(PDF) Effect of Visual Therapy on Expressive Art Performance of Autistic Children in Yaba Local Council Development Area in Lagos State

LITERATURE REVIEW

Conceptual review

Autism

Autism is a complex developmental disorder that causes impairments in social interaction and developmental language and communication skills combined with rigid, repetitive behaviors. An autistic child who is very sensitive may be greatly troubled sometimes even pained by lights, sounds, touches, smells, or sights that seem normal to others. Many people with autism are cognitively impaired to some degree. In contrast to more typical cognitive impairment, which is characterized by relatively even delays in all areas of development, people with autism show uneven skill development. Autism is four times more common in boys than in girls. Autism typically appears during the first three years of life. It knows no racial, ethnic, or social boundaries. Family income, lifestyle, or educational levels do not affect a child’s chance of being autistic (Aadil, 2014).

Symptoms of autistic disorder fall under three domains: social relatedness, communication, and behaviors and interests, with delays or abnormal functioning in at least one of these areas prior to age 3 years. To meet criteria for autistic disorder, an individual must demonstrate at least 6 of 12 symptoms, with at least 2 coming from the social domain and 1 each from the communication and restricted behaviors/interests categories (Ozonoff, et al., 2005).

Visual Arts

Visual art are forms of art that with the aim of presenting diverse concept and complex emotion as documented by the artist. This in turn is communicated to the audience through representation media. These are any works of art that appeals to our sense of vision which include drawing, painting, sculpture, textile design, graphics design, industrial design and ceramics. (Quadri, 2012)

Wangboje (1990) defines Art as a process as well as a product. He explains that art as a process is a means through which we give sensual and concrete expression to our ideas and feelings about the world around us. According to him art as a product includes pictures, images, buildings, clothes, furniture, utensils, music, dance, drama, food, etc.

Hornby (2001) defines Art as the use of imagination to express ideas or feelings particularly in painting, Drawing or Sculpture. While Elsen (1981) sees art as a skillful and imaginative process of expression that historically has led to the creation of objects capable of producing an aesthetic response.

Read (1966) his impression of what art is and what art cannot stand for depends on whether or not it is expressive. The man who makes, becomes potentially or partially an artist, the moment the things he makes express feelings and invite responses. Read (1972) also explains that Benedetto Croce defines art as an “expression”.

Conceptual meaning of visual art therapy

Visual Art Therapy is an effective, versatile treatment modality that addresses a list of complex issues such as Abuse, Adolescence, Bullying, Death & Bereavement, Disasters, Homelessness, Illness, Lifestyle Choices, Sexual Abuse, Terrorism, and Violent Crime Psychologically, art therapy is the use of artistic methods to treat psychological disorders and enhance mental health. Art therapy integrates psychotherapeutic techniques with the creative process to improve mental health and well-being. (Martin, 2009). It is also referred to as “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, foster self-awareness, manage behaviour and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem and achieve insight.” Art therapy practice requires knowledge of visual art (drawing, painting, sculpture, and other art forms) and the creative process, as well as of human development, psychological, and counseling theories and techniques. A goal in art therapy is to improve or restore a client’s functioning and his or her sense of personal well-being. (Betts, 2005).

Today Visual art therapy is widely practiced in diverse settings including hospitals, psychiatric and rehabilitation facilities, wellness centers, forensic institutions, schools, crisis centers, private practice, and other clinical and community settings. During individual and/or group sessions art therapists elicit their clients’ inherent capacity for art making.

The causes of Autism

Scientists aren‘t certain about what causes ASD, but it‘s likely that both genetics and environment play a role. Studies of people with ASD have found irregularities in several

regions of the brain. Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that ASD could result from the disruption of normal brain development early in fatal development caused by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function. While these findings are intriguing, they are preliminary and require further study (Pottie, 2008).

Economic Effects

According to a study in 2005 the expenses for autistic children was more than triple that of a child without it, and for those children that also had a co-occurring condition the costs were even higher. The larger portion of the expense is incurred during adulthood (Sonya & Jessica, 2012).

