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MICHIGAN STATE NI l llllllli 31 93 0089 T l iiiillii' L This is to certify that the thesis entitled The Effect of Improvisational Music Therapy on the Communicative Behaviors of Autistic Children presented by Cindy Lu Edgerton, RMT-BC has been accepted towards fulfillment of the requirements for _Masterls_degree in Music— g‘: A/W @239 Major professor v Date March 30, 1993 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution LIBRARY Mlchlgan State Unlverslty PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. DATE DUE DATE DUE DATE DUE ual Opportunity Institution cummm THE EFFECT OF IMPTDVISATIONAL MUSIC THERAPY ON THE WICATIVE BEHAVIORS 0F AUI‘ISI‘IC CHILDREN By Cindy Lu Edgerton. EMT-BC A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF MUSIC, MJSIC THERAPY Department of Music Therapy 1993 ABSTRACT THE EFFECT OF IMPROVISATIONAL MIC THERAPY ON THE WICATIVE BEHAVIORS OF AUTISTIC CHILDREN ' By Cindy Lu Bdgerton, EMT-BC Clinicians, researchers. and educators have studied extensively the conmunication deficits of people diagnosed with autism and have comnented frequently on their unusual responsiveness to music. The purpose of this study was to determine the effectiveness of improvisational music therapy, based on Nordoff and Robbins’ (1977) Creative Music Therapy approach, on autistic children'l conmunicative behaviors. Eleven autistic children, ranging in age from 6 to 9 years, participated in individual improvisational music therapy sessions for a period of ten weeks. A reversal design was applied. The Checklist of Conmunicative Responses/Acts Score Sheet (GRASS), designed specifically for this study, was used to measure the subjects’ musical and normusical conmunicative behaviors. Results strongly suggest the efficacy of improvisational music therapy in increasing autistic children’s comnunicative behaviors. Significant differences were found between the subjects' first session CRASS scores and those of their last sessions (p < .01). Also, abrupt and substantial decreases in scores were noted for all eleven subjects when reversal was applied. Dedicated to the children who participated in this study iii ACKNOWme I would like to express rm! gratitude and sincere appreciation to Professor Roger Smeltekop for his support, guidance, and expert advice during this entire project. Also, I thank Dr. Dale Bartlett for all of his contributions of expertise, suggestions, and assistance throughout the study. Furthermore. I would like to thank Professor Philip Hosford for his positive support and encouragement. All of my cortmittee's inspiration was essential in keeping me moving forward. A special thanks is extended to the children who participated in this study. I feel fortunate to have had the chance to meet you, make music with you, and learn from each one of you. Also. this project would not have been possible without the cooperation of all of the parents, teachers, administrators, and teacher consultants. Their support and enthusiasm remained at a high level throughout this past year. Additionally, I am extremely grateful to Andrea O’Donnell and Denise Travis, for all of their valuable time they gave in collecting the data. Thanks so much for your effort, willingness, helpful suggestions, and positive feedback. Finally, a very special thank you goes to my husband and my son for putting up with me - and without me - during this study. Both of you. along with our entire family, have provided me with the personal support, love. and encouragement needed to complete this project. iv TABLE OF CDNTENTS Page LIST OF TABLES ..................................................... vii LIST OF FIGURES ..................................................... ix CHAPTERS I. AN EXPERIMENTAL SIUDY Introduction ................................................ 1 The Problems and Subproblems ............. '. .................. 2 Definitions ................................................. 5 Assunptions ................................................. 7 Limitations ................................................. 7 Ethical Considerations ...................................... 9 II. A REVIEW OF RELATED LITERATURE Introduction ............................................... ID Autism and Cannunication/language ....... . .................. 12 (a) Historical Overview ................................. 12 (b) Importance of Camunication/Language in the Prognosis for Autisn ....... . ..................... 14 (c) Can'mmication/Ianguage Characteristics of Autistic Children ................... . ............ 16 (d) Commmication/Language Interventions with Autistic Children ................................ 26 Music'lherapyandAutisn.......... ..... . ........... . ....... 36 (a) Musical Responsiveness and Abilities of Autistic Children. ............................... as (b) Structured Music Therapy Techniques and Autism ...... 33 (c) Improvisational Music Therapy and Autisn ............ 36 V III. METHOD Subjects ................................................... 44 Consent and Approval ....................................... 45 Materials .................................................. 46 Experimental Design ........................................ 47 Measurement ................................................ 47 Independent Variable ....................................... 56 Pi lot Procedure ............................................ 62 Procedure ................................ ’ .................. 62 IV. ANALYSIS OF DATA Results .................................................... 64 V. SUMARY Discussion ................................................. 93 Reconmendat ions for Further Study ......................... 108 APPENDICES A. Approval Letters (a) Approval Letter from University Comnittee Involving Hanan Subjects ........................ 111 (b) Approval Letter from Lansing School District Office of Research and Evaluation ............... 112 B. Consent Forms (a) Parental Consent Form .............................. 113 C. Measurement Devices (a) Checklist of Cannunicative Responses/Acts Score Sheet ..................................... 115 (b) Commmicative Responses/Acts Definitions ........... 117 (c) Behavior Change Survey ............................. 122 LIST OF REFERENCES ................................................. 123 vi LIST OF TABLES TABLES Page 1. CRASS Scores for each Subject across Sessions. Individual Overall Gains. and Group Means ................. 72 2. Group Mean Quantity and Creativity of the Overall Level of Camunicativeness across Sessions ................ 75 3. Total First and Last Session CRASS Scores - Wilcoxon Matched-Pairs Signed-Ranks Test ........................... 76 4. Group Mean Musical and Normusical Cannmiicative Behaviors across 10 Sessions .............................. 78 5. Total First and Last Session Scores in Tempo. Rhythm. Structure/Form. and Pitch - Work-up for the Wilcoxon Matched-Pairs Signed-Ranks Test ............... . ........... BO 6. Total First and Last Session Scores in Speech Production, Cmmmicative-Interactive. and Comnunicative Intent - Work-up for the Wilcoxon Matched-Pairs Signed-Ranks Test ........................... 81 7. Total First and Last Session Spontaneous. Creative Cormunicative Acts - Wilcoxon Matched-Pairs Signed-Ranks Test ......................................... 84 8. CRASS Musical Vocal Gain Scores and Nonmusical Speech Production Gain Scores - Work-up for the Spearman Rank Correlation Coefficient .............................. 85 9. Mean Scores for each Question on the Behavior Change Survey as rated by Parents. Teachers. and Speech Therapists ......................................... 87 IO. CRASS Gain Scores and Total Behavior Change Survey Ratings as reported by Parents, Teachers. and Speech Therapists - Work-up for the Spearman Rank Correlation Coefficient ................................... 89 vii List of Tables - Continued 11. GRASS Gain Scores and Behavior Change Survey Categorical Ratings as reported by Parents. Teachers. and Speech Therapists - Work-up for the Spearman Rank Correlation Coefficient ................................... 91 12. Spearman.Rank Correlation Coefficients for CRASS Gain Scores and Behavior Change Survey Total and Categorical Ratings as reported by Parents. Teachers. and Speech‘Therapists ..................................... 92 viii LIST OF FIGURES FIGURES Page 1. Group Mean Comnunicative Responses/Acts across 10 Sessions ............................................... 65 2. Comnunicative Responses/Acts of Subject A across 10 Sessions ............................................... 66 3. Communicative Responses/Acts of Subject B across 10 Sessions ............................................... 66 4. Comnunicative Responses/Acts of Subject C across 10 Sessions ............................................... 67 5. Communicative Responses/Acts of Subject D across 1% Sessions ............................................... 67 6. Camunicative Responses/Acts of Subject E across 10 Sessions ............................................... 68 7. Comnunicative Responses/Acts of Subject F across 8 Sessions ................................................ 68 8. Communicative Responses/Acts of Subject G across 10 Sessions ............................................... 69 9. Comnunicative Responses/Acts of Subject H across 10 Sessions ............................................... 69 10. Communicative Responses/Acts of Subject I across 10 Sessions ............................................... 7O 11. Communicative Responses/Acts of Subject J across 9 Sessions ................................................ 7O 12. Commmicative Responses/Acts of Subject K across MD Sessions ............................................... 71 13. Group Mean Musical and Nonnusical Cormamicative Behaviors across 1% Sessions ................ . ............. 78 14. Group Mean Scores in Tempo, Imytlm. Structure/Form. and Pitch across 10 Sessions .............................. 82 ix List of Figures - Continued 15. Group Mean Scores in Speech Production, Caunmicative- Interactive. and Communicative Intent across 10 Sessions ............................................... 82 CHAPTER I AN EXPERIMENTAL STUDY Introduction Comnunication problems of autistic children have been major areas of investigation in the field of autism. For many years there existed the assunption that nonverbal children and children with limited meaningful comnunication lacked the skills needed to understand their envirorments. Within the past several years this assunption has been challenged, with research beginning to demonstrate the potential for conmunicativeness in autistic children. Avenues which provide opportunities for autistic children to develop comnunication skills are desperately in need. Recent literature on facilitated comnunication (Biklen, 1998) has described autistic people’s frustrations with their inabilities to comnunicate. Although this work is very controversial, the questions it raises cannot be overlooked. Research is needed to examine autistic people's comnunicative potentials. Music therapy has been widely used with autistic children. Nordoff and Robbins (1977) reported many therapeutic values of Creative Music Therapy for autistic children. and this technique is becoming more widespread. Nunerous case studies have demonstrated its effectiveness; however. to the experimenter’s knowledge, controlled experimental studies of improvisational techniques which are based on Creative Music Therapy have not yet been implemented. If this technique truly allows for comnunicative behaviors to emerge and develop in autistic children, it could both provide some answers to 1 2 questions raised in the field of autism and generate further questions. The Problem and Subproblems The purpose of this study is to determine the effects of improvisational music therapy on the conmunicative behaviors of autistic children. The specific questions to be answered are as follows: 1. Is there a significant difference between the nunber of total comnunicative behaviors as measured by the Checklist of Conmunicative Responses/Acts Score Sheet (CRASS) demonstrated by autistic children in their first improvisational music therapy sessions and the nunber demonstrated in their last sessions? 2. Is there a significant difference between the nunber of Comnunicative Responses/Acts in the tempo modality demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 3. Is there a significant difference between the nunber of Carmunicative Responses/Acts in the rhythm modality demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 4. Is there a significant difference between the nunber of Comnunicative Responses/Acts in the structure/form modality demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 5. Is there a significant difference between the nunber of Conmunicative Responses/Acts in the pitch modality demonstrated by autistic children in their first sessions and the amber demonstrated in their last sessions? 6. Is there a significant difference between the nunber of Cannunicative Responses/Acts in the speech production subcategory demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 7. Is there a significant difference between the nunber of Conmunicative Responses/Acts in the oannunicative-interactive subcategory demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 8. Is there a significant difference between the nunber of Cortmunicative Responses/Acts in the canmmicative intent subcategory demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 9. Is there a significant difference between the nunber of spontaneous and creative acts demonstrated by autistic children in their first sessions and the nunber demonstrated in their last sessions? 19. Is there a significant relationship between the subjects' musical vocal behavior score changes and their normusical speech production score changes as recorded on the GRASS? 11. Will any changes in the autistic children’s comnunicative. social/emotional. and musical behaviors be observed by the parents outside of the music therapy setting at the conclusion of the 10 week period? 12. Will any changes in the autistic children’s comnunicative, social/emotional, and musical behaviors be observed by the teachers outside of the music therapy setting at the conclusion of the 10 week period? 13. Will any changes in the autistic childrenfs communicative. social/emotional, and musical behaviors be observed by speech therapists outside of the music therapy setting at the conclusion of the 16 week period? 14. Is there a significant children's overall CRASS score on the Behavior Change Survey? 15. Is there a significant children’s overall CRASS score on the Behavior Change Survey? 16. Is there a significant children’s overall CRASS score ratings on the Behavior Change 17. Is there a significant children’s overall CRASS score ratings on the Behavior Change 18. Is there a significant children’s overall CRASS score ratings on the Behavior Change 19. Is there a significant children's overall CRASS score relationship between the autistic changes and the parents’ total ratings relationship between the autistic changes and the teachers’ total ratings relationship between the autistic changes and the speech therapists’ total Survey? relationship between the autistic changes and the parents’ communication Survey? relationship between the autistic changes and the teachers’ communication Survey? relationship between the autistic changes and the speech therapists’ communication ratings on the Behavior Change Survey? 20. Is there a significant children's overall CRASS score relationship between the autistic changes and the parents’ social/emotional ratings on the Behavior Change Survey? 21. Is there a significant relationship between the autistic 5 children’s overall CRASS score changes and the teachers’ social/emotional ratings on the Behavior Change Survey? 22. Is there a significant relationship between the autistic chi ldren’s overall CRASS score changes and the speech therapists’ social/emotional ratings on the Behavior Change Survey? 23. Is there a significant relationship between the autistic children’s overall CRASS score changes and the parents’ musical ratings on the Behavior Change Survey? 24. Is there a significant relationship between the autistic children’s overall GRASS score changes and the teachers’ musical ratings on the Behavior Change Survey? 25. Is there a significant relationship between the autistic chi ldren’s overall CRASS score changes and the smech therapists’ musical ratings on the Behavior Change Survey? Definitions Autism: The following definition and determination of autism given by the Michigan State Board of Education (1992) was utilized in this study: Rule 15.(1) "Autism" means a lifelong developnental disability which is typically manifested before 30 months of age. "Autism" is characterized by disturbances in the rates and sequences of cognitive, affective, psychomotor, language, and speech developnent. (2) The manifestation of the characteristics specified in subrule (1) of this rule and all of the following characteristics shall determine if a person is autistic: (a) Disturbance in the capacity to relate appropriately to people, events, and objects. (b) Absence. disorder, or delay of language, speech. or meaningful comnunication. (0) Unusual, or inconsistent response to sensory stimuli in 1 or more of the following: (i) Sight. (ii) Hearing. (iii) Touch. (iv) Pain. (v) Balance. (vi) Smell. (vii) Taste. (viii)'The way a child holds his or her body. (d) Insistence on sameness as shown by stereotyped play patterns, repetitive movements, abnormal preoccupation, or resistance to change. (3) To be eligible under this rule, there shall be an absence of the characteristics associated with schizophrenia, such as delusions, hallucinations. loosening of associations, and incoherence. (4) A detenmination of impainment shall be based upon a comprehensive evaluation by a multidisciplinary evaluation team. The team shall include, at a minimun, a psychologist or psychiatrist, a teacher of speech and language impaired, and a school social worker. (5) A determination.of impairment shall not be based solely on, [sic] behaviors relating to environmental, cultural, or economic differences. (pp. 11-12) Improvisational music therapy: An active spontaneous approach to individual therapy based on Paul Nordoff and Clive Robbins’ (1977) Creative Music Therapy technique, in which music is used as therapy. The music responds to, motivates. and supports the child in order to effect his/her therapeutic growth. Improvisation: The process of spontaneously creating any combinations of sounds and silences in a musical setting with a specific therapeutic meaning and purpose. Communicative behaviors: Verbal, vocal. gestural, or instrumental responses which a) demonstrate the ability for future communicativeness to occur. b) are influenced by the musical improvisation and/or the experimenter’s behaviors. or c) attempt to influence the musical improvisation and/or the experimenter’s behaviors. Conmunicative Responses: Verbal, vocal. gestural, or instrunental behaviors demonstrated by the child which are influenced by the experimenter’s improvisation. Conmunicative Acts: Verbal, vocal, or instrunental behaviors 7 which serve as prerequisite skills necessary for musical comnunication. and verbal, vocal, or instrunental behaviors initiated by the child in an attempt to influence the experimenter’s improvisation/behaviors or for the purpose of independent expression. Comnunicative modalities: The following specific musical elements are identified as cmmunicative modalities: tempo, rhyttvn. structure/form. and pitCh. Assumptions This study is based upon the following assunptions: 1. Music can have a significant influence on autistic children. 2. Autistic childrenfs musical responses have common characteristics. 3. The sample used in this study represents children who are diagnosed with autism. 4. Autistic children have common characteristics. 5. Change can be implemented within 16 halfehour sessions. 6. Ten half-hour sessions provide sufficient treatment time to show measurable change using a reversal design. 7. Improvisational music therapy represents a definable music therapy intervention. Limitations Both the small number of children in the sample and the use of a single-subject design may be regarded as limitations of this study. However, considerations must be given to the rarity of autism and the heterogeneity found within the autistic population. The prevalence of autism is approximately 4 per 10,800 (Lotter. 1966; Ritvo et al., 1989). Single-subject procedures allow for the analysis of 8 relationships between treatment and behavior changes in a small sample of heterogeneous subjects. The male:female ratio in this study. which was 19:1, does limit the generalizability of the results. The male:female ratio in autism ranges froni1.4 to 4.8:1 (Gillberg, 1989). Only one female subject who fit the category specified for research was found in both of the counties searched. Another limitation is the various settings in which the study occurred. Attempts were made to match the rooms according to size, lighting, and content; however. one of the settings was a music room which contained nunerous musical instrunents. Even though a piano-drun area was set up in this room for the study, the experiment was affected to some degree by these distractions. Due to practical and ethical considerations, the reversal phase was only one session in duration. It is possible that this limited the autistic children’s responsiveness, since resistance to change is one of the characteristics associated with autism. However, the subjects in this study did not exhibit behaviors commonly associated with changes in routine, such as tantruns. perseveration, expressions of distress and/or rage, and self-abuse. One subject did attempt to stop the music by placing his/her hand over the experimenter’s mouth and taking the experimenter’s hands off of the piano. The experimenter continued singing and/or playing, and this subject eventually stopped these behaviors, remained seated on the piano bench, and appeared to listen to the music. Overall, the subjects did not seem to be resistant, just less responsive. 