Assessment of Social Cognition and Related Skills
Assessment for Effective Intervention, 27, 73-80.
Assessment of social skills for students with Asperger syndrome and high-functioning autism
by Michelle Garcia Winner, MA, CCC-SLP, Social Thinking Center, San Jose, CA, USA
Students on the high end of the autism spectrum exhibit deficits in their ability to utilize appropriate social skills across a variety of contexts; however, standardized tests are usually not sensitive enough to identify the significance of these deficits. Social skills are a behavioral manifestation of social cognition. The I LAUGH Framework will be introduced to summarize areas of social cognition that are generally weak and impacts students' abilities to comprehend and participate in academic assignments as well as socially relate with others. A 5-step approach to assessment will be reviewed to more fully provide information regarding the origin and nature of students' social cognition and related skills. Informal assessment tools will be defined and described.
The demonstration of adequate social skills to initiate and maintain a diverse set of social relationships is a fundamental deficit in persons with Autism Spectrum Disorders (ASD). ASD generally consists of persons with Autism, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and Asperger Syndrome (AS), representing students with a large range of intellectual functioning and social abilities. Professionals often arbitrarily designate more specific labels to persons with autism to indicate their functioning level. B.J. Freeman (1999) defines "lower functioning" as those persons with verbal and non-verbal intelligence quotients (IQ) below 70. Persons who are considered "mid-functioning" are those whose nonverbal IQ's are above 70, but their verbal IQ's are below 70; persons with autism who are considered "high functioning" are those with verbal and non-verbal IQ's above 70. It is important to recognize that the use of the term "high-functioning" does not imply that the person is "high functioning" when compared student's peer group. While it may be easy to recognize the lack of ability to socially relate in students who are non-verbal or lower to mid-functioning, it becomes quite complex when assessing students who have language skills, have some friendships and/or are intellectually quite astute.
For students who function on the high end autism spectrum, such as those with High-Functioning Autism (HFA), PDD-NOS or Asperger Syndrome these labels do not pinpoint the range and extent of a student's social skill deficits, nor do they mandate specific treatments for any student with ASD (Waltz, 1999). Thus understanding and identifying the many and complex variables that interrelate to form a person's "social skills" are mandatory for professionals engaging in this type of assessment process.
Social skills are a behavioral manifestation of social cognition (Minshew & Goldstein, 1998; Loveland, Pearson, Tunali-Kotoski, Ortegon & Gibbs; 2001; Travis, Sigman & Ruskin, 2001). For example, the simple act of socially greeting another person while walking by them requires an underlying social intent that is demonstrated through a chain of events which generally includes initially establishing momentary eye-contact, physically moving into close proximity of the other person, performance of a communicative signal whether it be physical (waving "hi") or verbal (saying "hi") while simultaneously re-establishing eye-contact, showing a facial expression that acknowledges some aspect of pleasure (a small smile or relaxed face) and then recognizing to terminate the greeting when the person has passed by. The type of communicative signal utilized by a skilled communicator is also dependent on the social or environmental context in which the greeting is performed. A teenager is likely to perform a different communicative signal when acknowledging a peer than when acknowledging a grandparent; or when greeting a person at a funeral when compared to a wedding.
Defining components of social cognition
Students with ASD are frequently described as having "social cognitive deficits"(Schopler, Mesibov & Kunce, 1998) which implies that the underlying cognition fails to support the presentation of "appropriate" social skills. This core cognitive deficit appears to be the result of syndrome of weaknesses that would support the development of social cognitive knowledge. A number of theories have significance in understanding genesis of the behavioral outcomes, or social skills of persons with ASD. Central Coherence Theory (Frith, 1989; Happe, 1994) speaks to the fact that most persons on the autism spectrum are weak in their ability to conceptualize whole chunks of information; they demonstrate a preference for attending to details and relying on their rote memories to make sense of the ever-changing world around them. A lack of cognitive central coherence or gestalt processing can easily cause a person to miss the importance of the subtle cues that create meaning in a social context including the difficulty of intuitively understanding the main idea of a conversation or a passage in literature. Executive Dysfunction (Ozonoff, Pennington & Rogers, 1991; McEvoy, Rogers & Pennington, 1993; Hughes, Russell & Rogers, 1994; Russell, 1997) is similar in that it acknowledges that these students are weak in their ability to orchestrate tasks towards a desired outcome. Executive functioning does not have one definition agreed on by researchers, however, it is generally considered to describe the set of skills an executive would need to stay on top of his or her job; planning, organizing, prioritizing, multi-tasking. Executive dysfunction may make it difficult to maintain a topic in a conversation as the student with ASD has difficulty maintaining a sense of order in his spoken messages often producing tangential responses, he or she may also have difficulty with the organization of written expression or independently planning to complete class assignments. Theory of Mind (ToM), (Baron-Cohen, 1995) establishes that persons with ASD have difficulty considering the perspective of others, such as their emotions, motives and intents. By failing to account for other's perspectives, persons with ASD tend to misinterpret their messages (Tager-Flusberg, 2000). Persons with ASD also tend to talk at length about their own topic of interest because of their difficulty monitoring and responding to the social cues/social needs of their communicative partner. Twachtman-Cullen ( 2000) indicates many of the social skill deficits observed in persons with ASD may have their genesis in these students lack of ability to decipher subtle meaning from their environment in part due to all of the above mentioned theories; in other words, these students have a global processing deficit.
