Social-Skills Interventions With Adolescents

Christopher et aI.! ADOLESCENTS' SOCIAL SKILLS

During adolescence. the interpersonal interactions and behaviors necessary for successful social functioning become increasingly complex. In recent years, social-skills training with adolescents bas made a variety of advances beyond basic skill acquisition toward techniques designed to promote generalization and maintenance of an effective interpersonal repertoire. This article reviews relevant empirical literature for current issues and procedures in social-skills training with adolescents, including use of social-skills interventions for a variety of adolescent populations and problems. use of innovative and promising intervention pn.x:edures. and issues regarding ~neralization and social validity of intervention procedw:t:S.

Social-Skills Interventions With Adolescents Current Issues and Procedures JEANETTE SMITH CHRISTOPHER ClUldnns Hospilal. Boston.. H(Jf1Iard Medical ScJwoJ

DOUGLAS W. NANGLE West W'6'inia University

DAVID J. HANSEN University of Nebrasluz-Lincoln

Many of the developmental events that occur during the transitional period of adolescence have a significant impact on an adolescent's interpersonal interactions (Damon, 1983; Hansen, Christopher, & Nangle, 1992; Petersen & Hamburg, 1986). For example, more advanced cognitive, verbal, and reasoning abilities influence social interactions among adolescents. The physical and emotional changes associated with puberty may also alter the adolescent's interactions with both same-sex and opposite-sex peers. In addition, adolescents AUTHORS' NOTE: Send correspontknce and reprint requests to David J. Hansen, Depanment of Psychology, University of Nebrasktl-Lincoln, Lincoln, NE 68588-0308. BEHAVIOR MODIFICATION, Vol. 17 No. 3,July 1993 314-338

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may encounter a variety of other experiences that affect interpersonal interactions, including changes in family structure or functioning, school moves, peer group changes, and alterations in societal and community expectations (Hansen, Watson-Perczel, & Christopher, 1989; Petersen & Hamburg, 1986). Social interactions and relationships become increasingly complicated and adultlike during adolescence. The peer group becomes larger and more complex, more time is spent with peers, and interactions with opposite-sex peers increase (Berndt, 1982; Csikszentmihalyi & Larson, 1984; Petersen & Hamburg, 1986). Adolescents must make a transition from the primarily same-sex interests and playmates of childhood to increased opposite-sex interests and friendships. For example, Csikszentmihalyi and Larson (1984) found that high school freshmen spent 44% of their time in same-sex groups and 4% in opposite-sex dyads, whereas seniors spent 21 % of their time in samesex groups and 24% in opposite-sex dyads. Interactions and relationships with same- and opposite-sex peers are necessary for social development and, thus, may be related to adjustment and coping with the challenges of adolescence (ef. Hansen, Giacoletti, & Nangle, in press; Petersen & Hamburg, 1986). It is important for a youth to be socially involved with peers to facilitate the development of social skills, a sense of belonging with a peer group, and emotional and behavioral adjustment (Csikszentmihalyi & Larson, 1984; Hansen et al., in press). Socia! interactions may be critical for an adolescent's adjustment in a number of ways, such as (a) establishing support systems for emotional and social needs; (b) developing moral judgment and social values; (c) improving or maintaining self-esteem; (d) promoting interpersonal competence and adultlike socia! behavior; (e) developing independence assertion to aid in separation from the family; (f) recreation, including entertainment and sexual stimulation; (g) enhancing status within the peer group; (h) developing sexual attitudes, interests, and sex role behaviors; (i) experimentation' particularly with sex role behaviors and sexual activity; and G) courtship and mate selection (Damon, 1983; Hansen et al., 1992; Hansen et al., in press). The recognition that social interaction problems during childhood and adolescence have implications for current and future adjustment

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has led to a great deal of research on remediation of social deficits, although most of the research has occurred with children (cf. Elliott & Gresham, 1993 [this issue]; French & Tyne, 1982). Fortunately, in recent years, the research on social-skills interventions with persons of all ages has moved beyond basic skill acquisition procedures toward techniques designed to promote both the generaIization and maintenance of an effective interpersonal repertoire (Hansen, WatsonPerczel, & Christopher, 1989). This article reviews relevant empirical literature for current issues and procedures in social-skills training with adolescents, including use of social-skills interventions for a variety of adolescent populations and problems, use of innovative and promising intervention procedures, and issues regarding generalization and social validity of intervention procedures. The full range of adolescent development is discussed, from young adolescents (e.g., age 12) to adolescents in college.

