Building on Early Foundations into School: Fostering ...

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IntroductIon

Children across the autism spectrum experience pervasive challenges in socialization, which pose unique challenges in providing education and related support and services. For purposes of this chapter, we define socialization as the process through which people appropriate knowledge, skills, and values needed to engage socially, form relationships, and participate within natural socio-cultural contexts as a member of a group or com-munity. The socialization process is inherently influenced by multiple factors, including a per-son’s individual development, culture, language, socio-economic experience, and day-to-day life. Moreover, developmental domains that are central to the acquisition of social competence – commu-nication and language, cognition and learning, play and imagination, emotional and sensory – are inextricably linked to the trajectory of the sociali-zation process.

For children with autism, socialization issues emerge early in development and result in cas-cading effects over the lifespan if not addressed through appropriate intervention. Difficulties in socialization are closely tied to the core diagnos-tic features of autism spectrum disorder (ASD) – deficits, delays, and/or differences in social

interaction and verbal and non-verbal communi-cation, and the presence of restricted and repeti-tive patterns of behavior, activities, and interests (American Psychiatric Association, 2013). Consistent with the spectrum of autism, socializa-tion issues vary widely in degree of severity and how they manifest over the course of a person’s life (Charman et al., 1997).

Early indicators that may account for disruptions to the socialization process are evident in studies of infants who later are diagnosed with autism. This research shows that infants with autism orient less to human sounds and look less frequently at the eyes when attending to adult faces than do typical infants (Jones & Klin, 2013; Osterling & Dawson, 1994). This apparent lack of social attunement per-sists into early childhood in the context of early dyadic interactions between the adult and child. Studies show that young children with autism are less likely to orient to an adult’s social signals (e.g., eye gaze, facial expressions, gestures, call-ing their name) (Dawson et al., 2004), while they are more likely to attend to non-salient sensory or physical stimuli in their environment (e.g., light, sound, physical objects) (Klin, Jones, Schultz, & Volkmar, 2003). This, in turn, leads to develop-mental discrepancies in joint attention, imitation, shared affect, and social reciprocity (Baron-Cohen,

Building on Early Foundations into School: Fostering Socialization in

Meaningful Socio-cultural Contexts

L a k s h m i B a l a s u b r a m a n i a n , A l e x a n d e r M a r i o B l u m a n d P a m e l a W o l f b e r g

BK-SAGE-JORDAN_ET_AL-190087-Chp10.indd 134 17/04/19 5:38 PM

Building on Early Foundations into school 135

1989; Mundy, Sigman, Ungerer, & Sherman, 1987: Sigman & Ruskin, 1999) – the core underly-ing capacities for socialization.

Over the course of childhood, socialization issues become progressively complex and pro-nounced with growing exposure to peers in the context of play (Carter, Davis, Klin, & Volkmar, 2005; Jordan, 2003). Research suggests that chil-dren with autism initiate play less often and with less consistency than children at a similar devel-opmental level (Corbett, Schupp, Simon, Ryan, & Mendoza, 2010). When attempts are made to play with peers, their social approach may be sub-tle, obscure, or poorly timed, resulting in being excluded by their peer group. These socialization challenges persist and may worsen with age when there are increasing demands to cooperate and col-laborate with peers in school contexts (Orsmond, Krauss, & Seltzer, 2004; Rotheram-Fuller, Kasari, Chamberlain, & Locke, 2010). Research shows that children with autism have fewer social con-nections and reciprocal friendships than typical peers (Bauminger-Zviely & Agam-Ben-Artzi, 2014; Rotheram-Fuller et al., 2010). They also tend to be less accepted by their peer group and spend more time unengaged during unstructured periods than typical children (Chamberlain, Kasari, & Rotheram-Fuller, 2007; Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011). Because of difficulties with social understanding and prag-matic communication, children with autism may miss or misread social information that is necessary for interpersonal engagement and effective participation in both instructional and non- academic activities.

The developmental challenges children with autism face expose them to other risk factors that may compound difficulties in socializa-tion across diverse socio-cultural contexts. For example, while evidence suggests that children with autism are no different than typical children in their innate drive to socialize (Bauminger & Kasari, 2000; Calder, Hill, & Pellicano, 2013), what sets them apart from their peers is the idi-osyncratic nature of their social communicative attempts (Chamberlain et al., 2007; Kasari et al., 2011). Perceptions of their outward behavior sig-nificantly influence the way others respond, which further effects the socialization process. Thus, children with autism are at risk not only for social exclusion based on perceived differences in social communicative intent and ability, but also because of their social status as outsiders who do not fit into the norms of a given group (Killen, Mulvi, & Hitti, 2013; Bottema-Beutel, Turiel, DeWitt & Wolfberg, 2017). Consequently, misconceptions about the unique ways in which children with

autism communicate, play, relate, think, and learn make them vulnerable to being excluded from the social experiences that dominate in their age group. This leads to missed opportunities to gain the access and means to socially engage, form meaningful relationships, and participate as an accepted member of a social group.

Socialization is an ongoing and dynamic pro-cess that occurs across diverse socio-cultural contexts. Thus, efforts to overcome barriers for children with autism must be responsive to the distinct needs of individual children and their families with consideration of age, ability, back-ground, and socio-cultural experience. Research shows that with explicit and intensive interven-tion, children with autism are capable of making considerable progress in the area of socialization relative to their ability and situation at any given point in time (Corbett et al., 2010; Kasari et al., 2011; Wolfberg & Schuler, 2006). While there is no single antidote to socialization for every child, there are a wide range of high-quality practices, many of which show mutual benefits for children with autism and their social partners.

The purpose of this chapter is to provide an overview of pertinent practices for fostering the socialization of children with autism representing diverse ages, abilities, backgrounds, and needs. There are several common threads woven through-out this chapter that reflect emerging trends in the field. The first is recognizing the importance of preparing both specialists (educators, practition-ers) and non-specialists (parents, caregivers) to promote opportunities for socialization across meaningful socio-cultural contexts. Related to this is acknowledgment of the inherent value of promoting these opportunities within and across natural school, home, and community settings where children are likely to socialize with adults and peers. Another common thread is the empha-sis on the application of effective and socially vali-dated practices – practices that are grounded in an evidence-base (Rogers, 2000; Wong et al., 2013) and are recognized as beneficial by key stakehold-ers – that is, specialists, non-specialists, as well as children with autism and their peers and class-mates (Wolfberg & Buron, 2014). These practices implicitly respond to individual differences by incorporating strategies that are customized to each child’s developmental level, learning style, and socio-cultural experience. To that end, this chapter will highlight practices to promote sociali-zation in children with autism (from early child-hood through the school-age years) within three key socio-cultural contexts; adult–child dyad, play with peers, and cooperation and collaboration in school.


