Autism & Music Therapy Notes

Overview of Autism Spectrum Disorder (ASD)

  • Autism Spectrum Disorder (ASD) is a lifelong neurological and developmental disorder.
  • Etiology: Unknown.
  • Estimated prevalence: At least four out of every 10,000 children in the United States.
  • Onset: Before age three.
  • Gender ratio: Affects boys four times more often than girls, according to the DSM-IV.
  • Features:
    • Marked abnormal development.
    • Qualitative impairments in social interaction and communication.
    • Severely restricted repertoire of activities and interests.

ASD as a Spectrum Disorder

  • Severity of symptoms and affected behaviors varies greatly from individual to individual.
  • Diagnostic categories under ASD:
    • Autistic Disorder: Most profound impairment.
    • Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS): Some severe and pervasive impairment in social interaction or communication skills; stereotyped behavior, interests, and activities are present.
    • Asperger’s Syndrome: No language delay, but qualitative impairments in social interaction and restricted, repetitive, and stereotyped patterns of behavior.
    • Rett’s Disorder: Covered in a separate chapter.
    • Childhood Disintegrative Disorder: No longer a separate diagnosis under the DSM-5.

Special Education and IDEA

  • Children with disabilities require special education and related services.
  • These services are designed to meet unique learning needs and prepare them for further education, employment, and independent living.
  • Individuals with ASD often require special education services and therapies.
  • Individuals with Disabilities Education Act (IDEA) (2004):
    • Ensures that all students ages three through 21 are provided a Free Appropriate Public Education (FAPE).
    • Children with special needs are given equal access to their education.
    • Educational supports include special education and therapeutic-related services.

Supportive Services Under IDEA

  • Family training, counseling, and home visits.
  • Special instruction.
  • Speech/language pathology services.
  • Audiology services.
  • Occupational therapy.
  • Physical therapy.
  • Psychological services.
  • Medical services (only for diagnostic or evaluation purposes).
  • Health services needed to enable your child to benefit from the other services.
  • Social work services.
  • Assistive technology devices and services.
  • Transportation.
  • Nutrition services.
  • Service coordination services.
  • Music therapy is not specifically listed, but its inclusion as a related or supportive service has been endorsed.

Typical Interventions for Autism Spectrum Disorders

  • Four main categories of treatment interventions:
    • Behavioral strategies
    • Traditional therapies
    • Communication methods
    • Biological/health-related methods
    • Alternative/complimentary methods
  • Each category has its unique perspective and underlying philosophy.

Behavioral Interventions

  • Applied behavior analysis (ABA) has created an extensive procedure for effective interventions.
  • Comprehensive ABA programs have been successful in teaching a range of skills (Lovaas, 1987).
  • Behavior modification techniques:
    • Discrete Trial Training (DTT):
      • Skills are broken down into individual components and taught one skill at a time until mastered.
      • Lacks generalizability in the natural environment and does not encourage spontaneity (Whalen, 2001).
    • Pivotal Response Training (PRT):
      • Effective in teaching ASD children.
      • Uses naturalistic training procedures to enhance generalization by maintaining a child’s motivation.
      • Emphasizes child motivation by providing choices, preferences, and reinforcers that are related to the task.
  • Developmental, Individual Difference, Relationship-based (DIR®)/Floortime™ Model:
    • Comprehensive framework used to conduct assessments and intervention programming for children with ASD.
    • Attempts to create a comprehensive view of the child’s social-emotional functioning and potential, biological processing differences, and emotional interactions with his or her caregiver.
    • Children with ASD display difficulty in engaging in affective learning interactions due to individual differences in their nervous system (Greenspan, 1992).
    • Neurological differences manifest as difficulties with motor-planning, sensory modulation, sequencing, and sensory processing challenges.
    • Learning takes place within the context of relationships with caregivers, therapists, and peers.
  • Social Communication/Emotional Regulation/Transactional Support (SCERTS) Model:
    • Educational model developed by Prizant, Wetherby, Rubin, and Laurant (2010).
    • Uses practices from other approaches, including ABA (in the form of PRT), and TEACCH.
    • Promotes child-initiated communication in everyday activities.
    • Concerned with helping children with autism to learn and spontaneously apply functional and relevant skills in a variety of settings and with different people.
  • Joint attention may be a key pivotal skill in early childhood development (Koegel, Koegel, Harrower, & Carter, 1999).

