Effect research into Act-it-Out, as a game form for young people with autism spectrum disorder .

By Femke Crützen, dramatherapist
n.b. the information below is an abstract of the complete research report

  • Introduction
  • Effective game values of Act-it-Out in general
  • Act-it-Out and its link with people with an Autism Spectrum Disorder
  • Act-it-Out and its link with young people / adolescents

For my final thesis subject at the School for Drama Therapy at the Arnhem and Nijmegen University [Hogeschool Arnhem en Nijmegen (HAN)], I spent the academic year of 2004 – 2005 carrying out research into the usefulness of Act-it-Out with people with an Autism Spectrum Disorder. As a researcher, I took on the role of trainer and played Act-it-Out for two periods of six weeks with 5 young clients who had been admitted into the De Lingewal Child Psychiatric Clinic in Zetten. I observed and directed the process with therapeutic interventions. On completion of the game, the young clients and the participating trainers were asked to give their views on the game. The data gathered from my observations as a researcher and the responses from the participants were analysed by summarizing the common terms. This data resulted in a description of the effective game values of Act-it-Out. The effective game values in general are elaborated on in the following sections. The game elements that are particularly suited to the Autism Spectrum Disorder and adolescence are also examined below.

Game Values of Act-it-Out

  • Reward for effort
    In the game, the emphasis is always placed on what goes well in a role-playing situation and the player is always rewarded with a ring once the task has been carried out successfully. This strategy appears to be the perfect way of creating a good learning environment. The positive feelings that the young clients get from this approach stimulate their own creative ideas on how to effectively deal with tricky social situations. There is also an opportunity for (self) reflection. Positive reinforcement is therefore a precondition for the learning process!
  • Informal Therapy Situation
    A safe environment is of essential importance when starting out on the process of learning social skills. The instructions are difficult and intensive, even for people who do not have any explicit problems with social skills. An inviting and open atmosphere is essential for success; the informal quality of the game encourages and stimulates this atmosphere. There are always five chairs set out for the young clients, even if one of them does not attend the session. This means that the young client can change his/her mind at any time and still feel welcome. All the problems the young clients encounter during the game are open to discussion, for instance, the concentration problem within the group or any possible resistance within the group. Everyone can say what he/she feels and nobody feels restricted. This means that the young clients are free to come and go as they please with the implicit purpose of guaranteeing that they feel safe and secure during the sessions. With this in mind, it is extremely important to accept each other’s idiosyncrasies, such as the fervent urge to win or the inability to structure and plan time. In this aspect, the quality of the role-playing situation lies in the opportunity for the clients to be as creative as they like when they are playing the game. The comments about respect for each other are less emotional and, thanks to the playful character of the game, can be used in relation to an action or a joke.
  • Structure
    The game has a distinct and clear structure. The board is square-shaped. It is clearly divided into 6 squares and each square is a different colour. The instruction cards and cards containing tips and points for consideration fit in perfectly well with the design of the board and are clearly classified. The information on the cards is suitable for the target group (young clients) and it also has a logical sequence. The plasticized cards, counters and rings make the material tangible and concrete. What is particularly constructive and beneficial to clients with an Autism Spectrum Disorder are the clear discussion parameters that are described on the cards containing tips and points for consideration. This helps clients with this disorder enormously because this is exactly where they experience their problems. For example, this is reflected in the planned structure of taking turns when training the skill. Before practising the role-playing situation, the trainer helps to clarify the context and the objectives. During the role-play, the trainer assists in stimulating and encouraging the young clients to stick to their view. For instance, by accentuating your importance as a person in the role-playing situation. Sometimes this is related to a lack of empathy and other times to a lack of knowledge of social skills in itself. At the end of the game, the trainer helps the clients to reflect on their role-playing. The trainer sums up what he/she has observed and invites the others to add their own comments. Specific points relating to social interaction are also mentioned here. For example, think of the conflicts and the position and status of people opposed to each other who are both able to influence the context of the social role-playing situation.
  • Dynamics
    The unpredictable nature of the role-playing situation makes the session dynamic.
    When you land on a square where you have to practise a skill, who chooses whom and what are you instructed to do? For each player, the game also alternates between action and reaction, monitoring and relaxing. One important condition for this is that the group is not too large. During this research, the game was played with five young clients. However, it would have been better if it had been played with only four because then everyone would have had more turns and the individual tension and anxiety would have subsided less quickly.
  • Interactive Learning Environment     
    Thanks to the interaction when playing the game, the young clients are able to socialize with each other in a positive way. The sessions are enjoyable. The group interaction has an important function and also often provides the opportunity to add something current and fitting to the subject of social skills within the group. The group process has at least as much influence on learning social skills as do the role-playing situations in the game. Furthermore, the young clients in the group have the opportunity to get to know each other better and also to find support from other people with the same disorder, who are doing the same training. They can bring in the others as a network and also be there themselves to support other people. This can be done during a role-play and also when the role-play is being discussed afterwards. It is inspiring to see which creative ideas and solutions the young clients can devise together!
  • Concealment of the Topic, ‘Social Skills’
    Young clients with an Autism Spectrum Disorder lack social insight. They do try to interact socially but they are constantly running up against their limitations. On the one hand, they are motivated to learn social skills from this but, on the other hand, they are hurt by the repeated rejections and failures they encounter socially. Both these aspects must be considered when playing Act-it-Out with these clients. The link to treatment in the first instance lies in the sensitivity of the subject. In this respect, the game is suitable. The focus is not on the lack of social skills but rather on the fun and competitive aspects of the game. It is a matter of not focusing purely on the actual person. During the discussion following the role-play, the objective is to give feedback and criticism to the person who has followed the instruction and carried out the given task. Here, it is again important to take into consideration the vulnerability of the young client. To do this effectively, it is advisable not to be too personal when voicing criticism and giving feedback, but preferably to stick to facts and generalizations.

