Autism: Integrating a Personal Perspective with Music Therapy Practice

DIANE A. TOIGO Wassaic Developmental Center, Wassaic, New York

ABSTRACT: This article seeks to combine the insights of Dr. Temple Grandin with current music therapy practice. Dr. Grandin was diag­nosed as having autism as a child but went on to earn a doctorate in Animal Science. She has been a member of the Board of Directors of the Autism Society of America and has written and lectured ex­tensively. She is supportive of music therapy and recommends it in her writings. Dr. Grandin’s views about the experience of autism, the causes of autism, and the treatment of autism are summarized. Ways in which these insights can be applied to music therapy practice are then discussed.

As therapists, we are engaged in the process of trying to

understand our clients’ inner worlds. This has been particu­

larly difficult for people with autism because their experience

is so different from ours and because the limitations imposed

by the disability itself prevent the sharing of the experience

of autism. Because the world of the person with autism has

been so inaccessible, the insights of Dr. Temple Grandin, a

woman who was diagnosed as having autism, are particularly

valuable.

Grandin was a featured speaker at a seminar on autism at­

tended by the author in 1989 (Grandin, 1989b). This presen­

tation and her many writings provide a comprehensive picture

of her experiences as a person with autism. She was able to

overcome her disability, earned a doctorate in Animal Sci­

ence, and has successfully designed livestock handling facil­

ities worldwide (Grandin & Scariano, 1986). Grandin has been

on the Board of Directors of the Autism Society of America,

has toured facilities for individuals with autism throughout

the world, and has written and lectured extensively about

autism. Her articles have been published in numerous pro­

fessional journals. Although her experience cannot be con­

strued as being representative of the experiences of every

person with autism, she does provide a fascinating look into

the world of an individual with autism. In describing her child­

hood Grandin (1988b) wrote:

At the age of 11/2 to 3 I had many of the standard autistic behaviors such as fixation an spinning objects, refusing to be touched or held, preferring to be alone, destructive be­havior, temper tantrums, inability to speak, sensitivity to sud­den noises, appearance of deafness, and an intense interest in odors. (p. 144)

She had many of the symptoms of autism found on the Rim­

land checklist and would have scored +9 at the age of 11/2

(Rimland, 1971; Grandin, 19886). She had trouble with face

recognition and feared physical contact: “As a child I wanted

to feel the comfort of being held, but then I would shrink

away for fear of losing control and being engulfed when peo­

ple hugged me” (Grandin, 1988b, p. 151). Avoidance of con­

tact was caused by overstimulation, not anger or fear. Activ­

ities such as having her hair combed or her teeth brushed

could be excruciatingly painful (Grandin, 1990). As is true with

many people with tactile defensiveness, Grandin has always

craved deep pressure. She noted, “I liked intense stimulation

when I was young. Maybe the desire for intense stimulation

is what causes some autistic children to self-mutilate” (Gran­

din, 1988b, p. 166). In contrast, light touch and clothing could

be extremely painful.

Grandin (1988a) also had significant problems handling au­

ditory stimuli:

The most common sensory difficulties occur with the au­ditory and tactile senses. Noise was a major problem for me. When I was confronted with loud or confusing noise, I could not modulate it. I either had to shut it all out and withdraw, or let it all in like a freight train. To avoid its onslaught, I would often withdraw and shut the world out. (p. 3)

Motoric noises were particularly painful, and screening

background noises was so difficult that she was functionally

deaf in noisy situations. Overresponsiveness to auditory and

tactile stimuli was frequently the cause of violent behavior,

and high levels of arousal also increased her tendency to fixate

(Grandin, 1988b).

Language presented great problems. She understood ev­

erything that people said to her but could respond only by

screaming and flapping her hands (Grandin, 1988b). The fol­

lowing remarks illuminate the nature of her language prob­

lem: “Sometimes I heard and understood and other times

sounds or speech reached my brain like the unbearable noise

of an onrushing freight train” (Grandin & Scariano, 1986, p.

149) and “I had the words I wanted to say in my mind, but I

just could not get them out; it was like a big stutter” (Grandin,

1988a, p. 2). Interestingly, in times of emotional stress or fever

she could sometimes speak normally (1988b).

Grandin (1988a) also reported specific learning difficulties.

