The links between music and language have been described by many theorists (Radocy & Boyle, 2003; Tamplin, 2008). For example, it has been noted that speech and singing share a number of elements in common (Leung, 2008; Littlejohn & Foss, 2008).

For a child with special communication needs, the acquisition of language skills often requires extensive instruction, practice, repetition, and time (King, 2007). Music therapy interventions, which are often enjoyed by children with special needs, can be developed to target and develop specific speech sounds, complementing the work of clinicians such as the speech language therapist (McCarthy, 2008; Register, Darrow, Standley, & Swedberg, 2007).

Pellitteri (2000) stated, “when the music therapist creates a comfortable psychological environment children tend to feel relaxed and to decrease any inhibitions related to speaking, and natural language is allowed to emerge (p. 384).”

As such, children with speech needs who lack the motivation to participate in conventional speech therapy drills and exercises may enjoy, and thus be motivated by, music therapy interventions (Adamek & Darrow, 2005; Braithwaite & Sigafoos, 1998; Kennelly, Hamilton, & Cross, 2001; Knoll, 1998; Nelson, Anderson, & Gonzales, 1984). As an example, singing may provide an alternative and pleasurable avenue for communication while simultaneously addressing speech therapy goals (Cohen, 1992, 1994; Keith & Aronson, 1975).

This article will present a brief summary of music therapy with a young child with language and communication needs. The child received services at the author’s university. Music therapy was provided by an intern under the author’s supervision. The child was 3-year-old girl diagnosed with childhood apraxia of speech. She was seen for a total of 24 sessions over a period of nine months. Her music therapy treatment involved a mixture of behavioral, improvisational, and creative approaches.

A variety of musical interventions, visual, and interactive aids were used, as well as an engaging, playful relationship between child and the clinician. Her communicative methods at the beginning of her treatment process were almost exclusively non-verbal. By the final session, she was pronouncing a number of syllables, combination sounds, and words. A more detailed article on her progress can be found in Beathard and Krout (2007).

After viewing a local television report on music therapy featuring the author’s university music therapy clinic, the parents of this child contacted the author to see if music therapy might help their daughter. Music therapy assessment sessions were designed to gather information on language skill areas of concern to her parents, including nonverbal and verbal communication.

The music therapy assessment resulted in the following initial observations: (1) She appeared to be completely nonverbal except for a few /uh/ sounds when she wanted something, (2) She appeared to love music, (3) She displayed a very short attention span, and (4) She displayed the use of sign language and other hand gestures. Her apparent love of music and strong desire to play an instrument (as demonstrated by vocalizing the beginning instrument sound) was a great beginning to her therapy process.

Language goals were established based on background information from her parents and observations from the assessment sessions. These were designed to augment her ongoing speech therapy. Her overall goal was increased speech recognition and generation. At home, her mother was working on her producing the /m/ sound (for “mommy”) and the /f/ sound (for the first letter of their last name). Both parents shared that they would sing various songs at home with her, trying to emphasize these sounds. The mother stated that she would often appear to understand and comprehend what they were saying.

In the university music therapy clinic, pieces of paper with large capital letters labeling the various instruments were made and either affixed to the musical instruments themselves or on the shelf holding the respective instruments. These shelves were rearranged so that a wide variety of instruments with their corresponding labels sat on the lower shelves within her reach.

The intent in making the signs was to provide visual cues while prompting her to sound out the initial instrument letter sound. Initial thoughts in session planning also considered the use of augmentative and alternative communication (AAC) aids, such as picture exchange communication (PEC) symbols and a communication board to use when she wanted an instrument.

An additional important aspect of session planning by the clinician involved incorporating the use of motivating toys, books, and other props that elicited a sense of play while targeting vocalization of sounds. Music therapy sessions were organized around a similar and predictable structure and schedule for each week, beginning and ending with her unique “Hello” and “Goodbye” Song,, which was composed by the clinician. In addition, at least one new song and corresponding interactive visual aid was introduced each week and added to her song and activity book of songs.

Music therapy sessions included an eclectic mixture of behavioral, improvisational, and creative approaches. The child also seemed to enjoy playing the piano with the clinician, especially when smiles, giggles, and playfulness were a part of the interaction of taking turns with instruments, handing the mallet or instrument to the clinician to play.

Treatment progressed smoothly across the university academic year, and objectives adjusted as she continued to work toward her goals. By the end of the 24th session, when services were ended due to the conclusion of the spring semester, her objectives were met. Her music therapy treatment progress appeared to be the result of a combination of flexible treatment approaches, motivating musical interventions, visual and interactive aids, and an engaging playful dialogue between her and the clinician.

As evidence of her progress, her communicative methods at the beginning of her treatment process were almost exclusively nonverbal. By the final session, she was vocalizing the syllables /bah/, /duh/, /fuh/, /guh/, /huh/, /muh/, /oh/, /puh/, /que/, /tuh/ and the combination sounds /ba/, /da/, /ma/, /la/, and /on/. Her growing verbal vocabulary now contained the words /oh/, /no/, /more/, /mama/, /dada/, and /baby/.

Of importance to her parents, an increase in vocalization skills and cognitive recognition of the individual letters of her name was also observed. She could independently vocalize each letter of her name while placing the corresponding letter card in the correct sequence. By the end of her treatment period, she could also vocalize the syllables of her dog’s name when verbally prompted by the clinician.

