This study investigates improvisational music therapy (IMT) and its influence on the social interaction (SI) of a preschool child with autism spectrum disorder (ASD) in the Czech Republic. This case study tests the use of music therapy as an augmentative intervention for children with ASD. Using a qualitative design and incorporating microanalysis, the aim was to apply methodological protocols of direct and indirect observation on individual IMT sessions. Three SI domains were assessed using microanalysis in this single case study research: a) nonverbal communication, b) sharing, and c) solace. Varied musical features elicited certain intentional behaviors, allowing the interpretation of their meanings. The nonverbal communication studied shows intention to relate, self-awareness, awareness of others, and sharing. The IMT context provides a unique space for dialogues and reciprocity in a protected and settled environment. Children’s improved SI can provide insight into their ability to interact with others. IMT presents promising care for children with ASD, extending comprehensive care by including dimensions of individualization and an intrinsic, non-directive approach, allowing the child to acquire and further develop their own ways of expression for the regulation of SI. Ideas around the quality of SI within IMT need to be further investigated.
At present, music therapy serves various functions in different populations in
hospitals, rehabilitation centers, schools, and private practices worldwide. Individuals
with autism formed one of the first target groups of music therapy in the past century
(
ASD is one of the most widespread, pervasive developmental disorders. It is defined as a
spectrum of congenital developmental disorders based on neurobiological brain
dysfunction (
significant deficit in nonverbal communication (e.g., eye contact, facial expression, and gestures) associated with an inability to regulate SI;
inability to create and maintain relationships with peers due to the lack or complete absence of shared interests, skills, activities, and emotions;
insufficient social and emotional perception of surrounding people, preferring solo play, using other people only as mechanical tools to achieve a goal, and problems experiencing empathy; and
lack of ability and/or need to seek solace from other people to be calmed down in stressful situations and during grief, or an inability to support others in similar situations.
A deficit in reciprocal SI is always represented in individuals with ASD, fulfilling at
least two of the above-mentioned criteria, except atypical autism, where the SI deficit
might be milder (
Previous research confirms that music therapy interventions may benefit the SI of
children with ASD including the ability to take turns in dialogue situations, eye
contact, shared attention, and verbal and nonverbal communicational capacities. Several
studies highlight the motivational aspect of music as communication and the influence it
has on self-regulation, anger management, or behavioral difficulties (
The latest extensive multi-site randomized controlled trial of improvisational music
therapy (IMT) for ASD published by Bieleninik et al. (
There is a large body of research on music therapy with ASD (
Some generalized patterns of the development in IMT intervention for children with ASD
have been described recently by Salomon-Gimmon and Elefant (
This paper focuses on the analysis and investigation of IMT and its influence on the SI of a preschool child with ASD in the Czech Republic. The research applies direct and indirect observation (field notes and video recordings) on individual sessions. The microanalysis of SI in this study was carried out through a focus on three areas of SI: a) nonverbal communication, b) sharing, and c) solace. The study design and focus are intended to help understand the process of music therapy intervention.
This article presents a case study using a qualitative design and incorporating
microanalysis. This case study is descriptively-evaluative and qualitatively describes
and evaluates a phenomenon (
For this paper’s case study, I performed an IMT intervention with a preschool child with ASD. The research was carried out in cooperation with a kindergarten for children with ASD. Children are admitted to this kindergarten based on the recommendations of the local special education center. A total of three children out of nine with no previous experience in music therapy were selected for the IMT intervention. Consent was sought from the parents/legal guardians of the children. In this paper, the findings of IMT with one of these three children have been described for the sake of being concise. Out of the three children who participated in IMT, I decided to focus on the child who was less verbal and participated in music therapy with the most continuity, in order to enable more focused and direct analysis of the IMT intervention.
I first received ethical approval from the relevant university faculty members. Following that, I received informed consent from the kindergarten where I collected the sample from and finally, I also received informed consent from the child’s guardian.
However, before the intervention, with written consent, I examined the child’s anamnesis from medical and educational specialists’ documentation. The guardian was informed about the anonymization of the participant’s data and agreed.
Lukas (pseudonym) is a Czech boy of Czech ethnicity who lives with his family,
including one sibling, in a city. He was prematurely born at six months. Between two
and three years of age, his parents observed non-standard development, especially in
speech. Once they excluded the possibility of sensory impairment, he underwent a
psychological examination. When he was three years and nine months old, it was noted
that Lukas may have ASD due to his variations in SI, communication, and repetitive,
limited play. Subsequently, a psychiatric examination confirmed the diagnosis. At the
age of four years and five months, he was enrolled in the specialized kindergarten.
