Naming the Enemy an Art Therapy Intervention for Children With Bipolar and Comorbid Disorders

Abstruse

Art therapy and art psychotherapy are oftentimes offered in Child and Adolescent Mental Health services (CAMHS). We aimed to review the evidence regarding art therapy and art psychotherapy in children attending mental health services. Nosotros searched PubMed, Web of Scientific discipline, and EBSCO (CINHAL®Consummate) following PRISMA guidelines, using the search terms ("artistic therapy" OR "art therapy") AND (child* OR adolescent OR teen*). We excluded review articles, articles which included adults, articles which were not written in English and articles without outcome measures. We identified 17 articles which are included in our review synthesis. We described these in 2 groups—ten articles regarding the treatment of children with a psychiatric diagnosis and 7 regarding the treatment of children with psychiatric symptoms, merely no formal diagnosis. The studies varied in terms of the type of art therapy/psychotherapy delivered, underlying conditions and outcome measures. Many were instance studies/case serial or small quasi-experimental studies; there were few randomised controlled trials and no replication studies. Yet, there was some evidence that fine art therapy or art psychotherapy may benefit children who have experienced trauma or who have postal service-traumatic stress disorder (PTSD) symptoms. There is extensive literature regarding art therapy/psychotherapy in children but limited empirical papers regarding its use in children attention mental health services. There is some evidence that art therapy or fine art psychotherapy may benefit children who take experienced trauma. Further research is required, and it may exist benign if studies could be replicated in different locations.

Introduction

Child and Adolescent Mental Health Services (CAMHS) often offer art therapy, as well every bit many other therapeutic approaches; we wished to review the literature regarding art therapy in CAMHS. Previous systematic reviews of fine art therapy were non specifically focused on the effectiveness in children [i,ii,3,iv,v] or were focused on the use of art therapy in children with physical conditions rather than with mental health atmospheric condition [6]. The use of art or doodling equally a advice tool in CAMHS is long established—Donald Winnicott famously used "the Squiggle Game" to pause boundaries between a patient and professional to characterize a story through a simple squiggle [7]. Art is particularly useful to build a rapport with a child who presents with an issue that is also hard to verbalise or if the kid does not take words to express a difficulty. The term fine art therapy was coined by the creative person Adrian Hill in 1942 following admission to a sanatorium for the treatment of tuberculosis, where artwork eased his suffering. "Art psychotherapy" expands on this concept past incorporating psychoanalytic processes, seeking to access the unconscious. Jung influenced the evolution of art psychotherapy as a means to access the unconscious and stated that "by painting himself he gives shape to himself" [8]. Art psychotherapy oftentimes focuses on externalising the trouble, reflecting on it and analysing it which may then give fashion to seeing a resolution.

The UK Joint Commissioning Console for Mental Health 2013 recommends that psychotherapists and creative therapists are part of the CAMHS teams [9]. There is a specific UK recommendation that art therapy may be used in the treatment of children and immature people recovering from psychosis, peculiarly those with negative symptoms [10], just no similar recommendation in the Irish HSE National Clinical Programme for Early Intervention in Psychosis [11]. There is less clarity about the use of art therapy in the treatment of depression in young people—arts therapies were previously recommended [12], merely more than recent NICE guidelines announced to have dropped this advice, though the recommendation for psychodynamic psychotherapy has remained [thirteen]. Art therapy is oftentimes offered to care for traumatised children, just we note that current Nice guidelines on the management of PTSD do not include a recommendation for art therapy [fourteen]. The Irish gaelic document "Vision for Alter" did non include a recommendation regarding art psychotherapy or creative therapies [15]. Similarly, the certificate "Sharing the Vision" does non brand any recommendation regarding creative or art therapies, though information technology recommends psychotherapy for adults and recommends arts activities as part of social prescribing for adults [16]. Meanwhile, it is not uncommon for at that place to be an art therapist in CAMHS inpatient units, working with those with the highest mental healthcare needs. We wished to find out more about the bear witness for, or indeed confronting, the use of art therapy in CAMHS. We performed a systematic review which aimed to analyze if art psychotherapy is effective for use in children with mental health disorders. This review aimed to address the post-obit questions: (1) Is art therapy/psychotherapy an effective treatment for children with mental health disorders? (2) What are the various methods of art therapy or art psychotherapy which have been used to treat children with mental health disorders and how do they differ in terms of (i) setting and duration, (ii) procedure of the sessions, and (three) art activities details?

