How can Music Therapy help children who find it difficult or impossible to talk?
This was central focus of my final research project when I was studying to be a Music Therapist.
Moved by the words of a mother who was longing to hear the "little voice" of her child, I wanted to find out how you could help children with autism who would benefit from developing some basic, expressive language.
I studied all the different ways I could find that had been officially developed and researched to try to discover which were the most effective. The results surprised me...
"Her, little, voice"
What is certain is that music, even when not used by a trained therapist, is going to help. It's going to help because even just listening to music, never mind participating in it, lights up all the regions of the brain Music and the Brain: What Happens When You're Listening to Music (ucf.edu). It's also going to help because one of the first things it helps us all with is regulating the nervous system.
Once the brain has switched to the parasympathetic (rest and recuperate) rather than sympathetic system (fight or flight) then whatever you are trying to do therapeutically gets easier.
It's surely no coincidence that clients I treat with brain injury who are sometimes deemed 'not settled enough' to take part in the session (showing high levels of agitation by tearing their clothes etc.) if we can just get the music started then - wow - 20 minutes later we can be having a bit of conversation about 80s bands.
"There must be a language that doesn't depend on words, the boy thought" (Paul Coehlo, The Alchemist)
I investigated 5 different ways a Music Therapist can help children to develop speech. I fully expected that the more rigorous, repetitive methods such as the specially-adapted version of melodic intonation therapy Using Melodic Intonation to Facilitate Improvement in Language and Communication Skills in Autistic Children - Nancy Lurie Marks Family Foundation (nlmfoundation.org) might be the most effective.
However, in reality, I found (especially once I was able to do clinical work myself) that methods that involve rigour and doing things that the child is not necessarily that keen to do, are not easy to administer - especially to younger children.
Case study: 'Connie - a 4-year-old child with Autism who is yet to speak
Connie's mum approached me because she was very concerned about her child's lack of speech which was, in her view, causing a lot of problems in terms of frustration levels at home and at school. We agreed to try out music therapy and see how it might work for Connie.
It was lovely to see Connie's very strong response to music therapy from the outset, and, like many children with Autism she was keen to get as close as possible to the sounds - often pressing her ear to the instruments. We built up Connie's understanding of how to communicate nonverbally using the instruments through turn-taking exercises on simple percussion and keyboard. This enabled us to start to build up a relationship where we were not depending on words to carry all the meaning all the time.
After a while, we began to introduce more singing, and we went obout 'over-learning' some songs such as 'The Wheels on the Bus'. Interspersed with the songs we were including on a regular basis, I began to attach melodic fragments to common phrases such as 'I need a drink', 'I'm hungry'. We also included a lot of 'running commentary' songs to help start attaching words to objects but using the sung, rather than the spoken word.
It was exciting to hear Connie utter some words for the first time. It seemed natural that the ones we had paid most attention to came first. I recorded all our target word phrases for Connie to hear around the house inbetween session times. Mum would get in touch with me to let me know that Connie had said a new word that week. We kept a record of all these and reinforced them each time. Connie became able to fill in the final words of the over-learnt songs such as 'Twinkle, twinkle, little....'
After a while, Connie had some simple phrases that she could say and we were able to slowly build on these. Her anxiety levels apparently were reduced and music was used on a regular basis at home to induce a feeling of calm since we were able to identify which repertoire worked best for this (items with repeated arpeggios were the best!)
In the final analysis, I deduced that the most effective way to help a child with speech is to MIX several methods together and serve them in a format that feels to a child like a fun, largely client-led music session with a big emphasis on SINGING.
If you can sing the words then you will soon be able to say them! Yes, a little bit of melodic intonation therapy but research has shown how much psychodynamic music therapy helps too - improvisation, running commentary songs - and pre-composed music with the wonderful gap-leaving technique that comes so instinctively, especially to parents. 'The wheels on the bus go.....'
The creation of a relaxed, interactive dynamic between client and therapist where seeds are sown and watered each week, and then we encourage first of all any kind of vocalisation, and, in time the words to emerge but without any feeling of pressure or coercion.
At the same time, we are developing those all-important social skills and the ability to communicate. This often takes place using the instruments first to make some initial exchanges.
I have found that Music Therapy is particularly helpful in developing skills like giving shared attention, sustaining attention, moving away from looping behaviours, making eye-contact, playing even-handedly, and perhaps the biggest one for most, self-expression. The outpouring of pent up feelings, particularly at the beginning of a session can be very powerful and so beneficial for stressed clients. Music Therapy can also enhance social skills such as turn-taking, sharing and moving away from dominance.
Music is a wonderful vehicle for offering emotional support, fuelling cognitive development, fostering the imagination and igniting creativity. I have found that some clients with Autism are not able to put into words their need for emotional support, but this therapeutic need emerges through a gravitation towards music that has a subtext of belonging, acceptance and togetherness.
Of course, at the heart of any therapeutic work is that all-important relationship between therapist and client. The feeling for the client that somebody understands them at a deep level, cares about their well-being, fosters their development and offers them 'unconditional positive regard' (Carl Rodgers' concept from 'Therapeutic Conditions - Evolution and Practice' 1957) and non-judgmental support appears to come, for many clients, as a huge relief.
If you would like to help your child with speech or social skills then please consider working with us. We can visit your child in person, or, we can work online in some instances. Let's have an online coffee and a no-pressure chat.
or write to us here: info@thisinnervoice.com.
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