Foto: Peter Marek (2021)

Introduction

The article aims to clarify the meaning and purpose of art therapy work with children with developmental learning and behavioral disorders. In order to effectively set up the therapeutic process, it is necessary to know perfectly the children's artistic ontogenesis and the specifics of the artistic expression of the given group of children. Drawing is a holistic activity that requires the actor to coordinate various systems. Just as a child's cognitive, emotional, moral or psychological side changes and develops during maturation, so does his drawing and artistic expression. There are many concepts of the development of children's drawing. Most of their authors agree that in healthy children we can observe certain regularities appearing in a certain order. These expressions are also a reflection of children's thinking. However, the artistic expression also reflects the level of motor skills, auditory and visual perception, orientation on the surface, in space, the ability to plan and organize one's work, manipulate creative materials, and the like. It is therefore understandable that the creative expression of children with developmental learning and behavioral disorders is specific in many ways. V. Löwenfeld (1986) claims that very early children's drawings tell about the personality traits of their creator and are related to mental and physical constitution. G. H. Luquet (In: Piaget, 2010) as one of the first authors pointed out that artistic ontogenesis is related to cognitive development. Intelligence significantly affects the development and quality of a child's drawing. However, other factors also affect the quality of the drawing. In our article, we characterize the periods of artistic ontogenesis in comparison with cognitive development. In the introduction, we will take a closer look at the stages of cognitive development according to J. Piaget (2010) and specify the features of the creative expression of children with developmental learning and behavioral disorders. At the end of the post, we offer options for art therapy intervention suitable for this specific group of children.

Artistic ontogenesis in comparison

Children's creative work has already been examined and continues to be examined by many experts. These are scientists from the field of visual arts, but also from the field of psychology or pedagogy. This is the reason for the existence of a number of theories with periodization and an elaborated structure of artistic ontogenesis. C. Burnet's models are most often mentioned (In: Read, 1967). G. H. Luquet (In: Piaget, 2010) or V. Löwenfeld (1986). Among the contemporary authors, art ontogenesis is addressed by, for example, R. Davido (2008). Czech authors, especially M. Kyzour (In: Lhotová, Perout, 2018) and M. Vágnerová (2012), also made a significant contribution to the history of research into the development of children's drawing. Several of the mentioned authors applied Piaget's stages of cognitive development to their concepts. To understand their point of view, knowledge of cognitive theories as well as artistic ontogenesis is necessary. J. Piaget (2010) calls the period up to three years of a child's age the sensorimotor stage. During this period, schemes are created, which later serve for spatial orientation. Children experiment in handling different objects. The first attempts at drawings - doodles - also appear. This is followed by a period called pre-operational thinking. This stage lasts until approximately six years of a child's life and develops visual thinking. This thinking also brings with it the child's interest in real reality, which is manifested in artistic expression by concentration on one element and the inability to work with multiple objects. The period of specific operations lasts approximately until the child is twelve years old. During this period, children are able to carry out thought operations in specific activities. In drawing, this means accurate rendering of observed objects. According to J. Piaget (2010), the period of formal operations develops until adulthood. Adolescents are able to think at a higher level, they are able to deduce, analyze and synthesize. He can already work with abstraction in drawing.

One of the first authors dealing with artistic ontogenesis was G. H. Luquet (In: Piaget, 2010). J. Piaget chose G. H. Luquet's concept of artistic ontogenesis because it suited his understanding of cognitive development and the development of spatial imagination. His contribution to the study of children's understanding and rendering of space is mentioned in particular. Luquet's stages (In: Piaget, 2010) are actually individual steps that finally culminate in the stage of visual realism. In his observations, Luquet (In: Piaget, 2010) found that a child's drawing is basically realistic until the age of eight, which means that the child draws what he knows about the object and only later what he really sees. He called the doodles that appear first the period of accidental realism. The author also talks about the period of the so-called misunderstood realism, when the child is not yet capable of synthesis. This is followed by intellectual realism, in which the child emphasizes the model without perspective. Later, he moves to visual realism, when he perceives real visual reality and improves in the representation of space and also in working with three-dimensional objects. C. Burt also addressed the stages of artistic ontogenesis (In: Read, 1967). In his concept, he also included the period related to the so-called creative crisis and calls it the suppression phase. It occurs during puberty. However, after this period, the phase of artistic revival comes for many. A child's artistic expression around the age of fifteen can blossom and there is also a noticeable difference between the work of girls and boys. However, not all children reach the recovery period. It often happens that they remain in the previous stage.

