Little Music Training

Goes A Long Way

Study: practicing music for only few
years in childhood helps improve adult
brain
August 21, 2012 | By Pat Vaughan Tremmel

EVANSTON, Ill. --- A little music training in childhood goes a long way in improving how
the brain functions in adulthood when it comes to listening and the complex processing of
sound, according to a new Northwestern University study.

The impact of music on the brain has been a hot topic in science in the past decade. Now
Northwestern researchers for the first time have directly examined what happens after
children stop playing a musical instrument after only a few years -- a common childhood
experience.

Compared to peers with no musical training, adults with one to five years of musical training
as children had enhanced brain responses to complex sounds, making them more effective at
pulling out the fundamental frequency of the sound signal.

The fundamental frequency, which is the lowest frequency in sound, is crucial for speech and
music perception, allowing recognition of sounds in complex and noisy auditory
environments.

“Thus, musical training as children makes better listeners later in life,” said Nina Kraus, the
Hugh Knowles Professor of Neurobiology, Physiology and Communication Sciences at
Northwestern.

“Based on what we already know about the ways that music helps shape the brain,” she said,
“the study suggests that short-term music lessons may enhance lifelong listening and
learning.”

“A Little Goes a Long Way: How the Adult Brain is Shaped by Musical Training in
Childhood” will be published in the Aug. 22 edition of The Journal of Neuroscience.

“We help address a question on every parent’s mind: ‘Will my child benefit if she plays
music for a short while but then quits training?’” Kraus said.

Many children engage in group or private music instruction, yet, few continue with formal
music classes beyond middle or high school.
But most neuroscientific research has focused on the rare and exceptional music student who
has continued an active music practice during college or on the rarer case of a professional
musician who has spent a lifetime immersed in music.

“Our research captures a much larger section of the population with implications for
educational policy makers and the development of auditory training programs that can
generate long-lasting positive outcomes,” Kraus said.

For the study, young adults with varying amounts of past musical training were tested by
measuring electrical signals from the auditory brainstem in response to eight complex sounds
ranging in pitch. Because the brain signal is a faithful representation of the sound signal,
researchers are able to observe how key elements of the sound are captured by the nervous
system and how these elements might be weakened or strengthened in different people with
different experiences and abilities.

Forty-five adults were grouped into three age- and IQ- matched groups based on histories of
musical instruction. One group had no musical instruction; another had 1 to 5 years; and the
other had to 6 to 11 years. Both musically trained groups began instrumental practice around
age 9 years, a common age for in-school musical instruction to begin. As predicted, musical
training during childhood led to more robust neural processing of sounds later in life.

Prior research on highly trained musicians and early bilinguals revealed that enhanced
brainstem responses to sound are associated with heightened auditory perception, executive
function and auditory communication skills.

“From this earlier research, we infer that a few years of music lessons also confer advantages
in how one perceives and attends to sounds in everyday communication situations, such as
noisy restaurants or rides on the “L,” Kraus said.

A running theme in Kraus’ research is “your past shapes your present.”

“The way you hear sound today is dictated by the experiences with sound you’ve had up until
today,” she said. “This new finding is a clear embodiment of this theme.”

In past research, Kraus and her team examined how bilingual upbringing and long-term
music lessons affect the auditory brain and how the brain changes after a few weeks of
intensive auditory experiences, such as computerized training. Their current research is
investigating the impact of socioeconomic hardships on adolescent brain function.

“We hope to use this new finding, in combination with past discoveries, to understand the
type of education and remediation strategies, such as music classes and auditory-based
training that might be most effective in combating the negative impact of poverty,” she
said.

By understanding the brain’s capacity to change and then maintain these changes, the
research can inform the development of effective and long-lasting auditory-based educational
and rehabilitative programs.

https://news.northwestern.edu/stories/2012/08/kraus-childhood-music-training
Music Lessons Enhance IQ
E. Glenn Schellenberg
First Published August 1, 2004 Research Article

Download PDF Article information

Abstract

The idea that music makes you smarter has received considerable attention from
scholars and the media. The present report is the first to test this hypothesis
directly with random assignment of a large sample of children (N = 144) to two
different types of music lessons (keyboard or voice) or to control groups that
received drama lessons or no lessons. IQ was measured before and after the
lessons. Compared with children in the control groups, children in the music
groups exhibited greater increases in full-scale IQ. The effect was relatively small,
but it generalized across IQ subtests, index scores, and a standardized measure
of academic achievement. Unexpectedly, children in the drama group exhibited
substantial pre- to post-test improvements in adaptive social behavior that were
not evident in the music groups.

REFERENCES
Anvari, S.H., Trainor, L.J., Woodside, J., Levy, B.A. (2002). Relations among musical skills,
phonological processing and early reading ability in preschool children. Journal of Experimental
Child Psychology, 83, 111–130. Google Scholar, Crossref, Medline, ISI

Barnett, S.M., Ceci, S.J. (2002). When and where do we apply what we learn?: A taxonomy for
transfer. Psychological Bulletin, 128, 612–637. Google Scholar, Crossref, Medline

Ceci, S.J., Williams, W.M. (1997). Schooling, intelligence and income. American Psychologist,
52, 1051–1058. Google Scholar, Crossref

Chabris, C.F. (1999). Prelude or requiem for the “Mozart Effect”? Nature, 400, 826–827. Google
Scholar, Crossref, Medline,

http://journals.sagepub.com/doi/abs/10.1111/j.0956-7976.2004.00711.x
Music Education Can Help Children Improve
Reading Skills
Date:

March 16, 2009

Source:
SAGE Publications/Psychology of Music
Summary:

Children exposed to a multi-year program of music tuition involving training in

increasingly complex rhythmic, tonal, and practical skills display superior cognitive
performance in reading skills compared with their non-musically trained peers, according
to a new study.

Share:
FULL STORY

Children exposed to a multi-year programme of music tuition involving

training in increasingly complex rhythmic, tonal, and practical skills display
superior cognitive performance in reading skills compared with their non-
musically trained peers, according to a study published in the
journal Psychology of Music.

According to authors Joseph M Piro and Camilo Ortiz from Long Island University, USA, data
from this study will help to clarify the role of music study on cognition and shed light on the
question of the potential of music to enhance school performance in language and literacy.
Studying children the two US elementary schools, one of which routinely trained children in
music and one that did not, Piro and Ortiz aimed to investigate the hypothesis that children who
have received keyboard instruction as part of a music curriculum increasing in difficulty over
successive years would demonstrate significantly better performance on measures of vocabulary
and verbal sequencing than students who did not receive keyboard instruction.
Several studies have reported positive associations between music education and increased
abilities in non-musical (eg, linguistic, mathematical, and spatial) domains in children. The
authors say there are similarities in the way that individuals interpret music and language and
“because neural response to music is a widely distributed system within the brain…. it would not
be unreasonable to expect that some processing networks for music and language behaviors,
namely reading, located in both hemispheres of the brain would overlap.”
The aim of this study was to look at two specific reading subskills – vocabulary and verbal
sequencing – which, according to the authors, are “are cornerstone components in the
continuum of literacy development and a window into the subsequent successful acquisition of
proficient reading and language skills such as decoding and reading comprehension.”
Using a quasi-experimental design, the investigators selected second-grade children from two
school sites located in the same geographic vicinity and with similar demographic characteristics,
to ensure the two groups of children were as similar as possible apart from their music
experience.
Children in the intervention school (n=46) studied piano formally for a period of three consecutive
years as part of a comprehensive instructional intervention program. Children attending the
control school (n=57) received no formal musical training on any musical instrument and had
never taken music lessons as part of their general school curriculum or in private study. Both
schools followed comprehensive balanced literacy programmes that integrate skills of reading,
writing, speaking and listening.
All participants were individually tested to assess their reading skills at the start and close of a
standard 10-month school year using the Structure of Intellect (SOI) measure.
Results analyzed at the end of the year showed that the music-learning group had significantly
better vocabulary and verbal sequencing scores than did the non-music-learning control group.
This finding, conclude the authors, provides evidence to support the increasingly common
practice of “educators incorporating a variety of approaches, including music, in their teaching
practice in continuing efforts to improve reading achievement in children”.
However, further interpretation of the results revealed some complexity within the overall
outcomes. An interesting observation was that when the study began, the music-learning group
had already experienced two years of piano lessons yet their reading scores were nearly
identical to the control group at the start of the experiment.
So, ask the authors, “If the children receiving piano instruction already had two years of music
involvement, why did they not significantly outscore the musically naïve students on both
measures at the outset?” Addressing previous findings showing that music instruction has been
demonstrated to exert cortical changes in certain cognitive areas such as spatial-temporal
performance fairly quickly, Piro and Ortiz propose three factors to explain the lack of evidence of
early benefit for music in the present study.
First, children were tested for their baseline reading skills at the beginning of the school year,
after an extended holiday period. Perhaps the absence of any music instruction during a lengthy
summer recess may have reversed any earlier temporary cortical reorganization experienced by
students in the music group, a finding reported in other related research. Another explanation
could be that the duration of music study required to improve reading and associated skills is
fairly long, so the initial two years were not sufficient.
A third explanation involves the specific developmental time period during which children were
receiving the tuition. During the course of their third year of music lessons, the music-learning
group was in second grade and approaching the age of seven. There is evidence that there are
significant spurts of brain growth and gray matter distribution around this developmental period
and, coupled with the increased complexity of the study matter in this year, brain changes that
promote reading skills may have been more likely to accrue at this time than in the earlier two
years.
“All of this adds a compelling layer of meaning to the experimental outcomes, perhaps signaling
that decisions on ‘when’ to teach are at least as important as ‘what’ to teach when probing
differential neural pathways and investigating their associative cognitive substrates,” note the
authors.
“Study of how music may also assist cognitive development will help education practitioners go
beyond the sometimes hazy and ill-defined ‘music makes you smarter’ claims and provide careful
and credible instructional approaches that use the rich and complex conceptual structure of
music and its transfer to other cognitive areas,” they conclude.

Story Source:
Materials provided by SAGE Publications/Psychology of Music. Note: Content may be edited
for style and length.
 Journal Reference:
1. Joseph M. Piro and Camilo Ortiz. The effect of piano lessons on the vocabulary and verbal
sequencing skills of primary grade students. Journal Psychology of Music, 16th March 2009

Cite This Page:

 MLA
 APA
 Chicago
SAGE Publications/Psychology of Music. "Music Education Can Help Children Improve Reading
Skills." ScienceDaily. ScienceDaily, 16 March 2009.
<www.sciencedaily.com/releases/2009/03/090316075843.htm>.
SAGE Publications/Psychology of Music. (2009, March 16). Music Education Can Help Children
Improve Reading Skills. ScienceDaily. Retrieved March 20, 2018 from
www.sciencedaily.com/releases/2009/03/090316075843.htm

Musical experience shapes human brainstem encoding of linguistic

pitch patterns
 Patrick C M Wong
 , Erika Skoe
 , Nicole M Russo
 , Tasha Dees
 & Nina Kraus

 Nature Neuroscience volume10, pages420–422 (2007)

 doi:10.1038/nn1872
 Download Citation

Received:
08 December 2006

Accepted:

16 February 2007

Published:

11 March 2007

Abstract
 Music and speech are very cognitively demanding auditory phenomena generally
attributed to cortical rather than subcortical circuitry. We examined brainstem
encoding of linguistic pitch and found that musicians show more robust and faithful
encoding compared with nonmusicians. These results not only implicate a common
subcortical manifestation for two presumed cortical functions, but also a possible
reciprocity of corticofugal speech and music tuning, providing neurophysiological
explanations for musicians' higher language-learning ability.

https://www.nature.com/articles/nn1872

Print this page Share

Applied Cognitive Psychology Media Toolkit

More Press Releases related to this journal

READ NOW ONLINE
Contact Publicity to:
 Request an Interview
 Request a PDF of the article
 Request Permissions
 View the abstract for this article
on Wiley Online Library

Larger Image

More Press Releases in:

Business & Finance, Current

Affairs, Education, History & Literature,Home &
Garden, Law & Society, Medicine &
Healthcare, Psychology,Wiley-Blackwell

 Press Release

 About Author

 About Journal
July 27, 2010

Cardiff, Wales
Background Music can Impair Performance, Cites New Study
For decades research has shown that listening to music alleviates anxiety and depression,
enhances mood, and can increase cognitive functioning, such as spatial awareness. However,
until now, research has not addressed how we listen to music. For instance, is the cognitive
benefit still the same if we listen to music whilst performing a task, rather than before it?
Further, how does our preference for a particular type of music affect performance? A new
study from Applied Cognitive Psychology shows that listening to music that one likes whilst
performing a serial recall task does not help performance any more than listening to music
one does not enjoy.

