Thursday, August 5, 2010

Art Therapy Groups for ASD- How to Manage Behaviors in a Creative Environment

One of the challenges of conducting therapy groups for children is to balance structure with creative freedom. This is especially true for children with Autism Spectrum Disorders, because their behaviors can be very unpredictable causing the group to become chaotic and unsettling. So therefore a structured environment is essential and very often what this population thrives on. So, how can the art therapist still allow for creativity and mastery when behaviors are getting in the way? Not an easy task, but it can be done.


What kind of structure is needed? Well, it basically depends on the functioning level of the group but all in all I find it best to have a set plan of art making within a theme that the children can enjoy and relate to. For example "The Beach" or "Zoo Animals" and then have materials to support the theme, even sensory toys and books related to the theme helps to have on hand. Although as art therapists we try not to influence the art making, I always try to make a "sample" of the project to allow the children to have a visual representation; this very often is helpful to get them started. It is also useful to have "group rules" established before engaging in activity; this serves as a behavioral structure and will set boundaries for unaccepted behaviors.


Building social skills are a big component to ASD groups. Art making can allow for this to occur by designing the groups to "work together" or cooperatively. Murals, group collages and quilt making can allow this to happen. While children are engaging in the art making process, the therapist should always be mirroring back the accomplishments of each child's successes. Something as small as sharing a crayon can reinforce the skills being built. In addition, commenting on art elements within the child's work is great way to encourage individual creativity and to engage others in sharing thoughts as well. Making connections within the group is very powerful too. For example saying, "Look Johnny….. Billy's painting has the same bright green that your picture has……is that one of your favorite colors? Maybe it's Billy's favorite color, let's ask him…."


Some children on the spectrum who are lower functioning will need more assistance in order to participate in the group. Until they are comfortable in their surroundings some children will require a 1:1 aide within the group to help manage behaviors. It will benefit the child as well as the therapist to have this extra help in order to maintain group cohesion. As the child becomes more adaptable, the aide can be less involved and eventually weaned out of the group. In addition, the groups should have a manageable number of children based on available aides and volunteers. The ratio should be determined based on functioning level as well. An ideal group size is about 4-6 children with a lead therapist and at least one assistant as well as an aide for behavioral children.


One last thing to keep in mind when working with children on the spectrum is the choice of materials for art making. Make sure you are aware of sensory issues within the group as well as allergies and aversions which children with ASD often have. It is best to build up a tolerance to messier materials which can often be regressive. Painting is fine, however put out small amounts and use spill proof containers. Make sure that when messy materials are being presented there are enough aides to provide support and "hand over hand" assistance. Letting parents know beforehand is a good idea for dressing down and having smocks is a good idea as well.


Hope this is helpful and will have more on this topic to come………


TQArtTx said...

Pamela, this is excellently written, and validates what I've suspected has been working against more therapeutic dynamics and outcome in my current position leading groups. Out of curiosity, how long are your sessions? And do you see the children long term, which is so helpful for group cohesion and practicing social skills with each other?

Pamela Ullmann, ATR-BC, LCAT said...

Hi TQArtTx,
Thank you for your comment. I do know that this population can be a challenge and we need to support each other. Sessions, in my opinion should not exceed 45 minutes. Sometimes, a session can even be as short as 30 minutes with the last 15 minutes spent for "free play" time. One organization that I am clinical supervisor at has a year long program in which children sign up for an entire school year. Sessions are on Saturdays...this allows for social skill building and friendships to develop.

TQArtTx said...

It becomes that much more challenging to address the needs of children with ASD when they are part of mixed groups of children. In the psychiatric hospital where I work, children are divided by age group: elementary, middle school, and high school. So not only do I have a wide age range in any group, but also a wide diagnostic range. There are usually 8 to 10 children in each group, and I have no assistants beyond their teacher and a child care worker - who typically prefer to let me do everything. The children are not usually admitted for longer than three months, to boot...