An evaluation of the components of a Social Stories™ intervention package

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Abstract

The present study examined the effectiveness of Social Stories™, and Social Stories paired with a differential reinforcement procedure on disruptive behaviors of two elementary school children diagnosed with pervasive developmental disorder-not otherwise specified (PDD-NOS) and attention deficit hyperactivity disorder (ADHD). We implemented a multiple-baseline design across target behaviors, whereby the Social Story was implemented first, followed by the pairing of the story and a differential reinforcement of zero behavior (DRO) procedure. Results indicate that while the use of a Social Story was effective in decreasing problem behavior when compared to baseline levels, the pairing of the story with a DRO procedure resulted in lower average levels of the target behaviors across both participants.

Highlights

► Examined the effectiveness of Social Stories™ and Stories paired with DRO to decrease disruptive behavior of two children with PDD-NOS and ADHD. ► Implemented a multiple baseline across target behaviors. ► Social Story™ was implemented first, followed by the pairing of the Story and DRO. ► The Story was effective in decreasing problem behavior; but pairing the Story with DRO resulted in lower average levels of problem behavior.

Introduction

There are several strategies currently in practice to improve or teach social skills and appropriate interactions to children with autism spectrum disorders (ASDs). One such strategy is the use of Social Stories™, which are designed to describe a situation, skill, or behavior in terms of social cues, perspectives, and responses that are appropriate and acceptable within a specific context (Gray & Garand, 1993). The Stories are written in a very specific style and format that consists of six types of sentences written in the first person: (1) descriptive (i.e., provides information about the social setting, who is involved, and why they are doing it); (2) perspective (i.e., provides information about the internal states of others); (3) affirmative (i.e., expresses a commonly shared value); (4) directive (i.e., provides information about what a student should do in the situation); (5) control (i.e., sentences written by the student which help them identify strategies to remember the story); and (6) cooperative (i.e., provides information about what others will do to assist the student).

Depending on the child's level of functioning, the Story may contain pictures or drawings to provide a visual. Multiple Stories may be used to teach one specific skill, which may help with generalization of the target skills across settings. Multiple readings of the Story, in addition to comprehension questions, are recommended to ensure understanding (Gray, 2000). According to the guidelines and criteria for writing Social Stories™ (Gray, 2000), the intent of the Story is to provide an individual (often a child with ASD), with basic social information that is missing from his or her repertoire. This lack of information may lead to undesirable behaviors in a number of different contexts. Reading the Story may lead to changes in the problematic behavior, but the goal is only to provide the information, not to effect change. Despite this caveat, Social Stories ™ are often used in practice as means to change behavior. In a recent comprehensive review, Test, Richter, Knight, and Spooner (2011), found that Social Stories™ are not yet considered an evidence-based practice due to the lack of research to support their effectiveness when they are used in isolation. Specifically, the research that does exist has presented mixed results and left many unanswered questions.

One of the limitations of the existing research includes the use of Social Story “intervention packages,” which typically include the use of a Story, paired with one or more additional behavioral interventions such as response-cost (Swaggart et al., 1995), prompting (Barry and Burlew, 2004, Crozier and Tincani, 2005, Crozier and Tincani, 2007), role playing (Chan & O’Reilley, 2008), feedback and written textual cues (Kuoch and Mirenda, 2003, Thiemann and Goldstein, 2001), or reinforcement for viewing or reading the story (Bernard-Ripolli, 2007) and for appropriate behavior (Agosta et al., 2004, Burke et al., 2004). Although effective, the use of packaged treatment interventions present difficulties in determining which component of the package was responsible for the change in behavior. Results of studies that have implemented Social Story intervention packages to date have not evaluated this important aspect.

Therefore, the purpose of the present study was to evaluate the relative effectiveness of a Social Story, and the Social Story paired with a differential reinforcement procedure for the absence of problematic behaviors displayed by two students enrolled in an autism-specific classroom. The participants in this study displayed problematic behavior in the classroom maintained by attention from the teachers (as identified by indirect and direct functional assessments). In addition, the teachers had implemented classroom rules which were reviewed daily during a “social skills” activity. Despite these efforts, the participants’ problem behavior sustained at levels that warranted an individualized behavior intervention plan. The Social Story was selected as an intervention because it was deemed as a strategy that could be implemented by the classroom teachers with ease. If effective in isolation, this could be easily incorporated into the student's daily programming. By systematically assessing the effectiveness of a Social Story, and the Story paired with a differential reinforcement procedure, we also sought to address an important question within this area of research. Specifically, as described by Reynhout and Carter (2006), many studies on the effectiveness of Social Stories have been confounded by their use in combination with other empirically based procedures (i.e., prompting, reinforcement). Therefore, this study aimed to investigate the effectiveness of Social Stories in isolation, followed by a combination of the Story with another evidence-based procedure that directly addressed the function of the participants’ problem behavior.

Section snippets

Participants and setting

Adam was an 8-year old male and Ronald was an 11-year old male, both diagnosed with pervasive development disorder not otherwise specified (PDD-NOS) and attention deficit hyperactivity disorder (ADHD). Adam was in a first grade classroom and Ronald was in a fourth grade classroom in a community school for alternative learners in Northeast Ohio. Adam's classroom was comprised of six students (all males) and two female teachers. The number of students in Ronald's class varied throughout the

Functional assessment

The problem behavior questionnaire (PBQ; Lewis, Scott, & Sugai, 1994) was administered to both teachers in each classroom. Results of the PBQ indicated that the target behaviors were most likely maintained by attention from adults. In addition, informal direct observations conducted by the first author provided further support for this hypothesis. The PBQ and direct observations were conducted because it was deemed important to determine the maintaining function of each target behavior.

Baseline

In an

Results

Results of the present study indicate decreases in each of the target behaviors following the intervention. Specifically, some decreases were observed for one (Ronald) or both (Adam) of the target behaviors following implementation of the Social Story intervention. However, the levels of improvement varied. When DRO was paired with reading of the Story, levels of each target behavior for both participants decreased further.

Discussion

Two components of a Social Story intervention package were systematically implemented with two students with PDD-NOS and ADHD. Results indicated that the participants responded with decreased levels for at least one of the behaviors targeted following the Social Story intervention, but the levels of change varied across both participants and behaviors. Both Adam and Ronald demonstrated additional decreases in both target behaviors following the addition of a differential reinforcement

Acknowledgments

We thank the teachers and administrative staff from Summit Academy for allowing us to recruit participants and collect data at their school. We also thank Matthew Swerdan for assistance with reliability data.

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