Stacking the deck: teaching social skills to retarded adults with a modified table game

Aging and Engaging: A Pilot Randomized Controlled Trial of an Online Conversational Skills Coach for Older Adults

OBJECTIVE

Communication difficulties negatively impact relationship quality and are associated with social isolation and loneliness in later life. There is a need for accessible communication interventions offered outside specialty mental health settings.

DESIGN

Pilot randomized controlled trial.

SETTING

Assessments in the laboratory and intervention completed in-home.

PARTICIPANTS

Twenty adults age 60 and older from the community and a geriatric psychiatry clinic.

INTERVENTION

A web-based communication coach that provides automated feedback on eye contact, facial expressivity, speaking volume, and negative content (Aging and Engaging Program, AEP), delivered with minimal assistance in the home (eight brief sessions over 4-6 weeks) or control (education and videos on communication).

MEASUREMENTS

System Usability Scale and Social Skills Performance Assessment, an observer-rated assessment of social communication elicited through standardized role-plays.

RESULTS

Ninety percent of participants completed all AEP sessions and the System Usability Scale score of 68 was above the cut-off for acceptable usability. Participants randomized to AEP demonstrated statistically and clinically significant improvement in eye contact and facial expressivity.

CONCLUSION

The AEP is acceptable and feasible for older adults with communication difficulties to complete at home and may improve eye contact and facial expressivity, warranting a larger RCT to confirm efficacy and explore potential applications to other populations, including individuals with autism and social anxiety.

Interventions that support adults with brain injuries, learning disabilities and autistic spectrum disorders in dating or romantic relationships: a systematic review

PURPOSE

To evaluate the current evidence on dating interventions, their theoretical underpinnings and effectiveness for adult neuro-atypical populations.

METHODS

A literature search was completed using CINAHL, Communication Source, PsycARTICLES, PsycINFO, SocINDEX, MEDLINE, Embase, AMED and EMB Reviews (all), for English-language, peer-reviewed studies into interventions for relationships or dating among adults with acquired brain injuries (ABI), learning disabilities or autistic spectrum disorder (ASD). Demographic data and intervention details were extracted for all included studies. Standard checklists were used for methodological quality and intervention description. Narrative synthesis for studies rating above poor quality.

RESULTS

A total of 11 studies (13 articles) were eligible, ABI (n = 6), learning disability (n = 4), ASD (n = 1). These comprised five comparison or control group studies, two pre-post studies and four case studies. The methodological quality was varied, but intervention descriptions were generally poor. While all studies reported positive outcomes, firm conclusions on their effectiveness are difficult due to the high number of before-after analyses and variation in content and outcome measures used.

CONCLUSIONS

More high-quality studies are needed to assess the effectiveness of interventions. Also, greater consensus is needed on the key behaviors for dating and relationships and the measures to assess these.IMPLICATIONS FOR REHABILITATIONIntimate relationships are important to quality of life, but challenging for many people in neuro-atypical populations.There are a small number of researched interventions to support dating or marital relationships among adults with ABI, ASD or learning disabilities.Rehabilitation professionals should ask about dating and relationships and support people if this area is identified as important.Rehabilitation professionals should consider different interventions for dating skills and marital relationships.

An Evaluation of a Game-Based Treatment Package on Intraverbals in Young Children with Autism

The purpose of the current study was to evaluate a game-based treatment package on the acquisition of intraverbals in young children with autism. The treatment package was composed of using a listener response training game (i.e., bingo), providing verbal praise that contained the label for the listener response, and modeling a pretend play action related to the answer. During posttreatment probes, participants vocally answered wh- questions without any supplementary stimuli present and maintained responses during follow-up probes.

The Search for Valid Measures of Social Competence: The Variability and Consistency of Component Behaviour

Measures of component behaviour have been put forward as valid and reliable predictors of social competency. This study assessed the consistency of verbal and nonverbal component behaviours across situations and time. Thirty-seven people participated in an informal conversation with a confederate and a mock job interview with a second confederate. This scenario was repeated three weeks later. Social competency ratings were obtained from the confederates and subsequently from two observers along with specific measures of nine component behaviours. While nonverbal component behaviours were quite consistent across settings and time, verbal behaviours were less so, although none consistently predicted competency ratings across settings and time. Subjects who received high competency ratings were found to behave more variably across settings than those who received low ratings. The findings support the notion that evaluation of social skills training will require measurement of functionally equivalent, rather than topographically defined, classes of behaviour.

