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The reporter, Lisabel Ting, of The Straits Times Mind Your Body supplement should be applauded for writing an excellent article on dialogic-diagnostic art therapy (DDAT). She has clearly explained the difference between expressive art therapy and dialogic-diagnostic art therapy. I quote: “While expressive art therapy is geared towards having a curative effect on a mental, emotional or behavioral disorder, the dialogic-diagnostic art therapy allows a trained therapist to access the subconscious elements of a client’s psyche and to interpret drawings to help diagnose his/her condition” (ST Mind Your Body, March 26, 2008, p.8).

Mdm Salenah Mohd Ismail, a registered DDAT therapist, is quoted to say that “DDAT tells us about the somatic (physical) situation in a child. It can also tell us about the future … drawing is a bit like dreaming, there’s always a subconscious element in the images.” I may want to clarify her statement that DDAT is not fortune-telling or peeking at a crytal ball to see the future. It cannot tell us about the future. However, DDAT can tell us something about the individual who has drawn the picture and the likely consequence he/she is likely to encounter if no intervention comes in. Predicting a likely consequence is not telling about future of an individual through his/her drawing.

Another registered DDAT therapist, Mdm Loke Ying Ying, is quoted to say that DDAT can also be used to evaluate a child’s mental age and intelligence. One example is the Goodenough Draw-a-Person test. Another example is the Harris-Goodenough Draw-a-Person test - an up-dated version from its previous one. Today, such drawing tests are no longer used to measure a child’s intelligence. They serve better as a rough estimation of a child’s mental age and/or intelligence. A better and more accurate intelligence test is the widely used Wechsler Intelligence Scale for Children-IV Edition (WISC-IV). It is good that Mdm Loke explained that such drawing tests can be used to measure a child’s drawing quotient (dQ) instead. This helps to differentiate the two cognitive quotients, i.e., dQ and IQ. 

Another important point that has been raised in Lisabel Ting’s article is that the reporter mentioned “DDAT can also be used as an indicator of possible mental problems such as autism and schizophrenia” (ST Mind Your Body, March 26, 2008, p.9). Two things I have to mention here. First, autism is not a mental problem or illness. It is a neuro-developmental disorder of constitutional origin and whose triad of impairments include impairment in social interaction and communication, and repetitive behavioral pattern as well as a lack of imagination in play. Schizophrenia is a mental illness and medication is a must. Second, DDAT serves better in detecting suspected cases of social-emotional-behavioral disturbances (administering the Draw-a-Person: Screening Procedure for Emotional Disturbance or DAP:SPED for short). There is little or no evidence-based research studies been done on the efficacy of DDAT in identifying individuals with mental illnesses. Perhaps more studies will be done with the focus in this area in the near future.

Finally, I agree with Dr Noel K.H. Chia, a board-certified educational therapist and IACT-registered trainer in DDAT, on the issue of the reliability of DDAT although it seems very helpful. I quote: “Accuracy and reliability depend heavily on the years of experience and advance training that a DDAT therapist has gone through” (ST Mind Your Body, March 26, 2008, p.9). What is more important to us should we see a piece of unusual drawing done by a child is that we should never jump into a conclusion too quickly. Always refer to a professional trained and qualified to perform a proper diagnosis in the DDAT.   

Copyright © 2008 Esther Yap. All rights reserved. see Disclaimer  

Many people whom I have come into personal contact at seminars, workshops, etc. have often asked me this question: “What is dialogic-diagnostic art therapy?” Or another question like “Isn’t it the same like expressive art therapy or whatever it is called?” First of all, let us define what art therapy is all about.

Art therapy is an expressive form of therapy involving the creative process of art for the purpose of healing and life-enhancing. Wikipedia describes it as a combination of psychotherapeutic theories and techniques with an understanding of the psychological aspects of the creative process, especially the affective properties of the differen art materials. 

In dialogic-diagnostic art therapy, it is very different from the traditional expressive art therapy being practiced by most of the professionals. Two important terms have been added here: dialogics and diagnosis. What is dialogics? Also, what is diagnosis with reference to art therapy?

According to Bakhtin (1981), dialogics is the study of the way meaning is constituted out of the contending languages within any culture - contending because there is a constant tendency to try to unify languages within an official or unitary language that is undermined by the endlessly changing conditions of the society, which generates new languages and new relations between them. With reference to art therapy, dialogics focuses on the way meanings of the drawn icons, symbols or pictures are derived or understood within a society concerned based on the societal understanding of its collective archetypes. As the society changes,the meanings of its collective archetypes also change.

When diagnosis comes into the picture of art therapy, we are looking at the art (i.e., drawings, painting, etc) from an analytical perspective, deciphering the various icons, symbols or pictures drawn to make sense of them within a given context. To obtain an accurate understanding of the drawings, for instance, we need to establish dialogics before diagnosis can be made. Hence, the term dialogic-diagnosis comes to join art therapy forming a highly specialized field known as dialogic-diagnostic art therapy (or DDAT for short).

