e.g. Dialogue heard in a preschool setting,
Child 1: “I brought a cheese stick for lunch”
Child 2 “Me too”
Child 1 “Mine’s yellow”
Child 2 “Mine’s orange”
Child 1 “I have a big one”
Child 2 bites his and laughs and says “Mine’s small”

As can be seen in the conversational exchange, no questions were asked. Children responded to information given by reciprocating with their own information.  Individuals often are missing or deficit in turn taking, interactive skills upon initial assessment. This may be due to a dependence on the Question-Response format where the child is waiting to be asked “What color is yours?”

Sample of Pragmatic Skills:
Target skills include: Question-Question where the discriminative stimulus is obvious by including the response in the question. Examples include: “Do you know what we are having for dinner?” Child responds “What?”  Children generally start with a visual such as an item in a bag or behind your back or in your hand so that when the child asks the question, they get immediate reinforcement by seeing an item. 

Statement-Question, where the discriminative stimulus is not stated or obvious e.g., Parent “I bought something delicious for dinner” child should respond by asking a question to seek information e.g., “what?”  

Statement-Statement , where both objective and subjective comments are targeted.  Objective being items that are true or factual and subjective being matters of feeling or opinion.
Most children start with stating an objective statement with visual support.  Statements are prompted through visual cueing and verbal reminders.

e.g., Therapist: I’m picking the red car
Child: I want the blue car.
Therapist: Mine has blue stripes.
Child: Mine has fire painted on it.
Therapist: Mine is fast.
Child: Mine, too

Target skills progress to statements embedded in a paragraph, longer length of utterance, causation, negation and either statements, and fading visual cues.  Examples of each of these will be presented.
Intermixing Statement-Question, Question-Question, and Statement- Statement throughout a conversation is the ultimate goal.

Sample conversation from 2^nd-3^rd grade social skills group:
E.g.
Child1 Last night I won my baseball game.
Child 2 Did you get a home run?
Child1 No, but I got a run.
Child 4: I used to play baseball, but now I do karate because it makes me strong.
Child 1 Baseball makes me strong too.
Child 2 I do karate! I like to do the kicks and break the boards.
Child 3 I never did karate, but I know how to kick, watch me.

Then skills progress to more advanced objectives. These include topic goals such as: increase amount of turns in a conversation,
identify the topic in conversation, maintain topic, expand initiated topics, join in nonpreferred topics, and appropriately change topic.  Organizational/executive function skills include: sequence information, summarize information, predict from previous social situations, perspective taking, orient the listener to relevancy of information given, clarify statements, request clarification, and express feelings appropriately.  Further goals consist of the individual
understanding and using humor and idioms.  Aspects of nonverbal communication are also targeted such as the ability to recognize personal space, attend to nonverbal aspects of their communicative partner, and appropriate body orientation.

2.   Social Skills
Learning objective:
Understanding how to determine social objectives based on parental, teacher, and therapist input will be discussed. The importance of collaboration of goals across contexts, school, home, clinical settings will be emphasized.  Another objective will be for parents and therapists to understand that social skills are dynamic and not necessarily linear.

Primary issues from parents include:
1.   They have been told their child has a social communication disorder or has trouble making friends at school and yet they are not told what to do about it, or where to go, or what to teach, or how.
2.   Their child may be too high for groups founded under ABA programs or based on autism label.
3.   They have been told to wait until their child has language to begin to teach social skills
When individuals are initially assessed, they often have skills in various levels.  The goal is to increase skills in each area as well as fill in gaps.

Sample of Social Skills
Beginning Level Target Skills
Learning Readiness
          Attention
          Proximity
          Observation
Basics of Play
          Solitary Play
          Purposeful Play
          Exploratory Play
Basics of Social Interaction
          Responds to verbal and nonverbal cues
          Waits
          Pulls another person to show him an action or object
          Hands a book or toy to adult to read or share
          Imitates actions
Mid Level Target Skills
Understanding of Feelings
          Expresses affection physically and verbally
          Attempts to comfort others in distress
          Manages anxiety and frustration
Complex Play Skills
          Parallel Play
          Chooses and plays with a toy independently
          Takes part in simple game with peer
          Begins to understand simple rules
Prerequisite Interactive Skills
          Responds to Initiations
          Directed Sharing
          Takes turns
          Initiates play
High level Target Skills
Advanced Social Skills, Reciprocal Interactions
          Organizes
          Compromises
          Helps/asks for assistance
          Knows how to not join play appropriately
          Follows rules of group game
          Cooperative play
          Persistence
          Interprets social cues, innuendos, body language, humor
Skills for Dealing with Feelings
          Respects others and their property
          Takes pride in achievements
          Displays kindness, care, affection
          Shows increasing control of emotional reactions

To improve executive function skills, an emphasis is placed on perspective taking and self regulation. The individual’s goal is to understand what another person is thinking and how they are feeling and teach them to respond appropriately based on previously learned behaviors.  Individuals may have the knowledge about what to do in any given situation, but cannot access the appropriate response due to frustration or anxiety.  The use of self regulation techniques to teach children to change their behavior before emotions block executive function skills will be discussed. 

