Functional skill level is ready to begin after, after, after the client has achieved some organization and self-regulation ability. If we haven’t learned yet that trying to stop that “stimming” isn’t going too far, we better go back to the beginning. We have to do something about the need for the “stimming” first. My last blog in this series is a case study summary exemplifying this series; Music Therapy, from a Tentative to Functional Skill.
I first started to see “Cameron” in an early intervention center. I remember noticing “Cameron” in the halls before seeing him in Music Therapy. He was a three-year-old, severely autistic boy who daily caught my attention as he came into school. Daily, he silently stared into space while being led to the classroom. Upon entering the classroom unattended, the only motion one may see from this boy was that of covering his ears as other children made noise. Some of “Cameron’s” IEP goals look like this:
- Demonstrate attending to adult activities, follow simple and multiple step directions
- Match colors, shapes, letter recognition, and number concepts
- Demonstrate comprehension of vocabulary
- Follow instruction to completion
- Upon request, “Cameron” will use vocabulary in the form of words, signs, and sounds to label
- Imitate gesture of songs
(These are actual goals and how they were written. I did not write these individual goals.)
His IEP stated that “reinforcers are needed to promote independent work and task completion during activities. “Cameron” plays next to other children, but does not engage them in play. He is nonverbal and rarely displays emotions. His eye contact is limited and he does have a tendency to stare off during preschool activities. He has a limited response to his name. He has the capability of matching colors, shapes, numbers, letters, and a wide variety of objects; however, this skill is not demonstrated consistently due to his lack on interest and cooperation… Transition between activities and his ability to follow simple one-step verbal directions is extremely difficult. He follows one-step commands with an average of 55% accuracy. Identification of common objects/pictured objects is 50% consistent. His eye contact, response to his name, and turn-taking are emerging, but presently inconsistent.” These statements were made by his classroom teacher, occupational therapist, and speech therapist as he started Music Therapy. “Cameron” started Music Therapy in March of that school year. he came to Music Therapy very interested and easy to engage. After the initial assessment, the therapist wrote two long-term goals for “Cameron.”
- “Cameron” will play five short phrases with the music therapist, following verbal and/or musical cues
- “Cameron” will imitate a five-beat word phrase, three times
These goals were written intending to increase attending, increase following verbal direction, increase imitation skills, and increase awareness of multi-syllabic words.
Music was something “Cameron” enjoyed, and engaged in jointly without prompting of every kind. He demonstrated great eye contact and rarely stared off. When he did stare, he was easily re-engaged. By the third session, “Cameron” was following verbal directions. Therapist and client played “stop and go” games using words. Not only was “Cameron” following the directions, but he was also perceiving what would happen next. He demonstrated this by bringing the reed horn (the instrument of his choice) to his lips as I inhaled to say “go.” “Cameron” willingly played co-responsively with the therapist, smiling and demonstrating great eye contact. The “stop and go” game was repeated over and over. By the fourth session, a routine had been established, and “Cameron” was eager to engage in this game. Shortly after, “Cameron” began to say “sss” with the therapist as she said “stop.” This was something “Cameron” was doing on his own without request from the therapist. ‘Cameron’s” co-responsive playing had evolved into turn-taking “peekabo” games put to music. ‘Cameron” was actively involved in the music making game, consistently showing interest and making eye contact.
By May, ‘Cameron” knew the routine and was comfortable with the therapist. He began to test the boundaries (pushing the video camera, opening the door, etc.), yet his interest in eye contact continued. He began to vocalize often, and Mom also reported hearing this at home also. The therapist thought she heard him say, “good”, a couple of times. After the boundary testing ceased (approximately two sessions), More musical game playing continued. Using a telephone song, “Cameron” continued to respond by picking up the receiver and putting it back down according to the words of the song. “Cameron” also looked to the therapist for what was to come next. Throughout the month of May, eye contact, co-responsive interaction, and verbal direction following increased. By the end of the month, “Cameron” demonstrated interest in the ABC’s. Not only was he identifying the letters, but was also demonstrating interest in the sounds that the letters made. the therapist had “Cameron” pick a letter out of a bag, and then sang, “the B on the bus goes ba, ba, ba.” As she did this, “Cameron” watched her lips, and bounced the letter to the beat. “Cameron” was instructed to put the letter down on the ground. The process was repeated with a new letter. Throughout this process, “Cameron’s” eager attention was sustained as he followed the direction, eager to get to the next letter. ‘Cameron” sang the B sound with the therapist. When finished, he helped put the letters away as the therapist sang about each letter that he picked up. Routine and responsibility had been established. Hand-over-hand assistance was used only in the initial demonstration of the direction to put the letter down on the drum. All of “Cameron’s:” actions throughout the session were co-responsive and continuous.
