Running Head: BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

A Review of Best Practices for a

Social Skills Intervention Program

By Leora Fisher
EDPS 658
University of Calgary
Dr. Parsons

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

The term Theory of Mind (ToM) indicates that one has the ability to identify and
comprehend ones ideas, beliefs, wishes and intentions of other people in order to make sense of
ones own behaviour and therefore, infer what they may do next (Attwood, 2000). Theory of
mind has also been termed as mind blindness or mind reading (BaronCohen, 1995), and has
often been described as having difficulty putting oneself in another persons shoes. In 1985,
Baron Cohen, Leslie, and Frith reported on evidence that children with Autism Spectrum
Disorder (ASD) have an impaired theory of mind. Since then, numerous studies have confirmed
these findings.
Distinction is known as an essential basis of one`s Theory of Mind, which is not
explicitly taught by others. The following demonstration involves a child watching a movie in
which character A is dreaming about delicious ice cream (an example of a mental experience).
At the same time, Character B is purchasing and holding the delicious ice cream (an example
of a physical experience). Subsequent to watching the movie, the teacher asks the child who is
watching the movie to indicate which character can taste the ice cream. A typical four-year-old
child can easily conclude that character B can taste the ice cream, thus indicating his or her
understanding of the distinction between mental and physical entities (Wellman & Estes, 1986).
Studies have shown that children at an equivalent or older age with ASD appear to be
significantly impaired in making such judgments (Baron Cohen, 2000).
ToM skills are described as mental perceptions that typically begin to develop between
the ages of three and five (Baron-Cohen, 2000). Task batteries and broader ranges of tasks are
used to assess different components of ToM across various levels of complexity (Baron- Cohen,
2000). It is prudent that the diagnostic assessment being used includes an examination of the
subjects maturity in ToM skills. Therefore, there are a variety of assessments that an examiner

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

can utilize for diverse age groups. Many ToM assessments consist of stories that include
comprehension questions that one can administer in order to evaluate the capability to infer what
the character in the story would or should be thinking or feeling. The classic procedures for
evaluating ToM abilities are standardized false-belief tasks. An example of one task is telling
the child a story about an item that has been moved from one location to another without the
knowledge of the character in the story. The subject must comprehend that what the character is
thinking can contradict what is happening in reality.
Researchers testing ToM abilities have frequently examined the understanding of false
belief, utilizing the Wimmer and Perner (1983) paradigm. In this experiment subjects need to
predict a protagonists actions or thoughts while the protagonist is absent during a critical time.
For example, character A leaves her doll under the desk and leaves the room. While she is
away from the scene character B finds the doll and puts it in the toy case. When character A
returns to the original scene the subjects are asked to deduce where Character A will look for
her doll. In order to give the correct response, the subjects must understand that others may hold
a belief that is dissimilar to his or her own beliefs (Baron-Cohen, 2000). Studies such as this
have indicated that approximately 80% of the subjects with ASD do not attribute a false belief
and, consequently, are incapable of passing this task. Nonetheless, the remaining 20% of subjects
with ASD who initially pass the task are unable to pass the task when required to infer the belief
of one individual concerning another individuals belief (Baron-Cohen, et al., 1985).
One study conducted by Ami Klin (2000) uses the Social Attribution Task in which
subjects were asked to create cartoon animations for a silent film by means of an assortment of
geometric shapes. Subsequent to each of the segments, six segments in total, the researcher

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

requested that the subjects describe what happened in each particular segment as well as provide
personal characteristics regarding each geometric shape in the film. The findings signified that
typical adolescent students used anthropomorphic words to describe the actions and feelings of
each character in the film. Nevertheless, when the same study was completed by adolescents
with ASD it was found that their narrative for each segment of the film was considerably shorter
and included little or no social plots (Klin, 2000). These findings also demonstrated that the
comments made by subjects with ASD were not pertinent to the film, and they used only one
quarter of ToM terms compared to the control group (Klin, 2000). A comparable study utilizing
the same idea that additionally included brain structure showed that in typical adults, the
prefrontal cortex, the superior temporal sulcus and the temporal poles judge the attribution of
mental states. However, the adults in this study with ASD exhibited less activation of these
regions of the brain (Klin, 2000). Such findings suggest that there is a neurological explanation
for an impaired ToM.
Children with an impaired ToM can have immense difficulty distinguishing relevant
social cues and interpreting the thoughts and feelings in anothers facial expression, behaviour,
and tone of voice. These children struggle with day-to-day interaction with others, and
frequently make literal interpretations of what one may affirm. They are known to struggle with
comprehending and interpreting sarcasm and are therefore more susceptible to teasing and
bullying. They are repeatedly unable to read anothers subtle cues that one is becoming annoyed
and are often incapable of recognizing that their topic of interest may not be relevant to the
context. These social impairments consequently make it very difficult for them to make lasting
friendships. This is unfortunate and detrimental to their wellbeing, as it is known that a positive
social network encourages the development of social competences. Hence, it is imperative that

