Focus on Autism and Other

Developmental Disabilities
Volume 23 Number 2
The Impact of Social Scripts and Visual Cues June 2008 79-94
© 2008 Hammill Institute on

on Verbal Communication in Three Children Disabilities

10.1177/1088357607311447
http://focus.sagepub.com
With Autism Spectrum Disorders hosted at
http://online.sagepub.com

Jennifer B. Ganz
Maria Kaylor
University of Texas at San Antonio
Bethany Bourgeois
Male Family Support Center, Buffalo, New York
Kathy Hadden
University of Texas at San Antonio

Social script and visual cue use with students with autism spectrum disorders (ASD) were examined. A multiple baseline
design across activities with embedded withdrawal was used to measure student acquisition of verbal communication skills.
Three children with ASD, two boys and one girl, were taught a series of scripts and were shown a “quiet” picture when they
engaged in perseverative speech (e.g., repetitive phrases or words). The number of scripted statements increased during
treatment, with reductions in perseverative speech for all three students. One student’s unscripted statements increased dur-
ing intervention. Analysis of percentage of nonoverlapping data indicated that the intervention was highly effective for
scripted statements, ineffective for unscripted statements, and produced variable results for total communicative statements.

Keywords: autism; scripts; verbal communication; visual strategies; conversation; perseverative speech; unscripted speech

C hildren with autism spectrum disorders (ASD)

exhibit impairments in social interactions, language,
and communication (Baron-Cohen, 2004). They often
conversational skills in children with ASD is through the
use of pretaught scripts. As described below, previously
published literature has documented the efficacy of using
fail to make eye contact and infrequently respond to visually based scripts with young children with ASD,
parents and caretakers. Unlike other children with dis- particularly those of preschool or early elementary age
abilities who compensate for their lack of language and and those who cannot read well.
communication skills by gesturing or using nonverbal Research has demonstrated that when children with
means of expression, children with ASD infrequently autism are taught social scripts through modeling,
display spontaneous speech or engage in conversations prompting, and reinforcement, their interactions with
with other children or adults (Krantz & McClannahan, peers and adults increase. Students with ASD benefit
1993). Although some children with ASD spontaneously from the use of scripts in nonacademic and academic set-
interact with peers, they may respond but fail to initiate tings. Goldstein (2002) suggests that improving social
interactions (Janzen, 2003). interactions for students with ASD through the use of
Language and communication difficulties common to
ASD include challenges with processing input and gen-
erating output (American Psychiatric Association [APA], Authors’ Note: This research was supported by a mini-grant from
2000). Conversational speech requires the use of com- the College of Education and Human Development at the University
plex language skills. Initiation and expansion of a con- of Texas at San Antonio. The authors would like to thank Pat
Harwerth (director), Brooksie Key (teacher), and the children who
versational topic, taking turns in a conversation, and participated in this study. We also extend sincere appreciation to Dr.
maintaining that exchange are difficult for children Heflin and the blind reviewers, who provided thorough and significant
with ASD (Janzen, 2003). One approach to improving suggestions.

79
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80 Focus on Autism and Other Developmental Disabilities

social scripts may positively affect language skills and item were put with snacks and play props. The scripts
peer interactions. Krantz and McClannahan (1998) were taught through the use of gestures (e.g., pointing to
examined the use of written scripts with three preschool the script) and, once mastered, were faded back to front.
students with autism who had minimal reading skills. As a result of script implementation, participants signif-
Prior to this study, students initiated only single-word icantly increased their use of scripted and unscripted
requests for toys or food. The participants were taught to statements and results were maintained and generalized
follow photographic activity schedules that included the to new materials when the scripts were faded.
words look and watch me paired with activities. Furthermore, the study found that the students used
Participants learned to approach adults when those scripted statements even when there was no adult in
words appeared, say the phrases, and show the adult the room.
something they could do (e.g., put on a costume, play Audiotaped scripts also have been used to increase
with a toy). After the written scripts were introduced, the social interactions in children with autism. Stevenson,
participants used both scripted and unscripted statements Krantz, and McClannahan (2000) used audiotaped
and generalized new skills to different adult respondents scripts to examine their impact on the conversational
and to new activities. skills of four boys with autism between the ages of 10 to
Krantz and McClannahan (1993) used a multiple 15 years who had limited expressive language and could
baseline design across four participants with autism, not read. Twenty-five nonsocial activities (e.g., puzzles,
ages 9 to 12 years, to introduce a script fading procedure. tracing) and five social activities were taught using
The participants had some functional expressive lan- audiotaped scripts. Although the students demonstrated
guage (i.e., they responded when addressed by adults few social interactions prior to training, within nine ses-
and sometimes made simple requests to teachers, sions, each participant had mastered the five social
parents, or other familiar adults). Prior to social script scripts. After the scripts were totally faded, each partici-
training, the participants exhibited few independent initi- pant maintained the use of at least 15 unscripted state-
ations with peers (i.e., using unprompted statements or ments or questions within each 10-minute session.
questions directed at another child). Written instructions In addition to the literature supporting the use of
and scripts with 10 statements and questions were intro- scripts with individuals with ASD, research supports
duced along with a script fading procedure during which the use of other visual supports (Simpson, Myles, &
the written scripts were faded over time (i.e., the ending Ganz, 2008). Research has demonstrated the efficacy of
punctuation was removed, then part of each sentence, using visual schedules to improve behavior problems
until the entire sentence was gone). As a result of the (Dooley, Wilczenski, & Torem, 2001), task completion
intervention, each of the participant’s independent initia- (Bryan & Gast, 2000; Dettmer, Simpson, Myles, &
tions and responses, both scripted and unscripted, Ganz, 2000; MacDuff, Krantz, & McClannahan, 1993;
increased significantly. Massey & Wheeler, 2000), and play skills (Morrison,
Charlop-Christy and Kelso (2003) also examined the Sainato, BenChaaban, & Endo, 2002). Social Stories™
use of written scripts on cue cards with 6- and 7-year-old and similar scripted interventions also have been sup-
boys with autism to improve conversational skills about ported by research (Simpson et al., 2008). They have
topics in which they were not immediately engaged (e.g., been shown to improve task completion (Hagiwara &
past events, hobbies). Each cue card contained seven Myles, 1999), sociocommunicative skills (Norris &
statements and seven questions. Each participant was Dattilo, 1999; Roger & Myles, 2001), behavior prob-
taught to answer and ask questions by reading the cue lems (Agosta, Graetz, Mastropieri, & Scruggs, 2004;
cards and then responding without looking at the cards. Kuttler, Myles, & Carlson, 1998; Lorimer, Simpson,
Results indicated that the children did not acquire con- Myles, & Ganz, 2002; Scattone, Wilczynski, Edwards, &
versational speech during the baseline phase; however, Rabian, 2002; Swaggert et al., 1995), and preparation for
the children reached criterion during the cue card inter- special events (Ivey, Heflin, & Alberto, 2004). These
vention and this was maintained during testing without interventions demonstrate the efficacy of the use of visu-
the use of cue cards. ally based strategies with individuals with ASD. Thus, to
Sarokoff, Taylor, and Poulson (2001) expanded on the some extent, they contribute to the literature promoting
success of using scripts with students with autism by the use of visual scripts and point to the possibility of
using stimuli that had “naturally embedded textual cues.” using visual scripts and other visual cues in tandem.
They implemented written scripts with two 8- and 9- The purpose of the current research was to investigate
year-old boys with autism who could read at least 50 the effectiveness of written scripts and visual cues with
words each. Scripts with six or seven statements about an verbal elementary-age children with ASD. The following

