contributions of nordoff-robbins music therapy within the dir®/floortime™ framework to the...

Contributions of Nordoff-Robbins Music Therapy within the DIR®/Floortime™

Framework to the Treatment of Children with Autism

Contributions of Nordoff-Robbins Music Therapy within the DIR®/Floortime™

Framework to the Treatment of Children with Autism

John Carpente, PhD, MT-BC, LCAT, NRMTMolloy College & The Rebecca Center for Music Therapy

Mid Atlantic Regional Music Therapy Conference

Pittsburg, PA March 25, 2010

John Carpente, PhD, MT-BC, LCAT, NRMTMolloy College & The Rebecca Center for Music Therapy

Mid Atlantic Regional Music Therapy Conference

Pittsburg, PA March 25, 2010

Outline of the DayOutline of the Day

7:30 Overview of new developments 7:40 Revisiting ASDs criteria 8:00 Brief overview of NRMT & Music-

centeredness 8:15 Overview of DIR®/Floortime™ 9:00 Merging NRMT & DIR® 9:30 BREAK 9:45 MT Assessment & evaluation 11:00Break 11:15Basic musical frameworks for clinical

improvisation 12:15Post-test

7:30 Overview of new developments 7:40 Revisiting ASDs criteria 8:00 Brief overview of NRMT & Music-

centeredness 8:15 Overview of DIR®/Floortime™ 9:00 Merging NRMT & DIR® 9:30 BREAK 9:45 MT Assessment & evaluation 11:00Break 11:15Basic musical frameworks for clinical

improvisation 12:15Post-test

Focus: population-based Hybrid Model

Focus: population-based Hybrid Model

Within the context of Autistic Spectrum Disorders

Employing the NR modelMerging DIR™/Floortime™

principles & conceptsConceptualizing the child Musical relationship (NR)

interpersonal (DIR)

Within the context of Autistic Spectrum Disorders

Employing the NR modelMerging DIR™/Floortime™

principles & conceptsConceptualizing the child Musical relationship (NR)

interpersonal (DIR)

Population based Practice: what should an intervention for ASDs

Target?

Population based Practice: what should an intervention for ASDs

Target?

Matching the intervention to the criteria of the diagnosis

What are the core deficits of ASDs?

Matching the intervention to the criteria of the diagnosis

What are the core deficits of ASDs?

Part IPart I

Re-visiting the Diagnosis: Let’s go to the big gray

book…

Re-visiting the Diagnosis: Let’s go to the big gray

book…

DSM-IV-TRDSM-IV-TR

DIAGNOSTIC CRITERIA FOR 299.00 AUTISTIC DISORDER


(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(1) qualitative impairment in social interaction, as manifested by at least two of the following:



(a) impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(a) impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

DSM DIAGNOSTIC CRITERIA FOR 299.00 AUTISTIC DISORDER


(b) failure to develop peer relationships appropriate to developmental level

(b) failure to develop peer relationships appropriate to developmental level



(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)



(d) lack of social or emotional reciprocity

(d) lack of social or emotional reciprocity



(2) qualitative impairments in communication as manifested by at least one of the following:

(2) qualitative impairments in communication as manifested by at least one of the following:



a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)



(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others



Let’s Jump ahead to criteria B

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

Let’s Jump ahead to criteria B

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:



1. social interaction 2. language as used in

social communication 3. symbolic or

imaginative play

1. social interaction 2. language as used in

social communication 3. symbolic or

imaginative play

You want an intervention that will address…

You want an intervention that will address…

social interactionpeer relationships seeking to share enjoyment,

interests, or achievements with other people

social or emotional reciprocityThe ability to initiate or sustain a

conversation with others

social interactionpeer relationships seeking to share enjoyment,

interests, or achievements with other people

social or emotional reciprocityThe ability to initiate or sustain a

conversation with others

Part IIPart II

Brief Look at NRMTBrief Look at NRMT

NRMT: Brief OverviewNRMT: Brief Overview

Child’s roleMusic child

Primary therapist’s roleCo-therapist’s roleTherapist’s task

Child’s roleMusic child

Primary therapist’s roleCo-therapist’s roleTherapist’s task

NRMT: A Music-centered Approach

NRMT: A Music-centered Approach

The musical relationship is keyThe client’s experience in music is

primaryMusical goals are clinical goals

(clinical goals are contained in music goals)

