A Review of Music and Art Therapies

1
A Review of Music and Art Therapies

• For Individuals with Autism

2
Music and Art Therapies

• Music Therapy
• Art Therapy
• Discussion
• Questions

3
Music Therapy

• Definition
• History
• Models
• Settings
• Services
• Credentials
• Claims
• Parent and Therapist reports
• Outcomes
• Evidence

4
Art Therapy

• Definition
• Activity
• History
• Models
• Art Development
• Settings
• Credentials
• Claims
• Parent and Therapist reports
• Evidence

5
Search parameters

• Psychinfo
• Music and therapy in any fieldautis in
  subject
• Advanced search criteria Peer-reviewed journals,
  Journal articles, human, linked full text (time)
• 15 results
• Art and therapy in any field and autis in
  subject
• Advanced search criteria Peer-reviewed journals,
  Journal articles, human, linked full text (time)
• 26 results
• Google
• Music therapy
• American music therapy association
• Music therapy autism
• Art therapy
• American art therapy association
• Art therapy autism
• Art therapy and autism
• Art therapy autism history
• Center for Health and Healing
• Google news

6
Music Therapy Defined

• Music therapy is the clinical and evidence-based
  use of music interventions to accomplish
  individualized goals within a therapeutic
  relationship by a credentialed professional who
  has completed an approved music therapy program
• Refers to the application of music with the
  intent to enhance functioning

American Music Therapy Association. (2011).Who
are art therapists? Retrieved from
http//www.americanarttherapyassociation.org/ up
load/whoarearttherapists2009.pdf   Association
for Science in Autism Treatment. Music Therapy.
Retrieved from http//www.asatonline.org/interven
tion/treatments/ music.htm
7
Whats the appeal?
Music Therapy Clip Jammin Jenn
Jennmusiczack. (2010). Hope for autism through
music therapy. Available from http//youtube.com.
8
Is it founded?
9
History of Music Therapy

• Idea of music as healing goes back to Aristotle
• Discipline began after World War I and World War
  II when musicians went to Veterans hospitals to
  play for victims
• Notable responses of patients led to doctors
  hiring musicians
• Some musicians needed training before being in
  hospitals led to need for college curriculum
• First music therapy degree program at Michigan
  State University in 1944
• The American Music Therapy Association founded in
  1998

American Music Therapy Association (2008).
Autism Spectrum disorders Music Therapy Research
and Evidence-Based Practice Support. Retrieved
from http//www.musictherapy.org/factsheets/bib
_autism.pdf
10
Music therapy Models

• Receptive music listening
• Song writing
• Music performance
• Imitation
• Call and answer songs (Chase, 2009)
• Improvisational music therapy
• Creative music therapy model (Nordoff-Robbins
  Model) has been found most effective with
  children with autism
• Nordoff-Robbins Clip
• Music-making vs. music-listening to motivate
  learners and effect growt

American Music Therapy Association (2008).
Autism Spectrum disorders Music Therapy Research
and Evidence-Based Practice Support. Retrieved
fromhttp/ /www.musictherapy.org/ factsheets/bib
_autism.pdf Chase, E. (2009) Using the language
of music to speak to children with autism. The
Star-Ledger. Retrieved from http//www.nj.com.
Kim, J., Wigram, T., Gold, C. (2009).
Emotional, motivational and interpersonal
responsiveness of children with autism in
improvisational music therapy. Autism, 13,
389-409. doi 10.1177/1362361309105660
11
Settings Music Therapy

• Psychiatric hospitals
• Rehab facilities
• Medical hospitals
• Outpatient clinics
• Agencies for developmentally disabled persons
• Drug and alcohol programs
• Senior centers
• Correctional facilities
• Schools
• Private practices.

