Thursday, November 25, 2010

A Thanksgiving Favorite!

One of my favorite songs for the holiday season!

Monday, November 22, 2010

A Brief Overview of the Son-Rise Program

I presented this for an autism communications class on November 22, 2010.

(Notes: Some of the videos are longer than 2-3 minutes. I used the videos to highlight specific things I was referring to in the presentation and did not always show each video in its entirety. I wanted to have examples of the way the son-rise program suggested setting up the "playroom" and what it looks like when the teacher or parent "joins" in with the child in behaviors. You may want to watch 2-3 minutes of each video and then move along in order to better recreate the sense of the live presentation. Enjoy!)

Saturday, November 20, 2010

Get Your Groove On! Using Drumming in Therapy.

Prezi presentation from American Music Therapy Association National Conference 2010, November 21, 2010.

The information in this outline is partly based on information I developed into a course curriculum for using drums and percussion in music therapy. The course curriculum is based on the idea that teaching students usable drum skills and providing them with multiple opportunities to practice leading drum circles and percussion activities in a supportive environment will lead to increased confidence, decreased anxiety and a greater likelihood that the students will use drumming interventions in the future.




(Additional notes)
My tips:

1. Adapt! - Drum circles usually ebb and flow, changing as new beats and sounds are introduced or faded out. Every drum circle has a different set of people or moods, so you can never go in thinking that you want a certain sound or outcome. It is okay to start with a theme or even some prompted rhythms, but pay attention to the ability levels of the participants and take advantage of moments when you hear a cool beat or sound develop.

2. Experiment! - In my class I have encouraged the students to try out different instruments, sounds, singing, movements, etc. Drum circles are an amazing setting where so many things are possible in a supportive and non-judgmental environment.

3. Listen! - It is important to take time to listen while you are facilitating. You don't always have to be providing guidance. Listen for complimentary rhythms or interesting crossings of timbres. These can be your chance to facilitate and direct the circle into another direction.

4. Live the beat! - Allow the drumming to go where it wants to go. Don't prematurely end a drumming experience unless time is an issue. A drum circle will usually come to a close on its own or settle down to a point when it can easily be facilitated to finish. Just enjoy it while it lasts!

5. Engage your whole body. - Use your whole body to facilitate and not just your hands. Sometimes stomping works or a simple wink in a person's direction. You will want to find a comfortable way to dance to the beat as you are facilitating. Dancing energizes the circle and visually grounds the pulse.

6. Act like you're having fun! - Hopefully you ARE having fun! The point is not to stress about what you are doing. There is not a right and wrong way to facilitate a drum circle, just helpful strategies that experienced people have provided to help you be more successful. Drum circles should provide a supportive environment for many types of personalities and people who want to facilitate.

7. Watch for the "whites of their eyes!" - Good eye contact with the participants is a key to success. Try and look at all the different people and not just concentrate on a few. Their faces will tell you a lot about how they are feeling and what kind of experience they might be having. Obtaining eye contact is also vital before you provide non-verbal instructions or "sculpt" the drumming experience.

8. Start with "Passion" - Stop with "Clarity!" - You should approach a drum circle with a purpose and objective just like any other therapeutic intervention. Drum circles are powerful and can open up a world of emotion and thoughtful reflection for participants. Be prepared to process thoughts and feelings after the drum circle is over. This tip also reminds you to demonstrate excitement for the drum circle before it begins and to be in charge when the drum circle has reached the end of its natural life.

9. Mix and Match! - When possible, provide plenty of different types of drums, shakers and bell sounds mixed all over the drum circle. It is also a good idea to have at least two of each timbre so that everyone has a "partner" and doesn't feel like they stick out when playing a certain instrument. The availability of different timbres will also help you to facilitate when you are using techniques like Arthur Hull's "sculpting" ideas.

10. Make a Transfer! - What is this, you ask? Be prepared to relate something you learned or experienced in the drum circle to something meaningful in real life. It is nice to sit and drum for awhile and we do benefit while engaged in the experience, but hopefully we can take some essence of the circle with us when we go. A short discussion or processing of the drum circle experience after it ends can often spark an idea that can apply to another setting.

Happy drumming!


**Selected Drumming Bibliography**


American Music Therapy Association (2008). AMTA professional competencies. Retrieved April 23, 2010, from http://www.musictherapy.org/competencies.html

Bittman, B., Snyder, C., Bruhn, K., Liebfreid, F., Stevens, C. K., & Westengard, B. S. (2004). Recreational music-making: An integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: Insight and economic impact. International Journal of Nursing Education Scholarship, 1, 12.

Bittman, M. D., Berk, L. S., Felten, D. L., Westengard, J., Simonton, O. D., Pappas, J., Ninehouser, M. (2001) Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Alternative Therapy Health Medicine, 7, 38-47.

Friedman, R. L. (2000). The healing power of the drum. Reno, NV: White Cliffs Media.
Jaques-Dalcroze, E. (1921). Rhythm, music, and education. London: Chatto and Windus.

Kalani (2004). Together in rhythm: A facilitator's guide to drum circle music. Los Angeles, CA: Alfred Publishing.

Lewis, A. G. (1972). Listen, look, and sing. Morristown, NJ: Silver Burdett.

Matney, B. B. (2007). Tataku : The use of percussion in music therapy. Denton, TX: Sarsen Publishing.

Radocy, R., & Boyle, J. (2003). Psychological foundations of musical behavior (4th ed.). Springfield, IL: Charles C. Thomas Publisher, Ltd.

Stevens, C. (2003). The art and heart of drum circles. Milwaukee, WI: Hal Leonard.
Tousignant, M., & DesMarchais, J. E. (2002). Accuracy of student self-assessment ability compared to their own performance in a problem-based learning medical program: A correlation study. Advances in Health Sciences Education, 7, 19-27.

Tuesday, November 16, 2010

AMTA Conference Preview















I will be leaving for Cleveland this week for the American Music Therapy Association National Conference. In addition, we will be celebrating 60 years of music therapy in the United States! Here are some highlights:

  • Did you know that I am featured in the Erfurt Music Resource? Michelle Erfurt will have a booth in the exhibit hall displaying items from all the merchants who are part of her resource. Check it out!
  • I will be presenting my original research regarding a pilot drumming curriculum at the Research Poster Session. I would love to have you come by and see the results from my research questions! Day: Saturday, November 20 Time: 1:30 - 3:30 pm Place: Gold Room Foyer
  • Using Drums in Therapy: Get Your Groove On! My own session to present tons of useful ideas about using percussion in different therapy settings. It will be one hour of fast and furious drumming and learning! Day: Sunday, November 21 Time: 8:00 am Place: Ambassador Ballroom
Don't miss out on many other great events:

Rachel Rambach and company will be doing a CMTE on Music therapy and the web.
Thursday: 1:30 - 6:30 in Blossom
CMTE Q. Music Therapy in a Web 2.0 World: Technology
for Advocacy and Marketing
Presenter(s): Michelle Erfurt, NMT, NICU-MT, MT-BC; Rachel
Rambach, MM, MT-BC; Kimberly M. Sena Moore, NMT, MM, MT-BC
(Pre-registration and fee required) The new Internet (Web 2.0)
is an interactive and informative platform that provides many
opportunities to network, market, and learn. This part-lecture,
part-workshop will provide an introduction various Web 2.0
tools including personal websites and social media. Participants
are encouraged to bring a laptop for an enriching and in-depth
experience.