Traditional Therapies

  • Speech Therapy:
    • Addresses issues with receptive and expressive language, pragmatic language, and supralinguistic skills.
    • Administered individually or in groups, both at school and privately.
  • Occupational Therapy:
    • Addresses sensory issues, hypotonia, or coordination difficulties.
    • Clinicians have found that many children with autism have significant motor-planning and coordination problems affecting their ability to perform fine-motor tasks such as writing.
    • Works on improving functional skills.
  • Physical Therapy:
    • Sometimes necessary for individuals with ASD who also have difficulties with gross motor skills such as walking, riding bikes, skipping, kicking, throwing, and catching.
    • These skills are important not only for physical development, but also for social engagement in sports, recess, and general play.

Communication Methods

  • Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH):
    • Behavioral intervention approach that does not work on behaviors directly, but on their underlying reasons (e.g., lack of understanding, sensory issues).
    • Supports the child to express their needs and feelings by means other than challenging behavior.
  • Picture Exchange Communication System (PECS) (Bondy & Frost, 1998):
    • Teaches communication behaviors to children with developmental disabilities using pictures.
    • Instruction focuses initially on the requesting function of communication.
    • Child is taught to use the picture in exchange for the desired object.
    • Adult labels the item being requested and rewards the child by providing the object.
    • Teaches children to discriminate between objects and eventually places pictures together into “sentences”.
    • Later, the system teaches more social communication functions, such as initiating and commenting.
    • Conventional gesturing and gaze alternation are not a specific focus of intervention.
    • Verbal language on the part of the child is not a requirement for effectively using this system.
  • Developmentally Based Interventions: Focused on facilitating social awareness by progressing through a sequence (e.g., eye contact, attention to adult, turn-taking, anticipation behaviors, spontaneous requesting, and nonverbal joint attention).
    • Adults follow a child’s lead using ongoing interactions that involve interesting and novel activities.
    • Adults imitated the child’s behavior in an effort to engage him in an interaction and thus elicit joint attention (Jones & Carr, 2004).

Biological/Health-Related Interventions

  • Include the use of specialized diets and supplements, medical procedures, and medication.
    • Gluten- and casein-free diet: Some parents and professionals assert success in improving communication, social interaction, and sleep patterns, while reducing digestive problems and autistic behaviors.
    • Hyperbaric oxygen therapy as well as other common supplements (e.g., melatonin, omega-3 fatty acids, and vitamin methyl B12) are also common.
  • Some believe that ASD is the result of an autoimmune disorder or related to the presence of high levels of toxins such as mercury in an individual’s body.
    • Chelation therapy may be used to remove heavy metals from the body.

Pharmacological Interventions

  • Medications such as mood stabilizers, SSRIs, antidepressants, and psychostimulants might be prescribed to address behavioral and emotional symptoms present in children with ASD.
  • There is no medication to correct the repetitive behavior, communication, or social challenges that make up the core deficits of autism.

Alternative/Complementary Interventions

  • Include animal-assisted therapy, sensory integration therapies, augmentative communication, social skills training, and creative arts therapies (including art therapy, dance/movement therapy, and music therapy).
  • The guiding principle of music therapy in ASD is a focus on the development of communication and social skills.
  • The primary concern is to help the child meet developmental milestones in all areas of development and support their education.
  • Determining which music therapy methods are effective and valuable for an individual with ASD is directly connected to understanding their unique clinical profile.

