Visual arts participation and young children’s social emotional wellbeing: a scoping review

ABSTRACT

This scoping review examines the prevalence of visual art participation in studies of young children’s social emotional wellbeing. Systematic reviews were identified through a search of two databases, grey literature, and reference lists. 22 reviews contained at least one study of visual art participation in children 0–9 years. Ten of these were analysed in a subset of visual art participation in children 0–5 years. The studies therein were primarily delivered by art therapists, with associated scaffolding. Other studies involved performing arts or mixed artforms. A knowledge gap has been identified which the authors will address with a systematic review.

KEYWORDS:

• Child
• attachment
• wellbeing
• scoping review
• visual art

A child with social emotional wellbeing is happy, confident, autonomous, able to maintain relationships with others, and to regulate emotions (NICE 2012). The ability to regulate emotions at age 2 years is associated with academic success and productivity at age 5 years (Graziano et al. 2007). Social and emotional wellbeing are readily present in children with secure attachment styles which develop through early interpersonal interactions (Sroufe 2005). The quality of the relationship a child forms towards their primary caregivers is internalised by the child as a framework on which later interpersonal interactions are modelled (Bowlby 1969) and is associated with the quality of their peer interaction throughout the lifespan (Doyle and Cicchetti 2017). This framework develops in early childhood (Opie et al. 2021), which means that activities can be introduced in the early years of a child’s life to improve the quality of their relationships (Bakermans-Kranenburg, van IJzendoorn, and Juffer 2003; Wright and Edginton 2016). Achieving social emotional wellbeing in the early years is therefore essential for academic and social development at school.

Visual art therapy has demonstrable positive effects relating to parent–child relationships, including maternal mental health (Armstrong and Howatson 2015; Arroyo and Fowler 2013) and in dyadic attachment behaviours (Armstrong, Dalinkeviciute, and Ross 2019). However, a scoping review (de Witte et al. 2021) which identified positive factors specific to art therapy also called for empirical research into the mechanisms of change. The scaffolding provided by art therapists includes mechanisms such as the selection of appropriate art materials to reduce anxiety (de Witte et al. 2021) or the establishment of psychological structures such as the containment of ‘chaos’ (Hosea 2006, 70). This scoping review seeks to determine to what extent visual art participation has been studied as a tool for improving the attachment relationships and social emotional wellbeing of young children, and if any effect is reported without therapeutic scaffolding. The findings have implications for how the artform can be best applied in a health context (such as social prescribing, and early childhood interventions). All settings were considered, including pre-school and primary education, cultural venues, clinical settings, and homes. Relevant literature reviews were collated to identify knowledge gaps which inform the inclusion and exclusion criteria for a future systematic literature review (PROSPERO CRD42021257566).

Indicators of social emotional wellbeing were defined using the National Institute for Health and Care Excellence guidance (NICE 2012): as a state of happiness and confidence (emotional), emotional regulation and autonomy (psychological), and ability to maintain relationships with others (social). These indicators are reflected in a systematic review of 95 ‘well-being’ studies in young people (Szántó, Susánszky, Berényi, Sipos, and Murányi 2016), where commonly measured indicators included life satisfaction, happiness, self-esteem, social support, relationships with parents and peers, and social conduct. Cho and Yu (2020) state the importance of selecting wellbeing indicators appropriate to the life course: early childhood is underrepresented in the literature, and therefore there is the risk of skewing data by using developmentally inappropriate indicators of wellbeing. This review seeks to examine the arts and wellbeing literature to determine if this approach to ‘childhood’ as a homogenous life phase persists.

In this review, visual art is defined as being primarily appreciated by sight, such as painting and sculpting. It excludes time-based media such as film to avoid potential overlaps with performing arts. ‘Early’ childhood is defined both as 0–8 years (Scottish Government 2009; UNICEF 2019), and 0–5 years (Department for Education 2021). The search therefore included any reviews with children in either age group, but excluded arts participation in adolescent populations, defined as 10–19 years (World Health Organisation 2022). A subset of reviews that included studies with young children 0–5 years participating in visual art was then analysed for evidence relating to social emotional wellbeing or attachment. This subset was chosen to reflect the formative period when attachment security is most malleable (Opie et al. 2021; Pinquart, Feußner, and Ahnert 2013).