Kimberly Moore has a great new e-book out about music therapy and private practice.

And Kat Fulton has a new DVD out with great lessons about using drumming with older adults!

Let's go!

Sunday, November 7, 2010

Music Therapy for the Masses!

This story is rapidly going viral on the internet and I could not help but be part of it! What a great philanthropic project on the part of the Knight Foundation! I remember a similar event they did in the subway/train station there in Philadelphia. I am so glad that people in this new event stopped to listen. I think I only saw one lady still trying to make her way through the throng on some errand rather than just taking a moment to listen and enjoy. I was struck, however, by the number of people doing "air conducting." I love seeing how music affects people and how therapeutic it can be in all different kinds of situations. The choice of music was very important. Almost everyone knows the Hallelujah chorus and I think even the most hardened haters of classical music are secretly inspired by its majesty and musicality. Here is the video. I hope you will let me know your impressions and anything that you notice. Enjoy!


Friday, November 5, 2010

Another Market for Music Therapy?


FOXNews.com - If Aliens Exist, They'll Love Bach, Scientists Say

This is definitely a different take on why aliens would visit us. Society places so much importance on math and science, but art always seems to be the hidden force within cultures. I think the authors of this newly presented perspective may have a good point. Aliens may indeed be very interested in our cultures for their art and music. I thought it was humorous that they didn't know the effect of Lady GaGa on alien opinion! It would be very important for us to find out what their preference is since the client's music preference is usually the most powerful intervention tool!

~Live long and prosper...in music.

Tuesday, October 26, 2010

In the News: Autism Rates Still Increasing?

News reports are highlighting a recent study in Wisconsin that may show a stabilization of the autism rate. The investigators believe that autism awareness and changes in classification standards may have been responsible for the "increase" in autism rates over the last fifteen years. The examination of the data in Wisconsin deserves some consideration. There may still be environmental factors that are also part of the increase in the autism rate, but it is important to try and look at everything that might be going on.


http://www.foxnews.com/health/2010/10/25/study-autism-rates-stabilize-wisconsin-schools/

Friday, August 6, 2010

Painting by Numbers: A Musical Collaboration

I was able to collaborate recently with an art therapist during some groups with adults who have mental illness. I loved working in this situation and the art therapist really had some great ideas. I was very interested in the type of art project she presented to the clients and the logistics behind preparing for a large scale painting task. The art therapist was a consummate professional. The art supplies and preparation seemed like second nature to her, so she was able to focus on the process and individual impact of the art on the clients. In contrast, I usually shy away from some art projects because of a lack of knowledge about what type of paint, brushes or paper to use.

Her idea was to use paint on a large surface of different colored pieces of butcher paper. She provided the clients with both traditional and non-traditional "brushes" for tempura paint. The non-traditional brushes were rollers with different imprinted designs, foam brushes or even plastic caps used to stamp designs in the paint. We used six colors: black, green, blue, yellow, white, purple and red. We simply squirted a bunch of paint onto separate paper plates and had the clients gather around a big table with one of the large pieces of butcher paper covering the entire table.

The instructions to the clients were to use a color and style of painting that matched the music played. They were told that the music would be changing every few minutes and that the tempo and style of music would be different each time. Every time the music changed we encouraged the clients to move around the table and try a different part of the painting. We purposely did not give them very many instructions so that the music and their interpretation, if any, could play out. The goal at this stage was to cover the entire piece of paper with paint.

The music I used came from a huge variety of albums. In talking with the art therapist, we decided that there should be both music with and without lyrics. In my experience, music with lyrics provides much more structure for artwork and can be especially helpful to clients with decreased cognitive functioning. But we also wanted to assess the impact of music without lyrics that had strong thematic melodies or striking tempos or styles. Although the first time we did this activity I played the songs in a specific order, I played the selections in a different order the next times I did the activity. I think the main object is to vary the type of music with each change of music rather than try to come up with a certain sequence. Here is a list of music I used:

The Forest Gump Soundtrack (Disc Two): Raindrops Keep Falling on My Head, Medley: Aquarius/Let the Sunshine In

George Winston: Linus & Lucy: Skating

Cirque du Soleil: O

The Best of the Gypsy Kings: Bamboleo

The Forest Gump Soundtrack (Disc One): What the World Needs Now is Love

Classical Thunder II: Infernal Dance of King Kastchei

101 Famous Classical Masterpieces: Ode to Joy

Out of Africa (Soundtrack): Flying over Africa

Cecilia Bartoli: Mozart Portraits

Enya: Watermark: Watermark

George Winston: Plains: Muliwai (Slack key guitar)

Loreena McKennitt: The Book of Secrets

It was so interesting to see the way clients responded to the music. Differences in tempo and style often motivated the clients to paint with long strokes or staccato motions. They also used images described in song lyrics to add pictures to their paintings. When there was just instrumental music being played the painting generally exhibited geometric designs or impressionistic mixing of colors. Interestingly, the art therapist told me that it is common for people with schizophrenia to paint and draw geometric designs or frame pictures with borders. I definitely saw this trend in several of our groups. So far I have tried this intervention with clients on an admissions unit who are waiting to be stabilized and moved to a step-down unit. These groups have been either all male or all female. I have also implemented the activity in a co-ed step-down psych unit with more stable clients.

We allowed the painting to go on for about fifteen minutes until the paper was pretty well covered in paint. I used George Winston's piano version of Cast Your Fate to the Wind to facilitate the next portion of the activity. We had cut out picture frames from card-stock for the clients to use as "view-finders" on the large painting. Everyone was instructed to use their viewfinder to locate a portion of the painting that they liked. We cut out the rectangular images that each person found in their viewfinder and explained to them that they would now recreate this image in a larger size on a new canvas. Here is an example of what one client ended up with:

Sometimes, the clients are not able to cognitively grasp the abstract idea of recreating an image in a larger format. In these cases we taped their cutout image to the back of the card-stock frames and let them keep their piece of art. The art therapist was often able to use the artwork to encourage verbal dialog and discussion with each client.

The whole point of the exercise, of course, is to encourage positive social interaction, increase reality awareness and provide structure for appropriate expression of emotions and communication. We did end up with some nice pieces of art that were entered into a facility art exhibition. This was a nice way to promote client self-esteem.

