2020/02/15, by Julie Roberts, M.S., CCC-SLP

“Really, I am serious. You don’t have to do the eye-contact thing in speech, or anywhere for that matter.” He gives me a furtive, skeptical glance and then looks down. I am not sure if it’s his utter disbelief or his apparent concern that he is doing something wrong that makes me more angry with his previous therapy experiences. Then this sweet, respectful 16-year-old man-child and I have a conversation about his personal rights as a human being to not have to maintain eye contact unless he wants to. “Sometimes it’s really uncomfortable,” he says. I acknowledge his pain. We talk about boundaries and his right to personal autonomy, including body-autonomy. At the end of the session, I think it finally starts to sink in with him that speech therapy is going to be different this year, as I make a note in his IEP that the goal for “maintain eye-contact with a conversation partner for 6 exchanges” has been discontinued.

As a contract school-based therapist, it’s my job to step onto new campuses each year and get speech services up and running smoothly. So I typically inherit speech therapy goals I haven’t written, for students I don’t yet know. Among the 113 students, currently on my caseload, about 15 of them are Autistic, and unless I wrote their IEP goals last year, the objectives generally have targets for:

• Eye contact,
• Using appropriate body language,
• Behavior compliance with social stories,
• Compliance to adhere to verbal social scripts for things like making friends, asking to join in (because that always works – insert sarcasm and eye-roll here),
• and here are my two favorites: “Will interact with peers appropriately,” during unstructured play (recess, choice time),
• “Will play appropriately during unstructured recess (participate, share, follow directions/rules, take turns) with 1-2 peers for 10 minutes” (because if you are an Autistic student in the public education setting, your “unstructured” recess or free time is never really unstructured.)
  
  

Speech-Language Pathologists, it’s time to set your Autistic students free!
In 2017, research demonstrated 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.”[1] That is to say that “it is the autistic social presentation style rather than the substantive content of social speech (that drives) negative impression formation of”[2]  autistic individuals.

To sum up: Wasted years upon years of endlessly drilling autistic children and adolescents to memorize and parrot “appropriate” rote phrases for specific social situations will not lead to their peers perceiving them as more likable.  Social skills training is not a “cure” for autism despite what the ABA industry would like for us all to believe. All “social skills training’ does is to teach autistic people how to mask their autism. And the potential harms of masking (exhaustion, anxiety, depression, frustration, decreased self-esteem suicidal ideation) are significant.[3] [4] [5] [6]

So, what does the Speech-Language Pathologist target instead of “social skills training?”

“If our goal is to improve social interactions for (autistic) individuals, it may, therefore, be equally important to educate others to be more aware and accepting of social presentation differences, rather than trying to change the many interwoven factors of self-presentation that mark the expressions of (autistic) individuals as atypical. Given the social cognitive difficulties in perspective-taking associated with autism, some (autistic) individuals may lack insight into how their social presentation is viewed by potential social partners.

Based on earlier research studies demonstrating that autistic children “may be able to engage in visual perspective-taking but may have difficulty engaging in conceptual perspective-taking”[7] targeting perspective-taking is a logical therapy plan for the autistic client.

However, it is important to keep in mind that autistic students/clients in middle school or high school and beyond, “may be more cognizant of the perceptions of their peers, but are comfortable in their self-expression. For them, intervention strategies targeting awareness and acceptance among peers in their social environments may be a more sensitive and accommodating approach than encouraging impression management strategies.”[8] 

Targeting perspective-taking may include teaching children and teens to understand how and why neurotypical peers and adults act the way they do in various settings and situations. A good therapist does not use ableist rote social scripts or social stories to compel compliance or dictate verbal or behavioral scripts on the therapist’s terms, as this takes away self-determination and leads to inauthentic communication. Social stories, when used correctly are a visual aide for an autistic person to help them understand what to expect in a social situation or routine. They are used as information tools and are supposed to help reduce anxiety, not increase it.

Targeting perspective-taking may also 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. The final goal will be for students/clients to self-determine if, or in which specific situations, they will choose to apply this knowledge.

