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Children with autism spectrum disorders (ASD) are often referred to art therapy. To investigate what works in art therapy with children with ASD, the tacit knowledge of 8 experienced art therapists was explored through interviews. Promising components were arranged into the Context and Outcomes of Art Therapy (COAT) model. According to the respondents, art therapy with children with ASD contributes to becoming more flexible and expressive, more relaxed, and more able to talk about their problems in the therapeutic setting as well as in their home situation. Considering the evidence in this study, further empirical research into the process and outcomes of art therapy with children with ASD is strongly recommended.

The art therapy (AT) program for children diagnosed with Autism Spectrum Disorders (ASD), 'Images of Self', has been evaluated with repeated single case studies (n = 12) in a mixed-methods design. The program focuses on children's difficulties with their 'sense of self', 'emotion regulation', 'flexibility' and 'social behavior'. Parents, teachers and art therapists scored the BRIEF and CSBQ, instruments for rating child behavior. Children filled out the SPPC, a self-image scale. To evaluate the quality of the program, therapists used a child observation scale (OAT-A) and a therapists' self-evaluation scale (EAT-A). All instruments were applied three to five times per case, depending on the corresponding measurement objectives: one week before the start of the program (T0), during session 3 (T1), session 8 (T2), session 15 (T3), and 15 weeks after termination of the treatment (T4). Parents and teachers were invited to complete a form for qualitative comments which was structured around the four problem areas. Therapists video-recorded three sessions and evaluated these with parents and -during training sessions -with the principal investigator. At the end of the treatment parents, teachers and art therapists gave a rating for their overall satisfaction with the treatment. Main improvements after treatment were seen in children's flexible and social behavior. Overall satisfaction regarding the program showed averages between 7.1 and 7.7. Implications of our study for the AT-practice and future research are discussed.

Two instruments were developed and examined to enable treatment evaluation for art therapy (AT) with children diagnosed with Autism Spectrum Disorders (ASD). One instrument is the OAT-A (Observation in Art Therapy with a child diagnosed ASD), the other the EAT-A (Evaluation of actions of the Art Therapist during treatment of a child diagnosed ASD). Both scales were refined in a three round procedure. In each round raters (art therapists and students) observed and coded four videos of different AT sessions. For each round interrater reliability was tested and when necessary items were revised. In each round the first video was used for training purposes only. Both instruments showed in the third round an acceptable level of intercoder agreement. Using the OAT-A and EAT-A in clinical research requires extensive training of raters who preferably work in pairs, thereby enabling comparison of their assessments. It is concluded that important steps have been taken to enable systematic evaluation of art therapy with children diagnosed ASD including the actions of the art therapist.