Looking at social skills not only for those with ADHD but for any child who has problems within this area - many conditions have direct relationships with poor social skills. Problems with impulse control, attention and all these issue mean that our children tend to find integrating with their peers very difficult.
Our children will often but into conversations, not wait their turn in a queue or in a game. They often think of something which they really need to say before they forget it. Generally not being able to communicate at the same level as their peers - it is generally felt through a lot of the research which has been carried out, that children with conditions like ADHD develop at approximately 3 years below their peers in their emotional and comprehension abilities, this makes it very difficult for them therefore to interact with other children of the same age. They will very often get on really well with younger children who they obviously feel more able to communicate with. Or older children or adults as they do not feel as threatened when in conversation or interaction with these groups.
It is very difficult for them to understand all that is going on around them due to lack of attention and concentration they will often not be able to follow the flow of conversation and therefore will then often make inappropriate remarks to get back to the centre of attention!
There are a number of ways which we can do to help our children to overcome a lot of these problems. Obviously professional Social Skills Groups are the best option and all of our children would really benefit from these, however these are so rarely available that it is probably a good idea to try to incorporate as much as we can into daily life until these groups start to appear. Social Skills Groups can be found via the local Child and Adolescent Mental Health Services, some schools will run these during the school day for small groups and also the local Social Services Children's Service can arrange to hold these. The thing is that it does not cost a great deal in money terms to set something like this up and there are a lot of great materials around which you can get to help with this. Check out our Books and Resources Section - Social Skills. I found a copy of a great board game basically called "The Social Skills Game" which I got a copy of and lent to my sons small school unit and some of the children and teachers have written some great reviews for this. For an initial layout of approximately £40 this can be used over and over with many groups of children so would be a great investment for many schools who would be prepared to work with a group of up to say 6 children for no more than about 15 minutes twice or three times a week either during lesson time or maybe over a break time or lunch time. One of the bits I found the children loved when we used this was the part where they each had to whisper something then they had to shout it as loud as they could - well of course they all tried to out shout each other but it was great fun and they did learn a lot from it.
There are also a lot of Activity Books and other books including The Social Stories Book by Carol Grey which is based on cartoon strip type of everyday things which can be used to discuss appropriate situations and how to handle things a CD Rom called Gaining Face was also used at the school - this has various faces to enable the child to learn about facial expressions. On a larger scale there is an Interactive CD Rom from Behaviour UK called the conduct files which can be purchased by the LEA and used in a number of schools on a license basis which is for both primary school and senior school age groups and uses video clips and then questions and things to ask the children how they could handle the situation better than the child on the video. It all depends on how much the group is able to invest but anything that is purchased can be used for a number of years with a lot of children so these more than pay for themselves in time.
All of these are of course available for parents to purchase as well so maybe a group of parents could get together and get some of these to use with their own group of children to help them as no particular qualifications are really needed to do this - obviously to have groups run by professionals are probably the best option as then there are people there who can work with the children on other levels as well as it is very likely that after doing one of two of the sessions some children may have specific questions which may be best dealt with by a therapist, teacher or social worker but on the whole parents are quite able to run these groups as a starting point at least. This may also provide the evidence which could then be passed onto the authorities to show what need there is in your area for such groups to be run officially.
However first we need to consider a number of the main problems which hamper our children from being able to interact as well with their peers.
These can include:
a) Inhibited peer interactions or social relationships ..... the children may appear solitary, preferring their own company, even resisting any "invasion" of their space by others. They may seek interaction but are uncertain how to approach other children, fail to give out or read the appropriate social signals, and do not appreciate how behaviour may need to vary according to circumstances. They may appear actively anti-social.
b) Limited communication ..... vocabulary knowledge and articulator skills may be adequate but there is poor use of language, and communication may be one-sided and eventually break down altogether. There may be an obsessive repetition of the same questions or, at least, an insistence on focusing upon one topic. Understanding is often literal with an inability to understand humour or idioms. Tone of voice tends to be monotonous, the face may remain expressionless, and there is minimal use or understanding of non-verbal signals (including when the other person is becoming irritated).
c) A lack of imaginative play or flexible thinking ..... there is a common lack of true interactive play with other children so that the children with ADHD may focus upon individual activities and appear obsessed with some particular object or set of objects. They may seek to impose their choice of games upon others and may not be able to take part in "pretend" games.
