To investigate the effect of Music Therapy on the development of speech and language in non- verbal pre-school children with autism.

1. EFFECT OF MUSIC THERAPY ON THE DEVELOPMENT OF SPEECH
AND LANGUAGE IN NON-VERBALPRE-SCHOOL CHILDREN WITH
AUTISM
TITLE:To investigate the effect of Music Therapy on the development of speech
and language in non- verbal pre-school children with autism.
STATEMENT OFTHE PROBLEM:
About one-third to a half of individuals with autism do not develop enough natural
speech or have limited speech to express their daily communication needs.
Children with autism often are self-absorbed and seem to exist in their own world
where they are unable to successfully communicate and interact with others.
They may have difficulty developing receptive and expressive language skills and
understanding what others speak to them. They also may have difficulty
communicating nonverbally, for e.gthrough gestures, eye contact, facial
expressions and body language.The child’s ability to communicate with
otherswill vary and depends upon his or her cognitive and social development.
Some children with autism may be unable to develop speech. Others may have
rich vocabularies and be able to talk about specific subjects in detail. The
majority have difficulty using language effectively to explain, especially when
they talk to other people. Many have problems with understanding the meaning
and rhythm of words and sentences. They also may be unable to understand
body language and the nuances of vocal tones.They usually exhibit difficulties in
social interaction as well as in verbal and non-verbal communication. Since
autistic children are hypersensitive to external stimuli, they tend to have a strong
affinity for listening to music and playing musical instruments. Many autistic
children sometimes sing when they may not speak. They often restrict
themselves by closing their ears tightly with their fingers poked in and humming
a tune continuously. Music therapy being a well-established technique for using
musical interaction to help individuals with a wide range of cognitive and

2. emotional challenges to improve their ability to function, it was conducted on
non-verbal preschool children for development of speech, speech intelligibility
and language development.
REVIEW OF LITERATURE:
1.Science Daily (Sep.20,2006)- Researchers have found the firstevidence that young
children who take music lessons show differentbrain development and improved
memory over the course of a yearcompared to children who do not receive musical
training.
2. Institute of Cognitive Neurosciences of the Mediterranean, CNRS,Marseille,
France Center for Complex Systems and Brain Sciences, Florida Atlantic
University, Boca Raton, Florida 33431,USA-Compared the neural bases of
language and music and manipulated either the linguistic or musical dimensions
(or both) of song and studied their relationships. It was possible to gain important
information about the neural networks underlying language and music cognition.
They also conducted behavioral, electrophysiological, and neuroimaging studies
concerning with the functional and structural relationships of music and
language.
3. In 1994 ‘Discover magazine’ published an article which discussed research by
Gottfried Schlaug, Herman Steinmetz and their colleagues at the University of
Dusseldorf. The group compared magnetic resonance images (MRI) of the brains of 27
classically trained right-handed male piano or string players, with those of 27 right-
handed male non-musicians. Intriguingly, they found that in the musicians’
planumtemporale - a brain structure associated with auditory processing - was bigger in
the left hemisphere and smaller in the right than in the non-musicians. The musicians
also had a thicker nerve fibre tract between the hemisphere. The differences were
especially striking among musicians who began training before the age of seven.
According to Shlaug, music study also promotes growth of the corpus callosum, a sort
of bridge between the two hemispheres of the brain. He found that among musicians who

3. started their training before the age of seven, the corpus callosum is 10-15% thicker than
in non-musicians.
RATIONAL OFSTUDY:
Music therapy can help patients suffering from autism spectrum disorders to
physical injuries like spinal cord injuries. Different studies are being going on to
determine if music therapy can help treat Parkinson’s Disease, which is a brain
disease that causes its sufferers to shake uncontrollably. It’s also being used for
older people living in hospital or old age care as music therapy is believed to
decrease pain perception and provide distraction for people living with chronic or
extreme pain.Music therapy is also being used much more often to treat people
with autism, especially young children. Autistic people are often entirely closed
off in their own private world and they are unable to properly communicate with
the people around them. They struggle to interact with the world around them as
well. The left brain is responsible forgeneral music ability in musicians,
perception, production of speech, perception of rhythm and prosody, lyric
performance during singing and the temporal sequences of reading ability. The
right brain is involved with processing of musical pitch, control of intensity of
sound(amplitude), identification and detection of musical chords, melody
perception in non-musicians, visual pattern recognition, singing, auditory pattern
recognition(auditory training), and expressive rhythmic and melodic behaviour.
New studies are reporting of overlapping areas for music and language
processing. Rhythm has been found to positively influence brain activity during
learning; scientists have reported that after a rhythm sequence is stopped, brain
activity occurs in anticipation.Research supports connections between speech
and singing, rhythm and motor movements, memory for song and memory for
academic concepts, and overall ability of preferred music . Speech can range
from complete mutism to grunts, reflexive crying,shrieks, guttural and humming
sounds. There may be musically intoned vocalizations with some consonant-