The SAGe hAndbook of AuTiSm And educATion136

SocIalIzatIon In the context of the adult–chIld dyad

In typical childhood, the adult–child dyad serves as a foundational context for acquiring capacities that allow for everyday human interaction and interpersonal relationships. Through repeated experiences of increasingly coordinated and recip-rocal dyadic interactions with caregivers, babies develop capacities for emotional regulation, inten-tional communication, and mutual social engage-ment. Delving deeper, Hobson (1993) suggests that the ‘conceptual grasp of the nature of minds is acquired through an individual’s affectively pat-terned, intersubjectively coordinated relations with other people.’ This implies that an individual can arrive at a realization about another’s inner psychological state by sharing subjective experi-ences with them. While synchrony, attunement, and the sharing of positive emotion or affect are characteristic of successful early dyadic interac-tions, children with autism face obstacles that effect the quality and quantity of these interac-tions. Gaining an understanding of how best to overcome these obstacles requires us to train our lens on the developmental trajectory in typically developing infants.

Infant development is an outcome of the con-tinuous interactions and transactional influences of genetic, developmental, and environmental fac-tors (Sameroff & Fiese, 2000).

Observational and investigational research con-ducted over the last four decades posits that even very young infants differ in the manner in which they engage with people as opposed to objects (Ainsworth, 1979; Bakeman & Adamson, 1984; Brazelton, Koslowski, & Main, 1974). Studies have shown that infants as young as one week in age engage actively with their mothers by gaz-ing at them (Lavelli & Fogel, 2002). Caregivers constantly monitor and attend to what the child is looking at in the environment and use their voice to sustain the infant’s attention. Since the nature of interaction is fashioned by the unique qualities of the caregiver and the infant, with variations based on different cultures, they contribute proportion-ately to the characteristics of the dyadic contact (Cohn & Tronick, 1988).

In the early months of a baby’s life, there are highly dynamic face-to-face interactions with their caregivers (with a conversation-like pat-tern), each with their own natural flow and style of engagement that occur, which when interrupted purposefully (for reasons of research) display the systematized expressions of affect and attention (Tronick, 2003). Using the still-face experiments, Tronick and colleagues (Tronick, 2007; Tronick,

Als, Adamson, Wise, & Brazelton, 1978) demon-strate how babies get flustered when the typical interaction that they are used to gets disrupted. The mother and child play and relate routinely at first and then the mother is instructed to give the baby a ‘still face.’ The baby tries hard to gain the mother’s attention and, when the baby does not attract it, starts to display negative affect, averts gaze, and becomes distraught. Experiments such as these speak eloquently to the manner in which typically developing infants engage with the emo-tional responses and social exchanges from the world around them.

Within the first year, the child is able to shift their gaze between people and objects and divert their attention to what the caregiver is looking at. This gives the child vital clues about the emotional states of the caregiver. The ability to follow another person’s gaze later gives rise to joint attention, shared affect, and intentionality, which are foun-dational for the acquisition of language (Bruner, 1983) and social cognition (Tomasello, Carpenter, Caan, Behne, & Moll, 2005; Tomasello, Kruger, & Ratner, 1993).

This research by Tomasello and colleagues on the cultural origins of cognition ties together the concepts of human capacities for joint atten-tion, shared affect, and intentionality as arising from interactions within the socio-cultural envi-ronment. Joint attention is achieved when social partners share attention to an object or event through means of eye gaze, pointing, or other verbal or non-verbal indicators (Butterworth & Cochran, 1980; Tomasello, 2009). Social part-ners share affect by coordinating communicative signals and emotional states (eye gaze and smil-ing, laughing) as integrated acts (Stern, 1985). Intentionality encompasses sharing intentions by initiating a communicative signal, directing it towards another using eye gaze, physical proxim-ity or contact, monitoring its receipt and reactions towards it, and estimating if the intended goal was achieved (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2005). Research by Tomasello et. al. (2005) suggests that children on the autism spec-trum may understand intentions but struggle with sharing that intentionality.

It is at this critical juncture of development that we see the emergence of intersubjectivity, which is the ability to share those subjective experiences with another (Stern, 1985). Underlying this capac-ity is the attunement of the child’s behavior to that of others, thus forming the basis for recipro-cal social interaction and the acquisition of social knowledge and understanding.

Having examined the nature of the develop-ment of joint attention, shared affect, and under-standing and sharing intentions with typically



developing infants and children, we can now see how strengths and challenges in these skill sets influence the developmental trajectory of chil-dren with autism. It is well established that chil-dren with autism do not perceive social signals the way typically developing children do (Kiln et al., 2003; Wolfberg & Schuler, 2006). Hence their experience of the social world can often be different. However, this does not mean that they cannot learn or be taught the skills or underlying competencies. Let us examine further some of the manifestations and differences in how children on the autism spectrum engage, share attention and affect, and learn about themselves and others dur-ing the early years. At the core of it all is the issue of having challenges while engaging in reciprocal social interaction.

Individuals with autism often have an atypical social developmental trajectory. As discussed ear-lier, these disruptions in the socialization process are evident even at a very young age (Ozonoff et al., 2010). Around 12 months of age, there appears to be less eye contact, social gazing, and smiling, and less interest when partners engage them in joint attention (Nadig et al., 2007). This could potentially lead to a delay in learning the use of intentional communication signals, posing a disadvantage for learning symbolic language and social rules and cues.

While a typically developing child in the early stages of learning conventional gestures is show-ing, pointing, waving, and using adults to gain access to desired outcomes (proto declaratives and proto imperatives), children with autism on the other hand engage in unconventional motoric ges-tures like leading or pulling an adult to an object of desire often without eye gaze (Bates, Camaioni & Volterra, 1975; Curcio, 1978; Hobson & Lee, 1999; Wetherby, Woods, Allan & Cleary, 2004). Studies conducted demonstrate that while a child with autism was able to regulate the adult’s behavior to get what they wanted (request food, protest), they were less likely than carefully matched controls to spontaneously orient to naturally occurring social stimuli (namely humming, calling the child’s name, patting thigh, and snapping fingers) in their envi-ronment (Dawson, Meltzoff, & Osterling, 1998) or engage in joint attention (use of alternating eye gaze or following eye gaze or point), nor did they attend to affective signals such as another’s distress (Dawson et al., 2004). Serval studies suggest that when language or gestures were used to direct their attention, children with autism were less likely than other children to respond appropriately (Loveland & Landry, 1986; Mitchell et al., 2006; Sigman, Mundy, Sherman, & Ungerer, 1986).

As the child progresses to acquiring words and word combinations (1 to 2 years), joint attention

contributes heavily in the acquisition of recipro-cal communication and in the social cognitive processes involving the cooperative effort of shar-ing attention, affect, action, and eventually sharing experiences (Adriana Schuler, personal communi-cation). In addition to being less likely to visually orient with their partner, more likely to struggle with reliably interpreting their signal, and not having a repertoire of sophisticated mechanisms to gain their attention, the child with autism also struggles with being able to infer and decipher emotional states of their partner and maintain elaborate reciprocal interactions (Prizant et al., 2005). Paucity in the area of being able to tune into the adult’s focus of attention also limits the child from learning through social observation.

