Psychology, children & adolescents: Music therapy and language for Autistic Children

Written by Myra J. Staum, Ph.D., RMT-BC
Director and Professor of Music Therapy
Willamette University, Salem, Oregon

Music Therapy is the unique application of music to enhance personal lives by creating positive changes in human behavior. It is an allied health profession utilizing music as a tool to encourage development in social/ emotional, cognitive/learning, and perceptual-motor areas. Music Therapy has a wide variety of functions with the exceptional child, adolescent and adult in medical, institutional and educational settings. Music is effective because it is a nonverbal form of communication, it is a natural reinforcer, it is immediate in time and provides motivation for practicing nonmusical skills. Most importantly, it is a successful medium because almost everyone responds positively to at least some kind of music.

The training of a music therapist involves a full curriculum of music classes, along with selected courses in psychology, special education, and anatomy with specific core courses and field experiences in music therapy. Following coursework, students complete a six-month full time clinical internship and a written board certification exam. Registered, board certified professionals must then maintain continuing education credits or retake the exam to remain current in their practice.

Music Therapy is particularly useful with autistic children owing in part to the nonverbal, non threatening nature of the medium. Parallel music activities are designed to support the objectives of the child as observed by the therapist or as indicated by a parent, teacher or other professional. A music therapist might observe, for instance, the child's need to socially interact with others. Musical games like passing a ball back and forth to music or playing sticks and cymbals with another person might be used to foster this interaction. Eye contact might be encouraged with imitative clapping games near the eyes or with activities which focus attention on an instrument played near the face. Preferred music may be used contingently for a wide variety of cooperative social behaviors like sitting in a chair or staying with a group of other children in a circle.

Music Therapy is particularly effective in the development and remediation of speech. The severe deficit in communication observed among autistic children includes expressive speech which may be nonexistent or impersonal. Speech can range from complete mutism to grunts, cries, explosive shrieks, guttural sounds, and humming. There may be musically intoned vocalizations with some consonant-vowel combinations, a sophisticated babbling interspersed with vaguely recognizable word-like sounds, or a seemingly foreign sounding jargon. Higher level autistic speech may involve echolalia, delayed echolalia or pronominal reversal, while some children may progress to appropriate phrases, sentences, and longer sentences with non expressive or monotonic speech. Since autistic children are often mainstreamed into music classes in the public schools, a music teacher may experience the rewards of having an autistic child involved in music activities while assisting with language.

It has been noted time and again that autistic children evidence unusual sensitivities to music. Some have perfect pitch, while many have been noted to play instruments with exceptional musicality. Music therapists traditionally work with autistic children because of this unusual responsiveness which is adaptable to non-music goals Some children have unusual sensitivities only to certain sounds. One boy, after playing a xylophone bar, would spontaneously sing up the harmonic series from the fundamental pitch. Through careful structuring, syllable sounds were paired with his singing of the harmonics and the boy began incorporating consonant-vowel sounds into his vocal play. Soon simple 2-3 note tunes were played on the xylophone by the therapist who modeled more complex verbalizations, and the child gradually began imitating them.

Since autistic children sometimes sing when they may not speak, music therapists and music educators can work systematically on speech through vocal music activities. In the music classroom, songs with simple words, repetitive phrases, and even repetitive nonsense syllables can assist the autistic child's language. Meaningful word phrases and songs presented with visual and tactile cues can facilitate this process even further. One six-year old echolalic child was taught speech by having the therapist/teacher sing simple question/answer phrases set to a familiar melody with full rhythmic and harmonic accompaniment The child held the objects while singing:

Do you eat an apple? Yes, yes.
Do you eat an apple? Yes, yes.
Do you eat an apple? Yes, yes.
Yes, yes, yes.
and

Do you eat a pencil? No, no.
Do you eat a pencil? No, no.
Do you eat a pencil? No, no.
No, no, no.

Another autistic child learned noun and action verb phrases . A large doll was manipulated by the therapist/teacher and a song presented:

This is a doll.
This is a doll.
The doll is jumping.
The doll is jumping.
This is a doll.
This is a doll.

Later, words were substituted for walking, sitting, sleeping, etc. In these songs, the bold words were faded out gradually by the therapist/teacher. Since each phrase was repeated, the child could use his echolalic imitation to respond accurately. When the music was eliminated completely, the child was able to verbalize the entire sentence in response to the questions, "What is this?" and "What is the doll doing?"

Other autistic children have learned entire meaningful responses when both questions and answers were incorporated into a song. The following phrases were sung with one child to the approximate tune of Twinkle, Twinkle, Little Star and words were faded out gradually in backward progression. While attention to environmental sounds was the primary focus for this child, the song structure assisted her in responding in a full, grammatically correct sentence:

Listen, listen, what do you hear? (sound played on tape)
I hear an ambulance.
(I hear a baby cry.)
(I hear my mother calling, etc.)

Autistic children have also made enormous strides in eliminating their monotonic speech by singing songs composed to match the rhythm, stress, flow and inflection of the sentence followed by a gradual fading of the musical cues. Parents and teachers alike can assist the child in remembering these prosodic features of speech by prompting the child with the song.

While composing specialized songs is time consuming for the teacher with a classroom full of other children, it should be remembered that the repertoire of elementary songs are generally repetitive in nature. Even in higher level elementary vocal method books, repetition of simple phrases is common. While the words in such books may not seem critical for the autistic child's survival at the moment, simply increasing the capacity to put words together is a vitally important beginning for these children.

For those teachers whose time is limited to large groups, almost all singing experiences are invaluable to the autistic child when songs are presented slowly, clearly, and with careful focusing of the child's attention to the ongoing activity. To hear an autistic child leave a class quietly singing a song with all the words is a pleasant occurrence. To hear the same child attempt to use these words in conversation outside of the music class is to have made a very special contribution to the language potential of this child.

For more information about music therapy, contact the National Association for Music Therapy, 8455 Colesville Road, Suite 930, Silver Spring, MD 20910, U.S.A.