Describing herself as a visual thinker she wrote:

I do not remember non-visual information. Abstract con­cepts such as Betting along with people have to have a visual image. For example, my visual image for relationships with people is a sliding glass door. If you push on it too hard it will break. To make the abstract concept more real, I would

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sometimes act it out-for example, by walking through a real sliding door. (p. 7)

Music Therapy Perspectives (1992), Vol. 10

sensory receptors, and insist on an unchanging environment”

(Kootz, Marineuin, & Cohen cited in Grandin, 1988b, p. 156).

Grandin (1988b) believed that damage to the central ner­

vous system can create a deprived environment. In describing

her own experience, she (1989a) noted that pulling away from

her environment kept her from receiving stimulation which

was required for normal development. This presents the in­

triguing idea that brain damage may be both cause and effect

of autism as the child with autism avoids the very stimulation

that is necessary for normal development. In describing the

effect this could have on relationships with people Grandin

& Scariano (1986) wrote:

The original fetal defect in brain development is probably responsible for the baby’s avoidance of being touched and comforted. The longer a baby lives without experiencing the feeling of being comforted, the more likely the brain circuits involved in the development of emotional contact with peo­ple will be damaged. (p. 177)

She noted that many studies have confirmed the visual spatial

nature of theautistic mind (Hermelin, and Lockyer and Rutter,

cited in Grandin 1988a). Memorizing nonvisual material was

impossible for her, and melodies were the only things she

could memorize without a visual image (Grandin, 19886). Be­

cause her mind was completely visual, Grandin had difficulty

with sequential tasks, such as math, which cannot easily be

visualized.

In summarizing how a person with autism might think Gran­

din (1988b) wrote:

There may be two basic kinds of thinking, visual and se­quential. Society needs to recognize the value of people who think visually. Misinterpretation of psychological test results could label a brilliant visual thinker as below average in in­telligence. Einstein was a visual thinker who failed his high school language requirement and relied on visual methods of study. (p. 147)

Additional learning difficulties occurred because she had sig­

nificant gaps in attention, analogous to reality fading in and

out as if controlled by an on/off switch (19896).

Both as a child and as an adult, Grandin was tested exten­

sively with very interesting results. The Weschler IQ test, ad­

ministered at ages 9 and 12, yielded scores of 120 and 137

respectively (Grandin, 19886). On other tests her scores ranged

from the 6th percentile to the 95th percentile and from the

second-grade level to above the ceiling of the test (for visual

spatial ability). In summarizing the test results, Grandin (1988b)

wrote, “My difficulties on many of the subtests stemmed from

the inability to hold one piece of information in my mind

while I manipulated another piece of information” (p. 147).

She suffered a setback when she reached puberty and had

bouts of impulsive behavior and severe “stage fright.” She

attributes this to the increase in norepinephrine activity in

the brain which occurs at puberty (Grandin, 1988b).

Grandin (1986) managed, in large part, to overcome these

deficits. For this recovery she credited early intervention,

structured programs, a mechanical device she invented to

lessen tactile defensiveness (discussed further in this article),

loving parents, teachers, and friends, and the antidepressant

drug, Tofranil.

The Causes of Autism

Grandin & Scariano (1986) believed that autism may be caused

by many different kinds of brain damage and said, “It may be

like a TV with a poor picture. Damage to any one of many

parts in the tuning circuit would ruin the picture quality” (p.

174). Many instances of autism might be due to a hyperex­

citable central nervous system which cannot integrate incom­

ing stimuli effectively (Grandin, 1988b). There is an overre­

sponsiveness to some stimuli and an undersensitivity to other

stimuli (Ayres, 1979). Faced with a constantly changing world

that cannot be understood, the child with autism avoids stim­

ulation and might resort to self-stimulatory behavior to “flood

Grandin (1988b) noted that institutionalized babies develop

many autistic characteristics as they strive to adapt to their

state of sensory and emotional deprivation and that excessive

self-stimulation often occurs. Studies by Prescott (cited in

Grandin, 1988b) found that absence of tactile stimulation will

cause hyperactivity, autistic behavior, violence, and aggression

and concluded that these behaviors may be related to inad­

equate sensory stimulation. Grandin (1989a) also referred to

the work of Dr. Fein who believed that the lack of sensory

input early in the lives of children with autism deprives them

of the perceptual experiences necessary to form the building

blocks for higher skills such as language.

Grandin & Scariano (1986, 1989b) aIso has delved extensively

into the kinds of brain damage that might cause autism. In

summarizing her views, she has hypothesized that the original

brain damage is compounded as the child with autism fails to

receive adequate stimulation due to a failure to pay attention,

or due to withdrawal to block out an onslaught of painful or

confusing stimuli. Continuing hyperactivity and stereotypic

behaviors could damage the brain further and have been shown

to alter the brain at the dendritic level.

