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Newsletter  #1

What kind of therapy works with kids with social skills deficits?

When parents are told that their child or teen needs “social skills” therapy they often enter into a confusing process of looking for therapeutic services. This is partly because there are so many different types of therapeutic approaches. How do you know which is the right one? How do you even know what approach a certain therapist uses?

Cognitive-behavioural therapy is the therapeutic approach that is most effective in helping children with social skills deficits. Briefly, cognitive-behavioural therapy is a structured and directive type of therapy that aims to uncover how our thinking process effects how we feel and behave. Often children and teens with social skills deficits are having some type of difficulty reading the social environment and responding to it in appropriate ways. That is why they may stick out as different or shy away from social interactions. The cognitive-behavioural therapist helps by finding out what someone is thinking and consequently how they are feeling and reacting in certain situations. Work is then done to correct any misconceptions and develop different patterns of thinking and responding to events or feelings.

Here’s an example of how this might work with a real life situation:

Lachlan expects his Mum to pick him up from school and take him to the toy shop. He is very excited and has been thinking about it all day. Mum drives up and tells Lachlan they have to go to the doctors because Lachlan’s sister is sick. Lachlan thinks they should still be able to go to the toy store and becomes agitated and melts down when mum explains they will have to go another day. Lachlan’s distress lasts for the rest of the day and evening.

When Lachlan goes to therapy the next day his mum describes what happened when their plans changed the day before. The therapist identifies Lachlan’s inability to shift his thinking as the major contributor to Lachlan’s difficulty. Lachlan’s therapist understands that once Lachlan’s mum told Lachlan they couldn’t go to the toy store, he wasn’t really able to take in what she said afterwards (about his sister being sick),because his rigid way of thinking immediately led to strong emotions that he had difficulty coping with. Lachlan’s therapist visually maps out with  Lachlan what he thought and how he felt using cartoon drawings and having Lachlan fill in the thought and feeling” bubbles”. The therapist uses many different techniques to help Lachlan see how his way of thinking leaves him upset and unhappy. He will be given a visual tool to use in future moments when he gets “stuck” in his rigid way of thinking. The therapist’s short term goals with Lachlan will be helping him to become a more flexible thinker so that these common everyday situations don’t throw him off to the extent they always had.

This type of therapy works with kids who have social skills challenges because it helps fill in gaps of missing social information for the child. It also helps them become more aware of their thinking patterns and reactions to those patterns.

When trying to find a therapist for a child it is important to ask the therapist what is their particular approach. They may not specifically use the term “cognitive-behavioural therapy” but describe a structured approach like the one outlined above. It is also important to ask a therapist how much experience they have had working with children with social skill challenges. Most of the kids we see in our practise have a hard time using language to describe events and their emotions. A therapist needs to know how to get information from kids with language and processing issues. Often this takes experience, the ability to evaluate a child’s learning style, and the availability to access a variety of different tools that have been learnt and tested over time.

Should a child be in individual or group therapy?

It is always very helpful to see a child with social skills deficits with his or her peers. Ideally, these children should be seen in small groups with a low child to therapist ratio.

Basically, groups need to be safe experiences for all the children or teens in the group and the group leaders must insure that the “social cost” of one child’s behaviour does not make it impossible for the other group members to come to accept this child in future groups. Some children walk a thin in as they make their way into a group setting. Practitioners need to be very aware of how to balance the needs of the individual with the needs of the group.

There are times when group is not beneficial and we will outline some of them below.

  1. When a child is so resistant to the idea of group that they are determined to sabotage their experience.*
  2. When a child’s anxiety is so high in a group situation that they become aggressive or display behaviour that is unsafe to themselves or others.
  3. When a child is so defensive about their deficits that they are unable to accept that they need help and strike out at their peers (verbally or physically) as a result.

Many older children and teens express some displeasure at having to join a group, but that is usually a result of anxiety about the unknown. We find that within the first couple of weeks a majority of kids who had expressed some reluctance to join the group now enjoy coming. What we are speaking of in this instance is a child or teen that absolutely does not want it to work out and sees themselves as being forced to participate.

