using social stories to change problematic lunchtime behaviour in school

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Using Social Stories to ChangeProblematic Lunchtime Behaviour inSchoolRachel Toplis a & Julie A. Hadwin aa University of Southampton , UKPublished online: 19 Jan 2007.

To cite this article: Rachel Toplis & Julie A. Hadwin (2006) Using Social Stories to ChangeProblematic Lunchtime Behaviour in School, Educational Psychology in Practice: theory, researchand practice in educational psychology, 22:1, 53-67

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Educational Psychology in Practice,Vol. 22, No. 1, March 2006, pp. 53–67

ISSN 0266-7363 (print)/ISSN 1469-5839 (online)/06/010053–15© 2006 Association of Educational PsychologistsDOI: 10.1080/02667360500512437

Using Social Stories to Change Problematic Lunchtime Behaviour in School

Rachel Toplis and Julie A. Hadwin*University of Southampton, UKTaylor and Francis LtdCEPP_A_151226.sgm10.1080/02667360500512437Educational Psychology in Practice0266-7363 (print)/1469-5839 (online)Original Article2006Taylor & Francis221000000March [email protected]

This study used an ABAB design to investigate the effectiveness of social stories as an interventionwith five school children who were experiencing difficulties at school lunchtime related to indepen-dently entering the dining hall. Measurements of general behaviour using the Conners’ TeacherRating Scale-Revised (CTRS-R:L): Long Version and social cognition were also taken. The resultsshowed an increase in targeted behaviour when social stories were used for three of the five chil-dren. The profile of results from the CTRS-R and social cognitive tasks indicated that socialstories were an effective intervention for children who had poor social skills and difficulties under-standing the perspective of others.

Introduction

Social stories were originally designed to help individuals with autism to understandsocial situations and are aimed to change specific targeted behaviour (Gray &Garand, 1993; Gray, 1994, 2000). They can be defined as personalised stories thatare written in a specific style and format to explain what happens in challenging orconfusing social situations (Gray, 1994; Rowe, 1999). Social situations aredescribed in terms of relevant social cues and expectations and can help children tounderstand their own and others’ views of specific situations and to respond withappropriate behaviour (Kuoch & Mirenda, 2003; Norris & Dattilo, 1999; Scattone,Wilezynski, Edwards, & Rabian, 2002) where the aim is to ensure that social storiesare clear and “visually engaging” (Moore, 2004, p. 137). In some cases, socialstories are paired with pictures or videotapes to provide visual supports to enhance

*Corresponding author. Developmental Brain-Behaviour Unit School of Psychology, University ofSouthampton, Southampton SO17 1BJ, UK. Email: [email protected]

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54 R. Toplis and J. A. Hadwin

understanding (Hagiwara & Myles, 1999; Swaggart, Gagnon, Bock, et al., 1995;Thiemann & Goldstein, 2001).

A growing number of studies have evaluated the success of social stories withchildren who have an autistic spectrum disorder (ASD; Bledsoe, Smith, & Simpson,2003; Kuttler, Myles, & Carlson, 1998; Kuoch & Mirenda, 2003; Lorimer,Simpson, Smith Myles, & Ganz, 2002; Norris & Dattilo, 1999; Rogers & Myles,2001; Rowe, 1999; Scattone et al., 2002; Smith, 2001—see Jordan, 2003, for areview) or learning difficulties (Moore, 2004). Kuttler et al. (1998), for example,studied the effects of social stories on the frequency of two behaviours in the schoolenvironment (inappropriate vocalisations and dropping to the floor), where thesebehaviours served as precursors to tantrum behaviour for a 12-year-old child withautism. Here an ABAB or reversal design was used where social stories wereimplemented and then withdrawn in four phases. In addition to being read theirsocial story the child had free access to it during the intervention phases. The socialstory led to a decrease in precursors to tantrum behaviour (although thesebehaviours did increase post-intervention). Similarly, Scattone and colleagues used amultiple baseline design to demonstrate that social stories were effective in reducingdisruptive behaviour (staring, chair tipping and shouting) in two 7-year-old childrenand an adolescent with ASD. The authors argued that social stories allow childrenwith autism to use their characteristic preference for routine in order to understandsocial situations (Scattone et al., 2002).

