Theater-Based Interventions in Social Skills in Mental Health Care and Treatment for People with Autism Spectrum Disorder: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for sharing the review comments. Here are some suggestions on how the authors could address them:

 

Major Comments:

 1. The authors should add more discussion in the introduction linking the mediating role of self-efficacy to previous literature. Point out how examining self-efficacy as a mediator between attachment and social exclusion is a novel contribution.

 2. The authors should cite more studies relating social exclusion/ostracism and self-efficacy to individual goals. Highlight how this study expands on that prior work.

 

Minor Comments:

 3. The narrative summary of the results from the 29 studies provides helpful high-level findings. Including some quantitative details would enhance this section. For example, reporting the sample sizes and effect sizes for key outcomes.

 4. The discussion section can be reorganized to have separate parts addressing the study implications, limitations, and future research directions. The authors can consider clustering some of the policy and framework suggestions by country as suggested.

 

 

 

Author Response

Comments and Suggestions for Authors

Thank you for sharing the review comments. Here are some suggestions on how the authors could address them:

Major Comments:

1.The authors should add more discussion in the introduction linking the mediating role of self-efficacy to previous literature. Point out how examining self-efficacy as a mediator between attachment and social exclusion is a novel contribution.

2.The authors should cite more studies relating social exclusion/ostracism and self-efficacy to individual goals. Highlight how this study expands on that prior work.

 Thank you for the suggestion. In response to the reviewer's suggestions, it has been added in the introduction how the improvement of social skills can lead to an increase in the sense of self-efficacy in individuals with ADHD, which in turn may help overcome the social exclusion they often face.

Moreover, enhancing the social skills of individuals with ASD may impact their mental health by boosting their sense of self-efficacy. Several studies have indicated that social skills training for individuals with ASD has a positive influence on their self-efficacy [5, 6]. This is noteworthy because individuals with ASD often exhibit significantly lower levels of self-efficacy compared to normotypical individuals [7] . Similarly, improving social skills and self-efficacy could also help alleviate the adverse effects associated with ostracism or social exclusion experienced by individuals with ASD [8,9,10] , including those stemming from their own family members [11]

Minor Comments:

3. The narrative summary of the results from the 29 studies provides helpful high-level findings. Including some quantitative details would enhance this section. For example, reporting the sample sizes and effect sizes for key outcomes.

Thank you very much for the contribution. At the beginning of the results section, the range of sample sizes of the studies included in the review has been added.

The sample sizes in the reviewed studies varied, ranging from 1 person [27] to 77 persons [28]

4. The discussion section can be reorganized to have separate parts addressing the study implications, limitations, and future research directions. The authors can consider clustering some of the policy and framework suggestions by country as suggested.

Thank you for the suggestion. As noted by the reviewer, the discussion has been reorganized, with the expectation that this will result in a more straightforward reading experience.

Reviewer 2 Report

Comments and Suggestions for Authors

The primary objective of this research is to investigate the significance and effectiveness of diverse interventions targeted at enhancing the social skills of individuals diagnosed with Autism Spectrum Disorder (ASD) through the utilization of theatrical techniques. Specifically, the study aims to explore the relationship between these interventions and their impact on socioemotional reciprocity, nonverbal communication behaviors applied in social interactions, as well as the development, establishment, and comprehension of interpersonal relationships. It is important to note that this study relies solely on the methodology of a literature review for analysis. In order to contribute substantively to this field of research, it is strongly recommended that a meta-analysis method be applied.

1. While the author has presented an extensive discussion of previous research pertaining to the study's subject matter, the rationale for conducting this study mainly rests on the observation that limited research has been conducted in the past. To enhance the clarity and depth of the paper, it would be advantageous for the author to expound upon the theoretical and practical contributions of this study more explicitly.

2. The overarching objective of this study is in alignment with the global initiative to improve the quality of life and mental well-being for individuals, particularly those affected by Autism Spectrum Disorder. Nonetheless, it should be noted that the stated objective may be considered overly broad and extends beyond the direct scope of this paper.

3. With regard to the methodology applied in the literature analysis of this study, it is strongly advised that the author consider adopting a meta-analysis approach. This approach will serve to facilitate a more comprehensive evaluation of the effect sizes associated with past interventions utilizing theatrical techniques, thus enhancing the rigor of the research.

