The effect of social stories on reduction of challenging behaviours in autistic children

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1 Available online at Procedia Social and Behavioral Sciences 15 (2011) WCES-2011 The effect of social stories on reduction of challenging behaviours in autistic children Ahmad Beh-Pajooh a *, Ahmad Ahmadi b, Mohsen Shokoohi-Yekta c, Ali Asgary a Faculty of Psychology & Education, University of Tehran, Tehran, Iran b Faculty of Psychology & Education, University of Tehran, Tehran, Iran c Faculty of Psychology & Education, University of Tehran, Tehran, Iran Abstract Using a multiple baseline across participants design, the present study examined the effectiveness of individualized social stories on reducing of challenging behaviours of three boys with autism. Following the intervention, the numbers of challenging behaviours reduced for two out of three participants. Results from this study suggest that social story interventions may be effective in decreasing the numbers of challenging behaviors within the classroom Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Keywords: Autism; Challenging Behaviours; Social Stories 1. Introduction Core features of autism disorder are the presence of markedly deficits in social interaction and communication as well as displaying stereotyped and ritualistic behaviours (American Psychiatric Association, 2000). In addition, challenging behaviours such as aggression, noncompliance, and self-injurious behaviours are common in children with autism (McClintock, Hall & Oliver, 2003). Challenging behaviours interfere with children's learning, could put a child at high risk for later social problems or failure in academic achievement. However, such behaviours are not only harmful to the child but also could be harmful to the others (Kaiser & Rasminsky, 2007). Sturmey, Seiverling, and Ward-Horner (2008) report some negative effects of challenging behaviours including rejection by peers, siblings, and other family members, exclusion from public educational and typical work settings, having significant health risks for the child, and also may have negative impacts on family members. In recent years, one of the intervention programmes used to reduce challenging behaviours in autistic children is social story. Social story is an individualized short story written to describe a situation, specific activity and the behaviour expectations associated with that activity (Gray & Garand, 1993). According to Howley and Arnold (2005) social story may consist of some types of sentences including descriptive, directive, perspective, affirmative, cooperative, partial, and control sentences. * Ahmad Beh-Pajooh. Tel: ; Fax: address: behpajooh@ut.ac.ir Published by Elsevier Ltd. doi: /j.sbspro Open access under CC BY-NC-ND license.

2 352 Ahmad Beh-Pajooh et al. / Procedia Social and Behavioral Sciences 15 (2011) Theoretical and experimental support for social story Social story is based on theory of mind and the weak central coherence theory. Theory of mind is defined as an ability to understand that others have different thoughts, beliefs, and emotions from one's own (Colle, Baron-Cohen & Hill, 2007). According to this theory individuals with autism have difficulties attributing feelings to others, in taking the perspective of the others, and in mind reading (Baron-Cohen, 1995). Baron-Cohen, Tager-Flusberg and Cohen (2000) hypothesized that impairments in theory of mind underlie the symptoms seen in autism disorder. Gray and Garand (1993) believed that social stories could be used to help an autistic child to understand the situation and internal feeling of the people involved in the situation. The weak central coherence theory maintains that individuals with autism have a weak drive for central coherence, which is needed for general information processing (Wahlberg, 2001). In other words, this theory states that persons with autism cannot extract meaning from information and ideas in order to integrate them into a meaningful whole (Frith, 1991). Social story has been used to reduce challenging behaviours including crying, screaming, and hitting in children with autism (Adams, Gouvousis, VanLue & Waldron, 2004). Using case study with reversal design, Adams and colleagues (2004) reported that social story was an effective intervention on decreasing the challenging behaviours. Further support for social story has been provided by Agosta, Graetz, Mastropieri and Scruggs (2004). Using social story intervention, they have showed that the challenging behaviours of their subjects such as loud screaming, yelling, humming, and other distracting noises during class activities had decreased. Like Adams and colleagues (2004) and Agosta and colleagues (2004) some researchers have reported the positive effects for social story on decreasing challenging behaviours in autistic children (Gray & Garand, 1993; Kuoch & Mirenda, 2003; Moore, 2004). In contrast, Watts (2008) examined social stories as an intervention to reduce challenging behaviours of six participants diagnosed with autism spectrum disorder. The results indicated that the social story worked only for one participant and there was no significant reduction in number or duration of challenging behaviours as a result of a social story intervention for the rest of participants. It should be noted that it is not the only research reported mixed results for different participants or different target behaviours. Similarly, Graetz (2003) has reported that social story intervention reduces challenging behaviours in some participants and does not affect the target behaviours in others. Marr and colleagues (2007) and Sansosti and Powell-Smith (2006) also have found the same results. In review of the literature of social story, there are some limitations, for example some researchers have used social story along with additional intervention strategies, like verbal as well as physical prompting (Swaggart, et al. 1995; Scattone, Wilczynski, Edwards, & Rabian, 2002) and in some studies AB design has been used that decreased internal validity (Swaggart et al. 1995). 3. Method 3.1. Participants and Setting Three boys' ages 8 to 9 years participated in the present study. All the participants attended in a special school in Tehran, Iran. All the participants were taught by one special teacher. While intervention program was implemented in another room by the second author, observations were took place in the classroom by the special teacher. After social stories were read for participants the targets behaviours were observed by the second author as well as the special teacher at the same time Target Behaviours After participants were selected, via interviewing by the teacher and the school psychologist, the needed information was gained on the participant s behaviours, including factors that evoke the behaviours and behaviour s consequences. Based on the information from the interviews and direct observations prior to the study, target behaviours were identified for each participant including crying, wandering in the classroom and laying down on desk. Considering the nature of target behaviours, event sampling method was used to collect data. The target