My next collaboration with the art therapist will be using the "iso-principle" and music while working with clay. Very cool!




Monday, July 26, 2010

Cochrane Review Validates Music Therapy for Brain Injury

This Cochrane Review is basically a database for meta-analyses of research on different medical topics. What is a meta-analysis, you may ask? A meta-analysis is a review of research studies about a certain topic that compiles the data results from the different research studies and then evaluates the data results to find overall trends or significant findings. This month, the Cochrane Review published a meta-analysis of seven research studies involving music therapy and brain injury: Music therapy for acquired brain injury. The results of the meta-analysis showed that a certain kind of music therapy intervention, termed "Rhythmic Auditory Stimulation (RAS)," is an effective treatment for improving measures of walking. RAS is an acronym used to standardize the vocabulary and terminology for music therapy interventions such as using rhythm and tempo to affect gait training after brain injury from a stroke. RAS is a relatively new term from what is being called Neurologic Music Therapy (NMT). This movement within the field of music therapy seeks to do research that documents and explains how music psychologically and physiologically influences human behavior. The field of NMT has tried to codify and standardize much terminology such as "RAS."

The establishment of music therapy interventions in the Cochrane Review is important because the Review is often used as a reference when developing protocols for medical treatment. The Cochrane Review can also be used as supportive documentation for setting up music therapy as a reimbursable service. This latest publication regarding music therapy is a welcome development!

Tuesday, July 20, 2010

Repeat Signs: 7 Great Posts from the Past!

Rachel Rambach over at Listen & Learn Music recently took up a challenge by ProBlogger to publish a list of 7 links to posts that you and others have written that respond to 7 specific categories. I took up Rachel's challenge to continue the effort first started by Darren Rowse over at ProBlogger. Here are the seven categories:

1. Your first post.
2. A post you enjoyed writing the most.
3. A post which had a great discussion.
4. A post on someone else's blog that you wish you had written.
5. Your most helpful post.
6. A post with a title that you are proud of.
7. A post that you wish more people had read.

1. My first post was Schoolhouse Strategy: Counting Using Music. I wrote this on October 30, 2007! I can't believe it was that long ago! This blog was inspired by my work with teachers in special education. While I was doing music therapy in the school system I would often get asked similar questions by different teachers. I wanted a place where I could write down my answers and ideas so that I could provide teachers with a reference after we talked. The blog has become so much more than that over the years, but I love my roots in special education!

2. I enjoy writing my blog so this was a hard call! I loved writing about the gathering drum because it was a "staple" in my bag of tricks as I merrily went from school to school doing music therapy. I wrote a post about ten great ways to use the gathering drum: Schoolhouse Rock: Ten Great Ways to Use the Gathering Drum. I really enjoy writing posts that provide ideas that teachers and other therapists can use.

3. I think parents and sometimes teachers feel that there is a little mystery surrounding music therapy assessments and recommendations. Often people do not understand why a child is or is not recommended for music therapy services as part of an Individual Education Plan. I wrote a brief outline of what happens in a music therapy assessment to try and provide some information about the logistics and process for a music therapy assessment: FAQ: What Happens in a Music Therapy Assessment? I received several comments on this post from a wide range of people and enjoyed writing back to them.

4. Rachel listed one of Kat Fulton's blogposts as one that she wished she would have written. I must do the same! Kat is a wonderful writer and blogs about a variety of subjects. She wrote a great post about the differences between Music Therapists and Drum Circle Facilitators. She has some great insight into the subtle differences between drum circles led by these different facilitators and there is also a great video about "Bongo" Barry Bernstein at the end of the post. Drum Circle Facilitation and Music Therapy.

5. My most helpful post would have to be the one I wrote about music and memory. This post gets almost as many hits as my post about using a parachute or my post about music in a spin class. This post has also been part of a class reading list assignment for an online university music class. Memory Booster! Using Music to Memorize Lists and Facts.

6. Post titles are sometimes difficult to get just right. You are supposed to include pertinent information that is easy for search engines to find, but you don't want all the titles to be the same boring format. I like my Schoolhouse Story series and especially this one: Schoolhouse Story: Scooby Doo Meets His Match! This post talks about a client who has autism and the title doesn't exactly spell that out for search traffic, but I like the title anyway.

7. I have many posts that I wish more people had read, but I think that is how every blogger feels! I would like to introduce more people to Carly, a blogger who has autism. I think that her story opens up all of us to the possibilities that may occur with our clients, friends, and family who have disabilities. So many people discount them for their disabilities, but sometimes it is just a matter of engaging with them or providing a certain facilitation device or strategy that unlocks their interaction with the world. Carly definitely helps us understand more about autism! Carly Fleischmann: Blogger Extraordinaire!

Thanks for offering up the challenge Rachel! This was a fun post to think about!

Sunday, July 11, 2010

Therapy in the Psychiatric Hospital: Music for the Mind, Body and Soul


One of my readers recently asked me a great question. She is a music therapy graduate student working in a psychotherapy setting and would like to know some activities she can do for group activities. I have not written much about the psychiatric setting, although I did complete my internship at a psychiatric hospital and currently do some activity therapy at an in-patient facility. I think that my reader has reached out for ideas because in-patient psychiatric patients can often be a challenging population. Here are some of the things I consider as I develop group activities for clients in an in-patient setting:

1. Although there are many written examples of music therapy case studies with individuals with mental illness, group activities are often described as task analysis and not in narrative format. This makes it important to search out the research literature and try to transfer and apply the findings to practice. This leads to what is termed "evidence-based practice." My first idea is to look at some of the new research by Dr. Michael J. Silverman at the University of Minnesota. The latest issue of Music Therapy Perspectives, for example, published an article by Dr. Silverman that listed therapeutic goals and music therapy interventions by coordinating them with the medical goals and treatment objectives. Dr. Silverman has many other published articles and research papers about using music therapy with this population.

2. Another resource I go to is the edited book by Robert Unkefer and Michael Thaut: Music Therapy in the Treatment of Adults With Mental Disorders: Theoretical Bases and Clinical Interventions. In the back of this book there is a taxonomy of psychological symptoms with corresponding music therapy interventions. I sometimes look through this section to help focus my activities on a particular issue or symptom (i.e., disturbed affect and mood, psychomotor agitation).

3. Music therapy for the mind. One of the most difficult considerations for group music therapy is that the clients (also often called "consumers") have wide ranging states of cognitive ability. Consumers with dual diagnosis (drug and/or alcohol addiction plus mental disorder) and people with intellectual disabilities are often grouped with single diagnosis consumers. Medication changes and time on the unit can also affect cognitive abilities. I have found that the best approach to this problem is to be prepared with multiple activities or activities that can be implemented at different cognitive levels or utilize higher functioning clients as "peer" helpers. I do one fun activity called "Disco Nerf" where a ball is passed around while music is playing and then participants have to make up dance moves if they have the ball when the music stops. The clients who cannot dance can be chosen to be the "DJ" and are put in charge of starting and stopping the music. More advanced clients can be assigned to help their peers make up dance moves or keep the circle going if the music therapist has to leave to help the DJ. I have successfully done this activity in the admissions group as well as more stable step-down groups.

