15041611Voices: A World Forum for Music Therapy1504-1611GAMUT - Grieg Academy Music Therapy Research Centre (NORCE &
University of Bergen)10.15845/voices.v19i2.2598ResearchEffects of Instructor Gender and Visual and Auditory Melodic Recorded
Instruction on Sequential Working Memory Recall in Individuals with and without
Autism Spectrum DisorderSchwartzbergEdward Toddschwa155@umn.eduSilvermanMichael JUniversity of Minnesota – School of MusicRicksonDaphne JoanNooneJasonMurphyMelissa172019192191020182632019Copyright: 2019 The Author(s)2019This is an open-access article distributed under the terms of the
http://creativecommons.org/licenses/by/4.0/, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.https://voices.no/index.php/voices/article/view/2598
There is a lack of empirical inquiry concerning the effect of the therapist’s binary
gender and aspects of visual and auditory melodic instruction on working memory
recall in individuals with autism spectrum disorder (ASD). The purpose of this study
was to examine the effects of instructor gender and visual and auditory melodic
instruction on working memory in individuals with ASD. Participants ( n = 38
individuals with ASD and n = 18 neurotypical [NT] university students) viewed or
listened to four melodic sequences of seven randomized monosyllabic words sung by
female and male instructors. To assess working memory, participants’ tasks were to
sequentially recall the paired information presented within each condition. There was
no significant within-group difference between either the male and female instructor
conditions or the visual + auditory or auditory only melodic instruction. Although
not significant, participants tended to have slightly higher mean recall for the male
instructor with visual + auditory stimuli condition and lower mean recall for the
female instructor with auditory only stimuli condition. There was a significant
between-group difference with the NT group having greater recall accuracy than the
ASD group. Regardless of group or condition, participants tended to have greater
recall accuracy at primary and recency serial positions. As individuals with ASD may
have unique learning challenges, information paired with music may be delivered in
multi-sensory ways to increase the likelihood of recall and subsequent learning.
Implications for clinical practice, limitations of the study, and suggestions for
future research are provided.
Researchers continue to identify evidence-based interventions (NAC, 2009,, 2015)
that can offer safe, success-oriented, cost-effective, and generalizable results for
individuals with autism spectrum disorder (ASD). Providing a multi-sensory experience
that stimulates a myriad areas in the brain may improve working memory and subsequent
learning for individuals with ASD (Berger,
2002). While visual supports and video modeling (NAC, 2009,, 2015) are
best-practice approaches used to communicate with and teach individuals with ASD, there
is a lack of empirical inquiry concerning the presentation of the information to be
learned. As many music therapists work with individuals with ASD and approximately 87%
of music therapy clinicians are female (AMTA,
2018), investigating if the gender of the care provider impacts client
learning is warranted. In addition to the care provider’s gender, visual and auditory
aspects of the presentation of information may also impact recall. Therefore, the
purpose of this study was to examine the effects of instructor gender and visual and
auditory melodic instruction on working memory in individuals with ASD.
Literature Review
Researchers from the National Center for Education Statistics have investigated teacher
gender discrepancies. During the 2015 – 2016 school year, they concluded that
approximately 77% of public school teachers were female (National Center for Education Statistics, 2017). Due to the
gender difference in the teacher workforce, researchers have investigated same versus
different gender pupil-teacher interactions. In elementary public schools, Ehrenberg,
Goldhaber, and Brewer (1995) concluded that
female students’ test scores in mathematics and science did not increase more rapidly
when the teacher was a female than when the teacher was a male. Mancus (1992) concluded that while elementary aged
girls and boys attributed authority to male teachers, elementary aged girls and boys
attributed academic competence of the teacher most often to female teachers. Boys tended
to follow an egalitarian pattern of positive attributions, with slightly more made to
female teachers. Dee (2005) asserted that
both male and female students were more likely to be perceived as disruptive by an
opposite gender teacher. In a longitudinal study involving 54,000 students, Bettinger
and Long (2005) concluded that female
instructors might positively influence female freshman college students’ course
selections and major choices, thus supporting a possible role-model effect. The
researchers also noted that male faculty may positively impact same-gender student
interest in a subject of study.
Impact of Gender on Instruction and Therapy
Medically-oriented researchers have investigated the influences of care provider gender
and care receiver gender and have concluded that preexisting stereotypes, expectations,
or actual differences in physicians’ behaviors, and the tone and content of the medical
visit might be different depending on physician gender. Hall and Roter (2002) conducted a meta-analysis and concluded
that patients, regardless of gender, spoke more to female physicians than to male
physicians and disclosed more biomedical and psychosocial information. Similarly, Bhati
(2014) asserted a general “female effect”
and concluded that the female and male clients matched with female therapists reported a
higher therapeutic alliance, collaborative role enactment, and empathetic resonance than
when the female and male clients were matched with male therapists. In a related
investigation, Pikus and Heavey (1996)
concluded that the majority of female clients preferred working with female therapists.
Female clients specifically commented that they felt more comfortable talking with
someone of the same gender while most male clients expressed no preference for therapist
gender. In addition to gender matching potentially influencing therapeutic alliance,
gender matching also appears to be a factor in determining treatment retention.
Wintersteen, Mensinger, and Diamond (2005)
and Shiner, Westgate, Harik, Watts, and Schnurr (2017) reported that female patients who were treated by female therapists had
the highest retention rate while male patients who were treated by male therapists had
the lowest retention rate.
Neural Connectivity and Working Memory in Autism Spectrum Disorder
Individuals with ASD often present with deficits in cognitive processing (Bauman & Kemper, 2005; DiCicco-Bloom et al., 2006). These deficits are
specifically apparent in the frontal lobe, the area of the brain primarily responsible
for executive functioning (Geurts, Verte,
Oosterlaan, Roeyers, & Sergeant, 2004; Verte, Geurts, Roeyers, Oosterlaan, & Sergeant, 2006).
Researchers have also concluded that hyper-connectivity appears to exist between the
prefrontal and parietal cortices and a hypoconnectivity exists between the sensory-motor
regions (Holiga et al., 2019).
Researchers have labeled this difference in neural connectivity as the
“underconnectivity theory” (Just, Cherkassky,
Keller & Minshew, 2004; Just &
Varma, 2007). Proponents of this theory have asserted that inter-regional
connective in the frontal lobe of the brain is disrupted in autism due to poor
frontal-posterior connectivity (Just, Keller,
Malave, Kana, & Varma, 2012). Holiga and colleagues (2019) concluded that understanding brain connectivity
alterations in ASD might help the development of better diagnostic and therapeutic
tools.
Working memory is the ability to simultaneously store and process information (Baltruschat et al., 2011). Pennington and
Ozonoff (1996) concluded that working memory
functions as an organizational aspect of memory and has a role in goal-directed
behavior. Responsible for aspects of executive functioning, working memory is integral
to linguistic processing (Elliot, 2003) and is
primarily processed in the dorsal and lateral pre-frontal cortex (Nolte, 2002, p. 549). As a result of the structural differences in
the neural connectivity of the brain of individuals with ASD, individuals with ASD
regularly demonstrate deficits in working memory that can lead to challenges in
understanding social cues, academic progress, and independent living skills.
Non-Music Based Approaches to Enhance Working Memory
In order to improve cognitive processing for individuals with ASD, experts have
identified modeling and visual supports as two of the 11 established evidence-based
practices (NAC, 2009,, 2015). Video modeling is a combination of both modeling (Bandura, 1977) and visual supports (Quill, 1997) and can be an effective approach for
teaching social skills, self-care skills, and motor skills (Bellini & Akullian, 2007; Charlop-Christy & Daneshvar, 2003; Charlop-Christy, Le, & Freedman, 2000; Sherer et al., 2001). Video modeling may also be considered a
form of dual coding (Paivo, 1991), wherein the
target information is delivered and received through both the auditory and visual
channels. To assist with video modeling, clinicians and teachers commonly used
electronic recording devices such as the iPad® as an accessible and
visually stimulating reinforcement of teaching. Since the advent of the
iPad® in 2010, researchers have demonstrated the efficacy of the
technology for academic, social, communication, and emotional regulation skill growth.