Diagnostic Information

  • Autism is defined and diagnosed solely on the basis of symptoms.
  • Formal diagnosis often comes from a medical professional such as a pediatrician, neurologist, or a psychologist.
  • There is no single behavior that serves as a definitive diagnostic indicator.
  • Autism spectrum disorders also include Pervasive Developmental Disorder–Not Otherwise specified (PDD-NOS) and Asperger’s Syndrome.
  • DSM-5 Modifications:
    • Incorporates Autistic Disorder, Asperger’s Syndrome, Childhood Disintegrative Disorder and Pervasive Developmental Disorder–Not Otherwise Specified into the diagnosis of Autism Spectrum Disorder.
    • Individuals must demonstrate deficits in social-emotional reciprocity, nonverbal communication behaviors, and developing and maintaining relationships.
    • Restricted, repetitive patterns of behavior, interests, or activities and hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of environment.
    • These symptoms must limit and impair everyday functioning and be present in early childhood (although a specific age requirement is not listed).

Qualitative Impairments in Autism

  • Can be grouped into three categories: behavior, communication, and socialization.
  • Behavior:
    • Perseveration.
    • Poor compliance.
    • Lack ability to generalize previously learned materials.
    • Catastrophic reactions to trivial events.
    • Exhibit severe interfering behaviors (e.g., aggression).
  • Communication:
    • Echolalia.
    • Delayed nonverbal and verbal communication.
    • Poor abstraction and representational thought.
    • Difficulty understanding the intention of others.
    • Problems in sequencing.
    • Lack pretend play.
  • Socialization:
    • Lack of eye contact.
    • Low motivation to interact with others.
    • Use people as tools.
    • Lack imitation abilities.

Behavioral Impairments

  • Individuals with ASD may be more prone to temper tantrums and sudden changes in mood and affect.
  • Stereotypical repetitive movements (e.g., hand flapping, rocking, spinning).
  • Preoccupation with parts of objects (e.g., turning wheels on toy cars) and obsessive behaviors (e.g., insistence on closing doors, repeatedly watching same parts of a video).
  • Strive for sameness and familiarity and resist novel experiences.
  • Meet diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD).
  • Sensory issues (especially with textures and sounds).
  • Interrupted development of play skills.
  • Motor imitation and vicarious learning are also interrupted.
  • Poor imitation may be a critical deficit in autism that interferes with development of abilities in reciprocity, joint attention, and understanding emotional states

Communication Impairments

  • Significant impairments in language development.
  • Higher-order language processes are often impaired:
    • Difficulty with nonliteral language (e.g., figures of speech), idioms, inferencing skills, and pragmatic language skills.
    • Pragmatic language skills:
      • Being able to recognize appropriate topics for conversation.
      • Selecting relevant information for directions or requests.
      • Adjusting the communication level to the situational factors (e.g., age, relationship, setting).
      • Using language to express gratitude, sorrow, and other feelings.
  • Theory of mind (ToM) is the ability to attribute mental states to oneself as well as to others.
    • Deficits in ToM are common in individuals with ASD and ADHD.

Social Impairments

  • Developmental deviance and delay is one of the defining features of ASD.
  • Infants with autism:
    • Not seeking affection from others.
    • Stiffening when held or picked up.
    • Fail to acquire a social smile (Volkmar, Carter, Grossman, & Klin, 1997).
    • Fail to seek comfort from their parents when they are hurt or frightened.
    • Impaired eye contact, facial expressions, affect, peer relationships, social reciprocity, awareness of others, and spontaneous social initiation
  • Social interaction is one of the most basic developmental impairments that impact other areas of functioning.
  • Joint attention skills have been the subject of considerable research.
  • Low incidence of peer play and social interaction along with developmentally delayed contextual or inappropriate play tend to limit the development of peer relationships.
    • Joint attention deficits are seen as early as their first birthday.
    • Behaviors such as looking at others, pointing, showing objects, and visually responding to their name were markedly lacking.
    • Joint attention is one of the only skill deficits to discriminate autism from other developmental disabilities, mental retardation, and other childhood disorders.
  • Joint attention:
    • Two or more persons coordinating their attention toward objects or events of mutual interest.
    • Coordinate attention between others with respect to events or objects, or to share an awareness of such with another person.
    • Social cues such as gaze direction, pointing gestures, and postural cues indicate to another person the object or event that is currently under consideration.
  • Joint attention is the quintessential social milestone that develops toward the end of the first year after birth.
  • Coordinating attention begins by the age of six months and can follow a pointed finger by nine months of age.
  • The earliest demo of joint attention occurs around eight months of age, when an infant follows a caregiver’s gaze and looks in the same direction.
  • Late in the first year of life, a child is able to consistently respond to adults’ bids for attention and consistently turns his head to the speaker when his name is called by 10 months.
  • Between 12 and 14 months, children begin to check back with the adult by alternating their gaze from the object to the adult and back to the object.
  • By the middle of a child’s second year, joint attention skills are well coordinated.
  • Between the ages of 18 and 24 months, a basic understanding that persons are intentional beings is acquired typically.
  • Coordinated joint attention (CJA) also develops at this time.
  • By age two years, a child also uses language and gestures to direct an adult’s attention to aspects of the environment when gaze direction is insufficient.
  • Protodeclarative pointing also emerges.

