running head: a comparative analysis 1 a comparative … vance... · 2019. 1. 26. · autism...

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


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.


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.


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: 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


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


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).


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


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).


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


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.,


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,


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


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


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


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


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


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


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


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.


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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


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.

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