DDAT can be divided further into two sub-categories: art logotherapy and art nootherapy. The former concerns “meaning” and focuses on the meaning of human existence as well as on man’s search for such a meaning (Frankl, 1962) through art, especially drawing and painting. The latter concerns how our mind perceives the icons, symbols and/or pictures seen in drawings or paintings. It examines the mind of the drawer/artist in terms of his/her mental banks (or memories), mental books (i.e., perception, cognition, meta-cognition, affection, and volition), and mental states of mind.

The DDAT was introduced in Singapore by Dr Noel K.H. Chia in 2003 when he first taught diagnostic art therapy at the Family Resource and Training Centre to counsellors, social workers, BASC teachers, etc. He also trained volunteers at the PEACE Community Services to used diagnostic art therapy. Later, dialogics was added to make the therapy as thorough and as holistic as possible. In 2004, the International Association of Counselors and Therapists (IACT) accepted DDAT as a specialty therapy and Dr Chia became its only certified trainer/therapist to conduct the program in Singapore. In 2007, the IACT approved the DDAT for professional registration, full professional therapist credentialization, and board certification.

The first pioneering batch of seven DDAT professionals completed the specialty program in 2006 and all of them have become very successful practioners. One therapist moves on to set up her art therapy clinic - ArtsHeal - whose focus is on helping children, adolescents and young adults with socio-emotional behavioral problems as well as mental disturbances. Another therapist (the only Malaysian to be qualified in DDAT) returns to Kuala Lumpur in Malaysia to head a counselling centre using DDAT. The third therapist practices DDAT in school as a school counsellor while the fourth uses it to help her students at a student care centre where she heads. The fifth therapist goes on to conduct numerous workshops on DDAT to help parents understand their children and themselves better. The remaining two therapists have their own private practice in DDAT. Among the seven, two have gone on to become full professional therapists in DDAT while another two have become registered therapists. All the others remain as general therapists.    

References:

Bakhtin, M.M. (1981). The Dialogic Imagination. Austin, TX: University of Texas Press.

Frankl, V. (1962). Man’s Search for Meaning: An Introduction to Logotherapy. Boston, MA: Beacon.

Copyright © 2008 Esther Yap. All rights reserved. see Disclaimer  

There are two key aspects to be examined: (1) team performance and (2) supervision or mentoring on team performance.

According to Rodd (1998), the quality of early childhood programs or centres “is directly related to the quality of the personnel who operate the program/centre, from the designated leader to the staff who work with children, whether they are trained or untrained, experienced or inexperienced” (p.116). Most early childhood services operate under financial constraints and the likelihood of the continuation of these circumstances, the low salaries for childcare personnel and staff turnover and shortages, an early childhood leader often faces an ignominious situation.

Prospective and current leaders in early childhood must know and understand (1) the basic information about management and leadership and (2) the various approaches that help them recognize their own strengths and weaknesses and find ways to develop their abilities (Sciarra & Dorsey, 2002). The first component can be obtained in part by listening to speakers, reading and participating in discussions. The second component involves serious self-reflection, willingness to change, and sustained effort.

Sciarra and Dorsey (2002) believe firmly that successful early childhood leaders are likely to obtain results that parallel those of business leaders in other fields. These results include the following:

(1) Increased productivity: In early childhood education, this means that children have better quality interactions with teachers and that more of their time is spent in interesting, worthwhile learning. It means that teachers continue to develop professionally.

(2) More satisfied clients: This refers to families of children enrolled with the program or at the centre as well as to the children themselves. Centres with successful leaders are more likely to have clients who feel positive about the program and staff.

(3) Improved financial position: This position may occur as a result of better organization and management under a successful leader. More initiatives that produce grants or improved funding also may be a factor. However, in today’s society, it is challenging to find leaders who are capable of providing the kind of financial picture that allows them to do what should be done in terms of staff salaries in particular. This condition is affected by attitudes toward programs for young children. To date, these programs have not been seen as important as programs for older children in terms of funding.

The term “team performance” refers to collaborative engagement of teachers coming together as a team with the common goal of making their workplace a conducive environment for both teaching and learning (Turk, 1999). To become a team, members must participate in some sort of team-building opportunity. the group may be given opportunities to provide honest feedback to each participant that can help the individual modify her way of working with others (Sciarra & Dorsey, 2002). In other words, the relationship aspect of the team is based on mutual respect, trust and support. Team members recognize their interdependence as well as their independence. Individual differences and successes are valued. The climate is marked by concern for other team members, warmth and friendliness (Rodd, 1998). The team members help to make a unique but equal contribution to the task of delivering their services, and share responsibility for the efficient operation of a quality service with the leader whom they have mutual respect, trust and support.

