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Free ebooks ==> Sharon 75 long way in reducing their level of impairment, but they may not be able to entirely lose their symptoms. The second point is that some of the skills that Sharon used to compensate for her difficulties in TOM could be used by other higherfunctioning adolescents and adults with ASD to similar effect. In fact, there is a study showing that children with autism who were specifically taught a TOM were able to improve their ability to correctly assess others’ mental states. The skills they were taught were very similar to the compensatory mechanisms that Sharon had come up with on her own. She used her powers of logic and reason to monitor her social behavior and to set up rules for social interaction, to scan what was not appropriate under the circumstances. She used her insight, her memory, her reason, and her ability to think things through to navigate the social world. However, this study also showed that the newly acquired skills did not generalize to everyday encounters. Strategies are needed to take these skills out of the laboratory setting and into the real world. The skills have to be learned over and over again in different situations. Sharon had also developed other compensatory mechanisms that might be helpful in accomplishing this generalization. She used her strengths in visualization to conceptualize her emotions and to organize her day. In a similar fashion, Carol Grey, a teacher who has developed helpful strategies for children with ASDs, has described how social stories delivered in a visual format are a useful way of teaching social skills to young children with autism. Sharon kept to a routine and a structure to maintain order and reduce anxiety. What symptoms she had, she tried to keep private, aware that others would find her interests weird. She repeated others’ conversation to herself in order to understand the meaning and context of conversation. In essence, she used her strengths to compensate for her difficulties; she did not practice what she found hard because when she did, it made little difference. Most important, she was motivated to improve her social skills, and this was a key factor in her development. Developing these coping skills takes much effort, and the person with autism or AS must be motivated to learn them. Unfortunately, many people with ASD lack this motivation or find the effort too strenuous. Clinical experience suggests that the timing of the intervention must be absolutely right and works best when individuals are keenly aware of their difficulties and want to narrow the gap between themselves and peers. It also helps to break the social skill down to its component parts and practice each one in turn so that the task does not seem so onerous. Perhaps that is one of the reasons that behav-

76 A MIND APART iorally based approaches are so successful; they decompose a complex behavior into smaller and more manageable bits. * * * These ideas about social interventions apply to high-functioning people with ASD who have some self-awareness and are motivated to improve their social skills. Different techniques are required for younger children who are not as advanced developmentally. Several different programs have been developed that aim to improve social interactions of children with ASD. These differ with respect to their theoretical orientation and the techniques employed to bring those goals to fruition. The interventions can be broadly conceptualized as behaviorally based or developmentally based. In a behaviorally based approach, an adult systematically teaches simple social skills to a child with autism using trial and error with rewards for successful completion of a skill. These simple skills could include eye contact, orienting to one’s name being called, coming to sit near the therapist, learning to take turns, and so on. The idea is that on the basis of these simple skills, more complex social skills can be taught in a similar fashion, though the teaching sessions will eventually have to involve interactions with other adults and typical peers. The developmental approach starts with a careful assessment of the child’s current social skills, places those in a developmental context, and proceeds to set up situations that allow the child to gain skills at the very next level. It is less systematic and more naturalistic in that social interactions are often initiated by the child, with the therapist promoting further development and interaction. Sometimes typical children can be taught to act as therapists to the child with autism and so promote more appropriate social interaction in an inclusive setting. Both these approaches have been found to be successful, though which is most effective is not known because they have never been compared head to head. It is also probably true that characteristics of the child will influence the response to treatment. One can imagine that more developmentally delayed children will respond better initially to the behavioral approach, whereas higher-functioning children can perhaps proceed more directly to the developmental approaches. These can often be implemented in community settings with specialized help. In any case, structure, routine, and appropriate expectations based on the child’s

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