Building a Science of Friendship Yes, it’s challenging to measure progress in social skills groups for children with autism. But we need to. And determining best practices starts with each one of us doing it. Right now. Features
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Features  |   April 01, 2015
Building a Science of Friendship
Author Notes
  • Belinda Williams, MA, CCC-SLP, is a clinician with the Los Angeles Speech and Language Therapy Center, Inc., and a doctoral student in UCLA’s Human Development and Psychology Program. She is collaborating with Los Angeles Speech and Language Therapy Center colleagues Ashley Wiley, MA, CCC-SLP, and Pamela Wiley, PhD, CCC-SLP, to identify measures tied to a manual-based social skills program. For more information on the A-Team social skills program, visit www.speakla.com. blw252@gmail.com
    Belinda Williams, MA, CCC-SLP, is a clinician with the Los Angeles Speech and Language Therapy Center, Inc., and a doctoral student in UCLA’s Human Development and Psychology Program. She is collaborating with Los Angeles Speech and Language Therapy Center colleagues Ashley Wiley, MA, CCC-SLP, and Pamela Wiley, PhD, CCC-SLP, to identify measures tied to a manual-based social skills program. For more information on the A-Team social skills program, visit www.speakla.com. blw252@gmail.com×
Article Information
Special Populations / Autism Spectrum / Language Disorders / Social Communication & Pragmatics Disorders / Features
Features   |   April 01, 2015
Building a Science of Friendship
The ASHA Leader, April 2015, Vol. 20, 50-54. doi:10.1044/leader.FTR2.20042015.50
The ASHA Leader, April 2015, Vol. 20, 50-54. doi:10.1044/leader.FTR2.20042015.50
“His aunt said he finally started responding to her in conversation. She said he’s made tremendous improvement.”
“It’s like she really came out of her shell. We can’t believe she’s maturing so much!”
“He was so excited. He finally asked a girl to dance at his school prom!”
“She made her first phone call to a friend today!”
These are typical comments from parents after their children with autism spectrum disorder participate in the A-Team social skills program. Developed by speech-language pathologist Pamela Wiley and administered by me and other SLPs at the Los Angeles Speech and Language Therapy Center in Culver City, California, the program builds social skills using video modeling, role-playing, guided small-group interaction, self-critique, direct teaching and group outings.
But it’s often challenging to quantify the improvements parents see in their children. Why? Because we lack established measures of progress. Though social skills programs are often successful and sought out by parents, many SLPs struggle with this issue of measuring clients’ social progress. How we address this challenge is obviously complicated, but it starts with simple steps: Solicit reports from others in the child’s social world—parents, teachers and peers—and document, document, document.

Many SLPs struggle with this issue of measuring clients’ social progress. How we address this challenge is obviously complicated, but it starts with simple steps: Solicit reports from others in the child’s social world—parents, teachers and peers—and document, document, document.

It is crucial that we use these tools as best we can. It’s how we can ultimately determine what works best for whom—and learn from one another about how to continually improve our methods.
The social problem
Educators and parents want to see children with ASD succeed in mainstream education, thriving academically alongside their peers. But, of course, that’s only half the battle. Because for even the highest-functioning children with ASD, social relations with those peers is usually challenging.
Many parents worry that their children with ASD have no friends, eat lunch alone, isolate themselves for hours in their bedrooms or play only with siblings. And as SLPs, we well know that making friends is critical to social and emotional well-being. Friends serve as confidantes, companions, counselors and comrades, and children with friends report more confidence and less depression from feeling lonely. As SLPs, we’re also on the front lines of addressing the social difficulties of children on the spectrum, whether in social-skills groups or in one-on-one treatment.
All our social skills programs share a basis in research and a focus on structure. For example the A-Team program follows the AASIP (Autism: Attacking Social Interaction Problems) approach, a published treatment manual. The social skills group—four to 16 children with ASD—meets weekly for two hours. SLPs leading the group select units from the manual based on clinical observations and parent feedback.
All social skills programs aim to increase initiation and maintenance of play or conversation based on age-appropriateness. Younger children typically focus on cooperative play skills and increasing joint engagement; older children typically focus on executive-function skills such as planning peer hang-outs.
But there’s a problem: We and other professionals approach social skills intervention very differently. We need to conduct research and publish the results of our interventions, using the same outcomes measures, to see which methods reap the best results for which children.
Take stock
When it comes to what works best in teaching social skills, current research offers little assistance. In a 2013 review for my doctoral research, I found just nine published studies over the last decade that include these criteria:
  • A group delivery format of three or more students with an ASD diagnosis.

