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Running head: EXPRESSIVE THERAPIES AND AUTISM SPECTRUM DISORDER 1

Expressive Therapies and Autism Spectrum Disorder

A Research Paper

Presented to

The Faculty of the Adler Graduate School

_________________________

In Partial Fulfillment of the Requirements for

the Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

_________________________

By:

Rachelle Morrison

Adler Graduate School

December 2012

EXPRESSIVE THERAPIES AND AUTISM SPECTRUM DISORDER 2

Abstract

Expressive therapies are proven to be an effective intervention for deficits in Autism Spectrum

Disorder. McNiff (1981) observed that expressive therapies promote action into psychotherapy

and “action within therapy and life is rarely limited to a specific mode of expression” (p. viii).

Practitioners that use expressive therapies recognize that individuals with Autism Spectrum

Disorder and other populations have different expressive methods. Some individuals may be

more visual, others more tactile, and so on. When practitioners use expressive therapies they can

increase the client’s communication skills. The current paper explains the diagnosis of Autism

Spectrum Disorder (ASD), my experience working with clients with ASD, discusses what

expressive therapy is, the history, application in treatment, and studies that prove expressive

therapies effectiveness with the specific emphasis on art, movement, and music, work in treating

individuals on the Autism Spectrum and help to unify the family as a whole.


In loving memory of my father, Thomas Allen Morrison

10/1945-03/2009


Expressive Therapies and Autism Spectrum Disorder

The goal of this paper is to educate people about autism spectrum disorder, the expressive

therapies and how useful they can be in treating individuals with autism in order for them to

reach their fullest potential. Individuals with ASD need things that speak to their spiritual

personality. Another important concept is part of being a human being: body, mind, spirit, yet

discovering a modality that addresses all of these elements as a cohesive whole may be

challenging. The attempt to find information for an individual with autism, Asperger's syndrome,

ADD, or ADHD may be difficult. This paper also emphasizes the spiritual nature of a child:

without it the individual cannot be complete. It is the sensitive, feeling, spiritual nature that

propels the other two elements of the body and mind to function at their best.

There is a purpose to all life. When this is understood, accepting the diagnosis is less

difficult. If we accepted that these individuals are non-traditional (whatever the norm is),

traditional therapies are not as effective as they could be. If one of those elements are missing an

individual would be unstable.

Traditional or conventional therapies treat only the body and/or the mind. Some may treat

both, although it is uncommon that an effective therapy treats the mind, body, and spirit. It is an

individual’s spiritual nature that is motivated by classical music or beautiful colors and

encourages them to paint magnificent pictures.

Growing up in a family of artists, musicians, and dancers, music, singing, and dance has

always fascinated and motivated me. In addition to my Mom being a nurse and artist, a father

who was a jack of all trades who thoroughly enjoyed teaching ballroom and country dance, to a

bright step father who is an architect, a brother another amazing artist and musician, one sister an

excellent teacher and another a talented interior designer. The gift of the arts, teaching, and the


helping profession is what has motivated me to write this paper and get into this field.

Autism Spectrum Disorder

In 1943 Leo Kanner, a psychiatrist at Johns Hopkins University, was the first to describe

and label autistic disorder. Autistic disorder is a neurodevelopmental condition with distinct

communication and social problems as well as restricted interests and behaviors (American

Psychiatric Association [APA], 2000). It falls under what some researchers and experts in the

field may call an umbrella term of autistic spectrum disorder (ASD). Autism typically is

diagnosed before three years of age and is a lifelong disorder. (Khetrapal, 2009)

Autism is one of five disorders coming under the umbrella of Pervasive Developmental

Disorders (PDD). The DSM-IV Autistic Disorder is noticeable by three defining features with

the onset before the age of 3: impaired social interaction, impaired communication, restricted,

repetitive, and stereotypical behavior, interests, and activities (American Psychiatric Association

[APA], 2000).

Childhood Disintegrative Disorder (CDD) shares characteristics with autistic disorder,

but does not manifest until after the age of 2 and at times not until age 10. Rett's Disorder is a

neurological disorder that begins between 5 and 30 months. Individuals have slow head growth,

stereotypic hand movements, and severe impairments in language and cognitive abilities. PDD-

Not Otherwise Specified (PDD-NOS) is a diagnosis given to children who meet some, but not

all, of the criteria for autistic disorder. (American Psychiatric Association [APA], 2000)

DSM V Changes Coming in the Autism Definition

There has been a lot of discussion about how the upcoming DSM V definition of autism

will affect people on the spectrum. Any change in diagnostic terms or definitions is concerning

to those who depend on receiving diagnostic-specific supports from schools, social service

http://www.psychologytoday.com/conditions/autism


agencies, or health care providers.

This is the proposed definition of ASD. For an individual to be diagnosed, they must

meet criteria A, B, C, and D. (Robison, 2012)

A. Persistent deficits in social communication and social interaction across contexts, not

accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and

failure of normal back and forth conversation through reduced sharing of interests, emotions, and

affect and response to total lack of initiation of social interaction,

2. Deficits in nonverbal communicative behaviors used for social interaction; ranging

from poorly integrated-verbal and nonverbal communication, through abnormalities in eye

contact and body-language, or deficits in understanding and use of nonverbal communication, to

total lack of facial expression or gestures.

3. Deficits in developing and maintaining relationships, appropriate to developmental

level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different

social contexts through difficulties in sharing imaginative play and in making friends to an

apparent absence of interest in people

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two

of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects (such as simple

motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases);

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or

excessive resistance to change; (such as motoric rituals, insistence on same route or food,

repetitive questioning or extreme distress at small changes);

http://www.psychologytoday.com/basics/empathy

http://www.psychologytoday.com/basics/bias


3. Highly restricted, fixated interests that are abnormal in intensity or focus (such as

strong attachment to or preoccupation with unusual objects, excessively circumscribed or

perseverative interests);

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of

environment (such as apparent indifference to pain/heat/cold, adverse response to specific sounds

or textures, excessive smelling or touching of objects, fascination with lights or spinning

objects);

C. Symptoms must be present in early childhood (but may not become fully manifest until social

demands exceed limited capacities)

D. Symptoms together limit and impair everyday functioning.

The ASD definition above is very similar to the DSM IV definitions. Individuals with

Asperger's or PDD NOS may have to obtain a new diagnosis if they depend on it for services

(Robison, 2012).

All of the criteria remain subjective, which means clinicians have great flexibility in

defining phrases like "symptoms impair everyday functioning." A clinician who diagnosed a

person with an ASD condition under DSM IV is not at all likely to withdraw that diagnosis today

(Robison, 2012). However, there may be disturbances with schools and others when people with

Asperger’s or PDD NOS diagnoses are sent back to clinicians for re-evaluation under the new

guidelines (Robison, 2012).

The process of re-evaluation may be difficult, costly, and time-consuming. A doctor that

evaluates for a child is not likely to revise that opinion due to the changing of wording in the

DSM V (Robison, 2012).

http://www.psychologytoday.com/basics/attachment

http://www.psychologytoday.com/basics/environmental-psychology

http://www.psychologytoday.com/basics/child-development

http://www.psychologytoday.com/conditions/aspergers


The biggest change in the new definition is the addition of a severity grade. Here is how

they define level 1, the least severe affect: (Robison, 2012)

A - Without supports in place, deficits in social communication cause noticeable impairments.

Has difficulty initiating social interactions and demonstrates clear examples of atypical or

unsuccessful responses to social overtures of others. May appear to have decreased interest in

social interactions. (Robison, 2012)

B - Rituals and repetitive behaviors (RRB's) cause significant interference with functioning in

one or more contexts. Resists attempts by others to interrupt RRB's or to be redirected from

fixated interest. (Robison, 2012)

The definition is subjective. I think clinicians will maintain wide diagnostic latitude and

that most people who have a diagnosis, will have an ASD diagnosis under the new definition. A

child, who is diagnosed on the spectrum today, will still be ASD next year when these changes

take effect.

Characteristics of Autism

Autism affects the brain which makes obvious differences in the way these individuals

think, feel and solve socialization with others. Autistic children can be highly intelligent

although autism impairs affective communication and interaction skills, in addition to the way

they respond to external stimuli. Individuals with autism can often be recognized by their

difficulty in expressing themselves, or understanding others. They have challenges with

socializing with others, and they often also engage in repetitive or obsessive behaviors.

Diagnosing Autism

When a specific number of characteristics DSM-IV (Diagnostic and Statistical Manual of

Mental Disorders DSM-IV) are present a diagnosis of autism is made. Autism diagnosis typically

http://www.autism-pdd.net/.html


occurs between the ages three and five. The autism prognosis is consistent across a range

of studies (Autism-PDD Network, n.d.).

Prevalence of Autism

The New Centers for Disease Control and Prevention numbers now showing that 1 in 88

children in the United States are diagnosed with autism – nearly a doubling of the prevalence

since the CDC began tracking these numbers. Autism is an epidemic in the United States. Males

are usually more vulnerable with a ratio of 4 to 1 (Fombonne, 2005a).

Work Experience with Autistic Children

My previous work with St. David’s Center and The Minnesota Autism Center integrated

behavior therapy, art therapy, and expressive play. I have a strong knowledge of child

development and family dynamics which was helpful when working with this population. The art

and play materials engaged the children to be active, interact, and explore which provided many

pathways for communication, and support for different styles of learning. The children were able

to manipulate objects to create something substantial and have complete control. These activities

using art and play materials facilitated a foundation of healing. This experience it resulted in

breakthroughs of communication both verbal and non-verbal. Using art and play therapy built an

understanding of a child’s individual needs, strengths/weaknesses, and interests. It is where I

learned how to connect with children and when I was able to see each child as an individual.

It is known that if we respect one another that we will receive respect in return. If we love

someone, they will return that love. If we communicated with one another, even non-verbally,

they will respond. A person or child knows if you are sincere or just talking for the sake of it. It

is especially difficult to fool a child. They seem to have a sixth sense, or intuition that is

fascinated with the spiritual nature of art and people. Mutual respect and trust worked when


working with individuals with ASD and their parents as well. It opened up a new world for me of

truth, beauty, and goodness.

