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Making social competence a habit
Response: Making Social Competence a Habit
239
Response Paper
Diagnosis
Making Social Competence a Habit
Diagnostic criteria used in the DSM-IVprovide a list o f behaviors that t e n d to covary. A l t h o u g h these behaviors may occur together, they are n o t necessarily t r i g g e r e d or m a i n t a i n e d by similar events. Thus, identification o f a correct diagnosis does n o t necessarily h e l p in d e v e l o p i n g an effective treatment, a n d therefore may n o t be especially useful in t r e a t m e n t planning. In spite o f this, however, we recognize the i m p o r t a n c e o f diagnostic criteria for c o m m u n i c a t i o n a m o n g professionals and, increasingly, for r e i m b u r s e m e n t from third-party payers. After ruling o u t a specific disruptive behavior disorder, an anxiety disorder, a n d an a d j u s t m e n t disorder, Mike's behaviors were c o n s i d e r e d to be consistent with a diagnosis o f 312.9, Disruptive Behavior Disorder NOS.
C y n t h i a M. A n d e r s o n a n d K e i t h D. A l l e n Munroe-Meyer Institute f o r Genetics a n d Rehabilitation University of Nebraska Medical Center
We took a decidedly behavioral approach to solving this problem involving adolescent social-skills deficits. Following a functional assessment of both skill deficits and environmental contingencies, we would address the social problems presented in this case as if they were a persistent habit. Treatment would incorporate elements of simplified habit reversal technology, an empirically supported package of techniques for treating persistent habits. After teaching the client to detect, describe, and self-monitor each o/the relevant aspects of both appropriate and inappropriate social behaviors, both natural and artificial supporting contingencies would be arranged to teach new o r strengthen existing replacement behaviors in appropriate contexts.
Presenting Problems IKE presents with several behavioral difficulties that have a negative i m p a c t on his social interactions with peers a n d adults. These difficulties include inappropriate touching, i n a p p r o p r i a t e verbalizations, standing too close to others, a n d conversational deficits (e.g., voice volume regulations, facial expression). T h e case description listed two additional categories, "social rejection by peers" a n d "cognitive distortions," that we would n o t target for treatment. First, social rejection by peers does n o t directly relate to a specific behavior Mike is emitting. Rather, rejection is a likely c o n s e q u e n c e of his i n a p p r o p r i a t e social behavior. Second, we would n o t target "cognitive distortions" because we d o n o t view t h e m as causes o f his social behavior difficulties. Rather, we would view the distortions as b e i n g triggered a n d mainrained by the same e n v i r o n m e n t a l events that influence his overt social behavior problems. A l t h o u g h these private events would n o t be automatically selected as targets for treatment, we would address t h e m if the family teachers o r o t h e r team m e m b e r s felt that a r e d u c t i o n in verbalized cognitive distortions was an i m p o r t a n t goal o f t r e a t m e n t (i.e., if the verbalizing o f the distortions was in some way a n n o y i n g o r i n a p p r o p r i a t e ) .
M
Assessment
T h e p u r p o s e o f o u r assessment would be twofold: to identify e n v i r o n m e n t a l variables that trigger a n d maintain relevant social behaviors a n d to carefully evaluate Mike's c u r r e n t social-skills repertoire. First, the case inf o r m a t i o n already provides relevant i n f o r m a t i o n a b o u t p r o x i m a l e n v i r o n m e n t a l variables that seem to trigger a n d maintain p r o b l e m behavior. U p o n f u r t h e r evaluation, we would look to discern distal events that m i g h t trigger (e.g., how d o events in the m o r n i n g effect social exchanges later in the day) o r maintain (e.g., what sort o f teaching interactions d o staff direct toward the social deficits) p r o b l e m behavior. Additionally, we would a t t e m p t to identify e n v i r o n m e n t a l variables that trigger a n d possibly maintain appropriate social behavior. T h e case inform a t i o n suggests that Mike does, on occasion, exhibit app r o p r i a t e social behaviors. U n d e r s t a n d i n g the conditions u n d e r which these a p p r o p r i a t e social behaviors o c c u r may be helpful in a r r a n g i n g m o r e supportive environments in the future. Second, we would c o n d u c t a careful social-skills evaluation. T h e goal of this would be to d e t e r m i n e which social skills Mike reliably exhibits as well as those that he has in his r e p e r t o i r e b u t does n o t frequently exhibit. If the assessment reveals that Mike has a fairly c o m p l e t e repertoire o f skills, then t r e a t m e n t would focus o n c h a n g i n g Mike's e n v i r o n m e n t such that the social skills he has are more likely to be t r i g g e r e d a n d reinforced.
