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A Music Therapy Treatment Model for

Autistic Children
MICHAEL

H. THAUT,

Ph.D., R.M.T.

areas. Since then, the model has been used in the clinical
education of university music therapy students working with
autistic children. Revisions, additions, and modifications have
helped to improve the original concept. This paper tries to
present the theoretical, experimental,
and clinical experience
accumulated since the model was developed.

General Objectives andPreconditions


Diagnosis
Before setting up a treatment plan, careful consideration
of diagnostic findings should take place. Results from neu
rological assessments and differential diagnosis would partic
ularly help in applying symptom-oriented
and efficient music
therapy treatment. In order to emphasize the application of
consistent diagnostic criteria, the use of Rutters (1978a) or
Ornitz and Ritvos (1976) list of criteria is recommended.
It
is suggested that both lists complement
each other under
specific etiological considerations.
For screening purposes or
developmental
assessments, the Psychoeducational
Profile
(Schopler & Reichler, 1979), the A.S.I.E.P. (Krug, Arick & Al
mond, 1980), or the Assessment of Autism Checklist (Gilliam,
1979) are recommended.

The suggested treatment model was originally developed


as part of a masters thesis research project, conducted
by
the author between October 1979 and June 1980 and de
signed to explore the potential of music therapy in the treat
ment of autistic children.
The project was carried out in four parts:
1. A review of clinical and research literature was carried
out. Treatment areas where successful clinical experiences
with music therapy had been documented
were systemati
cally surveyed and possible new treatment foci were sug
gested based upon relevant research findings,
2. Clinical experience
gathered with 10 autistic children
(age range 5 to 14 years) during the time of the project in
dicated four prospective
treatment areas: development
of
language, socioemotional,
cognitive, and perceptual
motor
skills.
3. An experimental
study was designed to give children a
stimulus choice between auditory, musical, and visual stim
ulus conditions. The autistic children chose the musical time
involvement
significantly longer than two control groups of
normal children equated by mental and chronological
age
respectively.
4. In a second experiment,
autistic childrens improvised
tetrachordic
tone sequencer were analyzed for complexity,
rule adherence, originality, rhythm, and restriction. In a com
parative analysis, autistic childrens
tone sequencer
ap
proached scores of normal children and received significantly
higher scores than those of mentally impaired children.
The complete results of the research project are reported
elsewhere (Thaut, 1980). Based on those results, a treatment
model was developed where music therapy techniques were
described in their specific application to relevant treatment

Etiology
There is evidence in the research literature suggesting the
likelihood that autism has a neurophysiological
cause in terms
of some organic brain disorder. This disorder manifests itself
in a variety of perceptual, cognitive, and motor disturbances.
Ornitz (1974) has stated that perceptual disturbances are of
fundamental importance in autism. They manifest themselves
in perceptual inconstancy, lack of cross-modal associations,
distortion of normal receptor hierarchy, dependence on kin
esthetic feedback, and sensorimotor
disintegration.
Music
therapy, working on the level of sensory perception
in dif
ferent modalities as well as integrating sensorimotor process
es, can explain its treatment approach under these etiological
considerations.
Further, evidence is provided
by electro
physiological investigations about brain hemispheric special
ization which supports the frequent observation that autistic
children are able to perceive and process musical stimuli de
spite their various other perceptual deficits (Applebaum, Egel,
Koegel, & Imhoff, 1979; DeLong, 1978; Tanguay, 1976).
Treatment

Michael H. Thaut, Ph.D., R.M.T., completed his M.M. and Ph.D. degrees at
Michiagan State University. He Currently works at Riverside Correctional fa

Recent experiences in treatment programs for autistic chil


dren point out the efficiency of educational settings (Bartak
& Rutter, 1973; Rutter & Bartak, 1973). Thus it is recom-

cility, Psychiatric Center, Ionia, Michigan

1984, by the National Association for Music Therapy, Inc.

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ABSTRACT: An attempt was made to develops general music ther


apy treatment model for autistic children which is directed toward
their specific areas of deficiencies and dysfunctioning. The model
was based on results and experiences from an 8-month university
research project. Four relevant treatment areas for music therapy
with autistic children are included: (a) impaired language develop
ment, (b) impaired socio-emotional development, (c) impaired de
velopment of cognitive areas, and(d) perceptual motor disturbances.
For each treatment area, aspects of pathology and diagnostic char
acteristics are outlined and sequencer of pertinent music therapy
techniques are identified.

Michigan State University

Music Therapy Perspectives (1984), Vol. 1, NO. 4

mended that music therapy integrate its treatment concept


in a comprehensive
special education program for autistic
children. If this is not possible, there should be, nevertheless,
an attempt to adapt consistent treatment criteria in educa
tional and therapeutic
settings. Music therapy should stress
parental cooperation in all stages of treatment. Music therapy
should use a structural and developmentally
based approach
to set up its treatment: (a) macro-structure
(long-term goals
and assessment of learning steps); and (b) micro-structure
(or
ganization of learning situations and sequencing of activities
in order to facilitate appropriate behavior).

Learning processes in autistic children are always hampered


by perceptual problems such as lack of concentration,
fluc
tuating attention, fading eye contact, and preoccupation
with
ritualistic behaviors. Therefore, it is suggested that one em
phasize (a) rigid insistence on eye contact,(b) frequent recall
of attention,(c)
repetition of instruction in consistent word
ing until appropriate
effort of response has been made, and
(d) encouragement
of perservance during performance. These
principles have been very useful in the authors experience
to gradually shape attentive behavior in autistic children.
Impaired

Language Development

Etiology and Diagnostic Criteria


Language deficiencies are listed in all diagnostic systems as
a major autistic symptom. The acquisition of language is con
sidered to be a crucial aspect in further social and intellectual
development
of the child. It is assumed that a specific cog
nitive impairment
affects the four aspects of the language
system, namely, conceptualization,
symbolization,
compre
hension, and production. So far no convincing etiological ex
planation exists about the brain pathology responsible for the
autistic language disorder. Autistic children seem to suffer
from a disorder which impairs central coding processes and
also strongly affects social and other cognitive skills (Rutter,
1978b). Music therapy techniques work on production
pro
cesses as well as try to stimulate mental processes in respect
to conceptualization,
symbolization,
and comprehension.
Expressive language behavior of autistic children seems to
fall roughly into three categories. The category of lowest
functioning
is characterized
by muteness or occasional bab
bling which is sometimes accompanied
by pointing at or
showing desired items. The children with oral motor apraxia
must also be grouped in this category. A second category
comprises children with noncommunicative
speech or lim
ited communicative
intent. Main characteristics
are various
forms of echolalia, pronoun reversal, lack of core of verbs, or

Music Therapy Techniques

Basic Level

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autistic children are able to perceive and


process musical stimuli despite their various oth
er perceptual
deficits (Applebaum
et. al., 1979;
DeLong, 1978; Tanguay, 1976).
. . .

use of speech limited to labeling/requesting


items. Only a
small number of higher functioning autistic children acquire
functional speech beyond labeling/requesting.
The speech
patterns, however, are characterized by syntactical problems,
limited vocabulary and semantic concepts, and poor intona
tion patterns as well as lack of emotional attachment (Wing,
1976).
Proficiency in understanding
written or spoken language
ranges from complete unresponsiveness
and incomprehen
sion to limited understanding
of simply constructed
sen
tences. The nine-word language test by Churchill (1978) has
been found useful in the authors experience in determining
level of understanding
and identifying breakdown in the re
spective input or output channels (visual, auditory, motor).

1. On a basic level the therapist should try to support and


facilitate the desire or necessity for the child to communi
cate. Improvised musical accompaniment
of the childs ha
bitual expressions (crying, laughing, sounds, movements) is
intended to demonstrate a communicative
relationship be
tween a particular sound, rhythmic pattern, or movement
and some expression exhibited by the child. The autistic child
might perceive sounds or movements better than verbal ap
proaches. Awareness of music and of a relationship between
music and own action might serve as a motivational factor for
the desire to communicate.
Intermediate Level

2. If the child has understood and used communicative


intentions and responses, words or phrases may be combined
with a melodic or rhythmic pattern and a body movement.
The technique is intended to appeal to a maximum of per
ceptive channels in the child. Considering the specific per
ceptual pathology of autistic children, the integration of, for
example, an auditory rhythmic pattern and a kinesthetic cue
can facilitate perceptual awareness and comprehension
in a
teaching situation. As a starting point, names or action words
lend themselves easily to this technique.
3. Autistic children, as was frequently observed during this
project, tend to recognize the melodic/rhythmic
shape of
words or sentences better than the actual semantic meaning.
This may lead to curious results when retaining the intonation
patterns but changing sentence content. The authors use of
strong melodic/rhythmic
patterns in verbal instructions, along
with action patterns or flash cards to secure the word con
tent, were found beneficial in maintaining better attention to
and comprehension/retention
of the spoken word. For ex
ample, chants were widely used in combination
with body
percussion patterns as a teaching technique to aid the above
described goals.
4. If the child exhibits undifferentiated
vocal expressions,
oral motor exercises such as playing wind instruments or oral

Treatment

Model

for Autistic

Children

motor imitation practice can strengthen awareness and func


tional use of lips, tongue, jaws, and teeth.
Complex level

So&-Emotional

Etiology

and Diagnostic

Development
Criteria

The traditional autistic diagnostic criteria of maintenance


of sameness and aloofness are combined
in this treatment
area. The social withdrawal
was viewed as a primary autistic
feature for many years. Most of the etiological considerations
and treatment attempts centered around possible causes for
this behavior. This might have been the reason for viewing
autism for a long time primarily as a psychiatric condition
(Kanner, 1943). Today the impaired socio-emotional
devel
opment is considered to be a manifestation
of some kind of
physical disorder. Various perceptual and cognitive dysfunc
tions are emphasized
as underlying
factors for the socio
emotional behavior deficiencies (Churchill, 1972; Reichler &
Schopler, 1971). A central deficit in encoding stimuli and
building concept formation is assumed; this impairs all types
of complex behavior. Less is known, however, about neuro
biological factors underlying the formation of social behavior.
The features of impaired socio-emotional
behavior are most
pronounced
in early childhood
(Wing, 1978). Main charac
teristics are listed below grouped in three categories.
1. Deviant eye contact; limpness/stiffness
when held; ab
sence of social smile; lack of physical responsiveness.
2. Lack of affective responsiveness and empathy; aloofness;
lack of social play/role
play; lack of peer relations; lack of
attention; lack of perseverance; anxiety.
3. Attachment
to objects (often as obsessive preoccupa
tion); use of others as extension of self; maintenance of same
ness in environment.
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5. If the child has grown in his perceptual abilities, imitation


sequences which employ motion patterns with melodic/
rhythmic accompaniment
may be introduced.
Gross motor
imitation such as moving to music, dancing, clapping hands,
circling arms, etc. should proceed gradually to more precise
imitative behavior (e.g., fine motor imitation such as playing
with fingers). Oral motor imitation with various silent mouth
positions would follow. Next oral vocal motor imitation where
single sounds are imitated should be presented. An integra
tive technique would maintain gross and fine motor move
ments during the oral imitation process and use, for example,
words of the respective body parts (arm, eye, ear, foot, hand,
etc.) as teaching items. It would be advantageous to integrate
auditory, motor, and kinesthetic processes during the vocal
ization exercises.
6. If some kind of speech (e.g., some labeling abilities) has
been acquired, various activities for intonation problems or
fluency may be implemented.
Melodic
shaping of vocal
expressions, awareness of high/low and soft/loud, and stress
patterns may be introduced
by stimulation
of free singing
impulses through the accompaniment
of the childs vocal
expressions by organum chord progressions. Free singing of
the therapist along with his/her improvisations
can also aid
the above described goals and evoke songlike response by
the child.
7. Sound vocalization may be supported by bringing reson
ating instruments (chime bars) close to the childs ears. Reso
nating sounds seem to help to stabilize and encourage the
voice in terms of duration and volume. Full chords on the
piano may have the same effect after the child shows some
progress in sustaining sounds. However, an autistic childs
perceptual
sensitivity may change dramatically
from day to
day and too close a contact with a sound source may produce
undesirable
overstimulation.
Exercises of sustaining sounds
have also been used in this project to help children who have
problems with combining
syllables or letters smoothly and
meaningfully
(oral motor apraxia). Although in some cases a
positive effect was observed, no claims of validated success
can be made at this point.
8. Singing vowels by sustaining long sounds helps to further
refine the inflection of speech. Graphic notations can facili
tate the childs efforts: watching the movement of a pen on
paper, drawing lines or curves following the melody of the
sentence also appeals to the fascination for geometrical shapes
and forms exhibited by some autistic children (Alvin, 1978).
9. Breathing can be generally trained by playing wind in
struments. This activity exercises breathing processes, capac
ity, and laryngeal functions (Alvin). It also can aid the refine
ment of oral motor function and the awareness of physical
resistance in the breathing process by the pressure of wind
entering the lungs and the instrument in controlled ways.

Impaired

Autistic children . . . tend to recognize the me


lodic/rhythmic
shape of words or sentences bet
ter than the actual semantic meaning.
All of these features may change after 5 or 6 years of age in
terms of intensity. The social aloneness, however, markedly
remains (Wing, 1978).
Music Therapy
Basic Level

Techniques

1. Autistic children very often physically reject or ignore


social contact attempts by other persons especially if they are
in an early stage of relationship building. Therefore, it can be
more fruitful at times to initially provide an object relation
for the child (e.g., through playing instruments). Shape, sound,
and touch of the instrument will often fascinate the child. A
variety of instruments may be offered and freedom of explo
ration should be given. The experience
in this project has
shown, however, that the selection and exploratory
use of an
instrument should be structured from the very beginning to
minimize motility rituals or sensory overload. A cymbal, for
example, can sometimes be too intruding
with its ringing
sound, or the child might start spinning the cymbal which

Music TherapyPerspectives(1984),Vol. 1, No. 4

10

Intermediate Level
5. On this level the emphasis should be placed on thera
peutic experiences where definite demands on a childs at
tention and responses are made via some musical coopera
tion. The therapist thus sets up activities in a goal-oriented
manner: leading movement imitations, clap/slap gamer, lum
mi stick practices, or addition of ostinato patterns and rhythms
to musical improvisations.
6. Demands of social learning in a musical one-to-one
re
lationship can be established by structuring musical activities
with dynamics, speed, rests, movements, dance steps, alter
nate playing patterns, and melodic imitations. Resonator bells,
xylophones,
metallophones,
and other percussion
instru
ments are useful for these musical interactions. The therapist
may improvise (e.g., on the piano) music for particular move
ments: running, hopping, walking, standing still, sitting down,
standing up, etc. Acquired behavior, however, should never
become ritualistic. Frequent changes of the movement se
quence or the musical tempo are indicated.
Complex Level
7. After two years of therapy in a university music therapy
clinic, one lo-year-old
boy started to respond to mood im
provisations
on the piano, contrasting
happy (leaping,
rhythmic accentuated patterns) and sad (slow progressions of
tone clusters). He imitated the pattern on the piano, adding
a smiling face and swaying trunk movements for happy, and
laid his head down on the keys during the sad tone clus
ters. Pictures with facial expressions and flash cards can be
used as additional cues during these mood improvisations.
8. The child might be introduced to a group situation if the

setting of the therapy program provides the physical condi


tions for it. The main goals in a group of autistic children are
to establish (a) tolerance level for the presence of or the phys
ical contact with other peers, and (b) a growing distinction
between self and other group members. Movement and dance
experiences or action songs in circles emphasize and clarify
group concepts. Physical contact such as holding hands or
facing each other frequently
provides the experience
of
another persons presence. A one-to-one
client/staff
ratio
might be necessary in the beginning.
9. Orff methods can be successfully used for advanced
group participation.
Dance songs or instrumental pieces with
Orff instruments combine movement, singing, body percus
sion, and instrument playing. Pentatonic scales and ostinato
patterns provide a structured musical framework. The rondo
form can foster social learning by emphasizing the contrast
between self (solo) and others (tutti). Imitations of stereo
typed or ritualistic behavior in rondo form can help to tern
porarily decrease this behavior.
Impaired

