THE BLOG
11/21/2012 05:48 pm ET Updated Jan 21, 2013

Music Therapy for Individuals With Autism

Have you seen the video clip of Katy Perry and Jodi DiPiazza, an 11-year-old with autism, that is now all the rage on the internet? Katy and Jodi performed "Firework" at the Beacon Theater in New York as part of a Comedy Central special October 21 to raise awareness about autism. According to Neil Morton at 2 for Couples, "It's a real inspiring and moving duet, and shows the amazing talent autistic kids have when given a chance." I couldn't agree more! Thank you so much to Jon Stewart, Comedy Central, Katy Perry and many others for creating this outstanding opportunity to educate the public about autism and what we can do to help individuals with autism.

Similar to another recent video, "Alive Inside," which showed a social worker giving an iPod to a nursing home resident, Katy and Jodi's video allows viewers to witness the amazing power of music, in this case for individuals with ASD. Jodi DiPiazza is a lucky girl indeed -- her parents and educators, such as Bridget Taylor, have provided many intensive learning experiences to help shape her remarkable progress over the course of her young life.

But what about those individuals who do not have the rare experience of appearing with a superstar in front of a live audience or on television? Music can do much to enhance their lives, too. Music therapy in particular can provide many long-lasting benefits that go beyond performance and exposure.

Music therapy pioneers Nordoff and Robbins described their work with Edward, a young boy with autism: "Personal and musical conditions ... combined to make it possible for him to participate in sustained two-way communication. He became a successfully active partner in an interactive situation."[1] Music therapy might "include the use of behavioral, biomedical, developmental, educational, humanistic, adaptive music instruction, and/or other models." Chapters in a 2012 book edited by Petra Kern and Marcia Humpal highlight varied music therapy treatment approaches, such as applied behavioral analysis (Martin), social stories (Brownell), Nordoff-Robbins Music Therapy (Guerrero and Turry), and DIR R/Floortime combined with improvisational music therapy (Carpente), and strategies such as collaborative consultation (Kern) and family-centered practice (Walworth).[2]

According to the American Music Therapy Association:

Music therapy enhances one's quality of life, involving relationships between a qualified music therapist and individual; between one individual and another; between the individual and his/her family; and between the music and the participants. These relationships are structured and adapted through the elements of music to create a positive environment and set the occasion for successful growth.

Literature reports that most individuals with ASD respond positively to music.[3],[4] The frequency with which people with ASD show a heightened interest and response to music makes it an excellent therapeutic tool for working with them. And because music is processed in both hemispheres of the brain, it can stimulate cognitive functioning and may be used for remediation of some speech/language skills.

Wan, et al. (2010) suggested that music may engage brain regions that overlap the human mirror neuron system.[5]

Kaplan and Steele's 2005 outcomes research indicated goal areas typically addressed by music therapists among persons with autism include language/communication, behavioral/psychosocial, cognitive, and musical, as well as perceptual/motor skills.[4] Goal attainment was high within one year. Parents and caregivers surveyed reported that individuals generalized skills/responses acquired in music therapy to non-music therapy environments.

In a 2004 meta-analysis Whipple concluded that all music intervention, regardless of purpose or implementation, had been effective for children and adolescents with autism.[6]

Gold, Wigram, and Elefant's 2006 meta-analysis found that music therapy was significantly more effective than "placebo" therapy, no treatment, or standard care when addressing verbal and gestural communication skills but not for behavioral problems.[3]

Whipple's meta-analysis chapter in Kern and Humpal (2012) reported that music therapy may be considered an extremely effective treatment to develop communication, interpersonal, personal responsibility and play skills for young children with ASD.

Take, for example, a glimpse into what music therapy has done for these individuals:

Waldo is 19 years old and was diagnosed with autism at a young age. His parents hoped that music would "prove to be a good medium for improved language," for both following directions and communicating his desires.

Waldo's first music therapist reported he responded "positively to music and music activities, demonstrating a particularly strong sensitivity to the elements of melody, rhythm, and sung speech." In initial sessions Waldo rarely spoke, yet he hummed new and familiar tunes. During instrumental activities, his attention and compliance with directions increased and interfering behaviors (pinching, biting, putting objects in his mouth, and climbing on the furniture) decreased. Throughout the course of Waldo's music therapy, music has been used successfully as a reinforcer and as a medium through which to teach new skills.