Assessment
Cognitive and Behavioral Practice 7, 2 3 9 - 2 4 1 , 2000 107%7229/00/239-24151.00/0 Copyright © 2000 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.
Plan
Instruments and Strategies
To identify e n v i r o n m e n t a l variables related to Mike's i n a p p r o p r i a t e a n d a p p r o p r i a t e behavior, we would cond u c t a functional assessment using interviews a n d observation to look for variables in the e n v i r o n m e n t that trigg e r a n d m a i n t a i n identified social behaviors. Interviews
240
Anderson & Allen would likely include family teachers a n d teachers at school as well as (possibly) Mike's peers. Also, we would carefully interview Mike, helping him to identify situations where problems are m o s t - - a n d least--likely to occur. In addition to interviews, we would c o n d u c t direct observations in both Mike's home a n d the school. These observations would be arranged to sample several differe n t time periods each day across several different situations. To evaluate Mike's social-skills repertoire, we would likely ask Mike to engage in role-play situations, possibly with a familiar peer a n d also with an unfamiliar peer. These role-plays could involve various situations in which problems have been reported to occm:
Unique Features There are a n u m b e r of variables that impact this case. First, Mike has a long histo W of p l a c e m e n t in restrictive settings. As a result, he may have spent time a r o u n d peers who would not be considered good models of appropriate social behavior and who also may have intentionally reinforced inappropriate social behavior. In addition, many t r e a t m e n t settings have therapy groups that may address social deficits. These groups are often staffed by p e r s o n n e l with widely yawing degrees of training a n d it may be difficult to assess the influence of previous attempts to address Mike's social-skills problems. Finally; Mike's "borderline" cognitive f u n c t i o n i n g would require that i n t e r v e n t i o n be more experiential than languagebased. That is, treatment would likely require fewer abstract verbal exchanges about social skills, relying instead on a r r a n g e m e n t of e n v i r o n m e n t a l contingencies to strengthen a n d m a i n t a i n appropriate social behaviors.
Case Conceptualization O u r behavioral orientation leads us to conceptualize Mike's social deficits as primarily a flmction of c u r r e n t e n v i r o n m e n t a l contingencies. Although Mike's past may have played some significant role in the emergence of these behaviors, we believe that Mike currently engages in these inappropriate social behaviors because, relative to other social behaviors, these produce a greater probability of accessing r e i n f o r c e m e n t of some type. This reinf o r c e m e n t may take the form of increased frequency; duration, or intensity of peer interactions, albeit negative ones. The fact that peer interactions appear negative does n o t rule out the possibility that they are reinforcing (i.e., negative attention from peers a n d adults is preferred over b e i n g ignored). Likewise, the r e i n f o r c e m e n t may take the form of escaping from u n p l e a s a n t social situations. That is, Mike may have learned to avoid prolonged exposure to u n p l e a s a n t social situations by exhibiting un-
acceptable social behavim: Finally, it is also possible that Mike's problems are a result of a skill deficit. If so, Mike may lack the ability to regulate volume, physical proximity, a n d emotional reaction to social events. Thus, even in air e n v i r o n m e n t in which the contingencies support use of better social skills, Mike may not be able to because he does not "know how."
