1. The Effectiveness of Music Therapy in Children with Autism
Allison Cavallo
Char-Len Gorski

2. Definitions of Music Therapy:
The application of music to enhance a person’s communication skills.
A clinical treatment that utilizes brain function, adaptation, sensory systems, audition, music elements and personal interaction to encourage social, cognitive and perceptual-motor areas (Berger, 2002).
Hard to define!

3. Is It a Clinical Treatment?
The use of music as a therapeutic tool for the restoration, maintenance and improvement of psychological, mental and physiological health and for the rehabilitation and maintenance of behavioral, developmental, physical and social skills (Boxhill, 1985).

4. Is It a Form of Communication?
Music therapy is an effective form of nonverbal communication
It opens pathways for expression and learning.
It encourages one to explore a wider range of emotions and often leads to self-awareness.
Alvin & Warwick, 1992
Awakened awareness
Mobilized energy and inner resources

5. Is It A Science?
“As a science, it uses the application of established methods…it explores, investigates and discovers techniques that work and don’t work…”
“Data offers guidelines for theory, practice and research…” (Boxhill, 1985)
Piaget and his theroies of cognitive development
Erikson and basic trust, autonomy and socialization

6. Is It a Healing Art?
Those interested in exploring music therapy as a healing art are concerned with the creation of a medical database that will provide information about research and clinical practice (Rebollo-Pratt (Ed.), 1993).
Interdisciplinary team approach was discussed…psychiatrists, clinicians, educators and government officials used to develop fund and conduct research studies and explore more options and research outcomes.

7. Difficult to Define…
Whether music therapy is considered a healing art, a clinical treatment or a science, the literature agrees that there is a connection to music and a person’s sensory system.
Music does not require coding or decoding in the brain to be understood
Music evokes bodily and emotional sensations

8. Before We Get Started…A Brief History
The first academic program to train music therapists was instituted at Michigan State University in 1944.
In 1950, a group of psychiatrists, professional musicians and educators formed the National Association for Music Therapy.
By 1953, specific education and clinical training requirements led to a baccalaureate degree and registration as a music therapist.
In 1973, the American Association for Music Therapy was formed.

9. American Music Therapy Association
The American Music Therapy Association, Inc.  The American Music Therapy Association was founded in 1998 as a union of the American Association for Music Therapy and the National Association for Music Therapy.
Its purpose is to support the therapeutic use of music in hospital, educational, and community settings.
Currently, AMTA establishes criteria for academic programs in colleges and universities, clinical training sites, and professional registration of music therapists.
Members of AMTA adhere to a strict Code of Ethics and Standards of Practice that govern the clinical practice of music therapy. Through the Journal of Music Therapy and Music Therapy Perspectives, as well as other publications offered by AMTA, research findings and clinical studies relevant to the practice of music therapy are shared with interested professionals. (

10. Sensory Integration
Sensory Integration is the system’s way of taking in and organizing bits of uncoordinated sensory input (Berger, 2002).
The spinal cord, the brain stem, the organs in the paleoencephalon and the neo-cortex are responsible for encoding, decoding and using sensory input to interpret conditions (Berger, 2002).
We know there will be a whole presentation on this later but we would be remiss not touch upon it in one slide…b/c this approach it not behavioral this is their means of teaching and treating a disabled child….In the next slide you’ll see that…

11. A Connection
Music Therapy attempts to address the way in which sensory information is processed, coded and interpreted by the brain (Berger, 2002).

12. Music Therapy and Sensory Integration
By using music and music-related activities, music therapy teaches the brain system to “adapt” (or repattern brain circuits) and employ new and more functionally accommodating interpretations of sensory stimuli (Berger, 2002).

