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THE EFFECT OF MUSICAL SOCIAL STORIES" ON
TARGET BEHAVIORS OF PRESCHOOL CHILDREN WITH
AUTISM SPECTRUM DISORDERS:

THREE CASE STUDIES

presented by

DENISE ANNE TRAVIS

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THE EFFECT OF MUSICAL SOCIAL STORIESTM ON TARGET BEHAVIORS OF
PRESCHOOL CHILREN WITH AUTSIM SPECTRUM DISORDERS:
THREE CASE STUDIES
By

Denise AnneTravis

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
MASTER OF MUSIC IN MUSIC THERAPY
School of Music

2006

ABSTRACT

THE EFFECT OF MUSICAL SOCIAL STORIESTM ON TARGET BEHAVIORS OF
PRESCHOOL CHILDREN WITH AUTSIM SPECTRUM DISORDERS: THREE CASE STUDIES

By
Denise Anne Travis
The purpose of this research is to examine the effect of Social Stories”, set to
original music, on target behaviors of preschool children with Autism Spectrum
Disorders (ASD). Social StoriesTM and music have individually been shown to be
effective teaching tools for elementary and preschool children with ASD, aiding in ability
to focus and recall information. Social StoriesTM set to music make a logical pairing.
Musical Social StoriesTM have proven successful for elementary age children. This
research expands the current field of study to include preschool children, as indicated by
early intervention protocols. Three children with primary diagnoses of ASD participated
in the study. Musical Social StoriesTM were written, using original music, administered
and compared to pre- and post-test baselines. T -tests revealed a significant change in two
target behaviors, and approached significance in two target behaviors between the three
participants. Graphic representation of the data reveals a trend toward increased positive
behavior and decreased negative behavior during the musical Social StoryTM intervention
overall for all three participants. Examination of the anecdotal information collected
suggests a clinical or practical significance demonstrating the efficacy of musical Social
StoriesTM for all three preschool children. The researcher discusses importance of clinical
significance, subtleties of participant changes, limitations due to the sample size, merits
of original vs. pre-composed music, effects of reading level, and possibilities of at-home

application.

Joshua, Nathan and Lucas, I hope you learn to like homework as much as I do.
Mom, thanks for keeping the t.v. off and my curiosity on.

Dad, thanks for asking me "What's your plan?"

Jack, thanks for catching the bail.

iii

ACKNOWLEDGEMENTS

Professor Frederick Tims, Professor Cynthia Taggart, and Professor Roger Smeltekop:
Thanks for making the homework fun. I couldn't have had a better committee.
Carol Gray and the Gray Center:
Thank you for the guidance and inspiration.
Lori Lattin, Jill Remus, Amy Granger, and Pamela Green:
Unlimited gratefulness for your cooperation and collaboration on this project.
Your help and participation were invaluable. This project would not have been

possible with out you.

iv

TABLE OF CONTENTS

List of Tables and Figures ................................................. vi
Chapter 1: Introduction and Literature Review .................................. 1
Childhood Autism Rates ............................................. 1

Social StoriesTM ................................................... 2

Social StoryTM Literature ............................................ 4
Autism and Music ............................................... . 10
Summary ........................................................ 13
Statement of Purpose ............................................... 14
Chapter 2: Related Research ............................................... 15
Chapter 3: Method ...................................................... 23
Selection of Participants ............................................ 23
Criteria for Selection of Participants ................................... 23
Procedure ....................................................... 24
Definition of Research Questions ..................................... 26
Measurements and Analysis ......................................... 27
Chapter 4: Case Studies, Results and Reactions ................................ 28
Case Study: Ben ................................................... 28

Target Behavior ............................................. 28
Implementation Procedure .................................... 29

Results and Reactions ........................................ 29

Case Study: Emily ................................................ 32

Target Behavior ............................................. 33
Implementation Procedure .................................... 34

Results and Reactions ........................................ 34

Case Study: Aaron ................................................ 36

Target Behavior ............................................ 37
Implementation Procedure ..................................... 37

Results and Reactions ........................................ 38

Summary ........................................................ 40
Chapter 5: Summary and Discussion ......................................... 41
Appendix A ............................................................ 46
Appendix B ............................................................ 50
Appendix C ............................................................ 59
References ............................................................ 64

LIST OF TABLES AND FIGURES

Table 1: t-Tests for Condition Comparisons for Ben ........................... 30
Table 2: t—Test Condition Comparisons for Emily .............................. 35
Table 3: t-Test Condition Comparison for Aaron ............................... 39
Figure 1: Visual Analysis - Ben - Appropriate Play ............................ 30
Figure 2: Visual Analysis - Ben - Destructive/Inappropriate Play ................. 31
Figure 3: Visual Analysis - Ben - Seeks Help ................................. 31
Figure 4: Visual Analysis - Emily - Takes Object Without Asking ................. 35
Figure 5: Visual Analysis - Aaron - Leaving Circle ............................. 39

vi

CHAPTER ONE

Introduction and Literature Review

The Centers for Disease Control and Prevention report that as many as 2 to 6 in
1,000 persons in the United States are diagnosed with autism or related disorders (2001).
The incidence is higher in some states. The estimated autism rate for children in
Michigan is as high as l in 63. School districts are seeing a phenomenal increase in
autism enrollment. In the United States during the 2000-2001 school year 94,339 children
with autism received services under the Individuals with Disabilities Education Act
(IDEA). Fifteen thousand five hundred ninety of those were in preschool classrooms
(US. Department of Education, 2002). When first tracked in 1984, there were 304
students with autism reported to attend Michigan public schools. There were 7525
children with autism enrolled in 2003, a 14% increase from the previous year (Nuttall,
2004). This trend is a result of increased autism rates and the 1997 implementation of
IDEA, which assures a free appropriate public education for special needs individuals.
. . The practice of inclusion in the public schools has created a new demand for the
production of innovative techniques and interventions for students with autism”
(Brownell, 2002, p.117). The 2004 revision of IDEA requires schools to produce
measures of greater accountability. Increased accountability means finding easily
implemented methods that produce observable results. Social StoriesTM are proving to be

one such method of instruction.

Social StoriesTM

Gray & Garand (1993), Gray (20003, 2000b), Atwood (2000), Rowe (1999) and
DelValle, McEachem & Chambers (2001) advocate the use of Social StoriesTM as an
effective teaching method for children with Autistic Spectrum Disorders. Gray developed
Social StoriesTM in 1991 as a method of teaching social information to children with
autism from their perspective. Developed originally for elementary age children with
ASD, Social StoriesTM have been shoWn to also be beneficial across ages, and disabilities,
including individuals who are 'normally developing.‘ “Social stories are based on the
rationale that if a student’s ability to gain information about his or her environment is
impaired, that information should be presented in a format he or she may be able to
understand” (Gray & Garand, 1993, p. 9). The result of Social StoryTM use is often an
improvement in understanding on both sides of the social equation.

A Social StoryTM is a short story carefully crafted according to specific guidelines
to convey accurate information of the who, what, when, where, and why of a situation,
concept, or social skill. The child’s needs determine the topic of the story, while the
child’s perspective determines the focus of the story. The story is written in the first
person, as if the child is telling the story. The Social StoryTM uses positive language and
states desired responses positively. If a reference to a negative behavior is essential to the
story, it is mentioned carefully and in general terms (i.e., “Sometime people make
mistakes”). Sometimes alternative vocabulary must be used to avoid terms that might
elicit anxiety. “Another” might be used in place of “different.” “Replace” might be used
in place of “change.” “Better” or “another” might» be preferable to “new.” The Social

StoryTM must be literally accurate. The uses of “usually” and “sometimes” are examples

of words that insure the literal translation of the material presented. Drawing from the
same rationale, the use of “I will try. . .” is preferred over “I will” statements.

Social StoriesTM use four basic types of sentences. Descriptive sentences are
accurate, assumption-free statements of fact that answer the who, what, when, where and
why questions of a situation. They are used to bring logic and accuracy to the story.
Descriptive sentences are used most frequently, making up the backbone of the story.
Some Social StoriesTM may contain only descriptive sentences. Perspective sentences
describe a person’s thoughts, feelings, beliefs, or motivations. Most of the time they are
used to express the thoughts and feelings of other people. Affirmative sentences enhance
the meaning of surrounding statements and may express a commonly shared opinion.
They stress important points, refer to rules, and reassure the reader (i.e., “This is a good
idea.” “This is ok.” “This is a safe thing to do”). The purpose of directive statements is to
identity a possible response from the reader, or to gently direct behavior. Gray outlines
use for two additional sentence types (2000a). Control sentences are statements written
by the student with ASD to help identify recall strategies and apply information.
Cooperative sentences identify what others will do to help the student. Gray created “the
complete Social StoryTM ratio” to apply to the story as a whole. The focus of the story is
to describe more than direct; 0-1 directive or control sentences are used for every 2-5
descriptive, perspective, affirmative, or cooperative sentences.

