social stories™ for children with disabilities

Social Stories� for Children with Disabilities

Georgina Reynhout1,2

and Mark Carter1

A review of the empirical research literature on Social Stories� is presented, including adescriptive review and single-subject meta-analysis of appropriate studies. Examination ofdata suggests the effects of Social Stories� are highly variable. Interpretations of extant

studies are frequently confounded by inadequate participant description and the use of SocialStories� in combination with other interventions. It is unclear whether particular componentsof Social Stories� are central to their efficacy. Data on maintenance and generalization are

also limited. Social Stories� stand as a promising intervention, being relatively straightfor-ward and efficient to implement with application to a wide range of behaviors. Furtherresearch is needed to determine the exact nature of their contribution and the components

critical to their efficacy.

KEY WORDS: Social Stories�; autism; Asperger’s syndrome; behavior modification; social skills; special

education.

INTRODUCTION

In describing Social Stories�, Gray (2003) hasstated that:

A social story is a process that results in a product for

a person with autism spectrum disorder (ASD). First,

as a process, a social story requires consideration of

—and respect for—the person with ASD. As a

product, a social story is a short story—defined by

specific characteristics—that describes a situation,

concept, or social skill using a format that is

meaningful for people with ASD. The result is often

renewed sensitivity of others to the experience of the

person with ASD, and an improvement in the

response of the person with ASD (p. 1).

In the Social Story�’s original form, three typesof short, direct sentences, descriptive, directive, and

perspective, were used. Descriptive sentences describethe social situation in terms of relevant social cues;directive sentences specify an appropriate behavioralresponse; and perspective sentences describe thefeelings and responses of the student or others inthe targeted situation (Gray, 2000b). Gray (2003) hassuggested that perspective sentences should only berarely used to describe the internal states of personswith autism.

Originally the use of illustrations was not gen-erally recommended as ‘‘...they may be distracting, ora student may make an inaccurate interpretation ofthe situation based on the illustration’’ (Gray &Garand, 1993, p. 4). This recommendation wassubsequently revised and the use of illustrations‘‘...that reflect consideration of the age and personallearning characteristics of the person with ASD’’(Gray, 2003, p. 5) is now suggested as beneficial tosocial understanding. The use of pictures may beviewed as consistent with other research on visualsupports for children with autism (e.g., Dettmer,Simpson, Myles, & Ganz, 2000).

1 Macquarie University Special Education Centre, Macquarie

University, North Ryde, NSW, Australia.2 Correspondence should be addressed to: Georgina Reynhout,

Macquarie University Special Education Centre, Macquarie

University, 2109, North Ryde, NSW, Australia.; e-mail: georgina.

[email protected]

4450162-3257/06/0500-0445/0 � 2006 Springer ScienceþBusiness Media, Inc.

Journal of Autism and Developmental Disorders, Vol. 36, No. 4, May 2006 (� 2006)

DOI 10.1007/s10803-006-0086-1

Published Online: April 26, 2006

Over time, the suggested format for a SocialStory� has become more sophisticated. Gray (2003)now describes four basic sentence types: descriptive,directive, perspective and affirmative. ‘‘Affirmativesentences enhance the meaning of surrounding state-ments, often expressing a commonly shared value oropinion within a given culture’’ (Gray, 2003, p. 3).These four basic sentence types and a ratio thatdefines their frequency are the most importantcomponents of the Social Story�. A basic SocialStory� has a ratio of two to five descriptive,perspective and/or affirmative sentences for everydirective sentence.

Two other types of sentences can be included:control and cooperative sentences. ‘‘Control sentencesare statements written by a person with ASD to identifypersonal strategies to use to recall and apply personalinformation’’ and cooperative sentences are ‘‘...used toidentifywhat otherswill do to assist the student’’ (Gray,2003, p. 3). A ratio of zero to one directive or controlsentences to between two and five descriptive and/orperspective sentences forms the complete Social Story�ratio. Within a Social Story�, descriptive, perspective,control and directive sentences can be partial orcomplete. ‘‘Partial sentences encourage the studentwith ASD to make guesses regarding the next step in asituation, the response of another individual, or his ownresponse’’ (Gray, 2003, p. 3).

There are several considerations to be made whenwriting a Social Story� according to Gray’s format(2000a, 2000b, 2003). The author must adopt andmaintain the perspective of the child for whom thestory is written. The story should be well within thestudent’s comprehension level and clearly presentedusing vocabulary and print size that are appropriatefor the student. Behavioral responses should be statedin positive terms, for example using ‘‘I will use myquiet voice’’ instead of ‘‘I will not shout.’’ It issuggested that Social Stories� be used with students‘‘...functioning intellectually in the trainable mentallyimpaired range or higher who possess basic languageskills’’ (Gray & Garand, 1993, pp. 2–3).

Gray and Garand (1993) describe how SocialStories� can be modified to suit a wide variety ofpurposes. For example, checklist or sequence SocialStories� can teach and provide practice in thefollowing of routines, and curriculum stories can becreated by inserting pages involving academic activ-ities, such as math, into the Social Story�. Skillsrelated to specific curriculum objectives can then bepracticed in the context of real life situations relevantto the student. Generic Social Stories� can be used to

describe social situations frequently experienced bychildren with autism which can be individualized andadapted as the need arises (Gray & Garand, 1993).

A Social Story� intervention can be imple-mented in one of three ways and the approach isdependent upon the particular needs and abilities ofthe child (Gray & Garand, 1993). If the child is ableto read, the teacher can initially read the SocialStory� with the child, and the child thereafter readsthe story independently. If the child is unable to read,the story can be recorded on cassette and the childtaught to use the tape recorder, turning the pagewhen prompted by an auditory signal. In this way thenon-reader can ‘‘read’’ the story independently. Thethird method involves video modeling. The story isrecorded onto videotape and sequences depicting thesocial situation and desired behavioral responses arematched to the story. Peers can read the SocialStory� to the child and when targeted situationsarise, they are able to prompt the student toremember the Social Story�, thus reinforcing itsuse. Following the introduction of the story thestudent’s comprehension of the story is checked. Thisis a mandatory part of the process involving theteacher asking the student to respond verbally or inwriting to verbal or written questions, or to fill in achecklist (Gray & Garand, 1993). Fading a SocialStory� can be achieved for example, by extendingthe time periods between readings, or by rewriting theSocial Story�, omitting or revising selected sen-tences. Fading is highly individualized and again,dependent on the needs and abilities of the child(Gray & Garand, 1993).

Several possible explanations have been offeredfor the purported success of Social Story� interven-tion for individuals with autism. One explanationinvolves the concept of ‘‘theory of mind’’ (ToM).Garfield, Peterson, &Perry (2001, pp. 495) define ToMas describing ‘‘...whatever knowledge guides preposi-tional attitude attribution and the explanation andprediction of behaviour by means of inner states andprocesses.’’ Individuals with autism, lacking ToM, areunable to appreciate other people’s intentions, beliefs,needs and desires (Greenway, 2000). Research showsboth linguistic (Happe, 1995) and social skills (Ozonoff& Miller, 1995) support the development of ToM.Individuals with autism, demonstrating significantimpairments in both linguistic and social skillsdomains, consequently show ToM deficits (Garfieldet al., 2001). The perspective sentences in SocialStories� are seen to address this social-cognitivedeficit.

446 Reynhout and Carter

Another explanation involves the use of sharedschemata or background knowledge. Rowe (1999)suggests that a Social Story� builds a scaffold ofunderstanding for a schema (mental representation)that an individual does not yet possess. Myles andSimpson (2001) describe Social Stories� as providingaccess to a social skill’s ‘‘hidden curriculum.’’ Thiscurriculum is based on the dos and don’ts innatelyunderstood and adhered to by everyone, exceptindividuals with Asperger’s syndrome.

Social Stories� may also be seen to includeaspects of purported good practice in ASD, beingvisual, permanent, written in simple language, basedon careful assessment of the child, focused on keyareas (for example, social interaction), and factual,focusing on the perceptions of others (Smith, 2001). Ina survey of school staff, parents and caretakers trainedin the Social Story� approach, the majority reportedit to be enjoyable, practical and effective (Smith, 2001).

Kuoch and Mirenda (2003) offered a limitedreview of research of 10 Social Story� interventionsstudies prior to 2002 (including some case studies).Several limitations in the research were noted includ-ing non-conformity of many of the stories withrecommended guidelines, flawed and weak researchdesigns and confounding effects as additional inter-ventions were often employed with Social Stories�.However, Kuoch and Mirenda (2003) included somestudies that did not present learner outcome data, didnot attempt to quantify outcome strength, examinegeneralization or maintenance and did not attempt toanalyze whether intervention features were associatedwith differential outcomes. Thus, at this point, we donot have a comprehensive and detailed review ofempirical studies on Social Story� interventions.

Social Stories� have inherent attractions inbeing relatively undemanding to implement and arereported to be applicable to a wide variety ofbehavior. The use of Social Stories� has beenpopularized, widely discussed and recommended inthe literature (e.g., Backman & Pilebro, 1999; Chap-man & Trowbridge, 2000; Rowe, 1999; Simpson &Myles, 1998). Unfortunately, clinical popularity ofinterventions has not always been a good indicator ofefficacy (see Dawson & Watling, 2000; Elder, 2002;Kasari, 2002; Kerrin, Murdock, Sharpton, & Jones,1998; McWilliam, 1999). While there has been anincreasing quantity of research examining SocialStories� in recent years, no systematic and compre-hensive review of empirical literature appears to havebeen conducted to date. The present paper addressesissues related to the nature and quality of studies

conducted, the participants, characteristics of theSocial Story� interventions with relation to suggestedguidelines (see Gray, 2003; Gray & Garand, 1993),behaviors that have been targeted for intervention, theshort-term efficacy of the technique, and generaliza-tion and maintenance. The paper includes a descrip-tive review of extant research as well as applyingappropriate statistical analyses to relevant studies,including calculation of conventional effect sizes forgroup designs and single-subject meta-analysis.

