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1. The Effects of Music Therapy Incorporated with Applied Behavior Analysis Verbal Behavior Approach for Children with Autism Spectrum Disorders....................................................................................................... 1 Bibliography...................................................................................................................................................... 11

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The Effects of Music Therapy Incorporated with Applied Behavior Analysis Verbal Behavior Approach for Children with Autism Spectrum Disorders
Author: Lim, Hayoung A; Draper, Ellary Publication info: Journal of Music Therapy 48.4 (Winter 2011): 532-50. ProQuest document link Abstract: This study compared a common form of Applied Behavior Analysis Verbal Behavior (ABA VB) approach and music incorporated with ABA VB method as part of developmental speech-language training in the speech production of children with Autism Spectrum Disorders (ASD). This study explored how the perception of musical patterns incorporated in ABA VB operants impacted the production of speech in children with ASD. Participants were 22 children with ASD, age range 3 to 5 years, who were verbal or pre verbal with presence of immediate echolalia. They were randomly assigned a set of target words for each of the 3 training conditions: (a) music incorporated ABA VB, (b) speech (ABA VB) and (c) no-training. Results showed both music and speech trainings were effective for production of the four ABA verbal operants; however, the difference between music and speech training was not statistically different. Results also indicated that music incorporated ABA VB training was most effective in echoic production, and speech training was most effective in tact production. Music can be incorporated into the ABA VB training method, and musical stimuli can be used as successfully as ABA VB speech training to enhance the functional verbal production in children with ASD. [PUBLICATION ABSTRACT] Full text: Headnote This study compared a common form of Applied Behavior Analysis Verbal Behavior (ABA VB) approach and music incorporated with ABA VB method as part of developmental speech-language training in the speech production of children with Autism Spectrum Disorders (ASD). This study explored how the perception of musical patterns incorporated in ABA VB operants impacted the production of speech in children with ASD. Participants were 22 children with ASD, age range 3 to 5 years, who were verbal or pre verbal with presence of immediate echolalia. They were randomly assigned a set of target words for each of the 3 training conditions: (a) music incorporated ABA VB, (b) speech (ABA VB) and (c) no-training. Results showed both music and speech trainings were effective for production of the four ABA verbal operants; however, the difference between music and speech training was not statistically different. Results also indicated that music incorporated ABA VB training was most effective in echoic production, and speech training was most effective in tact production. Music can be incorporated into the ABA VB training method, and musical stimuli can be used as successfully as ABA VB speech training to enhance the functional verbal production in children with ASD. Introduction Communication deficits are one of the core symptoms of autism spectrum disorders (ASD); therefore, developing communication and language skills is a major goal for any training program for children with ASD (Lim, 2009; Paul, 2008; Prinzant &Wetherby, 2005; Sundberg &Michael, 2001). Music has been commonly used in autism treatment as behavior and developmental methods; it is interesting and motivating; it can promote attention, active participation, and verbal and non-verbal responses (Adamek, Thaut, &Furman, 2008; Buday, 1995; Hoskins, 1998). Music therapy is considered as an effective approach for addressing language and communication skills for children with autism (Adamek et al., 2008; Kaplan &Steele, 2005, Lim, 2010a). Lim (2010a) examined the effect of developmental speechlanguage training through music (DSLM) on the speech production of 50 children with autism spectrum disorders (ASD) , and found that music training was effective for enhancing the children's speech production including semantics, phonology, pragmatics, and prosody. Lim (2009, 2010a) stated that children with ASD appear to perceive important linguistic information 16 December 2013 Page 1 of 11 ProQuest

