Music Therapy and Early Intervention: Promoting Healthy Development Through Music Experiences

Do you know that it's possible to start tracking a child's development around the second month of life? Developmental milestones include things that most children should be able to do by a certain age. Parents can use the milestones highlighted by the Center for Disease Control and Prevention (CDC) to determine where their child falls developmentally. Developmental delay refers to a child's physical, cognitive, emotional, or social development not meeting typical milestones. Early identification and intervention help mitigate the impact of these delays and support the child's overall growth.

Early intervention (EI) refers to services that help babies and young children reach milestones and improve their abilities. There can be EI programs, such as Babies Can’t Wait, which is a program specific to the state of Georgia. Individuals must be eligible and apply to get access to these kinds of programs. Music therapy interventions are tailored to address the unique needs of children with developmental delays, fostering development in the crucial early years. Here are some needs that music therapists can treat for EI:

1. Sensory Integration:

Sensory processing can be a common need for a child with developmental delay. Stimulating the senses helps develop the brain. Music therapy can provide a structured environment for sensory exploration with auditory, tactile, and visual stimuli. Interventions like music listening, instrument play, or engaging in rhythmic activities can enhance sensory integration. The use of different musical elements such as dynamics, pitch, and tempo can be used to stimulate auditory senses.

2. Speech and Communication:

The rhythmic and melodic elements of music can serve as a scaffold for speech development, making it an engaging and effective approach for children with speech delays. Singing reinforces language development, especially when therapists utilize a simple melodic structure and repetition when trying to get a baby or young child to babble or speak. Music therapy can help reinforce verbal and nonverbal communication because music is a motivating structure for working on different sounds, words, gestures, and signs. A recent literature review states, “When nursery rhymes are incorporated into social routines, children are provided experiences that strengthen their early communicative skills. Listening or chanting songs or rhymes together allows for joint attention (the use of gestures or gaze to alert another to an object)” (Houde, et. al, 2018, pg. 6).

3. Motor Skills Development:

Movement-based activities in music therapy contribute to the improvement of gross and fine motor skills. Dancing, drumming, or playing instruments helps enhance coordination and motor planning in children with developmental delays. Body awareness is another area that children can work on in music. Movement interventions that utilize different parts of the body or allow the child to explore the room allow them to gain more spatial awareness. A child may be motivated by the sounds coming from a piano when they’re working on a skill such as isolating their fingers or coordinating movement of both hands.

4. Emotional Regulation:

  Music has a profound impact on emotional regulation. Music therapy interventions, through the use of calming or uplifting music, provide a non-verbal outlet for emotional expression. This can be particularly beneficial for children who are dysregulated. Children can also learn how to appropriately express emotions, recognize the emotions of others, and understand their own emotions through music therapy interventions. Music can provide a relaxed environment for a child to be calm and regulate themselves. Therapists can also use music to facilitate breathing exercises and other interventions to activate the parasympathetic nervous system.

5. Social Interaction:

Engaging in music interventions can increase social skills, turn-taking, joint attention, cooperation, eye contact, and more. Working on social interaction skills in early intervention is important because these skills only grow to be more important throughout one’s life. At this stage, this could just be getting a child to accept interaction from a music therapist. Music works as a mediator to promote interaction, participation, and communication from a child. Improvisation with sounds and instruments is a good way to assist a child in their responsivity, creative expression, self-awareness, and enhances their communication (Hanser, 2018).

Music therapists rely on evidence-based practices, and there have been many studies that provide evidence of the benefits of music therapy and early intervention. A study from the Canadian Journal of Music Therapy found that music therapy interventions improved communication and social skills in children with developmental delays (Houde, 2018). Another study demonstrated that rhythmic auditory stimulation, a neurologic music therapy intervention, positively influenced motor skills and coordination in children with developmental coordination disorder (Thaut, 2014).

Early intervention music therapy can address the diverse needs of children with developmental delays. As research continues to highlight the profound impact of music on various aspects of development, the integration of music therapy into early intervention programs becomes not just an option, but a harmonious necessity. Through this therapeutic medium, we can continue to promote development and provide children with the tools they need to reach their full potential.

-Lila Finke, Music Therapy Intern

References 

Centers for Disease Control and Prevention. (n.d.). Developmental Milestones. https://www.cdc.gov/ncbddd/actearly/milestones/index.html

Hanser, S. B. (2018). The new music therapist's handbook (3rd ed.). Berklee Press.

Houde, M., & Narendran, N. (2018). A literature review of the influence of early childhood music education and music therapy on child development. Canadian Journal of Music Therapy, 24, 27–39.