PROMISING USES OF SOCIAL-SKILI.S ThITER~ONS~SPE~C

POPULATIONS AND PROBLEM AREAS

Since it became a popular intervention in the early 1970s, increasingly diverse-PoPulations and behavior problems have heen treated or partiaI1y treated with social-skills training. The following review briefly examines several problems experienced by adolescents that have heen a recent focus of social-skills interventions. The emphasis is primarily on exemplary and promising procedures. For a detailed summary of the literature on social-skills training with adolescents, see the review by Hansen, Watson-Perczel, and Christopher (1989). SUBSfANCEABUSE

The use of scare tactics in the late 1960s and the teaching of underlying causes of substance abuse in the mid 1970s were not effective methods of preventing substance abuse (Forman & Neal, 1987). Given that peer influence (e.g_, modeling and attitude) has heen identified as a significant factor across substances such as alcohol, marijuana, and

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cigarettes (Ary, TIldesley, Hops. Lichtenstein, & Andrews, 1988), it is not sutprising that effective school-based prevention programs have begun to focus on helping the adolescent develop personal and social coping skills (Fonnan & Neal, 1987). The prevention programs typically focus on assertiveness training, communication strategies, problem-solving and decision-making skills, and relaxation techniques (cf. Forman & Neal, 1987). The Say It Straight (SIS) program utilizes a combination of intervention approaches by training communication, decision-making, and assertiveness skills (e.g., Englander-Golden, Elconin. & Miller, 1985; Englander-Golden, Elconin, Miller, & Schwarzkopf, 1986; Englander-Golden, Elconin, & Satir, 1986). In evaluations of the SIS program, adolescents developed role-play situations in which they wanted to say no but had difficulty and also developed situations in which they wanted to talk with a friend who was using drugs. They role-played these situations using a variety of communication styles (e.g., passive, aggressive, assertive). These situations were videotaped, and the adolescents received feedback from peers about their verbal and nonverbal messages. The adolescents then practiced the styles that they found to be most effective. The results on the effectiveness of the SIS program have heen very promising. In addition to demonstrating more assertive attitudes than the control group, the schools using the SIS program also had fewer alcohol- or drug-related school suspensions and referrals (Englander-Golden et al., 1985; Englander-Golden, Elconin, et al., 1986; Englander-Golden, Elconin, & Satir, 1986). Gilchrist, Schinke, Trimble, and Cvetkovich (1987) used a "culturally tailored" 100session skill enhancement program to teach decisionmaking, interpersonal, and communication skills to prevent substance abuse among 39 Native American adolescents. The investigators used culturaIly relevant assessment procedures (e.g., the Self-Image Scale for American Indians) and trainers (i.e., Native American research staff member with an indigenous community leader, such as a teacher or counselor). At a 6-month follow-up, the intervention participants had better interpersonal skills for managing pressures to use drugs, and they had lower rates of alcohol, marijuana, and inhalant use than the 58 control subjects.

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Social-skills intervention has become an essential part of current substance abuse prevention efforts, and programs that include behavioral-skills training appear to have the most success. Some of the recent research has been characterized by attempts to enhance the relevance of the intervention for specific target subjects by engaging the adolescent in the development of the program or attempting to make it culturally relevant (e.g., Englander-Golden et al., 1985; Englander-Golden, Elconin, et al., 1986; Gilchrist et al., 1987). For. more information on substance abuse prevention programs, the reader is encouraged to see the review by Forman and Neal (1987). BEHAVIORAL AND EMOTIONALD/SfURBANCFB

Adolescents with a variety of behavioral and emotional disturbances have been the focus of social-skills interventions, including aggression, conduct disorders, and juvenile delinquency. The aggressive and disruptive behavior of adolescents can make their own lives, as well as the lives of others, more difficult; estimates suggest that as many as 39% of the arrests for homicide, robbery, rape, aggravated assault, burglar;, motor theft, larceny, and arson are accounted for by juveniles (Feindler & Ecton, 1986). Many researchers have been conceptualizing aggressive and disruptive behaviors as indicating a skills deficit problem and have examined various techniques to train alternative nonaggressive and nondisruptive behaviors effectively (e.g., Englander-Golden, Jackson, Crane. Schwarzkopf, & Lyle. 1989; Feindler & Ecton, 1986; Feindler, Ecton, Kingsley, & Dubey, 1986; Kolko, Dorsett, & Milan, 1981). Investigators have intervened directly in the adolescents' school environment to maximize the potential for generalization of the newly learned skills. Englander-Golden et al. (1989) examined the long-term effectiveness of the school-based SIS program. described earlier, in reducing the destructive behaviors of 357 adolescents. This preventionoriented social-skills training package demonstrated significant differences between trained and untrained adolescents over a 1.5-year period. For example, untrained adolescents committed approximately 4.5 times more criminal offenses than the trained students, and their offenses were more severe.

