215: Why will no-one play with me?

Hi, I'm Adrian in suburban Chicago land and this is Your Parenting Mojo with Jen Lumanlan. Jen is working on a series of episodes based on the challenges you are having with your child. From tooth brushing to sibling fighting, to the endless resistance to whatever you ask. Jen will look across all the evidence from thousands of scientific papers across a whole range of topics related to parenting and child development to help you see solutions to the issue you're facing that hadn't seen possible before. If you'd like a personalized answer to your challenge, just make a video if possible, or an audio clip if not, that's less than one minute long that describes what's happening and email it to support@YourParentingMojo.com and listen out for your episode soon.

Hello, and welcome to the Your Parenting Mojo podcast. Does your child express big emotions, especially when playing with others? Do they have a hard time knowing how to start playing with another child? Do their ways of communicating end up alienating other children? And maybe they've asked you, "Why will no one play with me?"

I've been looking deeper into various forms of neurodivergence over the last couple of years I've been focused on ADHD at the moment and at some point, a parent in the Parenting Membership recommended the book Why Will No One Play With Me by Caroline Maguire with Teresa Barker. I read it and appreciated a lot of the ideas in it but with some REALLY big caveats. So I want to tell you about the book, as well as some other tools like social stories. But firstly, I want to put it in the context of broader research on teaching social skills to children, and especially to neurodivergent children. As we go through all of this I'll use a critical lens to put the research and the book into the context of what I've learned over the last few years about neurodivergences like Autism and ADHD. I do understate that I'm not an EXPERT on either of these things, but I've come to shift my perspective on the value that ADHD and Autism can offer both the individuals who have these narrative urgencies, as well as our society more broadly. Rather than assuming that these narrow divergences represent only a deficit that needs to be corrected, so the person can live a more "normal" life, I've moved towards seeing them as qualities that are an inherent part of their experience. It's true that people with these qualities may struggle with aspects of life that we consider to be important, but that doesn't mean we should immediately embark on a project to 'fix' the deficits. Rather, I believe we should take an approach that helps the individual to address the deficits where they decide they want to address them. Embrace the aspects of these qualities that bring positive things to the individual's life into our society, and also adjust our society's expectations and support offered to these individuals, rather than seeing them as the one with the problem to be fixed.

A lot of the research on this topic is done with neurodivergent children and the research on teaching social skills to neurotypical children often finds a very tiny effect size, because a lot of children have already learned the skills and don't really benefit from the additional training. Caroline Maguire says the method she describes in Why Will No One Play With Me can be used with both neurodivergent and neurotypical children, so we're going to consider the ideas from that perspective.

So let's start by taking a look at the research which as a whole assumes the typical perspective of seeing people who lack social skills, taking 'undesirable trajectories' and programs intervening, "aim to avoid the onset and persistence of antisocial behavior and young people to prevent children from embarking on a life of crime." Most of the modern concepts of social skills training include behavioral skill components, so teaching children how to communicate verbally and nonverbally, as well as training in social, cognitive, and social emotional skills, which means thoughts about the self and others and emotional regulation and expression of emotions. These all build toward the idea of social competence, which are the interpersonal and communication abilities that lead to positive social interactions. The program's help children to recognize their own social interests, while considering the social rights of others. And this balance can vary depending on age, context and situation. It helps to build positive relationships with peers as well as coping with family and school problems. Another aim of these programs is to prevent externalizing behavior problems like aggression, delinquency, and violence, as well as internalizing problems like anxiety and depression. Early aggression in children and conduct problems are seen to be major risk factors for behavioral, mental health, and social problems in later life. So researchers are looking for ways to prevent these so called negative outcomes by training children when they're young.

Programs tend to incorporate up to 20 training sessions with groups of about 10 participants, targeting all children in a school or neighborhood selected children who are perceived to have an enhanced risk of negative outcomes (like those from poor single parent backgrounds), or children who have already demonstrated behavior problems.

Papers on social skills in neurodivergent children tend to open with a predictable description of how terrible life is going to be for these children who lack social skills. I'm gonna just read you some samples. "Shy and anxious children that are afraid of being laughed at by others are not fun playmates for their peers. These children may be excluded from activities may become more socially withdrawn, and may even become the target of bullying behavior by others. On the other end of the spectrum, are domineering, controlling children that become angry quickly unable to regulate their impulses and emotions. These children are not fun playmates for their peers either and may also be at risk for marginalization in the peer context. The two types of children described above behave in very different ways, but both have difficulty in conducting themselves appropriately in social interaction."

Alright, here's another one: "High negative sociometric nomination rates, [which is a fancy way of saying that other kids say they don't want to play with the child in question] may anticipate subsequent psychopathology. For example, boys with ADHD and their difficult relationships with their peers in childhood are associated with more criminality, depression, and substance use in adolescence than boys with ADHD but no social problems with their peers. In a sample of girls with ADHD rejection by peers in childhood significantly contributed to academic disappointment in adolescence, disruptive behavior and internalizing symptoms."

Alright, and here's the last one: "As early as preschool, children with Autism Spectrum Disorder and Disruptive Behavior Disorders [which is an umbrella diagnosis that describes children whose responses to authority figures range from indifference to hostility] demonstrate social skills deficits that distinguish them from their peers. By elementary school, children may have significant social relational problems. As they become older, adolescents become more aware of social difficulties when interacting with peers, which may lead to difficulty establishing and maintaining friendships, despite an increased desire to have friends. Due to the social skills deficits, many children and adolescents may be victims of bullying and rejection from peers, which may result in an increased risk of social isolation, depression and anxiety. The behaviors of social immaturity were identified as being clingy, preferring younger children, clumsy, and acting young. The peer rejection behaviors were being teased, not being liked, and inability to get along with others. Aggression was also identified as a common variable in children with pervasive developmental disorders and disruptive behavior disorders, which also leads to peer rejection."

