THE FLOW OF INTERVENTION By: Nancy Rice, MA, CCC-SLP
SOCIAL THINKING® and THE FLOW OF INTERVENTION
By: Nancy Rice, MA, CCC-SLP
This blog is written based on my experience working with individuals with social communication disorders, which is largely based on the Social Thinking curriculum designed by Michelle Garcia Winner, MA, CCC-SLP, and colleagues. I will attempt to summarize the process I use in treating my clients with social communication disorders. This framework is designed primarily for individuals who have average to above average cognitive abilities; however, with creativity and care, it can be adapted to meet the needs of a wide range of clients.
Working with individuals with social communication disorders is challenging, to say the least. These clients are complex and their skills vary tremendously, making it difficult to know where to start and how to proceed. I have found that it’s important to start at the beginning (see diagram below), no matter the client’s chronological age or stage of social communication development. I have many adult clients with whom I adapt the materials and content delivery to respect their age and stage. Nonetheless, I always start at the beginning, with self-regulation of behavior.
Spend time teaching the “zones.” Blue Zone: sad, sick, tired, bored, moving slowly; Green Zone: happy, calm, focused, ready to learn; Yellow Zone: frustrated, worried, excited, loss of some control; Red Zone: mad/angry, mean, terrified, out of control. Work on developing an emotional vocabulary and tie each term to a real-life situation or role-play activity. Talk about how the body acts and reacts when experiencing each emotion (i.e. smiling, hitting, yelling, jumping, etc.). Develop strategies and “tools” for self-regulation of emotions and behavior. Zones can be continually inserted throughout the therapy process, so start with developing an understanding of the four zones and establishing tools that help the client, for example – breaks, physical activity, fidgets, problem-solving tools, etc.
Materials: “The Zones of Regulation” by Leah M. Kuypers, MA Ed. OTR/L; Problem and Reaction Meter (PDF)
- Develop an understanding of thoughts, feelings, actions and reactions. You want the client to understand that our thoughts and feelings can be comfortable or uncomfortable, and our actions/reactions can be expected or unexpected. Then, develop an understanding that, when we do something expected, we start (or continue) a positive chain reaction that makes us and others feel comfortable AND when we do something unexpected, we start (or continue) a negative chain reaction that makes us and others feel uncomfortable. The goal of this stage is to help the client realize that choosing to do what is expected (i.e. starting and continuing positive chain reactions) will result in making him/herself and others feel comfortable – a good choice to make.
- Develop an understanding of “thinking with your eyes,” including an understanding of WHY we should think with our eyes. This stage takes a while because the concept and process is new to them, and their eyes and brain are connected in a much different way than in a neurotypical brain. This stage involves a great deal of mirror work, imitating facial expressions, using exaggerated affect, and “look where I’m looking” games.
- Develop an understanding of how and why we want to identify and follow “group plans.” At this stage, start connecting all that was learned in skill #1 (above) with daily activities, games and learning activities. This is where the client really starts to understand the concept of expected and unexpected actions. Following the group plan is expected; and when one doesn’t follow the group plan, it starts a negative chain reaction.
- Develop an understanding of why we want to keep our “body in the group” and help the client to do so in a variety of activities. Along the way, you’ll be strengthening the ability to keep their body and brain in the group AND the “green zone.”
- Develop an understanding of using “whole body listening” – which is done with lots of help from the “Zones” tools. We want the client to realize that listening doesn’t just involve our ears. We listen with our brain, quiet hands, quiet mouth, caring heart, etc.
- Develop an understanding of how to “follow the leader” (i.e. understanding the concept of an authority hierarchy). This is done with lots of work on what it means to be a good leader/follower; and how and when to be leaders vs. followers. This stage is not in the Michelle Garcia Winner curriculum. It is my own stage that has been added because I’ve found that individuals with social communication disorders don’t know where they “fit in” and so they tend to take the lead (usually in an unexpected way – and then get confused because they think they’re doing what’s expected) or they get anxious (which also causes unexpected actions/reactions). In additions, individuals with social communication disorders tend to have difficulty identifying good leaders/followers. Taking time to add this stage helps clients deal with issues surrounding friendship, bullies, handling boring moments, parent/teacher/employer relationships, and more…
Materials: “Meet Thotso, Your Thought Maker” by Rachel Robb Avery, Ph.D.; “What is a Thought?” by Jack Pransky & Amy Kahofer; “We Thinkers, Volume 1” (formally “The Incredible Flexible You” series) by Ryan Hendrix, Kari Zweber Palmer, Nancy Tarshis & Michelle Garcia Winner; “Whole Body Listening Larry at School” and “Whole Body Listening Larry at Home” by Kristen Wilson & Elizabeth Sautter
- Develop an understanding of the “hidden curriculum:” the idea that there are always rules that we aren’t told but are still expected to follow. Spend time studying the rules of different settings and activities to the client. Practice following the rules by “thinking with our eyes.” Do this in role-play and pretend play activities and then in “real-time.”
- Introduce the concept of being “flexible.” We don’t have to do things our “own” way, we can do things “any” way. At this stage, provide lots of practice on being flexible about day-to-day things, i.e. playing a game someone else wants to play, doing an activity in a new way, dealing with disappoint or losing a game, not getting the color desired or handling it when told “No.”
- We have to teach our clients with social communication disorders to “share imagination.” This is done in pretend play with the younger clients and joint storytelling and conversation with the older clients.
Materials: “We Thinkers, Volume 2” (formally “The Incredible Flexible You” series) by Ryan Hendrix, Kari Zweber Palmer, Nancy Tarshis & Michelle Garcia Winner
- Develop an understanding of how to identify cues that help us to know what’s “expected and unexpected.” This is the stage where clients practice seeing and using social thinking skills in real-life experiences.
- Learn to use “flexible thinking” is all we do. Practice identifying when and where flexible thinking was or was not used.
- Develop “strategies” that will result in more flexible thinking – resulting in successful social interactions.
Materials: “You are a Social Detective!” by Michelle Garcia Winner & Pamela Crooke; “Superflex: A Superhero Social Thinking Curriculum” package by Stephanie Madrigal & Michelle Garcia Winner; “Superflex Takes on Glassman and the Team of Unthinkables” by Stephanie Madrigal & Michelle Garcia Winner; “Superflex Takes on Brain Eater and the Team of Unthinkables” by Stephanie Madrigal & Michelle Garcia Winner; “Superflex Takes on One Sided Sid, Un-Wonderer and the Team of Unthinkables” by Stephanie Madrigal & Michelle Garcia Winner; “Social Town Citizens Discover 82 New Unthinkables for Superflex to Outsmart” by Stephanie Madrigal, Michelle Garcia Winner & Pamela Crooke; “Superflex Superdecks”; Social Thinking YouTube (PDF); Video Modeling; Individual Social Thinking Binders (PDF)
Along the road to Social Interaction, try to keep the activities very content driven and always explain the “why” behind what you are doing. In addition, involve parents! After all, social thinking is a 24/7 thing.
I will be forever grateful for the contributions Michelle Garcia Winner and colleagues have made to the field of speech language pathology. They have provided a greater understanding of social communication development and disorders, and have opened my eyes to a world of intervention resources and techniques that really work! ~Nancy Rice