Our Dilemma

What options are there for Alex to learn much needed social skills with his peers? Is Alex too high-functioning (especially considering his giftedness) for Applied Behaviour Analysis (ABA) interventions? What will happen if he does not learn to read social cues? He needs to learn the skills to help him deal with current social situations and he needs ongoing support to help him handle new situations.

The dilemma is whether to create a behaviour plan for Alex or not. Alex definitely has lack of success in social interactions - either he learns how to interact (by going through a work- and time-intensive process) or he fails and remains in social isolation. He has not learned the social cues needed to successfully navigate the educational setting with his peers. He needs social skills training and ongoing support to help him with his tendencies to argue. He gets frustrated easily and these behaviours could significantly affect his educational experience and ultimately his personal outcome as an individual in society. ABA can be tailored to fit Alex’s needs and incorporate areas of strength and weakness according to each individual child. However, Ms. A worries about the possible negative effects of further isolating Alex by starting a special program for him.

Diagnosis and Next Steps

Diagnosis: 
Alex received his Asperger’s diagnosis near the end of Grade Four. His diagnosis came later than is typical because his giftedness actually masked some of his symptoms. Teachers and parents saw his fixation on certain topics, and his ability to relate to adults better than his peers, as symptomatic of his high IQ. It was only as the social gap between himself and his peers continued to widen that some of his idiosyncrasies became more obvious.

Next Steps/Possible Interventions:
Applied Behaviour Analysis – Alex’s parents are willing to try any therapy that might help him. They are a little sceptical of ABA, worried that he might be too smart for some of the methods, but they also want him to learn some much needed social skills. ABA could be used with Alex to reinforce good social behaviours in the classroom. When Alex was younger, his parents were told by a therapist that he was too high-functioning for ABA to work.

Alex loves the card game Magic: The Gathering. His teacher taught him the game and Alex caught on very quickly. Other students in the class like the game as well and are interested. Alex’s skill and knowledge of the game offer him a possible social opening with his peers. Alex is able to teach the other students the skills, but his lecturing about the game bothers them. Alex also has difficulty putting the game away when recess is over

Personnel Involved/More About Alex

Personnel Involved

Ms. A – Alex’s teacher
E.A. – Alex does not currently have an EA, but he has worked with one in the past.
Alex’s parents- supportive. Stay at home mom, dad is a medical professional with a history of Asperger’s Syndrome symptoms but not formally identified. German shepherd at home (Alex identifies him as his best friend).
School Administration, School Special Education teacher as a resource-Alex checks in occasionally with the SERT for enrichment purposes and to practice behavioural management strategies.



More about Alex
 
Likes: playing chess with his dad and reading books, Magic the Gathering (card game), Language, Art and Science
Dislikes: Organized sports/group activities
Social Profile: wants to fit in and gets frustrated at failed attempts to do so, does not like girls, knows he is different. Alex has one friend who sits beside him in class who has a learning disability and enjoys Alex’s guidance.

Pros and Cons of ABA

The goal is to ultimately teach Alex social norms and appropriate reactions while maintaining his interest and academic strengths.

Pros of Aba:

-A point system to help acquire social skills

-Can modify behaviour in older children

-Help with determining causes of unwanted behaviour and take preventative steps

-Teach strategies

-Individualized therapy

-Help to understand expectations in situations

Cons of ABA:

-Less effective with older and high functioning people

-Charting each desirable behaviour is time intensive (Could possibly find a more effective use of time)

-Thoroughness may not be consistent

-May be difficult for all parties involved to maintain consistency, and remain objective

-May disrupt other students’ learning

-False sense of real social interaction

-Consistency may be hard to maintain during unsupervised time such as recess

-Hard to determine if true understanding is achieved, or if desirable behaviours are simply being regurgitated

-May become bored and risk academic failure due to inability to challenge Alex’s giftedness

Our Decision

Partial ABA would be the most beneficial form of treatment in for Alex.  Since Alex is gifted in some areas and lower functioning in others; namely social situations, partial treatment seems ideal.

