social stories and pretend play for autistic children...

Social Stories and Pretend Play for Autistic Children:

Enhancing Social Interaction

Shum Yin Chau, Winnie

(06636527)

May 2008

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DECLARATION

I declare that the work in this honours project is original except where indicated by special

reference in the text.

Any views expressed in the honours project are those of the author and in no way represent

those of the bachelor degree programme in Psychology, Hong Kong Baptist University.

Signed:________________________ Date:___________________________

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Abstract

These studies investigated the effectiveness of social story and pretend play on one student

with autism. Treatment was implemented twice per week and consisted about half hour

session intervention within four months. Results showed physical and verbal responses of

social interaction of the autistic boy had better performance by social story with pretend play

intervention than just introduced social story. These findings support recommendations for

using social story with pretend play to enhance social interaction among autistic children in

Hong Kong.

撮要

本研究採單一個案設計的多基準線試驗設計，為期四個月。本研究試圖找出社交故事與假想遊戲

的介入處理能否提昇自閉症學童的社交互動。研究顯示：社交故事與假想遊戲的介入處理對該學童的社

交互動有明顯改善。

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ACKNOWLEDGEMENTS

My biggest thanks are due to my supervisor, Dr Chi-Hung Leung, for guiding me

throughout the entire study. Without Dr Leung’s excellent guidance and patient mentoring,

this thesis may not be completed. Also he provided me with lots of useful teaching strategies

on how to be a professional educational psychologist. Also I would like to thank Angela Siu

Fung Ying who taught me educational psychology last year. She provided me with useful

information on how to deal with autistic children.

Moreover, I would like to say thank you to the placement supervisor, Ms. Fong Yee

Man and the participant’s kindergarten teacher, Ms. Lui Ka Yee. They always provided great

insight to help me to be a good educator for special needy children. They also gave me useful

information about the case, so their help made me work on this thesis without great

difficulties.

Moreover, I hope to give thanks to Ms. Leung who is the participant’s mother as she

was willing to allow his son to be my participant and she provided me with useful

suggestions on how to teach her child. In addition, all three observers showed their

willingness and patience in answering my questions.

I received invaluable help from my friends and classmates. I would like to thank Ms.

Chung Ka Man, Rachel for helping me to check this thesis for grammar and spelling. I also

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want to thank my classmates, Alex Kong and Chester Lam who provided me with technical

help and Mr. Chow who helped me to make video recording in some sessions. In addition, I

would thank Ivy Tam for borrowing her computer to me and check this thesis for grammar.

Special thanks are given to my dear parents for being there to support me all these

years. They really love me and provide lots of support and freedom to me in my study. Also,

I thank my younger sister for helping me to draw some lovely pictures of social stories and

lend her camera to me for video recording. I also thank my younger brother who supported

me during this period. I love them so much and forever. Also, I hope to thank my dear GOD

who provides me with lots of friends to give me support to finish this thesis.

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Table of Contents

Page

CHAPTER ONE Introduction 1

CHAPTER TWO Literature review 5

Autistic children in Hong Kong

Importance of enhancing social interaction

Social story

Pretend play

Social interaction

Research Informed by Piagetian Theory

Research proposed by Vygotskian Theory

Purpose of the current study

5

5

6

9

14

14

15

17

CHAPTER THREE Methods 19

Participant 19

Setting 21

Instrumentation 22

Research design 23

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Procedure

24

CHAPTER FOUR Results

Observations from the child’s school principal,

teacher and mother

Observation from experimenter

27

27

33

CHAPTER FIVE Discussion 41

Research Implication

Factors that make the intervention not effective

Limitations

Suggestions

Conclusion

41

45

46

47

52

References 53

Appendix vii

Tables ix

Figures x

vii

Appendices

Page

Appendix 1

Appendix 2

Appendix 3

Individual education plan for enhancing social

interaction among autistic child

Social stories and teaching material

Informed consent for parents

59

64

68

Appendix 4

Appendix 5

Appendix 6

Appendix 7

Appendix 8

Appendix 9

Informed consent for school principal and teacher

Case study proposal of fieldwork placement

Intake diagnostic assessment form of fieldwork

placement

Case recording form of fieldwork placement

Case-evaluation form of fieldwork placement

Student final self-evaluation report of fieldwork

placement

69

72

75

77

78

89

Appendix 10 Sample questions to discuss during a meeting with

parents or guardians

92

Appendix 11 Interview of teacher 94

Appendix 12 Interview of school principal 95

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Appendix 13 Interview of mother 96

Appendix 14 Checklist for children’s emotional behavior 97

Appendix 15 Checklist for three observers 99

Appendix 16

Appendix 17

Checklist for experimenter

Evaluation criteria for the social interaction

101

103

Appendix 18

Appendix 19

Process of session

Three types of social interactions

104

105

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ix

List of Tables

Page

Table 1 Five evaluation criteria for the social interaction 26

Table 2 Research design 28

Table 3 Three types of social interactions 32

x

List of Figures

Page

Figure 1 Frequency of social interaction during baseline and two

interventions which was recorded by the teacher

29


interventions which was recorded by the mother

29


interventions which was recorded by the school

principal

30

Figure 4 Child‘s all types of social interaction of the child at

baseline and intervention B

35

Figure 5 Child‘s all type of social interaction of the child at

baseline and intervention C

36

Figure 6 Child‘s all type of social interaction at baseline and two

interventions

37

Figure 7 Child‘s physical responses at baseline and two

interventions which recorded by experimenter

38

Figure 8

Child‘s verbal responses at baseline and two

interventions which was recorded by experimenter

39

xi

Figure 9 Child‘s physical and verbal responses at baseline and

two interventions which was recorded by experimenter

40

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Social Story for Autism 1

CHAPTER ONE

Introduction

Autistic Disorder or autism is considered one of the pervasive developmental disorders

(PDD). Autism in infancy and childhood was first described by Kanner in 1943 (Butcher,

Mineka, Hooley & Carson, 2004). It has received clinical and research attention for decades

(Kamphaus & Frick, 2005). According to the study of International Epidemiology Institute,

the prevalence of autism among children or the trend of being autism is 0.6% in the world

(Singtao, 2007). Local studies indicated that there are around eleven thousands of children

with autism or having autistic features in Hong Kong (Singtao, 2007). In September, Autism

Parents Network Foundation (APNF), a Hong Kong-based parents support group, hosted the

Second Asian Autism Conference 2007 in Hong Kong. The meeting was about the treatment

for autistic children (“Asian Autism Conference”, n.d.). There has been a dramatic increase in

cases of autism in recent years. It was estimated 1 out of 150 children were diagnosed with

this developmental disorder and autism is more common, there is more awareness for this

condition. The above figure draws the public attention (Singtao, 2007) to this condition.

In Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the onset age for

autism occurred at 3 years old or younger (Kamphaus & Frick, 2005).More evidences from

literature support the need for early diagnoses of autism and referral for early intervention

(Twoy, Connolly & Novak, 2007). It was beneficial for the autistic children and their family


(Richard, Phyllis & Jean, 2007). For instance, the burst of vocabulary was between 18

months and at the age of 6, verbal responses of social interaction could be enhanced easily

within this critical learning language period among autistic children (Vasta, 2004). However,

there are limited resources in teaching and helping autistic children.

According to the DSM IV, diagnostic criteria for 299.00 Autistic Disorder included

developmental disabilities. The DSM-IV describes Autistic disorder as “the presence of

markedly abnormal or impaired development in social interaction and communications and a

markedly restricted repertoire of activity and interests” (APA, 1994, p.66). Social interaction

includes appropriate nonverbal behaviors, such as eye contact, facial expressions and body

gestures; develop development of peer relationships; development of spontaneous seeking to

share enjoyment and active participation in social play or games (Kamphaus & Frick, 2005).

In Hong Kong, enough support for teaching autistic children has not been provided.

Therefore some parents may give up their job to accompany their children or spend lots of

money to let them join some therapeutic sessions (“Hong Kong Economic Journal”, n.d.).

Even though some schools with inclusive education welcome autistic children, there is not

enough number of schools for them. Inclusive education was first promoted by Salamanca in

1994 (Kung, 2004). Since 1999, there have been more schools involved in the inclusive

education program and inclusive education will become a new learning style in Hong Kong.

According to the Education Bureau, there were 117 schools involved in the inclusive


education in 2003, and there are 700 special needy children studying in these schools (Kung,

2004). Moreover, 172 autistic children are studying in primary school while there are 24

students with autism studying in secondary school in 2004 (Kung, 2004). However, there are

about eleven thousands autistic children in Hong Kong (“Hong Kong Economic Journal”,

n.d.). It draws public concern about whether the inclusive schools can provide enough

resources for teaching autistic students (Kung, 2004). Besides, there are still more than

thousand of schools, which do not have suitable education strategy and teaching materials to

support the teaching for special needy students such as autistic students (Kung, 2004). The

present number of inclusive schools cannot support the growing number of autistic students.

Although there are successful strategies to address autistic children’s deficit, it involves

intrusive adult prompts and extensive time to train teachers and peers (Scattone, Tingstrom,

& Wilczynski, 2006). It is not easy to carry out strategies in Hong Kong, while there are

limited inclusive schools and human resources for autistic children. According to the previous

study, an intervention that is relatively simple for teachers and practitioners to implement on

autistic children is called social story (Gray, 1998). Social story is a widely used intervention

designed to improve social behaviors in children with autism (Scattone, Tingstrom &

Wilczynski, 2006). However, most research emphasized on social story with the aim of

reducing isolated inappropriate behaviors and less research is involved in enhancing

appropriate social interaction (Scattone, Tingstrom & Wilczynski, 2006). Although both


social story and pretend play had been mentioned in previous research, few studies had

attempted to incorporate both of the intervention in Hong Kong autistic children. Therefore,

the current study will study both of the intervention which are social story and pretend play

by using single case study. The data will be collected in a kindergarten at Mei Foo.

In this descriptive study, there are two objectives. The first one is to compare the

effectiveness of the intervention of social story with that of social story with pretend play for

children with autism. The second one is to evaluate whether social story with pretend play

can enhance social interaction for the children with autism.

This study investigates whether social stories with pretend play can increase

appropriate social interaction for autistic children in an inclusive school. An ABACA multiple

baseline design was employed in the present study. Some nonverbal behaviors will be taught

to the autistic child to enhance the social interaction. As language is a primary pathway by

which children can enter into and affect the social world (Vasta, 2004), communication with

others is a very important behavior to be trained among autistic children. By the age of 18

months, children can speak 50 words and understand about 100 words (Vasta, 2004). The

acquisition of words mostly starts in the baby’s second year at the age of two (Vasta, 2004)

Infants’ first word is usually about thing that is familiar or important to them, such as family

members (parents), food and toys. Therefore, enhancing the greeting language of the autistic

children will be the objective of this study.


CHAPTER TWO

Literature Review

Autistic children in Hong Kong

Inclusive education policy was first promoted in Hong Kong in 1997. The inclusive

education program provides children identified with special educational needs (SEN) within

mainstream education (Rogers, 2007). Nowadays, there are more autistic students studying in

the mainstream school. However, news has shown that autistic children may be isolated by

their peers in school. One of the reasons may be due to the lack of appropriate social

interaction with their peers, such as communication and eye contact. The autistic children

cannot respond to others appropriate was due to lacking of social understanding (Kuoch &

Mirenda, 2003). People with autism always experience social challenges even though they

are more capable individuals (Kuoch & Mirenda, 2003). It is because autistic children lack

the theory of mind which helps them to understand one’s own and other people’s mental and

psychological states such as thoughts and feelings (Ormrod, 2006). Therefore, learning social

interaction is important for autistic children.

Importance of enhancing social interaction

Peer is important for everyone, especially in adolescent life as teens seek reassurance

of worth and companionship from their friends. Teens with superficial or no friendships are

lonely and depressed with low self-esteem (John, 2008). Therefore, enhancing autistic


children social interaction is important for their lives as appropriate social inter-network can

support them. Besides, social interaction is the prerequisite condition to play with other peers.

If autistic children lack social interaction, they do not know how to play with other peers

appropriately. However, playing with other peers is important and good for children as they

can share their happiness, develop their creativity and critical thinking. Therefore, enhancing

social interaction of autistic children as soon as possible at an early stage is good for their

learning and personal growth in cognitive and affective aspects.

Social story

In the past decades, researchers had examined the intervention of social stories among

autistic children (Scattone, Tingstrom & Wilczynski, 2006). Social story is individualized

short story which includes relevant components of a given social situation (Scattone,

Tingstrom & Wilczynski, 2006). Social story is an intervention designed to provide people

with autism with some social information that they are missing (Gray, 1995, 2000a). For

instance, what people expect them to do in social situation may be greeting with someone

they know. Nowadays, social story is validated as one of the effective behavioral

interventions for children with autism spectrum disorders (ASD), as social story is easy to be

implemented and can be applicable to a wide range of behaviors. The idea of social story was

developed by Carol Gray in 1991 as an intervention to provide autistic children with concrete

information to improve their social skills and appropriate behaviors (“Social stories”, n.d.).


The purpose of social story is to improve socialization and social competence in individuals

functioning on the higher end of the autism continuum (Scheuermann & Webber, 2002). Even

the most capable autistic children, they also experience difficulty in social situation. The

social story intervention can be introduced to autistic children as it provides some knowledge

about social situation and people’s expectation on them. Therefore autistic children can have

better interpersonal understanding and behavior (Kuoch & Mirenda, 2003).