13. How Music Is Heard Audition is the act of hearing.
It involves auditory scanning, auditory tracking and auditory discrimination.
Auditory scanning occurs when sound is held long enough in short term memory for the brain to reference it. It anticipates the next sound event.
Back track a little…very basic terms

14. Music Heard cont’
Auditory tracking involves the ability to accurately follow a presented sequence.
Auditory discrimination is the ability to distinguish between frequencies and recall the exact sequence of auditory information that was presented.

15. Auditory Integration
Auditory Integration is most often used in connection with autism, language delays and learning disabilities.
It refers to the brain’s ability to decode, encode, organize and interpret all aspects of incoming sound frequencies in a synchronized and comfortable manner.
Most music therapy strategies are geared to adapting, improving a childs skills by focusing on their auditory integration deficts

16. The 6 Elements of Music
Rhythm- involves the pulse, pattern, repetition and tempo of music
Melody-it requires temporal tracking of the relationship between one pitch and another so it becomes recognizable
Harmony-provides, depth, texture, mood and feelings to statements
Melody has emotion and remnants of human calling and it reinforces melody

17. Elements Cont’
Timbre-is the quality of sound emitted from a voice or instrument
Dynamics is akin to the energy level of music
Form- is the beginning-middle-end of a tune or song; it creates anticipation until the information is concluded.
Timbre employs dimensional hearing…it is the difference b/w a human whistle and a bird call.
Form is important to m therapists b/c it is a behavior modification aspects of the musical interaction--testing the ability of a person to stay on task to the end.

18. Aspects of Music Therapy Treatment
Musical and non-musical stimuli are presented at a slower than average rate and in smaller quantities.
Frequent and exact repetitions are used, as are gestural, physical and verbal assistance and prompts.
Verbal communication must be adjusted to the clients’ cognitive functioning.

19. Goals of Music Therapy
Music Therapy treatments for people with autism address:
Motor planning, tactile defensiveness, auditory function, audio-visual coordination, physical coordination,communication and language.
Berger, 2002

20. Goals cont’
Incorporated into and resulting from that, also addressed is:
Creativity, social interaction, sense of self and others, self-initiative and body pacing and self-organization.
Berger, 2002

21. Strategies and Techniques
Use of music that is familiar to a person or group
Exact repetition of rhythmic patterns or words
Lining-out singing--filling in isolated words, last words or phrases
Call and response singing
Use of instruments
Humming

22. Strategies cont’
Onomatopoeic and action words sung or chanted with appropriate movements
Pacing and tempo adjustments of activities and musical stimuli
Expressive and exaggerated modeling of bodily movements
Use of repeated verse, chorus’ and refrains for memory, recall retention and word retrieval
Stressing and accenting of words and syllables to imitate natural inflections and cadences in speech

23. Strategies cont’
Use of nonmusical materials such as flashcards, mirrors, puppets, scarves, balls and costumes for added stimulation and comprehension.
Use of manual signs for start, stop, play, wait with simultaneous singing, chanting or verbalization.

24. Modes of Therapeutic Music Activity
Singing/Chanting
Instrument Playing
Music Movement

25. Singing and Chanting
It is considered a means of communication and contact that stimulates awareness of self and others
Singing “mobilizes energy” and is a “means of focus that create feelings of wholeness” (Boxhill, 1985)

26. Instrument Playing
“It is a nonverbal means of communication that allows students to speak to one another with meaning of their own…they create musical dialogues” (Boxhill, 1985)

27. Movement
Music improves a student’s motor planning and coordination by addressing:
Balance, agility, flexibility, strength, laterality (directionality)(Boxhill, 1985)
Balance-static and dynamic directionality-left and right
Agility-using body parts quickly and accurately
Strength-lifting, pushing, pulling, gripping

28. Recommended Frequency
Generally, a minimum of 2 1/2 hours per week, continuing through a child’s formative years.
It is preferable that the time is spread between several therapy contacts over the week…Three or four 30-minute or 45-minute sessions can provide consistent treatment (Berger, 2002).
Frequent short sessions are better because the body tends to shut down when receiving too much sensory input

