|Year : 2019 | Volume
| Issue : 2 | Page : 52-56
Efficacy of social stories in coping with bullying among children with childhood psychiatry conditions: A randomized controlled interventional study
S Sakthi Srija1, S Sugi1, D Srinivasan2
1 KMCH College of Occupational Therapy, Coimbatore, Tamil Nadu, India
2 Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
|Date of Submission||04-Apr-2019|
|Date of Acceptance||23-Apr-2019|
|Date of Web Publication||28-May-2019|
Asst. Prof. S Sakthi Srija
Kalapatti Main Road, Phase II, Balaji Nagar, Coimbatore - 641 048, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: In schools, bullying is a regular occurring behavior problem and the most common form of violence. As stated in studies, bullying peaks during middle school years and higher rates of being bullied are reported in children with special educational needs and disabilities. Social story, as a teaching intervention, helps in preparing the children to respond appropriately to a bullying situation and to develop adaptive coping responses. Objectives: The objective of this study is to identify the victims of bullying among childhood psychiatry conditions, to develop coping skills for them, and to determine the effectiveness of social stories. Study Design: A randomized controlled interventional study was chosen for the research. Methods: Children were screened using Illinois Bully Victim Scale, and 22 children, of both genders, aged 8–13 years diagnosed with attention-deficit hyperactive disorder, learning disability, and mild intellectual disability were randomly assigned to two study groups. Coping strategies were taught to the children in the experimental group with the help of social stories, for two target behaviors, and role play at end for 30 min, 3 days a week, for 13 sessions, whereas in the control group, children underwent conventional occupational therapy along with coping strategies and role play for 30 min for 13 sessions. The Canadian Occupational Performance Measure and the Coping with Bullying Scale for Children were administered before and after intervention. Results: Both experimental (n = 12) and control (n = 10) groups equally improved with their respective intervention. However, children achieved clinically significant scores in their mean values (68.42 ± 61.50,P < 0.02, 95% confidence interval [CI]: 0.00–0.12) in the level of performance, suggesting that they used more of adaptive responses in coping with bullying situation. Typically, children in both the groups showed some amount of maladaptive strategies even after their respective interventions (8.03 ± 6.2,P = 0.20, 95% CI: 0.00–0.13), referring that social story was found to have an impact only on adaptive coping responses. This warrants the importance of addressing the awareness of adverse consequences of maladaptive coping through social stories. Conclusion: Social stories were effective in improving coping skills as well as in enabling the strategies application of learned coping skills (performance) during bullying situation.
Keywords: Adaptive Coping Strategies, Coping Skill, Maladaptive Strategies, Performance, Role Play, School Bullying, Social Stories
|How to cite this article:|
Srija S S, Sugi S, Srinivasan D. Efficacy of social stories in coping with bullying among children with childhood psychiatry conditions: A randomized controlled interventional study. Indian J Occup Ther 2019;51:52-6
|How to cite this URL:|
Srija S S, Sugi S, Srinivasan D. Efficacy of social stories in coping with bullying among children with childhood psychiatry conditions: A randomized controlled interventional study. Indian J Occup Ther [serial online] 2019 [cited 2019 Aug 23];51:52-6. Available from: http://www.ijotonweb.org/text.asp?2019/51/2/52/259173
| Introduction|| |
School is a learning environment. Interactions are positive and respectful among peer–peer, peer–teacher, and teacher–teacher with an atmosphere of trust, cooperation, and collaboration in the classroom. Mistakes and skill deficits are good opportunities to learn and change and to develop appropriate communication, interaction, and social skills. School and teachers treat children with their rights and responsibilities and ensure their active role in their social, emotional, and academic learning and in eliminating bullying behaviors. In schools, bullying is a regular occurring behavior problem that is present in almost every school. Developmentally, peer bullying is evident as early as preschool, although it peaks during the middle school years and declines somewhat by the end of high school. Evidence also suggest that students in special education are at greater risk for victimization and may engage in higher levels of bullying than their typical peers in all contexts and at all ages. For addressing the problems faced by children during bullying, a teaching intervention is required for developing adaptive coping responses. Thus, social story developed focuses on children understanding about a particular situation and providing them with the ideas of how to respond, what to respond, and when to respond to a bullying situation.
The uses of social stories in improving various skills in children have been studied but do not include coping skills with bullying. The sociocultural context in the Indian population is not as same as the Western population pertaining to social stories. Thus, stories need to be prepared and researched according to Indian sociocultural context. The aim and objective of the study were to find the efficacy of social stories in improving coping skills for bullying among children with childhood psychiatry conditions.
| Methods|| |
Twenty-two children both boys and girls going to regular school or inclusive school with ages ranging from 8 years to 13 years with a mean of 10.75 years (standard deviation ± 1.28) were selected for the study. The children who were fulfilling the inclusion criteria were selected by convenient sampling technique and randomly allocated by odds and even method into two equal groups: experimental group and control group. Children selected for the study were diagnosed as learning disability, mild intellectual disability, or attention-deficit hyperactive disorder by a pediatrician or psychiatrist. Children with basic understanding capacity and verbal skills with >50% of score in victim subscale of the Coping with Bullying Scale for Children (CBSC) were included. Children with comorbid physical dysfunctions or vision and hearing impairment were excluded from the study.
