Cognitive Behaviour Drama: A Novel Intervention Model Designed to Address Fears In Children with Asperger Syndrome

Background:  

Childhood fears that persist over time and interfere with the children’s normal functioning may have detrimental effects on their social and emotional development (Strauss, Frame & Forehand,1987). It has been well documented in the literature that children with autism suffer from intense fears more than their typically developing peers (Matson & Love, 1990).  Yet, research on the treatment of fears in this population is scarce. 

Objectives:  

The purpose this study was to implement and evaluate a new intervention model specifically designed to address the issue of phobias in high functioning children with autism. Taking into consideration that most children with phobias have no desire to overcome their fears, and that oppositional behaviour is the greatest obstacle encountered in therapy; providing the participants with the motivation to wish to confront their fears was the prime objective of the proposed methodology.  

Methods:  

The method involved leading the participants through a series of belief building tasks to invest in the fictional context, so that when the fictional problem was introduced they would feel compelled to solve it. Once motivation was established, the feared stimuli were introduced symbolically as one more challenge amongst many others that the participants had to surmount to get to their fictional objectives. The study examined the application of the model in three single cases. Two high functioning children with autism participated in the study: an 11-year old boy who had a fear of hand-driers, and a fear of being touched; and a 7-year-old boy with a fear of hair-dressers. The sessions were one hour long and ran on a weekly basis until the treatment objectives were achieved. Measures included in session observation of the participants’ behaviour and parental reports of their behaviour prior to, during and following the interventions.  

Results:  

Treatment objectives were met within five to nine weeks. Results from all three interventions suggested that the model was successful in producing the complete elimination of fear related behaviour,  generalisation of the adaptive behaviour outside the therapeutic setting  and maintenance of the behaviour in a 3 year follow up period.

Conclusions:  

Despite the methodological limitations of this study such as lack of control groups and small size of sample, there are two aspects of the results that justify further evaluation of this method in dealing with childhood fears. First, lifelong fears that had shown no indication of spontaneous remission receded in the course of a short term intervention. Second the changes observed in the participants behaviour mapped onto the changing demands placed on them through-out the programme, indicating a causal relationship between the children’s increased tolerance towards the fear stimuli and the set tasks. Importantly, the validity of the model primarily lies in: its potential to reach younger children who may not benefit from traditional CBT, the inherently enjoyable and unobtrusive nature of the dramatic activities, the time efficiency and durability of outcomes.