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A Review of
Music and Art Therapies
For Individuals with Autism

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Music and Art Therapies

Music Therapy

Art Therapy

Discussion

Questions

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Music Therapy

Definition

History

Models

Settings

Services

Credentials

Claims

Parent and Therapist reports

Outcomes

Evidence

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Art Therapy

Definition

Activity

History

Models

Art Development

Settings

Credentials

Claims

Parent and Therapist reports

Evidence

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Search parameters

Psychinfo

Music and therapy in any fieldautis* in subject

Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text (time)

15 results:

Art and therapy in any field and autis* in subject

Advanced search criteria: Peer-reviewed journals, Journal articles, human, linked full text (time)

26 results

Google

Music therapy

Music therapy autism

Art therapy

American art therapy association

Art therapy autism

Art therapy and autism

Art therapy autism history

American music therapy association

Center for Health and Healing

Google news

Music therapy autism

Art therapy autism

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Music Therapy Defined

Music therapy is the clinical and evidence-based use

of music interventions to accomplish individualized
goals within a therapeutic relationship by a
credentialed professional who has completed an
approved music therapy program

Refers to the application of music with the intent to

enhance functioning

American Music Therapy Association. (2011).Who are art therapists? Retrieved from
http://www.americanarttherapyassociation.org/
upload/whoarearttherapists2009.pdf

Association for Science in Autism Treatment. Music Therapy. Retrieved from

http://www.asatonline.org/intervention/treatments/
music.htm

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Whats the appeal?

Music Therapy Clip: Jammin Jenn

Jennmusiczack. (2010). Hope for autism through music therapy. Available from http://youtube.com

Is it founded?

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History of Music Therapy

Idea of music as healing goes back to Aristotle

Discipline began after World War I and World War II when

musicians went to Veterans hospitals to play for victims

Notable responses of patients led to doctors hiring musicians

Some musicians needed training before being in hospitals led

to need for college curriculum

First music therapy degree program at Michigan State

University in 1944

The American Music Therapy Association founded in 1998

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support.
Retrieved from
http://www.musictherapy.org/factsheets/bib_autism.pdf

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Music therapy: Models

Receptive music listening

Song writing

Music performance

Imitation
Call and answer songs (Chase, 2009)

Improvisational music therapy

Creative music therapy model (Nordoff-Robbins Model) has been found

most effective with children with autism

Nordoff-Robbins Clip

Music-making vs. music-listening to motivate learners and effect

growt

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support. Retrieved fromhttp:/
/www.musictherapy.org/
factsheets/bib_autism.pdf
Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger. Retrieved from http://www.nj.com.
Kim, J., Wigram, T., Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13, 389409. doi:

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Settings: Music Therapy

Psychiatric hospitals

Rehab facilities

Medical hospitals

Outpatient clinics

Agencies for developmentally disabled persons

Drug and alcohol programs

Senior centers

Correctional facilities

Schools

Private practices.

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based
Practice Support.
Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf

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Music Therapy: Services

Considered related service under IDEA (Stetler, 2009)

IEP goals: related services

150 certified music therapists in New Jersey but this number is rapidly
expanding (Chase, 2009)

Medicare: 1994, reimbursable for service under benefits for Partial

Hospitalization Programs (PHP) under heading of Activity Therapy

Must be:
Prescribed by a physician
Reasonable and necessary for treatment of illness/injury
Goal directed and based on a documented treatment plan
Goal cannot be to maintain current level, must exhibit some level of improvement

Some medicade programs cover music therapy

Some private insurances cover music therapy

About 20% of Music therapists receive third party reimbursement

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice
Support. Retrieved f

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Music Therapist: Credentials

Participate in approved college music therapy curricula

to be eligible to sit for national examination offered by
Certification Boar for Music Therapists (MT-BC)

National Music Therapy Registry (NMTR) serves

qualified music therapy professionals with the
designation RMT, CMT, or ACMT

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Music Therapy: Claims

Interventions designed to:

Promote wellness

Manage stress

Alleviate pain

Express feelings

Enhance memory

Improve communication

Promote physical rehabilitation

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based
Practice Support.
Retrieved from http://www.musictherapy.org/factsheets/bib_autism.pdf

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Music Therapy: Outcomes for
Individuals with Autism

