Canadian Art Therapy Association Journal

ISSN: 0832-2473 (Print) 2377-360X (Online) Journal homepage: http://www.tandfonline.com/loi/ucat20

Part of the Team; Art Therapy with Pre-School

Children with Developmental Delays and
Disabilities in a Children's Treatment Centre
Setting
Karen S. Robinson B.A., C. EXA., D.TATI (thesis pending)
To cite this article: Karen S. Robinson B.A., C. EXA., D.TATI (thesis pending) (2009) Part of the
Team; Art Therapy with Pre-School Children with Developmental Delays and Disabilities in a
Children's Treatment Centre Setting, Canadian Art Therapy Association Journal, 22:2, 34-43,
DOI: 10.1080/08322473.2009.11434781
To link to this article: http://dx.doi.org/10.1080/08322473.2009.11434781

Published online: 01 Jun 2015.

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Date: 18 December 2016, At: 09:43

Part of the Team; Art Therapy With Pre-School Children with Developmental Delays
and Disabilities in a Children's Treatment Centre Setting
Karen S. Robinson, B.A., C. EXA., D.TATI (thesis pending)
services provided at all twenty-one centres are:
physiotherapy, occupational therapy, speechlanguage therapy and social work. In addition,
some centres provide psychological assessments
(through a psychologist or psychometrist),
therapeutic recreation, behaviour therapy, and
music therapy. Only one centre (the largest one
in Ontario) provides art therapy for its clients.
The mission statements, goals, and objectives of
each CTC vary somewhat but all twenty-one
centres operate from a family-based framework
where parents and families are recognized as
playing a pivotal role in their child's
development. Therapists and the families form a
team that work together in identifying
meaningful goals, individual strategies and
programming ideas for the child (One Kids Place
(OKP), 2009) . In addition, the centres identify
rehabilitation for children and youth as an
integration of multiple services that recognize the
changing physical, emotional and psychological
aspects of a child's development (Ontario
Association of Children's Rehabilitation Services
(OACRC), 2009). This statement reflects the
of the
understanding
and
importance
psychological well-being of an individual with a
developmental disability and how the quality of
psychological well-being may influence the
ability for the individual to reach their full
potential. In light of the importance of the
psychological well-being of the child with a
developmental disability, closer scrutiny into the
present method of delivering psychotherapy
services to clients of children's treatment centres
is key to maximizing the child's development.
Furthermore, it is important to understand why
art therapy is an ideal mode of psychotherapy for
this population as it is an effective intervention
on its own, but is also one that enhances,
compliments and reinforces the work of the core
services of occupational therapy, speech and
language therapy, and physiotherapy.
Terms
The terms developmental disability and
developmental delays used throughout this paper
are umbrella terms for delays, disorders, or
of motor,
impairments
in
the
areas
communication, cognitive, or social abilities that
exist during the human developmental period

Abstract:
There are twenty-one children's treatment
centres in the province of Ontario which provide
physiotherapy, occupational therapy, speechlanguage therapy, and social work to children
and youth with developmental disabilities. Some
of the centres provide the additional services of
psychological
assessments,
therapeutic
recreation, behaviour therapy, and music therapy.
Only one centre has an established art
therapy/expressive arts program.
This paper explores the present method of
delivering psychotherapy services to clients of
children's treatment centres and discusses the
relevance of art therapy as an effective form of
psychotherapy that also enhances and reinforces
occupational therapy, speech-language therapy,
and physiotherapy.
Part of the Team; Art Therapy With PreSchool Children with Developmental Delays
and Disabilities in a Children's Treatment
Centre Setting
The province of Ontario provides
rehabilitation services to children and youth with
developmental disabilities through a network of
twenty-one regional children's treatment centres
throughout the province. The centres are
operated as charitable, non-profit organizations
and also receive provincial funding. The centres
provide a range of services to help children,
youth (up to the age of 19), and their families
with
physical,
developmental,
and
communication delays and disabilities. The core
Editor's Note:
Karen Robinson, B.A., C. EX.A., D.TATI (thesis pending),
is currently working on her thesis to complete her training
as an art therapist at the Toronto Art Therapy Institute. She
is currently under contract to One Kids Place Children's
Treatment Centre for a special project in partnership with
the Parry Sound Best Start Network providing art therapy
services and workshops in the Parry Sound region of
Ontario. She can be reached at (705) 636-7950 or by email
at: karen@karenrobinsongallery.com.

