Recognizing Development and it’s Significance in Each Individual.

This weekly blog is about change, development, and growth and recognizing them.  Not only recognizing them, but attending to their significance in each individual. Sometimes when working with special needs children, most specifically in this case children on the spectrum, there comes a point in which growth appears to have come to a stand still, and work with the child seems to feel like blind wandering, leaving the dedicated professional to wonder if he/she know what he/she is doing. The bothered therapist will have to search, and think:  What do I do now?  What should I be doing?

This week while working with Derick, a non-verbal, autistic seven year old boy whom I have worked with for approximately three years, I had to ask a couple questions: Where was this going? Was it going anywhere? At the end of this week’s session, was I hearing or seeing what I thought I would? Had there been real work, was this making progress?  Three years and was this non-verbal boy developing, growing?  One of my earlier blogs was entitled “Why give up on speech?” I still feel very strongly about this, but Derick continually challenges this belief. Although I have worked with Derick for three years, “pop-out words” have been very few and far between. Progress at times makes me wonder. When the session was done, I had to look back and research.

Looking back after the session. two things stuck out in my mind. 1) When Derick was seen individually this week was when I questioned progress, when his autistic symptoms were all I could see.  Yet when I saw him in a small group with another little boy – Charles, who is three years younger with similar symptoms – I saw something else I had never noticed. Sometimes Charles is somewhat intimidated by Derick because Derick is bigger. Although because I realize this intimidation factor, I tend to be slightly more attentive to Charles in this group. As I was maintaining that attentiveness, I noticed Derick being very perceptive and not just with listening to my directions (which, because I have seen Derick for a while, I forget that that in itself, is very significant for Derick). As I was giving structure to the session, Derick watched me and waited to see what came next or what to do next.  It appeared to me as if he was filling the role of the older child,  being more responsive and considerate of Charles.  I had never noticed this about Derick before.

Then came the individual session.  Derick had pulled out two books we had put to song: “Brown Bear” by Eric Carle, and “Ten Wriggly, Wiggly, Caterpillars” by Debbie Tarbett. Derick taps out the name of the animals on a drum as I finish singing “Brown Bear, Brown Bear, what do you seeeee….”.  Then we sang the counting book where he points to each caterpillar as I count.  Later, he threw down his plastic mirror as I sang:  “It (G) is (D), then he sings “me” (C) over and over. (Derick had learned to make the “eee” sound from repetitious play with “eee” such as in “Brown Bear”. I repeatedly held “see” as he first matched pitch, then vowel sound.) Lastly he laid on my piano bench as I sang about his feeet, his kneees, and his hands while tapping those body parts with my lollipop drum as I sang. We had done this and done this over and over again, were we wasting time?

I looked at my developmental book (“Music Therapy, and Early Childhood: A Developmental Approach”, by Elizabeth Schwartz) and in the stage of developing independence, all these things were listed. The following skills were listed along with the need for repetition in this developmental stage:

– Extending the child’s world through vocalization. (Derick had played with babbling and was now filling in the appropriate word sound- “me”.)

– Attempting at gesturing and spoken language. (Derick was showing me what he wanted.)

– The need and craving for repeated sounds and movement. (Steps towards word formation).

Two of the most important points at this stage of development were:

A) “At this level children absorb more than they produce”.

B)  “Allow the need for time for child to move on their own to music”

I had forgotten six months ago, I did not hear specific vowel sounds such as “-ee” and when I did hear them, it was at random times – not at the end of the same phrase (“it is me”). Also, Derick goes and gets the mirror himself. Wanting to hear those same two books over and over was not random: Derick chose those books from a pile, and instead of flipping pages, as he would have six months ago, he waited patiently for the singing to finish. Derick now enjoys listening to me count/sing repeatedly as he counts caterpillars with his fingers consecutively.

His vocalizing isn’t the “ERKSH” sound he had first come to me with.  Now Derick’s sounds had definition. I wanted to see more. I had lost track of progress, that this independence was developing.  He had to move on his own time, not mine.

I flipped the pages to the next stage of “Control” to see what might be next.  Another phrase “Gaining Control takes WORK and PRACTICE, and there are many times when “success” is difficult.” While Derick was singing “meee” and getting out the mirror, he was now repeatedly demonstrating the skills of listening, processing, and responding.  This was carrying over to the small group session. Derick was listening to the direction and responding and then looking to me for what came next.  He was “absorbing the external information”, the chord progression and words (it is me).  He was not only controlling his understanding, but also controlling his reaction to it (singing “me” and getting the mirror as he happily looked at himself).

Derick was also recently learning how to control his breath and mouth by making a sound on the recorder. This was yet another skill area described in the book; “blow and sustain sound on a simple wind instrument”. At earlier sessions, he was practicing and becoming more successful as I played the recorder after singing “my turn”, then following suit after I sang “your turn”.  Derick was physically learning how to control his mouth to get it to do what he wanted.

What I also had forgotten, over time, was that I was now waiting for Derick to show me, by gesturing or by leading, what he wanted to do in Music Therapy.  Previously, I had given structure to his responses, sounds, and movement.  Now Derick was choosing what we did.

I have become much better at watching and being able to see a child as he/she processes things instead of demonstrating new skills. One has to watch subtle things like a change in posture or the child’s facial expressions. However, at times I struggle with allowing a child to move on their own. Usually with a bit of reflection and a check on what is happening developmentally, I regain my vision and know exactly where the child is.  Our society today has difficulty waiting.  Our society wants to see us produce, produce, produce.  One has to be able to look and see if there is forward movement.  Is there growth?  Where is the growth and what are the changes?  What direction are we headed?  If I can answer these questions confidently, then I know I am not aimlessly wandering.  Sometimes I need to look specifically at the child and see what he’s doing: what has his path been? How has the Music Therapy facilitated this?  Competency will be demonstrated in the carefully prescribed goals, objectives, and methodologies set forth in the paperwork.  Then at the end of the day I need to give the credit to the child and see that this child, this individual, did grow and is growing. He may not always grow on my timeline though. When I can say  that this child got from point A to point B. and demonstrated (through my paperwork) how the music has facilitated this growth, then I will be satisfied. Growth for the child and competent therapy have been procured.

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“Rock Around the Clock” Elicits First Word

    

Click here to hear Charles’s Song: Charles Song( Next click; ste-002)

Little Charles likes to leave me a gift before every holiday. He always does something unexpected, yet highly needed the last session before each holiday. This last session before Easter break, non-verbal Charles said his first word while climbing the stairs -“up”.

Charles began Music Therapy in October 2011. Charles, a three year old non-verbal client initially demonstrated very, very little fine and gross motor strength, and few cognitive abilities. Soon after beginning music therapy, Charles began to blossom. When he entered Music Therapy, it took both of his delicate hands to depress a single piano key and still not elicit a sound from the instrument. Just like his little hands, Charles didn’t make much sound beyond breathing. Charles was ambulatory and had the physical ability, but did not do much by his own motivation due to his very low arousal level. It appeared that first, Charles needed to get his motor running and life up those arousal levels. “Charles’s song” was developed following his very minimal movements and breathing. Before Christmas break, Charles was sitting at the piano kicking the foot board on the white upright piano as his sustained, vocalized aria came soaring out. The therapists and teachers who worked with Charles kept saying what changes they were beginning to see (those comments continue today just as frequently). Charles was like the newborn who cries at the awakening of their birth. Charles had emerged with his cry, an aria.Click here to hear Charles’s Song: Charles Song( Next click; ste-002)

I had not heard much more since that time other than the little grunts of effort that he gave when he climbed the stairs that came up to his little knees. However I noticed the accelerated development of a newborn. Charles was now picking things up and tossing them back down. He reminded me of my son Michael who enjoyed tossing single cheerios from his high chair when he was small. (That was a while ago; now he’s 6’7”.) Still today, whenever I hear a crunch under foot in the kitchen, I’m sure it must be a Cheerio.

The lively music really supported and gave Charles the jump start he seemed to need. This raising of arousal levels consequently alerted Charles to the outside world and peeked his interest in it. Now his muscle strengthening skills, adjoined to his interests in picking things up and tossing them were paired with the music. I filled a toy grocery cart with bean bags for Charles to take out and put in, and put out a three foot board over a small block of wood that worked in the same way as a see-saw. The bean bags gave Charles’s  little fingers an easy squeeze muscle strengthening, grasping work out while the weight of the bean bags added a little resistance for gross motor endurance of his arms. Simultaneously, as Charles took the grocery cart back and forth over the see-saw, his entire body got a little work out with the slight resistance of an incline and pushing. These actions, of course were put into words with the music. Anytime he threw the bean bags on the floor, the responsive language gap was aided with the word and actions “put them in”. Singing his name first aided in helping respond to being addressed verbally and following a direction. Charles soon began to demonstrate more eye contact, smile, and began to gesture for his wants and needs in and out of the therapy room Click here to hear Charles’s Song: Charles Song

Because Charles was allowed and supported in these repeated actions, (with his song adapted to his current strengths and needs) he began to grow out of them and wander off to new things. This week I eliminated the grocery cart and bean bags and Charles went straight for the drums, exercising his arms that way. Now we are working on endurance of the strength he has begun to build.

