“Bill is now singing”: Joint engagement and the emergence of social communication of three young children with autism

Abstract

Young children with autism spectrum disorder meet significant challenges in joint attention skills and in social communication. A child-centered, improvisational, music therapy intervention model was implemented to promote engagement in three young children with autism in a kindergarten classroom. A multiple baseline design compared the children’s performance through three phases of intervention: focus on faces, response to joint attention, and initiation of joint attention. A complimentary qualitative analysis of teacher and parent experiences allowed for an in-depth understanding of the role of social environment in supporting emerging social communication skills among three children. As all children showed improvement in joint attention and actions of social engagement, this study bears evidence on the potential of music therapy as a promising intervention for promoting social skills of young children with autism spectrum disorder.

Keywords

autism spectrum disorder joint attention music therapy social engagement

In typical child development, a child’s ability to co-create meaning with others is facilitated through joint engagement episodes (Adamson et al., 2004). Joint engagement episodes presuppose the child’s ability to share experiences with another person and require the ability of a child to share joint attention with others to an object or event (Hobson, 2010). Joint attention refers to the development of specific skills that involve sharing attention with communicative partners through actions of pointing, showing, responding to, and initiating object-directed gazes between objects and people (Adamson et al., 2004; Kasari et al., 2010; Schertz and Odom, 2007). Gradually, joint attention and the shared experiences between a child and other communicative partners lead to the development of joint engagement and social communication (Adamson et al., 2009; Alpern, 2012).

Engagement through the three components of joint attention (the ability to focus on a partner’s face, to respond to joint attention episodes, and to initiate joint attention episodes) is critical for children’s learning (Jones and Car, 2004). Research documents the importance of joint attention for the development of social competency and turn-taking in verbal communication (Hale and Tager-Flusberg, 2005; Siller and Sigman, 2002; Whalen et al., 2006), for symbolic and verbal language development (Paul and Sutherland, 2005; Bono et al., 2004), for symbolic play (Kasari et al., 2006; Keen et al., 2007), and, finally, for sharing affect (Schertz and Odom, 2004; Wetherby, 2006; Whalen et al., 2006). While the operational definition of joint attention may vary across different studies, there is a consensus that joint attention enables engagement episodes through continuing mutual interaction for social purposes and that it constitutes a critical area of intervention for young children with autism (Bruinsma et al., 2004; Wetherby, 2006; White et al., 2007).

A number of studies have shown that young children with autism have challenges with joint attention, symbolic communication, and share of positive affect (Kim et al., 2008; Tager-Flusberg and Sullivan, 2000). These challenges do not abate with age. School-aged children with autism may initiate fewer bids of interaction and/or continue interactions through fewer conversational turns (Jones and Schwartz, 2009), may have difficulty in interpreting both verbal and nonverbal social cues (Rao et al., 2008), and may have challenges participating in group activities in the classroom without rein forcers or visual learning materials (Broun, 2004; Bryan and Gast, 2000; Pelios et al., 2003). As the school social environments become more complex, children with autism tend to face more difficulties in organizing information from the environment (Dettmer et al., 2000), transitioning from one activity to another (Swanson, 2005), and completing activities with multiple steps (Pelios et al., 2003). Challenges in joint attention undermine children with autism broader capacity to share experiences and benefit from the learning opportunities found in interactive social contexts (Mundy et al., 2009; Rao et al., 2008; Wetherby, 2006). As such, identifying interventions that can help improve joint engagement skills of individuals with autism remains a priority.

Literature review

The National Standards Project conducted by the National Autism Center (2009) identified in its report the need for interventions that address the core challenges and associated features of individuals with autism spectrum disorder (ASD). In this report, music therapy (MT) was classified as an emerging evidence-based practice, useful in teaching individual skills or goals, through the use of specific music components, such as the songs and/or rhythmic cuing (National Autism Center, 2009). Similarly, integrated reviews of the literature on MT interventions noted music’s potential to support the social and affective development of young children with autism (Gold et al., 2006; Kaplan and Steele, 2005; Simpson and Keen, 2010). Music strategies noted in the literature for enhancing joint attention skills and engagement in children with autism include spontaneous music play (Kasari et al., 2006; Wetherby and Woods, 2006), singing (Starr and Zenker, 1998; Woodward, 2004), music as reinforcement (Standley, 1996; Gooding, 2011), musical attunement (Kim, 2006; Kim et al., 2008), and music improvisation (Bakan et al., 2008; Donnell, 2007; Holck, 2002; Katagiri, 2009; Kim et al., 2008; Woodward, 2004).

