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Current DSM-IV-TR (2000) criteria define autism and Asperger’s disorder as separate clinical entities; however, individuals diagnosed with Asperger’s disorder continue to be conceptualized as having a milder variant of autism. Extending from this notion, the terms Asperger’s disorder and HFA are frequently used interchangeably in the literature. A review of the recent literature by Macintosh and Dissanayake (2004) demonstrated that there is evidence of a substantial overlap between Autistic Disorder and Asperger’s Disorder in several areas. These areas include cognitive, neuropsychological, language and communication, and motor abilities, as well as medical and developmental histories, course and outcome, and repetitive behaviors and social development. The authors concluded that the literature supports the view that Autistic Disorder and Asperger’s Disorder belong on the same spectrum of autism. Thus, for the purpose of this poster, the term HFA will be used to identify high-functioning children with autism as well as those diagnosed with Asperger’s disorder.
Early in childhood, some of the most common symptoms of HFA are related to communication problems, failure to engage in imitation in play, nonresponsiveness to hearing one’s name and difficulty following another person’s gaze or pointing. Other behaviors, such as stereotyped or repetitive language, ritualistic behavior, and difficulty with relationships, can be observed after the age of two. Other symptoms of HFA may include a lack of appreciation for humor, literal approaches to language and clumsiness (Sattler & Hoge, 2006).
Children with HFA have marked social impairment, particularly in the use of nonverbal behaviors. They are unable to perceive and process emotional cues from those around them, possibly because of difficulty maintaining attention and selecting salient attributes of the environment to be processed. Failure to develop appropriate peer relationships is also common, and spontaneous interactions are difficult. Children with HFA tend to gravitate toward older children and adults, and lack skills for reciprocal social interactions. Because they are unable to empathize with others, they do not participate in the give and take of social interaction (Sattler & Hoge, 2006).
Children with HFA also have impairments in communication. While children with Asperger’s disorder do not have a delay in speech development, children with autistic disorder do. In either form, the lack of or delay in spoken words is not compensated for by nonverbal behavior. Initiating and maintaining conversation is difficult for these children. Spoken words are taken for their literal meaning, and turn taking in conversation and understanding others’ points of view is difficult. Children with HFA also have stereotyped, repetitive and idiosyncratic language. Pronominal reversal, or the reversal of pronouns (i.e., referring to oneself as “she”), and odd prosody of speech are common (Sattler & Hoge, 2006).
Children with HFA experience difficulty with appropriate behavior. Play skills are impaired and often children with HFA use toys in inflexible, repetitive, perseverative and mechanical ways (Sattler & Hoge, 2006). Children with HFA may be extraordinarily preoccupied with sameness in routines and environments, and changes to routine may result in tantrums or emotional shutdown. These children are also often preoccupied with a specific topic of interest. This topic, anything from hotel rooms to dinosaurs, is often all-encompassing. These children prefer to talk about, engage in play and ask questions only related to the topic (Sattler & Hoge).
Social skills in children with HFA are generally rated as problematic by parents (Barnhill et al., 2000). Children with HFA tend to engage in parallel play rather than coordinated play more often than typical peers (Bauminger et al., 2008). While some children with HFA have friends, the quality and quantity of the friendships differ from typical ones. It seems that children with HFA have to learn cognitive strategies to build and maintain friendships that come more naturally to typically developing peers (Bauminger et al., 2008). Children with social skills deficits may develop social anxiety, which, in turn, can lead to negative peer reactions, perpetuating the anxiety (LaGreca & Lopez, 1998).
Children with HFA experience profound difficulties in the social domain, leading to social exclusion, difficulties making and sustaining friendships, and employment problems (Parsons & Mitchell, 2002). Children with HFA have been found to respond well to intervention, and targeting social difficulties at a young age can be quite beneficial (Mundy & Crowson, 1997). Since there are no cures for autism spectrum disorders, intervention focuses on reducing negative and increasing positive behaviors (Sattler, 2006). One of the most important intervention outcomes is improved social functioning (Rogers, 2000). “Social-learning approaches are used to develop social communication skills and interpersonal skills through structured activities with peers who do not have disabilities” (Mesibov, Adams, & Klinger, 1997). Social interventions vary in several ways: the ages of the individuals with HFA involved; the targeted behavior being intervened upon (e.g., initiation, response and maintenance); and the type of social partner involved (peer or adult, socially impaired or not) (Rogers, 2000). The goal of such groups may be to provide opportunities for the child to interact in a variety of natural environments where reinforcement is available. Using games as part of this intervention helps the child learn many skills, such as accepting losing, working with a partner, taking turns, talking with others (Sattler, 2006).
Most studies on social skills interventions report an improvement in the specific skill or task being taught, but frequent failures to generalize these skills to real-world situations (Parsons & Mitchell, 2002). There are several ways to approach social skills training for children with HFA: behavioral techniques, cognitive approaches, social-learning approaches, theory of mind (Sattler, 2006). Behavioral methods use operant conditioning as a basis for learning within a highly structured setting. The principles of repetition and reinforcement seem to be effective in promoting changes in specific behaviors. Behavioral methods can be utilized in one-on-one training (i.e., Lovaas method) or in a group setting (i.e., passing out tokens for performing correct responses). More recently, there has been a shift in intervention strategies by recognizing the importance of embedding the intervention into a child’s natural setting and encouraging the behaviors to occur with those found in the natural setting (i.e., teacher, parents [Hwang & Hughes, 2000, Rogers, 2000]).
The use of game-play can create a naturalistic environment where the participant is forced to use his/her social skills in a variety of situations that are not planned or routine. For example, participants playing games are forced to share an understanding of the rules: play the game, follow the rules, settle disputes, exchange materials (pass the dice, etc.) and cope with disappointment. The group leader must be an active participant in the process and facilitate social exchanges by monitoring appropriateness of conversation, helping to mediate disappointment, aid in the participants' understanding of the situation and help the participants to have fun. One of the great side-effects of game play is that the participants are actively engaged in a game and are having fun, and they do not always realize that they are “practicing” their social skills.
The lead presenter is currently using games in a social skills group for adolescent males. The participants report that they enjoy attending the group and that they look forward to the weekly group sessions. The parents report that the participants have achieved greater social understanding and success by what they are learning in the group.
This poster will elaborate on tips for how to pick out games for social skills groups. The presenters will bring several examples of games they are currently using. Additionally, materials will be shared on specific strategies for facilitating game play. Overall, games can be a fun and effective way to facilitate social growth. The myriad of social and emotional opportunities that arise during game-play can help to create situations that can be generalized to real-life situations.