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Autistic spectrum disorder (ASD) is “characterized by impairment in social competence as well as restricted interests and behaviors.”1 These deficits, which many consider to be lifelong and resistant to treatment, manifest across multiple domains.2 Traditional treatments involve psychotropic drugs and specialized education.
However, other less traditional interventions may be helpful. One such intervention is the involvement of autistic youth in theater, both as performers and as audience. An article3 that appeared in the December 2016 issue of the AMA Journal of Ethics explored the role that theater might play in the lives of children with ASD.
To gain further insight into this novel intervention, Psychiatry Advisor interviewed Blythe Corbett, PhD, author of the article. Dr Blythe is an Associate Professor in the Department of Psychiatry and Behavioral Sciences and in the Department of Psychology, Director of the SENSE Lab, and an investigator in the Vanderbilt Kennedy Center in Nashville, Tennessee.
Psychiatry Advisor: What is the role of theater in the life of a child with ASD?
Dr Corbett: The role of theater is two-fold. One aspect is expressive. All forms of art have the potential to nurture talent, reduce stigma, and enable others to witness the abilities of a person with a disability. Art enables those with mental illness to build community and form a new identity. In the case of theater, performance can provide both entertainment and education about many vital aspects of human experience, stimulate the imagination, and provide opportunities to observe social communication in a live setting. Whether the person with ASD is on the stage or in the audience, theater can provide a unique setting in which to reduce rigidity of thinking and learn communication and other social skills.
PA: What is your approach to using theater as an intervention for children with ASD?
Dr Corbett: Our group utilizes an empirically validated approach called Social Emotional NeuroScience Endocrinology (SENSE) theater. We train non-autistic children and adolescents to actually be the interventionists. Some of them are young actors, who become role models for the children with ASD, showing them how to interact socially with others, how to initiate conversations, or how to understand humor. We use a variety of techniques, including role-playing, improvisation, theater games, video modeling, and character development.
PA: Has your group conducted any studies of SENSE theater in children with ASD?
Dr Corbett: Our group has performed studies that found SENSE to be effective in improving social skills and reducing anxiety in youth with ASD. For example, we studied 30 youth with ASD (aged 8 to 14 years) and found that SENSE improved social competence and reduced trait anxiety typically associated with social interaction with peers.2
PA: What interested you in this type of research?
Dr Corbett: My background is as a professional writer and actress, so I have an appreciation of the impact of theater in how we perceive and respond to the world. Since I also work with autistic children who are challenged in social communication, I thought this might be an ideal population in which to see whether theater can have an impact on enhancing these skills. I also have been involved with research in social play and stress. From this I realized that the social communication of children with ASD can be enhanced by engaging with a peer. This led to the idea of a peer-mediated intervention.
PA: What obstacles do youth with ASD have that might prevent them from enjoying the benefits of participating as an audience member at the theater?
Dr Corbett: There are actually several obstacles that autistic individuals face in the theater and in other cultural and recreational activities. Hyper- and hyposensitivity to an array of visual auditory and tactical stimuli can lead to difficulties with crowds, flickering lights, darkness, and loud noise. An even more significant obstacle is stigma. Although autism has become more familiar to the public through books, the media, and news, and there are fewer negative stereotypes than there used to be, stigma remains a major problem. Most parents of children with ASD report that individuals with autism are stigmatized. In autism, as in other mental illnesses, ignorance, prejudice, and discrimination continue to be apparent.
PA: What role might psychiatrists play in addressing the needs of youth with ASD?
Dr Corbett: In treating children with ASD, it is important for psychiatrists to think beyond the clinical setting and the more classical models of pharmacologic interventions and traditional therapies. A treatment plan should encompass other players within the community, including family, school, and community at large, and should retain a broad focus on the full functioning of the individual.
For example, psychiatrists can communicate with the school, perhaps facilitated by a social worker, and identify whether there is a “buddy program” in which the child with autism can be paired with a “helper” in the school. Classes in school can teach musical expression, public speaking or theater that can augment the more typical “social skills interventions” already in place, allowing the child with autism to engage with the community in an intentional way. This is part of the child’s treatment plan, but it utilizes naturally occurring resources within the community.
Psychiatrists can also play an important role in education and advocacy. I emphasize the importance of access to events such as theater performances. Participating in these events, feeling part of a community and society, is an important part of what enriches our lives as human beings and what makes them satisfying. I feel it is the responsibility of those of us in the mental health profession to help individuals with mental illness to gain greater access. This involves advocacy as well as education of the public to dispel myths and stereotypes.
PA: Are there other theater-based programs that use theatrical techniques as a form of treatment for children with ASD?
Dr Corbett: The Autism Theater Initiative and the Theater Development Fund have created “autism-friendly” performances with accommodations such as brighter lighting, reduced sound, and preparatory story guides. These make the experience less intense and stressful, and allow children with autism unprecedented access to theater.
References
1. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: APA, 2013.
2. Corbett BA, Blain SD, Ioannou S, Balser M. Changes in anxiety following randomized control trial of a theatre-based intervention for youth with autism spectrum disorder. Autism. 2016 May 5; doi:10.1177/1362361316643623. [Epub ahead of print]
3. Corbett BA. Autism, art, and accessibility to theater. AMA J Ethics. 2016;18(12):1232-1240.
4. Corbett BA, Key AP, Qualls L, Fecteau S, et al. Improvement in social competence using a randomized trial of a theatre intervention for children with autism spectrum disorder. J Autism Dev Disord. 2016;46(2):658-672.
