Effect of music_therapy_on_the_development_of_speech_rajiv_mishra

EFFECT OF MUSIC THERAPY ON THE DEVELOPMENT OF SPEECHAND LANGUAGE IN NON-VERBALPRE-SCHOOL CHILDREN WITHAUTISMTITLE:To investigate the effect of Music Therapy on the development of speechand language in non- verbal pre-school children with autism.STATEMENT OFTHE PROBLEM:About one-third to a half of individuals with autism do not develop enough naturalspeech or have limited speech to express their daily communication needs.Children with autism often are self-absorbed and seem to exist in their own worldwhere they are unable to successfully communicate and interact with others.They may have difficulty developing receptive and expressive language skills andunderstanding what others speak to them. They also may have difficultycommunicating nonverbally, for e.gthrough gestures, eye contact, facialexpressions and body language.The child’s ability to communicate withotherswill vary and depends upon his or her cognitive and social development.Some children with autism may be unable to develop speech. Others may haverich vocabularies and be able to talk about specific subjects in detail. Themajority have difficulty using language effectively to explain, especially whenthey talk to other people. Many have problems with understanding the meaningand rhythm of words and sentences. They also may be unable to understandbody language and the nuances of vocal tones.They usually exhibit difficulties insocial interaction as well as in verbal and non-verbal communication. Sinceautistic children are hypersensitive to external stimuli, they tend to have a strongaffinity for listening to music and playing musical instruments. Many autisticchildren sometimes sing when they may not speak. They often restrictthemselves by closing their ears tightly with their fingers poked in and humminga tune continuously. Music therapy being a well-established technique for usingmusical interaction to help individuals with a wide range of cognitive and

emotional challenges to improve their ability to function, it was conducted onnon-verbal preschool children for development of speech, speech intelligibilityand language development.REVIEW OF LITERATURE:1.Science Daily (Sep.20,2006)- Researchers have found the firstevidence that youngchildren who take music lessons show differentbrain development and improvedmemory over the course of a yearcompared to children who do not receive musicaltraining.2. Institute of Cognitive Neurosciences of the Mediterranean, CNRS,Marseille,France Center for Complex Systems and Brain Sciences, Florida AtlanticUniversity, Boca Raton, Florida 33431,USA-Compared the neural bases oflanguage and music and manipulated either the linguistic or musical dimensions(or both) of song and studied their relationships. It was possible to gain importantinformation about the neural networks underlying language and music cognition.They also conducted behavioral, electrophysiological, and neuroimaging studiesconcerning with the functional and structural relationships of music andlanguage.3. In 1994 ‘Discover magazine’ published an article which discussed research byGottfried Schlaug, Herman Steinmetz and their colleagues at the University ofDusseldorf. The group compared magnetic resonance images (MRI) of the brains of 27classically trained right-handed male piano or string players, with those of 27 right-handed male non-musicians. Intriguingly, they found that in the musicians’planumtemporale - a brain structure associated with auditory processing - was bigger inthe left hemisphere and smaller in the right than in the non-musicians. The musiciansalso had a thicker nerve fibre tract between the hemisphere. The differences wereespecially striking among musicians who began training before the age of seven.According to Shlaug, music study also promotes growth of the corpus callosum, a sortof bridge between the two hemispheres of the brain. He found that among musicians who

