social skills & children with adhd & learning disabilities dr. aubrey h. fine

Social Skills & Children with ADHD & Learning Disabilities

Dr. Aubrey H. Fine

Hallmark of ADHD

• Social Problems– Serious interpersonal difficulties

– Peer rejection• Associated feelings of loneliness• Unhealthy self-esteem• Poor school work• Possibly school drop out

Negative Peer Feedback• Don’t recognize or respect social boundaries• Can act intrusively at times• May appear to be annoying to others• May cause irritation to peers• Boisterousness• Lack of awareness on others• Stubbornness• Inflexibility• Aggression• Bullying

Verbal Skills• Selection of right topic to talk about

• Use of appropriate modes of speaking depending on the social situation

Non-Verbal Skills• Problem resolution skills

• Turn taking

• Internal ability to conceptualize social cues and feedback

Social Skill Deficits

• Begin because of perception, understanding, or interpreting environmental cues

• Encoding and perceiving social cues in the environment

• Limited behavior repertoire

Social Performance Deficit

• Behave appropriately

• Unable to consistently apply skills in everyday interactions

Performance Deficit

• Disengaged

• Reclusive

Social Skills DeficitRefers to the

presence of social skills in a

behavioral repertoire, but

failure to perform these behaviors at an acceptable level

in specific situations.

Review of Literature

•Why children who have LD and ADHDHave Social Skill

Deficits?

Snapshot of Research as it Pertains to Social Skills and LD• Baum et al. (1998): studied the prevalence of

social dysfunction among students with learning disabilities in the public schools of Iowa. Their results found that 38% of students with learning disabilities were in need of social skills training.

• Bryan (1998): Reported that students with learning disabilities demonstrated less effective communicative competence. They were found to be less tactful in most situations as well as being less persuasive in arguing their point of view.

• Bryan (1974): In her pioneer study provided evidence that youngsters with learning disabilities (when compared with their mainstream contemporaries) were less well accepted and often socially rejected.

• Bryan (1974): Suggested that many children with LD are rejected by their peers.

Snapshot of Research as it Pertains to Social Skills and LD– con’t• Carlson (1987): Noted that children with LD have

been found less skilled than their NLD contemporaries in the quantity of strategies chosen for hypothetical social situations.

• Conte and Andrews (1993): Concluded that the absence of limiting conditions in definitions of learning disabilities makes it difficult to exclude any particular skills or type of knowledge from falling with the bounds of the definition.

• Flicek (1992): Reported that the combination and quality of ADHD along with LD was associated with the greatest risk of social status problems.

• Kavale and Forness (1966): Suggested that 75% of children with learning disabilities manifest social skill deficits. The perceptions one how one does in school may have great bearing on the rejection that the student’s face.

Snapshot of Research as it Pertains to Social Skills and LD– con’t• Kavanaugh and Truss (1988): Recommended that

the definition of learning disabilities should be changed to include social skills disorders as one of the challenges.

• Kistner and Gatlin (1989): Pointed out that close to 60% of children with learning disabilities experience social problems and that many are rejected and ignored by their peers.

• Levine (2002): Discussed social language as a potential obstacle for optimal social development. He noted that children with language challenges have trouble regulating their tone of voice, may have week greeting skills, poor verbalization of feelings, may have trouble alternating their speech with various groups (code-switching), the prosody of the speech, and their overall ability to convey what exactly they mean may also be hampered. Some of these children may also have a lot of difficulties perceiving what others are actually trying to convey.

Snapshot of Research as it Pertains to Social Skills and LD– con’t• Levine (2001): Identified several other common

skill deficits that some children may also display. These children may struggle with the use of humor and have difficulty asking for things, as well as knowing what to talk about and when.

• Margalit (1994): Reported that children with LD are more likely to experience loneliness and engage in more solitary activities.

• Martlew and Hodson (1991): Acknowledged that children with mild learning disabilities were teased/bullied more and made fewer friends than mainstream children.

• Pearl and Bay (1999): Identified that many children with LD “are less accepted, more rejected, or more neglected than their nondisabled classmates.” Although academic concerns appear to be a priority, children with learning challenges face disproportionate levels of rejection than their mainstream friends.

Snapshot of Research as it Pertains to Social Skills and LD– con’t• Pearl and Bay (1999): In their review of the

psychosocial correlates of learning disabilities found numerous studies highlighting the fact that many of these children have deficits in interpreting social displays, especially understanding nonverbal emotional expressions. Furthermore, youngsters with learning disabilities had definite deficits in social insight, which included their ability to evaluate realistically their social status.

