This blog will include both person-first language (“a person with autism”) and identity-first language (“an autistic person”) to reflect the differences in preferred language in the autistic community. You should always directly ask a person’s preferred language. All references are hyperlinked. Neurodiversity is a term used to describe the differences in the way people’s brains work. It is the idea that there is no “right” or “wrong” way for the brain to function and that people perceive and respond to the world in different ways. It is often used in the context of autism spectrum disorder (ASD) but it also refers to ADHD, downs syndrome, dyspraxia (movement processing difficulties) and dyslexia (language processing difficulties) to name a few. The term was coined by Australian sociologist Judy Singer in the 1990s to promote equality and inclusion, as well as highlight the benefits of neurodiversity. The DSM-V describes autism spectrum disorder as a developmental disability characterized by difficulties with social communication and interaction, and restricted and repetitive behaviors. Historically autism research focuses on the social communication and interaction aspects of the disorder, often neglecting the sensory and motor needs of persons with autism. We have eight senses - sight, hearing, smell, taste, touch, vestibular, proprioceptive and interoceptive. The vestibular system senses balance and posture, while the proprioceptive system senses movement, action and location. The lesser-known interoceptive sense is responsible for understanding our body’s internal sensations, like whether we’re hungry, cold or tired. Autistic people often have difficulty interpreting sensory information which can result in difficulties with self-regulation. If you have trouble interpreting sensory information your body might feel uncomfortable but you don’t know why. This feeling of “not being in your body” can result in sensory seeking or sensory avoiding behaviors. A sensory seeking behavior might look like stomping one’s feet or squeezing one’s hand and a sensory avoiding behavior might look like avoiding physical touch with others. As a result persons with autism have difficulty with arousal regulation. If you’re over- or under-stimulated, it is more difficult to interact with others and to regulate your emotions. Unfortunately these sensory seeking and avoiding behaviors are often mislabeled as difficult behaviors related to the socio-emotional aspects of the disorder. Music therapy is often used to support autistic individuals with arousal and sensory integration, interaction and communication, and emotion regulation. Here are some ways music might be used! Movement to music can aid in the integration of the senses, such as auditory perception and the integration of the visual, tactile and kinesthetic senses to improve body awareness. Music and deep pressure input, such as hand squeezes, can also provide functional sensory input and reduce sensory seeking behaviors. The rhythmic component of music helps to organize the motor system. Music can then be used to improve gait, as well as fine and gross motor skills. For example, playing the piano to improve finger dexterity or hitting a drum bilaterally to practice trunk rotation. A music therapist might use developmentally appropriate songs to enhance speech and language development in children with autism. Through singing, instrument playing and movement children can learn things like the days of the week or how to get dressed independently. Singing can also be used to help with vowel and consonant production or word learning to support speech and language development. Improvisational music playing can be used to mimic social situations in order to teach turn taking, listening and responding and joint attention. For autistic individuals who are non-verbal, music can be a form of communication and self-expression. Singing, songwriting, improvisational music playing and music listening can be used to help identify and express emotions. The different qualities of music can help us to convey emotions without using words. Music can also promote relaxation. A guided meditation or progressive muscle relaxation with music can help calm the body and mind, as well as improve body awareness. These are just some of the ways that music can support persons with autism.

Developmental Coordination Disorder (DCD), also called dyspraxia, is a chronic condition affecting fine and gross motor coordination. Impacting nearly 6% of school-aged children, risk factors include being born prematurely or with a low birth weight, as well as a family history of the disorder. In kids with dyspraxia the issue is not with their muscles, but rather the communication between their brain and their muscles. Coordination problems happen because the brain has a hard time telling the body what to do. Symptoms of DCD include difficulty with fine motor skills such as using a pencil, eating with a spoon, making hand gestures or getting dressed, as well as gross motor skills such as walking, running, kicking and throwing. As a result children with DCD often avoid activities like drawing and writing or playing sports. While there is no cure for DCD, therapy can help children improve their coordination by being taught how to do an activity by breaking it into smaller parts and practicing them regularly. Activities can also be adapted to make them easier, such as using special grips for utensils. How does music come into play? Music activates different regions of the brain, creating alternative routes for the transfer of information. In fact, research shows that music activates the motor cortex. The structure and predictability of music helps the brain to time our movements - this is called priming. Moving rhythmically is important for full body regulation and allows the brain and the muscles to communicate more efficiently. For example, crossing the midline activates both sides of the brain. When we execute this movement to music we are strengthening the connection between our right and left hemispheres, as well as practicing reaching and trunk rotation. A music therapist might set up an instrument target, such as the drums or chimes, for the child to hit to practice this function. To target fine motor skills, a child can learn an instrument such as the piano to practice finger dexterity exercises that will make tasks like tying their shoes or fastening buttons easier. Improvisational instrument playing that involves the use of a mallet or drumstick can also improve grasping and reaching movements which can help with self-feeding or drawing and writing. To target gross motor skills, a music therapist can create different musical patterns that reflect a desired movement to provide spatial, temporal and force cues. For example, if you want a child to practice reaching you might play high on the piano versus low for touching the ground. Music and movement is an effective way to target coordination. Not only does the rhythm provide structure and timing, but the music can create a safe and motivating space to practice movements that a child with DCD might be struggling with.

