ASD Deficits

Impairment in Social Interaction

     Teachers and parents have observed that children with ASD have difficulty interacting with others. Children with ASD are variously described as being awkward, unable to fit in, targets of bullying, avoiding eye contact, speaking in a monotone, and lacking facial expression. Some children with ASD are not responsive to people or things that are interesting to others. They rarely initiate spontaneous socialization and may seem to prefer to be alone.

     It is important for music teachers to include students with ASD even though the students may not seem to show outward responses or interests. Numerous researches have shown that children with ASD respond to music stimulant and that active music therapy is beneficial to improving autistic symptoms.[1] Music teachers can encourage whole class participation by creating a friendly and non-threatening learning environment. To help facilitate social engagement, teachers may consider carefully structured social games and activities; the use of music can be an excellent vehicle and medium.[2] Another arrangement that may be useful is to assign a peer-buddy who may do class activities, practice, or perform together. Since many children with ASD also have sensory processing disorder, they can experience sensory overload even during a normal day’s class activity. The music teacher may prepare a quiet corner inside or adjacent to the classroom so that any students who may feel stress or anxiety can have a temporary respite before a meltdown occurs.

Impairment in Social Communication

     Social communication of children with ASD include lack in ability to exchange, process and understand verbal, non-verbal, and pictorial information. According to the CDC, about 40% of children with ASD do not talk at all, may have delayed speech and language skills,[3] although some are highly verbal. Hammel suggests a four-step process for teachers to effectively communicate with these students which includes establishing eye contact, encouraging joint attention, encouraging reciprocation of appropriate language and reflection.[4]  

Eye contact

     Human beings exchange a significant amount of information through eye contact; the non-verbal cues express information such as acknowledgment, approval or disapproval, the state of emotion, the expectation of reaction from the recipient, etc. There are multiple theories attempting to explain why people with autism avoid eye contacts.  In his Essay on Autism and Theory of Mind, Baron-Cohen explains that people with ASD lack the mechanisms that enable them to hypothesize and share other people’s thoughts, feelings, desire, and behavior.[5] Hence some children with ASD are described as “mindblind”, seemingly inattentive to the teacher’s and other people’s communication and information. On the other hand, Rieffe et al. studied high-functioning children with autism state that many of these children do possess the appropriate mind mechanisms but choose not to apply the capacity due to the intensified stress and anxiety resulting from their information processing disorder.[6] Senju and Johnson describe two variances of the affective arousal model for atypical eye contact seen in people with autism. The hyperarousal/gaze aversion model suggests that eye contact elicit an aversive emotional response in people with autism due to overstimulation which interferes with their ability to process the stimuli. Therefore, they actively avoid eye contact as an adaptive response to prevent the heightened sensitivity to social stimuli.[7] Richer’s research indicates that these children are flight motivated when they are being looked at. Therefore, he strongly discourages the purposeful engagement of eye contact with students with ASD even when the eye contact is of friendly nature.[8] The other variance of the affective arousal model, the hypoarousal/social motivation model, suggests that some people with autism withdraw from eye contact due the failure to associate the intrinsic rewards of positive social interaction to eye contact.[9] Therefore, they may show indifference to eye contact but can be trained to engage in eye contact without the aversion felt by others.

     Engaging in eye contact may imply full attention to most people, but in fact, causes great anxiety to many students with autism and interferes with their learning. Feedback from some individuals clearly indicate that it is more effective to focus on the task on hand, rather than focusing on establishing eye contact.[10] Therefore, teachers must consider the idiosyncratic ways each student responds to eye contact to determine whether it is beneficial to the student’s learning through social interaction.  

