Socio-Emotional and Psychological Outcomes: Music Therapy for Individuals with Autism Spectrum Disorders

Tyler Sabourin

Autism Spectrum Disorders (ASDs) are a collection of multisystem neurological disorders characterized by difficulty in the realms of social functioning, such as eye contact (Dawson et al., 2004; Mundy & Crowson, 1997), verbal communication (Tager-Flusberg, 1999), and emotional reciprocity (Mundy & Crowson, 1997). It is believed that these difficulties are caused by deficits in multi-modal integration as a result of short-range over-connectivity and long-range under-connectivity between different brain regions, meaning that while each area of the brain has a wealth of strong internal connections, there is a lack of connection between these areas (Belmonte et al., 2004; Courchesne et al., 2007; Minshew & Williams, 2007). Individuals with ASD also present with difficulties in physical functioning, such as repetitive (stereotyped) behaviors (Bodfish, Symons, Parker, & Lewis, 2000; Boyd, McDonough, & Bodfish, 2012), difficulty with dual-limb and multi-limb coordination (Green et al., 2009; Fournier, Hass, Niak, Lodha, & Cauraugh, 2010), postural control (Minshew, Sung, Jones, & Furman, 2004), gait (Hallett et al., 1993; Vilensky, Damasio, & Maurer, 1981), and imitation (Dewey, Cantell, & Crawford, 2007; Mostofsky et al., 2006).
Since the first documented case of ASD, one of the defining features of the disorder is a lack of responsiveness, particularly in regards to emotion (Hobson, 1989, 1990, 1993; Kanner, 1943). For example, individuals with ASD have difficulty recognizing the emotions expressed by different facial features, a well as difficulty matching the emotional tone of a voice to a facial expression (Bormann-Kischkel, Vilsmeier, & Baude, 1995; Hobson, 1986a,b; Hobson et al., 1989; Loveland et al., 1994; MacDonald et al., 1989; Ozonoff, Pennington, & Rogers, 1990; Scott, 1985; Tantam, Monaghan, Nicholson, & Stirling, 1989). Despite difficulty in emotion recognition within the context of nonverbal communication, individuals on the autism spectrum are just as able to accurately identify simple musical emotions as their typically-developed (TD) peers (Capps, Yirmiya, & Sigman, 1992; Heaton, Hermelin, & Pring, 1999), and show an equivalent enjoyment of music (Bhatara, Quintin, Fombonne, & Levitan, 2013).
The establishment of standard interpretations of musical emotion is supported by a number of studies that have found that differences in tempo (Hevner, 1935; Gagnon & Peretz, 2003; Rigg, 1940) and mode (Dalla Bella, Peretz, Russeau, & Gosselin, 2001) are associated with different valences. The ability to discern these emotional distinctions are present in children as young as nine months of age (Flom, Gentile, & Pick, 2008), across cultural boundaries (Balkwill & Thompson, 1999; Balkwill, Thompson, & Matsunaga, 2004; Fritz et al., 2009), and even in individuals with brain lesions in the auditory cortex (Peretz, 1996; Peretz, Belleville, & Fontaine, 1997; Peretz & Gagnon, 1999; Peretz, Gagnon, & Bouchard, 1998). Because of this consistency, the responses provided by those with ASDs not only add to evidence of the universality of music’s ability to communicate specific emotions, but provide theoretical support for the use of music as a tool to practice emotional recognition within ASDs.

Music has the potential to stimulate multiple brain regions (Srinivasan & Bhat, 2013). The practice of playing music, even individually, requires the simultaneous use of the auditory, visual, somatosensory, and motor cortices (Schlaug, Altenmüller, & Thaut, 2010). Brain scans of musicians show co-activation in auditory, visual, and motor areas of the brain when performing tasks that require only one of these areas, indicating multimodal integration following musical training (Bangert et al., 2006). Such promotion of long-range connectivity could work to increase the functioning of these networks in individuals with ASD (Wan, Marchina, Norton, & Schlaug, 2012).

Bruscia (1991) defines music therapy as “an interpersonal process in which the therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients improve, restore or maintain health” (p. 5).  has the potential to facilitate the experience and communication of emotion within a supportive social environment with the therapist(s) and group members. Because of the many facets that make up musical expression, music therapy also integrates social development with both gross and fine motor skill development, all of which work to alleviate difficulties found within ASDs while harnessing musical strengths (Darrow & Armstrong, 1999; Srinivasan & Bhat, 2013). This paper seeks to examine the efficacy of such music therapies in improving the social and psychological functioning of individuals diagnosed with ASD.

