5

How to conduct the sessions

Children and adolescents with an ASD are more responsive to programmes that are highly structured and appeal to the logical or scientific thinking associated with ASD. Their cognitive profile can include remarkable visual reasoning abilities, and the activities are therefore enhanced with the use of pictures and drawing, thereby placing less emphasis on conversation. Because children with an ASD often have problems with generalization and the recall of information in different situations, role plays and practice in reallife situations are important elements of the programme. You may also need to bear in mind other characteristics of people with an ASD – for example, the tendency to make literal interpretations, which means that that idioms and metaphor could be confusing.

The approach used in this programme appeals to the logical thinking of children and adolescents with an ASD. Due to their problems with Theory of Mind (the ability to reflect on the thoughts and feelings of other people as well as their own thoughts and feelings), there needs to be a greater component of the programme devoted to how to discover the salient cues that indicate specific thoughts and feelings, and how to perceive the various levels of affection from like to love within themselves and others. Strategies specifically designed for children with an ASD to improve Theory of Mind abilities are Social Stories™ and Comic Strip Conversations™, which have been developed by Carol Gray (see Recommended Resources).

Social Stories™ enable you to explore and understand the perspective of your child and discover together how he or she can express an appropriate level of affection in a specific situation. Social Stories™ also explain the value of expressing affection. For example, they can be used to explain why friends and family need frequent reminders that they are liked or loved, even if they have no reason to doubt there is genuine affection for that friend or family member.

Comic Strip Conversations™ use simple drawings with stick figures, and thought, speech and emotion bubbles to illustrate events and emotions. You can create a Social Story™ or use Comic Strip Conversations™ to supplement the designated activity within the session.

Another problem often experienced by children with an ASD is a diminished vocabulary to describe the different levels of emotional experience, especially for more subtle or complex emotions. The approach adopted in this programme aims to enable your child to express his or her degree of liking or loving someone using a thermometer or numerical rating to indicate the intensity of experience and enjoyment.

In Part 3 of the book there are worksheets for your child to record information, although this aspect is deliberately kept to a minimum since children with an ASD often have poor handwriting skills and prefer to listen, watch and do, rather than write. If your child has a genuine aversion to writing, you can listen to his or her spoken comments and answers and then write them on the worksheets. Readers have permission to photocopy all worksheets marked with a for personal use. They are also available to download from www.jkp.com/catalogue/book/9781849054362/resources.

At the end of each session the project to be completed before the next session is explained, and the information obtained from the project discussed at the start of the subsequent session. These projects are designed to obtain more information and to apply strategies in real situations. Your child may have an aversion to the concept of homework from bitter school experiences, so you need to emphasize the importance of completing the project and clearly encourage your child to do so. Good collaboration between home and school with regard to expressing affection to friends will be beneficial. Make sure that teachers are aware of the programme and ways in which they can contribute to your child’s knowledge base on expressing and responding to affection with peers. Teachers can also help with the successful implementation of strategies.

Always emphasize success and discovery, acknowledging contributions and discouraging ‘right’ or ‘wrong’ answers. Always encourage positive suggestions from your child. Feel free to deviate from the prescribed text to accommodate your child, and use aspects of ASD to illustrate a point; for example, use the feelings of elation associated with a special interest as a metaphor for feeling love for someone. The duration of each activity is variable, according to the attention and learning capacity and rate of progress of your child; however, as a general guide, each session is designed to be covered within one hour. The activities do not have to be completed in the sequence they occur in the workbook, and you may include additional activities and resources. Thus, the programme is flexible in structure and duration, and can evolve to meet the needs of your child.

Fear of failure

Clinical experience has identified that children with an ASD may have an almost pathological fear of failure. Make an effort to encourage self-confidence, and explain to your child that not knowing something or making an error is not a disaster but an opportunity to learn and become wiser. It is important to positively reinforce your child’s abilities throughout the programme.

Group sessions

If you are participating in the programme with other children and parents, there are some things to be aware of.

Participants

It is important to select participants carefully, as children and adolescents with an ASD are at risk of additional diagnoses, particularly ADHD and oppositional defiant disorder. The personality of each participant and his or her emotional and intellectual maturity will have an effect on group cooperation, mutual support and the possibility of the development of friendships within and after the group sessions. Reduce the potential for personality clashes and ensure an even distribution of support. Having a participant who requires extra supervision and explanations in comparison to other group members may impact the rate of progress and the success of the group.

Ideally you should conduct the programme with no more than two children per adult, as the content of the programme requires you to carefully observe the degree of engagement and comprehension of the participating children. If two adults conduct the programme with a group of four children, for example, one can lead each activity while the other maintains attention and records information.

Setting

There must also be some special consideration of the setting for the programme when conducted in a small group, with the provision of sufficient personal space and comfortable chairs, and an awareness of the sensory issues associated with ASD, for example, olfactory and tactile sensitivity, and sensitivity to bright light and the sound of machinery. It is also important that each person conducting the programme is aware of the time children with an ASD take to process and respond to social/ emotional information, and that such children are very sensitive to emotional atmosphere and attitude, especially criticism and negativity.

Conducting the sessions

Working as part of a group, there will need to be agreed ground rules on potential issues such as taking turns to speak, keeping to the point, and being courteous and friendly. Encourage your child to follow these rules.

During the first session of a group programme you will be asked to briefly introduce your son or daughter by way of age and personality characteristics, and to state your most important goal for the group. The sharing of problems/goals in this way can be a quick way to assist you and other parents to feel less alone, as you quickly discover that your problems are not unique. During the first or second session, a suggestion may be made to exchange email addresses with other parents for communication beyond the group.

The format of subsequent sessions essentially follows the sessions described in Part 3, sharing both the information given out to the children and unique information about each child during the group. The last five minutes of each session will be dedicated to sharing the project for the week and encouraging you to assist your child to complete their project.

We have found that during group sessions, a child may show remarkable moments of insight or clarity of expression. We call these ‘Words of Wisdom’. There may also be moments of humour. During each group session, one of the adults presenting the course should record the key points discovered by the participants, along with any ‘Words of Wisdom’ or humorous comments. Print these and distribute them to the participants at the start of the next session.

Time with other parents or your own family members after each group session

At the end of each group session, there should be time with the parents of the other participants, usually 30 minutes. The aim is to exchange information regarding your children’s responses and abilities during the activities, and to seek information on particular issues that could be addressed in a subsequent session. You will be encouraged to respond positively and appropriately to your child’s new abilities and understanding of affection and apply the strategies discovered during the programme in real-life situations. Group discussion with parents may encourage solutions to any problems expressing affection experienced by other family members.