Brushing away barriers: The healing touch of art as an intervention in children with autism

Art profoundly affects our lives, influencing emotions, behaviors, and well-being. Art, whether visual, musical, or performative, serves as a vital form of expression and communication, allowing individuals to convey thoughts and emotions in ways words cannot. Colors, integral to art, have the power to calm, energize, or inspire us. They enhance our environment, affect our moods, and even influence decision-making. Engaging with art enriches our lives, fosters creativity, and promotes mental health. It connects us culturally and spiritually, making it an essential, enriching element of human experience and interaction (Carroll, 2004).

Art serves as a powerful tool for non-verbal expression in children with autism, offering them an avenue for communication and self-expression. Due to differences and difficulties in verbal communication and social interaction, many children with autism find conventional forms of expression difficult. However, art provides a medium through which they can convey their thoughts, emotions, and experiences in a non-verbal manner (Bernier et al., 2022). For children facing challenges with verbal communication, the primarily non-verbal nature of art, which is more accessible, presents a unique opportunity for skill development and enhancement. Engaging with art encourages concentration on sensory experiences and personal expression. This involvement can foster a more holistic integration of cognitive, sensory, and kinesthetic experiences. Furthermore, such artistic activities can catalyze behavioral changes, offering a supportive environment where children can explore and express their thoughts and feelings without the need for words (Lusebrink, 2012). This approach nurtures their creative abilities and contributes to significant developmental improvements in areas they might struggle with due to communication barriers (Lusebrink, 2012). However, it is important to clearly distinguish between art and creative expression as a human right and art as a therapeutic context. Both are valuable, but they are distinct, and we should expect different levels or types of evidence for each.

In the education of individuals with autism, art has been recognized as a valuable tool providing an expressive form for communication, socialization, creativity, self-exploration, and manipulation of the environment (Wilson, 1984). Art enables autistic individuals to express and manage their emotions, thoughts, and challenges in a tangible form (Schweizer et al., 2014). Abstract emotions can be transferred into concrete artistic expressions, which make complex feelings manageable and understandable (Malchiodi, 2006). Children with autism can communicate their inner world, thoughts, and feelings through paintings, drawings, sculptures, or other art media in ways that are not otherwise possible. Art allows people to express themselves freely without the constraints of language or social expectations. It creates a safe space for exploration and self-discovery, promotes creativity, and enhances self-esteem (Malchiodi, 2006).

Art therapy can provide creative ways to establish mutual understanding and communication with children with autism (Emery, 2004; Gabriels, 2003), helping them build meaningful relationships and gain behavioral and communication skills (Evans & Dubowski 2001). Art interventions have been employed in children with autism to improve motor, cognitive, and social communication skills (Kuo & Plavnick 2015). Engaging in artistic activities can help reduce anxiety by improving emotional regulation and sensory integration in autistic children (Koo & Thomas, 2019). Art promotes socialization and peer engagement. Group art activities help children with autism acquire social skills, including teamwork, turn-taking, and sharing. Art helps autistic youngsters interact with their peers, developing empathy and inclusivity.

Music therapy has been used in autism for decades. It serves as an easily accessible stimulus that effectively engages and provides emotional benefits to children with Autism Spectrum Disorder (ASD) (Quintin, 2019). Thus, music therapy can use music processing strengths to improve social communication (Geretsegger et al., 2015). A Cochrane review by the same group of researchers aimed to assess the effects of music therapy on autistic individuals. The review included 26 studies (1165 participants) examining short- and medium-term effects. Results indicate that music therapy likely enhances global improvement, reduces autism symptom severity, and improves quality of life with moderate certainty, without increasing adverse events. However, evidence for improvements in social interaction, non-verbal communication, and verbal communication is less certain. The review highlights the need for further research to confirm these findings and explore long-term effects (Geretsegger et al., 2022). A well-known paper by Goldstein (1980) showed that music was especially good at causing “thrills” and that giving some people an opioid antagonist, naloxone, made this effect much weaker. This suggests that music therapy may involve opioidergic stimulation. The mechanisms behind other forms of therapies are less explored and warrant further research. Dance therapy is another intervention that is helpful in autism by contributing to body awareness and social involvement that minimize negative symptoms in adults with normal to high-functioning autism (Hildebrandt et al., 2016). Both these therapies use rhythm, movement, and sound as means to facilitate communication, emotional expression, and social interaction, areas often challenging for children with autism. This may improve their ways of expression and communication and thus, reduce the challenges faced by them. It has been suggested that the positive impacts of engaging in participatory art activities in autism may be partially influenced by the release of oxytocin and might potentially be used as a therapeutic approach for conditions characterized by social dysfunction (Tanaka et al., 2020).

There is a need for more targeted research and theoretical development in art therapy to understand how its unique non-verbal modes—such as drawing, painting, and sculpting—can aid children with autism, in reducing anxiety, development of creative ways to express their emotions and alternative ways to connect with their neurotypical peers. Exploring these aspects could provide a deeper insight into how sensory engagement and creative expression through art can similarly benefit these individuals, potentially leading to new methodologies and practices tailored specifically for art therapy.

Schweizer et al. (2014) proposed the Context Outcomes Art Therapy (COAT) model for art therapeutic intervention, visualizing four concentric circles with the central core of art therapeutical materials and expressions encircled by the other three areas of influence, including therapists’ behavior, context, and intended short- and long-term outcomes. Schweizer (2020) proposed several areas where more research is needed to strengthen the evidence basis for the therapeutic use of art in children with autism. This includes more clarity on the definition of core concepts of art therapy, including “sensory experiences,” “expressivity,” “personal artwork,” “flexible behavior,” “social-communicative behavior,” or “learning skills” in autism, the need for standardized treatment programs, validation and governance of art therapy practitioners, and studies which focus on impact of Art Therapy interventions.

Research has long indicated that individuals with autism are susceptible to developing mental health challenges, especially depression, throughout their lifespan (Lai et al., 2019). Art therapy has also shown promise as an approach to address various mental health issues like depression. It taps into their visual thinking abilities, releasing their thoughts and emotions by providing them with a natural and unrestricted means of self-expression (Wang, 2023).

Vogel et al. (2024) have pointed out the difficulties in comparing research on outcome studies implementing art therapy due to the heterogeneity of study population. There are not many avenues for training in art therapy, which may be a hindrance for its widespread use as a mode of intervention. World Health Organization recently provided a concise overview of how art interventions can enhance health and well-being (Fancourt & Finn, 2019). The available evidence regarding its effectiveness in children with autism is limited to systematic reviews. These few reviews are either focused solely on occupational therapy practice (Bernier et al., 2022), do not include comprehensive searches of high-quality databases (Vrisaba & Yudiharso, 2021) or include studies which lack standardization of intervention parameters and outcome measures (Vogel et al., 2024), while only one Cochrane review, as described earlier has evaluated studies on the short-term and long-term effects of music therapy in autistic individuals. The current research on art therapy in autism is somewhat limited and often lacks rigorous methodology, which makes it challenging to draw definitive conclusions about its efficacy. Many studies have small sample sizes, lack control groups, or use varied intervention protocols, resulting in inconsistent findings. Consequently, there is a need for further detailed research to establish clear, evidence-based guidelines and identify the most effective approaches for implementing art therapy interventions for children with autism. By conducting more robust and methodologically sound studies, we can better understand how art therapy can be optimized to support the developmental needs and enhance the quality of life for children with autism. Using art therapy as an intervention does not imply that children with autism need to conform to neurotypical social norms. It is important to explore the positive impacts of fostering an environment through art where friendships and social interactions can naturally occur.