Music Therapy for Children with Autism - Term Paper Example

Music Therapy for Children with Autism Introduction Music therapy is a technique and practice which applies and researches the use of music in all ofits forms to aid and coax the improvement of psychological as well as physical health. It has been used in the treatment of a number of psychological and physical disabilities including strokes, autism, Alzheimer’s and coma patients. Dating back to before the 17th century, its importance had been recognised in the treatment of mental illness (Burton, 1682). Indeed, many studies have shown that “the brain that engages in music is changed by engaging in music” (Thaut, 2008. p. 475). In everyday life, we hear of a troubled or sad individual who may listen to music, or a certain song, to ‘lift the spirits’, and there has much clinical research to support the link between music therapy and decreased depression and reduced anxiety (Nayak et al, 2000). However, music therapy is not confined to simply ‘listening’, although this is of course a major aspect; the expression of patients through the use of instruments and thus the creation of music has also been part of therapy sessions. This appears to be especially so for children who may often experience greater problems in self-expression than older patients; treatment given to a young boy suffering with psychotic disorder showed signs of immediate relief simply through the act of expressing his aggression through the use of instruments (D’ulisse et al, 1998). Although music therapy is used in the treatment of several disorders, this paper will focus on the use of music therapy to treat the autistic. Autism According to the work of Benenzon, 1996 those diagnosed with autism display behaviour patterns characteristic of the intra-uterine phase after birth. Such behavioural traits consist of isolation, pleasure experienced upon contact with water, tendency to go into the foetal position, and a perception of time based in their own personal psycho-biological rhythms. Those with autism also experience intense communicational problems, causing the child to become rigidly contained in his/her own pseudo-protective shell. This causes problems in respect of the parent-child relationship; indeed mothers of autistic children find it difficult to respond to the ‘unavailability’ of their child and become “directive in their speech, attempting to initiate cooperation even when the child is unresponsive, a strategy which is often counterproductive” (Papoudi, 1999 p. 134). Treatment Music therapy can take a number of different forms, depending on the patient, the settings, and what form of music therapy treatment the patient appears to respond to the most positively. The general process is that the patient is accompanied by a trained music therapist and is placed in a room with musical instruments. The setting is generally non-verbal, which will be further explained below. The patient is encouraged to express him/herself through the use of musical instruments, bodily movement in response to music and other such practices. The idea behind this treatment is that a form of communication other than verbal is utilised, so that the therapist may connect with the child through the music and establish a level-ground of understanding with the child. Indeed, music is an extremely expressive form of art, and even without lyrics can evoke and portray certain emotions, moods and occurrences. Thus, a child who is not able to communicate verbally is not missing the ability to communicate entirely, merely the ability to communicate verbally and on a generally social level. This serves to isolate the child, and prevents an understanding on any level of the child and of the child’s understanding of his/her surroundings. Music therapy seeks to extricate this inability to communicate, and the child is likely to be able to express himself through the use of instruments, as well as connecting with the therapist who will use the instruments in his/her presence. The form of music therapy developed by Nordoff/Robbins, 1986 seeks to aid patients in discovering their individual perception and performance, by way of the therapist locating the music of the patient. This technique encourages expression which is likely to have been restricted or underdeveloped due to the disorder – indeed, in autistic patients the level of expression is often severely restricted. The therapist embarks upon a musical dialogue in which the encouragement of the patient is attempted, either by improvisation or the mirroring of the patient’s musical expression, labelled “..not so much scientific method but rather practical human work” (Schmid-Degenhard 1994). The joint participation between the patient and the therapist creates a sense of communication, allowing the patient to express without the need to utilise it in verbal form. This connection between patient and therapist allows for the former to experience empathy, to emerge from their isolation. Furthermore, the patient is not only able to communicate with the therapist, but