Art Therapy and its Effectiveness of Stress Reduction for Children with Learning Disabilities (Autism and Down Syndrome)

Art Therapy and its Effectiveness of Stress Reduction for Children with Learning Disabilities (Autism and Down Syndrome)

Throughout a lifetime, people find themselves in stressful situations, where they find themselves stressed. As natural as a reaction this is, it seems that stress negatively effects anyone and everyone in some way. Stress affects people all over the world; it causes other disease and can shorten a life span. So why does it still seem to allude people when trying to alleviate symptoms of stress? When doing a simple Google search, thousands of articles pop up that state all kinds of different methods and advice for reducing and relieving stress during day-to-day life. Stress is a part of everyday life, despite its alternate effects. These different methods are dependent on the person and their situation. When considering this important factor, there are still a large variety of options that can give people the relief they want and sometimes need. One of these options is Art Therapy. The world of Expressive Therapies is still new, but the use of this type of therapy, with more research, can prove to be a turn-of-the-century benefit for those with learning disabilities, or for those who find themselves communicating better through body language, writing, movement, sound, or image.

Living in general can be confusing, hard, and stressful. Many people are left in a rut of just pure stress with no outlet for these emotions and negative feelings. These can involve marriage, divorce, money issues, job troubles, children, or anything else that can affect a person’s life overall. Stress is a natural occurrence in life that every person will most likely feel. When someone is stressed, they can try to create something in which their minds are then occupied, and their emotions are being dealt with indirectly. This in turn can help reduce stress. An extremely important example to this method of coping is Art Therapy. For some, this method is extremely helpful. A group of people who tend to benefit greatly when trying Art Therapy are the people who have mental disabilities. When everyday life is a struggle, there is an output for these people to communicate through the visual arts, instead of attempting vocal communication when sometimes it is hard for them to communicate vocally. Art Therapy is also helpful for those who work with this person or people with a disability, because they are now able to understand the emotion and feeling of the person they are trying to connect with. Communication is crucial in humanity and being able to communicate properly allows people to become productive members of their societies. Without proper communication, it is hard to bond with others and create meaningful relationships. It is also difficult to manage the everyday stresses in life without being able to communicate ways to make the stressor less rough or to keep oneself from getting even more stressed.

Stress is seen everywhere. No matter where you live or what you do, stress is inevitable and can happen at any time. The American Institute of Stress displayed 50 symptoms that are felt during a time of duress, which are important to remember is a short and unfinished list, as everyone experiences stress differently. These symptoms and all other symptoms of stress depend on ones’ lifestyle, levels of stress normally, coping capabilities, maturity levels, or even what the stress is. Humans experience a wide range of symptoms when dealing with stress. Some examples can range from inner body changes to pain in the muscles from constantly keeping them tense. Others like flight or fight responses, chronic bodily harm, or symptoms of anxiety prove to be typical symptoms of stress. The definition of stress is not clearly defined, but generally means physical, mental, and/or emotional strain (The American Institute of Stress, 2018). When looking into the definitions of stress, there seems to be three important models to look for: an external element, an internal element, and the interaction between the two.

It is important to know how stress comes into peoples’ lives, but it is equally as important to understand different types of stress. Acute stress is also known as a “fight or flight” response. Controlled by the central nervous system, this reaction is completely involuntary and different depending on your person (The American Institute of Stress, 2018). For example, when someone is going to steal something of yours, your response would be to either run away, or fight back. This is an innate response and usually done without thinking. When fight or flight begins, the body goes through extreme changes for a brief amount of time. The blood starts to rush faster, and adrenaline is released (The American Institute of Stress, 2018). Some people sweat when their body is in fight or flight. The American Institute of Stress states that fight or flight generally takes 90 minutes for one’s metabolism to return to normal levels.

Another important type of stress is called chronic stress. As one may be able to guess, this involves the stress that is felt during everyday life. Jobs, school, family, money are all factors in developing chronic stress. This type of stress is more often ignored and pushed away, and tends to be the stress that causes the most damage without noticing (The American Institute of Stress, 2018). People tend to feel this stress more often in their lives than that of fight or flight, eustress, or any other type of stress.

