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To cite this article: Alfredo Raglio , Daniela Traficante & Osmano Oasi (2011) Autism and music
therapy. Intersubjective approach and music therapy assessment, Nordic Journal of Music Therapy,
20:2, 123-141, DOI: 10.1080/08098130903377399
Introduction
In the last few years the definition, the hypothesis about the origin and the
perspectives of intervention related to autism underwent many changes.
In the early definitions (Kanner, 1943; Asperger, 1944) autism was
included among the premature ‘‘psychosis’’ or the ‘‘infantile schizophrenia,’’
while in the 1980s it was no longer classified in the area of infantile
psychosis, but it was part of the new category of Pervasive Developmental
Disorders. The essential features of Autistic Disorder are the presence of
markedly abnormal or impaired development in social interaction and
communication, and the presence of limited, repetitive and stereotyped
behaviours, interests and activities. Moreover in Autistic Disorder there are
the delay of the development of spoken language or total lack of it, and the
imaginative play is often absent or markedly impaired (American
The instrument
The instrument described and used in this work is the Music Therapy Coding
Scheme (MTCS) (Raglio et al., 2006). This is an instrument that can be used
during the assessment: in this case the aim is to define possible diagnostic
criteria that support clinical data or sustain music therapy treatment intake.
This instrument can also be used to evaluate the process of the music
therapeutic treatment. In agreement with what was stated by Wigram
(2004), we think that the analysis of the improvised musical material can
show specific behaviours that give elements to identify the direction, the
process and the result of therapy.
MTCS is a coding scheme for the patient–music therapist interaction
during music therapy sessions of 30 minutes, performed with the
130 A. Raglio et al.
improvisation technique. The behavioural classes considered are: non verbal
communication, sonorous-musical communication, the direction of the
look and the facial expression, and verbal communication. The MTCS is a
video-based, patient–therapist interaction assessment method measuring
both the affective and the behavioural characteristics expressed by the
patient and the therapist in a dyadic interaction during a music therapy
session. Coding was accomplished with a continuous method with the
software The Observer Video-Pro 5.1 (registered trademark of Noldus
Information Technology bv).
We mainly focused on those indexes considered indicative of the origin
of moments of affective attunement.
Procedure
The video recordings were performed with a fixed camcorder put in a corner
of the music therapy room, to allow a goodshot of the music therapist–
patient dyade. The first, the tenth and the twentieth sessions of the entire
therapeutic process were analysed.
Video recordings were coded by two music therapists. The observers
underwent training, coding the video recordings of other subjects, to reach
an adequate level of agreement.
Analyses
The data were submitted to two levels of analysis to see the changes in
time:
Results
Interobservers’ agreement was evaluated through Cohen’s k coefficient. For
the patient’s coding the mean value was .71; for music therapists’ coding the
mean value was .80 (Table 1).
the sonorous production: the differences are not remarkable between the 1st
and 10th session and between the 10th and 20th session, while they are
significant between the 1st and 20th (chi-square ¼ 4.62, p 5 .05).
Notes on contributors
Alfredo Raglio is a music therapist, teacher, supervisor, and researcher. He has worked
in the neuropsychiatric, psychiatric and neurological field since 1990, and carries out
research activities in collaboration with Italian institutions of research (Department of
Psychology, Catholic University of Milan; Department of Rehabilitation Medicine,
IRCCS Istituto Auxologico Italiano, Milan; Sospiro Foundation, Cremona;
Laboratory of Neuropsychology, Department of Clinical Neurosciences Fondazione
IRCCS Neurological Institute Carlo Besta, Milan, etc.). He is also a teacher of
Research Methodology in Music Therapy at Conservatory of Music of L’Aquila, the
Music Therapy School in Assisi and in others courses of music therapy. He is Member
of the Italian Professional Music Therapy Association Advisory Board. He published
several scientific articles and books about clinical and research topics.
Daniela Traficante, PhD in Social and Developmental Psychology, Researcher in
Developmental and Educational Psychology at the Catholic University of Milan
(Italy). Teacher in the following academic courses: Methods and techniques for the
infant behaviour observation; Advanced methods for the research in developmental
and communication psychology; and Psychometric Statistics. Research interests
include: observation techniques and data analysis; attachment bonds in childhood
(child-caregiver; child-teacher) and in adulthood (to the partner and to the family of
origin); language acquisition.
Osmano Oasi, PhD in Social and Developmental Psychology, Department of
Psychology, Catholic University of Sacred Hearth (Milan, Italy). He is psychologist,
psychotherapist and psychoanalyst (Italian Psychoanalytic Society). He is also a
researcher of Dynamic Psychology at the Faculty of Psychology. His main research
interests concern the assessment process, pathogenic issues and psychodynamics
treatment in severe mental illness such as Spectrum Autistic Disorder, Schizophrenia,
Major Depression and Borderline Personality Disorders. Between theoretical
subjects, particular attention for some recent model of psychoanalysis is given.
