This presentation describes how the theoretical framework of DIR (Developmental, Individual, Relationship)is a natural partnership with creative Art Therapy

1. Integrating Art Therapy and the DIR/Floortime Model For Children with Autism Spectrum Disorders Pamela Ullmann, ATR-BC, LCAT, CCLS

2. Presentation Outline Overview of Autism Spectrum Disorder Strategies of Working with ASD Description of the DIR/ Floortime Model Dr. Greenspan Videos Art Therapy with ASD/DIR Approach Case Study of Child with ASD Autism Awareness Puzzle Piece Art Project

3. Autism Spectrum Disorder Childhood Disintegrative Disorder Rett's Disorder Autistic Disorder Pervasive Developmental Disorder (PDD) Asperger’s Syndrome A person with ASD is a person diagnosed with one of these five disorders. The disorders within this “spectrum” are often ordered from low functioning to high functioning. (1 lowest- 5 highest)

4. Strengths and Weaknesses Strengths Weaknesses Auditory memory Visual memory Memory for routines Stimulus over-selectivity Attending to irrelevant stimuli Failure to generalize Impaired language & imitation skills Issues with attention/focus Crave routine and sameness Sensory and behavioral issues Cannot process visual and auditory information simultaneously

5. Misreading Behaviors Observed Behavior What may be happening

6. What “communication” may look like Primitive to more sophisticated: Tantrums Vague gestures Motoric Objects Pictures or PECS* Specific gestures or signs Written words Expressive verbal language *Picture Exchange Communication Symbols

7. Things to keep in mind…….. Not too many tasks at once Keep it simple Even with good cognitive skills! State positively Concrete/operationally defined Teach/practice the skills/ repetition Confirm directions by asking child to repeat back

8. What is DIR/ Floortime? The Interdisciplinary Council on Developmental and Learning Disorders

9. Dr. Greenspan Video

10. DIR/ Floortime Overview Developed by Dr. Stanley Greenspan Developmental ( 6 developmental milestones that every child must master for healthy emotional and intellectual growth) Individual Differences Relationship Based Floortime™ is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities.

11. DIR Comprehensive Framework Tailored to the child’s unique challenges & strengths Problem-solving exercises Emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child Affect based interactions to the child’s individual differences and developmental capacities

12. 6 Developmental Stages Stage 1: Self-regulation and interest in the world Stage 2: Intimacy, engagement, & falling in love Stage 3: Two-way communication Stage 4: Complex communication Stage 5: Emotional ideas Stage 6: Emotional & logical thinking

13. Individual DifferencesChildren with special needs have a variety of biological challenges that affect their ability to function in the world Difficulty with sensory reactivity Processing difficulty Difficulty with motor planning and sequencing Each type of challenge makes it difficult for the child to relate to and communicate with his parents and caregivers and thus impedes his ability to learn, to respond, and to grow.

14. Relationship Based Learning relationships with caregivers, educators, therapists, peers, and others Strong relationships help foster learning opportunities for child’s individual differences and developmental capacities Ultimately enables progress in mastering the essential foundations

15. Floortime Technique Follow the child’s natural emotional interests (lead) Challenge the child towards greater mastery With young children these playful interactions may occur on the “floor”, but go on to include conversations and interactions in other places

16. Circles of Communication Video Floor time with child, parent and Dr. Greenspan

17. How the DIR/Floortime Approach is a “natural” partnership with creative modalities Art Therapy and Autism

18. Focus: Behavioral Approach Sessions are more structured Goals are established Modeling of behaviors Reward systems Use of praise © 2009 Pamela Ullmann

19. Major Deficits or Difficulties in ASD Using the Creative Process to Enhance Skills and Functioning © 2009 Pamela Ullmann

20. Treatment Goals of Art Therapy Abstract Thinking (Imagination) Communication and Socialization Regulation and Integration of Sensory Help Creative Expression Developmental Progress and Growth (DIR) Recreational Skills Visual/ Spatial Deficits

21. The Art Therapy/ DIR Connection To focus on Communication, Imagination, and Socialization To address behaviors without pressure Foster strengths and abilities Adapt to child’s functioning level Allow choice for child Design groups to develop social skills & friendships Creative Expression, both 1:1 and groups © 2009 Pamela Ullmann

22. Floor Time and Art Therapy Video Emotional Expressions- Therapist models for the parent

23. Group Art Therapy with ASD Establish structure to session Have appropriate ratio for function level (trained aides or volunteers) Incorporate a theme (optional) Allow for flexibility-go with the group Make it fun and social Reinforce good behavior and model for others Use of alternative forms of communication (picture boards, schedules, or behavior charts/rules) © 2009 Pamela Ullmann

24. Individual and Dyad Art Therapy Benefits of 1:1- customize Setting goals DIR concepts in action Structure, yet allow for changes Routines, materials and methods Parent/Child Dyads

25. Case study: “Nathan” and Mom 9 years old, male Moderate to severe ASD Oral fixation ADD tendencies Limited expressive language Delayed drawing skills High functioning fine motor Sensory: tactile tolerance Prone to meltdowns Highly educated Understands therapeutic process Enjoys participating with Nathan Helps set boundaries Helps create limit setting Incorporates behavior mod Creative and expressive modeling Sensory support Nathan Mom

26. Goals of Art Therapy for Nathan Support behaviors that he is working on Introduce new creative materials Allow for choice making Encourage self expression Develop drawing skills Tie in the three areas: Communication Socialization Imagination

27. Setting up the session- comfort in routine

28. Image making with alternative materials “Wiki” sticks are waxy, colorful, and bendable allowing Nathan to explore shapes and image making without the pressure of drawing with traditional media. Also a sensory material to appeal to his tactile and fine motor strengths

29. More image making with alternative materials Combining foam building stickers and drawing media to create the “garden”. Nathan needs concrete directions to complete picture (“show me where the grass grows”)

30. Telling a story and using sensory materials Model magic used as flat, 2-D image making and having Nathan and mom create together a story about horseback riding; helping Nathan to express- needs “prompts” at times

31. Helping with transitions Nathan is starting a new school. Mom and therapist talk about “what to expect” by creating images and talking to Nathan. Nathan chooses placement colors and repeats back about scenarios.

33. Stickers

34. Model Magic

35. Markers

36. Using steps

39. Materials : Sharpie markers, assortment of letters and stickersThank you for coming today

40. References and Resources http://arttherapyandautism.com http://www.autismspeaks.org http://www.autismtoday.com http://www.icdl.com/ Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative ways. Advocate: Magazine of the Autism Society of America, 26-27. Betts, D. J. (2003). Developing a projective drawing test: Experiences with the Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art Therapy Association, 20(2), 77-82. Greenspan, S & Wieder, S (2006). Engaging Autism: using the Floortime approach to help children relate, communicate and think. PerseusBooks Henley, D. (2001). Annihilation anxiety and fantasy in the art of children with Asperger's Syndrome and others on the autistic spectrum. American Journal of Art Therapy, 39, 113-121. Kellman, J. (2001). Autism, art, and children: The stories we draw. Westport, CT: Bergin & Garvey Martin, N. (2009). Art as an early intervention tool for children with autism. London: Jessica Kingsley. Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25(1), 15-23. Miller, E. (2008). The girl who spoke through pictures: Autism through art. London: Jessica Kingsley. (Illustrations by Kim Miller)

41. Presenter's Websites and Contact Info WEBSITES www.colorsofplay.com www.healingartsfc.org INFORMATIVE BLOGS http://colorsofplay.blogspot.com http://creativefamilies.wordpress.com EMAILS: Pamela@colorsofplay.com and Pullmann@healingartsfc.org