EFFECT OF MUSIC THERAPY ON THE DEVELOPMENT OF SPEECH AND LANGUAGE IN NON-VERBALPRE-SCHOOL CHILDREN WITH AUTISM

TITLE: To investigate the effect of Music Therapy on the development of

speech and language in non- verbal pre-school children with autism.

STATEMENT OF THE PROBLEM:

About one-third to a half of individuals with autism do not develop enough

natural speech or have limited speech to express their daily communication

needs. Children with autism often are self-absorbed and seem to exist in their

own world where they are unable to successfully communicate and interact with

others. They may have difficulty developing receptive and expressive language

skills and understanding what others speak to them. They also may have

difficulty communicating nonverbally, for e.g through gestures, eye contact,

facial expressions and body language. The child’s ability to communicate with

others will vary and depends upon his or her cognitive and social development.

Some children with autism may be unable to develop speech. Others may have

rich vocabularies and be able to talk about specific subjects in detail. The

majority have difficulty using language effectively to explain, especially when

they talk to other people. Many have problems with understanding the meaning

and rhythm of words and sentences. They also may be unable to understand

body language and the nuances of vocal tones.They usually exhibit difficulties in

social interaction as well as in verbal and non-verbal communication. Since

autistic children are hypersensitive to external stimuli, they tend to have a strong

affinity for listening to music and playing musical instruments. Many autistic

children sometimes sing when they may not speak. They often restrict

themselves by closing their ears tightly with their fingers poked in and humming

a tune continuously. Music therapy being a well-established technique for using

musical interaction to help individuals with a wide range of cognitive and

emotional challenges to improve their ability to function, it was conducted on

non-verbal preschool children for development of speech, speech intelligibility

and language development.

REVIEW OF LITERATURE:

1.Science Daily (Sep.20,2006)- Researchers have found the first evidence that young

children who take music lessons show different brain development and improved

memory over the course of a year compared to children who do not receive musical

training.

2. Institute of Cognitive Neurosciences of the Mediterranean, CNRS,Marseille,

France Center for Complex Systems and Brain Sciences , Florida Atlantic

University, Boca Raton, Florida 33431,USA-Compared the neural bases of

language and music and manipulated either the linguistic or musical dimensions

(or both) of song and studied their relationships. It was possible to gain important

information about the neural networks underlying language and music cognition.

They also conducted behavioral, electrophysiological, and neuroimaging studies

concerning with the functional and structural relationships of music and

language.

3. In 1994 ‘Discover magazine’ published an article which discussed research by

Gottfried Schlaug, Herman Steinmetz and their colleagues at the University of

Dusseldorf. The group compared magnetic resonance images (MRI) of the brains of 27

classically trained right-handed male piano or string players, with those of 27 right-

handed male non-musicians. Intriguingly, they found that in the musicians’ planum

temporale - a brain structure associated with auditory processing - was bigger in the left

hemisphere and smaller in the right than in the non-musicians. The musicians also had a

thicker nerve fibre tract between the hemisphere. The differences were especially striking

among musicians who began training before the age of seven. According to Shlaug,

music study also promotes growth of the corpus callosum, a sort of bridge between the

two hemispheres of the brain. He found that among musicians who started their training

before the age of seven, the corpus callosum is 10-15% thicker than in non-musicians. 

RATIONAL OF STUDY:

Music therapy can help patients suffering from autism spectrum disorders to

physical injuries like spinal cord injuries. Different studies are being going on to

determine if music therapy can help treat Parkinson’s Disease, which is a brain

disease that causes its sufferers to shake uncontrollably. It’s also being used for

older people living in hospital or old age care as music therapy is believed to

decrease pain perception and provide distraction for people living with chronic or

extreme pain. Music therapy is also being used much more often to treat people

with autism, especially young children. Autistic people are often entirely closed

off in their own private world and they are unable to properly communicate with

the people around them. They struggle to interact with the world around them as

well. The left brain is responsible for general music ability in musicians,

perception, production of speech, perception of rhythm and prosody, lyric

performance during singing and the temporal sequences of reading ability. The

right brain is involved with processing of musical pitch, control of intensity of

sound(amplitude), identification and detection of musical chords, melody

perception in non-musicians, visual pattern recognition, singing, auditory pattern

recognition(auditory training), and expressive rhythmic and melodic behaviour.