The scoping review research questions were:

1. What do prior arts participation literature reviews address, in terms of psychological domains and population, and what common conclusions are made?

2. Within these reviews, how prevalent are studies that explore the effect of visual art participation with children 0–5 years old?

3. What proportion of the studies included in Question 2 focus on children’s social emotional wellbeing, or attachment relationships?

Method

Identifying the research question

The scoping review was conducted according to Arskey and O’Malley’s five-stage framework (2005). The research questions above were identified following a period of background research conducted by the primary reviewer, in which 60 cultural policy reports and studies on the topic of arts and wellbeing were scanned for references to young children. We identified a need for a summary of artform distribution in research with this age group.

Identifying relevant studies

Relevant reviews were identified through a title, abstract and keyword search of databases, grey literature, reference lists, and hand-searching. All searches were conducted in April 2021. Firstly, the PROSPERO register of systematic review protocols was searched four times for recent or ongoing reviews, using the terms ‘arts’, ‘attachment’, ‘creativ*’ and ‘visual art’, within the ‘Child Health’ or ‘Public Health’ areas of review, added to the register before 1st April 2021. Two electronic databases were then searched for published reviews: Cochrane Database, and Scopus. A supplementary search of grey literature was conducted with the search engine Google Scholar. Finally, a hand-search of reference lists and aggregate resource sites such as the Culture Health and Wellbeing Alliance (2021) was conducted. Full inclusion and exclusion criteria are shown in Table 1, but in summary the review subject must examine the effects of arts participation on children’s wellbeing, attachment relationships, or other related cognitive domains. At least one study in the review must address visual art participation. This does not necessarily mean an intervention has taken place, as correlational and longitudinal studies may be considered. Participation was defined as active creative ‘making’.

Table 1. Inclusion and exclusion criteria.

Category	Inclusion and Exclusion Criteria
Subject	The review subject must examine the effects of arts participation on children’s wellbeing, attachment relationships, or other related cognitive domains. At least one study in the review must address visual art participation.
Population	Children aged 0–9 years. Excluded: Adults and adolescents (10 years and older).
Review type	Included: Peer-reviewed articles: systematic reviews, rapid reviews, scoping reviews. Evidence summary reports in which synthesis has taken place. Excluded: Student theses, narrative reviews which do not attempt to locate all relevant literature or provide inclusion/exclusion criteria.
Publication date	Reviews must have been published before 01 April 2021.
Methodology	Search strategies and inclusion criteria must be clearly described.
Availability	Reviews must be available online, in English.

The Scopus search terms were: (TITLE-ABS-KEY (art OR creativ*) AND TITLE-ABS-KEY (wellbeing OR well-being OR attachment) AND TITLE-ABS-KEY (child) AND TITLE-ABS-KEY (literature OR review)). These terms were simplified in the search of Cochrane Reviews (‘art OR creativ*’ AND ‘child’) to retrieve any population-relevant material. Other considerations, such as child age, were not defined at the searching stage to ensure relevant material was not overlooked (for example with studies examining both child and adult populations). The effect of art participation on attachment relationships and social emotional wellbeing was the central research topic, but the more general term ‘wellbeing’ was included to retrieve material in related domains. ‘Health’ was not used, to exclude wellbeing studies pertaining to physical wellbeing, as defined by the World Health Organisation (2020).

Study selection

Study selection was conducted by the primary reviewer. Titles and abstracts were screened for relevance according to the inclusion criteria: art participation with a wellbeing outcome, an indication that a synthesis had been undertaken, and that children formed part of the population. Exclusions at this stage were titles/abstracts which did not indicate an exploration of the relationship between art participation and wellbeing, or those which were targeted at older adults or dementia patients. The selected articles were retrieved for full text appraisal. References of selected articles were hand-searched for additional studies.