4. Music therapy for the body. Consumers at in-patient facilities often lament the fact that they are stuck inside with little or no exercise. Their diets even have to be closely watched so that weight gain does not become a problem. In some facilities there are outdoor areas or courtyards that can be utilized by clients who have permission. Almost any activity seems to be more fun and engaging when it is done outside (assuming the weather is nice, of course!). Music and movement activities are also perfect for groups in any stage of treatment or stabilization. Aerobics, work-out videos, line dancing, progressive muscle relaxation and even the Wii Fit are all good options.

5. Music therapy for the soul. Religious themes can be problematic in the psych setting for several reasons. One possible pitfall is that some hallucinations and voices associated with schizophrenia have religious overtones. Another reason is the simple fact that you may find a wide variety of religious ideas in one group. Religious differences have often been the stimulus for conflict throughout world history so it can certainly be the case in a group activity of people with mental illness! On the other hand, many clients respond positively to spiritual music and this can be a normalizing experience and a chance to share positive emotions such as hope, happiness and gratitude. I have not usually had any problems with using songs like Down By the Riverside or He's Got the Whole World In His Hands. Mood is an important component to address in overall health, especially when it is known that depressed mood can lead to greater risk of heart attack and depression. One of the easiest and most neutral ways to affect the "soul" is through teaching and practicing relaxation to counter stress and anxiety. You may still be able to use some sedative spiritual music, but the emphasis will be on the relaxation and not on the content of the music.

6. I also wanted to mention the possibility of co-treating with other therapies. In my experience, clients with mental illness enjoy doing art, dance and even drama. If you have the luxury of working with these other kinds of therapists, it is a good idea to explore combining music listening and music creating with art and drama interventions. One of my favorite things to do is having a group create a circle similar to the Hindu or Buddhist "mandala" by using themes from music selections to guide the creative process. The group can make one giant mandala on butcher paper by rotating the circle by one person for each new song or theme. Each person adds his or her own element to each section of the circle. It is nice to see a group combine for a single product and supporting each other with compliments and ideas!



Thursday, July 8, 2010

Get your Groove on!


November 21, 2010.
American Music Therapy Association National Convention, Cleveland.

I will have the pleasure of presenting a session at the music therapy conference in November. I am very excited about the opportunity and I hope that those of you going to conference will be able to attend. I will be talking about some strategies music therapists can use to help them be more confident and comfortable using drumming and percussion in therapy situations. My presentation is partially based on the curriculum I have developed for a music therapy drumming class at Florida State University. I also took data on student performance and self-assessment that has provided some evidence of the effectiveness of the curriculum and its implementation.

I only have one hour, but I hope to share some activities therapists can start using immediately. It should be a fun hour with a good mix of me sharing and the attendees actively participating. I hope you will join me if you can!

Monday, July 5, 2010

All Aboard the Opera Express!



I thought this was great! I love all the smiles and the people who did a little dancing with the cast members. At the end there is a great moment when one observer pumps her fist in the air! What a perfect way to demonstrate the power of music to inspire and improve mood. When was the last time you were smiling in the middle of a huge crowd while waiting for the train?!

Friday, July 2, 2010

A Deceptive Cadence? One of the Hidden Consequences of Obamacare

The website "Americans for Tax Reform" has the headline: Six Months to Go Until the Largest Tax Hike in History.

I usually do not introduce political topics on Music Makes Sense unless they impact things like education and health or other areas that have to do with people with disabilities or medical issues. I know that just mentioning government sponsored health care can send people running to their respective idealogical corners and that is not my intention here. I do think, however, that it is important to be informed about the issues, especially as it relates to all the new laws and policies that will be implemented with the new healthcare laws. If the news articles are true, then what are known as "Flexible Spending Accounts" will become much more limited starting in January 2011. Currently, Flexible Spending Accounts (FSAs), can be used for up to $5,000 in approved medical expenses. This amount will be cut in half starting in January.

The reason this is important to those of us who work with people with disabilities is that FSAs can help pay for special needs education. I do not know the rationale behind the lowering of the amounts people can contribute to their FSAs and we may never know since the healthcare bill was so large and went largely unread by the congressmen who signed it into law. The legislators may not have even realized what they were doing at the time, but it seems like a poor decision unless other accommodations have been arranged to help parents who have children with disabilities.

I like to help my readers understand music and how it works to affect behavior, mood, our physical functioning, etc. I think it is also important to try and make sense out of the laws and rules of society that govern how we can work as therapeutic professionals in schools, hospitals and other settings. I don't know how much music therapy was made possible through people's FSAs, but I do know that if people have to spend more money on special education because they lose their tax credit, then it may lead to them reducing their ability to pay for allied and adjunctive therapies like music therapy.

It is important for us to try and get informed about the new changes to healthcare. There is a lot to learn in a very short amount of time, but now we know at least one consequence that may affect some of the families we work with.

Friday, June 25, 2010

Try to Remember: The Rhythmic Mind

The Spring 2010 issue of the Journal of Music Therapy has an interesting article about memory. Dr. Silverman, from the University of Minnesota, was interested in looking at how different combinations of pitch, rhythm and familiarity of a music selection affected working memory and anxiety.

Sixty undergraduate students were asked to recall six nine-digit sequences using the numbers one through ten, but not the number seven. The nine-digit sequences were recorded under different treatment conditions such as the digits paired with pitch only from a familiar melody (e.g., Old MacDonald) or the digits recorded with the rhythm only from a familiar melody, (e.g., Mary Had a Little Lamb.) The other four treatment conditions were: a familiar melody with both pitch and rhythm, an unfamiliar melody with pitch only, an unfamiliar melody with rhythm only and an unfamiliar melody with both pitch and rhythm. Although Dr. Silverman also investigated the anxiety levels of the participants before and after taking the memory tests, he did not find a significant difference in anxiety levels.

The results indicated that recall of the nine-digit sequences was best for the rhythm only condition. Participants actually remembered the least when the digit sequences were paired with only pitch or with pitch and rhythm. Dr. Silverman hypothesizes that working memory can become overloaded with information and does not function as well when more than one stimuli at a time is streaming in. The "rhythm only" treatment condition may have helped the participants to better "chunk" the digits into meaningful and more memorable groups of information, whereas the number sequences paired with pitch or pitch and rhythm together caused an "information overload" in the working memory.