Development

of Cognitive

and Other Areas

Etiology and Diagnostic Criteria


Cognitive deficits are viewed as results of some organic
brain dysfunction which cause perceptual problems on dif
ferent levels (Rutter, 1978a). Demonstrable
deficits include
memory functioning,
motor and perceptual integration, and

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will often elicit hand flapping, finger flicking, or almost hyp


notic staring at the spinning object. In a therapeutically
struc
tured situation, however, instruments can serve as interme
diary objects between
client and therapist,
providing
a
potential point for mutual contact, enjoyment without grasp
of abstract concepts, and satisfaction of a need for self
expression.
2. In addition to step 1, listening experiences (e.g., piano
improvisation) can be provided. Additional tactile and visual
experience
helps to establish awareness of sound and of
another person doing something in proximity to the child.
3. After a period of getting to know each other or becom
ing aware of each other, physical contact should be gradually
offered through, for example, (a) moving to music and hold
ing the childs hands, or (b) leading the childs hands to a
particular instrument.
4. Eventually step 3 should be extended by the therapists
becoming a more leading part of an activity. Hands might be
used in a more directive manner, Ieading the childs hands
on the keyboard, in clap-slap activities, et;. The therapist can
also try to match or imitate vocal sounds of the child. This
might lead to some interesting pre-verbal conversations.

some social features (Churchill, 1978). Nature and boundaries


of cognitive deficits are not yet fully discovered. In early clin
ical observations autistic children often were suspected of
possessing high intelligence which was only masked by autis
tic symptoms (Kanner, 1943).

. . . the selection and exploratory


use of an in
strument should be structured from the very be
ginning to minimize
motility rituals or sensory
overload.
Investigations in intellectual functioning of autistic children
now usually agree that their IQ-distribution
functions in the
same way as in any other group of the population (Rotter,
1978a). Mental retardation and autism can clearly coexist as
well as autism and higher intellectual
functioning.
Assess
ments of cognitive abilities try to demonstrate
the impor
tance of showing not only what autistic children can do but
also how much they can learn to do. Specific cognitive def
icits seem to become essential features in autism (Wing, 1978).
In order to be a valid diagnostic criterion, the cognitive dys
functioning
must be out of keeping with the autistic childs
mental age (Rutter, Schaffer, & Sheperd, 1975).
Impairment in verbal understanding,
abstraction, sequenc
ing, temporal information,
and decoding and encoding in
formation in auditory and visual modes is most often en
countered as a symptomatic
feature. Autistic children also
make only impaired use of symbols in play, organization, rule

Treatment

Model

for Autistic

Children

retrieval and evoked internal representations


in memory, and
gestures.
Gestalt-perception
and -recall of information apparently
function better than analytical (sequential) perception
and
recall of information in both visual and auditory modes (Her
melin & OConnor, 1970; Ritvo & Provence, 1953).

