"What is 'behavioral rehearsal' [the social skills method used for kids on the autism spectrum] and how do you use it exactly?"
Behavioral rehearsal is used primarily to teach basic social skills to children with Asperger’s (AS) and High-Functioning Autism (HFA) in a way that allows for the “creative practice” of such skills. This technique involves acting-out situations and activities in a structured environment in order to repeat newly acquired skills (or previously learned skills) that the youngster is having difficulties performing.
Behavioral rehearsal can be either scripted or spontaneous. In the spontaneous approach, the youngster is provided with a scenario (e.g., asking a peer to play with him), but not with the specific script. Usually, it’s best to combine scripted and unscripted elements to each rehearsal (e.g., the youngster might be provided with an opening statement or question, but the rest of the interaction would be spontaneous).
Behavioral rehearsal can be used to teach a variety of social skills, particularly those involving initiating, responding, and terminating interactions. For example, the youngster may be required to initiate a conversation with peers who are engaged in a separate task, thus he would have to ask to join in, or ask his peers to join him in an activity. The latter typically proves to be most difficult for kids with AS and HFA.
During the first few rehearsals, it is not uncommon for the AS or HFA youngster to get “stuck” in conversations or interactions without knowing what to say or how to proceed. During the early sessions, the youngster should be given ample time to process and respond to the different scenarios. As the sessions progress, speed and proficiency should steadily increase.
Examples of practice scenarios used in behavioral rehearsal:
1. Active Listening: Active listeners show speakers that they are paying attention. They do this through body language (e.g., offering appropriate eye contact, orienting the body in the direction of the speaker, remaining quiet, etc.) and verbal feedback (e.g., restating, in their own words, what the speaker is trying to communicate). One technique for teaching active listening to AS and HFA kids can go like this: Assign children to one of three roles (e.g., a speaker, a listener, and an observer). The speaker is instructed to talk for a few minutes about something important to her. The listener attends quietly, providing cues to the speaker that he is paying attention. When the speaker is finished talking, the listener also repeats back, in his own words, the speaker’s points. The observer’s job is to evaluate the speaker and listener (e.g., Did the speaker stay on topic? How did the listener indicate that he was paying attention?). After the observer shares the observations with the others, the players switch roles and try again.
2. Bullying: Bullying is popular theme in AS and HFA kids' rehearsal activities. One youngster can assume the role of a bully and pretend to hit or shove one of his peers. The bully will taunt the victim to fight back, at which point the victim should walk away, call for help, alert the nearest teacher, or some combination thereof.
3. Charades: Children engage in a variety of social skills activities during a game of charades. A player draws a slip of paper from a box and silently reads the word written on it. Then she tries to convey this word to her peers through pantomime. What gestures are most likely to communicate the important information? After each round, encourage the children to engage in analysis (e.g., Which gestures worked? Which ones didn’t? Why?).
4. Cooperative Group Construction Projects: Rehearsing group construction projects (e.g., collaboratively building a house using Legos) force an AS or HFA child to pay attention to his peers’ efforts, to communicate, to negotiate, and to cooperate. In one study of children with AS and HFA, students attended a one hour session of group construction play once a week for 18 weeks. Compared with students given special training in the social use of language, the students in the construction group showed greater improvement in their social interactions. Other research indicates that the benefits of these experiences last for years.
5. Saying “No” to Drugs: AS and HFA kids can learn about saying no to drugs through rehearsal exercises. When performing this type of exercise, one youngster takes on the role of a drug dealer who offers to give or sell drugs to one of his peers. When the peer refuses, the drug dealer will taunt her, calling her scared and chicken. But the taunts should have no effect on the peer, who will deliver a final firm "NO" and exit the scene.
6. Following the Leader: Standing in line and following a leader is another important skill for AS and HFA children. Have the children line up behind a leader and follow her through an obstacle course. All the children must stay in line and take turns as they pass through each section of the course.