Joint attention

     Joint attention is a critical social communication skill that begins to develop as early as nine months of age. It involves two people, usually a younger child and an adult, sharing attention through means of gesture or eye gaze over an interesting object or event.[11] McCord and Lee state that “Joint attention in children with autism is often a struggle, but children will often look at and engage with instruments that produce interesting and pleasing sounds.”[12] If a student shows interests in an item or a topic, the teacher can utilize the item or expand on the topic to encourage joint attention. If a student with ASD likes to play a certain rhythmic pattern, the teacher can expand on that pattern or have the student play the same pattern on the instrument of his/her choice. If the student responds to one question, the teacher can ask a second question to solicit more responses. Hourigan recommends choosing words carefully and specifically for children who have limited verbal skills, limiting instructions to a few words, and using hand gesture when appropriate.[13] Music teachers can consult with parents, special educators and other knowledgeable staff to choose the best communication methods. By extending and maintaining joint attention, the teacher can help the student with ASD to stay engaged and promotes learning.

Reciprocation of Appropriate Language

     Reciprocation means to respond to a gesture or action by making a corresponding one. Unfortunately, it is often difficult to elicit a reaction or a response from students with ASD when a teacher or another student initiates an interaction. To motivate a response, a teacher can first attract the student’s attention by various means, such as making a sound or playing a musical note. Then the teacher can plan activities such as performing music in the call and response format. The repetition of one or more patterns encourages reciprocation. The music teacher should allow adequate time for the student to explore and practice musical elements then observe what triggers responses from students. Another way to encourage reciprocation is to have the student point to pictures to help convey the student’s thoughts.[14] Studies have found that the Picture Exchange Communication System is an effective tool for children with ASD to learn to communicate and to enhance their social and communicative growth.[15] Music teachers can work with special educators on selecting a set of picture icons that are useful for music class instructions to be used with these students references.

Reflection

     Asking students to reflect on what they have learned in a music lesson is very helpful to retain learning.[16] At the end of a lesson, teacher can review the musical elements or concepts learned in the lesson. For example, if the lesson is learning different types of notes, such as whole note, half note, quarter note and eighth note, the teacher can ask students to to describe the duration of each type of note, point to the picture of the specified note, or clap the beats for each type of note. Some students may choose to answer verbally, some may enjoy the clapping. For the student with ASD, clapping or pointing to the picture of a corresponding note may be the preferred communication method. The music teacher can also observe and reflect on these communication strategies and choose what works best for his/her classes and students.

Restricted, Repetitive Patterns of Behavior, Interests, or Activities.

     Students with ASD often demonstrate restricted, repetitive patterns of behavior, interests or activities at different severity levels. Such behavior not only causes social impairment, but also has a negative impact on a student’s learning.[17] A student may like to repeat the same actions when it is interesting to him/her without concerns for perceptions from others. For example, a student may be fascinated with the black and white keys on a piano or the sound the keys produce and want to repeatedly play these two notes and refuse to be seated when the class is starting. Sigafoos, et al. found that repetitive behavior can be reduced by “replacing or displacing the obsessive repetitive acts with engagement in other more appropriate activities.”[18] This replacement must be a preferred object that is easily accessible in order to be an effective deterrent to such repetitive acts.[19] 

     Many students with autism have restricted interest in a particular topic or subject.  For example, a student is very interested in maps and spends all of his time and energy on collecting maps and learning the content of the maps. The student becomes an expert and will only engage in conversations in that subject area even when others are not interested. Unfortunately, the student does not want to engage in other activities or show indifference even resistance to participate. The teacher will need to find creative ways to engage the student’s interest in the lesson plan. For example, the teacher can point to a location on the map and play the music that is idiomatic to that region. The student will slowly recognize the music associated with each location on the map. By linking a student’s focused interest to the lesson, the teacher can expand the student’s interest and achieve learning goals.

