It’s always a pleasure to host one of my students’ articles on the website. Thank you, Carmen Franke, for sharing this essay as part of her coursework for the Art Therapy Diploma.
Enjoy.
Robert Gray
Director and Lecturer at CECAT
Registered Art Therapist, Psychologist and Theologian
MA A. Th., AThR; B. Soc. Sc. (Psych.) (Hons.), MAPS, AAPi.; BA. Theol. (Hons), MA Theol.
Express, Don't Conform
Art Therapy for Autistic & ADHD Adults
Introduction
This essay explores how art therapy can be effectively integrated into Behaviour Support for neurodivergent adults, highlighting its alignment with NDIS goals and Positive Behaviour Support (PBS) principles. It draws on practitioner insights, evidence-based literature, and case studies.
Neurodivergent people—those whose brains function differently from the "typical" neurological patterns—include individuals with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). The person may also have intellectual disabilities and other cognitive or sensory processing differences. These individuals often face challenges in emotional regulation, self-expression, communication, and social connection. Many also have co-occurring conditions such as anxiety, sensory processing disorder, or trauma histories that compound the complexity of their support needs.
Behaviour Support strategies focus on skill-building, environmental adaptations and response strategies. Art therapy, as a form of expressive therapy, can offer a complementary avenue for skill building that facilitates emotional exploration, builds regulation skills, and nurtures identity through the creative process. Used within Behaviour Support frameworks, art therapy activities can be tailored to the sensory, cognitive, and emotional profiles of clients.
Art as Therapy vs. Art in Therapy
Within the field of art therapy, a key conceptual distinction exists between "Art as Therapy" and "Art in Therapy"—a differentiation that carries important implications when integrating art-based approaches into Behaviour Support Plans (BSPs).
Art as Therapy is a model where the act of creating art is inherently therapeutic. This approach suggests that through spontaneous, self-directed artistic expression, individuals can achieve emotional regulation, self-soothing, and even healing—without necessarily interpreting or analysing the artwork (Kramer, 2021). The focus is on the process rather than the product. In Behaviour Support, this aligns closely with proactive and preventative strategies for reducing behaviours of concern. For instance, a client may be supported to engage in rhythmic painting or clay work as part of their daily routine, using the sensory and proprioceptive input to regulate their arousal levels and build tolerance to environmental stressors. This is particularly beneficial for neurodivergent individuals who may have limited verbal communication or difficulty articulating internal emotional states.
Art in Therapy, by contrast, uses artmaking as a component within a broader psychotherapeutic process. In this model, the artwork becomes a vehicle for insight, reflection, and meaning making. A trained art therapist helps the client explore the symbolic and emotional content of their creations to develop deeper self-awareness and emotional literacy (Martin, Kuhn, & Heffner, 2022). In the context of Behaviour Support, this method is especially useful when working with clients capable of engaging in reflective dialogue, including individuals with higher verbal skills or those with mild intellectual disabilities. It supports goals related to trauma-informed care, understanding behavioural triggers, and enhancing self-regulation through conscious insight.
Behaviour Support Practitioners can blend these two approaches. Initially, "Art as Therapy" may be introduced to establish a safe and non-confrontational way for clients to self-regulate and engage. Over time, as rapport strengthens and the client's emotional capacity grows, "Art in Therapy" techniques may be introduced to support more complex skill development, such as recognising behavioural antecedents, developing self-narratives, and improving interpersonal relationships.
For example, a client with autism who finds traditional talking therapies too overwhelming may begin with sensory-based mark-making to de-escalate when distressed. As trust builds, they may be supported to create a visual diary or emotion wheel, using these tools to identify patterns and gradually develop language around their feelings. This layered use of art therapy mirrors the tiered and person-centred ethos of Positive Behaviour Support, offering flexible entry points and goals that enhance both behavioural outcomes and overall quality of life.
Thus, recognising the distinction—and complementarity—between Art as Therapy and Art in Therapy allows Behaviour Support Practitioners to tailor their interventions with greater precision and empathy, ensuring that creative modalities are used in ways that genuinely align with the needs and capacities of each individual.
Neurodivergence and Art Therapy
Neurodivergence encompasses a range of cognitive and developmental differences that impact how a person processes information, communicates, experiences emotions, and interacts with the world. Common characteristics include heightened sensory sensitivity, differences in executive functioning, challenges with emotional regulation, and difficulty interpreting or expressing social cues (Milton, 2012; Mazefsky et al., 2014). These challenges often lead to behaviours that are labelled as “a risk” or “of concern,” particularly in environments that do not accommodate neurodivergent ways of being.
