Lastly, we will look the effective group therapy paradigm of Interactive-Behavioral Therapy from which we have proposed a group therapy outline using BIT, its interventions and techniques in an effort to help students with SAD. Literature review Conceptually Autism Spectrum Disorder (SAD) is a improvement’s disorder that affects brain development. Characteristics of SAD include social impairments, Sensory overloads, cognitive deficits, communication deficits and restricted and repetitive patterns of behaviors (Autism guidebook, 2009).
SAD is a lifelong disability with most diagnosis-taking place with the first 3 years of life, with no current known cause. Individuals diagnosed with SAD fall along a spectrum typically defined by level of impact or impairment, high functioning associated with low impairment and low functioning is associated with high impairment. An example of minor impairment could be a successful student with social skills deficits. An example of an overwhelming degree of impairment could be a student with no verbal communication abilities and limited emotion display and recognition.
More common Hallmarks of children with SAD include; impaired social interaction (including with closest Of caregivers); unresponsiveness to others; difficulty interpreting respective including age appropriate social cues, facial expression, social space and voice inflections (Rotterdam-Fuller, Karri, Chamberlain & Locke, 201 0) The latest statistics have established that the rate for children with SAD has increased dramatically over the years. Once considered rare, SAD diagnosis has increased with each passing year.
During the 2000-01 school years 94,000 students received special education services related to an SAD diagnosis, this number increased to 378,000 in just nine short years for over a 300% increase (Auger, 2010). Today, it is estimated that of one out of every 8 children will be diagnosed with SAD quickly becoming one of the most common disorders diagnosed (Autism guidebook, 2009). SAD occurs across racial, socioeconomic and ethnic groups with one notably discrepancy, males are around four times more likely to be diagnosed (Harris, Doddery & Caballeros, 2010).
Social Skills Impact Social skills and the development and maintenance of social relationships are one of the most significant problems affecting children with SAD. Children with autism spectrum disorders have difficulty interacting with others ranging from social acceptable ways of greeting to socially acceptable topics of inventions (Karri, Rotterdam-Fuller, Locke & Gulpers, 2012). Poor social skills are a major obstacle hindering success for children and adults with autism.
The ability to get along with other individuals in a proboscis manner affects almost every aspect of a person’s life (Karri et al. 2012). Children with autism are especially at a major disadvantage when negotiating a school environment because much of early schooling is understanding and navigating the various social cues and standards in place. Rotterdam-fuller (2010) implies that typically developing students for fear of rejection by association do not befriend otherwise rejected students, “rejected students” being those diagnosed with SAD.
Although individuals with autism can academically excel, many still have minor to substantial difficulty and need help navigating social areas (Auger, 2010). This weaker understanding of social norms or development of social skills is exemplified in schools where researchers have demonstrated that individuals with SAD have significantly lower inclusion rates when compared to their typically developing peers. Researchers have also demonstrated that as individuals affected with SAD age their social involvement with peers goes down.
Beyond the school, setting youth with SAD spend much of their free time alone engaging in activities that do not require the presence of others. High isolation rates and lack of age appropriate social and communication skills make youth with SAD easily normalized by staff and peers, resulting in few intimate social relationships typified by students with friends or networks of friends (Auger, 2010). Unfortunately, commodore anxiety disorders are common among children co-occurring in up to 80% of children with SAD (Auger, 201 0) and it is thought that maladaptive social skills has much to attribute.
Impact on School Counselors As we noted earlier youth diagnosed with Autism spectrum disorder has increased dramatically over the last decade, presenting formidable challenges to schools and school counselors. The increase of students with SAD entering the public school system presents a basic fundamental issue, ‘there are not enough trained professionals who can effectively serve the needs of students with SAD” (Auger, 201 0 & Autism Guidebook 2009). School counselors should be aware of this issues and advocate for professional development.
Add to that Researchers have reported that more than half of students in the current public school system, who receive mental health services, receive it at schools. Thus, it is paramount for current and future counselor to be aware, informed and knowledgeable of SAD, its manifestations and effective strategies aim at helping. Generally, school students impacted by SAD are at an increased risk for issues in areas including social deficits, anxiety, depression, aggression, peer factorization and academic underachievement.