IDENTIFICATION OF STUDIES

The following on-line databases were searchedfor sources appearing before December 2003: ABI/INFORM Global; Academic Research Library; Cur-rent Contents Connect; ERIC; Expanded AcademicASAP; First Search; Ingenta; Inspec; Kluwer Online;Proquest Education Complete; PsyARTICLES; psy-cINFO; Science Direct and ISI Web of Science. Amanual search of all issues of Journal of Autism andDevelopmental Disorders was made for articles after1990 and the reference sections of all located sourceswere reviewed for additional sources that did notappear in the on-line searches.

Only studies related to Social Stories� wereincluded in the review. Studies involving the use ofsocial scripts, mutual storytelling and narrative ther-apy were excluded. Descriptive cases not includingdata (Del Valle, McEachern, & Chambers, 2001;Rowe, 1999), and studies not based on learnerperformance but teacher perception were excluded(Smith, 2001). Noting that the body of researchremains relatively small, peer-reviewed journal arti-cles and unpublished dissertations were included inthe review. Eleven peer-reviewed journal articles(Bledsoe, Myles, & Simpson, 2003; Brownell, 2002;Hagiwara & Myles, 1999; Kuoch & Mirenda, 2003;Kuttler, Myles, & Carlson, 1998; Lorimer, Simpson,Myles, & Ganz, 2002; Norris & Dattilo, 1999; Rogers& Myles, 2001; Scattone, Wilczynski, Edwards, &Rabian, 2002; Swaggart et al., 1995; Thiemann &Goldstein, 2001) and five dissertations (Cullain, 2002;Feinberg, 2002; Pettigrew, 1998; Romano, 2002;Staley, 2002) were identified.

PROCEDURES

A summary of each study was prepared address-ing participants, research design, dependent variable

Social Stories� 447

class, target behaviors, use of Social Story� strategy,use of additional strategies, reliability, short-termfindings, maintenance, and generalization, for eachstudy that provided a verbatim copy of SocialStories� used in intervention (totaling 31 storiesfrom 13 of the 16 studies). Each sentence wasindependently rated for sentence type (i.e., descrip-tive, perspective, affirmative, directive, control andcooperative) using the guidelines provided by Gray(2003). Sentences were coded in multiple categorieswhere this was considered appropriate. In the case ofperspective sentences taking the format of ‘‘I feelhappy when,’’ information provided in the secondpart of the sentence was considered to be supportingthe first and was not coded elsewhere in terms ofGray’s (2000b, 2003) classification. Where perspec-tive sentences were employed, they were coded as towhether they took the perspective of the targetindividual and/or that of others. One sentence typenot described by Gray (2000b, 2003) was also coded.Sentences were also coded as to whether theyspecified a consequence of the actions of the targetindividual or others (e.g., ‘‘When I share my toys, myfriends will want to play with me again’’).

Both authors independently rated all stories toallow estimation of interrater reliability of sentencecoding. An agreement was recorded when both ratersindicated the presence of a particular coding categoryfor a sentence and a disagreement was recorded whenonly one rater coded the category. Reliability wascalculated by dividing agreements by the total ofagreements and disagreements and multiplying by100. Interrater reliability was 86.7% for descriptivesentences. 88.2% for perspective sentences, 85.7% foraffirmative sentences, 93.5% for directive sentences,85.7% for control sentences, 85.7% for cooperativesentences and 82.5% for consequence sentences.Where raters agreed on the presence of perspectivesentence, agreements on whose perspective was takenwas 96.8%.

Data on types of sentences were summarized interms of the percentage of stories containing eachsentence type and the mean percentage of eachsentence type per story. In addition, the percentageof perspective sentences taking the perspective of thetarget individual, other individuals and both werecalculated.

For group designs, presentation of effect sizesalong with inferential statistics is recommended(American Psychological Association, 2001). Consis-tent with this recommendation, effect sizes werecalculated on relevant studies by subtracting the

post-test mean of the control group from the mean ofthe experimental group and dividing by the standarddeviation of the control group (McCartney & Ro-senthal, 2000). Effect sizes were expressed positivelywhen change occurred in the predicted direction andnegatively when changes were opposite to thosepredicted. When targeting an increase in behavior,an effect size of .20 is small, .50 moderate, and .80large; the usually accepted minimum clinically accept-able effect size for educational interventions is 0.33(McCartney & Rosenthal, 2000).

Single-subject studies are typically interpreted byvisual inspection of graphed data. Such visual inspec-tion of single subject studies can be subjective and theobjective aggregation of results is problematic. Cal-culation of the percentage of non-overlapping data(PND) has been suggested as an alternative (Scruggs,Mastropieri, & Casto, 1987). Using a graphical dataplot of results from baseline to treatment,the percentage of non-overlapping data (PND) isthe number of treatment data points that exceed thehighest (or lowest, if appropriate) baseline data point,divided by the total number of treatment data pointsand multiplied by 100 (Scruggs et al., 1987). Whilethe procedure has been subject to criticism on severalgrounds (e.g., Salzberg, Strain, & Baer, 1987; Strain,Kohler, & Gresham, 1998; White, 1987), it has gainedcurrency and has been applied across a range of areas(e.g., Didden, Duker, & Korzilius, 1997; Mathur,Kavale, Quinn, Forness, & Rutherford Jr., 1998;Scruggs, Mastropieri, Forness, & Kavale, 1988; Xin& Jitendra, 1999).

In the present analysis, a PND statistic wascalculated for each study using the pooled number ofnon-overlapping data points across all subjects and allconditions. In addition, a PND statistic was calcu-lated for each relevant story. A PND between 91 and100 indicates a highly effective intervention, between71 and 90 moderately effective, between 51 and 70mildly effective, and between 0 and 50, non-effective(Mastropieri, Scruggs, Bakken, & Whedon, 1996).

RESULTS

A summary of the participants, research designand duration of study, target behaviors and settings,use of Social Story� strategy and use of additionalstrategies was constructed and is presented in Table I.Table II provides descriptive information on reliabil-ity, short-term findings, study effect size or PND,maintenance, and generalization results.


Table

I.Subjects,DesignandDuration,Target

Behaviors,andStrategies

Study

Participants

(A)ResearchDesign

(A)Target

behaviors

Use

ofSocialStory

�strategy

AdditionalStrategies

(B)Durationofstudy

(B)Setting

(A)Construction

(B)Im

plementation

Bledsoeet

al.(2003)

One

boy,aged

13

with

Asperger’s

syndromeand

ADHD.

Fullscale

IQof82.

(A)ABAB

(B)7daysbaseline,5days

treatm

ent;5dayreturn

to

baseline,

4dayreturn

to

treatm

ent.

(A)Appropriate

social

behavior(spillsoffoodor

drink,andnapkin

use).

(B)Schooldiningareaat

lunchtime.

(A)OneSocialStory

�adheres

toGray’sbasic

SocialStory

�form

at.

(B)SocialStory

�readby

researcher.

SocialStory

�accessible

tostudentfollowing

intervention.

Nocomprehension

session.

Use

ofphotos.

Noadditionalstrategies.

Brownell(2002)

Fourboysaged

6–9years,

withreported

autism

.

Allboyswereverbaland

possessedatleast

pre-readingskills.

(A)ABAC

(interventions

counterbalancedacross

participants).

(B)Fivedaysbaseline,

5daysSocialStory

�read;5daysreturn

to

baseline,

5daysSocial

Story

�sung.

(A)Delayed

echolalia.

Response

when

given

a

directionforthefirsttime.

Frequency

ofusingaloud

voice.

(B)Classroom.

(A)FourSocialStories

�;

threestories

adheringto

Gray’sbasicSocial

Story

�form

at,oneis

inappropriately

modified.

(B)SocialStory

�reador

sungbyresearcher.

Nocomprehension

session.

SocialStory

�presented

intraditionalandmusical

form

at.


*Cullain

(2002)

Fourboysand1girl,aged

6–10years,withautism

(diagnosisbasedon

DSMV-IV

manual).

Allparticipants

used

expressivelanguage

communication.

Allparticipants

had

histories

ofexcessive

behaviors.

(A)AB(reported

asABA

butnodata

werecollected

duringintervention

phase).

(B)SocialStory

�readto

childtw

otimes

per

day

for5days.

(A)Level

ofanxiety.

Excessivebehaviors

such

as:clingingto

onefriend,

ignoringrequests,verbal

complaint,refusalto

play,

throwingobjects,

touchingpeers.

(B)Threeparticipants

in

schoolsetting;tw

opartic-

ipants

inhomesetting.

(A)FiveSocialStories

�;

onestory

adheres

to

Gray’sbasicSocial

Story

�form

at,tw

osto-

ries

are

appropriately

modified

andoneisinap-

propriately

modified.

(B)SocialStory

�readby

researcher

orparent.

CopyofSocialStory

�taken

homefordaily

reading.

Nocomprehension

session.



Table

I.Continued

Study

Participants

(A)ResearchDesign

(A)Target

behaviors

Use

ofSocialStory

�strategy


(B)Durationofstudy

(B)Setting

(A)Construction

(B)Im

plementation

*Feinberg(2002)

Twenty

fiveboysand9

girls,aged

8–13years,

withautism

(diagnosis

basedonDSMV-IV

manual,A-D

OS-G

,

ADI-R

andGARS).

Allparticipants

hadat

least

phrase

speech.

Participants

hadamean

fullscale

IQof71.29,SD

23.9.

(A)Experim

entalpre-test-

post-testcontrol-group.

(B)Regularstory

readfive

times

adayforoneday

andSocialStory

�read

fivetimes

adayforone

dayforcontrolgroup;

SocialStory

�readfive

times

adayfor2daysand

once

per

dayathomefor

7daysforexperim

ental

group.

A)Socialskills:greeting

behaviors,requestingto

playagame,

askingan-

other

personwhatthey

wantto

play,accepting

another’schoiceofgame.

(B)‘‘Gameroom’’.

A)OneSocialStory

�inappropriately

modified.

(B)SocialStory

�readby

researcher

foronegroup,

andresearcher

andparent

forother

group.

CopyofSocialStory

�taken

homefordaily

reading.

Comprehensionsession

included

asacomponent

oftheintervention.

Verbalprompting.

Hagiwara

andMyles(1999)

Threeboysaged

7–

9years,withautism

(diagnosisbasedonscores

of108,96and82obtained

withABC).

ScoresonPEP-R

indi-

cateddevelopmentalages

of36,26and40months.

