Music Therapy for Children Who Are Hard of Hearing or Experience Hearing Loss

Because music is predominantly an auditory stimulus, it is often assumed that music listening and music therapy would not be appropriate for children who are hard of hearing or have experienced hearing loss. Research throughout the decades has concluded that music perception and appreciation influence other factors and make music therapy appropriate for improving language development, speech production, socialization, and the development of musicality.

Therapists must consider various types of hearing loss when planning music therapy sessions for clients with hearing impairments. Conductive hearing loss occurs due to disease, malformation, or obstruction in the outer or middle ear, and devices such as hearing aids are often helpful. Sensorineural hearing loss occurs due to damage or absence of the hair cells in the inner ear. Hearing aids and cochlear implants are used to assist with hearing. The thing to know about sensorineural hearing loss is that the more extensive the damage is the less effective hearing aid devices are. The final type of hearing loss is central hearing loss, which occurs due to damage to the central nervous system.

The age of onset of hearing loss often results in a wide variety of needs associated with hearing loss. The primary need of children who experience hearing loss is the development of spoken and written forms of language. An article on music therapy for children who are deaf or hard of hearing states that “children with severe hearing losses may have speech with improper pitch level, omitted or improperly formed speech, and less intelligible speech.” 

This results in music therapists targeting four main goal areas when treating individuals with hearing loss. These goals are language development, speech production, auditory training, and social skills attainment. Music therapy for language development uses interventions to increase the appropriate use of vocabulary, increase spontaneous communication, and increase sentence structure. Lyrics of songs should be selected to introduce and practice target vocabulary. This includes songs filled with vocabulary such as numbers, colors, and animals. Interventions such as writing songs or pairing sign language with music allow clients to generate new ideas through expressive language. Music therapy for speech production uses interventions to increase vocalization, increase production of natural speech rhythms, and increase the production of common speech sounds. Therapeutic singing allows for the controlled production of speech sounds in a predictable and controlled tempo. Lastly, music therapy interventions are used to increase social skills for children by providing structured opportunities for taking turns, paying attention, following directions, sharing, and expressing feelings appropriately.

Overall, music therapy is an adaptable approach that can support individuals with hearing loss and those who are hard of hearing. Music therapy can aid in the impact that hearing loss can have on a child’s life through targeting that enhances language and speech development.

-Rebecca Smith, Music Therapy Intern

References:

Edwards, J. (Ed.). (2017). The Oxford handbook of music therapy (First published in paperback). Oxford University Press.

Gfeller, K. (2024). Music as Communication and Training for Children with Cochlear Implants. In N. M. Young & K. Iler Kirk (Eds.), Pediatric Cochlear Implantation (pp. 443–458). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-67188-3_27

Angelman Syndrome and Music Therapy

Angelman syndrome is a condition that is caused by a genetic change in the UBE3A gene. This change can cause delayed development, speech problems, balance needs, cognitive disability, and occasionally seizures. The developmental delays begin between 6 months to a year of age and are often the first sign of Angelman syndrome. According to Sommese and Corrado (2021), more than 80% of Angelman syndrome patients experience seizures with onset before the age of three.

Additional characteristics of individuals with Angelman syndrome consist of the following:

• Seizures

• Stiff or jerky movements

• Small head size by age 2

• Tongue thrusting

• Hand flapping and arms uplifted when walking

• Crossed eyes

• Scoliosis

Angelman Syndrome is rare and most often researchers do not know what the cause is for the genetic change that results in the syndrome. Physical, Speech, and Occupational Therapy for individuals with Angelman syndrome has been proven to be effective and often targets physical and sensory goals.  Music therapy is an approach that can effectively target and improve these areas as well.

Common music therapy techniques used with Angelman syndrome consist of:

• Using mnemonic devices to teach factual information (name, address, phone number) as well as for cognitive rehearsal for life and leisure skills.

• Effective for gait training, using rhythmic entrainment. Engaging in movement to music can target gross motor skills, such as improving hand use, crossing the midline, and reaching both high and low.

• Targets receptive communication skills through choice-making, motor planning, sentence structure, speech intelligibility, phonemic awareness, and pattern of language. 

• When providing collaborative intervention with other disciplines, such as Speech Therapy, Occupational Therapy, or physical therapy , music therapy can provide sensory stimulation and increase motivation while targeting various areas. 

• The neurologic music therapy technique, Musical Attention Control Training, targets various kinds of attention, such as selective, divided, and sustained attention, by directing a patient using a musical stimuli (Thaut & Hoemberg, 2014).

Overall, there is very little current research on music therapy and Angelman syndrome. The most recent studies explored the differences in response to music in individuals with Angelman syndrome and individuals with Prader-Willi Syndrome. The most significant finding documented was the effect music had in reducing heart rate in individuals with Angelman syndrome. The article concluded that “because Angelman Syndrome is associated with short attention span, and because heart rate deceleration is known to be related to orienting response,” the auditory stimuli of music were seen to aid in therapeutic treatment for Angelman syndrome.

