An Introduction to Art Therapy and Autism

by Nicole Martin, ATR

2007; revision dates: Jan 2011, Jan 2012

http://arttherapyandautism.com/explain.html

Explanation

Autism spectrum disorder (ASD) is a commonly used, non-scientific term (now used synonymously with “autism”) that describes a category comprised of five related neurodevelopmental disorders (as described by the DSM-IV): Childhood Disintegrative Disorder, Rett's Disorder, Autistic Disorder, Pervasive Developmental Disorder (PDD), and 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 [that is, more severe disability, especially if co-morbid (also occurring) with mental retardation; ex: Childhood Disintegrative Disorder] to high functioning (an individual whose intellectual reasoning is unaffected; ex: Asperger's). What all ASD disorders have in common is the presence of deficits in three main areas to greater or lesser extents: communication, socialization, and imagination, as well as the presence of restricted and repetitive (often called “stereotyped” or “perseverative”) behaviors. Exactly how (and how much) these deficits present themselves depends on the individual (their specific diagnosis, personality, history, quality and timing of therapy received, family support, etc.). Hyper- or hypo-sensory sensitivity (tactile, aural, visual, etc.) is common and a huge influence upon (if not a reason for) the deficit areas listed above. Also common are obsessive-compulsive behaviors, self-injury or aggression toward others (most often to alleviate sensory discomfort or to communicate rather than to engage in deliberate violence), and seizure disorder.

See the General autism info section under Resources and Links for more information about ASD.

Art therapy is a masters-level profession (http://www.atcb.org/, http://www.americanarttherapyassociation.org/) that specializes in using visual art making and the creative process to help clients bring about therapeutic change. It is typically referred for situations in which words are difficult (ex: grief and loss), if there is a mind-body relationship to the nature of a person's trauma (ex: sexual abuse, PTSD), or for clients who are inept with words (ex: children, persons with a communication disability). Art therapy is also often sought out by clients who seek a more tangibly productive therapy (literally “rolling up your sleeves”), enjoy expressing themselves visually (artists, architects, crafters, etc.), or for whom talk therapy has not achieved the desired outcome and want to try something new. Art therapy is generally described as a highly illuminating, enjoyable, and unique experience.

There is a commonly held belief that art making is beneficial to people (particularly children) with ASD due to their intense sensory needs (especially visual and tactile self-stimulation) and disregulation, often nonverbal nature, and need for more visual, concrete, hands-on therapies. ASD therapists of all kinds acknowledge this and, despite a lack of appropriate training, many attempt to include therapeutic art making into their clients' activities on a regular basis. Despite limitations such as the difficulty of standardized assessment (due to the need for individual adaptations), the difficulty of quantifying the experience of art making, and the small number of art therapists publishing on the topic, art therapy literature on the subject is large enough to demonstrate that it is a useful treatment option (especially when supplemented with studies from the fields of art, art education, psychology, and other creative arts therapies).

In my experience, there are six major ASD treatment goal areas that art therapists are best qualified to treat:

1. Imagination/abstract thinking deficits

One of the three classic characteristics of autism, imagination deficits can be addressed by art therapists in a way that is without parallel in other fields. Art projects tailored by art therapists to the needs of a person with ASD provide a visual, concrete format in which to develop abstract thinking skills, express creativity, and increase flexibility.

Art therapy can provide safe, enjoyable sensory integration and exploration experiences that help create calm, regulated bodies and then move beyond mere exercises to help an individual incorporate their experiences into a product that helps to continue treatment. In art therapy, the process (making art, the therapeutic relationship) results in a product (the art piece) that furthers more process and provides a visual history of therapeutic progress.

Art therapists are trained in counseling techniques (many if not most obtain a counseling license) and their “tandem” use of visual expression and verbal counseling is definitely an asset when it comes to working with people with a communication disability. Having autism is mentally, physically, and emotionally stressful and many people living with it (particularly those on the “higher” end of the spectrum) can benefit from productive ways of expressing their feelings.

A bit of a catch-all term, developmental growth as a treatment goal means targeting delayed or atypical aspects of a person's development that are hindering that person's full potential. Autism is a pervasive, neurodevelopmental disorder that disrupts development in several areas; art therapists usually work on improving artistic/drawing development, fine motor skills, and social/relational skills. This is an important treatment goal area when working with young children with ASD.

Developing productive leisure skills is no small goal for many people with ASD. Self-direction, industriousness, patience, and pride in one's work are important life skills that require a great deal of teaching (best done through motivating activities). It is also a popular reason for referrals (parents want their child to be able to benefit from recreational art-making, and feel that a therapist will be better trained to provide adaptations, behavioral support, and more meaningful goals).