The I LAUGH Framework was developed to provide an overall model of social cognitive deficits. "I LAUGH" is an acronym that represents the following concepts:
- difficulty initiating language or action for interactions or tasks that are not routine.
L=Listening with one's eyes and brain:
- difficulty with auditory processing as well as visual processing of the subtle cues provided in social interactions that facilitate social knowledge.
A=Abstract and inferential:
- difficulty deciphering meaning from abstract language and non-verbal cues provided both through student's curriculum tasks as well as through social interaction.
U=Understanding the perspective of others:
- difficulty interpreting the motives, emotions and intents of others, which is fundamental for successful social interpretation and social regulation.
G=Getting the big picture or gestalt processing:
- difficulty recognizing and comprehending underlying concepts
- these students often demonstrate a lovely sense of humor but may fail to use humor appropriately given particular contexts.
The intent of the framework is to demonstrate how complex social skills, such as maintaining a conversation or personal problem solving, actually require a symphonic coordination of the I LAUGH Framework's cognitive components for a person to behaviorally demonstrate social the use of appropriate social skills. These same cognitive components are also required for academic success across a school day, such as working as part of a group, understanding what the teacher is implying and understanding the motives of the character being explored in a book of literature. The framework also helps professionals to understand that social skill assessments need to go beyond whether a student maintains a friendship with others, or whether he or she can politely answer the interview question of the diagnostician. The appendix summarizes how the components affect social relationships as well as academic performance across a school day. From this author's experience, there is a tendency for professionals to talk to caregivers about the fact that a student has an autism spectrum diagnosis without clearly articulating the functional components of a student's strengths and weaknesses that are pivotal in understanding not only how the diagnostic label applies to that child, but also how to create related specific treatment strategies to help the child improve. The purpose of the social skill assessment is to help clarify this information.
Limitations of Standardized Tests In The Assessment of Social Skills
Standardized assessment tools, which are often the tool of choice for busy clinicians and diagnosticians, generally provide the least amount of information about students' social skill abilities, or social pragmatics. Standardized test formats can actually destroy the social pragmatic assessment. The spontaneous nature of social skills defies assessing it through the more traditional structure of standardized test. The production of appropriate behaviors that are interpreted as our social skills require that multiple communicative signals to be spontaneous processed and immediately reacted via the encoding of a multi-layered (verbal and nonverbal) response that is appropriate in form as well as function given the communicative context. Most importantly this rapid exchange of communicative signals should remain fluid in that communicative partners should not actually notice the application of each person's social skills; the skills themselves are expected but not to be obviously detected. For example, when a student is conversing with a classmate, and the student wants to change the topic he is to do it subtly so that the classmate barely notices the transition. On the other hand, if the student announces, "I am now going to change the topic" the student's attempt to utilize a social skill is detected by the classmate and considered inappropriate.
In contrast to complex communicative environments, standardized tests are designed to study discrete skills that can be stripped of most competing variables. For example, when a speech language pathologist tests a student's auditory processing the assessment battery generally requires the student be tested in a quiet environment of not more than 25 decibels of noise, regardless of the fact that the student is virtually never exposed to that quiet environment when he has to process the messages from his teachers and fellow students across a school day.
