing does not show the deficits that these kids have. Many kids score
average or above on regular testing done by the schools.
Student does not have to look like RAINMAN to be autistic.
Should not be using the CARS on these kids. We need to have testing include “
ASDS: Asperger’s Syndrome Diagnostic Scale or GADS: Gilliam Asperger
Diagnostic Scale.” Also a good evaluation is the Vineland Adaptive.
School testing generally probes the more basic levels of skills in specific
cognitive domains. Our kids have problems in a more complex level which does
not show up on testing. Academic testing and IQ scores cannot be used alone to
determine the presence of autism. However, there is a tendency to see low
social cognitive scores and high visual problem solving scores. IQ testing is
highly structured and void of context – two qualities people with autism
crave.
Academic testing:
· Reading decoding is usually a strength
· Reading comprehension
o
factual is good
o
Inferential is often poor
· Math skills are not predictable
· Ask about students ability to create written expression efficiently.
Michelle Winner recommends that testing include:
· Observation of same age peers
· Use the I LAUGH components as a guide to assess informally
· Testing in intelligence, academic, exec. Functioning
· Learning styles – auditory or visual motor or sensory motor
· Informal assessments
· Emotional/differential diagnosis
· Interview with caregiver
· Review the school records
Language Evaluation:
· Language eval must include a careful observation
· Must have a pragmatic language sample
· Do informal tasks to gather information
o
Michelle gave an example of this by showing how she dropped a
paperclip on the floor while a boy was talking and she went under the table to get it
and stayed there. The boy kept talking as if she was still there.
· Test of Problem solving (TOPS) needs to be scored carefully
· Test of Language Competence
· Comprehensive assessment of spoken language (CASL) has a good abstract
language subtest
· Test of written language (TOWL)
· TOPS for elementary age kids is not as good since it is picture based
(visual)
· TOPL – test of pragmatic language is not a good test, it’s very
superficial and not sensitive to the finer issues.
· TLC: test of language competence is multiple choice and not sensitive to
functional issues
· The listening test – she leaves this one open to our own opinions
End of day One!