Methods

Process

The Preferred Reporting Items for Systematic Reviews (PRISMA) argument for systematic reviews was followed. Searches and analysis were conducted between September 2016 and April 2020 using the post-obit databases: PubMed, Web of Science and EBSCO (CINHAL®Complete). The following "medical bailiwick terms" were utilized for searches: ("creative therapy" OR "fine art therapy") AND (child* OR adolescent OR teen*). Review publications were excluded. Studies in the English language language meeting the post-obit inclusion criteria were selected: (i) use of art therapy/art psychotherapy, (ii) psychiatric disorder/diagnosis and/or mood disturbances and/or psychological symptoms, (iii) human participants anile 0–17 years inclusive. Articles investigating the efficiency of art therapy in children with medical weather were included only if the measured issue related to psychological well-beingness/symptoms. Exclusion criteria included: (i) awarding of therapies which do not involve art activities, (2) awarding of a combination of therapies without individual results for art therapy, (iii) non clinical studies (review, meta-assay, reports, others), (iv) studies which focused on the artwork itself/art therapy procedure and did non measure and publish any clinical outcomes, (5) absenteeism of whatsoever pre psychiatric symptoms or comorbidity in the participant sample prior to fine art intervention. All manufactures were screened for inclusion by the authors (MA, TR, IB, AM, DB), unblinded to manuscript authorship.

Data extraction

The authors (IB, TR, AM, MA, DB) extracted all data independently (unblinded). Data were extracted and recorded in 3 tables with specific data from each report on (i) the study details, (2) art therapy details and outcome measures and (iii) art therapy results. The post-obit specific study details were extracted: author/journal, state, twelvemonth of publication, study type (i.e. study design), study aims, study setting, participant details (number, age and gender), disease/disorder studied and inclusion criteria and exclusion criteria of the study. The post-obit details were extracted regarding the fine art therapy provided and upshot measures: blazon of art therapy provided (private or group therapy), the art therapy procedure and/or techniques used, the art therapy setting, therapy duration (including frequency and duration of each art therapy session), the type of event mensurate used, the investigated domains, the time points (for effect measures) and the presence or absence of pre-/mail service-test statistical analysis. Finally, we extracted specific information on the art therapy results, including therapy grouping results, control group results, the number and percent of who completed therapy, whether or non a pre-/post-exam statistical difference was plant and the full general outcome of each study. Post-obit the extraction of all data, studies included were divided into 2 groups: (ane) children with psychiatric disorder diagnosis and (ii) children with psychiatric symptoms. Finally, the QUADAS-ii tool was used to assess the risk of bias for each study, and a summary of the run a risk of bias for all data was calculated [17]. The QUADAS-two is designed to assess and record selection bias, functioning bias, detection bias, attrition bias, reporting bias and any other bias [17].

Results

Study inclusion and assessment

A total of 1273 articles were initially identified (Fig. i). After repeats and duplicates were removed, 1186 possible articles were identified and screened for inclusion/exclusion co-ordinate to the title and abstract, which resulted in 1000 articles existence excluded. The remaining 186 full articles were retrieved and full text considered. Following review of the full text, 70 articles were selected and further analysed. 50-3 of them did not meet our criteria for review. Reasons for exclusion were grouped into iv main categories: (one) not art therapy [due north = 2]; (2) not mental health [n = 5]; (three) no outcome measured [n = 18]; (4) other reasons (i.e. descriptive texts, full commodity not available) [due north = 28]. In conclusion, in that location were 17 articles remaining that met the full inclusion criteria, and further descriptive analysis was performed on these 17 studies. All the considered articles were produced in the 20-first century, between 2001 and 2020, most in the United states of america (60%), followed by Canada (30%) and Italy (10%). The characteristics of studies included in our final synthesis are reported in Tables 1 and 2.

