Music Therapy

Using Music Therapy to Enhance Social Connection in Children with Autism Spectrum Disorder

By: Sarah C Brown, 2020

Introduction

Autism Spectrum Disorder is a developmental disorder that affects the way a child perceives the world. It can affect the emotional side of the brain in charge of feelings, thinking, and the ability to relate to others (Eren, 2018). According to 2016 data from the CDC, 1 in 54 children in the U.S. is diagnosed with Autism Spectrum Disorder (Autism Speaks, 2020). With such high numbers, educators need to take extensive action to help these children develop and connect. One relatively new practice is Music Therapy. Music Therapy has shown that children with Autism Spectrum Disorder have a strong connection to music, and studies suggest that those with Autism Spectrum Disorder can recognize basic emotion in music (Quintin et al., 2011). This basic connection to music can be utilized to further the emotional development of children with Autism Spectrum Disorder

Music Therapy has been around for about fifty years. However, only in the last decade has it truly found a voice in therapeutic studies. The American Music Therapy Association defines Music Therapy as the “clinical and evidence-based use of music intervention in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals” (AMTA, 2020).  Music Therapy allows students to play and listen to music while interacting with the therapist. The playing of instruments uses fine motor skills which use the whole brain and allow increased activity. This increased activity allows those who play and interact with music to solve problems more quickly in social settings (Collins, 2014). Social connections are slower and sometimes nonexistent in those with Autism Spectrum Disorder. However, with Music Therapy research has shown an increase in children’s ability to express emotions (Vaiouli et al., 2015), longer duration of eye contact and turn taking (Kim et al., 2008), increased understanding of facial expressions (Eren B, 2018), increased understanding of basic emotions (Quintin et al., 2011), and an increased understanding of one’s own emotions (Eren, 2017).

Music has become recognized as a channel through which emotions can be communicated to children with Autism Spectrum Disorder (Quintin et al., 2011). The studies above and many other studies show the importance of music in the lives of young children with Autism Spectrum Disorder. McFerran and colleagues did a study about partnership between music therapists and school teachers and found that school teachers were excited about the opportunities and engagement they were seeing, but needed more guidance and resources (McFerren et al, 2016). The next step needed is to have Music Therapy incorporated into the learning process of those with Autism Spectrum Disorder. This could be done in a free period by a trained music therapist or through classroom teachers who take interest in Music Therapy and work with therapists to incorporate these practices into their teaching.  The integration of Music Therapy into the lives of children with Autism Spectrum Disorder can improve their general understanding of emotion in themselves and others through musically heightened connections made by instructive musical moments.

Autism Spectrum Disorder and Emotional Consequences

Characteristics of Autism Spectrum Disorder fall into three categories that include communication problems, difficulty in relating to people, things, and events, and repetitive body movements or behavior. Individuals with Autism Spectrum Disorder are limited and insufficient when it comes to non-verbal actions, social interaction, and the matter of communication, which are all integral when it comes to social interaction (Eren, 2017). Autism Spectrum Disorder can inhibit the understanding of facial expressions (Eren, 2018), the use of meaningful eye contact or any eye contact at all (Kim et al., 2008), the understanding of basic emotions (Quintin et al., 2011), and the understanding of one’s own emotions (Eren, 2017).

As mentioned above, according to 2016 data from the CDC, 1 in 54 children in the U.S. is diagnosed with an Autism Spectrum Disorder (Autism Speaks, 2020). While there is no cure for Autism Spectrum Disorder, research has shown that early diagnosis followed by individualized intervention can dramatically affect a child’s ability to function and grow to lead meaningful lives (Eren, 2017), improve learning, improve communication and social skills, as well as improve underlying brain development (Autism Speaks, 2020). 