Why was this very simple, repetitive music paired with a repetitive, mundane task eliciting so much from Charles? Charles was listening with his brain and his whole body:Click here to hear Charles’s Song: Charles Song

Listening is a whole brain, whole body experience. We might think of listening as a process that occurs primarily in the ears; however, in reality, when we listen, the whole brain light up. Processing sound creates connections in multiple locations in the brain, including the brain stem, the cerebellum, the reticular formation and the cortex. Since listening involves so many levels in the brain, it exerts influence over a wide range of biological functions, including emotional tone, arousal levels, activation of core postural muscles and sensory modulation and integration.” (Kathleen Morris MS,CCC/SP, Insights Into Sensory Issues, 2010p.86)

     We listen with not only our conscious mind, but also unconsciously. When a certain sound catches our attention, it takes the lead in our minds over other sound and we respond to it. The sound energizes our entire body to activate a response.: Click here to hear Charles’s Song: Charles Song

At the end of this last session before Easter break, Charles and I started back up the long stairway to Charles’s classroom. I heard the usual grunt as his first foot stepped to the next stair and he used all his effort to pull his second foot up to join the first. Going up the stairs takes us a little time. I started to sing “up, up, up” to the tune of “Rock around the clock” The next grunt I heard had form. . . “up”. Did Charles say this purposefully? No, I don’t think he even knew he said it. It seemed more like a subconscious response. But Charles’s brain heard “up” in a predictable, comfortable fashion. Like “pop up” words,  with repeated, structured practice there is a very good chance that Charles may learn to gain control of this word and use it purposefully.

     To illustrate my point, I have put Charles’s little adapted song on the blog to play repeatedly as you read. Besides the research, several people whom I know, who watched and read the earlier blog “Autistic Children, Watching for Learning for Developmental Cues”  told me that after watching and hearing my first video, “I couldn’t get that song out of my head all day!” It was just the reinforcer I needed. This repeated music that is slightly altered for each new response establishes a secure, predictable,  environment  providing a safe place for building on existing strengths and allowing development to occur.

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Musically Structuring Responses and “Stims”

This week I thought I would show a video of one of the previously mentioned children that had “pop out words” and how we arrived there.  As I began working with Jay, I worked toward attending, giving eye contact to the therapist when addressed, playing instruments or moving to the music and also giggling or vocalizing to the music.  Each goal encouraged responsiveness and each goal encouraged and supported one another.  The attending to the therapist encouraged the joint activity to the attending to the music and to the therapist.  Jay re-actively would move some and play instruments some to the music.  The more he played, moved and attended, the more we improvised together in a joint activity and the more eye contact the therapist received when addressing him.

The movement was supported and encouraged by the music.  Anything Jay did was matched by the same basic phrase of music which became Jay’s song.  The more he realized this, the more movement he gave just to see what would happen.  The movement, attending and curiosity to these joint activities encouraged giggling and vocalization.  At this time Jay vocalizes a lot and even begins to skip and vocalize on the way to the music therapy room.  If Jay were viewed in the classroom, one would see this boy not attending to others, very flat affect, and low interest in much of anything.  Also, an observer would probably hear silence from Jay.

The video demonstrates the repeated music structuring Jay’s activity.  One can see and hear him vocalizing re-actively.  Words, words, words are paired with the repeated music.  Unfortunately, the week that this was recorded, I was not able to capture what Jay demonstrated the week before.  Jay demonstrated his first steps toward purposeful controlled speech.  Previous to the recording, he had said “go, go, go” several times that day and also outside the music therapy session after completing music therapy.  Remember, as stated in previous blogs, growth is not a straight path up and forward.  I do not expect that Jay will say “go” at each session.  However, I do suspect this may be one of his first controlled, purposeful words.  As mentioned in previous blogs, with the repeated musical phrase a temporal sense begins to develop.  The repeated beginnings and endings and repeated chord structure helps to develop predictability.  Jay waits for the music and waits for the therapist to watch him to begin the music.  The word “go” is paired with this repeated musical phrase.  Now, “go” is not only given a beginning, an ending, and a melodic structure but it also is given meaning.

Many people in the area in which I live have heard very little about Music Therapy.  I often attempt to explain that Music Therapy is not teaching music but it uses music to develop growth among many other things.  Music is used here to structure a child’s response towards growth, development or functionality.  Often time when structure is given to a “stim” not only does some functionality emerge, but a “stim” may fade away.  In Jay’s case, not much “stim” existed but attending was a major accomplishment.

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Impulse Control and Transitioning

This week I ended up having two small groups of higher functioning four year old children with autism diagnosis. As I began the session and watched each group member, I quickly readjusted my plan. I knew exactly what  we were going to work on and how to work on skills such as sharing, taking turns, transitioning and impulse control. This was going to happen in one short, repeated, quick moving activity. Each individual child in these groups needed this for one reason or another.

In the am group, my only little girl who does terrific in Music Therapy needs to work on patience. There is a little boy who cries every time there is a transition from one room to another and from one activity to the next. It is mid March and since September there has been very little change with this. This boy needed to experience transitioning in a fun way repeatedly for brief periods of time. He needed just short amounts of time, not enough to think very much, just experience joy, and keep moving. There was a little boy with Downs syndrome in the group who has many difficulties following directions, but is very different and attentive in Music Therapy. I knew he would do just fine with this. The little boy who needed this most always takes forever and has lots of questions and ideas when it is time to transition. What helps this child with his plan is that he is as cute and has the most innocent face one can imagine. He needed to transition often and not be given the opportunity for delay. A fast moving activity would not allow time for one attention seeker to delay. The part I needed to stay aware of was to keep the fun moving and not give delay tactics any attention.

The second group (the pm group) needed this even more and would take intense, careful balance on my part. The first two little boys have terrible troubles with impulse control and following directions. The cutsie from the am group was also involved in this group. There was also a very hyper girl with very big impulse control issues. This group needed to be more carefully balanced than the am group.

The children came into the Music Therapy room to chairs with instruments in front of them. Each chair had a different instrument from the rest. The children were required to choose a seat. I sang “We are taking turns today” to the tune of London Bridge (this was also played on the piano). At the end of the tune, the children must stop playing (impulse control) and switch to the next instrument/chair.

The am group did very well. The little girl followed every direction. The crier looked forward to the next move, the anticipation and had a wonderful time transitioning! The little boy with Downs syndrome followed every direction unassisted, watching and listening every moment. The cute little boy (they are all cute children this one just knows how to make it work for him better than the rest) stuck to his delay tactics to begin with, but I stuck to mine. A little uncondemming behavioral repetition combined with the music and fun and a little hand holding assistance (moving from chair to chair) helped this little guy to catch on. Sometimes he did not get to play his instrument because he continued with his tactics as the group continued to play, but after a while, he got the idea.

The next group was a bit trickier. Fun and excitement needed a calm, slow quiet counterpart. As the impulse control children beat the bejingas out of my drum, I had to, after a warning, take the sticks and instruments away for that turn. The children would then transition to a new instrument. No guilt or condemning tones, just a follow through. If the little girl got up randomly to go do something else, she sat outside the room (with her tss worker) without an instrument (in order to take her way momentarily from the pace) and then join back in again on the next turn. During the switch, I had to calm things, move slower and use a very quiet and calm voice. In giving these children the natural, short lasting consequences to their behavior (which they did have the ability to control) then a” try again,”  done matter of factly, gave the children the opportunity to display their natural behaviors, but chances to keep trying again in order to gain something they wanted. The quiet, calming tones and actions in-between let the children know all was ok, and helped them to slow down enough to gain control – but then pick up again to keep their attention.

The children that are in the groups are more like a social skills grouping. They are higher functioning and can make their wants and needs known but need to learn how to do this now within a social context. The music now serves as the bridge between therapy and school. The music in theses groups fluctuates between music “as” therapy and music “in” therapy. The music gives the boundaries and aids the children to pick up on some of the social cues.

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Why Music Therapy – Not Just Music?

It recently was reported to me by three different family’s of non-verbal, autistic children with whom I work, of the commencement of “pop out words” that began (outside the Music Therapy room) as the child began Music Therapy sessions. This is the only change that each child seemed to have undergone as these words started to happen as reported to me by each family. One thing about this bothered me. I knew why I had implemented the interventions I had done with each child, but I had not purposely worked toward “pop out words” specifically. I love working with non-verbal children and this is a common occurrence, but why? How could I explain why Music Therapy was the common factor?
After considering some of the recent research I had done on child development, socialization, speech and music, I drew the conclusion that not therapy alone, not music alone, but Music Therapy was the common factor. There has recently been a surge of research being published on the neurology the brain with music and it’s effects on speech. I credit much of this recent attention to the publicized developments with Congresswoman Gabriell Giffords. But why not just music? After all most everyone has access to radio, mp3, ipods, or cd’s.
Of coarse, besides the obvious, unique training a certified Music Therapist receives on using the elements of music to influence, encourage, entrain and support, there is another very important factor for the reason for Music Therapy. That very big factor is RELATIONSHIP.
Music Therapists, especially when using music “as” therapy, connect first with music. They focus on a client’s response, whether it be vocal, instrumental or physical. Any response is supported in the same way in which it is elicited, by the music. There is give and take, back and forth reciprocal involvement, musical empathy being expressed, and energy in this process. Even if there is an enormous lack of receptive and/or expressive language, one feels recognized in the expression of empathy and support. The relationship supports the music, the music supports the relationship. To be recognized gives an individual a sense of self and aids in eliciting the attentiveness. This also explains the very importance of live music verses recorded music. Because the relationship uniquely begins with the music, a good Music Therapist’s paperwork should allow another Music Therapist to take over and continue the growth that has begun without starting therapy all over.

