This article describes the experimental process designed to determine the comparative efficacy of music therapy treatment and the standard Applied Behavior Analysis Verbal Approach (ABA VA) to speech development in preschool-aged children ages 3-5 diagnosed with ASD (autism spectrum disorder) and present echolalia in their speech. Targeted areas of communication were mand, tact, echoic, and intraverbal. Mand communication refers to the functional use of language to communicate a need or desire, e.g. when given a choice between two options (fast or slow). Tact refers to the ability to use language to identify or describe an object. This skill would allow a child to identify a picture as a “pink pig” or a “brown bear.” Echoic communication is merely the imitation of a word or combination of words, which is useful in certain social interactions, such as when responding to a greeting (e.g. “good morning). Intraverbal involves the functional and independent use of a term which suggests a comprehension of its meaning and is dependent on verbal stimuli. For example, when presented with a choice of words, a child with functional intraverbal communication would be able to finish the sentence, “She is my best___” with the word “friend” rather than “doctor.” Twenty-two subjects who were assessed to have echolalia were offered both treatments, randomly selected to determine which intervention they would first receive to provide the assumption that this factor would not contribute to the outcome. The treatment processes were each three-week courses with two sessions per week, amounting to a total of 6 treatment sessions with each approach. Results based on pretest and post-test comparisons indicate that both treatments are equally effective, though also highly dependent on the presence of echolalia as a baseline for functional speech that can be shaped and developed. Thus, in this respect, music therapy can be recommended as a supportive means of improving communication skills in children with autism for ABA-VA interventions.
Since both were group-interventions, it is possible that the results could differ in a private setting, wherein music therapy might be the preferred method, as it is more engaging without the presence of other students to interact. At the same time, this may not make a difference in many cases, given the social disconnect that is sometimes manifest in those on the spectrum. The methodological approach applied to both interventions would be a useful model for speech and music therapists to utilize in collaboration.
In this article, Isenberg offers a very legitimate challenge to the notion presented to her in earlier years of study that music therapy is a benign modality of clinical practice. Examining the hypothetical scenarios that were actually presented at national conferences in previous decades, intended to depict the “ideal” music therapist and the status of the music therapy assessment in the context of the interdisciplinary collaboration on behalf of a client, Isenberg reveals the danger of such a disconnected and romanticized perception of the professional regard for the work of a music therapist among other clinicians wherein those belonging to the professional group of music therapists fail to recognize the multitude of potential circumstances in which poor implementation of music therapy most certainly can cause significant harm to the clients being served. This assertion is established also in the context of the criteria by which the government of Quebec recognizes a professional body, in which protective orders are applied to ensure the highest level of practice and to protect those receiving these services from complications and harm that could result from incompetent practice. If the community of music therapists fail to recognize such risks in their practice, there would therefore be much less substance to support its eligibility to be recognized by the government, especially considering the fourth of five qualifying criteria established by Quebec’s Professional Code, which evaluates “the gravity of the prejudice which might be sustained by those
who have recourse to the services of such persons because their competence or integrity was not supervised by the order” (p. 69).
While I am not familiar with the Code of Ethics established by the CAMT (Canadian Association for Music Therapy), it is clear that the standards of practice upheld by AMTA identify very specific requirements for professional competence, practice, and ethics of certified music therapists. At the very least, this article underscores that while the recognition of the efficacy demonstrated in the highest standards of our practice has improved since previous decades, the risks and potential for harm to a client must consistently be respected in order to adequately advocate for the increased presence and funding for music therapy services to the general population.