Music Therapy and Adults with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition (Bergmann, 2016) defined by deficits in social communication and interactions paired with restricted, repetitive behaviors, activities, and interests (Velikonja, 2019; Andersson, 2020). Goals and objectives for adults with ASD seeking treatment can be addressed during music therapy sessions. Music therapy positively impacts adults with autism spectrum disorder by assisting in activities of daily living, social interaction, and cognitive function. Music therapy interacts with adults with ASD through improvisation, group music-making activities, and various other interventions to improve their quality of life. Symptoms and severity range in every person diagnosed with ASD, and how the condition progresses into adulthood is also unique to the individual and their level of care.

Activities of Daily Living [ADLs] are the everyday tasks (such as cooking, cleaning, and sustainability) that can be impacted by an individual’s diagnosis. Within ASD specifically, “Clinical characteristics… influence the relationship to the self, to other people, and to objects and thus include all areas of life” (Bergmann, 2016). Andersson (2021) released an article that studied positron emission and serotonin availability in adults with ASD and how this affects performance in cognition and functioning compared to neurotypical adults. They found that adults with ASD perform lower in social cognition, executive function, and central coherence (Andersson, 2021). The two most common goals for adults with ASD are understanding behavior and how it affects their lives and developing executive functioning skills.

Music therapy, as a treatment for ASD, can be rewarding and exciting for patients. Adults benefit from music therapy in the areas of “regulation/behavioral variability, imitation, disorders pertaining to different areas related with instinct, emotional disorders and interaction disorders” (Mateos-Moreno, 2013). The structure of music therapy can be comforting for adults with ASD because it can be uniquely tailored to their needs and wishes. A commonality amongst people with ASD is the comfort they receive in predictability and structure, and music therapy can provide that for its patients. Tony Wigram developed many improvisation techniques in music therapy that can be applied when working with adults with ASD. Improvisation is particularly effective in understanding emotions and emotional regulation. Portraying different emotions through piano or drumming can help a client connect with that particular emotion and how they can express it when it arises in their daily life. Group music-making allows adults with ASD to create joyful experiences and connections with their peers (Mateos-Moreno, 2013). An example of music therapy being used for adults with ASD was in 2013 when The Arts in Psychotherapy released an article discussing music and dance/movement therapy’s impact on adults with ASD. Their session started with everybody entering the room with soothing music and forming a circle. They then stated their names using a drum since the rhythm enhances the memory process. They continued the exercise by expressing their feelings by using the drum. After each client said their name and how they felt, the rest of the group chanted it back to them. This encouraged the participants to remember the details of their fellow peers and validate what the individual stated. Music therapy is a beneficial treatment option for adults with ASD because it is fun, safe, and inclusive and reaps real benefits for adults in the ASD community.

-Janelle Lockney, Music Therapy Intern

References:

American Music Therapy Association. (2005). What is Music Therapy? American Music Therapy Association. Retrieved 2022, from https://www.musictherapy.org/about/musictherapy/

Anderson, M. (2021). Serotonin transporter availability in adults with autism - a positron emission tomography study. Molecular Psychiatry. Vol.26(5), pp. 1647-1658

Bergmann, T. (2016) Music in diagnostics: Using musical interactional settings for diagnosing autism in adults with intellectual developmental disabilities. Nordic Journal of Music Therapy. Vol.25(4), pp.319-351

Buijsman, R. (2022). ‘Autistic man’ or ‘person with autism’?: Person-first language preference in Dutch adults with autism and parents. Autism: The International Journal of Research and Practice. Pp. 13623613221117914-13623613221117914

Mateos-Moreno, D. (2013). Effect of a combined dance/movement and music therapy on young adults diagnosed with severe autism. The Arts in Psychotherapy. Vol.40(5), pp. 465-472

Roberson, K. (2019). Goals of therapy for adults with autism spectrum disorder. Kenneth Roberson PhD. Retrieved July 2022, from https://kennethrobersonphd.com/goals-of-therapy-for-adults-with-aspergers/

Velikonja, T. (2019). Patterns of nonsocial and social cognitive functioning in adults with autism spectrum disorder: A systematic review and meta-analysis. JAMA Psychiatry, Vol.76 (2), p.135-151.

