Dance/Movement Therapy as an Intervention for Children with Autism Spectrum Disorders

Postural balance control interventions in autism spectrum disorder (ASD): A systematic review

BACKGROUND

Postural control (PC) disturbances in autism spectrum disorder (ASD) are associated with its severity. Varied sensorimotor interventions have been used for the management of these symptoms. However, there is a lack of a review elucidating all the available postural control interventions in ASD.

RESEARCH QUESTION

To comprehensively present the variety of interventions targeted at improving PC in ASD and to provide future research recommendations.

METHODS

PubMed, SCOPUS, Embase, Cochrane, ScienceDirect and Web of Science databases were searched for publications examining the effects of PC targeting interventions in those with ASD. Included articles were in English, published after 2000 in the peer-reviewed journals with full text available and used intervention targeted at improving PC or balance with a predefined objective outcome measure for accessing PC or balance. Initial database search yielded 1022 studies and 21 articles were included in this review after screening.

RESULTS

We identified diverse PC interventions including animal assisted therapies, karate/martial arts, aquatic exercises, virtual reality-based training, standard and customized exercises, and physical activity programs. The effect of long- and short-term interventions on PC improvement in children and adults with ASD is mixed. Future research should focus on undertaking randomized controlled trials with large sample size and participants with varying severity of ASD to improve generalizability of the study findings. The lack of population-specific, reliable, and validated motor outcome measures including neuro-imaging techniques should be addressed.

SIGNIFICANCE

While many of the interventions improved PC in those with ASD, the sample size and methodological quality of the studies was highly variable. There are limited studies exploring the long-term effects of the interventions. Rigorous study methods with population-specific objective outcome measures are warranted to draw generalizable conclusions regarding the PC interventions in individuals with ASD.

Mapping the Physical Language of Children Diagnosed with Autism: A Preliminary Study

Children diagnosed with autism spectrum disorder have a unique motor profile, characterized by, for example, unusual posture or compulsive use of the body. However, not much is known about specific characteristics of their physical language, such as their movement direction, their self-touch pattern, etc., and even less is known about these characteristics with regard to their typically developing siblings. In this first of its kind study, we attempted to map the physical language of children diagnosed with autism spectrum disorder and to compare it to their typically developing siblings. To this end, we recruited 12 pairs of siblings, comprising one sibling with a diagnosis of autism and one sibling who is typically developing. The siblings were asked to play for 10 min and were videotaped throughout the interaction. We evaluated the siblings' physical language using Laban's movement analysis. We found significant and substantial differences between the physical language of the children diagnosed with autism and their typically developing siblings. The results are discussed in terms of the implications of the differences in physical language between the two populations and how movement analysis could be important for interventions in order to improve the communication and social abilities of ASD children.

Caregivers' Assessment of the Sensory Processing Patterns Exhibited by Children with Autism in the Gulf Region

This study explored the nature, prevalence, and developmental profiles of sensory processing disorders among children with autism spectrum disorder (ASD). The participants comprised 119 children with ASD and 30 typically developing children and their parents. The Child Sensory Profile-2 was used to assess the children's sensory processing characteristics. The children with ASD exhibited elevated sensory processing difficulties. Deficits were observed in all the sensory modalities among the children with ASD, except the visual processing modality. Age-related improvements were observed in most sensory processing domains, although non-significant differences were noted in three domains. These findings should enhance understanding of the sensory challenges faced by children with ASD and contribute to the development of individually tailored, targeted, and age-specific therapeutic interventions.

Parents' long-term experiences in a recreational dance program for their children with autism spectrum disorder

Background and Aims

Motor impairments are associated with Autism Spectrum Disorder (ASD); yet few children receive appropriate therapy. Dance interventions are known to have diverse benefits, but research is lacking in how dance can benefit those with ASD. Ballet for all Kids is a novel program that has taught recreational dance classes to those with ASD for over a decade. We aimed to analyze families' experiences in the program over many years, specifically examining why they continue to participate.

Methods and Procedure

Semi-structured interviews were conducted with 20 parents and/or legal guardians of long-term participants of Ballet for All Kids. Inductive thematic analysis was conducted to elucidate their experience in the program.