T r e a t m e n t Plan If the assessment demonstrates that the specific social skills (volume, physical proximity, physical touch, contextually appropriate affect, a n d facial expressions) are not in tire repertoire, then the treatment would clearly involve an instructional intervention to shape these behaviors a n d then an effort to generalize them to the appropriate contexts. It seems likel}; however, that the necessa W skills are in the repertoire. RatheL the relevant social behaviors are n o t u n d e r control of appropriate environmental triggers a n d / o r the e~vironmental cm~sequem'e,~ do n o t support their use. Some might describe Mike's resuhing social behaviors as reflecting "poor social habits." There is an extensive body of empirical literature on the effectiveness of "simplified habit reversal" procedures for c h a n g i n g repetitive a n d persistent habits, a n d we think these techniques have application here. The critical comp o n e n t s most reliably associated with successful habitreversal intervention involve awareness training, selecting a c o m p e t i n g response, a n d arranging for social support. This involves increasing the client's awareness of inappropriate behaviors that occur in response to social triggers a n d arranging for socially acceptable replacements or c o m p e t i n g social behaviors. The social support c o m p o n e n t involves arranging for r e i n f o r c e m e n t of the client's efforts to both increase awareness a n d to substitute the appropriate r e p l a c e m e n t social behaviors.
Awareness and Change o f Social Behavior In the c u r r e n t context, social triggers from peers set the occasion for a variety of inappropriate social behaviors. Arranging for these triggers to occasion more appropriate social behaviors requires that we make Mike more aware of the inappropriate behaviors a n d the social events that trigger them. We also wish to make Mike more aware of the appropriate behaviors that are currently in his repertoire. Finally; we must help Mike select which of the appropriate c o m p e t i n g or r e p l a c e m e n t behaviors we would like social events to trigger. These goals could be accomplished in several ways. First, we would recruit a preferred prosocial peer to assist or tutor the client during awareness training. Second, we would use videotape a n d / o r mirrors to e n h a n c e awareness t h r o u g h better response detection, response description, a n d situation awareness. Additionally, we would provide Mike with im-
Response: Making Social C o m p e t e n c e a Habit m e d i a t e f e e d b a c k on his behavior. These p r o c e d u r e s would be used to e n h a n c e awareness o f both i n a p p r o p r i ate a n d a p p r o p r i a t e social responses. O n c e Mike reliably d e s c r i b e d b o t h a p p r o p r i a t e a n d i n a p p r o p r i a t e behaviors in the clinic, we would c o n d u c t observations (and possibly interviews o f peers a n d adults) to check for generalization of awareness from clinic to relevant social contexts. Based on the results of this evaluation, we would c o n d u c t awareness training in e n v i r o n m e n t s in which generalization h a d n o t occurred. Finally, to e n h a n c e Mike's ability to i n d e p e n d e n t l y m a n a g e his behavior, we would i n t r o d u c e self-monitoring. This would involve teaching Mike to d e t e c t a n d t h e n r e c o r d instances of app r o p r i a t e a n d i n a p p r o p r i a t e behavior. If Mike did not reliably r e c o r d his behavior, we would c o n s i d e r asking family teachers to periodically m o n i t o r Mike's behavior. Mike could then e a r n rewards for c o r r e s p o n d e n c e between his r e c o r d a n d the family teacher's record.
