Focus on Autism and Other Developmental Disabilities

http://foa.sagepub.com A Multimedia Social Story Intervention: Teaching Skills to Children with Autism
Taku Hagiwara and Brenda Smith Myles Focus Autism Other Dev Disabl 1999; 14; 82 DOI: 10.1177/108835769901400203 The online version of this article can be found at: http://foa.sagepub.com/cgi/content/abstract/14/2/82

Published by: Hammill Institute on Disabilities

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A Multimedia Social Story Intervention:

Skills to Children with Autism Taku Hagiwara and Brenda Smith Myles

Teaching

been used as a positive support intervention for people with autism and other developmental disabilities, their utility has primarily been supported by anecdotal records. This study developed an intervention that used social stories in a computer-based format. The results revealed that overall the social story intervention using a multimedia social story program for three boys with autism was

Although social stories have

high-functioning

autism disorder,

or

effective.

Asperger syndrome (Gray & Garand, 1993). In terms of format, Gray and Garand suggested that the entire story be presented on one piece of paper without
the
use

of visual stimuli. Furthermore,

they cautioned that, for social stories to be most effective, they should be indi-

ndividuals with autism have been shown to be responsive and productive when exposed to appropriate educational and training procedures and conditions (Dyer, Williams, & Luce,1991;
MacDuff, Krantz, & McClannahan, 1993; Mesibov, 1997). A structured and coneducational environment is essential for persons with autism (Mesibov, Schopler, & Hearsey, 1994) because they often have difficulties in assembling fragmented information into a meaningful whole and in decoding abstract information (Frith, 1989). Within the confines of creating a structured and concrete educational environment, various interventions and educational programs have been developed and implemented for children and youth with autism (Dawson & Osterling, 1997). Among those educational attempts, social stories appear to have promising effects to teach children and youth with autism. In this regard, Gray (1994), Gray and Garand (1993), and Swaggart et al. (1995) contended that social stories are one way to teach children with developmental disabilities appropriate social behaviors and interactions, increasing the
crete

likelihood of better performance across educational and vocational settings. This instructional technique is thought to minimize the confusion of verbal instructions and social interactions for persons with autism (Gray & Garand, 1993) through the use of pictures or symbols combined with short sentences in a small book format. A social story describes social situations in terms of relevant social cues and identifies appropriate responses for individual students. It typically comprises two to five sentences that are (a) descriptive, including information about the setting, participants, and actions; (b) directive, containing statements about the appropriate behavioral response; (c) perspective, describing the feelings and reactions of others in the targeted situation ; and (d) control, providing analogies with similar actions and responses using nonhuman subjects (Gray, 1994; Gray & Garand, 1993). In guidelines for social story use, Gray (1994) and Gray and Garand (1993) stated that social stories are most appropriate for students who have mild disabilities, such as learning disabilities,

vidualized for each student. Gray (1994) identified the following uses for social stories: (a) describing a situation, including social cues and rea nonthreatening manner; (b) personalizing social skills instruction; (c) teaching routines or student adjustment to routine changes; (d) teaching

sponses in

academic material in

realistic social

set-

ting, thereby assisting in generalization; and ( e ) addressing myriad behaviors,

such as and fear.
autism.

aggression, obsessive behavior, Thus, social stories have a broad application for children and youth with

According to the guidelines established by Gray (1994) and Gray and Garand (1993), social stories were most effective with higher functioning children and youth with disabilities. Swaggart et al. (1995) expanded the applicability of the social story intervention to children and youth with moderate to severe autism. First, the authors adopted a social story format consisting of a booklet with one sentence on each page. This procedure minimized the amount of information students received at a time. Second, they added an icon that matched the sentence on each page. Icons help

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83 students to recognize stories because, as the aforementioned research has shown, many students with autism are visual learners. Third, a similar social story was presented to more than one student. This enabled the use of an individualized social story in a small-group setting. Furthermore, this enhancement and modification of the originally established

physical disabilities (e.g., blindness, deafness, physical impairments). Each of the participants also met the following criteria: (a) mild to moderate social skill problems and related behavior problems; (b) basic listening or written language skills; and (c) fine motor skills that allowed for manipulation of a computer, such as moving the mouse or clicking its button. Selection of the participants was not limited to those who did not have prior experiences with social story interventions. Each of the participants scores on the following tests were obtained to confirm the presence of autism-related characteristics and students current social skill levels : the Autism Behavior Checklist (ABC; Krug, Arick, & Almond, 1988); the Behavior Assessment System for Children: Teacher Rating Scales (BASC; Reynolds & Kamphaus, 1992); and the Psychoeducational Profile-Revised (PEP-R; Schopler, Reichler, Bashford, Lansing, & Marcus, 1990). To evaluate the participants targeted behaviors, the Motivation Assessment Scale (MAS; Durand & Crimmins, 1992 ) was administered.

