The Impact of South Asian Dance on Engagement,Independent Movement and Social Skills for Autistic Children

Key Points

Introduction

Autism spectrum disorder (ASD) can be classified as a neurodevelopmental condition that can impact upon a child’s cognitive, social and adaptive skills.^1,2 Currently the National Autistic Society suggests that there are approximately 700 000 autistic adults and children in the UK, ³ equating to more than one in 100 people living with the condition which can include compulsions, echolalia, motor stereotypes, comorbid psychiatric disorders and difficulties with social and emotional behaviour including empathy, social understanding, aggression and non-compliance. ⁴ It has also been suggested that perceptions of pain or the ability to communicate pain is also reduced or not taken seriously, and thus the physical health needs of neurodivergent young people may be overlooked. ⁵

ASD is a condition with unique strengths and challenges and those diagnosed with it may face reduced wellbeing due to difficulties with social interactions and communication. ⁶ Recent research has focused on social cognition and the importance of experiential knowledge in order to develop interpersonal interactions. ⁷

Multiple studies have evidenced the benefit of complementary therapies and interventions for children with ASD including speech-language therapy, occupational therapy, behavioural therapy, and psychosocial therapy. However, the cost of such interventions from an early age is often extremely expensive for families as they require highly trained specialists and one-to-one support.^4,8 Furthermore, empirical results from these types of interventions have varying degrees of support. ² The impact of ASD can be felt throughout the family as caring for a child with the condition can be challenging and time-consuming. As a result, parents often seek additional support through external interventions to support their children. ⁶

There is a need to look at other more cost-effective therapies to help individuals with ASD cope better with their symptoms. Modes of exercise including arts-based activities such as dance could be a useful tool in helping to manage symptoms and improve social interactions and communication, but in a cost-effective way with minimal or no equipment needed.

Physical activity (PA) has been suggested as an appropriate therapeutic activity for autistic children with studies demonstrating how physical exertion can lead to reduced problematic behaviours and increased appropriate behaviour, as well improvements in locomotor skills, muscular strength and endurance. ² A systematic review ⁴ evidenced how exercise appears to benefit children with ASD by reducing stereotypic behaviours and improving social-emotional functioning while also referencing research that demonstrates activities such as jogging may be useful for cognition and attention. ⁹ However, the authors ⁴ point to some key methodological challenges in the field including a large variability in the types of interventions as well as the frequency, duration, intensity, and dosage, therefore making it difficult to fully understand the varying benefits of exercise and PA for autistic children. In addition, there has been much discussion as to the benefits and drawbacks of group-based interventions versus individual based activities. ² Although counterintuitive, greater improvements were seen in social behaviours when children experienced individual-based interventions, perhaps due to a reduction in unpredictable events by others, which may induce feelings of stress. ²

In addition to the benefits of PA including reduced risk of obesity and reduction of maladaptive behaviours, improvements to motor skills have been positively linked with social skills. ² Dance incorporates fine motor skills, particularly when focusing on mudras (hand gestures) in South Asian Dance. It could therefore be posited that the combination of PA and fine motor control seen in dance interventions, may foster benefits in social skills, reduction of stereotypical behaviours as well as improvements to physical health and wellbeing.

Over the past 20 years, research has seen an interest in dance as a complementary therapy for autistic children. Whilst most interventions seek to imbue socially acceptable norms and modes of communication on the children or focus on problems rather than enhancing their strengths, ⁶ dance by its nature encourages individual expression through bodily movement and thus may provide autistic children with another avenue to communicate and develop interpersonal skills. ¹⁰ A systematic review by DeJesus et al ¹ found dance to have a positive effect on ASD symptoms including social involvement, body awareness, communication and behaviour, however with fewer studies focusing on dance in comparison to other forms of PA such as martial arts, further research is required. ²

Several studies and systematic reviews have been conducted over the past decade looking at how dance therapy, or Dance Movement Psychotherapy (DMP) as it is known in the UK, may be of benefit to autistic individuals.^1,11-13 These studies have found dance therapy can improve “negative symptoms, social interaction, and empathy of individuals with ASD” (p. 2). ⁸ However, in connection to limitations discussed above regarding exercise interventions, research has noted similar methodological challenges with a large variability in frequency and duration of classes as well as a wide range of different measurements and scales being used to assess variables.

