Connect:

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• Connect
• A Social Skills Support Group
• For College Students With
• Aspergers Syndrome
• Insights and Lessons Learned
• Deborah Wright, Ph.D. and Hannah Bush, M.Ed.
• University of Missouri - Columbia

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True Confessions

• Learning Objectives!!!
• 1. Four areas that could be of benefit
• 2. Three social skills
• 3. Three group norms/guidelines
• 4. Two lessons learned
• You dont know what you dont know

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(No Transcript)
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Overview

• Prior Experience and Impetus
• A bit about Treatment for ASD
• Structure, Content and Process
• Case Study
• Evolution, Insights and Lessons Learned
• Goal To leave you with a sense that you were a
  fly
• on the wall during this group.

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Impetus

• Assessment and Consultation Clinic
• Thompson Center for Autism and Neurodevelopmental
  Disorders
• Student Health Center
• Crisis walk-in
• Campus Judicial Hearing

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Research Findings Aspergers Syndrome

• Most helpful resources
• The Complete Guide to Aspergers Syndrome (Tony
  Attwood, Ph.D.)
• Cognitive-Behavioral Treatment of Aspergers
  Syndrome (Valerie Gaus, Ph.D.)
• Preparing for Life (Jed Baker, Ph.D.)
• Areas of clinical presentation that can be
  addressed
• Reading nonverbal behaviors
• Social inference/Knowledge of Social Norms/Social
  Reciprocity
• Emotion regulation
• Executive functioning (e.g., problem-solving,
  time management)

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This Emotional Life clip (PBS)

• http//www.youtube.com/watch?vQWY3ntr3sdI

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Research Findings Treatment

• Process
• Therapy in short intervals
• Structured, skills-focused
• Need time to process
• When overwhelmed, teach deep breathing
• Provide autonomy on choice of topics
• Skills-streaming Didactic, Model, Role
  playPractice, practice, practice!

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Research Findings Treatment

• Content
• Focus on increasing instrumental skills, fund of
  knowledge about social norms, and social
  cognition
• Social skills menu Starting a conversation,
  maintaining a conversation, deepening
  friendships, etc
• Cognitive-behavioral therapy as treatment of
  choice for co-occurring mood and anxiety

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Connect Treatment Goals

• 1. Improve Social Skills
• 2. Improve Emotion Regulation
• 3. Increase Support Network

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Materials

• Developed detailed handouts on
• Conversation Skills
• Emotion Management
• Social Norm Descriptions

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Conversation Skills

• Compliments
• Disclosure including disclosure of diagnosis
• Forming friendships
• Expressing and reading welcoming and unwelcoming
  cues
• Greetings and farewells
• Starting conversations
• Sarcasm versus genuine expressions
• Attending, Asking and Telling
• Conversation Repair

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Emotion Management

• How to Deal Handouts
• Anxiety
• Frustration
• Sadness/Depression
• Cognitive Distortion Lists
• Asking for what you need
• Problem-solving
• Diaphragmatic breathing

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Social Norm Descriptions

• Unwritten Codes
• Roommates and Res Hall Advisors
• Developing friendships
• Dating
• Working in groups
• Misunderstandings and disagreements

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Group Format

• One hour, 9-week course
• Basic structure
• Small talk
• Mindfulness Meditation
• Didactic
• Practice in small group or dyad
• Individual work time
• Group discussion
• Mindful Meditation at closing
• Blackboard System

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Interventions/Techniques

• Meditation/Diaphragmatic breathing
• HRV Biofeedback
• Slowwwww the process!
• Allow time to write out thoughts
• Prompting when they give non-verbal cues
• Identifying relevant content
• Modeling
• Use of Humor
• Playful games

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Social Norms/Guidelines

• Confidentiality
• Respect
• Participation
• At individual pace
• Manage monologuing
• Peace sign

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Recruitment

• Office of Disability Services
• Student Services Coordinator
• Screening
• Length of time
• No formal diagnosis
• FS N5, SS N7
• Age 18-28
• Dropout

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Case Study, Insights and Lessons Learned

• Summary
• Didactic, skills-building versus interpersonal
• Experiential
• Anxiety
• Content/Process
• Connection

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Group 1 FS 2010

• Topic Deepening relationships
• Intervention
• Didactic
• Disclosing personal information
• Compliments
• Group Discussion

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Observations

• High anxiety
• They came anyway!
• Called a spectrum for a reason
• Facilitators getting caught up in their own
  thoughts
• Theme interpersonal skills are complicated!

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Group 2 and 3 FS 2010

• Topic
• Meeting new people
• Managing Anxiety
• Intervention
• Didactic, Modeling, Thought logs, Dyad
  discussions
• Blackboard
• Introduced possibility of having small group
  discussions at next group

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Observations

• Stuck in rumination (blackboard example)
• Facilitators anxiety
• I found it really difficult, but I also think it
  was useful.

