Running head: A COMPARATIVE ANALYSIS 1
A Comparative Analysis: Applied Behavior Analysis,
SCERTS, and Art Therapy
A Literature Review
Presented to
The Faculty of the Adler Graduate School
_____________________
In Partial Fulfillment of the Requirement for
The Degree of Master of Arts in
Adlerian Counseling and Psychotherapy
______________________
By
Taylor Vance
______________________
Chair: Erin Rafferty-Bugher ATR-BC, LPCC
Reader: Katie Kinzer MA, LPCC
_____________________
November 2017
A COMPARATIVE ANALYSIS 2
A Comparative Analysis: Applied Behavior Analysis,
SCERTS, and Art Therapy
Copyright © 2017
Taylor Vance
All rights reserved
A COMPARATIVE ANALYSIS 3
Abstract
This paper will integrate a synthesis of researched based on successful treatment strategies for
children with Autism Spectrum Disorder (ASD) that may contribute to successful and effective
approaches for children with ASD. Three researched based models will be explored for the
treatment of ASD; Applied Behavioral Analysis (ABA), Social Communication, Emotional
Regulation, and Transactional Support (SCERTS), and art therapy (AT) (Thompson, 2013;
Molteni, Guldberg, & Logan, 2013; Mirabella, 2015). Applied Behavior Analysis (ABA),
developed by O. Ivar Lovass, ABA uses techniques like paring, discrete trial teaching, and verbal
behavior analysis (Rivard & Forget, 2012; Leaf, Leaf, McEachin, Taubman, Ala’i-Rosales, Ross,
Smith & Weiss, 2016). SCERTS is a method researched for treating ASD, aims to teach children
with autism how to adapt appropriately to the environment. Art Therapy uses the creative
process by engaging with materials and media to support “…conflict resolution, enhance
interpersonal relationships increase self-awareness, support access and the management of
traumatic memories, and strengthen and promote a healthy self-esteem” (as cited in AATA,
2016). A summary of the three approaches to the treatment of ASD will be synthesized for their
strengths and challenges including how the Adlerian Concepts of belonging, connection and
social interest connected to working with children with ASD. A summary of the findings and
recommendations for future research will be included. The experiential portion of this paper will
reflect a synthesizing art piece exploring the interrelationship between each model. The resulting
art piece will be donated to a local ASD organization, St. David’s Child and Family
Development as way to educate, contribute and create connection to the children and families
who struggle with ASD.
A COMPARATIVE ANALYSIS 4
Acknowledgements
I would like to pay special thanks, appreciation, and warmth to the persons below who made this
paper possible. To my chairperson Erin Rafferty-Bugher, ATR-BC, LPCC for all your support,
guidance and understanding as I tackled this topic. My reader Katie Kinzer MA, LPCC for your
support and advice throughout this process. To the writing center staff at Adler Graduate School
for your help during the editing process. To my parents for your support, generosity, patience,
and understanding throughout this journey. To Derek, for your love, support, and encouragement
you gave me during this endeavor.