The Test of Pragmatic Language or TOPL (Phelps-Terasaki & Phelps-Gunn, 1992) was created as an attempt to standardize an assessment of pragmatic language. The result is that the test appears to explore more superficial social knowledge, rather than account for the complex variables of pragmatic language required in spontaneous discourse. For example, on this test battery the student is presented with a social scenario in which a girl wants to borrow a crayon from a boy. If the student indicates that the girl should say, "please" while asking to borrow the crayons the student gets credit for the correct answer. The reality is that this type of assessment instrument is often quite easy for many higher-level students with Asperger Syndrome to pass with scores in the 30th percentile or above. While this test may help to quantify deficits in students with ASD who have more severe social impairments, its results often confuse the assessment process for higher-level students. For example, the TOPL was the primary assessment tool used for a 10-year-old boy with Asperger Syndrome, who was reported as having tremendous functional difficulties relating to his peers and teacher across the school day. However, when he scored in the "average" range on this test an assessment report stated, "Sam, a boy with Asperger Syndrome, does not have social pragmatic deficits as measured by the TOPL".
The production of appropriate social skills is also not linked to intelligence as measured on traditional tests of intelligence (Frith, 1989; Wetherby, Prizant & Schuler, 2000). It is not uncommon that students on the higher end of the autism spectrum with tremendous language skills and least average IQ's also have significant deficits in their ability to use language effectively to develop appropriate relationships with others. These students are considered to have weak pragmatic language or social pragmatic skills.
Structuring The Assessment of Social Cognition and Related Skills
The assessment of social skills requires diagnosticians to set aside the more traditional belief that results of formalized tests provide the most valid information about an individual, and recognize that the diagnostician's quest is to explore more functional and complex components of human relatedness. Furthermore it is critical to understand that social skills emanate from our knowledge of communication and language use. Typically developing persons regulate social skills, which includes the formulation of language appropriate to the moment, through intuitive knowledge of how others perceive the message of the speaker and/or by reading other related contextual cues. Speech Language Pathologists' professional objectives include assisting persons in their communicative abilities; therefore it is quite appropriate for these professionals to be central in the assessment and treatment process when working with persons with social cognitive deficits. However, any type of medical or educational professional may complete an assessment of a student's social skills. There is no single profession that monopolizes this type of evaluation.
The assessment itself is multi-faceted, pulling information from a variety of sources and contexts. A thorough assessment of social skills includes: (a) observing the student with his peers and in different environmental contexts; (b) the diagnostician relating with the student without facilitating the student's social success; (c) a battery of informal assessment tools; (d) administering carefully considered standardized measures; (e) interviewing teachers and parents with regard to the students social cognition and social behaviors
Observing The Student With His Peers And In Different Environmental Contexts
The school environment is typically the most complex social environment in which the student participates. Observing the child in this environment is ideal and should be a priority for diagnosticians who work within this setting. Observation of the student with his peers is critical given that peers appear to be the quickest to assess social aptitude. While older students are more forgiving of a younger student's weak social skills and younger children are not as attentive to these details, the student's peer group is the most critical, while also having the most direct contact with him or her across the school day.
Observation of the student should be done in structured (classroom) and unstructured (recess or lunch break) settings. Upon completion of the observation the diagnostician should also ask a teacher or other familiar caregiver if the behaviors observed that day were typical of the student's day-to-day functioning. This allows for caregivers to provide descriptions of a student's behavior beyond the baseline of the observation.
The observation itself should allow for you to monitor a student over a block of time lasting at least 15 minutes in each environment. During this time it will be important to observe not only how he initiates relationships with others but also how the student sustains them during the unstructured time. During structured time it is important to observe how the student participates as part of the classroom by focusing attention, seeking assistance, engaging productively in assignments and responding to the needs of the teacher as well as the other students.
The observation is not only of the student himself but also of how the peers respond and relate to the student's approaches, or lack of social approach (Winner, 2000). In fact, observation of the peer group often guides professionals in their understanding of what is considered to be appropriate social behaviors for the specific context in which the student is functioning. Each social environment has its own set of expected social behaviors that can vary from campus to campus and/or classroom to classroom. The observation, in part, is to determine if the student is socially savvy enough to identify how to modify his own behavior to meet the needs of the varied social contexts in which he communicates. Taming the Recess Jungle (Gray, 1993) is a booklet that provides further information when assessing a child's understanding of the abstract social environment of recess.