This research may prove highly useful in a variety of settings. I think that when a music therapist does an assessment, for example, it might be a good idea to try a variety of interventions including the "rhythm only" method rather than only trying to use pitch, preference and rhythm together at the same time. Songs may become a memory aid over time after information is committed to long term memory, but using rhythm to aid in short term memory may provide a good evaluation of a client's response to music. Sometimes music therapists only get one chance to do an assessment with a client, so every successful response to music regarding non-musical goals is an important part of the assessment's conclusion and determination of recommendation.

I also think that this new information about rhythm and memory can be a powerful tool to use during behavior modification. There are many times when a client with autism or cognitive delays will benefit from performing something successful in a short amount of time in order to benefit from positive reinforcement. Perhaps using simple and familiar rhythms to teach key information would be the best approach to helping the client use working memory to respond appropriately and then receive a reward.

Just don't let advertisers get a hold of this new research or we might see a lot more impulse buying!

Silverman, M. J. (2010). The effect of pitch, rhythm, and familiarity on working memory and anxiety as measured by digit recall performance. Journal of Music Therapy, 47, (1), 70-83.

Sunday, June 20, 2010

Gentlemen, Start Your iPods!





The UK Telegraph reported on a recent research study out of France that looked at the effect of a romantic song versus a "neutral" song on the likelihood of a woman to give out her phone number. Interestingly enough, the study found that a woman gave away her phone number 52% of the time after listening to a romantic song playing in the background but only 28% of the women hearing the non-romantic song in the background gave out their phone numbers.

As a music therapist I often advocate for the power and influence of music on behavior, but I am not sure that this particular research proves anything. Although many of us would argue that romantic music "sets the mood," the results of this French research study probably should not be generalized too far.

First of all, the setting for the research does not transfer well to real world situations. The investigators had each lady sit in a room for five minutes and played one of the two songs. They were then told to go in and talk to the man about the advantages and disadvantages between organic and non-organic cookies! Maybe you could equate this situation with a blind date or the first date through a dating service, but otherwise I don't see how useful the findings of the research will be in real world situations.

The researchers also used a man with "average" looks as selected by a panel of women. I don't know about you, but when was the last time you really knew "what women want?!" We could cut Barnes & Noble to half its size if we had information like that!

Another problem with the study was that the researchers only used two different songs. I think it would be important to test a variety of "romantic" songs and then try to categorize and isolate the common elements of the songs that might characterize "romantic" songs with the power to influence behavior.

And for the American guys, this study is no help at all since the "romantic" song used in the research was a French song by Francis Cabrel. On second thought, my wifes loves Francis Cabrel!...I wonder if I can get her to give me her phone number?...

(Image by: Graeme Weatherston / FreeDigitalPhotos.net)

Monday, June 14, 2010

The Other MMS: Multimodal Stimulation with Premature Infants

Music Makes Sense meets Multimodal Stimulation

Multimodal stimulation (MMS) is one of the coolest music therapy applications to come out of the research in the last decade! Dr. Jayne Standley at Florida State University has spearheaded the multimodal stimulation research in the NICU (Neonatal Intensive Care Unit) at TMH (Tallahassee Memorial Hospital). Before I tell you about my experience with MMS, however, it is important to understand some basic ideas supported by the research literature regarding premature babies.

The first concept is that premature babies need sleep in order for their brains to develop. When they are sleeping, they form up to 250,000 neurons per minute. As you can imagine, any interruption to sleep can cause the baby to lose a lot of brain development! In fact, any startle response sends cortisol (a stress hormone) to the brain and stops the brain development until the baby can return to a relaxed state. The environment of a NICU is naturally startling no matter what we do to decrease the noise and intrusions. The medical staff is there to save the baby by whatever means necessary and survival takes precedence over development. The beeping of equipment, people talking, alarms, machinery and routine hands-on medical care are all startling to these babies.

The second concept to understand is that as the baby's brain is developing, it sends out new brain cells from the center outward to other parts of the brain. It is necessary for these brain cells to quickly find a job to do in that area of the brain or else they simply die off, never to be "re-born." A premature baby under all the necessary sedation and medication does not have the opportunity for normal environmental sensory input in order for all of these brain cells to find a "job" and establish themselves permanently in the brain.

These competing ideas of needing to provide appropriate stimulation without startling the baby led Dr. Standley to develop MMS for premature babies primarily 34 adjusted gestational weeks and older. The technique involves gradually layering different types of stimulation in a way that the baby tolerates the input without startling. The protocol works best with two people so that one can hold the baby while the other therapist plays guitar and sings. The music is gradually introduced so that only soft arpeggiated finger picking at a slow tempo and major key are used at first. If the baby does not startle, then the therapist can start humming and eventually begin singing. Most common children's songs are okay and there are even ways to adapt adult folk and easy listening songs to be appropriate for use as accompaniment. A trained music therapist is important for this aspect of the protocol.

The therapist holding the baby proceeds by gently stroking the baby on the face, back, arms, legs, etc., in a set pattern. The therapist is constantly observing positive and negative responses from the baby. Smiles, coos and snuggling are good signs, but any jerking movements, grimaces or cries indicate that the touching protocol immediately must stop until the baby is again relaxed. If the baby is able to tolerate the entire sequence of touch, then the therapist goes through the sequence again while adding gentle rocking. At this point the baby will be listening to music, feeling motion and touch. MMS continues for 15 minutes and is great before feeding time since it prepares the baby to appropriately accept physical handling and environmental input.

The music is a key factor for MMS because it helps to mask the sounds of medical equipment and other startling aural sensations. Sedative music has also proven to be very powerful in stabilizing the respiration rates of premature babies. In addition, the rhythmic music is essential in providing structure and timing for the touch/stroking and rocking.

It is very important to emphasize that MMS should only be done by a board certified music therapist with the NICU-MT certification. Parents of premature infants may also participate in the protocol under the supervision of the music therapist in order to increase parent child bonding.

I was able to participate in MMS during my training to become NICU-MT certified. I am used to holding a baby, since we just had a baby two years ago, but premature babies are so fragile! They are truly precious little miracles and I am always impressed by the parents of these little ones and how well they handle the stress and emotional duress of being separated from their babies so much while they are in NICU. One of the babies I was able to do some MMS with was not very cooperative, but he certainly wanted to communicate! If you remember the saying and gesture, "Talk to the hand!", this little guy had obviously been practicing! I was only able to do a few different touch strokes during the entire 15 minutes because he kept giving me the halt sign. Still, babies have good and bad days just like us and it is really the cumulative effect over multiple interventions that will hopefully show his progress in appropriately tolerating stimuli.

Another baby I worked with allowed me to do almost the entire protocol, including the rocking. This was great! I do have to admit, however, that my arm was rather tired after the 15 minutes. I guess it has been long enough since our own little one was small enough to be cradled that my baby holding muscles have already atrophied!

My description is only meant to be an introduction to one of the evidence-based music therapy interventions currently in use with premature infants. The definitive guide to music therapy in neonatal care can be found in Dr. Standley's book, "Music Therapy with Premature Infants."







