Cochavit Elefant

Learning ability in children with Rett syndrome

The purpose of this article is to present results of a research study examining learning ability in individuals with Rett syndrome. The material for this article was drawn from a more extensive doctoral study, designed to investigate intentional communication in this population, through the use of songs in music therapy. Rett syndrome is a neurological disorder resulting from an X-linked mutation, affecting mainly females, and found across racial and ethnic groups worldwide. One of the main areas affecting functioning in individuals with Rett syndrome is a severe impairment of receptive and expressive communication. This creates difficulties when attempting to reveal their potential learning abilities. This population has been observed as very responsive to music hence music therapy intervention has been advocated in promoting and motivating them to communicate and to learn. Seven girls with Rett syndrome, between ages 4 and 10 participated in the study. A single subject, multiple probe design was applied during 30-min trials, three times per week and lasted 8 months. During the trials the participants were asked to choose from a selection of 18 familiar and unfamiliar songs, while their ability to learn was observed and measured. Findings revealed that all seven girls demonstrated an ability to learn and to sustain learning over time. This intervention demonstrated that individuals with Rett syndrome could be promoted and motivated to communicate and learn when therapeutically employed by a trained music therapists.

Common Characteristics of Improvisational Approaches in Music Therapy for Children with Autism Spectrum Disorder: Developing Treatment Guidelines.

BACKGROUND Improvisational methods of music therapy have been increasingly applied in the treatment of individuals with autism spectrum disorder (ASD) over the past decades in many countries worldwide. OBJECTIVE This study aimed at developing treatment guidelines based on the most important common characteristics of improvisational music therapy (IMT) with children affected by ASD as applied across various countries and theoretical backgrounds. METHODS After initial development of treatment principle items, a survey among music therapy professionals in 10 countries and focus group workshops with experienced clinicians in three countries were conducted to evaluate the items and formulate revised treatment guidelines. To check usability, a treatment fidelity assessment tool was subsequently used to rate therapy excerpts. RESULTS Survey findings and feedback from the focus groups corroborated most of the initial principles for IMT in the context of children with ASD. Unique and essential principles include facilitating musical and emotional attunement, musically scaffolding the flow of interaction, and tapping into the shared history of musical interaction between child and therapist. Raters successfully used the tool to evaluate treatment adherence and competence. CONCLUSIONS Summarizing an international consensus about core principles of improvisational approaches in music therapy for children with ASD, these treatment guidelines may be applied in diverse theoretical models of music therapy. They can be used to assess treatment fidelity, and may be applied to facilitate future research, clinical practice, and training.

Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial

Importance Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. Objective To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. Design, Setting, and Participants Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. Interventions Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention. Main Outcomes and Measures The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. Results Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, −0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. Conclusions and Relevance Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. Trial Registration isrctn.org Identifier: ISRCTN78923965

Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the Autism Diagnostic Observation Schedule: A systematic review and meta-analysis

