A Review of Music Therapy, Art Therapy and Daily Life Therapy

1
A Review of Music Therapy, Art Therapy and Daily
Life Therapy

• Alex Mellor

2
Sources and information

• PsycINFO music therapy and autism, art
  therapy and autism, daily life therapy, and
  Higashi.
• Youtube videos found by searching music
  therapy, Nordoff-Robbins, art therapy, and
  Higashi.
• Emails to the American Music Therapy Associate
  (AMTA) resulted in a bibliography of
  evidence-based studies.

3
What is music therapy?

• well-established allied health profession that
  uses music therapeutically to address behavioral,
  social, psychological, communicative, physical,
  sensory-motor, and/or cognitive functioning.
• www.musictherapy.org
• Teaching a skill/goal through music, presented
  through song or rhythmic cue. Gradually fading
  the cue over time.
• National Standards Project
• 
  

4
What is music therapy?

• Difficult to define music therapy
• All participants exposed to music in some form.
• Kaplan (2005)
• 41 - language and communication
• 39 - behavior and psychosocial goals
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

5
History of music therapy

• 1944 Michigan State University
• American Music Therapy Associate (AMTA) founded
  in 1998 after a merger between the National
  Associate for Music Therapy (NAMT, 1950) and the
  American Associate for Music Therapy (AAMT,
  1971).

6
What does music therapy claim to do?

• Music therapy interventions can be used to
• promote wellness
• manage stress
• alleviate pain
• express feelings
• enhance memory
• improve communication
• promote physical rehabilitation
• 
  www.musictherapy.org

7
What does music therapy claim to do?
? ? ? ?

• Address the characteristics of autism
• Motivate and engage children with ASD
• Enable people without language to communicate
• Develop and express emotions
• Provide multi-sensory stimulation
• Structure and security
• Emphasize innate musical talents

8
Jammin Jenn!

• http//www.jamminjenn.com/JJMTC/Welcome.html
• What do you think?
• http//www.youtube.com/watch?vOFLJJlOCVsw
• http//www.facebook.com/group.php?gid200118661850
  refts

9
What they say

• Association for Science in Autism Treatment
  (ASAT)
• preliminary evidence suggests that music therapy
  could be effective in enhancing functioning
  (Kaplan, Steele, 2005 Whipple, 2004), but this
  approach has not been evaluated in studies with
  strong experimental designs.
• www.asatonline.org/intervention/treatm
  ents/music.htm

10
What they say

• ASAT
• researchers may wish to conduct studies with
  strong scientific designs to evaluate music
  therapy. Professionals should present music
  therapy as untested and encourage families who
  are considering this intervention to evaluate it
  carefully.
• www.asatonline.org/intervention/treatm
  ents/music.htm

11
What they say

• National Autism Centers National Standards
  Project
• Emerging treatments further research may
  produce favorable results, but more research
  needed to ensure not harmful treatment.

12
Experimental control?

• Varied independent variable only common aspect
  is that music is involved.
• No dependent variable
• Difficult to demonstrate experimental control

13
Evidence-based?

• Edgerton (1994)
• Parents reported behavior change, speech
  therapists did not.
• Evaluators not blind.
• Buday (1995)
• 10 children learned to vocalize and sign words
  better when put to music compared to when just
  read out loud.
• 21 studies
• 14 peer reviewed
• 11 successful
• 9 improvements related to music
• http//www.musictherapy.org/factsheets/bib_autism.
  pdf
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child works! Lynden, WA SKF Books USA,
  Inc.

14

• Lim, H. A. (2010). Effect of developmental
  speech and language training through music on
  speech production in children with autism
  spectrum disorders. Journal of Music Therapy,
  XLVII, (1), 2-26.
• Compared music training, speech training and
  no-training.
• 50 children, 3-5 years old, diagnosis of ASD.
• 36 target words
• Music (DSLM) 6 songs, each with 6 target words
• Speech 6 stories, each with 6 target words
• Both conditions used PECs symbols.

