Clinical research: Theater improves social skills in children with autism

Children with autism who participate in a specialized drama program show improvements in face identification and theory of mind, the ability to infer what others are thinking, according to a study published in the April issue of the Journal of Autism and Developmental Disorders.

A body of research has shown that imitation play boosts eye contact and other social skills in children with autism. The new approach uses proven behavioral intervention techniques in a setting where imitation takes center stage: the theater.

In the study, eight children and teenagers with autism and eight typically developing peers participated in a three-month program called Social Emotional NeuroScience Endocrinology (SENSE) Theatre. Each child with autism learned a part in a musical production with the help of one of the typically developing children.

The children went to a few dozen two-hour rehearsals, working out speaking parts, songs and choreography for Disney’s The Jungle Book. With the help of psychologists and behavioral specialists, the typically developing peers helped reinforce appropriate social skills to their partners with autism. The healthy children also acted out their partners’ roles on video, and this footage was then uploaded to a website so their partners could watch while practicing at home.

The researchers collected saliva from participants with autism before and after each rehearsal and analyzed it for cortisol, a stress hormone that is a strong indicator of anxiety. They found that cortisol levels were high at the beginning of the program, but then tapered off, suggesting that the children became more comfortable with the social interactions over time.

After the final curtain closed, the children with autism showed significant gains on two parts of A Developmental Neuropsychological Assessment, or NEPSY test: one that assessed their ability to identify faces they’d seen before and another that tested how well they understood theory of mind. The children did not improve on a NEPSY test for recognizing facial expressions, however, and parental questionnaires showed that the parents didn’t notice any differences in their children’s behaviors after the program.

Interestingly, although they didn’t measure it explicitly, the researchers also note that the typically developing children seemed to showed an increase in empathy and communication toward the children with autism, and that these skills spilled over into their school-day interactions with children who have disabilities.