Literature Review

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 INTRODUCTION

Art therapy has been a very successful way to help children with their cognitive development. In the first five years of a child’s life, mental health, behavioral growth, and temperament develop the most, according to the Institute of Medicine and National Research Council of the National Academies book on the Science of Children Birth to Age 8. In recent years, anxiety among children has risen.  Art can grow the imagination, motor skills, and developmental behaviors. In this review, I will analyze the discussions about art therapy successes, its impact on children's imagination, and the effectiveness of different materials. 

There haven’t been any studies regarding self-guided art therapy in places with extremely long wait times. The question that emerged became: Can self-guided art therapy in hospital waiting rooms increase imagination and cognitive growth while also being better for anxiety and stress?

LITERATURE REVIEW

DEFINING ART THERAPY

Art and art therapy are two different things. Art can be done anywhere, while art therapy is done purposefully. Art therapy explores thoughts and feelings through painting, drawing, or modeling. Art therapy guides the patient through a series of actions: “describing the goal, explaining that they don't have to be creative or artistic to benefit, helping to choose and use a medium, guiding them in expressing themselves, discussing the results (both the work of art and what the client felt), and planning for another session or for the client to work on their own.” 

Art therapy is very successful; however, many need help paying an art therapist monthly. At its core, art therapy is a guided artistic expression of art through understanding emotions. Creating art for therapeutic reasons can have equal benefits to professional art therapy: “Even in the absence of the formal art therapy process, however, art brings many benefits to mind, body, and brain, providing means of self-expression, communication, decision making, creativity, and stress reduction.” Completing art alone with the intent of doing it to aid mental health can sometimes be more beneficial. Without having certain time constraints, it is easy to be “in the zone” when creating art. Once “the zone” is achieved, the person creating art can be compared to a person meditating due to the area in the brain being used, the prefrontal cortex. Therefore, art therapy and guided art have similar impacts, and guided art is more cost-efficient than art therapy. Art can also help those working on self-expression and other neurological adolescent tendencies. 

COGNITIVE GROWTH WITH ART THERAPY

Art therapy has had a lot of research regarding art therapy and cognitive well-being. In Judith A. Rubin's book Art Therapy Today, she explains the importance of the “creative experience” in the first stages of a child’s development. She collaborated with other researchers who have already completed psychological studies. During these studies, one from the Walden School studied the effects of students having art and patients using art therapy in New York. The findings found that the “goals of the art therapist and the art teacher have much in common; both are trying to develop the growth of an individual to full ego realization, to come to grips with and master techniques which are intimately bound to the inner psyche.” In another study, Harriet Wadeson had her patients with schizophrenia draw a free picture, self-portrait, a picture of their illness, hallucinations, and delusions. From the study, the most common themes arose regarding depictions of brains, positive outlooks, and feelings. In her conclusion, she believes art language’s relevance helps patients understand and cope with their emotions. 

NEUROAESTHETICS

Art hasn’t just been in qualitative studies but also quantitative studies. With the advancement of technology, scientists can do studies incorporating monitoring the brain with activities involving art. One of these studies, by Coleen Smith, discusses the culmination of her findings in neuroaesthetics research. Neuroaesthetics focuses on “how arts measurably change the body, brain, and behavior and how this knowledge is translated into practice.” Through the rise of technology, brain imaging has allowed scientists to capture information about patients while creating art. Since art engages the brain’s neuroplasticity, it can enhance brain function: “We have 100 billion neurons, and how we grow and learn is through neuroplasticity. The more enriched environments, the more sensorial — not chaotic, but in a way that feels safe and often novel — is how our brains grow dramatically.” The American Congress of Rehabilitation Medicine has an interdisciplinary group called the Arts & Neuroscience Network Group that focuses on improving the lives of the disabled by researching fields like art on the brain. By gathering other studies, they can see the impacts of art on the brain: “In a study conducted by Professor Semir Zeki, chair in neuroaesthetics at University College London, participants underwent brain scans while being shown images of paintings by major artists. The study found that when people viewed the art they thought was most beautiful, blood flow increased by as much as 10% to the reign of the brain associated with pleasure — the equivalent to looking at a loved one.” This study was able to show the physical effects of just admiring art. Other studies are also being done using MRIs have shown the importance of visual cues for the growth of brains: “doctors now prescribe visits to art museums for some patients. More hospitals include art exhibitions and installations. Since color affects gray matter, colored light therapy is helping some Alzheimer’s patients.” 

