Music therapy with Autism: Top 10 Most Frequently Asked Questions

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1. What is music therapy? I really like Dr. Dale Taylor‘s biomedical definition of music therapy as the enhancement of human capabilities through the planned use of musical influences on brain functioning. Music influences human behavior by affecting the brain and subsequently other bodily structures in ways that are observable, identifiable, measurable, and predictable, thereby providing the necessary foundation for its use in treatment procedures.

So I think most people know that our brain responds to music and that music can feel ‘therapeutic’. In an upcoming podcast, my colleague, Dawn Iwamasa, is going to speak specifically to the differentiation of music therapy and therapeutic music. Meanwhile, I’m going to use my background as an example. I obtained both my Bachelor’s and Master’s in Piano before returning to Portland to study music therapy. I went to school for two more years and wove psychology, anatomy and physiology, statistics, music theory and 71 credits of specialized music therapy coursework and practicum experience together. THEN I embarked upon a 1040 hour internship that enabled me to fine-tune my assessment skills and set solid goals and objectives specific to each person with whom I worked. THEN I finally took my boards in January of 2009 before declaring myself MT-BC: music therapist, board-certified. Everyone’s path is different – some students go straight into a program from high school and obtain a Bachelor’s in Music Therapy. Some become MT-BC before pursuing a PhD in a closely related field or even in music therapy itself. Regardless, we are required to pass proficiencies in piano, guitar, voice and percussion. And, one of the most distinguishing factors between a musician, a music specialist, a music whatever, and a music therapist is that we approach each session with specific goals and objectives in mind. Our approach is client-centered, so the goals and objectives are unique to each individual or group. We document progress and actually spend a lot of time on paperwork.  To give you a better idea of this process, I’m sharing Dr. Dale Taylor’s 11 steps to:

Treatment Planning Using a Brain-Based Biomedical Music Therapy Approach

1. Collect & examine known client diagnostic information.
2. Assess to determine behavior capabilities and limitations.
3. Formulate your working model of client ability and disability.
4. Reformulate your model according to client brain functioning.
5. Determine what therapeutic outcomes would indicate improved functioning in client behavior.
6. Decide what changes in brain functioning would lead to improved client capabilities.
7. Determine what musically elicited behaviors utilize, require or develop those brain functions.
8. Determine what musical behaviors and interventions involve use of those behaviors.
9. Assess what musical styles, instruments, songs and participation modes qualify as Patient Specific Music (PSM). – this is also referred to as Client Preferred Music by a lot of music therapists.
10. Design the musical interventions specific to the desired behaviors that develop and activate  the particular brain function on which you want to focus.
11. Implement the planned interventions to stimulate altered Neural Impulse Patterning in the brain to elicit desired behavior outcomes.

2. Why do children with autism respond so strongly to music? So the short answer is that music provides structure. When I sing, “Twinkle, twinkle, little ___” and look expectantly at you, it’s pretty clear that you’re supposed to sing “star” right?

In addition, the musical aspects like rhythm, timbre, harmonic structure, sequencing and the ability to evoke emotional responses – all of these engage more of the brain than just speaking.

3. Why is singing so much easier than speaking for my child? My colleague, Dr. Elizabeth Stegemoller, is going to expand upon this subject in a separate podcast, so for now I’m going to say that there is less noise in singing than in speaking.

4. What does a music therapy session look like? How long? How often? I’m guessing that every music therapist has a slightly different style and approach, so I’m going to use myself as an example here again. I really like to have an initial assessment with a client so that I can observe their response to music, see how they react to particular instruments and songs, and estimate how long they might last in a one-to-one session. Most of my sessions are either 25 or 50 minutes long so that I have time to debrief with the family or caretaker and complete documentation on the session. How often I see a client depends – and honestly, if I had my way, I’d see them for shorter amounts of time 4-5 days a week. But I really like to see a client at least once a week and can usually see even greater improvement when I see them twice a week.

Within a session, I almost always incorporate an initial greeting song – if I’m with a child I sing a Hello song and allow her to play the guitar, clap her hands and wave at me. For me, this feels similar to the beginning of a talk therapy session where the therapist says something like, “So how are you today?” Although I’m not actually asking those words, I’m watching how my client is responding to my singing, is she looking at me, how is she playing the guitar, does she clap in time to the song – and I use this information to gauge the intensity of the rest of my session. My other musical interventions are going to vary according to the strengths and challenges of my client, but we generally have a drumming song, a movement song or two, some structured time at the piano along with some improvisational time at the piano, more movement, singing to a book, writing our ABCs as we sing them or counting speckled frogs. I’m always striving to move forward with the assumption that my client is taking in a lot more than they’re revealing in that moment. With autism in particular, I hear from a lot of parents that their child is singing one of our songs upstairs in her bedroom, or modifying the words but using the tune of one of the songs we used in our session. And I just have to say that this feedback is awesome and has really changed my perspective and approach to our sessions. Although I don’t usually set up a schedule of interventions within our session, I do try to provide opportunities for choices within the sessions like, “Do you want to play the piano or sing Old Macdonald next?” I also try to end each song with a clear V-I cadence and a The End! so that we all feel that sense of completion and can transition into the next intervention. Finally, I try my very best to end each song with, “Thank you for music” and incorporate my name and their name into the song so that we can acknowledge one another and say goodbye through music.

