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An Inclusive Summer Treatment/Camp Program for Children with High-Functioning Autism
Imagine a child that hides under the table when family comes to visit. Instead of a saying “hello,” he responds by barking like a dog. He has difficulty fitting in with peers and does not seem to understand how his unexpected behaviors impact friendship development. Parents are worried about whether or not he will be successful in an academic environment and if he will learn the skills to live independently as an adult. Many families have similar stories and worries — and they have difficulty finding support.
To help families such as the one mentioned above, the Knapp Center for Childhood Development initiated a partnership with the Jewish Community Center (JCC) of Youngstown to offer a new horizon for children with high-functioning autism and Asperger’s syndrome. This innovative treatment design, titled the Social Bureau of Investigation (SBI) Program, teaches children with high-functioning autism spectrum disorders (ASDs) the vital skills they need to be successful in social interaction. One parent testimonial states: “I attempted to find interventions since [our son] was four years old, and not one intervention that was applied even remotely helped. [They] were completely ineffective and useless . . . we are finally moving forward.”
Research on the intervention needs of children with ASD suggests that programming should be intensive and year-round to prevent regression in skills and avoid negative long-term outcomes. For children with high-functioning ASD, it is important to provide opportunities for interaction with typical developing peers. Since typical developing children generally do not spend their summers in schools, settings where there are appropriate peer models during the summer are in demand in order to teach the social skills that are pivotal for the success of children with ASD.
One way to address social skill deficits and maintain continuity of services is to provide intensive support services within neighborhood summer camp programs. A day camp provides an ideal setting for addressing peer interactions, social communication, development of interactive play skills, and engagement in group activities (Brookman et al., 2003). Summer camp allows the freedom to forgo a narrow academic focus that is typically associated with extended-school-year services and intensively concentrate on social skills — something that is often difficult to address adequately during the course of the school year. A summer camp program offers a more natural setting for addressing a broader range of social skills than possible in other typical environments, even an inclusive classroom. Chances are greater for generalization of skills from camp to home because the interventions occur in a naturalistic setting.
Why Teach Social Skills?
Children with ASD show a preference for solitary activities rather than spending time with others. There may be a lack of spontaneous seeking to share enjoyment, activities, or achievements with other people (American Psychiatric Association, 2000). Difficulty cooperating in groups is common and children may have difficulty establishing peer relationships and demonstrate little interest in making friends. Children with high-functioning ASD demonstrate a reduced awareness of others’ feelings and to social norms. They are less responsive to social cues such as smiles or eye contact. They may show impairment in the use of nonverbal behaviors such as eye contact, facial expressions, body postures, and gestures that regulate social interaction (American Psychiatric Association, 2000). These children often have difficulty processing social messages and social cues that promote socially appropriate behaviors (Morrison et al., 2001). They have great difficulty determining what social cues are significant. They can become frustrated and alienated by their lack of success with social contacts.
Most children learn social skills auto¬matically by observing other children and imitating their behaviors. Children with high-functioning ASD are less adept at recognizing and imitating social behaviors. When the natural approach to acquiring social competence fails, a didactic approach to teaching social skills can be effective in ensuring that children develop skills needed to have positive and fulfilling social interactions.
Preparation for Camp: Social Skills Training
To prepare children with ASD for camp, children in this program participated in social skills training throughout the school year at the Knapp Center for Childhood Development. Recognizing the need to follow treatment that is empirically supported in research, the program followed Winner’s (2005) Social Thinking curriculum. Objectives targeted included: expected/unexpected behaviors, big/little problems, social commenting, conversational skills (initiating, sustaining, and ending a conversation), reading and interpreting body language, understanding tone of voice, problem solving, compro¬mising, using our bodies to listen, making educated guesses (versus wacky guesses), and thinking of others.
