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Just Making Friends?

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Jess Hill

on 26 April 2014

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Transcript of Just Making Friends?

Just Making Friends?
The Unique Perspective Occupational Therapy Brings to Social Skills Training for Adolescents with High Functioning Autism
Core Beliefs of Occupational Therapy
Where Does Occupational Therapy Fit?
So What?
The Struggles of Adolescence
Occupational Performance
Impact to Psychological Well-being
Social Impairments of HFA
Quiet and Aloof
Socially awkward
Lack facial expression and eye contact
Does not seem interested in interacting with peers
Seemingly rude

Loud and Outgoing
Lack tact
Seems inappropriate and often offensive
Seems to speak without thinking
Embarrassing behaviours
Does not accept others opinions
Limited ability to participate in a reciprocal conversation
Seems to disregard personal space

Difficulty showing empathy
Difficulty understanding and reciprocating emotions
Difficulty understanding the unwritten rules of social interaction
Lack of facial expression and eye contact
Inability to recognise and appropriately interpret social cues
Inability to interact with peers or develop peer relationships
Inability to use non-verbal behaviours to regulate social interaction
Depression (approx 70%)
Anxiety (approx 84% - 17% experiencing social phobia)
Catatonia (approx 17%)
Lowered self-esteem
Lowered self-worth
Suicide ideation
Adaptation difficulties
Developmental delay
What are we talking about exactly?
In the broader context of professional identity, explore the unique perspective occupational therapists can bring to social skills training for adolescents diagnosed with HFA.

Professional Identity
Increased risk of academic failure
Long-term impact on ability to gain and maintain employment
Long-term impact on ability to develop and maintain meaningful relationships
Lack of leisure activities and interests
Overall decreased perceived quality of life and occupational satisfaction

Common interventions
Behavioural modelling
Behavioural rehearsing and role play
Performance feedback
Social Stories
Video modelling
Cognitive behavioural interventions
Social Work

Difficulty generalising skills to the "real world"
Limited evidence showing long-term impacts
Continued deficits in educational and employment success
Required interventions to be tailored to the teens specific social behaviour in order to maximise their potential
Increased confidence in social environments
Increase in social competence
Increased social initiation and willingness to participate
Improvement in a range of associated problem behaviours, including: affect regulation, self-isolation, stereotypical behaviours and self-harm
Reduced levels of anxiety and depression
An overall improvement in social skills as reported by teens, parents and teachers.
"The primary goal of occupational therapy is to enable people to participate in the activities of everyday life" (WFOT, 2012).
"Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations that they want to, need to, or expected to" (WFOT, 2012).
Consider the demands of this environment, physical, social, emotional, socio-economic, sensory and cultural
What does the individual want or need to do?
What occupations or tasks are combined to create the persons roles or identity?
What occupations are most meaningful to the individual?
What skills are required for the desired occupations?
Collaborate with the adolescent, parents, employer, teachers, etc
Specific interests
Motivation, values and goals
Strengths and challenges
Cognitive abilities
Performance pattern
Person-Environment-Occupation Model
(Law et al, 1996)
"Contexts and situations that occur outside the individual" (Law et al, 1996).

