Sitting in a circle, a group of children and young teens on the autism spectrum meet each other by mimicking the pulsating beat of a heart. This “heartbeat hello” is how the Shakespeare and Autism Project at Ohio State University begins its annual workshop each spring. In addition to providing fun for students after school, the program is providing data to the Nisonger Center at the Ohio State University Wexner Medical Center on how Shakespeare can mitigate symptoms of autism.

The program had its start in 2010, when the Royal Shakespeare Company (RSC) of London partnered with Ohio State to conduct a study on how Shakespeare affects children on the autism spectrum. The theatre department administers the workshops, which take place each spring at local elementary and middle schools. So far the science is backing up the anecdotal evidence: The Bard’s use of iambic pentameter, rhyming schemes, and fantastical characters are improving the social and interpersonal skills of participants.

The Shakespeare and Autism Project stems from the Hunter Heartbeat Method, an approach developed by RSC member Kelly Hunter that brings themes from The Tempest into a workshop setting. Hunter arrived to OSU in 2010 to lead an 11-week workshop and pilot study, and she still provides guidance for the program.

Hunter’s “heartbeat hello,” a helpful introduction to the rhythm of iambic pentameter, also serves as a transition to ease the participants into the new space.

“Transitions frequently cause a level of anxiety for the children, so we use it as a transitional tool,” says Kevin McClatchy, who leads the program. “[The heartbeat] is a familiar, primal feeling and everyone is able to connect to it quickly.”

The heartbeat hello also requires the participants to make eye contact with everyone across the circle. “Right out of the gate, we are addressing one of the core features of autism, which is the struggle with sustained and intuitive eye contact,” says McClatchy.

The next part of the method is games, all derived from characters and themes in The Tempest. That particular play, McClatchy explains, “seemed to go right to the heart of the matter in a lot of ways, in terms of being locked on an island and feeling like ‘the other.’”

One of the games, called “Cramps,” explores the plot of The Tempest as participants take on roles from the play. In pairs they take turns playing Prospero and Caliban in the scene where Prospero inflicts pain on Caliban, saying, “Fill all thy bones with aches, make thee roar.” The student playing Prospero yells “Cramps!” and the partnered Caliban writhes in pain.

“In that particular game we are addressing eye contact, spatial awareness, cause and effect, and emotional role-playing,” says McClatchy, adding that the students “find delight in pretending to be in agony as Caliban.”

McClatchy was a graduate student at OSU when the pilot project began and joined as a teaching artist after the initial study.

“The pilot project went so well that we embarked on a two-year project with two different groups of children—one at a middle school and one at an elementary school,” he says. “For 42 weeks, spanning over two academic calendar years, a team of five teaching artists went to these schools once a week and played games based on The Tempest with the children.”

During that two-year period, the teaching artists, OSU educators, and parents of the participants noticed that the children were more social in the program, at school, and at home. For example, parents noted that their children were actively seeking new friendships at school and sustaining conversations with people they didn’t know.

“It was this unique collaboration of art and science, where the science really couldn’t function without the art,” says McClatchy of the project. “There was a dependency on these teaching artists playing these games to help the Nisonger Center figure out how to turn this into data. Essentially their task was: How do you turn the alchemy, this sort of magic of the transaction of theatre workshops, into data? And they did a pretty spectacular job at it.”

In May 2016, OSU’s Nisonger Center published the initial results of the pilot program showing that the workshops had affected the participants. “The science confirmed what we had all been experiencing,” says McClatchy. “The children had made statistically significant progress in a number of areas.”

At the start of the program, all the participants are assessed on intellectual functioning. The Autism Diagnostic and Observation Schedule, which is used to confirm an autism diagnosis, is administered, in addition to tests assessing communication, facial and emotional recognition, social responsiveness, and other core features of autism. Then students are randomly assigned to either the Hunter Heartbeat Method group, or to the control group of Skillstreaming, a standardized research-based training program developed by scientists that is regularly administered in schools and clinics.

“All the kids, at the beginning and the end, were invited to complete an fMRI scan–functional magnetic resonance imaging,” says Marc J. Tassé, who heads the study at the Nosinger Center. “We wanted to look at different areas of the brain to see how kids access those areas, especially around recognizing faces and facial expression of emotions. That is the amygdala for the emotion side, and the fusiform gyrus—which is the part of the brain that we think is implicated in recognizing and identifying faces. So we looked to see how the activation levels were in those to regions in all the kids at the beginning and all the kids at the end.”

The results showed that the Hunter Heartbeat Method was just as effective as the standardized Skillstreaming program—and perhaps more fun for the participants. Students who are part of the control group are invited to participate in future Hunter Heartbeat Method groups. For a look at the facts and figures, the published results can be found here.

As the workshops continue, OSU undergraduate and graduate students have the opportunity to participate in the program as teaching artists. Each spring, 10 teaching artists are paired with a group of about 15 participants ranging in age from 9 to 16.

In addition to working on increasing the number of workshops offered each school year in Ohio, the Shakespeare and Autism Program is looking to expand its outreach.

“We are in the process of figuring out how we codify it as possibly a certification program at OSU, and how we can continue to support and help our teaching artists who get trained here and go off to do the work on their own,” says McClatchy. One former leader the program is currently building a curriculum for the Shakespeare and Autism Project at the University of North Carolina–Wilmington. Another OSU graduate is also facilitating workshops in New York City.

An added bonus of the method is that many students who completed the program are now participating in theatre at school and in their communities.

“Though we have been doing it for six years, because the research now just is coming out, we feel like we are still at the beginning of something that can be pretty incredible in terms of how far, how wide, and how many people we can impact,” says McClatchy.

After all, as someone once wrote, all the world’s a stage.