Sound therapy research widened to include children with autism

Professor Phil Ellis and Dr. Lieselotte van Leeuwen

13 year old John has been diagnosed as severely autistic. In addition he has severe learning difficulties and developmental delay associated with hypotonic muscles. He requires an individually planned educational programme to help him develop skills in all areas: physical, social communication and cognitive. He needs to be helped towards developing some independence.

As a focused case study into the effectiveness of Sound Therapy with this condition, John attended sessions for more than 6 months during 1999. Prior to the programme he was very tense, would grip people and objects with some ferocity, would make little eye contact nor show much concentration or co-operation. There were not many smiles in evidence. His walking gait was very stiff-legged and he would need constant encouragement both to walk, and also to leave objects untouched as he moved along corridors.

For these sessions two chairs were placed on the Soundbox, one for John and one for the therapist. All sounds made in the session, either through the sound processor and microphone, or generated from the Soundbeam, were both heard aurally and also experienced as vibration through the chairs. Significant feedback is thus experienced with every sound being felt physically.

The positioning of the Soundbeam itself is of interest to this case study. With SLD and PMLD children the best place to focus the beam has been always on the back of the head. In experience with a number of autistic children the best place seems to be for the beam to be pointing towards the chest, face or the front/side of the head. The reason for this remains obscure, but observing many sessions with autistic children, and trying several different beam positions, placing the beam in front, and slightly to the side of the child invariably seems to be successful.

At his first Sound Therapy session he was in a very, very disturbed, tense almost aggressive state and it was an achievement to get him to leave the classroom, but having arrived he stayed for over 18 minutes – a significant achievement. There was quite a lot of lateral head movement and almost hyper-ventilation in this session and he seemed very tense at moments. But there were also moments of smiling and laughter, and these were interesting as this response was not common. He became extremely tense when we arrived back in the classroom at the end of the session.

Two weeks later he was very willing alert and happy during the session, which lasted for 20 minutes. There were lots of smiles and laughter, lots of vocalisation, eye contact and controlled physical movement as well.

…changes in behaviour have been noticed beyond the Sound Therapy sessions… there has been an increase in eye-contact, in smiling, responding to others, more relaxed physical movements and an increase in co-operative behaviour…

Another month later and John seems to be developing a much more receptive approach to the sessions. He clearly anticipates the Sound Therapy time when collected from the classroom and often stands up from his chair with little or no ‘encouragement’ being needed. This is unusual for him, and shows a high degree of motivation. Sometimes there are also smiles and deliberate eye-contact when I arrive to collect him. Walking from the classroom to the Sound Therapy room has also become far less of a trial. Whereas at first his gait was very stiff-legged and awkwardly slow, progressively he walks more smoothly, with a flowing gait. Also, at first he would grip my hand with real force, quite painfully too, and try to tear pictures from the walls. This too gradually became less of a feature of his behaviour, and progressively he would hold my hand in a more ‘normal’ way as I led him to the room where we would work.

This growing relaxation and positive behaviour was increasingly mirrored during and beyond the Sound Therapy sessions. For example, in the fifth month prior to one session John had been very distressed during his lunchtime. He had been crying and was generally showing signs of discomfort and unhappiness. However he was quite acquiescent when he sat on the chair on top of the sound box ready to start the session. He quickly became quiet and seemed to have less difficulty with his breathing, particularly when the Soundbeam was turned on towards the end of the session. At the end of the session he patted the chair that I had been using and when he was told it was time to go he stood up and walked out without any fuss. He seemed a lot calmer and less troubled than before the session, and this mental state did not change significantly when he returned to his classroom.

Since starting Sound Therapy sessions John has made progress in a number of areas. Often when walking to and from the library he will now walk almost normally for a few steps rather than with stiff legs. He will be more cooperative on these journeys, holding one of my hands and without the painful grip of early times. During the sessions he has shown an increase both in eye contact and smiles. He will vocalise on occasion and clap his hands with evident pleasure. He is also showing increasing interaction with the Soundbeam through controlled and deliberate physical movements. There seems to be an increasing awareness and subtle interaction throughout the session. These changes in behaviour have been noticed beyond the Sound Therapy sessions where there has been an increase in eye-contact, in smiling, responding to others, more relaxed physical movements and an increase in co-operative behaviour.

John's autism symptoms and their change according to aspects which allow us to observe behavioural change.

Aspects of behaviourInitial symptoms of John's autismChanges

Movement control

Extremely stiff gait

Body movements are stiff and clumsy

Patterns of breathing in and out are extremely unbalanced

Episodes of relaxation

Episodes of smoother and more integrated movements

Periods of balanced breathing

Attention span & focus

Focus mainly self chosen;

Guided focus only incidental and short

20 minutes (sometimes longer) of focused attention in the session

Guided attention

Social Interaction

Very little eye contact

No language

Vocalization infrequent and only as negative expression Non co-operative

Increasing eye contact

Vocalizations with positive expression Co-operative

Responsive

Engaging episodes

Spectrum and expression of emotions

Occasional laughter in one-to-one situations

Anger, high level of disturbance

Smiling and laughter increased

Intended vocalizations

Autism presents many challenges for children, teachers, parents and carers alike. The severely autistic child’s mind is not ‘turned off’. It can be likened not so much as having a light switch with on / off positions, but rather like having a dimmer switch which can gradually increase levels of perception, interaction and communication. No one approach can offer a magic cure for autistic children. Sound Therapy appears to have some beneficial effects – it may be a key to open the door, to turn the dimmer switch and provide more illumination which can then lead to further progress in other aspects of their educational experience.