started their training before the age of seven, the corpus callosum is 10-15% thicker thanin non-musicians.RATIONAL OFSTUDY:Music therapy can help patients suffering from autism spectrum disorders tophysical injuries like spinal cord injuries. Different studies are being going on todetermine if music therapy can help treat Parkinson’s Disease, which is a braindisease that causes its sufferers to shake uncontrollably. It’s also being used forolder people living in hospital or old age care as music therapy is believed todecrease pain perception and provide distraction for people living with chronic orextreme pain.Music therapy is also being used much more often to treat peoplewith autism, especially young children. Autistic people are often entirely closedoff in their own private world and they are unable to properly communicate withthe people around them. They struggle to interact with the world around them aswell. The left brain is responsible forgeneral music ability in musicians,perception, production of speech, perception of rhythm and prosody, lyricperformance during singing and the temporal sequences of reading ability. Theright brain is involved with processing of musical pitch, control of intensity ofsound(amplitude), identification and detection of musical chords, melodyperception in non-musicians, visual pattern recognition, singing, auditory patternrecognition(auditory training), and expressive rhythmic and melodic behaviour.New studies are reporting of overlapping areas for music and languageprocessing. Rhythm has been found to positively influence brain activity duringlearning; scientists have reported that after a rhythm sequence is stopped, brainactivity occurs in anticipation.Research supports connections between speechand singing, rhythm and motor movements, memory for song and memory foracademic concepts, and overall ability of preferred music . Speech can rangefrom complete mutism to grunts, reflexive crying,shrieks, guttural and hummingsounds. There may be musically intoned vocalizations with some consonant-

vowel combinations, a sophisticated babbling interspersed with recognizable word-like sounds or a jargon speech.It is therefore necessary to study further, how speech and language can be developed in children with autism and how music-based communication is possible even when language processing is missing. DEFINITIONS:sic Therapy- Music therapy is an allied health profession and afield of scientific research which studies correlations between theocess ofclinical therapy and biomusicology, musical acoustics,music theory,psychoacoustics, embodied , music cognition and comparative musicology. It is an interpersonal process in which a trained music therapist uses music and all of its facets- physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health.ice Analysis- Voice analysis is the study of speech sounds for purposes other than linguistic content, such as in speech recognition. Such studies include mostly medical analysis of the voice . ASSUMPTIONS: Scientists have discovered that music training has significant influences on the brain development of young children which leads to improved memory and language recall skills .Researchers found that

musically trained children performed better in a memory test that is correlated with otherskills such as literacy, verbal memory, visual spatial processing, mathematics andintelligence.Since children with autism have affinity towards music and there is a provenco-relation between the music, speech and brain development, the research on abovetopic was pursued.HYPOTHESIS:1.To investigate the effect of Music Therapy in development ofspeech in non- verbal pre-school children with autism.2. To investigate the effect of Music Therapy in development oflanguage in non- verbal pre-school children with autism.LIMITATIONS:1. The sample size was small.METHOD:Research Design:Experimental research design.Independentvariable:Music TherapyDependent variable:Speech and Language Development in

non- verbal pre-school children with autism.Sample design:8 children with autism with no speech orminimal speech.Sampling Design: By convince samplingInclusion criteria: 1. Age-3-5 years. 2. Diagnosis- All children were diagnosed under Autism Spectrum Disorder By Child Psychiatrist and Clinical Psychologist.Exclusion criteria:None.

Instrumentation:1.Perceptual Evaluation of Speech Quality test .2.Voice Assessment Protocol for Children and Adults (VAP)3.Clinical Evaluation of Language Fundamentals–Preschool, SecondEdition (CELF-Preschool 2)4.Goldman-Fristoe Test of Articulation-Second Edition G-FTA-2)5. Peabody Picture Vocabulary TestMaterials and Equipments:1. Computer voice analyzer.2. Praat software program for acoustic voice analysis.3. Phonatory Aerodynamic System (PAS)4. Microphone5. Tape recorder6. Musical Instruments.Procedure:

The team comprised of a Music Therapist and Speech Therapist. The duration of theproject was from 26th January 2009 to 14th November 2009 at Ruptech Educational India.8 pre-school children with no or minimal speech with autism were assessed prior to thestart of therapy sessions. The child’s Speech Development milestones, Imitation skills,Articulation test, Voice Analysis (loudness, quality, pitch range) was assessed. Thechild’s receptive and expressive vocabulary and Situation-Facial Expression Matchingwere tested using photographs and video clippings. After assessing the strengths andneeds of each child with autism, the music therapist developed a treatment plan withgoals and objectives and then provided appropriate treatment. The therapist usedpercussion, tuned instruments and her own voice, to respond creatively to the soundsproduced by the children with autism and encouraged them to create his or her ownmusical language. Musical games like passing a ball back and forth to music or playingsticks and cymbals with a partner to foster interaction were played. Preferred music wasused contingently for a wide variety of cooperative social behaviours like sitting on achair or staying with a group of other children in a circle. Music selections and certainactive music-making activities were modified for child’s preferences and individualizedneeds (i.e., song selection and music may vary). Toolkits were available via AMTA andpublications.The therapy was conducted in individual and small group sessions. The childrenattended 40 music therapy sessions-19 individual sessions and 21 group sessions,twice/week, of half an hour each.The group session had 3-4 ASD students duringtherapy. Music therapy sessions were documented in a treatment plan, every week anddelivered in accordance with standards of practice. The speech and voice analysis wasdone by the voice therapist along with the music therapist.