The researchers explored the ‘irrelevant sound effect’ by requiring participants to perform
serial recall (recall a list of 8 consonants in presentation order) in the presence of five sound
environments: quiet, liked music (e.g., Rihanna, Lady Gaga, Stranglers, and Arcade Fire),
disliked music (the track “Thrashers” by Death Angel), changing-state (a sequence of random
digits such as “4, 7, 1, 6”) and steady-state (“3, 3, 3”). Recall ability was approximately the
same, and poorest, for the music and changing-state conditions. The most accurate recall
occurred when participants performed the task in the quieter, steady-state environments. Thus
listening to music, regardless of whether people liked or disliked it, impaired their concurrent
performance.

Lead researcher Nick Perham explains: “The poorer performance of the music and changing-
state sounds are due to the acoustical variation within those environments. This impairs the
ability to recall the order of items, via rehearsal, within the presented list. Mental arithmetic
also requires the ability to retain order information in the short-term via rehearsal, and may be
similarly affected by their performance in the presence of changing-state, background
environments.”

Although music can have a very positive effect on our general mental health, music can, in
the circumstances described, also have negative effects on cognitive performance. Perham
remarks, “Most people listen to music at the same time as, rather than prior to performing a
task. To reduce the negative effects of background music when recalling information in order
one should either perform the task in quiet or only listen to music prior to performing the
task.”

This study is published in the September 2010 issue of Applied Cognitive Psychology. To
view the abstract for this article, please click here.

Article: "Can Preference for Background Music Mediate the Irrelevant Sound Effect?" Nick
Perham, et. al.; Applied Cognitive Psychology; Published Online: July 20, 2010 (DOI:
10.1002/acp.1731).

Effects of Music Training on Attention, Processing

Speed and Cognitive Music Abilities—Findings from
a Longitudinal Study
Ingo Roden
Tanja Könen

Stephan Bongard

Emily Frankenberg

Esther Kamala Friedrich

Gunter Kreutz
First published: 2 July 2014

https://doi.org/10.1002/acp.3034

Cited by:10

Read the full text

PDF

TOOLS

SHARE

Summary
The present study addresses visual attention and processing speed in primary school children
(N = 345; 7–8 years of age) who received either music (MC) or natural science training (NC) over
a period of 18 months. Dependent variables were collected three times (T1–T3) and included
measures for processing speed, visual attention and cognitive music abilities. They were
submitted to latent or manifest change models including socioeconomic status and basic
cognitive functions as covariates. Groups performed similarly in all dependent tasks at baseline
(T1). MC showed significant increases in processing speed as well as in music abilities from T2
to T3 and increases in rhythmic abilities from T1 to T2. Although MC also showed increases in
both processing speed and visual attention over time, they were at a small advantage with
respect to the former and at a clear disadvantage with respect to the latter measure as compared
to NC. Copyright © 2014 John Wiley & Sons, Ltd.
A Collaboration Between Music Therapy and Speech Pathology in a Paediatric Rehabilitation
Setting

By Maggie Leung |Author bio & contact info|

Abstract

This article describes the importance of flexible music therapy practice when focusing on
communication skills with a speech pathologist within a paediatric rehabilitation setting. A brief
literature review on the combined use of music therapy and speech pathology in rehabilitation is
provided. A case vignette is then used to illustrate the unique role of music therapy and the
importance of changing the goals of music therapy in order to meet the patient’s needs.

Communication

But first, what is communication? What does communication involve? Let’s analyse and outline
communication from a daily example.

Johnny wanted a chocolate during grocery shopping with mum. He smiled, tapped and asked his
mum with a gentle voice. Sadly, his request was refused, so he gradually increased his protest. First,
he frowned and begged, then he increased his vocal volume and intensity by screaming. After that,
his breathing rate continued to increase, and he cried and stomped his feet and waved his arms.
Finally he finished his dramatic tantrum with his whole body rolling and lying on the ground.

Communication is essential to human survival. As this example illustrates, it can involve verbal
expression, corporal expression like gesture, movements, paraverbal expression like intonation,
rhythm, breathing and our entire body (Littlejohn & Foss, 2008). When the capacity for speech has
been impaired by a neurological injury, a human’s potential to communicate is limited. The results of
such impairment significantly affect that person’s ability to communicate basic needs, but also leads
to long term negative influences on the person’s vocational outcome (Brooks, McKinlay, Symington
& Campsie, 1987), social re-integration and quality of life (Malkmus, 1989).

Music Therapy and Speech Rehabilitation

Literature exploring the combined use of music therapy and speech pathology in the rehabilitation
treatment of speech impairments has largely focused on the adult population. Cohen was a frequent
contributor to this field in the 1990s and identified benefits in using music, particularly singing, to
expand the communication potential of people with speech disorders in a number of articles (Cohen,
1993, 1994 &1995). In 1992 she described how singing and speech share common elements and
suggested that instruction in basic singing techniques, such as correct breathing patterns,
coordinated phonation and efficient diction, could improve speech production even more effectively
than singing without strictly specificied techniques. Cohen concluded that rhythmic speech,
breathing and vocal exercises enhance patients’ speech rate, pitch, variability and intelligibility.

Baker and Wigram have noted in a number of articles (2000, 2004 & 2005) that song singing and
vocal exercises are the most frequently employed and documented intervention with people with
acquired neurological speech disorders. Furthermore, Baker described song singing as i) positively
affecting a person’s physiological state by reducing tension and increasing vocal muscles, ii)
stimulating neurological activation which may facilitate improvement in production of intonation,
and iii) evoking changes in emotion, which directly affect the vocal output. The results of Tamplin’s
investigation (Tamplin, 2008) further supports the benefits of music therapy and speech pathology
with adults with neurogenic motor speech disorders. At the 11th World Congress of Music Therapy
(2005), Tamplin described positive changes in the patients’ speech rate and intelligibility after
participating in an eight-week music therapy program, which consisted of breathing exercises,
intonation and articulation practice, rhythmic cuing and singing familiar songs.

In regards to the use of music therapy to address children with speech disorders, Hibben (1991)
suggested that children who receive music therapy exhibit a greater amount of spontaneous speech
than matched controls. She claimed that the use of music therapy facilitates social interaction,
enhances emotional expression and promotes positive behaviours. Similarly, Kennelly, Hamilton, and
Cross (2001) highlighted the parallels between music and speech and language development models
and report that a collaborative approach between speech pathology and music therapy can be
effective with children who have neurological speech impairment. These authors identified that
music therapy had both an individual and conjoint role to play in expanding the communication
potential of children with speech disorders and therefore, enhancing the quality of life for these
children and their families.

Gilberston (2005) identified that out of forty-six papers on music therapy and rehabilitation, only
fifteen described music therapy in paediatrics. The adult rehabilitation literature provides evidence
of the benefits of music therapy, and therefore we expect these positive results would transfer to
the paediatric population. However, it is important to consider that children are very different from
adults neurologically. Children’s neuro-structure, cognition and emotion change daily in response to
their continual growth. It is important for the music therapy profession that we continue to identify
which of these results can be expected in working with children through close scrutiny of our work.
The following case vignette contributes to the ongoing dialogue about clinical practice in
neurorehabilitation.

Case Vignette

The purpose of this case vignette is to illustrate the benefits of using combined music therapy and
speech pathology in neurorehabilitation. Some musical examples are included to demonstrate the
specific vocal exercises that were developed together by the music therapist and speech pathologist.
Written permission has been obtained from the patient and family in order for this material to be
published.

The Clinical Context

The following case vignette has been derived from clinical work undertaken at a rehabilitation unit
within a state paediatric hospital in Australia. In this unit music therapy services are provided to both
inpatients and outpatients as one of ten different disciplines making up the multi-disciplinary team.
The music therapy programs provide individual and joint-therapy work with the Speech Pathologist
when addressing the goal of communication. All rehabilitation programs are conducted at the child’s
bedside which is sometimes within an isolated treatment room on the rehabilitation unit.

The Patient

Sam is an eleven year-old boy who sustained a severe garrotting injury. He was riding a four-wheel
motorcycle and ran into a barbed wire fence. Sam’s injuries included:

 neck to head cervical spine injury with dislocation,

 wound of lower neck area involving cutting through the windpipe and the right neck muscle,

 broken jaw,

 and cranial nerve palsies affecting lateral gaze, facial movement and tongue function.

Sam spent 19 days in the intensive care unit and required fixation of his cervical spine with
application of a halo brace (figure 1) and tracheostomy. He remained an inpatient at the hospital for
five months.

Figure 1. A patient with a halo brace and tracheostomy.

Sam’s subsequent speech impairment was due to damage to cranial nerve 12 which provides motor
movements to the intrinsic and extrinsic muscles of the tongue. Initially, this resulted in complete
paralysis of the tongue. There was also some impairment of the cranial nerves that innervate the
pharynx and protect the airway during the swallow.

As the tracheostomy redirects breath below the level of the vocal cords, no voice can be achieved
with a tracheostomy in place. Sam was initially required to use non-vocal communication, including
mouthing and writing. Due to the aural motor injuries outlined above, Sam was also unable to
swallow safely and had no oral intake. The speech pathologist’s goal at this acute stage was to
provide regular swallow reviews.

Individual Music Therapy Program

Initially, Sam was referred to the music therapy program for improved verbal articulation and
communication by the speech pathologist. As the medical team outlined that Sam's rehabilitation
journey could be lengthy, they expressed their hope that music therapy would provide motivation as
well as emotional support for Sam during his speech rehabilitation program.

Music Therapy Assessment

During the music therapy assessment, Sam was alert and remained lying in bed with minimal head,
neck, shoulders and upper-arm movements. Although Sam was not able to verbalise due to the
tracheostomy, he responded to closed-questions with thumbs up and down, and some facial gesture
(ie. smile and frown).
 Referral To increase verbal and non-verbal communication skills
reason

Assessment An informal interview with Sam and his family, a medical chart
included review and liaison with the multidisciplinary team therapists,
and initial music therapy session for assessment.

Therapist’s To identify Sam’s needs and preferences in music/music

objectives background

To assess Sam’s current medical, communication, physical,

emotional and cognitive status as represented musically

To establish rapport with Sam

Session length 45mins.

Table 1: Assessment session outcomes

Assessment intervention Sam’s response

Singing songs that chosen and well  Used thumbs up/down to indicate
known to Sam "Yes/No"

 Smiled

 Fingers tapping in-time to the music

Listening to Sam’s favourite  Used thumbs up/down to indicate

CD/music "Yes/No"

 Smiled

 Fingers tapping in-time to the music

Improvisation  Improvised on hand-drum

 Played a range of rhythmic patterns,

tempi and dynamics

After discussing the initial music therapy assessment session, the multi-disciplinary team agreed that
Sam's medical condition was not stable enough to commence his speech rehabilitation. Sam became
fatigued easily and was unable to concentrate after 10mins of the session, requiring 5 minute breaks
between activities. Therefore, the music therapy program focused mainly on Sam's psychosocial
needs and empowering him within the hospital environment. The music therapy program goals were
to empower Sam in:

 adjusting to hospital and his injury

 providing a range of opportunities for choice and control

  using musical instruments for non-verbal self expression

The actual methods used to address these goals included: song listening, drum improvisation and
song parody – a technique where lyrics are substituted in known song. For song parody, Sam used a
white board and marker to write his lyrics. This activity required a good level of concentration and
upper limb movements, therefore, Sam would often participate only for 10mins before he became
fatigued.

