Measuring general hospital staff attitudes towards people with learning disabilities.

People with learning disabilities often experience health inequalities and barriers to healthcare services as a result of poor communication and discriminatory attitudes. We developed an educational package for healthcare staff as well as an attitude questionnaire to measure the impact of this training; the questionnaire is called the Attitudes of Secondary Healthcare Personnel Toward People with Severe Learning Disabilities (ASH-LD). This article describes the process of designing and piloting the ASH-LD questionnaire, and how it will be used to measure the effect of the planned training on staff attitudes.

Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy.

Through behavioural analysis, this study investigated the social-motivational aspects of musical interaction between the child and the therapist in improvisational music therapy by measuring emotional, motivational and interpersonal responsiveness in children with autism during joint engagement episodes. The randomized controlled study (n = 10) employed a single subject comparison design in two different conditions, improvisational music therapy and toy play sessions, and DVD analysis of sessions. Improvisational music therapy produced markedly more and longer events of 'joy', 'emotional synchronicity' and 'initiation of engagement' behaviours in the children than toy play sessions. In response to the therapist's interpersonal demands, 'compliant (positive) responses' were observed more in music therapy than in toy play sessions, and 'no responses' were twice as frequent in toy play sessions as in music therapy. The results of this exploratory study found significant evidence supporting the value of music therapy in promoting social, emotional and motivational development in children with autism.

The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study.

The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized tools and DVD analysis of sessions to evaluate behavioral changes in children with autism. The overall results indicated that improvisational music therapy was more effective at facilitating joint attention behaviors and non-verbal social communication skills in children than play. Session analysis showed significantly more and lengthier events of eye contact and turn-taking in improvisational music therapy than play sessions. The implications of these findings are discussed further.

Predictors of change in music therapy with children and adolescents: the role of therapeutic techniques.

Music therapy has been shown to be efficacious in experimental studies. However, there is little empirical research knowledge about what elements of music therapy influence its effectiveness in clinical practice. Children and adolescents with psychopathology (N=75) were assessed before and after participating in individual music therapy with 1 out of 15 music therapists in the Vienna region. Relationships between outcomes (as evaluated by parents) and therapy contents (as reported by therapists) were examined using general linear modelling. Results indicated that clients' symptoms and burdens on their social environment showed greater improvement when music therapy was limited to discipline-specific music therapy techniques and did not include other media such as play therapy elements. The findings indicate the importance of being aware of a therapy method's specific strengths and limitations. More research on the indicated specific ingredients of music therapy intervention is needed.

Learning ability in children with Rett syndrome.

The purpose of this article is to present results of a research study examining learning ability in individuals with Rett syndrome. The material for this article was drawn from a more extensive doctoral study, designed to investigate intentional communication in this population, through the use of songs in music therapy. Rett syndrome is a neurological disorder resulting from an X-linked mutation, affecting mainly females, and found across racial and ethnic groups worldwide. One of the main areas affecting functioning in individuals with Rett syndrome is a severe impairment of receptive and expressive communication. This creates difficulties when attempting to reveal their potential learning abilities. This population has been observed as very responsive to music hence music therapy intervention has been advocated in promoting and motivating them to communicate and to learn. Seven girls with Rett syndrome, between ages 4 and 10 participated in the study. A single subject, multiple probe design was applied during 30-min trials, three times per week and lasted 8 months. During the trials the participants were asked to choose from a selection of 18 familiar and unfamiliar songs, while their ability to learn was observed and measured. Findings revealed that all seven girls demonstrated an ability to learn and to sustain learning over time. This intervention demonstrated that individuals with Rett syndrome could be promoted and motivated to communicate and learn when therapeutically employed by a trained music therapists.

Music therapy as a tool for assessing hand use and communicativeness in children with Rett Syndrome.

A six-year-old girl with Rett syndrome was assessed in a multi-disciplinary specialist therapy clinic and aspects of her responsiveness and developmental potential were found in the music therapy assessment. Functional hand use, eye-referencing, motivated and intentional communication were observed and reported through video analysis of a 30 min session of music therapy employing improvisational methods. Absent or reduced hand clasping/plucking, interactive turn-taking, primary and secondary inter-subjectivity, and vocalisation with appropriate emotional expression were evident. Stable truncal positioning and occasional gentle restraint of either hand improved both spontaneous and prompted activity.

Regression in individuals with Rett syndrome.

Data on features of regression and pre-regression developmental history in a case series of 53 girls and women with Rett syndrome are presented. Consistent with the diagnostic criteria, hand skills and verbal or non-verbal communication skills were the most common skills lost during regression. Play and motor skills were also lost in half the cases. Regression most commonly occurred between 12 and 18 months of age but was noted in a few cases before 6 months or after 36 months. Pre-regression developmental delays or abnormalities were noted in over two-thirds of cases, increasing to 85% of the youngest cases where parental reporting was likely to be more accurate. Age at regression was not associated with severity of physical and growth symptoms, and thus did not appear to be an index of neurological severity. There is a continuing need to further elucidate the pre- and post-regression features of Rett syndrome in order to aid early identification, diagnosis and referral for genotype mutation analysis.

Effects of music therapy for children and adolescents with psychopathology: a meta-analysis.

BACKGROUND: The objectives of this review were to examine the overall efficacy of music therapy for children and adolescents with psychopathology, and to examine how the size of the effect of music therapy is influenced by the type of pathology, client's age, music therapy approach, and type of outcome. METHOD: Eleven studies were included for analysis, which resulted in a total of 188 subjects for the meta-analysis. Effect sizes from these studies were combined, with weighting for sample size, and their distribution was examined. RESULTS: After exclusion of an extreme positive outlying value, the analysis revealed that music therapy has a medium to large positive effect (ES =.61) on clinically relevant outcomes that was statistically highly significant (p <.001) and statistically homogeneous. No evidence of a publication bias was identified. Effects tended to be greater for behavioural and developmental disorders than for emotional disorders; greater for eclectic, psychodynamic, and humanistic approaches than for behavioural models; and greater for behavioural and developmental outcomes than for social skills and self-concept. CONCLUSIONS: Implications for clinical practice and research are discussed.

Findings from a multidisciplinary clinical case series of females with Rett syndrome.

Systematic data from a multidisciplinary clinical assessment of a large series of females with Rett syndrome (RS; n=87) is presented. Participants' ages ranged from 2 years 1 month to 44 years 10 months. Areas assessed included oromotor skills, feeding problems, growth, breathing abnormalities, mobility, postural abnormalities and joint deformities, epilepsy, hand use and stereotypies, self-care, and cognitive and communication skills. Many previously reported trends in the presentation of RS over time were confirmed, notably the increasingly poor growth and near pervasiveness of fixed joint deformities and scoliosis in adulthood. In contrast, there was a slight trend towards improved autonomic function in adulthood, whereas feeding difficulties increased into middle childhood and then reached a plateau. Improvements in mobility into adolescence were followed by a decline in those skills in adulthood. Levels of dependency were high, confirming findings from previous studies. Despite the presence of repetitive hand movements, a range of hand-use skills was seen in individuals of all ages. Cognitive and communication skills were limited, but there was little evidence of deterioration of these abilities with age. These findings confirm that RS is not a degenerative condition and indicate that intervention and support to maintain and increase motor skills, daily living skills, and cognitive and communicative functioning are appropriate targets for individuals with RS.