M. Kyzour (In: Lhotová, Perout, 2018) divided the development of children's drawing into three phases: egocentric, objective and reflexive. In the egocentric stage (4–8 years), illustrative thinking prevails, which is symbolic and anthropomorphic. In the objective stage, the ability of concrete thought operations is formed. In its concept, it mainly describes the development of spatial perception and its influence on artistic expression. It also brings the term so-called of the lost space, which he perceives as a metaphorical space for practicing social interactions. Work with this imaginary space appears in the period of concrete thought operations. The child works towards this visual realism based on experimentation with visual representation of space. However, the objective stage is also a stage of artistic crisis, which is related to the presence of a critical attitude towards the environment, towards oneself and thus also one's own result of artistic activity. However, unlike J. Piaget (2010), M. Kyzour (In: Lhotová, Perout, 2018) does not consider the stage of visual realism to be the last, but claims that it is followed by a reflexive stage. This stage coincides with the onset of formal thought operations, abstract and geometric drawings and also various artistic experiments appear in it. Practice shows us that the reflexive and objective stages often overlap.

V. Löwenfeld (1986) proceeded chronologically when defining individual stages. He divided artistic ontogenesis into six periods. He calls the first period the period of doodling (2-4 years), which is typical for children to create the foundations of patterns and ideas about the surrounding world and themselves. The time connection between the development of speech and the development of the symbolic function is also obvious. The first artistic attempts appear at the end of the sensorimotor period. He further divides the doodling period into four periods: chaotic (empty) doodling, mastered doodling, named doodling and colored doodling. The pre-schematic period (4-6 years) follows, in which the emotional component is dominant. The development of an artistic symbol is typical for the schematic period (6-8 years). The displayed object is very easy to identify. At the end of the stage, there is a transition from the emotional and fantasy realm to visual perception. A characteristic of the next period of drawing realism (8-12 years), more often referred to as the "Gang Age", is the effort to overlap objects. The drawing begins to take on a realistic form. The pseudo-naturalistic period (12-15 years) is a period of artistic typological delineation. Disillusionment may occur due to the inability to capture everything that the teenager would like, and this often leads to a decline in creative activity. The decision-making period (15-18 years) is sometimes a return to artistic creation and a revival of interest in artistic activities. The resulting artefact is influenced by the degree of aesthetic feeling, creativity and knowledge of art techniques and materials in adolescents.

M. Vágnerová (2012) looks at the development of children's drawing also from a cognitive point of view. He calls the pre-drawing period the pre-symbolic phase. This is mainly a period of doodling, during which the child can express feelings and knowledge. Around the third year of life, the child discovers that drawing can be used to depict something specific. He gives his doodle a name, discovers that it resembles something, that it represents something concrete. Later, in addition to naming, a verbal description of the drawing process is added. The drawing gradually becomes a symbol that represents an object, although it does not carry all its features. He calls this period the phase of symbolic drawing. Children in the preschool period tend to draw what they know about the given object and what they find important at the same time (Vágnerová, 2012). After this period there is a transition to visual realism. During this period, the child captures more precisely the shape of the object and its position in space. This transformation of the drawing is related to the development of thinking. Gradually, the ability to integrate individual parts into a whole develops. However, children become more critical of their drawings over time, which is related to a change in their thinking. The phase of secondary schematization begins, when the drawing begins to change. Adolescents in this period tend to simplify it and style it differently.

