Tuesday, April 29, 2008

Music Therapy: Examples of the Power of Live Music

Music therapy in the public school setting is usually provided to clients on a weekly basis. Depending on the student, the therapist may see the client one to one or in a small group setting with peers. Music therapists are trained to provide specially developed music activities in a variety of different musical styles and have knowledge of a wide range of disabilities and health issues. Sometimes music therapy services will be provided as a consult service instead of direct service so that other educational staff may be trained in using music strategies. These strategies can help clients across settings and more frequently throughout the week when the music therapist is not present. I have seen many clients through a consult role with some success, but there are limitations to what teachers and other staff can accomplish when using music activities. I would like to provide some specific examples about how live music can be the key to successful intervention with music therapy. The following case studies are based on occurrences at schools, but live music is also important in working with adults in medical treatment and older adults in rehabilitation and assisted living settings. (Although these are stories about real students, names have been changed for confidentiality.)

1. Clint is an elementary student who has autism. He functions higher than average on the spectrum of autism disorders closer to Asperger's. Clint does well with established routines, picture schedules and a structured environment, but he is often lost in his own imagination, making sounds and repeatedly talking about a topic. In the classroom, Clint requires picture prompts and sometimes physical prompts combined with verbal instructions in order to remain in a designated work area.

Music therapy group time for Clint is very structured, following a similar routine of songs and providing movement to music activities and instrument playing to help Clint remain focused. Although Clint is more focused during music therapy activities than during work without music, he often leaves his chair or starts talking to himself off the subject. I generally have my guitar as my accompanying instrument and have used improvised singing to help Clint return to his chair or follow simple directions. Clint is very focused on predictable melodies that have an obvious musical conclusion. He would definitely be able to finish the happy birthday song if it was incomplete! Clint almost always looks up to me as I sing instructions and usually finishes singing the lyrics himself as he sits back down, raises his hand or follows through with the physical directions in the song. My ability to obtain Clint's immediate and unprompted compliance has always impressed his teachers. They generally remark that they wish they had the ability to sing and play the guitar. I have been able to provide them with some easy songs to sing and remember, but Clint is very sensitive to musicality and will not respond to music stimuli that is out of tune or incorrect. This is a great challenge for teachers who are not musically trained.

2. Travis, another student with autism, is in junior high school. His teachers have been having problems with him not wanting to wear his shoes at school. Travis did not usually have his shoes off in music therapy, but one day he came without his shoes on. I immediately made up a song with a lively beat that said, "Put on your shoes and sit up straight, Travis is getting ready for music!" The song had a repeating lyric structure and very simple melody so that Travis started singing the song with me. He was able to sing the lyric by himself after two times singing through the song and proceeded to follow the directions in the song as he sang them to himself while I played the accompaniment on the guitar. I have recorded the song for his teachers to use, leaving the last phrase blank so that he can, "get ready for ______," whatever class he is in.

3. Scott has autism and is a student in elementary school. He has been sitting and listening in the music therapy groups, but not participating with verbalizations or eye contact. In a recent session, I noticed that Scott was tapping his foot during an upbeat song. I quickly matched the tempo of my guitar playing to his foot tapping. Scott immediately looked up and provided meaningful eye contact. He changed his foot tapping faster and slower and began smiling when the rhythm of the guitar accompaniment followed the tempo he set. In subsequent sessions, Scott has seemed more aware of the music when it encourages body movements or playing instruments.

4. Lisa is a student with multiple disabilities. She is a high schooler who uses a four button communication device to make choices or indicate her wants and needs. Lisa is much more active in using her communication device during preferred music activities with one exception. She does not seem to like music in a minor key. Lisa participates in choir class with her peers, but has cried and become emotionally upset when the choir is singing songs in a minor key. Her teachers are careful to monitor recorded music used in class to make sure that songs will not play that are in a minor key. During music activities designed to address Lisa's educational objectives, I have been very careful to use songs arranged around major chords.

Music should be encouraged as a stimulus and structuring force for many different learning and therapy situations even if a music therapist is not involved. Try to recognize the unique power of live music and take advantage of music therapists when they are available.

Sunday, April 20, 2008

Labeling: Stepping Into a Minefield In Special Education

I recently held a brainstorming session with a teacher regarding how to approach a parent about a child who is showing significant delays across many educational areas. This teacher had just experienced the fury of the parent after remarking to the parent that the child was exhibiting some behaviors consistent with those in some autism spectrum disorders. My teacher friend walked right into the "lion's den" of controversy. Currently, autism is a highly charged topic among parent networking groups, researchers and the media. It is not, however, the only word or disability that sparks instant debate or carries with it certain connotations, myths, and mental images. I have worked with many cases where parents are also concerned about using language like "mental retardation," or "Down Syndrome." The discussion I had with the teacher made me reflect on several strategies and conversational protocols that I use to help facilitate exploration of the educational issues in the world of special education.

1. Take vocabulary cues from your conversation partner ~ Defer all references to labels, disabilities, diseases, syndromes, etc. to the parent until he or she has mentioned one. If the parent names a disability first, then you can feel free to discuss the behaviors and attributes that might be common for that condition.

2. Use specific examples of behavior ~ Instead of comparing the actions and abilities of a student to those of a child with a disability, simply express your remarks as quantifiable measures of progress. One example of this could be that a student frequently echoes words or phrases but does not initiate appropriate verbal interaction. Describe this behavior through a numerical comparison between how many times, on average, the other children in class initiate conversations and how many times the child in question initiates verbal interaction. In this way, a teacher should use many specific examples to express concern to a parent without generating emotions that may be triggered by key words like Autism or Attention Deficit Disorder.