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 Ganz et al. / Scripts and Cues 81

questions were considered: (a) Do written and pictorial Aidan was a 7-year-old boy who was diagnosed with
scripts increase context-appropriate conversation? autism at age 2 years, 6 months, by a developmental diag-
(b) Do written and pictorial scripts have collateral effects nostic team, who noted that he was “high-functioning.”
on unscripted statements? and (c) Do visual reminders His cognitive skills were average and he independently
decrease perseverative speech? This study contributes to demonstrated self-help skills. Aidan’s phonologic and
the literature on social and communication interventions semantic skills were age-appropriate; however, he infre-
for individuals with ASD by, in part, replicating previous quently initiated or engaged in conversation with peers or
research, which is necessary to document the effective- adults. Furthermore, Aidan engaged in self-stimulatory
ness of single-subject research. In addition, this study behaviors, including jumping, putting his fingers in his mouth,
provides a variation on previous research via the imple- and self-talk (e.g., repeating phrases from favorite songs and
mentation of a visual cue to decrease repetitive speech books). Aidan often played independently with a variety of
in children with ASD who engaged in high rates of repet- materials, although play sequences often were repetitive.
itive, perseverative speech that interfered with their abilities Aidan’s IEP included the following social skill and communi-
to communicate effectively with peers. Moreover, the cation objectives related to this study: “use the names of indi-
participants in this study were older and higher function- viduals in his class,” “initiate and sustain play with a peer
ing than those in previously published literature, using a script,” and “greet every member of his class.”
although the participants in the present study had signif- Moira was an 8-year-old girl who was initially diag-
icant sociocommunicative delays, a core characteristic of nosed by a pediatric geneticist with Asperger syndrome
the range of ASD. at age 3. She was later diagnosed at approximately 3
years, 6 months, with PDD-NOS. Moira was a verbal
child who had previously learned many appropriate
Method phrases for a variety of play situations. For example, in
the sandbox, she frequently said, “I’m making a vol-
Participants cano.” Unfortunately, she repeated such phrases at a far
Three children participated in this study. All three had higher rate than her peers, causing the annoyance of
been diagnosed by a licensed medical or other clinical playmates, one of whom often told her, “You already
professional and met the criteria for Autistic Disorder or said that, Moira!” Such repetitious speech was consid-
Pervasive Developmental Disorder, Not Otherwise ered to be perseverative instead of communicative and
Specified (PDD-NOS), as defined in the Diagnostic and was categorized during this study as perseverative
Statistical Manual of Mental Disorders, Fourth Edition, speech as defined under Response Definitions. Moira’s
Text Revision (DSM-IV-TR; APA, 2000). IEP included the following social skill objectives: “use
Henry was a 12-year-old boy currently diagnosed appropriate greetings and salutations with all the
with PDD-NOS by a pediatric neurologist. He was ini- children in her class” and “use a set of appropriate
tially diagnosed at age 4 years, 6 months, with speech phrases with another child while playing.”
delay. Henry’s cognitive skills were average; however, he
had difficulty with wh- questions and abstract concepts
Settings and Materials
(e.g., idioms). Henry independently performed self-help
skills, such as toileting. He had age-appropriate phono- This study took place in a private school for children
logic and semantic speech skills; however, his speech with ASD and cognitive impairments. The school con-
sounded stilted and monotone. Henry usually worked sisted of two certified teachers, one of whom was a
and played independently and rarely initiated interac- Board Certified Associate Behavior Analyst (BCABA),
tions unless he needed or wanted something. In addition, and 10 students, half functioning at the high end of the
Henry infrequently made spontaneous eye contact. He spectrum and half with cognitive impairments. This
frequently engaged in self-talk, repeating phrases from school was located on the campus of a small, accredited,
television commercials and video games. Henry often private school serving elementary through high school
drew pictures and could write the letters of the alphabet students with mild disabilities. Each participant was
and read. Henry’s Individualized Education Program paired with a child with cognitive impairments who did
(IEP) included the following social skill and communi- not have ASD. During each activity, the participant and
cation objectives related to this study: “use the names of his or her partner would sit in close proximity with each
individuals in his class,” “speak fluently with appropriate other and the materials. Each activity chosen was one
inflection and prosody,” and “work cooperatively on an that the participant had already mastered independently
activity with a peer.” and in which he or she enjoyed engaging. Thus, the

