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imagine.magazine Fall 2014 l Vol.5, No.1

2014 Your resource for early childhood music therapy imagine 5(1), 2014


imagine.magazine ISSN 2153-7879 All rights reserved.

editor-in-chief Petra Kern, Ph.D., MT-BC, MTA, DMtG contributing editor Marcia Humpal, M.Ed., MT-BC editorial assistance Rose Fienman, MSW, MT-BC Gretchen Chardos Benner, LMSW, MT-BC Dana Bolton, M.Ed., MMT, MT-BC copy editing Lisa Jacobs, MM, MA, MT-BC business manager & design production Petra Kern, Ph.D., MT-BC, MTA, DMtG publisher de la vista publisher imagine is the primary annual online magazine dedicated to enhancing the lives of young children and their families by sharing knowledge, strategies, ideas, and policies related to early childhood music therapy with colleagues and parents worldwide. Visit to access additional multimedia contributions and 18 years of archives.

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join imagine imagine publishes articles that are directly related to early childhood music therapy (ages: zero to five), grounded in evidence-based practice. topics include professional wisdom event reports and reflections research snapshots and reports innovative clinical practice parents can series children's corner early childhood music programs intervention ideas color of us series video/audio podcasts teaching episodes photo stories useful online resources book reviews with audio bookmarks ....and much more possible formats mutlimedia article video or audio podcast photo story, or invited teaching episode for more details, visit our website at

sponsorship imagine is currently free and accessible to everyone. Make a donation and help us to cover the editing, production, and website costs. Sponsors are listed as supporting partners on the imagine website. advertise imagine is the perfect place to advertise your products and services for young children and their families, or music therapy education. Advertisement rates and specifications may be obtained by visiting the imagine website or sending an email to disclaimer The opinions and information contained in this publication are those of the authors of the respective articles and not necessarily those of de la vista publisher or members of the editorial team. Accordingly, de la vista publisher and the editorial team assume no liability or risk that may be incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this publication. No endorsement of authors, products, or services is intended or implied.

next submission deadline May 15, 2015

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editorial Your Access to Latest Trends and Practices As is evident by this fifth issue, imagine continues to be your access to the latest trends and practices in early childhood music therapy. The focus of imagine 2014 is on family-centered practice – a trend taking hold in music therapy circles worldwide. While many practitioners in the USA already embrace and implement key elements of family-centered practice in their music therapy sessions, researchers are now looking into the measured benefits it oers. This issue also presents research and practice articles as well as a podcast on Autism Spectrum Disorder (ASD), a continuing topic of interest among readers. Several colleagues also address parent-child attachment and emotion regulation. Furthermore, cultural sensitivity is examined as an all-time popular topic among those gathered at the 14. World Congress of Music Therapy in Vienna/Krems, Austria this year. Whether you are a visual, auditory, or kinesthetic learner, imagine has it all. This issue features 44 text-based articles plus 15 videos, 13 audio files, 9 audio podcasts, 4 photo stories, and numerous hyperlinks that invite additional exploration. Last year, imagine reached out to 1.15 million potential readers via email and social media. How many readers will our imagine authors reach this year?

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Our long-standing author and member of the early childhood music therapy network, Beth McLaughlin, opens this issue with 10 tips on creating successful song interventions. Renowned music therapists Mary Adamek, Alice-Ann Darrow, and Judith Jellison reflect on special education concepts and initiatives that should be part of every early childhood music therapist’s vocabulary when collaborating with schools. Our new imagine editorial team member Dana Bolton makes her debut in the featured article about early childhood musical development. Based on the literature, she created video clips from her early intervention sessions to demonstrate children’s musical developmental stages. The efforts of AMTA’s steering committee and advisory team on music therapy and ASD do not go unnoticed in this issue. Their efforts to encourage the translation of research into practice may be seen in Blythe LaGasse’s overview of current music-based research with young children (including those with ASD) and my summary of the recent national survey study on ASD. Edward Schwartzberg reviews three of his recently published studies on the clinical use of music for children with ASD. Grace Thompson features the effects of family-centered music therapy, supported by an exclusive video interview with a father of a child with ASD. Christopher Millett, Austin Robinson, and Olivia Swedberg Yinger round out the research section with an intervention tracking checklist that documents preoperative music therapy for young children. This issue also features a broad range of family-centered practices such as a case example with a Thai client and his family (Dena Register and Melissa Hill Gillespie), tips on supporting parent-child attachment (Becky Wellman), music supported bedtime routines for adoptive families (Erin McAlpin), and parental singing (Denton and Weeks). Through podcasts, authors address why, when, and how to discuss developmental concerns with families (Elizabeth Schwartz), support healthy sibling development with music (Meredith Prizzi), musically foster communication between premature infants and parents (Friederike Haslbeck), and build family and community through percussion and drumming (Bill Matney). Likewise, Rachel Rambach presents a teaching episode on involving fathers in music therapy sessions and I have created a list of annotated resources for you.

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Articles related to understanding emotion regulation development (Kimberly Sena Moore) and our intervention ideas section featuring former students from the University of Louisville and seasoned music therapists should be of special interest to clinicians. The podcast series also offers hands-on information with multiple music examples. We continued the early childhood music program series by examining the Kodaly (Kelly Foster Griffin), Dalcroze (William Bauer), and the Orff (Cindy Colwell) approaches to music therapy. We also included a list of selected Twitter handles related to early childhood (Rose Fienmann), publications, and book reviews with audio bookmarks. Generally, early childhood music therapists have been active around the world, presenting and meeting at conferences. Read about their ventures in the 2013 AMTA Early Childhood Network report, the AMTA government relations summary, and overviews of an early childhood symposium in Seattle, Washington, the inaugural meeting of MANDARI in London, UK, and the World Congress of Music Therapy in Vienna/Krems, Austria. Our color of us series features the World Congress round table on music therapy with young children and their families in Europe along with brief interviews. Cultural matters are also reflected in articles by Nicole Rivera and Danara Barlow, Illene Berger Morris, and Satoko Mori-Inoue. Introducing parents can last year, we now started a children’s corner asking children about their explanations, perspectives, and everyday wisdom about music therapy matters. Ed Gallagher, Marcia Humpal, and Kirsten Meyer asked the children with whom they work, “What is music therapy?” Find out what the children have to say. It is this energetic spontaneity, unpredictability, and element of surprise that keeps me smiling and loving my job. I imagine that is what inspires you, too. Sincerely,

Petra Kern, Ph.D., MT-BC, MTA, DMtG Editor-in-Chief, imagine


contents inside this issue editorial Your Access to Latest Trends and Practices Petra Kern............................................................


wisdom 10 Tips for Choosing and Creating Song Interventions for Young Children Beth McLaughlin................................................. 10 reports 2014 Early Childhood Music Therapy Special Target Population Network: Meeting Report from 11-22-2013 Gretchen Chardos Benner................................... 12 Policy News for Early Intervention (USA) Judy Simpson...................................................... 16 Emerging Trends in Early Childhood: Music Therapy Symposium 2014 Patti Catalano....................................................... 18 It Takes a Village…The Emergence of a Team Science Collaboration for Music and NeuroDevelopmentally At-Risk Infants: Meeting Report of the Inaugural Meeting of MANDARI from July 1-3, 2014 in London, UK Deanna Hanson-Abromeit and Helen Shoemark.................................................... 20 Cultural Diversity in Music Therapy Practice, Research and Education–World Congress of Music Therapy Vienna/Krems, Austria, July 7-12, 2014 Rose Fienman, Marcia Humpal, Kumi Sato, and Talia Girton............................................................ 24

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reflection Successful Interdisciplinary Communication in Schools: Understanding Important Special Education Concepts and Initiatives Mary Adamek, Alice-Ann Darrow, and Judith Jellison....................................................... 28 featured One, Two, Three, and Do, Re, Mi: Early Childhood Musical Development for Music Therapists Dana Bolton......................................................... 38 research 2014 Early Childhood Research Snapshot Blythe LaGasse.................................................... 42 Did You Know? Clinical Practice Trends in Music Therapy and ASD Petra Kern............................................................ 46 Supporting Parents to Support their Child through Music Therapy Grace Thompson................................................. 48 Effects and Clinical Uses of Music for Children with Autism Spectrum Disorder: A Review of Three Recently Published Articles Edward Todd Schwartzberg................................ 51 Tracking Interventions Used in Preoperative Music Therapy for Young Children Christopher R. Millett, Austin S. Robinson, and Olivia Swedberg Yinger........................................ 56 photos Photo Stories 2014.............................................. 61


practice Research, Clinical Practice, and Theory: Creating a Framework for Music Therapy in Early Intervention Dena Register .................................................... 62 Addressing Attachment, Emotion Regulation and Communication in a Clinical Setting Using a Case Examples with a Thai Client Dena Register and Melissa Hill Gillespie............. 66 Music Therapy and Parent-Child Attachment Becky Wellman.................................................... 70 Creating Safety at Bedtime: How Music Can Support Adoptive Families Erin McAlpin........................................................ 73 Understanding Emotion Regulation Development Kimberly Sena Moore.......................................... 76 Parent Singing in Relational Treatment of Children with Autism Spectrum Disorder Dorothy S. Denton and Kaja Weeks.................... 80 Developing Multicultural Sensitivity in Early Childhood Music Therapy Practices Nicole R. Rivera and Danara Barlow................... 86 Music Therapy to Support a Preschool Transitional Bilingual Educational Program Ilene Berger Morris.............................................. 90 Music Therapy: Following the Universal Newborn Hearing Screening in Japan Satoko Mori-Inoue............................................... 95 parents can Ideas for Parents of Children with Cerebral Palsy Jamie George, Andrew Littlefield, Andrea Johnson, Tasia Dockery, Lana Card, and Jordan van Zyl......................................................................... 99

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Ideas for Parents of Children with Speech Language Delays Jennifer W. Puckett, Chelsea Kinsler, Alison Williams, Hannah Bush, and Ashley Frazier................................................................. 100 Ideas for Parents of Children with Down Syndrome Jeffrey Wolfe, Rebecca West, Deborah Soszko, Jenni Rook, and Pan Ho..................................... 101 programs Organization of American Kodály Educators Kelly Foster Griffin.............................................. 102 Dalcroze Society of America William R. Bauer.................................................. 104 American Orff-Schulwerk Association Cindy Colwell.......................................................106 ideas What’s on the Mat: Traveling and Exploration Mary Brieschke................................................... 108 Groovin’ with My Scarf: Expressive Movement & Recognizing Colors Christopher R. Millett.......................................... 109 Drum Together: Improving Joint Attention Ashley Miller........................................................ 110 Circle Dance: Imitation and Social Interaction Lindsay Foster..................................................... 111 Roly Poly: Addressing Developmental Goals Ellen Trammel..................................................... 112 It’s Your Turn: Teaching Children Social Language Beth McLaughlin................................................ 113


Hooray for letter H! Brenda Calovini ................................................. 114 Heads and Shoulders 1, 2, 3 Ruthlee Figlure Adler.......................................... 115 color of us Color of us at the 14. World Congress of Music Therapy in Vienna/Krems, Austria Petra Kern and Rose Fienman.......................... 116 podcasts Stopping the Music: Why, When, and How to Discuss Developmental Concerns with Families Elizabeth K. Schwartz......................................... 120 Creative Music Therapy in Neonatal Care: Supporting Communicative Musicality from the Very Beginning Friederike Haslbeck............................................ 120 Co-treating With Speech-Language Pathologists– Before, During, and After the Session Matthew Logan and Rachel See........................ 120 Supporting Healthy Sibling Development with Music Meredith R. Pizzi................................................. 121 Percussion and Drumming: Building Family and Community Bill Matney.......................................................... 121 Clinical Decision Making in Music Therapy Carol Ann Blank.................................................. 121 Let’s Collaborate-A Follow up from 2013 Laurel Rosen-Weatherford.................................. 121 Across the Spectrum: Meeting the Needs of High Functioning Clients with ASD Laura S. Brown................................................... 121

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Rhythm, Rhyme, and Remarkable Repetition: An Effective Foundation for Literacy Kathy Schuhmacher........................................... 121 resources Empower Me: Family-Centered Practice Petra Kern ......................................................... 122 Follow Me: Connecting to the Early Childhood Community on Twitter Rose Fienman.................................................... 125 publications Publications 2013-2014 Petra Kern and Christopher R. Millett............... 126 reviews Walworth, D. (2013). Bright Start Music: A Developmental Program for Music Therapists, Parents, and Teachers of Young Children. Silver Spring, MD: American Music Therapy Association Amber Colliver.................................................... 128 Schumacher, K. (2013). Alphabet Stew and Chocolate Too: Songs for Developing Phonological Awareness, Literacy, and Communication Skills. Music Therapy Services, LLC. Nicole R. Rivera................................................... 130


Acknowledgment We would like to express our gratitude to all long-term authors and newcomers as well as those individuals and organizations who support imagine through their collaborations and advertisements.

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wisdom 10 Tips for Choosing and Creating Song Interventions for Young Children

Beth McLaughlin, LCAT, MSE, MT-BC

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1. Repetition and Predictability. When structuring an intervention, remember that children learn through repetition and are comforted by the predictable form and structure of music. 2. Humor. Incorporate sound effects, surprise endings, and nonsense syllables; they make children laugh and keep them coming back for more. 3. Active Participation. Engage children with movement, instrument play, and dramatics, as they can help children more easily remember the lyrics and internalize the concepts and emotions of a song. 4. Creativity. Leave space for children to contribute their own lyrics or ideas for extending the song into different domains. A song should always honor creativity and authorship. 5. Broad Appeal. A good song should have broad appeal. Do children sing it all day long? Do staff call it an earworm? If so, it’s a keeper! 6. Visuals and Props. Use items such as puppets, scarves, pictures, and pom poms to invite active participation, engage the senses, and stimulate learning. 7. Language. Use sentence structure and vocabulary that is meaningful and accessible to the child. 8. Musical Tools. Don’t underestimate children’s musical sophistication; they are exposed to many styles of music through today’s media. Incorporate scales and modes, orchestration, and the elements of music. 9. Relevance. Demonstrate respect for children and their families by choosing songs that reflect their cultural background. Make sure the song’s subject matters to the children, reflects the skills they are learning, or the books they are reading. 10. Fun. Enjoy yourself!


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reports 2. Early Childhood Network Information

2013 Early Childhood Music Therapy Special Target Population Network Meeting Report from 11-22-2013 Gretchen Chardos Benner, LMSW, MT-BC imagine, Editorial Assistance Fort Mill, SC

1. Welcome Dr. Petra Kern greeted attendees and excused co-chair Angela Snell. 21 colleagues were in attendance, representing 13 states (CA, SC, TX, TN, GA, NY, MD, OK, OH, MD, NJ, MN, IL) and Australia. The Early Childhood Network (ECN) also invited colleagues to participate through a google hangout this year.

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Update on imagine Due to limited funding, the three-year pilot project of publishing imagine with AMTA ended in December 2012. As of January 1, 2013, imagine found a new home with de la vista publisher, founded by the editor-in-chief Dr. Petra Kern in 2007. The imagine editorial team continues providing this online resource for free to early childhood music therapists, daycare professionals, related service providers, administrators, and parents while AMTA offers ongoing endorsement. imagine 4(1), 2013 included 73 contributions from 10 countries as well as 32 audio and video clips. “Next Generation Music Therapy: Clinical Applications of YouTube Videos” was the featured article written by Sarah Pitts and Kirsten Meyer. The 2013 issue reached approximately 1.15 mio readers via social media and over 20,000 via email. The average web traffic in 2013 was 1200/month from 117 countries. The imagine team continuous to collaborate with related organizations such as ECMMA. Dr. Kern thanked members of the ECN for their loyalty and ongoing support in making imagine the “doorway for evidence-based practice in early childhood music therapy.” She also thanked the imagine editorial team for their volunteering services. Members of the ECN applauded the team for an excellent publication that draws interest beyond the music therapy community. The deadline for submission to the 2014 issue is May 15, 2014.


Social Media The ECMT Facebook Group has grown to over 658 members (about 250 additional members than in 2012). Rose Fienman (imagine editorial assistant) is monitoring the group. As a reminder, please refrain from using this forum for advertisement only, instead view it as a space for collaboration and information sharing with colleagues. Rose Fienman also administrated the imagine Twitter account @imagineECMT, tweeting useful information about the magazine and related ECMT information. Government Relations Elizabeth Schwartz informed members of the ECN that the state of NY gave a letter of clarification for providing music therapy as a related service under IDEA in the state of NY, which has been printed in the recent Music Therapy Matters. Advocacy and New Trends Marcia Humpal chairs the AMTA Strategic Priority on Autism Spectrum Disorder (ASD) including Dr. Petra Kern, Dr. Blythe LaGasse, Barbara Else (ex officio), and Judy Simpson (ex officio) on the Steering Committee. Several ECN member are on the advisor board. The group targeted the following three areas: 1) Awareness and Recognition, 2) Training and Professional Development, and 3) Evidence-Based Practice and Research. Stay tuned for resources on the AMTA website. Dr. Petra Kern shared that the Division of Early Childhood (DEC) is re-visiting inclusion with the campaign ACT (All Children Together) and is updating the recommended practice guidelines (see recommendedpractices). Also, the National Association for the Education of Young Children (NAECY) has published a “Position Statement on Technology and Interactive Media in Early Childhood Programs” in collaborations with the Fred Rogers Center (see files/naeyc/file/positions/ KeyMessages_Technology.pdf). Additionally the Center on the Developing Child at Harvard University published “Five Numbers to Remember about Early Childhood Development,” providing

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evidence about the importance of early childhood intervention (see http:// multimedia/interactive_features/five-numbers/). 3. Year 2013 in Review Research Projects/Reports Todd Schwartzberg conducted three studies addressing short- and long-term memory, comprehension and generalization of social skills, and repertoire used by practitioners working with young children with ASD. He offered to provide a summary of outcomes with clinical applications in the 2014 issue of imagine and invited ECN members to his AMTA poster presentation. Dr. Grace Thompson from Australia discussed her study on supporting parents to support their child with ASD through music therapy. She will share a summary of the results in the 2014 issue of imagine as well. Dr. Petra Kern and Marcia Humpal updated the ECN group about the outcomes of the national survey study on clinical practice and training needs of music therapists working with individuals with ASD. Over 320 AMTA members responded to the survey. Results will be published in the Journal of Music Therapy in December, 2013 and presented at the 2013 AMTA conference. Carol Blank is sharing her dissertation topic “Music Therapists’ Decision-Making in Music Together Within Therapy®: Towards a Theoretical Framework.” 4. Presentations & Publications See imagine 4(1), 2013, p. 18 for pre-conference trainings, institutes, and CMTEs as well as concurrent sessions on ECMT. See imagine 4(1), 2013, p. 124-125 for ECMT publications in 2013. 5. Sharing Resources Dana Bolton recommended that Folkmanis Puppets® encourage interactions and language development in young children with various disabilities. See Content/17.htm Elizabeth Schwartz spoke about Milo the Bear™, which can support choice making, provide


communication opportunities, and invites making music. See Dr. Petra Kern mentioned the Technology for Early Childhood (TEC) Center, which hosts webinars on media and technology for use with young children. See

ovations for her 2013 AMTA Lifetime Achievement award. Dr. Jayne Standley received the first WFMT International Research award and Dr. Petra Kern, co-chair of the ECN network and editor-in-chief of imagine received the first WFMT International Service Award.

6. Upcoming Events

Please visit the event calendar on the imagine website at Join the ECN Facebook Group at https:// to learn more about upcoming events and member activities.

About the Author Gretchen Chardos Benner, LMSW, MT-BC is owner of Piedmont Music Therapy, LLC. She was a former President of AMTAS and has been a member of the imagine editorial team since 2012.

7. Other Members of the ECN gave Marcia Humpal, the cofounder of the Early Childhood Network standing


next ECN meeting in Louisville, Kentucky November 6, 2014

Watch video about Marcia Humpal’s 2013 AMTA Lifetime Achievement Award

Members of the Early Childhood Network Honored by AMTA and WFMT Video Credit: AMTA & IMC FH Krems

Watch video about Dr. Jayne Standley’s 2014 WFMT International Research Award

Watch video about Dr. Petra Kern’s 2014 WFMT International Service Award

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Policy News for Early Intervention (USA) Judy Simpson, MT-BC American Music Therapy Association Silver Spring, Maryland

Providing information and resources to support advocacy of music therapy is part of the Strategic Plan of the American Music Therapy Association (AMTA). The following two current government relations issues are important to early intervention services and are worth exploring closely: 1) the U.S. Senate Early Childhood bill that recently advanced out of committee, and 2) the information about a new program sponsored by the U.S. Department of Education and the U.S. Department of Health and Human Services, titled: Birth to 5: Watch Me Thrive! Senate Early Childhood Bill Advances Myrna Mandlawitz, AMTA Education Legal Consultant The Senate Health, Education, Labor and Pensions (HELP) Committee passed the Strong Start for America's Children Act (S. 1697), sponsored by Chairman Tom Harkin (D-IA) on a party line 12-10 vote. The bill would provide grants to expand access to high-quality preschool for four-year olds from low- and moderateincome families (incomes under 200 percent of poverty level) through State-federal partnerships. The Committee's ranking member, Senator Lamar Alexander (R-TN) offered an amendment as a substitute to the Strong Start bill. The amendment would have allowed States to consolidate funds from existing early childhood programs including IDEA programs for infants and toddlers and preschoolers, rather than provide additional funds for early childhood. During the committee debate, Senators Harkin and Alexander engaged in discussion that once again highlighted the parties' philosophical difference over the

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role of the federal government. While they agreed on the importance of having high-quality early education, Harkin's bill would provide significant increases in funding and Alexander's substitute amendment would have block-granted current funding under Head Start, the IDEA early childhood programs, parts of Title I of the Elementary and Secondary Education Act, the Child Care and Development Block Grant, and Temporary Assistance to Needy Families. Alexander's amendment also listed a variety of activities for which the funds could be used, with States being able to use the entire amount for only one activity, for example, consolidating all funds for use only with young children with disabilities. States could use 20 percent of the State-federal partnership grants to improve quality, including provision of scholarships, release time and other supports to help teachers meet the requirement that they get a bachelor's degree, and for ongoing professional development. States may also use up to 15 percent of the funds for high-quality early care and education for infants and toddlers from families with incomes at or below 200 percent of poverty level. Another grant program authorized under the Act would be available to Early Head Start agencies to partner with center-based and family child care providers, particularly those receiving funds under the Child Care and Development Block Grant, to expand high-quality programs for children from birth through age three. Priority would be given to applicants that coordinate with other federal and State-funded home visiting, child care, and prekindergarten programs in order to create a continuum of services from birth to school entry. Representative George Miller (D-CA), ranking member on the House Education and Workforce Committee, introduced a similar bill in the fall of 2013. However, the committee has not taken up the Miller bill, and there is no schedule to do so at this time. Birth to 5: Watch Me Thrive! Excerpts from U.S. Department of Education Press Release, March 27, 2014 On March 27, 2014, The U.S. Department of Education and Department of Health and Human Services (HHS) announced the launch of Birth to 5: Watch Me Thrive!, a


Watch video: Birth to 5: Watch Me Thrive!

collaborative effort with federal partners to encourage developmental and behavioral screening for children to support the families and providers who care for them. By raising awareness of child development, Birth to 5: Watch Me Thrive! will help families look for and celebrate milestones; promote universal screenings; identify delays as early as possible; and improve the support available to help children succeed in school and thrive alongside their peers. This initiative encourages early childhood experts— including practitioners in early care and education, primary health care, early intervention, child welfare and mental health—to work together with children and their families. Early screenings check developmental progress and can uncover potential developmental delays. If a child's screening result shows risk, families and providers will be in a better position to pursue more indepth evaluation, which is the first step toward getting help for a child who might need it. Birth to 5: Watch Me Thrive! resources include: A list of research-based developmental screening tools appropriate for use across a wide range of settings; Guides on how to use the screeners for a variety of audiences, from early learning teachers to doctors, social workers, and families;

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Toolkits with resources and tip sheets; Guidance on finding help at the local level; and A screening passport that allows families to track a child's screening history and results. The federal partners contributing to this program include: the Education Department's Office of Special Education and Rehabilitative Services and HHS Administration for Children and Families, Administration for Community Living, Centers for Disease Control and Prevention, Centers for Medicaid and Medicare, Health Resources and Services Administration, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Substance Abuse and Mental Health Services Administration. For more information visit: About the Author AMTA Director of Government Relations, Judy Simpson, MT-BC represents the interests of association members with state and federal agencies, staff, and legislators. Contact:


Emerging Trends in Early Childhood Music Therapy Symposium 2014 Patti Catalano, MM, MT-BC Music Works Northwest

“Early Childhood Education has long been considered one of the best monetary investments to ensure the success of children throughout their childhood into adulthood.” This opening line in the description of the Music Therapy Association of Washington’s 2014 Symposium series on emerging trends summed up the sentiments of Washington’s music therapists as they planned their third Symposium. Technology has provided therapists with many ways to invest in continuing education in order to expand and fine tune skills used when working with families to deliver quality services. However, investing in good old-fashioned face time by inviting nationally known Early Childhood Music Therapy experts to present in person gave music therapists and other early childhood colleagues the opportunity to practice interventions with peers, network with area specialists, and gain perspectives on trends across the United States in the field of Early Childhood Music Therapy. The Music Therapy Association of Washington (MTAW) welcomed Ronna Kaplan, MA, MT-BC from the Music Settlement in Cleveland, Ohio and Marcia Humpal, MEd., MT-BC, chair of the American Music Therapy Association’s Strategic Priority on Music Therapy and Autism Spectrum Disorder and also from Cleveland, Ohio, to share their expertise for the MTAW Symposium 2014 held at Seattle Pacific University May 2nd and 3rd, 2014.

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Day one of the event opened with a three-hour workshop on Emerging Elements: Uses of Orff-Schulwerk in Early Childhood Music Therapy presented by Ronna Kaplan. Participants reviewed Orff-Schulwerk’s history, elements and pedagogy, music therapy applications for targeted behaviors, research supporting Orff-Schulwerk’s use in music therapy, and received many opportunities for skill building as they went through the techniques and interventions in small group experiences led by Ronna Kaplan. Therapists left the workshop with additional music tools for their tool kits as well as an extensive reference and resource list for expansion of their work. Day two opened with Marcia Humpal delivering the keynote address Music Therapy with Young Children – Past, Present and Future. Attendees received an overview of the past views of early childhood and how these views evolved from seeing young children as “miniature adults” to understanding the developmental uniqueness of this age group. The growth in understanding continued with reviews of the current status as major stakeholders such as the National Association for the Education of Young Children (NAEYC) and the Division of Early Childhood (DEC) work together to promote best practices in working with young children. Private and government groups involved in Early Childhood are actively working to increase the knowledge base of information regarding these critical years in a young child’s life as well as advocating funding for these early years. Growth is being seen musically in early childhood music curricula for the young child as well as in music therapy services delivered to young children in Neonatal Intensive Care Unit (NICU) and via early intervention services. Marcia Humpal reminded the audience that “just because it’s ‘playful’ doesn’t mean that it’s unplanned” and had participants consider Developmentally Appropriate Practice as set forth by NAEYC, supported by music and brain research,


development, and Evidence-Based Practice (EBP). With a look at the future, a lively discussion ensued with audience members on the current highlights and pitfalls that will influence early childhood education as student assessments are pushed down to a preschool age while children are at a stage in their lives when play IS their work. Further symposium highlights included The Power of Movement and Music Using Nursery Rhymes with Infants/Toddlers led by Christine Roberts of Nurturing Pathways, which focused on the importance of sensory motor development in young children and how music and movement nurture that development. Board-certified music therapist Wendy Zieve presented Music Therapy for Facilitation of Social Communication in Early Childhood as participants expanded their knowledge of techniques to foster social skills in young children with impairments. David Knott, MT-BC, led an Early Childhood Panel consisting of himself, Annie Dillon, MTBC, and Patti Catalano, MM, MT-BC in A Discussion of the Use of Music Therapy to Address Neurological and Medical Issues in Early Childhood. Panelists discussed research and treatment models used with young children in Seattle Children’s Hospital and Music Works Northwest, a community music school in Bellevue, WA. Marcia Humpal and Ronna Kaplan both presented in unopposed sessions in the afternoon, further sharing their expertise. In her session Early Childhood Music Therapy and Autism Spectrum Disorder…Making and Substantiating Meaningful Music, Marcia reviewed the DSM-5™ changes in the definition of Autism Spectrum Disorder (ASD), the importance of using Evidence-Based Practice when working with young children with ASD, the progress and recognition music therapy is gaining as the National Autism Center (NAC) lists music therapy as an emerging practice (which is NAC’s second level of effectiveness), and what is needed for music therapy to reach NAC’s first level of effectiveness – “established.” Participants pondered the question: Should Music Therapy be evaluated as a Comprehensive Treatment Model or should it be evaluated as a therapy that can reinforce many focused interventions and comprehensive treatment models?

Ronna Kaplan introduced participants to the Music Settlement’s Lullaby 101: A Program for At-Risk Expectant and Parenting Teens and Adults. Within this project, music therapists found that young parents who were considered at-risk were not familiar with lullabies from their own childhood and needed to be taught lullabies to sing with their babies. Highlights regarding the justification of using lullabies were shared, including the universal care giving nature of lullabies across cultures, calming strategies for both parent and child, stimulation of early language development, fostering attention behaviors, and the social importance of making music. Ronna shared The Logic Model to be used as a template for program planning including needs, interventions or activities, and anticipated outcomes. Teens and adults in the Lullaby 101 program were guided through music therapy interventions, ways to choose calming music for their babies and coordinate the music with calming activities, songwriting, and generalization of their learning outside of class. Looking at the MTAW 2014 Symposium: Emerging Trends in Early Childhood from the perspectives of monetary and time-intensity was it worth the investment to offer in-person training in these specialized areas? Attendees of the symposium have the final say through their evaluations. Evaluations were overwhelmingly positive with high marks made by music therapists and non-music therapists alike. When asked what about the event participants liked and what would be most useful in their clinical practice, one participant said, “Meeting Ronna and Marcia and hopefully continuing a professional relationship with all of the wonderful people I’ve met today.” About the Author Patti is a Board-certified music therapist and Neurologic Music Therapy Fellow. She is the Music Therapy and Early Childhood Program Manager at Music Works Northwest, a community music school in Bellevue, WA. Contact:

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Photo courtesy of The Royal Children's Hospital Melbourne

It Takes a Village… The Emergence of a Team Science Collaboration for Music and NeuroDevelopmentally At-Risk Infants Meeting Report of the Inaugural Meeting of MANDARI from July 1-3, 2014 in London, UK Deanna Hanson-Abromeit, Ph.D., MT-BC University of Kansas, USA Helen Shoemark, Ph.D., RMT Murdoch Children’s Research Institute & The Royal Children’s Hospital, Melbourne, Australia

There is a saying, “it takes a village to raise a child.” This saying was popularized in part by Hillary Rodham Clinton’s book, It Takes a Village and Other Lessons Children Teach Us (1996), but in large part has been attributed to an African proverb (Clinton, 1996; Healey, 1998), as well as the writer Toni Morrison (Shapiro, 2011). Clinton (1996) used this proverb as the title of her book because it is a …”reminder that children will thrive only if their families thrive and if the whole of society cares enough to provide for them” (p. 12). This book was a way

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for Clinton (1996) to create a conversation with people about the value of children in society and how raising children is more than the responsibility of the parents, but of the larger society. As music therapists in early intervention we recognize the importance of environment and experiences, we understand the role of the child’s relationships, and we work within programs that advocate for effective and family-centered interventions that can make a difference to the children in our “village.” We should also consider the “village” in which we work and how our professional “village” can inform and strengthen the capacity of our services and research. Conversations with the larger society of professionals that inform our work can be vital to our sustainability and increased efficacy during the important developmental years of early childhood. The “village” of professional practice can be supported by conversations and agencies of change that involve all interested parties. In professional practice, the “village” is referred to as team science. Team science has grown over the last 20 years as a way to engage cross-disciplinary research and practice groups to address the complexity of the world’s social, environmental and public health problems. Effective team science creates discoveries that translate to high-impact research, new clinical practices, public policies and education training. Effective collaboration in the team science model promotes the emergence of concepts, methods and theories from multiple disciplines (Stokols, Hall, Taylor, & Moser, 2008). Multiple disciplines with scientific and art-based orientations play a role in the continued development of music therapy practice (Bruscia, 1998). Cross-disciplinary collaboration within a team science approach has the potential to affect change in music therapy theory, practice, and education,


as well as a higher level of significant integration into other research, practice and public health initiatives. Premature and medically complex newborn infants and those living in a compromised environment are neurodevelopmentally at-risk (Laing, et al., 2010; Teti, et al., 2009). Music neuroscience shows the infant brain is primed for auditory experience and that early exposure to music changes the architecture of the developing brain (Altimier & Phillips, 2013; Perani, et al., 2010; Schnupp, 2008). Timely and effective music strategies have the potential for immediate and long-term beneficial outcomes for infants and their families (Perani, et al., 2010; Standley, 2012; Trehub, 2003). Such complex issues require sophisticated and integrated innovation formed from a cross-disciplinary team science approach. A variety of science and arts based disciplines are interested in the efficacy of music on infant development; however, there are no known team science collaborations of this nature, particularly involving music therapists. The inaugural meeting of the Music and Neurodevelopmentally At-Risk Infant Research and Practice Group (MANDARI) was held July 1-3, 2014 in London to discuss integrated capacity for high-impact research and clinical application of music for greater efficacy with infants who are neuro-developmentally at risk. Spearheaded by Helen Shoemark (music therapy, Australia), a core group including Lauren Stewart (cognitive neuroscience, UK), Claire Flower and Stephen Sandford (music therapy, UK) and Deanna HansonAbromeit (music therapy, USA) worked together for over a year to organize this meeting. The meeting brought together 28 people representing research and practice from the perspectives of music therapy, neurology, psychology, nursing, neonatology, infant development, public health, parents, and composers from Australia, Austria, Colombia, Denmark, France, Switzerland, United Kingdom, and United States. Across three days participants discovered, questioned and discussed the practice and research of music with neurodevelopmentally at-risk infants.

Shoemark, Lauren Stewart, and Stephen Sandford, at the Royal Naval Academy Chapel. Meeting participants socialized over dinner hosted by BAMT. July 2nd was a daylong event hosted at Goldsmiths College, London. In the morning participants were introduced to one another followed by panel presentations to frame the current state of music therapy practice and research, and related highlights of scientific inquiry. The afternoon had people working in small break out groups based on themes that evolved from participant questions from the morning sessions. On July 3rd, meeting participants met again at Goldsmith College to explore the potential future of the MANDARI Research and Practice Group. In the evening, Chelsea and Westminster Hospital hosted a public seminar featuring keynote speaker Dr. Joanne Lowey (music therapy, USA), followed by brief presentations of MANDARI perspectives by Helen Shoemark, interdisciplinary collaboration by Lauren Stewart, and international collaboration by Deanna Hanson-Abromeit. The MANDARI events were supported in part by the British Association for Music Therapy, Chelsea and Westminster Health Charity, Chelsea and Westminster Hospital (London), Goldsmiths College University of London, and the Arnold Bentley Award from the Society for Education, Music and Psychology Research (SEMPRE). The core group is currently examining the meeting archives and conducting follow-up surveys with participants to refine the focus of this group. Merging the arts and sciences in a collaborative experience is expected to create novel thought and leadership for research and practice across disciplines. The motivation for this initial research and practice meeting was a desire to share situated knowledge, widen access to funding sources, increase the profile for music research, and increase capacity for sustainable integration of art and science. The excitement and enthusiasm generated at the MANDARI meeting created the foundation for a “village” of cross-disciplinary collaboration. This “village” has the potential to inform theory, research, and practice for neuro-developmentally at-risk infants, highlighting the role of music in their development.

