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A Review of Music Therapy, Art Therapy and Daily Life Therapy

A Review of Music Therapy, Art Therapy and Daily Life Therapy. Alex Mellor. Sources and information. PsycINFO – “music therapy” and “autism”, “art therapy” and “autism”, “daily life therapy”, and “Higashi”.

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A Review of Music Therapy, Art Therapy and Daily Life Therapy

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  1. A Review of Music Therapy, Art Therapy and Daily Life Therapy Alex Mellor

  2. Sources and information • PsycINFO – “music therapy” and “autism”, “art therapy” and “autism”, “daily life therapy”, and “Higashi”. • Youtube videos found by searching “music therapy”, “Nordoff-Robbins”, “art therapy”, and “Higashi”. • Emails to the American Music Therapy Associate (AMTA) resulted in a bibliography of “evidence-based” studies.

  3. What is music therapy? • “well-established allied health profession that uses music therapeutically to address behavioral, social, psychological, communicative, physical, sensory-motor, and/or cognitive functioning”. www.musictherapy.org • Teaching a skill/goal through music, presented through song or rhythmic cue. Gradually fading the cue over time. National Standards Project

  4. What is music therapy? • Difficult to define “music therapy” • All participants exposed to music in some form. • Kaplan (2005) • 41% - language and communication • 39% - behavior and psychosocial goals Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  5. History of music therapy • 1944 – Michigan State University • American Music Therapy Associate (AMTA) founded in 1998 after a merger between the National Associate for Music Therapy (NAMT, 1950) and the American Associate for Music Therapy (AAMT, 1971).

  6. What does music therapy claim to do? • Music therapy interventions can be used to: • “promote wellness • manage stress • alleviate pain • express feelings • enhance memory • improve communication • promote physical rehabilitation” www.musictherapy.org

  7. What does music therapy claim to do? ? ? ? ? • Address the characteristics of autism • Motivate and engage children with ASD • Enable people without language to “communicate” • Develop and express emotions • Provide multi-sensory stimulation • Structure and security • Emphasize “innate musical talents”

  8. Jammin’ Jenn! • http://www.jamminjenn.com/JJMTC/Welcome.html • What do you think? • http://www.youtube.com/watch?v=OFLJJlOCVsw • http://www.facebook.com/group.php?gid=200118661850&ref=ts

  9. What they say… • Association for Science in Autism Treatment (ASAT) • “preliminary evidence suggests that music therapy could be effective in enhancing functioning (Kaplan, & Steele, 2005; Whipple, 2004), but this approach has not been evaluated in studies with strong experimental designs.” www.asatonline.org/intervention/treatments/music.htm

  10. What they say… • ASAT • “researchers may wish to conduct studies with strong scientific designs to evaluate music therapy. Professionals should present music therapy as untested and encourage families who are considering this intervention to evaluate it carefully.” www.asatonline.org/intervention/treatments/music.htm

  11. What they say… • National Autism Center’s National Standards Project • Emerging treatments – further research may produce favorable results, but more research needed to ensure not harmful treatment.

  12. Experimental control? • Varied independent variable – only common aspect is that music is involved. • No dependent variable • Difficult to demonstrate experimental control

  13. Evidence-based? • Edgerton (1994) • Parents reported behavior change, speech therapists did not. • Evaluators not blind. • Buday (1995) • 10 children learned to vocalize and sign words better when put to music compared to when just read out loud. • 21 studies • 14 peer reviewed • 11 successful • 9 improvements “related to music” http://www.musictherapy.org/factsheets/bib_autism.pdf Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child works! Lynden, WA: SKF Books USA, Inc.

  14. Lim, H. A. (2010). Effect of “developmental speech and language training through music” on speech production in children with autism spectrum disorders. Journal of Music Therapy, XLVII, (1), 2-26. • Compared music training, speech training and no-training. • 50 children, 3-5 years old, diagnosis of ASD. • 36 target words • Music (DSLM) – 6 songs, each with 6 target words • Speech – 6 stories, each with 6 target words • Both conditions used PECs symbols.

