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+
A Review of Music and Art Therapies For Individuals with Autism
+ Music and Art Therapies
Music Therapy
Art Therapy
Discussion
Questions
+ Music Therapy
Definition
History
Models
Settings
Services
Credentials
Claims
Parent and Therapist reports Outcomes
Evidence
+ Art Therapy
Definition
Activity
History
Models
Art Development
Settings
Credentials
Claims
Parent and Therapist reports
Evidence
+ Search parameters
Psychinfo
“Music” and “therapy” in any field“autis*” in “subject”
Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text (time)
15 results:
“Art” and “therapy” in any field and “autis*” in subject
Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text (time)
26 results
Google
Music therapy
Music therapy autism
Art therapy
American art therapy association
Art therapy autism
Art therapy and autism
Art therapy autism history
American music therapy association
Center for Health and Healing
Google news
Music therapy autism
Art therapy autism
+ Music Therapy Defined
“Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”
“Refers to the application of music with the intent to enhance functioning”
American Music Therapy Association. (2011).Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org/ /whoarearttherapists2009.pdf Association for Science in Autism Treatment. Music Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/ music.htm
+ What’s the appeal?
Music Therapy Clip: Jammin Jenn
Jennmusiczack. (2010). Hope for autism through music therapy. Available from http://youtube.com
.
+
Is it founded?
+ History of Music Therapy
Idea of music as healing goes back to Aristotle
Discipline began after World War I and World War II when musicians went to Veterans hospitals to play for victims
Notable responses of patients led to doctors hiring musicians
Some musicians needed training before being in hospitals led to need for college curriculum
First music therapy degree program at Michigan State University in 1944
The American Music Therapy Association founded in 1998
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ Music therapy: Models
Receptive music listening
Song writing
Music performance
Imitation Call and answer songs (Chase, 2009)
Improvisational music therapy
Creative music therapy model (Nordoff-Robbins Model) has been found most effective with children with autism
Nordoff-Robbins Clip
Music-making vs. music-listening to motivate learners and effect growt
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved fromhttp:/ /www.musictherapy.org/ factsheets/bib_autism.pdf Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com. Kim, J., Wigram, T., Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13, 389409. doi:
+ Settings: Music Therapy
Psychiatric hospitals
Rehab facilities
Medical hospitals
Outpatient clinics
Agencies for developmentally disabled persons
Drug and alcohol programs
Senior centers
Correctional facilities
Schools
Private practices.
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ Music Therapy: Services
Considered related service under IDEA (Stetler, 2009)
IEP goals: related services
150 certified music therapists in New Jersey but this number is rapidly expanding (Chase, 2009)
Medicare: 1994, reimbursable for service under benefits for Partial Hospitalization Programs (PHP) under heading of Activity Therapy
Must be: Prescribed by a physician Reasonable and necessary for treatment of illness/injury Goal directed and based on a documented treatment plan Goal cannot be to maintain current level, must exhibit some level of improvement
Some medicade programs cover music therapy
Some private insurances cover music therapy
About 20% of Music therapists receive third party reimbursement
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved f
+ Music Therapist: Credentials
Participate in approved college music therapy curricula to be eligible to sit for national examination offered by Certification Boar for Music Therapists (MT-BC)
National Music Therapy Registry (NMTR) serves qualified music therapy professionals with the designation RMT, CMT, or ACMT
+ Music Therapy: Claims
Interventions designed to:
Promote wellness
Manage stress
Alleviate pain
Express feelings
Enhance memory
Improve communication
Promote physical rehabilitation
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ Music Therapy: Outcomes for Individuals with Autism
Increased attention
Decreased self-stimulation
Improved cognitive functioning
Increased socialization
Successful and safe self-expression
Improved behavior
Enhanced auditory processing
Decreased agitation
Improved verbal skills
Enhanced sensory-motor skills
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ From the therapists…
“For people with autism, the world is a chaotic place, full of overwhelming levels of sensory input,” says John Foley…”Music has form we all recognize, even if we don’t think in those ; music makes sense. In the early days of defining autism, heightened response to music was considered for the list of possible symptom.” (Chase, 2009)
“We know music therapy works with people on the autism spectrum, even if we don’t always know why or how” (Chase, 2009)
Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com
+ Music Therapy: Parent reports
“’I wish I could say how, exactly, but I just know that music is an avenue to get their little brains going.’ said Michelle Phalon” (Chase, 2009)
“’The proof is in what you see and the changes in your child…It’s hard to argue with physical progress. There are naysayers out there in everything. But you see the difference.’” (Chase, 2009)
“’She just engage more,’ Wismann said. ‘Instead of being in her own space, if you’re more singsong-y when you’re interacting with her, she seems to engage more and want to be interactive with you.’” (Thompson, 2011).
Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com. Thompson, D. (2011, May 27). Living with a child with autism. HealthDay News. Retrieved http://health.usnews.com
+ Evidence for Music Therapy
According to the Association for Science in Autism Treatment, preliminary evidence suggests that music therapy might be effective in enhancing functioning, but more rigorous research needs to be conducted
Association for Science in Autism Treatment. Music Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/music.htm
+ Evidence for Music Therapy
15 total articles
1 unrelated to music therapy
Dependent variables
Social responsiveness: 4 studies
Avoidant Behaviors, emotional responsiveness, t-attention behaviors, music skills, preferences, task performance, and auditory stimulus processing, object constancy: 1 study each
Vocal Stereotypy: 2 studies
Single-subject design: 3 articles
Group design 3 articles
Meta-analysis and analysis: 1 article each
Vignettes/Case studies: 6 articles
+ Evidence: Single-Subject Further evaluation of methods to identify matched Research stimulation (Rapp, 2007)
Effects of preferred stimulation on vocal stereotypy
Results: Sound-producing toys or non-contingent music led to decreased vocal stereotypy
Possibly auditory stimulation functioned as an abolishing operation for vocal stereotypy
The limits and motivating potential of sensory stimuli as reinforcers for autistic children (Ferrari & Harris, 1981)
Use of vibrations, music, and strobe lights as reinforcement.
Results varied but sensory stimuli has motivating potentials similar to those of food and social reinforcers
Ferrari, M., Harris, S.L. (1981). The limits and motivating potential of sensory stimuli as reinforcers for autistic children. Journal of Applied Behavior Analysis, 14, 339-343. doi: 10.1901/jaba.1981.14-339 Rapp, J. T. (2007). Further evaluation of methods to identify matched stimulation. Journal of Applied Behavior Analysis, 40, 73-88. doi: 10.1901/jaba.2007.142-05
+ Evidence: Single-Subject Research Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions.
+ Research: Social Responsiveness
Finnigan, E., Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions. Autism, 14, p. 321-348.
+ Evidence: Single-Subject Research
Participant: A 3-year, 8-month old girl with autism
Materials: 6 neutral toys randomly assigned to a condition
Setting: 4 15-minute sessions per week for 2 months in empty preschool classroom or at participant’s home
Alternating treatment design
Dependent variable: social responsive and avoidance behaviors Number of correct responses divided by the number of opportunities given Data summarized as percentage of correct responses Frequency count for eye and avoidance behaviors
Independent variable: Music and non-music conditions Music intervention: Familiar melodies sung with lyrics appropriate for toy being used. Guitar also played. Non-music intervention: Spoken scripts with words similar to those in melodies
Finnegan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-
+ Evidence: Single-Subject Research
Alternating treatment design: Baseline, Alternating Phase, Best-treatment phase, Follow-up
IOA collected for 20% of sessions with a mean IOA of 87% (range 85-96%)
Data analysis looked at the percentage of nonoverlapping data
Results: Authors demonstrated a functional relationship between the music condition and the increase of social responsive behaviors and decrease of avoidant behaviors.
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Research: Social Responsiveness
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Research: Social Responsiveness
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Research: Social Responsiveness
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Music Therapy: Social Responsiveness Results
suggest positive effects of Music Therapy on social responsiveness
Need
continued research with more rigorous experimental designs to establish functional relationships Small number of participants but not well-designed single-subject research
Use
of music (and other child-preferred activities) as motivation to increase socialization
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+
Music Therapy: Evidence for Outcomes
Increased attention
Decreased self-stimulation (+)
Improved cognitive functioning
Increased socialization (+)
Successful and safe self-expression
Improved behavior
Enhanced auditory processing
Decreased agitation
Improved verbal skills
Enhanced sensory-motor skills
+
+ Art Therapy Defined
“Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem, self- awareness, and achieve insight”
“Refers to the application of art with the intent to enhance functioning.”