Main environments of adolescents include:
Group or individualised programs
Possible parent intervention
Role-plays tailored to the participant's daily occupations
Participants maintained improvements over six-week period and at one-month follow up
Participants improved both verbal and non-verbal behaviour
Reports from parents and teachers showed that participants generalised their new skills into "real-life" situations
Follow up is required at 3, 6 and 12 month intervals to explore long-term effects
Larger number of participants is required to increase the generalisation
Occupational Therapy Across the Lifespan
Regulation of emotions and behavioural responses
Processing of sensory information
Self-care skills
Organisation and planning
Independent work skills
Assistive technology
School or work functions
Many more...
Occupational Therapy and Social Skills Training
Social Competence is a crucial aspect of successful occupational performance
Social skills allow an individual to successfully function within their environment enabling them to meet their occupational goals.
While psychosocial approaches aim to improve specific behaviours, occupational therapists address all aspects impacting a persons occupational performance.
Occupational therapy models that combine, psychosocial aspects, assist clients to improve occupational performance rather then one specific skill or isolated behaviour.
Behavioural challenges
Emotional response
Degree of autonomy
Sensory challenges
Taking into consideration that each adolescent is unique
Current Literature
Autism Spectrum Disorder
Autistic Disorder
Asperger's Syndrome
High Functioning Autism
Pervasive Developmental Disorder- Not Otherwise Specified
Occupational Performance
Lack of social competence continues to be considered as one of the most debilitating symptoms of HFA for occupational satisfaction
Occupational therapy has a unique role to play in social skills interventions with adolescents with HFA
To assist adolescents with HFA reach their full potential occupational therapists must understand their role with this population.
More Research is needed!!.
Gutman, S. A., Raphael-Greenfield, E. I., & Salvant, S. (2012). The effect of an occupational therapy role-playing intervention on the social skills of adolescents with Asperger's syndrome: A pilot study. Occupational Therapy in Mental Health 28(1), 20-35. doi: 10.1080/0164212X.2012.650953

Hillier, A., Fish, T., Cloppert, P., & Beversodorf, D. Q. (2007). Outcomes of a social and vocational skills support group for adolescents and young adults on the autism spectrum Focus on Autism & Other Developmental Disabilities, 22(2), 107-115.

Hillier, A., Fish, T., Siegal, J. H., & Beversodorf, D. Q. (2011). Social and vocational skills training reduces self-reported anxiety and depression among young adults on the autism spectrum. Journal of Autism & Developmental Disorders, 23, 267-276. doi: 10.1007/s10882-011-9226-4

Hyman, S. L. (2013). New DSM-5 includes changes to autism criteria. AAP News from http://aapnews.aappublications.org/content/early/2013/06/04/aapnews.20130604-1.full.pdf+html

Koning, C., & Magill-Evans, J. (2007). Social and language skills in adolescent boys with Asperger syndrome National Autistic Society 5(1), 23-36. doi: 10.1177/1362361301005001003

Lasgaard, M., Nielsen, A., Eriksen, M. E., & Goossens, L. (2010). Loneliness and social support in adolescent boys with autism spectrum disorders. Journal of Autism & Developmental Disorders, 40, 218-226.

Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program Journal of Autism & Developmental Disorders, 42, 1025-1036. doi: DOI 10.1007/s10803-011-1339-1

Law, M., Cooper, B. A., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance Canadian Journal of Occupational Therapy, 63(1), 9-23.

Loukas, K. (2007). Occupational therapy with adolescents in school-based practice: A qualitative inquiry of emergent roles, philosophy and practice. Creighton University Post-Professional Doctoral Program.

Lugnegard, T., Unenge Hallerback, M., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger's syndrome Research in Developmental Disabilities 32, 1901-1917. doi: 10.1016/j.ridd.2011.03.025

Mackey, H. (2007). 'Do not ask me to remain the same': Foucault and the professional identities of occupaitonal therapists. Australian Occupational Therapy Journal, 54, 95-102. doi: 10.1111/j.1440-1630.2006.00609.x

McMahon, C. M., Lerner, M. D., & Britton, N. (2012). Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future. Adolescent Health, Medicine and Therapeutics 4, 23-38.

Mitchell, K., Regehr, K., Reaume, J., & Feldman, M. (2010). Group social skills training for adolescents with Asperger syndrome or high functioning autism Journal on Developmental Disabilities 16(2), 52-63.

Mui Lim, S., & Rodger, S. (2008). An occupational perspective on the assessment of social competence in children British Journal of Occupational Therapy, 71(11), 469-481.