• Schachter et al. (1991): Examined the prevalence of emotional problems among children with learning disabilities. The children displayed a broad spectrum of behavioral problems.

• Strain (1981): Suggested that children with LD do not generally employ reinforcing behaviors (e.g., verbal compliments) and, as a result, are rarely sought out for social interactions by others.

Snapshot of Research as it Pertains to Social Skills and LD– con’t• Swanson and Malone (1992): Found that social skill

difficulties may not be due to social inefficiency, but rather to the inability to learn more positive social behaviors. It is important to emphasize that children with NVLD may have a hard time distinguishing what a person is trying to say when there is a contradiction between verbal and nonverbal messages.

• Vaughn et al. (1993): Reported that there is extensive research documenting that children with learning disabilities have tremedous difficulty forming and maintaining relationships.

• Wiener (1987): Reviewed 25 studies that compared the peer status of children with learning disabilities and students without learning challenges. The findings suggested overwhelmingly that children and adolescents with learning disabilities were lower in peer status than their mainstream peers. Academic failure may have much to do with peer status and how one is accepted.

ADHD: Snapshot into the Literature on Social Skills

• Bagwell (2001): Reported that children with ADHD were, as a group, more rejected by their peers in their teenage years than those teens without ADHD.

• DeWolfe et al. (2000): Suggested that for some school-age children with ADHD, negative social situations will ultimately result in social rejection by their peers. Furthermore, these disruptive and intrusive behaviors may eventually receive tremendous negative sanctions from parents and teachers, as well as their own peers.

• Dodge and Coie (1987): Identified that early aggressive reactions are a viable predictor to later social impairments.

• Fine (1993): Reported that although children with ADHD seem to know the correct answer to social dilemmas in real-life situations, there appears to be significant difficulty generating solutions to their own difficulties.


• Fine (1993): Identified that children with ADHD have difficulty adapting their behavior to situational demands. They do not seem as cognizant to the social cues.

• Flicek (1992): Pointed out that beyond aggression, the traits of off-task behaviors, distruptiveness, defiance, and the inability to exhibit self-control were other features that seem to dramatically impact social acceptance.

• Levine (2001): Identified several traits that children who are impulsive and hyperactive may display. The following lists some of the issues presented: Problematic conflict resolution skills, poor social predicting, failure to self-monitor social behavior accurately, and aggressiveness.

• Martlew and Hodson (1991): Suggested that children with MLD or ADHD tend to be bullied/teased more by peers and are subjected to increase amounts of teasing as they get older.


• O’Moore and Hilley (1989): In their study of Dublin schools, found that children with ADHD or MLD were bullied twice as much as nonremedial children.

• Salmon et al. (2000): Found that the most common disorder associated with bullying was conduct disorder, with ADHD being the most common comorbid disorder.

• Stormont (2001): Pointed out that children with ADHD often misread subtle social cues that can easily lead to teasing/bullying or being ostracized by peers.

• Stormont (2001): Suggested that children with ADHD are less popular among their peers and that aggression toward peers is strongly associated with peer rejection.

• Stormont (2001): Suggested that children with ADHD have a bias toward aggressive solutions and are less desirable to work with.


• Stormont (2001): Found that teachers are often negative when interacting with children with ADHD and may influence how the teacher interacts with the entire class.

• Stormont (2001): Pointed out that one of the most pervasive problems for children with ADHD is aggression. It appears that children with ADHD start more fights and arguments as compared to non-ADHD children.

• Wolfe et al. (2000): Pointed out that preschool children with ADHD were rated by their parents as being more aggressive, noncompliant, demanding, and less adaptive and socially competent than their peers.

Assessing Social Skill Deficits (Gresham 1993; 1998)

Three types of measures to consider in planning social skill interventions

• Social validity• Observations of the child’s behavior

in the natural environment• Measure component skills

Social Validity• Predicts long-term outcomes important

to society

• Measures– Peer acceptance– Friendship status– Parent and teacher judgments– Archival data

• School attendance• Disciplinary referrals• School suspension

Observations in Natural Environment

• Objective observations

– Direct observational recording

Observations in Natural Environment – con’t

• Did the child’s behavior change in a predicted direction?