3. Talk to an administrator ~ The appropriate time to speak about a student and use labels referring to disabilities is when discussing a child's progress with the principal, educational diagnostician or school psychologist. I have often had conversations with teachers and other professionals on the educational team about my clients and explored possible disabilities that should by looked at through an assessment process. The administrators should listen to these observations and proceed to contact the parent about assessing for specifically named disabilities.

4. Check the student files ~ I am called upon to evaluate some students to find out if they will benefit educationally from specially developed music strategies. The assessment process includes speaking with parents about their child's reactions to music stimuli outside of school. I routinely audit the student's files for information about what assessments have previously been completed and for the official reasons the student is already receiving special services through an Individual Education Plan. The IEP will list things like, MR for mental retardation, AU for autism, SI for speech impaired and so on. When I speak to the parent about the music therapy assessment and/or progress of their child, I only use the labels that have already been assigned in the student's record unless the parent uses another label.

As a music therapist who travels around to different classrooms and schools everyday, I have observed many different children with a wide range of disabilities. It is often easy for me to quickly come to a conclusion about the nature of a child's disability after only a short time of observation and interaction. I am trained to find out if music activities can benefit a student in achieving educational objectives, but I am not trained to assess and determine disabilities or disease. This limitation is the guiding factor when discussing a student and using specific labels too freely. There are many cases where a child exhibits classic behaviors from the autism spectrum, for example, but the origin of the behaviors is actually traced directly back to a seizure disorder or mental retardation due to trauma at birth. The child will technically be labeled with speech impairment, mental retardation or as other health impaired. Therefore, it is understandable how a parent can be quite upset if an educator is talking about autism and using terminology associated with that spectrum of disorders.

Educators must find a way to address the needs of every child regardless of parents who are understandably wary of believing that anything is wrong with their child. By using care in speaking with labels, educators can keep the dialogue open without creating an adversarial relationship with parents. Most teachers care a great deal about the welfare of their students. Let's all work together and take care of those kids!

Friday, April 4, 2008

Schoolhouse Rock: Five Exciting Ideas for Using an Ocean Drum!

The ocean drum is one of the most unique, yet versatile instruments I usually keep in my "bag of tricks." When it is tilted gently back and forth, the small ball bearings inside create a sound very much like that of waves on the beach. The drum comes in a variety of different sizes including a very large 22 inch drum. I generally use the 16 inch drum because it is easier to carry around but still provides a nice, rich wave sound. I have found that the smaller 12 inch drum does not provide enough surface area to make good ocean sounds, but if portability is an issue, this may be the better choice. The larger 22 inch drum sounds incredible and works well when used by a pair of children to teach sharing and team-work! If you have a closet or classroom close to the area where you are working, this is the drum to get! All of the sizes come in either a fish print graphic design or a plain white/tan. I use the fish print drum, but children who may be over-stimulated may respond more appropriately to the plain fabric.

1. Relaxation ~ The ocean drum works great for creating a background sound for relaxation. Play the drum by gently tilting it from side to side or in a motion that sends the ball bearings around in a circle. If you keep the clear side of the drum facing up, the ocean sound will be softer. I like to get a volunteer to play the ocean drum as I facilitate relaxation to music. Try some appropriate music from Enya or Kevin Kern and slowly describe some imagery of sitting on a warm beach or resting by a babbling brook.

2. Fishing ~ One of my favorite activities is to go fishing for songs. Turn a gathering drum upside down and use it as a "pond" for paper fish cutouts. Place paper clips on the mouth of each fish and use a magnet as the fishing lure to go fishing for songs written on the fish. As each child takes turns fishing, have another child play the ocean drum and sing the song, "You get a line, I'll get a pole..." In between fishing, sing the songs indicated on the fish that are caught. This is a great activity to give multiple kids something to do as they take turns using the fishing pole. The activity also provides a good structure for transitioning between songs and activities that can target specific learning objectives.

3. Portable gathering drum ~ An ocean drum has a great sound when played as a regular drum with your hands or soft headed mallets. This can be very useful if you want to share a drum with another person when sitting in chairs. A gathering drum, for example, is best played sitting around it on the floor. When sitting on the floor is not appropriate due to age or disability, the ocean drum provides a good substitute. The ocean drum can also be placed on a tray-table attached to a wheelchair. It maintains a good resonant sound even when it is placed on a table.

4. Focus of attention ~ The ocean drum is visually attractive and aurally unique. The drum with the fish graphic is colorful and full of a variety of sea creatures that stimulates discussion. The drum without the graphic still has the movement of the small ball bearings that have the ability to mesmerize! I have found that children with autism will often respond to the sound of the ocean drum by looking for the source of the sound. When they see the movement inside the drum they may respond to instructions to wait their turn or follow specific directions in order to gain the opportunity to play the ocean drum. This is a very strong motivator/reward for children with many different disabilities!

5. Surfing ~ This is an obvious choice of activity for use with the ocean drum. Get out your old Beach Boys recordings and turn on, "Surfing USA!" While two people make the waves on the ocean drum, get out those surfboards and catch a wave! This is a great movement to music activity for any age. Use pictures or a short video to set the stage if necessary.

Grab your ocean drum and I'll meet you down by the fishin' hole!

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