Art Therapy for Children with ADHD and Anxiety Disorders

on Feb 19 in Behaviors, Creative Interventions, For Professionals, General Information, Learning, Parent's Corner by

Those of us who have children with ADHD or have worked professionally with children with this disorder know the challenges of trying to engage them in an activity that they can sustain AND use their minds purposefully. I have both; a son with this disorder and I have had clinical cases with this disorder. As a parent of a child with this disorder, I know that giving my son opportunities to build his self-esteem is a very important aspect to sustainable focus. In other words, when the child can gain mastery in a particular activity, their confidence builds and hence they ”stick with it”.

 

The arts can be a great vehicle in this endevour. Engaging in creative activities such as art, music and dance have been shown to help children with ADHD calm down because it utilizes the part of the brain that controls emotions. When the emotions are under control, the focusing can be much easier. Most of us have experienced this; when we are upset about a personal issue….isn’t hard to concentrate at work? So, therefore reaching the emotional brains through the arts can infact increase focus.

 

Basically, children with ADHD find it difficult to slow down their minds and bodies in order to concentrate on basic activities. When use art based activities, we usually see a shift in mood. The creative mind helps most children (and adults) get to a focused state of “being in the flow”. If we in fact find the right fit of a creative activity, we can truely help the child with attentional issues have a fuller experience of engaement as well as see them feeling happy and confident.

 

For similar reasons, children suffering from other anxiety based disorders and issues can also benefit from creative activities and art therapy. When they become involved with expressing their feelings in a creative way, they are too busy and focused to be concerned about negative thoughts, the passage of time, or other distractions. Of course , this does not happen right away……we must build trust and assess the develolmental level of the child in order to offer the right approach.

 

I beleive in a flexible structure based on the needs of the child. Some children with ADHD will need more more breaks, specific times to complete a task, reminders about impulses and behaviors, etc…. Overall, the benefits of art therapy are the ways in which it can access the right brain and allow the child to be in the creative process; even within a structured environment. In addition when working with several children in a small group, we can involve cooperative art making which enhances social skills and communication; all things that children with ADHD can use.

Things to keep in mind:

1) Allow for choice and try to find something that interests the child

2) Limit the amount of art materials that are offered- it can over stimualte the child

3) Create structure for the child such as time limitations, behaviors that are not to be tolerated and scheduled breaks

4) Use praise when child completes the task, prompt child to remain on task when distractions take over

5) Encourage expression about feelings; acknowledge when they are frustrated and support their process

Not having all the answers when working with ASD

on Nov 13 in For Professionals, General Information, Learning by

As I observed a young boy with Autism in one of our groups, I kept trying to “figure him out”. Why does he flutter his hands? What makes him jumpy or make the sounds that he does? How can we get him to participate with the others in the art therapy process? As clinicians, we are always looking for the right approach or mix or perhaps the right ”connection” to the child. But what I am discovering is that maybe those answers will not be avaialble any time soon- so in the meantime I think that focusing on the journey with the child and staying with the unanswered questions can be the enough for the moment. It may feel as if we are not connecting or making progress, but as with all therapeutic processes the subleties can pave the way.

 

Here are some points to keep in mind when working with children with Autism Spectrum Disorders:

 

1) Remember that Autism is a challenging disorder and there will be a lot of tough days, so go easy on yourself.

 

2) Meet the child where they are at that moment in time. Sense the energy level and try to empathize with their potential discomforts. If the energy is high and overstimulating, offer calming activities with little pressure.

 

3) If the child’s voice or level of verbal sounds is loud….do not try to “speak over them” but rather lower your voice and calmly wait for them to see that you are trying to communicate with them, this takes patience. But, very often they will want to hear you and will become quieter in order to listen.

 

4) Sometimse offering a light touch or contact to their should or back may get their attention, calm them or regulate their energy. But be careful to ask the child if it is ok to touch them as it can be misread and there may be issues with touch.

 

5) Be aware of bright lights, loud outside noises or other stimulating sources in the environment. See if dimming lights helps, or adding soft music to the room helps. You can also teach the child to do deep breathing….this sometimes works wonders, espsecially if you make it into a game or use bubbles.

 

So, although we may not have all the answers to everything about how and why the child behaves a certain way or can’t seem to connect to his peers or to us, we can relax a bit and just try to be available for the child as best we can. As we travel the journey, an answer or two may just appear when its supposed to.

 

 

Creative Group Work with Children on the Spectrum

on Sep 26 in Creative Interventions, For Professionals, General Information, Learning by

When working with groups, it is just as important to always remain flexible and to adapt to the different levels of functioning displayed by each child. Sometimes providing a theme to the art making helps give the children a focus while still allowing for changes and flexibility. Here is an example of a group art therapy directive with that incorporates all three key treatment areas (communication, socialization, and imagination). This format can be adapted to other art activities. The session is structured to have a beginning, middle and end, with clear boundaries. This structure is especially effective for children with autism because it serves as a comforting routine. Aides or volunteers are used in a ratio appropriate or the level of functioning and the individual needs of each group member.