American Art Therapy Association. (2011). Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org //whoarearttherapists2009.pdf Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+ Art therapy: Activity
Brainstorm feeling words
Assign each word a color
Draw a heart
Color in the heart the amount of each color that you are feeling
Keep on file Benefits?
+ What’s the appeal?
Art Therapy
+
Google images
Is it founded?
+ History of Art Therapy
1900s
Psychiatrists began being interested in patients’ art. Educators recognized artwork reflected children’s development/growth.
1914: Margaret Naumberg starts Children’s School
Often identified as the founder of art therapy
Art therapy started to be included with traditional talk therapy
1940s: Distinct discipline emerged
1970s: Division in art therapists
Art therapy: innate healing power of making art Art psychotherapy: art as a healing tool within a framework of verbal psychotherapy
American Art Therapy Association. (2011). Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org//whoarearttherapists2009.pdf Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingn org/complement/art_how.html
+ Art therapy: Models
Acting/Filming
Photography
Painting
Drawing
Portrait drawing
Art as expression of feelings
Art as nonverbal communication
eHowArtsAndCrafts (2010). Art therapy activities: art therapy activities on feelings. Available from http://www.youtube.com PolarisMediaGroup (2009). Polaris global presents “Kids with Cameras”. Available from http://www.youtube.com
+ Art Therapy: Art Development
Neurotypical individuals’ drawing skills generally follow the same progression:
Scribbling in early childhood
Symbolic/schematic representation in middle childhood
Concern with achieving realism in adolescence
Shifts are influenced by and have an influence on cognitive development
For children with ASD, the development follows the same sequence and is related to the individual’s nonverbal mental age
Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23. Retrieved from http://www.arttherapyjournal.org/pdf/25-1_Martin.pdf
+ Art Therapy Settings
Work with health professionals in palliative care programs
Prisons
Trauma relief teams
Personal growth classes
School systems
Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingny org/complement/art_how.html
+ Art Therapy: Credentials
“Art therapists” must have a master’s degree or PhD in art therapy AND/OR be a ed art therapist (ATR)
Art therapists are skilled in multiple modalities of art (painting, sculpture, painting, etc.) for assessment and treatment.
Martin, N. (2011). Arttherapyandautism.com. Retrieved from http://arttherapyandautism.com/index.html.
+ Art Therapy: Claims
Art therapy = visual images that represent thoughts/feelings that individuals don’t know how to express verbally
Interventions designed to address:
Imagination/abstract thinking deficits
Sensory regulation and integration
Emotions/self-expression
Nonverbal communication
Socialization
Recreational/leisure skills
Visual-spatial deficits
Improving motor skills
Martin, N. (2011) Explanation. Retrieved from http://arttherapyandautism.com Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+ Art Therapy: Claims
“As a graphic, nonverbal means of communication, art can provide relief to the child for whom verbal communication is frustrating, overwhelming, too direct, or even nonexistent” (Martin, 2008).
“Art therapy can utilize the child’s visual strengths to address treatment goals while providing a socially appropriate outlet for self-stimulatory behaviors and sensory needs” (Martin, 2008).
“Use of icons, symbols, and social stories help the children to what they were taught” (Epp, 2008).
Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23. Epp, K.M. (2008). Outcome-Based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children and Schools, 30, 27-36.
+ Art Therapy: Parent reports
“It has given her confidence, self-esteem,” Mrs. Bigioni said. “She is proud of the work she does. It has brought friendships – peers and facilitators – developed a sense of community” (Joseph, 2011).
Joseph, S. (2011). Growing demand for art therapy. Yorkregion.com. Retrieved from http://www.yorkregion.com/news/article/1012624--growing-demand-for-arttherapy.
+ Evidence: Art Therapy
According to Association for Science in Autism Treatment there have been no scientific studies of art therapy for individual’s with ASD
Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+ Evidence for Art Therapy
26 articles returned
Dependent variable
Unrelated to art therapy 14 (related to music therapy etc.) Social skills Object constancy Face processing skills/portrait drawing
Design
Single-subject –None Group design – 2 Book Review - 6 Meta-analysis/Review - 3 Case study - 1
+ Evidence: Art Therapy
Assessing portrait drawings created by children and adolescents with autism spectrum disorder
25 children with autism with a mean age of 13 years and 15 neurotypical children with a mean age of 10
Completed the Portrait Drawing Assessment (PDA)
Portrait drawings didn’t indicate a difference in iconic skills in children with ASD
Participants with ASD were more often rated as interested and less often rated as indifferent than neurotyipcal participants
Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23.