There are definite musical qualities that relax, connect and uninhibit or aid in the reception in the brain of non-verbal clients. Trained Music Therapists should have the tools to work with. However it is the unique quality of the therapeutic relationship that factors in here also. As Hans Christians Anderson’s described: “Where words fail, music speaks.”

For more information on music and speech you can visit the American Music Therapy Association at www. musictherapy.org

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Autistic Children; Watching for Developmental Learning Cues

I have talked in many of my blogs on behavior being communication, stim behaviors as being useful and each person being unique, label or not. In today’s blog, I would like to show you an example of how utilizing music therapy has helped put these concepts into practice.

In October 2011, I acquired a four year old , non-verbal, autistic little girl. I will call her Emily. Emily came into Music Therapy for the first time squealing  with delight at all that was happening. The very first session, several pop out words were elicited. This is what her IEP (written five months earlier ) stated: “Emily was seen for a complete speech/language evaluation. She is non-verbal and does not utilize gestures or pointing to communicate… Emily does have tantrums and likes to line up objects. She also likes to turn pages in books… Emily does not request items at home or in the community. Emily has a tss worker who is currently working on motor imitation, categorizing pictures and objects and manding for (4 specific words), by signing for these items. Emily requires models for these mands and also hand over hand assistance. Emily is not currently working on any receptive language tasks at this time. Expressively, Emily had difficulty with the following: imitating words, utilizing 5-10 words; utilizing vocalizations and gestures to request, and babbleing short strings with inflection patterns.”

It was evident, with her attraction to the music and how easily words popped out, there was a very good chance at acquiring language in Music Therapy.

In the classroom of behavioral, developmentally delayed and autistic children, Emily came in the classroom daily crying and whining . This continued on and off through her half day stay for months. After about the second Music Therapy session, Emily found my crate of books. Emily is now working on two word phrases. This is a video clip of her six months (March 2012) after beginning Music Therapy:

Emily’s mother told me the only change she has had since this language explosion is her participation in Music Therapy. At this particular session, I had planned to video tape, Emily had previously taken out Eric Carle’s “Does a Kangaroo Have a Mother Too?” Never before could Emily wait long enough for the question to be asked. Today was a new day and a very good one. She has been labeling items in Music Therapy but today was beginning to answer questions. Notice how repeated tones in a repeated phrase helps Emily to get the word “Yes” out when it becomes stuck.

Some sessions are better “language” sessions than others, in which case Emily remains at the piano with her books. When Emily is having a difficult day getting out what she wants, she leaves the piano and books and just plays music with me allowing pop out word to flow out continuously. She has developed this habbit of stress releif after Christmas this year.

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Beyond the Diagnosis, Beyond the Shoes

I had to send this out today. As I was finishing sending my last newsletter out, my daughter was in the room talking to me about school. She read to me this essay she wrote . She chose a subject she enjoys and it seemed to link to my last newsletter very well. (She had no knowledge of what I was writing about.)

Boots In A Puddle

” SHOES”

” A symbol that I can relate to is a pair of shoes. A pair of shoes are placed on a pair of feet and walk through ice, hot sand, soft grass, and rocky gravel just as one’s life has difficult places and hardships and easy-going, warm, hospitable places. I am still young and I haven’t had many hardships , but even studying for a hard test or loosing a pet, you go through these things always with a sturdy pair of shoes. A pair of shoes leaves their own, individual mark on the world just as I, an individual do.”

Monica Morrison

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Can We See the Child Beyond the Diagnosis?

What is beyond the diagnosis? All that lingo; Developmental Delay, Self stimulatory Behaviors, Communication Delay, Echoic Speech, Sensory Processing Disorder, what lies beyond that? Who really are these children?

When a new child walk into a classroom, a good teacher of course, wants to be as well equipped as possible. If records, or IEP’s are available, a good teacher reads those before meeting the child, to know some of what to expect. However, does the lable sometimes, often, tell us who these kids are? Do our expectations of the lable limit these kids? I think, very often, that happens.

I have witnessed situations where one professional thought a child had autism, there was talk about getting the child evaluated for autism. The child was evaluated and no diagnosis was given. But in the transference of this child from one teacher to another, the second teacher saw the child as autistic. The teacher told me, “Oh he is autistic, watch, he does this and this.” I watched and never saw the behavior described. I mentioned I had not witnessed this, she watched, couldn’t see the behavior either but was very confused and insistent this child was autistic. After some time, and no diagnosis, the expectation of this behavior ceased to exist, and the behavior was actually never witnessed. Sometimes we think we see things because others say so.

There is the other side of the coin – which is much more frequent, which is my bigger frustration. When a child does have a diagnosis and does exhibit the behaviors being described set a very low bar for an expectation. For example, say a non-verbal child  who frequently flaps their hands is labeled severely autistic. This may be very true – but still, who is this person, this child? Is this a self-stimulation behavior and why do they do it? Lets go beyond self-stimulatory as being the definition for why.

I want to clarify.  I do believe, especially with older children, these repetitive behaviors learn to serve a negative purpose. I feel that sometimes this negative behavior or purpose could have been prevented at an earlier stage.  When we repeat something over and over, it is like digging a trench (the trench of a brain pathway).  The more we do something (dig) the deeper and more engraved the path becomes (the more we learn, develop or create a habit).

When young, non-verbal children, more especially demonstrate a behavior repeatedly (flapping the hands), this, I find, is often a physical symptom or form of some kind of excitement, distress, or other grand emotion. Grand emotions, excitement, distress exists within us and most of us can at least find temporary relief or expression of that through words, gasping, squealing, shouting or crying. It’s when a child has no speech and very little control over anything coming out of their mouth (that isn’t autonomic yet) that those feelings still exist within – just like all of us. These feelings need to get let out. If a child can not do that with their mouth, then next is the body (hand flapping). It is communication.

If a non-verbal pre-school-er never gains any vocal skills, more anxiety build – the hand flapping gets stronger. The older the child gets, this repetitive behavior that has been done over and over and over with no other direction for release becomes a one way street. The anxiety goes to hand flapping – no other release – more hand flapping builds anxiety and then – melt down. Now we have a self-stimulatory behavior.

If, on the other hand, a small child does something repetitively (example – hand flapping for anxiety) and we meat the behavior, reflect it and have the opportunity to inject the smallest alteration, we have broken that road. The child has shown us what he can do. When we can alter this slightly, we have opened the door to the next step.

What I have experienced is people seeing an “abnormal behavior”, for a nuero-typical child, and labeling that as self-stimulatory and that is it, end of story.  One experience I had recently was in talking to another professional who worked with the same child as I. I was told, up until recently, the child had been silent – but now babbles, a lot. This was exciting news for me, to begin work when some kind of block had been broken and progress was beginning naturally. All the possibilities! The professional I spoke with said, “yes, but all he does is babble, so we match things – he can do that.”

What I heard with this statement was: “That’s it, that’s all we’re going to get – so we will match”. My interpretation of what I heard may have been wrong, but having heard statements with that meaning frequently, that was what I took away from the conversation. As I watched this little child, I began to learn who he was. When he ran, he became alert, happy, excited and sound came out. In my therapy sessions I worked to get him to do this – sound is our starting point. He is very alert and watches me as he is moving. As I have spent more time with him, and he with me, when he stops, I stop playing and sing “stop” (sometimes I hear him make an “ss” sound) . I do not feel he is fully in control yet of this sound, can make it whenever he wants to, but that is a great place to start from, very exciting! When he gets ready to move, I say “ready set.. GO!” and continue to sing go until he stops again. With this predictable repetition, he now has also gotten to know me, has gained a sense of time and watches me as he slows or gets ready to move. He waits for the familiar words or sounds to come out of my mouth. I always use his name , and occasionally get eye-contact when calling his name. Music Therapy, through it’s predictable nature, has provided this boy a structure he can count on. It is reliable because it is paired with what he is already doing. I have learned his babbleing is a happy, energized release by watching his face and actions. It is not a meaningless activity, it has meaning.

As the music is paired with his excitable movement, (the movement and the music being a 2-way road – excitement being motivated by another sense) he babbles more. As he babbles more, and is excitably alert and connected to me with knowing, I am going to stop and start with him, he also hears the same sounds over and over and over – stop and go. These are beginning to gain meaning for him AND the verbal sounds are now linked to other sounds (the music which includes vibration, a physical sensation) all being processed together. The trench that began now has a direction. We have begun to build a road, a neurological path with direction and meaning.

Excuse me, I think I have jumped onto a new highway, back to my original position. Yes this boy is non-verbal and hand flaps, but by getting to know him, watching his cues, watching his communication, we have created social cues to watch together. I know he is happy, and excited. He also knows I see this because what is being reflected back to him in my music, my eyes when I watch him is that same excitement. This supports him.   He is reading and interpreting this. We have begun to know one another, and in that familiarity is comfort AND ability to step further. So many systems, goals, needs, strengths are now being linked and progress has begun.