Costs associated with having a child with autism are not, only, limited to the cost of interventions. Like any other forms of childhood disability, parents of a child with autism often face greater outlays of time and money than they would for a neurologically typical child (Aadil ,et al., 2014).

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In a few cases, fathers acknowledged that their child‘s autism might have encouraged a great commitment to work. In addition, many mothers who worked were often forced to miss work. They performed below average and some eventually worked part-time or ultimately left the workplace altogether (Sonya & Jessica, 2012).

Psychosocial Effects

Research into families under stress has demonstrated a link between relationship breakdown and poor physical and mental health. The evidence points ultimately therefore to a significant cost to the state in the stress placed on individual careers, and the consequent breakdown in health and family relationships (Fiona, 2001).

Other important factors associated with parental stress in families of children with autism, include, feelings of loss of personal control, absence of spousal support, informal and professional support (Aadil,.et al., 2014).

Parents of children with disabilities experience more marital stress and discord than parents with normal children. Families with autistic children face many stressors and challenges, today‘s partnership in marriage is more challenging and more difficult than in the past years; especially couples with special needs children (AlHorany, 2013).

Mothers of autistic children have higher parenting-related stress and psychological distress as compared to controls. Outwardly, it might appear as if the psychological stressors exerted specific effects resulting in mental ill-health attributable these stressors (Abdullahi& Samira, 2013).

Positive attitude, social support and faith in God, helped mothers generate psychic energy to cope with the physical, emotional, and financial aspects of care giving and Interventions focused on parents ‘coping skills have reported positive results (Ashum&Nidhi, 2005).

Siblings of children with autism are significantly more likely to experience depression than the general population. Along with psychological problems, exhaustion may affect siblings who may be responsible for domestic tasks and physical care (Ashum&Nidhi, 2005).

Fear of discrimination and the stigmas surrounding disabilities lead many families to refuse to go to professionals and receive a diagnosis for their children (Aadil.et al., 2014).

Theories on Autism

Refrigerator Parenting Hypothesis (RPH)

Kanner (1943) had originally suggested that autism was partly the result of cold‘, unemotional parenting, specifically by the mother. However, the prevailing current view is that parent‘s behavior doesn‘t initiate or in any way provoke autism (Powell, 1999). Indeed, any difference in parents‘ behavior towards their autistic child is more likely to be caused by the autism than vice versa (Powell, 1999). Also, autism seems to strike indiscriminately. It is not respecter of social class or family environment: it can affect a child with extremely warm and loving parents (Mitchell, 1997).

Genetic Theories (GT)

Kanner suggested that autism has a genetic component. According to (Rutter, Andersen‐ Wood, Beckett, Bredenkamp, Castle, Groothues, Kreppner, Keaveney, Lord, & O’Connor, 1999) finding from several independent studies provided compelling evidence for a strong genetic component underlying autism (Richard 2010). If one member of a twin pair is autistic, the probability that the other will also be autistic depends to a significant degree on whether they share all their genes or only half their genes (the same as ordinary siblings). Rutter et al (1999) autism is the most strongly genetically influenced of all multi factorial child psychiatric disorder.

Theories of Mind (TOM) and Mind-Blindness

The most influential theory of autism in recent years maintains that what all autistic people have in common (the core deficit) is mind- blindness (Boron-Coher, 1993). A sever impairment in their understanding of mental states and in their appreciation of how mental states govern behavior. Autistic individuals fail to develop the ability to attribute mental states to other people and this has fundamental implications for communication, where making sense of others‘ intentions enables the listener to understand what‘s being said (Baron-Cohen, 1993). The strongest evidence for autistic children‘s lack of a theory of mind (ToM) and mind-blindness is their consistent failure on false belief tasks by comparison; Down syndrome normal children reliably pass them. Autism individuals may become distressed by changes in their immediate ritualized behaviors: they don‘t plan to anticipate the consequence of their actions. Executive function deficit is not a sufficient explanation of the specific nature of autism (Lewis, 2003).