Other MT interventions for school-aged children focused on enhancing engagement among young children with ASD and their peers within inclusive school settings and compared music contexts to play contexts (Kern et al., 2007; Kim et al., 2008). In these studies, music experiences were designed to offer playful, interactive contexts in which the music interactions assisted the child’s emerging understanding of others’ intentions. As part of this moment-by-moment musical process, the therapist encouraged the child to respond to music and to explore musical, verbal, and/or nonverbal ways of listening to others, and to initiate music interactions for the purpose of social communication. Although different music techniques were used in the aforementioned literature, there was consensus that music offers a means of self-expression, communication, and interaction that can be more easily assimilated by the children than some other medium (Gold et al., 2006; Trevarthen, 2002).

The purpose of this study was to examine the effectiveness of a music intervention on the joint engagement abilities of three young children identified with autism in a kindergarten classroom. A secondary purpose was to study the parents’ and teacher’s experiences of the use of music as a means of social communication through a complimentary qualitative analysis. Through the qualitative analysis, the researcher sought to explore underlying factors that might have influenced the results of the intervention and to address questions on generalization and maintenance of the research findings in multiple social settings.

Research questions based on the purpose of the study addressed the following:

What are the effects of improvisational MT intervention on the joint engagement abilities of young children through actions of focusing on faces, responding to joint attention, and initiating joint attention?

How do the joint engagement abilities transfer in various social settings (e.g. classroom, family) according to the experiences of the teacher and the parents of the three children?

Method

Participants

The participants included three Caucasian children in kindergarten (two males and one female) with a school-based identification of autism and their teacher. Students ranged in age from 5 to 7 years. Parents provided informed consent for their child’s participation in the study. All students received services in a special education classroom for part of the instructional day and spent the rest of their day integrated into the general education classroom with typically developing peers. Participants received instruction in functional academics, targeting skills and content designed to help them participate in grade-level groups and activities throughout the day. In addition to academics, participants received intensive instruction in the development of functional communication skills, focusing on to express wants and needs such as “I want …” and “I like …” All three participants received speech services twice a week. None of the participants had any previous exposure or experience to a music intervention.

Bill

At the time of the study, Bill was 7 years old. He was able to communicate his full name, phone number, comment on the weather, and ask questions such as “how are you.” However, Bill needed adult prompting and support to accomplish those tasks. Bill asked his peers routine questions during the social circle time but did not engage in back-and-forth interaction. He showed no interest in his peers’ responses. According to the special educator, Bill needed adult support to participate in interactive games with peers and exhibited aggressive behaviors (yelling, banging doors, running away, and throwing objects) when faced with new routines or when he was under stress.

Erick

Erick was 5 years old at the time of the study. Erick communicated mostly with picture communication symbols (PECS) and used American Sign Language (ASL) and one-word utterances (“yes” and “no”) to express his needs. Erick typically requested with gestures or by guiding someone’s arm to his point of reference, but he did not engage in reciprocal, back-and-forth interaction or play, either with peers or with adults in the classroom. Erick demonstrated stereotypical behaviors such as shaking his head and moving his fingers while looking at them.

Ann

Ann was 5 years old at the time of the study. She had started using two-word sentences to communicate, but she typically pointed to objects of interest to request them. Ann needed adult support to participate in turn-taking activities during the social circle with peers and verbal prompts to share and take turns with others. Ann sometimes displayed aggressive behavior during peer interaction or play time, such as throwing objects to peers or adults, kicking, and biting.

The special educator

The special educator had 25 years of experience teaching students with special needs but no previous experience using MT strategies. She had extensive experience working with students with autism with an emphasis on building social skills. The three participants were identified on the special educator’s recommendation, based on their diagnosis and their individualized education program (IEP) goals for building social skills.

Setting

The study took place in a rural, Midwestern primary special education classroom. The special education classroom was composed of nine kindergarten students with various diagnoses, a special educator, and three instructional assistants.

Mixed-methods design

A mixed-methods design that combined a multiple baseline across behaviors and a case study was used. This methodology provided an opportunity for both data types to be collected, analyzed, triangulated, and reported within a single study (Creswell and Plano Clark, 2007). A multiple baseline across behaviors was used to determine causal inference as to the effect of the intervention and each child’s performance (Kennedy, 2005). Additionally, the school setting was defined as a bounded system, the unit within which the researcher found opportunities to examine and further understand the emerging joint engagement abilities of the three participants (Merriam, 1998).

Quantitative method

The dependent variable was the number of 10-s intervals during weekly 10-min instructional time periods. During this time, each child had one-to-one interaction with the teacher and engaged in focus on faces, response to joint attention, and initiation of joint attention. The researcher developed a detailed coding manual with specific descriptions and examples on the three targeted engagement actions, as following:

Focusing on faces aimed at measuring the child’s instances of looking at the communicative partner’s face. The look could be a response to the teacher’s questions, the child’s attempt to call the attention of the teacher, and/or a sign of interest for the activity on which he was working. This included instances that the child raised his head and looked at any part of the teacher’s face but did not include the child’s random or ambiguous looks at people or at things around him.

