Art Therapy: A Case of a Medically Ill Hearing Child of Deaf Parents

Cultural Considerations- CODA’s & KODA’s

CODA’s ({Hearing} Children Of Deaf Adults) or KODA’s ({Hearing} Kids Of Deaf Adults, referring to very young children) exist in a rather convoluted culture and world. Many of these hearing children grow up in a Deaf-culture environment. Numerous children such as Client S (herein referred to as CS) and her brother (herein referred to as E) converse, understand, and communicate in sign even before they can verbalize spoken language (Bull, 1998). Indeed, because of their placement within a Deaf-hearing family, they become interpreters by default, even when extremely young, thus complicating their childhood and forcing them into the ‘hearing’ advocate role for the family system. By proxy, they become ‘parentified’ (Harvey, 1982).

Thus was the scenario for CS and her hearing brother (E). When parents are part of a Deaf-culture environment, hearing children automatically participate in Deaf events (Harvey, 1982). Contemporaneously, these children must function in the hearing world: they function by way of auditory modality and attend hearing schools. In time, they form hearing friendships and simultaneously partake in auditory faculty events. Hence, CODAs and KODA’s are quite literally trapped between two distinct cultures: they are auricular, yet grow up “Deaf” and become duty-bound to accommodate those with their “Deaf” identities (Harrington, 2001).

Subsequently, many adult hearing children of Deaf parents become members of a support group called CODA, which helps them to come to grips with the conflicts involved (Bull, 1998). Still younger children become involved in the KODA support group. But in the meantime, oh what a weft they weave.

In this case, CS not only struggled with the above cultural issues, but also endured extreme medical illness that compounded the aforementioned. Moreover, both parents were exceptionally bright and accomplished individuals: the father elevated to full partner in a very prestigious law firm and the mother, graduated with a master’s degree. While Mother S chose to be a ‘stay-at-home Mom’ truly, even had she desired to re-enter the workplace, she had no choice: someone had to be the caretaker for this very ill child.

Mother S sublimated her feelings by ‘blogging’ openly on the Internet about her daughter and even posted a website that was continually updated with CS’s drawings and feelings. Indeed Mother S also posted her own feelings. So in this rare case, HIPPA fell to the wayside as Mother posted CS’s condition, artwork and feelings (sometimes daily) for public scrutiny and review. (We learned this before the first time we met CS at our Art Therapy Clinic at Nazareth College in Rochester, NY.) This was the first time that we worked with someone who so publicly presented ‘confidential’ dynamics to the public. On one level, it created an ethical conundrum for us; on the other hand, both Mother S was anxious for some relief since at referral, CS had become increasingly verbally and physically

aggressive towards the mother. However, upon referral during a relay conversation with the mother, Horovitz (author 1) went on to the website (per Mother S’s request) to learn more about this unusual medical case.

The dynamics were challenging: CS suffered from Eosinophilic Gastroenteritis (EG), a rare medical condition that pre-empted her ability to eat almost anything. (See Genogram and Timeline.) Her diet consisted of just a few fruits and vegetables.

“In the US, EG is rare, and the incidence is difficult to estimate. However, since the description of EG by Kaijser in 1937, more than 280 cases have been reported in the medical literature. The disease most often involves the stomach and the small bowel. A history of atopy and allergies is present in many of the cases. In children, a history of allergy is even more common. Children and adolescents can present with growth retardation, failure to thrive, delayed puberty, or amenorrhea.”


Yet, for all that she had endured, including retarded growth (due to lack of adequate nutrition even with supplements), CS was amazingly perceptive, artistic, endearing, attractive and intelligent. Thus even with a long waitlist, we made room to work with this very engaging young child. The work has been astounding and the case continues to unfold.

As always, more facts always seem to ‘spring eternal’ post the initial intake and this case was no exception: while Atkinson (author 1)

worked with the child, Horovitz (author 2) administered the case, interpreted for the mother (when she dropped off CS and came with both children) and with the other clinical supervisor, Lori Higgins, MS, MS, ATR, Dr. Horovitz obtained a more thorough timeline and genogram from Mother S and was able to (gently) suggest to Mother S that she return to her previous therapist for continued individual therapy. The reasons were myriad but primarily the suggestion came from Mother S’s need to work on her issues of loss (regarding her biological family system- e.g., maternal grandmother’s (MGM) death and maternal grandfather’s (MGF) subsequent depression and alcoholism- her age of 16) as well as her current family systemic issues involving her obvious depression and concomitant rage over having to contend with a ‘sick’ child.

Indeed it became clear, that family art therapy would need to be instituted to aid the family system with CS’s parentification issues and cultural divide. But presently, the case has focused on reparation via offering young CS the outlet she so sorely needs to sublimate her feelings concerning her medical illness, social alienation amongst her peer group, and exclusion from normal mealtime situations with both her family and peer group, in addition to overall anger and depression perceived due to her illness. Couple these antecedent factors with being a KODA and you have one very complicated case.

