The Cigna Group · NYSE:CI
The Cigna — Investor Presentation (June 2012)
49 slides from The Cigna's investor presentation, Jun 14, 2012
Slide 1: Fostering Friendships Between Children with Autism Spectrum Disorders and Typically Developing Peers
Fostering Friendships Between Children with Autism Spectrum Disorders and Typically Developing Peers CIGNA Summer Autism Series June 14, 2012 Jill Krata, Ph.D. Manager of Clinical Services, YAI Autism Center & Associate Chief, Premier HealthCare Autism Research and Treatment Institute
Slide 2: Overview
Overview • Introduction • Overview of autism and ASD • Overview of friendships and why they are important • Interventions to help foster friendships between children with ASD and their typically developing peer • Resources (parents & professionals)
Slide 3: Autism: A complex diagnosis
Autism: A complex diagnosis • There is no blood test or other biological marker for autism • The diagnosis is made by professionals observations and parental report.
Slide 4: What is Autism?
What is Autism ? • Autism is a complex neurodevelopmental disability that causes problems with social interaction, communication and behaviors • Symptoms usually start before the age of 3 and can cause delays in many different skills that develop from infancy to adulthood
Slide 5: What is an Autism Spectrum Disorder (ASD)?
What is an Autism Spectrum Disorder (ASD)? • Different people with autism can have very different symptoms • Autism is thought of as a “spectrum” disorder or a group of disorders with similar features • One person may have mild symptoms, while another may have severe symptoms, but they BOTH have an
Slide 6: What Does the ASD Category Include
What Does the ASD Category Include: • Autism (also called “classic” autism) • Aspergers disorder • Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS or atypical autism)
Slide 7: The Three Diagnosis on The Spectrum are
The Three Diagnosis on The Spectrum are: ASD Aspergers Autism PDD-NOS Disorder
Slide 8: What are the Symptoms of ASD?
What are the Symptoms of ASD? • Deficits in communication – both verbal and non-verbal, ex: pointing, eye contact and smiling • Deficits in social skills – sharing emotions, understanding how others think and feel and hold a conversation • Repetitive behaviors (sterotyped behaviors) or Routines – re
Slide 9: Symptoms of ASD
Symptoms of ASD Social Impairment Repetitive behaviors or interests Communication Impairment
Slide 10: What Falls Under the ASD Umbrella
What Falls Under the ASD Umbrella:
Slide 11: Friendships
Friendships YAI Network “% YAI Autism Center
Slide 12: Why are Friendships Important?
Why are Friendships Important? • Promotes confidence • Gives a sense of identity • Teaches loyalty • Stability • Boosts happiness • Reduces stress • Recreation / excitement
Slide 13: Components of a Successful Social Relationship
What are the Components Involved in a Successful Social Relationship: • Imitation • Learning give and take • Perspective taking • Opportunities for interactions over time • ‘Personal History’ • Verbal and nonverbal communication • Understanding non literal language and sarcasm • Problem solve simple
Slide 14: Why Do Children with ASD Have Difficulty Making Friends?
Why Do Children with ASD Have Difficulty Making Friends? • Lack of joint attention- • Have difficulty understanding independent sharing of peers’ feelings and thoughts enjoyment with others (ToM) • Inability to predict social • Difficulty making eye contact outcomes from cues in the environment and
Slide 15: Other Factors that Can Impede Forming Friendships
Other Factors that Can Impede Forming Friendships for Children with ASD: • Anxiety • Social isolation • Poor peer interactions • Rejection from peers • Depression * As a result of these factors, children with ASD struggle to develop and maintain friendships *
Slide 16: Keep in Mind
Keep in Mind YAI Network “% YAI Autism Center
Slide 17: Within Autism
Within Autism…. • Individuals with ASD often miss out on the incidental learning opportunities for these social skills • Adolescents continue to maintain decreased levels of motivation and interest in others • Difficulty interpreting subtle social cues • Interactions and social rules constantly chan
Slide 18: Communication Skills
Communication Skills • conversation abilities • perspective taking • language flexibility • voice tone • volume • difficulty with irony, sarcasm • very literal, i.e., “I have to run and catch a bus.”