+ Evidence: Art Therapy
Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum
66 participants
Parents filled a pre and post-test questionnaire (SSRS or Social Skills Rating System)
Attending a social skills group therapy program (with art therapy as a component) improved assertive social skills and decreased problem behaviors and hyperactivity.
Epp, K.M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children and Schools, 30, 27-36. Retrieved from http://web.ebscohost.com.ezproxy. caldwell.edu:2048/ehost/ pdfviewer/pdf viewer?sid=f824fe6f-6b6c-4f84-9de6-53a55d3f8975%40sessionmgr113&vid=32&hid=105
+ Evidence: Art Therapy
Interventions designed to address:
Imagination/abstract thinking deficits
Sensory regulation and integration
Emotions/self-expression
Nonverbal communication
Socialization
Recreational/leisure skills
Visual-spatial deficits
Improving motor skills
Object Object constancy? constancy? Faceprocessing? processing? Face
+ Discussion
Music therapy
Noncontingent reinforcement/preferred stimulation
Increased social responsiveness
Decreased problem behaviors
Auditory processing
Art therapy
Use of portrait drawing and photography to promote selfmonitoring and awareness
Use of portrait drawing to develop knowledge related to facial expressions
Fine motor skills
+ Discussion cont.
Behavior traps
Motor imitation
Gross and fine motor skills
Social interaction
+ Discussion cont.
Things to consider…
Individual’s with ASD as visual thinkers/concrete
Individual’s with ASD with processing differences (auditory and visual)
Use of preferred music as reinforcement is different than the application of music or art as a therapeutic intervention
Need for more research is clear!
+ Recommendations
Very little evidence at this point
The evidence on music therapy suggests positive effects but more research is needed
There is not evidence on art therapy thus far, research is needed!
If music/art are preferred they can be used at motivation without needing “therapy”
+ References
+ References
+ References
+ Questions?
A Review of Music and Art Therapies For Individuals with Autism
+ Music and Art Therapies
Music Therapy
Art Therapy
Discussion
Questions
+ Music Therapy
Definition
History
Models
Settings
Services
Credentials
Claims
Parent and Therapist reports Outcomes
Evidence
+ Art Therapy
Definition
Activity
History
Models
Art Development
Settings
Credentials
Claims
Parent and Therapist reports
Evidence
+ Search parameters
Psychinfo
“Music” and “therapy” in any field“autis*” in “subject”
Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text (time)
15 results:
“Art” and “therapy” in any field and “autis*” in subject
Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text (time)
26 results
Google
Music therapy
Music therapy autism
Art therapy
American art therapy association
Art therapy autism
Art therapy and autism
Art therapy autism history
American music therapy association
Center for Health and Healing
Google news
Music therapy autism
Art therapy autism
+ Music Therapy Defined
“Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”
“Refers to the application of music with the intent to enhance functioning”
American Music Therapy Association. (2011).Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org/ /whoarearttherapists2009.pdf Association for Science in Autism Treatment. Music Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/ music.htm
+ What’s the appeal?
Music Therapy Clip: Jammin Jenn
Jennmusiczack. (2010). Hope for autism through music therapy. Available from http://youtube.com
.
+
Is it founded?
+ History of Music Therapy
Idea of music as healing goes back to Aristotle
Discipline began after World War I and World War II when musicians went to Veterans hospitals to play for victims
Notable responses of patients led to doctors hiring musicians
Some musicians needed training before being in hospitals led to need for college curriculum
First music therapy degree program at Michigan State University in 1944
The American Music Therapy Association founded in 1998
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ Music therapy: Models
Receptive music listening
Song writing
Music performance
Imitation Call and answer songs (Chase, 2009)
Improvisational music therapy
Creative music therapy model (Nordoff-Robbins Model) has been found most effective with children with autism
Nordoff-Robbins Clip
Music-making vs. music-listening to motivate learners and effect growt
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved fromhttp:/ /www.musictherapy.org/ factsheets/bib_autism.pdf Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com. Kim, J., Wigram, T., Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13, 389409. doi:
+ Settings: Music Therapy
Psychiatric hospitals
Rehab facilities
Medical hospitals
Outpatient clinics
Agencies for developmentally disabled persons
Drug and alcohol programs
Senior centers
Correctional facilities
Schools
Private practices.
