Music Therapy In Early Intervention-A Family Perspective

Abstract

Music Therapy (MT) in Early Intervention currently works with children with disabilities or at risk of developmental delays in a family-centered model. Within a family centered approach the way parents receive and understand all the intervention is crucial, but has not been properly considered. This paper aims to identify the role and value of MT in the perspective and representations of parents that attended therapy sessions with their children in the context of an Early Intervention Program. Grounded Theory methodology is used to analyze data collected through interviews with 7 mothers and fathers of children with severe disabilities. Results show the significant value families set on Music Therapy specific interventions to facilitate motor areas, social and interpersonal relationships and engagement with music and sounds. Three large categories show that families are able to understand MT in Early Intervention context: what is Music Therapy, what are its benefits, and the effects it has on early development. Music Therapy can be applied in the practice of Early Intervention teams and is compatible with a family-centered programs. It has the capacity to provide an effective contribution to improve nonverbal communication in primary relationships, particularly in more severe disorders when communication is unconventional. This work also allows to broaden current concepts on the clinical practice of MT in Early Intervention, moving from a traditional clinical approach to a family-centered one.

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PhD,!Music!Therapist,!
Cerebral!Palsy!Association,!Évora,!Portugal.!!
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PhD,!Psychologist,!Department!of!Psychology,!
University!of!Évora,!Portugal!
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W'B)Q,/"(>) Music!Therapy,!Early!Intervention,! Disability,! Developmental!Disorders,!Family-
centered!practice!
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Music!Therapy!is!the!use!of!music!and!sounds!to!promote!integral!human!development!in!the!
psychological,!physiological!and!social!aspects.!Music!is!thought!to!extend!on!a!nonverbal!plane!
that! helps! human! beings! express! their! intimate! feelings! and! emotions! in! all! physical,!
intellectual!and!social!areas.!
!
Del!Olmo! (2005)! states!music! works! as!a! semiotic! mediator!between! infants! and!adults! and!
can!allow!understanding!what!happens!when!basic!emotional!feelings!such!as!anger,!joy,!fear,!
dislike!or! surprise,! are! expressed.! The! author! emphasizes! music! effects! are! linked! to! the!
hearer’s! states! of! motivation,! emotion! and! perception.! According! to! Ruud! (1993)! Music!
Therapy! also! has! an! impact! on! implementation,! promotion,! prevention! and! rehabilitation! of!
the!physical,!mental,!emotional!and!social!health!of!people,!groups!and!communities,!including!
its!intervention! with!babies! and! their!mothers.! From! the!neurosciences! perspective,! Koelsch!
(2009)!stresses!the!importance!of!early!treatment!for!prevention,!which!is!coincident!with!the!
Early!Intervention!perspective.!

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Despite!the! few! studies!published! about! perceptions! or!opinions!of! families! attending!Music!
Therapy!sessions!with!their!children,!Jonsdottir!(2008)!finds!that!parents!recognize!that!their!
children,! even! with! severe! developmental! disorders,! respond! to! different! sonorous! and!
musical!stimuli!with! gestures!and! movements.!Families! are! thus!encouraged! to!explore! their!
children’s!spontaneous!responses.!
!
Nevertheless!Music! Therapy! must!deal! with! a!larger! conception! of!early! Intervention! that! is!
not!just!a!rehabilitative!and!treatment!perspective.!
!
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Early!Intervention!programs!are!much!more!than!an!early!answer!to!the!needs!of!a!child!with!a!
disability! or! whose! healthy! development! is! at! risk.! It! is! actually! a! complex! system! of!
coordinated!services!based!on!a!family-centered!approach!that!assigns!the!family!a!key!role!in!
the!quality!care!of!child!development.!!
!
All!children!born!with!an!unfinished!maturation!process!and!newborns!brain!plasticity!makes!
them!more!fragile!to!face!adverse!environmental!conditions,!but!also!favors!their!development.!
Early!Intervention!takes!into! account!that!the!central! nervous!system!is!more! flexible!during!
maturation,!so!children!under! 6!years!benefit! from!accessing!early!intervention! in!this!stage,!
and! will! have! better! chances! to! maximize! their! potentials.! Thus,! environmental! factors! and!
social!responses!have!a!significant!impact!on!child!development.!
!
Early! Intervention! Network! is! based! on! theoretical! principles! of! development,! including!the!
contributions!of!neurosciences,!the!interactional!and! transational!perspectives!(Sameroff!and!