One thing that may have helped in my work and developed an almost immediate

connection with my clients and their families is that I encouraged them often, told them they

were important and special, let them know that they were loved (verbally and non-verbally), and

that I was proud of them. I reassured them that they could do things and that if they needed help

that I would be there. Because I was open, honest, and supportive I believe my clients trusted and

responded quickly and at times significantly.

Family Support

Parents of children with autism experience difficult and powerful emotions and how they

cope with these emotions can restrain or facilitate the connection with one another. Having a

child with autism is an ambiguous loss for parents. Early and intensive intervention and

treatment is important for these children to improve (Solomon, & Chung, 2012).

Family social support or resources are crucial. Raising a child with autism takes its toll.

Parents of children with autism have higher stress levels than parents of typically developing

children. These families are usually lower functioning. Parents with a child with autism are

nearly twice as likely to divorce as those without a child with autism. On the other side, raising a

child with autism can unify a family. Research shows that a number of families with children

with autism “display factors of resilience-reporting that they have become stronger as a result of

disability in the family” (Bayat, 2007, p. 702).

Parents of children with autism can benefit from psychotherapy to attend to the chronic

stresses of having a child with autism. These parents face problems in multiple domains such as

accessing supportive/therapeutic/educational services, balancing work and family, and dealing


with powerful feelings. An integrated approach gives the therapist flexibility to address

interconnected problems (Solomon, & Chung, 2012).

Working with meaning may involve supporting parents’ efforts to integrate their

spirituality; expressive therapies can aid in telling their story. By supporting these families their

journey may foster transformation, increase connection and empathy amongst the entire family

(Solomon, & Chung, 2012).

Parents of individuals with autism spectrum disorders (ASD) experience stressors

attributed with caring for their child. These stressors can cause significant anguish for families,

which at times can develop into crisis. This first study by Weiss & Lunsky (2010) presented a

preliminary effort at determining the subjective experience of crisis in 164 caregivers of people

with ASD, the Brief Family Distress Scale. The BFDS was negatively correlated with useful

coping skills (family hardiness, and parent empowerment), and positive modification (caregiver

quality of life and positive parenting experiences), and positively associated with known

stressors (severity of aggressive behavior, negative life events) and problematic coping and

outcomes (caregiver burden, worry, mental health problems). Results showed caregivers have

high levels of distress (approaching or in crisis) were significantly different from caregivers at

lower levels of distress in nearly all of the dependent variables (Weiss, & Lunsky, 2010).

I believe therapists have a unique role with this population, but some may feel

intimidated to work with these families possibly due to the belief they do not know enough about

the disorder to do this work. However, a family therapist and/or art therapist has an important

proficiency about family dynamics and adaptive coping. It is important to remain humble and

curious with parents such as asking questions as needed and being beside them through the

process of exploration of the impact of the diagnosis. It is my hope that by providing this


information about my work, my love and passion for the arts, that more therapists will be

properly trained to work with these families and utilize the expressive therapies. Learning about

autism helps families cope, coordinate treatments, and advocate effectively on their child’s

behalf.

Therapy for Families and Children

I worked with many preschoolers and older children also on the autism spectrum. I

provided therapy for children as young as toddlers and worked together with their parents and

peers. I assisted in treatment planning with staff, conducted in-home and in the community

therapy sessions, and supported parents and siblings. I communicated closely with schools and

other professionals.

In my experience working in the field and with a teaching specialization in art education

k-12 when children have specific needs and receive many specialized services; it is extremely

important not to lose sight of a child and family’s own goals, hopes, and dreams.

I worked closely with parents while in the home setting. Regardless of their child’s age,

the parents gain understanding of their child’s communication and expression, encouraged by

accomplishments and became more supportive with their child’s behavior in positive ways.

Practitioners that work with individuals through the healing arts know the complexity of

human nature and the diversity of human needs. Over the years through education and as an

educator, I have come to greatly appreciate the significance of movement to enlighten, clarify,

and heal. I also believe that the experience of movement, both symbolic and expressive levels,

can transform individuals and guide their journeys to recovery.

The arts can detour defensive intellectualization and can uncover underlying

psychodynamics as a result they can meet specific nonverbal needs. The most important element


is for the therapist to be open and have empathy for the patient. Through empathy and

compassion individuals learn that they are not alone. This is what facilitates the therapeutic

relationship. It is through empathy and spontaneity between therapist and patient that healing

occurs.

Although family caregivers experience high stress levels they do not have the time or

resource for, or interest in, caring for self or participating in activities to reduce their stress

because of their consuming focus on the child or patient. This next study measured the

effectiveness of a creative arts intervention to reduce stress, lower anxiety, and increase positive

emotions in family caregivers (Walsh, Culpepper Martin, & Schmidt, 2004).

Patients and caregivers changed their outlook when they were engaged in creative-arts

activities. Therefore the results prove the usefulness of the creative arts. In this study,

parents/caregivers stress decreased, anxiety declined, and positive emotions increased after

creative arts activities (Walsh, Culpepper Martin, & Schmidt, 2004).

Table. CAI Activities Displayed on the "ArtKart" Bulletin Board

Healthy image poster. A poster of a family member depicting a profession or hobby. A Polaroid

picture is taken of the "subject's" face and is glued on top of a predrawn body image (choice of

68 images).

Monoprint art activity. Abstract designs are created using watercolors dropped on Plexiglas

and transferred to paper. Greeting cards can also be made. Envelopes are provided for cards.

A mandala. An individual or several people participate in designing objects in and outside of a

mandala drawn on an 11 x 14-inch pre-cut paper. Plexiglas box frames are provided for display

following completion.


A silk wall hanging. A piece of silk is stretched over an embroidery hoop and a design is drawn

or message written using a liquid "resist" to block out the image. Silk inks are dropped onto the

silk; the silk dries and the "resist" is washed away in a fixative bath. A wall hanging is made

from the completed product.

A silk rubbing. This activity is a modification of the silk wall hanging. The participant uses a

board with embossed paper attached and rubs the design onto the silk with pastels. (Walsh,

Culpepper Martin, & Schmidt, 2004)

Robert Neimeyer addresses the healing power of the expressive arts: “For group leaders

and members alike, immersion in and reflection on performance, music, body work, painting or

creative writing offer the prospect of moving beyond grief to growth, beyond trauma to

transformation. Creative expression can detour intellect in order to allow a greater range of

emotions than talk therapy alone.”

Helping others to create in a physically and emotionally safe place is essential to the

therapeutic process. The product can be less important than the process: “It is not so much what

we do, but that we do” (Rogers, 2007, p. 285). Art enhances the healing qualities of the creative

process (Walsh, Culpepper Martin, & Schmidt, 2004).

Art, music, and dance are tools that are used for creative expression, but they can also be

used to help a person process and cope with emotional problems. Expressive therapy goes

beyond traditional talk therapy by using creative outlets as a means of expression, especially for

those who have difficulty communicating and conveying thoughts and emotions (Grumman

Bender, R., n.d.).

“Expressive therapy has to do with using various creative modalities such as music and

art,” explains Jaine L. Darwin, PsyD, a psychologist and psychoanalyst in Cambridge, Mass. “It


is often used with kids. They cannot completely talk about what is going on. Expressive therapy

often serves people who don’t know how to use ‘feeling’ words” (Grumman Bender, R., n.d.).

Expression happens in therapy in many ways. Expressive therapies celebrate all of the

arts and they are all close to my heart. Each one of these offers a lifelong focus for a therapist

and skill enhancement. What truly matters is the realization that all creative modes of expression

in therapy belongs together and that they can renew the practice of therapy.

Shawn McNiff believes in an integrated approach to the arts “art by its nature includes

everything imaginable” (McNiff, 1982, p. 123). All of the elements of creative expression:

imagery, sound, gestures, words, enactment, and movement work together and all are aspects of

imagination and should not be separated, in art or in life (McNiff, 1982). McNiff believes that

the creative art therapies have a special role in society to make cultural and spiritual connections

that is in need of “the restoration of an ancient and archetypal integration of the creative process

with healing” (McNiff, 1986, p. 5). The arts provide soul to medicine. McNiff (1992) thinks that

arts therapy should be conceptualized as “therapy of the imagination.”

McNiff was less interested in techniques but more of a intermodal process and more

interested in “the successful activation of creative ‘energy’ “a primary objective of my practice

has been the creation of a space that generated expressive energies that then act upon the people

within it” (McNiff, 2000, p. 320). McNiff’s dedication, belief, and trust in the healing

capabilities of the creative process motivate his work. In addition to this belief he also has a

deep respect for the imagination. McNiff has been a long time advocate to that the imagination

should be within the creative art therapies for cognitive framing of the experience. He believes

that there should be a theory indigenous to art, and artist psychology, which the mode of

psychology is artistic expression and reflection (McNiff, 1992).


“If we look to the past and to the healing practices of indigenous cultures, there is

considerable evidence that creative expression and healing belong together. In these traditions

the religious and philosophical conscious is integrated with what might be described as more

“scientifically oriented healing process. (McNiff, 1986, p. 6)

Many creative art therapists draw on the connections of the arts, religion, healing, and

cultural practices, therefore allowing the client to bring the whole self-body, mind, emotions,

spirit, and soul to recovery. McNiff’s belief is that by actively engaging the imagination “the

transformative and healing powers of the psyche” are released (McNiff, 1986, p. 6).

Expressive Therapies

The expressive therapies are defined as the use of art music, dance/movement, drama,

poetry/creative writing, play, and sandtray within the context of psychotherapy, counseling,

rehabilitation, or healthcare. Many of the expressive therapies are considered creative arts

therapies particularly art, music, dance/movement, drama, and poetry/creative writing according

to the National Coalition of Creative Arts Therapies Associations (2004a; NCCATA).

Furthermore, expressive therapies are often referred as an integrated or a holistic approach when

they are used in combination in treatment.

This therapy was developed on the principle that all people have the capacity to express

themselves creatively. Expressive therapy promotes self-awareness, emotional wellbeing and

healing, as well as empowerment.

