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http://foa.sagepub.com Disabilities Focus on Autism and Other Developmental DOI: 10.1177/108835769901400203 1999; 14; 82 Focus Autism Other Dev Disabl Taku Hagiwara and Brenda Smith Myles A Multimedia Social Story Intervention: Teaching Skills to Children with Autism http://foa.sagepub.com/cgi/content/abstract/14/2/82 The online version of this article can be found at: Published by: Hammill Institute on Disabilities and http://www.sagepublications.com can be found at: Focus on Autism and Other Developmental Disabilities Additional services and information for http://foa.sagepub.com/cgi/alerts Email Alerts: http://foa.sagepub.com/subscriptions Subscriptions: http://www.sagepub.com/journalsReprints.nav Reprints: http://www.sagepub.com/journalsPermissions.nav Permissions: by georgela taranu on April 17, 2009 http://foa.sagepub.com Downloaded from

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Disabilities Focus on Autism and Other Developmental

DOI: 10.1177/108835769901400203 1999; 14; 82 Focus Autism Other Dev Disabl

Taku Hagiwara and Brenda Smith Myles A Multimedia Social Story Intervention: Teaching Skills to Children with Autism

http://foa.sagepub.com/cgi/content/abstract/14/2/82 The online version of this article can be found at:

Published by: Hammill Institute on Disabilities

and

http://www.sagepublications.com

can be found at:Focus on Autism and Other Developmental Disabilities Additional services and information for

http://foa.sagepub.com/cgi/alerts Email Alerts:

http://foa.sagepub.com/subscriptions Subscriptions:

http://www.sagepub.com/journalsReprints.navReprints:

http://www.sagepub.com/journalsPermissions.navPermissions:

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A Multimedia Social Story Intervention:Teaching Skills to Children with AutismTaku Hagiwara and Brenda Smith Myles

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

ndividuals with autism have beenshown to be responsive and produc-tive when exposed to appropriate

educational and training procedures andconditions (Dyer, Williams, & Luce,1991;MacDuff, Krantz, & McClannahan, 1993;Mesibov, 1997). A structured and con-crete educational environment is essen-tial for persons with autism (Mesibov,Schopler, & Hearsey, 1994) because theyoften have difficulties in assembling frag-mented information into a meaningfulwhole and in decoding abstract informa-tion (Frith, 1989).

Within the confines of creating a struc-tured and concrete educational environ-

ment, various interventions and educa-tional programs have been developedand implemented for children and youthwith autism (Dawson & Osterling, 1997).Among those educational attempts, socialstories appear to have promising effects toteach children and youth with autism.

In this regard, Gray (1994), Gray andGarand (1993), and Swaggart et al.

(1995) contended that social stories areone way to teach children with develop-mental disabilities appropriate social be-haviors and interactions, increasing the

likelihood of better performance acrosseducational and vocational settings. Thisinstructional technique is thought to

minimize the confusion of verbal in-

structions and social interactions for per-sons with autism (Gray & Garand, 1993)through the use of pictures or symbolscombined with short sentences in a smallbook format.A social story describes social situa-

tions in terms of relevant social cues and

identifies appropriate responses for indi-vidual students. It typically comprisestwo to five sentences that are (a) descrip-tive, including information about the set-ting, participants, and actions; (b) direc-tive, containing statements about the

appropriate behavioral response; (c) per-spective, describing the feelings andreactions of others in the targeted situa-tion ; and (d) control, providing analo-gies with similar actions and responsesusing nonhuman subjects (Gray, 1994;Gray & Garand, 1993).

In guidelines for social story use, Gray(1994) and Gray and Garand (1993)stated that social stories are most appro-priate for students who have mild dis-abilities, such as learning disabilities,

high-functioning autism disorder, or

Asperger syndrome (Gray & Garand,1993). In terms of format, Gray andGarand suggested that the entire story bepresented on one piece of paper withoutthe use of visual stimuli. Furthermore,they cautioned that, for social stories tobe most effective, they should be indi-vidualized for each student.

Gray (1994) identified the followinguses for social stories: (a) describing a sit-uation, including social cues and re-

sponses in a nonthreatening manner;

(b) personalizing social skills instruction;(c) teaching routines or student adjust-ment to routine changes; (d) teachingacademic material in a realistic social set-

ting, thereby assisting in generalization;and ( e ) addressing myriad behaviors,such as aggression, obsessive behavior,and fear. Thus, social stories have a broadapplication for children and youth withautism.

According to the guidelines estab-

lished by Gray (1994) and Gray andGarand (1993), social stories were mosteffective with higher functioning chil-

dren and youth with disabilities. Swag-gart et al. (1995) expanded the applica-bility of the social story intervention tochildren and youth with moderate to se-vere autism. First, the authors adopted asocial story format consisting of a book-let with one sentence on each page. This

procedure minimized the amount of in-formation students received at a time.

