Music Therapy for children with intellectual disabilities

Senior lecturer, Phd., Viorel Agheană, Faculty of Psychology and Educational Sciences,
University of Bucharest

Music therapy has capacity to make positive changes in the psychological, physical, cognitive, or
social functioning of individuals with health or educational problems. When the interdisciplinary
nature of music, as it is used in music therapy, is fully understood, the treatment addresses
improving motor, cognitive, affective and social skills. We show that this interdisciplinary aspect
of music makes the therapy uniquely appropriate for disabled individuals because it supplements
and reinforces other therapies and disciplines while implementing its own program.

Key words: music, therapy, intellectual disability, special education

American Music Therapy Association1 (AMTA): “Music Therapy is an established health

profession in which music is used within a therapeutic relationship to address physical,
emotional, cognitive, and social needs of individuals”.
“When it comes to music and the mind, music has absolutely astounding, powerful, and positive
effects. When we talk about a matter of functionality when it comes to music, regions of the
frontal and parietal lobes are involved in a sort of radiating pattern of cortical activation that
moves outward as harmony, melody, and rhythm are perceived; forward, behind, and to the sides
of these sound processing areas lie ‘associative regions’ that ‘put together’ the experience of a
sound” 2.
Music therapy has capacity to make positive changes in the psychological, physical, cognitive, or
social functioning of individuals with health or educational problems. It also facilitates the
creative process of moving toward wholeness in the physical, emotional, mental, and spiritual
self in areas such as: independence, freedom to change, adaptability, balance, and integration. In
the very act of making music and responding to musical stimuli, a person experiences
instantaneous psychological and physiological sensations on many levels. The concrete reality of

1
https://www.musictherapy.org/about/musictherapy/
2
Brynie, Faith H. Brain Sense: The Science of the Senses and How We Process the World Around Us. New York:
American Management Association, 2009, p.151
sensing auditorially, visually, tactually, kinesthetically, and emotionally brings the person into
the present and has immediate results3.
Boxhill4 identifies the following fundamental reasons for the efficacy of using music as a
therapeutic agent:
• It is a cross-cultural mode of expression.
• Its nonverbal nature makes it a universal means of communication.
• As a sound stimulus, it is unique in its power to penetrate the mind and body directly, whatever
the individual’s level of intelligence or condition. As such, it stimulates the senses, evokes
feelings and emotions, elicits physiological and mental responses, and energizes the mind and
body.
• It facilitates learning and the acquisition of skills.
When the interdisciplinary nature of music, as it is used in music therapy, is fully understood, the
dimensions of the therapy become clear. Treatment addresses improving motor skills (physical,
occupational, and recreation therapies); cognitive skills (special education and speech and
language therapy); affective states and adjustment (psychology); and social skills (all disciplines).
This interdisciplinary aspect of music makes the therapy uniquely appropriate for disabled
individuals because it supplements and reinforces other therapies and disciplines while
implementing its own program.

***

Gheorghe Radu shows that „ Intellectual disability refers to the phenomenon of organic damage
and / or functional impairment of the central nervous system, with negative consequences on the
process of mental maturation, development in different aspects, to the individual concerned”5.
American Association on Intellectual and Developmental Disabilities (AAIDD) defines disability
as (2016): „Intellectual disability is characterized by the significant limitation of the functioning
of adaptive behavior at the conceptual, social and practical skills. Disability occurs from the age
of less than 18 years.”
The most common classification of intellectual disability is based on the measurement of the
intelligence coefficient by tests, the coefficient of mental development, the assessment of the

3 Anderson, W., Therapy and the arts: Tools of consciousness. New York: Harper Colophon Books, 1977
4
Boxhill, E.H., Music Therapy for the Developmentally Disabled, Rockville, MD: Aspen Pblication, 1985
5
Radu, G., Psihopedagogia școlarilor cu handicap mintal, București: Ed. ProHumanitats, 2002, p. 12
possibilities of adaptation and integration, the elaboration of the communication behaviors and
the relation with the others.
In discussing the utilization of music therapy in special education, we will focus on assessment
tools and treatment planning, development of goals and objectives, suggested activities,
materials, and equipment. The development of a music therapy IEP (Individualized Education
Plan) for special education students will be explored, and the following skill areas specified: (a)
social skills and appropriate school behavior, (b) conceptual learning and cognition, (c) recreation
and leisure skill development, (d) facilitation of communication, (e) gross and fine motor
development, and (f) addressing emotional needs of special education students.