 Act-it-Out and its link with people with an Autism Spectrum Disorder:

Time and space to train
Young clients with an Autism Spectrum Disorder have problems in processing information. They need more time to organise information and they all do this at their own pace. It is essentially important to take this seriously and not to force the issue. In this way, every young client is able to structure the situation in such a way that it is clear and manageable. The young client needs to take the time to achieve this if he is to master the situation. In this way, he broadens and strengthens his inner social structure. To this end, the game offers several possibilities:

Interruption of the training situation
The training situation can be interrupted and there is time to ask questions. Young clients with an Autism Spectrum Disorder miss this opportunity in their daily life and consequently lose the context of the social situation.

  • Breaking the span of concentration:

Since the players have to change turns a great deal during the game, this means that they do not have to continually concentrate on training their social skills. This is advantageous to them because focusing on social interaction is not something that comes naturally to them and therefore it is very exhausting for them.

  • Repeating the exercise:

The role-playing situation offers the opportunity to practise and train social skills by trying them out and repeating them. Here, the player’s contribution is important but so is the reaction of the other person playing the opposite role. Since young clients with an Autism Spectrum Disorder cannot assess the situation themselves, or they assess it incorrectly, such opportunities to practise and train their social skills are of the utmost importance. The game allows mistakes to be made without embarrassing the other person.

The direct training situation offers the clients the opportunity to master the rules and to learn to use them in a flexible way. Another important part of the learning process in young clients is supporting the choices they make. Listening to their motivation is an important way of showing them that they are being taken seriously. The more familiar and comfortable the young clients become with the game, the more role-playing situations they can devise to train their social skills.

Act-it-Out and its link with young clients / adolescents
Besides placing the emphasis on the autistic issue, there are also a number of points stated that make Act-it-Out worthwhile and interesting to young clients. These points are briefly described below:

  • Encourage the young clients to help you think about how to make the training sessions more appealing. Do they have any ideas or proposals on how to set up the role-playing situations? It is also important to stimulate their ideas for their own role-playing situations.
  • When discussing the social skills, relate them to the future prospects of the young clients and the interests they have in society, for example, with regard to work and friendships.
  • Create possibilities for discussion when things go wrong during role-playing situations. What ideas do the young clients themselves come up with to solve the problem? Here, it is important that they are given the chance to experiment with forming their own views on social interaction.
  • Humour and a casual, light approach are most beneficial; adolescents are already having a tough enough time during this phase of development.
  • An equal number of boys and girls enhance the feeling of security in the group. The so-called ‘peer group’ will be formed by the young clients of the same gender.


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