At the time, Lukas did not use verbal expression, but responded well to his name and
understood basic instructions. According to his parents, he tolerated other children
but preferred playing alone. He could also use gestures like imperative pointing.
Lukas had attended the kindergarten for two years before the start of the IMT
intervention and received individual treatment through the
The main aim of this study was to investigate the influence of an IMT intervention concerning SI in children with ASD to answer the main research question: “How does IMT intervention influence the SI of preschool children with ASD?” Three areas of SI that can be observed within the research were defined and constituted these sub-questions:
For the purpose of this study, nonverbal communication was operationalized
based on diagnostic criteria with established theories. For example, according
to
The observable parameters of sharing as a nonverbal mode of communication are
demonstrated as four interrelated categories listed in diagnostic criteria:
sharing interests, sharing activities, sharing emotions, and sharing attention
(
Sharing
Sharing
Sharing
Sharing
In observation, solace has been divided into two categories: (a) seeking
comfort or solace; and (b) providing comfort or solace. There is limited
attention given to solace in ASD treatment research, even in music therapy
research. This might be because the overall approach of IMT and mutual
music-making is based on providing solace or remedy to a participant. Solace
therefore stands as an intrinsic part of the music therapy process rather than
as a studied outcome. Seeking solace might be communicated easier through music
than in verbal communication (
The IMT environment influences the course of the intervention, and therefore is part
of the interpretative context of the case study. IMT applies a musical experience of
improvisation to promote change within the therapeutic relationship (
The observation took place in the specialized kindergarten throughout one school year, with an intervention of 30 minutes every week (excluding holidays and health-related absences of the child), totaling 20 sessions. The observation comprised two stages:
Direct participatory observation was conducted during the sessions (as a music therapist-researcher) and field notes were written as a complementary source of data to preserve clinical validity and sensitivity afterward.
A portable camera with a microphone recorded all sessions for indirect observation. The child could see that the session was being recorded.
In qualitative research, results are influenced by the subjectivity, perceptions,
biases, and approaches of a particular researcher (
The video recordings were transcribed into text descriptions—including
utterances—of observed SI of the child and therapist. The music played was not
scored (only described). Of the 12 categories of SI explained earlier, six of
nonverbal communication, four of sharing, and two of solace were observed and
verbally transcribed. The transcription was revised and completed by viewing each
session multiple times, revising the more complex parts in detail, or going over
the video recordings later while comparing sessions. The transcriptions were
enriched by field notes and further interpretations of behavioral symptoms,
situations, and interactions. The focus was on qualitative characteristics and
their changes, such as new appearances, repetitions, augmentations, and the
occurrence or absence of aspects of SI. Analytical methods of comparison and
deduction were used considering the beginning, middle, and end, or the first half
versus second half of the sessions. Each session was compared with previous
sessions, in parts, and as whole units. In the limited Findings section, I
selected four
Microanalysis deals with “the detailed analysis of a small but relevant amount of
data drawn from a single experience” (
Example of the Scheme.
During the analysis, an additional procedure of quantification was added for three nonverbal parameters: eye contact, physical contact, and proxemic changes. These changes were appropriate to provide further insight into the intervention. The behaviors were counted in the four selected sessions, one at a time, by observing the whole session video and pausing, and checking the quantity of the behavior defined as “engaging into eye contact (initiated or accepted by child),” “engaging into physical contact (only initiated by child),” and “shifting the physical distance between the child and therapist (only initiated by child).” No independent check was applied, as explained later.
I aimed to ensure credibility, dependability, confirmability, and transferability
(
This section contains two parts. The first part presents the four chosen sessions of the study as explained above. The findings are divided into description and interpretation, so that the first exposes the material from the intervention/session relevant to the research question (subjective researcher’s choice) and the latter connects it into relations (across the one described session or with other sessions), acquirable meanings, or broader understanding of the process (see Table 1, 2, 3, and 4). In the second part, synthesized findings according to key areas for the whole case are put forth.
This session took place in the second month of the school year. Additional activities in kindergarten are added after the few initial weeks so that the children settle into their basic educational programs. Lukas did not have any previous experience with IMT or with the therapist. Table 1 provides a description of what occurred in the session, with my interpretations.