Music therapy in children with intellectual disabilities

Music therapists have worked with people with intellectual disabilities since the earliest days of
the profession. Music therapy benefits have been reported for people with intellectual and
developmental disabilities in the areas of communication, cognition, physical development and
emotional development6.
In children with intellectual disabilities, melotherapy is used, in particular, in establishing another
type of non-verbal communication with these subjects. When working with these subjects it
matters less the level of development of the musical skills they possess, because in this situation
music is not used in therapy because of its aesthetic qualities. Weigl (1959) introduces the term
functional music, which means that effective music in therapy is the one for practical purposes,
depending on the needs of the subjects. “The main objective of music therapy is to establish
contact with the intellectual disabled person and to facilitate communication between him and the
educator transformed into a therapist”7.
Communication problems related to disability included: difficulties in using objects as a focus of
joint attention, difficulties in interpreting the interactive environment, being sufficiently
motivated to communicate, severely limited means of interaction, attaining and maintaining an
appropriate level of arousal, and lack of interest in interaction and the outside environment.
Research supports connections between speech and singing, rhythm and motor behavior, memory

6 Hooper, J., Wigram, T., Carson, D., & Lindsay,B., A review of the music and intellectual disability literature
(1943–2006) II: Experimental writing. Music Therapy Perspectives, 26(2), 2008, p. 80-96
7
Weigl, V., Functional Music, a Therapeutic Tool in Working with the Mentally Retarded.” American Journal of
Mental Deficiency 63, no. 4 (January 1959), p 675.
for song and memory for academic material, and overall ability of preferred music to enhance
mood, attention, and behavior to optimize the student’s ability to learn and interact. Rhythmic
movement helps develop gross motor skills (mobility, agility, balance, coordination) as well as
respiration patterns and muscular relaxation. Because music is reinforcing, it can be used to
motivate movements or structure exercises that are prescribed in physical rehabilitation.
Involvement in music may provide a distraction from the pain, discomfort, and anxiety often
associated with some physical disabilities.
Research8 demonstrates the efficacy of music used in the curriculum to enhance literacy skills.
Musical cueing is effective to improve word recognition, logo identification, print concepts and
prewriting skills of children in early intervention programs9. Shared reading paired with song
rehearsal of text facilitates greater text accuracy than spoken rehearsal with kindergarten
students10.
Selected verbal language and speech skills are enhanced through music activities in special
education populations. Musical presentation of new vocabulary words results in an increased
number of words learned and transferred in elementary school-age children. Music is effective as
a prompt and reinforcer to increase verbal response in preschool-age children with limited verbal
communication11.
In the context of the melotherapy activities, music is used to recover as much as possible the
decompensated personality of these categories of disabled. To achieve this goal, a breakthrough
between the use of therapeutic music and its use in various recreational activities organized with
disabled children should be made.
Research has shown that percussion instruments, such as castanets, bells, tambourines,
xylophones, facilitate communication, especially in the case of more severely mentally
handicapped or shy and anxious children. In such activities, for example, the combination of two
instruments, piano and drum could be used. The child is comfortably seated in an armchair and
listens to various melodies performed by a melotherapist, who watches the reactions carefully in