9 Ethical Considerations Since this research study involved hunan subjects, it was necessary to secure approval from the Michigan State University Cannittee on Research Involving Hunan Subjects (UCRIHS). The application was completed and reviewed under expedited conditions by a member of the [CRIBS conmittee. Approval was granted (Appendix A). Children were videotaped for purposes of data collection. The experimenter was responsible for the videotapes and erased them as soon as the study had taken its final written form.and all data had been collected and analyzed. No other person viewed the videotapes apart from the experimenter. her advisor, and the two observers who collected the data. Identifiable data was also kept under the responsibility of the experimenter and destroyed once the study had taken its final written form. Parents were assured that no names would be used in the actual report of the study. CHAPTER II A REVIEW OF RELATED LITERATURE Introduction In the first description of children diagnosed with early infantile autisn, Kanner (1943) devoted a large amount of attention to their cannunication deficits. Since then. research has continued to support Kanner’s observations of the nunerous problans related to autistic children’s comnunication developnent. The National Society for Autistic Children (1978). the American Psychiatric Association (1987 ). and the Michigan State Board of Education (1992) all list deficits in language developnent as one of the necessary symptans for the diagnosis of autism. The importance of language in determining future adjustment was studied by Eisenberg and Kanner (1956) in a follow-up study of 63 children diagnosed with early infantile autisn. When divided into speaking (children with useful speech at 5 years of age) and nonspeaking (unable to comnunicate verbally with others) groups. 16 of the 32 speaking children achieved a fair to good social development rating, and only 1 of the 31 nonspeaking children was rated the same. Rutter, Bartak, and Nemnan (1971) proposed that language problems may underlie the social difficulties of autistic people. Within the past decade, there has been a change in emphasis concerning language intervention techniques. Rather than simply attemping to increase vocabularies, emphasis has been placed on the development of meaningful comnunication (Schopler 8r. Mesibov. 1985). 10 11 Echolalia is now connected with comnunication, rather than seen as a self-stimulatory behavior to be eliminated (Schuler 8. Prizant. 1985). There has been an increase in research which canpares the language of autistic children with that of nonhandicapped children at the same developnental levels. Fran this research, a more sophisticated understanding of the language processes in autistic children has emerged. There is an increasing amount of literature describing music therapy programs and possible benefits for autistic children. The effectiveness of music therapy interventions with autistic children has been demonstrated through nunerous case studies, with improvanent in conmunication skills being one of the benefits frequently cited. The use of improvisation as a specific music therapy technique in improving cannunicative behaviors has been noted by Alvin and Warwick (1992). Hollander and Juhrs (1974). Nordoff and Robbins (1964. 1968a, 1971. 1977). and Saperston (1973). One of the advantages of interactions in a musical context is that comnunication is possible without many of the prerequisite skills necessary for expressive language. Improvisation has been widely used in developing commmication skills with a variety of handicapped children and adults, including those with autism. Since cannunication begins at the child’s level. improvisation allows for the flexibility needed for enabling a child to feel supported and accepted as he/she is. This support and acceptance help provide the child with confidence and security. thus facilitating the development of caummicativeness. Nordoff and Robbins (1964. 1968a. 1971, 1977, 1983) have done extensive work using imrovisation in working with autistic children. 12 Their technique. Creative Music Therapy. uninsizes the creation of musical improvisations which serve as a nonverbal means of communication between the therapist and the child. The music created is used to establish and maintain contact with the child and to provide opportunities for growth and development of musical catmunicative skills. After presenting a historical overview of the relationship between autism and cannunication/ language deficits, a review of the research that has substantiated the significance of autistic people’s comnunication/language problans in their prognosis will be provided. Specific aspects of the pragmatic or functional communication of people with autisn will be examined under the following two categories: prelinguistic and linguistic. Current language intervention techniques will then be reviewed. The research and literature pertaining to autistic children’s responses and abilities in relation to music and music therapy teChniques utilized with the autistic population will be presented. The review of music therapy techniques will consist of both structured and improvisational treatment methods. Autism and Canmmication/Language I_I_i§.torieaLl Overview Kanner (1943) gave the name ’early infantile autism’ to describe children he had encountered who had the following cannon characteristics: profound withdrawal, an obsessive desire for preservation of sameness, a skillful and affectionate relation to objects, an intelligent and pensive physiognotw, and either mutism or the kind of language that does not serve interpersonal cannunication. 13 A large portion of his writings elaborated on the communication deficits which he observed in autistic children. Even though research has changed parts of Kanner’s theory on autism, his observations of the communication problans have never been disputed (Fay & Schuler. 1980). Kanner’s language-oriented explanation of the autistic syndrome received support from research studies (Eisenberg & Kanner. 1956; Kanner. 1971); however, it was overlooked due to the predominance of psychodynamic theories which prevailed in the 19508. Autisn was generally viewed as an emotional and interpersonal problem, and the language symptoms were either overlooked or interpreted psychoanalytically. During the 1960s, a large nunber of studies appeared in the literature which supported Kanner’s (1943) language-oriented explarmtion. In 1964. Rimland’s book. Infantile Autism. proposed a cognitive model for understanding autistic behaviors. Rimland stated that the basic dysfunction in autism was the inability to interpret stimuli meaningfully. A shift from viewing autism as an anotional disorder to a language and cognitive disorder occurred. Further research continued to support Rimland’s theory (DeMyer et al. . 1973; Bermelin & O’Connor. 1970; Lockyer & Rutter, 1970; Rutter. Greenfeld, 8. Lockyer, 1967). Sane researchers have asserted that impaired sociability is the core deficit of autism. Ungerer and Sigman (1981) proposed a model which theorized that autistic children’s failure to engage in joint attention with others leads to deficits in social comnunicative interaction. Wing (1981) stated that the language and cannunication deficits of autistic children stem from deficits in social interaction 14 abilities. Paul (1987) stressed the importance of addressing the deficits in processing intonation about Iocial situations in order to begin to improve cannunicative disorders. The determination of whether autism is prinnrily a language, cognitive. or social disorder is unresolved and perhaps futile due to the interplay that exists between them. The most current view suggests that anphasis should be placed on the interrelationship between these three deve lopnental areas. Importance of Comnunicationzlggguage in the Prognosis for Autism The acquisition of language has been shown to be crucial to the prognosis of autistic children. The presence of useful speech by 5 years of age was one of the most significant distinguishing characteristics between autistic children rated as making poor adjustment and those who nude good adjustment (Eisenberg & Kanner. 1956). This finding, that the degree of language development by the age of 5 years is predictive of later developnent. was confirmed by Schachter (1986), who continued follow-up on two autistic people for 22 to 30 years. The subject who had acquired skills in language by 5 years of age achieved reasonably competent skills as an adult as compared to the other subject, who continued to be dependent on parental and institutional care. Brown (1963) also cited severely impaired language as being predictive of poor later adjustment and suggested a cutoff age of 3 years. Deliver et al. (1973) conducted a follow-up study of 85 autistic boys and 35 autistic girls with a mean age of 5 1/2 years at the initial evaluation and a mean age of 12 years at follow-up. Forty— three percent of the children who demonstrated comnunicative words 15 during the initial evaluation developed conversational speech beyond expressing inmediate needs. as compared to twenty-nine percent of the children who demonstrated echolalia without communicative value and eleven percent of the mute children. In another follow-up study, Bagley and McGeein (1989) found that autistic children. with a mean age of 8 years, who were mute and socially unresponsive at the time of their admission to a residential center for the treatment of autisn had poor outcomes four years later. Functional language skills by early school age was shown to be as powerful as intelligence in predicting autistic children’s later skills (Rutter, 1978). Gillberg and Steffenburg (1987) followed 46 autistic children up to 16-23 years of age. The most important prognostic factors found were IQ greater than 50 at diagnosis and commmicative speech development before 6 years of age. Ninety-seven autistic children with speech loss before the age of 30 months and 164 autistic children without speech loss were compared by Kurita (1985) several years after the speech loss had occurred. Speech loss was defined as total loss of the articulation of meaningful words or complete loss of gestural expressions. Prior to the speech loss, these children were able to meaningfully use a range of 1 to 30 words and varied from showing fairly normal development to showing abnornnlities in their development. The subjects with speech loss demonstrated more retarded mental developnent than the subjects without speech loss. Also. Mesibov’s (1983) follow-up study demonstrated that social and camunication problems were the mjor obstacles to adult adjustment. As a result of all of these studies, speech and language skills of autistic children became of paramount concern for researchers and 16 clinicians Itudying arnd treating the syrndrorne. municationzggyage Qgrwteristicg of Autistic Qildren The range of carrnunication skills in autistic children is extremely wide. Low functioning children may throw tanper itantruns, nuke vocalizations, or use physical actions in expressing discomfort, pleasure, or desire. or in initiating an interaction (McLean & Snyder- McLean, 1978).. Higher functioning communicative skills include the use of physical guidance. gestures, pictures, signs. typing, or speech. There is not any one pattern of autistic communication problems. These problems are variable and must be examined individually. In Kanner’s (1946) description of autistic children, he noted the following specific characteristics of their language deficits: muteness, imnediate and delayed echolalia, metaphorical substitution. literalness. simple verbal negation. repetitions. and pronoun reversals. He concluded that both the mute arnd the verbal children were the same as far as meaningful communication was concerned. Cunningham and Dixon (1961) studied the language of a 7-year-old autistic boy, analyzing it both quantitatively arnd qualitatively. Quantitatively, it resembled that of a normal child ranging in age from 24 to 30 months, and qualitatively, it was at a lower level of developnent. Characteristics included monotony. low rates of questions asked, low frequency of intonation given, frequent use of incomplete sentences, and a lower frequency of egocentric speech as compared to a rnormal child ranging in age‘ fran 24 to 30 months. A current view of these characteristics is offered by Frith (1989). Difficulties in pragmatics is now seen as a universal feature of autian. Varying levels of skills in syntactic and semantic aspects 17 of language are demonstrated by autistic people. There are many autistic children who are mute. but it is not yet known if they suffer fran phonological, syntactic, and/or semantic impairments. At least three-quarters of all speaking autistic children demonstrate echolalia, but it is not yet known why. Autistic children use bizarre idiosyncratic phrases and frequently demonstrate difficulty with pronouns and tenses. Their use of prosodic features for conversational purposes is also impaired. Frith points out that even though more has been written on the language impairments of autistic people than on any other of their deficit areas, nunerous questions rennain unanswered. In the area of cornnunication developnent. Austin (1962) and Searle (1969) laid the foundation for studying the pragmatic aspects of language. or how language is used for various purposes. Descriptions of language deficits in autistic children changed their emphasis in the 1970s, focusing on a pragmatic or functional viewpoint (Bates. 1976; Bates &.MaCWhinney, 1982). It has been found that autistic children’s communicativeness involves a primary deficit in pragmatics (Baltaxe & Simmons, 1981; Rutter. 1978; Tager-Flusberg, 1981). Specific aspects of pragnatic or functional cornnunication will be examined under two categories. The prelinguistic category will cover prerequisites of cornnunicative intent, imitation skills. aberrant behavior as fnunctional cornnunication, and early skills in social cornnunication. Cannunicative intent and functions, along with social-interactive communication will be examined in the linguistic category. Literature related to echolalia and speech prosody will also be reviewed. It is important to keep in mirnd the following two points: (a) No autistic children irndividually exhibit all of the following deficits, and (b) the 18 majority of autistic children’s cannunication deficits are multi- dimensional. Prelimistic The functional viewpoint of communication led to an increasing amount of research on prelinguistic issues. This research is valuable not only to younger autistic children. but also to sane of those who are mute. Incidences of muteness in the autistic population range fran 28 to 61% (Fish. Shapiro, 8. Campbell, 1966; Lotter. 1967; Wolff & Chess, 1965). Curcio (1978) studied nonverbal cannunicative acts of twelve mute autistic children ranging in age fran 4 to 12 years. Protodeclarative acts, or those that served as statements, were absent. These children used only protoimperative acts. or those that met their own needs or goals. The manners in which protoimperative acts were cannunicated varied between the autistic children and included demonstrating eye contact. offering an object to solicit the teacher’s help. using the teacher’s hand as a tool, and banging the object. Based on her investigation of the relationships between sensorimotor fnunctioning and cannunicative developnent. Curcio suggested that imitation skills and the understanding of causality and means-end relationships are prerequisites to intentional cannunication. This firnding was substantiated by Abrahamsen and Mitchell (1990) in their study of ten autistic children ranging in age fran 3 to 7 years. The means—end function was fournd to be significantly related to both the nunber arnd the diversity of pragmatic functions expressed. Pragmatic functions included requesting, getting attention, rejecting, seeking information. cannenting, giving information. and participating 19 in social routines. Also, vocal imitation was significantly related to the nunber of pragrtntic functions expressed. The ability to imitate differentiated the verbal fran the rnonverbal children. The achievanent of cannunicative intent correlated significantly with performance on the means-end scale. which suggests means-end is one of the prerequisites of intentional cannunication. Many autistic children lack purpose-oriented. means-end behaviors. Fay arnd Schuler (1980) discuss behavioral anamlies. such as stereotyped repetitive play, self-stimulatory behaviors. and rnonfunctional stereotyped speech, as a reflection of means-end limitations in autistic children. Imitation plays an invaluable role in the developnent of cannunication and social skills. A child must be able to imitate in order to learn words and certain prerequisite social skills (Schopler &. Reichler. 1979). Imitating ongoing actions is one of the three mjor strategies infants use in responding to language (Lord, 1985). Serious deficits in verbal arnd gestural imitative skills in autistic children have been noted by Curcio (1978). DeMeyer et a1. (1972). and Signan and Ungerer (1981). Stone and Lemanek (1990) also noted these deficits when canparing autistic children, ranging in age fran 3 to 6 years. and mentally retarded children. A parent report measure was utilized and resulted in significant differences between the two groups in imitating the movements of another child at play. Carr, Pridal. and Dores (1984) suggested a predictive relationship between vocal imitation skills and receptive language after firnding children who imitated somndI were more likely to acquire label recognition skills than children who did not have the ability to imitate. Studies have shown that autistic children have limited motor imitation skills, and those with the nnost impairment 20 in this area are the nnost socially withdrawn (Dawson 5 Adams, 1984; Dabber et al. . 1972). Failure to develop social imitation skills. as noted in autistic children by Rutter (1978). may be related to their deficits in social cannunication. One often overlooked form of cannunication is behavior problans. Research has shown that both normal (Bruner. 1979) and developnentally delayed children (Carr. 1977; Wolf. Risley. Johnston. Harris, & Allen, 1967) display behavior problems for attention-seeking or avoidance purposes. A pragnnatic viewpoint does not look at these behavior problems as problems to be eliminated. Rather, they need to be analyzed as possible cannunicative fnunctions. Durarnd and Carr (1985) list the following four basic motivators for aggressive or self- injurious behaviors: social attention, tangible consequences, escape. and sensory consequences. Teaching alterrnative socially appropriate forms of cannunication has been shown to be effective in replacing those behavior problems motivated by social attention. tangible consequences, or escape needs (Carr, 1985). The emphasis on pragmatics has led to an increasing amount of literature dealing with the social aspects of cannnunication and language problems. Impairments in social cannunication by nonverbal autistic children can range fran an overall absence of desire to cannunicate with others to lacking the ability to use nonspoken means of socialization. Social cannunication involves givirng and receiving social signals. which can be nonverbal arnd verbal. In normal children social cannunication begins as early as 2 months of age when conversational give-and—takes first appear through vocal izations, facial expressions. arnd body movements (Bullowa, 1979; Schaffer, 1974; 21 Trevarthen, 1974). According to Bruner (1975) this developnent of reciprocal activity is a prerequisite of intentional cannunication. Ricks and Wing (1975) state that babies of this age also begin to express feel ings by using a variety of intonations in their sounds. The analysis of twin boys at 16 weeks of age, one of which was diagnosed with autism at 30 months of age, showed differences in their interactions with their mother (Kubicek. 1980). A cyclical patterned interaction occurred between the normal boy and his mother and was characterized by repeated cycles of the mother nodding her head, pausing. and the baby smiling, moving his arms up arnd out. and then looking away. In canparison, the autistic twin turned away fran his mother and cut off the approach with an abrupt arm movanent. Another difference noted was that the autistic twin showed only a neutral face. and the normal twin showed smiles. frowns. arnd a neutral face. Attwood (1984) canpared autistic, normal. and Downs’ syndrane subjects and fournd that the Downs’ syndrane children made contact with others to a greater extent and the autistic children to a lesser extent than the normal children. Also. 0% of the gestures produced by the autistic children were expressive, as canpared to 50% of the Downs’ syrndrane chi ldren’s gestures and 26% of the normal children’s gestures. Ricks and Wing (1976) studied spontaneous facial expressions in autistic children and found that they used expressions of pleasure, distress, fear, and anger only in extreme forms. mm Canmunicative intent has been researched by examining spontaneous Ipeech, the initiation of conversations, and speech acts. Shapiro, Chiarandini. and Fish (1974) studied the spontaneous speech of children 22 with autism and described it as being rigid and contextually irnappropriate. Watson (1985) noted deficits in the infrequent nunber of attempts made by autistic children in initiating contact with others. Speech acts. or intentional communicative behaviors/vocalizations. of autistic children were compared to those of language impaired and normal children.by Ball (1978). She found that autistic children used both informing acts (those which direct other’s attention to the child or an object as an end in itself) and regulating acts (those which regulate others’ behaviors to obtain an environnental end) significantly less frequently and inappropriate utterances significantly more frequently than.both the language impaired and normal groups of children. The firnding of the limited use of regulating acts in autistic children has been challenged by several researchers examining functional cannunication (Curcio, 1978; Watson 8. Lord, 1982; Wetherby & Prutting, 1984); however, further research has supported her conclusion that autistic children functioned at a lower level of pragnatic developnent. Functions of autistic children’s communication directed toward others have been studied by numerous researchers. Cantwell. Baker. and Rutter (1978) analyzed functional language usage at both individual and group levels of autistic and aphasic children. They found that autistic children used more abnormal and egocentric speech arnd less socialized speech. Abnormal and egocentric speech included inappropriate echoes, thinking aloud. and.metaphorical speech. Socialized speech included spontaneous statements. appropriate echoes, and directions. Consistent differences between the cannunicative fnunctions of four 23 autistic and four normal children were fonund by Wetherby arnd Prutting (1984). The children were matched for expressive language stages. which ranged from pre-verbal to three-word combinations. The autistic children.demonstrated a more narrow range of functions than the normal children. They showed a high frequency of requesting objects and actions, protesting. and nonrcommunicative vocalizations. The functions of requesting information. acknowledging others, showing off. and cannenting were demonstrated by the rnormal chi ldren. but not by the autistic children. Wetson and Lord (1982) also found a high frequency of requesting objects and actions, along with requesting penmission. in the spontaneous communication samples collected from 11 autistic students. Rarely did these students request attention during these samples. Similar results were reported by Landry and Loveland (1989). who investigated attentionedirecting gestures and language in the following three cannunicative situations: adult-directed, requesting. and spontaneous. Fifteen autistic children. ranging in age from 5 to 13 years. were canpared to fourteen developmentally language-delayed children, ages 3 to 10 years, and thirteen nonmally developing children. ages 2 to 3 years. Attentionrdirecting behaviors were used less frequently by the autistic children. arnd they differed most fran the other two groups in the spontaneous communicative context. Attention—directing behaviors also varied less with the communicative context than that of the other two groups. Echolalia is one of the characteristics of autism.frequently cited. In normal children. it exists fran about 9 months of age to 2 or 3 years of age. As the child’s language skills increase in 24 complexity, echolalia decreases in frequency (Menyuk. 