LimeHouse Kids Inc.

 In my own professional experience working in the school system for 25 years, I have seen rates of anxiety whether formally diagnosed or not, rise dramatically among children and adolescents over the last 20 years.

Although there is an ongoing debate for the reason behind this upsurge, the reality is that increasing number of children, both in the general and special education population, are presenting symptoms of anxiety that are significant enough to represent a functional disturbance.Anxiety is a huge underlying current of many children regardless of their qualifying disability. Some of the most common anxiety-based disorders that impact students include...separation anxiety, generalized anxiety, school phobia, and obsessive-compulsive disorder. Additionally, and especially Attention Deficit Hyper-Activity Disorder ADHD and Autism Spectrum Disorder ASD.

PLAY is an integral part of how children learn; Therefore, the introduction of art, music, drama, recreation, creative expression, and social emotional mindfulness, especially within the special education sector, allows the children to engage more easily and respond to topics that may be more challenging for them in a traditional school setting.

"Expressive creative programs involving the use of creative expression within the context of the therapeutic environment, help children process and communicate their thoughts and emotions"

Although the expressive arts are often thought of as "non-verbal" therapies, verbal communication is actually a key part of the process. Once engaged in the activity, whether it is art, music, play, or drama, verbal communication occurs as part of the process, yet it is not the focus of the process.

The verbal discussion feels less about personal feelings, and more about the product itself. This makes the process less threatening, which allows children to lower their levels of defensiveness.

During the activity, the child is asked questions while performing the activity, as well as when reflecting on it afterwards. This encourages them to use the process as a way to discuss their feelings, reflect on their own experiences, or introduce coping strategies.

Expressive creative art has worked with children on the spectrum in a variety of ways, both in educational settings an in private practice. Although all forms of expressive therapies can be beneficial when working with children on the spectrum, ART is particularly useful because it helps address their primary deficits in communication and spontaneous imagination. 

"*** The creative act necessary in making ART is ITSELF an act of imagination"***

It involves the translation of an internal image in the mind into a tangible form on the sheet of paper. In other words, creating a painting or making a drawing is an act of communication because when we create an image, we expect that others will be able to understand what it is and what we are trying to communicate in some way.

Art can be utilized to increase a child's basic engagement with others, as well as build their motor skills and visual spatial skills. Other areas that can also be addressed with the use of art, such as social communication, sensory processing, an increasing verbal communication of feelings and needs. The basic act of engaging in the expressive arts can often provide an opportunity for social communication with peers and adults.

Drama has been found to improve social communication, reduce anxiety, and increase cognitive flexibility among children with ASD. It also helps children better understand the perspectives of others and improves their ability to recognize other peoples faces.

One reason behind the efficacy of Drama is that the introduction and use of role-playing, movement, and body language helps foster an understanding of how to communicate with an interpret communication from others.

School refusal and somatic complaints are symptoms that are commonly associated with several anxiety disorders. Often, children have problems  with consistently leaving class or excessive health office referrals with no documented health issues. Many times, the behaviour is dismissed as "defiance" or "overreacting" because they misunderstand the underlying anxiety to the behaviour. Identifying what is causing the anxiety is imperative, as doing so will allow you to get to the root of what is prompting students to leave class or develop somatic symptoms. 

Some of the best interventions for anxiety involve mindfulness and helping. 

Children develop self-awareness surrounding their current state of mind, so that they can evaluate and make appropriate changes in their thinking. Using guided meditation, art, music and play can be especially beneficial for students presenting with anxiety, as it allows children to move past the words and language that might limit their ability to process the strategies.

As a certified Hypnotherapist, some of the best expressive interventions for anxiety involve talking about the different types of emotions, calming breathing techniques, and guided mindful meditation. Children develop self-awareness surrounding their current state of mind so that they can evaluate and make appropriate changes in their thinking. 

Mandala Art can be effective in reducing anxiety because the design process of creating the Mandala is centering and helps restore a sense of balance.

Children with ADHD have difficulty applying what they have learned due to problems with impulsivity., distract-ability, and inattention. These issues cause them to either miss, misinterpret, or omit information that they may have previously been taught or mastered.

It is for this reason that ART THERAPY can be a particularly effective tool for ADHD; When a child creates a piece of art, it becomes a tangible memory that they can refer to throughout the course of therapy. Specifically, it provides a concrete benchmark at the initial intake session and serves as a visual representation of their progress throughout the remainder of treatment.

MINDFULLNESS is another great tool to include in treatment plans for children and adolescents with ADHD. Starting this journey can be overwhelming for these students because asking them to sit still and be present in the here and now is almost painful. However, in my experience as a Hypnotherapist, students begin to master the skill of mindfulness, as they start to understand its benefit in reducing their racing thoughts, calming their mind, and increasing their focus just listening to my guided visualization session.

In the expressive therapies, the goals for students with intellectual differences are different than those for other populations. The focus is much more on the process and product itself, versus trying to make any interpretations about the student’s creation.

Many students have difficulty understanding directions which can lead to a completely different end product than originally intended.

However, it is not the finished product that is of value to students with intellectual differences. Rather, it is the joy that comes from creating something and the sense of pride that comes from sharing that with the people involved in the process. Instead of asking reflective questions at the end of the session, the focus is more about the process of making the expressive piece.

Any opportunities to introduce Expressive Therapies such as songs in MUSIC help to teach children skills in a fun and creative atmosphere. Songs are something that children can learn and memorize, and you can utilize it as a tool to support and reinforce skills. The song becomes something that is predictable and familiar. In turn, children often respond positively when it is sung to them or when they are asked to sing it in a specific circumstance as a teachable moment. A perfect example is the “Clean Up” song. It serves as a cue for them to clean up their area and move on to another activity.