A COMPARATIVE ANALYSIS 5
Table of Contents
Autism Spectrum Disorder ............................................................................................................. 7
Evolution of ASD ........................................................................................................................... 8
Early Intervention ........................................................................................................................... 9
Treatment Methods ....................................................................................................................... 10
Applied Behavior Analysis ....................................................................................................... 10
Benefits and vriticisms of ABA.. ...................................................................................... 11
SCERTS ................................................................................................................................... 12
Theory of mind.. ............................................................................................................... 12
Benefits and criticisms of SCERTS. ................................................................................. 12
Art Therapy .............................................................................................................................. 13
Adlerian art therapy perspective:. ..................................................................................... 14
Art therapy and social and emotional regulation.. ............................................................ 15
Art therapy expressive therapies continuum.. ................................................................... 16
Integrating ABA and SCERTS and Art Therapy ...................................................................... 17
Conclusion .................................................................................................................................... 19
Discussion ..................................................................................................................................... 20
References ..................................................................................................................................... 22
Appendix ....................................................................................................................................... 26
A COMPARATIVE ANALYSIS 6
A Comparative Analysis: Applied Behavior Analysis, SCERTS, and Art Therapy
Autism spectrum disorder (ASD) has been studied since the 1800s. Despite the centuries
of research on this one disorder there is still not one way to treat autism spectrum disorder. One
of the most researched treatment methods for ASD is Applied Behavior Analysis (ABA)
(Thompson, 2013; Hastings, 2015; Reed & Osborne, 2012). This method uses a regimented
protocol to increase desired behaviors and decrease unwanted symptoms. Another well
researched method for the treatment of ASD is the SCERTS (Thompson, 2013; Molteni,
Guldberg, & Logan, 2013) model; Social Communication, Emotional Regulation, and
Transactional Support. This method uses the child’s environment to teach and implement the
skills necessary for the learning. Art therapy (Rafferty-Bugher, Brown, Hastings, & Arndt, 2016)
is another treatment approach that can be used for treating ASD. This approach can be integrated
into other models as a part of the protocol. Art therapy is an integrative process that is adaptable
and can reach parts of the brain that may not be accessed with traditional models of verbal
therapy alone. It is important to consider the proper training including ethical considerations
when using art therapy, ABA, and SCERTS approaches to the treatment of ASD.
Creating a treatment plan that is individualized for the child is imperative to identify the
most appropriate and beneficial types of treatment for ASD symptomatology. Using the most
effective evaluations and assessments will help caregivers and physicians decide on successful
methods of treatment for that child. Early intervention is a way for the child to receive treatment
at the most critical points of development and is crucial for success in their treatment (Reed &
Osborne, 2012; Rogers & Vismara, 2008).
Along with interventions at the critical points of development, utilizing non-verbal therapies
can be helpful to ensure all components of the treatment plan are addressed. Art therapy is an
A COMPARATIVE ANALYSIS 7
integrative therapy that can be adapted to other treatment modalities. Having the client engage in
art therapy offers an approach that can access the whole brain for optimal functioning and
support the development of new neuropathways in the brain (Lusebrink, 2004).
Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is pervasive disorder that effects social communication
and interactions. It varies in severity and types of impairments; the dysfunction resides in the
cerebral part of the brain (Hart & Whalon, 2013; Thompson, 2013).
Research on Autism Spectrum Disorder has changed dramatically due to technological
advances since the 1960s. The first appearance of autism spectrum disorder in the DSM was in
the DSM-III in 1980, revised in 1994 for the DSM IV, and again in 2013 for the DSM V
(Thompson, 2013). Diagnostic criteria include deficits in emotional reciprocity, repetitive
behaviors, strict routines, fixated or restricted interests, hyper- or hypo-reactivity, language
delays, and sensory aversities (American Psychiatric Association, 2013; Camarata, 2014).
Language delay and lack of communication is attributed to the inability to develop joint attention
skills (Mundy & Markus, 1997). “Joint attention skills have been observed to predict language
development from as early as 6 months of age” (Morales et at., 1997 as cited in Mundy &
Markus, 1997, p. 346). The lack of joint attention also leads to a delay in communication
(Mundy & Markus, 1997). For infants, the main detector of ASD is a delay in social interaction
and language (Camarata, 2014). Along with the deficits listed, it is suspected that children with
ASD struggle with Theory of Mind (ToM). ToM is the ability to see other’s points of view,
motives and intentions, and make sense of actions and behaviors of others (Baron-Cohen, 1995
as cited in Mundy & Markus, 1997). Other symptoms that may be present along with ASD are
A COMPARATIVE ANALYSIS 8
seizures, eczema, and gastrointestinal difficulties (Dillenburger, Jordan, McKerr, & Keenan,
2015).
Evolution of ASD
The first autistic features were coined by Jean Itard in 1802, then in 1943 they were
further developed by Leo Kanner. Kanner was the first to create clinical diagnostic criteria for
autism. (Thompson, 2013; Hastings, 2015). In 1944, Hans Asperger discovered similar social
deficits in children that had verbal capabilities (Thompson, 2013).