All right, so we might listen to these descriptions and think: well, clearly, my kid whose social skills are lacking needs to learn some so these terrible outcomes don't happen to them. But in this episode, I want to complicate that approach a bit. I've mentioned before the I think there's a deep irony in seeing the neurodivergent child or the one whose social skills are lacking, as the one we have the problem and the thought processes and the behaviors that need to be fixed, less they become, "bullying victims". Many scientists think that Autistic kids lack Theory of Mind, which means the ability to see something from someone else's perspective. But it's the neurotypical kids who supposedly have this ability that are doing the bullying. And somehow the literature on this topic doesn't identify these people as the ones whose behavior should be changed. Instead, researchers assumed that if we could get the neurodivergent child to act more like the normal children, then the neurodivergent children would do better in school and in life. They would BE better. But what if that wasn't always the case?

I mentioned in my autism self-diagnosis episode that I did NOT understand social situations when I was a child, particularly in high school. I think it didn't help that my Mum died in my last year at primary school. And the year after that was kind of a blur for our family, I could almost certainly have gotten admitted to the local grammar school, which is 600 years old and feeds kids into elite universities. But that required an application process that we did not have the capacity to navigate that year so I ended up with a comprehensive that did not send kids anywhere. And I think kids figured out a lot about social systems in school in that year while I was cooking dinner for my family every night, and that plus the fact that I just couldn't even really see the systems to be able to understand them, just found that I felt completely lost, I would have really benefited from a caring adult or even appear, showing me how my behavior was perceived by others but at the same time, it would also have helped if others could have accepted me for who I was.

Almost all the research on teaching and children's social skills is on children with ADHD and/or Autism, and there is a huge amount of comorbidity with between 30 to 50% of Autistic people also showing ADHD symptoms, and about 2/3 of individuals with ADHD showing Autistic features, with occasional forays with the research kind of developing outside that field into supporting foster children, children with other diagnoses like Oppositional Defiant Disorder, who are the targets of bullying as well. Despite this co-morbidity being well known in the literature the vast majority of studies on social skills look at only Autistic children or children with ADHD. The research suggests that co-occurrence of ADHD and Autism "is associated with a lower quality of life and poor adaptive functioning than in either of these conditions alone," which of course means these children become adults that look at least like normal people, assuming that's the gold standard to meet. The majority of papers on this topic don't acknowledge the co-morbidity issue they recruit Autistic children, or those with ADHD, never considering the other diagnoses might be present and impacting the children's ability to learn and use the skills the researchers are trying to teach.

So the typical method for promoting social skills is to teach individual children the individual steps of a particular social skill using an instructor and student roleplay. Researchers have often seen that while this method may produce improvements in children's ability to demonstrate the target skill within the training environment, Autistic children particularly tend not to generalize the skills meaning they don't then go and use the skills on the playground or in new situations. A slightly less common method of skills training involves training peer children to interact with the participant child in specific ways. For example, by asking the participant child for a toy responding to the participant child's attempts to communicate and offering contingent reinforcement, which is basically a reward when the participant child produces a behavior that the researchers say is desirable and represents a social skill. Just in case it isn't crystal clear, I want to make sure you see that the peer children are not being trained on how to accept and include neurodivergent children, but basically as substitute researchers, teachers and parents who will attempt to modify the neurodivergent child's behavior.

A meta-analysis of studies using this peer trading method found that 91% of the 42 studies included in the analysis reported positive results. But there are some heavy caveats here. 91% of study of anything showing a positive outcome is pretty high, nevermind in this field, where the vast majority of meta-analyses actually find highly equivocal results with an average finding that the intervention has no statistically significant benefit. The 42 studies involved a total of 172 participants so each study is working with an average of four children. Many of the studies didn't include even basic information on treatment fidelity, which means whether the peer children were actually interacting with the participant children in a way that the researchers intended. It's pretty typical and researched today's for treatment fidelity to be high when researchers themselves deliver the training, because they're the ones who developed it and have a vested interest in seeing the study be successful and getting a peer reviewed paper out of it. Treatment fidelity usually declines when teachers are implementing the treatment, I'm sure you can imagine being in the teachers position whose primary role is to get the children to learn things that will be on standardized tests, and incorporate ideas based on whatever social and emotional learning approach is prioritized by the administration this month, often with minimal training or support, and all the other things they have going on in the classroom. Delivering a treatment program accurately to for participant children is just not going to be a priority and it doesn't seem like a stretch of the imagination to think that peer children delivering an intervention are going to do it with less fidelity than the researchers intended and perhaps this is why many of the studies don't report this measure. I was amused to see that the one study that did check for treatment fidelity, use token reinforcements of stickers or small toys with appear children, and they achieved an implementation accuracy of 80% or more. I wonder how that aspect of the intervention affected the peer child's behavior both during the intervention and beyond it. These studies assessed a wide variety of outcomes, including joint attention communication, maintaining interactions turn taking various academic outcomes and challenging behavior. The meta-analysis did not provide any information on whether the results were statistically significant. And I'd hypothesize the vast majority of the results were based on teacher report data and using any kind of observational reporting data where the person doing the reporting knows which child is in the intervention and which isn't is notoriously unreliable. It would be far better to have a blind rater who doesn't know which children will be in the intervention and which won't do an assessment of each child's skills before the intervention and then again afterward, but none of the studies had enough participants to do this and yield meaningful results.

The meta-analysis did look at the benefits and drawbacks of using peers from the peers perspective, and express concern that the peer children would spend less time learning in the classroom because they're spending time on the peer intervention. No study that I found observe the potential impact on the participant child associated with the possibility of selecting a child who's been bullying the participant child to perform the intervention. Since you will recall being Autistic or having ADHD often makes participant children targets for bullying by unspecified peers. A number of studies reported that peer children enjoyed participating in the intervention and we can perhaps imagine that being out of the classroom for an hour in a low stakes environment with a high likelihood of getting stickers at the end of it could well be an attractive way to spend your time. The meta-analysis as well as another study specifically on the effects of being a peer and this kind of research, expressed concern that peers' willingness to be involved in this kind of research tends to decline over the elementary school years, and hypothesized that the peers develop more negative attitudes towards autistic children over this time. One parent of one peer in one study commented favorably on what she described as the peers quote, growing concern for others, which makes us wonder whether we're targeting the right children in these interventions. What if we were to do interventions with peers, rather than with the neurodivergent kids?