The team works efficiently and members of the team enjoy doing their work. The leader is able to relax and enjoy the fruits of previous efforts. However, the leader needs to keep close contact with the various teams in the centre and ensure that any small quality control adjustments are made and shared. Opportunities for contact and relationships with outside groups are pursued and assistance from outside sources is welcomed by team members. The team is willing to extend its energies beyond the confines of the program/centre. The leader has an opportunity to facilitate the development of appropriate staff members through the mentoring process (Turk, 1999) thereby contributing to the development of another future leader in early childhood education.

Supervision is a professional responsibility of the early childhood leader in which the leader helps staff members to use their knowledge and skills effectively in the performance of their work and to deepen their understanding of professional philosophies and values (Rodd, 1998). However, for leaders of early childhood centres, the range of supervisory responsibilities is more complex than just working with staff. The supervisory techniques employed by eladrs can “… promote positive relationships … among the staff” which will result in “… confident, motivated caregivers who want to provide quality care and early education for young children” (Kolb, 1989, p.16).

Caruso and Fawcett (1999) point out that most supervisors assist teachers in incrasing the control, authority, and responsibility they have for their own teaching and professional development. Hence, the primary purpose of supervision is “to help and support teachers as they refine their practices and grow professionally and personally” (Sciarra & Dorsey, 2002, p.144), and this can be done through effective mentoring involving a team or based on team performance (Turk, 1999).

If a team is to provide effective memtoring for the purpose of supervision, it must be a working team. Dumaine (1994) defines working teams as those that accomplish daily work, have stable membership, and are self-led. Stable membership is essential for maintaining the important element of trust. However, trust, the glue of relationships, takes time to grow and must begin with self-trust (Marshall, 1995). Trust among team members is the foundation for building caring relationships, and a set of caring relationships is a common element of successful team performance (Powers, 1996).

Mentoring teams must also possess high performance standards and there are various levels of team performance: (1) pseudo, (2) potential, (3) real, or (4) high- perfomance (see Katzenbach & Smith, 1993). High performance teams have an established purpose and are committed to a common working approach. The members have complementary skills and are individually and mutually accountable. Each member is committed to the personal growth and success of the other members. In other words, every member can be a leader, mentor and/or supervisor to others.

Copyright © 2007 Angie Ng. All rights reserved. see Disclaimer  

Many theories of learning have attempted to explain how young children learn. Recent studies have shown that young children are competent, active learners who are capable to set their goals, plan and revise, who can assemble and organize material, and are active agents of their own conceptual development. 

Children, especially those below 6 years of age, learn best through their senses; therefore, they require plenty of opportunities for sensory involvement. They also learn best by doing. They learn by interacting with concrete objects in the environment. Learning is most effective when children are interested in what they are learning.

One important factor involving how young children learn is their environment. Children learn best in an environment where they feel safe or unthreatened. Such an environment must allow for mistakes which children may commit as this is part of the process of learning. From there, learning is gradually built up and is most effective when experiences builds on what they already know.

Early learning experiences are most effective when they take children from simple to more complex levels. Activities should begin where a child is developmentally ready; significant learning tasks should be arranged in stages so that learning is sequenced step by step.

My model of a young child’s learning begins with the young child him/herself as an individual placed in a conducive, non-threatening environment that promotes positive learning. The child as an individual brings with him/her the (1) innate abilities, senses and skills; (2) motivation and interest; and (3) background experiences and prior knowledge into the learning process. One important requirement for good learning to take place is the presence of a good adult model, which is needed at this stage especially when a young child learns a lot through imitations and repetitions of what he/she has seen. The learning process can take place in two ways: sequential process and simultaneous process. The sequential process of learning takes into consideration the time spent/taken to learn a concept or complete a given task. The simultaneous process of learning looks into how a concept or a task is being processed using various senses/skills at the same time.

In the simultaneous process of learning, learning will begin with something that is (1) concrete and then move to abstract; (2) from simple to complex; (3) from easy to difficult; and (4) from familiar to unfamiliar/unknown/novel/new. While this part of the learning is taking place, the procedure (i.e., step-by-step or stage-by-stage) of learning also occurs through imitation and repetition. This could be a form of rehearsing until the mastery of a given task/concept is achieved. This is the sequential process of learning. The expected result is positive learning outcomes based on the learning objectives set by the teacher/parent when working with the child.

Learning is a dynamic process that is very personal and no two young children will learn in the same way or progress at the same pace. Other than being sequential and/or simultaneous, learning can also be associative or dissociative, divergent or convergent, parallel or unparallel, and so on. That will be another article all together.  