1977; Prutting & Connolly. 1976). This decrease in frequency has also been found in autistic children as their language skills becane more canplex (Bowlin. 1982). The belief that echolalic behaviors serve no significant cannunicative purposes has been challenged. Echolalia and stereotypical language of autistic children can be analyzed according to communicative intent. comprehension. and structural changes. Since most autistic children scan to be urnable to break down canponents of speech. it is possible that echolalia is an alternative strategy used in an attempt to cannunicate. Paul (1987) states that sane autistic people use echolalia to engage in conversations. The results of two major studies irndicated that four of the seven types of irnnediate echolalia (Prizant &.Duchan, 1981) and nine of the twenty categories of delayed echolalia (Prizant &.Rydell. 1984) are interactive. Tager— Flusberg (1985) stated, "Echolalia and stereotyped language are now seen as primitive strategies for cannunicating. especially in the context of poor comprehension" (p. 72). Another area concerning the pragmatic skills of verbal autistic children is discourse, or how autistic children’s cannunication relates to cannunication directed towards than. Various social impairments have been noted in autistic children’s speech. Tager-Flusberg (1981) observed difficulties in the ability to maintain a topic in a conversation. Baltaxe (1977) arnalyzed pragtmtic impairments in the give-and-take of speaker-listener relationships and in the flow of conversations. Autistic children repeated questions over and over. did not allow for differentiated responses. did not ensure their listener’s 25 attention, and failed to maintain social rapport while speaking. Another deficit area noted was the limited use of the nonverbal accanpaniments of speech, such as displays of affect through facial expressions and intonations (Ricks &.Wing, 1975) and the understanding and use of gestures (Bartak, Rutter, &.Cox, 1975). Another area of pragmatics in communication skills is prosodic developnent. Prosody, or the melody of speech, consists of intonation, accent, and rhythmic pattern in language. Acoustically, it is a composite of frequency, amplitude, and duration. Prosody plays an hmportant role in speech production and perception. Autistic children frequently demonstrate deficits in prosodic developnent, even when speech is significantly improved (DeMyer et al., 1973; Eisenberg & Kanner, 1956; Rutter, 1966; Rutter &.Lockyer, 1967). Current research suggests that these deficits are not as globally abnonmal in autism as once suspected, but they are more pervasive when canpared to aphasic and normal subjects (Baltaxe a Sirnnons, 1985). Baltaxe (1981) compared the prosodic production characteristics of autistic and normal children using an imitation task. The normal children synchronized their speech events using a regular rhytlln and accenting syllables at equal intervals. The autistic children followed a chain or serial model. where no adjustments in duration were trade when connecting words or syllables together. Intonation contours of normal, aphasic, and autistic children were compared in a study by Baltaxe, Sirnnons, and Zoe (1984). Autistic children demonstrated either a highly exaggerated or a narrow fundamental frequency range. In.analyzing terminal fall, overall intonation contour, and covariation of frequency and intensity over the entire intornat ion contour, results 26 showed variability both between arncl within subject groups. Both the autistic and aphasic groups danonstrated greater variation than the rnormal group. MmimtionzlanMe Interventions with Autistic Children Throughout the research arnd literature pertaining to autistic chi ldren, structured intervention approaches are frequently recannernded. A high degree of structure is seen as an essential element in autistic children’s treatment plans (Thaut, 1980). Having a planned time-table, succession of activities, and micro-organization within activities are among nunerous structural canponents which are generally accepted as the most useful approaches for working with autistic children. In reviewing the research of educational approaches, Clarizio (1983) found general agreement that autistic children learn best in structured enviromnents, where both the stimuli and the child’s responses are determined by the adult. Current trernds in language intervention programs with autistic children are numerous. There has been a change in emphasis fran teaching language skills to teaching carmnunication skills due to the importance place on functiornal cannunication. This shift focuses on accepting each child’s language impairment and working toward his/her optimun potential in cannunication development (Schopler & Mesibov, 1985). Most language development interventions fall into one of three major schools of thought: behaviorism, nativisrn, and constructivism (Snyder a Lindstedt. 1985). Behaviorism stresses the learning envirorment providing stimuli to elicit responses, the need for generalization, the role of imitation, arnd the need of reinforcement. 27 Nativists are concerned with children discovering the rules of a language systan. Specific techniques which emerged fran nativist language models include expansion (Brown at Bellugi. 1964). or taking the child’s responses arnd adding elanents to than for further developnent; modeling (Leonard, 1981), or observirng saneone produce the intervention target; and focused stimulation (Leonard, 1981). where language-specific rules are anbedded in a story. Constructivists, influenced by the work of Jean Piaget (1963), stress the role of cognition in language developnent. Materials, activities. and discussions designed to facilitate cognitive developnent are provided for the children. The assunption is that cognitive developnent will have a positive effect on a child’s language developnent. All three of these models, both irndividually and interactively, have been used with autistic children. Behavioral interventions have demonstrated effectiveness with yonung autistic children. However. fol low-up data have been discouraging. One exception was a two-year study cornducted by Lovaas and Snith (1988). who stressed the importance of early intensive intervention. Their study included 38 autistic children under the age of four years. The experimental group consisted of 19 children who received forty hours of one-to-one behavioral treatment per week. The control group consisted of 19 children who received ten hours a week or less of one-to—one treatment. Results irndicated that out of the 19 children in the experimental group, 9 of them achieved a normal IQ arnd were able to enter first grade, and 8 of than achieved an IQ within the mildly retarded to low rnormal range and entered into first grade in aphasia classes. Overall, the experimental group achieved 28 significantly higher IQ scores and had significantly higher educational placanents than the control group. Follow-up data on these children was encouraging. Gains were maintained, and none of the 9 experimental group children who achieved a normal IQ were classified as autistic in adolescence. They scored in the normal range on all assessments utilized. Division T'EACXIH is the North Carolina state program for autistic children which consists of thorough diagnostic evaluation, planned collaboration between the bane and school, consultants who work with teachers, arnd attention to the chi ld’s developnental level (Watson, 1985). The cannunication curriculun stresses the autistic student’s ability to cannurnicate as opposed to his/her ability to learn language skills. The criterion for success is the spontaneous use of newly developed cannunication skills. In their functionalist approach to intervention procedures. Prizant and Schuler (1987) and Schuler and Prizant (1987) suggest respornding to the child’s intentions, offering more appropriate means for expression, arnd creating contexts which encourage increased amournts of expression and an increased variety of intents. Rogers and Lewis (1989) noted significant treatment effects in autistic children who received a pragmatics-based language therapy model along with other intervention strategies for a period of six months. In this language therapy model, teachers were taught to interpret all potentially cannunicative verbal and nonverbal behaviors and to respornd at correspornding levels. Significant improvements were noted in language skills and in social/cannunicative play, and a reduction of autistic symptans occurred. 29 Functional consequences, or those that are logically related to certain actions, have been stressed in intervention programs for children diagnosed with autian. Koegel and Williams (1980) conducted a study in which autistic children learned communicative acts faster when they led to fnunctional as opposed to irndirect consequences. Fay and Schuler (1980) suggest teaching verbal imitation skills along with cannunicative intent and linking speech to rhytl'mic activities, which may improve overall intelligibility and intonatiornal quality of speech. In choosing alternative systems of cannunication, they state, "It nnay, for instance, be found that a particular system allows a child to respornd errorlessly, which may reduce the likelihood of off-task behaviors arnd thereby reduce the occurrence of behavioral problems" (p. 180). Another advocate of teaching alternative modes of cannunication is Wetherby (1984). She suggests using gestural modes of cannunication with severely autistic people since this technique uses and ernhances their existing strengths. The use of cannunicative gestures is seen as a foundation upon which further skills can be built. Nonspeech modes are also described as quicker arnd easier means of cannunication for children who do not have speech or have limited speech skills (Schuler &. Baldwin, 1981). The most recent intervention technique for people with autism is facilitated cannunication, a method developed by Rosanary Crossley (Biklen, 1990). This method is based upon a Ms theory, which presunes that autistic people have a neurologically based deficit, not in canprehension, but in expression. In her own autobiography, Brnergence Labelg Autistic (Grandin &. Scariano, 1986), Temple Grandin, a person with autism, describes her previous communication problems as 30 a ’one-way street’. She was able to comprehend what was being said, but she was unable to respord other than by screamirng and flapping her herds. Facilitated cannunication utilizes an electronic typing device and allows for education through dialogue and personal expression. Respect for the students is highly emphasized, and many of the outlined procedures are concerned with the teachers’ attitudes and beliefs. Due to the need for physical support, the inconsistency of results fran one situation to another, and the challenge this presents upon the widely held assunptions about capabilities of autistic people, much controversy has been raised. Only one research study on facilitated cannunication, corducted by the Intellectual Disability Review Panel (1989) in.Melbourne, Australia, has been published to date. This study produced support both for people who claimed facilitated canmunication was valid and for those who doubted its validity. Intervention programs have demonstrated success in autistic children’s socialization arnd canmunication achievements. However, treatment appears to have only a modest effect on long-term language adjustment. Music Therapy and Autism Musical Responsiveness and Abilities of Autistic Children My reports fran clinical observations ard experiments with autistic children.emphasize their special responsiveness toward and unusual interest in musical stimuli. various authors have noted musical talents in autistic wople, including Rimlard (1964) who concluded that interest in music ard musical ability are almost universal in autistic children. DeMyer (1979) interviewed parents of autistic children ard fourd 31 that music elicited some interest and response in 90% of these children, which he noted as being remarkable due to their general lack of positive response to the envirorment. Sherwin (1953) fourd that autistic children tend to show a special ability for and preoccupation with music. Three autistic children were studied ard demonstrated the following cannon musical responses: an interest in singing ard listening to music, the ability to remember melodies, the ability to identify known nnelodies, a preference for familiar songs, and a preference for rhythmic pieces. Slnerwin suggests that music may be a vehicle for canmunication for autistic children since it does not require the use of speech. Oppenheim (1974) states that not only do most autistic children enjoy music, but rrnany of than also are able to accurately sing alone at an early age ard have a good sense of rhytlun. Applebaun, Egel, Koegel, ard Imkoff (1979) corducted an experiment in which autistic children performed as well as or better than age- matched normal children in the ability to umitate individual tones and series of tones delivered by voice, piano, and synthesizer. Thaut (1980) found that improvised tetrachordic tone sequences of autistic children in his study approached those of normal children and received significantly higher scores than mentally impaired children when analyzed according to canplexity, originality, rhythm, rule adherence, ard restriction. Applebaun et a1. (1979) reported that autistic children are better able to imitate a pitch than to improvise. Studies have produced 'various results in determining auditory versus visual modality preferences in autistic children. One study corducted by Hermelin ard O’Connor (1970) indicated visual stimuli preferences. Kolko, Arderson, ard Campbell (1980) state that autistic 32 children’s preference is auditory when the auditory stimulus is musical as opposed to a pure tone or white noise. Thaut (1980) found similar results, reporting that autistic children preferred musical stimulus corditions over other auditory ard visual corditions. He also noted that the autistic children listened to the preferred musical stimulus significantly longer than the normal children in the control groups. Akogiounoglou (1990) studied the ability of autistic children to orient themselves and respond overtly to various familiar and novel auditory stimuli and found a slight preference toward the musical excerpts as canpared to the enviromnental arnd vocal sounds. Although several authors have fournd that many autistic children have strong positive responses to certain types of musical stimuli, others have also noted the individual differences that exist. Sane children respond negatively and others positively to the same musical stimuli (Alvin & Warwick, 1992; Nordoff & Robbins, 1971). Nordoff and Robbins (1971) analyzed the rhythmic responses of 145 developmentally disabled children. They found that separate categories of activity and sensitivity began to emerge from the children’s responses and defined 13 categories of response. One of these categories, canpulsive beating, was almost always associated with autistic children. Usually, this response was totally unrelated to the environment and appeared meaningless. Most children terded to beat a fixed regular tempo without any variations in accents or dynamics. Sanetimes, they seemed to be aware of the ongoing musical improvisation, but were not able or willing to relate their beating to that of the music. Toigo (1992) states that a connection can frequently be made between the chi ld’s rhythmic responses ard his/her 33 relationship with the envirounent. For example, one’s inability to mtch the tempo of an ongoing improvisation can mirror his/her inability to meaningfully cannunicate within his/her environnent. Structured Music Therapy Technigues ard Autism The literature regarding the therapeutic uses of music with autistic children yields studies supporting its value in many different areas. Stevens ard Clark (1969) fonud that music therapy techniques can be significantly effective in improving sane prosocial behaviors of 5- to 7-year-old autistic children. Prosocial behaviors were defined as those which are adaptive, adjustive, ard socially acceptable. Action songs, rhythmic imitation activities, a chord organ, ard an autoharp were utilized in eighteen music therapy sessions. Other noted changes included improved bodily image arnd coordination. Positive attributes of music therapy in the treatment of autian were fonud by Mahlberg (1973) in four areas: increase attention span, developed rnonverbal cannunication techniques, reduced autistic behaviors, ard increased self-expression. Goldstein (1964) reported on an 8-year-old autistic girl who received music ard creative arts therapy for a period of six months. Specific techniques used included vocal exercises designed to aid in verbalizing aggressions, singing activities for the purpose of increasing her vocabulary, action songs emphasizing body awareness, and movement to music improviIations designed to aid in rhytl'nn ard coordination. Psychological testing prior to ard after the music therapy sessions irdicated a 10-month improvement in mental age, increased ability to concentrate, ard an increased attention span. Other improvements noted by the author included progress in 34 interpersonal relationships, decreased frequency of tantrums, and an increased verbal expression with a decreased physical expression of frustration. Music therapy sessions were used as reinforcement for autistic students’ frequency of spontaneous speech by Watson (1979). Tbkens were given to students in one group who could exchange than for music therapy sessions, and in the other group, tokens alone were used for reinforcement. Both groups exhibited an increase in spontaneous speech; however, the music therapy reward produced a greater frequency of spontaneous speech responses. Saperston (1982) worked with a thirteenryear-old autistic boy for 24 months on the long-term goal of imitating vocalizations. At first, rapport was established with the boy by engaging him in a musical interaction with the therapist. This music interactional activity was then used as reinforcement for in-seat behavior, which further lead to the use of a bodybimage song and a hand-clapping activity in order to get the child to respord to auditory ard visual cues. Vocal imitation activities were then added, which consisted of the therapist singing a short melody canprised only of the vocalization to be imitated ard presenting the vocalization in isolation. Progress was noted in learning to respord appropriately to specific cues, imitating vocalizations, increasing attention span, enjoying physical contact, approaching others, and decreasing stereotypical and self-abusive behaviors. Farmer ( 1963) reported on the use of songs, dances, ard musical games with autistic girls rangirng in age fran 6 to 8 years. Attention spans were increased, physical contact was increasingly tolerated, ard 35 responsibility ard group awareness were developed. In 1966. North described music therapy activities which can build self-esteem, increase interpersonal relationships, ard increase appropriate verbal interactions in autistic children. Euper (1968) fourd the use of rtwttm bard activities effective in helping a 6-year-old autistic boy to purposefully relate to his envirorxnent. Difficulty was noted in the child’s ability to synchronize his own rhytl'mic activities to the rhyttm of the music. He eventually was able to alter his tempo in the same direction as the changes in the music ard increase his rhytlnicity. Cecchi (1990) presented a case study on a 28-month-old girl who developed an autistic syrdrane as a result of the violent abduction of her parents. During her sixteenth session, the girl uttered her first sound, a musical tone. The tone was imitated by the therapist. ard gradually, the child began using this tone as a means of canmunication. As the sessions progressed, soft melodies without ard with lyrics ard new songs were introduced. Progress was first noted in the child’s cannunication and production of new spontaneous sounds. Over a four- year period, she was able to use songs to reconstruct her history, express her confusion ard her feelings, ard finally, accept the death of her parents. The use of a simultaneous cannunication method with a 3-year-old nonverbal autistic boy was unsuccessful until an adaptation of melodic intonation therapy was introduced (Miller & Toca, 1979). This adaptation consisted of signing plus an intoned rather than a spoken verbal stimulus. The boy began respording first by signing arnd later by singing his responses. Trained, imitative, ard spontaneous intoned 36 verbalizations resulted ard generalized to a variety of settings. Bairston (1990) canpared mentally retarded autistic ard mental 1y retarded nonautistic chi ldren’s responses to music ard art therapy ard fourd no significant differences between the two groups in developnental gains. Significant increases in acceptance of physical contact, time spent observing the teacher, ard time spent in appropriate play were made by the nornautistic students, but not by the autistic students. The only specific music therapy activity reported in the study was an introductory chant. Other music therapy activities, unspecified by the authors, were used to stimulate noanusical canmunicative responses. Sane verbal approximations did appear in the autistic children; however, they were not consistent. Burleson, Center, ard Reeves (1989) reported that backgronud music reduced off-task responses ard increased task accuracy in four psychotic children, including both diagnoses of autian ard schizophrenia. Movisational Music Therapy ard Autism Improvised music has been fonund to be effective when working with autistic children. Nordoff ard Robbins (1964) noted several benefits of the use of improvisation. Vocal ard instrunental improvisation aided in establishing cannunication, eliciting speech, improving . interpersonal relationships, ard decreasing pathological behaviors. In arnother report, Nordoff ard Robbins (1968a) used improvised music to inspire ard accanpany various responses of clients. These responses were then sustained in order to give clients the opportunities to experience a shared musical activity. Working with a 6-year-old autistic girl, they used improvised music to improve her vocabulary. 