Treatments For Autism - Music Therapy

DISCLAIMER – The Autism Resource Foundation provides general information to the autism community. The information comes from a variety of sources, and the Autism Resource Foundation does not independently verify any of it, nor does it necessarily reflect the views and/or opinions of the Autism Resource Foundation. Nothing on this website should be construed as medical advice. Always consult your doctor regarding the needs of your family.

American Music Therapy Association, Inc.
Music Therapy And Individuals With Diagnoses On The Autism Spectrum

What is Music Therapy?
Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. It is a well-established allied health profession that uses music therapeutically to address behavioral, social, psychological, communicative, physical, sensory-motor, and/or cognitive functioning. Because music therapy is a powerful and non-threatening medium, unique outcomes are possible. For individuals with diagnoses on the autism spectrum, music therapy provides a unique variety of music experiences in an intentional and developmentally appropriate manner to effect changes in behavior and facilitate development of skills.

Music therapy may include the use of behavioral, biomedical, developmental, educational, humanistic, adaptive music instruction, and/or other models. 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.

Why Music Therapy for Individuals with Diagnoses on the Autism Spectrum?

The literature reports that most individuals with autism respond positively to music (DeMyer, 1974; Edgerton, 1994; Euper, 1968; Snell, 1996; Thaut, 1992).
People with diagnoses on the autism spectrum often show a heightened interest and response to music, making it an excellent therapeutic tool to work with them.
Music is a very basic human response, spanning all degrees of ability/disability. Music therapists are able to meet clients at their own levels and allow them to grow from there. The malleability of music makes it a medium that can be adapted to meet the needs of each individual.
Music is motivating and enjoyable.
Music can promote relatedness, relaxation, learning, and self-expression.
Music therapy addresses multiple developmental issues simultaneously.
Music therapy can provide success-oriented opportunities for achievement and mastery.
The structure and sensory input inherent in music help to establish response and role expectations, positive interactions, and organization.

How Does Music Therapy Make a Difference for Individuals with Diagnoses on the Autism Spectrum?
Individuals with diagnoses on the autism spectrum may display “qualitative impairments in social interaction and communication” and often manifest “restricted repetitive and stereotyped patterns of behavior, interests and activities.” Delays and/or abnormal functioning usually occur before age 3 and may be marked by a lack of symbolic or imaginative play as well. (Diagnostic Statistical Manual-IV, pp. 70-71).

Music therapy can be effective in addressing the typical characteristics of autism listed above in the following ways:
Music is considered a “universal language” which provides bridges in a non-threatening setting between people and/or between individuals and their environment, facilitating relationships, learning, self-expression, and communication.
Music captures and helps maintain attention. It is highly motivating and engaging and may be used as a natural “reinforcer” for desired responses. Music therapy can stimulate clients to reduce negative and/or self-stimulatory responses and increase participation in more appropriate and socially acceptable ways.
Music therapy can enable those without language to communicate, participate and express themselves non-verbally. Very often music therapy also assists in the development of verbal communication, speech, and language skills. The interpersonal timing and reciprocity in shared play, turn-taking, listening and responding to another person are augmented in music therapy with children and adults with autism to accommodate and address their styles of communication.
Music therapy allows individuals with diagnoses on the autism spectrum the opportunity to develop identification and appropriate expression of their emotions.
Because music is processed in both hemispheres of the brain, music can stimulate cognitive functioning and may be used for remediation of some speech/language skills.
Music provides concrete, multi-sensory stimulation (auditory, visual, and tactile). The rhythmic component of music is very organizing for the sensory systems of individuals diagnosed with autism. As a result, auditory processing and other sensory-motor, perceptual/motor, gross and fine motor skills can be enhanced through music therapy.
Musical elements and structures provide a sense of security and familiarity in the music therapy setting, encouraging clients to attempt new tasks within this predictable but malleable framework.
Many people with diagnoses on the autism spectrum have innate musical talents; thus, music therapy provides an opportunity for successful experiences. Emphasis is placed on strengths, which in turn may be utilized to address each individual’s areas of need.

