#JHFA Intern Research

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Autism Spectrum Disorder Research and Its Implications for Music Teachers

By Derek Kealii Polischuk Written by: Tucker Park Keywords: autism, music, education, ABA, DTT This article summarizes key research about ASD and how music teachers may apply this research to their classrooms. It discusses how high-functioning autism can sometimes be masked by above-average IQ scores, which may cause teachers to overlook the needs of their students. It also suggests that group music instruction and large ensembles may not be very effective for people with ASD, who often find social situations overwhelming, and how they may feel more secure in the calm, controlled environment of a private lesson. Minimizing stress can have great educational advantages for people on the spectrum, which is why it is best to keep things calm, structured, and free of last-minute changes. Teachers may also apply the principles of DTT (Discrete Trial Training), which is the science of breaking down learning into smaller steps that build off each other. Research also suggests that instructors should give all the steps necessary to complete an assignment, rather than assume that their student will intuitively know what to do next. These strategies provide a sort of solid base or “scaffolding” on which learning can occur.

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Article Summary: Hyperacusis in Autism Spectrum Disorders

Written by Kevin Bandel

Hyperacusis is the condition in which sounds which are not considered threatening or uncomfortable to most are perceived as intolerable. These reactions are to sound in general rather than a dislike of particular sounds. This report explores the prevalence of hyperacusis in the autistic population, the etiology (study of a condition’s causes) of hyperacusis in autism, and possible symptom management.

The exact cause of hyperacusis is unknown, but there are theories about what may increase its likelihood. One theory is that there is an increased synchronization between the auditory cortex and neurons that typically respond to loud sounds, which means the neurons would activate from lower intensity sounds. Another theory is an alteration between the limbic system (part of the brain responsible for emotional responses) or the auditory pathway. In observing those with hyperacusis, scientists have used Magnetic Resonance Imaging (MRI) on these subjects and detected elevated auditory activity in the midbrain, thalamus, and cortex.

While it is suspected that a significant portion of the autistic population experiences hyperacusis, studies have been inconsistent on how widespread it is. In 1999, one study reported an 18% prevalence for hyperacusis in children and adolescents with autism. Another study conducted in 2016 reported an increased sound sensitivity in 37% of the autistic children and adolescents it observed. The highest rate of hyperacusis was from a study in 2015, which tested autistic individuals ages 4 to 42, found that 69% of the participants were in the reported hyperacusis range.

Despite how large and inconsistent the estimated of range of hyperacusis in autistic individuals, a range of 18%-69% is a noticeable difference from the general population that possibly has hyperacusis, which is 3.2% to 17.1% The other important factor was of a study of 61 children with hyperacusis, 46% of them had a concurrent neurodevelopmental condition, with the most common being autism. The prevalence of concurrent autism and hyperacusis was likely influenced by autism influencing differences in sensory processing.

The article recommended three approaches to managing hyperacusis. One was habituation training, which involves playing a list of sounds the patient finds bothersome at a low level, with a gradual increase to the volume each week. Another was Cognitive Behavioral Therapy (CBT), which attempts to reframe a patient’s negative thoughts and behaviors. The last one was Auditory Integration Training (AIT), which plays an audio recording that filters out the sounds that the subject finds most intolerable, adding them back into the recording at a slow increase in volume. Of the three approaches, the article provided studies that Auditory Integration Training was the least supported in its effectiveness of dealing with hyperacusis.

An issue in assessing and coping with hyperacusis is the difficulty to measure and define it. Since it is a combination of both sound sensitivity and personal experience, studies would need to account for both dimensions of the condition. Subjective emotions are very challenging to measure precisely, but are a crucial part of hyperacusis since one’s perspective of sounds affects how much one can tolerate them.

While much is undetermined about hyperacusis, it appears to explain and conceptualize struggles that many autistic people face, especially since pursuing music involves a high exposure to sound.

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Article Summary: Sweet spot in music—Is predictability preferred among persons with psychotic-like experiences or autistic traits?

 Written by Kevin Bandel

(Note: Just because “psychotic-like experiences” and autism are used in the same sentence, it does not mean they are similar. For example, the sentence, “Dangerous psychopaths and morally upstanding people need water to survive,” does not mean that dangerous psychopaths and morally upstanding people are comparable in most ways.  Furthermore, having a psychosis does not make a person “bad.”)