Specific brain abnormalities have also been identified. The

cerebellum acts as a sensory modulator, and Grandin’s cer­

ebellum is 20% smaller than normal (Grandin, 1989b). Cere­

bella abnormalities could explain overreaction to touch,

nervousness, and overarousal problems (Grandin, 1989a;

Grandin & Scariano, 1986).

Damage to the reticular activating system could account for

overresponsiveness to stimuli, and problems with sensory in­

tegration could be partially responsible for damaging the hip­

pocampus or other brain areas (Luria, cited in Grandin, 1988b).

Reisman (cited by Grandin, 1988b) found that since the hip­

pocampus receives input from all sensory systems, lesions in

this area might cause distractability, immediate response to a

stimulus, or fixation on a stimulus. Grandin (1989b) also be­

lieved that autism could be caused by damage to the amygdala

or the lymbic system, which regulates emotional responses.

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Abnormalities in brain chemistry such as excessive amounts

of endorphins (Panksepp, cited in Grandin, 1988b) also may

play a role. Stereotyped behavior might serve initially to calm

the individual by producing endorphins but persists because

it is pleasurable and produces an endorphin “high.”

In summary, there is considerable evidence that autism may

be caused by diverse kinds of brain damage which, in turn,

lead to problems handling sensory input. This could cause the

child with autism to withdraw, and brain damage could be

compounded as the brain is denied the stimulation necessary

for normal development.

The Treatment of Autism

In their fascinating book, Emergence: Labeled Autistic, Gran­

din concluded, “A good program should have flexible non­

aversive behavior modification, sensory treatment, speech

therapy, exercise, and music therapy” (Grandin & Scariano,

1986, p. 184). She has visited treatment program worldwide

and has seen many diverse treatment approaches work ef­

fectively. In summarizing her views she wrote, “In many in­

stances the real magic that makes a program effective is early

intense intervention in a structured environment, meaningful

contact with normal children, and plenty of structured phys­

ical activity” (Grandin, 1988a, p. 1). Most of her treatment

recommendations involve structured educational programs,

sensory treatment, and selective use of medication.

Grandin & Scariano (1986) favors trying other approaches

before resorting to medication and said, “Giving a child med­

ication often just masks a symptom, but finding the right drug

which actually corrects or compensates for faulty biochem­

istry is very useful” (p. 149). She also noted, “There are many

different autism subtypes, and the brain abnormalities that

cause each subtype may be different. A medicine that works

for one subtype may be useless for another” (Grandin, 1990,

p. 11).

Grandin (19896) was helped significantly by the anti-de­

pressant drug Tofranil (Imipramine), which she believes acted

to calm the nervous circuit and elevate the mood circuit. She

received some relief immediately after starting on the drug,

while other changes, such as development of a sense of hu­

mor, took years. Grandin (1988b) cited a study by Campbell

et al. which examined the effects of lmipramine in children

with autism or schizophrenia. The drug affected five children

negatively while three children markedly improved, leading

Campbell to conclude that the drug merited further study in

children who are mute and who have autism, developmental

disabilities, and little psychotic symptomatology.

Dr. Paul Hardy successfully treated adolescents with autism

with different types of antidepressant drugs (Grandin & Scari­

ano, 1986). In his presentation, “The Use of Alternative Med­

ication to Treat Aggression and Self Injury,” Dr. Ratey (1989),

Assistant Director of Psychiatry at Harvard, spoke of his suc­

cess using beta-blockers for aggression and self-injury. He

noted that a state of hyperarousal often leads to social isola­

tion, reliance on repetition, violent behavior, self-injurious

behavior, and impulsive acts. Beta-blockers, developed to treat

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high blood pressure, do not have the many negative side

effects, such as drowsiness and cognitive problems, associated

with neuroleptics, major tranquilizers, and benzodiazepines.

A study by Ratey (cited in Grandin, 1988b) concluded that

beta-blockers greatly reduced aggressive behavior in some

adults with autism. In addition, positive behaviors such as lan­

guage skills, social skills, and sense of humor have increased

(Ratey, 1989). Ratey (1989) hypothesized that beta-blockers

may create a “pharmacological holding environment,” and

that they may also create “an optimal level of arousal for

learning.”

