What's the Story? What does the research say about how best to use social stories to help children with ASDs?

Transcription

1 What's the Story? What does the research say about how best to use social stories to help children with ASDs? by Tiffany L. Hutchins A universal feature of autism spectrum disorders (ASDs) is disruption in social cognition the ability to interpret thoughts and feelings of oneself and others. This disruption is related to struggles with behavioral, communicative, and social functioning. A young boy with an ASD might, for example, physically push a peer instead of asking her to step aside. Telling the boy not to push may seem like the default course correction. But a more promising approach may be to target the core social-cognitive deficit through a story that bolsters the boy's social understanding of the pushing event. Known in the literature as a "social story," the approach has become one of the most popular ways to address the social-cognitive difficulties characteristic of ASDs (Hess, Morrier, Hefiin, & Ivey, 2008; Reynhout & Carter, 2009). What's less clear, though, is what exactly social stories are and how best to use them. These questions are complicated because guidelines for using social stories have been offered not only by their originator educational consultant and former teacher Carol Gray (Gray & Garand, 1993) but by other professionals working with children with ASDs over the last 25 years (Hutchins, in press). For Gray, a Social StoryT»^ "describes a situation, skill, or concept" narrated according to 10 criteria. According to The New Social Stories^"^ Book, published in 2010, some of these key criteria include the use of: Background research and the collaboration of a team to answer who, what, when, where, why, and how. A patient, reassuring, and descriptive, rather than directive, approach. Language that is literally accurate and meaningful to the child. Careful consideration of formatting choices (e.g., length of story, font style/size, organization of text and illustrations). Specific sentence "types" that describe social information more than they direct audience behavior. A plan for editing, comprehension checks, and story review schedules. When it comes to research, however, most studies have examined social stories (lowercase) that don't necessarily follow Gray's 10 criteria or formal definition. Indeed, researchers and practitioners have not adhered to a uniform method of development and implementation, and a number of social-story "myths" have emerged (see sidebar). Despite this variability, the research in this area is substantive enough to provide some empirically supported recommendations for best practice. T H E 14 JANUARY LEADER A Social Story in Action "Jacob needs visual supports to understand the who, what, where, when, how, and why of our culture and how he fits and belongs." Mother of a 17-year-old boy diagnosed with pervasive developmental disorder not otherwise specified, cm ASD So what, according to the existing re.search, goes into developing accurate, meaningful social stories? The following example provides an illustration. Jacob was enrolled in a general education classroom at his local high school and was receiving services from a speech-language pathologist, special educator, case manager, and paraeducator. He loved wind chimes and music and could play a variety of instruments in a truly gifted manner. Previous assessments indicated that Jacob had deficits in auditory compreliension, his verbal expression was limited to two- to five-word sentences, and his areas of strength were reading and writing. Hutchins, T. L., "Social Stories" in Prelock, P., and McCauley, Treatment of Autism Spectrum Disorders: Evidence-Based Intervention Strategies for Communication and Social Interactions. Copyright 2012 by Paul H. Brookes Publishing Co., Inc., Baltimore. Forthcoming. Adapted by permission.

2 "Using My Excellent Voice," a social story for a 17-year-old boy with an ASD. Title Introduction My name is Jacob. I have many different voices. I am 17 years old and in high school. ol Body Sometimes my voice is a low Basso Profundo voice. other times my voice Is very soft and whispering. When 1 use my soft whispering voice, it's hard for people to hear what My mom likes what she calls my natural or real voice. Q.. 3i! (1 ^'-"^ 1 am saying. /^ '^\^ 0 I have worked hard with [Name] and [Name] and have found my excellent voice. [Name] and [Name] will When I use my excellent try to help me use my voice, it is easier for excellent voice. people to hear what They can remind me to use I am saying. my excellent voice. Conclusion My excellent voice is When I talk, I will EXCELLENT! try to remember to 1 call it my excellent voice. They can also speak clearly to me, use short sentences, and give me more time to talk. One important communication-enhancement goal involved his voice, which was often soft and whispered and trailed into silence. Following an examination that revealed normal structure and function of the larynx. Jacob began voice treatment with a universitybased SLP. Jacob worked hard over the course of several weeks to lengthen his sentences and find what he called his "excellent voice." which was louder and easier to understand. Unfortunately, he failed to generalize gains made in the clinic to other settings. Because we knew that Jacob could produce an "excellent voice." we decided to develop a social story with some specific objectives. One was to enhance Jacob's understanding of the social importance of using his "excellent voice." Another was to recruit the participation of those with whom he had frequent and direct contact. We collaborated with Jacob. Jacob's mother, and his SLP to learn about the "who. what, when, where, and why" that surrounded the production of his different voices. We used the Motivation Assessment Scale (MAS; Durand & Crimniins, 1992) a tool designed to help service providers understand the purpose behind behaviors and our previous observations of Jacob. We drafted a social story titled "Using my Excellent Voice" and revised it with input from Jacob's mother to ensure accuracy of content (see box). We also incorporated vocabulary important for Jacob that reflected his great interest in music (e.g., a "basso profundo voice"). When asked ahout pictures, Jacob noted that he would like "BoardMaker pictures" See What's the Story? page 16 LEADER' JANUARY

