Social Skills Training

Therapist Neurodiversity Collective rejects social skills training programs. 

We receive a lot of questions about our “No Social Skills Training” position from therapists, parents, and educators alike.
Here’s our rationale: Research, as well as Autistic lived experiences demonstrate that Social Skills Training doesn’t work.

Autistic children “generally receive the greatest amount of social skills intervention during this developmental period, which decreases precipitously after high school. Thus, despite being at an age when intense attention is often paid to social skills training, the children are nonetheless rated poorly by both adults and same-age observers.”
Sasson NJ, Faso DJ, Nugent J, Lovell S, Kennedy DP, Grossman RB. Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments. Sci Rep. 2017;7:40700. Published 2017 Feb 1. doi:10.1038/srep40700

 

 

 

Therapist Neurodiversity Collective understands that communication is a multi-way process and that the onus should not be placed solely on Autistic people to repair communication differences. Autistic (and more broadly neurodivergent) people communicate differently than neurotypical people. And yet we therapists (and the world) often expect them to change their communication styles, make adjustments, and comply with often confusing spoken and unspoken rules of social interaction. We don’t’ train social skills because we know that diversity in social intelligence is natural and viable.

Examples of Neurotypical Social Skills Programs that do not align with the Neurodiversity Movement:

In these social skills programs, Autistic children/teens are the social skills “novices” and Neurotypical children/teens are the “experts”. The programs involve the use of peer and facilitator modeling of neurotypical social skills. Autistic people are expected to imitate the modeled neurotypical social skills successfully. Praise is used as a reinforcer when autistic people successfully mask their autistic characteristics. The programs are ABA-based (positive reinforcement). Successful outcomes are based on parent, teacher, and provider “satisfaction”.

IPG® (Integrated Play Groups)  
PEERS® The Program for the Education and Enrichment of Relational Skills 
Social Thinking®

Historically, ‘social skills training/intervention’ has been generally based upon therapists teaching Autistic and other Neurodivergent children and adolescents to mimic neurotypical styles of communication through therapy models including:
  • Video, peer, or therapist modeling (direct instruction or ‘coaching’) of neuromajority Social Skills where the client/student imitates the ‘social skill standard’
  • Role-playing scenes where neuromajority outcomes are the target (also called behavioral rehearsal by ABA therapists)
  • Corrective feedback: “Yes, the child or adolescent is correctly mimicking the targeted social skill, or no, it’s incorrect.”
  • Behavior modification
  • Pivotal Response Treatment (PRT)
  • Natural Environment Teaching (NET)
  • Scaffolding
  • Proactive strategies (social stories, role play, priming)
  • Verbal Behavior Training
  • Extinction per function
  • Planned ignoring
  • Redirection
  • Behavior contracts
  • Token systems
  • Positive behavior support

Social Skills Training/Intervention does not take into account contemporary Autism Research

When therapists adopt a ‘curative’ approach and train Autistic children and adolescents to mimic neurotypical social skills through masking, fawning and ignoring sensory distress it can cause significant harm and trauma. Autistic masking research indicates that continually camouflaging one’s autism leads to suicidal ideation, decreased self-esteem, PTSD, depression, constant anxiety, and self-doubt because the person is taught to intently scrutinize and judge all of their social exchanges and communication, and interactions. Social skills training removes autonomy. Even when social skills intervention appears successful, what does that mean? Successful for who, to what end? By what measure do we define success?

Social skills training can lead to a lifetime of Autistic people experiencing high anxiety about social skills expectations, creating self-doubt, and even self-loathing. Therapists run the risk of potentially harming their clients or students through the teaching of camouflaging (training an Autistic young person to feign interest in someone’s conversation while cognitively laboring to come up with the right response or reaction in the interaction).  Constant self-monitoring of one’s personal interactions is exhausting, draining, and leads to autistic burnout.  No matter how hard an Autistic person tries to adopt predominant neurotypical conversation skills, it is unlikely to ever feel enjoyable or natural. The person may ruminate for hours after, worried if during that last social exchange they got it right or not. It’s an unnecessary burden to carry through life and creates internalized ableism and anti-autistic bias. 

