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Sunday, January 30, 2011

Drawing - more than illustration

If you're reading this blog, I'm going to assume that you know someone with autism, and that you're looking for information on how to reach and teach them. That's good, because this blog and the connected website (Autism and the Art of Communication) are all about sharing practical therapy and teaching techniques that I have developed over more than 20 years of working with this population (the website is currently under construction, as I come up to speed on the technical side of website production, so please be patient).

The first time I knowingly worked with individuals on the autism spectrum was in 1989, when I took a job with a school board specialized unit for adolescents and young adults with ASD. Starting with the older group was an advantage, because it quickly showed me the limitations of many established conventional therapy approaches. I met multiple people who were clearly intelligent, but had no effective means of communicating with the rest of the world - some had opted to withdraw, others had regular outbursts of frustration and anger. It was in this setting that I met my first "artist" - an non-verbal older teen boy who endlessly drew elaborate images of playing card faces. My training with teaching brain-injured adults to communicate using alternate modes said that it should be possible to use his drawing skill to bridge the communication gap. Unfortunately, at that time I was too green and he was too set in his patterns for us to make any headway, but the idea stayed with me.

In 1993, I met Adam. It was a time of professional change for me, as drastic cuts in public funding for speech-language pathology in Ontario bumped many SLP's (myself among them) from public service to private service contracts. Adam's family was relocating from the States to Canada, and they contacted me to see if I would take him on as a private client. I told Casey (Adam's dad) that I didn't actually have a private practice - his response? "Can I convince you that you do now?" And so it began.

Adam was three years old and profoundly non-verbal when I met him - he said "mmm" for "marble" sometimes. I was a communication professional certain of what I didn't want to see at an older level, but uncertain about how to change that picture. I have to say that Adam has been very patient with me over the years, and has always rewarded my therapy breakthroughs with a look that can best be described as "Could you not have just done that first?"

Initial therapy sessions were flitting bits of attention: putting fingerpuppets on his toes as he sat in a truck tire, looking at a page of a picture book under a blanket, bouncing balls down the steps in the back garden. Many times I went to his house, determined to tell his parents that they were wasting their money, and that I didn't know how to reach him - but then he would give me the slightest bit of something: a look, a brief connection, a surprise response; and I would say to myself "okay, one more week". One day, out of desperation, I began to draw for him, simple cartoon pictures that could match the imprecise sounds he was producing - it worked - he stayed in one spot, he made more sounds to get me to draw more things for him, we had a connection.

In those early years, we used the drawing as a platform for shared understanding. I drew endless vignettes and stories, explaining the world to Adam. We also used many visual computer programs to expand his knowledge of the world - reading and math programs that included the cartoon characters that he loved. Watching animated shows was one of his favourite pastimes - he would often rewind and repeatedly watch the same few moments of action, and his parents accomodated him in this, since it seemed important to him. Later on, when Adam became adept at using his drawing for expressive communication, it became obvious that during those endless rewinds, he was studying the cause and effect of physical and emotional interaction. A good lesson for all of us - just because a non-verbal person can't explain why they're doing something, doesn't mean that there's no purpose to their actions and choices.

I would not have predicted that Adam would develop usable coherent drawing skills. His fine motor skills were so severely affected that we took all fine motor requirements out of his academic program starting at preschool level - he used stickers, letter and number stamps, and computer keyboard to give answers in school. At the same time, he worked with an occupational therapist who patiently encouraged his fine motor development through copying tasks and games with little language load. If you had asked me at that time whether Adam would ever write or draw, I would have told you that it was highly unlikely, and that we were encouraging him to use a keyboard instead. Which only goes to show that you shouldn't make pronouncements about the future, especially when you're dealing with people as individual and complex as those on the autism spectrum.

When Adam was eight years old, he spontaneously drew a picture of himself on a large easel in the classroom, in the exact same form as I had drawn him endless times over the past four years (he even used a red marker, which was the colour we had chosen for his character in the cartoon comic strip stories I drew for him about everyday life). What a surprise. His expressive drawing took off from this point. Using a "follow me" approach I began to formally teach him how to represent objects with drawing (take a look at the website under "getting started" for more information about this technique). This process was made easier by the fact that everything I had drawn for Adam up to that point was stored in his very detailed visual memory - it was a matter of helping his motor system to catch up to his visual intellect.

Over the years, we have used drawing for all of Adam's academic learning (you've never seen the food chain represented with such action and emotional reaction). We have used the drawing as a "scaffold" to teach conventional language (first written, then verbal) and social interaction skills - we have worked out difficult everyday situations, discovering the often surprising sources of his stress and distress reactions, helping him to deal with changes in his life, new situations, other people.

Adam is now 21 years old, and drawing is still his clearest form of expression. Although he can now speak in generally intelligible full sentences, when he is upset, sick or suffering from allergies, he still loses his verbal language. Because he has expressive drawing, he is never left without a voice. He is a confident and generally happy person who knows that he can control his world with communication - much different from the distressed and frustrated young adults that I first met.

I have used the techniques that I developed with Adam for many other ASD individuals in my practice. These techniques have turned out to be widely applicable (for both verbal and non-verbal individuals), and I use them to some degree with all of the people that I work with. I have a lot of practical information to share, and will do my best to put it out here in a form that's helpful to any/all who would like to try it out. Feel free to post comments and questions and let me know what you're interested in hearing more about.

Sheila Bell


  1. I like the way you found that pictures could match sounds for Adam.

    Sometimes, drawing is very much about the senses and making sense.

  2. I think at a very basic level, it helped Adam to make sense of why people were always launching sounds at each other - that there was a purpose to it other than simply annoying him with the noise