Norris and Dattilo (2006) used social story to improve the social behavior of an

8-years-old autistic girl during lunchtime. They used “priming” strategy in which social story

intervention was given to the girl just before lunchtime to help her to reduce inappropriate

social behavior. There was no intervention during lunchtime. Norris and Dattilo (2006)

created three social stories according to the guidelines of Gray. The guideline included

present desired behaviors (Gray, 2000b). Besides, the content of social story helps autistic

children to understand social cues, such as who, what, where and when about some social

situation (Gray, 2000b). The content of social story is slightly below the autistic children’s

comprehension level. Norris and Dattilo (2006) used picture prompts in the social stories, and

each day they randomly selected and read the social stories to the autistic girl. In the result of

the study of Norris and Dattilo (2006), the inappropriate behavior such as verbalization was

reduced. However, the appropriate social interaction, such as having smile and eye contact

with other, was not enhanced greatly after the adoption of the intervention according to result


of Norris and Dattilo (2006). The result indicated that there was 6% of appropriate social

interaction during baseline and 4% during intervention. This meant frequency of social

interaction was reduced after social stories intervention. That may be because the target social

behaviors were too complex or not concrete for the autistic child. Therefore the participant

could not learn from the social stories intervention. An A-B design was employed as

experimental strategies to evaluate the social stories intervention. However, functional

relationship cannot be hypothesized because of low internal validity, such as maturational

effects and also threats to external validity such as the lack of replication of effects (Powell,

2005).

Thiemann and Goldstein (2001) investigated the effects of social story intervention

with written text and pictorial cuing on the social communication of five autistic children.

Verbal prompt and pictorial prompt and self-evaluative video feedback were included during

the intervention of the study. The result was that targeted social communication skills of those

autistic children were improved after the treatment was implemented. This study contributed

in several ways. For examples, there were generalized treatment effects across untrained

social behaviors, and one participant showed generalized improvements in the classroom.

Also, those autistic children had better topic maintenance skills (Thiemann & Goldstein,

2001). These findings supported using visually cued instruction to guide the social and

language development of young children with autism when they interact with peers who do


not have any disabilities. In the study, peers without disabilities were involved as social

partners with each autistic child. However, the effect of social story cannot be evaluated

clearly as there were different types of peers involved. So the effect of social communication

may be due to the social interaction with peers instead of social story intervention.

Scattone and his companions (2006) also used social story as the sole intervention for

three autistic children. Both the verbal and pictorial prompts were not included in the study

condition. The study showed that there was reduced disruptive behavior among the three

autistic children. However, the improvement of the third autistic child was modest. It may be

due to the lack of individual education plan (IEP) for each child as different autistic children

have different learning ability and social deficit. Individual education plan is education

program that developed by student’s teachers, school administrative and support personnel.

According to the student’s needs, learning objectives are specially designed for student.

(Vukelich, 2008). If researchers could design social stories according to different need of the

autistic children, these children may benefit a lot.

Pretend play

Erikson (1951) claimed that pretend play was a good method to examine social

interaction among people and to practice social roles (Macintyre, 2006). According to

Macintyre (2006), pretend play was also called symbolic play, fantasy or make-believe play.

Between two and three years old, children begin to have pretend play. Macintyre (2006)


suggested that helping children converse with others can start with some simple games which

require turn taking element, such as pretend play. Macintyre (2006) also claimed that play is

an important element in children’s life and this helps children understand the world around

them. Play is really good for children’s physical, emotional, cognitive and social development.

Therefore, play intervention such as pretend play with social stories will be investigated in

the current study. It is interested to explore whether pretend play with social stories can

enhance the social interaction of the autistic children.

However, there are some deficits among autistic children. It is difficult to get them

involved in pretend play. For instance, they may not be aware of the need for reciprocity.

Second, autistic children may have difficulty in being aware of other people’ interpretation of

their action. Third, it is not easy for them to use imagination. In addition, many autistic

children have poor social interaction skills such as poor initiation of conversation, poor eye

contact, poor skills at conversation repair, rigid idiosyncratic topics, poor turn taking, poor

awareness of the needs of the listeners and poor pretend play behavior (Wolfberg, 1995).

Some studies claimed that autistic children may have difficulty in shifting into other people’

world and prefer to avoid eye contact with others. Also, some findings showed that autistic

children have too limited language and symbolic thought to benefit themselves from pretend

play (Landreth et al., 2005). Children with autism do not typically play toys such as dolls as

agents or substitute one object for another object during play (Rutherford and Roger, 2003).


To conclude, the previous study indicated that children with autism have poor ability in

pretend play, which greatly influences their social skill development (Hess, 2006).

There are studies which indicated that pretend play have lots of advantages, such as

typically developing children ability in exploring social roles and rules to establish the mutual

meaning (Casby, 2003). Pretend play also provides an opportunity for children to allow them

to act out daily routines and the types of interactions that they may find familiar in their own

living environments. Through pretend play and interaction with adult, typical children can

develop the understanding of the relationships with adults and the ability to infer people’

needs beliefs and intentions (Rubin & Lennon, 2004). Wolfberg (1995) pointed out that

children must be able to enter a social group and coordinate the mutual activity to engage in

play with partners. Wolfberg (1995) stated that play can support the exploration of social

roles and children can learn how to negotiate compromise and become aware of and

understand the mental states of others. There are some important elements that children must

learn to manage their emotion and understand others’ perspective. In this study, pretend play

is suggested to be a good strategy to enhance the social interaction of the autistic children.

Researches indicated that children with autism may display a range of rigid and

impairment in symbolic play, creativity or imagination (Sherratt, 2002). Sherratt (2002) tried

to object to the previous study results. She manipulated a case study in which she aimed to

explore whether it was possible to teach children with autism by using pretend play. In her


study, five children with autism were involved in a 4-month- intervention. All the children

were able to perform some symbolic acts during play after intervention was involved. The

study suggested that this result was not the same as the result of the previous study. The

finding indicated that using modeling, prompting and eliciting were the significant elements

to produce significant changes in play intervention when compared with the previous studies

(Sherratt, 2002). It supported using pretend play as intervention among autistic children as it

seemed that autistic children can enjoy themselves in pretend play and learn from it. However,

Sherratt’s study (2002) lacks further study on how pretend play can benefit the social

interaction of the autistic children as social interaction is the main deficiency among them.

Some strategies need to be concerned during pretend play. Hobson (1993) reported that

even a child with autism does engage in pretend play, the child relies heavily on adult

prompts. The child rarely engages in spontaneous play. Vygotsky (1962) saw play as a

method to develop children’s symbolic representation and understanding. Vygotsky (1962)

suggested that play begins with the scaffolding of joint action with adults. While children

learn social exchanges, the adult adjusts the support to match or slightly exceed the children’s

abilities. It supported that the experimenter can be the partner in pretend play with the autistic

children in this current study. Hess (2006) also proposed the use of adult partner as

intervention technique. In her study, a ten-year-old autistic boy was read event story, retold

the story and then acted out the event. The autistic child used repetition of story routines and


expected social exchanges to augment his pretend play. In this study, the autistic child had

improved ability in answering the questions after play intervention. Hess (2006) found that

the last session was 100% correct which showed great improvement when compared with

72% correct in the first session. The largest type of question that was answered correctly was

“Wh” questions. The autistic child scored 0% correct initially and then achieved 100%

correct in the last session. Actually, children with autism have difficulty in answering “Wh”

questions because specific information must be processed when answering “Wh” questions

(Paul, 2001). The role of adult partner was to tell story and be involved in pretend play

intervention. It supported the use of case study which can provide a good intervention among

autistic children to enhance their language development. Adult partner acts as story teller

which is good for autistic child to learn. However, this study did not show whether the

intervention can be generalized into younger autistic children such as kindergarten children.