Interacting With The Student Without Facilitating The Student's Social Success
Adults facilitate interactive success when relating to students by simplifying and rephrasing unanswered questions, maintaining topics that have no real interest to the adult listener or allowing a child to engage in a monologue type interaction even though the student fails to demonstrate any significant interest in the adult he or she is speaking to. As professionals assess a student it is important that they devise methods to interact with students that purposefully overrides the tendency for the adult to facilitate success during this discourse. This author is not familiar with any readily available standardized assessments that actually monitor or measure social pragmatic skills while the child is actively engaged in discourse.
This author has devised an informal assessment of interactive skills to probe a student's ability to shift perspective, formulate questions about others and maintain a topic around another person's areas of interest. The informal assessment technique is referred to as "the double interview". The double interview encourages a student to engage in an interaction with diagnostician across 2 contrasting contexts: when the diagnostician interviews the student, and when the student interviews the diagnostician.
The Diagnostician Interviews The Student
Interviewing a student about his or her life is a fairly typical procedure when initiating an assessment. During this interview questions are asked that help to explore the child's awareness of his strengths and weaknesses, his friendships and his personal interests.
While gathering the information about the student the diagnostician notes the student's ability to respond appropriately to the questions, maintain eye-contact while producing other non-verbal social skills such as appropriate body language, proximity, tone of voice, loudness of voice and facial expression during the interaction. Upon completion of the interview, the diagnostician summarizes for the student the information learned based on the student's responses to the questions. For example, the diagnostician will say, "I learned that you go to Wilson school and Mrs. Hart is your teacher. You love math and don't like to write. All the students in your class are your friends. You live at home with your mom, dad and a little sister named Robyn. You have cats named Stephanie, Heidi and Reesa. Your favorite thing to do at home is play Nintendo."
The student makes inferences about pictures of the diagnostician's family
Immediately after the interview, the diagnostician explains that the student has come their office and has told the diagnostician neat information about themselves, but that the student knows very little information about diagnostician. He or she then explains that it is only fair that the student be allowed to interview this adult as well. However, to help with the interview the diagnostician presents the student with a carefully selected set of photographs that provides the student with visual information about the adult. For example, this author uses 3 pictures, one where she is pictured with her husband, one with her husband and her two daughters, and one with her husband playing in a jazz band. The student is then asked to interpret why this author has these pictures on her table. From this author's clinical experience, the majority of the students can accurately describe the relationship of the persons in the pictures to the author, and with an initial cue they can explain the importance of the jazz picture being that the author's husband plays trombone in the band. However, a significant number of the students who make errors have great difficulty accurately interpreting these relationships. Common errors include students not recognizing the author in the pictures, describing the author's husband as her "father", her daughters as "her friends", and/or cannot identify the easily recognized tall and skinny husband as a member playing in the band. The significance of the use of the photographs is that they help to reveal deficits related to a students ability to recognize faces and/or his ability to make functional inferences (not being able to recognize a husband, wife and 2 children as being a "family"). Not all persons with social deficits have difficulty recognizing persons through their facial features, but for those that do this one "screening" task may be revealing. Many persons with social cognitive deficits are weak at making inferences, which requires them to take what they know and make a guess. Weak inferencing skills may result from not being able to take perspective of the diagnostician or not accounting for contextual cues (e.g. when a student summarized that the author and her husband were actually the author's grandparents, not accounting for the cues of age and fashion). The photograph analysis task serves as one of many different ways to "screen" functional inferencing skills. After a student has provided explanations of the photographs, the diagnostician clarifies any confusion to ascertain that the student does understand the accurate interpretation of the pictures before advancing to the next task.
The Student Interviews The Diagnostician
Upon completion of the photograph identification task, the student is encouraged to begin the interview of the diagnostician. The diagnostician can remind the student that the adult asked the student questions about his or her life and now it is only fair that the student is allowed to do the same with the adult. The diagnostician again reminds the student that he or she can use any information they see in the office to generate questions to the adult, including the photographs, which are still positioned in front of the child. A cue card can also be presented to the child with words on it that are used to ask questions such as "who, what, when, where, why and how".
During the interview process it is critically important that initially the adult does virtually nothing to facilitate the students success in creating a good interview. After the evaluator has clearly explained what an interview is and discussed how questions are different from comments, his or her job is to sit and wait to be questioned by the student, while also noting the child's responses, or lack there of. This is often a very quiet time. If a student is demonstrating anxiety from the task, the diagnostician can assist in creating some structure for the student. For example, four small squares can be drawn on a piece of paper and the student can be told he only has to ask four questions to complete the interview. If the student still struggles to produce questions about the diagnostician, one of the photographs is shown to the student and he or she is encouraged to ask a question about a specific person in the photograph. Typically, the students are encouraged to ask questions about the author's daughters, since they are closest in age to the student.