Increased attention

Decreased self-stimulation

Improved cognitive functioning

Increased socialization

Successful and safe self-expression

Improved behavior

Enhanced auditory processing

Decreased agitation

Improved verbal skills

Enhanced sensory-motor skills

American Music Therapy Association (2008). Autism Spectrum disorders: Music Therapy Research and Evidence-Based Practice Support.
Retrieved from

http://www.musictherapy.org/factsheets/bib_autism.pdf

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From the therapists

For people with autism, the world is a chaotic place,

full of overwhelming levels of sensory input, says John
FoleyMusic has form we all recognize, even if we
dont think in those terms; music makes sense. In the
early days of defining autism, heightened response to
music was considered for the list of possible symptom.
(Chase, 2009)

We know music therapy works with people on the

autism spectrum, even if we dont always know why or
how (Chase, 2009)

Chase, E. (2009) Using the language of music to speak to children with autism. The Star-Ledger.
Retrieved
from http://www.nj.com

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Music Therapy: Parent reports

I wish I could say how, exactly, but I just know that

music is an avenue to get their little brains going. said
Michelle Phalon (Chase, 2009)

The proof is in what you see and the changes in your

childIts hard to argue with physical progress. There
are naysayers out there in everything. But you see the
difference. (Chase, 2009)

She just engage more, Wismann said. Instead of being

in her own space, if youre more singsong-y when youre
interacting with her, she seems to engage more and
want to be interactive with you. (Thompson, 2011).

Chase, E. (2009) Using the language of music to speak to children with

autism.
The Star-Ledger. Retrieved from http://www.nj.com.
Thompson, D. (2011, May 27). Living with a child with autism. HealthDay
News.
Retrieved http://health.usnews.com

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Evidence for Music Therapy

According to the Association for Science in Autism

Treatment, preliminary evidence suggests that music
therapy might be effective in enhancing functioning,
but more rigorous research needs to be conducted

Association for Science in Autism Treatment. Music Therapy. Retrieved from

http://www.asatonline.org/intervention/treatments/music.htm

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Evidence for Music Therapy

15 total articles

1 unrelated to music therapy

Dependent variables

Social responsiveness: 4 studies

Avoidant Behaviors, emotional responsiveness, joint-attention behaviors,

music skills, preferences, task performance, and auditory stimulus
processing, object constancy: 1 study each

Vocal Stereotypy: 2 studies

Single-subject design: 3 articles

Group design 3 articles

Meta-analysis and analysis: 1 article each

Vignettes/Case studies: 6 articles

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Evidence: Single-Subject
Further evaluation of methods to identify matched
Research
stimulation (Rapp, 2007)

Effects of preferred stimulation on vocal stereotypy

Results: Sound-producing toys or non-contingent music led

to decreased vocal stereotypy

Possibly auditory stimulation functioned as an abolishing

operation for vocal stereotypy

The limits and motivating potential of sensory stimuli as

reinforcers for autistic children (Ferrari & Harris, 1981)

Use of vibrations, music, and strobe lights as reinforcement.

Results varied but sensory stimuli has motivating potentials

similar to those of food and social reinforcers

Ferrari, M., Harris, S.L. (1981). The limits and motivating potential of sensory stimuli as reinforcers for autistic children. Journal of
Applied
Behavior Analysis, 14, 339-343. doi: 10.1901/jaba.1981.14-339

Rapp, J. T. (2007). Further evaluation of methods to identify matched stimulation. Journal of Applied Behavior Analysis, 40, 73-88.
doi:
10.1901/jaba.2007.142-05

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Evidence: Single-Subject
Research
Increasing social responsiveness in a child with autism: A
comparison of music and non-music interventions.

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Research: Social
Responsiveness

Finnigan, E., Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions. Autism, 14, p. 321-348.

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Evidence: Single-Subject
Research

Participant: A 3-year, 8-month old girl with autism

Materials: 6 neutral toys randomly assigned to a condition

Setting: 4 15-minute sessions per week for 2 months in empty

preschool classroom or at participants home

Alternating treatment design

Dependent variable: social responsive and avoidance behaviors

Number of correct responses divided by the number of opportunities given
Data summarized as percentage of correct responses
Frequency count for eye contact and avoidance behaviors

Independent variable: Music and non-music conditions

Music intervention: Familiar melodies sung with lyrics appropriate for toy
being used. Guitar also played.
Non-music intervention: Spoken scripts with words similar to those in
melodies

Finnegan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and
non-

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Evidence: Single-Subject
Research

Alternating treatment design: Baseline, Alternating

Phase, Best-treatment phase, Follow-up

IOA collected for 20% of sessions with a mean IOA of

87% (range 85-96%)

Data analysis looked at the percentage of

nonoverlapping data

Results: Authors demonstrated a functional relationship

between the music condition and the increase of social
responsive behaviors and decrease of avoidant
behaviors.

Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic
interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747

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Research: Social
Responsiveness

Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic
interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747

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Research: Social
Responsiveness

Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic
interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747

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Research: Social
Responsiveness

Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic
interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747

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Music Therapy: Social
Responsiveness
Results

suggest positive effects of Music

Therapy on social responsiveness

Need

continued research with more

rigorous experimental designs to
establish functional relationships
Small number of participants but not
well-designed single-subject research

Use

of music (and other child-preferred

activities) as motivation to increase
socialization

Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and nonmusic
interventions. Autism, 14, 321-348. doi: 10.1177/1362361309357747

Music Therapy:
Evidence for Outcomes

Increased attention

Decreased self-stimulation (+)

Improved cognitive functioning

Increased socialization (+)

Successful and safe self-expression

Improved behavior

Enhanced auditory processing

Decreased agitation

Improved verbal skills

Enhanced sensory-motor skills

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Art Therapy Defined

Art therapy is a mental health profession that uses the

creative process of art making to improve and enhance
the physical, mental and emotional well-being of
individuals of all ages. It is based on the belief that the
creative process involved in artistic self-expression
helps people to resolve conflicts and problems, develop
interpersonal skills, manage behavior, reduce stress,
increase self-esteem, self- awareness, and achieve
insight

Refers to the application of art with the intent to

enhance functioning.

American Art Therapy Association. (2011). Who are art therapists? Retrieved from
http://www.americanarttherapyassociation.org
/upload/whoarearttherapists2009.pdf
Association for Science in Autism Treatment. Art Therapy. Retrieved from
http://www.asatonline.org/intervention/treatments/art.htm

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Art therapy: Activity

Brainstorm feeling words

Assign each word a color

Draw a heart

Color in the heart the amount of each color that you

are feeling

Keep on file
Benefits?

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Whats the appeal?

Art Therapy

Google images

Is it founded?

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History of Art Therapy

1900s

Psychiatrists began being interested in patients art.

Educators recognized artwork reflected childrens development/growth.

1914: Margaret Naumberg starts Childrens School

Often identified as the founder of art therapy

Art therapy started to be included with traditional talk therapy

1940s: Distinct discipline emerged

1970s: Division in art therapists

Art therapy: innate healing power of making art

Art psychotherapy: art as a healing tool within a framework of verbal
psychotherapy

American Art Therapy Association. (2011). Who are art therapists? Retrieved from
http://www.americanarttherapyassociation.org/upload/whoarearttherapists2009.pdf
Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from
http://www.healthandhealingnorg/complement/art_how.html

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Art therapy: Models

Acting/Filming

Photography

Painting

Drawing

Portrait drawing

Art as expression of feelings

Art as nonverbal communication

eHowArtsAndCrafts (2010). Art therapy activities: art therapy activities on feelings. Available from http://www.youtube.com
PolarisMediaGroup (2009). Polaris global presents Kids with Cameras. Available from http://www.youtube.com

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Art Therapy: Art Development

Neurotypical individuals drawing skills generally follow

the same progression:

Scribbling in early childhood

Symbolic/schematic representation in middle childhood

Concern with achieving realism in adolescence

Shifts are influenced by and have an influence on

cognitive development

For children with ASD, the development follows the

same sequence and is related to the individuals
nonverbal mental age

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the American Art

Therapy Association, 25, p. 15-23. Retrieved from http://www.arttherapyjournal.org/pdf/25-1_Martin.pdf

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Art Therapy Settings

Work with health professionals in palliative care

programs

Prisons

Trauma relief teams

Personal growth classes

School systems

Center for Health and Healing (2011). Art Therapy -- How it works and when to use it. Retrieved from http://www.healthandhealingny

org/complement/art_how.html

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Art Therapy: Credentials

Art therapists must have a masters degree or PhD in

art therapy AND/OR be a registered art therapist (ATR)

Art therapists are skilled in multiple modalities of art

(painting, sculpture, painting, etc.) for assessment and
treatment.

Martin, N. (2011). Arttherapyandautism.com. Retrieved from http://arttherapyandautism.com/index.html.

