Authors: Michelle Garcia Winner, MA, CCC-SLP, and Pamela Crooke, PhD, CCC-SLP
Social Communicative Development
Social development appears to begin prior to birth and emerges in the early days of life as babies actively pursue social learning through their daily experiences (Hirsh-Pasek & Golinkoff, 2003). Marshall and Fox (2006) describe early social developmental milestones, identifying that babies as young as 36 hours of life distinguish between facial expressions while babies at seven months match vocal expressions of emotion to facial expression. By the end of the first year of life, infants are also developing pre-linguistic communication skills such as declarative/imperative points (Carpenter, Pennington & Rogers, 2002). Toddlers are actively developing social learning, which includes responding to the ideas of others, even before they can verbally express these ideas (Meltzoff, 1995). For example, the more a child engages in verbal communicative exchanges, the more he or she learns about what other people are thinking.
This early social thought ignites the development of perspective taking which encourages abstract language to communicate increasingly complex feelings and thoughts (Flavell, 2004). By four years of age, neurotypical children emerge in their use of mental state verbs (e.g., think, know, guess, decide, etc.) to express information about what they think others are thinking (De Villiers, 2000). By six years old they can understand the basic concept that people can lie, cheat and steal (Baron-Cohen, 2000). As children begin to realize they can manipulate other people, their language emerges into increasingly sophisticated linguistic trickery. It is not uncommon to see a third grade child trick someone into looking in a certain direction and then state, “made you look.”
Social manipulation and the ability to think socially appear to be critical not only for social participation but also for understanding aspects of play, problem solving, understanding communicative intentions, written expression and reading comprehension (Booth, Hall, Robison & Kim, 1997; Norbury & Bishop, 2002; Westby, 1985). Not coincidentally, abstract social language and communicative interpretation become heavily coded in academic curricula, as students are asked early in their educational journey to interpret the intentions of a character in a story to understand the motives for the actor’s actions. Children with typical development acquire this social communication foundation with ease; however, those with social learning challenges (autism spectrum, ADHD, etc.) do not intuitively understand and use these concepts without great effort and direct teaching.
Given these developmental progressions of social learning, it is clear that early development of neurotypical children involves actively learning social information which includes the awareness that we all think about each other’s different thoughts and feelings. It appears that this core conceptual information is required for even pre-school children to “act appropriately” with others, hence producing “good social skills.” Thus, it is expected that social awareness of socially related concepts (you feel and think differently from me) are critical for students to produce expected social behavior (social skills).
SLPs learn about social pragmatics to explore how we use social communication skills. Based on the above information it can be argued that not only should we as SLPs focus on the communication skill production itself but also on the knowledge students need to acquire in order to understand why they should produce this skill. For example, we often focus on teaching students the behavioral social skill of “eye-contact” by asking them to “look at me,” but in reality many higher level students with ASD we have worked with lack development of the social concept (e.g. Joint Attention) to know to follow the iris of people’s eyes to determine where they are looking and then infer what they might be thinking about. Our treatment takes on new meaning when we teach students the social concept that supports how we use the social skill we call “eye-contact.” This type of teaching we refer to as teaching “Social Thinking and related social skills.” This deeper study of how we learn socially and then develop related treatment strategies for those who lack in social pragmatic development has only recently taken on new urgency with the increasing presence of students on our caseload with reasonable verbal cognition and language skills who have diagnoses such as Asperger Syndrome, PDD-NOS and Nonverbal Learning Disability. Given their astute technical language skills and strong concrete learning style, they are critical consumers of the information we teach them. They often ask “why do I have to do it that way?” Teaching Social Thinking and related social skills appears to provide a deeper answer as well as lessons to increase social pragmatic functioning. But, how do we, as professionals, learn about the social thinking associated with production of social skills? Below is one framework to explore this information.