demonstrated other

guidelines appeared to increase appropriinteractions for children with autism in inclusive settings and provided a way to reach a large number of students in many environments with a low-cost intervention in terms of personnel, time, and equipment. To date, two studies have been published on the effects of social stories. Swaggart et al. (1995) investigated the effects of social stories to teach three children with autism (ages 7 to 11; two boys, one girl) social and behavioral skills. Kuttler, Myles, and Carlson (1998) studied the use of social stories to reduce precursors to tantrum behavior. Both studies reported positive changes in student behavior as a result of social story use. The purpose of this story was to expand investigation of the use of social stories by introducing a medium of presentation. The multimedia social story intervention was created by Hagiwara (1998) to allow students to learn new skills through social stories presented on a computer. The multimedia social story intervention embodies the characteristics of social stories in a structured, consistent, and attractive presentation with ample visual stimuli and sound made possible by the computer system.
ate

of age. He, too, was in inclusionary settings for most of the school day. His score on the ABC was 96, which was within the range of classification of autism. On the BASC, he scored 58 on the externalizing problems composite, 62 on the internalizing problems composite, 61 on the school problems composite, and 32 on the adaptive skills composite. Scores on the externalizing problems composite indicated average functioning; however, scores on the other composites were within the at-risk range. Participant Ils score on the PEP-R was 64, which indicated that his developmental age was 26 months. Results of the MAS ranked the reasons of motivation for his off-task behavior as escape, sensory, tangible, and attention.

White

Participant III. Participant III was a boy, 7 years 3 months of age. Although he was in inclusionary settings

part of the time, he spent half of his school day in the resource room. His score on the ABC was 82, which was within the range of classification of autism. On the BASC, he scored 54 on the externalizing problems composite, 51 on the

Participant I. Participant I was a White boy, 7 years 11 months of age, enrolled in inclusionary settings for most of the school day. His score on the ABC
108, which was within the range of classification of autism. On the BASC, he scored 48 on the externalizing problems composite, 57 on the internalizing problems composite, 59 on the school problems composite, and 34 on the adaptive skills composite. All scores of the BASC composites were within average ranges, except that of the adaptive skills composite, which fell in the atrisk range. Participant Is score on the PEP-R was 82, which indicated his developmental age was 36 months. Results of the MAS suggested that the motivation for his off-task behavior was sensory, escape, attention, and tangible, in this order.
was

internalizing problems composite, 60 in the school problems composite, and 34 on the adaptive skills composite. Scores on the externalizing problems and the internalizing problems composites indicated average functioning; however, scores on the school problems and the adaptive skills composites indicated that
he was at risk for school failure. His score on the PEP-R was 93, which indicated that his developmental age was 40 months. Results of the MAS ranked the reasons of motivation for his off-task behavior as sensory, escape, attention, and tangible.

Method

Participants
were

Three White elementary-age students recruited from a suburban school district in a midwestern state. All participants had previously been diagnosed with autism by a licensed psychologist,

Design
A multiple baseline design across settings was used (Tawney & Gast, 1984). This design was well suited to this study. According to Tawney and Gast, &dquo;teach-

psychiatrist, educator,

or

multidiscipli-

nary clinical team trained to assess children and youth with autism. None of the participants took seizure medications or

Participant
pant was

li. The second particia White boy, 9 years 11 months

social beresponsible for the havior of children across a broad range of environmental conditions, and it is often
ers are
...

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84
to concurrently modify behavioral excesses (or deficits) exhibited in several ... environments.... Beyond the classroom, educators assume responsibilities for children in buses, lunchrooms, playgrounds.... The multiple baseline design across conditions can prove helpful in identifying intervention programs that foster generalized responding across many natural environments&dquo; (p. 247). Each participants data were collected in three settings for one target behavior. Washing hands was chosen as a target behavior for Participants I and II. Settings for Participant I were before morning snack, prior to lunch, and after recess. Settings for Participant II were before going to the resource room, before lunch, and after recess. The target behavior for Participant III was on-task behavior. Settings for Participant III were lunch, resource room, and general education classroom.

necessary

Data Collection Scheme

Procedure

and

Reliability
Participants

Instruments
The following instruments were used in the study: (a) MacintoshTM computer systems for developing the multimedia social story program and executing the study in students classrooms (see Note); (b) a video camcorder to capture students actions on camera; (c) social stories created jointly by students teachers, paraprofessionals, and the investigator to address students needed skills that were input into the multimedia social story program; and (d) the multimedia social story programs developed for each par-

I and II, the task of hands was divided into the washing six following steps using task analysis: turn on the water, (b) put soap on (a) rub both hands under the hands, (c) take water, (d) paper towel, (e) dry both hands with paper towel, and (f) throw away paper towel. One paraprofessional for Participant I and two paraprofessionals for Participant II collected the relevant data. Scoring was based on the following criteria: (a) independent response, (b) prompted, and (c) physically assisted. An independent response was defined as the student completing the task without any external verbal requests or prompts. Prompts or cues were given by the paraprofessionals if the participant did not complete tasks within 5 seconds. Physical assistance was provided if the participant did not respond to prompts or cues after 5 seconds. Scores were coded and recorded on the data sheets provided by the investigator. Interobserver agreement was determined by comparing scoring agreements and disagreements between the paraprofessionals and the investigator. For Participants I and II, interobserver agreement was calculated by the following formula: agreements/( agreements + disagreements) x 100 (Tawney & Gast, For

following procedures occurred to develop the social stories, place them

within a multimedia context, and carry out the study:

The

Story Training. All trained participants by the investiTeachers and gator. paraprofessionals learned to interpret a functional analysis, clearly define targeted behaviors, and design a social story. Paraprofessionals who collected data received instruction on operating the multimedia social story intervention program, implementing the intervention, and collecting ongoing data.
were

Provide Social

Behavior and ConFunctional Analysis. A target behavior was set for each participant by

Specify Target
a

duct

consulting teachers, paraprofessionals, or parents, and observations made by the investigator. A functional analysis using
the Motivation Assessment Scale was conducted to evaluate situations and contingencies related to each students targeted behavior and to identify the sequence of

steps necessary to acquire a new or replacement behavior (see Design section).

Develop

the Multimedia Social

1984).
average durations of on-task behavior were per collected during 20-minute observation sessions (Alberto & Troutman, 1995; Tawney & Gast, 1984). On-task behavior was defined as any of the following behaviors: (a) reading or reading aloud, (b) having eye contact with teachers, (c) writing, (d) commenting related to the task in which the participant engaged, (e) answering to the teachers, and (d) watching objects related to the task For

Participant III,

occurrence

ticipant.

Validity
The validity of the social stories was established by consulting five educators and professors with experience in creating a social story. The examination focused on the contents of social stories, including clear focus on the target behavior and use of appropriate descriptive, directive, perspective, and control sentences in the social stories (Gray, 1994, 1995; Gray & Garand, 1993).

The multimedia social story programs were developed by the investigator using the HyperCardTM (Apple Computer, 1994) software. This program had a book-like format, which contained text of the social stories; movies of the participants actions corresponding to social story sentences; audio capability that read aloud sentences using a synthesized computer voice; and a navigational button clickable by the participants. Appendix A overviews the steps necessary to create the multimedia social story intervention. A copy of Participant Is multimedia social story appears in Appendix B.

Story Programs.

:1.

Implement Multimedia Social Story Intervention. The following steps occurred following identification of the target behavior through functional analysis and social stories creation:

(i.e., television, pictures, or computers).

For Participant III, the formula to calculate interobserver agreement was shorter number of minutes/longer number of minutes x 100 (Alberto & Troutman,

1995 ).

Collect baseline data across three environments. The first intervention was

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85

presented when the baseline data achieved an acceptable stability in

level and trend across all three conditions. Teach the use of the computer. The teacher or the investigator taught the participants the basic skills for using the MacintoshTM computer. These skills included moving the mouse to move the cursor on the display, clicking the mouse button to push the button on the display, and clicking the play button to start the movie. Apply intervention. Prior to entry into Environment I, the teachers, para-

as on a

table of anecdotal records. The vi-

morning snack, before lunch, and after

analysis method was employed to recess. Table 1 summarizes the anecdotal analyze the data for each participant. records taken during the observations. In the baseline condition in the mornAccording to the guidelines established by Tawney and Gast (1984), visual analy- ing snack setting, trend and level stabilisis is conducted on (a) the number of ties were established over five consecudata points plotted in each phase; (b) the tive observations. The trend direction number of variables changed between indicated a deterioration of Participant adjacent phases; (c) the stability and Is performance. Percentages of handchanges in level within and between washing completion ranged from 75% to phases and environments; and (d) trend 83%. Specifically, Participant I was prodirection, trend stability, and changes in vided prompts to complete the step of trend within and between phases and en- putting soap on his hands and physical
sual vironments.
water

professionals, or investigator introduced the participants to their tailor-made social story using the multimedia social story intervention. During the first condition, the social story named the location and Environment I (e.g., resource room) in which the appropriate behavior was to occur. The multimedia social story
program
was

Results

Reliability
Interobserver agreement was assessed approximately one third of all observations in which participants used the multimedia social story intervention. Reliability checks were conducted by the investigator, school paraprofessionals, and graduate special education students across the environments in which the studies were conducted. A coefficient of agreement was calculated for each setting chosen for the participants. These coefficients were averaged to yield a mean interobserver coefficient of agreement for each participant. The mean interobserver coefficient of agreement was calculated at 100% for Participants I and II during 33% and 37% of the total sessions, respectively. Reliability for Participant III was 89% for 33% of the sessions.
on

assistance to rub both hands under the during the baseline condition. In the morning snack setting during the intervention condition, trend and level stabilities were established over 17 consecutive observations. The direction of the trend line indicated improvement of Participant Is hand-washing performance. Between the first day (Day 6) and

operated once a day.

When stability in level and trend was established for Environment I, the identical multimedia social story program with a referent for Environment II was introduced prior to

(e.g., reading class). Following criterion

entry into Environment II

at-

tainment in the second condition, the intervention was applied to Environment III (e.g., general education classroom). Each multimedia social story program was operated by the

participants daily just prior to entry into the appropriate environment.

