Varun Ramnarayan Venkit
Anand Sharad Godse
Autism, Art Based Intervention, Behavioural Issues, Group-Drumming, Creative Movement, Drama Based Interventions, Dance movement therapy.
Art therapy helps individuals experience increased well-being through a number of creative pathways, that uniquely illuminate purpose and meaning and increase positive emotions and engagement (Wilkinson and Chilton, 2013). Over the past decade, health psychologists have cautiously begun studying how the arts might be used with children having Autism, Attention Deficit Hyperactivity Disorder (ADHD) and Pervasive Developmental Disorder, to increase their understanding of the self and others, develop a capacity for self-reflection, enhance social skills, and alter problem behaviours and thinking patterns. Art based therapies are complex interventions, that combine psychotherapeutic techniques with activities aimed at promoting creative expression. The creative process is used to facilitate self-expression within a specific therapeutic framework, the aesthetic form is used to ‘contain’ and give meaning to the patient’s experience, the artistic medium is used as a bridge to verbal dialogue and insight-based psychological development, and the aim is to enable the patient to experience him/herself differently and develop new ways of relating to others (National Collaborating Centre for Mental Health, 2009).
According to the American Psychiatric Association, individuals with Autism Spectrum Disorder (ASD) have difficulty with social interaction, communication, and imaginative play; they also display stereotyped and repetitive patterns of behavior, interests, and activities (American Psychiatric Association, 2000). Individuals diagnosed with ADHD, according to the American Psychological Association, exhibit a persistent pattern of trouble, with inattention and hyperactivity/impulsivity that is more pronounced than would be expected of individuals of a similar age. Behaviours that an individual with ADHD may live with, may be, low frustration tolerance, temper outbursts, bossiness, stubbornness, excessive and frequent insistence that requests be met, mood stability, demoralization, dysphoria, rejection by peers, and poor self-esteem (American Psychiatric Association, 2000).
Recent research shows that art therapy is useful for children with psychological disabilities such as Autism Spectrum Disorder (ASD) and ADHD. Art therapy facilitates cognitive development, the development of abstract thinking skills, improvement of social skills, and helps in decreasing problem behaviours (Thoemke, 2012). A social skills program using art therapy for children with Autism revealed a significant improvement in their assertion, coupled with decreased internalizing behaviours, hyperactivity, and problem behaviour (Epp, 2008). A study of an Art Therapy group for Impulsive Children revealed an increase in the child’s ability for self-control and in maintaining their physical space appropriately. The children took fewer risks, were able to share more appropriately and showed an increasing ability to keep to the limits and rules of the environment (Murphy, Paisley and Pardoe, 2004).
Dance and movement therapy enables attention to kinesthetic coherence or motor coordination, that may be the stepping-stone to the successful treatment of young boys diagnosed with ADHD. It gives boys with ADHD a possibility, like other children, to have an activity outside school which increases a child’s quality of life (Grönlund, Renck, and Weibull, 2005).
Creative dance and movement can enable the children to rebuild a healthier connection with the body, senses and cognitive skills, improving body awareness and body image. It can help to give children a ‘sense of wholeness’ by connecting body, mind and emotions (Sherborne, 1990). Art therapy as a component to social skills training may increase the willingness of children to participate, because art is an activity that they find acceptable (Julian, 2004). Music stimuli have often been used as therapeutic media in treating children with autism and other pervasive developmental disorders (Nelson, Anderson and Gonzales, 1984).
The current research explores the relationship between engagement in the creative arts and health outcomes, specifically the health effects of music engagement and movement-based creative expression. There is evidence that art-based interventions are effective in reducing adverse physiological and psychological outcomes; and that engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one’s own creative efforts, can enhance one’s moods, emotions, and other psychological states as well as have a salient impact on important physiological parameters (Stuckey and Nobel, 2010).
Introduced in August 2013, under a non-profit research organization – FLOW in collaboration with Artsphere, Art Talks is a long-term, inclusive and experiential arts-based intervention program for children with special needs like expression blockages, confidence issues, ADHD, Dyslexia, Autism, Down Syndrome and other similar issues.
Under Art Talks, specific therapeutic goals are identified upon commencement of the program, for every individual participant, and through the use of arts-based interventions such as rhythm (drumming), creative movement, fine arts and drama, the following areas are worked upon:
Expressive skills – verbal and nonverbal, attention span, group and social etiquette, recall and memory power, sensory stimulation, introspection and awareness.
The following practice focused report is based on a project that ran for the duration of nine months from the 7th of August 2013 to the 17th of May 2014. Since it was a pilot study to adjudge the positive influences of art-based interventions in children with special needs, there was no fixed intake. Interested participants were introduced in the session as and when they enrolled.
