Publication Title

American Occupational Therapy Association Annual Conference and Expo



  • To test the feasibility and effect of an interdisciplinary process drama program targeting social skill development in 3-5 year-old children with Autism Spectrum Disorder (ASD) characteristics
  • To develop a paradigm for testing brain-behavior relationships related to social skills in these children using EEG and testing its ability to detect intervention-related changes.

Background: Social skill deficits are a hallmark cause of disability in ASD. Such disability is of critical concern given the rising prevalence (1 in 54 Utah children) of ASD. [1] As children learn through social experiences, difficulty in social interactions can limit development and ability to succeed in school and eventually employment. One possible contributor to social interaction difficulties in ASD is a deficit in theory of mind (ToM), the ability to understand others' perspectives, proposed to rely on memories of cognitive and emotional events that allow one to experience others' situations as if they were one's own. [2.3] Children with ASD have deficits in ToM [2,3] and show aberrant neural activation patterns in areas most typically activated during ToM tasks in healthy children. [4,5] An effective intervention fostering generalizable social skill development in children with ASD remains elusive. We propose to address this need with an interdisciplinary process drama intervention involving collaboration among occupational therapists (OT), theatre faculty/teachers, and speech language pathologists (SLP) to improve social interactions in preschoolers with ASD. Process drama may be an excellent medium for fostering social skill development due to the ability to create specific learning experiences in an autotelic manner [6] in which people experience the embodied cognition and emotions without conscious commitment to abstract social skill improvement goals. The scenes can emphasize social and emotional cues and explicit identification of scene-related feelings for the formation of social cognitive and emotional memories that can be recalled as the basis for later social functioning.[3] Process drama programs foster communication development in typically developing children [7] and a few studies have shown such programs enhance social skills of children aged 8-17 with ASD [8,9] However, targeting process drama intervention in preschool children may have the greatest potential for effect on ToM and subsequent social skill development. The overpruning hypothesis [10] proposes that ASD results from abnormal neural pruning in widespread neural networks, with weaker long-range connections being more vulnerable to major disruption. As neural connections strengthen through experience,[11] providing interventions targeting desired processing will strengthen associated connections making them less susceptible to pruning and resulting in preserved function. Peak synaptic density for auditory and prefrontal cortices, both involved in social skills, occurs between age 3-5 years [11], suggesting an optimal period for strengthening connections through intervention.

Impact: The deficits in social skills of people with ASD significantly affect their ability to function in society. These deficits take a large toll on families and on independence and employability of the individual. Finding effective interventions to facilitate social skills would have a large impact on society by reducing disability in this prevalent population.

Results: The primary goal of the proposed study is to gather preliminary data on potential utility of an interdisciplinary process drama intervention to improve social skills in children with ASD. We will address the following specific aims:

1) determine the feasibility of:

a) the protocol for collecting neural activation data via EEG on preschoolers with ASD characteristics;

b) conducting a 3 month, 3x/week process drama intervention program led by a collaborative team of theatre teachers, OTs and SLPs aimed at improving social skills.

2) Determine preliminary effects of this interdisciplinary intervention on:

a) increasing positive social behaviors;

b) changes in neural activation during social tasks.


Poster accepted for presentation at the American Occupational Therapy Association Annual Conference and Expo in Boston, MA, on March 26-29, 2020.