Canadian Art Therapy Association Journal

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Volume 22 Number 2,2009

(typically before the age of 22). The term

developmental disabilities can be defined as: a
group of abilities and characteristics that vary
from the norm in terms of the limits they impose
on an individual's independent participation and
acceptance in society, and are generally
considered a life-long condition (Odom, Homer,
Snell, and Blacher, 2007) Terms with similar
meanings include the DSM-IV definition of
pervasive developmental disorders
not
otherwise specified which is considered
permanent, and developmental delays (which
may not be permanent).

Specifically, speech and language services at a

CTC perform assessments and carry out
treatment programs to increase a child's
functional ability to communicate successfully.
Speech-language assessments are carried out by
a speech-language pathologist. The treatment
program is developed by the pathologist and then
is carried out by either the pathologist or a
Communication Disorders Assistant (CDA).
Treatment
includes
teaching
language
development and sound production development
strategies to the family and caregivers such as;
making sounds correctly, developing vocabulary,
and putting words into sentences. In some
circumstances the speech-language pathologist
may recommend the child use a alternative form
of communication such as a picture system
(PECS - Picture Exchange Communication
System) or other communication device to
communicate their wants and needs effectively.
(Moore & Pearson, 2003)

CTC Services

As previously identified, the core services

provided at Ontario Children's Treatment
Centres (CTC) are physiotherapy, occupational
therapy, speech and language therapy, and social
work.
To understand and identify where art
therapy fits in the treatment model at a CTC it is
necessary to identify the specific goals,
objectives, and services of each form of therapy
offered there.

Occupational Therapy

Physiotherapy at a CTC, focuses on the

gross motor and functional mobility of children
and youth; their ability to move around.
Physiotherapy services help children and youth
with movement difficulties in order to reach the
maximum level of functional independence,
motor development, and mobility. Physiotherapy
assessments are performed by physiotherapists.
Treatment programs are developed by a
physiotherapist and are then carried out by either
the physiotherapist or a physiotherapy assistant
(PTA). Physiotherapy treatment programs aim to
address difficulties that the child may be
experiencing in the areas of; muscle and joint
function, strength and endurance, mobility and
gait, balance and coordination, posture and
stability, sensory and neuromotor development,
and recreational needs. (OKP, 2009)

Occupational therapy services

assist
children with the development of both fine and
gross motor skills as they relate to the activities
of daily living (ADL). Occupational therapy
addresses problems in the areas of sensory,
perceptual,
mobility,
and
hand
skills.
Specifically, the occupational therapist assesses
the child's ability in the areas of visual motor
skills (eye-hand coordination), balance, grasp,
and strength. Once the occupational therapist has
performed an assessment and developed a
treatment program, either she(he) will carry out
the program or an Occupational Therapy
Assistant (OTA) will do so. Therapy assistants at
CTC's have often received training to assist in
both physiotherapy and occupational therapy
programming and are referred to as OTIPTA's.
Occupational therapy programming activities
include; drawing, colouring, printing, cutting and
play skills (activities of daily living for children)
and other activities of daily living such as
feeding, dressing, toileting, and hygiene. (CaseSmith, 2004)

Speech-Language Pathology and Therapy

Social Work

Speech-language pathology and therapy

helps children with speech (articulation and
voice), language (words and sentences), and
communication
delays
and
disorders.

Social work services (also referred to as

Family Services) offered at CTC's aim to
enhance the child and family psycho-social
functioning by providing counseling, advocacy,

Physiotherapy

Canadian Art Therapy Association Journal

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Volume 22 Number 2, 2009

referrals to community agencies and support

groups to cope with social and emotional
difficulties. At the heart of the social work
services is the recognition that having a child
with special needs presents challenges that are
unique to the experience of parenting. The
services provided by the social worker may
include the following; home visits, psycho-social
assessments, individual, family, or group
therapy, grief counseling, assistance with
funding applications, and the sourcing of funding
for additional programming or equipment needs
not provided by the CTC. (Quinte Children's
Treatment Centre (QCTC), 2009). As indicated,
the list of social work services provided is
extensive. Areas for future inquiry include the
determination of how much time the social
worker at a CTC is able to devote to specific
child-centred mental health support work, and
whether the presence of a social worker
adequately
addresses
the
psychological
therapeutic intervention needs of the population
at the CTC.