Final Farewells

Reflecting on my time here at Therabeat Inc., I have grown so much from when I first started. With the support of my supervisors, I created new music games, helped clients reach their goals, and built a library of materials. I learned how to go with the flow during co-treats and address the client’s needs such as needing a break or moving around.

I have learned many valuable lessons. For instance, I learned how to play the ukulele. Before this internship, I had never played the ukulele. Now, I can play and teach clients how to play the ukulele in sessions. I have learned how to think on my feet and think outside of the box. For instance, when a client requested more of the gong during her physical therapy session. I used the gong and her preferred music to cue her to cross midline to play it.

Other skills I have learned include how to look at a chord sheet and keep eye contact with the client and the importance of small talk during a session. I found that talking with the clients during the session created a positive client therapist bond and I learned more about the client. It helped to inform the way I plan to create more opportunities for clients to reach their goals. For instance, using their preferred music to write a song to work on goals such as answering questions and creating original ideas.   

One of the memories I look fondly on is seeing how well all my clients did at the recital. They all worked so hard to perform for their family and friends. For instance, one client successfully played and sang his song. The joy and pride he felt for his performance reminded me why I am a music therapist in the first place. Another fond memory I have with a client is a client diagnosed with autism. She was working on spelling and pronunciation words, so I brought visuals, a letter puzzle, and a song with an easy melody to remember. Within 2 weeks, she could spell and pronounce 3 words of the song. Not only did I help her develop her speech and academic skills, but it made me feel accomplished as a music therapist.

Thank you to Therabeat Inc. for giving me the confidence and skills that you have taught me. I will carry all the memories and lessons to my next adventure. I am not sure where I will be, but wherever I go I know I will be ready thanks to this internship. Farwell Therabeat Inc. You will always have a special place in my heart.

-Teresa Dominguez, Music Therapy Intern

Music therapy and Treating Children Who Experienced Abuse and Trauma

Trauma can occur at any age, however, children who experience trauma may experience effects on many parts of their development. Developmental trauma or reactive stress disorder is when a child is in a constant state of stress (Drevitch, 2018). A situation that can cause constant stress is abuse. The constant stress disrupts a child’s development (Drevitch, 2018). According to Drevitch, “Development of upper parts depends upon prior development of lower parts. In other words, the brain is meant to develop like a ladder, from the bottom up” (p. 1, 2018). If a child is raised in a healthy environment, the upper and lower parts of the brain have a good foundation to continue to develop and grow. However, for children who have experienced trauma such as abuse, that crucial part of their foundation during development is missing. These delays in development can manifest as sensory processing disorder, attention-deficit/hyperactivity disorder (ADHD), and speech delays (2018). Children who experience trauma need therapy to process their experiences and address their needs.

An assessment created by Bruce Perry called Neurosequential Model of Therapeutics (NMT) is used to assess the brain development of those who have developmental trauma (Drevitch, 2018). The areas of the brain that are assessed include sensory integration, self-regulation function, relational function, and cognition (Douglas, 2022). After the assessment is complete, the scores show the neuro-developmental needs of the child being assessed. Information collected in this assessment includes the history of the child’s past and present and 32 areas of the brain (Douglas, 2022). The assessment maps out the brain to show the child’s current functions, age development, and relational health (Douglas, 2022).  

How does music therapy address the needs of a child who experiences trauma? Music therapists use a variety of methods including re-creative, improvisation, compositional, and receptive music therapy techniques. For instance, a music therapist used improvisation with an 8-year-old girl named Kelly who experienced sexual abuse (Strehlow, 2009). The music therapist began by giving Kelly space to reenact of the trauma through music (Strehlow, 2009). Kelly would play the recorder by herself first, but once she was comfortable she allowed the music therapist to play along with her using the xylophone. After the music therapist had gained her trust, they reenacted the trauma through the instruments and role playing. The music therapist’s role was to support the child’s expression of the trauma and promote self-expression.

