Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Social skills problems are main features of autism. The Over-Pruning Hypothesis suggests that such problems may be due to over-pruning of neural areas important to social skills. Intervention for social skills before age 5 years may strengthen connections, reducing pruning. Process drama may be a particularly effective way to practice social skills. This poster will describe the feasibility of an interdisciplinary (drama, OT, speech-language pathology) process drama program for social skills in preschoolers with autism.
Primary Author and Speaker: Lorie Richards
Additional Authors and Speakers: Heidi Woolley
Contributing Authors: Xan S. Johnson, Pamela Mathy, Stacy Manwaring, Megan Raby, Wendy Wilde, Lise Thornton, and Penelope Caywood
PURPOSE: This study's purpose was to test the feasibility and effect of an interdisciplinary (drama, OT, SLP) process drama program targeting social skills for preschoolers with ASD. Social skill problems cause disability in autism spectrum disorder (ASD). Difficulty in social interactions limit development, school success, and eventuality employment. More effective interventions fostering social skill development are needed. One possible factor is a deficit in Theory of Mind (ToM) (Astington & Dack, 2008). ToM is the ability to understand others' perspectives and relies on memories of cognitive and emotional events that allow the experience of others' situations as if they were one's own. Drama may promote ToM and social skills development as it creates learning experiences in an autotelic manner: people experience embodied cognition, emotional cues, and explicit identification of scene-related feelings. Thus, drama can facilitate formation of social-cognitive and emotional memories that can be recalled as a basis for later social functioning (Iacoboni, 2008). Some studies of drama for children with ASD have shown increased social skills in older children with ASD (Corbett, et al., 2019). Yet, drama targeting pre-schoolers may have the greatest potential for effect on ToM and social skills. The Over-Pruning Hypothesis (Thomas, Davis, Karmiloff-Smith, Knowland, & Charman, 2016) proposes that ASD results from abnormal neural pruning in widespread networks, with weaker, long-range connections more vulnerable. As neural connections strengthen through experience, interventions that strength these connection may reduce pruning in targeted areas. Peak auditory and prefontal cortex synaptic density, both important for social skills, occurs between age 3-5, suggesting preschool interventions might be optimal.
DESIGN: One group pre-post test feasibility study
METHODS: Participants were 3-4 year olds with ASD and typically developing peers. We evaluated recruitment, retention, child drama engagement, and organizational needs for feasibility. Participants completed the Social Skills Improvement System (SSIS) parent rating scale and the ToM Battery and Inventory at baseline. They then participated in a 3x/week, 1 hr/session, 3 month process drama program in which drama techniques related to emotional expression and understanding and drama scenes involving social conflicts were performed in each session. The sessions were lead by 2 drama specialists with an SLP and OT assisting in each session. The baseline assessments were repeated within two weeks following the end of the program and parents of the children with ASD were interviewed 3 months later.
RESULTS: Only 3/4 with ASD and 1/2 typically developing completed the program. The children were able to engage in the drama in the pretend space and join in the social problems created in scenes. Interviews with parents suggest that the children enjoyed the program and parents saw increased communication with their children. There were no changes on the SISS or the ToM assessments. Yet, there were many challenges to implementing this program, such as recruitment, consistent staffing, and selecting outcomes to measure.
CONCLUSIONS: While we were able to provide an interdisciplinary process drama program to pre-schooler with ASD, including child engagement, existing challenges may have contributed to the lack of significant changes in social skills in this group of children.
IMPACT STATEMENT: Theoretically, the use of drama with preschoolers with ASD may be a powerful intervention to build social skills, but not substantiated in this study. Implementing an interdisciplinary process drama program for these young children requires much planning and careful allocation of resources.
References
Corbett, B.A., Ioannou, S., Key, A.P., Coke, C., Muscatello, R., Vandekar, S., & Muse, I. (2019). Treatment effects in social cognition and behavior following a theater-based intervention for youth with autism. Developmental Neuropsychology, 44(7), 481-494. https://doi.org/10.1080/87565641.2019.1676244.
Astington, J., & Dack, L. (2008). Theory of Mind. In M.M. Haith & J.B. Benson, Eds. Encyclopedia of infant and early childhood development (pp. 343-356). Vol. 3. San Diego, CA: Academic Press.
Iacoboni, M. (2008). Mirroring people: The new science of how we connect with others. New York: Farrar, Straus, & Giroux.
Thomas, M.S., Davis, R., Karmiloff-Smith, A., Knowland, V.C., & Charman, T. (2016). The over-pruning hypothesis of autism. Developmental Science, 19, 284-305. https://doi.org/10.1111/desc.12303.