Despite the development in the diagnostic criteria, between 1943 and 1960, psychologists
were not trained in diagnosing autism and this led to a negative implication of the disorder.
Because of this negative connotation, getting treatment was less sought after by parents or
caregivers of children with similar deficits. In the 1960s and early 70s autism was mainly treated
with psychoanalytic techniques that did not provide any valuable outcomes (Thompson, 2013).
Treatment for autism during this time did attempt to strengthen the skills in the specific deficits
present. By the 1970s and 80s a diagnosis of Autism most likely resulted in the patient being
placed in a “private retreat”, if the family could afford it, where they received mainly palliative
care (Thompson, 2013).
As technology becomes more advanced, an increased understanding Autism has
developed due to magnetic resonance imaging (MRI). This technology made it possible to
understand the areas of the brain that are related to the symptoms of autism (Thompson, 2013).
Due to the neurological advances in technology, mental health providers have an increased
understanding of ASD including symptoms and presentation. For any individual with ASD,
having a better understanding of their brain, can provide opportunities for caregivers to refer
ASD clients to early treatment interventions (Thompson, 2013).
A COMPARATIVE ANALYSIS 9
There is currently no known cause for autism, but increasing evidence in neurogenetic
research alludes to genetic errors in synapse formation in the regions that are related to autism
symptoms. These areas being the amygdala, cingulate cortex, and orbitofrontal cortex (Oberman
et al., 2005, as cited in Thompson, 2013). Knowing what areas of the brain are affected in ASD,
can help doctors diagnose easier and allow the families to start treatments early to increase the
likelihood that the child will overcome deficits easier.
Early Intervention
Early interventions for autism has become increasingly popular as more children are
diagnosed. Early interventions include a year-round or long-term program with a low teacher to
student ratio (Hastings, 2015). The environment in early intervention programs are highly
structured with continuous assessing and documentation of progress (Hastings, 2015). The goal
of early interventions is not to find a cure, it is to change the path of the disorder, help the child
learn basic life skills such as eating, sleeping, toileting, dressing, and fostering peer relationships
(Awad, 1995). Early intervention is imperative because of the brains neuroplasticity (Thompson,
2005 as cited in Thompson, 2013) during these critical early developmental years. The brain is
based on a use dependent model, in which the more repetition and hard wiring, the more likely
for change to occur (Perry, Pollard, Blakley, Baker, & Vigilante, 1995).
There are many approaches to early interventions, depending the on the severity of the
child’s symptoms and deficits. Caregivers have many options available today that can
accommodate a wide range of behaviors. A Montessori approach is geared towards providing
practical education of everyday skills like personal care and hygiene, caring for the environment,
cooking, and caring for pets (Montessori, 2006, as cited in Thompson, 2013). The children work
A COMPARATIVE ANALYSIS 10
uninterrupted with their choice of materials, space for movement, and activities with limits set by
the environment (Thompson, 2013).
Behavior analysis, developed by B. F. Skinner and Ivar O. Lovaas, is another early
intervention approach. Behavior analysis assumes that children can be taught specific skills that
will allow them to communicate, care for themselves, and develop basic cognitive skills
(Thompson, 2013). Their approach, based on operant conditioning, is specific to the deficit that
is to be corrected.
Another respected approach to early intervention is a communications approach called
SCERTS: it stands for Social Communication, Emotional Regulation, and Transitional Supports.
This intervention incorporates behavioral interventions with the communication developmental
method (Thompson, 2013) This approach is more holistic and incorporates the cognitive process
and emotional well-being.
Treatment Methods
Applied Behavior Analysis
O. Ivar Lovaas was the pioneer of Applied Behavior Analysis (ABA), he believed that
children with Autism do not need to be hospitalized, but with effective interventions can live in
their homes (Smith & Eikeseth, 2011). He is quoted saying “If a child cannot learn in the way we
teach, then we must teach in the way the child can learn” (Leaf, Leaf, McEachin, Taubman,
Ala’i-Rosales, Ross, Smith, & Weiss, 2016). ABA is claimed to be one of the most effective
early interventions to treat autism, it greatly impacts the behavioral deficits and functioning of
the individual (Reed & Osborne, 2012). It uses strategies like pairing, discrete trial teaching, and
verbal behavior analysis (Rivard & Forget, 2012; Leaf et al., 2016).
