Beruflich Dokumente
Kultur Dokumente
brill.com/soan
Andreea A. Grigore
Research Department of Autism Transilvania Association, Gheorghe
Marinescu, Romania
Alina S. Rusu
Department of Special Education, Faculty of Psychology and Sciences of
Education, Babes-Bolyai University, Cluj-Napoca, Romania
alina.rusu@ubbcluj.ro
Abstract
This study explored the effects of a combination between two methods that have
proved to enhance the social abilities of autistic childrenSocial Story and Animal
Assisted Therapy. The main hypothesis of this investigation was that a naturally
enriched social environment (i.e., the presence of a therapy dog) improves the effective-
ness of Social Story method. Two social skills were targeted: (1) the ability to greet a
social partner and (2) the ability to introduce oneself to a social partner, by using a
standard single-subject research design. Three preschool autistic children were included
in the study. The dependent variables were the frequency of the appropriate social
interactions relevant to the target social skill, the level of prompt needed to provide the
expected social response, and the frequency of social initiations. The presence of the
therapy dog while reading the social story increased the frequency of social initiations
and decreased the level of social prompt needed to elicit social responses from children
with autism.
Keywords
1. The use of both words and images in coding social information addresses
the visual learning strengths of children with ASD (Travis & Sigman,
1998). By combining visual cues with verbal cues, they help children with
ASD to better understand desirable social behaviors, before they face the
real interpersonal interaction (Crozier & Tincani, 2005).
2. A design is provided at the level of verbal and cognitive comprehension
of each child (Ivey, Helfin, & Alberto, 2004).
3. They address specific strengths and deficits in ASD, such as the imperious
need for predictability, difficulty in acquiring long response chains, and
preference for visual instructions (Kokina & Kern, 2010).
The first step in designing a social story is to identify the target of the inter-
vention (Gray, 2004). This target can be a specific social skill or a more
complex behavior expected in a specific social situation. A child can use
the story as a learning environment and as a tool for understanding and
internalizing appropriate social behavioral elements (Sansosti, Powell-
Smith, & Kincaid, 2004).
To date, there are numerous studies that validate the Social Story method as
an effective behavioral intervention for improving the social abilities of autis-
tic children. Over the last decade, several authors have evaluated the effective-
ness of the Social Story method in decreasing the frequency and the intensity
of several problematic behaviors, such as aggression, screaming, grabbing
toys, and crying (Kuoch & Mirenda, 2003; Crozier & Tincani, 2005). Also, the
effectiveness of this method has been evaluated in increasing the frequency
and intensity of desirable behaviors, such as greeting and sharing things
(Swaggart et al., 1995), choice and playful behavior (Barry & Burlew, 2004), and
other types of social interactions (Scattone, Tingstrom, & Wilczynski, 2006).
In many of these studies, the Social Story method has been used either as a
sole intervention (Scattone, Tingstrom, & Wilczynski, 2006), or combined
with other interventions, such as verbal and pictorial prompts, the reinforce-
ment of appropriate responses, behavior charts, and various priming strategies
(Crozier & Tincani, 2005).
Other interventions that seem to be efficient in improving the social abili-
ties of autistic children are the Animal Assisted Activities (AAA) and Animal
Assisted Therapy (AAT). According to Delta Society (www.deltasociety.
org), AAA include visits by companion animals (i.e., casual meet and greet
events), while AATs are more elaborated, goal-directed interventions, which
are delivered by a health/human service professional with specialized exper-
tise within the scope of practice of his/her profession. Both AAT and AAA can
Participants
Three preschool children (two boys and a girl, aged 78 years) were included
in the study. The children were enrolled at the Daily Center of the Autism
Transilvania Association (Autism Transilvania Association, 2011). Written per-
mission was given by the parents of the children to disclose their personal
details. They were selected based on the following criteria: (a) previous diagno-
sis of autism, which was performed by a clinical psychologist using the Autism
Diagnostic Observation ScheduleGeneric ADOS-G (Lord et al., 2000) and
the Autism Diagnostic InterviewADI-R (Lord, Routter, & Le Couteur, 1994);
(b) lack of initiation or appropriate social response in a given social situation
during therapy or free time activities; (c) some reading prerequisites, such as
the ability to open and browse through a book and previous experience with
stories; (e) the therapists agreement to introduce Social Story and Animal
Assisted Therapy intervention in the individualized treatment plan; and
(f) results of the pre-intervention screening regarding their ability and willing-
ness to interact with therapy dogs.
