Music Therapy and Speech Production for Children with Autism
It is estimated that for every 1,000 children born, two to six will be diagnosed with autism. Because of its relatively large presence, treatments and therapies for the impairments autistic children face are constantly being developed and improved. One of the most significant impairments associated with Autism is extreme difficulty in the development of speech and language. Some of the features of the language and speech impairment that autistic children face are unusual word choice, pronoun reversal, incoherent discourse, unresponsiveness to questions, and a lack of drive to communicate among other problems. Despite these problems, over half of children diagnosed with autism possess the abilities to understand and produce speech and eventually develop a certain degree of functional speech. Music therapy has been studied as a potentially effective way to teach autistic children functional vocabulary words, however the previous concerning the effectiveness of music therapy studies have not been sufficiently controlled.
So, to study the effectiveness of music therapy in a more controlled situation, Lim (2010) studied whether or not learning functional words through music stories was more effective than learning words through regular speech therapy type stories. A total of 50 autistic children between the ages of 3 and 5 were used in this study. Based on the Childhood Autism Rating Scale or the Autism Diagnostic Interview Revised, the children were categorized as either ‘low-functioning’ or ‘high-functioning’. The target words for this study were selected from lists of functional vocabulary words that 3-year-olds could use in everyday interactions.
Knowledge of the 36 target words was evaluated with pre- and post-tests of the children. The tests took the form of a verbal fill-in-the-blank test where the phrase before the blank cues the correct word without being similar to the word. For example, the phrase: “Old MacDonald had a _____” cues the word “farm” without mentioning or being similar to the word “farm”. All of the phrases in the test were structured to end in the target word, like the example above. A picture of the target word was also presented to help prompt the participant to produce the target word upon hearing the first part of the phrase. It is important to note that a different picture was used every time (different types of farms, etc) to demonstrate that the children were not simply memorizing the picture.
The children were randomly placed into three groups: the music therapy condition, the speech therapy condition, and a control condition. For the music therapy condition, six songs were composed that contained six target words each encompassed all of the 36 target words. Each line of the song ended with a target word, for example:
Hello, hello brown bear.
What do you eat?
I’d like to eat an apple.
After eating apples, he is happy.
Brown bear says more.
Daddy bear says the apples are all gone.
Each song varied by key (i.e. C Major, d minor, etc), tempo (the speed at which the song is being played), and meter (the rhythm) but they were all similar in that they were very simple and repetitive songs, as one could imagine from the lyrics. In each song, the target word, which was also the last word, was always emphasized by a longer time duration (i.e. Daddy bear says the apples are allllllll gonnneeeee). There was also a picture presented in the video by the singer with every target word (but as in the pre- and post- tests, the same picture was never shown twice). All of the songs were sung by a female music student with guitar accompaniment. The songs were videotaped to be shown to participants on a TV monitor with each song being repeated twice in each video.
For the speech training condition, the same text from the six songs was simply recited without any musical accompaniment or melody. As in the music therapy condition, a picture was presented with each target word, the same female music student recited the stories, and the stories were videotaped and repeated twice each to show the children.
Finally, for the control condition, no training was given.
They were first given the pre-test (the verbal fill-in-the-blank test described above), then were either shown the music video, speech video, or no video (control condition). Each participant saw their respective video twice a day (which totaled four exposures to the song/speech a day since each song/speech was repeated twice in the video), for three days (totaling 12 exposures to the song/speech). On the fourth day, the post-test was given to each child. All of the pre-tests and post-tests were videotaped. It is also important to note that the pre-test, the video sessions, and the post-test were given to children individually to prevent the child from being distracted.
Each response given by each child was evaluated by two speech pathologists who assigned points to each response based on semantics, phonology, pragmatics, and prosody.
Semantics refers to if the child produced the correct target word.
Phonology refers to the correct pronunciation of the target word.
Pragmatics refers to the time delay between being presented with the verbal blank and the response of the target word.
Prosody refers to the way the word is said—which syllable is emphasized, question vs statement, etc.
Various levels of all of these criteria were assigned point values and then the speech pathologists scored each pre- and post-test video of each child. Both of their scorings were almost identical which demonstrates consistency in the rating system and the raters.
It was found that both the music and speech therapy conditions produced significantly more improvement in the verbal production score than the control condition. Overall, it appeared that there wasn’t a significant difference between the effectiveness of the two types of therapy. However, upon further investigation, it was found that the music therapy produced significantly more improvement with ‘low-functioning’ children than the speech therapy, while the ‘high-functioning’ children showed equal improvement in both the speech and music therapy conditions.

The graph shows the differences in scores between the pretest and posttest. The bigger the number, the bigger the improvement in speech production.
Though the speech and music therapies only differed when comparing low- and high-functioning children, this finding is significant. It suggests that the verbal instructions may be too confusing or the speech task not exciting enough to hold the low-functioning children’s attention. During this critical age for children to learn speech, it is especially important for the low-functioning children to be exposed to a therapy that is effective for them and this appears to be music therapy. The author of the study suggests that the predictable temporal pattern of music makes it easier to perceive by the low-functioning children and that the “exciting” nature of music holds the attention of low-functioning children better. Based on these findings, verbal therapies for preschool autistic children should heavily include music therapy since it is significantly effective for both the high- and low-functioning children. With research like this, we can improve the chances that an autistic child can grow up to become an independent, functional member of society instead of being dependent on others.
Lim HA (2010). Effect of “developmental speech and language training through music” on speech production in children with autism spectrum disorders. Journal of music therapy, 47 (1), 2-26 PMID: 20635521
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