Early childhood music therapy and autism spectrum disorder

Early childhood music therapy practice has experienced exponential growth in the 7 years since the publication of the first edition of Early Childhood Music Therapy and Autism Spectrum Disorders. In the second edition, Petra Kern and Marcia Humpal completely revised the presentation of important information to reflect the rapidly changing landscape of the treatment of autism spectrum disorder (ASD) in the early childhood period (<5 years). Kern and Humpal brought back most of the same authors from the first edition, all of whom have expertise in early childhood music therapy, specific to autism spectrum concerns, to inform clinicians’ practice and research agenda. Each chapter has a specific, clearly defined focus. Chapters include icons to signal the chapter’s focus, graphics to clearly represent trends and relationships between important concepts, and tables to summarize information. The artwork was designed by Joel Anderson, an artist, musician, and international ambassador who has ASD.

One of the difficulties with editing a book with multiple authors is managing writers’ styles and tone. Kern and Humpal set the tone for the book in the preface. The book is written in professional language with straight-forward sentence structure which may make the text accessible to non-native English readers. The chapters are strong enough to stand alone, increasing its utility as a text. Further, the chapters address topics that are covered in different academic classes which might serve the needs of a variety of courses: research, music therapy methods, and age/stage practicum experiences.

The first three chapters of the book provide overviews of (1) the current state of autism diagnosis criteria (Chapter 1 by Kern), (2) evidence-based practice as a process (Chapter 2 by Kern), and (3) music therapy research with young children with ASD (Chapter 3 by Whipple). The first chapter provides a primer of ASDs, including a history of the diagnostic criteria as well as current criteria. I found the chapter’s presentation of factual information to be engaging and learned new information even with my years of experience in this area.

In Chapter 2, Kern focuses on a discussion of evidence-based practice in music therapy specific to the book’s focus. Kern has written about evidence-based practice in music therapy journals, but the information here codifies the specific concerns around how music therapy practice is currently situated within the national norms for evidence-based practice. Clinicians within and outside of music therapy will benefit from reviewing this chapter as it relates to the implementation of music therapy or music-based interventions within their own practice.

Chapter 3 contains an expanded review of the foundational research that students and researchers should get to know, effectively presented with tables accompanying the review. The reader is provided with the link to the original meta-analysis by Whipple which can be downloaded from the publisher. The rate of publication of new findings in early childhood music therapy research may drive the timeline for the publication of the next edition of this text.

Chapter 4 (Humpal, Martin, Snell, and DeLoach) summarizes the Division of Early Childhood’s Recommended Practices for assessment. Music therapy assessments appropriate to this clinical population are reviewed and presented in table form for easy reference. The authors also outline a succinct model for approaching assessment (the Four-Step Assessment Model, pp. 76–79) that assists music therapists new to this area of practice.

Chapters 5, 8, 9, and 10 address different approaches in music therapy: Behavioral Approaches by Martin (Chapter 5); Nordoff-Robbins Approaches by Guerrero and Turry (Chapter 8); Neurodevelopmental Approaches by LaGasse (Chapter 9); and Sensory Processing by Wakeford (Chapter 10). The chapter on behavioral approaches is a systematic description of the tenants of behaviorism, a long-standing approach to autism treatment. The Nordoff-Robbins approach (one can argue the Nordoff-Robbins satisfies Bruscia’s definition of a model of music therapy rather than an approach, but the editors have chosen the chapter title for a reason) has been documented in a variety of texts over many years, though its inclusion in this text provides a necessary counterpoint to the previous chapter. The neurodevelopmental approach is the newest of the three approaches, driven by the advances in brain imaging and study whose clinical applications are clearly articulated. Wakeford’s chapter describes models of sensory processing and their implications in practice; Table 10.1 summarizes examples of evidence-based practices and strategies for the reader’s consideration.

