RESEARCH METHODS FINAL PAPER

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


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


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).


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,


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


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


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


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).


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


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


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.


References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed., text revision). Washington, DC: Author.

Bowlby, J. (1951). Maternal care and mental health. Bulletin of the World Health Organization,

3, 355–534.

Centers for Disease Control and Prevention. (2016). Autism Spectrum Disorder. Retrieved from

http://www.cdc.gov/ncbddd/autism/index.html on April 28, 2016.

Corbett, Blythe A.; Gunther, Joan R.; Comins, Dan; Price, Jenifer; Ryan, Niles; Simon, David;

Schupp, Clayton W.; Rios, Taylor. (2011). Journal of Autism and Developmental

Disorders, Vol 41(4). 505-511. Publisher: Springer; [Journal Article]

Durrani, H. (2014). Facilitating attachment in children with autism through art therapy: A case

study. Journal of Psychotherapy Integration, 24(2), 99-108.

Emery, J. M. (2004). Art therapy as an intervention for autism. Art Therapy: Journal of the

American Art Therapy Association, 21, 143– 147. [Journal Article]

Gattino, Gustavo Schulz; dos Santos Riesgo, Rudimar; Longo, Dânae; Leite, Júlio César

Loguercio; Faccini, Lavina Schüler. (2011). Nordisk tidskrift for musikkterapi – Nordic

Journal of Music Therapy, Vol 20(2). 142-154. Publisher: Taylor & Francis; [Journal

Article]

Gordon, Amanda J. (2014). American Journal of Dance Therapy, Vol 36(1), Jun, 2014 pp. 60

76. Publisher: Springer; [Journal Article]

Kenny, Maureen C.; Dinehart, Laura H. (2016) Winick, Charles B.; In: Play therapy in middle

childhood. Drewes, Athena A. (Ed); Schaefer, Charles E. (Ed); Publisher: American

Psychological Association; 2016, pp. 257-274. [Chapter]

http://www.cdc.gov/ncbddd/autism/index.html


Koch, S. C., Morlinghaus, K., & Fuchs, T. (2007). The joy dance: Specific effects of a single

dance intervention on psychiatric patients with depression. The Arts in Psychotherapy,

34, 340, 349.

Levy, Fran J. (2014) American Journal of Dance Therapy, Vol 36(1), Jun, 2014 pp. 6-27.

Publisher: Springer; [Journal Article]

Martin, N. (2009). Art Therapy and Autism: Overview and Recommendations. Art Therapy,

4(26), 187-190.

Osborne, J. (2003). Art and the child with autism. Therapy or education? Early Child

Development and Care, 173, 411– 423.

Schweizer C, Knorth EJ, Spreen M. (2014). Art therapy with children with autism spectrum

disorders: A review of clinical case descriptions on ‘what works’. The Arts in

Psychotherapy. 577-93. New York, NY.

Simon, Dennis J. (2016). In: School-centered interventions: Evidence-based strategies for

social, emotional, and academic success. Simon, Dennis J.; Publisher: American

Psychological Association; 2016, pp. 233-255. [Chapter]

Stagnitti, Karen. (2016) In: Play therapy in middle childhood. Drewes, Athena A. (Ed);

Schaefer, Charles E. (Ed); Publisher: American Psychological Association; 2016, pp.

237-255. [Chapter]

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RESEARCH METHODS FINAL PAPER