Outcomes and Results

In examining the program's retention factors, thematic analysis identified five themes: (1) authentic ballet training, (2) person centered program, (3) sensory integration and self-regulation, (4) skill development, and (5) interpersonal relationships.

Conclusions and Implications

Parents' reports add to the literature that dance can benefit participants psychologically, physically, and socially. High retention rates demonstrate the need and desire for a recreational dance program. The authenticity and individualized support of Ballet for All Kids was emphasized by parents and should inform the direction of similar programs.

Benefits and challenges of tele-dance movement psychotherapy with children with autism and their parents

Dance movement psychotherapy can be physically and psychologically beneficial for children with autism spectrum disorder. The coronavirus disease 2019 pandemic required therapy to take place online. However, tele-dance movement psychotherapy with children with autism spectrum disorder has yet to be studied. This mixed methods study involving qualitative research and movement analyses entailed providing tele-dance movement psychotherapy to children with autism spectrum disorder and their parents, during the coronavirus disease 2019 pandemic, and exploring its potential benefits and challenges. The parents who completed the programme reported positive outcomes including the child's social development, enjoyment, improved understanding of their child, insight and ideas, as well as relationship-building. Movement analyses using the Parent Child Movement Scale (PCMS) lent greater insight into these developments. All of the parents reported challenges in participating in tele-dance movement psychotherapy. These were related to screen-to-screen interactions, home, and physical distance. There was a relatively high attrition rate. These findings highlight the challenges of tele-dance movement psychotherapy with children with autism spectrum disorder and the unique benefits of meeting in person whilst the positive outcomes may indicate that tele-dance movement psychotherapy can be beneficial, perhaps particularly as an interim or adjunct form of therapy. Specific measures can be taken to enhance engagement.

Examining the efficacy of dance movement and music mixed treatment on social communication impairment in children with autism - Based on family parent-child situation

Despite impairments in social communication in children with autism spectrum disorder (ASD), existing studies only examine the effects of either MT or DMT interventions. In the family setting, few studies have investigated interventions for social communication impairments in children with ASD. This study designed and tested a mixed intervention program of both MT and DMT through a 3-month intervention and training for children with ASD in the family setting including parent and child. A pre-test and post-test were conducted in the experimental and control groups, and the childhood autism rating scale (CARS) and autism treatment evaluation checklist (ATEC) scales were used to assess the severity of ASD symptoms and the effects of intervention. A t-test and analysis of variance were performed based on the experimental results. The results indicated that the experimental and control groups did not differ significantly on the CARS pre-test (t = 1.218, p > 0.05) and that there was no significant difference in the ATEC pre-test (t = 0.546, p > 0.05; F = 0.074, p > 0.05, partial η2 = 0.003). There was no significant difference between the pre- and post-test scores for the CARS in the control group (t = 0.635, p > 0.05), and there was no significant difference between the pre- and post-test scores for the ATEC in the control group (t = 0.027, p > 0.05; F = 5.251, p > 0.05, partial η2 = 0.313). There was a significant difference between the pre- and post-test scores on the CARS in the experimental group (t = 4.327, p > 0.05) and the pre- and post-test scores on the ATEC in the experimental group (t = 5.763, p > 0.01; F = 32.615, p > 0.01, partial η2 = 0.759), with the post-test scores being lower than the pre-test scores. This demonstrates that the mixed intervention of MT and DMT in the family parent-child setting can reduce autism and improve social communication impairment in children with ASD.

A Systematic Review of the Contribution of Dance Movement Psychotherapy Towards the Well-Being of Children With Autism Spectrum Disorders

Background: The present review provides an original examination of published literature on the use of Dance Movement Psychotherapy (DMP) as an intervention for children with an Autism Spectrum Disorder (ASD).

Method: The review was systematically conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A protocol consisting of four phases: identification; screening and selection; data extraction and synthesis; quality assurance was developed and registered with the PROSPERO. A search strategy was developed using population and intervention as the key concepts and ten databases were searched between 6.1.2018 to 4.4.2018 and 10.07.2021 to 20.07.2021. The intervention characteristics were extracted based on the TIDieR template for intervention description and replication checklist. Quality assessment and level of evidence of all the included studies were evaluated using the Mixed Methods Appraisal Tool (MMAT) and the Centre for Evidence-Based Medicine (CEBM) for treatment criteria.

