(2015). New Zealand Journal of Music Therapy, 13, pp.

8-32
 Music Therapy New Zealand

Music therapy with people who have Autism Spectrum

Disorder – Current practice in New Zealand
Daphne Rickson, PhD, LTCL, MHealSc(MenH), MMus Ther, NZ RMTh

Senior Lecturer, Te Kōkī, New Zealand School of Music, Victoria

University of Wellington, New Zealand

Claire Molyneux, MA (Music Therapy), BA (Hons), PGCertHealSc (Adv

Psychotherapy Practice), NZ RMTh

Private practice, Auckland and Hospice West Auckland

Helen Ridley, MMus Ther, MMgt(dispute resolution), GradDipDispRes,

MEd(Hons)(Adult Ed), BMus(Hons), Cert. Supervision, NZ RMTh

Freelance Music Therapist and Mediator, New Zealand

Ajay Castelino, MMus Ther, LLCM (TD), BE (Hons), NZ RMTh

Music Therapist, BLENNZ Homai Campus School, Auckland

Erin Upjohn-Beatson, MMus Ther, NZ RMTh

Freelance Music Therapist, Wellington

ABSTRACT
This paper describes contemporary music therapy practice with children
and young people who have Autism Spectrum Disorder (ASD) within
New Zealand. Currently very little is known about the numbers of
children and adolescents with ASD who are receiving music therapy in
New Zealand, their goals, or outcome measures. Our paper draws on
the results of an exploratory study which aimed to gather information
regarding the practice of music therapy with children who have ASD in
New Zealand, in order to scope and design research appropriate for the
New Zealand context. Because the field is small, we also included
information regarding music therapy work with adults who have ASD
when it was offered. Music therapists agree that a variety of evidence is
needed to underpin the practice of music therapy. However we found

8
that opportunities for experimental research in this context are limited
by paucity and heterogeneity of practice.

KEYWORDS
Music therapy; autism spectrum disorder; New Zealand; music therapy
research; music therapy practice

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder

characterised by persistent deficits in two core domains of social
communication or social interaction; and restricted and repetitive
behaviours, interests or activities (APA, 2013). It usually manifests in
early childhood and persists throughout life (APA, 2013), and in New
Zealand affects the lives of over 40,000 people and their families
(Autism NZ, 2014). Children with ASD often have a unique attraction to
music and may have special musical abilities (Carpente & LaGasse,
2015) especially with regard to pitch perception (Heaton, 2004).

Internationally, work with children who have ASD is a major area for
practice in music therapy; arguably it is the client group with which
music therapy has the highest reputation (Dimitriadis & Smeijsters,
2010). A relatively large body of literature describes music therapists
using a wide range of approaches to address an array of ASD symptoms
(Carpente & LaGasse, 2015). In a recent survey of 328 professional
members of the American Music Therapy Association (Kern, Rivera,
Chandler, & Humpal, 2013) 27.3% of respondents indicated that
between a quarter and one-half of their clients had Autism Spectrum
Disorder. In a further analysis of ASD studies, mostly from the United
States, Carlon, Stephenson, and Carter (2014) found that approximately
a quarter of all parents of children with ASD favoured music therapy as
an intervention.

Music therapy is considered to be particularly helpful to support the

development of social interaction and communication skills in this
population (Gattino, Santos, Longo, Loguercio, & Faccini, 2011; Gold,
Wigram, & Elefant, 2006; Kim, Wigram, & Gold, 2008; Thompson,

9
McFerran, & Gold, 2013). While the results of Gattino et al’s (2011)
randomised control study to investigate the effects of music therapy on
communication were inclusive overall, there was a statistically
significant difference on the aspect of non-verbal communication.
Similarly, Thompson, McFerran, and Gold (2013) found that family-
centred music therapy led to improvements in social interactions in the
home and community and the parent–child relationship, but not in
language skills or general social responsiveness.

Methods

Methodology
The goal of exploratory research is to discover ideas and insights, to
find out ‘what is going on here’. The aim is to generate a grounded
theory, hypothesis and/or design for future research (Stebbins, 2001).
We employed a convergent parallel mixed methods design which
included (1) an online survey which enabled us to obtain demographic
data from as many people as possible, and to recruit participants for
interviews, and (2) a more in-depth exploration of issues via open-
ended interviews. Data were analysed separately and integrated at the
point of report writing.

Recruitment
Music Therapy New Zealand (MThNZ) disseminated information about
the study and invited all registered music therapists to participate in an
online survey. The 29 survey respondents represented almost 50% of
eligible participants. At the end of the survey, music therapists were
asked to inform other professionals and parents who work with music
therapists and children with ASD about the study, and to invite them to
express interest in participating in interviews.

