Читать книгу Social Engagement & the Steps to Being Social - Kathleen Taylor ORL/L - Страница 7
ОглавлениеWhat does it mean to be “engaged” with another person? No matter what age or level of social development, certain key components define the moments that we are actively involved in connection with someone else. Consider an infant who uses her limited motor skills to signal that she is ready to begin or end a face-to-face interaction. Or the toddler who throws food off the high chair tray with delight at watching an adult pick it up, only to begin the game again. These are the early moments of ENGAGEMENT that become the foundation of a lifetime of “being social.” Current research is helping us understand that very young children who are later diagnosed with ASD show a marked lack of orientation to the faces of their important people, while at the same time a heightened orientation to objects. This difference creates a change in early relationships as caregivers find a little one who does not respond to them in the ways that they expect; in turn, this often results in fewer opportunities to engage in and practice social interaction (Rogers & Dawson, 2010; Fuhrmeister, Lozott, & Stapel-Wax, 2015; Klin, 2014).
Self-regulation and shared space, focus, and pleasure are defined as the components of ENGAGMENT. The interactions designed to support ENGAGEMENT are usually facilitated by a skilled partner, often a family member in collaboration with a teacher or therapist. Similar-age peers can also be highly motivating and provide models for targeted behavior at this stage of learning. We will see that peers can be taught to directly teach targeted skills. For us, development of the FOUNDATION, born of a desire to understand the essence of what it means to be “engaged” with another person, has been one of the most enlightening aspects of this work.
Annie will help you get to know “ENGAGEMENT” ...
At four-years-old, Annie is most soothed when sitting straight backed, legs extended out while rocking forward and backward in a rhythmical pattern. Annie was diagnosed with ASD at 18 months. She has no verbal communication and uses simple gestures and vocalizations to get her needs met. She loves cylindrical items such as straws, hoses, tubes, and pipes. She enjoys being outside, playing in water, and looking at shiny silver items. Her parents work hard to find items of interest and play that keep her in “their world.”
ENGAGEMENT
Self-Regulation: Calm + Alert = READY
Everyone can think of a time when they have not been “ready” to engage in social interaction. Perhaps you had a hard day at work and just want to close the door in a quiet room. Maybe you are worried about a loved one and therefore not able to focus on other people in your life or just feel overwhelmed. Self-regulation can be considered the ability to gain control of one’s emotions and body to maintain and sustain attention for the task at hand, at all stages of our lives (Shonkoff & Phillips, 2000; Gillespie & Seibel, 2006). This task may be school work, running a business, or just “being social.” We think of self-regulation as being in an emotional and physical place to learn and respond positively to each situation. One needs to be able to be calm and at the same time alert enough to focus on another person and share experiences together (Kalberg, Laurel & Taylor, 2013; Williams & Shellenberger, 1996).
A key tenet of this model is that without self-regulation, there can be no ENGAGEMENT and without ENGAGEMENT there is no climbing the “social steps.” It becomes crucial then to understand the signs that an individual is READY and to have ideas about how to help him or her get ready for ENGAGEMENT, both at the beginning stages of learning and at any other moment of dysregulation.
Annie is self-regulated and READY to engage for about half of her pre-school day. At home, Annie has more options to help her regulate and less need to be on a specific schedule; therefore, she is regulated a bit more of the time. When regulated, Annie looks toward people with interest yet often does not make eye contact. Her body is calm and she appears to be aware of where she is and how she is moving through space. At these moments, Annie is in control of her emotions, not too frustrated, mad or sad, and not too happy. She might be making noises and moving rhythmically; this appears to help her maintain her regulated state. This is what self-regulation looks like for Annie and when she is in her best place to engage.
It is helpful to consider what types of sensory input (tactile/touch, auditory/sound, visual/sight, olfactory/smell, gustatory/taste, vestibular/movement, proprioception/position) can support an individual’s self-regulation and what type of input can help a person remain regulated throughout a social interaction (Laurel & Williams, 2014; Williams & Shellenberger, 1996). Ayres (1979) stated, “When the whole body and all of the senses work together as a whole, adaption and learning are easy for the brain” (p. 37). More than 30 years later, discussing young children with ASD, Tomchek, Little, and Dunn (2015) stated, “Children’s sensory processing patterns affect a child’s ability to sustain active engagement in activities that provide social communication opportunities” (p. 6). Clearly, being READY is critical to learning any skill, including “being social.”
Questions to consider when trying to help an individual maintain self-regulation include:
What type of sensory input is coming into a person’s system in this particular social environment?
Does there seem to be too much input or too little input?
Is there a way to adapt or modify the type of input coming in?
What type of sensory input is the person seeking?
Does that sensory input support the person to be calm, alert, and READY?
ONLY when self-regulated can one begin to share space to pursue a positive social interaction.