A music therapist using re-creative technique focusing on a child named Larna (3 years old) who experienced physical abuse (Pasiali, 2013). The music therapist used singing songs with instruments/props to address the child’s needs. The goal was to learn to play and explore (Pasiali, 2013). The songs used were age-appropriate songs, tunes with different modalities, and chants with instruments and props such as using a scarf to put over Larna’s head to pretend she was a princess while singing (Pasiali, 2013). Larna would sit on her mother’s lap and cuddle with her when singing songs. Other interventions included sitting on a parachute and playing games that involve singing short melodic phrases while touching another person at the end of each phrase pretending to “buzz” them (Pasiali, 2013).

Another music therapist who treated a child named Sally who experienced sexual abuse using a receptive technique. Sally went to music therapy from the age of 7 to 14. Music therapist worked on developing trust between Sally and the therapist (Robarts, 2006). The goal of each session included self-regulation and sensory integration (Robarts, 2006). The music therapist would play music and encourage her to play along. The music therapist would base the tempo and rhythm of the music on Sally’s mood and flashbacks during the session (Robarts, 2006). During the session, the music therapist was viewed as one of her abusers and the music therapist would address this by playing a steady rhythm and melody. The music would help to ground Sally and bring her back from her flashbacks (Robarts, 2006). It even inspired her to play with the music therapist (Robarts, 2006).

Another music therapist who treated a 5-year-old child named Leah who experienced sexual abuse, physical abuse, and neglect using a technique called compositional (Christenbury, 2015). The music therapist treating Leah used a compositional intervention called songwriting. The songs written during the session were based on Leah’s emotions such as being happy or sad (Christenbury, 2015). Emotions such as anger were more negative emotions and related to her trauma. Leah would draw pictures of what her emotions look like to her and the music therapist would work with her to create music to go along with her pictures. Leah would direct the music therapist to color with her using specific colors (Christenbury, 2015). All the pictures and lyrics were put into a book and the music therapist recorded all music for Leah to take with her. The pictures and music such as using minor keys for sad emotions reflect what Leah was feeling and process her feelings of sadness.

Music therapy supports children who have experienced trauma to process, self-regulate, cope, and build healthy relationships with others. For instance, in the case studies of Larna and Kelly the music helped them to build relationships with others by learning how to trust. In Sally’s case, she was able to entrain to the beat to bring her out of her flashbacks and prompted her to participate in making music (Robarts, 2006). Entraining to the beat helped Sally to learn how to self-regulate. Leah’s songwriting helped her to process current and past events (Christenbury, 2015). Music therapy supported these children in their journey to reach their goals and move past their trauma to trust and grow to be the best they can be.

-Teresa Dominguez, Music Therapy Intern

References:

Christenbury, R. K. (2015). I will follow you: The combined use of songwriting and art to promote healing in a child who has been traumatized. Music Therapy Perspectives, 35(1), 1 – 12. https://doi.org/10.1093/mtp/miv005

Douglas, A. C. Meeting children where they are: The neurosequential model of therapeutics. National Council For Adoption. (2022, March 15). ttps://adoptioncouncil.org/publications/meeting-children-where-they-are-the-neurosequential-model-of-therapeutics/

Drevitch, G. (2018). What is developmental trauma? Psychology Today. Sussex Publishers. https://www.psychologytoday.com/us/blog/expressive-trauma-integration/201808/what-is-developmental-trauma

Pasiali, V. (2013). A Clinical Case Study of Family-Based Music Therapy. Journal of Creativity in Mental Health. 8(3), 249 – 264. http://dx.doi.org/10.1080/15401383.2013.821925

Robarts, J. Z. (2006). Music Therapy with Sexually Abused Children. Clinical Child Psychology and Psychiatry.

