Music Therapy and the Education of Students with Severe Disabilities

Music therapists regard music therapy as a valuable intervention for students with moderate to severe intellectual disability or multiple disabilities, but many special educators would regard it as a controversial practice, unsupported by empirical research. This paper reviews the goals and strategies used by music therapists working with students with severe disabilities and the purported outcomes of music therapy. The recent research base that could validate music therapy as an effective educational intervention is reviewed. There is little evidence to support the use of music therapy as an educational intervention, but what evidence there is suggests that music therapy sessions, when planned in collaboration with educators, may provide a context for eliciting and practicing communication skills. Such music therapy interventions should be individually planned and monitored to ensure educational outcomes are achieved. Music therapy has been broadly defined by a music therapist with an interest in people with disabilities as “. . .the use of music as a therapeutic tool for restoration, maintenance, and improvement of psychological, mental and physiological health and for the habilitation, rehabilitation, and maintenance of behavioral, developmental, physical and social skills – all within the context of a client-therapist relationship” (Boxill, 1985, p. 5). Music therapy is used with a wide range of populations – people in hospital, people with psychiatric disorders, older people, people in hospices, people with neurological problems, people with autism and adults and children with intellectual disability (Aldridge, 1993). Music therapy is seen by music therapists as a useful contribution to the education of students with special education needs (Aldridge, Gustorff, & Neugebauer, 1995; Daveson & Edwards, 1998; Patterson, 2003). Music therapists view music therapy as a “. . .well established profession similar to occupational therapy and physical therapy” (American Music Therapy Association, 2002, p. 1). Others, however, would place it in the category of controversial or non-proven approaches in special education, due to the lack of empirical evidence regarding its effectiveness (Dempsey & Foreman, 2001; New York State Health Department, 1999). Its use is not included in standard texts on the education of students with moderate to severe disabilities (see Snell & Brown, 2000; Westling & Fox, 2004) and it is not included in articles reviewing effective approaches to educating this population (Browder & Cooper-Duffy, 2003; Wolery & Schuster, 1997). Music therapy does, however, meet some of the criteria for identifying controversial practices identified by McWilliam (1999) and Herbert, Sharp, and Gaudiano (2002). For example, promotion of its use relies largely on anecdotal and case study evidence, some proponents are hostile to scientific evaluation (Aigen, n.d.), and proponents claim benefits for a very wide range of conditions. Even so, the use of music therapy in educational programs for students with severe disabilities is widespread (Chase, 2004; Ockelford, Welch, & Zimmerman, 2002; Smith & Hairston, 1999; Stephenson, 2004). How then, should schools and teachers working with students with severe disabilities approach this therapy? This paper focuses on the use of music therapy in educational settings for school students Correspondence concerning this article should be addressed to Jennifer Stephenson, Macquarie University Special Education Centre, Macquarie University, NSW 2109, AUSTRALIA. Email: [email protected] Education and Training in Developmental Disabilities, 2006, 41(3), 290–299 © Division on Developmental Disabilities 290 / Education and Training in Developmental Disabilities-September 2006 with moderate to profound intellectual disability and multiple disabilities, excluding students with autism spectrum disorders. It will discuss prevalence of use of music therapy in special education settings, describe goals and practice of music therapy with students with severe disabilities, review recent research and then consider possible applications of music therapy in the education of students with severe disabilities. Use Of Music Therapy In Special Education Settings Music therapy is becoming increasingly associated with special education, particularly with the education of students with severe disabilities. It is seen as a desirable component of education by some parents of students with disabilities (Fidler, Lawson, & Hodapp, 2003). In the U.S. context, it is recognized in educational settings as a “Related Service” that may be provided to assist a child with special education needs (Mattson, 2001; Patterson, 2003). Also in the U.S., 12% of music therapists report working with people with developmental disabilities (Chase, 2004) and increasing numbers are working with children with developmental disabilities in school settings (Chase; Smith & Hairston, 1999). Smith and Hairston, in a survey of American music therapists who worked in schools, found that 78% worked with children with developmental disability and 71% with children with multiple disabilities. In the U.K. a survey found just over a third of schools enrolling students with severe or profound learning difficulties had a music therapist working on site, although the authors suggest as few as 2% of students may have received therapy (Ockelford et al., 2002). Similarly, in Australia, a survey of the websites of schools enrolling pupils with high support needs found just over a quarter of the sites included information about music therapy in the school (Stephenson, 2004). Goals Of Music Therapy Meadowes (1997) in a review of music therapy for children with severe and profound multiple disabilities, described six goals of music therapy for this population. The first is “fulfilling the child’s basic needs” (p.4) which involves creating a trustworthy and responsive environment. The second is “developing the child’s sense of self” (p. 4) where the child builds relationships with musical instruments, music and the therapist. The third is “establishing or re-establishing interpersonal relationships” (p. 4). The fourth is “developing specific skills” (p. 5) such as eye contact, reaching, or using a switch within musical activities. The fifth is “dispelling pathological behaviour” (p. 5), and the sixth is “developing an awareness and sensitivity to the beauty of music” (p. 5). Music therapists may approach these goals in a number of ways, depending on their philosophical and theoretical beliefs. Hooper (2002) cited Moranto (1993) as enumerating at least 123 forms of music therapy. It seems that only a subset of these are used with children with severe disabilities. According to Meadowes (1997) music therapists working with students with severe disabilities may focus on music as recreation, as a reinforcer for desired behavior, as a means to develop other skills and knowledge, and/or to “heal.” Similar outcomes for music therapy within special education are described by the American Music Therapy Association (1999a, b). Music therapists using the Nordoff-Robbins approach, often used with people with severe disabilities, emphasize the development of communication and relationships through music (Nordoff-Robbins Music Therapy Australia, n.d.). Daveson and Edwards (1998), writing in the Australian context also noted the use of music therapy in achieving academic goals, in teaching gross and fine motor skills, in developing social interaction skills and in using music as a motivator for other tasks. In a survey of assessment tools used by music therapists in the U.S., Chase (2004) reported that therapists assessed motor skills (fine and gross), communication skills, social skills and cognitive/academic skills. Pellitteri (2000), who also identified speech and language, gross and fine motor skills, academic, behavior, social and aesthetic goals as part of music therapy, sees this crossing of several areas as a strength of music therapy in special