Jacob Ciupe, 9, recently had a breakthrough: He told his mother he could tell she was happy.
Jacob hadn't recognized that emotion until he participated in a computer-based social skills program for children with high-functioning Autism Spectrum Disorder at Advocate Illinois Masonic Medical Center on Chicago's North Side.
Once Jacob started grasping how other people were feeling and better controlling his own emotions, interactions with peers were easier, said his mother, Lisandra Ciupe.
Jacob was already an honor student at Chicago International Charter School in Chicago's Bucktown neighborhood, but he lacked social finesse, she said.
"Before, he would not recognize what somebody was feeling or expressing," said Ciupe, of Chicago. "If somebody was angry, he couldn't tell unless the person shouted or said something mean."
The "Secret Agent Society" program offers 8-to-12-year-olds 26 weeks of computer games and lessons reinforced by group discussions and homework monitored by their parents. The Australia-based Social Skills Training Institute program uses an "avatar" that leads children through secret agent missions to identify emotions in people and choose appropriate responses to upsetting behavior like bullying.
Children also learn to express themselves appropriately, better manage frustrations and start, continue and end conversations with other people through the program.
Practitioners are required to complete training from the Social Skills Training Institute before leading the program.
A study published in The Journal of Child Psychology and Psychiatry in 2008 and led by Dr. Renae Beaumont, who developed the program, found that 76 percent of participating autistic children improved their social skills to the level of their peers without the disease.
"Sometimes feelings can be all or nothing," said Laura Mulford, hospital child psychologist who oversees the program. "It teaches them before they get extremely upset that there are a range of emotions and how they can cope with emotions at different levels."
On a recent Thursday afternoon, Jacob and four other children were using a hospital computer to identify the emotions of people in various scenarios on the screen.
After the computer session, Mulford led the children in an animated discussion about how they could better handle difficult situations through exercise, games, deep breathing, thinking pleasant thoughts or talking about their feelings. The children then wrote down on cue cards tips to remember when faced with anxiety.
Other sessions include games that reinforce what they have learned. Children get points for participation, positive interactions with classmates and a snack for their efforts.
Identifying other people's emotions is a big part of homework too. Teachers receive a tip sheet on the program, which includes hand signals children might use to show they are feeling upset and need to take a break.
Dr. Elizabeth Laugeson, who directs the University of California at Los Angeles' Program for the Education and Enrichment of Relational Skills (PEERS) clinic, an evidence-based social skills program for teenagers and adults with autism, noted that children with autism love video and computer games, making the "Secret Agent Society" program a good fit.
"So imagine you have a child with autism who really wants to make friends but doesn't know how to and is too socially anxious to even try. … Participating in a program like this might give him the jump start he needs to build his confidence and to practice in a virtual world before he uses the skills in the real world," Laugeson said.
Laugeson noted that further practice with other children outside of the sessions would be an important next step. Laugeson's PEERS program requires that kids practice skills they learn with peers in the real world.
Laura Schreibman, another autism expert, called the program "a good idea" because autistic kids have so much trouble relating appropriately to peers and making friends.
"This is the hardest nut to crack in autistic disorders … social cues and how to respond socially and be appropriate" said Schreibman, distinguished professor of psychology emeritus at the University of California at San Diego.