Socio-Emotional Outcomes

While many with ASD suffer from difficulties in social behaviors, both individual and group music therapy interventions provide a structured, cooperative social context in which they can learn to interact more effectively, either within the context of a client-therapist relationship or with other group members (Kirschner & Tomasello, 2010; Marsh, Richardson, & Schmidt, 2009; Overy & Molnar-Szacks, 2009). This allows for the practice of social skills such as imitation, turn-taking, joint attention, shared affect, and empathy (Overy & Molnar-Szacks, 2009). Because many people with ASD can communicate their emotions more easily through music than through words, such interventions provide clients with a space for self-expression and give them a sense of being truly heard (Srinivasan & Bhat, 2013). It is in this open environment that people who struggle with sharing experiences with others are given the opportunity to express themselves without fear of rejection and to support others’ self-expression.
Such therapeutic practices have shown significant results in the behaviors and lives of clients, not only within the therapy room, but within other areas as well. For example, studies have shown that children with ASD who undergo group music therapy interventions show improved play and peer involvement (Kern & Aldridge, 2006), enhanced verbal communication (Gold, Wigram, & Elefant, 2006; Shore, 2002), increased social involvement and interaction (Wimpory, Chadwick, & Nash, 1995), engagement with others (Toolman & Coleman, 1994), and increased eye contact (Wimpory et al., 1995).
Beyond improvements in interpersonal actions, music has also been shown to increase the understanding of emotions for those with autism. In a randomized study in which autistic children were taught about happiness, sadness, anger, and fear, participants in the group that utilized appropriate background music for each emotion showed the greatest gains in understanding (Katagiri, 2009). This improvement of emotional awareness further allows those with ASDs to respond appropriately in social situations. In learning to cooperate with others, the idea of social situations may begin to change from something that was once difficult and frightening to something enjoyable. Such a change would further allow these benefits to grow, for as clients become more able to successfully interact within their session, they become further able to take advantage of the benefits provided within a cooperative, music-centered relationship.

Psychological Outcomes

Positive social relationships are strong emotional buffers, functioning to reduce the impacts of negative stressful events and increase emotional well-being (Burns & Machin, 2013; Dirkzwager et al., 2003; Haden, Scarpa, Jones, & Ollendick, 2007). As such, the effects of music therapy are . Not only can the therapy itself lead to increased self-esteem (Hillier, Greher, Poto, & Dougherty, 2012; Shore, 2002) and reduced stress (Khalfa, Dalla Bella, Roy, Peretz, & Lupien, 2003; Miluk-Kolasa, Obminski, Stupniki, & Golec, 1994; Trevarthen, 2002), but the relationships that it fosters further these outcomes. In interacting with others in an effectively communicative way, not only will individuals diagnosed with ASD gain self-esteem as a result of personal mastery, but the supportive social environment in which they gain these skills also serves to improve their overall well-being.

The multiplicity of positive effects follows also in regards to emotional regulation. Simply the act of listening to music has been shown to reduce stress and improve mood regulation (Skånland, 2013; Thoma et al., 2013). Taking into account the emotional regulation fostered by improved social relationships and listening to music, music therapy interventions have been able to improve mood regulations in clients with ASDs (Trevarthen, 2002). In doing so, music therapy interventions have been effective in decreasing the frequency and intensity of self-injurious, aggressive, and stereotyped behaviors (Brownell, 2002; Carnahan et al., 2009a,b; Clauss, 1994; Devlin, Healy, Leader, & Reed, 2008; Gunter, Fox, McEvoy, & Shores, 1993; Lanovaz, Fletcher, & Rapp, 2009; Orr, Myles, & Carlson, 1998; Pasiali, 2004).
After a successful music therapy intervention, clients will be provided a number of things. First of all, they will have had the opportunity to not only improve personal mastery, but will have been able to enact this mastery in successfully participating in shared music experiences, utilizing instruments in a way that adds to the quality of the music made. Secondly, in actively participating they will have developed a relationship with the therapist(s) and any group members they may have had, providing them with a supportive environment to engage and interact with one another through shared experiences. Then, when taking into account the numerous neurological and emotional benefits that simply listening to and creating music provides, a client will have been exposed to a treatment that not only teaches skills or improves self-esteem, but is layered with a number of unique and rich benefits that all serve to compound the efficacy of one another.

Conclusion

With all the elements of music considered, music therapy has a distinct place in the treatment of individuals with ASDs (Srinivasan & Bhat, 2013). Because of its multimodal qualities, it has the potential to improve neurological connection between brain regions (Belmont et al., 2004; Courchesne et al., 2007; Minshew & Williams, 2007; Schlaug, Altenmüller, & Thaut, 2010). Such improvements may lead to increased communication skills, which, combined with the social nature of music therapy interventions, allow for the continued practice of these skills (Marsh et al., 2009; Overy & Molnar-Szacks, 2009; Kirschner & Tomasello, 2010). In addition to increased interpersonal competency, music reduces stress and anxiety and improves emotional regulation, making interpersonal relationships easier to form and maintain (Skånland, 2013; Thoma et al., 2013; Trevarthen, 2002). These newly developed relationships then work to further stress reduction, working bi-directionally to improve the social, emotional, and psychological state of clients with ASDs.

Despite all of this research, there are no studies that have specifically examined the effect that music has on either gross or fine motor skills in ASDs. Because it is very likely that movement difficulties compound the social problems that individuals with ASD struggle with, an improvement in physical control may also lead to improvements in social and psychological domains (Srinivasan & Bhat, 2013). Music practice has the potential to serve as a great way to improve motor skills in its ability to enhance patient motivation and allow for repetitive practice of specific motor skills in an enjoyable way (Rodriguez-Fornells et al., 2012; Schneider et al., 2007). Beyond this theoretical foundation, music-based movement therapies have been shown to improve motor skills in TD populations (Bachmann, 1991; Findlay, 1971; Hurwitz, Wolff, Bortnick, & Kokas, 1975), individuals diagnosed with dyslexia (Getchell, Mackenzie, & Marmon, 2010) and those with Parkinson’s disease (Duncan & Earhart, 2012). This indicates the potential for motor-skill improvement through music-based movement therapies to be generalized even amongst those with different disorders. Further investigation into the relation between these factors could help provide a clearer guideline for how to effectively treat ASDs within the field of music therapy.

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