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Social-skills training is an important part of intervention eff~rts for adolescents with anger control problems (e.g., Feindler & Ecton, 1986; Feindler et al., 1986; Kolko et al., 1981). For example, a comprehensive self-management program has been developed and used by Feindler and her colleagues to teach adolescents to modify their own arousal and behavior in difficult situations (e.g., Feindler & Ecton, 1986; Feindler et al., 1986). The 12-session group anger-control program consists of identifying the situational variables that trigger anger responses, relaxation training, self-cue training to remind subjects to calm themselves down, assertion training, evaluating the potential negative consequences of anger and aggression, training in the use of coping statements, and problem-solving training. Siguificant increases in appropriate verbalizations and a decrease in hostile verbalizations during role-play assessments have been demonstrated for adolescents in a residential program (Feindler et al., 1986). The treatment subjects also received fewer fines from the preexisting contingency-management system than did the control subjects (Feindler et al., 1986). Assessment of the adolescents' behavior outside the institutionalized setting was not obtained. Pentz (1980) .examined the effectiveness of various methods to teach assertion skills to unassertive and aggressive adolescents. The methods were structured leaming training (SLT) conducted by teachers, parents, or peers; verbal instructions by teachers; and no-treatment control. SLT was a combination training approach that included audiotaped and live modeling, rehearsal, feedback with social reinforcement, and practice of assertive behaviors. Results indicated that the three-session SLT training package led to improved assertive behavior on self-report measures and an in vivo problem situation assessment. Although the parent and peer SLT groups were effective, the teacherled SLT groups were even more assertive in teacher situations, suggesting the importance of enhancing the similarity between the training and in vivo situations. Additionally, the study indicates that a relatively brief intervention by others in the adolescent's environment can result in behavior changes. Elder, Edelstein, and Narick (1979) used a group format to teach four inpatient aggressive adolescents appropriate means of interrupting, requesting behavior change, and responding to negative comrou-

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nications. Results indicated that the training improved social appropriateness on role-played scenes and generalized to the adolescents' lunchroom and dayroom settings. Other research with inpatient aggressive youth has found similar improvement on role-play assessments but inconsistent generalization effects across subjects (e.g., Bornstein, Bellack, & Hersen, 1980). Conversational-skills training has been evaluated in a number of studies with behaviorally and emotionally disordered adolescents (e.g., Hansen, St. Lawrence, & Christoff, 1989; Maloney et al., 1976; Minkin et al., 1976; Plienis et al., 1987). For example, Hansen, St. Lawrence, and Christoff (1989) conducted group conversationalskills training with two groups of inpatient youth (four males, five females). Conversational component behaviors (e.g., questions, appropriate self-disclosure, speech acknowledgers) at baseline were compared to the behaviors of normal, community youth to determine target behaviors and criterion levels for training. Intervention effects were replicated across both groups and indicated that training resulted in improved ratings of conversational skill by trained raters and nonpatient peers. These effects generalized to conversations with unfamiliar persons and in vivo conversations in the cafeteria, and maintained through 1- and 3-month follow-up assessments. Tisdelle and St. Lawrence (1988) conducted social problem-solving training with inpatient adolescents, using a similar group format. Although the group of eight adolescents exhibited verbal improvement on the problem-solving component skills in response to hypothetical problem vignettes, the improvements did not generalize to problematic situations in a more naturalistic setting. Plienis et al. (1987) used both conversational and social problemsolving skills with a group of three emotionally disturbed adolescents. A variety of improvements were noted in unstructured conversations with unfamiliar teenagers, responses to scenarios of social problems, teacher ratings of adjustment, interactions during informal class parties, and scores on self-report measures of depression, self-esteem, and loneliness. A procedure referred to as "reciprocal social-skills training" has been used with delinquent adolescents and their parents (Serna, Schumaker, Hazel, & Sheldon, 1986). The youth were taught to give

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positive and negative feedback, accept negative feedback, negotiate, resist peer pressure, follow instructions, and use problem-solving skills. The parents were taughtreciproca1ly complementary social skills (i.e., accepting positive and negative feedback, giving negative feedback, negotiation, giving instructions, and facilitating problem solving). Results indicated that training increased performance of social skills for both parents and youths. When parents were involved in the training, observers and judges rated the parent-adolescent relationship higher than when parents were not involved in the training. Maintenance of posrtraining skill levels were evident at the IO-month follow-up. ADOLESCENTS WITH DEVELOPMENTAL DELAYS

The developmental tasks of adolescence, such as functioning effectively in school or work and building a sense of friendship and intimacy, can be difficult for the average adolescent. For the adolescent with a developmental disability, the difficulty in achieving these tasks may lead to considerable distress and criticism. Interventions used with handicapped adolescents have included a broad range of target behaviors and techniques. Adolescents with moderate to severe mental retardation have been successfully taught conversational skills (e.g., Bradlyn et al., 1983; Kelly, Furman, Phillips, Hathorn, & Wilson, 1979; Kelly, Wildman, Urey, & Thurman, 1979). With severe deficits in functioning, the initial target behaviors may be very basic. In a study by Matson et al. (1988), three adolescents with severe mental retardation were taught to maintain eye contact and to remain on task and in their seat. The behaviors were trained through verbal or physical prompts, verbal praise, and edible rewards. The skills were frrst taught in a separate setting, and they were then targeted in the classroom. All three adolescents showed marked improvement on the targeted behaviors. Adolescents with autism have also been tanght social skills. Using a novel intervention, Groden and Cautela (1988) taught social initiation skills to t.'rree children with autism. The procedure consisted of a modified covert reinforcement imagery procedure in which the therapist described the subject initiating a highly rewarding social interaction. After the intervention, the subjects exhibited increases in their

