Welcome, Hanlee!

Hello! My name is Hanlee McCart, and I am so blessed to say I am interning with Therabeat Inc. this year! Music therapy is a passion that I have had for many years and have seen it touch the lives of people in the most beautiful and unexpected ways. I spent my first four years studying music therapy at Georgia College & State University where my experience in the field was only the beginning. I am now close to getting my Bachelor’s in Music Therapy once I complete my internship with Therabeat this year! 

My primary instrument is cello, and I also love playing piano and the guitar. I absolutely love people and am passionate about using music to create deeper connections with people to serve their needs and advance their strengths. I have always had a passion for working with children specifically, of all ages and abilities! From what I have already experienced at Therabeat Inc., I am confident that this is the perfect internship for me! 

Some of my favorite things are listening to music, creating music, being with friends, meeting new people, laughing, laying in the sun, swimming in the ocean, going on runs, and spending time with my family. 

I am beyond grateful for the opportunity to serve alongside the Therabeat, Inc. team as an intern. While it is only my first week with Therabeat, I am already blown away by how I have seen so many different therapists use music therapy to connect with the many clients served here. I have already learned so much, and am so eager for all that I will learn from this team in the next 6 months! The reason why I chose Therabeat, Inc. is because I wanted to intern at a site that will develop my experiences in working with multidisciplinary and multi-diverse client family care with the support of professional music therapy supervisors. My first week with Therabeat has already proven this to be an accurate representation of what they care about. It is evident that their team of therapists prioritize the needs and desires of their clients over anything else. Being able to learn from the therapists at Therabeat, Inc. has been such a joy, and I feel beyond blessed to continue learning from them daily as I develop my skills into being a future certified music therapist!

-Hanlee McCart, Music Therapy Intern

3 Ways to Say "No" with Children with Autism

Children with autism may have a difficult time expressing and regulating their emotions --especially when being told “no” to a preferred activity or item. The National Autism Association states that, “Autism impacts the normal development of the brain in the areas of social interaction, communication skills, and cognitive function” (National Autism Association, para. 1). 1 in every 54 children is diagnosed with autism (National Autism Association, para. 2). Helping a child with autism manage emotional stress when being told “no” can seem like a daunting task to parents, teachers, and caregivers. An ABA (Applied Behavioral Analysis) case study done by Mace et al. (2011) may help to provide alternate strategies. Mace et al. (2011) “evaluate[d] the relative effects of three different methods of saying ‘‘no’’ to requests to engage in a preferred activity on the occurrence and escalation of oppositional, disruptive, and aggressive behavior” (p. 85-86). This is also pertinent information for Music Therapists in regards to managing behaviors and keeping a safe environment within a session.

At the beginning of the study, target behaviors --negative behaviors that occur after “no”-- of the participant with high-functioning autism were recorded. These behaviors included: oppositional vocalizations, loud vocalizations, disruption, aggression and/or threat of aggression (Mace et al., 2011, p. 86). Many of these behaviors are commonly seen amongst people with autism, specifically when told “no.” Mace et al. (2011) studied three different methods of saying “no” to a requested activity “to prevent occurrences of escalating behavior” (p. 91). The three methods include: 

1. “[saying] no and then offering an explanation for the refusal 

2. denying access to the requested activity but offering an opportunity to engage in a preferred alternative activity

3. denying immediate access to the requested activity, but permitting delayed access contingent on the completion of a low-preference demand” (Mace et al., 2011, p. 91).

Of the three methods, the last two alternative methods rarely caused the target behaviors. 

The first method did not include the child receiving anything in return other than “no,” which escalated all target behaviors. The last two methods included the child receiving “no,” but was offered the opportunity to engage in an alternative activity instead, such as playing baseball. The other strategy presented required a non-preferred activity where he had to engage in that activity first, then was able to receive the requested activity. The second alternative method was proven to extinguish most of the presented problem behaviors. 

In conclusion, the alternative methods of saying "no" are the best practice for dealing with problem behaviors. This case study had one participant, therefore further research is needed for generalization of this population. Autism Spectrum Disorder is on a "spectrum," therefore one method may not work for all children with autism. Parents may use this article and others to use creative ideas of alternate methods of dealing with inappropriate or unsafe activities other than the simple word, “no.”