Allparticipants

showed

mildto

moderate

social

skillproblemsandrelated

behaviorproblems,and

basiclisteningorwritten

languageskills.

(A)Multiple

baseline

across

settings.

(B)ForparticipantI:

5daysatbaseline,19days

treatm

ent(before

morning

snack);13daysatbase-

line,

11daystreatm

ent

(before

lunch);19daysat

baseline,

5daystreatm

ent

(after

recess).

ForparticipantII:4days

atbaseline,

12daystreat-

ment(before

resource

room);8daysatbaseline,

8daystreatm

ent(before

lunch);12daysatbase-

line,

4daystreatm

ent

(after

recess).

ForparticipantIII:3days

atbaseline,

11daystreat-

ment(lunch);7daysat

baseline,

8daystreatm

ent

(resourceroom);7daysat

baseline,

4daystreatm

ent

(classroom).

(A)Participants

IandII:

hand-w

ashingskills.

ParticipantIII:on-task

behavior.

(B)ForparticipantI,be-

fore

morningsnack,prior

tolunch

andafter

recess.

ForparticipantII

before

goingto

theresource

room,before

lunch,and

after

recess.

ForparticipantIIIlunch,

resourceroom,and

classroom.

(A)Only

oneSocial

Story

�ofthreeprovided;

inappropriately

modified.

(B)Multi-media

Social

Story

�program

operated

byparticipants.

Nocomprehension

session.

SocialStory

�presented

incomputerbasedform

at.

Use

ofvisualsymbols.

Verbalprompting.

Physicalassistance.


Kuoch

andMirenda(2003)

Threeboys,aged

3–

6years,withreported

autism

.Standard

scoresof

95,44and107obtained

withPPVT-R

.

(A)ABA

fortw

opartici-

pants.

ACABA

foronepartici-

pant.

(B)Foroneparticipant:

7daysatbaseline,

5days

treatm

ent,5daysreturn

tobaseline(sharing).

Foroneparticipant:

8daysatbaseline,

8days

treatm

ent,13daysreturn

tobaseline(eating).

Foroneparticipant:

8daysbaseline,

7days

bookandreminder,

7daysreturn

tobaseline,

8daysSocialStory

�,

8daysreturn

tobaseline

(playinggames).

(A)Sharingtoys.

Eating.

Playinggames.

(B)Oneparticipantin

homesetting,onepartici-

pantin

preschoolsetting,

andoneparticipantin

schoolsetting.

(A)ThreeSocialStories

�provided;oneadheres

to

Gray’scomplete

Social

Story

�ratio,tw

oappro-

priately

modified

basic

ratiostories.

(B)SocialStory

�readby

parent(w

howasa

teacher)in

thehome

setting,andbyearly

interventionists

inthe

preschoolandschool

settings.

Nocomprehension

session.

Use

ofvisualsymbols.


Kuttleret

al.(1998)

Oneboy,aged

12,with

reported

autism

,FragileX

syndromeandinterm

it-

tentexplosivedisorder;

withlimited

communica-

tionskills(vocalizations

enhancedbycommunica-

tionbook,manualsigns

andgestures).

ScoresonCallier-Azusa

scale

werecognition/

60months,receptivelan-

guage/48months,expres-

sivelanguage/24months,

andactualspeech/

18months.

(A)ABAB

(B)Fivedaysatbaseline,

5daystreatm

ent,3days

return

tobaselineand

6daystreatm

ent.

(A)Precursors

totantrum

behavior(inappropriate

vocalizationsanddrop-

pingto

floor).

(B)Self-contained

class-

room

forchildrenwith

autism

.

(A)TwoSocialStories

�;

oneadheres

toGray’sba-

sicSocialStory

�form

at,

oneinappropriately

modified.

(B)Each

SocialStory

�readbyteacher.

SocialStory

�accessible

tostudentfollowing

intervention.

Nocomprehension

session.

Use

ofvisualsymbols.

Stickers/prize

bagrein-

forcersincorporatedinto

SocialStory

�.

Lorimer

etal.(2002)

Oneboy,aged

5years,

withmildto

moderate

autism

(diagnosisbased

onDSMV-IV

manual),of

averagecognitiveability,

withlanguageskillscom-

mensurate

withchrono-

logicalage.

(A)ABAB

(B)Seven

daysbaseline,

7daystreatm

ent.

(A)Precursors

totantrum

behavior(interrupting

vocalizations).

Tantrum

behavior.

(B)Homesetting.

(A)TwoSocialStories

�;

both

adhereto

Gray’s

complete

SocialStory

�form

at.

(B)SocialStory

�readby

parents

andtherapists.

SocialStory

�accessible

tostudentfollowing

intervention.

Nocomprehension

session.

Use

ofvisualsymbols.



Table

I.Continued

Study

Participants

(A)ResearchDesign

(A)Target

behaviors

Use

ofSocialStory

�strategy


(B)Durationofstudy

(B)Setting

(A)Construction

(B)Im

plementation

NorrisandDattilo(1999)

Onegirl,aged

8years,

withreported

mildto

moderate

autism

,able

to

verballycommunicate,

withcognitivefunctioning

intheaverage,

low

aver-

ageormildly

intellectually

disabledrange.

(A)AB

(B)5daysbaseline;

15daystreatm

ent.

(A)Appropriate

social

interactions.

Inappropriate

social

interactions.

Absence

ofsocialinterac-

tion.

(B)Lunch-tim

ein

school

setting.

(A)NoexamplesofSocial

Stories

�provided.

(B)SocialStory

�readby

participant,withre-

searcher.

SocialStory

�accessible

tostudentfollowing

intervention.


included

asacomponent

oftheintervention.

Randomized

use

ofthree

differentstories

toprovide

interest.

Use

ofvisualsymbols.


*Pettigrew

(1998)

Forty-fiveboysand24

girls,aged

3–4years,with

averageintelligence

(85+)

andalanguagedelayofat

least

6monthsasmea-

suredbynorm

-referenced

tests.

(A)Experim

entalpre-

test–post-testcontroland

comparison-groupdesign.

(B)20sessions,20mins.

each.

(A)Socialskills:askingto

playwithapeer,sharing

toyswithapeer.

(B)Schoolsetting.


Stories

�provided.

(B)Nocomprehension

session.

Stories

personalizedby

insertingthefirstnameof

thechildhearingthe

story.

Use

ofvisualsymbols.

Scaffoldingactivities

involvingteacher

model-

ingandrehearsalto

prac-

tice

socialskills.

RogersandMyles(2001)

Oneboy,aged

14years,

withAsperger

Syndrome,

learningdiffi

cultiesand

behavioralproblems;able

toverballycommunicate.

(A)Pre-test/post-test

(B)5daysatbaseline,

5daystreatm

entforSo-

cialStory

�one.

Social

Story

�tw

o(comic

strip)

introducedday12.

(A)Response

toverbal

directions.

Tardinessto

class.

(B)Schoolsetting.

(A)TwoSocialStories

�;

oneadheres

toGray’s

basicSocialStory

�for-

mat,oneinappropriately

modified.

(B)SocialStory

�readby

participant,with

researcher.

Nocomprehension

session.

Use

ofvisualsymbols.

Treatm

entconditionD,

use

ofcomic

strip

conversation.


*Romano(2002)

Fiveboysand5girls,aged

4–8years,withreported

autism

,able

toexpress

needs/wants

either

verballyornon-verbally

(usingaugmentative

device,

communication

board,signlanguageor

gestures).

(A)Experim

entalpre-

test–post-testcontrol-

groupdesign.

(B)Fivedaysatbaseline,

30daystreatm

ent.

(A)Inappropriate

com-

munication(echolalic,

de-

layed

orim

mediate),

aggression(hitting,kick-

ingandspitting)and

inappropriate

socializa-

tion(solitary

playwhilein

agroup).

(B)Classroom.


Stories

�provided.

(B)SocialStory

�readby

SchoolPsychologist,

teacher

orchild.

Nocomprehensionses-

sion,role-playingactivity

followed

intervention.

Each

childreceived

three

SocialStories

�in

random

order

onadailybasis.

Use

ofvisualsymbols.


Scattoneet

al.(2002)

Threeboys,aged

7–

15years,withreported

autism

andcapable

of

communicatingusing

speech.

(A)Multiple-baseline

across

participants.

(B)Fourdaysatbaseline,

16daystreatm

ent(tip-

ping);8daysatbaseline,

12daystreatm

ent(star-

ing);13daysatbaseline,

7daystreatm

ent

(shouting).

(A)Disruptivebehaviors

(chair-tipping,shouting,

inappropriate

staringat

girls).

(B)Schoolsetting.

(A)ThreeSocialStories

�;

twoadhereto

Grays’ba-

sicSocialStory

�form

at,

oneadheres

toGray’s

complete

SocialStory

�form

at.

(B)SocialStory

�readby

teacher,teacher’saide,

or

student.

SocialStory

�accessible

tostudentfollowing

intervention.


included

asacomponent

oftheintervention.

Verbalprompting.

Aninterventionto

increase

on-task

behavior

wasim

plementedpriorto,

andduringthestudyfor

oneparticipant.

*Staley(2002)

Fivemales,aged

12–

14years,onewithre-

ported

autism

,tw

owith

DownSyndrome,

one

withFragileX

syndrome,

andonewithpervasive

developmentaldisorder

andseizure

disorder.

Allparticipants

hadat

least

kindergarten

level

readingskills.

(A)Multiple

baseline

across

participants.

(B)4–34daysbaseline,

6daysSocialStory

�(SS)

intervention,30daysSS

withquestions,6days

reinforcer,10daysreturn

toSSwithquestions,

20daysreturn

to

reinforcer.

(A)Appropriate

social

behavior(chew

ingwith

mouth

closed,andnapkin

use).

(B)Schoolcafeteria.

(A)TwoSocialStories

�;

oneadheres

toGray’s

complete

SocialStory

�form

at;oneisappropri-

ately

modified.

(B)SocialStory

�readby

teacher,teacher’saide,

or

doctoralstudent.


included

asacomponent

oftheintervention.

Verbalprompting.

Behaviormodeling.

Edible

reinforcers.


