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Autism Spectrum Disorder: Promoting Communication & Socialization Skills
Autism: Teaching Parents How to Prompt Communication & Socialization

Section 17
Social Story Interventions for Children with Autism

CEU Question 17 | CEU Answer Booklet | Table of Contents | Autism
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs, Nurse CEUs

Social Stories
Social Stories are an increasingly popular strategy for improving the social skills of children with ASD. A Social Story is an individualized short story that can be used to assist individuals with ASD in interpreting and understanding challenging or confusing social situations (Gray, 1997). The norms for behavior in a targeted context, the perspectives of others, and the specific steps for implementing the appropriate social skills are instructed and modeled through a short written story with picture cues. Specifically, “a Social Story is written to provide information on what people in a given situation are doing, thinking or feeling, the sequence of events, the identification of significant social cues and their meaning, and the script of what to do or say; in other words, the what, when, who and why aspects of social situations” (Attwood, 2000, p. 90). Essentially, a Social Story enhances an individual’s understanding of social situations and teaches an appropriate behavioral response that can be practiced by the individual. Subsequent social interactions allow for the repeated practice of the described behavioral response cue, and a new social behavior can be learned. In this sense, the story itself becomes a “how to” book for initiating, responding to, and maintaining appropriate interactions for individuals with ASD. Social Stories serve a wide variety of purposes, and they appear to be particularly helpful in facilitating the inclusion of students with ASD in mainstreamed classrooms (Gray & Garand, 1993).

Rationale for Social Stories
Social Stories are based on the growing consensus among researchers that children with ASD suffer from an inability to “read” and understand social cues and situations and the perspectives of others, as well as problems with formulating appropriate responses to such social events (Attwood, 2000; Baron-Cohen, 1995; Gray & Garand, 1993; Leslie, 1987, 1993; Mundy & Stella, 2001; Twachtman- Cullen, 1998). That is, individuals with ASD demonstrate significant difficulty identifying the behaviors, beliefs, and intentions of others. The logic follows that such impairments often lead to deficits in social communication such as following the conventions of maintaining a topic when speaking. Given these deficits, traditional instruction (e.g., direct instruction of skills, role plays, specific feedback) for children with ASD may have a less significant impact when compared to more typically developing peers. Traditional instruction involves an active interchange of reciprocal social interactions between the teacher and student. Considering that children with ASD often fail to interpret social cues accurately, such lessons may hold little meaning (Frith, 1989). Thus, the use of Social Stories to increase awareness and understanding of the what, when, who, and why of social situations may prove to be more beneficial because the child is using the story as the medium for learning, as well as a tool for understanding and internalizing appropriate behaviors necessary for successful social interactions.

Developing a Social Story Intervention
Gray (1995, 1998) and Gray and Garand (1993) outlined several basic steps necessary for developing a Social Story intervention.

First, the development of a Social Story involves targeting a specific problematic social situation that the Social Story will have as its focus. This target situation can be a specific social skill or a situation that has continued to be difficult for a child despite adequate interventions or environmental accommodations (Gray, 1995). Once a target situation is identified, the second step involves identifying the salient features of the context or setting (e.g., where a situation occurs, who is involved, how long it lasts, how it begins and ends, what occurs). Specifically, through direct observations and interviews with caregivers and teachers, information is gathered pertaining to the function and/or maintaining features of the inappropriate, or nonexistent, behavior(s). In addition, information is gathered regarding the child’s strengths and weaknesses, as well as his or her perspective on the targeted situation (Gray, 1995). It is important to note that this step is a data-collection phase and is crucial to establishing the frequency of behavior(s), as well as providing a basis for comparing the individual’s behavior during and following the Social Story intervention. Without this component, evidence-based outcomes are difficult to assess. After data have been gathered on the individual’s behavior, the third step involves sharing this information with the target child and other relevant individuals (e.g., teachers). Finally, this information is used to generate a Social Story. The focus of each story changes, but all Social Stories emphasize a specific skill and the behavioral steps necessary to successfully manage the target situation.

Guidelines for Writing Social Stories
Social Stories must be written with regard to the student’s comprehension level (Gray, 1995, 2000; Gray & Garand, 1993) and generally include multiple sentences of four basic types: (a) descriptive, which identify the contextual variables of the target situation; (b) directive, which assist in describing a desired behavior in response to a social cue or situation; (c) perspective, which describe the reaction and feelings associated with the target situation; and (d) affirmative, which express shared beliefs of a given culture. Gray (2000) recently incorporated two additional sentence types that may be used in a Social Story: control sentences, which provide the individual with understanding through the use of analogies, and cooperative sentences, which provide identifying information of who will provide help and how that help will be provided to the individual (Gray, 2000). Gray (1995, 2000) suggested using a balanced ratio of sentences throughout a Social Story. She outlined two Social Story ratios: The basic Social Story ratio consists of two to five descriptive, perspective, and/or affirmative sentences for every directive sentence in the story. The complete Social Story ratio is similar to the basic ratio but incorporates control and cooperative sentences. As a rule of thumb, it is customary for each complete ratio to have two to five descriptive, affirmative, or cooperative sentences for every directive or control sentence in the story (Gray, 2000). Within both of these ratios, the emphasis of the story is to describe more than to direct (Gray, 1998, 2000).