7. Good Sportsmanship: Team sports can make very effective social skills activities for AS and HFA kids. Before a game, talk to the children about the goals of good sportsmanship (e.g., showing respect to other players and to the referee, showing encouragement and offering help to other players who may be less skilled, resolving conflicts without running to the teacher, being a good winner by not bragging and taunting the losers and by providing supportive feedback to the losers, being a good loser by congratulating the winner and not blaming others for the loss, and so on). During the game, give children the chance to put these principles into action “before” you intervene in conflicts. If they don’t sort things out themselves after a few minutes, you can jump in. And when the game is over, give the children feedback on their good sportsmanship.
8. Gossiping: Behavioral rehearsal can help deter AS and HFA kids from speaking ill of their peers. In this rehearsal, one youngster pretends to spread vicious rumors about a classmate to one of his friends. After running out of gossip, he will ask his friend if he has dirt on any of his classmates. The friend will insist that he doesn't and, when pressed, will declare that it is harmful to talk about others behind their backs and that he doesn't want to be part of it.
9. Make Me Laugh: Learning self-control is a crucial skill for AS and HFA kids. Here’s a classic game that encourages these children to practice self-control: The children freeze like statues, then one youngster (who is “it”) must try to get them to break character and laugh. The first one to laugh becomes “it” for the next round.
10. The Name Game: AS and HFA kids need to learn the importance of getting someone’s attention “before” they speak. For this rehearsal, have children sit in a circle and give one child a ball. Then ask her to name another youngster in the circle and roll the ball to that youngster. The recipient then takes his turn, naming a youngster and rolling the ball …and so on.
11. Avoiding Strangers: Behavioral rehearsal is a good way to teach AS and HFA kids about stranger danger. For this type of rehearsal, a parent or teacher can assume the role of a stranger (e.g., Mr. Clark) who pulls up in a car and requests the youngster's assistance in reaching a certain address. After the youngster offers directions, Mr. Clark should insist that the youngster get in the car and accompany him to his destination. The youngster should adamantly refuse and promptly distance herself from Mr. Clark. If Mr. Clark continues to pursue her, the youngster should run and scream for help.
12. Reading Facial Cues: Helping AS and HFA children learn to pay attention to facial expressions in others is also a great subject for behavioral rehearsal. Collect photographs of people making different facial expressions and paste them to index cards. Your collection should include expressions of: anger, disgust, fear, happy, sad and surprise. These are basic emotions, and the facial expressions people use to communicate them seem to be similar across cultures. Before using your new cards with children, test them out on grown-ups, asking them to guess what emotion each expression represents. Re-do and pictures that adults have difficulty identifying. Although you can use the index cards as flash cards (e.g., “What is this person feeling”), there are also several games you can play. For example:
Have the children match each facial expression card with a situation that might evoke the emotion (e.g., a foot being stepped on, a person being snubbed or ignored by others, a person receiving a gift, a tower created from toy blocks being kicked over, an ice cream cone that has fallen on the ground, someone running from a mean dog, and so on).
Players take turns picking a card from the deck and inventing a reason for the facial expression displayed (e.g., if the player picks a card with a man showing disgust, the player might say, “He just stepped in mud puddle”).
Shuffle the cards and put them face down. The first player picks a card, keeps it to herself, and then mimics the facial expression on the card. The other player(s) have to guess the correct emotion.
Other ideas for behavioral rehearsal could include:
attending a funeral
being a guest
being a host
going to a restaurant
going to church
meeting new people
offering sympathy
receiving gifts or compliments
sharing toys
shopping for groceries
Behavioral rehearsal is a way for AS and HFA children to practice basic social skills. It is particularly helpful for children who have difficulty getting along with others. When using behavioral rehearsal, be sure to stress the process and not the end result. Know that there will be times when the youngster will handle a situation beautifully, yet things will not work out the way you thought they “should” have. Also, be sure the youngster in a good mood before starting a practice session.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
Anonymous said.. I am not sure why you give so much in the form of information for free. I just want you to know that it has helped my parenting so much. Because of you, I have a great high-functioning autistic teen-ager, and a great relationship with him.
Numerous case reports suggest that children with Asperger’s (AS) and High-Functioning Autism (HFA) think concretely instead of abstractly. For example, when these children hear the word “dog,” they may have a vivid, detailed image of their first pet dog, then the second pet dog, and so on. Conversely, neurotypical children (those not on the spectrum) are more likely to have an image of a generic or conceptual dog without much detailed imagery.