Empathizing Systemizing (E-S) Theory

The theory was developed by, Baron and Cohen (1993). According to the E-S theory, Female brain is hard-wired for empathy (E-type), while male brains are hard-wired for constricting system (S-type). These differences are reflected in male /female difference from birth until the adult skills and occupations, according to which the autistic individuals have an extreme male brain.

Implementing Visual Art therapy and challenges

In today’s world, majority of children spend more than half of their day in the school environment (Lasry, 2010). Based on this statistic, the school environment presents itself as ideal for implementing therapeutic interventions for children. As the simplistic painting and colouring materials required for art therapy are easily accessible, it can easily be assumed that integrating such a program into the school schedule entails little restructuring and planning. However, a large number of educators included in the reviewed literature experience a variety of challenges including financial impediments, busy schedules and public pressure from family members and school boards (Campbell & Townshend, n.d.; Lasry, 2010, Jordan & Dicicco, 2012).

Within the Ontario curriculum, art appears alongside three other mandatory components of programming for students in grades 1 through 9, indicating its importance within educational environment (Campbell & Townshend, n.d.). Unfortunately, although art programs exist within the large majority of schools; reports of the program’s duration is found to be inconsistent as some schools engage in strong creative art programs, while other institutions devote approximately less than 25% of their time and resources to creative arts (Campbell & Townshend, n.d.). School boards have reported experiencing struggle due to challenging programming and budgeting decisions such as eliminating arts programs and cutting budgets for creative materials, which have ultimately derived from financial impediments (Campbell & Townshend, n.d.).

While institutions experience financial crises, educators are faced with demanding school schedules in which they are expected to arrange and customise to fit the needs of their students and occupational expectations like meetings. Although visual art interventions are found to be effective for all students in the classroom environment, art programming is only required to be conducted on a weekly basis; therefore, it comes as no surprise that educational institutions have reported to lack art programming within the curriculum due to busy agendas (Lasry, 2010).

Although research supports the integration of art therapy within the school system, it also suggests that consistency is necessary and requires ongoing assessment and monitoring when implementing art therapy as it eventually becomes a routine process creating seamless transitions between subjects (Lasry, Stanovich & Perpt). However, based on alternative research that supports teacher’s demanding schedules, educators who strive to integrate art therapy within the classroom environment may feel pressured to create this consistency from time constraints and expectations from curriculum standpoints (2010).

“Children’s eagerness to produce marks seems to be innate” Evans (2016) claims however, as children are often observed running their fingers over a steamed pane of glass, using branches to form lines in sand, and will most likely produce drawings if paper and crayons are made available (2016, p. 19). Evans (2016) clearly indicates that although instructors may face demanding agendas, alternative approaches exist to implement the creative and therapeutic techniques of visual art especially if children innately hold such creative expressions. While pressures from daily agendas exist, as do pressures from external forces like family members, principals, and school boards as important decisions surrounding the arts curriculum are made

“locally, board by board, and often school by school” (Campbell & Townshend, n.d., p. 4). Family members hold a large percentage of external stress as approximately 72% of Canadians feel as though exposing children to the arts is important and necessary (Campbell & Townshend, n.d.). However, current and ongoing changes within the school curriculum, from principals and board members, create senses of urgency and confusion for both teachers and family members as art currently stands as a mandatory component in the school curriculum, while families obtain varying opinions and values regarding visual art that range from those who strongly support the visual arts to those who consider it to be frivolous in nature (Campbell, Townshend, n.d.; Ju, 2014).

Buttignol (1998) rises similar opinions within her research but found instead that teacher’s viewed art as frivolous as they explained that the nature of the classroom becomes disruptive and embodies opposing ideals or schemas in regards to the classroom environment. Although one may imagine a simplistic integration of art curriculum and art therapy in school systems; it is clear that educators would face a number of pressures deriving from possible financial issues, demanding schedules, and expectations held by principals, and family members.

