Art Therapy and ADHD

Art therapy is a very useful intervention for children with ADHD, as it can introduce several ways of making them more connected to themselves and promote a moment of focus time, which helps to correct attention and hyperactivity issues. At the same time, by using the tools of art therapy, the children can practice different skills and expand their perception of the world that surrounds them, making them see things through different lenses.

To be able to pay attention to details, one needs to be focused, alert, and calm. The process of making art promotes this kind of exercise. In this case, we are talking about art as therapy for children, and what the experience of making artworks can bring to children with attention-deficit/hyperactivity disorder. Art has the power to reach our unconscious and our souls, making us more connected to our inner selves. In this sense, during art therapy sessions with ADHD children, the outcomes of the artworks may require the patient to try to explain what they were going through while they were expressing their feelings through the art activity. At this point, we have art in therapy happening, and this can make the treatment reach a deeper level for improving the child’s condition.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly diagnosed in childhood. Recently, there have been several tests to help diagnose ADHD, bringing about an increase in the number of children with this diagnosis. The ADHD core components identified by the DSM-IV criteria are: inattentiveness, impulsivity, and hyperactivity. The three ADHD subtypes are: primarily hyperactive, primarily inattentive, and combined.

This condition has been identified as both hereditary (genetic) and potentially influenced by environmental and nutritional factors. As presented by some scientific articles, one of the most common environmental causes is the increased screen time in children, especially after the COVID-19 pandemic. This ongoing growth of the digital media landscape represents one of the most significant cultural shifts of the past decade (Wallace, 2023).

Emerging research suggests that heavy digital media use in adolescents may impact brain function and cognitive development, potentially leading to difficulties with attention, memory processing, impulse control, and the reward system (Wallace, 2023).

Art therapy can play an important role in helping children with ADHD develop what they lack when dealing with digital media, by working on their graphomotor skills as well as redirecting their energy and hyperactivity.

There are also studies that show that one of the characteristics of those with ADHD is a low level of dopamine in the prefrontal cortex area of the brain, and that drawing and other forms of artistic expression that involve physical activity can help increase the dopamine levels, therefore improving their focus.

Unusual dopamine levels in the brain are believed to play a role in ADHD symptoms. Dopamine influences attention and is linked to the desire for new experiences. Brain scans have revealed that regions high in dopamine, such as the prefrontal cortex, are impacted in people with ADHD. Doodling, which involves hand movements to make patterns on paper, is a form of physical activity. Research suggests that even small movements like doodling can help boost focus in children with ADHD by influencing dopamine levels in specific brain areas, in a way similar to how stimulant medications work (Wilcox et al., 2023).

Another response from our bodies while making art is the reduction of the cortisol levels – the stress hormone (Wilcox et al., 2023).

Below are some of the main art therapy approaches used to support people with ADHD, especially children and adolescents:

• Group Art Therapy
• Cognitive Behavioural Art Therapy (CB-ART)
• Mindfulness-Based Art Therapy
• Directive Art Therapy
• Non-Directive (Client-Centred) Art Therapy
• Sensory-Based Art Therapy

Some therapists use integrative approaches, blending directive + sensory or CBT + mindfulness. In this essay, I will focus on the following three approaches: Group Art Therapy, Cognitive Behavioural Art Therapy, and Mindfulness-Based Art Therapy.

Group Art Therapy

Children with ADHD can have learning disabilities that are commonly linked to the disorder. However, most of them are not aware of that and are prone to having low self-esteem. Attending an art therapy group, for example, is a good way for them to see that there are more children like them. The understanding of the reason why they are not doing well at school makes them more prone to accepting their ADHD. This also reflects on a better understanding by the parents towards the difficulties of their child, as there can be a parallel educational group for parents as well (Safran, 2002). “Setting up the group for children or adolescents is only half of the plan. Parents (and siblings too) need to receive the same education that the ADHD child is learning.” (Safran, 2002, pp. 45).

According to Safran (2002), a typical art therapy educational group can follow an eight-week program as summarised below:

Session 1: Introduction to ADHD for group members.

Session 2: Examining family history related to ADHD, comorbidities and possible alternative diagnoses.

Session 3: Understanding ADHD and co-existing learning disabilities in broader contexts (school, family, job, community).

Session 4: Behaviour management using children’s drawings and family meetings.

Session 5: Behaviour modification techniques, communication tools, parent burnout, and coaching.

Session 6: Focus on siblings of ADHD children and parents’ own childhood experiences.

Session 7: Psychiatrist discusses ADHD medication, how it works, and recent research.

Session 8: Reviewing behaviour modification and the impact of the sessions on the family’s life.

