Autism – Three-Chord Music Therapy

The Out-of-Sync Child Grows Up

A book review about coping with sensory processing disorders in the adolescent and young adult years.

Kranowitz, C.S. (2016). Out-of-Sync Child Grows Up: Coping With Sensory Processing Disorder in the Adolescent and Young Adult Years. New York, NY. The Penguin Group.

In Carol Kranowitz’s first book The Out-of-Sync Child, many challenges and strategies of living with sensory processing disorder (SPD) are brought to light. It was an enlightening read that I would recommend to professionals, parents, and friends that interact with individuals of all ages, stages, and diagnosis involving SPD. Based on the knowledge I gained from that book, I was excited to read its sequel The Out-of-Sync Child Grows Up. The material is very applicable to the age groups and backgrounds that Three-Chord Music Therapy works with.

Before jumping into details of the book, think back to when you were a teenager or young adult. The hormone changes, the emotions, the desires or disappointments, the perspective you had on life, how you compared yourself to others, maybe even how you judged others around you, and so on. Teenage years can be an awkward time of maturing and an exciting time of development, but they can also be a painful stage if support systems are not present. We can all remember mentors, parents, siblings, teachers, and coaches that influenced and encouraged us. But, what if you were different physically? What if you couldn’t wear clothes that were in style because they irritated your skin or you couldn’t participate in extracurricular activities due to physical challenges? What if people didn’t understand and support you? Not having certain opportunities in this stage of life can feel confusing, unfair, and often hurtful, as peers are not always accepting of anything or anyone deemed “different”. This is something that individuals with SPD face, especially considering that SPD is often diagnosed alongside other diagnoses such as autism, obsessive-compulsive disorder, and attention deficit disorder.

I would like to focus mainly on what Kranowitz shares about coping with relationships and gaining self-acceptance. Often individuals with diagnoses that cause them to perform differently than others are also seen differently, which can have a significant emotional impact. Through working with multiple populations that face SPD, especially motor movement differences and communication challenges, I know not to assume anything based on what is seen on the outside. There is always more going on with the body and mind of a person than what we see on the outside. This book exemplifies that reality.

Let’s talk about negativity. Many different emotions, like shame and guilt, stem from negativity. For individuals with sensory differences, these feelings are a huge issue. This is important for teachers, peers, caregivers, and especially families of individuals with SPD to be aware of. Although SPD has no found cure, individuals and families can learn to make adaptations and live in a way that works for them. Instead of frustration when it takes longer for an individual with SPD to complete classwork, there should be encouragement. Kranowitz shares one adult male’s testimony with SPD, who stated, “Stop listening to those that don’t understand you”. The individual went on to encourage people to research their symptoms, reframe their situation, and seek out effective therapeutic resources to help them overcome big challenges. This individual had friends and family that supported him throughout an occupational therapy journey. Overtime he was able to report feeling hopeful instead of hopeless in a world of sensory obstacles.

Sensory obstacles come in all forms. There are sensory modulation disorders, sensory discrimination disorders, and sensory-based motor disorders. No matter the form, everyday tasks like getting dressed, eating meals, and travel have unique challenges. Many normal daily activities may be painful, over stimulating, or physically challenging to individuals with SPD. Considering this, Kranowitz emphasizes the importance of family relationships amongst this population.

As teenagers with SPD struggle emotionally, so can their close family members. It is not easy when a parent lacks understanding for the way their child reacts to certain situations or stimuli. The family dynamic can be negatively affected if therapeutic approaches and lifestyle adaptations are not utilized. An example shared in the book is that of a teenager who grew up feeling distant from her parents and siblings because she was misunderstood. Her reactions to scratchy clothes and loud noises were treated as misbehaviors. When she would have a “meltdown” and receive additional attention from her parents, her siblings teased her and exhibited jealousy towards her. It wasn’t until later in life that she was diagnosed with mild autism and SPD. She was thankful to finally have an answer to why she felt so out of place.

For diagnosis like SPD music therapy becomes a wonderful option, because it creates a therapeutic atmosphere that is client centered, effective, and generalizable in the home. Music also becomes a means of sensory integration and coping through the support of music interventions. In chapter 13 individuals share examples of their successes and thriving careers. After years of therapy, supportive families, informed teachers, and applied coping strategies, they were able to overcome challenges to accomplish their goals. Several of them mention music in their excerpts. There is a drummer and a singer, both advocates in the SPD community. They share about how music was their lifeline, as it restored order in their bodies when other activities were too much (Kranowitz, 2016).

It is important to note that this book has a strong occupational therapy focus, but encourages all therapy options. After reading the testimonies and complimentary terminology to music therapy, I would LOVE to find the music therapy based equivalent of this book. Music therapy fits in so well with this population, and I have seen first hand sensory success made in music therapy sessions. One beneficial technique mentioned throughout this book is deep pressure. In music therapy we utilize a similar technique, called rhythmic body mapping. Other techniques used are lyric analysis, sensory integration using music and instruments, movement to music, music performance, and therapeutic singing.

