Autism Spectrum Disorder is defined and characterized as significant social, communication, and behavior disorder. These disorders do not have a cause, and are most likely related to genetics, neurological, and environmental factors. According to the Center for Autism and Early Childhood Mental Health there are “a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the brain.” ASD affects every individual person differently, and these affects can be mild to severe. However, the severity is based on the context of the case and does fluctuate over time based on interventions received throughout the person’s life.
“Because many children with ASD have a great sense of musicality, they are often good candidates for and very successful in music therapy (Vereen, 2017).” Other types of therapy used for ASD include occupational therapy and Applied Behavioral Analysis which is most common however this paper will focus on music therapy. The most common kind of music therapy used for children and others with ASD is Nordoff – Robbins Music therapy which falls under the humanistic umbrella. Music therapy is a practice that covers the treatment in multiple domains, such as cognitive, physical, developmental, emotional and social. Other types of music therapy used with ASD are psychodynamic music therapy and behavioral music therapy. Although there are five international approaches to music therapy, these three effective music therapy types can often be combined in interventions to meet the needs and goals of the child or client.
Music Therapy, as defined by Kenneth Bruscia in his book, Defining Music Therapy is “a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of change (Bruscia, 1998).” As there are many domains covered, there are also several approaches used to treat clients based on their needs. Some of the main approaches are psychodynamic music therapy, humanistic, and behavioral. Psychodynamic music therapy stemmed off of psychoanalysis and Freud’s psychosocial development stages. This method uses “free expression through sound” to help the client become more aware of their feelings, problems, thoughts and memories. This method often works on opening a dialogue through improvisation in music to engage the subconscious. Humanistic music therapy often notated as Nordoff – Robbins music therapy was built on the principle that everyone regardless of level of ability or illness are capable of responding to music. This is a client centered form of therapy that meets the client where they are physically, mentally and emotionally in that present moment during a session. Behavioral music therapy is often used with children with Autism Spectrum Disorder. This method uses music to accomplish therapeutic goals whether they are developmental, behavioral or medical. Only interventions that can be observed and measured are included in the treatment process.
“Nordoff – Robbins music therapy is a creative, improvisational approach to individual and group therapy developed by Paul Nordoff and Clive Robbins in 1959 (Cooper, 2010).” Paul was an American pianist and composer and Clive was a special education teacher. In 1982, the first NRMT facility opened in North London and later spread to other countries including the famed Nordoff – Robbins center at New York State University Steinhardt. In this form of therapy, there are typically two therapists co – leading in each session. One therapist acts as the primary clinical musician where they are often stationed at the piano, while the other therapist works directly with the client to help them respond to music and “the clinical intentions of the therapist at the piano (Cooper, 2010).” From start to finish, a standard NRMT session consists almost entirely of musicking which is the act of making, listening to or composing music. For children with Autism, Nordoff – Robbins Music therapy is often combined with Developmental, Individual – Difference, Relationship – based or DIR®/FloortimeTM. DIR®/FloortimeTM was developed by Drs. Greenspan and Wieder. This model “provides a comprehensive framework for assessing and treating a child (Greenspan & Wieder 2006b).” It’s focus is centered around facilitating foundational components of child development in the areas of relating, communicating and thinking through the development of relationships via interactive play – Floortime™ (Greenspan & Weider, 2006a; 2006b).”
Psychodynamic music therapy is based off of Sigmund Freud’s psychoanalysis. It also “includes various practices and theories derived from it such as analytical psychology, object relations, ego psychology, self psychology, and more (Kim, 2016).” Juliet Alvin who was a pioneer in the field of music therapy in the United Kingdom believed that through free improvisation, one could discover themselves within the music that they create. Along with Alvin, there were two other female pioneers for the work of psychodynamic music therapy; Mary Priestly who was “one of the first generation music therapists trained by Alvin in the UK (Kim, 2016),” and Florence Tyson who was an American music therapist that wrote about the psychodynamic orientation to music therapy. The therapist’s role in psychodynamic music therapy is to “identify therapeutic issues and relationship patterns that are played out in the client’s improvisation (Kim, 2016).” They should also have the skills to respond and interject during the improvisation either vocally or musically. Some of the techniques used in clinical improvisation are mirroring, which is to imitate the client, elicitation, which is to evoke a response from the client, or accompanying. In the case of children with ASD, “they often have limited capacity for the basic psychodynamics of human engagement through projection and introjection (Alvarez, 1992.” This means that the children are unable to take aspects of their personal and internal world and project them onto others or objects and that they may be unable to take the ideas and aspects of others like their behaviors and internalize them. “The child’s behavioral and musical expression can be met by the empathic improvisation of the therapist in the mutual music making process, and the child often seems to perceive the therapist’s music as part of his own expression originating from himself (musical projective identification, Kim, 1997).”
Behavioral music therapy is a systematic approach. Within a session the therapist should be able to observe the behavior of a client, assess and document the behaviors based on magnitude, introduce contingencies to modify behavior and evaluate the results. Behavioral music therapy references behavioral psychology and Applied Behavior Analysis which is a common used intervention for children with ASD. BMT uses music to either increase a behavior, weaken a behavior and/or teach a new behavior. For increasing behaviors, different types of reinforcement such as positive, negative and natural reinforcement may be used. To encourage speech in a child with ASD, a music therapist may take away sound or music being played for the child until they say the word, “more.” Each time the therapist closes the gap until the child is able to verbally ask for music without leaving space. This would be a form of a negative reinforcer. A technique fore teaching new behaviors can consist of modeling, such as a child with ASD that has lower motor functioning. A music therapist would play a drum in a certain way, while verbally prompting and encouraging the child to play the drum in that manner. This also works with task analysis which breaks down larger tasks into smaller, more easier tasks and other types of musical, verbal and nonverbal prompting. Behavioral music therapy aims to integrate the results of current music, science and psychological research as well as evidence – based practices to ensure an effective therapeutic intervention for children with ASD and other exceptionalities.
Music therapy can be beneficial to those that need it. This includes children, adults, and geriatrics. Music therapy treats a wide range of clients including those on the Autism Spectrum. It also covers a wide area of domains such as cognitive, motor, physical and social. Due to the large sense of musicality of a child with Autism Spectrum disorder, they are often good candidates for music therapy. Music therapy can help with some of the common challenges kids with ASD face such as verbal and non – verbal communication, achieving developmental milestones, cognitive function, motor function and socialization. Some of the three most prevalent types of music therapy used with children and adolescents with ASD are Nordoff – Robbins music therapy, behavioral music therapy and psychodynamic music therapy. While each approach is very effective individually, they can often be combined depending on the needs of the child and training of the therapist to increase the success of the child in sessions.
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