Ongoing Data. The paraprofessionals in each environment conducted daily assessments of the behavior targeted in each participants multimedia
social story programs. Methods of data collection were specified as previously discussed. Any external events, participants conditions, or other noteworthy changes of the participants or environments were anecdotally recorded.

Collect

Data

Analysis

the last day (Day 24) of introduction of the multimedia social story program, a 17% gain occurred. Participant Is performance appeared to be stable until Day 23 after the introduction of the multimedia social story program. From Day 6 to Day 23, task accuracy was between 75% and 83%; the same range that was observed during the baseline condition. On Day 9, data were not collected because Participant I had a tantrum. On Day 15, he ran back to his classroom without washing his hands after using the restroom. An improvement of performance was observed during the last 2 days of this condition. Participant I completed all steps of the hand-washing task without any prompts or physical assistance on Day 24, the last day of the observation. In the baseline condition of the before-

The data are presented in figures that represent the effects of the intervention using the multimedia social story programs for the three students who participated in the study. Each figure is structured using a multiple-baseline format that contains a set of three line graphs that represent the three settings assigned for each participant.

Data

Analysis
were one

lunch setting, trend and level stabilities established over 13 consecutive observations. Target behavior accuracy was between 75% and 83%, which was similar to that in the morning snack setting. Although an 8% deterioration in this condition occurred, the direction of trend line was level, which meant that there was no change in Participant Is perforwere mance.

Data

graphs,

three line reported for each participant, as well

on

Participant I. Figure 1 depicts Participant Is performance on the task of washing hands in three settings: before

Analysis of the intervention condition in the before-lunch setting revealed a

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86

day in this condition, Participant I independently completed all steps in the handwashing task analysis. In the before-lunch setting, an improvement in Participant Is perforobserved after the introduction of the multimedia social story program. The change in trend direction between conditions was negative to positive, although an initial effect of the intervention was not observed in this setting. A 73% overlap was evidenced between the baseline and intervention conditions. In the baseline condition in the afterrecess setting, trend and level stabilities were established over 17 consecutive observations. The direction of the trend line indicated a positive change. An 8% gain occurred during this condition.
mance was

Participant
tained
at

Is 87%

performance
over

was main6 consecutive days

(from Day

13

to

Day 18).

This level of

maintenance was not observed in the other two settings without introduction

FIGURE 1.

Participant

ls

performance on the hand-washing task.

was observed in this condition. during days I Specifically, Participant required prompts to dry both hands with a paper towel, although he completely rubbed both hands under the water on Day 22, and required prompts to rub both hands under the water on Day 23. On the last

of the multimedia social story programs. In the intervention condition in the after-recess setting, trend and level stabilities were established over six consecutive observations. The direction of trend line indicated a positive change. Level change was reported from 83% to 92%a 9% gain during this condition. High levels (92%) of task completion were observed during the final 4 days of observation. Specifically, on Days 21, 22, and 23, Participant I required only verbal prompts to rub both hands under the water. On the last day (Day 24), he independently completed rubbing both hands under the water, although he was prompted to turn on the water, which resulted in a 92% completion rate. Although not reflected in the data
in Figure 1, a gradual improvein Participant Is performance of rubbing both hands under the water was recorded in the anecdotal data. On Day 8, he put both hands under running water. On Day 8, he also stopped scream-

plotted
ment

positive change in Participant Is perforTrend and level stabilities were established over 11 consecutive observations. One day after the introduction of the multimedia social story program, the
mance.

percentage of completion
the last 3

participants performance improved

from 75% to 83% and was maintained over 6 consecutive days. An increase in

ing when physically assisted to complete this task by the paraprofessional. This change was observed across all settings from that day forward. Participant I

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87
TABLE 1 Anecdotal Records of

Participant

started rubbing his fingertips under the water on Day 14 in the after-recess setting. Pressing both hands under the water was observed on Day 19 in the morning snack setting. On Day 21, Participant I began rubbing both hands under the water, although he needed prompts to complete the task. In summary, Participant Is improvement in washing hands was observed after the introduction of the multimedia social story program. His performance reached 100% accuracy in completion on the last day of intervention in the beforemorning snack and before-lunch settings. Generalization and maintenance of task performance was observed during the baseline condition in the after-recess set-

ting.
Participant li. Figure 2 depicts Participant 11s performance on the handwashing task in three settings: before go-

to the resource room, before lunch, and after recess. Table 2 summarizes anecdotal records taken during the observations. In the baseline condition in the beforeresource room setting, trend and level stabilities were established over 4 consecutive days. Direction of the trend was negative, which indicated deterioration of Participant 11s performance. Range of data in this condition was 75% to 83% completion; level was unchanged. Participant 11s percentage of handwashing completion did not change during the intervention condition in the before-resource room setting. Over 12 consecutive days, his performance was maintained at a completion rate of 83%. Specifically, Participant II needed physical assistance to rub both hands under the water on all observation days throughout this condition. Although anecdotal records reported that Partici-

ing

pant II gradually improved his ability to rub both hands under the water from Day 12, he still required physical assistance. However, he at least pressed both hands under the water from that day forward. A between-condition analysis in the before-resource room setting revealed that there was little substantial improvement in the target behavior after the introduction of the multimedia social story program. Specifically, an 8% gain occurred between the baseline and intervention conditions. Data in the intervention condition overlapped 100% with data in the baseline condition. In the baseline condition in the beforelunch setting, trend and level stabilities were established over 8 consecutive days. An 83% completion rate was plotted. Participant II was provided physical assistance to rub both hands under the water on all days in this condition.