Due to their concrete learning style, children on the autism spectrum tend to remember individual examples precisely without noticing common themes among examples. For instance, the child may store the details of specific animals he encounters together with labels (e.g., dogs, cats), but he may be poor at learning features that define dogs and cats (e.g., both dogs and cats are pets, furry, playful, etc.).
On the other hand, neurotypical children learn from specific examples, and then “generalize” those examples to other areas (e.g., throwing a rock is similar to throwing a baseball). Since generalizing is far more efficient than coding a large number of individual examples, the neurotypical learning style de-emphasizes coding details of individual examples unless there is a need to do so.
Language facilitates abstract thinking and communication. Even “concrete” words such as “fatigued” are really abstractions of many related examples. AS and HFA children’s poor ability of abstraction contributes to their social skills deficits and their preference of “thinking in pictures” to thinking in language.
How can parents help their AS and HFA children to think more abstractly?
Creative thinking and problem solving are necessary life skills for all children. The therapeutic benefits of creative outlets (e.g., drawing, writing, photography, storytelling, etc.) are well-documented in medical literature. To teach creative thinking to your concrete thinker, start with a very structured approach, and then gradually relax it as the child becomes comfortable. Here’s how to get started:
1. Cook something with your child. Even when following a recipe very closely, there’s always some room for improvising in the kitchen. Encourage your child to decide if a little more of this or that is needed, if the oven needs to be turned up or down, if the lasagna needs an extra 5 minutes to cook, and so on.
2. Repair something with your child. Whether it’s a flat tire on a bicycle or a cracked vase, there’s usually more than one way fix it. Instead of using commands like “go find me a screw driver,” recruit your child’s help in ‘thinking things through’ (e.g., “I need something sticky to put these two pieces back together …got any ideas?” or “ I need to put this somewhere safe while the glue dries …any suggestions?”). Allow your child to suggest or improvise each step of the process with you.
3. Help your child make a book. Creating a book on a favorite subject will give your son or daughter a sense of authority and expertise. One Asperger’s child collected her doll pictures (cut from a coloring book all about antique dolls), stapled them together, glued a large photo of herself to the cover, and then gave copies of her book to her cousins. This act of kindness opened up new conversations for her.
4. Teach your child how to paint. For example, introduce your concrete thinker to watercolors, and show him or her how to draw and paint landscapes. Start off by teaching your child about perspective. A good time to do this is when you are outside. Show your child that objects in the distance appear smaller than when they are close-up. To start out, you will need heavy weight water color paper (which you can get at any arts and craft store) and a small selection of brushes (e.g., one wide brush about 2 inches for filling in large details, and a couple fine point brushes for outlining shapes and filling in finer details).
5. Show your child how to take pictures. AS and HFA kids see the world through a special lens. There is a purity to their imagination that, at some point, most grown-ups lose. If you have never put a camera in the hands of your unique youngster, you will soon discover that what he or she views in life is very different than your perspective. Start with the basics. The most important concept in photography is universally known to be “Fill the Frame.” Emphasize that the “subject” must fill the frame to remove distractions (it’s ok to show examples of subjects quite literally filling the frame with very few other elements). Once your child practices and masters the idea of removing distractions, you can go on to explain that other elements can be in the picture to support the main subject.
6. Write poetry together. A sophisticated command of the English language is not a prerequisite for writing good poetry. In fact, simple words often have a more lasting impact than complex ideas and metaphors. The most important tool for writing poetry is probably the rhyming dictionary, which is a book that lists the words that rhyme with ‘end sounds’ of other words (e.g., if you want to find a rhyme for “cat,” you would look up “at” in a rhyming dictionary, because “at” is the ending sound of the word “cat” …the rhyming dictionary would then give you a list of words such as “bat,” “fat,” “sat,” and so on).
7. Tell stories to your child. Storytelling is an ancient tradition across all cultures, and it’s an important part of cognitive development. Aside from the fact that a story does a better job than anything else of capturing the essence of value, people in general like to hear stories, especially when they are told well. Children like stories because, when they hear them, they have the chance to learn, to be enlightened and entertained. Stories, more than anything else, capture the essence of our lives. That is why we like to hear them.