Combined Music Therapy and Speech Pathology Program

As Sam’s medical condition stablised and his recovery progressed, it became possible for him to
participate in a more active rehabilitation program. This then became the priority focus of his
treatment and a combined music therapy and speech pathology program was commenced. The
combined program aimed to increase Sam’s tolerance in using the speaking valve. For successful use
of the valve, a patient must have adequate space between the trachea and tracheostomy tube to
ensure leak of air. If there is insufficient leak, the patient will demonstrate breathing distress due to
lack of oxygen exchange. Tolerance of the speaking valve can be difficult initially due to the need for
a change in breathing patterns.

When Sam demonstrated increased tolerance in using the speaking valve, the combined program
goals increased to:

 maximise exhalation strength and breath control

 distract the patient from the unfamiliar sensation of exhaling

 reduce feelings of anxiety

 build tolerance to the valve

 increase articulation

 improve precision of tongue movements

 and increase range and length of verbalisations.

The Combined Intervention

The program during this stage of treatment used similar methods but changed their intention in
order to address the most recent goals.

Song Singing

Each session began with singing familiar songs of Sam’s choice. Singing provided a predictable
structure which enabled Sam to focus. It distracted him from the unfamiliar sensation whilst using
the speaking valve, as well as increased his tolerance for the valve.

Drum and Vocal Improvisation

As outlined in figure 2, this improvisation exercise combines non-vocal (drum improvisation) and
vocal (vocal improvisation) output. Sam was encouraged to play the rhythmic pattern on the drum
then vocalize the same pattern with phonics/sounds that were suggested by the Speech Pathologist.
The music therapist would then improvise a new rhythmic pattern on the drum which Sam repeated.
The drumming provided an opportunity for Sam to practice the rhythmic pattern and to entrain his
body into the right tempo, which maximised his ability to vocalise the pattern accurately as well as
strengthen his breath control.

This exercise not only increased Sam’s communication capacity, but also provided motivation and
increased feelings of physical and psychological control; therefore reducing Sam’s level of anxiety
during the vocal exercise. Sam was able to create his rhythmic pattern, volume and tempo on the
drum based on what he thought he could manage during vocal improvisation.

Figure 2. Example of drum and vocal improvisation exercise

Speech and Language Evaluation

An evaluation of Sam’s improved tongue control and speech production was conducted by the
Speech Pathologist using the Frenchay Dyarthria assessment. This evaluates the rate and range of
movements of all the speech articulators as well as measuring intelligibility at the word sentence and
conversation levels. Sam made small gains throughout his inpatient stay but the most significant
improvement was observed after placement of the shunt (a medical device designed to transport
the excessive fluid in the brain into the chest) suggesting that recovery was spontaneous rather than
the direct result of music and speech therapy intervention. At the time of Sam’s inpatient discharge,
he was approximately 90% intelligible at the sentence level and in spontaneous speech. He could be
difficult to understand if excited about what he was saying. However, Sam was able to identify the
strategies he needed to improve the intelligibility that he had previously learned and practiced in the
therapy sessions.

Family’s Evaluation

At the conclusion of inpatient treatment, a written questionnaire was offered to Sam and his mother
to descriptively evaluate their experience of the combined music and speech therapy program.

Sam’s mother stated,

the individual music therapy program helped by lifting his spirits… he loved going to music therapy,
it made him happy.

the combined program was most helpful [to Sam] because he seemed to enjoy it more than
individual speech therapy. Sam doesn’t like ‘hard work’, so the music has distracted him. He was
working and practicing, but it didn’t seem like work to him.

from this [rehabilitation] journey, I remember Sam making his music and writing songs the most, not
the medical stuff.

Sam stated,

I hate the [vocal] exercises, whenever I say them, I feel stupid… because I can’t do them. But I love
doing it in music, because you [the music therapist] made it fun. I love coming to music, and mum
loves coming too.
It was fun to play [the drum improvisation] with mum. It was the only thing that made us laugh
when we are locked in here [the hospital].

Conclusion

In keeping with the literature, this vignette demonstrates that music therapy and speech pathology
can play complementary roles when addressing common goals in the areas of breath control, aural
motor coordination and speech production. Through combining music therapy and speech
pathology, we were able to offer an interactive and engaging rehabilitation program for this child.
Music therapy maximised Sam’s potential and motivation in achieving his communication goals,
while speech pathology provided therapeutic intervention and measurable outcomes while he re-
learned his speech skills. Together, both disciplines assisted Sam to integrate back to his community
as a communicating participant.

This vignette also illustrated that the provision of a holistic rehabilitation program requires flexibility
in programming, and responsiveness to changes in medical status . This was evidenced at times
where Sam’s body gesture and facial expression made it clear that he was not ready to focus on
speech goals, and in response, the music therapist would alter the intended session plan to meet his
more prominent psychosocial needs. As a music therapist, it was important to assess and evaluate
the patient’s condition and needs before and during each session, to ensure the benefit of music
therapy to the patient is being maximised.

Personal Comment

Music therapy plays a unique role within the allied health team in a paediatric rehabilitation setting.
Reflecting upon my clinical practice at the hospital, functional goals (such as bilateral motor skills,
communication skills etc) often become the major focus of my music therapy programs, working in
collaboration with the other allied health therapists. The medical, nursing and allied health team, as
well as the patient and family, focus heavily on "going home" and "getting better", however, we
sometimes neglect the patient’s emotional well being amongst the busy and ongoing work of
rehabilitation. As a music therapist, I experience the challenge and the importance of providing a
well balanced functional and psychosocial program for the patients. It was evident from Sam’s
program that the combined music therapy and speech pathology communication program was
important for his communication outcomes, but the individual music therapy introductory program
was equally important for Sam’s holistic well being. What was most important to the family was the
way the music therapy program responded to the constantly changing needs of the patient as he
journeyed through the complex emotional and physical journey of rehabilitation. In working
together with our fellow professionals, I believe we communicate and share each other’s expertise
and knowledge to promote a better, effective and patient-centered program that maximises the
patient and families potential in moving forward to achieve their goals.

Acknowledgment

The author wish to thank Dr Katrina McFerran, Senior Lecturer in Music Therapy, University of
Melbourne for her review of this article prior to submission.

References

Baker, F. (2000). Modifying melodic intonation therapy programs for adults with severe non-fluent
aphasia. Music Therapy Perspective, 2, 107-111.
Baker, F. & Wigram, T. (2004). Rehabilitating the uninflected voice: Finding climax and cadence in
the uninflected voice. Music Therapy Perspective, 22, 4-10.

Baker, F., Wigram, T., Gold, C. (2005). The effects of a song-singing programme on the affective
speaking intonation of people with traumatic brain injury. Brain Injury, 19(7), 519-528.

Cohen, N. (1992). The effect of singing instruction on the speech production of neurologically
impaired persons communication disorders. Journal of Music Therapy, 29, 87-102.

Cohen, N. (1993). The application of singing and rhythmic therapeutic intervention for persons with
neurogenic communication disorders. Journal of Music Therapy, 30, 81-99.

Cohen, N. (1994). Speech and song: Implications for therapy. Music Therapy Perspectives, 12(1), 8-
14.

Cohen, N. (1995).The effect of vocal instruction and visi-pitch feedback. Two case studies. Music
Therapy Perspectives, 13, 70-75.

Gilberston, S. (2005). Music therapy in neurorehabilitation after traumatic brain injury: A literature
review. In D. Aldridge (ed.) Music Therapy and Neurological Rehabilitation: Performing Health.
London: Jessica Kingsley Publishers.

Hibben, J. (1991). Group music therapy with a classroom of 6-8 year old hyperactive learning
disabled children. In Bruscia, K. (Ed) Case Studies in Music Therapy: USA, Barcelona Publishers.

Kennelly, J., Hamilton, L. & Cross, J. (2001). The interface of music therapy and speech pathology in
the rehabilitation of children with acquired brain injury. Australian Journal of Music Therapy, 12, 13-
20.

Littlejohn, S., & Foss, K. (2008). Theories of Human Communication (9th Ed.) Belmont, CA: Thomson
Wadsworth.

Magee, W. (1999). Music therapy with brain injury rehabilitation: to what extent is our clinical
practice influenced by the search for outcomes? Music Therapy Perspectives, 17, 20-26.

Malkmus, D.D. (1989). Community re-entry: Cognitive-communication intervention within a social

skill context. Topics in Language Disorders, 9, 50-66.

Tamplin, J. (2008). A pilot study into the effect of vocal exercises and singing on dysarthric
speech. NeuroRehabilitation, 23(3), 207-216.

https://voices.no/index.php/voices/article/view/417/341

istening to music lights up the whole brain

Date:
December 6, 2011
Source:

Suomen Akatemia (Academy of Finland)

Summary:
 Researchers have developed a groundbreaking new method that allows to study how the
brain processes different aspects of music, such as rhythm, tonality and timbre (sound
color) in a realistic listening situation.

Share:
FULL STORY

Finnish researchers have developed a groundbreaking new method that

allows to study how the brain processes different aspects of music, such as
rhythm, tonality and timbre (sound color) in a realistic listening situation.
The study is pioneering in that it for the first time reveals how wide
networks in the brain, including areas responsible for motor actions,
emotions, and creativity, are activated during music listening. The new
method helps us understand better the complex dynamics of brain
networks and the way music affects us.

The study was published in the journal NeuroImage.

Using functional magnetic resonance imaging (fMRI), the research team, led by Dr. Vinoo Alluri
from the University of Jyväskylä, Finland, recorded the brain responses of individuals who were
listening to a piece of modern Argentinian tango. Subsequently, using sophisticated computer
algorithms, they analyzed the musical content of the tango, showing how its rhythmic, tonal and
timbral components evolve over time. This was the first time such a study has been carried out
using real music instead of artificially constructed music-like sound stimuli. Comparison of the
brain responses and the musical features revealed many interesting things.
The researchers found that music listening recruits not only the auditory areas of the brain, but
also employs large-scale neural networks. For instance, they discovered that the processing of
musical pulse recruits motor areas in the brain, supporting the idea that music and movement are
closely intertwined. Limbic areas of the brain, known to be associated with emotions, were found
to be involved in rhythm and tonality processing. Processing of timbre was associated with
activations in the so-called default mode network, which is assumed to be associated with mind-
wandering and creativity.
"Our results show for the first time how different musical features activate emotional, motor and
creative areas of the brain," says Prof. Petri Toiviainen from the University of Jyväskylä. "We
believe that our method provides more reliable knowledge about music processing in the brain
than the more conventional methods."

Story Source:
Materials provided by Suomen Akatemia (Academy of Finland). Note: Content may be edited
for style and length.