embedded in music stimuli which were organized by principles of pattern perception, and to produce the words as functional speech. The effect of music on speech production in children with ASD might be explained by the inherent structure of music stimuli and the intact capacity of pattern perception and production in children with ASD. As a result, in almost every treatment approach for communication deficits in children with autism, music, in particular, age-appropriate and carefully designed music intervention, has been used as a consistent and reliable way to facilitate speech and language as well as develop communication skills (Adamek et al., 2008; Lim, 2010a; Prizant &Wetherby, 2005; Sundberg &Partington, 1998; Whipple, 2004). Applied Behavior Analysis (ABA) is based on strong and coherent science supported by extensive empirical research that is die basis for the technologies and procedures used with individuals with ASD. Such language training consists of the application of the ABA technology commonly called verbal behavior (VB) . The VB adds an ABA approach to teach all skills including, most importantly, language skills, to children with autism and related disorder; and the primary purpose of ABA VB approach is to enhance a child's ability to learn functional language (Barbera, 2007; Sturmey &Fitzer, 2007). According to this approach, language is treated as a behavior that can be shaped and reinforced while careful attention is paid not only to what a child is saying but why he or she is using the language (Barbera, 2007). Functional analysis of verbal behavior, mand, tact, echoic, and intraverbal are exclusively utilized in ABA VB approach (Barbera, 2007; Sundberg &Michael, 2001; Sundberg &Partington, 1998; Sturmey &Fitzer, 2007). In terms of its function, mand is a verbal operant of requesting where the response form is controlled by motivational variable (deprivation, satisfaction, or aversive stimulation) . Tact is a verbal operant of labeling or describing whose response form is controlled by a non-verbal stimulus such as a picture, photo or object. Echoic is a verbal operant of vocal imitation, and intraverbal is a verbal operant of social interaction or conversation whose response forms are controlled by verbal stimuli. Different verbal operants are associated with independent functional control (Sundberg &Michael, 2001). Researchers indicate that this independent functional control is especially important for language training with preverbal children who have language impairments (Skinner, 1957; Sundberg &Michael, 2001). Such training should be based on verbal operant analysis in terms of its function and controlling variables, and the behavior functional unit for the individual speaker and listener should be emphasized. ABA VB has often utilized music, especially songs, in its language assessments and training programs (Barbera, 2007; Lim, 2010b; Maurice, Green, &Luce, 1996; Sundberg, 2007; Sundberg &Partington, 1998). ABA practitioners are instructed to teach many simple types of intraverbal behavior using well known and favorite songs of the learner (Sundberg &Partington, 1998). Recently, Lim (2010b) proposed a theoretical and clinical implication for the use of music in ABA VB training by presenting various strategies for using music in language assessment and training. According to Lim (2010b), music can be used as a primary tool in ABA VB language assessment and training interventions for treating communication deficits of ASD. The music stimuli including various musical instruments and sounds can be used as effective antecedent variables (i.e., motivational factor) and strong reinforcement in ABA VB language training for children with ASD (Lim, 2010b). In particular, music stimuli can be replaced with verbal stimuli in the language training, which is often associated with demands and/or rigid didactic approach. Pairing target verbal behavior with musical experiences establishes effective automatic reinforcement, and it can increase the frequency of the communicative behaviors and social interaction in children with ASD. Participating in ongoing musical activities is a positive reinforcement for continuing the desirable verbal behaviors in children with autism (Lim, 2010b). Musical behaviors function as target verbal behaviors for the verbal operant training of ABA VB including mand (i.e., request for musical experience), tact (i.e., naming instruments or musical production and singing with pictures or books), echoic (i.e., singing along and musical imitation), intraverbal (i.e., completing songs, and call and response), and advanced social interaction (i.e., turn-taking and ensemble) (Lim, 2010b). Verbal stimuli or prompts for different verbal operants can be embedded in musical stimuli (within a structure of songs), and used 16 December 2013 Page 2 of 11 ProQuest

for die children to perceive the verbal stimuli attentively and to produce the verbal operants easily. In addition, carefully-designed training trials with music experiences facilitate transfer of the verbal operants and enhance more functional verbal communication and social interaction. The empirical and clinical verification of the use of music in ABA VB approach for treating communication deficits of ASD, however, is still required. Such a study needs to explore the effect of each verbal operant training with musical stimuli and to examine the training effects between a traditional ABA VB method and a music incorporated with ABA VB approach on verbal production in children with ASD. The purpose of the study is to compare a common form of ABA VB approach and music incorporated ABAVB method in the speech production (ABAVB operant production) of children with ASD. The following research questions were addressed: 1. Does verbal operant production in preschoolers with ASD differ by training condition: Music ABA VB versus Speech ABA VB versus No-training? 