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ Music Therapy: Services
Considered related service under IDEA (Stetler, 2009)
IEP goals: related services
150 certified music therapists in New Jersey but this number is rapidly expanding (Chase, 2009)
Medicare: 1994, reimbursable for service under benefits for Partial Hospitalization Programs (PHP) under heading of Activity Therapy
Must be: Prescribed by a physician Reasonable and necessary for treatment of illness/injury Goal directed and based on a documented treatment plan Goal cannot be to maintain current level, must exhibit some level of improvement
Some medicade programs cover music therapy
Some private insurances cover music therapy
About 20% of Music therapists receive third party reimbursement
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved f
+ Music Therapist: Credentials
Participate in approved college music therapy curricula to be eligible to sit for national examination offered by Certification Boar for Music Therapists (MT-BC)
National Music Therapy Registry (NMTR) serves qualified music therapy professionals with the designation RMT, CMT, or ACMT
+ Music Therapy: Claims
Interventions designed to:
Promote wellness
Manage stress
Alleviate pain
Express feelings
Enhance memory
Improve communication
Promote physical rehabilitation
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ Music Therapy: Outcomes for Individuals with Autism
Increased attention
Decreased self-stimulation
Improved cognitive functioning
Increased socialization
Successful and safe self-expression
Improved behavior
Enhanced auditory processing
Decreased agitation
Improved verbal skills
Enhanced sensory-motor skills
American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice . Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf
+ From the therapists…
“For people with autism, the world is a chaotic place, full of overwhelming levels of sensory input,” says John Foley…”Music has form we all recognize, even if we don’t think in those ; music makes sense. In the early days of defining autism, heightened response to music was considered for the list of possible symptom.” (Chase, 2009)
“We know music therapy works with people on the autism spectrum, even if we don’t always know why or how” (Chase, 2009)
Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com
+ Music Therapy: Parent reports
“’I wish I could say how, exactly, but I just know that music is an avenue to get their little brains going.’ said Michelle Phalon” (Chase, 2009)
“’The proof is in what you see and the changes in your child…It’s hard to argue with physical progress. There are naysayers out there in everything. But you see the difference.’” (Chase, 2009)
“’She just engage more,’ Wismann said. ‘Instead of being in her own space, if you’re more singsong-y when you’re interacting with her, she seems to engage more and want to be interactive with you.’” (Thompson, 2011).
Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com. Thompson, D. (2011, May 27). Living with a child with autism. HealthDay News. Retrieved http://health.usnews.com
+ Evidence for Music Therapy
According to the Association for Science in Autism Treatment, preliminary evidence suggests that music therapy might be effective in enhancing functioning, but more rigorous research needs to be conducted
Association for Science in Autism Treatment. Music Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/music.htm
+ Evidence for Music Therapy
15 total articles
1 unrelated to music therapy
Dependent variables
Social responsiveness: 4 studies
Avoidant Behaviors, emotional responsiveness, t-attention behaviors, music skills, preferences, task performance, and auditory stimulus processing, object constancy: 1 study each
Vocal Stereotypy: 2 studies
Single-subject design: 3 articles
Group design 3 articles
Meta-analysis and analysis: 1 article each
Vignettes/Case studies: 6 articles
+ Evidence: Single-Subject Further evaluation of methods to identify matched Research stimulation (Rapp, 2007)
Effects of preferred stimulation on vocal stereotypy
Results: Sound-producing toys or non-contingent music led to decreased vocal stereotypy
Possibly auditory stimulation functioned as an abolishing operation for vocal stereotypy
The limits and motivating potential of sensory stimuli as reinforcers for autistic children (Ferrari & Harris, 1981)
Use of vibrations, music, and strobe lights as reinforcement.
Results varied but sensory stimuli has motivating potentials similar to those of food and social reinforcers
Ferrari, M., Harris, S.L. (1981). The limits and motivating potential of sensory stimuli as reinforcers for autistic children. Journal of Applied Behavior Analysis, 14, 339-343. doi: 10.1901/jaba.1981.14-339 Rapp, J. T. (2007). Further evaluation of methods to identify matched stimulation. Journal of Applied Behavior Analysis, 40, 73-88. doi: 10.1901/jaba.2007.142-05
+ Evidence: Single-Subject Research Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions.
