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Music and Smiles: Development of Social Interactions in Children with Autism through Participation in a Community Music Group

Alexis Lyon California State University East Bay

With Special Thanks to my two supervisors for the continued support, the Multicultural Music Fellowship for the generous donation of harps, and the children who played all of the music! Music and Smiles: Development of Social Interactions in Children with Autism through Participation in a Community Music Group

Introduction

Music springs forth from the universal human soul, inviting us to express ourselves and communicate. But music is obviously more than just a means of communication, playing music and listening to music are ways for people to engage with each other and to feel connected to one another. Community music is a specific type of a collaborative music making process, which seeks to engage participants in a freeing and joyful musical practice. I was interested in exploring how community music could be employed to help children with autism experience togetherness with their peers. My action research project used community music as a platform to build social bonds, in an elementary school setting between participating group members. “This is a population that experiences failure on a daily basis, your challenge is to not allow failure to happen again.” (K.E. personal communication). Children with autism often have difficulty creating and maintaining social relationships; still, many children with autism strongly desire social connections and social experiences. The challenge is to provide a context in which children with autism and their neurotypical peers can have enjoyable social experiences together. Children with autism often take part in many types of therapy from a very young age, such as Applied Behavior Analysis (ABA), Occupational Therapy (OT), and speech therapy. Although these therapies have generally shown to be beneficial to this population in increasing their communication skills and academic skills, extensive participation in these therapies does not leave much time for children to experience some of the simpler joys of childhood such as just being with friends and free-play. Additionally, most of these therapies operate from a deficit model, which means that these children are experiencing failure on a daily basis as they are engaged in “fixing their deficits.”

Part of my work was to come up with an intervention that did not add to this daily failure and the possible resulting stress; I am interested in finding ways to work with children with autism that are strengths-based and which are naturally enjoyable for children.

The psychology theorist, Leo Vygotsky, suggested that play is an important part of childhood development, which can lead to strong learning behavior and the ability to build strong connections and relationships with others (Kravtsov et al, 2010). Therefore, if opportunities for play and joy are provided, children may naturally engage and will develop positive skills as a result. As part of my work at this school and my future professional work, I would like to be able to create joyful and playful programs, which address the social and emotional needs of children. Can community music can be used as an effective and enjoyable platform to help increase the social initiations and social responses between children with autism and their neurotypical peers? Literature Review Music therapy and community music are related models which both use music for mental health purposes but they operate from different perspectives. Traditional music therapy is a branch of psychotherapy and takes a medical model approach to addressing the needs of participants (McFerran & Rickson, 2004).

In a school setting, traditional music therapy would likely be practiced in a small, pullout group and would include participants who have specific goals to be addressed through the therapy (McFerran & Rickson, 2004). There are different types of music therapy; it sometimes involves active client participation and sometimes is completely led by the therapist (i.e. the therapist plays music and the client listens). In schools, music therapy may often be adult-led or guided (McFerran & Rickson, 2004).

Community music emerged in the United Kingdom during the 1960s as part of a political movement, which aimed to foster togetherness and human connection through the arts (Higgins, 2008). Part of the community music ethos is that the music making of all people is important and valid; thus, music made by children is considered as valid as adult produced music (Higgins, 2008). Community music in schools takes an ecological approach to addressing participant needs and would generally take place in a mainstream classroom (McFerran & Rickson, 2004). The community music practitioner would seek to create a musical participation culture within a school in order to promote an emotionally healthy environment school-wide and create a strong interconnected community (McFerran & Rickson, 2004). Community music groups tend to place emphasis on improvisation and child-led music making (McFerran & Rickson, 2004). Research from the field of music therapy suggests that music can be a powerful tool in helping to increase the social responses and social initiative in children with autism. This positive foundational research from the music therapy field justifies further exploring the positive social connections that can be made when children with autism participate in music groups and music projects.

The following quantitative research studies exemplify some of the positive research conducted on the efficacy of using music therapy with children with autism: · Children with severe autism participated in a music therapy group with their parents and the children’s rates of social responses with their parents showed positive increases over time (Thompson, McFerran, & Gold, 2013). In a single subject study, a young girl with autism was shown to have more social responses and social initiations when participating in music sessions with her therapists than when participating in play therapy with the same therapists (Finnegan & Starr, 2010). · In a study comparing play therapy to music therapy for children with autism, children in the music therapy group were shown to have more social responses and initiations than did children in the play therapy group (Kim, Wigram, & Gold, 2009.)