Second, they added an icon that matchedthe sentence on each page. Icons help

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students to recognize stories because, asthe aforementioned research has shown,many students with autism are visual

learners. Third, a similar social story waspresented to more than one student.This enabled the use of an individualizedsocial story in a small-group setting.Furthermore, this enhancement andmodification of the originally establishedguidelines appeared to increase appropri-ate interactions for children with autismin inclusive settings and provided a wayto reach a large number of students inmany environments with a low-cost in-tervention in terms of personnel, time,and equipment.To date, two studies have been pub-

lished on the effects of social stories.

Swaggart et al. (1995) investigated theeffects of social stories to teach three chil-

dren with autism (ages 7 to 11; two boys,one girl) social and behavioral skills.

Kuttler, Myles, and Carlson (1998) stud-ied the use of social stories to reduce pre-cursors to tantrum behavior. Both stud-ies reported positive changes in studentbehavior as a result of social story use.

The purpose of this story was to ex-

pand investigation of the use of socialstories by introducing a medium of pre-sentation. The multimedia social storyintervention was created by Hagiwara(1998) to allow students to learn newskills through social stories presented ona computer. The multimedia social storyintervention embodies the characteristics

of social stories in a structured, consis-tent, and attractive presentation with

ample visual stimuli and sound made

possible by the computer system.

Method

ParticipantsThree White elementary-age students

were recruited from a suburban school

district in a midwestern state. All partici-pants had previously been diagnosedwith autism by a licensed psychologist,psychiatrist, educator, or multidiscipli-nary clinical team trained to assess chil-dren and youth with autism. None of theparticipants took seizure medications or

demonstrated other physical disabilities

(e.g., blindness, deafness, physical im-pairments).

Each of the participants also met thefollowing criteria: (a) mild to moderatesocial skill problems and related behaviorproblems; (b) basic listening or writtenlanguage skills; and (c) fine motor skillsthat allowed for manipulation of a com-puter, such as moving the mouse or click-ing its button. Selection of the partici-pants was not limited to those who didnot have prior experiences with social

story interventions.Each of the participants’ scores on the

following tests were obtained to confirmthe presence of autism-related character-istics and students’ current social skill lev-

els : the Autism Behavior Checklist (ABC;Krug, Arick, & Almond, 1988); the Be-havior Assessment System for Children:Teacher Rating Scales (BASC; Reynolds& Kamphaus, 1992); and the Psycho-educational Profile-Revised (PEP-R;Schopler, Reichler, Bashford, Lansing, &Marcus, 1990). To evaluate the partici-pants’ targeted behaviors, the MotivationAssessment Scale (MAS; Durand & Crim-

mins, 1992 ) was administered.

Participant I. Participant I was a

White boy, 7 years 11 months of age,enrolled in inclusionary settings for mostof the school day. His score on the ABCwas 108, which was within the range ofclassification of autism. On the BASC, hescored 48 on the externalizing problemscomposite, 57 on the internalizing prob-lems composite, 59 on the school

problems composite, and 34 on the

adaptive skills composite. All scores ofthe BASC composites were within aver-age ranges, except that of the adaptiveskills composite, which fell in the at-

risk range. Participant I’s score on thePEP-R was 82, which indicated his de-velopmental age was 36 months. Resultsof the MAS suggested that the motiva-tion for his off-task behavior was sensory,

escape, attention, and tangible, in this

order.

Participant li. The second partici-pant was a White boy, 9 years 11 months

of age. He, too, was in inclusionary set-tings for most of the school day. Hisscore on the ABC was 96, which waswithin the range of classification of

autism. On the BASC, he scored 58 onthe externalizing problems composite,62 on the internalizing problems compos-ite, 61 on the school problems com-posite, and 32 on the adaptive skills

composite. Scores on the externalizingproblems composite indicated average

functioning; however, scores on the

other composites were within the at-riskrange. Participant Il’s score on the

PEP-R was 64, which indicated that hisdevelopmental age was 26 months.

Results of the MAS ranked the reasons of

motivation for his off-task behavior as es-

cape, sensory, tangible, and attention.

Participant III. Participant III was aWhite boy, 7 years 3 months of age. Al-though he was in inclusionary settingspart of the time, he spent half of his schoolday in the resource room. His score onthe ABC was 82, which was within the

range of classification of autism. On

the BASC, he scored 54 on the external-izing problems composite, 51 on theinternalizing problems composite, 60in the school problems composite, and34 on the adaptive skills composite. Scoreson the externalizing problems and theinternalizing problems composites indi-cated average functioning; however,scores on the school problems and theadaptive skills composites indicated thathe was at risk for school failure. His scoreon the PEP-R was 93, which indicatedthat his developmental age was 40 months.Results of the MAS ranked the reasons ofmotivation for his off-task behavior as

sensory, escape, attention, and tangible.

Design

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

ers are responsible for the ... social be-havior of children across a broad range ofenvironmental conditions, and it is often

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necessary to concurrently modify behav-ioral excesses (or deficits) exhibited inseveral ... environments.... Beyondthe classroom, educators assume respon-sibilities for children in buses, lunch-

rooms, playgrounds.... The multiplebaseline design across conditions can

prove helpful in identifying interventionprograms that foster generalized re-

sponding across many natural environ-ments&dquo; (p. 247).