Author Response

Comments and Suggestions for Authors

The primary objective of this research is to investigate the significance and effectiveness of diverse interventions targeted at enhancing the social skills of individuals diagnosed with Autism Spectrum Disorder (ASD) through the utilization of theatrical techniques. Specifically, the study aims to explore the relationship between these interventions and their impact on socioemotional reciprocity, nonverbal communication behaviors applied in social interactions, as well as the development, establishment, and comprehension of interpersonal relationships. It is important to note that this study relies solely on the methodology of a literature review for analysis. In order to contribute substantively to this field of research, it is strongly recommended that a meta-analysis method be applied.

1. While the author has presented an extensive discussion of previous research pertaining to the study's subject matter, the rationale for conducting this study mainly rests on the observation that limited research has been conducted in the past. To enhance the clarity and depth of the paper, it would be advantageous for the author to expound upon the theoretical and practical contributions of this study more explicitly.

Thank you very much for your input. A subsection on practical implications has been included in the discussion section.

At a practical level, the results of the present study show how the schools….

In the specific case of children with ASD, this type of intervention can help develop and enhance specific aspects associated with the difficulties they present, related to a greater extent to Theory of Mind (ToM) by attributing mental states to other people, to the development of play and symbolic thinking, language, as well as enhancing imitation, all of which contribute to the child's adaptation to the developmental contexts…

Finally, the joint participation of children with ASD and typically developing children in this type of activities can help the real inclusion of people with ASD [48], with benefits for typically developing children as well. To the extent that participants are part of a group, have the same objective, share experiences and all members of the group are important as part of a whole, it allows the development of a sense of belonging and identity, thus enabling the union and collaboration in other contexts outside the theatrical activities, and thus the real inclusion of people with neurodevelopmental disorders, among others. In this sense, this type of intervention can help to reduce social rejection and victimization which, according to different studies [49,50] is more frequent in autistic children who present indicators of autism that are less visible to the rest of their peers.

2. The overarching objective of this study is in alignment with the global initiative to improve the quality of life and mental well-being for individuals, particularly those affected by Autism Spectrum Disorder. Nonetheless, it should be noted that the stated objective may be considered overly broad and extends beyond the direct scope of this paper.

Thank you very much for the feedback. The objective has been modified to specify that it is a systematic review. Although the authors are aware of the limitations of the work in terms of the wellbeing and health objective of the SDGs, the authors relate these results mainly to the wellbeing and health SDG.

The aim of this study is to determine, based on a systematic review, the importance and effectiveness of different interventions aimed at improving social skills in people with autism spectrum disorder (ASD) through theatrical techniques. It aims to establish a direct relationship between the interventions and the benefits for socioemotional reciprocity, nonverbal communication behaviors used for social interactions and the development, establishment and understanding of interpersonal relationships.

In this sense, the results of the studies analyzed can be linked to SDG 3 Well-being and health of the United Nations Agency 2030, if the positive effect of theater-based interventions on the mental health of children with autism is taken into account. In turn, most of these interventions are carried out in school contexts, which can be related to SDG 4 quality education, facilitating inclusive education, taking into account the specific needs of children with disabilities in general and with autism in particular, thus favoring social inclusion in the center itself and, indirectly, in learning. These interventions should be framed as a better and greater educational attention to people with greater needs.

3. With regard to the methodology applied in the literature analysis of this study, it is strongly advised that the author consider adopting a meta-analysis approach. This approach will serve to facilitate a more comprehensive evaluation of the effect sizes associated with past interventions utilizing theatrical techniques, thus enhancing the rigor of the research.

The authors would like to thank the reviewer for his comments. The aim of the study was to carry out a systematic review of the interventions, so a meta-analysis was not part of the initial approach of the study. However, this suggestion has been incorporated in the article as a future research within the line of work to be developed by the research team.

 

Abstract: This study is intendedto determine, from a systematic review…

The aim of this study is to determine, based on a systematic review,…

Finally, future work should address, on the basis of a meta-analysis, the evaluation of the real impact of theater-based interventions through the analysis of effect sizes and sample sizes.

Reviewer 3 Report

Comments and Suggestions for Authors

Overall, the systematic review was well conceived and well conducted. I offer a couple of suggestions for improvement (please see attached suggestions).