4. vowel combinations, a sophisticated babbling interspersed with recognizable
word-like sounds or a jargon speech.It is therefore necessary to study further,
how speech and language can be developed in children with autism and how
music-based communication is possible even when language processing is
missing.
DEFINITIONS:
sic Therapy- Music therapy is an allied health profession and afield of scientific research which
studies correlations between the
ocess ofclinical therapy and biomusicology, musical acoustics,music theory,psychoacoustics,
embodied , music cognition and comparative musicology. It is an interpersonal
process in which a trained music therapist uses music and all of its facets-
physical, emotional, mental, social, aesthetic, and spiritual—to help clients to
improve or maintain their health.
ice Analysis- Voice analysis is the study of speech sounds for purposes other than linguistic
content, such as in speech recognition. Such studies include mostly medical
analysis of the voice .
ASSUMPTIONS:
Scientists have discovered that music training has significant influences on the brain
development of young children which leads to
improved memory and language recall skills .Researchers found that

5. musically trained children performed better in a memory test that is correlated with other
skills such as literacy, verbal memory, visual spatial processing, mathematics and
intelligence.Since children with autism have affinity towards music and there is a proven
co-relation between the music, speech and brain development, the research on above
topic was pursued.
HYPOTHESIS:
1.To investigate the effect of Music Therapy in development of
speech in non- verbal pre-school children with autism.
2. To investigate the effect of Music Therapy in development of
language in non- verbal pre-school children with autism.
LIMITATIONS:
1. The sample size was small.
METHOD:
Research Design:Experimental research design.
Independent
variable:Music Therapy
Dependent variable:Speech and Language Development in

6. non- verbal pre-school children with autism.
Sample design:8 children with autism with no speech or
minimal speech.
Sampling Design: By convince sampling
Inclusion criteria: 1. Age-3-5 years.
2. Diagnosis- All children were diagnosed
under Autism Spectrum Disorder By Child
Psychiatrist and Clinical Psychologist.
Exclusion criteria:None.

7. Instrumentation:
1.Perceptual Evaluation of Speech Quality test .
2.Voice Assessment Protocol for Children and Adults (VAP)
3.Clinical Evaluation of Language Fundamentals–Preschool, Second
Edition (CELF-Preschool 2)
4.Goldman-Fristoe Test of Articulation-Second Edition G-
FTA-2)
5. Peabody Picture Vocabulary Test
Materials and Equipments:
1. Computer voice analyzer.
2. Praat software program for acoustic voice analysis.
3. Phonatory Aerodynamic System (PAS)
4. Microphone
5. Tape recorder
6. Musical Instruments.
Procedure:

8. The team comprised of a Music Therapist and Speech Therapist. The duration of the
project was from 26th January 2009 to 14th November 2009 at Ruptech Educational India.
8 pre-school children with no or minimal speech with autism were assessed prior to the
start of therapy sessions. The child’s Speech Development milestones, Imitation skills,
Articulation test, Voice Analysis (loudness, quality, pitch range) was assessed. The
child’s receptive and expressive vocabulary and Situation-Facial Expression Matching
were tested using photographs and video clippings. After assessing the strengths and
needs of each child with autism, the music therapist developed a treatment plan with
goals and objectives and then provided appropriate treatment. The therapist used
percussion, tuned instruments and her own voice, to respond creatively to the sounds
produced by the children with autism and encouraged them to create his or her own
musical language. Musical games like passing a ball back and forth to music or playing
sticks and cymbals with a partner to foster interaction were played. Preferred music was
used contingently for a wide variety of cooperative social behaviours like sitting on a
chair or staying with a group of other children in a circle. Music selections and certain
active music-making activities were modified for child’s preferences and individualized
needs (i.e., song selection and music may vary). Toolkits were available via AMTA and
publications.
The therapy was conducted in individual and small group sessions. The children
attended 40 music therapy sessions-19 individual sessions and 21 group sessions,
twice/week, of half an hour each.The group session had 3-4 ASD students during
therapy. Music therapy sessions were documented in a treatment plan, every week and
delivered in accordance with standards of practice. The speech and voice analysis was
done by the voice therapist along with the music therapist.