Arrange for Supporting Contingencies Unfortunately, it is unlikely that changes in social behavior will recruit naturally o c c u r r i n g forms o f s u p p o r t a n d r e i n f o r c e m e n t in the c u r r e n t environment. That is, even if Mike b e c o m e s skilled at d e t e c t i n g early signs of ina p p r o p r i a t e behavior a n d skilled at i n t r o d u c i n g a competing, a p p r o p r i a t e social behaviox, his peers are unlikely to respond, at least in the short term, in a way that will maintain Mike's efforts. F o r Mike's peers, a long history o f negative social interactions with Mike has increased the l i k e l i h o o d that simply his physical presence will occasion social rejection, i n d e p e n d e n t o f his specific social behaviors. T h e solution is to a r r a n g e artificial s u p p o r t i n g consequences, or to a r r a n g e for a new social environm e n t where peers have no negative history with Mike. We would c o n s i d e r d o i n g both. To a r r a n g e artificial supporting contingencies, family teachers could be taught to increase the frequency, d u r a t i o n , a n d quality of teaching interactions c o n t i n g e n t on positive social attempts r a t h e r than negative a t t e m p t s - - t h a t is, to provide m o r e interaction with Mike following a p p r o p r i a t e behavior a n d less interaction when he behaves inappropriately. Additionally, points could be d i s p e n s e d specifically for use o f prosocial c o m p e t i n g responses a n d extra points could be m a d e available for accuracy o f self-recording. To a r r a n g e for a new social e n v i r o n m e n t we would look for special interest groups for Mike to j o i n , perhaps external to the Boys Town Campus, where the youth would have no knowledge o f Mike's past social deficits. These could be a useful "training g r o u n d " for Mike because special interest groups have a c o m m o n social interest (e.g., books, m o d e l trains, woodworking, volunteer group) a n d the g e n e r a l topic o f conversation is already known. Thus, a p p r o p r i a t e contributions could be anticip a t e d a n d rehearsed.
Adjunctive Interventions T h e data on physical attractiveness are fairly clear; individuals who are overweight are viewed as less c o m p e tent a n d less socially desirable. Regardless o f the skills Mike acquires, his weight may serve as a b a r r i e r to social acceptance. A l t h o u g h we would n o t be likely to a t t e m p t to m a n a g e a full-scale diet, we would c o n s i d e r working with Mike, c o n t i n g e n t on his interest, to m a n a g e his lifestyle to include behaviors that are likely to result in weight r e d u c t i o n (e.g., increased exercise, m o d e r a t e diet, stimulus control o f eating habits).
Potential or Anticipated Problems Working within the structure of the Boys Town program could i n t r o d u c e both advantages a n d disadvantages. Boys Town is a self-contained campus a n d most o f the youth's activities take place on that campus. A r r a n g i n g for Mike to have access to a supportive social e n v i r o n m e n t where the peers a n d staff do n o t already "know a b o u t Mike" could be difficult. Also, the teaching family m o d e l relies heavily on "teaching to" specific p r o b l e m behaviors. Thus, a g o o d deal of social interaction often occurs contingent on i n a p p r o p r i a t e behavior. In this environment, t r e a t m e n t r e c o m m e n d a t i o n s that involve "teaching to" the a p p r o p r i a t e social behaviors ( c o m m e n t i n g on, praising, reviewing, rehearsing, dispensing points, etc.) a n d largely ignoring the i n a p p r o p r i a t e behaviors (save for a standard p o i n t loss) are likely to contradict the Boys Town t r e a t m e n t model.
Expected Outcomes First, Mike will be m o r e skilled at d e t e c t i n g his own ina p p r o p r i a t e a n d a p p r o p r i a t e social behavior a n d the social conditions that trigger them. Second, Mike will e m i t a h i g h e r frequency o f a p p r o p r i a t e social behaviors a n d a d e c r e a s e d rate of i n a p p r o p r i a t e behaviors. Third, Mike will have a supportive e n v i r o n m e n t ( p e e r tutor, family teachers) in which adults reward attempts at a p p r o p r i a t e social interactions with increased frequency a n d with a l o n g e r d u r a t i o n of social e n g a g e m e n t . Similarly, adults will deliver a high ratio o f points e a r n e d for a p p r o p r i a t e social behavior to points lost for i n a p p r o p r i a t e social behavior. Fifth, Mike will have access to a social c o m m u n i t y (e.g., special interest groups outside the Boys Town campus) where there is the potential to recruit m o r e natural forms o f p e e r social r e i n f o r c e m e n t for attempts at a p p r o priate social interactions. Finally, Mike will have the opp o r t u n i t y to participate in a fitness p r o g r a m , if desired, to improve c o n d i t i o n i n g a n d r e d u c e body fat. Address correspondence to Keith D. Allen, Ph.D., Department of Psychology, Munroe-Meyer Institute, Omaha, NE 68105; e-mail: [email protected]. Received: July 24, 1999 Accepted: August 10, 1999
241
239
Response Paper
Diagnosis
Making Social Competence a Habit
Diagnostic criteria used in the DSM-IVprovide a list o f behaviors that t e n d to covary. A l t h o u g h these behaviors may occur together, they are n o t necessarily t r i g g e r e d or m a i n t a i n e d by similar events. Thus, identification o f a correct diagnosis does n o t necessarily h e l p in d e v e l o p i n g an effective treatment, a n d therefore may n o t be especially useful in t r e a t m e n t planning. In spite o f this, however, we recognize the i m p o r t a n c e o f diagnostic criteria for c o m m u n i c a t i o n a m o n g professionals and, increasingly, for r e i m b u r s e m e n t from third-party payers. After ruling o u t a specific disruptive behavior disorder, an anxiety disorder, a n d an a d j u s t m e n t disorder, Mike's behaviors were c o n s i d e r e d to be consistent with a diagnosis o f 312.9, Disruptive Behavior Disorder NOS.