8. Show that creativity is always an option. It may not occur to your concrete thinker that there might be more than one way to do something. Thus, ask him or her for alternative solutions to everyday problems. Since all children learn through play, play therapy is the ideal way to practice exploring multiple solutions to a challenge.
9. Demonstrate that you value creative expression and “thinking outside the box.” Valuing creative expression is more than visiting art fairs, museums and theaters. It means being curious about the world and constantly asking questions (e.g., What is this made of? How does that work? Why is this moving like that?). It also means looking for the answers in unusual places (e.g., through a telescope, in the mirror, under a rock, up in the attic, etc.).
10. Try drawing and /or sketching. Drawing and sketching help with attention, fine motor skills, visualization skills and anxiety reduction. This is exactly the type of activity your AS or HFA youngster may try to avoid! Here’s a good method to teach drawing:
Explain that drawing ability comes with practice and that there is no right or wrong answer when it comes to a finished art piece. Encourage the child to practice drawing his intended picture in the air with his finger first. This allows him to get an idea of how he will draw his picture.
Teach the child by using a simple object that you can place in front of her. Visuals are super important for kids on the autism spectrum and their learning process. Find a simple object such as a cereal box, and point out the separate shapes your child will need to draw in order to make the full box. By breaking down the drawing process into steps, she will be able to pause from her work and return later. Also, she will learn to become more detail-oriented.
Split up the drawing process into small portions (e.g., with a cereal box, point out the face of the box being a rectangle, the sides being smaller rectangles, etc.).
Continue to have your child draw the object chosen as many times as possible. Repetition is vital in learning to draw, just as it is in learning the alphabet or how to count.
Always encourage your child, and never point out a "mistake" in his drawing.
Never draw on your child’s papers. She will only improve her drawing ability through practice. AS and HFA children are easily discouraged. If they see your drawing and think it is better than theirs, they may shy away from their desire to improve.
For the child that can’t recognize shapes, still have him attempt to draw by breaking down the object into sections. This method will help him with shape recognition as well as improve his drawing ability.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"What exactly is a social story, and how do you write an effective one for children with autism?"
A social story is a frequently used method to teach social skills to kids with ASD Level 1, or High-Functioning Autism. A social story is a non-coercive technique that presents social concepts and rules to kids in the form of a brief story. This method can be used to teach a number of social and behavioral concepts (e.g., making transitions, playing a game, going on a field trip, etc.).
There are four major components that are crucial to a successful social story. The story should:
be commensurate with the child’s ability and comprehension level
be something the youngster wants to read on his or her own
be written in response to the youngster’s personal needs
use less directive terms (e.g., “can” or “could”) rather than more directive terms (e.g., “will” or “must”).
Making sure the story has all four components is especially important for kids who tend to be oppositional (i.e., a youngster who doesn’t decide what to do until parents tells him/her to do something, then he/she does the opposite).
A social story can be paired with pictures and placed on a computer to take advantage of the youngster’s tendency towards visual instruction and interest in computers.
Kids with ASD seem to learn best when social stories are used in conjunction with role-playing and used as a social primer (i.e., after reading the social story, the youngster then practices the skill introduced in the story).
For example, immediately after reading a story about joining-in an activity with friends, the youngster would practice the skill. Then, after reading the story and practicing the skill, the youngster would be exposed to a social situation where he or she would have an opportunity to perform the skill.
There should be a specific pattern to a social story, which includes several descriptive, perspective, and directive sentences:
A descriptive sentence describes what people do in particular social situation, and defines where a situation occurs, who is involved, what others are doing – and why (e.g., “Sometimes at school, the fire alarm will go off. It is a loud bell that rings when there is a fire or when students are practicing leaving the building. The teachers help us to line up and go outside as fast as we can. The alarm is very loud so that all the students can hear it.”).
A perspective sentence describes people’s reactions to a situation so that the child can learn how they perceive various events. It describes the internal states of others (i.e., their thoughts, feelings and mood). For example, “The fire alarm may bother some students. Teachers don’t understand how much it bothers me. Sometimes the teacher gets upset if I do not move fast enough or get confused. Her job is to get me outside as soon as possible so I am safe in case there is a real fire.”
