Social skills in children with learning disabilities: using psychotherapy in the classroom.
Subject: Children (Health aspects)
Learning disabilities (Care and treatment)
Learning disabilities (Reports)
Psychotherapy (Usage)
Author: Ruegg, Erica
Pub Date: 09/22/2006
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2006 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Fall, 2006 Source Volume: 9 Source Issue: 3
Product: Product Code: E121920 Children
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 152334725
Full Text: Abstract

This article provides information on children with learning disabilities (LD) and the social skills difficulties they often demonstrate. Although there might be a need for psychosocial intervention in children with LD, teachers and parents often have limited time or resources to provide one-on-one therapy with these students. However, psychotherapists, counselors, and social workers can provide training to classroom teachers in understanding the social skills nuances for children with LD and help translate the available psychosocial therapies into effective classroom strategies.

Key Words: learning disabilities, social skills, psychotherapy

Introduction

The purpose of this article is to provide information about the social skills difficulties children with learning disabilities (LD) exhibit and intervention strategies that respond to their needs. Despite their need for social skills development intervention in the classroom, children with LD tend to be overlooked in favor of those with more severe impairments. However, psychotherapists, school counselors, and social workers can provide training to classroom teachers in understanding the social skills nuances of children with LD and help them translate available psychosocial therapies into effective classroom strategies.

Children with Learning Disabilities

According to the Individuals with Disabilities Education Act (IDEA) (2004), a specific learning disability is a disorder of the processes involved in understanding and using language, including listening, thinking, speaking, reading, writing, and doing mathematical calculations. Children with LD often display major discrepancies between their intellectual abilities and academic achievements, which cannot be explained by sensory-motor or cognitive disorders (Turnbull, Turnbull, Shank, & Smith, 2004). Frequently, this discrepancy causes difficulty in oral or written expression, reading or listening comprehension, and social skills.

Research has shown that 90% of children with LD have some type of language deficit that might hinder their social development in the classroom (Garnett, 1989; Gibbs & Cooper, 1986; Ripich & Griffith, 1988; Roth, 1986). The DSM IV (2000) defines LD under learning disorders. It addresses the evidence of a discrepancy between a student's achievement scores and IQ and associated features including low self-esteem, demoralization, and social skills deficits (American Psychiatric Association, 2000). Research has also begun to show that psychiatric comorbidity might occasion social skills deficits in children with LD more than cognitive dysfunction (San Miguel, Forness, & Kavale, 2000). Many children with LD also report struggling with conduct/oppositional defiant disorders, attention-deficit hyperactivity disorder, and depression, any of which might result in social skills deficits that do not respond to basic academic intervention (American Psychiatric Association, 2000; Pavri, 2001; San Miguel, Forness, & Kavale). Classroom teachers are not trained to recognize the need for psychopharmacologic or psychological therapy.

IDEA (2004) and No Child Left Behind (2000) legislation require that students with disabilities be taught in the least restrictive environment and be placed with non-disabled students as much as possible. Due to the relatively mild nature of LD, this group of disabilities is most likely to be taught in a general education classroom with supports and services. With the push for inclusion of students with disabilities into general education classrooms, teachers are becoming more and more responsible for the total education of all students. In addition, according to this legislation, evaluations of every child referred for testing in the area of specific learning disabilities shall also include investigation into relevant behavior problems displayed during observation. This includes social skills difficulties (IDEA, 2004). Social skills deficits in children who are LD are used as a defining feature in most LD assessments. Haager & Vaughn (1995) estimated up to 75% of students with learning disabilities have social skills deficits.

The social skills difficulties of the LD student might also be linked to cognitive or language deficits (Benson, 2004). For example, using self-directed speech in problem solving or finding the appropriate strategy in problematic situations can be difficult for children with LD (Carlson, 1987). Social skills can determine success in academic attainment even more than intellectual ability. Impulse control problems, being off task, being unable to work independently, and engaging in negative peer interactions have been linked to academic and behavior problems in the classroom for children with LD (LaGreca & Stone, 1990; Sitlington, 1996). Students with LD and social skills deficits also report higher incidences for the need of special education services.