Journal Reference:
1. Vinoo Alluri, Petri Toiviainen, Iiro P. Jääskeläinen, Enrico Glerean, Mikko Sams, Elvira
Brattico. Large-scale brain networks emerge from dynamic processing of musical timbre,
key and rhythm. NeuroImage, 2011; DOI: 10.1016/j.neuroimage.2011.11.019
Cite This Page:

 MLA
 APA
 Chicago
Suomen Akatemia (Academy of Finland). "Listening to music lights up the whole brain."
ScienceDaily. ScienceDaily, 6 December 2011.
<www.sciencedaily.com/releases/2011/12/111205081731.htm>
Suomen Akatemia (Academy of Finland). (2011, December 6). Listening to music lights up the
whole brain. ScienceDaily. Retrieved March 20, 2018 from
www.sciencedaily.com/releases/2011/12/111205081731.htm

Effects of music therapy in the treatment of children with delayed

speech development - results of a pilot study
Wibke Groß, 1,2
Ulrike Linden,2 and Thomas Ostermann3

Author information ► Article notes ► Copyright and License information ►

Abstract
Go to:

Background
Music therapy is an established form of creative art therapy. By using music as a specific
medium of communication and expression and adapting it to the individual resources and
abilities of the patient, music therapy can be beneficial in activating and supporting mental
and psycho-physical recovery. Several systematic reviews have shown the effects of music
therapy in different clinical and therapeutic settings, such as for the treatment of psychiatric
diseases like schizophrenia or schizophrenia-like illnesses [1], psychosis [2], neurological
diseases like multiple sclerosis [3], dementia [4], or for the treatment of anxiety and pain [5].
In addition to these therapeutic fields, music therapy can also be applied in the treatment of
developmentally delayed children. Already in 1995, Aldridge et al. illustrated the use of
music therapy in children with developmental delay [6]. In another study, Duffy and Fuller
(2001) found that an 8-week music therapy intervention in social skills development in
moderately disabled children resulted in an increment in terms of turn-taking, imitation, and
vocalization [7]. Perry (2003) found direct relationships between the level of communication
skills and elements of musical interaction in children with severe and multiple disabilities [8].
Finally, Kim et al. (2008) demonstrated the effects of music therapy on joint attention
behaviours in preschool children with autism in a randomized controlled study [9].
Developmental delay often accompanies delayed speech development. Speech development
is an important predictor for later problems, such issues with reading and spelling, among
other learning difficulties. Gallagher [10] found that "studies of children with language
impairment have reported emotional and behavioural problems in 50-75% of that
population". According to Sallat [11], different authors describe children with delayed speech
development as being highly at risk of other cognitive, social-emotional, and school-related
problems.
However, definitions of speech development disorders still differ greatly and data on the
prevalence of delayed speech development actually range from 4 to 40% [12]. Grimm et al.
[13] detected substantial speech development disorders in 10% of children between the ages
of 4 and 5 in Bielefeld, Germany, and suspected speech development disorders in 20%.
General textbooks quote the epidemiology of specific speech development disorders as being
between 3 and 5%; however, this is without a traceable background [14]. According to a
study in Bavaria, 22.5% of tested children showed at least one problem in various tested areas
that required speech therapy [15].
Although there are considerable epidemiological variations due to the definition of
developmental speech delay, its prevention is a challenging social issue. In this respect, it is
of vital importance to apply therapies that are able to support the salutogenetic capacities of
the child with the aim of enhancing his or her speech development as early as possible.
According to findings of Aldridge [6] and Schumacher [16], music therapy is an approach
that may facilitate significant advances in speech development and communication skills,
particularly in children with autism. Additionally, Lathan-Radocy [17] described different
ways and methods of working with speech and language impaired children by engaging them
in music therapy. Finally, several case studies found positive effects of music therapy on
speech development in children [18-20].
Based on these findings, this study aims at examining the effectiveness of music therapy on a
child's verbal reasoning abilities. Furthermore, we wanted to investigate whether
experiencing musical structures, such as rhythm or strophic forms, and improvising with a
music therapist could stimulate a child's ability to understand sentences, as well as encourage
his or her interest in communicating with others.
Go to:

Methods

Study design
This observational pilot study was conducted in the Department of Music Therapy at
Herdecke Community Hospital between 2006 and 2008. We chose an ABAB reversal design
with alternations between music therapy and no treatment with an interval of approximately
eight weeks between the blocks. Before and after the music therapy blocks, a speech therapist
and a psychologist, who were both blinded to the conditions and timing, tested the children
using validated speech and nonverbal developmental tests. The study was approved and
accepted by the ethics commission at the University Witten/Herdecke (application number:
115/2006) and is registered in the German clinical trials register (Trial-No.:
DRKS00000343; http://www.drks.de).
Participants and inclusion criteria
All children were recruited via announcements in integrative and regular nursery schools.
Parents contacted the music therapy department at the hospital by phone and after the first
selection, 39 children aged 3.5 to 6 years, all with German as their native language, were
eligible to participate in the study. Participants had to pass a medical examination and take a
speech test to check whether they had a specific developmental speech disorder (ICD-10-
Codes: F80.1, F80.2, F83). They also had to score below 50 out of 100 points in the
phonological short-term memory test for non-words (German: PGN) and in one other
subscale of the applied speech test SETK 3-5 (see "Test instruments" section for a detailed
description). Children diagnosed with autism or muteness and/or a speech development
disorder due to any organic causes (e.g. deafness) were excluded, as well as those children
who had previous experience with music therapy.
As a result, a total of 18 children (6 girls; mean age: 4.3 ± 0.5 years) were selected to
participate in the study (see Figure Figure11 for the consort diagram of the study). None of
the participants were physically disabled and all were able to move and act independently.

Figure 1

Consort diagram of the selection process

Parents or guardians provided written informed consent for their child's participation in the
study before enrolment of the study. This included a discussion of the music therapist on the
nature and purpose of the proposed music therapy treatment and its potential risks and
benefits. Parents were also given the opportunity to ask questions to elicit a better
understanding of the music therapy treatment. Accompanying therapies, like speech therapy
and early intervention programs, continued uninterrupted due to ethical considerations.

Setting
Children received music therapy on an out-patient basis at the Department of Music Therapy
at Herdecke Community Hospital. The participants were brought to music therapy sessions
by their parents, but entered the music therapy room alone when possible. Single therapy
sessions had a mean duration of 25 minutes and were provided by a therapist and co-therapist
together. To meet the quality criteria of the hospital, the two music therapists had to have a
master's degree in music therapy and sufficient clinical experience (a minimum of two years)
in their field.

Music therapy
This study applied the concept of creative music therapy based on the Nordoff-Robbins
approach [18]. Both patient and therapist were active in singing and making music with
percussion instruments (i.e. bells, drums, pentatonic tone bars, shakers, reed horns, and lyres)
and a piano. Songs specifically composed for playtime and that dealt with the child's
interests, such as hide-and-seek songs or songs about animals, completed the therapeutic
spectrum. Individual themes and musical developments thus emerged for each individual
child; some wanted to sing and dance, others wanted to be sung to, and some wanted to play
an instrument on their own. According to this individualized approach, the improvised music
was oriented at the musical and vocal expressions of the child and therefore played the
central role of the therapy.

Test instruments

SETK 3-5
The speech development test for children aged three to five years (SETK 3-5) is the first
standardized German language test to examine speech abilities in children of this age group
with an immediate correlation between linguistic and auditory memory performance. With
Cronbach's alpha values between 0.62 and 0.89 and an inter-rater reliability of 90.1%, the test
yields a "reliable and valid description of receptive and productive speech abilities in
children" [21] and covers three areas of speech development, divided into three categories
with five subtests:
1. Children's understanding of speech (subtest "understanding sentences"; abbrev.: VS)
2. Speech production (subtest "generation of morphological rules"; abbrev.: MR)
3. Memory of speech, with a focus on abilities of speech processing, not on qualities of
pronunciation (subtest "phonological memory for non-words"; abbrev.: PGN; subtest
"memory for sentences"; abbrev.: SG, and subtest "memory for word sequences";
abbrev.: GW)

SON-R
The SON-R 2 1/2 - 7 is an individual intelligence test which does not require the use of
spoken or written language [22]. It is especially suited for children with problems in the area
of language and verbal communication and is comprised of six subtests of about 15 items that
address the dimensions activity patterns and cognitive structures.
Activity patterns include the scales "categories (abstract thinking, organizing principles)",
"analogies (abstract thinking)" and "situations (concrete thinking)". The scales "mosaics
(spatial comprehension)", "puzzles (concrete thinking)", and "drawing structures (spatial
comprehension)" represent the dimensions of the child's mental structure. Norm tables for
monthly age groups enable the transformation of raw subtest scores into normalized standard
scores. The total test results are represented as IQ scores and reference ages. IQ scores
between 89 and 110 are average, 79 to 88 are below average, 68 to 78 are borderline, and IQ
values below 67 indicate an intellectual deficit.
With a Cronbach's alpha value of 0.90 and a test-retest reliability of r = 0.79 for the overall
IQ score, the reliability of the test is sufficient.
All psychometric tests were conducted by speech therapists and a psychologist blinded to the
conditions and timing.
Music therapy assessment scales
All sessions were videotaped for analysis and consecutively assessed in detail after each
session independently by the therapist and co-therapist. Nordoff-Robbins assessment scales
were used to evaluate developments in music therapy for the first and last session of each
music therapy block respectively. Scale I assessed the "child-therapist relationship in musical
activity" (CTR) and Scale II assessed "musical communicative ability" (MCA); both were
measured on a 10-point scale where 0 denotes lowest values and 10 denotes highest values in
the respective categories. Inter-rater reliability values showed high agreement rates within the
range of one point of 82% in Nordoff-Robbins therapists ratings [18].

Statistical analysis
Data were analyzed using intention-to-treat analysis (ITT). Missing values were imputed
using the method of last observation carried forward with the following rules: a missing value
before a block of music therapy or no treatment was replaced with the corresponding pre-
session value. A missing value after a session was replaced with the according pre-session
value.
The Friedman test was used to analyze the effect of music therapy over the course of time
and the Wilcoxon rank-sum test was used for baseline comparisons (T0) and final
measurements after the last therapeutic session (T4). We judged p £ 0.05 as significant and p
between 0.05 and 0.1 as a trend. To quantify the outcome we also calculated effect sizes for
all scales between T0 and T4. According to Cohen [23], effect size values between 0.2 and 0.5
are indicative of a small effect; values between 0.5 and 0.8 denote a medium effect and
values greater than 0.8 indicate a large effect size.
Go to:

Results

SETK
Mean SETK scores yielded the following results: "phonological memory for non-words"
(PGN) and "understanding sentences" (VS) revealed distinct upward trends, whereby
increases were more pronounced during periods with music therapy. These two parameters
showed mostly parallel development. These two subtests PGN and VS showed a particularly
steeper increase after music therapy blocks (T0-T1/T2-T3) compared to waiting periods (T1-
T2/T3-T4). "Memory for sentences" (SG) also improved distinctively, starting from a very
low level. A second boost was registered after the second waiting period (see Table Table11).

Table 1
Changes in the course of time and overall effect sizes in SETK subscales and SON-R outcome
measures

"Generation of morphological rules" (MR) also increased after music therapy blocks while
decreasing during waiting periods. "Memory for word sequences" (GW) was the hardest
factor to assess. It was measured in different units compared to the rest of the parameters and
in addition it is only measured in children aged four and older, so that the number of test
results gained in this instance is far smaller. All general developments (T0-T4) for the five
subtests of the speech test SETK revealed a definite increase. Over the entire study period
(T0-T4), parameters PGN and VS showed statistically significant results (p < 0.001), which
suggest that music therapy may have an effect on the development of phonological memory
and understanding sentences. Phonological memory (PGN) indicated statistically significant
results during the first waiting period (T1-T2 p = 0,008) and also after the second block of
music therapy (T2-T3 p = 0,001; see Table Table11).

SON-R
The three parameters of SON-R (cognitive structures (DS), action patterns (HS), and IQ
increased significantly in the study course (DS p = 0,001; HS p < 0,001; IQ p < 0,001). The
parameter of cognitive structures (DS) showed higher mean scores compared to activity
patterns (HS) at time T0. It is interesting to note that DS and HS differed by several points at
first (T0, T1) but later converged after the first interval (T2) to almost identical levels. The
scores diverged again after the second music therapy intervention (T3), although this time on
a higher level. The scores finally converged after the second interval (T4) (see Table
Table11).

Difference between age and biological age

Analysis of reference age revealed that the developmental age of the children in the course of
music therapy interventions converged more and more towards their biological age. The
difference was reduced from approximately one year at baseline to seven months at the end
of therapy. Moreover, the variance in their developmental age increased meaning that some
of the children corresponded with their biological age at the end of the study, while other
children demonstrated a development approaching their biological age. The complete
development over the course of time is shown in Figure Figure22.