My Asperger's Child. (2013). Problems experienced by teens with Asperger's syndrome from http://www.myaspergerschild.com/2010/09/problems-experienced-by-teens-with.html

Pisula, E., & Lukowska, E. (2011). Perception of social relationships with classmates and social support in adolescents with Asperger syndrome attending mainstream schools in Poland School Psychology International 33(2), 185-206. doi: 10.1177/0143034311415784

Asperger's syndrome Foundation. (n.d.). Depression or mental health problems from www.aspergerfoundation.org.uk

Attwood, T. (2011). What is Aspergers? , from http://www.tonyattwood.com.au/index.php option=com_content&view=article&id=62&Itemid=176

Baghdadli, A., Brisot, J., Henry, V., Michelon, C., Soussana, M., Rattaz, C., & Picot, M. C. (2013). Social skills improvement in children with high-functioning autism: A pilot randomized controlled trial. European Child Adolescent Psychiatry, 22, 422-442. doi: 10.1007/s00787-013-0388-8

Bejerot, S., & Wetterberg, L. (2008). Autism spectrum disorders and psychiatric comorbidity in adolescents and adults Clinical Neuropsychiatry 5(1), 3-8.

Broderock, C., Caswell, R., Gregory, S., Marzolini, S., & Wilson, O. (2002). 'Can I join the club?': A social integration scheme for adolescents with Asperger syndrome The National Autistic Society 6(4), 427-431. doi: 10.1177/1362361302006004008

Cramm, H. (2003). The person-environment-occupation circle tool: A simple way to bridge theory into practice In Theory Meets Practice (Ed.).
Dikla, G., & Jarus, T. (2005). Effect of a social skills training group on everyday activities of children with attention deficit-hyperactivity disorder. Developmental Medicine & Child Neurology, 47, 539-547. doi: 10.1017/S0012162205001052

Doble, S. E., Bonnell, J. E., & Magill-Evans, J. (1991). Evaluation of social skills: A survey or current practice Canadian Journal of Occupational Therapy 58(5), 241-249.

Denshire, S. (2011). Joining networks, Finding Mentors [PowerPoint slides]. Retrieved from http://interact.csu.edu.au/portal/site/OCC413_201360_A
(Gutman, Raphael-Greenfield & Rao, 2012)
Schmidt, C., & Stichter, J. P. (2012). The use of peer-mediated interventions to promote the generalization of social competence for adolescents with high-functioning autism and asperger's syndrome Exceptionality, 20, 94-113. doi: 10.1080/09362835.2012.669303

Shtayermman, O. (2008). Suicidal ideation and comorbid disorders in adolescents and young adults with Asperger's syndrome: A population at risk. Journal of Human Behaviour in the Social Environment 18(3), 301-328. doi: 10.1080/10911350802427548

Stichter, J. P., Herzog, M. J., Schmidt, C., Randolph, J., Schulz, T., & Gage, N. (2010). Social competence intervention for youth with Asperger syndrome and high-functioning autism: An initial investigation Journal of Autism & Developmental Disorders, 40, 1067-1079. doi: 10.1007/s10803-010-0959-1

Stichter, J. P., O'Connor, K. V., Herzog, M. J., Lierheimer, K., & McGhee, S. D. (2012). Social competence intervention for elementary students with Aspergers syndrome and high functioning autism. J Autism Dev Disord, 42, 354-366.

Strong, S., Rigby, P., Law, M., Letts, L., & Cooper, B. A. (1999). Application of the person-environment-occupation model: A practical tool. Canadian Journal of Occupational Therapy, 63, 14-25. doi: 10.1177/000841749906600304

The National Autistic Society. (2013). Mental health and Asperger syndrome from http://www.autism.org.uk/working-with/health/mental-health-and-asperger-syndrome.aspx

The Scope of Occupational Therapy Services for Individuals With an Autism Spectrum Disorder Across the Life Course. (2010). The American Journal of Occupational Therapy, 64(6), 125-136. doi: 10.5014/ajot.2010.64S125

Tse, J., Strulovitch, J., Tagalakis, V., Meng, L., & Fombonne, E. (2007). Social skills training for adolescents with Asperger syndrome and high functioning autism Journal of Autism & Developmental Disorders, 37, 1960-1968. doi: 10.1007/s10803-006-0343-3

White, S. W., Koenig, K., & Scahill, L. (2010). Group social skills instruction for adolescents with high-functioning autism spectrum disorders Focus on Autism & Other Developmental Disabilities, 24(4), 209-219. doi: 10.1177/1088357610380595

Whitehouse, A. J. O., Durkin, K., Jaquet, E., & Ziatas, K. (2009). Friendship, loneliness and depression in adolescents with Asperger's syndrome Journal of Adolescence 32, 309-322.

