According to the DSM-5, to receive a diagnosis of Autism Spectrum Disorder, certain criteria must be met. One of the criteria is that there must be persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following: deficits in social-emotional reciprocity, deficits in nonverbal communicative behaviors, and deficits in developing, maintaining, and understanding relationships. While deficits in nonverbal communicative behaviors and deficits in developing/maintain/understanding relationships are somewhat self-explanatory, you may be wondering what “social-emotional reciprocity” entails.
The DSM-V defines deficits in social-emotional reciprocity as ranging from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. According the Autism Society of Baltimore, the term social reciprocity refers to how the behavior of one person influences and is influenced by the behavior of another person and vice versa. It is the dance of social interaction and involves communication partners working together on a common goal of successful interaction.
Social reciprocity in very young children begins with showing interest in interacting with others and exchanging smiles. This builds to sharing conventional meaning with words, and eventually topics in conversation. Deficits in social reciprocity may look like: not taking an active role in social games, preferring solitary activities, or using a person’s hand as a tool or a person as if they are mechanical objects. This might lead to not noticing other’s distress or lack of interest in the topic of conversation.
So, how can we help?
As speech-language pathologists (SLPs), it is our responsibility to develop speech and language goals focused on social language and literacy and assist students with self-regulatory and social interactive functions so they can participate in mainstream curriculum as much as possible. In addition, we provide counseling/education to individuals with autism and their families regarding communication-related issues.
Research shows intervention strategies work best when provided in a child’s natural environment. This article highlights an intervention approach that uses systematic planning to enhance social reciprocity during everyday routines. First, parents receive explicit instruction on how to learn specific strategies that help establish back-and-forth interactions with young children with autism. Then, parents participate in video conferences with an SLP to receive support needed to effectively implement intervention. Specific evidence-based strategies taught in this model include contextual support, balanced turn taking, environmental arrangements, time delay, model and request imitation, and prompting and fading procedures.
- Contextual support involves following the child’s lead by attending to what the child is attending to, getting face-to-face, using interesting materials, and providing activities at the child’s developmental level.
- Balanced turn-taking involves playful obstruction, playful construction, and playful negotiation.
- Playful obstruction: getting in the way of what the child is doing to provide opportunities for interaction.
- Playful construction: turning an independent activity into a social interaction
- Playful negotiation: “stretching” the interaction to increase the number of back-and-forth exchanges.
- An example of environmental arrangements is placing something out of reach, doing something unexpected, and give small amounts of preferred items to increase opportunities for communication.
- Time delay involves providing brief pauses accompanied by a positive look/facial expression to indicate a response is expected. You must pause long enough for processing to take place, but not so long that you lose the attention of your child.
- Model and request imitation means demonstrating what you would like the child to do or say, then providing an opportunity for the child to imitate your demonstration.
- Lastly, prompting and fading procedures involves using extra cues and supports then gradually reducing the level of support to allow your child to be more independent.
As SLPs, it is our responsibility to support and provide guidance to parents so they can implement intervention strategies during everyday routines to allow children with autism to learn in natural environments. If you feel this is something you are interested in, head over to our website for a free 20 minute consultation and we’d be happy to provide you with more information.
Another resource we love and use often in our therapy sessions is Everyday Speech. Everyday speech is a comprehensive, video-based social skills curriculum. They provide resources for teaching socials skills such as conversation skills, perspective taking, emotional recognition, play skills and many more for pre-k through high school. In addition, Everyday Speech has provided resources for COVID-19 such as videos about staying healthy home during COVID-19 and washing your hands, as well as templates for making your own schedule. Although Everyday Speech is typically used by SLPs, parents can opt for a 30-day free trial to get 100% access to the entire platform. This subscription may be cancelled at any time within 30 days without paying a penny!
To finish out Autism Awareness Month, next week we will be talking about how telepractice can benefit the autism population. Stay tuned!