Photo by NEC Corporation of America with Creative Commons license

Nowadays when we knock on the door of a child’s room to check in, we’re likely as not to see her staring at a screen. Is that a good thing? Should we be happier to find the kid reading, singing, or drawing?

These (and many other) questions lie at the heart of “Arts and Cultural Participation among Children and Young People: Insights from the Growing up in Ireland Study,” a 2016 report commissioned by the Arts Council of Ireland. The report attempts to gauge the impact of children’s cultural engagement in the context of our digital era.

Authored by Emer Smyth, research professor at the Economic and Social Research Institute (ESRI), “Arts and Cultural Participation” extracts and examines data from Growing up in Ireland – the National Longitudinal Study of Children (GUI), a government-funded study conducted from 2006 through 2013. Smyth’s analysis, which draws on the arts-and-culture part of the GUI data, views cultural engagement through a multifaceted prism. Covering a broad age range from early childhood to the throes of adolescence, “Arts and Cultural Participation” weaves seemingly tangential activities like reading, television viewing, and computer screen time into the findings, all while weighing the effects of social disparities in income, education, and cultural access.

Three key findings emerge from Smyth’s analysis of the data:

• Cultural engagement appears to boost both academic skills and socio-emotional wellbeing for participating children.
• The availability of school-based cultural activities correlates with extracurricular arts participation.
• Despite the best efforts of school-based interventions, engagement with culture and the arts varies widely among demographic groups in Irish society.

Casting a Wide Net

Growing Up in Ireland has a longitudinal design – with data gathered from the same subjects at progressive time points – that probes the cumulative effects of various activities in people’s lives over several years. The inquiry follows two cohorts of children: a group of 11,134 subjects recruited at 9 months of age and then surveyed at ages 3 and 5; and a second cohort of 8,568 children recruited at 9 years of age and again surveyed at age 13.

Smyth’s report for the Arts Council analyzes this data with respect to the likelihood of different groups of children to engage in cultural activities, the influence of schools’ emphasis on cultural activities on children’s cultural engagement outside of school, and the relationship between cultural participation, academic skills, and socio-emotional wellbeing. For younger subjects, researchers interviewed primary and secondary caregivers to learn about activities outside the classroom such as creative play and cultural outings. For older children, questionnaires given to principals and teachers tracked structured activities offered in schools – music, drama, painting and drawing classes – as well as more passive pursuits like attending cultural events. Data for the older group also includes interviews with the subjects themselves.

The GUI dataset tracks two sets of outcomes: cognitive development (as measured by standardized tests) and wellbeing (as measured by the prevalence of socio-emotional difficulties). They control for some individual and family characteristics, such as preschool childcare at age 3, but there are no controls for individual personality traits or certain other environmental factors that might have a role in shaping these outcomes. Thus, the findings are arguably not as reliable as would be the case if the study used an experimental design.

That said, there are other reasons to pay heed to “Arts and Cultural Participation.” While we can’t be sure that the outcomes in question follow solely from cultural engagement, the longitudinal nature of the study, with its ability to compare the same people at different points in time, points provides a useful (and relatively rare) companion to experimental inquiries that typically focus on the short-term effects of engagement. Also of note is GUI’s robust sample size (nearly 20,000 subjects) covering a broad and representative cross-section of Ireland’s population. And while there may be some cultural specificity to studying an ethnically homogenous country like Ireland, that makes the consistency of the findings with studies of the value of arts and culture in other countries all the more striking.

What is Culture, Anyway?

Perhaps the most distinctive trait of the Arts Council report is its broad definition of cultural engagement. The analysis incorporates the common pastimes of reading, watching television, and engaging in screen time (including video games) on computers or mobile devices.

The results are telling. Of all included activities, reading gets the highest marks in terms of enhancing both cognition and wellbeing. The report notes that among younger children, “being read to frequently and having more access to books contributes to improved vocabulary.” Unsurprisingly, such children later take up reading on their own. For older kids, “self-directed reading contributes to cognitive development (in terms of both verbal and numeric skills) as well as to academic self-confidence [and] socio-economic wellbeing.” The report cites the country’s relatively high use of libraries and recommends them as places to promote cultural engagement.

In contrast, television viewing and computer screen time yield mixed results: watching more television is associated with improved vocabulary and better reading achievement – but also with greater socio-emotional difficulties. Similar findings emerge for computer screen time. Smyth concludes that television and screen time may “promote verbal skills but at the expense of poorer socio-emotional wellbeing and more negative attitudes to school.” (Interestingly, no attempt is made to single out social media, possibly because at the outset of the GUI study in 2006, it was not as prevalent as it is now.)

