Shakespeare and Autism Pilot Outcomes

A Shakespearian Social Skills Intervention for Children with ASD

Margaret H. Mehling1, Marc J. Tass1, Ph.D., Kelly Hunter3, Robin Post2, M.F.A., & Lesley Ferris3, Ph.D.

Institutions: 1The Ohio State University Nisonger Center, 2The Ohio State University Department of Theatre, 3The Royal Shakespeare Company

Introduction
The core features of autism include qualitative impairments in social engagement and communication and presence of restricted interests and repetitive behaviors. Teaching social skills has been shown to be an effective intervention for children with autism spectrum disorders (ASD; Chung, Reavis, Mosconi, Drewy, Matthews, & Tass, 2007). Drama-based intervention may be a good vehicle to teach many social and communication skills that can benefit children with ASD. Drama intervention offers a structured approach to enabling and motivating hard-to-reach children to participate more meaningfully in a social world (Peter, 2003). Enabling children with ASD to engage in playful activity can strengthen those aspects of brain functioning necessary for more flexible thinking, with associated benefits in communication skills and greater sensitivity in social interaction (Sherratt & Peter, 2002). The Hunter Heartbeat Method, developed by Kelly Hunter of the Royal Shakespeare Company, has been used with children with ASD for the past 20 years. Over the years, teaching strategies and intervention methods have been refined and have been anecdotally effective in improving social and communication skills with children of all ages and abilities. The present pilot study explores the effects of participating in a Shakespeare theatre intervention using the Hunter Heartbeat Method on certain behavioral features associated with ASD including social engagement, eye contact, expressive and receptive communication, facial emotion expression recognition, and pragmatic language.

Pilot Design
Children (N=14) participating in the study were recruited through local area public schools. Children were selected based on the presence of an ASD diagnosis and absence of severe behavior problems (screened for with Nisonger Child Behavior Rating Form). Actors facilitating the intervention were selected from The Ohio State University Department of Theatre and received training in the Hunter Heartbeat Method as well as basic education in Autism Spectrum Disorders. Prior to participating in the Shakespeare intervention, pre-test evaluations were conducted to obtain baseline information for each child. Children were then divided into two groups (N=8 and N=6) based on scheduling needs and to allow for low actor to student ratios during the intervention (approximately 1:1 for group 1 and 2). Children participated in the Shakespeare intervention after school for approximately 1-hour per week for 10 weeks. At the end of the 10-week intervention period, post-test evaluations were conducted to measure potential change in ability. At this time parents and teachers were also asked to complete a brief questionnaire regarding their impression of the intervention, whether or not their child/student found the intervention enjoyable, and whether they noticed any progress in social skills, communication, or behavior.

Sample Demographics
Age: 10 years, 6 months to 13 years, 10 months; M = 12 years, 5 months Gender: 9 males (64%); 5 females (36%) Autism Diagnosis: Mean ADOS = 10.7, SD = 3.8

Results
Vineland Adaptive Behavior Scale
80

75

70

65

pre-intervention post-intervention

Measures
Test Autism Diagnostic Observation Schedule (ADOS) Nisonger Child Behavior Rating Form (NCBRF) Penn Emotion Recognition Test Vineland Adaptive Behavior Scales Second Ed. (Vineland II) Test of Pragmatic Language Second Edition (TOPL-2) Social Validation Questionnaire Skills Assessed Core Symptoms of Autism (Social Skills, Communication, Repetitive Behavior) Problem behavior Facial Emotion Recognition Adaptive Behavior; specifically communication and socialization domains Pragmatic language Parent/Teacher/Childs general impression of intervention; anecdotal report change in skills PreTest X X X X X X X X X X PostTest

60

55

50 Communication Domain Daily Living Domain Socialization Domain Total Adaptive Behavior Composite

Non-parametric statistics were utilized to analyze pre and post test statistics due to the small sample size and non-normal distribution of the data. The Wilcox Signed Ranks Test was used to test for differences between pre and post test measures tor the TOPL, NCBRF subscales, Vineland subscales, and Vineland composite scores. Significant differences between pre and post test measures were found for the TOPL composite score (Z = -2.40, p=0.02), the Vineland Expressive Language Subscale (Z = -2.45, p=0.01), the Vineland Daily Living Composite (Z = -2.53, p=0.01), the Vineland Relationships Subscale (Z = -2.44, p=0.02), and Vineland Composite Scores (Z= -2.37, p=0.02)
TOPL-2 Pre versus Post Test
100

Hunter Heartbeat Method

The Hunter Heartbeat Method is a Shakespearian based theatre intervention developed by Kelly Hunter of the Royal Shakespeare Company. The Hunter Heartbeat Method is based around the rhythm of iambic pentameter and the sound of the heartbeat. In this intervention, games based on Shakespeares The Tempest are introduced to the children allowing them to progress through the basic plot of the work while emphasizing the themes of the eyes, the mind and the heart. Games target skills such as eye contact, turn taking, facial emotion recognition and production, imitation, improvisation, basic play humor, and communication in a playful manner. Children learn the games while seated in a large group circle through imitation and observation rather than explicit instruction, have an opportunity to play the games one on one with an actor, and then have an opportunity to enter the middle of the circle and show their interpretation of the work to their peers. The Hunter Heartbeat Method emphasized the low actor to child ratio so children receive individual attention, feedback, and interaction as they play the games and develop core social skills.

Vineland Expressive Language Subscale

12 8.6 8.4 8.2 8 8 7.8 6 7.6

Vineland Relationships Subscale

10 95

90

85 4 7.4 7.2 80 2 7 0 Pre-Intervention Post-Intervention Pre-Intervention Post-Intervention 6.8 Pre-Intervention Post-Intervention

75

Funding from: OSU/RSC Partnership & OSU Nisonger Center (ADD grant #90-DD-0621) and the Maternal and Child Health Bureau Grant T73MC00049