‘Charting’ the data

Data were extracted on research objective(s), age of children, outcome measures, specific artforms in studies, quantity of studies, setting, publication date, search period, author’s assessment of quality, and their suggestions for future research. Following a broad overview of the characteristics of the field, which included all studies with children 9 years or younger, a further analysis was conducted on reviews that included children 0–5 years old and visual art. This subset was searched for unique studies that addressed the domains of attachment and social emotional wellbeing to assess the prevalence of this subject.

Collating, summarising and reporting the results

The first stage in summarising the results was to describe the characteristics of all selected reviews with children 0–9 years old. This included publication date, search period, outcome measures, author’s assessment of quality, and proportion of studies with visual art AND children 0–5 years old. This was to offer an overview of the current distribution of research in the field. The second stage was to conduct a subset analysis of reviews which included at least one study with children 0–5 years old participating in visual art, to determine what outcome measures were reported.

Results

Study selection

The PROSPERO register search returned a total of 164 records, using the terms ‘arts’ (105 records), ‘attachment’ (124 records), ‘creativ*’ (32 records) and ‘visual art’ (3 records). Only one protocol potentially addressed a similar population and activity: Verger et al. (2019) focussed on pre-school children aged 2–5 years old and considered social factors such as attachment style as part of a wider search on the effect of creative interventions on resilience. However, the record had not been updated since December 2019, and did not appear to have been completed.

Cochrane Reviews returned 158 results of which none were relevant. Reviews commonly appeared in the results due to the term ‘ART’ as an acronym for ‘anti-retroviral therapy’ or ‘assisted reproductive technology’. Scopus returned 298 results (after excluding the term ‘reproductive’, and 13 irrelevant subject fields, such as chemistry or dentistry). After abstract screening, six reviews were retrieved for full-text appraisal. Grey literature was also searched via Google Scholar and hand-searching through reference lists of included reviews. Google Scholar returned 14,700 results, but due to the relevance ranking built into the search engine, only the first 20 pages (200 results) were considered for title and part-abstract screening. 27 reviews were retrieved for full abstract screening, and nine were retained for full-text appraisal. Finally, 15 reviews were identified through hand-searching. Figure 1 illustrates the search process (Moher et al. 2009).

Figure 1. PRISMA 2009 Flow diagram detailing search process.

In total, 30 reviews were retrieved for full-text appraisal (see Appendix Table A1), and eight were subsequently excluded (see Appendix Table A2). 22 reviews are summarised in Table 2, which all include some visual art-based studies with children 9 years old or younger. From this selection, ten reviews featured studies of the effects of visual art participation on children 0–5 years old. These reviews are summarised later in Table 3.

Table 2. Characteristics of included reviews with children 0–9 years old.