By the end of the month, “Cameron” was improvising, eagerly following verbal direction and interpreting changes. His vocalizing increased and changed from “ba ba” sounds to jargon with diction that sounded more like words. “Cameron” ended the session by playing the “Goodbye” song with the therapist. The therapist played the beginning of the phrase, and “Cameron” intuitively ended the phrase on his horn. As summer approached, “Cameron” had done so well on all of his goals, a new goal was written. The Music Therapist had conferred with his Speech Therapist, and more consistency was established. “Cameron’s” long-term goal was to follow eight commands without prompting in a thirty minute session. “Cameron” was already following commands at this time, but now the therapist was looking for more consistency in his responses. By the end of the summer, “Cameron” was testing boundaries again, but continued to respond to verbal direction. At the end of the summer, “Cameron” verbalized letters T-Z, and H. He was also imitating some letter sounds and said,” Goodbye.”
The therapist continued to see “Cameron” on and off at the early intervention center as funding permitted until it was time for “Cameron” to enter kindergarten in a public school. At that time, “Cameron” began to see the therapist privately on a regular weekly basis. He continued with her until he moved at the end of first grade. Strides were still being made. “Cameron” began to speak in one-word sentences. The therapist began work on phrases by singing to a book or requested answer-games. She eventually would leave out one word for ‘Cameron” to put in until he was asking or speaking in phrases. This quickly carried over into daily life.
At the beginning of first grade, he was demonstrating behavioral issues often, in Music Therapy and in school. After conferring with his TSS worker, the Music Therapist concluded that as “Cameron” left kindergarten, there was less and less sensory time, which he sill needed. “Cameron” had made major strides in his development, but was still an autistic boy with sensory needs. ‘Cameron” was working hard at school and in Music Therapy. He spent some time in an autistic classroom and some time in a typical classroom. ‘Cameron” had demonstrated reading skills in Music Therapy while still in early intervention, but did not always demonstrate what the teacher would ask of him (in the area of reading). Sometimes ” Cameron” did this because of distraction (other classmates’ behavior), and sometimes he did this because what he was being asked was something he had learned long ago. If not stimulated, it was still easy for “Cameron” to stare off into space and lose his attention.
The Music Therapist decided to let Music Therapy be used as “Cameron’s ” sensory time. As she did this, “Cameron” demonstrated playful creativity while often leading the session, laughing and trying to trip up the therapist with his stops and starts. He really began to turn the tables on her as he started counting in Spanish in song and gradually picked up the speed. The Music Therapist is not strong in Spanish and often had difficulty keeping up. “Cameron” himself is not from a Spanish-speaking family, he was just very bright. As he was playing these games in Music Therapy, he also began to develop friendships in school, seeking out certain typical peers to play with in the regular education classroom. The TSS worker, who was with “Cameron” at school, also reported “Cameron” becoming more and more aware of his surroundings. She reported that when the children in the regular ed classroom sat in a circle on the floor, if “Cameron” sat a little inside the circle, he would notice himself and scoot back. In mid-summer after first grade, “Cameron’s” parents were transferred in their jobs, and “Cameron” had to move. “Cameron” continued to have areas in which he needed extra help (like all of us do), but was attending, learning, talking mostly in phrases and sentences, answering “yes” and “no”, making friends, and occasionally playfully testing limits like seven-year-old boys do. The developmental learning that took place did not cease when stress occurred. Stressful situations were not as common as they once were, and all that was gained in Music Therapy was transferred into every day life.
I hope this series on “Music Therapy- From Attentiveness to a Functional Skill” clarified what Music Therapy is and what it does. I would love to hear responses to these articles and am wondering if those of you that are not familiar with Music Therapy have gained a different view after this series. The next series will be about gaining speech through Music Therapy- how and why.
Antoinette Morrison MT-BC