• Objective observations in the natural setting indicates if the behavior did or did not change

Measure of Component Skills

• Least socially valid measure. This is a measure of how the child does in the following categories:

• Role-playing tests

• Problem-solving measures

• Measures of cognition

Social Skills Training

• Four Main Objectivesa) Promoting skill

acquisitionb) Enhancing skill

performancec) Reducing or removing

competing behaviorsd) Facilitating generalization

and maintenance

Strategies for Social Skills training programs to generalize beyond their therapeutic settings

(Stokes, Osnes 1989)

Current Functional Contingencies

• Connect behavior to the natural consequences

• Teach the child to “go after” the natural consequences

• At least temporarily stop the reinforcement for inappropriate behaviors.

• Aggressively reinforce any occurrence of generalization.

Train Diversely• Train in multiple settings with

multiple trainers

• Vary the antecedents of the behaviors as much as possible.

• Create multiple responses to the behavior.

• Vary the schedule and intensity of consequences.

Generalization Strategies – Con’t

–Some social skills either are not learned or performed because of the presence of stronger, competing, or interfering problem behaviors.


– Temporarily interrupting the contingency of peer attention by extinguishing disruptive behavior and reinforcing appropriate behavior strengthens the appropriate behavior.

Functional Mediators• Incorporate the “look” of the natural

environment in the training.• Incorporate relevant people in the

training.• Incorporate a tangible prompt/reminder

that he can take with him.• Incorporate self-mediated verbal

reminders/prompts.

Generalization Strategies – Con’t• Social skills can also be viewed from a

competing behaviors framework

– Interfering problem behaviors include behaviors that are internalizing or over controlled (e.g., anxiety, fear, social withdraw) and those that are externalizing or under controlled (e.g., aggression, disruption, impulsivity). For example, one might recruit the cooperation of peers in the child’s classroom to ignore disruptive behavior and reinforce the child for appropriate behavior.

Generalization Strategies – Con’t• Emphasize Training Diversity

– The more similar the training setting is to the natural environment the more likely the stimuli from training will elicit the trained response.

– If there are peers from the child’s classroom in the social skills training group, they will help increase the likelihood the child will respond with learned responses in the natural environment with the peers present.


– The more similarities to the natural setting that can be presented in the clinical setting the greater the probability of these stimuli prompting appropriate social behavior.

Some examples of a Generalization Plan

Target Behavior: Questioning an individual in a rude and aggressive manner.

• Connect behavior to the natural consequences.

• PLAN- Teach diplomatic verbal statements likely to be positively perceived and reinforced by teachers.

Some examples of a Generalization Plan – Con’t

• Teach the child to “go after” the natural consequences.

• PLAN- Have the student track their use of tactful questions and share with the teacher. Train the student to praise the teacher for answering his question.

Reviewing Social Skills Programs

1) How are social skill deficits assessed

2) How is treatment matched to deficits

3) How to encourage generalization of new skills

Social Skills Programs: How to Develop Intervention

• Social skills programs take a “One size fits all” approach – Highly inefficient

– Does not recognize the individual needs of the child

• Implementing a social skills program should always start with a functional analysis– Of the nature of the child’s current social

skill deficits

Social Skills Programs: How to Develop Intervention– con’t• Program should then determine type of

deficit– Does the child lack the knowledge to

execute particular social skills or fail to discriminate when certain social behaviors are appropriate?

– Is there a performance deficit?

– Is the social skill within his repertoire, but he fails to perform those behaviors at acceptable levels in specific situations?

– Is the social skills deficit one of fluency?

Social Skills Programs: How to Develop Intervention– con’t

• Develop strategies–Most effective strategies combine:

• Modeling

• Coaching

• Reinforcement procedures

–Weaknesses include:• Failure to generalize beyond the

therapeutic setting(Gresham, 1998; Dupaul & Eckart, 1994; Mathur & Rutherford, 1996;

Stokes & Baer, 1997; Stokes & Osnes, 1986)

Taxonomy of Social Skills• Communication Skills

– Introducing oneself– Beginning a conversation– Sustaining a conversation– Utilizing proper nonverbal behaviors– Ending a conversation– Speaks in an appropriate tone– Learning to evaluate how you sound to

others (e.g., friendly or unfriendly)– Matching your language style to the

group you are speaking to

Taxonomy of Social Skills – con’t• Friendship Skills

– Giving compliments– Accepting compliments– Sharing– Inviting others to play – Coping with not always getting one’s way– Listening– Saying nice things to others– Asking others if you can play– Asking for favors and doing a favor– Demonstrating kindness

