by Mariam Mansour and Dr. Judith Wiener
In Ontario, students with learning disabilities (LDs) are typically included in regular education classrooms. In addition to difficulties with acquisition of Reading, wRiting and mathematics (aRithmetic) skills – the 3 R’s, students with LDs often have challenges with a 4th R – Relationships (see Wiener & Timmermanis, 2012, for a review of the research). Social skills training is frequently used to help students with LDs develop improved social relationships. In this review we describe three SST interventions that have been demonstrated through research to be effective with children and adolescents with LDs and related difficulties. All of these programs can be implemented in school contexts, and have manuals and materials that can be purchased by educators. We then describe the components of SST programs that research has shown to enhance the social skills and peer relationships of students with LDs.
Why is SST Important?
Educators may notice some red flags that some of their students with LDs are facing challenges in social situations and may be concerned that this signals some deficits in social skills. In fact, it was found that more than 50% of individuals with LDs have social, emotional, or behavioural difficulties including specific difficulties with social skills (Kavale & Forness, 1996; Wiener & Timmermanis, 2012). In addition, approximately one-third of students with LDs are diagnosed with co-occurring ADHD (Willcutt et al., 2010). Compared to their classmates without disabilities, students with LDs are less socially accepted (Estell et al., 2008; Nowicki, 2003), have difficulty with developing close friendships (Estell et al., 2009; Wiener & Schneider, 2002), and are more often victims of bullying (Mishna, 2003; Nabuzoka & Smith, 1993). They are also more anxious (Nelson & Harwood, 2011a) and prone to depression (Nelson & Harwood, 2011b) than students without LDs. This anxiety and depression may be a consequence of having challenges with the 4th R – relationships (Bukowski & Adams, 2005).
The objective of social skills training is to teach students to acquire healthy social relationships by improving their social skills and social problem solving skills. Therefore, studies that evaluate the efficacy of social skills training programs typically examine whether students have acquired the social behaviours and social problem solving skills that are taught, whether they perform these behaviours and problem solving skills in their daily interactions, and whether this leads to improved social acceptance (or lower levels of social rejection) by peers. Some studies also assess whether enhanced social skills is associated with improvements in social self-concept and self-esteem.
What is SST?
SST involves explicit teaching of positive social behaviours and social problem solving skills to groups of children or adolescents who are experiencing difficulties with social relationships (Gresham, Sugai, & Horner, 2001; Kavale & Mostert, 2004; Wiener & Timmermanis, 2012). The aims of SST interventions are to teach new skills, enhance existing skills, and facilitate maintenance of previously learned skills (Gresham, 1998b). SST interventions for students with LDs are typically based on cognitive behavioural principles (Wiener & Timmermanis, 2012).
Literature-based SST programs such as social stories or drama for students with LDs were developed more recently (Kalyva & Agaliotis, 2009). Some interventions focus on explicit teaching of specific prosocial behaviours that students should use in specific social situations; other interventions focus on improving students’ ability to problem solve in social contexts, and other interventions combine the teaching of specific social behaviours and social problem solving (Wiener & Timmermanis, 2012). SST programs are usually delivered by therapists in clinical and community settings where children attend weekly or bi-weekly sessions, or in schools by teachers or educational assistants. SST programs usually have a manual that therapists, teachers and educational assistants can refer to when they deliver the interventions.
ASSET: A Social Skills Program for Adolescents (Hazel, Schumaker, Sherman, & Sheldon)
ASSET is a group SST program for adolescents with LDs that targets eight important social skills: giving positive feedback, giving negative feedback, accepting negative feedback, resisting peer pressure, following instructions, social problem solving, negotiation, and conversation (Hazel et al., 1981b). Skills are taught using video modeling, role-playing, group discussions, and take-home activities. ASSET includes a video of adolescents modeling appropriate and inappropriate behaviours for each of the target skills. Each skill is represented in four different video clips, which are watched and discussed by the group. The ASSET program involves weekly sessions for a period of 10 weeks. During each session, the instructor:
- reviews previously learned skills,
- introduces a new skill,
- provides a rationale for the new skill,
- discusses possible examples of the skill and contexts where it might be used,
- gives participants a written handout listing the skill components and steps,
- models the skill using the role-plays in the video-clips,
- works with the group members to learn the skill steps written in the handout in the appropriate sequence, and
- provides scaffolding and performance feedback as group members role-play the skill.