29. Auditory Integration Therapy
It is an approach developed by a French physician Guy Berard.
It based on a theory that autism is caused by auditory perception deficits that distort sound or produce sound hypersensitivity.
Class notes July 2005
Chapter 22 in our Jacobson book

30. The Treatment
It is a procedure that utilizes acoustically modified music. This music is played from a device called a Audiokinetron.
Modulation involves the random use of frequencies above or below 1000 HZ for different lengths of time.
Filtering entails the reduction of volume for frequencies at which the student is especially sensitive.
Mudford & Cullen, 2005

31. Treatment cont’
Audiological testing is used to determine hearing sensitivity (hyperacruity).
Two 30-minute sessions several hours apart are conducted for 10 days in a row.
Commercial popular music with wide range frequency is used.
Mudford & Cullen, 2005

32. Concerns
“It should be emphasized that no peer-reviewed scientific studies of the effects of AIT on persons with these disorders were located (Mudford & Cullen, 2005).
The FDA banned the importation of the Electric Ear and any other AIT device made by Tomatis International (class notes).

33. Concerns cont’
According to the Association for Science in Autism Treatment, “AIT is not yet objectively substantiated as effective subject to the rigors of good science.”
According to the NY State Dept of Health Early Intervention Guidelines, “a recent controlled study found no benefit of AIT and poorer scores on social and adaptive scores and expressive language scores after AIT.”

34. How Music Therapy Affects Children with Autism
According to Thaut (1984), Music Therapy:
Facilitates and supports the desire to communicate,
Breaks patterns of isolation and engages the learner in external experiences
Reduces echolalic responses
Decreases stereotypes patterns
Teaches social skills
Facilitates increased language comprehension

35. A Career in Music Therapy
  A Career in Music Therapy offers challenge, opportunity, and distinctive rewards to those interested in working with people of all ages with various disabilities.
Music therapists are employed in many different settings including general and psychiatric hospitals, community mental health agencies, rehabilitation centers, day care facilities, nursing homes, schools and private practice.
Music therapists provide services for adults & children with psychiatric disorders, mental retardation and developmental disabilities, speech and hearing impairments, physical disabilities, and neurological impairments, among others.
Music therapists are usually members of an interdisciplinary team who support the goals and objectives for each client within the context of the music therapy setting. (

36. Personal Qualifications
Personal Qualifications of a Music Therapist include a genuine interest in people and a desire to help others empower themselves.
The essence of music therapy practice involves establishing caring and professional relationships with people of all ages and abilities. Empathy, patience, creativity, imagination, an openness to new ideas, and understanding of oneself are also important attributes.
Because music therapists are musicians as well as therapists, a background in and love of music are also essential.
Individuals considering a career in music therapy are advised to gain experience through volunteer opportunities or summer work in nursing homes, camps for children with disabilities, and other settings which serve the needs of people with disabilities (

37. The Approved Curriculum
The Approved Curriculum for the baccalaureate degree in music therapy includes coursework in music therapy, psychology, music, biological, social and behavioral sciences, disabling conditions and general studies.
The undergraduate curriculum includes practical application of music therapy procedures and techniques learned in the classroom through required field work in facilities serving individuals with special needs in the community and/or on-campus clinics.
Students learn to assess the needs of their clients, develop and implement treatment plans germane to those needs, and evaluate and document clinical changes. (

38. The Education of a Music Therapist
The Education of a Music Therapist is unique among college degree programs because it not only allows a through study of music, but encourages examination of one's self as well as others.
The undergraduate curriculum includes coursework in music therapy, psychology, music, biological, social and behavioral sciences, disabilities and general studies.
Entry level study includes practical application of music therapy procedures and techniques learned in the classroom through required fieldwork in facilities serving individuals with disabilities in the community and/or on-campus clinics.
Students learn to assess the needs of clients, develop and implement treatment plans, and evaluate and document clinical changes.
At the completion of AMTA-approved academic training and internship, the student is eligible for admission to the certification exam administered by the Certification Board for Music Therapists, Inc.
Upon passing the national examination administered by the CBMT, the student acquires the credential Music Therapist-Board Certified (MT-BC). Coursework requirements vary. (depends on the educational institution)