I did find one remarkably robust study that actually aimed to do this, published by Dr. Connie Kasari at the Center for Autism Research and Education and her peers and I mentioned this because that center is housed at the University of California, Los Angeles, which is also where Applied Behavioral Analysis Therapy was developed, which many autistic adults who have experienced it describe as abusive. Dr. Kasari is also on the Science Advisory Board of the organization Autism Speaks, which many autistic people also don't appreciate because it spends much more on executive salaries than on helping autistic people. None of the people on his board of directors is identified as autistic, which means this is an organization of neurotypical people who use advertising to portray autism and Autistic people as mysterious and frightening and believe me, [I've seen some of these ads they're referenced in the in the episode page], and the families are these people as the saviors who will defeat autism for their children. And so I say all this just so that people who have strong opinions on Autism Speaks can go into this otherwise experimentally robust study with their eyes open. So it involves 60 autistic children, and 815, "typically developing children" and the autistic children were randomized into one of four treatment interventions, a social skills instruction program delivered by adults, a treatment where the child's peers were trained on how to interact with the autistic child but didn't attempt to change the autistic child's behavior in any way, both interventions or not either intervention, in the adult delivered program skills were taught that was specific to the autistic child's needs. So if they had trouble entering a handball game, the child was taught how to understand the rules and to the game gracefully wait in line, cheer on peers position, the hands hit the ball, run back to a good position on the court show good sportsmanship and return to the line went out. The study didn't say how these skills were selected but it would be unusual for researchers to ask the participating child what skill they want to work on, rather than the researcher identifying some kind of deficit, and then deciding to focus the training there.

The peer children in this study were trained on how to identify isolated children like those standing on the side of the yard instead of participating in a game, how to engage them like asking them to play in an ongoing game on the playground. Peers were taught to lend social support via direct instruction, modeling, role playing and rehearsal to any children in their class who might have social difficulties without specifically identifying the autistic child. The primary outcome measure was a common one used in these types of studies, the Social Network survey where children are asked whom they like to hang out with and whom they don't like to hang out with. And the research has developed a network diagram to identify which children have the most connections and which have the fewest. This study did also include a playground observation of the participant child on the playground, by a researcher who was blind to which condition the participant child was in, and looked at the percentage of time the child was alone rather than engaged in conversation or games with others. Overall, peer mediated interventions yielded greater movement toward more central roles in classroom social networks than the adult delivered interventions although both interventions together were even more effective. Children in the peer media mediated interventions received more friend nominations from all peers. Even those who were not peer models they were observed as less isolated on the playground at the end of treatment, and were rated by teachers as doing better socially in the classroom. The authors did note that reciprocal friendships remained low and stable for autistic children. The autistic children were more likely to be nominated as friends by the neurotypical children. But the autistic children didn't report having more friends themselves. This wasn't a primary goal of the study so perhaps the result isn't surprising, or it may indicate that the autistic children didn't recognize these friendship opportunities. I would add that some autistic people, myself included don't really have a goal of increasing our number of friendships. I have very few close friends and that's actually the way I like it. It takes a lot of energy for me to be present with a friend in the in depth way that I want to do it. And I don't have much interest in developing a lot of superficial friendships or in expending a lot of my energy, maintaining many deep friendships. This is an example of where a neurotypical researchers idea of what a goal should be, is quite different from the autistic child's idea of what a goal should be. The researcher assumes that all autistic children want more social connections and then designs a study to bring that about, instead of asking the child what are their goals and supporting them in reaching those goals.

Another issue in that study is that only the children who participated in the pyramid mediated groups decrease solitary playground play, and even having peers who consider them friends wasn't enough to improve all areas of child engagement on the playground. This means it may be necessary to conduct interventions on the playground itself to improve social interactions with peers. The researchers hypothesized that the participant children who are aged 6 to 11 were too young to advocate for themselves or too unaware of their own situation to make necessary changes to engage with their peers and my own experience corroborates this since I was pretty oblivious in primary school, and only started to recognize my difficulties in high school. I would have been pretty motivated to learn some new skills in high school, but probably not in the earlier years.

Another social skills training program is called Social Stories TM. The book the new social story book by Dr. Carol Gray contains a number of pre written social stories TM, and I'm not going to do the TM every time I just think is a bit obnoxious. It also offers guidance for parents or teachers on how to write a short story about a specific skill they want their child to learn. These are often used with autistic children who may not understand why other people do the things they do or say, unless the autistic child is explicitly taught this. And the stories are geared toward children in the elementary years. Here's an example of Story 110 from the book, which is called Please Hurry Up! Parents often say "Hurry up!" What might a parent be thinking at different times of the day? What might Hurry up mean? On a school day morning 'hurry up' may mean "I don't want you to be late" or "please move faster as you get ready for school." Once in a while. 'hurry up' may mean finishing an activity in another way like finishing a piece of toast in the car. instead of at the kitchen table. At home during free time, 'hurry up' may mean "Come now, it's time to leave an activity until later." Sometimes parents say 'hurry up,' knowing what 'hurry up' means may make it easier to follow their request. (End of story.)

So in the book, Dr. Gray specifically states that "the most common misconception is that the goal of a social story TM is to change a child's behavior. This has never been the case. The social story goal is to share accurate information meaningfully and safely. Admittedly, it is often a behavior that draws attention to a specific concept, skill or situation. However, if our objective is simply to change behavior, we are likely to focus on telling the child what to do. Chances are the child has been told what to do perhaps many times. Instead, our focus is on the underlying cause of frustration or misinformation. Story author's work to identify and share information that supports more effective responses. The theory is that the improvement in behavior that is frequently credited to a social story is the result of improved understanding of events and expectations." But what I hear in the Please Hurry Up social story is that the parent wants to change the child's behavior. They want the child to do what they're told when the parent uses this really ambiguous 'hurry up' language. Instead of supporting the parent in understanding why they're late and working on their end of the issue or even working to understand why moving on the parents schedule might be difficult for the child is just assume that the child isn't moving on the parents' schedule because the child doesn't understand what the parent means when the parent says 'hurry up.' Once the child understands the parents motivation, the child will of course be willing to modify their schedule and needs to accommodate the parentt, instead, the two of them could work together to understand what about the morning routine is hard for each of them, and how they could work together to make it easier.

