Saturday, March 19, 2011

Conversational Skills & HFA/Asperger's

Reciprocity in conversation is generally a struggle for individuals with ASD and during evaluations we specifically look at this skill (among many others) when determining a diagnosis.  It is important to look not only at how often an individual follows up on our conversational leads, but also at the quality of the person's responses and initiations. What we find is that many individuals with ASD can carry on a seemingly natural and reciprocal conversation around their intense interests and favorite subjects and may even be asking us a question or two, but when the topic switches to something less familiar or less interesting, it quickly becomes clear how awkward and one-sided it is.

 Generally we don't even notice how much we are carrying the conversation by asking question after question and probing more and more. When assessing someone's conversational and communication skills, however, it is important to hold back and pay attention to how often he/she initiates (asks us a question or gets us involved socially). How persistent is the individual in getting our attention? Does he/she make eye contact? Can you follow the train of thought? Oftentimes the person may assume that we have more information about his/her personal experience than we do and start a story about "Aunt Joan" in the middle, not realizing that we have no idea who Aunt Joan is in the first place! These are all common difficulties we see when working with individuals with HFA/Asperger's so what can we do to help develop these skills?

** Provide Conversational Topics/ Have a Time To Talk about Preferred Topics:

You may have heard of the term "Theory of Mind." This means understanding that other people have thoughts and feelings that are different from your own. This can be hard for many individuals on the spectrum. Therefore, one reason people with HFA/Asperger's may talk on and on about dinosaurs, computers, Pokemon, or whatever the favorite subject may be is because they do not realize that you may not have the same passion for that topic. Reading social cues, such as when the person is yawning or even walking away from the conversation because of boredom, may not register as disinterest to the person on the spectrum so sometimes we have to bluntly say that we would like to talk about something else.

One way to practice talking about other topics is to put a bunch of different topic ideas in a cup and while at the dinner table, riding in the car, or any other convenient time, take turns picking a topic and talking about it for a few minutes. If a person gets off topic, then you and gently point to the topic in hand to redirect. In schools, I have seen Speech Therapists make cards of "Conversational Topics" on a key ring that kids can put in their pocket and discretely refer to it on the playground when they want to chat with a classmate but aren't sure of how to get that started. Having said that, we do not want to deprive anyone of talking about something they are so passionate about. There is a time and a place for everything so show the person by writing it down on a schedule when he/she can talk all about the favorite topic. Some topics are so driven that even if we verbally say, "we're going to talk about it later," this is too abstract and we need to be more concrete.

** Use Visuals to Specify"Conversational Rules" when Practicing: 

When practicing conversations, it is also helpful to lay down some ground rules when it comes to etiquette and WRITE IT DOWN so the person can refer to the "cheat sheet" when they need to. Again, if a rule is violated (for example, the person is slumping in the chair looking incredibly bored), then you can point to the conversational rule or reminder you have written down so you do not have to verbally prompt again and again. Of course this feels awkward at first, but these are skills that do not always come naturally to people with ASD and we need to practice; It will become more natural over time!

** Emphasize Directing Language Without Stressing Eye Contact:

We have learned from adolescents and adults (and some children) who have articulated this to us that it can be extremely hard to look at a person in the eyes and simultaneously process what he/she is saying. This is perhaps one reason that eye contact can be so hard for individuals on the spectrum; it may actually cause anxiety and make it much more difficult to process verbal information. Therefore, we have moved away from insisting upon eye contact. Instead, we teach individuals to direct their communication by facing the person, perhaps looking at their forehead or ear, tapping their shoulder to make sure they have their attention etc (we will discuss other ways to teach communicative intent for individuals with less verbal language in future posts). Since no two people on the spectrum are the same, we also work with individuals who actually engage in too much eye contact, to the point of staring, which is another issue that needs to be addressed with written rules.

** Use Scripts during Stressful Initiations/ Practice by Role-Playing:

Again, initiating conversation, especially around someone else's interests can be hard for many. Also initiating in group or public situations, such as asking for help at school or purchasing something at the store are skills we also need to practice. One strategy we use is to actually give the person the words by writing them out so they are available to them during a stressful situation. I can't count how many times parents have told us that their child didn't finish their test at school or the EOG because their pencil broke and rather than asking for help, they simply sat there until the testing was over. Was the child just lazy or unmotivated? NO. At that time, the initiation piece of asking for help was just too hard. It is amazing what a difference it makes to simply write out "If I need help, I can raise my hand and say I need help with ___ please."

It is never too early to start thinking about teaching independent skills. Next time you're going to the store with your child, practicing social skills in a group setting at school, or whatever it may be, think about role-playing asking the sale's clerk for help in finding a favorite video game (for example) ahead of time. Video modeling is also big now, which is a great way to make it visual-- don't forget you can always script it out and write it on a note card so our Asperger's/HFA kids, adolescents, and adults have the words during anxious times when the words may escape them. We don't always think about teaching these skills, but visuals and practice can go a long way!

- Molly

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