During his first year in music therapy Waldo worked on initiating eye contact when someone called his name, speaking or signing the word "more" and answering "yes" or "no" through the use of an augmentative communication device (a switch), and following directions. He chose instruments and songs via pictures. He often enjoyed the multi-sensory experiences of rolling on top of the djun djun drum or lying inside it and feeling the beat played upon it.

The music therapist's frequent communication with Waldo's speech therapist resulted in the speech therapist incorporating more singing activities into her treatment and the music therapist generalizing switch use to music therapy sessions. Another important facet of music therapy was a "home program." The music therapist recorded music to send home and modeled use of instruments with this recording in her sessions while Waldo's father observed. Waldo's father then tried the activity on his own, with the music therapist intervening only if necessary.

It is amazing how far Waldo has come in music therapy! His skills continue to increase. He speaks more frequent sentences, answers and asks questions, gives compliments and makes comments. He follows more complex directions. He displays more advanced and varied instrument play. "Off-task" motor behaviors are totally absent today, with verbal praise and the music he hears and produces serving as powerful motivators. Waldo has progressed from playing instruments with color- or letter-coding to reading traditional piano and drum set notation and playing with both hands (and feet on drums), isolating correct fingers, and practicing at home.

A recent foray into an adapted musical theatre group and group music therapy provides opportunities to use his social, communicative, cognitive, motor, and musical skills to the max. He is now included in his high school band, and he recently began taking private baritone horn lessons at our community music school.

The father of Ishmael, another client, an adult with autism, summed up his music therapy experience:

It's not so much that Ishmael is going to be a brilliant musician after twenty-plus years of (music therapy) lessons. It's that he's a better musician and a better person ... Ishmael likes music enough that he does things that are difficult for him, like social things. The group puts him into a situation where he has to try and use these new skills. Music brings him to a place that he'd never be at otherwise.

So, the more music therapy the better for those with ASD! With the mission of "advancing public awareness of the benefits of music therapy and increasing access to quality music therapy services in a rapidly changing world," the American Music Therapy Association recently instituted a strategic priority and work group on autism. This initiative's outcomes include improving education and awareness of music therapy services as a viable and cost-effective option for persons with ASD among various stakeholders, training the music therapy workforce to help make music therapy an essential component for the growing number of individuals with autism, and increasing the research base and applications of research in clinical practice for music therapy and ASD.

Last year a very successful collaborative program among AMTA, Berklee College of Music's Music Therapy Program, and Autism Speaks in the Boston area, "Autism Speaks and Sings," provided interactive, educational sessions for parents, children, and teens.

To find out more about how you can bring such a program to your community, to access more resources, fact sheets, or a bibliography on music therapy with individuals with ASD, or if you are looking for a qualified music therapist to work with someone who has ASD, visit http://www.musictherapy.org/.

References:

[1] Nordoff, Paul and Clive Robbins. Creative music therapy. New York: John Day & Co. 1977.

[2] Early childhood music therapy and autism spectrum disorders: Developing potential in young children and their families, P. Kern & M. Humpal, eds. (2012). Philadelphia: Jessica Kingsley Publishers.

[3] Gold, C., Wigram, T. & Elefant, C. (2006). Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews, Issue 2. Art. No: CD004381. Doi: 10.1002/1465858.CD004381.pub2.

[4] Kaplan, R., & Steele, A. L. (2005). An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum. Journal of Music Therapy, 42 (1), 2-19.

[5] Wan, C., Demaine, K., Zipsea, L., Norton, A., & Schlaug, G. (2010). From music making to speaking: Engaging the mirror neuron system in autism. Brain Research Bulletin 82, 161-168.

[6] Whipple, J. (2004). Music in intervention for children and adolescents with autism: A meta-analysis. Journal of Music Therapy, 41(2), 90-106.

For more by Ronna Kaplan, MA, click here.

For more on autism, click here.

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