Response to joint attention included instances when the child responded and sustained shared attention to the teacher’s communicative prompt or question related to the activity they were doing with the teacher’s support and verbal encouragement. Actions coded in this phase included the child’s shifting gazes between the teacher and the worksheet/object (e.g. letter cubes) they had in front of them on the desk, pointing or showing to the worksheet/object, showing awareness and positive affect with smiles, giggles, nods, attempting to catch the object with looks alternating between the worksheet/object and the teacher, and turning his body physically toward the worksheet/object with his face oriented to the teacher. Response to joint attention did not include instances that the teacher was requesting the student to follow instructions and do something specific with the worksheet/object (i.e. show me the letter A).

Initiation of joint attention included episodes where the student engaged the teacher’s attention in relation to an object by exchanging looks between the object and the teacher for the sole purpose of sharing interest (as opposed to requesting). Examples of initiating joint attention episodes were pointing to the object/worksheet or showing it to the teacher while showing positive affect with smiles and physical gestures (such as nodding her head or making sounds), for the purpose of sharing interests with the teacher and the object. Initiating joint attention did not include instances of the child seeking the teacher’s support to get an object she wanted to play with by herself, such as taking the microphone and keeping it without saying something to the teacher. It presupposed that the child shared positive affect or other indication of social interest in relation to the object and the teacher.

Qualitative method

As a participant observer, the researcher spent the equivalent of at least 1 day a week in the school classroom of the three children for a period of 9 months. During that time, the researcher actively participated in the classroom activities, collaborated with other professionals in the room, and spent time with the children and the special educator in different aspects of their school day (e.g. during recess, in the cafeteria, in their general education classroom, and/or during their speech therapy session). Throughout the day in the classroom, the researcher had conversations with the special educator and other professionals about the social communication actions of the three children. These discussions provided insight into the teacher’s choices as they pertained to the children’s schedule and the shaping of communication opportunities within the school context.

As the intervention evolved, the researcher conducted two semistructured, informal interviews with the special educator and the teacher assistants who were directly involved in the education of the three children. Additionally, the researcher participated in the teacher–parent conferences of the three children and communicated bi-weekly with the parents via email. Information gathered through these processes included descriptions of the teacher–child, teacher–parent, and parent–child interactions. Data also included the gradual introduction of music experiences beyond the intervention time by the teachers and the parents with the purpose of enhancing the social communication competencies of each child.

Data collection

Data collection for all three children occurred after the intervention session, once a week, for a period of 10 min, during the individual one-on-one instructional time each child had with the special educator in the special education classroom. The primary investigator observed in situ and coded each 10-s teacher–child interaction interval for the equivalent of 10 min (60 × 10-s intervals per session) for the occurrence of the targeted outcomes. The day and time of the data collection remained the same throughout the duration of the study. This study took place over a period of 9 months. A range of 21–22 sessions were required to complete data collection for each child. Variations in the number of sessions were due to an individual child’s schedule (e.g. illness) (see Figures 1 to 3).

Figure 1.

Intervention data for Bill (Child 1).

Figure 2.

Intervention data for Erick (Child 2).

Figure 3.

Intervention data for Ann (Child 3).

Comprehensive field notes recorded weekly classroom observations. This included reflections on the researcher’s daily interaction with the participating children and adults in the room. The weekly observations took place over the course of the study (i.e. 9 months). In addition, the researcher conducted two semistructured interviews with the teacher and the parents of the participating children, one at the outset and one at the end of the study. An additional catalog of data included video-recorded music snapshots from the music intervention and the teacher’s progress monitoring logs. This method allowed the researcher to validate data as it related to the emerging joint engagement abilities of the three children within the school’s social environment.

Interobserver agreement

A special education graduate student attended a 3-day training session by the researcher in order to serve as an independent coder. Interobserver agreement (IOA) was collected for 25% of the data. For this purpose, the researcher and the independent coder observed together and coded independently 25% of the baseline and 25% of the student–teacher instructional time for each of the children participating in the study. Percentage of IOA was calculated for each student by summing the number of agreements (either presence or absence of targeted engagement actions) and dividing by the total number of agreements plus disagreements, and then multiplying by 100%. The percentage of IOA ranged from 91% to 96% (M = 94%) across all students and all phases. Bill’s IOA ranged from 93% to 98% (M = 92%), Erick’s ranged from 92% to 100% (M = 96%), and Ann’s ranged from 87% to 94% (M = 91%).