also to himself: by hearing his own music he can perceive himself and his own creation and expressions. In most cases, the first step (a) is an unconscious testing of the instrument, followed by (b) active exploration of what is possible, and perception of the qualities and abilities of the instrument and the music he is creating (c), the patient then enters into a dialogue with the material (d). The last step often consists of perception and performance, giving and taking in a figurative sense, and resembles a dialogue. The presence and the actions of the therapist encourages the patient to interact with the instruments whilst also leaving room for independent actions and thus music creation. Communication and a Non-Verbal Setting The general trend in music therapy that a non-verbal setting be used during sessions forms a strong basis upon which one may approach and understand this form of treatment. The very fact that autistic children find communication in a verbal manner extremely difficult allows for the music therapy to provide an alternative manner by which they can communicate. A study by D’ulisse et al, 1999 showed that by allowing F to communicate to the therapists through the piano and water clocks in a non verbal setting, his interaction with both the therapists and his parents greatly increased. He expressed the music and his self through imitation of sounds both vocally and bodily. This reduced the rigidity of his bodily movements and he was able to play the piano to evoke the movement of water. Thus it was held that “the use of non-verbal communication enables patients to increase their interaction with the surroundings and with the musical instruments, also modifying their body movements” (D’ulisse et al, 1999 p. 62). By providing an alternative mode to communication, the child responded quickly and in an extremely positive manner, resulting in highly increased communication with both the therapists and the parents of the child. However, non-verbal communication is not restricted to music which raises questions as to the use of other forms of non-verbal communication. Does this limit the use of music therapy as one of many alternatives to verbal communication, or can a relationship be established between music and communication which makes it effective as a means of treatment? This issue was recognised by Raglio, 1996 who sought “to establish a comparison between Music Therapy and other techniques of non-verbal communication by emphasizing the specific use of the sound-music element in the music - therapeutic context” (Raglio, 1996 p. 139). He put forth the assumption that the non-invasive presence of a therapist allows the musical instruments to be used as an intermediary form of communication, and that this is a fundamental aspect of music therapy. His conducted study showed an increase in replies and communication in music therapy sessions in comparison to control sessions with sound and objects. A massive increase in movement was also recorded in patients undergoing music therapy. Although Raglio recognised that research in the area of music therapy is overlapping and confusingly influenced by several factors, he encouraged that ongoing study and experimentation would help to improve and develop this area of therapy. It can be suggested with some strength that the use of music therapy in the area of autism is focused, although not confined to the alternative method of communication for children who find it challenging to socially communicate with those around them. In such cases, Wimpory et al call the treatment Musical Interaction Therapy which “uniquely synchronises live music to adult-child interactions” (1995, pp. 541-552). Yet, not only does it aid the communication of a child, it has also been shown to aid development. A study by Aldridge et al showed significant levels of development in children undergoing music therapy, particularly in the area of hand-eye coordination: “clearly the activity of listening, in a structured musical improvisational context without the lexical demands of language, is a platform for communicational improvement” (Aldridge et al, 1995 p.203). Research and Problems Pavlicevic, 1987 conducted studies in order to understand the ‘inter-musical processes’ during treatment between the therapist and the patient. She formulated the theory that music therapy was a form of treatment allowing music and emotion to merge in the communicational process, formulating a Musical Interactive Rating between the patient and the therapist in order to analyse data and levels of interaction. Strong implications were found in her results that showed musical improvisation to be a highly effective form of expression of emotion through music and thus aide the development of communication, indeed her work added ‘valuable weight to the body of evidence that music therapy has a measurable influence and effect’ (Wigram, 1993 p.142). Additionally, Müller, 1994 investigated the effects of music therapy on the bonding of mothers with their autistic children. She was able to obtain