Revealing the Hidden Social Code

Social Stories (TM) for People with Autistic Spectrum Disorders

Marie Howley, Eileen Arnold

• Publisher: Jessica Kingsley Publishers
• Year: 2005
• Print ISBN: 9781843102229
• eBook ISBN: 9781846421426
• Topic: Education
• Subtopic: Inclusive Education

The Social Stories(TM) approach is widely acknowledged as a key technique for teaching social and life skills to children with autistic spectrum disorders. This text, endorsed by the originator of Social Stories(TM), Carol Gray, offers clear and comprehensive guidance for professionals, parents and carers on how to write successful and targeted Social Stories(TM) that will help develop the autistic spectrum child's understanding of social interaction.

The book outlines the kinds of social challenges that people with ASD may experience and highlights the importance of learning social skills in meaningful contexts. An extended review of the guidelines for writing Social Stories(TM) will help writers to structure and develop their stories. The authors explain the key elements and highlight the potential difficulties that a writer may encounter, while providing encouragement and guidance through the various stages of what is often a challenging process. They include examples from their own professional experience, and suggest ways in which the Social Stories(TM) approach may enhance other strategies. Helpful advice on presentation and implementation is provided.

Revealing the Hidden Social Code is essential reading for any professional, parent, carer or teacher wanting to employ Social Stories(TM) to develop social understanding in people with ASDs.

Chapter One

Introduction and Rationale for Social Stories™

Social interaction is a fundamental aspect of all of our lives. Most everyday situations and events require us to interact with others. Often success within our social encounters depends upon our skills in, and understanding of, social interaction. The need to develop effective interaction should be reflected in any curriculum, as for example indicated in the English National Curriculum (Department for Education and Employment/Qualifications and Curriculum Authority 1999a, 1999b), which identifies ‘working with others’ as a key skill for all pupils, embedded across the curriculum, stating that: ‘if pupils are to work with others they must develop social skills and a growing awareness and understanding of others’ needs’ (p.21). The development of social interaction is crucial for children and adults, yet for many people with autistic spectrum disorders (ASD) social interaction remains an enigma and they are frequently socially excluded from a wide range of activities in the social world. Sainsbury (2000) recalls that it is as if ‘everybody is playing some complicated game and I am the only one who hasn’t been told the rules’ (p.8). Such social exclusion may result in increased levels of stress and anxiety, low self-esteem and inappropriate social behaviours (Barnhill 2001; Volkmar and Klin 2000). Given that social interaction is essential in order to participate and enjoy our very social world, it is equally essential that we consider ways of developing skills and understanding in this area for those who are at great risk of social exclusion.

One approach that is increasingly used to develop social skills and social understanding with individuals with ASD is that of Social Stories™, originated by Carol Gray. The purpose of this book is to reflect upon key principles of the approach and to provide writers of Social Stories™ with examples based upon extensive use of the approach in a diverse range of settings, including schools, home and workplace, with many individuals with ASD.

Gray’s Social Stories™ approach (1994a, 1998a) focuses upon the individual needs of people with ASD who face challenges in the area of social interaction every day of their lives. This chapter provides an explanation of the nature of social challenges that people with ASD may experience and explores the rationale for Gray’s approach. An understanding of the theoretical framework for the approach is crucial to developing and writing Social Stories™. This is crucial to understanding how the approach can be used and how Social Stories™ enable some people with ASD to participate in social interaction more successfully.

The nature of the social impairment

ASDs are viewed as developmental disabilities, the difficulties associated with the disorder affecting all aspects of the individual’s life (Mesibov, Adams and Klinger 1997). Since the original descriptions of an autism syndrome by Kanner (1943), cited in Frith (1991), the nature of ASD has been widely debated and is well documented (e.g. Frith 1989; Howlin 1986; Schopler and Mesibov 1986; Wing 1996). Wing and Gould (1979) defined a ‘triad of impairments’ associated with autism, suggesting that despite individual variation, individuals characteristically show impairments in reciprocal social interaction, verbal and non-verbal communication, and display a restricted range of activities and interests, stemming from an impairment in imagination. Diagnostic criteria (American Psychiatric Association 1994; World Health Organization 1993) identify these aspects as critical to diagnosis. Individuals with ASD will therefore face challenges, to a greater or lesser degree, in all three of these areas.

In particular, the social challenges facing individuals with ASD are well documented and accepted (e.g. Attwood 2000; Happé 1994; Howlin 1986; Schopler and Mesibov 1986; Wing 1996; Wing and Gould 1979). Wing and Gould (1979) identified a triad of social impairments, including impaired social interaction; impaired reciprocal communication; impaired socially oriented, imaginative, pretend play. They also defined three groups of individuals whose social interaction can be described as ‘aloof ’, ‘passive’ and ‘active but odd’. In 1996 Wing added a fourth group, described as ‘stilted and over-formal’ in their interactions. Individuals with ASD will of course vary in their abilities to interact with others: for example, an individual who may appear socially aloof in many contexts may, in a familiar situation where the topic is of interest to them, become more actively socially engaged. However, while there is much evidence reporting and describing the social behaviours characteristic of ASD, the nature of the social challenges facing people with ASD continues to be debated. As Baron-Cohen and Bolton (1993) point out, there is no single definition of the social impairment, rather there is a range of difficulties that varies from one individual to another. Moreover the difficulties characteristic of the social impairment are not restricted to the development of skills alone, rather the difficulties are all-encompassing, and include social skills and social understanding.

