+ a review of music and art therapies for individuals with autism

+

A Review of Music and Art Therapies

For Individuals with Autism

+Music and Art Therapies

Music Therapy

Art Therapy

Discussion

Questions

+Music Therapy

Definition

History

Models

Settings

Services

Credentials

Claims Parent and Therapist reports Outcomes

Evidence

+Art Therapy

Definition

Activity

History

Models

Art Development

Settings

Credentials

Claims Parent and Therapist reports

Evidence

+Search parameters Psychinfo

“Music” and “therapy” in any field“autis*” in “subject” Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text

(time) 15 results:

“Art” and “therapy” in any field and “autis*” in subject Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text

(time) 26 results

Google Music therapy

American music therapy association Music therapy autism Art therapy

American art therapy association Art therapy autism

Art therapy and autism Art therapy autism history

Center for Health and Healing

Google news Music therapy autism Art therapy autism

+Music Therapy Defined

“Music therapy is 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”

“Refers to the application of music with the intent to enhance functioning”

American Music Therapy Association. (2011).Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org/

upload/whoarearttherapists2009.pdf

Association for Science in Autism Treatment. Music Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/

music.htm

+What’s the appeal?

Music Therapy Clip: Jammin Jenn

Jennmusiczack. (2010). Hope for autism through music therapy. Available from http://youtube.com.

+Is it founded?

+History of Music Therapy

Idea of music as healing goes back to Aristotle

Discipline began after World War I and World War II when musicians went to Veterans hospitals to play for victims Notable responses of patients led to doctors hiring musicians Some musicians needed training before being in hospitals led

to need for college curriculum

First music therapy degree program at Michigan State University in 1944

The American Music Therapy Association founded in 1998

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support. Retrieved from

http://www.musictherapy.org/factsheets/bib_autism.pdf

+Music therapy: Models

Receptive music listening

Song writing

Music performance

Imitation Call and answer songs (Chase, 2009)

Improvisational music therapy

Creative music therapy model (Nordoff-Robbins Model) has been found most effective with children with autism Nordoff-Robbins Clip Music-making vs. music-listening to motivate learners and effect

growt

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support. Retrieved fromhttp:/ /www.musictherapy.org/

factsheets/bib_autism.pdf

Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com.

Kim, J., Wigram, T., Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13, 389-409. doi:

10.1177/1362361309105660

+Settings: Music Therapy Psychiatric hospitals

Rehab facilities

Medical hospitals

Outpatient clinics

Agencies for developmentally disabled persons

Drug and alcohol programs

Senior centers

Correctional facilities

Schools

Private practices.

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support.

Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf

+Music Therapy: Services

Considered related service under IDEA (Stetler, 2009) IEP goals: related services

150 certified music therapists in New Jersey but this number is rapidly expanding (Chase, 2009)

Medicare: 1994, reimbursable for service under benefits for Partial Hospitalization Programs (PHP) under heading of Activity Therapy Must be:

Prescribed by a physician Reasonable and necessary for treatment of illness/injury Goal directed and based on a documented treatment plan Goal cannot be to maintain current level, must exhibit some level of

improvement

Some medicade programs cover music therapy

Some private insurances cover music therapy

About 20% of Music therapists receive third party reimbursement

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support. Retrieved f

from http://www.musictherapy.org/factsheets/bib_autism.pdf

+Music Therapist: Credentials

Participate in approved college music therapy curricula to be eligible to sit for national examination offered by Certification Boar for Music Therapists (MT-BC)

National Music Therapy Registry (NMTR) serves qualified music therapy professionals with the designation RMT, CMT, or ACMT

+Music Therapy: Claims

Interventions designed to: Promote wellness Manage stress Alleviate pain Express feelings Enhance memory Improve communication Promote physical rehabilitation

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support.

Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf

+Music Therapy: Outcomes for Individuals with Autism Increased attention

Decreased self-stimulation

Improved cognitive functioning

Increased socialization

Successful and safe self-expression

Improved behavior

Enhanced auditory processing

Decreased agitation

Improved verbal skills

Enhanced sensory-motor skills

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support. Retrieved from

http://www.musictherapy.org/factsheets/bib_autism.pdf

+From the therapists…

“For people with autism, the world is a chaotic place, full of overwhelming levels of sensory input,” says John Foley…”Music has form we all recognize, even if we don’t think in those terms; music makes sense. In the early days of defining autism, heightened response to music was considered for the list of possible symptom.” (Chase, 2009)

“We know music therapy works with people on the autism spectrum, even if we don’t always know why or how” (Chase, 2009)

Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved

from http://www.nj.com

+Music Therapy: Parent reports “’I wish I could say how, exactly, but I just know that

music is an avenue to get their little brains going.’ said Michelle Phalon” (Chase, 2009)

“’The proof is in what you see and the changes in your child…It’s hard to argue with physical progress. There are naysayers out there in everything. But you see the difference.’” (Chase, 2009)

“’She just engage more,’ Wismann said. ‘Instead of being in her own space, if you’re more singsong-y when you’re interacting with her, she seems to engage more and want to be interactive with you.’” (Thompson, 2011).

Chase, E. (2009) Using the language of music to speak to children with autism.

The Star-Ledger. Retrieved from http://www.nj.com.

Thompson, D. (2011, May 27). Living with a child with autism. HealthDay News.

Retrieved http://health.usnews.com

+Evidence for Music Therapy

According to the Association for Science in Autism Treatment, preliminary evidence suggests that music therapy might be effective in enhancing functioning, but more rigorous research needs to be conducted

Association for Science in Autism Treatment. Music Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/music.htm

+Evidence for Music Therapy

15 total articles 1 unrelated to music therapy

Dependent variables Social responsiveness: 4 studies Avoidant Behaviors, emotional responsiveness, joint-attention behaviors,

music skills, preferences, task performance, and auditory stimulus processing, object constancy: 1 study each

Vocal Stereotypy: 2 studies

Single-subject design: 3 articles

Group design 3 articles

Meta-analysis and analysis: 1 article each

Vignettes/Case studies: 6 articles

+Evidence: Single-Subject Research Further evaluation of methods to identify matched

stimulation (Rapp, 2007) Effects of preferred stimulation on vocal stereotypy Results: Sound-producing toys or non-contingent music led

to decreased vocal stereotypy Possibly auditory stimulation functioned as an abolishing

operation for vocal stereotypy

The limits and motivating potential of sensory stimuli as reinforcers for autistic children (Ferrari & Harris, 1981) Use of vibrations, music, and strobe lights as reinforcement. Results varied but sensory stimuli has motivating

potentials similar to those of food and social reinforcers Ferrari, M., Harris, S.L. (1981). The limits and motivating potential of sensory stimuli as reinforcers for autistic children. Journal of Applied

Behavior Analysis, 14, 339-343. doi: 10.1901/jaba.1981.14-339 Rapp, J. T. (2007). Further evaluation of methods to identify matched stimulation. Journal of Applied Behavior Analysis, 40, 73-88. doi:

10.1901/jaba.2007.142-05

+Evidence: Single-Subject Research

Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions.

+Research: Social Responsiveness

Finnigan, E., Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions. Autism, 14, p. 321-348.

+Evidence: Single-Subject Research Participant: A 3-year, 8-month old girl with autism

Materials: 6 neutral toys randomly assigned to a condition

Setting: 4 15-minute sessions per week for 2 months in empty preschool classroom or at participant’s home

Alternating treatment design Dependent variable: social responsive and avoidance behaviors

Number of correct responses divided by the number of opportunities given

Data summarized as percentage of correct responses Frequency count for eye contact and avoidance behaviors

Independent variable: Music and non-music conditions Music intervention: Familiar melodies sung with lyrics appropriate for toy

being used. Guitar also played. Non-music intervention: Spoken scripts with words similar to those in

melodies

Finnegan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-

music interventions. Autism, 321-348.