American Music Therapy Association (2008).
Autism Spectrum disorders Music Therapy Research
and Evidence-Based Practice Support. Retrieved
from http//www.musictherapy.org/factsheets/bib_au
tism.pdf
12
Music Therapy Services

• Considered related service under IDEA (Stetler,
  2009)
• IEP goals related services
• 150 certified music therapists in New Jersey but
  this number is rapidly expanding (Chase, 2009)
• Medicare 1994, reimbursable for service under
  benefits for Partial Hospitalization Programs
  (PHP) under heading of Activity Therapy
• Must be
• Prescribed by a physician
• Reasonable and necessary for treatment of
  illness/injury
• Goal directed and based on a documented treatment
  plan
• Goal cannot be to maintain current level, must
  exhibit some level of improvement
• Some medicade programs cover music therapy
• Some private insurances cover music therapy
• About 20 of Music therapists receive third party
  reimbursement

American Music Therapy Association (2008).
Autism Spectrum disorders Music Therapy Research
and Evidence-Based Practice Support. Retrieved
f from http//www.musictherapy.org/factsheets/bi
b_autism.pdf
13
Music Therapist Credentials

• Participate in approved college music therapy
  curricula to be eligible to sit for national
  examination offered by Certification Boar for
  Music Therapists (MT-BC)
• National Music Therapy Registry (NMTR) serves
  qualified music therapy professionals with the
  designation RMT, CMT, or ACMT

14
Music Therapy Claims

• Interventions designed to
• Promote wellness
• Manage stress
• Alleviate pain
• Express feelings
• Enhance memory
• Improve communication
• Promote physical rehabilitation

American Music Therapy Association (2008).
Autism Spectrum disorders Music Therapy
Research and Evidence-Based Practice Support.
Retrieved from http//www.musictherapy.org/fact
sheets/bib_autism.pdf
15
Music Therapy Outcomes for Individuals with
Autism

• Increased attention
• Decreased self-stimulation
• Improved cognitive functioning
• Increased socialization
• Successful and safe self-expression
• Improved behavior
• Enhanced auditory processing
• Decreased agitation
• Improved verbal skills
• Enhanced sensory-motor skills

American Music Therapy Association (2008).
Autism Spectrum disorders Music Therapy Research
and Evidence-Based Practice Support. Retrieved
from   http//www.musictherapy.org/factsheets/bi
b_autism.pdf
16
From the therapists

• For people with autism, the world is a chaotic
  place, full of overwhelming levels of sensory
  input, says John FoleyMusic has form we all
  recognize, even if we dont think in those terms
  music makes sense. In the early days of defining
  autism, heightened response to music was
  considered for the list of possible symptom.
  (Chase, 2009)
• We know music therapy works with people on the
  autism spectrum, even if we dont always know why
  or how (Chase, 2009)

Chase, E. (2009) Using the language of music to
speak to children with autism. The Star-Ledger.
Retrieved from http//www.nj.com
17
Music Therapy Parent reports

• I wish I could say how, exactly, but I just
  know that music is an avenue to get their little
  brains going. said Michelle Phalon (Chase,
  2009)
• The proof is in what you see and the changes in
  your childIts hard to argue with physical
  progress. There are naysayers out there in
  everything. But you see the difference. (Chase,
  2009)
• She just engage more, Wismann said. Instead
  of being in her own space, if youre more
  singsong-y when youre interacting with her, she
  seems to engage more and want to be interactive
  with you. (Thompson, 2011).

Chase, E. (2009) Using the language of music to
speak to children with autism. The
Star-Ledger. Retrieved from http//www.nj.com.
Thompson, D. (2011, May 27). Living with a
child with autism. HealthDay News. Retrieved
http//health.usnews.com
18
Evidence for Music Therapy

• According to the Association for Science in
  Autism Treatment, preliminary evidence suggests
  that music therapy might be effective in
  enhancing functioning, but more rigorous research
  needs to be conducted

  Association for Science in Autism Treatment.
Music Therapy. Retrieved from http//www.asatonli
ne.org/intervention/treatments/music.htm
19
Evidence for Music Therapy

• 15 total articles
• 1 unrelated to music therapy
• Dependent variables
• Social responsiveness 4 studies
• Avoidant Behaviors, emotional responsiveness,
  joint-attention behaviors, music skills,
  preferences, task performance, and auditory
  stimulus processing, object constancy 1 study
  each
• Vocal Stereotypy 2 studies
• Single-subject design 3 articles
• Group design 3 articles
• Meta-analysis and analysis 1 article each
• Vignettes/Case studies 6 articles

20
Evidence Single-Subject Research

• Further evaluation of methods to identify matched
  stimulation (Rapp, 2007)
• Effects of preferred stimulation on vocal
  stereotypy
• Results Sound-producing toys or non-contingent
  music led to decreased vocal stereotypy
• Possibly auditory stimulation functioned as an
  abolishing operation for vocal stereotypy
• The limits and motivating potential of sensory
  stimuli as reinforcers for autistic children
  (Ferrari Harris, 1981)
• Use of vibrations, music, and strobe lights as
  reinforcement.
• Results varied but sensory stimuli has
  motivating potentials similar to those of food
  and social reinforcers