2. Does echolalia as the baseline speech performance in preschoolers with ASD indicate the level of verbal operant production? 3. Does any interaction exist between training conditions: Music ABA VB versus Speech ABA VB versus Notraining and types of verbal operant: mand, tact, echoic, and intraverbal? The independent variables were type of training condition: music, speech, and no-training and type of verbal operants: mand, tact, echoic, and intraverbal. The dependent variable was verbal operant production measured by the Verbal Production Evaluation Scale (i.e., posttest). Participant's pretest scores (i.e., echolalia) were used as covariates for analyzing the third research question, and used as a factor in an analysis of correlation for analyzing the second research question. Method Participants Twenty-two 3 to 5-year-old preschoolers (M = 4 years, 3 months) who were verbal or preverbal with presence of immediate echolalia participated in this study. All children met the diagnostic criteria for autism spectrum disorders (ASD) by his or her own health care provider, such as a pediatric psychologist or neurologist. In this study, 3 participants were 3 years old, 9 participants were 4 years old, and 10 participants were 5 years old. Seventeen boys and 5 girls participated in this study. Materials Target words or phrases were categorized by four verbal operants: mand, tact, echoic, and intraverbal (see Table 1). Target words for mand consisted of six pairs of vocabulary with the consideration that each participant would choose what reinforces him or her. The target words for mand were: (a) Fast - Slow, (b) Loud - Soft, (c) Stop - Go, (d) Drum - Guitar, (e) Car - Train, and (f) Sing - All Done. Target words for tact were: Brown Horse, Black Cat, Blue Fish, White Sheep, and Pink Pig. Target phrases for echoic were: Have a good day, Good morning, Nice to meet you, I love you, See you later, and / want more. Target words for intraverbal were: Fun, Happy, Hug, Point, Eat, and Friends. Target words and phrases were selected from functional vocabularies that 2 to 3-year-old typically developing children can use effectively in everyday interactions. The selection of vocabulary words in this study was based on a number of criteria, including meanings, functions and intentions that are commonly expressed in ABA VB approach and early language communication (Lim, 2010a). Music ABA VB training consisted of singing the verbal instruction. The music training protocol was specifically designed for developmental speech and language training through music for each verbal operant. In the present study, a music therapy session consisted of five trials for each assigned verbal operant (i.e., target words/phrases for mand, echoic, tact and intraverbal) and one board certified music therapist provided every music therapy session. Songs composed by the investigator were used in the music condition (see Appendix A). Songs in the music therapy protocol included a total of 30 target words (6 pairs of target words for mand and 18 target words for tact, echoic, and intraverbal) . Each song lyric included target words or phrases, and each 16 December 2013 Page 3 of 11 ProQuest

lyric line ends with a target word. The arrangement of musical elements within the songs was developmentally appropriate for 3-year-old children. Each song was presented in singing without accompaniment. Pictures for each of two target words in tact training Brown Horse, Black Cat, Blue Fish, White Sheep, Pink Pig and Orange Lion) were also presented by the music therapist. The music therapist presented each picture as she sings the congruent four target word. The same texts for the sentences and directions used in the music ABA VB training condition were used for the speech ABA VB training condition. The texts included the 30 target words. A speech training session consisted of five trials for each assigned verbal operant. Each verbal line or sentence included target words or phrases, and each sentence ended with a target word. The same music therapist in die music condition spoke the sentences. Pictures for tact training in the sentences were also presented by the music therapist. The music therapist presented each picture while speaking the congruent four target word. Testing materials. During the pre and posttests, data were collected in regard to each child's production of the target words. A correct verbal operant production consisted of four components, including: semantics, phonology, pragmatics, and prosody. A verbal production evaluation scale (VPES) designed by Lim (2010a) measured the participants' productions of the target words according to the four speech components, and the total score of the VPES was used for the score of the pre and posttests. The highest overall score for the verbal production of each target word was 6 points, and the lowest score was 0 points. Total score possible for pretest was 180 (for 30 words