Anxiety Symptoms, Childhood Autism and Improvisational Music Therapy: A Clinical Method
This capstone thesis explores the efficacy of improvisational music therapy in reducing symptoms of anxiety among children with autism spectrum disorder (ASD) Through a clinical review of the literature on the topic of anxiety symptoms, autism disorder and improvisational music therapy in conjunction with individual music therapy sessions with one student, which pertained one session of music therapy per week for a month with a client, diagnosed with autisms disorder. The participant was observed from his transition from class to music therapy session until the end of the day at school. The observations found from the study suggest that children who are diagnosed with autism and experience anxiety would benefit from improvisational music therapy. Running head: ANXIETY SYMPTOMS 4 Anxiety Symptoms, Childhood Autism and Improvisational Music Therapy: A Clinical Method Introduction Anxiety is one of the most common psychiatric disorders affecting people with autism. About 40 percent of youth and up to half of adults meet the clinical criteria of an anxiety disorder, such as social anxiety, phobia, panic disorder, or generalized anxiety, or obsessive compulsive disorder (van Steensel Heeman, 2017; van Steensel, Bogels, Perrin, 2011; Cai, Richdale, Dissanayake, Uljarevic, 2018; White, Oswald, Ollendick, Scahill, 2009; Buck et al. 2014; Lugnegard, Hallerback, Gillberg, 2011; Croen et al. 2015) A critical factor that currently remains unanswered, given the heterogeneity of autism and the complexity of anxiety, is the reason why autistic individuals are more vulnerable to anxiety (Rodgers Ofield, 2018) Many of the conditions' features (avoidance, irritability, fears, abnormal sleep habits, etc. associated with ASD overlap with symptoms seen in varying anxiety disorders (Kim, Szatmari, Bryson, Streiner, D. Wilson, 2000) therefore differentiating between co morbid anxiety and characteristics of ASD can be problematic (Tsai, 2006) Some of the most frequently reported anxiety disorders and symptoms seen in children with ASD are simple phobias, generalized anxiety disorder, separation anxiety disorder, obsessive compulsive disorder, and social phobia (White, Oswald, Ollendick, Scahill, 2009) Gaining a context for anxiety with children living with autism is a necessary step to take in developing treatment. Even though the relationship between anxiety and ASD has only recently become a focus of research (Fodstad, Rojahn, Matson, 2010) there Running head: ANXIETY SYMPTOMS 5 has been a known association between the two conditions since the original account of autism. Kanner (1943) in his original description of children with "classic" autism, noted that a number of them had substantial anxiety problems. Music, like language, is one of the universal aspects of human existence (Rose, 2010) Music's ageless influence and its uses are seen throughout history. Everyone has experienced music in some form, regardless of their nationality, age, or ethnicity. Even from ancient times, as evidenced by Paleolithic cave drawings and the remains of rudimentary flutes, it seems that music making is a human capability that is fundamental to human culture (Anthony, 1992) Ticker (2017) explains, music has primarily been proclaimed as an enjoyable tool in the past, but now it has been proven that its effects are much more than simple elevation of a person's mood. Scientists are discovering more and more positive effects that music has on our cognition and physical health. As a result of this research, fields such as music therapy have been expanding and growing. Clinicians are using music in therapeutic settings to help those with brain damage or developmental disorders, especially in regard to children with Autism Spectrum Disorder. Music is very powerful, and its effects on brain plasticity, cognition, emotion, and physical health have important and valuable repercussions for the field of healthcare. Reported benefits of music as a therapeutic intervention for individuals who have autism include the following (Cornhill, 2013; Simpson Keen, 2011) Increased appropriate social behaviors, improved attention to tasks, increased vocalizations, verbalizations, gestures, and vocabulary comprehension, increased communication and social skills, enhanced body awareness and coordination, improved self care skills and Running head: ANXIETY SYMPTOMS 6 reduced anxiety. Furthermore, studies have shown that individuals with ASD have normal or superior abilities with certain components of music processing, which makes music a potential intervention for this population (Molnar Szakacs, 2009) It is hoped that this study will contribute to the music therapy clinical practice by offering new clinical information about the use of improvisational music therapy with autistic children who experience anxiety. Exploring the experiences that arise when creating music in a therapeutic setting