The same goes for Story 111 on Permission, which describes adults giving or denying permission to children with no explanation of why they gave or denied it. The story concludes: "Permission is needed when a child has an idea and it's an adult's decision to make. Sometimes children get the permission they need. Other times they don't. Either way, that's life on planet Earth. As if permission is a universal and inexplicable as the laws of gravity. The entire concept of permission becomes a lot less relevant when both people know that we will work together to meet their needs most of the time, rather than the autistic child having to learn that the adult has some sort of power, which means they make all the decisions, and the child has to wait for those decisions and live by them whether or not they seem fair. I do think there are aspects of social stories that are useful particularly when the child is going into a situation over which both the child and the parent have very little control, such as in situations with other children where adults ability to control what other children say and do is understandably limited.

But the vast majority of social stories make a lot of judgments like Story 89, Three Gum Manners, that matter which says, "It's a good idea to keep the gum in my mouth until I am ready to throw it away. Sometimes a person may chew gum, take it out and chew it again over and over. This is a mistake. It's not a healthy idea. I will try to leave my gum in my mouth until I am finished chewing it," which has the judgments of this is a mistake. It's not a healthy idea. Is this not a story that's designed to change your child's behavior? If the child was to wash their hands before chewing gum each time, would it still be not a healthy idea to take it out and put it back in again? Most adults might not take the gum out of their mouth and put it back in but I'm sure most of us remembered doing this when we were children and we live to tell the tale. Most of us were probably told it over and over again not to do it as well and we just did it behind our parents backs. Maybe the main difference here is the autistic kid doesn't see why they have to hide it.

Terra Vance, who is an artistic psychologist And author rewrote some cartoons that look like social stories, although they don't seem to have been published by Dr. Gray so I guess they aren't official Social Stories TM. In the first one two children are playing a game that looks like what Americans call Chutes and Ladders which English people call Snakes and Ladders. A child with long hair has an upturned mouth that looks like a smile and is holding a card apparently toward a child off to the side whose open mouth is also upturned. This child is waving enthusiastically at the two who are playing and the child with shorter hair who is playing has a downturned mouth and is pointing at the board. The caption says, "I may want to talk to my friend when they are busy playing but I will wait until they are not playing any more then I will talk to them." So let's imagine that the primary lesson the author wants us to learn here is not appropriate punctuation, which there was way too much punctuation in that sentence if you see it on the page, or that social skills can be confusing when one child seems to be smiling at you and the other child isn't. Terra Vance's rewrite says, "Kids make room for other children when they are playing, but they don't seem to want to play with me. I do what other kids do and they are nice to the other kids but mean to me. The adults in my life don't talk about inclusion and neurodiversity and embracing differences. Instead, they tell me I'm being bullied because I don't have social skills."

Another one shows a child with long hair smiling sitting behind a desk. The child's hands aren't visible. There's a blank sheet of paper and three crayons on the desk. Next to the child, an older adult who appears to be a teacher holds a palette and a paintbrush with paint on it, and appears to be painting a picture on the wall. The printed caption says I will make good choices when I have something to say. I will keep my voice, hands and feet quiet if it's not my turn to talk. Terra Vance's rewrite says, "I fidget when I'm nervous or overwhelmed. It is called stimming and it keeps me from becoming too anxious. But I am being told that it is distracting. The more I make myself hold still, the less I'm able to focus. My teacher says I am making a good choice when I don't speak or move. I guess that means being invisible is better than learning the lessons."

Finally, there's a third cartoon showing two children painting at easels and an older adult standing nearby smiling. The provided caption says, "When I listen to my teachers and follow their rules, they feel happy with me. I feel happy too." Terra Vance's version says, "When I listen to teachers and don't seek clarification, I don't always understand the rules. When I ask questions, they seem annoyed. If I don't ask, I get it wrong and they say I wasn't listening. They think I'm not listening when I'm trying hard to understand. I get approval for pretending to understand and I'm supposed to also pretend to be happy when they cause so much anxiety." I hope this gives you an inkling of what it's like to be on the receiving end of these stories that are definitely not designed to change a child's behavior as they are experienced by those children.

So if you're thinking of using Social Stories, I would first ask yourself, what's your goal, and if your goal is to change the child's behavior, then this is not an appropriate tool to use. If you're trying to prepare your child for a new situation or environment, like a new classroom, a new teacher a new school, then social stories could be an appropriate tool, but make sure to use or write one that doesn't end up trying to change your child's behavior.

Alright, so as we start to transition toward the book, Why Will No One Play With Me, I want to look at the research on parent implementers since we know that treatment fidelity is often lower when the person delivering the intervention isn't a researcher. I found a PhD thesis on the effects of training for parents on behavior skills training steps found that parents were able to achieve a mastery of the material in just a few hours of training. Although their ability to get their child to adhere to the required steps was rather lower. Once again this study used typical neurotypical goals like increasing an autistic child's amount of eye contact rather than accepting the amount of eye contact the child is making already as the right amount which isn't surprising given the thesis was published as a paper in the Journal of Applied Behavior Analysis, and the goal of ABA is to change an autistic child's behavior not to meet the child's needs. The Children's lack of mastery may reflect this lack of understanding of why the child isn't making eye contact rather than the parents' inability to teach the child appropriately. This is corroborated by a study which focused on one autistic child named Matt. Matt's mother And sibling were trained to get Matt to make appropriate eye contact ask whether a conversation partner was bored or wanted to change the topic and to avoid topics of Matt's special interest. The sibling was included because the mother was legally blind and so couldn't see Matt's eye contact. Matt's brother was essentially training Matt not to use his coping strategies. There was a reason why he didn't make eye contact. Maybe that was because he was better able to focus on the speaker's words when he reduced the overwhelming overstimulation of eye contact.