Behavioral technologies from the science of applied behavior analysis, such as shaping, prompting, reinforcement schedules, and contingency reinforcement facilitated skill acquisition and generalization of targeted social skills. A token economy system taught self-regulation of maladaptive behaviors and recognition of positive social behavior. This system allowed for secondary reinforcers to be earned for demonstrating specific behaviors such as contributing to conversations, regulating emotions, and demonstrating use of social skills. Self-monitoring of behaviors was taught and paired with the token system at camp. This allowed fading of the token system, which helped prevent extinction of desired behaviors after program termination. Self-monitoring helped sustain desired behaviors after the program ended and is a skill that a child can take with them.
Generalizing skills is a key component of this program, as generalization means that children are displaying learned skills in new environments without external support. To help generalize skills taught in social skills training, a two-part plan was implemented:
- Parents met with the psychologist every other week during social skills group. Parent sessions targeted increasing generalization of a child’s social skills from group into the home and community. Parents learned skills to maintain behavioral change in their children and had the opportunity to raise questions with an experienced professional. To help facilitate generalization, parents were given weekly tasks to complete with their child. Tasks targeted skills the child learned that week. In addition, parents learned a variety of behavioral interventions for modifying behaviors and increasing socialization, such as differential reinforcement of alternative behaviors, social stories, token economies, and visual techniques.
- The majority of research supports that social skills training can be effective for children with ASD; however, research indicates social skills training falls short of helping children generalize their skills into a natural environment (Ozonoff & Miller, 1995; Rogers, 2000; Barry et al., 2003). As part of the SBI Program, the JCC offered the opportunity for children with ASD to generalize their social skills, communication and coping skills, and behavioral competencies in a more natural setting. The goal of the inclusive summer camp experience was to provide an opportunity for children with ASD to interact and engage socially with typical developing children. In addition, it provided opportunities for generalization of skills learned from social skill groups. Children were of fered a structured environment, providing opportunity for continuity of skills over the summer months. The camp program extended three days per week for six weeks, seven hours per day. Children were paired 1:1 or 2:1 with a behavioral coach. Children were “coached” within natural opportunities to put knowledge gained from social skills training into practice. The behavioral coaches provided social facilitation, direct instruction, and aided in generalization of skills. As in social skills training classes, social, cognitive, and behavioral interventions continued to be used throughout camp. To maintain the setting’s inclusive nature, only 6 percent of the children at the camp were associated with the Knapp Center for Childhood Development SBI Program.
|Skills taught were paired with visual icons (see Figure 1) to be placed in the child’s SBI kit. The SBI kit was utilized at summer camp to help generalize skills from training sessions into the natural environment: camp.|
The JCC of Youngstown, Ohio, offers summer fun to children. They are committed to promoting family values, building character, and opening new horizons for youth. There are many challenges to implementing inclusive, high-quality programs for children with ASD, especially in a summer camp setting.
Typical camp programs, although structured, may seem noisy and chaotic, which can be challenging for children with a need for sameness, routine, and structure. Children with ASD are accustomed to avoiding social interactions. Systematic desensitization programs and successive approximations of target behaviors were necessary approaches for addressing anxiety and/or fears. This gradual approach enabled children with ASD to experience social success, perhaps for the first time. As they began to experience success, they were more willing to try new things and participate in the social world, which is critical for ensuring success of children with ASD at Camp JCC.
Games and activities that constituted the curriculum of Camp JCC focused on tasks of childhood: playing; initiating; and responding to social overtures; building friendships; and learning rules for functioning in peer groups. Opportunities were plentiful for practicing social behavior with typical developing children in a variety of activities. Children enrolled in Camp JCC were given the opportunity to participate in the following activities:
Campers worked on skills necessary for “typical” art class experiences, such as listening to instructions, raising their hand for assistance, and waiting their turn while sharing materials. Some of the activities completed included making tie-dye shirts, nature lava lamps, and Fourth of July decorations.
During nature activities, children explored the camp grounds and helped take care of JCC’s community garden. They learned to maintain a garden and iden¬tify different types of plants and insects.
Outdoor games planned for campers included baseball, kickball, soccer, four square, and the occasional water balloon fight. Campers were required to work as a team and follow rules of the games.
Campers were exposed to the rudimentary skills of baking, such as measuring ingredients, following recipes, and mixing ingredients, while making ice cream, cookies, and banana bread.