While there has not been significant quantitative research on community music groups for children with autism, there are a few notable qualitative studies. In one study, parents of children who took part in a community music group in London were interviewed about their children’s experiences (Pavlicevic et al, 2014). The parents quite eloquently described how being part of a long-term community music group helped with their children’s communication needs, emotional expression, sense of belongingness, self-esteem, and independence (Pavlicevic et al, 2014). The “Music Play Project” is another notable community music group for children with autism, which aimed to put the joy of music making as the focus of the group and then explored the building of children’s social connections (Bakan, 2015). The group followed no pre-established genres and did not require children to learn specific pieces of music; instead, children were encouraged to express themselves through musical improvisation (Bakan, 2015). In order to explore the experiences of the children in the “Music Play Project,” Michael Bakan pulled from his ethnomusicology background to understand children’s musical experiences as they are, not as they could be. (Bakan, 2014).

From an ethnomusicological perspective, children with autism are music makers, participating and creating a culture of their own, rather than as music beneficiaries who are being “fixed” by the music (Bakan, 2014). Bakan used ethnographic techniques in his research such as interviewing the children about their musical experiences and participating respectfully in music making with them, thus the viewpoints and experiences of the children themselves are given center stage (Bakan, 2014). During an interview with the parent of a participate, the parent expressed that music provided her child with a strong means of communication and a creative outlet (Bakan, 2015). Another child used the music group to write a creative piece of musical theatre and used the musical platform and further interviews as venues to express her views on autism and to advocate for autism social justice (Bakan, 2015). This literature review helped shape my thinking about my action research project. My initial ideas reflected a music therapy viewpoint because I was specifically looking for music to change or “fix” something. However, over time, I came to see the community music model as a potentially more liberating model of music making in that it supposes that the creation of opportunities for joy and connection in a school setting might naturally increase children’s social connectivity with each other. Furthermore, from a community music point of view, enjoyable musical experiences are considered valuable in and of themselves, whether or not lasting change is created.


After reading Michael Bakan’s research, I decided to use a qualitative ethnographic style of data collection in order to reflect the children’s unique experiences with their community music sessions. Child-centered ethnography provided a manageable way to collect rich qualitative data. This style of data collection also allowed for a Participatory Inquiry Process (PIP) to take place as the community music group sessions progressed, because as children were observed in the music group and interviewed about their experiences, I was able to change and adapt the group sessions to fit their needs and desires. Community, School, Study Sample (Subjects) 
 This research was conducted at an elementary school, located in a suburb of a large metropolitan city in California. According to the most recent census data, the community consisted of nearly 76,000 people (Census, 2010). The suburb is a generally middle class community, with a median income of $74,000 and approximately 10% of individuals living in poverty (Census, 2010).

The population is comprised of 50% Caucasians, 31.2% Asians, 11% Latinos, and 6.4% African Americans (Census, 2010.) The population of the elementary school somewhat reflects the population of the larger community. According to the most recent School Accountability Report Card (SARC) data, the students who attend the elementary school are 43% Caucasian, 19% Asian, 15% Latino, and 2% African American, with 14% percent of students identifying as two or more races (California Department of Education, 2015). 17% of the students are considered economically disadvantaged. English learners make up 19% of the school (California Department of Education, 2015).

My pilot action research project did not target the entire elementary student body. Instead, I had five small groups of students with three to four students in each group, totaling seventeen participants. Fourteen children were 1st grade students who were in general education classrooms. I also had three 4th grade participants who were in the moderate/severe autism classroom. Of my action research participants, 64% were Caucasian, 24% were Asian, and 12% were Hispanic. Ten of the participants were girls and seven were boys. Participatory Inquiry Process
 The Participatory Inquiry Process (PIP) is a way of thinking about change in schools in which individuals question what is going well and what could be improved, then set about to create positive change, and through their participation in the creation of change, alter and improve their own methods working in schools (Lewis & Winkelman, In press.)

Thus, the participatory inquiry process is an exciting dynamic way of creating hopeful and positive change in schools.

Phase One: Initiating Conversations and Identifying Challenges When I first began asking about research projects that might benefit my school, the principal and the school psychologist, had several ideas and many areas of need at the school emerged. I actually was able to engage with the staff in more than one area of research at the school, a process that helped me come to feel more integrated into the fabric of the school. However, due to a variety of time constraints, none of those projects were appropriate for this action research project.