detailed information on the patterns of interactions between autistic children and their mothers and thus encode them (Muller, 1993). Such research has profound effects on the development and knowledge in the field of music therapy, and can overcome such problems as have been highlighted below. Indeed, Muller’s work drove forward the understanding of mother-child relationships in autistic children, and potentially eroded this as a problem of mothers with children suffering autism. Such research allows therapists to understand how, and in what form to administer music therapy in a manner that is most effective and positive on the child’s relationship with those around him/her. Considering that music therapy research and treatment is highly based upon the response of the patient, this had considerable breakthroughs for autistic patients, who are generally unresponsive and passive. Evaluation of music therapy is still very weak in studies and literature; most information available is related to the assessments of patients during treatment sessions. This has the disadvantage that sessions are varied depending on the patient and the disorder treated, the settings used and the particular therapist conducting the therapy. Because literature in this area is still premature, no specific set of criteria has been developed, and thus any evaluations of treatment are difficult to correlate. Furthermore, evaluation in this field of treatment is not limited only to the evaluation of patients; techniques, procedures, effectiveness, settings and so on play an important role, yet serve to further complicate findings in this area (Sabbatella, 1999). Furthermore, research conducted differs drastically depending on the culture and in which country the therapy has been administered; development is thus unequal across the globe. Indeed, a major problem of research and findings in the area of music therapy is that it is "too broad and complex to be defined, contained or limited by one research approach" (Bruscia, 1995 p. 73). Only time and studies and experience will enable the implementation of music therapy to become a more standardised form of treatment. However, it seems that there is no question of its merits as a form of treatment, and as studies show, the effects are largely positive in this ever increasing popular therapy. Word count: 1946 References Aldridge, A., Gustroff, G., Neugebauer, L. (1995). A Pilot Study of Music Therapy in the Treatment of Children With Developmental Delay. Complementary Therapies in Medicine 3. 197-205. Germany: Pearson Professional Ltd. Benenzon R.O. (1996). I Princìpi Della Musicoterapia, Sta in "Musicoterapia e Autismo: un Progetto di Ricerca", Atti di Convegno, Ist. Osp. di Sospiro, Sospiro (Cr), Febbraio. Bruscia, K. (1987). Improvisational Models of Music Therapy. USA: Charles Thomas Publisher. Bruscia, K. (1995). The Boundaries of Music Therapy Research, in Wheeler , B. (ed): Music Therapy Research: Quantitative and Qualitative Perspectives. Phoeni xvi lle, US A: Barcelona Publishers. Dulisse, M. E. et al. (1999). A Music Therapy Project Involving An Autistic Child and His Parents in an Attempt to Find New Ways of Communicating. In Music Therapy: A Global Mosaic – Many Voices One Song. 9th World Congress for Music Therapy. Muller, P. (1994). Autistic Children and Music Therapy: The Influence of Maternal Involvement in Therapy. Ph.D. thesis, University of Reading. Muller, P., Warwick, A. (1993). Autistic Children and Music Therapy: The Effects of Maternal Involvement in Therapy. In Heal, M., Wigram, T. (eds.) Music Therapy in Health and Education. London and Philadelphia: Jessica Kingsley. Nordoff, P., Robbins, C. (1986). Schöpferische Musiktherapie. Stuttgart: Fischer. Papoudi, D.I. (1993). Interpersonal Play and Communication Between Young Autistic Children and Their Mothers. Ph.D. Thesis, University of Edinburgh, cited in Trevarthen, C.B., Aitken, K., Papoudi, D.I., Robarts, J.Z. Children with Autism, 2nd Editions: Diagnosis and Interventions to Meet Their Needs. London and Philadelphia: Jessica Kingsley). Pavlicevic, M. (1990). Music in Communication: Improvisation in Music Therapy. Ph.D. Thesis, University of Edinburgh. Raglio, A. (1996). Qualitative Research. In Music Therapy: A Global Mosaic – Many Voices One Song. 9th World Congress for Music Therapy. Sabbatella, P. (1999). The process of Evaluation in Music Therapy. In Music Therapy: A Global Mosaic – Many Voices One Song. 9th World Congress for Music Therapy. Schmid-Degenhard, M. (1994). Betroffensein und Verstehen in der Begegnung mit dem Psychotischen Menschen. Schweizer Archiv für Neurologie und Psychiatrie, 145, (6), 25-28. Wigram, T. (1993). Music Therapy Research to Meet the Demands of Health and Educational Services: Research and Literature Analysis. In Heal, M., Wigram, T. (eds.). Music Therapy in Wimpory, D., Chadwick, P., Nash, S. (1995). Brief Report: Musical Interaction Therapy for Children with Autism: An Evaluative Case-Study with Two Year Follow-Up. Journal of Autism and Developmental Disorders, 25(5). Read More