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Art Therapy with Children on the Autistic Spectrum ofrelatedinterest AutismandSensing TheUnlostInstinct DonnaWilliams ISBN1853026123 AutismandPlay JannikBeyerandLoneGammeltoft ISBN1853028452 BrightSplintersoftheMind APersonalStoryofResearchwithAutisticSavants BeateHermelin ISBN1853029327pb ISBN1853029319hb Asperger’sSyndrome AGuideforParentsandProfessionals TonyAttwood ISBN1853025771 ArtTherapyandComputerTechnology AVirtualStudioofPossibilities CathyMalchiodi ISBN185302922X Art Therapy with Children on the Autistic Spectrum Beyond Words Kathy Evans and Janek Dubowski Jessica Kingsley Publishers London and Philadelphia Allrightsreserved.Nopartofthispublicationmaybereproducedinanymaterialform (includingphotocopyingorstoringitinanymediumbyelectronicmeansandwhetheror nottransientlyorincidentallytosomeotheruseofthispublication)withoutthewritten permissionofthecopyrightownerexceptinaccordancewiththeprovisionsofthe Copyright,DesignsandPatentsAct1988orunderthetermsofalicenceissuedbythe CopyrightLicensingAgencyLtd,90TottenhamCourtRoad,London,EnglandW1T4LP. Applicationsforthecopyrightowner’swrittenpermissiontoreproduceanypartofthis publicationshouldbeaddressedtothepublisher. Warning:Thedoingofanunauthorisedactinrelationtoacopyrightworkmayresultin bothacivilclaimfordamagesandcriminalprosecution. TherightofKathyEvansandJanekDubowskitobeidentifiedasauthorsofthisworkhas beenassertedbytheminaccordancewiththeCopyright,DesignsandPatentsAct1988. FirstpublishedintheUnitedKingdomin2001by JessicaKingsleyPublishers 116PentonvilleRoad LondonN19JB,UK and 400MarketStreet,Suite400 Philadelphia,PA19106,USA www.jkp.com Copyright©2001KathyEvansandJanekDubowski LibraryofCongressCataloginginPublicationData Evans,Kathy,1948- Art therapy with children within the autistic spectrum / Cathy Evans and Janek Dubowski. P.cm. Includesbibliographicalreferencesandindex. ISBN1-85302-825-8(pbk.:Alk.Paper) 1. Autism in children--Treatment. 2. Art therapy for children. I. Dubowski, Janek.IITitle. RJ506.A9E9632000 618.92’8920651--dc21 99-056346 BritishLibraryCataloguinginPublicationData ACIPcataloguerecordforthisbookisavailablefromtheBritishLibrary ISBN-13:9781853028250 ISBN-10:1853028258 PrintedandBoundinGreatBritainby AthenaeumPress,Gateshead,TyneandWear Contents Introduction 7 1 Developmental Deficit: Communication and imagination 15 2 Imaginative Play, Creativity and Art 23 3 Drawing Development 31 4 Symbols, Signs, Theory of Mind, Autism and Drawing Development 39 5 The Basis for Intervention: From theory to practice 49 6 Diagnosis, Understanding and Assessment 63 7 Working with Stephen 81 8 Developing an Interactive Art Therapy Template 97 REFERENCES 103 SUBJECTINDEX 107 AUTHORINDEX 109 Figures Figure3.1 Patrick’sconsolidateddrawing 34 Figure4.1 David’stiger 44 Figure4.2 David’selephantandmonkey 45 Figure4.3 OneofDavid’slaterpaintings 46 Figure5.1 Charlotte’spainting1 52 Figure5.2 Charlotte’spainting2 52 Figure5.3 Charlotte’spainting3 53 Figure5.4 Charlotte’spainting4 53 Figure6.1 Charlotte’spainting5 67 Figure7.1 Stephen’sfirstscribbles 84 Figure7.2 Stephen’spainting1 88 Figure7.3 Stephen’stwiddledtissues 89 Figure7.4 Stephen’spainting2 90 Introduction The application of art therapy for children with autism is not somethingnew.Astheprofessionhasdevelopedsincethe1960sand 1970s, countless practitioners have contributed to the educational and treatment programmes offered to autistic children in settings such as special schools and social services departments as well as in privatepractice.Differentmodelsofarttherapyhavebeendeveloped, ranging from working developmentally by helping individuals to move from one stage of drawing development to the next, to inter- veningpsychotherapeuticallywithafocusonthealleviationof psy- chologicalproblemsanddistress.Someofthesemodelsarediscussed inthisbooktogetherwithanemphasisontheparticularapproachwe have been developing since the mid-1990s. As our insight into the conditions associated with autism grows, our understanding of effective forms of support or intervention becomesenhanced.Inthisbookweexploreourunderstandingofthe art produced by children with autism and how art therapy may be able to help them. From the perspective of contemporary child and infantpsychologywithaparticularfocusonemotionaldevelopment and relationship as informed by studies into intersubjectivity, we attempttoprovideamodelofinterventionthataddressestheseverity