Thaut, M. H., & Hoemberg, V. (2014). Neurobiological foundations of neurologic music therapy: Rhythmic entrainment and the motor system. Frontiers in Psychology, 5, 1185. https://doi.org/10.3389/fpsyg.2014.01185

Music & Infants

Did you know that humans are first exposed to music while they are still in the womb? It's fascinating to think that even before we are born, we are already experiencing the rhythms and melodies that will become such an important part of our lives. Babies are exposed to rhythm from the mother’s heartbeat and footsteps. In the second trimester, babies will begin to hear melodies. We are exposed to music from the very beginning, and it has proven to have incredibly beneficial side effects that stimulate portions of our brain, which is so important for little ones who are rapidly developing and soaking in their environment.

Music therapy can be an excellent tool in areas such as parent-infant bonding, physical development, emotional development, and intellectual development. Therapeutic functions of music including rhythm, tempo, melody, dynamics, pitch, timbre, lyricism, etc. can each be used to promote growth for babies whose minds are rapidly developing and soaking up knowledge. For example, using rhythm and tempo to stimulate the cerebellum can promote movements such as foot tapping, clapping, or patting. Using different keys in songs can promote emotional awareness by using major versus minor keys to associate certain sounds with certain moods through the amygdala. Playing instruments can promote motor skills such as bilateral coordination or cross-body motions. Lyricism is an excellent tool for working on memorization, receptive language, speaking, or even dual language learning through the auditory cortex.

Music therapy is also beneficial for infants in the NICU or parent bonding in hospitals. According to a study completed in 2020 by Palazzi, et al, music therapy has been a beneficial tool in regulating preterm babies’ physiological responses as well as maternal mental health while their child remains in the NICU. The researchers sought out 33 mothers with infants each in the NICU for this particular study. Each of the mothers completed a survey prior to receiving music therapy services, called the State-Trait Anxiety Inventory as well as a postnatal depression scale.

The mother and child pairings would go on to participate in six music therapy sessions completed in the NICU. The music therapists conducting the study made sure to use soft sounds with rhythms matching maternal heart rates to promote comfort within sessions. Following the six sessions within the study, mothers filled out their assessment forms once again. The end of the study resulted in lower anxiety/depression levels for mothers, as well as musical techniques to work with their child on. There was a significant increase in infant weight gain and a slight reduction in how many days the infant spent in the NICU.

Music used to educate and grow babies can be so beneficial for parental mental health as well. Music is used often to develop and grow young children’s brains. When infants listen to music parts of their brain are stimulated to have natural responses that are necessary for growth. Infancy is such a magical and fast-paced growing period. Music can be a tool to guide parents and infants through these changes.

-Mallory McDonald, Music Therapy Intern

References

Baby Music: The soundtrack to your child’s development. UNICEF Parenting. (n.d.). https://www.unicef.org/parenting/child-development/baby-music-soundtrack-to-development

Palazzi, A., Meschini, R., & Piccinini, C. A. (2021). NICU music therapy effects on maternal mental health and preterm infant’s emotional arousal. Infant Mental Health Journal, 42(5), 672–689. https://doi.org/10.1002/imhj.21938

Stern, M. J. (2014, August 13). Why are we so nostalgic for music we loved as teenagers?. Slate Magazine. https://slate.com/technology/2014/08/musical-nostalgia-the-psychology-and-neuroscience-for-song-preference-and-the-reminiscence-bump.html

Article Review: The Use of Music Interventions to Improve Social Skills in Adolescents with Autism Spectrum Disorders in Integrated Group Music Therapy Sessions

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects the brain’s structure or chemistry. It is considered a spectrum disorder due to the wide range of characteristics, signs, and symptoms an individual with ASD can have. These individuals most commonly have problems with social communication, restrictive or repetitive behaviors, and restrictive or repetitive patterns and interests (Eren, 2015). Individuals with ASD, specifically children and adolescents, may have more issues interacting and communicating than their peers. Social skills affected by ASD include understanding emotions, expressing emotions, understanding sarcasm, social tact, facial expressions, and a lack of eye contact

Improving social skills in adolescents with ASD will help improve their relationships with others, their independence, and their ability to connect with the world around them. Each individual will have varying needs in different domains, as well as varying abilities. A group therapy setting is a great environment to help these individuals work on these skills. Interventions must specifically target these areas of need, and provide individuals with opportunities to socialize with others. Music, in general, is a great way to connect with others and create a safe space to work on these specific needs.

