SENSE Theatre - Bridging Art and Science to Improve Social Interaction in Autism

Background:  Deficits in social skills prevent children with autism spectrum disorders (ASD) from achieving age-appropriate developmental milestones and as a consequence, they struggle to establish interpersonal relationships, especially with peers.  Furthermore, many children with ASD exhibit notable stress in response to engaging with others.  

Objectives:  The purpose of the study was to evaluate social interaction skills and stress responsivity in children with ASD before and after a novel intervention, SENSE Theatre, using behavioral and theatrical approaches. A previous SENSE Theatre study occurred over a 3 month span, utilizing a distributed model of the program, whereas the current study used a massed practice model implemented in a two-week intervention summer camp concluding with two public performances of an original play.

Methods:  The intervention combined established behavioral strategies (e.g., peer-mediation, video modeling) alongside theatrical techniques (e.g., improvisation, role-play) to target social interaction and stress responsivity. Participants included 11 youth with ASD 7 to 18 years (7 males, 4 females), including nine Caucasian and two African-American children. Neuropsychological and observational measures of social perception and interaction as well as biological (cortisol) and parent report measures of behavioral stress were assessed using a within-group pre-test, post-test design with Wilcoxon signed-rank test for the pairwise comparisons.

Results:  Significant changes occurred in social interaction behaviors conducted by two independent raters for mutual planning (p=0.001, r = 0.75), eye contact (p=0.002, r = 0.37), negotiation (p = 0.001, r = 0.74), and sharing (p=0.002, r = 0.79). There were no changes on neuropsychological measures of social perception over the two week camp (all p>0.05). However, significant reductions in stress responsivity (cortisol) were observed on the first day compared to home sampling (p=0.04, r=0.48). Additionally, there was a significant  decrease in behavioral stress (SSS) reported for positive (p=0.03, r = 0.27) and sensory (p=0.004, r = 0.54) stimuli.

Conclusions:  The findings revealed within-treatment-context change in social interaction skills with peers, a lack of physiological stress and reductions in behavioral stress ostensibly stemming from participation in the two-week intervention.  The findings support the incorporation of trained peers in a community service model utilizing theatrical techniques for improving social interaction in youth with ASD.