Fig. 1

PRISMA 2009 flow diagram

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Table ane Children with psychiatric disorder diagnosis

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Table 2 Children with psychiatric symptoms

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Participant characteristics

Participants in the 17 studies ranged from two to 17 years old inclusive. In ten articles, children with an established psychiatric diagnosis were included (Group one, see Table 1). The type of psychiatric disorders equally (i) PTSD, (ii) mood disorders (bipolar affective disorder, depressive disorders, anxiety disorder), (three) cocky-harm behaviour, (iv) attachment disorder, (5) personality disorder and (vi) adjustment disorder. In seven manufactures, children with psychiatric symptoms were enrolled, usually referred by practitioners and school counsellors (Group ii, see Table 2). Participants had a broad diversity of weather including (i) symptoms of low, anxiety, low mood, dysthymic features; (ii) attention and concentration disorder symptoms; (iii) socialisation problems and (four) self-concept and self-prototype difficulties. Some children had medical conditions such as leukaemia requiring painful procedures, or glaucoma, cancer, seizures, acute surgery; others had experienced adversity such every bit parental divorce, concrete, emotional and/or sexual corruption or had developed dangerous and promiscuous social habits (drugs, prostitution and gang involvement).

Written report design: children with an established psychiatric diagnosis (Tabular array i)

A summary of the ten studies on art therapy in children with a psychiatric diagnosis can exist seen in Table 1, with further data near each study. At that place are just two randomised controlled in this category, both treating PTSD in children [xviii, 19]. Chapman et al. [eighteen] provided individual fine art therapy to immature children who had experienced trauma and assessed symptom response using the PTSD-I cess of symptoms one calendar week afterward injury and ane calendar month later on hospital admission [eighteen]. Their study included 85 children; 31 children received private fine art therapy, 27 children received treatment as usual and 27 children did not run across criteria for PTSD on the initial PTSD-I assessment [xviii]. The art therapy group had a reduction in acute stress symptoms, just in that location was no meaning departure in PTSD scores [18]. The second randomised controlled trial provided trauma-focused group art therapy in an inpatient setting and showed a significant reduction in PTSD symptoms in adolescents who attended fine art therapy in comparison to a control grouping who attended arts-and-crafts. Even so, this study had a loftier drib-out charge per unit, with 142 patients referred to the study and but 29 patients who completed the study [19].

The remaining studies regarding fine art therapy or art psychotherapy in children with psychiatric disorders are example studies, case series or quasi experimental studies, most with less than v participants. All these studies reported positive effects of art therapy; nosotros did not notice any published negative studies. We can summarise that the studies differed profoundly in the type of therapy delivered, in the setting (group or individual therapy) and in the types of disorders treated (Table 1).

Forms of fine art therapy intervention and assessment (Tabular array 1)

The various modalities and duration of art therapy described in the x studies with children with psychiatric diagnoses are summarised in Table 1. The treatment of PTSD was described in two studies, only each described a different fine art therapy protocol, and the studies varied in terms of setting and duration [18, 19]. The Trauma Focused Art Therapy (TF-ART) study described 16 weekly in-patient group sessions [19], whereas the Chapman Art Therapy Handling Intervention (CATTI) is a curt-term individual therapy, lasting i h at the bedside of infirmary inpatients [18]. Despite the differences, the methods have some mutual aspects. Both therapy methods focused on helping the individual express a narrative of his/her life story, supporting the individual to reverberate on trauma-related experiences and to describe coping responses. Relaxation techniques were used, such as kinaesthetic activities [xviii] and "feelings check-ins" [19]. In the TF-ART protocol, each participant completed at least 13 collages or drawings and compiled in a hand-made book to describe his/her "life story" [19]. The utilise of art therapy in a traumatised kid has as well been described in a single case written report [20].