Background Exploring ways to improve the trajectory and symptoms of autism spectrum disorder is prevalent in research, but less is known about the natural prognosis of autism spectrum disorder and course of symptoms. The objective of this study was to examine the temporal stability of autism spectrum disorder and autism diagnosis, and the longitudinal trajectories of autism core symptom severity. We furthermore sought to identify possible predictors for change. Methods We searched PubMed, PsycInfo, EMBASE, Web of Science, Cochrane Library up to October 2015 for prospective cohort studies addressing the autism spectrum disorder/autism diagnostic stability, and prospective studies of intervention effects. We included people of all ages with autism spectrum disorder/autism or at risk of having autism spectrum disorder, who were diagnosed and followed up for at least 12 months using the Autism Diagnostic Observation Schedule (ADOS). Both continuous ADOS scores and dichotomous diagnostic categories were pooled in random-effects meta-analysis and meta-regression. Results Of 1443 abstracts screened, 44 were eligible of which 40 studies contained appropriate data for meta-analysis. A total of 5771 participants from 7 months of age to 16.5 years were included. Our analyses showed no change in ADOS scores across time as measured by Calibrated Severity Scores (mean difference [MD] = 0.05, 95% CI -0.26 to 0.36). We observed a minor but statistically significant change in ADOS total raw scores (MD = -1.51, 95% CI -2.70 to -0.32). There was no improvement in restricted and repetitive behaviours (standardised MD [SMD] = -0.04, 95% CI -0.19 to 0.11), but a minor improvement in social affect over time (SMD = -0.31, 95% CI -0.50 to -0.12). No changes were observed for meeting the autism spectrum disorder criteria over time (risk difference [RD] = -0.01, 95% CI -0.03 to 0.01), but a significant change for meeting autism criteria over time (RD = -0.18, 95% CI -0.29 to -0.07). On average, there was a high heterogeneity between studies (I2 range: 65.3% to 93.1%). Discussion While 18% of participants shifted from autism to autism spectrum disorder diagnosis, the overall autism spectrum disorder prevalence was unchanged. Overall autism core symptoms were remarkably stable over time across childhood indicating that intervention studies should focus on other areas, such as quality of life and adaptive functioning. However, due to high heterogeneity between studies and a number of limitations in the studies, the results need to be interpreted with caution.

The Israeli Rett Syndrome Center. Evaluation and transdisciplinary play-based assessment.

Rett syndrome (RS) is a neuro-developmental syndrome of genetic origin, which mainly affects women. Individuals diagnosed with RS exhibit a variety of functional difficulties, which impair their quality of life. The variety of impairments and the differences between each child makes it necessary to administer skilled treatment, individually tailored to each client. Since the foundation of proper treatment is based on a structured, well administered, insightful assessment, the individual with RS with her complex array of difficulties should benefit from such a procedure. This notion has led to the establishment of the Israel Rett Syndrome Center. The center includes a medical branch located at the Safra Shildrens Medical Center at Tel Hashomer and an education/rehabilitation team, who performs assessments in special education facilities and residential settings throughout Israel. The assessment team works by means of arena assessment according to the concept of play-based assessment. This article presents the working model used by the education/rehabilitation team at the Israeli Rett Syndrome Center. The principles and working characteristics of the Israel Rett Syndrome Center team are suggested here as a potential model for establishing additional teams, presenting similar evaluation services for other individuals with RS as well as for analogous populations.

Effects of music therapy on facial expression of individuals with Parkinson’s disease: a pilot study

Neurological degeneration associated with Parkinson’s disease (PD) affects the verbal as well as the nonverbal communicative potential of individuals diagnosed with PD. Communicating with significant others is crucial to quality of life and maintaining healthy and satisfying relationships. Evidence indicates that Music Therapy (MT) improves communication in a range of neurologically impaired populations; however there is no research that has studied its effect on the facial expressions of PD patients. The objective of this study was to evaluate the effect of group music therapy on facial expression in individuals with PD. Ten patients diagnosed with PD were recruited from a large demographic study at the Haukeland Hospital Rehabilitation Centre in Bergen, Norway. Two groups, with five individuals each group, met once a week for a 60 minute music therapy session for 20 weeks. Facial expressions were measured using the Facial Action Coding System (FACS) tool, and the facial mobility and engagement evaluation. FACS results were measured twice by different observers to ensure stability (interrater reliability) of findings. Interrater reliability was found at ICC = 0.89. A large effect size was found in facial expression between pre- and post-test measurements taken during singing (ES = 0.9). A large effect size was found in both sets of data (singing and speaking) (ES = 0.8). A moderate effect size was found in facial expression between pre- and post-test measurements taken during speaking (ES = 0.5). We conclude that this MT program was found successful in significantly enhancing facial expression in individuals with PD.

Arts-based psychiatric rehabilitation programs in the community: Perceptions of healthcare professionals.

