Resilient Children and Creative Problem Solving

Resilient children are children who are adaptable despite circumstances, challenges, and traumatic events. These children are able to develop, as their peers, despite encountering adverse circumstances (p. 378-379).

Children who encounter protective factors tend to be more resilient. Protective factors are influences that decrease the effects of stress and trauma and allow a child to develop positively. Protective factors include positive relationships and positive cognitive functioning (p. 379). Perhaps due to their personality, intelligence or relationships they have encountered, resilient children are able to adapt and overcome stressful childhood experiences. Resilient children tend to have a positive connection with a parent, caregiver or with an important person in their life, such as a teacher or counselor.

A social worker friend and I came up with the word for to describe these care giving individuals, “cookie people”. People who give warmth and compassion, who model positive behaviors and give love and guidance. In our experiences we found children who did not have “cookie people” in their lives are more likely to have more severe mental health and behavioral issues, and have difficulty connecting with others (such as ODD/ CD children).


Moreover, intelligence and creative problem solving tend to allow a child to learn adaptive skills necessary for survival and development. Because these children are adaptable and intelligent, they in turn may attract “cookie people”, such as teachers or school personnel. Many of the homeless teens I worked with were resilient adolescents. They found school personnel willing to advocate for them and were likely to stay in school and graduate, despite experiencing traumatic and abusive childhoods from primary caregivers. These children found school to be a safe haven from the abuse and neglect they experienced and relied on the school to provide a consistent and encouraging environment (including the basics such as free breakfasts/lunches). Often these teens’ intelligence, coupled with their personalities, created situations where adults wanted to advocate for their interests.

Children who have had long-term trauma or abuse or multiple risk factors tend to have more difficulty adapting than children who had a single incident or only one negatively impacting risk factor.



Reference

Papalia, D. E., Olds, S. W., & Feldman, R. D. (2004). Human Development (9th ed.). Boston: McGraw Hill.

Art Therapy and Self Concept/ Self-Esteem

Parents often come to me as an art therapist asking how they can help improve their child's self-esteem. Let's look at the root of self-esteem, self- concept, and how art therapy may help.

Self-concept is a snap shot of our perceptions of who we are, our abilities and traits. Self-concept is derived from a cognitive construct of how we feel about ourselves and what actions we take as a result. It involves self-definition, characteristics that describe and support our self-concept (p. 269). As a child matures they move from single representations, a one-dimensional perspective of themselves. At age four a child may see their behaviors and emotions as “black and white”. During this concrete stage a child believes conflicting emotions cannot exist simultaneously. At this stage a child cannot differentiate their real self, the person they are vs. their ideal self, the person they desire to be (p. 270).

As a child matures between ages 5-6 they begin to develop representational mapping, connecting images and ideas about one’s self. However, they continue to use black and white concrete thinking and cannot delineate juxtaposing thoughts (p. 270).

As a child enters into middle childhood they develop representational systems, a development of self-worth via multi-dimensional concepts that incorporate conflicting thoughts about themselves.

Self-esteem is the part of our selves that evaluates our self-concept, and helps to form judgment about our self worth. Although a child cannot articulate concepts of self-worth until middle childhood, a younger child tends to rely on adults to evaluate and support their self-worth. Again, all or nothing thinking influences a child’s self-worth. They see themselves as all good or all bad, until middle childhood (p. 272-273). A child may evaluate self-esteem based on successes and failures. This externalized evaluation of self-esteem may develop into “helplessness” pattern of self-criticism and self-blame. A child’s understanding that they can change their behaviors and thoughts can help a child develop a stronger sense of self-worth. Children whom believe their attributes are fixed may suffer from low self-esteem (p. 273).


Art therapy may be helpful in developing a child's sense of competency in other ways beyond traditional therapy. It is understood that a child needs to develop a sense of self-worth, often this is done through mastery and competency. Meaning, your child delights in learning that allows them to be challenged, yet provides them opportunities to be successful. The creative process is aligned with helping children stretch themselves learning a new challenging skill that allows them to work through their frustrations, offers challenges, and opportunities for new ways of thinking and responding, and creates an outcome or a goal they are working towards. It is the challenge of using the art materials and working to learn new ways to communicate and express one's self that leads to a sense of mastery, and consequently a greater sense of self.