+Evidence: Single-Subject Research

Alternating treatment design: Baseline, Alternating Phase, Best-treatment phase, Follow-up

IOA collected for 20% of sessions with a mean IOA of 87% (range 85-96%)

Data analysis looked at the percentage of nonoverlapping data

Results: Authors demonstrated a functional relationship between the music condition and the increase of social responsive behaviors and decrease of avoidant behaviors.

Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-music

interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747

+Research: Social Responsiveness



+Music Therapy: Social Responsiveness

Results suggest positive effects of Music Therapy on social responsiveness

Need continued research with more rigorous experimental designs to establish functional relationshipsSmall number of participants but not

well-designed single-subject research

Use of music (and other child-preferred activities) as motivation to increase socialization



+Music Therapy:

Evidence for Outcomes Increased attention

Decreased self-stimulation (+)

Improved cognitive functioning

Increased socialization (+)

Successful and safe self-expression

Improved behavior

Enhanced auditory processing

Decreased agitation

Improved verbal skills

Enhanced sensory-motor skills

+Art Therapy Defined

“Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem, self- awareness, and achieve insight”

“Refers to the application of art with the intent to enhance functioning.”

American Art Therapy Association. (2011). Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org

/upload/whoarearttherapists2009.pdf

Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm

+Art therapy: Activity

Brainstorm feeling words

Assign each word a color

Draw a heart

Color in the heart the amount of each color that you are feeling

Keep on file

Benefits?

+What’s the appeal?

Art Therapy

+Is it founded?

Google images

+History of Art Therapy

1900s Psychiatrists began being interested in patients’ art. Educators recognized artwork reflected children’s development/growth.

1914: Margaret Naumberg starts Children’s School Often identified as the founder of art therapy

Art therapy started to be included with traditional talk therapy

1940s: Distinct discipline emerged

1970s: Division in art therapists Art therapy: innate healing power of making art Art psychotherapy: art as a healing tool within a framework of verbal

psychotherapy

American Art Therapy Association. (2011). Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org/upload/whoarearttherapists2009.pdf

Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingn org/complement/art_how.html

+Art therapy: Models Acting/Filming

Photography

Painting

Drawing Portrait drawing

Art as expression of feelings

Art as nonverbal communication

eHowArtsAndCrafts (2010). Art therapy activities: art therapy activities on feelings. Available from http://www.youtube.com

PolarisMediaGroup (2009). Polaris global presents “Kids with Cameras”. Available from http://www.youtube.com

+Art Therapy: Art Development

Neurotypical individuals’ drawing skills generally follow the same progression: Scribbling in early childhood Symbolic/schematic representation in middle childhood Concern with achieving realism in adolescence

Shifts are influenced by and have an influence on cognitive development

For children with ASD, the development follows the same sequence and is related to the individual’s nonverbal mental age

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art

Therapy Association, 25, p. 15-23. Retrieved from http://www.arttherapyjournal.org/pdf/25-1_Martin.pdf

+Art Therapy Settings

Work with health professionals in palliative care programs

Prisons

Trauma relief teams

Personal growth classes

School systems

Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingny

org/complement/art_how.html

+Art Therapy: Credentials

“Art therapists” must have a master’s degree or PhD in art therapy AND/OR be a registered art therapist (ATR)

Art therapists are skilled in multiple modalities of art (painting, sculpture, painting, etc.) for assessment and treatment.

Martin, N. (2011). Arttherapyandautism.com. Retrieved from http://arttherapyandautism.com/index.html.