What Do Music Therapists Do?
Music therapists provide direct or consultative services. They work individually or in small groups, using a variety of music and techniques to engage children and adults with diagnoses on the autism spectrum. They involve clients in singing, listening, moving, playing instruments, and creative activities in a systematic, prescribed manner to influence change in targeted responses or behaviors and help clients meet individual goals and objectives. They create a musical, familiar environment that encourages positive interpersonal interaction and allows clients freedom to explore and express themselves. They utilize music that is preferred by and reinforcing to clients and is appropriate for ages, cultures, and environments in which the clients interact.

Music therapists are trained professionals who accept referrals, observe clients’ behavior and interactions, and assess their behavioral/psycho-social/emotional, communication/language, perceptual/ and sensory/motor, cognitive/academic, and musical skills. After designing realistic goals and target objectives to address identified needs, music therapists plan and implement individualized music therapy treatment programs with strategies, procedures, and interventions to develop skills necessary to achieve an optimum level of success or quality of life for individuals with diagnoses on the autism spectrum. Music therapists document client responses, conduct ongoing evaluations of progress and performance, and make recommendations for future consideration. They often work as team members in conjunction with families and professionals to best address each individual’s needs. Music therapists may also make recommendations to team members and families regarding ways to include successful music therapy techniques in other aspects of clients’ lives.

What Can One Expect from a Music Therapist?

A music therapist is…

Professionally trained to utilize clinical musical interventions to address behavioral/psycho-social/emotional, communication/language, sensory-motor, & cognitive needs of individuals.
A competent musician who is both creative and resourceful.
An understanding, caring, ethical therapist, with a broad range of skills.
Well-versed in a variety of music therapy applications and pertinent research.
Informed regarding individuals with diagnoses on the autism spectrum and able to provide adaptations to address unique processing styles.
Able to create a therapeutic environment and engage in the therapeutic process.
An effective communicator, with clients, other team members, and the public.

Who is Qualified as a Music Therapist?

Graduates of colleges or universities from more than 70 approved music therapy programs are eligible to take a national examination administered by the Certification Board for Music Therapists (CBMT), an independent, non-profit certifying agency fully accredited by the National Commission for Certifying Agencies. After successful completion of the CBMT examination, graduates are issued the credential necessary for professional practice, Music Therapist-Board Certified (MT-BC). In addition to the MT-BC credential, other recognized professional designations are Registered Music Therapists (RMT), Certified Music Therapists (CMT), and Advanced Certified Music Therapist (ACMT) listed with the National Music Therapy Registry. Any individual who does not have proper training and credentials is not qualified to provide music therapy services.

Where Do Music Therapists Work?

Music therapists may work in public school systems, where, in accordance with the Individuals with Disabilities Education Act (IDEA), music therapy is recognized as a related service that provides a “significant motivation and/or assist” in the achievement of Individual Education Plan (IEP) goals and objectives.

In addition, music therapists may provide service in the following settings: early intervention centers, Head Start programs, day care centers, preschools through high schools, day treatment centers, hospitals, hospices, clinics, rehabilitation centers, substance abuse facilities, mental health centers, group homes, sheltered workshops, long-term care facilities, correctional institutions, private homes, camps, community schools of the arts, music retailers, wellness centers, holistic treatment centers, private practice, and more.

How Does Music Therapy Help Families of Individuals with Diagnoses on the Autism Spectrum?

Families of those with diagnoses on the autism spectrum may reap many benefits from music therapy:

An individual’s growth through music therapy may improve the quality of life for the whole family. If the client’s behavior is improved, there may be less stress or strain on other family members. In addition, with an increase in skills, the client may become more independent and aware and more able to interact and communicate with others.
Music therapy can provide additional opportunities for positive interaction and building relationships among family members and the client. New music-related leisure options among family members may be explored, while providing an acceptable emotional outlet.
Greater family cohesiveness, support, and coping skills may be achieved through shared, equal music making during sessions or in the home environment.
Music therapy interventions can teach family members alternative ways to interact, socialize, and communicate with their loved ones.
Music therapy can help promote generalization/transfer of skills in sessions to the home environment.
Participation in music therapy often allows family members to see their loved one in a “different light,” to witness their relative’s areas of strength and aptitude, perhaps seeing or hearing novel responses in this setting that they have not noted elsewhere. Music therapy may provide hope for the future and belief in the individual’s abilities.

