Social Cues and Autism
- August 22, 2022
Per the American Psychiatric Association, one of the factors by which autism is diagnosed is “persistent deficits in social communication and social interaction across multiple contexts.” This may take the form of, for example, difficulty with sharing interests and feelings with others, limited eye contact and gestural or body language, or trouble with identifying social cues. Overall, aspects of social development often occur differently or at a different pace for autistic people in comparison with their neurotypical peers.
Many “treatments” for autism, including applied behavior analysis (ABA) services offered by some organizations, focus on addressing these differences by teaching clients to conform with social norms and sometimes drastically change their behavior in ways that no longer align with their own interests and desires. This approach is based on the medical model of conceptualizing autism and other forms of neurodivergence: identifying things that are deemed “wrong” with a person and attempting to change or eliminate those things.
At Waypoints, we take a different approach to social skills, and all clients’ goals for that matter. If you’re interested, you can learn more about this in one of our previous blog posts titled “Why You Should View ABA as a Skill-Building Tool—Not ‘Therapy.’”
In this post, I’d like to say more about why it’s so important to celebrate the interests and expressions of all people, regardless of their diagnosis. I will also end with some suggestions for how to teach identification of social cues, with the understanding that how someone then reacts to those social cues is (in most circumstances) up to the individual.
A Neurotypical Kid Who Ignored Social Cues
But first, I’d like to share some anecdotes from my own childhood, highlighting why I believe it is so important to respect peoples’ preferences and methods of socialization. Fellow humans who happen to be neurodivergent are more likely to have their behaviors pathologized, even when those behaviors are well within the spectrum of “normal” human experiences.
I was a neurotypical kid and am a neurotypical adult (for whatever extent to which we can call anyone “neurotypical”), but I was nonetheless a deeply strange child from my peers’ perspective. The old-fashioned dresses that my grandma made for me to wear were cute in elementary school but then mocked mercilessly in junior high. I never got into popular music, and got a lot of weird looks for my tapes and CDs ranging from jazz piano to alternative bands like (my favorite to this day) They Might Be Giants. I watched anime and played Dungeons and Dragons at a time when those were DEFINITELY not accepted in the mainstream, especially not for a little girl!
I could go on, but my point is that while I was teased, I was never pressured by my parents or other adults around me into changing my social behavior. One key point is that, even at the time, I recognized the social cues from my peers signaling to me that I didn’t fit in and that my few scattered attempts to do so weren’t quite right. For the most part, though, I didn’t really care. I was sometimes embarrassed or angry, but I never felt motivated to behave differently.
At all stages of my life, I was still able to find wonderful friends with shared interests. To the degree that one does in fact want to make friends, I believe that is the goal around which social skills training should be centered.
The Dangers of Enforcing Conformity
In May of 2021, I attended an eye-opening presentation by Madi Holcomb titled “Make Yourself Uncomfortable: Navigating Autistic and Allistic Social Communication Differences and Encouraging Authenticity.” Madi shared a self-assessment for autism at https://embrace-autism.com/cat-q/#test based on the following common actions on the part of autistic people:
- Compensation – studying neurotypical social cues and incorporating them.
- Masking – the daily practice of pretending to be neurotypical, and hiding autistic traits. This often leads to hypervigilance about facial expressions, gestures, etc. because of the impression that one’s own social instincts can’t be trusted.
- Assimilation – buy-in to social norms with the perspective that one HAS to hide.
High scores on this assessment – that is, tendencies to engage in these actions – are correlated with depression and poor well-being. As such, I again argue that while it can be very helpful to teach people to recognize social cues, enforcing conformity based upon those social cues can be quite harmful. I really can’t say it better than Brian Middleton in his recent Facebook posts (as the Bearded Behaviorist) at both this link and this one. “The concept of appropriateness is difficult because it assumes that there is an agreed upon set of behaviors that everyone follows, yet the very fact that we use that term means that not everyone agrees.”
As a sidenote, though, autistic adults who have learned to mask over their lifetime may feel safer continuing to do so in some circumstances, and that should also be respected. In her Facebook account, Neurodivergent Researcher, one autistic practitioner shares a helpful anecdote to that effect at this link.
Important Social Cues
Autistic people are often stigmatized and teased for a lack of conformity with social expectations, such as repeating phrases from favorite shows or movies, using atypical tones of voice, expressing themselves non-vocally, or focusing the majority of conversations on special interests about which they are often deeply knowledgeable. These behaviors are not harmful or inherently dangerous; in our practice of ABA at Waypoints, we would only intervene based on the explicit request of our clients, with rationale based on their own personal goals.