  15. Lim, H. A. (2010). Effect of “developmental speech and language training through music” on speech production in children with autism spectrum disorders. Journal of Music Therapy, XLVII, (1), 2-26. • Correct verbal response defined as: semantics (correct target word), phonology (correct pronunciation), pragmatics (relationship between language and behavior), and prosody (intonation). • Verbal production evaluation scale • Speech therapists coded data – 0-6 points. • IOA – 99.9%

  16. Lim, H. A. (2010). Effect of “developmental speech and language training through music” on speech production in children with autism spectrum disorders. Journal of Music Therapy, XLVII, (1), 2-26. • “low functioning” – greater changes in the music condition. • “high functioning” – positive change in music and speech conditions. • Defined according to the CARS

  17. Lim, H. A. (2010). Effect of “developmental speech and language training through music” on speech production in children with autism spectrum disorders. Journal of Music Therapy, XLVII, (1), 2-26. • “music and speech training are effective for enhancing speech production” • “ the difference between music and speech training is not statistically significant”

  18. Lim, H. A. (2010). Effect of “developmental speech and language training through music” on speech production in children with autism spectrum disorders. Journal of Music Therapy, XLVII, (1), 2-26. • Limitations • Validity of VPES • Sample size • Use of PECs • Definition of “correct” • Do not experimentally show relationship between IV and DV.

  19. Music as a reinforcer… • Watson (1979) • Used music as a reinforcer to increase spontaneous speech • Nordoff-Robbin • http://www.youtube.com/watch?v=_CuAjiU7RBg • http://www.youtube.com/watch?v=Xpr2hC0OcdQ • “music lessons for autistic individuals provide a way for them to make friends and get involved in the community. Above all, you need to remember that music can be plain old fun.” (p.194). Shore, S. M., and Rastelli, L. G. (2006). Understanding Autism for Dummies. Wiley Publications, Inc. Hoboken, NJ.

  20. Is music therapy an effective autism intervention? • What is the purpose? • “Treat” characteristics of autism? • Teach functional skills? • Decrease undesirable behaviors? • Provide a service that the child enjoys and finds fun?

  21. What is art therapy? • “a psychological discipline that specializes in using visual art making and the creative process to help clients bring about therapeutic change” • Six major ASD treatment goals • Imagination/abstract thinking deficits • Sensory regulation and integration • Emotions/self-expression • Developmental growth • Recreation/leisure skills • Visual-spatial deficits www. arttherapyandautism.com

  22. History of art therapy • Emerged as a distinct profession 1940s • Early 20th century – psychiatrists became interested in artwork created by patients with mental illness. • Educators found that art expressions are reflected http://www.musictherapy.org/factsheets/bib_autism.pdf

  23. What art therapy can do! • Single-case research supporting art therapy to help: • ADD/ADHD/Aspergers • Aging/Elderly/Geriatric • Chemical dependency/Substance abuse • Grief/bereavement • Medical • Mentally retarded/Developmentally delayed • PTSD/Trauma • Prison/Incarceration • Psychiatric • School/Academic • Sexual Abuse • Traumatic Brain Injury http://www.musictherapy.org/factsheets/bib_autism.pdf

  24. Nicole Martin • Webmaster of www.arttherapyandautism.com • Author “Art as an Early Intervention Tool for Children with Autism.” • Discusses prompting hierarchy • Using “behaviorism” to manage difficult behaviors. • Incorrectly defines “autism” on her webpage and in the book. • http://www.youtube.com/watch?v=UbrvF7zUk8M&feature=related

  25. What they say… • ASAT • “there have been no scientific studies of art therapy for individuals with ASD” • “researchers may wish to conduct studies with strong scientific designs to evaluate art therapy. Professionals should present art therapy as untested and encourage families who are considering this intervention to evaluate it carefully”

  26. What they say… • “the cost of autism, as well as the characteristics of the disorder, may by reduced 2/3 with early diagnosis and appropriate interventions such as art therapy” ?www.art-therapy.us/autism/htm