In the article,  Gifted Students with Asperger Syndrome: Strategies for Strength Based Programming, the authors state that rather than focusing on the deficits of these students, programming should be strength based and include attention to students own interests.  In order to fully meet the needs of these dually exceptional students, a dually differentiated curriculum must be created for them, which addresses their full range of abilities and limitations.

                Higher intelligence can give autistic individuals the ability to modify some autistic traits, leading to their acceptance by others. It is the giftedness that allows these individuals to learn compensatory strategies for autistic behaviours.  There are specific strategies for students who struggle with social skills. In the article, Making the grade:  A new classroom for children with asperger’s and other pervasive development disorders; about a specialized classroom, regular subjects were still taught, but there was a constant focus on their individualized program for social skills development. All skills were constantly modeled and practiced.  The student was cued to use the skills already learned when in a new situation/setting. Students were rewarded for appropriate behaviours with a “social skills point system”.

                It is important to maintain consistency amongst all people involved with Alex, from school to home. The article, The social interactive behaviour of young children with autism spectrum disorder and their mothers: Is there an effect of familiarity of the interaction partner?, it is stressed that consistency in interaction style is very important. The behaviour of the child with autism is not affected by familiarity of the social partner, but by the interaction style. This study is helpful in addressing the ways to elicit the best level of responsiveness from children with Autism. It is not as important that the child is familiar with the partner (e.g. Teacher) in which they will interact, but that the partner is familiar with the most effective interaction style.

In terms of creating a partial ABA program, the causes of the inappropriate behaviour should be determined.  After the reason for the inappropriate behaviour is found, and an alternative acceptable behaviour agreed upon, a plan must be put in place to stop the first behaviour and start the desirable.  A chart will help to discover the causes of the undesirable behaviour.  Observations should take place over a week (at least) until a pattern can be determined.  From here, the style of interaction as well as ways to incorporate strengths and skills can be developed.

Establishing ABA with Alex

Walker (1983) defines social skills as “a set of competencies that a) allow an individual to initiate and maintain positive social relationships, b) contribute to peer acceptance and to a satisfactory school adjustment, and c) allow an individual to cope effectively with the larger social environment” (p. 27).  Alex has particular difficulty within the context of social and emotional learning.  He has trouble managing and recognizing emotion in the school setting.  Both his teacher and his parents are concerned about his ability or lack to socialize effectively in the school environment.  Applied Behaviour Analysis has been suggested as a possible solution.

Alex has difficulty having relationships with fellow students.  Has trouble connecting; he enjoys parallel play but not interacting with other students.  He can be in the same place at the same time, yet experience isolation in a crowd.  Alex’s parents are concerned that ABA may not be effective because Alex is too high functioning with his giftedness.  Through our research, we have found ABA could be a viable solution with supports added.  If the Ziggurat Model is used to define Alex’s specific academic and social needs, then an ABA program could be effectively administered to meet his needs well and carry into a secondary setting. 

The Ziggurat Model is a specific program for high functioning children with Asperger’s.  It’s designed to address needs and underlying deficits for children with ASD that result in social, emotional, and behavioural concerns.  The categories studied include sensory differences, reinforcement, structure, task demands, and skills to teach.  There are incorporated assessment tools that help to identify the deficits and strengths of an individual on the spectrum and also help to develop more thorough and effective interventions. Once behaviours are known, interventions can be developed to target the challenges while building on strengths and established skills.  The model provides a great diagnosis tool for what behaviours need to be targeted to encourage a healthier social development for Alex and his environment.

Along with after school support from the Geneva Center group that Alex attends, the teacher, parents and school can develop and implement an ABA program that encompasses participation of the class and school environment in effective social skills use.  The aim would be to prevent problem behaviour and encourage desired behaviours through a token economy and self management intervention.  Not only does this fit in with ABA, but it also adds to the UDL of the classroom.