The French psychologist F. Davido (2008) was based on depth psychology when defining the stages of artistic ontogenesis. According to the author, each age corresponds to a specific type of drawing. It describes the stage of spots that appear within one year of the child's age. It is later followed by the stage of doodling and doodling. From the age of three, he describes the stage of cephalopods or universal characters in children. During this period, the child begins to give some content to his drawings. According to the author, children's drawing is one of the most appropriate approaches to understanding personality. It can be used when testing the cognitive level or knowledge and perception of one's own body and its placement in space. He states that the child begins to draw himself only when he gets an idea of ​​his body. At the beginning of the period, the child draws a figure composed of circles and lines, only later is he able to be aware of his body structure and draws more compactly. The drawings are initially transparent and perspective is also absent. This is followed by the stage of visual realism, in which the child begins to draw figures and faces in profile, especially what he actually sees. Only after the age of twelve is the child able to visualize space and his drawings are elaborated in detail. It should be noted that the individual stages can overlap with each other, and there are also the usual differences among children in the individual stages of drawing development.

Tab. 1: Comparison of individual concepts of artistic ontogenesis (in comparison with cognitive development according to J. Piaget)

Specifics of artistic expression of children with developmental learning and behavioral disorders

From the mentioned stages, it became clear to us that artistic ontogenesis depends on the development of the child's cognitive abilities, but also on the development of motor skills, sensorimotor coordination and, last but not least, on the development of executive (control) functions. These functions control cognition and therefore enable the planning of activities, the observance of individual steps in their implementation, the ability to control and correct the procedure, control attention or use time and space effectively. Within the level of cognitive functions, creative activity is conditioned by the ability to understand and use symbols. Cognitive development is also linked to motor development. In early childhood, most cognitive activities require motor skills, and this confirms the co-occurrence of movement and cognitive difficulties in most developmental disorders. Drawing presupposes the mastery of graphomotor processes, i.e. the achievement of a certain level of fine motor skills and sensorimotor coordination. The formal features of the drawing then also depend on its level. Children with learning and behavioral developmental disabilities when drawing often press hard on the pencil and draw relatively large pictures because they are not able to control the movement of their hand well enough. The creative process requires the child to be able to plan, control and direct individual movements. Concentration of attention and memory capacity are also important, because it allows the child to remember what he wants to draw. Children with developmental learning and behavioral disorders have difficulty concentrating on performance and cannot control individual creative activities, which is reflected in a reduced quality of performance (Vágnerová, 2017). The executive functions of children with developmental learning and behavioral disorders are impaired, especially in the area of ​​cognitive planning, working memory, inhibition and control of one's own activity (Velez van Meerbeke, Zamora et al., 2013). It is necessary to note the contradiction between emotional and cognitive development, which can be manifested in inappropriate artistic signs and symbols in relation to the child's age.

M. Lhotová and E. Perout (2018) ask themselves whether there are other factors that apply in the process of creation and whether the development of a drawing cannot take place other than linearly. They refer to objections from authors who deal with the creation of exceptionally gifted children who also have a certain health disadvantage. There are examples of the fact that cognitive development does not always correspond to the often prematurely developed artistic expression of these children. They are exceptions that disprove the connection between artistic development and the level of intellect. Children with developmental learning and behavioral disorders form a specific group. It can be assumed that the inaccuracies in their artistic works are a consequence of their motor clumsiness and insufficient visuomotor coordination. M. Vágnerová (2017) also mentions in their case the inability to concentrate long enough on any activity. These children do not have enough patience to perform the task precisely enough, they often do not finish it and even miss it. As a rule, they act impulsively, are unable to plan, show a reduced ability to coordinate individual hand movements, and this results in a lower level of their drawing. Reduced psychological self-regulation and internal tension are also involved.

According to Vágnerová (2017, p. 83), the typical features of the drawings of the mentioned group of children include:

  • asymmetry and disproportion of the drawing of the human figure,
  • inappropriate body part connections (e.g. they are connected in the wrong place),
  • incorrect placement of details,
  • a small number of details (or they are missing only on a certain part of the image/body),
  • the image is variously deformed (e.g. forked hands, triangular or round torso),
  • frequent perseveration (i.e. monotonous repetition of certain shapes or elements),
  • inadequate placement of the image on the paper (e.g. at an angle),
  • mutual overlapping of objects,
  • non-contiguous and uncoordinated lines,
  • scribbling, crossing out, scribbles (similar to written speech).

