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Running head: THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 1
The Effects of Art Therapy in Children with Autism
Incia A. Rashid
Northwestern University
This article was prepared for COUN 406-0 SEC20 Research Methods in Counseling taught by
Dr. Jacob Goldsmith. The student ID number is 2886826.
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 2
Abstract
Autism spectrum disorder (ASD) is characterized as a neurodevelopmental disorder which causes
a variety of symptoms, including inappropriate or restricted social interactions, difficulty with
self-regulation and management, and issues with attachment (American Psychological
Association, 2013). Children with autism find it difficult to express themselves on a daily basis,
including challenges with vocalization and body language, the inability to focus, and difficulty
developing attachment in their interpersonal relationships (Durrani, 2014). These struggles have
led to increased anxiety, frustration, and aggression reported in both the child and the caretaker
(Simon, 2016). One of the most challenging aspects of ASD is that every child diagnosed can
have a different level of severity and different symptoms, therefore a one-size-fits-all treatment
model is impossible to implement, highlighting the importance of individual case studies in order
to assess the various treatment options available (Durrani, 2014). This paper will review and
analyze multiple case studies which incorporated the use of various forms of art therapy
techniques in order to help children with ASD become more socially fluent and have stronger
attachments to their caregivers. The range of art therapy that will be explored in this paper
includes mostly visual art therapy, however music and theater therapy, movement and dance
therapy, and play therapy will be discussed as well. Due to the multisensory and multifaceted
components of art therapy, it can be highly effective and tailored to the needs of each individual,
an important approach for the clinical application of therapists working with children and
adolescents on the spectrum. Through these techniques, each child with ASD can be guaranteed a
therapeutic experience which can be focused their own specific needs.
Keywords: autism spectrum disorder, art therapy, play therapy, theater therapy, movement and
dance therapy, attachment, social skills
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 3
The Effects of Art Therapy in Children with Autism
The Diagnostic and Statistical Manual of Mental Disorders (fifth ed.; DSM–5; American
Psychiatric Association, 2013) enacted a change in the categorization of ASD in 2013, combining
several formerly known disorders, such as Asperger’s Disorder and Pervasive Developmental
Disorder, to be included under the one umbrella term. While many cases are reported in adults
over the age of 25, the majority of ASD cases reported and studied involve an early diagnosis
occurring between the ages of two years and five years (American Psychiatric Association, 2013).
Due to the social, cognitive, and verbal effects which are most commonly present as a result of
ASD, it is often associated with other mental disorders such as attention deficit disorder, anxiety,
movement disorders, and mental retardation (Durrani, 2014). The symptoms which form as a
result of this disorder quite often lead to issues regarding attachment and communication with
primary caregivers (Emery, 2004), therefore leading many parents to report feeling helpless.
In an attempt to foster communication and attachment in children is ASD, nonverbal
therapeutic methods have become widely popular and have proven to be effective in a multitude
of ways. In order to dissect the effects and treatments of ASD, a series of case studies involving
multiple forms of art therapy will be examined (Durrani, 2014). The aim of this paper is to
illustrate the effectiveness of creative therapy in order to facilitate self-regulation and secure
attachment in children with ASD, while examining the multiple areas of art therapy.
The Effects of Autism on Attachment
The Centers for Disease Control and Prevention (CDC, 2016) predicted that 1 in 68
children aged two through eight years old is diagnosed with ASD, with a four to one ratio of
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 4
diagnosis among boys and girls (Simon, 2016). Many children with this disorder experience
uncontrollable repetitive behaviors, difficulties with self-regulation, dysfunctional sensory
capabilities, and limited interests, in addition to various other issues depending upon the severity
of the disorder (American Psychiatric Association, 2013). Those on the higher-functioning end of
the spectrum tend to display issues with fitting in at school or workplace settings and difficulty
with standard socialization. ASD has proven to be especially challenging in the arenas of making
friends, being understood by caregivers, and communicating daily needs which may not have
already been met (Simon, 2016).