Table1 Receptive and Expressive Language Age based on ClinicalEvaluation of Language Fundamentals–Preschool, SecondEdition (CELF-Preschool 2), on 27th March 2009(Pre-therapyassessment) Chronological Receptive Expressive Age(in years) Language Age(in Language AgeSubjects years) (in years)Child A 3.4 2.2 1.4Child B 4.6 3.4 1.8Child C 3.2 2.1 1.1Child D 4.2 2.3 1.4Child E 3.7 2.4 1.0Child F 4.10 3.0 1.9Child G 3.4 2.1 1.3Child H 4.9 3.8 2.0Table 2Receptive and Expressive Language Age based onClinicalEvaluation of Language Fundamentals–Preschool, SecondEdition (CELF-Preschool 2), on 3rd October 2009(Post-therapyassessment) Chronological Receptive Expressive Age(in years) Language Age(in Language AgeSubjects years)

(in years)Child A 3.10 2.6 1.7Child B 5.0 3.7 2.1Child C 3.8 2.4 1.6Child D 4.8 2.5 1.9Child E 4.1 2.7 1.3Child F 5.4 3.4 2.1Child G 3.10 2.3 1.5Child H 5.3 3.9 2.6Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child A. 3 2.6 2.5 Inprovement in Receptive and Expressive Language Age in years 2.5 2.3 2.2 2.1 2 1.7 1.6 1.5 1.5 1.4 1.4 Receptive Age Expressive age 1 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child B.

4 3.7 3.5 3.5 3.4 3.4 3.5 Improvement in Receptive and Expressive Language Age (in years) 3 2.5 2.1 1.9 2 1.8 1.7 1.6 Receptive Age 1.5 Expressive age 1 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child C. 2.5 2.4 2.4 2.3 2.2 2.1 IInprovement in Receptive and Expressive Language Age in years 2 1.6 1.6 1.5 1.4 1.3 1.1 Receptive Age 1 Expressive age 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child D.

2.5 2.5 2.5 2.4 Inprovement in Receptive and Expressive Language Age in years 2.3 2.3 2 1.9 1.7 1.5 1.5 1.4 1.4 Receptive Age 1 Expressive age 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child E. 3 2.7 2.6 2.5 Inprovement in Receptive and Expressive Language Age in years 2.5 2.4 2.4 2 1.5 1.4 1.3 1.3 1.2 Receptive Age 1 Expressive age 1 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child F.

3.4 3.5 3.3 3.3 3.1 3 Inprovement in Receptive and Expressive Language Age in years 3 2.5 2.1 2 2 1.9 2 1.4 Receptive Age 1.5 Expressive age 1 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child G. 2.5 2.3 2.3 2.3 2.1 2.1 Inprovement in Receptive and Expressive Language Age in years 2 1.5 1.5 1.4 1.4 1.3 1.3 Receptive Age 1 Expressive age 0.5 0Graph Representing Receptive and Expressive Language age based on ClinicalEvaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober2009 of Child H.