Art therapy uses media, images, and the creative process to create products of reflection.

It is a therapeutic way of reconciling emotional conflicts, promoting self-awareness, developing

social skills, managing behavior, solving problems, reducing anxiety, aiding reality recognition,

and increasing self-esteem (American Art Therapy Association, 2012).


Music therapy uses music to effect positive changes in the psychological, physical,

cognitive, or social functioning of individuals with health or educational problems (American

Music Therapy Association, 2012).

Drama therapy is the systematic and intentional use of drama/theatre processes, products

and associations to attain the therapeutic goals of symptom relief, emotional and physical

integration, and personal growth. It is an active approach that assists the clients in telling their

story, to solve problems, gain a sense of release, extend the depth of an inner experience,

comprehend meaning of images, and enhance the ability to observe personal roles while

increasing flexibility between roles (National Drama Therapy Association, 2012).

Play therapy is the systematic use of a theoretical model to establish an interpersonal

process where trained play therapists use the therapeutic powers of play to help clients prevent or

resolve psychosocial difficulties and achieve optimal growth and development (Boyd-Web,

1999; Landdreth, 1991).

Sandtray therapy is a creative form of psychotherapy that uses a sandbox and a large

collection of miniatures to facilitate a client to explore the deep layers of the psyche in a new

format. By putting together a series of sand pictures, a client is assisted to illustrate and integrate

his or her psychological condition (Malchiodi, 2005).

Integrated arts approach or intermodal therapy (otherwise known as multimodal) involves

two or more expressive therapies to foster awareness, encourage emotional growth, and build

relationships with others. It is based on a variety of orientations, including art as therapy, art

psychotherapy, and the use of arts for traditional healing (Knill, Barba, & Fuch, 1995).

Within the several different types of expressive therapy including art, music,

dance/movement, poetry/creative writing, play, and sandtray, and drama therapy each of these


areas can be used to articulate emotions and life events that are difficult to verbalize. For

example, a client might draw a scene that represents a traumatic event or dance to express

emotion by moving her or his body. The modality is used for discovery and to facilitate

communication, which allows the client to express his or her thoughts and emotions through art.

The therapist’s focus is not to critique the expressive artwork. Rather, the therapist works with

the client to understand the meaning of the art and the feelings that surround it. By addressing

interpersonal and intrapersonal issues in art therapy could facilitate solutions that evolve

naturally and offers a way to approach therapeutic issues (Moon, 2002).

Expressive therapy can be used as an addition to psychotherapy, for instance having the

client create an image that represents his or her problem or feelings then the client and therapist

talk about the art and emotions surrounding it. For some, the process of creating the art, whether

it is dancing, writing a poem or listening to music, is considered to be therapeutic in itself

(Grumman Bender, n.d.).

Expression through a painting, movement, or poem can recapture previous experiences

which can be healing for some. Most therapists using expressive therapies take advantage of the

capability of art, music, play, and other forms to include self-expression instead of encouraging

communication of unprocessed emotions or the repetition of disturbing memories. As therapist

and client work together, self-expression is used as a container in a sense for feelings and

awareness that can intensify into better understanding of self or possibly could be transformed,

concluding in emotional compensation, resolving conflicts, and a sense of

well-being (Malchiodi, 2005).

Expressive therapists typically do not interpret clients’ drawings, movement, poems, or

play, but instead try to facilitate their clients’ discovery of personal meaning and understanding


(Malchiodi, 2005). Self-expression in expressive therapies also involves verbal expression to aid

clients to understand experiences, feelings, and perceptions. Expressive therapies are utilized to

tap into senses as an origin of stories and memories. Whereas words are generally used to tell

stories (Malchiodi, 2005). Expressive modalities are extremely useful in helping people

communicate parts of memories and stories that may not be available through conversation,

because thoughts and feelings are not always verbal and are not always stored as verbal language

in the brain. Memories have been reported to emerge through touch, imagery, or guided by body

movements (Rothschild, 2000). For some people and especially with children telling a story

through one or more expressive modalities is easier to bear (Malchiodi, 2005).

Types of Expressive Therapy

There are several different types of expressive therapy. Art therapy can involve drawing

or painting images that represent the client’s thoughts and emotions. Music therapy includes

singing, songwriting, playing musical instruments and listening to music to promote healing and

positive emotions. Research shows a link between music therapy and a decrease in depression.

Writing or poetry therapy facilitates clients in working through difficult emotions. Research

shows that writing promotes health and wellbeing and appears to increase immune function.

Dance therapy can be used to help people, including those coping with mental and physical

illnesses like depression and cancer, express and process how they feel through movement. The

therapy helps clients improve both their mental and physical health. Drama therapy involves role

playing, improvisational techniques for puppetry to help clients express their emotions, achieve

catharsis and develop new and more effective coping skills (Grumman Bender, n.d.).

“Expressive therapy is a broad category of a variety of therapies - the primary strategy is

to help the person get in touch with their emotional state and subjective experiences and express


them,” explains Jeffrey L. Binder, PhD, a professor of psychology at Argosy University in

Atlanta. “The therapy helps them feel more control of their emotions.” (Grumman Bender, n.d.).

History of Expressive Therapies

McNiff (1981, 1992) proposed that the arts have consistently been part of life as well as

healing throughout the history of humankind. Now, expressive therapies are increasingly

accepted as part of mental health, rehabilitation, and medicine. Nevertheless, as McNiff

examined, these therapies have been used since ancient times as preventative and reparative

forms of treatment. There are many indications inside medicine, anthropology, and the arts to the

most primitive healing application of expressive modalities. For instance, the Egyptians are

known to have promoted people with mental illness to participate in creative activity (Fleshman

& Fryrear, 1981). Drama and music was used by the Greeks for its healing properties (Gladding,

1992). Afterwards, an English physician and writer Robert Burton in Europe during the

Renaissance believed that imagination was an important role in health and well-being. An Italian

philosopher de Feltre projected that dance and play were vital to children’s healthy development

and growth (Coughlin, 1990).

Using the arts as an addition to medical treatment started in the period from the late

1800s to the 1900s along with the beginning of psychiatry. At this time the progression to give

more humane treatment of people with mental illness began and included patient participation

with the arts (Fleshman & Fryrear, 1981). In the late-19th-century programs were temporary,

although the ideas in the wake of them reappeared in the early 1900s. For instance, uses of music

as therapy were found and documented after World War I when “miracle cures” was reported.

Patients were healing through music when they responded to nothing else. The founder of

psychodrama, Joseph Moreno (1923), projected the use of performance as a means to repair


mental health.

Simultaneously, Florence Goodenough (1926) studied children’s drawings and found that

they were able to measure cognitive development, and others, like Hans Prinzhorn, were

interested in patients with severe mental illnesses and art (Vick, 2003). Lastly, Margaret

Lowenfeld presented sandplay, sandtray therapy, and the foundations of play therapy in “World

Technique” in the 1920s (Lowenfeld, 1969). Lowenfeld initially started her training as a

pediatrician and then made observations about children’s play. She developed a method of using

toys to understand psychosocial aspects of child clients.

The creative arts therapies became commonly known throughout the 1930s and 1940s.

Psychotherapists and artists recognized self-expression through nonverbal methods like painting,

music making, or movement was useful for people with severe mental illness. The arts therapies

increasingly became more widely used (Fleshman & Fryrear, 1981).

History, Theory, and Practice

Practitioners in the field rapidly developed. In the last few decades, play therapy and

sandplay therapy became part of expressive therapies practice and have developed specific

theoretical foundations, methodologies, training, and professional associations. Recently,

expressive therapies have been integrated in an assortment of mental health, rehabilitative, and

medical settings as forms of treatment. Music and imagery therapies are now used regularly with

patients in hospitals for childbirth, relaxation, and pain reduction. Play and art are demonstrating

to be crucial in trauma resolution, debriefing, and recovery with children (Malchiodi,

2001) and writing is given to improve symptoms of illnesses like asthma and arthritis in addition

to decrease posttraumatic stress symptoms in individuals who have experienced crisis or loss

(Pennebaker, 1997).


Yoga, Music, Relaxation, Art, and Play

For children who are anxious or distressed, and for their parents, encouraging them to be

in tune to their bodies and breathing was never an easy task. The multisensory therapy like yoga

offers the opportunity to learn to relax and focus. Sensory toys can also help children with

anxiety and sensory challenges to regulate their emotions. Children can find rhythm through

playing the drums and other musical instruments, can feel soothed through movement in sand,

can shape clay, and learn to control the flow of paint.

Teaching children and also their parents’ simple yoga and relaxation helps them to slow

down, breathe, and gain control. When engaging the parents to do these activities with their

child; they are reinforcing the behavior and modeling positive coping strategies. Once they have

gained knowledge and control, children can be wonderful teachers. Parents then can support

children, and a calmer environment at home can be the outcome.

Benefits from Expressive Therapies

Children with Autism Spectrum Disorder are commonly misunderstood. I believe they

are also not treated with all of the most effective therapy available. Possibly the greatest

challenge is that there is minimal training and education in working with this population. These

children have difficulties using cognitive processes for appropriate self-expression, regulating

their bodies, have difficulty building functional skills, socializing with others, and experiencing

effective interpersonal communication.

Individuals with ASD abilities are affected by limited self control. This is sometimes

through volatile behaviors and potentially puts themselves and others at risk for potentially

abusive situations that often times have negative consequences. The approach of using

behavioral modifying techniques such as Applied Behavior Analysis can potentially change a


pattern of unsafe behavior and also help increase functioning levels.

I gained knowledge and experience with ABA conducting in home therapy sessions for

two years through my work at the MN Autism Center. However, in my opinion many of these

children remain anxious because they are being asked to conform to our mainstream society. The

issue could be that mainstream systems were designed for “normal” children.

Recent research supports the idea of neuroplasticity which is the ability of the brain to

change, grow, and revitalize according to human experience and need (Hancock, 2010). Some in

the therapy field recognize that children on the spectrum have challenges in communicative

abilities leads to the conclusion that they cannot participate in psychotherapy. Therefore, they

need an alternative way to access the psychotherapeutic process. There is another modality that

is more easily received by the child. However, this other modality can be perceived as extremely

mysterious for the “mainstream treatment community” as it is often unfamiliar.