Below is an example of a chart a Music Therapist may utilize with a patient with autism to remember how to sit at the piano. It is a great visual reminder that can sit at the piano while practicing music. When the patient is able to follow all three steps they are rewarded with a sticker on their music for the day, but if they struggle to follow the three steps they are unable to receive a sticker. Not receiving a sticker can provoke problem behaviors, but the Music Therapist can utilize “no” with an explanation to work harder next week so they can get a sticker. Again, every child is different and with some patients having a goal to work towards for next week is very motivating so they can transition fine without extreme problem behaviors out of the session. 

-Kennedi Walz, Music Therapy Intern

References

Mace, F., Pratt, J., Prager, K., & Pritchard, D. (2011). AN EVALUATION OF THREE METHODS OF SAYING “NO” TO AVOID AN ESCALATING RESPONSE CLASS HIERARCHY. Journal of Applied Behavior Analysis, 44(1), 83–94. https://doi.org/10.1901/jaba.2011.44-83. 

Autism Fact Sheet. National Autism Association. (n.d.). https://nationalautismassociation.org/resources/autism-fact-sheet/.

Music Therapy and Social Skills in Children with Autism

Music is often referred to as a universal concept, as well as used as a tool to teach different subjects, languages, and social skills. Children with autism often have a difficult time expressing and verbalizing thoughts to others. This can lead to people making incorrect assumptions of levels of intelligence and understanding. Furthermore, this can create a barrier between children trying to create friends or students trying to help each other at school. This is just one of many reasons that the need for a greater understanding of neurodiversity and alternate forms of communicating is growing every day. Within the field of Music Therapy, clinicians are continuously studying ways that music drives change in the brain, and this research is applied daily to individualized session and treatment plans. The beauty of music is the opportunity it provides each individual to connect, as well as to express themselves through it. Extensive research and evidence-based studies have shown that when provided with Music Therapy services, children with autism are given the opportunity to express their individuality as well as connect with their peers. Children with autism benefit greatly from sensory experiences as they are trying to navigate their world. Being able to listen, feel, and even move to the music along with other techniques improves their development (Khyzhna, O., & Shafranska, K., 2020). Music therapy sessions, both individual and group, can be an important step in helping a child with autism develop and improve their social skills. 

Group sessions allow clients to connect with one another and find their similarities. Some children will focus on the beat of a song while others may focus on lyrics instead. Regardless, this connection to music allows children the ability to look beyond differences and mentally and emotionally connect. The Art of Autism, a nonprofit organization that accepts submissions of various art forms in search of diverse viewpoints on all things Autism related, discussed in a 2017 blog post ways that music can be an effective tool in helping a child with autism overcome social barriers. Furthermore, when looking at group sessions, “group musical environments provide opportunities for learning social skills such as imitation, turn taking, social reciprocity, joint attention, shared affect, and empathy” (Music As An Effective Social Skill Tool, 2017, para. 4). These skills are vital in developing the social skills that a child needs to effectively communicate with peers and adults. Seeing others engage with the therapists and other students can sometimes be more effective than just being told how you should engage with others. 

(Coast Music Therapy, 2013)

During individual sessions, a client is able to connect one-on-one with the therapist and extensively focus on their individual goals. Although the session is conducted one-on-one, they too facilitate social skill development in children with autism. When in a session, communication  with the treating therapist is a key factor in working towards meeting the client’s goals. Therapists work tirelessly to create an individualized treatment plan for each client, including finding and providing a method of communication for clients with autism to be able to actively communicate. This may be done using presented visuals, sign language, an AAC device, etc.

A case study was conducted over a twenty-three week period. This study followed ten children with autism as they completed music therapy sessions to see if their social behaviors improved during and after completing the sessions. The results verified the effect of music therapy on increasing the social skills in a child with autism. According to the study, a statistically significant trend in data was found, and at least five of the children displayed improvements in the area of eye contact, adaptability, focus and attention span, taking another person into account, and verbally communicating throughout the course of the study. The study concluded that children with autism benefit from music therapy sessions and show a developmental and social growth by the end of the sessions as compared to beginning (Pater, M., Spreen, M., and van Yperen, T, 2021, para. 1-2).