Table

I.Continued

Study

Participants

(A)ResearchDesign

(A)Target

behaviors

Use

ofSocialStory

�strategy


(B)Durationofstudy

(B)Setting

(A)Construction

(B)Im

plementation

Swaggart

etal.(1995)

Threechildren,aged

7–

11years;oneboywith

pervasivedevelopmental

disorder,andoneboyand

onegirlwithreported

autism

.

Allparticipants

hadlim-

ited

expressivelanguage

skills.

(A)AB

B)9daysbaseline,

9days

treatm

ent(greets);

51daysbaseline,

10+

daystreatm

ent(aggres-

sion).

10daysbaseline,

17/

18daystreatm

ent(shar-

ing,grabbing,parallel

playandaggression).

(A)Appropriate

social

interactionsre:greeting,

touching,aggressionand

ignoring.

Appropriate

socialinter-

actionsre:sharing,grab-

bing,parallel

playand

aggression.

(B)Schoolsetting.


�;

twoadhereto

Gray’sba-

sicSocialStory

�form

at,

twoinappropriately

mod-

ified.

(B)SocialStory

�readby

teacher

orparaprofes-

sional.

Nocomprehension

session.

Use

ofvisualsymbols.

SocialStory

�paired

with

response–cost

system

for

oneparticipant.

Verbalpromptingand

physicalprompting,and

SocialStory

�paired

with

response-cost

system

used

withoneparticipant.

ThiemannandGoldstein

(2001)

Fiveboysaged

6–

12years,withautism

(diagnosisbasedon

CARSscores),withim

-

paired

socialcommunica-

tion,em

erging/acquired

word-identificationskills

andfunctionalverbal

communication,and10

peers

withoutdisabilities.

(A)Multiple

baseline

across

twoto

threesocial

communicationskillsrep-

licatedacross

fivetriads.

(B)Thirty

minutestw

icea

weekfortriad;10min

SocialStory

�reading;

10min.socialinteraction;

10min.video

feedback.

(A)Socialskillin

securing

forattention,initiating

comments,initiating

requests

andcontingent

responses.

(B)Schoollibrary.


�used;onestory

only

pro-

vided,adheringto

Gray’s

basicSocialStory

�for-

mat.

(B)SocialStory

�readby

studentwithhelpfrom

examiner

orpeers.

Nocomprehension

session.

Use

ofvisualsymbols.

Verbalprompting.

Directsocialskills

instructioninvolving

written

textcuerehearsal

androle-play.Self-evalu-

ationusingvideo-feed-

back.

Note:ABC,Autism

BehaviorChecklist;A-D

OS-G

,Autism

Diagnostic

ObservationSchedule-G

eneric;ADI-R,Autism

Diagnostic

Interview-R

evised;CARS,ChildhoodAutism

RatingScale;DSM-IV,Diagnosticandstatisticalmanualofmentaldisorders(4th

edition);GARS,Gilliam

Autism

RatingScale;PEP-R

,Psycho-educationalProfile-R

evised;PPVT-

R,PeabodyPicture

Vocabulary

Test-Revised.

*Dissertation.


Table

II.ReliabilityandResults

Study

Interobserver

reliability

Proceduralreliability

Reported

short-term

results

Effectsize

(ES)orPND

Maintenance

and

generalization

Bledsoeet

al.(2003)

Calculated

for

50%

of

sessions.

Meanagreem

ent

90

%.


not

reported.

Areductionin

foodspill-

ages.

Anincrease

innapkin

use.

PND

resultsfrom

baseline

tointervention

forreduc-

tionin

foodspillages

11,for

increase

innap

kin

use

22.

StudyPND

16

Notreported

Brownell(2002)

Calculated

for

40%

of

sessions.Meanreliabilities

were86%,94%,88%

and

93

%.


not

reported.

Areduction

intarget

behaviors

ofeach

partici-

pant.

Singing

condition

was

significantly

more

effectivethan

readingfor

oneparticipant.

PND

resultsfrom

baseline

1(A

)to

story

read(B)and

baseline

2(A

)to

story

sung(C

):Peter,90;Brian,88;Na-

than,80andJustin,90.

StudyPND

87.

Notreported.

*Cullain

(2002)

Notreported.


not

reported.

Areduction

inanxiety

levels

of

three

partici-

pants.

Areduction

inexcessive

behaviors

forall

partici-

pants.

PND

resultsfrom

baseline

topost-intervention

for

threeexcessivebehaviors:

Douglas,

26;Sander,80;

Derek,26;Kevin,53

Beth0.

StudyPND

37.

Maintenance

notreported.

Generalization:studycon-

ducted

intw

osettings;

three

participants

at

school,tw

oparticipants

at

home.

*Feinberg(2002)

Calculated

for

25%

of

observations.

Mean

agreem

ent85%.


not

reported.

Increase

insocial

skills

scores

for

experim

ental

group.

Nochangein

socialskills

scoresforcontrolgroup.

Meaneff

ectsize

forinter-

vention

based

on

total

socialskillsscoresover

six

trials:0.99

(highly

effec-

tive).

Notreported.

Hagiwara

andMyles(1999)

Calculated

for

33%

and

37

%ofsessionsfortw

oparticipants.100

%agree-

ment.Calculatedfor33%

ofsessionsforonepartic-

ipant.

Mean

agreem

ent

89

%.


not

reported.

Improved

hand-w

ashing

skills

dem

onstrated.Par-

ticipantIachieving100

%task

completion

intw

osettings;

participant

IIachieving92%

task

com-

pletionin

onesetting.

Partiallyim

proved

on-task

behaviorin

twosettingsde

monstratedbyparticipant

III.

PND

resultsfrom

baseline

tointervention

forhand-

washing:

ParticipantI,39.

ParticipantII,37.5.

PND

resultsfrom

baseline

tointerventionforon-task

behavior:

ParticipantIII,47.

StudyPND

40.

Maintenance

notreported.

Generalization:Studycon-

ducted

indifferentschool

settings.

One

participant

generalized

skills

totw

onew

settings.

One

partici-

pantgeneralized

skills

toonenew

setting.

Kuoch

andMirenda(2003)

Calculated

foreach

par-

ticipantacross

ameanof

23.5

%of

all

sessions.

Meanagreem

ent97.9

%.

Procedural

reliability

across

all

three

partici-

pants

was98.4

%.

Areduction

intarget

behaviors

foreach

partic-

ipant.

PND

resultsfrom

baseline

tointervention:

ParticipantI,0.

ParticipantII,100.

ParticipantIII,75.

StudyPND

66.

Maintenance:

decrease

intargeted

behaviors

reported

on

return

tobaseline

for

twoparticipants.

Generalization:reported

generalizationofsharingan

dap

propriategameplaying

skillsfortwoparticipants.


Table

II.Continued

Study

Interobserver

reliability


Reported

short-term

re-

sults

Effectsize

(ES)orPND

Maintenance

and

generalization

Kuttleret

al.(1998)

Calculated

for

34%

of

observations.

Mean

agreem

ent93%.


not

reported.

Adecrease

inprecursors

totantrum

behaviordur-

ingintervention.

Anincrease

inprecursors

totantrum

behaviorpost-

intervention.

PND

resultsfrom

baseline

1(A

)to

intervention

(B)

and

baseline

2(A

)to

intervention

(B)

during

morning

work

time

100

andlunch

time,

95.

StudyPND

95.

Maintenance

not

reported.

Generalization:

Study

conducted

intw

oschool

settings-

morning

work

timeandlunchtime.

Lorimer

etal.(2002)

Calculated

for

33%

of

observations.

Mean

agreem

ent96%.


not

reported.

Adecrease

ininterrupting

vocalizationsandtantrum

behaviorduringinterven-

tion.

An

increase

ininterrupt-

ingvocalizationsand

tantrum

behavior

post-intervention.

PND

from

baseline1(A

)to

intervention

(B),

and

from

baseline

2(A

)to

intervention(B)resultsfor

frequency

ofinterrupting

vocalizations

(B)86;for

frequency

of

tantrum

behaviors

0.

StudyPND

43.

Notreported.

NorrisandDattilo(1999)

Calculated

for

20%

of

baseline

sessions,

occur-

rence

agreem

ent89–100%.

Calculated

for

25%

of

intervention

sessions,

occurrence

agreem

ent88–

100

%(oneat64%).

Procedural

reliability

measures

for

each

story

were100

%.

No

increase

inappropri-

ate

socialinteractions.

Overall

decrease

ininap-

propriate

social

interac-

tions.

Increase

inno

social

interactions.

PND

resultsfrom

baseline

1(A

)to

intervention

(B)

for

frequency

of

appro-

priate

socialinteractions

17,

inappropriate

social

interactions,

8andnoso-

cialinteractions,25.

StudyPND

16.

Notreported.

*Pettigrew

(1998)

Notreported.


not

reported.

An

increase

inpre-test–

post-testSCBE

scoresfor

experim

ental

and

com-

parisongroups.

Meaneff

ectsize

forSCBE

scores,

experim

ental/con-

trol

0.34

(effective);

experim

ental/comparison

0.26

Notreported.

Rogers&

Myles(2001)

Notreported.


not

reported.

Improved

response

toverbaldirections.

Reduced

tardiness

toclass.

Insufficientdata

provided.

Notreported.


*Romano(2002)

Calculated

for

100%

of

sessions,

occurrence

agreem

ent90–100%.


not

reported.

Decrease

inaggression,

inappropriate

communi-

cation

and

inappropriate

socialization

dem

on-

strated

by

treatm

entand

controlgroupsfrom

pre-

test

topost-test.

Mean

effect

size

for

aggression,inappropriate

communicationandinap-

propriate

socialization

was

)1.59,range

)0.94to

)2.31.

Maintenance:increase

ininappropriate

behaviors

dem

onstrated

from

post-

test

tomaintenance

for

treatm

ent

and

control

groups.

Increase

ininap-

propriate

targeted

behav-

iors

dem

onstrated

pretest

tomaintenance

bycontrol

group.Decrease

ininap-

propriate

targeted

behav-

iors

dem

onstrated

from

pre-testto

maintenance

by

treatm

entgroup.

Generalization:not

reported.

Scattoneet

al.(2002)

Calculated

for

30%

of

observations.

Mean

agreem

ent

93%

for

one

participant.

Occurrence

agreem

ent100%

fortw

oparticipants.

Procedural

reliability

measuresof91%

forone

participantand

100%

for

2participants.