ENGAGEMENT
Shared Space: A Place to Be Together
This component of the FOUNDATION is defined as being in proximity to another person. As we grow and develop our social skills, we can “share space” over longer distances and even remotely, for example, by phone or text. However, for the purposes of our discussion, it is critical that we begin by thinking about an individual’s ability to be close to a communication partner, often within less than five feet. New learners need to be close enough to understand how to share focus and pleasure. Being aware of the space between ourselves and the person we are hoping to engage is extremely important (Richter & Oetter, 1990).
Guiding questions as you begin to think about places to share space include:
In what settings is this person comfortable?
What proximity to others does this person currently prefer?
How can you visually define the space to help this person understand what is expected?
How will you limit or organize materials within the space to encourage ENGAGEMENT?
Within a shared space, we can begin to be attentive together.
When Annie is regulated, the space she is comfortable sharing is quite close, often within three feet. She seems to notice objects in her peripheral field, but she responds best to other people who seek ENGAGEMENT when they are visually in front of her. During facilitated social interactions, Annie needs three-dimensional boundaries, with the space visually defined using furniture, walls, or people’s bodies. Success requires carefully timing the entrance and exit into and out of this space, which continues to be in the three- to five-foot radius. Limiting the materials of interest in this space and using materials with a definite purpose appear to support Annie to share the space, at moments when she is regulated, for more and more of her pre-school day and at home. Her skilled partner must share in Annie’s space and then present a highly motivating item for shared focus to support ENGAGEMENT.
ENGAGEMENT
Shared Focus: A Reason to Be Together
Shared focus is defined simply as two people paying attention to the same thing at the same time. Initially, we work to understand the interests of individuals with ASD and to promote shared focus using items and activities that excite them as they do the hard work of being together. Perhaps you did not imagine engaging quite so much about dinosaurs, cars, or even coat hangers or plumbing! However, we understand how crucial it is to reinforce the beginning steps of sharing these interests with another person.
Guiding questions as you begin to share focus include:
What is the person most interested in doing (e.g., objects, topics, movement)?
Does the person try to bring your attention to something he or she likes and, if so, what action is taken to accomplish that?
Are you able to bring the person’s attention to something you select?
How long can you share focus together?
Now that we are on the same topic, we can begin having fun together.
As Annie continues to stay regulated and READY to engage, she shares space and then focus with a skilled partner. The focus needs to be a tangible item that is of interest to Annie and one with a purpose or function. Annie needs to be able to easily understand what she is supposed to do with this item. Initially, hand-over-hand teaching is used with physical prompts to complete a visually structured task. For Annie, this is a “put on” or “put in” task that is durable and smooth to the touch. Her communication partner brings her attention to the pieces using exaggerated movements and helps orient her body to the activity. Four to seven pieces (e.g., blocks, rings, and tubes) may go into or on a stationary container (e.g., box, cone, bucket, and tube with a lid). The pieces of the task are structured so that Annie sees that the task will not go on forever, but rather has a clear end. Providing Annie with objects of high interest to hold in her hands, intermittently throughout the activity, increases the likelihood that she will share the focus again. Ideally, Annie will share the focus more frequently and for longer periods of time, thus increasing her ENGAGEMENT and teaching her that ENGAGEMENT with the people around her can have meaning and provide pleasure.
ENGAGEMENT
Shared Pleasure: Enjoying the Moment Together
Finally, the moment cannot be defined as ENGAGEMENT if there is no shared pleasure or enjoyment of the moment together. It is essential to be aware that each person shows pleasure in his own way, and for our learners with ASD, it can require careful observation to determine these cues. Prizant, Wetherby, Rubin, Laurent, and Rydell (2006) described social competence as “communication and playing with others in everyday activities and sharing joy and pleasure in social relationships” (p. 3).
We understand that cultures have their own languages, culture-specific behaviors, and social interaction styles. As described in the TEACCH model, teachers, therapists, and parents can function as “cross-cultural interpreters,” translating the social world around our friends with ASD and, therefore, expanding their options for learning (Mesibov & Shea, 2011). This in turn expands our options for sharing true pleasure together.
As you identify moments of pleasure for the people you work and live with, consider:
What nonverbal cues are associated with enjoyment for this person?
Who knows the person best and can help you to understand the person’s unique cues?
How and where can you observe the person to better understand how he or she shows happiness?
It is the synergy of shared space, shared focus, and shared pleasure in the context of a calm, alert state that defines the very special moments of ENGAGEMENT.
Shared pleasure can look different for everyone. Annie does not always laugh or smile when she is engaged. At times, her pleasure is expressed through a glance, a body gesture, or just an internal knowing that the skilled partner has connected with her. It can be brief or sustained. It looks different at pre-school than it does at home. Shared pleasure is a sense of being with another person. These moments of shared pleasure are what reinforce Annie to keep doing the very challenging work of “being social.” We know the desire is there; the challenge is to teach her the skills for ENGAGEMENT.