Is There Research to Support Music Therapy for Individuals with Diagnoses on the Autism Spectrum?

Through peer-reviewed journals inside the profession such as Music Therapy, the Journal of Music Therapy, Music Therapy Perspectives, and extensive articles in journals outside the profession, AMTA has promoted much research exploring the benefits of music therapy with individuals with diagnoses on the autism spectrum. A research bibliography of select articles and publications is available from AMTA for those interested in specific research examples.

What is AMTA?

The American Music Therapy Association (AMTA) represents over 5,000 music therapists, corporate members, and related associations worldwide. AMTA’s roots date back to organizations founded in 1950 and 1971. Those two organizations merged in 1998 to ensure the progressive development of the therapeutic use of music in rehabilitation, special education, and medical and community settings. AMTA is committed to the advancement of education, training, professional standards, and research in support of the music therapy profession. The mission of the organization is to advance public knowledge of music therapy benefits and increase access to quality music therapy services. Currently, AMTA establishes criteria for the education and clinical training of music therapists. Members of AMTA adhere to a Code of Ethics and Standards of Practice in their delivery of music therapy services.

How Can You Find a Music Therapist or Get More Information?

American Music Therapy Association
8455 Colesville Road, Suite 1000
Silver Spring, MD 20910
Phone (301) 589-3300
Fax (301) 589-5175
Web: www.musictherapy.org
Email: info@musictherapy.org

American Music Therapy Association
Autism Spectrum Disorders: Music Therapy Research and Evidence Based Practice Support

Statement Of Purpose
Music therapy is a well-established professional health discipline that uses music as the therapeutic stimulus to achieve non-musical treatment goals. In special education and settings serving persons with autism spectrum disorders, music therapists utilize music as an educational related service to promote learning and skill acquisition.

Research supports connections between speech and singing, rhythm and motor behavior, memory for song and memory for academic material, and overall ability of preferred music to enhance mood, attention, and behavior to optimize the student’s ability to learn and interact. Therefore, one of the purposes of music therapy for persons with autism is to provide the student with an initial assist using melodic and rhythmic strategies, followed by fading of musical cues to aid in generalization and transfer to other learning environments.

Recognized as a related service, music therapy serves as an integral component in helping the child with special needs attain educational goals identified by his/her IEP team*, either through direct or consultant services. The strength of evidence is growing and the Cochrane Collaborative with favorable results reviewed music therapy interventions for quality of evidence.

Standardization: Music therapy sessions are documented in a treatment plan and delivered in accordance with standards of practice. Music selections and certain active music making activities are modified for client preferences and individualized needs (i.e., song selection and music may vary). Toolkits are available via AMTA and publications.

Replication: Yes; has been used with different providers and populations also.

Outcomes:

Increased attention
Improved behavior
Decreased self-stimulation
Enhanced auditory processing
Improved cognitive functioning
Decreased agitation
Increased socialization
Improved verbal skills
Successful and safe self-expression
Enhanced sensory-motor skills

* The Individuals with Disabilities Education Act (IDEA) 20 U.S.C. §1400, provides that eligible children and youth with disabilities shall receive special education and related services. The law includes a definition of related services that the U.S. Department of Education notes is not exhaustive. In addition, in June 2000, the U.S. Department of Education issued a letter of policy clarification related to the use of music therapy. The letter reiterated the Department's continuing policy that "[i]f the IEP team determines that music therapy is an appropriate related service for a child, the team's determination must be reflected in the child's IEP, and the service must be provided at public expense....".