Slide 19: Nonverbal Skills
Nonverbal Skills • Proxemics – awareness of your body in space • gestures • body language • facial cues
Slide 20: Social/Interpersonal Skills
Social/Interpersonal Skills • interaction styles • social appropriateness • flexibility
Slide 21: Restricted Interests & Repetitive Behaviors
Individuals with ASD Have Restricted Interests & Repetitive Behaviors • Odd or repetitive whole body movements • Odd or repetitive hand mannerisms • Perseverative topics of interest • Repetitive speech • Delayed echolalia
Slide 22: What is a Basic Aim When Integrating Peers?
What is a Basic Aim When Integrating Peers? By allowing enjoyment, practice and coaching: Helping an individual move from no meaningful social interaction to some meaningful social interaction.
Slide 23: Interventions to Help Children with ASD Foster Friendships
Interventions to Help Children with ASD Foster Friendships with Their Typically Developing Peer • Social Skills Groups • Scripts • Push-In Services • Peer Group Entry • Buddy Time • Games • Incidental Teaching • Peer Support Network • Video Modeling • Circle of Friends
Slide 24: Social Skills Groups
Social Skills Groups Can use commercial curricula, such as • Navigating the Social World (McAfee, 2002) • Skillstreaming the Adolescent (Goldstein & McGinnis, 2000) Provide consistent group structure • Check-in, greet • Review last meeting’s skill • Introduce new skill • Model and role play new skil
Slide 25: Effective Techniques: Social Skills Training
Effective Techniques: Social Skills Training (Timler et al., 2007) • Teacher Redirects • Prompting children to play with one another • Rephrasing or restating one child’s statement for another • Praising children for playing together • Direct instruction in social language • Modeling and practice wi
Slide 26: Meta-analysis of Social Skills Interventions
Meta-analysis of Social Skills Interventions: (Bellini, Peters, Benner & Hopf, 2007) Most effective when: Deficits of child are systematically matched to intervention strategy • Ex.: If child lacks skills to enter peer group, teach those; if child can enter but cannot participate and maintain partic
Slide 27: Scripts
Scripts • Provide pre-taught language for specific situations • They include conversation starters, responses and ideas to connect conversations or change the topic • Social scripts may help reduce the stress associated with social interactions • Also, they can assist the student with understanding
Slide 28: Example of a Social Script
Example of a Social Script • Provide explicit written script of interaction: – Walk up to a classmate – Make eye contact – Say “Hi ----------” • Practice script with clinician • Practice with a peer • Script Fading: Cut off increasingly large parts of script, until the student can do the scene indep
Slide 29: Scripting with Peer Training
Scripting with Peer Training (McClannahan & Krantz, 2005) Peers taught 5 facilitative skills w/o target child present: 1. Look, wait, and listen 2. Answer questions 3. Start talking 4. Say something nice 5. Keep talking Target children given written scripts for social interaction (“Can I play checke
Slide 30: Push-in services with Peers
Push-in services with Peers Services given in a group or classroom context can include: • Teacher or related service professional (SLP) redirects behavior • Prompting children to play with one another • Rephrasing or restating one child’s statement for another • Praising children for playing togethe
Slide 31: Peer Group Entry
Peer Group Entry (Beilinson & Olswang, 2003) • Lead Child is assigned a role to establish group membership • Child is prompted to initiate interactions • Child is given highly valued objects, game, or ‘prop’ • Target child is taught five-step sequence for entering group, using Visual Schedule
Slide 32: Peer Group Entry
Peer Group Entry 1. Walk over to your friend. 2. Watch your friend. 3. Get a toy like your friend is using. 4. Do the same thing as your friend. 5. Tell an idea.