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88
data between the baseline and intervention condition. As observed in the before-lunch setting, Participant 11s level of performance was maintained in the baseline condition in the after-recess setting. Trend and level stabilities were established over 12 consecutive days. Throughout this condition, Participant II needed physical assistance on rubbing both hands under the water, which yielded an 83% completion rate. Anecdotal records indicated that Participant II demonstrated a gradual improvement in the task. Beginning with Day 10, he at least pressed both hands under the water when prompted by the paraprofessional. In the intervention condition in the after-recess setting, Participant Ils performance improved. Trend and level stabilities were established over 4 consecutive days. The range of his performance was between 83% and 92%. There was a 9% improvement in Participant IIs performance. Specifically, on the last 2 days (Days 15 and 16) in this condition, he completed the task of rubbing both hands under the water with prompts. Between-condition analysis for the after-recess setting revealed a positive change in Participant 11s performance. Although an initial effect of introducing the multimedia social story program was not observed, Participant IIs performance improved from 83% to 95% completion during the intervention condition. There was a 50% overlap in the percentage of task completion between the conditions. Participant II did not require any technical assistance to operate the multimedia social story programs. At the initial presentation of the program, he immediately learned to navigate through the pages of the program when the investigator pointed to the navigational button on the computer display. Participant II did not show any negative behaviors such as avoidance or tantrumming while operating the program. He complied with his paraprofessionals direction when the time came to go to the computer and operate the program. Furthermore, anecdotal records reported that Participant IIs attention was focused on the com-

FIGURE 2.

Participant

IIs

performance

on

the

hand-washing task.

Participant IIs performance during the intervention condition in the beforelunch setting was maintained at 92% completion, except on Day 13. Trend and level stabilities were established over 8 consecutive days. From the first day of introduction to the multimedia social story program, Participant II needed only prompts to complete the task of rubbing both hands under the water. He

physically assisted to complete this task only on Day 13. A between-conditions analysis on the before-lunch setting indicated a positive improvement in Participant IIs handwashing task completion. Although data trends in both conditions indicated maintenance of Participant Ils performance, a 9% gain between the conditions resulted. There was a 13% overlap in the
was

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89
TABLE 2 Anecdotal Records of

Participant

11

puter
gram.

display

while

operating
II

the pro-

In summary,

Participant

improved

his hand-washing skill after the introduction of the multimedia social stories. Specifically, gains were observed in the before-lunch and after-recess settings; however, he did not reach 100% accuracy during the intervention. Participant 11s performance improved to a 93% completion rate, which means that he needed prompts to complete the task.

Participant Ill. Figure 3 depicts Participant IIIs average duration of ontask behavior in three settings: lunch, resource room, and general education
classroom. Table 3 summarizes anecdotal records taken during the observations. In the baseline condition of the lunch setting, trend and level stabilities were established over 3 consecutive days. Direction of the trend was negative, which indicated a decrease in the average duration of Participant IIIs on-task behavior. On-task behavior in this condition ranged from 26 to 38 seconds. A de-

in on-task behavior of approximately 12 seconds occurred during the baseline condition. Substantial effects were not observed when the multimedia social story program was introduced in the intervention condition of the lunch setting. The overall trend direction of all data in this condition was negative, although on-task behavior increased initially. Trend and level stabilities were not established. Despite data variability, an increase in the average duration of on-task behavior was observed during the first 4 days (between Day 4 and Day 7) after the introduction of the multimedia social story program. Specifically, a 66-second gain was observed during the 4 days. Participant IIIs performance decreased from Day 9 to the last day of the intervention and did not show improvement. Observations were not conducted on Days 12, 13, and 15 because of an outside lunch with peers, lunch with families, and a field trip, respectively. A between-condition analysis in the lunch setting did not show improvement in Participant IIIs performance after the
crease

introduction of the multimedia social stories. Although he had a 15-second gain in on-task behavior between conditions, variable data existed in the intervention condition. There was a 44% overlap in the data between the conditions. According to anecdotal records, Participant IIIs on-task behavior during lunch was interrupted by his selfstimulatory behavior (i.e., touching or pulling his hair, tapping table with his hand, erratic eye movement, or unfocused eye gaze). Thus, his duration of on-task behavior increased when less selfstimulatory behavior was observed. In the baseline condition of the resource room setting, trend and level stabilities indicated variable movement of data. Data paths within the trend showed an initial increase followed by a decrease. On-task behavior levels ranged from 33 seconds to 1 minute 34 seconds. A 19second decrease occurred between the first and last days in this condition. Anecdotal records reported that Participant III refused to work with the teacher at the beginning of the class on Days 6 and 7.

