critical thinking for students with autism

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• Oct 11, 2022

Cultivating Critical Thinking Skills in Children with Autism

Does your child face rigidity in thought and routines, or difficulties with managing emotions and social situations? Your child might lack adequate critical thinking skills, an essential aspect of children’s development. Critical thinking is the ability to make sense of our environment and our experiences, allowing us to cope with diverse situations and to problem-solve.

Building critical thinking skills in children with autism helps them to increase flexibility of thought and improve self-regulation. Children with strong thinking skills can approach novel situations with an open mind, ask thoughtful questions, and understand that there might be more than one answer or method to do things.

It may be more difficult to develop critical thinking skills in children with autism as they often think in concrete terms, and may not naturally draw upon past experiences or make novel connections independently. Hence, they may benefit from more explicit teaching and guidance during moments of decision making and when internalising new information. Given that critical thinking skills are crucial, how do we cultivate these skills in children with autism? Here are three strategies to help you build critical thinking skills in your child!

1. Relate stories to your child’s knowledge and experiences

When reading stories or observing situations, draw similarities between the situation and your child’s knowledge and experiences. Relating others’ experiences to your child’s own past experiences helps him realise why the characters acted and thought the way they did. This teaches your child to recognise and adopt others’ perspectives, aiding them in developing critical thinking in similar situations.

To kick off this activity, you can choose a story where the main character goes through a situation familiar to your child, e.g. going to a dentist, or visiting a new place. While reading the book with your child, ask him about his own experiences and compare it to the character’s experience, e.g. “How did you feel when you visited the dentist for the first time? How was Bobby (character) feeling in this story? Why did you feel differently from Bobby?”

2. Vocalise your thought process

Research has shown that we make about 35,000 choices a day (Krockow, 2018). That amounts to thousands of thoughts that we filter through to come to those decisions. Critical thinking and problem-solving processes often come naturally to us, but your child may struggle with organising his thoughts and choosing a line of reasoning. By verbalising your thoughts in real time instead of contemplating silently in your mind, you will model your thought process for your child. Your child can observe how you arrived at certain decisions, and what considerations you reviewed in making those decisions.

For instance, you can vocalise your thoughts on choosing what to eat for dinner, or how to fix a broken chair. Use thinking-out-loud comments, which start with words like “I’m wondering about…” or “I’m thinking that…”. After sharing your thoughts, encourage your child to try talking through a decision he can make in that moment. Your thought processes will provide your child with many examples to learn from when making his own decisions.

3. Keep asking your child questions

It is important to develop a habit of questioning your child about their thoughts and opinions on everything that they experience. Some children with autism may have fleeting thoughts and fail to stay with a strain of thought for long; others may not view a situation from all angles and become easily fixated on a narrow perspective. Your repeated questions will remind your child to think more deeply and holistically, and will help him to learn what questions should be asked about each situation.

You can ask your child why something happened, and have him provide explanations and justifications. You can also ask for more information, or clarify something he shared that you may have questions about. Additionally, you can request for examples or counter-examples, or for the conditions necessary for certain situations to occur. When engaging your child, just remember to keep asking!

Relating stories to your child’s experiences, vocalising your thought processes, and asking questions are good starting points for you to build your child’s critical thinking skills. Grasp informal “in-the-moment” teaching opportunities throughout your child’s day to engage him in critical thinking. View your child as a little intellectual who can surprise you with his depth and complexity of thought. Although critical thinking skills may not come as naturally to some children with autism, your child has the potential to develop strong thinking skills if he is provided with the right stimulation and a rich learning environment!

Written by Hazel.

Greenberg, J. & Weitzman, E. (2014). I'm Ready! How to Prepare Your Child for Reading Success . Hanen Early Language Program.

Krockow, E. M. (2018, September 27). How many decisions do we make each day? Psychology Today. https://www.psychologytoday.com/sg/blog/stretching-theory/201809/how-many-decisions-do-we-make-each-day .

Marlowe, W. B. (2000). An intervention for children with disorders of executive functions. Developmental Neuropsychology , 18 (3), 445-454.

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Recommended Autism Resources for Developing Critical Thinking Skills

Autism Resources and Success Stories

June 28, 2009, Updated Feb. 27, 2024, by The Critical Thinking Co. Staff

The neurobiological disorder known as autism is part of a group of disorders known as autism spectrum disorders (ASD). Treatment and educational needs are often very similar for these conditions, even though there are subtle differences and degrees of severity among the disorders. Autism affects a person's ability to communicate and relate to others. It is also associated with rigid routines and repetitive behaviors, such as obsessively arranging objects or following very specific routines. Symptoms can range from very mild to quite severe.

The general term “autism” is often used either specifically to refer to Autistic Disorder (AD) or more generally to refer to ASD. Another term that is often used synonymously with ASD is Pervasive Developmental Disorders (PDD). This term is simply the diagnostic category heading under which five specific diagnoses are listed. The different diagnostic terms that fall under the broad meaning of PDD / ASD, include:

• Autistic Disorder (AD) • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

Autism disorders can usually be diagnosed by age 3; parents are usually the first to notice unusual behaviors in their child or a failure to reach appropriate developmental milestones.

If a child is diagnosed with autism, early intervention is critical. Although parents may have concerns about labeling a toddler “autistic,” the earlier the diagnosis is made, the earlier interventions can begin. There are no effective means to prevent autism, no completely effective treatments, and no known cure. Research indicates that early intervention, in an appropriate educational setting, for at least two years of preschool, can result in significant improvements for many young children with autism disorders. Effective programs focus on developing communication, social, and cognitive skills.

While products from The Critical Thinking Co.™ weren’t initially developed with autistic children in mind, over our 50-year history producing award-winning books and software, we’ve discovered (thanks to our customers) there are several titles parents with autistic children and teachers of autistic students find to be essential resources.

Many of our books and software programs can help children and adults living with autism. The Mind Benders® series presents challenging deductive reasoning activities for autistic children and adults. Building Thinking Skills® provides a comprehensive mix of visual-spatial and verbal skill development, highly recommended for teaching children and adults with autism. Math and Reading Detective® books and software can help children in grades 3 through 8, fine-tune reading comprehension and critical thinking skills in the content areas. Memory Challenge® software is an excellent tool for developing and testing visual memory skills.--> Visual Perceptual Skill Building® develops recognition of letters, words, numbers, and similar/dissimilar objects. It also improves sequencing and visual memory skills. Hands-On Thinking Skills uses manipulatives and helps non-verbal children increase their skills.

Here's what some of our customers have said regarding the use of our products with autistic children.

Carrie, a proud parent from Pennsylvania, said, "My son (10) is on the autism spectrum. He has a brilliant mind for facts and figures, but always struggled with his thought process.  Mind Benders® and  Building Thinking Skills® have given him solid direction in organizing his thoughts and following logical patterns. The progress my son has made in barely one year is incredible. No therapy or modification has come close to having such an impact in the 6 years since his diagnosis. There are no words to express how thankful we are for The Critical Thinking Co.™ ."

"My daughter, age 14, has PDD/Autism. Also, she has an accompanying non-verbal learning disorder (this doesn't mean she doesn't talk; it means that she has trouble interpreting body language and other non-verbal information). Something she has always struggled with has been visual problem solving. We have been using The Critical Thinking Co.™ materials since she was small, as they were the only materials that broke down tasks into small enough chunks for her. As she has grown older, we have also been using the software, most recently the Building Thinking Skills® software. The  Mind Benders® software also presented many challenging visual-puzzle activities, and we have used all of the  Math and Reading Detective® software to help her fine-tune her critical thinking skills in the content areas. When she was 12, I purchased [other] software… but The Critical Thinking Co.™ activities were more varied to hold her interest, and much more reasonably priced. The materials haven't 'cured' my daughter, of course, but they have helped her stick with practicing her skills even when it is difficult. She 'asks' to play the second Building Thinking Skills® software nearly every day. Thank you!" said parent Sandy from Maryland.

