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Autism Spectrum Disorders

Music Therapy and Autism

Reprinted with permission from CAMT Wilfrid Laurier University

The literature about persons with autism contains many generalized statements, about the effect of music upon these individuals. Comments that autistic individuals show an uncommon interest in music abound. Indeed, many studies show music and music therapy techniques to have significant, positive influences in the treatment of autism. Some authors (see reviews by Baker, 1982; Nelson, Anderson, & Gonzales, 1984) speculate that for children and adults with autism, participation in music is a non-threatening way to allow the individual to experience outside stimuli while avoiding direct human contact.

Activities and techniques incorporating music stimuli play potentially rich and varied roles in therapy for persons with autism. Music therapy techniques can, for example, facilitate and support the desire to communicate (Thaut, 1984); break patterns of isolation and engage the individual in external experiences (Baker, 1982; Thaut, 1984); reduce echolalic responses impeding functional language use (Bruscia, 1982); decrease stereotyped motility patterns (Scoraci, Deckner, McDaniel, & Blanton, 1982); teach social skills (Reid, Hill, Rawers, & Montegar, 1975); and facilitate increased language comprehension (Litchman, 1976).

Because of individual differences within the autistic population, no universal rules of therapy can be applied. While one individual may respond positively to a certain technique, another might easily be harmed. Music -can be a powerful tool. in,, for example, breaking patterns of isolation by providing alternative relationships with musical stimuli. However, the musical stimuli and experience could also create motility rituals or sensory overload and so must be carefully controlled and structured. In fact, Alvin (1975) cites several contraindications in working with persons with autism. She points out that music can itself become an obsession which reinforces withdrawal and selfisolation. Music can sometimes hypnotize autistic individuals into lethargy and turn them inward, making them oblivious to their environment.

Research has demonstrated that music therapy can have significant positive effects upon autistic behaviours and disorders and can therefore provide a valuable adjunct to available treatment services. It is important to stress, however, the need for a trained and knowledgeable music therapist when using music with this population. Circumstances exist under which music can have harmful effects and, particularly if applied improperly or in a therapeutically inappropriate way, can severely hamper or prevent successful treatment.

For persons with autism, music therapy can:

Interrupt patterns of isolation and social withdrawal and enhance socio-emotional development

Social withdrawal and isolation have been viewed as primary autistic features for many years. Characteristics of this impaired socioemotional functioning can include lack of eye contact, lack of physical responsiveness, aloofness, lack of peer relations, often obsessive preoccupation with objects, and maintenance of environmental sameness. While these may change in intensity as the individual matures, social aloneness markedly remains (Thaut, 1984).

Breaking the pattern of isolation and engaging the autistic individual in external rather than internal activities and relationships can prove central to addressing other cognitive and perceptual problems. Thaut (1984) further suggests that problems with social relations are also more amenable to initial therapy than are other underlying disorders.

Autistic persons, especially in the early stages of relationship building, often physically reject or ignore social contact attempts by other persons. Music therapy can provide instead an initial object relation with an instrument. Instead of threatening, the shape, sound and feel of the instrument will often fascinate the individual. The instrument can thus serve as an intermediary between client and therapist, providing an initial point of contact (Thaut, 1984). At the same time, a trained music therapist can structure this experience from the outset in order to minimize motility rituals or sensory overload that may draw the individual back into himself or herself.

Listening experiences can provide additional tactile and visual experience and help to raise awareness of sound and of another person creating that sound. Music and musical experiences can provide infinite kinds of relationships which can be the key to successful therapy with autistic persons. Alvin (1975), in working with autistic children, was able to draw them slowly outward by using music to develop a series of relationships between the client and the instrument, the client and the therapist's instrument, the client and the music, the client and the therapist's music, the client and therapist, the client and other clients, and so on. Once the barrier has been interrupted and contact established, the music therapist can pursue a variety of structured musical experiences that continue to engage these individuals and draw them further from their internal, ritualistic world. While the process can be slow and arduous, music therapy provides an unusual and pleasurable tool that can be easily adapted to meet the changing needs of the client.

As, the individual progresses, and relationships begin to form, music therapy can provide an effective means of teaching social skins as well. Schmidt, Franklin, & Edwards (1976) found music to be highly effective in shaping and reinforcing appropriate, social behaviours. Reid, Hill, Rawer, & Montegar (1975) found music to be instrumental in teaching social skills which,, in turn, facilitated the normalization of a child who had previously been isolated from everyday events. Further, they found that the behaviour changes accompanying music interventions generalized to non-music settings.

Also significant in music therapy with autistic persons, is that all of the musical experiences can be structured for success. Although interactions may be limited by language problems, social relations can become warm. and mutually satisfying if the autistic individual learns that he or she can succeed in the adapted, therapeutic environment. Nelson, Anderson, & Gonzales (1984) suggest that, in a sense, the social disability of autism may be the most treatable part of the disorder, especially in the context of music therapy, since it depends more on the quality of the experiences in their environment than on their underlying neuropsychological characteristics.