+ Research: Social Responsiveness
Finnigan, E., Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions. Autism, 14, p. 321-348.
+ Evidence: Single-Subject Research
Participant: A 3-year, 8-month old girl with autism
Materials: 6 neutral toys randomly assigned to a condition
Setting: 4 15-minute sessions per week for 2 months in empty preschool classroom or at participant’s home
Alternating treatment design
Dependent variable: social responsive and avoidance behaviors Number of correct responses divided by the number of opportunities given Data summarized as percentage of correct responses Frequency count for eye and avoidance behaviors
Independent variable: Music and non-music conditions Music intervention: Familiar melodies sung with lyrics appropriate for toy being used. Guitar also played. Non-music intervention: Spoken scripts with words similar to those in melodies
Finnegan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-
+ Evidence: Single-Subject Research
Alternating treatment design: Baseline, Alternating Phase, Best-treatment phase, Follow-up
IOA collected for 20% of sessions with a mean IOA of 87% (range 85-96%)
Data analysis looked at the percentage of nonoverlapping data
Results: Authors demonstrated a functional relationship between the music condition and the increase of social responsive behaviors and decrease of avoidant behaviors.
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Research: Social Responsiveness
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Research: Social Responsiveness
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Research: Social Responsiveness
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+ Music Therapy: Social Responsiveness Results
suggest positive effects of Music Therapy on social responsiveness
Need
continued research with more rigorous experimental designs to establish functional relationships Small number of participants but not well-designed single-subject research
Use
of music (and other child-preferred activities) as motivation to increase socialization
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747
+
Music Therapy: Evidence for Outcomes
Increased attention
Decreased self-stimulation (+)
Improved cognitive functioning
Increased socialization (+)
Successful and safe self-expression
Improved behavior
Enhanced auditory processing
Decreased agitation
Improved verbal skills
Enhanced sensory-motor skills
+
+ Art Therapy Defined
“Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem, self- awareness, and achieve insight”
“Refers to the application of art with the intent to enhance functioning.”
American Art Therapy Association. (2011). Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org //whoarearttherapists2009.pdf Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+ Art therapy: Activity
Brainstorm feeling words
Assign each word a color
Draw a heart
Color in the heart the amount of each color that you are feeling
Keep on file Benefits?
+ What’s the appeal?
Art Therapy
+
Google images
Is it founded?
+ History of Art Therapy
1900s
Psychiatrists began being interested in patients’ art. Educators recognized artwork reflected children’s development/growth.
1914: Margaret Naumberg starts Children’s School
Often identified as the founder of art therapy
Art therapy started to be included with traditional talk therapy
1940s: Distinct discipline emerged
1970s: Division in art therapists
Art therapy: innate healing power of making art Art psychotherapy: art as a healing tool within a framework of verbal psychotherapy
American Art Therapy Association. (2011). Who are art therapists? Retrieved from http://www.americanarttherapyassociation.org//whoarearttherapists2009.pdf Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingn org/complement/art_how.html
+ Art therapy: Models
Acting/Filming
Photography
Painting
Drawing
Portrait drawing
Art as expression of feelings
Art as nonverbal communication
eHowArtsAndCrafts (2010). Art therapy activities: art therapy activities on feelings. Available from http://www.youtube.com PolarisMediaGroup (2009). Polaris global presents “Kids with Cameras”. Available from http://www.youtube.com
+ Art Therapy: Art Development
Neurotypical individuals’ drawing skills generally follow the same progression:
Scribbling in early childhood
Symbolic/schematic representation in middle childhood
Concern with achieving realism in adolescence
Shifts are influenced by and have an influence on cognitive development
For children with ASD, the development follows the same sequence and is related to the individual’s nonverbal mental age
Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23. Retrieved from http://www.arttherapyjournal.org/pdf/25-1_Martin.pdf
+ Art Therapy Settings
Work with health professionals in palliative care programs
Prisons
Trauma relief teams
Personal growth classes
School systems
Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingny org/complement/art_how.html
+ Art Therapy: Credentials
“Art therapists” must have a master’s degree or PhD in art therapy AND/OR be a ed art therapist (ATR)
Art therapists are skilled in multiple modalities of art (painting, sculpture, painting, etc.) for assessment and treatment.