Joint Attention Milestones

  • Interaction:
    • Reciprocal smiling - Age: 2 months.
    • Coordinating attention with another person - Age: 6 months.
    • Gaze monitoring - Age: 8 months.
    • Initiating joint attention: Following a pointed finger - Age: 9 months.
    • Showing objects - Age: 10 months.
    • Following another’s eye gaze: Pointing to obtain an object - Age: 12 months.
    • Pointing to indicate to another an object of interest Checking back with the adults by alternating gaze from the object to adult and back - Age: 14 months.
    • Social referencing - Age: 16 months.
    • Consistent responding to adults’ bids for attention - Age: 18–24 months.
    • Using language and gestures to direct an adult’s attention - Age: 24 months.
  • Joint attention is becoming an increasingly important behavior in autism research.
  • Deficits in referential looking correctly diagnosed 94% of ASD children in a group of preschoolers that included both children with ASD and children with mental retardation.
  • Observations of joint attention skills development alone is able to differentiate 80%–90% of samples of ASD children from children with other developmental delays
  • Joint attention is crucial for the development of functional speech.
  • deficit in joint attention affects a child’s ability to use spontaneous language and may result in more echolalic and stereotyped speech.
  • ASD children also have deficits in symbolic play

Needs and Resources

  • Individuals diagnosed with ASD have a wide range of needs that require intervention to address deficits in:
    • Language and communication.
    • Cognitive and academic abilities.
    • Behavioral needs.
    • Social skills.
    • Emotional functioning.

Language and Communication

  • Successfully communicating with the child with ASD not only involves an understanding of how they communicate but also requires an understanding of why they communicate.
  • An individual with ASD may use some of the following to communicate with others:
    • Crying.
    • Taking the adult’s hand to the object they desire.
    • Looking at the object they desire.
    • Reaching.
    • Using pictures.
    • Echolalia.
  • Individuals with high-functioning autism and Asperger’s Syndrome struggle with the organization and flexibility that is required in a conversation.

Cognitive and Academic Abilities

  • Many individuals with ASD have uneven cognitive development.
  • Many individuals with ASD have slower processing speed and cognitive fluency skills, making it difficult for them to keep up academically with their peers.
  • The IEP is tailored to each student’s needs to help teachers and related service providers understand the student’s disability and how the disability affects the learning process.

Behavioral Needs

  • Many of them will meet clinical criteria for Attention-Deficit/Hyperactivity Disorder (ADHD), which is characterized by a persistent pattern of hyperactivity and/or impulsivity that is inconsistent with peers of a comparable age and level of development.

Social Needs

  • Understanding the social norms and expectations for different situations is also difficult.
  • Individuals with ASD often have to be implicitly taught these rules in order to learn them.

Emotional Functioning

  • Individuals with ASD are at greater risk for comorbid mood disorders.
  • The fears children with ASD have may be unusual (e.g., of holiday decorations, things of a certain color) or may not be readily identifiable at all.
  • Obsessive-Compulsive Disorder (OCD) is also common among individuals with ASD.

