Posts Tagged ‘ children ’

Design Brief: Body Pillows for Disaster-Affected Children

After a disaster, children often experience anxiety and stress that interfere with everyday activities from sleeping to socialization. Once a child has fallen off his developmental path, it is difficult to get back, even after symptoms of emotional trauma have been resolved. Adults that children rely on are often too stressed to provide effective emotional support. Professional therapy is often cost-prohibitive.

There are two major steps in trauma recovery: 1. establish a sense of safety and 2. make positive meaning. I developed this child’s body pillow as a comfort object to address the first step. The quilted textures and pocket for familiar smells help curtail hyper-vigilance through pattern sensory repetition. Post-disaster, these pillows could be distributed to help children move from a primal fight/flight response towards cognitive processing.

Inspiration

For most of my life, sleep has been the best part of the day because it was the only place I felt free. Losing even that is a terrifying thing. I want to provide children a source of comfort after a natural disaster in a way that helps them reclaim sleep.

Materiality

By marrying quilted textures from recycled fabric with new solid elements, I reference how successful post-disaster reconstruction memorializes the past while embracing the future.

Consequence

The body pillow will help children affected by disasters find comfort and could extend to non-disaster situations as a therapeutic accessory.

Manufacturing

I considered two forms of manufacturing: 1. pre-make and stockpiled by an NGO for disaster response and 2. provide the affected community with sewing machines, patterns and templates to make their own. Realistically, people affected by a disaster are too preoccupied to learn to manufacture a body pillow for children, who end up being a low-priority until they are developmentally derailed. By manufacturing the pillows in anticipation of a disaster, children can be helped in a way that leaves adults free to pursue other activities related to food, shelter and rebuilding.

Working Method

I worked with therapists to define design objectives and get feedback on prototypes. I worked with a third grade class to consider ergonomic factors.

Interview: Another Art Therapist on Therapeutic Toys

Last Thursday, I spoke with another art therapist on therapeutic toys. This time, the focus was on design. Below are selected interview notes.

What does a traumatized child need to get (developmentally) back on track?

BF: The first step is establishing a sense of safety and equilibrium. Trauma causes the brain to shut down or function in a state of hyper-vigilance. You need to down-regulate the autonomous nervous system. Bruce Perry and Bessel Van Terkolk talk about pattern sensory repetitive involvement as a therapeutic technique in these cases. The technique uses repetition when the child needs to down regulate. Lullabies, heartbeats, familiar sounds, familiar smells, and soft objects can all have a soothing influence.

The second step is processing. You help the child understand what happened and come to a different conclusion. Children will play out traumatic events given the toys or props to do so, but that doesn’t mean they will learn anything from it. You must help a child understand why something happened and what can be done about it.

What are some techniques that you’ve found useful in your practice?

BF: It’s important to break the mental state of hyper-vigilance by shifting the brain’s focus. When patients come in, I give them lavender hand lotion. The tactile sensation of rubbing one’s hands together, combined with a strong scent sets the stage for a productive session. Some therapists make drums out of coffee cans and duct tape at the beginning of their sessions. You’re providing a predictable pattern at the start of a session that creates an entry point into an oasis from the rest of that person’s day.

You mentioned sensory repetition as a therapeutic technique. Can you talk about some appropriate things that a sensory kit for children might include?

BF: Sound-making devices, perhaps mimicking heartbeat. Crayons, or whatever art supplies are culturally appropriate. Stencils, because if you’re giving kids a way to draw, the idea of containment is important. They are comforted by the edge. Yarn. Puppets. Stuffed animals. I knew a therapist that would put a satchel of peppermint in a stuffed animal and use it to focus the child’s mind. You could put a box inside to symbolize private space. The child could decorate it as she saw fit and put it into the larger container for the kit.

Lessons: There are two stages that need to be addressed in trauma recovery. Cognitive processing fails if a child’s brain function remains in the primitive “fight or flight” state. In the first six months, focus on establishing safety and equilibrium. Six months to a year out, give children the tools to play out their trauma.

Therapeutic Value of Play in Post-Disaster Settings

Play is a universally important means for expression across cultures. Children reflect on relationships and experiences with others, express needs, release unacceptable impulses, and experiment with solutions through play. A child can move towards inner resolution of a frightening or traumatic experience through play by returning to the event again and again, changing the outcome in the activity. In a post-disaster setting, play serves a restorative function in the lives of children.