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

children with ASD develop positive social skills so that they are able to create some long lasting
friendships. Such relationships will offer a safe and accepting environment where they can
practice their social skills thus creating positive social outcomes both during school and into
adulthood.
In reviewing the best practices for designing, implementing and evaluating an
intervention program for children with ASD, one should focus on a social skills intervention
program. A number of studies have examined the potential of improving ToM capabilities
through explicit ToM programs. Several programs employ social skill training groups, DVD
programs, and teaching guides. Comic Strip conversation is one exemplar of a means to teach
ToM skills. Comic strip conversations were initially developed by Carol Gray, who utilized
straightforward stick figure drawings and speech bubbles to teach ToM skills. By means of each
comic strip conversation the comic strip develops into a conversation, linking the student and
educator. This type of intervention consists of practicing scripts based on common social
interactions so that the student will learn to assess these interactions, plan a response, and then
evaluate that response. Research has shown that ASD children that participate in comic strip
conversation are more likely to learn to identify a problem or situation from the self
perspective and an other perspective, and therefore able to generate a number of positive
strategies to approach social situation. Furthermore, the illustrations support what the
character or cartoon is feeling or thinking. Comic strips have turned out to be extremely
popular as they present a clear and visual explanation of what one may be thinking and feeling.
Current studies have shown success when using comic strips as a method of teaching ToM skills
to children with ASD. This intervention technique will be broken down into implementation

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

steps as described by Upah and Tilly (2002) using a case study. The participant of this
intervention will be a fictional character named Adam who is an ASD student in grade six.
In planning to implement an intervention, according to Upah and Tilly (2002), the first
step is to decide on a behavioral definition. Upah and Tilly define a problem as the difference
between what is expected and the actual student behaviour or performance. The behavioural
definition needs to be described in specific observable and measurable terms and must be
objective, clear, and complete. During the problem identification step the school team needs to
answer the three following questions: What is the behavioural concerns and/or the desire
behaviour, What is the students current level of performance in the target behaviour, and how
does the students behaviour compare to his peers behaviour or environmental expectations?
Adams primary concern is his inability to understand that others belief, desires, and
intentions may be different than his. This has affected his ability to show empathy towards his
peers. As a result, he does not get along with others, has no friends, becomes aggressive, and has
a difficult time resolving conflicts. Therefore, an appropriate behavioural definition is the
following: Inability to read and understand social clues. An example of this behaviour includes
1) yelling and crying when dealing with conflict, 2) showing no empathy with his peers (i.e. not
allowing other to take a turn), and 3) physical aggression when he does not get his way (hitting
and pushing). A non-example of the inability to read and understand social clues incudes 1)
cooperating 2) showing empathy and allowing others to have a turn 3) seeing others point of
view.

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

The second step in the implementation process is to collect baseline data of the target
behaviour in the natural setting. Before this can be done one must first identify the appropriate
dimensions of the target behavior. Although Adams negative social responses vary in behaviour
and intensity, the primarily concerned is the frequency at which they occur. In this case study a
simply tally sheet should be adequate in tracking the occurrences of the target behaviour. Hence,
every time it is observed that Adam displays the above-mentioned behaviours with his peers it
will be recorded and tallied on a sheet. In order to track the frequency of the occurrence, Adams
assigned educational assistant (EA) will make these observations during recess and lunch on a
daily basis. The EA will use a clipboard, pen and a tally sheet, which includes the date, time and
observed behaviour. At the end of every week the mainstream support teacher will collect and
add the new information to the previously collected data. The data will be collected for two
weeks before any intervention begins so that a stable range of behaviour can be identified. It is
imperative to establish the students current level of functioning, which will provide the baseline
that will be useful when evaluating the current problem behaviour. This will also measure the
effectiveness of the intervention and the extent of the students progress over time. Lastly, one
needs to take steps in validating the problem behaviour, as even well adjusted students exhibit
problem behaviour on the playground. Hence, one needs to make sure that there is a discrepancy
between Adams problem behaviour and the expected standards for his age. This will be
evaluated based on school expectations and developmental norms. In this case study, it is clear
that Adams behavior does not meet school expectations or developmental norms for his age.
Adams frequency of incidence for problem behavior is above what is usual, therefore requiring
full time supervision in the school and on the playground.