Social Story Implementation Guidelines
Although there are three basic ways for implementing Social Stories, selection of the most appropriate technique is dependent upon the individual abilities and needs of the target child (Gray & Garand, 1993). Social Stories can be (a) read, either independently or by a caregiver; (b) presented through audio equipment; (c) presented through a computer-based program; or (d) presented via videotape (Charlop & Milstein, 1989). Regardless of the implementation method, it is necessary for comprehension of the story to be assessed. Gray and Garand (1993) recommended two approaches: Have the student complete a checklist or answer questions in writing at the end of the story, or have the student role play, demonstrating what he or she will do the next time the situation occurs. Once comprehension has been assessed, it is suggested that an implementation schedule be created (Gray, 1995, 1998). The most essential consideration when implementing a Social Story is monitoring of student progress once the Social Story has been introduced, to demonstrate improved social outcomes.

Effectiveness of Social Stories
A review of the published research available on both the PsycINFO and the ERIC database regarding Social Story interventions for children with ASD yielded 10 studies relating to effectiveness. All of these studies utilized single-subject research designs to test the effectiveness of Social Stories. Two studies found in this search, Rowe (1999) and Smith (2001), were not included in this review due to the fact that neither reported specific behavioral outcomes. Both of these studies provide anecdotal information regarding the effects of Social Stories on children with ASD. However, without detailed information regarding methods and specific outcome data, it is difficult to determine any level of experimental control. Therefore, these studies do not provide compelling evidence that Social Stories were responsible for reported changes in behavior, and their results should be considered with caution. From the original search, eight studies were included for a detailed review and synthesis. Two of these eight studies (Norris & Dattilo, 1999; Swaggart et al., 1995) failed to demonstrate experimental control because they used an AB single-subject research design. Although included in this review, studies that utilized AB designs were considered pre-experimental because they do not permit the assumption of a functional relationship (Kazdin, 1982).

The remaining six studies employed the level of experimental control necessary to show that the Social Story intervention resulted in observable changes in target behavior(s) (i.e., functional relationship). These six studies demonstrated experimental control by using single-subject research designs that repeated the Social Story intervention several times and recorded its effect on the target behavior(s). Designs that met these characteristics included ABAB/reversal and multiple-baseline designs. In using such designs, potential confounding variables were reduced or eliminated to the greatest extent possible, and assumptions of functional relationships were established.

Aside from the importance of experimental control, the reviewed studies also were examined regarding treatment integrity, generalization, and social validity (Wolf, 1978). Treatment integrity refers to the degree to which interventions are implemented as intended (Gresham, 1989). Unfortunately, only one study (Scattone, Wilczynski, Edwards, & Rabian, 2002) employed a measure of treatment integrity. In addition, none of the reviewed studies referenced consideration of programming for generalization (e.g., natural contingencies, multiple environments), as recommended by Stokes and Baer (1977). Furthermore, none of the eight studies incorporated methods to compare the social behavior of children with ASD to that of typically developing peers, and only one study assessed the social validity (whether the intervention is acceptable by members of the community) of the intervention (Wolf, 1978). However, all of the studies reviewed did show efficacy of Social Story interventions with a variety of children with ASD.

Discussion
Overall, the empirical foundation regarding the effectiveness of Social Stories is limited. Although the published research demonstrates positive effects of Social Stories and provides preliminary support that Social Stories are effective with individuals with ASD, the results of previous research should be considered with caution. Due to a lack of experimental control, weak treatment effects, or confounding treatment variables in the reviewed studies, it is difficult to determine if Social Stories alone were responsible for durable changes in important social behaviors. Thus, it may be premature, based on the current literature, to suggest that Social Stories are an evidence-based approach when working with individuals with ASD. Although the research base is limited, it is likely that the use of Social Stories will continue. Given this, future research regarding the effectiveness of Social Story interventions is necessary.
- Sansosti, Frank, Powell-Smith, Kelly & Donald Kincaid, A research synthesis of social story interventions for children with autism spectrum disorders, Focus on Autism & Other Developmental Disabilities, Winter 2004, Vol. 19, Issue 4.

Personal Reflection Exercise #3
The preceding section contained information about social story interventions for children with autism.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 17
What is the rationale behind using social story interventions? Record the letter of the correct answer the CEU Answer Booklet.

 
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