Drawing is a useful tool for both revealing and addressing visual-spatial deficits such as mental rotation and improving hand-eye coordination. People with autism sometimes exhibit exceptional or atypical visual-spatial skills, and this can be capitalized on by the art therapist in order to address other goals. As with the other treatment goals listed above, it is the individual's motivation to “play” with art materials that makes art therapy an attractive format to address profound deficits.

These six treatment areas are the “hats” that an art therapist wears when working with a person with autism. One of these hats might look similar to a sensory integration (SI) therapist, or to a psychologist, or to an occupational therapist, etc. but art therapists distinguish themselves by always using....art! Different goals will be more or less pertinent depending on the individual's specific diagnosis (both strengths and weaknesses), the goals of the child's family, the goals articulated in the child's individualized treatment plan/individualized education plan (ITP/IEP), and the expertise of the art therapist.

So how do art therapists and clients reach these goals? An therapy session basically involves the interaction of three dynamics: the therapeutic relationship between therapist and client(s), the art materials, and therapist adaptations/interventions. When working with people with autism, the therapist must be the driving force within a session (although the more you can incorporate and engage the client's interests, the better) by providing directives designed to address treatment goals. Making art with the client as a way to engage, model, build friendship, and encourage communication is important. Projects might involve materials such as paints, clays, pencils, creams, feathers, and beads and processes such as puppetry, printmaking, sculpture, or mural painting and much, much more. Safety is the only limit. Initial sessions will ideally involve family consultation, observation, assessment, establishment of treatment goals, and relationship/trust building. Therapy is often (but not always) long-term (as are most ASD therapies) due to the pervasive and permanent (although often improvable) nature of autism. For specific project ideas, I suggest familiarizing yourself with the generous art therapy section on the Resources and Links page.

Two misconceptions about art therapy include: 1. a person has to (or should) be talented in art in order to benefit, and 2. art therapy is an “alternative” therapy. (Known) talent is definitely not a prerequisite for art therapy, although a client with autism should be at least somewhat interested in the art materials to begin. (In fact, some families seek out art therapy because creativity or drawing skill is a deficit for their child with ASD.) Alternative therapies are often referred to as such because they offer an alternative choice to mainstream solutions (ex: acupuncture instead of medication to help manage pain), and in a number of situations, art therapy can indeed be considered an alternative to traditional “talk therapy” (verbal counseling/psychotherapy). But when talk therapy is not the standard treatment (as in the case of autism), I am not sure what art therapy is supposed to be an “alternative” to. Although small in numbers and thus a minority, creative arts therapists are unique and not a substitution for something else.

Qualifications

In the United States, in order to be an “art therapist”, one must have obtained:

1. A master's degree or PhD in art therapy AND/OR
2. Be a registered art therapist (ATR)

One cannot claim to practice art therapy without one of these credentials. A bachelor's degree, even if in creative arts therapy, pre-art therapy, etc. is not sufficient, nor is a master's degree in another albeit related field (art education, psychology, counseling, etc.) unless the individual holds the ATR credential. Continuing education certification programs exist, but a graduate from such a program cannot claim to be an art therapist until obtaining the ATR credential.

Organizations to know:
The American Art Therapy Association (AATA)
The Art Therapy Credentials Board (ATCB)
Art Therapy: The Journal of the American Art Therapy Association (adheres to the editorial standards of the American Psychological Association)

See http://www.americanarttherapyassociation.org/ for definition of the field, list of AATA approved graduate programs, links to state chapters, ethics guidelines, and news.

Visit http://www.atcb.org for information on credential requirements.

It is usually preferred that an art therapist hold or be in the process of obtaining:

1. ATR (registered) or ATR-BC (registered, board-certified)
2. State art therapy license if available
3. State professional counselor's license if possible

In order to develop a specialty in autism spectrum disorders, I recommend:

A. Clinical experience with people with ASD such as:

1. Supervised clinical internship
2. Supervised volunteer or work experience

1. Understanding of ASD symptoms/behaviors and how they interact with the art making process
2. Knowledge of relevant art therapy literature and general ASD literature
3. “Disability family” culture
4. Be familiar with the major autism organizations and research institutions
5. Emergency training
6. Understanding of behaviorist principles (ex: reinforcement, extinction) and be able to follow (or implement if necessary) behavior plans (consistent, clear response to problem behaviors)

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