37 The music used in the improvisations consisted of various tempi ard dynamics. Songs were improvised for the girl, who eventually began expressing herself through these songs. Her vocabulary increased, and she began to spontaneously use personal pronouns while singing. Other progress was noted in her behavior ard in her responsiveness at hane. Observations made by Nordoff ard Robbins (1971) after continuing this technique with nunerous autistic children illustrate ard corroborate the many values of improvisational music therapy. Sane of their conclusions are as follows: (a) Canmunication begins with sane autistic children by musically matching their apparent behavioral ard emotional levels, (b) musical cannunication by-passes children’s speech and language barriers, (c) music can be used to relax autistic children in order to allow for controlled and ordered responses, (d) musical improvisations which create an anotional envirorment can stimulate responses fran a child, ard (e) music as a nonverbal means of communication allows for a vast range of expression. Nerdoff and Robbins report on their success in using various improvisational music therapy techniques to lead children away fran the restricted categories of responses ard into freer, more cannunicative categories. In establishing a therapist-client relationship with a 5-year-old boy who exhibited autistic features, Nordoff and Robbins (1977) utilized improvisational techniques through both drun/cymbal-piano ard vocal interaction activities. Improvisations were used to accomplish the following: mtch the boy’s emotional intensity while accepting his expressions, accanparny the boy’s movements ard sourds to gain an initial contact, reach and activate the child, develop and sustain his cannunicative vocal responses, musically organize his vocalizations, 38 lead into intercanmunicative singing, ard actively involve him in instrunental activities. Progress was noted in several areas, incltding an increase in his vocabulary, developnent of spontaneous ard cannunicat ive speech, developnent of conversational jargon, acceptance of learning situations, increased interaction with other children, ard acceptance of change and rnovel situations. Saperston (1973) used improvised music to establish cannunication with an autistic child who had not previously appeared to experience any type of canmunication. His technique consisted of the improvisation of a specific nntif to natch each of the child’s basic nnvements. The child eventually learned that he was able to control the therapist’s responses ard that by canmunicating, he could influence his own enviromnent. Saperston noted innprovements in the child’s relationships with others, cannunicativeness towards him, increased frequency of vocalizations, ard increased eye contact. Alvin ard Warwick (1992) reported on a research project which consisted of approximately 20 music therapy sessions for each of 10 autistic children ard their mothers. Out of the as sessions, 10 of them were one-on—one with the child, ard the other 10 involved the therapist, the child, ard his/her nnther. The project was designed to investigate whether music therapy would show positive effects in autistic children, whether the effects would generalize, whether the nnthers’ involvement would help the generalization, ard whether canmunication would develop between the nnther ard child. Results of this project are still nuder analysis; however, Alvin ard Warwick reported on two case studies taken fran the project. In the first case study. improvisation was utilized to facilitate 39 interaction between the child, her nnther, ard the therapist ard to provide for appropriate expression of arnger ard frustrations by both the child ard her nnther. Progress was noted in the child’s learning to share musical experiences with her mother, becaning nnre aware of her feelings, ard learning appropriate ways to express these feelings. Cannunication ard urderstarding was developed between the child ard her nnther, ard a stronger relationship between the two developed. In the secord case study, improvisation between the child ard therapist helped develop a relationship of trust ard enjoyment. The improvisation continued to be nunintrusive ard nordirective when the nnther joined the sessions. Musical cannunication developed between the nnther arnd the child, ard interactive music activities gradually succeeded. The nnther reported that her son had developed awareness of others, awareness of his environnent, ard an affectionate relationship with her. Hollarder ard Juhrs (1974) used Orff-Schulwerk activities to help severely autistic children, ranging in age fran 4 to 16 years, invest in a meaningful group experience. Activities were designed to develop body awareness, laterality, gross ard fine motor skills, spatial relationships, ard receptive larnguage. Improvements were noted in all of these areas. Rordo arrangements were used to allow for both repetition ard innovation. Other Orff activities provided opportunities for the children to initiate ard becane involved in reciprocity ard interchange. Several authors have recannerded improvisational music therapy approaches for autistic children. Bruscia (1987) reported on one approach, Developnental Therapeutic Process, which was developed by 40 Barbara Grinnell ard consists of a canbination of music therapy, play therapy, ard verbal psychotherapy. The music therapy is used to establish nonverbal contact ard canmunication with the child during the initial stages of therapy. In these stages, the therapist improvises songs at the piano which reflect the child’s feelings ard/or evoke responses fran the child. The child either listens or plays a percussion instrunent along with the therapist. Integrative Improvisational Therapy was originally designed by Peter Simpkins for use with atypical children, including those with autism (cited in Bruscia, 1987). Piano ard voice improvisations are used by the therapist to encourage verbal ard musical interactions. The child is encouraged to play percussion instrunents, vocalize, sing, ard/or verbalize. Improvisation is used to reflect what the child discloses through his/her nnvements ard musical responses, to engage the child in a purposeful response/expression, ard to contain, clarify, ard confront enntional ard interpersonal struggles. Bnphasis is placed on eliciting a transference reaction within the improvisation in order for the child to reveal ard resolve his/her conflicts. Nordoff ard Robbins’ (1977) Creative Music Therapy approach allows for nonverbal cannunication, in which music is used to enter gently into the child’s world before placing demards on the child to enter into the therapist’s world. Temple Grardin (Grardin 8. Scariano, 1986) recannerded joining in autistic children’s stereotypical behaviors ard then broadening them into an activity. This approach has been used with success by Toigo (1992). Grandin also discusses the importance of conveying acceptance ard nuderstarding to autistic people, which is another aspect of Creative Music Therapy. In mtching the child 41 through the music, the child is given control over his/her environnent. Saperston (1979) developed a hierarchy for music therapists to establish cannunication with low-functioning autistic children. The three plnases which constitute Saperston’s approach are entering reality at the child’s level, sharing reality at the child’I level, ard manipulating reality at the child’s level. Benenzon (1976) suggests a four—stage music therapy technique for establishing cannunication with autistic children. This technique consists of firding sonuds to which the child will respord, using instrunents to reproduce the sourd or sane parameter of the sourd, using instrunents to establish direct contact with the child, ard imitating the child’s responses. This technique is used by both the music therapist ard the families of the autistic children. Nelson, Arderson, and Gonzales (1984) discuss methods of synthesizing music activities in accordance with specific areas of deficits in autistic children. Sane of their suggestions include balancing repetition ard variation since many autistic children exhibit insistence on environmental sameness, making a conscious effort to synchronize one’I own body ard speech rhythm to that of the child’s in order to help with autistic children’s problems in temporal perception, structuring activities to ensure a high rate of success, ard showing the child that he/she can have predictable control over his/her own envirorment. In their discussion of irdirect ard direct strategies, they state . .an overly directive strategy could result in mere canpliance on the child’s part (e.g. , the imitation of vocal or instrunental music) rather than in creative exploration (e.g. , improvisation)" (p. 104). Thaut (1984) suggests a variety of both 42 improvisational and structured techniques in evoking and developing autistic Childrenfs communication skills, along with numerous other skills. Sane of the cannunication/language activities include improvising musical accanpaniments of the child’s expressions, canbining words or phrases with a rhythnic or melodic pattern ard a body movement, using verbal instructions that consist of strong melodic/rhytlunic patterns, using imitation techniques, melodically shaping vocal expressions, ard learning to play wird instrunents. Improvised music therapy techniques have been widely utilized as part of the overall treatment provided for autistic children. The immediate acceptance of and respect for a child can be directly conveyed to that chi ld through the music. The unlimited nunber of idians ard styles utilized, along with the nunerous variations of each of the components within the musical elements, allow for individualized support, reflection, stimulation, activation, control. organization, relaxation, continuation, interruption, predictability, exaggeration, interjection, ard expression. In working to develop cannunication skills, these techniques can be nonthreatening and success-oriented. The suprasegnentals, or the basic preverbal furdamentals of human cannunication, which include timing, phrasing, rhythm pitch, ard timbre, are all parts of music. Cannunication, in both musical ard non-musical forms, involves the ability to listen and to respord appropriately to sound. ‘Meaningful communication and communicative intent are considered of primary importance in language programs for autistic children. Consequences of communicating musically can be both.meaningful and irnnediately reinforcing. Children are exposed to continuous cause-ard- 43 effect relationships in music experiences which may give them a sense of control over their envirorlnents ard may provide a framework for spontaneous and intimate nonverbal interactions. Musical improvisation allows for creativity, initiative, decision nnaking, frustration tolerance, arnd emotional release. Improvisational music therapy may be one intervention in which autistic children can not only learn how to cannunicate, but can also experience the joy of cannunication. CHAPTER III The purpose of this study was to evaluate the effects of improvisational music therapy on the cannunicative behaviors of autistic impaired children. Subjects Twelve autistic impaired sttdents were selected for this study. Selection was made by contacting school districts in Ingham ard Eaton counties ard the Lansing Society for Autistic Citizens. The parents of the students who fit the category specified for research were willing to allow their children to participate in the study. Out of the total fifteen students fourd, three had no facility available to them for the music therapy sessions. (he of the subjects initially dennnstrated the musical ard normusical abilities beyord the scope of the measurement device utilized. Consequently, eleven was the total nunber of participants in the study. All of the subjects were diagnosed "autistic impaired" according to the provisions set forth in the Michigan State Board of Education’s Revised Administrative Rules for Special Education (1992) ard rarnged fran severely to mildly impaired. There were ten nnales ard one female, ard they rarnged in age fran six to nine years. Nine of the subjects were Caucasian, two were Hispanic, ard one was African-American. Deficits in cannunication skills were canrnn to all of the subjects. Three of the subjects were nonverbal, ard three had very minimal Ipeech. Five of the subjects were verbal, three of whan 44 45 danonstrated limited spontaneous speech. Language ages , measured by standardized tests and/or observation and reported by speech therapists ard/or teachers, ranged fran ”no formal means of intentional communication" to five years. IQ scores were not available for all of the subjects. Additionally, the reliability of the IQ scores that were reported was stated as low due to the children’s apparent inability to convey their intellectual capacity. Six of the eleven subjects were integrated into regular education classes, ranging fran 1 to 30 hours each week. Speech therapy was provided for all of the subjects, and seven subjects also received occupational therapy services. The amonunt of music education opportunities for these children varied fran very rarely (once a year) to twice a week. Consent and Approval Following approval by the thesis cannittee, approval to implement the research study was secured fran the Michigan State University Cannittee on Research Involving Hanan Subjects (Apperdix A). The academic research proposal was then sent to the Office of Research ard Evaluation of Lansing Public Schools and the Director of Special Education of Charlotte Public Schools. The proposal was approved by both of the school districts, and the experimenter was notified of these decisions through a formal interview ard by nail (Apperdix A). Once approval was granted to begin research, the subjects were selected, ard the procedure to gather informed consent fran the subjects’ parents was implemented. Two forms, Description ard Purpose of Study and Consent for Participation in.Improvisational Music Therapy Study (Apperdix B), were distributed to the subjects’ parents. All of 46 the parents agreed to have their children participate. Materials The following musical materials were utilized in the treatment procedure: a piano, a snare drun with the snare rennved, ard a 16-inch cymbal. The snare drun ard the cymbal were nnunted on adjustable stands. The height and tilt of the snare drum and of the cymbal were adapted for each child to allow for successful attanpts at beating. A chair was available for the subjects, and the therapist was seated on a piano bench. The instruments and the chair were positioned near the treble end of the piano next to the piano bendh. A variety of heaters were also available, including regular median-weight drunsticks, both heavy and light tympani mallets, and one pair of brushes. A videocamera was also in the roan. Other equipnent in the roan was moved away from the piano area to avoid distracting the child. Also, any of the instrunents/beaters that interfered with the child’s ability to listen ard/or participate were rennved fran the roan for that child’s future sessions. The study was conducted at three different settings: two elementary schools ard the music therapy clinic at Michigan State University. No of the roans in which the experiment took place were similar in size and content. The other roan was a music education roan and was larger in size and contained a large variety of musical materials/instrunents. An area within this roan which resembled the other two roans was set up for the experiment. The experimenter ard each child were alone in the roan with the exception of a few unanticipated interruptions. 47 Experimental Design A reversal design was utilized and consisted of the following phases: (a) the intervention was implemented. (b) a one-session withdrawal of intervention was applied after a level of consistency in responses was achieved, and (c) the intervention was then reintroduced for the remaining sessions. Data analysis consisted of graphic analysis and nonparametric statistical techniques. Measurement The dependent variable in this study was cannunicative behaviors. Through consultations with speech therapists and through researching literature. a standardized test which evaluates musical and nonnusical cannunicative behaviors for autistic children was not found. Nonnusical cannunicative responses of autistic children are evaluated utilizing a large variety of standardized tests. Nordoff and Robbins (1977) developed a musical cannunicativeness scale in which reliability was established. However, this reliability was established using music therapists who were specifically trained in the Creative Music Therapy technique (C. Robbins, personal cannunication. May 26, 1992). Therefore, an original checklist. Checklist of Cannunicative Responses/Acts Score Sheet (GRASS. Appendix C), was constructed by the experimenter. The Caununicative Responses/Acts Definitions form (Appendix C) operationally defined the behaviors listed on the score sheet. The CRASS was based on items fran nunerous rating scales and assessments for musical cannunicativeness. autism. and cannunication skills (Brigance, 1978; Bzoch & League. 1970; Krug, Arick. & Almond, 1979; Nordoff & Robbins. 1977; Ruttenberg, Dratnnnn, Fraknoi, & Wanar. 1966; Stillman, 1978; Uzgiris & Hunt, 1975; Wetherby & Prutting, 1984). 48 The CRASS was divided into two categories: musical and nonnusical. Caununicative Responses were defined as verbal. vocal, gestural, or instrunental behaviors demonstrated by the child which are influenced by the experimenter's improvisation. Verbal, vocal, or instrunental behaviors initiated by the child in an attempt to influence the experimenter's improvisation/behaviors or for the purpose of independent expression were categorized as Cannunicative Acts. Behaviors which served as prerequisite skills necessary for musical cannunication were also categorized as Cannunicative Acts, e.g. , beats within a tempo range, vocalizes, etc. Within the musical category, operationally defined Cannunicative Responses and Acts were listed under four subcategories: tempo. rhythm. structure/form, and pitch. In the section titled manusical, operationally defined behaviors were categorized according to speech production skills. cannunicative-interactive skills. and cannunicative intent skills. The CRASS contained a total of 197 items. There were 91 items under the musical category and 16 items under the nomusical category. Sixty-nine items were categorized as Cannunicative Responses, and thirty-eight items were categorized as Cannunicative Acts. Time interval sampling was used, with one lfl—minute interval randanly selected prior to each 30-minute session. The sessions were videotaped for data collecting purposes. During the one lfl-minute interval. two observers independently recorded the cannunicative behaviors of each child using the CRASS. The observers were senior undergraduate music therapy students. A check was given for each of the behaviors that was observed. A maximun of one check was recorded 49 for each behavior. even if that particular behavior was repeated. All of the checks were then totalled. resulting in one total Caununicative Responses/Acts score per subject per session. The second observer served to check reliability throughout the study. During the first week of sessions, reliability checks were canpleted on all 11 subjects. After the first week. these checks were made on a range of two to five subjects per week. The subjects who were checked were alternated in order to allow a minimun of three reliability checks per subject during the 10-week period. Interobserver agreement was calculated for both occurrences and nonoccurrences using the following formula: agreements divided by the sun of agreements and disagreements. Interobserver reliability for occurrences ranged fran 75% to 1M, with a mean of 86.2%. For nonoccurrences, interobserver agreement ranged fran 77% to 100%. with a mean of 94.8%. The observers also subjectively rated both the quantity and the creative quality of the overall level of musical cannunicativeness for each of the 10—minute intervals. A scale of 1 (indicating a low level) to 7 (indicating a high level) was utilized for both quantity and creativeness. The observers circled the nunber that best described the overall level of musical cannunicativeness demonstrated by the subject. Behavior Change Surveys (Appendix C) were given to parents. teachers. and speech therapists for each subject imnediately following the conclusion of the study. This survey utilized a 7-point rating scale to indicate the nunber of changes seen in the subject's cannunicative, social/emotional. and musical behaviors. The nunbers, in sequence fran 1 to 7, represented the following descriptions: much 56 less. sanewhat less, slightly less. same. slightly more, sanewhat more, and.much.mcre. Independent variable Improvisational music therapy, based on.NOrdoff and Robbins' (1977) Creative Music Therapy approach. was the independent variable used in this study. It consisted of improvised.music with the experimenter creating music to establish contact with the child. to enable the child to respond, and to facilitate developnent of the child's musical cannunicativeness. The experimenter played the piano and/or sang, and each child had opportunities to play instrunents and to sing. There were two basic principles which were followed with all of the subjects. Each child was treated as competent, and it was assuned that he/she understood all that was said and was capable of musically expressing him/herself. Also, total anotional support was provided for each subject, with the experimenter remaining as responsive as possible to each child and conveying acceptance of him/her. A hierarchy of musical experiences/activities was provided as a guiding reference for ongoing decisions made by the experimenter throughout the intervention sessions. Specific techniques used were decided in the course of the music therapy sessions, dependent upon the child's responses. capacities. and needs. The large nunber of techniques described below were available to the experimenter in order to allow for flexibility within each session in creating an atmosphere for the child in which optimal growth and develoanent could occur. The expernmenter worked freely within the hierarchy of musical experiences/activities listed below. Many of these techniques were 51 taken fran the book entitled Creativa Music Therapy by Nordoff and Robbins (1977). Hierarchy of Musical ExnerienceslActivities Czeate a Musical fivironment at the Child'a Current Affective and Behavioral Level of Overall Fgctioning The goals for these experiences were to get the child to react to the improvisations and to establish initial contact with the child. This phase was based on the iso-principle. meeting the child at his/her own behavioral and emotional levels. The following techniques were used during this phase: 1. Observe the child's attitudes, moods, and feelings, and reflect them in the improvisation. 