The First Session
Description | Interpretation |
---|---|
Lukas enters the room rejecting the unfamiliar situation. He uses facial expressions, gestures, and voice to express what seems to be disagreement and anger; in a fit he screams, throwing away his shoes. | Lukas uses nonverbal expression, vivid facial gestures, and no eye contact. Emotional aspects can be perceived. He presents a lot of sound and rhythm in his movement. |
The therapist leaves space for these expressions, which appear harmless. | The therapist accepts his emotional expressions. Lukas is invited to express himself freely and the therapist reacts based on his communicational and emotional states. |
After his initial negativity, the therapist offers Lukas a seat through gesturing and he sits. The therapist contemporarily sings his name softly and then plays harmonic grounding on the keyboard. Lukas stays still, looking indifferent. | The therapist uses the same nonverbal channel of communication as Lukas—vocal—and then adds an IMT method—a musical instrument. |
Lukas stands up, moves toward the keyboard, and starts to play clusters with strong dynamics. The therapist stands next to him and gently imitates in soft and medium dynamics. | Lukas’s loud playing can be interpreted as his accepting a way to express his feelings differently. The therapist uses an imitation technique to show that she cares about him and to give him attention. |
Immediately during instrumental play, first eye contact is established. | Here, eye contact is short and rare, three times in the first half of the session and seven times in the second. |
Later, the first sharing of interest and activity appears. Lukas selects an object of interest (a bubble blower). The therapist elaborates this musically, working with sounds of breath and vocalization. A dialogic situation and alternation evolve. | IMT techniques of modeling, making spaces, imitating, and sharing
instruments ( |
At the end, Lukas does not want to leave. He throws away his shoes, pushes the therapist, and waves his arms preventing contact. He screams and cries. He runs to the next room and calms down slightly by jumping on a trampoline and vocalizing. The therapist carries him back to class in her arms. | Lukas’ difficulty in accepting change presents again with similar manifestations, but with more severity, edging toward aggression. Lukas leaves with rigid posture, neither opposing nor cooperating. |
The IMT sessions became regular in Lukas’s life as a part of his kindergarten schedule. He became familiar with the therapist and explored various possibilities within IMT (see Table 2).
One-third Into Treatment Intervention
Description | Interpretation |
---|---|
Lukas’s face and body seem calm, silent as he enters. | At the beginning of this session, he no longer rejects the situation; improvement came gradually with each session. This is supported by the same setting, schedule, consistent approach, and familiarity with the therapist. |
Lukas comes directly to the keyboard. For the first time, he does this without initially wandering through the room. | He becomes more direct in expressing himself through means offered in IMT. |
While playing the keyboard he calls the therapist with a gesture, initiating eye contact, leading to a sharing of activity and attention. (…) He sits on the therapist’s lap and plays the keyboard. After a scale-like improvisation, he pauses, turns his face toward the therapist, making eye contact, and smiles. | Here, we can interpret the sharing of emotion and the regulation of interaction through a specific sequence of musical and non-musical nonverbal expressions. |
When Lukas continues improvising, the therapist joins in with vocal tones. In response, Lukas shifts his eyes and his head, repeating eye contact and raising his hand to the therapist. | Similar behavior appeared in previous sessions. Here, he is engaging repeatedly in forms of nonverbal expression that he explored during the intervention. Additionally, he evolves it further. |
(…) Lukas asks for the lute with a word and a gesture. He improvises experimentally. The therapist interacts and accompanies with small vocal imitations and pauses. While playing, Lukas develops eye contact, proxemics, facial expressions, and a combination of these forms of communication. | He fluently shifts to different means of communication and different musical instruments. The therapist supports his experimentation with techniques of imitation and making spaces. Lukas uses other nonverbal communication clusters for spontaneous regulations of SI. |
Lukas lies down with his face relaxed and turns toward the therapist. Later, he moves to the music’s rhythm. | After expressing himself and experimenting, he seems to maintain his attention while listening to the therapist’s vocal and instrumental improvisations. |
After listening, he repeatedly responds with vocalizations and increased eye contact. He approaches and joins in playing the instrument with the therapist several times. | He regulates the amount of sharing by alternating engaging and listening. The frequency of eye contact increases to 12 times in the first half and 21 in the second. |
At the end, Lukas’s face is calm, he utters some minimal vocalizations. When the therapist announces the end of the session, he puts his shoes on, taking the therapist’s hand voluntarily. | Lukas presents better concentration and more interaction with the therapist. At the end, he seems more relaxed and calmer than in previous sessions. |
Here, there is more material to be referred to because more sessions have been conducted. This influences the intervention in its relational history and as well as in its interpretation (see Table 3).
