by Stephen M Edelson, Ph.D. Director, Center for the Study of Autism
Theory of Mind
Many children with autism, attention deficits (ADD and ADHD), learning disabilities (LD), and pervasive developmental disorders (PDD-NOS) have deficits in social cognition, the ability to think in ways necessary for appropriate social interaction.
These individuals do not realize that other people have their own thoughts, plans, and points of view. They also appear to have difficulty understanding other people’s beliefs, attitudes and emotions.
As a result, they may not be able to anticipate what others will say or do in various social situations. This has been termed as a lack of “theory of mind,” or the ability to take the perspective of another person.
An interesting technique, developed by Carol Gray, a consultant to students with autism in Michigan, helps individuals with autism “read” and understand social situations better. This approach presents appropriate social behaviors in the form of a story, which answer the “who,” “what,” “where,” “when,” and “why” questions necessary to interact appropriately.
There are four types of sentences used in social stories, each with a specific purpose.
Descriptive sentences describe social settings and what people do in particular social situations. An example is, “Children go to their classrooms where the teacher reads a story.”
Directive sentences move a person toward a desired, appropriate social response. They state in positive terms what the desired behavior is. Directive sentences are used in conjunction with descriptive sentences.
Gray has developed the social story ratio, which defines the proportion of directive sentences to descriptive sentences. She suggests that for every one directive sentence, there should be two to five descriptive sentences. Care must be taken not to limit an individual’s choices.
The greater the number of descriptive statements, the more opportunity for the individual to supply his/her own responses to the social situation. The greater the number of directive statements, the more specific the cues for how the individual should respond.
An example of this combination is, “I am playing during recess. The bell rings for me to come in. I stop playing and line up to come in. I follow the other children and quietly go to the classroom. When we get to the classroom, I sit down at my desk and listen as my teacher reads a story.”
Perspective sentences present others’ reactions to a situation so that the individual can learn how others perceive various events. Perspective sentences are combined with descriptive sentences in the same ratio as directive sentences.
An example of perspective sentences in combination: “When the bell rings for recess to end, the teacher is happy to see all the children line up quietly and walk to their classroom. Many children are excited that they get to hear a story. The teacher likes it when children sit quietly and listen.”
Control sentences identify strategies the person can use to facilitate memory and comprehension of the social story. Control sentences are created by an individual after reviewing a social story.
An example of a control story: “I remember that the bell means it’s time for recess to end by thinking of a teapot. I know that when it whistles, the water is done. The bell is like the whistle; when it rings, recess is done.”
Using Social Stories
There are a number of ways social stories can be implemented. For non-readers, the author reads the story on an audiotape with interspersed cues for turning the page. Readers can open a story independently. Stories are listened to once a day.
When the individual with autism successfully incorporates the skills or appropriately responds in the social situation depicted, the story is faded out. This can be done by reducing the number of times a story is read per week or by reviewing the story once a month. Fading can also be accomplished by rewriting a story, gradually removing directive sentences from it.
Social Stories for autism, ADHD and PDD-NOS are useful for helping children to learn appropriate ways to interact in social situations. They can be individualized to incorporate the specific needs of the person for whom the story is written. They can teach routines, how to do an activity, how to ask for help, and how to respond appropriately to feelings like anger and frustration.
While studies are currently assessing the effectiveness of social stories, they appear to be a promising method for improving the social behaviors of individuals with autism.
Sources & References
Use of a Social Story intervention to improve mealtime skills of an adolescent with Asperger syndrome. Autism. 2003 Sep;7(3):289-95.
Musically adapted social stories to modify behaviors in students with autism: four case studies. J Music Ther. Summer 2002;39(2):117-44.
An advanced test of theory of mind: understanding of story characters’ thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. J Autism Dev Disord. 1994 Apr;24(2):129-54.
, et al. Acquired ‘theory of mind’ impairments following stroke. Cognition. 1999 Apr 1;70(3):211-40.
Hutchins, T.L., et al. Using social stories and comic strip conversations to promote socially valid outcomes for children with autism. Semin Speech Lang. 2006 Feb;27(1):47-59.
Scattone, D., et al. Decreasing disruptive behaviors of children with autism using social stories. J Autism Dev Disord. 2002 Dec;32(6):535-43.
Thiemann, K.S., et al. Social stories, written text cues, and video feedback: effects on social communication of children with autism. J Appl Behav Anal. Winter 2001;34(4):425-46.