Chapters 6, 7, 11, and 12 focus on practices within music therapy interventions that address clinical goals: Instructional Practices by Kern and Humpal (Chapter 6); Social Stories™ by Brownell and Schwartzberg (Chapter 7); Communication Development by Lundeen-Smith and Lim (Chapter 11); and Inclusion Practice by Kern (Chapter 12). Taken together, these chapters provide a general overview of the opportunities for skill development through music therapy interventions. I particularly appreciated the discussion, complete with musical examples, of original versus “piggyback” songs in Chapter 7. There is some crossover of clinical interventions between Chapters 6, 7, and 11 with several of the chapters addressing approaches; these serve as through-lines to scaffold the reader’s learning.

Chapter 13, 14, and 15 attend to the needs and role of parents in music therapy treatment for their young child. In my opinion, these chapters provide the greatest contribution to this area of clinical practice. DeLoach guides the reader through the fundamentals of family practice and building capacity of families to be active participants in their child’s development in Chapter 13. Chapter 14 by Schwartzberg dives into the ongoing discussion of advocacy for music therapy through the discussion of key organizations that are policy and thought leaders in the field of autism. Schwartzberg details key aspects of music therapy, with accompanying resources, which should be included in the therapist’s discussions with stakeholders. Of particular interest is Chapter 15, as Humpal highlights the experience of music therapists who are also parents of children with ASD. Far from being solely the personal stories of colleagues, Humpal frames the discussion within the existing literature on parenting children with autism.

Early Childhood Music Therapy and Autism Spectrum Disorder is an ideal text book for undergraduate, equivalency, and graduate music therapy study. Each chapter concludes with three distinct sections: Review and Reflect, References, and Appendix. “Review and Reflect” offers questions to highlight important concepts and deepen the reader’s thinking about music therapy practice in general. These questions also are useful prompts for in-class discussion or reflexive writing as student-clinicians develop their own professional identity.

A review of the references makes it clear that the authors took the time to ground their work in appropriate sources (i.e., the Division for Early Childhood, the Council on Exceptional Children, the Centers for Disease Control and Prevention, and the National Professional Development Center for ASD). Information about autism and available treatments is widely available through internet searches, though the quality of the information may not be consistent with AMTA Standards of Clinical Practice or CBMT Domains (which represent the parameters of clinical practice for music therapists). Kern, Humpal, and the contributing authors guide the reader to appropriate sources of information that support the profession’s commitment to evidence-based treatment.

I am most excited about the appendix available at the end of each chapter. The appendix is the authors’ attempt to provide insight into the concerns that individuals with autism might be faced with as they get older. Each appendix is divided into three sections relevant to the chapter’s focus (i.e., Research, Research Guidelines, and Resources for Chapter 3 “Music Therapy Research: Effective Interventions for Young Children with Autism Spectrum Disorder” by Whipple) and provides useful information that clinicians may be asked during the course of treatment planning or termination of a child from music therapy service. By providing this content, the authors support the music therapist as the content expert. Having information about music therapy practice beyond early childhood that is relevant to the treatment of ASD provides depth to the communication with other professionals and clients’ families. Music therapists will find resources in the appendix that will help them make appropriate recommendations for their clients’ continued growth and development after early childhood.

One critique of Early Childhood Music Therapy and Autism Spectrum Disorders is that the content is focused on institutions situated within the United States. While Kern cites the World Health Organization’s International Classification of Disease, the discussion of the evidence-based practice movement, including the national evidence-based practices reports (Chapter 2), does not include other national sources for information on ASD. Similarly, the research summary, including the AMTA Strategic Priority on Music Therapy and Autism Spectrum Disorder (Chapter 3), while inclusive of researchers outside of the United States, does not highlight culturally based research done by music therapists outside of the United States. This may be due to a dearth of research internationally in music therapy with young children with ASD, or it may be due to the emerging nature of autism research itself that perhaps has not yet begun to scratch the surface of elucidating music therapy’s place in the treatment of autism in other cultures. Regardless, Kern and Humpal provide an excellent template for other researchers and clinicians to frame their work with young children with autism, their families, and those who serve them.