The primary focus is to enhance the client’s involvement in music

The musical relationship is keyThe client’s experience in music is

primaryMusical goals are clinical goals

(clinical goals are contained in music goals)

The primary focus is to enhance the client’s involvement in music

Musical Goals are Clinical Goals (Aigen, 2005)

Musical Goals are Clinical Goals (Aigen, 2005)

Clinical goals are expressed in purely musical terms

Musical process is the clinical process Does not deny that changes in nonmusical areas

occur

Changes in nonmusical areas accompany the primary process and are not what justify it (music)

Therapist is seeking develop and enhance capacities for musical experience

Therapist formulates strategies to deepen client’s musical experience

Clinical goals are expressed in purely musical terms

Musical process is the clinical process Does not deny that changes in nonmusical areas

occur

Changes in nonmusical areas accompany the primary process and are not what justify it (music)

Therapist is seeking develop and enhance capacities for musical experience

Therapist formulates strategies to deepen client’s musical experience

Taking on the Roles of the Floortimer and MT

Taking on the Roles of the Floortimer and MT

When to leave the bench/guitar?Does leaving bench mean leaving

music?Re-thinking all of our clinical tools

Body & physical spaceVoiceAffect, Affect, & AffectMusical formAwareness (musical and

interpersonal)Catering to the child’s differences

When to leave the bench/guitar?Does leaving bench mean leaving

music?Re-thinking all of our clinical tools

Body & physical spaceVoiceAffect, Affect, & AffectMusical formAwareness (musical and

interpersonal)Catering to the child’s differences

Part IIIPart III

Introduction to DIR®/Floortime™ Introduction to

DIR®/Floortime™

The DIR® ModelThe DIR® Model

“D” =Developmental-A child’s maturational processes work together with the child’s environment to shape development

“I” =Individual Differences-Every Child has unique physiological, neurological, psychological, communication, motor, and sensory processing patterns

“R” =Relationship-based-parent/caretaker relationships play a vital role in shaping development, learning, social and emotional growth

“D” =Developmental-A child’s maturational processes work together with the child’s environment to shape development

“I” =Individual Differences-Every Child has unique physiological, neurological, psychological, communication, motor, and sensory processing patterns

“R” =Relationship-based-parent/caretaker relationships play a vital role in shaping development, learning, social and emotional growth

Developmental LevelsDevelopmental Levels

The Functional Emotional Developmental The Functional Emotional Developmental MilestonesMilestones

1. Staying calm and regulated, and shared 1. Staying calm and regulated, and shared attentionattention

2. Engagement and relatedness2. Engagement and relatedness3. I3. Intentional 2-way communication - purposeful

interactions w/ gestures (open & closing circles of communication)

4. Problem solving, co-regulated interactions 4. Problem solving, co-regulated interactions with a with a continuous flowcontinuous flow

5. Creative and meaningful use of ideas and 5. Creative and meaningful use of ideas and wordswords

6. Building logical bridges between ideas 6. Building logical bridges between ideas

The Functional Emotional Developmental The Functional Emotional Developmental MilestonesMilestones

1. Staying calm and regulated, and shared 1. Staying calm and regulated, and shared attentionattention

2. Engagement and relatedness2. Engagement and relatedness3. I3. Intentional 2-way communication - purposeful

interactions w/ gestures (open & closing circles of communication)

4. Problem solving, co-regulated interactions 4. Problem solving, co-regulated interactions with a with a continuous flowcontinuous flow

5. Creative and meaningful use of ideas and 5. Creative and meaningful use of ideas and wordswords

6. Building logical bridges between ideas 6. Building logical bridges between ideas

Individual Differences and how they sound & look

through Music

Individual Differences and how they sound & look

through MusicMotor Planning and sequencing

Gross and Fine motorBalance and Coordination

Auditory/Language processingExpressive and Receptive

Visual-spatial processingSensory Modulation and

ProcessingTactile, propreoception, vestibular,

etc.