Survey Participants
Survey respondents comprised an equal spread of recent graduates,
those who had been practising between 4 and 10 years, and those who
had practised for more than 10 years. The majority of respondents were

10
from Wellington and Auckland. The number of people with ASD
currently receiving music therapy from survey respondents is estimated
to be 150 children and 30 adults.

18
16
14
12
10
8
6
4
2
0
1 to 5 6 to 10 11 to 15 More that 15
people with people with people with people with
ASD ASD ASD ASD

Individually In groups
Figure 1: Numbers of music therapist respondents working with people with ASD

160
140
120
100
80
60
40
20
0
Children Adults
Figure 2: Estimated number of people receiving music therapy from respondents

Interviewees
Twenty-four (24) people (13 music therapists, eight parents, and three
stakeholders) expressed interest and gave informed consent to be
interviewed individually or in one of four focus groups. Stakeholders
included a therapist from another field working with children who have

11
ASD in music, and two people who have both been members of the ASD
guidelines group, and have significant research, education and/or
managerial experience working with people who have ASD.

Interview methods and analysis

Interviews were semi-structured, and in-depth, with interviewers
guiding the interviews by asking relatively specific but open-ended
questions. All interviews were audio-recorded and transcribed in full.
Interview and focus group data were analysed using thematic analysis
procedures (Braun & Clarke, 2006). Braun and Clarke describe six major
steps in their thematic analysis process, specifically: becoming familiar
with the data; generating initial codes; searching for themes; reviewing
themes; and defining and naming themes. Four interviewers (co-
researchers) transcribed interviews, reviewed them with participants,
and returned them to the primary investigator (PI) with initial coding
and margin notes. The PI combined the data and sorted according to
initial codes; reviewed the codes, and renamed, combined, and
developed new codes after checking with interviewers; examined each
category and applied secondary coding with descriptions; met with
interviewers to review, revise, and agree on secondary coding;
developed themes (ideas generated by several participants), exceptions
(ideas mentioned by only one person), concepts (combinations of
ideas), and stories (examples from practice); and reproduced themes,
exceptions and concepts in the form of findings.

Ethics statements
Approval for this study was granted by the Victoria University of
Wellington Human Ethics Committee (Ref: 0000021142). Informed
consent in writing was obtained from all individuals participating in this
study. Real names have been changed.

12
 Findings and Discussion

The results are a combination of survey and interview data.

Music therapy referrals and assessments

The largest number of survey respondents, by far, work in private

practice and in school settings (see figure 3).

Other
Community 7%
Facility
8%
Private practice
34%
DHB
7%

Music therapy
centre
8%

Schools
36%

Figure 3: Music therapists’ work contexts

The context in which music therapists work naturally has an influence

on the ways referrals are made, and by whom. The origins of the
referrals are summarized in figure 4. Survey data suggested speech and
language therapists were the most frequent referrers. Interviewees
observed that referrals are often generated when someone who has
witnessed a session suggests that music therapy might be helpful for
another particular person:

I think a lot of it is word of mouth. Or somebody has watched a

session, and … has I guess developed an understanding of
music therapy that way. Yeah, there is a lot of that. Once, I

13
 guess, an allied health professional, or someone has sat in on a
session … then they talk to their colleague and go ‘well maybe
for that student, music therapy might be a good approach.

%
80

70

60

50

40

30

20

10

0
Self Family School Other Other Other
referral member institution professional

Figure 4: Origins of music therapy referrals

‘Interest in music’ was the most cited reason for referring a child with
ASD to a music therapist. Other reasons include anxiety; the
development of curiosity/motivation; relationship skills; sustained and
joint attention; communication; social interaction; behavioural needs;
emotional development; failure to thrive at school; supporting
transition; and having fun. Interviewees suggested music therapy is
sometimes considered to be the ‘last attempt’ to intervene; an
opportunity to ‘reach’ someone when other therapies have been
unsuccessful. The process of deciding what to focus on involves
listening to what people think is important, aligning their wishes with
what has already been documented e.g. in the learners’ individual
education plan (IEP) and with broader guidelines such as the Ministry of
Education’s Key Competencies 1 (Ministry of Education, 2007).

1. ‘Key Competencies’ are defined by the Ministry of Education as “the capabilities people have, and need to develop, to live and
learn today and in the future” (2014, http://nzcurriculum.tki.org.nz/Key-competencies). The Key Competencies encompass
knowledge, skills, attitudes, and values and help teachers to identify and strengthen students' capacity to participate in the world.

