© Springer Science+Business Media New York 2014
Jonathan Tarbox, Dennis R. Dixon, Peter Sturmey and Johnny L. Matson (eds.)Handbook of Early Intervention for Autism Spectrum DisordersAutism and Child Psychopathology Series10.1007/978-1-4939-0401-3_1515. Use of Visual Supports with Young Children with Autism Spectrum Disorders
(1)
Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, USA
(2)
University of California, San Diego, San Diego, USA
(3)
University of Wisconsin-Whitewater, Whitewater, USA
Keywords
Visual supportsVisual schedulesVisual cuesVisual supports are a commonly used intervention strategy for individuals on the autism spectrum. Broadly defined as “tools presented visually that support an individual as he or she moves through the…day” (Hume (2008)). visual supports take on a number of forms and functions. These include, but are not limited to, photographs, icons, written words, objects, furniture arrangement, schedules, maps, labels, organizational systems, timelines, and scripts (Hume (2008)). and have proven effective in both increasing prosocial behavior (i.e., task engagement, independent performance) and decreasing maladaptive behavior (i.e., self-injurious behavior) across age ranges and settings. Visual supports are recognized as an evidence-based practice by the National Professional Development Center (NPDC) (Odom et al. (2010). Evidence-based practices) and schedules, one example of a visual support, are deemed an established treatment by the National Autism Center’s National Standards Project (National Autism Center’s National Standards Project (NSP) (2009). However, the application of visual supports, the efficacy of their application, as well as the appropriateness of their use with very young children with autism spectrum disorder (ASD) remains less understood and less studied than their application to the school-age population. The purpose of this chapter is to describe the rationale for the use of visual supports in the broader early intervention field, the application to early intervention settings with young children with ASD, as well as the researchbase supporting their use. Specific supports identified in the literature will be highlighted, including environmental supports, visual schedules, visual cues, scripts, and video-based instruction, along with recommendations for future use and study. Please note that the use of picture activity schedules is covered extensively in its own chapter in this volume.
Definition of Visual Supports
A number of terms are used in the literature to describe and define visual supports, including visually cued instruction (Quill 1995), visual teaching aids (Rao and Gaige 2006), visual representations (Meada et al. 2011), and visual approaches (Devlin 2009). Each refers to the use of a concrete cue, such as an object, drawing, or written word, paired with or instead of a verbal cue to provide information about a routine or expectation and/or to support skill demonstration. Though in use in the autism field for almost 3 decades, visual supports gained popularity, as well as the increased attention and interest of researchers and practitioners, following the publication of Temple Grandin’s book Thinking in Pictures and Other Reports From My Life in 1995. Grandin, a well-known professor and public speaker with autism, provided a glimpse into information processing for individuals with ASD and revealed the importance of visual images to her ability to understand abstract concepts (Grandin 1995). This work, in combination with a wave of brain research that indicates some individuals with ASD have relative strengths in visual detail processing and visual search skills in comparison to typically developing individuals (Kaldy et al. 2011), has encouraged the use of visual supports, now one of the most frequently used intervention strategies in both research and practice (National Standards Project 2009; Stahmer et al. 2005).
Visual supports can employ simple techniques, such as presenting a photograph representing the next activity to a child with ASD (Schmidt et al. 2000), as well as more complex techniques, such as presenting a video clip of an upcoming event for individuals to view before it occurs (Schreibman et al. 2000). Beyond providing information about upcoming activities, routines, or behavioral expectations, visual cues can serve as a scaffold or support in the demonstration of communication skills (i.e., using text and pictures to increase verbal greetings, Reichow and Sabornie 2009), social skills (i.e., using a picture to initiate social interactions, Johnston et al. 2003), adaptive behavior (i.e., using a Social Story with pictures to increase appropriate responding during circle time, Schneider and Goldstein 2010), and academic skills (i.e., using picture dictionaries and product samples to increase task completion, Mavropoulou et al. 2011).
Application of Visual Supports to Young Children
Visual support for early learning has been effective for teaching young children with a range of special needs, particularly children with speech/language impairments, social-communication difficulties, and/or poor understanding (Bochner and Jones 2003). Through the use of visual supports, early intervention professionals can enhance their teaching of specific skills across all developmental domains, manage behavior, and promote independence (Wellington and Stackhouse 2011).