The structure of music and the repetition in order to learn a new concept can also help children with autism blossom in music therapy sessions. As stated in an article published by The Art of Autism , “music is predictable, structured and success oriented” (Music As An Effective Social Skill Tool, 2017, para. 7). For a child with autism, music and music therapy allows them to express their individuality while working towards goals that are achievable and rewarding. Not only are they learning valuable musical concepts and working to achieve predetermined cognitive goals, they are engaging in social interactions and learning to communicate appropriately and effectively with peers as well as their treating therapist. Given the opportunity to communicate using a preferred method, children with autism can thrive, and music therapy is just one of many outlets that may be used to break down the barrier between neurodiverse individuals. 

-Macie Skinner, Music Therapy Intern

References:

The Art of Autism (2017, September 11). Music As An Effective Social Skill Tool. https://the-art-of-autism.com/music-as-an-effective-social-skill-tool/. 

Khyzhna, O., & Shafranska, K. (2020). Music Therapy as an Important Element in Shaping Communication Competencies in Children with Autism Spectrum Disorder. Journal of History Culture and Art Research, 9(3), 106-114. Doi: http://dx.doi.org/10.7596/taksad.v9i3.2823

Pater, M., Spreen, M., & van Yperen, T. (2021). The developmental progress in social behavior of children with Autism Spectrum Disorder getting music therapy. A multiple case study. Children and Youth Services Review,120. https://doi-org.proxy.lib.fsu.edu/10.1016/j.childyouth.2020.105767 

Autism Music Therapy Activities. (2013, May 15). Retrieved March 12, 2021, from http://www.coastmusictherapy.com/autism-music-therapy-activities/ (image)

Music Therapy & Pediatric Oncology

The term pediatric oncology is not often a positive topic of conversation. There is grief, pain, anxiety, stress and many more feelings that encompass this topic. Fortunately, music therapy has been proven to help make lives and families experiencing pediatric oncology a more positive experience. Every child with cancer has their own perception of the hospital and treatment, most associate them with pain and anxiety, however, research shows that Music Therapy services have a positive impact on a child’s ability to regulate those experiences. Two articles show very similar concepts of music therapy being integrated into the hospital and the positive outcomes it accomplishes. 

Within the multidisciplinary team at a children’s hospital, music therapy is often included. The one difference between music therapy and other disciplines is the prescription of medicine. Tucquet and Leung (2014) described music therapy as addressing “a nonpharmacological approach to symptom management” within the hospital setting (p. 327). Common goals that are addressed within this population consist of increasing emotional support, pain management, parent/child bonding, rehabilitation, anxiety management, procedural support, and self expression (Tucquet & Leung, 2014, p. 330). Music is seen to be a positive avenue for children to actively engage themselves and begin regulating their bodies. Since every child is different, music therapy must be practiced by a trained and certified music therapist that can establish individualized and therapeutic goals for each specific child.

Approaches that music therapists utilize to achieve these goals can look very different. Some interventions include instrument play, song-writing, free improvisation, singing, creating playlists, (Giordano et al., 2020, p. 2) active music engagement, and music relaxation and imagery (2014, p. 328-29). For children receiving radiation, “a personalized music therapy CD” was created (2014, p. 328). Many of these interventions elicit opportunities for self-expression, connecting to the outside world, utilizing coping skills, increasing positive affect and quality of life. Music therapy has been shown to positively engage children inside the hospital, which in turn, has been shown to reduce stress amongst parents. Loewy, as cited in Giordano et al. (2020) stated, “these processes not only refocus the patient’s attention, but also distract from the procedure itself or from the waiting time beforehand and help the child acquire a sense of security and calm for future proceedings” (p. 3). Allowing these children to be a part of something positive is an important component of happiness for the child and their families. 

Receiving treatment can be a scary time for children. With the use of music therapy before, during and after invasive procedures, positive outcomes were discovered. In both studies, children were split between a music group and a control group. The findings all positively reinforce the use of music therapy. The children within the music group reported pain and anxiety levels to be lower before and after the procedure (2014, p. 328). Researchers also found that heart and respiratory rates were lower during the procedure, and respiratory rates were lower after the procedure (2014, p. 328). These results show that a response to music therapy can be self-reported as well as measured by physiological changes of the body. Giordano et al. (2020) stated, “None of the interviewees reported a negative opinion on the presence of MT” (p. 3). As the results show, music therapy positively affected these children, but it also provided positive experiences for the parents as well. “Parents reported music therapy also provided an opportunity for family bonding in the midst of an unpredictable and challenging journey . . .  and their gratitude toward the program and therapists was highlighted” (2014, p. 332). During the difficult times for these families, having a space for bonding and positive interactions is something hopeful and a time everyone cherishes. 