Decrease

indisruptive

behaviors

(chair-tipping,

shouting,

inappropriate

staringatgirls).

PND

resultsfrom

baseline

1(A

)to

intervention

(B)

forKenny

100,John

92

andHoward

57.

StudyPND

88.

Notreported.

*Staley(2002)

Calculated

for

15%

of

napkin

use

observations.

Mean

agreem

ent

97%.

Calculated

for

18%

of

chew

ing

observations.

100

%agreem

ent.


not

reported.

No

increase

infrequency

innapkin

use

orchew

ing

with

mouth

closed

with

Social

Story

�used

inisolation.Increase

infre-

quency

innapkin

use

and

chew

ing

with

mouth

closed

when

edible

rein-

forcersused

inisolation,

or

inconjunction,

with

SocialStories

�.

Mean

PND

for

partici-

pants

Ito

Vfornapkin

use,from

baseline(B)to

SocialStory

�(S)0,from

(B)to

SocialStory

�and

questions

(SQ)

17

and

from

(B)

toSocial

Story

�,

questions

and

reinforcer

(R)73.

ResultsforparticipantIto

Vforchew

ingwithmouth

closedfrom(B)to

(S)4,(B)

to(SQ)1,and(B)to(R

)66.

StudyPND

30.

Notreported.

Swaggart

etal.(1995)

Notreported.


not

reported.

Increase

inappropriate

socialinteractionre:

greeting,touching,

aggressionandignoring.

Increase

inappropriate

socialinteractionsre:

sharing,grabbing,parallel

playandaggression.

Mean

PND

for

greeting

behaviorfrom

baselineto

intervention

88,

for

aggressiveincidents

from

baselineto

intervention0.

StudyPND

24.

Maintenance

not

reported.

Generalization:

increased

appropriate

social

inter-

action

dem

onstrated

across

avariety

of

set-

tings.


A summary of the results of the analysis of thesentence types is presented in Table III.

Table IV provides a summary of aspects of storyconstruction and implementation in relation to PNDfor individual stories for which that metric could becalculated. All stories involved one participant exceptthose of Staley (2002), who used five participants fortwo Social Stories�, and Thiemann and Goldstein(2001), who used five participants for one story.

Social Story� use comprises Social Story�construction and implementation. Gray (2003)defines two Social Story� types, those adhering tothe basic Social Story� ratio, and those adhering tothe complete Social Story� ratio. Gray (2003) hasnoted that directive sentences may not be necessary insome instances so stories with a lower than recom-mended ratio of directive to other sentences wereconsidered to be appropriately modified. Based onanalysis of the Social Stories�, four categories ofSocial Story� were identified: (a) stories that adheredto the basic Social Story� ratio; (b) stories thatadhered to the complete Social Story� ratio; (c)appropriately modified Social Stories�, where thenumber of descriptive, perspective, affirmative or co-operative sentences is greater than that recommendedin the basic or complete ratios, but still acceptableaccording to Gray’s recommendations (see Gray,2003), and (d) inappropriately modified SocialStories�, where the number of directive or controlsentences is greater than that recommended in thebasic or complete ratios. The results of the analysisare presented in Table V.

Participants

Fifteen of the 16 studies involved a child orchildren with autism or Asperger’s syndrome; ofthese children, 60 were boys and 17 were girls, aged3–15 years. Pettigrew (1998) provided the only study

Table

II.Continued

Study

Interobserver

reliability


Reported

short-term

re-

sults

Effectsize

(ES)orPND

Maintenance

and

generalization

Thiemann

and

Goldstein

(2001)

Calculated

for

30

%of

sessions.

Mean

agree-

ments

for

participants

92%,89%,92

%,93%

and

90%.

Procedural

reliability

measuredfor20

%ofses-

sionsat89%.

Increase

intargeted

social

skills

from

baselinewhen

treatm

entim

plemented.

Mean

PND

forDan,70,

Greg28,John

22,Casey

77,andIvan17.

StudyPND

45.

Maintenance:

Lim

ited

maintenance

insocial

skills

dem

onstrated

by

threeparticipants.

Generalization:one

par-

ticipant

dem

onstrated

generalization

of

new

lyacquired

socialskills

toonenew

setting.

Abbreviation:SCBE,SocialCompetence

andBehaviorEvaluation-PreschoolEdition.

*Dissertation.

Table III. Social Story� Sentence Analysis

Sentence type

Percentage of

stories containing

sentence type

Mean percentage of

sentence type per

story (range)

Descriptive 97 42 (0–91)

Perspective 87 23 (0–60)

Affirmative 22 3 (0–21)

Directive 100 28 (9–89)

Control 10 1 (0–14)

Cooperative 13 2 (0–29)

Consequence 90 24 (0–50)

Note: All percentages are rounded.


Table

IV.Story

ImplementationandConstructionVariablesandPND

Socialstory

�Behavior

Percentageofsentence

type:

SSratio

COMP


PND

DES

PER

AFF

DIR

CON

COOP

CONS

Bledsoeet

al.(2003)

Foodspill,napkin

use

25

23

025

00

50

Basic

No

None

16

Brownell(2002;Brian)

Follow

directions

50

17

033

00

33

Inappropriately

modified

No

None

88

Brownell(2002;Justin)

Usingquietvoice

50

33

017

00

33

Basic

No

None

90

Brownell(2002;Nathan)

Usingquietvoice

57

14

029

00

29

Inappropriately

modified

No

None

80

Brownell(2002;Peter)

Echolalia

29

43

029

00

29

Inappropriately

modified

No

None

90

Cullain

(2000;Sander)

Playinggames

38

44

019

00

25

Basic

No

None

80

Cullain

(2002;Beth)

Talkingwithfriends

13

60

027

00

13

Basic

No

None

0

Cullain

(2002;Derek)

Computeruse

14

43

021

029

29

Complete

No

None

26

Cullain

(2002;Douglas)

Differentfriends

60

00

40

00

0Basic

No

None

37

Cullain

(2002;Kevin)

Playinggames

29

47

012

14

14

24

Complete

No

None

53

Hagiwara

andMyles

(1999)

Handwashing

011

089

00

0Inappropriately

modified

No

Verbalprompts,

physicalprompts

38

Kuoch

andMirenda

(2003;Neil)

Playinggames

45

15

21

18

00

27

Basic

(appropriately

modified)

No

None

75

Kuoch

andMirenda

(2003,Andrew)

Sharing

60

20

10

10

00

30

Basic

(appropriately

modified)

No

None

66

Kuoch

andMirenda

(2003;Henry)

Eating

45

32

514

50

40

Complete

No

None

100

Kuttleret

al.(1998)

Behavioratlunch

38

13

050

00

25

Inappropriately

modified

No

Reinforcers

(stickers/prize

bag)

90

Kuttleret

al.(1998)

Workingforsticker

67

17

017

00

50

Basic

No

Reinforcers

(stickers/prize

bag)

100

Lorimer

etal.(2002)

Talking

53

13

020

13

07

Complete

No

None

43

Lorimer

etal.(2002)

Waiting

91

90

90

09

Basic

(appropriately

modified)

No

None

43

Scattoneet

al.

(2002;Howard)

Shouting

43

14

029

014

29

Complete

Yes

Verbalprompts

57

Scattoneet

al .

(2002;John)

Lookingatgirls

50

10

10

30

00

10

Basic

Yes

Verbalprompts

92

Scattoneet

al.

(2002;Kenny)

Sittingonchair

50

30

020

00

50

Basic

Yes

Verbalprompts

100

Staley(2002)

Chew

ing

65

419

12

04

27

Complete

Yes

Verbalprompts,

modeling,reinforcer

(edibles)

32

Staley(2002)

Napkin

use

78

011

11

00

11

Basic

(appropriately

modified)

Yes

Verbalprompts,

modeling,reinforcer

(edibles)

39

Swaggart

etal.

(1995)

Greeting

40

00

60

00

40

Inappropriately

modified

No

Verbalprompts,

physicalprompts

88

Swaggart

etal.

(1995)

Appropriate

behavior

50

17

033

00

33

Basic

No

Verbalprompts,

physicalprompts,

reinforcer

(edibles)

0

Note:DES,Descriptive;

PER,Perspective;

AFF,Affirm

ative;

DIR

,Directive;

CON,Control;COOP,Cooperative;

CONS,Consequence;SSratio,SocialStory

�ratio;COMP,Comprehension

assessed.Allpercentages

are

rounded.


not involving children with autism or Asperger’ssyndrome. The criteria for inclusion in this study wasa language delay of at least 6 months and an age of3–4 years (Pettigrew, 1998). In most instances, only adiagnostic label of autism or autism spectrum disor-der was provided. Only three of the studies (Feinberg,2002; Hagiwara & Myles, 1999; Thiemann & Gold-stein, 2001) provided standardized data on theposition of the participants on the autism spectrum.The communication skills of participants in thestudies ranged from those who were non-verbal(using augmentative device, communication board,sign language or gestures), to those able to commu-nicate verbally (Table I). In seven studies (Bledsoeet al., 2003; Feinberg, 2002; Lorimer et al., 2002;Norris & Dattilo, 1999; Pettigrew, 1998; Scattoneet al., 2002; Thiemann & Goldstein, 2001), referencewas made to cognitive abilities of the participants;only four of these provided information based on theresults of standardized tests (Bledsoe et al., 2003;Feinberg, 2002; Scattone et al., 2002; Thiemann &Goldstein, 2001). Only five studies (Bledsoe et al.,2003; Brownell, 2002; Kuoch & Mirenda, 2003;Staley, 2002; Thiemann & Goldstein, 2001) provideddescription of the reading ability of the participants;four of these presented results of standardized tests(Bledsoe et al., 2003; Kuoch &Mirenda, 2003; Staley,2002; Thiemann & Goldstein, 2001). As the partic-ipant description provided in many studies consistedof little more than a diagnostic label, it was effectivelyimpossible to determine if any specific participantcharacteristics were associated with interventioneffectiveness.

