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A Case for Art Therapy as a Treatment for Autism
'The Version of Record of this manuscript has been published and is available in <Art Therapy > <20.05. 2019 >
http://www.tandfonline.com/< DOI: 10.1080/07421656.2019.1609326 >.'
Art therapy has the potential to address some of the core symptoms of autism spectrum disorder (ASD)
by promoting sensory regulation, supporting psychomotor development, and facilitating communication.
The multisensory nature of art materials and the relational aspect of art making lends itself to the
treatment of the challenges inherent in ASD while enhancing psycho-emotional well-being. These areas
offer promising pathways for research.
Autism spectrum disorder (ASD) can manifest as difficulties with sensory motor functions,
communication, and relationships (Volkmar, Chawarska, & Klin, 2005). Art therapy has the
potential to address these complex issues due to its multisensory nature and rela- tional
approach (Hass-Cohen & Findlay, 2015). However, art therapy is not sufficiently recognized as a
significant intervention for autism due to a paucity of quantitative research, which is considered
the benchmark for evidence-based practice (Van Lith, Stallings, & Harris, 2017). Consequently,
caregivers of children with autism opt for therapies that emphasize the criticality of early
intervention for skill building and modifying behaviors. The common behavioral interventions
are supplemented with speech and language therapies, occupational therapy for sensory motor
issues and, in some cases, biomedical and dietary interventions.
As a parent of a child with autism, I can understand why behavioral approaches that promise
relatively quick results appeal to distressed parents struggling with non- communicative or
behaviorally challenging children. These treatments are in contrast to a more measured
approach like art therapy that focuses first on relation- ship building before attending to
behaviors (Kuo & Plavnick, 2015). However, there appears to be an over- sight with regard to
the psychoemotional needs of the child with autism, a fact that dawned on me first as a parent
and later as an art therapist. Ignoring this aspect has detrimental effects, which become
especially significant due to a high incidence of reported comorbidities of anxiety and
depression in children with autism (Ben- Sasson et al., 2007). In addition, art making can be fun
and could be an excellent resource for a child struggling under the weight of an otherwise
tiresome therapy schedule.
I do not intend to undermine either the importance or the efficacy of the commonplace
therapeutic interventions for ASD. Rather, my aim is to draw attention to a possible gap in the
regimen of autism-specific treatments. Thus, I propose a broader view of art therapy as a treat-
ment for autism that can address psychoemotional needs of the child as well as promote
sensory regulation, sup- port psychomotor development, and facilitate communication. These
areas also represent promising directions for further research. Rather than focus on the final art
product, I describe important elements of the creative process to demonstrate Evans and
Dubowski’s (2001) claim, “communication does not reside just within the finished pictures
made by the child, but within the emerging and shifting dynamics of the whole art therapy
process and its context” (p. 57). What follows is a brief overview of how art therapy can address
some of the core symptoms of autism and indeed be a treatment of choice.
Sensory integration dysfunction (SID) is a core symptom of ASD and can adversely affect the
behavior and learning of children experiencing it. SID refers to an individual’s atypical response
to external stimuli per- ceived through the senses of smell, taste, vision, hearing, kinesthetic,
vestibular, or proprioception (Marco, Hinkley, Hill, & Nagarajan, 2011). Children with SID have a
varied sensory profile and might suffer from a high degree of anxiety resulting in behavioral,
psycho- social, and cognitive problems (Tomchek & Dunn, 2007). A child with SID might be
hypo- or hypersensitive to sensory stimuli; a child with tactile hypersensitivity might feel
extreme pain at the slightest touch,
whereas the hyposensitive child might seek extreme tact- ile stimulation. In my experience,
working with children with autism requires a keen understanding of sensory challenges and
familiarity with their sensory profiles. It is important to communicate with the child’s
occupational therapist, interview the caregivers, and observe the child in action.
The variety of textures, colors, smells, and tastes of art materials have an inherent capacity to
inhibit or induce emotional and sensory responses (Hinz, 2016). The visceral quality of art
materials and application techniques can involve whole body movements. These in turn can
stimulate different somatosensory and emotional regions of the brain, thereby generating
psycho- somatic reactions that can regulate affect (Hass-Cohen & Findlay, 2015). Therefore, art
therapists can harness the inherent qualities of art materials and their uses to supplement
For example, Max (pseudonym), a 6-year-old boy with autism, had extreme sensory-seeking
behavior that required heavy tactile input. At the beginning of each of our art therapy sessions,
he would regulate his anxiety by rolling dozens of balls of clay between his fingers while I sat
next to him. The tactile input from handling the clay calmed him sufficiently to allow him to
move on to other activities such as joint art making with me. Increased sensory regulation could
set the foundation for learning, communication, and relationship building (Durrani, 2014).