The principal suggested that I conduct a project that involved the population with autism. She explained that as the population with autism has grown, the need for programs and interventions for children with autism has also grown. She estimated that a decade ago, there were three or four children with autism in the entire school and now there are three or four children with autism in every grade. The principal explained that she is interested in developing more intervention options for this population and gave me an amount of free reign to design the project myself. The school psychologist suggested that there was a need for social programs for children with autism at the kindergarten level. She explained that there were five inclusion children with autism diagnosis in kindergarten and that it could be positive to help encourage inclusive play between those children and their peers. Both the principal and the school psychologist were on-board with my idea of creating an inclusive community music group at the school.

Phase Two: Engaged Inquiry
 While the typical opportunities to form social relationships and connections exist at the school, (recess, free playtime, lunch time, et cetera) sometimes children with autism do not take advantage of these natural opportunities to create social connections. There are not many intervention options available to children who have difficulty making friends. Children with autism who have Individualized Education Plans (IEPs) may receive social skills training through speech therapy or sometimes through the social skills groups run by the school psychologist and school psychologist intern. These groups generally are intended to explicitly teach the social skills that children may need to make friends and while they may be enjoyable groups for some children, they are not explicitly friendship groups. That is, children are supposed to learn social skills in these groups and then go onto the playground and use their new skills to make friends.

Through my own observations and in talking with others who facilitate these social skills groups, children often make progress in learning about social skills and are able to successfully practice their skills in the counseling or speech setting. However, many children have trouble generalizing their new skills to other settings and thus may often have difficulty in forming strong and lasting friendships at school. I wanted to see more opportunities at this school for children with autism to make friends and socialize with their peers outside of whole-school recess and social skills instruction groups. Small, interest-based clubs and “lunch bunch” social groups are some examples of potentially enjoyable activities that could promote healthy connectedness for this population. Small groups may feel safer and less overwhelming for some children and provided activities may take the pressure off of socialization, allowing children to interact at their own pace. Other staff at the school have also noticed the need for children to sometimes have small, facilitated, play and social groups. As the school psychologist pre-intern, I am often asked to create these groups and am inundated with requests for children to be in them.

A community music group fit both within the needs of the school and within my established role. As it had been suggested that there was a need for social group programs at the kindergarten level, I decided to reach out to those teachers to see if they believed that some of the children in their classes could enjoy community music groups and benefit from them. I sent permission forms home with the children that were recommended for the group and I telephoned all of their parents to discuss the group in more detail. None of the permission forms were returned and parents reported that they were confused about why their children were asked to be in the group. It was apparent that while administration and teachers saw a potential area of need for social group programs at the kindergarten level, the parents of these students did not see the same need. I approached teachers from other grades to inquire about whether they felt their students would benefit and enjoy community music groups. Most of the teachers at the upper grade levels informed me that they did not want their children missing too much class time. However, the first grade teachers were interested in the project and the teacher in the moderate/severe autism class also expressed interest. This time around, I sent out permission forms to entire classrooms rather than only to specific students who were recommended by their teachers and I had a much larger number of permission slips returned.

Phase Three: Collaborative Actions
 During the community music sessions, children were encouraged to improvise with instruments, sing, write songs, and direct the music. Available instruments included harps (generously donated by the Multicultural Music Fellowship), an ukulele, a mountain dulcimer, hand drums, and shakers. These instruments were chosen because they are considered to be “high yield, low input” instruments (i.e. even though they all require considerable skill to play well, they can still be played enjoyably by individuals who have little or no musical training.) Children were free to participate as much or as little as they liked. Each group began and ended with a ritual of the whole group listening to each child play on an instrument of their choice.

During the bulk of the sessions, children were allowed to freely improvise, sing, dance, or listen. I played along with the children and followed their musical leads. Improvisation games, such as call and response with instruments and playing different emotions on the instruments were sometimes introduced. I also taught some children simple tunes at their request. A special note should be made about the use of the harp for these groups, because harp playing featured prominently in all of the music sessions and playing the harps was considered a highlight for many of the children who participated. The harp has a long history of being used as a healing instrument and is often played in hospitals and retirement centers. Additionally, with the resurgence of availability of small harps, harps are also being used more and more in community music groups with children. The bright, colorful harps (we had them in yellow, green, blue, and lavender) were particularly attractive to the children; most of the children had never seen a harp, let alone been invited to play one. Beyond their novelty value and pretty visual appearance, the harp is also very pleasing to play immediately (children almost always start by playing glissandos, which sound so thrilling on the harp). The musical attractiveness of the harp for a beginning student means that children can feel musically successful on the harp almost immediately. Additionally, because I play the harp, I was able to use the harp to back the children as they played music, providing musical foundation and support for their exploration.