For the qualitative part, an independent, special education, doctoral-level student with experience in qualitative studies served as a peer debriefer. As such, she visited the school setting with the researcher 6 times (approximately 30% of the duration of the study) and she also worked on three random transcripts, identified codable items, and agreed on the researcher’s accuracy of quotes, coding, and interpretation of the source data. Finally, the researcher constructed a narrative to present each case study, drawing on all data sources available. The special educator, the teacher assistant, and the participants’ parents were asked to do a member check on the researcher’s analysis, twice, one after the interview and one last time when the researcher had the information analyzed.

Experimental procedures

Baseline

Baseline data were collected for three to five sessions for all three children on all targeted behaviors across the three phases of the intervention. During baseline conditions, no music intervention was introduced to the three children. After a stable baseline was established for all targeted competencies, the music intervention was introduced with activities appropriate for the first targeted competency. This process was repeated, in sequence, for the remaining phases in the design. A guided timeline of implementation, procedures, and data collection is included in Table 1.

Table 1.

Data collection timeline.

Type of data collection	Procedures overview	Timeline
Qualitative data collection	IRB permission slips	Weeks 1–8 (months 1–2)
	Teacher interviews
	Weekly classroom observations
	Parent–teacher school conferences
Quantitative and qualitative data collection	Baseline data collection for all 3 participants	Weeks 9–14 (months 3–4)
	Weekly classroom observations
	Parent interviews
Quantitative and qualitative data collection	Independent variables data collection	Weeks 10–24 (months 5–8)
Quantitative and qualitative data collection	Weekly classroom observations	Weeks 10–24 (months 5–8)
Quantitative data collection	Parent and teacher interviews	Week 28 (month 9)
Quantitative data collection	Follow-up single-subject data collection	Week 28 (month 9)

IRB: institutional review board.

The music intervention

Each child received weekly, individualized MT sessions by a board-certified music therapist (the primary investigator) in the school’s music room for approximately 30 min (the equivalent of an instructional school period). For each child in the study, the special educator had coordinated the time and the day for each intervention session. During the timeline of the study, sessions were consistently implemented over the course of each child’s weekly school schedule.

Improvisational MT was operationally defined as the use of music activities that varied from specific, age-appropriate songs, to instrumental music, and/or to short improvised rhymes designed to promote engagement and communication between the researcher and the child through the music interactions. The music room had a variety of musical instruments including keyboards (the therapist’s main instrument), diatonic hand bells, pre-tuned frame drums in different sizes, recorders, cymbals, triangles, shakers and maracas, xylophones, glockenspiels, and sticks. The room also included one chair and one desk. For the purposes of this intervention, only the musical materials were used. The instruments were stocked in cupboards around the room and the children could choose their instruments of preference and use them without assistance. During the intervention sessions for each child, the researcher and each child either sat on the mat, in the middle of the room, or next to each other at the keyboards bench. There were no other adults or children present in the room during the intervention session. A semi-flexible MT manual was designed to ensure consistency and replicability of the intervention.

The MT intervention design extended previous research on promoting joint attention for young children with autism (Schertz and Odom, 2007), by building on developmental principles and by following a three-phase sequence to promote focus on faces, responding to joint attention, and initiating joint attention. Also, for the MT intervention, the researcher followed literature on relationship-based interventions (i.e. Dawson et al., 2010; Greenspan and Wieder, 2006) in which adults follow the child’s lead, imitate the child’s actions, and use everyday opportunities in the child’s natural environment to promote joint attention skills and engagement of young children with autism.

Following a relationship-based approach, music interactions during each MT session provided the child with the context for establishing relationships and sharing her attention, intentions, and affect—all integral parts of joint engagement. The music activities introduced were within the child’s focus of attention and his or her range of interest. This was determined by the researcher’s observations and the discussions she had with the special educator. In each session, the researcher included child-appropriate action songs and rhymes (such as “pee-ka-boo” and the “eenee meenee mainee mo”), songs from the Ritholz and Robbins (2003) MT collection, or themes and variations from the child’s musical actions. Also, the researcher introduced songs from specific musical styles that the parents of the children reported they enjoyed listening to, at home.

Each session incorporated four specific components of the intervention: (a) greeting-welcome song, (b) child-led part, (c) adult-led part, and (d) goodbye song. The first component of the session, the welcome song, helped the child orient himself in the room and set the stage for a reciprocal musical interaction to begin. Also, during this part, the researcher supported the child’s ability to focus on faces and established musical and physical proximity with the child.

