Understanding social skill needs in children and adolescents who present with ADHD, Learning Disabilities, Aspergers and High-functioning autism spectrum diagnoses.

1. The pyramid to Success for Students with Social Skill Needs by
Ryan Wexelblatt, M.S.S.
I have had the privilege of working with many families who have a child that presents with social skill needs through my
work. Often, they share similar stories about the incredible time and energy invested in meeting with different professionals
and attending a variety of programs hoping that “this one” will be the solution to their child's social skill needs.
There are several common statements I hear regularly from parents during our initial conversation:
 I was hoping he would grow out of this as he got older.
 We sent him to a mainstream (school) hoping that he would learn from children who had better social skills. That
backfired and instead he was teased and excluded.
 We attended a social skills group however our child was the role model for the group and wasn't challenged.
 We’ve been to various therapists (and/or) behavior analysts for years but that did not seem to help with his social
skills.
 Our son is great with adults and with younger children but can't form connections with kids his age.
 He does great in school academically but has no friends outside of
school.
If a child is sick we take them to a pediatrician, if they are struggling with math we find a tutor, and if they are anxious we use
the services of a mental health professional. But it is far less clear where to seek help if the child is struggling socially. We also
have to consider where social skill needs fall in terms of priority when your child has so many other issues to deal with.
In order to answer this question, I created a pyramid model to help parents understand what I believe is the course of action
necessary to help their children improve socially while prioritizing and addressing their other needs. Starting with the base I

2. will explain why each section is located where it is on the pyramid and I will address what I find as the most effective ways to
address each level.
Mental Health Needs
Many children who struggle socially typically have neurological profiles that include ADHD, Asperger’s syndrome, autism
spectrum diagnoses, and learning differences. Each of these neuro-developmental profiles can impact social cognition (the
ability to think in a social context and apply skills relevant to the situation) and impair the child’s ability to think quickly in social
situations. Symptoms commonly associated with these diagnoses include impulsivity, anxiety, depression, and
inattentiveness. The vast majority of the students I've worked with take medications to help with these symptoms. Before we
can address any other issues, it is a necessity to address mental health needs. Symptoms related to mental health issues can be
a roadblock to learning due to their often debilitating nature. However, I will be the first to acknowledge that it can be difficult
to find a child & adolescent psychiatrist. If parents have trouble finding a psychiatrist, I would suggest contacting a
developmental pediatrician in their area and asking for a referral. Developmental pediatricians often diagnose ADHD,
Asperger's disorder and autism spectrum diagnoses and can be a knowledgeable resource for psychiatrists in your area.
Individual and family therapy is often a part of a holistic mental health treatment approach. This is often another component of
treatment that can be difficult. It is most important to find a therapist who you feel is a good match for you and your family.
I believe that it is critical to work with a therapist who specializes in treating children who have significant experience working
with your child’s diagnostic profile. In order for the treatment to be effective it should include parental involvement and not
just individual therapy with the child and clinician. I find that therapists who are trained in cognitive-behavioral therapy can
offer a structured treatment model that produces results. While it can sometimes be therapeutic to just have a place "vent," I
believe a more concrete approach is more effective for addressing the symptoms discussed above.
Though many parents seek therapy to address their child’s social skill needs, it is important to note that there is no formal
training in higher education programs to teach social thinking skill instruction. A professional (therapist or other) must seek out
their own training if they want to address these needs. By no means do I mean to discredit the important work done by mental
health professionals, however I do believe that social skill needs should be addressed separately than mental health needs. You
would not go to a podiatrist if you had a toothache and would not go to a dentist if you were having problems with your
feet. Similarly, mental health and social skills are separate and should be treated as such. While the term “social skills” is used
here, what really needs to be addressed are not social skills but social thinking skills.
Social Thinking Skills and Language
Skills
It is important to define the term "social thinking skills" and explain the difference between social skills and social thinking
skills. The term “social thinking skills” is a more user friendly way of explaining social cognition. Social cognition is the ability to
think in a social context which helps evaluate a situation and behave in a way that will make others have positive thoughts
about us. Social cognition and learning to think in a social context is the basis for The Social Thinking framework I have used
successfully in my work. This framework was created by Michelle Garcia Winner, a speech language pathologist.. You can read
more about this approach on the Social Thinking website. Traditional approaches to teaching social skills focus on rote
memorization of appropriate “surface skills,” or memorizing social scripts while the Social Thinking approach addresses social
thinking deficits at their foundation and then builds relevant skills. You can read about these foundation level skills in this article
about the ILAUGH model of social cognition.
The reason that social thinking skills are next on the pyramid is because of their importance to finding success in school, in peer
groups and in the workplace. The example I use when I present to parent groups is to ask the group how many people have
built successful careers and fulfilling lives yet do not have strong educational backgrounds. The reason people are able to do
this has much to do with their strong level of social cognition. I then ask how many highly intelligent people have they met who
lack good social skills (many hands go up at this point) and point out that successful people who lack good social skills are
typically in a field where there is a high demand for their skill set (doctors, engineers, etc..) It is very difficult to be successful in
life without strong social thinking skills. Underdeveloped social thinking skills can impede academics, the ability to be part of a
group and the ability to maintain employment. I believe it’s important to point out that social skill needs which are really
deficits in social thinking skills are a learning issue, not a mental health issue. Granted mental health issues can impede the
development of social thinking skills and social thinking skill deficits can most certainly contribute to depression, anxiety and
isolation.
So who should be addressing social thinking skill needs? In a perfect world this would be a holistic approach in which these
needs and addressed comprehensively in school (the place where kids spend the most time with same age peers), at home and