Music Therapy and its Connection to Autism Spectrum Disorder

From infant research, it is known that communication between a caregiver and child has musical features. Infants are attracted to the wilt in voices which is connected to emotional interaction and carries musical features such as: timing, form, pitch, and dynamics. A caregiver often attunes themself to the infant’s own movements and rhythms and mimics the child’s emotions in their own face and body. This attunement influences the development of social understanding. During this process, the child takes in information and gains understanding of how they are feeling and what that emotion looks like and sounds like in other people. This interaction and attunement link may be disrupted in infants that have autism. This disruption accounts for Autism Spectrum Disorder difficulties in “identification, distinction, and description” of emotions within themselves and others (Eren, 2017)

For children with Autism Spectrum Disorder, music therapists work as a stand-in for the child’s caregivers. They use this musical and emotional attunement to support both inter- and intrapersonal experiences that are similar to the attunement from early childhood. The music used can work as a buffer. This buffer allows the child with Autism Spectrum Disorder to interact with the music before they must interact with a person whom they don’t at first understand. Eren explains,

The child does not necessarily need to directly connect to or involve in reciprocal communication with the therapist, but can relate to the music between them. This gently scaffolds interactions along the child’s relational resources and might enhance a development towards the establishment of intersubjectivity. Similar to the interaction between infants and their caregiver, the music therapist proceeds in the pace of the child, trying to match her or his movements and sounds. Within these processes affective states can be met immediately through musical and emotional attunement. This leads to experiences of intra- and interpersonal synchronization which can foster processes of regulation, organization, and mentalization , all of which are known as preconditions for the meaningful as well as joyful engagement between individuals. (Eren, 2017)

This gentle scaffolding allows students to understand the music, which they have shown to be prone to, before then understanding the emotion connected to the therapist. Music Therapy allows students to play and listen to music while interacting with the therapist who may teach facial expressions that relate to the music or invite children to listen, interact, move, vocalize, make purposeful eye contact, share, and use fine motor skills when playing instruments. During this time of play and discovery, the body, the mind, and the environment are interacting and enhancing the connectivity in the child’s brain.

Music Therapy involves playing instruments which uses fine motor skills. Fine motor skills require the use of both the right and left sides of the brain. Therefore fine motor skills combine the linguistic and mathematical left hemisphere of the brain with the creative and novel right hemisphere of the brain. This use of both sides of the brain has been shown to increase the volume and activity of the brain’s corpus callosum, which bridges the two hemispheres. This increase allows the information to make it from one side of the brain to the other faster and in different connective ways. Thus those who play and interact with music can solve problems more quickly in social settings (Collins, 2014). Social connections are slower and sometimes nonexistent in those with Autism Spectrum Disorder. While Music Therapy is a relatively new practice, it has been shown that children with Autism Spectrum Disorder have a strong connection to music. Music can enhance an individual’s social learning because the brain makes more connections while making music.

There have been studies that suggest those with Autism Spectrum Disorder can recognize basic emotion in music. When researched next to atypical children those with Autism Spectrum Disorder only scored about 10% lower on recognizing which emotion fit each selection of music. This is a significantly better percentage when compared with atypicals and those with Autism Spectrum Disorder recognizing emotion in human interaction without music. Music therapists have come to recognize music as a channel through which emotions can be communicated to children with Autism Spectrum Disorder (Quintin et al., 2011). 

There have been many successes in research related to the improvement of social understanding in those with Autism Spectrum Disorder related to Music Therapy. A study showed that children with Autism Spectrum Disorder kept longer eye contact and had longer duration of turn taking both during and after Music Therapy sessions. This study researched a group of 10 children diagnosed with Autism Spectrum Disorder who had no previous exposure to Music Therapy. They specifically analyzed eye contact duration and turn taking duration during and after sessions. They also compared these results with results from the same children when doing play therapy and found significantly higher duration in the Music Therapy sessions. This shows that Music Therapy is more effective at facilitating joint attention behaviours and nonverbal social communication skills in music than basic play sessions (Kim et al., 2008). Another study with a five-year-old showed increased understanding of facial expression of others and the ability to mimic these emotions for themself (Eren, 2018). In one study of a group of students, after a month of Music Therapy, parents and teachers noticed a difference in the children’s ability to express emotions. This focus group of three children with Autism Spectrum Disorder with no previous exposure to Music Therapy started having weekly Music Therapy sessions in their school system. The results of this study show increased independence, new friendships forming, changes in communicative actions, and a newfound love for music. One of the boys even held another student’s hand during a circle time activity which had never even been close to happening before (Vaiouli et al, 2015). These and many other studies show the importance of music in the lives of young children with Autism Spectrum Disorder. 