2. Pair musical motifs to selected responses, and repeat than every time the child anits those responses. 3. Imitate the child's responses/behaviors successively. 4. Synchronize through simultaneous imitation of the child’s responses/behaviors . 5. Use the child’s requested musical activities and/or songs. Create a toad throag the Improvijsgtion that might Facilitate the Chi ld’s Resmnse The goal of these experiences was to get the child to begin to feel canfortable in the musical setting in order for future responsiveness to occur. The child demonstrated this by calming down. beginning to show brief responses, becaning more active, approaching the instrunents and/or the experimenter. changing the nature of his/her crying or vocalizations to show a musical influence. and/or verbalizing his/her own needs. In this phase, the child’s reality was manipulated. 52 One or more of the following techniques were utilized to help the Child reach his/her goal: 1. Improvise calm subtle music for a hyperactive or anxious child. 2. Improvise stimulating rhythmic music for a passive. listless, or obstinate child. 3. Improvise supporting expressive music for an evasive, scared, nervous, or delicate child. 4. Sing "hello". the child's name, about the child’s actions, about the child's appearance. and/or improvise vocally with the opening music. 5. Match the child's habitual sounds, crying. or vocalizations in the improvisation. 6. Continue to use requested musical materials, and gradually begin improvising on than. 7. Contact the child in a nondirective manner by giving the child control over aspects of the improvisation. 8. Exaggerate distinct characteristics of the child’s responses and/or behaviors. Lead into Siagiag Expariences For sane children. the music first began to influence their habitual sounds, vocalizations, and singing behaviors. For these children. the next step was to evoke musical sounds and/or to lead them into singing experiences. The goals of this phase were to evoke musical sounds. to provide structure within the child's singing. to develop musical cannunicativeness. to increase vocal responses. and to develop thematic material within the child's singing. Specific techniques for these goals are listed below. 53 1. Evoke musical sounds: a. Play and sing an improvised motif or phrase. and repeat it several times, making spaces within the improvisation for the child to interject. b. use stimulating musical techniques in the improvisation. such as crescendos. accelerandos, harmonic tensions, parallel motion. expressive vocal phrases, rising pitches, and dramatic rhytlnic and tempo changes. 0. Improvise using the "children's tune", which is the commonly recognized melodic configuration consisting of the following intervals: a descending minor third, an ascending perfect fourth, a descending major second, and a descending minor third. d. Improvise using the pentatonic scale and harmonization, Mid- Eastern scale and harmonization, and/or organun chord forms. e. Use the child’s spoken words to create a song. Repeat this song, pausing before one or more of the child’s words, and encourage the child to sing/say these words within the structure of the song. f. If the child verbally expresses a request or a protest. improvise, singing about his/her statement. g. USe a high vocal range to stumulate and a low range to support. h. Work with instrunental activities. 1. Make parts of the improvisation contingent upon the child's vocal behaviors. j. Vbcally improvise while clapping the child's hands to the melodic or basic beat. 2. Provide structure within the child's singing: 54 a. Introduce clear motifs Hatching the child’s mood. rhythn. inflection, approximate pitch range, tanpo, and dynamics. b. Sing along with the child using free improvisation. c. Vary the vocal improvisation in the attempt to try to develop a musical question and answer form. (1. Provide a basic beat using harmonies/chords which contain the tones that the child is singing. e. Sing back to the child any words he/she speaks or sings, placing these words within a rhytl'lnic and/or melodic structure. f. Begin working on vocal melodic and rhytlmic give-and-takes. 3. Increase vocal responsiveness - help the child to increase his/her confidence, to expand his/her duration and frequency of responses, to extend his/her vocal range. and to develop his/her ability to place tones: a. If the child sings a word repeatedly, add a related word or phrase to it. b. Use inverted chords containing the tone or tones the child is singing. c. Repeat the chords or chord progressions. (1. Once a technique begins to stimulate vocal responses, adapt it to support the child, fitting it to the child’s rhyttm, tempo, and mood. e. Create a game-like activity out of the behavioral/vocal responses of the child, e.g. , singing "Where is ?" when the child hides behind the piano. f. Improvise on songs suggested by the chi 1d. making them more significant to that particular child. 55 g. If a child sings a canplete song, continue working on the song and begin to introduce sane changes, e.g. , undulations. specific pitches. tempi, dynamics, words, etc. 4. Develop thematic material from the child’s responses: a. Improvise a short song, phrase, or motif with simple forms and expressive melodies, based on the child's vocal capabilities. Repeat it, encouraging the child to sing along. Place the important tones of the melody on the child's canfortable tones. b. Extend and/or transpose the song or song phrase. c. Use upbeat songs with nunerous repetitions of a rhythmic motif or phrase. d. Work with instrumental activities. Have the child beat and/or chant/sing melodic rhyttnns to help define structure. e. Use large exaggerated physical arm movements in instrunental activities, having the child play in the tempo of the song or phrase. f. Any songs or song material must directly relate to that individual child so that it holds a special meaning to the child. Use a variety of the child's responses in improvising songs. Lead into Instrunental Activity In this phase, the purpose of the improvisation was to bring the child into a responsive position by creating a musical envirorlnent that may activate him/her. The goal in this phase was to get the child actively involved in instrunental improvisation. The following techniques were available for the experimenter's use during this phase: 1. Accanpany the child's movements. and respond musically to any significant vocal, verbal, or behavioral response. 2. Be open and free in the improvisations. allowing for any 56 spontaneous adaptations to meet the child. 3. Use active silences. linking spaces for the child to respond or to nnke decisions, to signal for the music to continue, and/or to realize a relationship exists between his/her instrunental responses and the improvisation. 4. Make music contingent upon the child's instrunental responses. 5. Create a transitional activity-experience, which may be a new song or a playful activity, to help create a relationship with the child and to help lead to instrunental responsiveness. 6. Intervene, interrupting or redirecting any habitual or obsessional tendencies that may block the child's cannunicative respons iveness . 7. Play the child's instrunent. 8. Physically guide the child in playing his/her instrunent, using the amount of guidance appropriate for that individual. 9. Use verbal pranpts, both speaking and singing than. 1B. Repeatedly exchange the heaters the child is holding. L__e_ad into the Ba_sic Baa; "The basic beat is the foundation of musical-rhythmic order, the underlying time base of coherent musical activity and experience" (Nordoff & Robbins. 1977. p.134). The goals of this phase were for the child to play and experience the basic beat and to develop rhythnic continuity. The experimenter chose those techniques fran the list below that were appropriate for each child, which was determined by the frequency and duration of the child's beating responses and the type of basic beating the child danonstrated. 1. Allow the child to begin beating and improvise music 57 specifically suited to his/her beating. 2. lethnically imitate and/or synchronize with the child’s beating using the same tanpo. accents. and dynamics and matching the character of his/her beating. 3. Interject occasional brief stimulating ideas. 4. Sing freely to the child’s beating, using rhythnic anphasis. 5. Use a variety of musical styles and idians. 6. Create a harmonic or melodic idea to give tonal stability to the improvisation. 7. Develop a series of musical question and answer phrases. 8. Extend the child's response, supplanenting it with one or more measures. 9. Repeat any part(s) of the improvisation to which the chi ld responds rhythmically. 10. Follow any changes the child makes in his/her beating. 11. Incorporate, using any of the child's rhytl'mic motifs as a thane for the improvisation. 12. Use contrasting registers of the piano to stimulate responses fran the child. 13. If a child's beating becanes overwhelming. play a contrasting mood. dynamic, and/or tanpo. If this does not have an effect on his/her beating. stop the improvisation until the child changes his/her pattern of beating. 14. Use any of the following specific rhythmic techniques: a. Use repetitions of rhythnic phrases in the improvisation. b. When the child pauses, continue repeating the phrase or parts of it. pause with him/her while holding the last chord played. 58 and/or emphasize the interruption by repeating the last chord played or by playing a different chord and/or phrase. c. Improvise phrases utilizing basic beats and a regularly recurring rest on the last beat of each measure. (1. Rhytlunically ground by playing the basic beat or a rhythmic ostinato based on the chi ld’s improvisation. e. Experiment with a variety of time signatures. f. Introduce syncopations. rhytlunic irregularities, and unpredictable changes when trying to interrupt a child’s fixed repetitive beating. g. Differentiate, improvising simultaneous music that is independent yet canpatible with the child’s music. 15. Use any of the following specific harmonic techniques: a. Experiment with the different qualities of harmonic intervals and of chords. b. Use dissonant intervals and chords to stimulate the child. 0. Use intervals and chords in parallel motion to increase or lessen the anotional drive. (1. Avoid the use of cadences when needing to keep the improvisation continuous. e. Use authentic cadences to anphasize the basic beat. f. If the child is playing the piano. create progressions using a large variety of chords which contain the note he/she is playing. g. Connect the child’s beating responses by creating a harmonic progression, playing one chord on each beat. 16. Use any of the following specific melodic techniques: a. Improvise a melody in which each tone falls on a beat, and 59 play this melody alone (without an accanpaniment). b. Experiment with both similar and contrasting tonal movanent while improvising question and answer phrases. c. Relate the child's beating to a melody by playing and singing the melody. d. When singing words, place the child's beats on the stressed syllables. e. Develop short phrases or motifs to the child's beating. f. Repeat predictable tonal phrases set to the child’s beating. g. Develop a song to the child's beating. Directed Resmnsiveness The purpose of this phase was to work on rhythnic and melodic control, perception, and structure. Goals included increasing the ability to control and direct beating and the ability to organize and structure responses. Techniques listed below were utilized along with sane of the techniques already mentioned. 1. Create a simple structured activity with the drum and the cymbal, using a form and mood that is appropriate for the child. 2. Play in the high piano register for the cymbal and the low register for the drun. 3. Using previously established songs and/or phrases, accent the last note or chord and use clear cadences. 4. Provide as much assistance as needed to guide the child in cymbal punctuation -- ending the song and/or phrases with a cymbal beat. 5. Use a drun-cymbal waltz form. 6. Work on rhytlmic patterns, using chord progressions, cadences, and/or melodies. SO 7. Base rhythnic patterns on the rhythm of single words and/or speech phrases set to music. 8. Begin working together, playing the rhythmic patterns simultaneously, and then work antiphonally once the child gains confidence. 9. Intersperse free improvisation and rhythmic pattern activities within one improvisation. 10. Work with melodic rhythms of songs, physically guiding the child as needed, holding the child's finger and playing the rhythm on the piano, and/or encouraging the child to sing the rhytm. 11. Emphasize and exaggerate the melodic rhythm in the piano music. 12. Break down the melody into short phrases and motifs if necessary when working with melodic rhytlms. 13. Continue to improvise on the child’s suggested activities and songs, and begin to request that the child decide what elanents to improvise on. 14. Stress the development (changing rhythmic patterns and melodic tones) of instrunental rhytlxnic give-and-takes. Expressive Musical Mobility and Cannunicative E_notion_al Experieacg This phase was designed to increase the child’s involvanent in cannunicating musically with the experimenter and to increase the child's self—expression. The goals were to increase the child’s responsiveness and to develop the child's flexibility and control in the musical context. The following techniques were utilized in this phase: 1. Experiment with a variety of idioms. 2. Sing with the improvisations, allowing the child to choose the 61 topic of the improvisation and/or the words/vocalizations to be sung. 3. Introduce a wide variety of tanpo and dynamic changes into the improvisations. 4. Introduce new material and mix it unpredictably with previously established materials. 5. Deliberately use a variety of expressive canponents, such as accelerando, ritardando, tanpo contrast, fermata, rubato, crescendo, decrescendo, dynamic contrast, and accentuat ion. 6. Guide the child in using the free arm swing to loosen up tense postures and stiffness. 7. Continue working with melodic rhythns, introducing new songs that vary in time signature, rhythmic structure, tanpo, and mood. 8. Introduce instrunental arranganents. 9. Introduce new material which is not adapted to the child's beating, but in its own tanpo with careful rhytlnnic clarity. 10. Recede, taking a less controlling role and allowing the child to direct the improvisation. 11. Canbine instrunental rhythmic, vocal rhytl'nic, and vocal melodic give-and-takes. 12. Help the child canpose his/her own songs/improvisations, giving him/her control over as many aspects of the songs/ improvisations as possible. 13. Help the child improvise on his/her suggested songs/activities. 14. When the child musically expresses himself/herself, improvise music that specifically matches as many elanents of these expressions as possible. Give the child total musical support. 62 Pilot Procedure A pilot of this study was implanented prior to the actual experiment. Two children, one diagnosed with autism and the other diagnosed with fragile-X, participated in 5 one-half hour sessions. The child diagnosed with fragile-X danonstrated nunerous autistic features. Both children were chosen fran clients seen at the Music Therapy Clinic at Michigan State University. These children were not included as subjects in the actual study. Videotapes of these sessions were used to train the two observers for the experimental study. The observers viewed and rated these two subjects a nunber of times until they achieved 75% or greater interobserver agreanent on both occurrences and nonoccurrences of the measured behaviors. Actual results of their last observation training trial were 80% and 93% agreanent on occurrences and 98% and 92% agreanent on nonoccurrences. All other conditions in the pilot study were used unaltered in the experimental process. Procedure Each subject was scheduled for one 30-minute session per week for a period of ten weeks. Due to illnesses and unforseen circunstances, including school closings, transportation problans, and the start of a new auditory intervention program, two of the subjects were not able to attend all 10 sessions. One of the subjects attended a total of 8 sessions, and the other subject attended a total of 9 sessions. Intervention consisted of improvisational music therapy as described above. This phase continued until consistency in responses was noted. Due to the fact that all of the subjects' measured responses showed an ascending baseline by the sixth session, all of the 63 reversal sessions occurred in session 6. Reversal consisted of the experimenter playing and singing a variety of music therapy activity songs. During this phase, the experimenter continued to evoke, maintain, and/or develop the child’s responses. In addition to the use of structured, pre-canposed music as opposed to improvised music, the amount of eye contact was decreased and the amount of materials utilized increased. The amount of eye contact decreased due to the experimenter glancing at written music. The use of written music added additional materials to the reversal phase. During intervention, only two sheets of paper were on the piano. During reversal, this increased to five pieces of paper and a book of songs. Gestural invitations, verbal invitations, and reinforcanents ramined the same. During the first 10 minutes of the reversal session, pre-selected songs were played and sung. The songs, chosen prior to the implanentation of the study, provided opportunities for each child to respond in all of the areas listed in the Checklist of Caununicative Responses/Acts Score Sheet. Songs utilized during reversal included "I Have a Song to Sing" (Cross, 1989), "Charlie Ms Bow to Beat the Drun" (Nordoff & Robbins, 1962), "Drun Talk" (Nordoff & Robbins, 1968b), "3/4 and Strong" (Dubesky, 1982), and "It’s Music" (Dubesky, 1989). These songs were then repeated during the M-minute data collection interval, which was randanly chosen prior to the session. Following the reversal, intervention, as explained above, was continued for the ranaining sessions. CHAPTER IV ANALYSIS OF DATA Data were analyzed using graphic analysis and nonparametric statistical techniques. Justification for the use of nonparametric statistical tests was made for three reasons. The first reason was the small sample of subjects that participated in the study. The second reason was that the level of measuranent used in data collection was ordinal. The third reason was that the subjects in this study could not be assured to represent a nornnl population distribution. The experimenter selected the .05 level of significance as the criterion for this study. All nonparametric statistics were calculated using formulas and tables fran Siegel’s (1956) Noagrametric Statistics: For the Behavioral Sciencea. Results Cannunicative Responses/Acts were scored using the Checklist of Communicative Responses/Acts Score Sheet (GRASS, Appendix C), which was constructed by the experimenter. The scores were plotted graphically across sessions for each subject, and means for each session were calculated for the group as a whole (N'= 11). The initial intervention phase was five sessions in duration. The reversal design was applied during session six. Following the reversal, reinstatanent of treatment procedures occurred. 'Dhe duration of this second intervention phase varied, ranging'from.two to‘four sessions. Two of the subjects were not able to attend all 1% sessions due to illnesses and unforseen c i rcunstances . 64 65 Figure 1 show group mean Caununicative Responses/Acts for each session. as a whole, along with an abrupt decrease in the total group mean score An overall increase in total scores was noted for the group during the reversal (session 6). Figures 2-12 show individual graphs for each subject. Table 1 shows individual CRASS scores across sessions, individual overall gains, and group means. 8 7 7 m 6 #6 O5 4' . \5 m 4 :4 .3 O . a 2 :2 1 9:1 5 8 Exam;- Reversal Sessions GROUP MEAN SCORES Group Mean Cannunicative Responses/Acts across 10 Sessions. 66 ,\// Reversal Responsesflhcts @uHHNMwwnoummm-qqq . . 16 Sessions SUBJECT A Figare 2. Carrnunicative Responses/Acts of Subject A across 10 Sessions. 8 7 "" m 6 g ‘3‘ E: 5—1 It . a \ 5 u m 4 g a 4? I :3,. ,’ O 3 \ I Q 2* \ 32 x,’ a: i " 5 3 . 13 Sessions SUBJECT B Figare Q. Cannunicative Responses/Acts of Subject B across 10 Sessions. 67 U‘ l b"! Reversal fl I ‘1‘? / r I \ \ Responses/Acts Hewwwwoouummq on T v 5 9 . ie Sessions SUBJECT C Figare 4. Cannunicative Responses/Acts of Subject C across 10 Sessions. 8 ' E ? in m6 “ “5' U o5 3 «:5 \~4* \ fl “4 V I 313 * ~’ . \ ’ :2 :2 “ g1 K1 5 B . 18 Sessions SUBJECT D Figara 5. Caununicative Responses/Acts of Subject D across 1% Sessions. 68 8' 7' "‘ m u6 m ‘3‘ i: :3 : u4 it: :4 3 :3 / 9.2 N m2 /\ / 8.1 V I . V \ “1 VI 5 9 . .18 Sessions SUBJECT E Figare 6. Caununicative Responses/Acts of Subject E across 10 Sessions. 8: i ? fl 7? m6 3 #6 5' O5 4! (5 fl \ r a m 4 g :4 :3 o . n2 . 32 , / 1‘ § “1//'/./‘ \ I! 5 . V a « . 18 Sessions SUBJECT P Figare 7. Carmunicative Responses/Acts of Subject F across 8 Sessions. 69 8? 7: ” 6 m6“ m ‘3‘ i :3 : :4 , . g / o ‘ \ / fiz/v‘\ / :4 v a: i 5 9 . 18 Sessions SUBJECT G Figare 8. Cannunicative Responses/Acts of Subject G across 10 Sessions. Reversal / a \ I L J' x I . Y Sessions SUBJECTII Eigare 9. Conmunicative Responses/Acts of Subject H across 1% Sessions. Responsesfhcts ouhewwwwoouumeqqa 18 70 .1 l h;‘ Reversal .l l I \ Responses/Acts PHNNQWDifiUMO‘C‘Q _¢ in .. n .. a K DUI” . 16 Sessions SUBJECT I Figare 10. Carmunicative Responses/Acts of Subject I across 10 Swflms Reversal Responses/Acts hhwwwwhouueaq a at".j . 18 Sessions SUBJECT J Eigare 11. Communicative Responses/Acts of Subject J across 9 Sessions. 71 8.: 7' "' u. 3 :4 : 5 is 3 :14 g 04' “3 i \ / 01 Y H 1: 5 9 . 1.8 Sessions SUBJECT K Figme 12. Cannunicative Responses/Acts of Subject K across 19 Sessions. 