Music therapy

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This information sheet has been written to provide information on a particular intervention/approach and any research connected with it, not as a recommendation. The outcome of any approach will depend on the needs of the individual, which vary greatly, and the appropriate application of the intervention. An intervention that may help one individual may not be effective for another. It would therefore not be appropriate for The National Autistic Society to recommend any one particular practice or therapy.

Music therapy has become accepted as a useful intervention for people with autism since it was introduced to the UK in the 1950s and 60s by practitioners like Juliette Alvin, Paul Nordoff and Clive Robbins. Although music therapy can be used with people with other physical, cognitive and emotional disabilities, it has particular benefits for people with autism; much of the earliest work done by therapists like Alvin, Nordoff and Robbins was with this client group.

Since 1982 the profession has been recognised by the National Health Service as a Profession Allied to Medicine, and in 1999 music therapy became a State Registered profession in the UK. Many music therapists are employed by the National Health Service, local education authorities and social services; others work freelance. Music therapy departments are well-established within some Child Development Centres, and other primary and tertiary care provisions. In addition, some charitable organisations provide music therapy services (see Useful organisations, below). 

The Association of Professional Music Therapists (APMT) can put clients or carers in touch with a music therapist working in their area.

Music therapy is established as a profession in several countries and a World Music Therapy Federation has been formed to promote the understanding, use and development of music therapy for the international mental health community.

Becoming a music therapist

In order to become a professional music therapist, you must first have an undergraduate degree or diploma in music, or have a similar level of musical training and a degree in another relevant subject, such as psychology. A number of universities in the UK offer postgraduate qualifications in music therapy: the APMT maintains a current list of courses.

Music therapy

Case studies by music therapists (Agrotou 1998; Alvin and Warwick 1991; Nordoff and Robbins 1985, etc) indicate that, although far more restricted than in musical communication with a normally developing child, music can stimulate and develop more meaningful and playful communication in people with autism. Obviously, this may apply more to some individuals than others, but universal responsiveness of some kind to music is generally acknowledged and children with autism should not be excluded from this universal appeal.

Music-making involves many of the fundamental elements of social interaction - self-awareness and 'self in relation to another'. Because of this, the musical aspects of interpersonal timing attuned reciprocity in shared play, turn-taking, listening and responding to another person can be augmented in music therapy with people with autism to accommodate and address their frequently idiosyncratic and avoidant styles of communication. Rather than teaching a set of behaviours, which would then be specific to the music therapy or music context, music therapy encourages increased self-awareness/self-other awareness, leading to more overt social interactions. The therapy stimulates and develops the communicative use of voice and pre-verbal dialogue with another, establishing meaning and relationship to underpin language development. The client may also benefit from increased tolerance of sound, tolerance of and capacity for two-way communication, the opportunity to exercise joint attention, and other emotional needs met in the therapeutic process.

It is argued (Brown 1994) that participating in music therapy allows the person with autism to experience and explore a wider range of emotions.  The nature of music is to combine a secure structure with constant change; in therapy music can form a familiar environment which the person with autism can participate in, occasionally diverting into episodes of more spontaneous and new experiences of play, according to (or sometimes slightly beyond) his or her ability.

Where meaningful play is established with a client, obsessive-compulsive patterns of behaviour, self-harming and other such behaviours usually decrease, although this depends largely on the individual and their family, and their educational and general social circumstances. 

Music is increasingly used as part of early intervention programmes for children with autism, as it has been recognised that musical interaction stimulates similar communicative behaviour to the early emotional interaction between mother and infant, which is crucial to the later development of social skills, but is usually severely limited by a childs autism. For any age group, music therapy is most usually part of a multi-disciplinary programme, offering an enriched learning environment for development of communication and other aspects of a child's personality.

Music therapy can also play an important role for parents of children with autism by fostering relationships and developing positive interactions (Woodward, 2004).

What is the theory behind music therapy?

The treatment is based on the understanding that all people have an innate responsiveness to music, that this instinct can remain in spite of physical, cognitive or emotional disability, and that it can be used to build a relationship between the therapist and the client. Music therapists talk of the rhythm of our heartbeat, melody in the spoken voice, and turn-taking in the interaction between an infant and its mother as evidence that musicality is a basic human characteristic. Trevarthen et al (1998: 176) describes these phenomena as a musical hierarchy or orchestration of self-regulation and self-organisation. And because music is so integral to our being, by working ... to free the person's musical limitations, resistances and defences, and by building on the strengths of his or her musical elements, components and structures within an improvisational relationship, we are simultaneously working towards healing the other aspects of her or his cognitive, physical, neurological and emotional being. (Brown, 1994: 18)

What form does the therapy take?

