Blog #5 Music Therapy and Children with Special Needs
Children with specials needs are considered as one of the major population music therapist work with, in fact this population was the main focus for all the music therapy pioneers back in the 1960s. This population includes autism, ADHD, learning disability, speed and language delay, physical disability, downs syndrome and more. Music has the power to reach children even with the most severe disabilities (Hintz 2013).
Music therapist works with special needs children to address the following developmental goals:
-Speech and communication (i.e. improve pronunciation, increase vocabulary etc)
-Social skills (i.e. turn taking, eye contact, attention & listening skills, gesture, body languages, cooperation, accepting differences, following rules, sharing, self-control, building up tolerance, respecting others)
-Emotional expression
-Motor skills (i.e. motor planning, motor control,motor coordination, gait training and body awareness)
-Behavioural (i.e. learning appropriate behavioural response, minimalizing stereotypic behaviours etc)
Compared to my last blog’s entry on music therapy with psychiatric patient, music therapy with children with special needs employs a totally different sets of techniques and approaches. The session are structured and more directive, using music as a tool to improve developmental skills. Structured or improvised songs singing are the key element in the session.
In my first year of training as a music therapist, I was placed in a children development center in UK. In our session, music acts as a motivating agent to draw the child to achieve specific goals in each session. Perhaps it would be best to illustrate this with a case study for my reader to gain a sense of music therapy in action for children with special needs.
Case study:
Daniel (name has been changed to protect client’s identity) was a five-years-old boy diagnosed with development delay and learning difficulties, social communication difficulties and language delay. According to the parents, Daniel’s language had no progress since the age of two, his vocabulary usage was reported to be around 100 words and could not understand body parts nor colours. The consultant paediatrician commented that Daniel’s developmental age was about two year old; the school reported that he had some sensory issues and had a tendency to flit from activities but he did show some nice sequences of social interaction. Daniel was referred to music therapy by the speech and language therapist to support attention and language development.
Beginning Phase: Session 1-3
After the assessment phase that determined Daniel was highly motivated by music and would probably benefit from music therapy, the following aims and goals were established to support Daniel’s general development especially his language skills and social interaction skills. Daniel’s music therapy treatment consisted of nine sessions over a five-month period.
Aims of Music Therapy
• To provide opportunities to use music to develop Daniel’s language, social communication and interaction skills; by encouraging eye-contact, listening, awareness of others, turn-taking and sharing control
• To develop flexibility in play, to accept an adult’s choices and direction
• To extend Daniel’s focus and joint attention
• To provide an alternative, non-verbal means of self-expression
• To have fun making music with others whilst developing his confidence and self-esteem
Daniel was highly motivated by all kinds of drums-drum kit, bongos, Remo gathering drum and the drum machine. These drums acted as the perfect ‘stage’ for us to work on Daniel’s social communication skills. His drumming often started sporadically and non-pulsed, I would firstly match his movement on another drum then gradually introduced the game rule by saying ‘Stop’ where I stop following his drumming, after a short period of silence I would initiate again by saying ‘Ready, Steady...GO!’. Daniel was quick in learning the rules, attentively observed the moment to stop; my vocal prompt ‘Ready, Steady’ followed by a long period of silence often prompted him to fill in the word ‘Go’. At the third session, under my vocal prompt ‘Daniel says…’, he was able to initiated the game himself by saying ‘Ready, Steady, Go!’.
The drum was also used to facilitate turn-taking which is an important aspect of social communication. When Daniel established a strong rhythmic pulse, I would attempt to create an interlocking pattern that fit in-between his playing. i.e. Daniel plays on the strong beat and I play on the off beat. After the interlocking pattern has established, I would withdraw my playing for a brief moment and says ‘Daniel’s turn’ leaving the space for him to play, whenever he stops, I would say ‘my turn’. Daniel was very observant, playing while looking at me at all times noticing when the changes would happen.