Each participant’s data were collectedin three settings for one target behavior.Washing hands was chosen as a target be-havior for Participants I and II. Settingsfor Participant I were before morningsnack, prior to lunch, and after recess.Settings for Participant II were beforegoing to the resource room, before lunch,and after recess. The target behavior for

Participant III was on-task behavior.

Settings for Participant III were lunch,resource room, and general educationclassroom.

Instruments

The following instruments were usedin the study: (a) MacintoshTM computersystems for developing the multimediasocial story program and executing thestudy in students’ classrooms (see Note);(b) a video camcorder to capture stu-dents’ actions on camera; (c) social sto-ries created jointly by students’ teachers,paraprofessionals, and the investigator toaddress students’ needed skills that were

input into the multimedia social storyprogram; and (d) the multimedia socialstory programs developed for each par-ticipant.

ValidityThe validity of the social stories was

established by consulting five educatorsand professors with experience in creat-ing a social story. The examination fo-cused on the contents of social stories, in-cluding clear focus on the target behaviorand use of appropriate descriptive, direc-tive, perspective, and control sentences inthe social stories (Gray, 1994, 1995;Gray & Garand, 1993).

Data Collection Schemeand Reliability -

For Participants I and II, the task ofwashing hands was divided into the

following six steps using task analysis:(a) turn on the water, (b) put soap onhands, (c) rub both hands under thewater, (d) take paper towel, (e) dry bothhands with paper towel, and (f) throwaway paper towel. One paraprofessionalfor Participant I and two paraprofession-als for Participant II collected the rele-vant data.

Scoring was based on the followingcriteria: (a) independent response,

(b) prompted, and (c) physically assisted.An independent response was defined asthe student completing the task withoutany external verbal requests or prompts.Prompts or cues were given by the para-professionals if the participant did notcomplete tasks within 5 seconds. Physicalassistance was provided if the participantdid not respond to prompts or cues after5 seconds. Scores were coded and re-corded on the data sheets provided bythe investigator.

Interobserver agreement was deter-

mined by comparing scoring agreementsand disagreements between the parapro-fessionals and the investigator. For Par-ticipants I and II, interobserver agree-ment was calculated by the followingformula: agreements/( agreements + dis-agreements) x 100 (Tawney & Gast,1984).

For Participant III, average durationsper occurrence of on-task behavior werecollected during 20-minute observationsessions (Alberto & Troutman, 1995;Tawney & Gast, 1984). On-task behav-ior was defined as any of the followingbehaviors: (a) reading or reading aloud,(b) having eye contact with teachers,(c) writing, (d) commenting related tothe task in which the participant en-gaged, (e) answering to the teachers, and(d) watching objects related to the task(i.e., television, pictures, or computers).For Participant III, the formula to calcu-late interobserver agreement was shorternumber of minutes/longer number ofminutes x 100 (Alberto & Troutman,1995 ).

Procedure

The following procedures occurred todevelop the social stories, place themwithin a multimedia context, and carryout the study:

Provide Social Story Training. All

participants were trained by the investi-gator. Teachers and paraprofessionalslearned to interpret a functional analysis,clearly define targeted behaviors, and de-sign a social story. Paraprofessionals whocollected data received instruction on

operating the multimedia social story in-tervention program, implementing theintervention, and collecting ongoing data.

Specify Target Behavior and Con-duct a Functional Analysis. A targetbehavior was set for each participant byconsulting teachers, paraprofessionals, orparents, and observations made by theinvestigator. A functional analysis usingthe Motivation Assessment Scale was con-

ducted to evaluate situations and contin-

gencies related to each student’s targetedbehavior and to identify the sequence ofsteps necessary to acquire a new or re-placement behavior (see Design section).

Develop the Multimedia Social

Story Programs. The multimedia so-cial story programs were developed bythe investigator using the HyperCardTM(Apple Computer, 1994) software. Thisprogram had a book-like format, whichcontained text of the social stories;movies of the participants’ actions corre-sponding to social story sentences; audiocapability that read aloud sentences usinga synthesized computer voice; and a nav-igational button clickable by the partici-pants. Appendix A overviews the stepsnecessary to create the multimedia social

story intervention. A copy of ParticipantI’s multimedia social story appears in

Appendix B. 1

:1.

Implement Multimedia Social StoryIntervention. The following steps oc-curred following identification of the tar-get behavior through functional analysisand social stories creation:

Collect baseline data across three environ-ments. The first intervention was

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presented when the baseline dataachieved an acceptable stability inlevel and trend across all threeconditions.

Teach the use of the computer. Theteacher or the investigator taught theparticipants the basic skills for usingthe MacintoshTM computer. Theseskills included moving the mouse tomove the cursor on the display, click-ing the mouse button to push thebutton on the display, and clickingthe play button to start the movie.

Apply intervention. Prior to entry intoEnvironment I, the teachers, para-professionals, or investigator in-troduced the participants to theirtailor-made social story using themultimedia social story intervention.