Figure 2

Difference of developmental age (age IQ) to biological age over the study period. Error bars denote
the 95% confidence interval

Nordoff-Robbins Scales
Ratings according to the Nordoff-Robbins scales showed distinctly significant changes. Both
parameters CTR for child-therapist relation and MCA for musical communicative ability
increased after the first music therapy block (T2), then subsequently decreased (T3), and then
finally reached the previously achieved higher level after the second music therapy block
(T4). MCA showed a slightly higher increase (Figure (Figure33).
Figure 3

Development of Nordoff-Robbins rating over the study period

Compliance
The compliance of the children was a major problem in the developmental tests, particularly
in completing the SETK-questionnaire. While the SON-R was well accepted by the children
and Nordoff-Robbins items were scored by the therapist, completing the SETK with the
children was difficult, yielding to incomplete items in the SETK subscales (between 14%
(VS-Scale) and 36% (GW-Scale) of the items). However, the imputation of missing values
reduced these rates to a mean level of 10% remaining incomplete items.
Go to:

Discussion
This study is the first to provide valid information about the effects of music therapy in
children with developmental speech delay. It was found that music therapy had an effect on
fundamental qualities of speech development and resulted in significant improvements in
phonological memory and the children's understanding of sentences. Furthermore, a positive
shift in the memory of sentences and generation of morphological rules was observed. In
particular, the difference between the developmental age and biological age of the children
decreased significantly. These results were accompanied by a clinically significant effect of
music therapy on the child-therapist relationship and musical communicative ability, as
measured by the Nordoff-Robbins scales.

Initial effect
Empirical observations frequently described the phenomena of an "initial effect" of music
therapy on speech development (i.e. that music therapy seemed to stimulate the speech
development of developmentally delayed children even after a few music therapy sessions).
In accordance with these findings, results from this pilot study illustrate which aspects of
speech development are influenced specifically by music therapy and show to what extent an
initial effect may be detected. Results show improvements in the development of speech and
cognitive abilities even after the first block of music therapy treatment. Children may benefit
specifically in the areas of relationship and communication as shown by the rating according
to the Nordoff-Robbins scales.
It is assumed that a newly acquired ability, such as a basal social experience, has an initial
effect on the further development of the sense of self-perception and the perception of others.
Furthermore, it influences self-awareness and emotional mood. This 'snow ball effect' could
possibly explain the relatively fast positive development of the participants. Since
communication is a basic human need, it can be further assumed that the provided individual
communication model 'music therapy' was simply claimed by the participants after a
successful introduction and was also maintained.
Speech Development
The changes in phonological memory (PGN) and the understanding of sentences (VS)
increased significantly with a parallel slope. Test results suggest that music therapy
interventions may initially provide a boost in the development of these skills. Abilities
covered by the subscale PGN are obviously related to prosodic abilities [24]. We believe that
the improvements occur because music therapy addresses listening, perception, processing,
and the memorizing of sounds and musical structures. This corresponds to a study by
Jungblut et al. [25], who reported positive improvements in speech development in patients
with aphasia due to music therapy. Here, prosody was one of the parameters showing
substantial progress. This corresponds with the theoretical considerations of Grimm [24],
who regards prosody as a defining aspect of speech processing and language acquisition.
The improvement in the VS subscale is underlined by the empirical observations we made in
the study. In the beginning, most of the children we worked with had difficulty focusing their
attention with hand-eye-coordination and the concentration on a joint activity with the
therapist. During music therapy sessions, most of the children enhanced their concentration
and were increasingly able to direct their eyes and concentration to a joint activity with the
therapist and to playing an instrument. The improvement in the Nordoff-Robbins scales
especially underlines these observations. Children benefit specifically in the areas of forming
relationships and enhancing their communication skills. Parents, speech therapists, and
teachers reported that the children started to communicate more frequently and started to
have more social contacts. According to a deeper single case analysis of two children in our
study, we found that one important element in achieving linguistic understanding is the
ability to relate to another person [26]. Moreover, Grimm [24] describes three areas of so-
called anticipatory abilities that are essential even in infants for acquiring speech: social
cognition, perception, and cognition. These include the abilities to direct attention to objects
and events, to differentiate between them, and to remember the differences. In addition, he
determined that constructing a common point of focus has proved to be especially important
in acquiring language skills.
The scores measured for SG also show a distinct increase over the study period. This may be
explained through the inherent experience of structure and perspective in the process of
active music making with the therapist. Studies of infants' abilities to perceive speech found
that infants prefer well-structured speech patterns to less well-structured ones [24].
Perception and grasp of structures seem to be important skills for acquiring speech. Form and
general structure of a sentence must be understood in order to grasp the entire meaning.
These qualities are exercised and targeted all the time when making music. They may be
shortened or expanded step by step and thus be adapted to the individual making the music
and his or her abilities.
It is interesting to note that the parameter "generation of morphological rules" shows
improvements after music therapy blocks. This parameter, quite unrelated to music at first
sight, seems to address recognition and understanding of structures, which is continuously
practised in active music-making. Deficits in generation of morphological rules are
considered as particularly distinct and obstinate. Music therapy may give support to the
development of this ability.
Rhythmic-prosodic abilities seem to be central for acquiring language. Again, Grimm
describes that children with developmental speech delay frequently display considerable
difficulties in the rhythmic-prosodic area. An impaired ability to grasp the totality of prosodic
structures means that larger parts of the working memory must be relied upon, thus limiting
the amount of working memory available for the understanding and processing of language.
Training a child's reproduction capabilities of phonologic (and therefore also of prosodic)
structures could provide significant support in the child's development of language abilities
[24].
Aldridge [27] emphasized the importance of rhythmic structures and abilities for infantile
development: "rhythm plays a central co-ordinating role in the organization of human
perception and action, and for the developmentally delayed child, a controlled - yet flexible -
rhythmic structure found in musical playing seems to be an island of stability from which
new initiatives can take place." According to Trevarthen & Aiken [28], music therapy from a
neuropsychological point of view may support human communication skills that are
organized rhythmically in accordance with neurological processes. Thus, active, creative
music therapy works immediately with the contact and communication between the
improvising participants. In such a setting, the integration of several senses, like hearing or
seeing, motor abilities, and emotion, is of vital importance [29] because both verbal
communication and joint musical improvisation require a meaningful integration of these
senses. Thus, music therapy may offer a specific space to test and develop various senses on a
level appropriate to the child's individual abilities and speed.
From a music therapy perspective, Neugebauer [20] relates the steps of language
development to musical qualities and concludes that music therapy works on those musical
qualities and speech development can thus be enhanced. These findings are underlined by
Papousek's research on infants [30]. She analyzed mother-infant interaction and its relation to
musical parameters, even if the use of the musical metaphors has to be taken into account
critically [29]. This might be an explanation of why music therapy can be effective in
children with communication disorders. The therapeutic processes that took place in our
study have been described comprehensively in the case report of two patients [26].

Cognitive Development
The non-verbal development test SON-R produced encouraging results. The SON-IQ of the
entire group rose significantly and the difference between developmental age and biological
age of the children decreased significantly. Even here our study showed an initial effect. For
a majority of children it may be assumed that their intelligence potential had not been fully
exploited prior to the study. In music therapy we see many children who seem to have no
experience whatsoever with symbolism, imagining fantasy stories, or playing with sounds. At
first these children seem to soak up our imaginative-musical proposals before they start to
develop and share their own creative potential. Music therapy thus seems to evoke and reveal
unused potential. During music therapy, children seemed to access their potential and were
even able to adapt it to another setting such as in the test situation. This corresponded to a
detailed analysis by Rittelmeyer [31], who emphasized the impact of creative abilities in the
neurological, cognitive, and emotional development of children.
An analysis of the two subtests for cognitive structures and action patterns is also of interest.
At first, the two scales diverge, converge closely after the first waiting period in order to
diverge again, and approach each other on a significantly higher level at the end of the study
(see Figure Figure2).2). Cognitive structures are the first subtests to advance. Action patterns
keep up with the development during the waiting period. Again an initial effect of music
therapy can be assumed in this case. It is remarkable that action patterns converge to the
similar level with cognitive structures. Cognitive structures and action patterns are nearly
integrated at that point. A child cannot do much with certain cognitive abilities without
knowing how to use them actively. An integration of thinking and doing appears to be
indispensable for the meaningful use of cognitive abilities. Music therapy may therefore
provide an important contribution to the promotion of integrated thinking and doing and may
reveal a child's hidden potentials.

Limitations
Although the large effect sizes in the present study point to a potential impact of music
therapy, the small number of participants in the study should be mentioned as an important
limiting factor. The discussion of whether observational studies tend to overestimate the
effects of a therapy compared to the results of controlled clinical trials is still vital [32] and
the call for randomized controlled trials (RCTs) has already reached the borders of music
therapy [33]. Due to organizational and structural aspects we abstained from carrying out a
RCT in this case. However, other researchers recommend more naturalistic, observational
studies of patients in psychotherapy [34] and, with regards to external evidence, our findings
give an impression of the real world effectiveness of music therapy. In order to verify the test
results, further studies with a higher number of participants should be conducted to underline
and specify the effects found in this setting [35,36].
As there is no control group or a specific control condition we are of course aware that the
changes observed here might not be attributed to the music therapy applied. It could, for
instance, simply be the intervention itself associated with a high amount of care giving or the
attention given to the kids. A further point is that the children might have improved their
behaviour simply in response to the fact that they were being studied. This is also known as
the Hawthorne effect [37]. In his study on the effects of background music on quality of sleep
in elementary school children, Tan also suggested, that children might be responding to
music therapy treatment due to their awareness of participation [38].
Also, unblinding might be a potential source of bias. According to a study of Noseworthy et
al., blinded outcome evaluators do assess outcomes less optimistically than unblinded
evaluators [39]. Thus, we tried to avoid unblinding of the external evaluators in our study.
Consequently, they were not introduced in the therapeutic strategy at any time of the study to
rule out that they would for example focus on a special subcategory of the psychological tests
like phonologic memory. However as the evaluators in the case of the speech and intelligence
tests directly interacted with the children and did see them five times within the course of the
study, unblinding can not be ruled out.
Due to financial limitations, it was not possible for external therapists to conduct therapeutic
music therapy ratings. Although the findings on inter-rater reliability in [18] give sufficient
assurance on the reliability of the Nordoff-Robbins rating, an external rating would have
probably been of higher internal validity with a more objective character.
Considering these limitations, our results should be interpreted with care.