Social Skills Training with Chronic Schizophrenic Patients Living in Community Settings

Six patients meeting DSM III criteria for schizophrenia, residual phase who lived in community hostels underwent social skills training. The training programme utilized was “Stacking the Deck” developed by Foxx et al. which involves a structured board game incorporating modelling, behaviour and feedback. A multiple baseline across subject design was used to assess acquisition of targeted social behaviours in the training settings. Generalization of skills to a community setting was assessed by a structured interaction in the patients' homes at pre-treatment, post-treatment and follow-up. All subjects improved their social skills in the training setting, the improvement showed partial but weak generalization to the community setting, with some gains maintained to a three-month follow-up. Pre-treatment, post-treatment and follow-up measures of general social skills and psychiatric status indicated improvements for some of the subjects. The results suggest this approach has promise for achieving clinically significant change with chronic schizophrenic patients, but that strategies to enhance generalization of training effects are needed.

Involvement in Special Olympics and its relations to self-concept and actual competency in participants with developmental disabilities

The current study examined the relations among components of a physical activity program, Special Olympics (SO), and the self-concepts (i.e., perceived physical competence, social acceptance, and general self-worth) and adaptive behaviors of individuals with developmental disabilities. This research can assist in the development of theoretical models of how physical activity programs can be implemented to effect psychological change. Participants consisted of a randomly selected group of 97 individuals with developmental disabilities, between 9 and 43 years of age, and their parents. Participants' self-concepts and adaptive behaviors were measured both by direct interview and parental report. Examined program components consisted of the length of time affiliated to the organization, number of competitions attended, of hours spent in training, of sports, and of medals obtained. Multiple regression analyses suggest relations between specific components of SO and participants' self-concepts and adaptive behaviors. These relations highlight the importance of competition and sport for individuals with developmental disabilities.

Teaching deception skills in a game-play context to three adolescents with autism

Baron-Cohen (1992) found that students with autism are impaired in their ability to deceive. A multiple-baseline across-subjects design was conceptualized to test the hypothesis that such students could be taught to deceive. Two conditions were presented in baseline and treatment phases. In Condition 1, the student guessed in which hand a small object was hidden when the experimenter presented two closed fists. In Condition 2, the student hid the object and presented two closed fists to the experimenter for a guess. Reinforcement was delivered contingently upon independent guessing during Condition 1 in both baseline and treatment phases. Under Condition 2, reinforcement was delivered noncontingently during the baseline phase and contingently upon successive approximations to the target behavior of deception during the treatment phase. All students displayed the acquisition of at least three of the responses included in the deception response during the baseline phase, and two students showed an erratic acquisition of the total skill during the baseline phase. Results indicate that students with autism can learn to deceive, even without formal intensive training.

Road to awareness: an individualized training package for increasing knowledge and comprehension of personal deficits in persons with acquired brain injury

Research suggests that awareness of one's deficits may be a significant factor in the recovery process after acquired brain injuries (ABI). Various methods have been employed to teach awareness of the potential sequelae of ABI. The present study extended the use of a board game format to teach awareness to adults with ABI who exhibited serious unwanted behaviours. It used an individualized training package in conjunction with a game format in order to more specifically target individual client awareness of personal deficits in two areas: cognition and behaviour. Training focused on the first three levels within Bloom's Cognitive Taxonomy: knowledge, comprehension, and application. Components of both the multiple-baseline and multiple-probe design were used to demonstrate experimental control. All three participants responded favourably to training, as evidenced by increases in percentage of questions answered correctly during the game sessions and in pre/post-generalization probes in both cognitive and behavioural categories.

Parenting education for parents with intellectual disabilities: a review of outcome studies

Parents with intellectual disabilities (i.e., IQ < 80; mental retardation) are overrepresented in child maltreatment cases and have a variety of parenting skill deficits. Their children are at risk for neglect, developmental delay, and behavioral disorders. This review of parenting education interventions for such parents identified 20 published studies with adequate outcome data. A total of 190 such parents (188 mothers, 2 fathers), with IQs ranging from 50 to 79 were involved. Parenting skills trained included basic child-care, safety, nutrition, problem solving, positive parent-child interactions, and child behavior management. The most common instructional approach was behavioral (e.g., task analysis, modeling, feedback, reinforcement). Overall, initial training, follow-up, and social validity results are encouraging. Generalization and child outcome data are weak. Further research is needed to (a) identify variables associated with responsiveness to intervention, and (b) develop and compare innovative programs that teach parents with cognitive disabilities the necessary generalized skills to demonstrate long-term beneficial effects on their children.