            Eustress, or healthy stress, is often more forgotten in the world of stress. Because of this, people of all kinds tend to think that stress is always just a negative aspect of life (The American Institute of Stress, 2018). It is important to remember healthy stress, as it teaches our tunnel-thinking brains that sometimes being nervous and excited can be good things. Some examples of eustress are marriage, having a child, buying a home, changing jobs, or anything that could end up with a happy outcome, yet still causes a person stress.

When the body goes through stress, quite a bit can change. Small and subtle changes like teeth grinding or getting clammy can occur, whereas extreme events like panic attacks and long-term immune deficiency can pose lifelong troubles.

“Stress is a natural physical and mental reaction to life experiences. Everyone expresses stress from time to time. Anything from everyday responsibilities like work and family to serious life events such as a new diagnosis, war, or the death of a loved one can trigger stress. For immediate, short-term situations, stress can be beneficial to your health. It can help you cope with potentially serious situations. Your body responds to stress by releasing hormones that increase your heart and breathing rates and ready your muscles to respond,” (The American Institute of Stress, 2018).

Because of the different kinds of stress, the human body goes through various and often time different and unique experiences. Generally, many people feel the same few symptoms, but stress effects everyone very differently, especially depending on the lifestyle one lives. The first part of the body to be activated during a stressor is the central nervous system. This is the fight or flight response center. Once the immediate threat is acknowledged, the body continues to prepare for a fight or avoidance. During a stress response, typically the respiratory system is also affected. This is your breathing and heart. Those with asthma might experience symptoms of an attack, or just increased respiratory activity in general. The heart also begins beating faster, sending more blood throughout the body. Because of this, the blood pressure is raised. This is your body’s preparation to either run or fight off whatever is causing the stress reaction (National Down Syndrome Society, n.d.). Frequent stressors that can cause fight or flight to raise blood pressure can lead to long term health decrease, as the heart works harder for longer to pump blood through the body and is constantly prepared for fight or flight.

            The gut is also very important during stress. In fact, the entire digestive system begins to prepare for fight or flight as well. The liver raises sugar levels, boosting energy levels. When this is a chronic occasion, the body can have trouble keeping up with all the sugar being secreted, leading to diseases like diabetes (The American Institute of Stress, 2018). Another important aspect of the digestive tract is the stomach. During time of duress, heavy breathing and rapid heartbeat can help cause acid reflux and heightened acidity in the stomach. This can cause an increased risk in developing stomach ulcers or making current ones worse.

            The immune system is also an important factor when looking into stress. Those who get sick are more likely to have a less active and strong immune system. When dealing with a little bit of stress now and again, the immune system can actually get stronger (The American Institute of Stress, 2018). This works as if it were a vaccination of stress. When the stressor is faced and then dealt with in a timely manner, the body can grow stronger and be prepared for another stressor quicker. When dealing with chronic stress, however, the immune system is weakened. The hormones (like adrenaline) that are released are known to weaken the body over time. When adrenaline is released in short increments, it can be used to help someone get out of a dangerous situation and help the immune system heal wounds (The American Institute of Stress, 2018). But, when released constantly in the body, it is hard to return to normal levels, and the body expels quite a bit of energy to do so. This leaves people being at risk for viral infections and disease. If that isn’t enough, it is harder for the body to recover from these illnesses and injuries that become acquired after the chronic stress.

Because of these downsides, people find themselves in a vicious cycle of stress, where they are stressed about something constantly, find themselves in a pickle, and become more stressed about the situation they are then in. The chronic stress that many people face causes so many physical and mental issues while also keeping many from living a healthy and happy life. Due to the increased stress in the world today and the massive quantity and normalcy of chronic stress in those who try to live their lives, many people look for options to keep themselves sane and mentally balanced. Some try meditation or yoga; others try writing or dance. For quite a few, they find the use of art and creating imagery to be a very easy and efficient pathway to emotional and physical release of stress.