During the first condition, the socialstory named the location and Envi-ronment I (e.g., resource room) inwhich the appropriate behavior wasto occur. The multimedia social storyprogram was operated once a day.When stability in level and trend wasestablished for Environment I, theidentical multimedia social story pro-

gram with a referent for Environ-ment II was introduced prior toentry into Environment II (e.g.,reading class). Following criterion at-tainment in the second condition, theintervention was applied to Environ-ment III (e.g., general educationclassroom). Each multimedia socialstory program was operated by theparticipants daily just prior to entryinto the appropriate environment.

Collect Ongoing Data. The para-

professionals in each environment con-ducted daily assessments of the behaviortargeted in each participant’s multimediasocial story programs. Methods of data

collection were specified as previouslydiscussed. Any external events, partici-pants’ conditions, or other noteworthychanges of the participants or environ-ments were anecdotally recorded.

Data AnalysisData were reported on three line

graphs, one for each participant, as well

as on a table of anecdotal records. The vi-sual analysis method was employed toanalyze the data for each participant.According to the guidelines establishedby Tawney and Gast (1984), visual analy-sis is conducted on (a) the number ofdata points plotted in each phase; (b) thenumber of variables changed betweenadjacent phases; (c) the stability andchanges in level within and between

phases and environments; and (d) trenddirection, trend stability, and changes intrend within and between phases and en-vironments.

Results

ReliabilityInterobserver agreement was assessed

on approximately one third of all obser-vations in which participants used themultimedia social story intervention.

Reliability checks were conducted by theinvestigator, school paraprofessionals,and graduate special education studentsacross the environments in which thestudies were conducted. A coefficient of

agreement was calculated for each settingchosen for the participants. These coeffi-cients were averaged to yield a mean in-terobserver coefficient of agreement foreach participant.The mean interobserver coefficient of

agreement was calculated at 100% for

Participants I and II during 33% and 37%of the total sessions, respectively. Reli-

ability for Participant III was 89% for33% of the sessions.

Data AnalysisThe data are presented in figures that

represent the effects of the intervention

using the multimedia social story pro-grams for the three students who partic-ipated in the study. Each figure is struc-tured using a multiple-baseline formatthat contains a set of three line graphsthat represent the three settings assignedfor each participant.

Participant I. Figure 1 depicts Par-ticipant I’s performance on the task ofwashing hands in three settings: before

morning snack, before lunch, and afterrecess. Table 1 summarizes the anecdotalrecords taken during the observations.

In the baseline condition in the morn-

ing snack setting, trend and level stabili-ties were established over five consecu-tive observations. The trend direction

indicated a deterioration of ParticipantI’s performance. Percentages of hand-washing completion ranged from 75% to83%. Specifically, Participant I was pro-vided prompts to complete the step ofputting soap on his hands and physicalassistance to rub both hands under thewater during the baseline condition.

In the morning snack setting duringthe intervention condition, trend andlevel stabilities were established over 17

consecutive observations. The directionof the trend line indicated improvementof Participant I’s hand-washing perfor-mance. Between the first day (Day 6) andthe last day (Day 24) of introduction ofthe multimedia social story program, a17% gain occurred. Participant I’s per-formance appeared to be stable until Day23 after the introduction of the multi-media social story program. From Day 6to Day 23, task accuracy was between75% and 83%; the same range that wasobserved during the baseline condition.On Day 9, data were not collected be-cause Participant I had a tantrum. On

Day 15, he ran back to his classroomwithout washing his hands after using therestroom. An improvement of perfor-mance was observed during the last2 days of this condition. Participant I

completed all steps of the hand-washingtask without any prompts or physical as-sistance on Day 24, the last day of the ob-servation.

In the baseline condition of the before-lunch setting, trend and level stabilitieswere established over 13 consecutive ob-servations. Target behavior accuracy wasbetween 75% and 83%, which was similarto that in the morning snack setting.Although an 8% deterioration in this

condition occurred, the direction of trendline was level, which meant that therewas no change in Participant I’s perfor-mance.

Analysis of the intervention conditionin the before-lunch setting revealed a

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FIGURE 1. Participant l’s performance on the hand-washing task.

positive change in Participant I’s perfor-mance. Trend and level stabilities wereestablished over 11 consecutive observa-

tions. One day after the introduction ofthe multimedia social story program, the

participant’s performance improvedfrom 75% to 83% and was maintainedover 6 consecutive days. An increase in

percentage of completion was observedduring the last 3 days in this condition.Specifically, Participant I required promptsto dry both hands with a paper towel, al-though he completely rubbed bothhands under the water on Day 22, andrequired prompts to rub both hands

under the water on Day 23. On the last

day in this condition, Participant I inde-pendently completed all steps in the hand-washing task analysis.

In the before-lunch setting, an im-provement in Participant I’s perfor-mance was observed after the introduc-tion of the multimedia social storyprogram. The change in trend directionbetween conditions was negative to pos-itive, although an initial effect of the in-tervention was not observed in this

setting. A 73% overlap was evidenced be-tween the baseline and intervention con-ditions.

