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Music Therapy in Pediatrics



The soothing effects of music have been well described over the centuries and across cultures. In more recent times, studies have shown the beneficial effects of music in alleviating symptoms in a wide variety of clinical and psychologic conditions. Music therapy has been primarily used as an intervention to control emotional states, in pain management, cognitive processing, and stress management. Stress is associated with increased production of the stress hormone cortisol, which is known to suppress immune responses. Several studies in the past few decades have demonstrated a positive effect of music therapy on reducing stress or increasing immune responses, or both. Music therapy should therefore be considered as a valuable addition to standard pharmacologic therapeutic modalities in enhancing the immune response and lowering stress levels in such conditions. This article reviews the role of music as a therapeutic modality and the future for music therapy, particularly in pediatrics.
JMAJ, May 2001—Vol. 44, No. 5 241
Music Therapy in Pediatrics
JMAJ 44(5): 241–244, 2001
Toshikazu MATSUI
Director, Nihon Rinsho-Shinri Kenkyu
Abstract: Music has been utilized as a form of therapy due to ten factors; it has
been particularly effective in treating children who are not adept at adaptively
releasing their emotions, motivating children with little volition, in stimulating
communication among children with undeveloped language skills, in helping to
develop cognitive skills, and in overcoming abnormal habits or unadaptive be-
havior. Specific forms of therapy and techniques have been summarized and the
focal points have been explained. There are mainly three categories of patients
and music therapy has been applied in the treatment of children suffering from
retardation and some form of emotional and behavioral polarization or abnor-
mality, difficulty adapting due to physical functional disorders, and psychosomatic
disorders stemming from psychological causes.
Key words: Music; Communication; Developmental disorders; Psychotherapy
Music therapy is an ideal method of treat-
ment due to the following factors.
1. Music bypasses the intellectual process
and directly affects the emotions.
2. Music produces a sense of self-satisfaction
or self-love.
3. Music fulfills an aesthetic sense of beauty.
4. Music is liberating and provides a direct
means of emotional release.
5. Music induces physical movement.
6. Music is a form of communication.
7. Music is structured according to set rules.
8. Music is diverse and has wide-ranging
9. An integration of mental functions is
This article is a revised English version of a paper originally published in
the Journal of the Japan Medical Association (Vol. 122 No. 7, 1999, pages 1177–1179).
needed to participate in music activities.
10. Collective music activities meet a social
Additionally, in the field of pediatrics, music
therapy is greatly beneficial as an enjoyable
diversion and successfully provides distress-
free treatment for children who feel threat-
ened by the treatment.
In addition to the ten factors listed above,
music therapy has produced significant results
in treating children who are not adept at
adaptively releasing their emotions, in moti-
vating children with little volition, in stimulat-
ing communication among children with poor
or undeveloped language skills, in helping
to develop cognitive skills by utilizing the
fixed parameters in music, and in overcoming
242 JMAJ, May 2001—Vol. 44, No. 5
abnormal habits or unadaptive behavior.
Music, as is referred to in this paper, refers
to all kinds of organized music and it is not
restricted to the artistic or established forms
of music.
Adaptation and Treatment Methods
Music therapy was initially used to treat
adult patients suffering from mental illnesses,
but its use was rapidly adopted in the field of
pediatrics from the middle of the 20th century,
principally, as a means of treating develop-
mental disorders in children. As the pioneer-
ing nation in music therapy, the behavioral
treatment approach (applied behavioristics
method) was developed in the United States.
Nordoff Robbins, who developed creative
music therapy, adapted play therapy that
emphasized improvisation and effectively uti-
lized the characteristics of the music. His
approach has greatly influenced music therapy
in Japan.
Others such as the renown Montessori in
the field of education for mentally retarded
children, Carl Olaf in music education, and
Darkrose, famous for rythmique, and other
experts in educational therapy have estab-
lished various schools of thought in music
therapy, that has also influenced music
therapy in Japan.