A child-led component was designed to strengthen each child’s ability for sharing intentions and initiating joint engagement episodes. For that purpose, the researcher expanded on each child’s music-making actions. The researcher matched through music (on the keyboards and with her voice) the child’s rhythmic patterns, melodic contour, and musical and nonmusical expressions. Also, the researcher provided musical structure by adding melodic, harmonic, and/or rhythmical variations to the child’s music choices. For example, the children might use instruments (rhythm-sticks or hand-drums) to engage in solitary play on the mat. The researcher musically enriched the child’s play by using simple melodies and harmonies to mirror the child’s actions. The music typically followed an ABA form because the researcher had observed that all three children were more interested in music pieces that had predictable structure and repeated parts. Additionally, the ABA form offered space for the researcher to introduce new music elements according to each child’s growing abilities to interact through music with the researcher. The researcher’s goal was to maximize the musical and social interplay between herself and the child. As such, the more expressive each child became, the more time the researcher devoted to the child-led component.

In the third, adult-led component, the researcher gradually introduced rhymes, action songs, and musical activities and songs from the Ritholz and Robbins (2003) MT collection. Through that component, the researcher aimed to promote each child’s response to joint attention abilities. For that purpose, the researcher introduced predictable musical patterns, engaged in call-and-response music interactions, and created opportunities for the child to explore musical instruments, take initiatives, and be creative and playful. Also, the researcher modeled the expected action (that is “response to joint attention”) through music. For example, she sang with a dramatic voice, raised her head emphatically, and/or paused after each musical phrase. The music therapist’s goal was to musically invite the child’s response and create a shared musical context (Kim, 2006; Wigram and Elefant, 2008) for joint engagement to develop.

The “goodbye song” marked the end of the session and helped the child to make a smooth transition from the music room to the next school activity. Both the welcome and the goodbye songs remained the same for each child (with slight musical variations) throughout the study.

Results

Children’s independent actions of engagement

Bill

Figure 1 displays Bill’s independent actions of engagement during baseline, focus on faces, response to joint engagement actions, and initiation of joint engagement actions and generalization. During baseline, Bill showed low level of focus on faces and response to joint attention, and no initiation of joint attention actions. During the focus-on-faces phase, Bill increased independent actions of focus on faces to a 2.72 change of mean and met the criteria to move to responses-to-joint-attention phase. Bill independently responded to joint attention actions to a change of mean of 6.55 and independently initiated joint attention actions to a mean of 1.8. Maintenance data indicated that Bill had moderate but substantial gains in his levels of engagement 3 weeks after the completion of the intervention.

Erick

Results presented in Figure 2 show that Erick engaged in actions of focus on faces and response to joint attention during baseline, but he has no initiation of joint attention. When focus on faces was introduced, the change in mean was 0.8. During response to joint attention and initiation of joint attention, variability was observed in his data with a change in means of 1.05 and 1.96, respectively.

Ann

During baseline, Ann (Figure 3) exhibited a low level of focus on faces, and she showed no instances of responding to joint attention or of initiations of joint attention. As the intervention evolved, she showed variability in all three targeted behaviors with moderate and continuous effects with a mean change of 2 for focus on faces, of 1.56 for response to joint attention, and of 1.74 for initiation of joint attention. The maintenance data show that Ann increased the engagement actions 3 weeks after the end of the intervention.

Follow-up

All three children maintained generalizable results after a 1-month follow-up. These results were validated by both the teacher and parent responses.

Qualitative analysis: music is my friend!

Qualitative analysis and emerging themes were generated from the researcher’s observations, field notes, and information gathered through the parents’ and teachers’ interviews. This information was coded, organized into categories, and analyzed for emergent themes by the researcher. The analysis generated a report that was distributed to the parents and teachers of the children for their comments, corrections, and additions. The report and the feedback generated a convergence of ideas from the qualitative data and strengthened the credibility of the conclusions. Additionally, an independent, special education, doctoral-level student served as an independent coder. She underwent the same process of analyzing the qualitative data for emerging themes to ensure trustworthiness and eliminate bias in the analysis (McMillan and Schumacher, 2010).

The three following cross-data themes emerged from the qualitative analysis: “I need to be there: academic and social interactions intertwined,” “Bill has a friend: sharing of affect,” and “I can hear you with music”: communication in musical forms.” In the following, each theme is described and supported with examples across the data.

I need to be there: academic and social interactions intertwined

The special educator and the instructional assistants’ stories about the three children highlighted the link between engagement and academic challenges. The special educator said, “It is difficult to separate the two because [Erick] isolates himself and I do not know what he needs … and … [Ann] threw the [activity sheet] and the pencil and we had to stop.”

Shortly after the beginning of the intervention, the educators in the resource room started noticing changes in the children’s communicative actions and automatically contributed these changes in student actions to the music intervention. The educators in the resource room started noticing that “ … [the children] turn their head smile or move closer to the circle” when songs are included in the classroom activities. “I sang 1-2-3 that’s enough for me and [Bill] listened and came back …” the special educator said and she continued, “Bill held hands with Ayden during London Bridge … this was a big step!” Gradually, the educators in the room began incorporating songs and rhymes to enhance their instructional strategies. “Now they are singing their way through the day,” said Bill’s instructional assistant to describe the change in their daily routines.