Effects of Art Therapy on Autism

As both terms have already been appropriately identified, it is here where connections can be made between the convenient nonverbal processes of art therapy and how research has described its effects on children who fall within the spectrum of autism. The visual processing that takes place in the minds of children with autism spectrum disorder ultimately aids the processes of art therapy, as it is similarly visual and imaginative in nature (Evans, 1998, Pacheco, 2013). Art therapy allows children with ASD to utilise social, communication, and language skills, through the oral dialogue that occasionally takes place, preparing them to communicate effectively with their external environment (Evans, 1998). This bidirectional interaction only takes place when a level of comfort with all elements of the therapeutic process has been established as these elements become factors in the success of the treatment due to sensitivities, therefore; the environment, materials, and instructors are involved in fostering cognitive and meaningful communication amongst children with ASD (Evans, 1998).

Due to its versatility, art therapy can be recreated within settings external to a therapists office, such as classrooms for example, where art therapy can intentionally take place, through children’s art work, ultimately allowing teachers to further engage students requiring therapeutic interventions, or taking advanced actions in critical scenarios (Lasry, 2010). Being reported as one of the best methods for children with autism, these visual art processes have the ability to develop patience aside from improving communication skills as the focus relies on manipulating artistic elements instead of engaging in constant interpersonal interactions (Lasry, 2010 & Evans, 1998). This alternative approach, although sometimes lacking verbal communication, still creates dynamic interaction through a less intimidating approach for children with autism. Furthermore, this interaction, ultimately allow these individuals to appropriately discharge emotions or aggression enabling self-regulation (Pacheco, 2013 & Lasry, 2010). Visual arts also allow these exceptional students to produce work that contains deep meaning and reflecting, being elements in which may not be represented through written work or oral discussion (Lasry, 2010).

Discovering these connections through the visual, concrete, and playful nature of art, all children obtain the ability to develop a sense of self and resilience to effectively work through present difficulties (Ju, 2014, Pacheco, 1998 & Lasry, 2010; Case & Dalley, 2014). These connections however, are not formed solely from the manipulation of creative materials, but are formed through the oral conversation that can occurs during the creative experience as well.

Individuals have the opportunity to process rationales behind their creative piece and simultaneously express their emotions verbally (Evans, 1998). If a child has not yet acquired this ability to make sense of exterior anxiety through dialogue, the visual art process of art therapy can act as a substitute as it has been found to calm the inner chaos that exists in children with anxiety and ASD (Curry & Kasser, 2005).

Over 9 in 10 individuals shared such observation of children who had engaged in the visual arts within their school system indicating that creativity and imagination improve, self- efficacy increases, and that writing and speaking skills enhance as well (Campbell & Townshend, n.d.). These findings are especially useful for educators and parents of children with ASD as these children who fall within the spectrum of autism often experience a wide range of social complexities (Evans, 1998). Depending on the severity and of the neurological complexity of the child however, art therapy may not be as effective as it has been claimed (Mirabella, 2015). Outcomes are only experienced when the function of the brain is in a healthy state, indicating that because art therapy acquires the ability to access information and requires some form of communication, if cognitive operations of the brain have been severely compromised, reaping any form of benefit from art therapy will be nearly impossible (Mirabella, 2015).

In other settings, children with autism were observed engaging in visual art and among those who displayed little to no interest in the art work had later failed to recognise their own pieces of work, nor did they obtain the intention to see it again when asked (Evans, 1998). These observations raised several questions between researchers regarding whether or not children with autism are producing and or engaging in beneficial ‘artwork’ if the intention to communicate experiences cannot be fully managed (Mirabella, 2015). Unfortunately researchers concluded that additional testing is required for art therapy as its benefits have not been fully assessed (Mirabella, 2015). Regarding the purpose of this research, it is important that these findings are taken into account as there is a potential that, through further conduction of art therapy for children with autism, products may not be acceptable evidence to indicate underlying issues or emotional connections.

In this case, implementing art therapy into the classroom would serve educators, and children with autism, little to no purpose as true connections between self and world and emotional development would fail to take place ultimately challenging the purpose of this method. More research regarding the outcomes of art therapy may need to be evaluated, however, intentionally implementing art as a form of therapy in the classroom has evidently been proven to be effective for all children of developmental and neurological abilities.

