July 23, 2010

When doing research for our music and learning issue of "The Gift" newsletter, I came across a phenomenal book entitled, "Music Therapy, Sensory Integration and the Autistic Child." After reading it, I knew I had to chat with Dorita Berger, the author. This book not only describes what Music Therapy is, the goals of such therapy and how it is carried out but also the ins and outs of sensory integration and how music helps organize our kids' sensory systems. Yes, there are sections of the books that delve into brain structures and their functioning but, in my opinion, I think knowing the basics about the brain and what it's supposed to do can only be a bonus for parents interested to know.

So on that note, I introduce Dorita to our readers and hope you find our chat as insightful, informative and interesting as we did.

CHYNNA: Welcome to 'The Gift' Dorita. I'm so glad you found time to join us with all the things you have going on right now. For those who aren't aware of your fantastic background, would you share it with us?

DORITA: My relationship with music began when I was five years old and my mother took me to see the film, A Song To Remember, about the life of Chopin. It made such an impact on me that I insisted I wanted to study piano! So even at an early age, I was already aware of the impact that music has on people. That was in Mendoza, Argentina, where I was born. My training continued throughout. Continued when we migrated to the US, and never stopped. I attended the High School of Music and Art in NYC, then Carnegie Mellon University, majoring in Piano performance. I followed up with graduate work at Juilliard, and performed everywhere. I also taught piano. Then one day I read an article about music therapy, and thought it was my next logical step. So I obtained a Master's in music therapy from NYU, and took my first job at the Giant Steps School for Special Needs students in Connecticut. That was my first experience with Autism... and I then realized there was more to music therapy than simply making someone "feel good". Music elements, of which there are six, had important impact on sensory deficits, and I began to study and research as much physiology as I could. That led to my second book, Music Therapy, Sensory Integration and The Autistic Child! (My first book, "Toward The Zen of Performance" deals with music therapy for performance anxiety). The book on Music Therapy and Autism was the first of its kind (and continues to be a one-of-a-kind) daring to talk physiology along with music therapy! My second book, co-authored with Dr. Daniel J. Schneck, my physiology consultant, is called "THE MUSIC EFFECT: Music Physiology and Clinical Applications".... and talks about physiology, and tracks five different cases on how it works with music! Lots more to tell about myself, but too long to go into here. I ultimately left all school-work situations, and developed my own private practice in Norwalk, CT., "The Music Therapy Clinic", and have worked with many different populations, although specializing in Autism treatment with music therapy.

CHYNNA: What a wonderful and interesting background you have, Dorita. So inspiring. Did you have a specific experience throughout all your teachings, performances and work with special needs children that triggered your passion for focusing on children who have Autism?

DORITA: No. I knew nothing about Autism until I began to work at Giant Steps School in Fairfield, CT. But I immediately began reading and discussing issues of sensory integration and physiologic function as related to Autism characteristics, and realized that this was a new arena for a music therapist. And that's when my interest in Autism and music therapy took hold. As such, I am still a sole contributor to specific development of clinical goals and objectives for music therapy treatment of Autism characteristics. I love working with this population, and especially noting the progress that can be made through music interventions.

CHYNNA: Absolutely. I completely agree that music is a wonderful tool for our kids. What aspects of music are suited in treating children with autism and sensory integration (SPD) issues?

DORITA: All six elements of music serve as the "pharmaceutical" (if you will) when applied for specific Autism behaviors. First of all, it is important to understand that most behaviors of children on the spectrum results from the "fear" responses related to inadequate sensory processing, in which the brain finds much of the environment as threatening! So the first thing that needs to be done is the use of using slower music tempos in order to first calm the system! After that, each element of the six, serves particular purpose. The elements are: rhythm, timbre, melody, harmony, dynamics, form. Each one has a specific role to play to address specific issues. By the way, most children's CDs are much too fast.

CHYNNA: I agree with you on that point. There are times when my kids love to move fast and times when it's much better for them to slow down. That's why we have a huge music collection in our house. What inspired your book, "Music Therapy, Sensory Integration, and the Autistic Child"?

DORITA: My work at the Giant Steps school, and following in my private practice, I became very informed in sensory integration, the various sensory systems, the auditory system (in particular, since music is an acoustic intervention), and sensory information processing.... all this was information simply NOT OUT THERE for music therapy clinicians. I first presented a 2-hour lecture on this at a Music Therapy Conference, and began receiving endless phone calls for more information. This led to my further consultations with my colleague, Dr. Dan Schneck, who guided me through the physiology and enabled me to provide more extensive information to my professional colleagues. This book is still selling like crazy, and I just received an e-mail from New Zealand requesting more information as in this book.