What do these elaborate reciprocal social inter-actions teach children? According to Greenspan (2001), these affectively guided interactions teach the infant how to problem-solve and meaningfully use language and symbols. The infant’s ‘affect diathesis hypothesis’ explores how ‘affect is used to provide intent for the child’s actions and mean-ing for his words’ (p. 5). Critical delays in the cul-tivation of this skill, particularly in children with autism, leads to delays in developing complex social skills and higher order thinking capabilities (Greenspan, 2001). Eliciting ordinary interactions with their primary communication partners can become impaired causing confusion and frustra-tion to both parties. What appears to be a biologi-cal shortfall is fostered by a transactional process, which is fueled by the forfeiture of interaction and critical learning experiences.

Intervention Practices

Practices that address socialization for children with autism, especially in the early years, have received much prominence. A wide-ranging appraisal conducted by the National Research Council in 2001 established that optimistic results have been demonstrated by a number of method-ologies, but that ‘gaps remain in addressing larger questions of the relationships between particular techniques and specific changes’ (NRC, 2001, p. 5). To fill these gaps, a variety of adult-supported intervention approaches have gained considerable attention in the professional literature, many of which emphasize dyadic interactions. These inter-ventions represent different schools of thought that span the continuum from adult directed to child centered. For example, interventions that utilize principles of applied behavior analysis (ABA) are adult directed with the goal of increas-ing and decreasing observable social behaviors



through systematic, externally controlled tech-niques. At the other end of the continuum are developmental and relationship-based interven-tions that are child centered, where therapists form relationships with and take their cues from the child to scaffold social capacities. In the fol-lowing, we present a selection of current interven-tion models that address the socialization needs of children on the autism spectrum in the context of early intervention and the adult–child dyad.

Pivotal Response Treatment (PRT)

PRT is a comprehensive, early intervention ser-vice delivery model that is derived from ABA while targeting core areas of a child’s develop-ment (for overviews, see Koegel, Koegel, Shoshan, & McNerney, 1999b; Koegel, Openden, Fredeen, & Koegel, 2006). In fact, it has been demonstrated to be an efficacious parent training program (Koegel, Bimbela, & Schreibman, 1996; Schreibman & Koegel, 2005). This approach aims to utilize natural opportunities that arise in the child’s environment. As the name suggests, ‘piv-otal responses’ are those that when targeted lead to widespread transformations in central areas of the disability such as language, pragmatics, self-help, and academics (Koegel & Koegel, 2006; Koegel, Koegel, & McNerney, 2001).

The five pivotal areas that have been studied are: motivation, responsivity to multiple cues, self-management, self-initiations, and empathy. The authors emphasize the importance of a coor-dinated effort being consistently implemented across settings, by all relevant stakeholders, with parents being primary interventionists. This pro-gram supports implementation in inclusive set-tings that the child is naturally a part of (home, community, preschools, after-school programs). According to Koegel, Koegel, Harrower, and Carter (1999), the skill and effectiveness of the provider is more important than solely the number of hours of service provided.

The authors have described the ‘pivotal responses’ in the following manner. A common learning characteristic displayed by children with autism is the lack of responsivity to multiple cues. This means that some children with autism tend to respond based on a very narrow set of stimuli (fre-quently irrelevant) that are in their environment. If a cue had visual, tactile, and auditory components, the children tended to respond to only one of them at a time. Research deems this as ‘stimulus overselectivity’ and since the ability to respond to multiple cues greatly enhances learning outcomes, this is classified as a pivotal response. Other areas

where PRT can have a positive effect are on moti-vation and child’s agency (e.g., decision making; child choice), while also promoting the use of nat-ural reinforcers as opposed to arbitrary reinforc-ers. Self-management is another pivotal response that involves modulating one’s behavior and when children with autism learn this skill, they are bet-ter equipped to be actively involved in their own intervention process. This promotes independ-ence, improves social skills, increases engagement in tasks, and reduces disruptive behavior (Koegel et al., 1999b; Koegel, Matos-Freden, Lang & Koegel, 2011). The final pivotal area discussed by the authors is self-initiations. Social self-ini-tiations are notably lacking with this population and hence strategies and procedures to teach chil-dren with autism to ask questions that can be gen-eralized across settings and partners have shown improvements in the area of social communicative competence (Koegel et al., 1999ab).

The Early Start Denver Model (ESDM)

This intensive early intervention model is based on the principles of ABA with the integration of developmental approaches. The ESDM takes into consideration the knowledge base of infant and toddler learning, the research that addresses the challenges faced by young children with autism, and the family’s natural socio-cultural contexts while developing their intervention. This method-ology targets infants to preschool-aged children and has been demonstrated as efficacious in pro-moting IQ, adaptive behavior, and language (Rogers & Dawson, 2010). The ESDM is a parent coaching intervention wherein the caregivers are taught ESDM techniques that are an amalgam of two approaches, namely (1) the Denver model and (2) Pivotal Response Treatment (see above). The Denver model aims to promote growth in areas associated to autism while following developmen-tal sequences relevant to those without similar delays. Furthermore, the model aims to create a warm and nurturing social atmosphere that encourages positive relationships while fostering learning and development (Vismara & Rogers, 2008). The second approach that is part of the ESDM is PRT. As earlier described, PRT employs systematic teaching incorporated with motiva-tional variables to improve language, communica-tion, and social skills.

Implementation of the ESDM involves sessions led by trained therapists at regular intervals every week, along with parent training that involves imparting knowledge about the principles and practices that form the crux of ESDM. In addition,



parents are asked to use the strategies embedded in daily activities and routines while teaching them to pay attention to verbal and non-verbal com-munication, becoming responsive to child cues by employing a curriculum that tackles all the devel-opmental realms. Operant conditioning, shaping, and chaining are some of the teaching strategies used and these are based on the principles of ABA.

SocIal communIcatIon, emotIonal regulatIon, and tranSactIonal SupportS (ScertS)

SCERTS is a flexible, multidisciplinary approach that is research based, family centered, and indi-vidualized. It focuses on improving social com-munication, emotional regulation, and transactional supports for children with autism. The model is applicable across the spectrum of autism and can be customized based on need and severity of the challenges.

Given that individual variations in joint atten-tion skills are predictive of language develop-ment and communicative and social competence (Mundy, Sigman, & Kasari, 1990; Prizant et al., 2005), the social communication (SC) component of the model focuses on building capacity in two major functional areas, namely joint attention and symbol use. According to this model, the chal-lenges in joint attention influence the following critical areas in the social communicative sketch: namely, difficulties in coordinating attention, affect and sharing intent, restricted array of com-municative functions, and struggles in perspec-tive taking. Therapists trained in the SCERTS model analyze the child’s strengths and weak-nesses in the arena of joint attention and symbol use and utilize this while collaborating with the family to establish meaningful goals that can be implemented by multiple stakeholders across contexts. The child’s level of functioning drives goal selection, examples of which include, but are not restricted to, establishing social referencing, shared affect, expanding ability to communicate, increasing reciprocity across varied partners and contexts.

