Sensory behaviours in the classroom and the use of art materials for sensory modulation

Sensory behaviours in the classroom and the use of art materials for sensory modulation

Click on the link to read my article published in the International School Network

Zooming the Sensory-based Relational Art Therapy Approach (S-BRATA)

When I was approached by Sasha to work with her sons using the Sensory-Based Relational Art Therapy Approach (Durrani, 2020), I was completely thrown out of my comfort zone.

Not only were Sasha and I separated by multiple time zones until then I had not considered the possibility of ‘S-BRATA  online’. S-BRATA is a framework that originated from my doctoral research on impaired attachment and Sensory Integration Dysfunction (SID) in children with autism. It positions the art therapist as an attachment figure and targets both attachment and SID concurrently in children on the spectrum. The approach aims to ameliorate impaired attachment by lowering anxiety caused by SID which is implicated in attachment disruption in children with ASD. Underpinning the S-BRATA is an extremely sensitive, attuned reciprocity between child and therapist, involving nuanced layers of explicit and implicit interactions mediated through art materials and art-making. Hence, telehealth does not present as a viable option or at least that is what I believed until recently.

Sasha’s boys Ali (12-years-old) and Ahad (9-years-old) are on the spectrum. They are non-verbal and have significant communication and behavioural challenges. Sasha had read my publications on ASD (Durrani 2014; 2018; 2019; 2020) and was intrigued by what she thought was a “different way of working with children on the spectrum”. Sasha’s immense dedication towards her boys had made her leave her country of origin as a single mother to provide them with the best opportunities to achieve their potential. Her eagerness to try something out of the box that resonated with her overall approach to raising her kids convinced me to attempt ‘S-BRATA online’ with her. Another significant factor that influenced my decision was that Sasha was enrolled in an undergraduate art therapy program which meant that she was familiar with the inherent qualities of art materials and the power of relational artmaking. I felt a sense of community with her that further instilled in me the confidence for the undertaking.

Let the sessions begin

We decided to hold sessions once a week. Since I was not there in person, I would guide and train Sasha through directives and close observation of her interaction with the boys. As such I would be facilitating dyad therapy remotely. A few things had to be put in place before sessions could begin. I recommended a list of art materials that Sasha had to prepare such as paints in squeeze bottles, brushes, coloured sand,  shaving foam and a large plastic sheet to cover the living room floor where the sessions would be held. Also, Sasha had to figure out the optimal placement of the camera that would allow me a good view of the boys and their artmaking on Zoom. 

Goals

My goal for Ali is to facilitate communication through art which is a form of expression he enjoys and is motivated to use. Ali’s artwork can become a conduit for his feelings which he struggles to express verbally. Joint artmaking between Ali and Sasha can mimic a conversation where a verbal exchange is not necessary. 

Ahad needs are different from Ali’s. He appears to be more anxious and his receptive and expressive language is significantly more limited than his brother. My goal for Ahad is to induce regulation through art materials in order to lower his anxiety and to give meaning to his marks. 

For both Ali and Ahad, Sasha is the attachment figure that in my book Sensory-Based Relational Art Therapy Approach. Supporting Psycho-Emotional Needs in Children with Autism (Durrani 2020) is a role that I emulated as an art therapist.

Sneak peek into a session

Ali

I had Sasha laminate some photos of Ali taken at the trampoline park that he enjoyed visiting. The plan was to ask Ali to choose a photo and to create an association between his brush/hand strokes and the image of him jumping (action) and enjoying (feeling). After pointing to a photo, Ali picked up red paint and poured it on the paper using his hands to spread it out. Sasha prompted Ali to add more colours related to the moment the image represented, emphasizing the action and the emotion. My role was to observe and guide Sasha’s interactions and responses to Ali’s behaviour. For instance (a) when Sasha should step in to facilitate Ali’s process (b) when she should hold back interaction (c) when to use exaggerated affect (d) body positioning and so on. Ali created the artworks (Figures 1&2) requiring frequent verbal prompts and encouragement. This session was remarkable because in the previous ones he imitated Sasha’s artmaking whereas in this one he created the artworks independently.