Mackenzie,!2003)! and! the! engagement! of!caregivers,! and! above! all,! the! bio-ecological! model!
and!systemic!perspective!that!stresses!the!importance!of!the!contextual!factors!affecting!child!
development! (Bronfenbrenner!!and! Morris,! 2006).!!Three! basic! principles! are! implicit! in!
different!definitions:!!the!principle!of!globality,!the!principle!of!contextuality!and!the!principle!
of!opportunity.!The!principle!of!globality!emphasizes!the!understanding!of!the!child!as!a!whole,!
and! so,! all! the! different! developmental! domains! must! be! addressed! simultaneously! to! meet!
each! child’s! individual! needs! and! provide! support! accordingly.! !The! contextual! principle!
assumes!that!the!child!behaves!and!develops!in!the!context!of!a!family,!society!and!culture.!The!
principle!of! opportunity! recognizes!that! the! intervention!must! be! adequately!and! personally!
timed!to!meet!the!real!needs!of!the!child!and!family.!
!
The! modern! perspectives! of! Early! Intervention! are! family-centered,! thus,! all! children! with!
developmental! disorders,! or! exposed! to! the! risk,! should!receive! bio-psychosocial! assistance!
with! a! prevention! and! welfare! approach! in! order! to! potentiate! their! development! and! well-
being,! which! will! result! in! a! more! complete! personal! autonomy! and! inclusion! into! family,!
school!and!social!environments.!
!
Early!Intervention!network!in!Portugal!is!managed!to!satisfy!the!needs!of!families!and!children!
and!the!programs!delivered!by!team-based!transdisciplinary!service!model.!This!network!!(the!
SNIPI-! National! System! of! Early! Intervention! on! Childhood)! is! ruled! by! a! legal! framework,!
simultaneously!sponsored!by!the!ministries!of!Education,!Health!and!Social!Welfare.!The!latest!
update! of! the! Portuguese! law!defines! Early! Intervention! as:! “an# integrated# set# of# child# and#
family# centered# care# policies# and# procedures# to# promote# prevention# and# rehabilitation# in# the#
areas#of#education,#health#care#and#social#welfare”!(Decreto-lei!281/2009,!2009).!
!
With!this! objective,! the!SNIPI! is! run! on! a! community! base! all! over! the! country.! Local! direct!
intervention! teams! work! on! a! family-centered! approach!based! child! daily! life!routines,!

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supported!by!community!resources,!local!authorities,!associations!and!facilities!(Franco,!Melo,!
Santos,!Apolónio!&!Amaral,!2017).!
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The!local! intervention! teams! integrate!teachers,! psychologists,! speech! therapists,!
physiotherapists,!occupational!therapists,!social!workers!and!other!professionals,!eventually!a!
music!therapist.! All!intervention! is!seen! from!a! global!family-centered! perspective!and!these!
professionals!work!within!a!transdisciplinary!approach.!
!
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In! Early! Intervention! the! Music! Therapist! holds! sessions! with! the! child! and! family! to!
collaborate!and!promote!the!different!stages!of!development!with!sonorous,!musical!and!ludic!
activities,!as! follows! (Lazo!1998):! a)! Sonorous! and! visual! stimulation! activities;! b)! Rhythmic!
and!expressive!movement!activities;!c)!Music!and!movement!activities;!d)!Vocal!projection!and!
breathing!exercises.!
!
Music! Therapy! highlights! the! importance! of! the! sonorous-musical! background! of! the! family!
and!of!the!socio-cultural!environment!since!psychological!and!neurological!aspects!interact!in!
emotional!responses.!Benenzon,!de!Gainza!and!Wagner!(1998)!enphazise!the! specific!aspects!
of! each! individual’s! background! and! also! that! the! emotional! response! to! a! sonorous! and!
musical!stimulus!lies!on! each!subject’s!cultural! variables!and!life!history.! !Soria-Urios,!Duque!!
and! Garcia-Moreno! (2011)! describe! five! factors! that! make! Music! Therapy! effective! in! Early!