Research using social stories has focused on children with ASD or learningdifficulties (see Scattone et al., 2002). The Special Educational Needs Code ofPractice highlights that children with emotional and behavioural problems also needhelp in a number of areas including adjustment to school expectations and routines(Morris, 2001). The issue of how to support pupils with emotional and behaviouraldifficulties in primary schools has been problematic and has become critical inrecent years (Evans, Harden, Thomas, & Benefield, 2003). The difficulties thisgroup has demonstrated in developing social skills can lead to social isolation and itis unlikely that this situation will improve without intervention (Guralnick, Connor,Hammond, Gottman, & Kinnish, 1995). In addition, research has found asignificant relationship between early behavioural difficulties and long-termdelinquency, highlighting the need for early intervention in these groups of children(Long, 2000).

The present study aimed to assess the effectiveness of social stories in childrenwho did not have an ASD, but who did demonstrate challenging behaviour within aschool setting. Specifically, it used social stories to address problematic lunchtimebehaviour in five children who were all recorded at ‘Action Plus Level’ on theSpecial Needs Register for behavioural difficulties (Morris, 2001). In these cases,children were not leaving the classroom, entering the dining hall and finding thecorrect seat unless accompanied by an adult or a peer group member. Typically,children’s behaviour at lunchtime was described as inappropriate by teachers andincluded spending time in the toilet, corridor or the classroom. In order to considerthe behavioural profiles of these children a measure of general behaviour was taken

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Changing Problematic Lunchtime Behaviour 55

using the Conners’ Teacher Rating Scale- Revised: Long Version (CTRS-R:L). Inaddition, a measure of social cognition to measure first and second order false belieftasks (Baron-Cohen, Leslie, & Frith, 1985; Perner, 1991; Wimmer & Perner, 1983)was also used. Previous research has found that typically developing children agedbetween 3- and 4-years can understand the implications of beliefs on another’sbehaviour (first order beliefs; Wimmer & Perner, 1983). It is not until children arearound 6- to 7-years-old, however, that they can make predictions based on embed-ded beliefs (second order beliefs; Perner, 1991). In relation to the present study, itwas hypothesised that children who show enhanced perspective-taking ability willbenefit most from social stories.

Method

Participants

Five children from Year 2 took place in this study (three boys and two girls, meanage = 7 years and 5 months). All of the children were on the special needs register asa result of behavioural difficulties. Participants were selected through contact withthe Special Needs Coordinator and the Deputy Head Teacher at an inclusive two-form entry mainstream junior school. Decisions about inclusion in the study werebased on Gray and Garand’s (1993) observation that children with averageintelligence to moderate intellectual impairment with basic language skills are likelyto benefit from social story interventions. All of the children were required to havescored a Level 2 in Literacy and Numeracy in their Key Stage 2 StatutoryAssessment Tests. This gave an approximate guide to their cognitive ability. Theirreading age was also assessed using the British Ability Scales (BAS II) WordReading Test (Elliott, Murray, & Pearson, 1996). Their mean reading age was 7years and 2 months (range 6 years, 11 months to 7 years, 4 months).

Design

A social story was written for each child and was introduced following a single caseABAB design. The first and third phases were baseline conditions, where childrendid not have any access to social stories. During the second and fourth phases thesocial stories were read to the children prior to lunchtime and the children couldaccess the stories at other times during these phases.

Target Behaviour

The targeted behaviour was set by consulting teachers and teaching assistants whoworked with the five participants. The specific behaviour chosen for the study wasbehaviour at lunchtime. The basic lunchtime routine included all children in theclass being seated at 12:10 pm. The teacher would give children permission to leavethe room table by table. The children collected their lunchbox or dinner money and

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went to the dining room. This involved a short walk through the cloakroom andacross the corridor. In the dining room children would find their own designatedseat. When all of the members of a table were seated, an adult would give thempermission either to start eating their packed lunch or to collect their school dinner.The five children were not following this routine unless accompanied by an adult orpeer.