How Music can be Implemented in Schools

Autism is often diagnosed by the time a child is 3 or 4 (Lygeraki, 2019). At this point in a child’s life, they are usually in preschool or almost in first grade. This is the time when a child with Autism Spectrum Disorder needs the most intervention and developmental help. Using Music Therapy in these early school settings could help improve future social understanding in those with Autism Spectrum Disorder.

There are a few successful ways Music Therapy could be used in elementary schools to benefit those with Autism Spectrum Disorder. One is that those with Autism Spectrum Disorder have therapy time each week when a music therapist would come in and work with them for at least one hour a week. Another is that a music therapist would collaborate with classroom teachers to allow Music Therapy techniques to be used in the classroom. While both of these techniques would be helpful and perhaps suit some schools, the best way would be for a combination of one-on-one therapy sessions and classroom teacher collaboration. In this combined approach, those with Autism Spectrum Disorder benefit from a more personalized session while also using those tools in a classroom setting when they would be interacting with peers.

Working with students who have Autism Spectrum Disorder one-on-one is an important first step in the learning process. When working with the therapist, they can learn methods for interaction on a practical level with their peers. Additionally, one-on-one interaction enhances trust and understanding between the therapist and the student. Music Therapy is most efficient when the therapist and child have time to grow together. When the therapist can become musically and emotionally attuned to the child’s modes of communicating and relating, the child’s responsiveness can increase and thereby increase their learning throughout the process (Eren, 2017). 

The next step would be the collaboration between therapist and classroom teacher. McFerran and colleagues did a study about partnership between music therapists and school teachers and found that school teachers were excited about the opportunities and engagement they were seeing, but needed more guidance and resources on the topic (McFerren et al, 2016). If music therapists worked together with classroom teachers, it would help the students with Autism Spectrum Disorder make connections between their one-on-one sessions and their day-to-day routines. The way this is implemented depends entirely on the interaction between the music therapist and the classroom teacher. The classroom teacher would need to feel confident and supported in this new practice so that they can use these new ideas effectively and beneficially (McFerren et al, 2016). 

For this collaboration to be smooth it should be a slow gradual learning process. McFerran’s study worked in a phased plan of incorporating Music Therapy into a special needs school system. It started with the music therapist coming into the volunteer classrooms twice a week to work with the students and to get them familiar with the process and basic musical ideas. The next step was in letting the classroom teacher have more control during these sessions so they participated in the musical ideas as well. Then the music therapist mostly left the classroom teacher on their own to continue the lessons. The therapist always came to answer questions and occasionally did follow up workshops to continue the teacher learning process and reinforcing musical ideas they had already learned. Finally, over the next few years, the music therapist would come into the school a few times a year to hold workshops and reinforce that which the teachers had learned. They would talk about the successes and problems and work to overcome any difficulties (McFerren et al, 2016). The study above is a wonderful model for integrating Music Therapy practices into the classroom. It allows for the teachers to learn alongside the students and become fully confident before being left to implement it on their own.