14
Focus of music therapy programmes
Music therapists talked about the need to do specific music therapy
assessments, usually over six to ten sessions, to help decide whether
music therapy is the appropriate medium for this person, whether
group or individual work is needed, to determine goals, and/or whether
the way a child interacts in music therapy can contribute to a diagnostic
picture. Music therapy programmes focus on a range of goals. These
are summarised in figure 5, below. Communication and social skills are
the most common areas of focus.

Emotional expression
Engagement
Independence
Key Competencies
Wellbeing
Interaction
Resourcing families
Creativity
Mood regulation
Speech
Participation
Anxiety
Sensory integration
Inclusion
Relationships
Social skills
Communication

0 5 10 15 20

Figure 5: Areas of focus for music therapy

Communication is a complex concept that encompasses many forms of

interaction. Interviewees talked directly about focusing on specific
communication modes such as facilitating speech or emotional
expression. Others simply said that communication was a focus for
them, and variously mentioned aspects that they might work on. For
example they mentioned supporting participants to develop skills
related to receptive communication such as listening, attending
(including shared attention), concentrating, and engaging; facilitating

15
non-verbal expressive communication such as vocalisation and creative
musical expression; fostering verbal expression through singing and
speech; and promoting the development of language.

Increasing interaction and participation were specifically mentioned as a

foci for programmes, with the development of motivation, expressive
communication, turn-taking, play skills, and building relationships as
aspects of that. Developing relationships was another frequently cited
focus. Interviewees emphasised the importance of the participant and
therapist relationship, but also talked about helping people with ASD to
improve their communication skills specifically so they might make or
maintain friendships with peers; be able to engage in meaningful
activity with others; and develop social networks. The focus of music
therapy can be to develop independence, or to develop relationships
with people other than family members. Families can be resourced to
engage with children who have ASD, to rehearse specific strategies with
them outside of the session (e.g. working on oromotor skills), or to give
family members time out.

Like 'communication', 'social skills' is a broad category mentioned

frequently by interviewees as a focus for their music therapy
programmes. Developing an awareness of others and their needs,
listening, engaging, participating, sharing, turn-taking, cooperating,
and developing confidence were subcategories that have maintained
importance in music therapy work:

Tolerating others is the beginning point for interaction,

engagement, connection, and intimacy.

Some described working on social skills or developing confidence, with

the ultimate aim that their participants could be included with peers.
They argued that connecting with the musical culture of peers and
sharing musical skills or knowledge were powerful inclusive strategies.
Another broad category, ‘music therapy to support wellbeing or quality
of life’, was also underpinned by foci on 'meaningful activity' and
'inclusion'. Facilitating their participants' inclusion, mostly in school
communities, seems to be a big focus for interviewees.

16
Sensory issues, or sensory integration seems to be an important focus
for music therapy too. Interviewees suggested that music therapy is
helpful because participants can be in control of sound-making, and
increase their tolerance for unexpected sound and for being with others
(who may be unpredictably noisy).

Several interviewees related their work to the New Zealand Curriculum

'Key Competencies', specifically the categories of communication,
participating and contributing, thinking, managing self, and using
language symbols and text. Only one person talked specifically about
working on goals directly drawn from IEPs. Another was encouraged to
work on goals devised by the multi-disciplinary team but found that
inhibiting, preferring to “see where the (music therapy) takes us”.
Finally, at least one music therapist resisted having any specific
ongoing goals at all:

I think I like to have quite open-ended goals if you call them

that … and some of them can be musical ones and some of
them can be things like 'staying in the room'. And not to have a
quantitative goal like: 'we'll try to stay in the room for five
minutes today' but just 'we'll try and stay in the room and we'll
just keep a note of what happens week by week' or 'we'll try
and expand the range of instruments and objects, and styles of
play' but not to say ‘Oh we're going to play the drum, the
cymbal and the xylophone’ but to have a rich selection of
things that we could do and recording what happens.

Regularity of sessions, length of programmes

Ninety-five percent of survey respondents offer weekly sessions.

Programmes, especially private work, are predominantly ‘open ended’,
and long term, i.e. for one or more years. Decisions regarding closure
are predominantly made by the music therapists, but often in
collaboration with institutions and families. Time frames of sessions, as
well as lengths of programmes, are adapted to accommodate the
therapeutic needs of participants. Frequently the context in which

17
therapy takes place (e.g. school year timetable) and funding constraints
will be a deciding factor regarding when programmes close.

Group, individual, and family therapy

Music therapists described facilitating individual, group, and family
music therapy work, according to the needs of their participants. From
survey responses we can determine that the majority (66%) engage in
individual work with one to five clients with ASD, while almost half also
reported working with children with ASD in a group setting. Most
groups will comprise of four or five participants, but will often typically
include developing children, children who have another diagnosis,
family members, or ‘others’. Only nine music therapists reported
working with groups that include more than one person with ASD.
Group work was thought to be particularly helpful to address peer or
family relationship issues.