Intervention:! ! a)! Attentional! modulation! :! uses! the! attraction! of! music! to! call! attention! in! a!
more! powerful! way! than! other! sensual! stimuli;! b)! Emotional! modulation:! ! uses! music! to!
modulate!emotions!and!elicit!emotional!responses!involving!cortical!and!subcortical!regions!of!
the!brain;! c)!Cognitive! modulation:!! brain!networks! process!music! and!memory! involves!the!
processes!of! encoding,!storing! and! retrieval;!d)! Behavioural!modulation! or:! music!can! evoke!
movement! patterns! even! unconsciously! (rhythmic! auditory! stimulation! is! also! used! for!
rehabilitation! in! brain! injury! and! motor! disorders);! e)! Communicative! modulation! or!
interpersonal! factor:! music! is! communication! and! can! be! used! to! improve! nonverbal!
communication!skills.!
!
Koelsch! (2009)! also! describes! three! domains! for! the! beneficial! therapeutic! effects! of! Music!
Therapy.!The!first!is!the!emotions!domain,!with!clear-cut!effects!on!limbic!structures!as!well!as!
on!the!autonomic!nervous,!endocrine!and!immune!systems.!Second,!the!perceptual!and!motor!
development! domain! as! musical! perception! activates! the! auditory! and! motor! brain! areas!
favoring! motor! skill! learning! and! improving! comprehension! abilities.! And! third,! the! social!
cognitive!domain,!because! music! activates!brain!networks:! anterior!medial!prefrontal! cortex,!
superior!temporal!sulcus!and!temporal!lobes.!!
!
Practice!of! Music!Therapy! in! the!context! of! Early! Intervention! aims!to! develop! psychomotor!
and!perceptual-cognitive!areas!and!has!a!positive!impact!on!parent-child!and!socio!emotional!
communication.!
!
However,! in! moving! from! a! therapeutic! model! to! a! family-centered! model,! it! is! essential! to!
verify!the!extent!to!which!the!goals!and!practices!of!Music!Therapy!are!congruent.!For!this,!it!is!
important!that!the!family!has!a!clear!perception!of!what!MT!is!and!how!it!works.!
!
XN1F@E?4F+)XH)E[F)+EY=\)
This!study!aims!to!know!parental!perception!on!the!use!of!Music!Therapy!in!Early!Intervention!
family-centered!programs,!focusing!on!how!it!can!to!meet!the!needs!of!children!and!family.!!

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The!specific!objectives!are:!a)!Find!out!what!Music!Therapy!means!to!parents;!b)!Know!what!
benefits! parents! see! in!Music! Therapy;! c)!Find! out! the! outcomes! they! feel! had! an! impact! in!
their!children’s!lives.!
)
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Considering! the! objectives! of! the! present! study,! the! option! was! for! a! qualitative! approach,!
listening!parents! and!paying! close! attention!to! their! perception!and! opinions,!as! “qualitative!
methods! can#be#used!to!explore!substantive!areas! about! which!little! or! about! which!
much!is!known!to!gain#novel!understandings”!(Strauss!and!Corbin!2002,12).#
!
We!opted!for!the!constructionist!approach!of!Grounded!Theory!because!no!theory!was!guiding!
us!in!this!process!of!parents!listening.!
Grounded# Theory# approach# generates# a# latent# theory# directly# from# data.# Its#
methodology# is# analytical,# with# an# insight# on# data# collection# and# by# means# of#
systematically# applied# methods# it# uses# an# inductive# approach# to# generate# a#
substantive# code.# The# study# findings# constitute# a# theoretical# formulation# or# an#
integrated# set# of# conceptual# hypotheses# about# the# substantive# area# under# the# study#
(Glaser,#1992,#14).#
!
This!methodology!allows!direct!knowledge!about!the!individuals!involved!by!paying!attention!
to! their! views! and! experiences.! The! intention! is! not! to! test! a! theory! but! to! interpret! the!
phenomenon!under!study.!
!
Six!mothers,!aged!29-42! years,! and!a!43!years! old!father,!were!interviewed.! All!of!them!have!
severely! disabled! children,! and! receive! services! delivered! by! an! Early! Intervention! Service!
Team! (Local! Early! Intervention! Service! Team! Nr.! 2,! Cerebral! Palsy! Association,! Évora,!
Portugal).!
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The!interview!started!with!three!questions:!1.!What!is!Music!Therapy!to!you?;!2.!Why!did!your!
child!do!Music!Therapy,!and!how!useful!was!it?;!3.!How!do!you!think!your!child!benefited!from!
Music!Therapy!sessions?!
!
Interviews! last! twenty! minutes! long,! on! average,! were! audio-recorded! and! complete!
transcriptions!were!used!for!analysis.!!
!