Motor Planning and sequencingGross and Fine motorBalance and Coordination

Auditory/Language processingExpressive and Receptive

Visual-spatial processingSensory Modulation and

ProcessingTactile, propreoception, vestibular,

etc.

Relationship BasedRelationship Based

Describes learning relationships that are tailored to the child’s individual differences, and facilitate mastery of social, emotional, and intellectual development.

1.Caregivers2.Educators3.Therapists4.Peers

Describes learning relationships that are tailored to the child’s individual differences, and facilitate mastery of social, emotional, and intellectual development.

1.Caregivers2.Educators3.Therapists4.Peers

Part IVPart IV

The Marriage between NRMT & DIR®/Floortime™

The Marriage between NRMT & DIR®/Floortime™

Common Ground of NR & DIR

Common Ground of NR & DIR

Action-based Improvisation/spontaneousRelationship-based modelsAccepting every response and

using it in the context of the interaction

Joining the child self-stimulatory actions

Action-based Improvisation/spontaneousRelationship-based modelsAccepting every response and

using it in the context of the interaction

Joining the child self-stimulatory actions

NR & Floortime NR & Floortime

Observing childFollowing leadMeet childFacilitate expansion of the

interactionFacilitate a continuous flow of

back-and-forth interactions

Observing childFollowing leadMeet childFacilitate expansion of the

interactionFacilitate a continuous flow of

back-and-forth interactions

Common MissionCommon Mission

A back-and-forth continuous flow of affective (emotional) interactionsInteraction needs to move- not be

stagnant where it becomes memorizedAll develops within the interactionPlayful obstruction & playing “dumb”

expands the interaction and creates problems for the child (higher levels of thinking)

Developing the interaction develops relationship

A back-and-forth continuous flow of affective (emotional) interactionsInteraction needs to move- not be

stagnant where it becomes memorizedAll develops within the interactionPlayful obstruction & playing “dumb”

expands the interaction and creates problems for the child (higher levels of thinking)

Developing the interaction develops relationship

Neuroscience & Relationships: Insights from

Recent Research

Neuroscience & Relationships: Insights from

Recent Research1. The infant’s mind is “wired” for

relationship. It is in the context of relationship that development occurs.

2. The developing brain is “plastic”- malleable-able to grow and create new connections

3. Interactions with caregivers stimulate brain development

1. The infant’s mind is “wired” for relationship. It is in the context of relationship that development occurs.

2. The developing brain is “plastic”- malleable-able to grow and create new connections

3. Interactions with caregivers stimulate brain development

33

Neal Halfon

04-21204-212

SoundVisionSmell

TouchProprioceptionTaste

Part VPart V

Music (NR) and Social-emotional (DIR)

Music (NR) and Social-emotional (DIR)

Bringing the Musical to the Social-Emotional

(Carpente, 2009)

Bringing the Musical to the Social-Emotional

(Carpente, 2009)

I. Musical awarenessII. Musical (self) regulationIII. Musical mutuality & forming

relationshipsIV. Musical dialoguing/Intentional

musicingV. Musical adaptation VI. Musical

inter-relatedness/assimilation

I. Musical awarenessII. Musical (self) regulationIII. Musical mutuality & forming

relationshipsIV. Musical dialoguing/Intentional

musicingV. Musical adaptation VI. Musical

inter-relatedness/assimilation

Social-Emotional Levels /Musical Responsiveness:

Working from the Ground-up

Social-Emotional Levels /Musical Responsiveness:

Working from the Ground-up

Social-Emotional LevelsLevel 1: shared attention &

regulation

Level 2: engagement & relatedness

Level 3: 2-way purposeful communication

Level 4: shared problem-solving

Level 5: Creative use of ideas

Level 6: Building bridges between ideas

Social-Emotional LevelsLevel 1: shared attention &

regulation

Level 2: engagement & relatedness

Level 3: 2-way purposeful communication

Level 4: shared problem-solving

Level 5: Creative use of ideas

Level 6: Building bridges between ideas

Musical ResponsivenessLevel 1: Musical awareness

Level 2: Musical (self) regulation

Level 3: Musical Mutuality/form relatedness

Level 4: Musical

dialoguing/purposeful musicing

Level 5: Musical adaptation

Level 6: Musical inter-relatedness

Musical ResponsivenessLevel 1: Musical awareness

Level 2: Musical (self) regulation

Level 3: Musical Mutuality/form relatedness

Level 4: Musical

dialoguing/purposeful musicing

Level 5: Musical adaptation

Level 6: Musical inter-relatedness

Setting up the clipsSetting up the clips

The children are mainly working on the same lower foundational areas of development

Some show islands of capacities, some have stronger abilities

The commonalities are in their inability to get into a continuous flow of interaction based on their own initiative

Each display my attempt to work through this difficulty, and help create “threads” or links to the interaction, to facilitate some expansion and the experience of a sustained interaction

We are working in a relationship-based model- not looking at isolated behaviors, but the quality of the child’s ability to relate and communicate

The children are mainly working on the same lower foundational areas of development

Some show islands of capacities, some have stronger abilities

The commonalities are in their inability to get into a continuous flow of interaction based on their own initiative

Each display my attempt to work through this difficulty, and help create “threads” or links to the interaction, to facilitate some expansion and the experience of a sustained interaction

We are working in a relationship-based model- not looking at isolated behaviors, but the quality of the child’s ability to relate and communicate

VIDEO EXCERPTS(Refer to Handouts for IMCAP-NDD and

FEDLs)

VIDEO EXCERPTS(Refer to Handouts for IMCAP-NDD and

FEDLs)

Where’s is the interaction? What levels (musical & social

emotional) What’s getting in the way, preventing

the child from deepening their experience within the interaction?

How would the musical interaction sound without the “interference?”

What needs to happen, in musical terms, for the interactions to expand?

Is there musical relatedness/mutuality? Social emotional?

Where’s is the interaction? What levels (musical & social

emotional) What’s getting in the way, preventing

the child from deepening their experience within the interaction?

How would the musical interaction sound without the “interference?”

What needs to happen, in musical terms, for the interactions to expand?

Is there musical relatedness/mutuality? Social emotional?

“Feddy”EXCERPT“Feddy”EXCERPT

“D” Shows fragments of levels I, II, III Fragmented interactions/inability to

maintain regulation “I”

Visually over stimulated Sensory modulation difficulties motor-planning difficulties

Muscial Musical awareness, moments of musical

mutuality & dialoguing

“D” Shows fragments of levels I, II, III Fragmented interactions/inability to

maintain regulation “I”

Visually over stimulated Sensory modulation difficulties motor-planning difficulties

Muscial Musical awareness, moments of musical

mutuality & dialoguing

JeremyEXCERPTJeremyEXCERPT

“D” Levels I, II, III (limited range) Requires high arousal (affect/music) Engaging and working with Stim for interaction Work in-between the stim

“I” Mixed reactivity Visual processing Sensory modulation Interaction is limited in range of affect

Musical Musical awareness, mutuality, intentionality, musical

adaptation Musical interaction is limited in range of affect

“D” Levels I, II, III (limited range) Requires high arousal (affect/music) Engaging and working with Stim for interaction Work in-between the stim

