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Social Skills Deficits - Fact Sheet
 The most
characteristic features of an ABI are the  Cognitive disturbances that are often
present after the injury. Multiple areas may be disrupted, including attention,
memory, organization, judgment, perception, communication, and social skills.
It is in
the area of interpersonal/social functioning that judgment and perceptual
changes often lead to the most distressing disturbances. Confusion can arise
due to being overwhelmed by the sheer weight of information needed to redevelop
adult social skills. Insight and self-awareness can also be directly disturbed,
especially by frontal lobe damage. Orbitofrontal damage in particular (injury
to the very front of the brain) can disrupt an individual‘s ability to inhibit
unwanted responses such as inappropriate anger, sexual expression, humour or
tears without accompanying sadness. The potential for social isolation is very
great unless at least some of these social skills can be relearned.
What are social skills?
Social
skills are an incredibly complex system of behaviours that are central to
communication between individuals, involving giving, receiving and interpreting
messages. Social skills include verbal and nonverbal behaviour. They are
influenced by culture and the immediate social group, reflect environmental
factors including age, sex and status and depend upon an individual’s
personality, past experiences and perception of the other person.
Perhaps
most importantly, social skills are learnt, not instinctive. They increase with
social reinforcement from others and, when social isolation or a developmental
or acquired disability impact upon social skills, require feedback from others
in order to develop.
Social
skills deficits may be related to Impulsivity, both verbal and motor, poor
visual perception of facial and body language cues, poor auditory perception of
vocal cues, invasion of the personal space of others, inappropriate touching,
untidiness, disorganization, and a number of other such problems. Mood swings,
overreaction, and depression may also provide problems for the individual with
learning disabilities.
Social skills are the foundation for getting along
with others. A lack of social
skills can lead to behavioural difficulties, emotional difficulties, difficulty
in making friends, aggressiveness, problems in interpersonal relationships,
poor self-concept, academic and work failures, concentration
difficulties, isolation from peers, and depression. In short a lack of social skills is likely to
lead to a degree of social isolation.
Social Skills
Training
Social
skills training (SST) is a form of behaviour therapy used by teachers,
therapists, and trainers to help persons who have difficulties relating to
other people.
Social
skills training should rest on an objective assessment of the patient's actual
problems in relating to other people. Complex social behaviours are exactly
that: Complex. Each behaviour is composed of multiple small behaviours, any of
which may be impaired in a person with acquired brain injury or, alternatively,
may be perfectly intact. It makes no sense to focus on a behaviour that is
unimpaired: Therefore, a detailed assessment of behaviour should be conducted
first.
A Four Step Model for Social Skills Training
- Identify Social Skill Deficits
- Select Intervention Strategies
- Implement Intervention
- Assess and Modify Intervention as Necessary
1. Identify
Social Skill Deficits
The first step in any social skills training program
should be to conduct a thorough evaluation of the individual’s current level of
social functioning. The evaluation should detail both the strengths and
weakness of the individual related to social functioning.
2. & 3. Select
and Implement Intervention Strategies
-
Accommodation
and Assimilation
When selecting intervention strategies, it is
important to consider the notion of accommodation versus assimilation.
Accommodation, as it relates to social skills instruction, refers to the act of
modifying the physical or social environment of a person to promote positive
social interactions. For example, educating family, friends and work colleagues
about the problems in socialization that can be caused by an ABI.
Assimilation refers to instruction that facilitates
skill development that allows the person to be more successful in social
interactions. The key to a successful social skills training program is to
address both accommodation and assimilation.
Providing
skill instruction (assimilation) without modifying the environment to be more
accepting of the person with an ABI sets the person up for failure. This
happens the moment this person tries out a newly learned skill on a group of
non-accepting peers. The key is to teach skills and modify the environment.
This ensures that the new skill is received by peers with both understanding
and acceptance.
Some
commonly used strategies for training social skills include:
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Peer mentors have been frequently used to promote positive social interactions. Peer
mediated instruction allows us to structure the physical and social environment
in a manner to promote successful social interactions.
-
Role
Playing/Behavioural Rehearsal is used primarily to address basic interaction
skills. Role-playing consists of acting out various social interactions that
the person would typically encounter.
- Videotaped
Self-Modelling. Social skills are primarily acquired through learning that
involves observation, modelling, coaching, social problem solving, rehearsal,
feedback, and reinforcement-based strategies. VSM is an intervention where
individuals learn skills by observing themselves performing the targeted skill.
A strength of VSM is that it allows the individual to learn both through
observation and through personal experience.
4. Assess and
Modify the Intervention
Although
“Assess and Modify” is listed as the last stage in the intervention process, it
certainly is not the least important. In addition, it also is not the last
thing to think about when designing a social skills program.
Assessment
and modification of the interventions is an ongoing process that starts on the
first day of the training and in truth never actually ends.
Self-managed
social skills training
Because
social skills are social – involving more than one person – improving your
social skills requires the participation of other people who understand the
position you are in and are willing to help by providing encouragement, support
and, most importantly, feedback. It is very difficult to be tactful when it
comes to social skills, and not everybody has the trick. You must therefore be
prepared for fairly confronting criticism. Here are some tips if you are unable
to access a social skills trainer:
-
Enlist
the help of your family and friends. This may involve first teaching them about
acquired brain injury and the effect it has had upon you. Some people may not
accept that you have lost skills. On the other hand, some people may be
prepared to accommodate even severely inappropriate behaviour. You may need to
ask people to be more critical, and to give you more feedback in the home so
that you can relearn how to act appropriate in the community.
-
Join
a peer support group. Access to a group such as this will of course greatly
depend upon where you live. Contact your local Brain Injury Association for
possible groups in your area. Some groups are for everyone with a brain injury,
but there are also groups for specific causes of brain injury – for example,
motor vehicle accidents or stroke.
- Watch
other people. Don’t be too obvious about this! The best way of learning social
skills is to practice them, but the second-best way is to watch other people. Of
course, not everyone you may watch will behave appropriately – a good tip is to
avoid reality television and focus on busy public places. Sit at a café in a
shopping centre and watch the world go by.
Further information
The
Orbitofrontal cortex
Social
Skills Training
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Social Skills Deficits 