15

• Lim, H. A. (2010). Effect of developmental
  speech and language training through music on
  speech production in children with autism
  spectrum disorders. Journal of Music Therapy,
  XLVII, (1), 2-26.
• Correct verbal response defined as semantics
  (correct target word), phonology (correct
  pronunciation), pragmatics (relationship between
  language and behavior), and prosody (intonation).
• Verbal production evaluation scale
• Speech therapists coded data 0-6 points.
• IOA 99.9

16

• Lim, H. A. (2010). Effect of developmental
  speech and language training through music on
  speech production in children with autism
  spectrum disorders. Journal of Music Therapy,
  XLVII, (1), 2-26.
• low functioning greater changes in the music
  condition.
• high functioning positive change in music and
  speech conditions.
• Defined according to the CARS

17

• Lim, H. A. (2010). Effect of developmental
  speech and language training through music on
  speech production in children with autism
  spectrum disorders. Journal of Music Therapy,
  XLVII, (1), 2-26.
• music and speech training are effective for
  enhancing speech production
• the difference between music and speech
  training is not statistically significant

18

• Lim, H. A. (2010). Effect of developmental
  speech and language training through music on
  speech production in children with autism
  spectrum disorders. Journal of Music Therapy,
  XLVII, (1), 2-26.
• Limitations
• Validity of VPES
• Sample size
• Use of PECs
• Definition of correct
• Do not experimentally show relationship between
  IV and DV.

19
Music as a reinforcer

• Watson (1979)
• Used music as a reinforcer to increase
  spontaneous speech
• Nordoff-Robbin
• http//www.youtube.com/watch?v_CuAjiU7RBg
• http//www.youtube.com/watch?vXpr2hC0OcdQ
• music lessons for autistic individuals provide a
  way for them to make friends and get involved in
  the community. Above all, you need to remember
  that music can be plain old fun. (p.194).
• Shore, S. M., and Rastelli, L. G. (2006).
  Understanding Autism for Dummies. Wiley
  Publications, Inc. Hoboken, NJ.

20
Is music therapy an effective autism intervention?

• What is the purpose?
• Treat characteristics of autism?
• Teach functional skills?
• Decrease undesirable behaviors?
• Provide a service that the child enjoys and finds
  fun?

21
What is art therapy?

• a psychological discipline that specializes in
  using visual art making and the creative process
  to help clients bring about therapeutic change
• Six major ASD treatment goals
• Imagination/abstract thinking deficits
• Sensory regulation and integration
• Emotions/self-expression
• Developmental growth
• Recreation/leisure skills
• Visual-spatial deficits
• www. arttherapyandautism.com

22
History of art therapy

• Emerged as a distinct profession 1940s
• Early 20th century psychiatrists became
  interested in artwork created by patients with
  mental illness.
• Educators found that art expressions are
  reflected
• http//www.musictherapy.org/factsheets/bib_aut
  ism.pdf

23
What art therapy can do!

• Single-case research supporting art therapy to
  help
• ADD/ADHD/Aspergers
• Aging/Elderly/Geriatric
• Chemical dependency/Substance abuse
• Grief/bereavement
• Medical
• Mentally retarded/Developmentally delayed
• PTSD/Trauma
• Prison/Incarceration
• Psychiatric
• School/Academic
• Sexual Abuse
• Traumatic Brain Injury http//www.musictherapy.or
  g/factsheets/bib_autism.pdf

24
Nicole Martin

• Webmaster of www.arttherapyandautism.com
• Author Art as an Early Intervention Tool for
  Children with Autism.
• Discusses prompting hierarchy
• Using behaviorism to manage difficult
  behaviors.
• Incorrectly defines autism on her webpage and
  in the book.
• http//www.youtube.com/watch?vUbrvF7zUk8Mfeature
  related

25
What they say

• ASAT
• there have been no scientific studies of art
  therapy for individuals with ASD
• researchers may wish to conduct studies with
  strong scientific designs to evaluate art
  therapy. Professionals should present art therapy
  as untested and encourage families who are
  considering this intervention to evaluate it
  carefully

