Saturday, April 7, 2012

SOCIAL STORIES FOR AUTISM


 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. 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. 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.

Learners with autism often have difficulty understanding expectations in social situations. Over the past decade, social stories have become increasingly popular as an intervention strategy for learners with ASD. Social stories are brief descriptions of expectations that are explained in the context of a “story” created on an individual basis to describe a specific scenario the learner will encounter. Typically, the story is written from the perspective of the learner, in a meaningful format for people with ASD. A social story is created specifically for the student it is intended to help. Practitioners can create stories that are supplemented with pictorial cues or photos in addition to textual information. The use of stories to explain social rules and contingencies has been shown to be beneficial for learners with autism.

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. Social stories may also help organize social ides and cues that were previously disorganized. 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. In this way, autistic children can concentrate on what is being said rather than their relationship with the person who is saying it.

Suggestions for developing effective social stories. There are currently seven recognized sentence types used to create social stories:

 - Descriptive: (De) give who, what, where, and why details about the situation so the child can recognize when that situation actually occurs, Sentences that provide factual information.

 - Perspective: (P) describe one of the child's possible feelings or responses Sentences that provide insight regarding the thoughts, feelings, and behaviors of others.

-Affirmative: (A) often refer to a law or a rule or are a commonly shared opinion Sentences that are used to reassure the learner.

Directive: (Di) tell the child the appropriate social responses in that situation.  Sentences that tell the learner what behaviors are expected.

 - Control:  (Cn) are created by the child, to help remember strategies that work for him or her. Sentences that use analogies to explain situations.

 - Cooperative: (Co) describe how other people will help out in a given situation. Sentences that tell the learners who can assist them in different situations.

 - Consequence: Sentences that tell what will happen as a result of the actions.

For example, a social story using 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)
The two options for how to construct social stories using the different types of sentences: the basic social story ratio and the complete social story ratio.

In the basic social story ratio, should be using 2–5 descriptive, perspective, and/or affirmative sentences for each directive sentence.

The complete social story ratio includes the addition of control and cooperative sentences. For each control or cooperative sentence, 2–5 descriptive, perspective, affirmative, and/or directive sentences are recommended.

The objective of the social story is to describe rather than direct. The assumption is that changes in behavior may be a result of a greater understanding of expectations and events in their environment. Social stories reported in the literature are primarily composed of descriptive, directive, consequence, and perspective sentences. Social stories can be used to both increase and decrease behavior. For example, social stories can be used to explain the actions required to deposit a check at the bank or to explain the contingencies required to access a desired reinforcer (e.g., to access a trip to the park, they must not engage in any aggressive behavior). Social stories are often used for multi-element situations (which change on a frequent basis), fear situations, and to reduce challenging behaviors.

Often, social stories are used in combination with other treatments, as part of a packaged social skills intervention. In fact, when part of packaged interventions, some gains have been noted. However, multiple treatments limit the extent to which treatment effects can be attributed to social stories.

Development of the stories is highly variable. There are few guidelines for how to use the social story and when to curtail its usage. Two commonly used, but empirically unsupported, strategies to fade the use of a social story are to reduce the number of times the story is read each week and systematically removing sentences from the story, specifically the directive ones.

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. 

The literature describes a variety of strategies to implement the social story. They include having the teacher or parent read to the child, having the child read, listening to or watching the story on a computer or TV, and listening to the story embedded in a song.

It may be that social stories enhance parent and teacher attention to targeted behaviors, which may make it more likely that desirable behaviors are prompted and reinforced. There also appears to be a discrepancy between the perceived effects of treatment and the future use of the social stories. Studies were unsure if the social stories had an effect on the target behaviors, but planned to continue using them and even create new stories for other skills. Investment may come from face-validity or natural quality of approach for parents (e.g., all parents read to kids). Teachers liked using social stories and found their outcomes to be favorable, but did not continue to use the stories beyond the scope of the research study. The time consuming nature of reading a social story before an activity may have not made it feasible for teachers with large groups of students. To maintain the behavior, the stories would need to be a part of the lesson planning and become integrated into the classroom routine. Even in studies that have shown promising treatment effects using social stories, there is a lack of knowledge about the critical components. By developing more effective methods for evaluating social stories, improvements in creating and implementing them can be made.

It is possible that their effectiveness may be a result of other elements of the packaged interventions. In general, it is clinically wise to use social stories in combination with direct behavior change procedures.

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

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