The Treatment of ASD and ADHD with Sensorimotor Art Therapy
Cornelia Elbrecht AThR, SEP, ANZACATA, IEATA
Many times I read the mental health records of children and teens and shudder at the long list of ASD and ADHD related diagnoses, while I wonder how much these young clients’ learning and behavioural difficulties are in fact caused by developmental trauma. For young children, threat is not about what is actually dangerous, but about what their brain perceives as such. This can happen from real threats or perceived threats – the brain will respond the same way to both.
Trauma affecting the Sensory Division of the Brain
The brain develops bottom-up. The autonomic nervous system in the brainstem of a foetus becomes calibrated for survival in the womb; it will adjust to the mother’s implicit states of being as its role model for a future world. If the mother is content and regulated, so will be her child’s nervous system; if the mother is depressed, or the pregnancy is unwanted, or the mother experiences highly stressful events during the pregnancy, her child’s nervous system will be dysregulated and more hardwired for survival. (Perry, 2020) These events set the baseline in our brainstem. Because we have felt like this from birth onwards, our implicit identity remains mostly unquestioned throughout life.
In the first year the infant’s brains focus is now on the sensory division of the peripheral nervous system. The developing neuroceptors perceive through the skin. Babies learn attachment, love, and safety through skin contact. They also learn neglect and abandonment through the lack or uncaring quality of touch as inescapable threat. The Skin Sense shuts down, when the environment becomes too unbearable, because babies cannot run away and hide (Elbrecht, 2021), consequently the sensory division in the brain stem becomes dysregulated. Somatic Experiencing associates autism spectrum disorder with sensory trauma. (Heller and LaPierre, 2012) This does not necessarily need to be through caretaker abuse but can also be caused by neurological or medical issues that occurred during the perinatal developmental window.
Children with sensory trauma, usually diagnosed with ASD, need art therapy sessions that are predictable. Stephen Porges describes safety as predictability, and safety is a core need for this client group (Porges, 2011). Sensory play with warm water in Clay Field Therapy sessions may dominate, sometimes for years. (Elbrecht, 2021)
The therapist pours warm water with a sponge over the rigid, frozen hands of a seven-year-old girl.
The image shows the tension in the girl’s hands. It was upon her request that the therapist ‘nurtured’ her hands with a continuous flow of warm water, which can remind the nervous system how to be in flow again.
This five-year old boy is soothing himself by caressing his skin with a sponge. His left hand is visibly relaxed.
At this fragile stage the clay can be too resistant, and the sponge is better suited to respond to the initially often tiny pulsing movement patterns that emerge. Sometimes when I watch such terrified young clients, I think of them giving CPR to a little bird as they rhythmically squeeze the sponge.
In Guided Drawing these children frequently chose the lemniscate as their favourite shape, to be repeated for many sessions. (Elbrecht, 2018) The lemniscate is the Guided Drawing archetype for nervous system regulation. In EMDR the same shape is used for trauma processing. (Shapiro, 2001)
Lemniscate is the term for a horizontal figure eight. It needs to be drawn with both hands, on large sheets of paper in rhythmic repetition. It is almost without exception experienced as positive rising and settling flow without any threat of overwhelm.
Trauma affecting the Motor Division of the Brain
The second, third and fourth year of life are dominated by the development of the motor cortex in the midbrain. (Perry, 2006) Children learn how to walk upright and organize their bodies to be able to do things. Such development increasingly hones skill sets such as balance, rhythmic repetition, and the physiological organization of the body. At the Clay Field for example children are intensely interested in applying pressure onto the material, they experiment with making handprints, footprints, pushing the mass of clay away or pulling it towards their body, lifting it up and dropping the lot. In this context they learn to align their hands, wrists, elbows, shoulders, back, hips, legs, and feet to experiment with the impact they can have on an object. The alignment of their skeletal build, ligaments and muscles takes practice. Such motor achievements support the development of a physiological identity, which becomes the basis for confidence and competence.
Children with a usually short attention span tend to stay fully focused for 45 minutes, because they deeply know that in this setting, they can repair their insufficient motor cortex.
This 8-year-old boy and pushes with all his might. The therapist must firmly hold the box. He is standing up while the counter-pressure resonates as life-affirming through his entire body.
According to Somatic Experiencing, children diagnosed with ADHD have experienced trauma in their motor cortex during this developmental window. (Levine and Kline, 2007) Something happened in their lives that caused them to collapse internally and arrested their healthy development. As they grow into school age, they become increasingly frustrated, because they are unable to organize their body to do the things they want to do. Observing these children at the Clay Field can be a delight. Even older ADHD clients are not interested in age-appropriate symbolic play but in applying all their strength into learning how to push, pull and lift the clay, how to drill into it, while gradually understanding how to build with it.