Interviewees outlined several reasons why children might benefit from

individual sessions before joining group work: if they experienced
auditory sensitivity, were very easily distracted, or needed to develop
more awareness of self and other. However, group work can be
particularly important when the focus of the therapy is on the
development of social skills. Groups often include children with
considerably diverse needs, however, and often several adults will be
present. Interviewees recognised that this diversity presents significant
clinical challenges in terms of responding to individual needs, especially
in terms of timing, pacing, and adapting music. Smaller groups are
therefore preferred, with one respondent noting that group work tends
not to work well unless a highly structured approach is employed.
Taking a structured, focused and planned approach was considered to
be important when working with children with ASD overall, but
especially with larger groups. However, interviewees recognised that
while structure and routine can be important, 'rigid' expectations that
people with ASD will be able to adhere to typical social norms can be
unrealistic. They noted that music therapy can provide a balance of
structure and freedom, as dictated by the child's needs.

18
 14

12

10

0
Family Other clients Other clients with Peers without Other
members with ASD different identified
needs/diagnoses additional needs/
diagnoses

Figure 6: Whom people with ASD work with in music therapy groups

Almost all survey respondents (27) reported having family present in

sessions for some or all of the time, and the majority also describe
working collaboratively with other team members (23). However, survey
respondents took a broad view of the term ‘collaboration’ citing
activities from sharing reports, having parents and other professionals
observe and/or participate in sessions, supporting interactions between
siblings and classmates, to empowering others to facilitate music
sessions. Teachers, teachers’ aides and other staff members were
frequently cited as group participants.

Interviewees offered various reflections on family involvement in

sessions. Firstly, they suggested children’s music therapy groups can
provide helpful opportunities for parents to meet other parents who
might be having similar experiences. However, music therapists can
find it hard balancing the value of working with the family with the
needs of a child when, for example, the child seems happier and more
engaged in the process on their own. They noted that when parents are
involved, children present differently and can be disadvantaged in terms
of their developing independence. Some music therapists seemed
satisfied with communicating their intentions and actions to the family,
and asking for feedback regarding the perceived impact of the music
therapy intervention. However, it was also acknowledged that

19
communicating regularly face-to-face with families can be difficult,
especially when music therapy sessions are taking place in schools.
Families who have children with special needs are very busy, and often
tired. Some music therapists therefore utilise resources such as home-
school communication diaries to keep in touch.

Conversely, it was argued that the therapist needs to be aware of the

fundamental and ongoing nature of the child's relationship with the
parent – something that can only be understood in the context of
ongoing interaction. Further, some music therapists felt that it was
important for families to understand the music therapy process and
that this would only occur if they were thoroughly involved. Others see
the music therapy session as an important opportunity for meaningful
family interaction, such as having fun together. Parents also reflect on
their own needs as well of those of their children when considering
whether to attend sessions. One said she values having a ‘break’ from
her child, and would prefer not to attend; another said that she would
only attend a session if her child invited her to.

Music therapy approaches

Survey respondents suggested their work is, relatively evenly,
predominantly informed by creative, psychodynamic, improvisational
music therapy theory, and that they engage with ‘client-centred’ (also
known as person-centred or humanistic) and 'community music
therapy’ approaches. Interviewees also referred to medical, behavioural,
creative, relationship-based, and music-centred approaches. Some
were unspecific, and/or named the theories they drew on rather than
naming a specific music therapy approach, and many identified with
more than one approach because they were working across contexts
that demanded different ways of working.

Interviewees resoundingly reinforced the centrality of the therapeutic

relationship in music therapy practice, and their narrative explanations
highlighted a humanistic approach as dominant. Strong humanistic
(sometimes referred to as person-centred or client-centred) and
holistic values were emphasised during interviews. Respondents value
being ‘with’, in the moment, and developing a caring, respectful,

20
intimate, and creative environment in which people can share
meaningful experiences and grow:

You can just be together in music, so it comes back to that

relationship for me, about the therapist creating that
environment where a person can tolerate and be challenged, in
a musical or sound way. And through that, in a sense, a
trusting rapport is developed. And along the line you can
actually work specifically towards developing certain
interactions or certain communications, interpersonal
communication.

The ability to take a flexible approach, to respond to the varying needs

of participants in the moment and to construct the process together, is
highly valued. Interviewees linked flexibility with empowerment and the
potential for people with ASD to ‘open up’ and to show their abilities
and potential within the context of the therapeutic relationship:

I believe that humans are intrinsically musical and … I’ve got a

humanist philosophy about accepting everybody where they
are, respecting and valuing each individual and their
uniqueness, believing in the possibility of growth and the
importance of self-expression, creativity, self-esteem, choice,
relating to others, experiencing success and independence. I
think music is a really powerful tool to connect with people and
motivate people to be involved.”