A COMPARATIVE ANALYSIS 11
Lovaas’s goal was to provide 30 to 40 hours of individual treatment per week (Smith &
Eikeseth, 2011). Part of ABA intervention is pairing; an antecedent approach to reduce behaviors
that would disrupt teaching. Paring allows the therapist to gain compliance by becoming a
reinforcing figure (Kelly, Axe, Allen, & Maguire, 2015). By using pairing there is a higher
probability that the child will accept instruction at a higher intensity. In a study done by Kelly et
al. (2015), pairing before instruction led to a decrease in disruptive and challenging behaviors
allowing the child to learn without disruption.
ABA is more than just a strict protocol; a therapist trained in applied behavior analysis
must continually assess the child’s behavior and their environment (Leaf et al., 2016). This
means continuously finding reinforcers in the moment; what was reinforcing 5 minutes ago may
not be now. This keeps the child engaged and interested in learning.
Benefits and criticisms of ABA. A critique about ABA, is although it does well in areas
of intellect and behavior reduction, it does not prepare children for social school settings, such as
group and classroom teaching (Reed & Osborne, 2012). Another critique, is the chance that the
rates of increase in ABA intervention are not equal with the training of the ABA therapist.
Without sufficient training in the procedures and protocols, the therapist will not fully understand
what they are implementing in the interventions (Leaf et al., 2016). Along with a deficit in the
training of therapists, there is a lack of opportunities for children with ASD to learn in a group
format under ABA intervention strategies. Lovaas’s approach to intervention was driven towards
individual change, not social change (Gruson-Wood, 2016). Without social change, there is a
still a stigma around ASD, that it is unnatural or needs to be cured. Julia Gruson-Wood (2016)
argues, that this forces individuals with ASD to conform to “neurotypicality”. This does not
allow for the individual to develop a sense of identity or individuality. Gruson-Wood (2016) also
A COMPARATIVE ANALYSIS 12
argues that ABA does not involve the mind or psyche of the individual, only thoughts, behavior
and the environment. Dillenburger et al. (2015) adds benefits of ABA techniques to treating
autism spectrum disorder by stating that early behavioral interventions are significantly related to
positive outcomes like improved communication, and social skills as well as increase in quality
of life, and a decrease in symptoms from ASD.
SCERTS
The SCERTS model is based on a multidisciplinary team working in family-centered care
(Molteni, Guldberg, & Logan, 2013). It stands for Social Communication, Emotional Regulation,
and Transactional Support. The goals of this model are to develop a spontaneous functional
communication, secure attachments and relationships with peers and adults, learn to cope with
daily stressors, and adapt appropriately to the environment (Molteni et al., 2013). Learning is
directed towards daily routines, like the Montessori method.
Theory of mind. The SCERTS model is developed to allow children with autism to learn
to interact with the world around them instead of the world in front of them. “Mindblindness” is
a term coined by Baron-Cohen (1995), that illustrates how people with autism struggle to “mind
read” in a normal way (Baron-Cohen, 1995as cited in McGuire & Mickalko, 2011). This means
that children with ASD lack the ability to decipher the intentions, motives, and points of view of
others (McGuire & Michalko, 2011). Mindblindness is another way to talk about Theory of Mind
(ToM) and how it affects people with ASD. Under the umbrella of ToM there is also a lack of
imagination and empathy for others.