As providing early intervention for autistic children is beneficial to them and can make a

great positive change. In this current study, a 4-year-old autistic child will be the participant.

Pretend play is highly associated with social interaction of autistic children. According

to Hess (2006), pretend play can help to strengthen the autistic children ability to infer and

predict others’ intention which is an important component during social interaction. For

young children, social interaction depends much on shared play. Play is a main method for

children to socialize in a peer culture (Wolfberg, 1995). In the current study, pretend play will


be used as intervention for enhancing social interaction among autistic children. Also, trying

to apply both social story and pretend play to a younger autistic child is to examine whether

this type of intervention are more beneficial than social story telling. Early intervention for

autistic children is the best way to help them integrate in their daily life and reduce their

difficulty in social interaction.

Social interaction

Social interaction is important for children with autism as it can affect their learning and

help them to build social network. If they keep on living in their own life or lack appropriate

social skill, then they may face great challenge in their future lives. They may have conflicts

with others as autistic children do not know how to express their thoughts or delay their

learning by peer modeling. The more the autistic children are ignored by playmates, the more

likely they develop rigid play routines that become increasingly resistant to change (Hess,

2006).Therefore, social stories and pretend play will be good strategies as it does not need

much money and it is easy to learn. Both interventions can be used to enhance social

interaction among autistic child.

Research Informed by Piagetian Theory

Jean Piaget, a Swiss researcher, who studied the influential stage of children’s cognitive

development. His research has indicated the relationship between pretend play and cognitive

development, and the relationship between pretend play and language development in the


second and third years of life (Morelock et.al., 2003). In the typical development of a child,

pretend play emerges early in the second year of life. Piaget's (1962) view was that children

constructed their own knowledge through their action in the world. Studies indicated that if

children exhibited delays in the development of cognitive and language, pretend play and its

underlying processes are also delayed. Therefore, pretend play develops at a slower rate in

children with autism (Morelock et.al., 2003). All these studies supported that providing

pretend play can enhance autistic children’s cognitive development such as understanding the

social rules and social roles in the real world.

Piaget’s theory also suggested that children motivated to learn language while there was

adaptation value. For instance, the child wanted to get drink, then he or she would like to lean

communicate effectively with the caregivers. Thus, enhancing social interaction of autistic

child by teaching say greeting to other had adaptation value and motivation for the child

(Wadsworth, 2004).

Research proposed by Vygotskian Theory

Lev Vygotsky (1896) used a social constructivist approach which emphasized the

social contexts of learning and the construction of knowledge through social interaction

(Santrock, 2007). Vygotsky believed that social interaction is a prerequisite to learning and

cognitive development in children (Santrock, 2007). Learning always involves social


interaction in which learners can learn by modeling and interaction. More recent studies of

pretend play (Fiese, 1990; Haight & Miller, 1993; McCune, Dipane, Fireoved, & Fleck, 1994)

have been influenced by the work of Vygotsky, who emphasized the importance of the social

context to cognitive and language development.

To conclude, the purpose of this study was to examine the intervention of social stories

with pretend play on the social interaction of a 4 years-old boy with autism who studied in

an inclusive K1 classroom. In previous studies, social stories has been used successfully in

different social contexts and environment, such as having meals, washing hands and

improving social behavior (Quilty, 2007). While social story is an easy intervention for

autistic children, it is reasonable to use it as intervention in the current study. Since it was

interested to know whether there is better result when providing both the social stories with

pretend play for the autistic children, both of them will be investigated in the current study.

Many previous studies focused on the reduction of inappropriate behavior by using social

stories. There is research which provided little empirical evidence in support of their

effectiveness. Using pretend play is one of the successful strategies to enhance social

interaction among autistic children, but some skills are needed when giving the intervention

(Quilty, 2007). For instance, it involves adult partner to tell the social stories and it also

involves a role-play session. Then the children can have a concrete image to follow what to

do or how to do in the pretend play (Quilty, 2007). Through the guidance in pretend play,


participant can learn the skill of pretence and understand social roles. For instance, when he

sees teachers or classmates, he may give spontaneous verbal or nonverbal response to greet

them. In the current study, experimenter read social stories to the autistic child and then ask

him questions, such as “what will you do when you meet teacher?”. After story telling,

experimenter will invite participant having pretend play and act out the content of story

together. It is expected that the autistic child can use repetition of story routines and social

exchanges to augment his pretend play. In this study, positive behavior in daily life was

observed. Greeting and non-verbal behavior, use of spontaneous and appropriate social

exchanges can be the product of sessions. The rationale for pretend play as play intervention

is that the development of pretend play in shared play contexts can lead children ultimately

towards growing social competence.

Purpose of the current study

In the current study, there are modifications of intervention for autistic children

according to previous studies. First, autistic boys will be invited as the sole participant. An

individual education plan (IEP) will be designed to him after having an interview with his

mother, teacher and school principal. Therefore, the social interaction history of the child

can be obtained. According to the child's individual social deficit, social stories can be

designed for the boy to enhance his appropriate social interaction.

Second, an ABACA multiple baseline design is employed in the present study. The


two-treatment reversal design is good to assess the effectiveness of more than one

intervention (Powell, 2005). In the current study, the two interventions will be enhancing

social interaction of autistic child by social stories telling and social stories telling with

pretend play respectively.

Third, pretend play is combined with social stories intervention instead of sole social

stories. As pretend play can provide a concrete and simulated real social situation for the

autistic children, social interaction can be easily captured in this social situation.

Fourth, peers were not included in the intervention. It is more convenient as providing

training to other peers is not needed. Also, the effect of the study can be determined by

social stories and pretend play instead of the social interaction with peers.


CHAPTER THREE

Methodology

In the current study, a little boy with autism was invited to join a series of sessions in a

kindergarten at Mei Foo. An ABACA multiple baseline design was employed in the present

study. In previous study, appropriate social interaction may not be enhanced significantly

(Norris & Dattilo, 2006) due to the learning task was too complex. In current study, some

simple and appropriate social interaction will be taught to the participant. Enhancing physical

and verbal responses of social interaction will be the objective of the study. This study was

applied to an autistic child by two interventions which were social story and social story with

pretend play.

Participant

A young boy with autism was selected for participation. He was selected in

experimenter’s placement kindergarten. After a period of placement, experimenter found that

the participant always played alone and lack social interaction with other children. According

to the previous study, autistic children may have difficulty in shifting into people’ world and

prefer to avoid eye contact with others. (Landreth et al., 2005). Also, autistic children are

diagnosed to have too limited language and symbolic thought to benefit themselves from

pretend play (Landreth et al., 2005). Therefore, they lack interest and appropriate social

interaction with other people. Participant had some symptoms of autism. Therefore,


experimenter was interested to select him as the participant in this study. The objective of

study was improving social interaction of the autistic child. Since he was young, teaching

appropriate social interaction can be beneficial to his future life. The participant can help to

explore these research objectives.