3 Ahmad Beh-Pajooh et al. / Procedia Social and Behavioral Sciences 15 (2011) behaviour of the first participant, defined as crying, yelling, screaming, covering face with hands, and saying "I want to go home." The target behaviour for the second participant was wandering in the classroom, which was defined as standing up, leaving his seat, seating on the ground, and so on. For the third participant laying down on desk was defined as the target behaviour, such as putting legs on the chair, turn around and putting head on the desk Experimental Design We used a multiple baseline across participants design to assess the effectiveness of social story on decreasing of challenging behaviours. To compute the inter-observer agreement, we used the percentage agreement method which has reported by Beh-Pajooh (1991) and Kazdin (1982). In this method inter-observer agreement is calculated through dividing the number of agreements by the number of agreements plus disagreements and multiplying by 100. Also social validity was determined by asking the teachers to complete an IRP-15 (Martens, Witt, Elliott & Darveaux, 1985). 4. Results As can be seen in figure 1 data analysis shows that there was a reduction of challenging behaviours for two of the three participants after the implementation of the treatment. Figure1. Frequency of challenging behaviours Whereas, for the first participant, baseline data revealed that mean of crying from 5.71(range, 4-8) decreased to 2.81 (range, 0-6), and wandering in the classroom in the second participant dropped, from 7.33(range, 6-10) to On the contrary, for the third participant, the result is different. During the baseline phase, there is a highly variable

4 354 Ahmad Beh-Pajooh et al. / Procedia Social and Behavioral Sciences 15 (2011) number of laying down on desk with mean 2.23 (range, 0-4), although this mean showed reduction to 1.67 in the intervention phase, we cannot conclude from this reduction that social story reduces the number of laying down on desk. Because prior the implementing the intervention program, laying down on desk had been reduced. After each session, inter-observer agreement was calculated and means of these inter-observer agreements was achieved for crying (86%), wandering in the classroom (93%), and laying down on desk (83%). After the study concluded, participant s teacher completed an IRP-15 questionnaire. According to Mueller, Edwards and Trahant (2003) IRP-15 generates scores between 15 to 90 and scores above 52.5 shows acceptability of treatment by the rater. Data revealed high acceptability for the first participant (72), the second participant (72), and the third participant (78). Another way to report the results in single subject studies is calculating of the percentage of nonoverlapping data (PND) as an effect size. According to Scruggs, Mastropieri, Cook and Escobar (1986) a PND between 91 and 100 is considered as highly effective intervention, between 70 and 90 as moderately effective, between 51 and 70 as questionably effective, and between 0 and 50, as non-effective. In this study, the effect size for crying was.79, and for wandering in the classroom was.71 both indicating a moderate effect. Finally, the effect size for laying down on desk was zero that suggests no effects for social story on this behavior. 5. Discussion Although social stories are becoming more popular intervention for autistic children around the world, the present study was the first experimental research project on social story in Iran. The present study was designed to examine the effects of social stories on challenging behaviors of three children with autism. This study replicates the results of some previous research, which found positive effects of social story for some participant. It seems that participant s traits have important role in effectiveness of social story. Results of this study revealed that social story in terms of effects size has moderate effects for target behaviors of participants one and two, and has no effects for the third participant. After implementing social story, crying in the first participant decreased. These results support Adams and colleagues (2004) as well as Agosta and colleagues (2004) findings that show positive effects for social story in decreasing the crying behavior in autistic children. The reduction in challenging behavior in the second participant is also consistent with other findings reporting social stories can be effective in decreasing challenging behaviors in autistic children (Gray & Garand 1993; Kuoch & Mirenda 2003; Moore, 2004). Examining the results showed that crying and wandering in the classroom were decreased when social story was introduced. Although it is not possible to determine the exact variables responsible for the success of the social story, becoming aware of the class rules could have affected the decrease in challenging behaviors. Based on the theory of mind, understanding teacher s feelings and emotions may have a role in the reduction observed but there is no evidence showing improvement in the mind reading capability as a result of social story. In the baseline phase, lots of variability in performance occurred for the third participant and data showed that social story had no effects. This can be explained by participant s differences in terms of cognitive and language skills, and severity degree of autism disorder. Information gained by interview and anecdotal recording indicated that unlike two other participant, the third participant showed more severe impairment in social interactions, language, and reading skills, which may underline the ineffectiveness of social story for that participant. Although by using multiple baseline design and presenting social story alone this study controlled for some of the limitations reported in the literature, the study is still limited by having small number of the participants and not including generalization and follow up phase. Finally, IRP-15 questionnaire s data shows that the teacher thought that social story was a sufficient intervention. In other words, although results of observation shows that social story had no positive effects for the third participant, but his teacher indicated high acceptability for the intervention plan. In conclusion, the results of this study provide more support for social story and show that social stories may be an effective intervention to decreasing challenging behaviors in autistic children.

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