Standing up or slouching in a chair? Using formal language or casual expressions? Telling jokes to add humor to an awkward situation or simply staying quiet?
Social choices such as these -- and the more nuanced, which fall somewhere in between -- are a necessity for maintaining positive relationships with others. While most people develop increasingly sophisticated social skills as they age, some, often including individuals on the autism spectrum, fail to pick up basic cues as children and have difficulty blending in with their peers.
Social Thinking, created in 1995 by speech language pathologist Michelle Garcia Winner, aims to combat these issues through direct instruction. Groups of up to four students, divided by age and ability, work with therapists at clinics to broaden their social skills by participating in group activities both in and outside of the clinic. Currently, there are two clinics in San Jose and one in Boston.
Social Thinking is about the subtle choices we make. Since specific social reactions cannot be applied to every scenario, the main focus is on teaching students to consider the perspectives, feelings and intentions of peers and then responding appropriately.
"We have them think about their own social expectations; when they have good thoughts about people, when they have weird thoughts about people, how what we do affects how others think and feel," Winner said.
This, Winner explains, is where the difference between being "social" and "Social Thinking" lies. While being social refers not to partying or frequenting big events but to simply having the ability to share space with others unobtrusively, Social Thinking is about breaking down abstract communication norms into concrete ideas that all clients can understand.
The most basic form of this breakdown is called "social behavior mapping," in which students consider three facets for determining appropriate behavior: the situation, the expectations for that specific scenario and how others will feel about their reactions. Being a "social detective" -- the terminology Winner uses with younger children -- and using clues from one's surroundings leads to adaptability in a variety of situations.
"It's a Pandora's box," Winner said. "Everything you isolate can be expanded upon."
Stacey Howard, whose 16-year-old son attends sessions at the San Jose clinic, echoes these sentiments. Her son was not diagnosed with ADHD, as well as growth-motor and visual motor deficits, until he was 11. Social Thinking has aided in boosting his confidence as well as his understanding of nonverbal communication.
"(Social Thinking) provides individual therapy, but their real niche is that they provide small group opportunities to practice skills in a safe environment without judgment," Howard said. "It allows for immediate intervention and explanation."
The Social Thinking clinics serve students ranging in age from 3 to 70. The outfitting of the therapy rooms reflects this gap: two tables -- one small and plastic, with an accompanying set of brightly colored chairs, the other tall and made of wood -- decorate their respective halves of the room. Despite the disparity, curriculum is similar across all age groups, albeit presented in different ways.
For even the youngest clients, Social Thinking introduces the concept of "thinking with your eyes." According to Winner, children from "many diagnostic labels," including ADD, ADHD and non-verbal learning disabilities, can benefit from this tactic, as many do not otherwise understand exactly what to look at when asked to make eye contact. Being taught simply to follow the eyes of others, though, can lead once again to "clues" about others, as eye movement is often used to indicate emotion.
Social Thinking is made kid-friendly through the usage of comics that depict the "unthinkables." Villains like Rock Brain, Glass Man and Mean Jean, named for their inflexibility, easily-triggered breakdowns and cruelty, respectively, are defeated by SuperFlex, the hero equipped to handle every social situation with calmness.
The teaching strategy changes once children approach upper elementary school and teenage years. This, however, is often when the obstacles come into play.
"(Sociality) affects mental health," Winner said. "As kids get older, they have awareness of how they're not included the same way other kids are. As we help (students) to become more aware, (depression and anxiety) may become an issue."
"There's so much nonverbal language by middle school, and then there's so much sarcasm in high school," Howard said. "Not hearing the sarcasm, not reading the body language, just listening to the words that are said, not how they're said, not the way they're delivered, not the tone or pitch — it becomes a challenge."
Teens also have the challenge of dealing with rapidly shifting social norms — the skills they may have acquired during earlier years of Social Thinking are no longer relevant. The "hidden rules for a 7-year-old," speech language pathologist Pamela Crooke explained, are not nearly as nuanced or mature as those of a 16-year-old. To an extent, Social Thinking requires undoing some rules and substituting new ones as students age.
These changes once again draw on the importance of using perspective taking rather than strict rules.
"Social Thinking is not teaching the 'doing.' It's teaching the thinking underlying the doing," said Crooke.
Even adults seek help with Social Thinking deficits, though Crooke and Winner note that while children often need generalized instruction, most adults come into the clinic with a specific problem to address, like working alongside others in an office setting or communicating more effectively with family members.
A high priority for therapists who work with adults is doing more than sitting around a table at the clinic; Crooke often meets with her group of grownups at a coffee shop or at the mall so they can practice their skills in public settings.
Both Crooke and Winner are quick to emphasize that Social Thinking instruction is neither a cure nor a quick fix for social deficits. However, treatment can be "one piece in the puzzle" of the multifaceted social spectrum.
"Unless you're a good social observer," Crooke said. "You can't be a participant."