Finally, music therapy is also seen as a way for families to save money and it is beneficial for hospitals as well. It is possible that with the use of music therapy, procedural support time could be reduced which saves time, money and equipment (DeLoach, as cited in Giordano et al., 2020, p. 2). Eventually, children could progressively become more comfortable with procedures and entering the operating room which saves an abundance of time. Giordano (2020) stated “the anesthesiologists in this study observed that the absence of the MT called for a larger amount of anxiolytic drugs, with an increase in the residual effects of anesthesia” (p. 3). Music therapy, alternatively, is much more cost effective than sedation (2020, p. 2). When a child could get to a point to not have to become sedated for a procedure, that would be positive for everyone involved. That is just one other benefit of music therapy. 

In conclusion, there can be a light in the middle of the darkest times. Music therapy can provide a child with cancer and their family with peace of mind, comfort, and an avenue for bonding. It is proven, by setting individualized goals and utilizing supportive interventions, music therapy can have positive effects on one's mind and body. It can also be a positive alternative other than methods utilized in pharmaceuticals. Continuing research on this topic is important to education people on the effectiveness of music therapy in pediatric oncology.  

References 

Giordano, F., Zanchi, B., De Leonardis, F., Rutigliano, C., Esposito, F., Brienza, N., & Santoro, N. (2020). The Influence of Music Therapy on Preoperative Anxiety in Pediatric Oncology Patients Undergoing Invasive Procedures. The Arts in Psychotherapy, 68, 101649–. https://doi.org/10.1016/j.aip.2020.101649

Music Therapy Program - Center for Cancer and Blood Disorders: Children's National Hospital. (2021, March 28). Center for Cancer and Blood Disorders | Children's National Hospital. childrensnational.org/departments/center-for-cancer-and-blood-disorders/programs-and-services/music-therapy  (image) 

Tucquet, B., & Leung, M. (2014). Music Therapy Services in Pediatric Oncology: A National Clinical Practice Review. Journal of Pediatric Oncology Nursing, 31(6), 327–338. https://doi.org/10.1177/1043454214533424

Why does Music Therapy work?

Music Therapy—such an obscure term for many—but for others it is an avenue for socializing, recovery, self-expression, communicating, alleviating stress and so much more. The American Music Therapy Association defines Music Therapy as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, 2021). What sets music therapy apart from other therapies is that music therapists utilize music interventions to drive the change related to therapeutic goals individualized for each person. Evidence suggests that engaging in music has a significant impact on the human brain, making it an effective tool for therapy. In 2014, researcher Stegemöller explored the principles of neuroplasticity and how it can be applied within the clinical practice of music therapy. 

Music therapy is often tested on progress based on observable behaviors and actions that are witnessed during a session, but understanding how the music is actually affecting the brain can lead to much more information as to why music therapy is working. Neuroplasticity is the ability for the brain to reorganize or remap connections in the brain to learn in a new way. Neuroplasticity indicates the ability of the brain to continuously change its form and functioning. Stegemöller (2014) states, “. . . in neuroplasticity the connectivity and non connectivity of neurons, networks, and regions . . . determines the perception and response to stimuli in the world around us (p. 212). Understanding neuroplasticity is the first step to understanding the way the brain can change due to stimuli and how music therapy can affect the way the brain functions. 

Experiences are what build up the brain. In short, the synapse is the space between two neurons where signals are passed back and forth and with constant use, the neurons become larger and long-lasting. The neurons that are not in constant use become weakened. This phenomenon is described as “synaptic plasticity” (p. 213). “Long- term potentiation (LTP)” was discovered when a brief high frequency stimulation occurred and “enhanced the synaptic activity between neurons” (p. 213). Specific receptors were found to trigger the LTP response which in return admits learning and memory to occur (p. 213). Stegemöller (2014) explains this occurrence gives researchers an understanding of “how the brain retains specific properties of an encoded memory, as well as how the brain associates one experience with another” (p. 213). “Long- term depression (LTD)” was discovered when a long period of low rate stimulation occurred and decreased synaptic activity (p. 214). LTP and LTD processes suggest that utilizing music therapy as the stimulation could have the ability to change the strengths of an entire network of neurons. 

