Enhancing Social Competence in Adults With Autism

Enhancing Social Competence in Adults With Autism Spectrum Disorder: A Pilot RCT

SENSE Theatre®, combines several well-documented, effective behavioral strategies, such as the inclusion of trained peer models, theatre play techniques involving predictable (i.e., scripted) and flexible (improvised) role-play, and repeated performance of newly learned skills resulting in greater automaticity of behavior. The intervention has the potential to enhance social cognition and behavior in adults with autism spectrum disorder.

Study Overview

• Status: Completed
• Conditions: Autism Spectrum Disorder
• Intervention / Treatment: Behavioral: SENSE Theatre

Detailed Description

Autism spectrum disorder (ASD) is characterized by primary impairment in social competence. Effects of current psychosocial interventions often fail to maintain or generalize and few employ rigorous experimental methods. Our treatment, SENSE Theatre®, combines several well-documented, effective behavioral strategies, such as the inclusion of trained peer models, theatre play techniques involving predictable (i.e., scripted) and flexible (improvised) role-play, and repeated performance of newly learned skills resulting in greater automaticity of behavior. Recent findings from a randomized control trial (RCT) show immediate between-group effects and evidence of target engagement on the hypothesized mechanism of action, memory for faces, which was evaluated by neuropsychological and event-related potential (ERP) measures. Moreover, the RCT demonstrated treatment effects on social communication skills that generalized to home and community settings. Finally, maintained treatment effects were observed on communication symptoms. The proposed project will extend these findings and provide a stronger test of efficacy using an RCT of SENSE Theatre with a sample of approximately 40 adult participants with ASD (18 to 35 years) randomized to experimental (EXP; N = 20) and a wait list control group (WLC; N = 20) in two separate cohorts. The RCT will assess target engagement of memory for faces and functional change in social interaction with peers using examiners blind to study treatment group assignment. The significance and size of treatment effects on these cognitive and behavioral outcomes will be measured using ANOVA and linear mixed models. Thus, the overarching aim of the study is to determine whether detected changes in face memory and social interaction are due to the SENSE Theatre® treatment and the extent to which these changes generalize and maintain. If predicted results occur, it will provide strong empirical support for a community-based treatment that has generalized effects on a set of core deficits that otherwise have life-long consequences for adults with ASD.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Tennessee
    • Nashville, Tennessee, United States, 37212
      • Vanderbilt University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 35 years (Adult)
• Accepts Healthy Volunteers: No

Description

ASD Inclusion Criteria:

• diagnosed with ASD based on DSM-V criteria (APA, 2013), by a psychologist, pediatrician or psychiatrist with expertise in ASD will be enrolled. ASD diagnosis will be corroborated by the Autism Diagnostic Observation Schedule (ADOS-2) (Lord, 2012).
• Only adults not currently supported by educational opportunities will be enrolled.
• Participants must have a full-scale IQ > or = 70 (WASI; (Wechsler, 2011))

ASD Exclusion Criteria:

• Adults with intellectual impairment (WASI; (Wechsler, 2011) score < 70.
• Participants with current, frequent and uncontrolled aggression toward other persons or property in the past 6 months will be excluded based on phone screening and questions from the Adult Behavior Checklist (Achenbach, 2001) (e.g., "Physically attacks people").
• Participants with evidence of suicidality based on care-provider report, self-report, or clinical interview (i.e., endorsement of suicidal ideation in the past month and/or suicidal behavior in the past three months on the Columbia Suicide Severity Rating Scale (Posner, 2011),
• Previous SENSE Theatre® participants will be excluded.

Care-giver Inclusion Criteria:

• must be at least 18 years of age
• must be a parent, close relative, or spouse of the adult participant with ASD.
• must be able to provide current and historical observations of the functioning of the participant with ASD.
• must live in close proximity to and have frequent contact with the participant with ASD.

Care-giver Exclusion Criteria:

- Anyone not meeting inclusion criteria.

Confederates Inclusion Criteria:

• must be at least 18 years of age
• typically developing individual with no neurodevelopmental disorder.
• must successfully complete training and demonstrate consistent administration of research protocols.

Confederate Exclusion Criteria:

- Anyone not meeting inclusion criteria.

Peers Inclusion Criteria:

• must be at least 18 years of age
• typically developing individual with no neurodevelopmental disorder.
• must have an expressed interest in supporting young adults and adults with developmental disabilities or ASD
• must successfully complete SENSE Theatre® training.

Peers Exclusion Criteria:

- Anyone not meeting inclusion criteria.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SENSE Theatre; A peer-mediated, theatre-based intervention designed to improve social cognition and behavior.	Behavioral: SENSE Theatre; A peer-mediated, theatre-based intervention that involves 10 sessions of approximately 3 hours each that culminates in a public performance.
No Intervention: Waitlist Control Group; This group will not receive the intervention during the testing phase of the intervention but will eventually receive the theatre intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Incidental Face Memory	An event-related Potential Task that presents 51 novel faces and 51 novel houses one of each is randomly selected and presented 50 times (repeated). We are examining an increase in amplitude of 250-500 ms time window between the repeated and single face presentation. Positive values indicate better face memory.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Change in Contextual Assessment of Social Skills	An observational assessment measure of social cognition and communication which includes two 3-minutes conversations with typically developing peers showing interested or bored demeanor. The behaviors are rated based on raw scores on a likert scale from 1 to 7 with 7 reflecting better ability. Only the Interested Condiiton was analyzed.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Change in Social Responsiveness Scale - Self (SRS)	The SRS is a standardized measure of social competence self-administered by participants pertaining to behaviors characteristic of adults with ASD. T-scores range from scores of 38 to 90 with a mean of 50 and a standard deviation of 10. Higher scores reflect greater impairment. T-scores were used in the analyses. A decrease in scores from pretest to posttest or follow-up suggests a better outcome.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Change in Social Responsiveness Scale - Other (SRS)	The SRS is a standardized measure of social competence administered by care-givers pertaining to behaviors characteristic of adults with ASD. T-scores range from scores of 38 to 90 with a mean of 50 and standard deviation of 10. Higher scores reflect greater impairment. T-scores were used in analyses. Decrease in scores from Pretest to Posttest or follow-up suggest better outcome.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cambridge Face Memory Test	A standardized measure of face memory with 72 items. Total raw score ranges from 0-72. Any increase in the raw score pertaining to the number of faces identified constitutes an increase in face memory.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Wechsler Memory Scale Face Memory Delay Test	A standardized measure of face memory in which the participant is exposed to 24 faces in which they must remember amidst an array of 48 faces presented after a 30-minute delay. Raw scores range from 0-48 and are converted to age-adjusted scaled scores ranging from 1 to 19 (Mean of 10 and standard deviation of 3). Higher scaled scores reflect better delayed face memory. Scaled scores were used for analyses.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Wechsler Memory Scale Face Memory Test	A standardized measure of face memory in which the participant is exposed to 24 faces in which they must remember amidst an array of 48 faces presented immediately. Raw scores range from 0-48 and are converted to age-adjusted scaled scores ranging from 1 to 19 (Mean of 10 and standard deviation of 3). Higher scaled scores reflect better face memory. Scaled scores were used for analyses.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Adaptive Behavior Assessment System (ABAS) - Self-Report Global Adaptive Composite	The ABAS measures adaptive living skills, completed via self-administration, using a Standardized Scale in which in which scores ranging from ~70 to ~120, with 85 to 115 reflecting the broad average range. Lower scores represent greater impairment.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
Adaptive Behavior Assessment System (ABAS) - Other-Report Global Adaptive Composite	The ABAS measures adaptive living skills, completed by a caregiver or partner, using a Standardized Scale in which scores ranging from ~70 to ~120, with 85 to 115 reflecting the broad average range. Lower scores represent greater impairment.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
State-Trait Anxiety Inventory (STAI) Scale	The STAI is a measure of current (State) and enduring (Trait) anxiety that is completed by the participant. There are 20 items for each domain on a 4-point scale (1 = Almost Never, 4 = Almost Always). Scores range from 20 to 80, with higher scores reflecting greater anxiety.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
The Adult Self Report (ASR)	The ASR is a 126-item self-report questionnaire assessing aspects of emotional health. T scores range from 40 to 100 with a mean of 50 and a standard deviation of 10. The primary variables of interest were Depressive Problems and Anxiety Problems. Higher scores indicate more depressive or anxiety problems. A T score of 70 or higher is considered clinically significant.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)
The Adult Behavior Checklist (ABCL)	The ABCL is a 126-item caregiver-report questionnaire assessing aspects of emotional health. T scores range from 40 to 100 with a mean of 50 and a standard deviation of 10. The primary variables of interest were Depressive Problems and Anxiety Problems. Higher scores indicate more depressive or anxiety problems. A T score of 70 or higher is considered clinically significant.	Change from baseline to end of treatment (Week 11) and at Follow-up (Week 21)

Collaborators and Investigators

• Sponsor: Vanderbilt University Medical Center
• Collaborators: National Institute of Mental Health (NIMH)
• Investigators: Principal Investigator: Blythe A Corbett, Ph.D., Vanderbilt University Medical Center

Publications and helpful links

General Publications

• Corbett BA, Key AP, Klemencic ME, Muscatello RA, Jones D, Pilkington J, Burroughs C, Vandekar S. Investigating Social Competence in a Pilot Randomized Clinical Trial of a Theatre-Based Intervention Enhanced for Adults with Autism Spectrum Disorder. J Autism Dev Disord. 2025 Jan;55(1):130-146. doi: 10.1007/s10803-023-06214-0. Epub 2023 Dec 18.

Study record dates

Study Major Dates

• Study Start (Actual): October 21, 2020
• Primary Completion (Actual): March 15, 2024
• Study Completion (Actual): March 30, 2025

Study Registration Dates

• First Submitted: April 14, 2020
• First Submitted That Met QC Criteria: April 14, 2020
• First Posted (Actual): April 16, 2020

Study Record Updates

• Last Update Posted (Actual): January 29, 2026
• Last Update Submitted That Met QC Criteria: January 28, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: autism; social competence; theatre
• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Child Development Disorders, Pervasive; Behavior; Social Behavior; Autism Spectrum Disorder; Autistic Disorder; Social Skills
• Other Study ID Numbers: 192271; 1R33MH120149-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No