5. What’s the difference between a 1:1 session and a group? Which is best for my child? A 1:1 session is a great way to focus upon specific strengths and challenges for a client. I love 1:1 sessions because I can really focus on one client and engage in as much spontaneity and deviation from the original plan as necessary according to their response to music in that moment. Groups are great for addressing more social goals. I feel like groups are great for both the kids with whom I’m working and their parents. The parents get to watch their child excel and blossom within the confines of the safe musical container I’m providing and hopefully walk away with ideas of ways in which they can engage their child musically at home. The kids get to practice impulse control, sharing, passing instruments to one another and getting in each other’s space, and playing an instrument solo in front of their peers. Although I have very specific goals within a group setting, I certainly want the kids to have fun and feel like they can be themselves and embrace their own challenges and strengths within our circle. My professional recommendation, almost always, is for kids to receive both 1:1 and group music therapy sessions.

6. How much does it cost and is it covered by insurance? The cost of a music therapy session varies according to the therapist, but my published prompt pay discount is $85/hr. There are many music therapists throughout the nation who are successfully receiving reimbursement from insurance companies. It depends on the type of insurance, the diagnosis and codes and the state. My final answer is that it never hurts to ask and explore different ways in which a family may receive reimbursement for music therapy services.

7. What instrument is best for my child? My answer is almost always: Whatever instrument your child seems to respond to the most. As a pianist, I tend to announce my bias and then strongly recommend that you start with the piano as a foundational instrument. The answer to this question certainly depends upon the goals for your child. Within a music therapy session, we aren’t necessarily striving to make beautiful music or teach a particular instrument at all. We’re using music as the tool and the motivation to address a different goal. But I do have a lot of clients who come to me for adapted music lessons and the outcome can be really fantastic. There’s an upcoming podcast that delves more specifically into adapted piano lessons for autism, so I’m not going to say too much about it right now. But research done in 1995 by Dr. Gottfried Schlaug of the Beth Israel Hospital in Boston, shows a physical change in the brain structure in people who started music training at an early age. His publication in the journal Neuropsychologia reported that a bundle of nerve fibers called the “corpus callosum” which carries signals between the two brain hemispheres, is about 12% thicker among keyboard players who started training before the age of 7 when compared to both  keyboard players who trained later and non-musicians.

8. What kind of music do you use?  I addressed this a little in our first question about music therapy and Patient Specific Music, also referred to as Client Preferred Music . Music therapists don’t believe in prescriptive music. Rather, we cater each session to the needs of the client with whom we’re working. Not all music therapists have the chance to ask about client preferences – like when one walks into a patient’s room at the hospital and just has to make guesses according to what is observable in that moment. Fortunately, I usually have the chance to chat with parents or caretakers before seeing a new client and ask about favorite song preferences. If I can draw a client into the therapeutic process and captivate their attention  with a ‘hook’ – one of their favorite songs –

9. How can I use music at home with my child? There are a lot of ways in which you can use music at home with your child. Moving forward with the knowledge that singing is less noise than speaking – that your child may hear you better through song – start thinking about ways in which you can incorporate song into anything and most definitely challenging aspects of his or her day.

When you discover songs to which your child responds, learn them together. Learn the words, create motions to go with them. Then keep the tune and change the words into something more relevant to your child’s life.

Another intervention I really love is sequencing. You can examples on my youtube videos and discover ways to incorporate kitchen supplies or instruments from home into a sequencing intervention from home. Try getting three different sized pans and a couple wooden spoons or spatulas and play your own version of Simon Says with your child.

10. What are the biggest ways in which you’ve seen music therapy help a child with autism? The most precious moments of my job are those breakthrough moments when a previously  non-verbal girl says, “Goodbye, Angie,” for the first time and I get to look up at her parent and acknowledge the awesomeness of what is just the beginning. 

Music therapy can be very motivating. Sometimes we can get kids to do things that other therapists can’t. When allied health professionals are all working as a collaborative team, the results can be astounding. My favorite successes are helping a child intentionally utter their first word and watching that word turn into a sentence and eventually, an entire song. Teaching kids and parents how to use music as a coping mechanism can dramatically change everyone’s life. Changing the words of a song to help a child learn the steps involved in brushing their teeth or making it through the school day. And watching children succeed in a group setting or perform in a recital that ends with a bow and pride-filled smile – those are my favorite music therapy moments.