2 Current Theories
Theory of Mind:
● Attribute mental states to oneself and others
● Ability to understand that others’ point of view can be
... [Show More] different than one’s own Joint Attention:
● Two or more people coordinating attention towards an object or event of mutual interest
● Share awareness
Music Therapy Approaches to Autism
Relationship-based Framework:
● Goal areas: musical, social, emotional
● Techniques: improvisational, re-creative, compositional NMT:
● Goal Areas: cognition, communication, sensorimotor
● Techniques: auditory perception training, developmental speech & language training, social competence training
Receptive Methods
Social Stories
● Enhance interest in concepts
● Preparing for social interactions
● Use 1st person (“I”)
● Add words “sometimes” or “usually” Child-directed Singing
● Use of song to communicate and reflect moment
● Goal to absorb music, rather than expression
● When child disengages, change musical elements
Improvisation
● Arise from vocal and motor output by the child, MT then reflects and expands...captures essence
● Mirroring, then shaping into melodic motifs, rhythms, or lyrics
● Joining the child in his/her experience
Note: Can still include structure, repetition, and familiarity
Recreative
Adaptive Music Lessons
● Typically voice, piano, guitar, drums
● Goals: motor control, coordination, self regulation, self- awareness, sequencing, memory, and attention
● Higher functioning goals: leisure skills, self-esteem, frustration tolerance, social skills
Compositional
● Lower-functioning: more basic pre- academic, behavioural, and life skills
○ Goals: develop vocabulary, expand behavioural repertoire, understanding social cues
● Higher functioning: more psychological or emotional themes
○ Goals: more traditional; that is, expression, self-esteem, creativity
MT & Autism
● Those with ASD have strengths in the creative arts and demonstrate enhanced musical abilities
● Emotion processing deficits in ASD are domain specific, may not impact musical domain
● Greater song vs. speech response
● Music therapy has been suggested as a promising approach to improve social communication in ASD (Simpson & Keen, 2011).
Background Information
● 1940s: Early MT pioneers likely worked in psychiatric hospitals, institutions, schools
● Medical community in US begins shift to holistic treatment philosophy, began to employ part-time music therapists as profession began to define itself
● Autism diagnosis and music therapy profession simultaneously emerging; no publications
● First article to address MT treatment for children with autism was published in British Journal of Music Therapy in 1969
● Music therapists started delineating goals and objectives in their publications and articles by the end of the 1960s and articles specific to this population began accumulating
Nordoff Robbins
● Pioneers in improvisational music therapy
● Perceived music as a nonthreatening medium
● Creative Music Therapy technique for children with autism and other developmental disabilities
● “The Musical Child”
Improvisational techniques used to:
● Establish rapport
● Encourage expressive language and social skills
● Medium for self expression
● Allowed sensory activities to be explored
● Addressed behaviour challenges
More structured techniques to address:
● Attention
● Body Awareness
● Communication
● Video Example
Evidence-Based Practice
● Music therapists and non-music therapists have been critical of the level of evidence vouching for the effectiveness of their work with children with autism
● Response: Task forces to explore and offer recommendations for future directions for MT & autism
● Research! Clinical models and more rigorous assessment methods
○ Example: Rational-Scientific Mediating Model (R-SMM) developed by Thaut (2000) – Neurologic Music Therapy
● Social Communication, Emotional Regulation, and Transactional Support (SCERTS) curriculum model as intake and ongoing assessment tool in music therapy for children with autism
Recent Research Purpose
● To evaluate the effects of a music-based intervention (MT) on language and social
communication in school-aged children with ASD, compared to a non-music control intervention (nonMT) using a randomized control trial design.
● Investigating a direct link between effects of music interventions and changes in the brain for children with ASD
Methods
● Fifty-one children aged 6–12 years with autism were randomized to receive 8–12 weeks of music (n = 26) or non-music intervention (n = 25)
● The music intervention involved use of improvisational approaches through song and rhythm to target social communication.
● The non-music control was a structurally matched behavioural intervention implemented in a non-musical context
Skill Areas
● Speech articulation
● Communication skills
● Memory and attention
● Fine motor skills
● Reciprocal interaction
● Executive functioning skills
● Self esteem and confidence
● Expression
● Language comprehension
● Kinesthetic sense
● Imaginary play
Experiences
Musical
● Harmonica
● Djembe
● Melodica
● Handheld percussion
● Microphone
● Pete the Cat with shoes on
● Xylophone
● Recorder
● Drum set
● Piano
● Egg shakers
Non-Musical
● Darts
● Bubbles
● Pete the cat with shoes on
● Play doh
● Bean bags
● Finger puppets
● Lego
● Jigsaw puzzle
● The gruffalo / other story books
Findings
Post-intervention:
● Communication scores were higher in the music group
● brain functional connectivity was greater in music vs. non-music groups between auditory and subcortical regions and auditory and fronto-motor regions
● brain connectivity was lower between auditory and visual regions in the music compared to the non-music groups, known to be over-connected in autism
Takeaways
● Engaging in musical activities can directly influence auditory-motor connections in the brains of children with ASD
● Music might play a role in reducing the over-connectivity between auditory and visual brain areas
● 8-12 week 1:1 intervention may improve parent-reported social communication, family quality of life (FQoL) and intrinsic brain connectivity in school-age children
Autism Classrooms
● Specialized Music Programming
● Focus: Communication, socialization, quality of life, mood, behaviour regulation, sensory stimulation, recreation, learning about music
Celebrating and Respecting Neurodiversity
Lecture 7 - Class
Topic 1 Improvising as an intervention Topic 2 Music Therapy & ASD
Learning Objectives
● What is Improvising in MT
● Improvising techniques in MT
● What is Autism?