Slide 33: Buddy Time
Buddy Time (English, Goldstein, Kaczmarek, & Shafer, 1996) • 20 min. period during school day • Each child assigned a buddy • Buddies rotate • Class or peers are taught ‘buddy’ rules sequentially • Both buddies receive reward if follow rules for entire buddy period: 1. STAY 2. PLAY 3. TALK: say name
Slide 34: Games Based on Special Interests
Games Based on Special Interests (Baker et al., 1998) Use social games based on special interests of your child • Involve your child in materials and rules • Have your child teach game to sibling or friend • Set up special opportunities to play game • Take turns choosing games to play during interac
Slide 35: Incidental Teaching
Incidental Teaching (McGee et al., 1999) • Materials are controlled so that target child must interact to obtain needed objects and complete favored activities • Interactions are ‘engineered,’: • Child is assigned to complete puzzle • Peer holds all puzzle pieces and is told to hold them until asked
Slide 36: Peer Support Networks
Peer Support Networks (Haring & Breen, 1992) • Select 2-5 peers to serve as social support for student with ASD • Assign each support peer a 20 minute period/day to structure activities for student with ASD, e.g.: – Lunch: use Prompt and Praise to engage with others at table – Recess: teacher or cli
Slide 37: Video Modeling / Video Self-Modeling
Video Modeling / Video Self- Modeling (Nikopoulos & Keenan, 2004) • Video representation of a desired behavioral interaction • The child observes a video of a peer or him/herself engaging in a targeted behavior • Basic premise is to “learn through observation” • Examples: purchasing items at a store
Slide 38: Video Modeling
Video Modeling • View video, discuss reactions • View video, attend to focused cue, discuss what was noticed or what changed • Re-enact scene on video with clinician • Re-enact with peer • DESCRIBE VERBALLY while watching • Improvise similar situation
Slide 39: Circle of Friends
Circle of Friends (Barratt, Joy, Potter, Thomas & Whitaker, 1998) • This intervention promotes inclusion of students with special needs into the school community • It is a peer-based approach and engages peer groups and practicing social skills • A circle is formed by peers and classmates and a stud
Slide 40: Research Supporting Circle of Friends
Research Supporting Circle of Friends • Research has shown improvement in empathy, problem solving, communication skills, emotion expressions and awareness of individual ability (Barratt & Randall, 2004) • Additionally, improvements have been noticed in the area of social interaction, peer interacti
Slide 41: Benefits for the Focus Child
Benefits for the “Focus Child” • Gains more attention from members of the friendship network • Increases acceptance from the group • Increases self-esteem • Decreases loneliness and isolation • Decreases anxiety and stress
Slide 42: Important to remember
Important to remember • It is hoped that the experience of successful and enjoyable friendships will become a motivating force for your child to pursue better social contact; to make play and friendships a positive experience
Slide 43: Published Resources For Parents
Published Resources For Parents • Talk Ability: People Skills for verbal children on the autism spectrum- A guide for parents. By Fern Sussman (2006) Hanen Centre Publication. • More Than Words. The Hanen Program for Parents of Children with Autism Spectrum Disorder. By Fern Sussman (1999) Hanen Cen
Slide 44: References for Professionals
References for Professionals Barratt, P., Joy, H., Potter, M., Thomas, G., & Whitaker, P. (1998). Children with autism and peer group support: Using circle of friends. British Journal of Special Education, 25 (2), 60-64. Beilinson, J.S., & Olswang, L.B. (2003). Facilitating peer-group entry in kinde
Slide 45: References for Professionals Continued
References for Professionals Continued Haring, T., & Breen, C. (1992). A peer-mediated social network intervention to enhance the social integration of persons with moderate and severe disabilities. Journal of Applied Behavior Analysis, 25, 319-333. McAfee, J.L. (2002). Navigating the social world.
Slide 46: Online Resources
Online Resources • The Department of Education • www.ed.gov • The Council for Exceptional Children (CEC) – www.cec.sped.org • The Professional Development Center on Autism Spectrum Disorders – http:// autismpdc.fpg.unc.edu • Autism Speaks • www.autismspeaks.org
Slide 47: Special Thank You To
Special Thank You To: Moira Lewis, M.S., CCC, SLP for collaborating on these slides.
Slide 48: Questions?
Questions ? YAI Network “% YAI Autism Center
Slide 49: Thank You
THANK YOU !! Jill.Krata@yai.org