Music Therapy

This research explores musictherapy in special educational school setting with a particular focus onchildren with autism. The literature will aim to discuss music therapy in depth,the history of the diagnosis of autism, as well as some of the barriers facedby children with autism and how they are affected by music therapy. Precedingqualitative studies and small samples of quantitative studies have proposedthat music therapy is a viable treatment for children with autism. Howeverthere are others who may say otherwise. A valid argument presented by Freeman(1997) states that the most vital thing to remember when endeavouring toevaluate any treatment program is that every child with autism is an individualand what is appropriate for one child may or may not be appropriate for another(p.

647).DefiningMusic Therapy:Music therapy, originating in the United States ofAmerica the 18th century, has fast become a stimulating profession,persistently evolving all over the world (Bruscia, 1998). Gourney(1998) describes how music therapy is an growing discipline, one that has been required to develop quickly in cultures wherehealth experts are required to create results ‘no less spectacular than spacetravel’ (Bruscia, 1998). Unfortunately, it could be argued that countlessamounts of people are not familiar with music therapy as aprofession or the possible benefits that can be attained in the therapeuticapplication of music (Wigram, Saperston & West, 2013).

Adefinition sets limitations, but defining music therapy is challenging toattain (Bruscia, 1998). Music therapy can betermed as a ‘transdiscipline’ (Bruscia, 1998) which can create a common misconception in peoplethat music teachers can provide the same interventions as a music therapist(Wilson, 2002). As of theyear 2017, Ireland does not have its own definition for music therapy butaccording to the Irish Association of Creative Arts (IACAT), they adhere to thedefinition given by The American Music Therapy Association (AMTA). TheAmerican Music Therapy Association (2002) defines music therapy as: ‘Theclinical and evidence-based use of music interventions to accomplishindividualized goals within a therapeutic relationship by a credentialedprofessional who has completed an approved music therapy program…the prescribeduse of music by a qualified person to effect positive changes in thepsychological, physical, cognitive, or social functioning of individuals withhealth or educational problems. Music therapy is considered a powerful andnon-threatening medium and because of it, unique outcomes are possible (AMTA,2002)’.

During WorldWar I and World War II musicians in the United States visited hospitals to helpinjured veterans, changes were observed through the emotional and physicalreactions to music that the demand for additional training in the psychology and therapeuticbenefits of music evolved (Wilson, 2002). Although the therapeutic benefits ofmusic have been recognised since primitive times (Peters, 2000), it is only inthis century that music therapy is progressively accepted as being significantto a wide range of healthcare and social contexts which include areas ofgeneral medicine, mainstream education and community practise (Bunt and Stige,2014). Music therapy is implemented byqualified professionals and is most universally used for individuals with specialneeds (Peters, 2000). The importance of music therapy is using a musicalapproach to attain objectives in the areas of motor skills, social development,self-awareness, and cognitive development (Patterson, 2003). Music therapy delivers anunthreatening and structured environment which cares for the children’spreference for sameness and desire for predictable events (Bruscia, 1998).Ethics:Similar toother therapist music therapists have ethical duties that they must abide by. According to Dileo (2000) the professionalethics for the music therapist have been established through exploration. Musictherapists are accountable to uphold ethical behaviour.

Some ethical issuesthat a music therapist must follow are; boundaries, professionalism, confidentialityand different perspectives (Dileo 2000). In 1993 Ireland first IACAT AGMoccurred, here a code of ethics for the creative arts therapists wasestablished (iacat.ie).

Unfortunately in 2006 it was reported by Keaveney thatin the Republic of Ireland anyone can call himself or herself a ‘musictherapist’. This creates more contingency for an unqualified music therapist todamage the credibility of the profession. Perhaps through an absence inmotivation from the Government to change the status of the discipline, anopening may have been created between qualification and professionalrecognition. This gap according to Keaveney (2006) is inundated by people whohave the best intentions and an interest in the arts and health but are notessentially qualified to implement clinical interventions as music therapists. Healthcare:Clinical studies have shown thebenefits of music therapy with dementia patients, reducing asthma episodes,pain relief, improving communication capabilities with autistic children, improvingmotor function with patients who have Parkinson’s disease and to improve sleeppatterns and increase weight in premature babies (Musictherapy.org, 2017). Buntand Stige (2014) show how music therapy is accepted as being appropriate to awide range of healthcare and social contexts. There is an increasing awareness of thecollaborations now being created between music therapists and otherprofessions.

