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Learning and Teaching Social Skills: A Relationship-Based Approach by Adam J. Cox, Ph.D.
  This article originally appeared in the Learning Disabilities Association of Pennsylvania 2004 monograph on Social Skills
   
  The challenge of effectively teaching social skills is a goal shared by many mental health professionals, special education teachers, parents, and others invested in the development of children and adolescents. Social skills are fundamental to success because most areas of life require initiating and sustaining relationships. All of us understand the applicability of social skills in multiple contexts including family, school, and eventually, at work. Yet few psycho educational subjects have been as perplexing for learners, and as challenging for teachers (including psychologists and counselors), as social skills.
   
  The same conclusions are described in a recent “practice alert newsletter” forwarded to me by a colleague recently. The newsletter summarized the effectiveness of social skills instruction for students with learning disabilities, noting the limited success of most remedial programs in this area. The authors, themselves experts in the teaching of social skills, note that many social skills programs do not produce long-lasting results.
   
  For those of us committed to helping children adapt to various types of learning challenges, the quest to teach social skills is particularly salient. Social learning impairments are associated with a wide variety of learning disabilities, although they are especially problematic for people with nonverbal learning disabilities (NVLD), noted to have underdeveloped right-hemisphere abilities, including deficits in reading facial expressions, perceiving emotions, and using nonverbal communication. The constellation of social skills deficits often encountered in school age children are perhaps best described as pragmatic communication deficits, which encompass challenges understanding social conventions and applying social cognitive skills.
   
  Why Are Social Skills So Hard To Learn?
  In part, what makes elements of pragmatic communication so difficult to teach is that, generally speaking, they are reflexive cognitive skills that draw on the “hardwiring” of our brains, and are generally learned and applied without conscious thought. Most people use social skills quickly and automatically, and as a result, don’t have the benefit of time to analyze which skills will be used in particular situations, or how best to apply them. When our social reflexes are well-attuned and effective, we don’t need time to think - we just do and say what comes naturally.
   
  In my practice as a clinical psychologist, I have come to specialize in the treatment of social skills, primarily for boys, many of whom have pronounced pragmatic communication deficits. In this brief article, I want to discuss some of the psychological factors that make the treatment of social skills such a challenge, and explore why boys may be particularly vulnerable to these types of deficits. In addition, I would like to introduce what I believe is a somewhat unique perspective of how social skills are most effectively remediated. Included in my discussion will be how the very notion of “skills” directs our approaches to intervention in ways that may not be fully advantageous to the teaching of social skills.
   
  Important to emphasize is that social skills are built on a foundation of interpersonal awareness. Without an appreciation of other people’s nonverbal behavior, including sensitivity to nuances of language rhythm and intonation (prosody), it is difficult to formulate appropriate and constructive verbal and behavioral responses. In addition to having a basic awareness of other people, having an empathetic orientation toward others is very helpful in bolstering one’s intuition about how to relate effectively. As some readers may be aware, a disproportionate number of children and adolescents with learning disabilities are observed to have low empathy.
   
  In his recent book, The Essential Difference: The Truth about the Male and Female Brain, psychologist Simon Baron-Cohen, has argued that males and females differ with regard to baseline levels of empathy. More specifically, Baron-Cohen theorizes that males, in contrast to females, are not natural “empathizers”. While Baron-Cohen notes that females tend to be empathizers, he posits that males tend to be “systematizers,” preferring analogical, linear, and sequential thinking.
   
  As readers might surmise, systematizing is not nearly as useful as empathizing when it comes to perceiving the mind of others, including their intentions, motivations, and emotions. In addition, without adequate empathy for others, children (typically boys) may lack the motivation to learn how to effectively respond to other people. To be in an empathic relationship with another person or group is the opposite of self-absorption. Empathy implies a departure from a state of self-centeredness, and immersion into the subjective experience of others. By definition, empathy is prosocial, because it emphasizes the value of comprehending and appreciating the thoughts and feelings of other people.
   
  A willingness to consider the thoughts and feelings of others is fundamental to the expression of social skills. We all function in various types of groups: families, schools, teams, neighborhoods, and communities, among others. Social skills make our participation in these groups easier and more satisfying. Although lack of empathy has been associated with the presence of NVLD, I would argue that what is missing for many learning disabled children are overt expressions of empathy, as are often conveyed through pragmatic communication. This is very different from the absence of empathy found among antisocial children and adolescents. Many children with nonverbal learning disabilities are better understood as being asocial, meaning that they can appear indifferent to social interaction. Conversely, some learning disabled individuals have a low frustration threshold, and consequently struggle more with the modulation of anger than indifference. Yet again, empathy can be recognized as a core skill in modulating affect and shaping appropriate expressions of anger.
   
  Can We Help Teach Children to Solve Their Own Social Problems?
  Not long ago, I was leading a social skills group for 3rdrd and 4th grade boys, about half of whom had been identified as having a learning disability. We were huddled in my office with kids bunched on sofas, sitting on the floor, and twirling in my desk chair. One seven year-old boy, Grant, resisted joining in our group activity, which was to design and build a big “cyborg”. He stood near the door on the periphery of the group with a scowl on his face and body language that conveyed his fear and distrust of the group. Grant wasn’t responding to cajoling and encouragement to join us. I tried all kinds of approaches, changing the tone of my voice and my facial expression, in search of the combination that would help him join in. Still, he would not budge.
   
  Several years earlier, my frustration probably would have resulted in me taking Grant outside and pleading with him to sit down and join the group. That’s because I used to have the faulty impression that “leading” a group, meant “controlling” the group. Since then, I have come to appreciate the extraordinary strong will of boys to do things in ways that reflect their own logic about how problems should be solved.
   