Monday, June 7, 2010

An Insider's View of the Fight Against Autism Spectrum Disorder

Five Things You Should Consider When You Find Out Your Child Has Autism

I often talk about Autism because so many of my clients with ASD respond so well to music therapy strategies. I have mentioned The Thoughtful House in Austin, TX as one of the places that tries to take a holistic approach to treating the symptoms of the disorder. Specialists at The Thoughtful House believe that some autism disorders may sometimes be related to the inability of the body to correctly process toxins and metals. New research is starting to corroborate this theory and establish a link between problems in the gut with processes in brain functioning. In my review of the research, work with clients and examination of practice treating the issues of diet and toxicity in children with autism, I have found that treatment can be helpful for some children, although it does not seem to be a cure-all for Autism.

The following guest post is from the perspective of a mother who has a son with autism. She has found the combined treatment of ABA therapy and bio-medical treatment for her son to be highly successful. I am very excited to introduce her as my first guest blogger! Anne Marie White has a Bachelor of Arts in Communications from BYU-Idaho. She is currently working on a Master's degree in Speech and Language Pathology. Anne Marie lives in Texas with her husband and two boys, the oldest of which was diagnosed with PDD-NOS (Pervasive Developmental Delay - Not Otherwise Specified) two years ago. She has implemented intensive ABA (Applied Behavior Analysis) and bio-medical therapy for her son ever since that time. In her own words, "I work hard to be the best mother I can be to my children by learning everything I can about Autism."

I asked Anne Marie to write a post from the perspective of someone who had to learn quickly about what she could do to help her son with Autism. Since I have mentioned the Thoughtful House before, I asked her to provide some insight for parents and others who might be just starting out finding what to do in the case of a child with ASD (Autism Spectrum Disorder). As I read her thoughts, I could not help but feel her fierce determination and great love for her son. Here she is in her own words:

On December 15, 2008, my world as a mother changed forever. On that cold day, in a small room, I was told that my son had Pervasive Developmental Delay—Not Otherwise Specified (PDD-NOS). I was told that there was no hope that he would ever lead a normal life. They said that there was no cure and no one knew why 1 out of every 91 kids was being diagnosed with some form of Autism Spectrum Disorder (ASD). They told me the best I could do was to start some Occupational Therapy (OT), Speech Language Pathology (SLP), and try any other therapies I might hear about. In their opinion, I would be wasting my money, and I should expect to have to take care of my son for the rest of his life.

Well, after that day I felt very alone, like I had no hope. I had no idea what I was going to do. So for the next 4 months I did nothing but grovel in self-pity. Then one day it felt like God woke me up with a slap in the face. I was sitting at home and I got a phone call telling me to turn on the TV and watch the show “The Doctors” on NBC. That day they were talking about Autism. They said that there are kids recovering and living a normal life. These kids were recovering through bio-medical treatment and Applied Behavioral Analysis (ABA) and other forms of therapy. Ever since that day, I have never stopped looking for the thing that will cure my son. My son is now making great eye contact, he plays with other kids, he now has many words, and he has almost completely recovered. I would like to share five things that I wish someone had told me at the start of this journey my family has been on:

1. DO NOT blame yourself or your spouse.
I blamed myself for four months and didn’t want to do anything. I kept asking myself what I had done wrong. Let me be clear, you have done NOTHING wrong; it is what it is. We all have trials in this life. It’s what we do with them that makes us who we are. Give yourself permission to wallow in self-pity for some time and then pick yourself up and get started healing your child. I lost four precious months that could have been used more effectively!

2. Take action while your child is young. Do not wait.
A mother knows deep down that there is something not right with her child. Do not block out those feelings. You have them for a reason. As much as you don’t want to hear it, you need to get your child diagnosed so you can move on and recover your child. It is important to know where your child stands on the autism spectrum so that you can learn how to help him or her. Every child is different and what works for one may not work for another. You must be your own detective and find out what works with your child. Young children are amazing and can overcome things that seem impossible. And believe me, some days it does seem impossible! Just keep going! Find out early, and then get started quickly, helping your child to recover.

3. Go to a “Defeat Autism Now” (DAN) Conference.
This was a life changing event in my life and now I go every year. You will meet leaders in the field of autism and you will learn how bio-medicals may change your child’s life. You will learn about the newest research in autism and meet other parents who know how you feel and can give you ideas. My first DAN conference not only gave me the hope I needed to go on, it gave me a direction to go in.

4. Find a DAN Doctor.
There are DAN doctors all over the country that are doing bio-medical treatment with children who have autism and some of these kids are recovering. When you find the doctor that works for you, listen to him and follow what he says. Do the diets and the vitamins because it is worth the hassle. My son has improved so much from our diet change and by adding the vitamins to help him get what he needs. Do not let anything stop you from finding the right doctor. We have to drive 7 hours to get to Austin to go to “Thoughtful House”, but it is worth every hour and penny spent. I am changing my son’s life and he is changing mine.

5. Start therapy NOW.
My son does speech therapy, OT, ABA, and many other forms of therapy. Do as many hours as you can. I know therapy is very expensive, but if you do it now, hopefully you will not have to do it forever. ABA has done amazing things for my son. Find out what works for your child and run with it. Bio-medicals can only do so much. We must also find a way to teach our children what they have missed while they were in the fog caused by the pollutants in their brains.
Finally, learn as much as you can about autism. I am not saying every child will recover, but children do recover. We, as parents, have to fight for our kids and give them the best chance at a normal life. I hope this helps someone else to begin or continue on this journey with Autism.

~Anne Marie Tague White

In full disclosure, I should say that Anne Marie is my sister. Thanks, Anne Marie for sharing your story and being passionate about helping your son! I know your words will add to the community and strengthen others in their fight!



Thursday, May 27, 2010

Which one of you is the Music Therapist?

Reconciling Music Therapy and Arts in Medicine Programs

Music therapists have long sought to establish music therapy as a recognized therapeutic practice alongside physical therapy, occupational therapy and speech therapy. We have seen success in accomplishing this through much research and the establishment of clinically proven protocols. Music therapists are generally happy to see other people use music to aid in health and learning because most people already have a sense that music can aid in these processes. So more people providing music in a variety of settings is a good thing in my mind, but this situation has caused some small angst for music therapists over the years. Although music therapy, as an official profession in the United States, is now sixty years old, there are still many people who would see us as the "traveling minstrel" of the hospital or school.

Arts in Medicine programs have the benefit of providing access to the arts for patients who are forced to stay in hospitals for any length of time. They typically involve all art forms, including dance, art, music, poetry, and even gardening. One possible drawback, however, is the potential confusion about the roles of volunteers and trained music therapists in using music in the hospital setting. I honestly had not realized that Arts in Medicine (AIM) programs have been flourishing so well around the country. In a brief survey around the web, I found programs at the Cleveland Clinic, Texas Children's Cancer Center, and the University of New Mexico. We also have a large program at Tallahassee Memorial Hospital through Florida State University and there is another flagship program called the Shands Arts in Medicine program through the University of Florida in Gainesville.

