Ulla Holck

Randomised controlled trial of improvisational music therapy's effectiveness for children with autism spectrum disorders (TIME-A): study protocol

BackgroundPrevious research has suggested that music therapy may facilitate skills in areas typically affected by autism spectrum disorders such as social interaction and communication. However, generalisability of previous findings has been restricted, as studies were limited in either methodological accuracy or the clinical relevance of their approach. The aim of this study is to determine effects of improvisational music therapy on social communication skills of children with autism spectrum disorders. An additional aim of the study is to examine if variation in dose of treatment (i.e., number of music therapy sessions per week) affects outcome of therapy, and to determine cost-effectiveness.Methods/DesignChildren aged between 4;0 and 6;11 years who are diagnosed with autism spectrum disorder will be randomly assigned to one of three conditions. Parents of all participants will receive three sessions of parent counselling (at 0, 2, and 5 months). In addition, children randomised to the two intervention groups will be offered individual, improvisational music therapy over a period of five months, either one session (low-intensity) or three sessions (high-intensity) per week. Generalised effects of music therapy will be measured using standardised scales completed by blinded assessors (Autism Diagnostic Observation Schedule, ADOS) and parents (Social Responsiveness Scale, SRS) before and 2, 5, and 12 months after randomisation. Cost effectiveness will be calculated as man years. A group sequential design with first interim look at N = 235 will ensure both power and efficiency.DiscussionResponding to the need for more rigorously designed trials examining the effectiveness of music therapy in autism spectrum disorders, this pragmatic trial sets out to generate findings that will be well generalisable to clinical practice. Addressing the issue of dose variation, this studys results will also provide information on the relevance of session frequency for therapy outcome.Trial RegistrationCurrent Controlled Trials ISRCTN78923965.

Interaction Themes in Music Therapy: Definition and Delimitation

Based on a doctoral study, the author presents a type of music therapy interaction called ‘Interaction Themes.’ These are developed from session to session and often appear in music therapy interventions with children with severe functional limitations, especially children with autism. Although the Interaction Themes are characterised by a relatively simple and selfgenerated content, they have an essential function because they contain the childs and music therapists joint interaction history. They make up the context within which it is possible to create meaningful interaction with a client group whose expressions are often difficult to understand. The article describes the characteristics and functions of Interaction Themes, compares the phenomenon with music therapy case literature and delimits it in regard to other types of music therapy interaction with this client group. The results are described through qualitative analysis methods applied to clinical video material, including member checking, negative case analyses, and pattern-generalisation.

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 a Dyadic Music Therapy Intervention on Parent-Child Interaction, Parent Stress, and Parent-Child Relationship in Families with Emotionally Neglected Children: A Randomized Controlled Trial

BACKGROUND Work with families and families at risk within the field of music therapy have been developing for the last decade. To diminish risk for unhealthy child development, families with emotionally neglected children need help to improve their emotional communication and develop healthy parent-child interactions. While some researchers have investigated the effect of music therapy on either the parent or the child, no study has investigated the effect of music therapy on the observed interaction between the parent and child within the field of child protection. OBJECTIVE The purpose of this study was to investigate the effect of a dyadic music therapy intervention on observed parent-child interaction (mutual attunement, nonverbal communication, emotional parental response), self-reported parenting stress, and self-reported parent-child relationship in families at risk and families with emotionally neglected children, ages 5-12 years. METHOD This was a randomized controlled trial study conducted at a family care center in Denmark. Eighteen parent-child dyads were randomly assigned to receive 10 weekly music therapy sessions with a credentialed music therapist (n = 9) or treatment as usual (n = 9). Observational measures for parent-child interaction, self-reported measures for parenting stress and parent-child relationship were completed at baseline and 4 months post-baseline assessment. RESULTS Results of the study showed that dyads who received music therapy intervention significantly improved their nonverbal communication and mutual attunement. Similarly, parents who participated in dyadic music therapy reported themselves to be significantly less stressed by the mood of the child and to significantly improve their parent-child relationship in terms of being better at talking to and understanding their children than parents who did not receive music therapy. Both groups significantly improved in terms of increased positive and decreased negative emotional parental response, parenting stress and stress in general. There were no significant between group differences in self-perceived autonomy, attachment, and parental competence. CONCLUSIONS The dyadic music therapy intervention examined in this study improved emotional communication between parent and child and interaction after 6 to 10 sessions and can be considered as a viable treatment alternative or supplement for families at risk and families with emotionally neglected children.

How facial expressions in a Rett syndrome population are recognised and interpreted by those around them as conveying emotions

Rett syndrome (RTT) is a neurodevelopmental disorder, including autonomic nervous system dysfunctions and severe communication impairment with an extremely limited ability to use verbal language. These individuals are therefore dependent on the capacity of caregivers to observe and interpret communicative signals, including emotional expressions. People in general, including therapists tend to focus on changes in facial expressions to interpret a persons emotional state or choices, but with this population it is difficult to know if the interpretations are correct. The aims of this study were to investigate if the Facial Action Coding System (FACS) could be used to identify facial expressions, and differentiate between those that expressed emotions and those that were elicited by abnormal brainstem activation in RTT. The sample comprised 29 participants with RTT and 11 children with a normal developmental pattern, exposed to six different musical stimuli during non-invasive registration of autonomic brainstem functions. The results indicate that FACS makes it possible both to identify facial expressions and to differentiate between those that stem from emotions and those caused by abnormal brainstem activation. This knowledge may be a great help to an uninitiated observer, who otherwise might incorrectly interpret the latter as an expression of emotion.

Book Review Summaries

? Users may download and print one copy of any publication from the public portal for the purpose of private study or research. ? You may not further distribute the material or use it for any profit-making activity or commercial gain ? You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access to the work immediately and investigate your claim.This book offers exemplarily guidance for how therapists and researchers can work together, or therapists can work as researchers, to develop research knowledge highly relevant to practice, with data already existing in workplaces. Through clinical data-mining (CDM), music therapists can do low or no cost research which can make work-life more satisfying, interesting, accountable, and professional. Concerned about the ‘‘practice research divide’’, Prof. Epstein focused on engaging practitioners in research through CDM studies.

Book symposium on Even Ruud's Music Therapy. Improvisation, communication and culture

Notes on Music Therapy: Improvisation, Communication and Culture By: Even Ruud Comment A: Improvisation, Interplay and Interpretation By: Ulla Holck Comment B: Music and Identity By: Thomas Schepelern Comment C: A Multiparadigmatic Adventure By: Lars Ole Bonde Comment D: Communication, Culture, and Context By:Tony Wigman Closing Comments By: Even Ruud

Musical and emotional attunement - unique and essential in music therapy with children on the autism spectrum

Background: In improvisational music therapy for children with autism spectrum disorder (ASD), facilitating musical and emotional attunement has been found to be one of the unique and essential principles.Methods: Using videotaped sequences of therapy sessions from an international study (TIME-A), independent raters assessed therapists’ competence in using their behaviour and expression (e.g. through music, voice, arousal level, movement and facial expression) to allow for moments of synchronisation and attunement. Sequences with frequent occurrences of attunement were then examined in relation to musical parameters, aspects of timing in the interaction, joint vitality forms and emotional expression.Discussion: Attunement unfolds in different ways, including regulation, selective attunement and gentle redirections of the dynamic in order to regulate the child’s arousal, attention or mood. Both attunement to the child’s vitality forms and selective attunement can be seen as essential for music therapy in A...

Situation Songs - Therapeutic Intentions and Use in Music Therapy with Children

这篇研究的目的是探究儿科音乐治疗中的一种即兴方法——情景歌曲 所蕴含的多种治疗目的。 Plahl 和 K och- Temming 解释 情 景歌曲 是治疗师或患儿所即兴演唱的歌曲。“情景歌曲”反应了在治疗关系的支持下即时发生事情。文章主要研究治疗师的演唱和它所蕴含的的治疗目的。 这篇研究分为以下几部分 ：作者描述其本人在临床中运用 情景歌曲 的经历 （ P reunderstandings ）；相关文献的回顾；对三位分别来自丹麦、奥地利、德国的音乐治疗师的半结构化访谈 。 作者在诠释学原理的指导下，使用了灵活的研究方法。 研究结果表明儿科音乐治疗师经常使用情景歌曲 ，特别是在为年龄较小的患儿 做治疗时。使用情景歌曲 的治疗目的有以下几个：营造一个治疗氛围；支持治疗关系 的发展 ；促进 情绪、行为、表达、社交技能的体验和发展；表达话语中的讯息；为患儿 提供一个 有规律的 结构。 情景歌曲 最主要的目的是为患儿 的成长和发展提供必不可缺的体验。 文章作者也希望通过这篇研究促进各国间音乐治疗临床应用的交流。此篇研究是第一 作者于丹麦奥尔堡大学的硕士毕业论文。第二作者督导了论文的写作 。

Book Reviews and Summaries

Music Therapy Darnley–Smith, Rachel & Helen M. Patey (2003). Music Therapy. London: Sage Publications Psychodynamic Case Studies in Music Therapy Hadley, S (Ed) (2003) Psychodynamic Case Studies in Music Therapy. Gilsum, NH: Barcelona Publishers Dans på gränsen Krister Nystrøm (2002): Dans på gränsen. Demensdrabbades kommunikation i dansterapi. Stockholm: Pedagogiska institutionen. Stockholms universitet. Video i pædagogisk forskning Rønholt, Helle, Sven‐Erik Holgersen, Kirsten Fink–Jensen & Anne Maj Nielsen (2003): Video i pædagogisk forskning – krop og udtryk i bevægelse. Institut for Idræt, Københavns Universitet: Forlaget Hovedland. 291 sider, pris: 298 kr. incl. moms ISBN: 87 7739 653 7 A Comprehensive Guide Tony Wigram, Inge Nygaard Pedersen & Lars Ole Bonde (2002). A Comprehensive Guide to Music Therapy Theory, Clinical Practice, Research and Training. London: Jessica Kingsley Publishers.