Movement Therapy

Movement therapy refers to a wide range of Eastern and Western movement advances

used to promote physical, mental, emotional, and spiritual well-being. The physical benefits of

movement therapy include greater ease and range of movement, increased balance and

flexibility, improve muscle tone and coordination, joint resiliency, cardiovascular conditioning,

enhanced athletic performance, stimulation of circulation, prevention of injuries, greater

longevity, pain relief, and relief of rheumatic, neurological, spinal stress, and respiratory

disorders (Christman, & Frey, 2006) .

Movement therapy can also be used as a meditation practice to quiet the mind, promote

self-knowledge, and increase awareness. Furthermore, movement therapy is beneficial in

alleviating emotional distress that is expressed through the body. Movements are related to


thoughts and feelings; therefore, movement therapy can also encourage changes in attitude and

emotions. Individuals have an increase in self-esteem and self image, as well. Communications

skills can also be enhanced and the accepting of others improves. Movement therapy promotes

physical openness leading to a better emotional well-being and creativity. Movement is essential

to human life. Movement is life (Christman, & Frey, 2006).

According to physics the universe and everything in it is in constant motion. A somatic

educator, Thomas Hanna, “The living body is a moving body-indeed it is a constantly moving

body.” A poet and a philosopher, Alan Watts, had a similar perspective, “A living body is not a

fixed thing but a flowing event, like a flame or a whirlpool.” Indigenous societies around the

world have used movement and dance for individual and community healing. Movement and

songs were used for personal healing, encouraged a sense of community, to promote growth of

crops, and foster fertility. Movement is still a vital part of many healing traditions and practices

throughout the world (Christman, & Frey, 2006).

Dance/Movement Therapy

The American Dance Therapy Association (ADTA), founded in 1966, is a professional

organization dedicated to the profession of dance/movement therapy. The benefits of

dance/movement therapy as a psychotherapeutic intervention are well-known. Dance/movement

therapy (DMT) uses movement to further the emotional, cognitive, physical and social

integration. Through movement, DMT can help individuals with a wide range of psychological

disorders achieve greater self-expression (ADTA, 2012).

Based on the premise that the body, mind, and spirit are interconnected, the American

Dance Therapy Association defined dance/movement therapy as the psychotherapeutic use of

movement to further the emotional, cognitive, physical and social integration of the individual


(ADTA, 2012).

Dance/Movement

Dance/movement therapy focuses on movement behavior as it emerges in the therapeutic

relationship. Expression, communicative, and adaptive behaviors are all considered for group

and individual treatment. Body movement, as the core component of dance, simultaneously

provides the means of assessment and the mode of intervention for dance/movement therapy

(ADTA, 2012).

This type of therapy is practiced in mental health, rehabilitation, medical, educational and

forensic settings, and in nursing homes, day care centers, disease prevention, health promotion

programs and in private practice. It is effective for individuals with developmental, medical,

social, physical and psychological impairments. Dance/movement therapy can be used with

people of all ages, races and ethnic backgrounds in individual, couples, family and group formats

(ADTA, 2012).

Dance/movement therapy has been around for over fifty years. Dance/movement

therapists have pioneered the understanding of how body and mind interact in health and illness.

Whether the issue is finding a will to live, in search for meaning, or the ability to feel love for

life, dance/movement therapist mobilize resources from that place within where body and mind

are one (ADTA, 2012).

Autism Movement Therapy

A relatively new approach called Autism Movement Therapy (AMT) has been developed

by Joanne Lara, former LAUSD special day class teacher for individuals with moderate to severe

autism spectrum disorders, currently an Adjunct Professor in the Department of Special

Education at National University. Her innovative approach combines music with an increasingly


complex sequence of movements that stimulate hemispheric integration. AMT combines music,

rhythm and structured sequential movement patterns to activate areas of the brain in both left and

right hemispheres, which builds connections between the hemispheres. The part of the brain that

connects left and right hemispheres is called the corpus callosum, a bundle of nerve fibers

located in the middle of the brain (Lara, 2012).

Autism Movement Therapy (AMT) provides children with Autism a world of fun and

stimulating sensory/motor experiences. More importantly, AMT may prevent the development of

behavior challenges often associated with Autism, and/or may reduce the frequency and intensity

of such behaviour. AMT is a relaxation technique that supports children with Autism with

emotional regulation while they are engaged in a typical, age-appropriate and social activity

(Lara, 2012).

Integrated Movement Therapy

Integrated Movement Therapy is an individual and group therapy approach that combines

speech-language pathology, behavioral and mental health counseling, and yoga. It is taught by

master-degreed therapist-yoga instructors. It has been successfully implemented with children

with ADHD, Learning Disabilities, Pervasive Developmental Delay, Sensory Integration

Dysfunction, Dyspraxia, and other specific motor-based disorders, it has had especially

consistent results with children diagnosed with Autism Spectrum Disorders. Integrated

Movement Therapy has 6 core principles: structure, and continuity, social interaction, language

stimulation, self-calming, physical stimulation, and direct self-esteem building (Kenny, 2002).

This first study describes Autism in depth and will show how each of the six core

principles of Integrated Movement Therapy specifically addresses the characteristics associated

with Autism based on qualitative rating scales and parent feedback. In the past two decades, the


term Autism went from being a relatively rare medical diagnosis to being almost a common

household word. Therapy was largely outcome driven and because its rigid nature sustained the

child at a level sufficient to maintain satisfactory participation in the world, but not at a level of

support and develop his or her full potential and contribution (Kenny, 2002).

Autism applies to a broad variety of individuals, ranging from those who are nonverbal

and outwardly self-engaged and who need and obtain special services to those who are highly

verbal however incredibly socially uncomfortable with poor communication skills and who even

ten years ago would not have received any special accommodations or services, but would have

benefited from them.

Treatment options have broadened to some degree and more “higher functioning”

individuals are now recognized as requiring treatment specifically to learn social skills and to

increase self-esteem. Unfortunately, to meet insurance or other arbitrary bureaucratic standards

most intervention remains dependent upon external reinforcement and remains outcome driven.

They are often the most appropriate intervention for each child. Therefore, each professional

ends up providing an intervention for a specific area of deficit related to that teacher or

therapist’s own training or needs, rather than provider utilizing a holistic approach that

incorporated all modalities of learning and addressed multiple overlapping areas of need in the

child.

There is an abundance of research with excellent data supporting the relationship between

learning and movement, and the positive effects of multi-modal learning. There is also much

anecdotal evidence including studies done by Bonura (2007), Birdee (2009), Borremans (2010),

Hanson (2007), supporting the relationship between learning and yoga, especially the effects of

breath on all aspects of learning, including increased attentions/concentration and enhanced


mood (Kenny, 2002).

Yoga has been successfully used as an intervention for Attention Deficit Hyperactivity

Disorder and depressive disorders. Yoga has the advantage of being noncompetitive and

providing an optimal environment that encourages risk-taking and increases self-confidence both

integral aspects of effective learning (Kenny, 2002).

There appears to be specific areas of the brain responsible for regulating the functions

that are defective in children with autism. According to The Traumatic Brain Injury Resource

Guide, the function of the frontal lobe is to regulate consciousness, initiate activity in response to

the environment, control emotional language and expressive language, assign meaning to words

chosen and memory for habits and motor activities, and perform problem-solving functions. The

problems associated with the frontal lobe dysfunction include: inability to plan a sequence of

complex movements, loss of spontaneity interacting with others, loss of flexibility in thinking

persistence of a single thought, inability to focus on a task, mood changes, changes in social

behavior/personality, difficulty with problem solving, and an inability to express language

(Kenny, 2002).

Integrated Movement Therapy was developed to benefit from on the helpful effects of

movement and Yoga, and directly change frontal lobe efficiency, thus increasing physical and

cognitive functioning and improving therapeutic outcomes in children with Autism Spectrum

Disorders (Kenny, 2002).

Autism Spectrum Disorders includes Asperger’s Syndrome. Because many of the

characteristics associated with Attention Deficit Hyperactivity Disorder (ADHD) often manifest

in children with autism, ADHD was also included in this next study completed by Kenny (2002)

on Integrated Movement Therapy.


Children with diagnosed with Autistic Disorder have restricted repetitive and stereotyped

patterns of behavior evident in inflexible adherence to rituals and stereotyped and repetitive

behavior. This need for routine and repetition can be redirected to increase stability within

therapy sessions, and enhances learning and independence in the child with autism.

During the IMT session, structure and continuity was established through routine and

repetition and by use of visual systems to convey rules for positive behavior and cause/effect

relationships (Kenny, 2002). An individual is safe to explore the boundaries of his/her own

capabilities and effectively learn to use areas of weakness, both physically and

socially/emotionally.

Physical boundaries are created by the mat, the routine of taking off shoes, and the

creation of a schedule all provide sameness and structure that build both confidence and

competence. The schedule allowed the class to designate times for movement and times for

sitting still, provided the child with a clearer picture of what to expect during a session and

allowed the opportunity to direct the session according to his/her preferred activities hence

natural negotiation (Kenny, 2002).

Within the study all 24 had difficulties with impulse control, sensory management, and

social interaction skills (Kenny, 2002). All followed routine with minimal or no direct instruction

and comply with rules. The repetition and routine established in the Yoga-based therapy

provided each student with the necessary foundation to increase skills across all areas of

language learning, social competence, and self-esteem.

Physical Self-Esteem

Movement increases language learning. Exercise enhances general cognition, and every

speech pathologist notices that when a child is engaged in movement, more spontaneous and


complex speech occurs. Pairing physical movement with language learning appears to enhance

recall abilities and stimulate novel, appropriate language.

IMT allowed for experiential learning related to impulse control, the ability to calm the

body after activity, and overall self-regulation (Kenny, 2002). Children with autism and ADHD

lack some coordination and body awareness. Sensory Integration Dysfunction is a disorder that

manifests in children with Autism Spectrum and related disorders. Sensory Integration is the

ability to take in information through senses (touch, movement, smell, taste, vision, and hearing).