An approval from the ethical committee, permission from the institutional head, and written informed consent from the parents and special educators were attained. The children were screened using the Illinois Bully Victim Scale. Children who got scores ≥12 out of 16 under victim subscales were taken as a target population for the study. Two children from the control group dropped out before the commencement of the intervention sessions leaving a total of 22 children fulfilling the inclusion criteria were recruited from Kovai Medical Center and Hospital, Coimbatore, and St. John's Matric Higher Secondary School, Coimbatore, for the study. All the children were undergoing occupational therapy regularly. In the experimental group, out of 12 children, 11 were receiving special education for academics in integrated school and 1 child was going to regular school. In the control group, out of 10 children, 4 children were going to regular school and 6 children were getting special education in an integrated school. Children in the experimental group received individual social story sessions for half an hour, 3 days a week, followed by role play and control group were treated with individual coping strategy sessions for half an hour, 2/3 days a week, followed by role play. At the completion of intervention, both the experimental group and control group were assessed using the CBSC and Canadian Occupational Performance Measure (COPM) to evaluate the coping strategies used by the children and the performance and satisfaction levels to their target behaviors postintervention. Children chose two main target behaviors which were important to them such as calling names, hitting purposefully, and teasing. In this study, modification was done in the areas of occupational performance, where children can consider their behavioral responses along with their caretakers/special educators and rate their level of importance in target behavior and their coping performance and satisfaction in dealing with bullying.
Social stories with coping strategies were prepared as flash cards for each target behavior with pictorial representation. Social stories were given individually for 30 min on each targeted behavior and it was structured for 3 days a week for 13 sessions.
Coping strategies are taught to the children with the help of social stories for two target behaviors. The first social story is Simon's story and it is introduced to the children for addressing the first target behavior “name calling.” Coping strategies were explained by a therapist to the children with the help of this story. Then, the therapist will ask questions about the story to confirm the comprehension of the story and it is recorded as incorrect/correct responses. Later, according to the child's responses their maladaptive behavior and its negative consequences are corrected with adaptive behavior and its positive impact on self and the environment. After the narration of the story, the child is asked to explain the story by observing the pictures from the flash cards and a role play is conducted between the therapist and the child with few questions at the end of the session.
With the successful completion of the first story, the second social story – Tony's story – is introduced to the child addressing the second target behavior “hitting, beating, and pushing.” The therapist explained the coping strategies in different contexts (e.g.), while children playing in playground, during classroom hours, at hostel, while going out to public places, etc., using the social stories.
Children in the control group were introduced to coping strategies for 13 sessions along with role play. The control group participants underwent regular occupational therapy session along with coping strategies and role play for 30 min individually for 13 sessions. Coping strategies are introduced to the children for the first target behavior “name calling.” Then, the therapist will ask questions to confirm the comprehension of the strategies taught and it is recorded as incorrect/correct responses. Later, according to child's response maladaptive behaviors are corrected with adaptive behaviors respectively. After completing teaching coping strategies for the first target behavior, the second target behavior “beating, pushing, and hitting” was addressed. After teaching the coping strategies at the end of each session, a role play is conducted between the therapist and the child. The few coping strategies taught to children in the experimental group and control group are provided in [Appendix 1].
Statistical analysis was performed with SPSS version 20 (IBM Corp., Released 2011. Armonk, NY). The study analysis was done with setting a level of confidence at α ≤ 0.05, and 95% confidence interval (CI) values were also computed. Descriptive analyses were performed to characterize the groups, as mentioned in [Table 1] and [Table 2]. Inferential analyses were used to compare the performance of the groups. COPM and CBSC scores were analyzed using nonparametric Wilcoxon signed-rank test to know the difference within the groups. Mann–Whitney U-test was used to find the difference between the groups.
| Results|| |
Within-group comparison of the experimental group in CBSC scores, the adaptive strategy shows a significant difference in the pre- and posttest of experimental group (P = 0.002, 95% CI: 0.000–0.132) and control group (P< 0.005, 95% CI: 0.000–0.132) respectively. Within-group comparison of the experimental group in CBSC scores, the adaptive strategy shows a significant difference in the pre- and posttest of experimental group (P = 0.002, 95% CI: 0.000–0.132) and control group (P< 0.005, 95% CI: 0.000–0.132) respectively as mentioned in [Table 3]. It reveals that both the group showed improvement in their respective interventions.
|Table 3: Wilcoxon Signed-Rank Test for Canadian Occupational Performance Measure and Coping with Bullying Scale for Children within the Groups|
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Between-group comparison of pretest and posttest shows that there is no significant difference (P > 0.005, 95% CI: 0.000–0.127) in the experimental and control groups on both performance and satisfaction components indicating homogeneity of groups prior to therapy, and at posttest level, both the groups have equally improved. Between-group comparison of posttest shows that there is a significant difference (P< 0.005, 95% CI: 0.00–0.12) in the experimental and control groups on adaptive strategies indicating improvement seen in total scores postintervention, as mentioned in [Table 4].