The ILAUGH Model of Social Thinking
The ILAUGH Model of Social Thinking, developed by Winner (2000), is a theoretical model for use by parents and professionals to explore some of the many variables that lend themselves to what we call good “communication” or “problem solving” skills across the day. Winner created this based on her observations of what her students with social learning challenges were requiring to learn to help with their social skills and specific aspects of their curriculum. A literature review also found that each aspect Winner had identified had already been researched and demonstrated to be a relevant learning hurdle for students with ASD. Thus, the ILAUGH Model represents an integrated summary of the evidence based research. It is designed to: 1) help SLPs, educators and parents systematically organize and “make sense” of the challenges faced by those with social learning challenges, and 2) provide a direction for therapists to build on the student’s strengths and areas of need to tailor intervention . The ILAUGH Model also helps us understand the relationship between social interaction, problem solving and the ability to interpret and respond to aspects of the academic curricula to create more efficient treatment programs.
This model incorporates concepts known to impact persons with ASD and related diagnoses, namely executive functions (e.g. multitasking), (Hill, 2004; McEvoy, Rogers, & Pennington, 1993), theory of mind (e.g. perspective taking),(Baron-Cohen, Leslie, & Frith, 1985; Flavell, 2004), central coherence theory (e.g. gestalt processing), (Frith, 1989; van Lang, Bouma, Sytema, Kraijer, & Minderaa, 2006) and social emotional processing (e.g. human relatedness), (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2006a & b). The six components of the model are reviewed briefly below:
I = Initiation of Language (Krantz & McClannahan, 1993; MacDonald et al., 2006). Initiation of communication and language refers to the ability to use one’s skills to seek assistance or information. A student’s ability to talk about his own interests can be in sharp contrast to how she communicates when she needs assistance. Many individuals with social cognitive challenges have the ability to produce a great deal of language. Yet while these students talk frequently about their own knowledge and ideas, they may not be proficient using their sizeable language skills to communicate when unaware of what to do next or how to clarify when they don’t understand.
L= Listening with Eyes and Brain (Baron-Cohen, 1995; Jones & Carr, 2004; Whalen, Schreibman & Ingersoll, 2006). Many individuals on the autism spectrum, as well as others with social learning challenges have technical visual processing strengths, but may struggle to comprehend information presented via the dual challenges of social visual information (reading nonverbal cues) and auditory processing. In fact, listening requires more than just taking in auditory information. Listening requires the integration of information the student sees and hears to understand the deeper concept, or to make an educated guess about what is being said when the message cannot be interpreted literally. This is also referred to as “active listening” or “whole body listening.”
A = Abstract and Inferential Language/Communication (Minshew, Goldstein, Muenz, & Payton, 1992; Norbury & Bishop, 2002). Comprehension depends on one’s ability to recognize that most language or communication is not intended for literal interpretation. Abstract and inferential meaning occurs subtly through verbal and nonverbal communication and analyzing the language in context. One must be flexible in interpreting the intended meaning of a message by considering what they know about people within specific contexts (Simmons-Mackie & Damico, 2003).
U = Understanding Perspective (Baron-Cohen, 2000; Baron-Cohen, Jolliffe, Mortimore, & Robertson 1997; Flavell, 2004). The ability to interpret others’ perspectives or beliefs, thoughts and feelings across contexts is a critical social learning skill. It is central to group participation in the social, academic or vocational world. Individuals with social cognitive challenges are often highly aware of their own perspective, but may struggle to see another’s point of view.
G=Gestalt Processing/Getting the Big Picture (Fullerton, Stratton, Coyne & Gray, 1996; McEvoy et al., 1993; Norbury & Bishop, 2002; Shah & Frith, 1993). Many students with social learning issues are highly skilled at obtaining and retaining factual information related to their particular area of interest. However, both written and conversational language is conveyed through concepts, not just facts. For example, when having a conversation, participants intuitively determine the underlying concept being discussed. When reading a book, the reader must follow the overall meaning (gestalt) of the book rather than just collecting the details of the story, especially if expected to compose a cohesive written description of what has been read that others easily understand and interpret. Further, organizational skills fall within this area and are critical for completing homework, preparing written assignments, cleaning a household and finishing tasks at work. These skills require us to “see the big picture” and assess what needs to be done systematically before plugging in the details to accomplish a goal.