It is often assumed that music listeners prefer a balance of predictability. The ideal is that music is not so predictable that it becomes uninteresting, but not so unpredictable that it is jarring and incomprehensible. Individuals can vary in how they perceive a specific level of predictability. Some may find a piece of music monotonous; some may find the same piece chaotic, and others may have an opinion in between.

The authors of this article wondered if psychosis or autism would influence the amount of preferred predictability in their musical taste. Some symptoms of psychosis include paranoid ideas and difficulty telling reality from fantasy, which often leads to increased distress in unpredictable situations and an increased comfort with the familiar. Autistic people tend to experience heightened emotional arousal from the less known and may specialize in areas they are most focused on, which may also lead to an inclination toward a more consistent and regular lifestyle. The authors of this article were curious to see if these general behaviors applied to musical taste.

However, there are factors that can influence preferences to predictability in music outside of psychosis or autism. Individuals may be exposed to certain types of music most frequently, which may establish the baseline of predictability in music a person uses. Pieces often have conventions that can be observed across other pieces of the same genre, which would increase the level of perceived predictability for those familiar with a specific genre.

321 participants with either autism or psychosis were recruited from Prolific.co (a website designed to connect researchers and participants) and the Arctic University of Norway. The average years of music training (either formal or self-taught) was 5.69 with a standard deviation of 7.6. Participants rated various music excerpts on a scale of 0 (disliked very much) to 100 (liked very much). A panel of 8 music experts measured predictability of each excerpt and gave them a 1-10 rating, with 1 being the most predictable/least complex and 10 being the most difficult to anticipate/most complex. The average of the participants��� enjoyment of the excerpts was compared to the complexity score that the panel of experts gave the music.

A limitation of the study is that it did not measure the perceived predictability of the participants, only their enjoyment. Perceived predictability and enjoyment could be linked. Furthermore, age was not linked to participant responses to preserve anonymity. Age could impact both perceived predictability and enjoyment. With all aspects of the study considered, the authors concluded while research in the area is incomplete, there was insufficient evidence to suggest autism or psychosis affected the “sweet spot” for preferred predictability in music.

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The effectiveness of music therapy in improving behavioral symptoms among children with autism spectrum disorders: a systematic review and meta-analys

Written by: Tucker Park

This article is a meta-analysis of thirteen different experiments, all examining the effectiveness of music therapy on individuals with autism. Despite autism having a proven negative impact on financial, physical, and mental health, effective treatments are few and often untested. Music therapy shows promise as an impactful treatment, since it stimulates the cortical and subcortical brain areas, which are linked to emotions are rewards, which in turn could improve social motivation and emotional resonance. Engagement in musical activities can also strengthen the mirror neuron system in the brain, which enhances social imitation behavior. However, these benefits are still under scrutiny since a recent study found no significant differences between a music therapy group and a standard treatment control group.

Researchers began by screening and choosing literature to analyze. 43 studies were reviewed, but most were eliminated due to unclear study data, text inavailability, or unsuitable study topic. The thirteen remaining papers were then examined for bias, which was accounted for in the analysis. The authors concluded that music therapy indeed improved behavior symptoms of ASD. Children with autism view music as a safe and controlled stimulus, which allows them to partake in musical experiences and thereby train their communicative skills. Music also stimulates the brain’s sensory system with rhythm and melody, which creates a pleasant sensory experience which lessens the occurrence of maladaptive behaviors.

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Enhanced memory for vocal melodies in autism spectrum disorder and Williams syndrome (Weiss et al. 2021)

Written by: Tucker Park

In contrast to instrumental melodies, verbal or sung melodies have biological, communicative consequences. As a result, typically-developing adults and children exhibit a memory bias towards the vocal melodies, making them easier to remember than instrumental ones. This study examines whether people with Autism Spectrum Disorder (ASD) or with William’s Syndrome (WS), two conditions which are marked by abnormalities in processing communicative signals, experience the same memory bias. For the study, researchers recruited 26 subjects with ASD and 26 subjects with WS. The task was presented as two games; during the first game, participants listened to 12 musical excerpts, which were all western folk melodies sung by a female vocalist without lyrics. Participants were then asked to rate their enjoyment of each melody. For the second game, the subjects listened to the same 12 melodies intermixed with 12 new, unfamiliar melodies, and were asked to indicate whether they had heard that melody before or not. The study found that both groups were able to successfully separate the original 12 melodies from the new ones, showing a memory advantage for the vocal melodies. This has implications for the care and treatment of people with these conditions. In particular, the researchers recommend the use of vocal music in therapeutic interventions.