The participant was about 4 years old when the study commenced. He had been

diagnosed with autism at the age of 4 by a private clinic. The participant was a Chinese boy

who lived with his parents and a servant at the time of this study. He was the only child in the

family and he was looked after by his servant mostly. He had a longer time to stay with his

mother than his father. His mother works as an administrator and his father works in the

engineering field. His family is middle class. The participant was studying K1 in an inclusive

preschool in Mei Foo in which there was not any special training for him. He studied with his

classmates at the same time and was given the same content of teaching. There were some

story telling in the lesson and it is about moral teaching. According to the observation and

interviews with the child’s mother, teacher and school principal, it was found that the autistic

child lacked appropriate social interaction. For instance, he preferred to play alone and did

not have any conversation with other children and teachers. Besides, he had emotional

problem. For instances, he fought with other classmates when others approached him and

played with him. He yelled and lay on the floor when others did not follow his will such as

asking him to do homework or not allowing him to play. Prior to the study and during the


study, participant’s parents arrange some language therapy and play group treatment for the

autistic boy to enhance his social skills, emotion, self control, cognitive and motor movement.

The participant did not have previous experience with social stories and pretend play before

this study. In this study, the purpose of the social story was to provide him with some basic

concept of appropriate social behavior, such as smiling, nodding head, eye contact and some

greeting languages.

Setting

The interaction for the autistic child took place in his kindergarten and social story and

pretend play were implemented one by one. The intervention mostly occurred before class

(1:00pm) and after snack time (4:00pm) from September to April. The study mostly took

place in a small computer room in school. The setting for the sessions was controlled in order

to make it consistent within each session. There are several reasons to choose the computer

room. First, it was a quiet place and there were not any classmates, so it could reduce

disturbance during the session. Second, two chairs were provided for the experimenter and

the autistic child during story telling session. Therefore the participant could be controlled to

sit well instead of running in the room as the autistic boy liked to stimulate himself by self

stimulation such as running and he had such trend. Third, most of the attractive decorations

or toys were removed in the room as autistic children may easily be attracted by colorful

objects and are addicted to observe and play with them for a long time. Therefore reducing


some attractions in the room can help to make the autistic child pay more attention in sessions.

Fourth, during pretend play sessions, a screen was used to separate story telling area and

pretend play area. Therefore, the autistic child would not be disturbed by the toys in pretend

play setting and he might be aware that after story telling. Before having pretend play, let

participant knew that after social telling, he could join the pretend play. Therefore, he might

be reinforced and had better attention during story telling. Then he would have play time.

Fifth, video recorder was used to record the whole session. Therefore, the social interaction of

the participant can be analyzed by both the experimenter as well as three observers.

Instrumentation

Checklist is observational tool that specify what behavior to evaluate systematically.

(Vukelich, 2008). The checklist included two main social interaction responses which were

verbal and physical responses. 13 items were used to record the participant’s social behavior.

The statements included “Have eye contact with adult who is talking with a child.”, “Say

good afternoon with nod head.”, “Say Please or Thank you with eye contact.” and “Give

appropriate response when others greet the child (e.g. smile).” The participant’s mother,

teacher and school principal were invited to do the checklist and they answered affirmatively

to all 13 statements.

Besides, the result of the study was collected by interviewing with the participant’s

mother, teacher and school principal. Therefore the social interaction of the child could be


reflected objectively. There were three interviews. Each interview held during the beginning,

middle and end of 27 sessions. The interview took place in the kindergarten and was finished

in April. The content of the interview included the observation of the participant’s social

interaction in different places which were at school and at home in different time. It provided

useful information to help to design the social stories book for the participant and helped to

understand the participants’ behavior in each session.

In order to record the learning progress of the social interaction of the participant, a

checklist was designed according to his need. There were four evaluation criteria for the

social interaction and it was summarized in Table 1.

Research Design

An ABACA multiple design consists of baseline (no social stories or pretend play),

social story intervention (B) and both of social story with pretend play interventions (C), and

with the final A phase intended as the baseline. Therefore, the baseline (A) and two

interventions, which were social story (B) and social story with pretend play (C) could be

compared. In this study, there were two objectives. The first one was to compare the

effectiveness of the intervention of social story with that of social story with pretend play for

a child with autism. The second one was to evaluate whether social story with pretend play

can enhance social interaction for a child with autism. Through ABACA, the research

questions could be examined in a more objective and concrete strategy. The research design


was summarized in Table 2.

Procedure

Phase A: Baseline and Maintenance. Baseline and maintenance data were collected in the

target setting. Therefore, the appropriate social interaction such as smile, eye contact and

social greeting can be measured before interventions were implemented. In phrase A, the

experimenter played with the autistic boy, and tried to communicate with the boy to observe

whether there was any social interaction before interventions were provided.

Material. Toys and puppets were needed to play with the autistic boy and this helps to

build a relationship with him. Dautenhahn (2000) claimed that autistic children prefer a

predictable and stable environment. Using a robot as a communication tool was effective to

form the bridge between autistic children and experimenter as unpredictable social behavior f

human might frightening to children with autism.

Phase B: Social stories. This was the first intervention for the autistic boy in the study.

Material. Individual social stories books were written and designed by the

experimenter to enhance the social interaction of the boy. All of the stories followed Gray’s

(2004) basic social stories guidelines and format. There included several types of sentences

which were descriptive, perspective, affirmative, cooperative and control sentences. In order

to maximize the appropriateness of the social stories for the autistic boy, the social interaction

of the child with the others was observed in class. Besides, the boy’s mother, teacher and


school principal were interviewed. Therefore, the social interaction of the child can be

reflected, and individual social stories can be designed which can satisfy the need of the

child.

The social stories were drawn on an A4 size card. Cartoon pictures were drawn by the

experimenter. Some photos were chosen as tools to allow the child to understand the content

of the social stories concretely. There were few topics in the sessions, such as saying

greetings when he met someone, saying “Thank you” to the teacher when the teacher

delivered some snack to him, greeting people in public places when he met relatives in the

streets or at the restaurants. The content of the text was about 1 to 2 pages long for each topic.

Intervention. The social stories were read directly to the autistic boy. The session for

social stories telling was about 15 minutes. Each session included one topic of the social

interaction. For instance, giving greetings, smiling and eye contact to familiar adult.

Phase C: Social stories and Pretend Play. The combined interventions which were social

story and pretend play were studied and implemented in phase C.

Materials. The social stories book was designed by the experimenter. Toys and puppets

were required in social stories telling and pretend play. Also, some pretend play tools were

needed in the pretend play session.

