A Magic Trick Training Program to Improve Social Skills and Self-Esteem in Adolescents With Autism Spectrum Disorder

Abstract

Importance: Low social competence is one of the most complex and resistant challenges faced by adolescents with autism spectrum disorder (ASD). Occupational therapy practitioners have recognized the potential benefits of using the arts, including training in magic tricks, as a therapeutic medium to improve and enhance clients’ psychosocial well-being.

Objective: To describe the efficacy of a virtual magic trick training program (MTTP) to enhance social skills and self-esteem in adolescents with ASD.

Design: Pragmatic, nonrandomized, wait-list controlled trial with 1-mo follow-up.

Setting: Participants’ homes.

Participants: Seventeen adolescents (ages 9−15 yr) with ASD participated in the MTTP, 9 in the first cohort and 8 in the second (wait-list control) cohort.

Intervention: Participants received magic trick training from occupational therapy students in pairs via videoconferencing in 45-min sessions, 3 days/wk, for 3 wk.

Outcomes and Measures: Participants completed the Rosenberg Self-Esteem Scale and the Social Skills Improvement System before and after participating in the program.

Results: Between-cohort effect sizes (Cohen’s d) were 0.58 for social skills and 0.66 for self-esteem, considered moderate effects. Combining the two cohorts revealed significant improvements in social skills and self-esteem, with gains maintained at 1-mo follow-up.

Conclusions and Relevance: The results of this study support our hypothesis that adolescents with ASD who participate in the 3-wk virtual MTTP can experience enhanced social skills and self-esteem.

What This Article Adds: Learning magic tricks through individual coaching from occupational therapy students in a virtual environment can enhance the social skills and self-esteem of adolescents with ASD.

Adolescents with autism spectrum disorder (ASD) who participate in a virtual magic trick training program (MTTP) through individual coaching from occupational therapy students or practitioners can experience enhanced social skills and self-esteem.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by significant difficulties in social communication, social–emotional reciprocity, and social relationships with peers, as well as deficits in nonverbal communicative behaviors used in social interaction (American Psychiatric Association, 2013). As children with ASD enter adolescence, increased demands for social interaction make their deficits in social competence more prominent (Picci & Scherf, 2015). Adolescents with ASD may become more aware of their social difficulties and lack of friends despite repeated attempts to interact with peers (Mendelson et al., 2016). As a result, many develop social anxiety (Hammond & Hoffman, 2014) and secondary psychological disabilities, such as social withdrawal, isolation, and poor self-esteem (Menezes & Mazurek, 2021; van der Cruijsen & Boyer, 2021). In addition, many adolescents with ASD are unable to navigate their social milieu smoothly because of their poor peer interaction skills (White et al., 2009). Consequently, they may be rejected by peers or become targets of bullying, which increases their risk for mental health issues (Hu et al., 2019). Therefore, it is important that occupational therapy practitioners find ways to help this client population improve their social competence (Kasari & Smith, 2013).

Few effective treatments have been found for low social competence in adolescents with ASD. In school settings, these adolescents typically receive traditional social skills interventions to build social competence skills (Dean & Chang, 2021); in clinic settings, they most often receive evidence-based individual or group social skills interventions (Gates et al., 2017; Tanner et al., 2015; Wolstencroft et al., 2018). Group social skills interventions conducted in clinic settings are effective, but their benefits seldom translate to authentic daily social environments, such as home and school (Dean & Chang, 2021). School-based social skills interventions have been found to have a positive but small overall effect for enhancing social competence (January et al., 2011). Further, only limited evidence indicates that adolescents are able to generalize the skills acquired in school to their natural environments (Dean & Chang, 2021). Therefore, additional effective interventions that supplement school-based services are needed to improve these clients’ social skills before they enter adulthood.