While many music therapists might use improvisation in their work,

some also referred to an ‘improvisatory approach’ or working with an
‘improvisatory model’. Interviewees noted how the principles of
humanistic philosophy can be enacted in music-making, arguing that
flexibility in the music, the potential to adapt, compose, and improvise
in the moment is crucial, because it is the way music and its elements
are used in relation to vitality affects and attunement that makes music
therapy unique. Several interviewees suggested they employed a
‘music-centred’ approach:

21
 It's not about music as an object or an artefact or a song, it's
about music, it's about musicking 2 and about what we do to
make the experience of being part of the music really come
alive.

In contrast, others talked about music and/or the elements of music

being a ‘tool’ for therapy, and the importance of developing underlying
techniques in the use of music in therapy.

Music therapists indicated that they were working with participants in

multiple environments including homes, classrooms, and community
settings. Thus they linked their work to community music therapy
(CoMT), which focuses on resourcing not only the child but their wider
cultural, institutional, and social contexts. The community music
therapy approach is exemplified by therapists who describe helping
children to settle in the classroom and working with staff to encourage
the use of music therapy strategies across contexts. However, while it
was deemed important to consider the participant in context, music
therapists also seemed to value the music therapy session as an
opportunity to give children, their parents and other team members a
'break' from the challenges associated with other environments. Their
predominant emphasis was on ‘linking’ music therapy to other aspects
of participants' lives, by having peers in the music session, taking
artefacts from the music room to the classroom, and ensuring the
music that is familiar is used across contexts, rather than working
within, or developing other programmes outside of the music therapy
room. It seems though that some music therapists move quite readily
between contrasting community music therapy and psychotherapeutic
approaches:

When we’re working with a group, I think you kind of have

more of a community music therapy hat on because you’re
thinking of the context that the child is within. And also helping
the other children to understand how they can play with that
particular student. And then at the same time, the very next

2. Small (1998) coined the phrase ‘musicking’ to emphasise that music is not a ‘thing’ (noun) but an activity. Meaning is generated
through the process of producing and engaging in music.

22
 week, you’re working in more of a psychotherapeutic music
therapy approach, where it’s very individual, and you’re
working sort of on that level. So, I feel like it’s a very fluid …
movement between different approaches. But I guess at the
centre of it is … what’s important for that child at that
particular time. How do I need to work with this child, at this …
in this moment?

Music therapy programmes are based on participant’s strengths,

interests and needs, and a variety of individualised strategies and
techniques are introduced to meet those needs and to cultivate
potential. Some music therapists indicated that they employ behavioural
strategies in their work, by considering behavioural antecedents and
consequences, and introducing strategies to help children manage their
behaviour. Moreover it seemed, to a relative extent, to be expected
and/or desired by some parent interviewees. However, others
suggested they would feel constrained by the high levels of structure
and measurable outcomes that can be associated with behavioural
approaches, and were concerned that behavioural approaches resulted
in limited generalisability of behaviours. A holistic approach was
generally preferred.

Music therapy experiences, activities, and tasks to meet goals

Music therapists identified a variety of experiences, activities, and tasks
that were used to meet specific goals or focus areas. In particular,
improvisation was quoted as being an important way of connecting
people and increasing interaction. Musical structure and repetition
provide important nonverbal cues about when and how participants
might contribute, and are therefore used to both contain and facilitate
emotional expression and support emotional regulation; and in turn to
support the development of turn-taking and other social skills.

Interviewees suggested allowing participants to listen to familiar music,

to be in control of sound-making, and/or to move to structured or free
form music, can reduce anxiety.

The use of instruments was cited as a way to engage in meaningful

activity with others, develop relationships, and to promote inclusion.

23
The process of learning to play a musical instrument can promote
reciprocal interaction, and provide opportunities for expressive
communication. Singing is considered to be a highly engaging,
expressive, and inclusive medium that can be used as an expressive or
creative communication in its own right, or to support vocalisation and
speech development. Music therapists also reported developing songs
that can describe what their participants are doing, thus adding
meaning or purpose to their activity, and/or providing language for
what they are doing.

Music therapy is used as a process to develop inclusion. Music

therapists described supporting children with ASD to participate in
music in their classrooms and, in at least one case, in assemblies.
Facilitating classroom music allows music therapists to monitor and
promote interaction, and to support participants to move from
peripheral to full participation. Their classroom work is specifically
focused on supporting learners with ASD to develop relationships and
friendships with peers, by increasing their awareness of others’ needs,
facilitating cooperation, connecting them with the musical culture of
peers, and encouraging them to interact by sharing their musical
knowledge and skill (increasingly with the use of audio or video
technology). Interviewees also suggested that they use music to support
learners to engage in school routines and manage activities of daily
living.