They commonly fail to understand that other people may have and are entitled to have opinions, attitudes, or knowledge which differ from their own. They are likely to assume, instead, that others share their outlook and will be immediately able to tune into what they say and to understand what they are talking about without the need for introduction.
If there is no awareness of what someone else might be thinking or feeling, it will not be possible to make sense of that person's actions or to anticipate their reactions to a given situation or event.
Other difficulties which can include a resistance to change and anxiety at the prospect of an interruption to routines ( or distress/anger if someone makes any change in the way toys or belongings have been set out ). They really do prefer things to stay the same.
Some of our children may also have awkward motor skills, a clumsiness, and impaired ability to run or throw or catch.
Where, some children may show an exaggerated response to touch or sound, or display a sensory defensiveness.
Finally, these children may show a kind of innocence in not recognising teasing but a tendency to comply with being told to perform some unacceptable or silly action and then fail to comprehend why the other children laugh at them or why they are the ones who end up getting into trouble, they are also then unable to explain why they have done these things so will often end up lying about them, some can almost convince you that black is white as they are so adamant about things which can then lead them into even more trouble. The other thing that often ends up happening is that they get so used to getting into trouble and others being believed over them that they start to loose self esteem, confidence and sense of self worth with is a very sad and serious consequence of their lack of social skills.
In respect of anxiety ....... the technique involving " Social Stories " may be very helpful in individual work with a given child to reduce his or her anxiety over some identified activity or circumstance during the school day, with the implication that, if the negative thoughts and anticipations can be largely eliminated, the child will no longer feel the need to set him/herself apart or avoid significant parts of the school experience.
For example, in the initial description of the use of Social Stories, Gray (1995) refers to a child who is intimidated by the general noise in the dining hall but is encouraged to recognise that there is no need for anxiety so that (s)he can join peers in what is a particularly important, socially-speaking, part of the school day.
Research has confirmed that this approach is very useful for the ADHD child given its visual format, the use of simple language, the explicitness, and availability for repeated usage.
It needs also to be remembered that the child with ADHD may experience a range of negative emotions but not be able to label them or to express them to other people. The implication is for some help in recognising anxiety, in establishing some message or signal by which the child can make clear when anxiety or stress or anger is building up, and taking time to explore the reasons behind the feelings.
It is likely that a significant source may be the apparent unpredictability of the world, with the child with ADHD developing rituals by which to increase feelings of stability. Everything must remain in a certain place ; activities must be followed in the same sequence ... and the "free" social and play activities of various groups of children during school break times may be a particular source of the perceptions of unpredictability and feelings of insecurity, with the child motivated by a wish to escape from this setting.
So once we have done some background as to the problems have with Social Skills and how important these are for daily living to enable our children to participate fully in the daily life of school, peers and society as a whole then we can look at some of the things we can start to do to help them to learn some of these skills. As we have said earlier it is possible to do a lot of things in everyday circumstances and with our children on our own, however as we go through a number of things which are important for them to be able to learn our children often then start to question things which they may have come across which they do not understand and some of these may be better answered by a professional running a specific group as they will be able to go through things in a less emotionally attached point of view but until these groups become more common and available to access for our children then we can all do the best we can to help our children learn some of the vital skills they need to reach their full potential.
Once you have worked on these things with your own individual child then you could perhaps try to involve other children as well, these could be other classmates who do not have specific problems or siblings or even other children who have similar problems to your own child to get them used to working in a group to try out some of the skills you are working on with them. You will need to be there in the middle of things even if you have a friend over to play a game to make sure that they are sticking to the rules, taking turns and actually playing with the friend rather than just being in the same room! It can be fairly intensive so short periods of doing this is quite enough for both you and your child or tempers can start to fray!
Strategies for Enhancing Social Interaction
The direct teaching of social rules or conventions which guide interactions and which most children learn without direct input. These might include how to greet somebody, how to initiate a conversation, taking turns in a conversation, and maintaining appropriate eye contact.
Modelling of social skills such as the above for the target child to observe ; or shared viewing and discussing of a video-tape of two people talking or playing, including reference to any non-verbal messages which can be discerned.