Growing evidence indicates that the use of arts and art therapy as a supplementary treatment approach can help children and adolescents with ASD improve their social skills and psychological well-being (Bosgraaf et al., 2020). Occupational therapy is rooted in promoting engagement with arts and crafts as an essential component of practice (Lloyd & Papas, 1999). Engaging in arts-based interventions offers clients a means to support the development and deepening of social relationships and to improve communication and self-expression (Durocher et al., 2022; Lloyd & Papas, 1999). One therapeutic arts-based intervention that has shown promise for improving social competence in adolescents with ASD is learning magic tricks (Wiseman & Watt, 2018).

The Model of Human Occupation (MOHO; Kielhofner & Forsyth, 1997) provides a framework to explain how adolescents are motivated (volition) to engage in the occupation of performing magic tricks. Continued practice (habituation) allows adolescents to develop the skills to master magic tricks so that performing them becomes routine. Repeated performance of magic tricks can improve adolescents’ perception of their performance capacity, or physical and mental competence required to execute the tricks for others in a social and physical environment that supports their engagement. As conceptualized in the MOHO, when adolescents learn and perform magic tricks that were carefully selected to help ensure their success and then perform those tricks for others, their self-esteem improves. Consistent with the MOHO, we expected that engaging adolescents in the occupation of performing magic tricks would enhance their physical abilities and function and their social communication skills (Lim & Rodger, 2008).

Preliminary studies have provided evidence that adolescents with disabilities, including ASD, who participate in learning magic tricks in an organized MTTP can experience enhanced social motivation, self-confidence, self-esteem, social communication, and comfort levels when interacting with peers in social situations (e.g., Spencer, 2012). Thus, the positive impact of learning magic tricks on the psychological well-being of adolescents with ASD may offer a protective mechanism against their low social competence (Cooper et al., 2017). However, participants in these preliminary studies included adolescents with diverse developmental disabilities (Spencer, 2012). In addition, the researchers included all adolescents who participated in the programs in the data analysis without separating them into groups with specific conditions and diagnoses (Spencer, 2012). As a result, it is unclear whether learning magic tricks can enhance social skills and self-esteem specifically in adolescents with ASD.

The purpose of this pilot study was to evaluate the immediate effect of a 3-wk virtual MTTP (via Zoom videoconferencing) on social skills and self-esteem in adolescents with ASD. We hypothesized that participants would show gains in social skills and self-esteem after participating in the program. Additional objectives of this pilot study were to estimate the standardized effect size of the virtual MTTP as the basis for determining a sample size with sufficient statistical power for a full-scale randomized controlled trial (RCT) and to assess whether participants maintained any gains at 1-mo follow-up.

Method

Design

We used a pragmatic, nonrandomized, wait-list controlled trial with a 1-mo follow-up. The University of Alabama at Birmingham (UAB) institutional review board approved the study (IRB-300005328). The trial was registered at ClinicalTrials.gov (NCT04840498) before enrollment of the first participant.

Participants

The Department of Occupational Therapy in the UAB School of Health Professions, the UAB Institute for Arts in Medicine, and Hocus Focus, Inc., hosted a virtual MTTP for children with disabilities in summer 2021. We recruited participants through flyers posted on the websites of community agencies that served children with disabilities and through word of mouth on social media.

The requirements for participants to attend the virtual MTTP were as follows: (1) age 9–18 yr, (2) ability to follow at least two or three verbal instruction steps in English to complete a task, (3) ability to remember a simple sequence of actions to execute a task, (4) functional verbal communication, (5) attendance at a regular school, and (6) provision of documented evidence of a developmental disability diagnosis. The exclusion criteria were (1) a severe visual or hearing disorder that prevented learning and carrying out magic tricks and (2) lack of access to the Internet or a computer or smartphone enabled for web browsing.