Grouping fine art therapy has been described in the handling of adolescent personality disorder, in an intervention where adolescents met weekly in two separate periods of 18 sessions over half dozen months, with each session lasting ninety min, facilitated past a psychotherapist [21]. Sessions consisted of a brusque group conversation regarding events/issues during the previous calendar week followed past a brief relaxing activity (e.m. listening to music), a period of art-making and an opportunity to explicate their piece of work, guided by the psychotherapist.

A long class of fine art psychotherapy over three years with a vulnerable female adolescent who presented with self-damage and later disclosed being a victim of a sexual assault has been described [22]. The young person described an "enemy" inside her which she had overcome in her testimony to her improvement, which was included in the published instance study [22]. The arroyo of "art equally therapy" has been described with children with bipolar disorder and other potential comorbidities, such as Asperger syndrome and attending deficit disorder, using the "naming the enemy" and "naming the friend" approaches [23].

The concept of the "transitional object"—a coping device for periods of separation in the mother–child dyad during infancy—has been considered in art therapy [24]. It was proposed that "transitional objects" could be used as bridging objects between a scary reality and the weak inner-self. Children brought their transitional objects to therapy sessions, and the therapy process aimed to detach the participant from his/her transitional object, giving him/her the strength to face life situations with his/her own capabilities [24].

Two studies of fine art therapy in children with aligning disorders were included in our systematic review [25, 26]. Children attended two or 3 video-recorded sessions and were encouraged to use art materials to explore daily life events. The child and therapist and so watched the video-recorded session and participated in a semi-structured interview that employed video-stimulated call back. The therapy aimed to transport the participant to a comfortable imaginary earth, giving the kid the possibility to create powerful, stiff characters in his/her story, thus enhancing the ability to cope with life's challenges [25, 26].

Outcome measures and statistical assay (Tabular array 1)

Three articles on psychiatric disorders evaluated potential changes in consequence using an objective measure [18, 19, 22]. 2 studies used the "The University of California at Los Angeles Children's PTSD Index" (UCLA PTSD-I), which is a 20-item self-study tool [xviii, 19]. Statistical differences were evaluated by calculating the mean percent change [xviii] and the ANOVA [19]. The 12-detail "MacKenzie's Group Climate Questionnaire" was used to measure the outcome of group art therapy in adolescents with personality disorder, and a significant reduction in conflict in the group was found [21]. However, the sample size was modest, and there was no command grouping [21]. Many studies did not use highly recognised measures of upshot but relied instead on a comprehensive description of event or modify later art therapy/psychotherapy, in case studies or example series [20, 22,23,24,25,26,27].

Study pattern: children with psychiatric symptoms (Table 2)

Nosotros included seven studies in our review synthesis where art therapy or art psychotherapy was used as an intervention for psychiatric symptoms—many of these studies occurred in paediatric hospitals, where children were being treated for other conditions. Ii of these studies were non-randomised controlled trials, one of which was waitlist controlled [28, 29], and the other five were quasi-experimental studies [30,31,32,33,34].

Forms of intervention and assessment (Table two)

Three manufactures described art therapy in paediatric hospital patients but varied in terms of therapy and underlying status [28, 29, 33]. The effectiveness of art therapy on cocky-esteem and symptoms of depression in children with glaucoma has been investigated; a number of sensory-stimulating art materials were introduced during 6 individual 1-h sessions [33]. Short-term or single individual art therapy sessions have likewise been used in hospital aiming to improve quality of life [28, 29]. Art therapy has been provided to children with leukaemia; the children transformed unused socks into puppets called "healing sock creatures" [29]. Short-term art therapy prior to painful procedures, such as lumbar puncture or bone marrow aspiration, has too been described, using "visual imagination" and "medical play" with age-appropriate explanations about the procedure, with a cloth doll and medical instruments [28].

