SENSE Theatre: a Promising Intervention for Children with Autism Spectrum Disorders

Background: Social behavior is complex; therefore, interventions developed to address the challenging needs of children with autism must target a broad array of behaviors.  Almost by definition, the theatre involves the teaching and performance of many aspects of social and emotional functioning to include verbal and nonverbal communication, emotional expression, movement, pretend play, and reciprocal social interaction. Therefore, theatrical techniques in combination with established behavioral approaches may provide a rich and promising platform to treat children with autism.

Objectives: The pilot investigation evaluated a community-based theatrical intervention program, SENSE Theatre, designed to improve socioemotional functioning and reduce stress in children with autism spectrum disorder (ASD).  The intervention included peer and video modeling, behavior therapy techniques, social reinforcement and theatrical techniques, which were embedded in a full musical theatrical production. The primary aim was to assess SENSE Theatre in the context of an enjoyable, ecologically valid social experience. We hypothesized that children with autism would demonstrate significant improvement in the identification of faces, the expression of emotions, and theory of mind (TOM) skills.  In was also hypothesized that biological changes would occur to include a reduction in salivary cortisol level and a rise in the level of plasma oxytocin following intervention.

Methods: Eight children with ASD were paired with typically developing peers that served as expert models.  Neuropsychological (face perception, theory of mind (TOM), and emotion identification), biological (cortisol and oxytocin) and behavioral measures were assessed in a pretest-posttest design using paired sample t-tests.  To evaluate stress responsivity, the SENSE participants provided salivary samples at the beginning and end of practice for the First, Middle, and Last Rehearsal, which were analyzed using a repeated measures approach.

Results: The results of neuropsychological measures indicate statistically significant differences between the pre- and post-treatment measures for the identification of faces (t(7)-2.32, P=0.05, and TOM skills (t(7)-2.35, P=0.05).  Regarding cortisol, there was a significant interaction between Intervention Time (First, Middle, and Last rehearsals) and Rehearsal Time (Pre and Post Rehearsal) F(1,6)=19.302, P=0.001.  There were also main effects for Time F(1,6)=16.81 P<0.0001 and for Pre-Post Rehearsal, F(1,6)=127.36, P<0.0001. 

Conclusions: Taken together the findings suggest that the children with ASD exhibited improvement in social perception skills and reduced stress responsivity ostensibly in response to the intervention. The pilot intervention of SENSE Theatre shows promise in improving the socioemotional functioning of children with ASD through the utilization of peers, video and behavioral modeling, and theatrical techniques in a community-based theatrical setting.