Social Stories in mainstream schools for children with autism spectrum disorder: a feasibility randomised controlled trial

Abstract

ObjectivesTo assess the feasibility of recruitment, retention, outcome measures and intervention training/delivery among teachers, parents and children. To calculate a sample size estimation for full trial.DesignA single-centre, unblinded, cluster feasibility randomised controlled trial examining Social Stories delivered within a school environment compared with an attentional control.Setting37 primary schools in York, UK.Participants50 participants were recruited and a cluster randomisation approach by school was examined. Participants were randomised into the treatment group (n=23) or a waiting list control group (n=27).Outcome measuresAcceptability and feasibility of the trial, intervention and of measurements required to assess outcomes in a definitive trial.ResultsAn assessment of the questionnaire completion rates indicated teachers would be most appropriate to complete the primary outcome measure. 2 outcome measures: the Social Responsiveness Scale (SRS)-2 and a goal-based measure showed both the highest levels of completion rates (above 80%) at the primary follow-up point (6 weeks postintervention) and captured relevant social and behaviour outcomes. Power calculations were based on these 2 outcome measures leading to a total proposed sample size of 180 participant groups.ConclusionsResults suggest that a future trial would be feasible to conduct and could inform the policy and practice of using Social Stories in mainstream schools.Trial registration numberISRCTN96286707; Results.

A Pilot Randomised Control Trial of Digitally-Mediated Social Stories for Children on the Autism Spectrum

“…Previous research has often drawn conclusions on the effectiveness of social story interventions by measuring behaviour frequency (Rhodes 2014), however, intensity of the behaviour is also a critical dimension of maladaptive behaviours (Goodley 2001;Sofronoff et al 2004;Haggerty et al 2005). Therefore, a measure of intensity was included in the present study as was the measure of closeness to the social story goal, identified by Marshall et al (2016). However, by purely assessing behaviour outcomes an increase in understanding of behaviour cannot be identified, despite understanding being argued to be the central premise of social story interventions (Gray 2010) with some evidence from the neurotypical literature indicating that social stories increase a child's understanding of the social world (Toplis and Hadwin 2006).…”

“…The pilot study adopted a quasi-experimental RCT betweensubjects design, in order to overcome previously flawed social story research (Marshall et al 2016;Wright et al 2016). This RCT examined the impact of a digital social story intervention through comparison with an attentional control group, who received a simple poem of comparable length called 'Witch, Witch'.…”

“…However, to date, only four between group RCTs have been conducted using social stories, all of which did not meet inclusion criteria for a review by Wright et al (2016). The studies generally failed to successfully follow Gray's social story criteria and interventions tended to lack an individualised story constructed for the specific needs of the child and were vulnerable to selection and reporting bias (Marshall et al 2016;Wright et al 2016). In addition, social stories were read for a single day in all four studies.…”

“…In addition, social stories were read for a single day in all four studies. Consequently, Marshall et al (2016) argue that there is 'a strong justification to conduct a well-designed, ecologically valid, large-scale RCT on the effectiveness of Social Stories which used individualised stories within a school setting' (p. 2). Marshall et al (2016) conducted a feasibility study for RCTs on the use of social stories for children on the autism spectrum.…”

“…Consequently, Marshall et al (2016) argue that there is 'a strong justification to conduct a well-designed, ecologically valid, large-scale RCT on the effectiveness of Social Stories which used individualised stories within a school setting' (p. 2). Marshall et al (2016) conducted a feasibility study for RCTs on the use of social stories for children on the autism spectrum. The authors concluded that teachers are most appropriate to complete the outcome measures, which should include a measure of how close the child is to the goal of the social story, and that a 6-week follow-up was an appropriate time scale.…”