I often have heard a professional say, when referring to a parent of a special needs child, “They (the parent) only see it because they want to. More often than not, parents, you do see it, it is not just in your head. Your child has that comfort and predictablilty with you which allows things to happen more easily. Listen to your gut parents – you do know your children as who they are, not what they are – (autism, developmentally delayed, ppd, etc.). In that knowing, you have set those neurological connections at ease for things to happen. You may not know what to do next, but we as trained professionals may need your knowing, and your  persistence to keep us trying at those specialized tools we have been trained with. We may not see who, we may say what. We are also human, we have burnout and lives outside the facility we work in. We have regulations we have to meet, standards we have to go by and sometimes mindless, time consuming paperwork that has to be done to keep our jobs. We have our own children, worries, burdens outside work. You may have to push us beyond those things. We are not experts on your child, you are. We are experts with our own tools. We may be dressed nicely, neatly,  use correct terminologies and introduce you to new techniques, but you need to introduce us to who your child is.

I have one story left. When I was about 23 or 24, I worked with a psychotic, retarded 28 year old woman. She spent most of her time twiddling her fingers, not seeing people or hearing them (her vision and hearing were fine.) as they spoke to her. She lived with her parents and her mother primarily took care of her. She had no outside activity or companionship. This 28 year old woman had many “stories” or fantasies that she continuously ran through her head (thus the reason for not attending to others). After two years of Music Therapy, it finally surfaced (also by this time she greeted, spoke with and attended to others around her) and no social training, just work on her “stim”, she revealed to me that she was angry. She was angry with her mother, although very connected to her, because she was a 28 year old woman, dependent on her mother. That was who she was and that was a normal, appropriate response for someone 28.

Each and every person, diagnosis, several diagnosis or no diagnosis – “You have seen one of us…you have seen one of us.” We are each individual and unique.

 

     “Today you are you, that is truer than true. There is no one alive who is youer than you.”    Dr. Suess

 

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Solveable “Choice Stopper” Techniques In Helping Kids To Choose Well

So you read the last blog and it did not work out quite that easy? Did your child waffle, refuse to choose, take forever choosing, or keep changing his/her mind? Or were you in a classroom situation where the child had figured it out and is consistently choosing the lesser choice to get out of something they very much need? Here are some next steps for children who execute “choice stoppers.”

CHOICE STOPPER #1; Asking a gazillion questions to help them choose. Don’t let a small child behave smarter than you. Once this technique is fairly obvious to you, state the choices. If the child continues to question, you continue to use your very sweet, genuine voice and say “You need to choose by 3, or if it is to difficult to choose, I can help you choose. Count sweetly to 3, then; “Here, I will help you.” Now you make the choice, but do so gently. (Be ready for some tantruming the first time.)

CHOICE STOPPER #2; Is you child taking f-o-r-e-v-e-r to choose? Use the same technique as above, restate the choices, then “You can choose by 3 or if it is to difficult…” Then follow through. Remember the key to keeping out of a power struggle is to watch the words you use and the voice with which you use them. It is completely up to them until 3.

CHOICE STOPPER #3;Is your child changing his/her mind about the choice? Do not allow this. The child might have to do this once or twice before it is clear what is happening (The first time this happens refer to the previous technique.) When you see this is what his/her technique is “Remember, you need to pick one.” Follow through with the first choice the child picks, then genuinely reply, as the child starts to rebuttle, “I’m sorry, but you can only get 1 choice. You can try that one next time.” If you begin to see frustration on the child’s part then you are doing this right. Do not worry , this frustration will turn to happiness and confidence the more you do this. Compare it to this, the frustration the child feels , is life consequences, small ones. If a person is born into lots of money but never is taught how to manage it, then ends up penniless, the frustration and fear from that is life consequences. In giving you child boundaries to their choice making and their world, you build steps. These steps of frustration get smaller over time until the child learns what is beneficial him/herself. Thereby avoiding the huge, life changing circumstances that they did have control over the disastrous outcome.

CHOICE STOPPER #4; AHA, you have the detective child that figures out the code. Lets go back to “Julie” in the previous blog. The teacher wanted her to put the item on the board. Maybe this situation, putting the object on the board (maybe for hand coordination?) It is important for Julie to do with the kids. (in the previous blog Julie did not have to put it on the board when all the other kids did, but she had to put it on the board before she got to do the next activity.)In this case, the two choices are “You can do it, or I can help you if you need it.” Again, said sweetly and serenely. You may be thinking, but that does not really seem like a choice. The more chaotic the situation, the fewer choices they need to choose from.Too many choices gives an already chaotic situation room to spread. The child still wants to be in control, so you can let them. Let the child to be the one to choose well or not, and if they can not, you may need to help them. This gives the child what he/she wants – to be the one to decide. Narrow the choices, allow the child to choose no than you may need to use (gentle) hand over hand assistance to help them. Even when there is rebuttal, help the child get the item to the board. Help the child see him/herself as a good choice maker with a follow up “good job,” or thumbs up. Do not give tantrumming attention, but give it “you are hurting my ears and we can not hear. You can go over here (away from the group) until you are done.” Hurting is never allowed as a choice. The choice is to be nice (define) or be by yourself.” Give no mention of time outs – just logical consequences to maintaining order for the group.
Tools for the adult:
* Remember all children feel safe when there is an adult in charge, not a child or themselves.
* Help the child by avoiding ” punishment ” but always follow through with consequences of the lesser choice.
* Help the child always maintain their dignity by using a gentle, sincere voice and language. Avoid guilt or shame statements.
* Help the child see themselves as a good decision maker by rewarding even the most weighted choices or accidental good doings.

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Three Simple steps to Guide Your Child to Choose Healthy Behavior Independently

 

 

 

 

I don’t know how it got started, but my 18 year old was saying, “Yea, I really like it when you start out saying,” “I’ll tell you what,” like it is the deal of the century. “Then you end it with a choice of cleaning my room or cleaning the bathroom.” I had to laugh because I do this kind of thing purposefully, and often with children I am working with (Not suggesting they clean the bathroom). I guess I didn’t realize how automatically, often ,I do it with my own kids.

Now what I am talking about is giving what I call “guided choices.” Here are the 3 simple points I use:

1) Give children “weighted” choices.(Using a very sweet, genuine, non-pressured tone of voice, give a child 2-3 choices. One of the choices having the most benefits for them – this is also your preferred choice for them)

2)Let the child freely choose.

3) Lay out the truth. Proceed with the benefits or lack of, the way things logically will work in real life. (avoid guilt ridden language and use a sincere tone.)

 

How do “guided choices” work? The child genuinely chooses and you get to lay out reality but it must be done in a very neutral way. No guilt, pressure or fear involved in the presentation of the choices. The result – The child chooses the choice that will make his life most comfortable, other choices bear less desirable results. The best part is although you provide the guidelines, you do not enter into a power conflict with the child by providing the appropriate support for good decision making.

Now is it necessary you do this for every situation that comes along? No,  however the more attention seeking the child is or the more they are use to being in control, the more often you need to do this.  I can not stress this enough, AVOID THE POWER STRUGGLE, WATCH WHAT YOU SAY AND THE TONE OF YOUR VOICE.

The root of the word discipline means “to teach.” In giving young children limited choices and making the healthiest choice, the one with the best outcomes for the child, helps the child learn.

Here is one example; during circle time    at preschool, all children had an item to put on the board when it was their turn. One little girl,  Julie refused.  The teacher then replied with, “OK Julie, you can sit and hold that but before you can do the dance activity with the class you need to put the piece on the board” and “those that are following rules first get to be my leaders.” The teacher then continued on. The class finished the activity and went to dance.  The teacher then said to the class, “The children that are following directions first and have their eyes on me are the ones that will get picked  to be leader.”  All the children quickly followed the direction. Julie ran over and said” I want to be a leader!” The teacher replied with, “I’m glad you want to join us, however Julie, you need to put your piece on the board before you can join the children.” Julie quickly put her piece on the board then said “Can I be it now?” The teacher followed through with,”Oh, I’m sorry but I already told the children those that were following directions first would be picked, there were other children here first Julie, you can try again next time.”

1)  The choice: put the object on the board and play with the kids or sit and keep the object.

2) Julie chose to hold the object. The teacher gave this no attention and continued on.

3) Julie got to join the children after putting the piece on the board, but did not get to be a leader this time.

Sometimes screaming or a tantrum  can follow the first time (or the first few, depending on the child’s temperament and how often previously choosing to be in control appears to the child to be the best choice with the best outcomes)Remember , when a child is use to being in control, this outcome may not seem that great at first.( If a 4 year old is the one in control than the surrounding situation is fairly chaotic, and there is a need for the child to feel he /she must maintain control – these instances are to be found in an upcoming blog. In this instance, the child must turn up the heat to make things work the way they normally experience them.This method still works with a couple added steps)

Why does this work? Julie got to freely choose, she got to be in charge of her choice and bore the consequences without being coerced or shamed. Over time she learns to choose well . She gets positive attention, positive results , gains confidence and views herself positively.

What happens  when children  do not know how to choose positive actions  for themselves and you give unweighted choices?  Another example, I was assisting one of my children’s coaches once. He was excellent with High school kids, however he had a group of junior high kids that had a low motivation level. The group that was there that day was there to socialize, hang out and not much more.  He gave the kids 3 equal choices of what kind of warm ups they wanted to do. The kids answered with moans and groans and basically told him they wished to do nothing. This certainly was not the coaches intention, nor was it good for the kids at this point in time. In all fairness, this coach over saw several teams and did not work with this particular group often. He could have given that choice to the kids he usually worked with because he had already motivated those kids with positive attitudes, rewarding all effort with positiveness and encouraging those that lagged behind. The result of the kids he worked with was a leading team, kids that had started at all levels. This younger group of kids was not to that level yet and needed weighted choices.

