THE USE OF THE KINETIC FAMILY DRAWING IN THE EXPLORATION OF THE VIEW EACH PARENT HAS OF THE FAMILY AND THE IDENTIFIED PATIENT IN FAMILIES THAT HAVE A CHILD WITH THE ASPERGER SYNDROME
Josefa Frenkel, Art Therapist (M.A.). Nes Ziona Mental Health Center. Israel.
INTRODUCTION
Art therapy may be particularly successful with children having the Asperger Syndrome since these people have a predominantly visual style of thinking. This gives a tremendous advantage to the use of art in therapy, as outlined by Temple Grandin (1988), a well-known personality having the Asperger Syndrome. “My mind is completely visual and special work suck as drawing is easy… Every piece of information I have memorized is visual…When I think of abstract concepts such as human relations, I use visual smiles.” Great advances in science and art have been attributed to people with the Asperger Syndrome, partly due to their original way of thinking. Family art therapy provides parents and children with a more even leveled ground thus bringing them closer in their interaction. Art therapy may prove a very powerful working tool with this population. The lack of Theory of Mind in most cases of autism as well as Asperger Syndrome is responsible for social and communicative difficulties. Theory of Mind involves a person postulating the existence of mental states and then using these to explain and predict another person's behavior. There is a direct relationship between the Theory of Mind and social pragmatic abilities in everyday life. The direct concretization of feelings and thoughts possible through art materials can by-pass the "mind blindness" typical of children with Asperger's Syndrome.
The purpose of this study is to explore the view each parent (mother and father separately), has of his family and his child (the I.P.), who has been diagnosed with the Asperger Syndrome. These views will be researched through the use of the Kinetic Family Drawing projective evaluation test (K.F.D), as well as a semi-structured interview of each parent following the drawing session.
The K.F.D. test was developed by Burns & Kaufman in 1970 and gives expression to family dynamics. This research was influenced and guided by two additional relevant studies which developed and improved scoring techniques for the original K.F.D. Interpretative Manual by Burns & Kaufman (1972). These two studies are: "The Use of the K.F.D. as a Diagnostic Tool in Assessing the Child's Self-Concept" by Elin & Nucho (1979) and a later study named "Kinetic Family Drawing Scoring Method for Cross-Cultural Studies" carried out by Wegmann & Lusenbrink (2000). Another valuable study which influenced this research is Niesenbaum's study called: "Comparative Study of the K.F.D. and the Animal K.F.D. in regard to Self-Concept Assessment in Children of Divorced and Intact Families" (1983).
The underlying purpose of this study is to become familiar with commonly held "Asperger" family issues and views. These in turn may possibly assist the therapist working with these families and may prove a contribution in the formation of a future art therapy-working model for family therapy with this population.
* Asperger Syndrome - The diagnostic term Asperger Syndrome is relatively widespread today, this was not the case only a few years ago. The first definition of such children was published over 50 years ago (1944) by Hans Asperger, a Viennese pediatrician in his doctorate. He identified a consistent pattern of disabilities and behavior that predominantly occurred in boys. The pattern included a lack of empathy, little ability to form friendships, one sided conversations, intense absorption in special interests and clumsy movement. Unfortunately only in 1990 did Asperger's pioneering work receive international recognition (Attwood, T. 1998). The essential features of Asperger's Disorder are severe and sustained impairment in social interaction (Criterion A) and the development of restricted, repetitive patterns of behavior, interests and activities (Criterion B) (see p.66 in Autistic Disorder for a discussion of Criteria A and B - D.S.M. -IV, 1994).
The disturbance must cause clinically significant impairment in social, occupational, or other important areas of functioning (Criterion C). In contrast to Autistic Disorder, there are no clinically significant delays in language (e.g. single words are used by age 2 years, communicative phrases are used by age 3 years (Criterion D). In addition, there are no clinically significant delays in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood (Criterion E). Asperger Syndrome is about five times more common than Autism (Gillberg & Gillberg, 1989). The prognosis for Asperger Syndrome is considerably better than for classic Autism (Bishop D.V.P., 1989). In the 1990's the prevailing view is that Asperger Syndrome is a variant of autism and P.D.D. It is considered a sub-group within the autistic spectrum and has it's own diagnostic criteria (published in the D.S.M.IV).
