Family-Centered Music Therapy in the Home

Environment: Promoting Interpersonal Engagement

between Children with Autism Spectrum Disorder
and Their Parents
GRACE THOMPSON University of Melbourne, Australia

ABSTRACT: Family-centered practice is a widespread approach understanding of family systems theory, which deems that
guiding how early intervention services support families with children events affecting the family will ultimately affect the child
with special needs such as autism spectrum disorder. An important (Dunst et al., 1988).
feature of this support is its provision in natural settings such as the
Since then, ECI teams in Australian government and
home environment. Ultimately, family-centered practitioners endeav-
nongovernment organizations have implemented a broadly

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or to embed therapeutic approaches into the child’s daily routines so
that they can be facilitated in part by the family. This approach is based family systems approach to support pre-school aged
particularly useful with young children with autism spectrum disorder children with special needs. The Australian Early Child
as a way of promoting interpersonal engagement and therefore the Intervention Association’s Code of Ethics directs ECI practi-
development of early social and communication skills. A model for tioners to: develop collaborative partnerships with families;
applying family-centered practice to music therapy methods is
work to engage in shared decision making with families in
discussed through reflections on practice and case examples.
regards to the support given to their child; work to support and
complement the skills of the family by recognizing their
Autism Spectrum Disorder (ASD) is a group of neurological existing strengths; and respect the family’s right to choose the
disorders with lifelong implications. It is diagnosed based on way they wish to be involved in the services provided to their
impairments in social interaction, communicative behavior, child (ECIA, 2011). ECI services in Australia and elsewhere
and repetitive and stereotyped patterns of behavior or interests additionally acknowledge that young children are actively
(American Psychiatric Association, 2000). These three core engaged and learn best when their learning is part of their
features, sometimes described as the ‘‘triad of impairments of daily routine, emphasizing the need to embed learning
social interactions’’ (Wing, 1988, p. 92), highlight the defining strategies into natural environments such as the home,
feature for every age, stage and level of functioning of people childcare and preschool (Rantala, Uotinen, & McWilliam,
with an ASD as being the ‘‘lack of reciprocal social 2009; Roper & Dunst, 2003).
interaction’’ (Prior & Ozonoff, 1998, p. 83). While there are A central tenet of family-centered practice is practitioners
many different programs to support children with ASD to and families striving to work together in partnership (Davis,
develop early social communication skills, there is evidence Day, & Bidmead, 2002) with an emphasis on building the
to suggest that early, intensive, family-based programs that are capacity of the family (Dunst & Trivette, 2009). Respect,
responsive to the individual differences amongst children and empathy and emotional responsiveness are required from
families are particularly beneficial in supporting these skills practitioners as they attempt to support parents in the highly
(Roberts & Prior, 2006). private and personal responsibility of parenting their child.
Practitioners therefore aim to enhance parents’ self-esteem (in
Family-Centered Practice
this context, their feelings of self-worth as a parent) and their
Since the 1980s, therapists and educators working in the self-efficacy (their belief in their own ability to influence the
field of early childhood intervention (ECI) were expected to be care of their child). The way parents think about themselves in
family, rather than child-focused, practitioners (Dunst, Triv- general, including their skills in parenting, is believed to be
ette, & Deal, 1988). Informed by Bronfenbrenner’s (1975) influenced by the subtle ways that practitioners interact with
systems model, American researchers in the field of ECI, Dunst them (Davis et al., 2002). The quality of the relationship
et al. (1988) wrote their ground-breaking book ‘‘Enabling and between the parent and the practitioner is therefore of great
Empowering Families: Principles and Guidelines for Practice.’’ importance, requiring the practitioner to focus consciously on
They compelled ECI practitioners to turn away from an expert- recognizing and supporting the strengths of the parent (Dunst
model and toward an approach based on family participation & Trivette, 2009).
and collaboration. This shift occurred due to the emerging However, ECI practitioners also need to acknowledge and
respect the challenging circumstances in which parents of
Grace Thompson, PhD, RMT, has worked with young children with autism for the young children with special needs find themselves. These
past 13 years. She has worked at various Early Childhood Intervention Centres
across Melbourne, Australia, in a family centred, team-based model. This material circumstances may compromise their resources and the
was part of her doctoral study. energy they have to engage fully in services for their children
The author would like to acknowledge the contribution of her PhD supervisor, Dr.
Katrina McFerran, in the editing of this article.
(Dunst et al., 1988). Practitioners may therefore need to
Ó 2012, by the American Music Therapy Association balance promoting parent participation and independence
109
110 Music Therapy Perspectives (2012), Vol. 30

