Connecting Music Therapy and Autism

Connecting Music Therapy and Autism

Music therapy and autism are buzzwords that are being heard often in the news recently.  But many people still ask what is music therapy?  What is autism?  And what is the connection between the two?  I am a board-certified music therapist who has worked for seven years with children with various developmental disabilities, including those with autism.

Music therapy is a well-established health care profession that has been around since the 1940s.  Music therapy is the systematic use of music and music-based interventions (such as singing, instrument playing, or movement to music) within a therapeutic relationship to accomplish individualized goals.  Music therapy goals are non-musical (such as “to increase expressive language” or “to improve gross motor skills”) and may fall under a variety of domains, including: social/emotional, motor/physical, communication, academic/cognitive, or sensory.

Autism is a neurodevelopmental disorder characterized by social deficits, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior.  Children with ASD have difficulties with sensory integration and experience deficits in organizing sensory input.  In a typically functioning system, the bombardment of sensory information from the environment is organized into cohesive whole pictures that he brain can process.  However, in children with ASD, there is more input than the brain can sort out, leading to a state of sensory disorganization and at times, sensory overload (Berger, 2002).

What is the connection between music therapy and autism?  The favorable effects of music for children with autism are due to specific musical elements that facilitate the perceptual organization of auditory stimuli.  Music is organized into patterns.  Research has shown that when the brain takes in information, it prefers it to be in an organized, structured form, rather than discrete bits of information.  Because children with autism have a dysfunctional sensory system, the ordering of auditory stimuli that occurs in music helps to organize and make sense of the sensory input they are receiving (Berger, 2002; Thaut, 2008; Wigram & Gold, 2006).

Research also shows that children with autism have musical sensitivity and a perceptual preference for music (Blackstock, 1978; Frith, 1972; Pronovost, 1961: Thaut, 1987), which facilitates increased attention to musical stimuli (Kim, Wigram & Gold, 2008; Reitman, 2006).  Because of the increased attention to musical stimuli, music therapy interventions can be a motivating medium for addressing various non-musical domains, such as social, communication, and cognitive functioning.  Music therapy interventions are grounded in the needs of the child and subsequent goals, as determined during the assessment.  Each music therapy session is as unique as the child taking part in it (Kalas, 2010).

If the goal for treatment is to work on sensory integration, the music therapist may use a variety of instruments, such as the ocean drum, tone bars, or cabasa to provide unique auditory, visual, and tactile stimulation.  This can help desensitize the child to the auditory, visual, and tactile stimulation they are experiencing in their environment that can often be overwhelming.  The music therapist may also co-treat with an occupational therapist to accomplish shared goals.  If the goal is to provide proprioceptive or vestibular input for example, the music therapist can provide a steady rhythmic beat while the occupational therapist facilitates the child bouncing on a therapy ball or jumping on a trampoline.  These activities give the child the sensory input they may be seeking from their environment in other ways (such as rocking or spinning), while the rhythmic beat of the music provides a predictable and structured experience.

If the goals for treatment are to work on increasing social interaction and improving social skills, the child may be encouraged to join a group music therapy session.  The music therapist can engage the child with his peers in a non-threatening way by having him take part in active music making experiences.  Drumming can be used to direct attention to a leader who is cueing the tempo and dynamics of the song or who is engaging the group in a “call and response.”  Instrumental jams can be structured to include passing instruments at the sound of a specific musical cue or playing together on instruments like the bongos.  Social songs can also be used to teach proper greetings and behaviors in social situations.  A song I wrote called “What Do You Do?” addresses specific social scenarios and the proper action to take. The lyrics to the first verse are as follows:

What do you do? What do you do?
When you meet someone new?
You shake their hand, smile, and say “Hello!”
You shake their hand, smile, and say “Hello!”

Music therapists may also address goals in the speech and language domain.  If the goal for treatment is to improve receptive language skills, the therapist may design a music therapy intervention that requires the child to look at the therapist, listen, and follow directions.  For example, the music therapist could lead a shaker song where the child is instructed to play their shaker and follow musical cues given in the song.  Examples include: play when the music is going and freeze when it stops; shake up high when the musical accompaniment goes up high and shake down low when the musical accompaniment goes down low; or shake side to side when the lyrics of the song say to do so.  The child must constantly be looking at the therapist, listening, and following the cues of the song -- skills that transfer directly to the classroom setting.