Timeline for Client (CS):
• Mother is deaf ; Father is hard of hearing
• Both paternal grandparents (PGF and PGM) are deaf; maternal grandfather MGF is hearing; maternal grandmother MGM (deceased) was hearing
• 1 yr, CS becomes ill
• 3 yrs, CS is diagnosed with Eosinophilic Gastroenteritis (EG) which currently only allows her to eat selected fruits and vegetables; disorder has caused multiple surgeries and tests
• Brother E is born
• 6 yrs, CS becomes frustrated with food restrictions
• CS spends over a month at the KKI (Kennedy Krieger Institute) hospital in Baltimore for EG in November 2005
• February 2006, CS begins Art Therapy- referred for physical acting out and aggression towards Mother S; symptoms subside within 3 weeks of individual art therapy treatment.
• Spring of 2006, CS re-enters KKI (Kennedy Krieger Institute) for additional testing and treatment
• Returning to Hospital for weekend checkup in April 2006

(N.B.: Mother S’s history: Mother’s S’ mother (maternal grandmother – MGM) dies in fire at mother’s aged 16. Mother S’s father (maternal grandfather (MGF) was hospitalized for up to one year having sustained and survived the same fire. 90% of MGF’s body was burned, neck up -spared by fire. MGF suffered disability from the fire and no longer works. After one year in the hospital, MGF was released, became depressed and alcoholic for a period of @ 4 years.

(Mother S lived with relatives during this period of time.) Mother (S) helped get MGF into treatment. Currently MGF is RA (recovering alcoholic).)

(N.B.: (Editor’s Note: Eosinophilic Gastroenteritis (commonly referred to as EG) is a rare disease in which the lining of the stomach, small intestines and large intestines become infiltrated with eosinophilis. Eosinophilis is a type of white blood cell. Eosinophilic Gastroenteritis can spread to other organs. It mostly affects children and young adults. The most common symptoms are: a) abdominal pain b) weight loss c) nausea and vomiting d) diarrhea e) bloody diarrhea. Exact cause of EG is unknown at this time. Treatment Options such as Corticosteriod medications are usually successful in treating eosinophilic gastroenteritis.- (source:

Thus, looking at the presenting symptoms, the case will be presented by reviewing CS’s art therapy diagnostic work-up and then some significant sessions. Perusing this case, the reader will glean insight into a) the Deaf-cultural issues that CS faced b) CS’s ability to cognitively change her behavior c) resolve of ‘parentification’ d) sublimation regarding her medical condition, Eosinophilic Gastroenteritis (EG) and e) verbal expression related to excommunication from peers and family.

Art Therapy Diagnostic Assessment

CA: 6.8
Referred By: Mother S
Testing Dates: 02/26/2006, 3/6/2006, 3/27/2006
Test Administered: Complete Art Therapy Assessment (CATA),
Kinetic Family Drawing (KFD)
Silver Drawing Test (SDT)
Person Picking an Apple from a Tree (PPAT)
Formal Elements Art Therapy Scale (FEATS)
Reason For Referral: Anger towards mother, trauma caused by dietary restrictions

Psychosocial History: See Appendix A, Genogram

Observations and Behavioral Impressions
CS presented as an intelligent, well-groomed 6.8 year-old child, whose physical size appeared closer to that of a four year old. (CS’s size is the result of her medically restricted diet of fruits and vegetables due to Eosinophilic Gastroenteritis.) Since CS’s comes from a family where the mother is deaf and father is hard of hearing, CS communicated by using both speech and sign language. She appeared friendly upon entering the clinic and even more so after her mother left, thus suggesting relaxation of her overall generalized anxiety.

Cognitive Art Therapy Assessment

Paint Response: Schematic Stage, 7-9 years, Lowenfeld & Britain
Clay response: Preschematic Stage, 4-7 years, Lowenfeld & Britain
Pencil Response: Schematic Stage, 7-9 years, Lowenfeld & Britain
Overall Response: Schematic Stage, 7-9 years, Lowenfeld & Britain

Painting Response Subtest

CS chose to paint first. When asked if she knew how to mix colors, she stated that she did not need a demonstration. She began by painting the ground line, followed by outlining and filling in a giraffe. She finished by painting the flower.

CS was quick to solve problems encountered during the painting portion of the CATA, such as requesting black paint for the giraffe’s tail, which was not given at the beginning of the assessment. She explained what she was doing while she worked. According to Hammer (1980), a long neck may imply difficulty controlling and directing instinctual drives, perhaps indicating eating in CS’s case. Hammer (1980) also suggested that those who have difficulty swallowing or psychogenic digestive disturbances illustrate elongated necks, thus underscoring her current digestive problems. (The painting subtest falls within Lowenfeld & Britain’s Schematic stage, approximately age 7- 9 years.)

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