“I” Mixed reactivity Visual processing Sensory modulation Interaction is limited in range of affect

Musical Musical awareness, mutuality, intentionality, musical

adaptation Musical interaction is limited in range of affect

TylerEXCERPT

TylerEXCERPT

“D” Craves movement (circular)

Movement is linked to visual self stimming Difficulty with regulation- getting in the way of a

continuous flow of interaction Shows some capacity in levels I, II, II-FRAGMENTED

AND CYCLICAL “I”

Visual-spatial difficulties Difficulty tracking Seeks vestibular input

Musical Awareness (rhythm, syncopation), capacities

in musical mutuality

“D” Craves movement (circular)

Movement is linked to visual self stimming Difficulty with regulation- getting in the way of a

continuous flow of interaction Shows some capacity in levels I, II, II-FRAGMENTED

AND CYCLICAL “I”

Visual-spatial difficulties Difficulty tracking Seeks vestibular input

Musical Awareness (rhythm, syncopation), capacities

in musical mutuality

TommyEXCERPTTommyEXCERPT

“D” Difficulty with regulation- needs support (affect,

gestures, prompt) Capacities to engage, relate, problem-solve Unclear if intentions are to relate

“I” Sensory-motor detached (affect?) Under-reactive sensory system

Musical Awareness, capacities in musical mutuality,

adaptation Interaction is limited in range of expressiveness and

affect Finds basic beat with support Shows some musical range in tempo and dynamics

with a lot of support (gestures, affect)

“D” Difficulty with regulation- needs support (affect,

gestures, prompt) Capacities to engage, relate, problem-solve Unclear if intentions are to relate

“I” Sensory-motor detached (affect?) Under-reactive sensory system

Musical Awareness, capacities in musical mutuality,

adaptation Interaction is limited in range of expressiveness and

affect Finds basic beat with support Shows some musical range in tempo and dynamics

with a lot of support (gestures, affect)

Joey: Working in the higher levels of FEDLS and Musical

responsivenessEXCERPT

Joey: Working in the higher levels of FEDLS and Musical

responsivenessEXCERPT

“D” Levels I, II, III, IV, V Shows Islands of level V Maintaining co-regulation during stress (when others

walk in-body swaying) Musical

Showing a wide range in musical respsonsiveness throughout levels I through VI

Many subtle musical changes that he initiates and responds to

Range of musical expressivenes Harmony, Meter, Inflection, Phrasing, Deception in

resolving (substitution chord changes) Future work focuses of his ability to initiate

the expressive elements during musical play

“D” Levels I, II, III, IV, V Shows Islands of level V Maintaining co-regulation during stress (when others

walk in-body swaying) Musical

Showing a wide range in musical respsonsiveness throughout levels I through VI

Many subtle musical changes that he initiates and responds to

Range of musical expressivenes Harmony, Meter, Inflection, Phrasing, Deception in

resolving (substitution chord changes) Future work focuses of his ability to initiate

the expressive elements during musical play

Part VIPart VI

ASSESSMENT:Individual Music-Centered Assessment Profile for

Nuerodevelopmental Disorders of Relating & Communicating

ASSESSMENT:Individual Music-Centered Assessment Profile for

Nuerodevelopmental Disorders of Relating & Communicating

IMCAP-NDD®IMCAP-NDD®Looking the 6 levels & sub-

categories within the context of musical play (interaction)

Each level builds upon the previous

Each level offers deeper experiences of musical interaction

Looking the 6 levels & sub-categories within the context of musical play (interaction)

Each level builds upon the previous

Each level offers deeper experiences of musical interaction

IMCAP-NDD: 6 levels of musical responsivenessIMCAP-NDD: 6 levels of musical responsiveness

I. Musical awarenessII. Musical self-regulationIII. Musical mutuality

Dynamics Tempo Interpersonal gestures

IV. Musical dialoguing Basic beating w/intentionality vocalizations

V. Musical adaptation Range of musical expressiveness

VI. Musical inter-relatedness/assimilation

I. Musical awarenessII. Musical self-regulationIII. Musical mutuality

Dynamics Tempo Interpersonal gestures

IV. Musical dialoguing Basic beating w/intentionality vocalizations

V. Musical adaptation Range of musical expressiveness

VI. Musical inter-relatedness/assimilation

Review assessment grid…Review assessment grid…

Lets Assess Devon!Lets Assess Devon!