Overview Of Research

Trends regarding evidence-based review and recommendations regarding assessment and referral criteria based on current research and clinical evidence are emerging. Music therapy is a particularly important intervention for children with autism spectrum disorders to engage and foster their capacity for flexibility, creativity, variability and tolerance of change, in order to balance the more structured and behaviorally driven education required in school settings. One review protocol published in the Cochrane Collaborative of Systematic Reviews concluded music therapy was superior to 'placebo' therapy with respect to verbal and gestural communicative skills (verbal: 2 RCTs, n = 20, SMD 0.36 CI 0.15 to 0.57; gestural: 2 RCTs, n = 20, SMD 0.50 CI 0.22 to 0.79). The addition of music therapy intervention to a child's treatment program can have positive outcomes and may be an effective method for increasing joint attention skills in some children with autism.
An overall positive direction is noted in meta-analytic reviews of the literature on the subject of music therapy and autism in terms of an array of outcomes related to both therapeutic and specific educational goals. Variations for effect size occur within the broad category of the autism spectrum disorders and tend to reflect the idiosyncratic nature of the disorders between individuals. This is typical across disciplines.
Survey research indicates goal areas typically addressed by music therapists among persons with autism include language/communication, behavioral/psychosocial, cognitive, and musical, to perceptual/motor. Goal attainment was found to be high within one year; and, parents and caregivers surveyed indicated subjects generalized skills/responses acquired in music therapy to non-music therapy environments.

Survey research examining therapy trends of inpatient and habilitation care of autistic children revealed the most common therapies were physical therapy, speech, occupational and music therapy. One hundred and seventy-eight subjects out of 187 showed some improvement on the Childhood Autism Rating Scale (CARS). All modes of therapy were found to be useful.
Observational study of the effect of music therapy on communication skills revealed significant gains in autistic childrens’ communication behaviors as measured by Checklist of Communicative Responses/Acts Score Sheet (CRASS). Commensurate decreases in scores were noted when music therapy intervention was removed.
Preschool children in an early intervention music therapy program show high on-task behavior during sessions and a high success rate in language development, social skills, cognitive concepts, motor skills, and music knowledge.
Research demonstrates the efficacy of music used in the curriculum to enhance literacy skills. Musical cueing is effective to improve word recognition, logo identification, print concepts and prewriting skills of children in early intervention programs. Shared reading paired with song rehearsal of text facilitates greater text accuracy than spoken rehearsal with kindergarten students.
Selected verbal language and speech skills are enhanced through music activities in special education populations. Musical presentation of new vocabulary words results in an increased number of words learned and transferred in elementary school-age children. Music is effective as a prompt and reinforcer to increase verbal response in preschool-age children with limited verbal communication.
Research supports the use of music to structure and organize information in order to increase learning and retention of number concepts. Sequential verbal information, such as telephone numbers and multiplication tables, set to melodic and rhythmic patterns are more effectively memorized and recalled than through non-music presentation.
Music-facilitated interactions and structured instrument playing are effective to improve social skills in school-age populations. Social problem solving skills in 5-yearold students are increased on a long-term basis through creative musical activities. Positive affect induced by music helps to improve social problem solving skills in middle school students.

Cadenza Music Therapy

Can Your Child Benefit?
Music therapy can be a rich and rewarding addition to a comprehensive treatment program. In fact, it is becoming a more common part of a comprehensive treatment program for children with autism. Many parents seeking out music therapy have children who have been receiving more traditional therapies for many years, but are searching for something that will bring joy and meaning to their child’s life. Music therapy often brings out a child’s inner spirit, laughter, and a twinkle in their eye as they find satisfaction in their participation and creative efforts.

Music therapy is a related service under Part B of IDEA. Each state and its local school districts therefore must ensure that all children with disabilities receive related services at no cost to parents in conformity with an IEP. Yet, many parents are denied the opportunity to even have their child evaluated for appropriateness of music therapy services simply because it is not specifically mentioned.

In a letter dated June 9, 2000 to Andrea Farbman, Executive Director of the American Music Therapy Association, Kenneth Warlick, Director of the Office of Special Education Programs with the United States Department of Education writes: “… [a]s under prior law, the list of related services is not exhaustive and may include other developmental, corrective, or supportive services (such as artistic and cultural programs, art, music, and dance therapy), if they are required to assist a child with a disability to benefit from special education in order for the child to receive FAPE” (p.2). Further, should the IEP team determine that music therapy is an appropriate related service for a child, the team’s determination must be reflected in the child’s IEP, and the service must be provided at public expense and at no cost to the parents. Additionally, music therapy services are to be provided only by personnel who meet appropriate State standards for qualified personnel as defined in the regulations.

