This blog will include both person-first language (“a person with autism”) and identity-first language (“an autistic person”) to reflect the differences in preferred language in the autistic community. You should always directly ask a person’s preferred language. All references are hyperlinked. Neurodiversity is a term used to describe the differences in the way people’s brains work. It is the idea that there is no “right” or “wrong” way for the brain to function and that people perceive and respond to the world in different ways. It is often used in the context of autism spectrum disorder (ASD) but it also refers to ADHD, downs syndrome, dyspraxia (movement processing difficulties) and dyslexia (language processing difficulties) to name a few. The term was coined by Australian sociologist Judy Singer in the 1990s to promote equality and inclusion, as well as highlight the benefits of neurodiversity. The DSM-V describes autism spectrum disorder as a developmental disability characterized by difficulties with social communication and interaction, and restricted and repetitive behaviors. Historically autism research focuses on the social communication and interaction aspects of the disorder, often neglecting the sensory and motor needs of persons with autism. We have eight senses - sight, hearing, smell, taste, touch, vestibular, proprioceptive and interoceptive. The vestibular system senses balance and posture, while the proprioceptive system senses movement, action and location. The lesser-known interoceptive sense is responsible for understanding our body’s internal sensations, like whether we’re hungry, cold or tired. Autistic people often have difficulty interpreting sensory information which can result in difficulties with self-regulation. If you have trouble interpreting sensory information your body might feel uncomfortable but you don’t know why. This feeling of “not being in your body” can result in sensory seeking or sensory avoiding behaviors. A sensory seeking behavior might look like stomping one’s feet or squeezing one’s hand and a sensory avoiding behavior might look like avoiding physical touch with others. As a result persons with autism have difficulty with arousal regulation. If you’re over- or under-stimulated, it is more difficult to interact with others and to regulate your emotions. Unfortunately these sensory seeking and avoiding behaviors are often mislabeled as difficult behaviors related to the socio-emotional aspects of the disorder. Music therapy is often used to support autistic individuals with arousal and sensory integration, interaction and communication, and emotion regulation. Here are some ways music might be used! Movement to music can aid in the integration of the senses, such as auditory perception and the integration of the visual, tactile and kinesthetic senses to improve body awareness. Music and deep pressure input, such as hand squeezes, can also provide functional sensory input and reduce sensory seeking behaviors. The rhythmic component of music helps to organize the motor system. Music can then be used to improve gait, as well as fine and gross motor skills. For example, playing the piano to improve finger dexterity or hitting a drum bilaterally to practice trunk rotation. A music therapist might use developmentally appropriate songs to enhance speech and language development in children with autism. Through singing, instrument playing and movement children can learn things like the days of the week or how to get dressed independently. Singing can also be used to help with vowel and consonant production or word learning to support speech and language development. Improvisational music playing can be used to mimic social situations in order to teach turn taking, listening and responding and joint attention. For autistic individuals who are non-verbal, music can be a form of communication and self-expression. Singing, songwriting, improvisational music playing and music listening can be used to help identify and express emotions. The different qualities of music can help us to convey emotions without using words. Music can also promote relaxation. A guided meditation or progressive muscle relaxation with music can help calm the body and mind, as well as improve body awareness. These are just some of the ways that music can support persons with autism.