Typically, students with social cognitive deficits have a very difficult time with this task. The interview process appears to require specific skills that are prerequisite to communicative inquiry of another person in that this context requires:
- A shift in perspective taking from the student thinking about the student to the student thinking about the diagnostician.
- The ability to formulate questions to inquire about the diagnostician.
- Organization to follow one question up with a related question.
- The ability for the student to minimize self-referencing comments in an effort to learn about the diagnostician.
- Production of non-verbal aspects of communication that should be in sync with the verbal message forming clear communicative intent.
All of these skills are prerequisite to successful communicative interactions. If the diagnostician can more specifically explore a student's abilities in these areas, he or she can also help to develop a more functional treatment program that works specifically on enhancing the cognitive knowledge and related social and language skills that support each of these areas. These are fundamental skills that are usually overlooked through more formal assessment procedures.
Typical Responses Of The Double Interview
Anecdotal reports from diagnostician's using this format is that it is fairly unusual for a student with social cognitive deficits to conduct what might be considered a "healthy" interview. The vast majority of students' (3rd grade through adulthood) attempts to conduct the interview result in vague unrelated questions about the diagnostician, if the student is able to initiate any form of verbal interaction. The types of responses the students produce often consist of:
Comments about what they see in the photographs, with a failure to produce related questions. For example, a 9-year-old student said, "I see you have a husband and 2 girls, that's all I need to know about you."
Asking questions that relate specifically to the student's areas of interest. For example, one teenage boy inquired, "Have you ever thought about cryogenically freezing a gopher?" when the response from the adult was "No", he then elaborated on the process of cryogenics and his fascination with it.
Not formulating any questions at all. For example, when a 20-year-old man, who works at a department store, was requested to interview me, he literally dropped his head onto the table and responded, "I can't do that!"
Formulating isolated questions that fail to follow up with any previously discussed topic or thought. Thus, follow up questions are not used by many of the students to gain access to deeper levels of information.
The student asks the diagnostician the same questions that were asked of the student when he or she was interviewed.
The contents of the interview, when complete often reveal that a student who was remarkably verbal when discussing himself and his own thoughts, becomes remarkably non-verbal or minimally verbal when directed to only talk about someone else's thoughts or interests. It also appears that the double interview may yield distinct information about students' interactive communication abilities. It is not uncommon for the diagnostician to recognize how difficult it is for a student to formulate questions during the task and then ask the student, "Do you often have difficulty thinking of questions to ask when you are with your friends?" Students often affirm that this is a very difficult process and they then acknowledge that they are willing to work on it in therapy.
The results of "the double interview" appear to be quite revealing of significant social-pragmatic deficits. Standardizing the process and researching its significance in helping to define areas of abstract social skill deficits would be exciting.
Informal assessment tools
Using picture sequences to explore gestalt processing
The socially themed picture sequencing task provides information about how the student is able to create a gestalt from contextual cues in the pictures combined with the students' own life experiences. This type of information helps to reveal how well a student is able to organize themselves around conceptual thinking, which is a critical skill for school related tasks such as reading comprehension, written expression and playing games with others on the playground.
Present students with picture sequences that describe social themes the student should have experienced themselves, such as a birthday party. Boxed picture sequence sets are readily available from publishers of speech and language materials. Depending on the age of student, utilize picture sequences that vary in length from 3-8 pictures; it is imperative that the student understands the language concept of "first and last" to proceed with this task. Upon presenting the child with the set of unorganized pictures, observe:
The strategy the student utilizes to begin to create the organizational structure of the story.
Monitor how the student evolves through creating the sequence; does he or she understand the progression of events?
Can the student recognize his or her own errors, once they begin to tell the diagnostician the story using language to describe the sequence they created?
Monitor the student's problem solving skills, once the student has recognized an error or the diagnostician has pointed out an error, can the student create a new sense of organization without loosing track of which pictures are already in the correct order.