Two-thirds Into Treatment Intervention
Description | Interpretation |
---|---|
Upon entering, Lukas searches for the lute. He approaches the instrument, looks at the therapist, and grasps it carefully. His body movements are balanced, not agitated. He sits in front of the keyboard and starts vocalizing. | From the start, he focuses and concentrates his attention directly on the means of communication offered. He also invites the therapist to share attention. |
While sitting, he expresses himself by improvising alternately on the lute and the keyboard; with every change of instrument, he establishes concentrated and serious eye contact with the therapist. | Lukas is paying attention to the therapist, maintaining awareness of the therapist’s reactions, and the effects of his actions. He displayed similar behavior in previous and following sessions. |
Lukas communicates with imperative pointing (glancing and gesturing). He wants to run an automatic melody on the keyboard. The therapist refuses. He accepts the information with eye contact and moves away hiding behind the corner. After a while, he looks around the corner making eye contact and returns. | Lukas now accepts restriction without protest, when at the beginning of the intervention he responded to limits or restrictions with expressions of anger. |
Later, Lukas improvises on the lute and the therapist accompanies on keyboard. Eye contact increases along with varied facial expressions. Lukas’ expression changes from relaxed to a smile and laughter. He produces spontaneous vocalizations with instrumental play and the therapist imitates him. In longer pauses, the therapist adds a variation, which Lukas adopts and imitates. Lukas vocalizes an interrogative melody initiating eye contact. The therapist vocalizes the answer as a variation. | Lukas initiates a dialogic situation with meaningful variations. Musical dialogues may encourage Lukas to explore new ways of nonverbal expression. For example, he uses an interrogative melody that was not proposed before by the therapist. |
Lukas improvises on the keyboard and the therapist listens, leaving space for expression. In a break, the therapist plays one tone. Lukas watches the therapist’s hand, leans over toward this hand, and re-establishes eye contact. | Sharing of instruments occurs as Lukas starts playing and the therapist joins in. The child accepts and shares attention using proxemic changes. |
(…) The therapist brings forth the drum. Lukas responds with a sequence of nonverbal manifestations: eye contact, looking at the hand and drum, and smiling. | Lukas continues to share attention and manifest overall interest in the therapist’s actions. Reciprocity increases in his way of interacting. |
This session took place at the end of the school year. At this time, Lukas might have been aware of the upcoming change. He was also verbally told about the termination of the intervention. In the session, he engaged less in instrument play or movement activities and favored mediating through voice, silence, and pauses. This made the session particularly intimate and differentiated it from previous ones (see Table 4).
The Last Session
Description | Interpretation |
---|---|
The beginning is slow and without instruments. The only communication method used is vocal. Lukas enters the room, moves toward a chair, and sits. | Unlike at the beginning of other sessions, Lukas is not moving or choosing to play instruments. |
He sits in silence, looking around the room. Then he starts to vocalize syllables: “te-i (…) tu.” The therapist sits next to him, adding imitations. These are occasionally enriched by moments of silence. | The therapist waits for the child to express and listens. Then, a musical dialogue with regular turn-taking evolves. |
Silence is initiated by a lull from Lukas and adopted by the therapist during her turn. Continuing those dialogues, the therapist plays several tones on the keyboard. Lukas continues to vocalize, calmly takes the therapist’s hand, and removes it from the keys. He then continues to hold it in silence. | The vocalizations lessen in a diminuendo of voices ranging from moderately soft dynamics to very soft (“mp” to “ppp”) ending in slight breathing sounds. |
Another vocalization dialogue follows with two long periods of eye contact and then two minutes without eye contact while Lukas sways rhythmically in a chair, laughing. Then in silence again, Lukas lies down and reinitiates eye contact. | He regulates the intensity of the interaction with the therapist. An unusual, relaxed expression of laughter appears and it is maintained longer than in the session previously described. |
After another silent pause, Lukas starts a vocalizing dialogue with eye contact and small improvisations on the keyboard. The therapist listens, then adds and enriches these by singing his name. Lukas reacts with eye contact and vocalization with distinct intonation. Along with new improvisations on the keyboard, the vocalizations crescendo together with rising intensity of eye contact, succeeded by laughter. | Lukas holds long and attentive eye contact—a fully focused 6-second view with clearly articulated vocalization. He is attracted by the singing of his name. |
He pauses playing, watching the playing hands of the therapist, before he joins in sharing the instrument again. Continuing, Lukas laughs again then creates mimic grimaces, moving slightly away from the therapist and closer again. | Lukas seems to be interested and attentive toward the therapist’s playing. This might be because he has been reassured through the attention the therapist gives him. |
Later, when he plays the lute, his face is serious and focused. Once, he even frowns. Eye contact increases even more, and Lukas smiles at the therapist. Then, he makes another grimace and relaxes his face again. | He variates mimics for the regulation of SI, and combines them with proxemic changes, eye contact, and instrument play. |
Before the end of the session, the therapist sings a song created in the first sessions using improvisations and Lukas’ name. She verbally repeats that this is their last session. Lukas is calm, accepting this silently with repeated eye contact. | I perceive this session as the most significant with elements of vocalization dialogues interspersed with silent pauses. The session’s conclusion was silent for 20 seconds with repeated eye contact engaged four times in 10 seconds. The session ends the same way it started, in silence. |
This study aimed to investigate the influence of an IMT intervention on the SI of a preschool child with ASD in a fixed number of sessions in a qualitative paradigm. A description and interpretation of selected “key (or relevant) moments” in four sessions in the case study are presented to help understand the processes occurring in the music therapy intervention, which may lead to a change in SI during the sessions.