Polly Brophy from the LA Unified School District said, “I’m a special education teacher. I was surprised when my supervisor recommended I use The Critical Thinking Co.™ products for children below grade level. She said your books aren’t just for the gifted, and she was so right. Reading Detective® is wonderful for building verbal reasoning skills. One of my autistic students said the other day after finishing a lesson in Reading Detective® , ‘I can’t believe I can do this. I’m so proud!’ At first it wasn’t easy for them. Then they learned how to eliminate the wrong answers. Now some of them have gone up two whole grade levels. I wouldn’t have believed it was possible.”

“I am a very experienced teacher and cognitive trainer. One of my students was in the Special Education program for years; after working with the   Building Thinking Skills® books he returned to grade level in seven months,” said Claudette Anderson, of Prescription for Success Learning Center in Parker, Colorado. “I have worked with various brands of thinking skills materials, but The Critical Thinking Co.™ has the best on the market."

“ The Critical Thinking Co.™ … is a breath of fresh air in a special needs market that too often finds publishers focused on isolated skills rather developing students’ flexible thinking ability,” said John Alexander, executive director of Chartwell School for language learning disabilities, Seaside, California.

Whether your child with autism is 18 months old, or 18 years old, he or she will still benefit from therapy. Early intervention is always helpful, but you're not too late to make a difference in life of your child.

As with all students, but especially autistic children, we highly recommend finding out what the student’s strengths and interests are and emphasize them in your lessons to increase engagement and retention. This simple approach approach builds confidence and nurtures a love of learning.

Helpful Resources:

• Autism Society of America
• Top Ten Facts About Autism
• Symptoms of Autism
• Before You Let an Autism Diagnosis Drive You Crazy
• Autism Speaks
• Libraries and Programs Designed for Autistic Patrons

Autism Teaching Strategies: A Comprehensive Guide for Educators

Whisper-soft strategies and vibrant visual cues can transform a chaotic classroom into a nurturing haven where autistic minds flourish and educators become the architects of possibility. In the realm of education, few challenges are as complex and rewarding as teaching students with autism spectrum disorder (ASD). As our understanding of autism grows, so does our ability to create inclusive learning environments that cater to the unique needs of these exceptional learners.

Autism spectrum disorder is a neurodevelopmental condition characterized by differences in social communication, sensory processing, and behavioral patterns. While each individual with autism is unique, many students on the spectrum face common challenges in the classroom setting. These may include difficulties with social interactions, sensory sensitivities, and struggles with traditional teaching methods. However, with the right approach and understanding, educators can play a pivotal role in unlocking the potential of autistic students and fostering their academic and personal growth.

Understanding Autism in the Classroom

To effectively support students with autism, it’s crucial for educators to have a solid understanding of the common characteristics associated with ASD. Comprehensive Guide to Autism Modules: Enhancing Understanding and Support can provide valuable insights into the nuances of autism in educational settings.

One of the hallmark features of autism is differences in social communication. Students with ASD may struggle with interpreting social cues, maintaining eye contact, or engaging in reciprocal conversations. This can make group work and classroom discussions challenging without appropriate support.

Sensory sensitivities are another key aspect of autism that can significantly impact learning. Many individuals with ASD experience heightened or diminished responses to sensory stimuli such as lights, sounds, textures, or smells. A classroom environment that seems ordinary to neurotypical students might be overwhelming or distracting for those on the spectrum.

Communication challenges are also common among students with autism. Some may have delayed language development or use alternative forms of communication. Others might have advanced vocabulary but struggle with pragmatic language skills, such as understanding sarcasm or figurative speech.

Lastly, the importance of routine and structure cannot be overstated for many autistic learners. Predictability and clear expectations can help reduce anxiety and promote a sense of security in the classroom.

Creating an Autism-Friendly Classroom Environment

Transforming a classroom into an autism-friendly space involves thoughtful organization and strategic modifications. 20 Effective Classroom Modifications for Students with Autism: Enhancing Learning and Inclusion offers a comprehensive list of adaptations that can make a significant difference.

Organizing the physical space for optimal learning is a crucial first step. Consider creating clearly defined areas for different activities, such as a quiet reading corner, a group work space, and individual workstations. Use furniture and room dividers to create visual boundaries and minimize distractions.

Implementing visual supports and schedules is another powerful strategy. Many students with autism are visual learners and benefit from seeing information presented graphically. A visual schedule of the day’s activities can provide structure and reduce anxiety about transitions. Visual aids can also support understanding of classroom rules, routines, and expectations.

Minimizing sensory distractions is essential for creating a comfortable learning environment. This might involve using noise-cancelling headphones, installing dimmer switches for lighting, or providing fidget tools to help with sensory regulation. Be mindful of potential sensory triggers in the classroom, such as strong smells or flickering lights.

Establishing clear routines and expectations is fundamental for supporting students with autism. Consistency and predictability can help reduce anxiety and promote independence. Clearly communicate the daily schedule, classroom rules, and any changes to the routine in advance.

Effective Teaching Strategies for Students with Autism

Adapting teaching methods to suit the learning styles of students with autism can significantly enhance their educational experience. Understanding and Improving Instruction Comprehension in Children with Autism provides valuable insights into tailoring instructions for autistic learners.

Using visual aids and concrete examples is a cornerstone of effective autism education. Supplement verbal instructions with pictures, diagrams, or physical objects to reinforce concepts. For abstract ideas, try to provide tangible examples or real-world applications to enhance understanding.

Breaking tasks into smaller, manageable steps is crucial for many students with autism. Complex assignments or multi-step processes can be overwhelming, leading to frustration or shutdown. By breaking tasks down and providing clear, sequential instructions, educators can support students in achieving success step by step.

Incorporating special interests into lessons can be a powerful motivational tool. Many individuals with autism have intense interests in specific topics. By weaving these interests into curriculum content, teachers can increase engagement and make learning more relevant and enjoyable for autistic students.

Providing clear and concise instructions is essential. Avoid using figurative language or sarcasm, which can be confusing for literal thinkers. Use simple, direct language and check for understanding by asking students to repeat instructions or demonstrate comprehension.

Utilizing technology and assistive devices can open up new avenues for learning and communication. Tablets, educational apps, and text-to-speech software can support various learning styles and help overcome communication barriers. Effective Strategies to Improve Memory in Individuals with Autism: A Comprehensive Guide offers insights into using technology to enhance memory and learning for autistic students.

Supporting Social Skills and Communication

Developing social skills and communication abilities is a crucial aspect of education for students with autism. While these areas may present challenges, targeted strategies can help foster growth and confidence.

Teaching social cues and nonverbal communication often requires explicit instruction for autistic learners. Use social stories, video modeling, or role-playing activities to demonstrate appropriate social behaviors and responses. Practice interpreting facial expressions, body language, and tone of voice in various contexts.

Facilitating peer interactions and group work can be beneficial but requires careful planning and support. Consider using structured activities or cooperative learning strategies that provide clear roles and expectations for all participants. Peer buddies or mentoring programs can also help foster positive social connections.

Implementing social stories and role-playing activities can help students with autism navigate social situations more confidently. Create personalized social stories to address specific challenges or scenarios a student might encounter. Role-playing allows for practice in a safe, controlled environment before facing real-world situations.

Encouraging alternative forms of communication, such as Picture Exchange Communication System (PECS) or Augmentative and Alternative Communication (AAC) devices, can be vital for non-verbal or minimally verbal students. These tools can empower students to express their needs, thoughts, and feelings more effectively.