The authors espouse that for the child to be ‘available’ to engage in social contexts, emotional regulation (ER) is fundamental and is another cor-nerstone of the model. Considering that advances in the realm of socialization are more likely to be promoted when the child is emotionally well regu-lated, this model integrates strategies that assist the stakeholders involved in the care of the child

to read the non-traditional signals a child with autism may display when they are dysregulated. A well-coordinated plan is also developed to assist the child in developing appropriate self-regulatory (e.g., ways to maintain an organized state) and mutual regulatory (e.g., use socially suitable sig-nals to control environment) strategies with built-in monitoring mechanisms for efficacy.

As for the transactional supports (TS) in the SCERTS model, these emphasize the impor-tance of supports being fluid, adaptable, and responsive. They are provided in three essential domains: interpersonal, educational and learning, and family supports (Prizant, Wetherby, Rubin, & Laurent, 2003). In a review of comprehensive treatment programs conducted by Odom, Boyd, Hall, & Hume (2010), SCERTS was determined to have scored high in the area of operationaliza-tion, referring to the clarity with which the model was described and documented such that, with adequate training, it could be implemented with reasonable accuracy.

developmental IndIvIdual dIfferenceS relatIonShIp-BaSed (dIr)/floortIme model

This framework helps clinicians, families, and other professionals develop a comprehensive mul-tidisciplinary plan that addresses the individual needs of a child with autism while considering the child’s developmental and functional profile. At the core of this model is the emotional relation-ship the child has with their family (Wieder & Greenspan, 2001). The DIR model closely exam-ines three aspects (Greenspan & Wieder, 1999). The first aspect, namely the developmental (D) dimension, views how the child synthesizes vari-ous capacities that are essential to maintain a regulated state, communicate effectively, social-ize, problem-solve, and build on ideas, thus expanding their cognitive potential. The individ-ual differences (I) aspect considers the biological variations that exist in how the child modulates sensory input (e.g., hyper-responsivity to touch). The relationship-based (R) aspect of the DIR model explores the interactions and bonds that the child has with caregivers and therapists (Wieder & Greenspan, 2001). By conceptualizing these developmental dimensions, the DIR model helps facilitate a greater depth in the understanding of the core challenges faced in autism in an intercon-nected manner and allows for systematization in assessment and intervention.



Floortime is an approach used within the model that encourages therapists to follow the child’s lead, which involves being very attentive and tuned in to what the child is doing and joining the child in those activities. Once the child has let you share their world, the next step involves pulling the child, albeit slowly, to a shared world thereby encouraging the development of social, emotional, and intellectual capabilities (Hess, 2013).

SocIalIzatIon In the context of play wIth peerS

While play with peers is a fundamental socio-cultural context for the socialization of all chil-dren, those children on the autism spectrum require specialized support to reap the same ben-efits as typical children (Carter et al., 2005; Jordan, 2003; Wolfberg, 2009). When it comes to socialization within this context, children with autism are at a distinct disadvantage due to dis-parities in both their social and symbolic play development. Whereas typical play follows a tra-jectory of increasing diversity, imagination, and social sophistication, the play of children with autism tends to be less varied, creative, and socially oriented (Hobson, Hobson, Malik, Kyratso, & Calo, 2013).

Within the symbolic domain of play, research points to a particular impairment in the spontane-ous development of pretend play (i.e., symbolic representation of objects, events, self, and others). There is further evidence that this impairment also encompasses functional play (i.e., the con-ventional use of an object and association of two or more objects; Baron-Cohen, 1987; Jarrold & Conn, 2011). In comparing children with autism to typical and developmentally matched peers, the frequency with which they engage in manipula-tion or sensory play with objects is higher than either functional or pretend play (Dominguez, Ziviani, & Rodger, 2006; Libby, Powell, Messer, & Jordan, 1998). These disparities are reflected in a more restricted play repertoire, which tends to focus on one or a few favored activities, often in isolation from others (Hobson, Lee, & Hobson, 2009).

Many children with autism gravitate to play that offers intensive sensory and physical responses, such as by engaging in repetitive motions and manipulating objects that produce cause–effect actions (Doody & Mertz, 2013). Others become deeply absorbed in arcane subjects or special inter-est areas that may last long periods and endure over time (Winters-Messiers, 2007). Qualities of

functional and pretend play also differ in terms of showing less novelty, diversity, elaboration, and integration of various elements (Williams, Reddy, & Costall, 2001). There is evidence that the pre-tend play of children with autism is overall less advanced than the pretend play of typical children (Hobson et al., 2009). While many children are capable of comprehending more advanced forms of pretend play (i.e., object substitutions, treating a doll as an active agent, inventing imaginary enti-ties, creating complex narratives), the predilec-tion to produce these forms of play appears to be lacking (Baron-Cohen, 1987; Jarrold, Boucher & Smith, 1996; Lewis & Boucher, 1988).

The penchant to play in a more ritualized fash-ion may partially explain the tendency of children with autism to play apart from peers. On the one hand, the feedback from the ritual itself may be so compelling that they are less likely to tune in to the presence of their peers. By the same token, if typical peers are unresponsive to a child’s uncon-ventional interests and behavior, there is even less of an incentive for social play to ensue. These transactional influences likely interface with the social play styles of children with autism. Consistent with the early work of Wing and Gould (1979), children with autism may exhibit aloof, passive, and active–odd social play styles while in the company of peers. A child’s social play style may remain consistent, overlap, and shift in relation to the play context. The child who appears to be withdrawn or to evade peers is char-acteristic of having an aloof social play style. The child who appears to be indifferent to peers, but can be easily led to watch, follow, and go along with peers, is representative of having a passive social play style. The child who shows an appar-ent interest in being with peers, but does so in a peculiar, socially awkward, or one-sided fashion, is considered to have an active–odd social play style.

These variations in the play development of children with autism speak to the significant role of the peer group in fostering socialization as a part of a collective play culture. The play culture reflects the unique social and imaginary worlds children jointly construct apart from adults (Wolfberg, 2009; Wolfberg et al., 1999). A criti-cal aspect of play culture is that it offers natural opportunities for children’s socialization that essentially cannot be duplicated by adults. The challenge for specialists and non-specialists is in how best to support children in co-creating a play culture that transcends difference and is inclusive of neurodiversity – a play culture in which peers are responsive to the unique ways children with autism communicate, relate, and play, and builds genuine friendships.




As research and practice in the field has grown, greater attention has been placed on addressing the socialization needs of children with autism in the context of play with peers. While these prac-tices vary widely with respect to theoretical orien-tations and methodologies, they also offer complementary perspectives to help guide spe-cialists and non-specialists in making decisions about which techniques to use, when, and where, for a given child and their peers. In the following, we have selected a few interventions that are rep-resentative of play-based approaches that offer different configurations of contextually relevant support that contribute to children’s socialization.