The Animal Assisted Therapy screening forms were provided by the
Romanian Association of Animal Assisted Activities and Therapy. Informed
consent forms to participate to this study were signed by the parents of each
participant. The study was approved by the Institutional Review Board of
Babes-Bolyai University, Cluj-Napoca, Romania.
Social Stories
The childs therapist, together with the other three experimenters involved
in the study, designed an individualized social story for each participant. The
stories were developed using Grays (2000) construction guidelines. A specific
social skill deficit was identified for each child, as follows: Catalin and Nicus
stories were specifically designed to teach them how to initiate and respond
to greetings (i.e., target social skill was saying hello to a new social partner; see
Appendix 1), while Georgias story was designed to teach her how to introduce
herself to a person she recently met (i.e., target social skill was saying My name
is Georgia to a new social partner).
1. A value of 5 was given if the participant did not respond to any prompt
(gestural, physical, or verbal) and engaged in self-stimulated behaviors;
Experimenters
Three graduate students were trained by the first author in data collection pro-
cedure. The training consisted of clear definitions of the dependent variables,
examples and non-examples for each category of behavior, and observations
of appropriate behavior of typically developing peers. Training continued until
the inter-observer agreement reached 80% on two successive observations.
The three observers collected baseline and intervention data on social interac-
tions during 15-min unstructured interactions per participant over a period of
10 weeks, as follows: 2 days per week for Catalin, 3 days per week for Nicu, 3 and
three days per week for Georgia.
For each participant, inter-observer agreement was measured by assessing
the level of agreement and disagreement for at least 33% of the observation
sessions during both baseline and intervention periods (Scattone, Tingstrom,
& Wilczynski, 2006). All the unstructured social interactions took place in a
playing-room, where each child was left to freely play and interact with one of
the volunteers of the Center.
Research Design
The study included three single-case experiments. An ABAC design was used for
Nicu and Georgia, and an ACAB counterbalanced design was used for Catalin.
Each phase consisted of six sessions. In the baseline phase (A), each child was
observed for 15 min during social interactions (i.e., observation period) that
required the use of specific social skills, which were aimed to be improved by
the Social Story intervention (B) or by the Social Story plus Animal Assisted
Therapy intervention (C). Because the therapy dog could not be introduced
into the therapy room without the handler of the dog, the handler was asked
to participate in all the sessions of the experiment (i.e., the handler was placed
near the video-camera and the child was given the explanation that the han-
dler was in charge of the video-recording). For each participant, the social story
was introduced prior the observation period. After six sessions, the interven-
tion was withdrawn to the baseline condition. After permission was granted,
all the sessions were video-taped for further analysis. The video analysis was
manually done by previously trained experimenters, based on a list of behav-
ioral elements defining each appropriate social interaction involving the target
social skill. For each session, the three experimenters rated the level of prompt
needed by each child to perform the appropriate social interaction.
Inter-observer agreement was measured by assessing the level of agree-
ment and disagreement for at least 33% of the observation sessions during
both baseline and intervention. Agreements were scored when all the experi-
menters agreed that an appropriate social interaction involving the target skill
occurred or that it did not occur. Disagreements were scored when experi-
menters did not agree on the occurrence of an appropriate social interaction
during an observation session. Inter-observer agreement was calculated by
dividing the number of agreements by the total number of agreements plus
disagreements and multiplying by 100%.
Phase A (Baseline). Observers collected baseline data during six 15-min observa-
tion sessions for each participant. If the participant engaged in social interaction,
the therapist provided the level of prompt needed for a successful completion of
the social activity. No other activities were included during this phase.