72 Table 1. GRASS Scorestor each Sub ject agross Sessions, Individual er ins and Gro Means. Sessions S. 1 2 3 4 5 6‘"L 7 8 9 16 Gain A 23 31 35 40 54 24 57 53 65 68 45 B 15 21 23 30 33 14 46 49 59 63 48 C 14 19 21 21 23 12 23 32 31 34 2% D 16 25 39 44 50 23 47 56 62 63 47 E 13 18 21 23 25 8 39 33 34 49 36 F 3 10 14 16 17 6 17 24 - - 21 G 22 24 33 31 33 19 42 43 42 48 26 H 7 10 14 16 26 11 .21 23 25 28 21 I 12 22 23 29 52 15 58 65 75 72 60 J 26 26 27 32 37 14 32 34 49 - 23 K 22 22 25 25 30 16 28 31 38 36 14 Means 15.7 20.7 25 27.9 34 14.7 37.3 40.3 48 51.2 32.8b Note. CRASS = Checklist of Cannunicative Responses/Acts Score Sheet; S. = Subject. A dash indicates no score was available. nReversal session. bThis mean is not equal to the tenth session mean minus the first session mean because not all of the subjects canpleted 18 sessions. 73 Figures 2-12 reveal individual differences in the total number of Oarmunicative Responses/Acts and in the degree of improvanent in the GRASS scores over the 10 sessions; however, an overall trend was danonstrated, showing an increase in the CRASS scores during both intervention phases and a decrease in these scores during reversal for each individual. In the initial intervention phase, the level of change for all subjects was in an improving direction and ranged fran 8 to 40 points, with.a.mean of 18.3. The withdrawal of the intervention resulted in an abrupt and substantial decrease in the quantity of Communicative Responses/Acts. Decreasing level changes ranged fran 9 to 37 points, with a mean of 19.3. This level was reversed imnediately upon reintroduction of treatment procedures. Increasing level changes from the reversal to the reinstatanent of intervention ranged fran 10 to 43 points, with a mean of 22.6. During the second intervention.phase, the level of change was in an improving direction and ranged fran 6 to 17 points, with.a.mean of 11.3. A positive acceleration trend was noted in both intervention phases for all eleven subjects. Trend stability within conditions was determined for both intervention phases for each subject. Criteria for trend stability was set at 80% of the data points falling within 15% along the trend line (Tawney &.Gast, 1984). All 22 conditions showed a stable trend. Fer five of the subjects, scores achieved in the reversal phase overlapped with the first intervention phase. The overlap for four of these subjects occurred when comparing reversal and the first session scores. (he subject’s reversal score overlapped with the first and 74 second sessions of the first condition. For the other six subjects, the percentage of overlap between these two conditions was 0%. In canparing the reversal phase with the reinstatanent of intervention phase, the percentage of overlap was 0% for all 11 subjects. In addition to scoring the total nunber of points on the GRASS, each subject was also given subjective ratings for his/her overall level of cannunicativeness during every session. A scale of 1 (indicating a low level) to 7 (indicating a high level) was utilized for both quantity and creativity of cannunicativeness. Table 2 shows the group means for both categories across the ten sessions. The levels increased in both quantity, fran a mean of 1.6 to a mean of 4.9, and creativeness. fran a mean of 1.4 to a mean of 5.2. Also, during reversal, there was a noticeable change in all of the subjects’ cannunicativeness. Greativeness dropped fran a mean of 4. 1 to a mean of 1.8, and quantity decreased fran a mean of 3.6 to a mean of 1.7. These data support the trend observed in the total score data. Not only did the subjects increase their scores, but they also appeared to danonstrate more creativity and a greater nunber of cannunicative behaviors. 75 Table 2. Groap Mean Mtity gig Creativity of tha Overall Level of Micativeness across Sessions. Sessions 1 2 3 4 5 65 7 8 9 10 Quantity 1.6 3.1 3.7 3.6 3.6 1.7 4.1 4.4 4.7 4.9 Great iveness 1.4 3.0 3.8 3.6 4.1 1.8 4.2 4.3 5.1 5.2 I’Reversal session. Research estion #1 The Wi lcoxon Matched—Pairs Signed-Ranks Test was utilized to determine if a significant difference existed between all of the subjects' scores of their first sessions and those of their last sessions. Table 3 shows that all of the subjects’ last session scores were larger than their first session scores. Consequently, the differences between the scores were significant at the .01 level (T = 0). The subjects made significant gains in cannunicative behaviors when involved in improvisational music therapy sessions. 76 Table 3. Tbtal First and Last Sessioa GRASS Score ~ Wilcoxon.Matched~ Bairs SignaQ-Ranks Test. Tbtal CRASS Score First Last Rank Rank with less Subject Session Session d of d frequent sign A 23 68 ~45 ~8 B 15 63 ~48 ~10 G 14 34 ~20 ~2 D 16 63 ~47 -9 E 13 49 ~36 -7 F 3 24 ~21 ~3. G 22 48 ~26 -6 B 7 28 ~21 ~3. I 12 72 ~60 ~11 J 26 49 ~23 -5 K 22 36 ~14 ~1 7‘: 0* ugga. CRASS = Checklist of Communicative Responses/Acts Score Sheet; d = Difference session scores. Epi< .01 score ~ the difference between the first and the last 77 Research Qaestions #2 ~ #8 The GRASS was divided into the following two categories: musical and nonnusical. There were 91 possible points in the musical category and 16 possible points in the nonmusical category. Figure 13 and Table 4 show the group mean scores in these categories across 10 sessions. Gains were noted in the group>mean scores of both categories. In canparing the first and the tenth sessions, musical means increased fran 9.5, with a range of 0—18, to 39, with a range of 21-56. Using the same canparison, noanusical means increased fran 6.3, with a range of 3—11, to 12.2, with a range of 7-16. Four of the subjects achieved all of the 16 total points in the nonmusical category by their tenth session. 46 35 36 25 26 15 16 Connun i oat i ve Behavi ors Izflusical 78 Reversal M\¥r Sessions I : Nonnusical ;——-/'/' ' 16 Figpre 13. Group Mean Musical and Normusical Garmunicative Behaviors across 10 Sessions. Table 4. Group Mean Musical and Nonnusical Gomnunicative Behaviora across 10 Sessions. Sessions 4 5 6a 7 8 9 l0 Gain 9.5 13.5 17.1 mmkml 19.5 24.6 9.5 26.7 29.8 36.5 39 29.5 6.3 7.2 7.9 lbmmsMal 8.5 9.3 5.2 10.5 10.5 11.5 12.2 5.9 a Reversal session. 79 Each of the two categories was divided into subcategories. Musical subcategories included tanpo, rhythn, structure/form, and pitch, and normusical subcategories were speech production, cannunicative-interactive, and cannunicative intent. The subjects' raw scores of their first and last sessions in the four musical subcategories are shown in Table 5. Group mean scores across 10 sessions in these musical subcategories can be seen in Figure 14. Table 6 lists the subjects' raw scores of their first and last sessions in the three nonnusical subcategories, and Figure 15 shows the group mean scores across 10 sessions. In all subcategories, the group mean for the last sessions is different fran the group mean for the tenth sessions because not all subjects participated in a total of 10 sessions. Statistical analyses were applied to the subjects’ first and last session scores in all of the subcategories of the CRASS. The Wilcoxon Matched-Pairs Signed-Ranks Test indicated significant differences at the .01 level between first session scores and last session scores for tanpo (T = 0), rhythm (T = 0), structure/form (T = 0). pitch (T = 0), speech production (T = 0), and cannunicative-interactive (T = 0). Significant differences at the .05 level were found between first session scores and last session scores for cannunicative intent (T = 2.5). 80 Table 5. fljotal First and Last Session Scorga in Ta_npoa R_lyt_hm_,_ StructurelFoga, and Pitch ~ Work-pp for the WilcoxorLMatched-Paija i ~Ranks Test. Tanpo Rhythn Form Pitch Subject First Last First Last First Last First Last A 5 20 1 10 1 8 8 14 B 5 22 1 6 0 7 0 12 C 9 18 0 2 0 0 0 6 D 2 17 0 9 1 7 2 14 E 4 13 5 13 0 4 0 10 F 0 10 0 1 0 0 0 6 G 9 16 1 3 1 7 3 8 H 0 8 0 2 0 4 3 7 I 9 as 0 10 0 11 0 15 J 8 11 1 5 1 5 8 14 K 11 15 4 7 1 3 0 3 Means 5.6 15.5 1.2 6.2 .5 5.1 2.2 9.9 Total Itans 36 25 14 16 Nota. First = first session scores; Last = last session scores; Total Itans = total nunber of points possible in each subcategory. 81 Table 6. fljotal First and La_st Session Scores in Spaech Production, wave-Interactive. and Garmunicative Intent ~ Work-up for the W1 lcoxon Matched—Pairs Sigped-Ranks Test. Speech Product ion Garm. ~Interact ive Calm. Intent Subject First Last First Last First Last A 5 7 3 6 0 3 B 4 7 4 6 1 3 C 1 1 2 4 2 3 D 5 7 3 6 3 3 E 0 2 3 6 1 1 F 1 2 1 4 1 1 G 2 5 5 6 1 3 H 1 2 1 4 2 1 I 0 7 3 6 0 3 J 2 7 4 4 2 3 K 0 1 5 5 1 2 Means 1.9 4.4 3.1 52 1.3 2.4 Total Itans 7 6 3 &te. First = first session score; Last = last session score; Total Itans = total nunber of points possible in each subcategory; Cairn. = Garmunicat ive . 82 15 Scores Reversal Group Mean 16 ~\ Sessions I=Tenpo 0=lethn 4:Structure I=Pitch Figaro 14. Group Mean Scores in Tanpo, Rhythm, Structure/Form, and Pitch across 10 Sessions. 7 I_ HI 6 24 4 0 SI 0 o 5 o fi\\,,,¢/// g 4 ,/e//e/’* I xD——°/" 03 fl 2 \ g 2 o 1 fl “’8 Sessions 0=Speech Production IZCOMM. Intent I:Conn.~Interactive Eigpre 15. Group Mean Scores in Speech Production, Cannunicative- Interactive, and Cannunicative Intent across 10 Sessions. 83 Reaearch Qaestion #9 The Wilcoxon.Matched-Pairs Signed-Ranks Test was utilized to determine whether there were any significant differences between the nunber of spontaneous and creative acts as measured by the CRASS demonstrated by the subjects in their first sessions and those demonstrated in their last sessions. Table 8 shows that all of the subjects' last session scores were larger than or equal to their first session scores. Consequently, the differences between the scores were significant at the .01 level (7': 0). Research estion #10 A Spearman.Rank Correlation Coefficient was calculated between the musical vocal behavior gains and the nomusical speech production gains as recorded on the CRASS (Table 7). The coefficient corrected for ties was .645 which was significant at the .05 level (t = 2.532). These results indicate that as musical vocal behaviors increased, nonmusical speech production behaviors also increased. 84 Table 7. fljotal First and Last Session Sppntaneous. Creative (m1 cative Acts ~ Wilcoxon aM_a:tched~Paira Sigped-Ranks Test. Spontaneous Cannunicat ive Acts First Last Rank Rank with less Subject Session Session d of d frequent sign A 0 0 0 B 0 1 ~1 ~1.5 C 0 1 ~1 ~1 5 D 0 4 ~4 ~6 E 4 8 -4 -6 F 0 0 0 G 0 4 -4 ~6 H 0 6 ~6 ~9 I 0 5 ~5 ~8 J 0 2 ~2 ~3 K 2 5 ~3 ~4 T = 0* Means 5 3 3 Total Itans 19 d = Difference score ~ the difference between the first and last session scores; Total itans = total nunber of points possible. ip ( .01 85 Table 8. CRASS Musical Vocal Gain Scores and Normusical Smech Production Gain Scorea ~ Wbrk-up for the Spearman Rank Correlation Coefficient. Subject Vocal Gain Speech Production Gain A 23 2 B 26 3 C 9 0 D 32 2 E 21 2 F 8 1 G 19 3 H 12 1 I 36 7 11 5 HQ 00 1‘ Means 18.2 2.5 Note. CRASS = Checklist of Carrnunicative Responses/Acts Score Sheet. 86 The Behavior Change Survey (Appendix C) was the second measuranent device utilized in this study. This survey was completed at the conclusion of the study by 11 parents, 4 teachers, and 2 speech therapists. Thirty-three surveys were given out and twenty-nine were returned (88% return rate). Two of the surveys returned were filled out by teacher aides as opposed to speech therapists. These two forms were not utilized in the following analyses. Research flestionsLitll ~ #13 Table 9 shows the means for each of the 13 questions as answered by the parents, teachers, and speech therapists. Most of the means fell between 4, which indicated no change, and 5, which indicated a slight change. Overall, the parents gave the highest ratings 07:: 4.8), followed by the teachers 68’: 4.7), and finally the speech therapists 07‘: 4.2). The last two questions, which concerned the subjects’ musical behaviors, got the highest rankings, both achieving a mean of 4.9. The lowest rankings ([7 = 4.3) were given to questions #7 and #9, which asked about changes in emotional behaviors such as anxiety, irritability, and sadness. Changes were seen in all three categories by parents, teachers, and speech therapists. In the communicative category, the parents’ mean was 4.8, the teachers’ mean was 4.5, and the speech therapists’ mean was 4.2. In the social/emotional category, the parents’ mean was 4.7, the teachers’ mean was 4.7, and the speech therapists"mean was 4.2. Means in the musical category for the parents, teachers, and speech therapists were 5.3, 5.1, and 4.4, respectively. 87 Table 9. Maan Scorea for each'Qaestion on the Behavior Chapge Survey aa rated by Parents, Teachers, and Speech Therapists. Question # Parent Teacher Speech Therapist Tbtal Communicative Behaviors 1 4.7 4.5 4.0 4.4 2 4.7 4.5 4.6 4.6 3 5.1 4.4 4.1 4 5 4 5.0 4.7 4.3 4.7 5 4.5 4.6 4.1 4.4 Means 4.8 4.5 4.2 4.5 Social/Emotional Behaviors 6 5.0 4.9 4.1 4.7 7 4 5 4.3 4 1 4 3 8 4 8 4.8 4 1 4 6 9 4 5 4.3 4 1 4 3 10 4.9 4.9 4.3 4.7 11 4.7 4.7 4.3 4.6 Means 4.7 4.7 4.2 4.5 Musical 12 5.3 5.0 4.4 4.9 13 5.2 5.1 4.4 4.9 Means 5.3 5.1 4.4 4.9 Overall Means 4.8 4.7 4.2 4.6 88 Research mestionp #14 ~ #16 The Spearman Rank Correlation Coefficient was used to determine whether there were any correlations between (a) gains in CRASS scores (total score of" last session minus total score of first session for each subject) and parent Behavior Change Survey ratings, (b) gains in CRASS scores and teacher Behavior Change Survey ratings, and (c) gains in CRASS scores and speech therapist Behavior Change Survey ratings. Table 10 shows each subject’s gain in CRASS scores and his/her total ratings obtained fran the Behavior Change Survey. A significant correlation was found between the gains in GRASS scores and the parent ratings. The rho was .773, which obtained significance at the .01 level (t = 3.658). The rho corrected for ties for gains in CRASS scores and teacher ratings was .217 and did not reach significance. The Spearman Rank Correlation Coefficient corrected for ties for gains in CRASS scores and speech therapist ratings was .387 and did not obtain significance. Sane of the parents observed their child’s music therapy sessions. To determine whether these observations had an influence on the significant correlation between the parents’ ratings and the overall CRASS gains, two additional correlation coefficients were calculated. The Spearman Rank Correlation Coefficient for the ratings of the parents who observed their children’s sessions and overall CRASS gains was .400. The coefficient for the ratings of the parents who did not observe their children’s sessions and overall CRASS gains was .500. Neither of these two rho’s obtained significance. These results suggest that the factors or elanents basic to personal observation were not in cannon with factors underlying CRASS gains. 89 Table 10: GRASS Gain Scores and Tbtal Behavior Chapge Survey Ratipgs aa pepprted by Parents, Teachers, and Speech Therapists ~ Werk~ap for the Spaarman Rank Correlation Coefficient. Behavior Change Survey Tetal Ratings Subject GRASS Gain Parent Teacher Speech Therapist A 45 66 63 64 B 48 66 69 56 G 20 60 — ~ D 47 65 52 52 E 36 62 63 54 F 21 62 52 52 G 26 70 52 54 B 21 59 63 54 I 60 77 65 ~ J 23 52 ~ ~ K 14 54 66 - Means 32.8 62.9 60.6 55.1 Nete. CRASS = Checklist of Communicative Responses/Acts Score Sheet. A dash indicates no score was available. 90 Research mestiona #17 ~ #2_5_ The Behavior Change Survey consisted of three categories, cannunication, social/anotional, and musical. These categories were analyzed independently for correlations with CRASS gain scores. The Spearman Rank Correlation Coefficient was determined for gains in CRASS scores and (a) parent ratings in the cannunication category, (b) teacher ratings in the cannunication category, (c) speech therapist ratings in the cannunication category, ((1) parent ratings in the social/anotional category, (e) teacher ratings in the social/anotional category, (f) speech therapist ratings in the social/anotional category, (g) parent ratings in the musical category, (h) teacher ratings in the musical category, and (1) speech therapist ratings in the musical category. Each student’s ratings in the cannunication, social/anotional, and musical categories can be seen in Table 11. Significant correlations were found between GRASS gain scores and parent cannunication ratings (1'; corrected for ties = .711, t = 3.035, p < .02), parent social/anotional ratings (1': corrected for ties = .624, t = 2.395, p < .05), andparent musical ratings (rs corrected for ties = .612, t = 2.390, p < .05). The coefficients corrected for ties which did not obtain significance were (a) CRASS gains and teacher social/arotional ratings (rs =4 .513). (b) CRASS gains and speech therapist social/anotional ratings (rs = .206), (c) CRASS gains and teacher cannunication ratings (r, = .220). (d) CRASS gains and speech therapist cannunication ratings (1': = .638). (e) GRASS gains and teacher musical ratings (rs = ~.451), and (f) CRASS gains and speech therapist musical ratings (rs = ~.509). Table 12 lists all of the rho’s calculated in canparing the CRASS and the Behavior Change Survey. 91 Table 11. CRASS Gain Scores and Bahavior gaapge Survey Categorical Batipgs as reparted by Parents, Teachers, and Spaech Therapists ~ Wbrk- pp for the Spaarman Rank Correlation Coefficient. BEHAVIOR CHANGE SURVEY Cbmmunication Social/Emotional Musical Subject Gains P T ST P T ST P T ST A 45 25 23 24 29 32 32 12 8 8 B 48 25 26 24 30 31 24 11 12 8 C 20 23 ~ ~ 27 ~ ~ 10 ~ ~ D 47 27 20 20 28 24 24 10 8 8 E 36 27 21 20 26 30 24 9 12 10 F 21 25 20 20 28 24 24 9 8 8 G 26 23 20 20 33 24 24 14 8 10 H 21 20 20 20 29 29 24 10 14 10 I 60 27 26 ~ 36 31 ~ 14 8 ~ J 23 20 - ~ 24 ~ ~ 8 ~ - K 14 22 27 ~ 24 26 ~ 8 13 — Means 32.8 24 22.6 21.1 28.5 27.9 25.1 10.5 10.1 8.9 Note. CRASS = Checklist of Calmunicative Responses/Acts Score Sheet; P = parent; T = teacher; ST = speech therapist. A dash indicates no score was available. 92 Table 12. Smarman Rank Correlation Coefficients for CRASS Gain Scores and Behavior Me Survey Total and Categprical Ratipgs as remrted py brenta. Teachers, and Speech Therapists. Gaununicat ion Social/Erotional Musical Total Parents CRASS Gains .711** .624* .612* .773*** Teachers CRASS Gains .220 .513 ~.451 .217 Speech Therapists GRASS Gains .638 .206 ~.509 .387 Note. CRASS = Checklist of Cannunicative Responses/Acts Score Sheet; CRASS Gains = Last session CRASS scores minus first session CRASS scores. #p < .05. **p < .02. ***p ( .01. CHAPTERV Discussion Results of this study suggest that improvisational music therapy is effective in increasing the amount of cannunicative behaviors in autistic children. These results support nunerous case studies and clinical experiences which suggest the effectiveness of improvisational music therapy (Alvin 8: Warwick, 1992; Hollander &. Juhrs, 1974; Nordoff & Robbins, 1964, 1968a, 1971. 1977; Saperston, 1973). This study differs fran current research available in the area of improvisational music therapy and cannunicativeness in autistic children in that objective methods of control. observation, and data reporting were utilized. Although any one study alone cannot validate the effectiveness of a technique, this study strongly suggests that improvisational music therapy with autistic children is effective in eliciting and increasing cannunicative behaviors within a musical setting. The reversal design utilized in this study had the advantage of beginning and ending with an intervention phase, allowing two phases that danonstrated the effectiveness of the intervention. Practical considerations did not permit baseline data to be collected prior to intervention. In this design, each subject served as his/her own control. Each of the 11 subjects danonstrated gains in Gannunicative Responses/Acts across their sessions and abrupt decreases in the nunber 93 94 of Cannunicative Responses/Acts when reversal was applied. Significant differences were noted (p < .01) when comparing the total CRASS scores of the first sessions and those of the last sessions. Taking into account that one of the characteristics of autistic children is resistance to change, questions anerged concerning the validity of the first session scores. Therefore, a statistical analysis was computed to detenmine whether a significant difference existed between the subjects’ third session scores and their last session scores. ‘Utilizing the third session scores instead of the first session scores in the analysis was based on the assumption that by the third session, the subjects were not viewing music therapy as a change in their routine. Therefore, the third session scores may have been more accurate in portraying the communicative abilities of the children at the beginning of the study. Significance was achieved at the .01 level (T = 0), thus supporting the origiml analysis canpleted. The mean group gain in total nunber of Cannunicative - Responses/Acts fran the first to the last session was 32.8, with a range of 14-60, on the 107 point scale. The mean group decrease in total CRASS scores when reversal was applied was 19.3, dropping fran a mean of 34 to a mean of 14.7. Individual data indicate a range of 9-37 point decrease in total CRASS scores when reversal was applied. This range indicates an abrupt decreasing change in the nunber of Cbmmunicative Responses/Acts for each subject. Due to the abrupt and substantial level changes between conditions. it can be said with sane confidence that the improvisational music therapy approach produced the changes. Inherent within this single-subject design is the additional external validity of these findings since the positive effect of 95 improvisational music therapy on the total nunber of Caununicative Responses/Acts of one subject was replicated across 10 similar children. Reversal consisted of structured songs as opposed to improvisational music. The character of the improvisational music was responsive consistently to the child, where the structured songs were responsive only to their own forms. Also, in nmprovisational music therapy, the songs that were used belonged to that particular child since they anerged as a result of the child’s responses. The structured songs used in the reversal were imposed on the Child. There were two variables which were not controlled during reversal: 1. Eye contact with the subjects was decreased in frequency during reversal, due to the experimenter glancing at the written music. 2. Additional written music was placed on the piano during reversal. During intervention, there were 2 sheets of paper on the piano, one piece of staff paper on which were written music and words and another piece of paper on which were written words. During the reversal session, written music for the five songs used in conjunction with the session activities was on the piano. One of the subjects was distracted by the change in written music. He/she read the words to the songs at the beginning of the reversal session, which became evident when the experhmenter substituted this subject’s name for the name written in the music. lie/she stopped the experimenter and pointed to the name written in the music. Both the decrease in eye contact and the increase in written.music could have influenced the decreasing behavioral responses. 