The goal of therapeutic recreation programs

is to promote the development of an individual
leisure lifestyle through a variety of individual,
family and group interventions. Recreation
Therapy programs encourage active participation
for the optimum ability of an individual, and the
development of community-leisure partnerships
which enhance and emphasize inclusion.
Specifically, recreational therapists provide the
following services: locating recreation programs,
helping the individual to identify her(his)
recreational areas of interest, increasing activity
levels, helping an individual to learn a specific
leisure related skill, and investigating barriers to
leisure
involvement.
(OKP,
2009)
Behaviour Therapist/Consultant
At least five CTC's employ behaviour
therapists/consultants to provide support and
guidance for parents who are experiencing highly
challenging behaviours with their child . A
functional analysis is performed and an
individual treatment program is then developed
for the family to carry out with the support of the
behaviour therapist. The objective of the
behaviour management program is to address
skill deficits and/or reduce or eliminate
inappropriate
(aggressive,
self-injurious)
behaviours. (Ottawa Children's Treatment
Centre, 2009)

Other Services
An informal telephone survey of the twentyone Children's Treatment Centres in Ontario
(performed by the author on August 7 and 10,
2009) determined that in addition to the core
services described above; 11 centres employ
psychologists or psychometrists, nine centres
employ recreation therapists, five centers employ
behaviour therapists/consultants, four centres
employ music therapists, and one center employs
an art therapist.

Music Therapy
Music therapy involves the use of music and
musical elements (instruments, singing) in a
therapeutic relationship between the child and a
music therapist. The goals of music therapy are
to facilitate interaction, awareness of self, selfexpression, communication, and personal
development (Canadian Association for Music
Therapy, 2009). The services of a certified music
therapist at a CTC are only available to children
who are already clients of the CTC for core
therapy services. The objective of music therapy
is to enhance the quality of life for the child by
using musical elements to calm and/or stimulate
the child, and to engage the child in listening,
moving, playing, and singing. In addition, the
goals of music therapy are to help the child and
the child's family to develop the child's selfawareness, confidence, self-esteem, coping
skills, and to improve social behaviour.(George
Jeffrey Children's Centre, 2009).

PsychologistlPsychometrist
Children with developmental delay(s) or
disabilities often have unique learning issues that
can affect their schooling experience and core
therapy programs. Several of the CTC's employ
or contract with a psychometrist to provide
psychological assessments of the child to identify
individual strengths and challenges, and the
child's learning, behavioural, social and
emotional status. A psychologist is consulted for
interpretation of test results and for referrals for
further assessment or treatment if necessary.
(QCTC, 2009)
Therapeutic Recreation
Canadian Art Therapy Association Journal

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Volume 22 Number 2, 2009

Research shows that mental health problems

have not always been recognized as co-existing
with developmental disabilities (Sovner &
Hurley, 1983). A dual diagnosis of mental illness
and developmental disability is now understood
to exist at rates equal to or greater than in the
non-disabled population (Paschos & Bouras as
cited in Odom et al., 2007). While there are no
psychiatric disorders that can be considered
incompatible with developmental disabilities,
specifically, anxiety and affective disorders
present at increased rates compared to the nondisabled population (Cowley et al. as cited in
Odom et aI.). Studies by De Collishaw &
Maughan (2004), and Richards, Maughan,
Hardy, Hall, Strydom, & Wandsworth, (2001).)
determined that the presence of depression in
individuals with developmental disabilities not
only occurs at higher rates than the general
population,
but
frequently
remains
an
undiagnosed condition. Furthermore, the studies
identified several factors associated with the
unique vulnerability of the developmentally
disabled to depression such as; higher rates of
physical illness, socioeconomic challenges, and
inadequate life supports. While these findings
specifically refer to studies done with adult
participants with developmental disabilities, a
thread of bias against the identification and the
importance of treatment of mental illness for the
developmentally disabled is discernable. These
two forms of bias serve to create obstacles in the
development and delivery of mental health
treatment programs designed specifically for the
developmentally disabled population.
One of the obstacles to the identification
and effective treatment of mental illness in the
developmentally disabled is a clinical bias by the
population of professionals that provides support
services for the developmentally disabled.
Wittman, Strohmer, and Prout's 1989 study
found that mentally disabled clients were most
commonly referred for behaviour intervention
therapy when the problems the clients sought
counseling services for were: interpersonal
concerns
(22%),
general
psychological
functioning (18%), work issues (12%), sexuality
(6%), family (5%), adaptation to living situations
(5%). In addition, Jacobson and Ackerman's
1989 survey of psychologists working in mental
health services with the mentally disabled
showed that the emphasis the professionals
placed in therapy was in the areas of; adaptation
to living situations, peer group relationships,