We have seen that ENGAGEMENT is the foundation of all social development and we have considered the four components of ENGAGEMENT: self-regulation, shared space, shared focus, and shared pleasure. These early components of “being social” need to be broken down into even smaller, measureable, meaningful sub-skills. A sub-skill for our purposes is a measurable, critical mini-skill that when combined with others can lead to proficiency in one of the components of ENGAGEMENT.
Measuring a small skill which comes so intuitively to others is a challenge. In this model, we will rate the sub-skills of ENGAGEMENT using a concrete dichotomy: YES, the learner is observed to use the skill in a social situation, or NO, the learner does not use the skill in a social situation.
As you can imagine, individuals will have specific times, places, and people that best allow them to demonstrate the sub-skills of ENGAGEMENT. Furthermore, if an individual is unable to self-regulate, it is important to recognize that the circumstance is not a teachable social moment and that self-regulation needs to be addressed. In contrast, if a person is self-regulated but having difficulty sharing space, focus, or pleasure, it is important to work in this area to succeed in moving up the steps to being social. The goal is to acquire a YES on all the sub-skills to make moving into the LOWER 4 more successful.
Critical Strategies to Enhance ENGAGEMENT
Shrink the space
Arranging a setting or environment to create boundaries often helps the learner feel comfortable, focus on the task at hand, and understand that he is with a social partner. For example, you can move to a corner of a room instead of the middle, sit as opposed to stand, or bring peers in on each side of the learner and use their bodies to build a “container,” a safe space, if you will, to help the learner realize we want him to share the space for a period of time.
Use motivating items or topics
Determining a person with ASD’s items of interest is one key to success. This can be done by asking family members, observing in different environments, presenting items that provide various sensory input, and respecting that each person has items and ideas that spark interest. This process can take patience. Is the person’s interest in the light rays moving in and out of his peripheral vision, is it a colored hanger and the way that it moves, is it the wind on his face when he runs, is it the car magazine, or the neighborhoods in Albuquerque, New Mexico? Is it the characters on Star Trek or the beat of certain music, or sink drains or Minecraft? Whatever it is, everyone has something that is motivating, and we need to find out what that is to support true social ENGAGEMENT (Grandin & Panek, 2014).
Limit the materials
The facilitator of the social interaction needs to be:
In control of when a preferred item is available
Able to make the preferred item available within the time span an individual is able to pay attention
In addition, it is critical to realize that more than one or two motivating items should be made available because an individual will become bored and satiate on only one motivating item or topic.
Increase the duration and frequency of the engaged moments
When you find those moments of ENGAGEMENT, you should work to hold them for a longer period of time. Look for opportunities to make them happen more frequently. These moments need to be practiced in a variety of settings, with a variety of people, and using a variety of items.
Identify and teach others the importance of ENGAGEMENT
Everyone needs to understand that being READY and then sharing space, focus, and pleasure is the foundation to understanding the social world.
Evidence-Based Practices (EBPs) to Support ENGAGEMENT
Evidence-based practice is a process for informed decision making. In this process, results of high-quality research are used in combination with professional expertise and individual and family preferences to determine appropriate practices to use for a specific intervention. This process makes clear that the experiences, values, and preferences of educators, interventionists, and those with whom we work should contribute equally to our clinical decisions. As with all interventions, ongoing assessment and data collection are critical to ensure that the interventions are effective for a specific individual (Boehm, 2016). Also, remember that our work in intervention is a blend of art and science; each professional, along with the family members with whom she partners, will bring her own history, personal skill set, and creativity to the amazing job of teaching social skills.
The National Professional Development Center (NPDC) on ASD is one source of information for learning about and using evidence-based practices, including information briefs, steps for implementation, and fidelity checklists (http://autismpdc.fpg.unc.edu/). The NPDC website provides links to Autism Focused Intervention Resources and Modules (AFIRM), with modules for learning about evidence-based practices. In addition, the National Autism Center has identified established and emerging treatments through the National Standards Project (www.nationalautismcenter.org). Many practices are identified by both organizations. Evidence-based practices linked to Social Engagement & the Steps to Being Social are based on practices defined by the NPDC.
Information about evidence-based practices in autism is available to practitioners and parents. These practices cover an enormous range of skills and abilities. Practically speaking, it is especially important to learn to use knowledge about ASD, understanding of a specific individual, and clinical judgment to match the right practice with a specific goal for learning. Too often, a well-researched practice is used to support the development of a specific skill for which it does not make sense. Consider how the wrong screwdriver, even a brand new and well-crafted one, can derail afternoon plans for a simple home project. Similarly, employing well-known, useful practices such as social narratives, social groups, and video modeling, when applied at the early stages of ENGAGEMENT, is often ineffective.
The following EBPs have been shown to support aspects of ENGAGEMENT and have proven effective in our own practice to teach the FOUNDATION of “being social.”
