Girls with learning disabilities, attention deficits and pervasive developmental disorders commonly experience different degrees of social impairment. They can be referred to the Social Skills Program in our Child and Adolescent Outpatient Clinic at NewYork-Presbyterian Hospital-Westchester Division, coordinated by Jo Hariton, PhD. When compared to young boys, the number of young girls referred for social skills training is fewer, likely due to the lower prevalence of disruptive behaviors in group settings that are seen in younger girls compared to younger boys. However, as children grow and develop into adolescents and young adults, the prevalence of mood disorders like depression and anxiety, as well as eating disorders, is significantly higher among females.
This past summer, I developed through our outpatient department a group program for girls who were at high risk for being bullied, excluded by their peer group, lured into experimenting with illegal substances and developing a mood or other clinical disorder. The program was designed to empower each girl with necessary coping skills and tools to successfully manage challenges which could otherwise impede their optimal development. All girls completed an evaluation prior to joining the group to determine their eligibility. For this evaluation, the girls came accompanied by at least one parent. It offered an opportunity for them to ask questions about the program and for the group leader to assess their cognitive level, interests and goals as well as cohesion among prospective peers.
Eight 75-minute long sessions were offered and focused on social skills training around everyday issues. They included navigating relationships; dealing with bullies; strategies for diplomacy and problem solving; identifying one’s strengths and managing one’s weaknesses; understanding our changing bodies; achieving a healthy body image; educating oneself about nutrition, substances and medications; and achieving emotional and financial stability. The groups were led by a team of experts in Child and Adolescent Psychiatry and included games and discussions around a pre-selected topic, as well as some time outdoors if weather allowed.
The girls were separated in three different groups based upon their developmental needs and school grade level: elementary (3rd to 5th grade), middle (6th, 7th and 8th grade) and high school (9th through 12th grade) with a maximum of six girls in each group. They had the option to join as many or as few groups as they were able to participate in or interested in.
The format of the core curriculum for each unit was sensitive to and designed to accommodate the developmental differences among the three different age groups. As such, an introduction to the Cognitive Behavioral Therapy (CBT) model was incorporated in the unit to address strengths and weaknesses. The girls were invited to discuss how thoughts affect feelings and, much like the well-known domino effect, the direct impact of these feelings on the behaviors displayed in public and noted by others around us. Some exercises included vignettes from interactions at home with relatives or in school with peers which illustrated the connection between thoughts, feelings and behaviors; other times, a list of evidence against and evidence in favor of a previously identified belief or thoughts (i.e. “she doesn’t like me”) was completed. Girls were invited to use this skill in other situations back at home or in the community when meeting friends and peers. Similarly, clinical scales like the Children Depressive Inventory (CDI) and the Body Distortion Image in Children and Adolescents (BDI-CD) were used in all age groups to elicit measures of mood symptoms or body image distortion.
Although each unit was introduced with a unique set of projects, role plays, oral demonstrations and group activities, the girls often brought up for discussion real life scenarios that linked one or two of the topics together. For example, during the unit on problem solving the girls used examples that included difficult interpersonal relationships, bullying behaviors and/or issues about their developing bodies. Those girls who participated in more than one session had more opportunities to practice and review previously discussed skills.
A significant number of callers inquiring about the program had a special interest in the body image unit. A particular case is worth discussing because of the high level of distress that it brought to the family for an extended period of time. This young girl, who was 8 years old at that time, was verbalizing statements about her weight and how she was feeling “fat” despite reassurance from the pediatrician and family members to the contrary. Because of her mother’s past experiences with the girl’s older siblings, she was mortified and worried that not only were her daughter’s complaints increasing over time, but that the behaviors she was engaging in could endanger her health. Although initially the mother only wanted her daughter to participate in the body image unit, she considered and agreed to sign the girl up for the entire curriculum. While completing the bullying unit, the young girl provided details about the mean statements that this other girl in school was constantly sharing with anyone who cared to listen. Her mother was already aware of the bullying situation but the full content of the mean remarks and the vicious emphasis on weight and appearance were not fully disclosed until then. During the feedback session, the young girl taught her mother the strategies that from now on she was going to use. Mother agreed to remind her and practice these skills at home as frequently as needed in order to increase her daughter’s level of comfort and confidence. Mother later provided further feedback to the group leader a few weeks into the beginning of the academic year. She was pleased to report how much improved her daughter’s ability to handle situation in school with old and new peers was today in contrast to the last academic year. She was thankful for the opportunity and the gift of practical tools that the summer program offered to her daughter, and ultimately her family. As she stated, “these are tools that never get too old and could be used on more than one occasion to solve more than one problem.”
A parenting workshop was also offered to the legal guardians, where the skills introduced to the girls were taught to them as well. At the end of each session, every parent was asked to schedule an individual session with the group leader. Their daughters were invited to join them to discuss the skills taught and practiced during each unit. It was the goal of the program to enlist parents as their daughter’s personal coach beyond the group setting, transferring the role of the group leader to the family where the parents would ideally reinforce and encourage the practice of these skills. Hopefully, this strategy would allow the successful transition of the skills taught in the group setting to the lives of the girls in the community. It is in the community that these skills need to be practiced and reinforced again and again, in order to prevent the onset or an exacerbation of maladaptive behaviors.