(1) Social interaction, belonging and inclusion

In 24 selected articles, the key concept of contribution of the ABC to social justice for people with ID can be described as more or better human interaction. The data show a variety of concepts and terminology, such as: social inclusion and integration into the wider society (Curtis & Mercado, 2004; Schlosnagle et al., 2014; Stickley et al., 2012; Whitehurst, 2006), inclusion in the art scene (Levy et al., 2017; Macpherson & Bleasdale, 2012), and inclusive experiences for all within ABCs (Hourigan, 2009). Sense of belonging, relationships of belonging, person-directed experiences of belonging, and experiences of attachment as values in and aims of ABCs are of interest in a great number of articles. Hall (2010; 2013), King et al. (2016), and Kivijärvi and Poutiainen (2019) describe sense of belonging as an important experience in the ABCs. Other included articles addressing inclusion and integration, (social) collaboration, relationship and sense of belonging are by Caldwell et al. (2008), Calvert (2010), Dickinson and Hutchinson (2019), Goddard (2015), Harter et al. (2006), Johansen and Saur (2018), Macpherson and Fox (2016), Moore (2015), Nijkamp and Cardol (2020), Price and Barron (1999), Saur and Johansen (2013), Schnellert et al. (2021), and Scott and Watfern (2021).

In relation to the barrier between participants within the ABC, Hourigan (2009) writes that ABCs can create social interactions that help socially challenged persons make lasting relationships and create an inclusive tone of acceptance for all participants. Other examples are joining in with arts activities to feel part of the community (Stickley et al., 2012), and carefully listening to each other (Macpherson & Fox, 2016). Nijkamp and Cardol (2020) write that their study reveals that realising inclusion in a collaboration between actors with and without disabilities is not easy. Nevertheless, they found examples in which actors with and without ID co-created and collaborated on an equal basis.

Several articles addressed the reduction of the barrier between ABC participants and people outside the ABC. The concept of the contribution of ABCs to social justice concerning this barrier is described as fostering social inclusion into the wider society (Curtis & Mercado, 2004; Schlosnagle et al., 2014; Stickley et al., 2012; Whitehurst, 2006), or inclusion in the field of art (Levy et al., 2017; Macpherson & Bleasdale, 2012). Levy et al. wrote in 2017 that the boundaries of who could engage in the arts and experience the freedom to be the person they wanted to be, which for some might be a musician or a dancer, were only beginning to be disrupted.

According to authors, ABCs can transcend barriers in social interaction, such as traditional hierarchies (Harter et al., 2006; Macpherson & Bleasdale, 2012), enabling people to combat social alienation (Calvert, 2010), establishing a communicative space for encounters on equal terms (Calvert, 2010), creating connection on a deeper level (Hall, 2013), fostering understanding (Macpherson & Fox, 2016), and allowing people to be taken seriously (Price & Barron, 1999). According to others, ABCs that address resistance and activism support breaking down barriers of social interaction by transforming exclusion and stigmatisation into community engagement (e.g., Hall, 2010; Johansen & Saur, 2018; Moore, 2015; Saur & Johansen, 2013).

Two of the articles describe that it is not easy to break down barriers of social interaction by participation in ABCs (Hall, 2010; Nijkamp & Cardol, 2020). Hall (2010) writes that the belonging that people yearn for is largely that within the ABC. The development of belonging to wider society is much more limited.

(2) Empowerment and self-advocacy

According to 18 articles, ABCs contribute to social justice for people with ID by fostering empowerment and self-advocacy. This concept is underlined by three arguments:

First, being part of the arts-based community can contribute to building confidence, self-esteem, a sense of purpose and growth (Dickinson & Hutchinson, 2019; French & Jones, 2019; MacGlone et al., 2020; Schlosnagle et al., 2014). It is stated that people with ID become braver in relation to what they believe they can achieve, and that they can discover their personal and authentic preferences (King et al., 2016; Schnellert et al., 2021; Scott, 2021).