The remaining articles described the provision of fine art therapy to vulnerable patients, where the therapy aimed to increase self-confidence or address worries. Two studies focused on female self-esteem and self-concept, both using group activities [31, 32]. Hartz and Thick [32] compared two different art therapy protocols: fine art psychotherapy, which employed a cursory psychoeducational presentation and encouraged abstraction, symbolization and verbalization and an art as therapy arroyo, which highlighted design potentials, technique and the creative problem-solving process, trying to evoke artistic experimentation and accomplishment rather than different strengths and aspects of personality [32]. Participants completed a known questionnaire about self-esteem as well equally a study-specific questionnaire.

Coholic and Eys [34] described the apply of a 12-week arts-based mindfulness group program with vulnerable children referred past mental health or child welfare services, with a combination of group work and individual sessions [34]. Children were given tasks which included the "thought jar" (filling an empty drinking glass jar with water and diverse-shaped and coloured beads representing thoughts and feelings), the "me as a tree" activity, during which the participant drew him/herself equally a tree, enabling the participant to introduce him/herself, the "emotion listen and draw" activity which provided the opportunity to draw/paint feelings while listening to five dissimilar songs and the "bad day better" activeness which involved painting what a "bad day" looked similar, and so to decorate it to turn it into a "adieu". The enquiry included quantitative analysis and qualitative assessment using self-report Piers-Harris Children'due south Self-Concept Scale and the Resiliency Scales for Children and Adolescents [37, 38].

Kearns [30] described a single instance study of fine art therapy with a kid with a sensory integration difficulty, comparison teacher-reported behaviour patterns after art therapy sessions using kinaesthetic stimulation and visual stimulation with behaviour after 12 control sessions of non-fine art therapy; a greater improvement was reported with art therapy [30].

Event measures and statistical assay (Tabular array 2)

Well-nigh of the studies on art therapy in children with psychiatric symptoms (simply not confirmed disorders) used widely accepted effect measures [29,30,31,32,33,34] (Table 2), such every bit cocky-report measurements including the 27-item symptom-orientated Children'southward Depression Inventory or the Tennessee Self Concept Calibration: Brusk Course [33, 35, 36]. The 60-detail Piers-Harris Children's Self-Concept Scale (2d edition) and the Resiliency Scales for Children and Adolescents (RSCA) were used in a study on vulnerable children [34, 37, 38]. The Piers-Harris Children's Self-Concept Scale is a widely used self-study measure of psychological health and self-concept in children and teens and consists of 3 global cocky-report scales presented in a 5-point Likert-type scale: sense of mastery (20 items), sense of relatedness (24 items) and emotional reactivity (twenty items) [37]. A modified version of the Daley and Lecroy'due south Get Grrrls Questionnaire was administered at group intake and follow-up, to rank various self-concept items including torso image and cocky-esteem forth a four-signal ordinal scale in group therapy with young females [31, 39].

Some researchers created their ain outcome measures [28,29,30, 33]. One study group created a mood questionnaire for immature children—this was administered by a research assistant to patients before and afterward each therapy session, in their pocket-sized await-list controlled study [29]. Another group evaluated classroom functioning using an observational system rated by the teacher for each 30-min block of time every twenty-four hours during the study [thirty]. The classroom study also used the "person picking an apple from a tree" (PPAT) cartoon task—this was the only measurement tool in the studies we reviewed which assessed the features of the artworks themselves [thirty, 40]. Pre- and postal service-test drawings were evaluated for show of changes in various qualities over the course of the enquiry menstruum [thirty].

Hartz and Thick [32] used both the 45-items Cocky-Perception Profile for Adolescents (SPPA) [41] which is widely used and considered reliable, every bit well as the Hartz Art Therapy Cocky-Esteem Questionnaire (Hartz AT-SEQ) [32], which is a twenty-question post-treatment questionnaire designed by the author, to understand how specific aspects of fine art therapy treatment affect self-esteem in a quasi-experimental written report with group art therapy. 4 of the seven articles performed statistical analysis of the data collected, using the Wilcoxon signed-rank examination [31], Fisher's t [32], MANOVA [34], and 2-tailed Pupil's t test [29].