C y n t h i a M. A n d e r s o n a n d K e i t h D. A l l e n Munroe-Meyer Institute f o r Genetics a n d Rehabilitation University of Nebraska Medical Center
We took a decidedly behavioral approach to solving this problem involving adolescent social-skills deficits. Following a functional assessment of both skill deficits and environmental contingencies, we would address the social problems presented in this case as if they were a persistent habit. Treatment would incorporate elements of simplified habit reversal technology, an empirically supported package of techniques for treating persistent habits. After teaching the client to detect, describe, and self-monitor each o/the relevant aspects of both appropriate and inappropriate social behaviors, both natural and artificial supporting contingencies would be arranged to teach new o r strengthen existing replacement behaviors in appropriate contexts.
Presenting Problems IKE presents with several behavioral difficulties that have a negative i m p a c t on his social interactions with peers a n d adults. These difficulties include inappropriate touching, i n a p p r o p r i a t e verbalizations, standing too close to others, a n d conversational deficits (e.g., voice volume regulations, facial expression). T h e case description listed two additional categories, "social rejection by peers" a n d "cognitive distortions," that we would n o t target for treatment. First, social rejection by peers does n o t directly relate to a specific behavior Mike is emitting. Rather, rejection is a likely c o n s e q u e n c e of his i n a p p r o p r i a t e social behavior. Second, we would n o t target "cognitive distortions" because we d o n o t view t h e m as causes o f his social behavior difficulties. Rather, we would view the distortions as b e i n g triggered a n d mainrained by the same e n v i r o n m e n t a l events that influence his overt social behavior problems. A l t h o u g h these private events would n o t be automatically selected as targets for treatment, we would address t h e m if the family teachers o r o t h e r team m e m b e r s felt that a r e d u c t i o n in verbalized cognitive distortions was an i m p o r t a n t goal o f t r e a t m e n t (i.e., if the verbalizing o f the distortions was in some way a n n o y i n g o r i n a p p r o p r i a t e ) .
M
Assessment
T h e p u r p o s e o f o u r assessment would be twofold: to identify e n v i r o n m e n t a l variables that trigger a n d maintain relevant social behaviors a n d to carefully evaluate Mike's c u r r e n t social-skills repertoire. First, the case inf o r m a t i o n already provides relevant i n f o r m a t i o n a b o u t p r o x i m a l e n v i r o n m e n t a l variables that seem to trigger a n d maintain p r o b l e m behavior. U p o n f u r t h e r evaluation, we would look to discern distal events that m i g h t trigger (e.g., how d o events in the m o r n i n g effect social exchanges later in the day) o r maintain (e.g., what sort o f teaching interactions d o staff direct toward the social deficits) p r o b l e m behavior. Additionally, we would a t t e m p t to identify e n v i r o n m e n t a l variables that trigger a n d possibly maintain appropriate social behavior. T h e case inform a t i o n suggests that Mike does, on occasion, exhibit app r o p r i a t e social behaviors. U n d e r s t a n d i n g the conditions u n d e r which these a p p r o p r i a t e social behaviors o c c u r may be helpful in a r r a n g i n g m o r e supportive environments in the future. Second, we would c o n d u c t a careful social-skills evaluation. T h e goal of this would be to d e t e r m i n e which social skills Mike reliably exhibits as well as those that he has in his r e p e r t o i r e b u t does n o t frequently exhibit. If the assessment reveals that Mike has a fairly c o m p l e t e repertoire o f skills, then t r e a t m e n t would focus o n c h a n g i n g Mike's e n v i r o n m e n t such that the social skills he has are more likely to be t r i g g e r e d a n d reinforced.