Whilst the benefits of mirroring and other DMP techniques that emphasise kinaesthetic empathy have been stated as beneficial, the value of these techniques has been largely anecdotal. ⁶ Additionally, although DMP has been the main focal point for many studies in the field looking at dance for autism, there has been a lack of research focusing on dance as an artistic, and joyous practice for this group of people. Recent literature has clearly distinguished between DMP and Dance for Health (DfH) contexts with the latter defined as providing a “holistic, evidence-based activity for the individual to manage and adapt to physical, mental, and social health changes. In DfH sessions, trained teaching artists engage people as dancers, rather than patients, in joyful, interactive, artistic practice”. ¹⁴ There is a need to look more broadly at how different cultural and community dance practices can potentially benefit autistic children and help improve quality of life.

The aim of this research was to understand the potential impact of dance and movement classes influenced by South Asian Dance forms including Kathak, Bharatanatyam, Odissi and Bollywood for autistic children. The research focused specifically on the impact of these dance forms in relation to engagement, independent movement (ability to carry out actions without the need for physical assistance to move the body), and social skills. As far as the authors are aware this is the first research to investigate these specific dance genres in relation to Autism. Furthermore, the article advocates for a collaborative research design that focuses on the individual and their experiences and progressions within the dance setting.

Methods

Results

Response rates to the strengths and difficulties questionnaire were higher amongst teachers with 75% (N = 12) for January and 94% (N = 15) in July, compared with parent response rates of 50% (N = 8) for January and 13% (N = 2) for July. In January, 31% (N = 5) were completed by both parent and teacher, and 13% (N = 2) in July. This lower response rate from parents compared with teachers reflects earlier research by Salomone et al ²¹ who recorded a 48.6% response rate for teachers, 6.8% for parents and 44.6% for both, albeit with a much greater overall sample size of 615 participants. Both teachers and parents received reminder prompts to complete the surveys, with teachers also receiving additional prompts from the assistant headteacher which may have resulted in the higher adherence.

The SDQ can be further broken down into subscales of emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviour. Table 1 displays descriptive statistics for these subscales. The greatest scores in the present study occurred under the hyperactivity and peer problems subcategories, however scores were consistently greater than UK population normative data ²⁰ and in line with measures amongst other autistic young people in the Pan London Autism Schools Network (PLASN) study. ²¹

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Table 1.

Descriptive Statistics for Strengths and Difficulties Questionnaire Subscales.

	Teacher				Parent
Subscale	January 2024 (N = 12)	July 2024 (N = 15)	PLASN	ONS a	January 2024 (N = 8)	July 2024 (N = 2)	PLASN	ONS a
Emotional problems	3.25 ± 1.22	3.33 ± 1.11	3.32 ± 2.47	1.8 ± 2.0	2.63 ± 2.20	3.50 ± 0.70	3.67 ± 2.29	1.4 ± 1.9
Conduct problems	2.42 ± 1.08	2.53 ± 1.36	2.43 ± 1.97	1.7 ± 1.8	3.25 ± 1.91	3.50 ± 0.70	2.70 ± 1.82	1.2 ± 1.8
Hyperactivity	7.50 ± 1.68	8.07 ± 1.79	6.20 ± 2.73	4.0 ± 2.7	8.50 ± 2.00	7.00 ± 0.00	6.75 ± 2.37	3.7 ± 3.0
Peer problems	6.33 ± 1.37	5.67 ± 2.29			5.88 ± 1.81	5.50 ± 3.54
Pro social	1.42 ± 1.51	2.60 ± 1.84			3.50 ± 1.85	2.50 ± 3.54
Total difficulties	19.5 ± 3.03	19.6 ± 5.25			20.0 ± 6.05	19.5 ± 4.95