Facilitate communication, both verbal and nonverbal

Functional communication difficulties for persons with autism seem to lie fundamentally in the inability to manipulate symbols or symbolic representations (Nelson, et al., 1984). In other words, the individual seems unable to mentally 'see' or 'hear' something that is not immediately present in the environment. Language, a verbal symbolic system, remains largely misused and misunderstood. Autistic language is often characterized by muteness, occasional babbling, noncommunicative speech (echolalia, etc.), or limited communicative intent.

Music therapy techniques in the area of communication attempt to address speech/vocalization production processes and to stimulate mental processes in respect to conceptualization, symbolization, and comprehension (Thaut, 1984). On the most basic level, the music therapist works to facilitate and support the desire or necessity for communication. Improvised accompaniment to the individual's habitual expressions or behaviours can demonstrate a communicative relationship between a particular musical sound and the client's behaviour. Autistic persons might perceive such sounds more easily or readily than verbal approaches, and awareness of the music and of a relationship between the music and the individual's own actions might serve to motivate communication (Thaut, 1984).

As the autistic individual begins to display communicative (verbal or nonverbal) intentions and responses, music can be used to encourage speech and vocalizations. Alvin (1975) suggests that learning to play wind instruments is in some ways, equivalent to learning to make speech vocalizations. It can also strengthen awareness and functional use of lips, tongue, jaws, and teeth. The use of strong melodic/rhythmic patterns in. verbal instructions have been found to be beneficial in maintaining better attention to and comprehension of the spoken word (Thaut, 1984; Mahlberg, 1973). Nelson et al (1984), in a review of the literature, found reports, of music games being associated with a client's first purposeful speech production. Litchman (1976) found significant increases in language comprehension when music was, used in the learning environment. Alvin (1975) also points out how music can serve as an important link between parent and child, providing a channel of communication and a model of how both parties can relate to each other.

Music therapy has also proved useful in reducing instances of noncommunicative speech patterns which can impede progress in learning functional language skills. Bruscia (1982) had dramatic results when using music therapy in the assessment and treatment of echolalia. The treatment procedures employed reduced the subjects' echolalia from 95% of total utterances to under 10% in any setting. Consistent throughout much of the literature is also the finding that skills and abilities acquired in the music therapy setting generalize widely across. situations.

Decrease behaviours characteristic of disturbed perceptual and motor functioning, and enhance appropriate and integrated perceptual and motor development

In autistic persons one sees constant manifestations of pathological behaviour in the perceptual-motor area. Perceptual and motor disturbances have been linked by a suggested relationship between motor behaviour and the faulty processing of sensory input (Thaut, 1984; Nelson, et al., 1984). Characteristics of perceptual disturbances frequently encountered include tactile and kinesthetic receptor preference, hypo- and hypersensitivity to sensory input (i.e., staring, visual and tactile detail scrutiny, covering ears, etc.), preoccupation with isolated sensory impressions, and avoidance of new sensory experience. Motor disturbances are often manifested in delayed gross and fine motor development, poor body awareness/image, self injury, and motility disturbances (i.e., spinning of self or object, toe walking, rocking, and/or hand flapping).

Music therapy techniques are initially aimed at decreasing these behaviours, or breaking these stereotyped motility patterns. Rhythmic activities and movement to music at tempi other than that of body rocking, for instance, can be helpful in this regard (Thaut, 1984). Soraci, Deckner, McDaniel, & Blanton (1982) found that music possessing particular rhythmic characteristics was effective in reducing stereotypic behaviours. When engaged in stereotypies the individual is effectively "tuned out" from attending to events in the environment, but, when stereotypies were reduced or suppressed, the individual could be induced to, engage in productive learning activities. The music therapist can also structure the musical experience to ensure that movement responses to music are adaptive and nonrepetitive in nature (Nelson, et al., 1984).

The autistic individual can begin to exercise perceptual processes, and learn to relate tactile, visual, and auditory stimulation through manual exploration of instruments. Movement to music can also aid in the integration of tactile/kinesthetic and auditory perception and the differentiation of self/nonself (Thaut, 1984). Action songs may be beneficial in helping develop auditory-motor coordination and more refined body awareness/image (Alvin, 1975). Functional use of fingers and hands can be practiced by playing with mallets or on a keyboard. On a more complex level, perceptual learning sequences can first isolate, and then combine, concepts of pitch, loudness, and tempo, by having the client respond in kind on percussion instruments.

From the most basic level to the most complex, music therapy techniques can meet the individual at his or her developmental level, breaking stereotyped behaviour patterns and working toward the integration of different sensory experiences and appropriate motor responses.

