(c) Autism News of Orange County - Summer 2009
While most of us engage in social interaction/regulation intuitively, many students with social learning challenges who have good to excellent language and cognition (e.g., High Functioning Autism, Pervasive Developmental Disorder-Not Otherwise Specified, Asperger Syndrome and/or Attention Deficit Disorder) are weak in their ability to think about how we think socially. They also often lag behind their peers in the development of their social relationship skills. Professionals may regard this higher functioning group as being "quirky" with some level of "social skill problems," but struggle when determining whether or not these students should qualify for specialized services in our schools, given that they may demonstrate strong academic knowledge. Nonetheless, the peer group is generally critical of how these students relate and may actively reject those who don't fit in. Furthermore, the deeper social learning challenges faced by this group may have an impact on how they interpret and respond to academic lessons that require social knowledge, such as reading comprehension of literature, written expression of essays, organizational skills and participating in peer-based (less structured) work groups. (Westby, 1985; Winner, 2000)
Social intelligence has an impact not only on our ability to live productively, but also on our ability to experience relative satisfaction throughout our lives (Hersh-Pasek & Golinkoff, 2003; Goleman, 2006). In fact, the set of tools used for social understanding and social regulation/communication in our early years is the same set required in adulthood to participate effectively as a member of society (i.e., hold a job and live with others in the community). Several years of clinical experience by both authors has led us to the conclusion that IQ scores and achievement fail to predict whether or not an individual considered high functioning will achieve a similar level of success in adulthood (e.g., maintain employment and develop satisfactory interpersonal social relations within their desired community).
Most of us would agree that the purpose of receiving an education is to prepare students to participate successfully in the adult world. Therefore it is reasonable to assume that those with significant social learning challenges need extra supports for learning about the social world, as well as for improving their capacity to develop social relationship skills. However, given that a neurotypical child's social knowledge and social skills are learned intuitively from their earliest days of life (Sabbagh, 2006), generally, teachers need only provide subtle cues to help these students learn to adjust their social behavior across different situations and grade level expectations. Therefore direct, concrete and explicit social teachings are not taught as part of the daily core curriculum. These more intensive teachings are usually taught by special educators, speech-language pathologists and psychologists/counselors.
In order to "qualify" for an Individualized Education Plan (IEP), a professional must demonstrate, via an assessment, that a student's deficits are severe enough across the school day to warrant more intensive services. Most professionals are taught to rely on standardized measures to determine whether or not a student is eligible for services. Thus, the most logical place to turn to assess a student's social thinking and related social skills would be through formal measures. However, significant limitations persist with the use of standardized tools for higher functioning students with ASD and related disabilities. The dynamic nature of social interaction is not easily captured in a linear standardized test battery.
Simmons-Mackie & Damico, in their seminal article, Contributions of Qualitative Research to the Knowledge Base of Normal Communication (2003) acknowledge that communication is a synergistic and dynamic process that quickly becomes indecipherable when we try and break it down into parts in order to test specific aspects. Furthermore, speed is of the essence during the process of interpreting what another person is thinking/saying and coding our own related social response. It is expected that we respond to one another in an interaction within milliseconds to 2 seconds (Vuchinich, 1980). Unfortunately, standardized testing is a process that deconstructs and examines communication in parts, but fails to assess how a student integrates this information. This may result in test scores that demonstrate islands of social knowledge without the ability to combine this knowledge into a functional whole. In fact, Minshew and Goldstein (1998) state that Autism Spectrum Disorders (ASD) are best described as a deficit in the integration of complex information.
Many clinicians have reported experiencing frustration when trying to find assessment tools to fairly represent a student's social functioning in "real time." This frustration has been the impetus for the development of the strategies described later in this article. A student with very impressive test scores who looks good on paper, but has obvious social relationship issues, becomes perplexing to the diagnostician. These students have motivated the authors to better understand not only why this group should receive specialized teaching, but the specifics behind what should be taught.
What does it mean to assess social thinking and related social skills?
Before assessing social thinking and related social skills, one must consider the enormous task that a person's social mind must undertake in order to integrate and then respond when given social information. The term Social Thinking was coined by the first author to illuminate the fact that social skills do not merely exist as separate units of information learned through behaviorism. Instead as we age, including across the school years, social skills are the behavioral output of our more fine-tuned social thoughts. To interact "appropriately" for our age, we need to consider what others are thinking and feeling as well as the expectations imposed by the situations in which we share our space or interact. While this may seem well beyond the ability of the preschool or young elementary school child, it is not. This can be seen when observing a kindergarten class where most five-year-old children can work in a group of 20 students, adapting effectively to the teacher's expectations across time.
Winner (2000) developed the acronym, the ILAUGH model of Social Thinking to help explain to parents and professionals the many elements that contribute to Social Thinking:
I = Initiation of language to ask for help: enter/exit social interactions, or initiate other interactions that are not routine.
L = Listening with eyes and brain: we listen with both our ears and our eyes in order to interpret what people are doing with their bodies, facial expressions, gestures, tone of voice, language, etc.
