Expert: Dr. Sharon A. Mitchell - 1/1/2009

Question
I have a student with Aspergers Syndrome. His parents would dearly love me to assist him with his high pitched monotone voice and the fact that he dribbles, which does not encourage friendships. Should I buy the Carol Gray stories? From recall these issues are not covered. I am able to write my own stories, however these are beyond me. I have ABA experience, should I try a criteria exercise for the dribbling. Thank you for reading this, I truly would like to devise a plan of action. Regards, Aideen McLoughlin

Answer
No Aideen, I'm not sure that you need to buy any particular book and you're right. I can't recall any social story in the Gray books on the particular issues that concern you.

I don't agree with you though, that writing social stories is beyond you. Not at all. There is a certain formula Carol Gray recommends that social stories take. Many people take liberties with this though and find that the social story serves its purpose anyway.

Social stories need not be complicated or onerous. Here's one that a speech language pathologist friend of mine wrote in about five minutes as we talked about a student and his difficulties in playing games with peers:

“I like to play games.  Games are fun.  Sometimes I win the game.  Sometimes my friends win the game.  I enjoy the game when I win.  I have fun when my friend wins.   I am a good sport.  That means I am happy when I am winning and I am happy when I am loosing.  I am happy all of the time when I am playing a game.  

When I win I say to my friend, “good game!” or “thanks for the game!”  When my friend wins the game I say “congratulations” or “that was a good game!”  When I am happy my friends like to play with me.  If I get mad my friends do not want to play anymore, so I always smile and have fun when we play games.  Winning the game is OK and loosing the game is OK, but the best part is playing with my friends.  We are all good sports.”

Here are two links that have a collection of ready-made social stories plus give step-by-step directions on making your own:

- http://www.polyxo.com/socialstories/introduction.html

- http://www.frsd.k12.nj.us/autistic/

Social stories are a very useful tool to use with your student. When he's uncertain, a social story will explain to him what to expect and what is expected of him. Kids with autism frequently have trouble making sense of their world; a social story gives needed information. I find that collecting the stories in a binder allows the child to go leave through the collection on his own to find the one he wants. You'd first need to go over each story several times with the child, as the situation arose (or better yet, before the situation so that he's prepared).

But the two concerns you express are drooling as well as voice pitch and prosody. While they can be address through social stories, I think that may be farther down the road and used to reinforce practice.

First though, why is the child drooling? How old is he? Is he of the age where his peers may also drool? If he is school-aged, most kids have stopped drooling long before this.

If there is a medical condition causing him to drool, then no end of social stories will correct the problem, but may cause the child greater angst.

A speech language pathologist or therapist may be the place to begin. An SLP can look at the oral motor structure of the child's mouth to see if there is a structural reason for the excess saliva or the child not swallowing the saliva.

There are medical disorders than can contribute to or account for a child drooling. You can find some information on this here: http://www.asha.org/public/speech/disorders/OMD.htm and http://www.asha.org/public/speech/swallowing/FeedSwallowChildren.htm

Some kids have low muscle tone and may hang their jaw down, allowing saliva to dribble out. A pediatrician may help determine the reasons. If there is nothing structural that needs correcting and low tone is the culprit, then there are exercises that can help strengthen his facial muscles.

While you're waiting for a pediatric or SLP evaluation, there are a few exercises you can begin working on that are simple and safe. Consider having him do things like:

- drink through a straw
- blow a cotton ball through a straw or through pursed lips
- have a game where you each sit or kneel on opposite sides of a small table and you each try to blow a cotton ball over the the other person's side. Set up goal posts and defend your goal by blowing the cotton ball away.
- teach him how to whistle
- blow a toy whistle
- chew gum
- have him mimic your tongue movements - stick your tongue out, in, up, down, around....

In addition to an SLP, an Occupational Therapist (OT) can often offer suggestions on exercises and games to help a child decrease his drooling.

Here is some research on the efficacy of oral motor sensory stimulation to decrease drooling: http://convention.asha.org/2007/handouts/1137_1638Hammen_Vicki_107293_Nov26_2007...

If you have an ABA background, you might like this article on efforts to help a 17 year old boy stop drooling: http://pbi.sagepub.com/cgi/content/abstract/8/1/24

I quite understand the parents' concern that drooling is not an enticement for peers. While you're delving into why he drools, how is the drool being handled? Is he aware that his chin is wet? That may be a place to start. Many kids with autism have trouble registering their body sensations, especially if they are concentrating on something else.

Can you help him become aware of how his chin feels when it's wet and when it's dry? Without embarrassing him in front of other kids, have you arrange a signal so you can cue him to wipe his chin?

What should he wipe his chin with? Are there tissues handy? Some kids use their shirt sleeve. Others pick up the front their shirt to wipe their face. Neither are ideal but may be better than allowing his chin to remain wet. Hygiene is a concern. You might need a large supply of tissues available and a handy way for him to dispose of them. Other children will not appreciate drool puddling on their project, so wiping it up may stop problems.

I also understand the child's parents' concern about their son's voice quality. Again though, I don't think this is an issue with which you'd go directly to a social story. Perhaps later on in treatment social stories would be effective for guided practice. Instead, I would begin with an evaluation by a Speech Language Pathologist and follow his/her recommendations. The therapist may offer you suggestions and monitor progress or may work directly with the child herself. Social stories may be one tool that's implemented but would likely not form the basis for therapy.

If you're interested in purchasing some social story books, here are a few that I find useful for school:

- Autism & PDD: Things I Can Say and Do
Staying Clean & Healthy (http://www.linguisystems.com/itemdetail.php?id=859)

- Autism & PDD: Primary Social Skills (http://www.linguisystems.com/itemdetail.php?id=)

- Autism & PDD: Intermediate Social Skills Lessons(http://www.linguisystems.com/itemdetail.php?id=383)

You mention that you really want to devise a plan of action. That's admirable. I think you need more information from professionals in the area of voice and oral motor functioning though before you can make a realistic plan. Once armed with more information, you can help make a dramatic difference in this little guy's life. He is lucky to have someone like you.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca