Music therapy “is the systematic application of music, as directed by the music therapist in a therapeutic environment, to bring about desirable changes in behavior,” therefore it is based on applied behavior analysis (Davis 6).  In 1968 Madsen proposed music therapy uses a behavioral approach.  This is based on the thought that therapists use music as a reinforcer or as an operant to modify behavior therefore conditioning the client to exhibit the new behavior (Biomedical Foundations of Music as Therapy 6).  The current definition of Music Therapy according to the American Music Therapy Association reads as follows: Music Therapy is the clinical and evidence-based use of music intervention to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program (1). The belief in the power of music to affect mental and physical well-being has existed way back in beginning societies.  This has been demonstrated when a mother or father sings a lullaby to their crying child to calm them down.

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Margaret Anderton organized and taught the first music therapy course offered at a university (Davis 24).  Music therapy continued to gain support during the twentieth century.  More and more cases supporting music therapy were published by physicians, psychiatrist, musicians, and the general public.  These articles appeared in books, magazines, and newspapers (23).

In 1941, Harriet Ayer Seymour founded the National Foundation for Music Therapy.  Since then, clinics have begun to sponsor scientific research in music therapy (Davis 25).  As stated in the article published by American Music Therapy Association, “A substantial body of literature exists to support the effectiveness of music therapy” (2).  Dr. Temple Grandin was diagnosed as having autism at an early age.  She has written many articles about her personal experiences as an autistic individual.  An abstract written by Diane A. Toigo summarizes Dr. Grandin’s views about autism and music therapy.  She quotes Grandin as saying; “Music also has value for many children with autism because it is something that is inherently pleasurable, perhaps because it is absolutely predictable phenomenon in an unpredictable world” (13, 17).

It is believed that music therapy provides an opportunity for the brain to automatically replace “unacceptable “ social behaviors with new ones.  In this case the purpose of the music is to calm down the student/individual or relieve stress and the brain is then better organized and social learning can take place (Berger 60).  Music therapy interventions can present “listening” activities to train the brain. The student learns to listen, recall and imitate sequential sounds more efficiently.  Gaining listening and sound-retrieval skills can also stimulate oral-motor planning for vocal sound imitation.  appropriate as well as fit their culture and environment in which they interact (Music Therapy and Individuals with … 3).

Bibliography

“American Music Therapy Association: Frequently Asked Questions About Music Therapy.” 22 July 2005 http://www.musictherapy.org/faqs.html.

Berger, Dorita S. Music Therapy, Sensory Integration and the Autistic Child. Philadelphia, PA: Jessica Kingsley Publishers, 2002.

Davis, William B, Kate E. Gfeller, Michael H. Thaut. An Introduction to Music Therapy Theory and Practices. Burr Ridge, IL: McGraw-Hill, 1999.

“Music Therapy and Autism.” 18 July 2005 http://www.mtabc.com/autism.html.

“Music Therapy and Individuals with Diagnoses on the Autism Spectrum.” 18 July 2005 http://www.musictherapy.org/factsheets/autism.html.

Staum, Myra J. “Music Therapy and Language for the Autistic Child.” 18 July 2005 http://www.autism/music.html.

Taylor, Dale B. Biomedical Foundations of Music as Therapy. St. Louis, MO: MMB Music, Inc., 1997.

Toigo, Diane A. “Autism: Integrating a Personal Perspective with Music Therapy Practice.” Music Therapy Perspectives, Vol. 10 (1992): 13, 17.

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                                         LEAP Program

(Learning Experiences, an Alternative Program for Preschoolers and Parents)

• General Information

The LEAP program is a developmentally-integrated preschool program for typically developing peers and children with autism.

• Defining Characteristics

1. The program focuses on teaching typically developing peers to facilitate the social and language skills of the children with autism.
2. Uses only evidence-based practices.
3. Embeds opportunities within the preschool daily activities
4. Daily data collections based on IEP objectives
5. Teaches behavioral skills to adult members in home and in the community setting

• Targeted Population/Environment

1. Children with autism are targeted
2. Social and Language skills are focused on
3. The regular preschool environment is used
4. Typically developing peers are a must

• Strengths/Weaknesses

1. Strengths include:

-Supported by 36 peer-reviewed studies

-Includes family members in training

-Uses typically developing peers to facilitate

-Takes place in an inclusive setting

-Uses only evidence-based practices

-Funded by office of Special Education

-Uses developmentally appropriate practices

-Uses daily collection based on individual IEPs

1. Weaknesses Include:

-Program is only for children 3years or older

-Daily collection needed

-Training for peers and family members

• Research

According to Strain and Hoyson (2000), an 18-year follow up study showed improvements maintained over an extended period of time.  The research builds on the previous article, Hoyson, Jamieson, and Strain (1984).  The study included 6 participants diagnosed with autism and scoring within the moderate to severe range on the Childhood Autism Rating Scale (CARS).  The 6 participants ranged in age from 30-53 months of age.  Peer-mediated interventions were used throughout the day at an average rate of 86 opportunities a day.  Upon exiting the program at age 6 and again at age 10, the participants were assessed with improvements shown on the CARS, in direct observation, and within the family follow up surveys.  Five of the six participants were found to have gone through the schooling system within the regular education setting with no special education services.

Reference:

Strain, P.S., Hoyson, M. (2000).  The Need for Longitudinal, Intensive Social Skill Intervention: LEAP Follow-Up Outcomes for Children with Autism. Topics in Early Childhood Special Education. 20(2), 116-122.

• Defend Instructional Programs Appropriateness

1. Provides generalization in regular classroom
2. Peer-mediated
3. Generalization in home and community setting
4. Daily data collection based on individual IEPs
5. Includes non-biased assessments
6. Train family members
7. Complete follow-up studies
8. Uses developmentally appropriate practices
9. Targets early intervention
10.  Targets inclusive practices
11.   Targets generalizability

What is Vitamin Therapy?

Vitamin Therapy is an alternative therapy that is termed as part of CAM (complementary and alternative medicine) in relation to Autistic Spectrum Disorder (ASD). It is the use of any type of vitamin or nutritional supplement that is used to help someone’s general nutritional health or aide in treatment of a particular symptom or set of symptoms. The vitamins or nutritional supplements are taken orally in a recommended dosage, usually once or twice a day.

It is believed that mega-dose vitamin therapy started in the early 1950s when a few psychiatrists decided to provide massive doses of nutrients to patients with severe mental problems as part of their treatment.

Vitamin Therapy and ASD

Megavitamin therapy, which is mostly used with ASD, first began with the use in treatment for Schizophrenic patients in the early 1950’s. The first vitamin that was used with ASD was Vitamin B6 (Pyroxidine) when some children took large doses and had shown improvements in speech and language. Magnesium was then later found to reduce bad side effects from B6 so people began to use it in combination.

Vitamin therapy is related to ASD in that it reinforces the ideas of reinforcing desired behaviors and ignoring undesired behaviors as in applied behavioral analysis, since we are focusing on increasing desired behaviors through the ignoring of or reducing of undesired ones.

Vitamins and Supplements Most Commonly Used with ASD and their Potential Benefits

Vitamin C (absorbic acid)

A high dose has been observed to diminish stereotypic behaviors and aid with the depressive, manic, and paranoid symptom complexes, together with an improvement in personality functioning.

Vitamin B6 and Magnesium

B6 is used for a role in the generation of several neurotransmitters, the combination of the two is used for a potential increase positive behaviors.

Improvements that have been seen include an improvement in eye contact, less self-stimulatory behavior, more interest in the world around them, fewer tantrums, and more speech.

Dimethylglycine (DMG)

DMG is a nutritional supplement that is used because it may have excitatory central neuroactive effects. Positive changes in behavior are usually noticed in two weeks time if it is working. (sold as a food product rather than a vitamin)

Vitamin A

A high dose may improve immune function.

Research Findings

Over the past few decades there have been extensive studies done on the use of various vitamins and nutritional supplements and their effects on ASD, but due to faults in the studies there is little completely solid evidence to support an extensive knowledge of the benefits and costs.

In most studies that have been done in relation to taking a high dosage of vitamin b-6 with the addition of magnesium in most cases, positive results and very seldom have side effects been noted.

In studies researching the use of DMG with ASD, no adverse side effects, other than minor irritability and increased activity have been found even with extremely high doses taken and a positive effect on the immune system and physical performance has been found.

Few studies have been done on the use of vitamin C in particular with ASD, but in other research it has been found that vitamin C is extremely safe and that it is immensely beneficial to the brain and body and side effects are unusual. In the couple research studies that have been done, there was significant improvement seen. It is still yet to be determined what an optimal dose for ASD would be.

Not much research has been done on the effects of vitamin A on children with ASD, but it has been more recently under study. Hypervitaminosis A has been found to maybe have the side effects of anorexia, dry skin,

liver toxicity and hepatosplenomegaly, increased intracranial pressure, irritability, and carotenemia. Birth defects may also occur with excessive maternal intake of vitamin A during pregnancy, so it is a little bit more risky than the other vitamins and supplements at this point.

Overall, the research that has been done has shown more positive effects of b-6 and magnesium and DMG than the others. It is also indicated that there have been no side effects with children with ASD reported so far. More research needs to be done in this area though for more solid evidence of the benefits and also costs of treatment.

Who would specifically benefit?

Any child with ASD could potentially benefit from the use of vitamin therapy. It is highly recommended for the parent or guardian to consult with a physician before using them on their own though, in case particular children have something going on that is unusual.

Are there any concerns I should have?

Although vitamin therapy has been studied extensively, there is not completely solid evidence that exists documenting its effectiveness. The full extent of the benefits and costs are still unknown. There is still little knowledge about appropriate doses and it is difficult to determine these because of weight considerations. There could be possible overdoses if giving the wrong amount and especially when not knowing how much of a given vitamin is actually in a supplement if it isn’t a straight vitamin that is being taken. Vitamins and dietary supplements are also not restricted by the FDA. It is difficult to make an informed decision about what is completely safe with these factors to consider.

As far back as the work of Hans Asperger and Leo Kanner, sensory difficulties have been described as an area of concern for individuals with autism and Aspergers.  In Asperger’s first paper he described the unique sensory characteristics that some of the individuals portrayed.  However, modern day research has made very little progress in this field of study, particularly in the area of Asperger Syndrome.  According to the Diagnostic Criteria for Asperger’s Disorder and the Diagnostic and Statistical Manual of Mental Disorders-4^th edition, a characteristic denoted as part of Asperger’s Syndrome includes “stereotyped and repetitive motor mannerisms (e.g., hand o finger flapping or twisting, or complex whole-body movements.”  One of the leading clinics in sensory integration, the Ayres Clinic, notes that the following signs may indicate sensory issues:

-Overly sensitive to touch, movement, sights, or sounds

-Under reactive to touch, movement, sights, or sounds

-Easily distracted

-Social and/or emotional problems

-Activity level that is unusually high or unusually low

-Physical clumsiness or apparent carelessness

-Impulsive, lacking of self-control

-Difficulty making transitions from one situation to another

-Inability to unwind or calm self

-Poor self-concept

-Delays in speech, language, or motor skills

-Delays in academic achievement

While motor planning may not appear to be a huge issue to many people it can impact a person’s everyday actions.  Getting a lunch tray at school or work and playing sports can all be very complicated and negative task to someone who has motor planning difficulties.

“Sensory inputs have the potential to evoke a number of reactions.  And those reactions are seen as behaviors. (Asperger Syndrome and Sensory Issues, pg. 6).”  The human body is composed of seven sensory systems that all tie together to provide the body with input from the surrounding environment.  Effective sensory processing involves the body receiving stimuli from the environment and regulating/modulating how the input is handled.  When regulation and modulation are not balanced an under or over-response may occur.  For example, when something slimy is touched someone might respond by pulling away and saying that it was gross, by not regulating the sensory system that is out of balance might respond by physically getting sick (an over response).  Ineffective sensory systems can have a huge negative impact on the person’s physical, social, and emotional life.

According to a study done by Myles, Dunn and Orr (2000), more than 50% of individuals diagnosed with Asperger’s  have sensory modulation deficits in the areas of auditory, vestibular, touch, oral, and multisensory areas.  In their study of 42 children they found that two-thirds of the children had social and emotional difficulties related to sensory processing.  “Many children have abnormally strong dislikes for particular tactile sensations, for example, velvet, silk, cotton, wool, or chalk.  They cannot tolerate the roughness of new shirts or of mended socks.  Cutting fingernails is often the cause of tantrums” (Asperger, 1944) (Asperger Syndrome and Sensory Issues, pg. 23).Typically what is noticed first by parents, teachers, and professionals are the hypersensitive individuals, because of their extreme response to stimuli.  Frequently in the classroom, these are the individuals that teachers “need help” with, and students often target for teasing.  Hypersensitive individuals often standout and are socially ridiculed because of their sometimes extreme behaviors.  On the far other side are hyposensitive individuals whose lack of correctly receiving input is demonstrated by behaviors , again often seen as unusual, weird, different, and not normal.  Sensory Integration Dysfunction as defined by Wikipedia (2007), “is a neurological disorder causing difficulties with processing information from the five classic senses, the senses of movement, and/or positional sense.  Sensory information is sensed normally, but perceived abnormally.”  Sensory integration dysfunction can have devastating effects on the life of individuals on the autism spectrum.  The dysfunction by itself, without the other characteristics of autism can result in problems with paying attention and learning at school and in the home.  Just as autism falls on a spectrum so does sensory dysfunction, which each individuals symptoms being very unique to them.