138 A. Raglio et al.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed.). Arlington, VA: American Psychiatric Publishing.
Asperger, H. (1944). Die ‘‘Autistischen Psychopathen’’ im Kindesalter. Archiv für
Psychiatrie und Nervenkrankheiten, 117, 76–136.
Bakeman, R., & Gottman, J.M. (1997). Observing interaction: An introduction to
sequential analysis. Cambridge: Cambridge University Press.
Ball, C.M. (2004). Music therapy for children with autistic spectrum disorder. London:
Bazian Ltd.
Beebe, B., & Lachmann, F.M. (2002). Infant research and adult treatment: Co-
constructing interactions. Hillsdale, NJ: The Analytic Press.
Boso, M., Emanuele, E., Minazzi, V., Abbamonte, M., & Politi, P. (2007). Effect of
long-term music therapy on behavior profile and musical skills in young adults
with severe autism. Journal of Alternative and Complementary Medicine, 7,
709–712.
BPCSG. (1998). Non-interpretive mechanisms in psychoanalityc therapy. The
‘something more’ than interpretation. International Journal of Psychoanalysis,
79, 903–921.
BPCSG. (2002). Explicating the implicit: The local level and the microprocess of
change in the analytic situation. International Journal of Psychoanalysis, 83,
1051–1062.
Brunet, O., & Lézine, I. (1955). Echelle de de´veloppement psychomoteur de la pre`miere
enfence. Manuel d’instructions, Editions Scientifiques et Psychotechniques. [Scale
of psychomotor development for early childhood. Operating Manual]. Siene:
Clamart (Italian translation and adaptation, Florence [1967]: OS).
Bruscia, K. (1987). Improvisational models of music therapy. Springfield, IL: Charles
C. Thomas Publisher.
Bryce Boyer, L. (1992). Roles played by music as revealed during counter-
transference facilitated transference regression. International Journal of Psycho-
analysis, 73, 55–70.
Dapretto, L., Davies, M.S., Pfeifer, J.H., Scott, A.A., Sigman, M., Bookheimer,
S.Y., & Iacoboni, M. (2006). Understanding emotions in others: Mirror neuron
dysfunction in children with autism spectrum disorders. Nature Neuroscience, 9,
28–30.
De L’Etoile, S.K. (2006). Infant-direct singing: A theory for clinical intervention.
Music Therapy Perspectives, 24(1), 22–29.
Di Benedetto, A. (2000). Prima della parola. L’ascolto psicoanalitico del non detto
attraverso le forme dell’arte [Before speech. Psychoanalitic listening of the non-
said throughout the forms of art]. Milano Franco: Angeli.
Edgerton, C.L. (1994). The effect of improvisational music therapy on the
comunicative behaviors of autistic children. Journal of Music Therapy, 31, 31–62.
Emde, R.N. (1983). The prerepresentional self and its affective core. The Psycho-
analytic Study of the Child, 38, 165–192.
Emde, R.N., & Buchsbaum, H.K. (1989). Toward a psychoanalytic theory of affect:
II. Emotional development and signaling in infancy. In S.I. Greenspan & G.H.
Pollock (Eds.), The course of life (2nd ed., pp. 193–227). Madison, CT:
International University Press.
Fogel, A., & Lyra, M.C.D.P., Valsiner, J. (1997). Dynamics of development in
relashionship. In F. Masterpasqua & P.A. Perna (Eds.), The psychological
meaning of chaos: Translating theory into practice (pp. 75–94). Washington, DC:
American Psychological Association.
Nordic Journal of Music Therapy 139
Frith, U. (1989). Autism: Explaining the enigma. Oxford: Basil Blackwell.
Gallese, V. (2001). The ‘‘shared manifold’’ hypothesis. From mirror neurons to
empaty. Journal of Consciousness Studies, 8(5–7), 33–50.
Gallese, V. (2003). The roots of empathy: The shared manifold hypothesis and the
neural basis of intersubjectivity. Psychopathology, 36, 171–180.
Gallese, V. (2006). Intentional attunement: A neurophysiological perspective on
social cognition and its disruption in autism. Brain, 1079, 15–24.
Gallese, V., Eagle, M.N., & Migone, P. (2007). Intentional attunement: Mirror
neurons and the neural underpinnings of interpersonal relations. Journal of the
American Psychoanalytic Association, 55(1), 131–176.