The meeting began the evening of July 1st with an opening reception of choral music and introductions by Donald Wetherick, Chair of the British Association for Music Therapy (BAMT), and MANDARI organizers, Helen

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References Altimier, L. & Phillips, R. M. (2013). The neonatal integrative developmental care model: Seven neuroprotective core measures for family-centered developmental care. Newborn & Infant Nursing Reviews, 13, 9–22. Bruscia, K. (1998). Defining music therapy. Gilsum, NH: Barcelona. Clinton, H. R. (1996). It takes a village: And other lessons children teach us. (1st ed.). NewYork: Simon & Schuster. Healey, J. G. (1998). African Proverb of the Month, November, 1998. Retrieved from http:// Laing, S., McMahon, C., Ungerer, J., Taylor, A., Badawi, N., & Spence, K. (2010). Mother-child interaction and child developmental capacities in toddlers with major birth defects requiring newborn surgery. Early Human Development, 86, 793-800. Perani, D., Saccuman, M. C., Scifo, P., Spada, D., Andreolli, G., Rovelli, R., Baldoli, C. & Koelsch, S. (2010). Functional specializations for music processing in the human newborn brain. Proceedings of the National Academy of Sciences, 107(10), 4758-63. Schnupp, J. W. (2008). Auditory neuroscience: sound segregation in the brainstem? Current Biology, 18(16), R705-6. Shapiro, F. (2011). It takes a village. Retrieved from Standley, J. (2012). Music therapy research in the NICU: An updated meta-analysis. Neonatal Network, 31(5), 311-316. Stokols, D., Hall, K. L., Taylor, B. K. & Moser, R. P. (2008). The science of team science: Overview of the field and introduction to the supplement. American Journal of Preventive Medicine, 35(2S), S77-S89. Teti, D., et al. (2009). Intervention with African American premature infants: Four-month results of an early intervention program. Journal of Early Intervention, 31(2), 146-166. Trehub, S. (2003). The developmental origins of musicality. Nature Neuroscience, 6(7), 669-673.

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About the Authors Deanna Hanson-Abromeit, Ph.D., MTBC is an Assistant Professor at the University of Kansas. Her clinical and research focus is on preventive music-based interventions with infants who are neurodevelopmentally at-risk. She co-edited two monographs on hospital-based music therapy, has authored book chapters and peer-reviewed articles, and serves on the editorial boards for the Journal of Music Therapy and Music Therapy Perspectives. Contact:

Helen Shoemark PhD, RMT is a researcher at the Murdoch Children's Research Institute, and senior music therapist (Neonatology) at The Royal Children’s Hospital Melbourne. She is also an adjunct professor at the University of Queensland, and a Senior Fellow with the Department of Paediatrics and Melbourne Conservatorium of Music at the University of Melbourne.

MANDARI Research and Practice Group is a newly formed interdisciplinary collaboration to increase the capacity for, and impact of, music-based research and practice with neuro-developmentally at-risk infants and their families. Visit


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Photo courtesy of IMC FH Krems

Cultural Diversity in Music Therapy Practice, Research and Education 14. World Congress of Music Therapy Vienna/Krems, Austria, July 7-12, 2014 Rose Fienman, MSW, MT-BC Editorial Assistance, imagine Marcia Humpal, M.Ed., MT-BC Contributing Editor, imagine Kumi Sato, MS Student Representative for Western Pacific, World Federation of Music Therapy Talia Girton, Music Therapy Intern Recipient, 14. World Congress of Music Therapy Scholarship Award for Students

The 14th World Congress of Music Therapy in Austria was a vibrant international event. With over 1000 music therapists from 46 countries in attendance, it was an excellent opportunity to connect with and learn from professionals, interns, and students from various backgrounds. The following reports summarize eight paper sessions, workshops, and roundtables that were presented on topics relevant to early childhood.

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Using the Pacifier Activated Lullaby (PAL) with Infants Diagnosed with Neonatal Abstinence Syndrome (NAS) D.DeLoach and E. Hamm (USA) Summarized by Rose Fienman This presentation discussed some preliminary research on the Pacifier Activated Lullaby (PAL) with infants diagnosed with Neonatal Abstinence Syndrome (NAS). Infants born with NAS are addictive to substances that the mother had taken during her pregnancy; these addictive substances include cocaine, marijuana, and narcotics. In addition to other symptoms and general fussiness, the NAS babies generally are not successful at feeding; their latching on is weak and their sucking motion is too rapid. The PAL works by providing an infant with a musical stimulus (reward) when the infant sucks properly on the pacifier; the baby must perform an effective suck to start the lullaby. The PAL, developed by Jayne Standley, is approved by the Food and Drug Administration (FDA) of the United States, and is the first music therapy tool to have achieved this recognition. This pilot data has shown that infants generally begin learning that an effective suck starts the music within the first session with the PAL. Additionally, more than 95% of the infants studied were able to fall asleep in their crib during the session without being held. This second outcome is of great interest to neonatal nurses, as the NAS babies generally require much of their time and attention, especially when trying to calm the babies into sleep. These preliminary findings seem quite promising for increasing music therapy work with the PAL in the NICU. The presenters hope to publish this data in the coming months.


Developing Communication, Socialization, Creativity, and Musical Skills in Children with Autism Spectrum Disorders C. Zamani (Argentina) Summarized by Rose Fienman This informative session began with some background information on autism spectrum disorder (ASD). The presenter informed attendees that the current rate of autism incidence is 1 in 68 births, and that the current trend in practice is the integration of approaches. Best practices include the family-centered approach, the strengths-based approach, and working in natural and inclusive environments. The presentation then progressed into a clinical vignette featuring a client that Zamani has worked with since 2008. The client was just 3.9 years old when music therapy began, and he displayed many common features of ASD including few verbalizations and atypical rhythm of speech. Through video clips, Zamani recounted the changes observed in the music therapy environment. Around age 5, the client began to add spontaneous verbalizations to familiar songs, and Zamani noticed an increase in his creativity. 2012 brought an increase in his language comprehension and changes in melodic and prosodic speech for the then 8 year old client. Currently, this client is enrolled in piano lessons (separate from music therapy) and is fully included in the recitals.He enjoys playing the piano for his friends. Zamani concluded the presentation by drawing on her experiences with this client, as well as with other clients with autism, and expressing her belief that working with children with ASD requires all people and available resources to be working together and in agreement on various issues of treatment. Good, Better, Best: Recommendations on EvidenceBased Practice for Children with Autism Spectrum Disorder P. Kern, M. Humpal, J. Whipple, L. Martin, A. M. Snell, D. DeLoach, J. Carpente, H. Lim, L. Wakeford (USA) Summarized by Marcia Humpal

Disorder was presented on Tuesday, July 8th.The roundtable addressed various chapters of the book, Early Childhood Music Therapy and Autism Spectrum Disorders: Developing Potential in Young Children and their Families (Kern & Humpal, Eds., 2012). Chapter authors Petra Kern, John Carpente, Marcia Humpal, and Darcy DeLoach each responded to three predetermined questions about their chapters. Video appearances by additional authors Jennifer Whipple, Linda Martin, Angela Snell, Hayoung Lim, and Linn Wakeford added to the clarification of additional aspects of the book’s content. The roundtable featured the latest developments surrounding ASD and its increase in prevalence rate across all cultures and nations. Evidence-based practice, research-based knowledge, assessment and goals, and approaches and techniques for young children with ASD and their families were topics addressed by the panelists. Questions and comments from the audience added to the discussion of the topic at the end of the presentation. The Color of Us: Music Therapy for Children and Families in Europe P. Kern (USA), S. Lindahl Jacobsen (Denmark), K. Tuomi (Finland), E. Georgiadi (Greece), K. Stachyra (Poland) , C. Flower (UK), T. Stegemann (Austria) Summarized by Marcia Humpal On Friday, July 11th, music therapists from throughout Europe joined in the roundtable The Color of Us: Music Therapy for Children and Families in Europe. Moderated by Petra Kern of the United States, the panel consisted of Stine Lindahl Jacobsen of Denmark, Elizabeth Georgiadi of Greece, Krzysztof Stachyra of Poland, Claire Flower of the United Kingdom, and Thomas Stegemann of Austria. Kirsi Tuomi from Finland was a virtual participant. Presenters gave a brief snapshot of their country and its early childhood services, selected publications, background information (relating to federal regulations, educational and cultural influences, and predominate clinical approaches) and a brief case summary. They engaged the audience in delightful musical examples from each country to start off each segment. In closing, panelists discussed what they would like to see happen in the future and how international collaborations can be increased to address cultural diversities and practices.

Good, Better, Best: Recommendations on EvidenceBased Practice for Children with Autism Spectrum

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Holistic Approach in MT and Its Specific Features in Children Group Therapy S. Drlícková and M. Friedlová (Czech Republic) Summarized by Kumi Sato The presenters began this workshop by playing spiritual music. This was an effective starting place, as the unique quality of the music captured the audience's attention and piqued their curiosity. The presenters then talked about the five principles of holistic music therapy: 1) respecting the human being as a whole; 2) using high quality instruments made from natural materials; 3) incorporating vocal/instrumental improvisations; 4) providing live music only; and 5) sensing breath, voice, and body. Next, the presenters showed a variety of instruments such as a Bolivian flute and a Tibetan bell. One case study and two activities were introduced. The attendees were encouraged to experience an exercise at the end of the session, making them aware of own breath, voice, and body. This workshop suggested the importance of the quality of sound we create in sessions as well as the therapist’s skill to lead by music. Microanalysis Research for Autistic Children S. Valchová, Z. (Czech Republic) and G. Collavoli, G. T. (Italy) Summarized by Kumi Sato This presentation discussed some practical ways to record client’s behaviors during sessions. First, the presenters showed an example of a handwritten session note. On one sheet, a timeline was drawn horizontally, and a basic description of activities as well as behavior symptoms of social interaction was written along the timeline. They indicated clear criteria for social interaction, such as use of nonverbal communication or engaging in the same activity. The session note also included technical memos and information on music. Presenters noted that although it is easy to add information to a handwritten session note, analyzing the data may take a longer time. Dartfish Easy Tag software for the iPhone/iPad or Android devices help avoid this

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problem. Therapists choose target behaviors and create a tagging panel, and then simply tap the panel every time the target behaviors occur during a session. This app lets therapists see when each target behavior occurred later. Exploring more practical ways to record sessions and spending less time analyzing the data may allow therapists to spend more time preparing sessions. Music Therapy and Neuroscience: Clinical Applications for Children C. Zamani (Argentina) Summarized by Talia Girton Zamani's workshop consisted of the presentation of videos and interventions from her own private practice, and the theoretical underpinnings upon which she designs and implements her therapy. She discussed neurocognitive evidence-based clinical practices such as utilizing a simple melodic line, structured rhythmic patterns and simple harmonies, as well as verbalizing and reflecting the child's and the therapist's actions. Music therapy techniques such as non-verbal instrument play dialogues, joint singing, structured music activities and the imitation of rhythmic patterns were presented, discussed, and demonstrated for the group. Highlights included a game with finger cymbals where the therapist and child play together like a hand clap game, an activity with bells in which two sets of handled sleigh bells were joined so the therapist and children could play together, and a castanet intervention in which the instruments had faces so the child could be encouraged to create a musical story. Culturally Transformed Music Therapy in the Perinatal and Paediatric NICU H. Shoemark (Australia), M. Ettenberger (UK), M. Filippa (France), C. Flower (UK), D. Hanson-Abromeit (US), F. Haslbeck (Switzerland), J. Loewy (USA), M. Kwan (Singapre), J. Kim (Korea), S. Mori-Inoue (Japan) Summarized by Talia Girton This roundtable session was a unique opportunity to hear from NICU music therapists from around the world. In Switzerland, Germany and Austria, Neonatal Intensive Care (NICU) music therapy focuses on live music making with soft instruments, and the recorded voice of the


mother. In Italy, Maternal Vocal Intervention (MVI) is implemented to promote musical communication between mothers and hospitalized preterm infants. Most interventions involve live, musical interactions, but the effectiveness of live vs. recorded music is debated in this country. In the UK, NICU music therapy is an emerging field, and there are about 10 music therapists working in neonatal units. Moving to the other side of the world, NICU music therapy was established in Singapore as a new healthcare profession in 2007. MTs are employed as Allied Healthcare Professionals, and any team member in the hospital can make a referral with a doctor’s approval. Live music, such as personalized lullabies, is provided to increase tolerance to stimuli, promote developmental milestones, and decrease agitation. In Korea, music therapists work with infants after they are discharged from the NICU to improve sensory, motor and social skills, and to facilitate parent-child bonding. Infant directed singing and Korean lullabies paired with the mothers' voices are employed. In Japan, NICU music therapy is focused on family-centered care. Music therapy is provided to facilitate the development of communication skills through music to aid parents in communicating with their baby. There is just one NICU music therapist practicing in Colombia. Music therapy is combined with Kangaroo care, and live music (guitar, harp and voice) and composition are the techniques implemented to provide care. In the United States, music therapists work in 30 out of the 50 top hospitals in the country; 12 of those hospitals employ a NICU music therapist. There are two main approaches: the Armstrong model and the biomedical model. Finally, in Australia, a music therapist is employed in every oncology unit of every pediatric hospital in the entire country. NICU music therapy has existed in Australian hospitals for over 20 years. Music therapists from each country represented in the roundtable expressed concerns about lack of training in the medical setting, lack of public awareness, lack of funding and lack of quality assurance in training and practice.

About the Authors Rose Fienman, MSW, MT-BC, imagine editorial team member is a Program Director with Arts & Services for Disabled, Inc., and the WFMT Chair of the Public Relations Commission. She also practices at the Music Therapy Wellness Clinic at California State University, Northridge, where she supervises undergraduates completing fieldwork placements. Contact:

Marcia Humpal, M.Ed., MT-BC maintains a small private practice and continues her involvement with young children and their families. She was co-founder of AMTA’s Early Childhood Network, and currently serves on the imagine editorial team and several committees and projects for AMTA. She is the co-editor of Early Childhood Music Therapy and Autism Spectrum Disorders: Developing Potential in Young Children and Their Families.

Kumi Sato, MA was trained as a music therapist in the U.S. Now living in Japan, she is a Ph.D. candidate at the Tsukuba University researching the use of music to support children with special needs.

Talia Girton is a music therapy intern at UK HealthCare in Lexington, Kentucky, USA and previously attended the University of Louisville. She is one of the seven recipients of the 14. World Congress of Music Therapy Scholarship Award for Students.

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reflection Successful Interdisciplinary Communication in Schools: Understanding Important Special Education Concepts and Initiatives Mary Adamek, Ph.D., MT-BC School of Music, The University of Iowa Alice-Ann Darrow, Ph.D., MT-BC College of Music, Florida State University Judith Jellison, Ph.D., RMT Butler School of Music, The University of Texas at Austin

Successful interdisciplinary communication requires that stakeholders not only have knowledge of their own disciplines, but a clear understanding of their colleagues’ disciplines as well. Music therapists often work in education settings (primarily with students who receive special education services) which makes

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special educators one of their closest allies. Consequently, it is important for music therapists to understand concepts and initiatives in the field of special education, as well as to know and use the associated appropriate terminology when communicating with IEP team members, parents, and school or site administrators. While much of the following information mainly pertains to school settings and children above the age of five, it is important for music therapists to understand issues that young children and their families will face in the child’s next educational environment. A shared core vocabulary is helpful in establishing a common framework through which music therapists, early interventionists and special educators can best meet the needs of children with disabilities. Being able to converse about current topics in special education also demonstrates professional awareness, an understanding of recent developments in the field, and a willingness to work collaboratively with other professionals. A number of initiatives in special education have occurred over the past 15 years, with some being mandated by amendments to the Individuals with Disabilities Education Act. Having working knowledge of these current perspectives in special education is necessary for music therapists to have informed discussions with colleagues and to participate more fully in IEP meetings. Some initiatives in special education, or certain elements of initiatives, are already a part of music therapy practice, though terms may be identified by different names. Knowing what elements of special education and music therapy practices are shared or different, allows for more consistent and coordinated efforts on behalf of students with disabilities. Following are brief reflections on and summaries of special education concepts for music educators and therapists working in schools who would like a basic understanding of these important initiatives. We present below brief summaries for five special education concepts for music therapists as well as music educators who would like a basic understanding of these important initiatives. We begin with one in arts education that is closely aligned with the Common Core Standards, the National Core Arts Standards. National Core Arts Standards (NCAS) Most US educators are aware of the Common Core Standards for Math and English Language Arts. This

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national initiative describes what students should know in these content areas at the completion of specific grade levels. The purpose of the Common Core initiative is to establish consistent educational benchmarks for all states, and to ensure that students graduating from high school are prepared for the next level of educational experiences. The majority of the states have adopted these voluntary standards, while a few states have chosen not to adopt the national standards. The National Core Arts Standards (NCAS) is a new initiative currently being developed to provide a platform for excellence in delivery and outcomes of arts education in PreK-12 education. Music, Visual Art, Dance, Theater and Media Arts are included in the standards document. These voluntary arts standards are designed to promote thinking, learning and creating as processes of arts education. These standards provide comprehensive expectations and equitable opportunities for all students. Experts in arts in special education assisted the development team to ensure that the standards were written in an inclusive manner with opportunities for success at varied levels of abilities. This conceptual framework for arts learning is based on philosophical foundations and lifelong goals related to 1) the arts as communication, 2) the arts as creative and personal realization, 3) the arts as culture, history and connectors, 4) the arts as means to well-being, and 5) the arts as community engagement. Based on this foundation, artistic literacy is developed through the artistic processes of creating, responding, performing/ presenting/producing (based on the art form), and connecting. Anchor standards and Performance standards describe the general knowledge and skills that students are expected to demonstrate as evidence of their artistic literacy, both generally across the arts and in discipline specific language. Measurable learning goals are created through grade level achievement outcomes PK-8, and through Arts standards are proficiency levels in high school (proficient, designed to promote accomplished and thinking, learning and advanced) (NCCAS, 2013). creating as processes of arts education.


Breaking down the framework into various creative practices, we find strategies that are frequently utilized by music therapists in a variety of age and ability settings. These creative practices from the standards include ‘imagine,’ ‘investigate,’ ‘construct,’ and ‘reflect.’ Using developmentally appropriate practices, music therapists provide opportunities for students to create an image (imagine), observe and explore (investigate), create something new (construct) and discuss or think about outcomes (reflect). Combining these practices with Universal Design for Learning practices, the arts standards can be accessible to students of varying ability levels in inclusive settings as well as individualized or small group arts experiences (Malley, 2013). The National Core Arts Standards were developed to provide a foundation for balanced education through arts experiences. Teachers, specialists and administrators can use the standards to develop curriculum for success as informed students of the arts as well as educated and contributing members of society. Engagement in the arts can prepare students for better outcomes in school, career and engagement with others in the community. Response to Intervention (RTI) Response to Intervention (RtI) is a multi-tier, school-wide approach for the early identification and support of students with learning and behavior needs. This systematic, data-based approach provides a structure to assess needs of students and to implement additional support to improve learning and behavioral outcomes. Using RtI, all students are screened to determine their progress on specific benchmarks, and students who are not meeting benchmarks are identified for additional support to remediate learning and behavior deficiencies. Ongoing assessments continue to inform decisions about how to best support the students’ learning (Batsche, 2006;

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Brown-Chidsey & Steege, 2010; Reynolds & Shaywitz, 2009). School-wide teams create the foundation for the decision-making process, with specific teams responsible for navigating the process, evaluation, and instructional support. The team members identify the problem that the student is having, determine why it is happening, implement a process to remediate the student’s deficiencies, and then evaluate the student’s outcomes. Classroom teachers, administrators, support staff and related service providers are involved in the team decision-making process (Glover & DiPerna, 2007; McCook, 2006). RtI consists of a three-tier system of interventions (see Figure 1). Tier 1 is where all children receive core instruction in literacy and math. Approximately 80% of students will respond very well to the core instruction, achieve proficiency and have their learning needs met at this level. Tier 1 provides differentiated and flexible group learning experiences within the general education classroom, with at least 90 minutes per day devoted to literacy and 60 minutes per day for math. Tier 2 is focused on approximately 5-10% of the students who will need supplemental interventions in addition to the core instruction to help them make progress. In addition to Tier 1 instruction, students in this level receive a minimum of 30 minutes per day of small group instruction. Approximately 1-5% of the most deficient students may need the intensive support of Tier 3. These students need instruction that is significantly different than the core instruction, which includes additional small group instruction plus Tier 1 and 2 experiences. Progress monitoring occurs throughout to determine if the students are advancing or if instructional strategies need to be changed (Kovaleski, 2007; Whitten, Esteves & Woodrow, 2009). Music can be used to provide extra support needed by some students. Music researchers have investigated many topics related to literacy, such as music learning to improve reading, music embedded into the curriculum to enhance reading skills, music to develop auditory discrimination skills, and contingent music to promote reading behaviors (Darrow et al., 2009; Gromko, 2005; Humpal & Colwell, 2006; Lamb & Gregory, 1993; Pane &


Salmon, 2011; Register, 2001; Register, Darrow, Standley & Swedberg, 2007; Salmon, 2010; Telesco, 2010; Wolfe & Noguchi, 2009). Results from a meta-analysis focused on music to improve learning (Standley, 2008) indicate that the benefits are greatest for early intervention programs, students identified with learning difficulties benefit more than typically developing students, and contingent music can be effective to reinforce reading behaviors. Studies showing the best outcomes used music as a contingency, music as a cue for attention, or had reading tasks embedded into music concepts. So how does music therapy fit in to the RtI approach? With RtI, schools have a way to provide additional support to students without requiring that students qualify for special education services. Music therapists along with other related services providers are typically part of the RtI teams and can create specialized, research-based interventions for students who respond well to music. Students in Tiers 2 and 3 may be able to benefit from the addition of music therapy services to promote learning and positive behavioral outcomes in a general education environment.

Figure 1. Three tiers of response to intervention based on an image by ALEKS. Retrieved from Positive Behavioral Supports (PBS) Most music teachers and therapists will report that managing students with challenging behaviors is the greatest barrier to effective classroom instruction. Even though music is a highly desirable activity for most students, music educators have indicated that students with behavior disorders are the most difficult to manage in the inclusive music classroom. They typically exhibit

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unacceptable patterns of behavior, are nonconforming to the norms of the classroom, and often make the learning environment unproductive for others. These students, like many students with disabilities, require instructional interventions to manage their disability and to assist them in becoming educated and sociable adults. Positive Behavioral Support (PBS) is a special education initiative that has been particularly beneficial for these students. The purpose of Positive Behavioral Support (PBS) is to create a supportive and successful environment for all students, though particularly for those with the most challenging behaviors. It refers to a range of preventive and positive interventions designed to eliminate problematic behaviors and to replace them with behaviors that are conducive to academic and social success. PBS is also a comprehensive research-based approach intended to address all aspects of a problem behavior. It involves a proactive, collaborative, assessment-based process to develop effective and individualized interventions to discourage challenging behaviors (Shepherd, 2010). Professionals employing PBS are equally committed to teaching and reinforcing prosocial behaviors (Sailor, Dunlap, Sugai, Horner, 2009).

Figure 2. Supporting positive behavior. The core features of PBS are the (1) application of behavioral design by administering functional assessments of behavior, structuring the environment, teaching substitute behaviors, and applying rewards and consequences; (2) implementation of comprehensive interventions by addressing behaviors across all settings and in all contexts; (3) attention to lifestyle outcomes by addressing and assessing an individual’s quality of life; and (4) emphasis on cultural and organizational systems


change in order to adapt the environment such that students are provided the support needed to lead productive lives. In addition to these core features, PBS also utilizes a three-tier system of increasing support. Primary supports are provided to 80-85% of the student body. These supports are generally implemented in environments such as the cafeteria, hallways, or recess. Secondary supports are provided to 10-15% of the student body, and tertiary supports to those in the 5-10% who present the most challenging behaviors (Sailor, Dunlap, Sugai, & Horner, 2008). Along with reducing problem behaviors and teaching desired behaviors, the PBS approach is structured to address plans for a student’s future. It is an approach that merges values regarding the rights of people with disabilities with practical application of how learning and behavioral change occur. The principal goal of PBS is to improve the daily lives of students and their support providers in home, school, and community settings (Hallahan, Kaufman, & Pullen, 2009; Turnbull, Turnbull, Wehmeyer, & Shogren, 2013). PBS is supported by recent mandates, including the 1997 amendments to the Individuals with Disabilities Education Act, which call for the use of functional behavioral assessments and positive supports and strategies (IDEA, 2004).

Self-Determination Individuals who are in control of their lives, those who make sound decisions, solve problems, set attainable goals for themselves, and regulate their behavior are viewed positively by most cultures. They are considered to be self-determined individuals. These are volitional acts on the part of an individual to maintain or improve his or her quality of life. Ryan and Deci (2000) are most closely associated with self-determination theory. They propose that self-determination

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encompasses three innate psychological needs— competence (feeling a sense of achievement), autonomy (feeling in control), and relatedness (feeling safe and secure with other people). They postulate that these needs, when satisfied, can lead to self-motivation, physical and emotional well-being and, if not satisfied, can lead to physical and even mental illness. Research documents positive outcomes for children with disabilities who have learned skills related to selfdetermination—positive outcomes for their social development, academic development, and well-being. Although many children learn to become more independent and acquire the knowledge and skills associated with self-determination implicitly, other children require more guidance and instruction. Providing for self-determination is essential for successful transition in school and throughout life, but can it be taught? The concept of self-determination in the psychological literature and subsequent research led to the development of definitions, strategies and the development of specialized published curricula. Wehmeyer is cited frequently for his work promoting selfdetermined behavior in children with intellectual and developmental disabilities. For purposes of education and rehabilitation, he states that “self-determination is 1) best defined in relationship to characteristics of a person’s behavior; 2) viewed as an educational outcome; and 3) achieved through lifelong learning, opportunities and experiences” (Wehmeyer, 1996). Music therapists can make appropriate transfers to their settings for young children from his curriculum, The Self-determined Model of Instruction (Wehmeyer, Palmer, Agran, Mithaug, & Martin, 2000). Palmer and colleagues (2014) and others (e.g., Brotherson & Weigel, 2008; Erwin & Brown, 2003; Shogren & Turnbull, 2006) provide strong arguments for nurturing self-determination early in life and stress the importance of family-teacher partnerships, working together for meaningful outcomes across early childhood settings and homes. When included in the curricula, Palmer and her colleagues caution that “it would be developmentally inappropriate for preschool-age children to be expected to exercise independent choices,


decisions, and problem solving as self-determination is defined for adolescents and young adults (p. 39).” They propose a Self-Determination Foundations model with three interactive critical components as foundations for the later development of self-determination for young children with disabilities: a) child opportunities for expressing and making choices or engaging in simple problem solving, b) self-regulation, and c) engagement. Although many music therapists may incorporate skills associated with self-determination into their sessions with young children, no doubt children will benefit from more opportunities to learn and practice these skills. Introducing choices to students, teaching them how to self-regulate (set goals and reach them), giving them increasingly more autonomy, honoring their preferences, giving them problems to solve within their capacity and strategies to solve them, and providing opportunities for them to experience individual achievement require therapists to be aware of the short- and long-term consequences of students’ actions and to make students aware of these consequences as well. Children of all ages and with varying capabilities can learn what questions to ask themselves and what actions to take to accomplish their goals (i.e., academic, social or music). Differentiated Instruction (DI) Young children come to music sessions, and students later come to the music classroom with different educational readiness, learning styles, abilities, and preferences. In addition to these learner differences, classrooms in the United States are becoming more linguistically and culturally diverse each year. Differentiated instruction (DI) is an approach to teaching and learning that allows for these individual differences. Thousand, Villa, and Nevin (2007, p. 9) define differentiated instruction as “a process where educators vary the learning activities, content demands, modes of assessment, and the classroom environment to meet the needs and to support the growth of each child.” Various accommodations and adaptations are also included as a part of the instructional process. Working with individual children, as music therapists often do, is not the same as differentiated instruction. Differentiated instruction involves working with groups of

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students, and individualizing the curriculum for those within the group. It shares many of the Universal Design for Learning (UDL) goals for teaching and promoting student learning, with both initiatives established to embrace student differences and to ensure students have every opportunity to learn in ways that best suit their individual needs. Both UDL and DI include built-in supports for students and suggest scaffolding instruction. However, DI differs from UDL in how and when instructional adjustments are made for students. DI makes use of formative assessments with accompanying adjustments in the curriculum. Tomlinson (2001) identified three elements of the curriculum that can be differentiated: Content, process, and products. In brief, curriculum content should be aligned with learning goals and objectives, and the same for all students, with its complexity varied based on students’ abilities to comprehend the material. Content delivery is varied, based on groupings that are flexible and fluid, and beneficial to both students and teachers. In differentiated instruction, formative assessments are a key feature, and are used to direct the curriculum. Formative assessments are used to evaluate students’ readiness to learn and acquire knowledge. DI operates under the assumption that not all accommodations for learner differences can be planned proactively. Instruction should be fluid and variable, depending on the changing needs of the learners. A layered curriculum is one of the most salient features of DI. While the focus of the subject matter—the essential concepts—is the same for all students, individual students are learning the curriculum content at different levels of complexity, and are expressing what they know at different levels of sophistication. Giangreco, Cloninger, and Iverson (1993) suggested four levels of curriculum design: same, multilevel, curriculum overlapping, and alternative. In the first level, Differentiated students are instruction involves taught the same working with groups of curriculum with students, and only minor individualizing the changes in the amount to learn or the time to

curriculum for those within the group.


learn it. In the second level, students are involved in the same curriculum with the same goal, but have different learning objectives based on subject matter complexity. In the third level, students are engaged in the same lessons, but the overall goal for learning the material may be different, such as social versus academic. In the final level, alternative, students’ goals may be unrelated to those of their peers. The learner goals, objectives and curriculum content are appropriate alternatives that are more suited to the needs of the individual student. An example might be a student who is involved in a vocational training program while peers are given a more traditional academic curriculum. Another important component of DI is varying the instructional process, which is similar to the UDL principle of providing multiple means of representation. Ways of varying the instructional process is using multiple instructional formats, strategies, environments, as well as varying student and teacher configurations (Thousand, Villa, & Nevin, 2007). A final important component of DI is varying the expected products or outcomes of learning. Similar to the UDL principle of allowing for multiple and flexible expressions of student learning, this component of DI allows students to choose among options, or to design their own method of demonstrating what they know. Having varied methods of learner assessments in the same classroom also necessitates assigning multiple criteria for mastery of the curriculum content. While DI and UDL share several important principles for learning, the distinguishing feature of DI is less emphasis on proactive instructional design in favor of a formative instructional design based on student learning.

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Universal Design for Learning (UDL) The concept of a universal approach in education comes from the concept of universal design practices in architecture and products. As common needs of people with disabilities were gradually being met through accessible designs, these designs proved beneficial to everyone (e.g., curb cuts; lights controlled by a simple touch; lever handles for doors and sink faucets). Universal design is now required in IDEA, specific to the assessments of students. Inclusion in the law led to the development of educational practices, support, and the provision of resources for teachers (see the National Center on Universal Design for Learning). There are similarities in the overall concept related to architecture and education (UDL) as seen in the two definitions below: Universal Design. The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design (Center for Universal Design, North Carolina State University). Universal Design for Learning (UDL). A set of principles for curriculum development that give all individuals equal opportunities to learn. UDL provides a blueprint for creating instructional goals, methods, materials, and assessments that work for everyone--not a single, one-size-fits-all solution but rather flexible approaches that can be customized and adjusted for individual needs (Universal Design for Learning Framework, Center for Applied Special Technology [CAST], 2011). The perspective of UDL is one that moves away from the view of students in separate groups and toward one that views students on a continuum of all learners. Publications specific to early childhood special education are infrequent, although the primary concept remains the same, equity and access for all (Darragh, 2007). The goal of the Conn-Powers framework is the “design of early education programs that meet the needs of all learners within a common setting and [to] begin to move away from specialized programs. (Conn-Powers, Cross, Traub, & Hutter-Pishgahi, 2006, p. 2). Three primary principles provide a framework for UDL; principles were derived from stringent reviews of research evidence from different fields and are applicable for individual or group sessions in early childhood.


Principle 3. Provide multiple means of engagement (options to capture learner’s interest, challenge appropriately, and motivate). Use books, songs, and communication that involve and represent all children, regardless of cultural predominance or linguistic and skill levels. Share information with families through a newsletter written at an appropriate level. Have key phrases translated into families’ home languages, and include photographs of children engaged in an activity.

Figure 3. Three principles of UDL based on Universal Design for Learning Framework, Center for Applied Special Technology (CAST). Retrieved from A list of UDL principles with applications for young children from Conn-Powers and colleagues (2006) follows: Principle 1. Provide multiple means of representation (options for perceiving and comprehending information). Present content in multiple formats, including verbal, print, video, or concrete objects, repeating key words/phrases in children’s home language and using simple sentences with gestures. Use physical cues to focus children’s attention, such as pointing to the picture in the book, giving verbal prompts to help children begin a response, offering language models for children to imitate, and encouraging children to keep thinking and trying. Principle 2. Provide multiple means of action and expression (options for learners to navigate a learning environment and express what they know). Use other materials of different sizes, textures, and shapes to help each child actively manipulate the objects for learning. Vary your expectations for participation and performance. If children are listening to a story and are asked to recall events, some may attend to and repeat back key words; others may recall the names of characters by pointing to pictures or using signs and gestures; and even others may predict what will happen next using complete sentences in English. Invite and encourage all children to join in, using multiple means of communication (e.g., speaking English and/or children’s home language, signing, displaying symbols).

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The special education initiatives presented briefly in this article are familiar by name to most special education professionals and most all music teachers will soon be aware of the NCAS. Although music therapists may be implementing many of the strategies associated with the special education initiatives, efforts with special education colleagues will be more efficient and productive when music therapists have knowledge of special education perspectives and communicate with colleagues using a shared core vocabulary. As the situation calls for, music therapists and music educators also may be collaborating on music goals and exchange ideas for their students relevant to the NCAS. It must be said, however, that an understanding of concepts and initiatives is only a beginning to meaningful collaborations, and that students are best served through best practices as implemented by highly competent, intelligent, and sensitive music therapists. References Batsche, G. (2006). Response to intervention. Alexandria, VA: National Association of State Directors of Special Education. Brotherson, M. J., Cook, C. C., Erwin, E. J., & Weigel, C. J. (2008). Understanding self-determination and families of young children with disabilities in home environments. Journal of Early Intervention, 31, 22-43. Brown-Chidsey, R., & Steege, M. W. (2010). Response to Intervention. New York: Guilford Press. CAST (2011). Universal Design for Learning Guidelines version 2.0. Wakefield, MA: Author. Center for Universal Design (CUD). Retrieved from http:// Conn-Powers, M., Cross, A., Traub, E., & HutterPishgahi, L. (2006). The universal design of early


education: Moving forward for all children. Beyond the Journal, Young Children, September 2006. Retrieved from 200609/ Darragh, J. (2007). Universal design for early childhood: Access and equity for all. Early Childhood Education Journal, 35(2), 1676-171. Darrow, A., Cassidy, J., Flowers, P., Register, D., Sims, W., Standley, J., Menard, E., & Swedberg, O. (2009). Enhancing literacy in the second grade: Five related studies using the Register Music/Reading Curriculum. Update: Applications of Research in Music Education, 27, 12-26. Erwin, E. J., & Brown, F. (2003). From theory to practice: A contextual framework for understanding selfdetermination in early childhood environments. Infants & Young Children, 16(1), 77-87. Giangreco, M., Cloninger, C., & Iverson, V. (1993). Choosing options and accommodations for children (COACH): A guide to planning inclusive education. Baltimore, MD: Paul H. Brookes. Glover, T. A., & DiPerna, J. C. (2007). Service delivery for response to intervention: Core components and directions for future research. School Psychology Review, 36(4), 526-540. Gromko, J. (2005). The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education, 53, 199-209. Hallahan, D. P., Kauffman, J. M., & Pullen, P. C. (2009). Exceptional learners: An introduction to special education. Boston, MA: Pearson/Allyn & Bacon. Humpal, M., & Colwell, C. (2006). Early childhood and school age educational settings: Using music to maximize learning. Silver Spring, MD: American Music Therapy Association. IDEA (2004). Individuals with Disabilities Education Improvement Act of 2004. Retrieved from http:// Kovaleski, J. F. (2007). Response to intervention: Considerations for research and systems change. School Psychology Review, 36(4), 638-646. Lamb, S. & Gregory, A. (1993). The relationship between music and reading in beginning readers. Educational Psychology, 13, 1. McCook, J. E. (2006). The RtI guide: developing and implementing a model in your schools. Horsham, PA: LRP Publications.

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Malley, S. (2013). Students with disabilities and core arts standards: Guidelines for teachers. Washington, DC: John F. Kennedy Center for the Performing Arts. +Disabilities+and+Arts+Standards NCCAS (2013). National core arts standards: A conceptual framework for arts learning. Retrieved from +Framework. Palmer, S. B., Summers, J. A., Brotherson, M. J., Erwin, E. J., Maude, S. P., Stroup-Rentier, V., Wu, H. Y., Peck, N. F., Weigel, C. J., Chiu, S. Y., McGrath, G. S., & Haines, S. J. (2014). Foundations for selfdetermination in early childhood: An inclusive model for children with disabilities. Topics in Early Childhood Special Education, 34(1), 38-47. Pane, D. & Salmon, A. (2011). Author’s camp: Facilitating literacy learning through music. Journal of Reading Education, 36, 36-42. Register, D. (2001). The effects of an early intervention music curriculum on prereading/writing. Journal of Music Therapy, 38, 239-248. Register, D., Darrow, A., Standley, J., & Swedberg, O. (2007). The use of music to enhance reading skills of second grade students and student with reading disabilities. Journal of Music Therapy, 44, 23-37. Reynolds, C. R., & Shaywitz, S. E. (2009). Response to intervention: Ready or not? Or, from wait-to-fail to watch-them-fail. School Psychology Quarterly, 24(2), 130-145. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68-78. Sailor, W., Dunlap, G., Sugai, G., & Horner, R. (2008). Handbook of positive behavior support. New York, NY: Springer. Salmon, A. (2010). Using music to promote children’s thinking and enhance their literacy development. Early Child Development and Care, 180, 937-945. Shogren, K., & Turnbull, A. (2006). Promoting selfdetermination in young children with disabilities: The critical role of families. Infants & Young Children, 19, 338–352. Shepherd, T. L. (2010). Working with students with emotional and behavior disorders: Characteristics and teaching strategies. Upper Saddle River, N.J.:


Merrill. Standley, J. (2008). Does music instruction help children learn to read? Update: Applications of Research in Music Education, 27, 17-32. Telesco, P. (2010). Music and early literacy. Forum on Public Policy, no. 5. Retrieved from http:// Thousand, J., Villa, R., & Nevin, A. (2007). Differentiated instruction: Collaborative planning and teaching for universally designed lessons. Thousand Oaks, CA: Corwin Press. Tomlinson, C. (2001). How to differentiate instruction in mixed-ability classrooms (2nd ed.). Alexandria, VA: Association for Supervision and Curriculum Development. Turnbull, A.P., Turnbull, H.R., Wehmeyer, M.L., & Shogren, K. (2013). Exceptional lives: Special education in today’s schools (7th ed.). Upper Saddle River, NJ: Merrill/Prentice Hall. Wehmeyer, M. L. (1996). Self-determination as an educational outcome: Why it is important to children, youth, and adults with disabilities. In D. Sands & M. Wehmeyer (Eds.). Self-determination across the lifespan: Independence and choice for people with disabilities (pp. 17-36). Baltimore: Brooks. Wehmeyer, M. L., Palmer, S. B., Agran, M., Mithaug, D. E., & Martin, J. E. (2000). Promoting causal agency: The self-determined model of instruction. Exceptional Children, 66, 439-453. Whitten, E., Esteves, K., & Woodrow, A. (2009). RTI Success. Minneapolis, MN: Free Spirit Publishing, Inc. RTI Action Network. Retrieved from http:// Wolfe, D., & Noguchi, L. (2009). The use of music with young children to improve sustained attention during a vigilance task in the presence of auditory distractions. Journal of Music Therapy, 46, 69-82.

Thanks you to Dr. Adamek, Dr. Darrow, and Dr. Jellison for sharing valuable information from the field of Special Education.

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About the Authors Mary Adamek, Ph.D., MT-BC is a Clinical Professor and Director of the Music Therapy Program at The University of Iowa. She co-authored Music in Special Education, and has contributed chapters in several textbooks published by the American Music Therapy Association (AMTA). Dr. Adamek maintains an active leadership role in state, regional, and national music therapy organizations and is a Past President of AMTA. Contact:

Alice-Ann Darrow, Ph.D., MT-BC is Irvin Cooper Professor of Music in the College of Music at Florida State University. She has been the recipient of over 25 federal, corporate, or university grants related to music and deafness, and inclusive education. She is the co-author of Music in Special Education, Music Therapy and Geriatric Populations, and editor of Introduction to Approaches in Music Therapy. Contact:

Judith A. Jellison, Ph.D., RMT is the Mary D. Bold Regents Professor in Music and Human Learning and University Distinguished Teacher at The University of Texas at Austin. An internationally and nationally recognized speaker, teacher, and researcher, she is widely published on topics concerning inclusion and is the author of Including Everyone. Contact:


featured One, Two, Three, and Do, Re, Mi: Early Childhood Musical Development for Music Therapists Dana Bolton, M.Ed., MMT, MT-BC Bolton Music Therapy, Murfreesboro, TN

About the Author Dana Bolton, MEd, MMT, MT-BC co-owns Bolton Music Therapy in Murfreesboro, TN, and has worked in the early intervention field for 11 years. Dana is a new member of the imagine editorial team. Contact:

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Introduction When asked to define music therapy, many music therapists respond, “We use music to reach non-musical goals.� For music therapists working in early childhood education, these nonmusical goals fall under categories such as fine and gross motor skills, cognitive and preacademic/academic skills, communication skills, social skills, and adaptive or self-help skills. When focusing on these non-musical goals, music therapy practitioners must have in mind how musical skills typically develop in young children. Hence, the American Music Therapy Association (AMTA) includes learning and development of musical behaviors in the Professional Competencies document (AMTA, 2009). Models of Musical Development Luce (2004, p. 26) states that the field of music therapy has not yet accepted a single model of musical development as a common knowledge base or vocabulary among practitioners.


He lists the following three advantages for music therapists in understanding musical development of children: Recognizing developmental levels as they are related to musical ability, process or progress. Providing a musical vocabulary from which to describe musical experiences that occurred and translating those musical experiences into psychophysiological progress. Providing a musical framework or model from which to structure and implement clinical sessions. Barrickman (1989) states that music therapists must consider realistic musical abilities and responses when planning music therapy interventions for young children. Briggs (1991) concludes that understanding musical development assists music therapists in more accurate evaluation and in developing interventions during treatment. The Individualized Music Therapy Assessment Profile (IMTAP) includes a musicality section to assist music therapists with designing individualized interventions for clients (Baxter et al., 2007). Schwartz (2008) asserts that a thorough understanding of musical development is a foundational skill for music therapists practicing in the early childhood field. There are multiple models of musical development, including age-specific and stage-specific models. Guilmartin and Levinowitz (2008) believe that children progress through identifiable stages of primary music development in early childhood, but that children develop at different rates depending on factors such as the richness of the musical environment and their natural aptitude. They also state that rhythmic and tonal development do not necessarily develop in parallel with each other. Their model, based on Gordon’s music learning theory, provides broad age ranges for the stages of rhythmic and tonal development. Children begin with reflexive responses to music and move towards achieving basic music competence (the ability to sing a song in tune and move to a steady beat) at around 3 to 6 years of age. Briggs and Bruscia, as described by Schwartz (2008), provide another stage-specific model, which places musical development in the context of models of

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developmental psychology. Each phase has a broad age range, with age ranges for specific skills also noted. Phases included are the reflex stage (approximately birth to 12 months), the intention phase (approximately 9 to 18 months), the control phases (approximately 18 months to 3 years), and the integration phase (approximately 3 to 7 years). According to Briggs (1991), “This model is intended to contribute to the literature a structure that will allow clinicians to observe and understand musical behaviors in meaningful and applicable ways” (p. 2). The Individualized Music Therapy Assessment Profile (IMTAP) is a tool designed for music therapists to use for ongoing assessment during treatment. It includes a musicality section that examines intrinsic skills (infant/ toddler skills usually developed by 18 months of age), basic skills (toddler skills usually developed by 3 years of age), and learned skills (preschool skills usually developed by 5 years of age) (Baxter et al., 2007). The musicality section looks at innate responses to music, as well as the ability and desire to participate in music. Andress (1998) provides a description of typical music behaviors at various chronological ages in early childhood. Although she breaks behaviors down between infants (6-18 months), toddlers, three-year-olds, four-year-olds, and five-year-olds, she recognizes that musical skills will develop at different rates due to individual differences among children. In addition to musical skills that children learn, children’s aesthetic responses to music at various ages are included. In another age-specific model, Campbell and ScottKassner (1995) describe natural and incipient musical behaviors in the areas of rhythm, pitch, singing, listening, moving, playing, and creating. Their purpose is to provide educators with recommendations for creating musical experiences. Skills listed are very specific and include vocal ranges for children of different ages and suggestions for appropriate musical instruments at various ages. Schwartz (2008) synthesizes musical development research and provides an overview of musical behaviors in relation to chronological age. This model includes developed and learned musical skills, as well as information on how children process music at different


Table 1. Musical Development in Early Childhood Rhythm




Instrument Playing


Spontaneous movements   are  rhythmic,  but  do  not   match  pulse  of  movement   and  occur  i n  short  bursts

Vocalizes/coos around  one   tone,  typically  the  tonic  or   dominant

Moves to  music  with    whole   Vocalizes  spontaneously  to   body music Movements  begin  as   involuntary  movement  and   transitions  to  voluntary

Explores i nstruments  by   mouthing Begins  to  reach  for  and  grasp   instruments


Moves to  own,  i nternal   steady  tempo

Sings melodic  contours  of   songs  but  not  e xact  pitches

Moves to  music  with   separate  body  parts

Displays perseverative   pounding  and  banging  of   instruments


Vocalizes during  or  after   presentation  of  music

Will align  to  microbeat   Sings  beginning  and  e nding   Prefers  to  move  to  music   (eighth  note)  of  the  song  for   of  songs  more  accurately with  a  partner short  periods  of  time

Sings simple  one  or  two   word  song

Can i mitate  simple  rhythmic   Sings  parts  of  songs  i n  tune   Performs  l earned   patterns with  others movements  to  music

Can sing  words,  rhythms,  and   Plays  with  mallets  or  beaters   pitch  of  e ntire  song  along   in  a  more  coordinated   with  others manner Sings  spontaneous  songs

Movement may  align  to   macrobeat  (steady  beat)  of   song 4-­‐Year-­‐Olds

Maintains macrobeat  with   visual  and  auditory  cues

Sings descending  i ntervals   more  accurately

Performs simple  action   songs

5-­‐Year Olds

Able to  keep  macrobeat  i n   body,  i ncluding  i n  feet

Sings songs  i n  tune

Follows movement   Can  sing  e ntire  song   directions  to  simple  dances independently  and  i n  tune Spontaneous  movements  to   music  decrease

Video courtesy of Bolton Music Therapy

Video Examples

Sings e ntire  song  with  some   Explores  different  sounds  of   errors instruments Uses  alternating  hands  to   play  i nstruments

ages. Like the previous model, Schwartz includes specific information on vocal ranges and intervals easiest for children to sing. Each model and checklist differs in the scope and specificity of the musical behaviors included, and readers are encouraged to consult the original sources to access the full information. However, there are multiple skills (e.g., spontaneous repeated movements to music, singing spontaneous songs, and moving to a beat that does not match the music) that appear on all or most of the models at around the same chronological age. These skills are compiled into Table 1, with video examples available for many of the skills.

Watch video: Musical Development – Rhythm

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Watch video: Musical Development – Pitch

Watch video: Musical Development – Movement

Watch video: Musical Development – Singing

Conclusion Music therapists should be familiar with the musical skills listed on multiple models as they appear to be the most widely researched and agreed upon. Just as knowledge of early childhood development is necessary for setting appropriate goals and objects in early childhood music therapy, knowledge of early childhood musical development is necessary for designing appropriate interventions to meet those goals. Familiarity with multiple models will allow music therapists to develop a comprehensive view and strong interventions. References American Music Therapy Association. (2009). AMTA professional competencies. Retrieved from http:// Andress, B. (1998). Music for young children. Fort Worth, TX: Harcourt Brace College Publishers. Barrickman, J. (1989). A developmental music therapy approach for preschool hospitalized children. Music Therapy Perspectives, 7, 10-16. Baxter, H. T., Berghofer, J. A., MacEwan, L., Nelson, J., Peters, K., & Roberts, P. (2007). The Individualized Music Therapy Assessment Profile. London: Jessica Kingsley Publishers. Briggs, C. A. (1991). A model for understanding musical development. Music Therapy, 10, 1-21. Campbell, P. S., & Scott-Kassner, C. (1995). Music in childhood: From preschool through the elementary grades. New York: Schirmer Books. Guilmartin, K. K., & Levinowitz, L. M. (2008). Introducing Music Together®: Book 2. Princeton, NJ: Center for Music and Young Children. Luce, D. W. (2004). Music learning theory and audiation: Implications for music therapy clinical practice. Music Therapy Perspectives, 22, 26-33. Schwartz, E. (2008). Music, therapy, and early childhood: A developmental approach. Gilsum, NH: Barcelona Publishers. This 2014 featured

Watch video: Musical Development – Instrument Play

article is available as a full multimedia publication on the imagine website.

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research 2014 Early Childhood Research Snapshot Blythe LaGasse, Ph.D., MT-BC Colorado State University Fort Collins, Colorado

Research on music and early childhood populations continues to be published in numerous journals. This research snapshot will cover recent research on the use of music in early childhood, published in 2013 and 2014. The purpose of this snapshot is to help the music therapy clinician stay apprised of research in order to maintain an evidence-based practice. This review will explore research on music for infants born prematurely, the lasting impact of music experience in early childhood, and music for young children with Autism Spectrum Disorder. Music for Preterm Infants Over the past year several studies on music responses in infants were published. Two of the published studies failed to find significant differences on physiological states or behavioral responses with recorded music. One study looked at the effect of music and maternal presence on the physiological and behavioral state of infants born prematurely. Dearn and Shoemark (2014) found no discernible infant response to recorded music (Brahms’ Lullaby) played in compliance with the American Academy of Pediatrics’ (AAP) sound level

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recommendations. The music was alternated with ambient sound. When mothers were present the infants showed increased oxygen saturation for the first 12 minutes. The authors suggest that the infants may not have detected the music against the ambient sounds due to compliance with the AAP guidelines. Regardless of music presence, the infants responded to maternal presence. Another study investigated physiological and behavioral responses of 90 premature infants to recorded music or silence. Alipour, Eskandari, Ahmari Tehran, Eshagh Hossaini, and Sangi (2013) played recorded lullabies through headphones at 50-60 decibels for infants in the music condition. Other studies have looked at infant response to different stimuli types. The researchers also recorded physiological and behavioral measures in infants in a control group and a group that also wore the headphones in a silent condition. The results indicated no significant difference in physiological or behavioral measures between the groups. The authors suggest that more research is needed to determine if results from other studies finding significant differences can be replicated across settings. Although the above studies failed to find significance, Loewy, Stewart, Dassler, Telsey, and Homel (2013) found significant differences when live music therapy interventions were used with preterm infants (see Research Snapshot, LaGasse, 2013). Findings that live music intervention resulted in changes in physiological and behavioral measures warrants more research focused on differences between live and recorded interventions for preterm infants. The need for more research has also been stated by Allen (2013) in an evidence-based practice brief on the use of music in the Neonatal Intensive Care Unit (NICU). After a review of research, Allen concluded that music therapy and music in the NICU may be helpful; however, stated that there is a need for more robust studies and follow-up studies on infants who were exposed to higher than recommended sound levels. Another area of research with infants is the difference between spoken motherese and singing to engage infants. Corbeil, Trehub, and Peretz (2013) investigated infant responses to singing and speech presented in a

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happy tone or an affectively neutral manner. Forty-eight to fifty infants were involved in each experiment and were between the ages of 4 and 12 months. Three different experiments were used to determine infant preference through the head-turn preference procedure. Results indicated that infants responded more to a happy voice, regardless of presentation in singing or speech. This initial research supports the use of a happy vocal tone with infants when attempting to engage them in music experiences. Music Training in Early Childhood Researchers have continued to examine the impact of early exposure to music on later skills. One skill that has been of interest is the ability to synchronize motor movements to an external rhythmic auditory stimulus with different levels of complexity. Bailey and Penhune (2013) studied finger tapping synchronization abilities in 77 musicians and found a correlation between synchronization skill and individuals who began musical training earlier. Furthermore, working memory scores were predictive of synchronization ability, no matter age of onset for musical training. These results support the sensitive period hypothesis for musical training, where age of onset may impact future musical skills. Researchers have also looked at the relationship between the sensitive period for language learning and early music exposure. White, Hutka, Williams, and Moreno (2013) published a paper describing sensitive periods in language and music, including how learning is thought to occur at different ages. The authors suggest that there is a bi-directional transfer of skills between language and music, where exposure to tonal languages can impact music processing and exposure to music can enhance learning of language. Researchers have examined this phenomenon by conducting experiments to determine the impact of music instruction on nonmusical abilities including IQ, speech encoding, and attention. Kaviani, Mirbaha, Pournaseh, and Sagan (2014) investigated the impact of music classes on IQ test scores of preschool children. Children in the music group engaged in the “Orff Method” of music education. Children played by ear, played rhythmic games, and learned songs and dances. After 12 weeks of 75-minute


weekly music lessons, children in the music group demonstrated significant increases in verbal reasoning and short-term memory when compared to children who did not receive music instruction. Children who receive music instruction may also demonstrate differences in working memory and attention abilities. Strait, Parbery-Clark, Hittner, and Kraus (2012) studied neural encoding of speech in noise in fifteen 7-13 year old children who had begun private instrumental music trainings by age 5 and maintained weekly practice for at least four years. Children with musical training outperformed 16 non-musician children in areas of auditory working memory, attention tasks, and speechin-noise perception. The above studies further demonstrate that exposure to musical training in childhood has the potential to change abilities in nonmusical tasks. In contrast to the aforementioned studies, one study did not find a positive impact of music engagement on cognitive skills in preschool children. Mehr, Schachner, Katz, and Spelke (2013) conducted two experiments to determine the impact of a six-week music enrichment class modeled after the Eastman Community Music School’s Early Childhood Music Program. Parents attended classes and engaged in musical activities with their children. Children were tested on spatial reasoning, numerical discrimination, and receptive vocabulary and compared to children in a visual arts or control condition. Results indicated no differences between groups for all measures. The authors discuss limitations including the length of time children were exposed to the conditions. Music for Children with Autism Spectrum Disorder Many children with an Autism Spectrum Disorder (ASD) may demonstrate hypersensitivity to sound (Stiegler & Davis, 2010), which may influence musical preferences and responses. Bhatara, Quintin, Fombonne, and Levitin (2013) investigated incidence of avoidance of sounds in early childhood and musical preference and enjoyment in adolescence for persons with ASD. Results of the survey indicated that early sensitivity to sound did not impact musical ability, memory, reproduction, creativity, interest, or emotional response in adolescence. Furthermore, there were no differences in responses and preference of music when compared to neurotypical children, with the

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exception that more persons with ASD reported that classical music was their favorite genre. This study provides some initial evidence that children with ASD develop musical perceptual abilities despite hypersensitivities in early childhood. This may support the use of music intervention and instruction for persons with ASD. A recent study investigated the impact of music therapy intervention on young children with ASD. Thompson, McFerran, and Gold (2013) investigated the use of family-centered music therapy (FCMT) for social engagement between the child and parent. Twelve children received FCMT in addition to their regular early intervention program and eleven received only their regular program. The FCMT intervention consisted of sixteen weeks of interventions delivered in the home. Parents were engaged in music making experiences with their child including movement to music, songs, and improvisation. Results on the Intention-to-treat analysis and Vineland Social Emotional Early Childhood Scale indicated a significant effect of FCMT over regular early intervention programs alone. The authors also completed a qualitative analysis, which indicated that the parentchild relationship was strengthened through the therapeutic intervention. With relatively little research on home-based family-centered interventions, this study provides initial evidence for the use of music therapy for improved social engagement. The above studies highlight some of the current research in the early childhood setting. Although more research is needed to show the efficacy of music therapy in early intervention, evidence on how music impacts young children continues to provide support for music engagement in early childhood. In order to provide readers with the opportunity to explore these studies further, the reference list below has direct links to the study abstracts via PubMed (http:// or the digital object identifier (DOI) number ( References Alipour, Z., Eskandari, N., Ahmari Tehran, H., Eshagh Hossaini, S. K., & Sangi, S. (2013). Effects of music on physiological and behavioral responses of


premature infants: a randomized controlled trial. Complement Therapies in Clinical Practice, 19(3), 128-132. doi: 10.1016/j.ctcp.2013.02.007. PMID: 23890458 Allen, K. A. (2013). Music therapy in the NICU: Is there evidence to support integration for procedural support? Advance in Neonatal Care, 13(5), 349-352. doi: 10.1097/ANC.0b013e3182a0278b. PMID: 24042142 Bailey, J. A., & Penhune, V. B. (2013). The relationship between the age of onset of musical training and rhythm synchronization performance: Validation of sensitive period effects. Frontiers in Neuroscience, 7, 227. doi: 10.3389/fnins.2013.00227. PMID: 24348323 Bhatara, A., Quintin, E., Fombonne, E., & Levitin, D. J. (2013). Early sensitivity to sound and musical preferences and enjoyment in adolescents with autism spectrum disorders. Psychomusicology: Music, Mind, And Brain, 23(2), 100-108. doi: 10.1037/a0033754 Corbeil, M., Trehub, S. E., & Peretz, I. (2013). Speech vs. singing: Infants choose happier sounds. Frontiers in Psychology, 4, 372. doi: 10.3389/fpsyg.2013.00372. PMID: 23805119 Dearn, T., & Shoemark, H. (2014). The effect of maternal presence on premature infant response to recorded music. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43(3), 341-350. doi: 10.1111/1552-6909.12303. PMID: 24707819 Kaviani, H., Mirbaha, H., Pournaseh, M., & Sagan, O. (2014). Can music lessons increase the performance of preschool children in IQ tests? Cognitive Processing, 15(1), 77-84. doi: 10.1007/ s10339-013-0574-0. PMID: 23793255 LaGasse, A. B. (2013). 2013 early childhood research snapshot. imagine, 4(1), 30-33. Loewy, J., Stewart, K., Dassler, A. M., Telsey, A., & Homel, P. (2013). The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics, 131(5), 902-918. doi: 10.1542/peds. 2012-1367. PMID: 23589814 Mehr, S. A., Schachner, A., Katz, R. C., & Spelke, E. S. (2013). Two randomized trials provide no consistent evidence for nonmusical cognitive benefits of brief preschool music enrichment. PLoS One, 8(12),

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e82007. doi: 10.1371/journal.pone.0082007. PMID: 24349171 Stiegler, L. N., & Davis, R. (2010). Understanding sound sensitivity in individuals with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 25, 67-75. doi: 10.1177/1088357610364530 Strait, D. L., Parbery-Clark, A., Hittner, E., & Kraus, N. (2012). Musical training during early childhood enhances the neural encoding of speech in noise. Brain Lang, 123(3), 191-201. doi: 10.1016/j.bandl. 2012.09.001. PMID: 23102977 Thompson, G. A., McFerran, K. S., & Gold, C. (2013). Family-centred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child: Care, Health and Development, First published online November 22, 2013. doi: 10.1111/ cch.12121. PMID: 24261547 White, E. J., Hutka, S. A., Williams, L. J., & Moreno, S. (2013). Learning, neural plasticity and sensitive periods: Implications for language acquisition, music training and transfer across the lifespan. Frontiers in Systems Neuroscience, 7, 90. doi: 10.3389/fnsys.2013.00090. PMID: 24312022 About the Author Blythe LaGasse, Ph.D., MT-BC is Associate Professor and Coordinator of Music Therapy at Colorado State University. She is also the founder of the Music Therapy Research Blog, a resource aimed at helping music therapy clinicians maintain an evidence-based practice Contact:

For additional 2014 articles and books check the publications and reviews section.


Did You Know? Clinical Practice Trends in Music Therapy and ASD Petra Kern, Ph.D., MT-BC, MTA, DMtG Music Therapy Consulting Santa Barbra, CA

Autism Spectrum Disorder (ASD) currently aects 1 in 68 individuals in the USA. Each reader most likely does know someone with an ASD diagnosis. Does this also mean that music therapy practitioners have more individuals with ASD on their weekly caseload? What goal areas do music therapist target? With whom do music therapists collaborate? These and other questions were the focus of a national survey study conducted by Kern, Rivera, Chandler, and Humpal (2013). In this summary, readers will learn about the major outcomes.

Note: This summary is based on the following survey study: Kern, P., Rivera, N. R., Chandler, A., & Humpal, M. (2013). Music therapy services for individuals with autism spectrum disorder: A survey of clinical practices and training needs. Journal of Music Therapy, 50(4), 274-303.

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Professional Practice Compared to a decade ago, the caseload with an ASD diagnosis slightly increased for music therapists. Most music therapists provide services in public schools (K-12), family homes, private practice (though with decreasing tendency), or in community settings, which partially reflect the principles of practice guidelines for individuals with ASD. Clients with ASD seem to be shifting slowly to the 12-20 and older age range; however, music therapists also see more infants and young children compared to previous years – facts that possibly can be attributed to 1) the maturing of clients and 2) increased awareness of the impact of early childhood intervention for this population. Music therapists frequently collaborate and consult with parents/caregivers/family members, educators, speechlanguage pathologists, occupational therapists, and others for treatment planning and implementation. The rates of collaboration and consultation seem to be higher than those across populations in previous years. Within school-based settings, music therapists primarily oer group activities, whereas in other work settings individual sessions are more common. Yet music therapy services are still delivered primarily in a segregated versus inclusive environment. Most music therapy sessions are 30 minutes in length and are typically provided once per week with an average of 1-3 year service duration. Music therapy services mainly are funded by private pay, IDEA/Special Education State/County Funding, and grants.


Therapeutic Process Music therapists demonstrate a strong assessment practice, which is in compliance with recommended practices for ASD. Yet, there is no known validated music therapy assessment tool specific to ASD. Therefore, music therapists apply mainly self-created assessment tools and music-therapy or work-space specific assessment tools, although several new and specific tools are emerging. The top three goal areas targeted are communication skills, social skills, and emotional skills (almost not addressed a decade ago). Music therapy clients typically achieve intervention goals within 4-6 months. According to research-based practice, most music therapists apply a behavioral approach to music therapy, which is also reflected in the structuring of sessions (i.e., moderately to highly structured). Fewer music therapists reported using Nordoff-Robbins Music Therapy or Neurologic Music Therapy, while employing computer-based music activities is increasing. Music therapy techniques utilized to achieve therapeutic goals are mostly singing and vocalization, instrument play, movement and dance, and free and thematic improvisation.

Strategic Priority on Music Therapy and ASD for prioritizing outcomes, objectives, and tasks of the strategic plan. The Strategic Priority on Music Therapy and ASD now focuses its efforts on a) increasing awareness and recognition b) training and professional development and c) evidence-based practice and research. For immediate updates, please follow us on Twitter at #MTASD. Acknowledgment The author would like to thank Dr. Nicole Rivera, Alice Chandler, and Marcia Humpal for their collaboration in this national survey study. About the Author Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting is online professor at the University of Louisville, editor-in-chief of imagine and serves on AMTA’s Priority on ASD’s Steering Committee. Her research and clinical focus is on young children with ASD, inclusion programming, and educator/parent coaching. Contact:

Evidence-Based Practice Participants applied many of the National Autism Center’s eleven identified evidence-based practices. Most incorporated prompting, reinforcement, joint attention intervention, and picture schedules in their music therapy sessions. Music therapists implement all guiding principles of practices for ASD on a very high level, except for serving clients in natural and inclusive environments. More than half of the music therapists received training in some of the identified evidencebased practices, obtained mainly via education programs offered outside the field of music therapy. Music therapists indicated receiving training in the principles of practices in similar ways. End Notes The interest in clinical practice trends in music therapy and ASD is evident. In the Oxford University Press Publisher's Report to the American Music Therapy Association (AMTA) this study was listed at the top of accessed full-text Journal of Music Therapy articles in the first half of 2014. The outcomes of this study also were very beneficial to the steering committee of AMTA’s

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Study Background The purpose of this study was to evaluate the current status of music therapy practices for serving clients with ASD, the implementation of national ASD standards and guidelines, the awareness of recent developments, and training needs of music therapists. Participants were professional members of AMTA (N=328) working with individuals with ASD. The study design in use was a cross-sectional survey study. The 45-item online questionnaire was distributed through email and social media and accessed through SurveyMonkey®. Date were collected for a total of six weeks. Data from multiple-choice questions were converted into percentages. Narrative response were analyzed by completed an open coding procedure. Participation in this study was voluntary and anonymous.


Supporting Parents to Support their Child through Music Therapy Grace Thompson, Ph.D., BMusThp(Hons), RMT University of Melbourne, Australia

Working with young children with Autism Spectrum Disorder (ASD) is perhaps one of the most rewarding and challenging contexts for music therapists. The work is rewarding because music making is often something that children with ASD are motivated by and one of the few things that supports their engagement with others. Challenging, because the children have such a diversity of strengths and skills, and there is overwhelming and often contradictory information and expectations available to professionals and families.

About the Author Grace Thompson is an Australian music therapist whose clinical work focuses on young children with special needs in familycentered settings. She is currently a lecturer in music therapy at The University of Melbourne. Contact:

Diagnosis often occurs between the ages of three and five years. Family members may notice that developmental communication milestones are not being met or that there is something “different” about the way their child interacts with them and navigates the world. While parents are naturally concerned that their child is not talking or communicating like other children, they may be less aware that a disruption in social play and engagement at this crucial developmental stage often has devastating impacts on future social communication capabilities (Clifford & Dissanayake, 2009). Early Intervention A family’s first contact with therapy and special education services often includes information sharing about how communication skills develop and their link to social skills and engagement with others. However, while social skills can be trained and taught, social engagement is not as easily addressed by behavioral interventions (Schertz & Odom, 2007). The early intervention (EI) field has long recognized that strong parent-child relationships are a key factor in promoting social engagement, and so most EI services now work in a familycentered model (Dunst & Trivette, 2009). Family-centered ideals have long been incorporated into music therapy with young children with ASD, beginning with the work of Juliette Alvin (1978), Pierrette Müller, and Auriel Warwick

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(Müller & Warwick, 1993), then developed extensively by Amelia Oldfield (e.g., Oldfield 1993, 2006), and now continued by numerous researchers around the world. Family-Centered Music Therapy Recent research has investigated whether children’s social engagement in the home and community would improve following participation in a family-centered music therapy program. In this randomized controlled study, 23 children were assigned to either 16 weeks of family-centered music therapy sessions (once per week) in their home or treatment as usual in their community EI program (children were wait-listed for music therapy). Changes in social communication skills were measured by standardized parent-report assessments, including the Vineland Social Emotional Early Childhood Scales (Sparrow, Balla, & Cicchetti, 1998) and the Parent-Child Relationship Inventory (Gerard, 2005). In addition, qualitative data from parent interviews was collected. The quantitative results showed that children in music therapy made significant improvements in the quality of their social interactions in the home and community as well as their level of engagement within the music therapy sessions. There were no significant improvements in language skills or general social responsiveness. A thematic qualitative analysis of the interviews showed that the parent-child relationship grew stronger, with one parent describing the experience as follows: “In music therapy you’re free; you’re enjoying each other’s time, watching each other, learning from each other, bonding closer. It just brought us closer together” (Thompson, 2014; Thompson & McFerran, 2013; Thompson, McFerran, & Gold, 2013).

Watch video: Interview with a Father

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As part of the study, families were asked to keep a journal of how much, how frequently, and what type of music activities they did with their child without the therapist in between weekly sessions (Thompson, 2014). Perhaps not surprisingly, singing with their child and listening to music with their child were the activities most frequently used by parents (average of approximately 89 minutes per week each), while improvisation with instruments was used much less by comparison (average of approximately 25 minutes per week). After a further measurement at the 8-week follow up, the average use of improvisation had dropped to negligible levels each week (approximately 3 minutes), while singing was maintained at 84 minutes per week and listening fell slightly to 69 minutes per week. In the research sessions, many instrument based music therapy interventions were used, such as free improvisation, structured anticipation activities, structured instrumental matching games, and improvising stories supported by instrumental soundtracks. Yet, despite the parents participating in 16 weekly sessions where they experienced these instrumental methods first-hand, their use of instruments without the music therapist was low. Implications for Practice When many music therapists plan sessions in clinical practice for young children with ASD, instrumental improvisation often is featured strongly. These spontaneous, creative, interpersonally responsive methods offer a unique opportunity for children with ASD to interact with others and potentially develop the social engagement capabilities that are so difficult to train or teach. It was surprising to see the discrepancy between parents’ propensity for singing and listening over playing music, which has led to continued reflection on the implications for music therapy practice in a field that promotes sustainable approaches to services. If EI ethics require therapists to empower parents to support their child’s development, then music therapists have a responsibility to share knowledge and skills with those significant people in the child’s life. From a music therapy practice perspective, it raises interesting questions and challenges for working with families, such as “How can music therapists support


parents to support their own child?” This question is central to family-centered practice, as seen in EI ethics statements in Australia and elsewhere which advocate, and indeed mandate, that families be intimately involved in all services for their child (Early Childhood Australia, 2006). Therapists from all disciplines must now consider how therapeutic interventions and activities can be embedded into the child’s natural environments, and therefore managed and supported by the child’s community. For music therapists this ethos poses unique challenges, particularly in Western cultures where music skills are seen as specialist abilities for talented people. There is still much to be learned about how music therapists can support families who have a child with special needs to use music therapeutically in everyday life, irrespective of the parents’ musical background. The results from the parents’ musical journals prompted the following question: “Which aspects of music therapy practice can music therapists easily encourage others to use, which aspects need short- to medium-term support and modeling, and which aspects require specialist skills?” This question is central for therapists who wish to work in a collaborative partnership model with parents, where a sustainable orientation to practice is embraced (Bolger & McFerran, 2013). Understanding our role with families in this light has the potential to paradoxically both deepen and broaden the way music can be used as therapy, in therapy, and in everyday life. References Alvin, J. (1978). Music therapy for the autistic child. London: Oxford University Press. Bolger, L., & McFerran, K. (2013). Demonstrating sustainability in the practices of music therapists: Reflections from Bangladesh. Voices: A World Forum for Music Therapy, 13(2). Retrieved from 715/603 Clifford, S. M., & Dissanayake, C. (2009). Dyadic and triadic behaviors in infancy as precursors to later social responsiveness in young children with autistic disorder. Journal of Autism and Developmental Disorders, 39, 1369-1380. doi: 10.1007/ s10803-009-0748-x Dunst, C. J., & Trivette, C. (2009). Capacity-building family-systems intervention practices. Journal of

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Family Social Work, 12(2), 119-143. doi: 10.1080/10522150802713322 Early Childhood Australia. (2006). Code of ethics. Retrieved from http:// Gerard, A. B. (2005) Parent–Child Relationship Inventory (PCRI) Manual, 4th edn. Western Psychological Services, Torrance, CA, USA. Müller, P., & Warwick, A. (1993). Autistic children and music therapy: The effects of maternal involvement in therapy. In M. Heal & T. Wigram (Eds.), Music Therapy in Health and Education (pp. 214-234). London: Jessica Kingsley Publishers. Oldfield, A. (1993). Music therapy with families. In M. Heal & T. Wigram (Eds.), Music Therapy in Health and Education (pp. 46-54). London: Jessica Kingsley Publishers. Oldfield, A. (2006). Interactive music therapy in child and family psychiatry: Clinical practice, research and teaching. London: Jessica Kingsley Publishers. Schertz, H. H., & Odom, S. L. (2007). Promoting joint attention in toddlers with autism: A parent-mediated developmental model. Journal of Autism and Developmental Disorders, 37, 1562-1575. Sparrow, S., Balla, D. & Cicchetti, D. (1998) Vineland Social-Emotional Early Childhood Scales Manual. American Guidance Service, Circle Pines, MN, USA. Thompson, G. (2014). A survey of parent’s use of music in the home with their child with Autism Spectrum Disorder: Implications for building the capacity of families. Voices: A World Forum for Music Therapy., 14(1). Retrieved from voices/article/view/734/641 Thompson, G., & McFerran, K. (2013). “We’ve got a special connection”: Qualitative analysis of descriptions of change in the parent-child relationship by mothers of young children with autism spectrum disorder. Nordic Journal of Music Therapy. doi: 10.1080/08098131.2013.858762 Thompson, G., McFerran, K., & Gold, C. (2013). Familycentred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomised controlled study. Child: Care, Health & Development. Advance online publication. doi: 10.1111/cch.12121


Effects and Clinical Uses of Music for Children with Autism Spectrum Disorder: A Review of Three Recently Published Articles Edward Todd Schwartzberg, M.Ed., MT-BC University of Minnesota Minneapolis, Minnesota

This article summarizes three studies addressing short- and long-term memory, comprehension and generalization of social skills, and repertoire used by practitioners with children with Autism Spectrum Disorder (ASD), while addressing possible clinical applications of the study outcomes.

