Autism Therapy: social stories

What is it?

Social stories are used to teach social skills to children with autism ⁽¹⁾. A social story is a simple description of an everyday social situation, written from a child's perspective. Social stories can be used in different situations. For example, social stories can help a child prepare for upcoming changes in routine, or learn appropriate social interactions for situations that they encounter ⁽²⁾. The idea is that the child rehearses the story ahead of time, with an adult. Then, when the situation actually happens, the child can use the story to help guide his or her behavior ⁽¹⁾.

Each social story uses several different types of sentences:

• Descriptive sentences (De) give who, what, where, and why details about the situation so the child can recognize when that situation actually occurs.
• Directive sentences (Di) tell the child the appropriate social responses in that situation.
• Perspective sentences (P) describe one of the child's possible feelings or responses.
• Affirmative sentences (A) often refer to a law or a rule or are a commonly shared opinion.
• Cooperative sentences (Co) describe how other people will help out in a given situation.
• Control sentences (Cn) are created by the child, to help remember strategies that work for him or her. ^{(1, 3)}.

For example, a social story using all six sentence types is:

When we go to the shoe store,
There will be many shoes to choose from. (De)

I might not know which shoes I like. (P)
That is okay with everyone. (A)
I can hold onto my string while I decide. (Cn)

When I decide about the shoes, I will tell the grown-up. (Di)
The grown-up will go get the shoes for me. (Co)

It has been suggested that social stories should use each of these types of sentences only in specific ratios or amounts. For example, some researchers suggest that directive sentences should not be used as much as descriptive sentences ⁽¹⁾. However, social stories can still be effective without following these rules ⁽³⁾. Social stories are usually written by teachers, speech therapists, and parents, and are individualized for the child with autism ⁽⁴⁾.

What's it like?

Social stories are written in the first person, in the present tense, and from the child's point of view. The parent, teacher, therapist, or counselor should write the story to match the child's vocabulary and comprehension level. The story is written and put into booklet format. Once it is ready, an adult should read the story with the child at least twice, even if the child is capable of reading it. The adult then checks to make sure the child understands the important elements, either using a checklist or role-playing the situation ("Let's pretend we're at the shoe store. What happens next?") After that, the child reviews the story each day. For children who cannot read, audio tapes, videotapes, or picture books of the story can be made for the child to review each day. Finally, the effectiveness of each story should be monitored, with the story being faded out when the behavior has been learned. ⁽¹⁾.

Social stories can be enlightening and enjoyable. One child responded "Now I'll know what to do!" after the first reading of a social story about lunchtime behavior at school. Later, after using the story for about six weeks, that child remarked, "I don't even read the story. Now I just remember it." ⁽⁵⁾.

What is the theory behind it?

Difficulty with reciprocal social interaction is one of the main characteristics of autism. This impairment might result from unusual activity or functioning of certain areas of the brain that are used for social skills ⁽⁶⁾.

Social stories were developed to help improve social interactions in children with autism by giving simple and clear descriptions of social cues and appropriate behaviors ⁽¹⁾. However, it is not clear why social stories work for children with autism, when picking up social cues from the everyday environment does not. Some researchers believe that individuals with autism have trouble understanding what others believe, know, or don't know. This difficulty is sometimes called the theory of mind deficit in autism. ⁽⁷⁾.

There are several ways that social stories may help improve a child's theory of mind. One is that, by giving examples of specific social cues and behaviors, social stories may improve social problem-solving in general ⁽¹⁾. Social stories may also help organize social ides and cues that were previously disorganized ⁽⁵⁾. Moreover, by using print, audio, video, or pictures to replace in-person teaching, social stories may take away some of the anxiety of social relationships ⁽⁸⁾. In this way, autistic children can concentrate on what is being said rather than their relationship with the person who is saying it.

Does it work?

Recent research studies show that social stories can help reduce problem behaviors, increase social awareness, and/or teach new skills. In some cases, the new behaviors were maintained and generalized to other situations, even after the story was faded out. Social stories are most useful for children who have basic language skills ⁽²⁾.

To date, research studies on social stories have only had very small numbers of children (one to five children per study). One review article found that social stories were shown to be significantly effective on average, but not in every case ⁽³⁾. Another recent review article found that the limited studies available showed generally positive results, and concluded that the approach is promising ⁽⁴⁾.

Social stories have been used by teachers in the classroom. The teachers found them to be helpful ⁽⁹⁾. Another study reported improved social skills using a computer to present the stories in a school setting ⁽¹⁰⁾.

