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Autism: Are Social Skills Groups and Social Communication Therapy Worthwhile?
vortex2.71 (802986) writes I imagine that enough of us on Slashdot are on the Autism Spectrum or were once diagnosed as having Aspergers that this might be the right venue for this question. My son is on the spectrum, but is in a mainstream classroom at a private school. We have spent thousands of dollars on a bunch of different social skills groups, speech communication therapy, occupational therapy, and physical therapy. We've found that the specific skills and intuition that the therapists possess is much more important than their credentials and are frequently disappointed by the overwhelming mediocrity of special education teachers, speech therapists, and OT/PT therapists. We are at the point where we wonder if our time is better spent with playdates with peers that are facilitated by us than continuing with the groups. I'm curious if there are adult Slashdoters who are on the spectrum who participated in these therapies as children who can weigh in on this? What was your experience with social skills groups and social communication therapy? Did they help?
I'm sure this is meant to be humorous, but it's a real thing. My son was diagnosed as "being on the spectrum" at the age of 3 (!?) because he was a huge nerd. Let me define that for you: he could read and understand complex technical manuals and apply the concepts, he could do double digit addition and subtraction in his head, he set all our DVRs for his shows, balancing hard disk space... I'm not some crazy parent who sits there trying to drill crap into a 3yo head, it's useless, he just was like that. What he would not do, however, is talk in any "normal" way. He would answer your question with a simple word, but never initiate. He would not talk about things he liked, or stuff he wanted to do, etc. He took toys apart and put them back together, but he didn't really have any fantasy activity with them. All these are warning signs on your yearly checkup list at the pediatrician.
So eventually we were "compelled" to take him to a specialist, and she diagnosed him. We were very reluctant, we knew there wasn't anything wrong with him, but we were getting that "or else we'll call CPS on you" vibe. So they diagnosed him as ASD: PDD-NOS, doctor speak for "fuck if we know". They prescribed a bunch of therapy which we declined, and miracle of miracles, like a light switch was turned on he started talking. And when he started talking, he started talking in long sentences, with big words and complicated ideas. He was "cured" and somehow manages normal life as well as any kid, but he still doesn't behave the same.
Autism has become the dumping grounds for any social behavior that lies outside the first standard deviation of the bell curve. It's especially obnoxious since it's being diagnosed lately with sociology, rather than actual science. No one did a brain scan or anything like that, it was all based on proto-pavlov dog experiments. The downside here is that, having grown up around autistic people, there really is such a thing and those people are not being well served by all this distraction. Money is being misspent on "easy' cases, rather than helping people who are really suffering.
I've been diagnosed with borderline Asperberger, i.e., it wasn't specifically tested for, but 70% of other people who scored the way I did on certain tests also were diagnosed with Aspberger. I also have a son who's mildly affected, and is positively diagnosed.
This is a little off-topic relative to your questions, but here are some of the things we've found:
I would take this only so far, for the record. If I felt that his behavior was actively causing him unhappiness, harm, or putting him in danger, I would try anything, even things I don't believe in that didn't seem like they would cause greater harm.
However at 3yo, none of that was true. He was happy, we were happy, only very dubious medical diagnostics which evaluate "normalness" suggested otherwise. Those diagnostics were being wielded in such a way that i felt I needed to take action, or else face unspecified legal consequences. I'm not going to debate the latter, but sensible people would try to avoid such situations where possible. Fighting the man isn't the best thing for your child, until it is.
I agree completely that as parents we have to decide if the deviation from normal-ness is a bug or a feature, not based on our own context but based on the child. If he's unhappy, maybe it's worth it. But 4 years later, in my case, my son is pretty happy and confident. The advantage of being in STEM fields is that I meet a large number of very abnormal, very high functioning people every day and don't see a problem with that. I suspect many of them struggle in social situations where their fitness for that group is based strictly on adherence to normative behavior, but I also know that they avoid such situations. This seems like a reasonable trade, we should not all have to enjoy the same things. It is frequently the other people who seem to think something needs fixing.
I don't think you were paying attention to what the OP was saying, which is that credentials are not related to performance. Public schools, however, are generally unionized, so that credentials are valued more highly than actual performance. From local reports I have heard relating to students on the autism spectrum, it seems to me that they are either given some dumbed-down busywork, or efforts are made to keep them from disturbing "real students".