Needing more time to encode and produce language in the academic setting or acting out in an attempt to avoid language-based tasks are common characteristics of children with LD (Mellard & Hazel, 1992; Tur-Kaspa & Bryan, 1994). In most educational environments, these behaviors are seen as inappropriate. The student who takes longer to read in a group or has trouble learning a new vocabulary word can be isolated by teachers or shunned by peers, which can lead to misinterpretations of social skills ability. Children with LD have trouble with memory, processing, metalinguistics, reasoning, problem solving, and vocabulary. All these deficits can hinder a child's ability to adjust to behavioral demands and understand the unique dynamics of the classroom (Walker, Schwarz, Nippold, Irvin, & Noell, 1994).

Children with LD are more often placed in inclusive settings where delays in academic performance can trigger social difficulties. Teachers have been found to use a student's social skills performance to judge the quality of his or her academic tasks (Bryan, 1997; Cronin, 1996; Pavri & Luftig, 2000). A frequent complaint from teachers about students with LD is their lack of planning and their inability to identify sources of information (Carlson, 1987). This slow processing can frustrate the student, teacher, and peers, leading to less reinforcement and increased isolation. Pavri and Luftig state that middle school students with LD report more feelings of loneliness than their non-disabled peers. The classroom teacher puts demands on all students by making requests and commands for them to work independently or in cooperative groups. The students are expected to sit still, listen carefully, follow directions, and let their need for assistance be known. Students who are able to function on a behavioral level that is appropriate for the classroom setting are considered more teachable (Walker et al., 1994). Educators often also dismiss the need to teach social skills, stating it is something children learn from parents (Anderson, 2000). However, not addressing the social skills needs of children with LD in the classroom can lead to academic skill deficits as well as the need for therapeutic and psychological treatment (San Miguel et al., 1996).

In those with LD, poor peer relationships and a lack of social skills have also been linked to dropping out of school, juvenile delinquency, job termination, suicide, police contacts, and dishonorable discharges from the military (Bryan, 1997). Children and adults must display appropriate social skills to maintain relationships that will help them be independent and successful. Those who display inappropriate social behaviors are less appealing to their peers and have been found to have continual problems throughout life (Pavri & Luftig, 2000).

Social Skills in the Classroom

Social skills training and behavior management have long been a focus of concern in the classroom for students with severe emotional impairments. Social skills play a major role in how successful a child is in the classroom. Without adequate social competence, many students experience difficulty in learning environments. The classroom is a culture with specific procedures and rules. Being unable to complete tasks, comply with the rules, or engage in positive peer relations can add to the problems of children with severe emotional or behavior problems (Pavri & Luftig, 2000).

Social skills competence involves the ability to be able to recognize the various facets of social situations and behave accordingly (Goodwin, 1999). A student with severe impairments in social skills will exhibit behaviors that prevent learning. Children with LD might also have trouble with social development, but this can be lost in a focus on difficulties in academic skills. As noted earlier, children with LD frequently struggle with language reception and expression. Being able to ask clarifying questions, express the need for help on a task, or follow directions are social skills necessary for effective learning in the classroom (Bender & Wall, 1994; Mellard & Hazel, 1992). Furthermore, children with LD might have trouble making themselves understood, which can lead to negative interactions with teachers and peers that snowball into poor achievement and negative school experiences.

It has been suggested that the inability to process expressive or receptive language might be the underlying cause of social skills deficits in children with LD (Kavale & Forness, 1996). In receptive language this can manifest itself as difficulty in vocabulary, interpretation, or discrimination. Skills such as expressing ideas or opinions, understanding humor, or speaking in public can be difficult for children with LD (Turnbull et al., 2004). Their inability to use internal language is another area that is often addressed when children with LD have social skills deficits. This includes being able to use language to think, reason, or problem-solve. Teachers often note that children with LD do not think before they speak and are unable to use executive functions to control mental activities (Kavale & Forness). Teachers also consider social skills such as turn-taking, listening, managing conflict, and exercising ethics to be critical for academic success; many children with LD have difficulties in these areas (Kavale & Forness). Difficulties with language processes tend to create a host of social problems for children with LD, often complicating social communication with teachers and peers.