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Neural systems for speech and song in autism (Schneider et al. 2012)

Written by: Tucker Park

Neuroimaging on the brains of patients with autism has revealed decreased activity in Broca’s area, which is crucial for the production of language. At first glance this appears paradoxical since this does not explain the preservation of related functions, such as the understanding and creation of music. To investigate this discrepancy, this study utilized functional MRI and diffusor tensor imaging to compare the brain structures in autistic minds compared to an age-matched, neurotypical control. 36 people with autism and 21 non-autistic controls participated in this study. The parents of these children were also asked to rate how receptive their child was to music on a ten-point scale. The study found that all participants in the autistic test group were well above the minimum diagnostic criteria in the language and communication for autism. During speech, the control group exhibited activation in the left inferior frontal gyrus, while the test group did not. Furthermore, the fMRI results showed that the activation in posterior brain regions was also reduced in participants with autism. No regions in the test group were any more active in response to a speech stimulus than in the control group. In contrast to the differences in language impairment, there were no significant differences between the parent-reported musical affinity between the two groups. After compositing the data, researchers found that the reduced activation of the left inferior frontal gyrus in subjects with autism does not sufficiently account for language impairment in autism. A more likely theory, which is supported by data from related studies, is that this reduced activation might actually be a failure to receive information from lower-processing regions, not a disconnection of the system as a whole. This would indicate that impairments in these brain regions are the result of a speech-specific attention deficit, rather than towards social stimuli as a whole.

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Music, autism, and emotion (Zangwill 2013)

Written by: Tucker Park

This article examines the differences between how autistic and non-autistic people experience music by drawing on experimental data collected by Rory Allen and his colleagues. While those with autism spectrum disorder possess the regular scope of human emotion, they exhibit marked difficulties in their abilities to attribute emotions to others, imagine emotions when not having them, and describe emotions in words. For this reason, questionnaires of other self-report methods are ineffective for studying the experiences of people with autism. Instead, arousal in response to music is measured by capturing galvanic skin responses (GSRs), which measures the activation of sweat glands in the skin in response to a stimulus. Random, non-musical noise did not provoke a GSR in either sample group. However when participants were instructed to listen to a set of musical stimuli, both groups displayed a GSR, and there was no significant difference in the GSRs of the autistic and non-autistic sample groups. The study concludes that people with and without autism do not differ in their physiological arousal in response to music. One interpretation of this is that music uniquely triggers normal emotional cognition in people with autism. However, there is no evidence that listening to music is some kind of “cure” for autism. A more plausible conclusion is that listening to music does not involve an understanding of or the ability to imagine emotion. This position is supported by evidence on the efficacy of music therapy on people with autism. The reason music works so well as a therapeutic tool is because it does not involve having to think about things in terms of psychological states. While people with and without autism may still have different artistic experiences, this experience is independent of their understanding and imagining of emotions.

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Teaching Students with Autism (Link 2023)

Written by: Tucker Park

Individuals with autism spectrum disorder present with a variety of symptoms, including challenges with communication, social interaction, and learning. Consequently, teaching students with autism requires patience and flexibility to adapt to an individual’s educational needs. 

Since autism is categorized as a socio-communicative disorder, students with autism face a unique set of challenges in the school environment, which is dependent upon social communication between peers and teachers. Additionally, children with autism may face significantly higher rates of behavioral or emotional disturbance, highlighting the importance of autism advocacy and the need for accessibility in the classroom.

General education teachers can accommodate autism in their classrooms by using guided reading, formulated writing strategies, and well-planned transitions between stations or topics. In addition, it can be highly beneficial to relate the lesson to other subjects the student may be more interested in, as it encourages participation and self-confidence. 

Children with autism also frequently experience stress and anxiety in social settings, as well as sensory disorders related to light and sound. It is important to develop a behavior management plan to help identify stressors and de-escalate emotional or behavioral problems when they arise. 

Finally, aside from the student’s behavior, it is important to recognize the effects of having a child with autism on the family system. In order to serve a child’s educational needs, the parents must first acknowledge the problem, which can prove difficult for some to accept. Parents of a child with autism also face increased responsibility and stress, which negatively impacts family cohesion. To overcome these barriers, teachers, parents, and administrators must work together to best meet the needs of the student.