Recent research has broadened its lens to consider the neurological deficits underlying autism
rather than the singular focus on the relational aspect of the spectrum (Devito et al., 2007). This
shift in perspective regards autism as a whole mind and body disorder involving sensory and
psychomotor difficulties that underlie autistic behaviors. Whereas sensory difficulties arise
from inappropriate responses to environmental stimuli, psychomotor challenges are the result
of impairment in cognitive functions and bodily movement (Donnellan, Hill, & Leary, 2013). The
stories of individuals on the spectrum have contributed immensely to our understanding of the
challenges that can hamper simple chores and daily functioning. For instance, a seemingly
straightforward task such as smiling or walking into a room might involve multiple challenges
in perception, organization, control, and execution (Robledo, Donnellan, & Strand-Conroy,
Art therapists can support psychomotor regulation by adapting art materials and the art-
making space to suit the needs of their clients. It is important to have brushes in a number of
sizes and grips to aid fine motor skills. Handgrips might be necessary for pencils and cray- ons.
Rather than finger dexterity, hands and limbs can take over the function of tools. The kinesthetic
component of art making might involve cross lateral, bilateral
and whole-body movement (Lusebrink, 1992). Accordingly, artwork can be made on material
placed vertically on walls, horizontally on a table or floor, and at other angles on custom-built
surfaces to accommodate disabilities. Clients can make art while static or moving, sitting,
standing, or even lying down. Art therapists who are sensitive to the needs of their clients can
incorporate various aspects of psychomotor development within their session by the prudent
use of art tools, art materials, and directives.
For example, I encouraged 14-year-old Raj (pseudonym), a boy with autism who was low on
motivation, to spray shaving foam in large circles on a mirrored wall in my studio. I
demonstrated and joined him to spread the foam using large bilateral movements of his arms
and hands. Once Raj was engaged in the activity, I urged him to jump up, bend down, and stretch
as far as he could to reach the farthest ends of the mirror. To stimulate Raj further, I added paint
to the foam, which sustained and extended the activity into finger drawings.
Communication and Expression Within the Context of Attachment
The early attachment relationship with a primary caregiver is how human infants, born
completely help- less, learn about themselves and their environment through interaction with
others (Bowlby, 1973). Healthy physical, psychological, and emotional development is
contingent on their relationship with the significant other. A securely attached child is likely to
be resilient as well as possess the ability to self-regulate and relieve dis- tress. An insecurely
attached child might be anxious, have impaired regulation, suffer low self-esteem, and have
relational problems among other effects (van der Kolk, 2014).
The quality of attachment between a child and care- giver is subject to specific synchronous
behaviors (Schore, 2003; Snyder, Shapiro, & Treleaven, 2012). Many of these behaviors,
including reciprocal communication, attunement, coregulation, eye gaze, gestures, and
vocalizations, could be difficult for children with autism. Developmental delays and social and
emotional differences can negatively affect the attachment pattern of a child with ASD as
compared to his or her neurotypical peers (Sivaratnam, Newman, Tonge, & Rinehart, 2015).
Fortunately, later relationships in life can replace earlier patterns of impaired attachment
(Siegel, 2003). Therefore, an attachment between an art therapist and child with autism has
positive implications (Martin, 2009).
Children with autism face challenges in verbal and nonverbal communication; social skills
including under- standing others’ motivations, reading and responding to gestural cues, and
maintaining joint attention; as well as recognizing and understanding their own emotions
(Greenspan, 2002). Art therapy can alleviate frustration
by helping the child with autism express emotions and communicate with others. One way that
art therapists can support clients with autism is by adopting a relational art-making approach
(Hass-Cohen & Findlay, 2015). An art therapist can emulate a secure base for the child with
autism by incorporating attachment behaviors such as reciprocal cueing (responding to
gestures or vocalizations of the child), attuning to the child (paying attention to rhythm and
body language; Evans & Dubowski, 2001), and mirroring or reflecting the feelings or affect of
the child (Gallese, 2009).
For example, Ali (pseudonym), a 7-year-old boy with autism, was initially averse to social
interactions. He gradually began to relate with me through paint, a medium he enjoyed touching
and smearing. Although paint was the route through which Ali engaged with me, excessive use
of the material made him overexcited. Nevertheless, I was able to modulate Ali by directing him
to a more grounding material such as clay. Over time, Ali was able to return to paint and use it
alternatively with clay as a means to regulate his physical and emotional state. Once Ali was
calm, he was willing to remain in longer periods of engagement with me, which sustained our
cycle of communication through joint art making.
The multisensory nature of art therapy and the rela tional aspect of art making contextualized
within the psychological expertise of the art therapist present a strong case for art therapy as a
treatment option for ASD. Art therapists can help clients with autism by designing sessions with
attention to sensory regulation, psychomotor development, and communication. Rather than
see these three areas in isolation, an art therapist can incorporate sensory regulation through
the use of the art materials concurrent to relationship building, communication, and expression.
Art therapists must advocate more actively for their profession through research and its
dissemination, continuing to broaden the scope of art therapy.
Huma Durrani has a doctorate in art therapy from Mount Mary University in Milwaukee, WI, and is a part-
time lecturer in the Art Therapy Program LASALLE College of the Arts, Singapore. Correspondence
concerning this article should be addressed to the author at firstname.lastname@example.org
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