Review	Search Period	Publication Period of Studies	Population Age and Setting	Artforms Considered	Studies 0-5yrs & Visual Art
APPGAHW (2017)	Not specified	1946–2017	General population	Visual and performing arts, crafts, dance, film, literature, music, singing, gardening.	2/43^a
Armstrong and Ross (2020)	All periods to 2019	2000–2019	Parent-infant dyads	Visual art.	14/14
Bosgraaf et al. (2020)	All periods to 2020	1990–2020	4–20 years with emotional, behavioural, and social problems, in clinical and educational settings	Visual art therapy (2D and 3D techniques).	2/37
Bungay and Vella-Burrows (2013)	2004–2011	2004–2010	11–18 years, in community settings (one study with children 8–13 years).	Drama, performance art or forum theatre, visual arts, dance, music.	0/20
Callinan and Coyne (2020)	All periods to 29 Jan 2018	2006–2015	4–18 years, with chronic conditions receiving transitional care	Visual arts (film/video production, time-based media, photography, animation, sculpture, audio, installation, sound).	0/7
Dahan-Oliel, Shikako-Thomas, and Majnemer (2012)	1950–2011	2003–2011	0–19 years, with neurodevelopmental disabilities	Performing arts.	0/19
Derman and Deatrick (2016)	All periods to 2 Dec 2014	1993–2010	2–21 years, with cancer undergoing treatment	Visual art therapy.	5/6
Fancourt and Finn (2019)	January 2000–May 2019	1979–2019	General population	Performing arts, visual arts, design, craft, literature, cultural attendance, online/digital/electronic arts.	0/20^b
Jindal-Snape et al. (2018)	2004–2016	2004–2015	2–18 years, in formal education	Mixed artforms (visual art, music and creative movement), performing arts.	1/30
Jindal-Snape, Scott, and Davies (2014)	2004–2014	2004–2013	Children of school and pre-school age	Performing arts with a music focus, mixed artforms (inc. visual art).	1/31 (as above)
Leenarts et al. (2013)	All periods to 26 July 2012	2000–2012	2–25 years, exposed to childhood maltreatment	Visual art therapy.	0/33
McDonald and Drey (2018)	Not specified	1993–2013	7–13 years, at primary school, experiencing various issues	Visual art therapy (among other therapeutic techniques).	0/4
Menzer (2015)	2000–2015	2004–2014	0–8 years	Music and dance, drama/theatre, visual arts.	2/18
Moula et al. (2020)	1 Jan 1980–31 Mar 2018	2001–2017	5–12 years, at primary school	Visual art therapy, music therapy, drama therapy.	0/7
Moula (2020)	1 Jan 1980–1 Dec 2018	1993–2016	5–12 years, in school settings	Visual arts (drawing, painting, sculpture, clay, or digital art).	0/8
Mowlah et al. (2014)	2010–2013	2010–2013	General population	All arts and culture, including sport and libraries.	0/38^c
Schweizer, Knorth, and Spreen (2014)	1985–2012	1991–2012	<18 years, with ASD and normal/high intelligence	Visual art therapy.	1/18
Slayton, D'Archer, and Kaplan (2010)	1999–2007	1999–2008	General population	Visual art therapy.	6/35
Toma et al. (2014)	2004–2014	2004–2014	General population	Visual art, dance, craft, design, sculpture, music, drama, theatre, creative writing, cultural attendance.	0/25
Uttley et al. (2015)	All periods to May 2013	2001–2013	People with non-psychotic mental health disorders	Visual art therapy.	0/27
van Westrhenen and Fritz (2014)	2000–2012	2001–2012	0–18 years, who had experienced a traumatic event	Visual art, dance, drama, music, cinema.	6/38
Zarobe and Bungay (2017)	All periods to August 2016	2005–2016	11–18 years	Drama/theatre, music, visual arts, dance.	0/8

Note: Selection from relevant sections:

^a Gestation and Birth, Perinatal Mental Health, and Early Childhood Development.

^b Child Development: Mother Infant Bonding, and Educational Attainment.

^c Health and Wellbeing, Society, and Education.

Table 3. Characteristics of studies included in subset analysis of visual art studies with children 0–5 years old (excluding pregnancy and birth interventions).