After 13 one-hour sessions, max performance was "significantly improved," meaning he was making more eye contact. He would ask people if they wanted to change the conversational topic and he didn't talk about his special interest as much. The study included a rating scale where the mother said that she liked the procedures used, strongly agreed that the training was effective, and agreed that the training resulted in a meaningful change to her child's behavior, and strongly agreed she had a positive reaction to the training. The researchers didn't think to ask Matt what he thought of the training, or whether he felt frustrated that he couldn't talk about his special interest topics as often are whether he felt increased anxiety at the forced eye contact or not. Those factors were irrelevant, as long as Matt was producing the required behavior to be successful in social situations.

These four studies combined had a very slightly positive effect on children's social skills. But the parts of the studies that included parental training had no greater impact on children's skills than the parts that didn't. studies looking across the different types of ADHD tend to show much less behavioral change. Although this is likely partly because not all children with ADHD have social difficulties and the study authors don't always require participants to have social difficulties to participate, which limits the amount of improvement they can make. One of the most promising approaches I saw involved cooperative learning, which involves students working in small groups to reach shared objectives. There was an increase in the number of classmates who would choose to play with children with symptoms of ADHD in those who would like them as a teammate, and also a trend toward an increase in the number of their peers who would want a child with ADHD symptoms as a desk mate. Cooperative learning also promotes academic achievement and improves intergroup relationships with children from different backgrounds.

A meta analysis of eight studies where parents functioned as the trainers of their autistic children confirmed that parents can learn new strategies and use them with their children in natural environments to realize positive changes in children's social and communication skills. It concluded that "the next step needed to translate this research to parents is to develop and disseminate more parent friendly materials that describe these evidence-based intervention strategies in jargon-free language and that are readily available for parents to use with their young children." It's important to note that all of these studies involving parents included extensive support from the researchers who designed the intervention. I couldn't find any research at all indicating whether parents can effectively read about social skills training in a book and apply it to their children and the meta-analysis indicating this next step doesn't say how parents will maintain fidelity to the training protocols, rather than reacting in the same way that they do with timeout, which is to say they don't use it in the way researchers recommend, and then say it doesn't work. Caroline Maguire states that the skills taught in Why Will No One Play With Me can be used with any child who is struggling not just children with a diagnosis or a suspected diagnosis. The research on supporting children without diagnosis is even more thin with universal social skills programs aimed at general school populations, generating a score increase of about 13% on a social emotional program after a social skills training session, although this may mask the substantial benefit to a small number of families.

Okay, so let's turn now to the book Why Will No One Play With Me to see if we parents really can support our children in learning social skills. The first red flag for me when I picked up the book was that while the list of references runs a healthy 18 pages long, the individual ideas in the book are not referenced. So there's no way to tell whether a particular statement is based on the author's opinion or on a study and to me, that's a pretty important distinction. The book is specifically designed to be a reference guide for parents who want to use Maguire's ideas with their own children so I get that she wanted to make it approachable. But I don't think that's an excuse for not properly referencing the studies you rely on to build your thesis. You don't have to clutter the text with footnotes, or even little superscript numbers to provide references. You can just provide a section in the back of the book that states the chapter and the page number of the sentence that's supported by the reference and then give the reference. And that would give me much more confidence in the book. Most of the references provided are peer reviewed, but both What to Expect : The Toddler Years and 1,2,3 Magic made an appearance, which were concerning to me as not being peer reviewed, and also very focused on changing behavior rather than understanding why a child is behaving in a certain way.

The second thing that's challenging for me in the approach described in the book is that we don't really know whether her entire method is her own, or based on some of the studies she cites or some combination of them. I wouldn't mind so much if it was her own method if she stated that it builds on other people's methods but departs from them in these important ways with these important reasons, but we don't get that information. So Caroline Maguire says there are seven behavior Is that everyone needs to be socially successful. These are: 1. Managing emotions rather than letting them manage you. This means having coping techniques to respond to flooding emotions without becoming overwhelmed. 2. Reading the room-- What's the prevailing vibe or emotional tone of those present? Is it okay to interrupt a conversation or not? Do you need to adjust your energy level, tone, or expectations to match the setting? 3. Meet people halfway by introducing yourself starting a conversation answering a question or smiling and acknowledging someone else. 4. Understand social cues and unspoken rules and be ready to change your behavior in response to them by reading people's facial expressions, and body language and being aware of your own. 5. Learn to walk in someone else's shoes to take their perspective and understand their motives and reactions. 6. Be flexible and adaptive. Accept that you aren't always right. At times it's appropriate to place friendship or the larger group ahead of being right. Don't be argumentative. This includes knowing when to drop the debate and accept no for an answer. 7. Know your audience and adapt your communication to be appropriate. So for a 5 year old, this means filtering what's public and private information and not to "insulting teachers and friends by saying thoughtless things that hurt their feelings or ruffled feathers, like your dress makes you look fat." A 10 year old needs to be able to anticipate or predict what friends want to hear about what they find interesting and what they would like to talk about.

So I agree that these can all be important social skills and certainly I see several skills on the list that I struggled with as a child and still struggle with to some extent. But when we're only focused on what this child needs to learn to do differently, we're missing half the issue. We're only considering that the child who is deemed to have inadequate social skills has to do things to change. And we aren't considering the idea that we might be able to help the child. So yes, it's important to know how to manage emotions rather than letting them manage you. But emotions don't just come out of nowhere. Very often, anger comes from being treated in a way that we believe is unfair. So is just working on feeling less anger, the best strategy here? What about addressing whatever it was that created the anger? It might have been a sibling poking at them, or us saying 'no' to them, when there were ways we could have said 'yes'? But instead, all of the responsibility is put on the child to change how they're managing their emotions.

This theme follows in being flexible and adaptive. Certainly, some children can get hyper-fixated on following rules. But maybe that's because we have a lot of rules. And many rules are confusing. Connecting this to the idea of adapting communication -- we tell children is very important to be honest. But when they're actually honest and tell someone they don't like a gift that they were given, we tell them they're messing up. It's hard to learn when we actually mean be honest and when we really mean don't be honest, if it's going to hurt someone's feelings. The instruction that at times it's appropriate to place friendship or the larger group ahead of being right might be technically true but the really challenging part is when to do each of those things. Perhaps an autistic child might come down on the I'm right And you're wrong side of things and a neurotypical child might come down more on the I'm going to do what the group says even though it doesn't feel right to me, because nobody has modeled to me how I can set a boundary. But we don't tell the autistic child that sometimes it might be better if people came more of a toward their side.