New studies are reporting of overlapping areas for music and language

processing. Rhythm has been found to positively influence brain activity during

learning; scientists have reported that after a rhythm sequence is stopped, brain

activity occurs in anticipation. Research supports connections between speech

and singing, rhythm and motor movements, memory for song and memory for

academic concepts, and overall ability of preferred music . Speech can range

from complete mutism to grunts, reflexive crying,shrieks, guttural and humming

sounds. There may be musically intoned vocalizations with some consonant-

vowel combinations, a sophisticated babbling interspersed with recognizable

word-like sounds or a jargon speech. It is therefore necessary to study further,

how speech and language can be developed in children with autism and how

music-based communication is possible even when language processing is

missing.

DEFINITIONS:

Music Therapy- Music therapy is an allied health profession and a field of scientific

research which studies correlations between the

process of clinical therapy and biomusicology, musical acoustics, music theory,

psychoacoustics, embodied , music cognition and comparative musicology. It is an

interpersonal process in which a trained music therapist uses music and all of

its facets-physical, emotional, mental, social, aesthetic, and spiritual—to help

clients to improve or maintain their health.

Voice Analysis- Voice analysis is the study of speech sounds for purposes other

than linguistic content, such as in speech recognition. Such studies include

mostly medical analysis of the voice .

ASSUMPTIONS:

Scientists have discovered that music training has significant influences on the brain

development of young children which leads to

improved memory and language recall skills .Researchers found that

musically trained children performed better in a memory test that is correlated with other

skills such as literacy, verbal memory, visual spatial processing, mathematics and

intelligence. Since children with autism have affinity towards music and there is a proven

co-relation between the music, speech and brain development, the research on above

topic was pursued.

HYPOTHESIS:

1.To investigate the effect of Music Therapy in development of

speech in non- verbal pre-school children with autism.

2. To investigate the effect of Music Therapy in development of

language in non- verbal pre-school children with autism.

LIMITATIONS:

1. The sample size was small.

METHOD:

Research Design: Experimental research design.

Independentvariable: Music Therapy

Dependent variable: Speech and Language Development in

non- verbal pre-school children with autism.

Sample design: 8 children with autism with no speech or

minimal speech.

Sampling Design: By convince sampling

Inclusion criteria: 1. Age-3-5 years.

2. Diagnosis- All children were diagnosed

under Autism Spectrum Disorder By Child

Psychiatrist and Clinical Psychologist.

Exclusion criteria: None.

Instrumentation:

1.Perceptual Evaluation of Speech Quality test .

2.Voice Assessment Protocol for Children and Adults (VAP)

3.Clinical Evaluation of Language Fundamentals–Preschool, Second

Edition (CELF-Preschool 2)

4.Goldman-Fristoe Test of Articulation-Second Edition G-

FTA-2)

5. Peabody Picture Vocabulary Test

Materials and Equipments:

1. Computer voice analyzer.

2. Praat software program for acoustic voice analysis.

3. Phonatory Aerodynamic System (PAS)

4. Microphone

5. Tape recorder

6. Musical Instruments.

Procedure:

The team comprised of a Music Therapist and Speech Therapist. The duration of the

project was from 26th January 2009 to 14th November 2009 at Ruptech Educational India. 8

pre-school children with no or minimal speech with autism were assessed prior to the

start of therapy sessions. The child’s Speech Development milestones, Imitation skills,

Articulation test, Voice Analysis (loudness, quality, pitch range) was assessed. The

child’s receptive and expressive vocabulary and Situation-Facial Expression Matching

were tested using photographs and video clippings. After assessing the strengths and

needs of each child with autism, the music therapist developed a treatment plan with

goals and objectives and then provided appropriate treatment. The therapist used

percussion, tuned instruments and her own voice, to respond creatively to the sounds

produced by the children with autism and encouraged them to create his or her own

musical language. Musical games like passing a ball back and forth to music or playing

sticks and cymbals with a partner to foster interaction were played. Preferred music was

used contingently for a wide variety of cooperative social behaviours like sitting on a

chair or staying with a group of other children in a circle. Music selections and certain

active music-making activities were modified for child’s preferences and individualized

needs (i.e., song selection and music may vary). Toolkits were available via AMTA and

publications.

