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.

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.

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 regressive mindset.

I couldn’t be prouder of Mo who has a 3-9 pm job at McDonald's as their drive-thru cashier. Mo is fulfilling a dream that began when he was 11 years old and was actualized at 21 years after loads of hard work coupled with immense anxiety and self-doubt brought about by his autism. “You did it!” I tell Mo, but it does not end there because Mo's dream is already growing bigger as he continues to dream of more.

However, this is not what I really want to talk about here. It is what my second born Murad, who is 19 years old, said to me the other day. He shared that his supervisor at a local concern here in Singapore asked him how he felt about having an older brother with special needs and how he (Murad) was surprised, almost offended that such a question would even be asked. “As if people with special needs are not like you or me!” Murad stated. Quite honestly, had I been asked the same question about having a child with special needs, I don’t think I would have shared Murad's reaction, in fact, I would have expected the question and then gone on to talk about my journey and so on. Nevertheless, Murad is a child who, by virtue of being raised in a home where differences are not labelled as ‘inferior’ or considered an ‘affliction’, rather as challenges that must be dealt with and overcome, has grown up without prejudice against people who are differently able. I was delighted by Murad's comment that day and felt reassured that my husband and I had managed to raise our children without the preconceptions that he and I had grown up with.

Ready to go to work!

I am in no way downplaying the hard work and the struggles of caregivers of differently abled children and for that matter the carryover of the challenges to the siblings, but it is the perception of these challenges that precipitate stigma, discrimination and bias. This perception is mediated through language, beliefs, attitudes, government policies and so on.

As an example take our everyday language through which we might be unsuspectingly passing on messages that can have long-term ramifications for future generations. With regards to how we refer to differently abled individuals, I found an interesting blog that talks about whether to call a person with autism 'autistic' or 'someone with autism' https://www.parents.com/health/special-needs-now/should-we-say-with-autism-or-autistic-heres-why-it-matters/. Though this may not come across as a critical debate, it begs consideration and mindfulness about how we may be influencing people around us.

Back in Pakistan, I continue to hear words like ‘retarded’ and ‘pagal’ or ‘mad’ referring to individuals with special needs or mental health issues and it irks me immensely. Whereas earlier I would reprimand the use of such discriminatory language, I have changed my stance to bringing awareness to the sources of these deep-rooted biases and taboos that have nurtured centuries of regressive mindsets and dispositions.

I believe that firstly, the change needs to come from the very families and homes of differently abled individuals or those with mental health issues. As caregivers, siblings and friends, stand with your loved ones, speak for them and love them for who they are. Don't hold them back by not taking them to parks, malls, family gatherings and events just in case they might draw attention or censure. If you encounter offensive language or behaviour, take issue by educating and then advocating.

When Mo tells me that he cannot count money fast enough at the drive-thru and sometimes the customers complain, I draw his attention to the fact that in his first month in the job a customer wrote a wonderful note to McDonald's congratulating them on employing such a pleasant and polite worker. The charmer that Mo is, he often responds, "Thank you for raising me so well mama". However, for the future, I am preparing Mo to seek the understanding of dissatisfied customers by communicating his challenges to them so that he can stand up for himself. 

The paradox in raising a child with special needs

Mo bought a pair of sunglasses yesterday and he is loving his new look. I can tell they make him feel all grown up and super cool. Today, when his dad and I accompanied him on the bus, in order to familiarize him with the new route he has to take for his social skills group, Mo sat behind me, sunglasses and all, smiling broadly. Then, I heard him break into a song and suddenly my antennas went up. Who was he sitting next to? Would they think he was strange singing to himself? Would they judge or label him and so on and so forth? At once I turned around and whispered to Mo “you don’t sing in the bus” and the very next moment I chided myself silently “You’ve done it again Huma! So what if Mo is singing? So what if this is not the norm? Mo is happy, let him be, this is who he is. If the guy next to him finds him strange then that is his problem, not Mo’s’”!

Yet truly, is it really that simple? The fact is, it’s not just the guy sitting next to Mo’s problem, it’s mine too. I don’t want anyone, absolutely anyone to look at my son any differently than they look at me or you. I will simply not stand for anyone who will put my son down for being different and in case you are wondering what I will do faced with a scenario where such an occasion may arise, I have hidden fangs and claws that I will use to protect my precious offspring.

Then again, while I claim to celebrate Mo’s differences, I am also subconsciously and consciously trying to make him fit in with the ‘others’ or the stereotypical and therein lies the paradox and today’s incident, in the bus, made me reflect upon this conundrum. Is it because I myself am not comfortable with Mo being different or is it that I don’t want Mo to get hurt by others? I am going to go with the latter conclusion for truly it is Mo’s differences that make him the adorable bundle of love, simplicity, honesty and purity that he is. I am grateful for the joy as well as the challenges he has brought into my life and my family’s, for he has kept us grounded and thankful and honest. But Mo’s ego is fragile and he is vulnerable. He wants to be like his brothers and cousins and he does not want to be treated any differently. Yet he is different! So then, is there a solution to this paradox?

Indeed, there is and quite simply it is to embrace and accept differences so that they become the norm; so that parents such as myself feel safe in the knowledge that our special children will not be stared at, taken advantage of or thought of as any less than others.

It is Mo’s first day as a drive-thru cashier in McDonald’s tomorrow and I am nervous for him. He is so excited and stressed because working at McDee ’s, as he calls it, was Mo’s dream. Mo’s dream is about to come true but if he fumbles and falters will his dream turn into a nightmare? Will impatient customers be patient and respectful, and will his managers and colleagues treat him with understanding and kindness?

I am sending Mo off tomorrow with the counsel that mistakes are a precursor to learning, hence not to be afraid to make them. But my child is fragile and afraid as he is excited and hopeful. Thus, my counsel will be accompanied by constant prayers for this new stage in Mo’s life that could be a blueprint for his future.

For appointments with Huma for art therapy: go to www.colouredcanvas.net