Data! collected! from! interviews! were! coded,! compared! and! conceptualized.! We! started! with!
line-by-line! open! coding! of! data! based! on! GT,! categorizing! them! to! fit! the! questions! of! the!
study.!In!this!way,!new!categories!emerged,!which!were!grouped!and!given!code!names!along!
with!memo!writing,!in!different!colors,!for!categorization.!
!
Memos!were! then! conceptually! aligned! to! guide! us!to! the! next! step.! Codes! were! sorted!into!
categories,! subcategories! and! dimensions! to! fit! the! questions! from! the! data.! Indicators! and!
properties!were!analyzed! to!form! an!analytical! framework.!! In!this! stage!it!was! necessary!to!
explore! relationships! between! categories! and! a! complex! mapping! connection! between! them!
was!identified.!
!
This! sorting# process,# followed# by# conceptualization# and# description,# revealed# parents’# overall#
perception# about# Music# Therapy# in# Early# Intervention# contrasting# # different# incidents# to# a#
theoretically#saturate#core!and!related!concepts.!
)
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Results!were!grouped!in!three!categories:!!1)!What!is!Music!Therapy?;!2)!How!useful!is!it?!!3)!
What!were!the!results?!
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From!the!line-by-line!analysis!we!found!out!how!parents!describe!Music!Therapy.!Three!main!
subcategories!were!identified:!Therapy,!Well-being!and!Development.!
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a)!E0'/$AB! -! Parents!describe! Music! Therapy!as! a! therapy!through! music.! They!specify!two!
dimensions:!the!therapist!and!the!use!of!specific!materials!or!means.!
!
The! Music! Therapist#is! someone! with! specific! expertise! in! music! and! in! disability! issues.!!
Parents!first!define!Music!Therapy!as!a!treatment!through!the!creation!of!music,!but!later!they!
identify! their! experiences! in! Music! Therapy! sessions! with! the! Early! Intervention! team! and!
conclude! they! managed! to! develop! a! reliable! and! trusting! relationship! with! the! Music!
Therapist.!
#
“It#is#important#for#us#because#we#later#trust#the#work#they#do”#(EP04)#
!
The!therapist’s!professional!training!and!knowledge!of!their!children’s!pathologies!are!also!see!
as!fundamental!because!they!feel!confident!this!intervention!will!give!their!children!treatment!
for!their!specific!disorders.!
!
!Specific! Materials! consists! of! parents’! views! of! the! specific! materials! used! by! the! Music!
Therapist:!musical!instruments,!sounds!and!music.!They!recognize!Music!Therapy!mainly!uses!
music! and! colorful! musical! instruments! with! timbric! and! sound! intensity! that! elicit! their!
children’s!responses.!
#
“Playing#with#musical#objects,#he#likes#everything#related#to#music….#I#think#all#this#has#
to#do#with#Music#Therapy”#(EP01)#
!
b)!The! second! subcategory!is! T'--G;'*%C:! ! we! grouped! parents’! descriptions! reflecting! the!
impact!of!this!therapy!because!it!is!pleasurable!and!builds!their!children’s!state!of!well-being.!
They!also!think!that!materials!or!music!itself!engage!them!into!the!activities!and!this!therapy!

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definitely! fosters! well-being.! ! This! subcategory! is! presented! through! three! dimensions:!
Relaxation,!Motivation!and!Willingness.!
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Dimension!Relaxation!is! referred!as! a! very!important! feature! of!Music! Therapy!because!the!
children!feel!physically!and!mentally!relaxed.!
#
“…for# me,# Music# Therapy# is…I# think# it# is# relaxing# for# children# like# mine# …# It’s# good”#
(EP07)#
!
In!this!example,!the!parent!explains!how!Music!Therapy!gives!her!child,!with!spastic!cerebral!
palsy,!a!sense!of!peace.!!
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Dimension!Motivation!considers!data!in!which!parents!describe!Music!Therapy!as!one!of! the!
therapies!their!children!enjoy!and!how!they!are!always!happy!to!attend!sessions.!
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“She#has#always#liked#music,# she# has# never# paid# attention# to#television#but#she#has#to#
music#a#lot,#yes,#it#soothes#her#a#lot…#When#we#started#coming#here,#I#noticed#she#liked#
everything#to# do# with# sounds,# she# stopped# to#listen# to# everything# and…# She# takes# an#
interest#in#everything#and#then#therapist#suggested#my#daughter#should#take#up#Music#
Therapy# and# I# think# she# is# doing# well…# whenever# she# hears# anything,# she# generally#
doesn’t#look#but#she#starts#listening”#(EP05).#
!