            Art Therapy is defined as, “the use of art-making to help individuals improve physical and emotional well-being, resolve problems, develop interpersonal skills, increase self-esteem, and relieve stress” (Tsai, 2015). Adrian Hill coined this term in 1942 while he was recovering from tuberculosis. He found that drawing and painting, despite not relieving any of his physical symptoms, he found serious emotional relief and stress reduction (Good Therapy, 2016). Because of this finding, the term Art Therapy could be developed and defined much more clearly. Along with the definition being clarified, the actual process and implementation of the therapy was defined and perfected. “Art therapists blend the knowledge of visual art and psychotherapy to facilitate a safe environment and creative approaches for people to explore feelings, resolve emotional conflicts, foster self-awareness, manage behavior, develop social skills, reduce anxiety, and increase self-esteem” (Tsai, 2015). The process of using Art Therapy was increasing in popularity as the years went on and more positive research was conducted.

Art Therapy is a type of therapy is listed under that of Expressive Therapies. These therapies involve several artistic forms of coping, where speaking and talking sometimes take the back-burner to movement, sound, touch, and other forms of expression. Some examples of Expressive Therapies are Dance Therapy, Music Therapy, Movement and Audio Therapy. These types of therapies are used on a non-traditional level, where verbal or “Talk Therapy” are less of importance compared to the inadvertent use of creativity to lead to healthy releases of stress. Instead, the patient would be expressing their emotions through other outlets like movement and sound. This type of therapy is generally used by psychologists, in a cognitive-behavioral based therapy setting.

 “In addition to creative arts therapists, there are artists offering creative interventions to the patients in health institutions. They most often work without a therapeutic professional background, but also use the potential of the arts in order to foster health. In addition, psychologists, physicians, and other health care professions are increasingly discovering the contribution of the arts in their settings and conduct studies to investigate the workings of the ‘arts in health,’” (Martin, et al., 2018).

Using Art Therapy is very important for those with mental disorders, illnesses and disabilities as it keeps them on top of their emotions and thoughts while also allowing reinforcement in their positive aspects of life. For instance, someone drawing things that make them happy unconsciously connects their emotion to that happy thought, allowing them to fully engross themselves into their artwork on an emotional and physical level. This also gives them a reason to think of nice things, instead of what might be causing the stress and negative feelings. Making this work could provide an access point to address these feelings without directly feeling them; the new perspective and calmness can help someone with a deficit in communication gather their thoughts and words regarding how they might want to share their emotions.

When the term Art Therapy was used more, it wasn’t provided as a class or method quite yet; some psychologists and others working in the field started incorporating what they considered were aspects of Art Therapy. Looking into Art Therapy and how it works exactly, there are several factors that are involved in the ever-growing method of therapy. The profession began in the 60s, where the immediate work on children with disabilities became present. It is not uncommon not to notice children enjoying art, as they begin holding a writing instrument at around 15 mo. (around when language also starts) and putting it to paper (Evans & Dubowski, 2001). The child already prefers the kinesthetics of movement and the visual coloring that appears as they move the instrument around the page. As this develops, the child can find real comfort in this creation. “Every child is born with creative ideas, but if this creativity is not raised and nurtured, it will subside,” (Mehri Rahmani & Rahmani, 2014). An Art Therapist is this case can help aid a child through different stages of drawing, perhaps helping them get into more intricate and complex challenges as they develop at their own pace. The over and academic development of the student can then increase, allowing them to feel more satisfied and happier with themselves, leading to an overall less stressful experience.

            Another important aspect to Art Therapy, like other Expressive Therapies, is that the patient is not required to have any sort of artistic background or skill in the arts. The whole point of Art Therapy is to help those who are experiencing difficulties and providing them the opportunity to express themselves with no conflict or judgment. Because art has always been an important form of communication and expression, the use of art as means of communication in a therapy space can be extremely helpful, as well as second nature (Good Therapy, 2016). Art in the use of therapy has only been used in the past few decades, however. As it did grow, its use was seen in both Europe and the US almost simultaneously, with its benefits still questioned even today.

            People live stressful lives. More often than not, people find themselves more stressed than they would like to be. There are so many events that happen in life that can make some days more stressful than others. Now, imagine having trouble understanding anything around you, and how to communicate your lack of understanding to your peers. This is often the life of someone with a learning disability. Those with a learning disability cover 3-12% of the world’s population. Some of these disabilities effect life only slightly, while others require day-to-day care and adjustment. Stress can affect those with a learning disability more, and affect their contributions to society.

