Building Social Skills With Interdisciplinary Process Drama in ASD

Five children with Autism Spectrum Disorder (ASD) and 3-5 typically developing (TD) children
will complete baseline testing. The TD children will only complete the EEG testing, while the
ASD children and their parents will complete all outcome assessments. In addition to the
outcome measures listed in the Brief Summary, we will administer the Vineland Adaptive
Behavioral Scales (Vineland - II), the Mullen Scales of Early Learning, and the Autism
Diagnostic Observation Scale - II (if they have not had one administered within the past 12
months) for sample description.

During the EEG session, brain activity during theory of mind and other social stimuli will be
used to measure brain behavior relationships. The recordings will adhere to standard clinical
EEG procedures, using high density EEG providing a high spatial resolution for electrical
source imaging in brain space. They will be conducted by a Registered EEG Technologist (R.
EEG T) with a specially trained student assistant. The procedure will involve first
explaining to the parent and child what will be done. The participants will sit within a
chair or a parent's lap while the EEG is recorded. The EEG tasks will consist of the
following: First the child will be asked to open and close their eyes for a few minutes to
record a baseline resting EEG. Then there will be both auditory sounds (intonations and word
components) and images of social stimuli embedded between fun cartoon stimuli to maintain the
child's attention displayed on a screen. The pictures will consist of eye movements, facial
gestures, and point light diagrams of body movements.

The process drama program will be conducted with 5 children with ASD and 3-5 TD peer models 3
days per week for 12 week for 1-1.5 hours each day. The program will consist of several
sections. Each day will open with an opening ritual that is movement based involving
mirroring activity. This is followed by a welcome/greeting activity, involving things like a
song and Name activity. The remainder of the activities build around a story for the day. The
story will be one that holds interest for young children, such as a day in the life of a tree
who gets visited by animals and people. The story unfolds with problems to solve and social
interactions to do. Participants and the drama teachers take on different roles to bring out
the story. Engagement starts out with drama pieces that the children can do individually and
progress to those requiring a partner and then small groups. The sessions close with a
closing ritual, reminding the participants of what was done during the session and a song.
All the activities focus on building understanding the emotions and intentions of others and
appropriate social interactions. The setting of the program and the specific activities have
been planned with a collaborative team of drama teachers, an occupational therapists, and a
speech language pathologists.

The process drama sessions will be taped and later scored for social interactions and social
verbal and non-verbal communication. We will also examine the engagement of the participants
with ASD to determine if we need to change/alter any procedures/techniques that we are using
during the process drama sessions in subsequent versions of this research. We will also
examine the behavior of the peer models to identify areas in which the research team may need
to change to better engage the peer models in subsequent sessions.

After the end of the process drama intervention, the participants with ASD will repeat the
baseline assessments within 4 weeks of intervention end. The assessments that will be
repeated are the ToMT, SPA and SSiS. The children with ASD will also complete another EEG
session as they did at baseline. Parents will be interviewed at 3 months post-intervention
regarding changes in social skills.

Inclusion Criteria: for children with ASD:

- aged 3-4 years old

- documented diagnosis of ASD from a licensed professional using DSM 5 criteria12; If no
documentation available, meets cut off on Autism Diagnostic Observation Scale (ADOS
-2)13 that will be administered by trained study staff.

- passes language and cognitive screen (see attached screening document with decision
rules) and a receptive language age equivalence of ≥30 months and a non-verbal age
equivalent score of ≥30 months on the Mullen Scale of Early Learning

- have a caregiver willing/able to bring them to the University for the study sessions
and to schedule up to 3 assessment visits prior to intervention start and 3 assessment
sessions after intervention end

- family's primary language is English

INCLUSION for TD children:

- aged 3-4

- normal or corrected to normal vision and hearing

- English speaking

Exclusion Criteria: for children with ASD:

- have no other major medical conditions (i.e., no genetic disorders such as Fragile X,
Down syndrome)

- seizure disorder

- uncorrected hearing or visual impairment

- other condition causing motor impairment, such as Cerebral Palsy

Exclusion for TD children:

- history of developmental delay or neurological disorder