Underlying working principles

Until now, working principles of music therapy have mostly been examined using qualitative
research. Although single case studies tried to identify possible modes of action in music
therapy in speech development, we are still not able to isolate elements of music therapy as
the driving therapeutic force. The only aspect that is for certain is that a mutually created
musical dialogue improves the child's perception of him or herself and of the person who is
sharing the experience. As a result, according to [27] the "activity of listening, in a structured
musical improvisational context, without the lexical demands of language" may improve the
cognitive, gestural, emotional, and relational development of the child.
Neuro-physiological approaches might underline these results but, due to limited resources,
they have only been marginally applied in music therapy research. Additionally, it is
questionable whether neuro-physiological approaches would be able to show development in
areas such as social communication and self-consciousness, which are essential preconditions
for language acquisition.
In addition, some important parameters for the development of language skills are not
covered by the test parameters. Vital information was provided by the additional qualitative
data collected from parents and testers. Most of the children started to use their language with
increasing confidence; social skills improved and children were motivated to communicate
more intensively. Although these data often did not correlate with the test results, these
findings seem to be evidence of very important parameters that cannot be checked by the
speech test and development tests alone. The Nordoff-Robbins scales, however, do reflect
these aspects.
Go to:

Conclusions
Music therapy according to this study may have a beneficial effect on speech development. It
does not seem to influence individual isolated aspects of speech development but might
address and integrate many different aspects in a comprehensive way that are important for
speech development, including relationship abilities and prosodic abilities. It might be
supposed that music therapy interacts with very fundamental aspects of speech development
and has measurable effects even after a short period of time. Therefore, music therapy may
provide a very fundamental, basic, and supportive therapy for children with developmental
speech delay.
Go to:

Competing interests
The authors declare that they have no competing interests.
Go to:

Authors' contributions
WF carried out the study, participated in the evaluation of data, and helped draft the
manuscript. UL conceived of the study and carried out the study, participated in evaluation of
data, and helped draft the manuscript. TO participated in the design of the study, performed
the statistical analysis, and wrote the final version of the manuscript. All authors read and
approved the final manuscript.
Go to:

Pre-publication history
The pre-publication history for this paper can be accessed here:
http://www.biomedcentral.com/1472-6882/10/39/prepub
 Go to:

Acknowledgements
We are grateful to the foundation Aktion Mensch for their generous support of this study.
Our thanks go to Dr. B. Irion, Dr. B. Berger and Dr. M. Mousers, who helped organize the
study at the Herdecke Community Hospital, and Dr. K Boehm and Katie Renaud, who cross-
checked the manuscript.
We also thank the following foundations whose support enabled us to evaluate and publish
the results of the study: Gerhard-Kienle-Stiftung, Herdecke; Andreas und Emilie Olmstedt-
Stiftung, Witten; Werner Richard- und Dr. Carl Dörken-Stiftung, Herdecke; Stiftung Musik
HILFT by Nordoff-Robbins, Berlin and the Verein zur Förderung der Nordoff/Robbins-
Musiktherapie e.V., Herdecke.
Go to:

References

1. Gold C, Voracek M, Wigram T. Effects of music therapy for children and adolescents with
psychopathology: a meta-analysis. J Child Psychol Psychiatry. 2004;45(6):1054–63. doi:
10.1111/j.1469-7610.2004.t01-1-00298.x. [PubMed] [Cross Ref]
2. Silverman MJ. The influence of music on the symptoms of psychosis: a meta-analysis. J Music
Ther. 2003;40(1):27–40. [PubMed]
3. Ostermann T, Schmid W. Music therapy in the treatment of multiple sclerosis: a
comprehensive literature review. Expert Rev Neurother. 2006;6(4):469–77. doi:
10.1586/14737175.6.4.469.[PubMed] [Cross Ref]
4. Schmitt B, Frölich L. Creative therapy options for patients with dementia--a systematic
review. Fortschr Neurol Psychiatr. 2007;75(12):699–707. doi: 10.1055/s-2006-
944298. [PubMed][Cross Ref]
5. Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic
review. AORN J. 2008;87(4):780–807. doi: 10.1016/j.aorn.2007.09.013. [PubMed] [Cross Ref]
6. Aldridge D, Gustorff D, Neugebauer L. A pilot study of music therapy in the treatment of
children with developmental delay. Complementary Therapies in Medicine. 1995;3:197–205.
doi: 10.1016/S0965-2299(95)80072-7. [Cross Ref]
7. Duffy B, Fuller R. Role of Music Therapy in Social Skills Development in Children with
Moderate Intellectual Disability. Journal of Applied Research in Intellectual
Disabilities. 2000;13(2):77–89. doi: 10.1046/j.1468-3148.2000.00011.x. [Cross Ref]
8. Rainey Perry MM. Relating improvisational music therapy with severely and multiply
disabled children to communication development. J Music Ther. 2003;40(3):227–
46. [PubMed]
9. Kim J, Wigram T, Gold C. The effects of improvisational music therapy on joint attention
behaviors in autistic children: a randomized controlled study. J Autism Dev
Disord. 2008;38(9):1758–66. doi: 10.1007/s10803-008-0566-6. [PubMed] [Cross Ref]
10. Gallagher TM. Interrelationships among childrens language, behavior, and emotional
problems. Topics in language disorders. 1999;19(2):1–15. doi: 10.1097/00011363-
199902000-00003.[Cross Ref]
11. Sallat S. Musikalische Fähigkeiten im Fokus von Sprachentwicklung und
Sprachentwicklungsstörungen. Idstein: Schulz-Kirchner-Verlag; 2008.
12. Weber B. Auditive Wahrnehmung und Sprachentwicklung. Master Thesis. University of
Innsbruck; 2004. http://www.hss-
Innsbruck.at/Auditive%20Wahrnehmung%20und%20Sprachentwicklung.pdf
13. Grimm H, Aktas M, Jungmann T, Peglow S, Stahn D, Wolter E. Sprachscreening im
Vorschulalter: Wie viele Kinder brauchen tatsächlich eine Sprachförderung? Frühförderung
interdisziplinär. 2004;3:108–117.
14. Möller HJ, Laux G, Deister A. Psychiatrie und Psychotherapie. Stuttgart: Thieme Verlag; 2005.
15. Deutsche Gesellschaft für Sprachheilpädagogik e.V. Landesgrupe
Thüringen. http://www.dgs-
ev.de/thueringen/Fachliches/studie_zur_erfassung_von_kindern.htm
16. Schumacher K, Calvet-Cruppa C. Musiktherapie als Weg zum
Spracherwerb. Musiktherapeutische Umschau. 1999;20:216–221.
17. Lathan-Radocy WB. Pediatric Music Therapy. Springfield: Charlie C. Thomas Publishers Ltd;
2002.
18. Mahoney JF. Interrater Agreement on the Nordoff-Robbins Evaluation Scale I: Client-
Therapist Relationship in Musical Activity. Music and Medicine. 2010;2(1):23–28. doi:
10.1177/1943862109348616. [Cross Ref]
19. Bruscia KE. Case Studies in Music Therapy. Philadelphia: Barcelona Publishers; 1996.
20. Neugebauer L. The importance of music therapy for encouraging latent potential in
developmentally challenged children. Music Therapy Today. 2005;VI(3):430–
455. http://www.musictherapyworld.net
21. Grimm H, Aktas M, Frevert S. SETK 3-5 Sprachentwicklungstest für drei- bis fünfjährige
Kinder. Diagnose von Sprachverarbeitungsfähigkeiten und auditiven
Gedächtnisleistungen. Göttingen: Hogrefe-Verlag; 2001.
22. Tellegen PJ, Laros JA, Petermann F. SON-R 2 1/2 - 7. Nonverbaler Intelligenztest. Göttingen:
Hogreve-Verlag; 2002.
23. Cohen J. Statistical power analysis for the behavioral sciences. 2. New York:Academic Press;
1988.
24. Grimm H. Störungen der Sprachentwicklung: Grundlagen - Ursachen - Diagnose -
Intervention - Prävention. Göttingen: Hogrefe-Verlag; 2003.
25. Jungblut M, Aldridge D. Musik als Brücke zur Sprache - die musiktherapeutische
Behandlungsmethode SIPARI bei Langzeitaphasikern. Neurologische
Rehabilitation. 2004;10(2):69–78.
26. Linden U, Feenders W, Meusers M, Ostermann T. Musiktherapie bei Kindern mit
Sprachentwicklungsverzögerung-Zwei Einzelfallstudien aus einer
Pilotstudie. Musiktherapeutische Umschau. 2008;29(4):227–240.
27. Aldridge D. Music Therapy and it's Implications for Child-Development. Curare. 1996;9:357–
362.
28. Trevarthen C, Aitken KJ. Brain development, infant communication, and empathy disorders:
Intrinsic factors in child mental health. Development and Psychopathology. 1994;6:597–633.
doi: 10.1017/S0954579400004703. [Cross Ref]
29. Schwaiblmair F. Infant research and music therapy - The significance of musical
characteristics in early mother-child interaction for music therapy. Music Therapy Today
(online) 2005;6(1):48–59. http://musictherapyworld.net
30. Papousek M. In: Intuitive Parenting: a hidden source of musical stimulation in
infancy. Deliege I, Sloboda J, editor. Musical Beginnings. Origins and Development of Musical
Competence; 1996.
31. Rittelmeyer Ch. Kindheit in Bedrängnis. Zwischen Kulturindustrie und technokratischer
Bildungsreform. Stuttgart: Verlag W. Kohlhammer; 2007.
 32. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the
hierarchy of research designs. N Engl J Med. 2000;342:1887–1892. doi:
10.1056/NEJM200006223422507. [PMC free article] [PubMed] [Cross Ref]
33. Edwards J. Can music therapy in medical contexts ever be evidenced-based? Music Therapy
Today (online) 2004;5:4. http://www.musictherapyworld.net
34. Perry JC, Banon E, Ianni F. Effectiveness of Psychotherapy for Personality Disorders. Am J
Psychiatry. 1999;156:1312–1321. [PubMed]
35. Aldridge D, Pietroni P. Research trials in general practice: towards a focus on clinical
practice. Fam Pract. 1987;4(4):311–5. doi: 10.1093/fampra/4.4.311. [PubMed] [Cross Ref]
36. Aldridge D. Guidelines for clinical research in complementary medicine. J Altern
Complement Med. 2000;6(3):245–51. doi: 10.1089/acm.2000.6.245. [PubMed] [Cross Ref]
37. Whitehurst GJ, Falco FL, Lonigan CJ, Fischel JE, DeBaryshe BD, Valdez-Menchaca MC,
Caulfield M. Accelerating language development through picture book
reading. Developmental Psychology. 1988;24(4):552–559. doi: 10.1037/0012-
1649.24.4.552. [Cross Ref]
38. Tan LP. The effects of background music on quality of sleep in elementary school children. J
Music Ther. 2004;41(2):128–50. [PubMed]
39. Noseworthy JH, Ebers GC, Vandervoort MK, Farquhar RE, Yetisir E, Roberts R. The impact of
blinding on the results of a randomized, placebo-controlled multiple sclerosis clinical
trial. Neurology. 1994;44:16–20. [PubMed]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921108/

A music therapy clinical case study of a girl with childhood apraxia of speech: Finding Lily's voice

Author links open overlay panelBethBeathardBM, MT-BCRobert E.KroutEdD, RMTh, MT-BC

Show more

https://doi.org/10.1016/j.aip.2008.01.004Get rights and content

Abstract

This clinical case study describes a 3-year-old girl diagnosed with childhood apraxia of speech and
her progress in weekly music therapy. The child was seen for a total of 24 sessions over a period of 9
months. The music therapy treatment involved a mixture of behavioral, improvisational, and
creative approaches in what has been termed a data-based music therapy approach. A variety of
musical interventions, visual, and interactive aids were used, as well as an engaging, playful dialogue
between child and the clinician. The child's communicative methods at the beginning of her
treatment process were almost exclusively non-verbal. By the final session, she was pronouncing a
number of syllables, combination sounds, and words. The treatment program is described as it
unfolded in three phases, and significant events from each individual session are described in detail.

https://www.sciencedirect.com/science/article/abs/pii/S0197455608000051

Music Therapy: Study Says Music Key for Non-Verbal Children and Children
with Speech and Language Delays
M AR 3 0 , 2 01 66 55 06 VI EWS3 COMM ENTS
 







Music Therapy: Study

Says Music Key for
Non-Verbal Children
and Children with
Speech and Language
Delays
This article contains information regarding music therapy and how it helps improve learning
disorders and academics. Affiliate links are included for your convenience. To learn more
about Music Therapy, complete the form below.
The concept for using music as a form of healing dates back to the times of Plato
and Aristotle. The ancient Greek Philosophers thought that music could serve as a
therapeutic function for those suffering from many different illnesses. Aristotle
believed that if an ideal environment could be achieved the healing process could
be accelerated. Music was part of the ideal environment, and at that time, there
were healing shrines that housed hymn specialists as well as physicians (Gfeller, K.
E., 2002). The music therapy we are familiar with today began after World War I
and II with the treatment of veterans. Local musicians played for traumatized
military patients and doctors and nurses began to see positive results. Since then,
there has been continuous research on the effectiveness of music therapy.
An Introduction to Music Therapy: Theory and Practice, describes music therapy as an
evidence-based health profession that utilizes appropriate music as a tool to
support many populations in achieving holistic health goals. Interactive music
 therapy consists of numerous techniques that are specifically designed to help
children and adults with their specific health goals.
Some of the techniques used to integrate music therapy include the following:

 Making music with instruments

 Movement exercises

 Repetitive music listening with headphones

 Music and imagery

 Songwriting

 Music combined with other creative arts

 Rhythmic entrainment therapy

What is Entrainment?
Take a glance at that last listing. Have you heard of the word entrainment before?
Entrainment is actually a physics term that describes when two systems or two
objects start moving together with the same movement. This requires less energy
than moving in opposite directions. This phenomenon occurs even if two objects
are near each other and are not moving the same way. Over time, the objects
begin moving together. The same happens in our bodies to rhythm. When you are
jogging to music, you usually start running to the beat of the song. Each step is a
beat or a half beat and pretty soon your whole body is matching the rhythm. This
also happens at concerts. It’s almost impossible to not move your head, hips, feet,
or hands to the songs. In our own bodies, the lub dub of the heart has its own
rhythmic beat and it controls the circulation in our bodies. It brings the
oxygenated blood to the brain which controls the Central Nervous System (CNS).
When we are excited or nervous, the heart rate and respirations increase. When
we are tired or resting, our heart rate goes down. Music creates life and
expression.
 There are a multitude of universal traits that music carries. A few of these traits
include the following:

 Music encourages movement

 Music captivates and maintains attention

 Music helps release emotions

 People of all ability levels can participate

 Music taps into all regions of the brain

 Music facilitates learning

Why Entrainment Works

With music, our body systems naturally entrain with the available rhythm. When
music input enters into the auditory nerve and into the CNS, most of the
information goes to the brain for processing, but some input goes straight to the
motor nerves in our spinal cord. This allows our muscles to start moving without
even thinking about it. It is the reason people tap their foot, dance to a rhythm or
walk in time to a beat without much effort. This entrainment process is also the
reason why music therapists can help someone increase their language skills,
speech, balance and/or coordination. One study shows entrainment music therapy
is successful in cognitive rehabilitation, especially for speech and language
rehabilitation and skill building.
How Music Therapy Cultivates Speech
and Language
Over the years, the therapeutic, medical and educational communities have come
to understand the power of music. Music has both sound and rhythmic elements
that communicate to the human body. We can begin to learn another language
when we tap into the entrainment power music has. In The Well Balanced Child,
written by Sally Goddard Blythe, she portrays music as the child’s second
language. She defines the child’s first language as movement, and goes onto say
movement moves into language when the baby is discovering his own movements
and the environment. Before the child can speak words there is cooing and
babbling. Babbling includes tone, pitch and cadence. Babies will imitate the
rhythm of adult speech and adult sounds. This is all building a symphony of sounds
so their vocabulary will be constructed when ready.
Did you know that listening to or singing along with music uses the same neural
circuits as expressing speech? Music, the rhythm, the beat, the cadence, even the
lyrics share neural circuits used for language. Therapists can use this ability to help
a child who struggles with language and speech skills to communicate. Children
with developmental disabilities or those who have autism and other obstacles
many times struggle with communication and interpersonal skills. Just as music
therapy helps with interpersonal interaction and emotions, it can also assist with
communication skills.

Music therapy has helped many of our students with speech, language, auditory,
balance, coordination and emotional grounding. Music combined with movement
often stabilizes and opens the brain for higher learning. Concepts that are difficult
for many children at first, begin to make sense as music and movement organize
the brain by regulating its lower levels (balance, coordination, vestibular,
auditory) to open the mind for higher learning concepts that affect the higher
working portions of the brain (problem solving, critical thinking, communication,
speech, language, reading, writing and math). If you haven’t tried music therapy
yet with your child’s Occupational Therapy or movement therapy, ask questions
and inquire if this could be an option for your child. Music therapy may be another
piece to improving your child’s academics.
https://ilslearningcorner.com/2016-03-music-therapy-study-says-music-key-for-non-verbal-children-
and-children-with-speech-and-language-delays/

Music Therapy and the Emergence of Spoken

Language in Children with Autism
Christine Barton
June 9, 2008

 Articles

 Language Disorder(s)

 Autism/ASD/Social Emotional

 Music Therapy and the Emergence of Spoken Language in Children with Autism

Share:
Print

'My child knew music before he knew words.'

Kim, mother of an 8 year-old boy with autism and profound hearing loss.

Introduction

In 2007, the Center for Disease Control Prevention estimated that the prevalence of autism in the
United States had risen to 1 in 150 children (Autism Society of America, 2008). Since boys are
four times as likely to be diagnosed as girls, their incidence rate is an alarming 1 in 94 (Autism
Society of America). This makes autism the fastest growing diagnosis in the United States, more
than AIDS, diabetes, and cancer combined (Autism Speaks, 2008). The cause(s) of autism are
still elusive, but environmental as well as genetic factors appear to contribute to its increasing
occurrence (Autism Society of America). This crisis has focused national attention on the
monetary, as well as personal costs, to the families of these children. And the race is on to find
the treatments that yield the best outcomes. One of the positive predictors of social and
intellectual development in children with autism is the acquisition of functional language by five
years of age (Thaut, 1999). In this author's experience, music therapy is an intervention that can
increase communicative behaviors in young children with autism. This article will briefly define
autism, explain the effectiveness of music as a therapeutic tool with autistic children, look at the
connection between music and language, and finally, provide examples of music therapy in
action and ways to incorporate it into speech-language intervention sessions.

Autism and Autism Spectrum Disorders (ASD)

Autism is a complex, neurologically based developmental disorder (Autism Speaks, 2008). It is
often referred to as a Pervasive Developmental Disorder (PDD) because delays in certain areas
of functioning impact growth in other areas of development. It is a lifelong condition for which
there is no known cause, protection, cure, or completely reliable treatment. However, early
intervention can have a positive impact on an individual's ability to maximize the effectiveness of
existing treatments (Autism Speaks). Autism is also frequently referred to as a spectrum disorder
(ASD), meaning that there are many levels of developmental delay ranging anywhere from very
mild to profoundly severe (Berger, 2002). On one end of the spectrum is the high-functioning,
communicative individual, on the other, the minimally functional, nonverbal individual with severe
developmental disabilities.

Some of the hallmarks of the disorder include:

 A lack of or delay in spoken language

 Repetitive use of language and/or motor mannerisms (echolalia, hand flapping, twirling
objects)
 Minimal direct eye contact
 Unusual play or lack of creative play
 Lack of interest in peers (Autism Society of America, 2008).

Children with an ASD may demonstrate some or all of these traits and to varying degrees.

Music and Children with Autism

When autism was first observed and defined by Leo Kanner in 1943, he noted a particular
precocious musical orientation in the young boys he studied. At the age of one year, one boy
"could hum and sing many tunes accurately" (Kanner, 1943, p.1). From a review of the literature
regarding music and children with autism, Thaut concluded that:

1. "Many autistic children perform unusually well in musical areas in comparison with most
other areas of their behavior, as well as in comparison with many normal children.

2. Many autistic children respond more frequently and appropriately to music than to other
auditory stimuli.

3. Little is known about the reasons for the musical responsiveness of autistic children.
However, the most promising explanation may lie in the knowledge of brain dysfunction
and perceptual processes of autistic children" (1990, p. 171).

As these conclusions suggest, music is an effective therapeutic tool to use in treatment of the
child with ASD.

https://www.speechpathology.com/articles/music-therapy-and-emergence-spoken-1199

Integrating music therapy services and speech-language therapy

services for children with severe communication impairments: a co-
treatment model.
Article Type:
Clinical report
Subject:
Music therapy (Methods)
Speech therapy (Methods)
Communicative disorders in children (Care and treatment)
Motivation in education (Research)
Authors:
Geist, Kamile
McCarthy, John
Rodgers-Smith, Amy
Porter, Jessica
Pub Date:
12/01/2008
Publication:
Name: Journal of Instructional Psychology Publisher: George Uhlig Publisher Audience: Academic; Professional
Format: Magazine/Journal Subject: Education; Psychology and mental health Copyright: COPYRIGHT 2008 Ge
orge Uhlig Publisher ISSN: 0094-1956
Issue:
Date: Dec, 2008 Source Volume: 35 Source Issue: 4
Topic:
Event Code: 310 Science & research
Geographic:
Geographic Scope: United States Geographic Code: 1USA United States

Accession Number:
193791683
Full Text:
Documenting how music therapy can be integrated with speech-language therapy services for children with
communication delay is not evident in the literature. In this article, a collaborative model with procedures,
experiences, and communication outcomes of integrating music therapy with the existing speech-language
services is given. Using established principles of team planning, the co-treatment model is described in a case
study, a 4-year-old child diagnosed with global developmental delay. Results indicated increased engagement in
the classroom after integrating music therapy and speech-language therapy treatment strategies.

**********

As the number of cases of children being identified with communication disorders increases, the need for cost
effective treatment has become more apparent. Music therapists assess and develop treatment for people with
developmental disabilities and emotional issues in facilities such as hospitals, schools, and inpatient and
outpatient treatment centers. Speech-language pathologists not only work with people on speech and sound
issues, but also work with individuals who have learning disabilities, memory problems and individuals who have
problems with swallowing food or drink. In the past 25 years, the field also added augmentative and alternative
communication (AAC) to its scope of practice. AAC can include using signs or gestures, pointing to pictures in a
communication book, or using a computer-based device with synthesized speech output.

Currently, speech-language pathologists (SLPs) and music therapists (MTs) are diligently working to improve
techniques to address the varied and sometimes complex communication and educational needs of children with
disabilities (Geist & McCarthy, 2008). Music provides a structured medium to accentuate the prosody or meaning
of language in the context of an enjoyable, motivating stimulus (Pelliteri, 2000). Music therapists are trained to
adapt elements of music e.g. tempo, rhythm, melody, harmony, and texture to promote effective communication
strategies. Although communication and music therapy treatment have the potential to complement each other in
a therapeutic context, studies documenting this interdisciplinary approach are not common in the literature. This
article illustrates an example of how SLPs and MTs can effectively co-treat for a child with complex
communication needs. Short-term effects of this treatment are presented.

Music Promoting Speech

Research had found that music techniques promoted increased breath and muscle control (Peters 2000, Cohen,
1994), stimulated vocalization (Staum, 1989), developed receptive and expressive language skills (Miller, 1982),
and improved articulation skills (Zoller, 1991). Humpal (1991) and Cassity (1992) demonstrated how preschool
children with speech-language disorders demonstrated social communication skills in basic group music activities
with their non-disabled peers. AAC strategies paired with musical strategies are also noted in the literature.
Herman (1985) demonstrated how children point to music symbol pictures to contribute to group "story songs"
and what feelings they wanted to express. Signing and manual communication systems can be used to express
song lyrics, and signs and singing can be used together for total communications experiences (Darrow, 1987a;
Knapp, 1980). Buday (1995) found that children with autism learned more signs when they were paired with
music and speech than when they were taught with music alone or speech alone. Technology makes it possible
for students who are non-speaking to have a voice and participate musically (Humpal & Dimmick, 1995).

Music Therapy and Speech-Language Therapy Collaboration

When describing how music can be added to a speech-language therapy setting as treatment, Zoller (1991)
stated, "Musical activities stress nonverbal forms of communication and often surpass physical, cultural,
intellectual, and emotional limitations (p. 272)." Zollercontinues by describing specific musical strategies that can
be incorporated: relaxation exercises, breathing and vocalization exercises, song articulation experiences, word
and phrase rhythm chanting experiences, and vocabulary and concept development singing.

One model of collaboration between music therapy and speech-language therapy was demonstrated by Bruscia
(1982). This research described a music therapy assessment and treatment for a 14-year-old male with mental
retardation and autistic-like behaviors including echolalia. Working together the therapists developed a treatment
intervention that presented musical stimuli in various imitation exercises, singing experiences, and fill in the blank
rhythmic exercises. As a result of this intervention, the subjects echolalia was reduced from 95% of the total
utterances to under 10%

The purpose of the present study is to document the process of collaborative treatment with music therapy and
speech-language therapy intervention, specifically Augmentative and Alternative Communication (AAC), for a
child with severe speech impairments. This is an effort to derive best-practices for such intervention. Although the
number of treatment sessions with the child was limited due to time constraints, short-term therapeutic outcomes
are presented.