I was able to form five small community music groups, four of which were first grade groups and one group was comprised of fourth grade students from the moderate/severe autism class. Initially, I had wanted to create mixed groups of children with autism and neurotypical children, but due to scheduling conflicts, this was not feasible and the groups were unfortunately kept separate. Each group met for a half hour during school hours and on school grounds. One group was able to meet only one time, three groups met for four sessions, and a fifth group met for eight sessions. I used an anthropological/ethnomusicological framework for collecting data.

By collecting data through ethnographic interviews, observations, and participation in the music group with the children, I hoped to understand the children’s musical and social experiences in the group. I conducted post interviews with the children in order to understand how they felt about their musical experiences in the group and how they felt about playing music and interacting with their peers in the group. I videotaped the first and last sessions to look for qualitative change in the children’s interactions with each other. Additionally, I used a modified session rating scale (SRS) form to track the children’s feelings about their musical and social experiences (My Outcomes Tools, n.d.). On the SRS form, children were asked to answer the following three questions by coloring in a happy, medium, or sad face: “How was this session for you?” “How was it to be with your friends/peers in here?” and “How was it to make music in here?” Children were also allowed to verbally elaborate on their responses if they wanted to. Asking the children for their feedback on a daily basis, both served to convey to them that their experiences and opinions of the musical activities are valuable and also allowed me to adjust the musical sessions if necessary (Duncan, B.L et al, 2004).

Because very little practical information is available on how to facilitate a community music group, I contacted Michael Bakan (whose work I referenced in my literature review) and he was gracious enough to allow me to interview him over the phone. He suggested having a paraprofessional present during sessions with children with autism, using “high yield, low input” instruments, and limiting the availability of instruments with extremely high pitches (Bakan, M., 2016, personal communication). We also discussed how I could apply my listening and musical skills in such as way that I could enhance and honor the children’s music without taking over musically (the musical equivalent of “tracking” in play therapy) (Bakan, M. 2016, personal communication). He suggested that I follow children’s rhythms and melodies, softly echo their playing, or keep steady beats while they explored their instruments (Bakan, M. 2016; personal communication). Finally, he explained that participation should never be forced and that children may gain enjoyment from simply listening to their peers (Bakan, M. 2016; personal communication).

Gaining this information allowed me to implement community music group services in a more effective way, which reflect the current best practices of the small community music field. I hypothesized that participation in a community music group would foster social connectivity among the participating students. Research from the medical model of music therapy suggests that while social connections through music are often created in the musical environment, these skills and connections are not often generalized to other settings (Thompson, McFerran & Gold, 2013.)

Community music practitioners often take the viewpoint that while lasting change outside of the musical environment would be ideal, they also acknowledge that the joy and connections created in the musical environment should be considered valuable in and of themselves. Operating from a community music model, I was hoping to see connectivity occurring during the sessions, but would not expecting huge impacts outside of the sessions. Phase Four: Community Assessment and Reflection Each of the five groups made music very differently; they developed different music goals, had different music synergy, had different musical tastes, and had different challenges along the way. Three of the groups showed a similar musical and social trajectory- they were excited about the music groups but each individual had their own ideas for group musical goals. Some children wanted to play songs individually, some were interested in learning “real” tunes, some were interested in writing songs with lyrics, and some wanted to play percussion instruments loud and furiously, while others plugged their ears. I let the children navigate how they wanted to handle these individual goals and differences in musical taste. One of the groups preferred to have each child play separately and have a sharing circle at the end of the session in which each individual showed off what they had accomplished during the session. Another group would assign one child to be the director; the director controlled the volume of each member of the group and indicated when each group member should play.

[1] The third group worked together to assign different parts to each group member (one child played a drum; another child played a harp et cetera).
[2] The musical synergy ebbed and flowed throughout the sessions for each of these groups as each of these groups sought to find ways of making music together; sometimes they felt they were successful in coming together and other times children indicated that their group individual musical goals had not been achieved.