with providing appropriate support, mindful that high levels of some authors (Allgood, 2005; Jonsdottir, 2002; Oldfield,
stress may ultimately be detrimental to their capacity to parent 2006).
(Dempsey, Keen, Pennell, O’Reilly, & Neilands, 2009). Music therapists have also started to describe their work
In the past 5 years, researchers have investigated whether with children with ASD in natural environments such as
positive family and child development outcomes are attribut- preschools (Kern & Aldridge, 2006; Kern, Wakeford, &
able to family-centered practices (Dempsey & Keen, 2008; Aldridge, 2007; Kern, Wolery, & Aldridge, 2007), and the
Dunst, Trivette, & Hamby, 2007). In a meta-analysis of 47 home environment (Pasiali, 2004). In the preschool setting,
family-centered studies, Dunst et al. (2007) found that the use music therapists have promoted the inclusion of the child in
of family-centered practices was associated with improved the general activities of the day, including play time with their
parent self-efficacy beliefs, which in turn had a positive peers, by providing consultation and support to carers and
impact on the child’s development. Specifically, family- peers in these settings (Kern & Aldridge, 2006; Kern,
centered approaches that strived to establish strong relation- Wakeford, & Aldridge, 2007a; Kern, Wolery, & Aldridge,
ships between families and practitioners, as well as promoted 2007b). In the home setting, Pasiali (2004) described a
the active participation of parents in the helping process, had prescriptive song intervention for children with ASD where
better self-efficacy outcomes for parents (Dunst et al., 2007). the music therapist worked one-to-one with the child based on
Parents with higher levels of self-efficacy are more likely to goals identified by the family. Music therapy literature in
engage with their children in developmentally focused natural settings with children with ASD so far has focused on

