Music therapy and the child with learning disabilities

Music Therapy in Autistic Children

Autism is a relatively low-incidence developmental disability that, according to Frith (1991), results in impairments of socialization, communication, and imagination. In an article describing her experiences, Donna Williams (1994a), a person with autism, defined the disability as a pervasive developmental disability affecting recognition and comprehension including proprioception, kinesthetic sense, sense of self and other, visualization, sequencing, synthesis, analysis, and retrieval. People with autism often exhibit significant language problems such as delayed or absent speech, perseveration, and echolalia. Solitary, repetitious, patterned behaviors are often favored from infancy, sometimes to the exclusion of explorative and social behaviors (Wing, 1991). The majority of people with autism are thought to have severe intellectual disabilities (Yeung-Courchesne & Courchesne, 1997). Most people who are so labeled require supervision, support, and assistance throughout their lives.

People labeled autistic describe an unusual relationship with the world around them. From an early age, autobiographers distinguished the "real world" from how they personally experienced the world (Barron & Barron, 1992; Grandin, 1995; Sellin, 1995; Williams, 1992). Donna Williams (1992) characterized her relationship to others as mutually incomprehensible. Just as family members could not interpret the meeting of her solitary play, she could not understand their words or actions.

Differences in neurological development can result in altered sensitivity to sound, touch, visual input, and movement. Sensation may be fragmented, altered, variable, increased, or decreased. For example, Sean Barron described his early memories of people as fragmented: "Even when I saw them they were still in pieces" (Barron & Barron, 1992, p. 21). Autobiographers reported a limited capacity to both filter stimuli and to experience more than one sensation at any given time (Grandin & Scariano, 1986, Williams, 1994b).

Sensitivity to touch, sight and sound can result in a widely reported experience of what Williams (1992) has termed "shut down." In his autobiographical book of poetry, Birger Sellin (1995) described "shut down" as an acute panic attack that is brought about by sensory and emotional bombardment. The shut down experience appears to be worsened by intrusions that cannot be avoided or are of uncertain duration.

Donna Williams (1994a) observed that she, as well as others with autism, seemed to have a significantly limited ability to attend to more than one sensation at a time. This observation is confirmed by Courchesne and his colleagues who noted both a dissociation between auditory and visual attention, and an inability to rapidly shift attention in individuals with autism. They stated that deficient attention contributed to the social and cognitive delays in autism (Courchesne et al., 1994), perhaps due to the forfeiture of attention to one sensory mode for another (e.g., touch over vision). Although attentional limitations interfere with learning, the ability to focus acutely on one skill or activity to the exclusion of other stimuli can also lead to proficiency. Individuals with autism often have strong interests and some develop extraordinary talents. Examples were numerous in the autobiographical literature: Jesse Park (Park, 1992) became a respected artist; Temple Grandin (1995) gained international recognition as a designer of livestock equipment; and Donna Williams (1992) taught herself to play piano, developing her own notation system. Others exhibited skill in poetry, music, and mathematics (Akerley, 1992; Sellin, 1995; Sullivan, 1992).

Distress and anxiety are common emotional states for people who have a difficult time interpreting events and filtering stimuli. Parents of people with autism have noted that their children experience tremendous distress over seemingly minor problems such as an unexpected event or minor error (Park, 1992; Sullivan, 1992).

Certainly, not all emotions experienced by people with autism are negative. Donna Williams described the intense pleasure she received from reflected light patterns, stable fluctuations of sound, jumping, playing music, or watching a fire (Blakely, 1992, Williams, 1994a; Williams, 1994b). Likewise, Temple Grandin reported experiencing acute pleasure when interacting with animals or while involved in complex perceptual-spatial tasks (Grandin & Scariano, 1986; Grandin, 1995).

Even for individuals with autism who are very capable, problems with communication are often quite fundamental. Individuals with autism may misinterpret situational nuances, fail to consider context, and have difficulty distinguishing the essential from the trivial (Dewey, 1991; Happe, 1991). Temple Grandin (1992) wrote that, as a child, verbal communication was extremely difficult. She screamed when she could find no other way to communicate. Donna Williams (1994b) reported that she was often able to understand words, sentences, even contexts, without grasping the significance of a spoken message. Difficulty initiating conversations, use of idiosyncratic language, failure to listen to or follow-through on requests, and specific problems with receptive and/or expressive communication are commonly reported in literature on autism and related disabilities (Cox & Mesibov, 1995; Frith, 1991; Townsend & Courchesne, 1994).

Although several authors reported that they did not feel loneliness, sexual desire, or need for friendship in the same way that nonautistic individuals do, they sometimes desired relationships and friendship (Blakely, 1992; Grandin, 1995; Sinclair, 1992). Making friends is complicated by social deficits. The subtleties of body language, facial expressions, tone of voice, and physical proximity can be difficult for people with autism to interpret or produce (Grandin, 1995). Even the intentions and motivations of others are often difficult to comprehend (Sellin, 1995; Sinclair, 1992).