Review	Relevant Studies	Domains
APPGAHW (2017)^a	White et al. (2010)	Parental wellbeing
	Black et al. (2015)^b	Parental mental wellbeing and child emotional development
Armstrong and Ross (2020)	Armstrong, Dalinkeviciute, and Ross (2019)	Attachment relationships
	Armstrong and Howatson (2015)	Attachment relationships
	Arroyo and Fowler (2013)	Attachment relationships and parental mental health
	Black et al. (2015) (as above)	Parental mental wellbeing and child emotional development
	Hall (2008)	Attachment relationships
	Hosea (2006)	Attachment relationships
	Hosea (2011)	Attachment relationships
	Hosea (2017)	Attachment relationships
	Lavey-Khan and Reddick (2018)	Attachment relationships
	Meyerowitz-Katz (2017)	Attachment relationships, intergenerational trauma
	Parashak (2008)	Attachment relationships
	Proulx (2000)	Attachment relationships
	Proulx (2002)	Attachment relationships
	Proulx (2003)	Attachment relationships
Bosgraaf et al. (2020)	Saunders and Saunders (2000)	Problematic behaviours
	Siegel et al. (2016)	Mood in hospitalised children
Derman and Deatrick (2016)	Councill (1993)	Coping mechanisms expressed through art
	Favara-Scacco et al. (2001)	Cooperative behaviour
	Madden et al. (2010)	Quality of life, mood
	Massimo and Zarri (2006)	Coping mechanisms expressed through art
	Soanes et al. (2009)	Coping mechanisms expressed through art
Jindal-Snape et al. (2018)	Brown, Benedett, and Armistead (2010)^c	Literacy attainment
Jindal-Snape, Scott, and Davies (2014)	Brown, Benedett, and Armistead (2010) (as above)	Literacy attainment
Menzer (2015)	Muñiz, Silver, and Stein (2014)^d	Socio-emotional school readiness
	Brown and Sax (2013)^e	Emotional regulation
Schweizer, Knorth, and Spreen (2014)	Martin (2009)	Social/communication/learning skills in children with ASD
Slayton, D'Archer, and Kaplan (2010)	Ball (2002)	Emotional problems in children with attachment disorders
	Hosea (2006) (as above)	Attachment relationships
	Kearns (2004)	Behaviour in child with Sensory Integration difficulties
	Ponteri (2001)	Maternal mental health
	Saunders and Saunders (2000) (as above)	Problematic behaviours
	Favara-Scacco et al. (2001) (as above)	Cooperative behaviour
van Westrhenen and Fritz (2014)	Chilcote (2007)	Non-verbal expression of grief/trauma
	DiSunno, Linton, and Bowes (2011)	Non-verbal expression of grief/trauma
	Hanney and Kozlowska (2002)	Non-verbal expression of trauma-related feelings
	Howie et al. (2002)	Non-verbal expression of grief/trauma
	Klorer (2005)	Non-verbal expression of trauma
	Kozlowska and Hanney (2001)	Expression of trauma to manage anxiety/stress

Note: Selection decisions described below.

^a Studies and reports in relevant chapters (Gestation and Birth, Perinatal Mental Health, and Early Childhood Development). Report also included reference to the literature review by Menzer (2015), which appears in the table in its own right.

^b The report cites the author of this paper as South London Gallery, so for simplicity we have used the citation format which also appears in Armstrong and Ross (2020).

^c Mixed artforms including visual art.

^d Visual arts in the form of ‘block building’ as an aspect of ‘play’: measures frequency of family dinners, reading, storytelling, singing, and play.

^e Mixed artforms including visual art.

Characteristics of reviews with children 0–9 years old

To address the first research question, all reviews which included at least one study of child visual art participation and social emotional wellbeing were assessed. All 22 reviews selected for inclusion (Table 2) were published from 2010 to 2020, with two spikes in 2014 and 2020 respectively (see Figure 2). Eight reviews searched all periods, one from 1950, three from 1980s, one from 1999, three from 2000, four from 2004, one from 2010, and one did not specify a search date range. The reviews assessed 486 total studies, of which 52 studies were referred to more than once. The total number of unique references was 419. An evidence summary (APPGAHW 2017) was included because a literature review was conducted as part of the inquiry (Gordon-Nesbitt and Howarth 2020). Six reviews focussed on formal education settings, nine focussed on a clinical population (some of which were in an educational setting), and the others considered mixed settings or the general population.

Figure 2. Publication date of reviews.

As anticipated, some reviews used the term ‘health’ in addition to ‘wellbeing’, but these tended to include objective physical or mental health measures. The definition of ‘wellbeing’ included individual and social fulfilment (APPGAHW 2017), life-satisfaction (Mowlah et al. 2014), emotional wellbeing (Bungay and Vella-Burrows 2013; Zarobe and Bungay 2017), social wellbeing (Jindal-Snape, Scott, and Davies 2014), physical wellbeing (Toma et al. 2014), and the physical, mental and social facets of health defined by the World Health Organisation (Fancourt and Finn 2019).