Minor conflict arose in all three of these groups, the most common conflict was around volume levels, with some children enjoying playing louder than others found comfortable. The children navigated this common conflict in different ways; one group appointed a volume director and another group decided to ban the loud instruments. One group had two participants who actively disliked each other. They were able to play together during the first three sessions without their bringing their outside conflict into the group, but by the fourth and final session, their interpersonal conflict was more apparent. They were able to agree to put aside the conflict by agreeing to listen to each other but not play together. During later interviews, both of these children brought up the conflict, but each stated that they did not mind playing music with the other.

On the pre-session survey, all of these children indicated that they feel included with their peers at school, indicating an already strong sense of connectedness for all of these children. On a post survey and during interviews after the group sessions had ended, ten out of eleven children from these three groups indicated that they greatly enjoyed the music sessions, while the eleventh child said that she enjoyed the sessions sometimes but not all of the time. Common responses to favorite things about the sessions were “getting to play harps,” and “getting to play the thunder machine.” All of the children stated that they enjoyed being musicians. One child stated that it was enjoyable to get to play whatever she wanted to play and not have to follow rules like in her other music classes. Another child stated that she felt being a musician was inspiring. Another girl sang her answers to all of the interview questions and composed some on the spot lyrics about how much she liked being a singer and a musician. There was variation in how group members felt about playing music with their peers- some of the children indicated that they really enjoyed playing with their peers, while others showed less enjoyment of this aspect of the group sessions. One child stated that while he enjoyed the group, he was frustrated that his peers did not have the same interest in playing “real” tunes and stated that the noise level preferences of the other children were annoying to him. On the post session survey, all of the children reported that they continue to feel included with their peers at school.

A fourth group, comprised of three first grade students- two girls and one boy, had a somewhat different musical trajectory than the other first grade groups. The children in this group showed an interest in playing together from the beginning of the sessions. In early sessions, they attempted to copy each other’s noise levels. In later sessions, they developed high musical synergy and worked together to create intricate rhythms and songs. Interestingly, as they began to work together musically, their other social interactions began to decline. They would come quietly into the room, pick up their instruments and begin playing, often without much discussion of what or how they wanted to play together. They frequently sat with their backs turned away from each other, but still successfully listened to each other and played together.[3] On a pre-session survey, two out of three of these children reported feeling included with their peers at school, the third child reported that she only sometimes feels included with her peers.

During post surveys and interviews, all three children in this group indicated high levels of enjoyment of the group and playing with their peers. All three of these children indicated that they wanted to continue playing music in some form and would not mind continuing to play with each other. The girl who had indicated that she only felt included with her peers at school “sometimes,” stated that this was still the case after the sessions were over. She stated that she felt very included with the other children during the musical sessions and had liked playing with them. The other two children reported that they continued to feel high levels of inclusion with their peers at school. Due to difficulties with scheduling and the requirement for a paraprofessional (who was often unavailable), the group of children from the moderate/severe autism classroom were only able to meet one time. This group who comprised of three boys who were all in the fourth grade. We met on a warm breezy, day and we played music outside under a tree. One boy sat quietly and listening to his peers play music. Another child played the drum when it was placed in front of him but did not reach out for any of the other instruments. The third boy enthusiastically tried all of the instruments, before settling on the harp and strumming it for the rest of the session. He and I sat together playing harps and he occasionally reached over to my harp to strum it for a second before returning to play his own again. A paraprofessional who also helped facilitate this group session stated that he believed the children responded well to the free-flowing and non-restrictive nature of community music participation. He stated that when compared to other times of the day, the children appeared happy, calm, and content while playing and listening to the music. When asked how they felt about the session, all three children indicated enjoyment of the music session.

Limitations

I think the most obvious limitation to this project was that I was unable to create a situation in which the children with autism were able to join the groups comprised of neurotypical children. Additionally, the group with children with autism only met a single time due to scheduling constraints. Therefore, the nature of this project changed drastically from my initial ideas to it’s actual implementation and the data that I obtained never did truly answer my hypothesis question. However, I still found the project valuable because I was able to learn how this group of neurotypical children navigated the community music experience and was able to briefly observe how children with autism might respond to being part of a community music group. Recommendations I think if I were to recreate this project (and I do want to!), I might consider hosting the sessions during after school hours so that children who were interested could participate during a time which was specifically set aside for community music. Additionally, in another setting, I would like to offer community music experiences continuously so that community music could become part of the fabric of the culture of the school and not just be a one-time experience opportunity.


