Skip to main content

Generalized Effects of Social Stories with Task Analysis for Teaching Menstrual Care to Three Young Girls with Autism


Individuals with autism spectrum disorder (ASD) have distinctive needs with respect to sexual development and education. This pilot study evaluates the effectiveness of a parent-implemented Social Story intervention with an embedded visual task analysis to teach menstrual care skills to three young girls with ASD. Skill generalization was evaluated using two different types of pads and a simulated condition (i.e., a pad with red syrup). Social validity of target behaviors, intervention procedures and intervention effects were evaluated. Additionally, qualitative changes in participant behaviors were measured via phone interviews with the participants’ mothers (Bruess and Greenberg 1994) 1 year later. Results indicate that participants were more knowledgeable about reproductive development and were able to independently care for their menses regardless of pad type (wings vs. no-wings) and condition (clean vs. dirty). Parents reported high satisfaction with the intervention procedures and outcomes. Implications of the study and future research are discussed.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Haffner, D.W. (ed.): Health, National Commission Adolescent Sexual: Facing Facts: Sexual Health for America’s Adolescents. Sexuality Information and Education Council of the United States, New York (1995)

    Google Scholar 

  2. 2.

    Bruess, C.E., Greenberg, J.S.: Sexuality Education Theory and Practice, 3rd edn. Brown & Benchmark, Madison (1994)

    Google Scholar 

  3. 3.

    Aunos, M., Feldman, M.A.: Attitudes towards sexuality, sterilization and parenting rights of persons with intellectual disabilities. J. Appl. Res. Intellect. Disabil. 15, 285–296 (2002)

    Article  Google Scholar 

  4. 4.

    Travers, J., Tincani, M.: Sexuality education for individuals with autism spectrum disorders: critical issues and decision making guidelines. Educ. Train. Autism Dev. Disabil. 45(2), 284–293 (2010)

    Google Scholar 

  5. 5.

    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Text edn. Williams & Wilkins, Washington (2000)

    Google Scholar 

  6. 6.

    Realmuto, G.M., Ruble, L.A.: Sexual behaviors in autism: problems of definition and management. J. Autism Dev. Disord. 29, 121–127 (1999)

    PubMed  Article  Google Scholar 

  7. 7.

    Mansell, S., Sobsey, D., Wilgosh, L., Zawallich, A.: The sexual abuse of young people with disabilities: treatment considerations. Int. J. Adv. Counsel. 19, 293–302 (1996)

    Article  Google Scholar 

  8. 8.

    Hellemans, H., Colson, K., Verbraeken, C., Vermeiren, R., Deboutte, D.: Sexual behavior in high-functioning male adolescents and young adults with autism spectrum disorder. J. Autism Dev. Disord. 37, 260–269 (2007)

    PubMed  Article  Google Scholar 

  9. 9.

    Stokes, M.A., Kaur, A.: High-functioning autism and sexuality. Int. J. Res. Practice 9, 266–289 (2005)

    Article  Google Scholar 

  10. 10.

    Sullivan, A., Caterino, L.C.: Addressing the sexuality and sex education of individuals with autism spectrum disorders. Educ. Treat. Child. 31, 381–394 (2008)

    Article  Google Scholar 

  11. 11.

    Tarnai, B., Wolfe, P.S.: Social stories for sexuality education for persons with autism/pervasive developmental disorder. Sex. Disabil. 26, 29–36 (2008)

    Article  Google Scholar 

  12. 12.

    Koller, R.: Sexuality and adolescents with autism. Sex. Disabil. 18, 125–135 (2000)

    Article  Google Scholar 

  13. 13.

    Ruble, L.A., Dalrymple, N.J.: Social/sexual awareness of persons with autism: a parental perspective. Arch. Sex. Behav. 22, 229–240 (1993)

    PubMed  Article  Google Scholar 

  14. 14.

    Epps, S., Stern, R.J., Horner, R.H.: Comparison of simulation training on self and using a doll for teaching generalized menstrual care to women with severe mental retardation. Res. Dev. Disabil. 11, 37–66 (1990)

    PubMed  Article  Google Scholar 

  15. 15.

    Moudgil, A.C.: Teaching menstrual hygiene to a mentally retarded. Indian J. Ment. Retard. 3, 50–54 (1970)

    Google Scholar 

  16. 16.

    Richman, G.S., Ponticas, Y., Page, T.J., Epps, S.: Simulation procedures for teaching independent menstrual care to mentally retarded persons. Appl. Res. Ment. Retard. 7, 21–35 (1986)

    PubMed  Article  Google Scholar 

  17. 17.

    Richman, G.S., Reiss, M.L., Bauman, K.E., Bailey, J.S.: Teaching menstrual care to mentally retarded women: acquisition, generalization, and maintenance. J. Appl. Behav. Anal. 17, 441–451 (1984)

    PubMed  Article  Google Scholar 

  18. 18.

    Schopler, E.: Implementation of TEACCH philosophy. In: Cohen, D.J., Volkmar, F.R. (eds.) Handbook of Autism and Pervasive Developmental Disorders, pp. 765–795. Wiley, New York (1997)

    Google Scholar 

  19. 19.

    Gray, C.: Social Stories. The Gray Center for Social Learning and Understanding. Available online (2008). Accessed 11 Nov 2008

  20. 20.

    Gray, C.: What are Social Stories. The Gray Center for Social Learning and Understanding. Available online (2008). Accessed 11 Nov 2008

  21. 21.

