Generalization of Social Skills Among Young Adolescents with Asperger's Disorder

A Social Communication/Basketball Program
By Eugene J. D’Angelo, PhD and Ariel Botta, LICSW, Department of Psychiatry, Children’s Hospital Boston

While a number of very innovative approaches to teaching effective social communication skills have been developed for children with Asperger Syndrome (AS), the challenge for these children is to effectively apply these skills in a variety of social situations. Repeatedly, children diagnosed with AS and their families express frustration that the social skills so ably demonstrated within a structured group setting are not utilized effectively in more naturalistic life contexts. Why is it such a struggle to generalize social skills? Although social discourse has a seemingly natural set of rules to which most individuals subscribe, the settings and contexts in which we communicate with others can be very unpredictable. To be communicatively successful, one must be able to systematically evaluate what the social exchange requires, know how to frame what one wants to express, learn to listen to the comments of the other speaker, and develop a response based on the find ways to take the content of the other’s message. Typically, social interactions occur quickly, with limited structure, and few cues about what the participants might be expected to say to each other. This unpredictability can be can be especially challenging for those with social communication difficulties such as people with AS.

Candidly, we initially underappreciated this complexity; hence, our initial attempts did not prove to be successful. When we gathered independent ratings of pragmatic language and social skills from the participants, parents, and teachers after the completion of the group, we found that no significant improvements had occurred. We realized that we needed a setting where social communication skills could be taught, practiced, and then applied—with opportunities to see whether they would be spontaneously utilized in other contexts, and for the children to evaluate the degree to which they were actually applying these skills.

We decided to develop a social skills program using a modified basketball game as a structured but emotionally-charged setting in which children could work on generalizing social communication skills. We wanted children with AS to:

  • Learn essential pragmatic and social skills.
  • Develop a sense of identity within a group setting.
  • Learn to rapidly interact in situations where only basic rules are present.
  • React appropriately to ambiguous situations.
  • Learn more about perspective-taking and cooperative effort in pursuit of a group goal.
  • Adjust to changing and unpredictable circumstances.
  • Develop sportsmanship when attaining victory.
  • Learn to manage disappointment when losing a game.
  • Strengthen their capacity for self-appraisal.
  • Function in situations of high emotion.
  • Learn—in a more protected environment—how to play a game with high peer-group interest—a game children could possibly play in other settings and groups.

This specialized basketball program permitted us to combine pragmatic language training, a social skill program, some features of adaptive physical education, and modulation of sensory input for those children who needed it. Our focus has been primarily on 13-16 year olds, due to the fixed height of the baskets in the gym available to us. However, the program we developed can also work for younger children.

Children were clinically screened to confirm their diagnosis of AS, and to identify any relevant co-occurring clinical problems. Children who exhibit significant mood instability and aggressivity become too emotionally overstimulated by the competitive nature of the program; their emotional outbursts during the games were very distressing for the other participants. Some of those children could join the groups after being involved in interventions to try to diminish their aggressivity.

Upon completion of the screening, the children and parents were invited to observe the basketball program. A staff member would then talk with the child and parent about participation in the program, answer questions and, most importantly, reassure the child about the support/welcome s/he would receive for joining the program. Sometimes the children had to spend time with a parent and a staff member, dribbling a basketball and/or walking around the empty gym in order to feel sufficiently comfortable to agree to join the program. Most of the children voiced initial reluctance about participating for fear of not playing “well enough;” however, we spoke about the overriding goals of respect and acceptance among the teams.

The groups met on a weekly basis for 1½-2 hours. The weekly activities were organized in the following sequence: (1) Informal warmup, (2) Team meeting, (3) Introduction/Practice of a specific basketball skill, (4) Supervised game, and (5) Postgame team and self-assessment. Although no final version of the program has yet been determined, there is currently a sequence of 22 discrete group experiences/sessions, each designed to meet specific objectives, and organized around three levels of structure/staff support for each team member, depending on individual needs. Sessions can be repeated, and skills practiced, at more advanced levels when the group or individuals are ready to progress.

Warm-up: As children arrive for the program, they have an opportunity to take a basketball and warm up by dribbling and/or shooting baskets. This can be done alone, with another teammate or with one of the “coaches” (staff members). It is also an opportunity for the children to informally talk with each other and/or share mutual interests.