H= Humor and Human Relatedness (Greenspan, 1990; Prizant, Wetherby, Rubin & Laurent, 2003; Wolfberg, 2003). Many individuals with social challenges often exhibit an excellent sense of humor, but feel anxious as they miss many of the subtle cues that would help them understand ways to participate more successfully with others in a social context. Emotional processing is also at the heart of human relatedness.
Social Thinking and Teaching Related Social Skills: From Social Knowledge to Social Skills
Social skill interventions for persons with social challenges, especially those with Autism Spectrum Disorder (ASD), require treatment which includes these fundamental tenants (Krasney, Williams, Provencal & Ozonoff, 2003, p. 111):
- make the abstract concrete
- provide a scaffold of language support
- foster self-awareness and self-esteem
- program in a sequential and progressive manner
- provide opportunities for programmed generalization and ongoing practice
The ILAUGH Model provides one of the frameworks upon which the principles of Social Thinking intervention are built. Also fundamental to Winner’s work is the recognition that we all have thoughts and feelings about each other’s social behavior (e.g. social skills) (Goleman, 2006). Winner, in her quest to create concrete lessons to teach these abstract social concepts (2000, 2002, 2005, 2007, 2008), recognized the need for us to create specific language based concepts that could be used consistently by teachers, parents, SLPs, etc. to describe and explain our social expectations and related social thoughts and emotions.
These specific concepts are described as the Social Thinking Vocabulary, which represents one portion of the larger Social Thinking theoretical framework. However, for the purposes of this article, these concepts are considered foundational and give the reader a broad overview.
Think with Your Eyes. This is a statement used in lieu of telling a student to “use good eye-contact” or “look at me.” We have found that many students with social learning challenges don’t know what they are supposed to think about when we simply tell them to “use good eye-contact.” By explaining that they should “think with their eyes” we can begin to teach them that eyes aren’t just for looking at another person during an interaction. The eyes are powerful tools to be used for gaining information in almost any situation. For example, if a teacher is showing a picture book to a small group, students are not expected to use “eye contact” with the teacher. Instead, students are expected to show they are thinking about the book by looking at the book. Often a teacher will pause to ask a question. She may not state the student’s name, but instead signify that she is speaking to the student by just looking (e.g., “what would you do next?”). The concept of “thinking with your eyes” is also relevant in problem solving and perspective taking. For instance, children learn that they use their eyes to figure out other’s plans (e.g., I see him reach for the blue one, that means he wants the blue one) and determine what to do next (e.g., I see others lining up and know to line up too).
Expected/Unexpected Behavior. We teach that social and communicative expectations are contextually sensitive. In fact, for every situation there are a set of expected and unexpected behaviors that generate different types of thoughts. When a behavior is expected for a situation it encourages us to have good or okay or normal thoughts and feelings; when a behavior is unexpected we tend to have uncomfortable or weird thoughts* and related feelings. How we think about someone over time affects our “social memory” of them. *(Note: This is not the same as thinking a person is “weird.” Instead, we have a weird thought based on the behavior within that situation.)
Smart Guess/Wacky Guess. This concept is addressed by teaching students to “read the situation” and infer what actions to take based on the situation. Social inferencing is at the heart of determining what to say or do and occurs at a rapid-fire pace in everyday social communication as well as when comprehending text. We break down the process of inferencing by teaching students to become aware of words and nonverbal cues to “take what you (think, know, see and hear) to make a guess.”
Social Fake. This is a concept that explores how “genuinely” interested we feel as we engage in a social dialogue with others. Most of us are interested in getting to know one another, even though we aren’t always fascinated by exactly what they say. We teach that often we simply tolerate other’s conversational topic in order to maintain the social-emotional connection. How we make each other feel is more important than the exact words used to sustain the relationship.
