Social Skills in Children With ASD and Process Drama
Condition: Autistic Disorder
MeSH terms: Autistic Disorder
Study type: Interventional

Summary: 
      This is a one-group, pre-post feasibility study of an intensive, interdisciplinary (theatre,
      Occupational Therapy (OT), and Speech Language Pathology (SLP)) intervention targeted at
      social skill development in children, aged 3-4. The intervention uses process drama modified
      with OT and SLP techniques and using typically developing peer models. Feasibility outcomes
      are recruitment rates, retention rates, daily program records of ease of implementing
      program, and record of modifications needed. Child primary outcomes are Social Skills
      Improvement Scale (SSIS), Theory of Mind (T0M) Battery and Inventory, Structured Play
      Assessment (SPA), and Communication and Symbolic Behavior Scales (CSBS) scores within 4 weeks
      of program end. Secondary outcomes are brain activity in frontal lobe and temporal/parietal
      areas measured by high density EEG within 4 weeks of program end, parental interview at 3
      months related to child's social skills, and observational data on social skills during the
      program.
    

Detailed description: 
      Six children with Autism Spectrum Disorder (ASD) and 6 typically developing (TD) preschool
      children participate will complete baseline testing. The TD children will only complete the
      EEG testing, while the ASD children and their parents will complete all outcome assessments.
      In addition to the outcome measures listed in the Brief Summary, the children we will
      administer the the Vineland Adaptive Behavioral Scales (Vineland - II), the Mullen Scales of
      Early Learning, and the Autism Diagnostic Observation Scale - II (if they have not had one
      administered within the past 12 months) for sample description.

      During the EEG session, brain activity during theory of mind and other social stimuli will be
      used to measure brain behavior relationships. The recordings will adhere to standard clinical
      EEG procedures, using high density EEG providing a high spatial resolution for electrical
      source imaging in brain space. They will be conducted by a Registered EEG Technologist (R.
      EEG T) with a specially trained student assistant. The procedure will involve first
      explaining to the parent and child what will be done. The participants will sit within a
      chair or a parent's lap while the EEG is recorded. The EEG tasks will consist of the
      following: First the child will be asked to open and close their eyes for a few minutes to
      record a baseline resting EEG. Then there will be both auditory sounds (intonations and word
      components) and images of social stimuli embedded between fun cartoon stimuli to maintain the
      child's attention displayed on a screen. The pictures will consist of eye movements, facial
      gestures, and point light diagrams of body movements.

      The process drama program will be conducted with 6 children with ASD and 6 TD peer models 5
      days per week for 1 week for 2.5-3 hours each day. The program will consist of several
      sections. Each day will open with an opening ritual that is movement based involving
      mirroring activity. This is followed by a welcome/greeting activity, involving things like a
      song and Name activity. The remainder of the activities build around a story for the day. The
      story will be one that holds interest for young children, such as a day in the life of a tree
      who gets visited by animals and people. The story unfolds with problems to solve and social
      interactions to do. Participants and the drama teachers take on different roles to bring out
      the story. Engagement starts out with drama pieces that the children can do individually and
      progress to those requiring a partner and then small groups. Other artistic experiences
      related to the story are included in the session, such as music and movement related to the
      story and an art activity related to the story. The sessions close with a closing ritual,
      reminding the participants of what was done during the session and a song. All the activities
      focus on building understanding the emotions and intentions of others and appropriate social
      interactions. The setting of the program and the specific activities have been planned with a
      collaborative team of drama teachers, an occupational therapists, and a speech language
      pathologists.

      The process drama sessions will be videotaped and later scored for social interactions and
      social verbal and non-verbal communication. We will also examine the engagement of the
      participants with ASD to determine if we need to change/alter any procedures/techniques that
      we are using during the process drama sessions in subsequent versions of this research. We
      will also examine the behavior of the peer models to identify areas in which the research
      team may need to change to better engage the peer models in subsequent sessions.

      After the end of the process drama intervention, the participants with ASD will repeat the
      baseline assessments within 4 weeks of intervention end. The assessments that will be
      repeated are the ToMT, CSBS, SPA and SSiS. The children with ASD will also complete another
      EEG session as they did at baseline.

      Three months after the last testing session, the parents will be contacted to complete an
      interview to ask how their children are functioning related to play and other interactions
      with other children and with adults. These interviews may occur face-to-face at a mutually
      agreed upon location, could be over the phone, or could be via a video conferencing system,
      such as Business Skype. The interviews will be audio-recorded for later thematic analysis.
      After these themes are identified, the parents will be re-contacted and shown the identified
      themes to make sure that we have accurately represented what they intended to convey (member
      checking).
    

Intervention name(s): Interdisciplinary process drama
Intervention type(s): Behavioral
Intervention description(s): Process drama program (5 days/week, 1 week, 25-3 hour sessions) of movement-based activities combining music, art, and drama. Activities have been planned by a collaborative team of drama teachers, occupational therapists, and speech language pathologists.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: social skills; child; theory of mind; drama; occupational therapy; Speech-language pathology