Comments for author File: Comments.pdf

Author Response

Comments and Suggestions for Authors

Overall, the systematic review was well conceived and well conducted. I offer a couple of suggestions for improvement (please see attached suggestions).

Manuscript Review: Sustainability-2685923-peer-review-v1

-based Interventions in Social Skills in Mental Health Care and Treatment for People with ASD: A Systematic Review submitted to Sustainability. In my review of the manuscript, I found several strengths along with some suggestions for improvement of the current manuscript. My suggestion is for a revise and resubmit.

Among the notable strengths for the manuscript include: a very detailed method that follows established PRIMSA guidelines for conducting systematic reviews (and allows for replication), a comprehensive search strategy, linking their study with the UN 2030 agenda, and generally an effective review of the findings. That said, I do believe that there are some areas where I either had lingering questions or suggestions for improvement on the existing manuscript. These are listed in no order of importance:

1. On page 5, line 220, the authors mention excluding manuscripts that did not have a full text available. I was confused by this decision in terms of ascertaining whether attempts were made to obtain full texts, such as through an interlibrary loan or other option, and then these were unsuccessful? If so, could the authors indicate this number. Or, was the decision made to exclude these if they simply did not have full texts available upon initial search? If the latter, I believe this should be mentioned as a possible limitation of the study as this decision would unnecessarily exclude some studies and impact findings. In either case, if more information could be provided around the decision-making, this would be helpful for readers.

ANSWER: Thank you very much for showing your concern. It has allowed us to refine the process. In the method section, we have specified the number of papers that were excluded because the full text was not accessible. Specifically, there were 3 papers, which is not significant for the present review, since 29 articles were analyzed.

On the other hand, the authors were contacted through Researhgate and the corresponding author, but no response was obtained.

After eliminating duplicates, the title and abstract of 75 articles were read. Of these, 31 were excluded.

Of the 44 papers selected for full-text reading, 3 were eliminated because they could not access the text, while 12 were rejected because they could not access the text, while 12 were rejected because they could not access the text. of them were excluded because they did not match with the object of the present study. Finally, 29 articles were selected for the systematic review. On the other hand, the authors were contacted through Researhgate and the corresponding author, but no response was obtained.

 

2. For the Results, I wonder if there is a way to bring a broader organization to help readers make sense of the varied findings and then link the results to a discussion of the UN 2030 agenda suggestions for improvement in the Discussion section? For example, could a broader classification be presented by way of a table or Figure that lists: type of intervention x delivery x outcome studied and then linking these more generally with UN suggestions? I think some broader form of organization and meaning-making could help increase the impact of the current study. I offer this as a suggestion for improvement, not a requirement.

En general, la revisión sistemática estuvo bien concebida y bien realizada. I offer a couple of suggestions for improvement (see attached suggestions).

 

ANSWER: Thank you for showing the proposal. In order to improve the work presented, the results have been related to SDG 3 and SDG 4 in the conclusions section. In this sense, it is important to highlight how theater-based interventions have an improvement on mental health, which is related to SDG 3 Well-being and health. On the other hand, the fact that part of these interventions are carried out in a school context points to a sensitivity on the part of the school to promote the inclusion of children with ASD, thus improving their social skills, based on the needs of these children.

The results demonstrate the role of the realization of artistic potential through theater in the development of social skills, motivation, self-confidence, self-awareness, and generation of ideas that facilitate the resolution of conflicts, with an interest in education and in any area of life.

The results of the present review contribute to the evidence regarding how theater or drama can be used as a tool to promote mental health in different aspects of both prevention and treatment. In this sense, the results of the studies analyzed can be linked to SDG 3 Well-being and health of the United Nations Agency 2030, if the positive effect of theater-based interventions on the mental health of children with autism is taken into account. In turn, most of these interventions are carried out in school contexts, which can be related to SDG 4 quality education, facilitating inclusive education, taking into account the specific needs of children with disabilities in general and with autism in particular, thus favoring social inclusion in the center itself and, indirectly, in learning. These interventions should be framed as a better and greater educational attention to people with greater needs.

The nature of drama is that it engages through surprise and novelty, becoming a flexible form of pedagogy that generates benefits in teaching situations with little room for failure and creating a safe environment in which to practice social skills without fear of error.

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The author has revised according to the review comments or provided explanations for the review suggestions.