A directive sentence directs the child to an appropriate response. It states (in positive terms) what the desired behavior is (e.g., “A real fire is dangerous and can burn people. This is why it’s important for me to exit the building with the other students as quickly as possible, even though the alarm hurts my ears”).
So, this social story about fire alarms could read like this:
Sometimes at school, the fire alarm will go off. It is a loud bell that rings when there is a fire or when students are practicing leaving the building. The teachers help us to line up and go outside as fast as we can. The alarm is very loud so that all the students can hear it. It may bother some students. Teachers don’t understand how much it really startles me. Sometimes the teacher gets upset if I do not move fast enough or get confused. Her job is to get me outside as soon as possible so I am safe in case there is a real fire. A real fire is dangerous and can burn people. This is why it’s important for me to exit the building with the other students as quickly as possible, even though the alarm hurts my ears.
Resources for parents of children and teens on the autism spectrum:
"How can I help my 5-year-old AS child (high functioning) to have a better understanding of other people’s feelings? He often seems oblivious to some of the hurtful things he says and does, but I don’t think he does this intentionally."
Recognizing and understanding the feelings and thoughts of self and others is often an area of weakness for kids with Asperger’s (AS) and High-Functioning Autism (HFA) – and is essential to successful social interactions.
“Neurotypicals” (i.e., children not on the autism spectrum) continually modify their behavior based on the non-verbal feedback they receive from others. For example, they may elaborate on a story if their friend is smiling, looking on intently, or showing other signs of genuine interest. Conversely, if the other person repeatedly looks at her school book, sighs, or looks otherwise disinterested, most neurotypical children notice this non-verbal cue and stop talking or cut the story short.
Kids with AS and HFA often have difficulty recognizing and understanding these non-verbal cues. Because of this, they are less able to modify their behavior to meet the emotional and cognitive needs of their peers.
When kids with AS and HFA appear rude, aloof or unresponsive, it doesn’t mean that they don’t experience any emotions, or that they don’t have empathy for others. However, they do tend to express their emotions differently than neurotypical kids do. Also, studies have shown that AS and HFA kids do not always recognize facial expressions, which is part of the difficulty in reading the emotional responses of others.
The most basic technique used to teach “feelings skills” involves showing the child pictures of people exhibiting various emotions. Pictures can range from showing basic emotions (e.g., happy, sad, angry, scared) to more complicated ones (e.g., embarrassed, ashamed, nervous). Begin by asking the youngster to point to an emotion (e.g., “point to happy”), then ask the youngster to identify what the character is feeling (e.g., “how is he feeling”).
Most AS and HFA kids will pick up the ability to identify emotions quite easily. When they do, it is time to move on to more advanced instructional techniques, such as teaching them to understand the meaning (or “why”) behind emotions. This requires the youngster to make inferences based on the context and cues provided in the picture (e.g., “based on the information in the picture, why is this little girl sad?”). The pictures should portray characters participating in various social situations and exhibiting various facial expressions or other nonverbal expressions of emotion. You can cut pictures out of magazines, or download and print them from the Internet. You can also use illustrations from kids’ books, which are usually rich in emotional content and contextual cues.
Once mastery is achieved on the pictures, you can move on to television programs or videos of social situations. Many of the programs that air on some of the kids’ channels are excellent resources for this teaching technique since they portray characters in social situations and display clear emotional expressions. You can use the same procedure as for the pictures, only this time the youngster is making inferences based on dynamic social cues. Simply ask the youngster to identify what the characters might be feeling – and why they may be feeling that way. If the scenario moves too quickly for the youngster, press pause, and ask the question with a still frame.
Other ways to teach “feelings skills” include the following:
• Applied Behavioral Analysis (ABA): ABA therapy uses positive reinforcement to encourage desired behavior. ABA can also be used to teach an AS or HFA youngster about emotions by generally providing examples of appropriate emotional behavior for her to model, and then rewarding her when she gives the correct emotional responses.
• Online Games: Most AS and HFA kids enjoy playing computer games, and these games can be an effective learning tool for teaching about emotions. The Internet has many games and activities to help these kids learn about emotions in a way that engages them.