“Bill has a friend”: sharing of affect

While music had supported interactions among the three children and adults in the room, the special educator identified children’s challenges in engagement as a barrier to interacting with their peers. The participants had to be accompanied by an adult whose presence, however, would tend to hinder spontaneous peer interactions. “Erick usually spends the time in the bathroom, unless I take him out” said the instructional assistant and continued, “… (Erick) cannot be there without me, … and the kids get scared and I take them back (to the resource room).”

Shortly after the second month of the music intervention, Bill approached a little girl who was sobbing at the corner of the room and told her “Don’t be sad, Lisa!” Later in the year, the teacher assistant announced with triumphant pride: “Bill has a friend!” and shared how Bill during the previous period walked into the inclusive classroom and sat next to one of his classmate instead of sitting next to her. The special educator emphasized on how she was pleasantly surprised at Bill’s direct expression of affect and empathy because “… (Bill) is learning to be with others …”

“I can hear you with music”: communication in musical forms

The children’ social experiences seemed to reach beyond the school setting. Bill’s mother commented, “[Bill] is now singing in the car … he does well and this time spent in MT makes him more comfortable with new things and communicating in a new way.”

Erick’s mother shared with the researcher and the special educator that “He seems to love music now … we have a recorder home for his sister, and yesterday he took it and put it in his mouth in front of her.” She went on describing that Erick was gradually more social during family gatherings and more receptive to his siblings’ presence while he was watching his favorite puppet-music show on TV. What seemed to be more important “[Erick] took his recorder and started playing in front of his sister … and then sat next to her to watch the DVD.” According to Erick’s mother since Erick was more interactive, an increase in her other children’s ability to acknowledge his presence and actions during family routines was evident.

Social validity

At the conclusion of the study, the special education teacher and the two teacher assistants were asked to complete a social validity questionnaire. The survey was composed of five short-answer questions. It included questions on the importance of the intervention goals (i.e. promoting joint engagement and joint attention skills for the three young children), the appropriateness of using music as an intervention tool in the school setting, levels of ease, and the feasibility of implementing the intervention. Results from the survey can be interpreted to conclude that special educator and assistants involved believed the focus of the intervention positively affected the three children’s emerging social abilities in the school setting, the intervention was appropriate for their age, and it was easily incorporated in the school day.

Discussion

The findings of this study indicate that MT intervention is a promising practice in promoting the social engagement of young children with autism. According to the data, all participants demonstrated increased levels of focusing on faces, responding to joint attention, and initiating joint attention. Reports and observations from the parents and the teachers confirmed that the gains of the intervention transferred across settings and across trainers.

The findings from this study point to the importance of creating interactive opportunities and relationship-based approaches within the school setting as an essential perquisite for children’s successful social communication development. The special educator and the instructional assistants identified in the use of music an instructional strategy which they could embed into the classroom daily routines as a stimulating element of engagement and learning. The intentional use of songs and rhymes allowed the special educator to move away from drilling the students in social interactions. The teachers realized that music provided opportunities to arouse children’s curiosity and attention in relation to their interests and ability levels. As such, the playful atmosphere during the music activities allowed for social communication to evolve as an integral part of the children’s actions and routines within the school setting. Gradually, music experiences supported educators to focus on children’s strengths and be intentional when creating music opportunities for intensifying children’s learning and levels of engagement within the classroom.

Also, the findings of this study indicate that children’s social abilities transferred across settings into the children’s home. For example, parents described their children’s music interactions with other family members, as an enjoyable, new experience indicative of the children’s recognition of other family members’ presence. Such affection and emotional sharing allowed them to feel closer to their children and enjoy moments of proximity, and understanding as a family. The parents shared how music helped them experience their child as “a child with autism, instead of a child with autism” (Balkan et al., 2008). Laughter, smiles, and music games helped them interact more with their child with an emphasis on the child’s strengths, interests, and abilities.

Overall, the way teachers and parents responded to children’s actions affected the quality of the children’s interactions. In line with Bronfenbrenner’s (1979) systems model, incorporating music intervention activities into the children’s daily routines led to adjusted and more sophisticated peer and adult responses both in school and at their family environments. The more communicative partners related the children’s gestures and actions to a communicative function, the more they responded to the children. These experiences supported the sharing of communicative intentions, attentions, and affect so that the three participants were more active partners in the social classroom environment. Gradually, the three participants progressed to more complex forms of interactions based on their ability to share interests and communicative intentions. As expected, in this continuum of social engagement, new forms of sharing and communication evolved, co-constructed by the peers and the adults present.