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82 Focus on Autism and Other Developmental Disabilities

requirement for reciprocal communication was the only sessions, the intervention was implemented in the second
objective new to the participants. activity. The same sequence was followed in implement-
ing the intervention in the third activity. The activities
Henry. Henry’s first activity was reading, during were introduced in a discontinuous, rotating approach
which he and his partner would sit next to each other at (e.g., Moira had kitchen for Sessions 1, 4, 7, etc.; sand-
a table with several familiar books from which to choose. box for Sessions 2, 5, 8, etc.; and math game for Sessions
His second activity, drawing, also took place at a table
3, 6, 9, etc.) to ensure that each activity was implemented
and included colored paper, markers, and crayons.
Henry’s final activity, doing puzzles, took place on the the same number of times, to prevent boredom for the
floor and the children had the choice of a floor puzzle to participants when several sessions were implemented in
complete together. the same day, and for ease of implementation across a
number of researchers. Following intervention, each of
Aidan. Aidan’s first activity was pretend play in the the activities returned to baseline conditions for two ses-
“kitchen,” which included a small table and chairs, toy sions of data collection.
stove set, plastic food, and plastic plates and utensils. His In addition to visually analyzing the graphed results to
second activity was puzzles, which included the same evaluate the effects of the social scripts and visual cue
setting and materials as Henry’s puzzle play. Aidan’s intervention, the percentage of nonoverlapping data
final activity, playing with modeling clay, took place at a (PND; Scruggs & Mastropieri, 1998) was calculated for
table and included the clay and a variety of tools, such as
each participant. Marquis et al. (2000) criticized the use
cookie cutters, mallets, and rolling pins.
of PND as too easily influenced by outliers in the base-
Moira. Moira’s first activity was pretend play in the line or by differing phase lengths; however, Campbell
kitchen, which included the same setting and materials (2004) and Olive and Smith (2005) conclude that PND is
as Aidan’s kitchen play. Her second activity was play in valid for documenting the effects of interventions in single-
the sandbox, which was outside and included the sand subject research. To calculate PND, the number of treat-
and tools, such as pails, shovels, and sifters. Moira’s ment data points that exceed the highest baseline data
third activity was a math game involving matching point is divided by the total number of data points in the
manipulatives labeled with numerals to manipulatives treatment phase and multiplied by 100 (Scruggs,
labeled with drawings corresponding with the numerals. Mastropieri, & Casto, 1987). PND scores greater than
This activity took place on the floor in close proximity 90% represent highly effective treatments, scores from
with her partner.
70% to 90% reflect effective treatments, scores between
50% and 70% suggest questionable treatments, and
Research Design scores less than 50% are indicative of ineffective treat-
The study used a multiple baseline design with embed- ments (Scruggs & Mastropieri, 1998).
ded withdrawal across three 5-minute activities for each of
the three participants. Baseline data were collected on all
Script instruction. Prior to data collection, each of the
three activities per participant. Once two sessions of base- three participants was taught his or her scripts to mas-
line data had been collected for the first activity, the inter- tery (i.e., until he or she could read the entire script
vention was implemented in that activity while baseline without errors or prompts). Each participant initially
was continued in Activities 2 and 3. Only two baseline was given three sets of 10 phrases with line drawings
data points were collected during the first activity due to accompanying them. The 10 phrases were similar across
the low rate of scripted statements, which were the focus the three activities but varied slightly according to the
of the study, for each participant. Although data were col- content of the activity. Aidan’s scripts were reduced
lected and graphed for unscripted statements, these data from 10 to 6 per activity when it became apparent that
were not considered when making phase-change (e.g., he was not as fluent a reader as the other two partici-
switching from baseline to intervention) decisions because pants. In addition, the line drawings for his scripts were
unscripted statements, particularly those that occurred enlarged to support his reading of the scripts. During
script instruction, scripted phrases were presented one at
during baseline, were frequently not communicative or
a time and the participant was asked to read each. If he
related to the activity. or she was unable to read a phrase, these were reviewed
During intervention in the first activity, when the and reread several times. Script instruction took place
participant’s scripted statements occurred at a frequency once or twice per day until the participants could each
of at least twice the highest baseline data point, or more read their scripts independently. Once each participant
than two scripted statements occurred if no scripted state- could read his or her scripts independently, baseline data
ments occurred during baseline, for a minimum of three were collected.

