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

You can see a video demo on her website http://touchdrawing.com/2TouchDrawing/TDdemo.html

I recently decided  to re-explore this technique and began dabbling with touch drawing again. I thought that the tactile qualities of tough drawing might be an interesting material to try with the children and families that I work with that have mild ASD. In Open Studio, we had some children who had mild tactile defensiveness which proved to be an non-issue after offering the Touch Drawing!

I think this creative modality serves the child very well, as it has the ability to be very “hands-on” (literally) and yet is not as messy as traditional finger painting. In addition, there are ways to create texture and layers that allow the artist to experiment and discover new ways of expression. All ages can do this!

Here is the technique, as Deborah Koff Chapin describes:

Materials
• Oil paint or printing ink in any colors you like. We recommend water mixable student grade oil paints.
• Printmaking roller(brayer) is used to roll the paint smooth.
• A smooth, nonabsorbent surfacelike glass, plastic or dry erase board is used for a drawing surface.
•Plenty of paper; very lightweight like wrapping tissue is good but anything will work.

Doing Touch Drawing Yourself
• Put a small amount of paint on the drawing board. It is best to start with one color.
• Roll the paint smoothand place a sheet of paper on top of the paint.
• Touch the paper with your fingernails, fingertips and palms. Try using both hands some of the time.
• Become aware of body sensations and trace them on the paper. They might be abstract patterns or images.
• Lay the drawings on top of one another as they are done.
• Roll the board smooth between drawings. Only add paint after a few drawings.
• Draw whatever you feel in the moment. They do not have to be ‘pretty pictures’.
• The longer you stay with it, the deeper you will go.
• When you are finished drawing, roll the paint smooth and leave it to dry.

I recommend doing some touch drawing

Pamela Ullmann, MS, ATR-BC, LCAT

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.

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.

Color therapy or “chromotherapy” was practiced by ancient cultures including Egyptian and Chinese. They used color to heal and today in holistic or alternative settings, practitioners include it as well. Here are some interesting characteristics:

RED- Used to stimulate the body and min and to increase circulation (and appetite)

YELLOW- Used to stimulate the nervous system and help focus

ORANGE- Used to heal the lungs and promote energy

BLUE- Used to calm and sooth and treat pain

There are of course more nuances and uses of color that can be researched and debated, but how can some of this information be used in working with children? As an art therapist, I am always aware of visual stimulation when presenting art materials. When I notice a child is very hyper, I will avoid offering stimulating colors such as reds or oranges and try to stick with the blue tones.  Does this help? I beleive it does, but to what degreee I am not sure. I will never deny a child colors that they are asking for, but may steer the choices when possible.

Color can also be used to evoke emotions or make connections to feelings, memories and ideas. I have often used the book by Dr. Suess called “My Many Colored Days” which can help children identify their emotions through color referencing. The story is wonderfully illustrated with colorful images that connect a feeling……this of course is rather subjective and I  ask the children if the color in the book makes them feel different. Either way, the story helps them identify their own emotions which is often hard for children with developmental issues. After reading the story there are so many art making projects that can be presented as a follow up. I have had children create large murals, individual colorized portaits, and more……

Overall, color can be a great tool when working with sensory sensitive children. By experiementing and becoming aware of subtle reactions, we can taylor the activities and hopefully help them regulate. In addition, there are other things that compliment the use of color such as music and aromatherapy. More about those later…..

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.

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.

-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.

For typical children, play allows learning and social skills to build naturally. We usually do not have to “teach” children to play. However, a child on the spectrum may need some guidance. Play can be a great tool for helping children to go beyond autism’s self-absorption into a real and shared interaction. When directed properly, creative play can also help children explore their feelings and their environment. Eventually this can lead to stronger relationships with parents, siblings and peers.

Theories such as DIR/Floortime, a model created by Dr. Stanley Greenspan emphasize the use of play. The idea is to follow the child’s natural emotions and interests which he says is essential for learning and developing various parts of the mind and brain. In typical play therapy, clinicians are usually interested in letting the child take the lead. The therapist reflects back to the child their observations of what is happening in the session and mirrors back. Play Therapy with the Autistic child is a bit more challenging. We need to establish their functioning level and adapt to it. As stated above, they may not have the ability to play imaginative or symbolically. We need to be very animated and show them how to do this.

We may need to will get down on the floor with the child and truly engage him through the modality of play. For example, we might set out a number of toys that the child finds interesting, and allow them to decide what, if anything, interests her. If they pick up a toy car and run it back and forth without purpose, the therapist might pick up another car and place it in front of the child’s, blocking its path and saying “beep beep”. If the child responds — verbally or non-verbally– then a relationship has begun. If there is little reaction, the therapist might look for sensory or high-interest, options to engage the child. Bubble blowing is often successful, as are toys that are “cause and effect”- they can move, squeak, vibrate, and otherwise do something.

As the therapy builds, the therapist can build reciprocal skills, such as sharing, taking turns, and imaginative skills (pretending to feed a toy animal, cook pretend skills) and even abstract thinking skills (putting together puzzles, solving problems). Eventually, as the child becomes better able to relate to others, participating in a small group of peers would help further by engaging in more social play.