Accepting ASD

As I observed a young boy with Autism in one of our groups, I kept trying to “figure him out”. Why does he flutter his hands? What makes him jumpy or make the sounds that he does? How can we get him to participate with the others in the art therapy process? As clinicians, we are always looking for the right approach or mix or perhaps the right ”connection” to the child. But what I am discovering is that maybe those answers will not be avaialble any time soon- so in the meantime I think that focusing on the journey with the child and staying with the unanswered questions can be the enough for the moment. It may feel as if we are not connecting or making progress, but as with all therapeutic processes the subleties can pave the way.
Here are some points to keep in mind when working with children with Autism Spectrum Disorders:

1) Remember that Autism is a challenging disorder and there will be a lot of tough days, so go easy on yourself.

2) Meet the child where they are at that moment in time. Sense the energy level and try to empathize with their potential discomforts. If the energy is high and overstimulating, offer calming activities with little pressure.

3) If the child’s voice or level of verbal sounds is loud….do not try to “speak over them” but rather lower your voice and calmly wait for them to see that you are trying to communicate with them, this takes patience. But, very often they will want to hear you and will become quieter in order to listen.

4) Sometimse offering a light touch or contact to their should or back may get their attention, calm them or regulate their energy. But be careful to ask the child if it is ok to touch them as it can be misread and there may be issues with touch.

5) Be aware of bright lights, loud outside noises or other stimulating sources in the environment. See if dimming lights helps, or adding soft music to the room helps. You can also teach the child to do deep breathing….this sometimes works wonders, espsecially if you make it into a game or use bubbles.

So, although we may not have all the answers to everything about how and why the child behaves a certain way or can’t seem to connect to his peers or to us, we can relax a bit and just try to be available for the child as best we can. As we travel the journey, an answer or two may just appear when its supposed to.

The Power of Therapeutic Play

Children with Autism have many challenges with socialization and communication. They find it extremely difficult to relate to others; especially to their peers.  Instead of playing with toys in imaginative ways (such as pretending a doll is really "my baby”) they may use toys for self-stimulation, perseverate on objects, and become entirely self-absorbed.

For typical children, play allows learning and social skills to build naturally. We usually do not have to “teach” children to play. However, a child on the spectrum may need some guidance. Play can be a great tool for helping children to go beyond autism's self-absorption into a real and shared interaction. When directed properly, creative play can also help children explore their feelings and their environment. Eventually this can lead to stronger relationships with parents, siblings and peers.

Theories such as DIR/Floortime, a model created by Dr. Stanley Greenspan emphasize the use of play. The idea is to follow the child’s natural emotions and interests which he says is essential for learning and developing various parts of the mind and brain. In typical play therapy, clinicians are usually interested in letting the child take the lead. The therapist reflects back to the child their observations of what is happening in the session and mirrors back. Play Therapy with the Autistic child is a bit more challenging. We need to establish their functioning level and adapt to it. As stated above, they may not have the ability to play imaginative or symbolically. We need to be very animated and show them how to do this.

We may need to will get down on the floor with the child and truly engage him through the modality of play. For example, we might set out a number of toys that the child finds interesting, and allow them to decide what, if anything, interests her. If they pick up a toy car and run it back and forth without purpose, the therapist might pick up another car and place it in front of the child's, blocking its path and saying “beep beep”. If the child responds -- verbally or non-verbally -- then a relationship has begun. If there is little reaction, the therapist might look for sensory or high-interest, options to engage the child. Bubble blowing is often successful, as are toys that are “cause and effect”- they can move, squeak, vibrate, and otherwise do something.

As the therapy builds, the therapist can build reciprocal skills, such as sharing, taking turns, and imaginative skills (pretending to feed a toy animal, cook pretend skills) and even abstract thinking skills (putting together puzzles, solving problems). Eventually, as the child becomes better able to relate to others, participating in a small group of peers would help further by engaging in more social play.

Drawing with Alternative Materials

Some children on the spectrum seek sensory input when I work with them in art therapy. One client that I work with can not use tradition drawing materials for any focused amount of time. I have found that there are other ways to "draw" images that keep him engaged better.