Art Therapy
Art therapy provides a psychotherapy
treatment option that does not rely solely on
verbal interaction. Professional art therapists
provide a therapeutic setting in which children
with developmental disabilities are able to work
towards their full potential in the areas of: tactile
and kinesthetic awareness, fine and gross motor
skills, self-expression, and sensory integration
and processing. Art therapy also promotes the
development of self-regulation skills, the sense
of personal self-mastery and empowerment,
cognitive and problem solving skills, and
communication and interpersonal skills (Yack,
Sutton, & Aquilla, 2002). In addition, art therapy
supports the expression of negative emotions
such as anger, frustration and anxiety, in a safe
and effective manner.

History and Status of Mental Health Services

With
Developmental
for
Individuals
Disabilities
Before investigating precisely how art
therapy fits into the core services at a CTC, a
clearer understanding of the history and state of
mental health services for individuals with
developmental disabilities is required. It is
commonly found that individuals with
developmental disabilities have intellectual
challenges
in
meeting
non-disabled
developmental norms in the areas of social and
learning skills, communication, self-expression,
self-direction, health and safety, and leisure
(Yack et al., 2002). The challenges for a
developmentally disabled child in adjusting to a
world that does not readily adapt to their special
needs, is a source of frustration and anxiety for
the child and his(her) family. As well as anxiety,
depression is not uncommon for adult individuals
with developmental disabilities for reasons such
as; the inability to cope effectively (leading to
prolonged anxiety and depression), the necessity
of dealing with stressful life events (caregiver
absences, transitions of caregivers), and the
increased exposure or risk of some form of abuse
(Yack et al.). Sevin & Matson's 1994 study of
both clinical literature and empirical studies,
found that individuals with intellectual
developmental disabilities experience the same
range of psycho-social disorders as the general
population.
Canadian Art Therapy Association Journal

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Volume 22 Number 2,2009

developmental
disabilities
such
as
aggressiveness, maladaptive social skills,
depression, and anxiety (adorn et al., 2007).
The results of a 1993 study by Dorn and Prout
when looked at along with the results of
Jacobson and Ackerman's 1988 study, points to
the reality that neither the mental health service
sector nor the sector that provides services to the
developmentally disabled provided sufficient
support in the area of mental health for the
developmentally disabled population in the past.
However, Hurley's 2005 study (as cited in adorn
et al., 2007) found that attitudes toward the
suitability of a broader choice of psychological
therapies for the developmentally disabled is
beginning to be replaced with a recognition that
clients and their families can indeed benefit from
these interventions. More recent research, in the
form of meta-analyses (Prout & Nowak-Drabik,
2003) has shown the existence of at least a
moderate benefit for people with developmental
disabilities having received a broad range of
psychological therapy interventions. Study
results such as this are in part responsible for the
change in attitudes that has begun towards
providing a broader array of psychological
therapies to the developmentally disabled
population.