The adults involved were asked to describe the targeted situation, the exactreaction of the pupil in the situation and the frequency of their reactions. Directobservations were used to verify the accuracy of the information provided and toobtain a full picture of the interaction of the factors involved. The children involvedwere also interviewed and their perceptions of the targeted situation were recorded.The children were encouraged to draw pictures of their lunchtimes and to describethem. These perspectives determined the focus of the social stories.

Basic Structure of Social Stories

Social stories are made up from four types of sentences: descriptive, perspective,directive and affirmative sentences (Gray, 1994). Descriptive sentences give infor-mation about the situation including descriptions of the people, the reason andtiming of different actions, and the setting. Perspective sentences explain the reac-tions and responses of others. Directive sentences are statements of desiredresponses to the targeted situation, gently directing the behaviour of the child.Affirmative sentences are intended to enhance the meaning of surrounding state-ments, often expressing a commonly shared value or opinion within a givenculture. Usually affirmative sentences follow a descriptive, perspective or directivesentence.

All stories in this study applied the basic social story ratio (0–1 directive sentencesfor every 2–5 descriptive, perspective and/or affirmative sentences). One example ofa social story written for this study is included in Appendix A. The basic social storyratio defines the relationship between the different types of social story sentences.The ratio applies when the story is considered as a whole to ensure the descriptivequality of the story and a patient, reassuring and positive tone (Gray, 1994). Thesocial stories used also included simple icons from a clipart package.

Writing and Implementing Social Stories

Gray (1994) outlined four basic steps to be used when writing a social story. Each ofthese steps was followed in this study. The first step is to picture the goal of thestory, the second step is to gather information, the third step is to tailor the text andfinally, the last step is to teach with the title. In this study the goal of the story was toshare information about appropriate lunchtime behaviour and to encourage thechild to go to his or her seat in the dining room without difficulty. The second stepwas to gather information about the topic. The children were observed at lunchtime,with the focus on what they saw, heard and felt in the targeted situation. They were

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encouraged to talk about the situation and draw pictures or cartoons of theirlunchtime and explain what was happening. The third step was to customise the textto the learning style, needs, interests, and abilities of each child. Each social storywas written well within a student’s comprehension level, using vocabulary and printsize appropriate for the child’s ability. It was written on the class computer andbound in a book that consisted of a front cover and up to eight story pages. Thefront cover was plain except for the title. Each page contained one or two sentences.A corresponding icon was included if the child requested it. The fourth stepspecified by Gray (1994) was to “teach with the title” (p. 13). The title of a socialstory states the overall meaning of the story. The target behaviour for the five chil-dren was to independently enter the dining hall and sit on their seat within twominutes of being dismissed from class.

During the intervention phases of the study the researcher or a teaching assistantread the social story with the child for ten minutes before lunch each day in a quietarea of the classroom. Gray (1994) advised that staff involvement should be minimal,the goal being to place the student in “direct contact with the information of thestory” (p. 13). This approach was emphasised by the researcher to all staff involved.

Event Recording Procedure

Two teaching assistants involved in the recording procedure were also involved inthe reading of the social story with the child and they were both aware of the study’saim. Scoring of a child’s lunchtime behaviour was based on the following criteria:(2) independent response; (1) prompted response; and (0) physically assistedresponse. An independent response was defined as the child finding their seat in thedining hall, without any external verbal requests or prompts, within two minutes ofbeing dismissed from class. For a prompted response, the teaching assistant gaveone prompt or cue if the child did not find his or her seat in the dining room withintwo minutes. If the child did not respond to the prompt or cue after another twominutes had passed then the child was physically accompanied into the dining hall.Scores were coded and recorded on the data sheets provided by the researcher. Thiscoding system was developed in consultation with the staff involved who felt itwould be a practical and accurate procedure.

