Increasing appropriate social interactions of children with autism spectrum disorders using Social Stories[TM].

To date there are more than one dozen studies that validate the use of Social Stories[TM] as an effective behavioral intervention. Many of these studies focused on decreasing inappropriate behaviors (e.g., aggression, screaming, and grabbing toys), and most combined Social Stories with another intervention. The present study used a multiple baseline design across participants to investigate the effectiveness of Social Stories when used as a sole intervention to increase the appropriate social interactions of 3 children with autism spectrum disorders toward peers both with and without disabilities. During baseline, participants demonstrated few appropriate social interactions, although all had some functional expressive language. An increase in appropriate social interactions occurred for 2 of the participants after the intervention was implemented. These findings suggest that Social Stories may be effective for some children with autism spectrum disorders; however, the population they best serve has not yet been fully identified.

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The impairment in social interaction that characterizes children with autism spectrum disorders (ASD) is severe and profound and may manifest itself in language, play, eye contact, and gestures (Kanner, 1943). Although many strategies successfully address this core deficit, a majority of these procedures require intrusive adult prompts, extensive time to train teachers and peers (Gonzalez-Lopez & Kamps, 1997; Zanolli, Dagget, & Adams, 1996), and, in some cases, the presence of an expert (K. Pierce & Schreibman, 1997). An intervention that is relatively simple for teachers and practitioners to implement is called Social Stories[TM] (Gray, 1998).

Social Stories are individualized short stories that may increase appropriate social interactions of children with ASD by teaching them the relevant components of a given social situation (Gray, 1998; Gray & Garand, 1993). They focus on describing and explaining the cues in that situation as well as teaching appropriate responses. Gray (2004) has suggested that the most successful stories adhere to a specific format and guidelines (see Appendices A and B). According to Gray (1998), Social Stories have been used to decrease fear, aggression, and obsessions; introduce a change in routine; teach academic skills; and teach appropriate social behavior; however, Gray herself has not empirically validated their use.

Social Stories are similar to other interventions, including self-management (i.e., K. L. Pierce & Schreibman, 1994) and written scripts (Krantz & McClannahan, 1993, 1998) because they identify necessary components of a given social situation in a written format. In addition, like self-management and scripting, Social Stories transfer stimulus control from the teacher and peers directly to the child with autism. Furthermore, Social Stories share similarities with priming strategies (Zanolli, Daggett, & Adams, 1996) because they "prime" the appropriate responses to a given social situation just before the social situation takes place.

Over the past 10 years, researchers have shown Social Stories to be successful when applied to a wide variety of problem behaviors including aggression, screaming, grabbing toys, using inappropriate table manners, and crying (Kuoch & Mirenda, 2003; Rowe, 1999; Scattone, Wilczynski, Edwards, & Rabian, 2002). Swaggart and colleagues (1995) were the first to empirically validate this intervention by teaching a young girl with autism appropriate greeting behavior and two boys--one with autism and one with a pervasive developmental disorder--how to share. Swaggart and associates observed a reduction in aggression as well as an increase in appropriate greetings and sharing for these participants. Researchers have also found Social Stories to be effective in decreasing tantrums (Kuttler, Myles, & Carlson, 1998; Lorimer, Simpson, Myles, & Ganz, 2002), cheating, and negative comments when playing games. These behavior changes may be maintained over time (Kuoch & Mirenda, 2003).

Scholars have also used some rather unique adaptations of the Social Story format. Moore (2004) developed Social Stories in order to assist a young child to sleep in his own bed. Brownell (2002) adapted the Social Story texts to an original tune and sang them with a guitar accompaniment to four participants in order to improve problem behaviors (i.e., loud vocalizations, scripting, and repeating instructions). Brownell found that Social Stories were just as effective when sung as they were when read to these participants.

Researchers have also investigated the effectiveness of Social Stories for skill acquisition. Hagiwara and Myles (1999) adapted Social Stories to a computer-based format in order to teach hand washing to two participants and on-task behavior to another. However, they observed only modest improvements from baseline to intervention. Barry and Burlew (2004) taught play skills and choice to two participants with severe autism. Improvements occurred, and the participants learned to play appropriately with materials and peers. Ivey, Herin, and Alberto (2004) successfully taught three children with Pervasive Developmental Disorder-Not Otherwise Specified (PDDNOS) to prepare for novel activities, including having a birthday party, making a purchase, and playing with unfamiliar toys.

Investigators have also examined Social Stories as a means for improving social interactions for children with autism. Norris and Dattilo (1999) created Social Stories in order to improve a young girl's initiations and responses to peers during lunchtime. They developed three Social Stories that included picture prompts, and each day they randomly selected and read to her one of these stories. Although inappropriate verbalizations decreased, all social interactions also decreased, suggesting either that the varied content of the Social Stories made it difficult for the participant to focus on more than one instruction or that Social Stories may need to be part of a treatment package that includes other interventions when targeting behavior as complex as social initiations and responses.

Many studies have combined Social Stories with other interventions, including verbal and pictorial prompts, behavior charts, reinforcement for appropriate responding, and, in one case, a social skills training methodology and a response cost system (Swaggart et al., 1995). Thiemann and Goldstein (2001) used a treatment package in their Social Story intervention for targeting conversation skills (i.e., initiations, requests, responses, and securing attention) for five participants with autism. They combined the Social Stories with verbal prompts, pictorial cues, and self-evaluative video feedback. The treatment package was effective for developing these skills, and Thiemann and Goldstein observed some generalized treatment effects across untrained behaviors. However, they did not assess individual components of the package, making it difficult for other researchers to determine the exact role that Social Stories played in the improvements for the participants.

Scattone et al. (2002) investigated the use of Social Stories as a sole intervention without the use of verbal or pictorial prompts or another intervention for three participants with autism. A reduction in disruptive behaviors (i.e., chair tipping and staring) occurred for two of the three participants. However, improvements for the third participant (i.e., regarding shouting) were modest at best.

To date, many of the studies involving Social Stories have been undertaken with the aim of reducing isolated inappropriate behaviors, with some investigations targeting skill acquisition and increases in appropriate social interactions. Also, many of these previous studies have included other interventions or components in addition to Social Stories. The present investigation focused on building and increasing appropriate social behaviors rather than decreasing behaviors by using Social Stories as a sole intervention. In addition, the present study aimed to correct some of the limitations of a previous study (Norris & Dattilo, 1999) that attempted to promote appropriate social interactions. This was accomplished by administering only one Social Story to each participant. Thus, the present study was designed to evaluate the effectiveness of Social Stories in increasing the appropriate social interactions of children with ASD toward their peers when used without other systematic behavioral intervention(s).

Method

Participants

Three boys between the ages of 8 and 13 years who had been previously diagnosed with an ASD participated in the study. These students were selected because they did not initiate or respond to peers either appropriately or at all during free-time activities, according to teacher report. Each student was a member of a self-contained special …