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90

(from Day 13 to Day 15) after the intervention resumed. Level range at the first stage of improvement was 1 minute 31 seconds to 3 minutes 33 seconds, which yielded a gain of 2 minutes 2 seconds. Level range at the second stage of improvement was 24 seconds to 3 minutes 24 seconds, which yielded a gain of 3 minutes. Between-condition analysis of the resource room setting indicated a positive change in Participant IIIs on-task behavior after the introduction of the multimedia social story program. Although trend stabilities in both conditions were variable, trend directions changed from negative to positive across the conditions. An analysis of the initial effect of the intervention indicated a 58-second gain.
A 20% overlap in the data existed bethe conditions. Anecdotal records indicated that during observations in this setting, self stimulatory behaviors similar to those observed in the lunch setting were reported in the resource room. Thus, a negative relationship between occurrences of Participant IIIs selfstimulatory behavior and duration of his
tween

FIGURE 3.

Participant IIIs

average duration of on-task behavior.

.

,....

Five days of observation were conducted in the intervention condition in the resource room setting. On Days 10, 11, and 12, Participant III was assigned to complete independent computer tasks for the entire resource room period, because a resource teacher was unavailable to provide instruction. Participant IIIs teachers reported that his computer be-

havior was obsessive and was uncharacteristic of his on-task behavior in other settings. Therefore, data collection during this activity was considered inappropriate. However, improvements in Participant IIIs performance were observed during the 2 days (Days 8 and 9) of initial introduction of the multimedia social story program and during the 3 days

on-task behavior was observed. Due to the lack of opportunities to observe Participant IIIs performance in the general education classroom setting, the multimedia social story intervention was not introduced. His participation in the general education classroom was determined by the activities that occurred in this room. That is, if the general education teacher determined that class activities were not appropriate for Participant III, he would complete more appropriate activities in the resource room setting. Trend and level stability was not established in this condition. On-task behavior ranged from 6 seconds to 1 minute 22 seconds. There was an increase in the target behavior from Day 9 to Day 11from 8 seconds to 1 minute 22 seconds, which yielded a gain of 1 minute 14 seconds. It was difficult to determine whether this improvement was the result of generalization from interventions in other settings. In summary, no stable improvement in Participant IIIs average duration of on-

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91
TABLE 3 Anecdotal Records of Participant

III

task behavior was observed in the current

vention
on

study. However, improvements that might be effects of the intervention

some

observed in the lunch and the resettings. Intervention in the education classroom setting general could not be conducted because of program changes made by the general education teacher.
were
source room

An analysis of the data indicated that the intervention

Summary of Results.

settings. Furthermore, the data Participant I indicated generalization of the newly acquired skill in one setting. Participant II demonstrated improvements in newly acquired skills in two settings. Although Participant II did not achieve 100% completion in hand washing, his performance was maintained at 92% in one setting. Data on Participant III indicated partial improvements in his on-task behaviors in two settings. Discussion

the study also investigated the abilities of those students to generalize behavior changes to other environments in which the intervention was not conducted. In order to detect such generalization skills, three environments were chosen for each participant prior to intervention implementation.

Impact of the Intervention

rates of success consistent effect of the multimedia social story intervention was found. By comparison, to date, most interventions developed for children and youth with autism have not been universally effective. Because this study was the first attempt of its kind in the field of special education, no previous research could be directly compared with the results of this study. Possible explaacross

As illustrated

using the multimedia social story program increased the skill levels of some of the participants in certain settings. Moreover, some students showed generalization of newly acquired information to other settings. Participant I demonstrated improvements in hand washing across all three settings. He achieved 100% of completion in this task at the end of two inter-

by participants,

the

no

This study interventions

investigated the effects of using multimedia social

story programs for children with autism. Specifically, the study focused on the effects of the intervention for improving social or behavioral problems identified in three boys with autism. Furthermore,

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92

nations for the variability of results include (a) duration of the intervention, (b) individual differences among the participants, (c) nature of the target behaviors, (d) consistency in educational environments, and (e) enthusiasm for watching the multimedia social story
program.