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

The next stage is the problem analysis steps, which determines the underlying causes of
why the problem behaviour is occurring. For instance, it would be helpful to know if Adams
negative responses are a reaction from a specific stimulus (i.e. not getting his way or not being
able to see others point of view). To gather such information, further observation and interviews
will be required. This provides the critical link between the assessment information and the
intervention procedures. During this stage one needs to collect data pertaining to the instruction,
curriculum, environment, and learning needs for students diagnosed with ASD. One way of
doing this is by reviewing Adams past report cards, anecdotal comments pertaining to his
behavior, interviewing parents, teachers and EAs and others who are familiar with Adams
interactions with peers.
Once all of this data is gathered, a hypothesis statement must be formulated. In regards to
this particular case study and based on the information that has been collected, the following
hypothesis is formulated: Adam reacts negatively to social situations as he lacks the ability to a
understand that others have beliefs, desires, and intentions that may be different from his own
(i.e. impaired ToM). Once the hypothesis is formulated a prediction statement is needed, which
creates a link between the assessment information and the intervention action. In this scenario, an
appropriate prediction statement would be: If Adam develops empathy and social skills through
social stories, then Adams negative behaviour towards his peers will decrease.
Now that the hypothesis has been identified and a prediction has been generated one must
now begin to implement the intervention in order to solve the problem. The intervention
technique has been chosen (social stories), therefore it time to confirm that this type of
intervention technique is suitable for the problem at hand.

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

At this point, one needs to set the goal or objectives. One can do this by asking what the
intended goal is and what Adams behavior ought to look like if the intervention technique is
successful. The goal must be written in observable, measurable terms that include four
components: time frame, condition, behavior and criteria. In regards to Adam, the goal statement
is, In six weeks, when Adam is interacting on the playground with his peers, he will respond
positively, without anger or aggression at 50% of his typical rate.
In order for Adam to be successful one needs the criteria to be realistic and achievable.
While, 50% of his typical rate would still not meet school policy or meet the developmental
rates, it would be unrealistic to assume that Adams behaviour will change in only six weeks of
intervention. Adams impaired ToM will always be a factor; therefore one needs to understand
that his lack of social skills will always impact his behaviour. However, by teaching and
practicing empathy and social skills, through social stories, one hopes that they will improve his
ability to make long- term friends.
The next step in the process is to determine how the intervention will be implemented.
This six-week technique involves five 45-minute sessions weekly for 4 weeks; the first two
weeks the EA will be collecting data from observing Adam during recess and lunch to get a
baseline. These sessions will be held in a reliable meeting place, such as the mainstream teachers
classroom and will at occur at 11am every day. During the sessions, the mainstream support
teacher, EA and Adam will follow the same routine which involves participating in role playing
of social stories where each person will take turns playing the adult and child roles.
During each session, Three to five scripts will be read, role-played, and discussed. The
mainstream teacher and EA will lead these sessions so that a sense of trust and rapport is created.