Peer-Mediated Intervention (PMI)

Originated by Odom and Strain (1984), PMI is grounded in the principles of ABA to promote the socialization of children with autism in the con-text of play with peers (for overviews, see Disalvo & Oswald, 2002; Neitzel, 2008; Odom et al., 1999; Sperry, Neitzel, & Engelhart-Wells, 2010). PMI focuses on systematically training typical peers to elicit the social engagement of children with autism within play activities that are both adult directed and selected by the children them-selves. PMI is designed to be implemented with pairs or small groups of young children ages 3 to 8 years.

The overall goal of PMI is to increase the fre-quency with which social initiations, responses, and reciprocal exchanges occur, as well as the duration of the social exchanges. The application of PMI draws on principles of behavioral (Skinner, 1963) and social learning theory (Bandura, 1977). These methods operate on the premise that all social behavior can be learned by breaking down the behavior into a discrete set of skills and pro-viding direct instruction to demonstrate and teach the skill within a carefully engineered environ-ment. In most social skills training programs with similar theoretical orientations, the adult directly intervenes by instructing the focal children with autism. PMI is unique in that the adult first selects and then systematically trains peers who then deliver the intervention strategies to the children with autism.

Implementing PMI with efficacy involves train-ing practitioners to follow a carefully laid-out procedural plan. This begins with the systematic selection of typical peers who are assigned to play with a focal child. To select the children in a school setting, a teacher employs a socio-metric

method whereby peers are asked to list three other peers they would like to invite to play at recess, three peers they would invite to a party, and three peers they consider to be good friends. The teacher reviews the top three children chosen most often to confirm that they exhibit competent language and social skills and appropriate behavior.

Prior to bringing the children together for the PMI play sessions, the practitioner trains the invited peers. The peers are coached to understand the role they will have in the intervention and the strategies they will use to assist the children with autism. The training incorporates a variety of instructional methods appropriate to the age of the peers (e.g., using visuals, instructional videos, role playing). Specifically, the peers are taught a set of strategies designed to mediate social skills. These strategies include: modeling the desired social behavior for the child, prompting the child to elicit the desired social behavior, and reinforcing the child when the desired social behavior occurs. While implementing the PMI play sessions, the practitioner continually observes, providing peers with ongoing feedback to insure they are properly implementing the strategies. These observations are further used to monitor and evaluate the pro-gress of the children with autism.

Peer Social Networks (PSNs)

With strong parallels to PMI, and as an outgrowth of Haring and Breen’s (1992) seminal work, PSNs are being applied in elementary school settings to promote the peer socialization of children with autism using play as a medium (for overviews, see Kamps, Potucek, Lopez, Kravitz, & Kemmerer, 1997). Consistent with the principles of ABA, PSNs use adult-directed instruction to teach peers how to elicit explicit social skill use by children with autism. In a PSN, one child with autism par-ticipates with two to four typical peers in 30-minute play sessions that meet over the course of the fall and spring semesters in an academic year. Peers are involved in preselected activities and games designed to offer multiple opportunities for chil-dren to practice five keys skills: (1) ‘Ask and share’ – making requests and sharing play materi-als; (2) ‘Tell about my toys’ – commenting on one’s own play activities, or actions with objects; (3) ‘Tell about friends’ toys’ – commenting on peers’ play activities, or actions with objects; (4) ‘Talk nice’ – being polite and giving compli-ments or praise; and (5) ‘Ways to play’ – setting up the game or activity and explaining the rules.

Each PSN group is led by a school staff member (teacher, SLP, para-professional, school



counselor) who receives training and a set of teaching materials to serve in the role of imple-menter. Implementers participate in an initial training session that introduces the PSN interven-tion while highlighting the importance of direct instruction for children with autism. During this session, the implementers role play and rehearse the teaching of the skills to peers in a small-group format. Further training, consultation, and feed-back are provided to implementers with periodic on-site school visits throughout the school year.

The procedures for implementing the PSN intervention during play sessions follow a series of scripted lessons for introducing and teaching the skills in a sequential and cumulative fash-ion (Kamps et al., 2002; Thiemann & Goldstein, 2004). Each session follows a consistent schedule that includes periods of adult-led instruction and practice of the target skill, peer prompting of the skill use by the focal child during play, and peer reinforcement and feedback of the skill use by the focal child. During the instructional period, the implementer points to a ‘text cue’ (picture–word graphic) to introduce and define the skill for peers, and then demonstrates how to use the text cue to prompt the focal child with autism to use the skill. The implementer next prompts the peers to point to the cues to prompt the focal child with autism to use during the play period. The peers next act as reinforcing agents for the children with autism when the desired skill is performed. In subsequent play sessions, text cues taught in a previous ses-sion are made available to peers to use to prompt the child with autism based on individual progress.

Other features of the intervention include adult prompting of the peers if the focal child stops playing for 30 seconds. Peers can prompt the child a maximum of two times before the adult intervenes directly with the child. In addition, the implementers are evaluated on their delivery of the PSN intervention using a protocol manual to assure they are reliable in teaching preliminary skills before introducing new skills. Assessments of the focal children offer additional assurances that the PSN intervention has been implemented as it was intended with fidelity.

LEGO®-Therapy

Originally developed by LeGoff (2004), LEGO-Therapy has gained recognition as a research-based practice that supports the socialization of children with autism through constructive play in a group setting (for overviews, see LeGoff, Gomez de la Cuesta, Krauss, & Baron-Cohen, 2014; Owens, Granader, Humphrey, & Baron-Cohen, 2008).

The LEGO-Therapy approach is holistic drawing from a strong theoretical basis that taps into the unique cognitive profiles while capitalizing on the prevalence of LEGO in society as a high-interest play activity. LEGO-Therapy is designed for chil-dren ages 6 to 11 years whose diagnostic profile is considered mild to moderate in terms of degree of severity. The goals for children with autism are to enhance their intrinsic motivation to initiate social contact and sustain social interaction with peers while overcoming characteristic patterns of aloof and rigid social behavior.

LEGO therapists receive training by attending a course and following a comprehensive manual (LeGoff et al., 2014). In LEGO-Therapy, the chil-dren participate in pairs or groups of three with the focus on building with LEGO to solve a problem according to a prescribed set of procedures. There is a division of labor to allow the children to prac-tice joint attention, sharing, turn taking, joint prob-lem solving, and receptive and expressive social communication skills while achieving a common purpose. The therapist’s role is to facilitate by pre-senting a problem and helping children come up with their own solutions, as opposed to pointing out specific social problems or giving solutions to social difficulties. The therapist guides the chil-dren to practice the solutions that they identify until they are able to master them. In the event similar problems arise in the future, the therapist reminds the children of strategies they previously used which they may then apply to their current construction.

When building in pairs, one child takes on the role of ‘engineer’ and the other the role of ‘builder,’ while in groups of three, a child takes on the additional role of ‘supplier.’ The role of the ‘engineer’ is to give verbal descriptions of the pieces needed and directions for assembling them. The ‘builder’ follows the directions by collecting and putting the pieces together. When building in pairs, the players check back and forth to carry out their plan and creation. When playing in groups of three, the ‘supplier’ finds the correct pieces fol-lowing the ‘engineer’s’ instructions. In each of these scenarios, the roles are swapped so that each child has an opportunity to participate in the dif-ferent roles. There are also rules that children are required to follow that include building together, asking for help to fix a broken construction, ask-ing to use someone else’s materials, using polite words and other expected behavior for being respectful of each other and the play materials.

