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

Summary: 
      This is a one group pre-post feasibility study of an 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 the
      program, and record of modifications needed. Child primary outcomes are Social Skills
      Improvement Scale (SSIS) and the Theory of Mind (ToM) Battery and Inventory within 4 weeks of
      program end. Secondary outcomes will be the Structured Play Assessment (SPA) within 4 weeks
      post-intervention, observations of social interactions (e.g.,eye contract, joint attention,
      verbal utterances, physical contact) during intervention sessions, brain activity in frontal
      and temporal/parietal areas during ToM tasks measured by high density EEG within 4 weeks of
      program end, and parental interview at 3 months related to child's social skills.
    

Detailed description: 
      Five children with Autism Spectrum Disorder (ASD) and 3-5 typically developing (TD) children
      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, we will administer 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 5 children with ASD and 3-5 TD peer models 3
      days per week for 12 week for 1-1.5 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. 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 taped 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, SPA and SSiS. The children with ASD will also complete another EEG
      session as they did at baseline. Parents will be interviewed at 3 months post-intervention
      regarding changes in social skills.
    

Intervention name(s): Interdisciplinary process drama
Intervention type(s): Behavioral
Intervention description(s): Process drama program (3 days/week, 12 weeks, 1-1.5 hours per session) of movement-based activities combining music and drama. Activities that target understanding of emotions, intentions, and appropriate social interactions have been planned by a team of drama teachers, occupational therapists, and speech-language pathologists.
Intervention model: Single Group Assignment
Intervention model description: One group design
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: social skills; child; theory of mind; drama; occupational therapy; speech-language pathology; neural activation