Sessions were held twice a week. The first month was spent in rapport and therapeutic goal building. This seemed to be the minimum time required to elicit natural and unbiased responses from the participants, after they were comfortable with the facilitators, being without their parents, and started trusting the therapeutic process. This was also the period of time required for the facilitators to set an intention for the child that would be worked towards during the sessions.
There were two certified art-based therapists or head-facilitators, each with a team of one co-facilitator and one observer who led the sessions once a week. One of the facilitators was predominantly a dance/movement therapist and the other was a drum circle facilitator and majorly used drumming along with singing, movement, yoga, chanting as common tools for the sessions. Both facilitators worked towards the following goals:
- To bring out the inherent potential in children with special needs, using participatory and expressive arts interventions over a period of time.
- To increase attention span, expressiveness, confidence, sociability (group behaviour), and emotional awareness.
- To document the role of the arts in health and well-being of children with special needs.
Initial data was collected through in-depth interviews with the parents about their perception of their child, and their report of the child’s problem behaviour(s). Thereafter the child was put in the one-month rapport building or observation period where his / her ‘case report’ (Art Talks Report I) would be built. The facilitator, co-facilitator and observer maintained online reports after each session, reporting behaviour that showed positive movement in the target therapeutic goals. Each session had a plan based on a specific therapeutic goal. Based on this, each session was divided into warm-up activity, one or more main activities and a debriefing / cool-down activity. The observer would look for behavior indicators showing progress in the therapeutic goals identified for each child. Thereafter a progress report (Art Talks Report II) was generated after 3 months of the program, where feedback from the parents and school teachers was taken. This is also the period when the parent would be presented with a home plan. The home plan consisted of activities that would further reinforce the assimilation of our therapeutic goals. Finally, an end-of-module report (Art Talks Report III) was generated to mark the end of the stipulated 6 month module.
The cases that we studied showed noticeable positive differences in varying proportions on the parameters of expression (verbal and nonverbal), sociability (group skills), attention span and fine motor skills.
Using various components of arts such as drumming, creative movement, singing, stories and yoga-based activities, helped us provide a variety that kept the child engaged, and subliminally reinforced the therapeutic goals. Secondly, if a child did not take to a particular art form, then it was easy for the facilitators to narrow down to activities that worked for the child.
Dance Movement Therapy builds on the joy of movement and lust for life. When children are inspired to have fun together in a group, they can more easily share problems and even show compassion (Gronlund, 1994). In Dance Therapy, the connection between motion and emotion is stressed. The movement dialogue expands as the emotional content is brought to the surface, through the experience of moving the body. While words can be consciously disguised and self-censored to suppress the expression of emotional states, body movement is a more basic form of emotional disclosure (Berger, 1972). The dance movement therapy sessions, in our case studies, seemed to address the parameter of emotional expression more effectively than drumming. The children were able to identify their emotions with the activities better. These sessions also physically stimulated them more. Dance movement therapy expands self-expression and perception, builds body awareness, assists in defining and establishing healthy boundaries, releases tension and stress, increases the attentiveness of self and others, promotes building interpersonal relationships, and improves communication skills in children and adults of all ages and stages of development (Basiner, et.al, 2007).
In congruence with the findings of Venkit et. al, (2012), drumming worked better on the parameters such as attention, retention & retrieval (memory) and motor co-ordination development. Functional areas described to be positively affected by music are, learning history and responsiveness to therapy; responsiveness to sensory stimuli; attentional processes; transfer of learning and coping with change; temporal perception; rhythmic movement and praxia; representation, symbolic functions, and language; communication and socialization; and meaning, affect, and activity repertoire (Nelson, Anderson and Gonzales, 1984). Improvisational music therapy was more effective at facilitating joint attention behaviours and non-verbal social communication skills in children than play (Kim, Wigram and Gold, 2008).
Drumming helps foster a sense of confidence and achievement by way of increased eye contact and conscious verbal expression (Venkit, et. al, 2012). Based on interviews with the parents four months after the sessions, the progress made over the pilot study was long lasting in their home and social settings. The children seemed to have internalized these changes, exhibiting instances of initiating communication and instruction comprehension in other social situations as well.
It would be unrealistic to attribute these positive changes solely to Art Talks sessions considering that the children were, on an average, also going to occupational therapy, speech therapy and external counselling sessions in addition to Art Talks. It would be desirable to establish a consolidated and intensive after-school programme for these children to address a majority of their needs under one roof.
Art based interventions seemed to work well in addition to the ongoing therapeutic plan of the special needs children. Increasing the frequency and scope of these sessions will help build more credibility for the application of arts as a form of therapy for such a group.
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