Indeed, the Division for Early Childhood (DEC) of the Council for Exceptional Children specifically addresses the visual needs of young children in Promoting Positive Outcomes for Children with Disabilities: Recommendations for Curriculum, Assessment, and Program Evaluation (DEC 2007). This document highlights the importance of providing multiple means of representation and expression within the curriculum and through assessment and progress monitoring with the use of visual supports and other strategies. Instructional activities should therefore be designed to ensure that proper accommodations, such as visual supports, are put in place to meet children’s individual learning needs (Sandall et al. 2002, 2005).
Research evidence does show that children with and without disabilities benefit from visual supports. In fact, research has identified a picture-superiority effect where pictures are better remembered than words regardless of age and intellectual functioning (Cherry et al. 2002; Seitz 1997; Whitehouse et al. 2006). Therefore, in keeping with recommended practices, the use of visual supports in early intervention can help promote optimal learning and development (DEC 2007; Sandall et al. 2002).
Application of Visual Supports to Young Children with ASD
Given the characteristics of ASD, the use of visual supports for young children with ASD is particularly important (Hodgdon 1999). The core features of ASD include difficulties with social interactions, communication, and having restricted interests or repetitive behaviors. Visual supports can address all of these areas by making abstract concepts more concrete, facilitating communication, and increasing independence (Hodgdon 1999; Peeters 1997). Furthermore, visual approaches are consistent with supporting underlying cognitive features of ASD: enhanced perceptual functioning, weak central coherence, and executive dysfunction.
Enhanced perceptual functioning
Research indicates that individuals with ASD have enhanced perceptual functioning when engaged in visual processing (Bertone et al. 2005; Dakin and Frith 2005; Mottron et al. 2006; Samson et al. 2012). Through brain imaging studies and superior performance on visual tasks, individuals with ASD show enhanced visual mental imagery or “visual thinking” as compared to typically developing individuals. Instead of words, individuals with ASD have described their reasoning processes comprising a series of images or rather that they “think in pictures” when engaged in problem-solving behaviors (Grandin 1995; Kunda and Goel 2011). Therefore, visual strategies can be utilized to capitalize on this strength.
Weak central coherence
Individuals with ASD may exhibit a bias towards local processing rather than global processing (Happé and Frith 2006). Several studies have shown superior performance on tasks that are reliant on local processing versus those that rely on global processing of stimuli, thus supporting the theory that individuals with ASD may have more difficulty extracting the overall meaning or “big picture” while attending to specific details instead (Grinter et al. 2010; Ploog et al. 2010). While many of the tasks used to test local processing tend to be visual (e.g., embedded figures, block design, visual search), individuals with ASD also perform well on several nonvisual local tasks (e.g., pitch and melody perception; Happé and Frith 2011). While visual supports tend to be more global in nature as they represent chunks of information, their nontransient attributes do allow for children with ASD to take more time in processing information that is visually supported (Johnston et al. 2003).
Executive Dysfunction
Research suggests that individuals with ASD have impairments in executive functions impacting activities such as planning and organizing (Hill 2004). However, assessment of executive functions tend to rely heavily on language abilities and verbal working memory which may negatively limit the ability of individuals with ASD to excel on such tasks (Baldo et al. 2005; Russell et al. 1999). Further research is required to examine the types of tasks used to measure executive function and the level of verbal encoding of rules required to complete those tasks (Kunda and Goel 2011). In the meantime, specific attention is required to ensure that visual supports are provided for individuals with ASD to complete activities requiring executive functioning.
Research-Base
Visual supports are considered a focused intervention, a strategy or procedure designed to be utilized for a relatively brief period with the aim of producing specific behavioral and developmental changes related to targeted behaviors or skills (Odom et al. 2010). They are intended to be used as one component of comprehensive programming for individuals with ASD. Two national centers, the NPDC on ASD and the National Autism Center’s National Standards project (NSP), have recently conducted independent and complementary reviews of focused intervention practices for individuals with ASDs. These national centers were charged with reviewing the intervention research literature, identifying standards for determining research quality evaluating research designs, categorizing evidence-based practices, and disseminating that information to practitioners and families. In 2007, the Office of Special Education Programs in the US Department of Education funded the NPDC to promote the use of EBPs in programs for infants, children, and youth with ASDs and their families. An initial activity of this center has been to identify EBPs. In addition, the NSP, an initiative of the National Autism Center, has recently completed an exhaustive review of the strength of evidence for psychosocial and behavioral interventions for individuals with ASDs (NSP 2009). These two efforts are the most current, comprehensive, evaluative reviews of the literature on focused intervention practices for learners with ASDs (Hume and Odom 2011).