In comparison, the National Institute of Drug Abuse posted an article about their findings on brain development and art for adolescents. The Adolescent Brain Cognitive Development Study (ABCD Study) took more than 11,800 children and their families and had them grow up and submit photos of their artwork. Using machines, such as MRIs, they can thoroughly study and learn about the cognitive impacts that art has on children: “As NIDA’s Director Dr. Nora Volkow says, “Research already suggests that getting training in the arts or practicing art, strengthens parts of a person’s brain. The ABCD Study will help us answer many questions.” The growing field of neuroaesthetics can help further research on art’s impact on cognitive and physical functioning and help more patients. 

BEHAVIORS OF A CHILD’S IMAGINATION

Imagination is a massive aspect of children’s cognitive development. A group of studies were collected by the National Library of Medicine that connected imagination to the development of children. Heider and Simmel studied “how physical understanding informs social perception: shapes moving on a screen become meaningful social agents with interpretable goals, beliefs, desires, emotions, and relationships under certain physical conditions.” The study had different shapes and objects falling at different angles and times. Tamar Kushnir concluded that the experiment's findings had to do with the imagination of each participant’s mind because subjects were able to “operationalize as shapes moving ‘at various speeds’ and a rectangle 'a section of which could be opened and closed as a door is.'” These conclusions showed that participants used their imaginations to depict stories based on “conflict, aggression, courage, and heroism.” Like adults can depict stories from geometrically moving objects, “infants' social cognition relies on infants' intuitive physics to create social meaning.” 

Gergely did a study where 14-year-old infants were shown a person turning on an overhead light by touching it with their foreheads. One group of adults rested a hand on the table while the other held a blanket around themselves. The findings were astonishing; infants showed a resting freehand turned on the light with their foreheads, while the other group used their hands (data was ruled by the majority, over 60%). Since the infants had free hands, they felt most compelled to copy the adults with free hands. Though researchers argued that it was based on social interaction—the actions were perceived as more goal-oriented and rational-oriented for one group—Gergely believed that if it were based on rationality, most children in both groups would have used their hands. The study shows explicitly that infants can use their imaginations in social inferences. Researchers mapped out the series of events: “implicitly contrast the observed action with an imagined alternative, then base their motor plan on what they assume to be the goal of the demonstrator.” Since the infants were able to use their imagination to complete the task of touching their head to light, they showed they could use their imaginations to complete a task that they were shown even if they have never done it before/ This then creates the question of the capabilities of infants to imagine an action without gaining the ability to complete the action. 

Jerome L. Singer’s views on children’s imagination are also very similar.  He acknowledges that there is still a mystery and a miracle regarding the psychological knowledge in creating an unseen world with imagination. The internalized form of imagination is visual imagery, in which the realm of imagination makes a gateway into understanding the principles of reality for children. Because of children’s daydreams, researchers have speculated that the origins of thought resonated with the need for sensory development and satisfaction through imagination. The gratifier has a role in which they can create the vision of anything that links the studies to more perceptual and physiological theories. Ultimately, those who show strong imagination can help satisfy their cognitive needs and sensory tendencies. 

ANXIETY AND STRESS'S IMPACT ON YOUTH

Stress is a part of many children’s lives. There are many causes of stress, some positive and others negative, but it is hard for young children to know how to manage stress. If stress is not handled well, it can have a physical and mental effect on a child: “Sudden stressful events will accelerate your child's breathing and heartbeat, constrict blood vessels, increase blood pressure and muscle tension, and perhaps cause stomach upset and headaches.”  Chronic stress can cause even worse symptoms such as “high blood pressure, weaken the immune system, and contribute to diseases such as obesity and heart disease.”  If there is persistent stress, it can cause other mental health challenges like anxiety. Anxiety is the excessive and persistent fear of something or that something is going to happen. Many scenarios can be the cause of anxiety; for example, “more than one-fifth (22%) of children living below 100% of the poverty threshold had a mental, behavioral, or developmental disorder.3 Age and poverty level affected the likelihood of children receiving treatment for anxiety, depression, or behavior problems.”   It is affecting millions of young people throughout the world.  Mental health challenges are quite complex due to presenting differently in everyone; on top of that, anxiety can be dangerous because it is the anticipation of a threat that may happen so that it can persist much more as a thought or feeling in a person’s mind. 

