Type of study :Art therapy applied to an adolescent with Asperger's Syndrome
What is Asperger's Syndrome:
Neurodevelopmental disorder characterised by impairments in social interaction, restricted, repetive and stereotyped patterns of behavior, interests, and activities. Adolescents with this syndrome have developed a compromised self-regulatory system, which leads to difficulty in many ares of functioning - include social, behavioral, emotional and an increase in anxiety.

The goal of art therapy:
Clients to become more autonomous, spontaneous, and confident. Employing active expathic listerning in a safe space, the client feels fully heard and deeply understood and in the case of art therapy, active listening also includes active "seeing." Art expression creates a tangible outcome that taps into personal strengths and resources that can then be incorporated into positive, successful life changes.

Therapy period : 7 months

Case example: (Emma) An adolescent with Asperger's syndrome.

Aim: to address case subject's difficulties with social interaction and integration appropriate for her developmental age. Subject has difficulties in negotating the environment usually become apparent with Asperger's syndrome later than other pervasive developmental disorder (PDD) happens is not until a child reaches adolescence. The 1st sign of difficulty may show up within the secondary school setting, when peer interaction becomes integral to normal development. The adolescent does not receive the proper support, causing further delays in addressing the issues impeding normal development and academic achievement. In this case example of Emma presents an illustration of an adolescent who was initially misdiagnosed as to have social phobia.

Description of presenting problem:
Emma entered into therapy due to difficulty in school and socialization within her peer group. She was experiencing extreme anxiety, having difficulty tolerating the class room environment and engaging socially, and avoiding eye contact. When her stress level increased, she would ritualistically tug at her hair and clothes, many times creating holes in her shirts.
She was 1st diagnosis of Social Phobia - prescribed Lexpro, a serotonin reutake inhibitor for depression and anxiety, to help stabilize her mood and despite of that she still continued to be anxious and has the side effect of flattened affect.

At the beginning of the therapy:
. avoid eye contact
. sat in the corner of the couch
. wring her handsidiosnyncratic speech
. do not know how to begin
. bangs in a repetitive pattern
. suck on the sleeve of her shirt
. need to redirected and refocused

Over 7 month period of therapy using creating art, she became increasingly more communicative and comfortable in social interactions.
9 projects - 4 collages, 1 template design, conversation in crayon, coffee filter designs, mirror on tile and masks.

Project 1 - Magazine collage
Collage is a great approach for allowing adolescents with AS to be expressive without the anxiety that drawing and painting may trigger.
Materials: Different types of magazines
Directive: Using cut or torn out pictures from the magazines, create a collage that represents who Emma is. After finishing - she was asked to write adjectives that she would use to describe herself.
Procedure: Cutting, pasting a number of pictures. Written adjectived that she describe herself "carefree, loveable, unique, nice and spunky" very smalland tenatively throughout the collage.
Outcome: Gave a good indication of Emma's world. Included pictures - a garden, animals, a car, money, a camera and an anatomical heart with space still available between most of the picture, but she did not include many human figures and she make great effort not to have most pictures not ove3rlapping or even touching.
The written adjectives indicated that she does not see herself as being connected to social situations, but prefer situations where social interaction is not required, however looking at the adjectived she added did express a desire for connection, leaving her to feel isolated.


Project 2i - Geometric templates designing.
Materials: a variety of geometrical shaped templates, crayons, markers and colored pencils.
Directive: Create a picture using the templates provided as a guide.
Procedure: Used colored pencils, engaged with great intensity applying extremely heavy line pressure, traced and colored in the shapes, causing several pencil tips to break. As she was becoming more comfortable, she started to integrate and move her design to the center
Outcome: Indicated an interest in becoming a part of the whole.

Project 2ii - Conversation in crayon
Materials: Crayon
Directive: using crayon and converses, not with words but by taking turns drawing on a piece of paper.
Procedure: drawn once again remained in the corner, resisting moving toward the middle of the page, at one time therapist eventually moved closer and crossed ber line, Emma responded by moving closer but then retreated back to the corner of the paper.
Outcome: Apparently she remained very controlled, resistant to integrating her design - acknowledge she stays isolated, expressed that she had a strong desire to be socially involved, but felt exrtremely awkward when faced with most interpersonal interactions.