About the Author Edward Todd Schwartzberg, M.Ed., MT-BC, is professor and music therapy clinic coordinator at the University of Minnesota. He teaches classes, conducts research, and provides private and group music therapy sessions for children with ASD, and other neurological and physical disabilities through the On-Campus Music Therapy Clinic. Todd is also the current President of the Board of Directors for the Autism Society of Minnesota and Assembly Delegate for the Great Lakes Region of the American Music Therapy Association. Contact:

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Schwartzberg, E. T., & Silverman, M. J. (2012). Eects of pitch, rhythm, and accompaniment on short- and long-term visual recall in children with autism spectrum disorders. The Arts in Psychotherapy, 39, 314-320. Applying their experience (one of the three key elements of evidence-based practice), board-certified music therapists regularly pair music with visual information to facilitate memory and learning. The purpose of this study was to examine pairedassociate eects (i.e., a type of learning in which items are presented in pairs so that one item leads to recall of the other) of speech, rhythm, melody, and harmony on short- and longterm recall of visual information in children with ASD and in neurotypical children. Phase one of the study was conducted during three separate one-week summer camps and included 42 children with ASD. Phase two, with 14 neurotypical children, took place during an academic year at a local religious institution. Participants were presented with seven pictures named aloud (i.e., house, car, tree, boat, book, apple, and banana) paired with one of four music conditions. The pictures were then mixed up and participants were asked to put them back in the correct order. Long-term recall was tested by asking them to do it again seven hours later in phase one and a week later in phase two.


The four music conditions included speech, rhythm, melody, harmony. In the speech condition, pictures with their names were spoken on quarter notes without pitches. The orders of the music conditions and the visual stimuli were randomized to control for learning, order, and carryover effects. In the rhythm condition, pictures with their names were paired with a rhythm consisting of quarter and eighth notes, with quarter notes at 60 beats per minute. In the melody condition, the pictures and item names were presented within simple, unfamiliar pitch patterns composed by the researchers in the key of C Major (Jellison, 1976; Silverman, 2007) using quarter notes at 60 beats per minute. Intervals were limited to major thirds and seconds, beginning on middle C, moving up to a 5th above middle C, and resolving at middle C. The harmony condition presented pictures with their names using the same melody as the melody condition, adding harmony with a steel-string acoustic guitar. The therapist played the I, IV, and V chords with a downward strum on each word as it was vocalized.

Listen to Condition A Speech

Listen to Condition B Rhythm

Listen to Condition C Melody

Listen to Condition D Harmony

the harmony condition and least accurate in the speech condition. Regardless of condition, participants had better recall for items at the beginning and end of the list. Neurotypical participants had higher overall recall across all four conditions and time frames than participants with ASD. For participants with ASD, recall was highest in the harmony condition in both short- and long-term testing. For the neurotypical participants, mean recall was highest in rhythm (short-term) and harmony (long-term) condition. Paivio (1991) asserted in his Dual Coding Theory, that learning is best when visual and verbal information are paired. This may explain why memory recall was more accurate during the harmony condition as participants were able to see and hear the guitar. It is also possible that participants felt a sense of intrigue elicited by the acoustic guitar within an individualized and novel setting or that the diverse auditory stimulation promoted total brain activation and led to more accurate recall. The addition of the harmonic structure provided by the acoustic guitar may have led to increased structure and stimulation of cognitive processing related to the encoding and retrieval of visual information. Implications for clinical practice suggest that when delivering visual information to children with ASD, clinicians might consider pairing it with music to facilitate recall. A mnemonic memory device can be delivered in the form of a rhythm or melody, with or without harmony. In this study, the harmony, melody, and rhythm conditions yielded higher recall ability than the speech condition. This finding is consistent with related research in which researchers found similar results with other disability groups (Claussen & Thaut, 1997; Gfeller, 1983). One of the most common examples of a musical mnemonic is found in children singing the alphabet to the tune of Mozart’s Twelve Variations on “Ah vous diraije, Maman,” K. 265/300e. The use of mnemonics is recommended for many areas of education and therapy: Academic tasks

Results for phase one showed more accurate recall during the short-term phase. Although there were no significant differences between the music conditions, short- and long-term recall were most accurate during

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Use simple and repetitive rhythmic and melodic motifs to facilitate recall of academic information. Consult with general education and special education teachers about the use of musical mnemonics in the classroom. Social skill development and self-regulation Place social stories within simple and repetitive


rhythmic and melodic motifs as well as familiar and/ or unfamiliar melodies. Use rhythmic, melodic, and harmonic motifs as well as client-preferred familiar and/or unfamiliar melodies as prompts for appropriately expressing, comprehending, and understanding various states of self-regulation. The results of this study suggest that therapists and educators should consider using music whenever possible to enhance attention and learning in children with and without disabilities. However, clinicians should continue to consider age appropriateness, client preference, and ability level when selecting repertoire, instruments, and the rhythmic, melodic, and harmonic structure of music.

five yes or no comprehension check questions before camp and one week after camp. For three consecutive days during camp, the social story intervention was implemented during each group music therapy session. All participants completed comprehension check questions immediately following receiving social story. "The social stories were written according to Gray’s social story protocol (Gray & Garrand, 1993) and were based on one of the three subcategories of the ASSP (see example in Figure 1).

Schwartzberg, E. T., & Silverman, M. J. (2013). Effects of music-based social stories on comprehension and generalization of social skills in children with autism spectrum disorders: A randomized effectiveness study. The Arts in Psychotherapy, 40, 331–337. The purpose of the second study was to examine the effects of music-based social stories on the comprehension and generalization of social skills in children with ASD. Other researchers have studied the use of familiar melodies (Pasiali, 2004) and unfamiliar melodies (Brownell, 2002) to enhance the memory recall of social stories. However, there were no published studies of music-based social stories with large sample sizes or that investigated the comprehension and generalization of social skills in children with ASD. In this study, existing camp groups with a total of 30 children with ASD were randomly assigned to be included in one of three non-music control groups (i.e., social story read to them) or one of three experimental music therapy groups (i.e., social story sung to them). Then, they were assessed with the Autism Social Skills Profile (ASSP) created by Bellini and Hopf (2007). Parents completed the ASSP one week prior to and one week after camp. Participants answered

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Figure 1: Music-based social story.


An analysis of the results suggested that the scores for the comprehension check questions were highest on the post-test. However, there were few significant effects for the ASSP. While music-based social stories can serve as carriers of relevant information regarding targeted social situations, researchers/clinicians should continue investigating the benefits of familiar versus unfamiliar melodies on the recall and comprehension of social stories. Future analysis of the results of this study suggest that when visual information is delivered, it can be coupled with either a rhythmic, melodic, or harmonic progression to facilitate recall. Specifically, clinicians may consider integrating music-based social stories with children to address skills such as: Acquisition and maintenance of targeted social skills Comprehension and generalization of vocational tasks. Reminders for physical exercises and exercise adherence. Additionally, practitioners may Adhere to the protocol defined by Gray (2004) to integrate numerous opportunities within the therapeutic environment to learn and practice the music-based social story. Consider client preferences and ability level when writing the melody (or utilizing a familiar song to piggyback). Use video modeling/video self-modeling to assist with generalization and practice of the desired behavior beyond the therapeutic environment. Schwartzberg, E. T., & Silverman, M. J. (2014). Music therapy song repertoire for children with autism spectrum disorder: A descriptive analysis by treatment areas, song types, and presentation styles. The Arts in Psychotherapy, 41, 240–249. The third study was influenced by the findings and lessons learned from the previous two studies. The purpose of this descriptive study was to identify the song types, presentation styles, and song repertoire used within specific treatment areas with children with ASD. Surveys were sent to 257 music therapists who worked with children diagnosed with ASD, between the ages of birth through 19 years. Ninety-one music therapists participated in the survey, resulting in a 35% response rate. The number of participants responding to each question ranged from 72 to 91.

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Overall, the majority of respondents indicated they used more pre-existing songs, followed by original compositions and lyric replacement (piggyback) songs. However, when asked questions about song types used to address specific treatment areas, respondents indicated they used live original compositions across all treatment domains more frequently than live pre-existing and live lyric replacement songs. The most frequently stated songs included: Goodnight Ladies (for hello/welcome and goodbye/ closure) If You’re Happy and You Know It (for perceptual/ motor skills, behavior/psychosocial skills, and goodbye/closure) Hokey Pokey (for perceptual/motor skills and sensory integration/exploration) Head and Shoulders, Knees and Toes (for perceptual/motor skills) Shake Your Sillies Out (for perceptual/motor skills, instrument playing, and body regulation) I’ve Been Working on the Railroad (for perceptual/ motor skills and instrument playing) We Are the Dinosaurs (for perceptual/motor skills and instrument playing). The apparent tendency to use live original compositions across all treatment areas appears to be in disagreement with findings from related music therapy and ASD research. Researchers have investigated the use of unfamiliar/original live compositions on communication and social skills of children with ASD (Brownell, 2002) and in transitioning between activities (Register & Humpal, 2007). Kern and colleagues (2007) utilized all three song types in their alternating treatment single subject study to investigate the difference between speaking lyrics and using an original, piggybacked, or pre-existing song on self-care tasks in children with ASD. Interestingly, despite the fact that researchers have concluded that familiar songs would be more effective, participants of this survey study utilized original songs more often. Perhaps, music therapists may be relying on their clinical experience that familiar songs may hinder learning due to a previous association. Hence, the structure of unfamiliar songs as a template for the delivery of social and academic information may provide a more effective mnemonic device for individuals with ASD when practiced to familiarity. However, no databased evidence is available to support this notation.


These three research studies provided further insights into the effects of music on individuals with ASD as well as unanswered questions. Music therapists can help increase the acceptance of music therapy as a viable and possible treatment option by conducting future research and embedding evidence-based treatments into clinical practice while educating and collaborating with other care providers. References Bellini, S., & Hopf, A. (2007). The development of the Autism Social Skills Profile: A preliminary analysis of psychometric properties. Focus on Autism and Other Developmental Disabilities, 22, 80–87. Brownell, M. D. (2002). Music-based adapted social stories to modify behaviors in students with autism: Four case studies. Journal of Music Therapy, 39, 117-144. Claussen, D. W., & Thaut, M. H. (1997). Music as a mnemonic device for children with learning disabilities. Canadian Journal of Music Therapy, 5, 55-66. Gfeller, K. E. (1983). Musical mnemonics as an aid to retention with normal and learning disabled students. Journal of Music Therapy, 20, 179-189. Gray, C. (2004). Social stories 10.0: The new defining criteria. Jenison Autism Journal, 15, 1-21. Gray, C., & Garrand, J. D. (1993). Social stories: Improving responses of students with autism with accurate social information. Focus on Autistic Behavior, 8, 1-10. Jellison, J. A. (1976). Accuracy of temporal order recall for verbal and song digit spans presented to right and left ears. Journal of Music Therapy, 13, 114-129. Kern, P., Wolery, M., & Aldridge, D. (2007). Use of songs to promote independence in morning greeting routines for young children with autism. Journal of Autism and Developmental Disorders, 37, 1264-1271. National Autism Center (2009). National Standards Project findings and conclusions: Addressing the need for evidence-based practice guidelines for Autism Spectrum Disorders. Randolph, MA: NAC. Paivio, A. (1991). Dual coding theory: Retrospect and current status. Canadian Journal of Psychology, 45, 255-287.

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Pasiali, V. (2004). The use of prescriptive therapeutic songs in a home-based environment to promote social skills acquisition by children with autism: Three case studies. Music Therapy Perspectives, 22, 11-20. Register, D., & Humpal, M. (2007). Using musical transitions in early childhood classrooms: Three case examples. Music Therapy Perspectives, 25, 25-31. Schwartzberg, E. T., & Silverman, M. J. (2012). Effects of pitch, rhythm, and accompaniment on short- and long-term visual recall in children with autism spectrum disorders. The Arts in Psychotherapy, 39, 314-320. Schwartzberg, E. T., & Silverman, M. J. (2013). Effects of music-based social stories on comprehension and generalization of social skills in children with autism spectrum disorders: A randomized effectiveness study. The Arts in Psychotherapy, 40, 331-337. Schwartzberg, E. T., & Silverman, M. J. (2014). Music therapy song repertoire for children with autism spectrum disorder: A descriptive analysis by treatment areas, song types, and presentation styles. The Arts in Psychotherapy, 41, 240–249. Silverman, M. J. (2007). The effect of paired pitch, rhythm, and speech on working memory as measured by sequential digit recall. Journal of Music Therapy, 44, 415-427.

Author’s Note The author grants permission for readers to use the song presented in Figure 1 in their therapy or educational settings.


Tracking Interventions Used in Preoperative Music Therapy for Young Children Christopher R. Millett, MT-BC Austin S. Robinson, MT-BC Olivia Swedberg Yinger, PhD, MT-BC The University of Kentucky

Music and Preoperative Anxiety Preparing for a surgical procedure produces a certain amount of anxiety for patients and their families, particularly when the patient is a child (McCann & Kain, 2001). Children may not have a choice about whether or not they undergo a surgical procedure, the hospital may be an unfamiliar setting, and they will be separated from their parents at some point before the surgery. All of this factors may increase levels of preoperative anxiety. Young children who experience high preoperative anxiety tend to experience more pain postoperatively (Kain, Mayes, Caldwell-Andrews, Karas, & McClain, 2006). Chetta (1981) found that there were multiple ways preoperative information was being delivered to pediatric patients with the goal of reducing anxiety; one of those avenues being music. Gooding, Swezey, and Zwischenberger (2012) presented a review of research on the use of music in perioperative care. Two of the studies they reviewed specifically focused on the use of music with pediatric patients (Robb, Nichols, Rutan, Bishop, & Parker, 1995; Whipple, 2003). Robb and colleagues (1995) used recorded music and the participants ranged in age from 8 to 20 years. Whipple (2003) used live music and the participants ranged in age from 3 to 10 years. Intervention Reporting In spite of the previous positive research, there are limitations in the current body of literature that require further investigation. Robb, Burns, and Carpenter (2011) described the need for improved transparency and specificity of reporting music-based interventions and Gooding and colleagues (2012) echoed this need in their review of articles on music in perioperative care. Robb and colleagues (2011) suggested specific reporting

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guidelines intended to support Consolidated Standards for Reporting Trials (CONSORT) and Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statements while being understanding of the complexities that arise with music-based interventions. According to Robb and colleagues, “Clear, detailed intervention descriptions within research publications are essential to improve replication and translation of musicbased interventions to clinical practice� (2011, p. 348). They recommended that music therapy researchers report the following information about the interventions they use: (1) theory, (2) intervention content (who selected the music, information on the music itself, and the delivery method), (3) materials, (4) strategies, (5) delivery schedule, (6) qualifications and credentials of the interventionist, (7) treatment fidelity (ensuring that the intervention was delivered in a consistent manner), (8) setting, and (9) unit of delivery (i.e. group or individual). In addition to limitations, there are gaps in the existing research. Several studies focused on the broader pediatric age ranges but no studies were found focusing only on ages 1 to 5 years. Using music therapy in the preoperative pediatric setting may create pleasant experiences for the patients during these crucial developmental years. Children begin to understand emotions, develop fear of separation, and identify anxiety, along with other psychosocial milestones during this age range (Rathus, 2012). Providing pleasant early childhood medical experiences may lead to less avoidance of medical services throughout subsequent life stages.

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The purpose of this study was to design a checklist to capture information about preoperative music therapy interventions for pediatric patients ages 1 to 5 years following the intervention reporting guidelines established by Robb and colleagues (2011). Specifically, this checklist was created to capture information about the intervention content, materials, strategies, delivery schedule, and unit of delivery of music therapy interventions in a pediatric preoperative setting. This information could help provide treatment fidelity if used in a research context. Intervention Tracking The authors created a checklist to document the music therapy interventions. Two music therapists working part-time at a surgery center with children during preoperative music therapy sessions used the checklist. The authors collaboratively developed the checklist in order to accurately capture the music-based intervention recording criteria described by Robb and colleagues (2011). Common procedures performed at the surgery center included hernia and umbilical cord repair, various optical surgeries, dental surgery, tonsillectomy, adenoidectomy, and removal of skin tags and lesions. Both music therapists used a variety of materials during preoperative sessions including guitars, drums (e.g., djembe, lollipop drum, shape drums, hand drums, ocean drum), small percussion instruments (e.g., shakers, thunder tube), and children’s books. The music therapists had access to a Q-chord, autoharp, and keyboard, although these were


not used. Other materials included personal songbooks (paper or electronic) and small carts to carry instruments. Nurses at the surgery center referred children to the music therapy department. Each of the two boardcertified music therapists delivered individual music therapy services three mornings per week on days previously identified as having the highest number of pediatric patients. Referrals included children up to age 15 years, although ages 5 years and younger were the focus of this investigation. The music therapists typically began sessions 30 to 45 minutes before the child's surgery and continued until the child left the preoperative room. After each session, the music therapist gave the child's parents a satisfaction survey, documented the session, and completed the intervention checklist. Using the Intervention Tracking Checklist in Clinical Practice The music therapists used the checklist to track information about the interventions used in sessions over 11 weeks, during which time the authors saw 23 children ages 1 to 5 years. In addition to the criteria originally observed, the authors tracked the child's preferred music and whether or not parent(s)/ guardian(s) participated in the intervention. This information was recorded in the comment section of each intervention and was not included in the analysis for this study. An updated version of the checklist is included (see Figure 1). Further suggestions for improvement include tracking the length of individual interventions. The most frequently reported goals were normalizing the environment (100% of children), increasing control (87%), decreasing anxiety/separation fear (65%), and increasing relaxation (57%). The most frequently reported interventions were instrument play (97%), singing (91%), distraction (74%), movement (65%), imaginative play/game (65%), and iso principle

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(61%). The most frequently used materials were guitar (100%), drums (83%), and small percussion (78%). The average length of sessions was 35 minutes and 44 seconds (SD = 13:10). On average, the sessions contained 5.39 activities (SD = 2.89). This indicates that each activity lasted approximately 6 minutes and 38 seconds. This may initially seem like a long time for children age 5 and under to focus on one activity. It should be noted however, that beginning and ending the sessions as well as transitions between activities were not counted as separate activities, and time for these important components of the sessions were not counted in the total time. In addition, one activity (such as instrument play) may include numerous dierent components (such as instruments and songs), which help maintain the child's attention. In practice, it is recommended that music therapists working in pediatric preoperative settings have many dierent interventions, instruments, and songs prepared in order to help maintain the child's focus on the music therapist.

Figure 1. Intervention tracking checklist.


Recommendations Based on the goals most frequently addressed, assisting young children to feel comfortable in the preoperative environment is an important consideration. The information gathered from the checklist helps describe the interventions used to meet these needs and offers several implications for practice. Creating a more normal environment for young children may be attained through interventions that help increase their perception of control, decrease anxiety, and provide relaxation. Interventions frequently used by the authors, including instrument play, singing, distraction, movement, imaginative play/games, and the iso principle involve actively engaging children in the music-making process and appear to be age-appropriate for young children. In contrast, interventions such as lyric analysis and guided imagery may be beyond the child’s developmental level and were not used in this study. The fact that guitar was used in every session may be due to its portable nature, ease of sanitization, and musical adaptability. One of the music therapists preferred to use a full-size steel string guitar, while the other music therapist chose to use a ¾ size guitar. Advantages of a smaller guitar include the fact that it is well suited to providing music therapy in a small treatment room and its smaller size may be less intimidating to a young child. Advantages of a full-size guitar include the fact that many music therapists learn to play on full-sized guitars and are therefore more comfortable using them in sessions. Also, it is the observation of the authors that the intonation on smaller

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guitars may be less than ideal, particularly if a capo is used on the higher frets. If a ¾ size guitar is used, the authors recommend using a high quality instrument in order to help improve intonation. Instruments such as an autoharp, Q-chord, or keyboard may be substituted based on the therapist's preference and abilities. More research could be done to examine the effectiveness of different instruments within this population. As no studies were found which compared the effectiveness of specific instruments with children in the preoperative setting, music therapists should select instrument(s) that (1) are easy to clean/disinfect, (2) provide high quality musical sound, (3) the music therapist is adept at using, and (4) can be used effectively to meet the child's goals. Because the therapists had to consider infection control guidelines, certain materials such as children’s books, puppets, and various toys were not often used. The checklist captured the music therapy practices specific to the surgery center at which the authors worked. Although beyond the scope of the present study, additional research with a larger sample, control group, and multi-site data would be necessary in order to generalize information gathered from the intervention checklist. With that in mind, the checklist provides a useful tool for clinicians and researchers hoping to capture information based on Robb and colleagues’ (2011) guidelines. It is the authors’ hope that this checklist may be adaptable to various populations and used to test treatment fidelity in future studies.


Given the growing body of research in pediatric music therapy, following Robb and colleagues’ (2011) intervention reporting guidelines may help provide more evidence of music therapy as a cost-effective, noninvasive treatment method to address children’s needs in the healthcare system. Further research is needed to precisely define the role of music therapy with the preoperative young child. The aforementioned suggestions may provide starting points for closer study. References Chetta, H. D. (1981). The effect of music and desensitization on preoperative anxiety in children. Journal of Music Therapy, 18, 74-87. doi: 10.1093/ jmt/18.2.74 Gooding, L., Swezey, S., & Zwischenberger, J. B. (2012). Using music interventions in perioperative care. Southern Medical Journal, 105, 486-490. doi: 10.1097/SMJ.0b013e318264450c Kain, Z. N., Mayes, L. C., Caldwell-Andrews, A. A., Karas, D. E., & McClain, B. C. (2006). Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics, 118, 651-658. doi: 10.1542/peds.2005-2920 McCann, M. E., & Kain, Z. N. (2001). The management of preoperative anxiety in children: An update. Anesthesia & Analgesia, 93, 98-105. doi: 10.1097/00000539-200107000-00022 Rathus, S. A. (2012). HDEV (2nd ed.). Belmont, CA: Wadsworth, Cengage Learning. Robb, S. L., Burns, D. S., & Carpenter, J. S. (2011). Reporting guidelines for music-based interventions. Journal of Health Psychology, 16, 342-352. doi: 10.1177/1359105310374781 Robb, S. L., Nichols, R. J., Rutan, R. L., Bishop, B. L., & Parker, J. C. (1995). The effects of music assisted relaxation on preoperative anxiety. Journal of Music Therapy, 32, 2-21. doi: 10.1093/jmt/32.1.2 Whipple, J. (1996). Surgery buddies: A music therapy program for pediatric surgical patients. Music Therapy Perspectives, 21, 77-83. doi: 10.1093/mtp/ 21.2.77

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About the Authors Chris Millett, MT-BC lives in Lexington, Kentucky and is a graduate of the University of Louisville. Currently he is a graduate teaching assistant at the University of Kentucky, studying music therapy, and works part-time for Louisville Music Therapy, LLC. Contact:

Austin Robinson, MT-BC lives in Lexington, KY and is a graduate of Eastern Kentucky University. Currently pursuing a master’s degree in music therapy at the University of Kentucky, Austin is also owner of EDGE Music Therapy, LLC providing music therapy services in Lexington and surrounding counties.

Olivia Swedberg Yinger, PhD, MT-BC, is Assistant Professor of Music Therapy at the University of Kentucky in Lexington, KY. Her research interests include pediatric and neonatal music therapy.


photos 2014: Photo Stories One section of the imagine website is dedicated to photo stories related to early childhood music therapy. The photo stories are a sequence of three pictures along with a onesentence description of what happens in each picture during the music therapy session. Story #17 Music Therapist: Amy Kalas Buser, MM, MT-BC Affiliation: Wholesome Harmonies, LLC Photographer: Music Therapy Intern Story #18 Music Therapist: Gretchen Chardos Benner LMSW, MT-BC Affiliation: Piedmont Music Therapy, LLC Photographers: Nicholas Benner & Gretchen Chardos Benner Story #19 Music Therapist: Lic. Cecilia Di Prinzio Affiliation: Salvador University. Buenos Aires Argentina Photographer: Felix Padrosa Story #20 Music Therapist: Rachel Rambach, MM, MT-BC Affiliation: Music Therapy Connections (Springfield, IL) Photographer: Matthew Larison imagine 5(1), 2014


practice Research, Clinical Practice, and Theory: Creating a Framework for Music Therapy in Early Intervention Dena Register, Ph.D., MT-BC University of Kansas Lawrence, KS

Establishing and pursuing a theoretical framework for addressing the early intervention needs of young children in music therapy is critical to the continued development of our profession. For years, practitioners have observed the developmental shifts of clients who are particularly responsive to music. As our understanding of development and responsiveness to music has grown and the availability of neurological research has increased, we are able to begin piecing together scientific underpinnings. We have instinctively pursued and, in many cases, witnessed these without having firm answers for families, administrators and skeptics about why some children respond the way they do in music therapy sessions.

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We are able to build a better understanding of our clients’ needs and strengths when we reflect on our clinical practice. Connecting this clinical wisdom to research, either music or non-music, helps to catalyze a theoretical framework and thus establishes the cycle of evidence-based practice. By integrating an understanding of the theoretical foundations for attachment, emotional regulation, and communication, we establish a construct in the music therapy session that supports the growth and development towards which we work with our clients. In considering the various developmental domains (i.e., cognition, socialemotional skills, communication), we often are taught to think of these in isolation. In fact, these domains are part of a system; we cannot work on one of these areas or domains without seeing effects in another domain. As music therapists, we assess the system of developmental domains to determine an entry point for our work with an individual (and their family or support system). We affect change in one domain that can set in motion responses and changes in other developmental domains. It is this complexity that makes it difficult for new music therapists to decide which developmental domain or area of need to address initially. Music therapy with young children, regardless of developmental age, abilities or situation, really comes down to addressing three core elements: Attachment Emotion regulation Communication (both verbal and non-verbal). If we target these first two aspects of development while also fostering the third, then we open up an entire world of possibilities for young children with diverse needs. It is hypothesized that over time, the combined effect of targeting these three primary areas of needs results in one’s ability to self-regulate and adapt to the environment and circumstances that arise. While communication is addressed and discussed readily in the current music therapy literature, there is very little direct discussion of attachment and emotion regulation. Attachment was defined first by psychologist and attachment theorist, John Bowlby, as an enduring psychological connection between human beings and is considered a foundational element of the therapist-client

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relationship. Our ability to assess how our clients form and maintain relationships with others in their environment and to capitalize on each child’s strengths in this area helps us establish and build rapport with them. There is a rich body of research literature, which has direct application to music therapy clinical practice. For example, Drake, Belsky, and Fearon (2013) examined the role of attachment in children’s ability to focus and engage in learning activities at school. Results of this study suggest that attachment has a strong correlation to self-control in social situations as well as to a child’s emotional regulation. Additionally, an individual with secure attachments may display greater self-regulatory skills. Emotion Regulation (ER) is the second area music therapists may assess and address. Emotional regulation encompasses the range of emotions an individual experiences, when these emotions arise, and how they are experienced and expressed. Emotional regulation is related to mood regulation, defense and affect regulation, and coping mechanisms. Targeting this area of development involves focusing on selecting and modifying a particular situation (i.e., where individuals focus their attention) and practicing the ability to change how they think about and respond to a situation (Gross, 1998). Current early childhood research literature is exploring the link between ER and attachment and the relationship of those areas to brain function. For example, supporting children in pursuing new activities and decision-making, known as autonomy support, is believed to be a predictor of executive function. Executive function (EF) is developed over an individual’s lifetime and includes skills such as organizing, planning, strategizing, and paying attention to and remembering details. An individual’s ability to connect past experience to present decisionmaking is also a part of EF. It is influenced by his or her relationships with others, and impacted by their relationships with others. Current studies show a positive correlation between the sensitivity of caregiving children receive and performance on conflict executive functioning as infants move into toddlerhood. The same correlation holds true for the development of selfregulatory skills. Data indicate that the influence of parenting on the development of children’s self-


regulation can be observed in both behavioral and cognitive domains (Bernier, Carlson, & Whipple, 2010). In a recent study, Roque, Verissimo, Fernandes, and Rebelo (2013) investigated the relationships between children’s secure base and emotion regulation, particularly behavioral strategies and emotional expressiveness during different situational and social contexts in naturalistic settings. Fifty-five children (aged 18-26 months) and their mothers participated in this study. Children were exposed to three situational (fear, positive affect and frustration/anger) and two social (maternal constraint and involvement) contexts. Outcomes indicated that toddlers’ behavioral strategies differed based on the context of the situation, maternal involvement and attachment quality. Additionally, their emotional expressiveness varied by interaction involving situational contexts, maternal involvement and children’s attachment security. This and other studies suggest that the quality of the attachment relationship does influence children’s emotion regulation. Children who have at least one attachment figure are able to decrease the level of distress by being held, cuddled, and having someone with whom to talk. Attachment security does not mean that there is never negative affect, but rather it is characterized by the flexibility to integrate positive and negative emotions. In essence, it teaches the child flexibility of response and the ability to adapt to and tolerate threatening or frustrating situations and to overcome them more easily in the absence of a caregiver. Additionally, children who have positive ER strategies are able to be open, direct and actively expressive to the caregiver instead of hiding negativity. This relationship between attachment and ER is built over a number of years and is influenced by experiences with a sensitive and responsive caregiver. The clinical music therapist should consider how these critical areas of development (attachment and ER) interface with what is known about brain development, therapeutic functions of music and current music therapy practice. Musical behaviors activate nearly every region of the brain; musical experiences lead to structural changes in the brain, improve immune system function, modulate the stress response and mediate specific

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language impairment. There is also conclusive evidence that music can “play a vital role in bolstering the physical and psychological health of healthy individuals and in the treatment of patients across a wide variety of presentations” (Levitin, 2013). Music therapists do have the potential to design therapeutic interventions that directly address an individual’s needs related to attachment and ER issues. To address these issues in music therapy, the clinician must have a firm working knowledge of attachment and ER development, typical musical development as well as the Therapeutic Function of Music (TFM). Gooding and Standley (2011) summarized the current research literature on the development of various musical skills by age and developmental stage stage, highlighting patterns in development. These patterns can inform the work of a music therapist with a particular client. For example, children will develop an ability to clap to the beat before marching to the beat. Using this as a guideline, the music therapist would assess this ability during an initial evaluation to determine how rhythm can (or can not) be used as part of reaching a treatment goal. This is directly connected to the TFM as well. Therapeutic Function of Music was defined by HansonAbromeit (2013, p. 130), as “The direct relationship between the treatment goal and the explicit characteristics of the musical elements, informed by a theoretical framework and/or philosophical paradigm in the context of a client.” As the profession of music therapy has continued to evolve, the connections made in our research literature help link music therapy treatment procedures and outcomes to other related literature and treatment options. As members of a truly transdisciplinary, holistic profession, music therapists must account for a wide variety of factors and influences. There is an increase in the number of publications that look at the interaction of music, brain-related research and different developmental factors. In 2013, Moore conducted a systematic review of the neural effects of music on ER. Primary findings in the related literature indicate that certain musical characteristics and experiences produce neural activation patterns that are imperative to emotion regulation. This type of review provides an informed summary and direction for music therapists to


understand how and what musical characteristics and experiences impact an individual’s ability to regulate emotions. For example, based on Moore’s review, singing, music listening (to pieces considered ‘happy’) and improvisation (which decreased activation in the amygdala) are beneficial for supporting ER during a music therapy session. Similarly, Pasiali (2012) studied music therapy as a way to support parent-child interaction. Results of this study indicated that greeting and farewell rituals, and the flexibility of music-based therapeutic applications facilitated development of coordinated routines. Therapists’ actions (e.g., encouraging and modeling musical interactions) and bidirectional parent-child actions (e.g., joint attention, turn taking, being playful) facilitated harmonious communication. Behaviors that promoted mutual cooperation were evident when adults attempted to scaffold a child’s participation or when children sought comfort from parents, engaged in social referencing and made requests that shaped the direction of the session. The novelty of musical tasks captivated children’s attention, which increased impulse inhibition. Parent actions (e.g., finding delight in watching their child participate, acting silly) and parent-child interaction (e.g., play exploration, shared excitement, cuddling) contributed to a positive emotional environment. Pasiali (2012) concluded that music therapy helped parents develop and rehearse responses and provided adaptive ways for parents and children to connect with each other. Another clinical music therapy study (Standley, Walworth and Nguyen, 2009) investigating similar issues indicated that participation in even a few music therapy sessions (only 4-7 sessions) significantly increased higher-level developmental skills, including skills related to ER and attachment. Significantly more children in the music group demonstrated increased music and cognitive skills (such as following directions, responding to the names of others, shares, waits turn, socializes with peers, snuggles hugs) than did those in the control group. The authors of the study note that children who are considered “at-risk” receive primarily early intervention services individually through consultations with caregivers and referrals to address issues as they arise. Unfortunately, it is rare that early intervention services

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allow caregivers to “see their child’s responses within a group or teach caregivers educational activities to use with their children.” Music therapy services, however, provide opportunity for caregiver involvement and can be critical for modeling and structure. As a final example of the interconnectedness of all these topics, Pasali (2013) reviewed and summarized research literature that corroborates the use of music-based interventions to support attachement. Her findings articulate five specific ways that music can address attachment needs and facilitate communication as well. Of all the benefits noted, perhaps the most poignant is that music therapy as an attachment intervention model actually supports the presence of healthy attachment from the beginning and, as such, avoids the problem of poor attachment altogether. Each of these music therapy specific examples draws on insights from other related fields, including but not limited to psychology and social neuroscience. Music therapists must continue to focus attention and energy on articulating a clear conceptual model that addresses how music therapy interventions for our early childhood clients target attachment, emotion regulation and clearly defines communication. Continuing to focus on the connections and articulating these connections through research-based publication and in clinical documentation will allow us to grow as a profession and advocate for the vital, cost-effective role that music therapy can play in providing services for young children and their families. References Bernier, A., Carlson, S. & Whipple, N. (2010). From external regulation to self-regulation: Early parenting precursors of young children’s executive functioning. Child Development, 81(1), 326-339. Drake, K., Belsky, J. & Fearon, R. M. P. (2013). From early attachment to engagement with learning in school: The role of self-regulation and persistence. Developmental Psychology. Advance online publication. doi: 10.1037/a0032779 Gooding, L., & Standley, J. (2011). Musical development and learning characteristics of students: A compilation of key points from the research literature organized by age. Update: Applications of Research


in Music Education, 30(1) 32-45. Gross, J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299. Hanson-Abromeit, D. (2013). Therapeutic function of music. In Kevin Kirkland (Ed.), International Dictionary of Music Therapy (p. 130-xx). New York, NY: Routledge. Levitin, D. J. (2013). Neural correlates of musical behaviors: A brief overview. Music Therapy Perspectives, 31(1), 15-24. Moore, K. S. (2013). A systematic review on the neural effects of music on emotion regulation: Implications for music therapy practice. Journal of Music Therapy, 50(3), 198-242. Pasiali, V. (2012). Supporting parent-child interactions: Music therapy as an intervention for promoting mutually responsive orientation. Journal of Music Therapy, 49(3), 303-334. Pasali, V. (2013). Music therapy and attachment: relationships across the life span. Nordic Journal of Music Therapy. doi: 10.1080/08098131.2013.829863 Roque, L., Verissimo, M., Fernandes, M. & Rebelo, A. (2013). Emotion regulation and attachment: Relationships with children’s secure base, during different situations and social contexts in naturalistic settings. Infant Behavior and Development, 36, 298-306. Standley, J., Walworth, D., & Nguyen, J. (2009). Effect of parent/child group music activities on toddler development: A pilot study. Music Therapy Perspectives, 27(1), 11-15. About the Author Dena Register, Ph.D., MT-BC is an associate professor of music therapy at the University of Kansas. Her primary research interests include music therapy in early intervention and literacy skill development. She has developed several music-based literacy programs and co-authored The Sounds of Emerging Literacy: MusicBased Applications to Facilitate Pre-Reading and Writing Skills in Early Intervention. She continues working as a program consultant for curriculum development, clinical training and research mentorship at the Mahihol University, Bangkok, Thailand. Contact:

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Addressing Attachment, Emotion Regulation and Communication in a Clinical Setting Using a Case Examples with a Thai Client Dena Register, PhD, MT-BC University of Kansas/Mahidol University, Bangkok, Thailand Melissa Hill Gillespie, MT-BC Mahidol University, Bangkok, Thailand Developing theoretical frameworks through research and clinical practice is vital to the growth of music therapy as a profession. The previous article substantiates the importance of recognizing attachment, emotion regulation and communication as central areas to be assessed and addressed with young children. Despite


any cultural variability, these three elements are infused in children who are secure, independent and have the ability to problem solve in order to have their many needs met. Clinical examples from the Mahidol University College of Music, music therapy clinic in Bangkok, Thailand provide a platform for examining how children and families worldwide face very similar developmental challenges and how music therapy mediates these developmental needs. Client P. is a 5-year-old male, diagnosed with Autism Spectrum Disorder (ASD). He has a stable family; both parents and one typically-developing older brother live at his home. P.'s family seems to be loving and supportive. They frequently observe music therapy sessions, ask questions about P's progress, and respond positively to suggestions from the music therapists (MT) regarding the transfer of treatment strategies to P.'s other natural environments. In addition, P.'s father has shared that he frequently listens to many different types of music with P. while they are working together at home. He expressed that "alternative" treatments, such as music therapy, in addition to medical treatments he receives at Golden Jubilee, seem to be the most effective for his son. P.'s mother and father seem to have a solid understanding of what their son needs in order to be successful in daily living. For example, the MTs noted that P.'s father began coming with his mother (who typically brought P., alone), for 2-3 sessions to ease the transition when P.'s father would need to start bringing him to future sessions. P.'s mother also is careful about P.'s level of stimulation in different environments. She carries headphones with her, anticipating that P. may encounter uncomfortable stimuli, as unpredictable sounds are a trigger for P.'s maladaptive behaviors. Because P.’s family responds to his expressions of wishes and needs, it appears that a “secure” attachment exists between them. P. does not currently attend school; he spends his time receiving treatment or at home with one of his parents. Attachment Prior to treatment, P. demonstrated that he has a secure attachment to his mother. P. held his mothers hand, smiled at her after an assessment session, and was able to communicate basic needs to her nonverbally. While

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speaking with P.’s mother, the MTs gathered that she knows how her son might react to certain situations or environments and provides appropriate preventative measures. P.’s mother’s ability to understand and meet his needs may help P. feel comfortable and secure around her – increasing the security of his attachment to her and laying the groundwork for a successful communication system between them. Although often aloof or seemingly uninterested in social interaction, P. made eye contact with his mother when she spoke to him and followed simple directions when verbally prompted (i.e., using the restroom before the session). P. did not demonstrate signs of attachment to other people or objects in his environment. During assessment, the MTs did not yet understand P.’s nonverbal communication and were not able to anticipate his wants, needs or reactions within the music environment. P. had very limited opportunities to attempt to communicate his needs with someone other than his mother. This may have exacerbated his frustration and may have led to the many maladaptive behaviors encountered by the medical staff, which ultimately resulted in a referral to music therapy. The treatment strategies and interventions initially employed by the MT’s were unsuccessful in developing trust and a rapport that would be crucial in facilitating further treatment and progress toward goals. The MTs were not yet aware of the structural and environmental needs that would allow P. to be successful in his environment. In initial sessions, the MTs tried many different applications and instrument types to see what P. preferred, continuing until P. communicated that he was done (often via a self-injurious tantrum or crying). The treatment environment and the treatment strategies were then altered to assess how P. would function in a structured and less stimulating environment. P.’s behavior drastically improved in a new environment and he seemed compliant with the new, structured session schedule. The MTs then developed a level of attachment, or rapport, with P. by providing tools and frequent opportunities for P. to communicate his wishes and needs. An immediate response was then given. Through increased choice-making opportunities and teaching of non-verbal and verbal communication within the music environment, the MTs plan to increase P.’s ability to self-


regulate and communicate his needs in other environments, thus allowing for further attachments to develop (e.g., with teachers, other therapists, peers). Currently, P. and the MTs have developed a great deal of rapport. They communicate through a variety of means. The MTs prompt P. to communicate by choosing between two objects, by using sign language that corresponds to a spoken word, or by using a combination of sign language and verbalizations. P. can communicate 2-3 signs successfully and has recently started imitating verbalizations--saying 1-2 words successfully while using the corresponding sign language. The MT’s objective is to increase P.’s verbal and nonverbal vocabulary, the number of independent vocalizations, and eventually the transference of these skills to other environments. Because the MTs were able to find a successful environment and motivating applications for P., he often expresses that he wishes to stay for a longer period of time (e.g., by re-entering the room after the “Goodbye” song or trying to turn on the recorded music once more). He also makes more eye contact with the MTs, smiles when he greets them, and tries to communicate without becoming aggravated or self-injurious. Emotion-Regulation The MTs noted that P. had particular difficulty with regulation in the new environment. P. would typically participate in a given application for a few seconds before throwing materials, laying on the couch, and screaming while covering his ears. His behaviors escalated to self-injurious and aggravated levels in a very short time. Initially, the MTs believed that P. had extreme sensitivity to sound because of this behavior. The MTs observed P. in another, public environment which was crowded and full of noises. P. did not seem to have difficulty self-regulating (though his mother was also present). After ruling out sound sensitivity as the source of P.’s aggravation, the MTs hypothesized that his behavior may have been related to factors such as extraneous stimulation within the new environment, unpredictability of the session, inability to communicate successfully, the absence of his mother, or a combination of these factors.

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After the assessment period, the MTs added additional structure to the session and changed the environment in the treatment room so that P. knew what to expect, how long each activity would last, and how many activities would take place before the end of the session. The MTs predicted that increased structure in P.'s environment and choice-making opportunities would allow him to self-regulate, and therefore decrease maladaptive behaviors that were prohibiting progress toward communication goals (which, in turn, would build further rapport and ability to self-regulate). To increase structure, the MT implemented using an iPad with a sand timer app so P. could see how much time remained for the application. He could also press "start" and "stop" once time ran out and was always prompted to choose or sign “more” or “done” after the timer ran out. This gave some control of the environment. In addition, the MTs implemented a sequence board on which application icon cards could be placed in a preferred order. They specified "stations" around the room for each individual application and provided seat cushions to indicate a clear place to sit and smooth transitions from one station to another. Choosing the next application in the session sequence allowed P. the opportunity to self-regulate; he was provided options of two applications with very different stimulation levels so that he could pick an application that would suit his current need for more or less stimulation. P. is now able to self-regulate within the music therapy session. He has developed a secure attachment with the MTs because of this additional structure, which allows for progress toward goals and objectives. P. trusts that the MTs will understand his individual style of communication, will give him choices and reinforce his choice, and will provide a familiar overall structure with slight differences (i.e., a new song, a different way of playing the drum). This therapeutic relationship, or attachment, between the MTs and P., and the consequent self-regulation that P. has developed, has led to successful interventions related to P.’s communication goals. Communication P. initially communicated with the MTs by screaming and crying throughout the session--generally whilst laying on the floor or a couch. The MTs did not note any speech or


speech-like verbalizations. P. exhibited nonverbal communication by displaying self-injurious behaviors when he was uncomfortable or upset, throwing instruments or mallets to indicate he was finished with an activity, and only ceasing his crying when the session was over and he saw his mother waiting outside. It seemed as if P. was frustrated that he was not able to communicate with the MTs successfully – or did not know how – and after the session was happy to be back with his mother, with whom he had developed a successful means of communication (even if communication was nonverbal). Once the MTs increased rapport with P. and found a comfortable environment in which he could self-regulate, the MTs were able to implement various treatment techniques to increase P.’s communication skills. These included nonverbal choice-making tools (i.e., choices between two picture cards or objects) so that P. had an alternative, appropriate way to communicate his wants to the MTs. The MTs also demonstrated and modeled the use of American Sign Language for the words "more" and "done”--later prompting P. to use these signs by asking if he would prefer "more" or if he was "all done" between each application. To reinforce P. when he communicated “more,” the MTs would start the application again immediately. As soon as P. signed “all done,” the MTs would reinforce his communication by singing a transition song and move to the sequence board – signing “all done” once again, at the end of the transition song. After P. demonstrated an understanding and an ability to independently implement these signs when prompted, the MTs encouraged P. to use both his mouth and hands together to communicate the same words. P. is now able to make choices frequently within a given session through a variety of nonverbal and verbal means. While his choices are not always consistent with his actions, P. seems to be able to make a choice when he is engaged and focused (at an ideal stimulation level). P. is able to choose between two icon cards with some success. The MTs continue to look for ways to strengthen P.’s understanding of iconic representation of objects. When asked if P. wants “more” or is “all done,” P. signs a choice. Sometimes his actions do not reflect the choice he communicates, which may mean that he is

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echoing the last choice given or does not have a clear understanding of the relationship between his sign and his choice. On other occasions, P. signs without being prompted and follows-through with the choice he communicated. The MTs continue to reinforce P.’s communication and prompt P. again if he does not follow-through with his choices, to strengthen the understanding that he must be clear in his communication in order to access what he wants or needs. In addition to signing and choosing picture cards, P. has recently begun to imitate speech sounds when prompted (the MT points to her mouth and begins mouthing the word). Conducting weekly music therapy sessions with a client and focusing on these three areas- attachment, emotion regulation, and communication- provided an opportunity to assess the client's progress both formatively and cumulatively. This also gave the family information about how P. was influenced by music and how they might translate some of the interventions for use at home environments. About the Authors Dena Register, Ph.D., MT-BC is an associate professor of music therapy at the University of Kansas. She continues working as a program consultant for curriculum development, clinical training, and research mentorship at the Mahihol University, Bangkok, Thailand. Contact: Melissa Hill Gillespie recently graduated from the University of Kansas with dual degrees in music therapy and music education. Upon graduating in 2012, Melissa completed a clinical internship in music therapy with Dr. Dena Register in Bangkok, Thailand at the Mahidol University College of Music. Melissa currently teaches general and vocal music in the Kansas City area.


Music Therapy and Parent-Child Attachment Becky Wellman, Ph.D., MT-BC/L, DT Wellman Therapy Services Itasca, Illinois

Most professionals are familiar with the attachment research of Bowlby and Ainsworth (Bretherton, 1992) who determined that attachment can be considered secure, ambivalent, avoidant, or disorganized. Within this model, children preferably build a secure attachment with their parents. To attain this, children need to be able to separate easily from their parents when in a safe environment, find their parents when frightened, and greet them when they see them again (Wallach & Caulfield, 1998; Waters, Crowell, Elliott, Corcoran, & Treboux, 2002). Attaining these skills can be difficult for children with special needs or for those who are ill. The theory of Parental Acceptance or Rejection, an alternative view of attachment, is presented by Ronald Rohner (Rohner, Khaleque, & Cournoyer, 2012). In this theory, rejection is defined as being unaffectionate, hostile, neglectful, or “undifferentiated rejecting” (p. 2). Undifferentiated rejecting is when the child feels rejected even if there is no other behavior indicating rejection from the parent. There are several sub-theories within Rohner’s theory; these examine how parental acceptance or rejection impact a child's personality and ability to cope, and how the family's sociocultural system impacts the attachment process. Different family situations can impact how parents and children form attachment. Frequent medical treatments, work commitments, responsibility for other children, and

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anxiety about the future can impede efforts to build attachment. Even after a child comes home from the hospital, attachment may be difficult due to continued medical concerns, home medical equipment, increased travel to and from medical appointments and time spent at these appointments, or possible conflicts with other caregivers regarding care (Korja, Latva, & Lehtonen, 2012). Families with children who have cognitive and physical involvement may struggle with how to engage with their children (Wheeler & Stultz, 2008). Parents and caregivers can be overwhelmed by questions about what the child can understand, what the child can do, and what the future holds . Possible feelings of guilt also can delay or halt attachment development. Families with children with Autism Spectrum Disorder (ASD) also may find building attachment difficult. Diminished eye contact, limited social engagement, perseveration, and sensory issues can slow or stop the reciprocation of parental or caregiver approaches for attachment, or reject their bids for acceptance (Thompson, 2012). Similar to parents of those with cognitive and physical issues, parents of children with ASD may feel guilty or overwhelmed when engaging with their children.


Attachment or acceptance present differently for families of adopted children. The children may have been in living situations where attachment was not possible; adoptive parents may be unaware of previous issues or successes. Language barriers, new homes and rules, different food and clothing, or busier and/or noisier, or quieter, home environments can all hinder the attachment process (Stovall-McClough & Dozier, 2004). These children also may have undiagnosed medical, cognitive, or behavioral issues which can make attachment difficult. Families may be worried about the birth parents changing their minds or adoption agencies declaring the adoptive family unfit and reversing the placement. Families in these situations may withhold attachment or acceptance until they are more secure in their future. Music therapy can support both of the presented theories of attachment in individual or group therapy settings (Standley, Walworth, Engel, & Hillmer, 2011). The following is a list of interventions and approaches that can help make music therapy sessions more effective in building attachment: Infant directed singing. Music therapists can support parents in singing with their infants and young children in the neonatal intensive care unit, in individual sessions, and in groups. Parents are encouraged to make eye and physical contact as they are able with their child while singing simple songs to them. Parents may be hesitant to sing in front of others, but offering quiet guitar or other accompaniment may provide the support and encouragement parents and other caregivers need to bond with the child (Cevasco, 2008; de l’Etoile, 2006; O’Gorman, 2006; O’Gorman, 2007; Standley & Madsen, 1990; Whipple, 2000). Face-to-face interactions. Prompting children and parents to engage in interventions, which encourage them to face each other while sharing music can aid in supporting attachment and acceptance. Providing opportunities to turn off electronics such as smart phones, televisions, and tablet devices and thus truly connect can be valuable for families (Napier, 2014). Interventions such as lap songs, singing together, finger plays (with assistance as needed), and moving with scarves or other props which could allow for

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privacy (child and parent under the scarf at the same time) or cooperation (peek-a-boo) can help promote attachment and acceptance. Reduce parental stress and anxiety. While parental goals are not always the focus of early childhood music therapy sessions, reducing their feelings of stress and anxiety can increase their attachment to and acceptance of their children (Tharner et al., 2012). Music therapists can provide a safe environment in which parents can relax, feel supported, and find new ways to engage with their children. Music therapy sessions also may encourage parents to ask questions or discuss their concerns. Guidance for reading cues. Parents of children with special needs or children who are ill may have difficulty detecting or understanding the way their child interacts or bids for their attention. Music therapists can educate parents by guiding them in how to interact and engage with their children, show developmental stages, and thereby reinforce parental efforts for attachment and acceptance (Wheeler & Stultz, 2008). Music therapy can make learning these skills fun, relaxed, and non-threatening (Abad & Williams, 2007) Adaptation. Music therapists can adapt interventions so children who have difficulty with motor skills, cognitive processing, or interaction can still engage with their parents. Showing parents how to adapt their bids for attachment and providing them with activities to meet the abilities and needs of their child can make the interactions positive for all involved. Attaining attachment is an important developmental step for children of all abilities. Music therapists can play an important role in assisting families with building these skills. Through infant directed singing, face-to-face interactions, reducing parental stress and anxiety, guidance, and adaption, music therapists can provide supportive environments that not only build attachment for these children today but build a foundation for attachment patterns that will endure for life.


References Abad, V., & Williams, K. E. (2007). Early intervention music therapy: Reporting on a 3-year project to address needs with at-risk families. Music Therapy Perspectives, 25(1), 52-58. doi: 10.1093/mtp/25.1.52 Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28(5). 759-775. Cevasco, A. M. (2008). The effects of mothers’ singing on full-term and preterm infants and maternal emotional responses. Journal of Music Therapy, 45(3), 273-306. doi: 10.1093/jmt/45.3.273 de l’Etoile, S. K. (2006). Infant directed singing: A theory for clinical intervention. Music Therapy Perspectives, 24(1), 22-29. doi: 10.1093/mtp/24.1.22 Korja, R., Latva, R., & Lehtonen, L. (2012). The effects of preterm birth on mother-infant interaction and attachment during the infant’s first two years. Acta Obstetricia Et Gynecologica Scandinavica, 91(2), 164-173. doi: 10.1111/j.1600-0412.2011.01304.x Napier, C. (2014). How use of screen media affects the emotional development of infants. Primary Health Care, 24(2), 18-25. O’Gorman, S. (2006). Theoretical interfaces in the acute pediatric context: A psychotherapeutic understanding of the application of infant-directed singing. American Journal of Psychotherapy, 60(3), 271-283. Rohner, R. P., Khaleque, A., & Cournoyer, D. E. (2012). Introduction to parental acceptance-rejection theory, methods, evidence, and implications. Retrieved from 494/2014/02/INTRODUCTION-TO-PARENTALACCEPTANCE-3-27-12.pdf Standley, J. M., & Madsen, C. K. (1990). Comparison of infant preferences and responses to auditory stimuli: Music, mother, and other female voice. Journal of Music Therapy, 27(2), 54-97. doi: 10.1093/jmt/ 27.2.54 Standley, J. M., Walworth, D., Engel, J. N., Hillmer, M. (2011). A descriptive analysis of infant attentiveness in structured group music classes. Music Therapy Perspectives, 29(2), 112-116. doi: 10.1093/mtp/ 29.2.112 Tharner, A., Luijk, M. M., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Jadoe, V. V., Hoffman, A., … Tiemeier, H. (2012). Infant attachment, parenting stress and child emotional and behavioral

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problems as age 3 years. Parenting: Science and Practice, 12(4), 261-281. doi: 10.1080/15295192.2012.709150 Stovall-McClough, K. C., & Dozier, M. (2004). Forming attachments in foster care: Infant attachment behaviors during the first 2 months of placement. Development and Psychopathology, 16, 253-271. doi: 10.1017/SO954579404044505 Thompson, G. (2012). Family-centered music therapy in the home environment: Promoting interpersonal engagement between children with autism spectrum disorder and their parents. Music Therapy Perspectives, 30(2), 109-116. doi: 10.1093/jmt/ 30.2.109 Wallach, V., & Caulfield, R. (1998). Attachment and at-risk infants: Theoretical perspectives and clinical implications. Early Childhood Education Journal, 26(2), 125-129. Waters, E., Crowell, J., Elliott, M., Corcoran, D., & Treboux, D. (2002). Bowlby’s secure base theory and the social/personality psychology of attachment styles: Work(s) in progress. Attachment & Human Development, 4(2), 230-242. doi: 10.1080/14616730210154216 Wheeler, B. L., & Stultz, S. (2008). Using typical infant development to inform music therapy with children with disabilities. Early Childhood Education, 35(6), 585-591. doi: 10.1007/s10643-007-022401 Whipple, J. (2000). The effect of parent training in music and multimodal stimulation on parent-neonate interactions in the neonatal intensive care unit. Journal of Music Therapy, 37(4), 250-268. doi: 10.1093/jmt/37.4.250 About the Author Becky Wellman, Ph.D., MT-BC/L, DT has a private practice in the Chicago suburbs where she works with young children with special needs and older adults with memory loss. She is a part time instructor at Ivy Tech Community College of Indiana and Indiana UniversityPurdue University, Indianapolis. Contact:


Creating Safety at Bedtime: How Music Can Support Adoptive Families Erin McAlpin, MA, MT-BC Private Practice, Kansas City, MO

Children from challenging environments may often experience prenatal stressors, abuse, neglect, or trauma (Purvis, 2009). The result of these experiences may lead to difficult behaviors that may include sleep disturbance (Cuddihy, Dorris, Minnis, & Kocovska, 2013). Adoptive parents, while trying to respond compassionately and realistically to their son or daughter who may be experiencing sleep disruption combined with signs of sensory processing disorders, early sexual abuse, seizures, fetal alcohol exposure, mental or physical abuse, or neurological damage, often are in need of support (Evan B. Donaldson Adoption Institute, 2010; Purvis, Cross, & Sunshine, 2007). Bedtime offers an opportunity for adoptive parents to model empathy and safety at a time of day that may trigger a child’s past experience of abuse or neglect. Seeing beyond misbehavior allows adoptive parents to understand that a child’s sleep disturbance may be due to brain chemistry in fight-orflight mode or may be a learned response to remain alert and defensive toward past experiences (Purvis, Cross, & Sunshine, 2007). Adoptive parents need tools for supporting their son or daughter during the initial transition of adoption and creating a safe environment and home for their child to thrive. Clinicians can provide helpful practical applications to adoptive parents for using music to support parent-child connection at bedtime or while dealing with sleep disturbances. Building a Safe Predicable Environment One of the first critical steps in promoting bonding and higherlevel learning is developing a felt sense of safety. Feeling safe and secure allows a child to relax and thereby disarm the primitive brain areas such as the amygdala which is associated with survival needs, being on guard, fear, and hypervigilance. Strategies that promote a sense of safety include maintaining a predictable environment through routines and rituals and sharing control through appropriate choices (Hughes, 2009; Purvis, Cross, & Sunshine, 2007). By using music (e.g.,singing to their child at bedtime) adoptive parents may pre-select one, two, or three specific songs that develop a predictable structure to bedtime routines. Parents also may allow the child to choose or select the last song. Offering choices facilitates child success and allows adoptive parents to offer encouraging statements (Purvis, Cross, & Sunshine, 2007). Choosing a song also creates a safe opportunity for the child to share and integrate special songs or experiences from their own life prior to the adoption (e.g., including songs using their native language, perhaps known or unknown to the adoptive parents).

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Claiming a Child as One’s Own Adoption includes the unique experience of creating a family through choice and claiming a child as one’s own through choice. Creating a sense of “we” through shared experiences, clear and frequent family rituals, and enjoyment of one another leads to parent-child connection and belonging (Hughes, 2009; Siegel & Bryson, 2011). Sharing and creating music together is an opportunity to confirm that the child is a member of the family, similar to creating or sharing a secret family handshake. Adoptive parents can incorporate songs that have been passed to them by their own parents or grandparents as a way to claim the child as a son or daughter. Bedtime routines and rituals can also include songs that remind parents and child of shared memories or journeys to one another. Although singing and using a special song is common and natural with young children or infants, children adopted at older ages often miss out on this special parent-child bonding. Clinicians can assist adoptive families in writing or finding a song that becomes “their song” between the parent and child. Beneficial Touch and Non-Verbal Communication Skin is a human’s largest sensory organ;the sense of touch is crucial for healthy development (Purvis, Cross, & Sunshine, 2007). Music provides a steady beat for parent and child to rock, tap, massage, or touch. Singing also allows opportunity for nonverbal communication between parent and child through eye contact, facial expressions, tone and rhythm of voice, animated and flowing gestures, and active listening (Bailey, 2000; Hughes, 2009; Purvis, Cross, & Sunshine, 2007; Seigel & Hartzell, 2003). Bedtime with children from challenging backgrounds does not always feel like a nurturing time, as the child can be demonstrating withdrawn or defiant behaviors triggered from past experiences. Although the environment does not naturally feel nurturing, adoptive

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parents can intentionally create a felt sense of safety and nurture through routines and rituals that include touch and non-verbal communication. Conclusion Bedtime routines and rituals provide another opportunity for adoptive parents to remain playful, accepting, curious, and empathetic during interactions with their child as they continue to support the child through difficult transitions, behavior, and sleep disruptions. These are critical attitudes that enhance secure attachment bonds in parent-child relationships, viewing negative emotions or experiences as an opportunity for intimacy and teaching (Gottman, 1997; Hughes, 2009). Building routines and rituals around difficult child behaviors and circumstances will require adoptive parents to remain engaged even though they may be dealing with their own intense personal emotions (e.g., helplessness, despair, loss, frustration, and fear). Therefore, clinicians can also provide parental support through opportunities for personal empathy, reflection, and self-examination (McAlpin, 2013).

Take-Away Tools for Adoptive Parents and Bedtime Routines Pre-select one, two, or three specific songs that give a predictable structure to bedtime routines Create an appropriate sense of control by allowing your child to choose or select the last song Provide encouraging statements after your child’s song selection, creating a safe and accepting environment Incorporate songs that have been passed to you by your own parents or grandparents as a way to claim your child as your son or daughter Include songs that remind you of memories or stories of your child Incorporate or write a song that becomes “your song” between you and your child Intentionally incorporate beneficial touch while singing with your child through rocking, tapping, or touching Provide nonverbal communication while singing with your child through eye contact, facial expressions, tone and rhythm of voice, animated and flowing gestures, and active listening


Coda Professionals are responsible for developing a sensitive viewpoint of child behaviors in context of past experiences. This is crucial when working with adoptive families and children from challenging upbringings (Purvis, 2009). The purpose of the following video is to bring awareness and understanding to the emotional experiences of a child in the foster care system.

Purvis, K.B., (2009). Children from hard places: What everyone needs to know. Retrieved from http:// Siegel, D. J., & Bryson, T. P. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York: Mind Your Brain, Inc. Siegel, D. J, & Hartzell, M. H. (2003). Parenting from the inside out: How a deeper self-understanding can help you raise children to thrive. New York: Jeremy P. Taracher/Putnam.

About the Author

Watch video ReMoved

References Bailey, B. A. (2000). I love you rituals. New York: Harper Collins Publishers Inc. Cuddihy, C., Dorris, L., Minnis, H., & Kocovska, E. (2013). Sleep disturbance in adopted children with a history of maltreatment. Adoption & Fostering, 37, 404-411. Evan B. Donaldson Adoption Institute (2010). Keeping the promise: The critical need for post-adoption services to enable children and families to succeed. Retrieved from publications/2010_10_20_KeepingThePromise.pdf Gottman, J. (1997). Raising an emotionally intelligent child. New York: Simon & Schuster, Inc. Hughes, D. A. (2009). Attachment-focused parenting: Effective strategies to care for children. New York: W.W. Norton & Company. McAlpin, E. L. (2013). Promoting parent-child secure attachment bonds in adoptive families through community-based family music groups: A Heuristic grounded theory study. Unpublished master’s thesis. University of Missouri-Kansas City, Kansas City, MO. Retrieved from xmlui/handle/10355/36646 Purvis, K. B., Cross, D. R., & Sunshine, W. L., (2007). The connected child. New York: McGraw-Hill.

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Erin McAlpin, MA, MT-BC completed her undergraduate and graduate degree at the University of MissouriKansas City with her master’s thesis focused on promoting parent-child secure attachment bonds in adoptive families. Erin and her husband, Jon, have now grown their family through adoption with their beautiful daughter Aubrey, brought home at four days old. Contact:

Acknowledgement Thank you to the families that participated in my research for my master’s degree (McAlpin, 2013). Your insight and use of music with your children was the inspiration for this article.


Understanding Emotion Regulation Development Kimberly Sena Moore, MM, MT-BC Frost School of Music, University of Miami

Understanding Emotion Regulation Development Music therapists often work with children who have difficulties regulating their emotions. This difficulty is referred to as “maladaptive emotion regulation.” It is seen in children with aggression-related behavior problems (Mullin & Hinshaw, 2007; Stegge & Terwogt, 2007) and childhood depression (Stegge & Terwogt, 2007), and is implicated in disorders such as AttentionDeficit/Hyperactivity disorder (Masao, 2004; Mullin & Hinshaw, 2007), Autism Spectrum Disorder, and Asperger’s syndrome (Masao, 2004). Maladaptive emotion regulation (ER) significantly affects multiple areas in a child’s life that music therapists address, including the ability to learn in school, form and maintain healthy relationships with peers and adults, and control behavioral responses. Understanding how ER develops is key to effectively addressing maladaptive skills. Thus, the purpose of this article is to provide an overview of ER development and present preliminary guidelines for incorporating this knowledge into music therapy clinical practice. How Does ER Develop? The construct of ER emerged in developmental research in the latter two decades of the 20th century (Gross & Thompson, 2007). Although a single definition does not

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exist, authors tend to agree on key characteristics (Calkins & Hill, 2007; Eisenberg, Hofer, & Vaughn, 2007; Gross & Thompson, 2007; Mullin & Hinshaw, 2007; Thompson & Meyer, 2007). Synthesized, these characteristics define ER as interactive, goal-dependent explicit and implicit processes intended to help an individual manage and shift an emotional experience. Stated differently, ER involves voluntary (explicit) and automatic (implicit) strategies an individual uses to manage an emotional experience. This is achieved through maintaining, intensifying, or de-intensifying the emotion. Although ER development can be a lifelong process (Ochsner & Gross, 2007), the primary developmental window occurs in early childhood. The general trajectory follows a three-stage arc: 1. simple physiologic and reflexive responses (Calkins & Hill, 2007), 2. simple attention and motor strategies or caregiverdirected strategies (Eisenberg et al., 2007; Thompson & Meyer, 2007), and 3. self-regulation of emotions (Bargh & Williams, 2007; Calkins & Hill, 2007; Eisenberg et al., 2007; Stegge & Terwogt, 2007; Thompson & Meyer, 2007; Zeman, Cassano, Perry-Parrish, & Stegall, 2006).


ER skills are socially constructed (Thompson & Meyer, 2007) through one’s cultural experiences, family environments, caregiver interactions, and gender expectations. Furthermore, a close relationship exists between ER development and other developmental domains, such as attention, motor abilities, cognition, language skills, and brain development (Calkins & Hill, 2007; Eisenberg et al., 2007; Feldman, 2009; Gross & Thompson, 2007; Stegge & Terwogt, 2007; Thompson & Meyer, 2007; Zeman et al., 2006). Stage 1: Infancy (0-12 months) In the first year of life, ER strategies primarily center on controlling arousal (Calkins & Hill, 2007), managing emotions, and handling external and internal stress (Feldman, 2009). In the first three months, strategies include instinctive reactions that provide a reflex-like approach or withdrawal response (Calkins & Hill, 2007) or passive, caregiver-directed responses. Caregivers act as external regulators when they are responsive to infant distress, incorporating strategies such as rocking, singing, and feeding (Eisenberg et al., 2007). This responsiveness lowers infant arousal (Calkins & Hill, 2007; Eisenberg et al., 2007; Thompson & Meyer, 2007), demonstrates that stress can be managed (Thompson & Meyer, 2007), and facilitates the development of appropriate ER strategies (Gross & Thompson, 2007; Perry & Pollard, 1998; Thompson & Meyer, 2007). Primitive self-soothing strategies begin to emerge around three months. These include thumb sucking and signaling (e.g. crying) designed to bring caregivers close (Calkins & Hill, 2007). Months three to six are characterized by an emerging use of attentional strategies (e.g. gaze aversion, or directing attention away from an arousal-inducing stimulus) (Bargh & Williams, 2007; Gross & Thompson, 2007) and simple voluntary motor actions (e.g. turning the head away from an arousal-inducing stimulus) (Calkins & Hill, 2007). Around six months of age infants begin to intentionally seek assistance from caregivers (Eisenberg et al., 2007). By 12 months of age, they more consistently demonstrate attempts to respond to stressors through self-soothing strategies (e.g. thumb sucking) (Calkins & Hill, 2007; Eisenberg et al., 2007), social signaling (e.g. crying), and redirection (e.g. gaze aversion) (Calkins & Hill, 2007).

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Stage 2: Toddlerhood (1-3 years) ER development in toddlerhood is characterized by a transition from passive, caregiver-directed strategies (Feldman, 2009; Thompson & Meyer, 2007) to more selfregulation of emotions (Calkins & Hill, 2007; Eisenberg et al., 2007). This is especially evident through an increasing use of explicit ER strategies (Stegge & Terwogt, 2007), such as attentional deployment (e.g. shifting attention away from a stressor) (Ochsner & Gross, 2007), response modulation (e.g., using words to state a feeling instead of hitting) (Bargh & Williams, 2007), and self-distracting strategies (e.g., intentionally playing with a toy to ignore a stressor) (Eisenberg et al., 2007). Toddlerhood is also characterized by an emerging responsiveness to caregiver directions (Calkins & Hill, 2007). These are important as they externally “coach” the transition to self-regulation of emotions. Caregivers incorporate different strategies in these directions, such as distracting the toddler, helping the toddler problemsolve, providing alternate interpretations of situations, suggesting adaptive responses, or structuring experiences to decrease emotional demands (Thompson & Meyer, 2007). This coaching allows for frequent opportunities to practice ER (Zeman et al., 2006) and provides a way for caregivers to model cultural beliefs about emotions (Thompson & Meyer, 2007). Stage 3: Preschool (3-6 years) ER development during the preschool years is characterized by a decline in caregiver interventions and directives (Thompson & Meyer, 2007), a greater emphasis in the use of explicit strategies (Stegge & Terwogt, 2007), and an increase in the knowledge and use of cultural rules (i.e., cultural-based expectations for how one shows emotions in a given situation) (Zeman et al., 2006). Preschoolers begin to identify appropriate and inappropriate ER strategies and expand their repertoire of strategies. These developmental milestones are reinforced by caregiver-preschooler conversations about emotions, which convey cultural values, gender expectations (Thompson & Meyer, 2007; Zeman et al., 2006), and assist the child in identifying emotions and ER strategies (Zeman et al., 2006).