The construction of a Social StoryTM uses concrete, easy to understand text
enhanced by visual supports. The text and illustrations should reflect the student’s
reading skills, attention span and cognitive ability. Pictures, maps, photos or symbols

used as illustrations are printed in black and white to reduce distraction and limit any

unintentional relay of misinformation. The Social StoryTM is printed in black ink, on
white paper, in a clear font, sized according to the student’s reading level. Most Social
StoriesTM have only one or two sentences per page. The pages are then matted on black
construction paper and bound with a title page. Gray recommends “teaching with the
title” of a Social Story“. The title concisely states the purpose or content of the story,
reinforcing the most important information presented in the story.

The Social StoryTM book is presented to the child at an appropriate time, often
immediately prior to the situation or event described in the story. Gray suggests the
“J iminy Cricket” approach (2000a). The author sits beside and slightly behind the child to
. remove herself from the child’s view, and makes the story the joint focus of the author
and child. The author reads the story with a gentle, friendly tone, matching the reassuring
quality of the text. As the child learns, or as new situations arise, the Social StoryTM may
be faded or rewritten to address the new awareness of the child. The goal of Social
StoriesTM is not to change behavior, though that is often the result. The goal of a Social
StoryTM is to improve an individual’s understanding of events and expectations. This
improved understanding often leads to responses that are more effective from the
individual for whom the Social StoryTM is written. .
Social Stan/TM Literature

Anecdotal evidence relays the adaptability of Social StoriesTM to multiple uses.
Gray and Garand (1993) give the first accounts of Social StoriesTM in practice. Use of a
Social StoryTM allowed a 9-year-old girl with autism to ride quietly in the car, without the
hitting and scratching of others that she exhibited previously. After one reading of a

Social Story”, a 6-year-old boy with autism began performing the morning school

routine that had previously been problematic for him. The family of the same child was
able to use a Social StoryTM to teach the child to reduce mistreatment of the family cat.
The teacher of a 7-year-old girl with autism was able to teach the child appropriate means
of expressing anger, reducing self-abusive behavior, using Social StoriesTM where
positive reinforcement and behavior management techniques had failed. A member of a
high school choir who had autism learned to control his singing volume at an appropriate
level with review of a Social StoryTM. Adding to the anecdotal evidence, Chapman (2000)
describes the use of a Social StoryTM to help a 14-year-old boy with autism reduce his
anxiety during a camping trip. Rowe (1999) wrote an account of an elementary school
student who was able to eat his lunch peacefully in the lunchroom thanks to a Social
StoryTM that explained the behavior of other children during lunchtime and what
behaviors were expected of him.

Empirical research regarding the efficacy of Social StoriesTM for children with
autism spectrum disorders is limited but growing. Many of the studies examine Social
StoriesTM in combination with other methods, furthering the documentation of the
adaptability of the Social Story”. One such study was the first to examine Social
StoryTM use empirically. Swaggart, Gagnon, Bock, Earles, Quinn, Myles, et a1. (1995)
investigated social story use together with a traditional social-skill intervention model on
the target behaviors of three elementary students with autism. The researchers designed
the intervention procedures to decrease negative behaviors (e.g., aggression) and increase
positive outcomes (e.g., positive greeting behaviors). The findings for subject one
showed a decrease in aggressive behavior and an increase in appropriate greeting skills.

Analysis of subject two’s results revealed a decrease in aggressive behavior, a decrease in

screaming, an increase in parallel play, and an increase in appropriate sharing. The results
were similar for subject three: an increase in parallel play, an increase in spontaneous
sharing, and a decrease in grabbing toys from others.

Gray notes the importance of proper construction of Social StoriesTM to assure
that the story is accurate in the information relayed to the student (2000b). One of the
limitations seen in the literature is the use of Social StoriesTM that are not properly
constructed. Scattone, Wilczynski, Edwards, & Rabian (2002) is one of the few studies in
the literature that examined the effectiveness of properly constructed Social StoriesTM to
target disruptive behaviors of three children with autism, ages 7 through 15. Each child
received an individualized Social StoryTM program following the Social StoriesTM
guidelines. Each child reduced the incidence of target behaviors markedly. Analysis of
the data for the subjects showed a decrease in the first subject’s chair tipping (50% to
4.6%), a decrease the second subject’s inappropriate staring (66% to 18.3%) and a
decrease in the third subject’s shouting (16% to 5.1%) when compared to baselines.
Kuttler, Myles, & Carlson (1998) also used Gray’s guidelines for constructing Social
StoriesTM to reduce the occurrence of pre-tantrum behaviors for a 12-year-old boy with
autism (Gray, 1994; Gray & Garand, 1993). The occurrence of pre-tantrum behaviors
decreased to zero during repeated treatment conditions, with a return to near baseline
during removal of the treatment.

The intent of Social Story“ use is not to focus solely on reducing negative
behaviors but on teaching social information surrounding a particular situation, thus
increasing the likelihood of desired outcomes (Gray, 2000b). Barry and Burlew (2004)

chose to examine Social StoryTM implementation with the intent of increasing choice

making and play skills in an Exceptional Student Education classroom for two children,
ages 7 and 8, with severe autism. This study used a series of three Social StoriesTM using
pictures of the children whenever possible to explain choice making and appropriate peer
interaction in free-play time. Both students gained in ability to make independent choices
and appropriate play during free time, and one student increased in ability to play
appropriately with peers. This study is important, not only in its focus on reinforcing
positive outcomes, but also in its Social StoryTM success with children who have a
diagnosis of severe autism.

Lorimer (1999) investigated the portability of Social StoriesTM procedures. She
looked at the use of a social story program in a home setting for a 5-year-old boy with
autism. Following an ABAB design (where A represents baseline, and B represents
treatment), she used two Social StoriesTM to decrease interrupting verbalizations, seen as
precursors to tantrum behavior. The researcher found a decrease in precursors and
tantrum behaviors during each Social StoryTM treatment period. The precursors and
tantrums increased during the return to baseline (Social StoriesTM removed). Analysis of
the data found precursor behaviors reduced to zero on two days of the final treatment
period, and tantrums reduced to zero on all but one day of each Social StoryTM treatment
phase. Lorimer also found that incorporation of other interventions into the text of the
Social StoryTM helped increase the effectiveness of those previously unsuccessful
interventions after the Social Stories” treatment. The subject gained an understanding of
the use and importance of clocks and mini-schedules. This supports Gray’s contention
that a Social StoryTM presents a situation in a manner that makes sense to an individual

with autism spectrum disorder (Gray, 2000a, 2000b).

The portability of Socials StoriesTM across treatment modalities and the ease of
their implementation are assets of their use. Effectiveness of Social StoriesTM training is
also of interest. Agosta (2004) formed a teacher-researcher partnership that examined
Social StoryTM use. The researcher and a special education teacher collaborated to
determine the best course of action to reduce interruptive behaviors of a 6-year-old boy
with autism. The teacher-researcher team designed a Social StoryTM intervention, with the
teacher responsible for implementation. The treatment successfully reduced the target
behaviors of screaming, yelling, crying, and loud humming exhibited by the student
during group activities. A gosta’s study gives evidence for the ease of developing and
implementing a Social StoriesTM intervention by a teacher who had not previously used
them.

Moudry (2002) also investigated the efficacy of Social StoriesTM training. The
researcher implemented a Social StoriesTM training program for paraprofessionals using
Gray’s “Writing Social Stories” video presentation and accompanying workbook. The
paraprofessionals learned to effectively use and evaluate Social Stories“. These Social
Stories” had a positive effect on target behaviors of the ASD students paired with the
paraprofessionals. This study demonstrates both the ease of use and the effectiveness of
training using this video workshop as a Social StoryTM training tool.