9. Table1 Receptive and Expressive Language Age based on Clinical
Evaluation of Language Fundamentals–Preschool, Second
Edition (CELF-Preschool 2), on 27th March 2009(Pre-therapy
assessment)
Chronological Receptive Expressive
Age(in years) Language Age(in Language Age
Subjects years)
(in years)
Child A 3.4 2.2 1.4
Child B 4.6 3.4 1.8
Child C 3.2 2.1 1.1
Child D 4.2 2.3 1.4
Child E 3.7 2.4 1.0
Child F 4.10 3.0 1.9
Child G 3.4 2.1 1.3
Child H 4.9 3.8 2.0
Table 2Receptive and Expressive Language Age based onClinical
Evaluation of Language Fundamentals–Preschool, Second
Edition (CELF-Preschool 2), on 3rd October 2009(Post-therapy
assessment)
Chronological Receptive Expressive
Age(in years) Language Age(in Language Age
Subjects years)

10. (in years)
Child A 3.10 2.6 1.7
Child B 5.0 3.7 2.1
Child C 3.8 2.4 1.6
Child D 4.8 2.5 1.9
Child E 4.1 2.7 1.3
Child F 5.4 3.4 2.1
Child G 3.10 2.3 1.5
Child H 5.3 3.9 2.6
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child A.
3
2.6
2.5
Inprovement in Receptive and Expressive Language Age in years
2.5 2.3
2.2
2.1
2
1.7
1.6
1.5
1.5 1.4 1.4
Receptive Age
Expressive age
1
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child B.

11. 4 3.7
3.5 3.5
3.4 3.4
3.5
Improvement in Receptive and Expressive Language Age (in years)
3
2.5
2.1
1.9
2 1.8
1.7
1.6 Receptive Age
1.5 Expressive age
1
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child C.
2.5 2.4 2.4
2.3
2.2
2.1
IInprovement in Receptive and Expressive Language Age in years
2
1.6 1.6
1.5 1.4
1.3
1.1
Receptive Age
1
Expressive age
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child D.

12. 2.5 2.5
2.5 2.4
Inprovement in Receptive and Expressive Language Age in years
2.3 2.3
2 1.9
1.7
1.5
1.5 1.4 1.4
Receptive Age
1
Expressive age
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child E.
3
2.7
2.6
2.5
Inprovement in Receptive and Expressive Language Age in years
2.5 2.4 2.4
2
1.5 1.4
1.3 1.3
1.2 Receptive Age
1
Expressive age
1
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child F.

13. 3.4
3.5 3.3 3.3
3.1
3
Inprovement in Receptive and Expressive Language Age in years
3
2.5
2.1
2 2
1.9
2
1.4 Receptive Age
1.5
Expressive age
1
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child G.
2.5
2.3 2.3 2.3
2.1 2.1
Inprovement in Receptive and Expressive Language Age in years
2
1.5
1.5 1.4 1.4
1.3 1.3
Receptive Age
1
Expressive age
0.5
0
Graph Representing Receptive and Expressive Language age based on Clinical
Evaluation of Language Fundamentals (CELF-Preschool 2) from 27th March to 3rdOctober
2009 of Child H.