Therapist Neurodiversity Collective understands that communication is a multi-way process and that the onus should not be placed solely on Autistic people to repair communication differences. Autistic (and more broadly neurodivergent) people communicate differently than neurotypical people. And yet we therapists (and the world) often expect them to change their communication styles, make adjustments, and comply with often confusing spoken and unspoken rules of social interaction. 

We don’t’ train social skills because we know that diversity in social intelligence is natural and viable.

Examples of Ableist Social Skills Goals

  • (Non medically relevant) Tone of Voice Modification
  • Neuronormative conversation goals
  • Making eye contact
  • Compliance without complaint
  • Responding to bullying or teasing in an ‘appropriate way’
  • Topic Maintenance of communication partner’s choosing for so many turn-takes
  • Body Language (imitating neuromajority body language through masking)
  • Facial Expressions (imitating neuromajority facial expressions through masking)
  • ‘Active Listening,’ or ‘Whole Body Listening’ (Quiet hands, sitting in the seat without movement, etc.)
  • Learning and repeating ‘rote scripts’ to use in social situations
  • ‘Increasing comfort levels’ in social situations or group activities
  • Eliminating stimming behavior, monotropism (focus or attention on a small number of interests in conversation)
  • Interactive play skills with peers (based on the neuromajority what constitutes ‘play’) rather than true Autistic play, free time, or recreational time
  • Initiating play with peers on the playground (even when solo free time is preferred)
  • Reciprocal play (turn-taking on a peer’s terms)
  • Tolerating changes (Sensory system is overwhelmed, demonstrating anxiety with unexpected changes in routine, tolerating auditory or physical distress)
  • Tolerating unwanted touch (high five, shaking hands, hugs, kisses, arm around them)
  • Identifying and using ‘appropriate vs. inappropriate behavior
  • Reduction or elimination of ‘problem behaviors’
  • Accepting compliments ‘appropriately’
  • Refrain from interrupting others
  • Eliminating echolalia
  • Compliance with acknowledging communication initiated by others by giving ‘appropriate’ responses
  • Cooperation in group decisions when the student is not in agreement
  • Conveying emotions/feelings ‘appropriately’ by masking or fawning (Fawning – Walker, 2013: People-pleasing” or deferring to the needs and wishes of others, and surrendering one’s own in order to ‘blend’. )

Autistic Masking/Camouflage

A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice

Research into autistic masking has recently started to gain traction, showing that masking is related to late/missed diagnosis, and a selection of negative outcomes including burnout and suicidality in autistic people. Though masking is described as a social strategy, the application of social theory to understanding masking is sparse. In this analysis we review literature so far in light of the historical deficit focused narrative of autism and make suggestions for how we can use social psychological theory to better understand what masking is. We discuss the role of stigma on identity expression, and how social theory can be applied to understanding which aspects of contextual identity shifts are harmful to autistic people. We also discuss issues around a gendered narrative of masking, including the exclusion of non-binary autistic people, and those whose autistic characteristics do not fit within a binary narrative.

Finally, we make suggestions for future research, including the use of a multidimensional conceptualisation of masking that takes into account the role of internal and external aspects of masking, in interaction with the role of time as a developmental factor.
Pearson, A., Dr, & Rose, K. (2020, July 15). A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice. https://doi.org/10.31219/osf.io/6rwa5

‘People should be allowed to do what they like’: Autistic adults’ views and experiences of stimming
Kapp SK, Steward R, Crane L, et al. ‘People should be allowed to do what they like’: Autistic adults’ views and experiences of stimming. Autism. 2019;23(7):1782-1792. doi:10.1177/1362361319829628

Social camouflaging in autism: Is it time to lose the mask? (2019). Autism, 23(8), 1879– 1881.