Visual supports meet the criteria as an evidence-based practice for young children with ASD, as determined by the NPDC. Several other practices which include visual components that will be addressed in this or other chapters (i.e., Picture Exchange Communication System, social narratives, video modeling, and structured work systems) are also considered evidence based. In addition, schedules, a widely used visual support, are considered an Established practice by the NSP (2009). Both centers have recognized visual supports/schedules as effective with preschool age children with ASD, yet visual supports have not been identified as evidence based with the 0–2 population. Both centers are currently conducting updates to their literature review and evidence for efficacy with the toddler population which may be indicated in the more recent literature.
One consideration, however, is the broad definition of visual supports used by the NPDC, which includes maps, labels, timelines, graphic organizers, visual boundaries, and a number of other examples. While these can certainly be categorized as a visual support, which is deemed evidence based, there may not be enough evidence for each of these supports to independently be considered an evidence-based practice. For example, a thorough review of the literature revealed no evidence that supported the use of labeling classroom materials or furniture with photos to increase specific child behaviors (e.g., independence in cleaning up, use of a variety of materials, increased engagement). However, labels are included in NPDC’s definition of visual supports and environmental labels are often recommended for children with ASD (Ganz 2007). This should not preclude the use of these practices, as practitioner experience, family preferences, individual child characteristics, professional judgment, and the evidence base for individual visual supports established outside of the autism population should also assist in guiding the selection of specific visual supports. It is important to keep in mind, however, that all visual supports have not been proven effective for use with children with ASD, and fewer still with young children on the spectrum. Further discussion around these issues continues below.
Considerations Around Developmentally Appropriate Practice
Intervention differs for young children and older children because it must be developmentally appropriate (Sandall et al. 2005) and therefore target different skills and use different techniques for targeting those skills. Visual supports are particularly useful as they can be easily individualized for and promote development in young children with ASD (Meadan et al. 2011) and can be used to supplement current programing. For young children with ASD, visual supports may be particularly appropriate. For instance, they can attract and hold a child’s attention (Rao and Gagie 2006) and are fairly nonintrusive (Meadan et al. 2011). Additionally, they provide a concrete form of representation which is developmentally appropriate for young children who are not yet able to process more abstract concepts (Ginsburg and Opper 1988). However, choosing appropriate visual supports depends on the child’s developmental level as well as the child’s sociocultural context (Bredekamp and Copple 1997). Decisions about visual supports should be made by a team which includes the practitioners as well as the family of the young child with ASD (Sandall et al. 2005).
One particular area of visual supports is quickly emerging. The use of technology is increasingly used to provide visual support for young children with ASD (e.g., computers, handheld devices) and should follow the same developmental guidelines as other interventions (Haugland 2005; Izumi-Taylor and Blake 2010). Technological visual supports are especially attractive to young children with ASD and can allow children to use at their own pace (Izumi-Taylor and Blake). Additionally, procedures for determining devices should follow best practices for obtaining assistive technology which includes borrowing a device for a trial period, seeking funding, and providing adequate training for the child, family, and professionals (Judge 1998).
Specific Visual Supports
A number of individual visual supports are described below, along with the literature base supporting their use with individuals with ASD, and more specifically with young children with ASD. The supports are organized by category—environmental supports, visual supports used to establish expectations, visual cues, and video-based visual supports—and individual visual supports within those categories are italicized for quicker and easier identification by readers. This chapter is not exhaustive, as visual supports are often components of other focused interventions (e.g., a token board is a visual support when used with a token system for reinforcement) and will be discussed in other relevant chapters. In addition, visual supports are often components of comprehensive treatment models serving young children with ASD, such as Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH, Mesibov et al. 2005) and Learning Experiences and Alternative Programs for Preschoolers and their Parents (LEAP, Strain and Bovey 2011). Studies on these and other comprehensive treatment models utilizing visual supports are not included in this review. For further review of several models and their components, see Odom et al. 2010.