may provide music therapists with better information to implement the use of improvisation with children who struggle with symptoms of anxiety such as excessive worrying, feeling agitated, restlessness, fatigue, difficulty concentrating, irritability and avoiding social situations. The goal of this study was aimed at reducing symptoms of anxiety during and after improvisational music therapy sessions with a client diagnosed with autism. This study details the process in which the participant was given the opportunity to make use of social engagement and expression of emotions through improvisational music making. The researcher employed a child centered approach where the therapist used active, spontaneous music making and developed a relationship with the client throughout the process. Therapist anticipated to follow the child's focus of attention, behaviors and interests to promote strategies to recognize and manage symptoms of anxiety. The researcher also hoped to facilitate growth in other areas of need such as the child's social communicative skills, awareness and sense of self. Literature Review It is estimated that eighteen percent of the entire population in the United States has some form of anxiety disorder (Anxiety and Depression Association of America, Running head: ANXIETY SYMPTOMS 7 2016) Anxiety disorders can occur at any stage of life and they can range in severity from mild to debilitating. According to The Autism and Developmental Disabilities Monitoring (ADDM) Network, at 2014 about 1 in 59 children has been identified with autism spectrum disorder (ASD) Autism is reported to occur in all racial, ethnic, and socioeconomic groups and it is about 4 times more common among boys than among girls (Baio, 2018) Anxiety is one of the most common psychiatric disorders affecting people with autism. Researchers at The University of Amsterdam reviewed 31 studies that focused on the presence of anxiety disorders in children under 18 years old with autism spectrum disorder (ASD) Upon review of these studies, researchers concluded that about 40% of children with ASD had at least one comorbid diagnosed anxiety disorder (van Steense, Bogels, Perrin 2011) In addition to that, up to half of adults with autism meet the clinical criteria of an anxiety disorder, such as social anxiety, phobia, panic disorder, or generalized anxiety, or obsessive compulsive disorder (van Steensel, Heeman, 2017) By comparison, the prevalence of anxiety disorder among adults and adolescents in the United States is 19.1 and 31.9 percent. (U.S. National Institute of Mental Health, 2018) According to Dubin, Lieberman Betz Lease (2015) it is not uncommon for children with autism to experience high levels of anxiety. For children with autism, anxiety can occur more frequently and can be very intense. Seemingly simple daily activities such as interacting with peers, riding in the car, taking public transportation and leaving the house can become increasingly anxiety provoking and difficult. There have been several studies that show varying results, but it is estimated that between 11% and 84% of people with autism also have an anxiety disorder. Reason for such a wide variety Running head: ANXIETY SYMPTOMS 8 of result has remained unknown, however there are some studies, which have explored why anxiety may occur in people with autism at a higher rate than for the general population. Using interviews with parents, de Bruin, Ferdinand, Meester, de Nijs, Verheij (2007) examined the level of anxiety among children and adolescents with ASD and concluded that severe symptoms are highly prevalent in children with ASD. Parents were interviewed to assess DSM III R psychiatric disorders and symptoms in their children. In this study the Dutch version of the DISC IV P (Ferdinand Van der Ende, 1998) was used to measure reported anxiety by parents in children (n=94) Results showed that 55% of children met criteria for an anxiety disorder. There are many common behaviors seen in children with ASD that overlap with symptoms seen in varying anxiety disorders. For example, the obsessions and compulsions of Obsessive Compulsive Disorder may look similar to repetitive and stereotyped behaviors in children with ASD. For this reason, there is speculation as to what psychologists should consider symptom overlap and what is a distinctly different disorder (van Steensel, Bogels, Perrin, 2011) Other behaviors that are characteristic of both anxiety and autism include becoming over stimulated, making little eye contact, not initiating playing with others, heavily dependent on schedules, self injuring, outbursts of emotions, or becoming withdrawn. These behaviors may very well be present in socially anxious children, and may not necessarily be attributable to ASD. Muris, Steernemen, Merckelbach, Holdrinet, and Meesters (1998) found that, in their sample of 15 children with AD and 29 with Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS) simple (or specific) phobia