including every target word in pairs in mand) and posttest was 144 (24 target words after participants manding of one target word out of the pair) . As noted above, at pretest a single total score was calculated (to address Research Questions 2 and 3). At posttest (after the two weeks of training), a total score for each training condition (to address Research Question 1) an overall total score (to address Research Question 2) , and 12 subscores based on mand, tact, echoic, and intraverbal target words and training condition combination (to address Research Question 3) were calculated. The pre and posttest administration is further described below. The pretest was administered to measure the baseline performance levels of verbal production in the participants. Since one of the most salient examples of deviant speech in autism is echolalia, the pretest was designed to evaluate the participants' echolalic production of the target words. During the pretest, the investigator spoke each target word twice, and then gave an opportunity to the participants to imitate the target word or phrase. The objective of the procedure in the pretest was to prompt the participants to produce a target word and to assess their current level of speech/language acquisition by echolalia. The posttest was a form of corresponding verbal operants including mand, tact, echoic and intraverbal communication. The posttest consisted of the training materials for each verbal operant (see Table 1.) The posttest included 24 phrases that were structured so as to end with one particular corresponding target word or phrase. The investigator spoke the first part of each phrase which was the verbal instruction for training, and then left off the target word or phrase for the participant to respond. The phrase in the verbal instruction and the corresponding target word or phrase made a complete functional dialog form. For example, if the investigator says "How do you want to play? Fast or slow?" The participant responds "Fast." If the investigator asks "What is this?" while showing a picture, the participant responds "Pink pig." The posttest were designed for evaluating the participants' verbal production in functional communication. Therefore, the objective of the procedure in the posttest was to prompt the participant to produce a target word at the end of a phrase upon hearing the first part of the dialog. In the posttest, six pairs of target words: Fast, Slow, Loud, Soft, Stop, Go, Drum, Guitar, Car, Train, Sing, and All Done were composed to produce mand. For example, the question "How do you want to play?" was presented for a pair of target words Fast or Slow, and each child was supposed to choose one target word from the pair. Six phrases with target words: Brown Horse, Black Cat, Blue Fish, White Sheep, Pink Pig, and Orange Lion were composed to produce tact. A corresponding picture was presented with only six target words used in 16 December 2013 Page 4 of 11 ProQuest

tact training. Each picture was used only one time with its corresponding tact target word. For example, the question "What is this?" was presented with a picture of brown bear. Six phrases with target words: Have a good day, Good morning, Nice to meet you, I love you, See you later, and I want more are composed to produce echoic in a dialog. For example, the investigator said "Nice to meet you" for the participant to verbally imitate and respond "Nice to meet you." The last six phrases with target words: Fun, Happy, Hug, Point, Eat, and Friends are composed to produce intraverbal behavior. For example, the phrase "I'm going to give you a big ____ " was presented with the target word, Hug, omitted. The pretest for echolalia and the posttest of verbal operant production after training used the same target words and phrases that are functional vocabularies as listed above. Both test were administered individually. Research Design and Procedures This was a single group intervention with three training conditions and 4 verbal operant conditions. Each participant was observed under each training condition/verbal operant combination. A random number chart was used to establish the training order and target words for the each condition for each participant. For example, participant 1 received the music training for a set of 8 target verses/words (two words from mand, two words from tact, two words from echoic, and two words from intraverbal). The same participant received the speech training for a second unique set of 8 target verses/words. Lastly, the participant received no-training for a third unique set of 8 target verses/words. The verbal operant combinations for Participant 2 were arranged/selected differently from that of Participant 1. Participants were also randomly assigned which order to receive the trainings to avoid order effects. For example, some participants were assigned to receive the music training first and others were assigned to receive die speech training first. In this study, 11 of the 22 participants received music then speech training and another group of 11 participants received speech then music training, therefore the