Those in the more severe range of the spectrum can display destructive and harmful
behaviors toward themselves or others, inability to communicate full sentences or words, and
often require a high level of care from others (Simon, 2016). Since ASD is considered to be a
spectrum, no two individuals will display their symptoms or severity of the disorder in the exact
same way. As a result of this range of intensity, the treatment methods and creative routes used to
facilitate change can look highly different from one individual to the next. Although ASD is
categorized as a neurodevelopmental disorder, the most recent studies imply that environmental
factors alongside genetic irregularities are the most probable causes of the disorder (Martin,
2008). Mary Ainsworth and John Bowlby were two of the earliest pioneers of attachment theory,
having both been heavily influenced by the psychoanalytic theories of Freud (Durrani, 2014).
Bowlby (1951), and believed that a mentally healthy child should continuously experience a
supportive and intimate relationship with their mother in order for both the mother and child to
develop a content attachment. While a majority of children with autism are able to establish some
form of attachment with their primary caretakers, the attachment often lacks understanding and
adaptability when dealing with the need to connect with others vocally, thus hindering all other
forms of socialization from being developed later in the child’s life (Osborne, 2003).
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 5
Autism and Art Therapy
Psychoanalysts Sigmund Freud and Karl Jung were among the first to realize that verbal
expression was a highly ineffective method by which to display an individual’s inner world and
unconscious mind (Durrani, 2014). Because children with ASD tend to have difficulty with
verbal expression, their need for visual stimulation and expression increases significantly (Emery,
2004). In a recent study (Schweizer, Knorth, & Spreen, 2014), children suffering from autism
were able to successfully verbalize experiences and thoughts, have increased adaptability, and
behave in a way that is considered to be more socially acceptable after the therapists enlisted a
series of art therapy techniques. The findings strongly suggest that the use of art therapy as a way
to acclimate socially-challenged children with autism is a much more comfortable method of
therapy, not only for the child, but also for the parents who are urged to continue therapeutic
tactics in the home.
Visual Art Therapy
Durrani (2014) alludes to the possibility that the difficulties with vocalization and
attachment with children on the spectrum could directly be related to their sensory instincts, was
inspired to conduct a study of a 12 year-old boy who was struggling with attachment to his
caregiver. The boy, named Tom for the study, not only had issues with attachment, but reported
higher levels of anxiety. The study (Durrani, 2014) suggested that registering Tom for an art
therapy program would allow for positive changes in the way he interacted with his primary
caregiver, including how he communicated with them verbally and non-verbally. In addition to
this, Durrani (2014) also anticipated an increase in Tom’s ability to self-monitor and regulate,
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 6
allowing the facilitation of a much stronger attachment to his caregiver in the long run. This
study was conducted over the course of one year, where the first several sessions were only half
an hour long instead of a full hour. These first few sessions mostly entailed nothing more than the
therapist creating artwork in front of Tom in an effort to help him become familiar with the
process and establish an unpressurized alliance. This noninvasive method of allowing Tom the
control to either watch from afar or join in later on enabled him to approach the artwork at his
own pace.
These preliminary shorter sessions eventually developed into longer sessions where Tom
started to not only create artwork himself, but to also remain seated for extended periods of time,
decide which medium and tools he wanted to use, and even choose his own colors (Durrani,
2014). As the end of his treatment grew closer, nearly one year later, Tom demonstrated an
ability to successfully recognize the song that the therapist would play at the end of each session
in order to signal the last few minutes of session. Tom also demonstrated the ability to say “no”
whenever he felt uninterested in a part of therapy. His parents and therapist both reported a
noticeable change in Tom’s attachment to his parents, in addition to an increase in artistic
enjoyment and expression, and increased eye contact during conversation. The most significant
aspect of this study is that allowing the child to have the freedom to use a safe medium as a form
of expression helped to facilitate self-regulation, a decline in anxiety levels, and an overall
enhancement in social functioning (Durrani, 2014). This study in particular was an effective
example about the power of non-verbal therapeutic methods for children with attachment and
social development difficulties.
Martin (2009) provided a similar study regarding children with ASD, stating that art
therapy techniques allow the therapist to relieve some of the pressure of traditional therapy
settings on the child and allows them instead to focus on the creative side, and to not necessarily
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 7
feel pressured to speak or change drastically. She also associates the results of art therapy instead
of traditional therapy to feeling less forced to speak and maintain eye contact, areas which can be
especially anxiety-provoking for children on the spectrum. Through the gradual incorporation of
artwork formation, medium variety, and design features, the child will be able to conceptualize
what they would like to construct, the manner in which they would prefer to create it, and
ultimately be able to utilize the tools and medium of their choosing in order to produce a final
product (Martin, 2009). By enabling the child to tackle the issue of what to create, they are able
to effectively practice critical thinking skills without feeling overwhelmed or uncomfortable, thus
enabling therapy to be seen as an enjoyable period of time instead.