Second, creating art is considered to promote self-advocacy, empowerment and autonomy (Cook, 2020; Curtis & Mercado, 2004; Price & Barron, 1999). The art-making process, such as creating a theatre play, can be an empowering and rewarding process by promoting people to use their own voice of expression (Almeida et al., 2011; Nijkamp & Cardol, 2020; Richards et al., 2019). Within the creative process people can work according to their own perceived strengths and abilities (Stickley et al., 2012), and are involved in shaping their own personal outcomes (Levy et al., 2017).

Third, having the opportunity to perform the personal in public spheres, such as performances before an audience (Goddard, 2015; Harter et al., 2006), creates opportunities for people with ID to be taken seriously (Parry, 2017; Price & Barron, 1999). Johansen and Saur (2018) argue that when one is visible and claims space on a stage or with one’s artwork, it is not so easy to be oppressed without the oppression itself becoming visible.

(3) Awareness and challenging stigma

Thirteen articles outline concepts that the authors synthesised to the key concept of raising awareness and challenging stigma as a contribution of ABCs to social justice. The data show two perspectives on that concept:

First, that through performance arts it can be possible to understand and celebrate differing abilities, gifts, shared passion for the arts and the realisation that perhaps people are more alike than different (Curtis & Mercado, 2004). In this way, art is seen as having the ability to provoke an awareness transformation, in which persons with ID become more visible and less seen as incapable (Hall, 2010; 2013; Kivijärvi & Poutiainen, 2019; Parry, 2017; Price & Barron, 1999; Yoon et al., 2020).

Second, according to Richards et al. (2019), all persons with ID face direct or indirect stigma because of their label. Through sharing stories and counter-narratives by means of art, the stigma associated with disability stereotyping and the misconceptions of having an ID is challenged and questioned (Caldwell et al., 2008; Harter et al., 2006; Richards et al., 2019). Art is supposed to be an activity that shapes lasting relationships and attachment, which can create an inclusive tone against stigma (Hourigan, 2009; Macpherson & Bleasdale, 2012; Schnellert et al., 2021).

(4) Social change and advocacy for rights

In eleven articles it is mentioned that ABCs can serve as platforms for social change and advocacy for rights. The key concept leans into the perspective that artistic expression can bring attention to issues of social (in)justice, and that honouring the artistic expression of persons with ID is a political gesture (Johansen & Saur, 2018; Price & Barron, 1999).

The synthesis of the variation in the articles related to this key concept describes that artworks, art performances and art-based stories can increase the autonomy of people with ID (Harter et al., 2006), provide new economic and aesthetic opportunities for persons otherwise excluded from the public sphere (Harter et al., 2006; Macpherson & Bleasdale, 2012; Yoon et al., 2020), and transform understanding of persons with ID (Hall, 2010; Yoon et al., 2020).

According to authors, the ABCs can actively work against oppression (Goddard, 2015; Viscardis et al., 2019), transform beliefs and values, at least in some respect (Kivijärvi & Poutiainen, 2019; Viscardis et al., 2019), and disrupt traditional hierarchies and practices (Schnellert et al., 2021; Viscardis et al., 2019). Ineland (2005) writes, for example, that theatre group Olla operates from the viewpoint that they are renegades outside institutional norms and performs above the institutional range. Therefore, this has influenced the institutional environment. According to Saur and Johansen (2013), the traditional view on arts performances can be challenged and the actors will eventually be seen as a natural part of the city’s cultural life. The authors write that to succeed in changing old-fashioned ways of thinking, it requires brave decisions that dare to challenge both audience and actors. In their second article (Johansen & Saur, 2018), they underline that, by making the unexpected visible, one can create turmoil for the cause of a democratic society with shared decision-making on an equal basis.

(5) Skills and employment

Data show that some ABCs provide skill-development programmes and vocational training for individuals with intellectual disabilities. Eight of the included articles report that by fostering artistic abilities and personal, social or practical skills, participants gain greater independence and enhance their employability (French & Jones, 2019; Goddard, 2015; Harter et al., 2006; MacGlone et al., 2020; Price & Barron, 1999; Schlosnagle et al., 2014; Scott & Watfern, 2021; Yoon et al., 2020). Price and Barron (1999) write that the Lawnmowers Theatre Company operates, beside other purposes, as a vehicle for development of personal skills such as communication, dealing with key agencies, management and basic finance.