A therapy first hypothesized and introduced by Jean Ayers, is that of Sensory Integration Therapy (Ayers, 1972).  Occupational therapists around the world are attempting to help individuals modulate and regulate their sensory systems using this therapy.  Sensory Integration Therapy involves a wide range of specialized equipment that is thought to help individuals learn how to modulate and regulate sensory input.  The therapy is carried out in many different environments such as, the classroom, school setting, home, and around the community as needed. During sensory therapy the child that is hyposensitive might be exposed by the occupational therapist to strong sensations that will stimulate the senses.  A child with hypersensitivity might take part in peaceful or quieting activities to “bring down” their system.  “Despite the popularity of this treatment, there is remarkably little empirical evidence of the efficacy of Sensory Integration Therapy (Braneck 2002; Dawson & Watling 2000), (Attwood, 2007).”

Although there is little empirical evidence to support or denounce Sensory Integration many individual’s parents and caregivers swear by this therapy.  “Sensory Integration Therapy can reduce tactile defensiveness (Attwood, 2007).”  Again, Attwood (2007) discusses how Sensory Integration Therapy can reduce auditory sensitivity as well as increase dietary diversity.  Without lots of research to back Sensory Integration Therapy, many people are hesitant to attempt such a program.  However, there are programs that are not supported by a lot of empirically based research that people and individuals with expertise will swear by.

Current research in the area of sensory integration, related to the autism spectrum is limited.  There has been lots of empirically based research in regards to other developmental delays and schizophrenia.  According to Rogers and Ozonoff (2005) the 1960s brought about the hypothesis of over- or under-arousal theory.  Both theories are supported by research, and are currently a part of mainstream research today.  “Over-arousal theories are based on the hypotheses that children with autism 1) are more easily aroused by and reactive to sensory stimuli than other children, and 2) fail to or are much slower to habituate to stimuli in the environment than other children. (Rogers & Ozonoff, 2005).”  There are currently over 100 articles published in peer-review journals, most being within occupational journals.  However, because of the difficulties with designing double-blind research studies more research is needed.

Pertaining to my own professional experience, I can say that for many individuals with Asperger’s as well as Autism, Sensory Integration Therapy can be very beneficial.  I can specifically think of three students that reaped huge benefits from the therapy.  The great thing about therapies that work for individuals is they are typically not the only person who benefits.  In the case of my three students, their families and teachers benefited from the therapy as well.  The students were all formally assessed using a sensory profile and an occupational therapist worked with each student’s school team to setup a program that would meet their individual needs.  Since, all seven sensory systems are not always impacted just the systems that need to be regulated are targeted.  For instance, one student entire sensory system (including all seven systems) were targeted.  For oral motor input he is allowed to chew gum at school or use a chew tube, these allowances are often more socially acceptable to the teacher as well as other peers, instead of the student chewing on his shirt or sucking his toes in class.  However, when providing tools to modulate their bodies we must also teach the individual how to regulate the use of these tools.  Frequently, the individual may want or perhaps even need to use the provided tool all the time.  With time and teaching the individual can learn how to regulate the use to a certain number of times a day or use only during certain times of the day.  A visual schedule can be used to provide visual input to an individual as well as help them regulate their bodies on a schedule.  I have students that need proprioceptive input, in which we may have a rocking chair placed in the classroom, to be used during specified times.  The great thing about this therapy approach is that for instance, a rocking chair in a reading corner can be used by all the students, therefore not signaling out the individual diagnosed with Asperger’s.  I have seen many students that don’t receive direct OT therapy or even an IEP, benefit from sensory integration techniques.  Obviously, sensory dysfunction does not just occur in individuals diagnosed on the autism spectrum but it occurs frequently in individuals outside the spectrum.  One student in particular has a visual schedule (that the whole class utilizes), a visual timer, a bumpy seat, weighted vest, earphones (to block noise), and frequent built in walking breaks.  With these modifications in the regular education classroom this individual is completely successful and on grade level academically by himself.  The question to those that are skeptical then becomes, should we not use this therapy and have the student in the regular education classroom 100% of the time but have him in a more restrictive environment and his body still less modulated/regulated?