Grandin (1988a) also strongly supported sensory treatment

which is an area that is often overlooked:

Sensory methods of reducing nervous system arousal and physical activity should be used before a child is Put on drugs.. Prescribing drugs for young children should be avoided if possible. Sensory treatment in conjunction with traditional behavioral approaches is probably more effective than behavioral methods alone. (p. 5)

She particularly emphasized the importance of vestibular, tac­

tile, and kinesthetic stimulation because these systems start

to develop first after birth (Moore, cited in Grandin, 19886).

and their dysfunction may be responsible for strange senso­

riomotor behavior in children with autism (Ornitz, cited in

Grandin, 1988b). Grandin supported the sensory integration

theory developed by Ayres (1979) and noted, “Sensory inte­

gration therapy is based on the concept that stimulation of

the vestibular system and other sense modalities will help the

immature or damaged nervous system to develop” (Grandin,

1988b, p. 160). Both human and animal studies have found

that deep pressure is calming (Grandin, 1989a), and vestibular

and tactile stimulation are used very naturally by parents in

soothing their children.

Grandin (1989a) grew up with animals and believed that the

reaction of an untamed animal to touch is similar to the re­

action of a child with autism. She saw good results through

sensory treatment achieved in less than an hour of treatment

per day (Grandin, 1989a), and gives the following advice:

Therapists have helped many autistic children by gently ap­plying tactile and vestibular stimulation (Ayres, 1979; King, cited in Grandin, 1989a). One effect of this stimulation is to desensitize the tactile system. This is not a cure, but it has increased speech, affection, and eye contact in some chil­dren. It also helps to decrease stereotypical and self-injurious behavior. The sensory activities are done gently as fun games and are never forced. Strong encouragement and some in­trusiveness may be used but a good therapist knows how far she can intrude before the stimulation becomes so over­whelming that the child starts crying. (Grandin, 19094 p. 75)

A unique form of sensory treatment Grandin (19886) de­

vised is the squeeze machine. She came upon this idea by

spending time at an aunt’s ranch where she observed that

“the cattle sometimesappeared to relax when they were held

in the squeeze chute, a device for holding cattle for veterinary

procedures.. After a horrible bout of the ‘nerves’ I got in

the squeeze chute”(p. 5). She designed the squeeze machine,

later describing it as:

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Figure 1. Squeeze machine

completely lined with foam rubber. It squeezer the user very firmly, yet it is soothing and comforting.. The ma­chine is also equipped with an automatic pulsator so that the squeeze pressure can be rhythmically applied.. It is stim­ulating and relaxing at the same time. Pressure applied by the machine activates the pressure receptors from nearly every nerve branch which originated from the spinal cord. The machine was powered by a small air compressor which operates the squeeze sides by pulling them together with an air cylinder. (p. 151)

Grandin (1988b) hypothesized “Regular use of the squeeze

machine may help maintain an adequate number of endor­

phin and other receptor sites in the brain” (p. 153). She also

conducted a study in which 62% of college students liked

the squeeze machine and found it to be relaxing. In describing

its effect, she wrote:

When I was in the chute, I felt closer to people. Although the squeeze chute was just a mechanical device, it broke through my barrier of tactile defensiveness, and I felt the love and concern of there people and war able to express my feelings about myself and others. It war as if an accordion folding door had been shoved back revealing my emotions. (Grandin & Scariano, 1986, p. 96)

Grandin (1988a) also made a number of more general treat­ment recommendations. She suggested avoiding noisy en­vironments and recommended:

Autistics must be protected from noises that disturb them.. All the behavior modification in the world will not teach a child to tolerate a noise that is overloading a damaged ner­vous system. The classroom should be quiet and free from distracting noises, such as a high-pitched fan. Some teachers have found that disturbing noises can be blocked out with headphones and music. When a child has to make a trip to a bury shopping center, a headset with a favorite tape can help make the trip more peaceful. (p. 3)

Grandin & Scariano (1986) also recommended watching food

intake and testing for common allergies such as milk, wheat,

corn, tomatoes, chocolate, sugar, and mushrooms; also rec­

ommended was testing for zinc deficiency and excessive cop­

per. She noted that megavitamin therapy and vitamin B6 and

magnesium supplements might be beneficial.

In regard to developing language skills, Grandin (1988a) sug­

gested stimulating the vestibular system prior to or during

speech activities by having the child swing slowly on a swing.

Using pictures and written language to communicate (Gran­

din, 1988b) as well as a visualized reading method developed

by Miller and Miller (cited in Grandin, 19896) was also rec­

ommended.

