Swetha Veeraraghavan*, Dr Vivek Chincholkar **

* Clinical Psychologist and Arts Based Therapy Practitioner, ** Consultant Psychiatrist, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital

Mumbai, India

Presenting author Swetha Veeraraghavan

The ‘Unfinished Painting’ is a study on the efficacy of Arts Based Therapeutic interventions on improving the motor, cortical arousal, vocalization and self-expression skills among children belonging to a cohort of Pervasive Developmental Disorder, namely Autism. The results are of the intervention of approximately 2 months with a group of 9 children with autism (7 males and 2 females) chosen through random sampling in a before after design from a special school in Mumbai. The tools for assessment included Childhood Autism Rating Scale, Vineland Social Maturity scale, observations schedules of parents, teacher and neutral observer along with Arts Based Therapy Tools of E-P-R (embodiment-projection-role) in clay and free scribble drawing. The results show a significant increase in the levels of vocalization and self-expression in the children. Expression through non-verbal gestures as well as babbling sounds accompanying the gestures show that regular music and art allow for building the bridges in the brain anatomy and help the child function as a whole. This helps increase not only the target behaviors but also promote a composite increase in the level of functioning of the child. Music and narratives together help to provide the children the template to comprehend and process complex instructions and motor functioning. All in all, the metaphors combined with art based interventions allow for a complete mind body functioning of the children.

Introduction

Pervasive Developmental Disorders have come to the forefront of research today. There has been reported to be an exponential rise in the number of reported cases in the past few years. These disorders have been primarily defined as “A group of disorders characterized by delays in the development of socialization and communication”. The disorders of Autism, Rett’s Disorder, Childhood Disintegrative Disorder, and Asperger’s form this cohort of PDD. Autism, a developmental brain disorder characterized by impaired social communication skills and a limited range of activities and interests is one the most studied of this cohort. The primary characteristics of this group include their inability for effective social reciprocity and communication skills, a general lack of responsiveness to other people, serious deficiencies in communication skills especially language and unusual repetitive responses to the environment. The overall behavior of these children may appear to be bizarre. Perseveration and stereotypies may be evident and they often exhibit fascination for various inanimate objects. An insistence on sameness is common, and they may become catastrophically anxious if the familiar routines are transgressed. The lifetime prevalence of the disorder is approximately 0.05% with a male female ratio of 3-4:1. Although autism is usually chronic, some experience diminution of symptoms by teenage years, eventually leaving a stable pattern during adulthood. Almost two thirds require some degree of supervision. Some high functioning children with Autism (Savants) excel in their occupations.
Children with autism are known to have difficulties in sharing attention with others. Yet one-joint attention behavior, the ability to follow another person's head turn and gaze direction, may be achieved without necessarily sharing attention. In a study conducted by Susan Leekam et al it has been reported that when cues were added (pointing, language) or when feedback from targets was given their performance improved. Parent interview data indicated that children with autism, whatever their mental age, began to follow head turn and gaze direction years later than typically developing children. (Targets and Cues: Gaze-following in Children with Autism; Susan R. Leekam1, Emma Hunnisett1, Chris Moore).
Generalization of learning for children with autism has been answered in the article by author Colwyn Trevarthen that accounts for the effects and modality of treatment of music as therapy. The music therapy facilitates mental functioning and learning of children with autism, in that it mobilizes and strengthens coordination of reasons, not because it would provide cognitive stimulation or because it would lead to the perception of time musical or disclosure by the melody. The child is guided to produce answers in sympathy with the intensity and quality of the movements of others. The sense of rhythm and expression that children exhibit in proto-conversation as in the narrative remains a resource responsive to deep consciousness confused, negative emotions and impulsive motility of autism. The musical improvisations encourage episodes of concerted activity and this receptivity brings to life, controlling anxiety, contributing to a coherent awareness and memory, and encouraging the child to share the pleasure of contact with people and communicating more effectively.
The music therapy facilitates mental functioning and learning of children with autism, in that it mobilizes and strengthens coordination of reasons, not because it would provide cognitive stimulation or because it would lead to the perception of time musical or disclosure by the melody. The child is guided to produce answers in sympathy with the intensity and quality of the movements of others. Further, in a pilot study examined by the Social Emotional Neuro-Science Endocrinology (SENSE) Theatre as a social intervention for children with autism, it was observed that the children became better communicators and were able to generalize those skills to the classroom. This study cites the potential for theatre as a social skills intervention.Despite their difficulties, individuals with autism can increase their communication skills and develop a sense of self through the process of art therapy. These unique individuals can forge a positive relationship with the art therapist while facilitating sensory integration. These mechanisms can also help to decrease negative behavior while improving cognitive growth and emotional regulation (AATA, circa 1983), making art therapy a beneficial mode of treatment for many individuals in the spectrum.

Materials and method:
Sample: The sample consisted of 9 children (7 males and 2 females) diagnosed with moderate to severe Autism. The demographics of the sample include:
Age Range: 5 years to 12 years

Age Distribution:

Age Number of Children
5 years 2
7 years 2
8 years 2
9 years 2
12 years 1


Gender: 7 males, 2 females

Other relevant information: All the students have had experience with some informal schooling. They have been in the current set up of schooling for a minimum of a year and a maximum of 3 years. They undergo occupational therapy and special education as a part of their regular curriculum.

Tools: The assessment tools were designed along three points of view. The clinical perspective included the administration of the tools of Vineland Social Maturity Scale (VSMS) and the Childhood Autism Rating Scale (CARS). These scales were administered by a clinical psychologist. The VSMS which can be used from birth up to the age of 30 consists of a 117-item interview with a parent or other primary caregiver. Personal and social skills are evaluated in the following areas: daily living skills (general self-help, eating, dressing); communication (listening, speaking, writing); motor skills (fine and gross, including locomotion); socialization (interpersonal relationships, play and leisure, and coping skills); occupational skills; and self-direction. Raw scores are converted to an age equivalent score.

CARS is an interview schedule consisting of 15 domains; relating to people, imitation, emotional response, body use, object use, adaptation to change, visual response, listening to people, taste, smell and touch response, fear or nervousness, verbal communication, non-verbal communication, activity level, level and consistency of intellectual response, and general impression. Each of the domains is rated on a 7 point Likert type scale with the range of 1-4 with mid-point ranges also included. Total CARS scores range from a fifteen to 60, with a minimum score of thirty serving as the cutoff for a diagnosis of autism on the mild end of the autism spectrum.
Observation schedules designed in line with the therapeutic goals of each child were filled out by parents, teachers and a neutral observer.
All of the assessment tools were administered before the beginning of the action research phase for a baseline score. The scores obtained at the end of sixteen sessions with the children were recorded as the after score.