Download PDF
Semin Speech Lang 2022; 43(04): 255-276
DOI: 10.1055/s-0042-1750763
Review Article

Performance- and Theater-Based Interventions for Supporting Social Cognition and Social Communication in Autistic Youth: A Review and Theoretical Synthesis

Rachel G. McDonald   *
1   Psychology Department, Montclair State University, Montclair, New Jersey
,
Sadaf Khawar   *
1   Psychology Department, Montclair State University, Montclair, New Jersey
,
Nardin Yacoub
1   Psychology Department, Montclair State University, Montclair, New Jersey
,
Mary Isaac Cargill
1   Psychology Department, Montclair State University, Montclair, New Jersey
,
Matthew D. Lerner
2   Department of Psychology, Stony Brook University, Stony Brook, New York
,
Erin Kang
1   Psychology Department, Montclair State University, Montclair, New Jersey
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Social skills interventions (SSIs) are commonly used to improve social functioning in youth with autism spectrum disorder (ASD), which is a condition characterized by differences in social cognition and social communication. Although more traditional SSIs have used knowledge-based, didactic instruction, recent research has explored the utility of performance-based SSIs, which use various activities to support implicit learning of social skills in supportive, enriched environments. This article reviews the extant literature evaluating the effectiveness or efficacy of five performance-based SSIs using theater-based approaches on social cognition and social communication. Overall, this body of literature suggests social communication gains that include increased peer interactions, peer liking, and reciprocal friendships, as well as social cognitive gains in theory of mind and affect recognition. This review also discusses theoretical models that may help explain the emerging strengths of performance- and theater-based SSIs with underlying hypotheses related to the social communication and social cognitive differences in ASD. Limitations of performance-based SSIs in the evidence-base include several approaches in initial stages of research with small sample sizes and limited maintenance of effects. Future research should aim to bridge the research-to-practice gap and use more rigorous designs and more diverse samples, including those with cooccurring intellectual disability.

Keywords

social skills interventions - social communication - social cognition - autism spectrum disorder - performance-and theater-based social skills interventions

* Rachel G. McDonald and Sadaf Khawar have made comparable contributions to the preparation of this article and are designated as co–first authors.