Listening and watching the quality of the musical interaction

Remember, affect and interpersonal responses to music count too

Where are his strengths, in terms of the IMCAP-NDD, and area/s of weakness?

We are listening and watching his ability to relate and communicate within the context of musical play (interaction)

Listening and watching the quality of the musical interaction

Remember, affect and interpersonal responses to music count too

Where are his strengths, in terms of the IMCAP-NDD, and area/s of weakness?

We are listening and watching his ability to relate and communicate within the context of musical play (interaction)

Part VIIPart VII

Evaluation: Goal Attainment Scaling (GAS)

Evaluation: Goal Attainment Scaling (GAS)

GAS to measure musical goal areas

GAS to measure musical goal areas

GAS is a tool for tracking and recording the achievement of project activities and completion of project objectives.

GAS can be used at specified intervals to monitor the level of achievement for each anticipated outcome, or a daily session (each session)

GAS is a tool for tracking and recording the achievement of project activities and completion of project objectives.

GAS can be used at specified intervals to monitor the level of achievement for each anticipated outcome, or a daily session (each session)

Benefits GASBenefits GAS

Monitors improvement/progress not just achievement.

Enables easy, quantitative and qualitative comparison between very different activities.

Provides grant reviewers a “snapshot” of targets across all activities

Monitors improvement/progress not just achievement.

Enables easy, quantitative and qualitative comparison between very different activities.

Provides grant reviewers a “snapshot” of targets across all activities

GAS Scores or Degrees of Achievement

GAS Scores or Degrees of Achievement

Level +2:Much higher than anticipated outcome

Level +1:Higher than anticipated outcome

Level 0: Met anticipated outcome. Level -1:Less than anticipated

outcome Level -2:Much less that than

anticipated outcome

Level +2:Much higher than anticipated outcome

Level +1:Higher than anticipated outcome

Level 0: Met anticipated outcome. Level -1:Less than anticipated

outcome Level -2:Much less that than

anticipated outcome

Steps in GASSteps in GAS

Step 1: Develop and define goal area

Step 2: Develop activities needed to meet or complete each objective (operationally define).

Step 3: Set an anticipated outcome

Step 4: For each outcome, set targets for each degree of achievement.

Step 1: Develop and define goal area

Step 2: Develop activities needed to meet or complete each objective (operationally define).

Step 3: Set an anticipated outcome

Step 4: For each outcome, set targets for each degree of achievement.

GAS(figure 2.)GAS

(figure 2.)Rating Levels Goal 1: Bridging musical

ideas: Musicalinterrelatedness

Goal 2: Problem-solving:Musical interresponsiveness

Goal 3: Initiatesinteraction: Relationshipwithin musical activity

Goal 4: 2-way purposefulcommunication: musicalcommunicativeness

Goal 5: EmotionalRange: Range ofExpressiveness

(-2) MostUnfavorableoutcome Never% of time

Never uses music interrelatedly, connectingmusical ideas with therapist’sand elaborates during musicalplay

*Never uses musicinterresponsively by Imitating or copying amusical idea thenincorporate it into musicalplay

Child never enters intorelationship within musicalplay on own initiative

Never able to use musiccommunicatively, opening andclosing circles ofcommunication during

musicalplay

*Never displaysFlexibility indynamics and/ortempo duringmusical play

(-1) Less thenexpected successRarely1%-25% of time

*Rarely uses musicinterrelatedly, connectingmusical ideas withtherapist’s and elaboratesduring musical play