This seven-year-old boy diagnosed with ADHD was absorbed in putting all the clay into one lump, then lifting it up, smashing it down, lifting it all up again, and smashing it all down again. In the process he learnt to organise his body, feel his strength, and move out of helplessness.
Conclusion
The first group of ASD clients tends to need long-term therapy to learn nervous system regulation and to increase sensory tolerance. Bega Hõlz-Lindau’s PhD research in Germany supports the evidence that children in a psychiatric hospital diagnosed with severe ADHD showed significant behavioural and cognitive improvements after ten Clay Field Therapy sessions. (Hölz-Lindau 2020) We receive the same positive feedback from innumerable primary schools, where those children, who attended ten Clay Field Therapy sessions over one school term and another ten for the rest of the school year, improved significantly in their behaviour and learning to the extent that they had caught up developmentally with their peers.
Child psychiatrist Bruce Perry relates the sensorimotor base to the foundation of a house. If this base is constantly moving and shifting, due to feeling existentially unsafe, every higher brain function of behavioural and cognitive development will be impacted and compromised. This is the reason why these children, once they commence primary school, have learning and behavioural problems, not because they are naughty, stupid or they have ‘bad’ genes, but because their nervous system is easily triggered into chaotic upheaval eliciting chaotic responses. (Perry, 2006)
All these children do not have a conscious story of what happened to them. They cannot be reached through symbolic play or a narrative. Therapeutic interventions need to focus on the sensorimotor foundation, which is implicit and non-verbal. Those with a disorganised sensory base require recalibrating the sensory exteroceptors and interceptors in the brainstem through predictability. They may then proceed towards stabilising their autonomic nervous system through sensory perception and Skin Sense experiments. Those whose motor cortex in the midbrain has been affected by trauma benefit from developing voluntary control over their muscles through rhythmic repetition of usually simple motor impulses. With their sensorimotor base as a reliable foundation, these children can come into being and connect with life.
Bibliography
Ayres, Jean. 2015 6th edition. Sensory Integration and the Child. USA: Western Psychological Services.
Elbrecht, Cornelia. 2018. Healing trauma with guided drawing; a sensorimotor art therapy approach to bilateral body mapping. Berkeley, CA: North Atlantic Books.
—. 2021. Healing traumatized children at the clay field; sensorimotor embodiment of developmental milestones. Berkeley CA: North Atlantic Books.
—. 2013. Trauma healing at the clay field, a sensorimotor art therapy approach. London/Philadelphia: Jessica Kingsley.
Gerhard, Sue. 2004. Why love matters; how affection shapes a baby's brain. London and New York: Routledge.
Hölz-Lindau, Bega. 2020. Arbeit am Tonfeld bei ADHS; paedagogische und psychodynamische Aspecte der Affektregulierung. Giessen, Germany: Psychosozial Verlag.
Heller, Lawrence, and Aline LaPierre. 2012. Healing developmental trauma; how early trauma affects self-regulation, self-image, and the capacity for relationship. Berkeley CA: North Atlantic Books.
Karr-Morse, Robin: Wiley, Meredith. 2012. Scared sick; the role of childhood trauma in adult disease. New York: Basic Books.
Levine, Peter. 2010. In an unspoken voice; how the body releases trauma and restores goodness. Berkeley CA: North Atlantic Books.
Levine, Peter, and Maggie Kline. 2007. Trauma through a child's eyes. Awakening the ordinary miracle of healing. Berkeley, CA: North Atlantic Books.
Perry, Bruce. 2009. "Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics ." Journal of Loss and Trauma 240 - 255.
Perry, Bruce in, Cathy Malchiodi, and Bruce Perry. 2020. "Rhythm and Regulation; Innovative Approaches to Brain and Body During a Time of Immobilization." www.besselvanderkolk.com. May 30. MP3.
Perry, Bruce. 2006. The boy who was raised as a dog; what traumatized children can teach us about loss, love and healing. New York: Basic Books.
Porges, Stephen, W. 2011. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. New York: W. W. Norton Series on Interpersonal Neurobiology.
Shapiro, Francine. 2001. Eye movement desensitation and reprocessing (EMDR); basic principles, protocols and procedures. New York: Guilford.
AThR, SEP, ANZACATA, IEATA
Healing Trauma in Children with Clay Field Therapy®
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