Intervention. The social stories were mostly the same as that in phrase B, but some new

topics were added as there are four steps in learning, which are input, maintain, enhancement


and generalization. After a period of learning, the knowledge and skills that the learners

acquired affect how they learn or perform in another situation which is generalization or

transfer (Ormrod, 2006). Mostly, learning helps to perform in another situation, which is

called positive transfer. As the content of the social stories are the same as that in phrase B

and phrase C, it was expected that the autistic boy can apply the skills of social interaction

into daily life such as in school, relative’s home and restaurant. Therefore, some daily life

situations were shown in the social stories. The story telling will last for about 10 minutes

and there will be about 15 minutes for pretend play.


CHAPTER FOUR

Results

PART A

The goal of the current study was to investigate whether social story with pretend play

can enhance appropriate social interaction among autistic children in an inclusive school. The

participant was a 4-year-old autistic child who was studying K1 in an inclusive kindergarten

in Hong Kong. Data was collected in one case study to evaluate the effectiveness of social

story with pretend play. It was collected through checklists and interviews with three

significant people of the child. Also, experimenter recorded and analyzed the data from the

video recording of the 27 sessions. Data collection was finished in April.

Observations from the child’s school principal, teacher and mother

Checklist. Frequencies of targeted social interaction of the autistic child were recorded by

the child’s school principal, teacher and mother at the beginning, the middle and the end of

the sessions. The results were presented in figures 1, 2 and 3 respectively. The first

interview’s scripts of the three observers were also showed in Appendix 11, 12 and 13. The

participant demonstrated few social interactions during baseline, with an average of 0.5 per

session that he could finish the tasks without any physical or verbal prompting and an

average of four per session that he did not have social interaction (see Figure 1 to 3).

After providing the intervention of social stories (intervention B), the participant increased


his attention span to an average of one per session. He could finish the tasks without any

physical or verbal prompting. Also, he was no longer lacking social interactions within

intervention B. The participant showed improvements in social interactions as he could

perform social interactions when others provided verbal prompting. The frequency of social

interaction with verbal prompting was about four per session (see Figure 1 to 3).

In the last period of session in March, social story and pretend play (intervention C) were

introduced to the participant. According to the observation of the three observers, the

participant had more unprompted social interaction to the others. The treatment was effective

in increasing the frequency of social interaction of the participant from an average 0.5 to 3

per session as he could finish the tasks without any prompting. From figure 1 to 3, the

frequency of social interaction of the participant was about six times per session under verbal

prompting. When compare with baseline levels, the participant had a lower frequency of

social interaction under physical or verbal prompting, which was six times and once in a

session respectively. After providing intervention B and C, the social interaction of the

participant was enhanced and he had more stable performance. His improvement in social

interaction continued and prompts were reduced, so less physical and verbal prompting were

required for the participant to perform social interaction.


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Figure 1. Frequency of social interaction during baseline and two interventions which was

recorded by the teacher.

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recorded by the school principal.

Interview. The current study was designed by the central idea of individual education

program. Therefore, the information of the autistic child was collected from different sources

in order to design a suitable session for the child. Also, having a good relationship with the

child’s significant people is important as experimenter can have good cooperation with them

to help the participant. There were three individual interviews which were arranged for the

child’s school principal, teacher and mother in the beginning, middle and last period of

session. A warm welcome and invitation can help to establish a good rapport between

experimenter and the three observers. The observers recorded the child’s social interaction in

school and home in three different periods. The observers recorded the child’s social

interaction at school and at home in three different periods. The interview questions were


modified by other interview sample questions which were used to study special needy

children (Appendix 10). The content of the interview was about three types of social

interaction, such as greeting and giving smile to people.

The first interview was conducted in September. The significant parties reported that the

participant was poor at giving verbal and physical responses in social interaction. No matter

he was at school or at home. He would not gave take the initiative to greet the adults or peers

whom he was familiar with by saying “good afternoon” or “bye bye” to them. Also the

participant did not know how to express his need appropriately, so he had difficulty in

communicating with adults or peers and had emotional behaviors. For instance, he would cry

when teachers stopped him from playing.

In December, the participant had emotional behaviors. He did not listen to the instructions

of teachers and he had some self stimulated behaviors such as blinking and yelling. Longer

time was needed to calm down. Also, it was observed that child’s social interaction was

reduced since session six. Therefore, in the second interview, an emotional and behavioral

checklist was used to understand why he had some misbehavior during the sessions. The

checklist was modified after reading a book “Understanding why problem behaviors occur”

which was written by Frea in1997. The teacher reported that there were some people or

events interrupting his play. Then he lost his temper and performed misbehavior.

The third interview was conducted in March. A debriefing about the sessions was provided


for three observers. The content was about the overall evaluation of those sessions. During

the debriefing session, there was a discussion on how to teach the participant in coming

sessions and suggestions were provided to each other. Also, the social interaction of the

participant was evaluated by the observers.

Participant’s mother. The participant’s mother reported that her child was willing to have

social interaction with peers and could give greetings to people without verbal or physical

prompting. For instance, he was willing to play with his relatives and he said “thanks” to

security guards when they opened the door for him. Also, he could say “thanks”, “good

afternoon” and “bye bye” to people and had eye contact with them without any prompting. In

September, it was observed that he did not say greeting to people and just played alone. Now

he had great improvement in social interaction when compared with the social interaction in

September.

Teacher. The teacher claimed that the participant showed great improvement in social

interaction when compared with that in baseline in September. For instance, he had parallel

play with other peers in class. Sometimes, he took the initiative to play with his classmates by

joining the play group. In September and October, he did not play with his classmates even

his teachers forced him to play with others. Now, the participant has two friends in class and

he likes to play with them. The social interaction of this autistic child was enhanced. Also, he

is willing to express himself. For example, he lets people know that he wants to go to the


toilet by simple verbal and physical responses. In September and October, he could not tell

people that he wanted to go to the toilet.

School principal. The school principal observed that the participant had improvement in

social interactions. In verbal responses of social interaction, he could express himself, by

telling others “he does not need” or “enough”. In physical responses of social interaction, he

waved his hand to greet people. Less misbehavior of the participant was observed, such as

yelling, saliva-play and fighting with other peers. Now, he can play with other peers with

longer time.

PART B

Observation from experimenter

Figure 4 showed the frequency of all types of social interaction of the child at baseline

and intervention B. Figure 5 showed the frequency of all type of social interaction of the

child at baseline and intervention C. Figure 6 showed the whole process of 27 sessions within

four months of intervention. It seemed that there was steadily enhancement in the social

interaction of the autistic child within the four months.

Baseline and social story. The autistic child learned social interaction about greeting and

having eye contact with others. Figure 4 showed that during baseline (A), the child had little

social interaction with the experimenter. Most of the time, he just played alone and lacked of

eye contact with the experimenter. During the intervention (B), social story was introduced to


the participant. The social interaction increased dramatically on all of the three kinds of social

interaction in the first four sessions of social story telling (B), with the mean of 33 times that

he could give greeting to others or had eye contact with the experimenter without any

prompting during intervention. However, in session 7 and 8, the frequency of social

interaction decreased suddenly although the frequency of social interaction was still higher

than that in baseline, with the mean of 33 times. The last four sessions of social story telling

(B) had steadily increased of social interaction among the participant. The greatest

enhancement in social interaction was in the last session during social story telling (B). The

frequency of social interaction was 73. He could perform the items in the checklist without

any assistance. The social interaction of the participant declined from the mean of 40 times to

the mean of 14 times when there was no any prompting after withdrawing from intervention

B.


