Evidence Is Slim, but Experts Say Music Therapy Is Valuable in Addressing Autism
Tuesday, March 3, 2009
When it's bath time for Janna Simpson, her mother sometimes throws together a tune. "Take a bath, take a bath, take a bath," Judy Simpson might chant, luring her daughter into the water.
Janna isn't a toddler, and her mother isn't simply singing along. Janna is a 15-year-old with autism, a speech impairment and a seizure disorder. Music, Judy Simpson says, has been key to getting her to engage in such everyday activities as taking a bath; it's also an alternative to verbal instructions in helping her overcome social and behavioral problems.
Janna, who never developed normal speech, receives formal music therapy at West Virginia's Hedgesville Middle School, where she is enrolled in a classroom for students with autism. Her mother, a former music therapist who is director of government relations at the American Music Therapy Association, based in Silver Spring, continues with that therapeutic approach at home.
"Latitude, longitude, looking through a microscope: Such skills are not important," Simpson explains. "She needs basic skills to live, such as brushing her teeth, taking a bath, the pragmatics of engaging with people. This is a difficult thing to teach."
Simpson's confidence in music therapy is based on her own experience and that of other parents of children with autism who are eager to find ways to increase their children's ability to function. But exactly how and to what extent music therapy works is not well understood. Just over a year ago, a session titled "The Autism Agenda" at the American Music Therapy Association conference stressed the need for more research and for practice to be based on evidence.
Despite the limited data about its effectiveness, making music has become an integral part of many programs for children with autism. Leanne Belasco, a music therapist at the Kennedy Krieger School's Montgomery County campus in Rockville, says music gives structure and a predictable rhythm to verbal directions. When Belasco strums her autoharp to her students, she sings encouraging, instructive lyrics such as, "I know I have what it takes; I am a good listener" and "Be flexible."
At the school, where all 37 full-time students are enrolled in music therapy, Belasco begins her 30- to 45-minute sessions by singing a refrain: "Hello, everybody, it's time for music today." She wheels around the group seated in a horseshoe formation, addressing each student in song as she does so. A 16-year-old, who regularly wears headphones in class because of his auditory sensitivities, responds with apparent enjoyment, as does a younger boy, who strums the autoharp with seeming pleasure as he rocks back and forth in his chair. When Belasco asks her students to shake the blue plastic maracas she has passed out, classroom assistants help. When one student seems pained by the exercise, the assistants physically settle him in his chair.
Despite the benefits associated with music, there are special challenges for children with autism. "Some students are sensitive to sirens and vacuums; some are sensitive to music, to specific instruments or the frequency of the instrument," says Linda Brandenburg, director of school autism services at Kennedy Krieger, which is based in Baltimore. The music therapist gradually eases students with such auditory sensitivities into the group.
For higher-functioning students on the autism spectrum, music can be a creative outlet in addition to helping regulate behavior, therapists say. At Rockville's Frost School, for children with emotional disorders including those on the autism spectrum, ninth-grader Donny Toker has enjoyed music from a young age and now composes jazz and rock pieces, which he has performed at family gatherings and at school. His mother, Nancy Toker, says music helps him focus and relieves anxiety and frustration. "When he is in a musical environment, he is able to interact with his peers, and his conversational skills are appropriate, " Toker says.
Measuring the Impact
Creating studies to assess the benefits of music therapy is a challenge. Petra Kern, a professor of music therapy at the State University of New York at New Paltz and one of the organizers of the Autism Agenda conference, says it is difficult to conduct autism research using randomized controlled trials because autism is a spectrum disorder and individual behavior varies greatly. She advocates learning as much as possible from groups of related individual case studies to understand how and why music therapy works.
Catherine Lord, a professor of psychology at the University of Michigan specializing in autism research, says, "We know that music therapy treatment is associated with improvement, but we don't know what the cause of that improvement is." Studies suggesting positive results for music therapy, she says, typically "don't control for what you need to control to find out what causes the change." Students may improve because of factors such as the therapist's enthusiasm and attention rather than the music itself.
Lord notes that she would support the use of music therapy only if it could be shown that it helped to decrease problem behaviors and also if it was clearly determined that students with autism enjoyed the therapy. Many people with autism lack forms of entertainment and relaxation, so providing effective behavioral treatment that is also pleasurable would be worthwhile, she says.
Mijin Kim, a music therapist at the Beth Abraham Institute in New York, says music may be effective because it complements the cognitive abilities of people with autism, which include a strong inclination for creating patterns.
"Music is inherently structured and patterned," she says. "You can see people with autism who are hypersensitive to sound but respond differently to music because of its structure."