Papalia, D. E., Olds, S. W., & Feldman, R. D. (2004). Human Development (9th ed.). Boston: McGraw Hill.

CBT (Cognitive Behavior Therapy) and Art Therapy for Depression

If you are suffering from depression there has been a tremendous amount of research that suggests that Cognitive Behavior Therapy (CBT) is an effective form of treatment. The recent research on positive psychology that suggests it may be complementary to CBT interventions as it relates to depression. Moreover, how can we use art therapy to reinforce these theories and interventions?

Garratt, Ilardi, and Karwoski (2006) offer a compelling article on the integration of cognitive behavioral and positive psychology for the treatment of depression. The authors present the two primary goals of cognitive behavioral therapy, modifying dysfunctional thoughts and creating long-term cognitive skills to reduce relapse. The meteoric popularity of CBT as a treatment modality arose with Beck’s research of CBT and depression. However, studies suggest that long-term recovery is sustained in less than half of the clients who receive CBT for treatment of depression. It is the implication of long term success with clients that leads the authors to explore the principles of positive psychology as it relates to cognitive behavioral therapy.

The article suggests the conceptual overlap between CBT interventions and positive psychology approach, including a strong therapeutic alliance, focus on distinct goals, here-and-now focus, cognitive reappraisal, and client collaboration. Moreover, the authors suggest there is an overlap in techniques that are congruent in both CBT and positive psychology. Both encourage pleasant activities scheduling, identifying and reviewing success experiences, mood monitoring, relaxation training, and problem-solving. The authors suggest that positive psychology can provide CBT with the opportunities to move beyond removing negative affect, consequently moving the client towards positive affect, influencing quality of life. The positive psychology constructs that could blend with CBT to reduce depression and enhance over all well-being include: capitalizing on strengths, instilling hope, flow (being absorbed in the moment while engaged in an activity), mindfulness (being fully present), addressing unsolvable problems, optimism training, meaning, physical exercise, and humor.


The aforementioned interventions blend well with art therapy. Using art the art therapist can capitalize on the inherent creative strengths of the individual. Creating a picture of what the individual can imagine as a possible positive outcome can instill a sense of hope and provide a tangible road map to achieve their goals. Flow and mindfulness occurs when the individual is fully present in the creative process and is often accomplished in an art therapy session. The art making process can be used to explore choices for problems that appear unsolvable, and create meaning and purpose for the individual. Therefore, art therapy offers a bridge to CBT and positive psychology by the process of using therapeutic art interventions that reinforce the tenants of these two theories.

Reference

Garratt, G.M., Ilardi, S.S., & Karwoski, L. (2006) On the integration of cognitive- behavioral therapy for depression and positive psychology. The Journal of Cognitive Psychotherapy, 20,159-170.

Autism and Asperger's Syndrome and Creativity

An historical overview suggests an initial case of autism was identified in 1747, marked by the symptoms similar to what is diagnosed as autism spectrum disorder today, abnormality or language and cognition, obsessive behavior and mannerism, poor social skills (Wolff 2004). It was over the last 100 years that autistic mannerism was identified and not until the 1900’s was the distinct diagnosis for autism made. Interesting “Victor the wild boy of Aveyron” was viewed as having autistic behavior. However, in the 1900’s autistic behaviors were classified with mental retardation and psychosis. Kanner became aware of the divergence of symptoms of autistic children from children diagnosed with psychosis. However, during this period in history children were often treated with psychoanalysis and parents were deemed the root of etiology. In 1981 Wing developed the diagnosis of Asperger’s and autistic spectrum disorders (ASD). Throughout the years the conviction of what causes autism has changed. It is not longer believed that poor parenting leads to autism or that autism is among the group of schizophrenias, or that genetics or the MMR vaccine may be the cause. Because the number of children being diagnosed with autism has jumped 10 times over the last 20 years, public awareness has increased; consequently treatments, however controversial, have been on the rise (Ulick 2005). One in 166 children are diagnosed with autism and boys are diagnosed 4 times more than girls.