26
What they say

• the cost of autism, as well as the
  characteristics of the disorder, may by reduced
  2/3 with early diagnosis and appropriate
  interventions such as art therapy
• ? www.art-therapy.us/autism/htm

27
What they say

• Art therapy based on Freudian philosophy people
  with autism need to develop their ego.
• Help to organize their sensory world
• Art used to reach the child
• Similar to sensory integration therapy
• No defined treatment protocol
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

28
Evidence-based?

• Kearns, S. D. (2004). Art therapy with a child
  experiencing sensory integration difficulty. Art
  Therapy Journal of the American Art Therapy
  Association, 21 (2), 95-101.
• Case study (disguised as single-case design!)
• Teacher assessed behavior on a positive or
  negative scale, compared to the control group.
• Reported an increase in positive behaviors
  after the art therapy.
• Concluded that art therapy was a useful
  intervention
• http//www.americanarttherapyassociation.org/uploa
  d/OutcomeSingSubjectStudies2007.pdf

29
Evidence-based?

• Smitheman-Brown, V. R., and Church, R. P. (1994).
  Mandala drawing Facilitating creative growth in
  children with ADD or ADHD. Art Therapy Journal
  of the American Art Therapy Association, 13 (4),
  252-262.
• Multiple baseline design
• ongoing behavioral data were charted through
  direct observation
• Independent observers
• Objective
• Reported an increase in creative growth.
• http//www.americanarttherapyassociation.org/uploa
  d/OutcomeSingSubjectStudies2007.pdf

30
Empirically supported?

• Banks, S., Davis, P., Howard, V. F., and
  McLaughlin, T. F. (1993). The effects of directed
  art activities on the behavior of young children
  with disabilities A multi-element baseline
  study. Art Therapy Journal of the American Art
  Therapy Association, 10 (4), 235-240.
• Studied effects of art on behavior
• Multielement baseline across participants
• Target behaviors aggression, eye contract,
  social initiation.
• Data baseline and during intervention, 5 mins
  and 30 mins after art lesson.
• both experimental and control art activities
  resulted in therapeutic improvement in social
  behaviors, across individuals
• One participant showed no improvement.
• http//www.americanarttherapyassociation.org/uploa
  d/OutcomeSingSubjectStudies2007.pdf

31
Is art therapy an effective autism intervention?

• Based on the scientific research to date, there
  is no evidence to conclude that Art Therapy is an
  effective treatment for improving symptoms
  characteristics of autism (p. 253)
• Art is a fun activity, that can be a reinforcer
  for children with autism there is no evidence
  to suggest that it is an intervention
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

32
Music and Art

• Reach the child what is the operational
  definition of reach?

33
Daily Life Therapy/Higashi

• Our Mission is to help children and young adults
  with Autism Spectrum Disorder learn to reach
  their full potential through the application of
  the methodology of Daily Life Therapy. This
  unique educational philosophy, developed by the
  late Dr. Kiyo Kitahara of Tokyo, Japan
  incorporates a broad and balanced curriculum
  including academics, art, music, physical
  education, computer technology and social
  education. Students take on challenges, learn to
  overcome obstacles and gain confidence from their
  own success. This process allows our students to
  develop a love for learning so they may fully
  enjoy their family, community, and all that life
  has to offer. As each student grows and learns,
  their personality and individual character
  matures allowing them to benefit from and most
  importantly contribute to society as adults.
• 
  http//www.bostonhigashi.org/about.php
  ?id1

34
What is Daily Life Therapy?

• Educational approach based on three principles
• foster the development of human dignity and
  self-esteem in the growing child and allow him or
  her to contribute to and benefit from society
• education should by conducted in an environment
  of normality
• http//www.bostonhigashi.org/about.php?id7

35
Three pillars of DLT

• Create a predictable environment to help
  stabilize emotions so the child can the master
  skills for independence, subsequently making them
  feel accomplished and proud
• Establish a rhythm of life and physical health
  and well-being through exercise
• Broad, age-appropriate, individualized curriculum
  to stimulate intellectual and cognitive growth.
• http//www.bostonhigashi.org/about.php?id7

