ASAT Responds to The Indian Express’, “Enacting Shakespeare’s play helps autistic kids in developing communication skills”

December 15, 2016

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Dear The Indian Express,

We at the Association for Science in Autism Treatment (ASAT) are writing in response to your article highlighting some recent research – using Shakespeare’s plays (via the Hunter Heartbeat Method) to develop communication in children with autism.  This is an interesting story and we agree that the plays provide an environment for children with autism spectrum disorder (ASD) to interact with others.  Given the relaxed settings in which they are conducted, these plays may also serve as a much-needed recreation for children with ASD.

We are happy to read about the positive impact that the plays had for its fourteen participants.  Being able to learn new skills in an enjoyable environment is the ultimate aim of any program designed for children with ASD.  However, calling the Hunter Heartbeat Method a “novel therapeutic approach” is ill-advised as this is not corroborated by sufficient peer-reviewed research, nor are any limitations to the research mentioned in your article.  Several assumptions have resulted in the word “therapy” being overused erroneously.  We would like to mention that there are three criteria for an activity to be considered a “therapy” – it must treat autism in measurable ways, be provided by therapists who meet specific educational/training criteria, and be grounded in research.

You mention that the study focused on “emotion recognition, eye contact, gross motor imitation and turn-taking.”  We applaud you for reporting on specific objective skills and therefore, a reliable means to measure behaviour change.  But at the same time, you share the views of Dr. Marc Tasse and he is quoted as saying, “At the end of the study, the participants showed significant improvements in social skills and increased ability to engage in peer relationships.”  Such claims are vague, and it may serve to waylay families who are in desperate need of a solution to improve specific skills in their children with social deficits. It is harmful to the dissemination of evidence-based practices thus causing families to delay effective treatment for autism.  Moreover, the specific research you refer to (Mehling, Tasse & Root, 2016) appropriately describes limitations to the study including lack of a control group, possibility that the results were due to maturation rather than the intervention, limited information on participants’ history or experience with other social skills interventions, and subjective parent report to measure improvement in social functioning.  Making mention of or referring to these limitations in your article would help families make more informed decisions.

We commend you on providing a clear description of how the treatment is supposed to work.  You mention that the approach involves facilitators modeling the game and then providing the participants with feedback after their opportunity to engage in the skill.  This is an evidence-based approach called Behavioural Skills Training that consists of instructions, modeling, rehearsal and feedback (Miltenberger, 2004).  It has been used extensively in teaching a variety of behaviours including social skills and safety skills in children and also in parent and teacher training programs (e.g., Johnson et al., 2005; Gross et al., 2007).  Thus, when it comes to the techniques mentioned in your article, this is an approach that has been used successfully for more than a decade in a wide array of situations, the Hunter Heartbeat Method being one of the latest additions.  While incorporating evidence-based procedures into an intervention is a good start, this does not make the Hunter Heartbeat Method a “therapy” in and of itself.

We would like to thank you for your commitment to science in reporting objectively on how the treatment is supposed to work and highlighting measurable treatment gains.  However, we must exercise great caution in describing the benefits of an intervention, especially so when the treatments in question are not yet grounded in adequate research.  With more than 400 different treatments available for autism, families who are in a quandary about which intervention to choose usually turn to media reports as one of their sources of information. Including a caveat in such reports about the need for more extensive peer-reviewed research for a treatment to be viewed as a therapy would go a long way in the fight against fad treatments.

Sincerely,

Maithri Sivaraman, MSc, BCBA and Renee Wozniak, PhD, BCBA-D

Association for Science in Autism Treatment

References

Gross, A., Miltenberger, R., Knudson, P., Bosch A., & Breitwieser, C. B. (2007). Preliminary evaluation of a

parent training program to prevent gun play. Journal of Applied Behavior Analysis, 40(4), 691-695

Johnson, B. M., Miltenberger, G. G., Knudson, P., Egemo-Helm, K., Kelso, P., Jostad, C., & Langley, L. (2006).

A preliminary evaluation of two behavioral skills training procedures for teaching

abduction-prevention skills to schoolchildren.  Journal of Applied Behavior Analysis, 39(1). 25-34

Mehling, M. H., Tasse, M. J., & Root, R. (2016). Shakespeare and autism: An exploratory evaluation of the

Hunter Heartbeat Method. Research and Practice in Intellectual and Developmental

Disabilities, DOI: 10.1080/23297018.2016.1207202

Miltenberger, R. (2004). Behaviour modification: Principles and procedures (3rd ed.). Belmont, CA.

Wadsworth Publishing

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