Therapist Neurodiversity Collective

.Therapy.Advocacy.Education.

By Julie Roberts, M.S., CCC-SLP
January 11, 2020

Social Skills Training for Autistic and other Neurodivergent children, adolescents, and young adults is a multi-billion dollar industry.

Applied Behavioral Analysis (ABA) clinics, as well as many other for-profit and non-profit entities such as SLPs, OTs, and licensed Counselors, heavily advertise “social skills training” to the parents of Autistic children.

A quick Google search for “Social Skills Training” will provide links to thousands of ABA clinics, schools, therapy practices, summer camps, etc., along with thousands of books, videos, and “social skills training programs” that promise to “train social skills” into the autistic or other neurodivergent child, while simultaneously teaching them “how to make friends” through:

 Ivar Lovaas, early ABA pioneer: "You see, you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense—they have hair, a nose and a mouth—but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build the person." 
  • Modeling (masking autistic characteristics)
  • Differential Reinforcement (reinforcing only the desired response or behavior, and applying extinction to all other responses)
  • Memorizing rote verbal or behavioral scripts for social scenarios.
  • Role Playing (rehearsing rote verbal scripts)
  • Behavioral scripts that compel compliance.
  • Specific Social Skills Curriculum that predetermines rote expression

Investors across the United States, as well as around the world, enormously profit from the fact that while “Autism Awareness” is a fairly mainstream concept, Autism Acceptance sadly remains far from the norm.

2017 research published in Scientific Reports indicates that “first impressions of individuals with ASD made from thin slices of real-world social behavior by typically-developing observers are not only far less favorable across a range of trait judgments compared to controls, but also are associated with reduced intentions to pursue social interaction.”
Sasson, N. J. et al. Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments. Sci. Rep. 6, 40700; doi: 10.1038/srep40700 (2016).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286449/

The research demonstrates that it is the autistic social presentation style rather than the substantive content of social speech (that drives) negative impression formation of” (ibid) autistic individuals.

It is clear that the endless drilling of autistic children and adolescents to memorize and parrot “appropriate” rote phrases in specific social situations will not lead to their neurotypical peers judging them as more likable.

The “Business” of Autism incorporates tremendous amounts of money and time towards the task of “normalizing” the social, behavioral, developmental, and linguistic conventions of Autistic people. The end goal of ABA is to make the Autistic person appear indistinguishable from their peers.

As there is no “cure” for Autism, the only way to do this is for Autistic people to camouflage or compensate for their autistic differences through masking, which can lead to negative consequences such as exhaustion, anxiety, depression, negative self-perception, low self-esteem, and even suicidal ideation.

Neurodiversity-Affirming Therapists don’t “train” social skills. We believe that social skills training is one more way of dehumanizing Autism. Dictating how a neurodivergent person is expected to communicate in specific social situations takes away their self-determination. Training people as one trains animals is appalling. Therapist Neurodiversity Collective believes in respecting the authentic social communication of all people, which includes all Autistic people, rather than compelling compliance with neurotypical expectations through a system of rewards and punishments. Instead of role-playing and parroting memorized verbal and behavioral scripts, we use supports, such as visual schedules to help people navigate specific routines. We teach perspective-taking for all based on The Double Empathy Theory. We empower through teaching self-advocacy and encouraging self-determination.

" I wouldn’t treat a dog that way". IS ABA REALLY “DOG TRAINING FOR CHILDREN”? A PROFESSIONAL DOG TRAINER WEIGHS IN. THE ASPERGIAN. CAROL MILLMAN, MARCH 27, 2019 . https://theaspergian.com/2019/03/27/is-aba-really-dog-training-for-children-a-professional-dog-trainer-weighs-in/ 

Therapist Neurodiversity Collective believes that trauma-informed therapy means supporting the emotional well-being and sensory needs of our clients, first and foremost. It is important for neurotypical therapists to understand that social interaction can be exhausting for autistic people and other people who are neurodivergent, especially if they are being pressured to imitate neurotypical mannerisms and mask their autistic behaviors, mannerisms, and feelings. Neurodiversity-affirming therapists don’t “train” social skills, nor do we “treat Autism.” Historically, social skills training has been generally based upon neurotypical social communication expectations which do not take into consideration the diversity of the populations we serve.

Examples of Pro-Neurodiversity Objectives:

  • Self-Advocacy
  • Perspective Taking: Self and Others (The Double Empathy Problem)
  • Interoception for: Self-Regulation, Self-Awareness, Flexibility of Thought, Intuition, Perspective Taking, Problem Solving, Social Understanding
  • Teaching how one’s body sensations  correlate to emotions
  • Figurative Language: Metaphors, Similes, Personification, Hyperbole, Symbolism
  • Building upon strengths
  • Establishing and maintaining one’s own boundaries.

Note on Perspective Taking Therapy: 
Targeting perspective taking may include teaching children and teens to understand how and why neurotypicals act the way they do in various settings and situations. A neurodiversity-affirming approach would not use rote social scripts or social stories that compel verbal or behavioral compliance as this takes away self-determination and leads to inauthentic communication. (See more about the use of social stories below.)

Targeting perspective taking may include teaching consenting Autistic people (old enough to determine their personal “social skills” goals, and old enough to understand potentially harmful aspects of masking) neurotypical socially expected norms in various social, educational, and work environments. Clients will self-determine if, or when they choose to use this knowledge.