The ABCs partly collaborate with local businesses, organisations and galleries to create employment opportunities and promote the inclusion of people with intellectual disabilities in the creative industries (French & Jones, 2019; Goddard, 2015; Harter et al., 2006; Yoon et al., 2020). French and Jones (2019) report, for example, that the ABC led to a business called Positive You for the first author, who is living with ID. She writes that the business has provided her with many opportunities to meet new people and see new places, has enabled her to be taken seriously, boosted her self-esteem, and given her the experience that it is her right to be included in decisions that affect her.

Discussion

The object of this review is to identify concepts of ABCs that relate to their potential for contribution to social justice for people living with ID, to synthesise key concepts and to provide a foundation for future research.

During this systematic, replicable search, 33 articles were selected, assessed and reviewed, with a broad variety of study focus, samples and quality scores, to scope existing knowledge.

The first article that met the inclusion criteria dates from 1999. The findings show an upward trend in numbers from then on, indicating that there are increasingly more ABCs for persons living with ID and/or that there is increasingly more attention on ABCs in academic literature. This matches the findings of Finkel and Bat Or (2020) that there is, firstly, an increasing prevalence of studio art approaches in general, and that, secondly, the approaches shift into the realm of social action. The ABCs for people living with ID that foster social justice seem to be part of that shift.

The study design of most of the included studies are qualitative (case) studies or action research, with a small or unclear sample size. Future research should therefore focus on a richer, more rigorous body of knowledge, not only about the potential of ABCs as an intervention to foster social justice for persons with ID but also about the perceived effects of participation on their lives.

Only three articles have been assessed as inclusive research projects and only two articles are (co-)written by authors with experiential expertise on being an ABC participant with ID, providing a firsthand insider perspective. This means that to gain inside understanding, future research is advised to co-operate with, and therefore directly include, the voices of the persons the research is about (de Haas et al., 2022).

In the analysis of the selected papers, the examination of the terminology, ideas and perspectives that shed light on the ABCs’ concepts contributing to social justice was prioritised. Consequently, all papers meeting the selection criteria were included, irrespective of their quality scores. In future research investigating perceived effects, the quality of the publications needs to be considered to be able to understand the results, and whether caution is needed when including findings from poorer-quality articles. 

The ABCs in the included articles are almost all performed in Western, high-income countries, especially in the UK and the USA. One Australian article wrote about two ABCs in South Korea. The reason for this lack of geographical/cultural variation may be found in the inclusion criteria of our search, especially in the language restriction. Further research including publications in other languages could widen the scope to other regions of the world and provide new perspectives – for example, by exploring concepts that are not related to the CRPD. Between the regions of the included papers, no significant differences were found in relation to concepts or terminology.

We synthesised similar concepts and terminology into five key concepts that can be related to the CRPD and to art therapy literature about ABCs to address the needs of persons with developmental, physical or mental disabilities, as described in our introduction.

There are commonalities between literature on ABCs as a place of social justice for marginalised people in general and for those people with ID. Art therapy literature highlights mutual concepts such as fostering agency, facilitating empowerment and self-advocacy, promoting healthy interactions, increasing awareness, amplifying the voices of underprivileged or marginalised individuals, and fostering broader social change.

Related to the CRPD aims, we identified a variation of terminology of social inclusion that we synthesised with concepts of belonging, and better or richer social interaction inside and outside the ABC into ‘social interaction, belonging, and inclusion’. Further, we synthesised concepts and terminology such as self-esteem, autonomy, and working according to one’s own perceived strengths and abilities into ‘empowerment and self-advocacy’, which relates to the aspect of independence of the person living with ID in society. Another key concept, ‘skills and employment’, can also be related to the CRPD aim of independent living possibilities for persons living with ID.

The CRPD scope of social justice, which focuses on respect for independence, social inclusion, participation and accessibility (United Nations, 2006; World Health Organization, 2011), does not, according to Duffy (2023), make clear how to make these rights real. Duffy writes that there is a distinction between rights and entitlement in the concrete and practical form that a right takes in real life. For example, the entitlement to participate in the life of one’s own community instead of a day-care centre. Therefore, he pleads for a focus not on quality of life but on citizenship outside the service system – a life that is lived in community, one of meaning, within relationships and interactions in the community as a full citizen.