CHYNNA: I think that's fantastic that people out there are finally realizing the importance, and connection, among music, sensory integration, the sensory systems (like auditory and vestibular) and sensory processing. That's fantastic that the information is getting out there and absorbed. I loved the chapter in your book on 'touring the neocortex'. How important is it for caregivers to understand brain structures and their functionings? Which areas would be the most important for us to learn about and understand?

DORITA: We need to understand information processing by the brain, and the "fear" cycle. That means fully understanding the Limbic System and the Paleoencephalon (the inner, older part of the brain). The Hippocampus, the Amygdala, the Thalamus and Hypothalamus, and their relationship to sensory processing, and to the Frontal (Executive) Lobe. The problem is most people are more concerned with the "neocortex" (the newer brain), without understanding that this part of the human brain is the youngest part, while the Paleoencephalon is what keeps us alive and fully functioning on the emotional, instinctive level. We should not be so preoccupied with "cognition" and academic learning, if we do not fully understand information processing at the lower regions, the "fear cycle" (the most important for survival), and emotions (Amygdala). For instance, most people are not aware that in persons within constant "fear" (and I don't mean the "I'm afraid" type of fear, but the instinctive fear that we are hardly even aware of) in such persons, the Hippocampus (memory organ) shrinks, and the Amygdala enlarges. Learning cannot take place when the brain is busy trying to first figure out what's safe or dangerous. It's too busy trying to organize survival behavior.

CHYNNA: That's all very interesting. I have loved learning about the brain, the structures and how they all work together to function and process information. Learning about the brain was how I was able to understand Jaimie's form of SPD and how to help her better. I was also very impressed with your chapter on the sensory systems. Are you able to explain, generally, how music helps to integrate these systems?

DORITA: It would be difficult to go into those details in a short interview. But I can say that through specific tasks motivated by specific rhythms and tonalities, and using musical instruments that provide proprioceptive and tactile information, the system begins to understand that "this arm is mine, those are my legs moving... oh... that's midline..." and so on. Treatment interventions are designed specifically to address sensory deficiencies assessed by me, then put into priority order, so that first things are addressed first. I'm very detailed about how I will be using music activities to address specific issues. And since each person's system works differently, the interventions are individually designed to address that system's information processing, fear cycles, and sensory needs.

CHYNNA: That was a great explanation, thank you. What is the difference between 'hearing' and 'listening'? Why do our kids with SI issues struggle with this?

DORITA: Hearing is the receiving of auditory information, whether we are aware and "listening" or not! We cannot stop the ears from hearing in the same way as we can stop the eyes from seeing by closing the lids. The ears are always available to receive sound. "Listening" means focusing on specific auditory information - it takes focus, figure-ground ability (tuning out background in order to hear foreground), tracking and linking of sounds, and much more. So "to listen" involves focus in many parts of the brain, including both cortexes (upper and lower). "Hearing" just happens... but central auditory processing, and various auditory sensory issues often result in Autism ears being barraged by sounds without discrimination, focus, etc. In other words, it's an ocean of sound coming all at once, and the brain cannot separate what's necessary to 'hear' and what is background.

CHYNNA: Fantastic explanation, thanks very much. Those of us with children who have children with auditory issues will appreciate this information because it truly makes a difference in understanding how to help our kiddos. Please tell us about the elements for music and how they help with SI?

DORITA: Each person (including undiagnosed) has some level of SI issues-how we hear, what we see, how those coordinate, how we track sound, why we might drop things often, etc. So it's not a simple answer. But as stated before, each of the six elements can be treatment tools depending on what the sensory issues are. It took several books and articles to explain this, so obviously there's too much to discuss. However, a music therapy clinician who understands the elements of music specifically, and how to apply then in treatment, and who understand sensory systems and SI, will know what and how to approach. For instance, did you know that often a child on the Autism Spectrum cannot distinguish between a statement and a question? That's because in a statement, the tone (inflection) goes downward, while in a question, the tones (inflection) ends going upward, but if the auditory system cannot ascertain tonal directions, how will it know the difference between a question and a directive? So, for example, use of simple melodic contour tunes, ups and downs, (without harmony so that the brain hears just a simple tune), can begin to alter this and make the brain aware of differences. Also, having a client play xylophone going up..... and going down...... begins to instruct the brain. But it all takes time.

