STEPPING OUTSIDE THE BOX: A drama therapy intervention with adolescents with autism

by Clare Hudson, Speech and Language Therapy Manager, St Paul’s Hospital / School, Beaumont & Breffni Mc Guinness, Drama Therapist

Can Drama Therapy benefit children with Autism and Intellectual Disability?

Having worked with children with autism (ASD) for many years, I had reservations about the appropriateness of drama therapy as an intervention for students with autism. Specifically, the following questions came to mind:

  • Can an adolescent with ASD take on a number of different roles within a situation, showing some degree of empathy for characters?
  • Can an adolescent with ASD and limited verbal abilities direct other actors in a scene and use imaginary objects?
  • Can an adolescent with ASD understand conflict in relationships showing concern about his relationship with significant others in his life?

Breffni, a drama therapy student, and I co-facilitated a pilot drama therapy project consisting of 22 weekly one.hour sessions. Four adolescents—three boys and one girl, all with a diagnosis of autism and intellectual impairment—participated in the project.

In my opinion, what occurred during the drama therapy sessions for each participant pushed the boundaries of the construct of ASD, that is impairment in the areas of communication, social understanding and imagination. Following are the reflections of Breffni on the project.

Building bridges with children with autism (Breffni Mc Guinness, Drama therapist)
What do ‘Cristiano Ronaldo’, ‘Rocky III’ and ‘Nanny 911’ have in common? They are some of the stories created, directed and acted out by Larry, Donal and Gavin—three young men on the mild (Larry) to moderate (Donal and Gavin) autistic spectrum. They are also vehicles in which these three young men were able to carry aspects of their inner world to the outside world and play around with them. In so doing, they were able to have their inner world witnessed, acknowledged and validated. This was done in an indirect way—through stories created by the young men themselves, and to a large extent non-verbally, through the use of movement, costume, props, physical embodiment and gestures. By engaging their imagination, creativity and physicality using these techniques of drama and theatre, Larry, Donal and Gavin stepped outside their normal boxes and into a new world of expression where they could try things out in new ways—in effect, where they could play.

What is drama therapy?
Drama therapy is one of the creative arts-based psychotherapies (the others are Art, Music, and Dance/Movement—see, It uses theatre methods such as story, plot, role, movement, sound and costume. It is playing with a purpose, which is to use the medium of drama and theatre intentionally, to effect healing and change in clients (Emunah 1994, p.3). Let us now look at some examples of how they went about this.

Donal was a 15-year-old bundle of energy who was excellent on non-verbal communication, although he struggled with full conversation. He was a big Ronaldo and Manchester United fan (nobody’s perfect), and he liked nothing better than to create a story of his team winning by loads of goals and, of course, himself scoring the best ones. Using a simple three.step cartoon strip type of story making method, Donal first of all drew his story—beginning, middle and end, and then he directed the other boys in acting it out. See the pictures below.

Donal’s first Ronaldo story:
Oftentimes, this would be done non-verbally through gesture, facial expression, and physically moving people in to their correct positions—Donal didn’t leave anything to chance. Throughout the course of the drama therapy sessions Donal’s ability to communicate what he wanted, particularly non-verbally, was very evident—as was his sense of enjoyment in interacting and creating things with the other boys.

One of Donal’s football stories:
One of his most powerful moments was when he was enacting one of his football stories. Instead of a real ball we used an imaginary one. Donal struggled a bit initially with the idea, but gradually he got the hang of it, so much so that he scored one of his more spectacular goals with it. He was able to move outside of the
reality that there was no real ball and play with something that was imaginary. Through his passion for
football, Donal was able to develop his abilities to communicate and interact with others, while expressing his creativity and imagination in his unique way.

Drama therapy

Gavin did something similar through his favourite character, Rocky III—the boxer played by Sylvester Stallone in the film. For Gavin, Rocky was a hero who got involved in all sorts of adventures. One of these is shown in the drawing below.

Gavin’s Rocky III story.
Gavin directed this story with great enthusiasm and was very precise about what each of the other boys had to do when acting the parts of Rocky III and his friend. The story was about a meeting between the two of them, though it wasn’t entirely clear, in the way Gavin directed it, whether the interaction was conflictual or friendly. This is another important point about how drama therapy works. It doesn’t matter if the meaning is not clear to us, what is important is that Gavin had the opportunity to create and direct his own story—whatever that might be. In so doing, his story was witnessed and affirmed by others and in the process Gavin was too.

Further, by Gavin directing his own story and seeing it acted out by the other two boys, he gained a new perspective on it. Whatever the story represented to Gavin, what he experienced through the drama therapy was that he could direct and change the outcomes himself, thus modelling that things that are important to him (such as relationships) can be processed and worked with in a safe way.

One of Larry’s key stories was Nanny 911. This came about as an improvised role play which took place towards the end of the drama therapy sessions. Larry had made very good progress in being able to communicate, interact with others and express himself through stories and acting in the previous sessions. He was asked to think of a conflict situation and to create a role play around this. He chose a familiar TV program where the child in the house is being unruly, the parents are at their wits ends and they all turn to Nanny 911 to sort the problem out.

When asked which character he wanted to play, Larry chose the child and played the part with huge energy. After running the scene for a couple of minutes I then asked Larry if he would play the role of the father. He agreed and played this part with even more energy than before. This was significant for Larry as he stepped outside a familiar box and into a different role—one which he really relished. Being able to see things from the other person’s perspective is one of the more difficult things for a person on the autistic spectrum to do, and yet Larry was able to do this. This was in the last 3 of 22 sessions and while it required enough safety to be created and skills to be developed, he was still able to do it. In the final session, when Larry was asked what drama therapy meant to him, he drew the following picture of the Nanny 911 story with—interestingly—the speech bubble coming from the parents. For Larry, this story was significant. As with Donal and Gavin, Larry was able to externalise through Nanny 911 something of importance to him and have this validated by others. He was also able to see and experience different perspectives of that story.

‘Christiano Ronaldo’, ‘Rocky III’ and ‘Nanny 911’ show how in the right atmosphere, adolescents with autism can step outside their boxes and develop their abilities, not just to interact and communicate with others, but also to help others to communicate and interact with them. Drama therapy builds on the strengths and abilities of these young men and provides creative ways to help them express themselves and to work therapeutically.

Final thoughts (Clare)

Clinical experience and research indicate that individuals diagnosed with ASD are just that—individuals, in terms of their strengths, needs and experiences of the world. The students within the drama therapy group are no different, and importantly they are also adolescents who have their own perspective and understanding of the world, but for whom communicating and questioning the world in a conventional conversational manner can be a struggle owing to communication and language difficulties. As a result of the students’ limitations in expressing these views, thoughts and feelings verbally, those who work closely with the adolescents within educational and clinical environments may inadvertently reduce the opportunities they have to learn about and hear these inner thoughts. This may be due to reduced expectations of the individuals and also to the high language content of classroom and clinical sessions, which can create a barrier to opening up the issues. In my experience, drama therapy can certainly provide the context for expression for students with autism, and it struck me as a possible favourable alternative to discussion of adolescent topics and issues usually addressed in the classroom and clinic room.

Experiencing drama therapy with this group of students gave me an insight into the thoughts of the adolescents, an insight that can only enrich my understanding of who each of the students is, and thus my relationship with and ability to appropriately support him/her.


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