The Autism Society of America (Autism Society of America Panel of
Professional Advisors, 2000) and the National Institute of National Health (Strock, 2004)
recognize the importance of early intervention for children with ASD. The ASA
“supports an individualized approach that addresses the core deficits of autism spectrum

disorders,” including social skills deficits (ASAPPA, 2000). Despite this

recommendation, the research on Social StoriesTM in preschool settings is just beginning
to emerge. A study of three children by a teacher in a New Jersey preschool demonstrates
the efficacy of Social StoriesTM to increase positive behaviors in three preschool children
with autism (Wiesen, 1999). Wiesen found a 40% increase in subject one’s getting
someone’s attention appropriately over 33 days with the Social StoryTM read to the
subject daily. The treatment plan for subject two included fading the story. Review of
data for subject two revealed a 20% increase over 15 days when the Social StoryTM was
read to the subject daily, an additional 4% increase over 5 days when the Social StoryTM
was read to the subject every other day, and an additional 7 % increase over 8 days when
the Social StoryTM was read to the subject every third day, for a total of a 33% mean
increase over the entire treatment period totaling 28 days when compared to baseline. The
third subject’s results revealed an increase of a mean of 11% in hand raising in the
lunchroom to get appropriate attention. The Social StoryTM was read to the subject daily,
for 19 days, in the classroom prior to the lunch period. Subject one showed zero
incidence of hand raising for the first 13 days of this portion of the intervention, and a
mean of 32% increase for the last 6 days of this period. During the second phase of
subject three’s intervention, the subject reviewed the Social StoryTM in the kitchen daily
immediately prior to the subject receiving his lunch. The mean increase in hand raising
was 82% over baseline over the 12 days of this phase. During the third phase, a return to
the first condition showed a decrease in hand raising of 18% from the second phase,
retaining a 64% increase from baseline. The findings for subject three suggest that timing
and location of the Social StoryTM intervention may play a key factor in their

effectiveness. Wiesen’s findings are remarkable in showing the efficacy of Social

StoriesTM over a longer treatment period than most research allows. Social StoriesTM
often have an immediate dramatic affect for the reader. Wiesen’s findings suggest that
longer treatment periods may to necessary to achieve desired results. The findings of
Wiesen’s study also support the use of Social StoriesTM with younger children.

In a study of 5 subjects: two kindergarteners, one second-grader and two middle
school students with ASD, Delano (2003) found the greatest gains, and generalization of
gains, in duration of social engagement for the two kindergarteners. Delano’s findings
add to the body of evidence supporting early intervention for individuals with ASD.
Autism and Music

Many children on the autism spectrum display an interest in music. Leo Kanner
noted this interest in the first diagnostic description of the disorder in 1943 (Kanner,
1943). The American Music Therapy Association (2002) lists these features of music for
use with children with autism spectrum disorder:

0 People with diagnoses on the autism spectrum often Show a heightened interest
and response to music, making it an excellent therapeutic tool to work with them.
0 Music is a very basic human response, spanning all degrees of ability/disability.
Music therapists are able to meet clients at their own levels and allow them to
grow from there. The malleability of music makes it a medium that can be
adapted to meet the needs of each individual.
0 Music is motivating and enjoyable.
0 Music therapy addresses multiple developmental issues simultaneously.
0 Music therapy can provide success-oriented opportunities for achievement and

mastery.

10

o The structure and sensory input inherent in music help to establish response and
role expectations, positive interactions, and organization.

0 Music captures and helps maintain attention. It is highly motivating and engaging
and may be used as a natural "reinforcer" for desired responses. Music therapy
can stimulate clients to reduce negative and/or self-stimulatory responses and
increase participation in more appropriate and socially acceptable ways.

0 Because music is processed in both hemispheres of the brain, music can stimulate

cognitive functioning and may be used for remediation of some speech/language

Skills.

Early intervention strategies often employ music. Wimpory, Chadwick, & Nash
(1995) report the successful use of a music intervention for a preschool child with autism.
The researchers found that musically accompanied child-led games and interactions
increased social acknowledgement, eye contact, and initiation of interactive involvement
for a 3-year-old with autism, and a 2-year follow-up showed positive changes had been
sustained.

Humpal (1991) also examined music effect on preschool children. Subjects of this
study participated in an integrated early childhood music program designed to increase
interaction between special needs children and typical peers. Fifteen neurotypical
children age 4, and twelve children with special needs, ages 3 to 5, met at a preschool for
music sessions. After 15 weekly sessions, the researchers found that the program had

facilitated peer interaction and fostered acceptance of differences.

ll

Music may assist in the recall of information. Songs act as "mnemonic" devices to
aid in memory of new or difficult concepts. Musical presentation also provides an
optimal learning environment for those students who are highly attentive to music
activities but are often distractible using other modalities. The ability to learn and recall
information can only occur when a person is motivated and attending. Buday’s (1995)
study capitalized on music’s ability to focus attention and aid in recall. She examined the
ability to learn and recall signed and spoken words in ten children with autism, when
taught through speech or music. Seven words were set to a musical verse, and seven were
set to a rhythmic verse not set to music. Buday found subjects correctly imitated more
signs during the music sessions, and recalled more spoken words the day after the session
if the words had been introduced in the musical verse. Buday reported that subjects
displayed less self-stimulatory behavior during the music sessions, and seemed to enjoy
the music sessions more than the rhythm sessions.

The Autism Society of America (ASA) lists music therapy as a complimentary
approach for the treatment of autism. “While early educational intervention is key to
improving the lives of individuals with autism, some parents and professionals believe
that other treatment approaches may play an important role in improving communications
skills and reducing behavioral symptoms associated with autism. These complementary
therapies may include music, art or animal therapy and may be done on an individual
basis or integrated into an educational program. All of them can help by increasing
communication skills, developing social interaction, and providing a sense of
accomplishment. They can provide a non-threatening way for a child with autism to

develop a positive relationship with a therapist in a safe environment” (Autism Society of

12

America, 2006). The ASA goes on to state: "Art and music are particularly useful in
sensory integration, providing tactile, visual and auditory stimulation. Music therapy is
good for speech development and language comprehension. Songs can be used to teach
language and increase the ability to put words together. "
Summary

The anecdotal evidence of Gray and Garand (1993), Chapman (2000) and Rowe
(1999) give vivid accounts of the success of Social Stories“ for children with autism
spectrum disorders. Swaggart et al. (1995) give evidence of Social Stories“ paired with
other complementary methodologies to increase desired outcomes. Scattone (2002) and
Kuttler, Myles, & Carlson (1998) advocate strictly following Social Story“ guidelines,
while Lorimer (1999) shows the necessity to take the child’s perspective. The findings of
Barry & Burlew (2004) demonstrate the use of Social Stories“ to increase positive
outcomes, often replacing negative actions. Wiesen ( 1999) and Delano (2003) support the
use of Social Stories“ with preschool aged children with ASD. Consideration of these
findings leads this researcher to a Social Story“ implementation: (a) for children with
ASD, (b) following Gray’s Social Story“ guidelines (Gray, 2000b), (c) with a focus on
the child’s perspective, ((1) encouraging positive outcomes, (e) for preschool aged
children.

The findings of Wimpory, Chadwick, & Nash (1995), Humpal (1991), Buday
(1995), and the insight provided by the ASA (2004) and this researcher’s personal
experience with special needs populations, particularly autism spectrum disorders,

provide the rationale for inclusion of music in a Social Story“ presentation.

13

Statement of Purpose

With the intent of improving music therapy practice and education strategies for
special needs populations, the purpose of this research is to examine the effect of musical
presentations of Social Stories“ on target behaviors of preschool children with Autism
Spectrum Disorders (ASD). The problem of this study is to examine the occurrences of
target behaviors before, during, and after the music therapy treatment period in order to

evaluate the effectiveness of the treatment.

14

CHAPTER TWO

Review of Related Research

To date, three studies have examined the efficacy of music in combination with
Social Stories“ or narratives on target behaviors of children with Autism Spectrum
Disorders (Brownell, 2002; Pasaili, 2004; Pudenz, 2004). These studies are the focus of
this review.

