Autism Spectrum Disorder and Music Therapy

Nicole Alexander 

 

Introduction 

​

Medicine and the arts are usually considered separate, opposing disciplines. However, new research has shown the positive effects of artistic outlets if used as a form of alternative medicine (Allgood, 2005; Schweizer et. al., 2020; Sharda et.al., 2018; Thompson, 2012; Thompson & Elefant, 2019). Artistic therapies are an increasingly popular aspect of holistic healthcare that explore the use of activities like music, dance, drawing, painting and musical theater to promote physical and mental well-being. These approaches include clinical applications implemented by therapists as well as any form of musical outlets used by an individual. 

 

Specifically, one area of such research focuses on the possible use of music therapy for children and adults with Autism Spectrum Disorders (ASD). ASD encompasses a range of neurodevelopmental conditions, including autism and aspergers, associated with communication and behavioral differences that may affect social and emotional interactions (Allgood, 2005). Research in this field is mainly done one of  two ways: through experimental/clinical trials (Bhararthi, et al., 2019; DeJesus, et. al., 2020; Sharda, et al., 2018; Thompson et. al., 2013) or anecdotal/qualitative studies (Allgood, 2005; Schweizer, et. al., 2020; Thompson, 2012; Thompson & Elefant, 2019). Within most of these studies, there are positive correlations between music therapies and improved symptoms of ASD. However, despite the fact that over 500,000 people in the United States are affected by the condition, ASD symptoms are still considered “abnormal” in most of this research (Allgood, 2005). 

 

Due to these anomalistic presumptions, most literature regarding ASD and art therapy is based upon the assumption that these individuals must be fixed and brought back to what is considered to be “normal.” Music therapy is supposed to be a humanizing way to foster creative instincts, but when they are based upon the assumption that these alternative forms of medicine are simply a means to simply fix the social, behavioral or cognitive variation in a person, the humanistic intent is lost. As a result, these studies often end up being based in apathetic science, leaving out the ways in which this new field of research in music could help mental well-being, rather than just physical barriers. 

 

Methods

 

In order to examine music therapy and ASD, scholarly articles were chosen from a large array of databases including psycinfo and pubmed, both of  which were suggestions on disability research guides. After preliminary readings, many of the pieces used the term “ASD” rather than “Autism” as it is a more general term that encompasses a myriad of conditions. So, this became a more comprehensive label used in research.  Other keywords included “music therapy,” “art therapy,” “home therapy,” “music,” “music intervention,” “case studies” and “ASD,” all of which were used to widen the scope of research and obtain a variety of studies. 

 

Although the words “dehumanizing” and “humanizing” were not used as keywords for research, these terms frequently come up throughout this piece and their distinction is worth noting. In this usage, something that is humanizing takes into consideration all aspects of a person in a holistic sense, which includes their individualized differences, emotions and experiences. Something that is dehumanizing, on the other hand, ignores those aspects and mainly defines a person in a more limited manner; in the case of Autism, the defining feature is usually their disability. In many ways, this removes the human experience from a person and narrows their identity to one thing. 

 

While searching for scholarly articles, it became increasingly difficult to find pieces that discussed the personal benefits of music for individuals with ASD outside of a clinical setting since most of the research was based on controlled experiments; this revealed the clinical nature of the research. However, I was able to find qualitative studies that used case studies and interviews, rather than classic controlled experiments; these two types of studies became the main categories in which the topic was evaluated. From this material, I tried to obtain articles reflecting a variety of approaches and outcomes. I also made sure to include almost all major aspects of artistic therapies, like dance, drawing/painting and music. Regardless of the approach, most pieces drew connections to the improvement of social and communication skills. This shed light on the fact that most literature focuses on bringing people with ASD to a communication level considered to be “normal,” rather than using music as a platform for abled people to understand their unique forms of verbal and nonverbal communication. When the topic is discussed in this manner, the positive implications regarding disabled individuals' mental awareness and ability to appreciate their own differences may be overlooked. 

 

Experimental/Quantitative Research

​

There is a large portion of research that uses standard experimental techniques to quantify the relationship between music intervention and symptoms of ASD. Most of the data in these studies suggest that different types of art may improve communication skills, social skills and emotional awareness (Bhararthi, et al., 2019; DeJesus, et. al., 2020; Sharda, et al., 2018; Thompson et. al., 2013). Due to the objective and scientific nature of clinical research, much of this data only focuses on the improvement of standard behavioral norms, rather than more emotional, intangible results. 