Limitations of this study

To fully understand and apply the findings in the current study, several limitations need to be considered. This study is limited by the small number of participants and by the fact that the researcher was herself conducting the intervention sessions as well. Also, time restrictions related to changes in the school schedule of the typical school day and calendar may account for variability in the data points and the limited follow-up data points. Due to the end-of-the-year school activities, the researcher was able to get only one follow-up data point. Finally, issues related to treatment integrity were raised as the improvised nature of the music intervention did not allow for precise replication or transparent description of intervention procedures. A semistructured manual was generated by the researcher; however, there was no assessment ensuring the fidelity of implementation of the MT intervention.

Future studies

This study highlights the gains in social engagement that can be facilitated through child-centered, MT intervention, which follows a developmental framework for young children with ASD. According to the findings from previous and the current study, MT interventions hold the potential to create opportunities for social sharing, can be used to teach joint attention skills, and can enhance joint engagement abilities of young children with ASD. In a primary school setting, music is typically included in daily school routines. The intentional use of music in the classroom has the potential to provide an easy, cost-effective venue for children with autism to develop social communication and engagement abilities.

To increase external validity and generalizability of results, future research should include more participants, at least 2–3 follow-up data points and/or a control group, and an interventionist Music Therapist–Board Certified (MT-BC) to conduct the MT sessions, different from the researcher. Also, researchers could consider exploring opportunities for collaboration and training among school professionals (such as special educators) and the researcher/music therapist. This way, educators could implement music therapist strategies during instructional time to promote inclusive practices and promote social engagement skills of young children with autism in their group. These enhancements could strengthen the evidence that MT interventions can enhance social engagement of young children with ASD.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

References

Adamson

Bakeman

Deckner

(2004) The development of symbol-infused joint engagement. Child Development 75(4): 1171–1187.

Adamson

Bakeman

Deckner

. (2009) Joint engagement and the emergence of language in children with autism and down syndrome. Journal of Autism and Developmental Disorders 39(1): 84–96.

Alpern

(2012) Enhancing language and communication development. In: Zager

Wehmeyer

Simpson

(eds) Educating Students with Autism Spectrum Disorders: Research-based Principles and Practices. New York: Routledge, pp.281–294.

Bakan

Koen

Kobylarz

. (2008) Following Frank: Response-ability and the co-creation of culture in a medical ethnomusicology program for children on the autism spectrum. Ethnomusicology 52(2): 163–202.

Bono

Daley

Sigman

(2004) Relations among joint attention, amount of intervention and language gain in autism. Journal of Autism and Developmental Disorders 34(5): 495–505.

Bronfenbrenner

(1979) The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press.

Broun

(2004) Teaching students with autistic spectrum disorders to read. Teaching Exceptional Children 36(4): 36–40.

Bruinsma

Koegel

(2004) Joint attention and children with autism: A review of the literature. Mental Retardation and Developmental Disabilities Research Reviews 10(3): 169–175.

Bryan

Gast

(2000) Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Journal of Autism and Developmental Disorders 30(6): 553–567.

10.

Creswell

Clark

VLP

(2007) Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: SAGE.

11.

Dawson

Rogers

Munson

. (2010) Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics 125(1): e17–e23.

12.

Dettmer

Simpson

Myles

. (2000) The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities 15(3): 163–169.

13.

Donnell

(2007) Messages through music: musical dialogue as a means of communicative contact. Canadian Journal of Music Therapy 13(2): 74–102.

14.

Gold

Wigram

Elefant

(2006) Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews 19(2): CD004381.

15.

Gooding

(2011) The effect of a music therapy social skills training program on improving social competence in children and adolescents with social skills deficits. Journal of Music Therapy 48(4): 440.

16.

Greenspan

Wieder

(2006) Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Boston, MA: Da Capo Press.

17.

Hale

Tager-Flusberg

(2005) Social communication in children with autism. Autism 9(2): 157–178.

18.

Hobson

(2010) Explaining autism. Autism 14(5): 391–407.

19.

Holck

(2002) Music therapy for children with communication disorders. In: Wigram

Pedersen

Bonde

(eds) A Comprehensive Guide to Music Therapy. London: Jessica Kingsley Publishers, pp.183–187.

20.

Jones

Schwartz

(2009) When asking questions is not enough: an observational study of social communication differences in high functioning children with autism. Journal of Autism and Developmental Disorders 39(3): 432–443.

21.

Jones

Carr

(2004) Joint Attention in Children With Autism Theory and Intervention. Focus on Autism and Other Developmental Disabilities 19(1): 13–26.

22.

Kaplan

Steele

(2005) An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum. Journal of Music Therapy 42(1): 2–19.

23.

Kasari

Freeman

Paparella

(2006) Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Journal of Child Psychology and Psychiatry 47(6): 611–620.

24.

Kasari

Gulsrud

Wong

. (2010) Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders 40(9): 1045–1056.

