The Use of Positive Reframing to Reduce Negative Statements in Adolescents with ASD

Background:  Individuals with Autism Spectrum Disorder (ASD) often experience impaired social communication skills. With these difficulties, social isolation can occur which may lead to comorbid disorders such as depression and anxiety (Shtayermman, 2006; Ryden & Bejerot, 2008). New research shows that children with ASD are also susceptible to comorbid disorders such as depression and anxiety (Strang, J., F., Kenworthy, L., Daniolos, P., Case, L., Wills, M., C., Martin, A., & Wallace, G., L., 2012). Not many early interventions are targeting these comorbid disorders at this age (Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., Baird, G., 2008). Parents and educators report strained friendships with peers, name calling or bullying. These increased levels of negative affect and commenting may create difficulties in social conversation and establishing meaningful relationships. Positive reframing is the ability to perceive something previously viewed as negative in a positive light (Lambert, Fincham, & Stillman, 2012). It is empirically validated as a beneficial treatment for a range of psychological conditions, including; Depression (Lambert, 2010), Anxiety disorders (Goldin et al., 2012), Depression/anxiety in parents of children with ASD (Benson, 2010). This intervention aims at using positive reframing to increase social communication skill levels for adolescents with ASD.

Objectives:  To use positive reframing to effectively decrease the use of negative statements while reframing into neutral or positive statements during social conversations for adolescents with ASD. A second objective included if collateral improvements would be gained in affect/interest during social conversation.

Methods:  Participants included three adolescents, ages 9, 11, and 14, diagnosed with ASD. Participant selection criteria included making excessive negative comments to their conversational partner during at least 20% of intervals in 10-minute conversational probes. A multiple baseline design was used along with partial interval recording. Behavioral measures that were coded and analyzed included; negative/positive/neutral statements and affect. For intervention, a combination treatment package was implemented. This included defining reframing, video feedback monitoring and self-management of reframing. Participants were required to reach 80% fidelity before continuing onto each step.

Results:  Findings indicated that it is possible to each adolescent with ASD to effectively decrease the use of negative statements while reframing during social conversations with peers. Participant 1 decreased average negative statements from 25% to 2%, participant 2 decreased average negative statements from 24% to 4% and participant 3 decreased average negative statements from 22% to 5%. All three participants saw gains of positive or neutral statements around 15% of conversation, likely to typical range. Results also found that the use of positive reframing raises child affect along with collateral effects where peers have higher affect during social conversation.

Conclusions:  Implications of this intervention show that the use of positive reframing can improve social interactions and develop meaningful friendship and romantic relationships. Positive reframing may also be useful for adolescent’s future in accessing and maintaining employment as well as targeting decreasing symptoms of depression and anxiety. These are applicable techniques that can be used by parents, teachers, and clinicians across a variety of social conversations and settings.