            Mental illness accounts for almost half of those who are under the age of 65 years old. Of those, there are some diagnosed with a learning disability. Used for the first time in 1962, people’s opinions on the term were very strong and divided. The disability is based solely on cognitive function. When looking into the definitions of a learning disability and the cognitive ability and functions of it, the definition becomes loosely a way to organize the intense and constant stimuli received in the brain from the outside world (Tsai, 2015). Even today, the term can cause some people to feel negatively. People consider those with a learning disability a lesser person, or someone who are not capable of functioning in society. In fact, the US government didn’t even consider those with a learning disability a group of people until the 70s where they were finally able to obtain a special education (Mehri Rahmani & Rahmani, 2014). Now that those with a learning disability can receive an equal education along with being accepted and recognized, they can feel like people who are contributing to their society and lives.

“Office of Education, U.S. Public Law 101-476 defines learning disability as: disorder in one or more underling psychological processes which caused problem in understanding or using spoken or written language and can appear as: disability in listening, thinking, speaking, reading, and writing, spelling of words or math calculations,” (Mehri Rahmani & Rahmani, 2014).

Because a learning disability is such a broad term, there are some specifics to its definition. Learning disabilities can be brain injuries, mild or severe brain dysfunction, dyslexia, disability in speaking, learning, reading and writing, and doing mathematical problems. The term “learning disability” does not include those with auditory, visual, motor, or emotional deprivations and deficits (Mehri Rahmani & Rahmani, 2014). Under this, circumstances such as economic and environmental factors are also not considered reason to be learning disabled. Because of the lack of recognition of these disorders—and the still ever-growing awareness and presence of them—there was a way to create their own description and title for each disability. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is a series of manuals for all acknowledged mental illness according to the American Psychiatric Association. The DSM IV states several very similar disorders that can hold these uncharacterized and unlabeled disorders. For example, there is a reading disorder, a mathematics disorder, and even an impairment of spatial function. Now it is possible for all people to experience the care and help they need in order to thrive and achieve personal and societal greatness. Due of the extreme variety of each of these disabilities, Down Syndrome and Autism Spectrum Disorder are the main topics in this essay.  

            Down Syndrome is a genetic disorder in which the body creates an extra or partial extra of Chromosome 21. In each cell in our bodies, genes are passed on from each parent. Generally, a person inherits half of their genes from their first parent and half from the other. Because of the extra chromosome in those with Down Syndrome, the extra genetic material alters the careful and precise development that a human goes through during their lifetime from the womb until death. There are physical and mental deficiencies that need life-long assistance and managing after a diagnosis of Down Syndrome. Some of these deficiencies include that of planning skills, language skills, cognitive functioning, and general learning impairment. Originally, and for many following years, there was a stigma and a correlation between defining Down Syndrome and using mental retardation. Mental retardation is an intellectual disability, following slightly similar, but mainly distinctly different conditions. Comparing these differences and avoiding merging two disabilities that are not the same, the use of mental retardation is used much less, and the term Down Syndrome does not associate with using mental retardation as any sort of descriptive term.

            The cause of Down Syndrome is still not specified; therefore, the disability is unpredictable and can happen at any point of conception (National Down Syndrome Society, n.d.). Due to the extremely unique and individual form of mutation that occurs in those with Down Syndrome, there has been heavy research, and awareness has been spread thoroughly throughout the world. According to the National Down Syndrome Society, there are two types of Down Syndrome: Trisomy 21 (Nondisjunction) and Mosaicism. Trisomy 21—which is 95% of the cases of Down Syndrome—involves a third chromosome instead of the usually two. When this occurs prior to or at conception, “a pair of 21st chromosomes in either the sperm or the egg fails to separate” (National Down Syndrome Society, n.d.). Then, once the embryo begins developing into a fetus, the chromosome is duplicated into every cell in their body. Mosaicism, the second form of Down Syndrome, involves a mixture of chromosome count. Some cells contain the “normal” 46 count of chromosomes, while some contain the Down Syndrome amount of 47, with the duplicate of chromosome 21 being the extra. This form of Down Syndrome is the least common, with only about 1% being diagnosed (National Down Syndrome Society, n.d.). These life long diagnoses involve care daily and constant monitoring to keep the health of the person at their fullest. Down Syndrome, although also being a learning disability, differs heavily from Autism Spectrum Disorder, yet their level of care can equal often. Using the same therapy methods can be beneficial for both learning disabilities, with the research and data proving to be more efficient and clearer.