We are not OK, Kieran Rose, © August 10, 2018

Masking: An Act of Resistance, © Kieran Rose, July 28, 2018

Masking: I am not OK – Kieran Rose, © July 24, 2018

Camouflaging and unmet support needs appear to be risk markers for suicidality uniqueto ASC
Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism. 2018;9:42. Published 2018 Jul 31. doi:10.1186/s13229-018-0226-4

How to hide your Autism– Kieran Rose, © November 15, 2017

“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions Journal of Autism and Developmental Disorders. August
2017, Volume 47, Issue 8, pp 2519–2534

The Double Empathy Problem

Double Empathy: Why Autistic People Are Often Misunderstood

Crompton C, DeBrabander K, Heasman B, Milton D and Sasson N (2021) Double Empathy: Why Autistic People Are Often Misunderstood. Front. Young Minds. 9:554875. doi: 10.3389/frym.2021.554875

What Do New Findings About Social Interaction in Autistic Adults Mean for Neurodevelopmental Research?
“Deficit-based accounts of social and communication abilities continue to dominate autism research. However, emerging findings suggest that this view may be overly simplistic and discount the two-way nature of interaction.”
Davis R, Crompton CJ. What Do New Findings About Social Interaction in Autistic Adults Mean for Neurodevelopmental Research? Perspectives on Psychological Science. February 2021. doi:10.1177/1745691620958010

Study Challenges Assumptions About Social Interaction Difficulties in Autism
“Most studies attempting to understand social disability in autism focus exclusively on individual characteristics. This presumes that any difficulties in social interaction are driven solely by the autistic person. But how each person influences and is influenced by the other is key to understanding affiliation and social quality. The study focused on the so-called “double-empathy problem,” which predicts that two people who are neurologically different and have distinct modes of communication and understanding may have trouble connecting with each other, as commonly occurs in interactions between autistic and non-autistic adults.”

Milton, Damian (2020) The double empathy problem. International Conference on ‘Neurodiversity: A Paradigm Shift In Higher Education & Employment’, 3-4 Dec 2020, Dublin, Ireland (online).
(Unpublished)

Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism
“We believe that some influential accounts of autism rest on a questionable assumption that many of its behavioral characteristics indicate a lack of social interest – an assumption that is flatly contradicted by the testimony of many autistic people themselves. In this article, we challenge this assumption by describing alternative explanations for four such behaviors: (a) low levels of eye contact, (b) infrequent pointing,
(c) motor stereotypies, and (d) echolalia. The assumption that autistic people’s unusual behaviors indicate diminished social motivation has had profound and often negative effects on the
ways they are studied and treated. We argue that understanding and supporting autistic individuals will require interrogating this assumption, taking autistic testimony seriously, considering alternative explanations for unusual behaviors, and investigating unconventional – even idiosyncratic – ways in which autistic individuals may express their social interest. These steps are crucial, we believe, for creating a more accurate, humane, and useful science of autism.”
Mitchell, Peter; Cassidy, Sarah; Sheppard, Elizabeth.Behavioral and Brain Sciences; New York Vol. 42, (2019). DOI:10.1017/S0140525X18002212

Milton D.E.M., Heasman B., Sheppard E. (2018) Double Empathy. In: Volkmar F. (eds) Encyclopedia of Autism Spectrum Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6435-8_102273-1

On the ontological status of autism: the ‘double empathy problem’
Damian E.M. Milton (2012) On the ontological status of autism: the ‘double empathy problem’, Disability & Society, 27:6, 883-887, DOI: 10.1080/09687599.2012.710008

Diversity in Social Intelligence

Diversity in Social Intelligence

Diversity in Social Intelligence Project

“Innovative research has revealed that the apparent “deficits” in mental-state understanding exhibited by autistic people may apply only to understanding the mental states of nonautistic people.”
Crompton CJ, Ropar D, Evans-Williams CV, Flynn EG, Fletcher-Watson S. Autistic peer-to-peer information transfer is highly effective. Autism: the International Journal of Research and Practice. 2020 Oct;24(7):1704-1712. DOI: 10.1177/1362361320919286.

“Nonautistic people show impairments in detecting and interpreting the mental states of autistic people.”
Edey, R., Cook, J., Brewer, R., Johnson, M. H., Bird, G., & Press, C. (2016). Interaction takes two: Typical adults exhibit mind-blindness towards those with autism spectrum disorder. Journal of Abnormal Psychology, 125(7), 879–885. https://doi.org/10.1037/abn0000199

Beyond the Core-Deficit Hypothesis in Developmental Disorders
Astle DE, Fletcher-Watson S. Beyond the Core-Deficit Hypothesis in Developmental Disorders. Current Directions in Psychological Science. 2020;29(5):431-437. doi:10.1177/0963721420925518

Understanding Social Cognition in Autism | Diverse Intelligences Video

It is a myth that Autistic people lack a Theory of Mind (TOM).