Research Design

The experimental designs of the single-subjectstudies ranged in complexity from simple AB (Cul-lain, 2002; Norris & Dattilo, 1999; Swaggart et al.,1995) to withdrawal (Bledsoe et al., 2003; Brownell,2002; Kuoch & Mirenda, 2003; Kuttler et al., 1998;Lorimer et al., 2002), to multiple baseline acrossparticipants (Scattone et al., 2002; Staley, 2002),skills (Thiemann & Goldstein, 2001) or settings

(Hagiwara & Myles, 1999). Simple pre-test–post-testdata was reported in some instances (Rogers &Myles, 2001; Swaggart et al., 1995 for some partic-ipants). In a small number of studies group designswere employed including a pre-test–post-test control-group design (Feinberg, 2002; Romano, 2002) and apre-test–post-test control and comparison-groupdesign (Pettigrew, 1998). There was wide variationin study duration within and among the researchdesigns employed in the studies.

Interobserver and Procedural Reliability

Twelve of the 16 studies (Table II) providedmeasures of interobserver reliability. In general,reliability measures in the studies ranged from 85–100%, calculated for between 15 and 100% of sessions(20% being the conventional minimum standard). Onone occasion, in the study conducted by Norris andDattilo (1999), the interobserver reliability droppedto 64%, resulting in a revision by the authors of theirdefinitions of appropriate, inappropriate and absenceof social interactions, to reflect a greater level ofspecificity. Procedural reliability measures werereported for only four studies (Kuoch & Mirenda,2003; Norris & Dattilo, 1999; Scattone et al., 2002;Thiemann & Goldstein, 2001).

Target Behaviors and Settings

The studies addressed various behaviors. Sixstudies targeted disruptive or challenging behaviors(Cullain, 2002; Kuttler et al., 1998; Lorimer et al.,2002; Romano, 2002; Scattone et al., 2002; Swaggartet al., 1995), nine studies targeted social skills (Bled-soe et al., 2003; Feinberg, 2002; Kuoch & Mirenda,2003; Norris & Dattilo, 1999; Pettigrew, 1998;Romano, 2002; Staley, 2002; Swaggart et al., 1995;Thiemann & Goldstein, 2001), four studies targetedcommunicative behaviors (Cullain, 2002; Kuttleret al., 1998; Lorimer et al., 2002; Romano, 2002)and four studies targeted on-task behaviors (Brow-nell, 2002; Hagiwara & Myles, 1999; Kuoch &Mirenda, 2003; Rogers & Myles, 2001).

Twelve studies took place in a school setting(Bledsoe et al., 2003; Brownell, 2002; Hagiwara &Myles, 1999; Kuttler et al., 1998; Norris & Dattilo,1999; Pettigrew, 1998; Rogers & Myles, 2001;Romano, 2002; Scattone et al., 2002; Staley, 2002;Swaggart et al., 1995; Thiemann & Goldstein, 2001),one study took place in a home setting (Lorimeret al., 2002), two studies took place in a school andhome setting (Cullain, 2002; Kuoch & Mirenda,

Table V. Summary of Story Analysis

Category of Social Story� Number of stories

Basic 12

Complete 6

Appropriately modified 4

Inappropriately modified 9


2003), and one study took place in a ‘‘game room’’ atan unidentified location (Feinberg, 2002).

Effectiveness

The authors of nine studies (Bledsoe et al., 2003;Brownell, 2002; Cullain, 2002; Kuoch & Mirenda,2003; Kuttler et al., 1998; Lorimer et al., 2002; Norris& Dattilo, 1999; Rogers & Myles, 2001; Romano,2002; Scattone et al., 2002) reported an appropriatereduction in target behaviors and eight studies(Bledsoe et al., 2003; Feinberg, 2002; Hagiwara &Myles, 1999; Lorimer et al., 2002; Pettigrew, 1998;Rogers & Myles, 2001; Swaggart et al., 1995; Thie-mann & Goldstein, 2001) claimed an appropriateincrease in targeted behaviors from baseline tointervention, or from pre-test–post-test. Two studiesshowed no change in some behaviors when SocialStories� were used in isolation (Norris & Dattilo,1999; Staley, 2002) and two studies showed an actualincrease in disruptive behaviors post-intervention(Kuttler et al., 1998; Lorimer et al., 2002).

Effect sizes were calculated for three studies(Feinberg, 2002; Pettigrew, 1998; Romano, 2002).Based on total social skills scores for six trials(Feinberg, 2002) a mean effect size of .99 wascalculated, suggesting Social Story� interventionwas highly effective in increasing social skills in thisstudy. Romano (2002) failed to provide standarddeviations for the experimental and control groups atpost-test. The mean effect size at maintenance was1.59 (range .94 to 2.31) indicating that Social Story�intervention was highly effective in decreasing thetargeted behaviors for this group. These data shouldbe treated with extreme caution as the post-testresults indicated a massive experimental effect in thecontrol group, which was reversed at maintenance,raising serious questions about experimental controlin the study. Romano (2002) suggested that thismight have been a product of contamination of theintervention as control group students may haveoverheard the Social Stories�. Analysis of thePettigrew (1998) study (see Table II) revealed lowmean effect sizes for the experimental-control con-trasts of .34 and for the experimental-comparisoncontrasts of 0.26. In addition, these data also need tobe treated with caution, as there were clear discrep-ancies between tabular and graphic data. Staley(2002) has also pointed out other serious discrepan-cies in the data and analysis.

A total PND value was obtained for 12 studies(i.e., Bledsoe et al., 2003; Brownell, 2002; Cullain,

2002; Hagiwara & Myles, 1999; Kuoch & Mirenda,2003; Kuttler et al., 1998; Lorimer et al., 2002; Norris& Dattilo, 1999; Scattone et al., 2002; Staley, 2002;Swaggart et al., 1995; Thiemann & Goldstein, 2001).The calculated mean PND was 43 (range 16–95). Insome cases the data overlap may not provide anaccurate measure of treatment effectiveness, forexample, when baseline data shows an inappropriatetrend, or when ‘‘floor or ceiling’’ effects occur(Scruggs et al., 1987). Possible floor and ceilingeffects were certainly present in the data examinedin the present review (i.e., Bledsoe et al., 2003;Cullain, 2002; Kuoch & Mirenda, 2003; Lorimeret al., 2002; Norris & Dattilo, 1999; Staley, 2002;Swaggart et al., 1995).

To evaluate the possible effects of such effects afurther analysis was conducted. Data were eliminatedfor behaviors, subjects or phases that were expectedto decrease that contained a zero data point and,similarly, data were eliminated for behaviors thatwere expected to increase and a baseline ceiling wasevident in one data point (i.e., 100% of opportuni-ties). When these data were excluded and the PNDrecalculated, a total PND of 51(range 20–95) wasobtained. The mean PND values place the SocialStory� in the non-effective range or at very best, inthe low end of the mildly effective range (seeMastropieri et al., 1996). The most striking featureof the data, however, was the degree of inconsistency,including variation in responses to interventionacross participants or behaviors (see Table II).

Story Construction

Examples of Social Stories� used for interven-tion were not provided in three studies (i.e., Norris &Dattilo, 1999; Pettigrew, 1998; Romano, 2002).Examples of Social Stories� were provided for 13of the 16 studies (i.e., Bledsoe et al., 2003; Brownell,2002; Cullain, 2002; Feinberg, 2002; Hagiwara &Myles, 1999; Kuoch & Mirenda, 2003; Kuttler et al.,1998; Lorimer et al., 2002; Rogers & Myles, 2001;Scattone et al., 2002; Staley, 2002; Swaggart et al.,1995; Thiemann & Goldstein, 2001). Detailed exam-ination of these stories (see Table III) revealed thataffirmative, control, and cooperative sentences wereused infrequently while descriptive, perspective anddirective sentences were the most commonlyemployed. In contrast, with Gray’s (2003) recom-mendation that perspective sentences should onlyoccasionally be written from the viewpoint of theperson with autism, 47% of perspective sentences


were written from this viewpoint, 47% were writtenfrom the viewpoint of others and 6% were writtenfrom both perspectives. Consequence sentences werenot described by Gray (2003) but were identified in90% of stories and contributed a mean of 24% (range0–50%) of sentences per story.

It was of interest to examine whether specificaspects of story construction were associated withPND. Before proceeding with presentation of thesedata, it is appropriate to note that the analysis shouldbe treated with caution as is based on a relativelysmall number of stories (26) on which PND can becalculated. Gray (2003) offers clear guidelines on howSocial Stories� should be constructed. Inspection ofTable V indicates that analysis of the Social Stories�reveals 10 (39%) of the stories deviate from recom-mended basic or complete Social Story� ratios. Oneobvious question was whether deviation from Gray’sguidelines (Gray, 2003) would differentially affectoutcomes. From the data in Table IV, which islimited to stories where PND was available, it can bedetermined that the 14 stories with basic or appro-priately modified basic ratios yielded a mean PND of55.6. The six stories with complete story ratiosyielded a mean PND of 51.8 and the six inappropri-ately modified stories, with a combination of lessdescriptive and more directive sentences, yielded amean PND of 79.0.

In order to determine whether particular sen-tence types corresponded with differential outcomes,initially data in Table IV were ranked according tothe frequency of each type of main sentence. Storieswere then divided into approximate thirds and aPND statistic was calculated for the nine stories withthe highest frequency of each sentence type, the eightstories that were middle ranked and the remainingnine sentences with the lowest rank. There was noevidence of an effect for perspective sentences with aPND of 64 for the highest ranked stories, 60 formiddle ranked stories and 56 for the lowest rankedstories. The pattern was not consistent for directivesentences with a PND of 67 for the highest rankedstories, 45 for middle ranked stories and 66 for thelowest ranked stories. There was also inconsistency inthe pattern for descriptive sentences with a PND of59 for the highest ranked stories, 75 for middleranked stories and 48 for the lowest ranked stories.There was some evidence of a pattern in PND forconsequence sentences with a PND of 70 for thehighest ranked stories, 65 for middle ranked storiesand 47 for the lowest ranked stories. It was alsointeresting to note that the actual percentage of

consequences sentences was very low for the bottomthird of stories (11.0% vs. 26.2% for middle rankedstories and 41.0% of highest ranked stories).