Additionally, many expressive art activities can help students with intellectual differences learn social skills or life skills in a fun and engaging way. Always thinking outside the box is key.

Selective mutism is a rare but complex disorder. It involves an extreme form of social anxiety. In which children will not speak in specific social situations, often out of fear of embarrassment. It impacts both social and academic functioning and often causes students to be isolated. Expressive therapies are especially useful with children who present with selective mutism due to their nonverbal nature. Using expressive therapies gives students an opportunity to convey their feelings without feeling the pressure to talk.

Drama therapy can be effective with selective mutism in that the process of role-playing in the context of the drama directive naturally invites speech, as the child must usually speak to take on a role. It allows children to participate and be part of a social interaction with others without forcing them to speak or increasing their anxiety. The child has a choice in how much or how little to participate in both the action and the discussion in their role. Drama also allows for nonverbal role-playing and interaction such as pantomime (expressing yourself through gestures accompanied by music). Given that the process of role-playing can help naturally elicit spontaneous speech, a game like charades is another great way to encourage this interaction.

In addition to addressing specific qualifying diagnosis within the special education sector, the expressive arts are an effective tool that can address children's unique social emotional, behavioural, an academic needs. In particular, research has found that the arts help children process traumatic events, promote the development of social skills, improve impulse control and emotion regulation skills and facilitate academic growth.

· When we talk about trauma, it is important to note that trauma does not have to include a single isolated incident. In fact, many children live in a constant state of stress. They may worry about having their daily needs met, witness domestic violence, be exposed to drugs or alcohol. Another typical trauma that many children and adolescence experience is divorce. The stress that children experience in the context of divorce can result in anxiety, depression, and other problems that can benefit from the use of expressive art directives.

· As previously discussed within the context of ADHD, the expressive therapies can help children increase attention span, decrease impulsivity and reduce acting out behaviors. However, even for children who do not have a formal diagnosis of ADHD, executive functioning challenges are one area that seemed to generate the most mental health issues. In my experience, this is because after a certain amount of time, children with executive functioning difficulties become anxious, depressed, and present with a sense of inadequacy. We all want to succeed, and children who have these difficulties often don't get to feel the same successes as other kids. They're constantly being told to “refocus”, “listen”, “calm down”, and “stop doing that”.

In contrast to traditional talk therapy, the expressive therapies can help children uncover aspects of themselves that they were not otherwise aware of, since these tools often “bypass the intellectual thinking” part the brain. Expressive therapies can help address any anger, disrespect, or aggressive behaviors that children may exhibit as a result of their frustration or feelings of helplessness. One example is Crinkle Art Therapy, in which children create a piece art out of an angry episode and learn how they can turn something challenging into something positive.

Creative art directives can lead to improvements in academic performance and decrease in dropout rates as well. General idea is that if students are emotionally stable and happy, then they can better focus on their studies and graduate. The use of expressive therapies leads to an overall increase in feeling of well-being among students. And when students are in a positive state of mind, any emotional barriers to learning are removed, which opens the door for learning and accepting feedback. These students have had repeated challenges with learning and have led to feelings of helplessness and frustration, and after experiencing this frustration for years, feelings of anxiety, depression, and low self esteem begin to emerge. 

For example, a goal may be developed to help a student utilized appropriate coping strategies when emotionally escalated so that students can perform efficiently in the classroom. Directives and Activities that are more play- orientated tend to produce less anxiety. Joining in with the students and fellow students make it much easier to build a rapport and engage, so that the child can process more fluidly.

Anytime! Children naturally gravitate towards art regardless of their social economic status, age, family history, or gender. Most children enjoy some form of music, fantasy play, or visual arts, whether it be singing, creating music, dramatic play, drawing, painting, mask making, paper mâché, crafts, watercolor, or clay. There is usually some form of art that intrigues a child. 

The great thing about Art is that you can integrate it at any point. However, introducing art in the beginning can help establish rapport and build trust in relationships. Discussing students experiences after each art piece is a great way to understand the reasons behind their feelings and ask questions like…

· Did using that make you feel more calm or anxious?

· What was your favorite part about that activity?

· What was the thing you liked least about the activity?

Resistance is not uncommon in expressive therapy especially for students who are new to the modalities.

Mindfulness is a tool that is often used in conjunction with the expressive therapies because it allows children to be present in the here and now. By introducing activities such as mindful meditation and guided visualization, I help children tune out the noise and focus on being in the moment. 

It has been my experience as a Hypnotherapist and SpecEd Educator that often you will notice after introducing these techniques for a few sessions, students will begin to ask for Mindfulness Activities, or they remind me if I forget to start or end with these activities. It’s amazing!

When introducing mindfulness to children, I tell them that it is about recognizing any thoughts and feelings that come and go in their mind, releasing them, and then bringing themselves back to the present moment. 

It is helpful to start by asking children to list all the things they were thinking about before they came in the room. Then  explain that mindfulness or mindful meditation is meant to help them store those thoughts away for a bit so that they can focus on what we will be doing in the present moment.

Guided Visualization is a little different from Mindful Meditation in that instead of being present with their thoughts, children use their imagination to visualize a place of relaxation and calm. This is a great tool to use when children are feeling overwhelmed or anxious, or if they aren't familiar enough with mindfulness yet to practice Mindful Meditation.

 By using imagination as their guide, children can relax, unwind, and even find joy or peace when they are feeling upset. Guided visualization can actually change the way they are feeling and what they are focused on, which in turn helps redirect the focus to the present activity.