Category Archives: Music and development

Music-based therapy helps non-verbal autistic children to utter speech for the first time

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For a few years now there has been a great deal of interest in Melodic Intonation Therapy, a singing-based intervention that has been extensively tested by Gottfried Schlaug’s Boston group. This specially adapted sing-song training has been shown to help people with non-fluent aphasia (usually after stroke) regain some ability to speak. Today’s blog is about a variant of this type of therapy that has been tested by one of the Schlaug lab members, Catherine Wan, which can aid speech production in non-verbal autistic children.

In June of this year I attended Music and Neurosciences IV conference in Edinburgh and this was where I first heard about Auditory Motor Mapping Training (AMMT) as an intervention to help non-verbal autistic children. I wrote about a talk given on the subject by Catherine Wan in a previous blog which you can read here. In the past few weeks her first paper has been published in PLoSONE (hurray for free access!!)

Background: Up to 25% of individuals with Autism Spectrum Disorders (ASD) have difficulties communicating with speech. Regaining some ability to speak is a good prognostic indicator for children with ASD however, therapeutic interventions have had limited success up until now.

Catherine’s study tested the effectiveness of AMMT, an intonation based therapy which teaches children associations between sounds and articulatory actions. The therapy aims to capitalise on the well documented sparing and even heightening of musical skills that is often reported in ASD children, alongside their enjoyment of musical activities (see work by my colleague Pam Heaton). The aim of AMMT is to facilitate auditory-motor mappings by teaching children to speak at different pitches while playing tuned drums.

“The therapist introduces the target words or phrases by simultaneously intoning the words and tapping the drums tuned to the same pitches” (Wan et al. 2011: e25505)

The therapy is based on intensive repetition of the same words and phrases in a highly structured environment.

How might it work? The theory is that AMMT will likely engage and possibly strengthen a multi-sensory frontoparietal network of regions and pathways in the brain that respond to visual, auditory and motor representations of the same action, and sensory motor feedback. This network is thought to be crucial in our ability to speak, which involves mapping sound (the words we want to say) onto motor actions (movements of our mouth, throat and tongue).

Method: Six non-verbal ASD children between 5 and 9 years of age took part in the study. All had at least 18 months speech therapy prior to the study but had shown little progress. All were defined as ‘non-verbal’ meaning they had a complete absence of intelligible words.

Image of AMMT trial from Wan et al. (2011)

During each session the child sat opposite the therapist. In between them were two drums, one tuned to C4 (261.626Hz) and one tuned to E flat (311.127Hz).

Between the ‘Hello song’ and the ‘Goodbye song’ the therapist introduced 15 bi-syllabic items such as ‘mommy’, ‘more please’ and ‘all done’.

Using Boardmaker pictures as visual cues, the therapist held the child’s two hands in theirs and encouraged them to play the drums while they spoke the words, thereby encouraging bi-manual movement.

Results: The children’s vocal ability was tested with probe assessments using one set of trained items (the 15 test items) and one set of untrained items (15 similar items that were not presented during therapy). For each word/phrase the child’s best utterance was transcribed and scored by the number of consonants and vowels correctly produced.   

Experimental control was taken as three baseline tests that were taken prior to therapy.

Within 15 sessions of AMMT all the children showed a good response to therapy and by 40 sessions all of them showed significant improvements in their speech production, which was maintained at 4 week and 8 week follow-ups. There were even improvements for the untrained items, showing that the approximate consonant-vowel combinations that the children had learned extended beyond the words presented in therapy.

Conclusions: This first paper on AMMT is billed as a ‘proof of concept’ paper to demonstrate that they therapy can have positive impacts on speech production, even in children who have not uttered a word for the first 9 years of their life. Although their speech output was still extremely limited compared to age matched children, the ability to utter a few everyday phrases is a crucial step forward in their development. The fact that their improvements in some cases extended into a small number of phrases that were not even part of the therapy sessions is also an extremely promising finding. This paper will provide the basis for future randomized control trials.

Paper: Wan CY, Bazen L, Baars R, Libenson A, Zipse L, et al. (2011) Auditory-Motor Mapping Training as an Intervention to Facilitate Speech Output in Non-Verbal Children with Autism: A Proof of Concept Study. PLoS ONE 6(9): e25505. doi:10.1371/journal.pone.0025505

 

 

Music in baby/child development

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Today I have had the pleasure of visiting a parent-child music activity session in London. I was invited by Caroline, the UK general manager of Jo Jingles, to come and supervise three classes in one morning (for different age groups all under 5 years) to see what kind of activities go on and to see the reactions and interactions between the parents and the children. I am not one to turn down such an interesting invitation!

In the past couple of years I have become more and more interested in how music is used in the real world for positive benefits: As such, as I have been involved in projects looking at music in shops, music in language learning, music in film and music in therapeutic contexts. But to date I have not yet seen how music is used in a parent-child bonding/learning situation.

Children love music!

Parent-child interactive music session classes are becoming increasingly popular in the private sector in the UK. Studies from the US/Canada have investigated the positive impacts of these classes, as compared to listening to music passively in the home. You can read about some of the results in one of my previous music psychology blogs.

You can also read an excellent article by Alex Lamont on the importance of music in young children’s lives here, The results of studies like Laurel Trainor’s have been so encouraging that I was keen to see how the sessions were run, what was involved, how the parents reacted and how the babies and children responded.

The first Jo Jingles session of the day was for children from ‘walking’ to about 2 years old. There were around a dozen children with their mother or carer. Each pairing had a little mat that was part of a larger circle. Laura, the session leader and my guide for the day, was already in full swing with the ‘Freeze’ song. Here the parents move around the room in rhythm to simple child-friendly music, either carrying the child or walking them, and occasionally have to freeze when the music stopped. The aim of this type of activity, Laura told me, was to get the children moving, feeling rhythm, and also to teach them listening (for their freeze cue) and learning skills.

All the sessions were full of these types of little games, with varied music and movements. They were short enough to hold a child’s attention and to get them trying different movements, with different parts of their bodies, and to different rhythms. There was a lot of happy giggling going on!

There were also games that involved playing different instruments. These varied according to the age group of the children – from little maraca-type colourful fishes for the babies up to drums and cymbals for the 2-5 year olds. Laura used the instruments to again teach listening and attention skills, but also to teach simple word meanings (fast, slow, loud, quiet – they definitely understood ‘loud’ the best!) and numbers, manual and bimanual coordination, and balance.

Then there were the relaxing songs in between the more energetic activities. Here the little ones could be sung to and cuddled for a bit. This seemed a great idea to me as I can imagine a child getting a little overexcited if there was just drum bashing for 45 minutes! Laura also used the music for both ‘Hello’ and ‘Goodbye’ songs, as well as little warm ups and cool downs.

How might the music be helping in this type of class? What does it provide that any other type of parent-child class could not accomplish? In my opinion:

1) Music grabs the child’s attention: Laura used her voice well to  try to attract the children’s attention but they were always more focused when she did the activities with music in the background as compared to when she was showing them what to do before the music.

2) Music is internally motivating: This explains why it grabs a child’s attention in the first place. They get a sense of reward from listening to music. We know that the adult reward system in the brain responds to music and, even though it has not yet been demonstrated, I would guess the same is true for children.

3) Music facilitates fast transition: With an average of 8-10 different activities in each session the child must move quickly from jumping to cuddling. I am sure that this would not have been so effectively accomplished with verbal instruction alone. The children seemed to recognise that quieter and slower music meant it was time to return to mum and have a sit down – to consider putting the drum beater down for a minute!

4) Music stimulates vocalization/communication: Many of the older children were relatively quiet until the music came on, perhaps shy, but then began happily babbling or trying to mouth the words to the songs. Some of them even appeared to have learned the words and were happily engaged in singing with Laura or their mum/carer.

5) Music blends easily with other stimuli and boosts their effects: My favourite part of the morning was probably the baby class and the bubble song. Laura played slow, calming music and blew tiny bubbles into the air over the babies – every single child sat or lay watching, in complete awe. When the music stopped, the bubbles remained around us but the effect on the children was not the same.  Fascinating…and worth remembering!

In conclusion I thoroughly enjoyed my day at Jo Jingles. I think there is much work to be done in looking at the effects of these music classes on child development and I very much hope that I might be able to do some research into some of the effects that I observed today. There should certainly be more music in young children education, not less, judging by the happy smiling faces of these little ones.