In addition to this sampling of Social Thinking Vocabulary other key concepts related to Social Thinking include constant infusion of the following:
What are “good social skills”? Social thinking precedes the use of good social skills. First we have to be aware of the people and the situation before we select which sets of social behaviors (social skills) to employ. While sharing space with others we are constantly aware of people (social thinking) and then monitor and modify our behavior accordingly to encourage people to think about us the way we want them to perceive us. Interestingly, the majority of time we are socially thinking in the presence of others, we are not actually interacting with these people, rather we are co-existing. For example, consider how students all are expected to work quietly during tests to keep from distracting the thoughts of other students around them. In this example, the students are demonstrating good social skills but none are engaged in a verbal interaction.
The social rules change with age. Teaching social thinking and related social skills is a bit like shooting a bullet at a moving target. Although we may overtly teach a child to greet others with a friendly “hi” when in the early elementary years, students in high school realize that a friendly “hi” between two guys is no longer the norm (i.e., instead a grunt or “hey” is required). Social rules change in nuance and sophistication across our lifetime. We not only expect 15-year-olds to act differently than 10-year-olds, we also expect 20-year-olds to act differently than 30-year-olds. Teaching children to be keen observers of situations within environments is one way to learn the nuance of the social rules within their age and cultural group.
EBP and Social Skills/Social Thinking Therapy
Evidence-based practices (EBP), according to ASHA guidelines, are those which “recognize the needs, abilities, values, preferences, and interests of individuals and families to whom they provide clinical services, and integrate those factors along with best current research evidence and their clinical expertise in making clinical decisions” (ASHA, 2005, p. 1). This definition serves to help practitioners evaluate which new teachings are “best or promising practices” given the infancy of our emerging fields of study as well as the complexity of treatment that involves not only social communication but complex social emotional responses. Social thinking may, in fact, be one of the promising practices that has recently been the focus of research.
Crooke, Hendrix, and Rachman (2008) examined the effectiveness of teaching Social Thinking vocabulary to adolescents with Asperger Syndrome (AS) or High Functioning Autism (HFA). The published pre-post-study was one piece of a larger single subject treatment study where the authors measured verbal and nonverbal social behaviors in two separate settings (treatment and generalization). In the treatment setting, subjects were taught Social Thinking vocabulary such as “social files”, “thinking with eyes,” “filtering knowledge vs. opinions” and “expected” and “unexpected” for the situation within an environment. Lessons were designed to encourage students to think about the “why” underlying the actual production of the social skill. How to use specific social skills (e.g., turn-taking, eye-contact, topic maintenance) was never directly taught; rather the concepts of thinking socially were addressed by showing that others have thoughts and emotions related to their behaviors, both positive and negative. Generalization measures included the use of social skills such as initiations, looking at the speaker, on-topic remarks that added to the topic, and one-word comments that served to sustain the interaction, Results indicated statistically significant (p >= .03) changes from pre- to post- measures on both verbal/nonverbal ‘‘expected’’ and ‘‘unexpected’’ social responses in the generalization setting. Although not significant for the group (p >= .15, p)
An additional study was conducted by Adams (2008) who examined the effectiveness of a mentoring program for social thinking intervention in the schools. Results of this study indicated significant changes for the group based on the parent and teacher rankings using the Autism Social Skills Profile (Bellini & Hopf , 2007).
Finally, a new group of investigators at the University of Hong Kong translated Winner’s ILAUGH Model and Social Thinking Vocabulary into Chinese in 2006. The investigators (S.K. Lee and colleagues, personal communication, July 20-23, 2008.) infused Social Thinking into the school setting and measured teacher and parent perception of change over the course of a school year and reported significant changes (ongoing analysis in process).
Social Thinking, when compared to other paradigms, is still in its infancy, but represents a promising conceptual framework that can be utilized by SLPs and educators when developing treatment plans for individuals with social learning issues. As with any treatment regime, a multidimensional pattern of approaches must be considered. Ongoing and future research to address this population must consider the synergistic nature of these students’ multiple learning challenges and how their needs change across their lifespan.
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