Referral and Assessment

  • Behavior problems and limited communication often require professionals to make a variety of special accommodations during evaluations.
  • ASD cannot be diagnosed with a single instrument or test.
  • Psychological, communicative, academic, and behavioral assessments are the most frequently obtained.
  • Assessment of persons with autism and pervasive developmental disorders are completed by a myriad of professionals, including child psychologists and psychiatrists, speech and language pathologists, neurologists, and pediatricians, among many others.

Music Therapy Referral and Assessment

  • Music therapists are frequently referred children for therapy by parents, teachers, or other therapists.
  • The most cited goal that parents state is the desire for their child to talk and/or communicate.
  • The most often cited reason for the music therapy referral is the child’s inherent interest in and love of music.
  • Music therapy assessment can identify limitations and weaknesses in children, as well as their strengths and potentials.
  • Coleman and Brunk developed the Special Education Music Therapy Assessment Process, or SEMTAP (Coleman & Brunk, 1999) to assess the functioning of children and adolescents who receive special education services.
    • The purpose of the SEMTAP is to determine eligibility for music therapy services for children who have an Individualized Education Plan (IEP).
  • Another assessment tool, from Baxter et al. (2007), is the Individualized Music Therapy Assessment Profile (IMTAP).
  • Wigram (2000) outlines a music therapy assessment process used to differentially diagnose ASD children from children with other disorders.
  • Carpente (2009) created the Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders (IMCAP-ND), a specific improvisational music therapy assessment to be used within the DIR®/Floortime™ Model.
  • Through assessment, the music therapist gains understanding of the individual’s unique clinical profile and strengths and weaknesses and prioritizes needs.

Guidelines for Music Therapy Methods

  • The music therapist needs to have a high level of clinical musicianship and also interpersonal skills.
  • Jones and Carr (2004) suggest engaging the child in experiences of their choice during intervention.
  • It is recommended that music therapists use natural consequences to help to motivate the child to engage in joint attention.
  • Reitman (2005) suggested incorporating several strategies into music therapy treatment, including:
    • Using short phrases when speaking or singing.
    • Using simple, concrete vocabulary.
    • Using repetition and review.
    • Limiting directions to ensure the child’s success.
    • Imitating and validating the child’s efforts to engage the therapist.
    • Expanding on the child’s communication, play, affect, and language.
    • Using a visual schedule of musical activities being presented during the session.
    • Providing a variety of materials.
    • Providing a variety of musical experiences.
    • Facilitating interaction using present interest and motivation.
  • Carpente (2009) stated that it is important to understand “both the characteristics of ASD that may impede a child’s ability to engage in musical play as well as the child’s musical responses upon which musical goals are based”.
  • Researchers have suggested that presenting a variety of preferred items not only increases novelty but also helps to sustain attentional focus in persons with disabilities.
  • Reitman (2011) presented activities, songs, and experiences in slightly different ways to facilitate increased interest and novelty while promoting opportunity for generalization of skills.
  • For very low-functioning individuals with ASD or those with severely impaired communication, Reitman (2011) suggested using a picture schedule using a 2" x 2" picture and word representation for each of the session’s activities.

Overview of Methods and Procedures

  • Music therapists have documented their work with individuals with ASD for decades in order to promote nonverbal expression and communication, socialization, self-awareness, sensory integration, and musical and interpersonal relatedness.
  • The following methods and procedures are used most commonly with clients with ASD.

Receptive Music Therapy

  • Social Stories in Music Therapy:
    • use of music to support learning of concepts, sequences, and basic information from short stories, often depicted with short sentences with accompanying pictures, sequences to teach clients expected behaviors during interactions, social experiences, or activities of daily living.
  • Child-Directed Singing:
    • Based upon what the child is doing or experiencing, the therapist spontaneously sings as a means of communicating with or to the child.

Improvisational Music Therapy

  • Instrumental Improvisation:
    • The therapist and client create spontaneous musical improvisations using instruments.
  • Referential Improvisation:
    • Clients participate in improvised music structured around a nonmusical theme or idea using musical concepts of rhythm, dynamics, and tonality.

Re-creative Music Therapy

  • Song Singing:
    • Clients sing precomposed songs with or without instrumental accompaniment.
  • Instrumental Songs:
    • Consist of musical pieces with accompaniment and assigned instruments for clients to play parts.
  • Adaptive Music Lessons:
    • a form of individual music therapy in which the music lesson format (most commonly using voice, piano, or guitar) is used to accomplish therapeutic goals such as sequencing ability, self-awareness, and self-regulation.

Compositional Music Therapy

  • Songwriting:
    • occurs when changes are made to some or all of the lyrics and/or music of an existing song, or when a new song is written in its entirety.

Guidelines for Receptive Music Therapy

  • Receptive music therapy experiences are intended to engage the client in a musical experience designed to provide stimulation of sensory or cognitive processes.
  • As with strategies used for younger children or those with severe developmental delays, music therapists are more apt to engage individuals who are more severely impaired by ASD with simple, live accompaniment or unaccompanied singing using a higher pitch, slower tempo, more gliding between tones, and an interesting timbre.
  • The use of familiar melodies and repetition allows clients opportunity to make associations with the music.

Social Stories in Music Therapy

  • Music therapists often put stories into songs both to enhance children’s interest and provide a framework to convey concepts and ideas.
  • Social stories were originally developed by Carol Gray for children with ASD to communicate ways in which an autistic person can prepare for social interaction.
  • The stories combine auditory and visual information that can be repeated frequently.
    The musical social story may be either the entire focus of the music therapy session or a single component within the session.

Child-Directed Singing

  • In child-directed singing, the client is an active listener while the therapist uses her voice in song to communicate with and to the child.
  • Sounds are deliberately directed toward the child in an effort to reflect in-the-moment changes in the child’s affect, movement, attention, or engagement.
    The music components of child-directed singing, such as melody, rhythm, or lyrics, contain meaning and purpose that is specific to the child and their present situation.

Guidelines for Improvisational Music Therapy

  • Nordoff and Robbins (1964, 1968, 1971, 1977) found that music improvisation and musical composition could nurture, challenge, and support the “music child”.
    • They found that the child could develop beyond their present condition and form new ways of experiencing themselves and the world.
  • Their improvisational music therapy method (initially referred to as Creative Music Therapy), Nordoff-Robbins Music Therapy (NRMT), holds as its primary focus the interaction in the musical relationship between the child and therapists.
  • The musical experiences improvised during sessions typically arise from the vocal and motor output provided by the child.
  • The music therapist musically reflects and expands on this experience using musical instruments, voice, and expressive language to capture the affective essence of the behavior.
  • The child plays a central role in the creation of the music and is an active creator.
  • The child plays various instruments that require no formal training or experience, while the music therapist improvises music built around the child’s music-making, emotional state, and/or movements.

Instrumental Improvisation

  • Instrumental improvisation is a process wherein the music therapist and the client create music using instruments that become the vehicle on which they form a musical relationship.
    • The instrumental improvisation can be started by either the therapist or the child, and any object that can make a musical sound can be used.
  • The purpose is to promote relatedness, communication, socialization, and awareness within the music itself.

Referential Improvisation

  • Referential improvisations consist of improvised music structured around a nonmusical theme or idea sometimes called a “referent."
  • They are indicated for those clients who have adequate receptive language skills and who demonstrate ability to use imaginative play skills.
  • Clients are asked to connect their thoughts to music and vice versa.
  • The client should be positioned in close proximity to the music therapist, with any instruments being used within reach.
  • Music therapists observe clients’ musical and nonmusical behaviors and they interpret their understanding of the theme by the appropriateness of the musical expressions and qualities of their playing.

Guidelines for Re-Creative Music Therapy

  • Popular children’s songs are widely known and are easily accessed by parents and other adults through television and videos as well as music CDs.
  • Not surprisingly, the majority of music therapy literature focuses on the use of re-creative methods with individuals with ASD.
  • Singing these songs provides a child with ASD opportunity for connecting or relating with others.