The research took place over an 18-day period, see Table 1. The first baselinephase lasted for five days, from Monday to Friday. The social stories were written atthe end of this phase. The social stories were then implemented for the next five days

Table 1. The single case ABAB design used in the present study

Phase 1 (A) Phase 2 (B) Phase 3 (A) Phase 4 (B)

No intervention Social story introduced and read with child

No intervention Social story read with child

Five days Five days Four days Four days

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and behaviour recorded. The social stories were withdrawn for a total of four days inthe third phase. The final phase lasted another four days where stories werereintroduced to the pupils. The research was discontinued at the weekends when thechildren were not in school.

Inter-observer Reliability

Reliability checks were made during 28% of the total observations recorded duringthe study. Inter-observer reliability was then calculated using Cohen’s Kappa.

Conners’ Teacher Rating Scale-Revised: Long Version (CTRS-R:L)

The CTRS-R:L (Conners, 1997) uses information from teachers to evaluateparticipants’ general classroom behaviours. The scale was completed on the firstand the last day of the research. The teacher scale (59 items) reflects informationon children’s behavioural, social and emotional behaviour. Normative data ongender, age and ethnicity are available (Conners, 1997). Also available is evidencefor its reliability and validity (Conners, 1997). The CRS-R:L provides ameasurement of functioning for each child across a range of behaviours measuredin seven different sub-scales: oppositional (six items); cognitive problems (sevenitems); hyperactivity (seven items); anxious–shy (six items); perfectionism (sixitems); social problems (five items). It includes two global indices including rest-less–impulsive (six items) and emotional lability (four items). Finally it containsscales for overall functioning: ADHD index (12 items); DSM-IV inattentive (nineitems); DSM-IV hyperactive–impulsive (nine items); and DSM-IV symptoms sub-scales (18 items). Scores for each sub-scale are converted to a T score (a scorewith a mean of 50 and a standard deviation of 10). Higher T-scores are linkedwith increased reported behaviour and scores over 65 indicate clinically significantbehaviour.

First and Second Order False Belief Tasks

Performance on the first and second order false belief was assessed before and afterthe intervention to assess the participants’ ability to understand others’ perspectives(Baron-Cohen et al., 1985; Wimmer & Perner, 1983). Following Baron-Cohen andcolleagues, stories were presented pictorially. Children were told about two dolls,called Sally and Anne. Sally has a basket and Anne has a box. Sally places a marblein her basket and leaves the room. Anne takes Sally’s marble from the basket andplaces it in the basket. When Sally comes back in the room she wants to play withher marble. At this point participants are asked ‘Where will Sally look for hermarble?’ In order to assess children’s understanding of embedded beliefs a smallchange was made to this scenario whereby Sally secretly watches Anne move themarble. In this case, participants are asked ‘Where does Anne think Sally will lookfor her marble?’

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Results

Inter-observer Reliability

Reliability checks were made for 28% percent of the total observations of the study.A total of 25 observations were made by both the researcher and a teaching assistantand recordings were compared using Cohen’s Kappa. Cohen’s Kappa was 0.75which is consistent with the acceptable level of 0.7 or more (Bakeman & Gottman,1986).

Behaviour Observations

Children’s target behaviour during the study is represented separately in Figures 1and 2 for each of the four phases. A response of (2) indicates that the child showedthe appropriate response independently within two minutes of being dismissed fromclass, without prompting. A response of (1) shows that the child was prompted bythe teaching assistant after two minutes of being dismissed from class, and thengave the appropriate response within the next two minutes. A response of (0) showsthat the child did not give the appropriate response after being prompted, so theywere actually accompanied or physically assisted into the dining hall. Observationswere collected during baseline and intervention phases.Figure 1. Target behaviour of Child A, Child B and Child C for Phases 1 to 4 of the ABAB intervention, where A indicates baseline and B intervention phases. Physically assisted response, prompted response and independent responses are shown as 0, 1 and 2 respectivelyFigure 2. Target behaviour of Child D and Child E for Phases 1 to 4 of the ABAB intervention, where A indicates baseline and B intervention phases. Physically assisted response, prompted response and independent responses are shown as 0, 1 and 2 respectivelyThe procedures used for data analysis involve visual inspection of the graphdata. Tawney and Gast (1984) noted several advantages to using visual analysis.One of these advantages was that data was collected and graphed daily andtherefore can be continuously analysed. Another advantage is that the effects ofthe intervention on the participant can be assessed and judged by each individ-ual who views the graph. As recommended by Tawney and Gast (1984), theamount of variability and the trend of the data in each condition are inspected,as well as the amount of change in level within each condition and between adja-cent conditions.