Conclusion

Participation in community music groups provided these children with way of connecting with each other through music. While the effects of participating in one music group are not likely to be pronounced, small doses of joy in a child’s life have additive effects, which cumulatively lead to higher feelings of connectivity and belongingness. Even when challenges and conflicts arose within the groups, the children were able to find their own solutions and almost all of them stated that they still had a very positive experience in their community music groups. Throughout the past week, I have had children running up to me on the playground stating that they loved the music groups and demanding to know why they are over. One girl suggested that the school I will work at next year probably will not need me very much and I should really consider staying and at her school so I can continue running music groups! I do not think I will ever be finished with advocating for the inclusion of joy and play in children’s lives at school. I would like to repeat this project possibly several times over the course of my career as a school psychologist. I would certainly consider repeating this project with both populations of students with autism and with neurotypical populations. I think community music could simply be one of many interventions and options available to children who need are struggling with making friends and who possibly need an extra dose of joy in their calives.

References

Bakan, M. B. (2015).

Don’t Go Changing to Try and Please Me: Combating Essentialism through Ethnography in the Ethnomusicology of Autism” Ethnomusicology, Vol. 59 (1.) 116-114. Bakan, M. B. (2014).

Ethnomusicological Perspectives on Autism, Neurodiversity, and Music Therapy. Voices: A Forum for World Music Therapy, Vol. 14, No 3. California Department of Education (2015).

School Accountability Report Card (SARC). Retrieved from: https://www.cde.ca.gov/ta/ac/sa/ Census. (2010).

United States Census Bureau. Retrieved from: https://www.census.gov/data.html

Duncan, B. L., Miller, S. D., Sparks, J A. (2004).

The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy. San Francisco: Jossey-Bass, A Wiley Company. Finnegan, E. & Starr, E. (2010).

ncreasing Social Responses in a Child with Autism: Music vs. Non-Music Interventions,SAGE publications and the National Autistic Society Vol. 14 (4.), 321-348. Lewis, R. E., & Winkelman, P. (In press).

Lifescaping Practices for School Communities: Implementing Action Research and Appreciative Inquiry. New York, NY: Routledge. Higgins, L. (2008).

Growth, pathways, and groundwork: Community music in the United Kingdom. International Journal of Community Music Vol 1, No. 1. Kravtsov, G. Kravtsova, E., Favorov, S. (2010).

Play in L.S. Vygotsky’s Nonclassical psychology. Journal of Russian and East European Psychology, Vol 48(4). 25-41. Kim, J. Wigram, T. & Gold, C. (2009).

Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. SAGE publications and the National Autistic Society Vol 13 (4.) 389-409. McFerran, K. S. & Rickson D. (2014).

Community music therapy in schools: Realigning with the needs of contemporary students, staff and systems.

International Journal of Community Music Vol.7 (1). 75-92. My Outcomes Tools. (n.d.). ORS, SRS, CORS, CSRS [PDF].

Retrieved from: https://www.magellanofaz.com/media/250346/myoutcomes%20tools%20- %20ors_srs_cors_csrs.pdf.

Pavlicevic, Mercedes, O’Neil, Nicky, Powell, Harriet, Jones, Oonagh, & Sampathianaki, Ergina. (October 2013.) “Making Music, Making Friends: Long-Term Music Therapy with Young Adults with Severe Learning Disabilities.”

Journal of Intellectual Disabilities Vol. 18(1), 5–19. Thompson, G.A., McFerran, K.S., & Gold C. (2013).

Family-centred music therapy to promote social engagement in young children with severe autism spectrum disorder: a randomized controlled study.

Child: Care, Health, and Developmen Vol 40. 840-852.

[1]Example: Track 1 “Thunder”- A child directed the rest of the group, using hand gestures, indicating when different individuals should play and how loudly or softly they should play. Available at: https://www.dropbox.com/s/z4sk2zz6bvlsr8h/Track %201%20-%20Thunder%20.m4a?dl=0

[2] Example: Track 2 “Play”- A child is playing percussion, while I attempted to match her rhythm on the harp, a third child is directing us. Available at: https://www.dropbox.com/s/2ruc9x935rxzfck/Track%202%20- %20Play%21.m4a?dl=0

[3] Example: Track 3 “Cool Beat”- Two children are playing percussion, myself and another child are playing harps. Note how the children playing percussion have created a rhythm together. Available at: https://www.dropbox.com/s/sb14il41idtpz4f/Track%203%20 -%20Cool%20Beat.m4a?dl=0