In conjunction with targeting perspective-taking, a robust neurodiversity acceptance educational program for school peers, employees and family members is vital as well.

Rather than writing therapy goals targeting masking or reducing “behaviors” I aim to write therapy goals that are empathetic, meaning that I seek to understand why a particular student may be behaving in a manner that is drawing negative attention from either their peers or instructors and then figure out how to help them meet whatever need (behind the behavior) that they are not yet able to successfully communicate. I approach therapy practice with Dr. Ross Greene’s words foremost in my mind, “Kids do well when they can.” I really believe this. My number one job is to make sure my students have the supports, modifications, accommodations, and tools they need to be successful in the classroom spelled out clearly in the IEP, and then write therapy goals that empower them to learn to communicate as independently and effectively as they are able – and on their own terms, so they leave school knowing how to self-advocate with confidence. “Social skills training” silences authentic Autistic voices and violates dignity. Targeting perspective-taking and Autism acceptance respect Autistic student dignity.

The following are examples of Perspective-Taking speech therapy goals I have written for autistic school-aged children within the last three months, from grades kindergarten through 12.
Note: The therapy goals are never about compelling verbal or behavioral compliance. Individual goals are written with the intent to empower each student:

• With the ability to self-determine their communication choices,
• To be able to successfully describe their perception of events and situations,
• To describe the possible motivations and perceptions of others, and
• To understand how their communication choices, both speaking and behavioral may be perceived by those around them.
  
  

Examples of Perspective-Taking Therapy Goals:
After watching a video or listening to a passage, the student will demonstrate perspective-taking skills by indicating which verbal response or pragmatic language application might be expected to produce: a) negative feedback b) positive feedback from a communication partner.

After watching a video or listening to a passage, the student will demonstrate perspective-taking skills by indicating which pragmatic action (such as speaking over someone else, or interrupting, or answering for someone else) might be expected to produce:
a) negative feedback
b) positive feedback from a communication partner

(For an empathetic student who has perspective-taking skills, but does not understand how to convey empathy) In a contextual situation, after being reminded to observe personal bubbles of space through an inconspicuous gesture pre-taught to the student, he will convey the message he was trying to state through his behavior: “I care.” “I like you.” I am concerned about you.” “I want to comfort you.” “You are my friend.”

Student will
a) Label the emotions of others and his own in a contextual situation, and
b) use the labels in a social exchange rather than getting too physically close or touching someone without their permission. (Example, instead of touching someone’s face to convey that he feels compassion when they demonstrate sadness, he can say ” I see you are sad, upset, etc. and I am here to listen. “

Student will
a) independently explain “why” an unexpected behavior (getting too close, touching peer, grabbing peer, etc.) was “unexpected” or may make someone feel/express a negative emotion, and
b) state what he could do instead to communicate his message to that person (I care, I like you, I feel bad that you are upset, etc.)

After watching a video or listening to a passage with visual support, the student will predict or anticipate the reaction of the character independently, using emotional words to describe.

After watching a video or listening to a passage with visual support, the student will:
a) Describe possible motives that a character has for certain actions.
b) State whether or not he would have made the same decision in that situation; and if not,
c)  State how he would have responded instead.

The student will generate possible outcomes to a social situation or problem, and determine:
1) Which outcome would be most positively received for the situation, and
2)Why

The student will develop insight regarding others’ perspectives, as well as his own, as presented in videos, visual materials (photos, pictures) or in orally presented or read literature, by:
a) inferring why a particular person may say, feel or do the things they do in a presented particular situation.
b) identifying and expressing what he might say, feel or do in a similar situation.

When presented with videos, visual materials (photos, pictures) or orally presented or read literature, the student will demonstrate increased knowledge of the labels of emotions or feelings and the corresponding physical feelings that may be associated with them.
1) Label various emotions and feelings when presented with a corresponding picture
2) After listening to a passage or watching a video, recognize the person’s or character’s feelings and label them.
    a) Put himself in the other’s shoes to imagine how they might be feeling (physical sensations and emotions)
    b) Imagine and describe what type of response might make the person (or himself) feel better or worse.