Gallese, V., Fadiga, L., Fogassi, L., & Rizzolatti, G. (1996). Action recognition in
the premotor cortex. Brain, 119, 593–609.
Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum
disorder. Cochrane Database of Systematic rewievs, 2, CD004381.
Gopnik, A., Capps, L., & Meltzoff, A.N. (2000). Early theories of mind: What the
theory can tell us about autism. In S. Baron-Cohen, H. Tager-Flusberg & D.J.
Cohen (Eds.), Understanding other minds. Perspectives from developmental
cognitive neuroscience (2nd ed., pp. 50–72). Oxford: Oxford University Press.
Hobson, R.P., Ouston, J., & Lee, A. (1988). Emotion recognition in autism:
Coordinating faces and voices. Psychological Medicine, 18, 911–923.
Hobson, R.P., Ouston, J., & Lee, A. (1989). Naming emotion in faces and voices:
Abilities and disabilities in autism and mental retardation. British Journal of
Developmental Psychology, 7, 237–250.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2,
217–250.
Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal
responsiveness of children with autism in improvisational music therapy. Autism,
13(4), 389–409.
Langer, S.K. (1953). Feeling and form. New York, NY: Charles Scribner’s Son.
Leslie, A.M. (1991). The theory of mind impairment in autism: Evidence for a
modular mechanism of development? In A. Whiten (Ed.), Natural theories of
mind: Evolution, development and simulation of everyday mindreading (pp. 63–78).
Oxford: Basil Blackwell.
Leslie, A.M., & Roth, D. (1993). What autism teaches us about metarepresenta-
tion. In S. Baron-Cohen, H. Tager-Flusberg & D.J. Cohen (Eds.), Under-
standing other minds: Perspectives from autism (pp. 83–111). Oxford: Oxford
University Press.
Malloch, S., & Trevarthen, C. (2008). Communicative musicality: Exploring the basis
of human companionship. Toronto: Oxford University Press Canada.
Mancia, M. (2004). Sentire le parole. Archivi sonori della memoria implicita e
musicalità del transfert [Feeling the words. Sonorous archives of implicit memory
and transfert musicality]. Torino: Bollati Boringhieri.
McIntosh, D.N., Reichman-Decker, A., Winkielman, P., & Wilbarger, J. (2006).
When the social mirror breaks: Deficits in automatic, but not voluntary,
mimicry of emotional facial expressions in autism. Developmental Science, 9(3),
295–302.
Meltzoff, A.N. (1995). Understanding the intentions of others: Re-enactment of
intended acts by 18-month-old children. Developmental Psychology, 31(5), 838–850.
Meltzoff, A.N., & Gopnik, A. (1993). The role of imitation in understanding persons
and developing a theory of mind. In S. Baron-Cohen, H. Tager-Flusberg & D.J.
Cohen (Eds.), Understanding other minds: Perspectives from autism (pp. 335–
366). Oxford: Oxford University Press.
140 A. Raglio et al.
Meltzoff, A.N., & Moore, M.K. (1992). Early imitation within a functional
framework: The importance of person identity, movement, and development,
Infant Behavior and Development, 15, 479–505.
Meltzoff, A.N., & Moore, M.K. (1994). Imitation, memory, and the representation
of persons. Infant Behavior and Development, 17, 83–99.
Meltzoff, A.N., & Prinz, W. (Eds.). (2002). The imitative mind: Development, evolu-
tion, and brain bases. Cambridge: Cambridge University Press.
Nordofff, P., & Robbins, C. (1977). Creative music therapy: Individualized treatment
for the handicapped child. New York, NY: John Day.
Oldfield, A. (2006). Interactive music therapy, a positive approach – music therapy at a
child development centre. London: Jessica Kingsley.
Pavlicevic, M. (1997). Music therapy in context: Music, meaning and relationship.
London: Jessica Kingsley.
Pavlicevic, M., & Trevarthen, C. (1989). A musical assessment of psychiatric states in
adults. Psychopathology, 22, 325–334.
Raglio, A., Traficante, D., & Oasi, O. (2006). A coding scheme for the evaluation of
the relationship in music therapy sessions. Psychological Reports, 99, 85–90.
Raglio, A., Traficante, D., & Oasi, O. (2007). Comparison of music therapy coding
scheme with the Music Therapy Checklist. Psychological Reports, 101, 875–880.
Rizzolatti, G., Fadiga, L., Gallese, V., & Fogassi, L. (1996). Premotor cortex and the
recognition of motor actions. Cognitive Brain Research, 3, 131–141.
Robarts, J. (1998). Music therapy for children with autism. In C. Trevarthen, K.
Aitkin, D. Papoudi & J. Robarts (Eds.), Children with autism: Diagnosis and
interventions to meet their needs. London: Jessica Kingsley.
