Music Therapy

This research explores music
therapy in special educational school setting with a particular focus on
children 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 faced
by children with autism and how they are affected by music therapy. Preceding
qualitative studies and small samples of quantitative studies have proposed
that music therapy is a viable treatment for children with autism. However
there are others who may say otherwise. A valid argument presented by Freeman
(1997) states that the most vital thing to remember when endeavouring to
evaluate any treatment program is that every child with autism is an individual
and what is appropriate for one child may or may not be appropriate for another
(p. 647).

Defining
Music Therapy:

Music therapy, originating in the United States of
America 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 where
health experts are required to create results ‘no less spectacular than space
travel’ (Bruscia, 1998). Unfortunately, it could be argued that countless
amounts of people are not familiar with music therapy as a
profession or the possible benefits that can be attained in the therapeutic
application of music (Wigram, Saperston & West, 2013).

A
definition sets limitations, but defining music therapy is challenging to
attain (Bruscia, 1998). Music therapy can be
termed as a ‘trans
discipline’ (Bruscia, 1998) which can create a common misconception in people
that music teachers can provide the same interventions as a music therapist
(Wilson, 2002). As of the
year 2017, Ireland does not have its own definition for music therapy but
according to the Irish Association of Creative Arts (IACAT), they adhere to the
definition given by The American Music Therapy Association (AMTA). The
American Music Therapy Association (2002) 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…the prescribed
use of music by a qualified person to effect positive changes in the
psychological, physical, cognitive, or social functioning of individuals with
health or educational problems. Music therapy is considered a powerful and
non-threatening medium and because of it, unique outcomes are possible (AMTA,
2002)’.

During World
War I and World War II musicians in the United States visited hospitals to help
injured veterans, changes were observed through the emotional and physical
reactions to music that the demand for additional training in the psychology and therapeutic
benefits of music evolved (Wilson, 2002). Although the therapeutic benefits of
music have been recognised since primitive times (Peters, 2000), it is only in
this century that music therapy is progressively accepted as being significant
to a wide range of healthcare and social contexts which include areas of
general medicine, mainstream education and community practise (Bunt and Stige,
2014).

Music therapy is implemented by
qualified professionals and is most universally used for individuals with special
needs (Peters, 2000). The importance of music therapy is using a musical
approach to attain objectives in the areas of motor skills, social development,
self-awareness, and cognitive development (Patterson, 2003). Music therapy delivers an
unthreatening and structured environment which cares for the children’s
preference for sameness and desire for predictable events (Bruscia, 1998).

Ethics:

Similar to
other therapist music therapists have ethical duties that they must abide by. 
According to Dileo (2000) the professional
ethics for the music therapist have been established through exploration. Music
therapists are accountable to uphold ethical behaviour. Some ethical issues
that a music therapist must follow are; boundaries, professionalism, confidentiality
and different perspectives (Dileo 2000). In 1993 Ireland first IACAT AGM
occurred, here a code of ethics for the creative arts therapists was
established (iacat.ie). Unfortunately in 2006 it was reported by Keaveney that
in the Republic of Ireland anyone can call himself or herself a ‘music
therapist’. This creates more contingency for an unqualified music therapist to
damage the credibility of the profession. Perhaps through an absence in
motivation from the Government to change the status of the discipline, an
opening may have been created between qualification and professional
recognition. This gap according to Keaveney (2006) is inundated by people who
have the best intentions and an interest in the arts and health but are not
essentially qualified to implement clinical interventions as music therapists.

Healthcare:

Clinical studies have shown the
benefits of music therapy with dementia patients, reducing asthma episodes,
pain relief, improving communication capabilities with autistic children, improving
motor function with patients who have Parkinson’s disease and to improve sleep
patterns and increase weight in premature babies (Musictherapy.org, 2017). Bunt
and Stige (2014) show how music therapy is accepted as being appropriate to a
wide range of healthcare and social contexts. There is an increasing awareness of the
collaborations now being created between music therapists and other
professions. Researchers such as Twyford and Watson (2008) have conversed re
the effects of multidisciplinary collaboration between music therapists and
other professionals. Licht (1996) talked about the idea of music in medicine,
involving it alongside occupational therapy (OT). Instruments as well as the
voice would have been implemented in OT for the mobilisation of joints.