14. 3.9 3.9 3.9
4 3.8 3.8
3.5
Inprovement in Receptive and Expressive Language Age in years
3
2.6
2.5
2.5
2.1
2
Receptive Age
1.5
1.5 Expressive age
1
0.5
0
0
Table 3 Articulation Test based on Goldman-Fristoe Test of
Articulation-Second Edition G-FTA-2) on 27th March 2009(Pre-
therapy assessment)
Subjects Chronological Misarticulation
Age(in years)
Child A 3.10 N.A
Child B 5.0 N,A
Child C 3.8 aspirated sounds
Child D 4.8 Trill sounds
Child E 4.1 N.A
Child F 5.4 N.A
Child G 3.10 Glottal sounds
Child H 5.3 N.A

15. Table 4Articulation Test based onGoldman-Fristoe Test of
Articulation-Second Edition G-FTA-2) on 13th Oct 2009(Post-
therapy assessment)
Subjects Chronological Misarticulation
Age(in years)
Child A 3.10 N.A
Child B 5.0 N,A
Child C 3.8 aspirated
sounds(reduced by
40%)
Child D 4.8 Trill sounds(no
improvement)
Child E 4.1 N.A
Child F 5.4 N.A
Child G 3.10 Glottal
sounds(reduced by
30%)
Child H 5.3 N.A
Table 5 Voice Analysis ,on computerized Voice Analyseron 29th March
2009(Pre-therapy assessment)
Subjects Chronological Pitch Loudness Quality of
Age(in years) range(in Hz) voice (in%)
(in db)
Child A 3.4 230-560 40 Normal
Child B 4.6 135-257 60 Hoarse(40%)

16. Child C 3.2 321-460 30 Normal
Child D 4.2 110-730 45 Nasal (70%)
Child E 3.7 230-270 50 Normal
Child F 4.10 340-800 34 Nasal(70%)
Child G 3.4 120-224 35 Husky(40%)
Child H 4.9 130- 170 57 Hoarse(30%)
Table 6 Voice Analysis ,on computerized Voice Analyseron 7th October
2009(Post-therapy assessment)
Subjects Chronological Pitch Loudness Quality of
Age(in years) range(in Hz) voice (in%)
(in db)
Child A 3.10 130-730 60 Normal
Child B 5.0 130-454 65 Hoarse(30%)
Child C 3.8 232-640 40 Normal
Child D 4.8 110-870 36 Nasal(50%)
Child E 4.1 120-330 30 Normal
Child F 5.4 320-870 24 Nasal
Child G 3.10 110-344 43 Husky(30%)
Child H 5.3 120- 180 63 Hoarse(25%)
FINDINGS:

17. dings of this study gave significant insights into the relationship
en music, speech , language development in children with autism.
It was observed that there was an overall enhancement in their receptive and functional
expressive language skills. While all could speak in telegraphic speech post music therapy
sessions, 2 children could express in 3-4 word short sentences and developed functional
expressive skills. 1 child could narrate events in 3-4 sentences of 4-5 word length. It was
noticed that the articulation of 2 children improved in aspirated and glottal sounds and 1
child showed no improvement. There was significant improvement in pitch range,3children
could attain normal loudness. The voice quality improved of 4 children who had nasal or
hoarse or husky voice. There was an improvement of 5-20% in their voice quality.
IMPLICATIONS:
The above findings prove that music therapy helps to enhance attention ,speech
and language development to optimize the student’s ability to learn and interact.
It has been effective in the development and remediation of speech and
language. Therefore, the purpose of music therapy for children with autism
should be to provide the student with an initial assist using melodic and rhythmic
strategies, followed by fading of musical cues to aid in generalization and
transfer to other learning environments. The future of music brain research is
bright.
Additional study is needed:
-to specify the effect of each of the components of music (i.e. rhythm) on specific
areas of brain activity,
-to specify areas of brain activity during emotional responses to music,
- to analyze the structural similarities between music and language,