There are various approaches to music therapy, but most rely on spontaneous musical improvisation. The therapist uses percussion or tuned instruments, or her own voice, to respond creatively to the sounds produced by the client, and encourage the client to create his or her own musical language. Instruments will be selected which are non-threatening to the client. Some people have a strong preference for one type of sound and find others intolerable, and this individualistic approach is one of the strengths of music therapy for people with autism. The aim is to create a context of sound in which the client feels comfortable and confident to express himself, to experience a wider range of emotions, and to discover what it is like to be in a two-way communicating relationship.

Simple songs, pieces or musical styles may be used and become a recurring element in the therapy sessions, but these are always used flexibly to suit the mood and clinical and developmental needs of the client at any given moment. In fact, music as therapy need not fall into conventional patterns or even use words; the music therapist can respond to cries, screams and body movements by the client, all of which have rhythm and pitch and are susceptible to organisation in musical terms.

It is important to stress the difference between music therapy and music lessons. In the therapeutic context, the client is not taught to play an instrument, and while he may acquire musical skills in the course of the therapy sessions, this is a secondary effect and not the primary purpose of the therapy.

Music therapy sessions are usually held weekly. The number and duration of the sessions is normally agreed in advance to suit the particular needs and circumstances of the client. It may be decided that a client would respond better to music therapy as part of a group than on a one-to-one basis with the therapist. Because structure and consistency are so important for this client group, music therapy ideally takes place in the same place each week, in a quiet room where there are no distractions. Sessions may be recorded on audio tape or video to enable the therapist to develop musical components significant for the individuals development from week to week. These recordings are normally treated as confidential clinical records; however, in some cases video is used to share work with parents and other professionals, and for clinical teaching purposes.

Musical interaction therapy

Wendy Prevezer (1990) has described her use of musical interaction therapy with children with autism at Sutherland House School. Prevezer used music to reinforce the work she was doing in speech and language therapy, and not as a medium with its own healing potential. Her method differs from the profession of music therapy in that the musical interaction therapy practitioner is not required to be a musician nor to have trained at one of the recognized (APMT) training courses. (See also Chandler, 1997; Christie and Wimpory, 1986; and Wimpory et al, 1995.)

Research into music therapy

The efficacy of music therapy as an intervention for people with autism is widely endorsed by anecdotal evidence from parents and professionals. Case studies published over the years by therapists themselves (Alvin and Warwick, 1991; Nordoff and Robbins, 1985; Nolan 1989, and others) describe significant changes in the communicative and social behaviour of individuals with autism who have taken part in music therapy. Research by Nordoff and Robbins (1964-68) produced evaluation and rating scales for Child-Therapist Relationship and Musical Communicativeness: an early example of qualitative research in music therapy (Trevarthen et al, 1998). However, the nature of the therapy, which is grounded in one-to-one relationships, and in the emotional states of individuals, has made it difficult to gain scientific proof of its success: there is no neutral control against which to measure the apparent results, and observer bias will always be present.

More recently, collaborations between psychological researchers and music therapists have produced data within both quantitative and qualitative frameworks. The musical foundations of communication in the normal interaction between parent and infant have been established scientifically in infant developmental research. Robarts (1998) and Pavlicevic (1997) have shown that the clinical adaptation and augmentation of early constructs of communication is fundamental to the therapeutic use of music.

Controlled research studies such as those by Edgerton (1994) and Aldridge, Gustorff and Neugebauer (1995), have confirmed that improvisational music therapy can increase the communicative behaviour of children with autism. Boso (2007) investigated the effect of interactive music therapy on the behaviour of young adults with severe autism. The study concluded that active music therapy sessions could be of aid in improving autistic symptoms (Boso, 2007). Gold, Wigram and Elefant (2006) in a review of the effects of music therapy for individuals with autism spectrum disorder (ASD) conclude that available studies were of limited applicability to clinical practice. However they did report that findings indicate that music therapy may help children with ASD to improve their communicative skills. More research is needed to investigate the effects of music therapy in typical clinical practice, and to examine whether the effects are enduring (Gold, Wigram and Elefant, 2006).

Useful organisations

Association of Professional Music Therapists (UK)
24-27 White Lion Street, London N1 9PD;
tel: +44 (0)20 7837 6100; fax: +44(0)20 7837 6142; email: APMToffice@aol.com;
website: www.apmt.org

The professional body for qualified music therapists in the UK. Can advise on music therapy courses, and put clients in touch with therapists.