Special
Educational Needs Schools:

All
children, including children with special educational needs, have a right to an
education which is appropriate to their needs (Department of Education and
Skills, 2004). At present there are over 140 special schools in Ireland
providing for specific types of disability and special needs
(Citizensinformation.ie, 2017). Among them are: special schools for students
who have a general learning disability at a mild or moderate level; schools for
visually impaired and hearing impaired students; a few schools for students
with physical disabilities; a small number of special schools for students who
are emotionally disturbed (Citizensinformation.ie, 2017). Similar to the evolution of Music Therapy in Ireland,
the availability of public education in Ireland for students with disabilities
continues to evolve and move in new directions. Special schools
were established as far back as the beginning of the nineteenth century, mainly
for 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 therapy
instigated amongst children on the autism spectrum. In a school setting the aim
of a music therapist is to evaluate the child’s needs and to instil academic and
social skills in areas of weakness both with and without music (Patterson,
2003). Clinical studies focused on school-age children diagnosed with pervasive
developmental disorder (PDD) and, in particular, autism show extensive
improvements when music therapy is used (Duffy and Fuller, 2000). Brownell
(2003) noted that improvements were seen in behaviour, communication and social
skills with autistic children.

Defining
Autism:

Autism
has 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 (American
Psychiatric Association, 2003). Autism is not an illness or a contagious
disease but rather a developmental disability that affects a person’s capability
to communicate, understand language, play, and interact with others (Dunlap et
al., 1999). The neurological disability is assumed that it is existent from
birth and always apparent from the age of three, the exact cause of autism is
still unknown (Sahey, 2016). The definition of autism is based on the patterns
of behaviours displayed by the child (Sahey, 2016). The clinical picture of
autism varies in degrees and is altered by many factors, including education,
ability and temperament (Hill and Frith, 2003). There are many characteristics
of autism and people may fall on the lower or higher side of the autism
spectrum. Clinical features of autism spectrum disorders may include atypical
social responses and behaviours, inadequacies in speech and language, mental
disorders, repetitive behaviour, poor eye contact, and an infatuated persistence
on sameness (Bauman & Kemper, 2005).

Communication,
Behaviour, Emotion:

Children
with autism spectrum disorders have deficiencies in behavioural, communication,
emotional and cognitive areas (Wing, 1981). These areas of weakness are closely
related to each other that when an autistic child has impairments in
communication, there will unavoidably be related deficiencies in behaviour,
emotions and cognition.

1. Communication:

People
with autism often have developmental difficulties in verbal and non-verbal
communication skills (Sahey, 2016). Anything that one does with other people
must include communication (Hartley, 2002). Communication can be defined in
many ways; for instance it is being able to speak and write properly, or being
a good listener (Hartley, 2002). It can be argued that communication is the
most challenging part for autistic children (Bauman & Kemper, 2005). According
to Kanner (1943), children will autism exhibit many difficulties with language,
some of these include: muteness, delayed echolalia (repetitiveness of words or
phrases), pronoun reversals, word substitution, and literalness, with most noticeable
communication deficit being spontaneous speech.

In
a changing world music has remained a central part of human life and it has had
distinct effects on children and adults. Raffman (1993) stated that music
itself acts as a means of communication. If we trace back through history,
music will be found throughout various cultures where it was used for healing
illnesses, rituals or artistic means. Although this remains the same today
music has now becoming a functional tool in modern society which can be seen as
an instrument for entertainment, emotional expression and communication. Music
has fast become a form of non-verbal communication for humans supporting
Gaston’s (1968, p15) claims that ‘music is an essential and necessary function
of man’.

Pronovost
(1961) states that children with an autistic disorder who do not respond appropriately
to verbal communication or communal speech respond to language used through
music. Similarly Davis et al., (2008) argues that autistic children achieve
greater triumphs with the basic skills when using music as a medium than
without. Literature has acknowledged the advantage of using music to teach
children with autism and have instigated following studies where music is used
as a support in modifying behaviour (Patterson, 2003). Hairston (1990) examined
the effectiveness of music therapy on communication with those who had severe
autism, during the five week intervention positive results were recorded in the
children’s communicative ability.