Social competence: social skills and social understanding

The need to develop social interaction skills is crucial as access to so much of life’s events depends on an ability to interact with others. In addition, in order for an individual to be successfully included in social activities it is crucial that he or she develops a degree of ‘social competence’ (Harris and Handelman 1997). Howlin (1986) suggests that ‘the essence of social behaviour consists of the ability to relate to others in a mutually reinforcing and reciprocal fashion and to adapt social skills to the varying demands of interpersonal contexts’ (p.103). However, social reciprocity is frequently a challenge for people with ASD and the ability to generalize and adapt skills is often limited due to lack of social understanding. In addition, whilst the social impairment is acknowledged in ASD, Gray (1998a) also places an emphasis on the two-way nature of challenges to social interaction. By definition, social interaction requires at least two people to engage in a reciprocal exchange. Therefore, any ‘problems’ in interacting lie with all participants, not just the individual with an ASD. This is a key issue when considering the Social Stories™ approach. Any approach that addresses the social impairment in ASD must include the development of social skills and social understanding and take into account all social partners, rather than focus entirely upon the individual with ASD.

SOCIAL SKILLS

Social skills may be relatively easy to teach to individuals with ASD, although these may remain ‘splinter’ skills that are not necessarily used appropriately. A number of crucial aspects of social development are frequently not addressed by teaching specific skills in isolation. For individuals with ASD to develop ‘social competence’, it is crucial that social skills are taught within a broader, more meaningful social context. The development of social skills may be of minimal intrinsic value unless accompanied by the development of social understanding. In fact, developing skills without offering contextual information and guidance may be detrimental in the long term.

For example, Billy, aged 5, had difficulties accepting and initiating hugs with his parents who identified this as a priority area for development. Billy learnt relatively easily to hug his parents, first in response to their hugs, and eventually spontaneously. His parents were initially extremely pleased with this newly acquired skill and encouraged him to practise and demonstrate this behaviour with other family members and friends. However, it became clear over time that a number of more significant issues remained problematic. Although his parents were delighted that he now hugged them and his brother spontaneously, it became increasingly clear that he was unaware of how frequently he should hug them and for how long. Thus it became a problem when, for example, he continually approached his parents for a hug when it was inconvenient for them such as while preparing a meal. More importantly, Billy was not always able to distinguish between those he was allowed to hug and those who he should not. Consequently he began hugging strangers in a range of contexts such as at church, in shopping centres or on public transport. While this was perceived by some as mildly amusing and somewhat endearing at 5 years old, it became an increasing problem as he grew older. By the time he had reached his teens, it was a significant difficulty that became a priority area of concern. As a result, Billy now had to ‘unlearn’ a social skill he’d been taught previously, try to learn the appropriate times for giving hugs to his family and learn a new set of skills that were more appropriate (e.g. for greeting). This proved to be very difficult for him and caused great anxiety for his family. It is clear from this example that the social impairment was not restricted to the acquisition of skills alone. Billy was taught to hug, but knew nothing about who, when, how long for and where to hug. While he had indeed acquired a new social skill that was initially celebrated, it became clear that the difficulties he had in the broader areas of social development remained and continued to cause him significant difficulties in relation to social interaction. He was unable to make a social judgement about who and when to hug. He was limited in his ability to select appropriate behaviours for different contexts and he was unable to predict what was expected of him. Furthermore, he lacked social understanding to inform his decision making in different contexts. It is this area of social understanding that appears to be critical to the development of social competence.

It is generally accepted that individuals with ASD will need to continue to develop their social skills throughout adulthood (Howlin 1986, 1997; Mesibov 1986). A number of social skills programmes are available for developing social skills (Aarons and Gittens 1998; Schroeder 1996) and the role of social skills groups is also acknowledged (e.g. Attwood 2000). However, while it is agreed that the teaching of social skills is important, any social skills learnt by an individual will be of little functional use if taught in isolation. Volkmar and Cohen (1985) report that ‘higher functioning’ adults with autism who acquire a number of social skills still have major problems with relationships and social interaction. Howlin (1986) identifies areas of social functioning that continue to be problematic often into adulthood, including a failure to develop friendships and lack of empathy. Barnhill et al. (2001) suggest that when people with ASD initiate interaction with others, they are frequently rejected due to their lack of understanding about their inappropriate social behaviour.

It is the experience of the writers that it can be relatively easy to teach social skills in isolation, but that this results in little more than a series of unrelated tricks and splinter skills if not placed into useful and meaningful contexts and developed with a degree of social understanding of how and when to use those skills. Isolated social skills may not lead to increased social inclusion and individuals may therefore continue to experience high levels of stress, anxiety and low self-esteem (Volkmar and Klin 2000).