-Rebecca Smith, Music Therapy Intern

References:

Angelman Syndrome. (2024, March 8). Mayo Clinic Staff. https://www.mayoclinic.org/diseases-conditions/angelman-syndrome/symptoms-causes/syc-20355621#:~:text=Angelman%20syndrome%20is%20a%20condition,happy%20and%20easy%20to%20excite.

Guy, J. (2005). Music Therapy & Angelman Syndrome Fact Sheet. Music Therapy Center of California. https://www.themusictherapycenter.com/wp-content/uploads/2016/11/mtcca_angelman.pdf

Kotler, J., Mehr, S. A., Egner, A., Haig, D., & Krasnow, M. M. (2019). Response to vocal music in Angelman syndrome contrasts with Prader-Willi syndrome. Evolution and Human Behavior, 40(5), 420–426. https://doi.org/10.1016/j.evolhumbehav.2019.05.003

Sommese, M., & Corrado, B. (2021). A Comprehensive Approach to Rehabilitation Interventions in Patients with Angelman Syndrome: A Systematic Review of the Literature. Neurology International, 13(3), Article 3. https://doi.org/10.3390/neurolint13030036

Thaut, M. H., & Hoemberg, V. (Eds.). (2014). Handbook of Neurologic Music Therapy. Oxford University Press

Songwriting for Emotional Expression and Regulation

Songwriting in music therapy is a therapeutic intervention designed for the client and therapist to create lyrics and music. Songwriting is used to target a wide variety of clinical diagnoses and goal areas. These common goals consist of increasing verbal communication, improving self-concept, validating experiences and emotions, externalizing thoughts, and developing cognitive skills.  When planning a songwriting intervention, the therapist music takes into consideration the emotional and cognitive needs of the client. This results in the original goals of the intervention sometimes shifting to meet the present needs of the client.

When leading a songwriting intervention, the music therapist controls the content, structural components of the lyrics, and the melodic form, which contributes to the process. Types of songwriting consist of original compositions, Lyric substitution (piggy-back) lyric writing, fill-in-the-blank, guided, and improvisation. Lyric substitution (piggy-back) song writing consists of taking an existing song and the client adapts and rewrites their own lyrics. Fill-in-the-blank songwriting consists of the client completing lyrics with preexisting song structure. Guided songwriting consists of the therapist providing structure and suggestions collaboratively with the client during the songwriting process. Lastly, improvisation songwriting consists of the client engaging in spontaneous music making and/or lyric writing.

A case study example of song writing targeting the reduction of stress is found in the article “The Feasibility of Songwriting as Stress Management for Parents of Hospitalized Children.” In this study, patients are parents of children who are hospitalized for two or more weeks and are dealing with anxiety and stress. Short term prognoses consist of reduction of stress levels and long-term prognoses varied depending on the severity of reason for children’s hospitalization. These needs were assessed through self-report from patients/caregivers and then were also assessed through referrals from health care providers. There were three phases as part of the music therapy session that were used to target reducing anxiety. Live music for rapport building, guided music meditation and then song writing. The interventions specifically rely on counseling techniques such as paraphrasing, redirection, and body language to build rapport and allow for exploring of clients’ ideas. For the song writing intervention the therapist used lyric substitution and original song writing. The projected outcomes consist of decreased stress and anxiety levels of parents with children who are staying in the hospital longer than two weeks. The song writing intervention also allowed for bonding and processing of emotions for the parents. The interventions were personalized based on parent comfort and the current anxiety levels of the parents which allows for therapeutic discretion and manipulation of the session. This discretion allows for the generalization of this intervention to other clients with similar needs.  

Overall, music therapy provides the space for parents to reduce their stress and anxiety levels using song writing, by providing the parents with autonomy through discussion to promote positive coping skills.

-Rebecca Smith, Music Therapy Intern

References:

Marcovitz, J., Zhang, Q., Jang, H., Adelman, S., Pincus, B., Bauman, J., & Mullur, R. (2024). The Feasibility of Songwriting as Stress Management for Parents of Hospitalized Children. Music Therapy Perspectives, 42(2), 123–128. https://doi.org/10.1093/mtp/miae010

Aasgaard, T., & Blichfeldt Ærø, S. C. (2015). Songwriting Techniques in Music Therapy Practice (J. Edwards, Ed.; Vol. 1). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199639755.013.20

Music Teacher, ‟Ioan Sima” Art High School, Zalău, Romania. Email: ellie.pastor94@gmail.com., Pastor, E., Heath, B., & Music Therapist, Singer, Songwriter, Musician, Associate Lecturer, University of West England. Email: bob.heath.therapy@gmail.com. (2022). A Case Study on Songwriting in Music Therapy. Studia Universitatis Babeş-Bolyai Musica, 67(1), 37–48. ttps://doi.org/10.24193/subbmusica.2022.1.03

Music Therapy and Stroke Recovery

Music Therapy techniques can be imperative for aiding in post-stroke recovery. It can help improve speech, language, and motor function, as well as address cognitive deficits such as memory and attention. Additionally, music therapy can positively influence mood and emotional regulation, potentially accelerating neurological recovery. This research article explores, more in depth, the effects that music therapy can have on patients who have previously experienced strokes. During a stroke, many areas of bodily function are affected, specifically a person’s speech, movement, and memory. Rehabilitation from a stroke can be a lengthy process that consists of intensive and individualized programming. Stroke patients often work towards regaining functional abilities and levels of independence, rebuilding quality of life, and promoting the highest level of functioning possible.