Using a time series multiple baseline design, Hazel, Schumaker, Sherman, and Sheldon (1982) evaluated ASSET with a sample of 7 adolescents with LDs and 6 adolescents without LDs, all of whom attended an alternative secondary school. Each student was tested individually before and after each training session, using behavioural role-play to assess acquisition of the six skills on which students with LDs had more difficulty than students without LDs:
- giving positive feedback,
- giving negative feedback,
- accepting negative feedback,
- resisting peer pressure,
- social problem solving, and
Students with LDs were rated as having improved performance for each of the skills after training compared to baseline, and acquired the skills at the same rate as students without LDs. Although this study suggests that students with LDs who have social skill difficulties can acquire the skills and perform them competently in a controlled situation such as a role-play, the investigators did not examine whether the students used the skills in other contexts or whether training was associated with improved peer relationships.
Social Life - LD (Wiener & Harris)
The Social-Life LD program is a classroom-based social skills training program developed for 9 to 13-year old children with LDs. It is an adaptation of an intervention originally developed by Griffiths and her colleagues for adults with developmental disabilities (Griffiths, 1995; Griffiths, Feldman & Tough, 1997). The program is implemented in classrooms for students with LDs in 35 to 40 minute sessions that occur twice weekly. The central feature of the program is a board game that can be played between two and four students. Other materials include a facilitators’ manual and a database of cards that consist of social problems that children typically encounter (e.g., dealing with bullying, negotiating a compromise, resisting peer pressure).
Social-Life LD combines explicit teaching of social skills with fostering social problem solving skills. The social skills taught are individualized to the needs of the students in the group. The general categories of skills include:
- emotion regulation,
- dealing with bullying and peer pressure,
- expressing feelings,
- social communication,
- negotiation and conflict resolution,
- conveying empathy,
- age-appropriate behaviour, and
- planning and organization.
Students are first taught four problem-solving strategies to use when they encounter a social problem – Stop, Think, Act, and Check it Out. Then, as they play the game and draw cards with the social skills they need to learn, they are asked to either choose a viable strategy, to explain what they would do, or to role-play. Social problem solving is taught through mediated teaching (careful questioning to elicit problem-solving).
Compared to students in no-treatment control classrooms, students with LDs receiving the program were rated by teachers as having improved social skills on a standardized social skills questionnaire, and by peers as being less aggressive following treatment. These gains were maintained at one-year follow-up. The students in the control classes became more rejected by peers as the academic year proceeded, whereas the peer acceptance of students receiving the treatment remained stable (Wiener & Harris, 1997).
Compared to students in no-treatment control classrooms, students with LDs receiving the program were rated by teachers as having improved social skills on the Social Skills Rating Scale, a standardized social skills questionnaire; the scores of the intervention group improved from the 30th to the 42nd percentile whereas the scores of the control group decreased from the 30th percentile to the 21st percentile. These gains were maintained at one-year follow-up Peers also rated the students in the treatment group as being less aggressive following treatment. The students in the control classes became more rejected by peers as the academic year proceeded (Social Preference scores decreased from -.81 to -.1.17), whereas the peer acceptance of students receiving the treatment remained stable (Social Preference score showed a non-significant increase from -.73 to .61) (Wiener & Harris, 1997).
Social Stories™ (Kalyva & Agliotis)
Social Stories™, a social skills intervention initially developed for children with autism spectrum disorders in 1991 by Carol Gray (Gray & Garand,1993) and has been used more recently with 10 to 12 year-old children with LD to teach interpersonal conflict resolution (Kalyva & Agoliotis, 2009). Social Stories™ are stories with a social goal that introduce the reader to a relatable character and explore the feelings, thoughts, and behaviours of that character as he/she moves toward achieving the social goal of the story (Rogers & Myles, 2001). In the Kalyva and Agliotis study, children were exposed to social stories depicting dealing with conflict twice a week for one month. Each session took approximately 10 minutes at the beginning of class. The social stories, which reflected a conflict between two friends, introduced the social conflict, mentioned the feelings of each character and why they feel that way, and proposed an appropriate strategy to resolve the conflict.
Kalyva and Agliotis (2009) evaluated the efficacy of the social stories intervention using an experimental design in which 63 students with LDs were randomly allocated to a treatment group and a no-treatment control group. They found a significant reduction in the use of avoidance strategies and an increase in the use of prosocial strategies (compromise and accommodation) in the experimental group compared to the control group immediately post-intervention and at two-month follow-up. Additionally, the experimental group participants showed more appropriate social skills and fewer inappropriate social behaviours after training whereas there were no changes for the children who were not in the social stories intervention according to teacher ratings on a standardized social skills questionnaire.