Other Characteristics

     A few other characteristics often associated with students with ASD include intellectual disability, sensory processing disorder, and gastrointestinal (GI) disorders. According to CDC, 44% have average to above average range based on their IQ score, 25% are in the borderline range, and 31% of children with ASD are classified to have intellectual disability.[20] This data clarifies the misconception that ASD equates to intellectual disability. Many students with ASD possess talents in music, arts, math, science, and other subjects. Heaton, et al.’s research shows that children with autism “demonstrated a superior ability for single-note (pitch) identification.”[21] Fang, in her case study of Music in the Lives of Two Children with Autism, describes a teenage boy with severe ASD acquiring advanced skills in piano performance by learning through listening, i.e. without the capability of reading music notations. The boy’s mother created homemade adaptive devices that enable him to learn multiple musical instruments including drum set timpani, Yangqin (Chinese hammered dulcimer), and cello in addition to piano. The children with ASD may have different learning styles, often require adaptive devices and assistance from others.  However, being on the spectrum should not deprive them the opportunities to learn music.

     Another condition frequently observed in children with ASD is sensory processing disorders (SPDs). Researches have shown that the symptoms of SPDs in children with ASD have high incidence rates ranging from 45% to 95%.[22] Students with SPD may be hypersensitive or under-sensitive to the environment such as light and sound. For children who have hypersensitive hearing, what seems to be the “normal” sound generated by daily activities such as opening and closing doors, ruffles of page turning, gentle tapping of feet may escalate to overstimulation of hearing and sensory-overload, causing extreme anxiety or a meltdown.[23] It is important to establish a communication cue for the teacher and student to prevent the student from reaching the breakpoint in a classroom. A music teacher can turn down the volume of music or provide a noise-reducing headphone for the student if he/she is hypersensitive to sound.[24] For a student with hypersensitivity to light, the music teacher can allow the student to wear sunglasses or place the student in the area of the classroom away from the window or sunlight. The teacher may also excuse the student to a quiet corner of the classroom or a pre-arranged place before the student experiences sensory-overload.

     Finally, according to a special health report published by Autism Speaks in 2017, “Gastrointestinal (GI) disorders rank among the most common medical conditions associated with autism.”[25] A recent research conducted by Chaidez, et al. indicates that children with ASD experiences chronic GI symptoms eight times more than that of the typically developing children.[26] The implication for teachers is that these students will likely need to have frequent breaks to the restroom during class time.

After determining the student’s ASD characteristics, music teachers can consult with special educator, general classroom teacher, school psychologist, school nurse, and counselor to provide the best support for the student based on the education goals. Accommodations should be documented in the student’s Individual Education Plan or 504 plan. 

 

[1] Nick Zangwill, “Music, autism, and emotion,” Frontiers in psychology vol. 4 890, ( Dec 6. 2013), DOI:10.3389/fpsyg.2013.00890; Marianna Boso, Enzo Emanuele, Vera Minazzi, Marta Abbamonte, and Pierluigi Politi, “Effect of Long-Term Interactive Music Therapy on Behavior Profile and Musical Skills in Young Adults with Severe Autism,” The Journal of Alternative and Complementary Medicine. Volume: 13 Issue 7: (October 11, 2007, ahead of print), DOI:10.1089/acm.2006.6334.

[2] Alice Hammel and Ryan M. Hourigan, Teaching Music to Students with Autism (New York: Oxford University Press, 2013).

[3] “Signs and Symptoms of Autism Spectrum Disorders,” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, last modified April 26, 2018.  https://www.cdc.gov/ncbddd/autism/signs.html.

[4] Hammel, “Teaching Music to Students with Autism,” 31-47.

[5] Glenn Wilson, review of Mindblindness—an Essay on Autism and Theory of Mind, by Simon Baron-Cohen. Personality and Individual Differences 20, no. 2 (1996): 278-79.

[6] Carolien Rieffe, MM Terwogt, and L. Stockmann. “Understanding Atypical Emotions among Children with Autism.” Journal Of Autism And Developmental Disorders 30, no. 3 (2000): 195-203.

[7] Atsushi Senju and Mark H. Johnson, “Atypical Eye Contact in Autism: Models, Mechanisms and Development,” Neuroscience and Biobehavioral Reviews 33, no. 8 (2009): 1204-214. DOI:10.1016/j.neubiorev.2009.06.001.