39. Education( continued)
Individuals who have earned a baccalaureate degree in an area other than music therapy may elect to complete the degree equivalency program in music therapy offered by most AMTA-approved universities. Under this program, the student completes only the required coursework without necessarily earning a second baccalaureate degree.
Graduate programs in music therapy examine; issues relevant to the clinical, professional, and academic preparation of music therapists, usually in combination with established methods of research inquiry. Candidates for the master's degree in music therapy must hold a baccalaureate degree.
Some schools require either a bachelors degree in music therapy, the equivalency in music therapy, or that the candidate be working concurrently toward fulfilling degree equivalency requirements. Students must contact individual universities for details on pre-registration and entry requirements.
Although there is no AMTA-approved doctoral degree in music therapy per se, selected universities do offer coursework in music therapy in combination with doctoral study in related academic areas (

40. Employment Opportunities
Opportunities for Employment are available to the Music Therapist, not only in traditional clinical settings. These agencies are not only serving individuals with emotional, developmental, or physical disabilities, but in new and expanding areas of health care delivery.
Examples of the numerous options are: hospice care, substance abuse programs, oncology treatment centers, pain/stress management clinics, and correctional settings.
Additionally, many music therapists work in special education settings where they provide either direct services to students with disabilities or function as consultants for music educators and special educators. A recent hearing before the U.S. Senate's Special Committee on Aging and the subsequent passage of the Older Americans Act of 1992 have increased the recognition of music therapy's value, as well as employment opportunities. (

41. Proposed IDEA Part C Regulations
The Office of Special Education and Rehabilitative Services (OSERS) in the U.S. Department of Education recently published proposed regulations for the Early Intervention Program for Infants and Toddlers with Disabilities.
These proposed regulations would implement changes made to Part C of the Individuals with Disabilities Education Act (IDEA) by the Individuals with Disabilities Education Improvement Act of 2004 (

42. Proposed action( cont.)
Several years of advocacy have been directed toward recognition of music therapy as an early intervention service under IDEA.  
This call-to-action provides music therapists, parents, and colleagues another opportunity to influence this legislation by providing comments on the proposed IDEA Part C regulations.  
Once these regulations are completed, they will be utilized by schools to assist them in implementing the special education law.  U.S. Department of Education staff has indicated a need to hear comments from parents as well as clinicians, so AMTA encourages individuals to solicit participation from families, co-workers, and administrators if possible.
Comments are to be submitted through the Federal eRulemaking Portal.  
• Federal eRulemaking Portal: Go to (

43. Research Studies in Music Therapy
Impact of Music Therapy on the Communication Skills of Toddlers with Pervasive Development Disorder
(Yeou-Cheng M. MA, Joseph Nagler, Matthew H. M. Lee and Izumi N. Cabrera) (Annals of the New York Academy of Sciences 930: ,2001)
Introduction
The above individuals sought to evaluate the effect of music therapy sessions in a group setting on the communication skills in developmentally delayed children

44. Methodology
19 Preschool aged Children(18-48months) enrolled in Early Intervention at Mt. Sinai NYU/Rusk Institute Preschool and Infant Development Program invited to participate in the study
Only 6 met criteria: (1) Diagnosis PDD,(2) significant speech and communication delays,(3) ability to participate in at least four of the six sessions study
Data were collected through the use of Rosetti Speech and Language Scale, a music therapy rating scale, and panel analysis of videotapes of each session.
Six music therapy playgroup sessions were performed over a 3 week period and were incorporated into a preexisting school schedule.
At the time of the study the average chronological age was 35.3 months, with a range of months. Rating scales of the Southern California Ordinal Scales of Development indicated developmental presentations averaging 17.9 months with a range of months.