Story Delivery

In 15 of the studies, implementation of the SocialStory� was traditional, the Social Story� being readto or by the participant(s) (Table I). In one study(Hagiwara & Myles, 1999) the Social Story� waspresented on a computer; in another study (Brownell,2002) the Social Story� was presented in bothmusical and traditional formats. In 11 studies theauthors used visual symbols (Hagiwara & Myles,1999; Kuoch & Mirenda, 2003; Kuttler et al., 1998;Lorimer et al., 2002; Norris & Dattilo, 1999; Petti-grew, 1998; Rogers & Myles, 2001; Romano, 2002;Swaggart et al., 1995; Thiemann & Goldstein, 2001)or photos (Bledsoe et al., 2003) to enhance theinformation provided in the Social Story� text.

There was variation in the number of SocialStories� used in some studies. Norris and Dattilo(1999), for example, randomly used three differentstories with one participant, to provide interest,targeting social interaction only. Romano (2002)used three different stories, each one targeting differ-ent behaviors (those associated with communication,aggression and socialization). Other variations inimplementation procedures were also evident. Thefirst variation involved the inclusion of some form ofcomprehension exercise, undertaken by the studentfollowing the reading of the Social Story�, asrecommended by Gray and Garand (1993). In fivestories from two studies (Scattone et al., 2002; Staley,2002) for which PND data were available, compre-hension sessions were included as a component ofSocial Story� intervention to enhance student under-standing. From Table IV, it can be seen that thestories where authors reported a comprehensioncomponent yielded a mean PND of 64 and the 20that did not yielded a PND of 60. The second relatesto the student’s access to the Social Story� followingits reading. In seven studies (Bledsoe et al., 2003;Feinberg, 2002; Norris & Dattilo, 1999; Scattoneet al., 2002; Staley, 2002; Thiemann & Goldstein,2001) the Social Story� remained accessible to thestudent following its initial reading. During twostudies the Social Story� was taken home for theparents to read to the child (Cullain, 2002; Feinberg,2002). Examination of Table IV reveals that the PNDfor the seven accessible stories was 64 and for the 19remaining stories the PND was 63.


Use of Additional Strategies

Evaluation of the efficacy of Social Stories� wasconfounded in some instances by the use of addi-tional intervention strategies. Researchers used verbaland/or physical prompting in seven studies (Feinberg,2002; Hagiwara & Myles, 1999; Rogers & Myles,2001; Scattone et al., 2002; Staley, 2002; Swaggartet al., 1995; Thiemann & Goldstein, 2001) andtangible reinforcers such as stickers, or edibles wereused in three studies (Kuttler et al., 1998; Staley,2002; Swaggart et al., 1995). The study of Staley(2002) provided specific comparison of additionalstrategies and Social Stories�. Other strategies,including teacher modeling and rehearsal (Pettigrew,1998; Thiemann & Goldstein, 2001) and self-evalua-tion using video-feedback (Thiemann & Goldstein,2001), were also employed. From Table IV it can bedetermined that the 13 stories where additionalstrategies were employed yielded a PND of 59 andthose that did not a PND of 62.

Maintenance and Generalization

Maintenance results were only reported for threeof the 16 studies (Kuoch & Mirenda, 2003; Romano,2002; Thiemann & Goldstein, 2001). Thiemann andGoldstein (2001) describes maintenance data acrossparticipants as ‘‘not compelling’’ and suggests anumber of factors including length of training, skilldifficulty, and adult prompt and visual cue fading toaccount for this finding. Romano (2002) collectedpost-intervention data on both the treatment andcontrol group 6 weeks after discontinuation of theintervention for five consecutive days. Positive resultswere obtained for the treatment group, and negativeresults were obtained for the control group, that isthere was an increase in inappropriate behaviors frompre-test and post-test to maintenance. As previouslynoted, however, the data from the Romano (2002)study needs to be interpreted circumspectly. Limitedgeneralization in terms of targeted behaviors or newlyacquired skills being demonstrated in more than onesetting were reported in six studies (Cullain, 2002;Hagiwara & Myles, 1999; Kuoch & Mirenda, 2003;Kuttler et al., 1998; Swaggart et al., 1995; Thiemann& Goldstein, 2001). Cullain (2002) investigated SocialStory� intervention with three participants at schooland two participants at home; the study by Kuttleret al. (1998) was conducted in two school settings,morning work time and lunchtime, and (Swaggartet al., 1995) reported increased social interaction ofthree participants across a variety of settings.

Social Validity

Only three of the studies reviewed examined anaspect of social validity. Scattone et al. (2002) usedthe Intervention Rating Profile (Martens, Witt,Elliott, & Darveaux, 1985) with teachers to evaluatethe acceptability of the treatment with the interven-tion falling well into the acceptable range. Thiemannand Goldstein (2001) asked 13 teachers and graduatestudents to view videotapes of social interactionrecorded before and after intervention and to ratespecific social behaviors for the target children andtheir peers; improvements in reciprocal social behav-iors were reported by all raters. Hagiwara and Myles(1999) asked five educators and professors to verifythe appropriateness of story construction.

DISCUSSION

Twelve of the 16 studies examined in this reviewused single subject designs. A major criticism of singlesubject designs is that they have low external validity.This weakness can be addressed by replication(Tawney & Gast, 1984). It is difficult to conductreplications and draw sensible conclusions aboutexternal validity if one is unsure of the characteristicsof participants in existing research. A general criti-cism of the studies is that adequate descriptions ofparticipant’s communicative and cognitive skills werenot always provided. Gray and Garand (1993, p. 2)state ‘‘Social stories are most likely to benefit studentsfunctioning intellectually in the trainable mentallyimpaired range or higher who possess basic languageskills.’’ Documentation of the level of cognitive andcommunicative functioning is therefore relevant andimportant, particularly considering the extremevariation possible in ASD. It is possible that theintervention is suited to participants with specificcharacteristics that will only be identified if the natureof the participant(s) is known. It is worthy of notethat in all but one study (Pettigrew, 1998), partici-pants were diagnosed with autism or Asperger’ssyndrome. The efficacy of Social Stories� in pro-moting behavior change in children with disabilitiesother than autism or Asperger’s is yet to be substan-tively researched. While almost all students in thestudies reviewed were identified as being on theautism spectrum, quantification of the degree ofautism was not provided in the vast majority ofinstances. Again, this may be an important variableimpacting on the efficacy of Social Stories�.


Effect sizes in the small number of studies thatused group designs were highly variable. The major-ity of studies used single subject designs and the PNDstatistic was calculated. The PND method sets arelatively high standard for evaluation of graphicdata with the most extreme data point in baselineproviding the point of comparison for intervention.Nevertheless, small n designs are not generally suitedto detecting small treatment effects (unless data isexceedingly stable) and the practitioners are mostinterested in treatments with powerful clinical effects.The overall PND of 43 indicated Social Stories�were an ineffective intervention according to thecriteria of Mastropieri et al. (1996) and was only 51(marginally effective) if zero or ceiling comparativedata in baseline were removed. While some interven-tions evidence both high PNDs and reasonably cleardemonstration of experimental control (e.g., Brow-nell, 2002; Kuttler et al., 1998), effects were relativelymodest (and/or inconsistent) in relation to baselinevariation in other studies (e.g., Hagiwara & Myles,1999; Norris & Dattilo, 1999), accounting for therelatively low PND figures. High levels of baselineinstability in relation to the magnitude of interven-tion effects were certainly evident in a number ofstudies. In addition, Kuoch and Mirenda (2003) havenoted that behavior change following Social Story�intervention may not be fully reversible. Thus, it ispossible that some studies using withdrawal compo-nents may not have been ideally suited to examiningthe efficacy of the intervention. There was alsoenormous variation in responses of specific partici-pants to intervention. Considering the relatively smalldata set variation in PND across and within studies,the mean PND value should be treated with a highdegree of caution. Some studies or interventions withspecific students appeared to be highly effective withclear demonstrations of control and other studieswere relatively ineffective, indicating the possibilitythat specific participant or intervention featuresinfluencing effectiveness.

Social Stories� are claimed to be capable ofaddressing a variety of applications (Gray, 2003). TheSocial Stories� used in the studies examined in thepresent review certainly addressed a variety of behav-iors, supporting this claim. None of the SocialStories� employed in the studies were of the curric-ulum type (see Gray & Garand, 1993). Thus, theefficacy of teaching academic skills through SocialStory� intervention remains unaddressed.

Considerable variation was seen in the use ofSocial Stories� in the studies in terms of construc-tion, implementation and use of additional strategiesand these issues will be addressed in turn. Criticism ofprevious research has been offered by Kuoch andMirenda (2003) on the basis that many stories failedto conform to the recommended construction. In asummary of the composition of Social Storied� usedin a selection of 10 case studies or experimentaldesigns published in journal articles prior to 2003,Kuoch and Mirenda (2003) found five studies tocontain Social Stories� not conforming to applicableSocial Story� guidelines, although the impact of thison Social Story� efficacy as determined by, forexample, is not determined by the authors. Analysisof the Social Stories� from the 16 experimentalstudies in the present review that included studiesconducted prior to 2004, confirmed that a number ofthese also deviated considerably from the construc-tion prescribed by Gray (2003). There was, however,no evidence that this impacted negatively on PND. Infact, the small number of stories that varied fromGray’s (2003) guidelines (higher ratio of directive todescriptive sentences) seemed to be associated withconsiderably higher mean PND. The relationshipbetween frequency of particular sentence types andPND was also of interest. There was no clear patternof evidence that a higher absolute percentage ofdescriptive sentences impacted positively on PND.Stories in the middle third for descriptive sentencefrequency were associated with considerably higherPNDs than those in the upper and lower third. Therewas preliminary evidence that the level of conse-quence sentences might affect efficacy, with storiesdemonstrating very low levels of consequence sen-tences being associated with lower PNDs. In hind-sight, this is not surprising as strategies involving thesystematic use of reinforcement has been identified asone of the most powerful interventions in specialeducation (see Fuchs & Fuchs, 1986; Kavale &Forness, 1999; Skiba & Casey, 1985; Walberg &Wang, 1987) and have been consistently and demon-stratively effective in facilitating behavior changewith individuals with autism (see Heflin & Alberto,2001; McConnell, 2002). The potential value ofreinforcement is recognized by Gray (2003) whostates:

Social stories have another purpose that is equally

important: acknowledging achievement. In fact a

child’s first social story should describe a skill or


situation that is typically successful and problem-free.

Written praise may be far more meaningful for

children with ASD than its verbal counterpart. At

least half the social stories developed for the child

with ASD should bring attention to positive

achievements (pp. 1–2).