Strehlow, G. (2009). The use of music therapy in treating sexually abused children. Nordic Journal of Music Therapy. 18(2), 167 – 183. https://doi.org/10.1080/08098130903062397

Music Therapy in the Neonatal Intensive Care Unit (NICU)

What is the Neonatal Intensive Care Unit (NICU)? The NICU is a unit in the hospital for babies who are preterm (born before 37 weeks), have low birth weight (less than 5.5 pounds) or sick babies who need more intensive care. Babies can also be admitted into the NICU if they are not sick, but need specialized nursing care. Other causes for infants to be admitted include the health of the mother during birth such as high blood pressure, what happens during delivery such as fetal distress, or the health of the baby after birth such as low blood sugar. The treatment team in the NICU consists of a neonatologist, neonatal fellow, and pediatric resident. (Stanford Medicine Children’s Health, 2024). The doctors and nurses do a great job in caring for babies in the NICU, but how can music therapy help?

NICU Music Therapy is the use of musical elements by a certified MT-BC to address goals of infants in the NICU (AMTA, 2021). There are many benefits to music therapy being involved during an infant’s stay in the NICU. Benefits include increased parent/caregiver satisfaction, increased cost effectiveness, and increased cultural efficacy (2021). For instance, the AMTA fact sheet talks about increased weight gain and decreased length of stay as a result of music therapy. One of the ways this is achieved by a music therapist using a device called Pacifier Activated Lullaby (PAL) System (2021). The PAL system has a pre-recorded lullaby that is only activated by the sucking motion of the infant. Learning the sucking motion helps the infant feed and gain weight. The result of the infants learning how to feed and gain weight, decreases the length of their stay in the NICU (Cevasco A. & Grant R., 2005). By decreasing the length of their stay, it reduces the cost for both the family and the hospital.

Music therapy can also help the parent/caregiver to bond with their infant. The music used include lullabies and songs related to the culture/tradition of the parents/caregivers. Music therapy also reduces the parents/caregivers stress and boosts their confidence in their parenting skills (Gooding, J. et al., 2011). 

Although music therapy is beneficial for infants and their families, there are a few cases in which an infant would not be eligible to receive music therapy. For instance, infants under the age of 28-weeks should not receive music therapy because they are highly sensitive to light and sound. Infants in the NICU are sensitive to environmental factors such as light and sound. They can get overstimulated easily, which can cause their heart rate to increase (AMTA, 2021).

NICU-music therapists bring joy and comfort to both the parents and the infant. Music therapy can reduce the amount of time the infant stays in the hospital, which reduces the parents/caregivers stress. It also can help the infant learn the skill of sucking for feedings and bond with their parent/caregiver through the music of their culture/traditions. If the NICU-music therapist follows the guidelines of the facility and uses their training, they can help many babies in the NICU go home sooner and begin to reach developmental milestones. For more information on other intervention or information on training sites for NICU-music therapy visit www.musictherapy.org.

-Teresa Dominguez, Music Therapy Intern

References:

AMTA (2021). Music therapy and the Neonatal Intensive Care Unit (NICU). American Music Therapy Association. (2024). https://www.musictherapy.org/assets/1/7/FactSheet_Music_Therapy_and_the_Neonatal_Intensive_Care_Unit__2021.pdf

Cevasco, A. & Grant, R. (2005). The effect of the Pacifier Activated Lullaby on weight gain of premature infants. Journal of Music Therapy, 46(3), 273-306.

Gooding, J., Cooper, L., Blaine, A,, Franck, L., Howse, J., & Berns, S. (2011). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars in Perinatology, 35(1), 20-28.

