Children diagnosed with Autism Spectrum Disorder (ASD) have difficulties with social communication and relational interactions as well as repetitive and stereotypical movements. Based on the assumption that movement synchrony can be used to enhance social skills, this study examines the synchrony of body rhythms between children with ASD and their music therapists. A computerized diagnostic for calculating body synchrony characteristics, based on the Kestenberg Movement Profile, was developed. Data collection took place over a period of 20 weeks. The participants had been recruited for a large international controlled trial study where ‘improvisational music therapy’ was used as music therapy approach. The methods in the current study included microanalysis of video footage of nineteen 4- to 6-year-old children diagnosed with ASD. The results revealed higher levels of synchrony between the therapists and children when the latter were using repetitive rhythmicity that occurred 2 or more times per second. At the end of the treatment, there was no significant change in autistic symptoms and in the children's ability to synchronize with the therapists, although the therapists were significantly more synchronize with the children. We discuss the possible role of music therapists in promoting experiences for children through the use of basic body rhythmicity patterns.

The body communicates: Movement synchrony during music therapy with children diagnosed with ASD

Shared understanding is generated between individuals before speech through a language of body movement and non-verbal vocalisation, expression of feeling and interest made in gestures of movement and voice. Human understanding is co-created in these embodied projects, displayed in serially organised expressions with shared timing of reciprocal actions between partners. These develop in narrative events that build over cycles of reciprocal expressive action in a four-part structure shared by all the time-based arts: "introduction," "development," "climax," and "conclusion." Pre-linguistic narrative establishes the foundation of later, linguistic intelligence. Yet, participating in social interactions that give rise to narrative development is a central problem of autism spectrum disorder. In this paper, we examine the rapid growth of narrative meaning-making between a non-verbal young woman with severe autism and her new therapist. Episodes of embodied, shared understanding were enabled through a basic therapeutic mode of reciprocal, creative mirroring of expressive gesture. These developed through reciprocal cycles and as the relationship progressed, complete co-created narratives were formed resulting in shared joy and the mutual interest and trust of companionship. These small, embodied stories enabled moments of co-regulated arousal that the young woman had previous difficulty with. These data provide evidence for an intact capacity for non-verbal narrative meaning-making in autism.

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Making meaning together : embodied narratives in a case of severe autism

This paper offers a neuroscientific explanation of life with autism which recognizes that human behavior and experience is by nature both personal and interpersonal. With a focus on insights of Penelope Dunbar (Pum) who has lived with autism for decades, we explore an affective neuroscience understanding of autistic experience and how to work creatively with its impulses for health and personal development. Pum describes her autistic disruptions to the intrapersonal coherence of her basic states of being, moving-with-feeling in self-awareness, and how this disturbance to her internal subjective coherence of mind challenges her capacity to self-regulate arousal, and communicate with others. By examination of the source of her problems in childhood and ways of working with them, Pum has clarified fundamental elements in the development of her capacity to regulate self-care in creative efforts that facilitate both affective embodiment and sensory-motor coherence in growth of understanding in her mind and body. With her advice we explore how current neurobiological insights in autism as a disruption to the regulation of affective embodiment and sensory-motor integration leads to new recommendations for therapeutic care to relieve autistic distress and restricted modes of being. Although particular to her circumstances and cultivated habits of autistic expression, this analysis offers insight into the fundamental nature of autism, and ways of positive working with one’s autistic nature for creative gains.

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Disruption to embodiment in autism, and its repair

This topic of research moves the field of dance and movement therapy (DMT) into an area of clinical and social relevance by investigating the most beneficial features of rhythm and music for children diagnosed with Autism Spectrum Disorder (ASD). The current literature suggests that rhythm, used both inside and outside of DMT, can improve communication skills and social development in children with ASD. However, the optimum features of music and rhythm are ambiguous, consequently limiting the integration of rhythm-based interventions into practice. To answer the research question “What are the most common features of music and rhythm used by registered dance and movement therapists for children with ASD?”, we surveyed 113 registered dance and movement therapists, regarding the most common features of music and rhythm they used within their sessions with autistic children. Most dance and movement therapists used music that had a 4/4 time signature (64 %), was moderato tempo (45 %), and had lyrics (76 %). Qualitative findings validated why these were the most common features of music and rhythm. These musical elements could regularly be integrated into new music and rhythm-based interventions targeting communications skills and social development for children with autism to improve their therapeutic potential.

