Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components

Barry Wright; David Marshall; Joy Adamson; Hannah Ainsworth; Shehzad Ali; Victoria Allgar; Moore D Collingridge; Elizabeth Cook; Paul Dempster; Lisa Hackney; Dean McMillan; Dominic Trepél; Chris Williams

doi:10.3310/hta20060

Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components

Barry Wright, David Marshall^*, Joy Adamson, Hannah Ainsworth, Shehzad Ali, Victoria Allgar, Moore D Collingridge, Elizabeth Cook, Paul Dempster, Lisa Hackney, Dean McMillan, Dominic Trepél, Chris Williams

^*Corresponding author for this work

Peninsula Medical School

Research output: Contribution to journal › Article › peer-review

Abstract

BackgroundA Social Story™ (Carol Gray) is a child-friendly intervention that is used to give children with autism spectrum disorders (ASDs) social information in situations where they have social difficulties. Limited evidence mainly using single-case designs suggests that they can reduce anxiety and challenging behaviour.ObjectivesThe objectives were to conduct a systematic review, use this to develop a manualised intervention and run a feasibility trial to inform a fully powered randomised controlled trial (RCT) on their clinical effectiveness and cost-effectiveness in schools.DesignThis is a three-stage study following the Medical Research Council framework for complex interventions. Specifically, it involved a theoretical phase, a qualitative stage and a feasibility trial stage.SettingQualitative interviews and focus groups took place in Child and Adolescent Mental Health Service and primary care settings. The feasibility study took place in 37 local mainstream schools.ParticipantsFifty children (aged 5–15 years) in mainstream school settings with a diagnosis of ASD were entered into the trial. For each child, an associated teacher and parent was also recruited.InterventionsThe intervention was a goal-setting session followed by a manualised toolkit (including a training session) for creating Social Stories™ for use with school-aged children. The comparator treatment was a goal-setting session followed by an attention control. Both arms received treatment as usual.Main outcome measuresOutcomes tested as part of the feasibility study included child- and proxy-completed questionnaires for mental health, quality of life and goal-based outcome measures. Adults additionally completed behaviour diaries and the parental stress index.ResultsThe review found that the research into social stories is predominantly based in the USA, carried out in under-12-year-olds and using single-case designs. Most studies either did not follow established Social Story criteria or did not report if they did. The assessment of effectiveness presents a largely positive picture but is limited by methodological issues. There were no adequate RCTs and insufficient information to assess a number of important sources of potential bias in most studies. A manualised intervention was produced using an iterative process between user focus groups and a writing team, and assessed in the feasibility study. All 50 participant groups were recruited within the study time frame. Two outcome measures, the Social Responsiveness Scale-2 and the custom-made goal-based measure, showed high levels of completion rates and appeared to be capturing social and behaviour skills targeted by the use of Social Stories. Detailed recommendations for a full trial are provided.LimitationsBlinding of participants was not feasible. Treatment fidelity was not assessed because of low levels of story return rates.ConclusionsThe study showed that a fully powered RCT is feasible with an extended geographical footprint. A large amount of data and information has helped to inform the design of this RCT, which will be the subject of a future research grant application. Future work could focus on developing an appropriate blinded outcome measure for this population.Study registrationThis study is registered as PROSPERO CRD42011001440.Trial registrationCurrent Controlled Trials ISRCTN96286707.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 6. See the NIHR Journals Library website for further project information.

Original language	English
Pages (from-to)	1-258
Number of pages	0
Journal	Health Technology Assessment
Volume	20
Issue number	6
DOIs	https://doi.org/10.3310/hta20060
Publication status	E-pub ahead of print - Jan 2016

Access to Document

10.3310/hta20060

Fingerprint

Dive into the research topics of 'Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components'. Together they form a unique fingerprint.

Cite this

Wright, B., Marshall, D., Adamson, J., Ainsworth, H., Ali, S., Allgar, V., Collingridge, M. D., Cook, E., Dempster, P., Hackney, L., McMillan, D., Trepél, D., & Williams, C. (2016). Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components. Health Technology Assessment, 20(6), 1-258. Advance online publication. https://doi.org/10.3310/hta20060

Wright, Barry ; Marshall, David ; Adamson, Joy et al. / Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components. In: Health Technology Assessment. 2016 ; Vol. 20, No. 6. pp. 1-258.

@article{56a90d88f08c4702b9513e743d068554,

title = "Social Stories{\texttrademark} to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components",

abstract = "BackgroundA Social Story{\texttrademark} (Carol Gray) is a child-friendly intervention that is used to give children with autism spectrum disorders (ASDs) social information in situations where they have social difficulties. Limited evidence mainly using single-case designs suggests that they can reduce anxiety and challenging behaviour.ObjectivesThe objectives were to conduct a systematic review, use this to develop a manualised intervention and run a feasibility trial to inform a fully powered randomised controlled trial (RCT) on their clinical effectiveness and cost-effectiveness in schools.DesignThis is a three-stage study following the Medical Research Council framework for complex interventions. Specifically, it involved a theoretical phase, a qualitative stage and a feasibility trial stage.SettingQualitative interviews and focus groups took place in Child and Adolescent Mental Health Service and primary care settings. The feasibility study took place in 37 local mainstream schools.ParticipantsFifty children (aged 5–15 years) in mainstream school settings with a diagnosis of ASD were entered into the trial. For each child, an associated teacher and parent was also recruited.InterventionsThe intervention was a goal-setting session followed by a manualised toolkit (including a training session) for creating Social Stories{\texttrademark} for use with school-aged children. The comparator treatment was a goal-setting session followed by an attention control. Both arms received treatment as usual.Main outcome measuresOutcomes tested as part of the feasibility study included child- and proxy-completed questionnaires for mental health, quality of life and goal-based outcome measures. Adults additionally completed behaviour diaries and the parental stress index.ResultsThe review found that the research into social stories is predominantly based in the USA, carried out in under-12-year-olds and using single-case designs. Most studies either did not follow established Social Story criteria or did not report if they did. The assessment of effectiveness presents a largely positive picture but is limited by methodological issues. There were no adequate RCTs and insufficient information to assess a number of important sources of potential bias in most studies. A manualised intervention was produced using an iterative process between user focus groups and a writing team, and assessed in the feasibility study. All 50 participant groups were recruited within the study time frame. Two outcome measures, the Social Responsiveness Scale-2 and the custom-made goal-based measure, showed high levels of completion rates and appeared to be capturing social and behaviour skills targeted by the use of Social Stories. Detailed recommendations for a full trial are provided.LimitationsBlinding of participants was not feasible. Treatment fidelity was not assessed because of low levels of story return rates.ConclusionsThe study showed that a fully powered RCT is feasible with an extended geographical footprint. A large amount of data and information has helped to inform the design of this RCT, which will be the subject of a future research grant application. Future work could focus on developing an appropriate blinded outcome measure for this population.Study registrationThis study is registered as PROSPERO CRD42011001440.Trial registrationCurrent Controlled Trials ISRCTN96286707.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 6. See the NIHR Journals Library website for further project information.",

author = "Barry Wright and David Marshall and Joy Adamson and Hannah Ainsworth and Shehzad Ali and Victoria Allgar and Collingridge, {Moore D} and Elizabeth Cook and Paul Dempster and Lisa Hackney and Dean McMillan and Dominic Trep{\'e}l and Chris Williams",

year = "2016",

month = jan,

doi = "10.3310/hta20060",

language = "English",

volume = "20",

pages = "1--258",

journal = "Health Technology Assessment",

issn = "1366-5278",

publisher = "National Co-ordinating Centre for HTA",

number = "6",

}

Wright, B, Marshall, D, Adamson, J, Ainsworth, H, Ali, S, Allgar, V, Collingridge, MD, Cook, E, Dempster, P, Hackney, L, McMillan, D, Trepél, D & Williams, C 2016, 'Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components', Health Technology Assessment, vol. 20, no. 6, pp. 1-258. https://doi.org/10.3310/hta20060

Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components. / Wright, Barry; Marshall, David; Adamson, Joy et al.
In: Health Technology Assessment, Vol. 20, No. 6, 01.2016, p. 1-258.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components

AU - Wright, Barry

AU - Marshall, David

AU - Adamson, Joy

AU - Ainsworth, Hannah

AU - Ali, Shehzad

AU - Allgar, Victoria

AU - Collingridge, Moore D

AU - Cook, Elizabeth

AU - Dempster, Paul

AU - Hackney, Lisa

AU - McMillan, Dean

AU - Trepél, Dominic

AU - Williams, Chris

PY - 2016/1

Y1 - 2016/1

N2 - BackgroundA Social Story™ (Carol Gray) is a child-friendly intervention that is used to give children with autism spectrum disorders (ASDs) social information in situations where they have social difficulties. Limited evidence mainly using single-case designs suggests that they can reduce anxiety and challenging behaviour.ObjectivesThe objectives were to conduct a systematic review, use this to develop a manualised intervention and run a feasibility trial to inform a fully powered randomised controlled trial (RCT) on their clinical effectiveness and cost-effectiveness in schools.DesignThis is a three-stage study following the Medical Research Council framework for complex interventions. Specifically, it involved a theoretical phase, a qualitative stage and a feasibility trial stage.SettingQualitative interviews and focus groups took place in Child and Adolescent Mental Health Service and primary care settings. The feasibility study took place in 37 local mainstream schools.ParticipantsFifty children (aged 5–15 years) in mainstream school settings with a diagnosis of ASD were entered into the trial. For each child, an associated teacher and parent was also recruited.InterventionsThe intervention was a goal-setting session followed by a manualised toolkit (including a training session) for creating Social Stories™ for use with school-aged children. The comparator treatment was a goal-setting session followed by an attention control. Both arms received treatment as usual.Main outcome measuresOutcomes tested as part of the feasibility study included child- and proxy-completed questionnaires for mental health, quality of life and goal-based outcome measures. Adults additionally completed behaviour diaries and the parental stress index.ResultsThe review found that the research into social stories is predominantly based in the USA, carried out in under-12-year-olds and using single-case designs. Most studies either did not follow established Social Story criteria or did not report if they did. The assessment of effectiveness presents a largely positive picture but is limited by methodological issues. There were no adequate RCTs and insufficient information to assess a number of important sources of potential bias in most studies. A manualised intervention was produced using an iterative process between user focus groups and a writing team, and assessed in the feasibility study. All 50 participant groups were recruited within the study time frame. Two outcome measures, the Social Responsiveness Scale-2 and the custom-made goal-based measure, showed high levels of completion rates and appeared to be capturing social and behaviour skills targeted by the use of Social Stories. Detailed recommendations for a full trial are provided.LimitationsBlinding of participants was not feasible. Treatment fidelity was not assessed because of low levels of story return rates.ConclusionsThe study showed that a fully powered RCT is feasible with an extended geographical footprint. A large amount of data and information has helped to inform the design of this RCT, which will be the subject of a future research grant application. Future work could focus on developing an appropriate blinded outcome measure for this population.Study registrationThis study is registered as PROSPERO CRD42011001440.Trial registrationCurrent Controlled Trials ISRCTN96286707.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 6. See the NIHR Journals Library website for further project information.

AB - BackgroundA Social Story™ (Carol Gray) is a child-friendly intervention that is used to give children with autism spectrum disorders (ASDs) social information in situations where they have social difficulties. Limited evidence mainly using single-case designs suggests that they can reduce anxiety and challenging behaviour.ObjectivesThe objectives were to conduct a systematic review, use this to develop a manualised intervention and run a feasibility trial to inform a fully powered randomised controlled trial (RCT) on their clinical effectiveness and cost-effectiveness in schools.DesignThis is a three-stage study following the Medical Research Council framework for complex interventions. Specifically, it involved a theoretical phase, a qualitative stage and a feasibility trial stage.SettingQualitative interviews and focus groups took place in Child and Adolescent Mental Health Service and primary care settings. The feasibility study took place in 37 local mainstream schools.ParticipantsFifty children (aged 5–15 years) in mainstream school settings with a diagnosis of ASD were entered into the trial. For each child, an associated teacher and parent was also recruited.InterventionsThe intervention was a goal-setting session followed by a manualised toolkit (including a training session) for creating Social Stories™ for use with school-aged children. The comparator treatment was a goal-setting session followed by an attention control. Both arms received treatment as usual.Main outcome measuresOutcomes tested as part of the feasibility study included child- and proxy-completed questionnaires for mental health, quality of life and goal-based outcome measures. Adults additionally completed behaviour diaries and the parental stress index.ResultsThe review found that the research into social stories is predominantly based in the USA, carried out in under-12-year-olds and using single-case designs. Most studies either did not follow established Social Story criteria or did not report if they did. The assessment of effectiveness presents a largely positive picture but is limited by methodological issues. There were no adequate RCTs and insufficient information to assess a number of important sources of potential bias in most studies. A manualised intervention was produced using an iterative process between user focus groups and a writing team, and assessed in the feasibility study. All 50 participant groups were recruited within the study time frame. Two outcome measures, the Social Responsiveness Scale-2 and the custom-made goal-based measure, showed high levels of completion rates and appeared to be capturing social and behaviour skills targeted by the use of Social Stories. Detailed recommendations for a full trial are provided.LimitationsBlinding of participants was not feasible. Treatment fidelity was not assessed because of low levels of story return rates.ConclusionsThe study showed that a fully powered RCT is feasible with an extended geographical footprint. A large amount of data and information has helped to inform the design of this RCT, which will be the subject of a future research grant application. Future work could focus on developing an appropriate blinded outcome measure for this population.Study registrationThis study is registered as PROSPERO CRD42011001440.Trial registrationCurrent Controlled Trials ISRCTN96286707.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 6. See the NIHR Journals Library website for further project information.

U2 - 10.3310/hta20060

DO - 10.3310/hta20060

M3 - Article

SN - 1366-5278

VL - 20

SP - 1

EP - 258

JO - Health Technology Assessment

JF - Health Technology Assessment

IS - 6

ER -

Wright B, Marshall D, Adamson J, Ainsworth H, Ali S, Allgar V et al. Social Stories™ to alleviate challenging behaviour and social difficulties exhibited by children with autism spectrum disorder in mainstream schools: design of a manualised training toolkit and feasibility study for a cluster randomised controlled trial with nested qualitative and cost-effectiveness components. Health Technology Assessment. 2016 Jan;20(6):1-258. Epub 2016 Jan. doi: 10.3310/hta20060