Remember learning is a process,  that for most of us occurs over time. Choosing healthy does not happen automatically. We, as teachers, parents, therapists are guides to help children learn to make good choices for themselves. Will they always choose the best thing? No , life is life and we all make mistakes and have weaknesses, however the more experience we have at anything, the better we get at it.

 

 

 

 

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4 Steps in Turning Repetitive Behaviors into Functional/Playful Learning

It is part of who we all are – we need to play and have fun. Can even laborious tasks be turned into something not only useful, but healthy and enjoyable? Take a look at this study;

Play can change our perspective, give life a structure we want to do.  Each individual is different. Each individual client communicates through his or her own behavior how they learn, what his/her strengths are, what his/her needs are moment to moment as a clue for YOU, therapist, teacher or parent on how to meet that .

The best part is that it requires very little from you other than careful attention and the ability to use your voice. Like childs play, you can even begin the process before you figure out the answer to the what/how questions mentioned above. Here are the 4 steps;

1) Watch and Listen with full attention to your child.

2) Aknowledge their need, strength, worth by matching their actions through song.

3) Name these actions simply in a known tune.

4) Validate them by repeating as often as needed. Fine tune with minor adjustments according to your childs lead.

If you just read this and are thinking,”but I’m not a musician, or a good enough singer, get over yourself. Is it your goal to be a musician? Is it your goal to perform perfectly? Or is it your goal to give your child a happy, trust filled ability to learn, function, communicate or just simply know who your  child is beyond the autistic symptoms? Let me translate these steps through example.

Step#1; Watch and Listen with full attention.

One year I worked with a little boy who, if not directly engaged,  would spend all his time in front of a mirror watching himself clap his hands.  When he came to Music Therapy, besides hand clapping he could really beat on my drums. There were no musical happenings with this, just some major sensory stimulation going on.

Step #2; Acknowledge the childs need, strength and worth by matching their actions through song; I phrased my piano music to a 2-3 measure tune corresponding with his clapping. On each clap I hit an accented chord and set the music up to lead to this. This gave his random clapping and his sensory experience timing, predictability and more sensory experience with structure. It gave phrasing to his clapping, so that there was a beginning and an ending and the opportunity to  anticipate what comes next with success.

Step #3 Name these actions in a simple tune; I sang, while I played, what this little boy was doing. This caught this little boys attention (Normally he was only attentive to his sensory experience).  His  sensory experience was now joined, not done in isolation, and  given structure and language. The little boy then began to become vocal himself. Structure was given to the hand clapping by using hand tapping and pairing it with the children’ s names in his classroom. Up to this point he had demonstrated no notice of the children, but maybe that was because there was no pathway to do so. He now demonstrated an eager interest in knowing the children’ s names, next being able to tap them back to me and finally and eager interest in attempting to say their names. His original random, isolating, all consuming clapping now became a bridge to communication. His original, non-musical, forceful response to the music; beating a drum  with all his might, was given structure through the use of a short repeated tune. This pulled him in to be attentive to the musical elements of timing, pitch and dynamics in a way he was unaware of but helped him to become aware of a broader here and now  which included me, eventually others and an interest in taking a step to know others. This boy now played music with me , being sesitive and playing music with me instead of parallel to me.

How can you do this in your environment? The great news is you don’t need to be a musician, have a great voice or even be amazingly creative. If you are still reading this you have an eager interest in your child or the child you work with. All you need to do is to watch their behaviors with that same interest, and sing about their actions to a simple tune you  that you can easily repeat.  (you can use simple childrens unes such as the ABC’s, twinkle, twinkle, a Beech Boys mleody; Barbara Ann or anything you can easily remember and repeat). Try to match your singing to their actions. The rest between their movements can be the end of a phrase of your your singing.

This will help give your child a sense of; validity, identity, a sense of time, here and now, predictability, beginnings and endings. Do not worry about what comes next, just watch your child and stay in tune to what they are doing so well that as they vary a movement (even a hiccup) you mirror back through sound (and facial expression) what they are doing.

Soon their obsolete behavior takes on some meaning and can be broadened into a functional one.  “All behavior is communication,” this is their strength already – use it! They are showing what they already have, how they learn and what they need. Do not try to delete what already is demonstrated, use it and broaden it. Use lemons and make lemonade. Make it sweet, fun and playful – not work. The video at the beginning shows us, any task, even the tough ones, that are taken on with lightheartedness and fun can be made into easier, preferred behavior.  Have patience and child – like curiosity. Keep your eyes on even the smallest variation; a change in eye-glance, breathing, a slight alteration in movement, because this is telling you something. This is movement in a direction, not stagnation. Even if you can not interpret the change, you have accomplished what you set out to do, you have altered the  stagnation.

Every individual, autistic or neuro-typical, has abilities and strengths. When we have labeled something otherwise –  we have identified something about ourselves and projected it elsewhere.

 

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How To Nuture Developmental Progress That Your Child Will Love

Children Playing Outside On A Sunny Day

Sometimes kids need a little nudge, and then sometimes they just need to let go and have fun – that’s when it all comes together!

These recent weeks I have seen, or heard about, unusual behaviors from two of my autistic clients. Apparently, once again demonstrating the quote “All behavior is communication.” Both children, a four year old little girls and a seven year old boy were both non-verbal previous to Music Therapy. Both children have been working on expanding their language. The little girl is self motivated, she loves to keep trying until she gets the word, then tries it again. Every week she comes in the music therapy room and heads straight for the books which we have put to song. She doesn’t stop until I have to end the session.

The little boy has words and is quite content not using them or asking and answering in one word phrases. We have been working on putting together 2-3 word phrases. I use the music and visuals to keep the boy motivated, attentive and moving forward. He is not self-motivated but leans on the pull from the music. Both children worked from September up until December intensely. The boy started, in mid November, some harmless behaviors; behaviors that suggested to me that he was trying to get out of work. I wasn’t sure what was going on, so we loosened the structure and went to purely improvising instrumentally together for a while. I noticed he had some real sensory impulses to release. He played responsively with me for the full 30 minute session. He not only played responsively but tried to stay ahead of me. He was completely aware, responsive, happy, energetic and in the moment.

The little girl came back to  school after Christmas break and was speaking wonderfully. Soon after it was reported to me that this eager, compliant child was becoming aggressive towards her teachers, hitting and pushing them.

In Music Therapy she was happy as usual. This day she was doing terrific answering questions then all of the sudden could not get the words out and automatically went back to where we began by tapping out words on the drum. She then put her books away and just wanted to play music. Although she enjoys Music Therapy, she gave me a hard time about ending the session for the first time ever.

As I have said in previous blogs, progress isn’t a straight arrow forward, sometimes we need to level off and rest before proceeding. Sometimes we need a conscious, relaxing distraction to allow newly learned skills to slip into the automatic mode of the subconscious.

My advice to the little girls teacher was to encourage tapping words,(even if the staff did not understand what she wanted) My guess was that when she was getting upset, she knew what she wanted to say but could not express it and now was getting frustrated. (I find this often happens when non-verbal kids acquire some language and have command of what they do have, but they just do not have enough to convey all they want to express.)

The little girls predicament is very recent, however I have been able to witness the results of the little boys. Firstly, besides so much work in Music Therapy on language, he is also in first grade in a public school. Some of his time is spent in an autistic support classroom and some of his time is spent in regular education classes. Now that he is out of kindergarten, he is given very little time, if at all for sensory breaks. He had demonstrated at those first improv. sessions, that he still has sensory needs to address. He beat the drum with emotional force as if a release of emotion , sensory impulse or  of  a muscular nature. Secondly, as we stayed with the purely improvisational sessions, this boy played with pure joy, excitement, energy (something not often seen) and co-responsiveness. He was fully aware and perceptive of what the therapist was or was not doing at all times. When I would become so interested in watching him, I would forget to sing. He would look to me and wait for me to start again before looking away.  The three word phrases he was using only in Music Therapy and at home (comfortable places) were now being released anywhere, anytime, “wait a minute,” “That’s a big one,” “I want the trumpet.” These kind of phrases never came out with such ease before.

This little boy now has new areas needing lots of work, but is in much more control of his actions. His speech comes out with fluency and ease. He loves improvising and being the one leading the music now instead of the one being gently pulled by it. The boy who was passive and sublime is now demonstrating more typical behaviors for his age, testing limits with silly behavior. Now we spend 20 minutes letting him lead the musical conversation and the last 10 minutes we spend helping him to understand exactly what is being asked in a question. (This boy understands the question “What is it?” He can answer “It’s a yellow bear.” He now has difficulty understanding what is being asked when there are 4 sets of different colored counting bears and the question is “How many yellow bears are there. ” His answer: “Bears.”Having these two children begin to act out at about the same time after fairly intensive work brought about my reoccurring quote; “All behavior is communication.” What was being communicated? A need to relax the situation a bit, to have fun and give the brain a chance to stop concentrating so hard, allow play to happen.