A good beginning for establishing an ABA program for Alex  would include the Help Us Learn program developed by Kathy Lear (www.helpuslearn.com).  It’s a self paced program that provides ABA support for both home and school.  There are ideas and examples used to provide a solid understanding of ABA style teaching for Alex’s teacher that would help set up and managing the program.  After learning the base of ABA, Alex’s teacher and parents would be able to tweak the program to accommodate his higher functioning and giftedness.  The program will still be ABA based and provide social skills training so Alex will be able to interact appropriately in his natural social context, but it will also accommodate his teen years and his transition to secondary school when used in conjunction with the Red and Green Choices program.

The token economy and self-management program can effectively be continued at home.   A social skills point system will focus on the development of the skills and can be rewarded through a token economy.  A good example of a social skills program that is developed for classes with children with ASD is the Red and Green Choices program.  The program Red and Green Choices models effective social skills in the classroom and at home through praise, positive reinforcement and correction through redirection and eventual extinguishing of inappropriate behaviours (http://www.redandgreenchoices.com/about.htm).  The teacher will provide lesson plans and guidance for both individual and group activities to the whole class. Most lessons involve modeling successful social skills through activities, games, and role-play, with teachers and peers providing the necessary feedback that allow the students to rehearse interactions.  Through making this a group activity, Alex would not feel singled out and the class can gain an increased sensitivity for Alex and for their social interactions with each other.  Activities like this will contribute to overall UDL of the classroom.

A good example would include working on Alex’s patience with his fellow peers while he explains an academic concept.  To Alex, a concept may be evident due to his giftedness.  He has no patience for a lack of understanding and does not understand when fellow students do not want to interact.  The teacher could provide role play examples with students and a lesson plan that shows alternative outcomes.  The teacher could also provide the point system and award students points according to reactions in situations.  Alex is curious enough to wonder about who gets what and why.  The learning opportunities with this system will be varied which is what Alex needs in order to work on and master social skills needed for successful interactions.

Alex and his classmates will learn effective interactions with specific attention to the steps involved at the beginning, middle and end of an interaction. For example, they can all discuss the process of a conversation, showing how effective listening makes such interaction possible.   This technique will help Alex through ABA and will not underestimate him as a high functioning individual with Asperger’s.  The support for his social development will come through positive behaviour interventions, extinction of negative behaviours, and through modelling while including the class environment.  He won’t feel singled out or underestimated.  The class will be the focus, not Alex; group over individual.

Social Skills Point System

When using ABA, or in our case a partial ABA program, there will be a window of about a week where teachers and other involved personnel will be observing Alex and noting his unwanted behaviour. Alex’s unwanted behaviour stems from his Aspergers syndrome and directly affects his abilities to interact with his peers in a positive and helpful manner.

Alex’s support system will implement a social skills point system where Alex will be rewarded for using proper strategies for interacting with students in various social situations. Each time he uses a pre-taught strategy he can gain a point in order to do things he likes in the school environment, which will be agreed upon by Alex and set out by his teachers.

As stated in Bianco’s article it’s important to start work with the strengths and interests of the child rather than their deficits. This is why we think it’d be best to create a “Magic the Gathering” club where students can get together and play the game during their nutrition breaks. Not only does this provide a positive platform for Alex to express his interests but it also gives teachers opportunities to make observations for what behaviours need to be worked on with Alex. During the time spent at the recess club Alex can maximize his social interactions with something he enjoys doing as well he can have more opportunities to employ the various strategies for improved social interaction that he is taught.

We feel that this environment might lower the danger running into some of the cons of the ABA program such as disrupting other students learning, and having a false sense of real social interaction. Thankfully Alex and many of his classmates are interested in Magic cards so it will create places to use ABA outside of class time and create social interaction on real levels.