family relationships, self-control of unacceptable

behaviour, and social skills enhancement. There
was no mention of psychological functioning or
support for the treatment of anxiety, depression,
or self-esteem issues.
Finally, studies done by Levithan & Reiss
(1983), Reiss, Levithan, & Syszko (1982), and
Reiss & Syszko (1983) specifically identified a
form of clinical bias for which they developed
the term 'diagnostic overshadowing' to describe
a recurring tendency for mental health
professionals to either minimize or ignore
altogether, mental
health problems for
individuals with developmental delays and
disabilities. Not only were individuals more
likely to have a mental illness go undiagnosed,
but if a condition was identified, those
individuals with developmental disabilities were
not offered the same variety of interventions as
the general population. Alford and Locke's 1984
study determined that mental health clinicians
were most likely to recommend behavioural
interventions for the developmentally disabled as
opposed to the full range of interventions offered
to the general population. It is worth noting that
while Alford and Locke's study was done in
1984, the informal telephone survey ofCTC's by
this paper's author in August, 2009, found that
five of the CTC's either employed or contracted
the services of a behaviour therapist/consultant.
While the significant presence (23%) of
behaviour therapists in present-day CTC's might
suggest the continued bias to behaviour
interventions as a mental health support, it must
be noted that all twenty-one centres have social
workers on staff. As noted earlier, one of the
services social workers provide is counseling to
clients. The specific identification of how much
time social workers at CTC' s spend counseling
clients for psychological issues and what form of
intervention they employ in doing so, is an
indicated area for future research. Therefore, no
finding of present-day bias in CTC's to
behaviour
interventions
versus
other
psychotherapy interventions can necessarily be
inferred.
In fairness to the practice of behavourial
therapy it should be noted that the prevalence
and acceptance of such approaches is due in
large part to the wide body of evidence-based,
controlled research studies that have been
conducted in this area. In particular, behavourial
therapy has long been the mainstream approach
to addressing difficulties faced by people with
Canadian Art Therapy Association Journal

Types of Mental Health Interventions for

Individuals With Developmental Disabilities
With the recognition that individuals with
developmental disabilities are vulnerable to
mental illness at rates greater than or equal to the
general population, and, that developmentally
disabled individuals can benefit from a range of
psychological therapeutic interventions, the need
for specialized mental health supports is clear
(Paschos & Bouras as cited in adorn et al.,
2007).
In addition to
cognitive-behavioural
therapy, psychodynamic interventions can playa
role in supporting the expression of negative or
previously unacknowledged feelings such as
anger, frustration, and anxiety. Hollins &
Sinason's 2000 study determined that difficulty
in expressing negative feelings, particularly
anger, towards family, caregivers, and others on
whom they depend, is difficult for some people
with developmental disabilities. Family and
system-theory based therapy can be an effective
intervention because it works within a
framework that specifically recognizes the
38

Volume 22 Number 2, 2009

art therapy (which is provided in only one CTC

in Ontario presently), music therapy, has
successfully established itself in four of the
twenty-one CTC's in Ontario. Reasons for the
favouring of music therapy over other creative
arts therapies is not well understood at this point
and bears future investigation so that advocates
for the profession of art therapy may direct
advocacy activities and future research efforts
there.

interactional patterns within a family or other

similar closed-systems, and the resulting impact
on individual family members of these systemic
interactional patterns. Oliver & Smith's 2005
study (as cited in Odom et al.) found that personcentered therapy was an effective intervention
for individuals with developmental disabilities
because it afforded the individual the opportunity
to discuss personal experiences that impacted on
them and which others had either dismissed or
minimized.
Finally, creative arts therapies such as visual
art therapy, drama therapy, and music therapy
are all considered viable interventions that
provide
psychological
benefits
to
the
developmentally disabled population (Odom et
al., 2007). Art therapy is practiced using a
variety of psychological theoretical frameworks
which may include, psychodynamic, narrative,
solution-focused, system-based, and personcentered to name just five. Furthermore, art
therapy may done in a one-on-one format (client
and therapist), dyad (parent and child), family,
and group art therapy. Odom et al. state that
there is a lack of controlled studies on creative
arts therapies, however, Odom et al. also stated
that the shortfall of empirical studies on the
efficacy of creative arts therapies should not be
construed as justification for not making these
forms of psychological interventions available.
Instead, they suggest that attention to treatment
length, as well as treatment goals and
expectations, are areas that should be adequately
addressed early in the creative arts interventions.
Odom
et
al.(2007)
are
clear
in
communicating that at present no one model of
intervention or particular approach is identifiably
better than another, and that using a range of
interventions is of greatest help along with the
ability to modify whatever approach is used, in
order to match the needs of the developmentally
disabled client. Art therapy is uniquely adaptable
to the needs and abilities of the developmentally
disabled because, in part, of the broad range of
art materials that can be used to facilitate
expression of emotions and thoughts. The range
of art-making activities can be adapted
specifically to the needs of clients with
developmental delays and disabilities.
In Canada, outside of major urban centres, art
therapy is relatively unknown or notwell
understood to be a psychological intervention
suitable and effective for almost all populations
that require mental health supports. In contrast to
Canadian Art Therapy Association Journal