3.9 3.9 3.9 4 3.8 3.8 3.5 Inprovement in Receptive and Expressive Language Age in years 3 2.6 2.5 2.5 2.1 2 Receptive Age 1.5 1.5 Expressive age 1 0.5 0 0Table 3 Articulation Test based on Goldman-Fristoe Test ofArticulation-Second Edition G-FTA-2) on 27th March 2009(Pre-therapy assessment)Subjects Chronological Misarticulation Age(in years)Child A 3.10 N.AChild B 5.0 N,AChild C 3.8 aspirated soundsChild D 4.8 Trill soundsChild E 4.1 N.AChild F 5.4 N.AChild G 3.10 Glottal soundsChild H 5.3 N.A

Table 4Articulation Test based onGoldman-Fristoe Test ofArticulation-Second Edition G-FTA-2) on 13th Oct 2009(Post-therapy assessment)Subjects Chronological Misarticulation Age(in years)Child A 3.10 N.AChild B 5.0 N,AChild C 3.8 aspirated sounds(reduced by 40%)Child D 4.8 Trill sounds(no improvement)Child E 4.1 N.AChild F 5.4 N.AChild G 3.10 Glottal sounds(reduced by 30%)Child H 5.3 N.ATable 5 Voice Analysis ,on computerized Voice Analyseron 29th March2009(Pre-therapy assessment)Subjects Chronological Pitch Loudness Quality of Age(in years) range(in Hz) voice (in%) (in db)Child A 3.4 230-560 40 NormalChild B 4.6 135-257 60 Hoarse(40%)

Child C 3.2 321-460 30 NormalChild D 4.2 110-730 45 Nasal (70%)Child E 3.7 230-270 50 NormalChild F 4.10 340-800 34 Nasal(70%)Child G 3.4 120-224 35 Husky(40%)Child H 4.9 130- 170 57 Hoarse(30%)Table 6 Voice Analysis ,on computerized Voice Analyseron 7th October2009(Post-therapy assessment)Subjects Chronological Pitch Loudness Quality of Age(in years) range(in Hz) voice (in%) (in db)Child A 3.10 130-730 60 NormalChild B 5.0 130-454 65 Hoarse(30%)Child C 3.8 232-640 40 NormalChild D 4.8 110-870 36 Nasal(50%)Child E 4.1 120-330 30 NormalChild F 5.4 320-870 24 NasalChild G 3.10 110-344 43 Husky(30%)Child H 5.3 120- 180 63 Hoarse(25%)FINDINGS:

dings of this study gave significant insights into the relationshipen music, speech , language development in children with autism. It was observed that there was an overall enhancement in their receptive and functional expressive language skills. While all could speak in telegraphic speech post music therapy sessions, 2 children could express in 3-4 word short sentences and developed functional expressive skills. 1 child could narrate events in 3-4 sentences of 4-5 word length. It was noticed that the articulation of 2 children improved in aspirated and glottal sounds and 1 child showed no improvement. There was significant improvement in pitch range,3children could attain normal loudness. The voice quality improved of 4 children who had nasal or hoarse or husky voice. There was an improvement of 5-20% in their voice quality. IMPLICATIONS: The above findings prove that music therapy helps to enhance attention ,speech and language development to optimize the student’s ability to learn and interact. It has been effective in the development and remediation of speech and language. Therefore, the purpose of music therapy for children with autism should be to provide the student with an initial assist using melodic and rhythmic strategies, followed by fading of musical cues to aid in generalization and transfer to other learning environments. The future of music brain research is bright. Additional study is needed: -to specify the effect of each of the components of music (i.e. rhythm) on specific areas of brain activity, -to specify areas of brain activity during emotional responses to music, - to analyze the structural similarities between music and language,