    Lorimer, P.A., Simpson, R.L., Myles, B.S., Ganz, J.B.: The use of social stories as a preventative behavioral intervention in a home setting with a child with autism. J. Posit. Behav. Interv. 4, 53–60 (2002)

    Article  Google Scholar 

  22. 22.

    Quilty, K.M.: Teaching paraprofessionals how to write and implement social stories for students with autism spectrum disorders. Remedial Special Educ. 28, 182–189 (2007)

    Article  Google Scholar 

  23. 23.

    Scattone, D., Wilczynski, S.M., Edwards, R.P., Rabian, B.: Decreasing disruptive behaviors of children with autism using social stories. J. Autism Dev. Disord. 32, 535–543 (2002)

    PubMed  Article  Google Scholar 

  24. 24.

    Toplis, R., Hadwin, J.A.: Using social stories to change problematic behavior in school. Educ. Psychol. Practice 22, 53–67 (2006)

    Article  Google Scholar 

  25. 25.

    Hagiwara, T., Myles, B.S.: A multimedia Social Story intervention: teaching skills to children with autism. Focus Autism Other Dev. Disabil. 14, 82–95 (1999)

    Article  Google Scholar 

  26. 26.

    Soenksen, D., Alper, S.: Teaching a young child to appropriately gain attention of peers using a social story intervention. Focus Autism Other Dev. Disabil. 21, 36–44 (2006)

    Article  Google Scholar 

  27. 27.

    Bernad-Ripoll, S.: Using a self-as-model video combined with social stories to help a child with asperger syndrome understand emotions. Focus Autism Other Dev. Disabil. 22, 100–106 (2007)

    Article  Google Scholar 

  28. 28.

    Nichols, S., Hupp, S.D.A., Jewell, J.D., Zeigler, C.S.: Review of Social Story interventions for children diagnosed with autism spectrum disorders. J. Evidence Based Practices Schools 6, 90–120 (2005)

    Google Scholar 

  29. 29.

    Test, D.W., Richter, S., Knight, V., Spooner, F.: A comprehensive review and meta-analysis of the social stories literature. Focus Autism Other Dev. Disabil. 26, 49–62 (2010)

    Article  Google Scholar 

  30. 30.

    Wilkenfeld, B.F., Ballan, M.S: Educators’ attitudes and beliefs towards the sexuality of individuals with developmental disabilities. Sex. Disabil. Published online first: doi:10.1007/s11195-011-9211-y. Available online Accessed 14 May 2011

  31. 31.

    Isler, A., Beytut, D., Tas, F., Conk, Z.: A study on sexuality with the parents of adolescents with intellectual disability. Sex. Disabil. 27, 229–237 (2009)

    Article  Google Scholar 

  32. 32.

    Ballan, M.: Parents as sexuality educators for their children with developmental disabilities. SIECUS Rep. 29(3), 14–19 (2001)

    Google Scholar 

  33. 33.

    Sparrow, S.S., Balla, D.A., Cicchetti, D.V.: The Vineland Adaptive Behavior Scales. American Guidance Service, Circle Pines (1984)

    Google Scholar 

  34. 34.

    Wheeler, A.J., Miller, R.A., Springer, B.M., Pittard, N.C., Phillips, J.F., Myers, A.M.: Murdoch Center Program Library, vol. II. Murdoch Center Foundation, Incorporated, Butner (1997)

    Google Scholar 

  35. 35.

    Wrobel, M.: Taking Care of Myself: A Hygiene, Puberty, and Personal Curriculum for young People with Autism. Future Horizons, Arlington (2003)

    Google Scholar 

  36. 36.

    Snell, M., Brown, F.: Instruction of Students with Severe Disabilities, 7th edn. Prentice Hall, Upper Saddle River (2010)

    Google Scholar 

  37. 37.

    Kazdin, A.E.: Single-Case Research Designs: Methods for Clinical and Applied Settings. Oxford University Press, New York (2010)

    Google Scholar 

  38. 38.

    Gray, C.: Writing Social Stories with Carol Gray. Future Horizons, Arlington (2000)

    Google Scholar 

  39. 39.

    Gray, C.: Social Stories 10.0: the new defining criteria and guidelines. Jenison Autism J. 15, 2–21 (2004)

    Google Scholar 

  40. 40.

    Cooper, J.O., Heron, T.E., Heward, W.L.: Applied Behavior Analysis, 2nd edn. Pearson Prentice Hall, Upper Saddle River (2007)

    Google Scholar 

  41. 41.

    Morse, W.H., Skinner, B.F.: Some factors involved in the stimulus control of operant behavior. J. Exp. Anal. Behav. 1, 103–107 (1958)

    PubMed  Article  Google Scholar 

  42. 42.

    Kuttler, S., Myles, B.S., Carlson, J.K.: The use of social stories to reduce precursors to tantrum behavior in a student with autism. Focus Autism Other Dev. Disabil. 13, 176–182 (1998)

    Article  Google Scholar 

Download references


This research is supported by Grant H325K080108, Office of Special Education programs. The statements in this article do not necessarily represent the views of the U.S. Department of Education. The authors wish to thank Dr. Gregory MacDuff for his insightful comments, Allison Krug for her thoughtful editing, and all the mothers and young girls who participated for their time and assistance.

Author information



Corresponding author

Correspondence to Yasemin Turan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Klett, L.S., Turan, Y. Generalized Effects of Social Stories with Task Analysis for Teaching Menstrual Care to Three Young Girls with Autism. Sex Disabil 30, 319–336 (2012).

Download citation


  • Social stories
  • Autism spectrum disorders
  • Disability
  • Sexual education
  • Menstrual care
  • USA