When it is put it together with prior information it makes meaningful responses.

Art Therapy

"Art therapy is a mental health profession that uses the creative process of art making to

improve and enhance the physical, mental and emotional well-being of individuals of all ages. It

is based on the belief that the creative process involved in artistic self-expression helps people to

resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress,

increase self-esteem and self-awareness, and achieve insight (AATA, 2012).”

What is Art Therapy?

Art therapy is a human service profession utilized in personality assessment, treatment,

rehabilitation, and education. “Art is a powerful tool in communication. It is now widely

acknowledged that art expression is a way to visually communicate thoughts and feelings that are

too painful to put into words (Malchiodi, 2003, ix)”. An art therapist must have knowledge of

visual symbol production, skills in crisis intervention, understanding of normal and abnormal

behavior, and experience with creative expressions in art in order to develop diagnostic

assessments and treatment plans. These plans for treatment are incorporated into a total therapy

program developed by a variety of professionals such as psychologists, counselors, and medical


doctors.

This way is a sensory oriented treatment called Creative Arts Therapy. Art Psychotherapy

is the visual dimension of this pathway and is provided by credentialed and professionally

trained Art Therapists, who by their education and natural connection to this internal,

multisensory world can “connect” with individuals on the spectrum.

Creative Arts Therapy can be a powerful tool to the internal process of conscious /

unconscious emotional and spiritual expression. This may include processes like reasoning,

selection (choosing the right color), therapeutic release, spiritual awareness, transformation, time

and space perception, conquering the fear of failure, pride and accomplishment, and recent

research shows there is also a hormonal release that genes switch on / off when imagery is

involved (Hancock, 2012, ¶ 2). The process may seem disorganized, and it looks like “out of

control behavior” it is a necessary stage of the treatment where it may be understood as an

adaptive regression operating of the ego in order to build skills in self regulation and purpose

(Kris, 1952).

The result of concentration on these two key dynamics within the safety and trust with a

trained Art Therapists create outcomes of an individual’s ability to endure, self regulate, process,

have structure, and manage emotions in a therapeutic setting. The individual’s process can be

captured in the art work which can include forms, colors, and other symbols of sensory, spiritual

and mindful awareness, which can be translated and used to understand the process the person

has endured. This process can be a useful tool in the diagnosis and treatment of individuals.

Art therapy originated in the 1930’s and have grown slowly, but steadily. During the

1940’s, Adrian Hill in Great Britain and Margaret Naumburg in the Unites States was

responsible for the transition of art therapy from a theory to a profession. The educational


programs and requirements has grown from two master programs in 1970 to seventeen

accredited programs and over 80 other schools that offered claims or programs; the American

Art Therapy Association (AATA) that was founded in 1969, recorded 433 active members in

1976 (Ulman, 1976) and expanding (AATA).

Art therapy is the therapeutic use of art making within a professional relationship, by

people who experience illness, trauma, or challenges in living, and by people who seek personal

development. Through creating art and reflecting on the art products and processes, people can

increase awareness of self and others; cope with symptoms, stress, and traumatic experiences;

enhance cognitive abilities, and enjoy the life-affirming pleasures of making art (Ulman, 1976).

Art therapists are knowledgeable about human development, psychological theories,

clinical practice, spiritual, multicultural and artistic traditions, and healing potential of art. Art

therapists use art in treatment, assessment and research, and provide consultations to allied

professionals. Art therapists also work with people of all ages: individuals, couples, families,

groups and communities. Art therapists provide services, individually and as part of clinical

teams, in settings that include mental health, rehabilitation, medical and forensic institutions;

community outreach programs; wellness centers; schools; nursing homes; corporate structures;

open studios and independent practices. (AATA, 2012)

Creative art therapy has been applied to a number of patient populations including blind,

autistic, schizophrenic, abused drug-addicted, and abandon individuals of many ages, races,

religious sects, geographical areas, and socioeconomic levels (Alland, 1983; Di Leo, 1983).

Generally, creative art therapy is universal, but that stems from the fact that art is universal.

Humans have been drawing and creating artworks since before written history—otherwise,

anthropologists and archeologists would have very little information to determine the lifestyles


of lost cultures. The images and creative useful items found by archeologists help to

communicate the lifestyle to us today, just as art today helps people communication ideas and

emotions.

Because many different groups have been introduced to creative art therapy, a very wide

variety of media have been required. From computer art to pencils, paints, and clay, many

combinations are possible to form with the materials. These materials are carefully chosen and

experimented with in order to prevent problems that the specific populations may encounter with

certain media. For instance, elderly populations and persons with muscular disorders such as

cerebral palsy have a difficult time manipulating clay due lack of muscle strength and

coordination, and other media should be explored.

Therapy for Treating Autism

One of the characteristics of autism spectrum disorders is difficulty with verbal and social

communication. Some individuals with autism are non-verbal and are unable to use speech to

communicate at all. In other cases, individuals with autism have a hard time processing language

and turning it into consistent and effective conversation. People with autism may also have a

difficult time reading faces and body language. As a result, they may have difficulty with telling

a joke from a statement, or sarcasm from genuineness (Evans, 2001).

Individuals with autism have an amazing ability to think visually - "in pictures." Many

can turn that ability to good use in processing memories, recording images and visual

information, and expressing ideas through drawing or other artistic media. Art is a form of

expression that requires little or no verbal interaction, which potentially opens doors to

communication.

Often it is assumed that a non-verbal person or a person with limited verbal capabilities is


incompetent in other areas. As a result, individuals on the autism spectrum may not be exposed

to opportunities to use artistic media or the opportunities may be too challenging in other ways

(in large class settings, for example). Art therapy offers a chance for therapists to work one-on-

one with individuals on the autism spectrum to build a wide range of skills in a manner which

may be more comfortable (and thus more effective) than spoken language.

The research found was somewhat vague and extremely limited regarding the impact of

art therapy on individuals with autism. The literature I found consisted mainly of a few case

studies and papers describing the impact of art therapy programs. Some of the papers imply that

art therapy can be very effective and has opened up a world of opportunity to individuals with

autism that have significant artistic talent. It also has created a unique opportunity for

socialization. Other potential outcomes included improvements in the ability to imagine and

think symbolically, increased recognition and responsiveness to facial expressions,

advancements in managing sensory issues (problems with textures, etc.), and increased in fine

motor skills (Evans, 2001).

The next study presented a 6 year old boy diagnosed with autism who was treated with

art therapy. This case study explored the importance of art therapy in the young boy’s

development, growth, and ability to relate with others. His growth highlighted by his three

drawings which reflect his progress towards developing object constancy. The importance of the

art therapy in treatment of autism is explored. Artistic expression can reflect a child’s object

constancy, growth and development, and the ordering of his or her internal world (Robbins,

1994). An art therapist can assess a child’s relationship to pertinent objects through drawings.

While practicing art therapy, I have often gotten a sense of an individual’s world by observing

the execution of his or her drawing and the emotional significance in every object through color,


line, and body language. In my experience, it seems to become less as children mature and art

expression is intellectualized. However, symbolic meaning often continues to exist, and

therefore, artwork remains highly expressive (Horovitz et al., 1967).

Building a Relationship

All children can move towards building a trusting relationship with a therapist in a safe

environment. This relationship takes longer for children with autism and sometimes seems

impossible to attain because these children do not always want to please, follow a directive, or be

engaged with the therapist (Emery, 2004). Nonetheless, it has been my experience the autistic

symptoms become less evident when this relationship has time to develop. What drives children

with autism is remarkably different from what drives normal children in the developmental

process. Will is dependent on the ability to monitor intentions and understand the mind. For

example, normal children will show emotional preference when choosing activities while autistic

children frequently do not display emotions in these situations (Emery, 2004). Autistic children

may repetitively play with and direct their attention to objects that appear to have no importance.

The thought of closure, completion, or satisfaction seems unimportant, but process is (Green &

Luce, 1996).

Stages of Drawing

In this case study, the process of drawing contributed to the young boy’s development.

The boy began the process by working with colored play dough. He made a ball and then

flattened it out on paper in the shape of a circle. The process seemed difficult for him. Following

the directive given by the therapist and example, he drew a line around the flattened circular

shape using a marker. The play dough and the pounding was a releasing experience. His motor


skills were poor. However, he did the exercise repetitively for several months, and his motors

skills improved immensely (Emery, 2004).

The child started to draw consistently at home. The mother brought many of these

drawings into therapy session, and the boy shared them with the therapist. The therapist observed

his progress; his voice was now in a more normal tone. His eye contact improved his eye contact.

In the middle stage of therapy, he decided to use puppets. He was engaged through a puppet and

used normal voice in his exchanges with the therapist. After working with puppets, he chose to

draw. His early figures of people were fragmented and detached. It was also observed that he

was eager during the process of drawing (Emery, 2004).

Towards the end of therapy, he was able to have a conversation with the therapist in a

voice that seemed less mechanical (Emery, 2004). This can be particularly challenging for some

children with autism. Considering children’s behaviors through normal developmental

milestones art therapy can be very beneficial in helping children with autistic spectrum disorders.

The boy in the case study learned through drawing. Art continually proves to be an evolutionary

process. Art therapy for autistic children can be a significant intervention for encouraging their

growth.

The description of three drawings provides an example of this child’s advancement with

object constancy. Figure 1 showed his drawing of a toy McDonald’s sign with the big arches. It

is detailed with the registration trademark; the drawing in Figure 2 shows the exterior of a

McDonald’s playhouse with detailed rooflines. Figure 3 was his third drawing and is an outline

of a car. The person in the car is his mother and himself in the back seat. The boy put the three

separate drawings next to each other and drew a ground line across the bottom of the papers with

the objects on the ground. This is an extremely significant milestone in a child’s drawing. A


ground line indicates being and feeling grounded, which is a significant step in schematic

drawings (Horovitz et al., 1967).