3. possibly with the support of someone who has training in teaching social thinking skills. The challenge here is that at this point
in time few people have the background to teach these skills. In my work I find that the professionals most tuned into this work
are speech language pathologists, special education teachers and some people like myself who have a clinical background yet
chose to focus on this newly emerging field. You can contact the American Speech Language Hearing Association to find
speech language pathologists in your area who are familiar with this approach. You can also ask your child’s
school if they use this approach in school.
Some children, particularly those who have a high-functioning autism spectrum diagnosis present with expressive and/or
receptive language needs. These include the use of pragmatic/social language which are critical to be addressed. Most
children who present with these needs receive speech language services through their school system as part of their IEP. Some
children receive speech language therapy in outpatient settings. Language skills sometimes need to be addressed as a
separate entity from social thinking skills despite the fact there is a strong connection between the two.
Independent Skills and Executive Functioning Skills
Many children who struggle with social thinking skills also have not developed age-appropriate independent skills. Whether
this is due to their issues with executive functioning skills, self-confidence, level of maturity or in some cases having parents
who are doing more for their child than they should at their age it is essential to develop an age-appropriate level of
independence. I define independent skills as the life skills that are necessary to develop autonomy that will enable one to
manage tasks that are expected of someone their age. Most public school settings focus on teaching these skills only to
students with significant learning issues while students who may be in mainstream education for all or a portion of their day
often do not have training in these skills. The good news is that we can teach these critical skills at home and will the help of
professionals such as occupational therapists, home based therapists and other professionals who work with children outside of
the school setting.
Executive functioning skills is an umbrella term to describe the cognitive processes that involve planning, organizing, problem
solving, play skills and much more. I am not an expert in this incredibly important field that many of our kids struggle with and
believe it is best to be addressed by a professional who has a comprehensive understanding of this area. Occupational therapy
is typically the field people turn to in order to address executive functioning needs however there are a growing number of
professionals who come from a variety of backgrounds that are able to address these needs. An online search or contacting
advocacy organizations for people with ADHD, or Asperger’s syndrome may help you to find a professional who specializes in
working on executive functioning skills.
Academic Skills
Ironically the top of the pyramid is the one that many parents believe is the most important component to ensure success for
their child. Parents often begin their initial phone call with me by sharing how smart their child is yet how much they struggle
socially. I find that parents often are confused as to why their child is who is bright and academically capable can struggle
socially. I explain that there is very little crossover between academic ability and social thinking skills. So why are academic
skills at the top of the pyramid? Let me phrase this as a question-What becomes of a highly intelligent individual who lacks
sufficient mental health treatment, social thinking skills, independent skills, executive functioning skills or a combination of
these? In my experience I find that upon reaching young adulthood many of these individuals (many of whom successfully
completed college) often live at home well into adulthood and are either underemployed or unemployed or frequently change
jobs. While this may seem like a worst case scenario I believe it’s much more common that most people realize. There are
many very bright, academically prepared young adults who struggle in the adult world due to a lifetime of focus on their
academic skills while the other levels of the pyramid were not addressed effectively or in some cases ever
addressed. Academic skills can only take one so far in life, they in no way guarantee a successful future. Some kids also need
to develop a level of internal motivation before they are able to focus on their academics which comes with maturity and an
ability to look forward to their future.
While the intention with this article was to clearly spell out what needs to take precedence in order to help kids who struggle
socially get on a path to success I can imagine that it could also produce anxiety knowing that there may need to be more
professionals involved in your child’s life to help them move towards success. Parents often ask me if it’s possible and more
importantly realistic to address all of the levels of the pyramid at once. I have several concise answers:
1. It is possible to address all these levels of the pyramid at once without going bankruptcy or over scheduling your child. The first
step is to assess what supports your child is currently receiving and if they address a specific level of the pyramid. Ideally the
more services your child can receive in school the better but schools can only do so much in a day. Keep in mind that most of
the supports that are offered outside of the school setting occur once a week for an hour typically.

4. 2. Evaluate how your child spends their time outside of school. If they are involved in extra-curricular activities they enjoy I
always suggest to parents to not take these activities away. Being connected to a peer group is important however I believe it’s
important to acknowledge that in regards to developing social thinking skills simply being around peers who present with more
developed social skills will most likely not help your child to improve in this area. They need to receive instruction by a
professional who is able to help them develop these skills. The good news is that you can develop social thinking skills at any
age however social expectations become greater as children get older so waiting to address the social learning piece may have
ramifications if it is put off too long.
3. Independent skills are a great way to connect with your child at home if they’re willing to learn from you. Many parents
(including myself) find that their children are more receptive to learning these skills from other adults. I recommend to parents
to do a self-assessment to determine what things they are currently doing for their child that their child could be doing on their
own at this point. Developing skills like cleaning, learning how to do laundry, prepare simple meals, etc. can start in elementary
school. Your child will develop a greater sense of independence when they are able to master independent skills on their
own. When we enable children by doing things for them that they should be doing on their own we inhibit their ability to
become more self-reliant and self-confident.
It is important to keep in mind that with the right supports in place children progress at different speeds which is based on their
learning ability, temperament and internal motivation. I have often seen parents who become impatient when their child is not
progressing at the speed they would like thus they assume the support they are receiving is ineffective. Be patient with your
child yet keep in mind it is necessary to challenge them at the same time.
Ryan Wexelblatt, M.S.S.
Twitter: @ryanwexelblatt
LinkedIn: www.linkedin.com/in/ryanwexelblatt
Web: ryanwexelblatt.com