[8] J. M. Richer and R. G. Coss, “Gaze Aversion in Autistic and Normal Children,” Acta Psychiatrica Scandinavica 53, no. 3 (1976): 193-210. DOI:10.1111/j.1600-0447.1976.tb00074.x.

[9] Senju, Johnson, “Atypical Eye Contact.

[10] Rozella Stuart, “Should We Insist on Eye Contact with People who have Autism Spectrum Disorders,” The Reporter, 5(3), 7-12, Indiana Resource for Autism. Indiana University Bloomington, last modified March 6, 2019. https://www.iidc.indiana.edu/pages/Should-We-Insist-on-Eye-Contact-with-People-who-have-Autism-Spectrum-Disorders.

[11] Jones, Emily A., and Edward G. Carr. “Joint Attention in Children With Autism: Theory and Intervention.” Focus on Autism and Other Developmental Disabilities 19, no. 1 (February 2004): 13–26. DOI:10.1177/10883576040190010301.

[12] Kimberly McCord, Kimberly, “Universal Design for Learning: Special Educators Integrating the Orff Approach into Their Teaching,” Approaches: Music Therapy Special Music Education 5, no. 2 (2013): 188-93.

[13] Hourigan, “Teaching Music.”

[14] Hammel, “Teaching Music to Students with Autism,” 38.

[15] Andy Bondy, Lori Frost, “The Picture Exchange Communication System,” Behavior Modification Volume 25 Number 5 (2001): 725-744, October 5, 2001. DOI: 10.1177/0145445501255004.

[16] Hammel, “Teaching Music to Students with Autism,” 45.

[17] Tracy Raulston and J. Machalicek, “Early Intervention for Repetitive Behavior in Autism Spectrum Disorder: A Conceptual Model,” Journal of Developmental and Physical Disabilities 30, no. 1 (2018): 89-109. DOI:10.1007/s10882-017-9566-9.

[18] Jeff Sigafoos, et al., “A Classroom-Based Antecedent Intervention Reduces Obsessive-Repetitive Behavior in an Adolescent With Autism,” Clinical Case Studies 8, no. 1 (2009): 3-13. DOI:10.1177/1534650108327475.

[19] Brian Boyd and Lynn Wakeford, “Repetitive Behaviors and Sensory Features: Evidence-Based Intervention Strategies,” chap. 7 in Interventions for Autism Spectrum Disorders, ed. Naglieri J., (Goldstein S. New York, NY: Springer, 2013).

[20] Baio, Wiggins, Christensen, et al., “Prevalence of Autism Spectrum Disorder.”

[21] Pamela Heaton, Beate Hermelin, and Linda Pring, “Autism and Pitch Processing: A Precursor for Savant Musical Ability?” Music Perception 15, no. 3 (1998): 291-305. DOI:10.2307/40285769.

[22] Kanae Matsushima and Toshihiro Kato, “Social Interaction and Atypical Sensory Processing in Children with Autism Spectrum Disorders,” Hong Kong Journal of Occupational Therapy 23, no. 2 (2013): 89-96. DOI:10.1016/j.hkjot.2013.11.003.

[23] Interacting with Autism, “Sensory Overload,“ Youtube video, January 16, 2015, https://www.youtube.com/ watch?v=K2P4Ed6G3gw.

[24] Hourigan. “Teaching Music.”

[25] “Autism and Health: A Special Report by Autism Speaks,” Autism Speaks, 2017, https://www.autismspeaks.org/ sites/default/files/2018-09/autism-and-health-report.pdf.

[26] Virginia Chaidez, Robin L. Hansen, Irva Hertz-Picciotto, “Gastrointestinal Problems in Children with Autism, Developmental Delays or Typical Development,” Journal of Autism and Developmental Disorders 44, no. 5 (2014): 1117-127. DOI:10.1007/s10803-013-1973-x.