For the first time a specialized music therapy program, Voices Together, has enabled kids with autism speak and socialize in a manner never seen before.
Yasmine White, a certified music therapist and founder of Voice Together, has engaged developmentally disabled children and adults, who find social and emotional interactions very difficult, with remarkable success.
Researchers from various departments at Duke University, students from Bass Connections and faculty at the Social Science Research Institute (SSRI) have combined their resources to move Voices Together to the next step.
The multidisciplinary team has launched a rigorous research study to collect qualitative and quantitative outcome data, analyze the results and fine-tune a curriculum that could be used by music therapists across the country to improve the quality of life for their clients.
“It’s an exciting opportunity to be part of a research team in our area of expertise in something that means so much to us,” White said.
Geraldine Dawson, a professor of psychiatry and behavioral science, psychology and neuroscience and the director of the Duke Center for Autism and Brain Development, leads the Duke team that includes Dr. Laura Hans, a pediatrician who researches developmental and behavioral issues through SSRI; Jan Riggsbee, director of Duke’s Program in Education; Michael Murias, an associate research professor from the Duke Institute for Brian Sciences; Carol Ripple, associate director of education at SSRI’s Education & Human Development Incubator; and four students participating in Bass Connections.
Duke has a long history of fostering an interdisciplinary approach to research. SSRI brings together researchers from disparate fields to take on real-world problems and offers a collaborative space on Duke’s West Campus that brings together data analysis experts and behavioral and social science researchers. Bass Connections, launched in fall 2013, pulls undergraduates into the world of multidisciplinary research.
White had been looking for researchers to help her validate her anecdotal successes. A certified music therapist, she founded Voices Together in 2006 and, with a staff of four certified music therapists, conducts more than 60 music therapy groups each week in the Triangle and Triad. Each group has eight to 10 children or adults with developmental disabilities. Some groups are run in public schools, others in the community. All told, Voices Together serves about 700 individuals who have difficulty interacting with others through spoken language and struggle with identifying and expressing emotions and connecting socially.
During the hour-long sessions, which are half spoken and half sung, White strives for a constant, consistent flow of interaction among participants.
“Music triggers different things, and it processes differently from language,” she said. “Through music, we’re able to engage in new ways and create new pathways toward language. Our overriding goal is that clients generalize what they learn in this group into their lives.”
Most autism research focuses on people with language skills; less is done on nonverbal individuals. But recently, research has begun to explore therapies to promote social and language skills in individuals who have minimal speech. Some of the therapies that are being explored, including music therapy, have been shown to be effective in helping persons with stroke regain speech. Dawson, in considering research projects, observed a Voices Together session and was impressed by how engaged the children were and their facility with social interaction.
“Voices Together was developed to give kids confidence that they could speak and that their speech is valued,” Dawson said. “We need to understand how the therapy works, and we need to demonstrate that it has measurable benefits.”
Dawson gathered a team that includes a doctoral student from UNC-Greensboro who has developed a behavioral coding system that will enable the researchers to code affective and social behaviors observed in the videotaped therapy classes. She also enlisted the help of Guillermo Sapiro, professor of engineering and computer sciences at Duke, whose team will use computer vision analysis to study whether the therapy increases the range of facial emotional expressions in the children and adolescents with autism.
The study was carried out in three classrooms this past fall, and will continue into the spring. Three new classes have begun this spring, and they will serve as the comparison group. Comparing the results of the students who essentially had a double dose of therapy with those in the spring-only classes will allow the impact of the longer-term therapy to be evaluated.
All of the sessions are videotaped by Bass Connections students, who then observe the videos to look for behaviors that signal emotional expression or social engagement—eye contact with the therapist or another student, or speaking directly to anyone in the room, or a smile. Once the behaviors are coded and entered into the computer database, they can analyze whether the therapy resulted in measurable change in the children’s behavior. SSRI is helping with the software analytics and ensuring that the data are kept secure.
Ali Goldsmith, a sophomore at Duke’s Trinity College, applied to work on the Voices Together project through Bass Connections. Her brother is autistic. She has seen the myriad therapies he has tried and is well aware that there is no magic cure. She observed a Voices Together session for adults.
“It was amazing to see how much the participants came to life with the music,” said Goldsmith, who is considering a psychology major and plans to work in the field of autism in some capacity. “They were so happy. Watching them, I got teary.”
Goldsmith and the other Bass Connections students work directly with Hans, the pediatric researcher affiliated with SSRI. Hans makes sure the Duke students are getting the most out of the research experience. She teaches them about autism and will help them figure out what behaviors are important to catch in the video. And she guides them through the technical aspects of conducting research, everything from the broad—“Sometimes researchers are too ambitious in their first draft”—to the basic—“How do you get consent that protects the subject but lets you use the data you need?”
Bass Connections students do not need to be planning a career in research to participate in the program, Hans said. “Anyone can benefit from being part of a team doing something innovative that has an important application in the real world. Learning that starts from a problem or question is more enduring.”
The goal of Bass Connections is to learn to work in a diverse team that comes at a problem from all different angles, she said. “That experience can be helpful in any career.”
The team received approval from the Institutional Review Boards at Duke and at Durham Public Schools, the latter being a particularly competitive endeavor, given the large number of research proposals DPS receives. The team has launched the yearlong study in selected public schools
The Voices Together therapy is very affordable, seems to be successful and is not complicated to implement. And if the Duke study validates the method and outcomes, the therapy could have a wide reach.
“The more data you have that have been validated, and the more partnerships we have with professionals researching and focusing on the same area,” White said, “the more progress you’ll make in a community in finding solutions and support for individuals with autism.”