Wiki sticks are thin, bendable waxy materials that stick to surfaces and each other. We have been able to use them in image making quite successfully. This child loves the "stickiness" of the sticks and it encourages him to explore twisting and shaping them to create images on the paper. The sticks can be cut as well to help manage details in picture making. What is wonderful about this method, is that I am able to help the child learn some basic drawing skills; while at the same time engaing him and adapting to his sensory needs.

Model magic is another material that can be used for picture making. I think I have showcased this before, but can not emphasize its usefulness. This child was able to manipulate the modeling material into shapes thius creating the whole image. As he "practices" with engaing materials, his drawing skills improve and traditional media can be introduced gradually. 

Create Flash Cards to help Children with Autism Learn about Feelings

Children with Autism very often cannot fully comprehend feelings. They generally do not
understand how to read facial expressions on others and how these expressions
can indicate emotions. As a result, they have problems learning how to express
their own feelings and then can become frustrated. This frustration can turn
into meltdowns because they have difficulties communicating those feelings and
then frustration grows out of control. One of the best ways to teach children
with Autism to communicate feelings is to use or create visual aids so that they can begin to recognize these more fully.


Making flashcards together can be an effective way for children to relate and
recognize feelings. Gather magazines,stickers, scissors, index cards and glue to create your own flashcards. You can use pictures of favorite characters and actors and then cut out each one and paste it onto the card. You can also use stickers of different characters. Then
go through the flashcards with the child asking him how he feels about the
different pictures. See the nonverbal reactions as well. You can write the
correct emotion or feeling on the back and let him know what that emotion is.
Or you can write it on the front to encourage the verbal.

During your sessions,when emotions arise, ask the child for the appropriate card that corresponds to the feeling. Or model for him, for example when he gets angry, tell him that it
seems that he is angry and show him the right card. Do this for each card until
he starts to understand. Then you can praise or reward him for getting the
right card.

Use the words “I feel”along with the card, as in “I feel…” and then show the appropriate card. Or ifthe child is showing a particular emotion, say “I feel…” and show that card. Encourage the child to say the same phrase and show you the card. He doesn't have to verbally express the emotion yet, but try to have the child show you the emotion card
and if verbal, eventually say the phrase.

Continue to teach the child to say the emotion with the phrase. The goal would be that after sometime, he will be able to show you the appropriate card along with saying how he
feels. However, if verbal skills are limited, at least the cards will help him
communicate these feelings. You can use the cards less as the child is able to
express the emotions in other ways, but generally the visual aids can be useful
to keep on hand during all therapeutic activities.

Puppet Making: Imagination and Learning for Children with Autism

Most typical children naturally love to pretend play and intuitively use their imaginations at a relatively early age. We see this in normal development the strongest around 3-6 years of age. A child may pick up a toy car and “pretend” it is driving up and down the furniture; he may joyfully make sounds to indicate the car’s speed and motor. As the child becomes more mature and develops relationships in the world, he might race the car and tell us a story about who is in the car, where they are going and other details. Children learn about their world through play and then are able to develop healthy imaginations.

Children with Autism very often have challenges in developing healthy imaginations as well as engaging in purposeful or imaginative play. This, in addition to communication and socialization is an area that the creative therapies can help with. By engaging the child creatively and meeting them where they are, we can bring out their own interests and help them develop this skill in fun ways.

Puppet making is a great activity that combines art and play together! There are very simple ways to make puppets that can be executed by artists and novices alike. There is even pre-cut fabric or paper “blanks” that can be used as starters from various school supply or art supply vendors. There are a variety of styles such as paper bag puppets, sock puppets, finger puppets, stick puppets or glove puppets to name a few. Here is a link for a simple paper bag puppet in which all you need is a small brown bag, computer printer, scissors and glue: http://www.dltk-kids.com/crafts/teddy/mbearbag.html

There are many different styles and ways to create puppets and it really doesn’t matter which one you choose. The goal is to work together and encourage the child to be creative and imaginative with both the act of making the puppet and then with playing afterwards. A visual reference is always good to have, so making a sample puppet ahead of time might be helpful or having a picture. However, do try to promote creative changes as the child makes their own puppet. Verbal feedback is a good way to support the child’s efforts. Saying, “Oh, I like the way you used blue hair on yours instead of brown, it’s so fun and bright!” As you are creating the puppet with the child there may be opportunities to start “pretending” by making voices or giving the puppet a name.