-to study the neuromuscular effect of low-frequency vibration andmusic,-to study the effect of music on retrieval in short and long termmemory .BIBLIOGRAPHY Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of directed art activities on the behavior of young children with disabilities: A multi- element baseline analysis. Art Therapy: Journal of the American Art Therapy Association, 10(4), 235-240. Bentivegna, S., Schwartz, L., &Deschner, D. (1983). The use of art with an autistic child in residential care. American Journal of Art Therapy, 22, 51-56. Benveniste, D. (1983). The archetypal image of the mouth and its relation to autism. Arts in Psychotherapy, 10, 99-112. Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative ways. Advocate: magazine of the Autism Society of America, 26-27. Betts, D. J. (2003). Developing a projective drawing test: Experiences with the Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art Therapy Association, 20(2), 77-82. Betts, D. J., &Tabone, C. (2002). Working with autism: Contemporary assessment and treatment methods. Paper presented at the 33rd Annual Conference of the American Art Therapy Association, Washington, DC. Betts, D. J. (2001). Projective drawing research: Assessing the abilities of children and adolescents with multiple disabilities. Paper presented at the 32nd Annual Conference of the American Art Therapy Association, Albuquerque, NM. Betts, D. J. (2001). Cover story: weekend outings provide creative outlet: Individual expresses himself through art therapy. Advocate: Magazine of the Autism Society of America, 34(3), 20-21. Betts, D. J. (2001). Special report: The art of art therapy. Drawing individuals out in creative ways. Advocate: Magazine of the Autism Society of America, 34(3), 22-23(29). Buck, L. A. (1985). Artistic talent in “autistic” adolescents and young adults. Empirical Studies of the Arts, 3(1), 81-104.

Evans, K. &Dubowski, J. (2001). Art therapy with children on the autistic spectrum: Beyond words. Jessica Kingsley Publishers, London. Fleshman, B., &Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall. In Parker-Hairston, M. J. (1990). Analyses of responses of mentally retarded autistic and mentally retarded non-autistic children to art therapy and music therapy. Journal of Music Therapy, XXVII(3), 137-150. Henley, D. (2001) Annihilation anxiety and fantasy in the art of children with Asperger’s Syndrome and others on the autistic spectrum. American Journal of Art Therapy, 39(4), 113-121. Henley, D. (1992). Therapeutic and aesthetic application of video with the developmentally disabled. Arts in Psychotherapy, 18, 441-447.BIBLIOGRAPHY Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of directed art activities on the behavior of young children with disabilities: A multi- element baseline analysis. Art Therapy: Journal of the American Art Therapy Association, 10(4), 235-240. Bentivegna, S., Schwartz, L., &Deschner, D. (1983). The use of art with an autistic child in residential care. American Journal of Art Therapy, 22, 51-56. Benveniste, D. (1983). The archetypal image of the mouth and its relation to autism. Arts in Psychotherapy, 10, 99-112. Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative ways. Advocate: magazine of the Autism Society of America, 26-27. Betts, D. J. (2003). Developing a projective drawing test: Experiences with the Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art Therapy Association, 20(2), 77-82. Betts, D. J., &Tabone, C. (2002). Working with autism: Contemporary assessment and treatment methods. Paper presented at the 33rd Annual Conference of the American Art Therapy Association, Washington, DC. Betts, D. J. (2001). Projective drawing research: Assessing the abilities of children and adolescents with multiple disabilities. Paper presented at the 32nd Annual Conference of the American Art Therapy Association, Albuquerque, NM. Betts, D. J. (2001). Cover story: weekend outings provide creative outlet: Individual expresses himself through art therapy. Advocate: Magazine of the Autism Society of America, 34(3), 20-21.

Betts, D. J. (2001). Special report: The art of art therapy. Drawing individualsout in creative ways. Advocate: Magazine of the Autism Society of America,34(3), 22-23(29).Buck, L. A. (1985). Artistic talent in “autistic” adolescents and young adults.Empirical Studies of the Arts, 3(1), 81-104.Evans, K. &Dubowski, J. (2001). Art therapy with children on the autisticspectrum: Beyond words. Jessica Kingsley Publishers, London.Fleshman, B., &Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall. InParker-Hairston, M. J. (1990). Analyses of responses of mentally retarded autisticand mentally retarded non-autistic children to art therapy and music therapy.Journal of Music Therapy, XXVII(3), 137-150.Henley, D. (2001) Annihilation anxiety and fantasy in the art of children withAsperger’s Syndrome and others on the autistic spectrum. American Journal ofArt Therapy, 39(4), 113-121.Henley, D. (1992). Therapeutic and aesthetic application of video with thedevelopmentally disabled. Arts in Psychotherapy, 18, 441-447.

Effect of music_therapy_on_the_development_of_speech_rajiv_mishra

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