Art Therapy with Children and Adolescents — Stages of Drawing Development, Play and Trauma Treatment, Identity and Body Image, Evidence and Ethics

Know development first

To understand a child’s drawing, you first need to know how children of that age usually draw. This prevents mistaking developmentally normal features for “warning signs.”

Lowenfeld’s stages of drawing development

Stage	Approx. age	Features
Scribbling	2–4	Scribbles; enjoyment of movement itself; gradually naming scribbles
Preschematic	4–7	”Tadpole” figures with limbs coming out of the head; free use of size and position
Schematic	7–9	Baselines and skylines; personal, repeated schemas
Gang age (dawning realism)	9–12	Desire to draw realistically; more overlap and detail
Pseudo-naturalistic	12–14	Critical self-evaluation; confidence in drawing easily drops

Lowenfeld’s (1947) stages are still used as a reference, but they vary considerably with culture and educational experience. Kellogg (1969), who collected a very large number of children’s scribbles from around the world, reported that early scribbling starts from similar basic forms.

For example, a six-year-old drawing a person with arms growing from the head is developmentally normal. A twelve-year-old who says “I can’t draw” and resists drawing is also typical of that age, so switching to lower-pressure media such as collage or clay can help.

Children: play, art and trauma treatment

For children, art is an extension of play. Play therapy and art therapy are often combined, helping children regain a sense of control by replaying experiences through play and drawing rather than words.

For traumatised children, the treatment with the strongest evidence is trauma-focused cognitive behavioural therapy (TF-CBT) (Cohen, Mannarino & Deblinger, 2006). TF-CBT includes a trauma narrative phase in which children organise their experience in stories or drawings, so art activities can serve as tools within it. Art therapy is strongest when used alongside such evidence-based treatments.

Adolescents: identity and body image

The central task of adolescence is identity formation (Erikson). Art lets teenagers experiment with a “self” that’s hard to explain in words.

• Self-symbol work: mask making, decorating the outside and inside of a mask differently, explores the self shown to others and the hidden self.
• Respecting distance: adolescents can be defensive about direct questions. Talking about a figure or symbol in the artwork makes it easier to express themselves indirectly.
• Body image and eating problems: drawing the body with adolescents who have eating disorders can reveal distorted body image, but it can also provoke strong anxiety. Eating disorders are illnesses that need medical care, so art therapy should be used as part of a specialist treatment team.
• Digital expression: using media familiar to teenagers, such as phone photography and digital drawing, increases engagement.

How strong is the evidence?

Slayton, D’Archer and Kaplan (2010) reviewed art therapy outcome studies from 1999 to 2007 and found positive results reported across groups including children and adolescents, but few randomised controlled trials and small samples. Art therapy with children and adolescents is likewise at the stage of “promising, but in need of more rigorous research.”

Ethics when working with children

• Consent: seek consent from guardians together with the child’s own age-appropriate agreement (assent).
• Ownership and display of artwork: get permission from both the child and guardians before exhibiting or photographing a child’s work.
• Procedures when abuse is suspected: don’t “diagnose” abuse from drawings (see Chapter 3). If a child’s words or behaviour raise concerns, follow legally mandated reporting procedures.

Check questions

Question 1. A five-year-old drew a person with arms coming straight out of the head. If a parent asks, “Is my child developmentally delayed?”, how might you explain?

Answer. In Lowenfeld’s preschematic stage (ages 4–7), drawing “tadpole” figures with limbs coming out of the head is common. It is developmentally normal, and on its own gives no reason to suspect delay.

Question 2. A 13-year-old refuses to take part, saying “drawing is childish.” What approaches could you consider?

Answer. At this age (the pseudo-naturalistic stage), self-evaluation becomes critical and teenagers often avoid drawing. Suggest methods that don’t depend on drawing skill, such as collage, photography or digital media, and invite them to talk about symbols in the work indirectly.

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References

• Lowenfeld, V. (1947). Creative and Mental Growth. Macmillan.
• Kellogg, R. (1969). Analyzing Children’s Art. National Press Books.
• Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. Guilford Press.
• Erikson, E. H. (1968). Identity: Youth and Crisis. Norton.
• Slayton, S. C., D’Archer, J., & Kaplan, F. (2010). Outcome studies on the efficacy of art therapy: A review of findings. Art Therapy, 27(3), 108–118.
• Malchiodi, C. A. (Ed.). (2008). Creative Interventions with Traumatized Children. Guilford Press.