sequences for all participants were truly balanced. The investigator stayed with the sequence for each participant during the 2 weeks of training. The principal investigator asked parents of each participant to complete the informed consent form for their child. All screening procedures for participants were completed by the investigator. On the first day of the experiment, the investigator administered a pretest to the participants. Each child was tested individually for approximately 5 min. Participants received both music and speech trainings a minimum of 3 days a week for 2 weeks (6 days) . The investigators assumed: (a) whatever training condition was given first had no impact on what was given second; and (b) the training effect was not systematically higher or lower from the first condition to the second. The day after completing the six training sessions for music and speech conditions the principal investigator administered the posttest. The posttest took approximately 6-8 minutes. Each participant's verbal production during die pre and posttests was videotaped. Two speech/language pathologists who specialized in treating young children with language impairments and who were blind to the purpose of the study were trained for data coding. The speech/language pathologists watched each video tape one time and evaluated each participant's verbal production. Results Paired samples f-statistics were conducted to evaluate the effect of training condition (music vs. speech vs. notraining) on target words production of each participant (see Table 2). Score on the VPES for the target words from music training (M = 34.45, SD = 14.77) were higher than the score on the VPES for the target words from speech training (M = 32.91, SD - 15.53); however, the difference between music and speech trainings was not significant. The results indicated that both music training and speech training had a significant effect on the verbal operant production compared to the no training condition (M = 25.22, SD = 14.51). Another paired istatistic was conducted to examine whether level of pure immediate echolalia (i.e., baseline verbal production performance level: pretest) in preschoolers with ASD indicate the level of verbal operant production. The results 16 December 2013 Page 5 of 11 ProQuest

showed that participants scored much higher on echolalia production (M = 124.81/180; SD = 56.99) than verbal operant production (M = 92.41/144; SD = 43.53). The results showed a positive correlation between the pre and posttests (r = .857; p = .000). The difference between level of echolalia (pretest) and verbal operant production (posttest) is significant (t = 5.09; Sig. = .000) . This particular result indicates that the participants' level of performance on target word-verbal operant production heavily relied on echolalia and/or verbal imitation skill. An analysis of covariance (ANCOVA) by general linear model, repeated measure was conducted to answer the last research question "does any interaction exist between training conditions: Music ABA VB versus Speech ABA VB versus No-training and types of verbal operant: mand, tact, echoic, and intraverbal?" The analysis indicated a significant effect on the treatment condition on the participants' verbal productions after controlling for the pretest (echolalia) score. The parameter estimates analysis after testing homogeneity of variance showed that music training was most effective in echoic production (t = 2.207; p = .039; r = .56; partial ? = .20), and speech training was most effective in tact production (t = 2.096; p = .049; r = .51; partial ?2 = .18). The result also showed that there is a significant interaction between intraverbal score and the pretest score (F = 6.108, p = .023; partial ?2 = .23). Participants who produced the target words as echolalia during the pretest might produce the same target words as functional verbal operants in a dialog form (i.e., intraverbal operant). Interactions between pretest and other verbal operants such as mand (F = .567; p = .46) , tact (F = .020, p = .89), and echoic (F = 1.50; p = .24) were not significant. Discussion The results of the present study indicate that botii music and speech trainings are effective for production of the four ABA verbal operants (mand, tact, echoic, and intraverbal). The difference between music and speech training was not statistically different. The results suggest that music training is as equally effective as speech training for producing the functional verbal operants in children with ASD. The findings suggest that music can be incorporated into the ABA VB training method and that musical stimuli can be successfully used to enhance verbal production in children with ASD. The structure and curriculum in the ABA VB training method can utilize carefully designed musical sounds with various combinations of melody, rhythm, and dynamic. Pairing target verbal instructions/prompts with singing establishes effective antecedent variables and automatic reinforcement, and it may increase the frequency of the target verbal operant production in children with autism. Participating in music training might be a positive reinforcement for continuing production of the verbal operants in children with autism. Results of the present study indicate that within the target words or phrases from music training condition, the target phrases for echoic were mostly produced. In particular, the phrases for echoic training (e.g., "Have a good day," or "Nice to meet you") were longer than other verbal operants target materials (e.g., "Stop," or "Fun"). In addition, the echoic operants in the study were not designed to produce echolalia (a pure imitation), but designed to complete a daily greeting dialog. For example, the antecedent variable for an echoic training was "It's time to go. I say see you later, and you say ________ " and the target phrase was "See you later." Music training might provide more predictable temporal patterns for the children to produce echoic operants, therefore make it easier to perceive the target phrases in a functional dialog form by children with ASD. The significant effect of music training on the ABA VB echoic production may be explained by the characteristics and inherent structure of music stimuli in the antecedent variables of the verbal operant training. Lim (2010a) stated that structurally and functionally organized musical stimuli may enhance speech production and vocabulary acquisition in children with ASD. The findings of the present study support the premise that carefully designed and functionally organized musical stimuli can be used as the effective antecedent variables for the ABA verbal operant training, in particular for echoic training. Results of the study indicate that within the target words or phrases from speech training condition, the target words for tact with corresponding pictures were mostly produced. Tact is the ability to verbally label common items that a child can see, smell, taste, hear, touch, and feel. A tact is associated with the meaning of the 16 December 2013 Page 6 of 11 ProQuest

vocabulary word; however, this skill is very different from the receptive identification of items or actions. The antecedent variables for tact exclusively relies on verbal stimuli such as "What is this?" In addition, tacting is a more difficult skill because the child must not only identify the correct word, but must be able to have the vocal control to independently pronounce the word (Sundberg &Partington, 1998). In this study, all of target words for tact used a combined vocabulary with color and animal (e.g., brown horse or orange lion), and the antecedent variables were a corresponding picture and question "What is this? What is this? Can you tell me what this is?" In music training, die same picture was used for the antecedent variables for the target tact words, and the same question was sung with a melody. In addition, production of the target words for tact involved in recognizing the animal with color (i.e., semantics) and producing the correct vocabulary words right after hearing a question ("What is this? What is this? Can you tell me what this is?"). Musical stimuli might not directly enhance the process of tact production. The findings of the present study suggest that speech training might be more effective on a simple tact production than music training. The effect of music training on tact production using longer phrases or combination of different vocabulary words such as a picture book needs to be investigated. The results of the study showed a positive correlation between the pretest (i.e., pure immediate echolalia) and posttest (i.e., 4 verbal operants production). In particular, the results indicate that there is a significant interaction between the pretest score and intraverbal production after trainings. Intraverbal behavior is a type of expressive language where a word or phrase evokes another word or phrase, but the two are not identical. The finding of the present study suggests that children with ASD who can produce vocabulary words as echolalia might use the same words functionally. For example, if the child can imitate (i.e., echolalia) "hug," he can produce the same word in an intraverbal form with an antecedent variable "I will give you a big hug." This finding suggests that, with the language training, the child is able to use the word semantically within a correct sentence structure (i.e., pragmatic) . The language training resulted in die development of language skills; changes from the production of a pure immediate echolalia into use of a functional speech. The findings support that immediate echolalia has been considered a necessary stage of language development for verbal children with autism (Lim, 2010a; Prizant &Duchan, 1981). Echolalia is characteristic of at least 85% of the children with ASD who acquire speech, and once viewed as an undesirable, nonfunctional communication behavior. Many autism researchers have described echolalia as serving communicative functions, and explain echolalic behavior within the context of a child's cognitive and linguistic development (Lim, 2010a; Lord &Paul, 1997; Paul &Sutherland, 2005; Prizant &Wetherby, 1993, 2005; Sundberg &Partington, 1998). Echolalic behavior