In the baseline condition in the after-

recess setting, trend and level stabilitieswere established over 17 consecutive ob-servations. The direction of the trendline indicated a positive change. An 8%gain occurred during this condition.

Participant I’s performance was main-tained at 87% over 6 consecutive days(from Day 13 to Day 18). This level ofmaintenance was not observed in the

other two settings without introductionof the multimedia social story programs.

In the intervention condition in theafter-recess setting, trend and level sta-bilities were established over six consec-

utive observations. The direction of trendline indicated a positive change. Levelchange was reported from 83% to 92%-a 9% gain during this condition. Highlevels (92%) of task completion were ob-served during the final 4 days of obser-vation. Specifically, on Days 21, 22, and23, Participant I required only verbalprompts to rub both hands under thewater. On the last day (Day 24), he in-dependently completed rubbing both

hands under the water, although he wasprompted to turn on the water, which re-sulted in a 92% completion rate.Although not reflected in the data

plotted in Figure 1, a gradual improve-ment in Participant I’s performance ofrubbing both hands under the water wasrecorded in the anecdotal data. On Day8, he put both hands under runningwater. On Day 8, he also stopped scream-ing when physically assisted to completethis task by the paraprofessional. Thischange was observed across all settingsfrom that day forward. Participant I

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TABLE 1. Anecdotal Records of Participant I

started rubbing his fingertips under

the water on Day 14 in the after-recesssetting. Pressing both hands under

the water was observed on Day 19 in themorning snack setting. On Day 21,Participant I began rubbing both handsunder the water, although he neededprompts to complete the task.

In summary, Participant I’s improve-ment in washing hands was observedafter the introduction of the multimedia

social story program. His performancereached 100% accuracy in completion onthe last day of intervention in the before-morning snack and before-lunch settings.Generalization and maintenance of task

performance was observed during thebaseline condition in the after-recess set-

ting.

Participant li. Figure 2 depicts Par-ticipant 11’s performance on the hand-washing task in three settings: before go-

ing to the resource room, before lunch,and after recess. Table 2 summarizes

anecdotal records taken during the ob-servations.

In the baseline condition in the before-

resource room setting, trend and levelstabilities were established over 4 con-secutive days. Direction of the trend wasnegative, which indicated deteriorationof Participant 11’s performance. Range ofdata in this condition was 75% to 83%

completion; level was unchanged.Participant 11’s percentage of hand-

washing completion did not change dur-ing the intervention condition in the

before-resource room setting. Over 12consecutive days, his performance wasmaintained at a completion rate of 83%.Specifically, Participant II needed physi-cal assistance to rub both hands under

the water on all observation daysthroughout this condition. Althoughanecdotal records reported that Partici-

pant II gradually improved his ability torub both hands under the water from

Day 12, he still required physical assis-tance. However, he at least pressed bothhands under the water from that day for-ward.

A between-condition analysis in thebefore-resource room setting revealedthat there was little substantial improve-ment in the target behavior after the in-troduction of the multimedia social storyprogram. Specifically, an 8% gain oc-

curred between the baseline and inter-

vention conditions. Data in the interven-tion condition overlapped 100% withdata in the baseline condition.

In the baseline condition in the before-lunch setting, trend and level stabilitieswere established over 8 consecutive days.An 83% completion rate was plotted.Participant II was provided physical as-sistance to rub both hands under thewater on all days in this condition.

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FIGURE 2. Participant II’s performance on the hand-washing task.

Participant II’s performance duringthe intervention condition in the before-lunch setting was maintained at 92%

completion, except on Day 13. Trendand level stabilities were established over8 consecutive days. From the first day ofintroduction to the multimedia social

story program, Participant II needed

only prompts to complete the task ofrubbing both hands under the water. He

was physically assisted to complete thistask only on Day 13.A between-conditions analysis on the

before-lunch setting indicated a positiveimprovement in Participant II’s hand-

washing task completion. Although datatrends in both conditions indicatedmaintenance of Participant Il’s perfor-mance, a 9% gain between the conditionsresulted. There was a 13% overlap in the

data between the baseline and interven-

tion condition.

As observed in the before-lunch set-

ting, Participant 11’s level of performancewas maintained in the baseline conditionin the after-recess setting. Trend and

level stabilities were established over 12

consecutive days. Throughout this con-dition, Participant II needed physical as-sistance on rubbing both hands underthe water, which yielded an 83% comple-tion rate. Anecdotal records indicatedthat Participant II demonstrated a grad-ual improvement in the task. Beginningwith Day 10, he at least pressed bothhands under the water when promptedby the paraprofessional.

In the intervention condition in theafter-recess setting, Participant Il’s per-formance improved. Trend and level sta-bilities were established over 4 consecu-tive days. The range of his performancewas between 83% and 92%. There was a

9% improvement in Participant II’s per-formance. Specifically, on the last 2 days(Days 15 and 16) in this condition, hecompleted the task of rubbing bothhands under the water with prompts.

Between-condition analysis for theafter-recess setting revealed a positivechange in Participant 11’s performance.Although an initial effect of introducingthe multimedia social story program was

not observed, Participant II’s perfor-mance improved from 83% to 95% com-pletion during the intervention condi-tion. There was a 50% overlap in thepercentage of task completion betweenthe conditions.