From this author's clinical experience, some students demonstrate errorless, rapid sequencing, demonstrating the ability to comprehend basic level stories and an understanding of the contextual cues in each picture. Some students demonstrate difficulty establishing an order by which to sequence the pictures; they appear overwhelmed by the information. This implies a need to probe more deeply the organizational issues the child may have as well as his or her ability to recognize contextual cues and make related inferences as these skills may affects a student's understanding sequences presented in classrooms as well as reading comprehension skills. More specifically, some students demonstrate difficulty interpreting the meaning of the people's body language in pictures that would affect one's ability to make appropriate inferences. For example, the final picture in the birthday party sequence is of a boy leaving a party with a bunch of balloons, walking towards the car with him mom, while turning back and waving "goodbye", however some of my students interpret that picture to illustrate that the boy is coming to the party. Some students also demonstrate difficulty establishing the relationship of persons in the pictures (mother, grandmother, birthday boy, friends). This again affects the ability to interpret the gestalt. These students may also be demonstrating difficulty reading faces and body language. This information should be noted an more fully explored across time.
The sequence task for younger or lower functioning students
Some students cannot complete with socially themed sequencing task, when provided with this task they appear confused and their attempts to complete it are haphazard. These students appear to have a significant deficit in their ability to socially interpret the world around them. They appear unable to recognize meaning in social contexts. This is a typical response of a student who is younger and autistic. These students generally do far better on sequencing daily living activity pictures (pictures that show the stages of tying a shoe, or pouring orange juice). It is important to make the distinction between sequencing functional tasks and sequencing socially themed information, since gaps in a student's knowledge can significantly impact reading comprehension regardless of the student's ability to decode text, written expression and social play. Much of the classroom based literature presented to children as early as 1st grade is socially themed and may be a cause for comprehension deficits. For these students it is important to recognize that a source of their errors is in their lack of social knowledge and begin to slowly build a bridge from comprehension or written expression about factual information and then develop techniques to gradually increase awareness a student's awareness of how to interpret social themes. Currently, educators typically expect all students to be able to interpret social information as presented in the curriculum, even for students in classroom for the autistic. For some students with autism, even those who are excellent decoders, they may never be able to make sense of socially themed literature, but their reading decoding skills can be of a tremendous benefit in helping them learn to follow directions to gain skills towards independence.
Interpreting social scenarios through photographs
Isolated photographs that depict social scenarios can also provide valuable information on how a student interprets visually presented information to infer the social understanding. These are available in boxed picture sets often referred to as "emotion and expression" cards through speech and language publishers. When a student is presented with a photograph, the diagnostician asks the student to describe what is happening. For example, a 12-year-old boy, with high intelligence who had recently stopped attending his public school do to "school phobia" was presented with a picture that illustrated a woman standing behind a counter in a café handing the bill to a male customer, both persons were roughly the same age. The customer's take-out order was ready on the counter. The man stood, facing the camera, looking perplexed with his hands in his pulling out his empty pockets and his wallet open demonstrating that he had no money. When the was student as asked to describe what was happening in the photo, the student adopted the vocal features of a female and stated "honey, I told you one day we would run out of money!" Clearly this student had not considered many of the contextual cues of this photograph, and was relying on the fact the man and woman were roughly the same age when he demonstrated his opinion of the meaning of the picture. He continued to make errors in "reading" the picture, until the faces of the two people were covered up and he was asked to look at other information in the photo. Only at this time did he then consider the pictured context and the actions of the people to accurately interpret the photo. I light of this information it is easier to understand why this student is feeling stressed in the ever-changing environment and social contexts of middle school.
Many of the errors made by students with social cognitive deficits in their social relatedness as well as in their academic work, are from a lack of their ability to consider and comprehend contextual information. Devising informal assessments to explore a student's ability to abstract and infer information from contextual clues is another important feature of determining the depth and extent of social skill deficits. Ultimately it would be ideal to standardize these types of assessments, but currently it is most important to gain accurate and insightful information about a student to assist with creating a practical and beneficial treatment plan.
Administering carefully considered standardized measures
Standardized assessments provide relatively little information about the depth of social skill deficits. However, selected tests have clear value as part of the total assessment process. Psycho-educational assessment batteries that explore a students IQ as well as academic achievement help to define students' abilities to learn new information as well as pinpoint more specific academic strengths and weaknesses. From this author's experience the only academic test that may be weaker in accounting for students weaknesses are tests of reading comprehension. These tests provide fairly short samples of written text that a student is to read and answer increasing complex inferential questions. If a student scores well on this test it is assumed that he or she can then apply that level of reading comprehension to lengthy book of literature, however, many of our students who have difficulty understanding the gestalt and/or making social inferences do not seem to be able to maintain that same level of comprehension across an entire book. This may become cause for frustration and task resistance on the part of the student.
