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Music therapy and communication
A qualitative impairment in communication is another area
that is characteristic of individuals with ASD. Many children with ASD
have delayed speech and language or may even be non-verbal. Those that
do develop language may have difficulty engaging in social communication
in a typical manner. The give and take of conversation requires being
responsive to a partner’s non-verbal and verbal communication
as well as expressing ones’ own thoughts. The challenge of learning
effective communication skills is compounded for individuals with ASD
because of difficulty with the back and forth flow of social interaction.
It is difficult to separate social skills and communication since the
development of social skills is dependent on verbal and non-verbal communication
and communication occurs only within a social context. Typically developing
children learn communication skills so easily and naturally through
their social interactions with others. This is not the case for children
with ASD. They will need help deciphering the complexity of social communication.
This lecture will address just a few of the many communication skills
that might be addressed through music therapy.
Many children with ASD love music, or at least some kinds
of music and often have favorite musical audio or videotapes they watch
and listen to over and over. Some children with ASD may learn songs
they have heard again and again and some seem to quickly learn songs
they have heard only a few times. They may sing these songs to themselves,
repeating the words, intonation and rhythm exactly as they heard them.
They enjoy listening to the music and enjoy singing the songs again
and again. These same children may not be able to use spoken language
to answer simple questions or to tell others what they are thinking
about. Their speech may have an unusual rhythm or sound flat, lacking
the rise and fall of speech that lets their listener know if they are
asking a question or making a statement. They may be unable to speak
in sentences or even use 2 or 3 word phrases. It may be very difficult
for them to follow spoken directions such as “get ready for supper”
or “clean your room”. Learning new language concepts such
as the names of things, action words (jump, wave) or prepositions (under,
between) may also be a challenge. How can it be that this child is able
to sing an entire song perfectly but not answer a simple question? We
do not know for sure but we do know that music can be a bridge to learning
language and communication.
Some young children with ASD have great difficulty understanding
what language and communication is all about. They may not yet have
understanding of the “concept of words”, that the combination
of sounds coming out of someone’s mouth has meaning. They may
not even be able to distinguish the sound of another’s voice from
the sound of the dishwasher or birds chirping. They may have difficulty
alerting to sound, shifting their attention to the sound or finding
the source of the sound. All of these early listening skills are necessary
to begin understanding spoken language. Saperston (1972) taught initial
awareness of cause effect by relating musical tones on piano with an
eight-year-old boy’s movements (walking, stomping, rocking, shuffle
steps, hand pounding). The sessions progressed from initially no awareness
to stopping and starting, quick glances to therapist, growing recognition
that his movements resulted in music, increased movements, smiling and
eventually laughing in response to music, and increased eye contact
when therapist sang only when the child was looking at him.
Music can be an avenue for teaching sound awareness,
localizing sound, listening, discrimination, sound patterns, intonation,
and pacing. For instance, the simple skill of alerting and pausing to
listen for a moment might be taught by playing a variety of musical
instruments that are pleasurable and interesting to the child. Recognition
of the presence and absence of sound can be addressed through periods
of silence interspersed with the playing of musical instruments. Once
established, these skills can be expanded into localizing sound as the
therapist moves about the room or finding a hidden music maker. The
child’s ability to discriminate sounds may be enhanced through
the use of Musical Interaction Therapy (MIT) described in the
previous section. The predictable, repetitive patterns and sequences
provide a non-verbal base that supports understanding of spoken language.
For example, the therapist might begin by playing cords that match the
child’s movements and then add words that describe those movements
along with the cords. The child hears spoken language tied to their
actions with in the context of a familiar, enjoyable activity. Once
a child has the initial understanding that spoken language has meaning,
vocabulary development becomes an important goal. Vocabulary development
begins with understanding and using single words and gradually builds
to more complex phrases and sentences. The rhythm and repetition of
a song can highlight and emphasize the words or phrases to increase
understanding of language. Using language to communicate for a variety
of purposes is just as important as learning to understand and speak
the words.
Ellen was able to ask for the things she wanted using
single words. She did not learn new words easily and did not use her
words to answer questions or to tell people things. The music therapist
found there were a few nursery rhymes Ellen enjoyed listening and dancing
to. The music therapist changed the words of one of these simple, repetitive
rhymes and used it to teach Ellen to say the names of common objects
when asked. The words to the song were, “What’s in the bag?
What can Ellen find? Put your hand in, look and see.” Then “Ellen
found a _____. Ellen found a ____. Give the ___ to me.” She placed
a variety of common objects in a cloth bag, presenting the bag to Ellen
and guiding her to take an object out of the bag right before the part
of the song where she named the object. Ellen immediately enjoyed listening
to the song and taking the objects out of the bag. The music therapist
began to pause before naming the object Ellen took out of the bag. Ellen
started holding the object out and looking at the therapist waiting
for her to name the object and gradually began to name them herself.
The therapist taught this activity to Ellen’s mom who was pleased
to have a way to teach her daughter using an activity she and Ellen
could enjoy together.
It is not uncommon for children with ASD to have an unusual
voice quality. Music may be the intervention of choice to teach more
appropriate voice quality. The melody of a song stays the same every
time it is played unlike spoken language where the same phrase can have
very different intonation depending on the speaker and context in which
it is used. This consistency may reduce confusion and provide the practice
needed to learn how to use a more natural voice.
Andy spoke in phrases and short sentences. He was able
to answer and ask questions and could talk to others about things and
ideas. His speech was flat and had a steady rate and rhythm making it
sound robotic and emotionless. A music therapist was consulted to develop
an intervention program to increase his ability to use intonation, rhythm
and rate of his speech to match the meaning of what he wanted to say.
The music therapist designed and implemented a program that included
teaching emotional expression, pacing and intonation patterns. She wrote
a simple song with verses that gave simple explanations for a variety
of reasons people talk to each other, emphasizing the intonation pattern
and rate commonly used for each reason and using common phrases associated
with the intended meaning (“Hey, look at this!” for I want
to show you something, “That’s cool!” to compliment
others, “Can I have a turn?” to join others in play). She
accompanied the song with keyboard to help emphasize the emotional tone
of each verse. At first Andy just listened, then he began to sing a
long using the intonation patterns and pauses modeled by the therapist.
The therapist gradually faded the use of the keyboard and found Andy
was able to maintain the appropriate rate, rhythm and intonation patterns
of the phrases used in the song. His parents began to hear Andy use
these phrases during their interactions with him. Andy seemed to take
more interest in the emotional content of what others said and began
to first imitate then use rate, rhythm and intonation patterns more
appropriate to the meaning of his language.
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