36
Quill (1989)

• 5 principles that underlie the therapy
• Physical therapy
• Art-based curriculum
• Group instruction
• Learning through imitation
• Highly structured routines
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

37
What does DLT claim to do?

• Help children
• Form bonds
• Relate to others
• Communicate
• Control their anxieties
• http//www.bostonhigashi.org/about.php?id7

38
History of Daily Life Therapy

• Created by Dr. Kiyo Kitahara in 1964, introduced
  to the USA in 1987.
• Kindergarten teacher, worked with one child with
  autism.
• Based on vigorous physical activity and fine arts
• No certified practioners
• Mirrors Japanese philosophy
• Group interaction rather than 11
• Theory that children learn when exposed to
  interaction
• Shore, S. M., and Rastelli, L. G. (2006).
  Understand Autism for Dummies. Wiley Publication,
  Inc Hoboken, NJ.

39
Boston Higashi School

• http//www.youtube.com/watch?vuGcyF_XE7ksfeature
  related
• http//www.youtube.com/watch?vshjiPeg26NMfeature
  related
• http//www.youtube.com/watch?vshjiPeg26NMfeature
  related

40
Boston Higashi School

• Randolph, MA
• Opened in 1987
• Higashi means east
• Day program runs 217 days a year, residential
  program is 304 days.
• Two 2 week vacations in Winter and Spring, 4
  weeks in the summer.
• 3-22 years old
• Diagnosis of Autism, Autistic-like, Asperger
  Disorder, PDD, PDD-NOS
• 31 student teacher ratio
• http//www.bostonhigashi.org/about.php?id7

41
Physical conditioning

• Regular and rigorous exercise
• Jogging/unicycle/stilts
• Reduce stimming and aggression
• Increase sleeping habits
• No data!

42
Emotional regulation

• mastery of self care skills is believed to help
  with the development of self-esteem and
  contributes to emotional stability, which is
  important in getting along with others and
  yourself. (p. 156)
• Shore, S. M., and Rastelli, L. G. (2006).
  Understand Autism for Dummies. Wiley Publication,
  Inc Hoboken, NJ.

43
Academics

• as much as possible instructors at the school
  strive to teach their students as close to grade
  level as possible (p. 156)
• Shore, S. M., and Rastelli, L. G. (2006).
  Understand Autism for Dummies. Wiley
  Publication, Inc Hoboken, NJ.

44
Medication

• The fundamental mission of the Boston Higashi
  School is to provide education. Daily Life
  Therapy does not rely on medications, vitamins or
  other chemical substances in the treatment of
  children with autism. Dr. Kitaharas philosophy
  is that the child need to over its disability by
  its own strength
• http//www.bostonhigashi.org/about.php?id7

45
Strike a pose?

• DLT is also not a behavior modification
  approach. We utilize basic body postures
  throughout the day to encourage children to
  increase their self control.
• http//www.bostonhigashi.org/about.php?id7

46
What they say

• Based on the research to date, very little can
  be concluded about the efficacy of Daily Life
  Therapy (p. 116)
• If the Higashi school is to be considered a
  legitimate educational option for children with
  autism, I would need to see strong data from a
  study which has, at minimum, a hypothesis stating
  that those children who participate in the
  Higashi School over the period of a year are
  expected to show a decrease in the symptoms
  associated with autism. (p. 116)
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

47
What they say

• If the children in the Higashi School fair
  better than the children in the public school
  system, then we would know that the Higashi
  School is indeed a viable alternative to the
  public educational system for children with
  autism. The next step would be doe the Higashi
  School to test its intervention model against the
  other specialty school programs and home-based
  intensive behavioral intervention models designed
  for children with autism (p. 117)
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

48
What they say

• If you would like to enroll your child, I would
  suggest you consider the fact that due to the
  lack of data showing that this method is
  effective, you may want to augment your childs
  treatment with a well-settled treatment program
  so that your child will progress at least when
  not in school (p. 118)
• based on the scientific research to date, there
  is insufficient evidence that Daily Life Therapy
  has an effective curriculum for decreasing the
  symptoms associated with the condition of autism
  in children (p. 118)
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.