Assessing Social Skills

Comprehensive assessment is critical in obtaining the best intervention for children with LD who might display social skills deficits. Multi-disciplinary diagnostics are used to pinpoint the specific areas of difficulty (Lewandowski & Barlow, 2000). When students are referred for a possible learning disability, they are administered an individual intelligence test such as the Wechsler Intelligence Scale for Children (WISC) and various individual achievement tests to determine if there is a significant discrepancy between what they are capable of learning and what they are actually learning. This assessment step also helps limit and individualize the scope of the disability. Learning disabilities are heterogeneous, and various myths about the characteristics exist. Five children labeled with reading comprehension problems might have five different issues within the same area. In addition, because children with learning disabilities often do not have severe cognitive impairments, it is difficult to understand why they are not achieving academically, causing us to think that if they would just work harder in the classroom everything would change (Lewandowski & Barlow). Although the primary skills needed in the classroom are academic, a focus only on academic achievement can be destructive to the self-esteem of a child with LD.

Social skills deficits in children with LD are assessed during the multidisciplinary evaluation and Individual Education Plan (IEP) process. During the non-discriminatory evaluation process, it must be determined that the student's learning problems are not linked primarily to emotional/behavioral problems. Behavior rating scales, anecdotal records, and direct observation can measure and pinpoint social-skills issues that are causing or contributing to the academic or behavioral problems (Turnbull et al., 2004). Another necessary step in evaluating social-skills deficits is the Functional Assessment of Behavior (FAB). The FAB analyzes the antecedents to and consequences of a student's behavior in an effort to find out why the behavior is happening. The assumption of FAB is that behavior is functional and that the student engages in such behavior for a reason. Using interviews, questionnaires, and direct observation, the school counselor, social worker, and teacher can piece together the logic behind the social skills deficit (Alberto & Troutman, 2006).

Other empirically-based assessment tools are also available to evaluate social skills in students with learning disabilities. Tools such as the Social Skills Rating Scale (SSRS) or the Vineland Adaptive Behavior Scale can add validity and reliability to social-skill deficit identification. McClellan and Katz (1992) developed a checklist for social skills attributes that follows normal social development. The checklist includes questions about the student's individual attributes. For example, "the child is usually in a positive mood," or "the child displays the capacity for humor." Other sections of the checklist ask questions about specific social skill and peer relationship attributes, such as "is the student easily intimidated by bullies and is the student accepted or rejected by peers?" (McClellan & Katz). A combination of several types of assessment can be used to determine the skills deficits and what types of services are needed.

Social Skills Training and Intervention

Since most general education teachers are involved in the inclusion and mainstreaming of students with special needs into the curriculum, social skills training and intervention in the classroom often involves many of the same strategies used to teach academic skills. For children with LD, metacognitive and planning strategies such as alternative thinking, role-play, positive reinforcement, direct instruction, and coaching have been used in social skills intervention (Carter & Sugi, 1988; Conte, Andrews, Loomer, & Hutton, 1995). If the deficits are more severe the child with LD might be pulled out of the classroom by the school counselor or social worker for more specific social-skills training and psychological therapy (Conte et al.; San Miguel et al., 1996). However, school counselors and social workers might not have the time or experience to adequately intervene in the area of social skills or with children who display learning disabilities that present unique characteristics.