After the art making, the play can begin. At first, some children on the spectrum may not join in but rather observe the play, or just not be paying attention at all. This is ok; you may have to play for them instead of with them in the beginning. Eventually, they may become curious and try some things with the puppet. Even if it doesn’t seem to make sense, follow their lead and go with it.

At some point, the puppets may be a projection for the child’s feelings and thoughts. Although some children with ASD may not have the verbal skills to express it fully, they may be able to have the puppet make a sound, or do a dance or gesture. The storytelling or the imaginative play can very often reflect some real issues ultimately. So, while having fun and letting the child explore with the puppet, the therapist or parent may be able to pick up on some things that otherwise may have not been noticed. But ultimately, it will be a fun activity that can open up the child’s creativity and help develop imagination and play skills.

"Art As Therapy": Sensory Activities for the Child with Autism

Very often my goals as an art therapist will focus on the creative expression in developing the child’s imagination, communication and socialization skills. These are all areas that the child with Autism Spectrum Disorder is working on in school, home and other therapies as well. However, sometimes art can simple be used in a more non-directed way and purely allow the child to experience the sensory elements of the materials.


In the field of Art Therapy, using the model of “Art as Therapy” is a process that allows individuals to experience the art making with little direction. This then allows them to gain insight and open up to their feelings in their own time. However, with the population of Autism, I see the “Art as Therapy” model more about the intrinsic sensory processes and believe that it can benefit the child that needs to “just have fun” with the creative activities. Having fun and engaging in this experience can then ultimately regulate the senses, emotions and behaviors.

Let’s explore some techniques and materials that both professionals and parents can use to help their children have this experience. These are some activities that can be adapted for any functioning level by either limiting the amount of materials presented and/or limiting the time allotted

Cornstarch Goo

This activity can be a little messy, but often will be a fun way to build a tolerance to wet materials. It is more a “play” activity rather than an art making one, because there is no product at the end. Sometimes the simplest of ingredients can create a great tactile experience- cornstarch and water is a great example of that. Combining these two ingredients makes a fun “goo” that acts like a solid and a liquid at the same time. It’s a great learning activity that will fascinate the kids about how things work.

Making the goo: In a medium size bowl, start with 1 cup of cornstarch and add the water one tablespoon at a time. Stir carefully and add a bit more water or cornstarch as needed to get the right consistency. You’ll know the right consistency when you see it — you won’t quite be able to stir it, but it will still look liquid.

The mixture will act like a solid when you squeeze it or press on it, but when you let it relax; it turns into liquid-like goo. Have the child scrape some up out of the bowl and squeeze it in their hand and watch the material form shapes. Then tell them to relax their hand and watch the shape melt between their fingers and drip back into the bowl. Make a game out of it by seeing how long the shape can stay solid before dripping back to liquid.

Colored Rice Mosaics

This is a project that can be both tactile as well as creative. The senses are engaged, while the goal will be to produce a work of colorful art. The preparation should be done before presenting to the child.

Ingredients: 1 cup dry white rice, 1 teaspoon rubbing alcohol or white vinegar, 3 to 4 drops food coloring, medium size bowl and spoon, and waxed paper or aluminum foil.

Making the Colored Rice: Measure the dry rice into a bowl. Add the rubbing alcohol or vinegar, and stir well to coat. Drop on the food coloring, stirring between each drop. Add food coloring, and keep mixing until the rice is your desired color. Place a sheet of waxed paper or foil on a flat surface. Pour the colored rice onto the waxed paper or aluminum foil. Allow the colored rice to dry completely. This usually takes about 30-60 minutes. Repeat steps to make additional colors of rice.