Music Therapy

Some authors have argued that music therapy may be particularly useful in addressing the specific characteristics of autism. For example, Thaut (1984) proposed an intervention model designed to support the language, emotional, cognitiveand motor impairments associated with autism. Using the self-reports of adults with autism, Toigo (1992) argues that music therapy is well suited to assisting individuals with autism.There are very few studies that have examined the effectiveness of music therapy with individuals with autism. Indeed, the music therapy profession itself recognises that there is a need to conduct sound research to evaluate the efficacy of music therapy and, in particular, to develop reliable measures of change that may occurduring intervention (Toolan & Coleman, 1994; Wimpory, Chadwick, & Nash,1995). Some research reports in this area rely on single case studies (Monti, 1985).In others, the intervention procedures and the characteristics of the participants arenot clearly explained (Hairston, 1990; Toolan & Coleman, 1994). Music is also useful for auditory integration training.. In auditory integration training (Berard, 1993; Tomatis, 1991), students listen through earphones to electronically filtered music. This process can reduce hyperacute hearing typical of autism.

The most recent studies on autism seem to show that the child can greatly benefit from a structured therapeutic education. Certain positive pursuits are recognised as beneficial. Already Rutter (1967) expressed the opinion that:

Nearly all autistic children have specific cognitive defects, normally involving language and perception. Consequently at least at first, methods of instruction involving objects and activities may be more useful than those with emphasis on purely visual stimuli, such as pictures or spoken instructions which are used with normal children but are not suitable to the autistic child.

These remarks are pertinent to the use of music as a specific means towards the development of the autistic child. The cognitive pathology which affects him seems to produce more than an intellectual blockage. It brings about an inability to relate emotionally and socially, or to become part of the environment -- or even to relate one part of his own body to another. The child seems to suffer from a deficiency in grasping a logical process, although he can, to some extent, understand causes and effects in a concrete situation. Music is of value in such a situation since it can be enjoyed at a concrete level without an understanding of abstract processes.

The members of the team around the child -- doctors, teachers or therapists -- try to make the child use the information he receives from the environment. Since he does not develop in an integrated way, we try to use music as an integrating force, involving in one operation mental, emotional, physical and even social factors, affecting the child directly at his own level of intellectual and emotional tolerance. The techniques should ultimately make sense to the child and enable him to progress at his own pace. Each autistic child is a unique individual whose scattered abilities should come together as much as possible. Perhaps his attraction to music comes from a feeling of being fully involved and more complete within a musical environment.

Case Study

The literature search revealed one-depth case study of the effects of music therapy on an autistic child (Orr & Myles, 1996)... Melanie was an 11-year-old girl who met criteria for autism, according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). This African-American girl was 5'7" tall and weighed approximately 170 pounds. She had some expressive language skills but was difficult to understand. Melanie had a history of inappropriate behaviors such as pulling hair, screaming, and scratching during social interactions in an attempt to gain attention or communicate her wants and/or needs. She often engaged in tantrum behaviors that required the assistance of three to four adults to calm her as well as to ensure her and others' safety. Melanie's frequency of inappropriate behavior was not consistent; she experienced unpredictable increases and decreases in hair pulling, screaming, scratching, and tantrum behavior.

The study occurred in a self-contained classroom for children and youth with autism, which was housed within the special education department of a large state medical center. The classroom included four students, one certified classroom teacher, and three paraprofessionals. Students received one-on-one instruction; group instruction; speech-language, music, art, and adaptive physical education; and occupational therapy

An ABAB design was used to evaluate the effectiveness of rhythmic entrainment as a calming technique. The first and third phases of the study were baseline conditions during which Melanie interacted in her structured classroom environment as was typical for her schedule. This included walking into the classroom, hang'rag up her backpack, reviewing her daily schedule, eating breakfast, checking her schedule, going to the rest-room, rechecking her schedule, and participating in calendar time. During the intervention phases, Melanie's schedule remained the same, while the entrainment music played on the tape recorder for 20 minutes. The volume was set on 3, with the loudest setting of 10 and the quietest setting of 0. Data collection stopped when Melanie left the classroom (i.e., to use the bathroom) and resumed when she returned. Music ceased to play after 20 minutes of data collection. Data were collected by both the first author and the classroom paraprofessional on the frequency of head jerking and screaming each morning for 20 consecutive minutes during the class opening session. Before data collection on head jerking and screaming began, the behaviors were operationally defined and interrater reliability was achieved between the first author and the classroom paraprofessional with 100% accuracy over five sessions.