Ferrari, M., Harris, S.L. (1981). The limits and
motivating potential of sensory stimuli as
reinforcers for autistic children. Journal of
Applied Behavior Analysis, 14, 339-343. doi
10.1901/jaba.1981.14-339   Rapp, J. T. (2007).
Further evaluation of methods to identify matched
stimulation. Journal of Applied Behavior
Analysis, 40, 73-88. doi 10.1901/jaba.2007.142
-05
21
Evidence Single-Subject Research

• Increasing social responsiveness in a child with
  autism A comparison of music and non-music
  interventions.

22
Research Social Responsiveness
Finnigan, E., Starr, E. (2010). Increasing social
responsiveness in a child with autism A
comparison of music and non-music interventions.
Autism, 14, p. 321-348.
23
Evidence Single-Subject Research

• Participant A 3-year, 8-month old girl with
  autism
• Materials 6 neutral toys randomly assigned to a
  condition
• Setting 4 15-minute sessions per week for 2
  months in empty preschool classroom or at
  participants home
• Alternating treatment design
• Dependent variable social responsive and
  avoidance behaviors
• Number of correct responses divided by the number
  of opportunities given
• Data summarized as percentage of correct
  responses
• Frequency count for eye contact and avoidance
  behaviors
• Independent variable Music and non-music
  conditions
• Music intervention Familiar melodies sung with
  lyrics appropriate for toy being used. Guitar
  also played.
• Non-music intervention Spoken scripts with words
  similar to those in melodies

Finnegan, E., Starr, E. (2010). Increasing
social responsiveness in a child with autism A
comparison of music and non- music
interventions. Autism, 321-348.
24
Evidence Single-Subject Research

• Alternating treatment design Baseline,
  Alternating Phase, Best-treatment phase,
  Follow-up
• IOA collected for 20 of sessions with a mean IOA
  of 87 (range 85-96)
• Data analysis looked at the percentage of
  nonoverlapping data
• Results Authors demonstrated a functional
  relationship between the music condition and the
  increase of social responsive behaviors and
  decrease of avoidant behaviors.

Finnigan, E., Starr, E. (2010). Increasing
social responsiveness in a child with autism A
comparison of music and non-music
interventions. Autism, 14, 321-348. doi
10.1177/1362361309357747
25
Research Social Responsiveness
Finnigan, E., Starr, E. (2010). Increasing
social responsiveness in a child with autism A
comparison of music and non-music
interventions. Autism, 14, 321-348. doi
10.1177/1362361309357747
26
Research Social Responsiveness
Finnigan, E., Starr, E. (2010). Increasing
social responsiveness in a child with autism A
comparison of music and non-music
interventions. Autism, 14, 321-348. doi
10.1177/1362361309357747
27
Research Social Responsiveness
Finnigan, E., Starr, E. (2010). Increasing
social responsiveness in a child with autism A
comparison of music and non-music
interventions. Autism, 14, 321-348. doi
10.1177/1362361309357747
28
Music Therapy Social Responsiveness

• Results suggest positive effects of Music Therapy
  on social responsiveness
• Need continued research with more rigorous
  experimental designs to establish functional
  relationships
• Small number of participants but not
  well-designed single-subject research
• Use of music (and other child-preferred
  activities) as motivation to increase
  socialization

Finnigan, E., Starr, E. (2010). Increasing
social responsiveness in a child with autism A
comparison of music and non-music
interventions. Autism, 14, 321-348. doi
10.1177/1362361309357747
29
Music Therapy Evidence for Outcomes

• Increased attention
• Decreased self-stimulation ()
• Improved cognitive functioning
• Increased socialization ()
• Successful and safe self-expression
• Improved behavior
• Enhanced auditory processing
• Decreased agitation
• Improved verbal skills
• Enhanced sensory-motor skills

30
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31
Art Therapy Defined

• Art therapy is a mental health profession that
  uses the creative process of art making to
  improve and enhance the physical, mental and
  emotional well-being of individuals of all ages.
  It is based on the belief that the creative
  process involved in artistic self-expression
  helps people to resolve conflicts and problems,
  develop interpersonal skills, manage behavior,
  reduce stress, increase self-esteem, self-
  awareness, and achieve insight
• Refers to the application of art with the intent
  to enhance functioning.