Allen, Hartley, and Cain (2016) concluded
that the iPad may be a tool to assist children’s ability to generalize academic skills
outside of the formal school environment.
Due to the importance of utilizing visual and auditory supports as effective
enhancements to the educational and clinical environments of neurodiverse individuals,
the use of the iPad® as an instructional tool has become more prevalent over the last
decade. Therefore, researchers have investigated the effectiveness of this technology on
academic and social skill achievement. Allen, Hartley, and Cain (2016) recommended that iPads® might motivate children to engage
with learning. Maich and Hall (2015) offered
suggestions for using iPads® for educational purposes, choosing appropriate
applications, and integrating the technology into the inclusive classroom environments.
Researchers have also investigated the use of iPad®-based video modeling to teach
numeracy skills (Jowett, Moore, & Anderson,
2012), iPad®instruction on challenging behaviors and academic
engagement for children with ASD (Neely, Rispoli,
Camargo, Davis, & Boles, 2013), and the use of video self-modeling on an
iPad®to teach functional math skills to adolescents with ASD (Burton, Anderson, Prater, & Dyches, 2013).
El Zein et al. (2016) concluded that
teacher directed instruction was more effective for increasing the accuracy of
responding to curriculum-based measure probes than iPad® instruction. The researchers
also recommended using the iPad® to teach students skills that would aid in enhancing
their reading comprehension. Moreover, they identified that iPad® applications should
incorporate modeling, prompting, visual supports, and positive reinforcement. As
motivational processes directly impact knowledge acquisition and transfer, it would seem
that the integration and usage of the iPad® in educational and therapeutic environments
should be further explored (Wang, Teng, & Chen,
2015).
Paired Associate Music to Enhance Working Memory
Care providers often utilize music for social and academic skill attainment (Brownell, 2002; Schwartzberg & Silverman, 2013). Researchers have used melody to assist
with the immediate recall of information for individuals with neurologic disabilities
(Schwartzberg & Silverman, 2012; Thaut, Peterson, McIntosh, & Hoemberg,
2014). McElhinney and Annett (1996) concluded that there was a better overall recall of familiar words
correctly recalled in a song condition than in a reading condition. Silverman and
Schwartzberg (2014a) studied the effects of
voice timbre (male versus female instructor) on the sequential working memory recall of
university students and found better recall accuracy during the male voice conditions.
Researchers have also concluded that music conditions were more effective than speech
conditions on short- and long-term memory recall (Schwartzberg & Silverman, 2012). In a related study, researchers
investigated the effects of presentation style and musical elements on the working
memory of individuals with and without ASD (Schwartzberg & Silverman, 2018). Participants demonstrated significantly
more accurate recall during the live conditions than the recorded conditions.
Although music and iPads are frequently used in an attempt to augment learning, no
researcher has investigated the effects of instructor gender and video recorded
music-based instruction on the sequential working memory of individuals with ASD. These
data would be important to determine if instructor gender and aspects of video
instruction paired with music will have differing effects on the sequential working
memory of individuals with and without ASD. Therefore, the purpose of this study was to
examine the effects of instructor gender and visual and auditory melodic video recorded
instruction on working memory in individuals with ASD. Specific research questions
included:
Will a female or male instructor yield more accurate sequential working memory in
individuals with ASD?
Will visual + auditory or auditory only melodic instruction yield more accurate
sequential working memory in individuals with ASD?
Will there be a significant difference in sequential working memory between
individuals with ASD and neuro-typical (NT) university students?
In what serial positions is recall most accurate?
MethodResearch ParticipantsPhase One
The researchers’ affiliated Institutional Review Board (IRB) approved this study
before data collection initiated (1505S70921). Participants in phase one
were individuals with a primary diagnosis of ASD (n = 38). The
principal investigator (PI), a board-certified music therapist with 20 years of
clinical experience, initially recruited 108 individuals to participate in the
study. All 108 consented and assented to participate in the study. Of the 108
consenting individuals with ASD, 38 participated in all four conditions of the
study. Therefore, only these 38 participants were included in the data analysis.