Art Therapy and Early Interventions With

Developmentally Delayed and Disabled
Children at a Children's Treatment Centre
Thus far much of the discussion in this
paper has revolved around psychological
interventions with adults with developmental
disabilities. As stated previously the age range
served in CTC's is birth to nineteen years of age.
However, most of the services at CTC's focus on
the zero to six population and more specifically
pre-school children from three to six years of age
(the typical age reached before entering Senior
Kindergarten/Grade One in Ontario). The reason
for this focus is that other provincial agencies
take
over
the
programming-delivery
responsibility once the child reaches the age of
six. The question that must then be specifically
addressed is as follows: Is art therapy treatment
intervention with developmental delayed or
disabled pre-schoolers ofvalue and if so, what is
that value(s)?
As discussed previously in this paper,
research has shown that some adults with
developmental disabilities have difficulties
expressing negative emotions such as anger,
frustration, or dissatisfaction with family
members or caregivers. It would therefore seem
reasonable to assume that developmentally
disabled and delayed children would experience
similar difficulties of expression as well as
lacking coping skills to soothe themselves from
an agitated state. Patterns of behaviour,
resiliency, and self-calming strategies are all
psychological tools that are necessary for day-today functioning and good mental health which
all take root in early childhood. The
developmental years between the age of three
and six are well researched and known to be a
time of maximum brain plasticity, providing
fertile ground for laying the seeds for effective
coping skills for a lifetime (Horovitz, 1983).
39

Volume 22 Number 2,2009

In addition to the positrve mental health

outcomes that art therapy provides for children
and families at CTC's, art therapy is uniquely
effective in its interaction with the programs of
core services at CTC's for occupational therapy,
physiotherapy, and speech and language therapy.
Once a parent has expressed a desire for art
therapy services at a CTC where their child is
already a client, the art therapist will consult with
the occupational therapist, physiotherapist,
speech and language pathologist, and other
therapy assistants that are involved, regarding the
established goals, objectives, and program
specifics identified for each child. With this
program information, the art therapist will
include activities in the art therapy sessions with
the child that incorporate activities from the
other therapy programs.
Occupational therapy has a lengthy
historical connection to art-based actrvities
(Bissell & Mailloux, 1981). The ability to make
lines and shapes and cut with scissors remains
part of the fine motor assessment practice (CaseSmith, 2004). The use of creative arts in the
practice of occupational therapy, particularly in
mental health rehabilitation programs, has been
recognized as an effective though difficult to
measure intervention (Schmid, 2004). The
profession's recognition that art-based activities
have the potential to have a psychodynamic
dimension, in part, contributed to a decline in the
use of art in occupational therapy in some mental
health settings (Thompson & Blair, 1998). In
addition, the subjective nature of the experience
of art-making has contributed to a difficulty in
performing controlled studies on art-based
treatment outcomes. As the profession of
occupational therapy has moved to evidencebased practices only, fewer psycho-dynamicallybased therapeutic art-making activities have been
offered to clients. At CTC's, the art therapist can
reinforce the occupational therapist's program
with support in helping the child with a grasp of
the materials, and practicing forms of markmaking (vertical, horizontal, and diagonal lines,
circles, squares etc.). These activities contribute
to the goals of visual/motor integration and
eye/hand co-ordination. In addition, art therapy
interventions can incorporate and reinforce
strategies to address sensory integration
problems identified by the occupational therapist
(Kranowitz, 2004) through art activities that
involve tactile properties (different textures of
materials), vestibular input (moving about the