Evaluation
A wide variety of evaluation tools and techniques were mentioned
during interviews, but often by only one person. This included
‘monitoring sheets’, therapist-created evaluation forms, adapting
existing evaluation tools, measuring against child development charts,
using the Key Competencies as a guide, and creating ‘records of
learning’. Despite this diversity, it was clear that music therapists
generally prefer to write descriptive evaluations based on their
observations and interpretations of sessions. They usually record their
observations in note form after every session, and argued that – over
time – they can generate a clear picture of progress. Sometimes session
notes are shared immediately with parents and/or other team members,
24
but more often a longer period would be summarised in report form for
stakeholders. Information received from parents and other team
members is considered to be an important part of the evaluation
process, and their feedback is often incorporated into music therapy
reports. Comparing a child’s responses in the classroom with those in a
music therapy setting for example, can be helpful for understanding
their needs. The value of parental involvement in the review process
was described two-fold: it helps the therapist to gain a comparative
understanding of a child’s presentation, and enables parents to gain
further understanding of music therapy processes.

Video seems to be one of the most frequently used evaluation tools,

and it is valued because it enables practitioners to review sessions, to
observe change over time, and to provide more objective reports in
writing. However, reviewing video and finding words to describe
therapeutic processes can be time-consuming. It can therefore be
helpful for team members to view the video themselves, in order to get
a more accurate picture of what is happening. One parent reported that
receiving weekly session notes was valuable for increasing their
confidence in music therapy, but seeing a video was even more helpful.
Interviewees argued that demonstrating the music therapy process,
either live or on video, can be a powerful tool for convincing people of
the efficacy of the approach. Nevertheless, while music therapy ‘speaks
for itself’ when viewed on video, what it is, how it works, and why it
‘works' need to be clearly articulated to help parents and other
professionals understand processes and outcomes.

Regardless of how the music therapy process is captured, interviewees

communicated a relatively strong message that it was not easy to
measure or communicate the ways in which music therapy participants
‘progressed’. They suggested that progress can look different for
various people, be slow, hard to pinpoint, and difficult to quantify; and
it can be difficult to communicate what a little progress can mean in a
child’s life. Music therapists are very concerned, as are parents, with the
issue of generalisability. However, interviewees noted that it can be
difficult for children to generalise skills and/or behaviours that have
been developed within a specific therapeutic relationship. The gains

25
made in music therapy cannot always be demonstrated in the
classroom, for example.

In contrast, interviewees also argued that comparative data across

settings can help determine the value of music therapy programmes.
Teachers for example have been known to articulate ‘huge benefits’ of
music therapy because they observe children demonstrating new and
positive behaviours in the music therapy setting. And a parent who was
able to see video of her child across settings was convinced that music
therapy had significantly contributed to his developing social skills:

You’ve seen it in music therapy, and you’ve taken it outside of

music therapy to introduce in other environments. And that’s …
huge. Absolutely huge. Because it’s a big social skill to be able
to interact with others, and be included to society, so … hugely
valuable. But until I had seen the video of him, I couldn’t
measure it myself. There’s no way.

Closing programmes
It was argued that the needs of participants should dictate when music
therapy programmes finish, which suggests that a final assessment
would be necessary to determine whether the participants' needs had
been met. However, it seems that there are a variety of reasons why
music therapists are often unable to undertake formal assessments at
this time, or might choose to close programmes when participants
might still have significant needs. Most obviously there are occasions
when programmes close suddenly and it is not possible to gather end
of treatment data. Some music therapists are required to ‘turn over’
people on their caseloads to accommodate waitlisted potential
participants. Some programmes are voluntary and participants choose
not to return, or the therapist might consider they have simply ‘gone as
far as they can’.

In contrast, programmes might continue when progress is not evident

due to the belief that it can be slow and hard to observe. Interviewees
intimated that they use their professional judgement regarding the
value of music therapy for participants, regardless of whether they are
making progress.

26
Accessing music therapy
Interviewees believed there is a lack of awareness and understanding of
music therapy and what it can offer people with ASD, and that this can
affect both access and ongoing service provision. Music therapists
recognise the need to 'market' their service to target groups who
support people with ASD, yet feel restricted by time limitations and
their paucity of experience in the marketing field.