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 Ganz et al. / Scripts and Cues 83

Response definitions. During each baseline and inter- verbal statements. No other instructions or prompts were
vention session, data were collected under three main given. The only exception was that if a participant or
categories: scripted statements, unscripted statements, his or her partner tried to leave the activity, then he or
and perseverative speech. Observers recorded all phrases she was reminded to remain until the 5-minute timer
and sentences spoken by the participants during each 5- went off.
minute session and then analyzed the entire segment to
produce the frequency counts. Phrases or sentences were Script and quiet picture intervention. Intervention ses-
recorded as scripted statements when they were word- sions were each 5 minutes long. Intervention conditions
for-word the same as the phrases listed on the partici- were similar to baseline conditions with the addition of
pants’ cue cards and if only one word was different or the scripts. Each phrase and accompanying pictures were
absent (see Figure 1 for an example of Henry’s script). If typed onto 3″ × 5″ colored note cards. Every 30 seconds,
any statement was used more than once, then the repeti- a card was held up behind the participant’s partner to
tions also were counted. Any phrases or sentences that prompt the participant to say the phrase on the card. The
were not scripted or were two or more words different card was held up until the participant said the scripted
from the scripted statements were recorded as unscripted statement. In addition, Henry was taught to tap his part-
statements. Unscripted statements were counted as per- ner on the arm to get his attention as he said each phrase
severative speech if they were repeated word-for-word because it was noticed that his partner frequently did not
three or more times within that 5-minute session. That is, respond if Henry did not gain his attention first. For each
when the same statement was repeated three or more participant, during the intervention phase, scripts were
times, all occurrences of that phrase were counted as per- faded over three steps. First, the last half of the script was
severative speech and not in the category of unscripted cut off and only the first half was presented. Then, all but
statements. Perseverative speech included delayed the first word and picture of the script were removed.
echolalia that was out of context. Examples included Finally, in the return-to-baseline conditions, the entire
repetitive recitations of scripts from video games or tele- script and note card were removed. Points at which script
vision commercials that did not relate to the activity and fading occurred are indicated with arrows on Figures 2
were not conversational and phrases that were context through 7.
appropriate but more perseverative in nature than con- Intervention was initiated with Henry prior to begin-
versational because they were repeated word-for-word ning with the other two participants. The researchers dis-
multiple times (e.g., “I made a volcano. I made a vol- covered that perseverative speech was still occurring
cano. I made a volcano. I made a volcano.”). frequently and introduced a quiet picture (i.e., a 3″ × 3″
Two independent observers (the first, third, and fourth line drawing of a face with the index finger in front of the
authors) collected data simultaneously to calculate relia- mouth indicating “shhh”). Prior to the activities, the par-
bility for 52% of Henry’s sessions (35% of baseline, ticipants were shown the quiet picture and told that if it
59% of intervention, 33% of return to baseline), 42% of was held up, they needed to “stop saying the same thing.”
Aidan’s sessions (27% of baseline, 55% of intervention, This picture was held up by the adult sitting behind the
0% of return to baseline), and 42% of Moira’s sessions participant’s peer when a participant said a phrase more
(41% of baseline, 45% of intervention, 20% of return to than once and each subsequent time the participant said
baseline). Observer agreement was calculated using a the phrase. No verbal reprimand accompanied the pre-
frequency ratio by dividing the smaller total of state- sentation of the quiet picture. If the participant continued
ments recorded by an observer by the larger total to repeat the phrase a third time, the adult then used an
recorded by the other observer, multiplied by 100 exaggerated gesture (i.e., pointing) and held the picture
(Kazdin, 1982). Throughout the course of the study, closer to the participant and within his or her eyesight
observer agreement was calculated at 95% (range (no closer than 3 feet in front of his or her face). The
70–100%) for Henry, 89% (range 71–100%) for Aidan, quiet picture was initiated for Henry during the third day
and 92% (range 70–100%) for Moira. of intervention for Activity 1 and was implemented
along with the scripts for each of the other participants.
Baseline. Baseline and intervention sessions were
Quiet pictures were not faded out until the return-to-
each 5 minutes long and took place between two and
four times per week per participant, depending on school baseline conditions.
attendance and holidays. During baseline sessions, each
participant and a partner were brought to an activity and
told what they could do (e.g., “It’s time to do some read- Results
ing”). An adult researcher and occasionally a second
adult observer sat near the participant and partner Henry’s scripted and unscripted statements increased
throughout each session to write down the participant’s during intervention (Figure 2). During the reading activity,

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84 Focus on Autism and Other Developmental Disabilities