Making Art with the Colored Rice: To make a mosaic, have the child draw a simple a design onto a piece of cardstock or thin cardboard. Add glue to the design, one area at a time, and then sprinkle on the colored rice. Children with ASD might become over stimulated if given too much rice at once, so it is best to put the rice in small paper cups (bathroom size works well). Also, when applying the glue, give children a small amount with a paintbrush- this helps with the “over squeeze” we often see children engaging in when given the glue container. This activity can be a nice way to teach shapes and colors for younger children by filling simple outlines. For older children, more intricate designs can be incorporated.

Musical Shakers

By making a musical shaker, children can learn how the tactile elements create sound; allowing them to experiment and feel the items as they are used in fun ways.

Here are some things you can collect to make a variety of shakers: coffee cans, plastic yogurt containers, spice bottles, paper towel rolls. Inside materials: dried peas, popcorn, pennies, dried macaroni, dried beans, and other materials that child may be drawn to. (* this activity should be highly supervised with children who are very oral)

Steps for making shakers: Wash and dry all the empty containers. Have child pick out and choose one to decorate. They can use a variety of art materials to cover the container depending on their age and functioning level. Construction paper is usually a nice way to cover any lettering or labels that have not come off. Offer markers, crayons or glitter glue. Allow the container to dry before filling it.

Experiment with the dried materials by having child reach into the bowl and feel around. Ask child what they think adding that to a shaker would sound like? Let them do this with a few different textures.

When ready, fill each container between one half and two thirds full with the dried beans, macaroni, peas, popcorn seeds or rice. You can mix a couple of the dried ingredients together with some pennies to create different sounds. Attach the lids of the containers, making sure they are tightly sealed. Let them shake, shake, shake, and then you can turn on their favorite songs and let them play to the music.

Before the Meltdown: Sensory, Emotional and Behavioral Interplay

Most children who are diagnosed on the autism spectrum have difficulty regulating their emotions and maintaining a calm state as we know. Children with autism and special needs go through similar emotional challenges as typical children do, but it takes them longer to get through them and it may take some creative techniques. In addition, it is sometimes difficult to recognize which emotions may be prominent in the child with ASD because sensory needs may look like an emotional or behavioral reaction.

Parents, teachers and therapists can help by recognizing the emotions and offering empathy when behaviors escalate. De-escalation is the key. By learning about the child’s sensory issues, and behavioral triggers we can begin to recognize the signs before hand; and thereby help the child regulate and avoid an emotional meltdown.


If and when emotions become overwhelming to the child, try to acknowledge those feelings and not stop them from being expressed. Tell the child that when he cries it is caused by a feeling and that it will pass like a dark cloud. The sun will come out again, even though it feels like the sky is falling. Help him learn to take a few slow deep breaths when he first begins to feel upset.


In our creative arts therapy groups or in any other social skills or therapeutic groups, we can address these issues both in neutral times, when there is no upset as well as when a child in the group starts have difficulties. We can praise the children when we see them regulating themselves and we can offer mirroring for when we notice that negative behaviors are escalating.


Example
A child may start banging the table and fidgeting, so we need to recognize this behavior whether out of frustration or another sensory need and take it as a “sign”. We may reflect back to the child either verbally, “I see you are banging the table Johnny, sometimes it is hard to stay in our seats…. And you are doing so well…..” Or perhaps, non-verbally bang along with the child and create a playful interchange. (I have offered clay or model magic and that seems to work wonders for frustration control) However, that banging on the table could have in fact been a sensory need to move, or hear sound, or just feel the table against his hands. We may not always get it right, but we are still recognizing the need. In any case, as we get to know the children in our classes or groups we can distinguish their needs, emotions and behaviors.


Taking breaks and using sensory toys and art materials may help a child regulate when frustration levels seem overwhelming within the group. When a child needs that break, have an aide work with them for a set amount of time a little bit away from the group; not leaving the room entirely unless necessary. Then allow that child to slowly rejoin the activity when ready and then praise them for their efforts.