Integrating Art Therapy And The Dir

INTEGRATING ART THERAPY AND THE DIR/FLOORTIME MODEL FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

Pamela Ullmann, ATR-BC, LCAT, CCLS

Presentation Outline

I. Overview of Autism Spectrum DisorderII. Strategies of Working with ASDIII. Description of the DIR/ Floortime

ModelIV. Dr. Greenspan VideosV. Art Therapy with ASD/DIR Approach VI. Case Study of Child with ASDVII. Autism Awareness Puzzle Piece Art

Project

Autism Spectrum Disorder

Childhood Disintegrative Disorder Rett's Disorder Autistic Disorder Pervasive Developmental Disorder (PDD) Asperger’s Syndrome

A person with ASD is a person diagnosed with one of these five disorders. The disorders within this “spectrum” are often ordered from low functioning to high functioning. (1 lowest- 5 highest)

Strengths and Weaknesses

Auditory memory

Visual memory Memory for

routines

Stimulus over-selectivity Attending to irrelevant stimuli Failure to generalize Impaired language & imitation

skills Issues with attention/focus Crave routine and sameness Sensory and behavioral issues Cannot process visual and

auditory information simultaneously

Strengths Weaknesses

Misreading Behaviors

Inattentive/daydreaming Doesn’t understand what to do or where to start (executive functioning)

Child asks visitor, “When are you leaving”/rude behavior

Child may have an obsession with time, doesn’t know it is rude to ask

Child interrupts or acts outs, attention-getting behavior

May not know what questions are for him or the group, or that others may want to speak, too

Angry, upset, or frustrated for no reason

Sensory issues/ sensitivities

Observed Behavior What may be happening

What “communication” may look like Primitive to more sophisticated:

Tantrums Vague gestures Motoric Objects Pictures or PECS* Specific gestures or signs Written words Expressive verbal language

*Picture Exchange Communication Symbols

Things to keep in mind……..

Not too many tasks at once Keep it simple

Even with good cognitive skills! State positively Concrete/operationally defined Teach/practice the skills/ repetition Confirm directions by asking child to

repeat back

What is DIR/ Floortime?The Interdisciplinary Council on Developmental and Learning Disorders

Dr. Greenspan Video

Dr. Stanley Greenspan founder of Floortime speaks.wmv

DIR/ Floortime Overview

Developed by Dr. Stanley Greenspan Developmental ( 6 developmental milestones

that every child must master for healthy emotional and intellectual growth)

Individual Differences Relationship Based Floortime™ is a specific technique to both follow

the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities.

DIR Comprehensive Framework Tailored to the child’s unique challenges &

strengths Problem-solving exercises Emphasizes the critical role of parents and

other family members because of the importance of their emotional relationships with the child

Affect based interactions to the child’s individual differences and developmental capacities

6 Developmental Stages

Stage 1: Self-regulation and interest in the world

Stage 2: Intimacy, engagement, & falling in love Stage 3: Two-way communication Stage 4: Complex communication Stage 5: Emotional ideas Stage 6: Emotional & logical thinking

Individual Differences

Children with special needs have a variety of biological challenges that affect their ability to function in the world

Difficulty with sensory reactivity Processing difficulty Difficulty with motor planning and

sequencing

Each type of challenge makes it difficult for the child to relate to and communicate with his parents and caregivers and thus impedes his ability to learn, to respond, and to grow.

Relationship Based

Learning relationships with caregivers, educators, therapists, peers, and others

Strong relationships help foster learning

opportunities for child’s individual differences and developmental capacities

Ultimately enables progress in mastering the essential foundations

Floortime Technique

Follow the child’s natural emotional interests (lead)

Challenge the child towards greater mastery

With young children these playful interactions may occur on the “floor”, but go on to include conversations and interactions in other places

Circles of Communication Video

Floor time with child, parent and Dr. Greenspan

Circles of Communication.wmv

How the DIR/Floortime Approach is a “natural”

partnership with creative modalities

Art Therapy and Autism

Focus: Behavioral Approach

Sessions are more structured

Goals are established

Modeling of behaviors

Reward systems

Use of praise

© 2009 Pamela Ullmann

Major Deficits or Difficulties in ASD

© 2009 Pamela Ullmann

Using the Creative Process to Enhance Skills and Functioning

Treatment Goals of Art Therapy

Abstract Thinking (Imagination) Communication and Socialization Regulation and Integration of Sensory Help Creative Expression Developmental Progress and