96 Other than these two factors, all other conditions during reversal ranained the same as in the experimental intervention phases. The nunber of verbal pranpts, gestural pranpts, and reinforcement acts rennined at constant levels. Also, each subject was given the same nunber of opportunities to score points on the CRASS as in the intervention phases. Subjective data on the creativeness and quantity of overall musical cannunicativeness were also collected for each of the 107 videotaped segments observed. The scale utilized ranged fran a low level of 1 to a high level of 7. These data represented a gestalt subjective impression of each child’s level of cannunicativeness during every session. The results supported the trend observed in the objective data discussed above. The group mean creativeness rating increased fran 1.4 to 5.2, and the group mean quantity rating increased fran 1.6 to 4.9. Decreases in both of these ratings were noted when reversal was applied. Group mean creativeness ratings decreased fran 4.1 to 1.8, and group mean quantity ratings decreased fran 3.6 to 1.7. These data suggest that the improvisatory aspect of the music facilitated cannunicative growth and development in autistic children within the musical setting. Therefore, insight into the results may best be gained by looking at specific characteristics of improvisational music therapy. (he of these characteristics was the ability to convey acceptance and support through the music. Fran the time each subject entered the roan, he/she was accepted as he/she was, and the improvisation reflected this acceptance. The skills the subjects danonstrated were viewed as potential cannunicative modalities. Autistic children 97 frequently exhibit behaviors that my not be acceptable in sane classroan, therapeutic, hane, and social settings. (he example of a behavior that was incorporated into the musical improvisation and utilized to establish intercaununication was repetitious vocalizing. Five of the subjects in this study anitted repetitious vocal sounds throughout their sessions. All five of these subjects eventually utilized these vocal sounds cannunicatively, placing their vocal sounds on tones in the key of the improvisation and vocalizing in rhyttlnic relationships with the improvisation. Also, all of these five subjects’ vocal sounds were influenced by the music, which was shown by the subjects matching pitches of the improvisation and increasing or decreasing the tanpo of their vocal sounds. The supporting aspect of improvisational music therapy may provide an atmosphere in which autistic children are more willing to attarpt to use both new and difficult skills. For three of the subjects, calm subtle music was very effective in decreasing hyperactivity and physical and vocal expressions of fear, anxiety, and/or nervousness. One of the subjects began a session crying anxiously and running around the roan. Both his vocal and physical expressions of anxiety stopped upon hearing one organun chord. This subject inmediately walked to the piano area and sat down in the chair, giving eye contact to the experimenter. For the other two subjects, the chi ldren’s tune, improvised with a harmonic chord progression of a major seventh proceeded by a minor seventh chord, resulted in slower physical behaviors, less agitated vocalizations, and in sane cases, increased vocal and/or instrunental participation. A parental report indicated that the amount of time one of these subjects sat in the chair was 98 rarely observed in other settings. During the session after which the parent node that observation, this subject sat in the chair for 7 minutes. Several sessions later, he/she sat continuously for 14 minutes. Recent observations have reported that sane autistic people who were once thought to be severely disabled intellectually due to their cannunication deficits danonstrated unexpected levels of understanding and knowledge (Biklen, 1990). For these people, acceptance is of utmost inportance for any type of change to occur. One of the two basic principles used in the improvisational music therapy technique was treating each child as canpetent; such treatment occurred on both musical and normusical levels throughout each session. This variable could have interacted with the musical improvisation in effecting the large nunber of gains seen in CRASS scores. However, treating each person as canpetent also occurred during the reversal, which suggests that it was not this variable in itself that effected the positive changes. Another characteristic of the improvisational music therapy was individualization. The music improvised by the experimenter related directly to the child fran manent to manent and belonged to the child. Behaviors danonstrated and vocalizations/verbalizations anitted by the child were incorporated into the music. This technique of incorporation seaned to have a direct influence on increasing the amount of participation. Upon hearing their own words placed into an improvisation, several subjects imnediately increased their frequency of both vocal and instrunental participation. Also, several of the subjects then began spontaneously stating more words to be incorporated 99 into the improvisation. (he example of this increased participation occurred when one subject stated that he/she did not want to sing that day. Upon hearing the experimenter’s improvisation using those words, this subject imnediately joined in singing the words, ” doesn’t want to sing today, oh not today". This subject continued singing throughout that entire 30-minute session. The activity was individualized, allowing the subject to be and do what he/she wanted at that manent. Motivational factors must also be considered as a variable within improvisational music therapy. Motivation my be enhanced through the use of improvisational music therapy due to several factors. First of all. the music itself my be motivating to the child. Research has shown that marw autistic children show an unusual interest in music. Secondly, music as a cannunication median my be more manageable for autistic children who frequently danonstrate difficulties in conventional cannunication intervention techniques. If this is true, the children may experience initial successes which could reduce arot ional pressures that accanpany past experiences in attanpts to cannunicate. Subsequently, decreased pressures could lead to increased motivation to cannunicate. The motivation inherent in music itself was a variable present in both treatment and reversal. The motivation fran initial successes was more prevalent in the treatment phases than in the reversal session. Structured songs place more anphasis on specific responses and require the child to respond to extraneous musical damnds. Rhythnic settings, tanpi, and melodic tones are determined for the child as opposed to being determined by the child. Sane of the subjects did experience 1m success during reversal: however. the frequency of success was higher during intervention. In examining each of the subject’s willingness to cane to music therapy, five of the subjects danonstrated no resistance throughout the entire study. Four of the subjects danonstrated varying degrees of resistance during the first several sessions. Each of these four decreased his/her amount of resistance, and by the fifth session eagerness to attend music therapy was seen by the experimenter and reported by the parents. One subject was inconsistent in the amount of resistance danonstrated throughout the study. Parental reports also indicated that sane of the subjects were disappointed once the study was canpleted. According to parental reports. one subject danonstrated resistance, not wanting to attend the music therapy sessions, during the entire study. Even though this subject danonstrated gains in GRASS scores, parental and teacher reports indicated that he/she never really reached his/her potential, both musically and cannunicatively, within the music therapy sessions. No interpretations offered by the parent and the teacher, who observed the sessions, were that the subject was bored with the materials in the roan and that the setting was not structured enough to allow the subject to understand the expectations and requiranents. This raises several questions: Is the improvisatory atmosphere too threatening for sane autistic children? Research has supported structured enviroanents for autistic people. Was the amount of canmunication which can occur through the music overwhelming for this subject? This subject did danonstrate cannunication through music, but had a difficult time sustaining each cannunicative episode. 101 Should additional instrunents be utilized in order to increase motivation and supply additional means for cannunication to occur? One drun, one cymbal, and a piano might not provide enough motivation or means of expression for sane autistic children. Does musical cannunication necessarily result in subjects using all of their available musical skills? Research has shown that nany autistic children have canmunication skills which are not consistently utilized. Could this also be true when looking at musical cannunication? This question could suggest an explanation of why this subject did make gains in GRASS scores. It is possible that the amount of cannunication the subject was willing or able to engage in limited the nunber of actual musical skills utilized. Results of this study show that autistic children are able to mke gains in the area of cannunication when participating in a low structured intervention. These findings are contradictory to the current literature and research cited earlier in the literature review, in which structured approaches are frequently recannended. An important question anerges as a result of the increasing levels of cannunicative behaviors in these autistic children resulting fran this improvisatory intervention. Do autistic children need more opportunities to experience successfully spontaneity and creativity? The improvisational approach not only allows for spontaneity and flexibility, but it also allows for successful experiences. Within this spontaneity, music provides for sufficient predictability to give the child the amount of support he/she needs. The CRASS was divided into two categories: musical and normusical. All eleven subjects made gains in both of these categories 102 when canparing their first and their last session scores. These data suggest that within an improvisational music therapy setting, autistic children’s use of both musical and normusical skills can increase. Significant differences were noted between the nunber of each of the four musical cannunicative modalities used by the autistic children in their first sessions and the nunber used in their last sessions. In canparing these four modalities (tanpo. rhytl'ln, structure/form, and pitch), the group as a whole utilized tanpo most frequently in both the first and the last sessions. Also, the largest point gain fran the first to the last session was noted in tamo for the group as a whole (5? = 9.9). The other three modalities, in order of group mean decreasing point gains, were pitch (F! = 7.7). rhytl'ln (M = 5). and form (7"! = 4.6). One interpretation of these data concerns the rhytlmic repetitive behaviors characteristic of autistic children. Colman and his colleagues (1976) assert that there is a stability in the frequency at which repetitive behaviors occur. The modality of tanpo consisted of beating/vocalizing in a steady tanpo, mtching the experimenter’s tarpo, and beating/vocalizing and matching tempo variations. mcause of the fundamentally rhytl'lnic behaviors of autistic children, tanpo may initially be one cannunicative modality in which autistic children can ironediately experience success. Thaut (1980) suggested the possibility of rhythm being absorbed on a physiological level and bypassing the cognitive deficits of autistic children. His definition of rhytlm encanpassed both the tanpo and the rhythmic modalities measured in this study. This could be one possible explanation of the high levels of cannunicativeness danonstrated in the tanpo modality. However. as noted below, the subjects made minimal 103 increases in the rhythn modality. Another interpretation of the increased amount of cannunicativeness utilized in the tanpo modality concerns interactional synchrony. Condon (1976) found that listeners move in exactly synchronous relationships with speakers. In researching autistic children, this synchrony is distorted (Condon, 1975). The subjects in this study were able to synchronize their drun beating with the ongoing music in varying degrees. One could posit that this synchrony facilitated cannunicative interaction through the music. Also, for sane of the subjects, the music reflected their behaviors and vocalizations. The music was synchronized with the children’s repetitive movanents, using their levels of intensity, their rhythms, and their tanpi. This could have created a sense of awareness, sense of control over their environnent, and a new means of cannunication. In the modality of pitch, gains ranging fran 3 to 15 points were noted. All of the itans in this modality were vocal responses. It is significant that each of the 11 subjects mde gains in this modality. Overall gains were also noted in rhytlln and structure/form. However, the gains were analler than the previous two modalities discussed. Gains were mde by all 11 subjects in rhytlln and by 9 subjects in structure/form. The of the subjects mintained their scores in structure/form when canparing the first and the last sessions. Both of these modalities utilize more cognitive involvanent as canpared to tanpo. Perhaps there is a connection between the cognitive deficiencies found in autistic children and the modalities of rhytlln and structure/form. Participating in a give-and-take, one of the itans under structure/form, requires one to organize and retain n54 canplex sequences of information and then to use this information in responding. Autistic children’s cognitive deficiencies could account for the smaller amount of gains in this modality. However, it should be repeated that structure/form gains were mde by 9 of the subjects. Under the manusical modalities, group mean gains were noted in all three subcategories: speech production, communicative-interactive, and cannunicative intent. During their last sessions, five subjects achieved all of the itans under speech production (a total of 7). six subjects danonstrated all 6 of the itans under cannunicative- interactive, and seven subjects danonstrated all 3 of the itans under cannunicative intent. looking at individual data fran the first to the last sessions, one subject maintained his/her score and ten subjects danonstrated increases in speech production; two subjects mintained their scores and nine subjects danonstrated increases in cannunicative- interact ive; and one subject danonstrated a decrease, three subjects maintained their scores, and seven subjects danonstrated increases in cannunicative intent. Statistical canparisons between these subcategories are not possible due to the small nunber of itans within each subcategory. A significant correlation coefficient was obtained between the musical vocal behavior gains and the nonmusical speech production gains (rs = .645, p < .05), which indicates that as musical vocal behaviors increased, on the average. nonmusical speech production behaviors also increased. These results suggest that nmprovisational music therapy may be an effective language intervention approach for autistic children. Only one point was given for any vocalization anitted. The other points were given for spoken words/phrases of a song and 105 spontaneous appropriate words/ phrases. This approach incorporated the children’s spoken words and vocalizations. whether they were seen as nonfunctional or functional, into meaningful cannunicative activities. Several current cannunication intervention techniques stress the importance of this technique (Fay 8r. Schuler, 1980; Wetherby, 1984). These speech production skills were not analyzed according to the specific cannunicative functions they served. It has been stated that cannunication through music bypasses the speech and language barriers of autistic people. This could be one possible explanation for the increases in musical vocal behaviors. However, the significant relationship found between the increases in musical vocal skills and the increases in speech production skills leads to the question as to whether there is a cause-effect relationship. Further research is needed to examine this question. Nine of the eleven subjects made gains in the nunber of spontarwous and creative acts fran their first to their last seIsions. These increases ranged fran 1 to 6 points, and the group mean increase for all eleven Iubjects was 2.8 points. Even though the actual increases were relatively anall, these could be valuable data for a population in which spontaneity is very limited. One interpretation of these data could be that the improvisational approach allows for creative exploration as opposed to placing external structural danands on the child. All of the subjects’ creative explorations were incorporated into the ongoing improvisation and thus reinforced. Therefore, these explorations could have been perceived by the subjects as successful, which returns to the possibility discussed above of successes heightening motivation which in turn elicits increased 106 attanpts. Since it has been reported tint autistic children generally do not respond well to low structured environnents, they my be limited by their overall envirorlnent in experiencing successes in spontaneity. The Behavior Change Survey was the second measuranent device utilized. The group mean ratings for changes in the subjects’ cannunicative, social/anotional, and musical behaviors as noted by parents, teachers, and speech therapists ranged fran 4.2 to 5.3, with an overall mean of 4.6. This indicated that there was change seen in the subjects’ behaviors; however, it was minimal. Parents and teachers reported more changes than speech therapists in all three categories. This could be due to the limited amount of time the speech therapists see the subjects as canpared to the teachers and parents. Also, the placebo effect must be taken into consideration when interpreting these data. It is possible that the changes observed in the subjects’ behaviors could have been attributed to changes in the parents’ and teachers’ attitudes and expectations of the subjects since they were aware of the purpose of this study. The musical category was the highest rated category overall. This could have been influenced by the knowledge of the subjects’ participation in the music therapy research study. It is possible that due to this knowledge, the parents, teachers, and speech therapists became increasingly aware of the subjects’ attraction to musical stimuli and danonstration of musical behaviors. Through the Behavior Change Survey and verbal cannents, the experimenter was able to ascertain the feelings of my of the parents, teachers, and speech therapists. Interest in a continuation of music therapy services for the subjects was widespread. Also, the limited 107 amount of time the subjects participated in the study was stated as a possible reason for the minimal behavioral changes observed outside of the music therapy setting by three of the four teachers and both speech therapists. Significant correlations were found between the subjects’ CRASS gains and the parents’ total and categorical Behavioral Change Survey ratings. These results indicate that on the average, parents of the subjects who danonstrated the most GRASS gains rated their children higher on the Behavior Change Survey than the other parents. As stated in Chapter IV, this did not scan to be influenced by the parents who observed their chi ldren’s music therapy sessions. The question of possible generalization, or transfer of learning fran one setting to another, anerges fran these findings. The teachers’ total ratings and their ratings in the three categories of the Behavior Change Survey were not significantly correlated with the subjects’ CRASS gains. Also, no significant correlation coefficients were obtained between the speech therapists’ ratingI and the subjects’ CRASS gains. One possible reason for these differences might be that teachers and speech therapists utilize more of a structured setting than parents. Within the structured environnent, opportunities for the subjects to danonstrate spontaneity and utilize new skills my be limited. The experimental design utilized in this study mininally limited the improvisational music therapy technique. Within a preselected 10- minute interval. certain musical opportunities needed to be presented to the subjects during every session. It is possible that sane of 108 these opportunities would not have been presented at that specific time if not involved in an experimental study. Other than this limitation, the large nunber of techniques provided in the hierarchy of musical experiences/activities (listed in Chapter III) enabled the experimenter to individualize each session, responding to each subject according to his/her needs and capabilities. Recallnendations for Further Study The initial purpose of this study was to explore the effectiveness of improvisational music therapy on the cannunicativeness of autistic children. Analyses of individual responses to the study strongly suggests the efficacy of this technique as a cannunication intervention tool with autistic children. All eleven subjects danonstrated positive acceleration trends during both intervention phases and abrupt decreasing levels when reversal was applied. Also, significant differences were noted between the first session and the last session total CRASS scores. If this study is replicated, sane changes should be considered. First of all, a larger nunber of subjects would make the study more valid. Also, a male:fanale ratio which is proportional to the actual ratio found in autism would help increase the generalizability of the results. The uncontrolled factors, including the various settings of the study and the decrease in eye contact and increase in mterials during reversal, should be controlled in future studies. Another suggestion would be to increase the total nunber of sessions for each subject, which would allow for more sessions during the reversal phase. Sane changes in the CRASS are also recamended for future research. An increase in the nunber of itans in the nonnusical 109 category would provide a more canprehensive look at the cannunicative behaviors of autistic children in music settings and would balance the nonmeical and musical sections of this measuranent device. Also, it would be beneficial to categorize itans in the nonnusical section according to Gaununicative Responses and Cannunicative Acts. More research is needed in the area of unstructured learning environnents for autistic children in regard to their cannunicative and spontaneous behaviors. Although research has shown that autistic children learn best in structured environnents, do these envirorlnents limit the children’s nunber of opportunities and successful experiences in both cannunication and spontaneity? Other research questions concerning speech production and.musical vocal skills in autistic children anerge fran this study. The increases danonstrated by the subjects in both of these areas, along with the significant correlation found between these two areas. deserve further investigation. Studies which identify the specific cannunicative functions used by autistic children in an improvisational music therapy setting would provide additional information in the area of communication deficits of autistic children. The specific cannunicative functions utilized while singing and while speaking could then be compared within the music therapy setting. Also, studies which investigate specific variables inherent in.improvisational music therapy and their effects on vocal and verbal abilities of autistic children could enhance current knowledge of effective intervention techniques. Further research is also needed to study the transfer of learning fran music therapy settings to situations in other life contexts . 