Using Social Stories to Promote Behavior Change for Individuals with Autism Spectrum Disorders: A Scoping Review

Background: Social stories are a popular choice of intervention for many professionals to use when working with individuals with Autism Spectrum Disorders (ASD). Social stories have been used in a variety of settings and for a number of purposes, including helping children understand group situations, perceive how others behave or respond, develop self-care skills, academic abilities, and coping skills, and as a behavioral strategy. There have been a number of reviews exploring the quality and efficacy of social story interventions. However, the results of previous publications have highlighted the disparate outcomes of social story research.

Objectives: The objective of this scoping review is to identify, evaluate, and synthesize studies utilizing social story interventions targeting behavior change in individuals with Autism Spectrum Disorders (ASD).

Methods: A search of five databases (PsycINFO, Cochrane Systematic Database, PubMed, CINAHL, ERIC) targeting social stories was conducted. Articles with population term- [(Autis* OR ASD OR Asperger*)] AND intervention term- [(“Social Stories” OR “Social Story” OR Social Narrative)] were considered. Inclusion criteria: 1) individuals with Autism, Asperger, PDD-NOS, or Autism Spectrum Disorders; 2) published before February 2018; 3) social story/social narrative as intervention. Exclusion criteria: 1) literature reviews; 2) case studies without intervention; 3) qualitative understanding of user experience; 4) no control or alternate condition; or 5) comparisons of delivery modes (i.e., iPad vs. paper). Article titles, abstracts, and full-texts were independently reviewed by two reviewers; a third reviewer assisted during conflicts until consensus was met.

Results: Results of the systematic search produced 450 abstracts across five databases. After 136 duplicates were removed, 314 original titles and abstracts were screened, and 150 full-texts were evaluated for inclusion. Eighty-eight articles met criteria and were included in the qualitative synthesis. Primary outcomes of each study were identified and sorted into one of two macro-categories based on their aim: Reduce Disruptive Behaviors (RDB) (37.5%) and Increase Desired Behaviors(IDB) (62.5%). Gray’s Social Story fidelity criteria were used to assess intervention strength, and were met in 35% of the articles. The subcategories yielding effective results consistently across multiple studies targeted the following behaviors: aggressive actions, fear/anxiety, verbal protests, identifying emotions, executive functioning, and following directions. Since 2013, the focus of social story interventions has moved from reducing disruptive behaviors toward increasing desired behaviors, at a ratio of 2:5. The overwhelming majority of the articles (92%) are from the U.S, two are from Turkey, and one each from Japan, New Zealand, Thailand, United Arab Emirates and the United Kingdom.

Conclusions: This scoping review highlights how social story interventions are used to promote behavior change for individuals with ASD. The studies included in this review provide support for the use of social stories to improve social engagement through the development and enhancement of a pro-social skills such as recognizing emotions, initiating social contact, and learning how to utilize positive verbal and non-verbal communication abilities. Thus, the findings from this scoping review provide evidence supporting social story interventions as effective in facilitating positive social interactions, promoting regulation, and eliciting behavior change for children with ASD.