At the end of each play therapy session, the children are rewarded with certificates for their achievement in reaching a specific skill level. When they build together successfully for the first time, each child receives the ‘LEGO Builder’



certificate that demonstrates the ability to build models in a group and create their own models with adult help. Certificates for other skill levels include ‘LEGO Helpers’ who show the ability to find the bricks and sort them into the correct colors or categories and ‘LEGO Creators’ who show the ability to build models in groups and design freestyle models in pairs without adult help. The children receive individual certificates in front of the group as opposed to receiving a group reward. This serves to motivate the children to participate socially and build models together so that they can move up to the next level.

Integrated Play Groups (IPG) Model

Originated by Wolfberg with contributions from colleagues, IPG is an evidence-based model that offers intensive guidance for children with autism and typical peers to socialize within the context of play (Wolfberg, 2009; Wolfberg, DeWitt, Young, & Nguyen, 2015). Grounded in the principles of socio-cultural theory (Rogoff, 1990; Vygotsky, 1967; 1978), the IPG model is designed to support children in co-creating a play culture while par-ticipating in small groups centered on mutually engaging activities. The IPG model primarily sup-ports children aged 3 to 11 years; however, exten-sions of play are being applied to older groups that include drama, art, dance, multimedia, and other creative activities (Wolfberg, Bottema-Beutel, & DeWitt, 2012). For the children with autism (novice players), the goals are to enhance social and imaginary play development while building relationships with typical peers (expert players). Equal emphasis is placed on goals for the expert players to develop knowledge, empathy, and com-petence to be responsive social partners (Wolfberg, McCracken, & Tuchel, 2014).

Effective delivery of the IPG model relies on guidance from a competently trained adult (IPG Guide). Entry- to advanced-level preparation is offered through a course that includes an appren-ticeship in which participants receive training and supervision to run an IPG program. Following the IPG field manual (Wolfberg, 2003), IPG Guides attain competencies in the design, implementa-tion and evaluation of the intervention using a set of assessment tools and techniques. Fidelity of the intervention is established by using a protocol to evaluate each Play Guide’s effective-ness in implementing the various intervention components and through outcomes of a com-prehensive evaluation of the children’s social engagement and symbolic play development (Wolfberg et al., 2015).

The IPG model incorporates multiple layers of support in the design of the program and envi-ronment, delivery of the intervention, and pro-cess of conducting assessments and evaluations. An IPG includes three to five players, with typi-cal peers exceeding the number of children with autism. Peers are recruited from the child’s natural social network with consideration of multiple fac-tors including the potential to form long-lasting friendships.

IPG programs run for a minimum of 12 weeks, meeting twice weekly for at least 30- and up to 60-minute sessions. In the initial phase, all of the children participate in an orientation that includes ‘Autism Demystification’ activities (Wolfberg et al., 2014). Play sessions take place in a desig-nated play space that includes children’s preferred materials that have high social and imaginative potential, and that are intrinsically motivating to both novice and expert players. Play sessions incorporate predictable routines, rituals, and vis-ual supports that tap into the distinctive ways in which children with autism think and learn.

IPG sessions are organized with opening and closing routines that surround a period of ‘guided participation’ in play. Guided participation involves the holistic application of a set of key practices: (1) Nurturing initiations – recognizing, interpreting, and responding to a child’s conven-tional and unconventional attempts to socialize and play with peers; (2) Scaffolding play – modu-lating the intensity and amount of support by step-ping in and out while shifting between providing assistance at a high level (modeling and direct-ing), moderate level (coaching), and minimum level (standing-by); (3) Guiding social commu-nication – supporting the children to effectively elicit joint attention, initiate, respond, and sustain reciprocal exchanges in play using both verbal and non-verbal modes of communication; (4) Guiding play in the ‘Zone of Proximal Development’(ZPD) – using a continuum of approaches (orientation, imitation and mirroring, parallel play, joint focus, join action, role enactment, and role playing) that is slightly above and reflects the child’s emerging capacities while fully immersed in the experiences of the play culture.

SocIalIzatIon In the context of cooperatIon and collaBoratIon In School

As children advance in age, active participation in cooperative and collaborative school experiences takes on increasing importance in supporting



socialization. The process of cooperating and col-laborating with others is heavily influenced by both intrinsic and extrinsic factors. The degree of skill and sophistication in the areas of social cog-nition and communication, and the experience of peer group membership, are among those that pose significant challenges for individuals on the autism spectrum.

Social cognition requires the individual to track a range of people across different social situa-tions, and then use the information to inform their causal reasoning, later generalizing that informa-tion to new social situations (Seiver, Gopnik, & Goodman, 2013). Seiver and colleagues’ research shows that as children develop they increasingly use information about people (e.g., he is brave to jump on the trampoline) rather than external information (e.g., the trampoline is safe to jump on) to support their causal reasoning. This social cognitive skill is important to consider since infer-ences about the motives and causes behind an indi-vidual’s behavior serve an important function in social life.

When cooperating or collaborating with others in a group, the group members need to understand social roles, decide how to use their resources effectively, and set goals (Leman, 2015). Lehman found that while participating in groups, older children (13 years) used more complex social communication strategies than younger children (8 years) (i.e., establishing joint focus by sharing affective states; communicating by responding to others’ utterances to confirm or support state-ments; using meta-communication to initiate a conversation, or propose a strategy to coordinate activities). Overall, this suggests that children’s notion of collaboration shifts over time from being concerned about gaining information to involving more coordinated forms of social interactions and communicative exchanges.

Similar results were found by Gummerum and colleagues (2013) with 7 and 9 year olds. However, it was also suggested that since these skills develop over time, if a child is not engag-ing in these social experiences, the child’s social development may be delayed and lack the com-municative skill sets to engage in group-work efficiently and meaningfully, to further develop various social communication skills.

Group membership is another factor to con-sider. Abrams and colleagues (2007) examined this concept among children aged 5–12, and found that children perceived as in-group members were reported to be favored relative to out-group mem-bers who were judged more negatively and that this bias increased with age. There is further evi-dence to suggest that individuals seen as out-group members are more likely to be socially excluded,

which is often the case for individuals on the autism spectrum. Since children with autism are less likely to be favored relative to the socially per-ceived in-group members, then they are already at a disadvantage in gaining richer social experiences and a sense of belonging.

The skill sets in social cognition and com-munication that are required to cooperate and collaborate with peers in group contexts can be a great challenge for individuals with autism. These skill sets rely on integrating contextual information, perspective taking, empathy, and inhibition – capacities that they neither develop naturally nor easily learn. Here, we will discuss three theories which shed light on the possible challenges this population faces: Theory of Mind/Empathy–Systems theory (Baron-Cohen, Leslie, & Frith, 1985; Baron-Cohen, Richler, Bisarya, Gurunathan, & Wheelwright, 2003), Weak Central Coherence theory (Frith & Happé, 1994; Happé & Frith, 2006), and Executive-Function theory (Hill, 2004a; 2004b).

