Music-based therapy helps non-verbal autistic children to utter speech for the first time
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.
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
15 Comments
Tanya The Writer
This is a great article! I am touched that music can be used in so many different ways outside of entertainment.
vicky
Hi Tanya, thanks! It really can – we are only just beginning to scratch the surface. Please check out my other articles in this area for more ideas: http://musicpsychology.co.uk/category/music-medicine-therapy/
Best, Vicky
KarenB
I’m really intrigued by your article. Do you know if this music therapy has any applications for speech lost due to childhood seizures and seizure meds (regressing from speaking 2 to 3 word phrases to almost nothing — less than 10 words). The standard therapy our child is receiving now doesn’t seem to be improving anything, but he DID respond very well to a summer school session where the teacher used lots of music and chanting.
vicky
Hello
AMT therapy is still in the trial stages, and as I say in the blog this is the very first paper on those trials. It looks extremely promising but as yet, as far as I am aware, it is not available outside the trials. If your child responds well to music therapy then it might be worth contacting a local therapy centre or charity to see if there are any available sessions.
All the best, Vicky
nusrat khan
i like ur article. i will try music therapy on my son.
yugashri
This therapy looks very positive. My son is non verbal and I would try this with him. Can you please advise where
we can do it?
Regards
vicky
Hello
AMMT therapy is still in the trial stages in the US and this is the very first paper on those trials. It looks extremely promising but as yet, as far as I am aware, it has only been trialled on a small number of children and is not available as a mainstream therapy outside these US clinical trials. If your child responds well to music then it might be worth contacting a local therapy centre or charity to see if there are any available music therapy sessions, but those would be general and not yet based on this particular technique.
If you would like more specific information about AMMT then I would suggest that you contact the study authors directly – they will know if more trials are planned or if the therapy is being used anywhere yet. This is the lab http://www.musicianbrain.com/people.php#index
All the best, Vicky
Carmela C. Tadena
Thank you for the TIPS! it would be a great help…..
Ian Straehley
A very inspiring study, and well summarized. I want to conduct some of those future randomized control trials!
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Jon Tibke
Hi Vicky
I are you able to update this now, as a result of further trials? I know there may be more at the link you mention above.
Regards
Jon
vicky
Hi Jon. I do not know of any further published trials to date I am afraid, but these things take time. I am running an NHS study at the moment in the UK and that took 18 months to even get started let alone run all the trials and reach publication. I suggest contacting the scientists directly for the latest information, in this case Catherine Wan. All the best, Vicky
Jon Tibke
Thank you and I look forward to hearing/reading more of your study. I am regularly presenting a course for teachers on music and autism at present and always try to make delegates aware of promising research
Steve McConnon
Hi Vicky
Our son Tom is 12 years old and has Autism. He is completely non-verbal but does make sounds – particularly when asked to. We have just tried e-mailing a couple of the authors (Catherine and Gottfried) for an update on AMMT research but the e-mails have failed. Unsure if they have been blocked or the e-mail addresses have changed. Any ideas? The research, although limited, is promising and may be the way forward for our son who has good understanding. It is so frustrating being on this side of the fence, when the professionals keep putting barriers in the way. We are being forced into a corner as the common response is that they will not try an intervention as there is a lack of evidence of its efficacy.
Hopeful parents
Steve and Fi
vicky
Hi Steve and Fi. It is often the way that research takes time to filter through to practice level. I hear from many parents who would like to try the techniques of AMMT but they are not yet accepted in most UK pratice centres. I can’t comment on the efficacy of the technique – as a researcher all I can do is report the findings. I have heard that Dr Catherine Wan has left the Schlaug lab but I am afraid I don’t know where she went or if she is still working in research. However, the Schlaug lab is still very much live and you can find their site here (http://www.musicianbrain.com/#index) All I can suggest is that you try different people in the lab to find out who may know if research on AMMT is still ongoing in the centre and if any more up to date information is available. Also you might try contacting Prof Pam Heaton, a UK based expert in Autism and music who may be able to help (http://www.gold.ac.uk/psychology/staff/heaton/). Sorry I can’t help more, I wish you all the very best. Vicky