Abstract
Dodd, J. L., Ocampo, A., & Kennedy, K. S. (2011). Perspective taking through narratives: An intervention for students with ASD. Communication Disorders Quarterly, 33, 23–33.
Introduction
Because narratives reveal linguistic and social-cognitive knowledge, they are used to investigate typical and atypical language development. Based on developmental studies, children as young as age 3 have been found to interpret a narrative from the perspective of the main character (Rall & Harris, 2000); by age 5, children demonstrate the ability to take the mental perspective of a character in a story irrespective of the character’s actual physical location (O’Neill & Shultis, 2007). Ziegler, Mitchell, and Currie (2005) observed that neurotypical 4- to 9-year-old children’s ability to adopt a perspective and shift perspectives in a story were facilitated when the story content was about a main character.
Narrative analysis has been used to examine the social-communicative abilities of children with autism spectrum disorders (ASD). Deficits in theory of mind (ToM) hypotheses have been used to explain the social and language impairments presented by children with ASD (Baron-Cohen, 1995; Happe, 1993). Several researchers (Capps, Losh, & Thurber, 2000; Tager-Flusberg & Sullivan, 1995) have attributed difficulties in the narrative language abilities of children with ASD to deficits in ToM and, in effect, the understanding of the mental states of others. The ability to attribute mental states to a character and to make sense of the actions of characters in a story requires the ability to perceive the perceptions and intentions of others (Colle, Baron-Cohen, Wheelwright, & van der Lely, 2008). Studies of narrative development in children with ASD have found limited expressions of mental states (Baron-Cohen, Leslie, & Frith, 1986). The purpose of this study was to explore the influence of a narrative-based language intervention (NBLI) program on the perspective-taking skills in students with ASD. The researchers asked two questions:
Do students with ASD show greater gains in their abilities to retell stories from the perspectives of different characters following a narrative-based intervention that specifically targets perspective taking compared with a NBLI that does not include direct instruction in the area of perspective taking?
Do students with ASD show greater improvement in their ability to reference the mental states of the characters in their retell accounts (e.g., through the use of mental state verbs such as think, know, believe) following a narrative-based intervention that specifically targets perspective taking compared with students who receive a NBLI that does not include direct instruction in the area of perspective taking?
The Study
The participants were 18 students between the ages of 9 years 7 months and 12 years 2 months (M = 10:8, SD = 9:4) who had a diagnosis of ASD. Participants were randomly assigned to one of two treatment groups at their respective school sites. At each of the two school sites, one group of students received the perspective-taking intervention (PTI) using a narrative-based intervention that focused on characters’ emotions, cognitive states of mind, and perspective taking. The other students received the NBLI that focused on story elements, sequencing and organization, use of transitional wording, and vocabulary knowledge unrelated to emotions and characters’ states of mind. The intervention was provided in small groups consisting of five students and one SLP. Each group met 3 times per week, 30 min per session, for a total of 6 weeks. A new story was presented every 2 weeks; thus, three different books were used. The stories had a clear problem and solution and at least two characters’ perspectives from which the story could be retold.
PTI
Moreau and Fidrych’s (1994) Story Grammar Marker (SGM) provided the framework for the PTI. In the first lesson, the selected book was introduced to the students and then read aloud. After reading the story, the SLP modeled retelling the story using the SGM, a hand-held manipulative with icons representing story parts. Students then retold the story using their own SGM. Each subsequent lesson began with the SLP rereading the selected story. During Lessons 2 and 3, each student completed an adapted version of SGM Character Map. In the adapted version, students identified what they knew about each character (e.g., gender, physical traits, occupation) along with what they could infer about each character (e.g., information that was not explicitly stated).
As the SLP guided the students through the story, the students identified the different emotions that the characters experienced throughout the story and the influencing factors. Lessons 4 and 5 provided direct instruction in analyzing the story from each character’s perspective using the SGM Perspective Taking Map (Moreau & Fidrych, 1994). These two lessons focused on the students retelling the story as though they were the target character. The last lesson provided the students with a final opportunity to practice retelling the story from the different characters’ perspectives.