Throughout the 2000s, scientists have been monitoring anxiety and stress rates in children and adolescents. The National Institutes of Health’s 2022 National Healthcare Quality and Disparities Report has a section dedicated to Child and Adolescent Mental Health with cumulative data post-COVID-19. Most of the data that they have found is shocking: “Nearly 20% of children and young people ages 3-17 in the United States have a mental, emotional, developmental, or behavioral disorder.” Although the percentage seems low, what the NIH has been concerned about is the constant drastic increase in anxiety and stress. One of the significant statistics that is relevant to point out is that “Among U.S. children ages 5-11 years, the percentage of mental health-related ED visits increased 24%, and the percentage of these ED visits for adolescents ages 12-17 increased 31% from 2019 to March-October 2020.”  The increase in mental health concerns medical officials to the point where it is now a mental health crisis. Many hospitals are trying to find a way to regulate the increased numbers of mental health patients and decrease the ever-growing statistics.

CHILDREN’S HOSPITALS ED

Hospital wait times average around 2 hours and 30 minutes in the United States. On top of this, many people who have checked into ERs have left due to wait times being over 54 minutes. The National Library of Medicine studied stress and media in waiting rooms. The healthcare environment is stressful for most: “Even before being seated in the waiting room, a typical American is tied for fourth place as one of the most stressed citizens in the world.” In a hospital waiting room, this is exemplified by being in physical discomfort. The complex dynamic between healthcare providers and their patients can be summed up by patients feeling stressed from being in the hospital and worrying about the outcome of the appointment—on top of media exposure and waiting times— and how the staff treats them. On the other hand, doctors have stressors related to whether they can complete their jobs correctly—on top of staff problems, the number of patients, media exposure, absorbing previous patients’ burdens, and office design— and if they can see the patient on time.

For children’s hospitals specifically, there are around 250 patients they see per day. These cause long wait times for the ED, which can exacerbate the stressed children. The more the patients are stressed, the worse their symptoms can become. The increased number of patients has impacted the patients and the medical staff. The Children’s Hospital Association brings up the issue of crowding in children’s hospitals' Emergency Department. They stated that the problem is that “over recent years, the number of pediatric patients seeking care in EDs has been rising.” One of the ways they have monitored this is through their survey data: “The 2018 National Hospital Ambulatory Medical Care Survey data revealed that there were 130 million annual ED visits—25.6 million of those visits, or one-third, were made by children younger than 15 years of age. And the confluence of RSV, influenza, COVID-19, and pediatric behavioral health issues in late 2022 and early 2023 brought an unprecedented surge of ED visits from children.”  For medical professionals and patients, the Emergency Department has also been complex because of the increased numbers of mental health patients; “‘One thing that has contributed to crowding is the mental health surge occurring among pediatric and adolescent patients,’ says Timm.”  Overall, children’s hospitals across America are fighting the increased number of patients and mental health crisis, while patients are grappling with the mental health crisis and overwhelming anxiety that hospitals and wait times have caused.

CONCLUSIONS

For many who have gone to the emergency room and waited for hours on end, it can be nerve-wracking having to wait for a doctor. Parents, especially, need to distract their children from the waiting times. Children's anxiety grows while in the children's hospital Emergency Department, and the possible three-hour wait times can make that anxiety grow. Since art is shown to help with anxiety and stress, I would like to provide a solution for children's hospitals: putting art bags in waiting rooms for self-guided art therapy. The bags would have items specific to a particular age group. This would provide not only crucial cognitive development that art brings to a child’s mind but also help quell the anxiety child patients feel in the ED.

Works Cited

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