A = Abstract and inferential thinking: making smart or educated guesses about what people are saying and doing in context in order to decipher meaning.
U = Understanding perspective: considering one’s own and others' thoughts, emotions, motives, intentions, prior knowledge, belief systems and personality in context to help more accurately interpret and respond to information.
G = Getting the big picture (gestalt processing): focusing on main ideas and recognizing supporting details; as opposed to getting lost in details and struggling to see how they connect to broader ideas.
H = Humor and Human relatedness: valuing and fostering human relatedness while also exploring the value of humor at the right time, in the right place, and with the right person.
It is also critical that we realize that social behavior is ever-changing based on our own stage of development. We expect students to demonstrate increasing nuance and sophistication in the ways they engage with each other, in their social thinking and related social skills with each passing year. When children are young they have relatively little social knowledge, thus may act in a more "immature" manner. But as they grow, we expect increasing maturity which is reflected by the expression of more finely tuned social-behavioral responses, also referred to as social skills. Furthermore, social behavior is also dictated by our ability to "read" the changing "hidden rules" or "hidden curriculum" required in specific situations (Myles, Trautman, & Schelvan, 2004). Adapting to the complexities by considering and responding to all of these variables can best be understood as "complex social processing." To our knowledge, there is no standardized test or informal checklist that explores one's ability to socially adapt at a microscopic level, but it is at this level that we form perceptions of how people are "behaving" around us.
Remarkably, across cultures, we have subtle, nuanced behavioral expectations but we don't have a readily accessible way to describe when a child or even an adult is not "behaving" in a way that is expected. Yet interpreting those around us accurately and conforming our social behavior to situational demands, even for our youngest students, is considered a mandatory part of participating in the societies of our home, school and community. Therefore, creative approaches to assess this complex processing are in order.
Aspects of an Informal Dynamic Social Thinking Assessment Process:
The first step in assessing a student's social challenges is to understand the many ways in which we think socially and expect related social behavioral adaptations in others (Winner, 2007). As we acquire this knowledge, we can become better observers of our student's social behavior within social situations. Our goal is to not only observe in structured and unstructured naturalistic situations (Weatherby, 2006), but to also learn what about the student's social knowledge that may support or fail to support social behavioral or social academic expectations.
If a professional works in a school environment, observing a student in the naturalistic setting is an invaluable part of the assessment. Professionals may ask, "Where are the guidelines or written social standards on which we can base these observations?" The answer is that the professional has to observe, to some extent, the student in the setting to determine if the behavior of the student they are assessing is "expected" or "unexpected." For example, if a student is "blurting" out in class, it is important to note that to some extent all students "blurt" on occasion in a classroom. Thus it is not that the student has blurted, it is whether his level of blurting significantly exceeds the expected "norm" of the other students in the classroom.
If a professional does not work within the school, it is important to remember that social behavior happens 24 hours a day and so the assessment should begin in the waiting room or at the initial meeting. Knowledge of general social developmental expectations of students across childhood and into adulthood is helpful. This knowledge is most easily gained by actively observing "normal" behavior in a given situation, whether it is in a grocery store, a school, home, etc. A recent example of this occurred when a 13-year-old boy came for a first visit to the authors' waiting room. The boy stood very close, spoke in a very loud voice, and described his Playstation game in a very, very excited manner. This behavior may have been "expected" for a 6-year-old but was clearly "out of the norm" for a 13-year-old. Thus, the assessment had already begun.
Winner (2007) created a number of informal assessment tasks to better understand how individuals process and respond to social information that is complex in nature. The following is an example of one task within an informal Dynamic Social Thinking Assessment. The tasks in this assessment are designed to explore a student's thinking in "real time" and are a critical aspect of assessing the ability to relate effectively with others. This core task explores how students use their eyes to process and respond to other's thinking. The task will be described in three parts: a. the task itself, b. how this task relates to developing social interactive competencies, and c. how this knowledge is incorporated across a school or home day using the paradigm of the ILAUGH model of social thinking.
Thinking With Your Eyes:
a. Task description: The examiner works with the student in a relatively small room and asks him to guess what he thinks the examiner might be looking towards. The examiner can cue the student by telling him that the task relates to looking at her eyes. If the examiner is wearing glasses, she should take them off. The examiner then looks at one object in the room that is 8 feet or less from where the examiner is sitting. The student is to focus on what the examiner is looking at, follow her eyes and then state aloud what he or she thinks the examiner sees. For example, if the examiner is looking at a clock, the student should guess she is looking at the clock. The examiner should not correct the student if they are wrong.