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verbal initiations. The direct effects of the covert reinforcement are difficult to assess, given that it was part of a treatment package consisting of a play environment, appropriate toys, verbal prompts to play with other children, and covert reinforcement. The study does, however, suggest a Unique alternative to social-skills training. Gaylord-Ross, Haring, Breen, and Pitts-Conway (1984) taught three adolescents with autism to use leisure objects and then taught them to initiate interactions with nonbandicapped peers. Through verbal reinforcement and verbal and physical prompts, the adolescents were taught to initiate, maintain, and terminate an interaction that revolved around the use of one of the three leisure objects. Not only were adults used as the trainers, but six peer trainers were also used to promote generalization of the social-skills to other peers. These social skills generalized to other nonbandicapped peers in the same environment In studies in which the trainers consist of adults only, generalization to unfamiliar peers is more questionable. Fortunately, researchers have begun to conduct a more thorough assessment of the impact of their intervention. For example, Tofte-Tipps, Mendonca, and Peach (1982) taught social skills through instruction, modeling, rehearsal, and feedback, to a girl with mild mental retardation and a boy who had consistently been placed in special education classrooms. Although the adolescents' social-skills improvements generalized to novel roleplay scenes and conversations with adults, they did not generalize to conversations with unfamiliar peers. ADOLESCENTS WITH HEARING AND VISUAL IMPAIRMENTS

As with other adolescent populations, hearing or visually impaired adolescents may exhibit social-skill difficulties. In one study, a deaf adolescent female was referred because of difficulty maintaining interactions and lack of assertiveness (Lemanek & Gresham, 1984). Through an eight-session training program, the subject was taught to improve her communication (i.e., signing) content, duration, and response latency. These were taught through role-play scenarios, instructions, feedback, modeling, behavior rehearsal, and social praise. Problem situations encountered at home, school, and work were also

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discussed. Although communication improvements were evidenced during training, minor decreases in the target behaviors were found at follow-up. In a similar study involving four hearing-impaired adolescents, roleplay scenarios were used to train appropriate social-skills (Lemanek, Williamson, Gresham, & Jensen, 1986). In this study, however, discussion of problem situations encountered at home, school, and work were followed by social-skills training on these situations. Generalization of improvements in social skills was evidenced in analogue situations and novel role-play scenes. A social-validation questionnaire completed by the adolescents and their parents supported the effectiveness of the program, including increases in self-confidence, social initiations, and appropriate responses in social interactions. As with the previous study, this study did not directly assess improvements in social interactions in the natural setting. Although the social-skill deficits in visually impaired adolescents may not be as pervasive as was previously believed (Ammerman, Van Hasselt, Hersen. & Moore, 1989), there is certainly need for intervention with some visually impaired youth. In a study by Sacks and Gaylord-Ross (1989), 15 visually impaired students who had socialskills deficits were placed into one of three conditions. The teacherdirected condition consisted of the teacher individually teaching each student through modeling, role-play, and verbal feedback. In the peermediated condition, the visually impaired students were taught social skills by trained non-visually impaired peers from their mainstreamed classes. The third group was a control group. Both teacher-directed and peer-mediated conditions showed success in skill acquisition; however, only the students in the peer-mediated condition showed significant generalization and maintenance of social behaviors. m:rEKOSOClALPROBLEMS

Heterosocial problems are widely prevalent among adolescents. Unfortunately, heterosocial-skills interventions with adolescents have focused almost exclusively on the problems associated with the early stages of dating among college students, such as date initiation (e.g., Arkowitz, Hinton. Perl, & Himadi, 1978; Christensen & Arkowitz,