Meanwhile, participatory engagement with the arts – activities such as painting/drawing, music or other types of creative expression, and attending cultural events – correlate with improvement in both test scores and socio-emotional wellbeing. These trends are amplified as the subjects age. “Being involved in a structured cultural activity is associated with positive outcomes across all domains,” Smyth writes, “with higher achievement levels, academic self-confidence and happiness, and lower levels of anxiety and socio-emotional difficulties.” However, it’s worth noting that the magnitude of benefits of arts activities was quite a bit less than the positive impacts of reading for pleasure (for pre-teens) or being read to (for toddlers).

Disparities in Access

Which segments of the population actually enjoy the benefits of cultural participation? The data indicates disparities in youngsters’ cultural engagement along several dimensions:

• Income. Among younger children, “more advantaged families are more likely to read to their child, take them on educational visits and cultural outings, and encourage them to engage in creative play.” Older kids from advantaged families report higher participation in organized after-school activities (which often require payment).
• Gender. Girls engage more frequently than boys across several categories of arts and culture. E.g.: “Remarkable gender differences were evident in the prevalence of painting or drawing (67 percent of girls did so every day compared with 42 percent of boys) and in enjoying music or dance (73 percent compared with 46 percent doing so every day).”
• Population density. Living in an urban area facilitates greater access to some amenities such as cultural venues, libraries, and cinema houses. However, the report cites “no significant difference between urban and rural areas” for participatory activities like painting/drawing, reading, and taking lessons in music/dance/drama.
• Immigrant status. The report cites a “significant difference” between immigrant and native Irish children in involvement in cultural activities in and out of the home, relating this in part to language barriers.

Despite these societal disparities, there’s one place where varied demographic groups can simultaneously encounter arts and culture activities: in school.

The Great Equalizer?

The report reveals a clear correlation between school-based cultural programs and extracurricular participation, both in structured after-school activities and in reading for pleasure. This suggests cultural curricula can offset some of the disparities described above: “school may be the main point of access to arts and cultural activities for many students.”

This effect is apparent even after taking socioeconomic characteristics of individual students into account. Yet Smyth notes that interventions such as Ireland’s Delivering Equality of Opportunity in Schools (DEIS) program, which launched in 2005 to ensure exposure to the arts among disadvantaged students, have not completely corrected the imbalance among different social classes. “In spite of urban DEIS schools’ promotion of cultural activities,” she writes, “their students are much less likely than others to read for pleasure or to take music/drama lessons and are more likely to spend a lot of time watching television or playing computer games.” What is not clear from the report is whether disadvantaged schools with these programs promote higher levels of cultural engagement in their students than schools without the programs would.

All in all, “Arts and Cultural Participation” makes a solid case for the benefits of cultural engagement among young people across all demographics. It points to school-based cultural activities as one means of increasing children’s engagement with arts and culture, even if it’s not a panacea. But while what we traditionally think of as arts activities (painting, drawing, music, etc.) can lay claim to some of these benefits, the most striking finding of the report is the across-the-board value of reading for pleasure, both in early childhood and especially in adolescence. So to answer the question posed at the beginning, if you catch your 13-year-old deep into the latest volume of The Hunger Games, it’s occasion to celebrate.

“Human Brain Sections” by flickr user GorissenM

Title: “Shall I Compare Thee to a Dose of Donepezil?”: Cultural Arts Interventions in Dementia Care Research

Author(s): Kate de Medeiros and Anne Basting

Publisher: The Gerontologist, 54(3)

Year: 2013

URL: http://gerontologist.oxfordjournals.org/content/early/2013/06/07/geront.gnt055.full.pdf

Topics: Arts participation, older adults, dementia, arts therapy

Methods: Literature review (of systematic reviews)

What it says: This article reviews 27 systematic and integrative reviews of pharmacologic, psychosocial and cultural arts interventions in dementia care for older adults. (The authors use philosopher Susanne K. Langer’s 1966 definition of cultural arts as “the practice of creating perceptible forms expressive of human feeling,” accounting for the role of imagination more so than the outward senses.) Although individual studies of cultural arts interventions demonstrate positive outcomes, most are excluded from systematic reviews due to weaknesses in research design, such as small sample sizes and the lack of randomization or control groups. Only reviews published in English between January 2000 and September 2012 were included. Studies that didn’t involve humans or focused on biological aspects of dementia were excluded.

The authors grouped results of pharmacologic, psychosocial and cultural arts interventions into three categories: 1) cognition; 2) problematic behaviors or symptoms, such as agitation, anxiety or apathy; and 3) quality of life. Drug trials involving donepezil led to improvements in cognitive function and self-reported quality of life for people with mild to moderate dementia. Otherwise, pharmacologic interventions demonstrated minimal benefit in dementia care compared to psychosocial and cultural arts interventions. Psychosocial interventions involving cognitive training and stimulation led to improvements in cognition, and those involving reminiscence led to improvements in autobiographical memory. A wide variety of psychosocial interventions such as aromatherapy, group validation, and reminiscence were most effective in reducing problematic behaviors such as wandering, irritability, and disruptiveness, respectively. Some also led to improvements in quality of life, as reported by people with dementia and their caregivers.