Benefits and Criticisms of SCERTS. Because SCERTS is a multidisciplinary approach
it covers a wider range of developmental areas. It involves directing treatments in different
contexts and applying different skills that are used in those specific contexts (Molteni et al.,
A COMPARATIVE ANALYSIS 13
2013). There is a psycho-emotional aspect applied to this approach more than with ABA. The
National Autism Plan for Children (NAPC), and Welsh Action Plan state that the
multidisciplinary approach is important for children with autism because it avoids confusion by
allowing children to discriminate between environments. SCERTS allows for professional
creativity among every aspect of the child’s treatment. Another benefit is that is does not have a
protocol to follow, meaning it can be used in any setting that the child enters, but the success of
the treatment is dependent on the team in charge of the treatment plan. If there is no cohesion
among the team, the child’s treatment will suffer (Molteni, Guldberg, and Logan, 2013).
Art Therapy
The American Art Therapy Association (AATA) defines art therapy as involving the
creative process by engaging in materials and media that support “…conflict resolution, enhance
interpersonal relationships increase self-awareness, support access and the management of
traumatic memories, and strengthen and promote a healthy self-esteem” (AATA, 2016 as cited in
Rafferty-Bugher, Brown, Hastings, Arndt, & Hesse, 2016, p. 3). Art therapy can enhance self-
confidence by fostering psychological and emotional health (Mirabella, 2015).
Art therapy can be adapted to the child with ASD because “…art therapy is a
multisensory, multifaceted approach, it can be tailored to the individual needs of a particular
child with autism” (Durrani, 2014, p. 100). Art therapy promotes the exploration of stimuli, this
allows the child to manipulate his/her surroundings in a way that may not have been offered
before. The brain is being stimulated in various capacities when engaged with art materials, and
allows for safe exploration of emotions (Rafferty-Bugher, Brown, Hastings, Arndt, & Hesse,
2016; Mirabella, 2015). The environment is crucial when working with children with ASD,
creating containment within the environment of the studio stimulates positive learning, structure,
A COMPARATIVE ANALYSIS 14
and consistency (Rafferty-Bugher, et al., 2016). The use of visual art for children with ASD
fosters communication as an alternative dialogue (Bragge & Fenner, 2009). Along with fostering
communication art exploration can support coping with difficult situations, and experiences.
…in art therapy it is possible to facilitate the shaping of these feelings with art materials
and interactions, in a form children can understand, gradually making it possible for
associated feelings to be described as messy, uncomfortable, angry, happy, frightening,
wet, dry and to help them cope with difficult situations in the future. (Evans, 1998, p. 23)
Art making comes naturally to children, it typically starts with simple mark making and
scribbles that appear to have no symbolic meaning. According to Emery (2004), art making is a
nonverbal activity that allows children to draw with an intention to represent their experiences
and create an attachment with the art. “Children create art because it is rooted in the need to
relate to their world” (Emery, 2004 as cited in Durrani, 2014, p. 102). The process of making art
is more important than the product. Martin (2009) states that one of the important therapeutic
benefits that comes from creating art in art therapy is challenging the child with tactile tolerance
and experimentation that lead to self-discovery and communication.
Adlerian art therapy perspective: Belonging, connection and social interest. There is
movement in the art making process both literally and figuratively. When there is movement
there is progress. Alfred Adler considers movement to “include all thought, feeling and physical
activity” (Griffith & Powers, 2007, p. 70). The Adlerian art therapist will look for shifts in the art
work, thus reflecting movement within the mind (Rubin, 2005). For example, if the individual
usually uses light, bright colors in their artwork then switch suddenly to dark, opaque colors
could mean that they are trying to express a different feeling or emotion that they have not been
able to express verbally. The type of material is telling of where are an individual is at. If they
A COMPARATIVE ANALYSIS 15
are using clay or finger paints, then switch to markers or crayons, may suggest that they are
seeking control in an area of their life. For a child with ASD, movement is the first steps towards
the child’s connection to the world and their environment.