Dimension#Willingness!is!identified!because!parents!think!music!not!only!produces!well-being!
but!also!elicits!in!their!children!positive!responses!to!attending!Music!Therapy!sessions.!They!
feel! Music! Therapy! is! also! pleasurable! and! enjoyable! and! start! describing! in! detail! the!
emotions!their!children!feel!in!the!sessions.!
!
“He#loves#Music#Therapy.#He#is#very#happy#when#he#comes#to#the#sessions”#(EP02)#
!
c)!Subcategory#='#'-,AI'%<#includes! parents’! descriptions! of! Music! Therapy! as! a! practice!
that!responds!to!children’s! different!stages! of!global! development!and! their!perceptions! that!
sounds!have!the!potential!to!stimulate!them.!
#
“In#my#opinion,#Music#Therapy#is#stimulation#through#sounds”#(EP05)#
!
This!subcategory!identifies!five!levels:!
-!Motor:! according! to! parents’! considerations,!playing! instruments! is! associated! with!the!
body!and!e!motor!activity;!
-!Emotions:!it!refers!to!child!development!and!mood!variability.!
-!Cognition:!the!interviewees!find!Music!Therapy!aims!to!develop!cognitive!capacity,!such!
as!responding!when!called!by!the!name!or!to!simple!orders.!
-! Communication:! in! this! dimension! we! grouped! all! data! identifying! communication!
since!children! with! severe! pathologies! mainly! communicate! through! sonorous!
expressions.! Thus,! parents! find! Music! Therapy! to! be! a! direct! intervention! in! their!
children’s!production.!
-!Learning:!The!interviewees!feel!that!Music!Therapy!can!help!improve!children’s!learning!
and!development.!!
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Parents! also! identified! two! subcategories! of! benefits! of! Music! Therapy! for!children:!a)!
Pleasurable! Activity! and! b)! Therapeutic! Objectives,! which! are! intertwined! according! to!
parents’!opinions!about!the!ludic!and!therapeutic!character!of!music.!
!
a)!Subcategory! :-'$(2/$;-') !&<*#*<B!is! referred! to! MT! as! an! enjoyable!activity! because! it!
engages! the!children.! It! was! necessary! to! include! the! dimension! Ludic! Activities!because!
parents!view! Music! Therapy! intervention! as! beneficial! because! it! enables! them!to! play! with!
their!children!during!the!sessions.!They!understand!that!Music!Therapy!is!through!play.!And!a!
dimension! Musical! Activities#within! parents! refers!that!children! express! pleasure! when!
listening!!and!accompanying!music.!
)
OH*C2/')_5)N'%'S*<(),S)D2(*&)E0'/$AB)*%)F$/-B)?%<'/#'%<*,%P!
b)!Benefits!are!mainly!referred!to!the!E0'/$A'2<*&)X;`'&<*#'()of!Music! Therapy! through!the!
framing! and! causality! functions! of! music.! ! Parents! consider! Music! Therapy! fosters!
development!and!also!reduces!parental!stress!or!depression.!They!describe!this!subcategory!in!
three!dimensions:!
-#Level!of! Emotion:! Data! reveal! Music!Therapy! fosters! the! emotional! expression,! influencing!!
the!different!stages!of!their!children’s!development.!
!
-! Level! of! Communication:# parents! state! that,! above! all,! Music! Therapy! promotes! their!
children’s!communicative!intention!and!their!own!ability!to!understand!them.!
#
“She# has# improved# her# hearing,# she# tries# to# imitate# the# sounds# she# hears# with# her#
hands# and# many# sounds# with# her# hands# and# mouth.# And# it’s# the# only# way# we# can#
understand# what# she# wants# and# it# is# through# those# sounds# that# we# are# getting# to#
understand#her.#Her#progress#is#due#to#Music#Therapy”#(EP03).#
!

!"#$%&&'()*$+%,'(-)./-)0)1&2,34-)5/)6789:;/)<"=$3)>?'&2@A)B,)C2&DA)B,#'&E',#$4,)F)G)12+$DA)H'&=@'3#$E'/)!"#$%&'()*%)+,&*$-) +&*'%&'().'('$/&0)1,2/%$-3)
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By!improving! gestural! expression,! Music!Therapy! facilitates! the! child’s!own! interaction! with!
his!nuclear!family!with!the!reassurance!it!can!also!function!in!their!everyday!lives.!