45. Methodology(cont.)
6 children attended at least 4 of the 6 sessions.(30 min interactive playgroup)
Each session included a series of 8 songs with a specific purpose and intent. Examples of songs; Greeting song, I’m in the Mood for, Fingers in the Air, Beat the Drum, Bells, This is the Way, Five Little Ducks, Good-Bye Song)
Intent of songs were to establish eye contact and set tone for opening sessions, stimulate gross motor activity while identifying receptive language abilities, to gauge the interactive stimulus of activity when combined with instruments, determine how the children would communicate through getural prompting, monitor the presence of number concepts, foster greater impulse control, display fine motor abilities, monitor each child’s response to and communication directions, stimulate sign language, modeling of mood states, and transitional pieces.
Evaluations were made using a rating scale derived from the Rosetti Scale System. The following Four categories containing a total of 24 pts.:motoric/gestural language,abilitiescreating uniformity, expressive language, receptive language.

46. Results
Indicated (while preliminary), increased communication skills through child centered therapeutic musical activities
Findings indicate that children exposed to early intervention through music therapy display enhanced communication skills.
These increased communication skills were found to allow the opportunity for individuation from care providers. These responses include both musical and verbal responses to different musical play songs and activities.
The musical activities that provided both verbal prompting with tactile musical stimulation facilitated the greatest level of response from all subjects. The song activities that relied solely on verbal cueing received the poorest responses.
Music therapy sessions in a group setting provided an opportunity for individual interaction between child and care provider.
Interactive music activities with music selection tailored to the unique abilities of the children (with respect to harmony, melody, and timbre of instruments) produced better results than did singing alone.

47. Conclusions
In examining musical activities with different instruments, those involving vibration and tactile senses elicited the strongest response from children with PDD and developmental delays.
Mastery Rates of goals in the four categories ranged from 13-38%, suggesting the need for continued intervention.
Other aspects such as song order, population selection, length of study, and variables of therapy environment warrant further investigation.

48. Musical Processing in High Functioning Children in Autism
(P. Heaton, L. Pring,and B. Hermelin)
Introduction
The weak central coherence (WCC) theory of autism proposes that autism is characterized by a cognitive style that biases processing towards local features at the expense of global, context-dependent meaning.
However, some autistic individuals show exceptional abilities in music.
Musical autistic children all have pitch ability and in addition demonstrate detailed knowledge about key relationships in their improvisations and memory reproductions.
In order to explore the link between autistic cognition and musical ability, a series of experiments with musically naïve autistic children and intelligence, and age-matched normal controls were carried out.

49. Methodology Two investigations
First investigation: subjects exposed to musical tones that were presented in conjunction with animal pictures. After completion of these familiarized trials, the preexposed tones were presented in randomized order. Subjects were then asked to point to animals which they had previously paired.
The findings had again shown that the children with autism were able to pair animals and tones to a significantly higher level than controls
Thus the second investigation

50. The Second Experiment. Heaton Pring, B. Hermelin)
Experiment children were presented with 48 melodic pitch intervals and were asked to judge whether they moved up or down.
Results shown that children with autism demonstrated equally high levels of performance with small(1-4 semitones)
Medium(5-8 semitones) and large(9-12 semitones) intervals where as the controls could only achieve such good performance with medium and large intervals.

51. Results
The results shown from the first study that half the children with autism were able to identify 75% of the missing animals/tone pairs.
The second chord experiment ,the children were pre exposed to any individual tones and no paired associate stimuli were provided.
In this study no significant difference between the performance of autistic children and the controls were found.
Conclusions
Overall the findings from these studies suggest that the information processing style characteristic of those with autism conveys some advantage and no disadvantage when processing musical stimuli.
This might explain why music within the autistic ability flourishes.