I truly do not believe this is exclusive to autistic children but applies to nuero-typical children also. One more example is that of my own son, who is now a freshmen electrical engineering college student. Elementary school was somewhat of a struggle. Organization was not something this boy was blessed with and therefore needed close supervision and very clear, reinforced boundaries. It was typical for my sons grades to drop at the end of the school year. I remember in fourth grade specifically, going over math before a test. He did great, no problem but failed the test. I talked to the teacher who agreed with me that my son knew and understood the material. He demonstrated the knowledge of the material in class and on his homework. She re-tested the whole class and he did even worse than before. Our conclusion was to leave it alone. He had done all that he could and understood the information. His brain had come to it’s limits, it needed a rest. Without strict structure, my son’s disorganized manner took over and could easily get him lost academically. But he could only do this for so long. Long story short, the end result is an excellent college student, mostly on scholarships with an intense schedule. He enjoys the work he has chosen and is my model for balancing work and play. He is a young man who jokes a lot, very rarely demonstrates anxiety, works hard at any area that shows weakness and can usually get anyone around him to enjoy themselves. (I have a lot to learn from him besides computer skills.)

In sports, in musical training, there has always been exercises done which involve tension and relaxation, it helps build skill and control. A person needs both to be in balance. When walking up that steep hill of growth, we don’t start out and go straight up. After all, growth is never done until life is. We have to walk to the plateaus and rest or play before we begin the journey again.

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Secrets of Repetitive Behaviors and Organized People

Sometimes when kids have had an “out of the cave” moment, they need to go back to something familiar, to feel safe, know where they are in life before moving on.  Sometimes we become agitated or concerned (as parents, teachers or therapists) that a child is regressing, however we all do that sort of thing and it is OK.

Before any growth can occur, a child first and foremost needs to feel safe. Even new college freshmen often go back to high school for the first break or homecoming game to see old friends, old teachers. Rarely do you see them again in that school after the (college) freshmen year. They are then completely ready to keep moving on and they do.

Some people some autistic children drop back for only moments,some a little longer. It all depends on the individual. How startling “out of the cave moments,” children usually find their way back fairly quickly. Then there are those kids or situations where it feels like the safety net is where it all ends. There are always those kids that are, for the most part, compliant. They don’t ruffle our feathers, nor their own.Their sessions or their work may make us feel like, “is this it, is this as far as it goes?” or it may give us a feeling of monotony, or aimlessness. These kids often need a gentle nudge. What is this all about? The need to keep things safe, controlled and predictable, thus the need for a GENTLE nudge. How do we move them gently?

The therapist parent or teacher then needs to begin with the old, the familiar and gently, quietly,  put in the new in an almost unnoticeable way. This paves a new, smooth, safe path for a fearful child to take.

For example, I have many children at one agency that I work with that by Christmas time were all ready for new goals, to move on. I wrote the new goals, over break, and was ready to go upon the start up of school. However all the children had a week long change in schedule and routine, they had Christmas vacation. While at home, they saw people they do not usually see, went places they do not usually go and ate at times varying from the usual routine. Then they came back to school. Criers were crying again, tantrums were raging, no more Mom and Dad but back to 8:30 into class,hand up coats,8;45 circle time and so on. Then they were taken out of the classroom in the middle of the week by a person they only see once a week. How much more unpredictability can they take?

All the children started out their sessions that week with the old familiar tunes or routine, no changes yet. Some were ready for slight movement, others were not.

There is a boy that comes every week and does amazing things in music therapy. But every week, as he enters the room (almost ready to go home) he tantrums. I play his music to his internal beat and sing gently what he is doing. Then every week we move onto Eric Carle’s Brown Bear book put to music. We spend about 20 of the 30 minutes doing old familiar things before moving onto growth. The new things that happen are quite often not things I would have foreseen coming but are beyond what he has been doing. He usually initiates this and if not I alter an existing structure or tune something slightly.  We have tried diving in and he can accomplish his goals within the first couple of minutes, but the rest of the session is disconnected and chaotic. He leaves at those times  in an abrupt and corrosive mood instead of a pleasant, focused one.

Some of the small groups did the exact same routine or tunes and got only a word , phrase, or action slightly tweaked in the entire session in order to get grounded so that we could move on.

When we see there is a u turn beginning with children, specifically autistic children, we often brace ourselves and say”Oh no, not this again, I thought we were done with this,” or “what is going on here?”  We just need to step back, get some perspective and give them some room. After all, if you really think about it, when I watch children, typical or autistic, change can bring about very obvious undesirable behaviors. However the same thing often happens, or happens in a not so obvious a degree to all of us, but tends to last longer. We all need to feel safe before moving on. Often we need to step back and go someplace familiar to regain perspective, to feel  solid on the ground before we can proceed to newer and better methods. Change brings about unpredictability, uncertainties and therefore discomfort. We want to stay organized and predictable in order to maintain. It is ok to step back a bit before moving on.

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“Life is not a Race”

Tortoise And Hare Race Metaphor

One of my childrens teachers handed this out the night when we met the teachers. I just loved this and thought I would share it:

“Life is not a race – but indeed a journey. Be honest. Work hard. Be choosy. Say “thank you,” and “great job” to someone each day. Take time for reflection and meditation. Let your handshake mean more then pen and paper. Love your life and what you’ve been given. It is not accidental – search for your purpose and do it best you can. Dreaming does matter. It allows you to become that which you aspire to be. Laugh often. Appreciate the little things in life and enjoy them. Some of the best things really are free. Do not worry, less wrinklies are more becoming. Forgive, it frees the soul. Take time for yourself – plan fir longevity. Recognize the special people you’ve been blessed to know. Live for today, enjoy the moment.”

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The Shocking Truth About Crying: Autism and “Out of the Cave,” Moments

image photo : Caves-4

The shocking truth about crying is that sometimes it is a spring board towards growth. Upon bringing a non-verbal  child to his father at the conclusion of his session, the father asked me “What happened, why is he crying?”

Unfortunately, when children are non-verbal we don’t always know they are crying. However, as I have said in previous blogs, all behavior communicates something. At the very least, crying communicates some sort of discomfort. Sometimes in therapy this is not always a bad thing. Crying may actually be the beginning of some kind of growth. I usually compare this to being trapped in a dark cave for a long time and suddenly being let out into the sunlight.  Coming into the sunlight is certainly more healthy however can initially be overwhelming, scary, or at the very least, uncomfortable. Now most of the time in therapy change does not happen   “all of the sudden, out of no-where”. But even change we know is coming can feel that way when it happens.

As I later spoke to the father, I did not know exactly what this boy was crying about. I said to the father I did not pay too much attention to the crying, I did not feel alarmed by it. There have been times when I did feel alarmed by his crying and ended  the session feeling that there was some kind of pain, discomfort that was not related to the therapy that seemed to prevent any therapeutic interventions as being helpful. But this time, his crying did not alarm me. My best guess or conclusion was that possibly there had been that cave type of discomfort. I did not really even think about this much until the father posed this question to me. This non-verbal, autistic seven year old had previously been in a small group session. Soon after that session ended we went into his individual session.  I purposefully slowed the previous sessions vibrant, up-beat music. This boy had been very happy and energetic but with the continuing energy was becoming unregulated and unsafe in his movements. I had felt the need to slow the music to help this boy slow his actions for safety sake. He did some very positive, organizing things in that session that I had never seen him do before. As the music slowed he had also gone from very happy to swaying between quiet on and off crying and also slwed his actions down.

I believe I had accomplished what I had set out to do, to help this boy slow and regulate his actions himself ( I never left the piano nor ever used any kind of hand over hand assistance.) Ultimately, this did help the boy to organize, however reflecting on this, it may have likely been an “out of the cave” moment or discomfort. I did not set out to sadden him, however the move from feeling happy, energetic,, unrestricted and full of life to a calmer, more focused regulated way of being may have felt disappointing, shocking , uncomfortable or possibly just undesireable at the moment. As undesireable as this may have felt initially, this boy then proceeded to demonstrate actions that were more organized, sustained and co-responsive than I had ever seen from him before.

Sometimes an “out of the cave” moment can be followed by some regressive behaviors for a short period of time. A better term would be a reprieve or retreat to a more familiar, safe known way of being.  Sometimes it may be followed by a period of processing, in which you do not see much action for a period of time. You or I might say , if it were us, “Let me just take a moment to understand what just happened.” At these moments if you pay close attention to their face or posture, you can see they are not lost in their own little world, they simply are just not doing much. And other times, as was this case, they just move on from the “cave” moment.

The next session proved me right. There was no crying, but slower, much more purposeful actions. He was using gestures showing me what he wanted. This boy’s actions this tine were conscious efforts to understand how to get to point B, where we have been heading. This non verbal boy repeatedly handed me the microphone, watching my mouth as I said the predicable word in the song “me.”

Although growth is healthy, it is not always comfortable, nor does it always happen in a way we might choose. The way we would choose is  usually more a path toward the familiar.  A principle of a school  I was once in, undergoing big changes would repeatedly tell us “Change is inevitable, Growth is optional.” I personally live this quote and think of it every time big change is headed my way, change I can not control.