Behavior Management and Emotional Support

Supporting the emotional well-being and managing challenging behaviors of students with autism is an integral part of creating a positive learning environment. Comprehensive Sample Treatment Plan for Autism Spectrum Disorder: A Guide for Parents and Professionals can provide valuable insights into developing comprehensive support strategies.

Identifying triggers and preventing meltdowns is crucial for maintaining a calm and productive classroom atmosphere. Learn to recognize early signs of distress or overstimulation in your students. Create a designated “calm down” area where students can retreat when feeling overwhelmed.

Implementing positive reinforcement strategies can be highly effective in promoting desired behaviors. Use a token economy system, behavior charts, or verbal praise to acknowledge and encourage positive actions. Be specific in your praise, highlighting exactly what the student did well.

Teaching self-regulation and coping skills is essential for long-term success. Introduce techniques such as deep breathing, progressive muscle relaxation, or mindfulness exercises. Visual supports like emotion thermometers or coping strategy cards can help students identify and manage their feelings.

Collaborating with parents and specialists for consistent support is vital. Regular communication between home and school ensures continuity in strategies and allows for sharing of valuable insights about the student’s needs and progress. Consider implementing a daily communication log or regular team meetings to maintain alignment.

In conclusion, teaching students with autism requires a multifaceted approach that combines understanding, creativity, and flexibility. By implementing strategies such as creating a structured environment, using visual supports, tailoring instruction methods, and fostering social skills development, educators can significantly enhance the learning experience for autistic students.

It’s important to remember that each student with autism is unique, and what works for one may not work for another. Comprehensive Guide to Tutoring for Autistic Children: Strategies, Benefits, and Finding the Right Tutor emphasizes the importance of individualized approaches in supporting autistic learners. Continuous learning and adaptation of teaching strategies are crucial for meeting the evolving needs of students on the autism spectrum.

Creating an inclusive classroom community benefits not only students with autism but all learners. By fostering an environment of acceptance, understanding, and support, educators can help all students develop empathy, appreciation for diversity, and valuable life skills.

As we continue to advance our understanding of autism and effective teaching practices, it’s exciting to consider the possibilities for growth and achievement. Navigating College Accommodations for Students with Autism: A Comprehensive Guide highlights how support for autistic individuals can extend into higher education, opening doors to lifelong learning and success.

By embracing these comprehensive teaching strategies, educators can truly become architects of possibility, creating classrooms where autistic minds flourish and every student has the opportunity to reach their full potential.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Autism Speaks. (2021). Autism Facts and Figures. https://www.autismspeaks.org/autism-facts-and-figures

3. Centers for Disease Control and Prevention. (2021). Data & Statistics on Autism Spectrum Disorder. https://www.cdc.gov/ncbddd/autism/data.html

4. Grandin, T., & Panek, R. (2013). The autistic brain: Thinking across the spectrum. Houghton Mifflin Harcourt.

5. Koegel, L. K., Koegel, R. L., & Smith, A. (1997). Variables related to differences in standardized test outcomes for children with autism. Journal of Autism and Developmental Disorders, 27(3), 233-243.

6. National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author.

7. Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure: Alternative Education for Children and Youth, 54(4), 275-282.

8. Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS Model: A comprehensive educational approach for children with autism spectrum disorders. Paul H Brookes Publishing.

9. Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., … & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411-2428.

10. Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., … & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951-1966.

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Teaching Children with Autism Critical Thinking Skills

by Dan DeMarle | Jan 17, 2023 | Autism , Autism , Classroom , Parents/Guardians , Teaching

What is so important about teaching children with autism critical thinking skills? These skills are important to everyday decisions and obstacles an individual may face, there are many neurotypical and neurodivergent individuals that have a hard time with these skills. This article is going to outline abstract and conceptual thinking skills development, practice, and use in the school setting and at home. I plan on including ways that both parents and teachers will best be able to encourage and build these skills in children with autism spectrum disorder (ASD). It may take some creativity and thinking outside the box when interacting and teaching these skills. It is important to remember and take note of the differences and potential difficulties that your child may have when taking these ideas into consideration. As always, these are merely the tip of the iceberg and may not work for everybody. That is why the ability of parents and educators to think outside the box and use their own critical thinking skills when figuring out what will work best for the child. 

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• Nov 28, 2022

Critical Thinking Skills for Children with Autism

Critical thinking is an important skill our children need to learn. It enables a child to generate the ability for a higher level of conceptual thinking and appropriately solve problems in their everyday life.

Children with Autism may lack the ability to appropriately communicate their feelings or sometimes tend to engage in repetitive ways of rigid thinking and repetitive behaviors. When they are faced with challenges, moments of frustration occur when no clear expectations are provided to our children regarding their daily schedule, and the activities they are required to engage in throughout the day.

It is important to understand our children while equipping them with the skills needed to think critically (i.e., Executive Functioning and Problem-Solving Skills ) by teaching them:

● Be more open-minded, less rigid, and more flexible in adapting to their environment.

● Give them opportunities to learn creative mind thinking through play and leisure time.

● Identify problems and proper solutions, based on the intensity of the given problem.

● Understand their emotions and the likes/dislikes of others.

● Provide them with visual support to clarify expectations such as schedules and decrease verbal interactions during challenging times.

Applied Behavior Analysis is “the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior ”- 1968 Baer, Wolf, & Risley.

It is okay for our children to make errors, however, as caregivers and parents, we should create learning opportunities for our children, give them the emotional support they need and model proper responses.

For more information on how to manage aggressive behavior and proper communication, connect with us by sending your messages and questions to [email protected] or contact us directly at www.azinstitute4autism.com/contactus.

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Home » Autism Solutions » 5 Ways to Help Your Child with Autism Learn Flexible Thinking

5 Ways to Help Your Child with Autism Learn Flexible Thinking

By   Kari Dunn Buron

January 16, 2024

Children with autism are often frustrated with changes in their daily schedule, or the unexpected actions of another person.  Parents and teachers often find themselves responding to the behavioral outcome of the stress and anxiety involved with this “inflexible thinking,” rather than teaching flexible thinking in a systematic way. Here are five tips that may make teaching this skill easier:

• The first step in teaching this skill is to realize that your child might not understand why the world works the way it does; why people make the decisions they do; or why routines are sometimes disrupted by necessary changes. Your child might depend on some sense of predictability in order to be relaxed in different environments, and unexpected change might cause him significant stress.

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• Try using a calendar to teach “tolerance for change” in a very concrete, highly systematic way.   Make sure your calendar has room to write information on each day. Make note of birthdays and family or community events on the calendar, and then teach your child to “check” the calendar every morning to see what is happening and to check for any changes.  If a parent travels , you can mark out of town trips so that your child clearly sees when someone is leaving and returning.  If your child asks perseverative questions about when a particular event will happen (Halloween, vacation, trip to Disney, etc.) refer him to the calendar to find his answer.
• A “change board” can be used alone or in conjunction with your calendar. The classic change board is a white wipe-off board hung in the kitchen.  The board is always blank unless something is different about the daily schedule (such as a doctor appointment, a visitor, or something like the monthly disaster signal).  You will need to teach your child to look at the change board every day to check for changes.  Make this a habit.Once or twice a week, try creating a simple change (not too drastic or emotionally upsetting – something like shopping on a different day or going to visit someone after school) so that your child gradually becomes used to seeing a change posted on the change board. Then if your family has a last minute crisis that leads to an unexpected change in routine, you can write the change on the change board and prompt your child to check it.  Changes might still be unpleasant but by using a system to introduce change, you can take “the edge off” and make the change easier to tolerate.
• Teach your child a calming routine. An example might be taking two deep breaths, rubbing hands together, closing her eyes and then taking two more deep breaths.  Practice this routine several times every day.  Make a habit of doing the routine prior to events that are predictable difficult for your child to tolerate (like checking the calendar or the change board).
• Once your child understands the routine of checking the calendar and change board in your kitchen, try developing a portable warning system. For example, write the changes on the calendar on your phone and make it a habit to check the calendar prior to each daily transition.  Have a portable white board in your car to warn your child of any last minute changes while you are out.