Brownell (2002) looked at “musically adapted Social Stories“” and their effects
on four children with ASD. The subjects of the study were first and second grade students
in an eastern Iowa elementary school with a primary diagnosis of autism. Referrals from
teachers provided the basis for choosing subjects. Brownell screened the subjects for
previous positive responses to music therapy or general music to exclude those that might
have negative reactions to auditory stimuli. The subjects chosen for the study were four
males between the ages of 6 and 9 in either first or second grade. Each of the subjects
possessed expressive verbal skills and a minimum of pre-reading skills, and attended part
of the school day in a self-contained classroom by grade, with other children with ASD.
None of the subjects had used social stories for the target behaviors chosen as the focus
of this study. Using a ten-step procedure as outlined by Swaggart et al. (1995), Brownell
created and implemented a Social Story“ program as the research method. Target
behaviors considered most important to social and academic goals and best suited for
Social Story“ interventions were determined for each subject in consultation with the
children’s teachers. Data collection occurred at the time teachers indicated the target

behavior most likely to occur. Brownell minimized learning order effects by using an

15

ABAC/ACAB counterbalancing of treatment order design. A represents baseline, B
represents traditional Social Story“ treatment, and C represents musically adapted Social
Story“ treatment. Each condition lasted for one school week. The student’s classroom
teacher or paraprofessional collected baseline data on a form designed by the researcher,
specific to each student that included a written operational definition of the target
behavior. Brownell wrote a traditional Social Story“ for each student using the
prescribed Social Story“ ratio (Gray, 1997) paired with appropriate illustrations, printed,
and mounted in black and white as Gray suggests (Gray, 1994). Each Social Story“ was
then set to original music by the researcher. During the treatment condition, the
researcher either read or sung the Social Story“ to the student, in seclusion to reduce
distraction, immediately before the data collection period. After the first treatment phase,
Brownell repeated the entire procedure, alternating treatment of the subjects. The
researcher collected interobserver reliability data for two days of each condition for each
subject. Interobserver reliability for each student ranged from .86 to .93. For subjects I, II
and IV, Brownell found a significant difference in the effectiveness of the treatments on
the target behavior between both the reading presentations and music presentations
respective to their baselines. Comparison between the two-treatment conditions
approached significance. The music condition proved at least as effective as the reading
condition statistically. However, there were fewer instances of the target behavior during
the music condition overall. Subject III showed a significant reduction in target behaviors
during both sung and read Social Story“ presentations. In addition, the sung presentation

was found to be significantly more effective than the read Social Story“.

16

Brownell found that implementation of both traditional and musical forms of
Social Stories“ produced successful reduction in target behaviors in all eight-treatment
conditions. Further, the frequency of target behaviors was consistently lower in the music
condition than the read condition, regardless of the counterbalancing of treatment order,
extinguishing to zero during one observation for one subject. Brownell’s subject selection
is sound. The current study will replicate these criteria for subject selection where
appropriate. Brownell used Swaggart’s ten-step outline for writing and implementing a
Social Story“ (Swaggart et al. 1995). While these steps are similar to recommendations
made by Gray (1994), Gray has since revised her Social Story“ guidelines (Gray 2000a,
2000b). These revisions were not available to Brownell at the time of his study, and
Swaggart’s procedure was the best fit at the time. Today's literature changes the
perspective of Brownell's methodology. For this reason, the current research did not use
Swaggart’s outline, but followed Gray’s revised guideline.

Pasiali (2004) followed Brownell’s conclusionary suggestion of researching
Social Story“ presentations using familiar music (“piggybacking”). In a musical
application of Lorimer’s (1999) study, Pasiali examined the effectiveness of “prescriptive
therapeutic songs” in a home environment on problematic behaviors of children with
autism. Three children, boys ages 7 and 9 and a girl age 8, with ASD ranging from high
functioning to mildly impaired were subjects of this study. Pasiali obtained subjects
through newspaper advertising, a local advocacy group, and an on-line autism list server.
None of the subjects were hearing impaired, and none had previously received music
therapy to address the identified target behaviors of this study. Through phone

consultation, the researcher asked the parents to identify a problematic behavior

17

occurring in the home for use as the target behavior of the study. She also asked the
parents to name some of the child’s favorite songs. Pasiali then composed a “prescriptive
therapeutic song” for each child by setting the adapted lyrics to one of the songs listed by
the parents. Pasiali used an ABAB reversal design, where A represents baseline, and B
represents treatment. Each condition lasted 7 consecutive days. One parent acted as
observer responsible for data collection and the other parent or a paraprofessional was
responsible for inter-observer reliability data collection. Inter-observer reliability ranged
from 92 to 99 percent. Observers recorded the incidence of target behaviors for each
condition on a form designed by the researcher that included the operational definition of
the behavior on the top of the form. The length of data collection varied from subject to
subject dependent on the behavior targeted, and the situation surrounding its occurrence.
Data collection was 30 minutes for two subjects and one hour for the third. After the
initial baseline phase, Pasiali conducted a lS-minute music therapy session with each
individual child immediately prior to the determined data collection time. She used a
visual schedule (icon board) to provide a cue for the structure of the session. At the end
of each segment, the therapist asked the subject to remove the corresponding icon from
the session schedule. The session consisted of three music therapy applications
incorporating the prescriptive therapeutic song. First, she instructed the subject to listen
to the song as she sang and accompanied it on guitar. Second, she asked the subject to
play either maracas or egg shakers while she sang the song, playing the guitar. Third,
giving a lyric sheet to the subject, she invited the child to sing the song with her.

Following guidelines for writing Social Stories“ (Gray & Garand, 1993; Swaggart et al.,

18

1995), she printed the lyrics in black print on white paper to limit distraction and increase
ease of reading.

T -tests for subject I showed significant decrease in problematic behavior between
baseline A1 and treatment Bl, but combined baseline compared to combined treatment
did not reach significance. Subject H’s scores did show a significant decrease in
problematic behavior both in comparison of A1 and BI and combined baseline compared
to combined treatment. Subject III’s t-test analysis did not reveal significance in any
comparison. Visual analysis of the results shows fault in the criterion measures chosen.
Pasiali did not find statistical significance for subject HI; yet, clinical significance is
shown through extinction of the problematic behavior on five of the seven days of the
final treatment. The graphed results Show the use of prescriptive therapeutic songs was
successful in reducing the measured behavior of each child during the first treatment
phase.

Pasiali’s treatment protocol encourages auditory, visual, and kinesthetic responses
from the subjects, possibly increasing alertness. Gray’s guidelines include encouraging
the children to read the story for themselves if the child is developmentally able to do so
(Gray, 2000b). Pasiali’s encouraging the child to sing the adapted lyrics with her while
reading the lyric sheet is the musical application of this guideline. The current study used
this portion of Pasiali’s treatment protocol.

The purpose of Pasiali’s ABAB design is to examine initial baseline measure,
treatment measure, a second baseline to determine if treatment is the affecting variable,
and then a return to treatment to reexamine its effect. The criterion and analysis of this

design were poor choices for this study. Empirical and anecdotal evidence suggest Social

19

Story“ interventions often have dramatic, quick acting effects. In this instance, one
should expect baseline A2 to be lower than Al , and treatment BZ to be lower than its
corresponding baseline. This decreases possibility of finding significance in the second
treatment when compared to its baseline. The better comparison would be from treatment
B2 to the original baseline A]. Pasiali did not evaluate the overall effect of combined
treatment sessions. This evaluation would have been the most practically useful. Pasiali’s
study proves this ABAB design to be ineffective in measuring the practical outcome;
therefore, the current study did not replicate it. The current study removed the repeat of
the treatment measure, using an ABA design.

Pudenz (2004) more closely followed Brownell’s suggestion of researching
“piggybacked” musical presentations of Social Stories“. She used his ABAC/ACAB
reversal design, and followed his methodology of treatment including subject selection
criteria and classroom setting, except Brownell used original music and Pudenz set the
adapted lyrics to the children’s favorite childhood tunes. She makes note of her careful
application of story guidelines (Gray, 2000a) and her having chosen her lyrics with care
to present accurately the desired material without changing normal accents of words. The
subjects of the study were four children, ages 6 to 12, with primary diagnoses of autism.
The target behavior for subject one was number of touches, as too frequent touching was
a problem behavior. T-tests comparing the first baseline to the reading condition and the
second baseline to the sung conditions showed no significant differences. Visual analysis
of the data for subject one shows a greater decrease in touching during the sung Social
Story“ versus the read story. Subject two’s target behavior was following directions.

The number of directional repetitions required before the subject responded measured

20

this. Comparison of the music condition to its baseline showed a significant difference in
reduction of directional repetitions required, while a comparison of the spoken story to its
baseline did not reach significance. No significant difference was found between the two
treatments. The researcher measured the frequency of interruptions for subject three.
Subject three’s results showed no significant difference in reduction of interruptions for
the reading condition, while the music condition showed significance. No significant
difference was found between the two conditions. Subject four’s habit of talking to
himself was the identified target behavior. A t-test comparison of the first baseline and
the music condition produced a significant difference. The difference between the second
baseline and the reading condition did not Show significance. A final comparison of the
music and reading conditions showed a significant difference.

Pudenz found a significant reduction in target behaviors for three of the four
subjects during the music condition, and none during the read condition. This seems
contradictory to the Social Story“ evidence cited in Chapter One. Pudenz’s study seems
to suggest a musical presentation of a Social Story“ may be effective for a student when
traditionally spoken presentations of the same story were not. A student that does not
respond to the information in a read Social Story“, might accept the same information if
it is sung.