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Sensory Integration – Meeting the Need

Symptoms of autism, hand flapping, unusual sounds, toe walking are just some of them. What are they all about and what are we to do about them? I must once again refer to my previous blogging quote by Temple Grandin,”All behavior springs from a reason, and all behavior is communication.” What are we to do with these behaviors? The answer; feed them.
I could not wait until Friday to write this blog, I had to do it while my last session of the day was fresh in my mind, here’s the story. I have been working with an autistic boy for about three years now. At the time we began, there was no eye contact or language (at about the age of 3) or much of anything but the occasional covering of the ears at loud noises. He is now 6 and in public school spending half his time in regular ed. The other half in an autistic support classroom. We have been working on answering questions in full sentences which was coming along nicely. I started to see some behaviors such as trying to get out of work or flying from on item to another. I wasn’t sure if we should continue the structure we had been doing, which was moving away from the music or if more music was what was needed. His TSS worker had been telling me that his stimming in school was getting worse and he was not listening to her like he was the previous year when stimming occurred. In fact, in the classroom he seemed to be harder and harder to reach lately. This boy is quite bright and understands much more than he can demonstrate he understands on demand.
This afternoon I think I had figured it out. I followed him instinctively and left behind our usual structure. This boy, I will call him C, got to my drum and demonstrated what Nordoff/Robbins has named as “Emotional Force Beating.” In this category of musical response Nordoff/Robbins states;”The drum is not used rhythmically or musically but only as a means of using strength and making noise. The child responds to the music and the drum by taking the opportunity for unchecked activity to bring into expression emotional and physical force. He is engrossed in fulfilling his emotional and muscular impulses in the amount of noise he can generate.” When this response was stopped, he listened to the remnants of sound then began to play very softly in a very controlled manner. As he continued throughout the session alternating these patterns, I sang a description of what he was doing. He automatically looked at me to make sure I was continuing the descriptive singing with each change. This is not typical for this kind of response. Usually the child gets lost in his impulsive beating, but C was still connected, aware and expecting me to hold up my end of this reflective pattern.
When we were finished I told the TSS my thoughts. This response was meeting some kind of sensory need and possibly there were some kind of changes going on in C. This response was more like a runners need to run. (I am not a runner but this was the first analogy that popped into my head). Being the very attentive and responsive TSS she is, she told me he doesn’t get much let down time this year in school, and barely any sensory time.
Stimming can not be stopped with avoidance or statements such as “stop” or “stop stimming” Stim behaviors do serve a purpose. The best way I have found to reduce or extinguish those behaviors is to feed them properly. I do this by meeting them and giving them structure musically. I usually find the child is lending us a bridge to the next step or most urgent point of development with those behaviors. Sometimes these behaviors are a way to temporarily relieve stress or manage excitement.
Here’s the analogy; statistics show that dieters often gain more weight back after dieting (trying to eliminate the stim behavior) however, if fed smartly (low calorie foods,exercise and hydration) weight loss tends to be more permanent (structuring the stim appropriately). After-all, what initially made Temple Grandin famous was her Squeeze Box, an object which met her sensory need when too much stress existed. Once again, stims may be a helpful tool or a temporary means of maintaining regulation. “All behavior springs from a reason and all behavior is communication.”

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Treatment of Autism

In the treatment of autism,or really, the progress of any individual, there is something we all must remember. Progress is never a direct line forward. Specifically with autism, there must always be a careful watch on our own expectations of progress. We must always remember the individual and realize we need to see progress as it is and not always what we expect it to be. I’m going to re-use Temple Grandin’s quote from a previous blog,”All behavior springs from a reason, and all behavior is communication.”
Yesterday I had a student observe to see if this is what she wants to do with her life. All went well until the second to last session. I should have known better. I gave this boy a little build up because he comes into most sessions and changes quickly from a boy with abrupt, brusque, gruff mannerisms and voice to a boy who has a very sweet, creatively inquisitive and spontaneous attitude and a trusting and agreeable voice. He also transfers from echoic speech to being able to easily answer very simple questions. That is his current goal in fact, to be able to answer questions. He comes in the room and almost immediately interprets the music we are going to be playing by moving to a yet unheard beat. He resembles a teenager who thinks he is alone with the head phones on. Well guess what, not yesterday. In fact he looked as if he barely noticed the music at all despite all my attempts.
And what makes this even better, his TSS said he was having a very good day. You can imagine my discomfort after the build up.
When I started to write his note at the end of the session, I realized he not only met his objective in the first few minutes of the session, but he surpassed it quite a bit. He answered many simple questions within the first few minutes of the session. A few possibilities came to mind; maybe I was in such a hurry to show what he can do that I did not pay attention to his needs like possibly more warm up music before the questioning. Maybe (this was the second time on a good day he did not have great Music therapy session) I have to watch this pattern over time and see what the possibilities are. Or maybe when I watch the video, it is not the things I wanted to see that was important. This is what to keep in mind, maybe there was higher level processing going (framing and organizing) which often is not observable by any outward action but is only observable by much more subtle observances like close attention to facial expression and posture.
This is a common pitfall of mine. When a child seems to be making very observable strides, I’m anticipating more and more each time. But in reality, name 1 person that develops that way, autistic or not.
What is important here is patience with ourselves and keen awareness of our clients. Quick notes after is a good reflective method, so are videos and blogging helps to. Also an open mind to our expectations. Everyone is an individual who is changing daily with each experience and interaction. Even with my own neuro-typical teenagers, growth occurs in different ways than I expect.(Neuro-typical teenager, is there really such a thing?)
One more story (this time I get to be on the other side of things) I once had a mother of an autistic child whom I thought was making tremendous progress with communication. Yet still non-verbal,the mother wanted to take him back to the neurologist because of his behaviors at home. The neurologist,whom I did not know nor knew me, demonstrated to the mother my suspicions. This little boy now understood but did not have enough yet to make his desires known. Mom received the result because she was who he hoped would be able to meet those wants. As Temple Grandin put it”All behavior springs from a reason and all behavior is communication.” Good to remember, no matter who we may be thinking of. Progress has it’s own path in each individual. Whatever the form it may take, progress is always significant.

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4 Musical Methods that are Helping Moms Have Great Days

Here is a great article a fellow Music Therapist has on her sight. I thought I would share this and give recognition to another valuable site!

4 Musical Methods that are Helping Moms Have Great Days

There are moms out there who are averting meltdowns today! There are moms out there who are watching their child learn skills and enjoy doing it!

These tips below are designed to help you experience the great days that those moms are having!

One of the wonderful things about music is that is travels. You can have CDs, MP3 players, small instruments, and your voice! An excellent way to help music travel is to use it throughout your day so that your child become accustomed to its presence, as well as benefits from it’s naturally soothing effects on their sensory system!

Here are a few ways to incorporate it:

1.   Songs for daily events: Have music that plays during wake up, getting dressed, and any other standard events. It can be classical music, some of your child’s favorite popular tunes, or some songs that address skills necessary for getting ready in the morning. Having these songs signal the beginning of an event will ease the transition from one activity to another, and decrease the occurances of “Okay Jimmy, it’s time to…”.

2.   Songs while driving that teach skills: I am not a mom myself, but I do know a lot of moms, and I know that long drives (and short ones!) can be difficult! Why not use this opportunity to add to your arsenal a few CDs that will help your child grow, learn, and develop necessary skills! You can sing along with your child as they recite their ABC’s, order of clothes to put on, colors, and a variety of other things. Just be sure to have your own musical collection on standby for once you are alone in the car. I have a huge list of recommendations! If you are interested, just e-mail me back and I’ll get it to you!

3.   Songs for tasks: Brush, brush, brush your teeth! Adding a song to a commonly performed task like brushing your teeth, combing your hair, cleaning up, tying your shoes (the list goes on), will not only help motivate your child to perform these tasks, but they can also aid in building motor skills, thorough completion of the tasks, better comprehension of the tasks, and also build motor function and internal rhythm (try to brush your teeth while humming that song and see if you can brush faster or slower, it’s hard!).

4.   Songs during transitions: Transitioning from one activity to another is one of the most difficult times for children. This is when the outburts and tantrums happen! Preparing your child for these transitions musically can help make things much easier. For example, you can designate a particular song for when it’s time to clear the crayons from the table and eat lunch! Make sure that it is a song your child enjoys, and practice doing this with them for a few days until they get the hang of it!
Did you like these methods? Are you hungry for more? Check out my individual and group therapy sessions if you are near Columbia, SC. Out of town? Check out my Consultation services!

Thanks!
Natalie Mullis, MT-BC
http://www.keychangesmusictherapy.com

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Don’t give up on Speech!

The Best of Both Worlds


Share your inspiring, hopeful story of how autism touched you.

The Best of Both Worlds

The Best of Both Worlds

“If you’ve seen one child with autism, you’ve seen one child with autism.” As a parent of two on the spectrum, I could not agree with this more. There is a certain loss that often feels irretrievable when first faced with a diagnosis. Shortly after being given two diagnoses back to back, I came to realization that I was given the opportunity to understand an enigma and parent in an extraordinary way.

The challenges I faced at the beginning of this journey for both of my boys were equally overwhelming. Nevertheless, the distinction between my boys remained apparent from day one. I admit, before I was able to fully accept my blessing, hope was not always there. I often heard that Early Intervention worked wonders on children who were diagnosed at an early age, and I eagerly expected rapid results. It is difficult to watch your child exhibit mannerisms that no longer seem “cute”, but rather harmful. After a year or two with hardly any progression, what little hope a newly diagnosed parent builds begins to fade.