!
Parents! describe! music! as! a! pleasurable! and! healthy! activity! that! gives! their! children!
immediate!satisfaction!through!ludic!activities!and!helps!them!communicate!by!gestures!and!in!
turn,!facilitates!parent-child!interaction.!
!
G)@,C%*<*#')-'#'->)Parents!recognize!that!Music!Therapy!sessions!improve!children’s!cognitive!
skills,!as!shown!in!this!example:!
“He# has# started# to# help# us,# well,# if# we# ask# him# for# an# object# he# looks# for# it,# if# we#
sometimes#ask# him#to#do#something#or#bring#us#something,#he#sometimes#manages#to#
do#so”#(RP01).#
!
According!to!parents,!their!children’s!auditory!attentional!capacity!increased!during!treatment.!
#
“The#benefits#of#Music#Therapy#I#have#always#noticed#are….,#she#stops#to#listen#and#pay#
attention#to#anything.#If#people#talk#to#her#……#she#pays#more#attention#and#well...,#that#
was#what#I#noticed#more”#(RP05).##
!
From! this! category,! we! infer! that! parents! perceive! Music! Therapy! aims! to! improve!
interpersonal! relationships! since! it! enables! them! to! better! understand! what! their! children!
express.!
!
FSS'&<(),S)D2(*&)E0'/$AB)*%)F$/-B)?%<'/#'%<*,%)
It!emerges!from!our!data!parents’!views!of!the!long!and!short-term!'SS'&<(!of!this!intervention!
process.!
!
a)!+0,/<)<'/I)'SS'&<(:!this!subcategory!grouped!the!descriptions!of!the!immediate!effects!of!a!
Music!Therapy!session!during!the!therapeutic!process.!It!was!set!in!3!dimensions;!
-! Motivation:! grouping! of! data! from! parents! stating! that! one! of! the! immediate! effects! of!
Music!Therapy!is!motivate!to!action.!
-!Intention:!grouping!of!data! stating!Music!Therapy! sessions! result!in!an! improvement!of!
children’s!intentionality.!
-!Communication:)!it!was!found!in!both!subcategories!of!the!main!category!FSS'&<(.!Parents!
find! in! this! dimension! that! communication! is! one! of! the! most! tangible! outcomes!
observed! in! their! children! and! they! think! it! is! the! result! of! Music! Therapy! sessions.!!
They!believe! that!Music!Therapy! has!therapeutic! goals!that! are!transferred! into!other!
areas!of!children’s!daily!life!and!rotines.!
#
“And# even# at# home# we# have# noticed# her# progress,# the# best# she# has# achieved# is# her#
hearing.#And#we#notice#it#at#home#daily….”#(RP03).#
#

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Parents! also! refer! that! all! the! voice! projection! activities! and! breathing! exercises! in! Music!
Therapy!sessions!contribute!to!improve!their!children’s!self-expression.##
#
“It’s# very# noticeable.# The# therapist# kept# insisting# on# his# moving# arms# and# trying# to#
touch#and#now#we#can#see#he#tries#and#wants#to#grab…#he#also#makes#sounds#to#create#
laughter,# he# used# to# laugh# inwardly# but# now# he# laughs# openly.# And# if# there# is# a#
difference#in#the#sounds#he#makes#now#this#is#the#result#of#Music#Therapy”#(RP02).#
!
b)!Z,%C) <'/I) 'SS'&<(>) We!took! together!all! the!results! or! effects!parents! consider!persistent!
over!time!and! that!were! acquired! with!the! support!of!Early! Intervention!teams.! They!realize!
these!effects!are!beneficial!for!their!children’s!future!and!that!can!still!be!observed!today.!This!
subcategory!was!presented!through!three!dimensions:!
-#Image:!this!dimension!include!all!descriptions!stating!Music!Therapy!helps!a!change!of!image!
when!a! medical! perspective! of!disability! is! replaced! by! a! social! model! of! disability! becomes!
explicit! in! kindergarten! or! in! the! extended! family.! Thus,! parents! started! building! a! more!
positive!image!of!their!children.!
!
#“I#like#it#for#him#because#I#can#see#he#feels#more#self-confident”#(EP04)#
)
G)Autonomy:!parents!describe!how!their!children!manage!to!engage!in!some!activities!with!an!
increasing!degree! of!autonomy! as!a! result!of! the!support! provided!by! the!Early! Intervention!
Team.!