Abbreviations: ONS, Office for National Statistics; PLASN, Pan London Autism Schools Network. ²¹

a

ONS British data for the 5 to 15-year-old male sample. ²⁰

Dance Artist Reflective Logs and Content Analysis

The dance artist working within the school provided detailed and regular logs with complete adherence throughout the academic year. This provided a rich overview of the young people’s experience of their dance classes. The below points outline the key patterns that emerged through the content analysis:

Engagement and focus improved but fluctuated for many learners and were dependent upon other personal and environmental contextual factors (emotions, avoidance behaviours, other peers, different dance spaces, noise level).

Engagement and focus improved when the dance artist remained flexible in approach and adapted to the individual learner (reducing volume of music, moving from group to 1:1 lessons, moving at a faster pace with quick changes or moving and speaking more calmly to match the learners needs).

Independency in movement improved for many and this led to a wider movement vocabulary with learners being able to attempt and demonstrate many different actions without the need for physical support.

Many participants improved in their ability to fully and accurately demonstrate the movements. Bilateral Coordination improved for some learners however this only happened when engagement and focus were consistently good.

Some learners experienced reduced levels of avoidance behaviours during the dance sessions (less running around, trying to escape the room, climbing on furniture, or picking up unrelated objects).

Partner work appeared to help improve levels of engagement for many learners. Some became more confident, leading partnered movement, and were more willingly dancing with other support staff or the dance artist.

Figure 1 provides further clarification regarding exactly how many learners saw improvements in specific coded areas based on the artist feedback.

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Figure 1.

Overview of improvements in coded areas.

Improvements in range/quality of movement and movement competency from the majority (14) of learners can be seen with many learners demonstrating improved range of motion in the dance specific movements included in the sessions that encourage overhead reaching and full extension of the limbs. Many of the learners (12) also saw improvements in engagement and focus as well as in their independence in movement (13).

Analysis demonstrated that approximately half of the learners saw improvements in their bilateral coordination. However, developments in coordination as well as improvements in movement competency were reliant upon good levels of engagement and focus.

Notes from the dance artist demonstrated how partner work often helped learners to engage better with the dance material and further helped learners to develop movement confidence as they would sometimes lead the partnered movement or begin to partner with other people, such as different members of staff or the dance artist. Furthermore, some learners became better able to verbally and physically remember and demonstrate movements that they enjoyed doing without the need for prompting.

Adherence to completing the logs was 100%, with the dance artist able to provide detailed and consistent feedback for the learners across these two terms of dancing. It is thought that a combination of frequent communication between the researchers, host institution and the dance artist encouraged the strong adherence, however it is also due to circumstance and the space and time that the artist had to give to the project during those months. The ability of the artist to continue providing such rich and detailed data across a longer time period is a consideration for further longitudinal work.

Discussion

Dance provides a combination of movement and music, aiding children with rhythmic motor coordination, social interaction, acoustic stimulation, balance and memory, affection and emotions. ²² It has also been suggested that improvements in motor control are linked with improved social skills and reduction of stereotypical behaviours. ² The results to date from this preliminary study indicate that dancing led to individual improvements in co-ordination, range of motion, independence of movement, focus and engagement. However, due to the nature of this study and the inability to control multiple variables in their school environment, causality cannot be confirmed in relation to the dance activity.

Research has noted motor impairments in autistic children with substantial deficits in basic motor control skills including poor postural control, difficulty with bilateral co-ordination, object control, and visuo-motor integration skills. ²³ Therefore, a focus on the development of these motor skills can have significant impact on the child’s quality of life. The biggest perceived improvements in dance class as noted by the dance artist were observed in range of motion and movement competency. Difficulties with utilising full range of motion, particularly in relation to elbow extension and shoulder flexion, were noted by the dance artist and thus incorporated into the class objectives. Improving range of motion can have significant real-life application in relation to activities that can be challenging for autistic children such as toileting and maintaining personal hygiene, as well as reaching objects at a height such as a high shelf or cupboard. ²⁴