Facilitate creative self-expression and promote emotional satisfaction

Autistic individuals display a marked lack of affective responses to stimuli which some authors (see review by Nelson et al. 1984) have hypothesized is due to some defect in the process by which stimuli is arousingly pleasurable or meaningful. Since many autistic children and adults respond relatively positively to musical stimuli it becomes not surprising that music has often been used to motivate and encourage the autistic person. The positive affective responses of these individuals can enhance their participation in other activities designed to facilitate social, language, and perceptual-motor functions. In addition, music may also provide a useful context for encouraging the development of curiosity and exploratory interest in stimuli simply by virtue of the fact that it is pleasurable (Nelson, et al, 1984).

Music therapist Juliet Alvin (1975) contends that the music therapist and music therapy setting are especially conducive to ensuring that the client is deriving pleasure from the experience. The music therapy setting provides the client with the- freedom to behave in certain ways (i.e., making noise, shouting, banging instruments) as well as freedom from fear, of reprisals, threatening stimuli, etc- The music therapy setting allows the individual to discover and express him or herself at his or her own pace and chosen way. It provides a non-threatening means of communication and expression which is also pleasurable for many autistic individuals, and it promotes a sense of emotional satisfaction.

As Nelson et al. (1984) point out, therapy is not just a process of using an individual's strengths to improve his or her weaknesses, it is also a process of refining and improving the individual's strengths. For those autistic individuals demonstrating an aptitude for music, the world of music can provide a socially valued arena for the expression of competence and the attainment of self-worth. Learning to sing or play an instrument can have significant long term value even to an individual who has many inherent limitations in terms of language and social functioning.

MUSIC THERAPY FOR PERSONS WITH AUTISM A SELECTED ANNOTATED BIBLIOGRAPHY

Alvin, J. (1975). Music Therapy for the Autistic Child. London: Oxford University Press.

Baker, B. (1982). The use of music with autistic children. Journal of Psychosocial Nursing and Mental Health Services, 20(4), 31-34.

Explores the use of music, in conjunction with other therapies, as a successful treatment modality in interrupting isolation patterns in autistic children and in establishing patterns of communication.

Bruscia, K.E. (1982). Music in the assessment of echolalia. Music Therapy, 2(l), 25-41.

Discusses the development of an interdisciplinary programme using music in the assessment and treatment of echolalia. After approximately 30 sessions, subject's echolalia was reduced from 95% of total utterances to fewer than 10% in any setting.

Euper, J.A. (1968). Early infantile autism. In E.T. Gaston (Ed.), Music in Therapy (pp. 181-190). New York: Macmillan.

Discusses general characteristics of the autistic and traditional treatment approaches. Examines the role of music in treatment, building upon the unusual interest and talent often shown by persons with autism.

Litchman, M.D. (1977). The use of music in establishing a learning environment for language instruction with autistic children (Doctoral dissertation, State University of New York at Buffalo, 1976). University Microfilms International, No. 773557.

Subjects within music (vs. no music) treatment groups demonstrated statistically significant gains in language comprehension. Increased enthusiasm and cooperation were also noted among all subjects.

Mahlberg, M. (1973). Music therapy in the treatment of an autistic child. Journal of Music Therapy, 10(4),189-193.

Case study material presented demonstrates the use of music therapy with an autistic child in increasing attention span, reducing repetitive behaviours, and teaching nonverbal communication techniques.

Nelson, D., Anderson, V., & Gonzales, A. (1984). Music activities as therapy for children with autism and other pervasive developmental disorders. Journal of Music Therapy,21.(3),100-116.

Discusses important considerations for the music therapist when designing therapeutic music activities for the autistic child. Examines ways of synthesizing music activities in accordance with these children's neuropsychological characteristics as described in the research and clinical literature.

Reid, D.H., Hill, B.K., Rawers, R.J. & Montegar, C.A. (1975). The use of contingent music in teaching social skills to a nonverbal hyperactive boy. Journal of Music Therapy, 12(l), 2-18.

Three separate experiments demonstrate the effectiveness of contingent music in teaching social skills. The role of music in behaviour therapies is discussed.

Schmidt, D.C., Franklin, R. & Edwards, J.S. (1976). Reinforcement of autistic children's responses to music. Psychological Reports, 39(2), 571-577.

Shows the use of music in the curriculum to teach appropriate musical responses and as a context to shape and alter other individual and social behaviours.

Soraci, S., Deckner, C.W., McDaniel, C. & Blanton, R.L. (1982). The relationship between rate of rhythmicity and the stereotypic behaviours of abnormal children. Journal of Music Therapy, 19(l),46-54.

Demonstrates the impact of the rate of an auditory rhythm on the frequency of a number of potentially maladaptive stereotypic behaviours.

Thaut, M.H. (1984). A music therapy treatment model for autistic children. Music Therapy Perspectives, 1(4), 7-13.

Presents a general music therapy treatment model for autistic children directed toward their specific deficiencies and dysfunction. Aspects of pathology and diagnostic characteristics are outlined and sequences of pertinent music therapy techniques are identified.