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.

Fox News Story is here.

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

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!

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!