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Social Stories in Early Intervention: An OT Perspective
- 1. Social Stories in Early Intervention from an Occupational Therapy Perspective Suzie Kwon, MOTS University of Washington Department of Occupational Therapy
- 2. What are social stories? Developed by Carol Gray to help children with autism navigate social situations “A social story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses”- Carol Gray (2010) Brief stories that help children understand and prepare for a new situation or challenges Can be a written story, or visual story with pictures, or both (Miles, 2016)
- 3. 3 Sentence types in social stories Descriptive sentences: Objectively describes a situation, states the facts. “I am going to the zoo with my family. When I am at the zoo, there will be a lot of people and it will be loud” Perspective sentences: Describes feelings or thoughts about a situation. “Sometimes when I hear loud noises I get upset and want to go home. If I go home I will be sad I didn’t get to stay and see the animals” Directive sentences: Directs the desired behavior or appropriate response. Uses positive language such as “I can”. “When I hear loud noises I can ask for my headphones and put them on so it will be quiet. When it is quiet I can stay at the zoo and have fun”
- 4. Why might social stories work?: The theory of mind “Theory of mind” may allow people to understand another person’s perspectives, desires, and beliefs. Hypothesis that individuals with autism lack a “theory of mind” (Baron-Cohen, Leslie, & Frith, 1985) Social stories may be used to explain social situations in terms of what another person might be thinking and/or why they may behave in certain ways (Ali & Frederickson, 2006)
- 5. What are the benefits of social stories? Can be helpful for children that have difficulty with transitions, unexpected environments, or social situations Uses language that is literal and repetitive to help prepare a child for an upcoming situation to make it more predictable, or teach a commonly occurring social interactions Provide positive feedback to a child about an area of strength or achievement Social stories present information in a literal, 'concrete' way, which may improve a person's understanding of a previously difficult or ambiguous situation or activity.
- 6. Who uses social stories? SLP Educators
- 7. Evidence-based approach Do social stories effectively improve social interaction and decrease challenging behaviors in children with autism? Evidence suggests that social stories decrease challenging behaviors and may improve social interaction skills in children with autism if developed and implemented according to specified guidelines in a manner suitable to the individual child’s strengths and abilities (Mogensen, L. L., 2005). Research by Gray and Garand (1993) supports that social stories reduced disruptive behaviors and improved social skills in children with autism.
- 8. Evidence-based approach ● Difficulty in identifying effectiveness ○ Social stories paired with positive reinforcement, imitation, and prompting makes it difficult to identify if the story alone is working or if it is the combination of strategie (Kokina & Kern, 2010) Further research is recommended
- 9. How do OTs use social stories? Understand tasks, routines, and roles in daily occupations Help view the situation holistically Breaks down a challenging social situation into understable steps Social stories can help with sequencing (what comes next in a series of activities) and 'executive functioning' (planning and organising) - difficulties experienced by many people with autism. (Morgado, 2013)
- 10. What are the goals for social stories in OT? The Person-Environment-Occupation-Performance (PEOP) Model Emphasis on the interaction between person & environment, and how this affects occupation (Christiansen, Baum, & Bass-Haugen, 2015)
- 11. How do other professionals use social stories? SLP PT Educators
- 12. There’s an app for that! StoryMaker™ create Social Stories™ using pictures, text and audio. https://itunes.apple.com/us/app/storymaker-for-social-stories/id570007786?mt=8 Social Stories Creator and Library by Touch Autism create & share social stories, visual schedules & beautiful memories. https://itunes.apple.com/app/id588180598?mt=8
- 13. Tips for writing your own social stories A social story should have 3 to 5 descriptive and perspective sentences for each directive sentence Write in first person and on the child’s developmental skill level If possible, use photographs of the child or his peers.
- 15. References: Ali, S., & Frederickson, N. (2006). Investigating the Evidence Base of Social Stories. Educational Psychology in Practice, 22, 355-377. DOI: 10.1901/jaba.2008.41-405 Baron-Cohen, S., Leslie, A., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21, 37-46. DOI: 10.1016/0010- 0277(85)90022-8 Christiansen C .H., Baum C. M., & Bass-Haugen, J. (2015). Occupational therapy: Performance, participation and well-being (4th edition) Thorofare NJ: SLACK incorporated Gray, C., Garand, J. D. (1993). Social stories: Improving responses of students with autism accurate social information. Focus on Autistic Behavior, 8: 1-10. Miles, S. (2016, February 23). More than therapy: Raising children to their highest potential. Retrieved from http://www.childrenstherapycorner.com/news/item/189-what-are-social-stories Morgado, M. (2013). Use of social stories for children with autism. Retrieved from http://cslot.com/use-of-social-stories-for-children-with-autism/ Morgensen, L. L., (2005). There is preliminary evidence (level 4) that social stories are effective in decreasing challenging behaviours and may improve social interaction skills in children with autism spectrum disorders [PDF document]. Retrieved from Occupational Therapy Critically Appraised Topics website: http://www.otcats.com/topics/Lise%20Mogensen.html Zachry, A. (2011, November 2). Pediatric occupational therapy tips: An interactive social story. Retrieved from http://drzachryspedsottips.blogspot.com/2011/11/interactive-social-story.html
Editor's Notes
- In fact, visual schedule is a form of a social story, so reading skills or high receptive language skills are not required for all social stories. A modified social story can be as short as one sentence, such as “When I go to the store, I can push the cart and stay next to mom” or as long as multiple pages. This can be adjusted to the child’s skill level.