The information this book has to offer is GREAT and it was an enjoyable read. The author connects the medical research to real life examples. It was truly eye opening. For anyone wanting to read more into how it feels to live with SPD or a diagnosis with similar challenges, this is definitely the book for you!

Sensory Processing

I am a huge advocate for medical music therapy and have been accustomed to seeing a diverse approach in all settings throughout my career. Many people that receive music therapy services have neurological related diagnoses. Some of these diagnoses are Attention Deficit Disorder, Autism Spectrum Disorder, and Cerebral Palsy. Although each case is very different, some clients tend to show needs and deficits in similar areas, one of these areas being sensory needs. The Out-of -Sync Child is my go-to book when I need to refresh my understanding of the brain and sensory related disorders. Many music therapy clients have sensory needs and this book gives an in-depth overview of what makes up Sensory Processing Disorders (SPD). I would highly recommend it to any parent or caregiver.

What is a sensory disorder?

Kranowitz briefly defines SPD as the inability to use information received through the senses to function smoothly in daily life. Think with me for a moment about the five senses. Sight, smell, hearing, taste and touch. There is never a moment in our lives where we are not using all of these. But we are able to regulate, ignore, and organize the way we perceive the messages each sense sends to our brain at any given time. I can make myself aware of the way the air feels on my skin when I am sitting in a room, but that takes more conscious effort. I may never notice the feeling of the air on my skin if I wasn’t trying. The same goes for all the other senses. But what if it was the opposite? What if I suddenly couldn’t stand the way every small movement I made changed the way my skin felt against the air around me. It would be annoying and distracting. That is SPD on a small scale.

Before reading this book I had a very basic understanding of Sensory Processing Disorder (SPD). I knew that many clients I worked with and observed in the past had specific sensory preferences. I was not aware of the depth or anatomical specifics as to why each individual might behave or seek out certain sensory stimuli. This book answered all of my questions and more.

SPD involves more than just the five senses!

Kranowitz begins by breaking down SPD into two main dimensions, external and internal. External would be our five senses. Internal senses are the vestibular sense (inner ear), proprioception (muscles, joints), and introspection (internal organs). Since SPD is the neurological procedure of organizing the information we take in from the outside around us for daily use, it makes sense that our internal senses are included. Many times you may notice a child with autism that rocks back and forth repeatedly when seated. This is one instance in which SPD can be explained in the vestibular sense. Our inner ear is what sustains our since of balance. When the central nervous system is not smoothly signaling to the rest of our body then disorganization happens. The rocking we sometimes notice is stimulating the vestibular sense and helps the child know where their body is in space.

The central nervous system is explained in more detail in an interesting and relatable way. This is one of the reasons this book was such an enjoyable read. The author gives research facts on top of medical data to support findings. All of which are backed up by multiple scenarios and real life testimonies of parents, teacher, therapists, and individuals that deal with SPD.

What are proprioceptive senses?

Personally chapter five was one of the most eye opening for me. The chapter concentrated on the elements that make up the proprioceptive senses. In short, the proprioceptive is what tells our body where it is in space. This includes muscles, skin, and the central nervous system. The sense of touch informs the receptors in the body of so much. Without a normally operating proprioceptive sense, an individual can struggle with motor planning, body awareness, and motor control in general. I learned that a deficit in processing of this sense is usually accompanied by issues in other areas as well; the two most common being the tactile and vestibular.

I want to conclude by fast forwarding to the last few chapters in Part 2. It is true that knowledge changes perception and I feel strongly about what the last few chapters discuss regarding daily life with SPD, coping with SPD, school life, and parenting. Therefore all of the information prefacing these chapters is extremely important in understanding why such things as a “sensory diet” are necessary in the life of any child growing up with SPD. But before any advice can be taken, caretakers must recognize issues and seek out professional opinions. SPD can present itself alone, but often times coexist amongst other common diagnosis. This is yet another reason why this book is great resource for parents who see early signs of “out-of-sync” tendencies in their child’s life.

How are their primary needs being met and what adaptions need to be made?

For me, understanding, empathizing, and advocating for individuals with SPD boils down to first realizing primary needs. This is where a sensory integration is implemented. This is also where learning to cope is imperative to making productive changes at home. Acceptance can be challenging for parents, something we all observe from time to time. Comparing what we have and don’t have. What works and doesn’t work normally… This book speaks encouragingly and realistically to the parent dealing with a child with multiple disabilities, including SPD.

Overall I was impressed with this book and would highly recommend it to professionals, parents, and peers. It is educational and a great resource for anyone seeking knowledge on SPD or related disorders!