Summary

The process making art encourages children with autism to begin to symbolize their

experiences through the use of nonverbal expression. Drawing can encourage a connection to the

object. Children make art because it is embedded in a need to relate with the world. Individuals

with autism lack this need. However, art therapy for normal or autistic children may provide an

increase in awareness of self which remains a foundation for relating (Emery, 2004).

Experiencing this is a developmental process.

Music Therapy

Music Therapy is the therapeutic use of music to effect positive change in a person’s life.

Music Therapy uses the creative process in making music and in listening to music. It also can

facilitate change and builds a relationship between the therapist and the client. Music Therapy

can increase development and wellness addressing needs associated to physical, emotional,

sensory, cognitive, and social functioning in people of all ages. (Abyad, 2012)

Music Therapy as Treatment

Many people believe that music can heal the soul, however it can also aid to treat

physical and mental illness. Studies on patients with cancer, ADHD/ADD, and depression have

revealed that music therapy is useful in helping people deal with a situation, both mentally and

physically. A number of hospitals presently use music therapy to assist patients in managing

their illnesses. Music calms the mind and body and reduces stress. Certain tones, notes, or pitch

have an influential effect on the body, and this can facilitate in restoring and improving

emotional, psychological, and physiological health (Abyad, 2012).


Music therapists are hired by hospitals and organizations to help patients deal with

sickness or pain. A patient can be referred to a music therapist when symptoms of unnecessary

stress and tension are evident. Music therapists also work with patients who have special needs,

such as those who are suffering from abnormalities in motor and communication skills. There are

several other illnesses and disorders that can be treated with music therapy, and these can include

physical handicap, sensory impairment, psychiatric disorder, communication disorder,

relationship problems, aging, substance abuse, and developmental disabilities. The different

types of music therapies may consist of cognitive behavioral therapy, psychodynamic therapy,

and behavioral therapy (Abyad, 2012).

The model of therapy that is based on neuroscience is “neurological music therapy”, or

NMT. This therapy involves the study of the effects of music on the brain when music is turned

on and off. Physicians will know how to help a patient by understanding the way the brain

responds to music (Abyad, 2012).

Music therapy is also useful in the treatment of autism. Autism is a neurodevelopmental

disorder that affects children. Its effects can be visible as early as infancy. Symptoms may appear

at the age of six months. The disorder is evident before the child reaches three years of age.

Characteristics of autism may include impaired communication and social interaction, repetitive

behavior, and limited interest. Many individuals with autism are incapable of taking care of

themselves, although there are some cases that have succeeded in becoming independent after

receiving appropriate treatment and guidance during their childhood.

Music therapy is beneficial in treating autistic children because it engages autistic

children in dancing and singing helping them communicate and develop social skills. Autistic

children respond to music by singing in the same note. Some may even start communicating


through singing. They may take up an instrument to play, and this will help them in acquiring a

certain skill (Abyad, 2012).

Music therapy can help autistic individuals in different ways. It is helpful to them

because it makes them more responsive to things around them. Children with autism connect to

music. Music gives them an opportunity to express themselves. Music therapy may begin with

learning how to play a musical instrument. Gradually, the therapy can progress to incorporate

singing and even dancing. This facilitates an emotional outlet and also a sense of fulfillment.

Why Music Therapy for Individuals with Autism?

Literature reports that most individuals with autism respond positively to music (DeMyer,

1974; Edgerton, 1994; Euper, 1968; Snell, 1996; Thaut, 1992).

People with diagnoses on the autism spectrum often show a heightened interest and

response to music, making it an excellent therapeutic tool to work with them.

Music is a very basic human response, spanning all degrees of ability/disability.

Music therapists are able to meet clients at their own levels and allow them to grow

from there. The flexibility of music makes it a medium that can be adapted to meet

the needs of each individual.

Music is motivating and enjoyable.

Music can promote relatedness, relaxation, learning, and self-expression.

Music therapy addresses multiple developmental issues at the same time.

Music therapy can provide success-oriented opportunities for achievement and

mastery.

The structure and sensory input inherent in music help to establish response and role

expectations, positive interactions, and organizations.


Music Therapy Makes a Difference with Individuals on the Autism Spectrum

Individuals on the autism spectrum may present qualitative impairments in social

interaction and communication and often show restricted repetitive and stereotyped patterns of

behavior, interest and activities. Abnormal functioning usually occurs before the age of 3 and

may be marked by a lack of imaginative play. (Diagnostic Statistical Manual IV, pp. 70-71)

Music therapy can be effective in addressing the typical characteristics of autism

listed above.

Music is considered a “universal language” which provides bridges in a non-

threatening setting between people and their environment, facilitating relationships,

learning, self-expression, and communication.

Music captures and helps maintain attention. It is highly motivating and engaging and

may be used as a natural “reinforcer”. Music therapy can stimulate clients to reduce

negative behavior or self stimulating responses and increase participation in more

appropriate and socially acceptable ways.

Music therapy can enable those without language to communicate, participate and

express communication, speech, and language skills. The interpersonal timing and

reciprocity in shared play, turn-taking, listening and responding to another person are

improved in music therapy with children and individuals with autism to accommodate

and address their styles of communication.

Music therapy allows individuals with diagnoses on the autism spectrum the

opportunity to develop identification and appropriate expression of their emotions.


Because music is processed in both hemispheres of the brain, music can stimulate

cognitive functioning and may be used for remediation of some speech/language

skills.

Music provides concrete, multi-sensory stimulation (auditory, visual, and tactile). The

rhythmic component of music is very organizing for the sensory systems of

individuals diagnosed with autism. As a result, auditory processing and other sensory-

motor, perceptual/motor, gross and fine motor skills can be enhanced through music

therapy.

Musical elements and structure provide a sense of security and familiarity in the

music therapy setting, encouraging clients to attempt new tasks within this predictable

yet flexible framework.

Many people with diagnoses on the autism spectrum have innate musical talents;

therefore music therapy provides an opportunity for successful experiences. Emphasis

is placed on strengths, which in turn may be utilized to address each individual’s

areas of need. (AMTA, 2012)

Autism can be detrimental to the development of a child. It is essential that an expert in

music therapy is consulted and doing therapy with these individuals. A music therapist knows

what kind of treatment plan is successful in helping an autistic child or adult. It is also imperative

to note that treating a disorder like autism requires time, effort, and a lot of patience.

Music Therapy Engages Children with Autism in Outdoor Play

Autism is a developmental disorder that affects verbal and non-verbal communication

and social interaction. It also is linked with repetitive and restricted behaviors. Children with

autism can benefit from inclusive classrooms because they are able to engage with their peers


(FPG Child Development Institute, 2007). Previous research shows that children with autism are

interested in and respond well to music. Research also found that playground time for young

children is more important for learning and social development (FPG Child Development

Institute, 2007). Unstructured space of a playground can potentially be overwhelming for

children with autism who flourish on a structured routine.

This first study examined evaluated four preschoolers with autism. Music therapy

examined strategies to encourage positive peer interactions during outdoor play for preschoolers

with autism in inclusive childcare programs. Researchers developed an outdoor music center

with different instruments. A song was composed unique to each child. Parents and teachers

were given a CD and lyrics, which was a two part intervention process done by researchers. It

was a teacher driven and designed to create a predictable routine. Each day the teacher took the

child with autism and a peer buddy to the music center, initiated play between the children, sung

a unique song, incorporated the instruments, and taught the peer buddy how to interact with the

child. Next, the teachers gradually withdrew their help with the goal of peer buddy and the child

interacting independently (FPG Child Development Institute, 2007).

This study used an embedded music therapy intervention as a consultive service. The

therapist provided guidance, information, and training to regular classroom teachers to encourage

peer interaction.

The results concluded that most children experience a slight increase in interaction, but

the frequency was still low and often inconsistent. When the teacher was involved, peer

interaction increased. Eric-33% to 68%, Ben 53% to 93%, Phillip 33% to 93%, Lucas 28% to

80%. Once peer buddies were on their own interaction decreased, but remained higher than

baseline (FPG Child Development Institute, 2007). Ben 43% to 80%, Phillip 8% to 33%, Lucas


13% to 40% (FPG Child Development Institute, 2007)

All of the children were attracted to the sound and explored the instruments. Therefore,

the musical adaptation of a playground increased peer interaction on playground for young

children with autism. Prior to the teacher and peer intervention the children with autism did not

often play with peers. Yet, once the intervention occurred, children’s level of peer intervention

increased. Proving the use of an individually composed song, sung by the teachers and peers,

increased positive peer interaction on the playground for young children with autism (FPG Child

Development Institute, 2007).

Improvisational Music Therapy

Individuals with autistic spectrum disorder (ASD) with significant limitations in verbal

and non-verbal communication respond positively to music therapy both active, improvisational

methods and receptive music therapy approaches. Improvisational musical activity with

therapeutic objectives and outcomes facilitates motivation, communication skills and social

interaction, in addition to sustaining and increasing attention (Kaplan & Steele, 2005).

The structure in music supports shared interaction, therefore tolerance, flexibility, and

social engagement then builds relationships. Individuals with autism show poor perception of

affective cues within the social environments. These individuals often fail to interpret and

recognize vocal and facial expressions of emotions (Capps, Yirmiya & Sigman; 1992; Fein,

Lucci, Braverman & Waterhouse, 1992). Accurate perception and interpretation is essential for

living. Rehabilitation efforts have focused on ways where these deficits can be alleviated. Music

therapy has been successful in treating individuals with autism (Kaplan & Steele, 2005). The two

main goals in music therapy is improving communication/language and improving socio-

behavioral skills (Kaplan & Steele, 2005).


Edgerton (1994) examined the results of improvisational music therapy on

communicative behaviors and found an increase in musical communicative modalities across ten

music therapy sessions. A considerable positive relationship was also found between musical

vocal skills and nonmusical speech, which implies that communication through music, breaks

barriers in speech and language in individuals with autism.

It was also found that rhythmic patterns and melodies are beneficial for

supporting learning and memory in autism. Buday (1995) observed that the number of signed

and spoken words correctly imitated by children with autism was higher using song rather than

spoken text. Music as a form of intervention has valuable effects for the change of behavior.