Publication History

Article published online:
27 July 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, VA: 2013
    CrossrefGoogle Scholar
  • 2 Maenner MJ, Shaw KA, Bakian AV. et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Morb Mortal Wkly Rep 2021; 70 (11) 1-16
    PubMedGoogle Scholar
  • 3 Kang E, Gadow KD, Lerner MD. Atypical communication characteristics, differential diagnosis, and the autism spectrum disorder phenotype in youth. J Clin Child Adolesc Psychol 2020; 49 (02) 251-263
    CrossrefPubMedGoogle Scholar
  • 4 Rapin I, Dunn M. Update on the language disorders of individuals on the autistic spectrum. Brain Dev 2003; 25 (03) 166-172
    CrossrefPubMedGoogle Scholar
  • 5 Hale CM, Tager-Flusberg H. Social communication in children with autism: the relationship between theory of mind and discourse development. Autism 2005; 9 (02) 157-178
    CrossrefPubMedGoogle Scholar
  • 6 Morrison KE, DeBrabander KM, Jones DR, Ackerman RA, Sasson NJ. Social cognition, social skill, and social motivation minimally predict social interaction outcomes for autistic and non-autistic adults. Front Psychol 2020; 11: 591100
    CrossrefPubMedGoogle Scholar
  • 7 Lerner MD, Mikami AY. A preliminary randomized controlled trial of two social skills interventions for youth with high-functioning autism spectrum disorders. Focus Autism Other Dev Disabl 2012; 27 (03) 147-157
    CrossrefPubMedGoogle Scholar
  • 8 Brothers L. The social brain: a project for integrating primate behaviour and neurophysiology in a new domain. Concepts Neurosci 1990; 1: 27-51
    PubMedGoogle Scholar
  • 9 Lerner MD. Knowledge or Performance - Why Youth with Autism Experience Social Problems. University of Virginia; 2013
    CrossrefGoogle Scholar
  • 10 Solomon M, Goodlin-Jones BL, Anders TF. A social adjustment enhancement intervention for high functioning autism, Asperger's syndrome, and pervasive developmental disorder NOS. J Autism Dev Disord 2004; 34 (06) 649-668
    CrossrefPubMedGoogle Scholar
  • 11 Baron-Cohen S, Golan O, Chakrabarti B, Belmonte MK. Social cognition and autism spectrum conditions. In: Social Cognition and Developmental Psychopathology. Oxford University Press; 2008: 29-56
    Google Scholar
  • 12 Tine M, Lucariello J. Unique theory of mind differentiation in children with autism and Asperger syndrome. Autism Res Treat 2012; 2012: 505393
    PubMedGoogle Scholar
  • 13 Hutchins TL, Prelock PA. Supporting theory of mind development considerations and recommendations for professionals providing services to individuals with autism spectrum disorder. Top Lang Disord 2008; 28 (04) 340-364
    CrossrefPubMedGoogle Scholar
  • 14 Kimhi Y. Theory of mind abilities and deficits in autism spectrum disorders. Top Lang Disord 2014; 34 (04) 329-343
    CrossrefPubMedGoogle Scholar
  • 15 Bauminger N. Brief report: group social-multimodal intervention for HFASD. J Autism Dev Disord 2007; 37 (08) 1605-1615
    CrossrefPubMedGoogle Scholar
  • 16 Lerner MD, White SW, McPartland JC. Mechanisms of change in psychosocial interventions for autism spectrum disorders. Dialogues Clin Neurosci 2012; 14 (03) 307-318
    CrossrefPubMedGoogle Scholar
  • 17 Hwang S, Kim YS, Koh YJ, Leventhal BL. Autism spectrum disorder and school bullying: Who is the victim? Who is the perpetrator?. J Autism Dev Disord 2018; 48 (01) 225-238
    CrossrefPubMedGoogle Scholar
  • 18 Gates JA, Kang E, Lerner MD. Efficacy of group social skills interventions for youth with autism spectrum disorder: a systematic review and meta-analysis. Clin Psychol Rev 2017; 52: 164-181
    CrossrefPubMedGoogle Scholar
  • 19 Reichow B, Barton EE. Evidence-based psychosocial interventions for individuals with autism spectrum disorders. In: Handbook of Autism and Pervasive Developmental Disorders. 4th ed.. John Wiley & Sons, Inc.; 2014
    Google Scholar
  • 20 McMahon CM, Lerner MD, Britton N. Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future. Adolesc Health Med Ther 2013; 2013 (04) 23-28
    PubMedGoogle Scholar
  • 21 Bishop-Fitzpatrick L, Mazefsky CA, Minshew NJ, Eack SM. The relationship between stress and social functioning in adults with autism spectrum disorder and without intellectual disability. Autism Res 2015; 8 (02) 164-173
    CrossrefPubMedGoogle Scholar
  • 22 White SW, Ollendick T, Albano AM. et al. Randomized controlled trial: multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. J Autism Dev Disord 2013; 43 (02) 382-394
    CrossrefPubMedGoogle Scholar
  • 23 Hotton M, Coles S. The effectiveness of social skills training groups for individuals with autism spectrum disorder. Rev J Autism Dev Disord 2016; 3 (01) 68-81
    CrossrefPubMedGoogle Scholar
  • 24 Koenig K, De Los Reyes A, Cicchetti D, Scahill L, Klin A. Group intervention to promote social skills in school-age children with pervasive developmental disorders: reconsidering efficacy. J Autism Dev Disord 2009; 39 (08) 1163-1172
    CrossrefPubMedGoogle Scholar