Data were collected during the participant’s relaxation (rest) hour and therefore
some that consented may have been sleeping or refused due to relaxation. Of the 38
participants, 32 were male and six were female. The gender imbalance is similar to
the commonly asserted three to one imbalance of the male-to-female prevalence
ratio in ASD (Loomes, Hull, & Mandy,
2017). The ages of the participants ranged from ten to 32 years with a
mean age of 17.00 years (SD = 5.76).
Participants were recruited from a convenience sample at a summer camp for
individuals with ASD where the philosophy and mission of the camp is to provide a
week of vacation for individuals with ASD. Moreover, because the organization that
operates the camp does not request or collect personal health information, the PI
did not obtain personal health information such as present level of academic
progress, severity of ASD, or level of cognitive functioning. Therefore, no
clinical/educational assessment was conducted, no treatment plan was developed,
and no datum was taken on the progress of the campers.
Phase Two
Participants (n = 18) in phase two were neuro-typical (NT)
university students registered for an undergraduate Introduction to Music Therapy
course offered at an Upper Midwest University in the United States. Of the 18
participants, three were male and 15 were female. The ages of the participants
ranged from 18 to 24 years with a mean age of 18.72 years (SD =
1.53).
RecruitmentPhase One
At the onset of the study, the PI had been the music therapist at the camp for 15
years and had therefore developed a positive rapport with the campers. The PI
initially met with potential participants and their legal guardian(s) during
check-in on the first day of camp. During this time, the PI answered their
questions and concerns, and explained and obtained informed consent from the legal
guardian(s) and assent from the potential participants. The assent form was
created with visual supports to assist with the reading and comprehension of the
information presented on the assent form. If potential participants did not
understand the assent form, their legal guardian(s) helped read and confirm their
understanding of the information presented on the assent form. All participants
could withdraw from the study at any time without penalty and received no payment
or compensation to participate in the study.
Phase Two
On the first day of the semester, the PI verbally recruited undergraduate students
who were registered for an Introduction to Music Therapy course. Potential
participants were then given one week to consider their commitment to
participation. The PI returned to the class the following week to obtain written
consent from those interested in participating in the research study. There was no
course incentive or negative repercussion to participate and participation was
thus voluntary. Consistent with previous course enrollments indicating composition
of the class tends to be mostly female, the majority of participants in phase two
were female.
Digit Test
Adapted from Schwartzberg and Silverman (2012), the researchers utilized a visual recall test that included four
different seven-picture sequences using monosyllabic words: Car, house, boat, book,
tree, horse and dog. Each laminated picture measured one-inch by half-inch and were
created using the Boardmaker (Mayer-Johnson,
2008) computer program. The PI provided the participants with the score
sheet and laminated versions of the pictures. Participants placed their laminated
pictures on a scoring sheet that depicted a horizontal table with seven two-inch by
one-inch squares. The researchers created four randomized conditions: (a) female
instructor with visual + auditory stimuli, (b) female instructor with auditory only,
(c) male instructor with visual + auditory stimuli, (d) male instructor with auditory
only. In an attempt to control for learning and order effects, the delivery order of
the conditions was randomized using a Latin Square Design. All conditions were
previously video recorded onto an iPad in an attempt to control the independent
variables. Both the female and male instructors were selected because they would be
unknown to the participants. The video recording for the visual + auditory stimuli
conditions depicted the instructor standing behind a table with the score sheet
described above on the table. The participants then saw the instructor’s face and saw
the instructor place the laminated pictures, one at a time, on the score sheet as the
melody was sung. The auditory only conditions were pre-recorded and depicted a blank
screen with only the audio of each instructor presenting the melody.
Adapted from Schwartzberg and Silverman (2018), the rhythmic and melodic contours were developed to meet two
criteria: a) Information should be rhythmically chunked in clusters; and b) the
melody should be a narrow range with the same beginning and ending note. Three
clusters formed the rhythmic pattern for all conditions: eighth note-eighth
note-quarter note, eighth note-eighth note-quarter note, and quarter note. Each
melodic pattern began and ended on C4 and did not extend beyond A4. Each melodic
condition began with an ascending pattern and then descended at the half way
position. The four conditions are visual depicted in Appendix A.
