This article is written by Mr. Chester Tsang as a course assignment of "Music Therapy and Students with Special Needs", Department of Education, The University of Hong Kong. The course is taught by our Centre Director Mr. Pang. We are grateful to have Mr. Tsang's permission to reprint his writing on our Centre's website.
Introduction
There are 4 out of 67 students in my current teaching school who have been diagnosed as autistic. While suffering from such a severe developmental disorder, their behavior and performance in various areas do have great difference, as they are now aged 13-16. It primarily arises my interest to understand more about the nature of autism. The highest functioning one among them can play a Chinese string instrument, wu, very well and very abstract and conceptual communications have been experienced between us. The fact that I am the music teacher of all of these four students further arises my professional interest and need to learn more about how music therapy could help autistic children in any area.
Therefore, the nature of autism and accordingly how music therapy can address them would be the focus of this short paper. It is aim as a self-study assignment and the search and selection of literature is not carried out in a systematic way. Nevertheless, I have tried to search relevant work from the Journal of Music Therapy since 1990, and thesis or books concerning both autism and music therapy in the library of University of Hong Kong and the Hong Kong Institute of Education.
Diagnosis
The word "autism" was firstly appeared in 1906 by a Swiss psychiatrist Eugene Bleuler to describe the quality of some of his patients' psychotic ideations in which they referred everything in the world to themselves (Thaut, 1980).
However, Leo Kanner was the first one to name and describe the syndrome of early infantile autism and to delineate the behavioral abnormalities. Akogiounoglow (1990) summarized the listed as (1) a profound lack of affective contact with other people, (2) and anxiously obsessive desire for the preservation of sameness, (3) a fascination for objects, which are handled with skill in fine motor movements, (4) mutism, or a kind of language that does not seem to be intended to serve interpersonal communication, and (5) good cognitive potential.
Since then, many researches and clinical effort have been devoted, but little agreement could have been achieved about how to diagnose it (Thaut; Akogiunoglou). In my review, all research adopted either diagnostic criteria established by the American Psychiatric Association or the National Society for Autistic Children.
Etiology of Autism and Music Therapy
For educational purpose, the different explanations of the nature of autism would be much more important than the different in diagnostic definition. Relating to the subject matter of this review, I will try to discuss these different explanations with the accordingly shifted value and focus of music therapy for autistic children.
1a. Psychogenic explanation
According to Thaut (1980), psychiatrists attributed autism to an early emotional trauma or to faulty parenting when it was first recognized as a distinct disorder. Kanner (1943) also viewed autism as a result of genetic factors interacting with emotional deprivation.
1b. Establishing a relationship
This understanding of the nature of autism did influence the focus of music therapy. Juliette Alvin and Auriel Warwick (1992) reviewed Alvin's own study first published in 1978 still emphasized the therapeutic value of motherly physical contact during music therapy.
...other children need physical contacts of a motherly kind... The mother of an unresponsive, aloof child and the child himself are likely to experience bitter frustration in their emotional needs. How does the child react if the mother gives up her attempts at communication? He may still have an unexpressed need to be cuddled, caressed or rocked even if he does not seem to respond. Such physical need can be answered within a musical experience. (Alvin,1992;p.10)
Establishing a relationship with the autistic child in order to treat his emotional impairment was the focus of music therapy under the psychogenic explanation.
2a. Organic/neurophysiological explanation
Since no consistent patterns of social or emotional history emerged in autistic children, this psychogenic explanation later gave way to other etiological considerations. Since then, accumulated research evidence strongly suggests that autism is a neurophysiological disorder caused by brain dysfunction that is manifested in a variety of perceptual cognitive, and motor disturbances. According to Thaut (1980), Tanguay (1976) has put forward three new hypotheses under this explanation:
(1) Theory of defect in cross-modal association. This theory is based on the observation that autistic children seem to have great difficulties in perceiving sensory input in one modality and respond to it in another modality. Lovaas, etal (1971) was mentioned as one of the most prominently supporter of this theory.
(2) Theory of perceptual inconstancy. Ornitz and Ritvo (1968) suggest that the autistic child suffers from a faulty modulation of sensory input, which may be manifested as the disability to gain a stable inner representation of the environment. He extended this notion to faulty modulation of motor output as well in his later study (1974).
(3) Theory of a central cognitive defect. Rutter (1968) has postulated that autism involves severe cognitive defects which probably have their origin in some form of organic brain dysfunction.
Thaut(1980) points out that the focus of treatment will undergo an essential shift when findings pertinent to these organic explanation of autism. In light of any organic concept, establishing a relationship with the autistic child would be viewed rather as a necessary precondition to reaching the child in order to deal with his various perceptual, motor and cognitive disturbances. Music therapy would need to extend its potential from techniques for establishing relationships to the providing sensory stimulation according to the perceptual dysfunctions outlined above.
2b. As an integrating force
Sensory integration was then an important value of music therapy. Since an autistic child does not develop in an integrated way, music is used as an integrating force, involving in one operation mental, emotional, physical and even social factors, to affect the child. (Alvin, 1992) According to Thaut, music therapy can foster sensorimotor development. Sensory integration, sensorimotor integration, and sensorimotor coordination are learned during different musical activities, like singing an action song. Cognitive and motor integration can also be learned when playing an instrument, according to Alvin (1992). Many other examples were raised in different works.