Session 4-5
According to the speech and language report suggesting that Daniel couldn’t recognize colours, I offered Daniel and Sherry a set of rainbow bells and hand bells each in an attempt to incorporate colour naming in musical improvisation. While Daniel played on the bells, I accompanied him on guitar improvising a song according to the bells Daniel played while Sherry matched his playing on the rainbow bells. After the first round, Daniel started singing the labelled numbers on the hand bells while playing. To my surprise, during the second round of singing, after I sung about the first colour of the bell, Daniel continued naming each hand bell while he played each one of them. Sherry commented at the end of the session, that Daniel had suddenly started recognizing and naming colours during the week before our fourth music therapy session. In the same session, the adapted version of the song ‘She’ll be coming round the Mountain’ was used to facilitate learning new vocabulary of musical instruments. Daniel was offered a box of percussion to explore, while he played with each instrument, I would sing along with the tune of the song with changed lyrics i.e. ‘Daniel is playing on the triangle, tri-an-gle’.
In session 5, Tom came in with Daniel, a different family dynamic was presented in the room. The session was less goal-orientated which allowed Daniel to have more freedom to explore; as a result, Daniel’s creativity and imagination were being showcased in this session. During the ‘Hello’ song, when prompted by the gap at the end of the phrase ‘Hello to…….’, Daniel filled in the gap with the correct pitch and the word ‘Dolphin’, which Tom and I only realized after a while that Daniel was singing hello to the dolphin on the ukulele he was playing with. During the ‘Old Mcdonald’ song, Daniel surprised us once again by filling in the end of phrase ‘Old Mcdonald had a ……..’ by acting out the movement of a bird instead of singing the word.
Ending Phase: 6-9
This phase was characterized by the increased share music making between Daniel and I.
In session 6, Daniel chose the wooden xylophone and started brushing the beater up and down to create a glissando effect, I immediately tried to match his playing on the guitar by fingerpicking a chord to create an arpeggio, also provided a simple chord progression I-IV-V to provide a basic structure in our improvisation. As the music progressed, Daniel’s playing became more rhythmic and steady, he began to notice my change of dynamics and tempo and was sensitive to adapt his playing to match mine. Like a musical duet, there were times we played with each others and times when we took turn creating a call and response dialogue, it all happened without any verbal prompting but rely solely on observing one another’s facial expression and body movement as well as eye contacts to predict any musical changes. Daniel was fully engaged in the musical improvisation with the xylophone for around 10 minutes without being distracted.
In session 7, our musical interaction expanded to the box of blowing instruments. As Daniel made a sound on a whistle, I would respond to him by making a strange and funny musical noise on a recorder or kazoo. The interaction turned into a hilarious Peekaboo game where I hid behind a screen while responding to him with the funny sound. Daniel responded with excitement and joy, chasing me around the room screaming and laughing at the same time.
Our playful and expressive musical interaction allowed Daniel to experience freedom in self-expression, build up his sense of self as well as improving his verbal and non-verbal communication skills. As Smeijsters suggested that music therapy can help a client to develop an organized sense of self where the therapist should “develop musical actions whereby the client feels his personal will to act, feels himself being an actor, experiences that his action causes effects.” (Smeijsters, 2005, p. 117).
Conclusion:
Music has been an invaluable tool to support Daniel’s general development in particular his language development, social communication and extending his attention span. Music therapy also provided a space that encouraged his self-expression and exploration that might not be available very often at home. Daniel’s speech and language abilities have been progressing. At the end of the nine music therapy sessions, he was able to confidently name all colours, numbers, animals and various musical instruments. His parents commented that Daniel has been using more words at home since he started music therapy.
Reference:
Hints, M., 2013 Guidelines for Music Therapy Practice in Developmental Health. Barcelona Publishers
Smeijsters, H., 2005. Sounding the Self: Analogy in Improvisational Music Therapy. New Hampshire: Barcelona Publishers.