CHYNNA: That makes so much sense to me. I can completely understand, now, why speech has been so difficult for my son, Xander. Obviously a program that you would set up for a child would be based on his individual needs and concerns. Generally, how do you go about setting up a program? What do you look for and how do you know what to match to those needs?

DORITA: I assess general behavior to determine the extent of the "fear" cycle; I observe whether there is auditory/visual coordination, and what the sound tracking might be like. I also take a look at the proprioceptive and vestibular abilities, muscle tone, grasp, etc. Is the child able to imitate my movements? Can the child track auditorily (that is, does the child identify a familiar tune)? Is there breath-control (all my clients must have a recorder to blow, as our first activity, for breath regulation); what is the auditory system doing? Does child respond when called? Does child follow directives? What is the child's language ability? Is the child inquisitive, experimental, enjoying different instruments.......... and much, much more! My assessment period is usually 4-6 weeks depending on whether there is one session a week, or more.

CHYNNA: This is very useful to have for caregivers considering Music Therapy. Thanks for being so detailed. Do you help caregivers set up programs they can use at home? If so, how?

DORITA: Yes and No. Often caregivers know very little about music, tonality, pitch, etc. I like helping to set up follow-up activities at home, often involving rhythm clapping tasks, blowing recorder, marching, and singing. But this is iffy if a parent is, say, tone deaf and cannot carry a tune. I encourage caregivers to use found objects as musical instruments, and there are many around the house. I ask the parent to purchase some CDs that I recommend, that will help calm the child, help with language, and such. I also invite siblings to participate, so that there is some sense of 'group' music making at home. Most of all, I encourage parents to take the child to live music concerts! There's nothing like that to help the auditory system track sounds, coordinate auditory with visual, and more. I also encourage imitation tasks.

CHYNNA: You have some great suggestions there. Thank you for giving us a few ideas of activities to try. Do you have any upcoming projects, books or seminars you'd like to tell us about?

DORITA: I am in the midst of completing my PhD at Roehampton University in London, so that will be my most current project. It should be ending soon. In addition, I am proud to say that I have developed an interesting Conference with the New York Academy of Sciences, taking place in March 2011, which will bring together major science researchers in Autism, Pain Management, Dementia, Stress, etc. coupled with professional Music Therapists who will show the work of music therapy in those areas. I am on the Scientific Committee, and will be conducting a hands-on music therapy workshop during lunch, for attendees interested in seeing how/what the work is. We are also inviting poster presentations. Here is the link to the NYAS website, for those interested in this. It is the first time that a Conference is bringing together science research and clinical practice - feeding into the new Translational Medicine concepts developing in the medical community. Here is the link for information regarding the conference.

I expect to be doing several more presentations in the Fall, but these are not yet confirmed. I will let you know. One will be taking place in NYC, on Creative Arts Therapies.

CHYNNA: Wow! Good luck with all of your upcoming endeavors, Dorita. And we appreciate the link to check out what will be happening at your Conference. Please let us know about those presentations and we'll be sure to announce them on 'The Gift' blog. Before we let you go for today, would you have any final pearls of wisdom you'd like to share with our readers?

DORITA: 1) First, enjoy your child! Autism is not necessarily an impediment, but just an alternative way of being. Don't try to "cure" but rather, help to adjust the child to his environment; 2) 'Behavior' is communication! Try to understand what the behavior is communicating with regard to how the child's system is processing information. In the end, comfort and simplicity of behavior is what we all seek; 3) Music is a natural form of self-expression. It may be all your child needs in order to develop his/her sense of self, and ability to send out his feelings (or distress) in a non-verbal manner. Music Therapy does not aim to "cure", but rather, to develop more functional adaptation - meaning becoming comfortable in one's own skin! And 4) Enjoy your child's individuality! And don't clump all behaviors into the diagnosis. Many behaviors are age-appropriate, and personality-driven. That is not about 'autism', but about who your child is, as a person. Relax and enjoy that person.

We thank Dorita so much for taking time out of her extremely jam-packed schedule to chat with us. Good luck with your current endeavors, Dorita, and please do come back to 'The Gift' in the near future. If any of our readers are interested in receiving a copy of the poster for the Conference Dorita spoke about above, please contact me.