Parents may consider how their child will contribute to society in the future. When the
child is involved in art making, the art can be shared with their community (Willoghby, 2003 as
cited in Martin, 2009). The artist identity becomes part of the person’s identification beyond
ASD. Alfred Adler talks about an individual’s sense of belonging comes from their contribution
to their community. Children with ASD struggle with understanding how their actions can
contribute to their community. Using art as a means of contribution to their society will help the
child to understand the cause and effect of their actions and gain a stronger sense of self. A child
with autism is likely to have deficits in this area of social interest, creating art about community
and environment helps the child with ASD connect with others and learn pro-social ways to
function successfully in their community (Griffith & Powers, 2007).
Art therapy and social and emotional regulation. To combat texture aversions and
sensitivities, engaging in certain materials will help regulate the sensory system (Rafferty-
Bugher et al., 2016). Children with ASD often struggle relating in social settings or engaging in
relationships. Art therapy provides a safe outlet to practice these skills. Art therapy stimulates a
relationship with the therapist through the concept of the “third hand”. The therapist can become
the third hand when creating the art with children who have ASD (Malchiodi, 2007). This helps
to support the development of self and other identification and differentiation. According to
Bragge and Fenner (2009), the involvement of the art therapist during the creative process fosters
alternative communication through a shared space of creativity. Especially for children who are
withdrawn or have aversions to materials, therapist involvement in the creative process is a
A COMPARATIVE ANALYSIS 16
gentle intervention to shift the focus and become less threatening (Bragge & Fenner, 2009).
When the focus is on the art, and not the social expectations of what it means to communicate
with another person, anxieties decrease and makes it more tolerable for a child with ASD to
engage in art making (Evans, 1998). The social aspect of creating art is having a meaningful
relationship with the art therapist. Creating a significant attachment can open the door to
communication, whether it is non-verbal or verbal; the potential to develop the social skills to
express the art starts with the relationship with the client and the art therapist (Evans, 1998).
Along with being able gradually express feelings, to gradually build attachment is crucial for
future relationships; having a secure-base to relate future relationships is essential for attachment
development (Durrani, 2014).
Art therapy expressive therapies continuum. The expressive therapies continuum
(ETC) is a continuum that reflects the brain’s activity when engaged with art materials and
media (Lusebrink, 2004). The continuum provides an opportunity to understand the varying
brain functions and its relation to art materials. The continuum is organized similar to the brain
in that it is based on lower order functioning on the bottom up and moves towards a higher order
of brain functioning on the top. It addresses the left and right hemispheres of the brain and the
levels of creativity in connection to how each side is affected by different types of media (Hinz,
2009). The levels of processing for the left hemisphere are cognitive, perceptual, and kinesthetic.
The levels of processing for the right hemisphere are symbolic, affective, and sensory. The
optimal functioning of the brain is integration using all levels of the brain. Creativity can happen
at any level, but optimal functioning is utilizing the whole brain (Hinz, 2009). Art therapy is
successful because it can incorporate the entire brain when the individual is engaged in the art
making process. The left hemisphere is more analytical, and the right hemisphere is more
A COMPARATIVE ANALYSIS 17
expression and recognition of emotions (Lusebrink, 2004). When an art therapist incorporates the
senses into art making, it stimulates the haptic senses through kinesthetic sensations (Gibson,
1966 as cited in Lusebrink, 2004).
For children with autism spectrum disorder, the ETC allows the art therapist to create
directives around specific levels of the ETC. Being intentional with the levels of processing
allows for the child to experiment with media to illicit various ways to integrate regulation. This
allows the therapist to work at the child’s level. For example, if a child has deficits in sensory
integration specifically tactile resistant, the art therapist can begin working at a perceptual or
cognitive level and gradually begin to integrate sensory and tactile materials into the sessions.
The gradual and slow exposure using safe and comfortable material initially serves to support the
child’s sensitization with sensory and tactile resistance and ultimately move towards less
resistance with tactile/sensory media.
Integrating ABA and SCERTS and Art Therapy
There are many art therapy assessments that can fit into both ABA and SCERTS concepts
that can be integrated to help develop an integrated treatment plan. One of these is the Build-a-
Face (BAF), it focuses on the facial emotional recognition. This helps the therapist assess if the
child can identify emotions by being able to draw them (Richard, More, & Joy, 2015). This type
of assessment helps to foster “theory of mind” in children through emotion recognition. It
compares to the SCERTS model in fostering emotional regulation through facial recognition.
