Effect of Social Stories on Anesthesia Compliance in Children With Autism

January 29, 2026 updated by: Elif Sule Ozdemir, Diskapi Yildirim Beyazit Education and Research Hospital

The Effect of the Social Stories Technique on Anesthesia Compliance in Children With Autism Spectrum Disorder

Children with Autism Spectrum Disorder (ASD) frequently experience heightened anxiety and reduced cooperation during the perioperative period, which can complicate anesthesia induction and negatively affect procedural safety and efficiency. Non-pharmacological behavioral preparation methods that enhance predictability and understanding of medical procedures may improve anesthesia-related cooperation in this vulnerable population. The Social Stories Technique is a structured, visual-based behavioral intervention designed to support children with ASD by explaining upcoming experiences in a clear and developmentally appropriate manner.

This prospective controlled study aims to evaluate the effect of the Social Stories Technique on anesthesia compliance and preoperative anxiety in children with Autism Spectrum Disorder undergoing elective surgery. Children in the intervention group will receive Social Stories materials to be reviewed with their families prior to surgery, while the control group will receive standard preoperative information only. Primary and secondary outcomes will include anesthesia induction compliance, preoperative anxiety levels. The findings of this study are expected to contribute evidence regarding the effectiveness of a low-risk, non-pharmacological behavioral intervention to improve perioperative care in children with ASD.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Children diagnosed with Autism Spectrum Disorder
  • Patients scheduled for elective surgical procedures
  • Children aged 3 to 18 years
  • American Society of Anesthesiologists (ASA) physical status class I-II
  • Written informed consent obtained from a parent or legal guardian
  • Caregivers willing and able to read the Social Stories materials at home as instructed
  • Caregivers able to understand the Social Stories materials prepared in the Turkish language

Exclusion Criteria:

  • Children with ASA physical status class III or higher systemic disease
  • Patients requiring emergency surgery
  • Children with severe intellectual disability or significant visual or hearing impairment
  • History of severe behavioral problems during previous general anesthesia
  • Families unable or unwilling to comply with the Social Stories intervention during the study period
  • Inability to obtain written informed consent from a parent or legal guardian
  • Children receiving pharmacological treatment for a comorbid psychiatric disorder

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Social Stories Group
Participants in this arm will receive the Social Stories Technique as a behavioral preoperative preparation intervention. Following informed consent, families will be provided with age- and developmentally appropriate Social Stories materials describing the anesthesia and surgical process using simple language and visual supports. Parents will be instructed to review the Social Stories with their child once daily.
Behavioral: Social Stories Group
The Social Stories Technique is a non-pharmacological behavioral intervention designed to prepare children with Autism Spectrum Disorder for anesthesia. Social Stories materials will be provided to families and will be read to the child by caregivers once daily for 7-14 days prior to surgery. The effect of the intervention on reducing preoperative anxiety and on cooperation during anesthesia induction-specifically compliance with intravenous cannulation and/or face mask application-will be evaluated.
Active Comparator: Routine Preoperative Preparation Group
Participants in this arm will receive standard preoperative information as routinely provided in clinical practice. This includes verbal explanation of the anesthesia and surgical process given to the child's caregivers during the preoperative anesthesia consultation. No Social Stories materials or additional behavioral preparation tools will be provided.
Behavioral: Routine Preoperative Preparation Group
Routine preoperative care consists of standard verbal information provided to caregivers regarding the anesthesia and surgical process during the preoperative anesthesia consultation. No Social Stories materials or additional behavioral preparation interventions will be used. Preoperative anxiety and cooperation during anesthesia induction, including compliance with intravenous cannulation and/or face mask application, will be evaluated.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Anesthesia Induction Compliance
Time Frame: During anesthesia induction on the day of surgery.
Behavioral cooperation during anesthesia induction in children with Autism Spectrum Disorder will be assessed by compliance with face mask application and/or intravenous cannulation using the Induction Compliance Checklist (ICC).
During anesthesia induction on the day of surgery.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Preoperative Anxiety Level
Time Frame: Preoperative period on the day of surgery.

Preoperative anxiety will be assessed using the Modified Yale Preoperative Anxiety Scale (mYPAS).

The mYPAS is a validated observational scale evaluating preoperative anxiety across five behavioral domains (activity, vocalization, emotional expressivity, interaction with parents, and movement).

Total scores range from 0 to 100, with higher scores indicating greater levels of preoperative anxiety.

Clinically significant anxiety is generally considered at mYPAS scores ≥30-40.
Preoperative period on the day of surgery.
Postoperative Agitation / Emergence Delirium
Time Frame: Immediate postoperative period in the post-anesthesia care unit.

Postoperative agitation and emergence delirium will be assessed using the Pediatric Anesthesia Emergence Delirium (PAED) Scale.

The PAED scale consists of five items scored from 0 to 4, yielding a total score ranging from 0 to 20.

Higher PAED scores indicate more severe emergence delirium, and a total score of ≥10 is generally accepted as clinically significant emergence delirium.
Immediate postoperative period in the post-anesthesia care unit.
Parental Satisfaction
Time Frame: On the day of surgery.

Parental satisfaction with the perioperative process will be assessed using a 5-point Likert-type satisfaction scale, ranging from 1 (not satisfied at all) to 5 (very satisfied).

Higher scores indicate greater parental satisfaction.
On the day of surgery.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Diskapi Yildirim Beyazit Education and Research Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 30, 2026

Primary Completion (Estimated)

August 3, 2026

Study Completion (Estimated)

August 20, 2026

Study Registration Dates

First Submitted

January 13, 2026

First Submitted That Met QC Criteria

January 13, 2026

First Posted (Actual)

January 21, 2026

Study Record Updates

Last Update Posted (Actual)

February 2, 2026

Last Update Submitted That Met QC Criteria

January 29, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • AEŞH-EK-2025-311

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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