Remember that all of this involves a learning style .  It is not a character flaw or manipulative behavior so much as a response to stress and anxiety.  Teaching your child how to handle emotions when things get too confusing or frustrating is one of the most important things you can do as a parent or teacher.  Learning to think flexibly is an important part of learning to regulate one’s own emotions and responding to the world in a positive way.

Buron, Kari Dunn. 2013. When My Worries Get Too Big ! Second Edition. AAPC.

Buron, Kari Dunn. 2012 . Adalyn’s Clare. Autism Asperger Publishing Co. (AAPC).

Goleman, Daniel. 2011. The Brain and Emotional Intelligence: New Insights. More

Than Sound LLC. Digital Edition.

http://usevisualstrategies.com . Linda Hodgdon

This article was featured in Issue 46 – The Time for Acceptance

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Social Cognitive Interventions for Adolescents with Autism Spectrum Disorders: A Systematic Review

Angela tseng.

1. Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA

Bruno Biagianti

2. Department of R&D, Posit Science Corporation, San Francisco, CA, USA

3. Department of Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

Sunday M. Francis

Christine a. conelea.

Contributors

Associated Data

Introduction.

Autism spectrum disorder (ASD), a heterogeneous neurodevelopmental disorder, impacts social experience and functioning throughout the lifespan. Although the postnatal phase of neuroplasticity has been a focus for early interventions in ASD, a second critical period in adolescence has emerged as a promising target for experience-dependent remediation. Interventions addressing the multidimensional construct of social cognition have also shown potential as a therapeutic approach. Yet, to date, evidence-based social cognitive interventions (SCIs) designed for adolescents with ASD are still lacking. In this review, we aim to survey and synthesize the extant literature on SCIs for adolescents with ASD in order to inform next steps for treatment research.

Using the PRISMA guidelines, we limited our queries to peer-reviewed, English-language journal articles describing SCI trials for adolescents with ASD using a randomized controlled design.

Eighteen articles in total met our inclusion/exclusion criteria. We present and discuss these trials using the non-exclusive categories of group-based social skills interventions, experiential-based interventions, and computer-assisted interventions.

Limitations

To ensure a focus on adolescence, we excluded trials with teen-age participants if mean subject age was not between 12–18 years. Also, given the variability across studies in outcome measures, study designs, samples, and effect sizes, findings were incommensurable.

Conclusions

Several reviewed SCIs reported post-treatment improvements in varied domains but findings were inconsistent. Further investigations of existing and novel interventions are warranted; attention to assessing and improving long-term skill transfer is essential. Technology-assisted augmentations may improve treatment efficacy and ecological validity of therapeutic gains.

1. Introduction

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder (NDD) with diagnostic criteria specifying persistent deficits in social communication, social interaction, and restricted, repetitive patterns of behavior, interests, or activities ( American Psychiatric Association, 2013 ). The prevalence of ASD in the U.S. has been on the rise, reaching a recent estimate of 1-in-54, with most diagnoses occurring during the preschool years ( Maenner et al., 2020 ). Boys are more than four times as likely to be identified with ASD than girls, and amongst children with IQ scores available, one-third also have intellectual disability (ID). In addition to core symptoms, individuals with ASD often present with a variety of co-occurring medical, developmental, behavioral, or psychiatric conditions that further impact daily functioning and quality of life ( Kuhlthau et al., 2017 ), with many comorbid conditions persisting across the lifespan ( Lai et al., 2014 ).

Treatment approaches for ASD may include intensive behavioral therapy, medication, educational programming, and ancillary services such as speech/language, occupational, and physical therapy. Timing plays a significant role in therapeutic efficacy, and early intervention has been strongly emphasized so as to coincide with postnatal time-limited epochs of stimulus-driven neuroplasticity. Yet, a second key target for remediation occurs later in development during the mutable stage of adolescence ( Ismail et al., 2017 ); this incipient area of intervention research holds great promise. The onset of puberty creates a cascade of hormonal changes that stimulate numerous structural and functional changes in the brain ( Juraska and Willing, 2017 ). As such, adolescence is a period of heightened socio-affective experience-dependent learning and neural plasticity ( Cohen Kadosh et al., 2013 , Fuhrmann et al., 2015 ) that manifest as heightened regulation of emotional reactivity and increased social understanding. During this period, neural circuitry sensitive to social cognitive processes undergo adaptive change and maturation; these networks include regions involved in thinking about mental states (dorsal medial prefrontal cortex (PFC), temporoparietal junction), observing faces and biological motion (posterior superior temporal sulcus), applying social knowledge (anterior temporal cortex), and understanding the actions and emotions of others (inferior frontal gyrus) ( Blakemore, 2008 , Vetter et al., 2013 ).

For typically-developing (TD) individuals, the onset of novel, adolescent-specific challenges (e.g., forming caring and supportive relationships with peers, making independent decisions, acquiring autonomy from parents) and their success in accomplishing these tasks is predictive of adaptive functioning in adulthood (e.g., work competence, romantic competence) ( Roisman et al., 2004 ). For individuals with ASD, social impairments in childhood may become more pronounced during adolescence when increasingly complex social demands exceed their competencies. Indeed, an estimated 30% of children with ASD experience functional setbacks when undergoing pubertal changes ( Picci and Scherf, 2014 ). Adverse exposure to interpersonal situations and peer networks may preclude the experience of meaningful social interactions and the development of important social skills. Indubitably, further investigation at this juncture of potentially heightened susceptibility in adolescence is vital to the establishment of efficacious interventions for ASD.

Several areas of struggle for individuals with ASD are subsumed by the multidimensional construct of social cognition outlined as four partially-overlapping critical domains - emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias ( Pinkham et al., 2014 ). Impairment in or across these domains while navigating a complex social world can have a substantial impact on individual functioning and long-term quality of life for persons with ASD. Accordingly, interest in interventions that address these domains of social cognition has been on the rise. Consistent with the trajectory of research in ASD, the development of social cognitive interventions (SCIs) for adolescents with ASD has lagged behind treatments designed for younger children and adults. Although some studies have included participants within the adolescent age range, those programs were rarely designed specifically for teenagers. Hence, the goals of this review are to survey and synthesize the extant literature on SCIs for adolescents with ASD in order to inform next steps for treatment research.

Search Strategy

We conducted this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement ( Moher et al., 2009 ). Our overarching search strategy involved querying electronic databases (Embase, Elsevier; PsycINFO, APA; PubMed, APA) with customized search strings, followed by manual filtering of query results using predefined inclusion and exclusion criteria (See Figure 1 ). In an effort to capture social-cognition-based interventions whether or not they were labeled as such, we included key domain terms as well as terms analogous to “interventions” and variations of “autism” in our queries. We used Boolean operators (AND, OR) to delineate our results.

PRISMA Flow Diagram.

Eligibility Criteria and Study Selection

We first identified studies by restricting our search to peer-reviewed, English-language journal articles; non-human, review, and meta-analytic reports were excluded. We also included the MeSH term “adolescence” as an age group limiter which returned studies with any participants between 13–17 years of age. Ultimately, studies were included if they: (1) reported findings from randomized controlled trials (RCTs); (2) recruited and reported data for individuals with ASD diagnoses; (3) recruited and reported data for participant groups within the adolescent age-range; and (4) reported findings from an SCI. Studies were excluded if they (1) focused on adults or younger children; (2) did not include social cognitive constructs as an independent variable; or (3) included secondary analyses only. In order to reduce biological confounds due to the heterogeneity of study design and samples, we also excluded studies wherein the independent variables were primarily physiological, e.g., drugs (e.g., Oxytocin, Risperidone, d-Cycloserine), devices (tDCS, rTMS), neuroimaging (EEG, fMRI), physical therapy, or biofeedback.

