Are Social Stories Effective?
Do social stories help children with autism? Although a widely used intervention for social skills training how effective are social stories?
Are Social Stories Effective?
“The need for further research is paramount in order to ensure evidence-based practice in the use of Social Stories by practitioners working with children with autism."
- Reynhout and Carter (2009, p.250)
What Does the Research Say?
According to Kokina and Kern (2010, p. 825), the results from their meta-analysis on the effectiveness of Social Stories ‘confirmed previous findings regarding the questionable effectiveness of Social Story interventions for students with ASD’ but they then also state that their ‘results do not imply that Social Stories are ineffective’.
These two comments may seem opposing, however other reviews on Social Story interventions have drawn similar conclusions (e.g. Reynhout & Carter, 2006).
Kokina and Kern’s review drew from 18 studies, totalling 47 students, and found that the stories appeared to either work well or not at all. Overall, 51% of outcomes were classed as “highly effective” while 44% were classed as “ineffective”, with the effectiveness of an additional 4% classed as “questionable”.
In a more recent meta-analysis of 62 Social Story studies, Reynhout and Carter (2010, p.13) concluded their paper stating that ‘while there was considerable variation, on average, Social Stories appear to have only a small clinical effect on behaviour and practitioners should factor this consideration into decisions about appropriate interventions.'
The authors continued to say that 'Social Stories may be attractive to practitioners because they are easy to implement and require very limited resources. Nevertheless, given the limited potential for improvements, in many cases time may be better invested in more intensive interventions that are likely to yield more substantial gains.’
Comprehension Level and Effectiveness
In Kokina and Kern’s (2010) meta-analysis, they found improved outcomes when children’s comprehension levels were checked to ensure they would understand the Social Stories. This suggests that if a child has difficulty reading or understanding spoken language, there is little point using a written story as a method of explaining social situations.
This may be one possible cause for such variance in the effectiveness of social story interventions (Chan & O’Reilly, 2008) and highlights the importance of taking each child’s reading and comprehension levels into account when creating stories (Kokina & Kern, 2010).
As an example, Quirmbach, Lincoln, Feinberg-Gizzo, Ingersoll and Andrews (2009) investigated the effectiveness of social stories on improving game play (board games) in 45 children aged 7-14 with an Autism Spectrum Disorder (ASD).
They found improvements were only evident in children that were within or above the borderline range of the Verbal Comprehension Index (VCI) scores from the Wechsler Intelligence Scale for Children-Third Edition (WISC-III). In other words, stories used with children who had reasonable verbal comprehension levels were more successful.
Difficulty Identifying Effectiveness
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).
Discussed by both Crozier and Tincani (2007) and Santosti, Powell-Smith and Kincaid (2004), research suggests that it may be important to continue to provide access to social stories for children with Autism Spectrum Disorders regardless of whether they have understood (mastered) them already.
For example, in Crozier and Tincani’s (2007) study, two of the three boys with whom they implemented social stories with, returned to pre-treatment levels when the social stories were no longer used. Even though these two children understood the social story, once the stories were no longer read to them their behaviours returned to the same low levels as before they were introduced to the stories.
Kokina and Kern’s (2010) meta-analysis presented a large number of findings so we have summarised their main findings below to make them easier to read:
- Social Stories are primarily being used to either reduce inappropriate behaviours or to improve social skills.
- Stories used to reduce inappropriate behaviours were more successful than those for improving social skills.
- Stories used to describe single behaviours were more effective than those describing complex behaviours.
- Pre-requisite skills need to be identified before planning a social story intervention. A child may perfectly understand social situations (e.g. be able to answer questions about a social situation) but lack the actual skills to apply their knowledge.
- Stories used in general education settings were more successful than those in self-contained settings (e.g. home).
- Children allowed to work as their own “intervention agent” were more successful, i.e. the child read their own stories instead of their parent, teacher or instructor reading them out loud.
- Stories were more effective when they were read just before the child would have to engage in the target situation. This was expected given that priming effects have previously proved effective.
- Stories that used additional visual illustrations were more effective than written text alone.
- Studies that first used a Functional Behaviour Assessment (FBA) to guide the creation of the social stories were substantially more successful than those that did not.
