Introduction

Art therapy is an interactive therapy that uses art supplies and methods (such as paint, crayons, clay, wood, textiles, music, etc.) to deliver a range of sensory stimulation in a secure, well-organised environment. Thoughts, motor skills, task orientation, cause-and-effect relationships, spatial insight, shape recognition, the sense of self-awareness in the surrounding space, and the development of eye contact are all stimulated by art therapy. 

Overview of autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is the medical name for autism, which is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. The term ASD refers to people who exhibit the entire spectrum of symptoms, from the mildest forms of Asperger syndrome (AS), or pervasive developmental disorders not otherwise defined (PDD, NOS), to the most severe form of the condition, autistic disorder or autism. It can be diagnosed at any age but is mainly done so in childhood, with the symptoms generally appearing before the child is two years old. The American Academy of Pediatrics recommends that all children receive screening for autism, and caregivers should talk to a general practitioner or a health visitor if they are concerned about any developed symptoms.¹

Connection between art therapy and Autism

When treating autism, art therapy is seen as a complementary therapy; it has the same effect as music therapy, play therapy, and recreation therapy. However, since art supplies are accessible and an easy way for kids to express themselves, autistic children appear to be more receptive to art-based interventions.² Because the child's attention is focused on creating art and the art therapist is paying attention to the child's artistic process, art therapy provides chances to support and treat children with ASD. Art therapy's multimodal nature and relational approach make it a potentially effective solution for these complex difficulties.³

Understanding autism

Characteristics of autism

According to the Centers for Disease Control and Prevention (CDC), all ASD individuals share to a certain extent some characteristics that vary in their intensity from one person to the other.⁴ These characteristics are categorised into:

Social communication and interaction skills

These are the most challenging skills that face any autistic person. Examples of early developmental challenges with social communication and interaction include:

• Eye contact avoidance
• By the age of 9 months old, they do not respond to their name
• By the age of 9 months old, they express relatively limited facial expressions such as happy, sad, or annoyance 
• By the age of 12 months old, they have relatively few or no gestures (such as waving farewell)
• By the age of 18 months old, they do not point to objects that interest them 
• By the age of 24 months old, their ability to notice emotions is relatively limited 
• By the age of 36 months old, their ability to notice other children is relatively limited and they avoid joining them to play 
• By the age of 48 months old, their ability to play pretend (such as pretending to cook or be a superhero) is relatively limited 
• By the age of 60 months, they do not perform, sing, or dance

Restricted / Repetitive behaviours and interests

Unusual behaviours or interests are very common in people with ASD. Examples of these are:

• Repetitive behaviour in playing 
• Repetitive use of certain words or phrases (called echolalia)
• Plays with the same toy the same way every time
• Loves routine and gets upset by any minor change
• Flapping hands, rocking body when happy, or spinning in circles
• Obsessive interests
• Unusual reactions to sounds, smells, or even tastes

Other characteristics

Many people with ASD have other related characteristics. Examples of these can include:

• Delayed language skills
• Delayed motor skills
• Delayed cognitive or learning skills
• Hyperactive, impulsive, or inattentive behaviour (such as attention deficit disorder)
• Epilepsy or seizure disorder
• Unusual eating and sleeping habits (for example picky eaters)
• Gastrointestinal issues (for example, constipation)
• Unusual mood or emotional reactions
• Anxiety, stress, or excessive worry
• Absence of fear or more fear than usual

Sensory sensitivities in autism

What does appear to be common to individuals with ASD is the atypical behavioural responses to sensory information. Over 96% of children with ASD report increased or decreased sensitivities in multiple domains.⁵ 

For example, not hearing fire alarms when they were set off is considered a hyposensitivity to sensory stimuli, while experiencing extreme distress when made to wear certain clothing because the child could not tolerate the texture of the fabric is a hyperreactive response to sensory stimuli. The significance of sensory difficulties as a diagnostic criterion for autism is still unclear, despite its potential importance as intervention targets.⁶

You can help reduce discomfort and improve chances for learning, socialisation, communication, and community participation for individuals with ASD by acknowledging and addressing sensory difficulties. Making adjustments to the child's surroundings, utilising tools and techniques, or forming new routines or habits are all examples of accommodations. One of these accommodations is to participate in art therapy.

How art therapy works

Any activity that enhances creativity in a person is considered art. This can include a variety of activities such as drawing, painting, crafts, sculpture, music, and drama. Multiple studies recently reviewed the benefits of integrating these arts into the lives of ASD individuals and concluded the following benefits:^7,8

• Expressing themselves in a safe environment
• Providing a wide range of sensory experiences (auditory, tactile, and visual senses)
• Reducing stress, anxiety, and depression
• Improves communication and social skills by being present in a group of individuals and under the supervision of an occupational therapist
• Improving verbal communication as well as nonverbal communication
• Improving attention span and eye contact
• Stimulating the learning process by activating certain areas in the brain resulting in positive behavioural changes

It is important to emphasise that art therapy is an expressive therapy that only aids in boosting communication skills for ASD individuals but should never be the only therapy used, as every person with ASD has a unique personality and should receive individualised therapy according to their needs.