#
#“It’s#been#good# for# him…#Before#he#didn’t#use#to#have# his# milk#from#a#straw#and#now#
he#does.#He#didn’t#use#to#take#cookies#to#his#mouth#and#now#he#does,#and#all#this#is#the#
result#of#the#work#done”#(EP01).#
)

!"#$%&&'()*$+%,'(-)./-)0)1&2,34-)5/)6789:;/)<"=$3)>?'&2@A)B,)C2&DA)B,#'&E',#$4,)F)G)12+$DA)H'&=@'3#$E'/)!"#$%&'()*%)+,&*$-) +&*'%&'().'('$/&0)1,2/%$-3)
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G)Communication:! we! took! together! the! data! from! parents! referring! to! service! coordination!
between!W*%"'/C$/<'%) and! H$I*-B.! This! dimension! is! also! found! to! be! significant! in! short-
term!effects.!In!fact,!parents!report!Music!Therapy!facilitates!children’s!verbal!communication!
with! their! nuclear! or! extended! families! and! even! with! their! peers! and! teachers! in! the!
educational!context!of!kindergarten.!
!
=?+@Y++?X8)!8=)@X8@ZY+?X8+)
Parents’!perceptions! and! perspectives!on! Music! Therapy! have! been! scarcely! studied! despite!
the!interest!the!practice!of!this!intervention!generates,!especially!when!it!is!family-centered,!as!
it!is!the!case!of!Early!Intervention!services!nowadays!(Franco!et!al,!2017).!
!
From! the! first! paper!of! Trehub! and! Trainor! (1998)! on! musical! discrimination! at! early! ages,!
only! few!studies! have! been! published! on! the! concept! of! Music! Therapy! considering!the!
perception!of!parents!of!disabled!children.!Chiang!(2008)!finds!that!parents/caregivers!notice!
a!high! degree! of!motivation! in! children!with! disabilities! that!attend! Music! Therapy!sessions,!
and! that! this! motivation! moves! on! to! other! spaces! where! the! child! interacts.! Furthermore,!
parents!admit!that!they!also!benefit!from!attending!these!sessions!with!their!children!because!
they!feel!music!is!stress-reducing.!
!
According!to!Kern!and!Aldridge!(2006)!and!Benenzon! (1998)!parents!remark!Music!Therapy!
sessions!improve!their!children’s!psychomotor!skills!and!social,!psychological!and!intellectual!
functioning!in!their!daily!life.!!
!
Our! data! show! that! parents! recognize! Music! Therapy! is! comforting! for! their! children.! This!
description!is!very!important!because!it!is!from!parents!whose!seriously!handicapped!children!
underwent,!in!early!stages!of!life,!partially!invasive!clinical!practices!that!caused!the!children’s!
physical!discomfort!and!parents’!emotional!distress.!These! parents!also!compare!MT!to!other!
therapies!their! children!went! into!and! highlight! its!ludic! and! pleasurable! approach.! !In! their!
opinion,! Music! Therapy! facilitates! their! children’s! cognitive! and! motor! development!
motivating! them! from! a! ludic! approach! through! music! or! the! use! of! musical! instruments.!
Trolldalen! ! (2009)! questions! the! appreciation! and! recognition!in! musical! interaction! and!
describes!four! different!areas! where!potentially! significant! changes!can! be!observed! as!from!
the!process!of!Music!Therapy.!These!areas!are!also!considered!conclusive!in!the!present!study:!
a)! emotional! sharing;! b)!play! and!social! interaction;! c)!balance! to! focus! attention;! d)!social!
skills.!
!
When!we!ask!parents!about!their!opinions!about!benefits!of!Music!Therapy,!we!find!they!feel!
dependent!to!their!children’s!cognitive,! perceptual! and!motor!disabilities!but!they!find! Music!
Therapy!facilitates! their!playful! interaction! with!their! children.!They! refer!their! children! can!
listen!to! music,! recognize! and!identify! sounds! or! tunes! or!even! play! an! instrument! in!Music!
Therapy!sessions!and!this!activity!means!doing!something.!According!to!Haslbeck!(2013),!MT!
empowers!parents!to!potentiate!their!children’s!creativity!and!autonomy!in!terms!of!emotional!
responsiveness,!thus!creating!a!healthy!parent-child!interaction.!
!