Grandin (1988a) also addressed the issue of stereotyped be­

haviors and fixations:

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I have made a successful career bared on my fixation with cattle squeeze chutes. ..... .If my fixation had been taken away, I could have ended up in an institution. Do not confuse fixations with stereotyped behavior, such as hand flapping or rocking. A fixation is an interest in something external that should be directed and used to motivate. (p. 6)

She noted that fixations are tremendous motivators, fulfill a

need to reduce arousal in an overactive nervous system, and

should not be eliminated (Grandin, 1986, 1990). Instead of

eliminating fixations, she recommended using them, i.e., teach

concepts such as reading or counting in relation to vacuum

cleaners if that is the fixation. If possible, direct the fixation

into a career:

A high-functioning autistic woman who works doing graphic arts may never be able to fit in with the social whirl, but if they can develop an interesting career they will make social contacts.. People respect talent, even though they might think you are “weird.” Weirdness is more tolerable because other people like the good music or art an autistic person produces. (Grandin, 1988a. p. 7)

Since some people with autism are musically or artistically

gifted, these talents should be nurtured along with more tra­

ditional vocational skills. She strongly recommended that peo­

ple with autism have career mentors to deal with job-related

social complexities because it is very difficult for a person with

autism to understand how others might think and feel (Gran­

din, 1990).

In dealing with stereotype behavior, Grandin (1989b) rec­

ommended joining in the stereotype then broadening it into

an activity. This is an approach with which the music therapists

at the author’s facility have had considerable success, and it

is discussed further in the last section.

Grandin & Scariano (1986) was also supportive of behavior

modification but believed that “behavior modification may

be more effective if it is combined with calming sensory input

and exercise to reduce arousal” (p. 183). She recommended

a stable, ordered, secure environment, and giving individuals

with autism a private place to be themselves. She was partic­

ularly thankful for creative, unconventional teachers and

friends, people like a teacher who” didn’t see any of the labels,

just the underlying talents.. lie seemed to sense my search

for acceptance on my own level” (p. 86).

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Grandin’s References to Music

Throughout Grandin’s writings there are many positive ref­

erences to music therapy and to the value of music experi­

ences. As a child, she was enrolled in an intensive speech

therapy nursery school in which “two or three hours a day

were spent doing physical and musical activities. A strong

emphasis on these types of activities is an important part of a

successful autism program” (Grandin, 1988a, p. 1). She also

described her own musical abilities and deficits. As was pre­

viously noted, melodies are the only nonverbal material she

can memorize; however, rhythmic activities are more difficult:

Throughout Grandin’s writings there are many pos­itive references to music therapy and to the value of music experiences

Both as a child and as an adult I have difficulty keeping in time with a rhythm. At a concert where people are clapping in time with the music I have to follow another person sitting beside me. I can keep rhythm moderately well by myself, but itis extremely difficult to synchronize my rhythmic mo­tions with other people or with a musical accompaniment. (Grandin, 1988b p. 165)

She also dicussed possible impacts this might have:

Rhythmic activities with musical instruments can be very helpful. Many amistics have problems with rhythm. The rhythm prablems some autistics have may be related to speech problems. Research has shown that normal babies move in synchronization with adult speech. Autistics fail to do this.. I cannot fallow the rhythmic give and take of conversation. (Grandin, 1988a, p.2)

This implies that rhythm is an integral part of many life activ­

ities not usually thought of in this context. Rhythm is essen­

tially a sequential task, occurring over time, the kind of task

that Grandin and many individuals with autism find very dif­

ficult.

Rhythmic music, particularly when integrated with the tac­

tile and vestibular stimulation Grandin emphasizes, can have

a calming effect. Grandin was supportive of combining music

and movement and wrote, “Encourage the autistic child to

use his kinesthetic senses as in motor learning and educating

the musculature of the body.. Musical and rhythmic activ­

ities are highly recommended for autistic children” (Grandin

& Scariano, 1986, p. 147). Readers interested in further infor­

mation about rhythm are referred to the article, “My Expe­

rience as an Autistic Child and Review of Selected Literature,”

in which Grandin devoted several sections to advanced the­

ories of body rhythms.

Music also has value for many children with autism because

it is something that is inherently pleasurable, perhaps because

it is an absolutely predictable phenomenon in an unpredict­

able world. Grandin (19886) confirmed that responsiveness to

music and wrote:

Music also has value for many children with autism because it is something that is inherently pleasurable, perhaps because it is an absolutely predictable phe­nomenon in an Unpredictable world.