20 of the reviews described significant methodological problems with the studies surveyed. The exception was the leisure participation review (Dahan-Oliel, Shikako-Thomas, and Majnemer 2012), but only one of the studies was art-based. The All-Party Parliamentary Group on Arts, Health and Wellbeing Inquiry Report (2017) was uncritical of the evidence presented in the relevant chapters (6.1-3), having applied a quality assessment framework in the selection process (Gordon-Nesbitt and Howarth 2020), but discussed a general need for arts and health projects to move away from the historical use of anecdotal ‘evidence’. Common limitations identified in the other reviews were small sample sizes, researcher bias, lack of longitudinal research or follow-up data, lack of transparent methodology or definitions, inconsistent use of measurement tools, mixed artforms, no randomisation, and lack of controls. In general, it was difficult to attribute causation.

Ten reviews directly discussed either the lack of comparison between the effects of different artforms, or the lack of detailed descriptions of the arts intervention to enable such a comparison to be made (Bungay and Vella-Burrows 2013; Callinan and Coyne 2020; Derman and Deatrick 2016; Jindal-Snape, Scott, and Davies 2014; 2018; Menzer 2015; Slayton, D'Archer, and Kaplan 2010; Toma et al. 2014; van Westrhenen and Fritz 2014; Zarobe and Bungay 2017). McDonald and Drey (2018) state that interventions were described in ‘varying degrees of detail’ (2018, 39), which suggests it is difficult to synthesise results. Some reviews considered mixed arts interventions (such as storytelling or music within art therapy sessions) with no indication that separation of artforms might be necessary to attribute effects to specific mechanisms (e.g. APPGAHW 2017; Moula 2020; Moula et al. 2020; 2014). These were either broad cultural policy reports or focussed on therapeutic interventions. The review of visual art therapy interventions within paediatric cancer settings (Derman and Deatrick 2016) specifically discussed the heterogeneity of interventions, which included both group and individual sessions, and structured and free art-making sessions. Whilst each study was rated ‘good’ or ‘high’ quality in their literature review, it proved difficult to compare approaches. The authors suggest implementing standardised art interventions in future studies. Menzer (2015) suggests that for better understanding of the effects of art participation not only should artforms be separated, but art activity should also be separated from the social context, such as participation within a group.

To address the second research question, only 35 (8.4%) of the 419 unique studies in the reviews included children 0–5 years old participating in visual art (see subset analysis below). Menzer (2015) also concludes that not much research exists on the effect of visual art participation among infants and toddlers. Art therapy interventions are the exception (e.g. Armstrong and Ross 2020). Infants and toddlers in the general, non-clinical population predominantly appear in studies of performing arts, such as music (e.g. Fancourt and Finn 2019; Jindal-Snape, Scott, and Davies 2014).

Subset analysis of studies with children 0–5 years old

The ten reviews that included studies with children 0–5 years old and visual art (see Table 3) included 35 unique references relevant to this subset, as discussed. One study was published in 1993, and the others between 2000 and 2019. These studies will now be described to address our third research question regarding the proportion that focus on children’s social emotional wellbeing or attachment relationships.

Only two reviews (Armstrong and Ross 2020; Menzer 2015), specifically collated evidence on the effect of visual art participation on children’s relational experiences (15 studies on parent–child relationships and social emotional development respectively). To characterise the studies in the other eight reviews (see Table 3), two studies focussed on parental mental health and wellbeing (Ponteri 2001; White et al. 2010), and two studies on child emotional regulation (Ball 2002; Brown and Sax 2013). The other studies did not address the domains in our third review question (attachment or social emotional wellbeing). Instead, they included: coping mechanisms and mood in a hospital context (Councill 1993; Favara-Scacco et al. 2001; Madden et al. 2010; Massimo and Zarri 2006; Siegel et al. 2016; Soanes et al. 2009), art as expression of grief or trauma (Chilcote 2007; DiSunno, Linton, and Bowes 2011; Hanney and Kozlowska 2002; Howie et al. 2002; Klorer 2005; Kozlowska and Hanney 2001), academic or learning skills (Brown, Benedett, and Armistead 2010; Martin 2009), and behavioural problems (Kearns 2004; Saunders and Saunders 2000).