- Comprehension checks improved the effectiveness of the social stories.
- Somewhat higher effectiveness was found for children with lower cognitive abilities.
- Children with high levels of communication skills performed better with social stories than those with low levels. This may be expected given that social stories are a language-based intervention (Kokina & Kern, 2010).
Reviewing authors typically converge on the conclusion that although 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).
One major reason for this lack of evidence is that they are typically used with other interventions such as prompting, positive reinforcement or modelling, and so it is difficult to identify which specific intervention element was effective.
Reviews have found the Social Stories that do not meet the guidelines and criteria put forward by Gray (2000; as cited in Reynhout & Carter, 2009) are typically more effective than those that do. This is highlighted by Reynhout and Carter (2009) who state that Gray’s ‘prescriptive guidelines for Social Story construction do not appear to have any empirical or theoretical foundation’ and hence raise ‘questions about their veracity’ (p. 249).
Reynhout and Carter (2010, p. 12) state that ‘on the balance of evidence, the present analysis confirms the findings of earlier meta-analyses that Social Stories are of questionable or mild efficacy’.
Additionally, in an earlier review, Reynhout and Carter (2009, p.250) conclude that ‘the need for further research is paramount in order to ensure evidence-based practice in the use of Social Stories by practitioners working with children with autism’.
- 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
- Chan, J., & O’Reilly, M. (2008). A Social Stories intervention package for students with autism in inclusive classroom settings. Journal of Applied Behaviour Analysis, 41, 405-409. DOI: 10.1901/jaba.2008.41-405
- Crozier, S., & Tincani, M. (2007). Effects of Social Stories on Prosocial Behaviour of Preschool Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 37, 1803-1814. DOI 10.1007/s10803-006-0315-7
- Cooper, J., Heron, T., & Heward, W. (2007). Applied Behaviour Analysis. New Jersey: Pearson Education.
- Frith, U. & Frith, C. (2003). Development and Neurophysiology of Mentalising. Philosophical Transactions of The Royal Society B: Biological Sciences, 358, 459-473. DOI: 10.1098/rstb.2002.1218
- Gray, C. (2010). What are Social Stories?. In The Gray Centre. Retrieved October 15th 2010, from http://www.thegraycenter.org/social-stories/what-are-social-stories.
- Kokina, A., & Kern, L. (2010). Social Story Interventions for Students with Autism Spectrum Disorders: A Meta-Analysis. Journal of Autism and Developmental Disorders, 40, 812-826. DOI: 10.1007/s10803-009-0931-0
- Miltenberger, R. (2008). Behaviour Modification. Belmont, CA. Wadsworth Publishing.
- Quirmbach, L., Lincoln, A., Feinberg-Gizzo, M., Ingersoll, B., & Andrews, S. (2009). Social Stories: Mechanisms of Effectiveness in Increasing Game Play Skills in Children Diagnosed with Autism Spectrum Disorder Using a Pretest Posttest Repeated Measures Randomised Control Group Design. Journal of Autism and Developmental Disorders, 39, 299-321.
- Reynhout, G. & Carter, M. (2006). Social Stories for Children with Disabilities. Journal of Autism and Developmental Disorders, 36, 445-469. DOI: 10.1007/s10803-006-0086-1
- Reynhout, G. & Carter, M. (2009). The use of Social Stories by teachers and their perceived efficacy. Research in Autism Spectrum Disorders, 3, 232-251. DOI:10.1016/j.rasd.2008.06.003
- Reynhout, G. & Carter, M. (2010). Evaluation of the efficacy of Social Stories using three single subject metrics. Research in Autism Spectrum Disorders, 3, 232-251. DOI:10.1016/j.rasd.2008.06.003
- Sansosti, F., Powell-Smith, K., & Kincaid, D. (2004). A Research Synthesis of Social Story Interventions for Children with Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 19, 194-204. DOI: 10.1177/10883576040190040101
- Tager-Flusberg, H. (2007). Evaluating the Theory-of-Mind Hypothesis of Autism. Current Directions in Psychological Science, 16, 311-315. DOI: 10.1111/j.1467-8721.2007.00527.x