Learning and memory are two very important targets in music therapy, but “restoring lost behaviors or finding alternative behaviors'' (p. 214) are also very important aspects targeted within music therapy. Cortical remapping is one of the largest components in understanding how the brain changes in response to music. “In sensory areas of the brain . . . the arrangement of receptive fields (i.e., areas of the brain that respond to a specified stimulus) can change in response to altered circumstances'' (Jenkins, as cited in Stegemöller, 2014, p. 214). For example, someone who has experienced a stroke no longer has the same motor abilities as before, but with receiving therapy and remapping occurring in their motor functioning, they are soon to recover close to or completely back to normal. Therefore, music therapy can be utilized to create new pathways and rewire, as well as restore and alternate old and new behaviors by altering circumstances and remapping the brain. 

The brain is understood to be always changing whether positively or negatively. From birth to ages 2 to 3, new connections of neurons are continually increasing, which is considered the critical period (p. 215). It is defined as the “critical period” due to this being the time children are learning about the world, and it is important to ensure these children are being exposed to positive stimuli. “These experiences set the neuronal structure for future plasticity”—meaning this time is critical in learning basic social interactions and engaging in stimulations with ease until it becomes more difficult later on in life (p. 215). From ages 3 to 6, new connections are increasing as well as pruning, which is when the brain is removing synapses that are no longer seen as needed due to the neurons not being utilized (p. 215). The saying “Use it or lose it” pertains to this time in development. By the time of adolescents the brain is creating new connections and pruning about the same amount, until the early 20s where the brain is completely developed (p. 215-216). Neuroplasticity spans the entire lifetime of one person, so even though the brain is developed by the early 20s, positive changes can be made within the brain throughout the entire lifespan. Music therapy can be utilized in remapping neurons that were pruned and assisting in regaining knowledge and abilities. 

One signal that neurons pass back and forth is dopamine—which has been shown to be released during positive stimuli occurring. Research has shown that music plays a role in the production of dopamine which proposes the idea of music being a driving force of the idea of reinforcement learning and reward. “Most importantly, research has shown that the response of dopamine neurons is transferred to stimuli during learning” (Romo & Schultz, as cited in Stegemöller, 2014, p. 216). For example, when a bell sounds and candy is then rewarded due to homework being turned in, dopamine is firing due to the candy. The bell becomes a signal of dopamine firing predicting future rewarded occurrences. It is assumed that dopamine has much to do with the occurrence of neuroplasticity and cortical remapping. So based on research, music therapists have the capability to utilize music as a reward, produce dopamine, which then promotes the motivation to achieve therapeutic goals. All in all, once dopamine has been fired, due to a nonmusical task, the synapse “may be strengthened by LTP, which is mediated by dopamine, ultimately leading to the learning of a new task/behavior from which the music reward (i.e., music therapy) can be faded” (p. 217). 

Noise, on the other hand, has been proven to negatively affect neuroplasticity and increase stress, while music has had the opposite of effects (p. 218). High levels of stress restrain the occurrence of LTP which in turn has negative effects on memory, cognition, and emotion.  On the contrary, exposure to music has strengthened learning and promotes the occurrence of neuroplasticity. “Research has suggested that the acoustic signal of song is more consonant than that of speech and that professional musicians have less “noise” in both their spoken and sung signals” (p. 219). Therefore, it is proven that music therapists have the ability to promote the occurrence of neuroplasticity by calming the noise. 

In conclusion, music has the ability to stimulate neuroplasticity, produce dopamine, remap the brain wiring, and quiet the noise. Music is a unique tool music therapists pair with therapeutic goals to achieve them. The brain is ever changing and so is music. “Like the sculptor who meticulously adds and cuts away until a final masterpiece is revealed, music therapists are the artists that use music to prune and create new neural connections resulting in a beautifully crafted masterpiece” (p. 220). This study is just one part of the extensive research on the positive impacts of music therapy on the brain. It is important for continued research to educate people on the effectiveness of music therapy. 

-Kennedi Walz, Music Therapy Intern

References

American Music Therapy Association. (2021, February 12). What is Music Therapy. https://www.musictherapy.org/ 

Choy, L. (2018). Neuroplasticity and Mental Wellness: Our Path Forward. Thrive Global. https://medium.com/thrive-global/neuroplasticity-mental-wellness-our-path-forward-4c03a632868 (image) 

Stegemöller, E. (2014). Exploring a Neuroplasticity Model of Music Therapy. Journal of Music Therapy, 51, 211-227. https://doi-org.proxy.lib.utc.edu/10.1093/jmt/thu023