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Group 4 FS 2010

• Topic Thought logging with emphasis on disputing
  and active listening skills
• Intervention
• Individual logging
• Modeled active listening
• Group game
• Blackboard
• Robust discussion regarding disclosing ASD
  diagnosis

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Observations

• Games and humor reduced anxiety
• They were engaged in a genuine, authentic way
• Need for flexibility

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Group 5 and 6 FS 2010

• Topic What is it like to have ASD?
• Interventions
• Lily
• Group Discussion

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Lily Comfort Dog
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Observations

• Histories of bullying
• Level of pain and trauma related to bullying
• Genuine desire and ability to connect
• Feeling misunderstood
• Humor helps alleviate anxiety
• Genuine, empathic connection during this group
• Bs quote
• Facilitators were totally confused

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Group 7, 8, 9 FS 2010

• Topic Clarifying and maintaining conversations
• Interventions
• Group game
• Ambiguous statements
• Pointed out assumptions
• Individual work
• Writing how they would say to professor and a
  friend
• Themes Clear safety and trust was established

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Group 1 and 2 SS2011

• Topic Introductions and Emotional Bids
• Interventions
• Mindful observer exercise
• Dyads
• Didactic re CBT
• Group discussion

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Group 3 SS2011

• Topic SFBT
• Intervention
• Started with longer meditation
• Group discussion
• Theme
• Facilitators slowed the process
• Decreased anxiety
• More disclosure
• Blackboard
• More disclosure on blackboard this week

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Observations

• Affect appropriate to content
• Eye contact
• Facing facilitators
• Subtle nonverbals
• Slow process
• Most poignant
• Great depth of sharing
• All were clearly touched

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Group 4 SS2011

• Topic Relaxation
• Intervention
• Autogenics Exercise
• Group discussion
• Theme
• Autogenics was useful for most

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Group 5 SS2011

• Topic Connecting
• Intervention
• Brief Autogenics exercise
• Individual writing
• Dyads
• Group discussion

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Group 6 and 7 SS2011

• Topic Self-exploration and connection
• Intervention
• Autogenics Exercise
• Mini-SPIN
• MBTI-type inventory
• Didactic
• Dyads
• Theme
• Connection

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Observations

• Hitting the balance of content and process
• Giving them something meaningful to discuss
• Controlling anxiety
• More time for information processing
• Highly engaged!

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Group 8 SS2011

• Topic Stress management
• Intervention
• HRV Biofeedback
• Group discussion
• Reminder closing Blackboard
• Theme

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Lesson Learned 1

• Managing anxiety is key.
• Interferes with information processing and
  response time.
• Facilitators need to manage high level of
  anxiety.
• Interventions
• Starting and ending with mindful meditation
• Autogenics
• HRV

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Lesson Learned 2

• Balance between process and content is encouraged
  by
• Slowing the process
• Responding to nonverbals
• Using mindful meditation and other relaxation
  skills during the group
• Offering some ideas for relevant discussion
• Disclosing ASD diagnosis
• MBTI
• Bullying

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Lesson Learned 2

• Use of various modalities
• Individual time to reflect and write
• Dyads
• Group
• Games within group and humor
• Role play by facilitators
• The balance of process and content helped with
  meaningful social skill practice of
• Disclosures
• Showing verbal/nonverbal empathy
• Turn taking, mutual dialogue

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Lesson Learned 3

• Be flexible Remember, it is a spectrum.
• Tailor content to feedback from group members
• Blackboard
• Within group
• Need for facilitators to take risks
• No expectations for change embrace them for all
  of their wonderful uniqueness

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Lesson Learned 4

• Blackboard is an important tool
• Specific problem-solving assistance
• Building safety
• Getting to know each other
• Reduced anxiety Online practice

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Lesson Learned 5

• Genuine desire for authentic connection in
  tolerable doses
• Willingness to self-disclose
• Willingness to tolerate very high levels of
  anxiety
• Enormous capacity for empathy
• Exceptionally rewarding professionally

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Most Useful Skills Learned

• Controlling breathing rate has as large effect on
  stress level
• Breathingdeeply and slowly (learned through
  biofeedback) and thought-logging
• The biofeedback exercise was beneficial.
• Biofeedback-Relaxation skills, importance of
  heart rate variability, visualization meditation
  (forgot the name)
• Sleep does not equal relaxation
• Ways to respond to social engagement gave me a
  different perspective for thinking about social
  interaction
• I learned how to better judge the motivations of
  others, how to open up more, and how to react
  appropriately in society.
• I got better at asking questions when talking
  with someone, I learned how to breathe to relax
  me more, and I have gotten better at carrying on
  a conversation
• Ask questions,, just because I think of something
  to say doesnt mean I have to say it every time

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Most Beneficial

• The games aimed at clarifying and practice
  conversations.
• The small group size I was more comfortable.
• Blackboard part of it was very helpful.
• Support from group members and leaders
• Being asked our preference and made sure to
  accommodate us.
• I loved the discussions we had in session and
  thought the teaching was excellent as well.

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Most Beneficial

• I really appreciated doing the Myers-Briggs
  personality inventory. I have heard many social
  skills group try to change participants and
  make them be more socialso I thought the
  acknowledgment of the different personalities,
  some more introverted than others, was
  excellent!!
• Any time we got a chance to talk amongst
  ourselves (typically during the 1-on-1s)
• Also blackboard helped me talk to people. Also
  just the one on one talking with someone helped
  me improve my speaking skills.
• Some of the group talk sessions got me to open up
  more
• It was a relaxing break from the hardships of
  school and it was just fun to just listen to
  other peoples stories

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Least Beneficial

• Hmmhard to say. One of the interactions that was
  more staged we were in dyads felt a little
  forced. Although I think I was out of my comfort
  zone so not necessarily that it wasnt helpful.
• The length of the group.
• Longer sessions
• Longer group meeting
• Maybe 1.5 to 2 hour sessions just because they
  always seemed to end quickly.