Results: Nine research studies with a total of 133 participants were identified through a systematic search process. There was only one mixed-methods study with the component of randomisation found during the literature search. Collected information was synthesised in relation to (a) ways in which dance movement psychotherapists work with children; (b) data collection methods and findings. Results from the reviewed literature suggest that DMP can potentially promote various aspects of well-being in children with ASD. Eight out of nine studies mentioned the effects of DMP on improving different social and communication skills. However, results from quality assessments and synthesised outcomes indicate that research in DMP is still in its infancy.

Conclusions: We conclude that further large-scale, high-quality studies are required to generate further evidence that explains the processes involved in DMP, the effectiveness of DMP, the relationship between therapeutic factors of DMP, and research findings for children on the autism spectrum.

Systematic Review Protocol Registration: PROSPERO, identifier: CRD42018087912.

A Dance Movement Psychotherapy Intervention for the Wellbeing of Children With an Autism Spectrum Disorder: A Pilot Intervention Study

Background

Sustaining the wellbeing for children with an autism spectrum disorder (ASD) can be highly demanding. Dance Movement Psychotherapy (DMP), a form of psychotherapy with a non-verbal character, may present as a relevant intervention option for this group of children.

Methods

A protocol-based group DMP intervention was developed and implemented in two special educational needs schools in the North West of England. We aimed to investigate the effects of DMP on children with ASD using the Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ). Twenty-six children aged between 8 and 13 years (mean age = 10.65 years) with ASD were randomly allocated to DMP and a control group with standard care, following a crossover research design.

Results

Results showed no significant carryover or period effects for either the SCQ or SDQ (p > 0.05). A significant intervention effect was found only for SCQ (p = 0.005) but not for SDQ (p > 0.05). ANCOVAs were performed on the data before the crossover to test for differences in SCQ and SDQ scores between the DMP intervention and control groups while controlling for pre-intervention scores. Those in the DMP intervention group presented significantly lower SCQ scores following the intervention period than those in the control group (p = 0.001). No significant differences in post-intervention SDQ scores were found between DMP intervention and control groups (p = 0.2). However, minimal clinically important differences (MCID) were reached for both SCQ and SDQ measures before crossover for those in the DMP intervention group. Moreover, repeated measures ANOVAs performed on SCQ and SDQ measures following crossover were significant, with the change in both SCQ (p = 0.001) and SDQ (p = 0.009) pre-and post-intervention being significantly greater for those in the DMP intervention than the control group.

Conclusion

The pilot DMP intervention has shown promising results on the social and emotional wellbeing of children with ASD irrespective of whether they preferred verbal or non-verbal mode of communication. Limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed in detail. Overall, our findings highlight the value of creative therapies for improving the lives of young vulnerable groups.

The "Muscles of the Psyche": From Body Literacy to Emotional Literacy

Autism spectrum disorder (ASD) is a neuro-developmental condition, which requires a multi-disciplinary matrix of treatments, including functional, educational, and emotional interventions. The latter mode of treatment entails particular difficulties, inasmuch as the core deficits of this condition seem to challenge the very premises of traditional psychotherapy. Reciprocity, verbal, and symbolic expression and inter-subjective dynamics are often difficult to attain with clients diagnosed with ASD, and emotional treatment thus often turns out to be a frustrating process, which may well elicit questions as to the efficacy of psychotherapeutic emotional interventions. These core challenges, described in the literature, become particularly acute in view of the increasing number of clients diagnosed on the autistic spectrum in recent years, and the growing need for qualified therapists who have trained for working specifically with this condition. It seems, therefore, that it is high time for systematic research into the lived experience of therapists working with these clients in order to attain a better clinical and theoretical understanding of the condition itself and broaden the range of effective interventions. This study, informed by a phenomenological-hermeneutic approach which guided both the collection of data and its subsequent analysis, aims to address these issues by exploring the particular challenges faced by therapists in this field, the questions that come up in the process, modes of personal and professional coping, and the insights elicited by the therapeutic encounter. The research consisted of in-depth interviews with 28 practicing therapists from a broad range of clinical orientations, including dance/movement, arts, music, and drama therapists, clinical psychologists, and clinical social workers. The essential themes that emerged from the participants’ responses and the analysis of the findings lend support to theoretical and developmental approaches, which focus on the primacy and the foundational role of the concrete body in inter-subjective relationships and in the therapeutic process, and indicate the potential efficacy of somatic and kinetic interventions. The clinical implications of this study are thus highly relevant to the training and support of therapists working with ASD, who should be encouraged to develop greater receptivity to non-verbal modes of interaction in the therapeutic process.