Music Therapy Techniques

Etiology and Diagnostic Criteria


Perceptual and motor functioning are both components of
the sensori-motor
development
of children. A discussion of
the nature and importance of perceptual-motor
or sensori
motor function, its development,
and related theories goes
far beyond the scope of this paper. The interested reader
might be referred to the writings of Bruner (1968). Cratty
(1973). Flavell (1963), or Piaget (1965).
In autistic children one sees both developmental
delays
and constant manifestations of pathological
behavior in the
perceptual-motor
area, the latter often described as inability
to adequately modulate sensory input (Ornitz, 1970) and mo
tor output (Ornitz, 1974). Ornitz (1974) suggested a relation
ship between motor behavior and the faulty processing of
sensory input as a linking symptom between perceptual and
motor disturbances.
Ornitz and Ritvo (1976) not only view perceptual distur
bances as primary but as underlying all other autistic symp
toms. They put forward the notion of a central perceptual
disturbance in terms of some brain pathology. Neurophys
iological explanations center around the theory of perceptual
inconstancy (imbalance between neurophysiological
state of
excitation and inhibition), extended to the theory of sensori
motor inconstancy. Research focuses on the vestibular reac
tivity in the brain stem (Ornitz, 1970, 1974; Ornitz & Ritvo,
1966) and the operation of homeostatic brain stem reflexes
(MacCulloch
& Williams, 1971; Piggot, Ax, Bamford, & Fetz
ner, 1973). LeLord, Laffont, Jusseaume, and Stephant (1973)
have suggested defective interactions
of sensory receptive
pathways in the brain.
Most frequently encountered
characteristics of perceptual
disturbances include dependence on motor feedback to make
sense out of perception;
tactile and kinesthetic
receptor
preference (Schopler, 1965); hypo and hyper-sensitivity
to
sensory input (staring, catatonic-like
arresting, visual and
tactile detail scrutiny, covering ears, behaving as if deaf, over
reaction to sounds); failure to imitate behavior; preoccupa
tion with isolated sensory impressions; avoidance of new sen
sory experience; lack of cross-modal associations in different
sensory modalities; and stimulus overselectivity
(distorted
perception
of complex stimulus with several components)
(Ornitz & Ritvo, 1976).
Motor disturbances were not originally included in diag
nostic lists. They were often viewed as part of the criterion
maintenance
of sameness. Kanner (1943) had even empha
sized good motor skills in autistic children. Poor motor de
velopment is usually understood as part of the distorted per
ception of ego boundaries, resulting in poor body image and
disturbed motor functions. A disturbance in Central Nervous
System (CNS) functioning
is suggested (Ornitz & Ritvo, 1976)
in respect to motility disturbances since they are likely not
to be affected by environmental
factors such as presence of
persons or objects. Looking at a spinning top or cymbal fre
quently
elicits
patterns
of motility
disturbances.
A

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Music therapy experiences function as mediators and facil


itators of cognitive concepts. The following conceptual areas
were used in this project as teaching items on intermediate
and complex session levels.
1. Labeling concepts. Following directions of one or more
steps and identifying
musical objects by (a) pointing at, (b)
playing, (c) recognizing different sound, (d) recognizing
dif
ferent shape,(e) recognizing name of instrument.
2. Number concepts. How many, Give me one/
two . . ., add and subtract numbers by building scales with
resonator begs, chimes, etc.
3. Color concepts. Using instruments with different colors.
Using a set of keys or bars with different colors. Using colored
graphic notations.
4. Auditory memory. Imitation of single tones up to longer
tone sequences. Playing a sound (from tape or live) and let
ting the child find the instrument to which that sound be
longs.
5. Auditory-motor
memory. The therapist teacher (by visu
ally and verbally modeling) different chants with various body
percussion accompaniment.
The therapist then recites only
the chant and requests the child to perform the appropriate
body motions along with the chant. Thus, the child has to
remember the words of the chant (though not produce them)
and the correct body motions.
6. Matching skills.(Also applicable for color concepts, form
perception, language training.) Matching colors, shapes, names
of musical objects with word cards, picture cards, hand signs,
verbal responses. Activities are intended to work on audito
ry/visual perception and motor and verbal expression.
7. Form perception. Ordering and completing of tone scales
consisting of bars, bells, etc. in different sizer. Building geo
metric constructions with drums or chime bars.
8. Decoding and encoding symbols. Applying graphic no
tations using colors and geometrical shapes.
9. Integration of music in the learning environment. Learning
action words or spatial concepts as parts of songs (also of
dance/movement),
e.g., jump, walk or up, down. Alter
nation of instructional learning and music listening during a
learning task to achieve and maintain heightened perceptual
procession and attention (Litchman, 1977). Alternation of time
units with instructional
learning and musical play (Graham,
1976).
The last two techniques were not used in this project, but
both references show data in support of an improved learn
ing environment.

Perceptual and Motor Disturbances

12

Music Therapy Perspectives (1984), Vol. 1, No. 4

neurophysiological
relationship between faulty perception of
sensory input and occurence of motility patterns is suggested
by Ornitz and Ritvo (1976).
Most frequently encountered
characteristics of motor dis
turbances are no functional use of hands; delayed gross and
fine motor development;
poor body awareness/image;
poor
laterality; poor perceptual-motor
integration; self injury; mo
tility disturbances
(self spinning and object spinning, toe
walking, head banging, body rocking, hand flapping, finger
flicking).
Music Therapy