8 Colwell, C. M., Therapeutic applications of music in the whole language kindergarten. Journal of Music Therapy,
31(4), 1994, p. 238–247.
9
Register, D., The effects of an early intervention music curriculum on pre-reading/ writing. Journal of Music
Therapy, 38(3), 2001, p. 239–248
10
Standley, J., & Hughes, J., Evaluation of an early intervention music curriculum for enhancing pre-reading/writing
skills. Music Therapy Perspectives, 15, 1997, p. 79–86.
11
Braithwaite, M., & J. Sigafoos, Effects of social versus musical antecedents on communication responsiveness in
five children with developmental disabilities. Journal of Music Therapy, 35(2), 1998, p. 88–104.
order to determine the favorite, high or low frequencies, with which he further determines the
range of interpretation that will cause an avalanche of emotional responses to the subject caused
by a genuine affectional vibe to the listening music. The child is then given a drum that he is
asked to beat according to the rhythm of the song he listens to. In this way the child sets the
rhythm and by its action on the drum improves his motricity.
The results have shown that using this type of melotherapy session is beneficial to the whole
psychic of the subjects. When intellectual disability is associated with other mental disorders
such as hyperactivity and emotional instability, separate distinctions are required. In hyperactive
mentally disabled children, music therapy can be used to improve voluntary inhibition of motor
acts and to achieve successful performance.
Humprey’s research (1980) provides valuable methodological guidance on children's preferences
for various forms of melotherapy, depending on their level of activism. “Subjects with a global
level of activity choose the dance, those with average activity level choose the drum players
team, and those with low levels of activism are oriented towards groups of choirs or
accompaniments."12.

Music therapy and cognitive therapy

Music especially created for children must be accessible to their receiving power, give a higher
orientation to thoughts and actions, and decode cognitive values, going on the path of activating
and transferring ideas from the musical piece into thinking and feeling. That is why the
cultivation of children's access to beauty has to be graduated from the earliest age by presenting
easy and understandable musical creations. Rhythmic, melodic, harmonic-polyphonic musical
skills can be presented and consolidated gradually, consistent with age and native predispositions,
so as to reach an understanding of more and more complex musical works.
Based on the receptivity of the auditory analyzer, the perceptions and representations develop
qualitatively. Starting from this, all other psychic processes of knowledge imply a favorable
evolution, especially as they will be involved in various intellectual activities.
In the center of intellectual development concerns must be thinking, the most productive of
psychic processes, because through it, the child moves from the sensory and motor exploration to
internalise of the perception through logical operations, and thus it is possible to realize the
12
Humphrey, T.,The effect of music ear training upon the auditory discrimination abilities of trainable mentally
retarded adolescents. Journal of Music Therapy, 17(2),1980, p. 73.
understanding of the musical creation. The logical thinking of children is closely related to
sensitivity, perception, representation, and memory.

Music therapy aims to achieve in children performances of thinking, such as: flexibility,
independence, creativity. Through the song, they form the capacity to analyze and differentiate
more precisely the musical sounds, the rhythmic-melodic structures, actively and consciously
participating in its interpretation. At the same time, thinking develops in conditions where music
provides a framework that is as pleasant and appealing to its activities13.
More than any external stimulus, music awakens and keeps children's attention for a longer time,
either through rhythm or melodic line, or through harmony or text, causing deep emotions,
intense inner feelings, or spontaneous creation.
Memory evolves by reflecting past experience by fixing, preserving, recognizing and reproducing
sound, text, ideas, affective states, or assimilated movements. By learning musical-exercise
games, for example, color, strength, duration and height of the sounds are preserved, recognized
and reproduced, and through the actual musical and song plays contribute to the formation and
development of logical memory.
Hearing perceptions, as elements of music therapy, generate various images related to the sound
plan, and the sounds are transferred to the imaginative plane; for example, listening to certain
onomatopee or “instrumental voices”, children associate them with the animals, the birds or the
instruments that produce them.
Unlike perceptions, when sound images are made at the time of performing the respective
musical games, the sound representations reflect musical images created in the past. Therefore,
the sound representations are made with the help of the musical memory, when different images
are made about the particularities of the sound or the text of the songs and games. Based on these,
the imagination develops, and then, with those children with special inclinations, the creative
imagination.

Music therapy and language

In addition to the considerations made in connection with the evolution of psychological