Child A’s lunchtime behaviour is shown in Figure 1. The graph highlights thatChild A displayed physically assisted behaviour in four out of the five days ofbaseline collection. On one day of baseline collection the child displayed a promptedresponse. During the first intervention phase the child responded to the social storyand displayed independent behaviour on three of the five days. When the social storywas withdrawn in phase three the child showed a range of behaviour (independent,prompted and physically assisted). Independent behaviour was only shown on oneday. When the story was reintroduced in the final four days the child showedindependent behaviour for three consecutive days.

In Phase 1, Child B showed physically assisted behaviour every day, see Figure 1.During the intervention phase the child showed the appropriate behaviour whenprompted. When the social story was withdrawn Child B returned to their previousassisted behaviour for four days. In the final phase, when the social story was reintro-duced the child showed prompted behaviour on two days, and then independentbehaviour for the final two days.

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Days

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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Phase 1 (A) Phase Two (B) Phase Three (A) Phase Four (B)

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 180.0

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Figure 1. Target behaviour of Child A, Child B and Child C for Phases 1 to 4 of the ABAB intervention, where A indicates baseline and B intervention phases. Physically assisted response,

prompted response and independent responses are shown as 0, 1 and 2 respectively

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Child C displayed assisted behaviour throughout the baseline period, see Figure 2.However, from day six of the research the child showed independent behaviour onfive consecutive days. This suggests that the social story had had some effect on thechild’s response. When the social story was withdrawn the graph shows that thechild’s behaviour reverted back to a prompted response. In the final phase the childstill needed to be prompted on three days, but ended with an independent responseon the eighteenth day of the study, see Figure 1.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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Figure 2. Target behaviour of Child D and Child E for Phases 1 to 4 of the ABAB intervention, where A indicates baseline and B intervention phases. Physically assisted response, prompted

response and independent responses are shown as 0, 1 and 2 respectively

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Child D’s behaviour was prompted or physically assisted on all 18 days of thestudy. When the social story was introduced he showed prompted behaviour on fourof the five days. When the social story was withdrawn there was little change inbehaviour, and the child showed a prompted response on each day. The social storyalso met with limited success for Child E who also showed no independent behav-iour during the research. Like Child D, behaviour was either prompted or assistedon all 18 days of the study. Prompted behaviour was shown on a total of four out of18 days, but the pattern of this change does not appear to be related to the introduc-tion or withdrawal of the social story, see Figure 2.

Conners’ Teacher Rating Scale-Revised: Long Version

Teachers rated the five participants on the CTRS-R:L before and after the socialstory intervention. Paired-sample t-tests were used to assess if there had been anysignificant change in general behaviour in school during the 18 days of research.These showed that there were no differences in pre- and post-test scores (for allcomparisons p>.05). Therefore, only pre-test scores are shown in Table 2.

All five children received elevated scores in certain areas, implying behaviouraldifficulties. Children A, B and C, showed a different behavioural profile comparedwith Children D and E. Table 2 shows a peak on areas of social problems for ChildrenA, B and C. High scorers on this sub-scale are likely to be socially detached from theirpeer group—to have few friends and to be generally less accepted by their peers. Inaddition, they have fewer social skills and show little ability in fostering friendships

Table 2. Connors’ Teacher Rating Scale–Revised: Long Version (CTRS-R:L) sub-scale scores and total DSM-IV profiles for the five participants*

CTRS-R:L item sub-scales A B C D E

Oppositional 66 46 56 70 84Cognitive problems/inattentive 55 49 45 49 49Hyperactivity 71 54 57 57 59Anxious–shy 58 52 55 42 42Perfectionism 50 44 42 47 42Social problems 90 90 87 53 46ADHD global index 63 44 52 47 55Restless–impulsive global index 67 44 52 47 55Emotional lability global index 68 45 51 51 80Connors’ global index 69 43 52 48 65DSM-IV inattentive 62 45 50 54 54DSM-IV hyperactive–impulsive 66 51 51 58 62DSM-IV total 65 48 51 56 57

*Measured at Time 1, before the social story intervention. Note that scores of 65 and over (shown in bold) indicate behaviours of clinical significance.