Taxonomy of Social Skills – con’t• Friendship Skills – con’t

– Monitoring activity level– Playing fairly – Being assertive– Helping others– Controlling talking– Dealing with teasing– Taking turns– Follows rules of a game– Recognizing how you behavior impacts

others


– Being patient– Joins activities– Being a good sport– Dealing with embarrassment– Coping with losing– Monitoring how you are doing with others– Being able to call a friend on the phone– Demonstrates compassion and concern

for others– Conflict management skills (avoiding

fights and using positive solutions


– Avoiding arguments

– Apologizing

– Handling criticism

– Dealing with losing or not getting your way

– Negotiating and problem solving

– Learning how to interact with more than one person (do not dominate)

Taxonomy of Social Skills – con’t• Skills for dealing with your feelings

– Identifying various feelings

– Recognizing the feelings of others (both verbally and nonverbally)

– Demonstrating an awareness of how other’s feel

– Regulating one’s anger

– Dealing with fears and novel situations

– Controlling temper in conflict situations

Examples of Social Skills Programs

• Get Along Gang

• The Magic Within You

Taxonomy of Social Skills focused in the Get Along Gang

• Communication Skills– Introducing oneself

• Friendship Skills– Accepting compliments

– Saying nice things to others

• Skills for Dealing with Your Feelings– Dealing with fears and novel situations

Other Individual Strategies:Toolbox of Social Skills

Guidelines for Helping Children with ADHD and LD Demystify and meet their challenges

• Encourage children to always ask for help when something is difficult.

• Be careful not to explain the disorder or disability in a way that suggests they are incapable of something, have no responsibility for their behavior, or it somehow excuses them.

• Remember to point out individuals as models who have overcome their challenges or excelled.

Guidelines for Helping Children with ADHD and LD Demystify and meet their challenges – con’t• Answer your child’s questions at the

appropriate developmental level.• Be willing to share your own experiences if

you also have struggled with similar challenges.

• Involve your child in support groups or create the opportunity for your child to meet other children who are struggling with similar challenges.

• Be sensitive to your child’s emotional state.

Guidelines for Helping Children with ADHD and LD Demystify and meet their challenges – con’t

• Anticipate some of the negative experiences that children may have and help them learn how to respond.

• Help your child understand that labels such as ADHD are for the purpose of allocating resources.

• Help them to know how, when, and whom they can go to if they need help.

Guidelines for Helping Children with ADHD and LD Demystify and meet their challenges – con’t

• Be aware of situations that are a challenge for your child and try never to become frustrated, angry, or disappointed.

• Established realistic expectations and make those the challenge.

U. C. I. Child Developmental

Center Department of

Pediatrics Social Skills Program

Multicomponent Program

• Structured School Program

• Daily Social Skills Training

• Parent Training• Multiple Family Group

Structured School System

• Token System• Frequent Positive Feedback• Low Student / Teacher Ratio

Combined Clinical and Teaching Staff• Three half time psychologist

• Two social skills counselors

• Three teachers

• Two behavior specialists per class

Classroom Token System

• 2 POINTS - GETTING STARTED

• 4 POINTS - FOLLOW DIRECTIONS

• 4 POINTS - FOLLOWING RULES

• 4 POINTS - COMPLETING TASKS

• 4 POINTS - RELATIONSHIPS

• 2 POINTS - CLEAN-UP AND TRANSITION

DAILY REINFORCEMENT(LAST TWENTY MINUTES OF THE DAY)

• 90 % - 100 % = RED PATROL

• 80 % - 89 % = YELLOW PATROL

• 79 % OR BELOW = BLUE PATROL

90 % - 100 % = RED PATROL• PLAY OUTSIDE WITH STAFF

• PLAY COMPUTER GAMES

• SPECIAL ART PROJECTS

• LEGOS

80 % - 89 % = YELLOW PATROL• WATCH RED PATROL ACTIVITIES

• PUZZLES

• CARD GAMES • PLAY BOARD GAMES

• USE ART SUPPLIES

70 % AND BELOW = BLUE PATROL• READ A BOOK

• DRAW WITH PAPER AND PENCIL

• REST AT YOUR DESK

• LISTENING CENTER

Transitional Page

WEEKLY REINFORCERFUN DAY FRIDAY

(90% OF POINTS FOR THE WEEK)