  • 25 Laugeson EA, Frankel F. Test of adolescent social skills knowledge. Available from UCLA Parenting and Children's Friendship Program. 2006: 300
    PubMedGoogle Scholar
  • 26 Marro BM, Kang E, Hauschild KM, Normansell KM, Tamara Abu-Ramadan BM, Matthew Lerner BD. Social performance-based interventions promote gains in social knowledge in the absence of explicit training for youth with autism spectrum disorder. Bull Menninger Clin 2019; 83 (03) 301-325
    CrossrefPubMedGoogle Scholar
  • 27 Guli LA, Semrud-Clikeman M, Lerner MD, Britton N. Social Competence Intervention Program (SCIP): a pilot study of a creative drama program for youth with social difficulties. Arts Psychother 2013; 40 (01) 37-44
    CrossrefPubMedGoogle Scholar
  • 28 Corbett BA, Key AP, Qualls L. 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 (02) 658-672
    CrossrefPubMedGoogle Scholar
  • 29 Corbett BA, Ioannou S, Key AP. et al. Treatment effects in social cognition and behavior following a theater-based intervention for youth with autism. Dev Neuropsychol 2019; 44 (07) 481-494
    CrossrefPubMedGoogle Scholar
  • 30 Beadle-Brown J, Wilkinson D, Richardson L. et al. Imagining Autism: feasibility of a drama-based intervention on the social, communicative and imaginative behaviour of children with autism. Autism 2018; 22 (08) 915-927
    CrossrefPubMedGoogle Scholar
  • 31 Lerner MD, Girard R, Culp M, Cruwys S, Levine K. Spotlight Program Manual. Danvers, MA: North Shore Arc; 2007
    Google Scholar
  • 32 Lerner MD, Levine K. The Spotlight Program: An Integrative Approach to Teaching Social Pragmatics Using Dramatic Principles and Techniques. Research Gate; 2006
    Google Scholar
  • 33 Corbett BA, Gunther JR, Comins D. et al. Brief report: theatre as therapy for children with autism spectrum disorder. J Autism Dev Disord 2011; 41 (04) 505-511
    CrossrefPubMedGoogle Scholar
  • 34 Lord C, Gotham K, Guthrie W. Autism Diagnostic Observation Schedule. 2nd ed.. Western Psychological Services; 2012
    Google Scholar
  • 35 Lord C, Risi S, DiLavore PS, Shulman C, Thurm A, Pickles A. Autism from 2 to 9 years of age. Arch Gen Psychiatry 2006; 63 (06) 694-701
    CrossrefPubMedGoogle Scholar
  • 36 Gooding LF. The effect of a music therapy social skills training program on improving social competence in children and adolescents with social skills deficits. J Music Ther 2011; 48 (04) 440-462
    CrossrefPubMedGoogle Scholar
  • 37 Lerner MD, Mikami AY, Levine K. Socio-dramatic affective-relational intervention for adolescents with Asperger syndrome & high functioning autism: pilot study. Autism 2011; 15 (01) 21-42
    CrossrefPubMedGoogle Scholar
  • 38 Corbett BA, Blain SD, Ioannou S, Balser M. Changes in anxiety following a randomized control trial of a theatre-based intervention for youth with autism spectrum disorder. Autism 2017; 21 (03) 333-343
    CrossrefPubMedGoogle Scholar
  • 39 Corbett BA, Swain DM, Coke C. et al. Improvement in social deficits in autism spectrum disorders using a theatre-based, peer-mediated intervention. Autism Res 2014; 7 (01) 4-16
    CrossrefPubMedGoogle Scholar
  • 40 Ioannou S, Key AP, Muscatello RA, Klemencic M, Corbett BA. Peer actors and theater techniques play pivotal roles in improving social play and anxiety for children with autism. Front Psychol 2020; 11: 908
    CrossrefPubMedGoogle Scholar
  • 41 McGinnis E, Goldstein AP. Skill-Streaming in Early Childhood: Teaching Prosocial Skills to the Preschool and Kindergarten Child. Research Pr Pub; 1990
    Google Scholar
  • 42 Coie JD, Dodge KA, Coppotelli H. Dimensions and types of social status: a cross-age perspective. Dev Psychol 1982; 18 (04) 557-570
    CrossrefPubMedGoogle Scholar
  • 43 Lord C, Gotham K, Luyster R, Guthrie W. Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Manual (Part II): Toddler Module. Western Psychological Services; 2012
    Google Scholar
  • 44 Hunter K. Shakespeare's Heartbeat: Drama Games for Children with Autism. Shakespeare's Heartbeat; 2014
    CrossrefGoogle Scholar
  • 45 Mehling MH, Tassé MJ, Root R. Shakespeare and autism: an exploratory evaluation of the Hunter Heartbeat Method. Res Pract Intellect Dev Disabil 2017; 4 (02) 107-120
    PubMedGoogle Scholar
  • 46 Westby C, Robinson L. A developmental perspective for promoting theory of mind. Top Lang Disord 2014; 34 (04) 362-382
    CrossrefPubMedGoogle Scholar
  • 47 Bitel MC. Social Competence Intervention Program: A Drama-Based Intervention for Youth on the Autism Spectrum by Guli, LA, Wilkinson, AD, & Semrud-Clikeman, M. Champaign, IL: Research Press; 2008: 200 [Published online 2009]
    Google Scholar
  • 48 Ke F, Moon J. Virtual collaborative gaming as social skills training for high-functioning autistic children. Br J Educ Technol 2018; 49 (04) 728-741
    CrossrefPubMedGoogle Scholar