Researchers such as Twyford and Watson (2008) have conversed rethe effects of multidisciplinary collaboration between music therapists andother professionals. Licht (1996) talked about the idea of music in medicine,involving it alongside occupational therapy (OT). Instruments as well as thevoice would have been implemented in OT for the mobilisation of joints.

SpecialEducational Needs Schools: Allchildren, including children with special educational needs, have a right to aneducation which is appropriate to their needs (Department of Education andSkills, 2004). At present there are over 140 special schools in Irelandproviding for specific types of disability and special needs(Citizensinformation.ie, 2017). Among them are: special schools for studentswho have a general learning disability at a mild or moderate level; schools forvisually impaired and hearing impaired students; a few schools for studentswith physical disabilities; a small number of special schools for students whoare emotionally disturbed (Citizensinformation.ie, 2017).

Similar to the evolution of Music Therapy in Ireland,the availability of public education in Ireland for students with disabilitiescontinues to evolve and move in new directions. Special schoolswere established as far back as the beginning of the nineteenth century, mainlyfor the purpose of providing education for children with sensory impairments.According to Dempsey and Forman(2001), in more recent years music therapy has become an emergent therapyinstigated amongst children on the autism spectrum. In a school setting the aimof a music therapist is to evaluate the child’s needs and to instil academic andsocial skills in areas of weakness both with and without music (Patterson,2003). Clinical studies focused on school-age children diagnosed with pervasivedevelopmental disorder (PDD) and, in particular, autism show extensiveimprovements when music therapy is used (Duffy and Fuller, 2000).

Brownell(2003) noted that improvements were seen in behaviour, communication and socialskills with autistic children.DefiningAutism:Autismhas fast become one of the most predominant childhood conditions of this era,with reports that an estimated 1 in 88 children are born with autism (Sahey,2016) in comparison to a ratio of 1 in 150 a few years back (AmericanPsychiatric Association, 2003). Autism is not an illness or a contagiousdisease but rather a developmental disability that affects a person’s capabilityto communicate, understand language, play, and interact with others (Dunlap etal., 1999). The neurological disability is assumed that it is existent frombirth and always apparent from the age of three, the exact cause of autism isstill unknown (Sahey, 2016). The definition of autism is based on the patternsof behaviours displayed by the child (Sahey, 2016). The clinical picture ofautism varies in degrees and is altered by many factors, including education,ability and temperament (Hill and Frith, 2003).

There are many characteristicsof autism and people may fall on the lower or higher side of the autismspectrum. Clinical features of autism spectrum disorders may include atypicalsocial responses and behaviours, inadequacies in speech and language, mentaldisorders, repetitive behaviour, poor eye contact, and an infatuated persistenceon sameness (Bauman & Kemper, 2005). Communication,Behaviour, Emotion:Childrenwith autism spectrum disorders have deficiencies in behavioural, communication,emotional and cognitive areas (Wing, 1981). These areas of weakness are closelyrelated to each other that when an autistic child has impairments incommunication, there will unavoidably be related deficiencies in behaviour,emotions and cognition.

1. Communication:Peoplewith autism often have developmental difficulties in verbal and non-verbalcommunication skills (Sahey, 2016). Anything that one does with other peoplemust include communication (Hartley, 2002). Communication can be defined inmany ways; for instance it is being able to speak and write properly, or beinga good listener (Hartley, 2002). It can be argued that communication is themost challenging part for autistic children (Bauman & Kemper, 2005). Accordingto Kanner (1943), children will autism exhibit many difficulties with language,some of these include: muteness, delayed echolalia (repetitiveness of words orphrases), pronoun reversals, word substitution, and literalness, with most noticeablecommunication deficit being spontaneous speech. Ina changing world music has remained a central part of human life and it has haddistinct effects on children and adults. Raffman (1993) stated that musicitself acts as a means of communication.

If we trace back through history,music will be found throughout various cultures where it was used for healingillnesses, rituals or artistic means. Although this remains the same todaymusic has now becoming a functional tool in modern society which can be seen asan instrument for entertainment, emotional expression and communication. Musichas fast become a form of non-verbal communication for humans supportingGaston’s (1968, p15) claims that ‘music is an essential and necessary functionof man’.Pronovost(1961) states that children with an autistic disorder who do not respond appropriatelyto verbal communication or communal speech respond to language used throughmusic. Similarly Davis et al., (2008) argues that autistic children achievegreater triumphs with the basic skills when using music as a medium thanwithout.