Child-Robot Interaction in a Musical Dance Game: An Exploratory Comparison Study between Typically Developing Children and Children with Autism

Using robots in therapy for children on the autism spectrum is a promising avenue for child-robot interaction, and one that has garnered significant interest from the research community. After preliminary interviews with stakeholders and evaluating music selections, twelve typically developing (TD) children and three children with Autism Spectrum Disorder (ASD) participated in an experiment where they played the dance freeze game to four songs in partnership with either a NAO robot or a human partner. Overall, there were significant differences between TD children and children with ASD (e.g., mimicry, dance quality, & game play). There were mixed results for TD children, but they tended to show greater engagement with the researcher. However, objective results for children with ASD showed greater attention and engagement while dancing with the robot. There was little difference in game performance between partners or songs for either group. However, upbeat music did encourage greater movement than calm music. Using a robot in a musical dance game for children with ASD appears to show the advantages and potential just as in previous research efforts. Implications and future research are discussed with the results.

Dance promotes positive benefits for negative symptoms in autism spectrum disorder (ASD): A systematic review

BACKGROUND

Autism spectrum disorder (ASD) is characterized as a neurodevelopmental disorder with stereotyped and repetitive behaviors. Dance practice can elicit esthesia to stimulate the communication process through the notion of the phenomenal body that is recognized in an expressive and symbolic space.

OBJECTIVE

To conduct a systematic review to identify how dance promotes positive benefits for the negative symptoms in ASD.

METHOD

We formulated the research question based on PICO: "What is the influence of dance on negative symptoms in individuals with autism spectrum disorder?". Databases were searched in March 2019 and included PubMed, Science Direct, Scopus, PsycInfo and Web of Science.

RESULTS

We identified 9,350 studies of which five were selected for our review (a total of 266 individuals). All included studies showed an influence of dance on negative symptoms, including empathy, emotional expression, body awareness, behavior, and psychological wellbeing that impact on social reciprocity, and consequently the communication process, in ASD.

CONCLUSIONS

Dance practice may contribute to body awareness and social involvement using techniques that provide mirroring, synchronization, rhythm, and reciprocity in adults with normal to high-functioning ASD.

Two-Person Approaches to Studying Social Interaction in Psychiatry: Uses and Clinical Relevance

Social interaction is ubiquitous in human society. The two-person approach-a new, powerful tool to study information exchange and social behaviors-aims to characterize the behavioral dynamics and neural mechanisms of real-time social interactions. In this review, we discuss the benefits of two-person approaches compared to those for conventional, single-person approaches. We describe measures and paradigms that model social interaction in three dimensions (3-D), including eye-to-eye, body-to-body, and brain-to-brain relationships. We then discuss how these two-person measures and paradigms are used in psychiatric conditions (e.g., autism, mood disorders, schizophrenia, borderline personality disorder, and psychotherapy). Furthermore, the advantages of a two-person approach (e.g., dual brain stimulation, multi-person neurofeedback) in clinical interventions are described. Finally, we discuss the methodological and translational challenges surrounding the application of two-person approaches in psychiatry, as well as prospects for future two-/multi-person studies. We conclude that two-person approaches serve as useful additions to the range of behavioral and neuroscientific methods available to assess social interaction in psychiatric settings, for both diagnostic techniques and complementary interventions.