the multimedia social story program is established in the daily schedule of the students with autism, additional human resources are not needed to implement the intervention. Thus, the intervention has promising applicability in various educational settings. Several applications of the multimedia social story interventions to everyday ed-

watching

Generalization of the Intervention

One of the purposes of this study was investigate the participants ability to generalize their behavior changes across environments that were not targeted by the multimedia social story programs. To assess generalization skills, the study adopted a multiple baseline design across settings in which the same theme with different multimedia social story programs was sequentially presented. The results indicated that only one student, Participant I, demonstrated obvious generalization of skills across settings. Specifically, his performance increased and maintained in the baseline condition in the after-recess setting after he had been introduced to the multimedia social story programs in two other settings. Other participants did not transfer their behavioral improvements to the settings in which the intervention had not been conducted. This is consistent with the literature on autism. Students with autism often do not generalize skills (Arora & Goodenough-Trepagnier, 1989; Battenberg & Merbler, 1989; Chen & BernardOpitz, 1993; Kennedy & Haring, 1993; Kuttler et al., 1998; Swaggart et al.,
to

themselves. combine the social story intervention with an existing or newly developed behavior modification system (i.e., token economy, response cost) for students with autism (e.g., Kuttler et al., 1998; Swaggart et al., 1995). If a positive effect of a behavior modification system is expected for students with autism, conveying information about the system in the format of a social story might help students comprehension. Second, in order to maintain the consistency of the intervention, it may be possible to have the students with autism watch the multimedia social story programs in their homes, if an appropriate computer system is available. This application would be especially effective if the students target behaviors are social skills or behavioral problems that constantly occur in all environments. Third, if the students with autism are

ucational

settings present
to

First, it is possible

parents were major reasons for the relatively short intervention period. The second factor relates to a lack of consistency in educational environments in which the interventions were conducted. For example, mutual agreement and support for the intervention were not available from all educational personnel of the students. Further, variable changes made in some of the participants class schedules restricted implementation of the intervention and observation.

Conclusion
This study investigated the effects of a multimedia social story intervention newly developed for this study. The intervention incorporated the characteristics of three interventions used effectively with persons with autism: visual symbols, social stories, and computer-based instruction. The intervention appeared to have possible effects and applicability for children and youth with autism in the current educational system. Most current educational settings have incorporated a considerable amount of computer technology ; however, few attempts have been made to incorporate such technology into teaching social or behavioral skills to children and youth with autism. This study revealed that it is possible to use advanced technology with this population. This study was the first attempt to implement a multimedia social story intervention. We hope that this study will call to the attention of educational practitioners the possibilities of developing interventions using advanced technology to teach children and youth with autism.

developmentally capable of comprehending the process of developing multimedia social story programs, it would be helpful to have them participate in creating
multimedia social story programs. Although the development of the program requires considerable technical computer knowledge, the students might be able to create their social stories with teachers, create their own graphic interface of the program, or record their own voices to read aloud their social stories into the programs.
own

their

1995).

&dquo;- -

Implications for Educational

Practitioners
Because of the rapid increase in the use of computers in educational environments, there are ample opportunities for applications of the intervention conducted in this study (Hayes & Bybee, 1995). The multimedia social story intervention does not require special modifications of software and hardware, nor

ABOUT THE AUTHORS

Limitations of the

Study

in-depth techniques
ers.

to

Moreover,

once

operate computroutinization of

Two factors limit generalization of the results of this study. The first relates to the duration of the interventions. Restrictions caused by school schedules, availability of human resources to collect data, and time to obtain authorization to conduct the research from schools and

Taku Hagiwara, PhD, is project coordinator for several training and research grants related to students with autism and Asperger syndrome at the University of Kansas. Dr. Hagiwara also coordinates the Autism Assessment Team at the University of Kansas Medical Center. Brenda Smith Myles, PhD, is an associate professor of special education at the University of Kansas, where she is co-principal investigator of several

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93

federal and state grants related to individuals with autism and Asperger syndrome. She serves
as editor of Intervention in School and Clinic. Address: Taku Hagiwara, Dept. of Special Education, University of Kansas, 3901 Rainbow Blvd., Kansas City, KS 66160-7335.

Dyer, K., Williams, L., & Luce, S. C. (1991). Training teachers to use naturalistic communication strategies in classrooms for
students with autism and other
severe

Kuttler, S., Myles, B. S., &

Carlson, J.

K.

NOTE

Technical information on the computer system is available from the first author.

handicaps. Language, Speech, and Hearing Services in Schools, 22 (1), 313-321. Frith, U. (1989). Autism: Explaining the enigma. London: Basil Blackwell. Gray, C. (1994). Making sense out of the world: Social stories, comic strip conversations, and related instructional techniques. Paper presented at the Midwest Educational Leadership Conference on Autism, Kansas City, MO. Gray, C. A. (1995). Teaching children with autism to "read" social situations. In K. Quill (Ed.), Teaching children with autism: Strategies to enhance communication and socialization (pp. 219-242). New York: Delmar. Gray, C. A., & Garand, J. D. (1993). Social stories: Improving responses of students with autism with accurate social information. Focus on Autistic Behavior, 8 (1),1-10. Hagiwara, R. (1998). Multimedia social story intervention for students with autism. Unpublished doctoral dissertation, University of Kansas, Lawrence. Hays, J., & Bybee, D. L. (1995). Defining the greatest need for educational technology. Learning and Leading with Technology, 23(2), 48-50. Kennedy, C. H., & Haring, T. G. (1993). Teaching choice making during social interactions to students with profound multiple disabilities. Journal of Applied Behavior (10), 63-76. Analysis, 2 D. A., Arick, J. R., & Almond, P. J. Krug, (1988). Autism behavior checklist. Austin, TX: PRO-ED.