When art therapy is applied to ABA, it can be used to enhance fine motor skills.
Depending on the child’s treatment goals, art can be used as specific targets to master fine motor
skills like being able to properly hold a pencil or learning to cut on a line. Art in ABA is used in
small steps towards a larger goal. In this model, it is about how the art is used and not dependent
A COMPARATIVE ANALYSIS 18
on the process of creating art. Using art in an ABA setting can help foster communication by
providing motivating materials they can request (Hastings, 2015). Learning to ask for what they
want and ask for help will allow them to communicate with others in the future. For children
with ASD who are non-verbal, art can be implemented into ABA programing to foster joint-
attention, eye contact, and a means of self-expression (Hastings, 2015). An ABA art therapist can
apply art activities between intensive teachings, to help regulate and self-sooth (Hastings, 2015).
The benefits of integrating ABA, SCERTS, and art therapy is that by using an art therapy
approach, we can integrate the benefits of both ABA and SCERTS in a new approach to the
treatment of ASD. In a literature review by Erin Rafferty-Bugher et al. (2016) the benefits of art
therapy for treating ASD included:
“…assisting in the externalization of complex feelings, non-verbal process and product,
emotional regulation, recognition and literacy, learning calming, coping and relaxation
strategies, building and learning healthy socialization/relational skills, increased ability to
focus, development and strengthening of self-esteem and self-identity, support in
development of the self as object/differentiated from other , connecting between and the
formation of new neuropathways, sensory integration via therapeutic art media”
(Rafferty-Bugher et. al., 2016, p. 5).
Art Therapy affects underlying brain structures that create basic building blocks to form
sensory processing information (Lusebrink, 2004). Young children with ASD can build an
emotional vocabulary, learn how to draw and represent themselves, then learn how to make real
life connections to their emotional vocabulary (Martin, 2009). Art making for children with ASD
allows for exploration of their internal feelings in an external non-verbal process (Rafferty-
Bugher et al., 2016). An emotional release in the form of art can be cathartic. The act of putting
A COMPARATIVE ANALYSIS 19
feelings on paper or in other art materials allows for strong emotions to be released (Malchiodi,
2007). The art can be used to transform the unmanageable emotions into something manageable;
turning negative feelings into positive through the creative process. The visual aspects of
creating art enhance social skills and communication for children with autism and other
pervasive developmental disorders (Gabriels, 2003, as cited in Martin, 2009).
Conclusion
As discussed, there has been research expanding over a century addressing the treatment
of autism spectrum disorder. The most researched method, developed by O. Ivar Lovass, applied
behavior analysis. ABA uses a strict procedure that starts with mastering the smallest steps and
builds to conquering major skills. Applied behavior analysis uses protocols to continually assess
the behavior and environment of the child; using antecedent approaches and reinforcements to
reduce unwanted behaviors. Social Communication, Emotional Regulation, and Transactional
Support (SCERTS) aims to develop spontaneous functional communication, secure attachments,
and relationships with peers and adults, learn to cope with daily stressors, and adapt
appropriately to the environment. SCERTS applies learning techniques to the specific
environment of the child. The child learns how to interact with the world around them. Both
methods access different skills but ultimately have the same goal of decreasing negative
behaviors and increasing developmentally appropriate skills. Art therapy reinforces exploration
of emotions, alternative ways to foster communication, and increases sensory/tactile tolerance.
The creative process provides a safe place for the child to gradually learn how to express their
feelings, build attachments, ease anxieties, and regulate their sensory system. Art Therapy can be
adapted to these methods and used as a part of the treatment plan. Art therapy can act as its own
A COMPARATIVE ANALYSIS 20
treatment method for ASD by creating goals that use art as a way of communication and
expression; allowing less intrusive access into the child’s inner world.