Did you know that ADHD is one of the most common neurodevelopmental disorders in Canada? According to the Centre for ADHD Awareness, it affects 4-6% of adults and 5-7% of children or approximately 1.8 million Canadians. This means 1 in every 21 Canadians has the disorder. So what is ADHD? ADHD stands for Attention-Deficit/Hyperactivity Disorder. The DSM-V defines symptoms of ADHD as inattention, hyperactivity and impulsivity. Inattention might include failure to pay attention to detail and difficulty focusing and following through tasks. Hyperactivity might include excessive fidgeting and movement not appropriate to the situation, while impulsivity may include difficulty with turn taking or blurting something out. ADHD can be defined as a predominantly inattentive, hyperactive/impulsive or combined presentation, and often persists into adulthood. However sometimes the diagnosis is missed in childhood leading to a diagnosis later in life. Persons with ADHD have lower levels of the neurotransmitter dopamine. Dopamine is involved in attention and memory, movement, reward and motivation. A study from Lyon University found that listening to the music you like will increase the release of dopamine from your brain. Curious to know more about how music can support persons with ADHD? Well, music is often used to practice attention skills. Attention can be broken down into four types: sustained, selective/focused, alternating and divided. Did you know that learning to play an instrument can help develop different memory and attention skills? For example, while playing piano you have to sustain your attention on the task, alternate your attention between the music and your hands, as well as divide your attention between the treble and bass clef. If you catch yourself playing a wrong note, you might also pause to practice the passage. Other examples of attention exercises might include responding to different musical cues with music and movement. For example, to practice selective/focused attention a music therapist might have the client drum along to a beat with distractions in the background and a distinct musical cue that indicates stop and start. Another example of an alternating attention exercise might look like clapping if you hear the drum and swaying if you hear the guitar - this requires you to switch your focus between two different sources! Overall, attention exercises are important for improving focus on tasks, filtering out distractions and multitasking. Persons with ADHD often struggle with executive function. Executive function is our ability to plan, organize and make decisions etc. Research suggests that music therapy can improve executive functioning. Improvisational music playing and musical composition can help a client work on these skills in a pleasurable and motivating environment! In order to create a musical composition you have to plan and organize the structure, making decisions about your creation along the way. Finally music can also help with stress management and emotion regulation. Music and progressive muscle relaxation or movement can help calm the body and mind, as well as get rid of excess fidgeting. Improvisational music playing, listening and creating can also provide a means of self-expression in order to regulate one’s emotions. No matter your age - music can help improve attention, reduce hyperactivity and create pleasurable experiences for persons with ADHD. 

Parkinson’s disease is a progressive disorder that is caused by degeneration of nerve cells in a part of the brain called the substantia nigra, which is responsible for controlling movement. It’s the most common movement-related brain disease, affecting approximately 1% of people 60 years and over worldwide (AANS, 2023). When you hear Parkinson’s disease, what comes to mind? Most people will think of slowed movements (bradykinesia), tremors and rigidity, a stooped posture and shuffling (or festinating) walking pattern. But did you know that Parkinson’s disease heavily impacts the voice? Approximately 90% of people with Parkinson’s disease experience something called dysarthria (Moya-Galé, 2019). Dysarthria refers to a group of motor speech disorders characterized by weakness, slowness or poor coordination of the speech muscles. It is referred to as an execution disorder because the weakened speech muscles result in consistent speech errors. Signs of dysarthria might include an inability to speak loudly, abnormal speech rhythm, a strained, raspy or nasal sound voice, monotonous speech, difficulty moving the tongue and facial muscles, slow and/or slurred speech and rapid speech that is difficult to understand. While there are seven types of dysarthria, hypokinetic and hyperkinetic dysarthria are most commonly associated with Parkinson’s Disease. Hypokinetic dysarthria is marked by difficulty initiating speech, rigidity, short rushes of speech, a harsh of breathy sound, monopitch and monoloudness. In contrast, hyperkinetic dysarthria is marked by difficulty inhibiting speech, irregular articulation, emotions and facial expressions, as well as tremor, dystonia (involuntary muscle contraction) and tics. With all dysarthrias, the main concern is intelligibility of speech. Did you know that music therapy can be used to treat symptoms of dysarthria? In Neurologic Music Therapy, there are two main techniques I have used when working with client’s with Parkinson’s Disease. The first technique is Rhythmic Speech Cueing (RSC). In RSC, the rate of speech is controlled via auditory rhythm (Thaut & Hoemberg, 2016, p. 151). By practicing speech to a metronome the temporal characteristics of speech, such as fluency, rate of speech and intelligibility improve. The beat of the metronome is determined by assessing the client’s fluency and rate of speech. From here, functional sentences can be practiced. For example, if working on metric cueing, each syllable would be matched to one beat of the metronome (“I – want – a – glass – of – wa – ter”). The second technique is Vocal Intonation Therapy (VIT). In VIT, vocal exercises are used to maintain and rehabilitate aspects of voice control such as inflection, pitch, breath control, timbre and dynamics (Thaut & Hoemberg, 2016, p. 179). These exercises are similar to those used in vocal warm up. Another concern among those with Parkinson’s disease is monoloudness and reduced loudness because it can be difficult to communicate with others if they cannot hear you. A music therapist might use an exercise that has the client crescendo their voice to practice singing more loudly, and then transfer this skill to speaking. With the prevalence of Parkinson’s disease it is important to think about all aspects of the disorder – especially the voice – because it allows us to communicate with one another. In persons with Parkinson’s disease, singing can then be used as an effective tool for maintaining vocal function in an engaging and motivating way.