 

Autistic individuals tend to have overconnectivity in their brains, but music intervention may actually reduce overconnecteness between different cortices, often improving communication skills needed to build social relationships (Sharda, et al., 2018). One specific area that can be affected is the auditory-motor connection, which is usually linked to social impairments and are, thus, targeted in many studies (Sharda, et al., 2018). Neural networks in those with ASD also vary from those without the condition, leaving them with “abnormal circuits” which may be reorganized and used to improve social and motor skills through musical training (Bhararthi, et al., 2019, p. 183). To explain this, a study done by the Journal of Exercise and Rehabilitation states that “musical training involves cortical areas of  movement….and improves cortical plasticity and promotes structural and functional connectivity in the brain” (Bhararthi, et al., 2019, p. 183). Most of these tools are seen as ways to “improve quality of life” and enhance skills that are so-called “hindrance[s] to their everyday life” (Bhararthi, et al., 2019, p. 183). Other studies with music intervention have noted statistically significant improvements in social engagement both at home and with peers (Thompson et. al., 2013). 

 

Although many articles focus on music as the primary form of artistic therapies, other types, like dance, are also correlated with an improvement in social skills. A study performed by the journal of Complementary Therapies in Medicine associates negative symptoms of ASD with differences in things like social involvement and self expression, which may be improved by dance therapies that promote self-awareness (DeJesus, et. al., 2020). It is indicated that certain dance therapies, such as TALT, have led to statistically significant improvements in these areas of functioning (DeJesus, et. al., 2020). 

 

It should be noted that in these experiments, there is usually randomization, controls and specific artistic therapies used. As a result, the clinical art interventions are conducted and created by professionals, meaning it is usually not attainable for home-use without a facilitator. Families may be able to use these techniques at home, but the music interventions tend to be specific and medically-based, rather than simple artistic outlets. In other words, although this research has merit, the studies are usually tailored for a clinical setting. This, in addition to the medical jargon used, makes this category of studies non-emotional and only focused on simply solving “abnormal” impairments that are not accepted by society. 

 

Qualitative/Anecdotal Research

​

Other approaches to art and ASD use interviews or qualitative research that base conclusions off of stories recounted by participants (Allgood, 2005; Schweizer, et. al., 2020; Thompson, 2012; Thompson & Elefant, 2019). While it is still a type of clinical study, this category of research tends to rely on anecdotal evidence more than numerical data analysis. In one article in the Nordic Journal of Music Therapy, different experiences were accumulated from various studies and references, leading to the conclusion that artistic outlets add a playful aspect to these childrens’ lives not often present when living with ASD (Thompson & Elefant, 2019). The vitality and joy initiated from this therapy enabled children with ASD to be more expressive and communicative, improving social skills (Thompson & Elefant, 2019). Similarly, after the effects of a specific art therapy program, known as “Images of Self,” were observed, it was found through interviews that 58% of participants had improved levels of emotional regulation, flexibility and social behavior (Schweizer, et. al., 2020). Thus, painting and drawing therapies helped improve a child’s overall sense of self (Schweizer, et. al., 2020). 

 

Another major aspect of qualitative research resided in family-centered care which included the parents, siblings and guardians in the therapy for children with ASD. Compiled anecdotes indicate that parents originally expressed “disappointment” or considered their autistic child to be “lazy” before partaking in music therapy with them, but later observed how lively and engaged they were with the musical outlets (Thompson, 2012, p. 112, 113). Based on other studies which used pre- and post- intervention interviews, many of the parents reported improvements in the ways in which their children interacted with them as well as other peers (Allgood, 2005). Although this method of obtaining data occurs in a slightly more humanizing way that takes into account personal emotions and experiences, the end goals and results of all these studies still focus on bringing Autistic individuals with “disappointing” levels of communication to more “normal” levels of functioning. 

 

Discussion

 

Regardless of the type of research done, almost all of the literature had one thing in common: they were based on the assumption that ASD was a problem that needed to be fixed to meet societal norms. In many of those cases, the standard that needed to be met was the use of “normal” forms of communication and social interaction. However, both categories of research approached this in a different way. 