Visual Supports to Organize Learning Environments
The use of an organized intervention setting when working with young children with disabilities, including those with ASD, is a widely recommended and long-studied practice (Bailey and Wolrey 1984; Nordquist and Twardosz 1990; Sandall et al. 2005). An environment that provides functional cues about the activities that will occur in each space as well as the behavioral expectations for those activities is more likely to promote and sustain student engagement in young children (Norquist and Twardoz 1990). The DEC recommends providing clearly defined learning centers in early childhood settings and the use of visual cues to assist in segmenting the space (Sandall et al. 2005). In addition, the Early Childhood Environmental Rating Scale (ECERS), a widely used quality rating scale for early intervention environments, recommends barriers to separate quiet and noisy activities and space arrangements which discourage rough play or running (Harms and Clifford 1980). The literature suggests that an organized environment is key for young children with ASD, as several learning characteristics of young children with ASD, including distractibility and difficulty in processing environmental stimuli (Siegel 1999), can be supported through a carefully arranged intervention space. However, many of the recommendations in the autism literature related to an organized environment come from the well-established literature on this topic related to young children with and without disabilities, rather than children with ASD specifically (Bailey et al. 1983a, b; McWilliam et al. 1985)
Visual supports play a significant role in organizing the environment and providing clarity for young children in early childhood settings, as they provide cues to young children about what activity will be occurring and what behavioral expectation is required in each activity space. DEC recommends the use of colored area rugs, vinyl flooring, or colored masking tape to distinguish one activity area from another, as well as low pieces of furniture to visually and physically define learning centers (Sandall et al. 2005). Visual supports are widely recommended in the literature to segment space in early learning environments for young children with ASD. However, much of the literature cited when making these recommendations is from conceptual writings, practical pieces, and research reviews, rather than recent efficacy or effectiveness studies (e.g., Heflin and Alberto 2001; Iovannone et al. 2003).
Three studies directly examine the effects of an organized physical space, in conjunction with the use of visual supports, on the behavior of students with ASD (Duker and Rasing 1989; Hirasawa et al. 2009; Nordquist et al. 1991). Duker and Rasing found that providing visual boundaries for students (i.e., covering materials with sheets that were not to be accessed or attended to during instructional periods) reduced self-stimulatory behavior and increased on-task behavior in two adolescents with autism. Similarly, Hirasaw, Fujiwara, and Yamane found that rearranging low furniture and materials, which served as a physical and visual boundary for a student and reduced staff attention to inappropriate behavior, reduced self-injurious behavior in an adolescent with autism. In the only study including young children with ASD, Nordquist et al. (1991) studied the impact of an intervention package, including room arrangement which uses furniture as a visual cue or support, on adult and child behavior. Positive effects were documented in adult behavior, including an increase in adult smiles and affectionate words as a result of the room arrangement specifically.
Visual Supports Used to Establish Expectations
Visual supports can be used to concretely set the expectations for children during activities. These visual supports explain or depict how an activity/task should be completed and/or the behavioral expectations for the child using pictures, objects, or written words. They are provided before and/or during activities to support children in successfully engaging in or completing activities. Within the broad category of establishing expectations, several specific techniques exist, including visual instructions, structured work tasks, scripts, social narratives, and power cards.
Visual Schedules
Visual schedules are a type of visual support that allows young children with autism to “see” their upcoming events or activities through the use of objects, photographs, icons/line drawings, written words, or any combination of the listed formats (Mesibov et al. 2005). Visual schedules can be used for several purposes, but have historically been used to provide support for transitions between locations or activity periods, essentially serving as a between-activity support (i.e., move from location to location across the classroom, Dooley et al. 2001). In contrast, activity schedules, as described in the previous chapter, were historically used to support individuals in the completion of a series of steps or tasks or during one activity period (i. e., complete a series of activities during a free-time period, MacDuff et al. 1993; complete the steps of getting dressed, Pierce and Schreibman 1994), thus serving as a within-activity support. In the past two decades, however, the terms visual schedule and activity schedule have become interchangeable in the literature and in practice and are used to both support transitions between activities (e.g., moving from circle time to the bathroom) and to assist in the performance of a series of steps, tasks, or activities more independently (e.g., completing the steps of washing hands once in the bathroom). Thus, the rationale and research base supporting the use of visual schedules with young children with ASD is discussed in the previous chapter describing activity schedules.
Visual Instructions
Visual supports have proven effective in supporting academic instruction for individuals with ASD, though the research for young children is limited. This is likely due to the emphasis on curriculum areas outside of academics for young children with ASD such as play, social, and communication skills. However, several of the visual supports used to increase participation and engagement with elementary aged students are likely applicable to early intervention and early childhood curriculum/settings. These include interactive two- and three-dimensional visuals during storybook reading (Carnahan et al. 2009), and product samples and picture dictionaries during completion of play-based and preacademic tasks (Mavropoulou et al. 2011). These studies and visual supports will be briefly summarized, as they include several supports that are applicable to the 3–5-year-old population. However, the youngest children in these studies were age six and further research is required to ensure effectiveness with younger children. The growing body of research investigating the use of various graphic organizers, such as Story Maps (Stringfield et al. 2011) to support the development of more complex academic skills, as well as the use of visuals to enhance self- management in academic settings is beyond the scope of this review, as they are most often implemented with school-age children.