Although social stories in picture-book form are available for children with hearing impairments, there is no research to date on whether social stories have the same effectiveness if communicated with sign language.

More research is needed to understand what factors make social stories effective in some cases and not in others ^{(4, 11, 12)}.

Is it harmful?

There are no known negative effects of social stories. However, among physicians, there is a belief that social stories may train children with autism to learn only one response to a given situation. As a result, some physicians recommend RDI, Relationship Development Intervention, which seeks to teach children how to have appropriate responses in any situation ⁽¹³⁾.

Cost

Social stories may be included as a component of speech therapy. The cost of speech therapy is covered by the government through the Individuals with Disabilities Education Act (IDEA) of 2004. Private speech therapy can be expensive (approximately $100/hour or more). Parents, teachers, counselors, and caretakers can also learn how to use social stories ⁽²⁾.

Books, audiotapes, and videotapes of several commonly used social stories for children with autism are available at a fairly low cost (see Resources).

Resources

Healing Thresholds has partnered with Natural Learning Concepts. They sell many different social story books as well as audiotapes and videotapes of several commonly used social stories.

Autism is a condition covered under the IDEA of 2004. Services covered by IDEA include early identification and assessment by an occupational therapist. This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21 (U.S. Department of Education).

Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). School districts can coordinate special services for children 3-21 years old. For some additional coverage information in the U.S. go to: http://www.asha.org/public/coverage/autism.htm. In addition, there is a listing on this Web site for state early intervention centers (http://autism.healingthresholds.com/wiki/early_intervention).

The Gray Center works to improve social understanding in autistic children, and provides details about the social stories approach.

Several books that might be useful:

Social Stories (a series for children) by Natural Learning Concepts and Jene Aviram. Each book has 2 social stories (for example, Getting Angry and Sharing). 2006.

Writing and Developing Social Stories: Practical Interventions in Autism by Caroline Smith. Speechmark Publishing. 2003.

The Social Skills Picture Book: Teaching Play, Emotion, and Communication to Children with Autism by Dr. Jed Baker. Future Horizons. 2003.

The New Social Story Book : Illustrated Edition by Carol Gray. Includes basic illustrated social stories as well as a kit detailing how you can write your own social stories. Future Horizons. 2000.

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References

1. Gray, C.A., and J.D. Garand. 1993. "Social Stories: Improving Responses of Students with Autism with Accurate Social Information." Focus on Autistic Behavior 8(1):1-10.
2. Del Valle, P.R., et al. 2001. "Using Social Stories with Autistic Children." Journal of Poetry Therapy 14(4):187-197.
   
3. Reynhout, G., and M. Carter. 2006. "Social Stories for Children with Disabilities." J Autism Dev Disord. 36(4):445-469.
4. Ali, S., and N. Frederickson. 2006. Investigating the Evidence Base of Social Stories." Educational Psychology in Practice 22(4):355-377.
5. Rowe, C. 1999. "Do Social Stories Benefit Children with Autism in Mainstream Primary Schools?" British Journal of Special Education 26:12-14.
6. Iacoboni, M. 2006. "Failure to Deactivate in Autism: The Co-Constitution of Self and Other." Trends Cogn Sci. 10(10):431-433.
7. Leekam, SR, and J. Perner. 1991. "Does the Autistic Child Have a Metarepresentational Deficit?" Cognition 40(3):203-218.
8. Scattone, D, et al. 2002. "Decreasing Disruptive Behaviors of Children with Autism Using Social Stories." J Autism Dev Disord. 32(6):535-543.
9. Reynhout, G., and M. Carter. 2009. "The Use of Social Stories by Teachers and Their Perceived Efficacy." Res Autism Spec Dis. 3(1):232-51.
10. Sansoti, J.J., and K.A. Powell-Smith. 2008. "Using Computer-Presented Social Stories and Video Models to Increase the Social Communication Skills of Children With High-Functioning Autism Spectrum Disorders." J Positive Beh Interven. 10(3):162-78.
11. Rogers, S. 2000. "Interventions That Facilitate Socialization in Children with Autism." Journal of Autism and Developmental Disorders 30(4):399-409.
12. McConnell, S.R. 2002. "Interventions to Facilitate Social Interaction for Young Children with Autism: Review of Available Research and Recommendations for Educational Intervention and Future Research." J Autism Dev Disord. 32(5):351-372.
13. Gutstein, S.E., et al. 2007. "Evaluation of the Relationship Development Intervention Program." Autism 11(5):397-411.