Pudenz’s study confirms the successful use of musically presented Social
Stories“ in addressing target behavior. Despite her care in following Social Story“
guidelines in writing her stories, setting them to pi ggybacked or familiar pre-composed
music forces change in sentence structure to accommodate rhythm, meter, and verse

length. While a familiar tune might help recall, the necessity to make the words fit the

21

tune might limit the presentation of the information conveyed. The current study used
original music to allow the Social Story“ presentation to resemble Gray's guidelines as
closely possible. In order to make the music as appealing to the children as possible, the
researcher considered musical tastes when composing the music for the Social Story“
presentation.

All of the studies outlined in this chapter have looked at musical Social Stories“
or narratives with school age children. Evidence suggests that early intervention is
dramatically successful in helping individuals with autism reach their full potential. In
her writings on Social Stories“, Gray suggests that a minimum of pre-reading skills is
essential for Social Story success (1997, 2000a, 2000b). Despite this suggestion, she has
accounted Social Story“ success with preschool children (2000b). The current research
examined the use of musically presented Social Stories“ on target behaviors of

preschool children with Autism Spectrum Disorders.

22

CHAPTER THREE

Method

Selection of Participants

The children selected for this study came from an Early Childhood Special
Education (ECSE) classrooms in the Greater Lansing Area in Michigan, specifically in
Holt, Michigan. The chosen sample was reflective of the school's rich diversity in the
areas of culture, economic status, and family education. Two boys and one girl were
selected as participants for this study. The researcher notified ECSE teachers and support
staff of the study four months prior to the beginning of the data collection period. For the
purpose of this study, the term support staff will refer to all professionals that help with
the needs of the child, including, but not limited to, parents, speech therapists,
occupational therapists, physical therapists, music therapists, paraprofessionals, assistant
teachers, student teachers, social workers, school psychologists and autism specialists.
The researcher sought referrals from teachers and support staff to obtain participants for
the study.
Criteria for Selection of Participants

Diagnosis of ASD: This study was designed to evaluate musical Social Story“
interventions for preschool age students with Autism Spectrum Disorders. In order to
remain as close to the original Social Story“ intended audience, only students with a
diagnosis of ASD participated.

Targeted behavior: Target behaviors were defined on an individual basis. The

behaviors were determined as areas of need as seen by the teacher, support staff, parents,

23

or as indicated in the child’s Individualized Education Plan (IEP). Each target behavior
was operationally defined in terms of specific observable behaviors suitable for music
Social Story“ intervention.

Previous positive reaction to general music or music therapy activities: Some
auditory stimuli can be painful or disturbing for individuals with ASD. To avoid
unnecessarily causing adverse reactions in those with such sensitivity, the researcher
screened potential participants. Since some individuals may have hidden or unknown
sensitivities, previous positive music experience was required for acceptance as a
participant of this study.

Procedure

The following outline of procedure was repeated for each child individually.
Once a participant was accepted to the study, the researcher contacted the child's parents
to obtain written consent for participation and to obtain information on the child’s music
preferences. The researcher talked with all support staff working with the child, and
observed the class for two days to determine the behavior(s) to be targeted, and the time
of the greatest occurrence (or lack of occurrence) of this behavior. The researcher
operationally defined each target behavior for purposes of data collection. The study
consisted of three phases over a three-week period. During the first week, the researcher,
as primary observer, recorded daily the incidence of the target behavior (during a one half
hour interval) on a data collection sheet created for this purpose at the determined time of
greatest occurrence (see Appendix A). Week 1 was used as a baseline. The researcher
also used week 1 to further observe the nature of the target behavior and the situation or

events surrounding the time selected for data collection. This information provided the

24

basis for the Social Story“. In preparation for the second phase, the researcher wrote a
Social Story“ for each individual child following Gray’s guidelines (2000b). Pictures of
objects and places mentioned in the story were used where appropriate (see Appendix B).
This story was then set to original music using the child’s musical style preferences (as
indicated by parental and staff report and observations of the researcher) when applicable
(see Appendix C). During the second week (phase two), the researcher presented the
musical Social Story“ daily, just prior to the time of greatest occurrence (i.e., before
circle time or at the beginning of free choice). Each student used a schedule board with
activity tabs that were secured with Velcro. The students checked their schedules prior to
each activity daily to assist them with the transition between activities. A tab labeled
"Music Story" was included in the children's daily schedule at the appropriate time to
help establish this activity as a part of the school day. The student received the musical
Social Story“ presentation in partial seclusion to limit distractions. The researcher first
sang the musical Social Story“ while accompanying on guitar for participants one and
two, accapella for participant three, then she invited the student to sing with her using the
Social Storybook“ as a lyric sheet. The measurement period immediately followed. This
half hour data collection was at the same time as during week one. The treatment was
withdrawn the third week, and the behavior was recorded at the same time for the half-
hour interval. Exceptions to this schedule are outlined in the individual case studies. The
Social Story“ book was available to the child in the classroom throughout the day to
review if the child wished, as is recommended by Gray (2000b). One of the child’s

support team collected interobserver reliability data on two days of each of the treatment

25

conditions. Interobserver reliability was 93%. The support staff and the researcher also
made notes on the collection sheets to add anecdotal data.
Definition of Research Questions
With collaboration from the classroom staff and treatment team for the
participants, the researcher developed the following research questions:
1) Ben - What effect will the musical Social Story“ have on the target behavior of
independent initiation of activities, as evidenced by occurrences of:
a. Appropriate play
b. Disruptive/Inappropriate Behaviors
c. Seeking Help
2) Emily - What effect will the musical Social Story“ have on the target behavior of
taking toys from others, as evidenced by occurrences of:
a. Taking without asking
b. Asking for desired object
3) Aaron - What effect will the musical Social Story“ have on the target behavior of
remaining at circle time, as evidenced by occurrences of:

a. Trying to leave circle

26

Measurements and Analysis

After the collection of data, a series of dependent sample t-tests were performed
to answer the research question for each target behavior. The researcher prepared graphic
representations of each student's resulting data for the purpose of visual analysis. Case
studies describe the specific details of methodology and results case by case for each
participant. The names of participants and staff that participated in this study have been

changed to protect their identity.

27

CHAPTER FOUR

Case Studies: Results and Reactions

Case Study — Ben

A whirling-dewish, a Tasmanian devil, Stitch (ofDisney's Lilo and Stitch) - a
little boy with messy brown hair and mischievous smile. Aren't they all one and the same?
Ben sure is a hand full, and full of energy. He has already plowed his way through the
morning routine and dove into rough and tumble "play. " He insists on going without a
shirt. He just wandersfrom place to place, leaving destruction in his wake, chatting all
the while. My, what a verbal child 1 see what Joan means about his not knowing how to
play. He seems to really crave structure - as if he needs to be told what to do, exactly. 1

Target behavior: Ben was aged 4 years 6 months at the time of the study. Ben
showed a marked inability for purposeful play. His teacher reported that he "seems to not
know how to simply play. " He demonstrated disruptive, destructive and inappropriate
actions in place of appropriate activities. In addition, Ben would not ask for help if he did
not know what to do with a toy or activity with which he was unfamiliar. This behavior
was most apparent during free choice and "centers." Centers refers to a period of class
time during which students participate in various learning and play activities set out at
various stations or "centers" throughout the room. The researcher and classroom staff
chose centers as the period of data collection. Ben's treatment team identified the target

behavior as independent initiation of activities. The researcher numerically and

 

I The material in italics at the beginning and ending of each case study is a character composite based on
the researcher's field notes, the observer's notes, and conversations with the treatment team.

28

anecdotally collected data under the categories of "begin appropriate play,"

II II

"inappropriate or destructive play, seeks help, including watching others to learn how. ”
Implementation procedures: Baseline was collected for Ben for five days.
Following baseline, the researcher wrote Ben's Social Story“ and set it to original music

in a blues style based on the report of his preferred music given by his mother (see
Appendix C). During what was to be the second week of the study, Ben was kept home
from school with severe allergies. Ben returned to school for three days the following
week, and the musical Social Story“ was implemented then. Ben turned the pages of his
story, seeming to enjoy the music and the story. He remained engaged throughout the
song all three days. On the second day, he hummed during the repetition of the story,
when invited to sing along. On the third day, he sang along with the researcher during
both presentations of the song. Ben's teacher reported that he was humming the tune
during centers on the third day, while appropriately engaging in an activity. The
following week, Ben left school to attend an Applied Behavior Analysis program out of
state. Second baseline data of the removal of the musical Social Story“ condition could
not be collected as a result.

Results and reactions: A series of t-tests comparing baseline (Al) to the musical

Social Story“ intervention (B) show a significant difference between baseline and the

musical Social Story“ for the target behaviors of appropriate play (p = .050) and

29

seeking help (p = .009). The target behavior of destructive/inappropriate behaviors did
not indicate significance when the two conditions were compared (p = .082) (see Tablel)

although the results approached significance.2

Table l: t-Tosts for Condition Comparisons for Ben

Appropriate Play t df p
A1:B -2.44487 6 0.050139
Disruptive/Inappropriate Behaviors

A1:B 2.08878 6 0.081737
Seeking Help

A1:B -3.78506 6 0.009126

 

Figure 1 -Visual Analysis - Ben

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a M ~ — _ ..........

7 ———£I~— I; L
5 6 “T" r

4 - -
E. 3 ___.-_--__-_ / \ —-— Musical Social
g: 2 / \ A Story(tm)

1 - ~— .

o . . J;

1 2 3 4 5
Days of Condition

 

 

 

Images in this thesisare presented in color.

 

2 Numerical data was collected only on the specific target behavior outlined in the research questions in
Chapter Three. Only the target behavior data was analyzed statistically. Secondary behaviors listed on the
data collection sheets and outlined in the case studies were recorded anecdotally and therefore not subject
to statistical analysis or graphic study.

30

 

Figure 2 - Visual Analysis - Ben

 

/
/ + Baseline

 

 

 

 

 

 

 

 

Destructivellnapproprlate
Play
a:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 —I— msieel Social
Story(lm)
2 r ,. -
\_\ //..
0 "ar/
1 2 3 4 5
Days of Condition
Figure 3 - Visual Analysis - Ben
6 r *— ~ — w - —————
5 a“..-
\u
I: 3 ti ‘0 —I— Musical Social
0 2 _ -4 StOtYOM)
1 L“ Mu—fl
O V l l v T l
1 2 3 4 5
Days of Condition

 

 

 

Visual analysis of the graphed data for the baseline condition demonstrated Ben's
behavior tendencies of more inappropriate or destructive activity than appropriate play,
and limited occurrences of asking for assistance. Although the musical Social Storym
was utilized for only three days, a dramatic shifi in his behavior can be seen when

compared to baseline. Visual analysis shows a overall increased appropriate play,

31

decreased destructive activity, and increased inclination to ask for help during the data
collection periods following the musical Social StoryTM condition (see Figures 1 - 3).

Hiding within this chaotic buzz of a boy is a very musical child. He smiled with
great delight at having the opportunity to be involved in a musical activity with me. He
not only stayed with the Social StoryTM activity each day without additional prompting,
but he also hummed or sang along - including most of the correct words by the third day.
Mrs. B. said he even hummed the tune fiom the Social StoryTM while working with her on
another activity. When he first came into the classroom the third day of the music
condition, he was making up words to the tune of "T he Farmer in the Dell " to fit the
activities he was engaging in. I hadn't heard him sing otherwise. Interesting. It makes me
wonder if he used his Social StoryTM song to carry the information I presented in his
memory, and he is trying it out with other familiar tunes. I see so much possibility for
music therapy for Ben. On a Social StoryTM perspective, he demonstrates the fundamental
use of Social StoriesTM - a presentation of information and expectations of the child that
shows an almost instant understanding after the first reading. In Ben's case, the musical
presentation may have provided increased focus and thus attention to content. The music
might have also provided a pneumonic devise that allowed Ben to retain the information,
and recall it when needed.
Case Study - Emily

In a word, precocious. She enjoys music, books, and numbers. Wide eyes, set with
delicate features flamed by a veil of straight dark hair, with bangs squarely trimmed at
her brow line. In contrast with this poise and grace, she holds a pacifier with one hand

while allowing another to rest in her mouth. When she talks, she attempts to talk around

32

the pacifier rather than remove it. Rigid. Routine. Demanding. Emily has a behavior plan
that gives her warnings before she is removed from the classroom for time away to calm
down. Often she seems to prefer to go to time away than risk not getting her own way. It's
hard to tell how much of this is conscious decision and how much is compulsion. She
seems to demonstrate a somewhat flat aflect. I can 't seem to recall seeing her smile.
Target Behavior: Emily was four years and six months old at the time of the
study. Emily displayed a range of symptoms of autism spectrum disorder somewhat
different from Ben, including ritualistic play, insistence on sameness, repetitive behavior,
underdeveloped peer relationships, flattened demonstration of affect, and a preference for
parallel rather than cooperative play. Emily's classroom staff reported that she often
engaged in what we called "hoarding" behavior. She would play with a collection of
objects and take anything she thought should belong to this collection, even if it was a
part of another activity or another child was using it. For example, if she got out a
collection of toy dogs, she would also take a dog puzzle piece from a centers activity and
add it to her stuffed dogs, much to the dismay of the child using the puzzle. Even if she
did not add to her collection, she would rarely allow others to play with what collection
she had chosen to use at that time and would often guard her collections from use by
other children even when she was not actively using it. The other children in the
classroom seem to have become conditioned to no longer attempt to play with Emily
without encouragement from the classroom staff. Emily's tendency to take without askin,
and sharing toys became the focus of her musical Social Story”. The researcher and
interobserver collected data under the headings of: "hoarding" behavior, tries to take

object/toy from another, and asks for object/toy. Free choice was the time of greatest

33

occurrence of this behavior and was chosen as the period of data collection. Emily had
been seen in music therapy by one of the researcher's colleagues for nine months at the
time of the study. The therapist and the researcher have not discussed Emily other than to
verify her attendance in music therapy.

Implementation: The baseline measure lasted five days. After baseline, the
researcher wrote Emily‘s Social StoryTM and set it to music. Emily's musical Social
StoryTM was a sort of syllabic aria, matching her preference for 'operatic' voice as
determined through observation, conversation with her mother, and reports from her
classroom staff (see Appendix C). The researcher sang the musical Social StoryTM
accompanied by guitar. Emily preferred to hold the researcher's copy of the Social
StoryTM book, possibly because it contained more pages than her copy, although Emily
looked only at the pages of her StoryTM. Emily turned the pages of the StoryTM all five
days of the condition. Emily did not sing the song when asked to join in for the repeat of
the song daily, but did hum and strum the guitar each day. Emily's mother delivered a
baby on the fourth day of the musical Social StoryTM condition; thus Emily was absent on
days four and five of that week. The musical Social StoryTM condition was continued for
two days the following week. The researcher removed the musical Social Story condition
for the remaining days of that week. Emily was absent from school the last day of the
study period; thus the return to baseline condition consisted of two days, and one of those
days she spent 20 minutes in time away.

Results and Reactions: The researcher ran dependent t-tests comparing baseline
(Al) to the musical Social StoryTM (B), the musical Social StoryTM to the removal of the

musical Social StoryTM (A2), and the two baselines to each other (Al :A2). These

34

comparisons revealed no statistical significant differences in neither "takes toys from

others" nor "asks for desired toy" (see Table 2). The comparison of the baseline to the

musical Social StoryTM in the area of "takes toys fiom others" approached significance (p

= .06) (see table 2).

Table 2: t-Test Condition Comparisons for Emily

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Takes without asking T df p
A1:B 2.15728 8 0.063056
BzAZ 0.97590 5 0.373934
A1:A2 2.00446 5 0.101361
Asks for desired object
A128 0 8 1
B'AZ -0.70321 5 0.51331
A1:A2 -0.70321 5 0.51331
Figure 4 - Visual Analysis - Enlly
6 _-_.m-mm~.
g 5 A + Baseline
§ 2 3 \ /\ +Musical Social
§ 3 2 \, ,/ \ 3mm
' /-"\ \ Remo‘al mSS(tm)
' 1 f), ~>.,\ /..' I k\\ v
0 “"4?" l r :I/ l i
t 2 3 4 5
Days of Condition

 

 

 

The researcher prepared a visual analysis of the study conditions (see Figure 4).

Only a graphic representation of the occurrence of "takes toys" from others was prepared,

as the data for asking for a desired toy was statistically the same with one occurrence

each under each condition. A review of the graphic representation reveals a declining

tendency in the occurrence of Emily's taking objects from others during the musical

35

Social StoryTM condition, and a reduction to zero occurrences during the removal of the
musical Social Story“. The second baseline measure was only two days and two
consecutive zero occurrences would not be a long enough period to be considered
extinction of the behavior.