18. -to study the neuromuscular effect of low-frequency vibration and
music,
-to study the effect of music on retrieval in short and long term
memory .
BIBLIOGRAPHY
Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of
directed art activities on the behavior of young children with disabilities: A multi-
element baseline analysis. Art Therapy: Journal of the American Art Therapy
Association, 10(4), 235-240.
Bentivegna, S., Schwartz, L., &Deschner, D. (1983). The use of art with an
autistic child in residential care. American Journal of Art Therapy, 22, 51-56.
Benveniste, D. (1983). The archetypal image of the mouth and its relation to
autism. Arts in Psychotherapy, 10, 99-112.
Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative
ways. Advocate: magazine of the Autism Society of America, 26-27.
Betts, D. J. (2003). Developing a projective drawing test: Experiences with the
Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art
Therapy Association, 20(2), 77-82.
Betts, D. J., &Tabone, C. (2002). Working with autism: Contemporary
assessment and treatment methods. Paper presented at the 33rd Annual
Conference of the American Art Therapy Association, Washington, DC.
Betts, D. J. (2001). Projective drawing research: Assessing the abilities of
children and adolescents with multiple disabilities. Paper presented at the 32nd
Annual Conference of the American Art Therapy Association, Albuquerque,
NM.
Betts, D. J. (2001). Cover story: weekend outings provide creative outlet:
Individual expresses himself through art therapy. Advocate: Magazine of the
Autism Society of America, 34(3), 20-21.
Betts, D. J. (2001). Special report: The art of art therapy. Drawing individuals
out in creative ways. Advocate: Magazine of the Autism Society of America,
34(3), 22-23(29).
Buck, L. A. (1985). Artistic talent in “autistic” adolescents and young adults.
Empirical Studies of the Arts, 3(1), 81-104.

19. Evans, K. &Dubowski, J. (2001). Art therapy with children on the autistic
spectrum: Beyond words. Jessica Kingsley Publishers, London.
Fleshman, B., &Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall. In
Parker-Hairston, M. J. (1990). Analyses of responses of mentally retarded autistic
and mentally retarded non-autistic children to art therapy and music therapy.
Journal of Music Therapy, XXVII(3), 137-150.
Henley, D. (2001) Annihilation anxiety and fantasy in the art of children with
Asperger’s Syndrome and others on the autistic spectrum. American Journal of
Art Therapy, 39(4), 113-121.
Henley, D. (1992). Therapeutic and aesthetic application of video with the
developmentally disabled. Arts in Psychotherapy, 18, 441-447.
BIBLIOGRAPHY
Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of
directed art activities on the behavior of young children with disabilities: A multi-
element baseline analysis. Art Therapy: Journal of the American Art Therapy
Association, 10(4), 235-240.
Bentivegna, S., Schwartz, L., &Deschner, D. (1983). The use of art with an
autistic child in residential care. American Journal of Art Therapy, 22, 51-56.
Benveniste, D. (1983). The archetypal image of the mouth and its relation to
autism. Arts in Psychotherapy, 10, 99-112.
Betts, D. J. (2005). The art of art therapy: Drawing individuals out in creative
ways. Advocate: magazine of the Autism Society of America, 26-27.
Betts, D. J. (2003). Developing a projective drawing test: Experiences with the
Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art
Therapy Association, 20(2), 77-82.
Betts, D. J., &Tabone, C. (2002). Working with autism: Contemporary
assessment and treatment methods. Paper presented at the 33rd Annual
Conference of the American Art Therapy Association, Washington, DC.
Betts, D. J. (2001). Projective drawing research: Assessing the abilities of
children and adolescents with multiple disabilities. Paper presented at the 32nd
Annual Conference of the American Art Therapy Association, Albuquerque,
NM.
Betts, D. J. (2001). Cover story: weekend outings provide creative outlet:
Individual expresses himself through art therapy. Advocate: Magazine of the
Autism Society of America, 34(3), 20-21.

20. Betts, D. J. (2001). Special report: The art of art therapy. Drawing individuals
out in creative ways. Advocate: Magazine of the Autism Society of America,
34(3), 22-23(29).
Buck, L. A. (1985). Artistic talent in “autistic” adolescents and young adults.
Empirical Studies of the Arts, 3(1), 81-104.
Evans, K. &Dubowski, J. (2001). Art therapy with children on the autistic
spectrum: Beyond words. Jessica Kingsley Publishers, London.
Fleshman, B., &Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall. In
Parker-Hairston, M. J. (1990). Analyses of responses of mentally retarded autistic
and mentally retarded non-autistic children to art therapy and music therapy.
Journal of Music Therapy, XXVII(3), 137-150.
Henley, D. (2001) Annihilation anxiety and fantasy in the art of children with
Asperger’s Syndrome and others on the autistic spectrum. American Journal of
Art Therapy, 39(4), 113-121.
Henley, D. (1992). Therapeutic and aesthetic application of video with the
developmentally disabled. Arts in Psychotherapy, 18, 441-447.