The Hunter Heartbeat Method: Evaluating the Impact of a Theater-Based Intervention on Children on the Autism Spectrum

BACKGROUND AND PURPOSE: The Hunter Heartbeat Method (HHM) is a theater-based intervention that addresses the communicative challenges of people with autism spectrum disorder (ASD). HHM uses games related to Shakespeare’s plays that target eye contact, physical and spatial awareness, turn taking, facial emotion skills, and social skills (Hunter, 2015). Mehling et al. (2016) demonstrated improvement in participants’ communication through facial expression recognition, communication skills, social skills, and language use after an HHM intervention.

The purpose of this study was to explore HHM’s effect on the production of facial expression in children with ASD using Shakespeare’s plays. The use of Shakespeare’s plays as the strategic method is important because of the common themes of the sensations of being alive, expressing feelings, thinking, seeing, and loving (Hunter, 2015). These themes are directly related to the core features of autism, and the games incorporated in the HHM use the rhythm of the iambic pentameter to explore movement and the emotions and vocal expressions of Shakespeare’s characters (Hunter, 2015).

METHOD: This study used a pretest–posttest within-group design. Participants were nine children with ASD aged 7–14 who were able to verbalize and participate in an after-school program. Pictures of the children’s faces were taken before, during, and after the HHM intervention. A facial expression engine (Emotient FACET; iMotions, 2016) was used to analyze pictures of the children’s expressions. Using the raw expression scores exported by the program, children’s facial expressions were compared to thousands of others through a technical database that produces score values for each emotion and allows comparison over time of each child’s ability to produce various facial expressions (iMotions, 2016).

Descriptive statistics and within-group comparisons across trials were used to examine differences in mean expression scores as a function of exposure to intervention. A one-way repeated measures analysis of variance for each emotion was used to test whether the use of the HHM was effective.

RESULTS: Across the sample, significant differences were found in anger expression; significantly less anger expression occurred at Time 1 (M = –2.00 ± 1.45) compared with Time 3 (M = –0.85 ± .80; p = .04). Although other facial expressions did not produce significant results, there was an upward trend in joyful and disgusted faces for the sample. These results offer valuable information about how this intervention can affect facial expression production in people with ASD.

CONCLUSION: These results suggest that using this specific theater-based intervention may be an effective method for helping children learn how to modulate their emotional expressions, at times difficult for a population who often demonstrate deficits in social skills and emotional regulation. Both skills are critical for performance of everyday activities and success in social participation. Occupational therapy practitioners are in a unique position to use this unique occupation-based method to assist children with ASD with their social skills, facial expressions, and emotional regulation in order to be successful in everyday performance.

References

Hunter, K. (2015). Shakespeare’s Heartbeat: Drama games for children with autism. New York: Routledge.

iMotions. (2016). Facial expression analysis: Pocket guide. Retrieved from https://imotions.com/wp-content/uploads/Guides/iMotions_Guide_FacialExpressions_2016.pdf

Mehling, M. H., Tassé, M. J., & Root, R. (2016). Shakespeare and autism: An exploratory evaluation of the Hunter Heartbeat Method. Research and Practice in Intellectual and Developmental Disabilities, 4, 107–120. https://doi.org/10.1080/23297018.2016.1207202