|Table 4: Mann-Whitney U-Test for Canadian Occupational Performance Measure and Coping with Bullying Scale for Children Between the Groups|
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Both the groups showed a greater effect size (ES >1.00). On comparing, the experimental group showed higher values in performance component and the control group showed higher values in satisfaction component, as shown in [Figure 1].
|Figure 1: COPM and CBSC Scores – Effect Size|
COPM: Canadian Occupational Performance Measure; CBSC: Coping with Bullying Scale for Children
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On comparing, both the groups showed a greater ES (>1.00), but the experimental group showed higher values in adaptive strategies indicating children who used more of adaptive strategies in their coping performance.
| Discussion|| |
In this study, the effectiveness of social stories was analyzed by how well the child was dealing with bulling situation (COPM performance) and how much satisfied (COPM satisfaction) they were on handling the situation and their use of adaptive and maladaptive strategies.
Given a growing body of evidence that supports the use of social stories with students in the autism spectrum, there is a lack of documentation of their use with other disability children. Hence, these are used as a teaching intervention to help children understand and behave appropriately in specific social situations and hence are considered to be a powerful research tools. Moreover, the sociocultural context in the Indian population is not same as the Western population pertaining to social stories. Thus, in this study, social stories are prepared according to our sociocultural context.
Researchers, identified name calling as the most common form of bullying and it can be one of the most distressing teasing behaviors that children find difficult to cope with, and adults often underestimate its damaging effects. In the current study, SImon story was prepared to aid in the understanding of situation where children usually were called with names to describe the adequate responses like “not reacting to bully and moving away from that place. Similarly, another pattern of bullying observed in children are ganging up and striking, pushing, and punching which is also estimated to happen more likely. In the current study, a similar pattern of bullying was identified in the subject also. Tony's story was presented to the children for addressing the above bullying situation, and adaptive coping strategies were taught with the help of social stories.
The findings of this study suggest that both the groups improved in performance while coping with bullying. The experimental group with social stories showed a significant improvement in their performance, indicating that social stories helped the children to perform during bullying situation. This may be due to the apparent reasons that the children enjoyed the social story sessions.
The results of the current study were supported by the findings from a study done on social stories used as an instructional strategy to improve skills of children with wide range of disabilities suggested that social stories will increase appropriate behaviors in children. According to multidimensional model for coping with bullying, it is suggested that if children are provided with adequate teaching methods, they will respond in a positive way for handling a bullying situation. This is consistent with the results of the control group which showed a larger ES (=3.04), indicating that verbal teaching was also helpful for children for using adaptive coping styles.
Both the groups showed some amount of maladaptive strategies. This is supported from a study, suggesting that children with recent experience of victimization are more likely to respond in maladaptive way of coping. Therefore, social stories used for a long duration may reduce and replace the use of maladaptive strategies by adaptive coping strategies.
According to meta-analysis study conducted on social stories, it is also suggested that social stories improve social skills rather than decreasing inappropriate behavior. In the present study, social stories prepared were not used to address maladaptive coping styles. Thus, social story was found to have an impact only on the children's adaptive coping responses and was helpful in learning and using adaptive coping strategies in dealing with bullying situations.
However, on analyzing the satisfaction components of COPM, it revealed that the children in both the groups were satisfied on their performance, irrespective of their adaptive or maladaptive strategies. This warrants the importance of addressing on the awareness of adverse consequences of using maladaptive strategies through social stories.
Limitations of the Study
- Children who were victims of bullying only were considered irrespective of them to be either bullies or bystanders
- Duration of exposure to bullying was not considered
- The duration of social stories and coping strategy session were limited and only two target behaviors were focused
- Unawareness of parents/teachers about the importance of addressing bullying situation was not considered
- Generalization of study results is limited because of small sample size.
- Future studies should focus on children who are both bullies and victims in bullying situations and also normal children without any psychiatry condition
- Social stories can be used for children to identify and reduce maladaptive coping strategy to deal with bullying
- Social stories sessions can be increased in order to determine the long-term effects of bullying
- Follow-up should be done for modifying or changing social stories as the child learns.
| Conclusion|| |
From the study, it can be concluded that social stories are effective in improving coping skills for bullying among children with childhood psychiatric conditions. It enabled the application of learned coping skills (performance) during bullying situation. On the other hand, social stories did not reduce maladaptive skills adequately. Verbal teaching of coping skill was also effective in coping with bullying situation. Therefore, this study gives an evidence that social stories had a slightly greater impact on coping skills than verbal teaching in children for coping with bullying situations.
We would like to thank the institution, Kovai Medical Center and Hospital, and Head of the Department, KMCH College of Occupational Therapy, for the kind permission to conduct this project. We also extend it to the children, their caregivers, and teachers for their informed written consent to participate in this study.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]