Music therapy has been widely applied in
the treatment of children suffering from retar-
dation and some form of emotional and
behavioral polarization or abnormality, diffi-
culty adapting due to physical functional dis-
orders, and psychosomatic disorders stemming
from psychological causes.
1. Retardation and emotional abnormalities
impeding mental and physical
Music therapy has been utilized to treat
mental retardation, learning disabilities, devel-
opmental coordination disturbance, communi-
cation disorders, extensive developmental dis-
order, and others. Music activities that meet
the needs and the development level of the
patient are prepared and the aim is to help
adjust the emotions and behavior by having
the child listen to the music. The objective is
to enable the autonomic nervous system to
adjust and relax. Music activities are used at
various stages to stimulate the development of
movement, cognitive functions, communica-
tion skills, and others.
The skill to create as well as select music,
that is in correlation with the level of physical
and mental development and characteristics
of the child, is vitally important, in addition to
understanding the nature of the disorder and
accurately assessing its progress. It is impos-
sible for solely one therapist to develop and
implement this type of therapy for a patient
and a team approach or treatment which
incorporates consultation is required.
The use of musical instruments is also an
important means of therapy, but the approach
differs from the concerns of music education,
which addresses the issue of how to skillfully
play existing musical instruments. In music
therapy, the major objective is to select or
create a musical instrument that is most suited
to the physical and mental functions of
the patient. The teaching aids created by
Montessori or the musical instruments used by
Carl Olaf have been traditionally exploited,
but recently, musical instrument stores have
begun to carry instruments or teaching aids
that have been specifically developed for use
in music therapy.
In either case, the key factors that produce
successful results are the appropriate partici-
pation of the therapist and achieving goals
such as stimulating the natural pace of physi-
cal and mental development by taking advan-
tage of the patient’s interest, improving prob-
lematic behavior, and teaching daily living and
communication skills.
When the disorder is relatively moderate
and the possibility of a correlative relationship
exists, music therapy has been used in small
JMAJ, May 2001—Vol. 44, No. 5 243
repetition is used as part of the learning
process to address a clearly defined problem.
Incorporating music in both stages creates a
calming effect which in turn, encourages the
patient’s participation in the activity that is
being introduced. Additionally, the use of
music makes it easier to structure the treat-
ment and promotes the understanding of the
autistic patient.
2. Behavioral polarization and abnormalities
that impede adaptation
Repetitive behavioral disorders such as
Attention Deficit Hyperactivity Disorder
(ADHD) or antisocial behavior, Tourette dis-
order, silence and eating disorders, and other
repetitive abnormal habits are some of the
disorders that fall into this category. Although
the approach that is taken to treat these disor-
ders differs slightly and the causes and psy-
chological complications that stem from brain
disorders are varied, music therapy is a com-
monly utilized approach, where a variety of
music-related activities are selected to channel
and adaptively release inherent aggression.
The music activities are adjusted until adap-
tive behavior is attained.
The approach also differs according to the
disorder and the personality of the patient.
Music therapy has been successful in achiev-
ing relatively short-term behavioral changes in
cases where psychological complications are a
major factor.
3. Psychological factors as a primary cause
of diverse psychosomatic disorders
A major goal of the treatment for psycho-
somatic disorders is to release psychological
complications that stem from the disorder.
Music therapy has been incorporated into play
therapy and its related forms which are vitally
important to help release the patient’s pent up
emotions and frustrations. Adaptive behavior
is then taught through music activities, fol-
lowed by attempts to verbalize the patient’s
inner self. Music therapy follows the same
groups (3 to 5 patients). In addition to music
therapy targeting individuals, techniques based
on group dynamics are incorporated in such
cases, i.e., techniques that will apply the vari-
ous phenomena produced by group therapy to
the benefit of the individual patient.
The author has proposed the following
BED music skills as a therapeutic technique
for helping development impaired children.
E: Echo T (Ttechnique)
D: Dialogue
M: Modeling
U: Unaccomplished T
S: Stimulative T
I : Iso-T
C: Call T
The above is a list of improvised communi-
cation techniques. These techniques have been
published in other reports; therefore, a detailed
explanation has been omitted.
In the case of severe, extensive develop-
mental disorders such as autism, many aspects
of the disorder are unknown. However, sig-
nificant progress has been made in the area
of semiology and therapeutics in the past 20
years. Autism, at least, has been recognized
as a specific brain disorder and play therapy
and other related approaches that were hith-
erto employed, have been largely replaced
by behavioral therapy or a cognitive learn-
ing approach. The therapeutic educational
approach has produced consistent results.
Although a systematic approach has not
prevailed in Japan, some areas of the
approach have been enthusiastically adopted.
Music therapy within the field of educational
therapy in the treatment of autism is as yet
inadequate in Japan, but the author has
actively adopted music therapy as one form of
treatment for autism and as a means of moti-
vating patients.
Based on the author’s clinical experience,
the treatment of autistic patients is comprised
of two stagesa stage where free expression
of the patient is encouraged and a stage where
244 JMAJ, May 2001—Vol. 44, No. 5
process as the commonly utilized forms of
psychological therapy.
The significance and effectiveness of music
therapy in pediatrics have been explained in
this paper. Music therapy takes advantage of
the physical, psychological, and social impacts
of music by using selected music-related
activities in the treatment of children suffering
from various disorders. Further, a summary of
the major techniques and points, that is used
to treat the three major areas of develop-
mental and behavioral disorders and psycho-
logical complications, has been presented.
Due to the restricted length of the paper,
evaluations were not discussed. But, the
results that are achieved through therapy are
closely examined using a behavioral evalua-
tion scale and numerical values that are based
on the direct observations and introspection
of the therapist. It is hoped that music therapy
will be utilized as an enjoyable form of
therapy that provides gradual results, without
inflicting fear or pain on the patient.
1) Matsui, T.: Guide to Music Therapy, Bokunou
Shuppan, 1980. (in Japanese)
2) Matsui, T. ed.: The Practice of Music Therapy,
Bokunou Shuppan, 1995. (in Japanese)
3) Matsui, T.: Method and evaluation, develop-
mental disorders and music therapy. Com-
piled by Sakurabayashi, J.; Music Therapy
Research, Ongaku Tomonoyusha, 1996. (in
4) Matsui, T.: Theory; the general explanation of
music therapy. Compiled by Hinogen, S.,
Shinoda, K. and Kato, M. ed.: Standard Intro-
duction to Music Therapy, Shunkasha, 1998.
(in Japanese)
5) Nordoff, P. and Robbins, C.E.: Creative Music
Therapy, John Day Co., New York, 1977.
... Music intervention (MI), including music therapy and music treatment [7,8], refers to a non-invasive systematic interventional process in which music is delivered by therapist or medical personnel to improve patients' health outcomes [9][10][11]. MI facilitates a sense of control in patients [12] and provides mental distraction [8,13], emotional smoothness, and relaxation, which have been found to have pain relief effects. ...
... Therefore, music can be appreciated even by newborn babies, which indicates auditory access may be a key to pain relief [81]. On top of that, MI delivers rhythm, melody, and harmony that may smooth emotion and lead to relaxation [12]. Compared to other non-invasive and non-pharmacological pain relief interventions, such as sucrose and massage, MI is recommended for its convenience and effectiveness. ...
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... It is thought that the accurate interpretation of, and prompt response to, infant's needs will protect them from excessive stress and allow them to develop effective stress regulation (e.g., hippocampal control of hypothalamus-pituitaryadrenal axis activity). Music could be a therapeutic method to externally regulate the internal stress response by lowering cortisol levels and allowing sustained restful states (Avers et al., 2007;Anderson and Patel, 2018). ...