American Art Therapy Association. (2011). Who are
art therapists? Retrieved from http//www.american
arttherapyassociation.org /upload/whoareartthera
pists2009.pdf   Association for Science in
Autism Treatment. Art Therapy. Retrieved from
http//www.asatonline.org/intervention/treatments/
art.htm
32
Art therapy Activity

• Brainstorm feeling words
• Assign each word a color
• Draw a heart
• Color in the heart the amount of each color that
  you are feeling
• Keep on file
• Benefits?

33
Whats the appeal?

• Art Therapy

34
Is it founded?
Google images
35
History of Art Therapy

• 1900s
• Psychiatrists began being interested in
  patients art.
• Educators recognized artwork reflected childrens
  development/growth.
• 1914 Margaret Naumberg starts Childrens School
• Often identified as the founder of art therapy
• Art therapy started to be included with
  traditional talk therapy
• 1940s Distinct discipline emerged
• 1970s Division in art therapists
• Art therapy innate healing power of making art
• Art psychotherapy art as a healing tool within a
  framework of verbal psychotherapy

American Art Therapy Association. (2011). Who are
art therapists? Retrieved from http//www.american
arttherapyassociation.org/upload/whoarearttherapis
ts2009.pdf Center for Health and Healing
(2011). Art Therapy -- How it works and when to
use it. Retrieved from http//www.healthandhealin
gn org/complement/art_how.html
36
Art therapy Models

• Acting/Filming
• Photography
• Painting
• Drawing
• Portrait drawing
• Art as expression of feelings
• Art as nonverbal communication

eHowArtsAndCrafts (2010). Art therapy
activities art therapy activities on feelings.
Available from http//www.youtube.com
PolarisMediaGroup (2009). Polaris global
presents Kids with Cameras. Available from
http//www.youtube.com
37
Art Therapy Art Development

• Neurotypical individuals drawing skills
  generally follow the same progression
• Scribbling in early childhood
• Symbolic/schematic representation in middle
  childhood
• Concern with achieving realism in adolescence
• Shifts are influenced by and have an influence on
  cognitive development
• For children with ASD, the development follows
  the same sequence and is related to the
  individuals nonverbal mental age

Martin, N. (2008). Assessing portrait drawings
created by children and adolescents with autism
spectrum disorder. Art Therapy Journal of the
American Art   Therapy Association, 25, p.
15-23. Retrieved from http//www.arttherapyjournal
.org/pdf/25-1_Martin.pdf
38
Art Therapy Settings

• Work with health professionals in palliative care
  programs
• Prisons
• Trauma relief teams
• Personal growth classes
• School systems

Center for Health and Healing (2011). Art Therapy
-- How it works and when to use it. Retrieved
from http//www.healthandhealingny   org/compleme
nt/art_how.html
39
Art Therapy Credentials

• Art therapists must have a masters degree or
  PhD in art therapy AND/OR be a registered art
  therapist (ATR)
• Art therapists are skilled in multiple modalities
  of art (painting, sculpture, painting, etc.) for
  assessment and treatment.

Martin, N. (2011). Arttherapyandautism.com.
Retrieved from http//arttherapyandautism.com/inde
x.html.
40
Art Therapy Claims

• Art therapy visual images that represent
  thoughts/feelings that individuals dont know how
  to express verbally
• Interventions designed to address
• Imagination/abstract thinking deficits
• Sensory regulation and integration
• Emotions/self-expression
• Nonverbal communication
• Socialization
• Recreational/leisure skills
• Visual-spatial deficits
• Improving motor skills

Martin, N. (2011) Explanation. Retrieved from
http//arttherapyandautism.com Association for
Science in Autism Treatment. Art Therapy.
Retrieved from http//www.asatonline.org/interven
tion/treatments/art.htm
41
Art Therapy Claims

• As a graphic, nonverbal means of communication,
  art can provide relief to the child for whom
  verbal communication is frustrating,
  overwhelming, too direct, or even nonexistent
  (Martin, 2008).
• Art therapy can utilize the childs visual
  strengths to address treatment goals while
  providing a socially appropriate outlet for
  self-stimulatory behaviors and sensory needs
  (Martin, 2008).
• Use of icons, symbols, and social stories help
  the children to remember what they were taught
  (Epp, 2008).