Burleson, Center, and Reeves (1989) acquired outcomes that prove background music decreased

off-task behaviors and promoted increased performance by children.

Orr, Myles, and Carlson (1998) studied the results of rhythmic entrainment on chaotic

classroom behaviors with the study of a girl with autism. Rhythmic entrainment involves the use

of music to support relaxation by the introduction of externally produced rhythms, designed

specifically to re-entrain the body to its natural rhythmic patterns. They found that rhythmic

entrainment reduced problematic classroom behavior (Khetrapal, 2009).

In this next study, participants included thirteen boys and all children met the DSM-IV

criteria of Autistic disorder by adolescent psychiatrists (Khetrapal, 2009). Five children were

non-verbal, and another five children were verbal with various degrees of language skills. Two

music therapists, one play therapist and three music therapy graduate students formed the

research team. In order to avoid personal familiarity influencing the therapeutic outcome, the

music therapy and play sessions were carried out by two different therapists.


The participants had twelve weekly thirty minute improvisational music therapy sessions,

which were compared with twelve weekly thirty minute play session with toys. The participants

were randomly assigned into two groups. The first group (group 1, 5 children) had music therapy

sessions then play sessions afterwards, while group (group 2, 5 children) had play sessions first

followed by music therapy sessions. Each session was divided into fifteen minutes undirected

and (child-led) part where the therapist supports and elaborate the child’s play, followed by a

fifteen minutes directed part where the therapist gently introducing modeling and turn-taking

activities within the child’s focus of attention and the range of interest, each lasting

approximately fifteen minutes (Kim, Wigram, & Gold, 2008).

The purpose of this study was to examine the effects of improvisational music therapy on

joint attention behaviors on pre-school children with autism. The definition of joint attention

behavior is an interactive state of joint engagement that involved the child, the therapist, and

objects, or events in either musical form, or in play. Gaining joint attention skills are significant

in early development. Without joint attention skills functioning skills like communication, social

interaction, and language cannot increase (Kim, Wigram, & Gold, 2008).

This was a random control study that used a single subject evaluation in two different

conditions that included; improvisational music therapy and play sessions with toys. This study

used standardized tools to measure and analyzed DVD’s of each session to assess changes in

behavior with children with autism.

The results implied that improvisational music therapy was more successful in

developing joint skills in children than in play. The study showed more and longer durations of

turn-taking and eye contact in improvisational music therapy than play sessions (Kim, Wigram,

& Gold, 2008).


Figure 1 showed an analysis of the pooled scores made by both the professionals (the

left) and the mother (the right) on the social approach subscale from the PDDBI (y-axis) at the

three separate time points (x-axis). Group 1 is represented by dotted line and group 2 by solid

line. Group 1 in both graphs improved after music therapy and to a slightly lesser degree (the

professionals), or slightly worsened (the mothers) after play sessions. The scores by the

professionals indicated that group 2 improved slightly after play and to a larger degree after

music therapy, whereas the scores by the mothers showed that group 2 improved in both

conditions and there was not much difference between the two conditions (Kim, Wigram, &

Gold, 2008).

THE ESCS

Figure 2 showed the combined scores of joint attention behaviors of the participants and

indicates that there was improvement over time in both groups and the improvement appeared to

be greater after music therapy than after play (Kim, Wigram, & Gold, 2008).

Eye Contact Duration

A significant effect (p < 0.0001) was found comparing the music therapy condition with play

condition. Figure 3 showed eye contact events occurring markedly longer in music therapy than

in play (Kim, Wigram, & Gold, 2008).

Turn-taking Duration

For turn-taking duration, a significant effect was found comparing conditions (p < 0.0001) and

session part (p = 0.037), and results are illustrated in Figure 4. The ANOVA of the selected

sessions was approaching significance (p = 0.051) (Kim, Wigram, & Gold, 2008).

Figure 4 indicated that music therapy was more effective at facilitating a longer turn-

taking duration than the play condition. There was longer duration of turn-taking activity in the

http://www.springerlink.com/content/a8303q12263805n4/fulltext.html#Fig1






second (directed) half of the sessions in both music therapy and the play condition (Kim,

Wigram, & Gold, 2008).

This study explored and predicted that improvisational music therapy would be more

beneficial than play alone over time. Musical attunements opened up the child and maintained

communication. Concluding the child’s joint attention increased considerably in this study.

Therefore, music therapy may be better than in play.

In another study Wimpory, Chadwick, and Nash (1995) utilized musical interaction

therapy to synchronize interactions between a 3 year old girl with autism and her mother. The

girl had an increase in eye contact and other areas of social awareness. She initiated more

interactive exchanges with her mother. Furthermore, a two-year follow up showed that these

positive changes sustained.

Published reports range from controlled studies to clinical case reports of the significance

and usefulness of music therapy as an intervention for children with ASD. Additional articles

found highlight the purpose of using music therapy in diagnostic and clinical assessment. Music

therapy assessment can discover limitations and weaknesses in children, in addition to strengths

and potentials (Wimpory, Chadwick, & Nash, 1995).

Research found evidence from a review with two randomized controlled trials which

examined the short-term effects of structured music therapy. Noteworthy findings were

discovered in these studies. The results were significant because they demonstrated the potential

of music as an intervention for autistic children.

Another study focused on the effects of therapeutic approach on the social and symbolic

development of a young autistic child which was interaction therapy for children with autism: an

evaluative study that had a two year follow up conducted by Dawn Wimpory.


Frequent Use Eye Contact

Reciprocal interaction may be less coordinated between infants with autism and parents

or guardians. Deficits in eye contact and turn taking is present as well. In addition, interaction in

children with ASD is usually short and they also fail to show playful teasing.

The majority of conservative therapies may be ineffective to aid social creativity the

creativity and spontaneity of interaction shown by normally developing children. This case study

assessed and measured development prior to, during, and two years of completion of musical

interaction therapy (Wimpory, 1995).

Musical Interaction Therapy orchestrated live music to adult –child interactions. It

intended to enable children with autism to anticipate their partner’s actions on the basis of music

synchronized to those actions. It encouraged preverbal interaction in hopes of nurturing

interpersonal contact, joint attention, and understanding. It also engages games of physical

contact and social routines with imitation of child behavior (Wimpory, 1995).

The positive findings of this study confirmed developmental forecast. In the beginning of

Music Interaction Therapy there were increased improvements in the child’s use of social

acknowledgement, eye contact, and initiations of involvement. Spontaneous child contributions

to interaction which included teasing and symbolic play materialized later. The two-year follow-

up confirmed that these changes were sustained and the child did not appear to have any social

withdrawal symptoms.

Knill et al, (1995) observed that while all of the expressive therapies involve action. Each

of them also has intrinsic differences. Visual expression can be more private, isolated work and

may lead to increasing the process of the awareness of self. Music often taps into feelings and

may enhance socialization when individuals collaborate in song or in playing instruments


simultaneously. Dance/movement offer opportunities to interact and form relationships.

Furthermore, each of form of expressive therapy has its unique properties and roles in the

therapy based on how it is applied, the practitioner, client, setting, and objectives.

Conclusion

Expressive therapies promote a distinctive dimension to psychotherapy and counseling

because they have numerous particular characteristics, including, but not restricted to, (1) self-

expression, (2) active participation, (3) imagination, and (4) mind–body connections (Malchiodi,

2005).

The creative arts therapies have unique contributions to offer in the treatment of

individuals that have difficulties with these processes. The creative art therapies involve action.

The concreteness of image, relationship, and affect in an artistic form offers “explicitness of the

symbolic representation of emotional ideas. The connection between an experience and knowing,

have been utilized by art therapists that recognize the different ways that the arts make engages

affective, cognitive, and somatic processes harmoniously (Malchiodi, 2005).

Expressive therapies with psychology and counseling have surfaced and evolved for a

reason. Mental Health professionals are becoming aware of the benefits of expressive therapies

that some verbal methods in therapy may not be beneficial in treating some clients or

populations.

Creativity in therapy has significant potential to produce results with clients in ways that

some other interventions may not. When practitioners use expressive therapies, clients have the

opportunity to become active in treatment, and this can empower them to use creativity and

imagination in productive ways. Through art, play, music, movement, drama, or writing,


expressive therapies motivate the senses, thereby “sensitizing” individuals to untapped aspects of

themselves (Gladding, 1992) and therefore, aid in self-discovery, change, and healing.


References

Abyad, M. (2012). Music therapy and autistic spectrum disorder [Online]. Available at

http://www.examiner.com/article/music-therapy-and-autisticspectrum-disorder

Alland, A. (1983). Playing with form. New York, NY: Columbia University Press.

American Art Therapy Association. (2012). About art therapy [Online]. Available

at http://www.americanarttherapyassociation.org/upload/whatisarttherapy.pdf.

American Dance Therapy Association (2012). The definition of dance/movement therapy

[online]. Available www.adta.org/Content/Documents/Document.ashx?DocId=63425

American Music Therapy Association (2012). Definition of music therapy [Online].

Available at www.musictherapy.org.

American Music Therapy Association (2012). Music Therapy: As a treatment modality for

autism spectrum disorders. Available at

www.musictherapy.org/assets/1/7/MT_Autism_2012.pdf

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders

(4th

ed., text rev.). Washington, DC: Author.

Autism-PDD Network. (n.d.). Diagnosing autism. Available at http://www.autism-

pdd.net/diagnosing-autism.html.

Balk, D. (2010). The art of grief: The use of expressive arts in a grief support group.

Death Studies, 34, 274-288.

Behar, M. (2006). Yoga therapy for autistic children. Retrieved from

http://www.iayt.org/Publications_Vx2/ytip/may06/Behar0506.pdf

http://www.iayt.org/Publications_Vx2/ytip/may06/Behar0506.pdf


Birdee, G.S., Yeh, G.Y., Wayne, P.M., Phillips, R.S., Davis, R.B. & Gardiner, P. (2009). Clincial

applications of yoga for the pediatric population: A systematic review. Academic

Pediatrics, 9 (4), 212-220. doi: 10.1016/j.acap.2009.04.002

Borremans, E., Rintala, P. & McCubbin, J.A. (2010). Physical fitness and physical activity in

adolescents with Asperger syndrome: A comparative study. Adapted Physical Quarterly,

27, 308-320.