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activities (Dunst et al., 2007). the music therapist working in a consultative model or
providing one-to-one experiences with the child in the family
Interpersonal Engagement and Relationship home. This literature provides an excellent foundation for
The active participation of parents in their child’s therapy music therapists to develop their work in line with collabo-
has the potential to support the development of interper- rative models such as family-centered practice.
sonal engagement between parent and child. Thriving
A Model for Family-Centered Music Therapy Practice
interpersonal engagement in children is considered an
essential precursor to successful communication develop- Broad concepts such as family-centered practice; working
ment (Moore, 2009; Stern, 1985; Stern, Hofer, Haft, & in natural settings; and relationship oriented approaches,
Dore, 1985). Interpersonal engagement incorporates skills could be incorporated into music therapy practice in a wide
such as: the child focusing on the face of their parent; turn- variety of ways. The literature encourages all ECI practition-
taking as part of dyadic play (Schertz & Odom, 2007); the ers to share openly and collaboratively their knowledge and
child responding to joint attention bids of the parent; and skills with the people central to the child’s life (Roper &
the child initiating joint attention (Mundy & Stella, 2000). Dunst, 2003; Sheldon & Rush, 2001; Vismara, Colombi, &
The social communication impairments of children with Rogers, 2009). However, music therapists’ highly specialized
skills in music performance and improvisation present a
ASD often significantly interrupt the acquisition of some or
challenge to collaboration. The following model, based on
all of these skills (Mundy & Stella, 2000). As these early
the author’s 13 years of practice wisdom, is offered as one
skills are non-verbal and rely on reciprocal interactions,
way of conceptualizing family-centered music therapy
they are difficult to promote through interventions involving
sessions. It specifies the skills that may be utilized by music
targeted skill training (Schertz & Odom, 2007). Any
therapists working in this framework, with case examples
intervention aiming to improve interpersonal engagement
provided to illustrate the process of working collaboratively
with children with ASD needs to be based in relationship-
with families. This information is summarized in Figure 1 and
oriented approaches so that skills can be generalized and
illustrates both the contextual and ecological nature of the
maintained (Schertz & Odom, 2007).
music therapy encounter. The various components are
Music Therapy with Families discussed below.
Music therapists have acknowledged the value of working Various Components of Family-Centered Music Therapy
with the families of young children with ASD since the early Sessions
1990s (Müller & Warwick, 1993; Warwick, 1995). Parents (a) Family-centered practice. The outer circle in Figure 1
described feeling supported in music therapy sessions (Müller represents the knowledge the music therapist brings to the
& Warwick, 1993) and experienced music therapy sessions as session and her readiness to work in partnership with the
fun and enjoyable (Chiang, 2008; Nicholson, Berthelsen, family. The music therapist’s knowledge of musical conven-
Abad, Williams, & Bradley, 2008). Further, families described tions; social conventions; social communication develop-
enjoying the fact that the whole family could participate ment; and her experience of working with children with
together in music therapy sessions, which was a rare autism, are all pertinent. Rather than imposing this knowledge
experience for them (Allgood, 2005). After participating in upon the family, family-centered music therapists endeavor to
music therapy sessions, families were also better able to share their professional skills. Through a process of gentle
identify strengths in their child with ASD (Oldfield, 2006; negotiation, the music therapist works to promote a relation-
Oldfield, Adams, & Bunce, 2003). The active participation of ship between herself, the parent, and the child based on
the family in music therapy sessions is considered an essential equality and collaboration. The different yet complementary
part of working with preschool aged children with ASD by expertise of the parent and the therapist is openly acknowl-
Family-Centered Music Therapy with Young Children with ASD 111

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Figure 1. Model for family-centered music therapy.

edged, and the parent is enabled to be an active participant in (b) Attune to the child’s mood and behavior/following the
the sessions to the extent they feel comfortable (Davis et al., child’s lead. Working to establish musical and emotional
2002; Dunst et al., 2007). This approach has similarities with synchronicity (Kim, Wigram, & Gold, 2009) through following
the resource-oriented theoretical framework, which has been the child’s lead and meeting them where they are musically
incorporated into music therapy practice in recent times, most and/or emotionally (Wigram, 2004; Wigram & Elefant, 2009)
notably in the area of mental health. Similar to family- underlies all elements of the author’s family-centred music
centered practice, collaboration and equality in the therapeu- therapy sessions. Rapport with the child is built through
tic relationship between the therapist and client are para- incorporating their interests and skills in the session (Carpente,
mount in a resource-oriented framework, with the focus being 2009). For parents, observing a therapist following their child’s
on working with the client’s strengths (Rolvsjord, 2004). lead may be an unfamiliar experience. One parent shared
Case Example: Collaborating with the Parent their observations of the music therapy sessions with the
author, stating ‘‘...in music sessions he was different. He
Adam was the third child of four in his family, with all the enjoyed participating. I didn’t have to push him into it.’’
siblings aged less than 6 years. His house was busy and (c) Enticing the child with motivating activities. Children
lively, yet he had a quieter, gentler personality than his with severe ASD, demonstrated through considerable com-
siblings. His younger sister, Amy, joined in his music therapy
sessions along with his mother, Riley. After several sessions munication delays and repetitive behaviours, may have
together, Riley expressed that she would like to focus on limited play repertoires and interests (Rogers, Hepburn,
turn taking between Adam and Amy. Turn taking proved Stackhouse, & Wehner, 2003). When working with a child
very stressful for Adam, who grasped tightly to his who has limited interests, it can be valuable for the music
instrument and would not let it go. Riley had experienced therapist to lead some activities sensitively with the intention
this situation numerous times with her children, as often
they would snatch objects away from each other. She of introducing new ideas to the child that expand their
shared her expertise and explained that usually she would experiences. Some young children with ASD, especially those
give each child an object, and then ask the children to swap with severe social communication impairments, may be
with each other at the end of the turn. Swapping rather than musically naive to the possibilities within the music therapy
relinquishing instruments worked perfectly for Adam, session. In the context of a therapeutic relationship, the music
reducing his anxiety considerably. We used this strategy as
our starting point for turn-taking and together Riley and I therapist shares her history of music with the child, and invites
planned how we would progress from a swap to an the child to join in with her. The child is free to respond in his
individual turn in future sessions. own unique way—which is in turn responded to by the music
112 Music Therapy Perspectives (2012), Vol. 30