It is a myth that Autistic people fail to understand that other people have a mind or that they themselves have a mind. Despite the prevailing theory that Autistic people lack TOM, the evidence fails to support the claim.

Empirical Failures of the Claim That Autistic People Lack a Theory of Mind
The claim that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. This article (a) reviews empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks; (b) highlights original findings that have failed to replicate; (c) documents multiple instances in which the various theory-of-mind tasks fail to relate to each other and fail to account for autistic traits, social interaction, and empathy; (c) summarizes a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by researchers working inside the theory-of-mind rubric; and (d) concludes that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.
Gernsbacher, M. A., & Yergeau, M. (2019). Empirical failures of the claim that autistic people lack a theory of mind. Archives of Scientific Psychology, 7(1), 102-118. http://dx.doi.org/10.1037/arc0000067

The closing of the theory of mind: A critique of perspective-taking
“Theory of mind (ToM) is defined as the ability to attribute mental states to oneself and others and is often said to be one of the cornerstones of efficient social interaction. In recent years, a number of authors have suggested that one particular ToM process occurs spontaneously in that it is rapid and outside of conscious control. This work has argued that humans efficiently compute the visual perspective of other individuals. In this article, we present a critique of this notion both on empirical and theoretical grounds. We argue that the experiments and paradigms that purportedly demonstrate spontaneous perspective-taking have not as
yet convincingly demonstrated the existence of such a phenomenon. We also suggest that it is not possible to represent the percept of another person, spontaneous or otherwise. Indeed, the perspective-taking field has suggested that humans can represent the visual experience of others. That is, going beyond assuming that we can represent another’s viewpoint in anything other than symbolic form
Cole, G.G., Millett, A.C. The closing of the theory of mind: A critique of perspective-taking. Psychon Bull Rev 26, 1787–1802 (2019). https://doi.org/10.3758/s13423-019-01657-y

Is Implicit Theory of Mind a Real and Robust Phenomenon? Results From a Systematic Replication Study
Recently, theory-of-mind research has been revolutionized by findings from novel implicit tasks suggesting that at least some aspects of false-belief reasoning develop earlier in ontogeny than previously assumed and operate automatically throughout adulthood. Although these findings are the empirical basis for far-reaching theories, systematic replications are still missing. This article reports a preregistered large-scale attempt to replicate four influential anticipatory-looking implicit theory-of-mind tasks using original stimuli and procedures. Results showed that only one of the four paradigms was reliably replicated. A second set of studies revealed, further, that this one paradigm was no longer replicated once confounds were removed, which calls its validity into question. There were also no correlations between paradigms, and thus, no evidence for their convergent validity. In conclusion, findings from anticipatory-looking false-belief paradigms seem less reliable and valid than previously assumed, thus limiting the conclusions that can be drawn from them.
Kulke L, von Duhn B, Schneider D, Rakoczy H. Is Implicit Theory of Mind a Real and Robust Phenomenon? Results From a Systematic Replication Study. Psychological Science. 2018;29(6):888-900. doi:10.1177/0956797617747090

Clinically Significant Disturbance: On Theorists Who Theorize Theory of Mind
Copyright (c) 2013 Melanie Yergeau, Disability Studies Quarterly SSN: 2159-8371 (Online); 1041-5718 (Print)

For further reading

So an SLP was late-diagnosed as Autistic this week…
Nothing about Social Skills Training is Neurodivergence-Affirming – Absolutely nothing.
“Training” Social Skills is Dehumanizing (Part 1)
Why Perspective-Taking and Neurodiversity Acceptance? (Part 2 of “Training” Social Skills is Dehumanizing: The One with the Therapy Goals)
On Writing Masking Goals for Autistic Middle School Girls – Stop It!
A Letter from an SLP to a Parent, Immediately After an Autism Diagnosis for a 5-Year-Old