Assessment
Cognitive and Behavioral Practice 7, 2 3 9 - 2 4 1 , 2000 107%7229/00/239-24151.00/0 Copyright © 2000 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.
Plan
Instruments and Strategies
To identify e n v i r o n m e n t a l variables related to Mike's i n a p p r o p r i a t e a n d a p p r o p r i a t e behavior, we would cond u c t a functional assessment using interviews a n d observation to look for variables in the e n v i r o n m e n t that trigg e r a n d m a i n t a i n identified social behaviors. Interviews
240
Anderson & Allen would likely include family teachers a n d teachers at school as well as (possibly) Mike's peers. Also, we would carefully interview Mike, helping him to identify situations where problems are m o s t - - a n d least--likely to occur. In addition to interviews, we would c o n d u c t direct observations in both Mike's home a n d the school. These observations would be arranged to sample several differe n t time periods each day across several different situations. To evaluate Mike's social-skills repertoire, we would likely ask Mike to engage in role-play situations, possibly with a familiar peer a n d also with an unfamiliar peer. These role-plays could involve various situations in which problems have been reported to occm:
Unique Features There are a n u m b e r of variables that impact this case. First, Mike has a long histo W of p l a c e m e n t in restrictive settings. As a result, he may have spent time a r o u n d peers who would not be considered good models of appropriate social behavior and who also may have intentionally reinforced inappropriate social behavior. In addition, many t r e a t m e n t settings have therapy groups that may address social deficits. These groups are often staffed by p e r s o n n e l with widely yawing degrees of training a n d it may be difficult to assess the influence of previous attempts to address Mike's social-skills problems. Finally; Mike's "borderline" cognitive f u n c t i o n i n g would require that i n t e r v e n t i o n be more experiential than languagebased. That is, treatment would likely require fewer abstract verbal exchanges about social skills, relying instead on a r r a n g e m e n t of e n v i r o n m e n t a l contingencies to strengthen a n d m a i n t a i n appropriate social behaviors.
Case Conceptualization O u r behavioral orientation leads us to conceptualize Mike's social deficits as primarily a flmction of c u r r e n t e n v i r o n m e n t a l contingencies. Although Mike's past may have played some significant role in the emergence of these behaviors, we believe that Mike currently engages in these inappropriate social behaviors because, relative to other social behaviors, these produce a greater probability of accessing r e i n f o r c e m e n t of some type. This reinf o r c e m e n t may take the form of increased frequency; duration, or intensity of peer interactions, albeit negative ones. The fact that peer interactions appear negative does n o t rule out the possibility that they are reinforcing (i.e., negative attention from peers a n d adults is preferred over b e i n g ignored). Likewise, the r e i n f o r c e m e n t may take the form of escaping from u n p l e a s a n t social situations. That is, Mike may have learned to avoid prolonged exposure to u n p l e a s a n t social situations by exhibiting un-
acceptable social behavim: Finally, it is also possible that Mike's problems are a result of a skill deficit. If so, Mike may lack the ability to regulate volume, physical proximity, a n d emotional reaction to social events. Thus, even in air e n v i r o n m e n t in which the contingencies support use of better social skills, Mike may not be able to because he does not "know how."