One promising approach to working with students with autism, demonstrated through research, is the incorporation and adaptation of group psychotherapy and psychodrama, which is titled Interactive-behavioral harpy(lbs.) (Throat, Wood, See & Dyke, 2011 What is BIT and how can it help this population. Bats theoretical foundation and most of it evidence based techniques are directly based on Moron’s psychodrama therapy (Tomatoes & Razz, 2006).
Psychodrama therapy (OPT) has been established through research as an effective treatment for students with cognitive disabilities (Cladding, 2012). Reasons for OPT include it emphasis on fully engaging clients sensor intake with its inherit ability in not limiting interaction to just cognitive tasks of thinking and verbalizing (Tomatoes & Razz, 2006). This ability to act out or otherwise engage with a stress-inducing event has proven to work effectively with intellectually disabled students including those diagnosed with autism.
Bits adaptation to standard psychodrama psychotherapy in short, is an added behavioral stage at the beginning and end of therapy that work to allow therapeutic factors Of psychodrama to work. Founders of BIT understand that students with ID are impacted in such a way making standard therapy unobtainable. A few major deficits towards establishing a therapeutic environment include the following behaviors, Individuals lampooning for facilitator attention, talking over people, talking accepting not being listened to (Tomatoes & Razz, 2006).
In essence, students with ID devalue their peers and themselves and must first work to establish values. BIT works to combat this by changing behaviors through and rewarding behaviors through its orientation and affirmation stages. BIT and the research on it have demonstrated remarkable outcomes for students with Intellectual disabilities making BIT a therapy school counselors should at the very least familiarize themselves with the research and techniques. The rest of this paper outlines the dynamics of group when working with Autistic youth in a school setting.
Group Participants This group is to take place at a high school with the target population including mildly impaired students with SAD. The criteria for mild Autism (high functioning SAD) can be defined as, students with normal language and intellectual development in relations to age and peers but delays and impairments in social skills and relationships. Below are common impairments of mildly impacted students with SAD. Avoidance of eye contact Staring at others Unusual facial expressions Abnormal posture
Inability to recognize changes in speech tone and pitch, which could change the meaning of what the person is saying Speaking in a monotone voice Lack of social skills Difficulty starting or maintaining social interactions Difficulty taking turns talking (dominates conversations) Difficulty reading other people’s body language Talking a lot about certain topics with which he has a preoccupation Verbalizing internal thoughts Students will range from ages for typical high school students 15-18 mixed gender and will additionally serve students in the transitional stage who still receive support through the high school whose ages can range from 8-21 mixed gender. The referral for this group will take place with families and staff. Staff and families will fill out assessments based on the student’s abilities and deficits further discussed in the membership section. Group goals and objectives The overarching goal for this group is twofold. One is to allow individuals with intellectual disability including those diagnosed with SAD the opportunity to experience the therapeutic environment from which group therapy can Offer/ provide.
Second, combat and red cue the risk of development of psychiatric disorders that are extremely common in individuals with intellectual capabilities and Autism through an improvement in their social skill ability. Let us make therapy an accessible now and for a lifetime. Specific goals to this population and group are in general targeting maladaptive/non-existent adaptive social skills, peer relations along with social relationships that exist in their everyday environment. Objectives for group can be appropriately broken down for each stage of the group. The objective for stage one “Orientation and cognitive networking’, in its simplest form, is to shape proboscis group behavior. Let us develop skills and behaviors that are conducive to group therapy.
This includes developing positive communication skills that include proper topics of conversation, active listening, turn taking, waiting and basic levels of reflecting. To accomplish these goals behavioral treatment utilizing the principles of applied behavior analysis mainly positive reinforcement through facilitator acknowledgement will be used. Objective for this stage two ‘Swarming up and sharing”, is basically to encourage self-disclosure in any sense of the way and prepare group members for the enactment phase (action phase). Focus would be horizontal disclosure which is less emotionally charged group deader will discuss how it felt to disclose, comfort levels this is less emotionally charged.