Project 3 - Soft material collage
Material: Cloth, ribbons, string, decorative trim, 11' x 14' white paper, scissors, glue, clitter glue, and puff paint.
Directive: Have fun with the materials supplied
Procedure: She chose a selection of items and glued them on white paper, stated to use the glitter glue, enjoyed making dots in almost a ritualistic manner throughout the artwork. Used her finger to spread the glue aroung - appered ritualistic but to her soothing. Utilized the entire page to create a composition, however she continued to keep a large amout of white space. Enjoyed the glitter glue, relaxing to make the repetitive dots.
Outcome: Spreading the glue around - soothing. Glitter glue - relaxing.

Project 4 - Coffee filter designs - to focus on integration.
Material: Coffee tilters, watercolor.
Directive: create a free flowing visual design
Procedure: At first she had a hard time allowing the colors to run on the wet filter. But began to paint a controlled circle on a dry filter. Given colour markers to create a design using the markers on the coffee filter, which would then be dipped in water.Got excited when designs were dipped in water and the colour stated to run.
Outcome: became mesmerized, enjoying the sensation of the repetitive circular motion. Activity acted as the catalyst to their conversation, focusing on allowing things to come together and being part of the situations. She likes being included and part of social situations, but sometimes she gets uncomfortable not knowing how to react when everyone is talking. At this point, therapist suggested a role-play activitiy focused on how to interact in conversation and respond to what other's say.

Project 5&6 - Mirror and tile design
Material: tile, a variety of mirrors, art supplies
Directive: Design the rtile anyway you want, but you need to include at least one of the mirrors in you design.
Procedure: Firstly - glued the mirror onto the tile, only worked on the side of the tile, resisted moving to the top where the mirror was mounted. Engaged with glitter glue by using her finger in a tactilely soothing manner, then added a row of plastic beads, then surrounded by glitter glue.
Later - moved slowly to the top of the tile, adding plastic beads, ribbon moving up toward the mirror, allowing herself to see her reflection.
Finally - finished off her design with a ribbon surrounding the mirror.
Outcome: Able to integrate the mirror, commented can see herself working, this project also pointed out to Emma that facial expressions are very imprtant in order to engage socially.

Project 7: Expression collage
Material: Magazines
Directive: List different expressions and then find pictures that represent each of those expressions.
Procedure: Written list included, annoyed, surprised, mad, upset, confused, deep in thought, excited and happy.
Outcome: Therapist asked the following - when might someone make that expression, give an example of a time you observed someone using that expression, have you every used that expression? but Emma quickly came up with - when and why someone might make a certain facial expression. She still cannot fully relate to her own experiences, therefore comes the next project.

Project 8i: Pulp masks
Material: White pulp mask, a variety of media, paint, flitter, clooth, ribbon, glitter glue, and glue.
Procedure: Used her fingers to mix the red and yellow paint, very similar to the tactile experience of glitter glue in earlier projects. Add red and used her fingers to blend it together. She started to add more pressure, and used black for the eyes, continued to use fingers and alternarted between layering paint and wiping it off. Eventually the pulp started to break down. At this point emma spoke about her frustration regarding her father's reaction to her leaving for school.
After finishing exdpredssing herself and a role-lay was completed, she stopped working and stated that she did not like the mask and wanted to start over.
Outcome: Through this project she spoke of
- excited and nervous of graduation from high school and going to college
- frustation regarding her father's reaction to her leaving for school
- her mother's supportive and ready to let go

Project 8ii: Pulp mask - new
Procedure: she started to paint a new mask bright green, stated that the green was more like her, there appeared to be a lighter person emerging. But the next session, Emma painted over the mask with a darker green. Stated that she was making "Elphie" from the play "Wicked" who has dark green skin. Added red eyes and chose letter beads to speal out "ELPHABA THROPP" which is the character's formal name.
Outcome : Like the character, she is sparkling on the inside, but perople do not understand her. Wheh she gets mad the spark is ignited and the fire comes out. She expressed that many times she feels misunderstood and that people just get upset with her. She said she was practicing her social skills, which helped to relieve her frustaration and anxiety.

Project 9 (Termination): Final magazine collage
Material: Magazine
Directive; Using cut or torn out pictures from magazines create a collage that represents who Emma is.
Procedure: Engaged, including pictures of mostly people laughing, thinking, enjlying life, pile of money, chopsticks, the beach, the word Capricorn, and her own hand drawn picture of Tinkerbell.
Outcome: When she finished she stated that she used picture of things she enjoyed. Explained that she added Tinkerbell because even though she is ready to grow up, she wants to continue to enjoy things young people like, video games and baseball. Using Peter Pan and Tinkerbell as representation of the relationship between Emma and her father. Able to tell her story through her interest and connection to both Peter Pan and Wicked.

To be continued - on Conclusion.