52. The Musical Therapists Code of Ethics( American Music Therapy Association Inc.)
2.0 General Standards
2.1 The MT will strive for the highest standards in his/her work, offering the highest quality of services to clients/students.
2.2 The MT will use procedures that conform with his/her interpretation of the Standards of Clinical Practice of the American Music Therapy Association, Inc.
2.3 Moral and Legal Standards
2.3.1 The MT respects the social and moral expectations of the community in which he/she works. The MT is aware that standards of behavior are a personal matter as they are for other citizens, except as they may concern the fulfillment of professional duties or influence the public attitude and trust towards the profession.
2.3.2 The MT refuses to participate in activities that are illegal or inhumane, that violate the civil rights of others, or that discriminate against individuals based upon race, ethnicity, language, religion, marital status, gender, sexual orientation, age, ability, socioeconomic status, or political affiliation. In addition, the MT works to eliminate the effect on his or her work of biases based upon these factors

53. General ethic standards continued
3.0 Relationships with Clients/Students/Research Subjects
3.1 The welfare of the client will be of utmost importance to the MT.
3.2 The MT will protect the rights of the individuals with whom he/she works. These rights will include, but are not limited to the following:
- right to safety;
- right to dignity;
- legal and civil rights;
- right to treatment;
- right to self-determination;
- right to respect; and
- right to participate in treatment decisions.

54. Relationships with clients cont.
3.3 The MT will not discriminate in relationships with clients/students/research subjects because of race, ethnicity, language, religion, marital status, gender, sexual orientation, age, ability, socioeconomic status or political affiliation.
3.4 The MT will not exploit clients/students/research subjects sexually, physically, financially or emotionally.
3.5 The MT will not enter into dual relationships with clients/students/research subjects and will avoid those situations that interfere with professional judgment or objectivity (e.g., those involving competitive and/or conflicting interests) in their relationships.
3.6 The MT will exert caution in predicting the results of services offered, although a reasonable statement of prognosis and/or progress may be made. The MT will make only those claims to clients concerning the efficacy of services that would be willingly submitted for professional scrutiny through peer review, publication in a professional journal, or documentation in the client's record.

55. 3.7 The MT will offer music therapy services only in the context of a professional relationship and in a setting which insures safety and protection for both client and therapist. The MT will avoid deception in representations of music therapy to the public.
3.8 The MT will inform the client and/or guardian as to the purpose, nature, and effects of assessment and treatment.
3.9 The MT will use every available resource to serve the client best.
3.10 The MT will utilize the profession's Standards of Practice as a guideline in accepting or declining referrals or requests for services, as well as in terminating or referring clients when the client no longer benefits from the therapeutic relationship.
3.11 In those emerging areas of practice for which generally recognized standards are not yet defined, the MT will nevertheless utilize cautious judgment and will take reasonable steps to ensure the competence of his/her work, as well as to protect clients, students, and research subjects from harm.
3.12 Confidentiality

56. References
Rebollo-Pratt, R. (Ed.) (1993). Music therapy and music education for the handicapped: Developments and limitations in practice and research. Library of Congress Cataloging-In-Publication Data.
Mudford, O. C., & Cullen, C. (2005). Auditory integration therapy. In Jacobson, J. W., Foxx, R. M., & Mulick J. A. (Eds.) Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice (pp ). Mahwah, NJ: Lawrence Erlbaum Associates.

57. References
Alvin, J., & Warwick, A. (1992). Music therapy for the autistic child. New York, New York: Oxford University Press
Berger, D. (2002). Music therapy, sensory integration and the autistic child. London, England: Jessica Kingsley Publishers.
Boxhill, E. (1985). Music therapy for the developmentally disabled. Austin, Texas: PRO-ED.

58. References
The Biological Foundations of Music copyright 2001, Annuals of the New York Academy of Sciences 930: (2001)
The Biological Foundations of Music copywriter 2001, Annuals of the New York Academy of Sciences 930: (2001)