Emery (2004) emphasized that children are generally capable of solid connection to their
therapist, however due to the anti-social and anti-verbal components of ASD, children on the
spectrum often struggle to develop any level of a working therapeutic alliance with the clinician.
The case study she displayed involved a child with autism, aged six, with whom she noticed
immediate difficulty with processing visual mental images of things being described to him
(Emery, 2004). For example, when she would ask him to draw a house, he would instead write
out the word “house”, being unable to visualize what a physical house looks like in even the most
basic form. Similar to the studies mentioned above, the child demonstrated initial resistance to
creating artwork and becoming actively involved in the process with the clinician. However, this
study ultimately emphasized the use of other variations of art therapy, in addition to the positive
effects of including the materials from sessions into the effect of having the same materials in the
therapy sessions home setting as well (Emery, 2004). She described that the child, who already
had access to foam cutout letters in his own home, ultimately reached for similar letters in the
supply kit while attempting his first art therapy project with the clinician. The foam letters
eventually became a catalyst for additional materials, allowing the child to become comfortable
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 8
with later creating projects with clay, paint, and markers, a demonstration of increased tolerance
and curious exploration (Emery, 2004). Through this gradual progression, the child was
ultimately able to visualize the object being suggested for him to draw instead of writing out the
actual name of the object instead. As the child neared termination of therapy, he was able to
demonstrate the designing and drawing of a car from memory, including additional details such as
background objects and setting details, wheels, door handles, and windows. This study
effectively demonstrated that the gradual increase of creativity and challenges allows the child to
develop their skills in a way that feels comfortable to them (Emery, 2004).
Play Therapy
Children with ASD have a difficult time establishing interpersonal relationships, and
while there is no standard treatment plan for ASD, play therapy has been empirically proven to
support the development of interpersonal relationships and attachment (Kenny, Dinehart, &
Winick, 2016). Play therapy is considered to be a developmentally responsive intervention in
which a child’s natural play instincts are utilized for alleviating internal distress and disruptive
behaviors which, for example, could be causing a variety of issues within school settings.
Stagnitti (2016) described the primary goals of the Learn to Play program, an intervention of play
therapy which is derived through a developmental theoretical lens. Being highly influenced by
Carl Rogers’ person-centered therapy, Virginia Axline developed nondirective play therapy in the
1940s (Stagnitti, 2016). Through this method, the development of a welcoming therapist and
child relationship occurs and fosters an unconditional acceptance of the child. This method has
proven to be effective because it allows the child to take control and pave their way through the
session by exploring with toys and objects supplied to them. While this has proven to be a highly
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 9
effective method for enhancing the child’s motivation, natural ability, and general curiosity,
Stagnitti (2016) notes that not all children respond well in a toy-driven developmental play model,
and thus other methods of play therapy are needed, particularly pretend play. This is highly
effective for multiple reasons, one of which being that it simultaneously promotes solitary and
social play, and includes the skills of play scripts, logical sequencing of play actions, object
substitution, social interaction, role play, and play with an object outside of the self, such as a doll
or figurine (Stagnitti, 2016). Ultimately, the practice of these skills can eventually be applied to
outside settings, causing school staff members to comment upon the increased levels of social
turn-taking and sharing, engaging with peers, and verbal expression.
Music and Theater Therapy
One of the main areas of focus in music therapy research involves the enhancement of
communication among children with autism (Gattino, et. al, 2011). Often times, children with
ASD display impairments with expressive communication, including the use of words, vocal
sounds, and gestures. Through music therapy, children have been able to develop a sense of
expressiveness, allowing for improvements with verbal and nonverbal communication (Gattino,
et. al, 2011). Relational Music Therapy (RMT) was designed by music therapist Ruben Gallardo
and featured the development of motor, communicative, social, cognitive, and emotional
capacities. The techniques involved to facilitate growth include singing, composing,
improvisation, and the playing of musical games, with the main focus being on the actions of the
individual. While the technique tends to operate from a psychodynamic lens, paying specific
attention to the behaviors involving free association and unconscious drive serves the therapist
well in terms of being able to observe in an unobstructed manner (Gattino, et. al, 2011).