  Figure 1 

     

                                                                        Figure 2     

After Ali’s artmaking, I reflected with Sasha on his process and her interaction with him. I recalled how Ali struggled with lack of structure and was always looking to either imitate or be directed to do something as was the norm in school and otherwise. Moreover, I observed that Sasha had the tendency to scaffold him or step in to help if he was not responding as per the expectations. However, the flexible structure of the S-BRATA that emphasizes meeting the child at their level and following their lead seemed to have struck a note with Ali.

Ahad

Ahad who was seated at the table began drawing the shape of a snake from his favourite Erik Carl book. Sasha stepped in to help him. When she had completed the outline,  Ahad attempted to colour the snake. His body language conveyed a sense of restlessness. It is possible that the lack of structure in the session made him uncomfortable. Sasha shared that Ahad liked to do things fast so maybe he was struggling with the pace of the session where I was trying to keep his attention sustained for longer in an activity. Therefore, I decided to follow Ahad’s lead and move from drawing one animal to another at the pace he desired. After he had coloured the snake Ahad indicated that he wanted to draw a bear. When Sasha moved forward to help him this time I stopped her. Ahad scribbled a shape with a brown coloured pencil and I named it ‘bear’.  In order to hold his attention, I quickly asked him what the bear wanted to eat and he indicated ‘bat’.  Then Ahad scribbled with a green pencil next to the bear representing the bat (Figure 3)

I discussed with Sasha how in future sessions an activity could be developed using Ahad’s interest in animals and building a narrative around them. So for the following session, Sasha and Ahad created a landscape with papier mache animals  (Figure 4) that sustained Ahad’s attention for significantly longer than the previous session.

 Figure 3

Figure 4

According to Sasha:

“I love the fact that in the sessions, it is possible to work with each boy independently, according to their ability and they both are attracted to each other's sessions; they are interested in what will happen after they start. I was so happy when Ali painted his happy jumps and was able afterwards to make up a sentence describing his activity (similar to what we work on with the SLP) and then write it on the writing lines ( in a similar manner to what we do with the OT). For Ahad,  after I told the SLP about what you did she asked him what he wanted and he chose the bat, then she gave him the marker to draw the bat ( in the past she would draw it for him). Next, she asked him “what do you want the bat to eat” and he chose lollipops. She loved the idea of building on his choice instead of repeating descriptions of which animals he wants or sees. What I wanted to say is that your approach combined with the input from SLP and OT and me (the mom) was able to have a positive impact on the boys and me. On the other hand, your approach is teaching their SLPs and OTs to follow the boys' lead in a creative way that they didn't use before, like building on their choices, instead of repeating the same activity. For me, this will have great benefits for the boys. This all shows me how powerful your approach would be if it is incorporated in the IEP ( Individualized Educational Plan ) which is done at the beginning of the school year or if it is included in the boys' activities regularly”.

Future possibilities

So it seems that all is not lost with telehealth. In fact, had Zoom not been a forced trend in these times, perhaps Sasha and I would not have entertained the thought of trying out S-BRATA online. 

There is great value in training caregivers and teachers of children with autism in approaches like the S-BRATA, as it departs from the traditional focus on modifying behaviours and skill-building. It emphasizes the emotional, sensing, feeling child who can be in danger of getting lost in the flurry of conventional approaches. Also, S-BRATA is not limited to the use of art therapists only and can be used as a guiding framework by all therapists using creative, multi-sensory, multi-modal approaches.

References

Durrani, H. (2020). Sensory-Based Relational Art Therapy Approach (S-BRATA): Supporting Psycho-Emotional Needs in Children with Autism. New York: Routledge.

Durrani, H. (2020). Sensory-Based Relational Art Therapy Approach (S-BRATA): A Framework for Art Therapy With Children With ASD, Art Therapy, DOI: 10.1080/07421656.2020.1718054

Durrani, H. (2019). Art Therapy’s Scope to Address Impaired Attachment in Children With ASD and Comorbid SID, Art Therapy, DOI: 10.1080/07421656.2019.1677063 

Durrani, H. (2018). A Case for Art Therapy as a Treatment for Autism Spectrum Disorder. Art Therapy: Journal of the American Art Therapy Association, 0 (0), 1-4.