  27. What they say… • Art therapy based on Freudian philosophy – people with autism need to develop their ego. • Help to organize their sensory world • Art used to “reach” the child • Similar to sensory integration therapy • No defined treatment protocol Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  28. Evidence-based? • Kearns, S. D. (2004). Art therapy with a child experiencing sensory integration difficulty. Art Therapy: Journal of the American Art Therapy Association, 21 (2), 95-101. • Case study (disguised as single-case design!) • Teacher assessed behavior on a positive or negative scale, compared to the control group. • Reported an increase in “positive behaviors” after the art therapy. • Concluded that art therapy was a “useful intervention” http://www.americanarttherapyassociation.org/upload/OutcomeSingSubjectStudies2007.pdf

  29. Evidence-based? • Smitheman-Brown, V. R., and Church, R. P. (1994). Mandala drawing: Facilitating creative growth in children with ADD or ADHD. Art Therapy: Journal of the American Art Therapy Association, 13 (4), 252-262. • Multiple baseline design • “ongoing behavioral data were charted through direct observation” • Independent observers • “Objective” • Reported an increase in creative growth. http://www.americanarttherapyassociation.org/upload/OutcomeSingSubjectStudies2007.pdf

  30. Empirically supported? • Banks, S., Davis, P., Howard, V. F., and McLaughlin, T. F. (1993). The effects of directed art activities on the behavior of young children with disabilities: A multi-element baseline study. Art Therapy: Journal of the American Art Therapy Association, 10 (4), 235-240. • Studied effects of art on behavior • Multielement baseline across participants • Target behaviors – aggression, eye contract, social initiation. • Data –baseline and during intervention, 5 mins and 30 mins after art lesson. • “both experimental and control art activities resulted in therapeutic improvement in social behaviors, across individuals” • One participant showed no improvement. http://www.americanarttherapyassociation.org/upload/OutcomeSingSubjectStudies2007.pdf

  31. Is art therapy an effective autism intervention? • “Based on the scientific research to date, there is no evidence to conclude that Art Therapy is an effective treatment for improving symptoms characteristics of autism” (p. 253) Art is a fun activity, that can be a reinforcer for children with autism – there is no evidence to suggest that it is an “intervention” Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  32. Music and Art • “Reach” the child – what is the operational definition of “reach”?

  33. Daily Life Therapy/Higashi • “Our Mission is to help children and young adults with Autism Spectrum Disorder learn to reach their full potential through the application of the methodology of Daily Life Therapy®. This unique educational philosophy, developed by the late Dr. Kiyo Kitahara of Tokyo, Japan incorporates a broad and balanced curriculum including academics, art, music, physical education, computer technology and social education. Students take on challenges, learn to overcome obstacles and gain confidence from their own success. This process allows our students to develop a love for learning so they may fully enjoy their family, community, and all that life has to offer. As each student grows and learns, their personality and individual character matures allowing them to benefit from and most importantly contribute to society as adults.” http://www.bostonhigashi.org/about.php?id=1

  34. What is Daily Life Therapy? • Educational approach based on three principles • “foster the development of human dignity and self-esteem in the growing child and allow him or her to contribute to and benefit from society” • “education should by conducted in an environment of normality” http://www.bostonhigashi.org/about.php?id=7

  35. Three “pillars” of DLT • Create a predictable environment to help stabilize emotions so the child can the master skills for independence, subsequently making them feel accomplished and proud • Establish a “rhythm of life and physical health and well-being” through exercise • Broad, age-appropriate, individualized curriculum to stimulate intellectual and cognitive growth. http://www.bostonhigashi.org/about.php?id=7

  36. Quill (1989) • 5 principles that underlie the therapy: • Physical therapy • Art-based curriculum • Group instruction • Learning through imitation • Highly structured routines Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  37. What does DLT claim to do? • Help children: • Form bonds • Relate to others • Communicate • Control their anxieties http://www.bostonhigashi.org/about.php?id=7

  38. History of Daily Life Therapy • Created by Dr. Kiyo Kitahara in 1964, introduced to the USA in 1987. • Kindergarten teacher, worked with one child with autism. • Based on vigorous physical activity and fine arts • No certified practioners • Mirrors Japanese philosophy • Group interaction rather than 1:1 • Theory that children learn when exposed to interaction Shore, S. M., and Rastelli, L. G. (2006). Understand Autism for Dummies. Wiley Publication, Inc: Hoboken, NJ.