Empirical Review

Historical Development of Autism

Autism was first described by Leo Kanner in 1943 based on the case histories and observation of children who showed a similar pattern of behaviors including language delay, social remoteness, excellent rote memory, obsessive to sameness, oversensitivity to stimuli and delayed echolalia. At that time, the term autism was used to describe early infantile autism or infantile autism. In 1944, Hans Asperger independently described a syndrome which is now known as Asperger Syndrome (AS). The descriptions of Kanner and Asperger shared a similarity in some autistic characteristics such as poor eye contact, stereotyped language and physical movements, resistance to change and narrowed special interests. The important value of the identification of AS was the recognition that autistic-like syndromes can arise in individuals of normal language and cognitive development but who have often shown subtler abnormalities in communication patterns. With the development of research and clinical practice, more behavioral symptoms were described and categorized as autistic characteristics (Hens and Van Goidsenhoven 2017).

Prevalence of ASD

Recent reviews estimate a global median prevalence of 62/10 000, that is one child in 160 has an autism spectrum disorder and subsequent disability. In Europe, the median rate is 61.9/10,000 (range 30.0–116.1/10,000) and in America, the median rate is 65.5/10 000 (range 34–90/10 000). Autism spectrum disorders account for 0.3% of all disability adjusted life years. Autism spectrum disorders impose a huge emotional and economic burden on families (WHO, 2013).

Although most studies on ASD prevalence reflect the estimates for developed countries, little is known about the ASD /PDD prevalence in low income countries. However, the estimates suggest that it is less that or as high as in developed countries (Nyoni and Serpell, 2014).

Although prevalence studies reflect the prevalence of developed countries and the global rate is adopted for developing countries, chronic problems related to reproductive health, prevalence of diseases like malaria, poverty and food security are assumed to contribute for increased prevalence of ASD and PDD in Nigeria and other low income countries (Elizabeth et al., 2003).

Studies conducted by different researchers at different region revealed that, the prevalence of all forms of autism combined is estimated to be 1 in 162 individuals (Elsabbagh et al., 2012). Taking the global median estimate, Autism Spectrum Disorder ASD=17/10000 and Pervasive Developmental Disorders (PDD) 62/10000. 5000 and 18500 children and parents/care givers are estimated to suffer from having children with ASD and PDD (Elsabbagh et al., 2012).

If one in every 115 children is diagnosed with autism in the United States, we should fairly be able to say that with Nigeria‘s population of more than 80 million, we can estimate that there are at least 530,000 children suffering from autism and related developmental disorders in the country (Nyoni and Serpell, 2014).

Despite the above estimated number of children suffering from ASD and other PDD syndromes, the prevailing lack of prevalence study and diagnostic capacity/setup implies the pervasive lack of attention and awareness. There is lack of awareness among the community and parents about ASD. Usually when parents found out that their child has some kind of mental development problem, even without being diagnosed, they consider him/her as useless. Children with ASD are often denied any rights whatsoever, even the right to see daylight, enjoy sunshine, or the right to in some way participate in society. Such disorders are sometimes even seen as “punishment for some spiritual wrongdoing or a tragic incidence‖ (Autism in Nigeria, 2014).

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Content Structure of Effect of Visual Therapy on Expressive Art Performance of Autistic Children in Yaba Local Council Development Area in Lagos State

The abstract contains the research problem, the objectives, methodology, results, and recommendations
Chapter one of this thesis or project materials contains the background to the study, the research problem, the research questions, research objectives, research hypotheses, significance of the study, the scope of the study, organization of the study, and the operational definition of terms.
Chapter two contains relevant literature on the issue under investigation. The chapter is divided into five parts which are the conceptual review, theoretical review, empirical review, conceptual framework, and gaps in research
Chapter three contains the research design, study area, population, sample size and sampling technique, validity, reliability, source of data, operationalization of variables, research models, and data analysis method
Chapter four contains the data analysis and the discussion of the findings
Chapter five contains the summary of findings, conclusions, recommendations, contributions to knowledge, and recommendations for further studies.
References: The references are in APA
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