Can Theater Ditch Surprises for Compassion?

BY SUSAN SHERKOW M.D.

It’s no surprise that ASD children may want to experience the thrill of seeing a live performance. However, the reality of sitting quietly, not moving or talking for more than an hour, can be very difficult for children on the autism spectrum.

The issue of theater etiquette and compassion arose recently after one actor posted, in response to audience members’ complaints about a disruptive child: “When did we as theater people, performers, and audience members become so concerned with our own experience that we lose compassion for others?”

Luckily, in this age of immersive theater, Trusty Sidekick has nurtured such compassion, and created a performance specifically for Autistic children! The company’s name is taken from the idea that each cast member is meant to serve as the sidekick to each child—who, in a sense, becomes the hero throughout the journey of the play as it is experienced together. From this alone, it is clear what the company’s priorities are: that each ASD child is free not only to attend a real theater performance, but also to experience it however he or she chooses.

On September 25, The New York Times published a review of Trusty Sidekick’s performance of the production “Up and Away,” describing in detail how the company tailored their production to meet the needs of their very special audience of ASD children.  It is truly refreshing to see how a theater performance can still be “theater,” even while it is guided by strategies and flexibility that takes into account the way an ASD child would likely react to a live theater experience.

In particular, almost every aspect of the production of the play is aimed at easing the transition into “watching a theater performance” for ASD children. We, at the Sherkow Center,  applaud not only their overall intentions, which were evidently very successful, but the ways in which they tailored their production values to be most effective in working with this population.

In particular, these particular elements tailored to the special needs of the ASD audience members:

1. Before arriving, an online video is sent to each child in the audience, so that he knows what to expect from thetheater and cast. Here, the goal is to gradually diminish the factor of the “unpredictable”– the sense of surprise one has when seeing a live theater performance for the first time.  ASD children have great difficulty experiencing anything “new.” (See our earlier post on the issue of “unpredictability” and anxiety about “surprise” in the ASD population.) While this might seem to go against the ideals of traditional theater, one of Trusty Sidekick’s founders knowingly states, “[ASD children] need to have information ahead of time to feel safe.”  Far from detracting from the experience of live theater, the ASD child comes to the theater prepared to participate in the wonder of the story-telling, a feeling enhanced by having been able to anticipate and process the story when it finally arrives!

2. The cast themselves assist in transitioning the children from the outside world into the world of theater. As each child arrives at the theater, he is greeted by his own personal cast member who is waiting for them. He or she allows each child to acclimate to the new surroundings of the lobby before casuallycontinuing to a solarium, which is filled with lounging chairs. Then the child is taken to the performance room, where each cast member sits next to his or her child in the fused set/audience space of hot-air balloon replicas. When the performance is finished, each of the cast members then escorts her child back to the lobby with a celebration song, in lieu of a curtain call, and waves goodbye. Not only is this a casual encounter from start to finish, but the close presence of the cast members throughout helps avoid any sudden changes that may trigger anxiety for an ASD children.

3. The solarium room itself is an innovation that allows the children the flexibility of leaving and reentering the production space during the performance should they feel the need to “take a break.” The personal cast member even follows their child, leaving the rest of the cast in the performance space to adapt, improvise, and continue the story in their absence! No child is forced to sit still the entire hour, and the freedom of each child to move about and experience the performance as he or she wishes is truly unique.

Trusty Sidekick’s methods of providing entertainment for ASD children is groundbreaking. They fully embody the essential compassion, knowledge of ASD children’s psychology, and remarkable thoughtfulness that make it possible for parents to bring new experiences to their ASD children. If you have an interest, we encourage you and your child to experience this for yourself!

How Are Guinea Pigs Helping ASD Children?

BY LOUISA REVSON

An article recently published in The New York Times (6/29/15) titled “Guinea Pigs Are Autistic Child’s Best Friend,” discusses a fascinating new study in which the presence of guinea pigs was found to reduce the anxiety of autism spectrum disorder (ASD) children in a social environment, improving their ability to interact with their peers and enhancing their overall success at school. While the benefits of having a class pet, such as a guinea pig, have been recognized in past research, this study goes one step further by providing physiological data which proves that these creatures have calming effects on ASD children.

All of the 192 children participating in this study– of which 64 were on the spectrum and 128 typically-developing– wore special wrist bands that tracked their arousal levels, or levels of anxiety, by measuring electrical signals in their skin. The children were separated into groups of three with one ASD child and two typically-developing children in each group, and their arousal levels were measured as they were directed to perform specific tasks.

Performing any task, whether playing with a toy or even reading, in the presence of a small group caused an increase in each ASD child’s arousal level, indicating an increase in anxiety. The moment that two guinea pigs were introduced into each small group, however, the ASD child’s arousal level dropped. For all of the ASD children, completing tasks in front of or with the two other typically-developing children no longer caused their anxiety to rise, and, in addition, they displayed an increase in sociability.