Regarding independent movement, as the dance artist encouraged the learners to expand their movement vocabulary and push beyond what they are normally asked to do in their everyday lives, they appeared to be growing more aware of their physical capability and were better able to accomplish these movements independently without as much need for physical support. Franciane dos Santos Silveira et al ²⁵ reiterate the importance of interventions that focus on the achievement of functional independence and quality of life improvement noting that clinical features of autism can increase the level of functional dependence requiring “greater demand for parental care and professional interventions” (p. 284). ²⁵

Physical activity has been shown to improve cognition skills in pre-school children, particularly in relation to attention, memory and behaviour ²⁶ with improvements in motor skills also positively linked with social skills. ² Over the course of the study, reductions in avoidance behaviour can be seen in the children, as well as greater focus and engagement in the dance activity. However, focus often fluctuated week on week for learners depending on their general mood and emotions on that day as well as other contextual factors such as the environment, objects/furniture in the surrounding space, noise level and distraction from other learners. The dance artist continually made adjustments and used tools to help guide engagement and focus back into the space during times of distraction. For instance, when learners were sensitive to noise, the dance artist would reduce the music volume and adjust her voice to encourage a calm space. Furthermore, when the artist sensed that the learner(s) needed to continually move around the room to remain engaged, she would adjust the material accordingly to match what the learner needed, sometimes even moving to the floor if the learner was falling to the ground. The ability of the artist to remain flexible and adapt in the moment resulted in gradual diminishing of avoidance behaviours and greater engagement and focus across time, again highlighting the importance of individualised and responsive classes. Furthermore, the children attended dance classes either individually or as a group activity, and this was adapted depending on the dance artist’s observations of their progress. In some instances, a child became distracted or distressed by other learners in the room and was therefore moved to a 1:1 class to enable better engagement and reduce emotional distress. As noted by Sefen et al, ² learning in a 1:1 environment actually helped to improve social skills, perhaps due to decreased stress levels in relation to other learners. It is therefore important that dance interventions are adapted to the needs of the individual.

If the learners were not engaging well or demonstrated avoidance behaviours such as trying to run around the room, pick up objects, or leave the room, they were not as likely to develop aspects such as coordination, quality and range of movement or movement competency. This suggests a developmental approach to dance or exercise activities for autistic children, with a focus on engagement and focus in the preliminary stages, moving to rhythm and coordination at later stages.

A multi-informant approach to the use of the SDQ has been recommended, most commonly including teachers and parents, providing an overview of psychometric properties, however interpretation of the subscale values should be treated with caution as they have demonstrated weaker reliability and validity. ¹⁹ The results of the SDQ reflect the findings of Salomone et al ²¹ who focused on the subcategories of emotional problems, conduct problems and hyperactivity and found both parent and teacher results to be higher than the UK wide population survey. The results of these subscales can also be categorised into a three-band categorisation of “Normal”, “Borderline” and “abnormal” with the latter being defined as the top 10% of a UK based population survey. ²⁰ In addition to the similarities with Salomone et al ²¹ our results showed parent and teacher scores for the subcategories of peer problems and pro-social fall into the abnormal score.

Although the results of the SDQ substantiate the need for further support for these learners due to these higher scores, the results of the strengths and difficulties questionnaire do not provide enough detail of the individualised journey of each learner. As is apparent from the heterogeneity of these results, progress was not always linear for these learners. Examining the mean of a group of autistic learners masks the fluctuations in these subcategories for individuals across time, however does provide an opportunity to compare these results with previous studies in autistic populations and UK wide population data. It was hoped that gathering perceptions of the children’s strengths and difficulties from parents and teachers across time would demonstrate adaptations to certain behaviours as a result of the dancing, however it is clear from the results that these alterations may currently be short-term as the dancing is integrated into their school life and as such results may fluctuate across time. Despite apparent differences in perceptions between parents and teachers, these findings are common amongst previous SDQ studies^19,21 and underline the importance of garnering these measures from various individuals involved in different areas of the child’s life. These results may also be impacted by current circumstances for the individual such as the learning environment, family or changes to medication which are not apparent through these results. For example, one learner changed medication mid-term which impacted upon their focus and levels of hyperactivity whilst they became accustomed to their medication. It was however not within the scope of this study to gather data relating to individualised medication plans. Small sample sizes due to response rate also render statistical analysis difficult due to low power and therefore providing any meaningful statistical analysis. It may be that greater longitudinal data is required to see change over time in relation to behaviours in this population.