ER and Childhood Stress Given that early ER development centers on controlling arousal (Calkins & Hill, 2007) and handling stress (Feldman, 2009), it seems valuable to connect ER development to the childhood stress response. In adults, the classic “fight, flight, or freeze” response is the body’s adaptive reaction to a stressor (Perry & Pollard, 1998). Stress responses exhibit differently in children. A child’s stress response generally takes one of two forms, hyperarousal or dissociative (Mullin & Hinshaw, 2007; Perry & Pollard, 1998). One’s preferred response pattern is formed in infancy and is influenced by caregiver-infant interactions. For example, when an infant experiences stress, its initial reaction is to cry, a hyperarousal response intended to draw the caregiver closer (Perry & Pollard, 1998). If this does not work, the infant will attempt to manage the stress without caregiver support; these self-soothing “managing” behaviors are on the dissociative end of the continuum. In general, behaviors that indicate a hyperarousal response include inattention impulsivity, anxiety, hyperactivity, hypervigilance, and antisocial behaviors (Mullin & Hinshaw, 2007; Perry & Pollard, 1998) whereas those that indicate a dissociative response include poor attention control, poor behavior initiation (Eisenberg et al., 2007), and maladaptive selfsoothing behaviors such as rocking, avoidance, numbing, daydreaming, and fainting (Perry & Pollard, 1998). Practice Recommendations Although research is needed to understand how music therapy may address ER development, the following preliminary guidelines are recommended: View hyperarousal and dissociative behaviors as indications that a child may be dysregulated. These behaviors do not need “fixing” but are clues about the child’s current state and how he or she responds to stress. If a child is dysregulated, the music therapist’s first response should be to facilitate the transition to a regulated state. Once regulated, processing can occur to understand the trigger that instigated the dysregulation and to develop strategies for coping with future triggers. ER development is closely tied to the caregiver-child relationship. Thus, the client would likely benefit if

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the music therapist maintained an open communication with caregivers on issues related to the child’s ER abilities (e.g., regulatory challenges that emerge or triggers that are identified) and music strategies that facilitate regulation. Given the shared neural networks implicated in music and ER processing (Sena Moore, 2013), music may serve as a useful ER strategy. Furthermore, developing strategies are frequently practiced in early childhood. Thus, an effective approach may involve developing, teaching, and practicing a musicbased ER strategy (e.g., singing, improvising, moving to music) during sessions and, if appropriate, training caregivers on effective music strategies for use outside music therapy. Some moments during sessions may be considered stressful to clients prone to ER challenges (e.g., transitions, when a new experience is introduced, or when a group member is added). One factor that mitigates stress is familiarity, which can help a client feel safe. If working with a group prone to ER difficulties, the music therapist should consider consistently incorporating experiences that are familiar and “safe” for clients. These can serve to structure the session and can be utilized on an ad hoc basis to facilitate a client’s shift to a regulated state. As stated earlier, poor ER skills put children at an increased risk for poor interpersonal skills, social competency difficulties, and academic challenges (Calkins & Hill, 2007; Eisenberg et al., 2007)—all of which can be addressed through music therapy. Furthermore, there seems to be a neural connection between music and ER processing (Sena Moore, 2013). Thus, although music therapy research in this area is in its infancy, ER development is an important concept for music therapists to understand and incorporate into practice. References Bargh, J. A. & Williams, L. E. (2007). The nonconscious regulation of emotion. In J. Gross (Ed.), Handbook of emotion regulation (pp. 429-445). New York, NY: The Guilford Press. Calkins, S. D. & Hill, A. (2007). Caregiver influences on emerging emotion regulation: Biological and environmental transactions in early development. In


J. Gross (Ed.), Handbook of emotion regulation (pp. 229-248). New York, NY: The Guilford Press. Eisenberg, N., Hofer, C., & Vaughn, J. (2007). Effortful control and its socioeconomic consequences. In J. Gross (Ed.), Handbook of emotion regulation (pp. 287-306). New York, NY: The Guilford Press. Feldman, R. (2009). The development of regulatory functions from birth to 5 years: Insights from premature infants. Child Development, 80(2), 544-561. Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. Gross (Ed.), Handbook of emotion regulation (pp. 3-24). New York, NY: The Guilford Press. Masao, I. (2004). “Nurturing the brain” as an emerging research field involving child neurology. Brain and Development, 26(7), 429-433. Mullin, B. C. & Hinshaw, S. P. (2007). Emotion regulation and externalizing disorders in children and adolescents. In J. Gross (Ed.), Handbook of emotion regulation (pp. 523-541). New York, NY: The Guilford Press. Ochsner, K. N. & Gross, J. J. (2007). The neural architecture of emotion regulation. In J. Gross (Ed.), Handbook of emotion regulation (pp. 87-109). New York, NY: The Guilford Press. Perry, B. D. & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation: A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7(1), 33-51. Sena Moore, K. (2013). A systematic review on the neural effects of music on emotion regulation: Implications for music therapy practice. Journal of Music Therapy, 50(3), 198-242. Stegge, H. & Terwogt, M. M. (2007). Awareness and regulation of emotion in typical and atypical development. In J. Gross (Ed.), Handbook of emotion regulation (pp. 269-286). New York, NY: The Guilford Press. Thompson, R. A. & Meyer, S. (2007). Socialization of emotion regulation in the family. In J. Gross (Ed.), Handbook of emotion regulation (pp. 249-286). New York, NY: The Guilford Press. Zeman, J., Cassano, M., Perry-Parrish, C., & Stegall, S. (2006). Emotion regulation in children and adolescents. Developmental and Behavioral Pediatrics, 27(2), 155-168.

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Acknowledgment The author would like to thank Dr. Deanna HansonAbromeit for her guidance and mentorship with this project. This project was completed in partial fulfillment of the requirements for a doctoral degree. About the Author Kimberly Sena Moore, a Ph.D. Candidate at the University of Missouri-Kansas City, joined the music therapy faculty at the University of Miami in Fall 2014. Outside of academia, Ms. Sena Moore serves as CBMT’s Regulatory Affairs Associate, co-hosts the Music Therapy Round Table podcast, and writes the blogs "Your Musical Self" for Psychology Today and Music Therapy Maven. Contact:


Parent Singing in Relational Treatment of Children with Autism Spectrum Disorder Dorothy S. Denton, BM, MT-BC Music Moves Studio, Mansfield, OH Kaja Weeks, B.A. ITS-DTS, Inc., Kensington, MD

Introduction The purpose of this article is to draw attention to the goodness of fit for singing and vocalizations in Developmental, Social-Pragmatic (DSP) thinking and to illustrate introductory strategies for music therapists working in a developmental, relational model for treatment of young children with Autism Spectrum Disorder (ASD). Among the broad hallmark symptoms of ASD are persistent deficits in social communication and interaction (including eye contact, facial expressions and gestures), and restrictive or repetitive behaviors linked to ideas, movements, sensations, speech, or objects. An array of individual, unique manifestations of symptoms shapes the complexity this disorder (American Psychiatric Association, 2013). Developmental, Relational Models The DSP Model encompasses a wide array of approaches, which espouse relational principles for intervention based in developmental theories, such as attachment, hierarchical progressions, Vygotsky’s, and affect diathesis

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(Greenspan, 2001). These share numerous common outlooks and strategies, including the belief that a child’s functional communication grows best in warm, affective relationships with caring adults in naturalistic settings. They are embedded in specific therapeutic interventions for young children who have, or are at risk for, neurodevelopmental disorders. Established practices, which show grounding in DSP include Theraplay (Booth & Jernberg, 2010), Developmental, Individual, Relational (DIR) (Greenspan & Wieder, 2006), The Play Project (Solomon, 2007), Hanen (Manolson, 1992), Relational Developmental Intervention (RDI) (Gutstein, 2002), and SCERTS (Prizant, Wetherby, Rubin, & Laurent, 2003), among others. Parent Role Interventions such as these often view the parent-child dyad as the broader client, relying on parents to play an active, primary role. When the therapist joins the child in play, she simultaneously functions as a model for the parent. In an ensuing shift, the parent interacts directly with the child while the therapist watches, reflects, and coaches the

parent, or the play may also become triadic. Continual follow-up with reflective mentoring of the parent is optimal, with a focus on questions such as "What was addressed? What was missed? How did it feel?" Drawn from early infant mental health models (Fenichel, 1992), this practice increasingly includes work with children on the autism spectrum (Longtin & Gerber, 2008) Affect and Singing The centrality of affect is essential in developmental approaches, in which learning is thought to be driven by the child’s affect and displayed by motivation. Indeed, affect is seen as a “primary probe” that enables double coding of experience (Greenspan, 2001). Singing, whether with words or wordless vocalizations, has been recognized as a powerful carrier of affect, which combines internal and external sensations (Powers & Trevarthen, 2009). Moreover, Porges' polyvagal hypothesis posits that there is an evolutionary basis for the connection between singing and affect.


Elements of Typical Development Typical development informs how the earliest dyadic vocal parlay between mother and infant extracts the affective value of a musical voice within a liminal space of prosodic speaking, singing, chanting, and sound-making (Malloch & Trevarthen, 2009). Fernald documented cross-cultural expressions – smooth, downward glides for soothing, bursts of staccato for attention, coos of contentment, elongated rise and fall of praise – as the meaningful melodies of “motherese” (Fernald, 1992). Later, overlapping and turntaking full of rhythmic and melodic patterns prevail (Malloch & Trevarthen, 2009). All this is rich material from which to draw when

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addressing the social and communicative difficulties of young children with ASD and their parents. Harnessing Musicality Not only should therapists have an understanding of vocal development stages of children, but they should also be able to supportively coax the parents’ rudimentary singing. For the benefit of the parent, functional breathing, posture, chanting, recitative-like prosody, and sound exploration can be woven into play sessions. Kodaly-based John Feierabend (2003) asks, “Can your voice do this?” (e.g., whoosh, shush, wheee, hoot) in a collection of imaginative vocal explorations (which coincides with early developmental trajectory) that can easily be adapted for

parent modeling, coaching and children’s imitation. In the following sequences, a DSP framework including vocal and relational parent coaching, and the music therapist's own experience and reflections inform the clinical treatments. Containment and Communication David was a cautious and sweetnatured 3.6 year old boy who initially found a way in his music therapy sessions to retreat from social engagement and overwhelming sounds, and to avoid the disorientation of movement; it was through his favorite spot. His favorite spot was a small rug on the floor where he sat still or played in


parallel with his parent, while the parent and the therapist sang around him. David made sounds consisting mostly of grunts that were sometimes accompanied by broad gestures such as sweeping his hand, pulling, and tugging. The therapist interpreted these gestures as invitations to his parents to engage. In response to prosodic inflections and expressive face and hand/arm movements, the therapist modeled for David's parents ways to attune to their son's loosely communicative sound signals.

Child shapes his environment, finds his comfort zone (The PLAY Project, 2005-2013) by choosing his place (the small rug) Child chooses mode of interaction (mouth sounds, gestures). Therapist maintains stability for the family through structured group singing Therapist follows child’s sound lead; acknowledges his intentions and creates shared meaning (Greenspan & Wieder, 2006). Parents are led to a specific destination where they can join child – his vocal sounds.

Joining, Improvising, and Imitating David was delighted when his parents imitated his mouth sounds and were able to improvise gurgling, popping and slippery “bubble” sounds. But David also had lowpitched monotonic sounds and his parents’ quiet, un-modulated voices and tired faces matched it. To

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elevate the affect, the therapist began at the level of their sound play but improvised lively facial expressions and small gestures like shrugs, outstretched hands and anticipatory breath. Eventually parents’ sillier sounds came to be articulated by their bodies. With long enough waiting to process and form a response, David was able to imitate.

The mutual mouth sound playing is successful – affective pleasure and surprises; parents learn regulatory strategies through timing. Therapist joins parents’ and child’s lower tone sounds but simultaneously uses multi-modal systems (sound, face, gestures) for more energetic expressions, which the child imitated.

Extending Vocal Exploration Simple consonant-vowel (c-v) sounds (e.g., ba, da, ma) appeal to children and are a comfortable way to help adults explore their singing voices. Diverse sounds learned through singing, listening, moving, or musical dialogue are tools that enable parents to explore their child’s unique sound patterns, gestures, movements and moods. The therapist extended the play with formulaic songs, such as a composed hello song with space for inserting names and “Old McDonald,” a parents’ favorite. The therapist also composed a song that encouraged an echo of unique

silly sounds. The song “Make a mighty pretty motion” became “Make mighty pretty noises...doodly doo.”

Parents were able to use playful, game-like interactions instead of automatic, repetitious verbal instructions. Parents’ confidence increased with pitch and improvisational sound play. Their broader dynamic range increased affect.

Full Body, Full Space The therapist encouraged the parents to use their bodies and voices more dynamically (or more fully) by tossing, blowing, shaking and improvising sounds with the aid of a lightweight chiffon scarf or small bean bags. Combining visual and dynamic movement with sound quickly led to lively songs with bubbles, popcorn and flowing water sounds. Tweaking dynamic intensity and rhythmic emphasis maintained interest. The duration and frequency of interactions increased, as did David's joyful engagement and his exploration of the 25' by 25' room. Now he uses tiptoes and marching to move about while visually referencing his parents.

Helping parents develop meaningful singing interactions was accomplished sequentially, with structure, creative simplicity, and improvisation, always with a mind toward warm affect. The child made rapid progress (in 10 weeks) in self-regulation, purposeful interactions, and longer chains of social reciprocity. 82

Relational Turns, Transactional Repair A particular vulnerability in caring for children with immense, roundthe-clock needs impacts parent psychological states and these negative affects may be carried by their voices. Robb’s (2000) acoustic voice pattern analysis shows maternal depression reflected by stunted vocalizations – shorter phrases, lower pitch, and longer silences – which, in turn, the infant matches in an attempt to attune to mother. In gradually dwindling space the infant loses interest in reciprocal communication (Gratier, 2000). In such situation mutative influences, intervention using affective vocal play with the child by therapeutic or communal caregivers is crucial in order to break the cycle, as seen in the following vignette. Dr. Harold Wylie, a seasoned psychoanalyst, observed a mother who sat apart from her baby in a circle of playfully singing mothers. While other mothers sang hello and bounced their children, she was silent and her dull gaze and slouch reflected growing depression since her husband’s military departure. Her little girl, Linda, was silent as well, though she looked at the singers. Without verbal commentary, the other mothers began to sing Linda’s name, angle their bodies toward her, smile and make eye contact. Linda brightened, moved her upper body rhythmically to the music and then referenced her own mother. The smile on the child’s face pulled in her mother, who began to sing her daughter’s name. Post-session, Dr. Wylie framed the episode as a clear

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example of mother-infant dyadic rupture through symptoms of maternal depression and uncharacteristic yet important repair by the baby, which initially took third party intervention (Weeks, 2002). There is insight to be drawn from this vignette. While a music therapist may be more effective in vocally alerting and engaging a child, she should be ready to momentarily “turn over” the child’s positive responses to the mother. This back-and -forth action may have to be negotiated many times. Mother’s responses may well be scaffolded with a soft vocal drone using vowels or humming. The beauty of such vocal support is how subtly responsive it can be, waxing and waning in volume and tonal color, unifying in pitch with child or mother, or dissipating by infinitesimal degrees as the primary dyad assumes its relational agency. Conclusion In developmental, relational approaches that respond to individual differences, a preverbal child’s spontaneous sounds and movements are valuable launching points for the parents’ contingent affective responses. The child’s unverbalized communication may nonetheless be felt through his or her body. Though these expressions may be inchoate, the parents’ use of singing may organize reflection and response through effective sound patterns. Music therapists working with young children with ASD can help their parents by drawing from relevant research combined with the unique conduit of affect that is the singing voice.

References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing. Booth, P. B., & Jernberg, A. M. (2010). Theraplay: Helping parents and children build better relationships through attachment-based play. (3 rd ed.). San Francisco, CA: Jossey-Bass. Casenhiser, D., Shanker S.G., Stieben J. (2011). Learning through social interactions in children with autism: Preliminary data from a socialcommunications-based intervention. Autism, 17(2): 220-41. doi: 10.1177/1362361311422052 Feierabend, J. M. (2003). The book of pitch exploration. Chicago, IL: GIA Publications, Inc. Fenichel, E. (1992). Learning through supervision and mentorship to support the development of infants, toddlers and their families: A source book. Arlington, VA: Zero to Three. Fernald, A. (1992). Meaningful melodies in mothers' speech to infants. In H. Papousek, U. Jürgens, & M. Papousek (Eds.), Nonverbal vocal communication: Comparative and developmental approaches. Cambridge: Cambridge University Press. Goodyear-Brown, P. (2009). Theraplay approaches for children with autism spectrum disorders. Applications of family and group Theraplay.


Lanham, MD: Jason Aronson. Gratier, M. (2000). Expressions of belonging: The effect of acculturation on the rhythm and harmony of mother-infant vocal interaction. Musicae Scientiae, 3(1), 93-122. doi: 10.1177/10298649000030S10 7 Greenspan, S. I. (2001). The affect diathesis hypothesis: The role of emotions in the core deficit in autism and in the development of intelligence and social skills. Journal of Developmental and Learning Disorders, 5(1), 1-45. Greenspan, S. I. & Wieder, S. (2006). Engaging autism. Cambridge, MA: Da Capo Press. Gutstein, S. E., & Sheely, R. K. (2002). Relationship development intervention with young children: Social and emotional development activities for Asperger syndrome, autism, PDD, and NDL (Vol. 2). London: Jessica Kingsley Publishers. Longtin, S., & Gerber, S. (2008). Contemporary perspectives on facilitating language acquisition for children on the autistic spectrum: engaging the parent and the child. Journal of Developmental Processes, 3(1), 38-52. Malloch, S., & Trevarthen, C. (2009). Communicative musicality: Exploring the basis of human companionship. Oxford University Press, USA. Prizant, B., Wetherby, A. M., Rubin, E., & Laurent, A. C. (2003). The SCERTS Model: A transactional, family-centered

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approach to enhancing communication and socioemotional abilities of children with autism spectrum disorder. Infants and Young Children, 16(4), 296-316., Porges, S. W. (2011). The Polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: WW Norton & Company. Powers, N. & Trevarthen, C. (2009). Voices of shared emotions and meaning. In S. Malloch & C. Trevarthen (Eds.), Communicative musicality: Exploring the basis of human companionship, (pp. 210-2011). Oxford, UK: Oxford University Press. Robb, L. (2000). Emotional musicality in mother-infant vocal affect, and an acoustic study of postnatal depression. Musicae Scientiae, 3(1), 123-154. doi: 10.1177/10298649000030S10 8 Solomon, R., J., Necheles, C,. Ferch, &. Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism 11(3), 205-224. The PLAY Project. (2005-2013). About the PLAY project. Retrieved from http:// Weeks, K. (2002). Tune into interactive musical play: Intellectual and emotional learning. Jenny Waelder-Hall Center Speaker Series. Lecture presented for Baltimore-Washington Institute

for Psychoanalysis, Washington, DC. Weiss, M. W., Trehub, S. E., & Schellenberg, E. G. (2012). Something in the way she sings enhanced memory for vocal melodies. Psychological Science, 23(10), 1074-1078. About the Authors Dorothy Denton is a boardcertified music therapist (CBMT) and certified early childhood music and movement specialist (ECMMA). Dorothy has a private practice in Mansfield, Ohio and also serves as the Montessori music specialist at Montessori Good Shepherd, Ashland, Ohio. Contact:

Kaja Weeks is a classically trained singer and Developmental Music Educator with certification in the DIR® model. She supports young children and families at an interdisciplinary clinic in Kensington, MD, conducts trainings and presentations, and writes on the topic of early childhood and music. Contact:



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Developing Multicultural Sensitivity in Early Childhood Music Therapy Practices Nicole R. Rivera, Ed.D., MT-BC Danara Barlow, Student North Central College Naperville, Illinois According to the National Association for the Education of Young Children (NAEYC), the demographics of children in the United States are changing. There will continue to be “dramatic increases in children’s cultural and linguistic diversity, and unless conditions change, a greater share of children living in poverty” (NAEYC, 2009, p. 2). These changes are confirmed by Child which tracks key indicators of the well-being of American children and indicates that the “population is projected to become even more diverse in the decades to come” ( and includes a projection of significant growth of Hispanic children. As demographics continue to change, music therapists must become increasingly aware of how linguistic and cultural diversity impact the therapeutic experience.

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NAEYC, one of the leaders in the field of early childhood care and education, includes building an understanding of the social and cultural contexts in which children live as part of their recommendations for developmentally appropriate practices. They further indicate that “practitioners must strive to understand in order to ensure that learning experiences in the program or school are meaningful, relevant, and respectful for each child and family” (NAEYC, 2009, p. 10). Music therapists have long been aware of the need to explore multicultural perspectives in music therapy (Darrow & Molloy, 1998). Their survey data indicated that music therapists recognize “the need to understand and respect the clients’ cultural differences” (p. 31), but they express frustration about their preparation. Subsequently there have been more professional

development opportunities and articles written about multicultural perspectives in music therapy. For example, Rilinger (2011) wrote about the cultural implications and practical considerations of providing music therapy services for Mexican American children. She provided a review of significant cultural themes, important holidays, and information about relevant music. Last year’s edition of imagine included an article by Berger Morris (2013) in which she defined cultural beliefs systems among Latin American families that may impact the work of music therapists who are serving young children with disabilities. Music therapists have heard the message that it is important to understand the context of their clientele, but the ever changing demographic is a reminder to continue efforts to work in a diverse world.


Defining Cultural Perspective Much of the literature on multiculturalism or cultural perspectives is written in the vein of understanding the other. While this is absolutely vital, it is contended that to best serve young clients who are linguistically or culturally diverse, music therapists must also examine their own cultural perspective. Rogoff (2003) argues that “understanding development from a sociocultural-historical perspective requires examination of the cultural nature of everyday life” (p. 10). She goes on to present five orienting concepts to help understand the cultural nature of human development (Rogoff, 2003, p. 11-12): Culture isn’t just what other people do. Understanding one’s own cultural heritage, as well as other cultural communities, requires taking the perspective of other people of contrasting backgrounds. Cultural practices fit together and are connected. Cultural communities continue to change, as do individuals. There is not likely One Best Way. These orienting concepts underscore the importance of music therapists examining their own perspective and experience rather than just looking at the other. It is important to take time to be reflective practitioners and understand one's own beliefs and biases. What does one believe about disabilities and child development? What does one

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believe about the role of music in the lives of our young clients? Beyond personal beliefs, one must also recognize that the field of music therapy is populated by a dominant group that represents a majority perspective in the United States. It is therefore important to both examine the dominant perspective and respect the cultural contexts that informs the client’s development. If this perspective is not examined, then there is a higher risk of viewing norms and expectations as the “right way” or failing to recognize one's part of dynamic and changing belief systems. Development in Context The knowledge about child development is rendered through a cultural lens. In large part, information has been based on research that has been carried out through a predominantly Western perspective with majority populations. Our goal is not to suggest that this is either right or wrong, but to encourage music therapists who work with young children to recognize the lens that informs an understanding about child development and consequently become more sensitive to how this dominant perspective potentially informs therapeutic interaction. An example of the dominant orientation of contemporary developmental theory is the concept of developmental milestones, which provides a framework for understanding and evaluating young children. While it is generally accepted that there is

variation in how children move through developmental milestones, it is important to recognize that the context in which the child grows up can have a significant impact on the rates of passing through the milestones. Rogoff (2003) states that “differences in communities’ values and expectations underlie varying parental efforts to help children learn skills” (p. 159). Different families and environments stress different skills and behaviors. In later research, Silva and colleagues demonstrated that family practices impacted attentional processes and learning in Mexican-heritage children living in the United States (Silva, CorreaChavez, & Rogoff, 2010). Attentional processes, which are essential for learning, are just one example of how cultural context can shape development. Gaskins (2000) also advocates for studying children’s learning and development within their sociocultural context. Her work with Mayan children has demonstrated differences in play and emotional development. Gaskins argues that when a child’s behavior is viewed from a dominant perspective rather than a culture-centered perspective, then the view of the behavior may be skewed. “For many years developmental research on play was conducted mainly with middleclass European or EuropeanAmerican children in laboratory playrooms by researchers from the same cultural backgrounds, but since this work was done with little or no attention to a cultural level of analysis, it did not yield evidence relevant to describing play as a


cultural phenomenon” (Gaskins & Miller, 2009, p. 6). When theory building is based on only dominant perspectives, the dominant version becomes the accepted norm. Gaskins and Miller demonstrate this through a cross-cultural comparison of emotional expression between European-American children and Mayan children. The Mayan children demonstrated notably different patterns of emotional expression because “the culture itself has a norm to be reserved about cultural expression” (p. 11). Music therapists who work with young children from diverse backgrounds should recognize how cultural context has shaped the child’s development. For example, a child may have skills that are advanced or delayed in comparison to typical developmental milestones, but relevant to the child’s context. Decisions about the goals and directions of music therapy should therefore be informed by this understanding. Working with a perspective of sensitivity is often referred to as a culturally responsive practice. Developing Culturally Responsive Practices In their article entitled, “No Child Misunderstood: Enhancing Early Childhood Teachers’ Multicultural Responsiveness to the Social Competence of Diverse Children,” Han and Thomas (2010) discuss the trend that early childhood classrooms are becoming more and more diverse. While this change is evident, it is also clear that a large amount of early childhood educators are of European culture

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and middle class. The article provides pointers and recommendations on how early childhood professionals can become aware and more responsive to cultural differences. They focus on three themes: 1) multicultural awareness, 2) multicultural knowledge; and 3) multicultural skills. Consistent with aforementioned work by sociocultural researchers, Han and Thomas (2010) suggest that the first step to “developing multicultural responsiveness is an understanding of the complexity of such work as a life-long process by engaging in self-reflection” (p. 472). The authors recommend a series of questions to help professionals become more aware of their feelings and biases related to children’s social development such as: “I think that the value of obedience and assertiveness does not differ by culture; I think that all cultures place equal emphasis on independence; and I think that the manner of achieving social competence is universal” (Han & Thomas, 2010, p. 472). Multicultural knowledge focuses on the professional being cognizant of his or her own cultural values, practices and beliefs as well as those of cultures opposite their own. Multicultural knowledge also involves the researching or gaining of knowledge about the cultures you will be involved with. This includes learning about beliefs, practices, musical preferences among others. Multicultural skill refers to the professional having the ability to challenge what is

considered the norm while noting his or her own behavior as well. For example, a clinician may recognize the skills that are fostered by the child’s context. For professionals, it is important to become sensitive and responsive to the needs of young clients who are linguistically and culturally diverse. In order to continue to grow, music therapists need to become aware of their own cultural context, recognize and embrace the context of their clients and continue our efforts to understand the behaviors, skills, and beliefs that are supported by their client’s cultural perspective. References America’s Children: Key Indicators of Well-Being (2013). Retrieved from: americaschildren/demo.asp Berger Morris, L. (2003). Culture matters: Latin American cultural attitudes towards disability and their implications for music therapists working with young children. imagine 4(1), 80-83. Darrow, A. & Molloy, D. (1998). Multicultural perspectives in music therapy: An examination of the literature, educational curricula, and clinical practices in culturally diverse cities in the United States. Music Therapy Perspectives, 16, 27-32. Gaskins, S. (2000). Children’s daily activities in a Mayan village: A culturally grounded description. Cross-Cultural Research, 34, 375-389. Gaskins, S. & Miller, P. (2009). The cultural role of emotions in


pretend play. In Transactions in Play. Dell Clark, C. (Ed.). Lanham, Maryland: University Press of America, Inc. Han, H. S. & Thomas, M. S. (2010). No children misunderstood: Enhancing early childhood teachers’ multicultural responsiveness to the social competence of diverse children. Early Childhood Education Journal, 37, 469-476. doi 10.1007/ s10643-009-0369-1 National Association for the Education of Young Children. (2009). Developmentally Appropriate Practices in Early Childhood Programs Serving Children from Birth through Age 8. Retrieved from: http:// positions/PSDAP.pdf Rilinger, R. (2011). Music therapy for Mexican American children: Cultural implications and practical considerations. Music Therapy Perspectives, 29, 78-85. Rogoff, B. (2003). The Cultural Nature of Human Development. New York: Oxford University Press. Silva, K. Correa-Chavez, & Rogoff, R. (2010). Mexican-heritage children’s attention and learning from interactions directed to others. Child Development, 81(3), 896-912.

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About the Authors Nicole R. Rivera, Ed.D., MT-BC worked as a clinical music therapist for over 17 years serving children with autism spectrum disorder. She is a Visiting Assistant Professor of Psychology at North Central College in Naperville, IL. Contact:

Danara Barlow is a psychology student at North Central College with a strong interest in advocacy for persons with disabilities. She currently studies with Dr. Rivera. Contact:


Music Therapy to Support a Preschool Transitional Bilingual Educational Program Ilene “Lee” Berger Morris, MM, LCAT, MT-BC Alternatives for Children Suffolk County, NY Mira, Sofia! It’s our turn to play the drum – es muy grande! Excited, happy voices ring out from the transitional bilingual classroom at Alternatives for Children’s (AFC) Southampton, New York site. This new preschool program was developed to meet the needs of the growing population of Latin American residents on the east end of Long Island. Many of the children served come from families that have recently immigrated to the United States from Spanish-speaking countries. In most cases, the children and their family members have limited skills in speaking and understanding the English language. In AFC’s transitional bilingual classroom, the children and their families find a preschool environment in which their native language and culture are considered vital and valued, and which prepares the children for kindergarten taught in English in the local school district. AFC’s transitional bilingual class is set up in the inclusion model of special education. Children with disabilities are

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educated alongside their typically developing peers. A special educator and teaching assistant who are fluent in Spanish, and a regular educator who is English-speaking staff the classroom. The children range fairly widely in their degree and direction of language dominance as well as overall speech-language proficiency and developmental achievement. Throughout the day, classroom instruction and interaction is divided approximately equally between the two languages. Children who receive speech therapy services work with a bilingual speech language pathologist. In the transitional bilingual education model, the second language is systematically introduced and embraced, while skills in the first language are reinforced and built upon. Proficiency in the second language develops over time, not as a separate function in the brain, but as a product of the child’s developing communication and literacy skills. Fostering a child’s native tongue through this process is supported by research indicating that meta-cognition skills achieved through learning in the home language serve as a foundation for the development of similar skills in their second language (Burchinal, Field, López, Howes, & Pianta, 2012; Cummins, 1983, 1991; Kremer-Sadlik, 2005). The primary goals of transitional bilingual education (Lindholm-Leary & Genesee, 2010; McCarty, 2012) are To ensure mastery of age-appropriate skills and knowledge To facilitate and accelerate the process of learning English To promote successful assimilation into the local educational system and culture.


Additionally, many transitional bilingual education programs, such as the one at AFC, include a parent component, aimed at cultivating a strong relationship between the home and school. Music can support each of the program goals and facets in specific ways. At AFC, the music therapist works with the educational staff of the transitional bilingual class and other therapists serving the children to create a weekly music session that promotes general development, reinforces concepts and material presented in the classroom, and addresses the challenges of learning in two languages. Ensuring Mastery of Age-Appropriate Skills and Knowledge A form of communication itself, music is not tied to one particular language system, and can serve as a bridge for understanding and learning. Words deliver meaning when the child can relate an experience to them. Learning concepts and developmental skills can be facilitated through purely music experiences, not dependent on conventional language. Loud/soft, fast/ slow, other opposites and contrasts that can be expressed auditorily, movement and spatial complements such as up/down, go/stop, patterns, order, numbers, cooperation, and turn-taking are well suited to experiential learning through sound. To support ageappropriate skills in the transitional bilingual classroom, the music therapist uses songs with neutral language (instrumental or syllabic/nonsense), Spanish language, English language, or English/Spanish bilingual content. An example of a neutral language song used for this purpose is Oh Ah, sung to the tune of Chiapanecas, or, The Mexican Hand Clapping Song.

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In this version, language is stripped down to the syllables “Oh” and “Ah,” common to English and Spanish. With linguistic decoding out of the way, the emphasis is on distinguishing two ways to sing, use body percussion, and play instruments. While singing “Oh,” the lips form a tight circle, singing is restrained but expectant, and the hands rub together in rhythmic anticipation of the next part. “Ah-Ah” is sung with a bold, open embouchure and new, contrasting movement and sound: two hand claps! After four repetitions, the children join hands, swinging gently while singing the legato section to the syllable


“la.” Turn-taking is exercised by applying the Oh-Ah patterns to the guiro. This happens by using a mallet to rub the guiro’s ridges while singing the "Oh" section, then striking the guiro twice while singing “Ah-Ah.” Many Spanish songs for children speak to general developmental skills and can be featured in music therapy interventions designed to foster such advancement. Un Elefante Se Balanceaba is a counting song, Vengan a Ver Mi Granja explores farm animals and the sounds they make, and Mi Cuerpo identifies body parts and encourages movement and body percussion. The “Roots and Branches” songbook by Matney & Stock (2010) contains many traditional songs in Spanish. Mama Lisa’s World ( lists lyrics to many Spanish songs, categorized by country of origin. Songs in English are also used to teach age appropriate skills in the transitional bilingual classroom. During the course of the year, as the children’s English skills improve, more English language songs with a greater variety of semantic content are added. Facilitating and Accelerating the Process of Learning English The process of learning English (including increasing vocabulary, receptive and expressive language, and sequencing skills) can be facilitated through music (Kennedy, 2008, 2013; Matney & Stock, 2009; Paquette & Rieg, 2008; Schunk, 1999; Schwantes, 2009). Musical forms that feature repetitive sections help ensure that the children have multiple opportunities to experience and master pronunciation, vocabulary and other information presented in song. Children can be exposed and accustomed to the English language through music in several ways. Rather than being confronted by complex songs with advanced vocabulary, the children in AFC’s transitional bilingual class begins with learning English-only songs with examples containing simple lyrics that can be reinforced though action or accompanying materials. When children sing I Can Sing a Rainbow, colored scarves serve as movement aids to understanding the English names for the colors that make up the rainbow. Learning English songs from the common preschool repertoire is an important avenue toward cultural literacy for a child being educated and socialized in the U.S.

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Adapted and custom-composed songs are also used, targeting specific words and phrases used in interaction, classroom activities, and instruction. In our program, a bilingual approach to music experiences occurs in a number of ways. Certain songs will be presented in both languages, with accurate translations. Using a familiar song in Spanish in conjunction with its English translation supports English acquisition by melodic reference (Rilinger, 2011). Wellknown English songs can be taught first in Spanish to provide a foundational understanding for the English version. A challange inherent in direct translation is the greater number of syllables in many Spanish words as compared to their counterparts in English. For example, Head, Shoulders, Knees and Toes with 6 syllables would translate word for word to Cabeza, Hombros, Rodillas y Dedos, nearly twice as long syllabically. Fitting inequivalent syllables into a predetermined rhythmic structure requires the singer to squeeze in or omit rhythmic units, and may result in awkward or difficult to understand phrasing. Furthermore, the occurrence of stresses and accents will likely differ between phrases in English and Spanish. It can be challenging to preserve the rhythmic integrity or drive of the original song when employing direct translation of existing songs. However, songs may be specifically composed to function in this way, and can be very powerful. Haz Lo Mismo/Do the Same Thing is an example of a song that can be sung interchangeably in Spanish or English without disrupting the rhythmic flow.

When a song doesn’t translate smoothly, adaptations or new, customized songs can be employed. Again, the


repetition so natural in children’s musical forms comes into play. In music, there is no need to say, “This means that.” The placement of English and Spanish semantic parallels in temporally and/or structurally close setting delivers that message. Commonly used settings feature repetition and congruity between rhythmic, melodic, movement contour, and/or harmonic elements. Contrast is important too, as it highlights the linguistic differences. The chorus to Vamos a la Playa/Let’s Go to the Beach, begins in Spanish to establish the concept, set the construction and to build confidence and attainment through repetition. The English part completes the chorus with a distinctive melody, but retains the rhythmic and harmonic patterns already heard. Thus, the pieces function as an integrated whole. Variations on the melody (M), rhythm (R) and harmony (H) are indicated in the notation with numbers (e.g., M1 = the first melody).

