Reimagining Autism: How Drama Environments Can Aid the Diagnosis and Understanding of Autism
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Reimagining Autism: How drama environments can aid the diagnosis and understanding of autism Hannah M. Newman Submitted in fulfilment of the degree of Doctor of Philosophy by Research in Drama School of Arts University of Kent January 2018 Word count: 90,854 ACKNOWLEDGMENTS The research was funded by a scholarship from Kent Health at the University of Kent. I would like to thank my team of supervisors (Julie Beadle-Brown, David Wilkinson, Nicola Shaughnessy and Melissa Trimingham) who have been continually supportive and challenged me, helping to develop this thesis beyond what I initially imagined possible. Thank you for your patience and understanding as I have tried to navigate the interdisciplinary work. Thank you to all the postgraduates who have offered moral support and a kind ear to help me through this process, in particular Annette, Astrid, Judi and Robbie, as well as any School of Arts staff who have developed my thinking, shown interest and offered support. I would also like to acknowledge the University of Kent technical team, and in particular Faith Austin for your invaluable support. I had a wonderful team of practitioners who helped to make this research possible and volunteered their time to this: Tom, Josh, Angela, Kate, Arielle, Verity, Elise, Claire and Stephanie. I would like to say a huge thank you particularly to Vicki for the effort you put in and the laughs you gave me. To all of my participants and your families (both those in the actual research and the practice sessions) thank you for taking the time to come and participate, and sharing experiences with me, extending my knowledge of autism far beyond what I expected. I would like to acknowledge the team at Kent and Canterbury Hospital and in particular Yvonne Parks and Nicky Wood for being generous with your time and helping me with the research. Thank you to all those autistic individuals who have been open and honest in their experiences of autism and continued to extend my knowledge, challenging current understanding of the condition. I would like to thank my family, Mum, Dad, Chloe and Ross for being continually supportive, and particularly Dad for your incredibly useful feedback. Lastly, a huge thank you to James for putting up with me through this whole process. 1 ABSTRACT Using the practical approaches developed for the research project, Imagining Autism, the PhD investigates whether engagement in a play-based drama environment can help aid the diagnostic process and understanding of autism. The research has used drama workshops to see if these can enhance the profile of strengths, difficulties and differences obtained in a more traditional clinical diagnostic assessment. The exploratory study also seeks to see whether the ADOS (the clinical assessment tool) can be completed in a different environment and if there is agreement between the two settings on these scores. In addition to this, what supplementary information may be provided about the individuals because of their engagement in this drama environment. Eight participants (aged 3 – 11 years) were recruited through the NHS and had gone through the clinical assessment. They engaged in the arctic environment twice, where they encountered puppets, props and full-body characters e.g. the slapstick snowman, in play-based interactions with trained practitioners. The sessions were documented and analysis occurred afterwards, using a novel coding framework, and additional information obtained from parents and practitioners. These were then compared to the clinical assessment scores and reports, to test the hypotheses. Both qualitative and quantitative analysis will compare the two sets of information from the different environments, seeking to present a more holistic and rounded view, focusing not only on the difficulties but also on the strengths of the individual. 2 Table of Contents ACKNOWLEDGMENTS ................................................................................................................................... 1 ABSTRACT ......................................................................................................................................................... 2 INTRODUCTION ............................................................................................................................................... 7 Introduction to Autism ................................................................................................................... 9 Why Drama? ................................................................................................................................... 12 Introduction to iA .......................................................................................................................... 16 The iA Methodology .................................................................................................................. 19 Research and Thesis Development ............................................................................................ 29 About the Author ....................................................................................................................... 31 Structure of the Thesis ................................................................................................................. 31 Terminology ................................................................................................................................... 34 CHAPTER 1: THE CONSTRUCTIONS OF AUTISM ................................................................................. 36 Autism: The medical and scientific construction .................................................................... 37 Biological Factors ...................................................................................................................... 38 Psychological Theories ............................................................................................................. 40 Environmental Causes .............................................................................................................. 44 Autism: The social construction ................................................................................................. 48 Autism: Alternative construction ............................................................................................... 54 Autistic Artists ............................................................................................................................ 55 Drama and Autism in Research .............................................................................................. 56 CHAPTER 2: A HISTORICAL ACCOUNT OF AUTISM DIAGNOSIS .................................................... 84 Labelling and Diagnostic Criteria ............................................................................................... 85 Pre-Kanner ................................................................................................................................. 85 Kanner’s Autism......................................................................................................................... 86 Post-Kanner ................................................................................................................................ 88 Inclusion in the Diagnostic Manual and Beyond ................................................................. 94 Diagnostic Tools .......................................................................................................................... 105 Before Inclusion in Diagnostic Manuals .............................................................................. 106 Screening Tools ........................................................................................................................ 107 Scales and Interviews ............................................................................................................. 112 Observational Tools ................................................................................................................ 117 Current UK Diagnostic Practices .............................................................................................. 120 3 Conclusion .................................................................................................................................... 123 CHAPTER 3: METHODOLOGY ................................................................................................................. 124 Questions ...................................................................................................................................... 125 Design ............................................................................................................................................ 126 Settings .......................................................................................................................................... 126 Recruitment.................................................................................................................................. 132 Participants .................................................................................................................................. 133 Measures ....................................................................................................................................... 134 ADOS-2 ......................................................................................................................................