They also argued that it can be hard to communicate to other

professionals and interested parties about 'how music therapy works’
when music therapy processes, especially those involving improvisation,
are unique and complex. There was general agreement that increased
awareness and understanding can be promoted by talking to
colleagues, sharing information through conference presentations,
facilitating music therapy workshops in the community, the presence of
music therapy students, official sources such as MThNZ website, and
when schools enable student teachers to witness music therapy:

You need to be proactive, and go ahead and have meetings with

other professionals, you need to be out there, and … not just
engaging with the music therapy community, but engaging with
the speech and language therapy community, the Ministry of
Ed, principals, families…

Nevertheless, despite concerns about a general lack of awareness and

understanding of music therapy, our findings suggest that the demand
for music therapy for children who have ASD can exceed availability. In
specific geographic locations there are examples where posts have not
been filled, and/or there are insufficient music therapists to meet an
increasing demand for service.

On the other hand, there also appears to be a number of music

therapists who want but are unable to get work in music therapy with
clients with autism. In the context of private practice, they
predominantly see this as related to poor education and promotion of
music therapy in the community, so that they are unable to connect
with those families that might want the service. However, in an
institutional context, they generally see this as related to funding

27
issues. There is a perception that administrators and managers don’t
know how to access funding for music therapy. And when institutions
don’t have the funding, music therapists feel constrained in terms of
how they might gain external funding for potential participants who are
missing out. Lack of evidence is often cited as the reason for lack of
support for music therapy. However, music therapy and other 'action-
based therapies' seem also to be perceived as expensive and luxurious
interventions. When funding is short, ‘generalists’ (i.e. people who can
provide a range of services) are seen as more cost efficient than
specialists such as music therapists.

When people with ASD were living in larger institutions or going to

special schools they could more readily receive music therapy from
music therapists employed by the institutions and schools. Managers
and administrators who had experienced and/or valued music therapy
would sometimes be able to 'find the money' to fund music therapy
from existing budgets. Increasing deinstitutionalisation means
institutions have less funding to run existing programmes, and music
therapy positions in this context are decreasing. Resources are scarce,
and there is not enough funding even for ‘mainstream’ programmes
such as speech and language therapy. When competition for therapy
funding is fierce and other professionals are also experiencing job
insecurity, they are not likely to advocate for the inclusion of a music
therapist on the team. Potential expansion of programmes is likely to
be viewed as unrealistic:

The amount of funding we get to actually run the service is

minute compared to the demand. That’s our biggest barrier. I’d
like to be doing lots of different things than we are doing at the
moment. … So funding is the major, major issue. Our baseline
funding … It’s tiny. And we’ve currently got 600 children on the
waiting list. … That’s what I’m faced with every day. How do we
provide the maximum possible service that we can with that
level of resource?

Music therapists are recognised as professionals who can provide a

service for children who have ongoing difficulties, via the Ongoing
Resource Scheme (ORS) – a Ministry of Education initiative. Children who

28
are ORS-funded are more likely to receive music therapy at school than
those who are not. However, some schools use their funding more
flexibly, and when music therapy is valued by the school, administrators
will prioritise and find the money from somewhere in order to provide
music therapy to others who need it.

As well as seeking ORS funding for their work with children who have
autism, music therapists seek philanthropic funds and engage in ‘fee
for service’ models in which families pay. Our findings suggest that
parents often value music therapy enough to pay for private sessions. It
is important to note, too, that there is no pathway for ongoing music
therapy funding once children leave school. Two interviewees
suggested that while music therapy has the potential to support
learning in adults with intellectual disability, it is easier to get services
for younger people with ASD. The importance of early intervention was
acknowledged but it was also argued that music therapy can be helpful
throughout the lifespan, and it can be harder for potential participants
to access services once they reach adulthood. People with intellectual
disability are rarely financially independent.

Summary and Conclusion

New Zealand music therapists, like their international counterparts,

work with relatively high numbers of children who have ASD.
Nevertheless, the actual numbers of music therapists and children are
still low. The work mostly takes place in private practice or schools, in
music rooms; programmes predominantly focus on supporting the
children’s communication and social skills; and the dominant approach
is humanistic and improvisational. Local music therapists value highly
the flexibility to introduce what is needed, in the moment. The work is
usually evaluated from descriptive data generated from naturalistic
observations made by music therapists and other team members,
including parents, and from video of music therapy sessions.

The music therapists in our study generally believed it is not easy to

measure or communicate the ways in which participants in music
therapy progress, yet also put forward a strong argument that people

29
who witness music therapy in action develop more understanding and
appreciation for what can be achieved, and can be readily convinced of
its importance. Video data can be powerful for ‘telling stories’ of music
therapy interaction, as well as the transfer of other benefits outside of
the music therapy session, including inclusion. It is therefore a very
promising potential data source for research.