The patient’s areas of needs, within the article, were increasing balance and gait disorders after a stroke. Patients before treatment had a short-term prognosis of requiring an assistive device to walk. Music therapists conducted a study using the music therapy intervention, Rhythmic Auditory Stimulation, developed by neurological music therapists. Rhythmic auditory stimulation interventions use a metronome or musical cue as an external trigger to elicit movement and to improve motor symptoms. In this specific study the therapists used a metronome to provide accented beats. Patients who received this intervention showed an increase in balance and improved motor skills both with and without a walking assistive device. Patients also reported an increase in quality of life through the increased autonomy they gained.

The applications of this research article are extensive when working towards movement and balance goals within a music therapy session. This intervention would work with any population working towards increasing walking distance and increasing smooth gait because the rhythmic auditory stimulation provides a steady pulse for clients to entrain to and thus increase smooth gait. Knowing this information increases the generalizability of the interventions used not only for stroke patients, but for any client who is working towards similar goals. This learning matters because it serves as evidence and provides the foundation for neurological rehabilitation and music therapy for patients who have experienced a stroke. In conclusion, Rhythmic Auditory Stimulation uses a steady pulse to improve balance, mobility, and gait while simultaneously improving functional independence and quality of life for patients who are post stroke.

-Rebecca Smith, Music Therapy Intern

References:

Editorial: Understanding stroke recovery to improve outcomes: From acute care to chronic rehabilitation. Frontiers in Neurology, 13, 1021033. https://doi.org/10.3389/fneur.2022.1021033

Gonzalez-Hoelling, S., Reig-García, G., Bertran-Noguer, C., & Suñer-Soler, R. (2024). The effects of rhythmic auditory stimulation on functional ambulation after stroke: A systematic review. BMC Complementary Medicine and Therapies, 24(1), 45. https://doi.org/10.1186/s12906-023-04310-3

Autism Spectrum Disorder and Sensory Integration

Music is a powerful tool for integrating sensory systems during a therapeutic session with individuals with Autism Spectrum Disorder (ASD). Autism Spectrum Disorder, according to the National Institutes of Health, is a condition characterized by difficulties in communication, flexibility in behavior, and social interaction These sensory based behaviors impact how one responds to auditory, tactile, and visual stimuli. ASD is a spectrum, and there is no one-size-fits-all method to aid sensory processing needs. Current research concludes that an individual's sensory needs must be met before a therapist can target developmental and social-emotional goals.

The link between music and the sensory system is through the nervous system. Music therapy helps by aiding in the disruption that occurs in the organization of sensory input. This is done through the perception of music throughout the brain combined with the emotional reaction music can produce.

Music therapy aids in working with individuals with ASD and maintaining sensory needs through many different interventions. A few of these interventions consist of:

• Movement to music supporting both proprioceptive and vestibular input.

• Tactile Input through musical instruments and props such as scarves, rain sticks, ocean drums, bean bags, stretchy bands, etc.

• Calming/ sensory music used to regulate, reduce frustration, and increase tolerance.

In addition to these interventions, many principles that set up a music therapy session for success. This enables the therapist to more effectively address the sensory needs of their clients. These principles consist of:

• Creating emotional attunement through music by altering the music, voice, and arousal level 

• Scaffolding interactions musically by using musical, verbal, visual, or physical cues to support the needs of the client

• Targeting goals through interventions the clients enjoy by altering affect in tone of voice, facial expressions, musical actions, and gestures

-Rebecca Smith, Music Therapy Intern

References:

Geretsegger, M., Holck, U., Carpente, J. A., Elefant, C., Kim, J., & Gold, C. (2015). Common Characteristics of Improvisational Approaches in Music Therapy for Children with Autism Spectrum Disorder: Developing Treatment Guidelines. Journal of Music Therapy, 52(2), 258–281. https://doi.org/10.1093/jmt/thv005

Marco, E. J., Hinkley, L. B. N., Hill, S. S., & Nagarajan, S. S. (2011). Sensory Processing in Autism: A Review of Neurophysiologic Findings: Pediatric Research, 69(5 Part 2), 48R-54R. https://doi.org/10.1203/PDR.0b013e3182130c54

Perrin, F., & Magee, W. L. (2023). Music as Sensory Stimulation and Therapeutic Intervention. In C. Schnakers & S. Laureys (Eds.), Coma and Disorders of Consciousness (pp. 99–113). Springer International Publishing. https://doi.org/10.1007/978-3-031-50563-8_6

Simhon, V., Elefant, C., & Orkibi, H. (2019). Associations between music and the sensory system: An integrative review for child therapy. The Arts in Psychotherapy, 64, 26–33. https://doi.org/10.1016/j.aip.2018.11.005