Several types of visual instructions were provided to two 7-year-old boys with autism to increase independent activity completion during playtime (Mavropoulou et al. 2011). These included a product sample (sample of what the task or activity will look like when completed), a picture dictionary, a jig (two- or three-dimensional visual cues outlining how an activity is assembled), and color coding, and when in use the visual instructions supported on-task behavior and a reduction in adult prompting for one student. These visual instructions were applied to play materials such as puzzles, picture matching cards, and Legos, which are similar to those found in many early childhood settings, which may increase the applicability of these visual supports to young children with ASD.
Similarly applicable to the early childhood setting are the visual instructions and supports examined in Carnahan et al.’s study (2009) with six children with ASD, ages 6–11. In a study of student engagement and responding during group story time, researchers studied the effects of two- and three-dimensional interactive story pieces, such as: pictures of relevant items that could be removed from the pages, small apples that could be picked from the page and a basket to place them in, colored cotton balls to be used as a snowman’s nose. For example, in the baseline condition the students were asked to respond to teacher questions with only verbal prompts and the storybook pages (“Where is the red hat?” and student would point to the red hat on the teacher’s book page), while in the intervention condition, students had access to visuals to interact with and to support the verbal instruction (“Where is the snowman’s nose?” and students could remove a cotton ball nose that was attached to the page). The addition of visual interactive materials/instructions increased engagement and responding for three of the students.
Structured Work Systems
A work system is a visually based organizational system that provides individuals with visual information about what to do. Work systems are an element of structured teaching developed by Division TEACCH and they visually communicate at least four pieces of information to the individuals: (1) The tasks or activity the individual is supposed to do, (2) How much work/how many tasks to complete or how long the activity will take, (3) How the individual knows he/she is finished (progress towards goal), and (4) What to do when he/she is finished (Hume and Reynolds 2010). Information in a work system is presented visually to students based on the developmental level of the child and can range from pictures or objects for those who are more concrete learners to written lists for individuals with strong reading and comprehension skills.
Work systems are similar to activity schedules in that they provide a visual sequence of activities or steps of an activity to complete, however they differ in several ways. First, visual information in the work system is often presented in a more concrete format than typically described in the activity schedule literature, as the actual tasks to be completed may be placed in individual containers on shelves to the individual’s left, rather than in a photo sequence. Next, once tasks are completed they are typically placed in a designated location, often called a finished box or finished shelf, located to the right of the individual, encouraging a left to right work pattern. Last, visual information representing the activity that will take place after the series of tasks are completed is present for the individual to view as he/she is completing the tasks within the work system. This activity may be purposefully selected as a preferred/reinforcing activity, or may be simply the next activity in the individual’s day (Mesibov et al. 2005). Work systems have primarily been used as a time/space for mastered skills to be practiced independently, similar to a fluency building period (Bennett et al. 2011; Hume and Odom 2007; Mavropoulou et al. 2011). More recently, however, the work system has been used to support skill acquisition (Hume et al. 2012), yet further research is required to support this application.
Structured work systems are an evidence-based practice per the NPDC, and are included in the Schedules category per the NSP (referred to as workstations). Work systems have been studied both as an element of a broader TEACCH-based model (e.g. Ozonoff and Cathcart 1998) as well as an individual component apart from the model (e.g., Hume and Odom 2007). Several recent studies have examined the use of work systems with preschool and elementary aged students and have found similar positive results in increasing on-task behavior while simultaneously decreasing adult support (Bennett et al. 2011; Hume and Odom 2007; Mavropoulou et al. 2011). Hume and Odom introduced a work system to two boys with ASD, ages six and seven, during free play sessions in an effort to increase their appropriate play and the number of play materials used. A withdrawal design indicated an increase in play behavior and number of play materials accessed, along with a decrease in adult prompting. In a replication of this study with three preschool age students, Bennett et al. introduced a work system in an inclusive classroom to support student engagement and task completion during an independent work and playtime (e.g., completing puzzles, ring stackers, matching game). Positive effects were observed for all three students and included a reduction in both escape and stereotypic behavior. Finally, in a similar replication with two 7-year-old students, Mavropoulou et al. studied the effects of the work system in combination with the use of visual instructions (described more specifically below). The work system was beneficial for one of the students in increasing on-task behavior and decreasing adult support.
