By Daniel Ifrah, LCSW
Gaby’s body language was loud and clear that he had little interest sitting in my office, let alone chatting, this morning.
I already had been clued in that one of Gaby’s favorite pastime activities was chess. His face lit up at my unexpected offer- How about a game of chess, Gaby? I’m white –you can be black” …. Gaby had his pieces all set up to go in no time. I on the other hand take
my time- “ok I went -now go! . Hang on second let me finish my setup I said- – I heard Gaby blurt out can I change my last move, Pleassssssssee????
Mom had brought Gaby to my office looking for help with his social skills. Difficulty carrying on conversation, a lack of consideration for his siblings, and disrespect were just a few of the compelling reasons Mom felt it was time to seek professional help. “My son needs to learn to relate and interact with others, he’s getting older now…..
This plea from Gaby’s mom is something many of us can relate to.
We all value social skills. Think of how we teach our toddlers to be good people: “You cannot take her toy.” “Play nice.” “No biting.” We model the same behaviors to help them learn. For many children, that’s enough to help them grasp the paradox: To be successfully social, each individual must do his or her part. Yet to become successful individuals, we must put aside our individualism to become aware that we are all part of a whole.
As children reach middle school age, disparities in social skills grow more apparent. When parents see that their children are lagging behind socially, and are frustrated by their own attempts to effect change, they turn to a professional for help. Some days, I find so many requests for such training on my answering machine, you’d think I could just offer weekly etiquette classes and re-train them all in one swoop.
The irony is that while requests to address social skills deficits may sound the same, developing a treatment plan is anything but.
Re-teaching social skills rarely works
You recall taking that high school class in social skills, right? (Now was that before or right after math class?) Of course you don’t, because such a class didn’t exist. Most of us pick up social skills by osmosis. Even if your child is disruptive and isolated, you likely modeled and taught appropriate social behavior with the same reinforcement techniques that have been used since the beginning of time.
This is one case in which the age-old advice of “try, try again” may not be helpful. In fact, the most fundamental mistake that parents make (and, unfortunately at times, professionals as well) is assuming that their child’s social deficits can be repaired through social skills retraining.
For one thing, by the time a parent or a spouse comes to my office with significant social concerns about a loved one, re-teaching has most certainly been tried already. Secondly, if it was as easy as teaching the skill, then why did our socially unsavvy friend not learn in the same way others did?
No, our first step must be to explore what has caused him or her to lag so far behind that help is now sought.
Ask why your child needs this training
There is little point in attempting to repair something if we don’t truly understand what it is that is broken. That would be like fixing a flat tire by just filling it with air. We can hope our flat was just a fluke, but the outcome is rarely in our favor.
To help someone gain social skills, and the corresponding awareness needed to maintain them, we must first accurately identify the root problem.
Several different core issues may disrupt the normal development of social skills. The first step is to isolate that underlying issue and then assess if, in fact, that issue needs to be addressed directly in order to achieve the desired correction in skills.
Let’s take a closer look at two of the more common disorders that are often diagnosed at a young age. Attention Deficit Hyperactivity Disorder (ADHD) and anxiety can negatively impact social skills, each in its own way.
Accurate assessment is key to an effective treatment plan
I recently saw two 11-year-old boys whose parents reached out to me. While David and Gaby were both referred to me for social skills training, each case had its own unique presentation
Although David was a hardworking student with an A- average, he lagged far behind in the social arena. His peers called him a sore loser for the way he would storm off the playing field during class games, and peers were growing less welcoming in including him. The irony was that David was a sensitive and caring individual, who often put the needs of others before his own.
During my assessment, David exhibited perfectionist traits, which in turn pointed toward the possibility of an underlying anxiety. I suspected David’s was mild, but regardless of its intensity, his anxiety would directly impact situations where he perceived winning as the priority. Any hindrance to winning would trigger strong waves of anxiety, resulting in
David’s desire to avoid the game by walking off. As a result, David’s lack of exposure to group activities robbed him of group play experiences, resulting in what was perceived as a social skills deficit.
Gaby (remember him)? the oldest of three children, was fun-loving and active. He struggled to keep up in class and was often accused of being disrespectful to his teacher. He was also a frequent visitor to the principal’s office for getting into physical fights with his peers.
His mother was frustrated. “Gaby just doesn’t get it. He needs to learn that other people exist and that he’s not the only child alive. He grabs from others, has difficulty waiting his turn, and is often in his own world. When playing basketball, he always shoots the ball himself rather than strategically passing it off to other players. Sometimes Gaby puts his foot in his mouth, unaware of how his poor word choices impact others.
My assessment suggested that Gaby had ADHD. (Amazing what one can learn from a game of chess isn’t it?) But even treating ADHD has no one-size-fits-all solution.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) specifies that at least two different criteria must be in evidence when diagnosing ADHD. Inattention is first and foremost (Gaby’s mother said he was off in his own world). To prove the complexity of diagnosis, the DSM lists at least six different variations of inattentiveness, several being related to social situations. The second component of ADHD is impulsivity, or the disruption of the normal process of thinking before acting (Gaby grabs things from others, and in basketball, shoots without developing a passing strategy). Both inattentiveness and impulsivity were affecting Gaby’s performance in the social arena.
It stands to reason that an inability to pay attention could impair the natural process of observation and adaptation of social skills. Over a period of time, the child misses out on important signals and begins to run behind in skills others can pick up intuitively. Impulsivity, on the other hand, throws a wrench into whatever social skills the individual may have actually retained and practiced. Impulsive behaviors can cause the individual to act out suddenly without having the luxury of weighing the potential consequences of his actions. This happens on a neuro-processing level: the brain tends to ‘misfire’ action, and before you know it, the person acted upon a poor choice before having a chance to decide not to. This is can significantly impact one’s perceived social abilities.
With so many possible factors in play, even a diagnosis of ADHD does not provide enough information to inform treatment. In Gaby’s case, further assessment will be needed to determine the specific components of his ADHD and how they are impacting his lack of skills. Only then can a custom-designed treatment plan be drawn up, ensuring every component is properly addressed.
In both Gaby and David’s cases, simply re-teaching social skills would be, at best, a waste of time and money—or, even worse, may further discourage the individual when
the skills taught cannot be successfully implemented. It is interesting to note that both in David and Gaby’s cases, previous attempts were made to do just that—David in social skills groups, and Gaby with a social skills tutor. That neither met with success is not at all surprising given the complexities of their deficits.
Other root causes
In addition to anxiety and ADHD, undetected depression can contribute to social inhibition.
Perhaps the most concerning social deficit is one of an inherent nature. The individual simply lacks the social intuition to connect socially. This is an even more complex situation, requiring a thorough assessment to determine the nature of this disconnect. Is it of a rigid nature? Does he struggle with nonverbal social cues? Is there a language component? Social deficits caused by how the person is wired are quite complex and can be challenging to address. We will more specifically address autism and other spectrum disorders in future articles.
One size does not fit all
One thing is for certain: social skills deficits may look alike but can be caused by a variety of combined factors. If you care to meet with success, it is crucial to have a professional tease apart causative factors before any treatment plan is put in place.
The bad news is that those etiquette lessons will most probably be ineffective when trying to correct a social deficit.
But the good news is that there may be several appropriate treatment options. Accurately determining the root cause is crucial. The next step is formulating a customized treatment plan. With the correct treatment plan addressing the appropriate targets, I have seen many individuals who were previously unable to address their issues now succeed with flying colors.Posted on