Special weekly activities included field trips to local zoos and animal parks, water parks, and theme days. Field trips gave campers the opportunity to generalize skills across multiple environments and settings.
Campers participated in weekly tennis activities with JCC’s certified tennis professional. The children were exposed to the fundamentals and rules of tennis while participating in age-appropriate games.
Swim time included both swim lessons and free swim. During free swim, campers had access to pool toys and a chance to use their imagination and work together to come up with fun pool games.
The two agencies involved in making this program a success are the Knapp Center for Childhood Development and the JCC of Youngstown. The Knapp Center provided the experts in autism to ensure programming was tailored to meet each child’s needs. The JCC offered a camp setting for the children to have fun and generalize their social skills. In addition, Autism Speaks, a national leading organization in autism research and treatment, provided Julie Knapp, PhD, BCBA-D (when Knapp was on staff at the Cleveland Clinic Center for Autism), a grant that offered seed money for this innovative treatment approach. Because of this generous grant, the SBI Program was able to be created and made affordable for participating families. Knapp and her team then replicated the program through the Knapp Center for Childhood Development with the JCC to ensure program sustainability in various locations around the state.
Recommendations for Replication
For camps interested in developing a similar program for children with ASD, it is critical to establish a relationship or partnership with a local center for autism, hospital, community agency, or university that offers expertise in ASD.
Vital components of the program include:
- Social skills training for children with ASD prior to entering camp to increase their chance for success in the camp environment.
- Parent training/meetings in order to foster generalization and maintenance of treatment progress.
- Structured summer camp activities that are adapted for children with ASD.
- Interns or a similar aide (placed at camp) to support the child with ASD.
- Effective communication among all parties involved in the program.
The Knapp Center for Childhood Development offers consultation to those interested in replicating their program.
Success Breeds Success
The camp experience offered by the JCC was a huge success this past year. This camp not only offered children with ASD an opportunity to learn social skills, but enabled them to learn skills to help them succeed in life. One parent who partici¬pated in the program commented: “The program, people, and facilities were a true blessing! Thank you! Words cannot express our appreciation for your dedication to improve [our son’s] life and give him the life skills he needs to be successful!” The children were faced with new and exciting obstacles that increased their confidence, self-esteem, emotional regulation, and friendship skills. In the long run, camp is about making friends. This year at the JCC of Youngstown, children with ASD proved that even kids with autism can make friends at camp!
Resources for Working with ASD and Program Development
Julie Knapp, PhD, BCBA-D, is a licensed pediatric neuropsychologist and board certified behavior analyst who is the director of the Knapp Center for Childhood Development. Dr. Knapp is on staff at Rainbow Babies and Children’s Hospital. She is on the board of directors for Autism Speaks, Ohio Chapter and Autism Society of Ohio, Mahoning Valley. Dr. Knapp recently wrote four books on ABA curriculum for individuals with autism, which were published spring 2013.
Cecelia Maderitz, MS, BCBA, is a graduate of Youngstown University’s master’s program in applied behavioral analysis. Ms. Maderitz completed her internships at the Rich Center and the Knapp Center for Childhood Development. She is coordinator of the social skills and camp programs at the Knapp Center.
Adam Hirsh is the assistant director and camp director at the JCC of Youngstown. Originally from Lyndhurst, Ohio, a suburb of Cleveland, Hirsh graduated from Ohio University in 2009 with a bachelor’s degree in business administration.
American Psychiatric Association. (2000). Pervasive developmental disorders. Diagnostic and statistical manual of mental disorders, fourth edition—text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 69–70.
Barry, T.D., Klinger, L.G., Lee, J.M., Palardy, N., Gilmore,T., & Bodin, S.D. (2003). Journal of Autism and Developmental Disorders, 33, 685–701.
Brookman, L., Boettcher M., Klein, E., Openden, D., Koegel, R.L., & Koegel, L.K. (2003). Facilitating social interactions in a community summer camp setting for children with autism. Journal of Positive Behavior Interventions, 5, 249–252.
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Winner, M.G. (2005). Think Social! San Jose, CA: Think Social Publishing, Inc.