Music therapy interventions may also be used to improve articulation.  The music therapist can sing songs that include the consonant/vowel combinations that the child needs to practice (such as /ba/, /tee/, /shoo/, /fa/, etc).  Songs inherently provide repetition in a way that is fun and motivating for children.  A song I wrote called “Bubbles” repeats the phrase “Bubbles, bubbles, bubbles, flying through the air” and allows the child multiple opportunities to practice the /bu/ sound.

These examples illustrate the scope of music therapy and the wide range of skills and behaviors that can be addressed during sessions.  These examples also exemplify why music is an effective medium for bringing about functional changes in behavior.  Music provides concrete, multisensory stimuli to engage children.  Music is organized into patterns, which facilitates perception and provides necessary structure for children with autism.  Music involves rhythm, which can be used to structure movement patterns and help sustain a child’s attention throughout a therapeutic intervention and session. Finally, music is universal; it is a fun, motivating medium to address functional, non-musical outcomes for children with autism (Kalas, 2010).


References

Berger, D.S. (2002) Music therapy, sensory integration and the autistic child. UK: Jessica Kingsley
           Publishers Ltd.

Blackstock, E. (1987). Cerebral asymmetry and the development of the early infantile autism.
          Journal of Autism and Childhood Schizophrenia, 8,
339-353.

Frith, U. (1972). Cognitive mechanisms in autism: Experiments with color and tone sequence production.
          Journal of Autism and Childhood Schizophrenia, 2, 160-173.

Kalas, A. (2010). Joint attention response of children with Autism Spectrum Disorder to simple versus
          complex music.
(Master’s thesis). University of Miami, Coral Gables, FL. In press.

Kim, J. Wigram, T., and Gold, C. (2008). The effects of improvisational music therapy on joint attention
          behaviors in autistic children: A randomized controlled study. Journal of Autism and
          Developmental Disorders, 38,
1758-1766.

Provonost, W. (1961). The speech behavior and language comprehension of autistic children. Journal
          of Chronic Diseases, 13,
228-233.

Reitman, M. (2006). Effectiveness of music therapy interventions on joint attention in children
          diagnosed with autism: A pilot study. (Doctoral dissertation, Carlos Albizu University, 2005).
          Dissertation Abstracts International, B66(11). (UMI No. 4194217).

Thaut, M. (1987). Visual versus auditory (musical) stimulus preferences in autistic children: A pilot study.
          Journal of Autism and Developmental Disorders, 17, 425-432.

Thaut, M. (2008). Individuals with autism and Autism Spectrum Disorders (ASD). In W. Davis, K. Gfeller,
          & M. Thaut (Eds.), An introduction to music therapy: Theory and practice (pp. 117-142). New York:
          Taylor & Francis Group, LLC.

Wigram, T. & Gold, C. (2006). Music therapy in the assessment and treatment of autistic spectrum
          disorder: Clinical application and research evidence. Child Care, Health, and Development, 32(5),
          535-542.

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Written by: Amy Kalas, MM, MT-BC See other articles by Amy Kalas, MM, MT-BC
About the Author:

Amy Kalas, MM, MT-BC is a board-certified music therapist with seven years of experience working with children and adolescents with special needs. She received her Bachelor’s degree in Music Therapy (2005) and Master’s degree in Music Therapy (2010) from University of Miami. Amy currently works full-time as a music therapist and internship director at United Cerebral Palsy of Miami.

Amy also runs a private practice, Wholesome Harmonies Music Therapy, providing music therapy services around Miami. Services include: music therapy evaluations, group and individual music therapy, and adapted lessons on guitar and piano. If you are interested in learning more about music therapy or would like to sign your child up, please contact Amy by email: [email protected]. You can also visit her website for Wholesome Harmonies Music Therapy at www.WHmusictherapy.com.

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