Notes on The Effects of Drama Therapy for Children with Autism Spectrum Disorders (Emmett)

The roots of drama therapy are credited to a few select individuals, one being the Austrian psychodrama therapist, Jacob L. Moreno at the start of the 20th century (Bailey, 2010: Courtney & Schattner, 1981). In Courtney and Schattner’s (1981) Drama in therapy Volume 2: Adults, the authors describe two defining features of Moreno’s therapeutic process: the actual performance of an individual’s problem and the community support. It is the “acting out” of an issue that helps one work through his/her difficulties (O’Leary 3).

Courtney and Schattner (1981) also divide the collective term of drama therapy into two different scenarios: one where drama is used in a clinical situation, the other where drama is used in a non-clinical situation. The latter scenario is the type of drama therapy this literature review will focus on; one that is flexible in both the qualifications of its participants and leaders (O’Leary 3).

The literature concerned with drama therapy specifically for those with Autism Spectrum Disorders (ASD) is minimal. There are currently only three Master’s level programs in North America that provide Drama Therapy programs, two in the United States and one in Canada (North American Drama Therapy Association, 2013). Drama therapy resources specifically geared towards children with special needs is an even smaller list, with focuses in autism a part of this division (O’Leary 3).

In order for a student with an ASD to learn to communicate using theatre, the following four components of drama are highlighted by Silverman as aiding an individual through the therapeutic process: performance, projection, narrative, and improvisation (O’Leary 4).

Projection includes the different ways the individual communicates, such as using masks, puppets, written stories, role play, etc. When one is not able to directly express themselves, these mediums help the individual access a different form of communication. Certain forerunners, such as Autism Theatre Network leaders Andrew Nelson and Parasuram Ramamoorthi, have been partnering together to do groundbreaking work in the field of autism and theatre (O’Leary 4).

Students with ASDs have trouble communicating emotions, and by giving them a character to transform into, they can learn how other people feel and behave by becoming that character themselves. Theory of Mind is a concept that many of those on the autism spectrum struggle with immensely. Typically developing children learn to understand how others feel, think, believe, and operate, normally acquiring Theory of Mind skills by the age of four or five. While this ability comes naturally for most, someone with ASD may never learn such skills. However, the seemingly distant and uninterested attitude we receive from those with autism is not indicative of their true intentions (O’Leary 5).

Improvisation in theatre is nerve wracking for most people at first. We visualize the idea of getting up on stage and creating a completely fluid scene without any preparation as a nearly impossible task. However, we are constantly using improvisational techniques throughout our daily lives, such as conversation and play skills. Just as theatrical improvisational techniques, these natural “improv” skills can take extra practice and time to develop, especially for those with ASDs. Improvisation in drama therapy begins with warm ups in order to help everyone prepare for the session. “It also provides a way for clients to connect creatively with the current emotional state and spontaneously expresses this state through movement, sound, image, or improvisational play” (Silverman, 2006, p. 227). One of the most important lessons to take away from improvisational work is the ability to be flexible and adaptive. When the individual can apply this ability to real life situations, the result can be invaluable (O’Leary 6).

The spectrum is such a diverse one that practically every child has an ability that establishes his or her theatre skills. Those children on the spectrum who are classified as higher functioning already speak with a unique intonation that is expressive. Many “reproduce specific vocal intonations and qualities” (Chasen, 2011, p. 97), perfectly capturing the essence of a character. Others, particularly younger children, use their “media obsessions” in the theatre to explore these drama therapy elements (O’Leary 6-7).

Other unique skills include the ability to memorize dialogue (echoic abilities), adherence to rules, and adaptability to routines in order for rehearsal and plot performance. No child diagnosed with autism is the same –some children may possess all, some, or none of these qualities. It is important to remember that no routine of therapy is flawless, either (O’Leary 7).

Each participant was in an environment where he or she was working with others, interacting and engaging with peers, learning parts for the performance, concentrating his physical body in games and exercises, and learning how to behave through a different character that each student was assigned as an actor. The therapeutic use of theatre for those with autism is a quickly growing field and holds a lot of potential as being able to affect the different neural configuration of a child affected with ASD in a positive manner (O’Leary 7).

My volunteer training was a great chance to sit down with all of my volunteers at one time and review their duties for the program. I explained how rehearsals would typically run and handed out detailed reports of each student’s goals, abilities, impairments, and specific needs/wants. This was very beneficial in letting everyone get an idea of variety of students s/he would be working with and begin to brainstorm about who would work well with each participant and what problems may arise (O’Leary 8).

I went through countless web sites and books designed for children’s theatre. I knew before I began that I did not want to rehearse and perform a full length play; anything over 10 minutes long I eliminated as an option. I wanted multiple skits to keep attention and interest, as well as for a chance to showcase every student and work on a variety of different behaviors and skills. The full production ran for just a little less than 30 minutes and was divided into three parts: Aesop’s fables, the student’s “creations,” and three small skits that we referred to as our “group skits” (O’Leary 9).

Interviews were done with all of the students. Almost all took place in the family’s home with one being at the student’s school. The following questions were approved by the Human Subjects Research Board:

Have you ever been in a theatre before? If yes, what was it like?
Have you ever been in a show? If yes, did you like being in the show?
Do you want to be in the show and are you excited to see what it is like?
Have you ever had to stand in front of your class and present something? Was it scary? Who do you like to talk to when you’re at school? At home?
What do you like to talk about?
Would you want a big or small part in the show? If you want a big part, you’ll be speaking more. Is that okay with you?
What are some trouble areas that you work on at school?

Are any of these behaviors/skills especially hard for you?