When a child's needs are not being met in the general education classroom, parents and teachers will seek out psychological support for problem behavior. These types of programs use psychotherapy to help the child understand and control behavior. However, many students do not display deficits severe enough for one-on-one therapy, yet they are not effective socially in the classroom (San Miguel et al., 1996). Additionally, in some cases the psychiatric comorbidity of ADHD or depression increases the need for special education support beyond classroom services. Lopez, Forness, MacMillan, Bocian, and Gresham (1996) examined the social skills of 60 children labeled LD. Forty-two of these children also had comorbid ADHD or another emotional impairment and displayed significantly lower social skills, classroom social behavior, and academic proficiency than those children who were just LD. However, there were no significant differences in IQ and achievement, indicating that there might be a psychosocial component that is not addressed through traditional academic interventions (Lopez et al.; Forness, 1988). These students must be taught how to make appropriate choices and to regulate social situations with planning, checking, and practice opportunities within the classroom setting.

Psychotherapeutic Approaches

Psychotherapy interventions have been widely researched as ways for treating children with emotional impairments and mental illnesses (Benson, 2004; Evans et al., 2005; Lam, 2003). Psychoeducation therapies specific to cognition and behavior often deal with self-management, anger management, and problem-solving skills (Benson). In individual sessions, the child's irrational thinking or inappropriate behavior is seen as an attempt to cope with the environment. Sharing and discussion in small groups or with a partner helps the child to construct meaning and make logical inferences as to why the behavior is occurring (Chrystal, 2005).

However, the one-on-one or group nature of psychotherapy might be counteractive to children with LD who might not be able to rely heavily on verbal counsel or talk therapy (Lewandowski & Barlow, 2000). Pulling the child out of the classroom setting might also hinder the social process. Further, due to the lack of resources for teachers and parents, it might not be feasible to engage a child with LD in one-on-one clinical settings (Conte et al., 1995). A child who has difficulty with receptive language might not benefit from psychoeducation techniques that try to help the student understand and control behavior (Lewandowski & Barlow). These interventions might also be too time consuming for the classroom teacher to establish a relationship with the student or to guide the student to understand how to cope with the environment. Instead, teachers need to be able to incorporate therapeutic strategies into the everyday classroom; various one-on-one therapies can be translated into classroom strategies. These need to focus on the individual psychological and learning needs of each student, which is necessary when working with a heterogeneous group such as those with LD.

It is first important to understand the specific area of social difficulty for each student with LD. Comprehensive assessment and observation should help identify the child's psychosocial weaknesses (Lewandowski & Barlow, 2000). Then, adapting psychoeducation therapies can help the teacher develop a relationship with each child and understand that the student's behavior might be an attempt to cope with academic frustrations. Therapies such as classroom counseling or irrational thinking logs (Appendix A) that help a child stop and think about behavior in a classroom setting can be useful. A classroom teacher might opt to have the child with expressive language problems draw a picture or act out the issue instead of writing a journal or going to counseling (Lewandowski & Barlow). Teachers in the classroom might also use group meetings, published curricula, or role-play for social-skills instruction. Long-standing techniques such as cooperative learning and group meetings have been shown to help teachers promote social skills in the classroom and holds strong principles in social and organizational psychology (Johnson & Johnson, 1994). The entire area of group work is based on the premise that social skills are the key to productivity and achievement in the classroom (Johnson & Johnson, 1991).

Lam (2003) describes applying a family therapy approach to children who might be acting out in class. According to Lam, parents and teachers have lost sight of their roles as social educators. However, by evaluating various relationships (understanding, trust, and authority) therapists can attend to the social needs of parent-child or teacher-child interactions. When applied to teacher-child relationships, through meetings and observations, the therapists can determine the answers to key questions: does the teacher understand the child's feelings, does the teacher show a willingness to relate to the child, does the teacher relate and show respect to the child, and does the teacher effectively model and coach appropriate behavior (Lam)? Such questions can be informational and therapeutic. Interventions can be determined from these discussions, and awareness and collaboration can be established to support the teacher in the classroom (Lam).