* The Family of the Exceptional Child - In a study of coping and coherence among parents with disabled children carried out by Malka Margalit, Amiram Raviv and Dee B. Ankonina of Tel Aviv University (1992), some relevant information was put forth. The parents with disabled children showed significantly more avoidant coping, lower sense of coherence and less emphasis on family members inter-relations and personal growth than did the control parents or normal children. Significant discrepancies between mothers and fathers were found in three areas: avoidant coping, sense of coherence and personal growth.
The rationale for family art therapy is rooted in the recognition that an individual's learned responses to life and difficulties in living evolved from and are a part of an ongoing network of family relationships (Wadeson, 1980). The pathology of the child is seen as residing in the family matrix rather than in the individual alone, demanding treatment for the entire family in order to bring about long lasting change. The social aspect of development receives the greatest emphasis during latency, thus, most of the energy is free to concentrate on social and inter-personal aspects of development. Should he lack the necessary tools to succeed in these, his self-image will be hurt.
* The Kinetic Family Drawing - Burns & Kaufman discovered that the K.F.D. reflected primary disturbances more quickly and adequately than interviews or other probing techniques. Today the K.F.D. is considered an important addition to the psycho-diagnostic field. The K.F.D. gives expression to the family in dynamic action in contrast to other akinetic family representations.The analysis of kinetic drawing focuses on the action or movement rather than the inert figures. The addition of movement mobilizes the child's feelings about himself and about his place in the family, thus exposing the quality and extent of inter-personal relations in the family. This researcher believes the same is true of the adult parent drawing in the K.F.D.
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METHODOLOGY
A sample of five married couples aged 25-55 years, parents of latency boys 7-11 years and early adolescents aged 12-13 years diagnosed with Asperger’s Syndrom, were administered with the K.F.D. projective evaluation test. These were followed by a personal semi-structured interview of each parent. Three main variable factors were studied: the self-concept of each parent, his view of the other parent and his concept of the I.P. child. These gave a sense of the quality of family dynamics and interaction in such families.
Information gathered from the K.F.D. standard Burns & Kaufman scoring sheet, Elin & Nucho's scoring system and Wegman & Lusenbrick's scoring method, as well as the information based on the personal interviews, was all charted. These charts were examined for patterns in family history, art contents as well as for patterns across the groups of mothers and fathers.
Elin & Nucho's K.F.D. Scoring Sheet was used to assess the self-concept of mothers and fathers separately. The scoring system records the obstacles in the studied interactions. Hence, The higher the score the more problematic the interaction or relationship seen in the K.F.D. A low score in contrast, indicates a relatively positive interaction and relationship. The dimension of interaction versus isolation is assumed to be central in assessing self-concept. This is operationalized through the following factors: Action, Hands, Access, and Affect. Action refers to the interaction among family members. The presence of hands reflects the ability to have effect on persons and objects in the environment. Access implies the number of obstructions and the physical distance between individual figures studied. These are subdivided into: Barriers, Compartments and Quadrants. Affect reflects the feeling tone displayed by the figures in the K.F.D. Thus each drawing is rated along these variables yielding numerical values. The total score corresponds to the self-concept of the person studied.
The factors of action (extent of interaction versus isolation) and of barriers in Elin & Nucho's scoring sheet are the two factors most influential on the total score acquired by each parent, in this study. The three variants: barriers, compartments and quadrants refer to obstacles in the interaction between parents and their (I.P.) child. Rimmerman (1983) writes that these various types of obstacles stand in the way of expression of emotional energy between individuals. In a healthy familial environment positive emotional energy is expressed without obstacles. In contrast, when internal or external factors affect feelings obstacles will prevail among the individuals in the K.F.D. It is assumed that the projection of feeling in the K.F.D. reflects the quality of interaction between the figures portrayed as well as one's general state of well-being. This is supported by research done by Coopersmith in 1976. In this study, the high percentage of neutral affect expressed by both parents K.F.D.'s in the drawing of the I.P. child is supported by the fact that the children with the Asperger Syndrome have limited use of gestures and facial expression and have a peculiar stiff gaze.