Integrating the three methods together will allow therapists to create a treatment plan that
accesses all parts of the brain. With these specific methods, a holistic treatment is possible. Using
the procedure of ABA, the social and emotional components of SCERTS, and the creativity of
art therapy allows for a integrated treatment that accesses the whole brain. Parallel the expressive
therapies continuum (Hinz, 2009), ABA would access the left side of the brain with its linear
process, while SCERTS access the right brain with spontaneous learning techniques. When art
therapy is incorporated into the treatment plan the combination of both the left and right
hemispheres of the brain can be accessed at the same time. Working from symbolic to sensory,
goals can be individualized to the child’s specific deficits. Autism spectrum disorder is
continuously researched and constantly being redefined. It is important that therapists are
flexible in their treatments, and allow for new interventions to be tested, to ensure the best fit
method can be discovered.
Discussion
Despite all the research, these methods have gaps in the treatment. Autism spectrum
disorder is so complex that finding one treatment is impossible. When looking at ABA’s
structure and procedure it is easy to see why the strict procedure and routine of the method works
as one treatment for a child with autism. But, it does not allow exploration and identification of
emotions as much as the SCERTS method. Where SCERTS excels in developing social and
emotional skills, it lacks in starting at the smallest steps of development, and does not promote
mastery of the skills. Art therapy does not have all the research behind it to promote it as its own
A COMPARATIVE ANALYSIS 21
treatment method for ASD. Art therapy does not yet have a researched procedure for treating
autism.
It is recommended that future research is applied to the areas of integrating multiple
approaches into one treatment for ASD. There is a lack of comparative studies for different
treatments of autism spectrum disorder. This makes it difficult to find a best fit practice to treat
ASD (Rogers & Vismara, 2008). Along with a lack of comparative research there is a lack of
psychoemotional aspects of children with autism, focusing on how the struggle to form
interpersonal relationships (Durrani, 2014). There is a need for more comparative studies of all
treatment methods to determine the best fit for treating autism spectrum disorder.
A COMPARATIVE ANALYSIS 22
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
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Appendix
In response to this research, the writer created a painting to represent the points made in this
paper. The main component of this paper is the individualism of the child. Any child diagnosed
with ASD is not like and other child diagnosed with ASD. The child still has their own personality
characteristics and the symptoms and deficits reflect their personal experience. What looks like
sensory dysregulation in one child, will look completely different in another. This painting reflects
the individuality of the person with ASD and their specific uniqueness. The technique for the
painting was pouring and splattering. The randomness of this style represents the randomness of
symptom development when it comes to a child with autism spectrum disorder.
The focal point of the painting is the large circle that stretches to all three canvases. This
circle represents the individual. If the writer tried to recreate the same circle using the same
technique, it would be impossible to recreate it with exactness. It would still be a circle, it would
still have the same color palette, but the result would not be the same. This is how therapists
should see a child who has autism. Each child has their own deficits that will present in a specific
way to that child, and no other. Outside of the circle represents the world outside for a child with
autism; chaotic and disorganized. Creating order and routine is something they seek to regulate.
For parents and therapists alike, it is important to treat each child like they are their own person
and not just like every other child. In addition, providing structure, safety and containment is
imperative.
The process of creating this painting was about experimenting with different media
(liquid enamel and gel medium), and techniques (pouring). Using new media and techniques
allows for exploration and incites the intuition. In art therapy, allowing room for clients to
experiment with media can invoke new insights. The three panels represent the past, present, and
A COMPARATIVE ANALYSIS 27
future of research of autism spectrum disorder. Looking at how far research has come for ASD
motivates researchers to continue to create treatment methods that can help a child with ASD
live a full, successful life. The color pallet for this painting was intentional. The intention was to
create a celestial, space effect. This was to represent the unending curiosity that comes from
researching the human brain. The brain of an individual with ASD is as mysterious as the
universe. Not one individual with ASD is the same, creating an individual universe inside their
head that only they understand, but cannot interpret. The individual universe of a person with
autism spectrum disorder is unique and overwhelming. This painting reflects this overwhelming
sense of the unknown when it comes to the inner world of an individual with autism spectrum
disorder.