H. Mati-Zissi and M. Zafiropoulou (2001) published an extensive study in which they focused on the detection of developmental disorders using the characteristics of preschool children's drawing expression. The ability to draw was assessed in terms of the following aspects:

  • coordination of parts into an organized whole,
  • visual-spatial coding,
  • spatial orientation,
  • size scaling,
  • display of recognizable objects,
  • ability to plan.

The results showed that the perception of the position, limits and distances between the parts of the picture, the orientation and alignment of individual figures and parts, the concept itself develops in children with learning disabilities in a similar specific way as the ability to read and write. Stereotypes, few details and the like were typical for their drawings.

A. Ghanizadeh, S. Safavi, and M. Berk (2012) conducted a study investigating the drawing level of children with ADHD. As a research tool, they used a standardized graphic test of a clock face drawing (Clock Face Drawing Test). This test requires the use of various functions, such as auditory processing and understanding of instructions, planning, executive functions, organizational skills, concentration, and abstract thinking (Shulman, 2000). 95 children diagnosed with ADHD aged 8-14 participated in their research. The control group consisted of 191 normal children in the same ratio in terms of age and gender. The results showed that children with ADHD scored significantly lower in the test compared to the control group.

M. Galli, S. L. Vimercati, G. Stella, G. Caiazzo, F. Norveti, F. Onnis, Ch. Rigoldi and G. Albertini (2011) conducted a quantitative research in which they compared the artistic expression of a group of ten-year-old children with learning disabilities and a group of normal ten-year-old children. Their results showed that children with developmental learning disabilities have lower average scores on all graphics tasks. They draw smaller lines, make more mistakes in both straight lines and arcs. Their drawings are often disproportionate, tilted to one side, have uneven line length, instead of vertical lines they draw oblique lines. A comparison of the drawings of normal children and children with learning disabilities also showed a lack of precision and accuracy in drawing pictures in children with developmental learning disabilities or incorrect drawing orientation (up or down). The authors of the study used common clinical testing methods examining individual elements of the drawing. Simple drawing tests are commonly used to clinically assess cognitive abilities in children.

Already in 1926, F. L. Goodenough empirically proved that children's drawings are able to reflect intellectual abilities and cognitive development, and based on this assumption, she developed the Draw-A-Man test (character drawing), which focuses on determining the level of cognition and the ability to create abstract concepts. Later, many graphic (projective) tests were created to examine the level of cognitive abilities, which also assess the level of fine and gross motor skills, for example in tasks where the child has to trace a cross, figure, circle, square, etc. Although tasks aimed at delineating a picture do not require the child to use memory processes, the ability to switch between perceptually extracted relations and also a certain degree of drawing skills are required. These tasks also require the child to consider visual form (picture) as well as neuromuscular adjustments of line, control, direction, speed, and pressure (Khalid et al., 2010). One such type of test is, for example, the Denver Developmental Screening Test (DDST) (Frankenburg, Dodds, Archer, Shapiro, Bresnick, 1992). According to L. Lagae (1998), among the disorders that are most often evaluated by i. using graphic tests, include developmental learning disabilities. Children with learning disabilities have various specific difficulties, especially with drawing and writing, which are caused by perceptual-motor problems. A low level of graphic performance may be due to insufficient abilities in capturing differences between images, in connecting parts into an organized whole, in spatial and right-left orientation, in estimating size and distinguishing figure from background. Therefore, standardized graphics tests are helpful in detecting them. Along with other standardized diagnostic methods, artistic expression is also an effective assessment tool.

C. Malchiodi (2012) recommends using the Kinetic Family Drawing (Burns, Kaufman, 1972), House – Tree – Person (Buck, 1978, Hammer, 1967), Silver's drawing test (Silver, 2007), the LECATA test (Art Therapy Assessment of Emotional and Cognitive Abilities, Levick, 2009) and the Drawing of a Person in the Rain (Cane, 1951, Naumburg, 1966). These tests provide information about the child's ability to organize and use space, plan and divide the steps in the drawing process.