The AIMS (Arts in Medicine Service) program here in Tallahassee does a very good job of differentiating music therapy from the volunteers and students that bring the art and performing art into the hospital. The AIM program for Tallahassee Memorial Hospital (TMH) is designed to, "Improve the aesthetic environment" of the hospital. There is no attempt by members of the AIM program to implement goals and objectives to directly influence health or treatment outcomes. Since TMH has two full-time music therapists and generally two music therapy interns, all direct patient care involving music is handled by the music therapy department. AIMS participants are supervised by Florida State University and receive college credit for their work. They do not use music in one to one contact with patients, but are regularly scheduled to perform concerts in the hospital atrium. In this way, the line between music therapy and AIMS personnel are clearly defined and easy to understand by patients and staff.



The University of Florida employs a completely different model of providing the arts to the hospital setting. The Shands Arts in Music program actually employs full-time "artists in residence" who work at the hospital and supervise the other AIM participants. The "artists in residence" who provide music are not necessarily music therapists, and music therapy is not provided at the hospital. The Shands program is a robust endeavor with more than one hundred volunteers participating throughout the year alongside the "artists in residence." The program at Shands was specifically designed to apply the arts to patient care and not simply improve the aesthetic environment through exposure to the arts. As seen in the picture above, the environment at Shands hospital has been dramatically impacted by the AIM program, but the "artists in residence" are also specifically tasked with developing arts interventions to aid in patient care. I find this idea troublesome since art, dance and music therapists go through much specialized training in psychology, counseling, anatomy, etc. in addition to training in their medium in order to meet the needs of clients.

I think I prefer the AIMS model at TMH because of the well defined boundaries between people doing music therapy and other people doing music to increase the aesthetics of the environment. I admire the University of Florida program for its creativity and dedication to the arts, but it would be nice for them to also recognize the use of music by musicians who have been trained in applying it therapeutically using research-based protocols. I would like to know how other music therapists feel about this situation. I also wonder what it looks like from the outside looking in, from non-music therapists approaching a hospital with one or both programs. Maybe I am over-sensitive to the development of AIM programs or do you think that it might be confusing for a patient to distinguish music therapy from AIMS program members?

Please feel free to share you story of an encounter with music therapy or AIMS when you went to the hospital!


Monday, May 24, 2010

What's In a Name? (Part 2)

Bipartisan Senate bill aims to take 'retarded' out of federal lexicon - TheHill.com

I have already blogged (here) about the changes coming in the new Diagnostic Statistical Manual of Mental Disorders (DSM-V) in May 2013. Congress, always trying to join the "popular" club and somehow redeem themselves, has also jumped on the bandwagon. The American Psychological Association has not endorsed the new bill trying to make it out of committee, but they are also not opposing it. The new bill would change all federal references to "mental retardation" and "mentally retarded individuals," to "intellectual disabilities" and "individual with an intellectual disability." The bill is also known as Rosa's Law, named after Rosa Marcellino of Maryland who has Down Syndrome. Rosa's family successfully lobbied the legislature in Maryland to change the wording at the state level and the crusade was picked up by the national legislature.

I don't see anything wrong with the name changes and just want to keep you up to date on the current proceedings. Society will probably insist on changing the name again in the future as "intellectual disabilities" becomes a "bad" word or phrase. I think that we must continue to strive against ignorant people and people who don't think before they speak. There will always be these people in the world, but it is really their actions and not their words that we should pay attention to.

Sunday, May 23, 2010

Hit List! 5 Ways to Successful Drumming with Older Adults.

Drumming activities can be very effective with a variety of populations, including older adults. Many older adults who have been placed in care facilities have symptoms of dementia or may even be diagnosed with Alzheimer's Disease. Although this client population typically presents with lower motor skill coordination and less spontaneous social interaction, this should not discourage you from doing drumming activities! Here are five things to keep in mind when working with older adults in group settings. These ideas will assist you in successfully leading a drumming activity:

1. Use the power of Entrainment! This means that objects in motion or rhythms and beats tend to coalesce or converge when given the opportunity. Imagine a large group of people all start drumming a simple beat at the same time. At first, the sound will just be random drumming without a sense of rhythm or underlying pulse. The beat will eventually emerge and the group will naturally begin playing together on a unified pulse. This phenomenon holds true for any group of people, including some people with disabilities. I have witnessed entrainment many times in groups of older adults. In order to facilitate entrainment, try to provide a steady beat or pulse on a drum with a low sound. Entrainment also takes time. Don't feel bad about allowing what may sound like rambling drumming to continue until entrainment starts to occur.

2. Reminiscing. This is an important tool for working with older adults because it helps to improve their quality of life. Remembering and talking about favorite places and things promotes positive emotional responses and improves interactions with staff and family. Groups of older adults will probably have varying ability to remember things about their life, but props, pictures and songs can be helpful in encouraging participation. I like to use word rhythm drumming about favorite places, hometowns, foods, etc. Word rhythm drumming is simply breaking down words into their syllables and playing the syllable parts with the same emphasis and cadence you use while speaking the word. Different words can be used with different types of drums, shakers or bell sounds to create unique and fun drum activities.

3. Themes. Theme-based activities compliment the use of reminiscing. The easiest way to employ themes is to talk about current events and holidays. Many of these events have songs that are already well established, so the chances are greater that many of the clients will know the songs. Christmas, the Fourth of July and Baseball are all good examples of events to build themes around. Other themes can be found through investigating songs and events from the clients' early adult years. The ages of 18-30 have been found to be the most significant for developing taste and preferences for music. This age span is also sufficiently young enough that clients with Alzheimer's will be more likely to remember things from that time. Songs like, Alexander's Ragtime Band, My Bonnie Lies Over the Ocean, BINGO, and Deep in the Heart of Texas have been big hits with some of my groups! All of these songs have natural places to add in instrument and drum playing.

4. Dancing, moving, sharing. One of the most important ways to increase success with older adults is to get them moving! Kinesthetic involvement with the music is a key to unlocking old memories. Moving to music also increases entrainment and meets goals and objectives set by medical staff to practice motor skills. Exercise routines, stretching, and relaxing can all be facilitated with drums and instruments. Try using an ocean drum to facilitate moving a parachute up and down. Another great idea is to end the group with very soft rhythmic drumming facilitated with ambient sounds of the ocean drum or rainstick and soft music while doing deep breathing and relaxation to simple imagery. Ocean drums, paddle drums and gathering drums are great instruments to encourage sharing. Older adults in facilities tend to keep to themselves and can benefit from strategic settings that promote social interaction.