3 What's the Story? from page 15 in his story so we added Picture Communication Symbols. We incorporated particular font and formatting choices to highlight key messages (for instance, different fonts represent soft and loud voices). We also made specific choices about the length and complexity of sentences and illustrations on each page. We shared hard and electronic copies of the social story with Jacob, Jacob's mother, and his special education team members. They agreed to read the social story with him across contexts, such as home and various school settings, to facilitate acquisition and generalization of skills. The electronic version of the social story was particularly important for Jacob, who often used an ipod touch; we expected use of this medium to enhance Jacob's interest in and access to the story. Our team identified a topic Jacob's voice that seemed critical to his success as a communicative partner. Through testing, discussion, and observation, we determined that the target represented an area in which Jacob had demonstrated some competency, which increased the likelihood that it was a developmentally appropriate target. We learned that Jacob was more likely to use his "excellent voice" when others spoke to him using short sentences and gave him more time to respond. Research Basis This example of the development and application of a social story is supported by research. But first, a caveat from descriptive reviews (Ali & Frederickson, 2006; Nichols, Hupp, Jewell, & Ziegler, 2006; Rust & Smith, 2006, 2011 ; Sansoti, PowellSmith, & Kincaid, 2004) and quantitative literature reviews (Kokina& Kern, 2010; Reynhout & Carter, 2006, 2011; Test, Richter, Knight, & Spooner, 2010): Most authors agree that social stories are a promising intervention, but they universally acknowledge such methodological limitations as confounding treatment variables, lack of experimental controls, use of weak designs, and lack of research on efficacy, which demands rigorous experimental controls. Three Myths About Social Stories Myth : The purpose of a Social Story''''" is to change audience behavior. The purpose of a Social Story''''^ is to share meaningful and accurate information in a supportive, safe, and positive way. "The theory is that the improvement in behavior that is frequently credited to a Social Story is the result of improved understanding of events and expectations" (Gray, 2010, p. xxxi). \ yi., U :: Social Stories''''" are quick IVI y LI II and easy to develop. Myth : The planning, development, implementation, monitoring, and revision of Social Stories can be an incredibly time-intensive procedure. Ideally, it involves gathering accurate information and the participation of a team that has direct contact with the audience. Gray (2010) has written with emphasis that "50% of all Social Stories must applaud what the audience is doing well.,., The rationale is simple. Given that Social Stories are helpful in teaching new concepts and skills, they may also be just as powerful in adding meaning and detail to praise" (p. xxxv). The conclusions of others have been more positive. For instance. The National mmmm Standards Project (National Autism Center, 2010) identifies social story intervention as an established treatment for ASDs for children ages 6-14, based on sufficient quality, quantity, and consistency in the evidence base. Much of that evidence base points to effectiveness of the following practices, used in our work with Jacob: A team approach to gathering information. Although the research contains a few examples of appropriately rich data collection practices (Crozier & Tincani, 2005, 2007; Delano & Snell, 2006; Hutchins & Prelock, 2008; Lorimer, Simpson, Myles, & Ganz. 2002), experience suggests that these aspects are often underdeveloped or entirely overlooked in practice. To understand more fully the cause and purpose of problematic behaviors, social story authors are encouraged to as done with Jacob conduct observations and interview relevant others (e.g., parents, teachers, and other involved professionals). 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See brochure tor hours, MENTION THIS AD AND SAVE AN ADDITIONAL ^10 OFF YOUR REGISTRATION FEE! Visit tor special & early bird rates and to download brochures. kellv@ccseminars.com or call 413,374,2804 with any questions. Performance of a functional behavioral analysis (FBA). This problem-solving process is designed to identify the purpose of a maladaptive behavior and strategies to address it. In our case, we used observation and the Motivation Assessment Scale to explore the purposes behind Jacob's behavior. In support of this approach, a recent meta-analysis concluded that studies that used some form of FBA yielded higher effect sizes than those that did not (Kokina & Kern, 2010). U.se of comprehension checks. Before formally launching our intervention with Jacob, we introduced the story to him and checked his comprehension of the text and 1 6 JANUARY 17, 2012 LEADER Social Stories^'^ focus only on challenging situations. images. Ensuring that key messages in a social stoiy are understood as intended has received empirical support (Kokina & Kern, 2010; Reynhout & Carter, 2006). Use of repetition in teaching of the story. In Jacob's case, he and all participants agreed to read the social story once or twice a week for several weeks to ensure constant exposure and reinforcement (Hutchins & Prelock, 2008; Norris & Datillo, 1999). The research base is murkier on other aspects of social stories. They've been used successfully to address an extraordinarily broad set of intervention targets (Hutchins, in press), including behavioral targets such as tantrums and aggression, communicative targets such as greeting and eye contact, and social interaction targets such as peer engagement and joint attention. In a recent meta-analysis, Kokina and Kern (2010) suggested that social stories targeting the reduction of problem behaviors may be more effective than those that teach appropriate social skills; however, researchers have rarely considered whether and which prerequisite skills or social understandings are needed to achieve social interaction goals (Kokina & Kern, 2010). In