  • 49 Zhang L, Warren Z, Swanson A, Weitlauf A, Sarkar N. Understanding performance and verbal-communication of children with ASD in a collaborative virtual environment. J Autism Dev Disord 2018; 48 (08) 2779-2789
    CrossrefPubMedGoogle Scholar
  • 50 Serret S, Hun S, Iakimova G. et al. Facing the challenge of teaching emotions to individuals with low- and high-functioning autism using a new serious game: a pilot study. Mol Autism 2014; 5 (01) 37
    CrossrefPubMedGoogle Scholar
  • 51 Zapata-Fonseca L, Froese T, Schilbach L, Vogeley K, Timmermans B. Sensitivity to social contingency in adults with high-functioning autism during computer-mediated embodied interaction. Behav Sci (Basel) 2018; 8 (02) E22
    CrossrefPubMedGoogle Scholar
  • 52 Vincent LB, Openden D, Gentry JA, Long LA, Matthews NL. Promoting social learning at recess for children with ASD and related social challenges. Behav Anal Pract 2017; 11 (01) 19-33
    CrossrefPubMedGoogle Scholar
  • 53 Wang JG, Cai KL, Liu ZM. et al. Effects of mini-basketball training program on executive functions and core symptoms among preschool children with autism spectrum disorders. Brain Sci 2020; 10 (05) E263
    CrossrefPubMedGoogle Scholar
  • 54 Fu L, Weng J, Feng M. et al. Predictors of change in play-based communication and behavior intervention for high-risk ASD: the role of mother-child dyadic synchrony. Front Pediatr 2020; 8: 581893
    CrossrefPubMedGoogle Scholar
  • 55 Aithal S, Karkou V, Makris S, Karaminis T, Powell J. A dance movement psychotherapy intervention for the wellbeing of children with an autism spectrum disorder: a pilot intervention study. Front Psychol 2021; 12: 588418
    CrossrefPubMedGoogle Scholar
  • 56 Dissanayake C, Macintosh K. Mind reading and social functioning in children with autistic disorder and Asperger's disorder. In: Repacholi B, Slaughter B. eds. Individual Differences in Theory of Mind: Implications for Typical and Atypical Development. 2003: 213-239
    Google Scholar
  • 57 Gresham FM. Social competence and students with behavior disorders: where we've been, where we are, and where we should go. Educ Treat Child 1997; •••: 233-249
    PubMedGoogle Scholar
  • 58 Jeste SS, Nelson III CA. Event related potentials in the understanding of autism spectrum disorders: an analytical review. J Autism Dev Disord 2009; 39 (03) 495-510
    CrossrefPubMedGoogle Scholar
  • 59 Chevallier C, Kohls G, Troiani V, Brodkin ES, Schultz RT. The social motivation theory of autism. Trends Cogn Sci 2012; 16 (04) 231-239
    CrossrefPubMedGoogle Scholar
  • 60 Jaswal VK, Akhtar N. Being versus appearing socially uninterested: challenging assumptions about social motivation in autism. Behav Brain Sci 2018; 42: e82
    CrossrefPubMedGoogle Scholar
  • 61 Klin A, Jones W, Schultz R, Volkmar F. The enactive mind, or from actions to cognition: lessons from autism. Philos Trans R Soc Lond B Biol Sci 2003; 358 (1430): 345-360
    CrossrefPubMedGoogle Scholar
  • 62 Beauchamp MH, Anderson V. SOCIAL: an integrative framework for the development of social skills. Psychol Bull 2010; 136 (01) 39-64
    CrossrefPubMedGoogle Scholar
  • 63 Bennett TA, Szatmari P, Bryson S. et al. Theory of mind, language and adaptive functioning in ASD: a neuroconstructivist perspective. J Can Acad Child Adolesc Psychiatry 2013; 22 (01) 13-19
    PubMedGoogle Scholar
  • 64 Karmiloff-Smith A. Development itself is the key to understanding developmental disorders. Trends Cogn Sci 1998; 2 (10) 389-398
    CrossrefPubMedGoogle Scholar
  • 65 Sari NP, Luijk MPCM, Prinzie P, van IJzendoorn MH, Jansen PW. Children's autistic traits and peer relationships: do non-verbal IQ and externalizing problems play a role?. Child Adolesc Psychiatry Ment Health 2021; 15 (01) 67
    CrossrefPubMedGoogle Scholar
  • 66 Hillier A, Fish T, Cloppert P, Beversdorf DQ. Outcomes of a social and vocational skills support group for adolescents and young adults on the autism spectrum. Focus Autism Other Dev Disabl 2007; 22 (02) 107-115
    CrossrefPubMedGoogle Scholar
  • 67 Bauminger N. Brief report: individual social-multi-modal intervention for HFASD. J Autism Dev Disord 2007; 37 (08) 1593-1604
    CrossrefPubMedGoogle Scholar
  • 68 Happé FGE. The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Dev 1995; 66 (03) 843-855
    CrossrefPubMedGoogle Scholar
  • 69 Hoogenhout M, Malcolm-Smith S. Theory of mind predicts severity level in autism. Autism 2017; 21 (02) 242-252
    CrossrefPubMedGoogle Scholar
  • 70 Kang E, Gioia A, Pugliese CE. et al. Alliance-outcome associations in a community-based social skills intervention for youth with autism spectrum disorder. Behav Ther 2021; 52 (02) 324-337
    CrossrefPubMedGoogle Scholar
  • 71 Kang E, Clarkson T, Keifer CM, Rosen TE, Lerner MD. Discrete electrocortical predictors of anxiety and anxiety-related treatment response in youth with autism spectrum disorder. Biol Psychol 2019; 146: 107710
    CrossrefPubMedGoogle Scholar
  • 72 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988: 18-74
    Google Scholar