Finally, all authors reviewed the remaining articles in-depth. Several investigations identified by our initial query included teen-age participants even though full study samples largely comprise adults or younger children. Thus, in order to better circumscribe the adolescent age group, we agreed to limit our review to studies in which the mean age of participants with ASD was between 12–18 years. Consensus for inclusion was reached after discussion with all authors involved.

We conducted full database queries in February 2020. Our search strategy returned 117 unique results after duplicates were removed. After initial screening by the lead author (AT) and group review of titles and abstracts, 84 articles were excluded. We ruled out 14 additional reports because mean age of participants was not between 12–18 years, and 1 report was not reviewed because the full-text was inaccessible. Eighteen articles in total were included in the final review. Study design and key findings are presented and discussed below under the broad, non-exclusive categories of group-based social skills interventions, experiential-based interventions, and computer-assisted intervention; key details about study methods are presented in supplementary material .

Group-Based Social Skills Interventions (GSSI)

Over the last decade, group-based social skills interventions have grown in availability and popularity as a means to address social cognitive deficits in individuals with ASD. GSSIs vary considerably in their content, teaching strategy, mode of delivery, and intensity. However, often, GSSIs are informed by a cognitive behavioral therapy (CBT) framework and utilize behavioral modeling of a specific social skill, role play activities to practice skills, and individualized feedback on performance. Teaching strategies may employ structured lessons or in vivo skills-practice with differing levels and combinations of therapist, parent, peer, or teacher involvement. Whereas several systematic reviews have evaluated GSSIs for use in ASD (e.g., Gates et al., 2017 , Wolstencroft et al., 2018 ), to our knowledge, none have assessed RCTs for the adolescent age-range specifically.

We identified 12 RCTs that used a GSSI approach and met our inclusion criteria. All of these trials included ASD participants with Verbal IQs > 70 or the equivalent; this is not surprising given that GSSIs are generally designed for high-functioning individuals. Six reports described implementations of PEERS (Program for the Education and Enrichment of Relationship Skills), one of the few evidence-based social skills programs available for adolescents with ASD. Five trials applied the following manualized, group-based, in-person programs: Multimodal Anxiety and Social Skills Intervention (MASSI), Social Skills Group Training (SSGT; “ KONTAKT ”), and SOSTA -FRA (Social Skills Training Autism-Frankfurt). One additional study used a multi-family group psychoeducation approach (Transitioning Together) designed for families of individuals with ASD during the transition to adulthood.

PEERS (Program for the Education and Enrichment of Relationship Skills) utilizes principles of CBT to teach skills for solving real-life social dilemmas, appraising affect and social contexts, and initiating and maintaining conversations while receiving feedback from peers and clinicians. Structured practice interactions during socialization activities (e.g., playing sports, games) are integrated into the curricula. Concurrently, parents attend separate sessions and are taught how to assist teens in making and keeping friends by providing feedback during weekly socialization homework assignments. In the initial RCT testing PEERS, Laugeson and colleagues (2011) reported gains in social skills and responsiveness that were largely maintained at a 14-week follow-up assessment. Subsequently, Schohl et al. (2013) completed an independent replication and extension of PEERS with additional measures of social anxiety and problem behaviors. This treatment group also demonstrated social skills improvement along with a reduction in social anxiety, core ASD symptoms, and problem behaviors. Overall, findings contributed to knowledge of treatment efficacy and support the application of PEERS as an intervention. However, one potential caveat is the use of TASSK (Test of Adolescent Social Skills Knowledge), a self-report measure created by the developers of PEERS ( Laugeson et al., 2009 ), to assess PEERS outcomes. TASSK tests knowledge of specific, key social skills that are taught during the intervention. Ideally an outcome measure would also gauge real-world skills application and generalizability to novel situations. In a recent trial, Matthews and colleagues (2018) contrasted a novel, peer-mediated PEERS (PwP) against the traditional PEERS curriculum and a delayed treatment control group. Findings suggest that PwP is feasible and may have a modest advantage in improving social skills knowledge and social functioning relative to traditional PEERS. RCTs of adaptations of PEERS to Hebrew, Chinese, and Korean ( Rabin et al., 2018 , Shum et al., 2018 , Yoo et al., 2014 ) have also reported significant social skills improvements for their treatment groups along with cross-cultural validation of the translated/adapted versions.

MASSI (Multimodal Anxiety and Social Skills Intervention) was developed in response to the high co-occurrence of social anxiety disorder with ASD and evidence that social disability in ASD may be driven in part by social anxiety ( White et al., 2012 ). MASSI uses CBT strategies to target concurrent anxiety (e.g., exposure, cognitive restructuring, psychoeducation) and social skills deficits (e.g., modeling, feedback, role-play practice) with specific, individualized content selected by the therapist. All group sessions include one unaffected peer tutor volunteer. White and colleagues conducted a feasibility trial of MASSI in 30 adolescents with ASD and anxiety symptoms of moderate or greater severity. Their data suggest the possibility that this intervention may have more specific effects on core ASD-related social deficits than on anxiety symptoms, such that participants improved significantly on the Social Responsiveness Scale (SRS) but not on anxiety measures. Subsequently, Ireri et al. (2019) adapted MASSI for a special educational setting in Kenya; parents, teachers, and 40 children with ASD were randomized by school to either MASSI or treatment as usual (1 active and 1 control school). This version of MASSI applied a higher treatment dose by including a second phase of 20 more sessions focused on skills practice. Results from this trial demonstrated significant improvements in both ASD-related social impairment and anxiety, suggesting that adding teacher-mediated skills practice and additional training sessions may improve outcomes. These findings support the cross-cultural expansion of MASSI to a school-based implementation model. It should be noted, however, that no measure of cognitive function was reported and concurrent interventions were not tracked in this trial.

SOSTA-FRA (Social Skills Training Autism-Frankfurt), a highly structured, CBT-based GSSI developed in Germany, combines computer-assisted and social learning methods of teaching and practicing social skills. Freitag et al. (2016) conducted a multicenter RCT comparing SOSTA-FRA to treatment as usual that featured a rigorous design, including sample characterization using ADOS and IQ testing, large sample size, follow-up through 3 months, and a naturalistic inclusion criterion that allowed concurrent pharmacotherapy and psychosocial interventions.. Attrition was low and therapy quality was rated positively by participants. Pre-treatment parent-rated (p)SRS and IQ were positively associated with stronger improvement at follow-up. The authors also report a descriptive observation that female participants improved more than males on the pSRS. However, due to the high male:female ratio common to ASD studies, power was too low to compare effect sizes. These findings underscore the importance of assessing the relationship between IQ, sex, and SCI outcomes in future trials.

KONTAKT or SSGT (Social Skills Group Training), a Swedish CBT-based GSSI for youth with ASD, includes exercises in social skills as well as discussions of social cognition, social interaction, self-reflection, and descriptions of self and others. The program is conducted in cooperation with both parents and teachers and can be delivered in a brief (12 sessions) or long (24 sessions) format. Each therapy group consists of 4–8 youth (child or adolescent sub-groups) with two group leaders. Similar to SOSTA-FRA, KONTAKT trials featured a rigorous design including multiple sites, large N, follow-up through 3 months, ADOS characterization, and IQ assessment, while affording a pragmatic implementation (natural clinical setting, common comorbidities allowed, delivered by regular clinic staff). Choque-Olsson and colleagues (2017) compared KONTAKT to treatment as usual and reported that significant treatment effects on primary outcome measures were limited to pSRS-2 for the adolescent and female subgroups, suggesting that age and gender may moderate the effects of GSSIs for ASD. While findings were moderate and inconsistent, this trial demonstrated the feasibility of delivering KONTAKT in real-world mental health service settings. Subsequently, Jonsson and colleagues (2018) conducted the long form (24 sessions) of KONTAKT with a comparatively smaller group of youth with ASD (N=50). Scores on the pSRS-2 revealed large effects post-treatment which were maintained at follow-up, indicating that dosing and duration of treatment play key roles in SCI efficacy.