may play a role in the acquisition of linguistic function and structure of speech among children with autism. Tager-Flusberg (1985) stated, "Echolalia and stereotyped language are now seen as primitive strategies for communicating, especially in the context of poor comprehension" (p. 72). Goldstein (2002) reported that children with ASD who benefit most from communication interventions (e.g., modeling, prompting, fading or use of visual modality) seem to have better verbal imitation skills. Furthermore, children with good verbal imitation skills (i.e., echolalia) are more likely to demonstrate speech production in addition to or in lieu of sign production than children without echolalia. Echolalia is regarded as a speech imitation skill, and this particular speech production may predict further speech-communication development in children with ASD. These findings with the results of the present study suggest that a positive correlation might exist between verbal imitation skills of children with ASD and their communication development. In the present study, die verbal imitation skills (i.e., echolalia) resulted in some negative (not functional) verbal production in a couple participants. During testing their mand production (posttest), those participants imitated the antecedent variable for mand target words instead of manding the words. For example, when the investigator asked "What do you want to play? Drum or Guitar?" the participants answered "Drum or Guitar" instead of choosing either "Drum" or "Guitar." The researchers also observed a carried-over training effect on 16 December 2013 Page 7 of 11 ProQuest

mand production during the posttest. Some participants who received mand training through both music and speech produced the mand target words for no-training condition during the posttest. The antecedent variable for mand production was a question giving an option to choose such as "How do you want to play? Fast or Slow?" Even tiiough participants received no-training for the corresponding words, they produced mand for the words. In other words, the participants were able to mand "Fast" without any training. The present study may provide evidence of die close link between music and language development in children with ASD, and explain the similar mechanisms in their perception and production of music and verbal operants (Lim, 2010b). The present study may provide an example of how to utilize musical elements in teaching functional verbal operants within the ABA VB method for children with ASD. The findings of the present research might provide the empirical support of the use of music in ABA VB training by presenting various strategies for using music in language training. Several limitations of the present study need to be noted including a small sample size (N = 22), die division of the training conditions by the target words, the number of target words, and different format for the pre and posttests. Due to the small sample size, the investigator classified the training conditions by the target words. Future studies could classify the training conditions by the participant's groups. In addition, die implicit assumption that there were no carry-over or period effects needs to be tested. Future studies should also examine the training effects on production of newly learned verbal operants and transfer of verbal operants. Separate training for each verbal operant is essential in ABA VB language training, as the child develops more functional language skills; however, it is almost impossible to teach and use only a single verbal operant. Transferring verbal operants in the language training becomes necessary; therefore a further investigation of the effect of music training on transferring verbal operants and generalization of the verbal production is suggested. Replication of the study could utilize other verbal operants in the ABA VB approach such as textual (reading) , transcriptive, and copying a text. Future studies could use more musical stimuli including accompaniment for the music therapist's singing, different musical instrumental sounds, and more various combinations of musical components (e.g., pitch, rhythm, accent, timbre, etc.) as antecedent variables, motivational variables (EO), automatic reinforcement, verbal stimulus to respond, and nonverbal stimulus in evaluating the verbal operants. Future studies could provide the treatment outcomes of using music therapy language training session protocols within the ABA VB approach that can enhance functional speech and develop communication skills in young children with ASD. References References Adamek, M. S., Thaut, M. H., &Furman, A. G. (2008). Individuals with autism and autism spectrum disorders. In W. Davis, K. Gfeller, &M. Thaut (Eds.), An introduction to music therapy: Theory and practice (pp. 117-142). Silver Spring, MD: AMTA. Barbera, M. L. (2007). The verbal behavior approach. London: Jessica Kingsley Publishers. Buday, E. M. (1995). The effects of signed and spoken words taught with music on sign and speech imitation by children with autism. Journal of Music Therapy, 32, 189-202. Goldstein, H. (2002). Communication intervention for children with autism: A review of treatment efficacy, fournal of Autism and Developmental Disorders, 32, 373-396. Hoskins, C. (1988). Use of music to increase verbal response and improve expressive language abilities of preschool language delayed children. Journal of Music Therapy, 25, 73-84. Kaplan, R. S., &Steele, A. L. (2005). An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum. Journal of Music Therapy, 42, 2-19. Lim, H. A. (2009). Use of music to improve speech production in children with autism spectrum disorders: Theoretical orientation. Music Therapy Perspectives, 27(2), 103-114. Lim, H. A. (2010a). The effect of DSLM on speech production in children with autism spectrum disorders. 