Autism Therapy: social stories

definition of social stories: Short stories that describe a social situation, including social cues and appropriate behavior. Social stories are used to teach social skills through the use of accurate information about those situations that the child may find difficult or confusing.

Social Stories Therapy for Children with Autism

Published Nov 6, 2009, last updated Dec 22, 2009

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.
Education and Training in Developmental Disabilities, by Wang, P., and Spillane A., published in 2009, summarized Jan 15, 2010

Video modeling may be the most useful of all social skills therapies for children with autism.

The authors reviewed the results of 38 studies that measured how well social skills therapies worked on autism symptoms. The authors looked at the results of the studies and compared the results to see which type of social skill therapy worked best in children with autism and autism spectrum disorder (ASD). The authors said that the data from the studies best support the use of Social Stories, peer-mediated social skills therapy, and video modeling. Use of these three techniques can be thought of as “evidence-based.” Use of video modeling gave the best results in many studies.


Topics in Language Disorders, by Prelock, PA, and Hutchins TL, published in 2009, summarized Sep 2, 2009

Family-centered care programs may help guide research for children with autism. Parents and caregivers play an important role in therapy success for their children with autism. Family-centered care encourages caregivers to be part of all aspects of therapy. This article describes how this approach may be very helpful for research studies. During research studies, parents and caregivers may be involved in planning and collecting information. For example, researchers for a social stories study asked parents about their children's needs before designing the therapy research plan. They also asked parents to keep diaries during the research study to gather more information about how well the children did at home. The authors think that researchers got more information from their research when they include the caregivers.


Research in Autism Spectrum Disorders, by Whittingham, K., Sofronoff K., Sheffield J., and Sanders MR, published in 2009, summarized Aug 6, 2009

The parenting program "Stepping Stones Triple P" may teach helpful strategies to parents of children with autism.

Parents of 29 children (2-9 years old) with autism received training using the Stepping Stones Triple P program. Parents learned how to deal with behavioral issues for children with autism. Strategies included timeout, physical guidance, and blocking. Many of the parents also learned how to use Comic Strip Conversations and Social Stories. Most of the parents liked the parent training, and said the strategies they learned were helpful when dealing with their children with autism.


Research in Autism Spectrum Disorders, by Reynhout, G., and Carter M., published in 2009, summarized Mar 26, 2009

Many teachers use Social Stories and consider them to be a good way of teaching certain behaviors to children with autism.

This study looked at how teachers use Social Stories in school. The study used a survey of teachers working with children with autism. The surveyed teachers relied on Social Stories for children with a range of ages and a range of IQs. Teachers used Social Stories for many reasons and the authors suggest that this is because the Social Stories are easy to construct and use. The Social Stories used by teachers did not conform to the published Social Story guidelines.


A group of kids with autism in Brownsville, Texas got some practice navigating their new school before the school year started. Their teacher helped with social stories and videos on a Flip video camera of the new school. In the spring, the children and their parents went to the new school late in the afternoon when it was quiet and calm. The children and their parents were allowed to visit the school over the summer as well. Other ideas to help children make the transition include driving the route to the new school, making a calendar with changing activities as the summer ends, pictures of school supplies, and beginning the fall schedule of school, homework, and bedtime.

Read original article: Beginning a New School Year For Children with Autism


Shannon Des Roches Rosa bought a $5 raffle ticket that resulted in a new iPad for Leo, her son with autism. Leo had tried the iPod Touch, but his motor skills make the iPad much easier for him to use. His mom says it’s sturdy and can handle Leo’s touching, swiping, and tapping. Leo has already mastered more detailed drawings. He enjoys apps such as the spelling programs, First Words, and IwriteWords. One program the entire family has used to help Leo is Stories2Learn. Shannon says, “Our entire family had a great time putting together the photos, captions, and voiceover for this social story about Leo visiting a local cafe – the process was so easy, and fast, and Leo loves the story so much I had to have his sister demo it, as Leo likes the voiceovers to repeat several times.” Shannon shares with readers other iPad applications and augmentative and alternative communication (AAC) apps she’s found that help children with autism.

Read original article: The iPad: A Near-Miracle for My Son with Autism


The Indiana Resource Center for Autism has put together some helpful tips on preparing children with autism and their families for the holidays. One step is preparation, whether it is putting up a big calendar or showing photographs from last year so that the child will know what to expect. Another tip is to decorate the house slowly, especially if your child has difficulty with change. If you are travelling, make sure you have your child's favorite books or toys and prepare them with social stories about the trip. Sometimes crowds of people may be overwhelming, so help your child with ways to disengage without becoming too upset. You may want to try role playing with other members of the family to practice opening gifts and taking turns for other holiday activities. And finally, if your child eats special foods or is on a gluten-free/casein-free diet, remember to have their food readily available for them.

Read original article: Making the Most of the Holidays for Your Family and Your Son/Daughter on the Autism Spectrum


Heather Conditt, a kindergarten teacher in Tennessee, knew she would have a six-year old boy with autism in her classroom. Since she had not worked with children with autism before, she let Jake teach her. Conditt learned that consistency and structure were important to Jake and she learned that a visual schedule helped him anticipate each activity during the day. Jake loves social stories and loves to use the classroom computer. His attendance at a regular kindergarten, with help from Conditt and his aide, has improved his socialization and his speech skills.

Read original article.



Please comment on this autism topic.

The Mighty Mother

Feb 16, 2010 by megan

The Mighty MotherA positive outlook on the world of Autism from around the world, written by the parent of an autistic child. Social stories, news and resources.  


 


this is exactly pure education for normal people and should be taught exactly as you are doing. I am amazed at what I read on your webpage. Education is healing allways. Now the story is a hard one for me also, I am disciplining myself to notice the story, nature, my own dreams, entertainment choices that have an into, body, and END. This is important to any story and helps us develop complete rythmic sexual cycles of response, awareness and nocturnal orgasm necessary for age appropriate behavior orientations. Thanks so much for writing and reminding us all to be aware of this area of life and those gifted to write creative stories are so needed. God bless you all there at Healing Thresholds. Kathy


Hi there,

My name is Dan, and my wife Carey and I are parents to a four-year-old boy (with autism) and a two-year-old girl (neurotypical). Both of our kids are adorable and keep us laughing!

Our son is verbal, though his expressive language is weak and he struggles with sensory processing, particularly in new environments. We were turned on to picture-based communication aids by the Connecticut Birth to Three system -- laminated strips of pictures, notebooks, magnet boards, etc. 

These tools worked. They helped Evan a good deal. Unfortunately, though, they weren't the most "workable" solution. Carrying around notebooks and boards is inconvenient. We'd lose the symbols, or not have the right one on hand when needed. 

So, we invented an application for the iPhone and iPod Touch that lets caregivers customize and present visual schedules, social stories, timers and choices -- all right there in the palm of your hand. It's called iPrompts -- check it out at http://www.iprompts.com. We've gotten some incredible feedback about it. Hope it helps!

 

- Dan


My son is very loud also

Nov 27, 2008 by Anonymous

My son is 10 and has an ASD diagnosis- he get VERY LOUD when he is angry or excited or out in public. He is so loud when he screams it hurts your ears. I have tried to use social stories , read a mr men book called mr loud, Showed him volume control on stereo and different volumes and put a number factor to them eg. you are at volume 6 now - can you try and be at volume 3 like the stereo? he say his mouth is same size as mine- he says do I think his mouth is biggar than my own?? He says he is sick of me saying to be quite or use is softer voice and that he cant control it- Please any advice???



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