Social Competence Treatment

Description of the Strategy

Interpersonal difficulties are considered one of the hallmark qualities of children with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Children with these disorders, collectively referred to as externalizing disorders, are rated more negatively by peers on sociometric measures and are more likely to experience peer rejection. Thus, peer relationships are an important target of comprehensive treatment for externalizing disorders. For over 30 years, researchers have investigated and disseminated treatment packages targeting the social competence of children with externalizing disorders. Social competence treatments (SCT) for these children focus on teaching and reinforcing the use of adaptive social skills and social [Page 1042]problem-solving strategies during interactions with peers and adults across settings. Two broad classes of SCT for children with externalizing disorders include social skills training (SST) and social problem-solving training (SPST).

SST interventions aim to remediate the basic social skills knowledge and performance deficits of children with externalizing disorders by teaching and reinforcing the use of appropriate social skills (e.g., communication, cooperation, participation, validation) during interactions with peers and adults. The rationale for this approach is based on literature suggesting that (a) deficits in social skill knowledge and application underlie the social incompetence of children with externalizing disorders and (b) social skills can be learned through instruction and practice.

In contrast with SST, SPST focuses on modifying deficits in social cognitive processes (e.g., encoding and interpreting social cues, social problem solving) that have been shown to mediate the inappropriate social behavior of children with externalizing disorders. SPST interventions teach children with externalizing disorders to (a) recognize errors in their social information processing, (b) cope with stressful interactions using self-talk and perspective taking strategies, and (c) utilize more appropriate problem-solving strategies when conflicts arise with others. For example, anger coping programs were developed from the theory that anger-eliciting stimuli are not the cause or sole determinant of aggressive responses. Rather, children may respond aggressively to perceived provocation by peers because they misperceive the stimuli (e.g., inaccurately attributing hostile intent to others) and utilize immature coping strategies (e.g., aggression) to control their responses to the stimuli. Taking an alternative approach, problem-solving skills programs focus on deficits in social problem solving and teach children to identify the problem, generate multiple solutions, evaluate alternatives, and select adaptive solutions. In sum, anger coping and problem-solving interventions focus on teaching children with externalizing problems to recognize their cognitive biases and to utilize coping and problem-solving strategies that facilitate more appropriate responses to others.

SST and SPST programs for children with externalizing disorders tend to include most, if not all, of the following instructional components to develop and reinforce knowledge and use of proper social skills and social problem-solving strategies: didactic instruction, group discussion, role play, modeling, in vivo play experience, coaching, social reinforcement, contingency management, and homework. Teachers or therapists implementing SST or SPST programs use didactic instruction to introduce a social skill or problem-solving strategy by describing the skill and providing multiple examples. To illustrate, a typical SST session might begin with the therapist defining cooperation and providing examples of how children can cooperate with others at home, school, and on the playground. The therapist also engages the children in a discussion regarding the importance of the skill and further elicits examples from the children about how the skill can be used in interactions with others.

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