Using self-recording, evaluation, and graphing to increase completion of homework assignments

This article describes the use of self-monitoring procedures to increase the number of daily homework assignments completed by eight students with learning disabilities. Students ranged in age from 13 to 16 years and attended Grades 7 through 10. The experimental procedure involved the use of a sheet listing all daily assignments given by regular classroom teachers. A multiple-baseline design across subjects demonstrated a clear relationship between the introduction of self-monitoring of assignments and an increase in assignments completed. Goal setting and self-graphing of data appeared to increase this effect.

Parent behavioral training. An examination of the paradigm

This article examines the parent behavioral training (PBT) paradigm as an important development in child treatment that emerged some two decades ago. Several points of evaluation in the paradigm are identified, and the recent literature has been reviewed to determine how well the paradigm has been empirically validated. Overall, PBT has been well validated as a model for bringing about therapeutic improvement in children and parents under certain conditions. The conditions are identified, as are needed areas of research.

Conversation skills training of thought-disordered schizophrenic patients through attention focusing

An attention-focusing procedure was designed as discrete trials and multiple prompts with contingent social reinforcement to facilitate the acquisition of conversational skills in thought-disordered schizophrenia patients. Three patients with DSM-III-R diagnoses of schizophrenia completed a standard social skills training program and the attention-focusing procedure in multiple baseline experimental designs. While social skills training had little effect on the acquisition of skills, patients who completed the attention-focusing procedure significantly increased performance of conversational skills and showed some generalization of trained behaviors.

Training interactional behaviors of adults with developmental disabilities: a systematic replication and extension

This study was a replication and extension of research by Foxx, McMorrow, Bittle, and Ness (1986) that assessed generalization effects of a social skills training program on the interactional behavior of adults with developmental disabilities. Target skills were a verbal action or reaction in six skill areas that specifically addressed the participants' skill deficits. In the present study, we trained 5 adult residents of a group home across these six skill areas using the "Sorry" game format and the scoring criteria described by Foxx et al. We extended the results of Foxx et al. by (a) using pretreatment assessment procedures to identify participants' specific skill deficits, (b) training all residents in the natural environment, (c) training participant-participant interactions, (d) training participants to respond to four of the six skill areas through the use of a role-play procedure, and (e) omitting rewards, criterion levels, and self-monitoring. Additionally, the trainer in the present study modeled correct responses only as an error correction procedure during training. Similar to those of Foxx et al., our results indicated that all participants increased their use of the trained interactional behaviors during the generalization assessments in the presence of other trained peers.

Dating-skills groups for the developmentally disabled. Social skills and problem-solving versus relaxation training

Efficacy of three different group treatment strategies for teaching dating skills to the developmentally disabled was examined for 41 outpatient adults. Clients were randomly assigned to one of three groups: traditional problem-solving training (TPS), flexible problem-solving training (FPS), and relaxation training (RT). Role-play assessments were conducted at pretreatment, posttreatment, and at a one-month follow-up. Ratings of social skills based on the role plays favored the TPS and FPS groups over the RT and dropout groups. Clients in the TPS group, but not the other groups, significantly increased in physical attractiveness. Changes in physical attractiveness were correlated primarily with changes in pleasantness of facial expression. Clients in the TPS group also maintained a higher rate of social interactions with opposite-sex peers during midsession breaks than did clients in the FPS and RT groups. Implications for teaching dating skills to the developmentally disabled, the merits of traditional over flexible problem-solving procedures for teaching social skills, and the impact of social skills on physical attractiveness are discussed.

An analysis of social skills generalization in two natural settings

The interactional behavior of two groups of elderly mentally retarded residents of a community facility was measured in two generalization situations before, during, and after one group received social skills training. The training group received social skills training within a game format, whereas the contrast group simply played a game with no emphasis on interactional behavior. Results suggested that generalization to natural interactional situations may be delayed following training and that it is more likely in some situations (i.e., with trained peers) than others (i.e., in the presence of untrained peers).

Teaching social/vocational skills to retarded adults with a modified table game: an analysis of generalization

In this study, a social skills training program for institutionalized mildly or moderately retarded adults was extended to include skills relevant to vocational settings. Target behaviors involving a verbal action or reaction within six skill areas were taught using a commercially available board game, Sorry, and a specially designed card deck. The training program featured response specific feedback, self-monitoring, individualized reinforcers, and individualized performance criterion levels. Using a multiple baseline across two groups (n = 3 per group), the game contingencies increased social/vocational skills in all targeted areas. Generalization was assessed in two settings: a simulated workshop in which pre and post measures were taken and in the institutional workshop where the residents worked. The posttraining simulated workshop results revealed that the residents' newly learned skills had generalized. However, repeated generalization measures of the residents' social interactions in the institutional workshop were equivocal as were measures of their productivity.