I heard a claim this week that has thrown me for a loop:
Music therapists should not be allowed to work by themselves with individuals with communication disorders.
Given that I am a board certified music therapist (and have been for 10 years), my reaction to this claim is likely stronger than most. Nonetheless, I am struggling to understanding how music can be divorced from communication. Certainly you can have communication without music . . . but can you have music without communication?
The American Speech-Language-Hearing Association (ASHA) defines a communication disorder as
"(A)n impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be evident in the processes of hearing, language, and/or speech. A communication disorder may range in severity from mild to profound. It may be developmental or acquired. Individuals may demonstrate one or any combination of communication disorders. A communication disorder may result in a primary disability or it may be secondary to other disabilities."
As a music therapist, it is within my training and scope to use music to elicit spontaneous speech and communication, to address speech, language, and communication needs, and to target nonverbal expressions. I don’t diagnose or evaluate communication disorders. I don’t treat communication disorders. I assess and address speech, language, and communication needs . . and if the client is lucky enough, I get to do this in collaboration with a speech-language-pathologist (an option not feasible in all situations).
Personally, I have worked with people who have had a stroke or have Parkinson's and have used music to elicit spontaneous speech, to work on specific articulation patterns, and to increase their respiratory strength. Singing and speech utilize distinct and shared neural pathways (Thaut, 2005), which can make singing a tremendously beneficial therapeutic option for strengthening neural connections needed for speech production. I am a trained clinical musician and am adept at creating a singing experience designed specifically for that individual’s speech- and communication-related need.
I have also worked with children with a history of complex trauma, who struggle exhibiting appropriate nonverbal communication behaviors. Instrument play and music improvisation can be valuable ways to structure and practice nonverbal communication. For example, I am trained to facilitate a group music improvisation experience that provides these children the opportunity to musically dialogue with their peers, a back-and-forth nonverbal communication behavior necessary for listening and for verbal dialogue.
In addition to these brief examples, I know music therapists who have done amazing work helping improve verbal and nonverbal communication behaviors for children and adults with autism, Traumatic Brain Injuries, learning disabilities, strokes, cerebral palsy, and more. Should these clients be denied a valuable therapy that has helped improve their skills, abilities, and quality of life due to the belief of some who feel that music therapists should not work on communication needs?
So those are my experiences, but what does the research say? Here's a sampling:
- Edgerton (1994) studied the effectiveness of improvisational music therapy on communication behaviors in a group of children with autism, finding that the treatment significantly increased the number of communication behaviors they exhibited.
- Beathard & Krout (2008) described a case study in which a 3-year-old with apraxia participated in weekly music therapy sessions. Over the course of nine months of services, she progressed from being mostly nonverbal to pronouncing syllables, combination sounds, and words.
- Lim (2010) also explored the effect of music therapy on speech production in children with autism. Her results indicated that, although all the children improved with speech therapy and music therapy, children considered low functioning improved significantly more as a result of music therapy.
- Finally, multiple studies have explored and reported on the efficacy of using rhythm as a cueing strategy to control the rate and intelligibility of speech for individuals with dysarthria, Parkinson's, and gross motor dysfunction (Pilon, McIntosh, & Thaut, 1998; Thaut, 1985; Yorkston, et al., 1990).
So where does that leave us? I’m still thrown for a loop, still a little stumped, and thus not entirely sure right now. What I do believe is that it is in the best interest of those with communication disorders to have access to both speech AND music therapy services. This allows them to utilize treatment options that work best for their individual needs.
However, just as there is debate about whether music or speech evolved first in humans, perhaps there will continue to be a debate about whether music therapists can address communication needs.
I, for one, do not see how you can divorce the two. What do you think?
Follow me on Twitter @KimberlySMoore for daily updates on the latest research and articles related to music, music therapy, and music and the brain. I invite you also to check out my website, www.MusicTherapyMaven.com, for additional information, resources, and strategies.
Beathard, B. & Krout, R. E. (2008). A music therapy clinical case study of a girl with childhood apraxia of speech: Finding Lily's voice. The Arts in Psychotherapy, 35, 107-116.
Edgerton, C. L. (1994). The effect of improvisational music therapy on the communicative behaviors of autistic children. Journal of Music Therapy, 31(1), 31-62.
Lim, H. A. (2010). Effect of "developmental speech and language training through music" on speech production in children with autism spectrum disorders. Journal of Music Therapy, 67(1), 2-26.
Pilon, M. A., McIntosh, K. W., & Thaut, M. H. (1998). Auditory versus visual speech timing cues as external rate control to enhance verbal intelligibility in mixed spastic-dysarthric speakers: A pilot study. Brain Injury, 12, 793-803.
Thaut, M. H. (1985). The use of auditory rhythm and rhythmic speech to aid temporal muscular control in children with gross motor dysfunction. Journal of Music Therapy, 22, 108-128.
Thaut, M. H. (2005). Rhythm, Music, and the Brain: Scientific Foundations and Clinical Applications. London: Routledge.
Yorkston, K. M., Hammen, V. L., Beukelman, D. R. et al. (1990). The effect of rate control on the intelligibility and naturalness of dysarthric speech. Journal of Speech and Hearing Disorders, 55, 550-560.