The researchers controlled for whether the guinea pigs’ calming effects resulted from the distraction that they provided for the ASD children just by virtue of diverting attention away from the stressful social situations. This was tested by introducing a toy into each group as a “distraction object” in place of the guinea pigs. The same calming effects were not seen, which indicated that there is something in particular about these small, friendly creatures that helped abate the social anxiety experienced by the children on the spectrum.

While The New York Times article does not go beyond stating that the mechanisms behind the guinea pigs’ calming effects are currently unknown–they hypothesize that they act as “social buffers”– we at The Sherkow Center believe it is vital to uncover and understand these mechanisms, in order to gain a more comprehensive understanding of ASD.

What are the mechanisms at work here?

Children on the autism spectrum are born with a neurobiological difference that makes it difficult for them to process information and stimuli— to make sense of the information from the external and internal world coming at them. The processes by which infants learn about other people’s feelings and ideas, and about their own emotions and ideas, are the ingredients necessary to forming a relationship and maintaining it. ASD children seem to be neurobiologically altered in some way that affects making sense of the social world.

We also know that the more predictable the patterns of their experiences, the easier it is for an ASD child to absorb social, emotional, and cognitive information.  By contrast, the more unpredictable a system, the harder it is for an ASD child to process or make sense of it. The technical term for this is “failure of theory of mind,” referring to the diminished ability of an ASD child to form a coherent picture of what is going on in his own mind—or in the mind of his mother or father, his teacher, or his school mate.

A school mate is an unpredictable source of information. In a group setting, the study demonstrated what we have seen in our work: an ASD child becomes anxious at the prospect of sharing with or in front of peers because his processing difficulties interfere with his understanding the expectations of others. However, in a group scenario where a guinea pig is the shared object, participation in such sharing is much easier for the ASD child. Not only is the guinea pig able to elicit an emotional bond from the ASD child and typically-developing children alike, its lively actions are safely predictable. Even though the guinea pig’s behavior is hardly static, as it moves about, drinking and nibbling, it remains predictably unpredictable!

Another important element of this study is that unlike toys, or the demands of a social group, playing with a guinea pig doesn’t demand the use of imagination or pretend play, areas classically difficult for an ASD child. The guinea pig makes no demands or expectations of the child, yet another source of potential anxiety for ASD children.

Last but not least, all of the children, typical or ASD, can experience the guinea pig in an identical fashion, importantly providing a source of joint attention that enables a social interaction between two people to get started. The typically-developing and the ASD children will process the experience of the guinea pig in exactly the same way, providing a source of shared experience as a springboard for a relationship between the children. Thus it stands to reason that the presence of the guinea pigs would decrease anxiety while enhancing the capacity of the ASD child to grow in the context of participating in a group.

The physiological data collected in this study demonstrates very concretely not only how anxiety-provoking social interaction is for children with ASD, but how relatively readily this stress can be reduced simply by introducing a joint-attention inducing phenomena into the social group. That the ASD children so readily displayed an improved ability to play and socialize with their peers points to the key role anxiety plays in exacerbating the social deficits we seen in children on the spectrum

What Prompts Rage in Adolescents

ASD children who are not particularly symptomatic in early childhood may still manifest features of social isolation (difficulty with forming and maintaining relationships) as well as suffer from difficulty with transitions. This may progress through middle childhood and adolescence, and these children often experience anxiety and depression. In the course of their development, having not received early diagnosis nor early intervention, many overtly high functioning ASD children fail to develop the building blocks essential for recognizing and modulating their angry feelings, and can run into severe problems with their aggression.

When ASD teens are given unlimited access to video games and social media that have aggressive and/or sexual content, there can be significant consequences. Too often, this type of media exacerbates the poorly regulated sexual and aggressive urges that can morph into horrific fantasies. These fantasies have the potential to turn deadly.

It is of paramount importance to address these children’s needs for attention, care and success at every stage of development. The public and professionals alike must understand just how crucial it is to find the means to identify and help this very vulnerable population.

An Excerpt from The Book "Autism Spectrum Disorder"

Here is the inaugural post to the “On Autism” blog, excerpted from Dr. Sherkow’s book  Autism Spectrum Disorders: Perspectives from Psychoanalysis and Neuroscience:

“… optimizing parent-child interactions plays a major role in successful early intervention and, with early diagnosis and treatment, perhaps even prevention… While neurobiology informs us about the workings of the brain, a psychodynamic understanding of development can open a window to the inner world of the ASD child. Understanding the dynamic interplay between biological and psychological processes in autism is of utmost importance in the development of vital interdisciplinary collaboration in ASD research and treatment.”

Promoting the optimal development of children and adolescents through services and education is the mission of the Sherkow Center.