Autistic people often have a very strong sense of what's right and wrong, and that's deemed to be okay as long as it matches with the parents sense of what's right and wrong. If the two don't match up, then it's assumed it's the autistic child's responsibility to drop the debate and know when to accept 'no' for an answer, rather than the parents' responsibility to consider why they're asking the child to do something or not do something and see if it might be possible to reconsider their request.

The core of Carolyn Maguire's "Play Better" approach, which is the actual social skills training component involves doing practice simulations, there are three elements to the simulation. Firstly, recalling a recent incident where the child has had a hard time and saying that when you see it happening again, you'll interrupt to do a practice together. So the parent is encouraged to say, "We're going to work together on this because I understand that you want to improve this situation and use your strategies, but sometimes you forget them when you feel overwhelmed." And then she guides the parent to interrupt with a pre-agreed cue, help them to pause to identify feelings, driving the behavior And coaching them through other ways to manage the emotional state. And then the parent is to say, "That's the deal."

And then you practice in everyday situations like sibling squabbles, not being able to stop a video game or "uncontrolled excitement that needs to dial down." When one of these happens, you cue the break, you ask open questions like "you seem to be having trouble calming down," or "I noticed you're getting upset." You ask questions like "how do you feel?" "what's going on in your body right now?" "how excited are you on a scale of 1-5?" and "what do you think you can do differently?" You draw connections between the child's feelings and their options for managing them in the moment by asking something like, "What is something you could do right now to calm yourself?"

Based on my reading of the research, as well as my work with thousands of parents over the years, I don't think it's likely the child is going to react well the first time the parent interrupts like this. While role plays outside of the stressful situation probably aren't very effective teaching methods by themselves, they might provide the child with enough context to know what to expect when the parent interrupts the actual stressful situation so they could be a good place to start. They may also help a child to identify a strategy that they can then try when the parent interrupts which they're unlikely to be able to do in the moment when they're already stressed out.

One of the more helpful ideas in Why Will No One Play With Me is the somewhat unfortunately named play better bridge to betterment, which applies the idea of change readiness to children's ability and willingness to learn new skills. If the child isn't ready, they're in the pre-contemplation stage. They have no intention to take action in the foreseeable future, and are likely unaware that their behavior is problematic. And of course, we can replace the phrase their behavior is problematic with they don't understand all the implications of their behavior. When they're getting ready to make change, they're in the contemplation stage. They have the beginning of an awareness that their behavior is problematic, and they start to look at the advantages and disadvantages of their actions. In the ready or preparation stage, they have awareness to take action in the immediate future, and may begin taking small steps toward behavior change. In the action stage, they're taking specific actions to modify their problem behavior or acquire new 'healthy behaviors.' In the maintenance stage, they can sustain the 'new healthy behavior' for at least six months and work to prevent relapse.

I think this idea is helpful because it allows us to see that making big changes is not at all simple from the child's perspective. If I think back to my self diagnosis episode, when I started at a new high school, the drama teacher divided up a class and asked us to perform short plays and then critique each other's plays. And I didn't know that it wasn't socially acceptable for us to actually offer it meaningful critiques of each other's plays and especially not for the new kid to do that. I was on the pre-contemplation stage and a supportive adult could have helped me to access the contemplation stage, where I could see what impact my actions were having. I think an important idea that is missing from the Play Better Bridge to Betterment model is the idea that you might choose not to do anything. So if a parent or teacher had said to me,"Hey, when you're the new kid, and all the other kids aren't speaking up, then you might want to consider not speaking up, even when the teacher is asking you to do it," then I would have been in the contemplation stage. At that point, I might have chosen the preparation stage and asked for help learning new skills. Or I might have said, I don't really care what the other kids think of me right now I'm going to do what I want. And that would have been okay. It would have been my choice and not one that an adult was forcing me to make simply because I had moved into the contemplation stage.

I was pretty amused to see that one of the key tools that Maguire describes for adults to use is very similar to the problem solving approach we use here. It involves approaching the child outside the difficult interactions using open ended questions to understand the child's thoughts and feelings, clarifying concerns, and expressing empathy and then as we might expect, in a culture where we don't understand how important needs are, we jumped right over those two brainstorming solutions to the problem. It's likely that the solutions we brainstorm won't actually meet the child's needs since we don't understand what these are. And we also don't know what are the needs of the other person involved in the situation we're working on.

In place of this understanding of needs is a reward and incentive structure because "incentives and rewards make hard work more fun. They add to a child's sense of purpose and their motivation to keep working deepening the lessons learned." Maguire advises parents to set the reward for positive behavior beforehand and define the criteria the child must meet to get the reward. For example, computer time might be a reward for participating during in home coaching sessions. We've already talked about rewards using social skills training programs. I've also covered the topic extensively in other episodes, including my conversation with Alfie Kohn so I'm not going to go into that too deeply here. But I do want to point out a couple of things. Firstly, the research from the old episode on How do I get my child to eat vegetables? which found that rewarding children for eating their vegetables by offering dessert only made them like dessert more and like vegetables less. And the only predictor of how many vegetables a child ate was how much they liked vegetables. So if we can extrapolate this to children's behavior and other situations, we can imagine how rewarding children for producing the correct behavior could make them less likely to want to do it. And only more likely to do it when they know they're being watched. And likely to get the reward.

The other issue is related to a combination of consent and power. When the parent decides what behavior matches the expectations that the parent sets, and when the child produces the required behavior, the parent offers the reward that puts the parent in a position of power over the child, which ideally isn't where I want to be in a relationship with a child. Maguire says we should choose behaviors the child cares most about to reward which provides a built in incentive. But if we're rewarding behavior the child already cares about changing, why do we need to reward them for doing it?