Possibilities of art therapy intervention for children with developmental learning and behavioral disorders

Knowledge of the development of children's drawing is also important when creating and setting up an art therapy activity. Art therapy is an invaluable tool for helping children with developmental learning and behavioral disorders to develop their social skills (especially in group work) and also to understand the nature and consequences of their disorder. Arterotherapy has many benefits as a treatment modality. It provides a number of specific advantages when working with a given group of children. C. Malchiodi (2012) states that art therapy:

  • uses visual educational abilities and skills,
  • thanks to therapy, children learn organization and structure.
  • offers children the opportunity to express their feelings and needs.

The result of the art therapy process - an artifact, gives the child a visual report about his ideas and emotions. Children with developmental learning and behavioral disabilities often have trouble remembering what they have learned. Artistic activities are a way for them to recall ideas and knowledge, which ultimately facilitates the learning process. Artistic expression and expression is a preverbal activity, that is, it does not need to rely exclusively on words. Children whose vocabulary is not sufficient to express their experiences are comfortable with non-verbal communication during therapy, as well as the use of visual signs and symbols. It can also serve as a tool for ordinary children to understand the experiences of children with developmental learning and behavioral disorders. The method of analyzing children's drawings is a proven and effective diagnostic method for teachers, educators and other professionals who work with children and youth. It is one way to understand the impact of the disorder on their overall quality of life. Encouraging the child to express himself creatively helps to identify and assess comorbid problems and other cognitive factors that may interfere with the child's performance. Art creation is an activity that children know intimately from school. It is an activity requiring auditory and visual perception, the ability to concentrate on only one specific task, to plan, organize and use space and materials appropriately. It also supports spontaneous behavior and is therefore also suitable for the child observation method. The space in which the art therapy process takes place should not be saturated with stimuli, the most suitable are white walls and empty bulletin boards, on which the created works of clients can be continuously displayed. Care should also be taken when choosing materials and techniques. These clients require predictability, consistency and an adequate organizational structure of meetings. The art therapist must take into account the reduced ability to concentrate for a long time, easy distraction and fatigue. Art therapy activities are usually divided into several sections and contain simple and interesting techniques. Group work is particularly suitable for children with developmental learning and behavioral disorders. Thanks to it, they practice social skills and interaction with peers with similar problems.

According to C. Malchiodi, (2012), the goals of helping children through group art therapy are as follows (the text was edited by the author of this post):

  1. Support children's self-awareness.
  2. Support the acquisition and development of social skills in children.
  3. To help children increase their level of self-awareness and support the ability to manage psychological problems.
  4. Support children's self-confidence.
  5. Support the education and learning of children.
  6. Mutually share the progress of the child's personal development in the circle of support children's groups.

Conclusion

The conducted research showed that children with developmental disorders use less sophisticated and organized strategies and, for this reason, cannot trace geometric shapes and simple pictures in detail. As a rule, the development of drawing skills is also burdened by problems in understanding spatial dimensions, specifically difficulties in processing and differentiating visual stimuli. This is then reflected in the disproportion of the drawing and in the inaccuracy of individual details. The result also reflects the inability to notice possible mistakes and imperfections.

Art therapy, whether individual or group, offers many options for children with developmental learning and behavioral disabilities. However, in order to set up the therapeutic process, it is necessary to know the individual phases of artistic ontogenesis and the specifics of drawing expression in the children we work with. In our article, we tried to summarize the given information and bring closer the possibilities of working with children with developmental learning and behavioral disorders using creative activities. Since this is a very specific group of children, which is not only at risk of school failure, but also faces problems in establishing and maintaining relationships with peers, it is necessary to use new and non-standard approaches. Arterepapia is, of course, most effective in combination with psychotherapy, psychological, therapeutic-pedagogical and special-pedagogical services.

Author: Mgr. Barbora Sender, PhD.

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