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Music Therapy and Music-based Instruction

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by Bridget Kulik, MA, MT-BC
Autism Asperger’s Digest | November/December 2011

Music, Music Therapy, and Autism
Music is everywhere. From home to work to school, there is no escaping it.  I distinctly remember an assignment in one of my undergraduate music courses where I had to avoid listening to any kind of music in my environment for an entire day.  It was virtually impossible!  For me, music is an essential component to not only my personal life (I enjoy playing the piano), but my professional life as well.

I am currently employed as a full-time Neurologic Music Therapist at a therapeutic day school for ages 5–21 with an Autism Spectrum Disorder (ASD) diagnosis.  Neurologic Music Therapy (NMT) uses standardized treatment techniques based on scientific research of music and the brain. NMT is defined as “the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurologic disease of the human nervous system” (Thaut 2005, p. 126). I have the unique opportunity and privilege of being able to witness the power of music firsthand on a daily basis.  When I am asked about my profession, I am proud to say that I am a music therapist.  “You’re a what?!” is often the most common response, followed by “Oh, so you sing for kids all day long and teach them how to play musical instruments?”  The answer to these questions is not a simple “yes” or “no.”

For individuals with ASD, music can be quite motivating because it provides a sense of structure in an otherwise unpredictable, chaotic world.  Every song has a definite beginning, middle, and end.  Research indicates that the entire brain is activated while engaging in musical experiences.  According to the American Music Therapy Association (AMTA), “Music therapy is the clinical and evidence-based use of musical interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional (2006, p. 1).”  Music therapy is one of the only therapeutic modalities that achieves whole-brain activation, thus allowing an opportunity for “both hemispheres of the brain to work together” (AMTA 2006, p. 2).  In short music therapy addresses non-musical goals through musical interventions.  Music therapy has a specific therapeutic purpose and is focused on the process—how one person gets from one point to another.
In contrast music education emphasizes the product—the final outcome such as a concert or musical performance (West Music Company 2011).

Music therapy services at our therapeutic day school are considered a related service, meaning that it is part of each student’s individualized education plan (IEP).  Students typically receive 90 minutes of music therapy services per week (two separate sessions) administered either in a small group or classroom setting.  IEP goals and objectives are targeted during the music therapy sessions.  Commonly addressed goal areas include socialization, communication, starting/stopping, sequencing, and imitation.

Music therapy socialization goals involve cooperative play (sharing a musical instrument with a peer or adult and/or tolerating someone else in his or her space) and reciprocal play (back-and-forth turn taking on a musical instrument).  Communication goals are both receptive (answering questions through song as well as following 1-step and 2-step verbal directives) and expressive (requesting musical wants and needs either verbally, with sign, with a picture exchange communication system [PECS], or using an augmentative and alternative communication system [AAC]).  Starting/stopping goals include starting and stopping musical instrument play, gross-motor movements, or verbalizations when musically cued to do so, leading to individual self-regulation.  Sequencing goals involve referencing a visual support to complete presented tasks.  Imitation goals cover vocal imitation (even for students who are not verbal, this provides an opportunity for them to explore and imitate phonemes such as ahh, and ooo), gross-motor imitation (e.g., clap hands, stomp feet), and fine-motor imitation (e.g., wiggling fingers, finger isolation).  The ultimate goal for music therapy is generalization of learned skills to other environments.

Music Therapy and Co-Treatments
Throughout the course of the past school year, I have had the opportunity to co-treat with two of my colleagues during the week.  One co-treated session is a music therapy and social work group; the other session is a music therapy and occupational therapy (OT) group.  The music therapy/social work co-treat focuses primarily on the initiation of greetings, turn taking (reciprocal and cooperative), and choice making (answering “wh” questions) through familiar games and activities.  The session consists of two students, the social worker, and the music therapist, along with paraprofessionals.  The opportunity to co-treat allows me to see my students outside the context of the music therapy room and observe strategies and techniques from the social worker, which I can implement into my music therapy sessions.  She, in turn, is able to observe how music could be incorporated into her social work sessions.