T r e a t m e n t Plan If the assessment demonstrates that the specific social skills (volume, physical proximity, physical touch, contextually appropriate affect, a n d facial expressions) are not in tire repertoire, then the treatment would clearly involve an instructional intervention to shape these behaviors a n d then an effort to generalize them to the appropriate contexts. It seems likel}; however, that the necessa W skills are in the repertoire. RatheL the relevant social behaviors are n o t u n d e r control of appropriate environmental triggers a n d / o r the e~vironmental cm~sequem'e,~ do n o t support their use. Some might describe Mike's resuhing social behaviors as reflecting "poor social habits." There is an extensive body of empirical literature on the effectiveness of "simplified habit reversal" procedures for c h a n g i n g repetitive a n d persistent habits, a n d we think these techniques have application here. The critical comp o n e n t s most reliably associated with successful habitreversal intervention involve awareness training, selecting a c o m p e t i n g response, a n d arranging for social support. This involves increasing the client's awareness of inappropriate behaviors that occur in response to social triggers a n d arranging for socially acceptable replacements or c o m p e t i n g social behaviors. The social support c o m p o n e n t involves arranging for r e i n f o r c e m e n t of the client's efforts to both increase awareness a n d to substitute the appropriate r e p l a c e m e n t social behaviors.
Awareness and Change o f Social Behavior In the c u r r e n t context, social triggers from peers set the occasion for a variety of inappropriate social behaviors. Arranging for these triggers to occasion more appropriate social behaviors requires that we make Mike more aware of the inappropriate behaviors a n d the social events that trigger them. We also wish to make Mike more aware of the appropriate behaviors that are currently in his repertoire. Finally; we must help Mike select which of the appropriate c o m p e t i n g or r e p l a c e m e n t behaviors we would like social events to trigger. These goals could be accomplished in several ways. First, we would recruit a preferred prosocial peer to assist or tutor the client during awareness training. Second, we would use videotape a n d / o r mirrors to e n h a n c e awareness t h r o u g h better response detection, response description, a n d situation awareness. Additionally, we would provide Mike with im-
Response: Making Social C o m p e t e n c e a Habit m e d i a t e f e e d b a c k on his behavior. These p r o c e d u r e s would be used to e n h a n c e awareness o f both i n a p p r o p r i ate a n d a p p r o p r i a t e social responses. O n c e Mike reliably d e s c r i b e d b o t h a p p r o p r i a t e a n d i n a p p r o p r i a t e behaviors in the clinic, we would c o n d u c t observations (and possibly interviews o f peers a n d adults) to check for generalization of awareness from clinic to relevant social contexts. Based on the results of this evaluation, we would c o n d u c t awareness training in e n v i r o n m e n t s in which generalization h a d n o t occurred. Finally, to e n h a n c e Mike's ability to i n d e p e n d e n t l y m a n a g e his behavior, we would i n t r o d u c e self-monitoring. This would involve teaching Mike to d e t e c t a n d t h e n r e c o r d instances of app r o p r i a t e a n d i n a p p r o p r i a t e behavior. If Mike did not reliably r e c o r d his behavior, we would c o n s i d e r asking family teachers to periodically m o n i t o r Mike's behavior. Mike could then e a r n rewards for c o r r e s p o n d e n c e between his r e c o r d a n d the family teacher's record.