Macintosh & Dissanayake (2004) explored the distinction between high functioning autism and Asperger’s syndrome by an exhaustive literature review. This review was complied to help in the diagnosis and differentiation of the two disorders. It is interesting to note that despite the prevalent usage of the term Asperger’s Syndrome, the DSM has only recently included Asperger’s as a discrete category in its classification. The similarities between the two disorders include impairment of socialization, imagination and communication. The authors attempt to find differentiations of the two diagnoses to aid in assessment and individualized treatment. Despite the extensive research review, the authors’ find little quantifiable differences that would separate Asperger’s from the autistic spectrum disorder. A noteworthy theory proposes that language development of children with Asperger’s allows for more functional development of secondary gains, such as social skills development, where as autism may limit language development and consequently impact social and perceived cognitive development.

Ulick (2005) offers definitions and treatment recommendations for ASD. Individuals with autism present more severe language problems, limited interest in others, repetitive behaviors, resistance to change, and irrational routines. Individuals with Asperger's are stated to have stronger verbal skills, but experience difficulty with reading social situations, and sharing enjoyment, and tend to have obsessive interests. Ulick (2005) describes PDD-NOS: Known as 'atypical autism,’ whereby individuals have less severe social impairments. In addition, Childhood Disintegrative Disorder (CDD) occurs after 2 to 4 years of normal growth, then autism like symptoms develop. Rett Syndrome: is akin to CDD, but symptoms occur earlier and it if mostly seen in girls.

Ulick (2005) discusses options for children and families who are impacted by ASD. Multiple therapies can be use in treatment, including speech and occupational therapy, ABA, Applied Behavioral Analysis offers positive reinforcement for the acquisition of language and social skills, Floor Time model consists of a child-directed approach that stresses personal interactions, while introducing variables within the relationship, TEACCH taps into the child’s interests to motivate them to learn in a structured environment, Social Stories incorporates stories to teach social skills and insight into others’ perspectives, PECS uses pictures to build communication skills, and RDI, which encourages experience sharing, relationship building and parental involvement. In addition, prescriptive medications do not treat the core of the symptoms, however there are used to help in modifying behavioral issues. Medications include
Risperidone an anti-pyschotic used to decrease aggression and hyperactivity, SSRIs which may reduce repetitive behaviors, anticonvulsants like Depakote are being used to treat aggression, and stimulants such as Ritalin may lessen hyperactivity.


My work involves using RDI / Floor Time to develop a master-apprentice relationship. Within this relationship and within the consistency of the setting new variables are introduced to help the client self-regulate and modify their behaviors. Often this is with the content that the client has created, i.e. I see several children who have our sessions be TV shows (per their request). They structure the TV show format, so there is a sense of consistency, and the shows are the same each week (one teen is the star of his own art show and paints pictures, another younger client has a show with clay characters he has made). Within these shows I introduce new “plots” i.e. new picture ideas to paint, a new problem for the clay characters to solve. The latest thinking on ASD has changed from ABA, teaching children scripts for eye contact and cueing them to say hello, to a more genuine relationship based model (Gutstein 2000). The latest models contradict ABA, suggesting that these children adapt too well to consistent patterns, which they try to replicate often via self-stimulation behaviors. Instead of teaching more “rote” learning (ABA), teaching them to be flexible, to manage frustrations in an ever changing environment, to help them develop self-regulation by developing episodic memory of their successes will be much more meaningful for these individuals. Needless to say ABA professionals are at odds with these new findings and it will be interesting to see how professionals adapt in the upcoming years to meet the needs of this vastly emerging population.



References

Gutstein, S.E. (2000). Solving the relationship puzzle. Arlington, Texas: Future Horizons.

Macintosh, K. E. & Dissanayake, C. (2004). Annotation: the similarities and the differences between autistic disorder and Asperger’'s disorder: a review of empirical evidence. Journal of Child Psychology and Psychiatry, 45(3), 421-434.

Ulick, J. (2005). What to watch for. Newsweek, 145(9), 48-49.

Wolff, S. (2004). The history of autism. European Child & Adolescent Psychiatry, 13(4), 201-208.