Emily, Emily, Emily. If only you could find the ability and desire to share all that
goes on behind those wide eyes. Your words are so succinct, when you share them at all.
And yet you chose to bring me into your circle, thanks to the music. T he first week
(baseline), you all but ignored me. As soon as that guitar came out, I became a thing of
interest, and eventually I became a playmate. 0n the last day of the musical Social
StoryTM condition Emily engaged in appropriate eye contact with me throughout the
song. Afterward, she invited me to play uni/ix cubes with her. We played together for 20
minutes, trading blocks back and forth. Unbelievable. She indicated a desire to continue
with the song/guitar on all days of the intervention, preferring music to her "hoarding"
opportunities. It was interesting to see the "change" in Emily's behavior during the music
condition. T he first day she chose to keep the Social StoryTM book, and looked through it
a few times before getting out one of her collections. She played with the collection in an
animated way, and left the activity to do a shared activity with Mrs. B. She didn't get
upset when another child approached the collection she left unguarded She seems to be
watching the other children more, and willing to share more, within reason! During the
music phase, and return to baseline she shared some of her favorite things - her favorite

dolls, the unifix cubes, and even time on the computer!

36

Case Stuay - Aaron

Aaron, a study in motion and expression through silence. Young, small, almost
delicate. He reminds me of a quiet little mouse. Specialists consider Aaron "non-verbal, "
although I have heard him correctly name letter magnets, and hum to himself He
wanders the room seeming not relate to the objects or people in it. Yet he loves to be
tickled. His laugh "tinkles. " He seeks out a certain closeness - the first time I met him he
tried to burrow in to my lap.

Target behavior: Aaron was three years and six months old at the time of the
study. He displays more behavioral symptoms typical of autism than the others in the
study exhibit. He avoids eye contact, engages in self-stimulatory behaviors, including
running small toy cars over his chest and legs, and humming to himself. He appears
physically withdrawn. Aaron has difficulty sitting and focusing attention on others.
Aaron tends to 'run laps' around the room. Aaron's difficulty in sitting still and tendency
to wander impedes group learning. Aaron's team selected the target behavior from this
tendency. The target behavior was defined as remaining with the proximity of the group,
preferably in his chair, during group learning. "Circle time" is the period of daily group
learning, usually lead by the head teacher or speech therapist. Circle time was identified
as the time of greatest occurrence, and data were collected during this class period under
the headings of going to the circle, number of times he tries to leave the circle, and
number of prompts to return.

Implementation: Aaron's baseline was measured for five days. After the
completion of the baseline measure, the researcher wrote Aaron's Social StoryTM with a

focus on circle time, and set it to music using the children's tune as its main theme, based

37

on the music preferences indicated by Aaron's father and upon intervals he had been
heard humming to himself during initial observations. During the musical Social StoryTM
presentation, the researcher sang the song unaccompanied. Aaron seemed to prefer
having the story sung while in a secured position, on the researcher's lap, or immediately
in front of the researcher, with the researcher's arms around him to hold the book in front
of them both, impeding guitar use. Aaron remained in this position for the duration of the
StoryTM presentation all five days of this condition. A copy of the "circle" tab from
Aaron's daily schedule board was attached to a page his Social StoryTM book with Velcro.
The researcher helped Aaron remove this tab during a particular phrase of the song:
"When I pull circle on my schedule..." reinforcing the class procedure for transitions
between segments of the daily schedule. The musical Social StoryTM was presented for
five days during week two of the study. The StoryTM condition was removed during week
three, and data were collected for two days at the same time as previous data collections
(circle time). Aaron was absent from school on the last three days of the study.

Results and reactions: The researcher performed dependent sample t-tests
comparing the following conditions: baseline (A1) to the musical Social StoryTM (B),
the musical Social StoryTM to the removal of the musical Social StoryTM (A2), and the
two baselines to each other (A12A2). None of the comparisons reached statistical
significance (see Table 3). Aaron received physical assistance to come to the circle daily.
The researcher and independent observer were unable to determine how often this was
the result of Aaron requiring the physical guidance to get him to join the group from how

often this was done out of habit by the support staff.

38

Table 3: t-Test Condition Comparison for Aaron

Tries to leave circle t or p
A1 :8 0.97980 8 0.355884
B:A2 1.27775 5 0.257444
A1 'A2 1.72590 5 0.144956

 

Figure 5 - Visual Analysis - Aaron

 

 

 

 

 

 

 

 

 

 

 

 

 

6 --—— -__ _____._.__... a“,
!

' 5 A i +Basellnel
s 41-“ —— ------ _. -.,
g 3 ._._._T\ \ J +Mueical Social
é / /\ 3 Stomun)
: 2 'H_"' “7"». ' f; i Removal of
J 1 rt" 7, /v 4”], \ mSS(tm)

o -—-——/. V - . ,

1 2 3 4 5
Days of Condition

 

 

 

The researcher prepared a graphic representation of the data for visual analysis.
Aaron's attempts to leave the circle varied considerably throughout the first two
conditions (see Figure 5). Aaron's attempts at leaving the circle were reduced fiom 14
during the initial baseline (Al) to total of 8 during the musical Social StoryTM condition
(B). Aaron did not attempt to leave the circle during the two days of the return to baseline
(A2). However, this period is much too limited to consider two occurrences of zero an
extinction of behavior. On day five of the musical Social Story”, there was a break in
the normal circle time routine. The head teacher was not in the room for circle time and a
substitute teacher attended the class. In addition, the changing table in the room was
borrowed by a parent of a child in another class to change the diaper of a very distressed

baby. This diaper change took nearly ten minutes. During this time, the substitute

39

suspended her presentation of group learning materials due to the noise of the crying
baby. Aaron attempted to leave the circle three of the four occurrences reported during
this disruption.

Aaron made purposeful eye contact with me! After I sang the StoryTM to him the
first time, he looked at me - engaged me - eye to eye during circle time. What a wonderful
feeling to be acknowledged as apart of his circle now. It gets better. He hummed along
with the song on the third day. Perhaps it is the music and not just the book and
individual attention that has captured his interest. Then even better - on the final time of
the song presentation Aaron said, "Circle! " Since the introduction of the StoryTM, Aaron
seems more engaged in circle activities. He is being more verbal, even if only slightly. He
said "ball " during a colored ball activity on Wednesday and "blue" before sitting in the

blue chair when coming to circle on Friday.

Summary

T -tests revealed a significant increase in the occurrences of appropriate play and
seeking help for Ben, approached significant decrease in the occurrences of
destructive/inappropriate play, and approached significance in the decrease of Emily's
target behavior of taking objects from others. All other target behaviors failed to
approach statistical significance. However, graphic representation of the data shows
increased positive behavior and decreased negative behavior overall during the musical
Social StoryTM intervention for all three participants. Examination of the anecdotal
information collected suggests a clinical or practical significance demonstrating the

efficacy of musical Social StoriesTM for all three preschool children.

40

CHAPTER FIVE
Summary and Discussion
Summary

Implementation of a musical Social StoryTM resulted in changes in target
behaviors that met or approached statistical significance for two of the three subjects.
Visual analysis showed a change in behavior in a desired direction during the musical
Social StoryTM implementation for all three subjects. Ben's results showed a significant
difference between baseline and the musical Social StoryTM condition for the target
behaviors of "appropriate play" (p = .050) and "seeking help" (p = .009), and the target
behavior of "destructive/inappropriate play" approached significance (p = .082). Emily's
target behavior of "takes toys from others" approached significance (p = .063) in
comparison between the first baseline and the musical Social StoryTM condition. Her
target behavior of "asks for desired object" showed no change between conditions.
Aaron's results showed no significant change between conditions, although visual
analysis appeared to show a lower rate of the target behavior of "leaving the circle"
overall during the musical Social Story” condition.

For Emily and Aaron, 8 limited return to baseline showed zero occurrences of the
target behavior suggesting lasting effect of the musical Social StoryTM after its removal. It
is possible that Emily's new understanding of the social mics regarding play as outlined
in her StoryTM effectively reduced her target behavior of "taking toys from others" to
practically zero. Aaron's occurrences of the target behavior of "leaving the circle" also

reduced to zero for the two days of return to baseline. However, the occurrence of the

41

target behavior during the other conditions was not consistent enough to suggest an
extinction of behavior without a much longer data collection period.