Often, parents who request music therapy for their child are met with the response that “our teachers already include music in their program so we do not need to provide music therapy.” But, music therapy and general music education are distinct disciplines and professions; the intent of the services themselves set them apart. While music educators strive to teach music-related skills, abilities, and appreciation, music therapists strive to use music to accomplish non-musical goals such as improving behavior, attention span, receptive and expressive language skills, and social skills. Therefore, school music educators may not have the appropriate training to provide music therapy for a child with disabilities. In addition, and contrary to widely-held positions, there is an abundance of research and literature spanning over 30 years to support the use of music therapy with children on the spectrum.

Music therapy treatment with children on the autism spectrum often addresses the four main qualitative impairments: behavior, communication and symbolic play, socialization, and sensory issues. Impaired social interaction affects all areas of a child’s functioning. The most basic of these skills involves motivation to become and remain engaged with another person. Music therapy provides intrinsically rewarding and motivating practice in appropriate play with objects and creating meaning with others. In addition to the socio-emotional and educational benefits, students receiving music therapy exhibit enhanced social skills, generalization of previously learned skills, improved sensory integration and motor planning, and expanded language and communication skills.

Music therapists use a wide variety of interventions developed to benefit children with special needs. These creative activities provide an emotional outlet of the greatest value that integrates a child’s emotional, physical, and mental experiences. Goal-oriented musical experiences may be receptive or active and may involve such activities as: singing, dancing, imitation and action songs, academically-oriented songs, musical games, or music listening. But, how does one begin to determine if music therapy may be appropriate for a child with disabilities? The answer may be “yes” if the child:

Easily learns words to songs, but has trouble remembering more “simple information;
Is more animated and engaged when involved in music activities than when not;
Spends time humming, singing, or vocalizing to himself;
Has his/her first words emerge in song rather than speaking;
Demonstrates improved attention when engaged in music;
Has limited joint attention skills and/or poor imitation;
Needs practice in any of the following:

organizing sensory information
sequencing events
being more flexible within a structure
generalizing skills

Rarely engages or interacts with others in a meaningful way;
Has not yet established purposeful communication

While most music therapy services are paid out of pocket, there have been recent advances towards getting reimbursement. In Michigan and Indiana, music therapy is a covered service under the state’s Medicaid Children’s Waiver program; and North Carolina is considering new Medicaid Waiver language that includes music therapy coded as a therapeutic service for support and comprehensive services for individuals with developmental disabilities. And, finally music therapists in several states, including Florida, are actively pursuing state funding for their clients. If your child participates in music therapy, you are encouraged to support these efforts by talking to your Medicaid support coordinator, getting a prescription for a music therapy evaluation or services, and/or discussing the possibility of incorporating music therapy into your child’s educational plan at your next IEP meeting.

Center for the Study of Autism/Autism Research Institute (ARI)
Music Therapy And Language For The Autistic Child

Music Therapy is the unique application of music to enhance personal lives by creating positive changes in human behavior. It is an allied health profession utilizing music as a tool to encourage development in social/ emotional, cognitive/learning, and perceptual-motor areas. Music Therapy has a wide variety of functions with the exceptional child, adolescent and adult in medical, institutional and educational settings. Music is effective because it is a nonverbal form of communication, it is a natural reinforcer, it is immediate in time and provides motivation for practicing nonmusical skills. Most importantly, it is a successful medium because almost everyone responds positively to at least some kind of music.

The training of a music therapist involves a full curriculum of music classes, along with selected courses in psychology, special education, and anatomy with specific core courses and field experiences in music therapy. Following coursework, students complete a six-month full time clinical internship and a written board certification exam. Registered, board certified professionals must then maintain continuing education credits or retake the exam to remain current in their practice.

Music Therapy is particularly useful with autistic children owing in part to the nonverbal, non-threatening nature of the medium. Parallel music activities are designed to support the objectives of the child as observed by the therapist or as indicated by a parent, teacher or other professional. A music therapist might observe, for instance, the child's need to socially interact with others. Musical games like passing a ball back and forth to music or playing sticks and cymbals with another person might be used to foster this interaction. Eye contact might be encouraged with imitative clapping games near the eyes or with activities that focus attention on an instrument played near the face. Preferred music may be used contingently for a wide variety of cooperative social behaviors like sitting in a chair or staying with a group of other children in a circle.