5. Look for Rhythm Allies. This is term coined by Arthur Hull, Christine Stevens and the other founders of drum circle facilitation. Rhythm Allies are your special helpers that you have instructed before the activity to help maintain the beat, work with specific clients or play special instruments at appropriate times. Rhythm allies are usually staff or family members, but I have also received help from capable clients when possible. Rhythm allies are more important with groups of clients who have more severe dementia or physical disabilities.

In addition to the previous considerations, I suggest a 30 minute music session as an optimal time to maintain focus of attention. It is also important to be aware of clients prone to agitation or who have pain that prevents certain movements.

Good luck and please let me know how it goes!

Saturday, May 15, 2010

Primer on Music Therapy from the Library of Congress




Concetta M. Tomaino is a music therapist and executive director for the Institute for Music and Neurologic Function. The Library of Congress has been doing a great series of presentations on Music and the Brain. Ms. Tomaino spoke on March 12, 2010 with a presentation titled: The Positive Effects of Music Therapy on Health. She then did a podcast discussing how music therapy has changed over the last ten to fifteen years and provided a wonderful modern primer on what music therapy is and where it is being used.

Dr. Jayne Standley from Florida State University did a presentation on May 14, 2010 titled: Wellness and Growth: Acoustic Medicine and Music Therapy. This presentation is not yet available through the Library, but I am confident it will be a must read in the future. I will try and link to it when I can. In the meantime, here is the podcast from Concetta Tomaino. It is only 17 minutes long, so well worth your time and manageable to fit into hectic schedules!

Library of Congress Podcast: Music and the Brain

Friday, May 14, 2010

The World Gone Crazy!





The story describes a middle-school boy who drew a picture of two stick figures. One of the stick figures is the student holding a gun and pointing it at the other stick figure who is labeled as the teacher. The mother of this 14 year-old boy claims that he has autism and a documented I.Q. of around 75. If this is true, then he most certainly should be in the special education system and have an Individual Education Plan. The school is refusing to confirm anything about his case, so at this point we only have the information from the mother. If her statements are true, then I have no idea what this school system is doing!? The school district has this boy scheduled for a "tribunal" and charged with terrorism! Apparently the drawing goes against the districts "zero tolerance" policy. What are people thinking!!??

So, we are to believe that charging a 14 year-old with terrorism charges is going to help the situation or somehow prevent others from drawing pictures!? Obviously the student was upset with his teacher about something and if he has autism, then probably lacks the ability to appropriately express his feeling. He also might be simply drawing something that he saw on TV! Who knows! That is the whole problem with Autism Spectrum Disorder, of course. We often do not understand why the stereotypical behaviors, verbalizations or acting out are occurring.

It would be nice if school administrators with their misguided, although well-intentioned, rules (i.e., zero tolerance) would step aside and allow the trained therapists and diagnosticians handle cases like this. Now that there is all this publicity it will probably make the situation worse and this student's education and learning will end up taking a back seat on the priority list.

I hope you will share your thoughts about this. I am obviously a little outraged, but maybe there are other circumstances we do not yet know about. It should make us all, however, try to think critically about the rules and standards in our public schools. District superintendents get paid hundreds of thousands of dollars per year in salary. I question their value when they lack the courage to take a look at individual cases instead of deferring to blanket rules and standards.

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Saturday, April 24, 2010

The Wheels on the Bus!

WARNING! This is not your typical book review!

This semester I have been in Dr. C. Madsen's class on the Modification of Behavior. The textbook for the class is:

Teaching/Discipline: A Positive Approach for Educational Development

I could choose any book to review by taking ideas we learned in class and explaining how they applied to the book. I chose, The Wheels on the Bus, because I thought if I could apply the theories of behavior modification to a children's book, then I should have a good grasp of the concepts! (I also happen to love this book!) If you get lost with some of the behavior "mod" jargon, then go read Teaching/Discipline. That book is the basis for every successful behavior management program out there. Every therapist should have a thorough understanding of the ideas Dr. Madsen presents.





Zelinsky has created a wonderful book that I frequently use in therapy and with my own daughter, Darby. The book is colorful and has pop-ups and moving parts that are visually appealing to young children. Zelinsky has remained faithful to the song for his inspiration and kept the traditional lyrics as text for the book. On the surface, Zelinsky’s book tells a simple story, but it also contains many examples regarding the principles of behavior modification.

The story centers around a city bus opening its doors to a myriad of townspeople on their way to various destinations. Any city bus system is part of an overall strategy of government to promote mass transit as a preferred mode of transportation. In essence, the city is running a government sponsored behavior modification program. The pinpoint is that there are too many cars on the roads causing traffic and congestion. A city usually has several parts of a highly developed consequent in order to increase bus ridership. Taxes are levied on automobiles, gas and parking. Parking restrictions are enforced so that there are fewer spaces for cars and more room for bus stops. Positive reinforcement includes the city subsidizing payment for bus fare and creating special bus lanes to allow buses freedom of movement. Public awareness advertising emphasizes the value of using the bus system. Evaluation of these programs indicated that bus ridership increased, but only for people who did not also have a car.

The people on the bus often must contend with noisy distractions like the windows going up and down and the window wipers swishing back and forth. Another nuisance is the crying babies. In the story, the mamas on the bus just tell the babies, “Shush, shush, shush!” The babies do not necessarily respond to this plea because it is not a sufficiently powerful disapproval and there are not contingent consequences. One possible solution to the crying babies could be a program that includes rewards for quiet behavior. Pacifiers, food and toys would be good motivators. The mothers may also want to approach bus riding in steps of successive approximation by taking their babies on the bus for short rides at first and increasing the time on the bus as the babies increase their tolerance and time of quiet behavior. In extreme cases, some mothers may have to practice systematic desensitization by exposing their babies to progressively louder noises as they are relaxed and happy until they are able to be on the bus without crying. Evaluation of these strategies has indicated that babies on the bus were able to sleep, sleep, sleep.

Zelinsky tells the story of the bus as it makes several stops throughout the city. The bus maintains a schedule on a variable interval, so some people miss the bus and others have to wait. Each time the bus picks up a rider, the bus driver provides verbal reinforcement by saying, “Move on back!” Some of the riders accept this as verbal approval, while others feel that it is disapproval, but they all respond to the reinforcement by following through on the directions. The narrative also relates that there is sometimes traffic and bad weather. The driver on the bus frequently hits the horn, “Honk, honk, honk!” This behavior usually does not solve the traffic problem since the bus driver is unable to follow through with contingent rewards or punishments and must continue to drive the bus to the next stop.
Overall, Zelinsky offers a colorful tale of life in the city. The characters in the story lead a life of repetition and generally allow their environment to dictate their actions. In reality, who decides what kind of bus system a city will have and who decides who will decide? Children love to read this book over and over until they have developed conditioned responses to many different phrases such as, “The wheels on the bus,” go, “round and round!” This has been a favorite book in my house and for road trips as we travel all through the town.

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