- Social stories may help children with autism because of the hypothesis that individuals with autism lack a “theory of mind” (Baron-Cohen, Leslie, & Frith, 1985). It is proposed that having a theory of mind allows us to understand another person’s perspectives, desires and beliefs. Through lacking a theory of mind, social interaction for individuals with autism may be difficult, confusing and unpredictable. A Social Story might then be used to explain social situations in terms of what another person might be thinking and/or why they may behave in certain ways; thus reducing or removing the confusion and unpredictability (Ali & Frederickson, 2006).
- to develop self-care skills (eg how to clean teeth, wash hands or get dressed), social skills (eg sharing, asking for help, saying thank you, interrupting) and academic abilities to help a person with autism to understand how others might behave or respond in a particular situation, and therefore how they might be expected to behave to help others understand the perspective of a person with autism and why they may respond or behave in a particular way to help a person to cope with changes to routine and unexpected or distressing events (eg absence of teacher, moving house, thunderstorms) to provide positive feedback to a person about an area of strength or achievement in order to develop self-esteem as a behavioural strategy (eg what to do when angry, how to cope with obsessions).
- As can be seen in our social story case study, Social Stories can be paired with “supplementary tactics”. Although these tactics may be beneficial, they have made it difficult for researchers to clarify whether Social Stories are effective when used alone (Kokina & Kern, 2010). For example, there is already a large body of evidence showing that imitation, prompting, priming and positive reinforcement are effective methods of teaching children with ASD (Cooper, Heron & Heward, 2007; Miltenberger, 2008). These tactics are often combined with a Social Story intervention and so it is difficult to identify if the story alone is working or whether it is the combination of tactics (Kokina & Kern, 2010). This limitation is highlighted by reviewing authors who conclude that social stories can have positive outcomes but that much more research is needed to identify their effectiveness in controlled studies (Reynhout & Carter, 2009, 2010; Sansosti, Powell-Smith, & Kincaid, 2006). Social Stories are a promising intervention option, there is still a lack of evidence identifying the specific factors that lead to their success or failure (Reynhout & Carter, 2006, 2009; Kokina & Kern, 2010).
- to develop self-care skills (eg how to clean teeth, wash hands or get dressed), social skills (eg sharing, asking for help, saying thank you, interrupting) and academic abilities to help a person with autism to understand how others might behave or respond in a particular situation, and therefore how they might be expected to behave to help a person to cope with changes to routine and unexpected or distressing events (eg absence of teacher, moving house, thunderstorms) as a behavioural strategy (eg what to do when angry, how to cope with obsessions). If this adverse behavior affects FUNCTION
- Very client-centered, and is top-down, first considers the individual in context, identifying the client’s roles, occupations and goals. The model requires the occupational therapist to use this context to address the personal performance capabilities/constraints and the environmental performance enablers/barriers that are central to the occupational performance of the individual. Intrinsic factors in the PEOP Model that are central to occupational performance are: • physiological, including strength, endurance, flexibility, inactivity, stress, sleep, nutrition and health • cognitive, including organization, reasoning, attention, awareness, executive function and memory, all necessary for task performance • neurobehavioural, including somatosensory, olfactory, gustatory, visual, auditory, proprioceptive and tactile, as well as motor control, motor planning (praxis) and postural control • psychological and emotional, including emotional state (affect), self-concept, self-esteem and sense of identity, self-efficacy and theory of mind (social awareness) • spiritual: that which brings meaning. Extrinsic factors in the PEOP Model that are central to occupational performance are: • social support, practical or instrumental support and informational support • societal, including interpersonal relationships (groups), social and economic systems and their receptivity (policies and practices) to supporting participation, laws • cultural, including values, beliefs, customs, use of time • the built environment, including physical properties, tools, assistive technology, design and the natural environment, covering geography, terrain, climate and air quality. This representation is intended to convey that occupational performance is determined not only by the nature of the activity, task or role to be performed, but also by the characteristics of the person or client (depicted as intrinsic factors) and the environment (depicted as extrinsic factors). Performance and participation always occur in context, and ultimately determine well-being and quality of life.
- StoryMaker: iPad, iPhone, iTouch. $39.99 Social Stories Creator and Library: Free
- The special needs child should be the main character. Make the setting of the story familiar to the child. Specifically describe the other characters in the story, making them familiar if possible. Make the dialog realistic and appropriate child’s ability-level. The important story points should be repeated. If possible, use photographs of the child or his peers. Read the story to the child as frequently as possible. http://drzachryspedsottips.blogspot.com/2011/11/interactive-social-story.html