Most of the research on children with autism is focused on their social skills and emotional awareness. Although these are major need areas for children with autism, these skills aren’t the only skills that come up as “needs” in the assessment. The ability to attend, follow-though with an exercise, and inhibit behaviors are also areas of need; however, there is less representation of these skills in the research literature. Today, MTRB will take a look at a review of literature on attention in autism and generalize this information into the music therapy clinic.

A review completed by Sanders et al. (2008) looked at studies reporting on attention function, cognitive flexibility, and inhibition. They start by reviewing the many different theories of autism (i.e., the weak central coherence hypothesis, the empathising-systematising theory of autism, etc…). This is followed by a review of the literature on cognitive function in autism. Some noteworthy findings include:

• Sustained attention – Appears to be normal; however, children with autism are found to have difficulty attending to stimuli on demand, but excellent attention to desired stimuli
• Orienting attention (Disengage, shift, re-ingage) – children with autism have difficulty disengaging attention. Also difficulty in orienting when cue is social, but not otherwise (with non-social cue).

They cite two possible reasons for repetitive behaviors:

• Response inhibition – children with autism have difficulty inhibiting and get “locked-in” to behaviors (conflicting results)
• Set-shifting (changing in response to situatino) – children with ASD show difficulties in changing behavior in accordance with situation.

The authors also review the neurological studies on children with autism that correspond with each of these cognitive functions.

What does this information tell the music therapist?

First of all, we need to be looking at more than just the social components of children with autism. We should consider what these cognitive findings mean for social engagement. For example, if a child can’t disengage from a visual stimuli they will be less likely to interact with the peer sitting next to them.

Secondly, attention in the music therapy session. Singing the child’s favorite Disney Movie song may keep them in their chair, but this evidence shows that you would be working on an unimpaired skill. If the child has an unimpaired sustained attention to preferred tasks, but not to demanded tasks – then we need to work on their attention in non-preferential tasks. We can then use music to make the transition to and completion of these tasks more rewarding and motivating. My inclination is that this in one reason that music is so successful with children with autism. We can make non-prefeered/demanded tasks interesting, thereby engaging the child in learning/participating.

Thirdly, pairing music with social indicators may be a way to use the unimpaired non-social stimuli orienting skills to help reinforce the impaired skill of orienting to social stimuli. Basically, encouraging disengagement through external cues and facilitating a shift to social stimuli.

Lastly, this article points out the importance of looking at nonmusical evidence when maintaining an evidence-based practice.  This article is filled with excellent information that can be considered in the music therapy setting. Here is the nonmusical baseline, we would now need to research these areas with music intervention to see if we could change these nonmusical skills.

Reference:

Jane, S., Johnson, K., Garavan, H., Gill, M., & Gallagher, L. (2008). A review of neuropsychological and neuroimaging research in autistic spectrum disorders: Attention, inhibition and cognitive flexibility. Research in Autism Spectrum Disorders, 2(1), 1-16. doi:10.1016/j.rasd.2007.03.005.