When my older son began to blossom into what is commonly referred to as “high functioning”, I naively assumed his brother would follow in his footsteps. Along with a high-functioning child come amazing qualities and little quirks (echolalia, perfectionism, etc.) that I embrace in my son whole-heatedly. However, along with a low-functioning child come violent self-stimulatory and self-injurious behaviors, with little to no communication or self-help abilities.

As challenged parents we are in tune with our frustrations, as I’m sure our children are as well; after all, how often do are we faced with the screeching sounds of frustration from a fierce yet angelic child who just can’t find it in them to say “mommy”.

Julianna Gil de Lamadrid
College Point, NY

A couple of years ago I read this article somewhere. After reading this article written by a mother with children on the autism spectrum, I was compelled to write an opinion on the subject . When I wrote this article originally, I stated that I may change my opinion, but I have not, so here it is, once again. I have an opinion I’m not so sure all would agree on . I even started to change my mind until my gut moved me to keep searching.  I can only speak here of my own work because I have not researched others results. The popular solution for non-verbal kids, it seems to me nowadays, is some type of communication board. These devices seem to not only help with communication, but also relieve frustration and sometimes significantly improve behavior by relieving frustration for children who can use them. However my question is , with all the recent research on the elasticity of the brain, if there is no physical reason for lack of speech, is it good enough to stop at communication here? Why not continue to strive for some kind of speech?  Personally I have yet to see an IEP with continued speech goals where communication devices show some success.

This is where this posted article comes in. High functioning versus low functioning.  To me, “high functioning” means this child has more control over their responses than the “low functioning ” child. To me high functioning vs low functioning does not tell of actual cognitive ability. It tells me that the high functioning child finds it easier to tell or show what they know than does the low functioning child. Regardless, why give up on speech if there is elasticity in the brain and no physical reason for lack of speech.

Here is my analogy;  If you compared a 5-year-old with no musical exposure to Mozart, is there reason to say  that 5-year-old will never have any musical ability ever?  What if he learns to sing “Twinkle Twinkle Little Star,” but if you ask him to play a Piano Sonata, he screams and tantrums. Yet every time the radio is on, you see him stop and listen attentively to the piano part, no matter how difficult it is to distinguish it in that particular song, should you give up on that Sonata?

I almost gave in to no speech when I worked with a little boy for 2 years and we were still no closer to speech than the day he started. Eye contact? Definitely highly improved. Attentiveness? Almost a complete turn around. Affect? Huge, huge difference. Joint attention? Wow, playing tag in the store with his brother. But speech? Maybe I should be satisfied with a ll the other significant strides we had made. But a mother’s words wouldn’t let me do that. This mother said “I tried it one day. I went without speech for an entire day. It was very frustrating”. Sure, there were other ways to communicate, to make the point or even tell someone exactly what she wanted. She could write it if she needed to. So I kept going. I researched and listened. It was not only speech that had come to a stand still but also only a certain amount of motor planning was under his control.  We are not there yet, however we have made it to speech approximations. Yes, there is still more work to be done.

I will have to recheck this article in 5, 10, 15 years and see if I still feel the same way. I feel that even poor speech is still better than none at all. It is immediate and reactive. Only Mozart can begin with a sonata. The rest of the world has to start with one note at a time, a little every day. The rest of us have to carve out our own musical abilities, our own brain pathways to tell those fingers where and how to move, with time, persistence and practice.  If we really have a desire, with persistence and usually guidance, we can learn that sonata or at least learn as much as satisfies the desire.

I believe that those of us who have been given the job to help autistic children develop owe it to these kids to give them the continued opportunity for speech. If the world was unpredictable, scary, and frustrating wouldn’t it help if we could say “stop” at least. Don’t start with words or sonatas. Start with any sound, work toward a pattern first, maybe and interval. Start where the child is, go from there. They will tell you where they are. Ask questions, research, collaborate but don’t give up on some sort of speech! It is just my opinion. It is my opinion that which comes from the inside of us is much more satisfying than what we produce outside.

Antoinette Morrison MT-BC

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Self Regulation, Music Therapy and an Autistic Child?

 Looking Through The Chaos

Imagine living in a body where nothing is predictable.  Day and night come and go without much recognition or seem to be an unidentifiable background seen which is barely noticeable.  The world that is seen, heard and or felt is so unpredictable and uncontrolled that soiling oneself goes completley unnoticed.  What must it be like to live in a world like this?  How can one break through to a person who stares off in space because everything coming in is so erratic, unpredictable and disorganized that there is no one single thing to notice.  All one can do is stand still and hope it’s ok.  Stand still and wave his hands or flick his fingers.  At least with this motion, he feels something.  He is pretty sure he exists.

How does Music Therapy fit in here?  As I mentioned in a previous blog, the children often simultaneously bring to Music Therapy their strengths and their needs.  If the only way at this time that this time responds to music is to flap his hands or tweak his fingers, will take it!

As the boy flaps, the therapist begins to play to the beat, the speed of the flapping.  If it’s not regulated flapping, the therapist will improvise some kind of tune with syncopated rhythms (jazz or blues possibly) that gives the irregular flapping a pattern.  The same phrases will played over and over again as the child begins and stops, or stoops and straightens while flapping.  All the while the therapist sings simple phrases reflective of what the child is doing (example:  “go, go, go – stop”, or, “N is flapping, flapping – stop”, “N plays high, then plays low”).  The music and the words reflecting the child.  Sometimes a child like this gets it and looks right away. Sometimes it takes many, many repetitions.   Or maybe, instead of looking, the child flapping begins to reflect the music (instead of the reverse).  This is it, this is the beginning!  The child is linked to something, something with predictability, dependability, repitition and something temporal they can count on!  This is it, this is the beginning!

Is it because the child feels the vibration of the beat, the vibration of the tones that resonate with their own unique sounds?  Is it that they hear all this or maybe it’s not necessary to know why, just yet? Maybe all that is important is that you are both speaking in the same predictable, dependable language.  Beginnings and endings have been established, a temporal sense has been established. Someone speaks to me in my own unique way but somehow contains my voice and makes it gives it boundaries.  Self regulated learning has begun.  Self regulated behaviors establishing a route for the development of self.

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Autistic Individuals and community

    Imagine a group of individuals coming together, some flapping their arms, others chaotically running back and forth, and yet others screaming. All of them together in one room. No-one  in the group acknowledging that any other individual exists besides themselves.

     Suddenly,  someone who appears to look like a telephone operator  walks into the room.  She eyes each individual  and takes notice of what each and every person is doing. The telephone operator does her job.  She knows what connections to put into which sockets.  Only, she doesn’t use a switchboard, she uses a piano.  her fingers begin to dance at the piano as she sings to each individual and sings about their “original” versions of “dance”, her hands do their tricks.  her left hand plays in time to the hand flappers, her right hand, matching pitch with the screamers  plays simultaneously  the to the footsteps of the runners.   All individuals are playing, flapping, dancing, signing to the same tune.  As the music stops, so does all it’ s participants.  As the music begins, they all begin again in unison.

     Maybe they have not looked at one another this time yet, but they all stayed and participated willingly together.  This is the start, the start of community.  A start at a relationship, a start at attentiveness to something outside themselves.  A beginning to communication.

     This is the place where all these unique individuals bring their greatest strengths which happen to also display their greatest needs . Everyone has a job that they enjoy, that they are good at.  A job that includes them , a job unique to each individual yet includes them in a community function.  Where is this place?  It is the Music Therapy room.

     What happens when they leave this room?  They leave with new strengths that help them to function in jobs outside that room.  Jobs where the other workers the work with all talk alike, walk alike and all speak the same language.  Now these unique individuals can have new jobs that probably will not include music.  In these new jobs they may or may not talk and walk like all the other workers, but they can still function with them, in this new group of like minded individuals.

     Now the little boy who came in screaming leaves the Music room instead ,saying ” I am very disappointed.”  The little boy flapping all by himself now leaves the room saying “bye ,bye” to all his new friends.  The boy who ran back and forth, walks out of the room, stops, turns back and looks at the telephone operator (Music Therapist) and smiles and waves “Goodbye.”

                                                                            Kids Dancing Silhouettes

 

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Behavioral Health

“All Behavior springs from a reason, and all behavior is communication,” Temple Grandin Phd.  I ran across this quote in the book Insights into Sensory Issues for Professionals by Kathleen Morris. I love this quote, not only for the autistic community,  but also for children in general.  Firstly, I  have found when an autistic child comes in clapping his hands and I put music to this we can do something with this .  One case in particular it became the starting point for not only communication but also verbalization.  The question then is , what purpose does this action or behavior serve for this individual? What need is it meeting?  What sensory issue is it attempting to satisfy?

I find this to be true also for typically developing (neurologically speaking)  children.  What is their behavior again attempting to satisfy?  That child who keeps interrupting, why, what need is it meeting?  If we can successfully answer this question then usually we can move on from this point.  These are the big clues the child gives us to help us with our work.  This is the child’s means of communicating to us what he/ she needs.

To the parent who disclosed that when his autistic son ran approximately 8 feet in front of him in a (safe) public warehouse, trying to engage his little brother to play, and was thrilled with this despite others looks: Bravo for your insights and devotion!

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Welcome

Welcome to the exciting re-opening of backmountainmusictherapy.com!  As you can see, I have not completely figured out the new website builder yet, however, I will be taking a new class to learn the intricacies of blogging/website building! Please feel free to click any of the links above for information regarding music therapy.

Two Children Singing

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