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1974). The many significant problems related to sexual activity among adolescents, such as unwanted teen pregnancy, AIDS and other sexually transmitted diseases, date rape, and dating violence, have been largely ignored (Hansen eta!., 1992). Failure of the social-skills intervention literature to address sexual interactions is particularly disturbing, considering reports by adolescents that the social interactions surrounding sexual activity are the most problematic beterosocial situations (Knox & Wilson, 1983; Mueblenhard & Linton, 1987). There is preliminary evidence suggesting that social-skills deficits are related to such problems as inadequate contraceptive behavior and date rape (Balassone, 1989; Beck & Davies, 1987; Lundberg-Love & Geffner, 1989; Nangle & Hansen, 1993). An example of how socialskills· procedures can be used to help prevent problems related to sexual interactions between adolescents is provided by Schinke, Blythe, and Gilchrist (1981). A combination of assertion and problem-solving skills training procedures was employed in an intervention aimed at improving the contraceptive bebavior of a small group of bigh school seniors. Ratings of posttraining videotapes of role-play performances indicated that the treatment group received bigher ratings than the control group in the use of eye ·contact, declarative ''no'' responses, statements expressing refusal to risk pregnancy, and requests that partners share responsibility for contraception. Most important, the intervention was effective in improving the actual contraceptive practices of these adolescents at 6-month follow-up. Warzak and Page (1990) successfully used a similar training procedure to teach refusal skills to sexually active adolescent females. The application of social-skills training to the heterosocial-sexual problems of adolescents is an exciting and much-needed area for future intervention research (Nangle & Hansen, 1993). However, the increasing rates of problems related to the sexual behavior of adolescents, especially the current AIDS health crisis, might pressure researchers to employ social-skills training procedures before muchneeded aSsessment research is conducted. More research is needed to determine and empirically validate exactly what specific skills are associated with competent sexual interactions. The failure to demonstrate that behaviors targeted for intervention are actually related to successful interpersonal interactions is a general weakness of the ado-

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lescent social-skills literature (Hansen, Watson-Perczel, & Christopher, 1989).

PROMISING FEATURES OF ADOLESCENT SOCIAL-SKlLLS INTERVENTION PROCEDURES

Promising and innovative features of adolescent social-skills intervention procedures are reviewed in the following section. The procedures discussed include group training, problem-solving training, peer-mediated interventions, training of individuals in the natura! environment, and self-management training. In addition, the use of videotape in social-skills training is discussed. Although the procedures are described separately for ease of discussion, interventions with adolescents typically consist of a combination of several procedures. GROUP TRAINING

Group training is frequently used in social-skills interventions with adolescents (e.g., Bierman & Furman, 1984; Christoff et a1., 1985; Hansen, St Lawrence, & Christoff, 1989; Kelly, Wildman, Urey, & Thurman, 1979; Kirkland, Thelen, & Miller, 1982; Plienis et al., 1987). Typically, the procedures used for social-skills training with individuals are applied to the group. These procedures usually include skill instruction and rationale, modeling, rehearsal, and feedback. The group-training format has many potential advantages. A major advantage of group training is time and cost efficiency. This makes group interventions more practical and feasible than individual interventions in applied settings. In an intervention designed to prevent substance abuse among adolescents, Englander-Golden, Elconin, et al. (1986) were able to teach assertion skills to 1,055 adolescents using a school-based group-training format. These skills were taught to groups of approximately 30 students in 5-7 sessions. Group training might also increase the effectiveness of social-skills training interventions by creating increased opportunities for the modeling and rehearsal of skills (e.g., Bierman & Furman, 1984; Bradlyn

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et aI., 1983; Hansen, St. Lawrence, & Christoff, 1989). For example, Hansen, SI. Lawrence, and Christoff (1989) had subjects rehearse conversational behaviors in front of the group and then practice the same skills in dyads, while the therapist gave feedback and praise. Immediately following each session, the subjects were randomly assigned to dyads and instructed to practice the sk:i1ls learned in session, These dyadic conversations were video recorded and later rated for the component behaviors exhibited by each subject. This increased exposure to multiple stimulus and response exemplars might also facilitate the generalization of group-training interventions (Hansen, Watson-Perczel, & Christopher, 1989), The potential advantages of group training are in need of empirical evaluation. Group social-skills training does have potential drawbacks, It is often very difficult to keep each adolescent actively involved and interested (Hansen, St. Lawrence, & Christoff, 1989), In addition, group training is difficult to tailor to the needs of individuals. Targets for intervention are typically selected because the group displays common deficiencies in the sk:i1l areas, Another difficulty with group interventions is evaluating each individual's response to treatment because a focus on group means can mask the individuals' responses to treatment. In addition, interventions for groups of subjects often require control groups for comparison. Researchers have used an extension of the multiple baseline design to help address these potential problems (e,g" Hansen, SI. Lawrence, & Christoff, 1989; Kelly, WIldman, et aI., 1979). Tbe usual single subject application of the multiple baseline design is replaced by a "single group" application. CompOnent skills are taught to the group sequentially over time in a multiple baseline fashion, This eliminates the need for control groups, provides data for each individual, provides a larger data base, and is a cost- and time-efficient strategy.