When provided with hypothetical difficult social situations as encountered in role-playing with speech services, in videos, movies, short stories, and literature sources, the student will:
1) Identify the social problem (breakdown in communication, misunderstanding, disagreement, etc.)
2) Generating a communication response to solve the problem which would be socially acceptable to most audiences, without sacrificing self-determination and self-advocacy. (A socially acceptable solution could include not engaging at all until the student is in a self-regulated state.

The student will demonstrate insight regarding others’ perspectives of a social situation, whether encountered within peer/peer or peer/instructor interactions or as presented in visual materials or in orally presented literature, by:
a) inferring why a particular person may say, feel or do the things they do in movies, videos, short stories, and other literary sources.
b) relaying his personal perspective on the same social situation, and state why.

The student will communicate with a peer through the use of AAC rather than physically touching a peer (Communicate “Sad” rather than touching a crying peer’s face).

The student will develop an understanding of the relationship between his verbalizations and their effect on others by:
a) Describing his reasons for the verbalization.
b) Describing the person on the receiving end’s possible perspectives of the student’s verbalizations.
c) Deciding whether or not he is satisfied with his choice of communication (self-determined).
d) If he is not satisfied, describing other options he has for communicating his feelings.

The student will develop an understanding of the neurotypical rationale for various expected social skills by stating the reason when asked (i.e. Why do we say excuse me?)

Examples of Ableist Objectives:

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

The true lesson of training social skills (“compliance training”) teaches our students that unless they learn to successfully mask their autistic traits, they are inherently less valuable members of the human race. Social skills training communicates conditional acceptance based on the conditions that non-autistic people determine. It’s not fair or ethical. SLPS: Stop training social skills. Set your Autistic students free from compliance training and let them be themselves.

[1] 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/

[2] ibid

[3][3] Compensatory strategies below the behavioural surface in autism: a qualitative study. The Lancet Psychiatry –  VOLUME 6, ISSUE 9, P766-777, SEPTEMBER 01, 2019.  Lucy Anne Livingston, MSc, Punit Shah, PhD, Prof Francesca Happé, PhD. https://doi.org/10.1016/S2215-0366(19)30224-X

[4] Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder. The Journal of Child Psychology and Psychiatry – Lucy Anne Livingston  Emma Colvert ,Patrick Bolton  Francesca Happé: First published: 26 March 2018. https://doi.org/10.1111/jcpp.12886

[5] “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders. Laura Hull, K. V. Petrides, Carrie Allison, Paula Smith, Simon Baron-Cohen, Meng-Chuan LaiWilliam Mandy. August 2017, Volume 47, Issue 8, pp 2519–2534 https://link.springer.com/article/10.1007%2Fs10803-017-3166-5

[6] Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder. Neuroscience & Biobehavioral Reviews. Lucy AnneLivingston. Volume 80, September 2017, Pages 729-742 https://doi.org/10.1016/j.neubiorev.2017.06.005

[7] Reed, Taffy; Peterson, Candida (1990-12-01). “A comparative study of autistic subjects’ performance at two levels of visual and cognitive perspective taking”. Journal of Autism and Developmental Disorders. 20 (4): 555–567. doi:10.1007/BF02216060. ISSN 0162-3257.)

[8] 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/

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• Author
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Julie Roberts, M.S. CCC-SLP

Founder & CEO at Therapist Neurodiversity Collective

Julie Roberts, M.S., CCC-SLP, founding CEO of Therapist Neurodiversity Collective, Inc. is a late-diagnosed Autistic ASHA certified, licensed Speech-Language Pathologist who has been practicing since 1999.
She is a frequent speaker, educator, and trainer who delivers high-energy presentations that challenge audiences to re-examine their beliefs about Autism and re-access outdated and damaging therapy and education practices.
Julie’s work focuses on professional, and public education about empathetic evidence-based therapy alternatives to ABA and behavioral therapy models that are non-trauma inducing and respectful of autistic social communication differences, social justice, and human rights. Her articles and educational resources have reached well over three-quarters of a million people and are frequently cited in other presentations and articles.

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