Basic Social Skills Training

Common teaching strategies used to help encourage and support the academic success of children with LD can also be used on a psychosocial level to address their social skills deficits in the classroom. Allowing more time to process information and understand the purpose of the behavior can often defuse difficult situations (Carter & Sugai, 1988). Examining the student's learning style can assist in narrowing the scope to see if the child with LD would respond better to one form of psychotherapy over another. Classroom counseling or classroom meetings use the basics of group cognitive therapy to help discuss the consequences of behavior, review what happened, and provide reinforcement in a naturalistic setting (McIntyre, 2005). Oden and Asher (1977) used modeling and role play to improve students' social competency. The three components of this coaching strategy are verbal explanations of social skills, opportunities to practice skills, and post-skill reviews. All three can be implemented in the daily activities of any classroom. A classroom teacher might choose to use social autopsies to help improve skills by addressing the social error and helping the child make better decisions.

When a child with LD displays a social error in the classroom, the social autopsy helps the student analyze and identify feelings and emotions involved in making the error (Lavoie, 1994). Graphic organizers such as behavior report cards or checklists posted throughout the classroom are visual supports for social skills (Lewandowski & Barlow, 2000). Mnemonics and rewards have been shown to reinforce social competence. Such strategies help reinforce what the teacher wants the student to do instead of pointing out what the student should not do (Carter & Sugai, 1988). Token rewards have been used effectively in residential settings for the emotionally disturbed, self-contained special-education classrooms, and general education settings (Bos & Vaughn, 2005; Buisson, Murdock, Reynolds, & Cronin, 1995; Wood & Flynn, 1978). These strategies can help the classroom teacher capitalize on the supports often already implemented in teaching academic skills to children with LD and transform them into social skills training tools (see Table 1).

Summary

Being socially incompetent can hinder the basic need of children to relate to others and interact appropriately in society. The need for social skills can be seen in every aspect of a child's life, especially in school. Teachers have access to the students in their classrooms and know that the mastery of social skills relates to academic success. However, children with LD have fewer opportunities to interact and share in experiences that can build social competence.

Bridging the gap between academic and therapeutic social skills training or behavior intervention can be done within the classroom setting. Teachers and parents do not always have the time or resources to seek and implement clinical intervention. Consequently; school counselors, therapists, and social workers must be able to provide services during the school day and support classroom teachers in recognizing the intertwining of learning and social skills. With collaboration, therapists can help teachers assess students' social deficits, select interventions or curricula, and measure the effects. For a list of resources see Appendix B.

Appendix A: Irrational Thinking Logs and Think Aloud

The Irrational Thinking Log (ITL) was developed by Albert Ellis (2002) as part of Rational Emotive Behavior Therapy (REBT) and cognitive behavior therapy. The ITL helps students take action and change any faulty thinking they might have about their behavior or situation. Changing how students think about their negative internal events or perceptions will positively change their behavior.

IRRATIONAL THINKING LOG

What happened (A)

What I thought (B)

What I did, how I felt (C)

Tell students: Each day when you become upset about something, use this as a cue to write in your log. Write down "A" and tell "What happened." Do not go into detail. Just give the facts. Next, write down "B" and what you thought about the event. This is not a description of the event (that takes place in A), but ask yourself "What was going on in my head when I first started feeling/acting as I did?" Finally, write down "C," this is where you write down how you felt in relation to the event or the consequence of your thinking this way. What you thought and how you felt are two different things.

Think-Aloud is a literacy strategy developed to help students monitor their comprehension and direct their thinking as they problem solve. Think-Aloud is a metacognitive awareness tool that uses teacher modeling to talk students through the thinking process. It has been used in a variety of content areas including social skills training. Think-Aloud uses basic classroom strategies to help students become aware of strategies and monitoring behaviors of good readers, but it can easily be implemented to teach social competency. Modeling, coached practice, and reflection are the main points of Think-Aloud (Oster, 2001).