There were no cultural arts interventions included in the studies that adequately measured changes in cognition. Some music therapies led to reduction in problematic behaviors such as irritability, aggressiveness, agitation, and inappropriate vocalization, although application of the therapies varied widely. One study involving visual arts interventions distinguished between individual and group activities, noting higher levels of fear and verbal agitation for people with dementia assigned to individual art projects compared to those in weekly art classes. Results regarding improvements in self-reported quality of life varied widely for cultural arts interventions, with many facing methodological limitations. Those involving dance/movement therapy found increases in communication and quality of life as reported by participants and their caregivers, however, no validated assessment tools were used. One study involving storytelling similarly demonstrated improvements in communication and “expressions of pleasure,” but no significant change in wellbeing. Although lacking standardized outcome measures, visual arts interventions demonstrated similar improvements in participants’ expressions of pleasure. Music interventions also had positive outcomes, such as increases in self-reported quality of life, but with limitations in sample sizes, non-validated measures, and poorly defined outcomes.

The authors note that reviews were selected for inclusion based on topic, so the quality of individual studies was not evaluated. In addition, the authors clearly indicate inconsistencies amongst reviews, such as definitions of key outcomes, variability in measures used, and the level of detail offered in each study. Based on their review, the authors conclude that the quality of a study should be based on what is being measured and how, rather than its adherence to randomized controlled trial designs, since the latter does not necessarily capture changes in affect or meaningfulness. The authors also call for the consideration of the individual nature of cultural arts, noting that outcomes may differ significantly from person to person, but also note the importance of including the larger social network of people with dementia that play a role in improving their social connectedness.

What I think about it:

Although measures vary widely and findings are not suitable for direct comparison, this review is helpful in situating arts interventions among a broader pool of interventions for treating dementia, most of which are medically oriented. Much like other studies investigating the health impacts of arts and cultural participation, the authors point to the need for improved research designs. Perhaps the most notable takeaway from this review is the recommendation to move away from interventions that fall into the boundaries of traditional arts disciplines, and towards better understanding what the actual activities comprise, how they’re delivered, and to whom specifically. In other words, the priority should not be to determine which art form is most effective but instead, seeking clarity around what exactly it is that the arts offer in this realm that non-arts interventions with similar characteristics do not.

What it all means:

Given the relative weakness of drug interventions in this review, overall findings begin to suggest that cultural arts and psychosocial interventions may be viable alternatives to drug treatment. It offers a broad perspective of promising outcomes for people with dementia, and asks important questions about whether or not the clinical trial model suits arts interventions. This is consistent with the methodological limitations cited in the Cultural Value Project, namely its recommendation to better understand where rigorous qualitative methods, which are often more suitable for arts interventions, might fit within traditional hierarchies of evidence that prize RCTs. An appropriate next step would be to design research studies that begin to answer the what, how, and who questions previously outlined by de Medeiros and Basting.

“Sculpture by Ron Mueck – Two Women 2005” by flickr user Lance

Title: Participatory Arts for Older Adults: A Review of Benefits and Challenges

Author(s): Tony Noice, Helga Noice, and Arthur F. Kramer

Publisher: The Gerontologist, 54(5)

Year: 2013

URL: http://gerontologist.oxfordjournals.org/content/early/2013/12/10/geront.gnt138.full.pdf+html

Topics: Arts participation, older adults, creative aging, quality of life, health benefits, cognition

Methods: Literature review

What it says: This article reviews literature on the health benefits of active arts participation among older adults ages 60 and older in good general health. Arts activities include dance, expressive writing, music (singing and instrumental), theater, and visual arts. The review included a combination of 31 experimental and correlational studies conducted between 1985 and 2013. The following were excluded: case studies; studies with small sample sizes (n < 8); reports in non-peer-reviewed journals; articles not written in English; and studies focusing on arts therapies to treat those with illness, trauma, or other life challenges.