Examples of Ableist Objectives:

  • Treating Autism
  • Eye Contact with Communication Partner
  • Quiet Hands and Whole Body Listening
  • Extinguishing perceived neurodivergent social deficits
  • Teaching social scripting that encourages masking (feelings, emotions, stimming, sensory needs, quiet hands, compliance for rehearsed role-play, etc.) Using “Social Stories*” that are written and used in a manner that is meant to compel compliance
  • Social skills goals that focus on making the client appear indistinguishable from their neurotypical peers

Notes on Social Stories


Carol Gray Social Stories:
What is a Social Story? https://carolgraysocialstories.com/social-stories/what-is-it/  
versus ABA Social Skills: Weiss, M., (2013)Behavior Analytic Interventions for Developing Social Skills in Individuals with Autism.” Excerpted from Social Skills and Adaptive Behavior in Learners with Autism Spectrum Disorders. edited by Peter F. Gerhardt Ed.D, & Daniel Crimmins Ph.D. http://archive.brookespublishing.com/documents/Gerhardt_social-skills.pdf

 

Carol Gray’s approach:
” First: Abandon all assumptions. Second: Recognize that the social impairment in autism is shared, with mistakes made on all sides of the social equation. Third: When Typical people interact with people with autism, both perspectives are equally valid and deserving of respect. To this day, these three principles define the Social Story philosophy and guide the development of each Story.” – Carol Gray

ABA approach:
“Social Stories are often used to convey behavioral expectations for multielement situations (which change frequently), for fear situations, and to reduce challenging behaviors.” – Mary Jane Weiss.

 

Resources: 

Carol Gray Social Stories. Origins of the Social Story Philosophy (1986-1989). https://carolgraysocialstories.com/social-stories/origins-of-the-social-story-philosophy/

Excerpted from Weiss, M. (2013)  “Social Skills and Adaptive Behavior in Learners with Autism Spectrum Disorders”, edited by Peter F. Gerhardt Ed.D, & Daniel Crimmins Ph.D. http://archive.brookespublishing.com/documents/Gerhardt_social-skills.pdf? 

Gray (2000) outlined suggestions for developing effective Social Stories and included guidelines about the types of sentences to be used.
There are seven recognized sentence types for creating Social Stories (Barry & Burlew, 2004; Crozier & Tincani, 2007; Reynhout & Carter, 2006)

Respectful practices will never use ABA methods in conjunction with the use of social stories.

Empathetic practitioners use “social stories” formats that do not compel compliance or dictate verbal or behavior scripting.

In the words of Carol Gray, “Story research, development, and implementation to ensure an overall patient and supportive quality, and a format, “voice”, content, and learning experience that is descriptive, meaningful, and physically, socially, and emotionally safe for the (Autistic) child, adolescent, or adult.”

Carol Gray Social Stories: What is a Social Story? https://carolgraysocialstories.com/social-stories/what-is-it/ 

Ally clinicians must strive to further the cause of Autism Acceptance by educating the public, our professional peers, and especially our client families, while promoting “acceptance and inclusion and changing the dialogue about autism from fear, pity, and tragedy to support, acceptance, and empowerment.”

ASAN Autistic Self-Advocacy Network, Autism Acceptance Month: https://autisticadvocacy.org/projects/community/autism-acceptance-month/

 

 
Julie Roberts, M.S. CCC-SLP

5 Responses

    1. Thank you for your kind words. More resources are coming soon, including a blog on how to write and target perspective taking goals. The website has research to support the article and our practices if you go to the home page, click on “Therapy” and then”Pragmatic Language.”

  1. Outstanding information! Re: teaching why neurotypical children/teens behave the way they do in certain situations-would love more information/directions on this topic to address (adequately) in therapy sessions. Wonderful resource!

  2. This is a very good article with lots of good information. Thank you. The one thing I would add is that people often think of “teaching” people to “learn” or “understand” something. (This is true of neurotypical and neurodiverse). While there is a time and place for teaching for sure, when we are “teaching” we are showing someone something and telling them the way it is. We are imparting knowledge upon them. Inherently, there is some judgment and/or opinion in this method. From a DIR perspective, we generally think more about how to develop core capacities rather than teaching information or skills. We follow the child or individual’s motivation, interest, and strengths to help them explore the world on their terms and through interactions that are led by the child or individual we help them build upon their current capacities to support continued development. These joyful interactions help to support the core developmental capacities for regulation, engagement, communication, problem solving, etc rather than teaching specific skills for these things. For example, in this article it states under the pro-neurodiversity objectives “…Targeting perspective taking may include teaching children and teens to understand how and why neurotypical act the way they do…”. This is great, but it is still a teaching technique where the therapist is imparting knowledge or information. One problem with that is that the information in some way will be informed by the teacher’s opinions or perspectives. A second problem with this teaching method occurs if the learner does not have the capacity for seeing other’s perspectives, then teaching just the information will most likely have limited effects. For example, I sincerely wonder whether the current US President has the ability to truly see other people’s perspectives. So, just giving him information does not seem to get us anywhere. Even though I have given up hope when it comes to him, with most children and even adults, we can expand this capacity by using joyful and dynamic interactions that are about developing these core capacities by building off of strengths using a “developmental” method rather than “teaching” method. Besides a developmental approach being more effective in many ways, it also avoids the judgement and opinions that can come along with “teaching” information. Some reading my comment here may think I am splitting hairs and see this as a nuanced difference at best. But, it is much more than that. As I stated, I think there is a time and place for teaching, but I believe we need to see how we can support core development more than teaching information or skills. It is why a DIR practitioner does not teach social “skills”. We support the development of the capacity for engagement. This “developmental” process is quite different than a “teaching” process and fully allows the child or individual to develop on their own terms and in their own unique way.

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