Each task required the participants to visually identify their seven monosyllabic
pictures and then place them in the order they saw and heard the PI present them. The
order of the seven pictures was randomized and set by condition (each condition had
one randomized order for the seven familiar pictures). Each correct position received
one point with a high score of seven and a low score of zero for each condition.
Procedure
All participants watched each video on a 4th Generation Apple iPad®
with Retina Display, Model MD511LL/A. To assess working memory, participants’
tasks were to sequentially recall the paired information presented within each
condition. At the conclusion of each condition, the PI verbally and visually prompted
the participants to place the seven pictures in the order in which they saw and heard
them presented.
Phase One
Data collection took place during the camper’s daily scheduled relaxation time (a
scheduled 60-min block of time, when no other camp activities are scheduled). Data
collection took place in the dining hall of camp when no other campers or staff
members were present. The PI escorted each participant to the dining hall. The PI
then read the assent form to the participants, obtained their permission to
participate, and delivered the four randomized conditions.
Phase Two
A research assistant collected the data utilizing the same procedures described in
phase one. Data collection took place during the participant’s weekly scheduled
class and the research assistant escorted the participants to a private lab room.
In an attempt to ensure reliability of the procedures and test, the PI taught the
research assistant the same protocol used for data collection during phase one.
The research assistant then read the consent form to the participants, obtained
their permission to participant, and delivered the four randomized conditions.
Power analysis
The researchers conducted a power analysis using G*Power (Faul, Erdfelder, Buchner, & Lang, 2009) to determine
adequate sample size. Power analyses indicated 54 total participants were necessary
in order to detect a medium partial n2 (.25) when = 0.05 for a power of
0.95 with two independent treatment groups using a repeated measures analysis of
variance consisting of within and between interactions.
Quantitative Analyses
In the original four-way repeated measures analysis of variance (ANOVA), there was no
significant main effect or significant interaction between order and the other
variables (all p > .05). We therefore removed order from all
subsequent analyses. We then utilized a three-way repeated measures ANOVA where
within-subject variables were instructor gender (female versus male) and presentation
style (auditory only versus visual + auditory stimuli) and one between-subjects
variable (ASD group versus NT group). We checked to ensure that assumptions needed
for the statistical tests were met by using Box’s Test of Equality of Covariance
Matrices. This result was not significant, p = .121. Analyses were
computed utilizing SPSS version 19.0.
Results
The overall model of the three-way repeated measures ANOVA was not significant,
F(1, 54) = 0.008, p = .928, partial n2=
.000.
Research question one: There was no significant difference in sequential recall between
male and female instructors, F(1, 54) = 1.432, p =
.237, partial n2 = .026. Although not significant, the mean recall for the
male instructor (M = 3.59, SE = 0.17) tended to be
slightly higher than for the female instructor (M = 3.35,
SE = 0.18).
Research question two: There was no significant recall difference between visual +
auditory stimuli condition and the auditory only condition, F(1, 54) =
1.824, p = .182, partial n2= .033. Although not significant,
the mean recall tended to be slightly higher for the visual + auditory stimuli condition
(M = 3.62, SE = 0.20) than for the auditory only
condition (M = 3.32, SE = 0.16). A summary of the
descriptive statistics and pairwise comparisons is reported in Tables 1 and 2,
respectively.
Descriptive statistics
Female InstructorVisual + Auditory
Female InstructorAuditory Only
Male InstructorVisual + Auditory
Male InstructorAuditory Only
M
SD
M
SD
M
SD
M
SD
ASD(n = 38)
2.21
1.44
2.10
1.36
2.61
1.42
2.30
1.54
NT(n = 18)
4.70
1.85
4.44
1.69
5.00
2.20
4.50
1.76
Total Participants(N = 56)
3.00
1.94
2.84
1.84
3.38
2.03
2.98
1.91
Pairwise comparisons (N = 56)
Variables
Mean Difference
p value
95% Confidence Interval
Female versus Male
-0.242
.202
-0.65, 0.16
Auditory + Visual Stimuli verses Auditory Stimuli Only
0.30
.18
-0.15, 0.74
ASD versus NT
-2.36
.001
-2.94, -1.78
Research question three: There was a significant between-group difference concerning
group, F(1, 54) = 66.576, p < .001, partial
n2=.552. The NT group demonstrated higher recall accuracy than the ASD
group (mean difference = 2.36, p <.001, 95% CI = 1.78, 2.94).