A term that is frequently heard is ‘quality of life.’ (QoL) The World Health Organization defines QoL as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” [ WHOQOL Measuring Quality of Life (2012)] There are various indicators, measures, tools to evaluate quality of life. In health care, QoL may be thought of as how an ailment affects someone subjectively, whether they are enjoying life and what it holds. Mood, resiliency, anxiety, memories and arousal are 5 ways music can impact quality of life on an individual level. 1. Music releases dopamine Research by Dr. Valorie Salimpoor from the Rotman Research Institute at Baycrest found that listening to music that gives you the chills, triggers the release of dopamine in your brain. Dopamine is a chemical released in the brain that makes us feel good. It acts as our reward center and is involved in functions such as motivation, movement and mood. This evidence suggests that dopamine is not only released when we experience chills, but that it’s also released when we anticipate experiencing chills. So the more pleasurable music you listen to, the more dopamine you’ll produce! 2. Music improves resiliency An analysis by Lee (2021) provided evidence that music had statistically significant effects in decreasing pain and emotional distress on self-report scales, as well as improving heart rate, blood pressure and respiration rate in patients experiencing pain. Although more research is required to pinpoint whether pain relief is due to the release of endorphins, the use of music as a distractor or the use of music to create positive associations, there is no doubt that music improves our resilience in times of need. 3. Music reduces symptoms of anxiety and depression A study by Gfeller (2002) found that music may help reorganize affective content. This might look like rethinking how you process life experiences, changing your perception of self and others, learning new coping skills or setting new goals for yourself. These changes in thinking patterns can help you reduce symptoms of anxiety and depression. This may be why, when you’re feeling upset, you find yourself reaching for your playlist. 4. Music helps recall memories We know from research that areas of the brain that encode musical memory show little damage in Alzheimer’s Disease. A study from the University of Utah in 2019 found that playing personally meaningful music for people with Alzheimer’s Disease stimulated those areas of the brain. A study by Alfredson et al. (2004) found that when older adults listen to self-selected emotionally significant music, there was increased brain activation in regions that link music perception, emotional responses and memories. 5. Music improves arousal Studies have shown that music can both increase or decrease arousal depending on the type of music. There’s a reason that we listen to music when we work out! A study by Eliakim et al. (2007) found that stimulative music increased heart rate, an indicator of increased arousal. In contrast, a study by Yamamoto et al. (2003) found that the gentle and calming qualities of music can decrease arousal. In clinical studies with older adults, researchers also found that music improved sleep quality and decreased night waking. Whether we listen to music, play an instrument or sing, music is a powerful tool we can harness to improve our QoL and make ourselves feel just a little bit better!

There is both qualitative and quantitative evidence to suggest that music has the capacity to fill liminal space and reach into the depths of consciousness. In part 1 , we looked at brain wave research and consciousness in persons who are dying, indicating that music may be a bridge to accompany them through the transition from life into consciousness beyond. In part 2 , we saw how the various dimensions of music appears to be recognizable in all states of consciousness, through hearing, entrainment, music as dialogical activity, and transcendence.