therapist or the parent—developing together a shared history tone that gave him a cuddly appearance. Maxim often
of musical experiences (Holck, 2004). looked like he was in a daze and did not respond overtly to
Maggie’s or my own attempts to engage with him. At times
Case Example: Enticing the Child to Explore New Possibilities when a glazed look would come over his face, Maggie
would say to him ‘‘where did you go?’’ Maxim showed
Jimmy was a 4½-year-old boy who could sing many glimmers of interest in the instruments, and would pick
children’s nursery songs. While his lyrics were often difficult them up and turn them around in his hands. I met him
to understand clearly, he could reproduce melodies with where he was, matching the music that he was inadver-
accuracy. His speech was mostly echolalic but he could use tently making. I stopped when he stopped, and matched
augmented communication systems, such as picture the sounds he made. Maggie gradually joined in with the
exchange, to communicate his needs and make choices. activity by playing a percussion instrument, sensitively
One session he started to sing ‘‘Hickory Dickory Dock,’’ matching both Maxim’s music my own. Over time, there
and I accompanied him on the guitar. I then took out a was a growing awareness from Maxim of the music being
small teddy bear from my bag, and made it climb up the created. He started to be more responsive to the music, and
cymbal stand while I sang ‘‘Hickory Dickory Dock, the could match simple changes in tempo or volume made by
teddy ran up the clock.’’ As I sang ‘‘the clock struck one,’’ I Maggie or myself. Maggie noticed these changes too and
hit the cymbal, and continued to act out the remainder of began incorporating musical playtime throughout the week.
the song with the teddy. Jimmy watched me intently and When reflecting on the changes in Maxim’s social aware-
then started to imitate my actions. As the activity ness, she revealed her understanding of the therapeutic
principles in the sessions, saying ‘‘You were very patient.