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Art Therapy: Claims

Art therapy = visual images that represent

thoughts/feelings that individuals dont know how to
express verbally

Interventions designed to address:

Imagination/abstract thinking deficits

Sensory regulation and integration

Emotions/self-expression

Nonverbal communication

Socialization

Recreational/leisure skills

Visual-spatial deficits

Improving motor skills

Martin, N. (2011) Explanation. Retrieved from http://arttherapyandautism.com

Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm

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Art Therapy: Claims

As a graphic, nonverbal means of communication, art

can provide relief to the child for whom verbal
communication is frustrating, overwhelming, too direct,
or even nonexistent (Martin, 2008).

Art therapy can utilize the childs visual strengths to

address treatment goals while providing a socially
appropriate outlet for self-stimulatory behaviors and
sensory needs (Martin, 2008).

Use of icons, symbols, and social stories help the

children to remember what they were taught (Epp,
2008).

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy: Journal of the
American Art Therapy
Association, 25, p. 15-23.
Epp, K.M. (2008). Outcome-Based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum.
Children
and Schools, 30, 27-36.

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Art Therapy: Parent reports

It has given her confidence, self-esteem, Mrs. Bigioni

said. She is proud of the work she does. It has brought
friendships peers and facilitators developed a sense
of community (Joseph, 2011).

Joseph, S. (2011). Growing demand for art therapy. Yorkregion.com. Retrieved from http://www.yorkregion.com/news/article/1012624--growing-demand-for-arttherapy.

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Evidence: Art Therapy

According to Association for Science in Autism

Treatment there have been no scientific studies of art
therapy for individuals with ASD

Association for Science in Autism Treatment. Art Therapy. Retrieved from http://www.asatonline.org/intervention/treatments/art.htm

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Evidence for Art Therapy

26 articles returned

Dependent variable

Unrelated to art therapy 14 (related to music therapy etc.)

Social skills
Object constancy
Face processing skills/portrait drawing

Design

Single-subject None
Group design 2
Book Review - 6
Meta-analysis/Review - 3
Case study - 1

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Evidence: Art Therapy

Assessing portrait drawings created by children and

adolescents with autism spectrum disorder

25 children with autism with a mean age of 13 years and 15

neurotypical children with a mean age of 10

Completed the Portrait Drawing Assessment (PDA)

Portrait drawings didnt indicate a difference in iconic skills

in children with ASD

Participants with ASD were more often rated as interested

and less often rated as indifferent than neurotyipcal
participants

Martin, N. (2008). Assessing portrait drawings created by children and adolescents with autism spectrum disorder. Art Therapy:
Journal of the American Art Therapy Association, 25, p. 15-23.

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Evidence: Art Therapy

Outcome-based evaluation of a social skills program

using art therapy and group therapy for children on the
autism spectrum

66 participants

Parents filled a pre and post-test questionnaire (SSRS or

Social Skills Rating System)

Attending a social skills group therapy program (with art

therapy as a component) improved assertive social skills
and decreased problem behaviors and hyperactivity.

Epp, K.M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on
the autism
spectrum. Children and Schools, 30, 27-36. Retrieved from http://web.ebscohost.com.ezproxy.
caldwell.edu:2048/ehost/
pdfviewer/pdf viewer?sid=f824fe6f-6b6c-4f84-9de6-53a55d3f8975%40sessionmgr113&vid=32&hid=105

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Evidence: Art Therapy

Interventions designed to address:

Imagination/abstract thinking deficits

Sensory regulation and integration

Emotions/self-expression

Nonverbal communication

Socialization

Recreational/leisure skills

Visual-spatial deficits

Improving motor skills

Object
Object constancy?
constancy?
Faceprocessing?
processing?
Face

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Discussion

Music therapy

Noncontingent reinforcement/preferred stimulation

Increased social responsiveness

Decreased problem behaviors

Auditory processing

Art therapy

Use of portrait drawing and photography to promote selfmonitoring and awareness

Use of portrait drawing to develop knowledge related to

facial expressions

Fine motor skills

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Discussion cont.

Behavior traps

Motor imitation

Gross and fine motor skills

Social interaction

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Discussion cont.

Things to consider

Individuals with ASD as visual thinkers/concrete

Individuals with ASD with processing differences (auditory

and visual)

Use of preferred music as reinforcement is different than

the application of music or art as a therapeutic intervention

Need for more research is clear!

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Recommendations

Very little evidence at this point

The evidence on music therapy suggests positive effects

but more research is needed

There is not evidence on art therapy thus far, research is

needed!

If music/art are preferred they can be used at

motivation without needing therapy

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References

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References

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References

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Questions?