Peers, Play, and Performance to Build Social Salience in Autistic Youth: A Multisite Randomized Clinical Trial

Objective: Individuals with autism spectrum disorder (ASD) have significant impairment in social competence and reduced social salience. SENSE Theatre, a peer-mediated, theater-based intervention has demonstrated posttreatment gains in face memory and social communication. The multisite randomized clinical trial compared the Experimental (EXP; SENSE Theatre) to an Active Control Condition (ACC; Tackling Teenage Training, TTT) at pretest, posttest, and follow-up. It was hypothesized that the EXP group would demonstrate greater incidental face memory (IFM) and better social behavior (interaction with novel peers) and social functioning (social engagement in daily life) than the ACC group, and posttest IFM would mediate the treatment effect on follow-up social behavior and functioning. Method: Two hundred ninety participants were randomized to EXP (N = 144) or ACC (N = 146). Per protocol sample (≥7/10 sessions) resulted in 207 autistic children 10–16 years. Event-related potentials measured IFM. Naive examiners measured social behavior (Vocal Expressiveness, Quality of Rapport, Social Anxiety) and functioning (Social Communication). Structural equation modeling was used to assess treatment effects. Results: SENSE Theatre participants showed significantly better IFM (b = .874, p = .039) at posttest, and significant indirect effects on follow-up Vocal Expressiveness a × b = .064, with 90% CI [.014, .118] and Quality of Rapport a × b = .032, with 90% CI [.002, .087] through posttest IFM. Conclusions: SENSE Theatre increases social salience as reflected by IFM, which in turn affected Vocal Expressiveness and Quality of Rapport. Results indicate that a neural mechanism supporting social cognition and driven by social salience is engaged by the treatment and has a generalized, indirect effect on clinically meaningful functional outcomes related to core symptoms of autism. What is the public health significance of this article? Few treatments exist to target social competence in autism. The present study provides compelling evidence for a peer-mediated, theater-based treatment to enhance salience of social stimuli that over time increases spontaneous social behavior.

Description

This article was originally published in Journal of Consulting and Clinical Psychology. The version of record is available at: https://doi.org/10.1037/ccp0000821. © 2023 American Psychological Association 2023

Keywords

autism, social competence, event-related potentials, social salience

Citation

Corbett, B. A., White, S., Lerner, M., Preacher, K. J., Klemencic, M. E., Simmons, G. L., Pilkington, J., Gable, P., Gioia, A., & Key, A. P. (2023). Peers, play, and performance to build social salience in autistic youth: A multisite randomized clinical trial.Journal of Consulting and Clinical Psychology, 91(7), 411–425. https://doi.org/10.1037/ccp0000821

URI

https://udspace.udel.edu/handle/19716/33019

Collections

Open Access Publications

Full item page