Brittany Schmidt, MA-CCC/SLP-L www.abc-autism.com
[email protected] 605-351-1002 Social Thinking Case Studies
Impressions and Ideas Slide 2 Why this topic? Thinking about what
skills point towards the best outcome What are the red flags? Slide
3 What are the greatest predictors of vocational success? Slide 4
Poor outcomes for job placement for youth with ASD Rates vary from
80-95% Project Search
Data:www.vcu-autism.org/about/index.cfmwww.vcu-autism.org/about/index.cfm
87.5% in treatment group acquired employment while 6.25% in the
control group did. Slide 5 Social Thinking at Work (Michelle Garcia
Winner and Pamela Crooke) Social Mind at Work Social Memory
Strategies for Adult Communication Emotions Perspective Taking (7
core tenets) Four Steps of Communication What People Mean by What
they say and How they say it The Importance of Conformity,
Teamwork, and Networking Relating at work Tips and Strategies Slide
6 Book designed to be used independently or as a workbook of sorts
to guide instruction for ST on the job Slide 7 Case Studies
Overview All of the following case studies were adults that were VR
funded to receive Social Thinking therapy between the years 2010
and 2014 Ages: 19 (A), 27 (AS), 33 (N) Slide 8 Case Study #1 19
year old male: A Graduated in 2010 Plan for transition fell apart
due to school district realizing he wasnt qualified for the support
they had intended 2 weeks before graduation. Had worked at HyVee
for about 1 year. Evaluated A and goals established. Significant
concerns for progress. Communicated that to VR. Slide 9 Positives
Wanted to do well and cared about thoughts of others. Liked his job
(mostly). Had a low average IQ and could reason and understand
directions. Very nice and kind. Learned quickly at work. Slide 10
Challenges Hygiene Time Management and Organization Concrete
Thinking (all clocks are a few minutes off) Initiation of
communication Expression in general. Very limited understanding
about thoughts of others and E/UE behaviors. Becoming overwhelmed
when social interactions impacted job completion Mild depression
and anxiety. Slide 11 Treatment Plan 1. A will demonstrate a use
and understanding of the core Social Thinking vocabulary as it
pertains to himself and his perspective taking abilities. 2. A will
demonstrate an understanding of the hidden curriculum as it applies
to various situations he encounter both in the community, at home,
and at school by being able to relate his observations to the
therapist with 1-2 examples per week. 3. A will increase his
emotional vocabulary to include at least 5 picture and vocabulary
words for 5 key emotions including examples of what may cause those
emotions. 4. A will be able to monitor his facial expressions and
tone of voice to reflect or mirror both his message and that of the
message of the speaker as evidenced by self monitoring on video
tape or through parent report Slide 12 Progression 1 st week 15
minutes late. Noted significant challenge with expression and
emotional vocabulary. Introduction of ST vocabulary. The next week
did not show up or contact SLP. 2 nd Week: 15 minutes late. E/UE
with time management. The next week: Came to the office much later
and told receptionist he had a meeting but couldnt remember when. 3
rd week 20 minutes late. Started to work on strategies for
organization and time management. Slide 13 Continued.. 4 th week I
called a meeting with parent, A, and VR. Good discussion about
extent of needs and possibility of ST not being the appropriate
support for meeting those needs. Decided to increase communications
with HyVee supervisor and provide a plan for organizational
supports (with parent assistance) within his home. Slide 14
Continued. 5 th week: 30 minutes late couldnt find phone and didnt
have much money to put gas in his vehicle to return home. 6 th
week: Arrived on time and clean shaven. Good session with progress
noted in insight and E/UE behaviors. 7 th week: Arrived 10 minutes
early but was not clean and was quite messy. Could not find his
phone and was worried he would be late so did not shower. Slide 15
8 th week: 5 minutes early. Unclean. SBM being in a group. Did well
with most columns. Most difficulty with thoughts of others. Slide
16 Week 9 Progress Note I am seeing some gains in As abilities to
use social thinking skills. He was on time and said he showered
last night. His phone wasnt charged so we discussed making sure
that he follows through with keeping his phone on the kitchen
counter (to charge it there) so he can have it with him at all
times. Had people file information about one person at work.