She demonstrated cognitive recognition of facial parts during the drawing intervention on the dry erase board, and by independent vocalization of the beginning sounds of words such as /mouth/, /eyes/, /ears/, /nose/, and /face/ while drawing these on the board. She also demonstrated a sense of humor and playfulness throughout the course of her music therapy treatment. Her animated facial expressions, smiles, and giggles indicated obvious pleasure and enjoyment in the music therapy sessions.

A key aspect of her success was the clinician’s use of motivating music experiences, especially the use and adaptation of songs to focus on her language and communication goals. These music experiences included:

• The use of a standard hello song. This facilitated the recognition/vocalization of her name and vocalization of the beginning sound /huh/ of the word /hello/
• The use of a name song – recognition/vocalization of name (letters and syllables)
• The adaptation of “Old McDonald Had a Farm” (with plastic toy farm animals – vocalization of beginning sound of animals at appropriate times in song. Through this, she learned to independently vocalize /e/, /i/,/e/, /i/, /o/.
• Use of the song “Pop Goes the Bubble” (adapted from Pop Goes the Weasel) – blowing bubbles while vocalizing /puh/
• The clinician’s original “Letter Song” – recognition/vocalization of letters using flash cards
• Use of the song “Wheels on the Bus” – vocalization attempts at sounds within the song accompanying this colorful, interactive book.
• A song adapted from the children’s song “BINGO” for her dog’s name – recognition/vocalization of dog’s name (letters and syllables)
• The use of a standard goodbye song. This again facilitated the recognition/vocalization of her name and vocalization of the beginning sound /g/ of the word /goodbye/

In summary, the creative use of music therapy, combined with visual and interactive aids in the sessions, proved to be motivating and beneficial for this child, as demonstrated by her overall responses and progress over the course of the study. This example illustrates the use of music therapy to aid a child with speech disorders, and supports the position of authors such as Hibben (1991) and McCarthy (2008), who suggested that children with language and communication needs who receive music therapy often demonstrate improved functional and spontaneous speech.

It also reinforces observations such as those by Kennelly, Hamilton, and Cross (2001), who described similarities between music and speech and language development models. They also reported that music therapy can be an effective modality with children with neurological speech impairment. As such, music therapy can play an important role in expanding the language and communication skills of children, such as the girl in this case example with communication and speech disorders.

— Robert E. Krout, EdD, MT-BC, is professor and director of music therapy in the Meadows School of the Arts and Southern Methodist University in Dallas. Questions and comments can be directed to editorial@therapytimes.com.


References

Adamek, M. S., & Darrow, A. A. (2005). Music in special education. Silver Spring, MD: American Music Therapy Association.

Beathard, B., & Krout, R. E. (2008). A music therapy clinical case study of a girl with childhood apraxia of speech: Finding Lily’s voice. The Arts in Psychotherapy, 35, 107-116.

Braithwaite, M. & Sigafoos, J. (1998). Effects of social versus musical antecedents on communication responsiveness in five children with developmental disabilities. Journal of Music Therapy. 35(2), 88-104.

Cohen, N. (1992). The effect of singing instruction on the speech production of neurologically impaired persons communication disorders. Journal of Music Therapy, 29, 87-102.

Cohen, N. (1994). Speech and song: Implications for therapy. Music Therapy Perspectives, 12(1),    8-14.

Hibben, J. (1991). Group music therapy with a classroom of 6-8 year old hyperactive learning disabled children. In Bruscia, K. (Ed) Case Studies in Music Therapy: Gilsum, NH: Barcelona Publishers.

Keith , R. L., & Aronson, A. E. (1975). Singing as therapy for apraxia of speech and aphasia: report of a case. Brain and Language, 2(4), 483-488.

Kennelly, J., Hamilton, L. & Cross, J. (2001). The interface of music therapy and speech pathology in the rehabilitation of children with acquired brain injury. Australian Journal of Music Therapy, 12, 13-20.

King, B. (2007). Language and speech: distinguishing between aphasia, apraxia, and dysarthria in music therapy research and practice. Music Therapy Perspectives, 23 (1), 13-18.

Knoll, C. (1998). Music therapy in action: Anecdotes and observations from the field. Music Therapy Perspectives, 16(1), 9-12.

Leung, M. (2008). A collaboration between music therapy and speech pathology in a paediatric rehabilitation setting. Voices: A World Forum for Music Therapy. Retrieved November 1, 2009, from http://www.voices.no/mainissues/mi40008000273.php

Littlejohn, S., & Foss, K. (2008). Theories of Human Communication (9th Ed.) Belmont, CA: Thomson Wadsworth.

McCarthy, J. (2008). A survey of music therapists’ work with speech language pathologists experiences with augmentative and alternative communication. Journal of Music Therapy, 45(4), 405-426.

Nelson, D. L., Anderson, V. G., & Gonzales, A. D. (1984). Music activities as therapy for children with autism and other pervasive developmental disabilities. Journal of Music Therapy, 21(3), 110-116.

Pellitteri, J. (2000). Music therapy in the special education setting. Journal of Educational & Psychological Consultation, 11(3-4), 379-391.

Radocy. R. E., & Boyle, J. D. (2003). Psychological foundations of musical behavior (4th ed.). Springfield, IL: Charles C. Thomas.

Register, D., Darrow, A. A., Standley, J., & Swedberg, O. (2007). Teaching child-care personnel to use music in the classroom: a comparison of workshop training versus on-site modeling. Journal of Music Therapy, 44(1), 23-37.

Tamplin, J. (2008). A pilot study into the effect of vocal exercises and singing on dysarthric speech. NeuroRehabilitation, 23(3), 207-216.