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developed, I incorporated drums and other instruments to
bring the story of the song alive. I supported his Mother, You just didn’t give up on him, and kept trying to get him to
Hanna, to join in by giving her a drum and encouraging her play.’’
to add to the story. At one point, I extended the ‘‘running
(e) The music therapist presents as a play partner. This idea
down’’ music with an improvisation on the guitar and drum.
Jimmy smiled and joined in with the dramatic, dynamic builds on section (d), presenting with positive affective
song play, which continued for several minutes. In behaviors. In addition to the affective aspect of the
subsequent sessions, Jimmy began to make changes and encounter, the author strives to convey an active message
extensions to other familiar songs and a growing interest in to the child—‘‘I want to play with you...let’s play
playing and creating together developed. Hanna used this together’’—through her affirming behavior. The intention
strategy to extend Jimmy’s play with toys by joining him in of the author’s behavior is to promote engagement between
play and weaving in her own ideas when his play routines
became repetitive. the child and parent/music therapist, and so a mixture of
approaches may be applied including: following the child’s
(d) Music therapist presents with positive affect, accep- lead; presenting with positive affect; and being playful and
tance, and affection. Children with ASD may be difficult to present in the actions of the child. Within the author’s
read emotionally, even by those who know them well. They clinical work, many parents have described the pressure
can appear aloof, disinterested and non-reactive (Wing, they feel to teach their child something rather than play
1988), and it may be difficult to tell by observation whether with them. One parent, when reflecting on the music
the child is interested in an activity or object. Alternatively, therapy sessions, stated ‘‘In other surroundings when I teach
they may be highly reactive to stimuli that would hardly be him generally, he doesn’t want to participate—it’s like I
noticed by others (Prior & Ozonoff, 1998; Volkmar, Lord, have to force him to do certain things. But he actually
Bailey, Schultz, & Klin, 2004). In the author’s experience, enjoyed doing music therapy.’’ Perhaps this ‘teaching’
families have expressed a sense of being rejected or disliked approach is due in part to the fact that as the child grows
by their child with ASD if the child is aloof and does not in age, parents may feel that play is no longer age
give many social signals to their family. Conversely, when a appropriate. Music therapists can support parents in the
child is highly reactive and has difficulty tolerating various creative building of interactions with their child based on
stimuli, families have expressed fear that any demands they the child’s interests or presenting behaviors (Aud Sonders,
make of their child might result in the child becoming more 2003).
upset or reacting unexpectedly. Research suggests that in
these situations adults reduce communication attempts Case Example: Building an Interaction Based on the Child’s
towards the child with ASD without realizing it (Dawson, Behavior
Hill, Spencer, Galpert, & Watson, 1990; Rocha, Schreib-
man, & Stahmer, 2007). By modeling positive affect, Jake presented as an anxious boy who sought solitude and
familiarity. He repeatedly watched DVDs and would often
acceptance and affection, music therapists can reframe
go up close to the screen, smile, and vocalize. The music
the meaning of the child’s behaviors towards a more therapy sessions seemed challenging for him—he would
positive interpretation. often leave the room or start to engage in a solitary activity.
On one such day, he curled up on the couch with his
Case Example: Supporting Maxim’s Mother to Reinterpret blanket and closed his eyes. His mother, Naomi, and I
His Behavior talked quietly for a moment, and I then asked her if I could
try to make a game of Jake’s behavior, to which she
Maxim had just turned 4 years of age at the beginning of agreed. In an exaggerated way, I said ‘‘look Mum, Jake is
music therapy. His mother, Maggie, described him as ‘‘lazy’’ sleeping....ssshhh.’’ I then sang the words ‘‘good night
because he often just sat or lay on the floor, seemingly Jake’’ to a simple improvised tune. Naomi began to rub his
inactive. He was a large boy for his age, with low muscle arms. Jake started to smile as he scrunched his eyes tightly
Family-Centered Music Therapy with Young Children with ASD 113

shut. I sang the song again, and then counted ‘‘1 – 2 – 3 structure. Hanna began to praise the short turns Jimmy
...’’ paused, and then Naomi gently tickled him. He would have in less structured activities, which helped to
responded by jumping up onto her lap, where they keep the session as a positive experience. Hanna recog-
cuddled for a moment. The blanket accidently fell to the nized that making-up-a-story-with-music was an activity
floor, and Jake quickly jumped off and grabbed it, and that gave Jimmy some structure but also encouraged
then lay down again. Naomi and I repeated the game dynamic and creative changes to occur through improvis-
several times. At the end of each turn, Jake lay back down ing extensions to the story. Hanna was able to use this
and scrunched his eyes closed which we interpreted as a activity as a model for play outside of music therapy
request for more. Naomi expressed that building an sessions and reported happier, less rigid play times between
activity based on Jake’s behavior was a more successful her and Jimmy.
and gentle way to engage Jake compared with expecting
him to follow an adult directed activity. (g) Matching the child’s abilities, and (h) Understanding
social communication development theories. Assessment of
(f) Keep the child’s anxiety low. Assess the need for
the child’s abilities in music therapy is ongoing and care is
structure, choice or control. If a child is stressed and
pressured, their ability to concentrate and participate will be taken to introduce or extend activities in ways appropriate to
compromised (Sussman, 1999). The type of structure provided the child’s presenting social communication abilities. This
in music therapy sessions is an important factor in moderating assessment is based on a sound understanding of social
anxiety for children with ASD. Some children are only able to communication development theories. When following the

