Sunday, November 18, 2007

Schoolhouse Story: Bobby and the Ladybug

I never cease to be amazed at the power of music to reach out and communicate with children with disabilities. Recently I conducted a music therapy assessment with a second grade student with autism who I will refer to as "Bobby" for the purpose of this article. Bobby had received music therapy before, but was withdrawn from services in order to spend more time in the general education classroom. As he moved into the second grade this year, his stereotypic behaviors (i.e., hand flapping, rocking and perseverative vocalizations) increased and diminished his ability to participate and keep pace with his peers. One of Bobby's teachers noticed that Bobby reduced his stereotypic behaviors and provided better eye contact during songs and activities used in routine group instruction times. A music therapy assessment was requested to evaluate the possibility of developing specialized music activities to help Bobby make progress on his Individual Education Plan objectives.

I observed Bobby working in the classroom during his regular work tasks such as writing, coloring and cutting. He required one to one supervision by the teacher in order to perform his work. He was not providing eye contact to the teacher and only spent a few seconds at a time doing his work even when prompted continually by his teacher. She used verbal prompts, gestural cues and some hand over hand help to encourage and guide Bobby in his work. Bobby often became agitated and upset as demonstrated by his yelling, hitting himself or stabbing the wall with a pencil.

I began the music session with a familiar "Hello" song that Bobby immediately seemed to remember from over one and a half years ago. He had actually started singing the song to me before I had even taken my guitar out of the case. He sang the melody and used my name in the song. He was also able to calm his hand flapping and provide direct eye gaze focus to me and the guitar I was using. As long as the music stimuli continued Bobby did not exhibit his hand flapping and rocking behaviors. He also remained focused on the activities without verbal prompts or physical redirection.

One of the most impressive moments was when Bobby used a song to point to and count spots on a picture of a ladybug. Bobby had not been willing to count the spots before the song was introduced, even with hand over hand prompts. He was not focusing his attention and was actively engaged in hand flapping. Bobby calmed his behaviors as I began singing the song and he was able to pat his knees in rhythm to the music by the time two spots had been added to the picture of the ladybug. The Ladybug song repeats as a new spot is added each time for up to ten spots. Bobby learned the song very quickly so that after only two spots he was adding spots and counting them independently! As each spot was added, Bobby counted the spots by singing up a major scale, one note for each number counted.

Bobby's responses may seem miraculous, but there are reasons behind his success. The music provided stimuli and structure that helped him to calm his stereotypic behaviors and engage his cognitive functioning. I believe that in many cases, the music serves as an auditory stimuli to replace the need for hand flapping, rocking and other behaviors. Fortunately, music is an appropriate stimulus when used in a controlled setting. Once Bobby was focused on the music, he was able to respond to the rhythm and melody of the song to help him maintain interaction through the activity. The melody, rhythms and harmonic structure in the song helped him to provide verbal and physical responses in a predictable sequence. As he was counting, for example, the steady beat of the music helped Bobby to point to each spot without going too fast or slow. The ascending melodic scale provided direction and harmonic urgency to move to each successive note in the scale while he was singing and counting.

Children with autism often have the desire to make sure that events, verbal phrases and in this case, music, are complete and not open-ended. Once the repeating lyric and melodic lines of a song are established, the child with autism may be compelled to continue an activity to its completion. In this case, the visual representation of the ladybug was also incomplete with only a few spots. Bobby was likely compelled to follow through with placing all of the spots so that the picture could be finished.

The song was intrinsically ordered with a beginning and end and repeating lyric refrain. The only new words for each verse of the song were new numbers as Bobby counted more spots each time. As he sang more numbers each time through the song he also ended up on a different note in the musical scale. Many of the notes in a musical scale may feel less satisfactory to end up on without moving on to a more harmonically stable note in the scale. In this way, a singer is compelled to a sense of forward motion. This motivation may have appealed to Bobby and helped his desire to move on to each successive verse in the song. Bobby was ultimately able to count up to nine spots without help during the Ladybug song.

Bobby continued through the assessment to demonstrate behaviors that illustrated the power of music to help him interact with the world around him. He beautifully provided another example of a situation where music makes sense.

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