According to Burns & Kaufman (1972) encapsulation (The lines that enclose or encircle a whole figure) is a subtle technique for isolating family members. 60% of parents encapsulated either themselves or the I.P. child. This gives expression to the quality of the interaction prevailing between them and their child. 40% more mothers than fathers used encapsulation. It can be summarized that the general affect portrayed in the K.F.D.'s of all parents in mainly neutral. The I.P.'s affect is in complete agreement to the specific parent doing the K.F.D. This suggests a strong mutual influence between parents and the I.P. in their concept or view of self.
RESULTS
The most striking and significant fact revealed by this study is that in most of the K.F.D.'s of both parents, no interaction whatsoever among family members was expressed. 80% of the mothers and 60% of the fathers have a poor interaction with their child. As indicated by Elin & Nucho (1997) poor interactions are assumed to lead to negative self-concept.
Thus is appears that the entire family suffers from the most prominent disability of the child with the Asperger Syndrome, namely social impairment which expresses itself in prominent difficulties in inter-personal and social communication. This is the single most important pattern revealed through the family dynamics of the sample studied in this research. It was demonstrated that there is a direct relationship between inter-personal relations and self-concept, (Elin & Nucho, 1997). All results indicated a tendency for a negative self-concept of both parents. The difference in the self-concept between mothers and fathers was not significant (4% in favor of fathers) in Elin & Nucho's scoring. In general it appears that the more realistic picture of family dynamics was exposed in the K.F.D.'s rather than by the interview where a degree of general idealization of the I.P. was expressed. The interviews’ contribution lies mainly in the exposition of family health history and relevant information regarding dynamics in the original core families, which was important in this research where the K.F.D. was administered to adults rather than to children.
Comparative K.F.D. Scoring Sheet
Mothers / Fathers / I.P. in Ma KFD / I.P. in Fa KFDActions / 60% = 3
40% = 2 / 80% = 3
20% = 2 / --- / ---
Hands / 80% = 0
20% = 1 / 80% = 0
20% = 1 / 100% = 0 / 80% = 0
20% = 1
Barriers / 12 Total / 7 Total
Compartments / 5 Total / 6 Total
Quadrants / 100% = 1 / 60% = 1, 20% = 2
20% = 0
Affect / 80% = 1
20% = 0 / 60% = 1, 20% = 1
20% = X / 80% = 1
20% = 0 / 60% = 1
20% = X
Total / 43 = (57%)
75 100 / 40 = 53%
75 100
Ma = Mothers, Fa = Fathers, X = no affect could be deciphered
DISCUSSION AND CONCLUSION
The birth of an exceptional child shatters many parental expectations. The typical stages such parents usually undergo are: a loss of self-esteem, guilt feelings, shame, ambivalence of contradictory, positive and negative feelings toward the I.P. child, and depression. The entire family may turn into an exceptional family adopting pattern of family seclusion both within and without (Mishori, 1992).
In discussing coping patterns Greenspan & Weidler (1998) report some parents of exceptional children saddened and disappointed by their child, become hostile and rejecting; they withdraw physically and emotionally, keeping their interaction to a minimum. Only by keeping a "safe" distance between them and their child can they protect themselves. Becoming over-protective and anxious, other parents limit their child's interaction with others thus affecting negatively the I.P. child's self-image.
Elin & Nucho's greatest contribution is their appreciation of the importance of inter-personal relationships in shaping a sound self-concept. In this study Elin & Nucho's scoring system for the K.F.D. was used mainly to study each parent's self-concept and their relationship with the I.P. child, which is instrumental in the child's formation of a sound self-concept, (Elin & Nucho, 1979). Other family dynamics were also explored. The dimension of interaction versus isolation is assumed to be central in assessing the child's self-concept (Elin & Nucho, 1979). This researcher believes there is a mutual effect and influence of the lack of interaction on the concept of self of both parent and I.P. child. The study of Coopersmith (1967) lends support to the influence of interaction on self-esteem.