Figure 1 the puzzle activity were 3.78 (range = 0–10) during

Sample of Henry’s Reading Script baseline, 4.78 during intervention (range = 2–10), and 2.50
(range = 2–3) during the return-to-baseline conditions.
Good reading, [name]. Henry’s perseverative speech significantly decreased
throughout intervention (see Figure 3). These results
[Name], do you like to read? were maintained during the return-to-baseline conditions.
Do you want to read? During Henry’s first activity—reading—perseverative
Wow that’s good! speech averaged 9.50 statements (range = 9–10) during
baseline, decreased to 1.00 (range = 0–13) during inter-
I’ll get a book. vention, and remained low at 2.00 (range = 0–4) during
You get a book. the return to baseline. In comparison, total communica-
I’m using [name of book]. tive statements averaged 1.50 (range = 0–1) during base-
line, increased to 14.13 (range = 0–10) during
This is fun! intervention, and fell to 4.00 (range = 0–8) during the
Let’s read some more. return-to-baseline conditions. During the drawing activ-
[Name], what do you want to do? ity, means for perseverative speech were 8.50 (range =
0–27) during baseline and dropped to 0 during interven-
tion and the return-to-baseline conditions. Means for
total communicative statements were 5.33 (range = 0–11)
his scripted statements ranged from 0 to 2 (M = 1.00) during baseline, 9.75 (range = 11–32) during interven-
during baseline but sharply increased (range = 9–14, tion, and 2.00 (range = 1–3) during the return to baseline.
M = 10.75) during intervention. As the script was faded, During Henry’s final activity—puzzles—he averaged
scripted statements began to decrease slightly during the 15.22 perseverative acts during baseline (range = 0–59),
remainder of the intervention phase. During the return- 0 (range = 0) during intervention, and 1.50 (range = 0–3)
to-baseline conditions for reading, Henry’s scripted during return to baseline. Means for total communicative
statements returned to 0 for all sessions. Similar patterns statements were 3.78 (range = 0–10) during baseline,
were noted for Henry’s other two activities: drawing and 12.56 (range = 10–17) during intervention, and 2.50
puzzles. Means for scripted statements during the draw- (range = 2–3) during the return to baseline.
ing activity were 0.33 during baseline (range = 0–2), To augment the visual analysis, PND calculated for
6.83 during intervention (range = 4–9), and 0.00 during Henry reveal a score of 100% for scripted statements, a
the return-to-baseline conditions. Means for scripted score of 38% for unscripted statements, and a score of 92%
statements during the puzzle activity were 0.00 during for total communicative statements. The PND for scripted
baseline, 7.78 during intervention (range = 5–13), and statements suggests a highly effective intervention, the
0.00 during the return-to-baseline conditions. PND for unscripted statements indicates an ineffective
Henry’s unscripted statements also increased during intervention, and the PND for total communicative state-
intervention, although the data were much more variable ments reflects a highly effective intervention.
during baseline sessions and less so during intervention. Aidan’s data are displayed in Figure 4. During kitchen
During two of the three activities, the number of play, Aidan used no scripted statements during baseline.
unscripted statements returned to near-baseline numbers His use of scripted statements increased during interven-
during the return-to-baseline conditions. During the read- tion, ranging from 3 to 18 statements (M = 7.77), and
ing activity, Henry’s unscripted statements ranged from 0 dropped back to 0 during the return to baseline. Aidan’s
to 2 (M = 1.00) during baseline, increased (range = 0–10, results were similar during the puzzle and clay activities.
M = 3.38) during intervention, but did not clearly decrease Means for scripted statements during the puzzle activity
during the return-to-baseline conditions (range = 0–8, were 0.50 during baseline (range = 0–3), 8.78 during
M = 4.00). However, from visually inspecting the data, it intervention (range = 6–13), and 0 during the return-to-
appears that during intervention, unscripted statements baseline conditions. Means for scripted statements dur-
began to increase, whereas scripted statements began to ing the clay activity were 0.29 (range = 0–1) during
decrease as the script was faded. Means for unscripted baseline, 8.00 during intervention (range = 6–10), and 0
statements during the drawing activity were 5.00 during during the return-to-baseline conditions.
baseline (range = 0–11), 9.75 during intervention (range = Aidan’s unscripted statements during baseline, inter-
4–26), and 2.00 (range = 1–3) during the return-to-base- vention, and return to baseline are difficult to interpret
line conditions. Means for unscripted statements during with visual inspection; however, the means during his

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 Ganz et al. / Scripts and Cues 85

Figure 2
Henry’s Scripted Versus Unscripted Communicative Statements

Baseline Script & Quiet Picture Intervention Baseline

16

14

12

10 Scripted Statements
8
Quiet Pic
Unscripted
Added Statements
6

4
Reading
2

0
1 4 7 10 13 16 19 22 25 27 30 32 35 38 41 44 45 47 50 53
Number of Communicative Statements

30

25

20

15

10 Drawing
5

0
2 5 8 11 14 17 20 23 26 28 31 33 36 39 42 48 51 54 56 59

14

12

10

6 Puzzles
4

0 HENRY
3 6 9 12 15 18 21 24 29 34 37 40 43 46 49 52 55 58 60 61
Session

Note: Arrows indicate each fading step. Session numbers for each activity are not continuous because the participant rotated through each
activity and sessions were numbered accordingly. For example, Session 1 was the Reading activity, Session 2 was the Drawing activity, and
Session 3 was the Puzzle activity.

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86 Focus on Autism and Other Developmental Disabilities

Figure 3
Henry’s Communicative Statements Versus Perseverative Speech

Baseline Script & Quiet Picture Intervention Baseline

70

60
Perseverative Speech
50
Scripted +Unscripted
Statements
40

30
Reading
20

10

0
1 4 7 10 13 16 19 22 25 27 30 32 35 38 41 44 45 47 50 53

70
Statements/Perseverative Speech
Number of Communicative

60

50

40

30
Drawing
20

10

0
2 5 8 11 14 17 20 23 26 28 31 33 36 39 42 48 51 54 56 59

70

60

50

40

30 Puzzles
20

10 HENRY
0
3 6 9 12 15 18 21 24 29 34 37 40 43 46 49 52 55 58 60 61
Session

Note: Arrows indicate each fading step.

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 Ganz et al. / Scripts and Cues 87