Phase B (Social Story). The therapist introduced the story to the child by
saying, I have a new story for you. Let us read it! It is a story about how to greet
someone/Learning to introduce yourself. I will read the story, and then I will ask
you some questions. When they needed to, the therapists attracted participants
attention with brief comments on the accompanying pictures (e.g., Look, Nicu
is waving!). The Social Story reading was followed by a list of comprehensive
Data Analysis
Data were analyzed using SPSS version 16. Descriptive statistics was used for
the analysis of the data collected per each participant, for each dependent
measure (i.e., the frequency of the appropriate social interactions, the level
of prompt needed to perform the target social skill, and the frequency of the
social initiations). Before the implementation of each intervention, checks
were performed for the behavioral trends, by using the turning point test
(Morley & Adams, 1989). During the baseline and the intervention phases, data
were repeatedly collected (i.e., six sessions per phase) and were graphed on the
target behavior.
The Mann-Whitney U test was used to analyze the differences between
the baseline and the interventions, and between the two types of interven-
tions. The choice of the non-parametric Mann-Whitney U test was motivated
by its assumptions-free characteristics, and by the type of the design of this
exploratory investigation; that is, a single-study experiment, in which, for
each case, the data collected during the baseline and during the intervention
phases are considered independent measurements (Todman & Dugart, 2009).
The Gpower test was used for the calculation of the size effect of each type of
intervention (Cohens d); that is, the Social Story and Social Story plus Animal
Assisted Therapy intervention.
Results
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Figure 1 Frequency of the appropriate social interactions (mean values) for Catalin, Nicu, and
Georgia during the four phases of the experiment. Each intervention phase included
six sessions, where SS means Social Story intervention, and SS + AAT means Social
Story plus Animal Assisted Therapy intervention. The target social skill for Catalin and
Nicu was the ability to greet a new social partner, whereas the target social skill for
Georgia was the ability to introduce herself to a new social partner.
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Figure 2 Level of prompt needed to provide the expected social response (mean values) for
Catalin, Nicu, and Georgia during the four phases of the experiment. The level of
prompt was measured using a 5-point scale, where a value of 5 was given if the
participant did not respond to any prompt (gestural, physical, or verbal) during the
15-min session and a value of 0 was given if the participant independently and
spontaneously engaged in appropriate social interactions without any type of prompt.
level of prompt decreased to 0.66 (SD = 0.51), but with no statistical signifi-
cance (phase C, Figure 2).
For the third participant (Georgia), the initial baseline data indicated that
she needed full prompts most of the time to appropriately interact with a
social partner (see Figure 2). The introduction of the Social Story was associ-
ated with a decrease of the level of prompt from a mean value of 4.50 (SD =
0.54) to a mean value of 1.33 (SD = 0.81). The withdrawal of the Social Story
intervention indicated no treatment reversal (Figure 2). Compared to baseline,
the level of prompt had a statistically significant decrease during the introduc-
tion of the Social Story plus Animal Assisted Therapy intervention (U = 4.5,
p < 0.05; Figure 2).
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Figure 3 Frequency of the initiations of social interactions (mean values) for Catalin, Nicu,
and Georgia during the four phases of the experiment. Each intervention period
included six sessions, where SS means Social Story intervention and SS + AAT means
Social Story plus Animal Assisted Therapy intervention.
indicates a high effect size for all three participants; that is, Cohens d = 0.83 for
Catalin, d = 0.92 for Nicu, and d = 0.79 for Georgia, p < 0.05.
Discussion
Several studies on the therapy methods aiming at decreasing the social deficits
of autistic children have recently emphasized the necessity of performing this
type of investigation in close-to-real-life situations with naturally occurring
stimuli (Prothmann, Ettrich, & Prothmann, 2010; Klin, Jones, Schultz, Volkmar,
& Cohen, 2002; Klin, Schultz, & Volkmar, 2003). Companion animals, such as
dogs, not only provide this type of multi-sensorial, natural stimulation, but
also some data suggest that autistic children can interact better with animals
than humans (Leslie, 1994; Prothmann, Ettrich, & Prothmann, 2010).
In this light, an exploratory investigation was performed, which combined
two methods that have proved to increase the level of social abilities of autistic
children: Social Story intervention (Gray, 2000) and Animal Assisted Therapy.
The main hypothesis was that a naturally enriched social environment (the
presence of a therapy dog) would improve the effectiveness of Social Story
method in enhancing the social abilities of three preschool autistic children.
Two social skills were targeted (i.e., the ability to greet a social partner and the
ability to introduce oneself to a social partner), while a standard single-subject
research design was followed. The results are discussed below, for each depen-
dent measure.
The data show that Social Story plus Animal Assisted Therapy is associated
with a statistically significant increase in the frequency of the appropriate
social interactions for one of the three participants to the study: Catalin. As
Figure 3 shows, this hybrid intervention is associated with an increase of the
appropriate intervention for the other two participants, but without statistical
significance. Even though all the participants enjoyed the presence of the dog,
Catalin consistently showed the highest level of enthusiasm every time Arwan
(the therapy dog) visited the Autistic Center. His enthusiasm toward the dog,
which was translated into prosocial behaviors, such as hugs and touching the
dog, might have contributed to the significant effect of the Social Story plus
Animal Assisted Therapy intervention.
Additionally, these effects might be explained by the fact that Catalin had
a mild to moderate score on the autism scale, compared to the other two
participants who had moderate scores. In the case of Georgia, the graphical
analysis indicates that, even though with no statistical significance, compared
to baseline, both methods (Social Story and Social Story plus Animal Assisted
the mechanism of change for the effects of dog presence on the social abilities
of autistic children, further studies should include the phase Animal Condition.
Conclusion
The method of Social Story (Gray, 2000) is widely used by specialists working
with autistic children in Romania in clinical settings and in centers founded by
parents of autistic children, such as the Autistic Center that hosted our inves-
tigation. Also, recent surveys indicate that dogs are the most common pets in
this country (Cocia & Rusu, 2010), and they are affordable companion animals to
Romanian families. The interest in Animal Assisted Therapy has increased over
the last five years at national level, as proven by the educational and scientific
activity of the Romanian Association of Animal Assisted Activity and Therapy.
In this light, the inclusion of a well-trained dog or an AAT team (the handler
and the therapy dog) in the therapy environment of autistic children would
be a low-cost and efficient way of improving the results of the Social Story
methods used to improve the social skills of ASD individuals. This comes in
line with the suggestion of Prothmann, Ettrich, and Prothmann (2010) to use
an enhanced methodological spectrum for the experimental studies of chil-
dren with autism. Although the mechanisms underlying these positive effects
of animals on the social communication abilities of the autistic children are
not yet clear, the clinical implications of bringing therapy dogs to interact with
children with ASD to improve specific deficits deserve future investigation.
Acknowledgements
The participation of Alina Simona Rusu in this research was supported by CNCS-
UEFISCDI, project number PN-II-RU-TE-20113-0080. The authors would like to
thank the Autism Transilvania Association (Cluj-Napoca, Romania) for facilitat-
ing the participation of the three autistic children in this investigation.
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Appendix 1. An example of a Social Story designed for Nicu (i.e., target social skill How
to say hello), based on the Grays (2000) guidelines.
People greet each other when they meet people they already know.
Whenever I meet a person I already know, that person might smile to me and say:
Hello, Nicu.
I should smile, too, and reply to him/her: Hello. He/she might stop and talk to me.
When my mum will show up at the Center, I should go to her and say to her: Hello,
mum. Then I should give her a hug. My mum should feel happy when I greet her by
saying hello and hugging her.
It is nice to greet a person I know. People like when I smile to them and when I greet
them.
Comprehensive Questions:
1.What are you supposed to do when you meet a person you already know?
2.How do people feel when you say hello to them?
3.What are you supposed to say to your mum when she shows up at the Center to
pick you up?