As a young child I hummed constantly to myself and made little peeping noises. Even as an adult I often hum. Eight-year old autistic children have a tendency to prefer music., Autistic children preferred to turn on a speaker playing sung lyrics instead of turning on a speaker playing spoken lyrics

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of the same song (Blackstock, cited in Grandin, 19886). I can hear a song once or twice and reproduce the melody and pitch accurately. Autistic children can imitate tones as well as or better than normal children. (Applebaum, Egel, Koegel, & Imhoff, cited in Grandin, 19886, p. 148)

Grandin found that music can also play a role in developing

communication skills. She wrote that “some autistic children

can sing a response when they are unable to speak it” (Gran­

din, 1988a, p. 2)and that “Lorna King (1981) found that singing

instructions to a 12.-year-old autistic boy resulted in better

communication and obeying of the instructions” (Grandin,

1988b, p. 48).

Grandin(l986a) has known individuals with autism who have

made successful careers in the arts and wrote, “If an autistic

student shows a talent for art or music, the talent must be

nurtured like a delicate flower” (p. 6). She noted that some

people with autism have succeeded at piano tuning because

they have perfect pitch (Grandin, 1990), and that even some

very visual thinkers are able to succeed musically-“Discus­

sions with other people with autism have revealed visual

methods of thinking on tasks that are often considered se­

quential and nonvisual. A gifted autistic composer told me

that he made ‘sound pictures”’ (Grandin, 1990, p. 6). Musical

successes often lead to significant gains in self-esteem and

social acceptance.

Implications for Music Therapy Practice

The applications of Grandin’s insights to music therapy

practice are many and varied. Within the music therapy lit­

erature, there is support for the musical responsiveness of

people with autism which she noted. Thaut (1984). for ex­

ample, found that children with autism chose musical time

involvement significantly longer than control groups of nor­

mal children. Several studies(Applebaum et al., cited in Gran­

din, 19886; DeLong, cited in Thaut (1984); Tanguay, 1976) con­

cluded that children with autism process musical stimuli

despite other deficits. Nelson, Anderson, and Gonzales(1984)

found that children with autism can respond very positively

to music or to sound vibrations, such as from a radio. Purvis

and Samet (1976) found music to be a highly effective means

of developing the social-emotional skills of children with au­

tism. Positive response to music has also been confirmed by

Alvin (1978), Hairston (1990), Michel(1976), Nordoff and Rob­

bins (1977,1965), and Oppenheim (1974). King (cited in Gran­

din, 1988b)found that slow rhythmic movements are soothing

tochildren with autism, although the rate which was preferred

was faster than the rate which was quieting to them.

The three basic treatment recommendations Grandin

(1988a) makes can provide a foundation for music therapy

programs. Her emphasis on structure is easily carried over

into the music therapy setting, where there is both the struc­

ture of the session and the structure provided by the music

itself. Structure can be provided through a consistent greeting

and goodbye song, and through familiar songs and activities

done in a consistent manner. Thaut (1984) referred to the

Music Therapy Perspectives (1992), Vol. 10

microstructure of activities within sessions and the macro­

structure provided by music therapy goals and learning steps

implemented over time. That also found that adding rhyth­

mic or melodic structure to verbal instructions aided com­

prehension. Nelson et al. (1984) emphasized the importance

of structuring for a high rate of success and noted that music

is inherently a highly structured stimulus due to its repetitive,

concrete nature. They identified two specific ways to struc­

ture a session for success: a firm, directive approach with

frequent, clear expectations, or a more open-ended approach

with many opportunities for success without many demands.

The latter approach was mentioned by Alvin (1978)and could

be implemented through the improvisational approach dis­

cussed later in this section.

Grandin (1988a) also has advocated exposure to normal chil­

dren noting that a person with autism who has skills could be

integrated into a group of individuals who are nonautistic,

providing him with a more normal music experience and ex­

posure to behavioral norms.

Structure also could be achieved through a behavioral ap­

proach, and it was previously noted that Grandin supported

flexible, non-aversive behavior modification. The use of music

as a reinforcer certainly meets this criterion. Boyle (1991) suc­

cessfully trained a girl with autism to come when called by

using access to a music box as a contingent reinforcer. Michel

(1976) reported success by using the playing of instruments

as a contingent reinforcer in teaching a boy with autism to

button his shirt. Music therapists using a behavioral approach

could consult with family or treatment team members about

the use of music as a reinforcer in the classroom or home.