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Common Characteristics of Improvisational Approaches in Music Therapy for Children with Autism Spectrum Disorder (Geretsegger et al, 2015)

By: Tucker Park

Improvisational music therapy has seen increasing popularity as a treatment for ASD. This study evaluates the common practices in music therapy for people with autism, with the goal of using this data to refine treatment guidelines. While music therapy is a very diverse and individualized practice, there is still a need to operationalize in order to ensure the replicability of research findings and to improve transparency and training for incoming professionals. 

In order to gather this data, focus group workshops were held in three different countries by music therapy professionals from ten different countries. To measure treatment fidelity, a six-point scale was devised. The therapists would be filmed while administering their treatment, and then these video clips were reviewed by independent raters of various skill levels (undergraduate students, masters students, and certified music therapists). Following this, researchers compiled an initial list of treatment guidelines, which was then reviewed by established professionals from around the world. Based on the feedback from these music therapy professionals, a finalized version of the treatment guidelines was presented. It sorts music therapy techniques into three categories: compatible (tools, toys, or media that are not inherently related to music), essential (but not unique to improvisational music theory), and unique and essential. One critical point in the “unique and essential” category is “scaffolding the flow of interaction musically.” This involves the therapist reacting to the child’s behavior as communicatively intended, even if the child’s signals are scarce or poorly timed. The therapist then uses musical means such as matching the volume or rhythm of the patient’s expressions through musical interactions. This reinforces the child’s communication skills while acting as a scaffolding to enable the child to engage in the interaction. 

The study concludes that there is an international consensus on the characteristics of improvisational music therapy for autism, and that the compiled guidelines will enable music therapists to further develop and reflect on their clinical practices.

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Music Therapy

Written by: Tucker Park

Music therapy is a clinical practice recognized for over 200 years that utilizes music as a therapeutic tool. It can be used to address a variety of issues such as aggression, dementia, autism, traumatic brain injury, and stress. In this summary, I will be focusing specifically on the section of this paper regarding autism. 

During music therapy, the therapist and patient engage in creating music through instruments or singing. There are five main types of music therapy, which can be used either alone or in combination. These are receptive (listening to music), compositional (writing original music), improvisational (spontaneously creating music), re-creative (learning how to play an instrument), and activity (playing musical games).

The left hemisphere of our brains controls language functions, which may be underdeveloped in children with autism spectrum disorder. A type of music therapy called melodic intonation therapy can be used to help children on the spectrum develop their language skills. Melodic intonation therapy initially combines music and singing, then removes the music component once speech improves, with the goal that speech will continue to develop. These techniques have proven to be highly beneficial in aiding people recovering from strokes or traumatic brain injuries in relearning speech. However, one downside of this method is that empirical evidence for its effectiveness is limited, since it is unclear whether the development of language skills comes from the therapy itself or from the maturation of the child. Various ongoing studies are aimed at exploring modified forms of melodic intonation therapy, which may include additions such as phonetic placement or tapping.

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Prolonged Auditory Brainstem Response in Universal Hearing Screening of Newborns with Autism Spectrum Disorder (Miron et al. 2020)

Written by: Tucker Park

A prolonged auditory response (ABR) is defined as a delayed brain response to sound, and is observed in children and adults with ASD. It shows potential as a diagnostic tool for autism, but it was previously unclear whether newborns who are later diagnosed with autism showed these ABR abnormalities. In this study, 139,154 newborns were tested with the Universal Newborn Hearing Screening (UNHS) exam, which uses surface electrodes to measure the brainstem’s response to sounds. The experiments found that newborns who were later diagnosed with ASD exhibited prolonged ABRs, especially in the right ear. These differences could be the result of anatomical abnormalities in the brainstems of those with ASD. From these findings, it was determined that ABRs are an accurate prediction of whether the child will be later diagnosed with ASD (although other causes, such as hearing loss, must be ruled out first). This has possible implications for the development of an early screening system, which could be greatly beneficial since previous studies have revealed that earlier autism intervention is correlated with better overall outcomes. Currently, diagnoses are typically made after 3 to 4 years of age, but testing ABRs may be an untapped opportunity for even earlier intervention.

  Prolonged Auditory Brainstem Response in Universal Hearing Screening of Newborns with Autism Spectrum Disorder

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Celebrating the Artmaking of Children with Autism

Written by: Tucker Park

Artmaking may be uniquely meaningful and pleasurable both for children with autism and neurotypical children. Since visual art provides evidence of the artist’s thought process, often childrens’ drawings are visual representations of their obsessions with a particular narrow interest. This article shines a spotlight on Jessica Park, an artist with autism, and her mother Clara Park, who wrote various articles on autism and was one of the founding members of the Autism Society of America. Clara Park explains that children with autism will not learn how to make art by simply observing others; they must be explicitly taught. With the support of family, teachers, and classmates, Jessica was able to create “complex, intricately ordered systems” that beautifully illustrated the inner workings of her world, as well as showcased her natural talent for sensing colors, patterns, and composition.