In order to play, children need toys, creative materials and other props. Games and storytelling can also serve as vehicles for play. The adult sets the stage, observes and participates by providing reassurance for feelings the child may be experiencing.

Play does not require the direct supervision of mental health professionals to be beneficial. For example, The Kids’ Corner (KC), a therapeutic play area conceived after the September 11, 2001 attacks, was staffed with volunteers from both mental health and other professions.The work done in this space was considered “play therapy” when conducted by mental health professionals and “play that had therapeutic value” when supervised by other relief workers. KC is a model that has been replicated with positive results in other disasters such as the 2004 tsunami in Sri Lanka. The fact that Western play methods work in Eastern cultures suggests the transcendent healing properties of play in post-disaster settings.

Hosin, Amer A. Responses to Traumatized Children. Basingstoke England: Palgrave Macmillan, 2007. 66-90. Print.

GFRY Inspiration Boards for a Playscape

This week, we developed the playground idea by creating inspiration boards around the ideas of learning, sound, and physical activity. We wanted to give children a positive avenue of anxiety relief through play.

Based on feedback, we need to…

1. Research Chilean games and game frameworks (such as game show premises for the learning function)
2. Diagram a framework for collaboration with our partners in Chile that incorporates prototyping and feedback loops
3. Develop prototypes of the appropriate resolution to facilitate collaborative design

Interview: Art Therapists on Therapeutic Toys

Monday, I spoke to two practicing art therapists (separately) about how a toy might soothe a traumatized child while improving the child-caretaker relationship. Below are the combined and selected interview notes.

What do traumatized children choose as transitional objects and why?

AB: The first transitional objects that a child has are the nipple, the bottle and the thumb. Traumatized children regress to thumb sucking as a surface behavior that indicates that they are looking inward to soothe themselves. It might help to understand how the brain develops. The bridge between the left and right brain forms around age five. Between five and eight, children are the most vulnerable. Most phobias are developed in this age range. Any positive or negative experience with objects will help form a child’s personality.

CM: That’s often a matter of personal preference. What does it smell like? Who does it remind the child of? Then there’s the question of age and developmental level.

How do children interact with these objects?

AB: Children think of a teddy bear as a part of their arm. It’s an extension of their ego. The teddy bear is them. You’ll see them talking out internal conversations through puppets.

CM: Traumatized children will act out (sometimes repetitively) the traumatic event through toys. There’s something called, “Sand Tray Therapy” where the child is given a large tray of sand and a shelf of objects to play out scenarios. These objects include human representations of various sizes, models of everyday things, animals, and so forth. The sand tray is a stage that lets the child act out his internal struggles. It’s part of the healing process.


If a toy were to improve the relationship between a child and its caregiver, what would be some signs that a caregiver should intervene in a child’s play? What should the caregiver do?

AB: In crisis management, we are taught to deal differently with each stage of the anger cycle. First comes anxiety, where we try to create a safe environment. Second is the defensive stage where the person attacks verbally. We need to set clear and simple limits that we are ready to enforce. In the third stage, the acting out is physical when we need to talk them down, restrain them, and give them quiet time. Finally, there is a time for tension reduction. This is the best time to start a therapeutic rapport by being supportive and non-judgmental.

CM: You have to trust that your child knows how to work through his problems. Some parents are too eager to make the child talk about something that he isn’t ready to discuss. As children play out the trauma, they will often work in metaphor. It’s important not to assume what a certain representation is. Rather, ask the child to tell the story of what he’s drawn or the scenario that the toys are showing. Children will talk when they are ready.

What are some things I should consider in designing a therapeutic toy?

AB: There are a few avenues that come to mind. One, you could look into objects that make regression safe from ridicule. Dual-purpose objects such as a water bottle that can simulate nipple/thumb sucking can be comforting and the parent would have to refill it. You could make a plush backpack that would function as comfort and storage. Two, you can examine the signal value in a toy. Plush toys can transform by having certain parts of itself pulled over or inverted. When a child does that, it can intuitively signal distress to the caregiver.