Moving Along and Beyond the Spectrum: Creative Group Therapy for Children With Autism

Group therapy for autism confronts the core of the syndrome. Non-directed dynamic approaches, in which moment-to-moment spontaneous expressions drive the content of group sessions, are even more intricate. The implementation of nonverbal creative techniques holds the key to self-expression and self-other exploration, promoting communication and play. This manuscript offers an integrative conceptual model and a case report regarding such mind-body therapeutic perspective. The creative arts intervention is presented via a small group of young minimally verbal children with autism, deprived of communicative language, offering an interdisciplinary perspective to delineate group challenges and rationale, process, and outcomes. Vignettes are provided to illustrate the group development. A thorough discussion follows, addressing three intertwining axes: firstly, the implications of nonverbal creative means are considered; secondly, the psychophysiological processes set in motion through sensory-motor experiences are deliberated; and thirdly, the emergence of "moments of meeting" and spontaneously generated playful group activities are enlightened.

Performance and visual arts-based programs for children with disabilities: a scoping review focusing on psychosocial outcomes

Purpose: There is a growing movement in pediatric rehabilitation to understand how approaches addressing aspects beyond body function contribute to enhanced psychosocial well-being. Among such approaches is the use of creative arts. A scoping review was undertaken to synthesize the current literature on performance and visual arts-based programs and outcomes for children with disabilities.Methods: Data sources included CINAHL, MEDLINE, and PsycINFO. Eligible articles described programs involving performing or visual art activities in community and ambulatory care settings, delivered to children between 6 and 18 years with physical or developmental disabilities, and reported on at least one psychosocial outcome. Domains of interest included emotional, social, behavioral, physical, cognitive, and/or communicative functioning, which are known to impact well-being and participation. No limits were applied to study design.Results: Twelve articles using primarily case study and quasi-experimental designs were identified, encompassing an 11-year period. Most programs focused on theater as the central modality. A majority of papers addressed changes in physical, cognitive, and communicative function (n = 8), followed by social function (n = 6), emotional function (n = 5), and finally, behavioral function (n = 3). Across individual papers, diverse study designs, measures, and outcomes were examined with positive qualitative and/or quantitative findings noted across all domains.Conclusions: Within an emerging evidence base, arts-based programs show potential to positively impact psychosocial well-being and warrant further investigation with broader populations of children with physical and developmental disabilities. A greater emphasis on programmatic approaches and enhanced methodological rigor to establishing benefits is needed to advance understanding.Implications for rehabilitationPediatric therapists may wish to consider recommending arts-based programs for children with ASD, TBI, and other developmental disabilities given their potential in achieving psychosocial outcomesArts-based programs in rehabilitation provide creative ideas (e.g., drawing, painting) and techniques (e.g., modeling, role-play), which may be incorporated into individualized or group-based therapy to promote psychosocial well-beingProgram evaluators and researchers are encouraged to adopt a programmatic approach to further explore how art activities facilitate psychosocial outcomes.

Impact of dance therapy on children with specific learning disability: a two-arm cluster randomized control study on an Italian sample

BACKGROUND

Dance therapy can improve the quality of life of a person with several conditions, especially psychological well-being and quality of life, in the short and long-term. The aim of the study was to examine the effects of the dance therapy (DT) on specific learning disability (SLD) children. We wanted to test the impact on cognitive and emotional patterns on children with learning disorders.

METHODS

A two-arm cluster randomized control study was applied comparing 2 groups of SLD children (treated vs. non-treated). All children have been measured applying psychological battery before and at the end of the experimental protocol.

RESULTS

Our data revealed significant differences between groups for auditory and visual recognition, for interpersonal relationships and for emotions recognition. DT seemed to provide positive evidence as an educational intervention for children with SLDs.

CONCLUSIONS

Our results confirmed that DT protocol was an effective way to improve self-esteem, attention and concentration and emotional recognition in SLD children.

Dancing Effects on Preschoolers' Sensorimotor Synchronization, Balance, and Movement Reaction Time

In the present study, we compared an experimental group of preschool children ( n = 22; mean age = 5 years, 8 months) who followed an 8-week dance program with a control group ( n = 20; mean age = 5 years, 5 months) on pre-post measures of sensorimotor synchronization (K-Rhythm Test), balancing on one leg and movement reaction time. Compared with the control participants, the dance group demonstrated significantly better pretest to posttest improvements on sensorimotor synchronization and balance (but not movement reaction time). Considering the importance of sensorimotor synchronization and balance for subsequent child development and performance of daily and sport activities, these results suggest that dancing should be included in early childhood curricula.