This study involved a group of six clients with ASD, three teachers, and the music therapist (MT). The group of clients included three boys and three girls. The group met twice a month for 90 minutes over/for the course of four months. The MT utilized a greeting to establish trust and participation in the group. The song allowed everyone to sing their name and get a greeting from the rest of the group. Starting the session with a song like this allows the group to build rapport with each other and feel safe and supported. After hello, the MT created a rhythm game that the group first worked on as a whole, but then split into groups to work on the rhythms together. The MT prompted them to listen to each other’s ideas, and the clients were able to learn how to work together. The MT was able to scaffold and build the activity over time, which allowed the clients to continuously be successful, yet challenged. The MT had the group individually come up with rhythms to present to the group to work on independence and confidence, while the other members were expected to demonstrate respect and repeat the pattern to reinforce the feeling of support and teamwork. Utilizing rhythm games allowed the group to work on social, emotional, and communication skills through a musical medium.

Another intervention that the MT utilized was dance and movement interventions. One of them included an intervention where one client came up with movements, and another stood in front of them and tried to mirror the movements. This intervention allows two individuals to connect and work on their nonverbal communication skills. Another movement intervention allowed the class to dance around the room however they wanted, but they had to listen to the musical cues. The cues provided by the MT on a drum included prompts to move fast, slow, smooth, or accented. When the MT stopped the music, the clients were prompted to greet the peer closest to them. The purpose of this intervention was to increase self and peer awareness and to work on listening for verbal and nonverbal communication. When the clients had to greet a peer when the music stopped, they had to be aware of who was around them, know how to appropriately greet someone, and use context clues to see if there was someone left without a partner.

After  4 months of group therapy, the MT noted that the group was originally hesitant to socialize with others in the group, but there was increased participation and progress every session. Simulating real-life experiences within a music therapy setting was concluded to be beneficial for individuals to work on these life skills in a nonjudgmental and creative setting. Overall, the MT found progress towards the specific goal areas of, “turn-taking, eye contact, listening, self-expression, coordinated movement in the group, decision-making with others, and acceptance of others’ differences” (Eren, p. 212, 2015). The MT also concluded that these interventions are also recommended for other populations with special needs.

-Lila Finke, Music Therapy Intern

References

Eren, B. (2015). The Use of Music Interventions to Improve Social Skills in Adolescents with Autism Spectrum Disorders in Integrated Group Music Therapy Sessions. Procedia - Social and Behavioral Sciences, 197, 207–213. https://doi.org/10.1016/j.sbspro.2015.07.125

Article Review: International Music Therapists’ Perceptions and Experiences in Telehealth Music Therapy Provision

Telehealth music therapy has become increasingly popular in recent years due to the COVID-19 pandemic. This article explores the benefits, strategies, and implementation of this form of remote healthcare services. Telehealth provides a safe way for clients and therapists to receive and provide therapeutic services, especially for individuals who are immune deficient. It also provides easier access to healthcare for individuals who have limited resources. The American Music Therapy Association (AMTA) released a survey highlighting how music therapists felt about the transition to telehealth in 2020. The study revealed that 74% of the music therapists reported that their clients had positive reactions to TMT, and some clients were even considered to be thriving in new ways. 

This article discusses the benefits, strategies, and implementation of telehealth music therapy. Telehealth is a term used to describe remote healthcare services. These services have been in high demand globally in recent years due to the COVID-19 pandemic. Telehealth provides a safe way for clients and therapists to receive and provide therapeutic services, especially for individuals who are immune deficient. It also provides easier access to healthcare for many individuals who have fewer resources. The COVID-19 pandemic allowed TMT to gain further development due to the decrease in in-person therapy. The American Music Therapy Association (AMTA) released a survey highlighting how music therapists felt about the transition to telehealth in 2020. The study revealed that 74% of the music therapists reported that their clients had positive reactions to TMT, and some clients were even considered to be thriving in new ways. Family involvement in sessions also increased, which also presented positive effects on the treatment as a whole.

When working with technology, there are some drawbacks. Depending on the internet connection and other factors, there can be a lag in music playing or sound quality issues. Some clients may not have access to musical instruments, limiting the interventions that therapists can utilize in therapy. Older adults with dementia may also have difficulty with telehealth without a third party helping them in person. A therapist should always consider these things when determining if a client is a good candidate for telehealth music therapy.