The therapy was conducted in individual and small group sessions. The children

attended 40 music therapy sessions-19 individual sessions and 21 group sessions,

twice/week, of half an hour each. The group session had 3-4 ASD students during

therapy. Music therapy sessions were documented in a treatment plan, every week and

delivered in accordance with standards of practice. The speech and voice analysis was

done by the voice therapist along with the music therapist.

Table1 Receptive and Expressive Language Age based on Clinical

Evaluation of Language Fundamentals–Preschool, Second

Edition (CELF-Preschool 2), on 27th March 2009(Pre-therapy

assessment)

Subjects

Chronological Age(in years)

Receptive Language Age(in years)

Expressive Language Age

(in years)

Child A 3.4 2.2 1.4

Child B 4.6 3.4 1.8

Child C 3.2 2.1 1.1

Child D 4.2 2.3 1.4

Child E 3.7 2.4 1.0

Child F 4.10 3.0 1.9

Child G 3.4 2.1 1.3

Child H 4.9 3.8 2.0

Table 2 Receptive and Expressive Language Age based on Clinical

Evaluation of Language Fundamentals–Preschool, Second

Edition (CELF-Preschool 2), on 3rd October 2009(Post-therapy

assessment)

Subjects

Chronological Age(in years)

Receptive Language Age(in years)

Expressive Language Age

(in years)

Child A 3.10 2.6 1.7

Child B 5.0 3.7 2.1

Child C 3.8 2.4 1.6

Child D 4.8 2.5 1.9

Child E 4.1 2.7 1.3

Child F 5.4 3.4 2.1

Child G 3.10 2.3 1.5

Child H 5.3 3.9 2.6

Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child A.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5

3

2.22.1

2.32.5

2.6

1.41.5

1.41.6

1.7

Receptive Age

Expressive age

Inp

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Rec

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child B.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5

3

3.5

43.4 3.4 3.5 3.5

3.7

1.81.6

1.91.7

2.1

Receptive Age

Expressive age

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child C.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5

2.12.2

2.32.4 2.4

1.4

1.1

1.3

1.6 1.6

Receptive Age

Expressive age

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child D.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5 2.3 2.32.4

2.5 2.5

1.4 1.41.5

1.7

1.9

Receptive Age

Expressive age

Inpr

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ent i

n R

ecep

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and

Expr

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angu

age

Age

in y

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child E.

27th Mar

09

5th May09

25th June

17th Aug09

3rd Oct0

9

0

0.5

1

1.5

2

2.5

3

2.4 2.42.5

2.62.7

1.4

11.2

1.3 1.3Receptive Age

Expressive age

Inpr

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and

Exp

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child F.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5

3

3.53

3.13.3 3.3

3.4

1.4

1.92 2

2.1

Receptive Age

Expressive age

Inp

rov

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Rec

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and

Ex

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child G.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5

2.1 2.1

2.3 2.3 2.3

1.41.3

1.41.3

1.5

Receptive Age

Expressive age

Inp

rov

emen

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Rec

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and

Ex

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Graph Representing Receptive and Expressive Language age based on Clinical Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rd October 2009 of Child H.

27th Mar

09

5th May

09

25th June

17th Aug09

3rd O

ct09

0

0.5

1

1.5

2

2.5

3

3.5

43.8 3.8 3.9 3.9 3.9

2.1

1.5

0

2.5 2.6

Receptive Age

Expressive age

Inp

rov

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Rec

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and

Ex

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Table 3 Articulation Test based on Goldman-Fristoe Test of

Articulation-Second Edition G-FTA-2) on 27th March 2009(Pre-

therapy assessment)

Subjects Chronological Age(in years)