2c. Enjoyment and successful experience
Such integrating function also provides enjoyment and successful experience. Quoting Howery (1968), Hairson (1984) suggested that although the degree and emphasis may be different, music functions with the autistic retarded just as it does with the normal. And it provides experiences that bring about greater development of self-esteem. Alvin explained probably the same point in another way:
Perhaps the attraction of music to an autistic child comes from a feeling of being fully involved and more complete within a musical environment. (1992;p.2)
3a. Special responses to musical stimuli
A common observation and research findings throughout the literature is that autistic children show unusual interest in music (Akogiounoglow; Hairson; Alvin). Thaut (1980) also found similar results, reporting that autistic children preferred musical stimulus conditions to other auditory and visual conditions. He also noted that the autistic children listened to the preferred musical stimulus significantly longer than the normal children to orient themselves and respond overtly to various familiar and novel auditory stimuli. A slight preference toward the musical excerpts s compared to the environmental and vocal sounds is found.
According to Hairson (1984) and Edgerton (1993), Rimland (1964, 1975) suggested that the musical ability and interest in autistic children are almost universal. He even suggested there might be a direct connection between the autistic condition and this musical interest.
3b. Brain hemispheric research
Thaut (1980) had referred to two hypotheses in regard to brain hemispheric specialization of autistic children to explain the special response to music. Tanguay (1976) referred to the fact that differentiation of functions between two hemispheres develops in the first few years of life; at first, both hemispheres may function as a unit relatively immature and plastic, mostly able to process information in a holistic and spatially oriented manner. It is the functional characteristics of the right hemisphere in later brain development. Thus Tanguay suggests that autistic children fail to develop hemispheric specialization and remain at the immature level of brain functioning.
Delong (1978), carried out a pneumoencephalographic investigations with 17 autistic children and found in 15 cases enlargement of the left lateral ventricle, a particularly enlargement of the left temporal horn. He related these pathological findings to the possibility of hemispheric lesions in autistic children, particularly on the left side. He also suggests that in autism the left hemisphere seems uniquely impaired without taking over of the disturbed functions by the opposite hemisphere. Thus good skills in music would account for normal right-hemispheric functions whereas left hemispheric function, 2g. language ability, would remain low and uncompensated.
Thaut then maintained that these brain hemispheric research is pertinent to music therapy: autistic child would be predominantly capable of processing meaningfully only right-hemisphere information such as non-verbal, musical or spatial information but virtually ignore language or any sequentially organized information. Then music could be used as a starting point to influence the perceptual processes of autistic children.
3c. Non-verbal characteristic
Music is then of value since it can be enjoyed at a concrete level without an understanding of abstract processes. In contrast, verbal language requires the understanding, coding and decoding of conceptualized symbols. Music can for a time by-pass the cognitive process and reach the emotional and personality disturbance. The concrete and perceptual aspects of a musical experience can ignore verbal language, and satisfy the child's need for non-verbal self-expression (Alvin; 1992). Edgerton (1993) also suggested that one of the advantages of interactions in a musical context is that communication is possible without many of the prerequisite skills necessary for expressive language.
4a. Right hemisphere arousal
Morton, Kershner & Siegel (1990) have reported a bilateral arousal effect of music exposure. They suggested it might be due to a music-induced right hemisphere arousal mediated bilateral arousal. Ensuring right hemisphere arousal through music may then facilitate concurrent left hemisphere arousal. Increased memory capacity and reduced distractibility are reported. If information processing may be enhanced by music-induced arousal, then there is clearly a potential strategic role for music in educational and therapeutic settings, particularly for autistic children who most of them have lower left hemisphere functioning.
4b. Speech
Buday (1995) reported better memory for manual signs with autistic children in music condition training. He described the results representing a potential first step in using music within a simultaneous communication context to promote better pragmatic skills with autistic children.
Nevertheless, the union of speech and melody is widely used music therapy. We know that music or sound can trigger off a verbal or vocal response, which may be the beginning of speech (Alvin; 1992). Nordoff & Robbins (1971), as cited by Hairson, have also recommended playing musical instruments to stimulate communication. They reported observation of having the non-verbal commutation of music gradually become verbal communication. In term of music elements, this triggering effect may be better explained by the expectation effect of certain cadences, which is comparatively universal.
Remarks
No conclusion can be made by the above brief review. As said, it only aims oas a conceptual clarification of applying music therapy, or in my case adopting techniques and elements of music therapy in music classroom, for autistic children.
An important area that is not included due to the limitation of this assignment is the improvisational music therapy. Edgerton (1993) provided an alternative view on autism: a neurologically based deficit, not in comprehension, but in expression, when introducing this approach. Temple Grandin, a person with autism, was quoted comprehend what was being said, but she was unable to respond other than by screaming and flapping her hands. Such frustration is also told to me by one of my autistic students in rare occasion when he can articulate his emotion better.
An area need to be further studied is also found: Among the works reviewed, no address has made about the qualitative difference among different autistic classification, or different functioning level of autistic condition when applying music therapy. |