Since many individuals with autism do not respond to tradi­

tional reinforcers such as praise or affection, contingent music

could become an important motivator. When employed at a

community residence for male adolescents with autism, the

author noted that two of the eight residents enjoyed recorded

music deeply and were themselves musically gifted. With in­

dividuals such as these, live music experiences or recorded

music would provide a powerful motivational tool.

Grandin has been a strong supporter of physical activity,

exercise, and sensory treatment, all of which expose the in­

dividual to sensory and motor stimulation in order to develop

his ability to process and learn from this input. Music therapy

can provide the client with a rich variety of sensory and motor

experiences including the vestibular, tactile, and kinesthetic

experiences which Grandin emphasized.

In attempting to provide these experiences, the music ther­

apist should be knowledgeable about sensory integration the­

ory (Ayres, 1979). James (1984) discussed the application of

sensory integration theory to music therapy practice and con­

cluded that an inability to process information from the en­

vironment leads to withdrawal from that environment. The

music therapist, using a sensory integration approach, would

work less on teaching a specific skill, such as shape discrimi­

nation, but would work at a more basic level of enhancing

the brain’s capacity to integrate and organize the sensory

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Autism and Music Therapy

stimuli necessary before the development of shape discrim­

ination. Results, though possibly slower initially, would be

more generalized (James, 1984). Use of sensory integration

techniques by the music therapist would be done most ef­

fectively with a thorough knowledge of the field and through

consultation with an occupational therapist. Music therapists

also need to be aware of the possibilities of abnormal re­

sponses to sound due to auditory input not being processed

normally. Nelson et al. (1964) confirmed that individuals with

autism could be hyporesponsive or hyperresponsive to sound,

and Condon (1975) found that persons with autism might ex­

perience echoes of auditory stimuli, leading him to recom­

mend the consideration of short, separate stimuli. Children

with autism can be particularly responsive to resonant instru­

ments (Thaut, 1984), and it has been the author’s experience

that this can become a fixation. A woman with pronounced

withdrawal and self-stimulatory tendencies became totally ab­

sorbed in loud, compulsive drum beating and could not be

reached when so engaged. Helping her to feel rhythms and

tempi by tapping on her body and the use of quieter melodic

instruments was a much more effective therapeuticapproach.

When dealing with hyperresponsiveness to sound, the rnu­

sic therapist must provide auditory stimulation in such a way

that it is pleasurable to the client with autism. Sisco (1991), in

her work with a very withdrawn, tactilely defensive woman,

found that initially the woman could only tolerate a single

melodic line. A very gentle, nondemanding approach was

used, and the woman gradually became more tolerant of open

fifths and then more complex harmonies. Her social responses

improved, she made eye contact, she vocalized in tonality,

and she began to tolerate touch.

Music therapy activities can serve to integrate auditory,

proprioceptive, tactile, and vestibular stimulation in many ways.

The act of playing an instrument combines the motoric input

from moving muscles with the sound these movements pro­

duce. Nelson et al. (1984) believed that “. learning to control

and predict the timing of sounds will improve the child’s

ability to integrate sequences of sounds” (p. 110). Similar re­

sults could be achieved through movement to music and

through action songs. The use of action songs was supported

by Alvin (1978) and Stevens and Clark (1969). Thaut (1984)

found that “movement to music also aids the integration of

tactile/kinesthetic and auditory perception and the differ­

entiation of self/non-self” (p. 12). By using sounds in syn­

chrony with movement or by using body percussion (Thaut,

1984), the music therapist can facilitate the process of sensory

integration.

Music therapy could also provide opportunities for the in­

tegration of auditory and visual stimuli. Auditory experiences

can become visual through many means. That (1984) rec­

ommended the use of graphic notations to visually represent

the elements of music. In the author’s experience, visually

representing the concepts “same” and “different” with no­

tation cards showing different numbers of beats immediately

allowed a client who functioned at a high level but who had

19

poor conceptual skills to grasp these concepts which had

given him great difficulty when presented auditorily.

Computer music programs also would add a visual com­

ponent to sound, make auditory experiences more meaning­

ful, and facilitate successful experiences. Movement activities

would combine auditory, motor, and visual input effectively.

By addressing these basic levels of sensory integration, the

music therapist could be laying the foundation for successful

learning experiences at higher levels.

Music also could be used to the calm the hyperresponsive

central nervous system to which Grandin referred. Music could

have a soothing effect on a hyperexcitable nervous system,

helping the client to become more receptive to the learning

environment or providing him with respite from a world which

is difficult to understand. Tallarigo (1991) reported a very pos­

itive response to the soothing sound of a guitar among ado­

lescents with autism.