Participant II did not require any tech-nical assistance to operate the multime-dia social story programs. At the initial

presentation of the program, he immedi-ately learned to navigate through the

pages of the program when the investi-

gator pointed to the navigational buttonon the computer display. Participant IIdid not show any negative behaviors suchas avoidance or tantrumming while op-erating the program. He complied withhis paraprofessional’s direction when thetime came to go to the computer and op-erate the program. Furthermore, anec-dotal records reported that ParticipantII’s attention was focused on the com-

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TABLE 2Anecdotal Records of Participant 11

puter display while operating the pro-gram.

In summary, Participant II improvedhis hand-washing skill after the introduc-tion of the multimedia social stories.

Specifically, gains were observed in thebefore-lunch and after-recess settings;however, he did not reach 100% accuracyduring the intervention. Participant 11’sperformance improved to a 93% comple-tion rate, which means that he needed

prompts to complete the task.

Participant Ill. Figure 3 depictsParticipant III’s average duration of on-task behavior in three settings: lunch, re-source room, and general education

classroom. Table 3 summarizes anecdo-

tal records taken during the observa-tions.

In the baseline condition of the lunch

setting, trend and level stabilities were es-tablished over 3 consecutive days. Direc-tion of the trend was negative, whichindicated a decrease in the average dura-

tion of Participant III’s on-task behav-ior. On-task behavior in this condition

ranged from 26 to 38 seconds. A de-

crease in on-task behavior of approxi-mately 12 seconds occurred during thebaseline condition.

Substantial effects were not observedwhen the multimedia social story pro-gram was introduced in the intervention

condition of the lunch setting. The over-all trend direction of all data in this con-dition was negative, although on-task be-havior increased initially. Trend and levelstabilities were not established. Despitedata variability, an increase in the averageduration of on-task behavior was ob-

served during the first 4 days (betweenDay 4 and Day 7) after the introductionof the multimedia social story program.Specifically, a 66-second gain was ob-served during the 4 days. ParticipantIII’s performance decreased from Day 9to the last day of the intervention and didnot show improvement.

Observations were not conducted on

Days 12, 13, and 15 because of an out-side lunch with peers, lunch with fami-

lies, and a field trip, respectively. A be-tween-condition analysis in the lunch

setting did not show improvement inParticipant III’s performance after the

introduction of the multimedia socialstories. Although he had a 15-secondgain in on-task behavior between condi-tions, variable data existed in the inter-vention condition. There was a 44% over-

lap in the data between the conditions.According to anecdotal records, Par-

ticipant III’s on-task behavior duringlunch was interrupted by his self-

stimulatory behavior (i.e., touching orpulling his hair, tapping table with hishand, erratic eye movement, or unfo-cused eye gaze). Thus, his duration ofon-task behavior increased when less self-

stimulatory behavior was observed.In the baseline condition of the re-

source room setting, trend and level sta-bilities indicated variable movement ofdata. Data paths within the trend showedan initial increase followed by a decrease.On-task behavior levels ranged from 33seconds to 1 minute 34 seconds. A 19-second decrease occurred between thefirst and last days in this condition.Anecdotal records reported that Partici-pant III refused to work with the teacherat the beginning of the class on Days 6and 7.

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FIGURE 3. Participant III’s average duration of on-task behavior.

Five days of observation were con-ducted in the intervention condition inthe resource room setting. On Days 10,11, and 12, Participant III was assignedto complete independent computer tasksfor the entire resource room period, be-cause a resource teacher was unavailableto provide instruction. Participant III’steachers reported that his computer be-

. ,....

havior was obsessive and was uncharac-teristic of his on-task behavior in other

settings. Therefore, data collection dur-ing this activity was considered inappro-priate. However, improvements in Par-ticipant III’s performance were observedduring the 2 days (Days 8 and 9) of ini-tial introduction of the multimedia social

story program and during the 3 days

(from Day 13 to Day 15) after the inter-vention resumed. Level range at the first

stage of improvement was 1 minute 31seconds to 3 minutes 33 seconds, whichyielded a gain of 2 minutes 2 seconds.Level range at the second stage of im-

provement was 24 seconds to 3 minutes24 seconds, which yielded a gain of 3minutes.

Between-condition analysis of the re-source room setting indicated a positivechange in Participant III’s on-task be-havior after the introduction of the mul-timedia social story program. Althoughtrend stabilities in both conditions were

variable, trend directions changed fromnegative to positive across the condi-tions. An analysis of the initial effect ofthe intervention indicated a 58-second

gain.A 20% overlap in the data existed be-

tween the conditions. Anecdotal recordsindicated that during observations in thissetting, self stimulatory behaviors similarto those observed in the lunch settingwere reported in the resource room.