Enhancing the singing experience with movement, instrument playing, and visual aids or manipulatives adds to the benefit for the children (Kennedy, 2008; Schwantes, 2009). Promoting Successful Assimilation into the Local Educational System and Culture The accessibility of music enables it to act as a bridge between cultures. At AFC, families are invited to various open school events where they can see the children participating in activities, including music groups. The families may sit in on a typical music session, or observe the children singing and performing music we have practiced in preparation. Information about the value of

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music in childhood development and language acquisition, and families’ own music experiences is exchanged. The music repertoire of the transitional bilingual education program effectively demonstrates the progression the children are making linguistically from Spanish to Spanish and English, and culturally via information embedded in songs and activities associated with them. Assimilation is a long process, but a systematic music therapy approach designed to foster development in both the home and school languages and cultures can play a very instrumental role. The coordination between the music therapist, classroom educational staff, bilingual speech therapist, other therapeutic professionals, administrators, and families ensures that the children are gaining the skills needed to function in their local kindergarten placements when they transition out of preschool. References Burchinal, M., Field, S., López, M. L., Howes, C., & Pianta, R. (2012). Instruction in Spanish in prekindergarten classrooms and child outcomes for English language learners. Early Childhood Research Quarterly, 27(2), 188-197. Cummins, J. (1983). Bilingualism and special education: Program and pedagogical issues. Learning Disabilities Quarterly, 6, 373-386. Cummins, J. (1991). Interdependence of first- and second-language proficiency in bilingual children. In E. Bialystok (Ed.), Language Processing in Bilingual Children (pp. 70-89). Cambridge, England: Cambridge University Press. Kennedy, R. (2008). Music therapy as a supplemental teaching strategy for kindergarten ESL students. Music Therapy Perspectives, 26(2), 97-101. Kennedy, R. (2013). The Cloud Forest School: A music therapy service project. imagine, 4(1), 84-86. Kremer-Sadlik, T. (2005). To be or not to be bilingual: Autistic children from multilingual families. Proceedings of the 4th International Symposium on Bilingualism (pp. 1225-1234). Somerville, MA: Cascadilla Press. Lindholm-Leary, K., & Genesee, F. (2010). Alternative


educational programs for English learners. In Improving Education for English Learners: Research-based Approaches (pp. 323-382). California Department of Education: Sacramento. Matney, B., & Stock, C. (2009). Music therapy in bilingual education. imagine, 15, 19-20. Matney, B., & Stock, C. (2010). Roots & branches: Songs of tradition and culture. Denton, TX: Sarsen Publishing. McCarty, S. (2012). Understanding bilingual education series. Child Research Net–Language Development and Education. Retrieved from http:// 2012_01.html Paquette, K., & Rieg, S. (2008). Using music to support the literacy development of young English language learners. Early Childhood Education Journal, 36(3), 227-232.  Rilinger, R. (2011). Music therapy for Mexican American children: Cultural implications and practice. Music Therapy Perspectives, 29(1), 78-85. Schunk, H. A. (1999). The effect of singing paired with signing on receptive vocabulary skills of elementary ESL students. Journal of Music Therapy, 36(2), 110-124. Schwantes, M. (2009). The use of music therapy with children who speak English as a second language: An exploratory study. Music Therapy Perspectives, 27(2), 80-87. About the Author A music therapy clinician for over 30 years, Ilene "Lee" B. Morris, MM, LCAT, MT-BC lives and works in Suffolk County, Long Island, NY. She provides music therapy to young children and adolescents in special education settings, and to patients of all ages in a community hospital. Contact:

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Music Therapy: Following the Universal Newborn Hearing Screening in Japan Satoko Mori-Inoue, Ph.D., MT-BC Child Development Center “Kokko” Mejiro University Otology Clinic Institute Music Therapy Connection Group “Kakehashi”

Brief Overview of Sensorineural Hearing Loss Hearing loss in infancy–often congenital though not always–can be divided into four categories: 1) conductive, 2) sensorineural, 3) mixed, and 4) auditory neuropathy. Between one and six people out of every 1000 are born with a hearing loss (ASHA, 2014). Infants who are born prematurely are at greater risk for hearing loss after birth as a result of ventilation, oxygen supplementation, and use of ototoxic drugs (Robertson, Howarth, Bork, & Dinu, 2009). Sensorineural neural hearing loss, the most common type, is caused by damage to the inner ear or auditory nerve and may be present at birth (SIEMENS, 2014).

Early Intervention (EI) Programs for Sensorineural Hearing Loss Diagnosis of sensorineural hearing loss increased in the U.S. in the 1990s after the UNHS was implemented in all 50 states. The UNHS includes screenings, re-screenings, and diagnostic evaluations. Many pediatricians and other primary care providers recognize the benefits of early detection and intervention (Moeller, Whipte, & Shisler, 2006). Unfortunately, follow-up care for these infants has been a challenge due to a) a lack of service-system capacity, b) a lack of service provider’s knowledge of available service for children and their families, and c) an information gap in the literature (Shulman et al., 2010).

In the United States, early identification of sensorineural hearing loss in newborn infants has improved with the use of Universal Newborn Hearing Screening (UNHS) since the 1980s (White, 2003). The UNHS was introduced to Japan in 1999 and almost immediately adopted by 14 government-based facilities. Since then, the use of this screening tool has spread widely to other institutions in Japan, highlighting the importance of screening and early diagnosis of sensorineural hearing loss (Newborn Hearing Screening Manual, 2007).

EI programs focus on minimizing the impact of sensorineural hearing loss on speech and language development. Yoshinaga-Itano (2004) suggested that establishment of the UNHS may result in lowering the age of intervention. Moreover, it may produce better outcomes in children and promote better access to language and communication. Consistent with this idea, a 2010 study found an increase in diagnoses after implementation of the UNHS, as well as a decrease in diagnostic age and use of hearings aids and cochlear implants (Halpin, Smith, Widen, & Chertoff, 2010).

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In Japan, the Automated Auditory Brainstem Response (AABR) was first introduced in 1999 and data collected on its usage led to implementation of the UNHS in 2000. It is now part of newborn screenings if desired by parents (Newborn Hearing Screening Manual, 2007). Use of the UNHS also led to written guidelines and protocols for early intervention programs for sensorinural hearing loss. These protocols include a child program and a parental program (Newborn Hearing Screening Manual, 2007). The former consists of a hearing test, ear molds/ hearing aid selection/adjustment, and learning programs (i.e., recognition and experience of sound), while the later includes basic information about hearing loss, child language development, use of hearing aids, an overview of available education and welfare systems, a record check and advice, and parent support groups. Both programs continue through different stages of child development (with hearing aid fittings when appropriate). Music Therapy and Sensorineural Hearing Loss Due to national regulations, medical music therapy is limited in Japan. One program that focuses on sensorineural hearing loss is the Mejiro University Otology Clinic Institute, which has offered music therapy services as part of the “Sound & Hearing Classroom” since 2010. The program is staffed by physicians and provides comprehensive support for families including medical care, psychosocial care, and educational/ therapeutic services from nurses, speech-language pathologists, educators, and music therapists. The music therapy program attempts to a) provide music-based activities that allow for exploration of sound through vibrations, b) provide opportunities for hearing development through music, c) promote child development (i.e., cognitive, social, communication, motor skills) through music-based activities, and d) promote parent-child bonding through music. As part of this program, music therapists use sound vibrations to help children with congenital hearing loss recognize sound through tactile and auditory stimulation. For example, during a music therapy session, infants experience sound by using a large drum (i.e., 46 inch Remo table drum) and many small instruments (e.g., woodblock, guiro, bells, egg shaker). Infants with sensorineural hearing loss may be able to

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recognize sound by analyzing vibratory information. The recognition of sound vibration may lead to speech and language development and other developmental goals. Choosing a balance of music activities, which adress various goals is an important element of the music therapy program for children with sensorineural hearing loss. This program also provides emotional care of family members, especially for mothers. Through engaging music activities, mothers are provided with opportunity to bond with their children. Group-based sessions support information exchange and communication beyond the clinical setting. Sample Session Plans The following two tables provide sample sessions for the “Niko Niko” group, targeting infants from 1-24 months, and the “Waku Waku” group for 3-year old children. The “Niko Niko” group focuses on development and parentinfant bonding while the “Waku Waku” group focuses more on communication and kindergarten readiness. Prior to each group, a speech pathologist assesses and tests each child’s hearing aids and conducts an otoscopy of each child. After the music therapy group session, the music therapist gives a questionnaire to parents who participated. This questionnaire focuses on 1) the parent’s interaction with the child, 2) the parent’s observation of child’s behaviors during the music activities, and 3) the parent’s feelings during each musicbased activity.

Table 1. Session Plan for the “Niko Niko” Group


neural hearing loss of children after neonatal intensive care because of prematurity: A thirty-year study. Pediatrics, 123, 3797-3803. doi:10.1542/ peds.2008-2531

Table 2. Session Plan for the “Waku Waku” Group Conclusion Music therapy services can be beneficial for children with sensorineural hearing loss. Regulations and policies in Japan make it difficult to establish new medical music therapy programs. More work needs to be done to establish other programs like the one at Mejiro University Otology Clinic Institute in order to better address the needs of children with sensorineural hearing loss in Japan. References American Speech-Language Hearing Association (ASHA) (2014). The prevalence and incidence of hearing loss in children. Retrieved from public/hearing/Prevalence-and-Incidence-ofHearing-Loss-in-Children/ Halpin, K. S.; Smith, K. Y., Widen, J. E., & Chertoff, M. E. (2010). Effects of universal newborn hearing screening on an early intervention program for children with hearing loss, birth to 3 years of age. Journal of the American Academy of Audiology. 21(3), 169-175. Moeller, M. P., Whipte, K. R., & Shisler, L. (2006) Primary care physician’s knowledge, attitudes, and practices related to newborn hearing screening. Pediatrics 118(4), 1357-1370. Newborn Hearing Screening Manual (2007). Health sciences children and family research project: A study on the evaluation and support early and efficient implementation of newborn hearing screening. Retrieved from sep2012/JAPANESE/jigyo/JYOSEI/shinseiji_html/ shi-contents.html

Sakata, H. (2005). Hearing as a Communication. Retrieved from 2005/00474/contents/0014.htm SIEMENS (2014). About a child with hearing loss. Retrieved from children/understanding/types/sensorineural/ sensorineural_article.html Shulman, S., Besculides, M., Saltzman, A., Ireys, H., White, K. R., & Forsman, I. (2010). Evaluation of the universal newborn hearing screening and intervention program. Pediatrics 126, 19-S27. Yoshinaga-Itano, C. (2004). Levels of evidence: Universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). Journal of Communication Disorders, 37(5), 451-465. White, K. R. (2003). The current status of EHDI programs in the United States. Mental Retardation and Developmental Disabilities Research Reviews, 9(2), 79-88? About the Author Satoko Mori-Inoue, Ph.D., MT-BC, music therapy researcher at Mejiro University Otology Clinic Institute (Japan) is currently establishing a music therapy program within the Child Development Center "Kokko." Her early childhood music therapy practice focuses on infants with sensorineural hearing loss and children with developmental delays. Contact:

Robertson, C. M. T., Howarth, T. M., Bork, D. L. R., & Dinu, I. A. (2009). Permanent bilateral sensory and

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parents Parentscan This imagine series is dedicated to parents of young children with developmental delays and disabilities.

Just for


Experienced music therapists oer specific musical ideas that can be easily embedded by parents in daily family routines. Singing, chanting, rhyming, dancing, listening to music, or playing an instrument oer joyful and rewarding learning experiences for young children that may enhance communication, academic, motor, social, and communication skills. Make the most of your family play time by supporting learning through music. imagine 5(1), 2014


parentscan Ideas for Parents of Children with Cerebral Palsy

1. March to the Beat Music is a terrific tool for use during gait training and practice! Songs that are a slow to moderate speed with a simple, strong, steady beat typically work the best. Some of our favorites are “When The Saints Go Marching In,” “The Ants Go Marching,” or “We Are The Dinosaurs” by The Laurie Berkner Band. Get ready to sing, stomp, and march along to the beat!

3. Row Your Boat Put a laundry basket with soft edges on a carpeted surface and place your child inside the basket in a seated position. Slide the laundry basket across the floor… back and forth, side to side, and round and round while singing Row, Row, Row Your Boat. This activity provides a safe way for your child to work on trunk control without falling out or over. If you child loses balance he/she will just bounce off the side of the laundry basket.

Written by Jamie George, MM, MT-BC, Andrew Littlefield, MM, MT-BC, Andrea Johnson, MT-BC, Tasia Dockery, MT-BC, Lana Card, MT-BC, and Jordan van Zyl, MT-BC from The George Center for Music Therapy, Inc.

2. Body Awareness Songs "Head, Shoulders, Knees, and Toes” and the “Hokey Pokey” are great songs to use to facilitate body awareness. As you sing the song, use hand over hand to assist your child in locating each part of their body. As the child continues to grow and develop their skills, begin to allow them to independently locate each body part.

4. Bumping Up and Down Parents can help their child develop balance during playtime by using different games and rhymes. Try incorporating a few rounds of “Little Red Wagon” while gently bouncing your child up and down on your knees and supporting them as they bounce. Giggles and smiles are sure to abound!

5. Grip, Reach, and Play Instrument play can be a fun and effective way to address range of motion and motor control. This can be as simple using a drum stick to play a drum or cymbal that is just out of reach and requires the child to stretch out to play. Adaptive mallets can be found online with thicker handles and straps to assist with grip, or a simple hair "scrunchie" can be used to help keep the mallet in a child's hand. imagine 5(1), 2014


parentscan Ideas for Parents of Children with Speech Language Delays Bubble Play Using bubbles along with songs can enhance speech-language development of young children in outdoor play. The following adapted bubble songs can be easily implemented by parents and siblings.

1. Variation on “Twinkle, Twinkle, Little Star” Bubbles, bubbles way up high, bubbles, bubbles touch the sky. Bubbles, bubbles, way down low, bubbles on the ground below. Bubbles, bubbles in the air, bubbles, bubbles everywhere!

3. Variation on “ "Farmer in the Dell" Bubbles in the air, bubbles in the air, I reach to pop them, bubbles in the air. Bubbles on my toes, bubbles on my toes If I blow them down low, there are bubbles on my toes. Bubbles in my hair, bubbles in my hair, If I blow them up high, there are bubbles in my hair.

Written by team Therabeat Jennifer W. Puckett, MT-BC, NMT, Chelsea Kinsler, MTBC, Alison Williams, MMed, MT-BC, Hannah Bush, MTBC, NMT, and Ashley Frazier, MT-BC from Therabeat, Inc.

2. Variation on “Old McDonald” Bubbles, bubbles all around “B,” “B,” “B,” “B,” “B.” We can “pop” them all around “P,” “P,” “P,” “P,” “POP!” With a “B,” “B,” “B,” and a “P,” “P”, “P,” here a “P” there a “B” everywhere a “P,” “B.” Bubbles, bubbles, all around “B,” “B,” “P,” “P,” “POP!”

4. Variation on “Like to Eat Apples and Bananas”  "I like to pop, pop, pop     Pop the bubbles (pop, pop, pop).     I like to pop, pop, pop,     Pop the bubbles (pop, pop, pop).    I like to pop, pop, pop,     Pop the bubbles (pop, pop, pop). Replace “I” with your child's name and add in sounds or words that need to be practiced. imagine 5(1), 2014


parentscan Ideas for Parents of Children with Down Syndrome 2. La La Land To practice articulation, sing one of your child’s favorite songs. Next, replace each syllable with “la” (e.g., “Twinkle, Twinkle” becomes, “La-la, La-la”). Encourage your child to sing along, leave out the final syllable ending the phrase and wait for your child’s response.

1. Toy Tapping To work on motor skills, hold a toy that makes a sound at a distance from your child. For instance, hold it by your child’s feet so that she/he will be motivated to kick and extend her/his legs.

3. I've Got the Sillies in My ____ Work on body part identification to the tune of “She'll Be Comin' Round the Mountain.” I've got the sillies in my ____, in my  ________ (repeat) I've got the sillies in my____, and I've got to get my sillies out 'cause I've got the sillies in my __________.

4. C is for Cookie To target letter identification, articulate letter sounds, and words, use pictures or real objects of the letter "C" to use with the song “C is for Cookie.” Have your child point to various items or objects in your home, then sing the song with the new letter or word.

Have your child point to or shake the body part you are singing about. Then, let your child point to the body part and sing about it.

Written by Jeffrey Wolfe, MT-BC, Rebecca West, M.M., MT-BC, Deborah Soszko, MT-BC, Jenni Rook, MT-BC, LCPC, and Pan Ho, MT-BC from the Institute for Therapy through the Arts.

5. The Sound of my Emotions To help your child learn to understand emotions, play very slow music when your child feels sleepy, sad music when appearing unhappy, or wild music for happiness. Act out and add a word to the feeling (e.g. "When you are happy you might want to jump up and down.” imagine 5(1), 2014


programs professional development workshops for the benefit of the local teaching community, and over 30 OAKE-

Envisioning a world where the power of music as a unifying, humanizing, and healing force is an integral part of the lives of the American people. In the Beginning... Zoltán Kodály, Hungarian composer, musicologist, linguist, educator and lecturer, had a profound impact on the musical culture in his homeland of Hungary and abroad. In 1905, he began collecting and analyzing Hungarian and other folk music. In 1925, his focus shifted to education, and he began to formulate the underlying philosophies of his approach to music education. He believed that music belonged to everyone, all children should first learn the music of their home culture, and all children should receive instruction in music, including singing, reading, and notating, in their early education years. His philosophy and techniques began spreading around the world in the 1960s. Who and Where? Since the founding of the Organization of American Kodály Educators (OAKE) in March 1974, OAKE has grown from twelve founding members to approximately 1700 members. There are now 40 OAKE-affiliated chapters across the country that provide year-round,

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endorsed teaching institutions. OAKE is governed by a Board of Directors that includes a representative of each region of the country. Purpose and Goals Inspired by the vision of Zoltán Kodály, OAKE exists to support music education of the highest quality, promote universal music literacy and lifelong music-making, and preserve the musical heritage of the people of the United States of America through education, artistic performance, advocacy and research. Profile of Clients In North America, the Kodály Approach is most often used in elementary music education classrooms. However, it can be used effectively in secondary choral and instrumental instruction. The philosophies of the Kodály approach make it ideally suited for use with students in special education. OAKE-endorsed teaching institutions provide training and certification in the Kodály Approach during academic year and/or summer months. Programs renowned for their focus on early childhood music education include: 1) Silver Lake College with Sister Lorna Zemke, D.M.A.; 2) Holy Names University, Oakland, CA with guest teacher Helga Dietrich, Anne Laskey, Program Director; and 3) The Hartt School, University of Hartford, CT, “First Steps in Music” with John Feierabend, Ph.D.


Services and Products OAKE publishes the Kodály Envoy four times annually, holds a national conference each year, awards grants to local chapters for special projects, has various resource publications available to members and the general public, offers a free video library to its members, and advocates for excellence in music education. Key Elements of the Program The Kodály approach has four key elements: singing, folk music, music literacy, and curriculum sequencing. Kodály believed that singing is the foundation to learning music as it allows for self-expression and trains the musical ear. He also believed that folk music, children’s songs and games, and pedagogical exercises by master composers provide the richest source of musical material to learn from. Folk music from the child’s home culture is seen as a tool to help the child understand the musical language of his or her homeland and to connect to national identity. The "moveable do" tonic sol-fa system, highly developed in English choral training, and the use of rhythmic duration syllables, developed by music theorist Emile Chevé, were both advocated by Kodaly as tools for teaching musical literacy. Hand signs adapted from John Curwen provide a visual representation of pitch. Teachers can use these techniques to provide aural, visual, and kinesthetic experiences of musical elements. The Kodály approach uses the pentatonic scale extensively in the early stages of musical development because of its predominance in folk music and absence of half-steps, aiding the development of accurate intonation. Rhythmic, melodic, and metric elements are extracted from the literature, sequentially arranged from simple to complex, and then methodically prepared, presented, and practiced. Music Therapy Applications Kodály’s belief that music is for all children aligns very well with music therapy philosophy. The Kodály approach is ideal for music therapists who work in school systems or collaborate with music educators to adapt music curricula for children with special needs, as well as for music therapists in private practice who provide adapted music lessons. The developmental approach and multisensory experiences that make up the Kodály approach make music learning accessible to those with

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special needs. Goals that can be addressed by music therapists through the Kodály approach include improving perceptual-motor skills, temporal and spatial abilities, language and social skills, and general cognitive skills. The Kodály curriculum includes a sequential process to teach children “sound before symbol.” During preparation, children are exposed to varied and multisensory experiences of musical concepts through songs and activities. In the next phase, the musical elements are made conscious and children are guided through discovery of the musical concept. During reinforcement, children go back to songs learned previously and identify the musical concepts and gain more practice. During assessment, the child applies what he or she has learned to new songs and improvisations. The sequential strategies can be adapted and presented at the appropriate pace for any given client or group and can be used to shape client behavior. The reinforcement and assessment phases mirror techniques that music therapists already use in their practice. Example 7447,Demonstration_Lesson_with_the_children_of_th e_Bocskai_Nursery_School_Kecskemet

Watch video Kodály'Pedagogy'

References Brownell, M. D., Frego, R. J. D., Kwak, E. M., & Rayburn, A. M. (2008). The Kodály approach to music therapy. In A. A. Darrow (Ed.), Introduction to Approaches in Music Therapy (2nd ed., pp. 37-46). Silver Spring, MD: American Music Therapy Association. About the Author Kelly Foster Griffin is a National Board Certified Teacher and received her Kodály certification from Kodály Musical Training Institute, University of Hartford, and her MA Mus. Ed with Kodály Emphasis from Holy Names University. Contact:


Who and Where? The Dalcroze Society of America (DSA) has an Executive Board with five officers, as well as an Advisory Board and several committees. There are seven regional chapters around the United States. This not-for-profit organization was incorporated in Pittsburgh, PA in 1974. It currently has about two hundred members. The mission of the Dalcroze Society of America is to promote the artistic and pedagogical principles of Émile Jaques-Dalcroze (1865-1950) through educational workshops, publications, financial and consultative assistance, and the support of local chapters. In the Beginning... Émile Jaques-Dalcroze began questioning conventional teaching methods when, at the age of 21, he spent a season in Algeria conducting an orchestra of native musicians. In 1892, while a professor of solfege at the Geneva Conservatory, he observed that his students could display technical proficiency and imitate their teachers’ interpretations of written compositions, but had difficulty initiating musical impulses, playing expressively, and even keeping a steady beat. In response, Jaques-Dalcroze systematized the kinesthetic study of music through rhythmic movement and improvisation, building on his earlier encounters with the expressive cultures of non-Western peoples. In the years between 1903 and 1910 he attracted some attention by giving demonstrations of his “Rhythmic Gymnastics” throughout Europe and Russia. In 1911, Jaques-Dalcroze founded a school in Hellerau, where he refined his pedagogical methods and mounted innovative theatrical productions informed by the aesthetic principles he had developed. It was the latter “festivals,” especially, that had the most profound affect on his reputation, drawing audiences that included many of the leading thinkers of the day, including Rudolf von Laban, Darius Milhaud, Serge Rachmaninoff, Rainer Maria Rilke, and many others. By the time he left Germany in 1914, his work had created an international sensation. The following year, he founded the Institute Jaques-Dalcroze in Geneva, where he continued to develop fresh applications of his approach until his death in 1950. The school continues to train new instructors who have, in turn, established training schools around the world. imagine 5(1), 2014

Purpose and Goals The DSA welcomes musicians, actors, therapists, and artist-educators to the small, yet thriving, community of practice in the United States that sustains the artistic and pedagogical methods of Émile Jaques-Dalcroze. Profile of Clients Certified Dalcroze teachers work in conservatories, universities, public and private schools, early childhood programs, and private studios. The Dalcroze approach is studied by performers, teachers, dancers, actors, young children, and senior citizens. There are three credentials offered in Dalcroze Education: the Certificate, the License, and the Diplôme Supérieur (a doctoral equivalent). Training centers are located in Denver, CO; Cambridge, MA; New York, NY; Scarsdale, NY; Bethlehem, PA; Pittsburgh, PA, and Seattle, WA. Each sets its own standards for teacher certification, administers its own examinations, and has its own fee structures. Services and Products The DSA promotes the Dalcroze approach through educational workshops and conferences, publication of the American Dalcroze Journal, financial and consultative assistance for local chapter activities and through scholarships for Dalcroze training, and the support of local chapters throughout the United States. The DSA represents American Dalcroze practitioners and provides members with ways to participate at the local, regional, and national level through committees and task forces that are actively involved in promoting Dalcroze education. Key Concepts of the Program The three components of the Dalcroze approach, often called Eurythmics, are solfège rhythmique (ear training), improvisation, and eurhythmics. Dalcroze solfège uses the fixed-do approach and is always combined with 104

rhythm and movement. Students learn to improvise movement first, before improvising musically and on instruments. Improvised performances help to improve response time, communication accuracy, and spontaneity of expression. Eurhythmics consists of participants moving purposefully and spontaneously to music that is usually improvised on the piano. Partner and small group activities are used in sequential lessons to teach the various elements of music, to cultivate good ensemble skills, and to promote social engagement. Dalcroze practitioners are trained to use exercises and games that feature improvised music and movement. In their training, they also learn how to attune their vocal and instrumental improvisations to their clients’ and students’ physical actions. The practitioner can then exert an influence over listeners’ attention, directing it to specific events in the music as obvious as changes in tempo or dynamics or as subtle as the nuanced inflections that distinguish one kind of skipping rhythm from another. Participants have multiple sensory-motor experiences with specific musical elements before learning the theoretical concepts and notational symbols used to represent them. Music Therapy Applications Jaques-Dalcroze was a proponent of adapting curriculum to the individual and using music as a way to educate the whole child, mirroring many music therapy philosophies. His initial idea to train conservatory musicians was expanded to the music education of young children and those with special needs. He believed that sensory experiences and kinesthetic learning were vital for the learning process. The portion of the Dalcroze hierarchy that incorporates hearing to moving to feeling to sensing to analyzing can be translated into goals set by music therapists. By tapping into the power of physical movement, the Dalcroze approach offers therapists a set of tools for bringing their clients to higher levels of musical understanding and skill. The Dalcroze experience satisfies our instinctual desire to move in synchrony with others and find our place in a community. Eurhythmics also has the ability to improve self-regulation and interpersonal attunement (Foolen, 2012). Music therapists have used eurythmics to address goals such as body and spatial

awareness, self-expression, improving mental alertness and attention, fostering creativity and imagination, fostering peer acceptance and group inclusion, and to provide relaxation experiences. Example

Watch video Dalcroze Eurhythmics class

References Black, J. and Moore, S. (2003). The Rhythm Inside: Connecting Body, Mind and Spirit Through Music. Van Nuys, CA: Alfred Music. Foolen, A., Lüdtke, U. M., Racine, T. P., & Zlatev, J. (2012). Moving ourselves, moving others: Motion and emotion in intersubjectivity, consciousness and language. Amsterdam: John Benjamins Publishing Company. Frego, R. J. D., Liston, R. E., Hama, M., & Gillmeister, G. (2008). The Dalcroze approach to music therapy. In A. A. Darrow (Ed.), Introduction to Approaches in Music Therapy (2nd ed., pp. 25-36). Silver Spring, MD: American Music Therapy Association. About the Author Current President of the Dalcroze Society of America, William R. Bauer, Ph.D. teaches music full time at City University of New York’s College of Staten Island and is a member of the CUNY Graduate Center’s musicology faculty. Dr. Bauer holds the Dalcroze License and Certificate. Contact:

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Orff Schulwerk is primarily targeted at the musical development of children in music education settings. The approach has been expanded for work with adults and older adults in wellness or community music settings and adapted for use in music therapy settings focusing on therapeutic outcomes.

The American Orff-Schulwerk Association is a professional organization of educators dedicated to the creative music and movement approach developed by Carl Orff and Gunild Keetman. In the Beginning… Carl Orff’s Schulwerk was first developed in the 1920s with colleague Dorothee Gunther at the Guntherschule in Munich, Germany, a school that trained young adult women. As the school’s music director, Orff focused on improvised music. Gunild Keetman, a student at the school, collaborated with Orff to develop an elemental style of music-and-movement education. After the Guntherschule was destroyed in World War II, Orff and Keetman adapted their approach to teaching via radio broadcasts targeting children in German schools. Music from these broadcasts was originally published in the 1950s in a five-volume collection, Orff Schulwerk: Music for Children. This publication is a model for creating improvisatory elemental music with children in the classroom. Who and Where? The American Orff-Schulwerk Association (AOSA) was founded in Muncie, Indiana in 1968 by a small group of elementary music teachers. From that core group of ten, the Association has grown to a current membership of over 3000 with headquarters now located in Chagrin Falls, Ohio. AOSA has an Executive Director and Board of Trustees with Regional Representatives for each of the six geographic regions encompassing 96 local chapters. Purpose and Goals AOSA’s mission is to demonstrate the value of Orff Schulwerk and promote its widespread use, support the professional development of its members, and inspire and advocate for the creative potential of all learners. Profile of Clients

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Professional development is a key focus of the American Orff-Schulwerk Association and includes an annual national conference, workshops hosted by local chapters, advanced training through three levels of certification, and Master Classes. Certification is not required to use Orff Schulwerk in the classroom but it can provide a deeper understanding of the philosophy behind the approach, the process, and how to create orchestrations adaptable for the participant’s setting. The cost of these opportunities varies based on the level of professional development being provided and by whom. Graduate credit may be granted for attendance at workshops or certification courses at additional cost. Services and Products AOSA’s primary focus is to support the creative movement and music approach of Carl Orff and Gunild Keetman. Orff Schulwerk is not a predetermined curriculum but instead an approach. The implementation of the process is left to the individual teacher, with the intent that the material and foci are developmentally and culturally relevant to the learner. A specified curriculum for the teacher education certification courses ensures consistency across training sites. Professional development is made available at conferences, local workshops, and teacher training courses. AOSA publishes the peer-reviewed journal, The Orff Echo, as well as Reverberations which is an online journal that focuses on best practices of Orff Shulwerk. An extensive video library, available digitally, includes concurrent sessions from AOSA Professional Development conferences. Key Concepts of the Program Schulwerk means “schoolwork” or “learning by doing.” Orff Schulwerk is an approach to music and movement education that is based in play. It is intended to be an active and creative modality for all children that targets both conceptual and aesthetic development.


Through speech, singing, movement, body percussion, drama, and instrument play, children develop skills in spontaneous exploration, improvisation, and creation. The approach initially focuses on hearing and doing. Reading and writing music occurs later; the approach uses poems, rhymes, games, songs and dances that are either traditional of the culture or original. Orff instruments (glockenspiels, metallophones, and xylophones) provide a pleasing musical quality and offer development of ensemble participation. The emphasis is on the process of the music experience rather than on the product or performance. It is assumed and expected that each participant will engage at his of her own level. Learning occurs during an interaction between the leader and the students in an environment that encourages risk taking and participation in developmentally appropriate creative tasks. Music Therapy Applications Based on the Orff Schulwerk approach, Orff MT was developed by Gertrud Orff in clinical settings with children with developmental disabilities in Germany. She believed that clients would learn to interact with their environment through positive experiences playing and moving to music (Orff, 1989). She viewed four factors as essential to adaptation of the Schulwerk to music therapy: 1) music defined as inclusive of word, sound and movement (elemental music); 2) structured and free improvisation; 3) a diverse instrumentarium (including glockenspiels, metallophones, and xylophones); and 4) multisensory aspects of music (Voigt, 2003). The focus on adaptability and creativity is inherent in the Orff Schulwerk process and supports the flexibility and responsiveness needed in music-based interventions for therapeutic outcomes. The process is a series of steps through which the leader guides participants to reach goals. Experience begins with the simple and moves to the more complex. The process is intended as discovery learning, with opportunities for expression being guided by spontaneity, experimenting, making decisions, and offering suggestions. Several aspects of the Schulwerk naturally support music therapy: allowing everyone to participate, beginning at the individual’s current developmental level, using a multi-sensory approach, moving from experiential to conceptual, designing success-oriented experiences, using

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culturally specific material, viewing rhythm as a foundation, and focusing on process rather than product (Colwell, 2013). The Orff approach to music therapy can bring diverse music-based intervention strategies to clinicians working in various settings. It engages the client in singing, saying, moving, and playing as is developmentally and therapeutically appropriate. The Orff process is inherently adaptable to a range of therapeutic outcomes, as the building blocks of the approach – that is the basic elements of music (pitch, timbre, texture, harmony, rhythm, tempo, contour, lyrics, style and form) – are easily adjustable, informed by individual client needs and clinical research. Example

Watch video Orff Schulwerk

References Colwell, C. M. (2013). Orff Music Therapy. Entry in International Dictionary of Music Therapy. Oxford, UK: Routledge Press. Orff, G. (1989). Key Concepts in the Orff Music Therapy. Translated by Jeremy Day and Shirley Salmon. London: Schott. Voigt, M. (2003). Orff Music Therapy-An overview. Voices: A World Forum for Music Therapy. Retrieved from 134/110 About the Author Cindy Colwell, Ph.D., MT-BC is the Director of Music Therapy at the University of Kansas. She is a past President of the Kansas Orff Chapter and holds her three levels of Orff certification. Contact: 107

ideas What’s on the Mat: Traveling and Exploration

instruments, engage him/her in music play. 3. Move to the opposite side of the mat and repeat steps 1-2. Adaptations

Mary Brieschke, MT-BC Chris Evert Children’s Hospital Fort Lauderdale, Florida

Move instruments farther away from the child. Set up “stations” with other materials on all sides of mat; use the song to transition to the “stations.”

Description The purpose of this song intervention is to encourage infants to use movement to explore their environment. Goals to provide opportunities for environmental orientation to reinforce the action of rolling over/crawling to encourage music play Behavior Observation The child will: orient toward the sound source roll/crawl to side of the mat where music is playing explore instruments provided on side of the mat Materials Play mat (or blanket) Various instruments appropriate for infants (e.g., shakers, quackers, jingles) Directions 1. Place infant in center of a play mat and set various instruments on two opposing sides of the mat. 2. Sing the song and play instruments from one side of the mat while encouraging the infant to move towards the instrument. When the infant reaches the

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What’s on the Mat? Recorded 2014 by Mary Brieschke

About the Author Mary Brieschke, MT-BC, Alumni of the University of Louisville, currently works at Chris Evert Children’s Hospital in Florida. Contact:


Start singing the song and model dance moves. 4. Continue through the verses and invite all children to dance in the middle when their color is sung about. 5. Repeat until all the colors have “danced out” again, then proceed to the ending of the song. 3.

Adaptations Have children get up and dance only when their scarf's color is called. Have children trade scarf colors throughout.

Groovin’ with My Scarf: Expressive Movement & Recognizing Colors Christopher R. Millett, MT-BC University of Kentucky Lexington, Kentucky Description The purpose of this intervention is to encourage color identification, turn taking, and expressive movement through dancing. Goals to increase expressive movement to support turn-taking to improve color identification Behavior Observation The child will: move expressively through dancing with a scarf wait his/her turn to dance in the middle identify the color of the scarf Materials Instrument (e.g., guitar or piano) Various colored scarves Directions 1. Introduce activity by laying out scarves and asking children to pick up their favorite color. 2. Prompt the children to stand up.

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Groovin’ with my Scarf Recorded 2014 by Chris Millett

About the Author Chris Millett, MT-BC is a graduate of the University of Louisville. Currently he is a graduate assistant at the University of Kentucky and works part-time for Louisville Music Therapy, LLC.



the group watches for the child’s nonverbal cues indicating the end of his/her solo. 4. Wait for eye contact from all children before beginning the second portion of the song as a group. 5. Repeat so that all children get a turn playing the solo.

Drum Together: Improving Joint Attention Ashley Miller, MT Student University of Louisville Louisville, Kentucky

Adaptations Use a different instrument, such as a shaker, and change lyrics accordingly (e.g., “shake together”). Use intervention in an individual session by taking turns soloing with the child, giving him/her the opportunity to respond to nonverbal cues and give nonverbal cues. Depending on age/ability level, adjust the level of verbal and nonverbal prompting to structure the group for success.

Description The purpose of this intervention is to promote development of joint attention skills. Designed for implementation within a group music therapy setting, the melody for the intervention song is an adaptation of Come Together by the Beatles. Goals to promote following cues to enhance initiation of social interaction to facilitate social reciprocity Behavior Observation The child will: respond to nonverbal cues regarding when to play give nonverbal cues to let peers know when to play play a drum solo of appropriate length Materials Table drum (or large gathering drum) Directions 1. Introduce the song initially without the drum; encourage children to listen to the directions. 2. Play a steady quarter note beat on the drum as a group and sing the first portion of the song, inserting one child’s name into the blank. 3. Let that child play a solo in the break while the rest of

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Drum Together Recorded 2014 by Ashley Miller

About the Author Ashley Miller is a senior music therapy student at the University of Louisville in Louisville, Kentucky. Contact:


Directions 1. Have children stand in a circle around you. 2. Chant and play the first verse of the drum game. While children follow the directions, model and improvise a drum beat to allow children time to imitate and interact. 3. Repeat each verse in a similar fashion. 4. During the final verse, encourage children to sit down. Adaptations Instead of using a drum, join children in the circle and chant the song. Vary drumming dynamics or invite a child to drum along.

Circle Dance: Imitation and Social Interaction Lindsay Foster, MT Student University of Louisville Louisville, Kentucky

Description The purpose of Circle Dance is to encourage children to imitate gross motor movements and engage in social interactions with peers through a drum game. Goals to increase gross motor movement to increase imitation skills to increase social interaction Behavior Observation The child will: follow the directions embedded within the song improvise with the leader when it is his/her turn stop playing and return to her/his seat when instructed to do so

Circle Dance Recorded 2014 by Lindsay Foster

About the Author Lindsay Foster is a senior music therapy student at the University of Louisville in Louisville, Kentucky. Contact:

Materials Drum (e.g., djembe)

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Directions 1. Have children sit in a circle and introduce the “Roly Poly” (i.e., Hoberman Sphere) by singing the chorus of the song. 2. Demonstrate expanding and reducing (i.e. making larger and smaller) the Hoberman Sphere. 3. Introduce some of the colors of the Hoberman Sphere and let children fill in. 4. Roll the “Roly Poly” to each child as you sing the third verse of the song. Adaptations Sing melody on syllable “la” to introduce the music first. Encourage children to come up with other ways to use the Hoberman Sphere.