In many of the included publications there are concepts of inclusion within the ABC and with people outside the ABC, especially with art performances and exhibitions. To our understanding, until now, ABCs have been designed to perform mostly within care systems, with less attention given to addressing social change in the direction of entitlement to life as a full citizen outside the care system. Next to these publications, we found others focusing more on social change with a political focus by, for example, creating turmoil for the cause of a democratic society with shared decision-making on an equal basis (Johansen & Saur, 2018), disrupting traditional hierarchies and practices (Schnellert et al., 2021; Viscardis et al., 2019), and taking positions as renegades outside institutional norms (Ineland, 2005).

To summarise, there seems to be an increasing movement of ABCs towards social justice inside and outside the care system. The perceived effects of both designs, and if or how they challenge this binary, are not clear yet.

Fulfilment of the aim of the convention, to create an inclusive and socially just society, where all persons deserve equal economic, political and social rights and opportunities, and can participate without experiencing obstacles (United Nations, 2006; World Health Organization, 2011), seems to be placed on the shoulders of persons with ID (Treanor, 2020), even in the ABCs, rather than being seen as a responsibility of all of society. The ABCs in our review put much focus on the growth of persons with ID, and their ability to empower themselves, advocate for themselves and develop more skills. For many people with ID this has many practical impossibilities and may be a pitfall, keeping the attention on what people with ID cannot yet achieve instead of what they need from others, including financial facilities, to be able to live a life as a citizen.

Duffy (2023, p.10) also advocates for telling stories about people’s lives in order to connect and make sense of each other’s perspectives, to move towards social justice. Art therapist, artist and disability rights activist Yi (2019) pleads from a critical, disability culture standpoint for exploration of community art-based practice to foster social justice. She underlines the need for disability culture and activism to move away from the historical medical disability narrative towards a narrative of disability being part of a cultural disability identity, existing next to and interacting with other cultures. In “Res(crip)ting art therapy: Disability culture as a social justice intervention” (2019), Yi describes two self-advocacy projects to bring visibility to the often silenced and hidden performative desire of people living with disability. Her goal is to rescript the contemporary, suppressive disability-as-impairment narratives.

These approaches in relationship to fostering social justice need more understanding, as they were left out of the scope of this article. For example, exploring how telling stories becomes a two-way street instead of an endless effort that people with ID have to make, and examining how creating better disability narratives can change the perspectives of non-disabled persons. The authors of this article are currently preparing a second article that will delve deeper into the designs and approaches of ABCs, offering a comprehensive understanding of their implications for social justice.

The ABCs, their designs and approaches in relationship to their key concepts, art as a medium for social change and the perceived effects of participation, raise questions for future research. Topics worthy of future research are the potential of ABCs to break down barriers in social interaction between persons living with ID and others outside the ABC, successful designs and approaches that can be applied in future ABCs, and the perspectives of participants on the power of ABCs in relationship to resistance, activism and social change.

Conclusion

ABCs conceptualise their contribution to social justice for people living with ID in a variety of concepts and terminology that has been synthesised into five key concepts in this study. These can be related to the CRPD aims and to claims of ABCs in existing art therapy literature.

As our search led to a rich variation of studies, the understanding of the key concepts and their value for future ABCs as interventions for social justice for persons living with ID needs more research – especially in the direction of successful designs and approaches, and perspectives and perceived effects in the lives of ABC participants.

Limitations of the review

The selection criteria and the search strategy limited the review. First, no ‘grey’ data were included, such as videos, live performances or presentation papers. ‘Grey’ data could elaborate knowledge on the subject by adding empirical data, perhaps even from an evaluative perspective of participants with ID. Second, publications focusing on ABCs with no other purpose than including children in mainstream education were excluded. During our study, many of these publications were identified. A review on that subject could increase knowledge about ABCs that aim to foster inclusion in education. Third, some of the articles included were assessed with low-quality scores. After discussion, they were included in the study, because empirical data to answer our question were expected from these publications. Fourth, the language restriction in the inclusion criteria led to a lack of geographical/cultural variation of data.