Assessment of bias

The QUADAS-ii cess of bias for each study included in our systematic review synthesis can be seen in Table 3, with a summary of the results of the QUADAS-2 cess for all included studies in our review in Table 4. Studies marked in green had a low chance of bias; those marked in red had a high risk of bias while those in yellow had an unclear run a risk of bias. Just 2 studies were plant to accept a depression risk of bias [19, 29].

Tabular array three QUADAS-2 cess of bias for each study included in the review

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Table 4 Summary of the Bias assessments (QUADAS-2) for all studies included in the review

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Discussion

We constitute all-encompassing literature regarding the utilize of fine art therapy in children with mental health difficulties (N = 1273), with a big number of descriptive qualitative studies and cases studies, just a limited number of quantitative studies which we could include in our review synthesis (Northward = 17). The predominance of descriptive studies is not surprising considering that the field of art therapy and art psychotherapy has developed from the descriptive writings of Freud, Jung, Winnicott and others, and for many years, academic psychotherapy focused on detailed instance descriptions rather than quantitative issue studies. The numerous descriptive and qualitative publications generally described positive changes in participants undergoing art therapy, which may represent publication bias. Our aim was still to describe the quantitative bear witness regarding the use of fine art therapy or art psychotherapy in children and adolescents with mental health difficulties, and we found a limited number of studies to include in our review synthesis. In that location were but two randomised controlled trials, no replication studies and bereft information to permit for a meta-analysis. Withal, the articles in our review synthesis suggested that fine art therapy may accept a positive outcome in various groups of patients, peculiarly if the therapy lasts at to the lowest degree viii weeks.

There is some evidence from controlled trials to support the utilise of fine art therapy in children who have experienced trauma [xviii, 19]. It should be noted that art therapy or art psychotherapy was delivered as individual sessions in virtually of the studies in our review, especially for children with a psychiatric diagnosis. A grouping approach to art therapy was used in some studies with vulnerable children such equally children in need, female adolescents with cocky-esteem issues and female offenders [22, 31, 34]. However, the studies on group art therapy or psychotherapy are quasi-experimental studies of limited size, and information technology would exist useful if larger, more than robust studies such equally randomised controlled trials could study the efficacy of grouping art therapy or group art psychotherapy.

Many of the studies included in our review synthesis ranked low in the Cochrane Hazard of Bias criteria, with a high adventure of bias. Our review synthesis highlights the heterogeneity of the studies—diverse methods of individual or group art therapy were delivered, with some studies delivering psychoanalytic-type interventions while others delivered interventions resembling cognitive behaviour therapy, delivered via art. The literature also showed a general lack of standardisation with regard to the duration of art therapy and outcome measures used. Despite this, the authors of many of the studies described common themes and hypothesised about the value of fine art therapy or art psychotherapy in improving self-esteem, communication and integration. The interventions oftentimes encouraged the child to re-enact or to process trauma, and the authors described improved integration, and therapeutic change or transformation of the young person. It appears that in that location were varied interventions in the studies in the review synthesis merely that many studies had theoretical similarities.

Strengths and limitations

We used conspicuously defined aims and followed PRISMA guidelines to perform this systematic review. Still, we did not contain unpublished studies into our review and did not examine trial websites. Past following strict exclusion criteria, we excluded studies on fine art psychotherapy and mental health where one or more than participant commenced handling earlier his/her eighteenth birthday and completed after the eighteenth altogether such every bit that past Lock et al. [42]. The Lock et al. [42] study may be of interest to those who are considering commissioning art therapy services for CAMHS, every bit it is a randomised controlled trial and suggests that art therapy may be a useful offshoot to Family-Based Treatment for adolescent anorexia nervosa in those with obsessive symptoms [42]. Our strict criteria likewise led u.s. to exclude many studies where the primary focus was on educational issues including school behaviour or educational achievement—this is both a strength and limitation of our study. By excluding these studies, our systematic review can give useful information to CAMHS staff regarding the suitability of art therapy or fine art psychotherapy for children and adolescents with mental wellness difficulties. Even so, we annotation that a complete assessment of the effectiveness of art therapy or art psychotherapy in children would too include studies on the use of fine art therapy or fine art psychotherapy with children who have educational difficulties [43, 44], those with physical affliction or disability, also as describing the many studies on fine art therapy or art psychotherapy in children who are refugees or living in emergency accommodation. We focused our review on quantitative enquiry, only there are many mixed-methods studies in art therapy and fine art psychotherapy, where qualitative studies analysis may exist used to generate hypotheses, and quantitative methods are used to examination the hypothesis. A complete analysis of the effectiveness of fine art therapy or art psychotherapy in children could include summaries of qualitative or mixed-methods studies likewise as quantitative studies.