Oftentimes a child or teen may need individual therapy prior to joining a group in order to be “group ready” and get the most out of the group situation as possible. After one-on-one work with the therapist, which is aimed at helping the child develop coping skills for use within the group, the child can enter a group and have a much better chance at success. Another combination is to have the child come right before group for an individual session so that they can be prepared for their group experience by one of the group leaders. This often helps a child who wants to be in group, but is having difficulty tolerating the length of the group meeting or has some small behaviour that gets in his way with particular group members. (for example, always wanting to go first in a game or not being able to tolerate losing a game.)

Individual therapy is always helpful in addressing issues outside the group (for example, experiencing a loss or family problems.) or when a child seems depressed or anxious. Some issues are too large or not relevant enough to the group work to be dealt with in a group setting.



How will my child learn to read and respond appropriately to social situations?

As we discussed in the last newsletter when parents are told that their child or teen needs social skills therapy they often enter into a confusing process of looking for the right therapeutic services. Part of that confusion may stem from the fact that we don’t think about social skills in the same way that we think about academic skills. Academic skills are broken down into small segments that are then tracked and graded. Social skills are not typically broken down, tracked or graded. Social skills difficulties are not noticed until there is a problem such as when a child is consistently behind his peers in social behaviours. Or if a child is bullied, constantly excluded or ostracized.  If a child is at grade level academically it may take a long time for these social difficulties to be noticed and considered an issue. At that point parents need to look at all of the recourses available to their child, both in and out of school, which their child can tap into to develop stronger social skills.

The long term goal for the child is that they be able to read and respond appropriately to social situations. But how do they get there? Through our work with many children we have found that this remediation needs to be offered in small, incremental steps, each step leading toward that long term goal. Understanding the depth and breadth of this process is key to helping a child be successful. Pushing a child ahead before the incremental steps have been taught or keeping a child insulated by making the social world so accommodating by not expecting them to take these steps will prevent that goal from being attained.

To begin with it is important for as many people in the child’s life as possible to understand that some social skills deficits are not a choice, not a result of bad parenting, not an oppositional response to authority ( as it can often look). Many children with social skills deficits have a neurological basis to their disability. The children tend to be bright, might be academically on (or above) grade level in most subjects and might do better socially with adults or children much younger than themselves. The idea that these children only need to be with socially proficient peers to learn more adaptive social skills is a fallacy. While most children learn to read and respond appropriately to social situations, a child with a social skills disability is unable to do that, even though this child might have an average or above average cognitive IQ and pick up information and academic skills quite well.

Once this is understood remediation can begin. An accurate assessment of the child’s social skill level is key. We have found that almost all children with social skills deficits have a very difficult, if not impossible time of reading nonverbal (and sometimes verbal) social cues. They tend to think concretely, and their use and understanding of language stays concrete even as they get older. Because of this they can misperceive the intentions of others. Much of social interaction is quite abstract. Children who think and learn concretely need this information translated in order to understand it, process it, and respond to it. This translation can be done verbally and visually. We have found that children who have people in their lives who can do this begin to take the steps necessary to reach their social goals. Whoever is providing this type of translation needs to be proficient in taking abstract concepts and making them concrete. They also need to know the child well so that the language or visual aids they use will match that child’s learning style and emotional readiness to move from step to step along the social skills continuum. This is best accomplished in an ongoing social skills group where real life situations present the therapist/translator with the opportunity to observe the child’s difficulties and to intervene with the appropriate information.

Individual sessions may also be needed for the child who needs more encouragement and motivation to take these difficult steps. Once the child has accomplished some of the smaller basic steps in this process, other people in their lives can play an important role by helping the child generalize these skills. To do this, they can provide additional clear, concise, concrete social information to the child using the language that the translator/therapist has developed with the child.

Repetition is a necessary component of this type of learning. When more people in the children’s lives are speaking this concrete language and helping them stretch their social skill ability at an appropriate pace, the long term goals can be reached.