Method

Participant Selection

Requirements for inclusion in this case study were that the child (a) was between ages 2-12; (b) had a severe
communication impairment such that their natural speech was inadequate to meet his/her daily communication
needs; (c) demonstrated an observable, positive behavior change (e.g., increased alertness, change in affect) in
the presence of musical stimuli; and (d) had parental consent to participate. The subject presented here, Allen,
met all of the requirements for this study.

Procedures

The intervention procedure consisted of: (a) assessment of the child's current communication needs and skills;
(b) assessment of the child's potential to benefit from music therapy; (c) team meetings with the parent(s) and
investigators to target priority communication goals (d) target communication goals selected; (e) collaborative
music therapy/speech-language therapy intervention determined; and (g) implementation and evaluation of
treatment.

Case Study: Allen--Classroom-Based Collaborative SLP/MT Model

Background Information. Allen was a 4-year-old only child, living with both parents. Allen was born at 27 weeks
gestation and was subsequently placed on a respirator for the first 17 weeks of life. At 8 months of age, Allen
received a tracheostomy and was decannulated at 21 months. He received speech-language therapy services in
the home prior to decannulation. Allen was diagnosed with bronchopulmonary dysplasia resulting in an increased
susceptibility to illness. For this reason, his opportunities to interact outside of the home were greatly decreased
in his earliest years.

Allen used gestures to protest or request actions. For example, he gained attention by tapping others and raised
arms to be picked up. He exhibited problems in the comprehension of words and commands and did not produce
any intelligible words or sentences. Allen's parents reported that he was familiar with social routines such as
brushing teeth and initiated interactions with adults by pulling the adult's hands toward a desired object.

According to the results of The Rossetti Infant Toddler Scale (Rossetti, 1990) Allen's skills in language
comprehension, language expression, and gesturing were commensurate with a child of 9-12 months. Allen
demonstrated pragmatic and play skills in the 15-18 month age range by participating in turn-taking games, such
as "hide-and-go-seek" and vocalizing when his name was called.

Prior to this study, focuses of speech-language therapy included decreasing sensory defensiveness, transitioning
from bottle-feeding to cup drinking ,and expressing wants and needs by exchanging appropriate picture cards to
choose activities/objects. Allen signed "again" to request continuation of an activity. He also used Mayer Johnson
Picture Communication Symbols to request favorite items, such as, a toy star and a ball. He did not receive
music therapy services prior to this study. During the team meeting, it was discussed how Allen needed
strategies for one on one and group situations. He had limited experience with AAC and no experience with voice
output. Further, he had difficulty generalizing and participating in repeated practice of greetings in a therapy
room. First, Allen's parents were concerned with Alien's lack of greeting other children, despite greetings being
an important part of the classroom routine. Observation of Allen in the classroom confirmed that he never greeted
classmates. Allen's teachers also noted that during story time Allen would play with his toes, try to leave the
circle, or would otherwise be unengaged in the activity. Other children in the classroom would ask questions or
say repeated lines in a story together.
Speech-Language Therapy and Music Therapy Assessment Summary

During the speech-language therapy assessment, Allen responded to "no" by stopping whatever he was doing,
communicated by gestures such as "want up" by looking at the person and holding his arms up. He consistently
used specific vocalizations for different family members, imitated non-speech sounds, and gestured to caregivers
(e.g. swinging arms to request being swung and raising arms to be picked up).

During the music therapy assessment, it was found that Allen consistently walked toward a sound source, such
as a cd player playing a recording of classical music, an instrument such as a drum or piano. When the sound
stopped, he would indicate by signing "more" for the experience to continue. He participated in music
experiences by playing the drum, piano, and strumming the guitar.

Most significant communication interactions included choosing a picture of an instrument that he wanted and
pressing a voice output device to say Hello at appropriate times during the Hello Song. Results also indicate that
social interaction increased in a 1:1 setting when using music as reinforcement. For example, he attended to
listening to a book sung to him, "Brown Bear Brown Bear, What Do You See?" (1991) by sitting, looking at the
book, smiling, and looking at the therapist for the duration of the 5 minute experience. Behaviors such as playing
with his toes, standing up and walking around the room, seen quite often in private speech therapy and in his
classroom, decreased as Allen demonstrated an increased engagement when music was used in an activity.

Communication Goals

Despite seeing some success in individual speech-language therapy, Alien's team was most concerned with his
lack of interactions with other children in his preschool classroom. Consequently a broad goal chosen was to
increase his classroom participation. The team decided to target greetings and increased engagement during
story time activities.

Classroom Based Collaborative Model

A music therapy and speech-language collaborative approach was ideal for Alien. Since he demonstrated
increased social interaction and engagement in music experiences, it was decided that the music therapist would
support speech therapy goals during individual music therapy sessions, moving toward small group music
session, and finally to the classroom environment where the teacher would implement the music experiences
during group time. The speech therapist's role in the model would be as a consultant to the music therapist and
the classroom teacher on appropriate communication strategies. When the teacher utilized the music treatment
experiences in the classroom, the music therapist was available as a consultant to the teacher.

Treatment Intervention

The treatment setting determined was for Allen to begin in a 1:1 music therapy setting where specific music
experiences were introduced. These experiences were a greeting song, an active listening songbook experience,
an instrument playing experience, and a closing song. Significant positive behavioral responses during 1:1 music
therapy included, spontaneous greetings, increased time engaged in one activity, and expressing choice. After 3
initial 1:1 music therapy sessions, Allen was introduced to a small music group setting with 4 or 5 of his
classroom peers at his school. The music therapist conducted the 4 music group sessions while the classroom
teacher observed/assisted and the SLP observed and consulted on appropriate clinical techniques of using a
voice output device during music experiences.

The same experiences were used as in the 1:1 music therapy sessions. The challenge for Allen in this setting
was to wait his turn. This would require that he sit and wait. Allen practiced greetings during two different "Hello"
songs. He also said repeated lines at the appropriate time in the music, using a voice output device, from several
songs, e.g. "all through the town" from Wheels on the Bus (1988) or books where the text was sung, e.g. "looking
at me" from Brown Bear Brown Bear What Do You See? (1991). At first, Allen used a Big Mac[] to participate but
later moved to spontaneous greetings of waving his hand. Again, Allen picked from a choice of instruments
moving from reaching for the actual instrument to picking a picture and giving it to the therapist. Data indicated
that Allen increased time waiting for his turn. Off task behaviors of playing with his shoes and getting up during
experiences were evident at the first session but decreased as the sessions progressed. With these positive
results in mind, both the MT and SLP then taught the teacher the proper techniques, both with the voice output
device and the music experience, specifically for the Brown Bear Brown Bear What Do You See? (1991) book.
The teacher then implemented the strategy when asking Allen, using the Big Mac[c], to say "looking at me" 10
times during the large classroom setting along with 20 of his classmates.

Results of Treatment

In addition to tracking Allen's progress during small group sessions pre and post videos of Allen's participation in
the classroom were taken to confirm the social validity of the results. Ten pre-service teachers blind to the
treatment condition were asked to review the videos in random order and select the one they felt Alien appeared
more involved in the class. The activities in both videos were similar (involving reading a book). Ten out of ten
pre-service teachers selected the post-treatment video as the one where Allen was more involved in the
classroom. There were no instances of off task behaviors in the final group session.

Summary

Although music therapists and speech-language pathologists do collaborate in schools, hospitals, and other
treatment facilities across the country (Peters, 2000), the results of significant improvement in communication
with children as a result of this collaboration are not evident in the literature. In this article a model demonstrating
positive results of SLP/MT-BC collaboration within a short time has been presented

Clinical Implications

Several benefits were noted in incorporating music therapy. First, music allowed opportunities for repeated
practice than would seem natural in non-music activities. For Allen, one "Hello" song allowed for 10 opportunities
to practice hello within a 3-minute song and to see others modeling it as well.

It is not always easy to quantify the value of music in a person's life. When music is incorporated to augment
other communication goals however, some of its influence may be easier to track. Social validation, and
engagement may be useful tools across multiple goals whereas other goals that are already a part of therapy can
also be charted before and after the introduction of music.

It should be noted that not all children with communications delay may benefit from music therapy treatment.
Generally, children who demonstrate a motivation to exhibit more communicative behaviors when music is
present vs. when it is not will most likely benefit more from collaboration. Therefore before trying out the models,
both a music therapy and speech assessment should be conducted to see if the student is a candidate for the
services.

The current findings are preliminary. The short-term effects have been noted but each model should be tested
over time with larger numbers of students. The current study did not address children in elementary and
secondary schools who may already be involved in music classrooms. There is a need to document the role of
music therapist acting as a liaison between music teachers and SLPs to help students achieve classroom and
communication skills. As speech and language pathologies and music therapists continue to explore the
possibilities of collaboration with children with communication delay, the definition of the models can be
expanded.

References

Bruscia, K. (1982). Music in the Assessment and Treatment of Echolalia. Music Therapy 2(1), 25-41

Buday, E. M. (1995). The effects of signed and spoken words taught with music on sign and speech imitation by
children with autism. Journal of Music Therapy, 32(3), 189-202.

Cohen, N.S. (1994). Speech and Song: Implications for therapy. Music Therapy Perspectives, 12(1), 8-14.

Cassity, J. W. (1992). Communication disorders: Effect on children's ability to label music characteristics. Journal
of Music Therapy, 29(2), 113-124.

Darrow, A. A. (1987a). Exploring the arts of sign and song. Music Educators Journal, 74(1), 32-35.

Herman, F. (1985). Music therapy for the young child with cerebral palsy who uses Blis-symbols. Music Therapy,
5(1), 28-36.

Humpal, M. E. (1991). The effects of an integrated early childhood music program on social interaction among
children with handicaps and their typical peers. Journal of Music Therapy, 28(3), 161-177.

Humpal, M. E., & Dimmick, J. A. (1995). Special learners in the music classroom. Music Educators Journal,
81(5), 21-23.

Knapp, R. A. (1980). A choir for total communication. Music Educators Journal, 66 (6), 54-55.

Martin, B., & Carle, E. (1991). Brown bear, brown bear, what do you see? New York: Henry Holt and Company.

McCarthy, J., Geist, K., Zojwala, R. & Schock, M. (2008). A survey of music therapists' work with speech-
language pathologists and experiences with augmentative and alternative communication. Journal of Music
Therapy.
Miller, S. (1982). Music therapy for handicapped children: Speech impaired. Project Monograph Series.
Washington, DC: National Association for Music Therapy, Inc.

Pelliteri, J. (2000). Music therapy in the special education setting. Journal of educational and psychological
consultation, 11,379-391.

Peters, J.S. (2000). Music therapy: An introduction. Springfield, I1: Charles C. Thomas.

Rossetti, L. (1990). The Rossetti infant-toddler language scale. East Moline, IL: Linguisystems, Inc.

Staum, M.J. (1989). Music as motivation for language leaming. In R.R. Pratt & H. Moog (Eds.) First research
seminar of the ISME commission on music therapy and music in special education: Proceedings of 1986; Bad
Honnef, W. Germany (pp. 62-68). St. Louis: MMB Music.

Wickstrom-Kantorovitz, S. (1988). The wheels on the bus. New York: Crown Publishers, Inc.

Zoller, M. B. (1991). Use of music activities in speech-language therapy. Language, Speech, and Hearing
Services in Schools, 22, 272-276.

Kamile Geist, JohnMcCarthy, Amy Rodgers-Smith, and Jessica Porter, Ohio University.

Correspondence concerning this article should be addressed to Kamile Geist at odonne@ohio.edu.

Gale Copyright:
Copyright 2008 Gale, Cengage Learning. All rights reserved.
http://www.freepatentsonline.com/article/Journal-Instructional-Psychology/193791683.html