BEST PRACTICES FOR A SOCIAL SKILLS INTERVENTION

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The scripts/social stories, which were developed by Carol Gray, are kept in a binder for
safekeeping and future use.
At the end of the six weeks, the information collected will be executed the same way it
was done during the baseline data collection period, Adams EA will once again monitor him on
the playground and tally the frequency of any negative reactions he has with his peers. This data
collection period will continue for one week after the intervention has ended. Lastly, it is
imperative to use the same EA during and after the intervention process. Thus, ensuring
continuity in the interpretation of the actions presented by Adam, otherwise one might risk
collecting inaccurate data, which could invalidate the final findings.
During the decision making phase one needs to determine how the final data post
intervention will be summarized and analyzed. The data that was collected prior to the
intervention must be divided into days and calculated as an average. For example, in the first
week Adam presented 52 negative social responses, with an average of 10 per day. During the
second week he presented 62 negative social responses with an average of 12 per day.
Consequently, Adam presented approximately 11 negative social responses per day. Finally, one
needs to establish a range, for instance, the lowest amount of occurrences in a day is 8 while the
maximum is 16. This information is then compared to the post intervention data, which is
calculated the same way.
It is important to remember that data collection will take place at the end of every school
week (i.e. Friday) by the same EA who will then compare each weeks data with the baseline
data. This will be achieved by putting all the data on a graph to clearly monitor Adams progress.
The information on the graph will help one to determine whether the intervention program is

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effective. For example, if Adams daily average of negative social responses still meets or
exceeds the pre-intervention data, then one can assume that the intervention program in not
working. Hence, one will need to alter the intervention plan. One example of altering the
intervention plan would be to include some of Adams classmates in the sessions so that he has
the opportunity to practice with peers his own age. Another option is to have Adam role play
some social stories on the playground with a peer after each daily session with the mainstream
and EA.
In order to properly evaluate the intervention program, one must ensure that the program
has treatment integrity, which is the degree to which the intervention is delivered and intended.
One would not be able to identify the effectiveness of an intervention plan without proper
implementation. Without proper implementation, false conclusions may be drawn. In order to
maintain treatment integrity one needs to have a written intervention plan for all to implement
correctly. This should be done during the planning phase of the intervention. In addition, one
should have an observation component (observe the EA) and weekly meeting with implementers
in the plan. This will ensure that information is recorded correctly, there is a consensus regarding
the behaviors that are to be noted and tallied, and frequent feedback is provided.
After the six weeks has ended, the team will determine whether the intervention plan was
effective in order to create a summative evaluation. To do this the team will compare the data
collected after the intervention with the baseline data. Lastly, the team needs to agree what
defines a significant change in behavior. For example, Adams occurrences of negative social
reactions decreases by only 4 times per day, does this mean that the intervention is effective or
successful even if it does not meet the 50% goal? If it is determined that the change in behaviour
was significant and the intervention was effective, then it is important to observe Adam several

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more times over the next few months. This will help determine if the intervention had lasting
impact or if the results were short-lived.
In summation, comic strip conversation is just one example of an evidence-based
intervention to teach ToM skills for students with ASD. Upah and Tilly (2002) present a valuable
outline for all intervention programs, which ensures accountability, integrity, and validity.
Treatment integrity is a valuable concept, which is under-discussed in most schools and
educational settings for children with and without developmental disabilities. It is highly
recommended that anyone planning on implementing evidence based interventions follow these
steps.

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References
Attwood, T. (2000) Strategies for improving the social integration of children with Asperger
syndrome. Autism, 4, 85-100.
Baron-Cohen, S., Leslie, A., & Frith, U. (1985). Does the autistic child have a theory of Mind?
Cognition, 21, 37-46.
Baron- Cohen, S. (2000). Theory of mind and autism: A fifteen year review. In S. Baron Cohen,
H. Tager- Flusbeg, & D.J. Cohen (Eds.), Understanding other minds: Perspectives from
developmental cognitive neuroscience (pp. 3-20). Oxford: Oxford University Press.
Castelli, F., Frith, C., Happe, F. and Frith, U. (2002). Autism, Asperger syndrome and brain
mechanism for the attribution of mental states to animal shapes. Brain, 125, 1839-1849.
Frith, U., & Happ, F. (1994). Autism: Beyond "theory of mind." Cognition, 50, 115-132.
Gray, C. (1994). Comic Strip Conversations. Arlington: Future Education.
Happ, F. (1994). An advanced test of theory of mind: understanding of story characters
thoughts and feelings by able autistic, mentally handicapped, and normal children and
adults. Journal of Autism and Developmental Disorders, 24, 129 -154.
Klin, A. (2000). Attributing social meaning to ambiguous visual stimuli in higher-functioning
autism and Asperger syndrome: the Social Attribution Task. Journal of Child Psychology
and Psychiatry, 41, 831-846.
Upah, K. R., & Tilly III, W. D. (2002). Best practices in designing, implementing, and evaluating
quality interventions. Best practices in school psychology IV, 1, 483-501.

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