Virtual MTTP Program

Participants had two opportunities to participate in the 3-wk virtual MTTP in summer 2021; the first session was held June 7−25 and the second July 12−30. Participants’ parent (or guardian or caregiver) chose the session in which to enroll the child. If a parent had no preference, research staff flipped a coin to randomly assign the child to a session. The virtual MTTP was open to all children with disabilities free of charge. Because the focus of this study was on adolescents with ASD, only children with this diagnosis were enrolled. The only difference between study participants and nonparticipants was that participants were required to complete assessments at three time points: the beginning of June (T0), the end of June or beginning of July (T1), and the beginning of August (T2). Study participants received a payment of $30 after completing the study. Table 1 provides a summary of the study design and assessment timeline.

Table 1.

Study Design and Assessment Timeline for the Magic Trick Training Program

Time Point	Intervention Cohort	Wait-List Control Cohort
Wk 1 (T0)	Preprogram baseline assessment	First preprogram baseline assessment
Wk 2–4	3-wk MTTP	3-wk wait period
Wk 5–6 (T1)	Postprogram assessment	Second preprogram baseline assessment
Wk 7–9	3-wk wait period	3-wk MTTP
Wk 10 (T2)	1-mo follow-up assessment	Postprogram assessment

Note. MTTP = magic trick training program; T = Time.

Approximately 2 wk before the June MTTP start date, a professional magician (Kevin Spencer) trained a group of UAB occupational therapy graduate student coaches via Zoom to teach selected magic tricks to participants. During the virtual training session, the magician demonstrated the magic tricks and taught the student coaches how to do them. The training session lasted about 2 hr and was recorded so students could review it afterward. The magician also produced a short training video for each magic trick that was made available to the students (see the Supplemental Appendix, available online with this article at https://research.aota.org/ajot, for examples of magic tricks and training videos).

Pairs of student coaches evaluated each other’s magic trick performance using the validated Hocus Focus Magic Performance Evaluation Scale to ensure that they could perform the magic tricks competently and deliver them consistently and reliably (Spencer et al., 2019). The student coaches completed the peer performance assessment as part of an occupational therapy nonthesis research course requirement.

A week before the program, we sent a magic kit to participants’ parents through the mail. The kit contained all items required to perform the tricks, including a deck of cards, rubber bands, two 40-in. lengths of rope, crayons, and a magic wand. The student coaches then communicated with participants’ parents to arrange weekly meeting times for the virtual MTTP sessions. These sessions typically lasted 45 to 50 min, depending on the participant’s attention span and skill level in learning the tricks. Participants attended the program 3 days/wk (Monday, Wednesday, and Thursday or Friday) for 3 consecutive wk. Their total time spent in MTTP sessions was approximately 7 hr.

The MTTP took place through Zoom because of the social distancing requirements of the COVID-19 pandemic. During these sessions, the student coaches demonstrated and taught magic tricks to the participants individually to ensure that the participants achieved mastery of each trick. Participants learned an average of two new magic tricks on Monday and Wednesday (i.e., 3−4 tricks/wk). If participants mastered all assigned tricks, the magician taught the student coaches more challenging magic tricks, which they then taught the participants. The students made modifications to the tricks as needed to meet participants’ perceptual, cognitive, and motor skills limitations.

The student coaches encouraged the participants to practice the magic tricks after each session and to perform them for friends and family. The student coaches typically reviewed previously taught tricks with the participants in the following session. The last session of each week (i.e., Thursday or Friday) was designated as a social opportunity for small groups of participants and their student coaches to gather virtually (each group included three participants and three pairs of student coaches). In these sessions, the participants performed the magic tricks for one another and could meet and socialize with the other participants. The student coaches did not teach the participants new tricks during these sessions or ask them to follow any scripted instructions, to allow the participants to practice generalizing their learned skills to a less structured environment.