Types of art therapy activities

As mentioned before, any activity that enhances creativity is considered art. Therefore, you can use multiple art therapy activities to enhance sensory perception processing and emotional regulation in ASD individuals. Examples include: 

Visual arts

Drawing and painting 

Drawing and painting are the most common forms of art therapy and often the most applicable as they can be applied in all environments. It includes various kinds of drawing and painting with different materials such as water painting, oil pastels, and regular ink colours. Research has found that helping children with ASD recognise themselves can be achieved through hand printing, sketching faces, and drawing different facial expressions. The results achieved were better imitation, communication skills, and cognitive development. ⁹ 

Sculpture, clay work and cooking

Participating in sculpture and clay artwork stimulates tactile and visual senses by using hands-on production.¹⁰ Similarly, cooking and baking can have a similar effect and can be done at home with your child. This could help with bonding and communication in addition to promoting language development.

Performing arts

Music therapy

Positive changes in the psychological, physical, cognitive, or social functioning of people with ASD are achieved through the use of music in music therapy. It relieves stress, anxiety, and depression and can help with self-expression and mind clearance.¹¹

Drama and dancing

Drama and dancing are considered acts of liberation that many individuals with ASD would enjoy. It is one of the purest forms of self-expression which promotes verbal and non-verbal communication among peers and therapists. 

In addition to that, dancing can be considered a great form of exercise. When performing any drama or act, your child can express their feelings, learn to embrace others' feelings, and enrich their personality. Many kids enjoy engaging in a drama or theatre act and this can improve their language skills significantly.

Case studies

One case study involved a therapist meeting a 6-year-old child who suffers from a severe developmental impairment. The child displayed symptoms of ASD, including poor social skills, lack of eye contact, and disinterest in the teacher. The child saw a therapist a total of twelve times. The programme began with free drawings and gradually increased the complexity of the artwork, culminating with the youngster sketching their face and creating a cake. 

As a result, there was an improvement in the child's ability to interact socially, including prosocial body posture, social responsibility, self-assertion, and overall score.¹²

Another noteworthy study included a 7-year-old autistic child who was originally uncomfortable in social situations. They had an interest in paint, which they liked to touch and spread, and over time, they started to relate to the therapist through painting. While painting served as the medium for the child and the therapist to communicate, overuse of it gave them excessive excitement. Nevertheless, by directing the child towards alternative art materials, like clay, the therapist was able to help the child regulate their emotional well-being. 

The child eventually found a way to control their bodily and emotional states by going back to painting and using clay as an alternative. After the child settled down, they were open to spending more time with the therapist, which allowed the communication cycle to continue while creating art together.¹³

Implementing art therapy at home

Today, art therapy is widely used in many different contexts, such as within private practice, senior communities, schools, crisis centres, forensic institutions, wellness centres, hospitals, psychiatric and rehabilitation facilities, and other professional and community settings. However, you can practise art at home for yourself or for your child using whatever materials are accessible and available and in which your child is interested. Art therapy can be started as early as the age of 2 or 3 years old, for example, using paper and colours, sand art, clay shaping, playdough sculptures, or even listening to music and dancing. 

Challenges and considerations of art therapy in autism

You should be aware that there are some challenges and considerations when applying art therapy to the routine of an individual with ASD. Some of these considerations were mentioned in a study in 2017 published in The Arts in Psychotherapy book and are listed below:

• Using the same structure in each session provides the sense of a routine which is favourable
• Explaining instructions for each activity is important
• Enhancing the sense of curiosity in each activity is important to teach a new skill
• Giving great attention to the transition between different activities and keeping it smooth after the approval of the individual

It was also found that some of the following practices were not useful:

• Giving too many instructions
• A lack of loose instructions
• Using overstimulating art materials that provoke stress in the individual (too many colours or materials)
• Imposing restrictions on communication techniques

Summary

Autism is not a disability, it is simply a difference in ability. Individuals with ASD can convey their thoughts and feelings about the world through art therapy. By recognising and resolving sensory issues, it is possible to lessen discomfort and increase opportunities for learning, socialisation, communication, and community involvement for people with ASD. Accommodations can include changing the environment, using tools and methods, or developing new routines or habits.

While every child's experience is unique, one of the most popular objectives of art therapy is to help children become more tolerant of unpleasant stimuli while trying to redirect their self-stimulating behaviours into creative play. While art therapy is recognized as a valuable tool for individuals with ASD, it needs to be sufficiently emphasised the importance of individualised therapy plans and the need for a holistic approach in addressing the diverse needs of those on the autism spectrum.