The Effect of Art Therapy on a Child with a Disruptive Behavior Diagnosis

THE EFFECT OF ART THERAPY ON A CHILD WITH A DISRUPTIVE BEHAVIOR DISORDER DIAGNOSIS: A CASE STUDY ___________ A Research Project Presented to the Faculty of Springfield College ___________ In Partial Fulfillment of the Requirements for the Degree Master of Science ___________ by Heather S. Weinberg April 2008 ii Dedication To my vinyl toys, you have stood by me through thick and thin . mainly because you cannot move on your own. iii Acknowledgments I would like to express a ridiculous amount of gratitude to my family - Mom, Dad, and Kevin. Without their support, love, encouragement, and laughter, I would probably be living in a van down by the river. You guys rock. I am also deeply indebted to Pat Davidson, Samantha Penny, and Laura Woods who have helped me not only survive this journey, but have some fun along the way. Special thanks to my fellow residents in the Grad Annex, I have heard everything you have done for the past two years. In addition, I would like state my appreciation to Ken Duffy for his assistance in my data collection, for being there when I needed him, and agreeing to go to a hardcore/metal show even though he does not like that kind of music and it gave him a two-day headache. Words do a bad job of expressing it, but I could not have done this without you. I would like to thank the Graduate Art Therapy program faculty for sharing their knowledge and time with me. Dr. Leslie Abrams has been a valuable source of support, guidance, and wisdom. I do not think I would have made it through in two years if not for your help. I would also iv like to extend my gratitude to Dr. Simone Alter-Muri for her assistance in the research process. Finally, I have to mention Alex Pardee, Chuck Palahniuk, Touma, Venom, Kathie Olivas, Optimus Prime, Evergreen Terrace, skulls, Usugrow, Denis Johnson, Dunnys, Every Time I Die, Bloopy and Binkerstaff, Poison the Well, Geek Love, headphones, The Devil’s Rejects, Brian Morris, Grey’s Anatomy, things that go bump in the night, David Lynch, ToDieFor, Kenzo, From Autumn to Ashes, Brad Pitt’s abs in Fight Club, Greg Simkins, Converge, Derek Hess, the tree I can see from my window, Thundercats, fresh air, Luke Chueh, The Hills, Edgar Allan Poe, Sam Flores, Refused, Pinkytoast, Coolvader, Juxtapoz, ParkeHarrison, hooded sweatshirts, and birds for inspiring and motivating me. May 2008 H.S.W. v Table of Contents Page List of Tables . viii Abstract . 2 Introduction . 3 Method . 9 Participant . 8 Measures. 10 Procedures. 14 Data Analysis . 20 Results. 20 Participant Artwork and Session Summaries . 21 CAFAS Results . 37 Behavioral Level System Results . 40 Discussion . 45 References . 55 Appendix A. RESEARCH DESIGN. 61 Statement of the Problem. 62 Definition of Terms . 63 Delimitations . 66 Limitations . 67 Research Questions. 67 Appendix B. REVIEW OF LITERATURE . 69 vi Appendix B. REVIEW OF LITERATURE (Continued) Art Therapy with Children. 72 Disruptive Behavior Disorders, Behavior Problems, and Art Therapy. 77 Disruptive Behavior Disorders and Behavior Problems . 78 Art Therapy with Children with Disruptive Behavior Disorders and Behavior Problems . 89 Art Therapy with Aggressive Children . 97 Summary. 106 Appendix C. CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT SCALE. 108 Appendix D. ART THERAPY SESSION NOTES. 124 Appendix E. AGENCY CONSENT LETTER. 125 Appendix F. PARENTAL CONSENT LETTER. 127 Appendix G. SESSION DIRECTIVES . 129 Appendix H. PARTICIPANT ARTWORK. 130 Session #1. 130 Session #2. 132 Session #3. 134 Session #4. 135 Session #5. 136 Session #6. 138 vii Appendix H. PARTICIPANT ARTWORK (Continued) Session #7. 140 Session #8. 142 BIBLIOGRAPHY . 143 viii List of Tables Table Page 1. Child and Adolescent Functional Assessment Scores . 58 2. Pre-Intervention and Post-Intervention Behavior Level Drops . 59 3. Behavior Level and Notes Pertaining to Art Therapy Session Dates. 60 Effect of Art Therapy 1 Running head: ART THERAPY AND DISRUPTIVE BEHAVIOR DISORDERS The Effect of Art Therapy on a Child with a Disruptive Behavior Disorder Diagnosis: A Case Study Heather S. Weinberg Springfield College Effect of Art Therapy 2 Abstract This case study examined the effect of art therapy on a child with a disruptive behavior diagnosis. Level of functioning was assessed prior to commencement of an art therapy intervention and again at the conclusion of the intervention utilizing the Child & Adolescent Functional Assessment Scale (CAFAS; Hodges, 2000). An improvement in rating on the behavior towards others subscale as well as in overall level of functioning was observed. Additionally, change was tracked through session notes and artwork produced. Participant artwork demonstrated a marked difference in scribbling technique, the release of aggression and