Copyright © 2007 Angie Ng. All rights reserved. see Disclaimer  

Dysgraphia is often confused with visual-motor integration dysfunction, which is the result of the inability to coordinate the motor movement with visual stimuli. A developmental optometirst should be consulted in this case for a child suspected of having visual-motor integration dysfunction.

Dysgraphia can be divided into two main categories: developmental dysgraphia (normally of childhood onset) and acquired dysgraphia (normally of adulthood onset). According to Kay (2006), dysgraphia refers to a disorder of written language expression in childhood as opposed to a disorder of written language acquired in adulthood. Symptoms of dysgraphia include difficulty copying from the blackboard, sloppy writing skills, poor spacing between words, inability to write on lines, problems in putting concepts onto paper, excessive erasure, can respond orally but find it laborious to write answers down, difficulty in completing written work within given time limits, apparently knows the subject but does poorly on written tests, and problems in putting numbers in columns for mathematics.

Deuel (1994) has identified three subtypes of dysgraphia: (1) dyslexic dysgraphia; (2) motor dysgraphia; and (3) spatial dysgraphia. Children with dysgraphia often perform poorly on the Processing Speed Index of the WISC-III assessment. It has been noted that these children may also perform in the following Performance Scale subtests: Coding, Object Assembly, Block Design, and Symbol Search (known as COBS Profile for short).  In addition, children suspected to have dysgraphia should also be assessed using one or more of the following tests which include the Lafayette Grooved Pegboard Test, Gardner Test of Visual Motor Skills, Beery Buktenica Visual Motor Integration Test, Frostig Developmental Test of Visual Perception, Rosner Test of Visual Analysis Skills, and the Wold Sentence Copy Tests.

Case Study 1: A boy aged 10 with FSIQ of 97, VIQ of 104 and PIQ 0f 91 (where VIQ > PIQ by 13 points) has the following WISC-III subtest results: Verbal Scale = Information (10), Similarities (10), Arithmetic (9), Vocabulary (13), Comprehension (11), and Digit Span (11); and Performance Scale = Picture Completion (8), Coding (7), Picture Arrangement (10), Block Design (9), Object Assembly (9), and Symbol Search (8). Based on the results, the child seems to display that he has Non-Verbal Learning Disorder (NVLD). However, further diagnostic evaluation of the assessment results indicates that he has specific learning disorder (a reverse of NVLD) and presence of Executive Function Disorder whose hallmark is disorganization. Using the Bannatyne Profile to analyze the WISC-III subtest results fails to indicate that the child is dyslexic. However, the spatial category in the profile is the weakest of the four Bannatyne categories (the others being Conceptual, Sequential and Acquired knowledge). The child also fails in the Processing Speed Index and the COBS Profile, suggestive that the child displays spatial dysgraphia - the third subtype of dysgraphia (Deuel, 1994). This is confirmed by administering the Rosner Test of Visual Analysis Skills in which the child fails very badly.  

Case 2: This is taken from a journal article written by Brunsdon, Coltheart & Nickel (2005) of a child with developmental surface dysgraphia (also known as dyslexic dysgraphia). Based on the child’s WISC-III results, he has FSIQ of 112, VIQ or 106 and PIQ of 116 (where VIQ > PIQ by 10 points) suggesting that he has Specific Learning Disability (SpLD) with the following subtest results: Verbal Scale = Information (12), Similarities (15), Arithmetic (5), Vocabulary (11), Comprehension (12), Digit Span (7); and Performance Scale = Picture Completion (12), Coding (4), Picture Arrangement (17), Block Design (16), Object Assembly (13), and Symbol Search (4). Using the ACID and SCAD profiles, both show that the child is dyslexic positive. In addition, the ACoDS and AIDS profiles also indicate that the child has attention deficit. The Bannatyne Profile confirms that the child is dyslexic with its classical dyslexia pattern: Spatial Category > Conceptual Category > Sequential Category. The child also performs poorly on the Processing Speed Index and the COBS Profile, suggestive of dysgraphia. The WISC-III results have more or less confirmed the child to have dyslexic dysgraphia, which is the first subtype of dysgraphia (Deuel, 1994). However, it would be good if the Bangor Dyslexia Test could be administered to confirm the child’s dyslexic tendency. In addition, if the Schonell Graded Spelling Test were to be administered, poor performance in the test would certainly indicate that the child had developmental surface dysgraphia (also known as dysorthographia or spelling disorder).

I have yet to come across a case of a child with suspected motor dysgraphia based on the WISC-III and visual-motor integration test results. Children with motor dysgraphia are noted to have motor clumsiness (Deuel, 1994).  It would certainly be interesting to compare assessment results of children with motor dysgraphia and those with developmental dyspraxia to find out in which ways their problems and/or traits are similar and/or different. 

Copyright © 2007 Dr Noel K.H. Chia. All rights reserved. see Disclaimer