For those who know about ASD, however, this is not entirely unexpected. One of the problems is that autism is a *spectrum* of behaviours, meaning that everyone with autism is different. Of a hundred people with the disorder, you will find those with developmental delay as well as mental giants, those with physical handicaps and the physically healthy, some who dislike being touched and others who don't mind, some who speak and some who don't, etc. etc. Lumping them all into a single classroom, or using a single teaching method, is bound to leave many of these kids behind.
Scheduling playdates for your son is a recipe for bitterness and disappointment. Without feedback or direction for what the proper behaviour is, the end result will be ridicule and ostracism. Over and over. And this will continue into his adult life.
Since your son has no "feel" for interaction, the best you can get is an "intellectual appreciation" for correct behaviour. He has to learn the skill that everyone else will pick up naturally.
The first half is to get him to want to learn. You do this by rewards and other incentives, as outlined by any of a number of teaching methods. Sit down with him at regular scheduled intervals, be sure to show appreciation when he does things correctly, and show disappointment when he screws up. When he screws up, do the disappointment thing *quickly* and move on. Promise him a big reward at the end of a semester of these if he does well, and follow up on it (take him to an arcade, get him a specific toy, take him snorkeling in Hanauma bay, whatever.) Little rewards at intervals is good too (take him out for ice cream, his special time with his dad &c).
Make him want to change.
The second half is being able to recognize his behaviour *yourself* and communicate to him instantly. I cannot describe how incredibly difficult this is, you have to be alert for specific patterns and people are just not wired to do this. People go through their daily lives on autopilot, and don't normally evaluate what they're hearing/seeing/doing on a continual basis. It's s a difficult skill that needs to be developed through discovery and practice.
The problem with therapists is that the feedback isn't immediate. The therapist might be able to analyze and correct and connect with your son, but your son will tend to forget outside the session. Like I said, most people are on autopilot and changing the autopilot programming is hard.
When you get the ability to recognize his behaviour, simply say "ding!" when you see it.
It's immediate feedback, and when he hears it he should stop to consider what he's doing and change his behaviour. That's all it takes.
Be very clear that saying "ding!" doesn't mean you're angry with him or that he should stop or that he's being punished. It's simply a signal, and it's not meant to get him to stop, it's meant to get him to *think*. Also be very clear that he can ask you why you said it, and that there's no penalty for doing this.
Start with small, obvious behaviours such as repetitive habits or sentence construction, then slowly work into tactical advice (always look someone in the eye, always ask how they are doing, always remember their name), then into strategic advice ("never lie to a friend", "never tell something told to you in confidence"), then into planning advice (see what other people do and imitate them, dress like them, try to act like them).
Get a copy of "How to Make Friends and Influence People" (Dale Carnegie) and use it as a syllabus for what to teach. Also check out "Influence, the science of persuasion" as a guide for what to watch out for (so that others don't take advantage of him).
Best of luck to you.
I was diagnosed with Asperger's syndrome (now high functioning autism) at the age of 19. I went through 2 or 3 years of therapy (though not the therapy you described, mine was just one on one with a therapist), but what helped me the most (in my experience) is that I read an ungodly amount of fiction between then and now (I'm 30 years old now). Books really describe how people think, and I've found that if I interpret what people do based on what authors say people think in books I'm usually not far off. That is, I'm close enough that interpreting people based on what I've read in books is close enough to the truth that it doesn't lead to major social fuck ups. When I was in high-school (ie., before I was diagnosed), teachers would sometimes get mad at me for what I thought then was 'no reason', but I now understand that it was caused by my behavior.
For example, I remember one time when my 9th grade German teacher asked the class about our 8th grade German teacher, and I said that he was a huge asshole. This caused the teacher to flip his shit, but I had no idea why, because he and the 8th grade German teacher were clearly different people, so why would my opinion of the one affect the other? I now understand that my use of language was inappropriate, as well as that they were probably friends, or that it is inappropriate to shit on one teacher in front of another one in a classroom setting.
I'm basing my interpretation of my memory of what happened then on what I've read in the (among others) Harry Potter series. Interactions with teachers and classmates are explained very well there. I may not be able to intuitively feel what is the right way to behave, but because I have a good memory and because I read so much I'm usually able to determine what's going on now. So, in my experience, reading has been more fruitful than therapy.