• POP CORN AND MOVIE

• WATER PLAY DAY

• FIELD TRIP

• TRANSPORTATION DAY

Transitional Page

DAILY SOCIAL SKILL(ONE HOUR PER DAY)

• COMBINE TEACHING AND CLINIC STAFF

• INTEGRATED THROUGHOUT THE DAY

• INTEGRATED INTO THE HOME PROGRAM

Transitional Page

SOCIAL SKILLS CURRICULUM• IGNORING PROVOCATION

• ASSERTION

• ACCEPTING

• GOODSPORTSMANSHIP

• PROBLEM SOLVING

SOCIAL SKILLS SESSION• FEELING TIME

• GOAL SETTING

• ROLE PLAY SOCIAL SKILL

• PLAY GAME SOCIAL SKILLS GAME

• CONTINUOUS FEEDBACK

Transitional Page

GROUP SOCIAL SKILLS CONTIGENCY

• GOOD SPORT PIZZA - GROUP SHOWING GOOD

SPORTSMANSHIP(PIZZA PARTY)

• BIG DEALS INDIVIDUAL STUDENTS

EARN FOR THE CLASS(FIESTA)

Transitional Page

LEVEL SYSTEM• LEVEL 1

• LEVEL 2

• LEVEL 3

• LEVEL THREE 3.1 - 3.10

Transitional Page

U.C.I. Outpatient Social Skills Program

• Another of Group Therapy

Generalization Strategies

• Principle 1: Exploitation of current functional contingencies – con’t–Another approach is to program

opportunities for the child to come into contact with environmental settings, which may naturally prompt and reinforce appropriate social skills.

Generalization Strategies• Principle 1: Exploitation of

current functional contingencies– In selecting a target behavior to

change, one could choose behaviors that are highly unlikely to be reinforced in the natural setting each time they are exhibited. Also know as trapping (Stokes & Baer, 1977).

Generalization Strategies – Con’t• Principle 2: Social skills can also be viewed

from a competing behaviors framework– Interfering problem behaviors include

behaviors that are internalizing or over controlled (e.g., anxiety, fear, social withdraw) and those that are externalizing or under controlled (e.g., aggression, disruption, impulsivity). One must help the child by perhaps scheduling consequences that maintain inappropriate behaviors so that more appropriate behaviors can be developed. For example, one might recruit the cooperation of peers in the child’s classroom to ignore disruptive behavior and reinforce the child for appropriate behavior.

Generalization Strategies – Con’t• Principle 2: Social skills can

also be viewed from a competing behaviors framework–Some social skills either are not learned or performed because of the presence of stronger, competing, or interfering problem behaviors.

Generalization Strategies – Con’t• Principle 2: Social skills can also

be viewed from a competing behaviors framework – con’t– Temporarily interrupting the

contingency of peer attention by extinguishing disruptive behavior and reinforcing appropriate behavior strengthens the appropriate behavior.

Generalization Strategies – Con’t• Principle 3: Emphasizes training

diversity– When the goals and procedures of

training are more widespread so are the outcomes widespread.

– The more similar the training setting is to the natural environment the more likely the stimuli from training will elicit the trained response.

– If there are peers from the child’s classroom in the social skills training group, they will help increase the likelihood the child will respond with learned responses in the natural environment with the peers present.


• Principle 3: Emphasizes training diversity – con’t– The more similarities to the natural

setting that can be presented in the clinical setting the greater the probability of these stimuli prompting appropriate social behavior.

– Another strategy in training diversity is to allow a variety of conditions of training so that the child will not readily discriminate performance to a particular set of circumstances.

Generalization Strategies – Con’t• Principle 4: The use of functional

mediators– A mediating stimulus is usually one that

can be carried easily by the child to a diversity of conditions to facilitate generalization.

– One strategy is to incorporate salient physical stimuli; physical items common and obvious in natural and relevant generalization environments are incorporated into the training. For example, a simple report card targeting specific social skills taught in the weekly clinical sessions could be used in the school setting to prompt the use of these skills in school. The report card itself serves as a cue to use appropriate social skills.


• Principle 4: The use of functional mediators – con’t–A strategy that incorporates many

of the generalization strategies reviewed earlier is incidental learning. Incidental learning takes advantage of the naturally occurring behavioral incidents or events to teach social behavior.

Reviewing Social Skills Programs

1) How are social skill deficits assessed

2) How is treatment matched to deficits

3) How to encourage generalization of new skills

social skills & children with adhd & learning disabilities dr. aubrey h. fine

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