Providing specific and structured activities which are to be shared with one or two selected classmate(s). These might range from some jobs to be completed in the school during break or lunch time, games involving turn-taking (board games based on logic or spatial intelligence such as Chess rather than games based on inference-making like Cluedo, simple card games ), tasks or mini-projects to be completed on the computer ( e.g. preparing large print labels for work to be displayed around the classroom or having the major responsibility for printing a class newsletter ).
Identifying particular skills in the target child and inviting him/her to offer some help to another child who is less advanced (e.g. if your child is really good with the computer then maybe they can help another child who may find computers more difficult).
Encouraging his or her participation in school clubs or organised/structured activities during the lunchtime.
Direct advice about when and for how long the child may go on about a favourite topic, perhaps with the use of a signal by which to indicate when to stop ( or not to start ! ). Giving notice of something fifteen minutes before the need to go out or change then a reminder every 5 minutes then every minute 2 minutes before the deadline - you must make sure to make it clear each time e.g. in 15 minutes we need to get ready to go to the shop, in 10 minutes we need to get ready to go to the shop, in 5 minutes we need to get ready to go to the shop, 2 minutes to get ready to go to the shop, 1 minute to get ready to go to the shop. Keep things very clear and specific.
Recognising the Views/Feelings of Other People
In the classroom setting, instructions should be very precise with no opportunity to misunderstand what is expected. It may be necessary to follow up group instructions with individual instructions rather than assuming that the target child has understood what is needed or can learn "incidentally" from watching what other children do.
Direct teaching about social situations such as how to recognise when someone is joking or how to recognise how someone else is feeling. This latter might begin with a series of cartoon faces with clearly drawn expressions indicating anger, amusement, etc., with the target child helped to identify the various feelings and guess what caused them.
Games or role play to focus upon the viewpoint of another person. This might include simply looking at pictures of children or adults interacting or working together or sharing some activity, and asking what is happening or what a given individual is doing, and what he might be thinking.
Direct teaching of what to do ( or what not to do ) in certain situations, such as when the teacher is cross either with the individual child or with the whole group.
Avoiding Social or Communicative Breakdown
Helping the child to recognise his/her own symptoms of stress or distress, with a "script" by which to try relaxation strategies ; or having in place a system where it is acceptable for the child briefly to remove him/herself from the class as necessary.
The establishment of a "buddy" system or a system where the child in question is encouraged to observe how other children behave in particular situations.
Having selected peers specifically model social skills. The buddy might also be encouraged to be the partner of the ADHD child in games, showing how to play, and offering or seeking help if the child is teased.
The use of the " Circles of Friends " approach designed to identify (social) difficulties, and to set targets and strategies by which other children in the class can be helpful and supportive, with the long term aim of increasing social integration and reducing anxiety.
The availability of a regular time slot for support from an adult in terms of feedback concerning (social) behaviour, discussing what is going well and less well, and why ; and enabling the child to express concerns or versions of events.
A clarity and explicitness of rules in the classroom to minimise uncertainty, and to provide the basis for tangible rewards.
Reminders about conversation rules ; and using videos of TV programmes as a basis for observing appropriate interaction.
In a group setting, adopting the circle time strategy of limiting verbal contributions to whomsoever is in possession of some object (while ensuring that the object circulates fairly among the whole group).
Using a video of a situation to illustrate behaviour that is inappropriate in, for example, causing irritation to other children, then and discussing why ; making a video of the target child him/herself and discussing where there are incidents of good social behaviours.
In respect of repetitive questioning or obsessive topics of conversation ......... :
Provide a visual timetable plus bulletins of any innovations so there is no uncertainty about the day's routine.
Make it clear that you will only respond to a question when a given task has been completed.
Agree a later time for responding to the question and allow the child the opportunity to write it down so they don't forget.
Specify one particular place, such as the playground, where the question will be answered.
Explain quietly and politely that the child has asked this before and maybe suggest that it might be a good idea to write down the answer so that the next time they want to ask the same question rather than you becoming a bit exasperated with them that they can pick up the card where the answer is written.
If obsessive talking appears to mask some anxiety, seek to identify its source, or teach general relaxation techniques.
Specify times when the obsessive topic can be introduced, or allow an opportunity as a reward for finishing a piece of work.