Meanwhile, it should be noted that there is considerable evidence for the effectiveness of psychotherapy in full general [45, 46]. Information technology has long been established that the common factors of brotherhood, empathy, expectations, cultural adaptation and therapist differences are of import in the provision of effective psychotherapy [47]. Art therapy and fine art psychotherapy are more than probable than the traditional talking therapies to provide these factors for those working with children.

Conclusions and hereafter perspectives

There is extensive literature which suggests that fine art therapy or art psychotherapy provide a non-invasive therapeutic space for young children to work through and process their fears, trauma and difficulties. Art has been used to heighten the therapeutic relationship and provide a non-verbal means of advice for those unable to verbally describe their feelings or past experiences. Nosotros noted that at that place is considerably more than qualitative and case description research than quantitative enquiry regarding fine art therapy and art psychotherapy in children. We constitute some quantitative evidence that art therapy may be of benefit in the treatment of children who were exposed to trauma. However, while there are positive outcomes in many studies regarding art therapy for children with mental health difficulties, further robust research and randomised controlled trials are needed in club to ascertain new and stronger prove-based guidelines and to establish the true efficacy of fine art psychotherapy in this population. It would exist helpful if in that location were studies with standardised outcome measures to facilitate cross comparison of results.

Availability of information and fabric

Information tin be made available to reviewers if required.

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Acknowledgements

Even so we would similar to acknowledge the back up of the European Erasmus mobility scheme which immune Dr. Irene Braito and Dr. Dicle Buyuktaskin to join the Department of Child and Adolescent Psychiatry, University College Dublin for placements. We would besides like to acknowledge the summer pupil inquiry scheme in University Higher Dublin which supported Mohammad Ahmed.

Funding

Open up Access funding provided by the IReL Consortium

Writer information

Affiliations

1. School of Medicine, University College Dublin, Dublin, Ireland

   Irene Braito, Dicle Buyuktaskin, Mohammad Ahmed & Caoimhe Glancy

2. Paediatric Medicine, Slap-up North Children's Hospital, United Kingdom, Britain

   Irene Braito

3. Dublin North City and County Kid and Adolescent Mental Health Service, Dublin, Ireland

   Tara Rudd & Aisling Mulligan

4. Section of Kid and Adolescent Psychiatry, Cizre Dr. Selahattin Cizrelioglu State Infirmary, Cizre, Sirnak, Turkey

   Dicle Buyuktaskin

5. Department of Child and Boyish Psychiatry, University Higher Dublin, Dublin, Republic of ireland

   Aisling Mulligan

Corresponding author

Correspondence to Aisling Mulligan.

Ethics declarations

Competing interests

Professor Aisling Mulligan is the Managing director of the UCD Child Fine art Psychotherapy MSc programme. At that place are no other interests to exist declared.

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Braito, I., Rudd, T., Buyuktaskin, D. et al. Review: systematic review of effectiveness of art psychotherapy in children with mental wellness disorders. Ir J Med Sci (2021). https://doi.org/10.1007/s11845-021-02688-y

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• Received: 14 December 2020

• Accepted: 09 June 2021

• Published: 06 July 2021

• DOI : https://doi.org/10.1007/s11845-021-02688-y

Keywords

• Adolescent
• Fine art therapy
• CAMHS
• Child
• Mental health
• Psychotherapy

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