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(Connors, 1997). Child A also showed elevated scores on seven other measureswhich were oppositional behaviour (66), hyperactivity (71), restlessness–impulsive-ness (67), emotional lability (68), Conners’ total index (69), DSMIV hyperactivity–impulsivity (66) and DSMIV total (65); see Table 2.

Children D and E, for whom the social stories were not effective, showed differ-ent patterns of behavioural difficulty. Their scores were not significantly high onthe sub-scale of social problems (53 and 46 respectively), but they both scoredhighly on the oppositional sub-scale (70 and 84 respectively). Individuals scoringhighly on the oppositional sub-scale can be described as rule breakers, they aremore likely to argue with adults and to show anger and annoyance compared withindividuals their age. Child E also scored highly on the emotional lability sub-scale,with a total of 80 on this measure, reflecting increased displays of emotion in thischild.

Perspective-taking ability. First and second order perspective taking measuredusing the Sally-Anne task was assessed before and after the social story intervention.At both time points, Child D and Child E passed first and second order perspective-taking tasks. Child A and Child B failed the second order perspective-taking tasks atboth time points. Child C failed the first and second order perspective-taking tasks atboth time points.

Results Summary

The present study found that social stories were an effective intervention for threeout of the five children who took part. Three children (A, B, and C) showed anincrease in targeted lunchtime behaviour (independently going to the dining hall)when their social story was introduced and some decrease in targeted lunchtimebehaviour when it was withdrawn. Specifically, by the end of the intervention allthree children showed independent behaviour in relation to going to the dining hallduring the intervention phases of this study. Scores on the CTRS-R:L indicated thatthese children all had elevated scores on the social problems sub-scale. In addition,performance on first and second order perspective taking tasks highlighted poorperspective-taking skills relative to their chronological age. Social stories, however,had little or no effect on the behaviour of the two other children (D and E). Thesetwo children did not display any independent lunchtime behaviour throughout thestudy. Here, baseline and intervention phases were either prompted or physicallyassisted in going to the dining hall. Scores on the CTRS-R:L highlighted increasedoppositional behaviour in these two children. In addition, both children showedgood ability to perspective-take where performance was consistent with chronologi-cal age.

Discussion

Previous research has found that social stories have been used successfully to changetarget behaviours in children with autism spectrum disorder (see Kuttler et al., 1998;

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Lorimer et al., 2002). Children with autism have been found to show perspective-taking difficulties (see Baron-Cohen, 2000, for a review) and social stories are arguedto provide an effective structure with which to help children understand others’thoughts and feelings (Kuoch & Mirenda, 2003). The current study extends previousresearch to highlight that social stories are effective in changing targeted behaviour inother groups of children. Specifically, it found that social stories were effective withthree children, all of whom were reported as having social problems by their teachers.Interestingly, these children demonstrated perspective-taking difficulties relative toage level as reflected in their performance on first and second order theory of mindtasks. In contrast, the two children for whom social stories proved to be ineffectiveshowed age appropriate perspective-taking. In addition, these two children were alsoreported as displaying oppositional behaviors by their teacher. The results are consis-tent with the proposition that social stories provide a useful tool to facilitate a child’sunderstanding of their social world (Kuttler et al., 1998; Moore, 2004).

The differential results for children with social and oppositional profiles suggestthat problematic lunchtime behaviour in school is a function of different emotionaland behavioural problems in childhood. Researchers have begun to conceptualise anddescribe developmental pathways through childhood (Compas, Hinden, & Gerhardt,1995). The principle of equifinality, for example, states that diverse pathways can beassociated with the same outcome for different children (Cicchetti & Cohen, 1995).The five children who took part in this study exhibited similar lunchtime behaviour.The behavioural and perspective-taking profiles of these children and the relativesuccess of social stories suggests that the factors and developmental pathways respon-sible for their lunchtime behaviour were different. In the present study, social storiesdemonstrated effectiveness in addressing behaviours associated with specific causalfactors and developmental pathways leading to social problems in childhood.