16 December 2013 Page 8 of 11 ProQuest

Journal of Music Therapy, 47, 2-26. Lim, H. A. (2010b) . Use of music in the Applied Behavior Analysis Verbal Behavior Approach for children with autism spectrum disorders. Music Therapy Perspectives, 28(2), 95-105. Lord, C, Sc Paul, R. (1997). Language and communication in autism. In D. Cohen &F. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (pp. 195-225). New York: John Wiley &Sons, Inc. Maurice, C, Green, G, &Luce, S. C. (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed, Inc. Paul, R. (2008). Communication development and assessment. In K. Chawarskia, A. Klin, &F. R. Volkmar (Eds.), Autism spectrum disorders in infants and toddlers (pp. 76-103). New York: The Guilford Press. Paul, R., &Sutherland, D. (2005). Enhancing early language in children with autism spectrum disorders. In F. Volkmar, R Paul, A. Ktin, &D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 946-974) . New York: John Wiley &Sons, Inc. Prizant, B. M., &Duchan, J. F. (1981). The functions of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46, 241-249. Prizant, B. M., &Wetherby, A. M. (1993). Communication in preschool autistic children. In E. Schopler, M. Van Bourganthen, &M. Bristol (Eds.), Preschool issues in autism (pp. 95-128). New York: Plenum Press. Prizant, B. M., &Wetherby, A. M. (2005). Critical issues in enhancing communication abilities for persons with autism spectrum disorders. In F. Volkmar, R. Paul, A. Ktin, &D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 925-945). New York: John Wiley Sc Sons, Inc. Skinner, B. F. (1957). Verbal behavior. England/Cliffs, NJ: Prentice Hall. Sturmey, P., &Fitzer, A. (2007). Autism spectrum disorders: Applied behavior analysis, evidence, and practice. Autsin, TX: Pro-Ed, Inc. Sundberg, M. L. (2007). Foreword. In M. L. Barbera, The verbal behavior approach (pp. 9-11). London: Jessica Kingsley Publishers. Sundberg, M. L., 8c Michael, J. (2001). The benefits of Skinner's analysis of verbal behavior for children with autism. Behavior Modification, 25, 698-724. Sundberg, M. L., &Partington, J. W. (1998) . Teaching language to children with autism or other developmental disabilities. Pleasant Hill, CA: Behavior Analysts, Inc. Tager-Flusberg, H. (1985). The conceptual basis for referential word meaning in children with autism. Child Development, 56, 1167-1178. Whipple, J. (2004). Music in intervention for children and adolescents with autism: A meta-analysis. Journal of Music Therapy, 41, 90-106. AuthorAffiliation Hayoung A. Lim, PhD, MT-BC Ellary Draper, MM, MT-BC Sam Houston State University Subject: Autism; Children & youth; Behavior modification; Music therapy; Speech; Linguistics; MeSH: Autistic Disorder -- complications, Child, Preschool, Combined Modality Therapy, Comprehension, Female, Humans, Language Development, Language Development Disorders -- etiology, Language Therapy -methods, Male, Music, Treatment Outcome, Autistic Disorder -- rehabilitation (major), Language Development Disorders -- therapy (major), Music Therapy -- methods (major), Verbal Behavior (major) Publication title: Journal of Music Therapy Volume: 48

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Issue: 4 Pages: 532-50 Number of pages: 19 Publication year: 2011 Publication date: Winter 2011 Year: 2011 Publisher: American Music Therapy Association Place of publication: Silver Spring Country of publication: United States Publication subject: Education--Special Education And Rehabilitation, Music ISSN: 00222917 CODEN: JMUTAZ Source type: Scholarly Journals Language of publication: English Document type: Feature, Journal Article Document feature: Tables References Accession number: 22506303 ProQuest document ID: 916999901 Document URL: http://search.proquest.com/docview/916999901?accountid=15533 Copyright: Copyright American Music Therapy Association Winter 2011 Last updated: 2013-02-22 Database: ProQuest Central

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Bibliography
Citation style: APA 6th - American Psychological Association, 6th Edition Lim, H. A., & Draper, E. (2011). The effects of music therapy incorporated with applied behavior analysis verbal behavior approach for children with autism spectrum disorders. Journal of Music Therapy, 48(4), 532-50. Retrieved from http://search.proquest.com/docview/916999901?accountid=15533

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