Overall, the studies demonstrate positive cognitive, affective, and quality-of-life outcomes. The review categorizes findings based on art forms

• A number of dance studies using quasi-experimental designs demonstrated cognitive and physiological improvements (e.g., increased attentional control). Dancers also scored higher on self-assessments of general health and subjective wellbeing compared to control groups. One of the studies suggests that cognitive benefits might be attributed to dance’s aesthetic qualities, rather than aerobic exercise, as no significant improvement in cardiorespiratory fitness among study groups (dancers and non-dancers alike) was observed.
• Studies related to expressive writing include evidence of improved processing, speed, attention, verbal learning, and memory, although this may be moderated by participants’ educational level and interest in writing. One study revealed psychological benefits, indicated by improvements of scores on a standard depression scale. The authors note that studies involving expressing writing were the only ones where a professional artist was not involved. This is a notable distinction because it may 1) point to why effects were likely moderated by participants’ level of educational attainment, or existing interest in writing, and 2) shed light on the value of formal arts instruction, which is likelier to draw sustained engagement (and produce substantive effects) than one-off attendance at events or other modes of passive engagement in the arts.
• Music-related studies produced a wide variety of results. For singing, there were self-reported decreases in doctor visits, falls, and use of over-the-counter medicine, decreases on a standard depression/anxiety scale, as well as improvements in overall health and involvement in activities and statistically significant improvements in emotional wellbeing, quality of life, and knowledge of singing;increases in self confidence were marginally significant. As for playing a musical instrument, results include: decreased levels of anxiety and depression, increases in the human growth hormone (associated with higher energy and improved memory and sex function), significant improvements in cognitive processes, and perceived favorable effects on health, and to a lesser extent, on social relationships and personal development. In some cases, positive outcomes did not persist over the longer term following music participation,unless, instrumentalists had trained or practiced over an extended period of their lives.
• Theater studies produced positive evidence, mostly related to increases in memory, comprehension, creativity, problem-solving, and personal growth. A study on improvisational drama yielded positive changes in anxiety, and another demonstrated improvements in wellbeing and physical measures, but not psychological health.
• Lastly, visual arts studies using qualitative methods revealed increases in social engagement, sense of empowerment, psychological health, skills development, ability to set new challenges, and identity preservation. One study using a randomized controlled trial yielded positive outcomes measures for anxiety, affect, and self-esteem.

The authors acknowledge the limitations of the research: the total number of studies reviewed is relatively small; a variety of instruments were used to measure change; and not all experiments were well controlled. To improve consistency across future research, they propose standardizing measures, vocabulary, and behavioral outcomes to assess effectiveness of interventions across art forms. They also recommend consistent use of pre/post design, and including control groups, where appropriate, as well as pursuing more meaningful sample sizes, more diverse populations, and longitudinal studies that measure effects over a long period of time.

What I think about it: The review offers a useful overview of health benefits associated with older adults’ arts participation. Some of the claims that were summarized had no indication of statistical significance, which may be a result of authors’ attempt to succinctly summarize findings from studies that used a wide variety of research designs. Nonetheless, the summary chart prepared by the authors is useful in showing the breadth of methods, sample sizes, and outcome measures used across arts interventions among older adults.

What it all means: Noice, Noice, and Kramer’s review was published the same year that NEA released The Arts and Aging: Building the Science, a report summarizing findings from its public workshop exploring research gaps and opportunities for understanding the relationship between the arts and health and wellbeing among older adults. A preliminary version of this review was prepared as a paper for the workshop, so this is a useful, evidence-based supplement to the mostly anecdotal findings in the NEA’s summary. The two combined – in addition to the NEA’s 2011 white paper on the arts and human development, which has a chapter on arts, health and wellbeing among older adults – show that there is growing momentum in the field of creative aging. The health focus and population specificity of this field offers a unique opportunity to lay the groundwork for developing more rigorous research designs for arts inventions broadly. In doing so, researchers can begin to identify the specific benefits of aesthetic engagement. In addition, researchers and advocates can use this evidence to gain support not only from public arts agencies, but also from non-arts agencies serving aging populations.

Author(s): Ingo Roden, Gunter Kreutz, and Stephan Bongard

Publisher: Frontiers in Psychology

Year: 2012

URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528082/

Topics: arts education, music, cognitive benefits

Methods: quasi-experimental longitudinal study

What it says: Twenty-five German primary-school students taking weekly 45-minute instrumental training lessons for 18 months showed increased verbal memory compared to 25 students receiving extended training in the natural sciences and 23 students receiving no intervention, even after controlling for age, IQ and socioeconomic status. No such benefits were observed for visual memory skills. Both findings are consistent with previous research, although there has been disagreement in prior work on the connection between music and visual memory.

What I think about it: Overall, the study seems solid, though it treads relatively familiar ground. The treatment groups were not randomized, so there is a possibility that some unobserved variable is accounting for the improvements in verbal memory rather than the exposure to music lessons. However, the study design appears to anticipate all of the most obvious potential objections of this nature. The relatively small sample size of 73 students is notable, but not a major concern.

What it all means: There seems to be a strong evidence base suggesting that participating in music training has benefits for verbal memory, and this study adds to it. On the other hand, claims that music training is connected to visual memory are weakened by this study.