Social–Emotional Learning Approach

The virtual MTTP was constructed using the social– emotional learning framework developed by the Collaborative for Academic, Social, and Emotional Learning (CASEL; Lawson et al., 2019). The MTTP was designed to address the five core competencies identified by CASEL as essential to human development (Lawson et al., 2019): self-awareness, self-management, social awareness, relationship skills, and responsible decision making. Adolescents with ASD must develop these skills to achieve social competence (Zins et al., 2007). The MTTP helps learners develop the five competencies in the following ways:

Self-awareness: Learning and practicing magic tricks in a group setting gives learners opportunities to recognize their emotions and thoughts as they move through the frustrations and joys of acquiring a new skill. Success confers a sense of self-efficacy and confidence.

Self-management: Learning a magic trick requires learners to set a goal, be resilient, and manage their emotions.

Social awareness: Participation in the MTTP encourages meaningful social interactions and recognition and implementation of the codes of social conduct. Watching a peer perform a magic trick increases learners’ empathy, allows them to identify with peers with different abilities, and creates commonalities as learners come to understand and appreciate differences.

Relationship skills: Participation in the MTTP is a collaborative experience involving active listening, understanding, and appropriate responding. Acquiring these skills can help learners communicate effectively with words, body language, facial expressions, and gestures and to understand turn taking.

Responsible decision making: Learning to perform magic tricks as a group activity encourages learners to follow directions and engage in problem solving.

Procedures

Approximately 1 wk before the first day of the June program, we invited participants with ASD to participate in our research component, which involved completing the study assessments at three time points. Participants and their parents provided signed assent and consent, respectively, before beginning participation in the research component, and the parents provided participants’ background information. In individual Zoom meetings, the occupational therapy student pairs assisted participants in completing the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965) and the Social Skills Improvement System (SSIS; Gresham & Elliott, 2008). Participants either read the questions independently through screen sharing with the student coaches or listened as a student read the questions. The students entered all participants’ responses online.

Regardless of their program cohort (i.e., June or July), all participants completed the assessments at the same time. They completed the baseline assessment (T0) before the first day of the June program (June 7), the second assessment (T1) at the completion of the June program, and the third assessment (T2) at the completion of the July MTTP (see Table 1). The participants and student coaches had no access to participant responses after each measurement.

Outcome Measures

We measured social skills using the child self-report version of the SSIS (Gresham & Elliott, 2008). The SSIS measures aspects of social skills in children and adolescents suspected of having significant social difficulties. Children rate 46 items on a 4-point Likert scale that indicates how true each social skill is for the child (0 = not true to 3 = very true), with higher scores indicating better social skills. The SSIS manual provides extensive evidence of the sound psychometric properties of the measure, which include strong reliability and validity (Gresham et al., 2011). The SSIS is one of the most commonly used standardized self- report social skills assessments to measure social functioning in children and adolescents with ASD and has been recommended for use in the evaluation of social deficits in this population (Otero et al., 2015).

We measured self-esteem using the RSES (Rosenberg, 1965), which consists of 10 items quantifying respondents’ feelings about themselves on a 4-point scale (1 = strongly agree to 4 = strongly disagree). After reverse scoring five items, examiners total the responses to form a summation score ranging from 10 to 40, with larger scores indicating higher self-esteem. The RSES is used widely as a validated outcome measure to evaluate psychosocial programs aimed at improving self-esteem in adolescents with ASD (Gordon et al., 2015; Sehlin et al., 2020).

Data Analysis

We compared the mean change scores for the two outcome measures at pre- and postprogram between and within the June MTTP cohort and the July wait-list control cohort. Because this comparison was exploratory rather than confirmatory, the objective of the analysis was to estimate the between-cohort effect size (Cohen’s d) to evaluate the efficacy of MTTP in improving participants’ psychosocial functioning, rather than to engage in formal hypothesis testing. The analysis was descriptive, with no planned a priori hypothesis testing; thus, no inferential statements are made. We calculated 95% confidence intervals for the difference in change scores between cohorts to describe the magnitude of the effect (i.e., mean difference) of participation in the MTTP.