3.   Natural Contexts: Learning objective: for parents and therapists to acquire knowledge on types of settings and how to make skills learned in groups become more naturally occurring. Discussion will include interventions within school, in a clinic setting including, cooperative learning and social/pragmatics groups, and on field trips called Outdoor Adventures.

Social and Cooperative Groups
 A discussion will include goals and resources to assist parents and therapists to form or select cooperative learning and social groups.  Various settings including structured and unstructured opportunities will be discussed regarding their relevance toward acquiring skill. Group configurations can vary to include typical, all special needs, various age ranges and ability levels. Some social skills groups focus on a lesson such as “how to handle someone saying “no”’ where others are more spontaneous and dynamic by sharing events of the week. Parents should look for certain elements to ensure they are in the right program.
Components of Social Skills Instruction
·        Identify and define specific target behaviors
·        Choose motivating activities
·        Simplify complex skills into small teachable steps
·        Introduce skill and list components of skill
·        Teach components through direct instruction
·        Role play an appropriate example while pointing out relevant skills
·        Ask children for components of skill
·        (optional) Role play inappropriate example and ask for components of skill
·        Rehearse the skill with the individual
·        Give Positive Feedback
·        Ask children for rationales for using the skill
·        Reality check
·        Build in multiple contexts for generalization

An essential element of cooperative groups is an understanding that each individual has a responsibility to other children in their group to achieve success.  Objectives of cooperative learning consist of teaching individuals to resolve conflict constructively.  Children learn to communicate accurately and learn to accept and support each other.

Outdoor Adventures: The summer, week long, and weekend trips are referred to as Social Immersion Programs.  The Philosophy of the Program emphasizes the following:
1.   Social Immersion-every moment and every activity of the day is an opportunity to interact with peers and work together so that being with friends is part of the child’s normal daily occurrence and becomes habitual
2.   Extrinsic to intrinsic-one objective is for children to transfer their reinforcement system from being externally provided through praise or other reward systems to becoming intrinsically reinforcing so that being with friends is more enjoyable than being alone and therefore the friendship is the reward
3.   Improve executive function through group interaction: consistently working on problem solving through real life events and utilizing time management techniques and self regulation to reduce frustration and anxiety
4.   Develop Independent skills which lead to increased confidence and self concept

Outdoor, sports, and extreme camps have become popular for individuals with special needs as referred to in June 2007 Autism Advocate issue.  The USA Weekend Magazine referred to outdoor nature experiences as pivotal in assisting all children with physical, cognitive, and social growth.  The article was based upon Richard Louv’s book ‘Last Child in the Woods: Saving our Children from Nature-Deficit Disorder”.   He proposes that time spent playing outside in the trees can reduce depression and stress and stimulate the senses which may help children who have difficulty with attending skills. Louv also notes that creative thinking is also promoted through the use of unstructured activities and raw materials like sticks, rocks, and dirt.

That is what Amazing Child Outdoor Adventures has been doing for four years. It is an opportunity for individuals to experience nature through camping in tents and cabins, hiking, and exploring the habitat indigenous to the area, for example, learning about the everglades.  We include rule based organized sports from flag football, croquet, and frisbee to badminton to assist kids in understanding the rules of a sport and promote self confidence.  Unstructured activities such as swimming, hiking, hay rides, tubing and fishing provide opportunities for children to practice social skills they have learned. What some would consider to be extreme sports, our children look at as adventures, and look forward to telling all their family and friends “I did that!” or documenting in their journals.  These include horseback riding, boating, and white water rafting.  Children are encouraged to participate in all adventures, prompted to “find a friend” when they have news to share or have something to show someone, or when they have been alone for too long.  Children are positively reinforced for joining in and staying with their peers. 

The camp’s therapists and counselors facilitate interaction between children with issues and typical campers.  Typical children are encouraged to help others join in and welcome their participation.  Counselors range from teachers of typical children, therapists trained in applied behavior analysis, pragmatics, social skills, mental health counseling, psychology, child development, and education. There is a great counselor to child ratio which is generally 1:3 or 1:4.

The camp therapists assess a child and set individual goals for each child at his or her level.  Parents fill out surveys that identify which issues to address such as sleeping, dressing, eating, medication, and other areas of concern.  Therapists and counselors utilize every activity from cleaning up after breakfast to deciding which car to ride in as an opportunity to teach a new skill.  The goal of camp is not focused on children facing their fears.  However, the counselors encourage and reinforce campers to get out of their comfort zone of being alone, insistence on sameness, or doing self stimulatory behaviors.  Calming strategies are targeted to assist children when focusing on trying new foods and activities that they have avoided.

Weekend trips take place in various areas within southern and central Florida, while week long and summer trips take place in various states and national parks such as Smoky Mountain National Parks. Spring Break 2008 will be the first trip to California.
The Outdoor Adventures are useful as a reward system for individuals during their normal academic, social, and pragmatic therapies. In addition, the trips are also an opportunity for families to get respite as they are able to send siblings as well and work on sibling relationships.