Scripts
Scripts are created phrases taught to children in order to provide them the language needed to participate in conversations. Scripts are often taught through modeling, role-playing, prompting and/or the use of reinforcement (Ganz and Flores 2010). In addition, scripts generally include a script-fading procedure to increase spontaneous use of language in natural settings (e.g., Sarokoff et al. 2001). Scripts have specifically been shown to be especially effective in improving social and communication skills in children with ASD (Krantz and McClannahan 1998) and are most appropriate for children who have some verbal skills, as opposed to those who are preverbal (Ganz and Flores 2010). Much of the research on scripts has been with school-aged children or adolescents and include written scripts (e.g., Brown et al. 2008; Ganz et al. 2008; Krantz and McClannahan 1993; Sarokoff et al. 2001). For example, Ganz et al.(2008) used cards with type written scripts to teach three school-aged children with ASD to increase their use of script phrases and decrease their perseverative speech. Scripts have also been used for young children, but we often use audiotaped scripts that children can access by pushing a button (e.g., Betz et al. 2011; MacDuff et al. 2007; Reagon and Higbee 2009; Wichnick et al. 2010; Wichnick et al. 2010). For example, Betz et al. used audiotaped scripts with colored stickers on the buttons to teach three preschool children to request snack items. However, there is emerging research on the use of pictorial scripts, appropriate for young children. See Ganz and Flores 2010 for a detailed description of how to use visual scripts to support preschoolers with ASD in play.
Using a changing criterion design, Ganz and Flores (2008) evaluated the effectiveness of visual scripts with preschoolers during playgroups. Three preschoolers participated in playgroups with one to two typically developing peers. During play sessions, the preschoolers with ASD were shown cards with the scripts they learned to prompt them to use the scripts. At the end of intervention, the three preschoolers increased their play behaviors and use of play-related language. Similarly, Murdock and Hobbs (2011) implemented the use of scripts with preschoolers in an attempt to increase the use of play-related language. This intervention, called Picture Me Playing, utilized pictures in addition to written scripts. Using within-subject analysis of intervention versus comparison groups, they found that play-related dialogue increased for the children with ASD who participated in the intervention. Further, participants increased in their use of novel utterances and generalized their play-related dialogue to novel toys.
Although there is limited research on visual scripts for young children, research with older children suggest that it has potential for use with young children ASD. Because many young children are not readers, scripts including or consisting entirely of pictures may be most beneficial. Future research should continue to explore the different types of visual scripts that could be utilized to support young children with ASD in their social and communication skill development.
Social Narratives
Social narratives briefly describe social situations by highlighting relevant cues and offering examples of appropriate responding using pictures or other visual aids. Individualized for children with ASD, social narratives can specifically help children with ASD learn social skills, engage in appropriate behaviors, use effective communication, or adjust to changes in routines (Collet-Klingenberg and Franzone 2008). Refer to the work of Gray (2000) for examples and instructions for creating social stories.
Since the early 1990s, researchers have been studying the effectiveness of social stories for individuals with ASD. Two recent comprehensive reviews of the social stories literature have concluded that further rigorous research is needed (Karkhaneh et al. 2010; Test et al. 2011). Karkhaneh et al. found that out of six controlled trials which met their predefined criteria for quality research in their systematic review of the literature published between 2002 and 2006, only five showed statistically significant benefits for social interaction outcomes. However, Test et al. conducted a meta-analysis with 18 studies using single-case experimental designs published between 1995 and 2007, and concluded that since only six of those studies indicated “effective” or “very effective” results, there is not enough evidence at this time to support the use of social stories as an evidence-based practice. Thus, while social narratives may be beneficial in modifying target behaviors for some children with ASD, they may be generally ineffective in producing robust behavior changes (Karkhaneh et al.; Test et al.).
Related posts:
Psychological Theories of Childhood Autism
Economics of Autism Spectrum Disorders: An Overview of Treatment and Research Funding
Designing Curriculum Programs for Children with Autism
Families of Children with Autism Spectrum Disorders: Intervention and Family Supports
Reinforcement Arrangements for Learners with Autism Spectrum Disorder
Discrete Trial Teaching and Discrimination Training
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