  39. Boston Higashi School • http://www.youtube.com/watch?v=uGcyF_XE7ks&feature=related • http://www.youtube.com/watch?v=shjiPeg26NM&feature=related • http://www.youtube.com/watch?v=shjiPeg26NM&feature=related

  40. Boston Higashi School • Randolph, MA • Opened in 1987 • Higashi means “east” • Day program runs 217 days a year, residential program is 304 days. • Two 2 week vacations in Winter and Spring, 4 weeks in the summer. • 3-22 years old • Diagnosis of Autism, Autistic-like, Asperger Disorder, PDD, PDD-NOS • 3:1 student teacher ratio http://www.bostonhigashi.org/about.php?id=7

  41. Physical conditioning • Regular and rigorous exercise • Jogging/unicycle/stilts • Reduce “stimming” and aggression • Increase sleeping habits • No data!

  42. Emotional regulation • “mastery of self care skills is believed to help with the development of self-esteem and contributes to emotional stability, which is important in getting along with others and yourself.” (p. 156) Shore, S. M., and Rastelli, L. G. (2006). Understand Autism for Dummies. Wiley Publication, Inc: Hoboken, NJ.

  43. Academics • “as much as possible instructors at the school strive to teach their students as close to grade level as possible” (p. 156) Shore, S. M., and Rastelli, L. G. (2006). Understand Autism for Dummies. Wiley Publication, Inc: Hoboken, NJ.

  44. Medication • “The fundamental mission of the Boston Higashi School is to provide education. Daily Life Therapy does not rely on medications, vitamins or other chemical substances in the treatment of children with autism. Dr. Kitahara’s philosophy is that “the child need to over its disability by its own strength” http://www.bostonhigashi.org/about.php?id=7

  45. Strike a pose? • “DLT is also not a behavior modification approach. We utilize basic body postures throughout the day to encourage children to increase their self control.” http://www.bostonhigashi.org/about.php?id=7

  46. What they say… • “Based on the research to date, very little can be concluded about the efficacy of Daily Life Therapy” (p. 116) • “If the Higashi school is to be considered a legitimate educational option for children with autism, I would need to see strong data from a study which has, at minimum, a hypothesis stating that those children who participate in the Higashi School over the period of a year are expected to show a decrease in the symptoms associated with autism.” (p. 116) Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  47. What they say… • “If the children in the Higashi School fair better than the children in the public school system, then we would know that the Higashi School is indeed a viable alternative to the public educational system for children with autism. The next step would be doe the Higashi School to test its intervention model against the other specialty school programs and home-based intensive behavioral intervention models designed for children with autism” (p. 117) Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  48. What they say… • “If you would like to enroll your child, I would suggest you consider the fact that due to the lack of data showing that this method is effective, you may want to augment your child’s treatment with a well-settled treatment program so that your child will progress at least when not in school (p. 118) • “based on the scientific research to date, there is insufficient evidence that Daily Life Therapy has an effective curriculum for decreasing the symptoms associated with the condition of autism in children” (p. 118) Freeman, S. K. (2007). The Complete Guide to Autism Treatments. A parent’s handbook: make sure your child gets what works! Lynden, WA: SKF Books USA, Inc.

  49. What they say… • ASAT • No information about Daily Life Therapy/Higashi • National Autism Center’s National Standards Project • No information about Daily Life Therapy/Higashi

  50. What they say… • National Autistic Society (U.K) • “The goal of this educational approach is for the children to develop as closely to normal physically, emotionally, intellectually and to achieve social independence and dignity.” • “This web-page has been written to provide information on a particular intervention/approach and any research connected with it, not as a recommendation. This outcome of any approach will depend on the needs of the individual, which vary greatly, and the appropriate application of the intervention” http://www.autism.org.uk/living-with-autism/approaches-therapies-and-interventions/service-based-interventions/daily-life-therapy-higashi.aspx

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