first and third activities demonstrate an increase during kitchen play, Moira used no scripted statements during
intervention and decrease during return to baseline. baseline. Her use of scripted statements increased during
During kitchen play, Aidan’s unscripted statements aver- intervention, ranging from 8 to 15 statements (M = 10.29)
aged 5.00 (range = 5) during baseline, increased (range = and ranged from 0 to 9 (M = 4.50) during the return to
3–19, M = 10.31) during intervention, and decreased baseline. Moira’s results were similar during the sandbox
during the return-to-baseline conditions (range = 4–9, activity and math game. Means for scripted statements
M = 6.50). Means for unscripted statements during the during the sandbox activity were 0.86 during baseline
puzzle activity were 8.50 during baseline (range = 5–19), (range = 0–3), 9.50 during intervention (range = 7–13),
9.56 during intervention (range = 5–16), and 7.50 (range = and 1.50 (range = 0–3) during the return-to-baseline con-
6–9) during the return-to-baseline conditions. Means for ditions. Means for scripted statements during the math
unscripted statements during the clay activity were 9.57 game were 1.25 (range = 0–6) during baseline, 6.43 dur-
(range = 5–17) during baseline, 14.00 during interven- ing intervention (range = 3–10), and 4.00 (range = 2–6)
tion (range = 9–21), and 5.50 (range = 4–7) during the during the return-to-baseline conditions.
return-to-baseline conditions. During kitchen play, Moira’s unscripted statements
Aidan’s use of perseverative speech significantly averaged 13.00 (range = 12–14) during baseline, 11.71
decreased throughout intervention; however, during the (range = 2–19) during intervention, and 12.50 (range =
return-to-baseline conditions, these results were reversed 10–15) during the return-to-baseline conditions. Means
(see Figure 5). During Aidan’s first activity, kitchen play, for unscripted statements during the sandbox activity
perseverative speech averaged 7.50 statements (range = were 15.57 during baseline (range = 10–24), 8.40 during
3–12) during baseline, decreased to 3.31 (range = 0–14) intervention (range = 4–11), and 4.00 (range = 4) during
during intervention, and increased to 44.50 (range = the return-to-baseline conditions. Means for unscripted
33–56) during the return to baseline. Total communica- statements during the math game were 21.00 (range =
tive statements averaged 5.00 (range = 5) during baseline, 11–29) during baseline, 19.00 during intervention (range =
increased to 18.08 (range = 13–27) during intervention, 10–29), and 19.00 (range = 17–21) during the return-to-
and decreased to 6.50 (range = 4–9) during the return-to- baseline conditions.
baseline conditions. During the puzzle activity, means for Moira’s use of perseverative speech significantly
perseverative speech were 26.00 (range = 0–54) during decreased throughout intervention and these results were
baseline, dropped to 2.78 (range = 0–6) during interven- maintained during the return-to-baseline conditions (see
tion, and then increased to 21.50 (range = 21–22) during Figure 7). During Moira’s first activity, kitchen play, per-
the return to baseline. Means for total communicative severative speech averaged 23.00 statements (range =
statements were 9.00 (range = 0–19) during baseline, 21–25) during baseline, decreased to 7.64 (range = 0–26)
18.33 (range = 11–29) during intervention, and 7.50 during intervention, and decreased to 2.00 (range = 0–4)
(range = 6–9) during the return to baseline. During during the return to baseline. Total communicative
Aidan’s final activity, clay, he averaged 25.86 (range = statements averaged 13.00 (range = 12–14) during baseline,
5–49) perseverative statements during baseline, 3.14 increased to 22.00 (range = 10–27) during intervention,
(range = 0–10) during intervention, and 20.00 (range = and decreased to 17.00 (range = 15–19) during the return-
13–27) during the return to baseline. Means for total to-baseline conditions. During the sandbox activity, means
communicative statements were 9.86 (range = 5–17) dur- for perseverative speech were 29.00 (range = 10–42) dur-
ing baseline, 22.00 (range = 9–21) during intervention, ing baseline, dropped to 1.90 (range = 0–5) during inter-
and 5.50 (range = 4–7) during the return to baseline. vention, and increased to 0 (range = 0) during the
PND calculated for Aidan reveal a score of 100% for return-to-baseline conditions. Means for total communica-
scripted statements, a score of 41% for unscripted state- tive statements were 16.43 (range = 11–25) during base-
ments, and a score of 67% for total communicative state- line, 17.90 (range = 11–21) during intervention, and 5.50
ments. The PND for scripted statements suggests a (range = 4–7) during the return to baseline. During
highly effective intervention, the PND for unscripted Moira’s final activity, the math game, she averaged 18.25
statements indicates an ineffective intervention, and the (range = 0–44) perseverative statements during baseline,
PND for total communicative statements reflects a ques- 0.43 (range = 0–3) during intervention, and 2.00 (range =
tionable intervention. 0–4) during the return to baseline. Means for total com-
Moira’s scripted statements increased from baseline to municative statements were 22.25 (range = 11–30) during
intervention and decreased during the return to baseline baseline, 25.43 (range = 19–33) during intervention, and
for each of her three activities (see Figure 6). During 23.00 (range = 23) during the return to baseline.
(text continues on page 92)
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88 Focus on Autism and Other Developmental Disabilities

Figure 4
Aidan’s Scripted Versus Unscripted Communicative Statements

Baseline Script & Quiet Picture Intervention Baseline

20
18
16
14
12 Scripted
10 Statements
8 Unscripted
6 Statements
4
2
0 Kitchen
1 4 7 10 13 16 19 21 24 26 29 32 35 38 41 44 47
Number of Communicative Statements

20
18
16
14
12
10
8
6
4 Puzzles
2
0
2 5 8 11 14 17 20 22 25 27 30 33 36 3 9 42 45 48

25

20

15

10

5 Clay
0
3 6 9 12 15 18 23 28 31 34 37 40 43 46 49 50
Session AIDAN

Note: Arrows indicate each fading step. Session numbers for each activity are not continuous because the participant rotated through each
activity and sessions were numbered accordingly. For example, Session 1 was the Kitchen activity, Session 2 was the Puzzle activity, and Session
3 was the Clay activity.