49
What they say

• ASAT
• No information about Daily Life Therapy/Higashi
• National Autism Centers National Standards
  Project
• No information about Daily Life Therapy/Higashi

50
What they say

• National Autistic Society (U.K)
• The goal of this educational approach is for the
  children to develop as closely to normal
  physically, emotionally, intellectually and to
  achieve social independence and dignity.
• This web-page has been written to provide
  information on a particular intervention/approach
  and any research connected with it, not as a
  recommendation. This outcome of any approach will
  depend on the needs of the individual, which vary
  greatly, and the appropriate application of the
  intervention
• http//www.autism.org.uk/living-with-autism/approa
  ches-therapies-and-interventions/service-based-int
  erventions/daily-life-therapy-higashi.aspx

51
Hope for the Shadow Children

• London Sunday Times Magazine March 1988
• severe autism affects 5 in 10,000 children
• In 1988, one year at Higashi cost 47,000
• Dr Kitahara
• Autistic children are like wild horses the
  parents dont know how to control
• when her students return home they will
  inevitably slip back into their odd behaviors.
  But years of training will eventually win
• http//www.maryellenmark.com/text.magazines/london
  _sunday_times/904G-000-010.html

52
Hope for the Shadow Children

• Prompting
• behind each chain of marching children a teacher
  is crouched, physically manipulating those
  children who remain remote from the razamatazz
• the majority do make they journey across the
  stage on their own and the rest either carry
  their Hoppas or sit looking remote but happy
  until their instructors hand guides them ahead
• The use of helpers as physical prompts is
  integral to the Kitahara system. It may take
  months, even years before the child will raise
  his arm for himself, but, eventually, he will
• http//www.maryellenmark.com/text.magazines/london
  _sunday_times/904G-000-010.html

53
Hope for the Shadow Children

• Reaching the children
• In the classroom there is an air of urgency,
  only the teachers voice and the strength of his
  gaze stop the children slipping back into the
  remote darkness of their own words
• Gershan, a 14-year old becomes excited and
  shouts moon, moon over and over again. His
  neighbor deliberately breaks his pencil and stabs
  the point into his own palm. The girl behind
  rocks and examines her fingers. Stephen sits with
  an empty, angelic smile on his face
• http//www.maryellenmark.com/text.magazines/london
  _sunday_times/904G-000-010.html

54

• Larkin, A. S., and Gurry, S. (1998). Brief
  report Progress reported in three children with
  autism using daily life therapy. Journal of
  Autism and Developmental Disorders, 28 (4).
  339-342.
• Do students with autism make progress using
  Daily Life Therapy, and in what areas?
• 6 students in 1987-88, when returned in 1990,
  followed up with 3.
• Attending behavior when child is demonstrating
  appropriate classroom behavior and/or watching
  the teachers and/or the task and/or other
  students when no specific response is requires of
  the student.

55

• Larkin, A. S., and Gurry, S. (1998). Brief
  report Progress reported in three children with
  autism using daily life therapy. Journal of
  Autism and Developmental Disorders, 28 (4).
  339-342.
• Inappropriate responses when child is not on
  task, not performing desired response and is
  making any inappropriate vocalizations or
  actions
• Appropriate responses when child is
  demonstrating appropriate classroom behavior and
  specific situational responses required of
  students

56

• Larkin, A. S., and Gurry, S. (1998). Brief
  report Progress reported in three children with
  autism using daily life therapy. Journal of
  Autism and Developmental Disorders, 28 (4).
  339-342.
• Attending behavior substantial increase
  between 1988 and 1990
• Inappropriate responses substantial
  decreaseduring data collection period
• Appropriate responses either they made no
  progress in this area, or at least one student
  appeared to lose skills that he had prior to
  enrolling at this school

57

• Larkin, A. S., and Gurry, S. (1998). Brief
  report Progress reported in three children with
  autism using daily life therapy. Journal of
  Autism and Developmental Disorders, 28 (4).
  339-342.
• Children attending more, and showing more
  appropriate behavior, but are not gaining any
  academic, social or communication skills.
• When making a decision about where to education
  children with autism, parents and professionals
  in the US and internationally deserve the most
  complete and honest data. Only then can parents
  make well-informed decisions about the best
  educational program for their child.