 

In the experimental research, authors used medical jargon and behavioral measures of success, rather than measures of mental well-being. This dehumanized these individuals, making it seem as though they only had impairments associated with their disability that needed to be addressed. Focusing so heavily on the motor and communication functions of the brain medicalizes the diagnosis and treats it in a very clinical fashion that ignores the positive psychological impact of music. Much of the language associated with ASD in the studies uses terms like “lack,” “abnormal” and “negative,” which immediately positions ASD as an unfavorable issue that must be remediated (DeJesus, 2020, p. 1; Bharathi et.al., 2019, p.183). Even the art methods used are clinical ones that are only performed in controlled settings, meaning they cannot be used to benefit the individual in a more relaxed, non-clinical environment. By medicalizing the connection between ASD and art interventions, very methodical, science-based approaches often look for a problem and try to correct it. This model is not inherently flawed, but, in cases like these, it ignores the fact that individuals with ASD are humans with emotions that should not just be “fixed.” 

 

Although qualitative, anecdotal studies based on observation add more of a humanistic level, they still focus on the idea of bringing abnormal behavior, especially relating to communication and interaction, to a socially acceptable level. One parent in Allgood’s study even said that before the therapy she was “often uncomfortable taking her son to extended family members’ homes because she [was] worried about her son’s behaviors” (Allgood, 2005, p. 96). This shows that she enrolled in the therapy with the assumption that they would ameliorate embarrassing, or unorthodox, behaviors. Another mother in the same study said that “her daughter is sometimes embarrassed by her sibling,” which shows inherent non-acceptance of the behaviors of Autistic individuals (Allgood, 2005, p. 97). At the end of Thompson’s study, she notes that a parent of the Autistic child said that after therapy “he didn’t look or act Autisic” (Thompson, 2012, p. 114). Comments like this one emphasize the fact that people see ASD and the behaviors associated with it as inferior to the “norm,” and, thus, something they want to rectify. If the studies were based on the idea of simply helping children with ASD, outcomes would look beyond the social and  behavioral skills they gained and into how each individual with ASD feels after the artistic therapies. Since these studies, both anecdotal and experimental, are rooted in the assumption that art therapy will “fix” the individual, rather than help them mentally navigate their condition, the humanistic and psychological implications are missing throughout the literature. If these aspects were added to ASD studies, possible alternative methods could quantify improved personal perceptions and emotions associated with music interventions, rather than solely collecting data on behavioral improvements.  

 

Implications/Conclusion

​

Due to the “fix-it” mentality underlying most ASD and art literature today, the issue is medicalized and only viewed in a clinical way that modifies the individual’s communication methods to reflect those of the general population. As mentioned above, much is missed in this approach, including the human experience and emotions behind the condition. However, this focus on pathologization also detracts from the inherent benefits of the arts in a setting outside of a controlled therapy environment. There are few sources that discuss simply listening to music or easy methods to help an individual with ASD at home if therapy is too expensive. 

 

One of these non-clinical, easy methods that helps calm emotions includes watching musical theater. Even if some pieces of literature do discuss alternative forms of music therapy, the barriers to accessing these non-clinical art therapies are not addressed. For example, although musical theater is beneficial for those with Autism, they also have certain light and sound sensitivities that inhibit them from attending normal productions. Additionally, even though it may cost less than clinical therapy on a relative scale, the financial burden may still exist since live theater requires transportation, time and money to buy tickets. However, due to the fact that literature regarding this topic is often so focused on the clinical art methods that “fix” the individual, the non-clinical forms of art therapy are often overlooked and the barriers to receiving even the most basic forms of art interventions are not recognized. If more humanizing studies are done that examine each individual with ASD on a more holistic level, focusing on mental well-being and personal barriers, then more art options may become attainable for each person. Once the literature shifts in this direction, people may be more aware and willing to look into solving financial and sensory obstacles. Perhaps non-profit theaters could raise money to create autism-friendly productions or implement ASD scholarships to be a part of the show, as well as funding tickets. As the barriers to effective art therapies are addressed, the human experience can be seen with each person with ASD, allowing them to reap, not only the behavioral benefits, but also the psychological ones that affect their overall happiness and well-being.