4 fact, from a theoretical perspective, any behavior that would benefit from enhanced social cognition may be an appropriate target of social stories when intervention is responsive to the individual's developmental level. Social stories have been used successfully with children and adolescents with ASDs who vary widely in their cognitive and linguistic profiles. Gray (Gray & Garand, 1993) suggested early on that social stories were likely to be most effective for individuals with good language skills. Subsequently, Gray (1998) suggested that, with modification, social stories can be used successfully for individuals with ASDs with more severe challenges. However, investigations of the use of social stories in this population are comparatively rare and the evidence so far is mixed (Barry & Burlew, 2004; Quirmbach et al., 2009; Swaggart et al., 1995). A number of questions also persist about the best strategies for developing social stories. Gray (e.g., 1998, 2010) has asserted that sentences in a Social StoiyTM,yn,j;t be of a particular type and those types must adhere to a specific ratio. Readers familiar with the history of the social story literature will recognize various sentence types (e.g.. perspective sentences, control sentences, directive sentences) that have undergone revision over the years. When researchers have systematically examined this issue, however. AM, S., & Fredrickson, N. (2006), Investigating the evidence base of Social Stories, Educational Psychology in Practice, 22(A), Gray, C. (2010), The New Social Stories Book. Arlington, TX: Future Horizons, Hutchins, T. L., & Prelock, P. A. (2008), Supporting theory of mind development: Considerations and recommendations for professionals providing services to individuals with autism spectrum disorder. Topics In Language Disorders, 28(4), , Kokina, A., & Kern, L. (2010), Social Story'^'^ interventions for students with autism spectrum disorders. Journal of Autism and Developmental Disabilities, 40, , Additional references for this article can be tound at The ASHA Leader Online. Search on the title ot the article at org/leader.aspx Effective Counseling in Stuttering Therapy No Stuttering Therapy: Transfer and Maintenance, A $58 value! 2txiEd. No, 0019 Do You Stutter: A Quide for Teens, 4th Ed, No Stuttering and Your Child: Questions and Answers, 4th Ed. No Sometimes I Just Stutter No Trouble at Recess No A Stutterer's Story, 2nd Ed. Nt) The Qenius of Dean Williams No Buy all 15 and save! Discount rates available when\ you and your coiieagues pur- \ chase as a group. Call 800- I for a quote. / THE STUTTERING FOUNDATION P,O, Box Memphis, TN Tiffany L. Hutchins, PhD, is assistant professor of communications sciences and disorders at the University of Vermont. Her research interests include child language development, measures of Theory of Mind, and the efficacy of social stories to remediate deficits associated with autism. Contact her at tiffany, uvm. edu. Selected References Complete Set of Books $30! Build your library on fluency and save with this special offer.!- Stuttering Words, 4th Ed. No Advice to Those Who Stutter, 2nd Ed, No, 0009 Therapy for Those Who Stutter No, 0010 If Your Child Stutters: A Quide for Parents, 8th Ed, No, 0011 Self-Therapy for the Stutterer, 11th Ed. No may be explained not only by the positive effects they may have on the audience, but also by their potential benefits to authors (Ali & Fredrickson, 2006). il^ the usefulness of Gray's sentence types and ratio has been seriously challenged (see Okada, Ohtake, & Yanagihara, 2008; Quirmbach et al., 2009; Reynhout ÄCarter, 2006, 2011). One point, however, is clear: What's critical in the development of a social story is the gathering of accurate and individualized information. Ideally, this process involves collaboration among family members, caregivers, and professionals. The collaborative process we used in Jacob's case helped us refine our thinking, coordinate workable plans, and develop shared responsibility for supporting his success. Indeed, the increasing popularity of social stories Please use this form or order online at Stutterlnc Help,org Special offer No, $30 per set '^"' '"" Shying & Handling $ $J Donation to this iwin/m'/iili' cause Treating the SchoohAge Child Who Stutters: A Quide for Clinicians, $ Enclosed is check to; Total Enclose J $ U.S. FUNDS The Stuttering Foundation P.O. Box 11749, Memphis, T N nd Ed. No Stuttering: An Integration of Contemporary Therai)ies,4thEd. No Name. u Facebook,com/StiitteringHelp X H E Address. UPS CANNOT DELIVER TO P.O BOXES City - Stute Zip -Tel,- A S M A LEADER' lanuary 17,

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