In the scoring sheet of Burns & Kaufman (1972) symbols give expressions to family style of behavior. The symbols most commonly used were computers and T.V.s, which are common modern age symbols associated with isolation and lack of human interaction. In the K.F.D.'s most of these were in use by either fathers or I.P. children. In the variant of actions of individual figures: in 40% of the K.F.D.'s of mothers and in 60% of the K.F.D.'s of fathers the I.P. was working on the computer by himself.
According to Burns & Kaufman (1972) compartmentalization (Lines that organize space, placing figures in compartments and structure the entire drawing) occurs in K.F.D. of children when feelings of love cannot be expressed naturally. It seems only natural to assume that the same is true for adults. The K.F.D. analysis sheet used to score the K.F.D.'s of parents in this study revealed that 40% of the fathers and 20% of the mothers used compartmentalization in their drawings, i.e. twice as many fathers than mothers drew obstructions in expressing their feelings towards their families, especially towards the I.P, or their wives. This fact may serve to support the hypothesis set forth in this research that since most children with Asperger Syndrome are males (4:1 Ehelers & Gillberg, 1993), the self-image of the father may be more negatively affected than that of the mother. However, this was not a clear-cut picture projected by other scoring factors.
According to Burns & Kaufman (1972) edging is an expression of a position of staying outside without getting involved. 60% of the fathers and 40% of the mothers used edging in their K.F.D's. This implies that nearly half of the mothers and more than half of the fathers feel the need or desire not to be involved. This surely influences their capacity and desire to be in communication with their families. In turn this affects the child's acquisition of communication skills, which will help him socialize and promote his development.
It appears that the most significant fact revealed through the Burns & Kaufman K.F.D. analysis sheet in this research is the fact that no actions between individuals whatsoever were scored in any of the drawings of either mothers or fathers. In their study of social behavior on Asperger children made in Sweden, Gillberg & Gillberg (1989) describe the social impairment of children with Asperger's Syndrome as failure in interaction with their peers. D.S.M. IV describes the child's qualitative impairment in social interaction and his lack of social and emotional reciprocity. This researcher believes that this social impairment seems to affect and characterize the entire family of the exceptional child, who in Mishori's words (1994) becomes "an exceptional family".
When adding the sum total of percentage of the three types of obstacles namely, compartmentalization, encapsulation and barriers, there is a 100% correlation between the K.F.D.'s of both parents. Interaction and relationship is expressed by various variants. The K.F.D.'s of both parents expose no interaction whatsoever among family members. There is also no direct facing among family members in any of the K.F.D.'s drawn. There is complete agreement in this variant with its equivalent "action between individual figures" in Burns & Kaufman's analysis sheet where no action between individual figures was described; and between the variant "action" in the Elin & Nucho scoring sheet. Here action or rather the lack of it, was the most influential element affecting the negative tendency in scoring the self-concept of both parents. These reflect a gloomy picture of lack of communication within the family of a child with Asperger's Syndrome. In the variant of shared activities, there appears to be no shared activity between either parent and the I.P. child in any of the ten K.F.D.'s studied.These findings indicate a damaged level of communication among family members as was already expressed in the lack of interaction and high level of obstacles present among family members.
* Discussion of the Semi-Structured Interview - Most interviews revealed a much greater daily involvement and operational interaction between mothers and their I.P. child than between fathers and their I.P. child. This researcher believes therefore that the greater frequency and degree of interaction makes mothers more aware of the difficulties involved in communication with their child than fathers, thus accounting for the considerably higher number of barriers appearing in the K.F.D.'s of mothers. It is also possible that the greater degree of awareness of mothers to their child's limited capacity to interact effectively causes the mothers to apply barriers to protect themselves against pain and disappointment.
20% of the fathers reported difficulties in communication present in their core families and 20% in the present family except for the I.P. child, whilst mothers reports rates three times higher i.e., 60% of difficulties in communication in their core families and 60% in their present family except for the I.P. child. This significant discrepancy in reports about the present family (40% difference between fathers and mothers) may again be a result of the greater awareness of mothers to their family styles since they spend much more time with the children at home than does the father. The fathers are either less aware or in need of greater denial in order not to damage their concept of self, already at stake due to the fact that their exceptional child is a male like themselves.