Of the 15 studies which addressed parent–child relationships, reviewed by Armstrong and Ross (2020) and Menzer (2015), all but two were conducted by art therapists. The two other studies were a project delivered by visual artists, in partnership with a mental health trust (Black et al. 2015), and a cohort study in which the only visual art component was ‘block building’ (Muñiz, Silver, and Stein 2014). This was one aspect of a wider ‘play’ category and is therefore not isolated clearly enough for the purposes of this review.

The authors of the two most relevant reviews concluded that data was limited by sample size and lack of control groups (Armstrong and Ross 2020), and by unstandardised measurement tools (Menzer 2015). However, positive wellbeing changes were identified in parents, and improvements in parent–child relationships following visual art participation (Armstrong and Ross 2020). Menzer (2015) concludes that arts participation in general benefits social emotional development in the short-term but as most of the studies focussed on intrinsically social arts activities (such as parent–child or group activities) the effects of art participation itself were difficult to isolate.

Discussion

‘Wellbeing’ encompassed various domains in the 22 reviews, including fulfilment, life satisfaction, and social, emotional and physical wellbeing. Only one review exclusively considered the impact of visual art making on young children’s attachment relationships or social emotional wellbeing (Armstrong and Ross 2020). This scarcity of published evidence does not reflect the volume of work on clinical attachment interventions (e.g. Bakermans-Kranenburg, van IJzendoorn, and Juffer 2003), but may reflect child wellbeing studies in general. Cho and Yu (2020) found that only four of 186 child wellbeing studies focussed exclusively on children 0–5 years old. Pollard and Lee (2003) argue that younger children’s wellbeing is at risk of being under-reported as there were a greater number of wellbeing indicators used in studies with older children. This may indicate a lack of appropriate tools to capture the experience of very young children. In a rights-based approach to wellbeing, where children have the right to have their views heard (Convention on the Rights of the Child 1989), subjective measures allow children to offer their own perspective and be treated as an active entity within a family. This is more difficult when children are pre-verbal, and requires wider adoption of infant-focussed observational tools (e.g. Armstrong and Ross 2021).

Art therapists facilitated most of the relevant studies in the reviews. As discussed in the introduction, the scaffolding provided by art therapists involves several potential mechanisms of change (de Witte et al. 2021; Hosea 2006), which may confound the intrinsic effects of art making. This has implications for the scale of benefits achievable in public or pre-school art settings without therapeutic guidance. However, Armstrong and Ross (2020) found potential properties which could potentially be isolated from therapeutic processes in future research, including the production of physical artworks. de Witte et al. (2021) similarly isolate the ‘artistic product’ (as a mechanism for transference), as a visual art-specific factor in comparison to other creative arts therapies. The production and display of physical artworks offer a means of reflection, whether taken home, or displayed in a group setting (Armstrong and Ross 2020). Encouraging parents to recognise and support their young child’s interests in the activity, by providing developmentally appropriate art materials and the means to regulate ‘mess’ may support emotional regulation (Armstrong and Ross 2020). This, as discussed, is associated with academic productivity (Graziano et al. 2007).

Most studies in the age group were in performing arts or mixed artforms. This is an important distinction because performing artforms involve different physical properties to visual art making, such as vocalisation and movement. These have unique physiological, neurological and hormonal effects. For example, music participation and listening decrease cortisol levels (Fancourt, Ockelford, and Belai 2014), and even a comparison between music and drama participation found different effects on children’s social skills (Schellenberg 2004). UK health advisory bodies recommend dyadic visual arts participation to develop positive attachment behaviour (NHS Education for Scotland 2016), bonding, and perinatal mental health (APPGAHW 2017), but there must be clear evidence to support these recommendations. Without further robust research, it is difficult to advocate for the social emotional wellbeing benefits of participation in visual art compared to performing arts, despite promising evidence in art therapy. Only one study reviewed by Armstrong and Ross (2020) was delivered by practicing visual artists (Black et al. 2015), which suggests that there may be a benefit to the field if training was widely adopted by artist-educators on supporting early childhood social emotional wellbeing.