This study corroborates the finds of Brownell (2002), Pasiali (2004), and Pudenz
(2004) and adds to the growing body of evidence suggesting the efficacy of musical
Social StoriesTM on target behaviors for children with autism spectrum disorders. The
behaviors chosen for measurement in this study produced small numbers of occurrences,
making statistical significance difficult to establish. Small samples present limitations in
design and analysis, diminishing statistical power. In a study such as this, the 'clinical
significance' may become more important than the statistical significance. The participant
of a study may or may not show a change in behavior that reaches statistical significance.
However, these mathematical results may not reflect a practical or clinical outcome that
shows the intervention to be beneficial in an everyday setting.

The clinical significance, the subtleties in the participants' everyday reactions,
were the important and moving results of the study: Aaron's increased time in the chair,
increased vocalizations, and increased participation, Emily's increased social play, Ben's
increased time spent on individual activities and his taking time to "learn" how to play.
Music for all three of these children captured their attention. Emily preferred the music
and music making over her ritualistic behavior, and requested the guitar as an activity
during free choice. All three participants demonstrated a shift in their behavior in a
favorable direction during the musical Social StoryTM condition that seemed to carry over
into the return of baseline once the condition ended. A longer-tenn study would need to

be conducted to examine any lasting effects from the procedure.

42

The current study was limited to a single, self-contained, special education
classroom, and had a small sample size. While this study proved successful in this
setting, from a practical standpoint, it is important from a research and a clinical
perspective to test if this result is reproducible in similar settings and expandable to
varied settings. In addition, the limitations of the small sample found in this setting
produced undesired, though unavoidable, changes in the individual subject protocols. A
larger sample might help minimize these difficulties and insure successful application of
protocol for a larger number of participants. This study should be expanded to include a
larger number of participants from a variety of preschool classroom settings including
inclusive classrooms, Developmental Kindergarten (DK), and Young Fives programs. A
longer period of treatment and measurement for each might also be advisable.

In an exchange of e-mail with Carol Gray, the researcher confirmed her decision
to set the Social StoriesTM to original music. Gray felt that, in her experience, children
with autism spectrum disorders may hold a rigid insistence on sameness in regard to
musical texts, and may have adverse reaction(s) if the words to a familiar or favorite song
where changed (C. A. Gray, personal communication, July 2005). Further, even if the
child did not outwardly demonstrate resistance to the change of words, the child might be
repeating the known words silently in his/her head, effectively blocking the intake of new
information. In contrary evidence, Pudenz (2004) reported successful use of "piggy-
backed" tunes in her study with four elementary students with autism. The use of
piggybacked song presentations of Social StoriesTM has not yet been tested with
preschool children. One consideration in favor of examining the use of altering the words

of pre-composed songs is the ease of use. Setting Social StoriesTM to piggybacked music

43

might be easier for a classroom teacher or other support staff than attempting to write
original music, especially if the teacher does not have any composition experience or
formal music training. Gray's prediction that piggybacked songs might prove less
effective than original music has not been tested. A study comparing the effectiveness of
Social StoryTM presentations with pi ggybacked songs to the effectiveness of Social
StoriesTM set to originally composed music might help to establiSh a musical Social
StoryTM protocol.

The reading level of the students in this study was unknown, although behavior
seemed to suggest the older two participants had greater pre-reading skills than the
youngest; however, this could not be assumed and was not tested. If the older two did
have greater reading skills, this may have enhanced their understanding of the Story“.
The effectiveness of musical Social StoryTM presentation for individuals across reading
levels and across ages is another area of recommended study to further the development
of musical Social StoryTM protocol.

The effective use of musical Social StoriesTM could go beyond the classroom into
the homes of the preschool children with autism. There is potential for home use. Parents
need an arsenal of teaching tools and coping methods of their own when an autistic child
is in the home. Parents could be taught how to write Social StoriesTM and either set them
to original or "piggybacked" music. This is a recommended area of future study.

Although Social StoriesTM were originally developed by Gray as a teaching tool
for children with autism, their successful use has been demonstrated for others as well,

with and without disabilities. As musical Social StoriesTM are researched and a procedure

44

 

for their creation and implementation begins to emerge, their application beyond the area
of autism should also be explored.

Autism is a spectrum disorder. Every individual with autism displays a unique set
of symptoms at varying degrees of intensity, making formalized study of treatments,
programs, or procedures to assist individuals with ASD extremely difficult. Even when
rigorous studies are carried out, their findings are not generalizable, but rather, suggestive
at best. However, the individual nature of autism requires that we as educators, therapists
and support staff have as many tools in our bag of tricks as possible in order to assist each
child to the best of our abilities. Musical Social StoriesTM seem to be one more tool at the
disposal of teachers and therapists to introduce information that other more conventional
methods of teaching or treatment have not been successful in presenting to a child with

autism.

45

APPENDIX A

Data Collection Sheets

Subject 1 = Ben's Data Collection Sheet

Subject 2 = Emily's Data Collection Sheet

Subject 3 = Aaron's Data Collection Sheet

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APPENDIX B

Social StoryTM Texts

Reproduction of Ben's Social StoryTM book.
Reproduction of Emily's Social StoryTM book.

Reproduction of Aaron's Social StoryTM book.

Images in this thesis are presented in color.

50

Playing at Centers

 

51

 

Playing at Centers

My name is Ben. Mrs. Beeman is my teacher.

Most days at school I do centers after circle time.
During centers there are activities and games to play.
Sometimes I choose what I want to do during centers.

Sometimes Mrs. Beeman, Jan, or Katie chooses what
I need to do.

52

Some activities I have played before.
Some activities I have not played before.
It is ok to try to do an activity I have not done before.

If I do not know how to do an activity I can ask for
help.

Centers gives me a chance to play and explore.

This is ok.

53

Playing Together with Toys

 

54

 

 

 

Playing Together with Toys

My name is Emily. I play with many toys in Mrs.
Beeman’s room. These are some toys I play with
often.

 

Sometimes people want to play with the same toys.
Sharing toys is important. Sometimes someone has a
toy I want to use. Asking to use a toy lets the other
person know that I want a turn. Taking a toy away
from someone may make the other person sad or
angry. I will try to let the person finish using the toy
I want before I may take it.

55

Staying in My Chair at Circle Time

 

56

Staying in My Chair at Circle Time

My name is Aaron. On most school days I have
circle time.

 

When I pull Circle on my schedule it is
time to sit in a chair on the circle.

 

57

Teachers use circle time to talk or sing with

many children at the same time.

 

It is important to stay in my chair unless a
teacher asks me to stand up. Adam will try to

stay sitting in a chair during circle time.

58

APPENDIX C

Music

Music written for Ben's Social StoryTM
Music written for Emily's Social StoryTM

Music written for Aaron's Social StoryTM

In Aaron's song, the word "schedule" is notated with the standard grammatical break of
"schedule" for ease of reading. The researcher used a mid-westem dialect pronunciation
of the word as found in Webster's New World Dictionary, third edition, (ske' joo el). This
pronunciation adds an additional unaccented syllable. The researcher sang this word as

two eighth notes on the note e and a quarter note on the note g.

59

Playing at Centers

with a blues feel Denise Travis
G

    
   

My name is Ben. Miss- es Bee- man is my teach-er. Most

 
   

v
v

days at school I have cen- ters af- ter cir- cle time.
C

    
    

Dur- ing cen- ters there are ac-tiv-it-ies and
G C

V

games to play. Some-times I choose what I

 

want to do dur - ing cen - ters
C

    
    
    

Some-times Miss- es Bee-man, Jan, or Ka- tie choos- es what I need to
G

do. Some ac - tiv - it - ies I have

v

v
played be- fore. Some ac- tiv- it- ies I have not played be- fore.

60

 

It is O-K to try to

 

_ . v
do an ac- trv - rt - y I have not done be- fore. If

C G

       

v
I do not know how to do an ac- tiv-it- y I can ask for help.

 

Cen - ters gives me a chance

C G

    

to play an ex - plore. This is O - K.

61

 

Playing Together with Toys

Denise Travis

 

 

 

 

 

 

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My name rs Em - r - ly. I

 

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Some - times some - one has a toy I want to use.
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may take it.

62

Staying in My Chair at Circle Time

Denise Travis

 

My name is Aar-on. On most school days Ihavecir-cletime.

 

When I pull cir- cle on my sched- ule it is time to sit in a

 

chair on the cir - cle. Teach- ers use cir - cle time to talk or

 

sing with ma - ny child- ren at the same time. It is im- por-tant to

 

stay in my chair un - less a teach- er asks me to stand up.

 

Aar- on wil try to stay sit- ting in a chair dur-ing cir-cle time.

63

 

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