Rogers, S. (1999). An examination of the imitation deficit in autism. In J. Nadel & G.
Butterworth (Eds.), Imitation in infancy (pp. 254–279). Cambridge: Cambridge
University Press.
Sander, L. (2008). Living systems, evolving consciousness, and the emerging person: A
selection of papers from the life work of Louis Sander. New York, NY: The
Analytic Press.
Schopler, E. (1990). Psychoeducational profile revised (Pep-R). Spiral-bound
paperback, Austin, TX: Pro Ed.
Schopler, E., Reichler, R.J., & Rochen Renner, B. (1993). Childhood autism rating
scale. Los Angeles, CA.: Western Psychological Services.
Schumacher, K. (1999). Musiktherapie und säuglingsforschung [Music therapy and
research on sucklings]. Frankfurt am Main: Perer Lang.
Schumacher, A., & Calver-Kruppa, C. (1999). The AQR – an analysis system to
evaluate the quality of relationship during system therapy. Nordic Journal of
Music Therapy, 8, 188–191.
Snow, M.E., Hertzig, M.E., & Shapiro, T. (1988). Expression of emotions in young
autistic children. In S. Chess, A. Thomas & M.E. Hertzig (Eds.), Annual progress in
child psychiatry and child development (pp. 514–522). New York, NY: Brunner/
Mazel.
Stern, D. (1985). The interpersonal world of the infant. New York, NY: Basic Book.
Stern, D. (1993). The role of feelings for an interpersonal self. In U. Neisser (Ed.),
The perceived self: Ecological and interpersonal sources of self-knowledge (pp.
204–215). New York, NY: Cambridge University Press.
Stern, D. (1995). The motherhood constellation. A unified view of parent–infant
psychotherapy. New York, NY: Basic Book.
Stern, D. (1998). Babies and music: Some reflections on the temporal aspects of an infant
daily experience. In E. Darbellay (Ed.), Le temps et la forme [Time and Form].
Geneva: Cahier de la Faculté des Lettres, Musicologie, Université de Genève.
Nordic Journal of Music Therapy 141
Stern, D. (2004). The present moment in psychotherapy and everyday life. London:
Norton & Company.
Stern, D., Jaffe, J., Beebe, B., & Bennett, S.L. (1975). Vocalizing in unison and in
alternation: Two modes of communication within the mother–infant dyade.
Annals of the New York Academy of Sciences, 263, 89–100.
Target, M., & Fonagy, P. (1996). Playing with reality: II. The development of psychic
reality from a theoretical perspective. International Journal of Psycho-Analysis,
77, 459–479.
Trevarthen, C. (1979). Communication and cooperation in early infancy. A
description of primary intersubjectivity. In M. Bullowa (Ed.), Before speech:
The beginnings of human communication (pp. 321–347). London: Cambridge
University Press.
Trevarthen, C. (1984). Emotion in infancy: regulators of contact and relationships
with persons. In K. Scherer & P. Ekman (Eds.), Approaches to emotion (pp. 129–
157). Hillsdale, NJ: Lawrence Erlbaum.
Trevarthen, C. (1998). The concept and foundations of infant intersubjectivity. In S.
Braten (Ed.), Intersubjective communication and emotion in early Oontogeny (pp.
15–46). Cambridge: Cambridge University Press.
Trevarthen, C. (2001). Autism, sympathy of motives and music therapy. Enfance, 1,
86–99.
Trevarthen, C., & Aitken, K.J. (2001). Infant intersubjectivity: Research, theory, and
clinical applications. Journal of Child Psychology and Psychiatry, 1, 3–48.
Tronick, E.Z. (1989). Emotions and emotional communication in infants. American
Psychologist, 44, 112–119.
Tronick, E.Z., Members of the Change Process Study Group. (1998). Dyadically
expanded states of consciousness and the process of therapeutic change. Infant
Mental Health Journal, 19(3), 290–299.
Whipple, J. (2004). Music in intervention for children and adolescent with autism: A
meta-analysis. Journal of Music Therapy, 8, 6–24.
Wigram, T. (2000). A method of music therapy assessment for the diagnosis of
autistic and communication disordered children. Music Therapy Perspectives, 18,
13–22.
Wigram, T. (2004). Improvisation. Methods and techniques for music therapy
clinicians, educators and students. London: Jessica Kingsley.
Wigram, T., & De Backer, J. (1999). Clinical applications of music therapy in
developmental disability, paediatrics and neurology. London: Jessica Kingsley.
Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of
autistic spectrum disorder: Clinical application and research evidence. Child:
Care, Health and Development, 32(5), 535–542.