Alex’s social skill point system will consist of him earning points (for example collecting popsicle sticks) where he can earn a new privilege in the school environment. For example when Alex finds himself becoming frustrated with another student, instead of having a meltdown, he uses a pre-taught coping method (eg. walking away and coming back when he has calmed down) he will earn a point. It may be best for Alex to continue to earn points to gain privileges directly related to his Magic card game. Some ideas may include:

• Being the spokes person for the club
• Writing morning announcements/advertisements about the club
• Organizing tournaments
• Deciding when the club will meet
• Allowing additional weekly meetings

These are just a few ideas about how incentives for Alex that might work however these can also be extended to in class activities if his teachers should see fit depending on the situations. Alex will have to earn enough points to be able to select and take part in his specific rewards. As some students with Aspergers have social behaviours based on familiar situations rather than the social partner, some concern might be that Alex will only be able to practice good social skill techniques while playing Magic Cards; but we argue that things such as, taking turns, discussing what is fair, explaining rules/giving instructions to friends, listening, and sharing other interests will arise in this time.

When Alex has the incentives to gain points to do additional things around the school and classroom that he enjoys it will help direct his academic performance. He will know that to continue to do well he must stay on task when recess is over. Alex learning to control his frustrations and avoid his meltdowns will translate into his math curriculum as his hyper focus can get him stuck on some details in his math work. Alex’s teachers and support system will continue to nurture his giftedness by continuing to provide a supportive environment for him by providing curriculum to support his gifts in the subjects of reading and writing.

The Geneva Center for Autism

As Alex and his family are fortunate enough to reside within the city of Toronto, they have access to the services provided by the Geneva Center for Autism.  An international leader in the development and delivery of clinical intervention services and training, the Geneva center offers a wide range of programs which Alex has begun to participate in, as well as resources to assist his parents, and educators.

The Asperger Program, at the Geneva Center is geared to “meet the needs of individuals with Aspergers who are between the ages of 12 and 18, and their families”.   Services provided include:

• Individualized consultation with members of a multidisciplinary team
• Series Workshops: Parent training on topics including behaviour, social communication and independent daily living
• Groups: Teen groups focusing on learning social boundaries, building self-esteem and coping with anger and anxiety
• Social settings: movie nights, held 8 times/year for individuals with Aspergers and their guests

In order to address the behaviours which are most in conflict with Alex’s academic and social success, Alex has begun attending Teen Groups at the Geneva Center, outside of the school day.  The skills learned through these groups are being reinforced in the home and in the school environment.  Alex is showing improved self-esteem and improved confidence in social settings.  He has even made a couple new friends.  The programs offered which are appropriate for Alex to attend are:

Coping with Anxiety / Anger Management

Using the principles of Cognitive Behaviour Therapy, participants learn strategies to help them manage anger and anxiety.  Participants learn how to identify their own anger and anxiety as well as possible triggers for expression of these emotions.  Group members develop a set of individualized “tools” (based on Tony Attwood’s Emotional Toolbox curriculum) to help “fix” negative emotions.  Strategies learned may include relaxation exercises, visualization, antidotes to “poisonous” thoughts, role play and rehearsal.  The group is run by a Behaviour Communication Consultant and a member of Geneva Centre for Autism’s clinical team. 

Understanding Asperger Syndrome and Building Self-Esteem

This group is designed for youth who are aware of their diagnosis of Asperger’s Syndrome and would benefit from further explanation and support in understanding the diagnosis and developing self-esteem. Emphasis in placed on learning about one’s own strengths and challenges, developing respect for differences in other people and fostering self-acceptance. Some of the topics explored are:  differences inside and out; individual strengths and challenges, special interests, sensory differences, learning styles, dealing with emotions and who to tell about their diagnosis.  The group is run by a Behaviour Communication Consultant and a member of Geneva Centre for Autism’s clinical team.

Circles:  Learning Social Boundaries

This group explores the CIRCLES® Program to help explain interpersonal relationships that can sometimes be puzzling for children with ASD.  The CIRCLES® Program represents different types of inter-personal relationships as a series of different coloured concentric circles that radiate out from the individual.  Participants learn the differences between each circle and to distinguish between the different levels of talk, touch and trust associated with the different people in their lives.  Topics covered include the concepts of public and private, awareness of personal space, social boundaries, appropriate behaviour in the community, the definition of a friend compared to an acquaintance, the different levels of intimacy & trust, personal safety, and safety of others.