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use their social communication skills in highly structured child’s lead, this knowledge guides the way activities are
activities that allow them to predict what is coming next. extended to gently challenge the child’s abilities and promote
Other children are only able to participate socially when the development. While typically developing children move
session is free flowing and determined by their interests. As through a predictable sequence of stages in social communi-
interactions in natural environments typically require children cation development, children with ASD often do not follow
to be flexible in their need for structure, the social inclusion of the usual sequence of skills (Carpenter, Pennington, & Rogers,
children with ASD can be compromised by either of these 2002; Clifford & Dissanayake, 2008). Early skills, such as
extremes. sharing attention, may be underdeveloped, while later skills,
Music therapy can promote flexibility in children with ASD such as object manipulation, may be strengths.
in a variety of ways, most notably using improvisational Therefore, for children with severe ASD, it may be useful to
methods. For children who participate best when others follow conceptualize these skills as building blocks of social
their lead, improvisation enables the music therapist to communication development. This analogy acknowledges
promote interaction with the child through mirroring and the importance of all these skills for continued social
matching the child’s music, vocalizations or behavior. communication development, but reasons that the order in
Paradoxically, improvisation can also support structured which they occur is less relevant. These building block skill
interactions by incorporating predictable musical patterns areas include: shared attention; focus on faces; turn taking;
and encouraging musical dialogue (Wigram, 2004). The object play and manipulation (Adamson & McArthur, 1995;
dynamic, multifaceted applications of improvisational meth- Bakeman & Adamson, 1984); affect attunement (Hughes,
ods make it a versatile tool to encourage children’s flexibility. 2009; Stern et al., 1985); response to joint attention; and
By modeling and sharing experiences from practice with initiation of joint attention (Prizant, Wetherby, & Rydell, 2000;
parents, the author encourages them to be guided by their Schertz & Odom, 2007).
child’s level of anxiety. Initially parents are encouraged to (i) Child initiates engagement. While the outer circle in
meet their child’s need for structure and then gently to Figure 1 describes the various theories, approaches and
introduce some balance or variety (Aud Sonders, 2003; knowledge the music therapist calls on in family-centered
Sussman, 1999). practice, the inner circle depicts the author’s main social
Case Example: Introducing the Family to Less Structured communication aim for the child with ASD. Communication
Methods and social skill development are often cited as aims for music
therapy with children with ASD (Allgood, 2005; Kaplan &
Jimmy excelled at structured activities. He had a quick mind Steele, 2005; Walworth, 2007; Wigram, 2002). The author
and could learn the expectations of an activity with ease. considers that when trying to promote interpersonal engage-
He followed instructions most of the time and smiled when ment between children with ASD and their families, the
his family praised his efforts. However, in unstructured pivotal aim is for the child to initiate engagement with others;
activities, such as instrumental improvisation, Jimmy would
quickly lose interest and only participate for several meaning that the child attempts to interest someone in
seconds. His behavior sometimes prompted his parents to something, or keep the interaction going. This aim speaks to
express disappointment toward him because they interpret- an understanding of social communication development as
ed his behavior as uncooperative. In order to keep the being more than a cued response to another person. The child,
sessions positive, and the activities needed to be carefully having been immersed in the norms (or culture) of the music
structured for success, but with opportunities for develop-
therapy sessions as discussed above, has a lived experience of
ment of new skills. I shared information with his Mother,
Hanna, about the challenges unstructured activities can those norms that hopefully provides him with useful tools for
cause for children with ASD, and together we planned engaging. Supporting the active, independent participation of
some activities to help Jimmy experience different types of the child is vital for successful social skill development
114 Music Therapy Perspectives (2012), Vol. 30