Social stories are used to help children to learn about specific social situations(Gray, 1994; Moore, 2004). The extent to which children can benefit from their usewithin a wider social context is unclear. Gray (1994) introduced social stories tomodify specific targeted behaviour which is causing concern for the child and thosearound them. Gray (1994) argues that social stories are not intended to equip a childwith general skills or to universally change behaviour in school. Consistent with thisproposition, previous work in children with an ASD has found that they havedifficulty generalising new behaviours or skills to a new context (see Hagiwara &Myles, 1999). The present study found no change in the behavioural profiles asmeasured by the CTRS-R:L or in perspective-taking over the four phases of theintervention. It is likely, however, that the time frame used in the current study wastoo short to allow any broad changes to develop. In addition, because the children inthe current study for whom social stories were effective showed problems withperspective-taking, a greater use of perspective-taking sentences within their storiesmight have increased the possibility that they could generalise learnt skills to othersettings. Future research needs to establish whether lack of maintenance and abilityto generalise new skills to different contexts is characteristic of children with andwithout an ASD and for social stories which have more perspective-taking sentences.

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In relation to difficulties with generalising new skills, research in children with anASD has also found that maintenance of any improvement over time has been prob-lematic (Kuttler et al., 1998; Norris & Datillo, 1999). Most studies have assessed theimmediate impact of social stories on behaviour. Future research needs to establishthe extent to which new behaviours are maintained over time and whether lack ofmaintenance is characteristic of children with and without an ASD.

While the results of the present study highlighted the effectiveness of social storiesfor children who experience social problems, there are a number of methodologicalshortcomings. The study did not measure maintenance over time and or the extentto which behaviours of children generalised across multiple contexts. The differentialsuccess of social stories did support the behavioural and perspective-taking profiles ofchildren in the current study; however, the sample size was small. In addition, it is notclear how older children would respond to an intervention of this type. Future researchshould aim to replicate these results with a wider sample of children of different ages.In addition, the current study; did not allow any assessment of which other factorspotentially contributed to change (Scattone et al., 2002). It is possible that childrenin the current study did not behave as they normally would because the conditions ofthe experiment were different from their ordinary experience (Kane & O’Reilly-DeBrun, 2001). A non-intervention control group would have provided furtherinformation about the exact effect of the intervention. In this case, a non-interventiongroup could have read a fiction story before lunch, rather than a social story.

In summary, the results of this study highlight that social stories are effective withsome children who demonstrated difficult lunchtime behaviours. They highlightedthat children who would benefit the most from a social story are those who showsocial problems (as rated by teachers) and are poor at perspective-taking. Futureresearch should aim to establish more clearly the relative success of social storieswith children who have social, emotional and behavioural difficulties.

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Appendix A. An example of a social story written for this study

THINGS TO DO AT LUNCHTIMEThe school bell for lunch goes at ten past twelve. It rings three times. (Descriptive.)That means we go to our seats and sit down. (Descriptive.)When all my table is waiting our teacher tells us to go. We can wash our hands in thesmall sink if we have been doing art or messy stuff. (Descriptive.)The cloakroom is busy with lots of children. Some get their lunch boxes. (Descriptive.)Some children are talking to each other. (Descriptive.)I try to walk past them and into the dining room. Sometimes I say ‘excuse me’ andwait for them to move. (Directive.)My seat is on table number three by the door. (Descriptive.)Eating lunch is good. (Affirmative.)Then it is time for play. Playtime is a good time to get rid of my energy that buildsup when I am sitting. (Descriptive and Affirmative.)In the play ground the children run and shout. They are loud because they arehaving fun. (Descriptive and Perspective.)

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using social stories to change problematic lunchtime behaviour in school

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