Theatre of Mind: Results from a Large Randomized Control Trial of a Theatre-Based Intervention Showing Improvement in Social Cognition and Behavior in Youth with Autism Spectrum Disorder

Background:  Individuals with Autism Spectrum Disorder (ASD) are impaired across many levels of social competence, to include social cognition and the ability to perceive and respond to others. Theory of Mind (TOM) is the ability to attribute mental states including beliefs, intentions, desires, and knowledge to oneself and others and to understand that these perspectives are different from one's own. Theatre techniques such as role-playing, improvisation, and character development have been shown to enhance TOM skills in typically developing children. SENSE TheatreÒ, a peer-mediated, theatre-based intervention has resulted in significant improvement in social competence in children and adolescents with ASD (Corbett et al., 2016a) as well as reduction in anxiety related to engaging with peers (Corbett et al., 2016b).

Objectives:  The purpose of the study was to examine the impact of a peer-mediated, theatre-based intervention, SENSE TheatreÒ, with a large sample of participants with high-functioning ASD using a randomized control trial (RCT) design. It was hypothesized that significant differences between the Experimental (EXP) and the Waitlist Control Group (WLC) would be found for measures of social cognition (TOM), social brain (ERP, Incidental Face Memory (IFM)), social behavior (Cooperative Play), and social functioning (SRS).

Methods:  Participants included 80 high-functioning youth with ASD between 8-to-16 years randomly assigned to the EXP (N=43) or the WLC (N=37) group. The 10-session treatment involved theatrical approaches and behavioral strategies, implemented by trained typically developing peers. The primary dependent measures were the NEPSY TOM, including the Verbal (TOM-V) and Contextual (TOM-C) components, IFM, Cooperative Play from the Peer Interaction Paradigm, and the SRS. Analysis of Covariance was used in which the post-intervention score served as the outcome variable, group (EXP/WLC) as a main independent variable, and baseline (pre-intervention) score as a covariate.

Results:  The two groups did not differ with regards to age, gender, or symptom profile measured by the Autism Diagnostic Observation Schedule, all p >0.05. However, significant differences between the EXP and the WLC group were observed post-treatment on multiple measures. Specifically, the EXP group showed better performance on the TOM Total F(2,75)=5.96, p=0.02 and on the TOM-V F(2,76)=4.54, p=0.04. Regarding social brain IFM, the EXP group showed greater memory for faces F(1,78)=3.92, p=0.05. In the domain of social behavior, the EXP group engaged in more cooperative play with novel peers F(2,77)=7.49, p=0.008, and demonstrated more social communication in daily functioning (SRS; F(2,75)=3.81, p=0.05).

Conclusions:  Youth that participated in the treatment were better able to verbalize and attribute mental states and behaviors to others, engage in more cooperative play with peers, and exhibit more daily social communication in community settings. The study replicates and extends previous findings showing that the peer-mediated, theatre-based intervention contributes to improvement in multiple areas of social competence. The results contribute to a modest albeit expanding literature showing the promise of theatre for treating core deficits in youth with ASD.