Literature has acknowledged the advantage of using music to teachchildren with autism and have instigated following studies where music is usedas a support in modifying behaviour (Patterson, 2003). Hairston (1990) examinedthe effectiveness of music therapy on communication with those who had severeautism, during the five week intervention positive results were recorded in thechildren’s communicative ability.2. Behaviour:Byreason of the weighty difficulties in successfully communicating as mentionedabove, children with autism may experience recurrent incidences ofcommunication breakdowns as both speakers and listeners which may impact thebehaviour of the autistic child (Stokes, 2017). It is acknowledged that insome individuals with autism spectrum disorders may exhibit aggressive and/orself-injurious behaviours (O’Reilly et al, 2005). Music therapy can assistmutual behaviours which relate to the social-communicative development ofchildren with autism spectrum disorders (Benenzon, 1981).  Repetitive and obsessive behaviour is acommon behavioural characteristic of an autistic child (Hill and Frith, 2003).

Thecondition involves an incompetence to participate in the conventional socialinteractions (Stokes, 2017). Hill and Frith (2003) explain this by acknowledgingdeficiencies in the initiation of new actions and the inclination to be trappedin a given task set. Due to a compulsive need for sameness the learning environmentfor the autistic child must be very structured (Rump et al, 2009); musictherapy can be used to create an environment in which a child with ASD canlearn more naturally.Accordingto Berger (2008) music therapy has the capacity to train the brain systems ofchildren with autistic spectrum disorders. Music, as a repetitive stimuli, canaid children with autism to cypher sensory information correctly (e.g.

introducing a melody into daily routines and the melody is familiar to orrepeatedly sang to the child) (Berger, 2008). Kern and Aldridge (2006)conducted a study where two customized songs tailored for two children withautism spectrum disorders in the morning routine were used (e.g. entering theschool and greeting teacher and peers). Both songs specified the steps of thegreeting routine and the children’s teachers were taught how to sing the songin the morning routine for the objective of the child. Results showed that thesongs helped the children in carrying out the morning routines (e.

g. greetingthe teachers and peers). Emotion:Anincapability to control emotions or to respond to emotions in others has been assumedas a key deficit in autism (Rump et al, 2009). Gaigg (2012) acknowledges thatpeople with autism express difficulties in their understanding of self andothers is in the comprehension of emotions. People with autism commonly fail torespond applicably to the emotions of others, and many academics have proposedthat a deficiency in emotional expression recognition may add to these incongruousreactions and to their understanding of emotion in general (Rump et al, 2009).These difficulties experienced by the autistic individual relates back to thesocial-communicative characteristics of the condition.Aperson with autism will struggle with monitoring their emotions (Bauman , 2005).  Using music to controlour emotions resonates with many people.

According to Juslin and Laukka (2004)emotion is at large connected to people’s main purposes for listening to music.Researchers claim that music has the capability to change, release, induce, andmatch emotions (Dimaio, 2010; Juslin & Vastfjäll, 2008). The ability tomaintain a well-regulated emotional state to cope with everyday stress, and tobe the most available for learning and interacting is extremely difficult forchildren with autism (Sahey, 2016). Ina study conducted by Kim et al. (2009) measured emotional variables includingjoy significant and emotional synchronicity. The first two variables weremeasured by duration and frequency and the latter one was only measured only bythe frequency. Results of the study were suggestively positive, arguing thatmusic therapy had a positive impact on the clients’ emotional functioning.Thompson et al.

(2013) measured a similar variable in the research. In allowingthe autistic child to experience music therapy could have a positive effect onthe emotion regulation, even when the music therapist is not present. It hasbeen shown that repetitive exposure to music has a positive effect on numerousbrain structures that underwrite an individual’s capability to understand andregulate their own emotions (Schmahmann, 2010).

Unfortunately,there is an inadequate quantity of study that measure the effect of musictherapy on the emotional outcomes among the ASD population (Dimaio, 2010). Conclusion:In conclusion, areview of the literature reveals that music may be beneficial and soothing forthose on the autism spectrum. The research lacks significant studies as to thebenefits of music as an educational tool for communication skills with childrenwith autism. In the next chapter, the investigator will describe themethodology utilized in her study, which is designed to attempt to find thespecific affects to communication, behaviour and emotions through music therapyfor children on the autism spectrum.