However, individualised, qualitative analysis of an autistic child’s journey is imperative for designing interventions and learning strategies that seek to develop the child’s pre-curriculum behaviour, engagement and social skills, and centre the child’s needs and experiences. Although perceived as “gold-standard”, it should be acknowledged that randomised control trials, particularly those that move autistic children to unfamiliar settings for analysis, may not be appropriate for this population, nor truly represent the autistic children’s experience due to the alteration to their familiar daily structure and amalgamation of results in a heterogeneous population. Here we advocate for detailed case studies that investigate on a more granular level, the arts activities and learning environments that allow autistic children to thrive.

Methodological Challenges

The nature of this research posed some methodological challenges, laying research into an existing learning environment with an attempt to avoid the research from impacting on the dance activity and thus the learners’ experience of dancing. As the learners had been dancing prior to the start of data collection it is therefore possible that the notable change happened mainly in the term before data collection when the dance artist first started working with the learners. As a result, we may have not captured some useful change and benefit that took place earlier in their dancing journeys.

The SDQ requests the respondent to complete the survey reflecting on the previous 6 months in the first instance, and over the previous month in the follow-up questionnaire. However, responses were submitted across multiple weeks from both teachers and parents due to busy schedules, and there were many incomplete or non-submissions, particularly from the parents. While the researchers were able to connect directly with the parents via email to ask for their support in completing the questionnaires, it could be that these emails were one of many coming from the school and therefore were ‘lost in the mix’. Furthermore, busy schedules and family life are considerations for future research that wishes to rely on parent involvement for data collection purposes. Teachers on the other hand also received prompts from the assistant headteacher and may have therefore felt more of a duty to complete the survey as part of their job role. Additionally, teachers initially attempted to reflect only on the learner’s dance class despite not being present, rather than their behaviour more widely across the school day. Emails were subsequently sent to teachers to remind them that the aim was to reflect on the learners in the school setting outside of the dance class.

Conclusions

Due to the nature of this research within an existing educational environment and fluctuations in participant circumstances and behaviour, this research took an iterative approach to research design. Perceived improvements have been noted in coordination of arms and legs (homolateral and contralateral movement), range of movement vocabulary, movement quality and competency, extension of limbs and independence in movement. Many of these movements are also linked to daily activities that the children may struggle with such as toileting, twisting, reaching to pick things up. These are important considerations when designing a movement-based intervention for autistic children, as well as the ability to adapt each class to the individual’s needs.

Results of the SDQ indicate similar levels of difficulties in relation to areas such as hyperactivity, peer problems and emotion problems, but also reveal significant variance in results that may mask fluctuations in the child’s development. These results highlight the non-linear progress of autistic children, rendering measurement of improvement difficult over short time periods.

Implications

As autism and the dance classes are experienced differently by each individual, generalising findings through statistical methods would not be appropriate. Instead, each learner needs to be considered at an individual level to ascertain the impact and potential benefits of participating in a dance-based intervention. As such, broad statements pertaining to the outcomes of an intervention must be considered with caution when viewing results across literature in this field.

Further research with this group of participants will focus on the generalisation of these skills developed within the dance class into other real-world settings including curriculum classes and home life. It is recommended that future research further investigate the individualised nature of autistic learners’ experience of dancing in relation to their own unique diagnosis as well as developing longitudinal data that provides a clearer picture of progressions and regressions of these learners over time. This in turn can lead to child specific interventions to elicit the most beneficial results for that child.