Dawson, French, & Unis, 1987; Plienis et aI., 1987; TIsdelle & St. Lawrence, 1988), Most problem-solving procedures follow the general outline suggested by D'Zurilla and Goldfried (1971), which includes the following components: (a) goal definition, (b) generation of alternatives, (c) evaluation of alternatives, and (d) generation of a plan for implementation. When applied specifically to social problems, the focus of training might be helping an individual to plan practical ways to meet others, discriminate when and with whom to initiate interactions, and generate effective methods for maintaining appropriate interactions and resolving interpersonal conflicts (e.g., Christoff et aI., 1985; Plienis et ai" 1987). Because it is a cognitive and verbal strategy, problem-solving training can be easily employed in any setting. This ease of use is a major advantage in the treatment of inpatient or incarcerated adolescents, because other potentially effective interventions (e.g., parent training, peer-mediated social-skills interventions) are often not practical, given environmental constraints and logistical problems, Because problem-solving training combines skills training with cognitively based rules and strategies, there is a potential advantage of increased generalization of effects (Plienis et aI., 1987). Despite the increasing use of problem-solving training, there is a dearth of sound research supporting its effectiveness. Few studies assess the acquisition of actual problem-solving skills, and even fewer address the issue of social validity (see Kazdin et aI., 1977, and TIsdelle & SI. Lawrence, 1988, as exceptions). The failure to assess the acquisition of actual problem-solving skills makes it almost impossible to evaluate the generalization and validity of interventions. In addition, there is a significant need in the literature for methods to assess the ability of problem-solving skills to mediate behavior (TIsdelle & SI. Lawrence, 1988).

SOCIALPROBLEM-80LVING TRAINING

PEER·MEDIATED INTERVENTIONS

One current trend in social-skills training with adolescents is the growing use of social problem-solving training, either as a component of a broader intervention or as the focus of intervention (e.g., Christoff etal, 1985; Hansen, MacMillan, & Shawchuck, 1990; Kazdin, Esveldt-

Recent investigations have demonstrated the utility of peer-mediated intervention with socially isolated elementary school children (e.g" Christopher, Hansen, & MacMillan, 1991; Guevremont, MacMillan, Shawchuck, & Hansen, 1989). Peer-mediated intervention is an infre-

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quently used, but promising, addition to adolescent social-skills training (e.g., Biennan & Furman, 1984; Hansen et aI., 1990; Sacks & Gaylord-Ross, 1989). In peer-mediated interventions, a target child's peers become active treatment agents. For example, after training conversational and social problem-solving skills to a socially rejected and isolated 14-year-old autistic female, Hansen et al. (1990) utilized a peer-helper intervention to facilitate generalization and maintenance in the natural environment (i.e., high school). The two peer belpers were students in the same school who were taught to initiate and maintain conversations with the subject, respond to refusals to interact, and respond to negative behaviors. Increased positive interactions with other adolescents were achieved. In general, the peers selected as "helpers" meet some specified criteria, such as regular school attendance and compliance with adult instructions (e.g., Christopher etal., 1991; Guevremontetal., 1989). The major advantage of peer-mediated procedures is their potential ability to facilitate and maintain the generalization of treatment effects in the child's natural environment (Hansen, Watson-Perczel, & Christopher, 1989; Hansen et aI., 1990). Peer-mediated interventions increase the youth's opportunity to contact the natural reinforcing contingencies that help maintain positive social behavior, while directly addressing the negative attitudes and responses of the peer group that help to maintain the withdrawal of social behavior. Efficient use of therapist time is another significant advantage of peer-mediated interventions. There are some potential concerns with peer-mediated approaches. Involving an adolescent's peers in the intervention makes the maintenance of confidentiality more problematic (Hansen et al., 1990). Another concern with peer-mediated interventions is the lack of research directly evaluating the effects of participation on the peer helpers themselVes. TRAINING INDIVIDUALS IN TIlE NATURAL ENVIRONMENT

Conducting interventions in the natural environment is a welcome trend in social-skills training with adolescents (e.g., Anderson, Rush, Ayllon, & Kandel, 1987; Bierman & Funnan, 1984; Englander-

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Golden, Elconin, et al., 1986; Gilchrist et ai, 1987; Hansen et ai, 1990; M. F. Jackson & Marzillier, 1982). Such interventions might provide advantages over typical office-based social-skills training programs, which often fail to demonstrate generalization to the natural environment Intervening in the natural environment also allows the treatment of individuals who are unable to come into a clinic or other treatment setting. The opportunity to intervene with individuals in the natural environment, however, may not be available to many therapists. SELF·MANAGEMENT TRAINING

Teaching adolescents the skills necessary for self-management is another procedure with possible implications for social-skills training (e.g., Groden & Cautela, 1988; Smith, Young, West, Morgan, & Rhode, 1988). For example, adolescents can be trained to evaluate their own behavior, compare self-ratings to teacher ratings, and select appropriate reinforcement for accurate self-ratings (Smith et aI., 1988). Self-management training addresses a major problem with external management programs, which is the control of behavior when the "manager" is not present (Smith et al., 1988). In addition, such interventions may facilitate the maintenance and generalization of treatment gains (RhOde, Morgan, & Young, 1983). However, the application of self-management procedures to social-skills training may prove difficult, as it is likely that adolescents with deficits in social behavior will also have deficits in their abilities to monitor and evaluate their own social behavior. USE OF VIDEO TECHNOLOGY