The aim of the art therapy group for ADHD children is to make sure they acquire knowledge and understanding of this disorder, as learning how to deal with ADHD will result in a better life quality for them. The patient needs to be open to participating in the group activities and willing to be medicated, if needed.

Creating art during therapy supports learning by adding a multisensory element and involves both fine and gross motor skills. The drawings serve as visual reminders of insights about the ADHD child and help validate emotions. Additionally, art offers a constructive way to channel energy and manage hyperactivity (Safran, 2002).

Based on Safran’s (2002) experience, the eight-week program is a manageable trial that aims towards positive experiences and helps assess if ongoing art therapy is suitable, though not all participants are invited to continue.

Another benefit of group art therapy for ADHD children is the possibility to socialise with their peers.

The art therapy group provides a safe and controlled environment where children can achieve a successful social, therapeutic, and educational experience. It is a place where they can observe and interact with their peers who have the same problems and where the therapist can observe them (Kariž, 2003, pp.02).

Art Therapy Group Activities for ADHD

There are many art activities that can be done in groups to promote interaction, improve social skills, practice appropriate behaviour, as well as functional and emotional skills.

In regard to the social and behavioural areas, activities like group paintings, games, and work in pairs have been highly effective in fostering positive social interactions among children, helping them learn to listen, share, collaborate, support others, appreciate diversity, enhance self-control, and cultivate feelings of happiness and optimism (Kariž, 2003).

For functional skills such as graphomotor skills, focus, organisation, memory, and visual perception, there are a few art-based exercises that could be done. For instance, the group could work together in a pattern drawing, a geometric drawing, building a 3D object, assembling a mosaic or puzzle, as well as making an individual collage. Afterwards, they could write about their experience and share it with the group.

For the emotional skills, there are activities like drawing an outline of the children’s body on a big piece of paper on the floor and then adding personal characteristics to that outline. The children can also create a self-box (Jungian box), masks, self-portraits, and other similar activities. After finishing each activity, they can share what they made with the group.

After each session, children share and discuss their artwork, including expressing their feelings, which helps to improve communication, build trust, and connect emotions to their creations, especially important for those with ADHD who may struggle to express themselves clearly (Kariž, 2003).

Cognitive Behavioural Art Therapy

Cognitive behavioural art therapy is a powerful blend that can help children with ADHD. It is a combination of cognitive behaviour therapy, which helps to better manage thoughts and therefore feelings and behaviours, with art therapy, which helps to express emotions that might need to be verbalised.

For ADHD, specifically, this combination can help deal with aspects of this disorder, such as impulsivity, inattention, emotional dysregulation, low self-esteem, and difficulty with organisation and time management.

There are many ways in which art therapy can be applied to enhance Cognitive Behaviour Therapy for ADHD. We can see some techniques and tools exemplified below:

Visual Learning:

Usually, people with ADHD are very visual and practical learners. So, making them engage in a tactile activity such as creating art (drawing, painting, sculpting) will help them focus so they are able to externalise what’s going on with their inner self in a less stressful way than talking. Connecting with their emotions at this creative level allows them to bypass the cognitive barrier and express their feelings and thoughts in a way that can’t be accessed only with talk therapy.

Sequence of Drawings to Structure Mind through Creative Work:

Cognitive behaviour therapy focuses on identifying unwanted thoughts. Through art therapy, it’s possible to illustrate a common unwanted thought that can be transformed by using this technique (Gray, 2019) that is similar to Creative Mind Ordering. So, initially, a drawing of the unwanted thought is made, and then the feelings of this experience are described to the therapist. The next drawing will then focus on showing some aspect that is dormant in the child, precisely because of the cognitive control, helping them shine a light on it so it becomes visible to the consciousness. The following step will be merging this hidden, powerful quality illustrated in the second drawing with the first drawing, which will provide an alternative narrative to the brain. This becomes more concrete when the child is able to describe it through the use of their own words.

After that, further drawings are required to promote the change from an unwanted thought to a wanted thought. Therefore, the fourth drawing is the illustration of a wanted thought and how it would be reflected in their life. Then, the next drawing should represent the positive consequences of this wanted thought in their life. The process culminates in a fusion drawing of both the wanted thought and the positive consequences.

In every step, it’s important that the child describes how they experienced that specific feeling/thought in each drawing.

This assessment helps the brain to have a visual sequence of images, which gradually helps with a transition of mindset for the ADHD child. In a pleasant way, the change begins to be assimilated at a deeper level, and sometimes children can access it more easily than adults.

Behaviour Tracking in a Creative Way:

A behaviour tracking journal is another good tool for people with ADHD. For children, charts or journals can be boring to keep up with, so creating a “mood collage” or colour-coded diary can be a more interesting way to track behaviours and emotional states as well as improve self-awareness. Through this daily practice, it’s easier for them to stay mindful of their moods and feelings, and it can promote self-reflection and growth.