Research question four: More accurate working memory recall is typically observed in
sequential positions of primacy and recency and numerous interactions between serial
position and other variables have been previously reported (Schwartzberg & Silverman, 2012,, 2018; Ward, 2002).
Therefore, the researchers did not statistically analyze recall data by serial position.
Rather, the researchers graphed these data in Figures 1 and 2. Mean recall scores tended
to be more accurate in serial positions of primacy and recency.
Mean # of Correct Responses by Condition for Individuals with ASD
Mean # of Correct Responses by Condition for Neuro-Typical University Students
Percent correct mean responses by serial position for individuals with ASD
Percentage correct mean responses by serial position for neuro-typical university
students
Discussion
According to the American Music Therapy Association, approximately 87% of music therapy
clinicians are female (AMTA, 2018).
Moreover, many care providers pair music with information to be learned in an attempt to
augment working memory. Therefore, the purpose of this study was to examine the effects
of instructor gender and visual and auditory melodic instruction on working memory in
individuals with ASD.
The mean recall of information presented by the male instructor tended to be slightly
higher. Traditionally, male teachers have been perceived as more authoritative and
female teachers as more academically competent (Mancus, 1992). Moreover, these factors may be further challenged when an
individual presents with deficits in perspective taking. Identifying how to demonstrate
these perceived leadership traits, which can lead to enhanced rapport and therapeutic
alliance, might be helpful for the achievement of targeted goals. However, as instructor
gender results did not reach statistical significance and more males participated in the
study, readers should be cautious regarding the conclusions.Care provider
gender may not be an influential variable on the success of the client when music is
integrated into the learning environment.
As demonstrated through the results of research question three and congruent with
previous research (Schwartzberg & Silverman,
2012,, 2018), there was a
significant between-group difference with the NT group demonstrating higher levels of
recall accuracy. The difference in age between the two groups may be one rationale for
the significant difference in mean scores. While the mean ages of the two groups was
only separated by one year, the participants in the ASD group ranged from ten to 32 and
the participants in the NT group ranged from 18 to 24 years. Developmentally, the
younger participants with ASD had less time to develop their working memory skills and
compensatory strategies to assist with working memory recall than the NT college
students. The neurological difference between the two groups is another potential
rationale for this significant difference.
A limitation of the study was the access to participant health records as participants’
cognitive functioning was not obtained through personal health information or formal
assessment. Therefore, participants’ memory recall was not analyzed according to
cognitive functioning or other demographic factors. Another limitation was the use of a
convenience sample for both groups as there was a disproportionate number of males in
the ASD group and females in the NT group. Finally, the attrition that occurred in the
ASD group represents an additional limitation.
Recall is a necessary cognitive function required for all aspects of cognitive,
communication, motor, and social skills. Although within-group differences were not
significant and generalizations are not warranted, results tended to be consistent with
existing literature. As individuals with ASD may have unique learning challenges,
information paired with music may be delivered in multi-sensory ways to increase the
likelihood of recall and subsequent learning. Future research is warranted to continue
to determine the preferred learning style and approaches that may yield the best
immediate recall and enhance subsequent learning in individuals with ASD.
Conflict of Interest Statement
The authors do not have any actual or potential conflicts of interest including any
financial, personal, or other relationships with other people or organizations within
three years of beginning the submitted work that could inappropriately influence, or be
perceived to influence, their work.
About the authors
Edward T. Schwartzberg (M.Ed., MT-BC) is a Senior Teaching Specialist and Clinic Coordinator in the Music Therapy Program.
Michael J. Silverman (Ph.D., MT-BC) is Professor and Program Director of Music Therapy.
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