Certified music therapists who had conducted at least ten telehealth sessions participated in a survey on their perspectives of telehealth music therapy. It reviewed their thoughts on the benefits and challenges of TMT, how to improve the practice, and what contributes to successful TMT implementation. Qualitative and quantitative data were collected from 572 music therapists from 29 countries. The majority of the therapists utilized humanistic approaches, followed by integrative and neurologic music therapy (NMT). A majority of them were therapists who also worked in the areas of private practice, followed by healthcare and education. These therapists treated a wide range of clients and diagnoses. However, the most common populations treated were children with developmental delays, individuals with intellectual and developmental disabilities, and mental health patients. When transitioning to TMT sessions, therapists said that there were changes in goal areas, with the most common goal areas being emotional expression, speech and language/communication, mood, anxiety, and cognition. The changes in goal areas depended on the specific needs of the clients. They noted that they mostly utilized singing, music-listening, songwriting, movement, and improvisation interventions. Although there was less success in using live and pre-recorded music in these sessions compared to in-person, the therapists stated that they were successful in utilizing both live and pre-recorded music most of the time. The study also highlighted that almost half of these therapists took additional training courses to improve their knowledge of technology and the implementation of TMT. Clients experienced increased access to music therapy, continuation of services during the pandemic, and therapy in the comfort of their homes. 

During and after COVID-19, TMT has been a way to provide specific individuals with care that they may not have access to otherwise. During the pandemic, TMT provided continuation of care, which was beneficial for therapists and clients. The pandemic made music therapists shift to TMT relatively quickly, and it has most likely advanced since 2020. Data collection for this study was collected from January through July of 2022 and provides a perspective of TMT two years after the onset of the pandemic. Recommendations from the study suggest that MTs should continue to assess if TMT is suitable for an individual and should consider a hybrid treatment plan that includes in-person sessions as well. TMT allows individuals of different circumstances the opportunity to get treatment, and therapists should consider furthering their education on cultural humility and competencies. Overall, telehealth music therapy is beneficial for many populations and can be easily facilitated in most cases by a trained music therapist. In conclusion, implementing this form of healthcare highlights the flexibility of music therapists and their dedication to the specific needs of their clients.

-Lila Finke, Music Therapy Intern

References

Clements-Cortés, A., Pranjić, M., Knott, D., Mercadal-Brotons, M., Fuller, A., Kelly, L., Selvarajah, I., & Vaudreuil, R. (2023). International music therapists’ perceptions and experiences in telehealth music therapy provision. International Journal of Environmental Research and Public Health, 20(8). https://doi.org/10.3390/ijerph20085580

Music Technology for Individuals with Disabilities

Instrumentation is a regularly used form of music that can be enjoyed and played by many. Most instruments are made for the neurotypical individual to use. Over time, instruments have been adapted and adjusted to meet the needs of individuals with various physical, intellectual, or mental disabilities to use and enjoy for themselves. There is a wide range of needs addressed in music therapy sessions. That being said, a music therapist’s job is to find ways to accommodate those needs by adapting various aspects of instruments to meet the client where they are.

One example of a way to adapt instruments is by using color coding, whether that be for strings on a guitar or ukulele, color-coded sheet music for bells, or colored dots to use on piano keys. Color coding, according to Dorothy Pino, assisted her guitar students with learning the guitar chords and strings. The students that she taught with these adaptations displayed more confidence and learned the guitar at a much quicker pace than individuals without them. Pino recommends using Orff color order, with C being red and each diatonic pitch remaining in rainbow order. This way, individuals will be more likely to learn other instruments quickly, as that is a universal color system for a variety of other instruments as well. Color coordination is also excellent for clumping and sorting musical sections to provide cues for individuals who may have trouble with knowing what comes next, sight reading, or having difficulty with change.

An article written by Carlin McLellan explores when and why to use music technology within sessions and how modifying musical instruments technologically can be beneficial despite music therapists’ initial hesitations. Some examples of modifications that have been made just recently, following the COVID-19 pandemic, include digital instrumentation, such as ROLI blocks, a Makey Makey connected to an application such as garage band, or even the eye harp, which utilizes client head/eye movements. ROLI blocks are light-up boxes that connect to an application and allow for various sounds to emerge based on where an individual touches the blocks. Similarly, the Makey Makey is an adaptive instrument that uses touch to create sound using an application and wiring to an outside object. These instruments provide musical output in a way that still allows clients to feel that they have autonomy within their musical realm.

The important thing to remember when working with clients is that instruments should be accessible and motivating, meeting them where they are in terms of physicality, cognition, or intellectual level. Instrumentation should provide a structure for meeting goals and objectives, but should also provide feelings of confidence and excitement. Simple switches with instrumentation can make all of the difference for individuals with disabilities and provide that support and structure to achieve the best results possible.

-Mallory McDonald, Music Therapy Intern

References

McLellan, C. (2021). The Accessible Music Model: A Framework for Understanding When, How, and Why to Use Music Technology in Music Therapy. Australian Journal of Music Therapy, 32(1), 113–123.

Pino, D. (2022). Color-Coding for Confident Chording. School Band & Orchestra, 25(5), 24.