A recent article challenges us to take a different look at autism – to consider that the typical approach may not be the only or the most effective approach in treating children who have an ASD. This week we’ll consider this perspective and look at a few non-music research studies that challenge how we typically think of ASD.
The original article that sparked this post was by Mirenda (2008) and proposed a “backdoor” approach to AAC with children with ASD. The author challenges us to look beyond the typical view of autism and to consider some other issues that are less-commonly brought up in ASD treatment including the possibility of motor differences and assumption of co-occurring intellectual disability. These points are then considered in terms of using AAC for communication. Although this article is a review/opinion article (therefore “low” in terms of research hierarchy), the author brought up some great points about looking at things differently for the sake of the individual.
One point made in the Mirenda article was the possibility of movement differences in autism. There are numerous researchers that have considered movement difference in autism (for example, Hardan et al. 2003; Jeste, 2011; Minshew et al. 2007). Most of these studies have been completed via observation or brain-imaging techniques.
A recent study by Forti (2011) utilized motion-capture technology to record movement kinematics in children with and without ASD. Children with ASD showed overall accurate movement for a ball pick-up and drop task; however, their total movement time was much longer and they showed differences in control-based movements including a lack of reduction in velocity pre-drop and extra movements post-drop. The researchers suggested that children with ASD may only plan for the initial phase of the movement and therefore required corrective sub-movements in the later stage of the movement.
The finding of movement differences in autism could have several implication for music therapy practice since this is not commonly an area that is assessed, let alone treated, in autism care.
Another way to look at ASD differently is to challenge our own assumptions about what we think our client’s desire or “need”. I know that in my practice I will often hear that (fill in name) must have his/her (fill in item) or he/she will not be able to function/behaviors will occur. Preferential items (and music) can be extremely valuable when treating children with ASD; however, a recent study challenges our perception of client preference.
In a study by Kenzer and Bishop (2011), children with ASD were presented with staff-reported high-preference stimuli, staff-reported low-preference stimuli, and researcher-selected novel stimuli (that was often more age appropriate). This study was a observational study where the children were presented with high preference vs. low or novel stimuli. Although there were no statistics completed, there was high inter-rater agreement on measures. Twenty-seven out of 31 children showed preference for both novel and staff-reported low-preference stimuli, indicating that their preference went beyond assumptions made by the staff. This may be due to habituation to preferred stimuli and suggests that those completing interventions with children with ASD should consider ongoing assessments of preference so that children are not limited to what the therapist assumes is their preference.
Both of these studies could have implications for music therapy. Considering a different view of the clients that we work with may help us to develop a more flexible and sensitive treatment outlook. If we don’t take a step back and consider other possibilities, we may risk becoming “stuck” in our treatment approach/thinking, which may not provide our clients with the best opportunity for growth.
References:
Forti, S., Valli, A., Perego, P., Nobile, M., Crippa, A., & Molteni, M. (2011). Motor planning and control in autism. A kinematic analysis of preschool children. Research in Autism Spectrum Disorders, 5(2), 834-842. doi: 10.1016/j.rasd.2010.09.013
Hardan AY, Kilpatrick M, Keshavan MS, Minshew NJ. (2003). Motor performance and anatomic magnetic resonance imaging (MRI) of the basal ganglia in autism. J Child Neurol, 18(5), 317-24. PMID: 12822815
Jeste SS. (2011). The neurology of autism spectrum disorders. Curr Opin Neurol. PMID: 21293268
Kenzer, A. L., & Bishop, M. R. (2011). Evaluating preference for familiar and novel stimuli across a large group of children with autism. Research in Autism Spectrum Disorders, 5(2), 819-825. doi: 10.1016/j.rasd.2010.09.011
Minshew NJ, Williams DL.(2007). The new neurobiology of autism: cortex, connectivity, and neuronal organization. Arch Neurol. 2007 Jul;64(7):945-50. PMID: 17620483
Hello,
Thanks for sharing this interesting article. I think defining ASDs can be extrememly difficult, as it can disguise itself in so many ways. That being said, however, in looking at ASDs, in my opinion, and according to the DSM, ASD is a disorder that affects the individuals ability to relate & communicate. In essence, it’s a disorder of relating and communicating that may call for interventions that involve relationship-based techniques to facilitate a continous flow of back and forth dialogue to encourage realtional expereinces. And interactive music therapy interventions, in my opinion, naturally and directly target the core deficits of ASDs: relating and communicating. According to the DSM, ASD is not a disorder of memory (although many therapists implement memory-based interventions), and it is not a disorder of motor, or sensory integration, etc. To that end, motor-planning, sequencing, sensory modulation and other biological challenges are certainly present in people with ASDs, however, they are the individual-differences that interfere with a person’s ability to relate and communicate. You can have a client with motor issues, or sequencing issues, however, that does not necessarily mean that they have an ASD.