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 Ganz et al. / Scripts and Cues 89

Figure 5
Aidan’s Communicative Statements Versus Perseverative Speech

Baseline Baseline
Script & Quiet Picture Intervention

60

50

40
Perseverative
30 Speech

Scripted +
20
Unscripted
Statements
10

0 Kitchen
1 4 7 10 13 16 19 21 24 26 29 32 35 38 41 44 47
Statements/Perseverative Speech

60
Number of Communicative

50

40

30

20

10
Puzzles
0
2 5 8 11 14 17 20 22 25 27 30 33 36 39 42 45 48

60

50

40

30
Clay
20

10

0 AIDAN
3 6 9 12 15 18 23 28 31 34 37 40 43 46 49 50

Session

Note: Arrows indicate each fading step.

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90 Focus on Autism and Other Developmental Disabilities

Figure 6
Moira’s Scripted Versus Unscripted Communicative Statements

Baseline Script & Quiet Picture Intervention Baseline

20

18
16

14
12
Scripted
10
Statements
8 Unscripted
6 Statements
4
2 Kitchen
0
1 4 7 10 13 16 19 20 23 25 28 30 33 36 39 42 45 48
Number of Communicative Statements

30

25

20

15

10

5
Sandbox
0
2 5 8 11 14 17 21 24 26 29 31 34 37 40 43 46 49 51 53

35

30

25

20

15

10

5 Math Game
0
3 6 9 12 15 18 22 27 32 35 38 41 44 47 50 52 54
Session MOIRA

Note: Arrows indicate each fading step. Session numbers for each activity are not continuous because the participant rotated through each
activity and sessions were numbered accordingly. For example, Session 1 was the Kitchen activity, Session 2 was the Sandbox activity, and
Session 3 was the Math Game activity.

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 Ganz et al. / Scripts and Cues 91

Figure 7
Moira’s Communicative Statements Versus Perseverative Speech

Baseline Script & Quiet Picture Intervention Baseline

50
45
40
35
Perseverative
30 Speech
25
Scripted +
20 Unscripted
15 Statements

10
5 Kitchen
0
1 4 7 10 13 16 19 20 23 25 28 30 33 36 39 42 45 48

50
Statements/Perseverative Speech

45
Number of Communicative

40

35

30

25

20 Sandbox
15
10

0
2 5 8 11 14 17 21 24 26 29 31 34 37 40 43 46 49 51 53

50
45
40
35 Math Game
30
25
20
15
10
5
0 MOIRA
3 6 9 12 15 18 22 27 32 35 38 41 44 47 50 52 54

Session

Note: Arrows indicate each fading step.

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92 Focus on Autism and Other Developmental Disabilities

PND calculated for Moira reveal a score of 90% for pattern throughout any of her three activities. Prior to
scripted statements, a score of 16% for unscripted state- intervention, both Aidan and Moira had high rates of
ments, and a score of 45% for total communicative state- unscripted statements. PND results for unscripted state-
ments. The PND for scripted statements suggests a ments for all three participants indicate that this is an
highly effective intervention, the PND for unscripted ineffective treatment. Although frequent, these phrases
statements indicates an ineffective intervention, and the were rarely appropriate or directed at their partners. For
PND for total communicative statements reflects a ques- example, during session four, the kitchen activity, Aidan
tionable intervention. said, “Sunday, Monday” and “there’s the camera,” but
these phrases were unrelated to the content of the activ-
ity, were made under his breath, and were not directed
Discussion toward his partner. Aidan often repeated lines from
books, movies, and songs. If these were not repeated
Prior research has demonstrated that the use of written more than two times during a session, they counted as
scripts increases peer initiations and promotes the con- unscripted statements, although they were not necessar-
tinued use of unscripted exchanges in children with ily communicative.
ASD, particularly those with limited expressive lan- The procedures outlined in this research show poten-
guage. In addition, these scripts were found to generalize tial for positive social outcomes, particularly for students
to settings other than those in which the scripts were who make context-related comments at extremely high
taught (Krantz & McClannahan, 1998). As a result of rates and repeatedly such that they annoy their peers.
instruction in and subsequent fading of scripts, students Moira had high rates of unscripted statements prior to
with autism have learned to initiate interactions with intervention; thus, there was little room for change in
peers. Script instruction has resulted in increased peer unscripted statements throughout intervention. However,
initiations and unscripted initiations (Krantz & she spoke so much that she overwhelmed her partner. Her
McClannahan, 1993). The present study demonstrated comments were generally on topic but too frequent and
similar findings using written scripts with students with usually repetitive. Increasing Moira’s unscripted state-
ASD, though the fact that the participants engaged in high ments was therefore not a goal of this research, although
rates of perseverative speech complicated the interpreta- increasing the quality of those interactions was a goal.
tion of the results, particularly the examination of Whereas previous studies (Krantz & McClannahan,
unscripted statements. The present study contributes to the 1993, 1998) focused on fading scripts while maintaining
literature by providing a partial replication of previous and increasing unscripted and elaborated statements, such
studies, further proving the efficaciousness of this inter- an analysis is not as readily made in the present study
vention. In addition, this study applied scripts to older, due to the complexity and frequency of the participants’
higher functioning, elementary-age students, who nonethe- perseverative speech.
less had significant delays in using sociocommunicative The most striking result of the current research was the
skills. Finally, this study provides a variation on previous participants’ decreased perseverative speech during inter-
research with the addition of a visual cue used to decrease vention. Prior to intervention, all three of the participants
repetitious speech that interfered with the participants’ used high rates of repetitive speech. Henry often repeated
abilities to communicate effectively with peers. portions of television commercials and programs and
All three participants’ scripted statements increased phrases from video games. For example, during the first
from baseline to intervention and decreased again in the baseline for the reading activity, Henry repeated “don’t
return-to-baseline conditions. Henry clearly showed an you dare” and “call XXX-XXXX for free installation” (a
increase in unscripted statements during intervention; commercial) more than twice. During Session 3 of base-
however, such a relationship is not as clear via visual line for the puzzles activity, he repeated phrases such as,
inspection of Aidan’s and Moira’s data. PND results for “Robot Jones” and “It’s Captain Planet,” all of which
scripted statements for all three participants indicate that were unrelated to the activities. Aidan often repeated
this is a highly effective treatment. By investigating the phrases that were appropriate to the activity but they were
averages of unscripted statements within baseline, inter- repeated numerous times in an echolalic manner. He also
vention, and return to baseline, the means during Aidan’s repeated phrases from songs and books. For example,
first and third activities demonstrate an increase during during session five of baseline for the puzzle activity, he
intervention and decrease during return to baseline. repeated “a puzzle” 16 times. During Session 9 of base-
Moira’s unscripted statements did not show a clear line for the clay activity, he repeated “he threw that cat