Singing Songs

  • Singing songs is very prevalent in music therapy literature due to its prevalence across all cultures and societies.
  • Singing songs can be therapist-directed or child-directed and implemented with or without instrumental accompaniment.
  • Nearly all children enjoy singing songs, but it is the music therapist who determines the therapeutic intent.
  • With ASD children, singing songs can serve a number of clinical needs, including:
    • Providing opportunities for learning new information (e.g., academics, manners).
    • Practicing fundamental communication skills (e.g., call-and-response, filling in the blanks).
    • Challenging and practicing shifting attention.
    • Increasing motivation for engagement with others.
    • Expanding repertoires of responding.

Instrumental Songs

  • Instrumental songs are musical experiences wherein a client plays along with an accompaniment or as specifically instructed.
  • The music therapist engages individuals in a musical experience that incorporates repetition and structure to promote functional skills.
  • When used in group settings, the goals often include social skills development.

Adaptive Music Lessons

  • Adaptive music lessons are a form of individual music therapy wherein the intent of instruction is on clinical goals rather than development of musical skill.
  • While adaptive music lessons could be conducted on any instrument, the most common are typically voice, piano, guitar, and drums.
  • During the adaptive music lesson, the therapist interacts with the client in the process of making music on a selected instrument.

Guidelines for Compositional Music Therapy

  • Within the context of compositional methods, the focus is on the use of therapist-generated musical experiences to address nonmusical goals.
  • Songs and instrumental compositions in therapy generally arise out of an identified clinical issue.

Songwriting

  • Songwriting is simply the composing of original music and lyrics to express an idea or feeling.
  • In individual music therapy, therapists use songwriting for clients with ASD to:
    • Share information.
    • Problem-solve situations.
    • Express feelings.
    • Provide for creative expression.

Working with Caregivers

  • When working with children with ASD, consideration of the child as part of a larger system is essential.
  • Therefore, music therapists are encouraged to recognize the essential role that parents and other family members play in children’s development.
  • Music therapists share music therapy strategies with others to ensure generalization and opportunity for practice and retention of skills.

Research Evidence

  • During the last 40 years, research in music therapy and autism has been broadly focused.
  • Music therapists’ work with ASD children typically focuses on four main deficit areas:
    • Language development.
    • Social and emotional development.
    • Cognitive concept development.
    • Sensorimotor development.

Music Therapy and Motivation

  • Music captures and helps maintain attention.
  • It is highly motivating and engaging.
  • It can be used as a motivator and as a natural reinforcer for desired responses.
  • Music focuses attention to on-task behaviors and that this focus can be reinforcing to ASD children.
  • There seems to be a transfer effect possible once a child demonstrates a level of attention and skill during music therapy activities.

Music Therapy for Language and Communication

  • ASD children show delays in acquisition of language that range from complete absence of communication to deficits in use of language for conversation.

Music Therapy for Social Development

  • Music therapy is an effective way for ASD children to work on their problems related to creativity and initiation.

Receptive Methods

  • Empirical efficacy studies have shown that music therapy is effective in:
    • Increasing socialization and communication.
    • Decreasing perseverative behaviors.
    • Developing musical and nonmusical communication.
    • Improving parent/child relationships.

Improvisational Methods

  • Several studies have explored the use of improvised music with ASD children.
  • Autism learning processes are always negatively affected by perceptual problems such as lack of concentration and fluctuating attention.
  • Music therapy can offer a context to facilitate exchange and reciprocity.

Re-creative Methods

  • Music therapy provides a nonverbal means to communicate.
    In their study, Harding and Ballard (1982) used songs and singing to reinforce spontaneous speech, and they found that this intervention also produced an increase in spontaneous speech.

Summary and Conclusions

  • The incidence of autism is increasing at an alarming rate.
  • The needs of persons with ASD are almost as varied as the goals addressed in music therapy practice.
  • With continuation of this promising work, music therapy stands to become a legitimate and effective treatment intervention for individuals with autism.