Through the Kinesthetic Lens: Observation of Social Attunement in Autism Spectrum Disorders

This paper will present a movement-informed perspective to social attunement in Autism Spectrum Disorders (ASD).

BACKGROUND

Dance movement therapy (DMT) is a psychotherapeutic intervention that is used with participants with ASD in various settings. Regular clinical outcome monitoring in an outpatient setting in the Netherlands had shown positive effects on social attunement capacities in young people with ASD. However, a systematic study of the development of social attunement movement behaviors of participants with ASD throughout a DMT intervention was not yet available.

METHODS

A series of individual cases of DMT with young people with ASD (mean age 12.2 years.) were analyzed for changes in interpersonal movement behaviors employing video-based retrospective observation.

RESULTS

The findings were summarized in an observation scale for interpersonal movement behaviors. This scale was then tested for its applicability for the monitoring of social attunement behaviors throughout therapy.

DISCUSSION

A movement-informed perspective may be helpful to inventory changes in social attunement behaviors in participants with ASD. The relevance of a movement-informed perspective for the concept of social attunement in ASD will be discussed.

"We Dance and Find Each Other"1: Effects of Dance/Movement Therapy on Negative Symptoms in Autism Spectrum Disorder

The treatment of deficits in social interaction, a shared symptom cluster in persons with schizophrenia (negative symptoms) and autism spectrum disorder (DSM-5 A-criterion), has so far remained widely unsuccessful in common approaches of psychotherapy. The alternative approach of embodiment brings to focus body-oriented intervention methods based on a theoretic framework that explains the disorders on a more basic level than common theory of mind approaches. The randomized controlled trial at hand investigated the effects of a 10-week manualized dance and movement therapy intervention on negative symptoms in participants with autism spectrum disorder. Although the observed effects failed to reach significance at the conventional 0.05 threshold, possibly due to an undersized sample, an encouraging trend towards stronger symptom reduction in the treatment group for overall negative symptoms and for almost all subtypes was found at the 0.10-level. Effect sizes were small but clinically meaningful, and the resulting patterns were in accordance with theoretical expectations. The study at hand contributes to finding an effective treatment approach for autism spectrum disorder in accordance with the notion of embodiment.

Fostering Social Cognition through an Imitation- and Synchronization-Based Dance/Movement Intervention in Adults with Autism Spectrum Disorder: A Controlled Proof-of-Concept Study

BACKGROUND

Since social cognition is impaired in individuals with autism spectrum disorder (ASD), this study aimed at establishing the efficacy of a newly developed imitation- and synchronization-based dance/movement intervention (SI-DMI) in fostering emotion inference and empathic feelings (emotional reaction to feelings of others) in adults with high-functioning ASD.

METHODS

Fifty-five adults with ASD (IQ ≥85) who were blinded to the aim of the study were assigned to receive either 10 weeks of a dance/movement intervention focusing on interpersonal movement imitation and synchronization (SI-DMI, n = 27) or a control movement intervention (CMI, n = 24) focusing on individual motor coordination (2 participants from each group declined before baseline testing). The primary outcome measure was the objective Multifaceted Empathy Test targeting emotion inference and empathic feelings. Secondary outcomes were scores on the self-rated Interpersonal Reactivity Index. The well-established automatic imitation task and synchronization finger-tapping task were used to quantify effects on imitation and synchronization functions, complemented by the more naturalistic Assessment of Spontaneous Interaction in Movement.

RESULTS

Intention-to-treat analyses revealed that from baseline to 3 months, patients treated with SI-DMI showed a significantly larger improvement in emotion inference (d = 0.58), but not empathic feelings, than those treated with CMI (d = -0.04). On the close generalization level, SI-DMI increased synchronization skills and imitation tendencies, as well as whole-body imitation/synchronization and movement reciprocity/dialogue, compared to CMI.

CONCLUSIONS

SI-DMI can be successful in promoting emotion inference in adults with ASD and warrants further investigation.