Misarticulation

Child A 3.10 N.A

Child B 5.0 N,A

Child C 3.8 aspirated sounds

Child D 4.8 Trill sounds

Child E 4.1 N.A

Child F 5.4 N.A

Child G 3.10 Glottal sounds

Child H 5.3 N.A

Table 4 Articulation Test based on Goldman-Fristoe Test of

Articulation-Second Edition G-FTA-2) on 13th Oct 2009(Post-

therapy assessment)

Subjects Chronological Age(in years)

Misarticulation

Child A 3.10 N.A

Child B 5.0 N,A

Child C 3.8 aspirated sounds(reduced by 40%)

Child D 4.8 Trill sounds(no improvement)

Child E 4.1 N.A

Child F 5.4 N.A

Child G 3.10 Glottal sounds(reduced by 30%)

Child H 5.3 N.A

Table 5 Voice Analysis , on computerized Voice Analyser on 29th March

2009(Pre-therapy assessment)

Subjects Chronological Age(in years)

Pitch range(in Hz)

Loudness

(in db)

Quality of voice (in%)

Child A 3.4 230-560 40 Normal

Child B 4.6 135-257 60 Hoarse(40%)

Child C 3.2 321-460 30 Normal

Child D 4.2 110-730 45 Nasal (70%)

Child E 3.7 230-270 50 Normal

Child F 4.10 340-800 34 Nasal(70%)

Child G 3.4 120-224 35 Husky(40%)

Child H 4.9 130- 170 57 Hoarse(30%)

Table 6 Voice Analysis , on computerized Voice Analyser on 7th October

2009(Post-therapy assessment)

Subjects Chronological Age(in years)

Pitch range(in Hz)

Loudness

(in db)

Quality of voice (in%)

Child A 3.10 130-730 60 Normal

Child B 5.0 130-454 65 Hoarse(30%)

Child C 3.8 232-640 40 Normal

Child D 4.8 110-870 36 Nasal(50%)

Child E 4.1 120-330 30 Normal

Child F 5.4 320-870 24 Nasal

Child G 3.10 110-344 43 Husky(30%)

Child H 5.3 120- 180 63 Hoarse(25%)

FINDINGS:

The findings of this study gave significant insights into the relationship

between music, speech , language development in children with autism.

It was observed that there was an overall enhancement in their receptive and functional

expressive language skills. While all could speak in telegraphic speech post music therapy

sessions, 2 children could express in 3-4 word short sentences and developed functional

expressive skills. 1 child could narrate events in 3-4 sentences of 4-5 word length. It was

noticed that the articulation of 2 children improved in aspirated and glottal sounds and 1

child showed no improvement. There was significant improvement in pitch range,3

children could attain normal loudness. The voice quality improved of 4 children who had

nasal or hoarse or husky voice. There was an improvement of 5-20% in their voice quality.

IMPLICATIONS:

The above findings prove that music therapy helps to enhance attention ,speech

and language development to optimize the student’s ability to learn and interact.

It has been effective in the development and remediation of speech and

language. Therefore, the purpose of music therapy for children with autism

should be to provide the student with an initial assist using melodic and rhythmic

strategies, followed by fading of musical cues to aid in generalization and

transfer to other learning environments. The future of music brain research is

bright.

Additional study is needed:

-to specify the effect of each of the components of music (i.e. rhythm) on specific

areas of brain activity,

-to specify areas of brain activity during emotional responses to music,

- to analyze the structural similarities between music and language,

-to study the neuromuscular effect of low-frequency vibration and

music,

-to study the effect of music on retrieval in short and long term

memory .

BIBLIOGRAPHY

Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of directed art activities on the behavior of young children with disabilities: A multi-element baseline analysis. Art Therapy: Journal of the American Art Therapy Association, 10(4), 235-240.

Bentivegna, S., Schwartz, L., & Deschner, D. (1983). The use of art with an autistic child in residential care. American Journal of Art Therapy, 22, 51-56.

Benveniste, D. (1983). The archetypal image of the mouth and its relation to autism. Arts in Psychotherapy, 10, 99-112.

Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative ways. Advocate: magazine of the Autism Society of America, 26-27.