Objective: Despite the increase in arts-based programs in community rehabilitation services in many countries, little is known about how these programs are perceived by health professionals who can refer individuals with mental health conditions to community-based psychiatric rehabilitation services. This study examined how senior professionals with key positions in the public health system perceive the integration of the arts in community-based psychiatric rehabilitation services in Israel. Method: Semistructured interviews were conducted with 10 professionals. Results: The thematic analysis revealed 2 main themes. The first reflected “the perceived position of arts-based programs among other rehabilitation services,” and had 2 subthemes: arts as a legitimate supplemental service, and arts as a motivating rehabilitation. The second theme reflected “the unique contribution of the arts to recovery processes,” and had 3 subthemes: art-making facilitates self-expression and communication and bypasses resistance, art-making facilitates socialization, and art-making shapes and enhances personal identity. Conclusions and Implications for Practice. Because most of the professionals were exposed to the creative arts in their workplace, they valued their contribution to the rehabilitation process. Thus, direct contact can provide more information, more accurate perceptions, and a better understanding of the benefits of arts-based services, which may in turn encourage service managers and policymakers to include these services.

Development of vocal communication in children with autism spectrum disorder during improvisational music therapy

ABSTRACT This preliminary study examined vocal communication in children with autism spectrum disorder during improvisational music therapy. It investigated trends and patterns of vocal development, and identified and categorized vocal interventions during music therapy sessions. The research is based on rigorous‎ video microanalysis of 4 cases of children who received music therapy over the course of 5 months. One session per month was analyzed for each case, yielding data from a total of 20 sessions. The cases and sessions were selected based on a purposeful sample strategy, so as to choose materials with apparent vocal expressions that are likely to illuminate the focus of the investigation. ‎The findings revealed that, in most cases, vocal communication developed over the course of the music therapy sessions and that this development is not linear, but rather is characterized by complex development patterns. In addition, 16 key vocal interventions used by the music therapists throughout the treatments were categorized.

Reliability of the Music in Everyday Life (MEL) Scale: A Parent-Report Assessment for Children on the Autism Spectrum

Background For young children on the autism spectrum, the inclusion of shared parent-child music activities in everyday life may provide additional opportunities for social interactions in the home. However, no psychometrically validated assessment exists to measure the extent of shared music activity within family or community contexts. Objective This study aimed to develop and test the reliability of a self-report assessment to measure the use of Music in Everyday Life (MEL) by parents with young children on the autism spectrum. Methods A total of 45 mothers of children with autism aged between 4 and 7 years completed the MEL questionnaire. Internal consistency and item-total correlation were examined. Results Analysis confirmed the reliability of two predetermined subscales: Music in Everyday Life-Joint Activities using Music (MEL-JAM) and Music in Everyday Life-Routine Activities using Music (MEL-RAM). Internal consistency (Cronbachs alpha 0.63 and 0.75) and positive item-total correlation (Pearsons r between .23 to .62 for MEL-JAM and between .30 to .67 for MEL-RAM) were demonstrated. Conclusions The reliability of the MEL assessment to measure the use of music in everyday life by parents with their children with autism was confirmed, filling an important gap in the availability of assessment tools.

Book Reviews: Summaries

Music Therapy and Group Work Davies, Alison. & Richards, Eleanor (2002), Music Therapy and Group Work: Sound Company, London: Jessica Kingsley Publishers. Contemporary Voices in Music Therapy Carolyn Kenny and Brynjulf Stige (Ed.) (2002), Contemporary Voices in Music Therapy – Communication, Culture, and Community, Oslo: Unipub forlag. Pediatric Music Therapy Lathom–Radocy, Wanda B. (2002), Pediatric Music Therapy, Springfield, IL: Charles C Thomas. Culture–Centred Music Therapy Stige, Brynjulf (2002), Culture–Centred Music Therapy, Gilsum, NH: Barcelona Publications. 361pp. ISBN 1–891278–14–2 Music, Music Therapy and Trauma Sutton, Julie P. (Ed) (2002), Music, Music Therapy and Trauma, International Perspectives. London: Jessica Kingsley Publishers.