Martin, N. (2011). Arttherapyandautism.com. Retrieved from http://arttherapyandautism.com/index.html.
+ Art Therapy: Claims
Art therapy = visual images that represent thoughts/feelings that individuals don’t know how to express verbally
Interventions designed to address:
Imagination/abstract thinking deficits
Sensory regulation and integration
Emotions/self-expression
Nonverbal communication
Socialization
Recreational/leisure skills
Visual-spatial deficits
Improving motor skills
Martin, N. (2011) Explanation. Retrieved from http://arttherapyandautism.com Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+ Art Therapy: Claims
“As a graphic, nonverbal means of communication, art can provide relief to the child for whom verbal communication is frustrating, overwhelming, too direct, or even nonexistent” (Martin, 2008).
“Art therapy can utilize the child’s visual strengths to address treatment goals while providing a socially appropriate outlet for self-stimulatory behaviors and sensory needs” (Martin, 2008).
“Use of icons, symbols, and social stories help the children to what they were taught” (Epp, 2008).
Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23. Epp, K.M. (2008). Outcome-Based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children and Schools, 30, 27-36.
+ Art Therapy: Parent reports
“It has given her confidence, self-esteem,” Mrs. Bigioni said. “She is proud of the work she does. It has brought friendships – peers and facilitators – developed a sense of community” (Joseph, 2011).
Joseph, S. (2011). Growing demand for art therapy. Yorkregion.com. Retrieved from http://www.yorkregion.com/news/article/1012624--growing-demand-for-arttherapy.
+ Evidence: Art Therapy
According to Association for Science in Autism Treatment there have been no scientific studies of art therapy for individual’s with ASD
Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm
+ Evidence for Art Therapy
26 articles returned
Dependent variable
Unrelated to art therapy 14 (related to music therapy etc.) Social skills Object constancy Face processing skills/portrait drawing
Design
Single-subject –None Group design – 2 Book Review - 6 Meta-analysis/Review - 3 Case study - 1
+ Evidence: Art Therapy
Assessing portrait drawings created by children and adolescents with autism spectrum disorder
25 children with autism with a mean age of 13 years and 15 neurotypical children with a mean age of 10
Completed the Portrait Drawing Assessment (PDA)
Portrait drawings didn’t indicate a difference in iconic skills in children with ASD
Participants with ASD were more often rated as interested and less often rated as indifferent than neurotyipcal participants
Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art Therapy Association, 25, p. 15-23.
+ Evidence: Art Therapy
Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum
66 participants
Parents filled a pre and post-test questionnaire (SSRS or Social Skills Rating System)
Attending a social skills group therapy program (with art therapy as a component) improved assertive social skills and decreased problem behaviors and hyperactivity.
Epp, K.M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children and Schools, 30, 27-36. Retrieved from http://web.ebscohost.com.ezproxy. caldwell.edu:2048/ehost/ pdfviewer/pdf viewer?sid=f824fe6f-6b6c-4f84-9de6-53a55d3f8975%40sessionmgr113&vid=32&hid=105
+ Evidence: Art Therapy
Interventions designed to address:
Imagination/abstract thinking deficits
Sensory regulation and integration
Emotions/self-expression
Nonverbal communication
Socialization
Recreational/leisure skills
Visual-spatial deficits
Improving motor skills
Object Object constancy? constancy? Faceprocessing? processing? Face
+ Discussion
Music therapy
Noncontingent reinforcement/preferred stimulation
Increased social responsiveness
Decreased problem behaviors
Auditory processing
Art therapy
Use of portrait drawing and photography to promote selfmonitoring and awareness
Use of portrait drawing to develop knowledge related to facial expressions
Fine motor skills
+ Discussion cont.
Behavior traps
Motor imitation
Gross and fine motor skills
Social interaction
+ Discussion cont.
Things to consider…
Individual’s with ASD as visual thinkers/concrete
Individual’s with ASD with processing differences (auditory and visual)
Use of preferred music as reinforcement is different than the application of music or art as a therapeutic intervention
Need for more research is clear!
+ Recommendations
Very little evidence at this point
The evidence on music therapy suggests positive effects but more research is needed
There is not evidence on art therapy thus far, research is needed!
If music/art are preferred they can be used at motivation without needing “therapy”
+ References
+ References
+ References
+ Questions?
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