Provide time and attention, and positive feedback, when the child is not talking about the given topic.
Agree with the child and his classmates a signal to be used by those classmates when they are tired of the topic.
Allow some practice of talking at a reasonable volume, with an agreed signal to be given if it is too loud ; or tape-recording speech so that the child can evaluate the volume him/herself.
Peer Awareness
A common theme in much of the on going research and studies about social skills in the child with ADHD is that the work intended to help the child needs to involve other children to at least some extent. If the focus is upon peer interaction, there is little logic in seeking to improve performance by using only one to one sessions.
It would therefore be desirable for perhaps two or three non-ADHD peers to participate in the activities or video watching so that there could be a shared discussion and an actual possibility to practice some of the skills by the children in various make believe situations and not simply by target child and adult. This latter arrangement risks being somewhat abstract when evidence suggests the value of working on social skills within a social context.
Also, if peers are involved in the training strategies and share the same rules, this may reduce stress upon the ADHD child and increase the rate at which (s)he internalises the targeted behaviours in real situations they can identify with.
The idea that simply placing a child with ADHD in a mainstream class will not actually be the solution for that child to develop socially appropriate behaviours. There needs to be direct teaching or modelling of the behaviours, and it is likely that the number of such behaviours needs to be limited to one or two at a time if true learning and consolidation is to take place.
Learning from peers can take three forms:
Where the target child is placed within a group of peers whose positive social skills will be modelled constantly by other and where it has been made clear to the ADHD child what to observe and imitate. So the need to explain carefully what you want your child to watch the other children doing needs to be fairly specific - e.g. watch how this group take turns to throw the dice in the game.
The training approach involves peers being shown how to prompt some particular response from the child with ADHD and then to offer praise when the child acts appropriately. So the group you are working with need to know exactly what you are wanting your child to learn - e.g. turn taking so they can go round with the dice with the person with the dice passing this to the next child saying it is now your turn to throw the dice all round the group until it comes to your child's turn. Then the child before can hand your child the dice and say clear that it is now their turn to throw the dice and thank them for waiting nicely for everyone else to have their turn. Then once the child has thrown the dice for them to then pass the dice to the next child saying it is now your turn to throw the dice when that child can then say thank you for giving me my turn. Things like this although may sound very strange help our children to learn the idea of turn taking by constant reinforcement as they learn much better by various forms being taken - watching - speaking the instruction and then interaction of praise for getting it right.
The peer-initiated approach involves showing peers how to talk with the ADHD child and how to invite him or her to respond. It enables the other children to learn that this particular child has a problem and that you are trusting them to help the child to learn how to take part correctly, this therefore also helps the other children to work on the skills they need to continue to involve the child in other activities by asking them in the right manor and how to explain the rules in a way your child will understand in the future.
There is evidence that involving all children in the development of social skills has more benefits than working with the targeted child(ren) only ; there is also the point that this approach avoids singling out the child with the ADHD characteristics which might otherwise introduce a further disadvantage before one even begins ! There is a similar risk in a constant pairing of the ADHD child with a support assistant in that a dependency may be established, and any need or motivation to interact with other children is reduced.
A further implication behind all this is that there will be benefits in providing some sensitive awareness-raising among classmates of the nature of ADHD characteristics and behaviours. There is evidence ( e.g. Roeyers 1996) that giving peers this kind of information can improve the frequency and quality of social interaction between the ADHD child and classmates ; and that it can increase empathy towards the ADHD individual whose idiosyncrasies become more understandable and are not seen as provocative or awkward.
The whole point of this being a Social problem leads everyone to realise that the best way to help your child is to involve them in controlled social situations as this helps not only your child but it also allows others to learn how to involve your child in other situations without this causing as many problems as it may have done in the past.
REFERENCES
Roeyers H. 1996 The influence of non-handicapped peers on the social interaction of children with a pervasive developmental disorder. Journal of Autism and Developmental Disorders 26 307-320
Novotini M 2000 What Does Everyone Else Know That I Don't
Connor M 2002 Promoting Social Skills among Children with Asperger Syndrome (ASD)
Gray C My Social Stories Book
Searkle Y, Streng I The Social Skills Game (Lifegames)
Behaviour UK Conduct Files
Team Asperger Gaining Face, CD Rom Game