• Play therapy: Play therapy strategies can help AS and HFA kids emotionally connect with their mom, dad and siblings. The simple act of “child-led” play to teach new ideas is quite effective for kids on the spectrum.
• Social Stories: Social stories help teach social skills to AS and HFA kids through stories that provide examples of common social situations. The stories outline how to respond to the situation. Stories about feelings and appropriate emotional responses can help the youngster learn how to understand emotions in context.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
Anonymous said... He is probably not thinking what he is saying is rude. My son is full of fun truths as he sees them. You have to help teach him what kinds of things are not "appropriate" to say, without making him feel he's done something bad because he probably really hasn't. It's just how he sees it. Just because something may be a fact doesn't make it ok to say to someone's face and that can be hard to manage. Danny has learned a lot but still hasn't gotten it all down yet, plus part of him lives the shock factor of it all.
Anonymous said... Just keep talking to him about it. That is what we do with our 8 year old. They do start to at least think about it but its not easy. We are thinking about getting a therapy dog. My son connects with animals and hope to be chosen to get a dog. On the bright side my son was able to form a friendship with a classmate and this year they have become best of friends. Unfortunately they maybe moving to Japan (Military family) in the fall. Secretly hoping orders fall through.
"Why is it that children on the autism spectrum seem to prefer objects (e.g., toys, games, digital devices, machines, etc.) rather than relationships with people?"
To answer this question, we must first look at the concept of "weak predictive ability"...
If one has the ability to predict, he or she can come up with an educated guess about what may happen in the near or distant future (i.e., some outcome is expected), but this ability is not necessarily based on experience or knowledge.
Prediction is a skill that allows us to “generalize” (i.e., since the occurrence of “situation A” resulted in “outcome B,” then a situation similar to “A” will likely result in an outcome similar to “B”). For example, after observing enough moving objects, a child can understand momentum and, through generalizing, predict the position of a moving target in the near future. Likewise, after seeing enough human faces, a child can generalize (or predict) that human faces all have similar parts in a nearly fixed spatial layout.
Prediction not only affords quicker and more accurate reaction, but also more efficient neural coding. For instance, after learning the common face structure of human beings, a child’s brain can store an average face and encode individual faces only as deviations from the average. This is more efficient than encoding individual faces fully.
Children with autism spectrum disorder have poor predictive abilities (i.e., they have great difficulty predicting future events). However, the impairment from a weak predictive ability is not limited to time. Autistic kids also have difficulty with face-processing (called “face-blindness”). In other words, they have difficulty recognizing the faces of those they don’t know well. Face-blindness is a neurological disorder that makes facial recognition difficult or impossible. Research suggests that up to two-thirds of ASD kids have difficulty recognizing faces until they have interacted with a particular person on a number of occasions.
Weak predictive ability can also contribute to ASD kids’ sometimes dangerous behaviors since they can’t fully “predict” serious consequences of certain actions (e.g., running their heads into walls, running out into a busy street, wandering off alone, etc.). In addition, poor prediction of bodily movements (and sensory consequences of such movements) can contribute to their weak sense of “body boundary” (e.g., they may violate other’s personal space by standing too close to them).
Another function of prediction is to fill-in missing information (e.g., if the driver in front of you veers his car sharply to the left and then to the right, you might “predict” that he swerved in order to avoid hitting something in the road). Thus, autistic kids’ impaired predictive ability means impaired filling-in of missing information for perception and action.
So, what does “weak predictive ability” have to do with preferring objects to people?
Since children on the spectrum have to live everyday with the uncertainty inflicted by their poor prediction skills, they tend to favor relatively predictable and precise events and tasks. Wouldn’t you? As a result, they like to play with objects (which are more predictable) instead of with people (which are less predictable – and I think you would agree that people are very unpredictable). Objects like computer games, trains, bridges, and spinning wheels that autistic children are attracted to represent stimuli that are both interesting AND predictable.
Due to difficulties with generalization skills, kids with ASD have a lower tolerance for unpredictability and complexity. They argue that objects are predictable and simple, whereas people are not. Thus, they gravitate toward objects.
Resources for parents of children and teens on the autism spectrum: