development, empathy, concrete instruction, clear communication, and literacy skills.
Social Stories in Medical Settings The Developmental Medicine Center at Children’s Hospital Boston has used Social Stories to help children with Down syndrome get ready parental involvement in the psychoeducational preparation of children
Social Stories and ADHD hyperactivity disorder (ADHD), because they set expectations for behavior child given its visual format, the use of simple language, the explicitness, situations and people helps them to concentrate on elements of the narrative that they will be able to remember thereafter.
Social Stories and Anxiety Social stories have also been used abundantly with anxious children. Robb (n.d.) has a teaching module for using Social Stories with anxious Personally, I have embraced the Social Story approach and adapted it for use with children with anxiety. Although Gray promotes her approach skills, communication, and theory of mind, a child experiencing anxiety will often show some of the same symptomatology.
The anxious child, who has become emotionally stifled and behaviorally constricted, will be unable to access the cognitive and emotional resources needed to engage in some target behaviors. An anxious child may indeed possess the skill for which a Social Story is written. However, trepidation about performing that skill may lead to avoidance of the behavior, leaving them stuck at an earlier developmental level. As such, the beauty of a storybook format, such as a Social Story that provides elements of rehearsal, preparation, and exposure, is that it can deliver a cognitive behavioral therapy (CBT) intervention to a child demonstrating reduced behavioral options.
Anxious individuals often experience dysfunctional thoughts. The success of CBT within this population has been grounded in the notion that changing thinking patterns helps a person to recognize distortions in their thinking, gain a better understanding of the behavior and
abilities (American Psychological Association, 2019).
When a Social Story is written for an anxious person, perspective sentences must take center stage in order for the distortions to be revealed. Unlike Gray’s suggestion that they more often refer to the internal feeling states of others, I ask anxious clients to recognize and reflect upon their own feeling states. Directive statements may appear in greater proportion than suggested in Gray’s ratio, because CBT therapists often instruct their clients to perform certain relaxation exercises to counteract the increased anxiety that occurs when exposure to a feared stimulus becomes too great to move to the next level. The step-by-step breakdown in the task analysis of a Social Story is akin to the hierarchy developed in the process of systematic desensitization, although the former assumes the need to learn and implement a new skill while the latter presumes that emotional constriction, rigidity, or avoidance is responsible for a person’s inability to demonstrate a behavior rather change, to avoid risk taking and the unfamiliar, overrides the desire to
Within the context of my play
therapy private practice, I have developed social stories to help worried children learn to take a bus to school, sleep over at a
friend’s house, go to camp, manage outdoor activities among flying
insects, wait for parents who may be late for pick up, and prepare for an upcoming hospital procedure.
Concrete Examples Within the context of my play therapy private practice, I have developed social stories to help worried children learn to take a bus to school, sleep over at a friend’s house, go to camp, manage outdoor activities among flying insects, wait for parents who may be late for pick up, and prepare for an upcoming hospital procedure. They have effectively helped anxious children by delivering a cognitive behavioral approach through a story format, resulting in an increase in the ratio of perspective sentences to examine and challenge the child’s dysfunctional thoughts. When the story format contains just one sentence or idea to a page, it can grow with the child. Over time, pages that are no longer needed may be exchanged for new ones, with revisions reflecting change in the child’s abilities (see next page).
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