Betts, D. J. (2003). Developing a projective drawing test: Experiences with the Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art Therapy Association, 20(2), 77-82.

Betts, D. J., & Tabone, C. (2002). Working with autism: Contemporary assessment and treatment methods. Paper presented at the 33rd Annual Conference of the American Art Therapy Association, Washington, DC.

Betts, D. J. (2001). Projective drawing research: Assessing the abilities of children and adolescents with multiple disabilities. Paper presented at the 32nd Annual Conference of the American Art Therapy Association, Albuquerque, NM.

Betts, D. J. (2001). Cover story: weekend outings provide creative outlet: Individual expresses himself through art

therapy. Advocate: Magazine of the Autism Society of America, 34(3), 20-21.

Betts, D. J. (2001). Special report: The art of art therapy. Drawing individuals out in creative ways. Advocate: Magazine of the Autism Society of America, 34(3), 22-23(29).

Buck, L. A. (1985). Artistic talent in “autistic” adolescents and young adults. Empirical Studies of the Arts, 3(1), 81-104.

Evans, K. & Dubowski, J. (2001). Art therapy with children on the autistic spectrum: Beyond words. Jessica Kingsley Publishers, London.

Fleshman, B., & Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall. In Parker-Hairston, M. J. (1990). Analyses of responses of mentally retarded autistic and mentally retarded non-autistic children to art therapy and music therapy. Journal of Music Therapy, XXVII(3), 137-150.

Henley, D. (2001) Annihilation anxiety and fantasy in the art of children with Asperger’s Syndrome and others on the autistic spectrum. American Journal of Art Therapy, 39(4), 113-121.

Henley, D. (1992). Therapeutic and aesthetic application of video with the developmentally disabled. Arts in Psychotherapy, 18, 441-447.

BIBLIOGRAPHY

Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of directed art activities on the behavior of young children with disabilities: A multi-element baseline analysis. Art Therapy: Journal of the American Art Therapy Association, 10(4), 235-240.

Bentivegna, S., Schwartz, L., & Deschner, D. (1983). The use of art with an autistic child in residential care. American Journal of Art Therapy, 22, 51-56.

Benveniste, D. (1983). The archetypal image of the mouth and its relation to autism. Arts in Psychotherapy, 10, 99-112.

Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative ways. Advocate: magazine of the Autism Society of America, 26-27.

Betts, D. J. (2003). Developing a projective drawing test: Experiences with the Face Stimulus Assessment (FSA). Art

Therapy: Journal of the American Art Therapy Association, 20(2), 77-82.

Betts, D. J., & Tabone, C. (2002). Working with autism: Contemporary assessment and treatment methods. Paper presented at the 33rd Annual Conference of the American Art Therapy Association, Washington, DC.

Betts, D. J. (2001). Projective drawing research: Assessing the abilities of children and adolescents with multiple disabilities. Paper presented at the 32nd Annual Conference of the American Art Therapy Association, Albuquerque, NM.

Betts, D. J. (2001). Cover story: weekend outings provide creative outlet: Individual expresses himself through art therapy. Advocate: Magazine of the Autism Society of America, 34(3), 20-21.

Betts, D. J. (2001). Special report: The art of art therapy. Drawing individuals out in creative ways. Advocate: Magazine of the Autism Society of America, 34(3), 22-23(29).

Buck, L. A. (1985). Artistic talent in “autistic” adolescents and young adults. Empirical Studies of the Arts, 3(1), 81-104.

Evans, K. & Dubowski, J. (2001). Art therapy with children on the autistic spectrum: Beyond words. Jessica Kingsley Publishers, London.

Fleshman, B., & Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall. In Parker-Hairston, M. J. (1990). Analyses of responses of mentally retarded autistic and mentally retarded non-autistic children to art therapy and music therapy. Journal of Music Therapy, XXVII(3), 137-150.

Henley, D. (2001) Annihilation anxiety and fantasy in the art of children with Asperger’s Syndrome and others on the autistic spectrum. American Journal of Art Therapy, 39(4), 113-121.

Henley, D. (1992). Therapeutic and aesthetic application of video with the developmentally disabled. Arts in Psychotherapy, 18, 441-447.