For neurodivergent adults, navigating the world often involves masking—suppressing one’s natural responses to conform to social expectations. This can lead to chronic stress, burnout, and a reduced sense of self (Gillespie-Lynch et al., 2022). Art therapy provides a safe, accepting space where clients are not required to mask. They can stim, sit quietly, or engage deeply in the creative process without being corrected or judged. Importantly, art therapy removes the pressure of verbal communication, allowing thoughts and feelings to emerge visually, symbolically, or through gesture and texture.
Neurodivergent individuals often struggle with proprioception and interoception—awareness of their body's position in space and the internal cues it provides. This can limit their ability to identify signs of stress building up. Art therapy can indirectly build these connections by engaging motor planning, body-based awareness, and visual-symbolic reflection, supporting gradual skill development.
Skill Development in Behaviour Support
Within the Positive Behaviour Support (PBS) framework, skill development is a foundational component. It moves the focus from reactive behaviour management to proactive and capacity-building strategies. Behaviour is viewed as a form of communication and an adaptive response to an environment that may not be accommodating the person’s needs. Therefore, reducing behaviours of concern must go hand-in-hand with teaching new skills that empower individuals to meet their needs more safely and effectively.
For neurodivergent individuals, skill development often involves learning how to recognise internal states, articulate needs, manage sensory input, and navigate social environments. These are not simply "behaviours" to be taught and reinforced—they are complex biopsychosocial processes that require a safe, engaging, and adaptive learning context. Art therapy provides such a context.
Art-making naturally engages executive functioning, sequencing, decision-making, and emotional modulation. For example, when a client is asked to draw their week or sculpt a recent feeling, they are practising emotional recall, narrative sequencing, perspective-taking, and symbolic communication. These processes are foundational for building skills related to:
- Emotional literacy and self-regulation
- Visual and symbolic communication
- Self-advocacy and choice-making
- Sensory integration and modulation
- Relationship-building and social reciprocity
By embedding these skill-building opportunities within the creative process, art therapy aligns seamlessly with the goals of Behaviour Support Plans (BSPs) and facilitates measurable progress toward NDIS goals.
Consider a neurodivergent adult client with limited verbal communication and a history of aggressive outbursts when routines are disrupted. The Behaviour Support Plan identifies a need to develop emotional regulation skills and alternative communication strategies. Art therapy is introduced as part of the plan. The client begins with simple sensory-based mark-making using soft pastels, which offer calming proprioceptive input. Over time, the sessions progress toward creating visual emotion maps and drawing storyboards of triggering events. This enables the client to reflect, anticipate, and rehearse coping strategies visually.
Another client with ADHD and a mild intellectual disability struggles with transitions between activities and often experiences dysregulation due to executive functioning challenges. Through art therapy, he creates visual checklists and goal boards, externalising his tasks through drawings and icons. These artworks are not only expressive but also serve a functional purpose. He is taught to visually identify how he feels before and after a task, and which sensory strategies (e.g., using clay, breathing exercises) help him manage transitions.
Thus, the integration of art therapy is a mechanism for achieving skill development in a neurodiversity-affirming, engaging, and evidence-informed manner.
Therapeutic Role of the Practitioner
The therapeutic relationship is a core element in both Behaviour Support and art therapy. While Behaviour Support is often seen as a structured, outcome-focused intervention, its success is significantly dependent on the quality of rapport, trust, and co-regulation between practitioner and client—particularly when working with neurodivergent individuals who may have a history of trauma, rejection, or misunderstanding in services (Crane et al., 2021).
Art therapy naturally supports relationship-building by reducing the demand for eye contact, sustained verbal dialogue, and emotional disclosure that many neurodivergent individuals find confronting or exhausting. Instead, the relationship is formed “side by side” through joint attention to the art process—a dynamic that feels less intrusive, more collaborative, and inherently respectful of neurodivergent communication preferences (Martin et al., 2022).
The practitioner’s role shifts from expert or instructor to co-explorer. In my experience, this shift enables greater client agency and empowerment, particularly for individuals who have been subject to high levels of control, compliance-focused support, or restrictive interventions in the past. By offering choice in materials, respecting neurodivergent processing styles, and affirming creative self-expression, the practitioner signals that the client’s experience is valid and welcomed—whether or not it conforms to neurotypical expectations.
