The Social Skills Picture Book. Jed Baker, PhD

      is a term used to describe a wide range of symptoms that span an individual’s sensory, cognitive, motor,

      language, and social-emotional development. Current diagnostic criteria characterize autism as involving deficits in

      three general areas: (a) social interaction, (b) communication, and (c) repetitive and ritualistic behaviors (American

      Psychiatric Association, 1994).

      Problems with social interaction can include difficulties initiating or responding to communication or play, difficulties

      using or responding to non-verbal gestures (e.g., pointing out objects), lack of or inconsistent eye contact, impairments

      in responding to others’ feelings, and subsequent failure to develop peer relationships. Understanding what to do or say

      in social situations is a core problem for autistic individuals.

      Communication problems may include pragmatic, semantic, and structural language difficulties. Pragmatic language

      refers to the social use of language, as is involved in sustaining or initiating communication. For example, some autistic

      individuals may appear to have perfectly intact language in terms of their ability to express themselves and understand

      others, yet they may have great trouble with social communication (e.g., talking at people instead of with people,

      relaying factual information or phrases memorized from TV shows without responding to what their listener is saying or

      doing). Many autistic individuals also have a semantic language problem involving trouble understanding the meaning

      of words, especially with abstract words, metaphors, or sayings. For example, they may hear the saying “Don’t let the cat

      out of the bag” and search for a cat and bag rather than grasp the symbolic meaning regarding not spoiling a surprise.

      Structural language problems refer to difficulties with the use of grammar and syntax. Many autistic individuals may

      have difficulty putting sentences together and understanding grammatically correct sentence structure.

      Repetitive and ritualistic behaviors reflect a preference for sameness and repetition with regards to interests, daily

      routine, and body movements. Many youngsters with autism develop a fascination with a particular area of interest and

      elaborate on that interest, to the exclusion of learning about new things. For example, I knew a youngster who became

      obsessed with vacuum cleaners and was reluctant to attend to or talk about anything else. Many autistic individuals

      also exhibit non-functional routines that appear superstitious in nature. One youngster I worked with had to hang

      every picture in the house at a crooked angle before he could use the toilet. Other youngsters might repetitively line up

      toy blocks, letters, or numbers in a certain manner. Such autistic individuals may become very anxious or upset when

      changes or transitions are introduced. Youngsters may also demonstrate repetition in their use of language (repeating

      the same phrase over and over) or in their physical movements (e.g., repetitive hand flapping, body rocking, or twirling

      around and around.)

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      By definition, autism refers to difficulties in all three of the core symptom areas (social interaction, communication,

      repetitive behaviors). However, there are individuals who have difficulties in one or two areas, but not a third. As a result

      of the variety of symptom profiles across these three areas, researchers and clinicians often refer to them as autism

      spectrum disorders rather than just referring to autism. Autism spectrum disorders include autism (and high-functioning

      autism), Asperger’s Syndrome, and Pervasive Developmental Disorder-not otherwise specified (i.e., PDD-NOS, a category

      for individuals who meet some of the criteria for an autism spectrum disorder, but do not fit neatly into a specific disorder

      like autism or Asperger’s Syndrome). Within the autism spectrum there are individuals with no language and severe

      mental retardation, as well as people who are very articulate with gifted IQs, despite problems in social interaction and

      repetitive behaviors. For example, individuals with Asperger’s Syndrome have average to above average intellectual

      development, few or no problems with the structural use of language, but have problems in social interaction and

      repetitive behaviors.

      Given the variety of symptoms and intellectual functioning among individuals with autism spectrum disorders, a

      number of researchers have theorized about the core underlying problem within the disorders. Three, perhaps related,

      theories have received the most attention:

      •

      Frith (1989) suggests that autistic individuals lack the ability to simultaneously integrate multiple language, social,

      and emotional messages typically present in social situations. Something about their neurological functioning

      makes it difficult to assimilate and organize all the pertinent information. Since most social situations have multiple

      levels of sensory input, autistic individuals do not always fully grasp what is happening or how to respond. Instead,

      they may attend to and process only a fragment of the social experience, resulting in repetitive and atypical social

      behavior.

      •

      Baron-Cohen (1995) suggests that the core problem is the inability to understand the thoughts and feelings of

      others, a process termed “theory of mind.” Thus, autistic individuals have difficulty taking other people’s

      perspectives.

      •

      Hobson (1996) suggests that autism involves the inability to perceive and understand emotional expressions. This

      would then lead to difficulties in perspective taking and subsequent problems in social interaction.

      These three theories can be considered complementary. Both Baron-Cohen and Hobson’s theories suggest that

      autistic individuals cannot easily empathize or understand another person’s view of the world. Frith’s theory helps explain

      why. The inability to simultaneously integrate information about what is happening in a social situation makes it difficult

      to imagine what others might be thinking and feeling. To take another’s perspective, one has to synthesize information

      about the other person (e.g., the person’s recent past experiences and preferences), along with what is happening to the

      person.

      Most social skills rely on the ability to mentally adopt another person’s perspective. For example, knowing why to

      say hello when you greet someone is based on understanding how others might think or feel if you ignore them rather

      than greet them. Knowing when to stop talking, take turns, respond to others’ initiations, compromise, help others, or