Martin, N. (2008). Assessing portrait drawings
created by children and adolescents with autism
spectrum disorder. Art Therapy Journal of the
American Art Therapy Association, 25, p.
15-23. Epp, K.M. (2008). Outcome-Based
evaluation of a social skills program using art
therapy and group therapy for children on the
autism spectrum. Children and Schools, 30,
27-36.
42
Art Therapy Parent reports

• It has given her confidence, self-esteem, Mrs.
  Bigioni said. She is proud of the work she does.
  It has brought friendships peers and
  facilitators developed a sense of community
  (Joseph, 2011).

Joseph, S. (2011). Growing demand for art
therapy. Yorkregion.com. Retrieved from
http//www.yorkregion.com/news/article/1012624--gr
owing-demand-for-art-therapy.
43
Evidence Art Therapy

• According to Association for Science in Autism
  Treatment there have been no scientific studies
  of art therapy for individuals with ASD

  Association for Science in Autism Treatment.
Art Therapy. Retrieved from http//www.asatonline.
org/intervention/treatments/art.htm
44
Evidence for Art Therapy

• 26 articles returned
• Unrelated to art therapy 14 (related to music
  therapy etc.)
• Dependent variable
• Social skills
• Object constancy
• Face processing skills/portrait drawing
• Design
• Single-subject None
• Group design 2
• Book Review - 6
• Meta-analysis/Review - 3
• Case study - 1

45
Evidence Art Therapy

• Assessing portrait drawings created by children
  and adolescents with autism spectrum disorder
• 25 children with autism with a mean age of 13
  years and 15 neurotypical children with a mean
  age of 10
• Completed the Portrait Drawing Assessment (PDA)
• Portrait drawings didnt indicate a difference in
  iconic skills in children with ASD
• Participants with ASD were more often rated as
  interested and less often rated as indifferent
  than neurotyipcal participants

Martin, N. (2008). Assessing portrait drawings
created by children and adolescents with autism
spectrum disorder. Art Therapy Journal of the
American Art Therapy Association, 25, p. 15-23.
46
Evidence Art Therapy

• Outcome-based evaluation of a social skills
  program using art therapy and group therapy for
  children on the autism spectrum
• 66 participants
• Parents filled a pre and post-test questionnaire
  (SSRS or Social Skills Rating System)
• Attending a social skills group therapy program
  (with art therapy as a component) improved
  assertive social skills and decreased problem
  behaviors and hyperactivity.

Epp, K.M. (2008). Outcome-based evaluation of a
social skills program using art therapy and group
therapy for children on the autism spectrum.
Children and Schools, 30, 27-36. Retrieved from
http//web.ebscohost.com.ezproxy.
caldwell.edu2048/ehost/ pdfviewer/pdf
viewer?sidf824fe6f-6b6c-4f84-9de6-53a55d3f897540
sessionmgr113vid32hid105
47
Evidence Art Therapy

• Interventions designed to address
• Imagination/abstract thinking deficits
• Sensory regulation and integration
• Emotions/self-expression
• Nonverbal communication
• Socialization
• Recreational/leisure skills
• Visual-spatial deficits
• Improving motor skills
• Object constancy?
• Face processing?

Object constancy? Face processing?
48
Discussion

• Music therapy
• Noncontingent reinforcement/preferred stimulation
• Increased social responsiveness
• Decreased problem behaviors
• Auditory processing
• Art therapy
• Use of portrait drawing and photography to
  promote self-monitoring and awareness
• Use of portrait drawing to develop knowledge
  related to facial expressions
• Fine motor skills

49
Discussion cont.

• Behavior traps
• Motor imitation
• Gross and fine motor skills
• Social interaction

50
Discussion cont.

• Things to consider
• Individuals with ASD as visual thinkers/concrete
  
• Individuals with ASD with processing differences
  (auditory and visual)
• Use of preferred music as reinforcement is
  different than the application of music or art as
  a therapeutic intervention
• Need for more research is clear!

51
Recommendations

• Very little evidence at this point
• The evidence on music therapy suggests positive
  effects but more research is needed
• There is not evidence on art therapy thus far,
  research is needed!
• If music/art are preferred they can be used at
  motivation without needing therapy

52
References
53
References
54
References
55
Questions?