110 Future research studies in improvisational music therapy could be designed to study both the effects of specific techniques within improvisational music therapy and autistic children’s specific responses in the various musical cannunicative modalities. This study answered sane of the initial questions and raised nunerous new questions. Further experimentation and investigation might help to better understand the cannunication deficits of autistic children. This increased knowledge could possibly facilitate the develoanent of intervention programs in which autistic children are able to express thanselves and experience the joys of cannunication. APPENDICES APPENDIX A Approval Letter fran University Cannittee on Research Involving Hanan Subjects MICHIGAN STATE UNIVERSITY OI'HCE Ol’ VICE PRESIDENT FOR RESEARCH EAST LANSING ' MICHIGAN ' 48824-1046 AND DEAN Of THE GRADUATE SCHOOL August 26, 1992 Cindy Lu Edgerton 443 Forest Charlotte, MI 48813 RE: THE EFFECT OF IMPROVISATIONAL MUSIC THERAPY ON THE COMMUNICATIVE BEHAVIORS OF AUTISTIC CHILDREN, IRB {92-435 Dear Ms. Edgerton: The above project is exempt from full UCRIHS review. The proposed research protocol has been reviewed by a member of the UCRIHS committee. The rights and welfare of human subjects appear to be protected and you have approval to conduct the research. You are reminded that UCRIHS approval is valid for one calendar year. If you plan to continue this project beyond one year, please make provisions for obtaining appropriate UCRIHS approval one month prior to August 26, 1993. Any changes in procedures involving human subjects must be reviewed by UCRIHS prior to initiation of the change. UCRIHS must also be notified promptly of any problems (unexpected side effects, complaints, etc.) involving human subjects during the course of the work. Thank you for bringing this project to my attention. If I can be of any future help, please do not hesitate to let me know. incerely, \e‘flfike) avid E. Wright, Ph.D., University Committee on Research Involving Human Subjects (UCRIHS) DEW/pjm Dr. Roger Smeltekop 111 APPENDIX A Approval Letter from Lansing School District Office of Research and Evaluation SCHOOL DISTRICT Committed to Quality 14 September 1992 Cindy Lu ldgerton, AMT-BC 443 Forest Charlotte, a: 48313 Dear as. ldqerton: In regard to the proposed study, "The lifect of Improvisational Music Therapy on the Communicative Behaviors of Autistic Children", the request to conduct the study in the Lansing school District has been approved. The following comments apply to the study: No student contact may be made until written parent permission is on tile in the school(s). Any teacher participation must be clearly voluntary. If you have any questions or need additional information, please contact me (374-4347). .Pat Petersen PP/mlc cc: Research Review Committee Members Research & Evaluation Services Office - 500 W. Lenawee St. Lansing, Michigan 48933 As “no! Opportunity District 112 APPENDIX B Parental Consent Form Description and Purpose of Study m name is Cindy Edgerton, and I am writing to ask your permission for your child to participate in my music therapy research study. This study is a partial fulfillment for m Masters Degree in Music Therapy and is being supervised by Roger Smeltekop, Chairperson of Music Therapy at Michigan State University. The purpose of my study is to see if improvisational music therapy can increase cannunicative behaviors in children diagnosed with autism. Improvisational music therapy allows for spontaneous music making in which musical interactions between the therapist and the child can occur. Beginning in September. your child will have the opportunity to participate in a half-hour individual music therapy session per week for a period of ten weeks. During the majority of the sessions, I will be creating music on the piano and singing/vocalizing, and your child will have opportunities to beat the drun and the cymbal. play the piano, and vocalize or sing along with me. He/She will be videotaped for purposes of data collection only. Videotapes will be erased once the final written copy of the study is completed. There are no potential risks anticipated to your child. Benefits cannot be guaranteed. However, your child’s participation may help us to better understand the cannunication deficits of children with autism and to develop more treatment interventions designed to increase and expand their cannunicative behaviors. This study has already been approved by my thesis conmittee at Michigan State University. the Lansing School District Office of Research and Evaluation Services, the Director of Special Education of Charlotte Public Schools, and the Director of Special Education of Eaton Intermediate School District. With your help, we may be able to use this information to improve our ability to help children with autism. I would appreciate if you would indicate your approval by signing the Consent for Participation In Improvisational Music Therapy Study and returning it to me in the self-addressed stamped envelope. If you have any questions or concerns, please contact me at the phone nunber listed below. Thank you very much for your support. Cindy Lu Edgerton, RMT-BC Roger Sneltekop, RMT-BC music therapy graduate student Chairperson, Dept. of 443 Forest Music Therapy Charlotte, MI 48813 Michigan State University (517) 543-1981 (517) 355—6758 113 APPENDIX B Parental Consent Form Consent for Participation in Improvisational Music Therapy Study I consent to my child’s participation in a study which intends to investigate the effects of improvisational music therapy on the cannunicative behaviors of children diagnosed with autism. I have read the Description and Purpose of the Study and have had the opportunity to obtain additional information regarding the study. I understand that my child's participation is voluntary and that he/she may withdraw from the study at any time without prejudice to me or to him/her. I also understand that my child's permission will also be obtained if possible. My child's identity will remain confidential. Videotapes of my child will be used for purposes of data collection only and will be erased once the final written copy of the study is canpleted. Finally, I acknowledge that I have read and fully understand the consent form. I have signed it freely and voluntarily. When the study is completed, I understand that I may send the researcher a written request to receive a copy of the smmary of the final results. Parent's signature Date Child's name 114 V APPENDIX C CHECKLIST 0F COMMUNICATIVE RESPONSES/ACES SCORE SHEET - RESPONSES 1. Match Approx Matches Matches Matches Matches Responds Matches Matches Responds Matches Matches Corres Imitates Imitates Imitates Imitates Imitates Imitates Responds Responds Produces a. Resp a. Resp 1. MUSICAL IEMEQ Steady tempo (3 responses) a. Vac/Beats w/in a single tempo range ACTS - I A. b. Basic Beat (1) Fast (>149 bpm) Voc/Beats (2) Mod. (95-149 bpm) Voc/Beats (3) Slow (<95 bpm) Voc/Beats c. 12 continuous beats Vac/Beats Accelerando a. Voc/Beats b. Increases own c. Accurately or approximately d. Accurately . Ritardando a. Voc/Beats b. Decreases own 0. Accurately or approximately d. Accurately B- EEXIBM Vac/Beats multiples of basic beat (4 ther beats) 2 diff synchronized rhythms Beats Rhythmic pattern/moi motif (1 measure or less) a. Simultaneously b. Subsequent to therapist (after) 0. Creates . d. Repeats own Rhythmic/melodic phrase (greater than 1 measure) a. Simultaneously b. Subsequent to therapist (after) 0. Creates d. Repeats own Entire melodic rhythm (2 or more phrases) a. Simultaneously ‘ b. Subsequent to therapist (after) c. Creates C- SIBQQIHBELEQBM Phrase a. End of phrase b. Phrase or measure beginning-specific a not let One word at appropriate time Rhythmic give a take (th-ch-th-ch) b. Initiates (ch-th-ch) c. Develops ("lch 2nd reponse diff) Melodic give a take (th-ch-th-ch) b. Initiates (ch-th-ch) c. Develops ("Ich 2nd response diff) 115 116 D-EIIQE a. Voc 1. Vocalizes (singing quality) _____ Responds b. In key of improvisation Matches c. Therapist's pitch 2. Varies pitch a. Ascends in pitch b. Descends in pitch 3. Melodic motif a. Voc/Sings Matches b. Melodic contour-approx or accurately Matches 0. Pitches-approx or accurately 4. Melodic phrase a. Voc/Sings _____ Matches b. Melodic contour-approx or accurately Matches c. Pitches-approx or accurately d. Spontaneously creates new melodic phrase 5. Entire song a. Voc/Sings _____ Matches b. Melodic contour-approx or accurately Matches c. Pitches-approx or accurately d. Spontaneously creates‘new song II. NONeMUSICML A- SEEEQH_£BQDQQILQH_SK1LL§ 1. Produces sound/vocalization/word 2. Song vocalization/word Produces a. Word of song being sung Produces b. Motif of song being sung Produces c. Phrase of song being sung Spon prod 3. Appropriate vocalization/word Spon produces a. Appropriate 2-word combination Spon produces b. Appropriate >2-word combination KW Plays instrument Plays 2 instruments Uses both hands simultaneously in beating Vocalizes and beats simultaneously Tolerates entire 10 minutes Participates w/ther in entire 10 minutes 0W Expresses emotional reaction Indicates any need/want Indicates wanting a music activity/song (barb-UNI— “NH - IQIAL Communicative Responses/Acts WWW Quantity ------ (low level) 1 2 3 4 5 6 7 (high level) Creativeness--(low level) 1 2 3 4 5 6 7 (high level) APPENDIX C Cannunicative Responses/Acts Definitions Beats - This term refers to the playing of the drun, cymbal, or piano with mallets or with hands, and/or making a percussive sound using body parts or mallets. Vocalizes - To produce musical tones or tones with musical inflections by means of the voice I - Instrunental - Any response in which the child beats (as defined above ) V - Vocal - Any response in which the child vocalizes (as defined above) I. NUSICAL: A. TEMPO 1 . Steady tempo a. Vocalizes/beats within a single tempo range-a minimun of 3 responses in the same tempo range. Tempo ranges are defined in section I.A.1.b. (1-3) Matches Approx-vocalizes/beats a minimun of 3 consecutive responses in the same approximate tempo of the therapist Basic beat-an equal nunber of beats per minute for 3 consecutive beats/vocalizations (1) Fast-Vocalizes/beats a basic beat in a fast tempo range or greater than 149 beats per minute Matches-vocalizes/beats the same fast basic beat as the therapist (2) Moderate-Vocalizes/beats a basic beat in a moderate tempo range or from 95 to 149 beats per minute Matches-vocalizes/beats the same moderate basic beat as the therapist (3) Slow-Vocalizes/beats a basic beat in a slow tempo range or less than 95 beats per minute Matches-vocalizes/beats the same slow basic beat as the therapist Vocalizes/beats 12 continuous beats-vocalizes/beats 12 continuous basic beats Matches 12 continuous beats-vocalizes/beats 12 continuous basic beats which match that of the therapist-therapist must initiate tempo 2. Accelerando (a minimun of 19 beats per minute change) a. b. Vocalizes/beats an accelerarxio-increases own tempo Responds/ Increases own-while continuously beating/vocalizing, increases own tempo when therapist increases hers 117 118 c. Matches/Accurately or Approximately-follows the therapist's accelerando accurately or by playing close approximations-almost with therapist's beats during the entire accelerando-all child's beats must speed up d. Matches/Accurately-follows the therapist's entire ~.acce1erando accurately 3. Ritardando (a minimun of 10 beats per minute change) a. Vocalizes/beats a ritardando-decreases own tempo b. Responds/Decreases own-while continuously beating/vocalizing, decreases own tempo when therapist decreases hers c. Matches/Accurately or Approximately-follows the therapist’s ritardando accurately or by playing close approximations-almost with therapist's beats during the entire ritardando-all child's beats must slow down (1. Matches/Accurately-follows the therapist's entire ritardando accurately B. RHYTHM (Rhythmic Pattern-the grouping of 2 or more beats/vocalizations/words played/vocalized/sung in succession which differs from but is referenced to the basic beat. The length of a rhythmic pattern will be no longer than 1 measure. Phrase-any short figure or passage complete in itself and unbroken in continuity. The length of a phrase will be greater than 1 measure. Motif-a part or portion of a phrase. Melodic phrase/motif-a phrase/motif taken from the played or sung melody. ) 1. Corresponds/Vocalizes/beats multiples of basic beat- vocalizes/beats any multiples the therapist's basic beat- minimun of 4 of the therapist's beats- therapist must be playing the basic beat 2. Beats 2 different synchronized rhythms-simultaneously uses both hands to beat 2 different rhythms which are both referenced to the same basic beat 3. Rhythmic pattern/melodic motif a. Imitates simultaneously-accurately vocalizes/beats the rhythmic pattern/melodic motif with the therapist b. Imitates subsequent to therapist-accurately vocalizes/beats the rhythmic pattern/melodic motif after the therapist finishes playing/vocalizing it- therapist can not be singing or playing it c. Creates-vocalizes/beats a new, definite rhythmic pattern/melodic motif-must be referenced to a basic beat and be repeatable d. Repeats own-vocalizes/beats own new rhythmic pattern/melodic motif 2 times 4. Rhythmic/melodic phrase a. Imitates simultaneously-accurately vocalizes/beats the rhythmic/melodic phrase with the therapist b. Imitates subsequent to therapist-accurately vocalizes/beats the rhythnic/melodic phrase after the therapist finishes playing/vocalizing it-therapist can not be singing or playing it d. 119 Creates-vocalizes/beats a new, definite rhythmic/melodic phrase-must be referenced to a basic beat and be repeatable Repeats own-vocalizes/beats own new rhythmic/melodic phrase 2 times 5. Entire melodic rhythm a. b. Imitates simultaneously-accurately vocalizes/beats the entire melodic rhythm with the therapist Imitates subsequent to therapist-accurately vocalizes/beats the entire melodic rhythm after the therapist finishes playing/vocalizing it-therapist can not be singing or playing it Creates-vocalizes/beats a new, definite entire melodic rhythm-must be referenced to a basic beat and be repeatable C. STRUCTURE/FORM 1. Phrase a. Responds/end of phrase-stops beating/vocalizing at the end of a phrase, beats/vocalizes only on the last beat of the phrase. punctuates the last beat of the phrase using accented beat/vocalization or a different instrument, or holds note at the end of a phrase Responds/phrase or measure beginning-specifically places beats to coincide with beginning of measure or phrase, accents first beats of the measure/phrase while beating/vocalizing the basic beat, responds with a differentiated use of two instruments, beats/vocalizes the first beat only. and/or vocalizing/beating song phrases using appropriate rests-2 successive measures/phrases 2. Produces one word at appropriate time-says or sings one word of a motif/phrase/song at the correct moment of the motif/phrase/song 3. Rhythmic give-and-take (must follow a meter/beat/tempo and be continuous-child’s response must consist of more than one beat/vocalization) 8.. Responds-Participates in rhythmic give-and-take initiated by the therapist-1 therapist-child-therapist- child cycle Initiates-Begins a rhythmic give-and-take-l child- therapist-child cycle Develops-While participating in a rhythmic give-and- take initiated by the therapist or by the child, the child's second response is different from his/her first response (Either child-therapist-child or therapist- child-therapist-child cycle) 4. Melodic give-and-take (must follow a meter/beat/tempo and be continuous-child's response must consist of more than one vocalization) 8.. Responds-Participates in melodic give-and-take initiated by the therapist—1 therapist—child-therapist- child cycle 129 b. Initiates-Begins a melodic give-and-take-l child- therapist-child cycle 0. Develops-While participating in a melodic give-and-take initiated by the therapist or by the child, the child's second response is different from his/her first response (Either child-therapist-child or therapist- chi ld-therapist-chi 1d cycle) PITCH (Phrase-any short figure or passage complete in itself and unbroken in continuity. Motif-a part or portion of a phrase. ) 1. Vocalizes a. Vocalizes-produces any sung vocalization/word/somid b. Responds in key of improvisation-a minimun of one note must be within the key of the therapist’s music c. Matches therapist’s pitch-sings the same pitch the therapist is vocalizing/playing Varies pitch a. Ascends in pitch-produces a minimun of two ascending pitches b. Descends in pitch-produces a minimun of two descending pitches Melodic motif a. Vocalizes/sings a melodic motif b. Matches melodic contour approximately or accurately- sings/vocalizes a melodic motif with or after the therapist, accurately matching the melodic contour or producing close approximations of the melodic contour c. Matches pitches approximately or accurately- sings/vocalizes a melodic motif with or after the therapist, accurately matching the pitches or producing close approximations of the pitches Melodic phrase a. Vocalizes/sings a melodic phrase b. Matches melodic contour approximately or accurately- sings/vocalizes a melodic phrase with or after the therapist, accurately matching the melodic contour or producing close approximations of the melodic contour c. Matches pitches approximately or accurately- sings/vocalizes a melodic phrase with or after the therapist. accurately matching the pitches or producing close approximations of the pitches d. Spontaneously creates new melodic phrase-one not known by therapist and observers Entire song (a minimun of 2 phrases) a. Vocalizes/sings an entire song b. Matches melodic contour approximately or accurately— sings/vocalizes an entire song with or after the therapist, accurately matching the melodic contour or producing close approximations of the melodic contour 0. Matches pitches approximately or accurately- sings/vocalizes an entire song with or after the therapist. accurately matching the pitches or producing 121 close approximations of the pitches d. Spontaneously creates new song-one not known by therapist and observers 11- W: A. SPEECH PRODLIII‘ION SKILLS 1. Produces sound/vocalization/word-spoken, stated, or sung 2. Song vocalization/word a. Produces word of song being sung-at any time during or imnediately after song (within 5 seconds after the song ended) b. Produces motif of song being sung-at any time during or inmediately after song (within 5 seconds after the song ended) c. Produces phrase of song being sung-at any time during or inmediately after song (within 5 seconds after the song ended) 3. Spontaneously produces appropriate vocal ization/word-any vocalization/word appropriate to the ongoing activity a. Spontaneously produces appropriate 2-word combination b. Spontaneously produces appropriate >2-word combination WICATIVE- INTERACTIVE SKILLS huNi-e 01 Plays instrument Plays 2 instrunents Uses both hands simultaneously in beating Vocalizes and beats simultaneous ly-must approximate synchroni zat ion Tolerates entire 1O minutes-does not demonstrate any of the following behaviors: attempt to leave the room, physically stop therapist fran improvising, vocalize/beat disruptively, suggest another activity, and exhibit aggressive and/or self-injurious behaviors Participates with therapist in entire 13 minutes-stays in piano/drun/cymbal area the entire time and actively participates the majority of the time-must tolerate the entire 1O minutes WICATIVE INI'ENI' SKILLS 1. Expresses emotional reaction to music-e.g. , smiling. laughing, clapping. crying, frowning, moving body excitedly, vocalizing excitedly, hugging therapist, vocalizing intensely, throwing arms up in the air (like "hurray!!) Indicates any need/want-throug’h verbalizing. vocalizing, signing. gesturing. or physically prompting Indicates wanting a music activity/song-specific activity/song, element of music. instrunent Overall Level of Cannunicativeness-rate the child according to both the quantity and creativeness of cannunicative behaviors, both musical and normusical. demonstrated during the 1% minute segment APPENDIX C BEHAVIOR CRANE SLRVEY Child’s Name Date Your Name Please circle one nunber for each statement using the following scale: much somewhat s l ight 1y s l ight ly somewhat much less less less same more more more 1 2 3 4 5 6 7 I. WICATIVE BEHAVIORS A. Changes in the quantity of gestural cannunicative behaviors: 1 2 3 4 5 6 7 B. Changes in the quantity of nonverbal vocalizations: 1 2 3 4 s 6 7 C. Changes in the quantity of verbal behaviors: 1 2 3 4 s 6 7 D. Changes in the quantity of spontaneous cannunicative behaviors: 1 2 3 4 5. 6 ‘7 E. Changes in the amount of variation in dynamics of verbal/vocal behaviors: 1 2 3 4 5 6 7 II. SOCIAL/DUTIONAL A. Changes in the quantity of emotional behaviors such as happiness. conf idence. and contentment: 1 2 3 4 ' S 6 7 B. Changes in the quantity of emotional behaviors such as anxiety. irritability. and sadness: ' 1 2 3 4 s 6 '7 C. Changes in the intensity of emotional behaviors such as happiness. conf idence. and contentment: 1 2 3 4 5 6 7 D. Changes in the intensity of emotional behaviors such as anxiety. irritability, and sadness: 1 2 3 4 s 6 7 E. Changes in the quantity of interactive behaviors: 1 2 3 4 5 6 7 F. Changes in comfort in relating to others: 1 2 3 4 5 6 ‘7 III. MBICAL A. Changes in attraction to musical sounds: 1 2 3 4 s 6 7 B. Changes in quantity of musical behaviors: 1 2 3 4 s 6 7 IV. Please use the back of this sheet to meat on your responses above or to provide me with any additional information. Once again. 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