Growth (DIR) Recreational Skills Visual/ Spatial Deficits

The Art Therapy/ DIR Connection To focus on Communication, Imagination,

and Socialization To address behaviors without pressure Foster strengths and abilities Adapt to child’s functioning level Allow choice for child Design groups to develop social skills &

friendships Creative Expression, both 1:1 and groups

© 2009 Pamela Ullmann

Floor Time and Art Therapy Video

Emotional Expressions- Therapist models for the parent

Autism Play Project (Floortime) _Drawing_.wmv

Group Art Therapy with ASD

Establish structure to session Have appropriate ratio for function

level (trained aides or volunteers) Incorporate a theme (optional) Allow for flexibility-go with the group Make it fun and social Reinforce good behavior and model for

others Use of alternative forms of

communication (picture boards, schedules, or behavior charts/rules)

© 2009 Pamela Ullmann

Individual and Dyad Art Therapy Benefits of 1:1- customize Setting goals DIR concepts in action Structure, yet allow for changes Routines, materials and methods Parent/Child Dyads

Case study: “Nathan” and Mom

9 years old, male Moderate to severe ASD Oral fixation ADD tendencies Limited expressive

language Delayed drawing skills High functioning fine motor Sensory: tactile tolerance Prone to meltdowns

Highly educated Understands therapeutic

process Enjoys participating with

Nathan Helps set boundaries Helps create limit setting Incorporates behavior mod Creative and expressive

modeling Sensory support

Nathan Mom

Goals of Art Therapy for Nathan

Support behaviors that he is working on Introduce new creative materials Allow for choice making Encourage self expression Develop drawing skills Tie in the three areas:

Communication Socialization Imagination

Setting up the session- comfort in routine

Image making with alternative materials

“Wiki” sticks are waxy, colorful, and bendable allowing Nathan to explore shapes and image making without the pressure of drawing with traditional media. Also a sensory material to appeal to his tactile and fine motor strengths

Combining foam building stickers and drawing media to create the “garden”. Nathan needs concrete directions to complete picture (“show me where the grass grows”)

More image making with alternative materials

Telling a story and using sensory materials

Model magic used as flat, 2-D image making and having Nathan and mom create together a story about horseback riding; helping Nathan to express- needs “prompts” at times

Helping with transitions

Nathan is starting a new school. Mom and therapist talk about “what to expect” by creating images and talking to Nathan. Nathan chooses placement colors and repeats back about scenarios.

Using strengths/preferences to help create art

•Cutting

•Stickers

•Model Magic

•Markers

•Using steps

•Color recognition

Redirecting Obsessions

Oral sensory needs

Focused on earning jelly beans

Redirect into art making

Use skills for success

Cut Paper Collage

Brief Q&A andAutism Awareness Project

Why Puzzle Pieces? The puzzle pieces reflect the mystery and complexity of autism. The different colors and shapes represent the diversity of people and families living with this disorder. The brightness of the pieces signals hope – hope through research and increasing awareness through people like you!!! Directive•Create a puzzle piece that represents your interpretation of Autism•Materials : Sharpie markers, assortment of letters and stickersThank you for coming today

References and Resources http://arttherapyandautism.com http://www.autismspeaks.org http://www.autismtoday.com http://www.icdl.com/ Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative

ways. Advocate: Magazine of the Autism Society of America, 26-27. Betts, D. J. (2003). Developing a projective drawing test: Experiences with the

Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art Therapy Association, 20(2), 77-82.

Greenspan, S & Wieder, S (2006). Engaging Autism: using the Floortime approach to help children relate, communicate and think. PerseusBooks

Henley, D. (2001). Annihilation anxiety and fantasy in the art of children with Asperger's Syndrome and others on the autistic spectrum. American Journal of Art Therapy, 39, 113-121.

Kellman, J. (2001). Autism, art, and children: The stories we draw. Westport, CT: Bergin & Garvey

Martin, N. (2009). Art as an early intervention tool for children with autism. London: Jessica Kingsley.

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25(1), 15-23.

Miller, E. (2008). The girl who spoke through pictures: Autism through art. London: Jessica Kingsley. (Illustrations by Kim Miller)

Presenter's Websites and Contact Info

www.colorsofplay.com

www.healingartsfc.org

WEBSITES

http://colorsofplay.blogspot.com

http://creativefamilies.wordpress.com

INFORMATIVE BLOGS

EMAILS: Pamela@colorsofplay.com and Pullmann@healingartsfc.org