Team Meeting: A coach facilitates the team meeting. Team members learn that one of the most important ingredients for a successful team effort—on the basketball court or in daily life—is to learn to communicate clearly, flexibly, and supportively, and to work cooperatively with each other. In the team meeting we work on these relational and communication skills. Group members share and discuss their experiences of the past week. The coach provides significant structure/support to specific team members as needed. Staff then lead specific pragmatic language and social skill activities, drawing upon many of the activities already found in the clinical literature regarding interventions for children with AS. Next, staff describe the basketball skills we will focus on for the session. The meeting ends with physical warmup activities led by the captain; staff members rotate into this role on a weekly basis.

Basketball Skills Practice: Because our team members came from several communities, we could only meet one day each week. Therefore, we included team meeting, basketball practice, and games all on the same day. (In a more local school or community-based or format, staff might wish to modify the schedule.) The basketball skill and practice was typically compatible with the pragmatic/social skill activity being undertaken that day. For example, we developed an exercise that paired learning the names of the teammates with the skill of a basketball bounce pass. In this way, the players quickly learned the names of their teammates and also an essential basketball skill. This type of activity could eventually be modified: using additional types of basketball passes, or different player identification activities.

Many of the children participating in our program had motor planning and/or postural control difficulties. While not using formal physical therapy interventions, we have sought input from physical therapists and adaptive physical education teachers about how to address some of these issues in our practice sessions. We were surprised to learn that a substantial subgroup of our program participants had very limited physical activity during the course of the week, hence, the program became one of their major physical outlets. As part of each team member’s self-evaluation of his/her basketball skills with a coach, some practice goals were created so that they might lead to practicing/physical activity during the course of the week as well. We were impressed with how the feeling part of the team motivated children to practice.

The Basketball Game gives each player opportunities to practice communication skills, cooperate with teammates, apply basketball skills, and practice managing anxiety and/or strong emotional reactions in a safe and reasonably controlled environment. While the basic rules for each game were similar to standard rules, we made some modifications.

  • Defensive play only begins at mid-court, to enable both the offensive and defensive teams to become organized.
  • Prior to a shot being taken, the team with the ball has to complete a minimum of two passes to different teammates. This latter rule minimized the tendency for some players to dominate the basketball, attempt to dribble down the court without passing to other players, and single-handedly take a shot.
  • The referee or a player on either team could call for a timeout at any time. There were two types of timeouts, namely, a “team timeout” (used to rest and/or for a team to discuss basketball strategy, or ways to change the manner in which they are communicating) and a “game timeout” (to solve problems related to the feelings or behavior of one or more players). In this latter situation, players could apply skills learned during team meetings and through efforts at self-evaluation. During the game timeout, the distressed player had an opportunity to hold a brief, private meeting with his/her coach, to describe what was upsetting, and discuss how best to present the issue to the other players on both teams for possible resolution. Possible reactions by the other players were anticipated, and the distressed player had the opportunity to rehearse the presentation of the concerns to the coach prior to speaking with the players. Meanwhile, the remaining players from both teams sat at center court with another coach (and assistants), discussed what they thought might be of concern to the distressed player, anticipated how they should listen/respond, and what alternative issues might be presented. Both the distressed child and the other players were practicing how to communicate emotionally-laden concerns to others and how to solve interpersonal problems. Coaches structured and modified this activity according to the communicative skills levels of the various participants.
  • The coaches actively played on their teams during part or all of the game. Thus, coaches could facilitate passing, and modulate the intensity of the emotions that arose during the course of the game. They could also regulate the tempo of play and prompt others to utilize either their social communication or basketball skills on the court.
  • Significant emotion was elicited by keeping score during the game. Emotions influenced how the players communicated and felt during the course of the game—essential experiences to bring about game timeouts and efforts at practicing effective social communication skills.

Postgame Evaluation: At the end of the game, both teams were asked to shake hands and then sit in a circle at center court. Players were requested to make positive comments about various players on the other team, noting aspects of their play or sportsmanship that were particularly impressive or meaningful. Subsequently, each player completed a brief self-evaluation of his or her participation in each facet of the day’s program—from team meeting to the postgame evaluation. It was at this time that players and coaches could identify which basketball skills and/or social communication activities each person could practice during the coming week.

Conclusion: We have not completed the overall program manual; the content of the sessions and/or the number of meetings may change. Using a systematic, research-informed approach to the development of this manual, we want to produce an intervention of proven, evidence-based effectiveness—a program truly meaningful for the children who participate. Although several challenges do remain, our preliminary results from the program are encouraging. The ratings/reports from the players, parents, and teachers suggest that there are positive changes in both pragmatic language functioning and social skills for the participants demonstrated in different social settings. What is also heartening for us is the observation that several of the participants have begun to play in basketball leagues in their own communities.

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