Theory of mind (ToM) has its roots in the work of Premack and Woodruff (1978) who presented a model that describes a cognitive mechanism that is essential for social skills and taking the per-spective of another. ToM is essentially a system that allows the individual to know that people have different thoughts, desires, and beliefs from themselves. Baron-Cohen and colleagues (1985) tested this construct with individuals with autism, and found that they had relative challenges using this cognitive process. Baron-Cohen and col-leagues (2003) updated this theory through devel-oping the Empathy–Systems theory; they posit that systemizing and empathizing are two differ-ent cognitive processing biases, and that individu-als with autism tend to have relative strengths in tasks that favor systemizing (e.g., paying atten-tion to relatively smaller input details, to gen-erate a predictable output), and have relative challenges in tasks that require empathic skills. Golan and Baron-Cohen (2006) suggest that a systems-oriented way of seeing the world tends to be constrained to phenomena that are more or less lawful, finite, and deterministic to a relatively larger degree.

The challenge for individuals with autism comes when trying to apply a systems-oriented way of thinking to social situations, particularly predicting human behavior. If one relies on sys-temizing vs. empathizing for processing and thinking about the world, they would have diffi-culty predicting people’s behaviors and motives, since they are not completely rule governed. This cognitive process includes identifying the mental state of another, and responding in an appropri-ate manner. This has also been related to making



inferences about agents, animals, and non-agent context’s (White, Hill, Happé, & Frith, U. (2009).

Weak Central Coherence theory also sheds light on the socialization challenges of individu-als with autism (Frith, 2003; Frith & Happé, 1994; Happé & Frith, 2006). This theory focuses on how well one can integrate information from various sources into a greater whole, further dem-onstrating a disposition towards local vs. global coherence. Frith and Happé (1994) found that individuals with autism had a bias toward tasks that favored local processing, whereas typically developing individuals tend to do relatively bet-ter on tasks that favor global processing. However, the challenge lies in integration. Nuske and Bavin (2011) have further shown that their participants with autism had relative challenges when asked to engage in inferences that require the integration of world knowledge with details in the narrative, to generate a causal inference (e.g., global process-ing), relative to inferences that require linking dif-ferent concrete events (e.g., local processing).

These dispositions for local coherence vs. global coherence can be challenging in social situ-ations because one must integrate a wide array of diverse details in order to understand context, and thus know how to navigate through the social situ-ation. This may also interfere with communication since tone, metaphor, and other forms of abstract representations can be difficult to interpret, if not integrated with the information provided by the context. Happé and Frith (2006) further suggest that although individuals with autism have rela-tive strengths in detail processing, these may be maladaptive in social situations and cause a cer-tain level of distress when small changes are made that they did not predict.

Hill (2004a; 2004b) describes four key char-acteristics of having good executive function: planning, mental flexibility, inhibition, and self-monitoring. Planning is a complex operation where a series of actions toward a particular goal must be constantly monitored, evaluated, and updated. This is often tested through engaging in tasks where there are a limited amount of steps allowed, requiring the individual to identify alter-native approaches, make decisions, and revise con-clusions. Mental flexibility is the ability to shift to different thoughts and actions based on changes in context. This is often tested by having partici-pants engage in a task with specific rules, and then having to generalize those rules to different con-texts. Inhibition requires the ability to refrain from exhibiting or ending a behavior. A lack of mental flexibility goes hand-in-hand with a lack of inhibi-tion (e.g., engaging in a perseverative stereotyped activity, continuing to talk about a preferred topic, becoming dysregulated when plans are changed).

This is also why self-monitoring is so important, because if you do not monitor your own thoughts and actions, it may be challenging to self-correct depending on the social contextual demands (Hill, 2004b.) These skills have been found especially challenging for individuals with autism (for a review, see Pellicano, 2012).


Increasing efforts have focused on promoting socialization within the context of cooperative and collaborative groups in school and related learn-ing contexts. Many of these are designed to tap into individual strengths for attaining social com-petencies – that is, empathy, perspective taking, and the integration of relatively smaller bits of information into a greater whole to understand the context, and to know what the socially agreed-upon practices and norms are for that context. In the following, we highlight a selection of these intervention practices.

Social Cognitive Approaches

These intervention approaches utilize both behav-ioral strategies and cognitive processes, with the aim of effecting behavioral and cognitive changes (Dobson, 2009). Different social cognitive approaches fall under a framework that focuses on how cognitive activity effects behavior, how cog-nitive activity can be monitored and altered, and how this change in cognition can bring forth a desired behavior.

One of the biggest hurdles for children with autism is learning what Myles and Simpson (2001) call the Hidden Curriculum within and across dif-ferent social settings. The Hidden Curriculum includes the skills, actions, and overall socially agreed-upon norms and practices of a particu-lar social setting. This of course means that it is completely situated, thus dependent on context, and can be a challenge in academic settings. For example, in a group project students must know the teacher’s and peers’ expectations, pleasing behaviors, who to interact with, who to avoid, and behaviors that attract positive and negative atten-tion. Myles and Simpson (2001) give a series of suggestions for teaching the Hidden Curriculum, including scope and sequence, direct instruction, social stories, acting lessons, and self-esteem building. They describe scope and sequence as an essential component to avoid overlooking impor-tant prerequisite skills, which is why it is essential to break down the task into its individual parts.



Direct instruction is a helpful teaching modality to execute these lessons through a series of steps: (1) providing a rationale (e.g., the relevancy of a skill), (2) presentation (e.g., telling the student the goal, and being transparent with why and what they need to learn), (3) modeling (e.g., teacher demonstrates how to execute a skill), (4) verifi-cation (e.g., monitoring the student’s emotional state), (5) evaluation (e.g., ways of assessing), and (6) generalization (e.g., how these skills can be applied to different settings. Acting lessons are also recommended because they can teach social skills through practice expressing non-verbal and verbal emotions, interpreting other people’s emo-tions, feelings, tone, and language, all the while receiving feedback (Myles & Simpson, 2001). As for self-esteem, Myles and Simpson recommend classroom strategies such as making the student a helper or peer tutor, teachers using positive lan-guage and praise, and building strengths instead of focusing on perceived deficits (Myles & Simpson, 2001).

Another social cognitive strategy that has been well received is creating Social Stories (Gray, 1994; 1998; Gray & Grand, 1993). These are designed to teach specific social behaviors through emphasizing the relevant social cues and contextually appropriate responses. Due to relative challenges in social cognition for individuals with autism, teachers need to consider questions that students may not know to ask. Gray and Grand (1993) recommend that teachers include answers to who, what, when, where, and why types of ques-tions when introducing the story and teaching the social skills associated with the story. These stories have been used to help students engage in the gen-eral education setting through teaching changes and new routines, reasons for different people’s actions, and teaching social skills. However, they suggest that these stories are intended to be flex-ible, and the teacher should avoid using absolute language (e.g., always vs. sometimes). They can also be introduced in a format where teachers can create comics with their students, one panel at a time, to teach and introduce the same social skills.