Stanford Medicine Children’s Health (2024). The Neonatal Intensive Care Unit (NICU). https://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-nicu-90-P02389

Music Therapy and Parkinson’s Disease

What is Parkinson’s Disease (PD)? PD is a degenerative disorder of the central nervous system (Magee, 2013). Symptoms begin slowly and may be barely noticeable such as tremor in one hand. Other symptoms include stiffness, moving slowly, impaired posture and balance, lack of facial expressions, changes in writing, and soft or slurred speech. Causes of PD include environmental toxins, genetic factors, Lewy bodies in the brain or Alpha-synuclein found within Lewy bodies. The average age of someone being diagnosed with PD is 60 or older. It is rare for someone younger to be diagnosed with PD, but it is possible. Women are less likely than men to be diagnosed with PD. Currently there is no cure for PD, but there are medications to improve symptoms and surgery can help regulate the affected regions of the brain (Mayo Clinic, 2024).

How can music therapy help people diagnosed with PD? Music therapy has been shown to improve motor skills, mood and coping skills, and voice quality. Interventions used to improve PD symptoms include rhythmic auditory stimulation (RAS) and group singing. RAS is a music therapy technique that addresses motor control in rehabilitation by using rhythmic cues to cue motor movements. Group singing is a music therapy technique that uses singing in a group to address speech goals and gives the person the opportunity to socialize with others.

A study done by Chumma (2007) uses RAS to treat gait disorder in those with PD. Gait disorder causes imbalance, shuffling, frequent falls, staggering, and freezing. RAS was used to keep a steady beat during exercises. The results showed improvement in the patience’s motor function and the possible benefits of RAS during exercise training (Chumma, 2007). 

An interview with a music therapist Ruth Breuer conducted by Williams (2019), discusses the use of regulative music therapy to address a client with PD’s mood and coping skills. Breuer used mindfulness exercises in addition to regulative music therapy (Williams, 2019). During the interview, Breuer shared that regulation music therapy encouraged discussion and the development of coping skills (Williams, 2019).

Another study conducted by Elefant et al (2012), worked on speaking, singing quality, and depression symptoms with those diagnosed with PD. Some people with PD have difficulties with speaking and may avoid social situations (Elefant et. al., 2012). This study had 10 participants and was conducted over the course 20 weeks. The music therapist used group voice and singing techniques in weekly sessions. The results of the study showed improvements in their voice and singing range, but not in their speech quality. Even though their speech quality did not improve, the quality of their speech did not decrease (Elefant et. al., 2012). The data supports the use of group singing to improve the quality of a person’s voice with PD. However, more research needs to be done to see all the benefits that this method has to offer.

Music therapy has many benefits for treating those with PD. As the research demonstrates, music therapy can improve motor skills, mood and coping skills, and voice quality. Further research will certainly continue to support these and other benefits.

-Teresa Dominguez, Music Therapy Intern

References

Chuma, T. (2007). Rehabilitation for patients with Parkinson’s disease. J Neurol 254, IV58-IV61. https://doi.org/10.1007/s00415-007-4010-1

Elefant, Cochavit, PhD., M.T., Baker, Felicity A, PhD., R.M.T., Lotan, Meir, M.ScP.T., PhD., Lagesen, S. K., M.A., & Skeie, Geir Olve,M.D., PhD. (2012). The Effect of Group Music Therapy on Mood, Speech, and Singing in Individuals with Parkinson's Disease - A Feasibility Study. Journal of Music Therapy, 49(3), 278-302. https://ezproxy.queens.edu/loginurl=https://www.proquest.com/scholarly-journals/effect-group-music-therapy-on-mood-speech-singing/docview/1181173563/se-2?accountid=38688

Magee, Wendy I. (2013). Guidelines for Music Therapy Practice in Adult Medical Care. Barcelona Publishers.

Mayo Clinic (2024). Mayo Foundation for Medical Education and Research. (2024, April 5). Parkinson’s disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055 

Williams, E. T. (2019). Development of Regulative Music Therapy guidelines for early to mid-stage Parkinson's disease. The Australian Journal of Music Therapy, 30, 54-66. https://ezproxy.queens.edu/login?url=https://www.proquest.com/scholarly-journals/development-regulative-music-therapy-guidelines/docview/2407609042/se-2?accountid=38688