Durrani, H. (2014). Facilitating Attachment in Children with Autism Through Art Therapy: A Case Study. Journal of Psychotherapy Integration, 24 ( 2 ), 99-108.

Addressing challenging behaviour in the classroom, with Yasmin Vasi and ...

My new book: S-BRATA:Supporting Psycho-Emotional Needs in Children with Autism

Hi,

Excited to share that Routledge is releasing my new book Sensory-Based Relational Art Therapy Approach on 28.12.20!

Below is an excerpt from my book

...what led me to the development of the Sensory-Based Relational Art Therapy Approach (S-BRATA) was the desire to seek a deeper understanding of an approach that I had developed organically over the years while working with children with autism and comorbid SID. The way I conducted art therapy seemed to work well for these children, but there were gaps in my knowledge that needed to be filled, and a doctorate seemed to be the best way to bridge those gaps between theory and practice.

S-BRATA is the result of the search for a deeper understanding of a concern that was instigated by my son’s condition and gradually grew into a passion. Essentially, the framework that S-BRATA provides for doing art therapy with children with autism is preliminary; however, it has potential for further development and growth. 

Importantly, S-BRATA is not meant as a guide for art therapists alone but for all professionals using a multisensory kinesthetic approach, be it art, music, dance/movement or other therapies espousing a mind-body approach. Due to the flexibility of its scope and its capacity to integrate different modes of expression and creativity, the principles of the S-BRATA can be adapted and incorporated across multiple disciplines. 

The relational aspect of the S-BRATA can also serve as a guide for caregivers who want to gain insight into interacting and communicating with children with sensory challenges and those who may be highly anxious and appear to be averse to interaction with the outside world.

You can pre-order the book on Amazon or The Routledge website.

Why art therapy works well for children

I am continuously amazed by the raw authenticity of children’s artwork. Compared to adults, creative expression comes naturally to children for communicating deep emotional content that they may not be able to put into words. After all, how many kids do you know who can articulate the underlying reasons for their difficult behaviors? However, the process of art making, under the guidance of an art therapist, is a highly effective way of accessing information that may be troubling the child. The art therapist is able to do that by using suitable art materials and providing directives.

Moreover, art therapy is a gentle and non-confrontational way of addressing difficult emotions that may be related to family, school, self-image, trauma, loss and so on. The art therapist can work through metaphors or symbols in the artwork without tackling the problem directly. For instance, a child who is being bullied at school may be able to work through the issue by sculpting the bully as an animal or an object rather than talking about the fear-inducing reality. Similarly, another child who may be experiencing divorce between parents can express feelings by drawing a landscape that is indicative of the difficult circumstances at home.

5- year-old boy processing his parent's divorce through his drawing

As a result, most children like coming for art therapy as it provides them relief through fun-based activities. Parents like the approach because it is a safe and effective way of tackling difficult situations/emotions and finding workable solutions without the burden of having to drag the child to therapy.

Mo's Angels

The other day I read a comment in the Straits Times made by the veteran diplomat Mr Tommy Koh that Singapore is a "first-world country with a third world people". His comment was based on the perception that is shared by many that Singaporeans are unkind, selfish and impolite in general.  Mr Koh added, "I love Singapore. I would die for Singapore. But are we perfect people? We are not,". But then, are any people perfect? I would think not!

Raising a differently-abled child anywhere in the world is the litmus test for gauging the civility and compassion of a nation. My intention is not to debate the third worldliness of Singaporeans rather it is to share my two sides of the story in relation to Mo, my 22-year-old son with autism.

Mo is a Universal Studios and Orchard Road regular, meaning his two days off from work are spent either browsing/hanging out on Orchard or riding roller coasters on repeat in Universal Studios. On occasion, he has come across shopkeepers who have threatened him with calling security because he was staring at some expensive merchandise for too long or for instance when once he was trying out too many pairs of glasses, he was reprimanded and asked to leave. Unable to comprehend the reaction of people towards his naïve behaviours, Mo returned home perturbed, questioning his actions and why they were perceived as inappropriate. Despite my endless explanations, understanding the intricacies of appropriate vs inappropriate social behaviour continues to be a struggle for Mo. I suppose life will teach him through trial and error some of its complexities, as he continues to navigate its ups and downs. However, the reason for my writing today is not to highlight the not so pleasant encounters that Mo has had in his life, rather it is to acknowledge the angels that he has come across this past year.