Another main object for this stage is for the group facilitator to encourage group interaction and personal awareness that may have been recognized. Objective for stage 3 the “Enactment Stage” is to introduce the problem and take action changing behavior, emotions and thought around a story of issues that causes distress for a particular group member. Goals are to establish a better understanding of themselves, resolve the issue, improve their social skills and relationships and develop new skills and behaviors that re proboscis. Objective for stage 4 the “affirmation stage” is to validate participation and teach member to affirm one another.
Everyone should leave the group feeling positive about themselves and what they have contributed to the group. Type of membership This group will be limited to 5-7 students and will remain open unless at capacity. The group will be ongoing while it will take place weekly throughout the school year (minus breaks). Researchers have demonstrated that there are major benefits to having an open, ongoing group as opposed to a time limited group format when working with individuals with disabilities Tomatoes & Razz, 2006). Establishing an open group is beneficial as it allows new group members adapt to established group behavior quickly as it allows the facilitator to focus attention on behavior off new member.
Research has also indicated for this population that that ongoing therapy can provide individuals the opportunity to be genuinely helpful to others, thus gaining a valuable sense of self-efficacy over time (Tomatoes & Razz, 2006). In essence, hope to establish a group that will continue indefinitely and cycle through individuals as they graduate out. Priority will be given to older students. Students will need a verified diagnosis of autism. Then students will need to be referred by either staff or guardians. From there we will use an variety of methods in an effort to evaluate an individual’s adaptive social skills and social relations. Natural observations are one of the best methods for assessing social skills.
Typically, observations are conducted at school where there are many opportunities to observe children interacting within social and learning environments. Role of leader- Role of the leader is at best an ever-changing fluid part The leader will be a teacher (co-educational), they will be a drama producer and drama erector, and they will be in part a behaviorism as well as a tracker and analyzer of content and interaction. The success fifths group is highly reliant on the ability of the leader to wear many hats of action and where them correctly and efficiently. This is one major drawback to BIT as group is so reliant on the knowledge and execution of the facilitator.
The leader will run the session form start to finish, and play an executive function role directing the group through the session. Group leader is to establish the norms and group members towards adaptive interpersonal behavior. Models behaviors ND rewards positive behavior while protecting all students who are in a vulnerable state. The leader must be knowledgeable of the methods and techniques of OPT, as OPT employs a hundreds (Cladding, 2012). The director encourages trust and spontaneity, protecting members from abuse. As each group session ends, the leader seeks to reinforce therapeutic factors such as self-disclosure, self-reflection, self-awareness and behavior change within new role(Cladding, 2012).
Format This group will be run during school days and since it will be an ongoing group, session it is best to be ran directly after school once a week. Session will consist of a standard 60-minute session once a week for every regular school week. Group rules Group rules are to be established by the group leader given the complexity and inherit dynamics within the SAD population. The rules are to be established through positive reinforcement and modeling by the facilitator and possible group members thereafter. As The initial stage of group is critical stage to the outcome of the group. The leader must work to establish adaptive and therapeutic behaviors within the populations as this one area/ issue they can be extremely impacted.
Group stage plans The group is strongly lead by the group facilitator but the sessions are developed out of events that have caused students distress. Goal is to develop emotional and cognitive insight by working through past and present situations and events that have caused distress. Thus students will gain renewed self; awareness, acceptance and control. The following will be a plan on how to run each stage (not each session) along with a framework and techniques to use for psychodrama that can help individuals with social deficits. “Orientation and cognitive networking’ the focus and theme of this stage is to make group and principles of group accessible.
This stage the group facilitator is working on positively reinforcing fundamental aspects of group counseling. These fundamental aspects being active listening, waiting, reflecting and interacting with peers. Technique/activity to involve would be as follows. Have a group member share an information very topic very safe about something (content does not matter, as it could be procedural steps of their day). When the individual is speaking, the facilitator will interrupt them and ask them to identify whom in they thought was listening. This way they are actively seeking who is listening, now they understand what it feels like kooks like to be listened too.