Music therapy also can play a significant role for individuals

who are autistic with low functioning abilities. Grandin rec­

ommended joining in a stereotype behavior (such as hand

flapping or rocking) then broadening this into an activity. At

the author’s facility, this approach has been used with sub­

stantial success with people with autistic characteristics and

developmental disabilities. This approach is based on the cre­

ative music therapy approach originated by Nordoff and Rob­

bins (1977), in which individualized music is improvised to

reflect the client’s motoric, vocal, and instrumental behaviors

and responses. For instance, music might be improvised vo­

cally or instrumentally to reflect the rhythm of the client’s

rocking or the pitches or emotional quality of their sounds.

It is an approach in which the music comes from the client,

allowing them considerable control over the amount and kind

of auditory stimulation they receive. Combinations of impro­

vised music and movement, i.e., moving with the client while

music is improvised instrumentally or vocally to reflect the

client’s rhythms and moods, also have been used. This im­

provisational approach may be successful because it conveys

the acceptance and understanding that Grandin indicated is

so important to a person with autism.

The creative music therapy approach to working with an

autistic child is described in Nordoff and Robbins’ book, Cre­

ative Music Therapy (1977). Additional case studies are docu­

mented in their book, Music Therapy for Handicapped Children

(1965). Music is used as a powerful means of nonverbal com­

munication, a means of gently entering the client’s world

before demanding that he enter ours.

Nordoff and Robbins also analyzed the rhythmic responses

of many developmentally disabled children and identified

specific categories of rhythmic response such as compulsive,

impulsive, and chaotic creative. These categories provide an

interesting framework through which to analyze rhythmic re­

sponses and confirm the rhythmic disturbances that Grandin

noted in some individuals with autism. The author has noted

compulsive rhythmic responses, a tendency to become fix­

ated in one tempo or rhythm, in several clients with autistic

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20 Music Therapy Perspectives (1992), Vol. 10

tendencies, and often an analogy can be drawn between cli­ents’ rhythmic responses and their relationship with their en­vironment. The client’s inability to match the therapist’s tem­po mirrors her inability to interact meaningfully with her world. Nordoff and Robbins achieved substantial success by matching and reflecting clients’ rhythmic responses, linking the client’s inner world with the outer world. Many other suggestions for specific rhythmic interventions are also given. Additional rhythmic work was done by creating music which matched the rhythms of speech and through helping the children to feel rhythms through tactile stimulation and movement.

Another area in which music therapists could achieve suc­cess is in the development of communication skills. Grandin (1988a) related some of her speech problems to rhythmic difficulties and cited the work of King in using musical direc­tions. It is possible that adding a musical component to speech would increase comprehension for some individuals. Thaut (1984) recommended combining language, melody, and rhythm by adding a strong rhythmic or melodic component to verbal instructions. Since individuals with autism also often have disturbances of intonation, he used music activities to develop an awareness of high/low, loud/soft, and stress pat­terns. This awareness was then used for melodic shaping of vocal expressions. Tallarigo (1991) successfully used signing with songs to make words visual, and in some cases, the use of sign language facilitated the acquisition of spoken language. With clients who function at a low level, music can provide a less threatening, nonverbal means of communication and self-expression that can be the beginning of language. A com­prehensive group of activities/approaches for the develop­ment of communication skills is found in Thaut (1984).

Nelson et al. (1984) offered several other suggestions for the music therapist. They noted the necessity for matching music stimuli to specific client characteristics and confirmed the need to program for generalization and transference of learning. They concluded that music can be an effective way for clients with autism to develop two traditionally weak areas, creativity and initiative. It is gratifying to note that they also recommended music therapy for children with autism simply because responsiveness to music might be a significant strength, and wrote that, “therapy ... is also a process of refining and improving the individual’s strengths” (p. 113). In summarizing the use of music therapy with individuals with autism they concluded:

Whether the strategy is directive or non-directive, the goal is the same: to show the child that he can have predictable, positive effects on the environment through his or her own actions, (p. 104)

Conclusion

It is tremendously exciting to be able to glimpse the world of a person with autism through the experiences of Grandin. It has been gratifying to find many references to music therapy in her work and to consider how powerful music can be as a therapeutic tool in developing the potential of people with

autism. Grandin & Scariano (1986) wrote that people with autism live in a “world they are desperately trying to give some order to” (p. 16). As music therapists, we have a unique means of making a more ordered world a reality.

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