Conclusion and Unanswered Questions

How is Alex doing now?

Playing Magic has helped Alex with his social interactions.  He has learned the proper and socially acceptable responses that are required when interacting with others in a game situation.  He has become much better at waiting for his turn, accepting loss, and moving from one activity to another (i.e. when recess ends and the game needs to be put away – Alex understands that by cleaning up quickly and getting ready for class again means that he will be allowed to play the game at the next recess as well).

Some concerns we still have about Alex and his future are:

What happens if Alex ever loses interest in this card game?

Obviously if this happens, it will be necessary to find a new activity/topic of interest that can be used to help teach Alex social skills.  It is likely that his teachers will be able to use this game for the rest of his time at elementary school, but as he grows older his interests are likely to change and new strategies will have to be worked out. 

There is also the chance that when Alex enters high school he will be able to fit in better as he will be taking more classes that are of specific interest (more course choices)to him with other students who share those some interests. 

Is Alex just regurgitating the information he thinks the teacher wants to hear? (Is this okay if he is acting in a socially acceptable manner?)

There is definitely a chance that Alex will just be regurgitating the techniques that he has been taught through ABA.  But, this means that he has understood the reasoning behind this type of behaviour training to be able to use it appropriately.  Even if he is just responding in the way that he knows the teachers/resource teacher/parents want him to, he is still improving his ability to interact with others in a socially acceptable way.

How do we know that our partial Applied Behaviour Analysis (ABA) system has really worked for Alex?

The problem is that Alex is very smart.  An initial concern was that Alex may be too high-functioning for an ABA type program to work.  ABA involves learned responses for specific situations and Alex may refuse to react in the “expected way” or question everything about the response and situation.  Even if this is the case, it is showing that ABA training has had some effect on Alex.  Just by teaching Alex a socially acceptable response we are helping to train him.  It is still his choice to use the appropriate response or not, but through his own experimentation he will learn which response give him positive results and which do not.  So, when Alex really wants something, he will figure out the best way to act to help him to succeed.

Will Alex be able to bring the skills he has learned playing the game into other real-world situations?

It will probably take a while, but eventually Alex will start to see how the skills he has learned playing the card game help him to interact with others in an acceptable way.  It will be a lot of trial and error on his part as he sees how others react to him and in turn how he reacts to them. 

His classes at the Geneva Center will also be a great spot for him to practice his newly learned interaction skills (and they will able to provide him with plenty of feedback as well).

What sorts of transition assistance does the Geneva Centre provide for elementary to high school and high school to work force? 

The website does not specify any transition information for elementary to high school, but it does run a program for students entering the work force.  This program is called Steps for Success.  There are also Adult evening groups which allow adults with ASD to socialize with peers through various activities or access social support as needed.

What happens if the other students in the class become bored of this card game and Alex still enjoys the game?

In order to keep the students interest in the game there may be modifications upgraded to this card game, techniques, rules and/or rewards. Developing changes to the game may spark in a peer discussion amongst the students and Alex which would also assist Alex with his social skills. This conversation between Alex and his peers could also assist the process of getting to know one another and finding similarities between them.

When asked, what is Alex’s first choice; to be placed in an inclusive setting or withdrawn from his regular classroom?

Depending on Alex’s initial feeling, it may have some effect on the different programming being put into place for him.

Is everyone, professionals, on board with Alex’s new program aware and/or educated prior to the recent date concerning Alex with the ABA program?

        Again, depending on if the professionals have a clear understanding of what exactly implementing partial ABA looks like and means, may have an effect on how well Alex receives the program, long term.

The next few questions have been left unanswered.  The purpose of the questions is to encourage discussion about Alex and the way that we have chosen to solve his dilemma.

Steps For Success: This program is designed to facilitate the successful transition from high school to community-based activities for young adults with an ASD.

Steps For Success: This program is designed to facilitate the successful transition from high school to community-based activities for young adults with an ASD.