In fact, consequences of actions were describedin 90% of the Social Stories� examined in the presentstudy, suggesting the role of consequences may wellbe more important than suggested by Gray (2003).The exact role of consequences sentences in SocialStories� awaits further empirical investigation but itis at least plausible that their role in identifyingnatural or artificial consequences of actions may beimportant. Analysis of the effects of Social Story�composition should be interpreted carefully due tothe small number of stories available, the fact thatthese variables were not experimentally manipulatedand the percentages of various sentence types variedconsiderably. Nevertheless, there is some suggestionthat some sentence types may impact on story efficacyalthough not necessarily in the way that might bepredicted by Gray (2003).

In relation to reinforcement, it should be notedthat three studies employed tangible reinforcers suchas stickers or edibles (Kuttler et al., 1998; Staley,2002; Swaggart et al., 1995) and a further study usedself-evaluation with video-feedback (Thiemann &Goldstein, 2001). One study (Staley, 2002) is ofparticular interest in this regard. Five participantswere read two Social Stories� intended to increasetheir chewing with their mouth closed and increasetheir napkin use. The researchers also gave partici-pants edible reinforcers for chewing with their mouthclosed and for appropriate napkin use during lunch.Using a reversal and multiple-baseline designs tocompare the effects of Social Stories� and reinforc-ers, results clearly showed no effect of Social Sto-ries�, but an almost immediate effect of reinforcers(Staley, 2002).

A range of other additional interventions, mostfrequently physical and verbal prompting, wereemployed in addition to Social Stories�. In studieswhere prompting and/or reinforcement are used asadditional strategies, it becomes difficult to ascertainwhich of the treatments, prompting, reinforcement orSocial Story� is the critical component of the inter-vention, or whether a combination of these has thegreatest effect. While there was no clear evidence of adifference between stories using additional strategiesand those that did not in the present analysis, manyconfounding variables were evident. There is a very

clear research need to examine the extent to whichSocial Stories� contributed additional impact to thesewell-validated intervention strategies.

The use of more than one Social Story� totarget one social situation, or the use of several storiesto target several behaviors, the frequency with whicha specific Social Story� is reviewed, the inclusion ofcomprehension activities and the access of the par-ticipant to the Social Story� outside the interventionphase are all variables that could affect interventionefficacy. The significance of these issues in terms ofthe effectiveness of the treatment requires furtherinvestigation.

Researchers used visual symbols in 11 of thestudies examined. Originally, Gray and Garland(1993) advised against the use of illustrations,describing them as distracting and liable to makethe student misinterpret the situation. This recom-mendation has subsequently been revised and the useof illustrations ‘‘...that reflect consideration of the ageand personal learning characteristics of the personwith ASD’’ (Gray, 2003, p. 5) is now suggested asbeneficial to social understanding. The use of visualsymbols is in keeping with current Social Story�guidelines, and is consistent with other research onvisual learning and children with autism (e.g., Dett-mer et al., 2000).

From the preceding discussion, it is obvious thatSocial Stories� are multifaceted interventions. It isunclear from the present review that the prescribed(and complex) story construction is necessary to theefficacy of the intervention, which components arecritical to effectiveness and whether Social Stories�necessarily add to the effectiveness of other interven-tions. The confounding of Social Story� interven-tions with other strategies is a problem in manyexisting studies (Kuoch & Mirenda, 2003).

Maintenance and generalization were also inad-equately addressed in the studies. These issues are ofpivotal importance for children with ASD. On thebasis of the limited information provided in thestudies, it is not possible to draw conclusions aboutthe efficacy of Social Story� intervention in terms ofmaintenance and generalization. Programming formaintenance and generalization are typically essentialcomponents of an effective intervention. The inherentflexibility and portability of Social Stories� maypredispose them to be of use over time and in anumber of settings.

Social validity usually refers to validation ofgoals, procedures and outcomes (Wolf, 1978) by


consumers, who can include participants, implement-ers, as well as members of the broader community.Hawkins (1991) and Schwartz and Baer (1991) haveargued for more objective functional validation ofintervention (habilitative validity), which may includecomparison of performance with community stan-dards. For example, Hughes, Harmer, Killian andNiarhos (1995) collected social comparison data onregular peers when teaching social initiation skills tostudents with intellectual disabilities. Thus, as well asdemonstrating that the skills of interest could betaught, they also established that performance waswithin the broad functional range of regular peers.Smith (2001) has presented data suggesting thatteachers viewed Social Stories� as effective butobjective data on learner performance was notprovided, hence the study was not included in thepresent review. Only three of the studies reviewedaddressed social validity, one examining acceptabilityof the intervention to teacher (Scattone et al., 2002),the second the appropriateness of the Social Story�construction and the third provided subjective vali-dation of skill improvement in social skills by blindraters (Thiemann & Goldstein, 2001). Interestingly,none of the studies examined habilitative validity,although social comparative data would seem rele-vant to many of the skills addressed.

Some aspects of reliability measures in thestudies were problematic. While interobserver reli-ability was reported in 12 studies but proceduralreliability reported in only four studies. The relativesimplicity of Social Stories� intervention may lead toan assumption that procedural reliability does notneed to be measured. Examination of Social Stories�revealed deviation from recommended constructionin a substantial proportion of instances and it wouldseem at least possible that there may have beendeviations in the intended implementation. Reliabil-ity measures, including measures of procedural reli-ability, are a quintessential component of goodresearch design; the lack of these undermines confi-dence in the research.

An important limitation of the existing reviewshould be acknowledged. Results should be treatedwith caution given the modest data set available. Inparticular, analysis of specific study features shouldbe treated circumspectly. This analysis was based ona subset of studies that yielded PND data and thusshould be considered preliminary in nature. Interpre-tation is further limited by the degree of variation instory construction and implementation. Within theresearch reviewed there were several clear examples of

well-controlled studies suggesting the interventionwas effective. Nevertheless, the intervention was notrobustly effective across studies, participants andbehaviors as reflected in mean PND. Consequently,the existing research does not demonstrate unequiv-ocally that Social Story� intervention is consistentlyeffective in facilitating behavior change in childrenwith autism. The majority of studies used singlesubject designs and the mean PNDs were marginal atbest although there was substantial variation inresults across studies, with some interventions prov-ing very effective. This raises the possibility thatundetermined factors (such as participant character-istics or story construction and implementation) maybe important to the success of the intervention. Thisfinding alone provides justification for further inves-tigation of the strategy.

FUTURE RESEARCH

While there is a number of issues that need to beaddressed in future research into Social Story�intervention, several stand out as being of particularimportance. Firstly a number of other proceduralconsiderations should be addressed in future researchon Social Stories�. Inadequate participation descrip-tion in extant research has made it difficult todetermine whether participant related variables mod-erate the effect of Social Story� interventions.Adequate participant description, in terms of resultsof standardized tests, providing information pertain-ing to cognitive ability, position of the participant(s)on the autism spectrum, and language should be anintegral component of future research investigatingSocial Story� efficacy. The procedural integrity andsocial validity of Social Story� interventions has notbeen examined in much of the extant research. Boththese features are hallmarks of good research practiceand should be routinely incorporated into futurestudies. In particular, habilitative social validity(Hawkins, 1991) should be examined to provide ameaningful framework for interpreting behaviorchange. In addition, there is some question whetherthe intervention is typically fully reversible and theuse of reversal designs should be questioned.Repeated demonstrations of experimental controlthat are characteristics of strong small n researchdesigns can be achieved using the multiple baselinedesign, without requiring interventions to be effec-tively reversible. Finally, very high levels of baselineinstability in relation to intervention effects that was


evident in much of the research examined may beinterpreted as indicating that future researchers mightdo well to concentrate more on establishing baselinestability.

Research on individuals with ASD and signifi-cant intellectual disabilities is extremely limited. Grayand Garand (1993) have suggested that the interven-tion may be suitable for individuals with a moderatelevel of intellectual disability (‘‘trainable’’ in theirterminology) who possess ‘‘basic language skills’’ butvery few participants in the existing studies clearly fitthis profile. Thus, the applicability of the interventionof students with ASD and significant intellectualdisabilities needs to be explored further. Similarly,there is little research examining the potential forSocial Story� interventions to be used with studentwho do not present with ASD but do have majorsocial skills deficits. Many interventions that havebeen successful with individuals who present withASD (e.g., reinforcement, response prompting, visualsupports) have also been effective with other groups.The extent to which Social Stories� are effective withother populations or deferentially effective with ASDremains to be explored.

There remains a question as to whether theconstruction of Social Stories� contributes to thehigh variability in efficacy reported in the literature.Further research should be conducted to determinewhether recommended story construction affectsoutcome or whether particular sentence types play acritical role. Noting that the recommended construc-tion of Social Stories� is not based on theoretical orempirical rationale (Kuoch & Mirenda, 2003), thisissue should be considered a priority for futureresearch. In addition, the comprehension componentof Social Story� intervention may be important toefficacy. Further research is necessary to explore thispossibility.

The findings of many of the existing studies havebeen confounded by the use of Social Stores� incombination with other empirically verified proce-dures, such as prompting and operant reinforcement.Thus, there is a pressing need for further research intothe effectiveness of Social Stories� in isolation.

Great variability was evident in the researchreviewed in terms of story construction and imple-mentation, including significant deviations from rec-ommended practice. If such variation was evident in(presumably) relatively controlled research environ-ments, questions are raised as to how the interventionmight be being applied in the field. Noting that itcould be argued that practice often outstrips the

research base, it would be of some interest toinvestigate the extent of Social Story� use in thefield as well as how the strategy is being applied.

Finally, research addressing issues of mainte-nance and generalization is extremely limited. This issurprising given that Social Story� interventions arerelatively simple and would seem suited to use overextended time periods as well as across persons andplaces. Future studies should be extended to incor-porate investigation of maintenance and generaliza-tion a matter of priority.

CONCLUSION

A small corpus of research literature pertainingto the use of Social Stories� raises many questionsregarding their effectiveness in facilitating behaviorchange in children with autism. The present review ofthe literature highlights the need to adopt a system-atic, rigorous scientific approach to future research ifthese questions are to be answered, and the efficacy ofSocial Stories� determined.

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