From the beginning of the intervention, Lukas uses gestures he is familiar with as per his history. Later, he improvises spontaneous gestures during vocalization dialogues. For example, he raises his hand and stops, open-palmed, before the therapist’s face in response to her singing his name. Then he flutters one hand above his head, holding this position in a moment of long eye contact.
Lukas uses facial expressions, especially in expressing what appears initially to be disapproval and anger, and later joy, playfulness, and reciprocity. There was a qualitative change in facial expressions from the 12th session when Lukas began using new, more subtle facial gestures combining these with playful experimentation. He formed his mouth into wide vowel shapes “a, ae,” contrasting with a form similar to the pronunciation of “u,” switching repeatedly in a constant rhythm. These expressions were observed in the turn-taking game with the therapist. Later, he changes his forehead creasing and eyebrow movements in grimaces. He repeats distinctly different facial expressions when looking at the therapist and an instrument. The first is interpreted as a social smile and the second as concentration.
Lukas’ eye contact stood out as the biggest observable change in behavior. It became gradually more frequent and was sustained for longer during the intervention (see Figure 2). He used eye contact in adequate ways for communication of SI. Furthermore, he synchronized this with other nonverbal expressions such as facial expressions, gestures, body postures, use of instruments, vocalization, and dialogue. Lukas used eye contact repeatedly in situations of turn-taking, playing an instrument, and joint activities. He initiated eye contact when starting, changing, or terminating his solo activity, and to monitor the therapist’s responses.
Quantity of Eye Contact, Body Contact, and Proxemic Changes in Four Selected Sessions.
Proxemic changes increased during the intervention, except for the last session where Lukas moved less. It was observed that Lukas used moving away, while maintaining eye contact and a distinct facial expression, during dialogical situations. Sometimes this was accompanied by grimaces and laughter.
At the beginning and end of the first session, Lukas maintained a rigid posture standing sideways to the therapist. In following sessions, he acted similarly but gradually started standing or sitting facing the therapist. These reciprocal postures often coincided with instrument sharing, handling, or improvisations and were accompanied increasingly by eye contact. During improvisation on the keyboard Lukas sat on the therapist’s lap and in later sessions lay down silently listening. This showed his enjoyment of pleasant moments, calmness, and his trust in the evolving relationship.
Lukas did not use many expressions of physical contact, but this aspect evolved
throughout the intervention with some of these expressions indicating solace.
There may be a pattern within therapeutic relations that starts with an awareness
of one’s self and an awareness of others and continues with support (proofs of
availability and boundaries) and with solace exchanges. For example, Lukas gently
removed the therapist’s hand from the keyboard or he used the therapist’s hand to
improvise on the keyboard. At the end of the 7th session, he took the
therapist’s hand of his own accord and in the next session, he touched her hand to
greet her. Additionally, Lukas sat on the therapist’s lap while playing the
keyboard. In the 10th session, he embraced the therapist repeatedly
after playing and listening to a loud sound. This moment could be interpreted as
the seeking of solace during stress. Similar behavior, however, did not occur in
every stressful moment (e.g., at the end of the initial sessions Lukas did not
notably seek solace). The only situation that Lukas may have been close to
offering solace was at the end of the 19th session, where he encouraged
the therapist to conclude the session with a word and intonation. This, presuming
that the end of the intervention is a grief-like experience for both participants
(
Sharing of the activity occurred in the first session. Lukas expressed himself through new means, and he accepted the therapist’s joining in the same activity. In the course of the intervention, longer periods of concentrations of attention appeared as a prerequisite for the ability to share attention. For example, in the 18th session, Lukas played seven minutes of a continuous improvisation, both independently and accompanied by the therapist.