Video Modeling

Video modeling draws on the benefits of mode-ling for teaching children a wide range of social skills through observation (Bandura, 1977). This often involves an individual watching a video demonstration, and then engaging in some form of practice executing this newly learned behavior (Bellini & Akullian, 2007). This can be done with peers, siblings, adults, or the individual

themselves can serve as a model, known as video self-modeling (VSM) (Dowrick, 2000). In addi-tion, skills gained from VSM have been reported to generalize across settings and can be main-tained for an extended period of time after the intervention (Dowrick, 1999).

Bellini and Akullian (2007) performed a meta-analysis exploring the effectiveness of video mod-eling and VSM interventions for individuals with ASD. They found that video modeling and VSM were very effective in promoting social commu-nication and functional skills for individuals with ASD, and have the potential to generalize across settings. They further suggest that this is an effec-tive strategy because the recorder has the ability to remove irrelevant components of the modeled skill or behavior through the editing process. This in turn promotes opportunities for the viewer to better focus on the most important aspects of the targeted social skill or behavior. Furthermore, they posit that this technological intervention can be conducive for individuals with social anxiety since it can be implemented with limited human interac-tion. Another potential benefit is that it capitalizes on culturally relevant tools involving the use of technology that have broad appeal to both indi-viduals with autism and typical peers.

Multimedia Technology

Another technological approach for promoting the social skills of individuals with autism has been the use of different types of computer software. Golan and Baron-Cohen (2006) suggest that using computer software as an intervention offers many advantages, since it falls more within a systems-oriented perspective; there is a relatively higher degree of predictability, consistency, and it does not require the social demands that may serve as a hurdle for many learners on the autism spectrum. Using computer software they developed, Golan and Baron-Cohen (2006) found significant improvement in recognizing complex emotions and mental states derived from faces and voices; Silver and Oakes (2001), using different software (The Emotional Trainer), found improvement in predicting emotions generated by external stimuli and mental states; and Lacava, Golan, Baron-Cohen, and Myles (2007) found, using The Interactive Guide to Emotions (Baron-Cohen, Golan, Wheelwright, & Hill, 2004), improvement in recognizing basic and complex emotions in faces and voices as well.

Lacava and colleagues (2007) suggest this soft-ware can be implemented in multiple settings (e.g., home and school); can foster relationships since it



can be used by different populations; be a tool for diverse professionals (e.g., teachers, speech thera-pists); supplement social skill instruction; serve as a tool for reinforcement; and be applied in congru-ence with other approaches (e.g., Social Stories).

Social Skills Groups and Special Interest Areas

While there are a wide range of social skills group interventions designed for individuals with autism (Reichow, Steiner, and Volkmar, 2013), those that incorporate special interest areas (SIAs) are gain-ing considerable attention (Winters-Messiers, 2007). Overall, social skills groups vary consider-ably, but most often are designed for children aged 6 and up, include up to six group members, and are led by up to three facilitators. Most meet once a week, for 12 or more weeks, and each session is approximately 60–90 minutes. Sessions are most often described as being structured, focusing on a specific skill, where the skill is modeled, used in activities (e.g., role playing, games), discussed, and members provide feedback to each other. Reichow et al. (2013) conducted a systematic review of a wide range of scholarly articles that investigated the efficacy of social skills groups for improving social behaviors, social communica-tion, and quality of life for individuals with autism ages 6–21 years. They specifically found that participants who engaged in this approach signifi-cantly improved their social competencies and quality of friendship.

Incorporating highly preferred activities or SIAs in social skills group interventions offers unique opportunities for enhancing the socializa-tion of individuals with autism. Although some may argue that SIAs are examples of repetitive and obsessive behaviors, others posit that, from the perspective of the individual with autism, these behaviors are also a source of joy and posi-tive experience that can enhance personal devel-opment (Mercier, Mottron, & Belleville, 2000). Other researchers represent SIAs as ‘passions that capture the mind, heart, time, and attention’ of individuals with autism in order to help them make sense of the world (Winter-Messiers, 2007) that allow for more of strength-based understand-ing (Jordan & Caldwell-Harris, 2012).

It has been suggested that SIAs are inherently rewarding and reflect information processing styles and cognitive strengths (Caldwell-Harris & Jordan, 2014). Despite having relatively more repetitive or obsessive qualities, SIAs are not seen as static, but rather as dynamic (Mercier et al., 2000). Mercier and colleagues found that these

interests develop over time, in terms of content and how it occupies an individual’s life. Furthermore, they posit that individuals with autism develop strategies to adapt these interests to the demands of their social world, thus suggesting that they are sensitive to social pressures (Mercier et al., 2000).

Caldwell-Harris and Jordan (2014) posit the argument that SIAs exist on a continuum, from interests that require more empathic skills (e.g., relatively larger granularity) to interests that require more systemizing (e.g., relatively less granularity). Typically developing individuals tend to have more interests that utilize empathic skills (e.g., casual conversation with friends, play-ing interactive games) while individuals with autism have more systemizing oriented interests (e.g., computer programing, collecting and put-ting together model airplanes). Through in-depth interviews with individuals with autism, Winter-Messiers (2007) found that SIAs related to per-sonal self-image, and often served as a coping mechanism, a source of happiness, and pride, whether physically engaging in it or thinking about it. Her research also showed benefits in the areas of non-verbal communication skills (e.g., more animation in gesturing, enthusiasm in tone, and complexity of responses) and the ability to regulate negative emotions and cope in stressful situations.

concluSIon

This chapter focused on the socialization of indi-viduals on the autism spectrum across meaningful socio-cultural contexts. We presented founda-tional theories and a selection of pertinent inter-ventions that highlight ways to address socialization issues through interacting with adult caregivers, engaging with peers in play and other culturally relevant experiences, and participating in cooperative and collaborative group activities.

One of our implicit aims included overcoming the many misconceptions about how to interpret the socialization issues individuals with autism face. Often, studies will compare social behaviors of individuals with autism with typically develop-ing peers, and find differences between their per-formances on a given task. However, in doing so, it is very easy to focus on the social behaviors that individuals with autism fail to exhibit, thus sub-scribing to a deficit perspective. Such perspectives run the risk of grossly underestimating the present capacities and emergent potential of individuals with autism in the area of socialization. In addi-tion, the capacities needed to socialize should not



be viewed as ‘light switches’ that simply turn on and off, as though some people have social skills, and others have none. Rather, these capacities must represent a gradient of individual differ-ences, which exist not only within people across the autism, but also within the neurotypical popu-lation at large. This allows us to adopt a neurodi-versity perspective, one that stems from the idea of neurodivergent ways of relating, communicating, playing, thinking, and learning. Given that there is no one-size-fits-all approach, we hope that the the-ories and interventions presented in this chapter will help to enhance your toolkit as practitioners to further inform and serve the unique socializa-tion needs of the individual.

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