ASSSIST2
Research type
Research Study
Full title
Autism Spectrum Social Stories™ In Schools Trial 2 (ASSSIST2)
IRAS ID
251805
Contact name
Catherine Hewitt
Contact email
Sponsor organisation
Leeds and York Partnership NHS Foundation Trust
ISRCTN Number
ISRCTN11634810
Duration of Study in the UK
3 years, 0 months, 30 days
Research summary
Research Summary
Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder that affects up to 1.6% of children in the UK and has an adverse impact on overall adult outcome. Many children with autism struggle to manage social anxiety, feelings of anger, which this can lead to outbursts of aggression, and social communication difficulties are frequently associated with persistently disruptive behaviour. As an aggravating factor, teachers face many demands on their time in the classroom and may not be able to focus enough on the child’s needs for them to achieve their full educational potential. One intervention that attempts to alleviate these social difficulties whilst not being intrusive, time consuming or requiring extensive involvement of outside experts is Carol Gray’s Social Stories™. Social Stories™ are short stories which describe a social situation or skill to help children with ASD to understand a situation applicable to the child more easily. They write a child into their own story about themselves to help them learn new social information. Research has examined Social Story™ use both in special education and mainstream education settings. Through use of this intervention, children with ASD have shown improvements in social interactions and decision making as well as in addressing disruptive behaviours like reducing tantrums and behaviours associated with frustration. This research also suggests that it is possible to train tier one professionals, for example teachers, in the use of developing Social Stories™ tailored to a child, and for these stories to benefit children with ASD. There are to date no good quality fully powered randomised controlled trials and this study seeks to address this. The current trial aims to establish whether Social Stories™ are clinically and cost-effective in improving child social responsiveness, reducing challenging behaviour and improving social and emotional health in children with ASD in primary schools.
Summary of Results
Autism Spectrum Social Stories in Schools Trial 2 (ASSSIST-2): a randomised controlled trial and economic evaluation of a Social Stories intervention to address the social and emotional health of children on the autism spectrum in primary schools Who carried out the research?
The trial was sponsored by Leeds and York Partnership NHS Foundation Trust and was funded by the National Institute for Health Research Health Technology Assessment programme (NIHR HTA). The research was undertaken by a team of researchers based at the University of York and within the Leeds and York Partnership NHS Foundation Trust. The chief investigator was Professor Barry Wright until his retirement in October 2021 and Professor Catherine Hewitt thereafter.
The core trial team comprised:
Professor Barry Wright, Dr Kerry Bell, Dr Jane Blackwell, Dr Catarina Teige, Laura Mandefield, Dr Han-I Wang, Charlie Welch, Dr Arabella Scantlebury, Dr Judith Watson, Professor Dean McMillan, Emma Standley, Leah Attwell, Hayley Carrick, Amelia Taylor, Olivia Taylor and Professor Catherine Hewitt.
We declare the following competing interests:
Catherine Hewitt is a member of the NIHR HTA Commissioning Board and Deputy Chair. Barry Wright is a co-author of “How to Write Social Stories”, the reference manual distributed to schools as part of the intervention. All royalties are donated to Martin House Children’s Hospice. Grant income was used to support the salaries of various research staff.
What public involvement there was in the study The development of the trial was supported by three core patient and public involvement (PPI) members, a parent of an autistic child, a specialist teacher, and a member of the National Autistic Society with lived experience through being an autistic adult. A local youth council who worked on a previous trial of Social Stories also reviewed and contributed to the design of the trial. Advice was gathered from parents, teachers and educational psychologists. A PPI event was held at the end of the trial to discuss the findings with representatives from educational settings, parents, charities, mental health services, and the local authority.
Where and when the study took place
The study took place between July 2018 and January 2022. Primary schools and families were located throughout Yorkshire and the Humber.
Why was the research needed?
Individuals on the autism spectrum require different levels of support from different services, such as the NHS and charities, as the condition can impact quality of life, relationships, education, and standards of living. The cost of providing support is high, currently around £2.7 billion for children. Low cost, child friendly interventions are needed to support children. This trial aimed to explore whether one promising intervention, Social Stories, could be effective in supporting children on the autism spectrum in primary schools.
What were the main questions studied?
The main aim of the study was to establish whether Social Stories can improve social skills in children on the autism spectrum. We also wanted to understand whether Social Stories can reduce behaviours that challenge, improve social and emotional health, quality of life, and parental stress. We also wanted to establish whether Social Stories represents good value for money. The main outcome measure was a questionnaire called the Social Responsiveness Scale-2 which measures the child’s social skills. This was completed by teachers at 6 months.
Who participated in the study?
249 children aged 4-11 years alongside their parents/carers, 254 teachers and 192 interventionists from 87 schools took part in the study.
What treatments or interventions did the participants take/receive?
We trained school staff and parents to write and deliver Social StoriesTM. We agreed with teachers and parents, what each child needed help with and wrote stories with this in mind. Trained staff in schools read the Social Story™ with the child at least 6 times over 4 weeks. Follow-up information was collected from parents and school staff at the start of the study and after 6-weeks and 6-months What medical problems (adverse reactions) did the participants have?
No problems were associated with the intervention.
What were the results of the study?
Using these measures, the results suggest that Social StoriesTM do not lead to any significant changes in social skills, mental health, parent stress or general health. Children in schools allocated to Social StoriesTM met their goal more frequently than children who did not. Parents and educational professionals found the Social StoriesTM intervention and training beneficial.
How has this study helped patients and researchers?
The study has shown that Social Stories may be useful to support children in schools and could potentially save money, but further research is needed.
Details of any further research planned
As our study was impacted by the COVID-19 pandemic, there is some uncertainty in our results. Because of this there may be value in further evaluation Social Stories. Schools highlighted that the psychoeducation portion of our training was particularly useful, this aimed to education parents and school staff on the differences associated with children on the autism spectrum. Future research could further evaluate the importance of this. Finally, our sample included few ethic minority families. Future research could explore ways to establish trust with child mental health services within communities and improve uptake of services.
Where can I learn more about this study?
The full report will be published in the NIHR Journals Library. We will also be publishing some open access journal articles.
Acknowledgements
We would like to thank all the participating schools and families for taking part in the trial.REC name
North East - York Research Ethics Committee
REC reference
19/NE/0237
Date of REC Opinion
24 Jul 2019
REC opinion
Further Information Favourable Opinion