Enhancing Social Skills for High
Functioning Children with Autism
Attending School
Naoufel Gaddour MD
Child Psychiatrist,
University of Monastir
Tunisia
naoufel.gaddour@rns.tn
Autism: important variation in intensity
Severe picture, with neurological
morbidity
Moderate picture, with language
and intelligence impairments
Mild forms, with more or less
developed language and
normal intelligence
Age of first referral (Monastir)
475 recorded cases 2003-2011
7 yrs
3 yrs
High functionning autism
+
Children who improve dramatically
after early intervention
 NEW CHALLENGES
Settings to take care of children with
ASD in Tunisia
Tunisia had a poor school inclusion policy until 2004
For children with special needs, special education
centres are preferred and except for autism, they
represent a widespread network.
Many children with autism attend centres for mental
handicap, but usually without autism focused
intervention (work on self-help, leisure, academic and
professional skills…) and most of them usually carry
other problems (mental retardation, epilepsy..)
Autism: no specific answer
Parents of children with « pure » autism often would
not put their children in centres for mental handicap
Once the preschool years are over (Kindergarten often
accept autistic children), they worry.
Many have complicated time frames with individual
sessions with multiple professionals (special educator,
speech therapist, psychomotrician…) and pay a lot of
money in « side » activities: animal assisted therapy,
swimming pool…
Tunisian Programme of School Inclusion
for Children with Special Needs
Law for the Promotion and
Protection of Persons with Disability (August 2005)
"Is guaranteed to all persons with disability
the right to appropriate education and
professional training, in priority in the
mainstream system , in order to ensure
equal opportunity and protection
against all forms of discrimination "
Practical Aspects
Some schools are inclusive (special
managements)
Children with mild disabilities are accepted after
decision of a regional committee of professionals
(health, education, social affairs, NGO’s…)
Teacher receives training
1 child with disability = - 5 students per class
2 hours of individual work per week
IEP with other professionals
Current picture
From year to year, a higher number of
children with ASD are acceptec in
inclusive schools
After a first period of distrust and fear:
school teachers are often more
enthusiastic
According to our experience, inclusion has
more chances to succeed if
Asperger’s syndrome
High Functionning Autism
No disruptive behaviour
Existence of expressive language
CHALLENGES
Related to learning and cognitive
functioning
Related to communication and
socialization impairments
Challenges related to learning
and cognitive functioning
Organizational skills
Often intuitive approach to solve problems
Difficulties to guess and follow tacit
instructions
Confusion of different steps
impulsivity
Generalization of learned skills
Poor creativity
Important difficulties if exam different
from lesson
Problem of contextualized learning
Autistic intelligence
Sensory rather than deductive
Visual memory (+++),
Learning made through sensory
approach (e.g. Hyperlexia)
Daniel Tammet
Dawson, Mottron 2001
Theory of mind impaired:
• Problems in representing mental states
• Important problems in producing texts
(‫)التعبير الكتابي‬
• Difficulties in understanding mentalized
stories (e.g. the fox and the crow)
Example (Yahya: 4th grade)
• Subject: You visited a friend who was
sick. Describe what you felt
• Answer: I visited my friend Aymen. He
did not come to school because he was
sick. I bought him flowers and candy.
Excess of systematization
Student attracted by « mechanical »
learning: systematic research for
repetetive patterns, order, rituals
Cumulative rather than hypotheticdeductive learning (e.g. how to learn
arithmetics)
Major problem: rigidity
Poor central coherence
distractibility and failure if stimulus is
presented in two or more differnent
sensory dimensions at once.
Challenges Related to
communication and
socialization impairments
Balance between academic and
psycho-social
Our experience: often, the various
stakeholders are fascinated by the
academic achievement and neglect
social aspects
Examples:
Anxieties: Dhaker, 8 years
Excellent marks
But no friends
Massive and strange phobias and
anxieties (Orthopedic problem
suspected because he refused to walk
for a week without explanations after
floor tiles were changed)
Theory of mind again
Inability to imagine invented situations
Difficulties to understand irony, guilt,
regret, shame
Problems with figured speech and
metaphors
Socially naive kids
Hamma: lost in town. When asked why
he said « teacher said you can go », «
she did not say go home !»
Many children with ASD stick to Classic
Arabic when they speak to others
Can’t share other students’s interests
Narrative skills
Often poor ability to report on what
happened at school
Difficulties in putting different scenes
in a continuous story
Hyperactivity
Very often present during first years
Not really ADHD, but difficulties to
adjust to school schedule + selective
attention problems
Many children with ASD take antiADHD medications
Bullying
Long term physical or psychological violence
perpetrated by one or more perpetrators
(bully) against a victim (bullied) in a
domination relationship
The goal is to hurt others
Physical, verbal (nicknames, insults)
psychic (harassment, exclusion ..)
Juvonen, 2001
40% of children with ASD (NAS, UK)
Enhancing Social Skills for
children with attending schools
Initiative
Joint project between child and
adolescent psychiatry unit and NGO
running a special education centre for
autism
7 children of first and second grades (3
were regular)
Therapists: child psychiatrists,
psychologists, educators
The session
One hour per week (Saturday)
Circular table
Session begins with greetings and
announcing who is present and who is
absent
Activities are proposed  a visual
schedule is proposed
The rest of presentation will be
interactive around actions that will be
described in pictures or videos
Major activities
Role play
Social games
Puppet play
Collaborative problem solving
Narration
Emotions recognition (faces) and
expression
Humor
Proposals for actions to do at
school setting
Visual strategies
Structured learning, space, time
Avoid tacit instructions
Use academic learning for social targets
(sharing experiences, competition…)
Begin with individual learning 
generalization to group situation
Reduce quantity of language and distracting
stimuli
anti-bullying strategies
Example of Think-Feel-Say-Do