Adaptive Changes in Anxiety and Arousal Following a Randomized Control Trial of a Theatre-Based Intervention for Youth with Autism Spectrum Disorder

Background: Increased anxiety and stress are frequently found in children with autism spectrum disorder (ASD) and often associated with social challenges. Following a randomized control trial of a peer-mediated, theatre-based intervention, significant treatment effects were shown across several areas of social competence including increased group play with novel peers. 

Objectives: Elevated anxiety and physiological arousal are often associated with peer interaction in youth with ASD. Peer-mediation has been shown to facilitate positive social effects.  Furthermore, participation in theatre games and social play in the treatment setting may generalize to other settings, leading to higher quality, less distressing interactions during social play. Thus, the purpose of the current study was to examine the impact of the intervention on reducing anxiety and stress. 

Methods: Participants included 30 high-functioning (IQ >70) youth with ASD (8-to-14-years of age) randomly assigned to the Experimental (EXP, N = 17) or Wait-list control (WLC, N = 13) group.  Participants were exposed to the Peer Interaction Paradigm (PIP) before and after the treatment to assess duration of play with novel peers, self-reported anxiety, and cortisol levels. A series of Analysis of Covariance (ANCOVA) models were used to test the between-group differences for the anxiety and stress variables.  Specifically, the variables included the STAIC anxiety scale (Trait and State), as well as baseline and social stress cortisol collected during group play with peers. Pearson product moment correlations were conducted between anxiety, cortisol, and Group Play.  

Results: Significant pre-test-adjusted between-group differences at posttest were observed on Trait-anxiety (F (1, 27)=9.16, p=0.005) showing lower Trait-anxiety in the experimental group. However, no group differences were observed for State-anxiety (F (1, 27)=0.03, p=0.86). Additionally, there were no between group differences on the diurnal or stress based cortisol values.  There was a significant negative correlation between Group Play and Trait-anxiety   (r=-.362, p=0.05) showing a self reported reduction in anxiety following the intervention for the EXP group. Playground cortisol was positively correlated with Group Play, for the experimental group (r=0.55, p=0.03) showing higher arousal for more engagement with peers.   

Conclusions: The theatre-based, peer-mediated intervention not only results in improvement in social competence in youth with ASD, but also contributes to reductions in trait-anxiety associated with more social interaction with peers.  In SENSE Theatre, peers serve as models for reciprocal social exchange. It is feasible that social engagement during the intervention may facilitate positive appraisals of peer interaction thereby reducing perceived anxiety during subsequent social exchange. Positive correlations between cortisol and Group Play in the EXP group suggest that increased physiological arousal may facilitate social engagement with peers.  Optimal performance on demanding tasks requires greater arousal and for children with ASD, engaging with peers may be conceived of as challenging. Therefore, some degree of physiological arousal is essential for social interaction and may be adaptive for individuals with ASD.