Dramatherapy intervention for adolescents with autism spectrum disorder: a mixed methods approach

Abstract

This thesis focuses on the potential benefits of dramatherapy intervention for adolescents with autism spectrum disorder (ASD). Dramatherapy is a form of psychotherapy practised by qualified and clinically trained dramatherapists and concerns the intentional use of theatre and drama as a vehicle to promote therapeutic change, adaptation or self-development.

There is a scarcity of research exploring the effectiveness of dramatherapy for children and adolescents with an ASD diagnosis, who tend to experience mild to severe challenges in social-emotional reciprocity, non-verbal communication and relationship building. This thesis comprised three studies aiming to contribute evidence to the field.

Firstly, a systematic review of published research on the effectiveness of dramatherapy for children and adolescents with ASD was conducted. Nine studies were identified and findings suggested that dramatherapy can support children and adolescents with ASD by fostering behavioural, expressive and social skills and promoting emotional well-being through the use of various art forms, techniques and frameworks. However, the limited research and the need for a formalised approach to evaluation were recognised.

Using the Delphi method, a structured process focused on achieving specialist consensus, the second study examined practitioners’ views of dramatherapy for children and young people with ASD. Qualified dramatherapists (n = 33) shared views on key aspects of dramatherapy sessions for children and young people with ASD, such as essential components as well as session structure and facilitation approaches. During a two-stage survey, the panel members reached consensus on 33 items, endorsing, among others, the flexibility of this form of psychotherapy incorporating a plethora of drama techniques and creative processes, the use of metaphor and rituals and consistent session structure. In addition, they identified the need for additional knowledge or training in ASD practice and the avoidance of generalised assumptions as well as the importance of therapeutic alliance intertwined with sessions tailored to individual needs.

Guided by the Delphi consensus views, study three, ‘Journey on Stage: Dramatherapy and Autism’, evaluated the effects of a 15-session dramatherapy group intervention on autism-related traits, psychosocial behaviour, empathy and Theory of Mind in adolescents with ASD. A sequential embedded mixed methods design was employed, integrating quantitative and qualitative approaches to provide an in-depth, contextual understanding of dramatherapy effectiveness coupled with generalisable evidence. The quantitative strand included a quasi-experimental between-subjects approach, comprising a control group design with pretest-posttest outcome measures completed by the adolescents and their parents/carers. Using analysis of variance, the results indicated significantly greater improvement in social skills and Theory of Mind abilities for the intervention participants (n = 28) compared to the control group (n = 9). Furthermore, an improving trend in almost all domains assessed was revealed.

Following the completion of the intervention, 25 semi-structured individual/pair interviews were conducted with parents/carers (23 females; 16 males) of adolescents who participated in the sessions. Thematic analysis of parental perceptions on the process and impact of the dramatherapy group intervention corroborated the enhancement of adolescents’ relational, social and empathising abilities. Unique parental views further highlighted the benefits of acceptance and bond-building within dramatherapy sessions.

Lastly, the caregivers emphasised positive changes in adolescents’ self-expression, developing autonomy as well as efforts of anger and stress management. The aforementioned changes instilled parental feelings of hope and optimism as well as promoted growth and trust in family relationships.

In conclusion, the systematic review and Delphi study provided the evidence base for the benefits of dramatherapy for children and adolescents with ASD and a guide to key aspects of dramatherapy practice that might facilitate positive change. The final study ‘Journey on Stage: Dramatherapy and Autism’, developed and evaluated a dramatherapy group intervention for adolescents with ASD, revealing positive effects on social competence and Theory of Mind abilities and importantly, perceived benefits for parents/carers. This body of research facilitates a real-life contextual understanding of dramatherapy group intervention for adolescents with ASD and provides evidence for the research community, adolescents, families and practitioners.