CM: Simple is better. Give the child the opportunity to fill in the details with his imagination. There’s a big opportunity to train parents through toys. After a disaster, the parents are often themselves stressed but don’t have the socially acceptable option to play with toys. So playing with their children can be helpful by itself. I like the idea of some sort of signaling device that reminds and alerts parents to moments when their child wants to talk or to show them something. It’s not always a display of anger that requires attention. But you also can’t force the stories. A toy that asks the child to face an issue before he is ready isn’t helpful. Giving the child a choice of what to express is. If you’re going site specific, give the child options to directly relate to the trauma. In New Orleans, boats and water are symbols of what happened.

Lessons: Children relate to toys on a personal level. They use them to frame and re-contextualize traumatic events. Creating positive meaning requires a safe space and tools for the child to explore what has happened. Perhaps the plush toy isn’t the right way to go. (I also don’t know if they are as common in Chile as in the US.) Perhaps it makes more sense to create a series of plastic toys that enable a level of reenactment of events: pieces of traditional houses, people of various sizes, animals and large objects that are central to the disaster and the culture. In turn, these objects become a way of communicating with caregiver about what happened and the need to look forward. If I design something that is more directly comforting (that the child can hug), it should enable the tactile and emotional support of regression; it has to feel right.

Overview of Trauma Psychology

Disasters often destroy the physical structures children rely on for their daily activities: schools, homes, places of worship, and places of play. This places a burden on children as they are generally unnerved by changes in the pattern of daily life. These structures are transitional objects. Children rely on them for ego function.

One of the most destructive effects of PTSD is the delay and damage to a child’s ability to engage in normal developmental experiences. Anxiety, withdrawal, regression, and difficulty concentrating interfere with a child’s participation in socializing and succeeding at school. Once a child has fallen off his developmental path, it is difficult to get back, even after symptoms of emotional trauma have been resolved. A child that is behind her social peers is likely to suffer rejection. A child no longer doing well in school may reformulate his self-image as no longer being a good student and stop trying. Catching up can be very difficult. Trauma also fosters defiant behavior. In turn, that behavior can increase the risk of further victimization and lead to a cascade of problems including depression, substance abuse, aggressive behavior, and problems with the law.

Steps in the Treatment of Traumatized Children

1. Parental guidance and counseling in parallel with child
2. Creation of a narrative of the traumatic event to desensitize the child
3. Safety planning with the child

There are several forms of therapy for PTSD in children. The most successful evidence-based forms are cognitive behavioral therapy (CBT) and art therapy. CBT views the child as an active, equal partner, who collaborates with learning tools towards recovery. It works well when the child wants to get better. Art therapy can be a more successful entry point into the foray of therapeutic options. Children who often have difficulty verbalizing their experiences after traumatic events. Play, drawing, painting, and sculpting is easier and provides a medium for exploring events and creating a joint narrative with the therapist. Children who won’t cooperate with CBT sometimes feel more comfortable engaging in art therapy because it provides an environment in which a sense of safety can be established.

Hosin, Amer A. Responses to Traumatized Children. Basingstoke England: Palgrave Macmillan, 2007. 1-65. Print.

Post-Katrina Trauma Recovery Process in Children

From Lauren, a friend of mine and a native to New Orleans:

Post-Katrina, I worked with kindergarten and fifth grade students. Art turned out to be one of the most beneficial aids in addressing and even diagnosing PTSD in children. Crayons, markers, paints, finger paints, and even creating clay sculptures of jewelry all helped. In some cases, the jewelry was sold and proceeds went to developing a playground. Since so many schools lost their play equipment, just having outdoor play equipment (or not having it) impacted the children and their behaviors tremendously.

Acting/drama/singing was another tool that proved useful. At first, it was serious stuff dealing with the storm, during, after, etc. Later, acting became their outlet to relieve stress and help others understand their personal views and emotions.

Free writing and writing on specific topics helped children address issues they were facing (such as living in FEMA trailers) or dig deeper into issues that were important to them (both free writing and writing on specific topics were helpful in their own ways).

Children like to feel like they are a part of the recovery process and are making a difference. We did things like toy and clothes drives for students who lost everything. In some cases the kids who lost a lot of “stuff” still wanted to share what they had with friends who lost more.

Any sense of normalcy is also helpful. They liked special treatment and privileges, visits from dignitaries and media, but one thing that almost all of the children said they really liked about school was that it was predictable, familiar, and had a sense of normalcy. Some students said that their favorite times were those spent at school because they could forget about living in a FEMA trailer (with eight other people) and about what had happened.