25.

Katagiri

(2009) The effect of background music and song texts on the emotional understanding of children with autism. Journal of Music Therapy 46(1): 15–31.

26.

Keen

Rodger

Doussin

. (2007) A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism. Autism 11(1): 63–71.

27.

Kennedy

(2005) Single-Case Designs for Educational Research. Boston, MA: Pearson.

28.

Kern

Wolery

Aldridge

(2007) Use of songs to promote independence in morning greeting routines for young children with autism. Journal of Autism and Developmental Disorders 37(7): 1264–1271.

29.

Kim

(2006) The effects of improvisational music therapy on joint attention behaviours in children with autistic spectrum disorder. Doctoral Dissertation, Aalborg University, Aalborg.

30.

Kim

Wigram

Gold

(2008) The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders 38(9): 1758–1766.

31.

McMillan

Schumacher

(2010) Research in education: Evidence-based inquiry. Boston: Pearson.

32.

Merriam

(1998) Qualitative Research and Case Study Applications in Education: Revised and Expanded from Case Study Research in Education. San Francisco, CA: Jossey-Bass Publishers.

33.

Mundy

Sullivan

Mastergeorge

(2009) A parallel and distributed-processing model of joint attention, social cognition and autism. Autism Research 2(1): 2–21.

34.

Nation Autism Center (2009) National Standards Report: The National Standards Project – Addressing the Need for Evidence-Based Practice Guidelines for Autism Spectrum Disorders. Randolph, MA: National Autism Center. Available at: http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf

35.

Paul

Sutherland

(2005) Enhancing early language in children with autism spectrum disorders. In: Volkmar

(eds) Handbook of Autism and Pervasive Developmental Disorders. New York, NY: Wiley & Sons, 946–976.

36.

Pelios

MacDuff

Axelrod

(2003) The effects of a treatment package in establishing independent academic work skills in children with autism. Education & Treatment of Children 26: 1–21.

37.

Rao

Beidel

Murray

(2008) Social skills interventions for children with Asperger syndrome or high functioning autism: a review and recommendations. Journal of Autism and Developmental Disorders 38: 353–361.

38.

Ritholz

Robbins

(2003) More Themes for Therapy. New York: Carl Fischer Music.

39.

Schertz

Odom

(2007) Promoting joint attention in young children with autism: a parent-mediated developmental model. Journal of Autism and Developmental Disorders 37(8): 1562–1575.

40.

Schertz

Odom

(2004) Joint attention and early intervention with autism: a conceptual framework and promising approaches. Journal of Early Intervention 27(1): 42–54.

41.

Siller

Sigman

(2002) The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders 32(2): 77–89.

42.

Simpson

Keen

(2010) Teaching young children with autism graphic symbols embedded within an interactive song. Journal of Developmental and Physical Disabilities 22(2): 165–177.

43.

Standley

(1996) A meta-analysis on the effects of music as reinforcement for education/therapy objectives. Journal of Research in Music Education 44(2): 105–133.

44.

Starr

Zenker

(1998) Understanding autism in the context of music therapy: bridging theory and practice. Canadian Journal of Music Therapy 6(1): 1–19.

45.

Swanson

(2005) Provide structure for children with learning and behavioral problems. Intervention in School and Clinic 40: 182–187.

46.

Tager-Flusberg

Sullivan

(2000) A componential view of theory of mind: evidence from Williams syndrome. Cognition 76(1): 59–90.

47.

Trevarthen

(2002) Autism, sympathy of motives and music therapy. Enfance 54(1): 86–99.

48.

Wetherby

(2006) Understanding and measuring social communication in children with autism spectrum disorders. In: Charman

Stone

(eds) Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention. New York: The Guilford Press, pp.3–34.

49.

Wetherby

Woods

(2006) Early social interaction project for children with autism spectrum disorders beginning in the second year of life. Topics in Early Childhood Special Education 26(2): 67–82.

50.

Whalen

Schreibman

Ingersoll

(2006) The collateral effects of joint attention training on social initiations, positive affect, imitation, and spontaneous speech for young children with autism. Journal of Autism and Developmental Disorders 36(5): 655–664.

51.

White

Keonig

Scahill

(2007) Social skills development in children with autism spectrum disorders: a review of the intervention research. Journal of Autism and Developmental Disorders 37(10): 1858–1868.

52.

Wigram

Elefant

(2008) Therapeutic dialogues in music: Nurturing musicality of communication in children with Autistic Spectrum Disorder and Rett Syndrome. In: Trevarthern

Malloch

(eds) Communicative musicality. Oxford University Press (in press).

53.

Woodward

(2004) Music therapy for autistic children and their families: a creative spectrum. British Journal of Music Therapy 18: 8–14.