  As the situation unfolded, it became apparent that Grant’s resistance provided the boys with a good problem-solving opportunity, and so I posed a question to the group. Did anyone have any ideas about how we could get Grant to join us? Most of the kids responded with suggestions of various kinds of rewards: games, candy, or premium seating (twirling chair). One typically shy boy, Tyler, suggested we could “buddy-up” so that everyone could have a partner, including Grant. Tyler also suggested that buddies sit next to each other so they could share tools. Most of the boys agreed this was a good idea and so we began a discussion of how buddies would be chosen. Again, Tyler spoke up, suggesting that Grant could pick his buddy.
   
  Throughout this process, I was watching Grant closely, and was struck by his awareness of the group’s concern about him. His facial expression changed from one of distrust to a cautious grin. He’d obviously had some significant doubt about whether the boys would accept him, and how he would fit in – figuratively and literally. Tyler’s leadership in breaking through his fears paved the way for his integration in the group. As you might imagine, I felt very proud of Tyler for his sensitivity to Grant, and his ability to apply that sensitivity through active problem-solving. Although he never verbalized Grant’s feelings, Tyler’s suggestions were, emotionally speaking, quite sophisticated, and reflected an understanding of what Grant was feeling.
   
  Socializing is not Systematizing
  When we think about teaching social skills to children, it is a natural step for us to begin thinking about skills as component parts of a larger system. While this may be a logical and practical way to go about the teaching of a “system,” it is not necessarily the best, or only, aspect of a therapeutic process designed to facilitate the development of social skills. In addition, for individuals such as psychologists or counselors who may teach social skills, there is a tendency to systematize the teaching of such skills in limited periods of time, such as teaching one skill per session for 12 – 15 weeks. When social skills are taught to groups this approach may be inevitable, but when working with children individually, there is typically more latitude, including allowing the child to play an important role in how the learning evolves. My experience has taught me not to exclude the importance of the relationship between teacher and student, or therapist and client, in helping children integrate new skills. In this sense, professionals allow the process of learning to be as organic as would be the process of healing syndromes like depression or anxiety.
   
  Several years ago, I read a book called The Silent Child: Bringing Language to Children Who Cannot Speak by Laurent Danon-Boileau, a French psychoanalyst and professor of linguistics at the Sorbonne, in Paris, France. The book profiled several types of children who were resistant to traditional therapies targeted at facilitating verbal expression. What I gained from reading the book was the importance of a slow and well-developed relationship with a child that involved elements of consistency, encouragement, and enlightenment. While I don’t want to suggest that psychoanalysis is the optimal approach for teaching social skills, I do believe that an excellent working alliance is a critical foundation for learning most things, including how to relate to others. This is because gaining social competence is more than conceptually grasping “skills,” it also involves relaxing enough to take risks – trying new things with uncertain outcomes.
   
  Productive working alliances usually take time to develop. I have repeatedly noticed that the children I am treating, who are most successful in assimilating desired social skills, are those children whose parents bring them consistently to appointments over a significant length of time, often for more than one year. Some readers may be shocked that such an extended period of time is required to teach something as seemingly concrete as social skills. However, because they are automatic and reflexive, social skills deficits are often difficult to change, requiring a substantial effort on the part of a whole system of people including parents, teachers, and sometimes even peers.
   
  From Skills to Awareness
  Perhaps we need to remember that for the brain and mind to integrate new ideas, a fertile ground of receptivity must first be prepared. That receptivity often springs from an effective, trusting, working alliance. For many children, this means engaging in therapeutic and relational activities that are not purely didactic, because such structured activities are often associated with domains where they lack success. In other words, you can make it fun – play is the work of children.
   
  If we as parents, teachers, and professionals can make the transition from thinking about social skills to social awareness, we may gain an appreciation of new possibilities about how to teach that awareness. Building awareness may require helping children attune to their social environment, a process potentially well modeled by interpersonal psychotherapy. The teaching of skills is implicitly active, and suggests a directive approach in the treatment of social deficits. Conversely, if social awareness is built upon a foundation of motivation, then the real challenge is to find a way to adequately motivate children to develop social awareness.
   
  While I would never want to give up my use of behavioral charts and records, or surrender my collection of therapeutic games designed to teach things like communication pragmatics and listening skills, I have come to believe that those exercises are somewhat empty without a solid alliance between my clients and myself. The alliance gives clients the capacity to be receptive. Sometimes, people may not even be aware of their own resistance to learning new skills. It is only in the consistent supportive relationship of therapy that many children will allow the walls that limit learning to come down. For children with learning disabilities, these walls often come down slowly, but they do come down with tools like patience, commitment, and belief in the desire of children to connect with others.
   
  There is no doubt that strategies focused on strengthening executive control skills are highly valuable. Frequent prompting and reminding, along with role-play and rehearsal, are critical components of successful social awareness training. Still, those interventions should be integrated into a comprehensive approach to teaching social awareness, and enhancing children’s motivation for developing that awareness.
  Sometimes, that will necessarily involve the use of instructional aides such as videos, movies, cartoons, or books. Anything that might help a child connect the development of social awareness with a positive outcome should be considered a potential tool. Still, we should remember that what we are building with these tools is a mind, and a mind is not a machine – it is the very essence of being a person. We simply can’t program a mind according to standards of efficiency without regard for the individual within whom that mind lives.
   
  References
  Baron-Cohen, S. (2003) The essential difference: The truth about the male and female brain, Perseus
   
  Danon-Boileau, L. ( 1995 ) The silent child: Bringing language to children who cannot speak
   
  This article originally appeared in the 2004 monograph of the Learning Disabilities Association of Pennsylvania. Portions of this article were adapted from Dr. Cox’s forthcoming book, Boys of Few Words: Helping Our Sons Across the Communication Divide.
 
 
 


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