2. Behaviour:

By
reason of the weighty difficulties in successfully communicating as mentioned
above, children with autism may experience recurrent incidences of
communication breakdowns as both speakers and listeners which may impact the
behaviour of the autistic child (Stokes, 2017). It is acknowledged that in
some individuals with autism spectrum disorders may exhibit aggressive and/or
self-injurious behaviours (O’Reilly et al, 2005). Music therapy can assist
mutual behaviours which relate to the social-communicative development of
children with autism spectrum disorders (Benenzon, 1981).  Repetitive and obsessive behaviour is a
common behavioural characteristic of an autistic child (Hill and Frith, 2003). The
condition involves an incompetence to participate in the conventional social
interactions (Stokes, 2017). Hill and Frith (2003) explain this by acknowledging
deficiencies in the initiation of new actions and the inclination to be trapped
in a given task set. Due to a compulsive need for sameness the learning environment
for the autistic child must be very structured (Rump et al, 2009); music
therapy can be used to create an environment in which a child with ASD can
learn more naturally.

According
to Berger (2008) music therapy has the capacity to train the brain systems of
children with autistic spectrum disorders. Music, as a repetitive stimuli, can
aid children with autism to cypher sensory information correctly (e.g.
introducing a melody into daily routines and the melody is familiar to or
repeatedly sang to the child) (Berger, 2008). Kern and Aldridge (2006)
conducted a study where two customized songs tailored for two children with
autism spectrum disorders in the morning routine were used (e.g. entering the
school and greeting teacher and peers). Both songs specified the steps of the
greeting routine and the children’s teachers were taught how to sing the song
in the morning routine for the objective of the child. Results showed that the
songs helped the children in carrying out the morning routines (e.g. greeting
the teachers and peers).

Emotion:

An
incapability to control emotions or to respond to emotions in others has been assumed
as a key deficit in autism (Rump et al, 2009). Gaigg (2012) acknowledges that
people with autism express difficulties in their understanding of self and
others is in the comprehension of emotions. People with autism commonly fail to
respond applicably to the emotions of others, and many academics have proposed
that a deficiency in emotional expression recognition may add to these incongruous
reactions and to their understanding of emotion in general (Rump et al, 2009).
These difficulties experienced by the autistic individual relates back to the
social-communicative characteristics of the condition.

A
person with autism will struggle with monitoring their emotions (Bauman &
Kemper, 2005).  Using music to control
our 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, and
match emotions (Dimaio, 2010; Juslin & Vastfjäll, 2008). The ability to
maintain a well-regulated emotional state to cope with everyday stress, and to
be the most available for learning and interacting is extremely difficult for
children with autism (Sahey, 2016).

In
a study conducted by Kim et al. (2009) measured emotional variables including
joy significant and emotional synchronicity. The first two variables were
measured by duration and frequency and the latter one was only measured only by
the frequency. Results of the study were suggestively positive, arguing that
music therapy had a positive impact on the clients’ emotional functioning.
Thompson et al. (2013) measured a similar variable in the research. In allowing
the autistic child to experience music therapy could have a positive effect on
the emotion regulation, even when the music therapist is not present. It has
been shown that repetitive exposure to music has a positive effect on numerous
brain structures that underwrite an individual’s capability to understand and
regulate their own emotions (Schmahmann, 2010).

Unfortunately,
there is an inadequate quantity of study that measure the effect of music
therapy on the emotional outcomes among the ASD population (Dimaio, 2010).

Conclusion:

In conclusion, a
review of the literature reveals that music may be beneficial and soothing for
those on the autism spectrum. The research lacks significant studies as to the
benefits of music as an educational tool for communication skills with children
with autism. In the next chapter, the investigator will describe the
methodology utilized in her study, which is designed to attempt to find the
specific affects to communication, behaviour and emotions through music therapy
for children on the autism spectrum.