The result of this creative process in the form of a diary also helps the child to increase their self-esteem.

Structured Art Tasks:

Creating an art project like a comic strip of a daily routine or drawing a time map can facilitate the improvement of planning and sequencing skills. Furthermore, it creates a visual representation for the child of how they are spending their time. They can then realise that they are spending more time on a certain thing and not enough on another that should also receive time and attention. This tool specifically helps in the organisational and time management areas, which is also a challenge for children with ADHD.

Mindfulness-Based Art Therapy

Mindfulness, by definition, means the state or quality of being mindful. It is the ability to maintain the awareness of thoughts, feelings, bodily sensations, and the surrounding environment.

Mindfulness has its origins in Buddhist traditions, but in recent years it has gained widespread popularity among various non-religious communities, including those in healthcare, education, and the workplace, ranging from pre-school children to adults across the world (Zhang et al., 2021).

Art-making naturally promotes a mindfulness moment by helping to focus, calming down the nervous system, and giving a break to the overthinking state of mind. A well-rested mind is better equipped to handle inattention and emotional dysregulation. One way to enhance sensory regulation is to use textured materials, such as clay, fabric, sand, leaves, flowers, stones, and other natural elements.

Additionally, when a child is fully immersed in their painting, drawing, sculpting, or another art activity, they are more focused and relaxed to channel their self-expression through this medium, and this increases self-awareness.

Mandala:

A very good mindfulness-based art for ADHD children is Mandala drawing and/or colouring. It’s an ancient meditative tool in the Tibetan Buddhist tradition that brings a sense of unity and integration. It can help to anchor attention and reduce distractibility.

Mandala exercises gradually enhance attention and reduce impulsive behaviour, leading to improved task completion, overall developmental progress, and a growing appreciation for personal aesthetics (Smitheman-Brown, Church, 1996).

Calm Box:

Another mindfulness activity that can be presented to a child with ADHD is to build their own calm box. The child will decorate the box and fill it with self-calming tools, such as coloured pencils, crayons, stickers, blank papers, mandala colouring pages, Play-Doh, stress ball or squishy toy, bubble wrap, glitter jar, soft fabrics, a calming book, a picture of a loved one, positive affirmation cards, and other similar things. This will help the child to calm down, refocus their attention, and self-regulate.

The child will need to be taught when they need to use the calm box. They will need to learn how to recognise the signs that they need it, such as feeling angry, restless, anxious, having focus issues, or needing a break from stimulation or noise. They will then need to find a quiet space to use the box. After learning this tool, the child can start going to this kind of place voluntarily. They will then pick one of the things from the box that helps them feel better at that moment.

Conclusion

Each of the three approaches explored — Group Art Therapy, Cognitive Behavioural Art Therapy, and Mindfulness-Based Art Therapy — offers holistic techniques for managing ADHD by merging their core therapeutic principles with the expressive power of art therapy. As integrative interventions, they provide creative and effective pathways for individuals with ADHD to address challenges and foster personal growth. Furthermore, these approaches can be seamlessly blended, allowing for a personalised and flexible treatment experience.

References

Gray, Robert. (2019). Integrating and Advancing Art Therapy and Cognitive Behaviour Therapy (CBT). CECAT Art Therapy Course. https://online.arttherapycourses.com.au/

Kariž, Barbara (2003). ART THERAPY AND ADHD. https://www.researchgate.net/publication/267473163_ART_THERAPY_AND_ADHD

Rubin, J. A. (2012). Approaches to Art Therapy: Theory and technique (2^nd ed.). Routledge.

Safran, D. S. (2002). Art Therapy and AD/HD: Diagnostic and Therapeutic Approaches. Kingsley.

Sin, Jiah (2017). Mindfulness-Based Art Therapy in Working with School-Aged Children with ADHD in Emotional Regulation.  [Degree of Master of Arts]. Concordia University. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://spectrum.library.concordia.ca/id/eprint/982399/1/Sin_MA_S2017.pdf

Smitheman-Brown, V., & Church, R. R. (1996). Mandala Drawing: Facilitating Creative Growth in Children with ADD or ADHD. Art Therapy, 13(4), 252–260. https://doi.org/10.1080/07421656.1996.10759233

Wilcox, K (2023). How Doodling Helps Kids With ADHD to Focus. https://www.psychologytoday.com/intl/blog/mythbusting-adhd/202304/how-doodling-helps-kids-with-adhd-to-focus

Wallace, J., Boers, E., Ouellet, J. et al. Screen time, impulsivity, neuropsychological functions and their relationship to growth in adolescent attention-deficit/hyperactivity disorder symptoms. Sci Rep 13, 18108 (2023). https://doi.org/10.1038/s41598-023-44105-7

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