Thus, a negative relationship betweenoccurrences of Participant III’s self-

stimulatory behavior and duration of hison-task behavior was observed.Due to the lack of opportunities to ob-

serve Participant III’s performance in thegeneral education classroom setting, themultimedia social story intervention wasnot introduced. His participation in thegeneral education classroom was deter-mined by the activities that occurred inthis room. That is, if the general educa-tion teacher determined that class activi-

ties were not appropriate for ParticipantIII, he would complete more appropriateactivities in the resource room setting.Trend and level stability was not estab-lished in this condition. On-task behav-

ior ranged from 6 seconds to 1 minute

22 seconds. There was an increase in the

target behavior from Day 9 to Day 11-from 8 seconds to 1 minute 22 seconds,which yielded a gain of 1 minute 14 sec-onds. It was difficult to determine

whether this improvement was the resultof generalization from interventions inother settings.

In summary, no stable improvement inParticipant III’s average duration of on-

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TABLE 3Anecdotal Records of Participant III

task behavior was observed in the current

study. However, some improvementsthat might be effects of the interventionwere observed in the lunch and the re-source room settings. Intervention in thegeneral education classroom settingcould not be conducted because of pro-gram changes made by the general edu-cation teacher.

Summary of Results. An analysis ofthe data indicated that the intervention

using the multimedia social story pro-gram increased the skill levels of some ofthe participants in certain settings. More-over, some students showed generaliza-tion of newly acquired information toother settings.

Participant I demonstrated improve-ments in hand washing across all threesettings. He achieved 100% of comple-tion in this task at the end of two inter-

vention settings. Furthermore, the dataon Participant I indicated generalizationof the newly acquired skill in one setting.Participant II demonstrated improve-ments in newly acquired skills in two set-tings. Although Participant II did not

achieve 100% completion in hand wash-ing, his performance was maintained at92% in one setting. Data on ParticipantIII indicated partial improvements in hison-task behaviors in two settings.

Discussion

This study investigated the effects ofinterventions using multimedia social

story programs for children with autism.

Specifically, the study focused on the ef-fects of the intervention for improvingsocial or behavioral problems identifiedin three boys with autism. Furthermore,

the study also investigated the abilities ofthose students to generalize behavior

changes to other environments in whichthe intervention was not conducted. Inorder to detect such generalization skills,three environments were chosen for each

participant prior to intervention imple-mentation.

Impact of the InterventionAs illustrated by the rates of success

across participants, no consistent effectof the multimedia social story interven-tion was found. By comparison, to date,most interventions developed for chil-dren and youth with autism have notbeen universally effective. Because this

study was the first attempt of its kind inthe field of special education, no previousresearch could be directly compared withthe results of this study. Possible expla-

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nations for the variability of results in-clude (a) duration of the intervention,(b) individual differences among the par-ticipants, (c) nature of the target be-

haviors, (d) consistency in educationalenvironments, and (e) enthusiasm for

watching the multimedia social storyprogram.

Generalization ofthe Intervention

One of the purposes of this study wasto investigate the participants’ ability togeneralize their behavior changes acrossenvironments that were not targeted bythe multimedia social story programs. Toassess generalization skills, the studyadopted a multiple baseline design acrosssettings in which the same theme withdifferent multimedia social story pro-

grams was sequentially presented. Theresults indicated that only one student,Participant I, demonstrated obvious gen-eralization of skills across settings.Specifically, his performance increased

and maintained in the baseline conditionin the after-recess setting after he hadbeen introduced to the multimedia so-

cial story programs in two other settings.Other participants did not transfer theirbehavioral improvements to the settingsin which the intervention had not been

conducted. This is consistent with the lit-

erature on autism. Students with autismoften do not generalize skills (Arora &

Goodenough-Trepagnier, 1989; Batten-berg & Merbler, 1989; Chen & Bernard-

Opitz, 1993; Kennedy & Haring, 1993;Kuttler et al., 1998; Swaggart et al.,1995). &dquo;- - .

Implications for EducationalPractitioners

Because of the rapid increase in the useof computers in educational environ-

ments, there are ample opportunities forapplications of the intervention con-

ducted in this study (Hayes & Bybee,1995). The multimedia social story in-tervention does not require special mod-ifications of software and hardware, norin-depth techniques to operate comput-ers. Moreover, once routinization of

watching the multimedia social storyprogram is established in the daily sched-ule of the students with autism, addi-tional human resources are not needed to

implement the intervention. Thus, theintervention has promising applicabilityin various educational settings.

Several applications of the multimediasocial story interventions to everyday ed-ucational settings present themselves.

First, it is possible to combine the socialstory intervention with an existing ornewly developed behavior modificationsystem (i.e., token economy, responsecost) for students with autism (e.g., Kutt-ler et al., 1998; Swaggart et al., 1995). Ifa positive effect of a behavior modifica-tion system is expected for students withautism, conveying information about thesystem in the format of a social storymight help students’ comprehension.

Second, in order to maintain the con-sistency of the intervention, it may be

possible to have the students with autismwatch the multimedia social story pro-

grams in their homes, if an appropriatecomputer system is available. This appli-cation would be especially effective if thestudents’ target behaviors are social skillsor behavioral problems that constantlyoccur in all environments.