Watched a video about bagging groceries and also printed off a list
of bagging techniques. He said his primary challenge with bagging
is knowing how to bag items when they are not grouped correctly so
the two videos we watched showed how to group things into
categories and then how to bag according to weight and height (also
fragility). Slide 17 Next Week A texted me saying he couldnt get
out of his street due to road construction. Mom confirmed this. 10
th Final Week: Arrived at 12:50. Appointment was at 3:00. I offered
to see him with a group of boys that I had at 1:00, he declined and
returned on time at 3:00. Good session with higher level concepts
covered. Slide 18 Progress 1. A will demonstrate a use and
understanding of the core Social Thinking vocabulary as it pertains
to himself and his perspective taking abilities. Progress: A
understands the concepts of expected and unexpected behavior and
resultant good or uncomfortable/thoughts in others. He also
understands social wonder questions, 4 parts of communication and
people files. He does not recognize UE behavior in himself without
a prompt. He can recognize it in others via homework assignments
and scenarios used during STG. 2. A will demonstrate an
understanding of the hidden curriculum as it applies to various
situations he encounter both in the community, at home, and at
school by being able to relate his observations to the therapist
with 1-2 examples per week. Progress: goal not met. 3. A will
increase his emotional vocabulary to include at least 5 picture and
vocabulary words for 5 key emotions including examples of what may
cause those emotions. Progress: Part met for simple emotions such
as mad, happy, and joyful. 4. A will be able to monitor his facial
expressions and tone of voice to reflect or mirror both his message
and that of the message of the speaker as evidenced by self
monitoring on video tape or through Parent report. Progress: Goal
not addressed. Slide 19 Outcome Slight improvement in time
management and organization. Maximum supports at home required.
Slight improvement in understanding E/UE behavior in others and
thoughts of others. Parent sought guardianship and SSI supports.
Still on VR caseload. Slide 20 Case Study #2 AS 27 year old male.
Graduate HS Attended vocational school Expelled due to aggression
(bullied and handled it very poorly). Used a PASS plan to establish
a business (lawn care and snow removal) Business expanded to
Christmas light displays. Slide 21 Challenges Limited perspective
taking. Time management. Fiscal management. Very little social
activities besides sister and her son. Rigid thinking. Slide 22
Strengths LOVED his work. Used his area(s) of interest for job
development. Has a very supportive family. Has very little to no
mental health concerns. Slide 23 Progress Saw for 10 weeks in his
home town in 1:1 session. No challenges with timeliness or
scheduling. Good understanding of concepts (E/UE, ToY vs. JM, BIG,
PF, etc.) Very little carryover at home with support system.
Discontinued after the 10 weeks funded by VR. Slide 24 Outcome Good
understanding but little usage of ST concepts. Did develop some
business ideas based on thinking of you concepts that he liked and
incorporated into his business plan. (surveys of satisfaction,
quarterly letters to communicate thank you) Parent and AS report of
greater understanding of thoughts of others. Slide 25 Case Study #3
(N) 33 year old male. Late diagnosis of ASD. Long history of being
fired due to explosive behavior on the job. Varied jobs but mostly
retail and food industry Long history of anxiety and depression,
questioned PTSD in himself. Average IQ (last IQ was in High
School.) Slide 26 Challenges Cycles of mood. Concrete thinking.
Limited by present understanding about thoughts of others.
Emotional regulation. Hygiene Body language and affect No job (lost
it the 2 nd week of our therapy), no insurance, debt Slide 27
Strengths VERY motivated for change. Recognizes need areas. Needs
little assistance to grasp concepts. Support of VR and family (west
river) Stabile mood most of the time. Slide 28 Communication with
VR I told VR counselor that I felt N was going to do well and was
excited to see what he could do with ST therapy. By week 5 I was
communicating that I would really love to see him for an additional
10 weeks due to progress. VR approved 2 nd 10 weeks due to
documented progress. Completed last week on 9/24/14. Slide 29
Beginning Weeks Very limited affect. Scared/Worried. Introduction
of concepts and established rapport/trust. Got fired from a job due
to rigid thinking, ER, and lack of POV. Saw great gains in ability
to manage emotional regulation. Note strong understanding about how
others may be feeling. Realizes he was fired due to his own UE
behaviors. Slide 30 Middle Weeks Requested and obtained second 10
weeks. Incredible increase in ability to apply concepts learned in
therapy to his real life situations. Met with his mom and he when
she was visiting. Email communications with mom also occurred.
Moving towards August which is usually a month of stress/anxiety
due to school history. Slide 31 Ending Weeks Moved to an every
other week schedule. Wanted to be able to extend our sessions and
also felt he was doing well enough to do so. Increased anxiety in
August results in UE behaviors at work however did not get fired
and really handled the stress nicely. Announced moving back west
river in mid-October. Slide 32 Progress Understanding and
application of all ST concepts introduced including use during
times of emotional distress. Got insurance Got a job (held this for
over 6 months) Arranged for doctor appointment(s) to start
medication. Did all communications with work as it pertained to
needed days off. Disclosed his disability first with VR present and
then advocated for himself on 3 more occasions. Arranged for a
transfer west river independently. Slide 33 Why this topic?
Thinking about what skills point towards the best outcome
Perspective taking level Lack of mental health concerns Ability to
think about thinking (CBT) Support network What are the red flags?
Mental health Low perspective taking level Rigid thinking
predominates Poor or no support network Slide 34 Questions or
Comments?