This is particularly important for clients who mask or camouflage their neurodivergence in social settings. Within the art therapy space, masking is not necessary. Clients are invited to be as they are—stim, pause, explore, be silent, or focus intensely. This creates a psychologically safe environment that fosters true emotional processing and growth.
Crucially, art therapy also supports the development of social connection and interpersonal skills, especially for clients who find traditional social skills training too abstract or contrived. Collaborative art-making tasks—such as shared drawing exercises, storytelling panels, or mirroring shapes—allow clients to practice turn-taking, shared focus, and emotional reciprocity. The therapist can scaffold these moments by modelling reflective listening, helping clients label emotions, and supporting them to respond in socially appropriate ways without relying on didactic instruction.
For clients with intellectual disability, the therapeutic relationship can also provide a foundation for trying new interpersonal roles. Through symbolic play, storytelling, or collaborative artwork, clients can safely explore being assertive, curious, nurturing, or vulnerable—roles they may not otherwise feel able to adopt. This fosters relational flexibility and supports the development of broader social skills.
Case examples
Case 1: Emotional externalisation
A client in his mid-30s with a diagnosis of ADHD and a mild intellectual disability was referred for Behaviour Support after repeated incidents of verbal aggression and shutdowns at his day program. He was non-verbal during periods of distress and struggled to explain what triggered his emotional outbursts. As part of the behaviour intervention, we introduced symbolic art-making activities. One early session involved using colour and shape to draw “what your day felt like.” The client used jagged red lines and black shapes to describe a bus ride that had been noisy and overwhelming. In later sessions, we built a library of visual metaphors—storm clouds for agitation, swirls for confusion, blue waves for calm—that became an internal toolkit for communicating with staff. Over time, staff were trained to recognise his visual cues and offer breaks or sensory support when early signs of distress emerged.
Case 2: Identity development
A female client with Autism and a trauma background had difficulty articulating how she felt about herself and often engaged in self-injurious behaviour following social interactions. She described feeling “wrong” or “broken” but couldn’t identify why. We invited her to create an abstract self-portrait using oil crayons. The process allowed her to express complexity through layering—muted greens, jagged yellow strokes, fragmented shapes. Through reflection, we explored these as metaphors: “unseen”, “electric under the skin”, “pieces that don’t fit together.” This led to new insights about her sensory experiences and social masking. Over weeks, her work evolved, with colours softening and images becoming more integrated. The abstract art-making process bypassed shame and allowed for authentic self-expression, thereby improving her self-compassion and reducing self-injury.
Case 3: Building social confidence
A 28-year-old autistic client presented with a strong desire to make friends but was unsure how to initiate and sustain interactions. He was often perceived as “too intense” or “talking too much” and became increasingly isolated. Traditional social skills programs had left him feeling self-conscious and discouraged. In therapy, we used six-panel drawings to storyboard recent social situations. We explored what worked well and what felt uncomfortable, using visual mapping to highlight emotions, intentions, and outcomes. We also did collage work representing “Friend Me” and “Private Me,” helping him understand personal boundaries and reciprocity. Through joint art tasks, like shared story drawing, he practised subtle turn-taking and co-creation. Over time, he developed a clearer awareness of social cues, built confidence in navigating conversations, and was able to identify safe and supportive peers.
Art Therapy and Quality of Life
At the heart of Behaviour Support under the NDIS is the goal of enhancing a person’s quality of life. According to the NDIS Quality and Safeguards Commission (2021), effective Behaviour Support must be person-centred, focus on the individual’s goals and preferences, and work toward outcomes that improve daily living, participation, and wellbeing.
Quality of life for neurodivergent individuals is closely linked to autonomy, meaningful engagement, emotional well-being, and positive identity development (van Heijst & Geurts, 2015). Art therapy provides an accessible and strengths-based modality through which individuals can explore and construct meaning in their lives. It enables self-reflection and storytelling, allowing clients to frame their experiences through a lens of agency and creativity.
For adults with autism and/or intellectual disability, who may experience limitations in verbal self-expression or who feel disempowered by prior experiences in healthcare or education, art therapy creates a context of psychological safety. It validates non-verbal ways of knowing and offers opportunities to experience mastery, pride, and connection—all of which are critical to wellbeing (Martin et al., 2022).
Art therapy also enhances quality of life by improving emotional regulation and reducing stress. Neurodivergent individuals are often in a heightened state of arousal due to sensory or cognitive overload (Baranek et al., 2018). Engaging in tactile, rhythmic, or visually focused activities has been shown to activate parasympathetic nervous system responses, resulting in increased calmness and focus (Kramer, 2021).
