Effects of Social Stories for Individuals with ASD: A Quantitative Review

Background:   Delayed social communication skills and restricted and repetitive behavior are the recognized characteristics of ASDs (American Psychiatric Association, 2013). Although there is a burgeoning set of evidence-based practices (EBPs) related to positive outcomes for children with ASD (National Autism Center, 2009), there also exists a plethora of alternative, fad, or complementary interventions related to ASD. Due to the fast increase in the prevalence of ASDs, there is a growing demand for EBPs. Although several reviews of social story-based interventions have been published, the findings across reviews were not consistent.

Objectives: The primary goal of this study was to provide a quantitative synthesis of the effectiveness of social stories intervention for individuals with ASD. Specifically, this review will: (a) evaluate whether each study met the What Works Clearinghouse (WWC) design standards, (b) determine the strength of the evidence using a set of visual-analysis-based evidence criteria, (c) calculate multiple nonoverlapping indices scores, and (d) establish whether the social stories intervention might be an EBP.

Methods:   Studies were identified using Academic Search Complete, Education Research Complete, PsychINFO, and the Education Research Information Center (ERIC). Inclusion criteria were: (a) the author(s) included at least one participant with ASDs; (b) studies were published in an English language, peer-reviewed journal prior to July 2013; (c) the authors used a single-case research design (SCRD); (d) the study included a graphic display of outcomes; and (e) social stories were the sole intervention. Twenty-two studies met the inclusion criteria for review.

Results: First we evaluated the quality of methodology of research. Only 4 studies met the WWC design standards and 18 met design standards with reservations. Second, the WWC evidence criteria (based on visual analysis) were used to determine whether there was a functional relation between social stories and the outcome variables. Only one study provided strong evidence, 6 provided moderate evidence, and 15 provided no evidence. Third, four nonoverlapping indices including percentage of nonoverlapping data (PND), percentage of data exceeding the median (PEM), percentage of data exceeding the median trend line (PEM-T) and pairwise data overlap squared (PDO²) were calculated. The overall median PND of 70%, the mean PEM of 78%, PEM-T of 70%, and the mean PDO² of 82% for the intervention phase placed social stories in the effective range based on the criteria set by Scruggs and Mastropieri (1998). Finally, the WWC guidelines (5-3-20) were used to determine whether social stories were evidence based (Kratochwill et al., 2013): (a) a minimum of five SCRD studies that met standards or met standards with reservations, (b) studies conducted by at least three independent research groups, and (c) at least 20 individual demonstrations of an effect (Kratochwill et al., 2013). Studies included in this review met all three criteria, thus, social stories intervention were considered evidence based.

Conclusions: It is important to continue to explore SCRD synthesis methods in conjunction with visual analysis and clinical judgment to identify evidence-based practices for individuals with ASD.