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Figure 4. Child‘s all types of social interaction of the child at baseline and intervention B.

Social story with pretend play and baseline. Figure 5 showed that after the introduction of

the intervention B, the frequency of social interaction of the participant was higher in the

second baseline than that in the first baseline. During the play, the child was able to answer

questions correctly in questions such as “what you must say when others give the snack to

you?” He showed improvement after the introduction of intervention B as he did not give any

responses initially and he almost gave correct responses in interaction C. While the

participant was quite familiar with the pretend play procedure, he did better in interacting

with the experimenter instead of going to his own world. Therefore, he had more

communication and physical responses with the experimenter. The misbehavior such as

saliva-play and yelling reduced. He took the initiative to give the book to the experimenter


and he liked to read the social story book during intervention C. He understood the content of

social stories and he was able to perform what the social story said during the pretend play.

For instance, he gave money to the experimenter when he pretended to buy food and he

would say “thanks” and “bye bye” to the experimenter who pretended to be the seller. He

could pretend to drink an empty cup of tea and helped the experimenter to fill up the empty

cup of tea when he was invited to do so. Also he was willing to give food to the experimenter

when they pretended to have tea time. This study demonstrated an effective intervention

which helped the child to establish turn taking and spontaneous utterances during the pretend

play.

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Figure 5. Child‘s all type of social interaction of the child at baseline and intervention C.


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Figure 6. Child‘s all type of social interaction at baseline and two interventions.

Three categories of social interaction. The social interactions of the autistic child were

analyzed under three categories, which were verbal, physical and verbal with physical social

interactions. The three categories of social interaction were showed in Appendix 19.

Physical responses of social interaction. Figure 7 indicated the result of physical

responses during 27 sessions. During the baseline, there were few physical responses of

social interaction of the child. Most of the time he just played alone and paid attention to his

own world. Appropriate physical responses of social interaction of the participant were

changed after interventions B and C were introduced. The best performance of social

interaction in physical responses during intervention B had the mean of 35 times which is

more than that of baseline without prompting. After withdrawing from intervention B, the


physical responses decreased to the mean of 14 times in the second baseline. There was an

obvious improvement social interaction in physical responses after social story telling was

introduced. The best performance of social interaction in physical responses during

intervention C had the mean of 39 times without prompting. The frequency of social

interaction in both of the interventions was similar. Therefore, social story or social story with

pretend play also enhanced the physical responses of social interaction and the effectiveness

of both interventions was similar.

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Figure 7. Child‘s physical responses at baseline and two interventions which recorded by

experimenter.

Verbal responses of social interaction. Figure 8 indicated the result of verbal responses


during 27 sessions. At the beginning of few sessions, the autistic child nearly did not say

anything during the session, or just expressed simple sound like words to express his anger or

happiness. When he was asked some questions, he could not provide suitable responses. It

seemed that he did not understand the questions. Few complex sentences were followed after

social story telling (B) was provided. For instance, he could say “good afternoon” and “bye

bye” during social story telling and pretend play. Also, it was not expected that there was an

increase in the participant’s ability in answering the questions appropriately without any

physical or verbal prompting after intervention of social story and pretend play (C) was

provided. He could say “thanks” and “bye bye” when people gave gift to him and he left.

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Figure 8. Child‘s verbal responses at baseline and two interventions which was recorded

by experimenter.


Physical and verbal responses. Figure 9 indicated the result of physical and verbal

responses during 27 sessions. It was noted that participant’s social interaction of both

physical and verbal prompting appeared to be enhanced after the introduction of social story

and social story with pretend play on the social interaction of the autistic child and then the

enhancement became slower in both cases.

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Figure 9. Child‘s physical and verbal responses at baseline and two interventions which

was recorded by experimenter.


CHAPTER FIVE

Discussion

The purpose of this study was to answer the following two research questions. The first

one is to compare the effectiveness of the intervention of social story and social story with

pretend play for a child with autism. The second one is to evaluate whether social story with

pretend play can enhance the social interaction of the child with autism.

Research Implication

Effects of social story and social story with pretend play on the social interaction of the

autistic child

Physical responses. In previous studies, social story has been designed to reduce

inappropriate social behavior (Rogers & Myles, 2001). Social story also had positive effect

on the social interaction among the children with autism (Scheuermann & Webber, 2002).

The result of the current study was consistent with the previous findings on the social

interaction of the autistic child who had great improvement after the provision of social story

as intervention (Gray, 1995, 2000a).

Verbal responses. The greatest improvement on the verbal responses of social interaction

of the participant was in intervention B and C where there were verbal promptings. The

highest frequency was 22 and 23 respectively under verbal prompting. The improvement on

verbal responses of intervention C was greater than that of intervention B. It was consistent


with Piaget’s finding which illustrated that there was a relationship between pretend play and

language development in the second and third years of life (Morelock et.al., 2003). Pretend

play can enhance the verbal responses of the child and verbal responses also let child commit

in pretend play. Besides, the result could be explained by the previous study that there was

adaptation value which motivated children to learn and communicate with others (Wadsworth,

2004). Therefore, the participant had better social interaction in intervention C. Also, the

participant was experiencing the critical learning period of language. Some psychologists

believe that the burst of vocabulary was between 18 months and at the age of 6 as children

can learn six new words in the critical learning language period (Vasta, 2004). Therefore,

verbal responses of social interaction were enhanced more easily by social story with pretend

play intervention.

Physical and verbal responses. Result showed that social interaction of both physical

and verbal responses of social interaction enhanced after the introduction of social story and

social story with pretend play and then the enhancement became slower in both cases. It

could be explained by four learning processes, which were input, maintenance, enhancement

and generalization. At the first few sessions, social interaction could be learned fast as the

participant was at the input stage. Then the social interaction reduced but it was higher that

that at baseline as he was at the maintenance stage. According to the result, the enhancement

magnitude of intervention C (social story with pretend play) was higher than that of


intervention B (social story). It indicated that social story with pretend play was a better

strategy to enhance the physical and verbal responses of social interaction of the autistic child.

According to the interviews and checklists recorded by the three observers, the participant

had improvement on verbal responses and physical responses in other time and place. The

external reliability was high in this study. The improvement was not just happened during

sessions. It could be explained by the previous finding which illustrated that after a period of

teaching social interaction, the social skills that people acquired affect how he or she learnt or

performed in another situation which was the generalization or transfer (Ormrod, 2006).