Appendix B: Other Resources

Commercially available and online social skills programs www.psychoed.net

This website is designed for educators, child care workers, and mental health professionals who live and work with severely emotionally disturbed and behaviorally disordered children and youth. The strategies and approaches described might be particularly helpful to those who resist traditional interventions.

www.LDOnline.org

This site provides the leading information service in the field of learning disabilities. LD Online features thousands of helpful articles on learning disabilities and ADHD, monthly columns by noted experts in the field, a free and confidential question-and-answer service, active bulletin boards, and a Yellow Pages referral directory of professionals, schools, and products. LD Online is often the first destination for parents and educators seeking information on how to help children and adults with learning disabilities.

http://www.colorado.edu/cspv/blueprints/ model/programs/PATHS.html

The PATHS (Promoting Alternative Thinking Strategies) curriculum is a comprehensive program for promoting emotional and social competencies and reducing aggression and behavior problems in elementary school-aged children while simultaneously enhancing the educational process in the classroom. This innovative curriculum is designed to be used by educators and counselors in a multi-year, universal prevention model. Although primarily focused on the school and classroom settings, information and activities are also included for use with parents.

http://www.loveandlogic.com/Pages/0100about.html

This site provides training materials that teach the Love and Logic approach to raising children. This approach puts teachers and parents in control and teaches children to be responsible and prepares them for the real world. Love and Logic is easy to learn, changes lives, and raises responsible kids who are fun to be around.

www.behavioradvisor.com

This site offers thousands of tips on managing student behavior and provides step-by-step directions for implementing a great number of standard interventions. It also contains a bulletin board on which you can post your disciplinary concerns and receive suggestions from teachers around the world.

McGinnis, E., & Goldstein, A. P. (1997). Skillstreaming the elementary school child: New strategies and perspectives for teaching prosocial skills. Champaign, IL: Research Press. (Adolescent and early childhood versions also available-http://www.skillstreaming.com)

Spence, S. (1985). Social skills training with children and adolescents: A counselor's manual. Windsor, Berks, London: Nelson Publishing Company.

Walker, H. M. (1988). The Walker social skills curriculum: The ACCEPTS program. Austin, TX: ProEd.

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Erica Ruegg, EdD, is an assistant professor in special education at Oakland University in Rochester, Michigan. Her research interests include the development of social skills in children with learning disabilities and perceptions of children with disabilities.
Table 1: Basic Social Skill Training/
Intervention Tools

Modeling          Exposing students to appropriate behavior
                  by showing them "what to do." Examples
                  include video vignettes, cooperative
                  learning, and role-play.

Positive          Using steps and reinforcement to shape
Reinforcement/    the student toward a goal, increasing
Shaping           the chances of appropriate skill
                  development, and practice. Examples
                  include token systems, adult
                  attention, and preferred
                  activities.

Prompting         Giving hints or clues about displaying
and Coaching      appropriate behavior and purposely
                  guiding the student on
                  what to do and when to do it.

Rehearsal         Engaging in role-play or any activity that
and Practice      provides opportunities to perform and
                  repeat appropriate behaviors. Often follows
                  direct instruction or modeling and
                  includes positive feedback.

Literature        Commonly used in therapy sessions and
                  is an easy way to plan and implement
                  social-skills training into the
                  classroom. Literature can help teach
                  empathy, sensitivity, alternative
                  thinking, and problem solving.

Cognitive/        Help students explore how they think
Problem-Solving   and control their social skills by
Approaches        identifying interpersonal
                  problems, creating alternative solutions,
                  and evaluating the consequences.
                  Examples include psycho-educational
                  techniques such as Life Space Interviews
                  (Long, Wood, & Fecser, 2001), Love & Logic
                  be more socially competent in the classroom
                  can be done using the same techniques
                  used to teach academics. There are
                  (Fay & Funk, 1995), FAST (Freeze and think,
                  What is the problem; Alternatives,
                  what are the possible solutions; Solution
                  evaluation, choose the best one; Try it,
                  did it work?) (Bos & Vaughn, 1994).

Note: Teaching children to be more socially competent in
the classroom can be done using the same techniques used to teach
academics. There are a wide variety of effective exercises;
practitioners must choose a strategy (or strategies) that provides
direct instruction, opportunities for practice, and feedback.
These are some basic approaches for teaching appropriate behavior
and cognitive/problem-solving skills in the classroom.
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