  • Set measures to assess progress.

  • A specific time limit for intervention.

Social skills programs for children with ASD are many and varied: They use direct and indirect teaching, social-language games, computer software, role-playing, typical peer models, and parent/caregiver training. And outcomes data collection methods are just as varied, with providers differing on who is best positioned to assess participants’ progress (teachers, peers or parents).
The most favored method, however, is pre- and post-treatment parent and teacher reporting. A few studies have used direct-measurement techniques, while another—led by Cyndie Koning and published in 2013 in Research in Autism Spectrum Disorders—used a typical peer actor to assess participants’ performance in a staged social interaction. Shortcomings of these methods can include difficulties capturing small changes, and discrepancies between reporters’ assessments.
Also challenging is the fact that social expectations change across contexts and time. Teachers, parents and peers may differ markedly on their social expectations. And different environments demand different social skills: For example, the social landscape from fifth to sixth grade morphs dramatically as children transition from elementary school to middle school. In what Pamela Wiley, our center president, describes as “the social fast lane,” children who were well-adjusted in elementary school might suddenly find themselves lost as they navigate the new social rules of middle and high school. Such challenges can make documenting social skills progress daunting, but they also make it necessary to find ways of monitoring these children throughout the school years and periodically providing services that are effective at helping them successfully make these transitions.
Get started
So how do you go about measuring the effectiveness of your social skills interventions? The effort starts right in the social skills sessions you run every day. Based on the research I’ve reviewed, I recommend taking the following steps:
  • Carefully define your focus. Social skills as a topic is too broad, so narrow it to a specific aspect of social interaction: increasing turn-taking skills for younger children, for example, or improving conversational skills for teens.

  • Pick a set timeframe to address these skills. Generally, programs like the A-Team recommend at least six weeks to allow for initial instruction, carryover activities and a generalization probe—such as a community outing—that can assess skills in natural contexts.

  • Find at least two different measures. Choose from measures such as self-report, parent report, teacher report, direct observation and standardized tests to quantify your results from start to finish.

  • Don’t discredit the value of qualitative reports. Ask your clients and families about the changes they have noticed. Include their feedback in your progress reports, particularly to assess carryover of skills into different environments. If a child is making improvements, those skills should be evident to all.

  • Assess your results. Based on your analysis of quantitative and qualitative measures, what social differences are seen in the child? For example, is the child greeting others independently and approaching peers to play or talk without adult facilitation?

  • Spread the word. Find journals and conferences that are interested in your work and explore how to disseminate your methods.

  • Keep at it. Social-interaction skills are critical to helping kids with ASD make and keep friends. The more you can do to demonstrate a method’s success, the better.

Tracking children’s progress in our social skills groups can certainly be challenging, but that doesn’t mean we should avoid doing it. In fact, the opposite is true: The challenges and inconsistencies make it even more crucial that we measure our interventions to find—and then share—what works. We need to find consistent, measureable ways to document children’s progress, both quantitatively and qualitatively.
Track These Core Skills

Assessing participants’ success is a lynchpin of the social skills groups we run for students on the autism spectrum at the Los Angeles Speech and Language Therapy Center.

For example, here’s how we gauge progress in a unit on initiating friendships: After two to three weeks with the unit, we solicit feedback from parents and observe the child for signs of self-motivated socializing during semi-structured play. We ask parents and ourselves: Is the child initiating a conversation with peers? If so, is the child initiating independently or only with adult facilitation? We do the same at the unit’s conclusion.

Other key areas of social deficit that we recommend targeting and tracking include:

  • Establishing and maintaining eye contact.

  • Taking turns in conversation.

  • Adopting the listener’s perspective (theory of mind).

  • Using appropriate tone of voice (speech prosody).

  • Expressing and understanding emotions.

  • Interpreting figurative language.

  • Asking questions in conversation.

  • Extending conversations by offering relevant personal narratives.

  • Maintaining a conversation topic.

  • Using humor appropriately.

  • Participating actively in the to-and-fro of conversation.

  • Using greetings appropriately.

  • Demonstrating appropriate rate of speech and vocal volume.

  • Using appropriate body language, such as not standing too far or too close during conversation.

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April 2015
Volume 20, Issue 4