British Society for Music Therapy
24-27 White Lion Street, London N1 9PD;
tel: +44 (0)20 7837 6100; fax: +44(0)20 7837 6142; email: info@bsmt.org;
website: www.bsmt.org

Promotes the use and development of music therapy. Publishes journals, monographs and videos, organises conferences and meetings.

The Nordoff-Robbins Music Therapy Centre
Pauline Etkin, Managing Director
2 Lissenden Gardens, London, NW5 1PQ; tel: +44 (0)20 7267 4496; fax: +44 (0)20 7267 4369;
email: admin@nordoff-robbins.org.uk; website: www.nordoff-robbins.org.uk/

Offers music therapy sessions at venues in London and across the UK; training for professionals and the general public; maintains resource centre and promotes research.

Information on a number of providers of music therapy is available on the Autism Services Directory at www.autismdirectory.org.uk  

Bibliography and further reading

Journals

British Journal of Music Therapy. Contact: Simon Procter, Editor, c/o British Society for Music Therapy (contact details as above)

Nordic Journal of Music Therapy. [Publishes in English and Scandinavian languages] Contact: Dr. Christian Gold, Editor in Chief, Grieg Academy Music Therapy Research Centre, (GAMUT), c/o Grieg Academy, Dept. of Music, Lars Hilles gt. 3, N-5015, Bergen, Norway; tel: +47 97 50 17 57; fax: +47 55 58 69 60; website: www.njmt.no/

Books and articles

Accordino, R., Comer, R. and Heller, W.B. (2007). Searching for music's potential: a critical examination of research on music therapy with individuals with autism. Research in Autism Spectrum Disorders. 1(1), pp. 101-115.
Available from the NAS Information Centre

Agrotou, A. (1988). A case study Lara. Journal of British music therapy. 2(1), pp. 17-23.

Aldridge, D. (1996). Music therapy research and practice in medicine: from out of the silence. London: Jessica Kingsley Publishers. 1853022969.

Aldridge, D., Gustorff, D. and Neugebauer, L. (1995). A preliminary study of creative music therapy in the treatment of children with developmental delay. The arts in psychotherapy. 21(3), pp. 189-205.

Alvin, J. and Warwick, A. (1991). Music therapy for the autistic child. 2nd ed. Oxford: Oxford University Press. 0198162766.

Berger, D. S. (2002). Music therapy, sensory integration and the autistic child. London: Jessica Kingsley Publishers. 1843107007.

Boso, M. (2007). Effect of long-term interactive music therapy on behavior profile and musical skills in young adults with severe autism. Journal of Alternative and Complementary Medicine. 13(7), pp. 709-712.

British Society for Music Therapy (1993). Music therapy for autistic disability. London: BSMT.

Brown, S. M. K. (1994). Autism and music therapy: is change possible, and why music? Journal of British music therapy. 8(1), pp. 15-25.

Brunk, B. K. (1999). Music therapy: another path to learning and communication for children in the autistic spectrum. Arlington, Texas: Future Horizons, Inc. 1885477538.

Chandler, S. (1997). Musical interaction therapy as early intervention: case study of a two and a half year old. In: Living and learning with autism: perspectives from the individual, the family and the professional; a collection of papers from the conference held at St Aidans College, University of Durham, April 7-9 1997, pp. 145-154. Sunderland: Autism Research Unit.
Available from the NAS Information Centre

Christie, P. and Wimpory, D. (1986). Recent research into the development of communicative competence and its implications for the teaching of autistic children. Communication. 20(1), pp. 4-7.
Available from the NAS Information Centre

Cooley, N. (2006). Singing John's song. Autism Asperger's Digest. January - February, pp. 26-28.
Available from the NAS Information Centre

Darnley-Smith, R. and Patey, H. M. (2003). Music therapy. London: Sage. 0761957774.

Edgerton, C. L. (1994). The effect of music therapy on the communicative behaviours of autistic children. Journal of Music Therapy. 31(1), pp. 31-62.

Feigh, M. (2006). Music to our ears: the positive effects of music therapy on adults with autism. Autism Advocate. 42(2), pp. 48-50.
Available from the NAS Information Centre

Gold, C., Wigram, T. and Elefant, C. (2006). Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews. 2, CD004381.
Available to download from http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004381/pdf_fs.html

Kaplan, R. S. and Steele A. L. (2005). An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum. Journal of Music Therapy. 42(1), pp. 2-19.

Kern, P. and Aldridge, D. (2006). Using embedded music therapy interventions to support outdoor play of young children with autism in an inclusive community-based child care program. Journal of Music Therapy. 43(4), pp. 270-294.