Advances in video technology offer many exciting opportunities for social-skills training with adolescents (e.g., Elias, 1983). Methodological advantages include the standardization of interventions and variables (enhancing ability for replication and comparison), improvement of pre- and posttraining assessments, minimization of trainer effects due to standardization of presentation, and the ability to investigate post hoc hypotheses (cf. Harwood & Weissberg, 1987). Video can be helpful in teaching adolescents to change nonverbal behaviors

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and discriminate nonverbal social cues. In addition, the use of video can facilitate discussion of topics that make adolescents feel uncomfortable, minimize the potential distractions of live modeling, and improve the ability of the trainer to select appropriate models (cf. Harwood & Weissberg, 1987). Video presentations might also be easier for the adolescent to understand than verbal presentations. Fmally, the use of video might make social-skills assessment and training more accessible for individuals through its use in the home, school, and so on (Walther & Beare, 1991). The full potential of video technology remains to be developed and evaluated.

ADDrnONALGENERAUZATION AND SOCIAL VALIDATION ISSUES ASSESSING AND PROGRAMMING GENERALIZATION

Generalization of skills from the clinic or laboratory to real-life problem areas is an obviously important issue. Most intervention studies with adoiescents assess the generalization of treatment effects (Hansen, Watson-Perczel, & Christopher, 1989). Studies have assessed generalization of social-skills interventions to the following: (a) interactions with novel persons, including peer-aged individuals (e.g., Hansen et aI., 1990; Kelly, Furman, et al., 1979); (b) other settings, such as a play area (e.g., Kelly, Furman, et al., 1979) or a school lunchroom (e.g., Bierman & Furman, 1984); (c) other or new situations to demonstrate generalization, such as novel role-play or novel problem situations (e.g., Elder et al., 1979; Plienis et aI., 1987; Tisdelle & St. Lawrence, 1988); (d) actual interactions during in vivo contrived situations (e.g., Tisdelle & St. Lawrence, 1988); and (e) interactions with peers in the natural environment (e.g., Hansen et aI., 1990; Rhodes, Redd, & Berggren, 1979). Maintenance of treatment gains has been assessed for periods from 2 weeks to I year (e.g., Bomstein et al., 1980; Elias, 1983). The time and cost involved with direct observation of peer inleractions has often prevented clinicians and investigators from utilizing this assessment technique. From a clinical and empirical standpoint,

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the necessity for some type of direct assessment of peer interactions as a fmal check on the intervention should not be neglected. Generalization of treatment effects to interactions with peers should never be assumed (Hansen, Watson-Perczel, & Christopher, 1989). Practical, efficient methods of evaluating generalization may be necessary. For example, assessments with familiar or unfamiliar peer-age youth may be conducted periodically to "probe" for generalization, and assessments with adult role-play partners may be used more frequently to monitor the impact of intervention (e.g., Hansen et al., 1990; Rhodes et al., 1979). As described earlier, a variety of techniques designed to promote generalization have been used (cf. Hansen, Watson-Perczel, & Christopher, 1989), including use of group training to increase exposure to multiple stimulus and response exemplars, social problemsolving training, and peer-mediated interventions. Although the use of novel partners for interactions (e.g., Kelly, Furman, et al., 1979; Tofte-Tipps et al., 1982) and use of multiple, novel problem situations (e.g., Tisdelle & St. Lawrence, 1988) are generally described as assessment procedures, these procedures also seem to function as repeated exposure to multiple exemplars. Introduction to natural maintaining contingencies and programming common stimuli may also facilitate generalization of treatment effects (Stokes & Baer, 1977; Stokes & Osnes, 1989). For example, Bierman and Furman (1984) found with preadolescents that a group experience designed to promote involvement with peers increased peer acceptance and selfperceptions of social-efficacy. It is encouraging that many investigators have gone beyond the train-and-hope method of achieving generalization (Stokes & Baer, 1977; Stokes & Osnes, 1989). SOCIAL VALIDATION

For the most part, social-skill interventions have consisted of teaching subjects behaviors that therapists assume are important, to levels that therapists assume are appropriate (Hansen, Watson-Perczel, & Christopher, 1989). A social-validational approach to social-skills intervention is more suitable (Hops, 1983; Kazdin, 1977). Socially relevant target behaviors should be increased to clinically and functionally

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significant skill levels, using socially acceptable intervention procedures. The ultimate goal of social-skills intervention is to increase l"'er acceptance and interaction and increase the subject's satisfaction with peer relations and social perfonnance by using procedures that the subject and the subject's significant others find acceptable. Investigations on social-skills training should include (a) selection of socially valid behaviors and criterion levels for training, (b) demonstration of socially valid improvements in perfonnance and peer acceptance, and (c) evaluation of acceptability of treatment goals, procedures, and effects by the subject and others in the environment.