Mo landed a job in McDonald’s last year thanks to Yahya the ex-manager at McDonald's Alocassia Serviced Apartments. Yahya received Mo with open arms and trained him patiently despite his very busy schedule and lack of resources. Mo was given the job of drive-thru cashier where at

the beginning he made mistakes sometimes resulting in a cash deficit but the staff at Mc. Donald’s supported him and were instrumental in the completion of a successful and happy one year at work (thank you Adila, Clarence and Mohan among others). When recently, Mo left Mc. Donald’s, because according to Mo “I enjoyed working in Mc. Donald’s but I have to upgrade my skills” his managers contacted me to express their affection for Mo and regret at his leaving. My heart swelled with pride and gratitude.

 

Once again two more angels have appeared in Mo’s life at his new job at Starbucks. Royston who is the manager of Starbucks in the CBD picked up Mo’s enquiry and offered to train him. When I met him and Mon (the other manager who Mo will be working under) I felt that I was entrusting Mo into safe hands. Both managers welcomed Mo onboard with extreme warmth and encouragement. Mo is super excited to work at Starbucks and not just because he gets to have his favourite caramel Frappuccino every day. As for me, I am beginning to believe that Mo’s dream of opening his own café one day will really come true thanks to some very first world people in this first world country.

THE UNLIKELY DUO: Pairing a mainstream child with a special stream child for art therapy

I wasn’t sure if it would work, but bringing together 8-year- old Andy (pseudonym), a mainstream child who is intellectually mature for his age and 10-year-old Tim (pseudonym) who is in a special stream and diagnosed with inattentive ADHD, was worth a try. I had been seeing both boys individually for art therapy for quite some time before I decided to pair them for once-a-week art therapy sessions with a focus on their social skills, that being one of the reasons why they came to me in the first place.

Andy has a fascination for numbers. He wants to be an architect and he loves to construct fairly ambitious structures and complicated board games with art materials and found objects. Tim, on the other hand, is gentle and gregarious and has an undying passion for movies, film stars and animated characters. He loves to draw and talk about the movies he has watched and his favourite film stars. Both Tim and Andy are polar opposites as far as their interests are concerned but the one thing they have in common is their joy of artmaking.

The fact that Tim and Andy are so different is what struck me as an opportunity to bring them together for their mutual benefit. I felt that the strength of one child would compensate for the challenges of the other. For instance, Tim is highly creative and a perfectionist but his tendency to be controlling has, in the past, lead to rigid behaviours in social setups. Andy, on the other hand, is funny and laid back but struggles with focusing outside his busy head-space and that presents its own set of challenges when it comes to relationships and social situations.

So, banking on their common interest in art and the attachment that they have to me within a therapeutic context, I began to see Andy and Tim for joint sessions. The first few times they came together were fairly challenging as resistance was strong from both ends. Not only did the boys struggle to share space and time, but they were also reluctant to collaborate,  challenged each other’s boundaries and my ability to contain them. At one stage I was ready to give up and felt that my well-intentioned idea was not working but I chose to go along with my gut feeling that things would turn. And then slowly the dynamics between the boys began to change. I had to face the storm to ride the wave!

By structuring the sessions to create opportunities for the gratification of Tim and Andy’s individual needs, setting boundaries that helped me in managing their behaviours and granting independence and control alternatively to both boys, I was able to plant the seeds of a bond that I continue to nurture in our weekly sessions.

Tim and Andy's joint creations

Both boys look forward to the art therapy sessions and await each other’s arrival at the studio. They have learned to accommodate one other, compromise when necessary and collaborate, at times through facilitation from my end. The unlikely duo has proved to me that the power and process of the group (no matter how small) within a therapeutic context is undeniable.

On another note, my experience with Andy and Tim got me thinking how wonderful it would be for schools to promote inclusivity in the true sense of the word. Not only in schools though, but children of typical/mixed/different abilities also have so much to teach and learn from each other in all spheres of life. It is such a loss and tragedy for all our children to deny or not create opportunities for integration and inclusion.

For enquiries into art therapy with me, go to www.colouredcanvas.net