According to the Heart and Stroke Foundation, stroke is the leading cause of disability in adults in Canada. The annual occurrence rate has increased to 108,707 which equates to approximately one stroke every five minutes. With the rapidly aging population in Canada, the prevalence of stroke is only expected to increase. And with that, a growing need for strong stroke care. With stroke, one of the most common side effects is impaired speech. Some stroke survivors may experience dysarthria (muscle control difficulties), apraxia (muscle coordination difficulties) or aphasia. Aphasia is a language disorder that can result in difficulties with speaking, reading, writing and understanding speech, depending on the type of aphasia. Research indicates that aphasia occurs in 25-50% of individuals post-stroke. While there are several types of aphasia, we’re going to focus on Broca’s aphasia. Sometimes referred to as an expressive or non-fluent aphasia, Broca’s aphasia is characterized by diminished speech output. Persons with Broca’s aphasia may be able to comprehend speech but have difficulty producing speech. So how does music come into play? Melodic Intonation Therapy (MIT) uses the melodic and rhythmic elements of singing words and phrases to aid in speech recovery. This technique is used with patients who have aphasia. Several studies have indicated that the Neurologic Music Therapy technique MIT can help reroute speech pathways from the damaged left hemisphere to the language-capable regions of the right hemisphere (Thaut & Hoemberg, 2016, p. 141). In MIT the therapist begins with humming, then singing and gradually moves into speaking. The therapist may employ a vocal technique called sprechgesang. In sprechgesang, the therapist uses their voice in an expressive manner, halfway between singing and speaking. Throughout the exercise, the therapist also taps the client’s left hand. Why the left hand? MIT can help reroute speech from the left to the right hemisphere. This is because our brain is organized contralaterally. This means when we tap our left hand we are activating the right side of our brain! Research by Gentilucci and Dalla Volta (2008) also indicates that left hand tapping activates right hemispheric language networks. You may have even heard of MIT in the news before. Congresswoman Gabby Giffords suffered a traumatic brain injury, and was diagnosed with aphasia. MIT was part of her journey to recovering her ability to speak. This is just one way music can be used in speech rehabilitation. It can be difficult to watch a loved one experience the loss of their ability to speak. The beauty of music is that it can aid in rehabilitating the voice while encouraging meaningful moments of connection with others.

The most common speech disorder in children is Developmental Apraxia of Speech (DAS). According to the American Speech-Language-Hearing Associating, 1-2% of children for every 1,000 have DAS. In DAS there are three main features: inconsistent errors in sound production, disrupted transitions between sounds and syllables and inappropriate prosody (Thaut & Hoemberg, 2016, p. 196). Children with DAS also struggle with motor speech function and the structure of speech sounds (American Speech-Language-Hearing Association, 2007). One way a child can develop their speech and language is through music therapy. The Neurologic Music Therapy technique Developmental Speech and Language Training through Music (DLSM) uses developmentally appropriate musical experiences through singing, playing musical instruments and engaged in music and movement to improve speech and language development. Music may be an effective means to enhance speech and language because music and language shared similar brain mechanisms (Thaut & Hoemberg, 2016, p. 196). When working with children, music should be creative, motivating and exploratory! This creates an engaging environment for the child to work on things that may be quite difficult and frustrating. Another thing to consider when creating songs for children is the structure because repetitions can help solidify concepts and provide several opportunities for the child to execute the skill. For example, here is a line from a song I wrote for a child learning vowel production using animal sounds. “Animal sounds, animal sounds, what does the animal do? Does he go ee, ee, oo? Your turn…” Repeating this line several times can give the child lots of opportunities to explore the sound and their voice, which can help increase voice production. Movement, props and other tools can also be incorporated while singing. In the animal song, you might have the child mimic the different movements the animal would make. When working with children, it’s important to imitate. Not only does it provide them a model to follow, but it can create a safe place between you and the child. Encouraging exploration while developing speech and language can be critical for success! For children who may not be able to use their voice to communicate, alternative and augmentative communication (AAC) devices may be used. Their devices can be incorporated into a song by giving them opportunities to respond to the music by making selections. These are just some considerations for how the playful nature of music can be harnessed to engage children in speech and language development.

While certain sights and sounds can remind us of beautiful times, they can also remind us of difficult times, transporting us to a place that we don’t wish to be. Post-traumatic stress disorder or PTSD occurs when someone experiences or witnesses a traumatic event and struggles to recover from it. PTSD can affect someone’s emotional, physical, social and spiritual well-being. Although we often associate PTSD with combat veterans, individuals at any age who experience natural disasters, war, violence, historical trauma and even bullying can suffer from PTSD. It's important to know that PTSD is different for everyone. For some PTSD might look like reliving the event through flashbacks and nightmares, while for others it might look like increased emotional distress. PTSD can result in reactive responses to ordinary sounds, as well as isolation from others and avoidance of daily activities for fear of reliving the traumatic event. So how does music come into play? Music is linked to our emotions, whether negative or positive, it has the ability to bring our memories back to life. Think of how playing a song from the past can help an individual with dementia remember memories that are otherwise forgotten. A concept called state-dependent memory can help us explain why. State-dependent memory occurs when material encoded in a particular state is better remembered if the same state is experienced at recall. This applies to both positively and negatively emotionally charged memories. For someone with PTSD, if a specific sound or song mimics that of the traumatic event, it can prompt them to relive it. The part of our brain responsible for our emotional memories is the amygdala. If someone with PTSD experiences a trigger similar to the traumatic event, it can send a signal through their body to activate their fight-or-flight response. The special thing about music is that it can also be used to override the traumatic event and tap into an individual’s positive memories. Music associated with positive memories can then be used to refocus attention and calm the nervous system. Research shows that guided music listening can help regulate emotions, reduce symptoms of PTSD and increase connections among others, especially if in a group. This can help someone with PTSD increase control over their physiological stress symptoms by creating reassuring experiences that encourage trust in oneself and others. Music can also train the brain to increase tolerance to sounds. For example, responding to different musical cues with a triggering sound in the background helps to work on diverting one’s attention and increasing tolerance to triggering sounds.  Whether it be to relax, distract or transport, music can be used to effectively improve the quality of life for individuals living with PTSD.