It!is!worth!mentioning!that!all!these!children!have!deficit!in!symbolic!play,!show!little!interest!
in!objects!like!dolls!and!feel!more!attracted!to!multi-sensory!light-up!toys.!They!do!not!express!
graphically!or!have!spontaneous! social!interaction!with!peers! and!are!dependent!on! parents’!
care.!! However,!parents! reported!that! by!means! of! musical! activities! they!find! their!children!
can!do!different!things!and!that!sounds!also!promote!parent-child!interaction.!
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If!so,!Musical!Therapists!play! an!essential!role!considering!their!professional!training!and!the!
affectionate! involvement! with! the! child! and! family.! Parents! greatly! value! a! Music! Therapist!
with!openness! to! new!ideas! and! clear!set! objectives.! Music! Therapy! is! considered!a! therapy!
facilitated! by! a! well-trained! Music! Therapist! and! parents! appreciate! the! importance! of! this!
music-based! intervention! in! their! children’s! development.! They! feel! primarily! satisfied! with!
this! therapy! because! it! promotes! parent! participation! and! provides! them! with! a! space! that!
facilitates!interaction!with!their!children,!therefore!potentiating!child!global!development.!
!
Since!these!parents!also!play!the!role!of!caregivers,!which!is!time,!energy!and!care!consuming,!
they!sense!Music!Therapy!offers!them!a!relaxing!atmosphere!to!play!with!their!children,!play!
musical!instruments!and!elicit! their!responses!as! well.!Thompson!(2014)! also!advocates!that!
sonorous-musical! activities! help! build! the! bond! between! parents! and! children! with! severe!
communication!difficulties!and!also!improve!communication!skills.!
!
Parents! understand! it! is! of! central! importance! the! way! the! Music! Therapist! offers! a! full!
explanation!of!each!of!the!activities!and!of!the!goals!intended!to!achieve!in!the!sessions!since!
this! is! a! key! factor! in! ensuring! a! trust! relationship! between! the! family! and! the! Early!
Intervention!team.!
!
Parents!also!recognize!the!use!of!music!in!music-therapeutic!processes!is!an!effective!tool!for!
helping!their!children!relax!and!feel!better!with!their!own!bodies.!It!also!aims!to!improve!the!
child!physical! capacities,!like! breathing!and! emotional!expressions! like!laughter.! Parents!feel!
these!are!specific!Music!Therapy!competencies.!
!
In!conclusion,! parents! regard!that! Music!Therapy,! along!with! other!therapies,! is!a! significant!
intervention! to! support! the! needs! of! their! handicapped! children.! One! of! the! main! and! most!
effective! benefits! of! Music! Therapy! is! about! communication.! ! These! children! present! a! non-
verbal!condition! and! Music! Therapy! facilitates! their!speech! development! and! activates! their!
own!pre-language!acquisition!to!help!them!interact!better!with!parents,!educational!contextes!
or!extended!family.!!
!
The!category!Communication! involves!the!concept! of!understanding!lallation! or!sounds!their!
children!make!and!Music!Therapy!helped!parents!interpret!them.!
!
As!for!benefits!or!outcomes,!parents!also!find!that!the!activities!in!Music!Therapy!sessions!are!
transferred!or!have!effects!on!their!children’s!daily!life.!!In!this!way,!parents!acquire!pragmatic!
knowledge! of! therapy! and! intervention! and! value! the! outcomes! resulting! of! their! active!
participation! and! close! relationship! with! the!children.! They!find! their! children! reflect!
improvements!in!facial!expressions,!relaxation!and!breathing!capacity!as!immediate!effects!and!
recognize!some!kind!of!autonomy!as!a!long-term!effect,!which!they!associate!with!the!activities!
in!Music!Therapy!sessions.!
!
We! can! conclude! that!Music! Therapy! can! be! used! with! good! success!in! the! context! of!Early!
Intervention,! because! it! has! the! capacity! to! provide! an! effective! approach! to! improve!
nonverbal!communication!in!primary!relationships!particularly!in!more!severe!disorders!when!
communication! is! unconventional.! ! Music! Therapy! can! be! applied! in! the! practice! of!Early!
Intervention!teams!and!is!compatible!with!family-centered!programs.!!
!
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Benenzon!R.O.,!de!Gainza,!V.!H.!&!Wagner,!G.!(1998).!La#Nueva#Musicoterapia.!Buenos!Aires:!Numen.!

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Thompson,!G.!(2014).!A!Survey!of!Parents'!Use!of!Music!in!the!Home!With!Their!Child!with!Autism!Spectrum!
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