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 10
Social Emotional NeuroScience Endocrinology (SENSE) Theatre is a theatrical
intervention program designed to increase an autistic child’s socioemotional functioning while
facilitating a reduction in anxiety and stress (Corbett, et. al, 2011). The founding idea behind this
version of creative therapy is that the anxiety and biological stress levels reported among those
with ASD can be drastically diminished by the use of social interaction to calm the stress
response within the individual (Corbett, et. al, 2011). This creative social skills training involves
a multitude of methods, including group interventions, social problem solving, social storytelling,
and script and cue procedures. Corbett (2011) and her team conducted a study involving SENSE,
and ultimately found that the participants exhibited decent improvement in facial recognition,
higher levels of self-efficacy, increased empathy, social referencing and communication, and a
greater awareness toward others.
Movement and Dance Therapy
Gordon (2014) described dance/movement therapy (DMT) as having a primary goal of
achieving positive affect. She explains the findings of a study (Koch, Morlinghaus, & Fuchs,
2007) in which the affective changes among the participants of a DMT group were monitored and
recorded. The results of this study exhibited higher levels of overall confidence, including feeling
relaxed, accepted by others, likeable, and having increased feelings of affection. In addition to
these effects, significantly reduced levels of anxiety and inhibitions were also reported among the
participants. Gordon later explains that in another study (Koch et. al, 2007), motivation, coping,
strength, enjoyment and overall energy were all shown to increase, while also displaying a
dramatic reduction in depression, anxiety, and tension. In another study (Levy, 2014) movement
therapy proved to allow participants to access and effectively process non-verbal events, as well
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 11
as to externalize conscious and unconscious information. The significance in such findings
pertains to the fact that the mind and body connection could ultimately be fine-tuned in order to
allow the individual to no longer be stuck in their thoughts due to their inability to express
themselves verbally to others.
Analysis
When vocalization proves to be difficult for a child with autism, art therapy techniques
can be employed to help foster social and communicative skills and develop a stronger attachment
to caregivers. As mentioned earlier, no particular treatment plan exists for ASD considering that
each child is different and therefore will respond to different methods of treatment, allowing art
therapy’s multifaceted approach to be highly flexible for both the therapist and the parents, while
maintaining a sense of calm and creativity for the child. With additional art therapy methods
involving sand, clay, pets, horses, and journaling, a variety of non-traditional options exist for the
improvement of social expression in children with ASD. While it seems to be a daunting task to
try out numerous methods until an effective one is found, research has stated that art therapy for
children with ASD has been shown to be more effective than traditional talk therapy (Martin,
2009).
In terms of clinical application, art therapy techniques are highly effective tools which a
practicing clinician should be aware of when working with a client on the spectrum. The author
of this paper is hoping to specialize in working with children and adolescents that are on the
spectrum, therefore being mindful of the specific challenges that individuals on the spectrum face
is an essential piece of future practice. Attempting to enforce traditional talk therapy onto an
individual with ASD could cause significant stress, anxiety, and discouragement from continuing
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 12
therapy if the traditional methods cause the client discomfort or feelings of being pressured.
While there is significant information and research to enforce the idea that art therapy techniques
are highly effective, additional studies in the future can help to raise awareness of these
techniques with both therapists and parents seeking therapy for their child.
Future research should involve the continuation of examining individual case studies of
children with varying degrees of ASD in order to provide insight as to which combination of art
therapy techniques can be the most effective for each severity level. By becoming aware of the
options that are available, including those which can easily be implemented later within the
child’s home, they can further their development when they are away from the therapist and allow
the awareness and treatment of ASD to grow and develop as well. In terms of the author’s future
clinical practice, having this knowledge will allow her to become fully engaged with a child with
ASD and provide treatment and coping mechanisms to not only the child, but to the family as
well.
INCIA RASHID- THE EFFECTS OF ART THERAPY IN CHILDREN WITH AUTISM 13
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