With that being said, such goals might include making friends, and that is certainly something that an autistic child or teen could struggle with more than a neurotypical peer. In particular, autistic people may have trouble identifying and interpreting subtle cues such as tone of voice, body language, and non-literal language like jokes and metaphors. Learning to recognize these aspects of social interactions can also help one to recognize when others are not being friendly, such as in cases of bullying or lying.
Other important social cues that can directly affect safety and well-being include:
- Others giving or withdrawing consent for social interactions, especially (but not limited to) those involving physical touch
- Signs that others are not respecting one’s own consent for social interactions
- Safety in speaking to family and friends vs. authority figures vs. strangers in different contexts
How to Teach Social Cues
A recent article by Christiana Butera and colleagues provides excellent insight into the fact that while autism is often associated with a harder time with “the ability to imagine how another person is thinking or feeling,” no such deficits appear to exist for “the ability to share and feel emotions others are experiencing.” Difficulty interpreting social cues may arise from difficulty interpreting one’s own physical and emotional states, let alone those of others, based on subtle external signs.
With this in mind, helpful skill-building techniques may revolve around mindfulness in the sense of focusing on the sensations and impulses within one’s own body, as well as learning to attend to external cues such as the location, people present, what those people are doing or paying attention to, and how they appear to be reacting. To that end, taking advantage of learning opportunities in day-to-day settings and interactions while providing very clear and direct explanations can be very helpful. Procedures to formally teach social skills and recognition of social cues can be incredibly complex and should always be individualized for each client, but here are some general suggestions.
Joint Attention and Social Referencing
Joint attention is the coordination of eye contact and other behaviors like pointing that leads to multiple people interacting with the same thing in the environment. Some signs of joint attention are a person shifting their gaze between the thing they’re paying attention to and other people in the room, or engaging in behaviors like pointing specifically to get the attention of the other person.
Social referencing is a similar concept to joint attention, with some additional complexities. Social referencing is based more on reacting to something in the environment in a similar way as another person, rather than simply paying attention to it.
For these behaviors to develop, it’s important for social interactions to actually be reinforcing! This can be accomplished by engaging with things in the environment that the person is actively interested in, not things that you think that they should be interested in.
One common step is to teach a learner to look at the same things that you’re looking at, and then look at your face or body language, with the goal of your behavior in response to those things affecting the behavior of the learner. This can help with giving warnings about safety concerns, but also with relating to peers when they’re excited about something.
Consent
This topic deserves its own blog post at the least, but it’s important enough in the context of social cues that I wanted to mention it here too. These suggestions come directly from my dear friend and colleague Worner Leland, who I trust more than anyone when it comes to teaching and respecting consent.
One important aspect of consent is to learn that someone saying “no” in the moment must be accepted, but furthermore that several repeated “no’s” over time on the same topic means that the request probably shouldn’t be made again.
Adding complexity to this issue, some people may not want to be impolite, or may not feel safe explicitly saying “no.” In such cases, a learner must try to attend to those subtle cues such as tone of voice, body language, and non-literal language. Sometimes, clear rules about this can help. For example, if you’ve asked about the same thing three times and haven’t received an enthusiastic yes, then that person should be left alone about that topic for at least X-amount of time. These scenarios can be practiced through roleplay and in real life with low-risk requests like asking to borrow something!
Learning how to give and withdraw consent is a whole ‘nother issue. Autistic people are often taught “compliance,” with an emphasis on obeying authority figures. I hope that it goes without saying that this can be very dangerous if compliance overgeneralizes. The blog Real Social Skills (which I highly recommend) discusses this topic. My foremost suggestion for teaching this skill is to give opportunities for choice-making throughout day-to-day life, and respect and praise the learner’s choices and boundary-setting.
Social-Emotional Learning Curriculum
There are entire curriculums dedicated to teaching social skills and identification and expression of emotions, both in the classroom setting and for independent or self-guided learning.
One excellent option is the Social-Emotional Acuity Bridge offered by Bridges Learning System, with a free demo available at this link. This isn’t a paid advertisement; this is just the best curriculum I’ve found yet! A wonderful first-hand account review by an autistic parent of an autistic child can be found at this link. As she puts it, “the truth is, adult providers and educators need this more than children do. Adults have had more years of being socialized into harmful perceptions and norms. Even as an autistic, dyslexic, ADHD person, I caused harm as a teacher (to myself and my students) because no one had ever given me permission to regard my differences as anything but something to be ‘overcome’ or to hide in shame. Everything I had learned was coded in shame.”
Another option for learning these skills is neurodiversity-affirming social groups and activities; you can find some suggestions for local Michigan options in our recent blog post here. And as always, you can learn more about the services that Waypoints offers at https://waypoints.life/our-services/aba-skills-training/!
Please feel free to contact us at info@waypoints.life if we can answer any questions.
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