Concerns

Some raise the question that while these musical strategies help those with Autism Spectrum Disorder, is it wise to incorporate them into a classroom full of different levels of children? The fact of the matter is that Music Therapy has been shown to help a very wide range of abilities. It has shown positive results in focus for those with ADHD (Rickson 2006), healing for those with trauma, calm to those with anxiety (Hess & Bradley, 2020), as well as the many benefits provided above for Autism Spectrum Disorder. Music Therapy is not just beneficial to those with physical, emotional and mental disabilities but to everyone. 

Children of all levels benefit from Music Therapy in the school system and classroom. Some benefits of music education include: enhanced language capabilities, improved memory, strengthened hand-eye coordination, powerful study habits, increased teamwork, and heightened mental processing and problem solving (Silverstone, 2018).  These are just a few of the many benefits of music being incorporated into the classroom. It is clear that music education nourishes learning skills and ways of thinking that correlate to other areas of learning. Music is a connective pathway between all types of human beings no matter what their abilities are. No matter the person or their life circumstances, it has been shown that “music is a strong stimulus, a powerful motivator, a positive reinforcement, and a desirable reward to create or maintain appropriate behaviors” (Eren, 2017). Therefore, it is not only wise but widely encouraged that music should be incorporated into any classroom of children.

Conclusion

Music Therapy is a “clinical and evidence-based” therapeutic practice that has been shown to help those with Autism Spectrum Disorder understand themselves and others’ emotions better. It should be incorporated into the lives of young kids with Autism Spectrum Disorder. This can be done through one-on-one therapeutic sessions and through the integration of Music Therapy practices into the classroom. Those with Autism Spectrum Disorder tend to connect to music and understand the emotion evoked through music. The integration of Music Therapy into the lives of those with Autism Spectrum Disorder can improve their general understanding of emotion in themselves and others through musically heightened connections made through instructive musical moments.

References

Autism statistics and facts (2020). Autism Speaks. Retrieved October 2020, from https://www.autismspeaks.org/

Collins, A. (2014). How playing an instrument benefits your brain. From https://www.youtube.com/watch?v=R0JKCYZ8hng&feature=youtu.be

Eren, B. (2017). Profiles of the most preferred and the most effective music therapy approaches being utilized with children with autism spectrum disorder according to the opinions of music therapists in the U.S.. Journal of Education and Practice, 8(20), 115-128.

Eren, B. (2018). Teaching the skill of reading facial expressions to a child with autism using musical activities: a case study. Journal of Education and Learning, 7(6), 156–164.

Hess, J., & Bradley, D. (2020). Dewey’s theory of experience, traumatic memory, and music education. Studies in Philosophy and Education, 39(4), 429–446.

McFerran, K. S., Thompson, G. & Bolger, L. (2016). The impact of fostering relationships through music within a special school classroom for students with autism spectrum disorder: an action research study, Educational Action Research, 24(2), 241-259, DOI: 10.1080/09650792.2015.1058171

Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders, 38(9), 1758–1766.

Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational Music Therapy. Autism, 13(4), 389–409. https://doi.org/10.1177/1362361309105660

Lygeraki, A. (2019). Development of academic skills in children with autism. Online Submission, 3(2), 1–12.

Quintin, E.-M., Bhatara, A., Poissant, H., Fombonne, E., & Levitin, D. J. (2011). Emotion perception in music in high-functioning adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 41(9), 1240–1255.

Rickson, D. (2006).  Instructional and improvisational models of music therapy with adolescents who have attention deficit hyperactivity disorder (ADHD): a comparison of the effect on motor impulsivity. Journal of Music Therapy, 43(1): 39-62.

Silverstone, J. (2018). Tuning in: Six benefits of music education for kids. New England Journal of Higher Education.

Vaiouli, P., Grimmet, K., & Ruich, L. J. (2015). “Bill is now singing”: Joint engagement and the emergence of social communication of three young children with autism. Autism: The International Journal of Research and Practice, 19(1), 73–83.

What is Music Therapy? (2020). American Music Therapy Association. Retrieved October 2020, from https://www.musictherapy.org/about/musictherapy/