Arrange for Supporting Contingencies Unfortunately, it is unlikely that changes in social behavior will recruit naturally o c c u r r i n g forms o f s u p p o r t a n d r e i n f o r c e m e n t in the c u r r e n t environment. That is, even if Mike b e c o m e s skilled at d e t e c t i n g early signs of ina p p r o p r i a t e behavior a n d skilled at i n t r o d u c i n g a competing, a p p r o p r i a t e social behaviox, his peers are unlikely to respond, at least in the short term, in a way that will maintain Mike's efforts. F o r Mike's peers, a long history o f negative social interactions with Mike has increased the l i k e l i h o o d that simply his physical presence will occasion social rejection, i n d e p e n d e n t o f his specific social behaviors. T h e solution is to a r r a n g e artificial s u p p o r t i n g consequences, or to a r r a n g e for a new social environm e n t where peers have no negative history with Mike. We would c o n s i d e r d o i n g both. To a r r a n g e artificial supporting contingencies, family teachers could be taught to increase the frequency, d u r a t i o n , a n d quality of teaching interactions c o n t i n g e n t on positive social attempts r a t h e r than negative a t t e m p t s - - t h a t is, to provide m o r e interaction with Mike following a p p r o p r i a t e behavior a n d less interaction when he behaves inappropriately. Additionally, points could be d i s p e n s e d specifically for use o f prosocial c o m p e t i n g responses a n d extra points could be m a d e available for accuracy o f self-recording. To a r r a n g e for a new social e n v i r o n m e n t we would look for special interest groups for Mike to j o i n , perhaps external to the Boys Town Campus, where the youth would have no knowledge o f Mike's past social deficits. These could be a useful "training g r o u n d " for Mike because special interest groups have a c o m m o n social interest (e.g., books, m o d e l trains, woodworking, volunteer group) a n d the g e n e r a l topic o f conversation is already known. Thus, a p p r o p r i a t e contributions could be anticip a t e d a n d rehearsed.
Adjunctive Interventions T h e data on physical attractiveness are fairly clear; individuals who are overweight are viewed as less c o m p e tent a n d less socially desirable. Regardless o f the skills Mike acquires, his weight may serve as a b a r r i e r to social acceptance. A l t h o u g h we would n o t be likely to a t t e m p t to m a n a g e a full-scale diet, we would c o n s i d e r working with Mike, c o n t i n g e n t on his interest, to m a n a g e his lifestyle to include behaviors that are likely to result in weight r e d u c t i o n (e.g., increased exercise, m o d e r a t e diet, stimulus control o f eating habits).
Potential or Anticipated Problems Working within the structure of the Boys Town program could i n t r o d u c e both advantages a n d disadvantages. Boys Town is a self-contained campus a n d most o f the youth's activities take place on that campus. A r r a n g i n g for Mike to have access to a supportive social e n v i r o n m e n t where the peers a n d staff do n o t already "know a b o u t Mike" could be difficult. Also, the teaching family m o d e l relies heavily on "teaching to" specific p r o b l e m behaviors. Thus, a g o o d deal of social interaction often occurs contingent on i n a p p r o p r i a t e behavior. In this environment, t r e a t m e n t r e c o m m e n d a t i o n s that involve "teaching to" the a p p r o p r i a t e social behaviors ( c o m m e n t i n g on, praising, reviewing, rehearsing, dispensing points, etc.) a n d largely ignoring the i n a p p r o p r i a t e behaviors (save for a standard p o i n t loss) are likely to contradict the Boys Town t r e a t m e n t model.
Expected Outcomes First, Mike will be m o r e skilled at d e t e c t i n g his own ina p p r o p r i a t e a n d a p p r o p r i a t e social behavior a n d the social conditions that trigger them. Second, Mike will e m i t a h i g h e r frequency o f a p p r o p r i a t e social behaviors a n d a d e c r e a s e d rate of i n a p p r o p r i a t e behaviors. Third, Mike will have a supportive e n v i r o n m e n t ( p e e r tutor, family teachers) in which adults reward attempts at a p p r o p r i a t e social interactions with increased frequency a n d with a l o n g e r d u r a t i o n of social e n g a g e m e n t . Similarly, adults will deliver a high ratio o f points e a r n e d for a p p r o p r i a t e social behavior to points lost for i n a p p r o p r i a t e social behavior. Fifth, Mike will have access to a social c o m m u n i t y (e.g., special interest groups outside the Boys Town campus) where there is the potential to recruit m o r e natural forms o f p e e r social r e i n f o r c e m e n t for attempts at a p p r o priate social interactions. Finally, Mike will have the opp o r t u n i t y to participate in a fitness p r o g r a m , if desired, to improve c o n d i t i o n i n g a n d r e d u c e body fat. Address correspondence to Keith D. Allen, Ph.D., Department of Psychology, Munroe-Meyer Institute, Omaha, NE 68105; e-mail: [email protected]. Received: July 24, 1999 Accepted: August 10, 1999
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