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 Ganz et al. / Scripts and Cues 93

down” seven times. Moira typically repeated phrases that the study, Moira responded to the use of a quiet picture
were context appropriate but these phrases were repeated to reduce inappropriate and repetitive comments during
so frequently that they were annoying to her peers. For Sunday School classes; however, this study would have
example, during Session 1 of baseline for the kitchen benefited from data collection regarding these long-term
activity, she repeated “here’s some water” six times and effects as well as the collection of social validity data
“a pizza is ready” 10 times. The implementation of the from the participants’ teachers and parents.
quiet picture quickly decreased perseverative speech for Overall, this study demonstrated that the use of scripts
Henry. Aidan and Moira responded as well, although not and visual cues can increase communicative speech and
as quickly as Henry. Henry and Moira maintained these decrease perseverative speech. The use of visuals is less
decreases, demonstrating low rates of this repetitive invasive and less socially stigmatizing than verbal
speech even in the return-to-baseline conditions. Aidan, prompts or reminders. They are also less distracting for
however, did not maintain decreased rates of persevera- other students who may be in the same classrooms as the
tive speech during the return-to-baseline conditions. It is individuals who are using prompts and cues. In addition,
possible that Aidan might have maintained the results had such strategies have value to teachers in that they are eas-
the intervention continued for longer or if there had been ily and quickly implemented with a minimum of materi-
a more gradual fading of the use of the quiet picture. als. This research contributes to and extends previous
A major limitation to this research may have been the research on scripts and visual cues by reporting results
length of time the intervention was implemented. It with participants who engaged in a large amount of per-
appears that the participants’ responses were under stimu- severative speech and by adding the use of a visual cue
lus control of the script cards, preventing their generaliza- to the implementation of visual scripts.
tion of use of the scripted phrases when the cards were
completely removed. Indeed, although this study par-
tially replicates previous research on script interven- References
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there is clearly an experimental effect replicated across Dettmer, S., Simpson, R. L., Myles, B. S., & Ganz, J. B. (2000). The use
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The use of social stories as a preventative behavioral intervention interaction skills for children with autism: A script-fading proce-
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MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Myles, B. S., et al. (1995). Using social stories to teach social and
Teaching children with autism to use photographic activity sched- behavioral skills to children with autism. Focus on Autistic
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Marquis, J. G., Horner, R. H., Carr, E. G., Turnbull, A. P., Thompson, Jennifer B. Ganz, PhD, Board Certified Behavior Analyst
M., Behrens, G. A., et al. (2000). A meta-analysis of positive (BCBA), is an associate professor of special education at the
behavior support. In R. Gersten, E. Schiller, S. Vaughn, & J. University of Texas at San Antonio. Ganz conducts research and
Schumm (Eds.), Contemporary special education research:
writes on interventions for behavior and autism spectrum disorders,
Syntheses of knowledge base on critical instructional issues (pp.
137-178). Mahwah, NJ: Lawrence Erlbaum.
including strategies to address social and communication skills.
Massey, N. G., & Wheeler, J. J. (2000). Acquisition and generaliza- Please address correspondence to Jennifer B. Ganz, UTSA, Dept.
tion of activity schedules and their effects on task engagement in of ILT, One UTSA Circle, San Antonio, TX 78249; e-mail:
a young child with autism in an inclusive pre-school classroom. jennifer.ganz@utsa.edu
Education and Training in Mental Retardation and
Developmental Disabilities, 35, 326-335. Maria Kaylor, PhD, is an assistant professor of special edu-
Morrison, R. S., Sainato, D. M., BenChaaban, D., & Endo, S. (2002).
cation at the University of Texas at San Antonio. Her research
Increasing play skills of children with autism using activity schedules
and correspondence training. Journal of Early Intervention, 25, 58-72.
and teaching foci include special education teacher prepara-
Norris, C., & Dattilo, J. (1999). Evaluating effects of a social story tion and technology-based interventions.
intervention on a young girl with autism. Focus on Autism and
Other Developmental Disabilities, 14, 180-186. Bethany Bourgeois, MA, is a clinical supervisor at the Male
Olive, M. L., & Smith, B. W. (2005). Effect size calculations and single- Family Support Center in Buffalo, New York, where she serves
subject designs. Educational Psychology, 25, 313-324. children with emotional and behavioral disorders and their families.
Roger, M. F., & Myles, B. S. (2001). Using social stories and comic
strip conversations to interpret social situations for an adolescent
with Asperger syndrome. Intervention in School and Clinic, 36, Kathy Hadden recently completed her master’s degree in
310-313. education with an emphasis in special education at the
Sarokoff, R. A., Taylor, B. A., & Poulson, C. L., (2001). Teaching University of Texas at San Antonio. She currently does volun-
children with autism to engage in conversational exchanges: teer work and is a published photographer.

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