An Example of a group art therapy directive with ASD

Theme: Friendship

• Directive: Create images related to friendship, friends, and children. Group project (mural) will be included.

• Beginning of session: Have children sit at table and introduce theme/project. Show pictures related to friendship and see verbal and nonverbal reactions to photos. Ask children to design their own “friend” (using multicultural outlines of gingerbread style figures). Offer a variety of pre-cut papers, fun googly-eyes and drawing materials as well. Encourage sharing of materials, and recognizing each other’s work.

• Middle of session: Invite children to help decorate a group friendship poster/mural by adding their “friend” to the paper and continue to fill in the environment where the friends can play. Offer “starters” (such as some outlines of trees or grass) and direct aides to help children. Assess how children are working together – whether they are staying contained in work area or are becoming over-stimulated. Allow children to take short breaks with their aides if needed.

• Closure: Offer children some free time to play creatively with sensory materials such as model magic or some drawing with crayons or markers.Then, if the group is still focused (and there are verbally-expressive children participating), conduct a “sharing circle” where they will be encouraged to describe their friend to the group or ask about another group member’s work.

• Goals and Outcomes:

1. Children will learn about “working together.”

2. Children will learn social skills and group awareness by sharing materials and comments

3. Children will experience the sensory aspects of collage, texture, and art materials.

4. Children will have choices and be able to express creatively.

Bear in mind that working with this population can be very challenging. What works for one session or child may not for another. It is important to remain open-minded and aware of each child’s status in each moment; in essence, we are constantly assessing, adapting, and co-creating our sessions with the children with whom we work.

DIR®/Floortime Model and Creative Arts Therapy

on Jul 28 in Behaviors, Creative Interventions, General Information, Learning, Parent's Corner by

In recent years, there has been a great effort to meet a rising need and demand for innovative and therapeutic services that can give children on the Autism Spectrum the best chance to develop intellectually and socially; to discover their talents and to cope with their challenges. There are more creative art therapists offering services for this population, but are seeking effective and imaginative ways to work without compromising the goals of the field.

Art Therapy can help the child with Autism in many ways. Some main areas that art therapists focus on include: increasing communication and social skills, developing a sense of individuality, building of relationships, and facilitating sensory integration (Betts, 2005). Children on the Autism Spectrum struggle with all these challenges in varying degrees however communication is an area that will affect them the greatest. We need to define what communication is for the child with Autism. It is not just language as a form of communication, but rather the totality of the communicative framework that appears from infancy onward which experts such as Daniel Stern and Donald Winnicott theorize. (Evans and Dubowski, 2007). We need to understand these basic areas and become aware of the level which the child with Autism is functioning developmentally in order to provide appropriate therapeutic interventions.

The DIR®/Floortime™ Model( Developmental, Individual Difference, Relationship-based) is a systematic way of working with the child that enables him to climb the developmental ladder and takes him back to the milestones that may have been missed earlier on (Greenspan and Weider, 1998). The six milestones within the model include: 1) Self regulation and interest in the world, 2) Intimacy, 3) Two-way communication, 4) Complex communication, 5) Emotional ideas, and 6) Emotional thinking. This model is a framework that helps clinicians, parents and educators perform a comprehensive assessment and develop an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders and other developmental challenges.
Greenspan explains that the five activities to engage children in Floortime are to observe, approach, follow the child’s lead, extend and expand play, and let the child close the circle of communication.

The Creative Arts Therapies combined with the DIR®/Floortime™ Model creates a unique and comprehensive approach that accomplishes these tasks. The blend of a child-centered focus along with creative and expressive modalities brings together a dynamic and integrative model that children thrive on. Art Therapy can help children with sensory issues or deficits “play” with materials in
their own way and at their own pace; then develop a system of regulation to participate in artistic expression. Dance and Movement Therapy has been incorporated successfully as well; using the kinesthetic qualities to help children move purposefully and engage socially in sensorial activities. Dr. John Carpente, a music therapist has incorporated the DIR®/Floortime™ Model into his work as well. He states that the therapist’s task is to improvise music built around the child’s responses, reactions, responses, and/or movements to engage him or her in a musical experience that will facilitate (musical) relatedness, communication, socialization, and awareness (Carpente, 2009).

Art Therapy has unique qualities that help the child with Autism. Many children with Autism tend to be visual learners and traditional methods of instruction can often be quite challenging. Therefore, visual art directives and projects are a great way to help children with Autism learn and communicate, as well as interact and function in the world.

References

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.

Carpente, J (2009). The Effectiveness of Nordoff-Robbins Music Therapy within a
Developmental, Individual-Differences, Relationship-based (DIR®)/Floortime™
Framework to the Treatment of Children with Autism. Dissertation, Temple
University.

Evans, K., & Dubowski, J. (2001). Art Therapy with children on the Autistic
Spectrum: Beyond Words. London, UK: Jessica Kingley.

Greenspan, S. and Wieder, S. (1998). The child with special needs. USA: Da Capo
Press.