(Campbell, Milbourne, & Wilcox, 2008; Poulsen, Rodger, & Sonders, 2003; Mundy & Stella, 2000). These moments of
Ziviani, 2006). engagement, which are often coupled with emotional
synchronicity (Kim et al., 2009), nourish and sustain
Case Example: Ash Initiates Using Musical Skills Learned relationships (Hughes, 2009; Stern, 1985; Stern et al., 1985).
During Sessions Therefore, the sometimes-fragile connections between parents
and their child with ASD can be strengthened by these
As Ash participated in more and more instrument activities,
interactions.
he became familiar with the repertoire of styles that were
used in the sessions. After hearing his mother, Anne, play
Case Example: Emotional Synchronicity between Ivan and
soft and then loud in her improvisations, Ash incorporated
these elements into his improvisations too. After hearing me His Mother
improvise on the guitar with an accelerated beat, he too
started to initiate this idea in his own improvisations for Ivan was fascinated with the slide whistles, and particularly
other people to follow. Over several music therapy sessions, with his mother, Angel’s, playing of them. Ivan would
Ash had opportunities to observe how Anne and I would initiate this activity by getting the slide whistles out of the
combine soft, loud, fast, and slow styles into our playing. bag and giving one to Angel. I encouraged Angel to position
These styles became his repertoire for musical improvisa- herself face to face with Ivan, and to give him his own
tion, initiated in varying ways during his instrument playing whistle. Angel would move the slide in and out, and do
on the drum or cymbal. actions with her whistle such as move her head up and

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down, or in circles while she played. Ivan would play his
The challenge for parents and therapists is to create an whistle in the same way as Angel, copying her actions and
environment that is conducive to child-initiated engagement. looking at her intensely. Often the pair would stop and
According to self-determination theory, a child who is smile or laugh at each other. In an interview with Angel as
intrinsically motivated will have higher levels of unprompted part of the evaluation of the sessions, she commented about
how she felt during this activity: ‘‘My favorite time was
participation and persistence in activities (Poulsen et al.,
when I was playing the slide whistle with him. During this
2006). There are three categories of intrinsic motivators, time, he would constantly look into my eyes and smile. It
namely: the acquisition of knowledge; mastery of skill; and would make me feel really special.’’
sensory pleasure. Of these, sensory pleasure is an intrinsic
motivator particularly relevant to music therapy sessions with Conclusion
children with severe ASD. The inner circle in Figure 1
therefore describes the music therapist’s or parents’ endeavors Providing music therapy within a family-centered frame-
if/when a child initiated engagement occurs: respond to the work complements the relationship-focused methods that are
child in an attuned way; and try to extend the duration or a typical feature of music therapy practice. Within this
content of their initiation. Hopefully, the child will show framework, the practitioner is not only concerned with
awareness of the music therapist’s or parents’ responses and be outcomes for children but also the ways these outcomes are
motivated to engage further. facilitated. The challenge is to collaborate with families in a
Traditionally, attunement is a dyadic encounter, which participatory way, so that families’ knowledge and skills are
could seem to be at odds with the collaborative style of family- fostered in the hope of enhancing children’s developmental
centered practice. It is important for music therapists to opportunities in the natural setting of their home environment
collaborate and negotiate with parents throughout the session (Roper & Dunst, 2003). The active involvement of parents in
so that a consistent response to the child can be given, and music therapy sessions opens the possibility for positive family
parents’ self-efficacy is not undermined. For example, if outcomes as well as meaningful child development outcomes.
parents express a desire to understand more about responding One Mother’s response to an evaluation interview illustrates
to their child’s initiations of engagement, the negotiation the multiple outcomes experienced during music therapy. She
might take the following form: sometimes the music therapist articulated the benefits of music therapy for her child and her
will take an active role of interacting with the child if she is the relationship with him in this way: ‘‘Music therapy for me
one who notices the child’s attempts at engagement; changed the way I saw my son. On many occasions watching
sometimes it will be the parent who recognizes the him, I saw a happy, normal boy interacting, learning and
idiosyncratic attempts at engagement by their child and they having fun. He was free, doing something he enjoyed. He
are the ones to interact with them; and at other times, the didn’t look or act autistic.’’
music therapist might be the first to respond to the child but
will withdraw involvement as the parent begins to take on the
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