Developmental Neurorehabilitation

ISSN: 1751-8423 (Print) 1751-8431 (Online) Journal homepage: http://www.tandfonline.com/loi/ipdr20

A treatment comparison study of a photo activity

schedule and Social Stories for teaching social
skills to children with Autism Spectrum Disorder:
brief report

Sabrina D Daneshvar, Marjorie H. Charlop & Debra Berry Malmberg

To cite this article: Sabrina D Daneshvar, Marjorie H. Charlop & Debra Berry Malmberg (2018): A
treatment comparison study of a photo activity schedule and Social Stories for teaching social skills
to children with Autism Spectrum Disorder: brief report, Developmental Neurorehabilitation, DOI:
10.1080/17518423.2018.1461947

To link to this article: https://doi.org/10.1080/17518423.2018.1461947

Published online: 21 May 2018.

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DEVELOPMENTAL NEUROREHABILITATION
https://doi.org/10.1080/17518423.2018.1461947

A treatment comparison study of a photo activity schedule and Social Stories for
teaching social skills to children with Autism Spectrum Disorder: brief report
Sabrina D Daneshvara*, Marjorie H. Charlopb, and Debra Berry Malmbergc
a
Claremont Graduate University, Claremont, USA; bDepartment of Psychology, Claremont McKenna College, USA; cDepartment of Psychology,
California State University, Northridge, USA

ABSTRACT ARTICLE HISTORY

Purpose: To compare the efficacy of two procedures, a photo activity schedule intervention and Social Received 26 September 2017
Stories, to teach social skills to four children diagnosed with Autism Spectrum Disorder (ASD). Revised 24 February 2018
Methods: An adapted alternating treatments design with an additional multiple baseline control was Accepted 3 April 2018
used, and two social skills were targeted for each of the four participants, one under each intervention KEYWORDS
condition. Autism; photographic
Results: Results indicated that all four participants learned the target social behaviours with the photo schedule; social behavior;
activity schedule intervention, but did not learn target social behaviours with Social Stories. social skills; Social Stories
Conclusions: Findings support the use of a photo activity intervention for teaching social skillsto
children with ASD; we discuss the implications of inconsistent findings of effectiveness of Social Stories.

Visual activity schedules can consist of photos, drawings, Method

or other visual symbols and are usually used as prompts to
promote independence for children with Autism Spectrum
Disorder1 (ASD). Photographic activity schedules have
been used for a variety of behaviors, ranging from play
to socio-communication skills.2,3 However, in a recent
review of the literature, Knight and colleagues1 found
that half of the studies reviewed did not demonstrate
experimental control, leading the authors to highlight the
need for methodologies permitting experimental control in
research on visual activity schedules.
Social Stories™, which are brief narratives describing
desired social behaviors,4,5 are another procedure often
used to teach socio-communication skills to children
with ASD. Recent research has shown inconsistent results
and methodological challenges, with concerns that the
efficacy of Social Stories may be due to the associated
treatment package rather than the story.6,7 Recently,
researchers who have isolated the components of Social
Story interventions have found that other social skill inter-
ventions such as prompting, video modeling, or the teach-
ing interaction procedure resulted in social skill
acquisition at higher levels than Social Stories.8–11
The present study was designed as a replication and exten-
sion study to: (1) expand the photographic activity schedule
literature by (a) creating a new photo-based social skill pro-
gram and assessing its efficacy for acquisition of social skills
and (b) using a strong experimental design permitting meth-
odological control and (2) provide a treatment comparison of
the photo activity program with Social Stories in isolation.
Participants
Four children with ASD12 participated in this study. Mental age
(MA) equivalents for the children were derived using the Peabody
Picture Vocabulary Test – Revised Edition.13 All children had
significant social skills deficits as indicated by on-site assessment
(structured observations and the Vineland Adaptive Behavior
Scale14) and as reported by their parents, teachers, and therapists.
Carrie was a 10-year, 5-month-old Filipina-American girl
(MA of 2 years, 5 months) who did not initiate to others,
respond to their social bids, and or take turns or share with
others. Gary was a 6-year, 7-month-old Hispanic boy (MA of
1 year, 11 months), who often played alone, rarely initiated
social interaction, and did not spontaneously share or take
turns with others. Mark was a 5-year, 11-month-old Chinese-
American boy (MA of 3 years, 10 months), who did not initiate
social interaction and rarely responded to others’ social inter-
action. Fiona was an 8-year, 3-month-old Caucasian girl (MA
of 6 years, 1 month), who interacted with others when
prompted, but often not appropriately, and she frequently
asked others to leave her alone. None of the participants had
experience with either of the two interventions or similar types
of interventions (e.g., picture or photo use) prior to this study.
Target behaviors
Table 1 shows target behaviors for each intervention condition.
Carrie’s and Gary’s target behaviors were greeting and sharing,
and Mark’s and Fiona’s target behaviors were commenting and
initiating.

CONTACT Debra Berry Malmberg dmalmberg@csun.edu Department of Psychology, California State University, Northridge, 18111 Nordhoff Street,
Northridge, CA 91330-8255, USA
*Sabrina Daneshvar is now at Autism Spectrum Therapies.
© 2018 Taylor & Francis
2 S. D. DANESHVAR ET AL.

Table 1. Target behaviors and stimuli across condition and participant.

Child Social Stories Stimuli Photo steps Stimuli
Carrie Sharing Variety of toys Greetings Entry/exit door
Gary Greetings Entry/exit door Sharing Basketball and hoop
Mark Comments Variety of toys Initiations Variety of toys
Fiona Initiations Variety of toys Comments Don’t Break the Ice®

Settings First, baseline sessions were conducted, with generalization

All sessions took place in a playroom (2.6 × 4.4 m) at an after-
school behavior management program for children with ASD.
In the playroom were a variety of large toys, a small table and
chairs, and a cabinet holding toys and books. Generalization
of skills was assessed in a nearby café and a grassy courtyard.
Materials
The photo activity program (hereafter called the photo steps
program) was comprised of a series of photographs depicting
the participant engaging in each step of their target social
behavior (see Table 2, for the steps of the photo program
for each participant). For verbal initiations, the specific target
phrase was typed and attached to the bottom of the photo-
graph. Photographs were placed in order in a rolodex.
For the Social Stories condition, a story was chosen or
created based on the content guidelines outlined by Gray.15
The stories were comprised of four types of sentences: a
descriptive sentence, a directive sentence, an affirmative sen-
tence, and a perspective sentence.15 Stories were printed on
paper using large font (Times New Roman, size 18).
Experimental design
The design was an adapted alternating treatments design,
within child and across tasks,16 with different targets across
condition, permitting comparison of the two intervention
conditions while minimizing potential carryover effects.
probe data collected, then intervention comparisons were
implemented. After these comparisons, generalization probe
data was once again collected.
Procedure
For each participant, two social skills were identified from
each participant’s program curriculum and randomly assigned
to either the photo steps condition or the Social Stories con-
dition. Prior to random assignment, the social skills were
rated of equal difficulty by 10 behavior interventionists.
During each weekly visit to the after-school program, partici-
pants received each type of intervention, and these phases
were alternated.
Baseline
During baseline, each child was observed and filmed partici-
pating in the free play setting for 5 min. Frequency of the
target social behaviors was recorded on a 10-s partial interval
occurrence and non-occurrence scoring procedure. Each min-
ute the experimenter provided the discriminative stimulus
(SD) specific to the participant’s social skill. For the target
behavior of initiations, the SD was, “can you ask me a ques-
tion?” For the target behaviors of commenting and taking
turns, the SD was, “play with me.” For the greetings target
behavior, at each minute, five times during the 5-min play
session, a different person entered the playroom and
approached the child; the target response was “hello.” For
“good-bye,” a different person entered the room, waited for

Table 2. Task analysis for each photo in the photo steps program.
Child Target social behavior Steps
Gary Sharing/turn taking (1) Gary picks up a basketball
(2) Gary approaches a specific person and gives them the ball
(3) Gary says “your turn” and waits while the other person shoots the ball
(4) Gary says “my turn” and takes the ball and shoots it in the basket
Carrie Greetings (1) Carrie approaches the person
(2) Carrie makes eye contact with the person
(3) Carrie says, “Hi, what’s up?”
Mark Social initiation (1) Mark picks up a toy
(2) Mark approaches a specific person from across the room, holding the toy
(3) Mark taps the person’s shoulder
(4) Mark makes eye contact with the person
(5) Mark says, “Look at my toy!” and hands the toy to the person
(6) Mark says “my turn” and takes the toy back
(7) Mark says “your turn” and hands the toy to the other person
Fiona Social commenting (1) Fiona picks up “Don’t Break the Ice” game
(2) Fiona approaches a specific person from across the room, holding the game
(3) Fiona taps the person’s shoulder
(4) Fiona makes eye contact with the person and says, “Let’s play Don’t Break the Ice.”
(5) Fiona hits a piece of ice, says “your turn” and hands the hammer to the other person and waits for the other person to play
(6) Fiona says “my turn” and takes the hammer back
(7) Fiona hits all pieces in, loses, and says “Good job, congratulations!” to the other person

15 s, then approached the door and opened it, then waited
another 10 s before exiting. For all target behaviors, no
prompts were provided. If the child responded correctly,
verbal praise was provided; this reinforcement continued in
both intervention conditions. The experimenter was present
throughout the entire 5-min play session but stood approxi-
mately 6–8 feet away from the social interaction.
Maintenance and generalization
Maintenance of skills without teaching stimuli was assessed
immediately after meeting mastery criteria. Generalization
probes were conducted across person and setting during base-
line and after acquisition of target responses.
Intervention
Photo steps intervention
A forward chaining procedure was used for the photo steps
program. Intervention began with one photograph in the
rolodex, and the experimenter instructed, “let’s see what you
need to do,” then modeled how to flip to the first photograph.
The experimenter prompted the child to engage in the first
response depicted in the photograph. As in baseline, the
participant was observed for a 5-min session, and each min-
ute, the experimenter presented the photo steps program and
stated, “let’s see what you need to do” to see if the participant
engaged in the target behavior. When the child successfully
reached criteria in completing the first step in the social skill
(4/5 opportunities for two consecutive sessions), the next
photograph was introduced. Each introduction of a new
photograph was depicted by a phase line in Figures 1 and 2.
The experimenter gave the instruction again and modeled
how to flip from the first to the second photograph. The
child was then required to complete both behaviors depicted
in the first two photographs. This process was repeated until
the child independently flipped through all the pictures and
completed all of the steps required for the target behavior (see
Table 1 for steps). Training was complete when the child
independently performed the behavior presented in the
photos to criterion. If a child did not reach criterion within
10 training sessions, then the child returned to the prior step
in the chain (i.e., the prior photo) for five trials.
Social Stories intervention
During the intervention phase, the experimenter read the
Social Story to the participant (except during Fiona’s ses-
sions, who read her own story out loud). The experimenter
assessed comprehension of the story by asking three ques-
tions relating to the story (e.g., “what is this story about?,”
“what are you supposed to do?,” and “how will your friends
feel if you do?”). As in baseline, the participant was then
observed for 5 min to see if they engaged in the target
behavior. The experimenter provided the discriminative
stimulus specific to the child’s target behavior once every
minute. To control the number of learning opportunities
across intervention conditions, for two participants (Fiona
and Mark), the Social Story was read once every minute
during this 5-min session to match the photo steps pro-
gram; for the other two participants, the Social Story was
DEVELOPMENTAL NEUROREHABILITATION 3
read once at the beginning of the 5-min session, which is
standard Social Story protocol.
Reliability
All sessions were filmed and scored by the primary experi-
menter. An independent rater scored 33% of all conditions
(baseline, intervention, and generalization probes) to permit
calculation of inter-observer reliability. Inter-observer agree-
ment on the children’s social behaviors ranged from 88% to
100%, with a mean of 95.25%.
Results and discussion
Figures 1 and 2 display the data for each participant during
baseline, treatment, and generalization probes across each
social skill intervention procedure (Social Stories and photo
steps). All four participants learned their social skills during the
photo program but did not during the Social Stories procedure.
After mastery, when the steps program teaching materials were
removed, three out of the four children (all but Carrie, who
required a booster session with materials) continued to per-
form the target behaviors. Generalization results were varied,
but all participants showed some generalization of skills. Given
that no social behaviors were seen in the Social Stories condi-
tion, the data clearly suggest that the photo program was
associated with more social behavior (e.g., greetings and turn-
taking) than the Social Stories condition.
There are several potential factors that could explain these
results. It is possible that the children in the present study respond
more favorably to the procedure based on visual stimuli than on
verbal stimuli.17 Many children with ASD benefit from visual
stimuli, and the literature supports the use of picture activity
schedules with children with ASD.1,17 In addition, the photo
steps program used chaining principles to break down complex
behaviors into smaller components. Each step in the photo steps
program built upon the previous one, as opposed to Social Stories,
which presents a large amount of social information at one time.4
Also, the participants might have learned quickly in the photo
steps program due to the tendency of many children with ASD to
enjoy seeing themselves in the mirror or in pictures.18 The teach-
ing materials were appropriate because they allowed for easy
access, use, and reuse of photos for other similar
social behaviors, the wheel-like structure of the rolodex could
enhance motivation through stimulus novelty,19 and the materials
could be used across a variety of settings and people.
These results add to the inconsistent findings of effectiveness of
Social Stories and further questions their widespread clinical and
educational use. Though some previous studies have demon-
strated positive effects of Social Stories, these studies have metho-
dological concerns or do not demonstrate experimental
control.7,20–22 More recently, a number of more strongly con-
trolled studies have demonstrated lack of effects or inconsistent
results about the effectiveness of the procedure.7,8,11,22,23 Further,
Kokina and Kern7 identified the large variability in outcomes for
individual participants in a meta-analysis, finding that Social
Stories were highly effective/effective for only 24 of the individual
outcomes and ineffective for 21 of the individual outcomes, which
represents 45% of participants. Additionally, many studies use
4 S. D. DANESHVAR ET AL.

100
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ai

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ai
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en

os

M
G
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Bo
Greetings 1 photo

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Setting

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Greetings Social Stories

80

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Gary

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.
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.
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80

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Gen.
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Stimuli

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47

Sessions

Figure 1. Percentage of correct responses across two target behaviors and intervention conditions (Social Stories and photo steps program) for Carrie and Gary.
 DEVELOPMENTAL NEUROREHABILITATION 5

100
Baseline Social Stories
Comments
80

60

40

Gen. Gen.
20 Person Setting
Mark

.
nt
ai

.
Photo Steps

en
M

G
100
Initiations
80

60
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40

Gen.
20 Gen. Setting
Person

100
Social Stories
Initiations
80

60

40

Gen.
20 Gen. Setting
Person
Fiona
0

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.
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100
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80

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Person

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76

Sessions

Figure 2. Percentage of correct responses across two target behaviors and intervention conditions (Social Stories and photo steps program) for Mark and Fiona.

treatment packages, which combine Social Stories with many ways to improve generalization of skills and use the photo
evidence-based behavioral procedures, such as prompting and steps program for other socio-communication skills.
reinforcement,6,24–26 that when used alone, would likely be just
as effective.
It is important to note that procedural fidelity was not Acknowledgments
assessed in this study, and future research should include The authors would like to thank Gina Chang, Kari Berquist, and the children
this assessment. Additionally, future studies can explore and families who participated in this study.
6 S. D. DANESHVAR ET AL.

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