Singing to Social Skills

The opportunities that music brings to the therapeutic process are endless. Communication, motor movement, processing, stimulation, sensory elements, and so much more are easily accessed through the use of music alone. As a certified music therapist, I have had the privilege to witness first hand how the power of music increases growth and empowers individuals and families in this way. I love getting to watch music benefit the lives of individuals everyday through this growing profession. Considering this, I decided to elaborate on how music therapy compliments the therapeutic goals and IEP goals for children with autism spectrum disorder (ASD). I am passionate about this population, among many others and feel strongly that individuals with ASD should receive quality care in all areas of life.

In my experience, ASD looks, sounds, and presents itself differently in every child. The saying, “If you have met one child with autism, you have met one child with autism” rings true every. Single. Time. There is beauty in this, but it definitely does NOT make an easy job for science. ASD can still be a highly controversial diagnosis in many settings and even in many homes. The history of therapy for this population can be both inspiring and heartbreaking to those who know how far the world of healthcare has come in regards to individuals diagnosed with ASD. All of this is exciting as we see research lead to successes being documented, especially with music therapy.

According to this particular article, statistics show that 1 in 88 children in the United States are diagnosed with Autism Spectrum Disorder (ASD) (LaGasse, 2014). However, recent statistics in the US report a frequency as high as 1 in 59 children (CDC, 2019). ASD is defined in short, as a neurodevelopmental disorder. Current research suggests that neurological aspects influence specific features of ASD. Some of these directly relate to motor deficits and difficulties with sensory processing. However, research also confirms that individuals with ASD demonstrate different musical processing skills, in that the activation of their brain surpasses that of neurotypical or normally developing individuals (LaGasse, 2014). So, good news: music is a multisensory medium! AND it works!

You may ask, “What is one of the biggest challenges for children with ASD?” I would venture to say that one of the largest areas of focus in general is socialization and communication. Therefore, it may be language development we are trying to foster; other times it is socialization skills and interactions that are required on a daily basis that we are trying to build on or make more tolerable through music therapy. Expressive, receptive, verbal, nonverbal- all of these fall under social and communicative areas of development. One way music therapy can help children that battle issues like this is through group interventions.

Studies show that music therapy can improve social behaviors and joint attention in children with ASD. LaGasse delves into what impact music therapy has in a group setting along with areas of focus within the groups, which included eye gaze, joint attention, and communication. To examine this in the study children ages 6-9 with ASD were assigned a music therapy group or a non-music therapy group. The children participated in ten 50-minute sessions over the next 5 weeks. Each group was designed to target social skills.

Social skills are important to be addressed in children with autism because the lack of development in these skills will have lifelong implications(LaGasse, 2014). It is stressed that social skills are needed in every relationship and activity. Noting this, another important piece of research is referenced in this article, stating that, “ The notion that persons with ASD do not want to be involved in their environment is being challenged as self-advocates with autism indicate that it is not a matter of wanting to interact; rather, they have an inability to follow through or tolerate the desired interaction”. Key words there are inability and desired. As research like this advances, it is becoming more apparent that by helping develop these skills in children with ASD, we are also giving them tools to enhance their overall quality of life.

The outcome of this study was very interesting. Through the use of uniform scales to measure the changes in social behaviors, the results found over this brief period of time that the music therapy group showed more improvements. Positive differences primarily showed up in attention with peers and eye gaze towards individuals (LaGasse, 2014).

These results are important because they validate techniques being used in music therapy and highlight an issue that has a lasting impact on the ASD population. In the music therapy group of this study, some intervention tools used were rhythmic cueing, rhythmic deep pressure exercises with songs, instrument playing, as well as music and movement. For both groups the goals were the same, however, outcomes for the music therapy group were different. Both groups had interventions revolving around group interactions, cooperative play, and sensory experiences. Musically, rhythmic and structural components can provide a cue or foundation externally that assist individual’s with ASD in organizing their responses to their surroundings (LaGasse, 2014). This one fact supports why the music therapy group had higher positive outcomes.

This article is one of many that scientifically support the use of music therapy for children with ASD. The importance of early intervention and consistent complimentary treatments like music therapy cannot be advised enough by professionals. It is my hope that through being able to share small pieces of this, that parents, teachers, and current therapists will continue to take initiative and stay updated on ASD research. This relates to our professions, our caregivers, our community, and most importantly our loved ones impacted by this diagnosis everyday. Lets keep advocating for and supporting these individuals! If you don’t already receive music therapy services, or want to know more about how music therapy helps other populations, lets talk! Three-Chord Music Therapy Services can help you connect with a music therapist near you.

Blythe LaGasse (2014). Effects of a Music Therapy Group Intervention on Enhancing Social Skills in Children with Autism, Journal of Music Therapy, 51,(3). 250–275.