From here the speaker will pick someone to speak next with a motive to pick someone who they thought was listening and why. When they pick the next group member, they positively reward that person for listening in front of the group and build value within themselves (being listened too) and other listen group members (value peer talk). With the hopes of conditioning, others to change maladaptive behaviors while building value in peers. I hope that after time this will become a habit and active listening and reflecting will be inherit in all members and group can rocked to the next stage. Stage 1 can take as long as 8-12 sessions. Once stage one is complete group therapy session will aim to hit all four stages. Warm and sharing” focus in this stage is to get members ready for the next phase (enactment) but with that to get members more in touch with themselves and their bodies as well as their relation to their peers. In this Stage, we work up to a vertical level Of self-disclosure. This Stage also involves a number of activities that get people involved and help them feel creative and spontaneous. Techniques used here are guided imagery and sensory awareness. The goal is to get clients moving, in touch with their senses and hopefully engaged with their peers and their peers perspectives (in a limited fashion). Starry night guided imagery can be used to establish a relaxing mood while asking students to be engaged a creative with the activity. Tasting and Smelling’ Activities create awareness for other perspectives by eating a wide range of food then have group member describe taste to one another. Some members will share an experience and some will differ, which is a great learning tool for understanding and appreciating different (non- emotional content). Enactment” Enactment The creation of scenes from the protagonist’s life that explore past, present and future situations and one’s inner world within that situation. The enactment promotes maximum expression of actions, thoughts and feelings while working through issues by developing and integrating new responses. Each psychodrama group will include a protagonist, the person whose story or issue is presented through drama techniques.
The rest of the member will be broken into two groups. The auxiliary egos group members will assume the roles of significant others in the drama. The audience group members who witness the drama and who ay become involved in auxiliary roles. A member or leader will introduce a problem based on a specific event, relationship or dynamic in a person’s life. The group will take on various roles and explore behavior, thoughts and conflicts and learn new ways about a situation (perspectives) to behave (new proboscis behaviors) and process (can I do anything different). Participation in enactment generates feelings of understanding and trust amongst group members.
The following techniques are great for widening ones perspective on social problems while providing an opportunity to understand and try new behaviors, which is perfect for autistic students struggling with social skills. “The Double”Doubling occurs when a member of the group takes on the physical stance of the protagonist and attempts to enter their internal world by speaking their inner thoughts and feelings. With social skills in mind, the function of this technique would be to understand the nonverbal clues established while interpreting thoughts, feelings and behaviors. This will allow group members the ability to broaden the protagonist understanding and awareness of others (Cladding 2012). ROLL Reversal” A core part of psychodrama, role reversal allows a protagonist to experience a situation in one mode of perspective (typically their own) then to switch into another conflicting character. The group leader needs to challenge, and enable the protagonist to go fully into the role of the other to gain a deeper and more empathic view of the person. It can be very powerful for a protagonist to experience him or herself from the other person’s role. This in itself can correct a distorted view of the other person and the relationship between. It also develops empathy for the other person, and this is particularly important hen working with people who struggle developing and maintaining friendships and peer relations.
Forms and Materials See appendix for appropriate forms Practical considerations: Group counseling is an effective and efficient service allowing multiple students to work on or through a variety of shared issues and experiences. Overall group positively affects a student’s health and wellness along with SACS standards of academic, career, and personal social emotional issues or concerns. This group proposal follows both Automata’s 18TH and Monomer’s psychotherapy modules, which have been established through evidence- eased research littered throughout this paper. Evaluation of Group We will approach the evaluation of group members towards goals and objectives in a variety of ways.
To evaluate the progress group members have made during therapy against the group goals and objectives pre mid and post behavior scales will be given to teachers and guardians. The rating forms given out consist of three components (1 ) problem behavior (Appendix A) (2) Social Skills Survey (Appendix B), and (3) Social Skills Rating (appendix C). The Problem Behavior Rating Scale contains descriptors of behaviors that the exponent rates On a four point scale. Questions target number Of friends, number of peer interaction opportunities, and preference for different types of social activities. The Social Skills Rating Form contains descriptors of social behaviors in areas that include affective understanding, perspective taking, initiating interactions, and maintaining interactions.