processes through music therapy mentioned above, it is necessary to specify that it is manifested
with a special balance in the development of language, in terms of the correct pronunciation of
13
Popovici D. V., Terapia ocupațională pentru persoane cu deficiențe, Constanța: Ed. Muntenia, 2005
the text of the songs, the activation and enrichment of the lexical vocabulary. Playing a learned
song involves both the exact execution of the melody line and the correct syllable pronunciation
of the text. Musical sounds must overlap with the syllables in the text. A perfect synchronization
is achieved after the educator first sets out stages of staged exercises, aiming at:
- Adjusting the balance between inspiration and expiration, because most children, especially
preschoolers, speak in inspir. The educator has the task of following diligently the consolidation
of an expiring speech;
- The development of phonematic and musical hearing, by voice and syllable transmissions
presented in various game combinations, pronounced in expiration.
- Coordination between breathing- motion- pronunciation.
It is necessary to specify that these steps must be taken before the stage of learning the songs.
Practise balancing exercises between inspiration and expiration, as well as the development of
phonematic hearing, can take on various forms of exercise-games. They are very important,
because under this form some distortions, replacements, inversions and omissions of syllables /
words can be corrected. Their resumption and diversification leads to the automation of a correct,
clear pronunciation of vowels, syllables, and later of words. Note that besides these exercises,
other musical exercises with a higher difficulty, which involve vocal and motor synchronization,
can be gradually exerted.
Research14 has revealed that those children who have been active for a long time in a choral band
or have evolved as vocal soloists are the beneficiaries of a clear diction, of a tinted, fairly phrased
speech. Also, those who sing more form their phonematic and musical hearing faster,
discriminate more easily consonant and dissonance, separate in syllables, and even write more
orthographically. It has also been found that these children have a richer vocabulary.

Music therapy and socio-afective integration

Musical education also influences certain aspects of the socio-behavioral side. Thus, integration
into the collectivity is accomplished more easily through music. The practice of choir music leads
the children to listen individually but also to the others, they can learn the ability to listen to
model interpretations of the educator or other children, to self-control for signal interpretation
and synchronicity with the choir. Thus, music contributes to the education of the order and

14
Popovici D. V.,Terapia ocupațională pentru persoane cu deficiențe, Constanța: Ed. Muntenia, 2005, p. 134
discipline spirit. During playing the game songs, for example; the children go in order, one after
the other, they make certain movements suggested by the text of the songs, in perfect
synchronization with the given rhythm, and so, being careful, the discipline takes on itself.
It is not to be neglected the carols and prayers singed, true moral paradigms of spiritual
ascension, which can lead the children to become better, more confident in their own forces. The
religious songs contribute to the formation and development of the volitional and characteristic
side of children, defining the personality.
Beyond the fact that it provokes true delight for children, the music corresponds to the
spontaneous need for play, movement and relaxation, and the interventions of the educator
demand a very good professional training, a lot of tact and knowledge of the particularities of
each child, so that the educational therapy, unfolded in a such a framework, be as efficient as
possible.

Bibliography

1. Anderson, W., Therapy and the arts: Tools of consciousness. New York: Harper Colophon
Books, 1977
2. Boxhill, E.H., Music Therapy for the Developmentally Disabled, Rockville, MD: Aspen
Pblication, 1985
3. Braithwaite, M., & J. Sigafoos, Effects of social versus musical antecedents on communication
responsiveness in five children with developmental disabilities. Journal of Music Therapy, 35(2),
1998
4. Brynie, Faith H. Brain Sense: The Science of the Senses and How We Process the World Around
Us. New York: American Management Association, 2009
5. Colwell, C. M., Therapeutic applications of music in the whole language kindergarten. Journal of
Music Therapy, 31(4), 1994, p. 238–247.
6. Hooper, J., Wigram, T., Carson, D., & Lindsay,B., A review of the music and intellectual
disability literature (1943–2006) II: Experimental writing. Music Therapy Perspectives, 26(2),
2008
7. Humphrey, T.,The effect of music ear training upon the auditory discrimination abilities of
trainable mentally retarded adolescents. Journal of Music Therapy, 17(2),1980
8. Popovici D. V., Terapia ocupațională pentru persoane cu deficiențe, Constanța: Ed. Muntenia,
2005
9. Radu, G., Psihopedagogia școlarilor cu handicap mintal, București: Ed. ProHumanitats, 2002
10. Register, D., The effects of an early intervention music curriculum on pre-reading/ writing.
Journal of Music Therapy, 38(3), 2001, p. 239–248
11. Standley, J., & Hughes, J., Evaluation of an early intervention music curriculum for enhancing
pre-reading/writing skills. Music Therapy Perspectives, 15, 1997
12. Weigl, V., Functional Music, a Therapeutic Tool in Working with the Mentally Retarded.”
American Journal of Mental Deficiency 63, no. 4 , 1959
13. www.musictherapy.org/about/musictherapy/