Music Therapy is particularly effective in the development and remediation of speech. The severe deficit in communication observed among autistic children includes expressive speech, which may be nonexistent or impersonal. Speech can range from complete mutism to grunts, cries, explosive shrieks, guttural sounds, and humming. There may be musically intoned vocalizations with some consonant-vowel combinations, a sophisticated babbling interspersed with vaguely recognizable word-like sounds, or a seemingly foreign sounding jargon. Higher-level autistic speech may involve echolalia, delayed echolalia or pronominal reversal, while some children may progress to appropriate phrases, sentences, and longer sentences with non expressive or monotonic speech. Since autistic children are often mainstreamed into music classes in the public schools, a music teacher may experience the rewards of having an autistic child involved in music activities while assisting with language.

It has been noted time and again that autistic children evidence unusual sensitivities to music. Some have perfect pitch, while many have been noted to play instruments with exceptional musicality. Music therapists traditionally work with autistic children because of this unusual responsiveness which is adaptable to non-music goals Some children have unusual sensitivities only to certain sounds. One boy, after playing a xylophone bar, would spontaneously sing up the harmonic series from the fundamental pitch. Through careful structuring, syllable sounds were paired with his singing of the harmonics and the boy began incorporating consonant-vowel sounds into his vocal play. Soon simple 2-3 note tunes were played on the xylophone by the therapist who modeled more complex verbalizations, and the child gradually began imitating them.

Since autistic children sometimes sing when they may not speak, music therapists and music educators can work systematically on speech through vocal music activities. In the music classroom, songs with simple words, repetitive phrases, and even repetitive nonsense syllables can assist the autistic child's language. Meaningful word phrases and songs presented with visual and tactile cues can facilitate this process even further. One six-year old echolalic child was taught speech by having the therapist/teacher sing simple question/answer phrases set to a familiar melody with full rhythmic and harmonic accompaniment The child held the objects while singing:
Do you eat an apple? Yes, yes.
Do you eat an apple? Yes, yes.
Do you eat an apple? Yes, yes.
Yes, yes, yes.

and

Do you eat a pencil? No, no.
Do you eat a pencil? No, no.
Do you eat a pencil? No, no.
No, no, no.

Another autistic child learned noun and action verb phrases. A large doll was manipulated by the therapist/teacher and a song presented:
This is a doll.
This is a doll.
The doll is jumping.
The doll is jumping.
This is a doll.
This is a doll.
Later, words were substituted for walking, sitting, sleeping, etc. In these songs, the bold words were faded out gradually by the therapist/teacher. Since each phrase was repeated, the child could use his echolalic imitation to respond accurately. When the music was eliminated completely, the child was able to verbalize the entire sentence in response to the questions, "What is this?" and "What is the doll doing?"

Other autistic children have learned entire meaningful responses when both questions and answers were incorporated into a song. The following phrases were sung with one child to the approximate tune of Twinkle, Twinkle, Little Star and words were faded out gradually in backward progression. While attention to environmental sounds was the primary focus for this child, the song structure assisted her in responding in a full, grammatically correct sentence:
Listen, listen, what do you hear? (sound played on tape)
I hear an ambulance.

(I hear a baby cry.)
(I hear my mother calling, etc.)

Autistic children have also made enormous strides in eliminating their monotonic speech by singing songs composed to match the rhythm, stress, flow and inflection of the sentence followed by a gradual fading of the musical cues. Parents and teachers alike can assist the child in remembering these prosodic features of speech by prompting the child with the song.

While composing specialized songs is time consuming for the teacher with a classroom full of other children, it should be remembered that the repertoire of elementary songs are generally repetitive in nature. Even in higher level elementary vocal method books, repetition of simple phrases is common. While the words in such books may not seem critical for the autistic child's survival at the moment, simply increasing the capacity to put words together is a vitally important beginning for these children.

For those teachers whose time is limited to large groups, almost all singing experiences are invaluable to the autistic child when songs are presented slowly, clearly, and with careful focusing of the child's attention to the ongoing activity. To hear an autistic child leave a class quietly singing a song with all the words is a pleasant occurrence. To hear the same child attempt to use these words in conversation outside of the music class is to have made a very special contribution to the language potential of this child.

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