This scoping review was limited by the number of databases searched. However, the hand-searching was thorough, and the search terms were inclusive of all artforms and child age. The specific population area could then be explored in the knowledge that cross-age reviews had not been excluded.

Conclusion

In the initial selection of 22 reviews which included children 0–9 years old, the majority concluded that there were significant methodological problems in the field, and that inconsistencies in design, measures, and reporting made the synthesis of evidence very difficult. Only 8.4% of studies represented in the 22 selected reviews included visual art participation with children 0–5 years old. These studies were found in ten reviews from the initial selection, two of which addressed the effects of visual art participation on the social emotional wellbeing of young children. The other eight addressed different aspects of wellbeing, such as emotional regulation and coping mechanisms in hospitalised children. Only Armstrong and Ross (2020) addressed the target population, visual art activity, and parent–child relationships, and found some evidence to suggest that there are mechanisms of change unique to visual art. Menzer’s review (2015) focussed on social emotional development in children 0–8 years, in all artforms. There is therefore a knowledge gap regarding the effect on the social emotional wellbeing of young children participating in visual art. In addition, relevant studies in these two reviews were primarily conducted in a therapeutic context, and the remaining studies utilised mixed artforms. The heterogeneity of artforms was identified as a problem in almost half of all reviews. Therefore, there is a significant knowledge gap regarding effects attributable to visual art making as distinct from the confounding factors of therapeutic scaffolding or mixed artforms.

The authors have registered a protocol (PROSPERO CRD42021257566) for a mixed methods systematic review to address the knowledge gaps identified. This scoping review also forms a rationale for researchers to conduct controlled studies with preschool children, perhaps within a visual art organisation, to assess the effect of parent–child art participation in a non-therapeutic setting.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by an Economic and Social Research Council Collaborative Award from the Scottish Graduate School of Social Sciences.

Appendix

Table A1. Reviews selected for full-text appraisal.

	Review
1	All-Party Parliamentary Group on Arts, Health and Wellbeing (2017)
2	Armstrong and Ross (2020)
3	Bosgraaf et al. (2020)
4	Bungay and Vella-Burrows (2013)
5	Callinan and Coyne (2020)
6	Colegrove and Havighurst (2017)
7	Dahan-Oliel, Shikako-Thomas, and Majnemer (2012)
8	Daykin et al. (2008)
9	Derman and Deatrick (2016)
10	Fancourt and Finn (2019)
11	Galloway (2007)
12	Hogan, Sheffield, and Woodward (2017)
13	Jindal-Snape et al. (2018)
14	Jindal-Snape, Scott, and Davies (2014)
15	Leckey (2011)
16	Leenarts et al. (2013)
17	McDonald and Drey (2018)
18	Menzer (2015)
19	Moula (2020)
20	Moula et al. (2020)
21	Mowlah et al. (2014)
22	Perruzza and Kinsella (2010)
23	Schweizer, Knorth, and Spreen (2014)
24	Slayton, D'Archer, and Kaplan (2010)
25	Toma et al. (2014)
26	Tomlinson et al. (2018)
27	van Westrhenen and Fritz (2014)
28	Urquhart et al. (2020)
29	Uttley et al. (2015)
30	Zarobe and Bungay (2017)

Table A2. Reviews excluded at full text appraisal stage.

	Review	Reason For Exclusion
1	Colegrove and Havighurst (2017)	No visual art
2	Daykin et al. (2008)	Adult population
3	Galloway (2007)	Adult population
4	Hogan, Sheffield, and Woodward (2017)	Adult population (maternal focus)
5	Leckey (2011)	Adolescent and adult population
6	Perruzza and Kinsella (2010)	Only one child study, not described
7	Tomlinson et al. (2018)	Adolescent and adult population
8	Urquhart et al. (2020)	Narrative literature review