Moreover, art therapy facilitates social participation by creating opportunities for shared meaning-making and co-creation. In both individual and group settings, clients learn to express their needs, empathise with others, and practice relational reciprocity in a structured and supported way. This can lead to improvements in interpersonal relationships, self-esteem, and community inclusion.
Finally, when integrated into a Behaviour Support Plan, art therapy helps build a life that is not merely free of concerning behaviours but full of purpose, connection, and joy. As Behaviour Support Practitioners, our role is not only to minimise harm but also to maximise potential—and art therapy offers a unique and effective pathway for achieving this.
Conclusion
Art therapy offers a profound and respectful modality for supporting neurodivergent adults—whether or not they have an intellectual disability—within the context of Behaviour Support under the NDIS. It provides a bridge between emotional experience and expression, offering sensory-safe ways for clients to develop skills in regulation, identity, and interpersonal connection.
For Behaviour Support Practitioners and Counsellors, art therapy represents an alternative to directive or compliance-based interventions. It is person-centred, creative, and affirming. It provides visual, sensory, and relational tools that reduce reliance on verbal processing, making support more accessible. When combined with clear behaviour hypotheses and proactive strategies, it strengthens the foundation of Positive Behaviour Support planning.
Whether it is through drawing emotions, sculpting challenging feelings, developing visual metaphors for social dynamics, or simply being accepted in an affirming space, neurodivergent clients benefit from the expressive, therapeutic, and co-regulatory power of art. As practitioners, we are not just helping people manage behaviours—we are nurturing the conditions for them to thrive.
References
Antshel, K. M., & Russo, N. (2019). Executive functioning and emotional regulation in individuals with ADHD. Journal of Attention Disorders, 23(6), 591–603. https://doi.org/10.1177/1087054716647478
Arnold, S. R. C., Hwang, Y. I., Trollor, J. N., & Lawson, L. P. (2020). Practice priorities to improve the mental health of autistic adults: A community-informed eDelphi study. Autism, 24(4), 822–833. https://doi.org/10.1177/1362361320908410
Baranek, G. T., Schaaf, R. C., Miller, L. J., Honaker, S. M., & Schoen, S. A. (2018). Sensory features in autism spectrum disorders. In Volkmar, F. R. (Ed.), Handbook of Autism and Pervasive Developmental Disorders (4th ed.). Wiley.
Crane, L., Batty, R., Adey, S., Goddard, L., Henry, L. A., & Hill, E. L. (2021). Autism diagnosis in the United Kingdom: Perspectives of autistic adults, parents and professionals. Journal of Autism and Developmental Disorders, 51, 2145–2158. https://doi.org/10.1007/s10803-020-04632-0
Gates, J. A., Kang, E., & Lerner, M. D. (2017). Efficacy of group social skills interventions for youth with autism spectrum disorder: A meta-analysis. Clinical Psychology Review, 52, 164–181. https://doi.org/10.1016/j.cpr.2017.01.006
Gillespie-Lynch, K., Daou, N., & Crane, L. (2022). Autistic identity and well-being: The role of diagnosis, advocacy, and community connection. Frontiers in Psychology, 13, 801291. https://doi.org/10.3389/fpsyg.2022.801291
Kramer, E. (2021). Art as therapy: Collected papers. Charles C Thomas Publisher.
Martin, N., Kuhn, C., & Heffner, A. (2022). The neurodiversity-affirming art therapy space: Honoring autistic ways of being. Art Therapy: Journal of the American Art Therapy Association, 39(1), 4–12. https://doi.org/10.1080/07421656.2021.2013475
Mazefsky, C. A., Borue, X., Day, T. N., & Minshew, N. J. (2014). Emotion regulation patterns in autism spectrum disorder: Comparison to typically developing youth and association with psychiatric symptoms. Autism Research, 7(3), 344–354. https://doi.org/10.1002/aur.1366
Milton, D. (2012). On the ontological status of autism: The 'double empathy problem.’ Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008
NDIS Quality and Safeguards Commission. (2021). Positive Behaviour Support Capability Framework. https://www.ndiscommission.gov.au
van Heijst, B. F., & Geurts, H. M. (2015). Quality of life in autism across the lifespan: A meta-analysis. Autism, 19(2), 158–167. https://doi.org/10.1177/1362361313517053