Transitioning Together is a multi-family group psychoeducation intervention designed to reduce family distress and improve social functioning for adolescents with ASD. In a preliminary evaluation, DaWalt et al. (2017) found significant improvements in social interactions following treatment for the intervention group, but not for controls. Also, parental depressive symptoms decreased and problem-solving improved for parents in the intervention condition. Notably, IQ was significantly higher in the intervention group despite random assignment; this may have influenced outcomes and future studies should consider the role of cognitive ability as a moderating variable.

Experiential-Based Interventions

Many existing SCIs rely on systematic instructional methods to address social cognition deficits associated with ASD. However, embedded opportunities for practice in real-world situations are limited; while structured interventional context may confer a therapeutic effect, the predominantly didactic approaches do not address ecological barriers to application. For example, an individual with ASD may not be able to practice a newly acquired social skill with peers who reject or ignore them. Interventions that take these obstacles into consideration may improve transfer of skills to novel, everyday interactions.

The START (Social Tools And Rules for Teen) program ( Vernon et al., 2017 ) is an immersive socialization intervention that focuses on improving social motivation, insight, and skills by incorporating a club-like environment that emphasizes learning through experiential and interactive lessons. Adolescent participants, college-aged social facilitators, high school peers, and parents (only at end of session) attended each group. Significant improvements between pre- and post-intervention assessments were reported for multiple social cognitive outcome measures, suggesting that experience-based SCIs can help improve social readiness in adolescents with ASD. One selection bias concern is that, despite random assignment, the treatment group endorsed significantly lower adolescent-reported SSIS scores at pre-intervention and this may have skewed results.

Strickland et al. (2013) evaluated JobTIPS, an internet-accessed tool designed to teach job interview skills to nearing transition-age individuals. Treatment included multimedia educational content with ToM-based guidance, video models, and visual supports for 1 week and virtual reality practice session with avatars led remotely by an experienced clinician. Training was associated with significant improvements in the verbal content of responses to job interview questions along with a trend toward improving the delivery (e.g., posture, eye contact, facial expression) of those responses. This trial is one of the few to assess and demonstrate generalization, such that JobTIPS afforded skill-transfer to face-to-face mock interviews that simulate real-world situations.

CONTACT (Conflict Orientation and Negotiation Training Among Children and Teens), a computerized video modeling and video self-modeling application, was developed to improve conflict negotiation strategies in adolescents with ASD who may be inclined toward avoidance of social conflict ( Hochhauser et al., 2017 ). Negative socialization experiences often lead to poor quality peer friendships or isolation. Video modeling interventions typically involve watching video demonstrations of an adaptive behavior before imitation; video self-modeling involves watching and learning from one's own positive behavior. CONTACT was designed for pairs of participants, matched on similarities in their social and cognitive abilities, to engage in training with mediation (e.g., prompts, guided questions, and explanations) by an experienced moderator. One advantage to this experiential approach is that it enables participants to practice their adaptive responses to socially-relevant stimuli in simulated conflict situations that may be less threatening than real-world interactions. Hochhauser and colleagues reported significant improvements for the treatment group in their self-reported negotiation attitudes and behaviors, specifically in their self-confidence, communication factors, and willingness to engage in cooperative negotiation.

The Referential Communication Training Program ( Olivar-Parra et al., 2011 ) addressed participants’ ability to select and organize information for a communicative exchange. Training sessions included pairs of verbal-mental-age and sex-matched ASD and TD participants as speakers and listeners with an adult to guide and facilitate learning. Notably, this trial is one of the few that did not exclude participants for ID. Although introducing a wide range of verbal ages and cognitive levels amongst participants impacts interpretation of results from a small sample (N=20 pairs), the inclusion of varying levels of cognitive ability is more reflective of the heterogeneous presentation of ASD. Further, speakers in the trained and untrained groups did not differ in chronological age, level of receptive language, IQ, or number of ASD symptoms. Finding showed significant increases in the complexity of emitted messages in the treatment group; however, these improvements were not maintained at the follow-up generalization stage.

Computer-Assisted Interventions

Rapid progress in the fields of technology offer tremendous possibilities for innovation in treatment for individuals with ASD. In recent years, computer-assisted and other technology-aided approaches to supplement existing therapies or as the primary delivery modality have been proliferating, with varying levels of efficacy and generalizability. Computer-based technologies may be particularly beneficial to individuals with ASD because of their capacity to limit distractions from extraneous sensory stimuli, to provide consistent and predictable responses, and to offer clearly defined tasks. Surprisingly, in addition to the CONTACT program described earlier, only two RCTs fit our criteria, in large part because we excluded programs where the mean age of participants was not within the adolescent age-range.

The earliest trial meeting our criteria ( Silver and Oakes, 2001 ) used The Emotion Trainer, an interactive multimedia computer program with corrective feedback; significant improvements were reported on emotion recognition in cartoon but not human faces for the experimental group. Although these gains did correlate significantly with the number of times each participant used the computer program, it was unclear whether these skills would be transferred to real-world situations.

More recently, Fage and colleagues (2018) tested a tablet-based intervention using a set of mobile applications, School+, to support school inclusion of children with ASD in mainstream classrooms. Assistive and rehabilitation applications were used for three months by 33 youth (ASD: 14, ID: 19 ) from special-education classrooms during their first inclusion in mainstream classrooms in secondary schools. Fifteen children with ASD, who were not equipped with School+, participated as a comparative group. Both tablet-equipped groups exhibited significant improvements on socio-cognitive functioning measures. Tablet-ASD participants, but not Tablet-ID participants, exhibited improvements on socio-adaptive behaviors and social response. It is difficult to draw conclusions about the use of School+ in individuals with ID as a non-equipped ID comparative group was not included in the study. However, in contrast to the equipped-ASD group, the non-equipped ASD group demonstrated no significant changes across time. These findings provide support for the efficacy of using the School+ program with individuals with ASD.

4. Discussion

Summary of findings.

For this systematic review, we aimed to ascertain the current state of knowledge in the development of social cognitive interventions for adolescents with ASD. Altogether, eighteen studies met our inclusion criteria. Two-thirds of the publications used CBT-informed group-based social skills interventions; half of those applied versions of PEERS. A small number of programs integrated experiential-based learning paradigms to augment CBT approaches by enabling real-world practice and reflection. Technological advancements such as virtual reality platforms have emerged as a means to include remote interactions between participants and clinician or teacher facilitators (e.g., Strickland et al., 2013 ). Immersive technology that affords opportunities for practice in a simulated but realistic environments may improve ecological validity of programs. Further, the use of computer-assisted modalities to enhance existing interventions may increase their versatility and overall appeal, enabling individualized mediation and facilitation by trained professionals ( Khan et al., 2019 ).

Several shortcomings exist in the field across all ages. For example, most GSSIs are time and resource intensive so sample sizes tend to be small, thus limiting power. In-person treatments may be geographically inaccessible to families who live in remote areas. While technology-assisted interventions may offset some of these constraints, they may also require a means to connect to internet. Further, most SCIs have been designed for and tested in individuals without ID (IQ >70), effectively neglecting one-third of individuals with ASD. Moreover, given the prevalence ratio of about 4 males for every 1 female diagnosed with ASD, it is not surprising that SCIs have been evaluated with more males than females. However, research suggests that IQ and sex may moderate SCI outcomes for ASD ( Choque-Olsson et al., 2017 , Freitag et al., 2016 ), necessitating further investigation with these under-sampled individuals.

