Tuesday, 10 June 2014

The Benefits of Creative Arts Therapies for Autism

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Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects a growing number of individuals all over the world. It is characterized by difficulties in communication. These include perceiving emotions in other individuals, language production, and emotion regulation.

In our social world, we connect to people by subtly imitating each other. Many dating and job websites often recommend mimicking gestures of an employer or a person of interest in order for that person to feel closer to you. This is a behaviour that actually happens naturally and non-consciously in many everyday social interactions. Mimicry facilitates closeness, as a result of us perceiving the other person as being more akin to ourselves, and therefore we accept them more readily. In addition, it is thought that we understand their emotions more readily, because we are producing echoes of those same emotional expressions ourselves. In autism, this tendency to imitate across verbal and body language is impaired, leading to deficits in social understanding and acceptance.

Photo source: http://www.hanen.org

Arts-based therapies provide an abstract route of communication that reaches individuals with autism. The enjoyment factor also creates a safe environment to experiment with imitation. It’s often been found that autistic individuals respond more towards emotion that is directed through song and creating visual art. While there is lots of room to conduct more research, initial research findings are incredibly promising. In the present article we will address a few of these findings and discuss the mechanisms by which these arts therapies may work. We will also discuss these findings in relation to work in our own laboratory, where we have found beneficial effects of song and movement therapy for children with autism.



Music

Music therapy provides a promising route to emotional communication training and behaviour regulation in autism. In 1964, Norddoff and Robins developed Improvisational Music Therapy, which incorporated the use of musical instruments as voice during conversation. This therapy was later developed into Creative Music Therapy, yielding positive results in communicative responses from once non-verbal children.

Photo source: www.hanlen.com


Drawing from Nordoff and Robins, Miller and Toca developed Melodic Intonation Therapy in 1979. They paired signs, then words with musical tones to assist in speech production with a 3-year-old nonverbal autistic boy. After 35 sessions, the child was capable of producing, responding, and understanding simple sentences. 

Auditory Integration Training therapy has been used to treat self-destructive behaviour. A particular study that adopted this methodology managed to eliminate head-jerking in an 11 year-old. The method teaches beat entrainment to metered music that mimics the rhythm of a relaxed heartbeat. The goal effect is for the listener to relax with entrainment. In a way, it is teaching listeners how to relax by bopping to Pink Floyd rather than Metallica.

Combining elements of Dance and Music therapy may prove to be effective in enhancing imitation and behaviour regulation, as well as emotional control and social interaction. In a more recent preliminary study conducted in 2013, sixteen adults with severe autistic syndrome participated in activities that involved drum and dance, expressive story-telling, and learned genre-specific dances such as the rhumba. Although more testing needs to be done, the results after 4 months of training have shown remarkable changes in the participants. See our review paper here for more information on the potential benefits of dance/movement therapy for autism.

Dance

In Dance and Movement Therapy (DMT), an individual is able to express internal impulses and emotions through guided and controlled movement. Through synchronous movement with others, dance has also been shown to enhance empathic understanding and social connectedness. In two studies that involved group dance and “follow the leader” activities, both autistic groups showed a decrease in stimming behaviour and aversive touch responses. There was also an increase in eye contact and the use of communicative gesture. These studies span from 1978 to 2001, suggesting that the success of Dance Movement Therapy is not just a recent finding. 



Photo source: www.fitfutures.com

Drama 

Drama has been found to be a promising avenue to promote prosocial behaviours in autistic children. In one recent study, ASD participants aged 6-17 were paired with 8 typically developing children (peers). The children participated in a musical theatre production, and peers performed the participant’s roles on video for the participants to watch and practice at home via video modelling. Children with autism showed improvement on identification of faces and theory of mind skills. 

Photo source: blog.camperoo.com/

In another study, children with ASD were provided with drama therapy in their schools. The drama therapists introduced structured ways of saying hello/goodbye, singing songs, playing ball games and drama games, storytelling, imaginary play, movement work, and relaxation. According to parent/caregiver and teacher feedback, improvements in five themes were found: feelings (a safe place to explore), peers (being included and making friends), social skills (role play provides a short cut to learning about and practicing social skills), structure (predictability lessens anxiety), and family (drama therapy supports families as well). These findings suggest that drama therapy is a suitable intervention for people with autism.