and complexity of disability associated with deficits in communication and imagination characteristic of autism. Amongthevariousdevelopmentaldeficienciestobeobservedin childrenwithautism,deficitsincommunicationandimaginationare veryapparent.Althoughthemajorityofautisticchildrendodevelop 7 8 ARTTHERAPYWITHCHILDRENONTHEAUTISTICSPECTRUM language, language use is often idiosyncratic and may involve echolalia, repetition and delayed processing. Therearemanyparallelstobefoundwhenobservingtheplayof children with autism, for example the repetitive building of towers out of Lego bricks or the lining up of crayons in a specific order of colour.Theplayisnotwhatwewouldterm‘imaginative’:itdoesnot involvepretendplaynordoesitsuggestthatthechildhasthecapacity toimaginethatanobjectcanstandforsomethingelse.Whileforthe normal child a banana can stand in for a telephone receiver, or a broom handle may represent a hobby-horse, for the autistic child they will always be bananas and broom handles. Theseexamplesgiveanindicationoftheseverityandcomplexity ofdisabilityassociatedwithdeficitsincommunicationandimagina- tionthatarecharacteristicofautism.Amongthemanyformsofinter- vention that have been and are being applied in helping these childrentoworkthroughthesedisabilities,arttherapyappearstobe promising.Whenwemakeapictureitisacommunicativeact,wean- ticipateandhopethattheviewer,whetherthisisthechild’smotheror the artist’s public, will understand something about what has been depictedwhentheyviewtheimage.Thecreativeact,necessaryinthe makingofart,isitselfanactofimagination.Itinvolvesthetranslation ofaninternalimageinthemindintoatangibleformonthesheetof paper. Later on we shall describe the developmental processes by whichanormalchildgainsthecapacitytomakeimagesthatareboth communicativeandimaginativeandweshallexplorewhatitiswithin autism that interferes with these processes. Inthesamewaythatmanychildrenwithautismdeveloplanguage but use it in an idiosyncratic and inappropriate way, these children oftenlearnhowtomakerepresentationalimages.Indeedwehavecel- ebrated cases of individual children who have shown a remarkable abilityandtalentintheirdrawing,themostnotableexamplesperhaps being Nadia and Steven Wiltshire (Selfe 1977, 1983). However, in INTRODUCTION 9 ourwork,timeandtimeagain,wecomeacrossthesameidiosyncra- sies and inappropriateness in image making as are found in languages. Theseobservationsandquestionsformthestartingpointforour inquiryintotheartofchildrenwithautisticspectrumdisorder.Asart therapistsweimaginethatartcouldhelp,atafundamentallevel,the development of both communication and imagination but in our work we have developed a number of cautions that need to be observed.Itismoretheactofmakinganimageandallthatisinvolved inthisactthatitisimportanttounderstandthanthefinalimageitself. Indeed,wehavefrequentlyfoundthatananalysisofthefinalimage alone gives a misleading understanding or interpretation of what is goingonforthechild.Inthesamewaythathigh-functioningautistic children’svastvocabularymightleadustoassumethattheyhaveso- phisticatedcommunicativeskills,thedraughtsmanshipexhibitedby childrensuchasNadiaandStevenWiltshiremightleadustosuppose thattheyhavedevelopedsophisticatedchannelsforgraphiccommu- nication. It is important to understand something about normal drawing development in childhood before we can see how the condition of autismaffectsthis.Inthisbookweshallmakesuchcomparisonsand demonstrate some of the drawing processes developed by autistic children.Thiswillbedoneinthecontextofarttherapy,inwhichthe therapeuticrelationshipbetweenclientandtherapistisasimportant as the art-making process itself. Weshallshowhowthisisparalleledinnormaldevelopmentinthe non-verbal communicative dialogue that takes place between the child,otherpeopleandtheartworkthattheyareengagedin.Pictures are a form of communication and the development of this does not takeplaceinisolationbutwithinacomplexrelationshipthatinvolves thesethreeelements:thechild,theimageandthespectator.Thistri- partite relationship is reflected in the therapeutic environment: the

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Recent research has shown that art therapy can be particularly effective for children with autism and related communication disorders. The extensive range of symptoms experienced by autistic people makes them extremely individual in presentation, so any treatment used must be tailored to a range of