The result indicated that the participant had greater improvement in intervention C. It

was consistent with Erikson’s theory which stated that pretend play was a good teaching

strategy to provide social interaction and practicing social roles for autistic children

(Macintyre, 2006) The different findings of this study and the previous findings showed that

autistic children can enjoy themselves in pretend play. Although there was previous finding

which showed that autistic children had limited language and symbolic thought which helped

them to benefit from pretend play (Landreth et al., 2005), the participant in the current study

could understand the experimenter’s instructions and turn taking was improved during

pretend play sessions. It was due to the function of social story as the child could have

concrete pictures in his mind which tell him what was the appropriate social interaction in

some situations. Therefore, there was schema in the child’s mind and he could follow the


schema to have pretend play.

Effect of social story with pretend play on social interaction of autistic child

Throughout 27 sessions, the social interaction of the participant exhibited improvement

after intervention was introduced. Especially the intervention of social story with pretend

play was introduced in intervention C. The results suggested that social story with pretend

play could enhance the social interaction among autistic children.

Results showed that the participant had a great improvement in three types of social

interactions. For instance, he showed more willingness to say greetings to the others. It had

even been found that the participant tried to say “goodbye” to his familiar people

automatically. It was supported by previous research that social story can enhance social

interaction of autistic children (Scheuermann & Webber, 2002). Also, most 5-years-old

children know enough vocabulary to communicate about everyday things (Senchal &

LeFevre, 2002).While participant was aged 4-years-old, he was under a critical period to

learn conversation.

It seemed that the participant was more willing to ask other classmates to play with

him. Although he still did not know how to express himself appropriately when he showed

interest in interacting with others, he tried to touch his classmate’ head and then run away. It

showed that the child had interested to play with other. When compared with his pervious

behavior, the participant just played in the corner and did not show any interest to play with

the others. Now he really had better social interaction with the others. That was the

observation by the experimenter, teachers, school principal and his mother.


Factors that make the intervention not effective

Result indicated that there was some unstable social interactions among the participant

during the 27 sessions. Sometimes, the frequency of social interaction decreased suddenly.

After analyzed the data which was collected from interviews, checklists and observation by

three observers and experimenter, there were little assumptions on the decrease of social

interaction among the participant.

Physical factor. First, child was sick in December. Therefore he was very tired and lack of

energy to pay attention during sessions. The verbal or physical responses of social interaction

decreased greatly.

Family factor. Second, there was great decrease in social interaction of participant in

March. It was because participant was given higher tolerant in home during Chinese New

Year holiday, so he lost his temper easily during session when he came back to school. Also,

the child lacked of training sessions, he forgot how to perform the appropriate social

behavior.

Environmental factor. Third, it was consistent with previous finding that using puppet

could draw the attention of participant and communicate with him (Dautenhahn, 2000).

Sometimes, participant was attracted by toys and then just focused on playing toy during

sessions, then the session could not held fluency and he also not willing pay attention to

learn.


Limitations

While the sessions were took place in kindergarten, the intervention was disturbed by

noise and other people in school. Also, there was not enough room in kindergarten,

sometimes the place for session need to change. It caused participant to feel unstable as the

place was changed.

Besides, single case study provided detailed information among the study of social

interaction of autistic child. Also, using single subject design by reversal designs was ideal to

investigate the effectiveness of two interventions for one participant (Powell, Symbaluk &

MacDonald, 2005). However, firm conclusions about the effectiveness of the interventions

could not be made (Powell, Symbaluk & MacDonald, 2005). It was because there was many

factor of the single subject affect the results of study. For instance, there was maturation

effect among the participant. Therefore, the effect of intervention changes may be

overshadowed by biological or psychological of the participant (Salkind, 2006).

As the participant is the only child in a middle class family, he was well treated at

home by his parents and servant. What he prefers to get something, most of the time his

family members provided him with that immediately. Therefore, he developed rigid and

stubborn personality which was commented by the experimenter and the other three

observers. He lost temper easily. When he could not get something he liked or he was

prohibited to play, he would lie on the floor and cry loudly until he got what he wanted. He


seldom followed the adult’s instruction at the beginning of September. For instance, the

participant could not sit well in class, and always run or walk in the classroom. He could be

disturbed by other objects easily when he found something he liked. Then he paid much

attention on it. It was a great challenge to stop him from playing and then have session time.

It was the greatest difficulty to start to teach the participant. Also, it was not easy to control

his behavior at the beginning of the sessions due to his personality. In the first session, the

participant cried a lot and kept on running in the classroom. Sometimes, he just wanted to

play outside and was not willing to have the sessions. It was difficult to make the child quiet,

so that he can pay more attention in sessions at the beginning.

Also, the content of the session was to teach the participant to say greetings to people,

but he was weak at saying and was not interested in communicating with the others at the

beginning of the sessions. Even he could understand experimenter’s requirements, he might

not model me immediately. His learning and modeling depended on his emotion on that day.

Sometimes he was willing to say a lot and sometimes he rejected to say anything and just

wanted to have time to play.

Suggestions

Special Cues. Experimenter used lots of visual cues to help the child for understanding

what appropriate social interactions are. Puppet, picture and photo were used as visual cues.

It is useful to provide real teaching tools during social stories session as it not only can draw


attention from the autistic children, but also it can convert some abstract ideas into concrete

ones. In this study, some real photos about how to have social interaction with others are

showed and these photos matched with the content of the social stories. The autistic children

can learn a lot from these photos. The participant showed higher interest to learn while visual

cues used, such as photo of fast food shop. It was supported by previous study done by

Thiemann and Goldstein (2001). It was easier for autistic children to remind attention in

session. There were several physical cues we applied in the session. For instance, combined

“good afternoon” with nod the head, and saying “bye bye” with hand shaking. It could be

easier to learn for the autistic child.As the participant lacked the interest to have session, the

experimenter can try to use some tools to capture his attention. More interesting tool can be

used to attract his attention to model what the experimenter say. He might be more willing to

learn how to greet people.

Cooperation with school is important to help the autistic children. Since the participant

was not willing to have session because of the attractions from the outdoor activity or toys

during play time, the experimenter can communicate with the school and try to cooperate

with the teachers, so that the school can arrange the time for the session after class instead of

after the play time.

For school. Individual education program (IEP) and social stories needed to be tailor-made

for each autistic child as each child is different and has different physical and psychological


need. Also, providing suitable training for teachers is important as autistic children can be

taught more easily and can be more involved in social interaction with effective and

appropriate teaching method. Teacher is one of the important people in their lives as children

spend a lot of time at school. If teachers can build up a good relationship with them, the

autistic children will be more likely to be taught. As a result, they can learn their social skills.

During the four-month-sessions, it was observed that having a close relationship with a child

is important to be a guider in their learning. If teachers and children can build up a good

rapport, it can be beneficial to improve the social interaction of the autistic children as these

children will be more willing to approach some adults that they are familiar with in order to

have social interaction. Same result can be observed when the experimenter tried to approach

the autistic child. He is more willing to smile at and say something to someone that he likes.

For parents. Actually social story is one of the most effective strategies to enh

social stories and pretend play for autistic children...

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