Rarely uses musicinterresponsively by imitating orcopying a musical idea thenincorporate it into musical play

*Child rarely enters into

relationship withinmusical play on owninitiative

*Rarely uses musiccommunicatively, openingand closing circles ofcommunication duringmusical play

Rarely displays flexibilityin dynamics and/or

tempoduring musical play

(0) Expected level

Sometimes26%-50% of time

Sometimes uses musicinterrelatedly, connectingmusical ideas with therapist’sand elaborates during musicalplay

Sometimes uses musicinterresponsively by imitating orcopying a musical idea thenincorporate it into musical play

Child sometimes enters intorelationship within musical play on own initiative

Sometimes uses musiccommunicatively opening andclosing circles ofcommunication during

musicalplay

***Sometimesdisplays flexibility indynamics and/ortempo duringmusical play

(+1) More thenexpected success Often51%-75% of time

Often uses music interrelatedly,

connecting musical ideas withtherapist’s and elaboratesduring musical play

***Often uses musicinterresponsively byimitating or copying amusical idea thenincorporate it into musicalplay

Child often enters intorelationship within musicalplay on own initiative

***Often uses musiccommunicatively, openingand closing circles ofcommunication duringMusical play

Often displays flexibilityin dynamics and/or

tempoduring musical play

(+2) MostFavorableoutcomeConsistently76%-100% oftime

***Consistently usesmusic interrelatedly,connecting musical ideaswith therapist’s andelaborates during

musicalplay

Consistently uses musicinterresponsively by imitating orcopying a musical idea thenincorporate it into musical play

***Child consistentlyenters into relationshipwithin musical play onOwn initiative

Will consistently use musiccommunicatively, opening andclosing circles ofcommunication during

musicalplay

Consistently displaysflexibility in dynamicsand/or tempo duringmusical play

0%

10%

20%

30%

40%

50%

60%

Mus

ical

Aw

aren

ess

Mus

ical

(sel

f)R

egul

atio

n

Mus

ical

Mut

ualit

y

Mus

ical

Dia

logu

ing

(Com

m)

Mus

ical

Ada

ptat

ion

(Pro

blem

-so

lvin

g)

Mus

ical

Inte

rrela

tedn

ess

Series1

Assessment AreasAssessment Areas

Timmy’s GAS(figure 3.)

Timmy’s GAS(figure 3.)

Changes in Goal Attainment Levels

-2

-1

0

1

2

Musical Interrelatedness

Musical Mutuality

Musical

Communicativeness

Musical

Problem-solving

Range of

Expressiveness

Musical Goal Areas

G

AS

LE

VE

LS

Pre Post

Part VIIIPart VIII

Frameworks for Clinical ImprovisationFrameworks for Clinical Improvisation

Working with drumsWorking with drums

Musical frameworkListening with empathyWhat’s the focus/intent of your

music?How will you use or not, your voice?Meet the drumDevelop the musical form based on

drumAware of the musical elements

Musical frameworkListening with empathyWhat’s the focus/intent of your

music?How will you use or not, your voice?Meet the drumDevelop the musical form based on

drumAware of the musical elements

Considerations when working with drumming?

Considerations when working with drumming?

Consideration when working with melodic

instruments?

Consideration when working with melodic

instruments?

CONTACT INFO:John Carpente, PhD, MT-BC, LCAT,

NRMT

CONTACT INFO:John Carpente, PhD, MT-BC, LCAT,

NRMT

[email protected]: Therebeccacenter.org

[email protected]: Therebeccacenter.org

contributions of nordoff-robbins music therapy within the dir®/floortime™ framework to the...

Documents

dsm diagnostic criteria

posttest slide

mime slide

tr slide

social interaction slide

autistic disorder c

revisiting asds criteria

emotional reciprocity