58
Generalization?
59
DLT vs ABA?

• Daily Life Therapy is not just a set of
  protocols to reduce symptoms but takes as its
  mission and responsibility the task of developing
  and educating the entire child
• specialized services for students to meet
  deficits in various developmental domains are
  integrated and addressed throughout the entire
  day rather than offered on a 11 basis
• The goal is not remediation of deficits but new
  learning appropriate to developmental level. The
  teaching style and the subject matter address
  these area in functional meaningful contexts
  rather than as exercises to be practiced
• http//www.bostonhigashi.org/about.php?id7

60
Is Daily Life Therapy and effective autism
intervention?

• There is no empirical evidence!
• Why is there only one school in the whole of the
  USA?

61
Any questions?

• Thank you ?

62
References

• Banks, S., Davis, P., Howard, V. F., and
  McLaughlin, T. F. (1993). The effects of directed
  art activities on the behavior of young children
  with disabilities A multi-element baseline
  study. Art Therapy Journal of the American Art
  Therapy Association, 10 (4), 235-240.
• Freeman, S. K. (2007). The Complete Guide to
  Autism Treatments. A parents handbook make sure
  your child gets what works! Lynden, WA SKF Books
  USA, Inc.
• Larkin, A. S., and Gurry, S. (1998). Brief
  report Progress reported in three children with
  autism using daily life therapy. Journal of
  Autism and Developmental Disorders, 28 (4).
  339-342.
• Lim, H. A. (2010). Effect of developmental
  speech and language training through music on
  speech production in children with autism
  spectrum disorders. Journal of Music Therapy,
  XLVII, (1), 2-26.
• London Sunday Times Magazine. (1988). Hope for
  the Shadow Children. http//www.maryellenmark.com/
  text/magazines/london_sunday_times/904G-000-010.ht
  ml
• Kearns, S. D. (2004). Art therapy with a child
  experiencing sensory integration difficulty. Art
  Therapy Journal of the American Art Therapy
  Association, 21 (2), 95-
• Shore, S. M., and Rastelli, L. G. (2006).
  Understand Autism for Dummies. Wiley Publication,
  Inc Hoboken, NJ
• Smitheman-Brown, V. R., and Church, R. P. (1994).
  Mandala drawing Facilitating creative growth in
  children with ADD or ADHD. Art Therapy Journal
  of the American Art Therapy Association, 13 (4),
  252-262.

63

• http//www.americanarttherapyassociation.org/uplo
  ad/OutcomeSingSubjectStudies2007.pdf
• http//www.art-therapy.us/autism.htm
• www.arttherapyandautism.com
• www.asatonline.org/intervention/treatments/music.h
  tm
• www.autism.org.uk/living-with-autism/approaches-th
  erapies-and-interventions/service-based-interventi
  ons/daily-life-therapy-higashi.aspx
• http//www.bostonhigashi.org/about.php?id1
• http//www.bostonhigashi.org/about.php?id7
• http//www.bostonhigashi.org/gallery.php?pageNum_R
  Sphoto11totalRows_RSphoto14pageNum_RSalbum0y
  ear2009id34
• http//www.facebook.com/group.php?gid200118661850
  refts
• http//www.jamminjenn.com/JJMTC/Welcome.html
• http//www.musictherapy.orghttp//
• http//www.youtube.com/watch?vUbrvF7zUk8Mfeature
  related
• http//www.youtube.com/watch?vuGcyF_XE7ksfeature
  related
• http//www.youtube.com/watch?vshjiPeg26NMfeature
  related
• http//www.youtube.com/watch?vshjiPeg26NMfeature
  related
• http//www.youtube.com/watch?vXpr2hC0OcdQ
• http//www.musictherapy.org/factsheets/bib_autism.
  pdf