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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
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
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
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
+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
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
+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
Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+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
Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+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
+Evidence: Art Therapy
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.
+Evidence: Art Therapy
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
+Evidence: Art Therapy
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
+References
+References
+Questions?
Recommended