Selection of socially valid behaviors and criterion levels for training. Unfortunately, many clinicians and researchers choose the specific components to be trained on the basis of face validity alone and arbitrarily judge improvement without reference to criterion levels that may be appropriate in the youth's social setting (Hansen, St. Lawrence, & Christoff, 1989). In recent years, however, a number of procedures have been utilized to select socially valid behaviors and criterion levels for training, including (a) examining the relationship between global ratings of social skill and ratings of specific social-skill component behaviors (e.g., Hansen, St. Lawrence, & Christoff, 1989; H. J. Jackson & Bruder, 1986; Minkin et aI., 1976); (b) use of "social~validation samples" to show that the subjects are deficient in particular behaviors when compared to similar-age, same-sex "normal" peers who are successfully functioning (e.g., Hansen, St. Lawrence, & Christoff, 1989; Ttsdelle & St. Lawrence, 1988); (c) use of staff or teacher ratings of desired social behaviors (e.g., Elder et aI., 1979); and (d) use of a peer survey regarding socially desired behaviors (e.g., Plienis et aI., 1987). Certainly one of the most accurate means of establishing criterion levels for training is to assess the levels of the behaviors exhibited by youth in interactions in the natural environment. Determining the appropriate levels of specific behaviors, such as eye contact, is obviously difficult, but determining levels of global behaviors, such as rates of social interactions or initiations in specific settings, is much more feasible (e.g., Hansen et aI., 1990). For example, investigators have assessed rates of positive social interaction of children in a target

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child's playground setting (i.e., "setting norms") for use in determining criterion levels for intervention (e.g., Christopher et aI., 1991). Investigators have also used similar procedures with adolescents in a high school lunchroom (e.g., Hansen et aI., 1990).

Treatment effectiveness. The most common social-validation procedure involves obtaining global ratings of overall competence within investigations that increase the frequency of specific component behaviors (e.g., Bradlyn et aI., 1983; Maloney et aI., 1976). This type of social-validation procedure is particularly useful if the global ratings are made by individuals similar to those with whom the subjects are likely to interact in the community (e.g., similar in age, sex, and other demographic characteristics). Numerous social-skills training investigations with adolescents have attempted to socially validate the effectiveness of treatment. Investigations have utilized a variety of procedures, including (a) ratings by unfamiliar adult judges (e.g., Bradlyn et aI., 1983; Maloney et aI., 1976; Minkin et aI., 1976; Rhodes et aI., 1979); (b) ratings by unfamiliar peers (e.g., Hansen, St. Lawrence, & Christoff, 1989; (c) ratings by peers in the natural environment (e.g., Bierman & Furman, 1984); (d) ratings by staff or teachers (e.g .. Elder et aI., 1979; Kazdin et aI., 1987); (e) comparisons with social-validation samples (e.g., Hansen, St. Lawrence, & Christoff, 1989; Minkin et aI., 1976; Tisdelle & St. Lawrence, 1988); and (f) documentation of improved social interaction in the natural environment (e.g., Bierman & Furman, 1984; Hansen et aI., 1990). Normative data from standardized rating scales (e.g., parent or teacher inventories) or self-report measures (e.g., loneliness or depression scales) can also provide useful social comparison information (e.g., Plienis et aI., 1987). Obviously, one of the best procedures is to observe the youth's social interactions in the natural environment unobtrusively and document pre- to posttraining improvements (e.g., Hansen et al., 1990). Measures of peer acceptance and subject satisfaction with performance, interactions, or relationships are especially underutilized. Treatment acceptability. One of the initial social-validation emphases was the acceptability of treatment to the subject and others in

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the environment (Kazdin, 1977). This includes the acceptability of the goals, procedures, and effects. Thus it is interesting that this aspect of social validation is notably absent in the social-skills training literature with adolescents. Because obtaining compliance with treatment can be a problem, an essential component of socially validating socialskills intervention should be to determine the acceptability of the intervention procedures for the adolescent (e.g., M. F. Jackson & Marzillier, 1982; Kazdin et al., 1987), parents and family members (e.g., Lemanek & Gresham, 1984), and teachers (e.g., Elias, 1983).

CONCLUSION

The research on social-skills intervention with adolescents, like the research with children and adults, has advanced considerably in recent years. There is much less reliance on office-based intervention to increase specific content or stylistic behaviors that were selected by the best guess of the clinician. There is clearly more effort to evaluate a variety of procedures that may facilitate the impact, genera1ization, and social validity of the intervention. In addition, there is more effort to apply social-skills interventions to a variety of populations and problems. Continued research should further elucidate the use and effectiveness of social-skills intervention with adolescents experiencing different types of problems and should further assess the impact of social-skills interventions on the actual social functioning and adjustment of adolescents, including during long-term follow-up. In addition to evaluating the effectiveness of social-skills interventions, future research needs to focus on the development of practical and efficient assessment and intervention procedures that are appropriate for the developmental issues and transitional period of adolescence.

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Anderson. C. G_ Rush. D_ Aylloo. T_ & Kandel. H. (1987). Tmining and generalization of social slcilIs with problem children. Joumm of Child and Adol..cent Psyclwv..rapy. 4. 294-298. Arl