            Autism Spectrum Disorder, informally known as just Autism, is a learning disability that consists of social challenges, repetitive behaviors, and speech and nonverbal communication. The challenges that follow some with Autism can range from learning deficits, differences in ways of thinking, and can show that they are either extremely intelligent or extremely challenged. There are also usually sensory sensitivities and medical issues. Some experience gastrointestinal issues, seizures, sleep disorders, as well as anxiety or depression and attention issues. “According to the Centers for Disease Control, autism affects an estimated 1 in 59 children in the United States today,” (Autism Speaks, n.d.). Influenced by genetic and environmental factors, Autism is known to have many subtypes. These challenges can cause minor changes and adjustment to everyday life, or can require lifelong interventions and assistance, or anything in between.

ASD is considered an “umbrella term.” This learning disability is so broad, that it is said that children with Autism are compared to snowflakes, being extremely unique in symptoms and signs. As Dr. Stephen Shore said, ‘If you’ve met one person with Autism, you’ve met one person with Autism.” This being said, someone diagnosed with Autism find themselves on what is called the Autism Spectrum.

There are several different forms of ASD which have been approved and organized by the American Psychiatric Association under this spectrum: Asperger Syndrome, autistic disorder or classic autism, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) (Autism Speaks, n.d.). By ages 2 or 3 years old, the signs of Autism begin to be prevalent. When this is the case, Early Intervention begins. This is best used when the child is younger, as their brains are still growing, and learning is optimal, especially social learning.  “Research shows that early intervention leads to positive outcomes later in life for people with autism,” (Autism Speaks, n.d.). Without these researches and studies, the therapeutic help for those with Autism would never be found, and those with any learning disability would have trouble communicating efficiently when in a time of stress.

Research has been only very recent regarding Art Therapy’s influence on those with learning disabilities, and in overall stress reduction in anyone. In a way, it was only recently that Art Therapy was considered officially influential and effective due to the lack of evidence and data. “For some people, art therapy may provide more profound and long-lasting healing than more standard forms of treatment, perhaps because it can provide an alternative means of expression and release from trauma,” (Evans & Dubowski, 2001).

            According to the World Health Organization in 2018, stress is the most profound health risk. Not to mention, “stress and other psychological health problems have an effect on the mortality risk of otherwise healthy individuals,” (Martin, et al., 2018). Polls of people from Germany showed that about 23% of people describe themselves as being extremely stressed (Martin, et al., 2018). According to the study in 2018, the Lazarus model of stress and coping was the most well-known model to date on stress. In his method, stress is considered that of the outcome of people’s actions in life. This is also a form of “appraisal of his or her environment,” (Martin, et al., 2018). When a person comes upon a challenging or different situation, they then experience stress. This is known as primary appraisal, according to Lazarus. Then, the person is supposed to understand that their coping abilities are inefficient (secondary appraisal), and therefore need to perform a new form of stress management.

             An article in 2018 showed increases in benefit and stress reduction in people from 1980 to 2016. In this study, only peer-reviewed articles were used, and the studies were very specific (Martin, et al., 2018). It began with 243 studies, and each were narrowed down to more specific needs and outcomes. In the end, 11 studies were used for the Art Therapy research in this article, all with a total of 465 participants. Each of these studies used a specific method, known as the PICOS principle: patient, intervention, control, outcome, study design). “Stress was assessed with various different instruments, such as the Stress Adjective Checklist, the State-Trait Anxiety Inventory, The Global Measure of Perceived Stress, or the Perceived Stress Questionnaire,” (Martin, et al., 2018). Because everyone is affected by stress, there were both adults and minors used in the study. There were 11 studies that found themselves less stressed significantly after their session. Three studies also showed significant positive mood changes, with two studies found no change in mood after the study, and two studies said that their mood changed depending entirely on the content of the intervention.

In a study done in 2001, randomized patients diagnosed with non-psychotic mental illnesses were observed and recorded to see just how well Art Therapy might work. The non-psychotic mental illnesses were assumed to be those that are like anxiety, depression, phobias, etc. These illnesses are considered nonviolent, and common. While trying to discern between what was going to be a positive result or not, the observers found that the use of Art Therapy or Art Therapy methods showed some improvement and little improvement in each study (Evans & Dubowski, 2001). This, despite being a small benefit, is considered a benefit in general and helps more than it hurts.