Dance, rhythm, and autism spectrum disorder: An explorative study

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports (cues, accents, turbulence) and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches (Dance Movement Therapy, Improvisational Music Therapy, Play Therapy, and Musical Interaction Therapy). These clinical case examples are introduced here and several more are included in the Supplementary Material (Examples of Rhythmic Relating in Practice). A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach.

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Rhythmic Relating: Bidirectional Support for Social Timing in Autism Therapies

Consideration is given to the hypothesis provided by Trevarthen and Delafield-Butt (2013) – that disruption of social synchrony in autism is rooted in disturbance of prospective motor control for expressive action and active perception of other's expression: crucially, autism is a disturbance of “sensorimotor intentionality” (Delafield-Butt and Gangopadhyay 2013). The feedforward qualities of communicative musicality ( Malloch, Trevarthen, Malloch, and Trevarthen (2009)) ) – the temporal motivation and organisation inherent in pulse and vitality – are taken as foundational for a series of therapeutic principles developed here. The aim: to support disrupted prosocial “intentional movements” by overlaying, integrating, and piggy-backing on intact rhythm and vitality imported, in the moment, from cross-modality experiences – to imbue a child’s interaction with forward looking organisation and impulse to interact. These principles are illustrated in the form of mini case studies, taken from real play therapy sessions. Certain key concepts are introduced, including: the use of rhythm as compelling structure, the 'jazz gap' as temporal catalyst, the calming and engaging effect of inter-synchrony, and the vitality-matching of a child's emotive and motoric patterns.

Loops and Jazz Gaps: Engaging the Feedforward Qualities of Communicative Musicality in Play Therapy with Children with Autism

The Emotion Regulation Checklist with Young Autistic Children: Data Set for Comparative Use in Intervention Studies.

Emotion Regulation is a key factor in the psychological well-being of children on the autism spectrum. Therapeutic co-regulation is posited here as fundamental to addressing Emotion Regulation needs. A therapeutic combination of Child-Centred Play Therapy and Rhythmic Relating is assessed in its potential to improve Emotion Regulation outcomes (over 10 months; 25 weekly sessions), via co-regulatory experience, in a case study of a 5-year-old autistic boy. The parent-rated Emotion Regulation Checklist (Shields & Cicchetti, Developmental Psychology, 33, 1997, 906) was completed every week. Mean Start and Finish scores were taken for checklist total and all subscales. Emotion Regulation percentage-change-over-time values are calculated for the participant and, using percentiles, are compared and statistically ranked in relation to our comparison group: Autistic boys without concurrent cognitive impairment, not receiving psychological or behavioural therapies (over 10 months; N = 66). A graphical representation of Emotion Regulation demonstrates weekly change. As compared to our comparison group, our participant's overall Emotion Regulation improvements (over 10 months) are statistically likely to be due to his participation in therapy (p < 0.04). Graphical representation of Emotion Regulation over time demonstrates a compelling blind correlation between the period of significant positive change in our participant's Emotion Regulation and the therapist's clinical notes on positive change observed in the clinic. 

Stuart Daniel

Papers

Loops and Jazz Gaps: Engaging the Feedforward Qualities of Communicative Musicality in Play Therapy with Children with Autism

Rhythmic Relating: Bidirectional Support for Social Timing in Autism Therapies

The Emotion Regulation Checklist with Young Autistic Children: Data Set for Comparative Use in Intervention Studies.

Child‐Centred Play Therapy and Rhythmic Relating improves emotion regulation in autism: A single‐N pilot intervention study