Thanks so much for the post and the opportunity to exchange dialogue. I feel that it is this is a great topic that will promote the exchanging ideas as we all try to discover effective ways of working with people with ASDs.
Best,
John
Thanks for the comment – I’d love to hear more thoughts from people. Just to make it clear, my point in posting this one is to bring forth this idea that we might consider looking at things differently – not to tell you how to look at things. I think that considering the the research, even if different from our own ideas, is part of an evidence-based practice.
Thanks, Blythe. Great timing as I plunge into teaching our new intern about autism, one of our primary populations at Music Works Northwest. It also aligns with some of what I’m already seeing – looking at other areas such as motor functions gives us more knowledge about how the child functions as a whole, which really influences their processing of the world around them. At one point years ago there was a study on looking at crawling patterns and early signs of ASD to see if there was a correlation.
I love the reminder to step back and rethink! I work exclusively with hospice patients, rarely anyone with ASD, but the same advice is valid– just because someone’s 89, demented and nonverbal doesn’t mean they’re going to want the same repertoire visit after visit. Rethinking and, sometimes, reframing keeps us MTs fresh and alert to nuances in pur patient’s responses. Thanks for the article!
Blythe, thanks for doing this blog- it is great! It really challenges us to not remain in our box of what we think we know and constantly allows us to identify best practice for the individuals we serve.
I work with children with autism regularly and have been intrigued by the concept of movement differences in autism for over a decade now. I have used music, specifically rhythm, to influence motor behavior, and have found that when I address those subtle movement differences, I see changes in communicative and cognitive demonstration- and then am able to really assess the needs in these domain areas. No doubt are communication and socialization deficits in autism, but what if addressing motor allows greater success in that individual’s ability to show who they are/what they are capable of? If you think about it, communication and social (and cognition/IQ testing) requires motor output. If motor IS impaired in any way, then it is unlikely that a ‘true’ reflection of skill level in autism is being identified.
I actually just finished my graduate work looking at cerebellar abnormalities in autism, the controversy of movement differences, and the impact rhythm may have on motor in this population. It makes sense that if the cerebellum is abnormal (which is one of the most robust findings), then movement/motor will be impacted based on the role of the cerebellum in typical functioning.
Interestingly, Kanner, in his original description of autism noticed movement issues, but in the time that he defined autism, he was using purely behavioral criteria as that was what was available. Teitelbaum (the individual I think Patti is referring to above) reviewed movement in early infancy and saw a lot of movement disturbances in rolling patterns, posturing, crawling, gait, etc. It is really fascinating stuff- and shouldn’t be overlooked because it challenges and broadens our understanding of autism. The reality is that we don’t have enough research to say either way for sure- so we must keep an open mind and watch the research unfold.
I think we will see more and more of these types of research studies and it can only provide us with more information to truly treat the individuals we serve most effectively.
Thanks again, Blythe, and others for this dialogue!
Michelle
yes, we should never stop continually challenging our ideas about ASD. You have some great points, and I look forward to discovering future insights, along with you, in the years to come. Go Neurodiversity Go! 🙂