The present systematic review has limitations. In order to restrict our results to SCIs for adolescents with ASD, we did not include several trials that included teen-age participants but did not focus on the adolescent age group. The majority of therapeutic advances in the field have been developed for younger children or adults; often adolescent trials are essentially extensions of child- or adult-directed programs. However, as noted, the period during and after puberty is a unique developmental stage and considering adolescent-specific variables in treatment design and outcomes is warranted. In addition, given the diversity of social, cognitive, and clinical assessments used across investigations, as well as the heterogeneity of study designs, samples, and effect sizes, outcome findings were incommensurable.

5. Conclusions & Future Directions

Findings from our review highlight the paucity of social cognitive interventions designed specifically for adolescents with ASD. Although much attention is given to ASD in early childhood ( Wolff et al., 2018 ), the interval of neuroplasticity between puberty and the transition to adulthood affords an opportunity to capitalize on the dynamic structural and functional reorganization of neurons susceptible to developmental and experiential demands ( Blakemore, 2010 ). In particular, for individuals with NDDs, neuroplasticity may subserve the compensatory mechanisms modulating symptom severity ( Dow-Edwards et al., 2019 ). Notably, PFC, the nucleus of higher-level cognitive functions, undergoes the most protracted development; synaptic spines within PFC exhibit overproduction during childhood with remodeling and pruning of spines continuing beyond adolescence and throughout the third decade of life ( Petanjek et al., 2011 ). Hence, interventions directed at this sensitive phase of neurodevelopment may result in more significant impact on long-term outcomes.

Potential areas for advancement in the development of SCIs for adolescents with ASD are substantial. We have identified several promising areas that warrant further investigation. For example, a primary concern in the application of treatment programs is whether skills acquired during therapy transfer to real-world settings over time. Extended follow-up of participants would help evaluate the longevity and generalizability of therapeutic gains. SCIs that incorporate simulated or real-world practice of skills have shown favor; technology-based augmentations of existing evidence-based strategies may not only enhance treatment uptake but also enable remote delivery of efficacious interventions.

• A second window of neuroplasticity that occurs in adolescence has emerged as a promising target for experience-dependent remediation in autism spectrum disorder (ASD)
• Evidence-based, social cognitive interventions (SCIs) for ASD that target the critical period between puberty and the transition to adulthood are lacking
• Extant treatments that address the multidimensional construct of social cognition in adolescents with ASD include group-based social skills interventions, experiential-based interventions, and computer-assisted interventions
• Some programs demonstrated post-treatment improvement but findings are inconsistent; further research is needed to assess and improve long-term transfer of skills and to develop technology-assisted tools that augment efficacy and ecological validity of treatments

Supplementary Material

Acknowledgments.

Role of the Funding source

This study was supported by the National Institute of Mental Health under Award Numbers R43 1 R43 MH121209-01 (BB, CC) and R01MH115046-02 (SJ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Conflict of Interest

BB is Senior Scientist at Posit Science, a company that produces cognitive training and assessment software. CC is a site principal investigator for a Small Business and Innovation Research grant awarded to Posit Science that tests the effects of a cognitive behavioral digital intervention for adolescents with social anxiety. SJ, AT, and SF report no conflict of interest to the therapeutic modalities and topic of this review.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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7 Executive Functioning Challenges for People With Autism

Executive functioning issues are common and problematic for autistic people..

Posted August 18, 2021 | Reviewed by Devon Frye

• What Is Autism?
• Find a therapist to help with autism
• Executive functioning is necessary for planning, decision-making, impulse control, and emotional regulation.
• People with autism often have problems with executive functioning.
• This can cause problems with communication, follow through, planning, self-care, and rigid thinking.

As humans, much of what we do happens without any conscious thought. We don’t need to think about breathing, for instance, and we’ll automatically take our hand away from burning heat.

For the rest of our daily responsibilities, we rely heavily on what is called “ executive function ” (EF). We need to have the ability to plan, set and meet goals , refer back to previous experiences, complete tasks, and manage our emotions. For this, we rely primarily on the front part of our brain (the prefrontal cortex). Life is increasingly complex, and EF allows us to meet these complexities by drawing on what we already know about the world, making links, and controlling our impulses. EF keeps us at our desk working when we’ve got a tight deadline to meet instead of taking the day off to lie in bed with a supply of coffee and biscuits. It’s a bit like having an effective boss keeping things in control.

But many children, adolescents, and adults with autism have issues with EF. 1 No matter how good their memories may be for things like facts and details, and no matter how clever they may be, they may have difficulties with day-to-day living and emotional regulation . Having high-functioning (or level 1) autism doesn’t mitigate these difficulties—and while many people can handle complex and difficult information and careers, they may face considerable difficulties managing the more basic, but essential, aspects of life.

Understanding Executive Function

EF is usually broken down into the following categories:

1. Working memory

Working memory refers to a person’s capacity to hold onto a limited amount of information in their mind so that it is ready for immediate use. Working memory can be thought of like a sticky note: the information is available and accessible when you need it—for instance, while you’re in the middle of a task. During conversations, working memory is what allows you to store information until you're ready to talk. Working memory also helps the brain store information for long-term memory .

2. Cognitive flexibility

This refers to a person’s ability to switch between separate concepts and think about something in more than one way. If you were in a group of people, for example, and suddenly the conversation shifted from talking about holidays to talking about dogs, your level of cognitive flexibility would determine how rapidly, and how well, you would respond to this shift.

Cognitive flexibility also refers to the capacity to update beliefs and respond to new situations, to be aware of a variety of choices, and to deconstruct bigger thoughts into smaller chunks. Difficulties with cognitive flexibility can cause rigid thinking, make it hard for people to switch tasks, and cause problems when it comes to making bigger life changes.

3. Inhibitory control

Inhibitory control refers to the ability to ignore distractions and to control our attention . It refers to the ability to suppress impulses and, for instance, could refer to the ability to delay a behaviour in order to benefit from doing so. A lack of inhibitory control can cause us to act in automatic but inappropriate ways and to lack the ability to come up with well-considered responses.

Executive Function and Autism

Some of the ways in which EF issues affect people with autism include:

1. Communication

EF can contribute to communication issues, particularly if someone finds it challenging to hold information during a conversation. Communication can also be affected by a lack of inhibitory control and a tendency to say inappropriate things.

2. Planning

Devising a plan can be difficult for people with autism; they can become easily overwhelmed and struggle to see how they can carry out what needs to be done in a manageable way. They may face difficulties with organising the tasks required to meet a bigger goal.

3. Daily tasks

Working memory is required for daily tasks, such as getting up, getting dressed, making breakfast, and doing housework. While many people with autism have incredible memories for facts, carrying out the types of activities that rely on working memory can pose a significant challenge.

4. Impulse control

Poor impulse control can lead to unhealthy or self-destructive behaviours. For instance, a lack of impulse control may contribute to someone with autism staying up all night researching their new hobby.

5. Attention

People with autism often have a great ability to focus, but they may experience difficulties in directing their focus in an appropriate way. If they have sensory issues, for example, their focus might be directed towards the ticking of a clock or the intensity of overhead lighting, while they cannot direct their attention to someone speaking to them or other more important information.

6. Verbal reasoning

People with autism may struggle to understand and process verbal concepts.

7. Rigid thinking

It can be difficult for people with autism to change their way of thinking. This may make it hard for them to adapt to new situations and can cause them to have rigid, unchangeable opinions.