As well as evaluating participants’ individual progress, music therapists

are particularly interested in how music therapy generalises to other
settings, especially to promote inclusion in classrooms and other
community environments. They note that their role includes working
with families, and other team members, skill-sharing and resourcing
them in their use of music. However, while our interviewees argued that
parents of children with ASD need personal and practical resources to
help them manage their parenting tasks, music therapists referred little
to the ways music therapy might resource family and other team
members to engage children with ASD in music.

In summary, the New Zealand music therapists who participated in this

study favour naturalistic, flexible, improvisational approaches when
working with children who have ASD, which allow them to respond to
the needs of their participants in the moment; the focus of their
programmes can be broad; and evaluation is predominantly descriptive.
While participants in our study agreed that a variety of evidence is
needed to underpin the practice of music therapy, these findings
suggest opportunities for experimental research in this context are
limited by paucity and heterogeneity of practice. On the other hand,
mixed methods would be a useful paradigm for music therapy research
in the current New Zealand context.

Acknowledgement

The authors gratefully acknowledge funding assistance for this research

awarded by the IHC Foundation of New Zealand
(http://www.ihcfoundation.org.nz/)

30
References
APA. (2013). Diagnostic and statistical manual of mental disorders (DSM-5).
Arlington, VA: American Psychiatric Publishing.

Autism NZ. (2014). What is Autism? What is Asperger Syndrome? Retrieved from
http://www.autismnz.org.nz/about_autism.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative
Research in Psychology, 3(2), 77–101.

Bruscia, K. E. (2001). Improvisation Assessment Profiles - Abridged Forum IAP

revisited (pp. 54-58): Retrieved May, 15, 2006 from
http://hisf.no/njmt/forumiap.html.

Carlon, S., Stephenson, J., & Carter, M. (2014). Parent reports of treatments and
interventions used with children with autism spectrum disorders (ASD):
A review of the literature. Australasian Journal of Special Education,
38(1), 63-90. doi:10.1017/jse.2014.4.

Carpente, J. A., & LaGasse, A. B. (2015). Music therapy for children with autism
spectrum disorder. In B. L. Wheeler (Ed.), Music therapy handbook. New
York: The Guilford Press.

Dimitriadis, T., & Smeijsters, H. (2010). Autistic spectrum disorder and music
therapy: theory underpinning practice. Nordic Journal of Music Therapy,
20(2), 108–122.

Gattino, G. S., Santos, Longo, D., Loguercio, & Faccini, L. S. (2011). Effects of
relational music therapy on communication of children with autism: a
randomized controlled study. Nordic Journal of Music Therapy, 20(2),
142–154. doi:10.1080/08098131.2011.566933.

Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum
disorder. The Cochrane Database of Systematic Reviews 2006(2), Art.
No: CD004381.pub004382.
doi:004310.001002/14651858.CD14004381.pub.14651852.

Gray, C. (1994). The new social story book. Arlington, TX: Future Horizons.

Heaton, P. (2004). Interval and contour processing in autism. Journal of Autism

and Developmental Disorders, 35(6), 787–793.

Kern, P., Rivera, N. R., Chandler, A., & Humpal, M. (2013). Music therapy services
for individuals with Autism Spectrum Disorder: A survey of clinical
practices and training needs. Journal of Music Therapy, 50(4), 274–303.

31
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music
therapy on joint attention behaviors in autistic children: A randomized
controlled study. Journal of Autism and Developmental Disorders,
38(9), 1758–1766. doi:10.1007/s10803-008-0566-6.

Ministry of Education. (2007). The New Zealand Curriculum. Wellington, NZ:

Learning Media Ltd.

Ministry of Education. (2015). Early childhood curriculum: Te Whāriki. Wellington:

Learning Media Ltd.

Moore, S. (2015). Music therapy advocacy for professional recognition: A

historical perspective and future directions. Music Therapy
Perspectives, 33(1), 76–85.

Nordoff, P., & Robbins, C. (2007). Creative Music Therapy (2nd ed.). New York:
John Day.

Ruud, E. (2010). Music therapy: A perspective from the humanities. Gilsum, New
Hampshire: Barcelona Publishers.

Small, C. (1998). Musicking: The meanings of performing and listening . Hanover:

University Press of New England.

Stebbins, R. A. (2001). Exploratory research in the social sciences. Thousand

Oaks, CA: SAGE Publications.

Taylor, D. B. (1997). Biomedical foundations of music as therapy. Saint Louis:

MMB Music Inc.

Thompson, G. A., McFerran, K. S., & Gold, C. (2013). Family-centred music

therapy to promote social engagement in young children with severe
autism spectrum disorder: A randomized controlled study. Child: care,
health and development, 40(6), 840–852.

32
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.