How do you think Alex has changed after going through the ABA process?  Are there any significant changes to his overall demeanor (personality/behaviour/emotions)?

Do you think Alex feels better about himself and his abilities to understand others after his involvement with ABA and the Geneva Centre?

If Alex and his parents were to go through this again, what do you think they would choose to do differently (i.e.  starting ABA when Alex was much younger)?

Is the card game basically a bribe?  Is this ethical?

If the after school programs provided through the Geneva Centre for Autism begin to occupy to much after school time for Alex and his grades or homework assignments start to slack, what will his parents decide is more important for him to be focused on; his homework assignments or practicing his social skills in this centres various settings? What suggestions will the teacher have for Alex and his parents?

References

Bianco, M., Carothers, D., & Smiley, L. (2009, March). Gifted Students with Asperger Syndrome: Strategies for Strength Based Programming. Intervention in School and Clinic.  Austin: 44(4), 206-215.  Retrieved February 17, 2011, From Proquest.

Cash, Abbey B. (1999, September). A Profile of Gifted Individuals with Autism: The Twice-Exceptional Learner. Roeper Review, 22.1, 22-27. Retrieved  February 17, 2011, from ProQuest

Meirsschaut, Mieke, Herbert Roeyers, and Petre Warreyn. (2010, October). The social interactive behaviour of young children with autism spectrum disorder and their mothers: Is there an effect of familiarity of the interaction partner? Autism 15, 43-64. Retrieved  February 14, 2011, from Sagepublishers (DOI: 10.1177/1362361309353911)

Nelson, Dorta. (2003, March).  Making the grade:  A new classroom for children with asperger’s and other pervasive development disorders.  The Exceptional Parent, 33(3), 44-45.  Retrieved February 13, 2011, from ProQuest Education Journals.  (Document ID: 320211841).

Ashley, Susan. The Asperger's Answer Book - The top 300 Questions Parents Ask.  Napierville, Illinois: Sourcebooks Inc.  2007.  Pages 220-223.

http://www.autismontario.com/client/aso/ao.nsf/web/Our+Vision+for+Education

Retrieved from the World Wide Web February 20, 2011

It is helpful for Alex and his peers to have resources available to them to help them to understand what Aspergers is and how it affects the individual, his family and friends.  The following is a list of resources, geared specifically to older children and teens,  which may assist in this respect:

Books

Welton, J. (2003). Can I Tell You About Asperger Syndrome?: A Guide for Friends and Family.  London, UK, Jessica Kingsley Publishers

Attwood, T. (2008). The Complete Guide to Asperger's Syndrome. London, UK, Jessica Kingsley Publishers

O’Neill, J. (1999). Through the Eyes of Aliens: A Book About Autistic People.  London, UK, Jessica Kingsley Publishers

Jackson, L. (2002). Freaks, Geeks & Aspergers Syndrome. London, UK, Jessica Kingsley Publishers

Websites

http://aspergerteens.com/

 

Movies

Temple Grandin (2010)

Ziggurat model-http://www.doe.virginia.gov/special_ed/disabilities/autism/enews/2007/v5_2_oct_07.pdf

Walker, H.M. (1983). The ACCESS program: Adolescent curriculum for communication and effective social skills: Student study guide. Austin, TX: Pro-Ed.

Zins, J., Weissbert, R., Wang, M., & Walberg, H. (2004). Building academic success on social and emotional learning: What does the research say? New York: Teachers College Press.

Social Skills Interventions for Children with Asperger’s Syndrome

or High-Functioning Autism: A Review and Recommendations

Patricia A. Rao Æ Deborah C. Beidel Æ Michael J. Murray-Published online: Springer: 20 July 2007

http://www.myaspergerschild.com/2010/06/behavioral-interventions-for-aspergers.html

Dr. Aspy-The Ziggurat Model (2007) http://www.texasautism.com/AboutBook.html

Red and Green choices

http://www.redandgreenchoices.com/about.htm