These questions were a great chance for me to get a better understanding of how much interest the student had in the program, his previous experience, and what target behaviors we could possibly develop. However, much more was gained from the pre-interviews from what wasn’t said. I paid attention to the student’s physical activity, his mannerisms, his attention span, his relationship with his parents, his ability to communicate, his attitude in interacting with me for the first time, and so many more subtle behaviors that helped me in preparing the program for each individual student (O’Leary 9-10).

Interestingly enough, we used improvisational activities to help set a routine. In order to establish the structure that helps students on the autism spectrum to excel, every rehearsal began with a warm up. We used this time as a group to review how our last rehearsal went and open the floor to any questions. During the warm up, I also let them know our schedule for the day and sometimes asked for feedback such as game preferences and/or ideas. Most importantly, this was a time for all of the volunteers and me to get a feel for how each student’s day was going (O’Leary 13).

Numerous games were played throughout the course of the program. Referring back to the importance of improvisation for students on the spectrum, a few young participants struggled with these activities frequently. Over time, we adjusted the expectation level for certain students but still required everyone to push their boundaries in order to work on those flexibility skills (Silverman, 2006). I had a list of games I went into the first rehearsal with, but there were additions later on in rehearsals of either activities I came up with on the spot or recommendations the students made (O’Leary 13).

Out of the seven program participants, four of these children agreed to be research participants, signing assent forms with the parents’ consent. All names mentioned have been changed for the research participants’ privacy. The following is an overview of what significant observations were made by me, the volunteers, the participant’s parents, and the participants themselves:

Research Participant #1 was Kaleb. Kaleb was 9-years-old at the start of the program and is diagnosed with autism. Kaleb came off as very disinterested in me during our pre-interview. I soon learned that this was not so much an issue of lack of interest as it was the difficulty of making conversation. He answered many of my questions with “I don’t know” and made infrequent eye contact with me. His mother gave me more insight to his daily behavior and areas where he tended to excel. Kaleb struggles in school with writing and science but is very skilled in reading and learning concepts visually, such as math. Kaleb also is good at memorizing, but will only do it if he likes what he’s been told to memorize. Social skills are a central focus in his IEP, so from there we came up with the following target behaviors: Initiating conversation, making needs/wants known, and casual “chit chat” with peers and volunteers (O’Leary 17).

Research Participant #2 was Luke. Luke was 9-years-old at the start of the program and has been diagnosed with AD/HD and Asperger’s syndrome. During our pre interview, Luke was shy to come out to meet me at first. He made little eye contact with me but was fairly talkative. I learned that Luke loved to make up his own stories and characters. He has a great imagination and enjoys entertaining people. Luke doesn’t handle criticism well and is not always able to discern the difference between a “big deal” and a “small deal.” Luke also rarely initiates or reacts to conversation, as his parents described him as being very disinterested in other students. Target behaviors we agreed to work on included initiating and holding a conversation, accepting constructive criticism, and learning to think about whether issues are a big or small deal in the long run (O’Leary 20).

Research Participant #3 was Evan. Evan was 13-years-old when he started the program. He has been diagnosed with Asperger’s, AD/HD, and anxiety disorders. I sat down with Evan to discuss some issues he struggles with from day to day. Just as Nelson and Ramamoorthi (2011) describe a child who struggles with planning for new settings, Evan and his parents agreed that he gets very frustrated when the schedule changes, a symptom many individuals with ASD possess (CDC, 2012). I developed a role play scenario in which the participants pretended to have their schedule during school changed at the last minute with Evan in mind. I encouraged Evan to find the positive aspects in the change, such as getting to go to art class earlier. Evan was able to recall this lesson on his own during our post interview almost five weeks later and said that he felt that it was a lesson he would “try and think about” next time he was struggling with this issue. Evan also said that he enjoyed the role play scenario regarding bullying. He liked acting the different parts out and learned how to handle bullying “in a good way” (O’Leary 22).

Research Participant #4 was Sam. Sam was 9-years-old at the beginning of the program and has autism. During our pre-interview, Sam was very animated and outgoing. He answered most of my questions but would trail off onto other irrelevant subjects such as the game Angry Birds, his iPod, or food. Sam understood everything he would be doing in the program, but was not what I would call “excited.” Sam and his mother identified strengths being video games, exercise, anything involving physical coordination, Legos, and math. Areas that prove to be difficult for Sam are recognizing social cues from others, concentrating on others, and conversation etiquette (O’Leary 23).

Two of the original five research participants did not complete the program. One student was just not ready for such an environment and had to drop out. The other participant dropped

out after four weeks, which made his consent/assent forms void. This was disappointing to everyone who had worked with him, but I did ask Evan if he was interested in being a research participant as soon as possible. Observations were not made about Evan until June 18th, which hindered our ability to record his progress over the course of an entire six weeks. My volunteer team was made of undergraduate college students, so it was very much a learning process the first few weeks for everyone, including myself. None of us had ever conducted research before and three volunteers had little to no experience with children with disabilities. It took us quite a few rehearsals to get accustomed to each student and how to go about creating the best atmosphere for everyone simultaneously. Even with seven adults, it was still difficult to write down as many notes as we wanted to on each research participant (O’Leary 24-25).

For our first time out, I don’t think Brighter Connections Theatre’s first program could have gone any better. Every rehearsal was a learning opportunity and constant adjustments were being made by me, the volunteers, the parents, and the participants themselves. I believe all seven of the students made positive advances in certain social and behavioral skills as is reflected by the results of the four research participants. I saw every student come into this program with a target behavior to work through and focus on throughout the process and, as a result, I saw every student struggle to grasp new concepts and stretch their physical and emotional boundaries. I think the research results we gathered prove that drama therapy has the potential to reach many more children with ASDs and to continue helping those who have been through the program (O’Leary 25-26).

Overall, this was a very interesting paper. I really got to see just how humanistic the whole process of Dramatherapy really is.

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