With regard to more language based testing, it is important to recognize that students who have good basic expressive and receptive language skills can still have remarkable problems with social understanding, this is the nature of students with Asperger Syndrome. Administering more traditional tests of expressive and receptive language to students who teachers report have good syntax and vocabulary may not be a good use of time since they often fail to reveal any deficits and perpetuate the notion that this student functions within normal limits on all aspects of language.
Standardized tests that can be of value for gaining better insight into the challenges of bright students with possible social cognitive deficits are tests that explore critical thinking skills particularly related to personal problem solving, determining the main idea, and those that assess ones ability to infer or abstract language based information. All that being said, always keep in mind that standardized assessments create an artificial structure and context that is more easily interpreted than the analysis of language cues in a "live" moment of interaction. Tests that have multiple-choice answers to test probes help to provide further structure, which can artificially increase measured test performance. Some tests this author utilizes that meet the above criteria include: The Test of Problem Solving, TOPS, Elementary and Adolescent Versions (1992); subtests that assess supralinguistic information on the Comprehensive Assessments of Spoken Language, CASL, (Carrow-Woolfolk, 1999); The Listening Test (Barrett, Huisingh, Zachman, Blagden, Orman, 1992). As mentioned earlier, this author actively avoids giving standardized tests of pragmatic language to any student who is functioning with an average IQ or above.
Interviewing teachers and parents about the student's history and current experiences
A critical component of any diagnostic assessment for students with possible social cognitive deficits is an interview with the parent and/or close caregiver. The Asperger Syndrome Diagnostic Scale ASDS, (Myles, Bock & Simpson, 2001) and the Gilliam Asperger Rating Scale, GADS, (Gilliam, 2001) have recently been published to explore the more atypical language, social, sensory and organizational development we might expect to observe in students with Asperger Syndrome. Neither scale is designed to be the single instrument used to make a diagnosis, but each is useful for directing the evaluator to explore the more specific nature of developmental issues associated with persons with Asperger Syndrome. The information they elicit is valuable and serves as an excellent supplement to social-pragmatic observations and deeper informal and formal assessments of language.
The Walker McConnell Scale of School Competence and Social Adjustment, Adolescent and Elementary versions (Walker & McConnell, 1995) is useful for evaluating a student's behavior across the school day. This scale is designed for teachers to score after working with a student for 8 weeks. The elementary version explores behaviors in three subscales: teacher preferred social behavior, peer-preferred social behavior and school adjustment behavior. The adolescent version explores behavior across 4 subscales: self-control, peer-relations, school adjustment and empathy. These scales provide standardized scores as well as good descriptive information about a student's behavior across these contexts.
Social skills are a manifestation of social knowledge. A student's social intelligence is not directly contingent upon his or her academic intelligence as measured through psycho-educational testing. Thus, it is not uncommon to find very "bright" students having significant social skill deficits, which are difficult to measure and define through traditional assessment procedures. Since few appropriate standardized assessments exists, the importance of utilizing informal assessment tools is stressed in this type of evaluation.
Appropriate social skills are a demonstration of subtle but complex social knowledge. To more fully understand the origin of social skill deficits it is important to gain further knowledge about a student's ability to process and react to different types of socially based information. The "I LAUGH Framework" describes different components to consider in the evaluation of students suspected as having social cognitive deficits.
Mandatory components of an assessment of high-level student's social skills include: (a) observing the student with his peers, across different aspects of his environment, (b) relating with the student without facilitating the student's social success, (c) informal assessment tools, (d) administering carefully considered standardized measures, (e) interviewing teachers and parents about a student's daily functioning.
The result of a more interactive, informal assessment of social cognition is that it provides specific functional information to better define treatment strategies that foster the development of social thinking and related skills. Further research to support and possibly standardize some of the currently used informal assessment tools is critical; however, teachers and families need functional information now to assist students in their quest to develop functional knowledge and related social skills that ultimately help to facilitate independence and interpersonal satisfaction.
Minshew, N. & Goldstein, G. (1998) Autism as a Disorder of Complex Information Processing. Mental Retardation and Developmental Disabilities Research Reviews 4:129-136
Barrett, M., Huisingh, R., Zachman, L., Blagden, C., Orman, J. (1992). The Listening Test. East Moline, IL: LinguiSystems.
Carrow-Woolfolk, W. (1999). Comprehensive Assessment of Spoken Language. Circle Pines, MN: American Guidance Service.
