Autism, the Brain and Music

The first clinical population I ever worked with was autism. Back in 1979, I was looking for a part time job. Working in restaurants or offices was never my calling. Somehow I heard of a new residential and day school just established for people with autism. These children and adults, almost all boys or men were being educated in life skills and in academic subjects with the latest approaches of the day— Skinner’s behavioral theories and macrobiotic diets. It was a new world to enter.

I was a musician and a music education student in my first year at college. I could see and hear the musicianship of these people I served and struggled to use their abilities in the tasks at hand. Here is an example.

One little boy that I adored would almost always stand with his head all the way back and his eyes looking up. By looking up, he could play with the light using his fingers. When you stood over him and looked in his eyes, it was as if he was looking through you and not at you. He was typically in this position unless you sang to him. When you sang to him, he would look straight at you with a remarkably intense gaze for the entire duration of the song. As soon as the song was over, he would go back to playing with the light. In this position, he did not follow directions and seemingly could not be reached.

You have to imagine how difficult this was to getting him dressed.  He would not follow any verbal directions I gave him. There was no meaningful eye contact. He was resistive to gestures and physical directs. In time, I stumbled onto using the song he loved  (‘Camptown Races’) with a lyric substitution. The lyrics I substituted would direct him. For example, in the steps for dressing, he had to take off his pajama top, pick up his shirt, etc. Each step for dressing was a line in the song.

It’s time to take your shirt off, doo dah doo dah,

It’s time to take your shirt off, all the doo dah day.

I could repeat the directive one to four times. Each directive was alternated with the familiar (and meaningless) “doo dah”. This gave him time to process what I sang and complete that step before he heard the next. It worked like a charm. He dressed tout suite (“all the doh dah day”). 

In the years to come, I would assess comprehension and compliance with sung directives as contrasted with spoken directives. The clinical evidence was strong that sung cues were more efficacious. I observed this phenomenon in children with intellectual deficits, autism and those with Rett syndrome. 

But why would sung cues work better than spoken cues? There are two primary reasons. The first being available to all people who have receptive language challenges.

Changes in the auditory signal move more slowly in music than they do in speech. Cruttenden reported that a typical speaking rate in English is 4 syllables per second. If I take Camptown Races at a bonny tempo, I get as ‘camptown’ sung in one second. That is half the syllables of an average speech rate. When music therapists use music to develop language, the reduction of information per second helps the person comprehend what is being said. This is an important advantage in early childhood development.

The second reason relates to people with autism. Catherine Wan and colleagues used brain imaging with young children who were diagnosed with autism and nonverbal, between the ages of 5 and 8. What Wan and colleagues reported was an asymmetry in an important brain structure in those with autism compared to neurotypical peers. Wan writes “it is possible that this unusual pattern of asymmetry may underlie some of the severe language deficits commonly found in autism, particularly in children whose speech fails to develop.” The asymmetry is in a brain structure that is related to speech and language in the left hemisphere and melody in the right. For those of you reading this, your left structure would be thicker. With the children in the study, it was their right. Not only would this help explain why they are nonverbal but also why they are so attracted to music. 

Here are a couple of other interesting points to consider:

In a study with musicians, those with perfect pitch scored high on autistic traits (Dohn, et al., 2012). 

The best musicians in the world are both autistic and blind. Their capacity for music is astounding. They can hear a complex piece of music just once and play it back. In the case of Rex Clack, he went one step further.  After hearing a new song just one time, he plays it back in the style of Mozart.

Across 40 years of clinical work with people on the spectrum, I have found their attentiveness to music to be a tremendous strength. That strength has allowed me the leverage needed to facilitate speech, language and social development. The neuroscience research is catching up with this work, offering validity to the art and science of music therapy. 

Bibliography

Cruttenden, A. (2014). Gimson's Pronunciation of English. Routledge. p. 54.

Dohn, A., Garza-Villarreal, E.A., Heaton, P. & Vuust, P. (2012). Do musicians have more autism traits than musicians without perfect pitch? An empirical study. PloS one, 7(5)

Wan CY, Marchina S, Norton A, Schlaug G. (2012). Atypical hemisphere asymmetry in the arcuate fasciculus of completely nonverbal children with autism. Annals of the New York Academy of Sciences, 1252, 332-337.