SOCIAL UNDERSTANDING AND SOCIAL COGNITION

Frequently individuals with ASD are described as behaving socially inappropriately, but invariably their social responses are based upon their unique experiences and understanding of the social world. This experience consequently impacts upon their social understanding of the world. Gray’s approach, Social Stories™, is innovative in that the approach focuses not only upon developing appropriate social skills, but also upon developing social understanding. Rowe (1999) supports this view by suggesting that Social Stories™ are not about teaching isolated social skills, but rather more about providing information about the social world to the individual in order to develop his or her schema. Gray (1998a) suggests that social understanding should be taught as ‘an integral and prerequisite component to teaching social skills’ and the Social Stories™ approach is underpinned by this philosophy. Gray states:

The goal of a social story is to share relevant information. This information includes (but is not limited to) where and when a situation takes place, who is involved, what is occurring, and why. (Gray 1998a, p.171)

Social understanding depends upon having some insight into how to use social skills in a variety of social situations. This is usually developed as individuals engage in social experiences and establish schemata for interacting with others. However, for individuals with ASD it is suggested that they may not experience the social world in the same way as those who do not have ASD (sometimes called neurotypicals), hence their reactions may seem unusual or inappropriate. The Social Stories™ approach has been developed in response to our growing understanding of the difficulties that people with ASD may face in relation to developing their understanding of social situations. The approach is underpinned by some of the key psychological theories that offer possible explanations for the social challenges in ASD, and which may account for their different experiences of the social world, in particular theory of mind and central coherence.

Theory of mind

Frith (1989) suggests there is a consensus that individuals with autism are ‘socially inept’, especially in relation to two-way interactions. She believes that it is crucial to look beyond the realm of social behaviour alone, as the overt behaviours are only symptoms of an underlying deficit; for example, a lack of a ‘theory of mind’. Leslie (1987) proposes that individuals with ASD have difficulties attributing thoughts and feelings to others. It is suggested that they also have difficulties in taking the perspective of another person and are unable to ‘mind read’ (Baron-Cohen 1995; Baron-Cohen, Leslie and Frith 1985; Happé and Frith 1995). This research concludes that individuals with ASD have specific difficulties with understanding that other people may have different beliefs and intentions from their own. Baron-Cohen et al. (1985) suggest that individuals with ASD are unable to ‘mentalize’; that is, they have difficulties understanding the thoughts, intentions and feelings of others. This would suggest an impairment of ‘social cognition’, leading to difficulties with reciprocal interaction.

Central coherence

Whilst lack of theory of mind may well account for many of the difficulties associated with social impairment, including a lack of ability to see another person’s point of view, an egocentric view of the world and consequently an inability to understand social nuances of reciprocal social interaction, such a lack does not account for all the social challenges in ASD. Frith (1991) suggests that individuals with ASD lack what she calls ‘central coherence’. This means that individuals are unable to extract meaning from information and ideas in order to integrate them into a meaningful whole. Frequently, individuals with ASD fail to see the ‘whole picture’, often focusing on irrelevant details and missing relevant and important cues which give meaning to the context. This is exemplified by the child who completes a jigsaw puzzle easily without seeing the picture. The individual pieces are not seen as an integrated whole picture; hence the picture clues most children would rely upon become meaningless. In relation to social contexts this means that they may not ‘see’ the whole ‘social picture’ and this may lead to inappropriate behaviour. For example, an office worker with ASD who is sent to another office with a message may not ‘read’ the facial expressions and gestures of the colleague who would like him or her to wait as they are on the telephone. The individual may deliver the message regardless of these signals. Such behaviour may be interpreted as impolite and inappropriate. As a consequence of weak central coherence, individuals with ASD are often unable to apply their knowledge to changing contexts and situations. They may fail to generalize their social skills and are unable to adapt skills to different social situations and contexts.

Lack of theory of mind and weak central coherence may mean that individuals with ASD are missing essential information in social situations. Often individuals may be trying to respond in social situations but their responses are based upon their different experiences of the social world. Gray (1998a) suggests that the ability to ‘mind read’ and to be aware of the perspectives of others, together with the drive for central coherence, means that ‘most people are privy to a secret code’ (Gray 1998a, p.169). She describes this code as ‘a system of unspoken communication that carries essential information; a system that eludes and frustrates individuals with high functioning autism and Asperger syndrome’. This may account for some of the challenges they are faced with when interacting with others and w...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Acknowledgements
• Foreword
• 1. Introduction and Rationale for Social StoriesTM
• 2. Preparing to Write: Gathering Information
• 3. Sentences and Structure: Descriptive, Perspective and Directive Sentences
• 4. Advanced Social StoriesTM
• 5. Presenting, Implementing and Monitoring
• 6. Introductory Social StoriesTM and Complementary Strategies
• 7. Problem Solving and What to Do When Social StoriesTM Do Not Work
• Final Thoughts
• Appendix 1: Checklist for Drafting a Social StoryTM
• Appendix 2: Checklist for Monitoring Individual Progress
• Appendix 3: Checklist for Problem Solving
• Appendix 4: Social StoryTM Checklist
• References
• Subject Index
• Author Index