Freeman, B.J. (1999). Autism: What We Know. Handout from lecture. Los Angeles, California.
Frith, U. (1989). Autism: Explaining the Enigma. Oxford. Basil Blackwell Ltd.
Gilliam, J. (2001). Gilliam Asperger Disorder Scale. Austin, TX: Pro-Ed.
Gray, C. (1993). Taming The Recess Jungle. Arlington, Texas: Future Horizons, Inc
Happe, F. (1994). Autism: An Introduction to Psychological Theory. Cambridge, MA: Harvard University Press.
Hughes, C., Russell, J., & Robbins, T. (1994). Evidence For Executive Dysfunction in Autism. Neuropsychologia, 32, 477-492.
Loveland, K., Pearson, D., Tunali-Kotoski, B., Ortegon, J. and Cullen Gibbs, M. (2001). Judgments of Social Appropiateness By Children and Adolescents With Autism. Journal of Autism and Developmental Disorder, Vol. 31, No. 4, 367-376.
McEvoy, R.; Rogers, S. and Pennington, B. (1993). Executive Function and Social Communication Deficits in Young Autistic Children. Journal of Child Psychology and Psychiatry, 34, No. 4, 563-578.
Minshew, N. and Goldstein, G. (1998). Autism As A Disorder of Complex Information Processing. Mental Retardation and Developmental Disabilities Research Reviews, 4: 129-136.
Myles, B., Bock, S., & Simpson, R. (2001). Asperger Syndrome Diagnostic Scale. Austin, Texas: Pro-Ed.
Ozonoff, S., Pennington, B. & Rogers, S. (1991). Executive Function Deficits in High-Functioning Autistic Individuals: Relationship to Theory of Mind. Journal of Child Psychology and Psychiatry, 32, No.7, 1081-1105.
Phelps-Terasaki D. and Phelps-Gunn, T. (1992). Test of Pragmatic Language (TOPL), Austin, Texas: Pro-Ed.
Russell, J. (1997). Autism As An Executive Disorder. England: Oxford University Press.
Tager-Flusberg, H. (2000), Language and Understanding minds: connections in autism. In S. Baron-Cohen, H. Tager-Flusberg, & D. Cohen (Eds.), Understanding Other Minds, Perspectives from Developmental Cognitive Neuroscience (pp. 124-149). England: Oxford University Press.
Twachtman-Cullen, D. (1998). Language and Communication in High-Functioning Autism and Asperger Syndrome. In E. Schopler, G. Mesibov, & L. Kunce, (Eds.), Asperger Syndrome or High Functioning Autism? (pp. 199-225). New York: Plenum Press.
Travis, L., Sigman, M. and Ruskin, E. (2001). Links Between Social Understanding and Social Behavior in Verbally Able Children With Autism. Journal of Autism and Devlopmental Disorders, Vol. 31, No. 2, 119-130.
Walker. H. & McConnell, S. (1995). Walker-McConnell Scale of Social Competence and School Adjustment, Adolescent Version. San Diego, CA: Singular Publishing.
Waltz, M. (1999). Pervasive Developmental Disorders, Finding a diagnosis and getting help. Sebastopol, CA: O'Reilly & Associates Publishing.
Wetherby, A., and Prizant, B. & Schuler, A. (2000). Understanding The Nature of Communication and Language Impairments. In A. Wetherby, & B. Prizant (Eds.) A Transactional Developmental Perspective, (pp.225-249). Baltimore, MD: Paul Brookes Publishing Co.
Winner, M. (2000). Inside Out: What Makes The Person With Social Cognitive Deficits Tick? Michelle G. Winner Publisher, San Jose, CA.
Zachman, L., Barrett, M., Huisingh, R., Orman, J. & Blagden, C., (1991) Adolescent Test of Problem Solving; (TOPS-A). East Moline, IL: Linguisystems.
Zachman, L., Huisingh, R., Barrett, M., Orman, J. & LoGuidice, C. (1994). Elementary Test of Problem Solving, Revised; (TOPS-E). East Moline, IL: Linguisystems.
Assessment of social cognition and related skills
Appendix: The I LAUGH Framework for understanding social cognition
How do social deficits affect classroom performance?
Type of Social Cognitive Deficits
How it affects social interaction
How it affects classroom functioning
|I =Poor Initiation of Communication or Action||
|L=Listening with eyes and brain||
|A=Abstract and Inferential||
|U= Understanding Perspective||
|G=Gestalt processing; getting the big picture||