Boso M., Emanuele, E., Minaazzi, V., Abbamonte, M., Pierluigi, P. (2007). Effect of long-term

interactive music therapy on behavior profile and musical skills in young adults with

severe autism. The Journal of Alternative and Complementary Medicine, 13(7), 709-712

Bonura, K. (2007). The Impact of Yoga on Psychological Health

Older Adults. Retreived November 2, 2012. Available at

diginole.lib.fsu.edu/cgi/viewcontent.cgi?article=2537&context=etd

Boyd-Webb, N. (Ed.). (1999). Play therapy with children in crisis (2nd ed.). New

York, NY: Guilford Press.

Buday, E. M. (1995). The effects of signed and spoken words taught with music on sign and

speech imitation by children with autism. Journal of Music Therapy, 32(3), 189-202.

Burleson, S. J., Center, D. B. & Reeves, H. (1989). The effect of background music on task

performance in psychotic children. Journal of Music Therapy, 26(4), 198-205.

Capps, L., Yirmiya, N. & Sigman, M. (1992). Understanding of simple and complex emotions in

nonretarded children with autism. Journal of Child Psychology and Psychiatry, 33, 1169-

1182.

Carson, D., & Becker, K. (2004). When lightning strikes: Reexamining creativity in

psychotherapy. Journal of Counseling and Development, 82, 111-115.


Chaiklin S. & Wengrower H. (2009). The art and science of dance/movement therapy: Life is

dance. New York, NY: Taylor & Francis.

Christman L., & Frey, R. (2006). Movement therapy. Gale Encyclopedia of Medicine (3rd ed.)

Farmington Hills, MI: Gale-Cengage.

Columbus Music (n.d.). Music therapy and autistic spectrum disorder. Retreived on June 29th

,

2012. Available at http://link.springer.com/article/10.1007/s10803-006-0272-1#page-1

Coughlin, E. (1990). Renewed appreciation of connections between mind and body stimulate

researchers to harness the healing power of the arts. Chronicles of Higher Education, 36,

9.

Di Leo, J. H. (1983). Interpreting children’s drawings. New York, NY: Brunner/Mazel.

Edelson, S., Arin, D., Bauman, M., Lukas, S., Rudy, J., Scholar, M., & Rimland, B. (1999).

Auditory integration training: A double blind-study of behavioral and

electrophysiological effects in people with autism. Focus on Autism and Other

Developmental Disabilities, 14(2) 73-81.

Edgerton, C. (1994). The Effect of Improvisational Music Therapy on the Communicative

Behaviors of Autistic Children. Journal of Music Therapy, 31(1), 31-62.

Emery, M. (2004). Art therapy as an intervention for autism. Journal of the American Art

Therapy Association, 21(3), 143-147.

Evans, K., Dubowski, J. (2001). Art therapy with children on the autistic spectrum: Beyond

words. Philadelphia, PA: Jessica Kingsley Publishers.

Fleshman, B., & Fryrear, J. (1981). The arts in therapy. Chicago, IL: Nelson-Hall.

FPG Child Development Institute. (2007). Music therapy engages children with autism in

outdoor play. FGP Snapshot No. 39. Chapel Hill, NC: University of North Carolina at


Chapel Hill. Retrieved from

http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED

496633

Gladding, S. (1992). Counseling as an art: The creative arts in counseling. Alexandria, VA:

American Counseling Association.

Goodenough, F. (1926). Measurement of intelligence by drawings. New York, NY:

Harcourt, Brace, & World.

Grumman Bender, R. (n.d.). Expressive therapy. Retrieved on July 14th

, 2012, from

http://www.helpfordepression.com/article/psychotherapy/expressive-therapy

Hanson, E., Kalish, L.A., Bunce, E., Curtis, C., McDaniel, S, Ware, J. & Petry, J. (2007) Use of

complementary and alternative medicine among children diagnosed with autism spectrum

disorder. Journal of Physical and Developmental Disabilities, 37, 628-636. doi:

10.1007/s10803-006-0192-0

Hancock, P. (2012) Telluride art therapy. Retrieved on July 12th

, 2012

Available at http://www.telluridearttherapy.com/arttherapy.htm

Horovitz, B., Lewis, H. P., & Luca, M. (1967). Understanding children’s art for better teaching.

Columbus, OH: Charles E. Merrill.

Kern, P., Wolery, M., Aldridge, D. (2006). Use of songs to promote independence in morning

greeting routines for young children with autism. Journal of Autism and

Developmental Disorders, 37(7) 1264-1271.

Kenny, M. (2002). Integrated movement therapy: Yoga-based therapy as a viable and

effective intervention for autism spectrum and related disorders.

International Journal of Yoga Therapy, 12, 71-79.


Khetrapal, N. (2009). Why does music therapy help in autism? Empirical Musicology Review,

4(1), 11-18.

Kim, J., Wigram, T, & Gold, C. (2008). The effects of improvisational music therapy on joint

attention behaviors in autistic children: A randomized controlled study. Journal of

Autism and Developmental Disorders, 38(9) 1758-17.

Knill, P., Barba, H., & Fuchs, M. (1995). Minstrels of the soul. Toronto, ON: Palmerston Press.

Landreth, G. (1991). Play therapy: The art of relationship. Muncie, IN: Accelerated

Development.

Lara, Joanne (2012). Autism movement therapy. Available at

http://www.autismmovementtherapy.org/site/

Malchiodi, C. (2003). Handbook of Art Therapy.

The Guildford Press. New York, NY. (pp. ix)

Malchiodi, C. A. (2001). Using drawings as interventions with traumatized children. Trauma and

Loss: Research and Interventions, 1(1), 21–27.

Malchiodi, C. (2005). Expressive therapies: History, theory, practice. New York, NY: The

Guilford Press.

McNiff, S. (1981). The arts and psychotherapy. Springfield, IL: Thomas.

McNiff, S. (1982). Great debate: The place of art in art therapy: Working with everything we

have. American Journal of Art Therapy, 21(4), 122-123.

McNiff, S (1987). The shaman within. Arts in psychotherapy, 15(4), 285-291.

McNiff, S (1992). Art as medicine: Creating a therapy of the imagination. Boston, MA:

Shambhala.

McNiff. S. (1992). Art and medicine. Boston, MA: Shambhala.


McNiff, S. (2000). Pandora’s gift: The use of imagination and all of the arts in therapy. In J.A.

(Ed.), Approaches to art therapy. Theory and technique (2nd

ed., pp. 318-325).

Philadephia, PA: Brunner-Routledge.

Moon Hyland, C. (2002) Studio art therapy: Cultivating the artist identity in the art therapist.

Philadelphia, PA: Jessica Kingsley Publishers.

National Coalition of Creative Arts Therapies Associations (2004c). National Coalition of

Creative Arts Therapies Associations [online]. www.nccata.org

National Coalition of Creative Arts Therapy Associations (2004b). Dance/movement therapy

[online]. www.nccata.org/dance.html

Neel, R., Jenkins, Z., & Meadows, N. (1990). Social problem solving and aggression in young

children: A descriptive observational study. Behavioral Disorders, 16, 39-51.

Orr, T. J., Myles, B. S. & Carlson, J. K. (1998). The impact of rhythmic entrainment on a person

with autism. Focus on Autism and Other Developmental Disabilities, 13(3), 163-166.

Pennebaker, J.W. (1997). Opening up: The healing power of expressing emotions.

New York, NY: Guilford Press.

Pylvänäinen P. (2003). Body image: A tripartite model for use in dance/movement therapy.

American Journal of Dance Therapy, 25(1), 39-55.

Robbins, A. (1994). A multi-modal approach to creative art therapy.

Bristol, PA: Jessica Kingsley.

Robison, J. (2012). How will the DSM V changes in autism affect people?

Retrieved on January 14th

, 2013. Available at http://www.psychologytoday.com/blog/my

life-aspergers/201201/how-will-the-dsm-v-changes-in-autism-affect-people?page=2

https://springerlink3.metapress.com/content/?Author=P%c3%a4ivi+Pylv%c3%a4n%c3%a4inen

https://springerlink3.metapress.com/content/xl014068x5951521/

https://springerlink3.metapress.com/content/0146-3721/


Rogers, Earl R. The Art of Grief: The Use of Expressive Arts in a Grief

Support Group. New York: Taylor & Francis Group, 2007.

Rothschild, B. (2000). The body remembers: The psychobiology of trauma and trauma

treatment. New York: Norton.

Rudy, L. (2010). Art therapy for autism. Retrieved on August 1st, 2012. Available at

http://autism.about.com/od/autismtherapy101/a/arttherapy.htm

Solomon, A., & Chung, B. (2012). Understanding autism: How family therapists can support

parents of children with autism spectrum disorders. Family Process, 51(2), 250-264.

Vick, R. M. (2003). A brief history of art therapy. In C. A. Malchiodi (Ed.), Handbook

of art therapy (pp. 5–15). New York, NY: Guilford Press.

Ulman, E., & Dachinger, P. (Eds.). (1976). Art therapy in theory and practice. New York, NY:

Scholken.

Walsh, S. Culpepper Martin, S., & Schmidt, L. (2004). Testing the efficacy of a creative-arts

intervention with family caregivers of patients with cancer. Journal of Nursing

Scholarship, 36(3), 214-219.

Weiss, J., & Lunsky, Y. (2010). The brief family distress scale: A measure of crisis in caregivers

of individuals with autism spectrum disorders. Journal of Child and Family Studies,

20(4), 521-528.

Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of autistic

spectrum disorder: clinical application and research evidence. Child: Care, Health and

Development, 32(5), 535-542.


Wimpory, D. (1995). Brief report: Musical interaction therapy for children with autism: An

evaluative case study with two-year follow-up. Journal of Autism and Developmental

Disorders, 25(5), 541-552.