To evaluate the MTTP’s impact, we treated scores at T0 of the June cohort and T1 of the July cohort as the preprogram measures and scores at T1 of the June cohort and T2 of the July cohort as the postprogram measures. Change scores for both the SSIS and the RSES met the assumptions of normality as indicated by p values greater than .05 in the Shapiro–Wilk test (SSIS, p = .95; RSES, p = .45). Consequently, a paired-sample t test was used to evaluate significant within-cohort differences between pre- and postprogram scores. On the basis of a prior study that investigated the impact of the MTTP on children with ADHD (Yuen et al., 2021), we hypothesized that improvement in the two measures would be significant; therefore, a one-sided t test at α = .05 was used to evaluate within-cohort improvement. Finally, we explored the sustained effect of the MTTP on the June cohort at 1-mo follow-up by inspecting the mean scores and standard deviations (SDs) at T1 and T2.

Results

Fifty-three adolescents with disabilities attended the virtual summer MTTP. Of the 20 participants with a primary diagnosis of ASD, 18 signed informed assent and consent for participation in the study. Ten participants enrolled in the June cohort and 8 enrolled in the July cohort. One participant (an Asian boy age 15 yr) in the June cohort was nonverbal and unable to complete the measures even with assistance and so was excluded from the study. One participant (a White boy age 10 yr) in the July cohort did not complete the postprogram measures. Therefore, the analytic sample was 17 for the between-cohort comparison and 16 for the within–combined-cohort comparison.

None of the participants, who came from seven different states, had any previous formal learning experience with magic tricks. Of the 17 participants, 3 were girls and 14 were boys; 7 were White, 4 Black, 2 Hispanic, 2 Asian, and 2 of mixed race. Their mean age was 11.5 yr (SD = 2.0, range = 8.6−15.4). There was no significant difference in age between participants in the June (M = 12.3, SD = 2.3 yr) and July (M = 10.5, SD = 1.2 yr) cohorts (p = .06). Six participants (4 in the June cohort and 2 in the July cohort) had a secondary diagnosis of ADHD.

For the SSIS, the mean difference between change scores of the two cohorts (June cohort, M = 5.56, SD = 19.50, n = 9; July cohort, M = –4.38, SD = 14.29, n = 8) was 9.9 points (95% confidence interval [CI] [–8.0, 27.8], d = 0.58). For the RSES, the mean difference between change scores of the two cohorts (June cohort, M = 1.44, SD = 2.79, n = 9; July cohort, M = –1.75, SD = 6.43, n = 8) was 3.2 points (95% CI [–1.8, 8.2], d = 0.66).

In the within–combined-cohort analysis (N = 16), participants’ mean SSIS scores improved 7.1 points, from M = 81.50 (SD = 28.61) to M = 88.63 (SD = 31.02), t(15) = 1.88, p = .04, d = 0.47. Their mean RSES scores improved by 1.8 points, from M = 19.13 (SD = 5.93) to M = 20.88 (SD = 5.54), t(15) = 2.43, p = .014, d = 0.61.

The June cohort maintained their improvements in SSIS and RSES scores from postprogram to 1-mo follow-up; 2 participants (one White girl age 14 yr and 1 Asian boy age 15 yr) did not complete the follow-up assessment. Mean SSIS scores were 84.89 (SD = 30.75, n = 9) at postprogram and 84.29 (SD = 33.32, n = 7) at 1-mo follow-up. Mean RSES scores were 21.67 (SD = 4.50, n = 9) at postprogram and 21.29 (SD = 4.23, n = 7) at 1-mo follow-up. Thus, their scores on the outcome measures remained almost identical between postprogram (T1) and 1-mo follow-up (T2).