Third, if the students with autism aredevelopmentally capable of comprehend-ing the process of developing multimediasocial story programs, it would be help-ful to have them participate in creatingtheir own multimedia social story pro-grams. Although the development of theprogram requires considerable technicalcomputer knowledge, the students mightbe able to create their social stories with

teachers, create their own graphic inter-face of the program, or record their ownvoices to read aloud their social storiesinto the programs.

Limitations of the Study ,

Two factors limit generalization of theresults of this study. The first relates tothe duration of the interventions. Re-

strictions caused by school schedules,availability of human resources to collectdata, and time to obtain authorization toconduct the research from schools and

parents were major reasons for the rela-tively short intervention period. The sec-ond factor relates to a lack of consistencyin educational environments in which theinterventions were conducted. For ex-

ample, mutual agreement and supportfor the intervention were not availablefrom all educational personnel of the stu-dents. Further, variable changes made insome of the participants’ class schedulesrestricted implementation of the inter-vention and observation.

Conclusion

This study investigated the effects of amultimedia social story intervention

newly developed for this study. The in-tervention incorporated the characteris-tics of three interventions used effectivelywith persons with autism: visual symbols,social stories, and computer-based in-

struction. The intervention appeared tohave possible effects and applicability forchildren and youth with autism in thecurrent educational system. Most currenteducational settings have incorporated aconsiderable amount of computer tech-

nology ; however, few attempts have beenmade to incorporate such technologyinto teaching social or behavioral skills tochildren and youth with autism. Thisstudy revealed that it is possible to useadvanced technology with this popula-tion.

This study was the first attempt to im-plement a multimedia social story inter-vention. We hope that this study will callto the attention of educational practi-tioners the possibilities of developing in-terventions using advanced technologyto teach children and youth with autism.

ABOUT THE AUTHORS

Taku Hagiwara, PhD, is project coordinatorfor several training and research grants relatedto students with autism and Asperger syndromeat the University of Kansas. Dr. Hagiwara alsocoordinates the Autism Assessment Team at the

University of Kansas Medical Center. BrendaSmith Myles, PhD, is an associate professor ofspecial education at the University of Kansas,where she is co-principal investigator of several

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federal and state grants related to individualswith autism and Asperger syndrome. She servesas editor of Intervention in School and Clinic.Address: Taku Hagiwara, Dept. of SpecialEducation, University of Kansas, 3901 Rain-bow Blvd., Kansas City, KS 66160-7335.

NOTE

Technical information on the computer systemis available from the first author.

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APPENDIX ASteps for Creating a Multimedia Social Story Program Using HyperCard TM

HyperCardTM is a software development tool that enablesa user to create software called a stack, which runs underthe MacintoshTM operating system. Basic steps required todevelop software on HyperCardTm are object-oriented; mostframeworks are preconfigured so that the user can manipulateand modify objects used for the software, such as page frames,navigational buttons, or visual effects, using a graphical userinterface without writing a specific programming language.However, HyperCardTm does have its own computer languagecalled HyperTalkTM to allow the user more complex program-ming. The HyperTalkTM language was used for creating originalcommand scripts and adjusting each program individually insome portion of the multimedia social story programs as follows:

~ Creating the frames of a program. This included allHyperTalkTM scripts. Once created, the frame of the pro-gram may be duplicated to make another program withminor modification of the script.

~ Typing the sentences of the social story on each page.The same sentences were written in the scripts that com-manded the computer to read aloud texts for each page.

~ Videotaping the participants’ activities that related to theirtarget behavior and settings.

~ Editing the video on the computer. Using Avid TM Video-Shop software, segments of the video of the participantswere recorded as QuickTime TM movie files on a hard disk

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or removable drive at the size of 256 x 192 pixels. A moviefor each page of the program was made by carefullyarranging short lengths of video frames so that thecontents of each video were matched with the socialstories written on each page. The edited movie fileswere saved without using any compression schemes oraudio track.

. Compressing video files. Each movie file was compressedusing the Movie Cleaner LiteTM software for smooth play-back and size reduction. The compression scheme calledCinepak was chosen because of the quality of its com-pressed video images and smooth playback operation ona wide range of computers. At the compression, eachmovie file had the finest picture quality at its very lastframe to ensure maximum visibility to the participants atthe end of each movie and to enable the computer on

.......’~ «.x .

which the multimedia social story program was operatedto obtain the exact end time of the movie. The final prod-ucts of the edited movies were saved with unique namessuch as &dquo;pg1-classroom.mov.&dquo;

&dquo;

. Combining the frame of the multimedia social story pro-gram and the movie files. The name and duration of eachmovie file was written in the appropriate place of theHyperTalkTM scripts. This procedure enabled the programto call up a specified movie file and play it in each page onoperation.

. Saving the multimedia social story program as an applica-tion file. HyperCardTM allowed the user to save the createdproduct as a stand-alone application. The program savedas an application file did not require the HyperCard TM pro-gram, so that the user could operate it on any MacintoshT^&dquo;

computers so long as the program requirements were met.

APPENDIX BParticipant l’s Multimedia Social Story

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(Appendix B, continued)

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