NBLI
The NBLI focused on story elements, organization and sequencing, use of transitional wording, and vocabulary. With the exception of the final lesson, each session began with the SLP reading the targeted story. In the first lesson, the selected book was introduced to the students and then read aloud to them. During this first lesson, the students were introduced to Gardill and Jitendra’s (1999) advanced story map. The advanced story map was completed during each lesson and was used to assist the students’ identification and organization of the story elements:
Name the problems or conflict.
Identify the main characters and describe them.
Where does the story take place.
Tell how the characters try to solve the problem.
Is there an added twist or complication in the story?
Tell how the problem is or is not solved.
What is the theme of the story? What is the author trying to say?
Lessons 3 and 5 provided the students with direct instruction in organizing and using transitional wording in their story retells. During the third lesson, the students completed a beginning, middle, and end worksheet, and brainstormed various transitional words they could use in their own story
Pre- and postintervention data collection
The baseline and postintervention data were collected using a story retell activity. Prior to hearing the story Harry the Dirty Dog (Zion, 1976), participants received the following instructions: I am going to read this story to you. I will read it to you twice. After I read the story I am going to ask you to retell the story to me as though you were one of the characters. Then I will ask you to tell me the story again but this time you will be a different character.
After hearing the story twice, each student was instructed to retell the story first from the perspective of Harry and then from the perspective of one of the children. The same procedures and story were used for both baseline and postintervention measures.
Narrative analyses
Each narrative language sample was evaluated with regard to total number of words, perspective-taking score (PTS; adapted from Garcia-Perez, Hobson, & Lee, 2008), and total number of psychological terms used. The PTS, which was an adaptation of Feffer’s (1966) role-taking shift, was adapted to examine each student’s ability to retell the story from the perspective of the different characters. Each student’s retell samples were independently evaluated with respect to the participant’s ability to retell the story from the character’s perspective:
story was not told from the perspective of the identified character (e.g., retells story using third person)
“some” reference provided to the character’s perspective, such as using a quote
emerging role taking as evidenced by reference and correct use of personal pronouns
target character’s actions and perceptions referenced or any two psychological terms used: desire, perception, emotion, emotion–behavior, emotion, or cognition
use of two or more psychological terms from the following categories: desire, emotion–behavior, emotion, or cognition
a minimum of four psychological terms used (e.g., desire, perception, emotion, emotion–behavior, cognition), two of which must have been from the cognition category
Psychological terms were coded in the following categories:
Desire, for example, need, care, want, wish, crave, beg
Perception, for example, see, hear, notice, watch, smell, spot, feel, look
Emotion behavior, for example, cry, kiss, smile, laugh, scream, giggle
Emotion, for example, hungry, tired, love, sad, exhausted, worry, lonely, starving, surprised
Cognition, for example, realize, believe, forget, remember, know, think
Other, for example, like, hate
Results/Discussion
The differences between the means of the PTI and NBLI groups at pretest was small, indicating comparability among the participants before interventions occurred.
The PTI group exhibited significantly greater growth in perspective taking than the NBLI groups. The effect size was large.
At post-test, the PTI group used significantly more mental state terms and a greater variety of mental terms than the NBLI group. The effect size was large.
In both groups, six out of the nine students showed improvement in their PTSs. For those participants in the PTI group who did not show improvement, their PTSs remained the same. The three participants in the NBLI group who did not show improvement in their PTSs actually showed a regression in their performance over the course of the study, as demonstrated by a collective loss of 10 points. The students who participated in the PTI group exhibited a collective total of 31 points improvement, compared with 22 points for the students in the NBLI group. These findings suggest that PTI is the preferred intervention to address one of the unique needs of students with ASD. As the data demonstrated, there was greater growth in the ability to retell the story from the perspective of different characters following the PTI compared with the NBLI.
The authors of this study also noted that the students in the PTI group not only increased their semantic understanding of emotional state terms but also improved their ability to recognize the underlying causes and/or influencing factors to changes in the character’s emotional states of mind. As a component of the PTI, students identified changes in the emotional states of the key characters as they changed throughout the targeted stories. After identifying a character’s emotional state, the students were then asked to identify the cause or influencing factor of that particular emotion. As the PTI intervention progressed, a number of students improved in their ability to identify the causes of the emotions.