Inside the Mirror: Effects of Attuned Dance-Movement Intervention on Interpersonal Engagement as Observed in Changes of Movement Patterns in Children and Adolescents with Autism Spectrum Disorder

The research presented in this thesis is an explorative study into the basic concepts and the effects of dance movement psychotherapy (DMP) intervention on the attunement behaviours of children and adolescents with autism spectrum disorders (ASD). From a retrospective analysis of positively evaluated single cases of DMP with ASD participants, movement markers of interpersonal relating behaviours have been formulated in terms of Social Engagement and Attunement Movement (SEAM) behaviours. These were organised into an observation scale, and used subsequently to generate nominal observation data on the behaviours of a small sample of children with ASD. Evaluation with the SEAM observation scale yielded a significant increase of SEAM behaviours in the course of the dance therapy. Retrospective analysis of the actions of the therapist throughout four single cases of DMP with ASD participants yielded a specific approach that was described as Shared Movement Approach (SMA). SMA has been specified as an improvisation based method of DMP that takes the child's interpersonal attunement and engagement behaviours as cues for the therapist to accommodate her interventions, so that the child's interpersonal relating behaviours are facilitated and supported. Through her kinaesthetically informed interventions the DMP therapist contributes to an increase of interpersonal engagement and attunement by the ASD participant from within the shared movement actions. The SEAM observation scale was explored on conceptual clarity and consistency in a group of independent movement analysts, and interrater agreement was used as an indication of its contents validity. An interval rating procedure with the SEAM scale yielded the best results on interrater agreement as expressed in Cohen's kappa. The Shared Movement Approach and the SEAM observation scale were then tested for replication of outcome on SEAM behaviours within four repeated single subject cases in a pilot study in a Dutch outpatient clinical setting. The outcome monitoring yielded the replication of increase of interpersonal relating behaviours as measured with the SEAM observation scale. Within subject therapy outcomes, although diverse in their individual profiles, were found to be significant when analysed with non-parametric tests. Group averages showed a significant increase of SEAM behaviours. The effects beyond therapy were evaluated with the somatic and social sub-scales of the Child Behaviour Checklist (CBCL) and the Social Responsiveness Scale (SRS), showing individual differences and a significant problem reduction on average. The outcomes as experienced by the juvenile participants were evaluated with the somatic and social sub-scales of the Youth Self Report (YSR), which on average showed a significant decrease of experienced social and somatic problems. The results obtained are discussed in view of current theories on experiential approaches and concepts for psychotherapy with an ASD population