Discussion

This is the first study we are aware of to examine the impact of a virtual magic trick training program on the social skills and self-esteem of adolescents with ASD. The results of this pilot intervention study support the hypothesis that adolescents with ASD who participate in a 3-wk virtual MTTP can experience enhanced social skills and self-esteem as assessed using standardized measures. On the basis of the standardized effect sizes derived from this pilot study, a minimum sample size of 38 in each cohort (total N = 76) is required to provide sufficient statistical power to reject the null hypothesis of equal means in RSES change scores between MTTP and wait-list control cohorts. A higher minimum sample size of 48 in each cohort (total N = 96) is required for the SSIS measure. Results showed negligible change from postprogram to 1-mo follow-up on the two outcome measures, providing preliminary evidence of the sustained influence of the MTTP on participants’ social skills and self-esteem.

The design of this pragmatic, nonrandomized, wait-list controlled trial with 1-mo follow-up appears to be appropriate for evaluating the virtual MTTP. This design was able to meet this pilot study’s three key objectives: (1) to evaluate the MTTP’s impact on social skills and self-esteem in adolescents with ASD, (2) to estimate the program’s standardized effect size as the basis to determine the minimum sample size with sufficient statistical power required for a subsequent full-scale RCT, and (3) to assess whether the MTTP’s effects on participants were maintained at 1-mo follow-up.

Feedback from participants and parents indicated that they preferred to increase the length of the virtual MTTP; however, the existence of the Fourth of July holiday in the middle of the 2-mo summer school break presents a challenge. For future trials, researchers can lengthen the virtual MTTP, with participants in the wait-list control group receiving the MTTP sessions after August or during the following summer.

Limitations

Limitations of this pilot study include the small sample size and the nonrandomized nature of the research design. These factors preclude decisive confirmation of the efficacy of the virtual MTTP in improving social skills and self-esteem in adolescents with ASD, which limits the generalizability of the findings. The virtual Zoom environment, with its lack of in-person guidance, made learning magic tricks difficult for some participants. In addition, technology issues, such as intermittent Internet connectivity, on several occasions affected participation in and the effectiveness of training sessions.

With a longer duration of the virtual MTTP, we expect that the effect size of the results would increase accordingly. Further studies using an RCT design with a larger sample size and a 3- to 6-mo follow-up assessment are needed to evaluate the program’s efficacy and to assess the maintenance of intervention effects. Along with self-report measures from the child, future studies should include the parent and teacher versions of the SSIS to assess the parent’s and teacher’s perspective on the child’s social skills and social responsiveness to help confirm change in the child’s social functioning and social skills and evaluate the generalization of the acquired skills to other social environments.

Implications for Occupational Therapy Practice

The results of this study have the following implications for occupational therapy practice:

▪ A virtual MTTP guided by occupational therapy student coaches can improve the social skills and self-esteem of adolescents with ASD.

▪ Incorporating the teaching of magic tricks into occupational therapy sessions may enhance the social skills and self-esteem of adolescents with ASD.

▪ An MTTP can serve as a supplement to school-based social skills training for adolescents with ASD.

Conclusion

Adolescents with ASD who participated in a 3-wk virtual magic trick training program experienced improvements in social skills and self-esteem that were maintained 1 mo later. Incorporating the MTTP into occupational therapy clinical practice has the potential to enhance the social skills and self-esteem of adolescents with ASD.

Supplemental Material

Supplemental Appendix

Supplementary material for A Magic Trick Training Program to Improve Social Skills and Self-Esteem in Adolescents With Autism Spectrum Disorder

Supplementary material, sj-pdf-1-aot-10.5014_ajot.2023.049492.pdf for A Magic Trick Training Program to Improve Social Skills and Self-Esteem in Adolescents With Autism Spectrum Disorder by Hon K. Yuen, Kevin Spencer, Lauren Edwards, Kimberly Kirklin and Gavin R. Jenkins in The American Journal of Occupational Therapy

Footnotes

Acknowledgments

We thank all the adolescent participants with ASD and their parents who participated in the MTTP and all the occupational therapy students in the Class of 2022 who assisted with this project.

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