After the examiner determines the student's ability to follow the examiner's eye gaze, she can then say, "Now I want you to guess what I am thinking about and this also has to do with my eyes." Now she should look back towards some of the objects from the previous task. For example, if the student thinks she is looking at the clock he should now state she is thinking about the time. If the student can do this, it indicates that he is able to shift his observation of another person's eyes from thinking about what they seeing to inferring the concept the examiner may be considering or thinking.
b. Assessment of social knowledge: In the research on early development, the ability to follow eye gaze is called "Joint Attention" and it is expected that neurotypical students are proficient by 12 months. When a student is limited in his ability to "read someone's eyes" or what we describe as "thinking with your eyes about what someone else is thinking," it impacts social understanding of the situation. For example, a student is required to determine what the teacher may be thinking in the classroom each and every day (e.g., observing the teacher to figure out whose turn it is to speak or what is expected from the students). This is also the case when two or more individuals are actively engaged in a discussion or conversation. If you take time to observe this skill in yourself, you will begin to notice how much we depend on watching and reading others' eyes to figure out their intentions, etc.
c. How this knowledge is incorporated into the school and home day: Awareness of another person's eyes (and related thoughts) is a central skill for understanding how a person works as part of a larger group in a classroom as well as how to relate to others through play and conversation. It is also considered a part of our own personal safety as we monitor what others see as it relates to thoughts they may be having about us. Typically, when a student has "poor to good eye contact" we determine they need to learn to use appropriate eye contact. What we may not realize is that they are lacking more than the understanding of eye contact itself; many students with social learning challenges are inefficient social thinkers who do not easily making the eye-gaze/social thinking connection. With regards to the ILAUGH model of Social Thinking the concept of "thinking with your eyes" is central not only to "Listening with eyes and brain" but also "Understanding Perspective." The ability to efficiently think about what someone else is thinking also leads to better abstract/inferential thinking as we infer what people mean by what they say, based on what we think they might be thinking about.
Many instances of using this task in hundreds of individuals of all ages has shown us that how a person performs on this task cannot be predicted based on their diagnostic label, IQ scores, or language skills. The task is unique in that it assesses the ability to actively engage in Social Thinking in the moment of social interaction and appears to be a crucial aspect of the assessment of social competencies. Winner (2007) has described a number of tasks that attempt to capture a more "real time" assessment of social thinking and related social skills and discusses how the information gleaned from these tasks helps to more accurately predict a student's actual social processing and responding.
A comprehensive assessment should include a blend of standardized assessments, checklists of social functioning, such as Bellini's Autism Social Skills Profile (2006), and Informal Dynamic Measures of Social Thinking. However, if the professional has time constraints, the least informative method for predicting how a student relates and responds to social information in real-time interactions and in their core curriculum is through standardized tests. In the process of understanding the social mind in action, it is critical to consider that formal tests are not the best and most accurate indicators of a student's ability to function in day-to-day social and academic skills. Instead, this article has given one task to inspire diagnosticians to dig a little deeper into the assessment of the social mind; there are many other creative ways in which dynamic social thinking and related social skills can be explored. Professionals should realize they are on the cutting edge of a new field for which the research has not been completed, but the need for creativity combined with continued learning about the complex social mind and its many functions is crucial. Individuals with social learning challenges are here now and they can't wait for our field and our research to evolve.
Bellini, S. (2006), Autism Social Skills Profile within Building Social Relationships; A Systematic Approach to Teaching Social Interaction Skills to Children and Adolescents with Autism Spectrum Disorders and Other Social Difficulties; p. 73. Autism Asperger Publishing Co.; Shawnee Mission, KS.
Goleman, D. (2006) Social Intelligence: The New Science of Social Relationships. New York, NY: Bantam Books.
Hersh-Pasek, K., & Golinkoff, M. (2003). Einstein never used flashcards (p. 183), New York, NY: St Martin's Press.
Minshew, N., Goldstein, G. (1998) Autism As A Disorder Of Complex Information Processing. Mental Retardation and Developmental Disabilities Research Reviews, Vol. 4: 129-136.
Myles, B., Trautman, M., Schelvan, R. (2004) The Hidden Curriculum: Practical Solutions for Understanding Unstated Rules in Social Situations. Autism Asperger Publishers, Inc. Kansas City, KS.
Sabbagh, M. (2006). Neurocognitive bases of preschoolers' theory of mind development: Integrating cognitive neuroscienceand cognitive development. In P. Marshall & N. Fox (Eds.), The development of social engagement. Neurobiological perspectives pp. 153-170. NY: Oxford University Press.
Simmons-Mackie, N. and J. Damico. "Contributions of Qualitative Research to the Knowledge Base of Normal Communication. American Journal of Speech Language Pathology. Vol 12. May 2003 144-154.
Westby, C. (1985). Learning to talk-learning to learn: Oral literate language differences. In C. Simon (Ed.), Communication skills and classroom success, pp. 181-218. San Diego, CA: College Hill Press.
Wetherby's (2006) chapter in Social & Communication Development in Autism Spectrum Disorders. Eds Charman, T. and Stone, W. The Guilford Press, New York, NY.
Winner, M. (2000). Inside out: What makes the person with social cognitive deficits tick? Think Social Publishing; San Jose, CA.
Winner, M. (2007). Thinking about you thinking about me, 2nd edition. Think Social Publishing; San Jose, CA.
Vuchinich, S. (1980) Logical relations and comprehension in conversation. Journal of Psycholinguistic Research, Vol. 9, 5, 473-501.