In a recent study involving children with Asperger’s syndrome, each student was given time on stage to explore different roles that involved improvisation, role-play, and movement work. The students reported greater self-confidence, self-esteem, cooperation, and emotional expression. It appears that drama therapy is a prosocial venture that could help kids with autism to flourish socially.

There are further case studies that demonstrate individual situations in which actingsongvisual art, or a combination, have helped families to make breakthroughs with their ASD children. While future research should use groups of individuals in order to be sure of the beneficial effects of arts therapies, current findings are incredibly promising.



Future Directions

In our own lab, we are currently using song, slowly scaled back to speech, in order to facilitate understanding of emotions in sentences for children with autism. We also ask the participants to mimic the emotional expressions of individuals in videos. This action may help them feel as though they were expressing the emotion themselves, and project how they feel during that type of expression while discerning the expression of the other person. So far, we have found that many of the children improve following 2 weeks of playing a video game that capitalizes on these methods. On the basis of our preliminary results, we have received a government grant to further develop the video game for tablet devices (eg., iPad). The new version of the game will be released in October, 2014. 
              
       


How does it work?

What exactly is it that makes these arts therapies so effective? There are a few different mechanisms at play here. The opportunity to become specialized in a certain activity is definitely one – there is plenty of research showing that mastery of a discipline enhances self-esteem. Even after one class, these kids can feel proud about having learned something new. In time, their talents will increase, along with their confidence.


A second mechanism involves the areas of the brain that are stimulated when people engage in artistic endeavours, especially music and dance. The mirror neuron system, which is noted to be deficient in activity during perception of other people in autism, is engaged during dance and music. It is even engaged by just watching dance or listening to music, but this is increased when actually participating. Synchronizing one’s movements with another person makes this system become especially engaged. Our theory is that when these kids engage in music or dance therapy, they are exercising the part of their brain that is important for social understanding.


Music presents itself on a multi-synchronous level due to the coordination of vocal inflection, entrainment to beat and meter, and facial manipulation in order to articulate notes. By pairing music with imitation therapy, a multi-modal system of synchrony in imitation is produced. Entrainment to the beat may help with the efficiency of movement production. In addition, since many individuals with ASD respond positively to music, this pairing seems promising in social development training


A third mechanism relates to synchronization. Spontaneous, or non-conscious mimicry of postures and positions of peers is an example of matching yourself to the surrounding social environment. Known as the chameleon effect, mimicry during social interaction creates rapport and encourages more prosocial behaviour. Kids with autism exhibit some deficits when it comes to timing, as well as binding of audio and visual information. Music and dance both rely heavily on proper timing. In many cases, learning of music and dance involves moving in synchrony with an instructor or moving in synchrony with a group of peers. Synchronous movement has been shown to assist in cooperation, liking, trust, and empathy for the person we are moving in synchrony with


Think of when you were in school and were part of a choir, or had to sing “Oh Canada” with your classmates in the morning. It’s been found that this kind of synchronous behaviour enhances camaraderie. In terms of autism, it is quite possible that practice with synchronous behaviour will help with two things:

          1.  It will help them practice moving synchronously, and to practice their general timing skills.
          2.  Through practice with synchronous movement, they may carry this skill over to their everyday life, which could benefit them in terms of enhancing emotional understanding and trust for other people.

You can participate!

The message is a positive one when it comes to arts therapies and autism. If you are interested in learning more about research going on in autism therapy, and new research applications, click here to join our mailing list. You can also participate in a study we are currently running in the SMART lab at Ryerson University. We are looking for kids aged 8-12, with high-functioning autism, as well as neurotypical kids who do not have autism for our comparison group, to take part in a video game singing study aimed at enhancing social skills and emotional understanding. We are measuring changes in brain activity, emotional responsiveness, and social behaviours that evolve as a result of the therapy. So far, we are seeing some promising benefits of synchronous singing and speaking on social deficits in autism.


Written by Lucy McGarryEmma Bortolon-Vettor, Abby Tong, and Frank Russo

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