... Music therapy has shown beneficial effects on relieving symptoms and is mainly related to emotional state control, cognitive processing, stress management, and stress immune response (Avers et al., 2007). Gibbons (1983) argued that rhythmic task performance could improve internal organization and impulse control, as the creation of organized music requires considerable attention and self-control with other members in the group. ...
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... One of the causes of falls in the elderly is the occurrence of postural disorders caused by the aging process, the disease experienced, and a decrease in bodily functions. Falling incidents experienced by the elderly can result in fractures, muscle disorders and the most fatal risk is death [5]. Postural balance disorders occur due to a decrease in the number and size of muscle fibers (muscle atrophy). ...
... Musica e colori sono linguaggi universali che riescono a raggiungere persone di ogni età, appartenenti a popoli diversi, a etnie diverse e a culture diverse, e che possono quindi essere un valido strumento per aiutare chiunque a esprimere le proprie emozioni e i propri stati d'animo. Musica e colori sono universali, ma allo stesso tempo individuali: l'ascolto di una stessa melodia può infatti evocare emozioni differenti in rapporto a chi la ascolta 1 . ...
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... La musicothérapie est l'une d'elles et a pu être évaluée dans de nombreux travaux scientifiques. 14 Elle a particulièrement été étudiée dans certains domaines d'application tels que la pédiatrie [15][16][17][18] , la cancérologie [19][20][21] , ou la neuropsychiatrie. 22-24 L'évaluation de l'intérêt analgésique de la musicothérapie a fait récemment l'objet d'une méta-analyse du groupe Cochrane qui conclue à un bénéfice en termes de diminution de l'intensité de la douleur et du recours aux analgésiques médicamenteux. ...
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Protocol French version. (PDF)
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This study investigated the effect of daily relaxation on concentrations of serum immunoglobulins A, G, and M and secretion rates of salivary immunoglobulin A (S-IgA). Twenty-four volunteers were randomly assigned to practice a relaxation technique daily for 3 weeks and 16 to a waiting list control condition. Blood and saliva samples were collected before and after a supervised 20-min relaxation session at the beginning and end of the 3-week practice period. S-IgA secretion rate increased significantly (pbefore to after relaxation samples was higher (p=.014) in subjects who had practiced relaxation once a day for 3 weeks than in waiting list control subjects practicing for the first time. Serum IgA (ppp
The professional activity of air traffic controllers (ATC) is often considered to be rather stressful. Certain characteristics of this job are likely to produce stress; for example an ATC can not predict when a situation becomes critical and he is not able to regulate the workload. In order to assess psychophysiological stress reactions in this working situation, saliva samples were taken from 158 male air traffic controllers before and after each of two working sessions. In contrast to the expected immunosuppressive effects, the working sessions caused a marked increase in the concentration and secretion rate of salivary immunoglobulin A (sIgA), as well as in the concentration of salivary cortisol. The increase in sIgA, however, was not correlated with the salivary cortisol response or with the amount of actual or perceived workload, whereas the cortisol response was correlated with both workload measures. It is suggested that positive emotional engagement is responsible for the observed sIgA increase and that measuring this physiological response may be a valuable tool for differentiating between positive and negative stress effects or between successful and unsuccessful adaptation or coping with situational demands.
Salivary immunoglobulin A (IgA) is one characteristic humoral factor of the local immune system in the upper respiratory tract. Epidemiological studies emphasize the importance of secretory IgA in the protection from infections of the upper respiratory tract. However, due to high interindividual variability of secretion of salivary IgA, it remains difficult to define normal ranges. This series of studies focused on identification of factors influencing basal secretion of salivary IgA. The results indicate a significant relationship between age and salivary IgA concentration. Children below 7 years have lower salivary IgA concentration than children above 7 years or adults. Furthermore, a significant inverse relationship between saliva flow and salivary IgA concentration was found. Gender, mood states, salivary albumin, salivary catecholamines, and salivary cortisol were not associated with salivary IgA. It can be concluded that for defining normal ranges of salivary IgA, age and saliva flow have to be considered.