Maguire also draws on Dr. Carol Dweck's growth mindset work when she instructs parents to tell children that there is an icon mindset and a possibilities mindset. When we give up easily or won't try new things we're in a current mindset. And when we try a little harder to overcome an obstacle or keep an open mind about new things, we're in a possibilities mindset. For me, this gets to the heart of the challenges with teaching social skills, because it locates the problem entirely in the child who's deemed to have the lagging social skills. We know autistic children, children with ADHD are bullied at a much higher rate than their so called neurotypical peers. So why is this issue the autistic child or the child with ADHD is problem to fix? Yes, if a child who is struggling with social skills always says that things won't work out, or they can't do something, then moving toward a growth mindset could potentially help. But if this isn't equally matched by the child's peers, being willing to consider this child as a playmate and welcoming them into a group, rather than putting this child down in an effort to improve their own social standing, then this child's efforts are not going to go very far.

The book concludes with what I think are likely to be very helpful exercises to do things like going to a public place, and working to understand people's thoughts and feelings based on their behavior, as well as the unspoken rules about interacting in different situations. But it also has an impressions you create in the world exercise, which lists behaviors that might alienate people, including showing a negative, scary face and scowl speaking with a sharp, cranky tone of voice, telling someone they are wrong all the time, holding up my hand, and telling someone to shush and ignoring unspoken rules. When we say our child shouldn't do things like this because it will alienate people, we're essentially teaching them to mask their real thoughts and feelings. Maybe it's actually the other children's and even the teacher's job to understand that a face can't be "negative" or "scary." And that perhaps this expression just means I'm not fully awake yet, and I need more time before I can greet you. Maybe a child talking in a sharp, cranky tone of voice is having trouble managing a lot of sensory input. And if we've ever said something to our partner in an inappropriate tone when we were feeling overwhelmed, we might have some sympathy for this. Maybe there's a classroom rule about not talking and our child follows the rules, but they don't like it when other children whisper in class. Perhaps the teacher tolerates this whispering in our child gets upset and tells the other children they're wrong and holds up their hands to shush them because other children are "breaking the rules." Now it's our child who's perceived as the problem not the other children who are really breaking misstated rule because our child doesn't know that there's an unspoken rule that actually a bit of whispering is okay as long as it stops when the teacher says it has to stop. Perhaps our child focuses on one specific thing very intently and the whispering pulls their focus away and makes it very difficult for them to refocus. But nobody realizes this because the problem is with our child and not with the other children's behavior. The same goes for characteristics of inflexible behavior, like: getting stubborn when things are not what you want; campaigning to get your way; arguing with everyone; feeling rules are absolute and unbending.

We're supposed to try to get the child to be more flexible because a child who acts like the real police alienates her peers. It takes a lot of time and practice for neurotypical children to learn that come and ask an adult if you're having a hard time with a friend doesn't actually mean that it means try and handle it by yourself because if you come to me too often, we'll call you a tattletale. And this can be an even more difficult lesson to learn for neurodivergent children because it's an unspoken rule. We say come and tell me but we don't really mean it. It seems to me the real problem here is not with the child to whom we're trying to teach social skills but the top down methods of control where a person in charge says how things are going to be when often there's no real reason for it other than that person's convenience. And then we expect children to easily figure out whether and when and how much they can depart from the stated rules by themselves instead of just, you guessed it, understanding each person's needs and working to meet both of their needs.

Maguire picks up some of the same challenges with the Social Stories when she provides instruction on how to be a good listener which involves things like having your eyes on the speaker, having quiet hands, having your shoulders and body squared toward the speaker. There's no recognition that for some people eye contact can feel overwhelming that they can pay attention much more effectively when they don't have to make eye contact. For people who are sensory seekers playing with a fidget spinner bouncing on a ball, maybe even with their shoulders and body not pointed directly at the speaker could allow them to get enough sensory input that they can focus on the speaker's words. But these aren't options here.

The problems continue when our job is to instruct a child on how to tell a concise story rather than "monologue dominate conversations or tell stories that never seem to end." This assumes there's a single right way to tell a story--an example story is provided about a trip to Washington DC, it's nine lines long and it ends: "I counted 50 trees near the Vietnam War Memorial on that big open green space, well, maybe 50--I lost count several times--that's two of the nine lines. So the whole thing is not very long and our child's task is to figure out what details to remove to make it a "tight" story, which means one that conveys what the story is about, why they're telling the story, and who they're telling it to. Yes, we might argue that if we were submitting this story for an essay writing competition, we might coach the author they don't need to tell us they lost track of counting. But with a child telling a story this to me reads like infectious enthusiasm.

We could imagine this is just a bad example, because the story is only nine lines long. Some autistic children do what's called monologuing, which is the opposite of how most neurotypical children learn to talk. A neurotypical child will usually learn single words And then how to use them And then start combining two words And phrases And sentences. Some autistic children can recite entire movie scripts before they can use single words. They might break these entire scripts down into chunks, and then individual lines, and then start using individual words in increasingly accurate contexts. They might say a line from a script that makes no sense in the context of a conversation you're having with them. But once you consider the context of the film, they're conveying something about what the character in the film was experiencing when they said the line and then you understand what they mean. It's a different way of learning language and it's just as valid as the way neurotypical children learn language, if we adults can get our heads around it. So that processing is called kind of Gestalt processing and then monologuing is when children tend to recite the whole script or large chunks of information about their topic of special interest. But if we think back to the autistic child, Matt from earlier in this episode, our goal isn't to understand why the child is talking so much about one topic is just to stop them from doing it.

The other problem with the 'concise' story is it assumes the way stories are told in school, which is the way that White families tell stories is the right way to tell stories. You might possibly remember my episode on socialization from the beginning of the pandemic, when we were really worried about what schools being closed might mean for children's socialization. And I started thinking a lot about what we socialized children into in schools and it turns out there's research indicating that school is a place where ideas about what constitutes good communication are conveyed. And that it's primarily the ways that narrative of White families communicate that are prioritized. I'm thinking of Dr. Shirley Bryce Heath and Dr. James Paul Gee's detailed descriptions of how some Black families communicate, and their reasons for using these communication patterns which may be very different from a white family's goals. Almost 80% of school teachers are White and White ways of communicating like using short, concise stories are considered much more valuable in school than telling a more meandering story or a story where the listener has to try to figure out the point, rather than being told directly.