How People with Autism Can Cope

All of the above EF issues can make it extremely difficult for people with autism, no matter where they are on the spectrum, to cope with life. But both children and adults can develop strategies to help with executive function—including, for example, creating “to-do” lists and breaking down larger tasks into manageable steps, sometimes in a visual or flowchart manner. Putting systems into place and having routines can be useful so that tasks aren’t left until the last minute to be dealt with at a stage when the situation feels overwhelming.

One of my clients reported that she consistently couldn’t face making breakfast, which left her feeling drained and anxious . By preparing breakfast in advance, she noticed a huge improvement in her day. Seemingly simple, proactive, and routine steps can create huge changes when it comes to EF. Seeking out the right support, therapy , and acknowledging that some regular tasks, no matter how “simple” they might seem, are simply more difficult for you can help improve your quality of life.

1. C. Hughes, J. Russell, and T. W. Robbins, “Evidence for executive dysfunction in autism,” Neuropsychologia, vol. 32, no. 4, pp. 477–492, 1994

Claire Jack, Ph.D. , is a hypnotherapist, life coach, researcher, and training provider who specialises in working with women with autism spectrum disorder (ASD). She was herself diagnosed with ASD in her forties.

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More Than ABCs: Building the Critical Thinking Skills Your Child Needs for Literacy Success

What Is Critical Thinking?

Critical thinking happens when a child draws on her existing knowledge and experience, as well as on her problem-solving skills, to do things like:

• Compare and contrast
• Explain why things happen
• Evaluate ideas and form opinions
• Understand the perspectives of others
• Predict what will happen in the future
• Think of creative solutions

During book reading, you can help your child develop all of these skills so she fully understands the stories she hears.  

How to Build Critical Thinking Skills – It's All About Conversation!

If your child just listens to a story and says very little, she won’t have much opportunity to build and use the critical thinking skills she needs to understand stories. That’s because this kind of thinking happens during back-and-forth conversations in which your child can draw upon her own experiences and problem-solving skills to talk about the story. So remember to add a little conversation to every book you share with your child. Pause several times during the story to talk about what interests her, and take a few minutes after the reading to keep the conversation going.

E’s and P’s – How to Get Your Child Thinking Critically             

As you and your child talk about the story, keep the “E’s and P’s” at the back of your mind. These are the things your child needs to think about to exercise her critical thinking skills and deepen her understanding of the story:

E xperiences — Connect the story with your child's knowledge and experiences

When you relate what you’re reading to something your child already knows or has already experienced, you help her better understand the characters’ perspectives and why they think and act the way they do.  

E xplain — Why things happen

It’s important for your child to understand not only what is happening in a story, but why it’s happening. This builds her understanding of cause-and-effect, as well as her understanding of what motivates the characters in the book.  

P roblem-solve — How to solve the problem in the book

To understand a story, your child needs to understand the problem that must be solved. Recognizing the problem and thinking of possible solutions builds the problem-solving skills she’ll need later when analyzing texts on her own.  

P redict — What will happen in the future

A good reader uses her knowledge and experience to predict what will happen in a story. When you encourage your child to think about what will happen next, you get her into the habit of searching for meaning, which is really what reading is all about.  

By helping your child think critically now, you’re laying the foundation for her to make judgements, solve problems, think creatively, empathize with others and communicate effectively – skills she’ll need not only for literacy, but for lifelong success.  

Greenberg, J. & Weitzman, E. (2014). I'm Ready! How to Prepare Your Child for Reading Success . Toronto: Hanen Early Language Program.  

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Social Thinking: 6 Strategies for Teaching Children with Autism

Topics: Early Childhood Education , Autism and Language , Autism & Emotions , Elementary (4-12) , Teen (13-17) , Parents , Articles , Socializing with Autism

What is Social Thinking?

Social Thinking is a flexible teaching framework that is designed to help individuals ages four and up with autism spectrum disorder and other social and communication difficulties. The framework helps these individuals better understand the process by which we interpret the thoughts, beliefs, intentions, emotions, and actions of another person within the context of a situation. We use this information every day to better understand the experience of those around us. This understanding helps us respond in a way that will effect the other person’s thoughts about us in order to ultimately achieve our social goals.

Impact on Academics

The concepts that individuals learn through the Social Thinking framework are essential to academic success. Students learn the skills necessary to effectively share space with their peers, work well as part of a team or group, and build healthy relationships with others. Additionally, it teaches students when it is appropriate to talk in class versus when they should stay on task and work independently. These concepts are also important in writing an essay or reading a book. Social Thinking helps students improve their ability to take the perspective of the reader to make effective arguments and how to organize information so that it will make sense to the reader.

How Does it Work?

The Social Thinking framework breaks down concepts that may otherwise be challenging to explain. It provides the teacher or counselor with a language that makes these topics accessible. Educators are free to adapt the curriculum to best suit the needs of the individual learner. Through clear instruction and support, Social Thinking helps individuals learn how to read implicit clues about what someone is thinking, what they might do next, and how these clues may differ depending on the context of varying situations.

The 6 Social Thinking Strategies

• Flexible Thinking

Many individuals with autism may have the tendency to exhibit rigid thought patterns. Social Thinking utilizes a group of superheroes to encourage flexible thinking. “The Unthinkables” are a group of comic characters that try to make people inflexible and experience challenges such as getting off topic, getting distracted, and getting stuck on topics. “Superflex” can be called on when someone is exhibiting rigid thinking to help encourage that person to see the situation from a different, more flexible, perspective.

We notice when someone’s brain or body is not part of the group. It is important to explain the importance of whole body listening to individuals who struggle with social and communication skills. Whole body listening is a phrase that is used to describe when someone’s eyes, ears, mouth, hands, feet, bottom, and brain are quiet, still, and focused on the rest of the group.

• Size of the Problem

Not all problems warrant a big reaction. Social Thinking introduces students to a rating scale to help better understand the range of their problem. Consequently, this will help them to better understand the idea that one’s reaction should match the size of the problem. Big problems call for strong emotional reactions and help from others, where little problems can be worked out if you remain flexible.

• Expected vs. Unexpected

In our society, a range of hidden rules exists in every situation. People are responsible for figuring out what those rules are and for following them. A behavior is considered unexpected when we fail to follow the set of rules in the environment. Doing what is expected helps others feel positively about us, or keeps them “thinking good thoughts”. When people are acting in unexpected ways, it causes others to have “weird” or “uncomfortable” thoughts about them.

When we are conversing with our peers, the best way to keep them engaged is to discuss common or relevant interests. Over time, we collect information about others that we can place in our “mind file” about a specific person. We can then use this information to have a meaningful and engaging conversation with them.

• Social Detective

We must use our ears, eyes, and brains to figure out what to do or say in a given situation. When we are good “social detectives” we use our senses to “read the room” and gain an understanding of what behaviors are expected or unexpected. We also need to use good social detective skills when talking to peers to determine what they will likely do next, what they are presently doing, and what they mean by what they are saying so that we can respond in an expected way.

To help your child practice their social thinking strategies, download our free "How Big is My Problem?" worksheet!

Resources  

Kelly, K. (2015). Social Thinking: What You Need to Know. Retrieved from https://www.understood.org/en/school-learning/partnering-with-child-school/instructional-strategies/social-thinking-what-you-need-to-know

Socialthinking - Social Thinking's Mission. (n.d.). Retrieved from https://www.socialthinking.com/LandingPages/Mission

Written by Courtney Chase

Courtney Chase is a graduate student at Lesley University studying clinical mental health counseling with a specialization in school adjustment counseling. She is currently interning as a school counselor at Atlantic Middle School in Quincy, MA. Her primary role as a school adjustment counselor is to help facilitate the academic and social success of each unique learner. She helps each student identify individualized goals and strategies for success and promotes the realization of these goals by supporting the student through his or her educational journey.

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