World Federation of Occupational Therapists (WFOT). (2012). Definition of Occupational Therapy from http://www.wfot.org/aboutus/aboutoccupationaltherapy/definitionofoccupationaltherapy.aspx

Image 1: “Rainbow umbrella”, (October 2013). Retrieved from:

Image 2: “Alone in a crowd”, (October 2013). Retrieved from:

Image 3: “Teenage boy alone in a park” (October 2013). Retrieved from:

Image 4: “Teenage boy separated from the group”, (October 2013). Retrieved from:

Image 5: “Sad boy sitting on bench”, (October 2013). Retrieved from:

Image 6: “Boy leaning on wall”, (October 2013). Retrieved from:

Image 7: “Sad boy at locker”, (October 2013). Retrieved from:

Image 8: Puzzle in the mind”, (October 2013). Retrieved from:

Image 9: “Blue puzzle piece”, (October 2013). Retrieved from:

Image 10: “Green puzzle piece”, (October 2013). Retrieved from:

Image 11: “Orange puzzle piece”, (October 2013). Retrieved from:

Image 12: “Smiling boy with friends”, (October 2013). Retrieved from:

Image 13: “Group of teens”, (October 2013). Retrieved from:

Image 14: “Teens talking in a group”, (October 2013). Retrieved from:

Image References
To all those who have supported me in the development of this presentation, particularly my three younger brothers who have continued to inspire me throughout my entire course.
Jess Hill
"The occupational therapist's concept of what it means to be and act as an occupational therapist (Mackey, 2007).

(Whiteford &Wright-St Clair, 2005, adapted by Denshire 2013)
[Image 1]
[Image 2, 3, 4]
[Image 5, 6,7]
[Image 8]
[Image 9]
[Image 10]
[Image 11]
[Image 12, 13, 14]
(Attwood, 2011; Hyman, 2013; Koning & Magill-Evans, 2007; My Asperger's Child, 2013; Pisula & Lukowska, 2011)
(Asperger's syndrome Foundation, n.d.; Bejerot & Wetterberg, 2008; Farrugia & Hudson, 2006; Lasgaard et al, 2010; Lugnegard, Hallerback & Gillberg, 2011; Shtayermman, 2008; The National Autistic Society, 2013)
(Baghdadli et al, 2013; Broderock et al, 2002; Koning & Magill-Evans, 2007; Laugeson et al, 2012; Lerner, Mikami & Levine, 2010; McMahon, Lerner & Britton, 2012; McMahon, Vismara & Solomon, 2012; Mitchell et al, 2010; Sticher et al, 2010; Sticher et al, 2012)
(Baghdadli et al, 2013; Broderock et al, 2002; Koning & Magill-Evans, 2007; Laugeson et al, 2012; Lerner, Mikami & Levine, 2010; McMahon, Lerner & Britton, 2012; McMahon, Vismara & Solomon, 2012; Mitchell et al, 2010; Sticher et al, 2010; Sticher et al, 2012)
(Baghdadli et al, 2013; Broderock et al, 2002; Koning & Magill-Evans, 2007; Laugeson et al, 2012; Lerner, Mikami & Levine, 2010; McMahon, Lerner & Britton, 2012; McMahon, Vismara & Solomon, 2012; Mitchell et al, 2010; Sticher et al, 2010; Sticher et al, 2012)
(The American Occupational Therapy Association, n.d.)
(Dukla & Jarus, 2005; Doble, Bonnell & Magill-Evens, 1991)
(Brown, 2009)
(Strong et al, 1999)
(Law et al, 1996; Strong et al, 1999)
(Asperger's syndrome Foundation, n.d.; Hiller et al, 2011 The National Autistic Society, 2013)
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