Roly Poly: Addressing Developmental Goals Ellen Trammel, MT Intern University of Louisville Louisville, Kentucky Description The purpose of Roly Poly is to address several developmental areas using the Hoberman Sphere. Goals to increase attention to task to encourage social interaction skills to practice academic concepts (i.e., colors, opposites)

Roly Poly Recorded 2014 by Ellen Trammel

About the Author

Behavior Observation The child will: attend to task as prompted through the song participate in turn-taking with the leader and peers address academic concepts presented in song

Ellen Trammel is a music therapy intern at the University of Louisville. She expects to graduate in the summer of 2014 with her Bachelor's in Music Therapy.

Materials Hoberman Sphere (small ball-size)


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Adaptations Add different body parts to the first verse, ending with ‘nose’ to keep the rhyme. Sing about changing tempo instead of body parts (e.g., I can play real fast, I can play real slow).

It’s Your Turn: Teaching Children Social Language Beth McLaughlin, LCAT, MSE, MT-BC Wildwood School Schenectady, New York Description The purpose of It’s Your Turn is to teach young children appropriate social language to use when engaging a peer in turn-taking. Goals to pass instruments to a peer to use appropriate social language Behavior Observation The child will: engage in instrument play/stop playing according to lyrics and musical cues complete the phrase ‘Here ____ it’s your turn’ while passing the instrument to a peer Materials Set of hand percussion (e.g., sticks or maracas) Directions 1. Sit children in a circle. 2. Sing the song and model playing the instrument. 3. At the appropriate point in the song, pass the instrument to the next person in the circle while modeling the appropriate language as per the song lyric.

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It’s Your Turn Recorded 2014 by Beth McLaughlin

Note: Song adapted with permission from I Know How it Goes by Elizabeth Schwartz. About the Authors Beth McLaughlin, LCAT, MSE, MT-BC is coordinator of music therapy services and internship director at Wildwood School in Schenectady, New york. She is a regular contributor to imagine and a frequent presenter on music therapy in special education and early childhood. Contact:


Directions 1. Introduce upper and lower case H by showing visual examples of printed letters and modeling the beginning sound. 2. Show pictures for the words hello, happy, hippopotamus, and hooray and demonstrate the sign or action that goes with it. 3. Wave for hello, sign for happy (i.e., upward motion with fingertips on chest), shake hips for hippopotamus, and hand high in the air for hooray. 4. Sing the song and ask the children to sing and move as directed.

Hooray for letter H! Brenda Calovini, MA, MT-BC Private Practice Cleveland, Ohio

Adaptations Announce that when they hear a word that starts with H, they will jump up and shout, “hooray!” followed by the singing of Ha Ha This Away (adapt words). Mix in words that do and do not start with H so that children can practice listening for the beginning H sound.

Description The purpose of this activity is to introduce the letter H and encourage children to use pre-literacy skills by listening for, moving to and singing words that begin with letter H. Goals to reinforce the connection between word and letter to identify the beginning letter of a word to practice producing the sound of letter H Behavior Observation The child will: move in a particular way for the words “hello,” “happy,” “hippopotamus,” and “hooray” name pictures or actions that begin with the letter H Sing words that start with H Materials Pictures to depict action, feeling, or animal that begin with the letter H. ( e.g., waving hand to depict “hello,” smiley face for “happy,” hippopotamus, cheering crowd for “hooray!”) Instrument for accompaniment

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Hooray for letter H! Recorded 2014 by Brenda Calovini

About the Authors Brenda Calovini has been a music therapist for Toddler Rock at the Rock’n Roll Hall of Fame in Cleveland, OH for the past ten years. She is currently an adjunct supervisor for music therapy students at Cleveland State University. Contact:


Directions 1. Face a partner and sing the first two body part names of “Head Shoulders 1, 2, 3,” while touching your own head and shoulders with both hands. On “1,”extend your right hand diagonally in front of you to clap your partner’s right hand. Repeat on “2” with your left hand to your partner’s left hand and on “3” simultaneously clap both your partner’s hands. 2. Sing and demonstrate the 2nd verse “Shoulders Knees” and repeat steps as above. 3. Proceed to the third and optional verse, or ask children to name other body parts for inclusion in the song.

Head Shoulder 1, 2, 3 Ruthlee Figlure Adler, MT-BC Private Practice Bethesda, Maryland

Description The purpose of Head Shoulders 1, 2, 3 is to address many developmental areas while engaging children in repetitive song lyrics and body movements. Goals to identify body parts and improve body awareness to increase social interaction to encourage communication (verbal and nonverbal) to increase attention and memory Behavior Observation The child will: touch the correct body part following song lyrics observe and imitate another’s actions participate in singing and interacting with a partner follow directions in response to auditory/visual/ kinesthetic cues Materials Repetitive song chant (i.e., “Head Shoulders 1, 2, 3”)

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Adaptations If crossing the midline for partner opposite hand claps on “1” and “2” is too difficult for a child, mirror clapping the child’s left hand with your right hand, etc. When children have mastered the lyrics and movements with you, they may repeat the experience with a peer/partner.

Head Shoulders 1,2,3 Head Shoulders 1,2,3 (repeat) Shoulders Knees 1,2,3 (repeat) Knees Toes 1,2,3 (repeat) Optional verses: Repeat above sets in reverse order (e.g., Toes, Knees 1,2,3. Then, continuing to original verse and end with “That’s All, 1,2,3” (repeat).

About the Authors With over 50 years of passionate commitment to music therapy, Ruthlee Adler, MT-BC now maintains a part-time private music therapy practice/consultancy for variouse ages and populations in Bethesda, Maryland. Contact:


color of us Color of us at the 14. World Congress of Music Therapy in Vienna/ Krems, Austria The color of us series started at the 12. World Congress of Music Therapy in Buenos Aires, Argentina. This year’s roundtable, organized and moderated by Dr. Petra Kern, featured colleagues from Denmark, Finland, Greece, Poland, UK, and Austria. Presenters highlighted cultural diversities, trends and perspectives of providing music therapy services for young children and their families in Europe. The video clip provides a snapshot of the event.

Watchvideo videosnapshot snapshotofofthe thecolor colorof ofus us Watch Roundtable2014 2014 Roundtable

Exclusively for imagine, presenters oered their personal perspective on the following three questions:

1. What do you enjoy most about working with young children?

Video edited and produced by Dr. Petra Kern, Ph.D., MTBC, MTA, DMtG, imagine editor-in-chief

2. What are the current trends in music therapy and early childhood in your country? 3. What do you think the future hold for early childhood music therapy in your country?

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Interviews conducted and transcribed by Rose Fienman, MSW, MT-BC, imagine editorial assistant.


Stine Lindahl Jacobsen, Ph.D. Head of Music Therapy Program Aalborg University, Denmark

1. I enjoy their immediacy. Children are just so open with their feelings and their actions and it is just very life confirming. 2. For many years, we had a focus on children with Autism Spectrum Disorder (ASD) and Developmental Disabilities. However, the new trends are working with the families at-risk and in neonatal intensive care – nurses are discovering research and inviting music therapists in. Also, there are now refugees of all ages. The majority has historically been older, but now there are also young children. However, there are not so many music therapists in Denmark, so it is difficult to expand the profession. 3. There is some dialogue between university and government on whether they should recommend music therapy for children with (ASD), but the government thinks the research may not be strong enough. What would really help is if it was recommended by the government. In the future, I hope they do something for the field and the children and families. Kirsi Tuomi, Music & Theraplay Therapist, MPh President of the Finnish Society for Music Therapy

1. I definitely enjoy engaging children in play. They are so alive – I am alive with them as well. Of course, one can see the potential in every child that receives music therapy services. 2. Currently, early childhood music therapy is mostly provided as individual sessions. It is funded by the National Healthcare Institution. Sessions are mostly one time a week for 45 minutes applying psychodynamic and attachment based approaches. 3. Family-centered practice has become well-known by now. I hope there will be a shift from working with individuals only to dyadic and family systemic work. Another trend is using music therapy with pre-term infants; there have been a few training courses offered and excellent research is on its way. As research-based information is expanding, the work will grow.

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Elizabeth Georgiadi, DipMP, PgDipMT President of the Musical Movement Foundation, Athens, Greece

1. I really enjoy working with children because no matter

Krzysztof Stachyra, Ph.D., MT-BC Assistant Professor at Maria Curie-Skłodowska University, Lublin, Poland

1. I used to be afraid of working with young children. My training was not targeting children. Meaning, my first visit in the center for children with disabilities was like entering a different world. I discovered that it is amazing – the potential in music is like a miracle for children. I discovered that the energy of the children influenced my mood and gave me energy as well. 2. The first music therapy training was established in in Poland in 1973, but it addressed mostly theoretical work. One model, called Mobile Music Recreation was created by a music therapist/ medical doctor who developed the framework for this approach. Five to ten years ago, music therapists from abroad started visiting Poland. By now, we have learned about NRMT, Bright Start, and behavioral music therapy. 3. The future is bright! I am optimistic, because the discipline is growing fast. People are more interested in music therapy, and medical doctors are open to alternative treatments. For example, one director of a neonatal unit decided to offer relaxation music for infants and mothers in his hospital. There is also more interest in music therapy for preschoolers and education in general.

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how much they withdraw or demonstrate negative behaviors, you can reach them through music. They show you pure excitement and openness. There is great potential for reaching children in therapy. The significance of early intervention can make a big difference. 2. Music therapy in Greece is in its formative stages. There are few therapists, maybe 50 in total, and very few work in early intervention. Most are qualified as music therapists and have done significant work to promote positive parenting in dyads. 3. The economic crisis has intensified the problem of establishing music therapy because there is minimal funding for early childhood and no trainings in Greece. Therefore, music therapists are not registered or have no standardized regulations. More and more families and organizations are starting to incorporate music therapy in early intervention. A music therapy organization has been started in Greece. There should be a focus on what is the role of music in the development of the child, especially how to use music in everyday life as related to development so there can be an explanation of why using music in therapy is unique to other therapies.


Claire Flower, DipMTh, Ph.D. Candidate Music Therapist at the Chelsea and Westminster NHS Foundation Trust, London, UK

1. There is something special about the liveliness and the

Thomas Stegemann, MD, Dr. sc. mus Head of the Department of Music Therapy, University of Music and Performing Arts Vienna, Austria

potential for growth, change, and development in young chidlren. I love working with families, parents, siblings, the family themselves, and seeing the family grow as the child grows. 2. A lot of work happens in a community based way. Children’s centers, community based groups (babies, toddlers, children and their families), and the more medically based areas (i.e., pediatric and neonatal units). I have to think hard to accurately describe what that practice looks like. 3. The future probably holds more music therapy; at least I think there will be mores services provided. There has been a big emphasis at the government level for early intervention, and part of that is financially driven. That is, put the money in now to avoid putting in money later on. The evidence is that it is good for infants, children and families.

1. Every music therapy session with children is like a journey without knowing where you will arrive at the end. It’s a journey full of adventure and surprise – a challenge and a gift at once. 2. Since the music therapy law came into effect in 2009, music therapy in Austria is expanding and prospering. The collaboration and exchange between the three music therapy training institutes (including the new Ph.D. program at the University of Music and Performing Arts Vienna) is another example of how music therapy continues to thrive in Austria. 3. Thinking about the future of music therapy in Austria, I’m very positive. By the 2016 European Music Therapy Conference in Vienna, we hope that our efforts to reimburse music therapy services in private practice, especially for young children under the Austrian health care system, will be fruitful. Additional information available at Kern, P., Lindahl Jacobsen, S., Tuomi, K., Georgiadi, E., Stachyra, K., Flower, C., & Stegemann, T. (2014). The color of us: Music therapy for young children in Europe. In J. Fachner, P. Kern, & G. Tucek (Eds.). Proceedings of the 14. World Congress of Music Therapy. Special issue of Music Therapy Today 10(1), 256-257. Retrieved from

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Elizabeth K. Schwartz, LCAT, MTBC Raising Harmony: Music Therapy for Young Children Mount Sinai, NY Stopping the Music: Why, When, and How to Discuss Developmental Concerns with Families Knowing why, when, and how to talk with families about the overall development of their child can be a daunting task. This podcast is designed to serve as a guideline for music therapists for initiating or engaging in challenging discussions with parents related to their child’s development.

Friederike Haslbeck Ph.D., DMtG, SFMT University Hospital Zurich, Switzerland Creative Music Therapy in Neonatal Care: Supporting Communicative Musicality from the Very Beginning This podcast introduces results of a qualitative study of Creative Music Therapy (CMT) in neonatal care via two case examples. It demonstrates how CMT offers the potential for premature infants to engage in communicative musicality and to empower parents by supporting the quality of interactions with their infant through music.

Matthew Logan, MA, MT-BC UCSF Benioff Children’s Hospital & Research Center Oakland, California Rachel See, MA, MT-BC Music Therapy Services of Austin Austin, TX Co-treating With SpeechLanguage Pathologists – Before, During, and After the Session This podcast discusses practical tips and considerations for cotreating with speech-language pathologists to maximize client outcomes in medical and community settings.

available at imagine 5(1), 2014


Meredith R. Pizzi, MT-BC Raising Harmony: Music Therapy for Young Children Melrose, MA Supporting Healthy Sibling Development with Music This hands-on podcast shares ideas about using music with parents and young children to enhance the bonds and connections between siblings as families grow.

Laurel Rosen-Weatherford, MM, MT-BC Monroe County Intermediate School District, Monroe, Michigan Let’s Collaborate-A Follow up from 2013 This follow-up podcast features a 30-minute sing-along that focuses on bringing families together to provide learning opportunities beyond the music therapy session. Musical examples can be implemented in the classroom and the family’s home.

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Bill Matney, MA, MT-BC University of Kansas Lawrence, KS

Carol Ann Blank, LCAT, LPC, MMT, MT-BC Drexel University, Philadelphia

Percussion and Drumming: Building Family and Community This engaging podcast addresses music-making experiences and simple percussion techniques that can promote child development and family bonding in the home environment.

Clinical Decision Making in Music Therapy Clinical decision making is an important component of providing music therapy. This podcast shares the author's thoughts about the clinical decisions she makes when working with a mother-child dyad in individual music therapy.

Kathy Schumacher, MT-BC Music Therapy Services, LLC. Ripon, WI

Laura S. Brown, Ph.D., MT-BC Ohio University, Athens, OH

Rhythm, Rhyme, and Remarkable Repetition: An Effective Foundation for Literacy The development of phonological awareness is critical for both learning to communicate and to read. This podcast gives an overview of phonological awareness and illustrates how the skill of rhyming can be taught through music. A brief summary of research supporting the use of music for teaching these skills is included.

Across the Spectrum: Meeting the Needs of High Functioning Clients with ASD This podcast offers suggestions for using original songs with highfunctioning children on the autism spectrum. The songs referenced in this podcast were written and recorded by Elisa Padro, a student at Western Illinois University.


resources Empower Me: Family-Centered Practice Petra Kern, Ph.D., MT-BC, MTA, DMtG Music Therapy Consulting Santa Barbara, California

One of the guiding principles of service delivery for young children with disabilities and their families is family-centered practice. Qualities characterizing family-centered practice encompass strengthbased, collaborative, enhancing, and empowering strategies that provide families with a sense of confidence and competence about their child’s learning and development. Meaning, families and professionals work together in partnership to achieve goals by utilizing services, resources, and supports mutually agreed upon.

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While most early childhood music therapists in the USA are familiar with family-based practice models, colleagues abroad are only starting to consider them. Family-centered music therapy sessions are provided in various music therapy settings including community programs, hospitals, institutes, and the family’s home. As the familycentered practice model is gaining momentum in music therapy practice around the world, it is necessary to know about the benefits and be informed about latest developments. The following resources invite reflection on and encourage continued growth and progress in providing familycentered music therapy services to empower families to manage their own lives effectively while supporting their hopes and dreams for their children. Family-Based Practices DEC Monograph Series No. 5 This classy 2002 collection of articles discusses the values, beliefs, and practices inherent in DEC’s recommended practice definition while providing practical

information and examples of how to implement family-centered practice in early intervention/early childhood special education services. The monograph also emphasizes the understanding of family perspectives and the importance of honoring and supporting cultural differences, values, and languages spoken in each home. Family-Professional Collaboration: Resources FPG Child Development Institute at UNC at Chapel Hill Looking for a compilation of resources? This webpage offers a list of research articles (currently from 2007-2012) that provide evidence for family-centered practice under Why Do It?, selected books, chapters, and articles suggesting strategies for parents and practitioners on how to implement family-centered practice under Read All About It, videos for hands-on illustrations under See for Yourself, and web resources featuring organizations that support family-based practice under Find It Online.


Child Welfare Information Gateway: Family-Centered Practice U.S. Department of Health & Human Services “To build on families' strengths to achieve optimal outcomes,” the U.S. Department of Health & Human Services created a webpage that defines key elements of family-centered practice, provides overarching strategies for implementation across the service continuum, and explains how to engage families and involve them in the decision-making process about the best care for their child. There is also a focus on encouraging communities to support families and how to create a familycentered agency culture that embraces family participation and engagement. Family-Professional Partnerships CONNECT Module 4 FPG Child Development Institute at UNC at Chapel Hill Currently seven online modules are offered for professional development; one addresses family-centered practice. Each module goes through a 5-step process starting with 1) a practice dilemma demonstrated in videos, 2) a PICO question to find the evidence behind the practice, 3) key sources (e.g., definitions, research, policies, and experiencebased knowledge from practitioner and families) to make an informed decision, 4) the decision-making process to plan for implementation, and 5) the evaluation of the plan. This online module is also available in Spanish and can be easily applied to music therapy practice.

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FINE Newsletter Harvard Family Research Project In 2013 the FINE Newsletter highlighted new and innovative approaches to preparing and training educators for family engagement. Participants observed classrooms and searched online to find out how college/university faculty and professional development trainers are supporting current and future educators to learn and practice family engagement techniques through hands-on activities, simulations, online courses, and case-based discussions. Following this initiative, resources for training community outreach workers on different cultural views and norms in the area of family engagement are in the planning stages. Parent Engagement Child Care & Early Education Research Connections This site features Topics of Interest highlighting newly released research, policies, and topic-related resources. In 2014, the site spotlighted recent review of research on a) the role of parents’ engagement in promoting academic learning of young children, b) parent engagement in the context of Head Start programs, and c) the quality of relationships between families and early care and education providers. The outcomes of this evolving body of research resulted in a recent policy brief describing models, state initiatives, and policy strategies to strengthen parent engagement from preschool to grade 3.

National Resource Center for Family-Centered Practice Located at the University of Iowa School of Social Work, this center promotes family-centered, community-based, culturally competent practice within organizations and across systems. The National Resource Center offers training and technical assistance in family-centered practice such as Family Centered Assessment Training, StrengthBased Case Planning, Family Group Decision Making: A Decision Model that Strengthens Families, and Welcoming Fathers into the Circle of Family Centered Practice. An online curriculum for familycentered practice and a certification program are provided as well. The resources and related links section of the website offers reports, publications, presentations, and project descriptions and outcomes. Center for Parent Information and Resources Based on the idea of familycentered practice, this fairly new website quickly has become a hub for parents and professionals alike. Under the presently 14 priority topics listed, practitioners and families can find fact sheets on disabilities transferred from NICHCY, information related to parent-centered practice, and other valuable resources. The intention of this site is to provide products and material that support the work with families, to increase parents’ knowledge and capacity in specific domains, and to increase the coordination of parent training efforts.


Music Therapy with Families Network At the 2013 European Congress of Music Therapy in Oslo, Norway, four music therapists from around the world (i.e., D. Thomas, UK; K. Tuomi, Finland, P. Kern, USA, and G. Thompson, Australia) discussed in a roundtable the benefits of a worldwide Music Therapy with Families Network. Over the past year, a LinkedIn Group served as a platform for the exchange of resources. As of September 2014, the group migrated to a closed Facebook Group with monthly discussion themes. Professional music therapists are invited to join.

ECMT Network AMTA’s Early Childhood Music Therapy Network provides a platform for information exchange, discussion, and support for music therapists working with young children and their families. During the annual meeting and at the ECMT Network Facebook Group, members are exchanging current trends and topics of interest including family-centered practice. As a contribution to the Music Therapy with Families Network, imagine 5(1) 2014 has been dedicated to family-centered practices, which is reflected in the articles and podcasts of the issue.

About the Author Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting is online professor at the University of Louisville, serves as editor-inchief of imagine and on AMTA’s Priority on ASD’s Steering Committee. Her research and clinical focus is on young children with ASD, inclusion programming, and educator/parent coaching. Contact:

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Follow Me: Connecting to the Early Childhood Community on Twitter Rose Fienman, MSW, MT-BC Arts & Services for Disabled, Inc. California State University, Northridge, Los Angeles, CA Music therapists are raising their online profiles across social media, and Twitter is no exception. With many individuals, organizations, and companies tweeting and retweeting posts, it can be tricky to locate information that is relevant to clinical work in early childhood education. However, if knowing where to look, Twitter can be a valuable resource for quick ideas and concise information. With a limit of 140 characters, busy music therapy practitioners may even have time to read a few items during a full day of sessions. The following is a list of selected Twitter handles that provide solid information related to early childhood. @NAEYC Informative tweets published by the National Association for the Education of Young Children (USA), the largest organization working solely on behalf of young children.

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@ECMMA This handle belongs to the Early Childhood Music and Movement Association. Their mission is centered on promoting best practices for using music and movement with children from birth through age seven. They often tweet links to articles and blog posts. @TEC_Center The TEC Center provides information regarding the use of technology with young children. This is a great resource for early childhood practitioners in multiple disciplines as they share articles about the use of technology with young children. @YellowDoorUS This handle provides information on multisensory teaching resources, as well as interesting articles related to educating children from early childhood through first grade. @EarlyYearsEW This account regularly tweets articles from the Early Years in Education Week's early-childhood education blog. @FredRogersCtr Based on the work of everyone’s favorite neighbor, Fred Rogers, this organization is interested in advancing the fields of early learning and children’s media through communication, collaboration, and creative change. Their tweets are a diverse mix of articles about early childhood topics and ideas for working with young children.

@sesamestreet The account associated with the long-running children's television program tweets fun pictures and videos starring the residents of Sesame Street and their celebrity guests, as well as games and ideas for activities appropriate for young children. @imagineECMT The account associated with imagine Early Childhood Online Magazine strives to supply useful information about the magazine, including articles and deadlines, as well as retweets of relevant information. If there are other handles that are valuable to early childhood music therapist, please tweet us @imagineECMT. About the Author Rose Fienman, MSW, MT-BC, imagine editorial team member is a Program Director with Arts & Services for Disabled, Inc., and the WFMT Chair of the Public Relations Commission. She also practices at the Music Therapy Wellness Clinic at California State University, Northridge, where she supervises undergraduates completing fieldwork placements. Contact:


publications New Publications 2013-2014 Compiled by Petra Kern, Ph.D., MT-BC, MTA, DMtG Editor-in-Chief, imagine and Christopher R. Millett, MT-BC Graduate Assistant, University of Kentucky

This list features a selection of publications related to early childhood music therapy released in 2013-2014. Allen, K. A. (2013). Music therapy in the NICU: Is there evidence to support integration for procedural support? Advances in Neonatal Care, 13(5), 349-352. Bronwyn S., Fees, M. K., Holmberg, T., Teagarden, J., & Delreal, D. (2014). Children’s responses to a social story song in three inclusive preschool classrooms: A pilot study. Music Therapy Perspectives. First published online June 23, 2014. doi:10.1093/mtp/ miu007 Chorna, O. D., Slaughter, J. C., Wang, L., Stark, A. R., & Maitre, N. L. (2014). A pacifier-activated music player with mother’s voice improves oral feeding in preterm infants. Pediatrics, 133(3), 462-468. Cominardi, C. (2014). From creative process to transcultural process: Integrating music therapy with arts media in Italian kindergartens: A pilot study. The

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Australian Journal of Music Therapy, 25, 3-14. Creighton, A. L., Atherton, M., & Kitmura, C. (2013). Singing play songs and lullabies: Investigating the subjective contributions to maternal attachment constructs. The Australian Journal of Music Therapy, 24, 17-44. Dastgheib, S. S., Riyassi, M., Anvari, M., Niknejad, H. T., Hoseini, M., Rajati, M., Ghasemi, M. M. (2013). Music training program: A method based on language development and principles of neuroscience to optimize speech and language skills in hearingimpaired children. Iranian Journal of Otorhinolaryngology, 25(2), 91-97. Dezfoolian, L., Zarei, M., Ashayeri, H., & Looyeh, M. Y. (2013). A pilot study on the effects of Orff-based therapy music in children with Autism Spectrum Disorder. Music and Medicine, 5(3), 162-168. Forrest, L. (2014). Your song, my song, our song: Developing music therapy programs for a culturally diverse community in home-based pediatric palliative care. The Australian Journal of Music Therapy, 25, 15-27. Hartling, L., Newton, A. S., Liang, Y., Jou, H., Hewson, K., Klassen, T. P., Curtis, S. (2013). Music to reduce pain and distress in the pediatric emergency department: A randomized clinical trial. JAMA Pediatrics, 167(9), 826-835. Kern, P. (2014). Music Therapy: Personalized Interventions for Individuals with Autism Spectrum Disorder. In V. Hu (Ed.), Frontiers in Autism Research: New Horizons for Diagnosis and Treatment, pp. 607-625. Singapore: World Scientific Publishing Company.


Kern, P., Humpal, M., Whipple, J., Martin, L., Snell, A. M., Walworth, D., Carpente, J., Lim, H., & Wakeford, L. (2014). Good, better, best: Recommendations on evidence-based practice for children with autism spectrum disorder. In J. Fachner, P. Kern, & G. Tucek (Eds.). Proceedings of the 14. World Congress of Music Therapy. Special issue of Music Therapy Today 10(1), 254-255. Retrieved from http:// Kern, P., Lindahl Jacobsen, S., Tuomi, K., Georgiadi, E., Stachyra, K., Flower, C., & Stegemann, T. (2014). The color or us: Music therapy for young children in Europe. In J. Fachner, P. Kern, & G. Tucek (Eds.). Proceedings of the 14. World Congress of Music Therapy. Special issue of Music Therapy Today 10(1), 256-257. Retrieved from http:// Kwak, E. E., & Kim, S. K. (2013). The use of rhythmic auditory stimulation in gait habilitation for children with cerebral palsy. Music Therapy Perspectives 31(1): 78-83 .doi:10.1093/mtp/31.1.78 LaGasse B. A., & Hardy, M. W. (2013). Considering rhythm for sensorimotor regulation in children with autism spectrum disorders. Music Therapy Perspectives 31(1): 67-77. doi:10.1093/mtp/31.1.67 Loewy, J., Stewart, K., Dassler, A. M., Telsey, A., & Homel, P. (2013). The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics, 131(5), 902-918. Maguire, D. (2014). Care of the infant with neonatal abstinence syndrome: strength of evidence. Journal of Perinatal and Neonatal Nursing, 28(3), 204-211. Malloch, S., Shoemark, H., Crncec, R., Newnham, C., Paul, C., Prior, M., & Burnham, S. (2012). Music therapy with hospitalized infants: The art and science of communicative musicality. Infant Mental Health Journal, 33(4), 386-399. McNair, C., Campbell, M., Johnston, C. (2013). Nonpharmacological management of pain during common needle puncture procedures in infants. Clinics in Perinatology, 40(3), 493-508. O’Callagan, C., Dun, B., Baron, A., & Barry, P. (2013). Music’s relevance for children with cancer: Music therapists’ qualitative clinical data-mining research. Social Work in Health Care, 52(2-3), 125-143. Parsons, C. (2012). Augmentative and alternative communication during music therapy sessions with

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persons with Autism Spectrum Disorders. Journal of Clinical Practice in Speech-Language Pathology, 14(2), 105. Swedberg Yinger, O. (2014). Graduate research award: Music therapy as procedural support for young children undergoing immunizations: A randomized controlled study. Music Therapy Perspective 31(2), 157-258. doi:10.1093/mtp/31.2.157-a Tucquet, B., & Leung, M. (2014). Music therapy services in pediatric oncology: A national clinical practice review. Journal of Pediatric Oncology Nursing, July 15, 2014 Thompson, G. A., McFerran, K. S., Gold, C. (2013). Family-centred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child: Care, Health, and Development. doi:10.1111/ cch.12121 Walworth, D. (2013). Bright Start Music. A Developmental Program for Music Therapists, Parents, and Teachers of Young Children. Silver Spring, MD: AMTA. Yinger, O. S., & Colliver, A. (2014). Procedural support music therapy for pediatric patients. In Yinger, O. S., Walworth, D., & Gooding, L. (2014). Procedural support music therapy: A guide to evidence-based practice and program development (pp. 20-37). Saarbrücken, Germany: Lambert Academic Publishing.

We invite colleagues from around the world to send their early childhood music therapy references for future inclusion in this annual list.


reviews program are appropriate for both typically developing children and children demonstrating delays in development. The introduction begins with background information on the Bright Start Curriculum and describes the domains covered in the program, which include cognitive, language, motor, and social-emotional. Research on the eects of music in each domain is discussed. Additional research on the benefits of music for caregiver and infant interactions, caregiver mood state, premature infants, and caregiver training is provided.

Walworth, D. (2013). Bright Start Music: A Developmental Program for Music Therapists, Parents, and Teachers of Young Children. Silver Spring, MD: American Music Therapy Association. 480 pages. ISBN 978-1-884914-30-0. $65.00 Bright Start Music: A Developmental Program for Music Therapists, Parents, and Teachers of Young Children by Darcy Walworth contains resources for the Bright Start Music program which was developed through research and clinical work in the early childhood setting. The Bright Start curriculum focuses on enhancing developmental objectives in infants and toddlers through music interventions which are designed for the school setting and parent-child groups. Throughout the book, session plans are broken into three dierent age groups: 6 to 12 months, 12 to 18 months, and 18 to 24 months. The activities and interventions in the Bright Start

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In the first section, general session information and instructions are explained along with the format for session plans. The author explains the advancement of levels in the curriculum; the children are given more independence as they progress. This section also describes how to get started with the Bright Start curriculum for music therapists, parents, and teachers (e.g., instruments and materials needed, location of groups, storage of materials, format modifications, and singing skills). The next section contains twelve session plans for each age group with parent instructions. These plans are designed for 30-45 minute sessions, but abbreviated plans are included for 10-15 minute sessions. Domainspecific session plans for both motor and communication skills are also included. Session plans without parent instruction are also provided, along with recommendations for using the curriculum in hospital


settings (inpatient and outpatient), early intervention settings, and child development centers. The last part of this section focuses on developmental skills addressed in each session plan, giving codes that correspond to specific developmental skills found on the included developmental skill charts and grouped separately by age and domain. The final section of the book includes chords, lyrics, and recordings of all of the songs used in the Bright Start curriculum. The book contains a total of 104 songs, both traditional children’s songs and original songs by various authors. Images are provided that can be used as visual aids during songs. This book provides a well-organized guide to starting, implementing, and maintaining a successful Bright Start Music program for not just music therapists, but for parents and teachers as well. Lyric/chord sheets and recordings allow for easy learning of songs, and the session plan layout makes for structured planning according to domain, age, or length of session.

Includ es CD with o ve 100 so r ngs!

In summary, this book is a practical resource that can help music therapists, parents, and teachers create developmentally appropriate session plans and activities for young children and expand song repertoire. Walworth has created an excellent evidence-based curriculum for using music with young children to enhance developmental objectives. Listen to my audio bookmarks! About the Author Amber Colliver, MT-BC, provides music therapy services to students with special needs in Fayette County Public Schools. She is currently working on her master’s in music therapy at the University of Kentucky. Contact:

Now Available in the AMTA Bookstore: AMTA’s Newest Publication!!!

Bright Start Music

grew out of a need to provide developmental services for premature infants after going home from the hospital. While many parent-infant music groups are available to promote bonding and development, the need to create an inclusion-based, comprehensive developmental program for children at risk for developmental delays became evident. The curriculum is structured to identify specific developmental skills that can be demonstrated, practiced, and mastered through music engagement. Although this program is rooted in the profession of music therapy, the resources in this curriculum can be implemented by early childhood educators or staff working in child care facilities, community groups, or hospitals. The various formats of engagement highlighted in this program provide the user with many options for targeting developmental interactions. All of the developmental skills that can be observed while young children engage in music interactions are outlined, providing a rich resource for anyone interested in specifically targeting developmental skill achievement. Visual aids, suggested materials, chord sheets, and audio files are included to enhance the usefulness of this program. All of the songs used in this curriculum either were written by music therapists or songwriters specifically for use with young children, or are in the public domain. With over 100 songs, this curriculum provides a wide diversity of song choices to use with young children who are constantly moving, growing, and changing!


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$15 discount to current AMTA members


Schumacher, K. (2013). Alphabet Stew and Chocolate Too: Songs for Developing Phonological Awareness, Literacy, and Communication Skills. Music Therapy Services, LLC. Available at http:// products/ 215 pages. $20 Alphabet Stew and Chocolate Too: Songs for Developing Phonological Awareness, Literacy, and Communication Skills is an excellent resource for music therapists, parents and teachers who focus on literacy with young children and children with disabilities. According to Schumacher, the “focus of this book is on teaching phonological awareness skills through music, along with offering some ideas about how to teach other areas of literacy such as sight words, inflection, and comprehension” (p. 11). The preface of the book provides a review of the author’s history and what brought her to this work on literacy. This autobiographical context helps to both draw out the connection between literacy and music therapy, but also identifies Schumacher’s careful training and expertise related to literacy. From there, she carefully defines literacy concepts such as the “Ph” words (phonological awareness, phonemic awareness, and phonics). After a brief review of available research, Schumacher sets the stage for the importance of developing early phonological awareness on later development of reading and spelling skills. She further states that skills develop along the following continuum: rhyming, alliteration, blending, segmenting, and manipulating (p. 22).

collaborative relationships with both parents and professionals in education and literacy. The body of the book is divided into chapters that move through the continuum of literacy, from emergent literacy skills to strategies for sight words and inflection. Each section or chapter provides an initial definition of the skill area, instructional strategies, and resources and songs/ interventions designed to develop the identified skills. Most of the songs in the book are original compositions and include printables and suggestions for how to use them. For example, the section on Onset and Rime defines these concepts as “parts of monosyllabic words in spoken language. The onset is the initial consonant sound of the syllabus. The rime is the vowel and all that follow it (e.g. b-ag, sw-im)” (p. 73). Worksheets, a model for making a word wheel, and suggested songs all provide the reader with a strong guide for addressing these skills. Schumacher's years of training and expertise in literacy and music therapy are thoughtfully synthesized in this book, making it a valuable resource for music therapists who are looking for a tool that provides a strong theoretical framework directly linked to songs and interventions that can be integrated into music therapy practices. It is a practical guide, well-suited for any music therapist who is working to use music to support a student's Individual Education Program (IEP) and learning goals. It would be important, however, to maintain a collaborative relationship with members of the child’s team who are reading specialists and certified educators. Listen to my audio bookmarks! About the Author

This book is far more than a song or activity book. The strong theoretical base, clear outline of developmental continuum from preschool to second grade, and connections to language and literacy research make this text a guide to integrating literacy-focused practices into the music therapy process. Schumacher provides a list of language and literacy assessments including two assessments that are available for free. This foundational information will also serve music therapists by providing a framework through which the reader can foster

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Nicole R. Rivera, Ed.D., MT-BC, worked as a clinical music therapist for over 17 years serving children with autism spectrum disorders. She currently teaches psychology courses at North Central College in Naperville, IL. Contact:


next submission deadline may15,2015

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Profile for imagine

imagine 2014  

The focus of imagine 2014 is on family-centered practice – a trend taking hold in music therapy circles worldwide. While many practitioners...

imagine 2014  

The focus of imagine 2014 is on family-centered practice – a trend taking hold in music therapy circles worldwide. While many practitioners...