Early intervention research has shown that

there are four types of early intervention
practices that have a significantly positive impact
on the learning and development of pre-school
children with developmental disabilities (Odom
et al., 2007). First, response-contingent child
learning describes scenarios where the
production of a certain behaviour by the child
elicits a positive consequence (reinforcer) (Odom
et al.), Second, parent responsiveness in
interactional patterns with the young child has
been well-researched and proven to be a strong
determinant of successful child development for
developmentally disabled children (Shonkoff and
Phillips, 2000, as cited in Odom et aI.).
Responsive interactional patterns between child
and parent lay the foundation for emotional
resiliency in later life (Hawley & Gunner, 2009).
This holds true for the general population of
children as well as the developmentally delayed
or disabled (Odom et al.), Art therapy dyads can
be an effective intervention in helping to repair
or change the way that the child and parent
interact as it is the parent that is encouraged to
follow the lead of the child in the art-making
activities (Proulx, 2003). Art therapy dyads
emphasize parental responsiveness to the child.
Third, natural learning opportunities in
everyday activities of young children are rich
areas for learning opportunities for the child and
have the secondary benefit of enhancing parents'
sense of parental-competence (Raab & Dunst,
2006, as cited in Odom et al., 2007). Art therapy
provides natural learning opportunities for the
child as it involves creative activities that are, at
least in part, somewhat familiar to the child from
home-based, day-care, or pre-school programs in
which they may have participated. Finally,
capacity-building/help-giving practices where
professionals encourage and support parents by
providing environments where both the parent(s)
and child can learn has been shown to build
parents' personal confidence, enjoyment, and
feelings of parental confidence with their special
needs child (Odom et aI.). Art therapy provides
capacity-building, learning opportunities for both
parent and child as they explore art materials and
activities together.
Role of Art Therapy in Enhancing,
Complimenting, and Reinforcing Core CTC
Services

Canadian Art Therapy Association Journal

40

Volume 22 Number 2, 2009

room to show and talk about their artwork), and

proprioceptive needs (kneading clay).
Physiotherapy programs that address gross
motor skills development can be complimented
in art therapy through various means such as
body positioning at a table or easel, arm, leg, and
body
movement incorporated into the artmaking activities, and movement throughout the
room showing and discussing the artwork,
Speech and language programs can be enhanced
through communication efforts between the child
and art therapist. The use of play in carrying out
speech and language programming is frequently
used by both the speech and language pathologist
and the communication disorders assistant
(CDA). Art therapy provides a natural learning
environment where the child, occupied with the
fun of making art, can practice his(her)
articulation, phonology (sound acquisition), and
language (vocabulary and grammar).

university-based programs over private institute

training programs may be a factor in the
recognition of music therapy over art therapy at
CTC's. Third, art therapy is not a well
recognized
or
understood
therapeutic
intervention in Canada at present. Whether due
to a lack of advocacy for the profession of art
therapy, or a bias against art therapy because of
an absence of controlled studies proving its
efficacy, the fact remains that many art therapists
spend a substantial portion of their time
explaining what art therapy is, and how and why
it is effective. Fourth, CTC directors and clinical
services supervisors may assume that mental
health support interventions are fully and
adequately provided by the social workers
employed at CTC's. Finally, a general trend of
health-sector services moving to a business
model of management has been the pre-cursor to
requiring that interventions be based on
evidence-based practices (EBP's) as determined
by controlled research studies. While this is
especially true in the United States, where the No
Child Left Behind (NCLB) federal act regarding
services to developmentally disabled children,
favours the use of EBP's (Odom et al.), the
impact of the reasoning behind the policy may
have reverberations on the art therapy profession
here in Canada.
Conclusions and Recommended Research
Directionsfor Art Therapy in CTC's
The establishment of CTC's in Ontario that
provide multiple core support services under one
roof reflects the understanding that early
interventions in the areas of gross and fine motor
skills, speech, language, and communication
skills are crucial in helping the developmentally
delayed or disabled child reach her(his) full
potential. Art therapy as a psychological therapy
treatment on its own, can provide a form of early
intervention for the child and his(her) family that
effectively and uniquely addresses mental health
support needs. In addition, art therapy is able to
compliment, reinforce, and enhance the
programs of the other core services at a CTC.
Arising from discussions within this paper, three
specific areas for future research serving to
promote art therapy's efficacy as an integral part
of the team of professionals at Ontario CTC's are
indicated. First, the question "how much
counseling of children and families do social
workers do, and, what frameworks of
interventions do they use?" needs to be
answered. Second, exploration of the reasons