+Art Therapy: Claims Art therapy = visual images that represent

thoughts/feelings that individuals don’t know how to express verbally

Interventions designed to address: Imagination/abstract thinking deficits Sensory regulation and integration Emotions/self-expression Nonverbal communication Socialization Recreational/leisure skills Visual-spatial deficits Improving motor skills

Martin, N. (2011) Explanation. Retrieved from http://arttherapyandautism.com


+Art Therapy: Claims “As a graphic, nonverbal means of communication, art

can provide relief to the child for whom verbal communication is frustrating, overwhelming, too direct, or even nonexistent” (Martin, 2008).

“Art therapy can utilize the child’s visual strengths to address treatment goals while providing a socially appropriate outlet for self-stimulatory behaviors and sensory needs” (Martin, 2008).

“Use of icons, symbols, and social stories help the children to remember what they were taught” (Epp, 2008).

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy

Association, 25, p. 15-23.

Epp, K.M. (2008). Outcome-Based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children

and Schools, 30, 27-36.

+Art Therapy: Parent reports

“It has given her confidence, self-esteem,” Mrs. Bigioni said. “She is proud of the work she does. It has brought friendships – peers and facilitators – developed a sense of community” (Joseph, 2011).

Joseph, S. (2011). Growing demand for art therapy. Yorkregion.com. Retrieved from http://www.yorkregion.com/news/article/1012624--growing-demand-for-art-therapy.

+Evidence: Art Therapy

According to Association for Science in Autism Treatment there have been no scientific studies of art therapy for individual’s with ASD


+Evidence for Art Therapy

26 articles returned Unrelated to art therapy 14 (related to music therapy etc.)

Dependent variable Social skills Object constancy Face processing skills/portrait drawing

Design Single-subject –None Group design – 2 Book Review - 6 Meta-analysis/Review - 3 Case study - 1


Assessing portrait drawings created by children and adolescents with autism spectrum disorder 25 children with autism with a mean age of 13 years and 15

neurotypical children with a mean age of 10 Completed the Portrait Drawing Assessment (PDA) Portrait drawings didn’t indicate a difference in iconic skills

in children with ASD Participants with ASD were more often rated as interested

and less often rated as indifferent than neurotyipcal participants

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23.


Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum 66 participants Parents filled a pre and post-test questionnaire (SSRS or

Social Skills Rating System) Attending a social skills group therapy program (with art

therapy as a component) improved assertive social skills and decreased problem behaviors and hyperactivity.

Epp, K.M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism

spectrum. Children and Schools, 30, 27-36. Retrieved from http://web.ebscohost.com.ezproxy. caldwell.edu:2048/ehost/

pdfviewer/pdf viewer?sid=f824fe6f-6b6c-4f84-9de6-53a55d3f8975%40sessionmgr113&vid=32&hid=105


Interventions designed to address: Imagination/abstract thinking deficits Sensory regulation and integration Emotions/self-expression Nonverbal communication Socialization Recreational/leisure skills Visual-spatial deficits Improving motor skills Object constancy? Face processing?

Object constancy?Face processing?

+Discussion

Music therapy Noncontingent reinforcement/preferred stimulation Increased social responsiveness Decreased problem behaviors Auditory processing

Art therapy Use of portrait drawing and photography to promote self-

monitoring and awareness Use of portrait drawing to develop knowledge related to

facial expressions Fine motor skills

+Discussion cont.

Behavior traps Motor imitation Gross and fine motor skills Social interaction

+Discussion cont.

Things to consider… Individual’s with ASD as visual thinkers/concrete Individual’s with ASD with processing differences (auditory

and visual) Use of preferred music as reinforcement is different than

the application of music or art as a therapeutic intervention

Need for more research is clear!

+Recommendations

Very little evidence at this point The evidence on music therapy suggests positive effects

but more research is needed There is not evidence on art therapy thus far, research is

needed!

If music/art are preferred they can be used at motivation without needing “therapy”

+References

+Questions?

+ a review of music and art therapies for individuals with autism

Documents

music therapy research

music therapy clip

music therapy degree

approved music therapy

application of music

review of music

models receptive music

music performance imitation