What components of SST programs are associated with positive outcomes?
Both qualitative and quantitative literature reviews suggest that here are several principles that enhance the effectiveness of SST programs (Kavale & Mostert, 2004; Maag, 2005; McIntosh, Vaughn, & Zaragoza, 1991).
- Teaching of social skills needs to be embedded into the everyday activities of the classroom. Teachers should explicitly teach cooperative behaviour, negotiation, leadership, conflict resolution, emotion regulation, and social communication skills before students work in group activities and verbally reinforce students who display these skills while working in groups.
- The skills selected for teaching should be those needed at home, in school, and in recreational activities and that are valued by the family and peers.
- The following strategies should be used to teach specific social skills during social skills training sessions:
- Modelling of skilled social behaviour using videos or live role play
- Discussing and showing multiple examples of the skilled social behaviour in various contexts
- Asking students to role play and providing feedback on their performance
- Overlearning – practicing the skill beyond the point when it has been acquired
- Using highly interesting materials such as games or situations that are relevant to the students
- The following strategies should be used to teach social problem solving skills during social skills training sessions:
- Ask students to identify the nature of the social problem and to determine a social goal by asking them questions such as: What do you think might be a problem with doing/saying that? When is another time you might need to…?
- Ask students to generate several alternative strategies to solve the identified social problem by asking them questions such as: Yes, that’s one way you could do it. What else can you do? Can you think of things other kids do in this situation?
- Ask students to think about the potential consequences of each of the solutions they offered by asking questions such as How do you think the other kid(s) would fee if you did/said that? What do you think might happen then?
- Ask students to evaluate the solutions and select a course of action by asking questions such as: Is this way better than…? Why do you think so? How did you know it was right?
- Ask students to develop a plan of action by asking them questions such as: What is your goal if you do this? I know that your goal is to…, but what are the steps you need to take to get there? What problems might you have along the way? How long do you think it will take to reach your goal?
- Reinforce unprompted generalization of skills learned in social skills training by labelling the skill that the student used, and indicating why it is a good skill in that context.
- Ask the social problem solving questions (see number 4 above) when social problems occur in the classroom or on the playground.
- Discuss situations outside the classroom in which the skills taught in sessions can be used and give students homework where they document when they used these skills. This strategy may also enhance self-awareness.
Level of evidence
We identified two meta-analyses that have examined the outcomes of social skills interventions for students with LDs (Forness & Kavale, 1996; Kavale & Mostert, 2004). The more recent Kavale and Mostert meta-analysis, which synthesized the results of 53 studies with over 2000 participants, showed small effect sizes (M = .211; range = .674 – 1.190). This indicates that overall, SST produces at best a modest effect on functioning. The only moderate effect size was for self-reports of peer acceptance. There were no differences in the efficacy of programs by age of participants or length of training. Neither meta-analysis, however, analyzed the components of programs that predicted stronger effects. This was mainly because, as discussed by Kavale and Mostert, most of the programs were developed by the researchers, and were not based on a sound conceptual framework of social skills or social competence. The three programs described above, however, are based on a sound conceptual framework for social skills and the types of social skill difficulties experienced by students with LDs, and the studies that evaluated these programs are well-designed using either a pre-post-follow-up treatment/control group design (Kaliva & Agaliotis, 2009; Wiener & Harris, 1997), or a time series single subject design (Hazel et al., 1982). As discussed above, students with LDs achieved significant gains on the variables measured including: negotiation, providing positive feedback, providing negative feedback, taking negative feedback, providing prosocial conflict resolution strategies, resisting peer pressure, and being perceived as having improved social skills and less aggressive by teachers and classmates. Consequently, these interventions should be considered evidence-informed.
Click here for another article co-authored by Dr. Wiener along with Dr. Jillian Haydicky on the Mindfulness program and how it can help promote the social and emotional development of students with LDs.
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Dr Wiener is a Professor in the Department of Applied Psychology and Human Development at OISE/University of Toronto. Working in the School and Clinical Child Psychology program she teaches a number of course about assessment as well as the education of children and youth with learning disabilities and ADHD. She is also the Past President of the International Academy for Research in Learning Disabilities. Prior to her academic career Dr Wiener served as a School Psychologist for six years in school districts in Quebec and Ontario.
Dr. Wiener’s research focused on understanding the peer relations of children with learning disabilities and the social, behavioural and emotional impacts of different approaches to special education service delivery. Currently her research is focused on the social and emotional adjustment of children and adolescents with learning disabilities and ADHD. With her team she has researched mindfulness therapy interventions to address some of their challenges.