 

Art Therapy and Autism: Working with Parent and Child Together

on Jul 19 in Creative Interventions, Learning, Parent's Corner by

Within my private practice with the Autism population, I have discovered that the parent-child dyad can be a wonderful way to  work if the circumstances are right. It enables me to model for the parent and  offer creative strategies and techniques for their child. But even beyond that  it is an enriching experience for me as the therapist as well. I learn how parent and child relate and communicate with each other; helping me work better  for the child.

I have been working with a young  client for over a year where I am fortunate to have this situation. Mom is very open to working with her son (around 9 years old  with moderate ASD) and helping him to discover his inner creativity. Having her part of the session is also a great asset because she can comfort and “regulate” him when over stimulation occurs. She then becomes a model for me as well!

So how does this dyad really work? Besides having mom there for a comfort to the child, she is able to tap into her own process. In addition, I can sense the energy and synergy between mother and child; bringing them back to the beginning stages of attachment. This helps the child explore the creative modalities that I present to the both of them. The trust is there and the child and mom play off each other with my direction.

However, the session must still have a structure. This child (like most ASD children) thrives on having a schedule and knowing what comes next; behavorial strategies are still incorporated maintaining focus and engagement. I have adapted a child-centered approach by combining it with behavorial techniques-not easy, but possible. There is a lot of mirroring, but also redirecting.  There are limits set and he responds well to this. However, within the limits, I always include choice making.

The mom and I set the stage together. We create a “schedule” (see diagram below) for her son to visually see and have him make choices (he is verbal) about what activities he would like to include.
Throughout the course of the session, we refer back to the schedule and cross off the activities that we have already completed. This feels comforting for the child as he maintains awareness and control by actively knowing what is next.

I also allow for breaks when needed. This allows him to regulate his sensory needs. He gets up and jumps, stretches, goes to the bathroom, has a snack, or just relaxes. Sensory issues and/or basic needs can sometimes come up during the session and all that is needed is a “mini” break. For example, he has oral needs and will eat a chewy fruit snack and be fine. I may have not known this if mom was not available.

Would this approach work for all children? I think it depends on the needs, age and their issues of attachment. With this particular client, I do know that at the end of the session, it appears that both the mom and her child are satisfied and have enjoyed the creative process and the activities presented. At times, she becomes so overwhelmed by his accomplishments it is quite emotional to witness. The artwork lines the kitchen counter and both mom and her son gaze together very proud; feeling good about the time spent together.

 

Learning Styles for Children on the Spectrum

on Jul 13 in Creative Interventions, General Information, Learning, Parent's Corner, Sensory Intergration by

Many children with autism tend to be visual learners and traditional methods of instruction can often be quite challenging. For example, while the average child learns language through social interactions by mimicking the words they hear in everyday conversations, children with autism spectrum disorder may not absorb speech and languageskills as readily. Often, children with autism do not imitate others in the same way that average children do, making it necessary to take a more direct approach. Signed speech, which uses sign language in conjunction with spoken language to visually reinforce new words and concepts, is a hands-on approach to teaching speech and language skills.
Hands on projects use that same principle of multisensory learning, combining visual, tactile, and verbal stimuli to teach new skills and concepts, appealing to the learning characteristics of many autistic children. Hands on projects can be integrated into nearly any learning experience. For example, you can tell a story while working together to illustrate it with simple drawings that can aid in comprehension, while keeping children engaged in social interaction. Paper cutouts, used to act out a story as it is read can be great literacy and comprehension reinforcement, and having the child participant in creating them offers another hands-on activity.

-Drawing and coloring flashcards can help in the development of fine motor skills while teaching letter and number recognition, or decorating them with fabrics and objects of varying textures can add tactile elements to the lesson.

-Mixing instant puddings or homemade play dough can help children learn to follow simple instructions with the help of tactile stimulation to maintain attention.

-Older children can benefit from cooking or baking projects, learning math skills through measuring ingredients and gaining competency in following directions. Also, getting to eat the finished product is a tangible reward for a job well done.

-Art projects that correspond with lesson plans for the day can be very helpful in reinforcing academic subjects, such as making clay models of animals or objects learned about earlier in the day.

-Model building, painting, or drawing projects can bring history or social studies lessons firmly into focus for autistic children, and lessons on plant biology can be brought home with a plant growing project.

Short attention spans are common in children with autism, another issue that is often eased with the use of hands on projects for autistic students. Active learning can be a great help in keeping children focused, alert, and engaged, making it easier to stay on task. If attention span becomes an issue when hands on projects are underway, divide each project into small steps with breaks given after each one. Lengthening those intervals between breaks gradually can help the child slowly build a more appropriate attention span.

Hands on projects are a great way to teach children on the spectrum. In fact, all children can benefit from the combination of activity and education that these modalities offer. In an integrated learning environment, hands on projects can help children with autism interact and cooperate with other children, promoting understanding and fostering those vital social and communication skills. And of course hands on projects are much more fun for all involved.