anxious energy, and current issues. The behavioral level system employed by the residential treatment facility highlighted participant conduct improvement following each art therapy session. Effect of Art Therapy 3 The Effect of Art Therapy on a Child with a Disruptive Behavior Disorder Diagnosis: A Case Study According to the Surgeon General’s report on mental health, approximately 10.3% of children in the United States, roughly 6 million individuals, have a disruptive behavior disorder (DBD) diagnosis (U.S. Department of Health and Human Services, 1999). Behavior disorders, behavior problems, and aggression are the most common reasons for which children are referred to mental health services (Keenan & Wakschlag, 2002). The prevalence of behavior problems in this population necessitates new treatments and modalities as the needs of children diagnosed with DBDs are not being met utilizing current methods. Residential treatment facilities, schools, and other therapeutic services rely heavily on verbal therapy. Children with disruptive behavior disorders and the related behavior problems, however, struggle to get involved in verbal therapy (Pergjini, 1999). Talking about complex issues and behaviors is difficult for children, particularly those with psychological disorders. Moriya (2000) pointed out that because people most often Effect of Art Therapy 4 communicate verbally, a variety of defenses have developed on that level of communication. Thus, children with DBD diagnoses are often resistant to speaking with a therapist. Those children with DBDs are characterized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2000) as argumentative, angry, hostile, and openly defiant toward authority figures and adults. The features of these disorders create another treatment challenge that goes beyond verbal resistance and prevents traditional therapeutic methods from being effective. Art therapy is a modality with the capacity to be beneficial to children diagnosed with DBDs. Creating artwork allows for the exploration of feelings and emotions, without solely emphasizing verbal communication (Bush, 1997). Art therapy can help to combat verbal defenses by not only providing a nonverbal task, but also allowing the children to distance themselves from the emotion or issue and work within the metaphor of the art (Moriya, 2000). The art product created combined with the artistic process form the basis for art therapy and provide a structure within which this form of therapy can be effective with the DBD population. Effect of Art Therapy 5 More than just a means to an end, the creative process in art therapy has an “inherent healing power” (Malchiodi, 2007, p. 6). The process taps into the unconscious and channels that material into a tangible form through creativity (McMurray & Schwartz-Mirman, 2001). Once a product is created, the issue can be examined from a position external to the individual. Through creating and processing the image, control and a sense of understanding can be gained. Children can easily take advantage of the creative process because art is instinctual for them, a natural drive (Rubin, 1984). Regarding children diagnosed with DBDs, the artistic process can work to calm these individuals or direct their hostility into an alternate venue (Neibauer, 1988). Kramer (1993) found that unconscious primal drives, such as aggression, can be altered into constructive energy during the artistic process. Venting these powerful emotions during art making redirects impulses and relieves children who struggle in maintaining control. The process is crucial to those with behavioral problems as they often experience outbursts. Art therapy can also provide an outlet for those who are hesitant to show emotions, a characteristic of children Effect of Art Therapy 6 with DBDs (Broecher, 2000). Often, these children associate feelings with exposing weakness. Art therapy helps break down some of the obstacles connected with psychiatric help by working through symbols. Children are apt to become more open if they are speaking about the artwork rather than directly discussing their issues. Additionally, presenting children with a creative task can aid in overcoming refusal to participate in the therapeutic process (Dunn-Snow, 1994). For children with DBDs, art making allows them a means of communication, expression, and therapy. Specifically, art therapy operates as a calming influence and a venue in which resistance is lowered. The challenges that working with the DBD population provide are directly addressed by the attributes associated with art therapy. Working with art therapeutically permits children with DBD diagnoses to more easily express their emotions, diminishing acting out behavior and detrimental cognitive processes

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