Researchers have also been studying the question of whether there is such a thing as “distinctive autistic art,” pointing to common features such as perceptual accuracy, spontaneity, and oddity. For example, the book Nadia: A Case of Extraordinary Drawing Ability in an Autistic Child tells the story of a young British girl who was able to draw animals with a sense of space, motion, profile, and shadows that psychologists previously thought impossible for children of her age. In fact, many children with autism demonstrate these high levels of visual-spatial skills, with some describing it as “thinking in pictures.” 

Art education is critical to all children, but especially those who are developing atypically, such as children on the spectrum. It is important for art educators to acknowledge and appreciate the unique artistic abilities of children with autism, and design their lessons in a way that enables them to use their preferred mediums and express their special interests.

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Performance-Based Measures and Methods to Assess Emotional Dysregulation

Written by: Tucker Park

This chapter discusses why student performance data is a valuable complement to self-reported data about mood and behavior. Challenges with emotional regulation are rooted neurologically in the student’s prefrontal cortex, and are also linked to difficulties with attention, executive functioning, working memory, and verbal fluency. 

Although performance-based assessments are often not a high priority for students presenting with dysregulation, they can be useful in informing us about the student’s learning style, which has implications in optimizing their engagement in other forms of treatment. Furthermore, varying or unexpected patterns of scores can raise flags about previously unknown learning difficulties that may exacerbate emotional dysregulation. For example, an adolescent who struggles with verbal memory may also face difficulties listening and note-taking, and the resulting frustration may escalate into meltdowns or angry outbursts.

Two valuable performance-based measurement methods are the Rorschach and narrative techniques. Rorschach assessments involve tracking how a person experiences and manages their emotions throughout a series of tasks. For example, we may look for patterns about which conditions trigger different emotions, how intense the experiences are, and to what extent other psychological capacities are affected. Narrative methods, such as the TAT, CAT, and TEMAS, involve the instructor telling stories that include what the characters are thinking and feeling in order to sample the patient’s emotional vocabulary. For example, if a patient labels characters’ feelings with somatic states (e.g. tired, hungry, sick), this may indicate that they require more help in expanding their awareness of their internal experiences. 

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What Are Specific Learning Differences? (Judith and Smith 2024)

Written by: Tucker Park

Specific learning differences, or SpLDs, can be difficult to measure, observe, and quantify. In order to understand them, we must take into account both a biological and a behavioral view, while also accounting for external environmental factors. Some ways in which SpLDs may manifest include reading and spelling difficulties, as well as problems in memory and organization. One approach to defining a SpLD is to test how a student responds to an educational intervention; if low academic achievement persists even after the intervention, then a SpLD may be present. 

Teacher education programs are instrumental to providing support to students with SpLDs. Some techniques include giving clear and brief instructions, rotating a variety of awards for positive behavior, modifying academic tasks, and providing more frequent intervals between activities. Specifically for children with ASD, strategies may include music and art therapy, cooperative games instead of competitive ones, and providing supervision at break times, which may be particularly stressful to these students due to their unstructured and unpredictable nature.

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Autism, music, and the therapeutic potential of music in alexithymia

Written by: Tucker Park

This article examines why emotional responses to music are unaffected in people with autism, and how music could be used to treat alexithymia (defined as an absence of insight into one’s emotions, affecting around 85% of those with ASD). Self-reported accounts from participants with ASD showed that their uses of music were very similar to those of neurotypical adults and adolescents, including self-management of mood and a sense of belonging within a musical community. However, they differed in their descriptions of music, tending to describe properties of the music rather than the emotions it evokes. These findings are understandable since individuals with ASD are known to engage in less top-down processing, meaning that their judgements are likely to come from the properties of the stimulus rather than emotional characteristics. These findings can be beneficial to the treatment of alexithymia by allowing patients to identify their internal state using music, for example describing their mood as, “the way I always feel when I hear Brahms’s Piano Concerto.” Although this may not help the individual deal with the social implications of alexithymia, it can greatly reduce the sense of helplessness and anxiety caused by this disorder by allowing individuals to externally label an internal mood state.

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Article Summary: Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention

Written by Kevin Bandel