Techniques
and
sen

Basic level
1. The autistic child can learn to relate tactile, visual, and
auditory stimuli through manual exploration
of instruments.
The appropriate
use of hands and fingers can be encouraged
and practiced with this activity.
2. In the beginning of therapy, it is often necessary to break
stereotyped
motility patterns. Rhythmic activities with snare
drums, cymbals, claves, etc. at tempos other than the tempo
of body rocking may aid this goal.
3. Movement
in physical contact with the therapist should
already begin at a basic level to prepare the child for specific
developmentally
oriented motor interventions.
The music
therapist should at this point become familiar with the de
velopmental
sequences
of fundamental
motor patterns.
Movement
to music also aids the integration
of tactile/kin
esthetic and auditory perception
and the differentiation
of
self/nonself. Exercises to improve the body resistance of the
child might be incorporated
here, by positioning
the child
on the floor or against the wall and rhythmically
exerting
pressure on arms or knees.
Intermediate

Level

4. On this level imitation exercises should begin which work


on more refined body awareness such as stretching, extend
ing arms or legs, stepping back and forward, moving arms up
and down, crossing the body at mid-line by hitting each oth
ers lummi sticks crosslaterally, or imitating crosslaterally by
perhaps placing different instruments in right and left hand
and playing together the instrument in the left hand, then
the instrument in the right hand. Therapist and client should
be seated facing each other during these activities. In the
beginning the child might have difficulty imitating crosslater
ally. A frequent observation in this project was that when the
therapist extended his left arm sideways and started to shake,
for example, a maraca, the child started shaking his maraca
with the left hand as well but tried to bring his arm over to
the right side to mirror the therapists arm. Physical cuing
might be appropriate
at this point to give the child a feeling
for the desired movement.

Movement to music also aids the integration of


tactile/kinesthetic
and auditory perception and
the differentiation of self/nonself.
6. If basic perceptual awareness has been established, that
is, the child does not strike instruments erratically or use them
for stereotyped
motility patterns, playing instruments can be
used to work on the development
of gross and fine motor
skills. Visuo-motor
exercises might be incorporated
by plac
ing resonator bells in different spacings apart from each other
on a table and having the child strike the bells simultaneously
or sequentially
with the respective hand. Functional use of
fingers can be practiced by playing with mallets, plucking
strings, or playing keyboard.
Complex Level

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All techniques are intended to work on (a) perceptual


motor development,
and (b) the integration of different
sory experiences and appropriate
motor responses.

5. After the imitative responses are shaped through the


previous step, developmentally
based imitation
exercises
should take place using uni-, bi-, ipsi-, and crosslateral limb
movements.

7. Percussion playing was very useful during this project to


work on any type of limb coordination
or motor sequencing
problem involving, for example, different laterality patterns
or right/left
awareness. Action songs can incorporate
learn
ing of body parts or can help to practice spatial concepts.
Rhythmic/musical
accompaniment
was widely used to work
on fundamental
motor patterns such as hopping, skipping,
walking, heel-toe balancing, or general strengthening
and
gymnastic-type
exercises.
8. On a more mature level the child can acquire command
over concepts of pitch, loudness, and tempo by responding
with the desired quality on percussion-type
or Orff instru
ments. A perceptual learning sequence would start with each
concept separately and eventually combine, for example, soft
and fast or loud and slow playing. Different combinations
of
cues might be used, comprising auditory verbal, auditory mu
sical, and visual modes. A sole reliance on the auditory mu
sical cue would show the most matured perceptual ability.
Conclusions

The treatment model presented has divided the complex


ity of a therapeutic
situation into separate areas and has de
velopmentally
sequenced steps although the reality of ther
apy often yields a much more interwoven and interconnected
picture. The model approach has been chosen for method
ological reasons, however, because music therapists have to
be able to justify and explain their treatment steps for every
level and stage of the childs pathology as well as the overall
therapeutic development
according to the clients diagnostic
background and the particular pathological characteristics in
volved. Therefore, it has been attempted in this model to tie
aspects of the etiology/diagnostic
characteristics,
character
istics of music as a therapeutic
medium, and appropriate
mu
sic therapy techniques together in a systematic fashion.

Treatment

Model

for Autistic

Children

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