Levinge, A. (1990) "The use of I and me": music therapy with an autistic child. British Journal of Music Therapy. 4(2), pp. 15-18.

Lund, H. N. (1995). Music therapy with high-functioning autistic clients: a case study. In: Pedersen, I.N. and Bonde, L. Ole (eds.), Music therapy within multi-disciplinary teams: proceedings of the 3rd European music therapy conference, 1995. Aalborg: Aalborg University Press.

Muller, P. and Warwick, A. (1992) Autistic children and music therapy: the effects of maternal involvement in music therapy. In: Music therapy in health and education: papers from the European conference at King's College Cambridge University, UK, April 1992. London: BSMT.

Nolan, A. (1989). Music therapy with autistic children. Communication, 23(2), pp. 30-31.
Available from the NAS Information Centre

Nordoff, P. and Robbins, C. (1985). Therapy in music for handicapped children. London: Gollancz.

Oldfield, A. (2006). Interactive music therapy - a positive approach. London: Jessica Kingsley. 9781843103097.

Oldfield, A. (2006). Interactive music therapy in child and family psychiatry: clinical practice, research and teaching. London: Jessica Kingsley. 9781843104445.

Pavlicevic, M. (1997). Music therapy in context: music, meaning and relationship. London: Jessica Kingsley. 1853024341.

Pedersen, I. N. (1992). Music therapy with autistic clients. In: Music therapy in health and education: papers from the European conference at King's College. Cambridge University, UK, April 1992. London: BSMT.

Prevezer, W. (1990). Strategies for tuning in to autism. Therapy weekly, October.
Available from the NAS website (see Related resources at the bottom of this page)
Available from the NAS Information Centre

Purdie, H. (1996). Music is a world. In touch, Summer, p. 33.

Schalwijk, F.W. (1994). Music and people with developmental disabilities: music therapy, remedial music making and musical activities. London: Jessica Kingsley Publishers. 1853022268.

Toigo, D. (1992). Autism: integrating a personal perspective with music therapy practice. Music therapy perspectives, 10, pp. 13-20.

Trevarthen, C. et al (eds.) (1998). Music therapy for children with autism. In: Trevarthen, C. et al (eds.) Children with autism: diagnosis and interventions to meet their needs. 2nd ed. London: Jessica Kingsley Publishers. 1853025550.
Available from the NAS Information Centre

Tyler, H. M. (1998). Behind the mask; an exploration of true and false self as revealed in music therapy. British Journal of Music Therapy, 12(2), pp. 60-66.

Videsott, M. et al (1992). Music therapy with autistic adult subjects. In:  Music therapy in health and education: papers from the European conference at King's College, Cambridge University, UK, April 1992. London: BSMT.

Walworth, D. D. (2007). The use of music therapy within the SCERTS Model for children with autism spectrum disorder. Journal of Music Therapy, 44(1), pp. 2-22.

Warwick, A. (1988). Questions and reflections on research. British Journal of Music Therapy, 2(2), pp. 5-8.

Wheeler, B. (1995). Music therapy research: quantitative and qualitative perspectives. Phoenixville, Pennsylvania: Barcelona Publishers.

Whipple, J. (2004). Music in intervention for children and adolescents with autism: a meta analysis. Journal of music therapy, 41(2), pp. 90-106.

Wigram, T. (1992). Assessment and diagnosis of children with communication disorders: musical personality in the autistic child. In: Music therapy in health and education: papers from the European conference at King's College, Cambridge University, UK, April 1992. London: BSMT.

Wigram, T. (2001). Indications in music therapy: evidence from assessment that can identify the expectations of music therapy as a treatment for autistic spectrum disorder (ASD); meeting the challenge of evidence based practice. British Journal of Music Therapy, 16(1), pp. 11-28.

Wigram, T. and De Backer, J. (eds.) (1999). Clinical applications of music therapy in developmental disabilities, paediatrics and neurology. London: Jessica Kingsley Publishers. 1853027340.

Wimpory, D et al. (1995). Musical interaction therapy for children with autism: an evaluative case study with two-year follow-up. Journal of Autism and Developmental Disorders, 25(5), pp. 541-552.
Available from the NAS Information Centre

Woodward, A. (2004). Music therapy for autistic children and their families: a creative spectrum. British Journal of Music Therapy, 18(1), pp. 8-14.

 

Further information on interventions is available on the Research Autism website at www.researchautism.net Research Autism is the only UK charity exclusively dedicated to research into interventions in autism. The interventions section of their website provides information about a wide range of interventions, including what they are, what they are supposed to achieve and whether there is any supporting scientific evidence behind them.

 

Compiled by Eona Bell

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