REFERENCES

Alberto,

P. A., & Troutman, A. C. (1995). Applied behavior analysis for teachers (4th ed.). Englewood Cliffs, NJ: Prentice Hall. Apple Computer. (1994). HyperCard [Computer software]. Cupertino, CA: Author. Arora, A., & Goodenough-Trepagnier, C. (1989). Feasibility of VIC for students with language impairments associate with autism. Paper presented at the RESNA 12th Annual Conference, New Orleans, LA. Battenberg, J. K., & Merbler, J. B. (1989). Touch screen versus keyboard: A comparison of task performance of young children. Journal of Special Education Technology,

of social stories to reduce precursors to tantrum behavior in a student with autism. Focus on Autism and Other Developmental Disabilities, 13, 176-182. MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89-97. Mesibov, G. B. (1997). Formal and informal measures of the effectiveness of the TEACCH programme. The International (1), Journal of Research and Practice, 1 25-35. Mesibov, G. B., Schopler, E., & Hearsey, K. A. (1994). Structured teaching. In E. Schopler & G. B. Mesibov (Eds.), Behavioral issues in autism (pp. 193-205). New York: Plenum. Reynolds, C. R., & Kamphaus, R. W. (1992). Behavior assessment system for children. Circle Pines, MN: American Guidance Service.

(1998).

The

use

Schopler, E., Reichler,

Lansing,

(2), 24-28. 10 Chen, S. H. A., & Bernard-Opitz, B. (1993).

of personal and computerassisted instruction for children with autism. Mental Retardation, 31, 368-376. Dawson, G., & Osterling, J. (1997). Early intervention in autism. In M. J. Guralnick (Ed.), The effectiveness of early intervention (pp. 307-326). Baltimore: Brookes. Durand, V. M., & Crimmins, D. (1992). Motivation assessment scale. Topeka, KS: Monaco & Associates.

Comparison

R. J., Bashford, A., M. D., & Marcus, L. M. (1990). Individualized assessment and treatment for autistic and developmentally disabled children, Vol. 1: Psychoeducational ProfileRevised (PEP-R). Austin, TX: PRO-ED.

Swaggart, B. L., Gagnon, E., Bock, S. J., Earles, T. L., Quinn, C., Myles, B. S., & Simpson, R. L. (1995). Using social stories
teach social and behavioral skills to children with autism. Focus on Autistic Behavior, 10 (1), 1-15.
to

Tawney, J. W., & Gast, D. L. (1984). Single subject research in special education. New
York: Merrill.

APPENDIX A

Steps for Creating

Multimedia Social

Story Program Using HyperCard TM

~

HyperCardTM
a user to

is

create

software development tool that enables software called a stack, which runs under

the MacintoshTM operating system. Basic steps required to develop software on HyperCardTm are object-oriented; most frameworks are preconfigured so that the user can manipulate and modify objects used for the software, such as page frames, navigational buttons, or visual effects, using a graphical user interface without writing a specific programming language. However, HyperCardTm does have its own computer language called HyperTalkTM to allow the user more complex programming. The HyperTalkTM language was used for creating original command scripts and adjusting each program individually in some portion of the multimedia social story programs as follows:

the frames of a program. This included all HyperTalkTM scripts. Once created, the frame of the program may be duplicated to make another program with minor modification of the script. Typing the sentences of the social story on each page. The same sentences were written in the scripts that commanded the computer to read aloud texts for each page. Videotaping the participants activities that related to their target behavior and settings. Editing the video on the computer. Using Avid TM VideoShop software, segments of the video of the participants were recorded as QuickTime TM movie files on a hard disk

Creating

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94
.......~

.x

or removable drive at the size of 256 x 192 pixels. A movie for each page of the program was made by carefully arranging short lengths of video frames so that the contents of each video were matched with the social stories written on each page. The edited movie files were saved without using any compression schemes or audio track. Compressing video files. Each movie file was compressed using the Movie Cleaner LiteTM software for smooth playback and size reduction. The compression scheme called Cinepak was chosen because of the quality of its compressed video images and smooth playback operation on a wide range of computers. At the compression, each movie file had the finest picture quality at its very last frame to ensure maximum visibility to the participants at the end of each movie and to enable the computer on

which the multimedia social story program was operated to obtain the exact end time of the movie. The final products of the edited movies were saved with unique names such as &dquo;pg1-classroom.mov.&dquo; Combining the frame of the multimedia social story program and the movie files. The name and duration of each movie file was written in the appropriate place of the HyperTalkTM scripts. This procedure enabled the program to call up a specified movie file and play it in each page on
&dquo;

operation. Saving the multimedia social story program

tion file.

as an

applica-

allowed the user to save the created product as a stand-alone application. The program saved as an application file did not require the HyperCard TM program, so that the user could operate it on any MacintoshT^&dquo; computers so long as the program requirements were met.

HyperCardTM

APPENDIX B

Participant

ls Multimedia Social

Story

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95

(Appendix B, continued)

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