The music therapy/OT co-treated session focuses primarily on sensory needs, crossing the midline, and activities of daily living.  The session consists of two students, the OT, and the music therapist, along with paraprofessionals.  Music therapy is a “multisensory approach” (AMTA 2006, p. 2) where the co-treated session provides a perfect opportunity for students to practice engaging in a variety of sensory techniques.  The session often begins with vestibular input, with the students bouncing on the large exercise balls to attain and maintain a regulated state of arousal.  They then identify whether to bounce fast or slow when provided with visual supports.  A proprioceptive input activity follows, such as an obstacle course, where the students are crawling, wheelbarrow walking, and/or lying on their stomach on a scooter board.  Students then participate in a gross-motor movement intervention such as dancing or seated movement.  Finally, there is fine-motor musical instrument play involving finger isolation (e.g., playing with index fingers on a drum).  It is not uncommon for the music therapy/OT session to also focus on auditory (identifying instruments by listening), visual (playing clear rain sticks and watching the beads pass through), and vibrotacile (placing their hands on top of the drum or their feet on top of the tone bar to feel the vibrations) input.

Crossing the midline is often difficult for many students due to low core strength.  This is often targeted during the music therapy/OT session through musical instrument play involving paddle drums and tambourines.  The students alternate their hands to cross the midline while entraining (playing in sync with another person) to the presented beat.  Activities of daily living, such as shoe tying and tooth brushing, are commonly addressed.

Music-based Instruction
Music is not just relegated to therapy sessions; techniques are practiced in the classroom as well. Successful transitioning and navigating of one’s environment during the school day can be tricky.  For the students who have a difficult time transitioning from one room to another or one task to another, rhythmic input has proven to help.  Rhythmic input can be as simple as clapping your hands or tapping your leg to establish a consistent beat.  I have a student who would often drop to the floor during a transition.  Attempts at redirection were unsuccessful.  One particular day, he began to hum the words to the “ABC” song while lying on the floor.  I slowly began to match the rhythm of his singing by tapping my lap.  Once he established eye contact with me, I sang the directives to him while continuing to tap my lap with the beat he provided when singing.  He gradually began to sit up and ready his body for the upcoming transition.  On that particular day I had a metronome (a small battery-operated device that keeps a consistent beat) with me and set the beat to the tempo he provided.  With the metronome supplying a consistent rhythm, he was able to successfully walk to his next class without protest.

I also have students use MP3 players and iPods with preselected music during transitions.  One student uses a transition song throughout his school day.  When he hears the melody, he knows that it is time to move from one task to another.

Music at Home
The home-to-school connection is crucial to a student’s success. The parents whom I work with are eager for tips and techniques to implement at home. This may include ideas for adding music to familiar routines such as dinner or bath time.  The song does not have to be the next symphony.  In fact, the shorter and simpler the tune, the more likely it will be that your child will retain the information.

Using music to teach routines at home can be as simple as A, B, C! A) Think of a familiar routine at home that your child is currently having difficulty completing and select a familiar song such as “Twinkle Twinkle Little Star,” “The Farmer in the Dell,” or “Bingo.”  B) Break the routine into steps.  For example, 1) Take out your toothbrush. 2) Get your toothbrush wet, etc. C) Apply the song to the steps of the routine and start singing it each time you complete the routine with your child.  You can experience the power of music with your child.  It is quite amazing!

References
American Music Therapy Association (AMTA). 2006. Accessed September 2. Music Therapy and Individuals with Diagnoses on the Autism Spectrum.

Thaut, M. H. 2005. Rhythm, Music, and the Brain. London: Taylor and Francis.

West Music Company. 2011. Accessed September 2. What Is Music Therapy?

Music Therapy Websites American Music Therapy Association: musictherapy.org

The Center for Biomedical Research in Music (Neurologic Music Therapy): www.colostate.edu/depts/cbrm/
Bridget Kulik, MA, MT-BC, is a Neurologic Music Therapist at Giant Steps in Lisle, Illinois.  She can be contacted at bkulik@mygiantsteps.org.

Copyright © Autism Asperger’s Digest. 2012. All Rights Reserved. Distribution via print is prohibited without written permission of publisher.


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