There are some really redeeming ideas in the book for a child who never joins in with play because they don't know how to engage, Maguire recommends having a go to strategy for when a child freezes in a play situation. Example child Wilson And his mother decided that if Wilson felt uncomfortable on a play date, he would suggest they play outside. If he felt physically uncomfortable, he would suggest they play an active game like soccer, which would help him release some stress and self-regulate. He memorized some things to talk about a popular movie and an upcoming school event and he worked on understanding other children's interests. If he could uncover these and build on the conversation, then they would talk about that. And if they weren't interested, he'd have the backup plan of the movie and the school event. And this is basically what I figured out for myself over a lot of years of trial And error. And ironically, the book notes that most people like to talk about themselves--and most neurotypical people do like to do this...but somehow it's a problem when neurodivergent people do it. I figured out that most neurotypical people will like another person who lets them talk about themselves so that's essentially what I do. I don't look to share much of what I do and think and instead just try to keep them talking. And as far as I can tell, it works pretty well. It's also a strategy my daughter uses although she isn't diagnosed with linear divergent, she often has has a hard time entering play situations with children she doesn't know well. We've talked about strategies you can use like offering to help a child with a project they're working on which she has used effectively. Recently, she was about to meet three siblings for the first time in a year. And she hadn't spent that long with them the last time we met them, the parent was kind enough to ask what we could do to support Carys starting to play and Carys's own suggestion was that they offer a game that they could all do together that didn't have many rules. We got out of the car at their house to find them all waiting for her on the front lawn and they invited her to jump on the trampoline. She agreed, and in five minutes, she was integrated into the group. So this is the action phase of the Bridge to Betterment in action, as it were. And she decided that she was ready to do something other than be snuggled up to me for an hour and we went into the new situation, and she said what would help her.

Crucially, it was the other children who agreed to her request for a specific type of play, which made the whole thing successful. If they'd refused, her attempt to be in the action step would have been wasted. I didn't assume that she had a social skills deficit, she and I and the other parent and children work together to support all of the children in playing together.

And this brings me to the final point that I want to make about all of this social skills training. It is one that I've been alluding to throughout the episode, but I wanted to be really clear before we leave each other for the day. Well, all of the recent studies on this topic adhere to institutional review board guidelines, and many of them specifically request consent from the participating children and not only their parents to be involved in the study is not at all clear to me that children are actually consenting to the specific intervention. So they might consent to participate in a study on social skills but my guess is the researchers never asked the children what skills they want to work on and focus on that. They never give the children the option to opt out, rather than working on skills that don't interest them. It's always the adult who makes that decision because if the child was really interested in learning the skill, they wouldn't need to be rewarded for doing it and punished when they don't do it.

In Why Will No One Play With Me? the parent says I've noticed you need these skills, and I'm going to help you get them. And there's no space for the child to decide whether they want to participate or not. Over the past few months, we've been offering entry level, medium and advanced practices to start engaging with the ideas in the episode. And I don't think that's so relevant here. Instead, I want to offer some general guidance for anyone who sees that your child might be struggling in social situations, I see your first role as helping the child get from the pre contemplation to the contemplation stage. So the child has an awareness of the effect of their words and actions. If they don't already do that. And then wait, and listen and see if the child has any interest in changing their behavior, but doesn't know how to do it. And then you move on. From there, you can ask what skills the child thinks they're lacking and wants to change and support them in doing that. And then you can roleplay and interrupt difficult situations and offer the strategies the child thinks will be helpful. And you can also look at your role in the situation and whether your expectations are inappropriate, or whether the thing actually has to be done at all or in the way that you've been asking for it to be done. And adjust your perspective if needed so both your need and your child's need can be met.

When we work on the child's goals rather than our goals for them, we reduce the risk that they will mask their feelings to match our wishes. In the autistic circles I'm in people generally seem to see that masking and non-acceptance by peers, teachers and family members unless they mask effectively is a far greater source of their pain and ongoing difficulties than the lack of social skills we were trying to get them to learn in the first place. Any gain and social skills is going to be exceeded by a loss of trust between us and our child if we don't make sure we have our child's consent by doing these methods to them. Rather than doing these methods with them. And the whole time, we should keep our eyes firmly on the benefits that neurodivergence brings for our children and for our families if this is at play. Autistic people can have incredible focus and memory. We may think logically and learn quickly. We're often honest and loyal and reliable. We can excel in academic and technical and logical subjects that don't require heavy social interaction. We often have amazing attention to detail, observational skills, and pattern recognition. We have a strong sense of justice and we dive amazingly deeply into our special interests, which might end up benefiting you when we tell you about them.

People with ADHD are often highly creative. They have abundant ideas. They're solution oriented, they can act quickly in emergency. They can focus on a single task for hours as long as they find it interesting blocking out all distractions. They may have a high degree of curiosity and not be afraid to question the status quo. They're often more willing to try new ideas rather than getting stuck in habits that don't serve them. They have a lot of energy and can channel that energy into courageous activities that offer challenges. If your child is what we currently describe as neurotypical, even though such a thing may not exist, they have all kinds of valuable qualities we should nurture and appreciate, instead of focusing so much time and energy on areas where they struggle, until they decide they're ready to change something. Even when the child has learned the skills, there may be days or communities they're in where they say, I don't want to mask who I am, I want to be myself. I don't care if that means I don't measure up. And that's also okay. We can support our children like my friend did when she asked me what would help Carys to integrate with our kids, and they proposed an activity she enjoyed, rather than requiring her to do all the work of figuring out how to integrate.

Whether or not your child identifies as neurodivergent I hope this episode has given you some insight into the ways that you can support them in learning social skills, if and when your child decides they're ready.

If you'd like Jen to address the challenge you're having in parenting, just email your one minute video or audio clip to support@YourParentingMojo.com and listen out for your episode soon.