Why Art Therapy Is Not Offered In eTC's

This paper has discussed the wellresearched need for mental health supports for
the developmental disabled including young
children. In addition, it has been the intention of
this paper to have shown that art therapy is not
only suitable, but uniquely effective as an early
psychological intervention for children with
developmental disabilities and their families. As
well, the paper has reviewed the ways in which
art therapy compliments, enhances, and
reinforces the programs of the core services at
CTC's. The next question that begs to be
addressed is, "why is art therapy not utilized in
more of Ontario's CTC's?".
Five possibilities have been identified by
the author. First, the historical connection of arts
and crafts to occupational therapy, before the
profession adopted an evidence-based practicesonly philosophy, may have an impact on the
perception of the efficacy of art-based activities
meeting, or measuring up, against expected
outcomes. Second, the majority of training
programs for art therapists in Canada is provided
by private educational institutes. At present, only
three universities in Canada (St. Stephens,
Concordia, Sherbrooke) provide training for art
therapists and all three are Masters programs. In
contrast, music therapy is offered in numerous
university programs in Canada at both an
undergraduate (honours-level) program and a
masters-level program. The preference for
Canadian Art Therapy Association Journal

41

Volume 22 Number 2, 2009

why music therapy has been favoured over art

therapy in establishing its team-member role at a
CTC is necessary. Third, the body of controlled
studies on art therapy outcomes must be
expanded so that art therapy is included amongst
other evidence-based practices considered in the
choice of psychotherapy treatment options.
Finally, advocacy efforts for the profession of art
therapy need to be stepped up by Canadian

(including

provincial)

sssocistions

New perspectives. British Journal of

Psychiatry, 176, 32-36.
Horovitz, E., (1983). Preschool aged children:
When art therapy becomes the modality of
choice.
The Arts in Psychotherapy, 10, 23-32.
Retrieved July 15,2009 from Scholars Portal
database.
Jacobson, J., & Ackerman, J. (1988). An

of

appraisal of services for persons with mental

retardation

professional art therapists in order that art

and psychiatric impairments. Mental

Retardation, 27, 377-380.
Jacobson, J., &
Ackerman, J. (1989.
Psychological services for persons with mental
retardation
and psychiatric impairments. Mental
Retardation, 27, 33-36.
Kranowitz, C. (2003). The out-of-sync child has
fun: Activities for kids with sensory
processing disorder. New York: Penguin.
Moore, S., & Pearson, L. (2003). Competencies
and strategies for speech-language pathology
Assistants. New York: Thomson Delmar
Learning.
Levithan, G., & Reiss, S. (1983). Generality of
diagnostic overshadowing across disciplines.
Applied Research in Mental Retardation, 4,
59-64.
Odom, S., Homer, R, Snell, M., Blacher J.
(Eds.). (2007). Handbook ofdevelopmental
Disabilities. New York: Guildford Press.
One Kids Place Children's Treatment Centre
(OKP), (2009). Retrieved Aug. 11,2009 from
http://www.onekidsplace.calenglish!
Ontario Association of Children's Rehabilitation
Services (OACRC), (2009). Retrieved Aug.11,
2009 from http://www.oacrs.comlabout.php
Ottawa Children's Treatment Centre (OCTC),
(2009). Retrieved August 12,2009 from
http://www.octc.calservices/index e.asp
Proulx, L. (2003). Strengthening emotional ties
through parent-child dyad art therapy;
Interventions
with
infants
and
London:
Jessica
Kingsley
preschoolers.
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Prout, H., & Nowak-Drabik, K. (2003).
Psychotherapy with persons who have mental
retardation: An evaluation of effectiveness.
American Journal on Mental Retardation,
108(2), 82-93.
Prout, H., & Strohmer, D. (1998, April). Issues
in mental health counseling with persons with

therapy is recognized as an effective intervention

and more widely accepted by both professionals
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