Another study in 2014 was based on the effects of Art Therapy on children with learning disabilities. “Luminous, Blumenthal and Lewis in 2007 found that preschool programs for artistic themes include: figure painting, sculpture, design could increase creativity and emotional growth of children,” (Mehri Rahmani & Rahmani, 2014). From this finding, the study that was conducted on 30 children showed no change in the flexibility and fluidity of the students’ work. The expansion and initiative in students, however, showed a significant change. When coming to this conclusion, the observers noticed that if the children applied color to their work that is different from their natural reality, they show and increase in creativity (Mehri Rahmani & Rahmani, 2014). The study used three activities during its duration: drawing images, completing images, and duplicating images. This study was done in 30-minute sessions, over a period of 45 days. Because of this extensive and lengthy time frame, the information contains fewer errors.

The National Institute for Health and Care Excellence (NICE) recommends cognitive-behavioral therapy for those with nonviolent and non-psychotic mental health disorders. Art Therapy is recommended for those with schizophrenia only, according to the 2001 study. “However, for some people, art therapies may provide an approach to psychological therapy with which they find it easier to engage,” (Evans & Dubowski, 2001). Those who have trouble communicating verbally are also recommended for Art Therapies and Expressive Arts. This can be considered to be those on the Autism Spectrum and Down Syndrome. Also, Expressive Therapies are important in releasing and coping with stress. According to this study, “…there is a small body of evidence to support the claim that art therapy is effective in treating a variety of symptoms and disorders in patients of different ages,” (Evans & Dubowski, 2001). Unfortunately, there is not a more current and in-depth research method and full review of this subject, so some of this information could be out of date or slightly inaccurate.

            When considering all of the results of these few studies, it is clear that there is a significant difference in those who are given the opportunity to use Art Therapy and benefit from it. The struggles in life can cause people to become horribly stressed, causing bodily danger and immune deficiency with chronic stressors. These stresses of everyday life can be even worse on those who have learning disabilities. Learning disabilities effect so many children worldwide, and stress from needing extra help can lead to other complications, and a lesser quality of life. Some people can find their own healthy outlets to relieving stress, but many people still struggle with coping with stress. For those with Autism Spectrum Disorder or Down Syndrome, life is harder and more complex, leading to trouble coping with the stresses of everyday life and academics. Those who discovered Expressive Therapies have given those a chance to have a freeing and flexible outlet to help them cope with their stresses that are more difficult to communicate verbally. While research and reliable data is still hard to find, the newness and growing want for Art Therapy as a helpful and efficient form of therapy is enough for researchers to spend time on studies and attempt to begin a usable evidence-based benefit. The three studies depicted are just the beginning of a long line of studies, proving not only that Art Therapy is extremely helpful, but that it can be a primary use of therapy for those who find talk therapy to be less efficient.

Bibliography

Autism Speaks. (n.d.). What is Autism? Retrieved from Autism Speaks: https://www.autismspeaks.org/what-autism

Evans, K., & Dubowski, J. (2001). Art Therapy with Children on the Autistic Spectrum : Beyond Words. London: Jessica Kingsley Publishers.

Good Therapy. (2016, April 4). Art Therapy. Retrieved from Art Therapy: https://www.goodtherapy.org/learn-about-therapy/types/art-therapy

Martin, L., Oepen, R., Bauer, K., Nottensteiner, A., Mergheim, K., Gruber, H., & Koch, S. C. (2018). Creative Arts Interventions for Stress Management and Prevention—A Systematic Review. Basel, Switzerland: Electronically Published.

Mehri Rahmani, & Rahmani, A. (2014). The Effectiveness of Art Therapy in Promotion of Creativity in Children. Iranian Journal of Cognition and Education, 1-5.

National Down Syndrome Society. (n.d.). Down Syndrome. Retrieved from NDSS: https://www.ndss.org/about-down-syndrome/down-syndrome/

The American Institute of Stress. (2018). What is Stress? Electronically Published.

Tsai, M.-C. (2015). Art Therapy Interventions for Individuals with Down Syndrome. Herron School of Art and Design.

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