● Symptoms
● History
● Causes
● MT Examples
Improvising as a Music Therapy Intervention
● Courseware: Pg 9-24
What is improvisation?
● Which model or approach is likely to use improvisation?
● Why would an MTA implement improvisation?
It is creating something musically that has not existed before - it is an expression of themselves
- nobody else can say that something in that improvisation is incorrect It is a free space to create, without judgement
Free Improvisation & Playing Rules
● improvising can be daunting and overwhelming
● For this reason there are techniques that music therapists use as a tool for improvising but in a directed way - providing some kind of structure so that improvising seems more manageable
● Playing on the black keys always sounds good - they don’t crash - as one gains more confidence they can start to try new things like playing on the white keys
○ Ie) playing only on the black key of the piano
Technique of mirroring
● Empathic
● Doing what the client is doing at the same time - in the music
● (allows client to see themselves in the therapist) - im with you https://www.youtube.com/watch?v=DSbp0Ffqvm8
Technique of Matching
● Empathic
● Validates client
● Therapist creates music that is compatible with the client’s (matches)
● Supporting the client in music
● Same style and quality
● Concept of together yet separate
Grounding
● Creating a musical anchor for the client
● Used when improvisation of the client is becoming too chaotic
● Therapist uses the base notes at the same time like a constant beat - provides some kind of consistency in the music experience
● Recording example…
Holding
● Used to support expression of a chaotic client, like grounding - but the difference is that in holding they are not using the same notes repetitively but instead creating a pattern of music
● Musical anchor & container (container - strong patterned music which provides a structure for musical “chaos”)
● Recording Example….
Dialoguing
● Musical conversation
● Music therapist and client take turns improvising back and forth like a conversation
● https://www.youtube.com/watch?v=YDjeK57ftTw&t=11s
● ( matching – 2 MT students ) ( Dialoguing – in session, child & MTA)
Improvisation
● Playing Rules
● Mirroring & Matching
● Grounding, Holding/Containing
● Dialoguing (musically)
● Interplay between all of these can occur in a session
Music Therapy & ASD
● Courseware pg. 47 - 74
Everyone is a genius, but if you judge a fish by its ability to climb a tree it will live its whole life thinking its stupid
It is the goal of the music therapist to facilitate the abilities of the client
Ex: if music therapist was working with a fish they would be using the strength of swimming to fulfill their goals rather than urge the fish to try to climb a tree
What is Autism Spectrum Disorder
● Autism is a pervasive developmental disability that affects a person’s ability to communicate and interact with others.
● Spectrum - the way that symptoms are observed and experienced differ in intensity for each individual
The Bigger Picture
● Globally, autism is estimated to affect 24.8 million people as of 2015. In the 2000s, the number of people affected was estimated at 1–2 per 1,000 people worldwide. In the developed countries, about 1.5% of children are diagnosed with ASD.
A Complex Disorder
● If you have met one person with Autism, you have met one person with Autism
● You cannot generalize your experience of one person with autism
● Some are verbal and independent, some are non verbal,require assistance for day to day living
● PDD, Rett's Syndrome, Asperger’s
● Not specific to socio-economic or cultural factors
● MT & ASD – Amelia Oldfield
● Youtube video
Symptoms
● Deficits in communication & social skills
● May display behaviours
● Typically by age 3
● There are many reasons why people would have certain symptoms of autism, without actually having the disorder
● Diagnosis includes: impairment of reciprocal social interaction, verbal communication, & restricted repertoire of interests (may include stereotypical / repetitive movements)
● Although spectrum, all experience challenges with social, communication and behaviour (levels vary, and can skills can be learned)
● Often very intelligent and have abilities above the average person
History
● Leo Kanner (psychiatrist) introduced the label early infantile autism in 1943
● Also introduced refrigerator mothers - was a result of cold mothers with lack of connection to their child
Causes
● Unknown (genetic/environmental) - lots of theories
● No genetic markers found yet
● “Refrigerator Mother” (debunked)
● Youtube video
Rethinking ASD
● Research is helping us to gain a better understanding of ASD. How to support people, and how to recognize abilities within a diagnosis such as ASD.
● Music can often highlight abilities.
● Many support and awareness groups advocating for people with ASD.
● https://www.youtube.com/watch?v=6fy7gUIp8Ms
ASD and MT Interventions
Communication, Social Interactions, Sensory Processing, Behavioural Issues & Music Therapy
● PECS (Picture Exchange Communication System) – Collaborate with SLP - a way for non-verbals to communicate what they want
● Music is flexible - can reflect what is happening in the moment - music can reflect anxieties client is having or movements
● Expressive and Receptive language
● Call & Response -- Repetitive lyrics
● Motivation / prompt interaction – successful tool for meaningful interactions [Show Less]