Lukas accepted the presence of the therapist during his playing and musical improvisation. He and the therapist shared many improvisations, vocalization dialogues, and breathing sounds, which evolved into dialogues. Lukas enjoyed various movements like jumping, dancing, and rhythmical rocking as solo activities, but in the 10th session, he directly invited the therapist to share in these activities, thus sharing interests.
To delineate the difference between expressing emotion and sharing emotion at a nonverbal level, one should always include an aspect of subjective interpretation. It could be argued that every emotional expression is already shared. Additionally, IMT intervention works on a relational basis where emotion is intrinsically present. Lukas initially expressed anger, disapproval, and confusion. Later during the intervention, he shared many moments of music-making enjoyment but also listening enjoyment, happiness, and sometimes surprise.
This study aimed to investigate the influence of an IMT intervention on the SI of a preschool child with ASD in a fixed number of sessions in a qualitative paradigm. A description and interpretation of selected relevant moments in four sessions in the case study are presented to help understand the processes occurring in the music therapy intervention, which may lead to a change in SI during the sessions. Observing as well as applying micro-analysis enabled plausible findings in three areas of SI: (1) nonverbal communication, (2) sharing, and (3) the search for solace or offering solace to other people.
The present research aims to emphasize that IMT works closely with the child, especially
with musical and nonverbal expressions (
Lukas used a variety of nonverbal communications from all the observed categories:
gestures, facial expressions, eye contact, proxemics, body postures, and physical
contact. He also manifested behavioral symptoms in various meaningful combinations.
During the intervention, the variety of behaviors he displayed expanded. These results
seem to depict the possibilities of non-directive and child-centered approach of IMT for
a child with ASD. Furthermore, the musical features of many situations allow us to
interpret the meanings or motivations of these behaviors. Lukas’s nonverbal
communication (used for regulation of SI) shows efforts to create a relationship,
self-awareness and awareness of others, and of sharing in all the observed categories.
Being able to use nonverbal communication as well as becoming aware of this ability and
practicing it are important signs of a healthy personality. This may be enabled by the
IMT context that provides unique methods for engaging dialogues and reciprocity in safe
and comfortable environments. The benefits of musical dialogues established during this
process hold value during the intervention and may hold value after the intervention.
The improvement in SI achieved by children can prove their ability to interact with
others. This also compares well with Benenzon’s (
It should be noted that other children’s reactions to such an intervention may differ or
they may need a professional and sensitive adjustment of treatment. However, the
spectrum of the child’s musical expressions that the therapist builds upon is very broad
and therefore, allows individual adjustments. This spectrum includes vocal expressions,
body sounds, instrumental play, and movement. Beyond this, rhythm, an intrinsic part of
movement, is often accompanied by a sound (e.g., rubbing or a thud). Music therapy
professionals agree that following the child’s lead is an essential principle enabling
the sharing of emotion (
This study does not include a comparison with control conditions such as standard care
or placebo conditions nor does it investigate the influence or impact of the
intervention outside the sessions. There are limitations to the generalization of these
findings due to the heterogeneity within ASD and the unrepeatability of the
intervention. The evaluation of moments of SI regulation and especially solace must be
framed in the overall approach of IMT and mutual music-making. This approach is based on
providing solace or remedy to a participant. It is particularly useful in the case of a
child who can be misunderstood or feel disconnected throughout life while using
idiosyncratic attempts to communicate (
Future research could further expand our understanding of the processes involved in IMT.
Presuming that knowledge is formed through an ongoing interaction between the researcher
and the subject, acknowledging the subjectivity of the researcher is essential (
IMT presents promising opportunities for the care of children with ASD, bringing the aspect of individualization intrinsic in a non-directive approach into comprehensive treatment. IMT, thus, empowers children to learn, and further develop their own expressive channels for the regulation of SI. Future research could compare SI development inside and outside the intervention. Multiple observers and interpretations, along with cross-observer agreement checks, present another possibility for future study-design. We would like to encourage ongoing research into para-medical treatments in general, providing joint relevant information for care-takers, stake-holders, and interested audience with the scope of enriching the clinical practice.
This qualitative case study investigates the influence of individual, non-directive IMT on the SI of a preschool child with ASD and took place in a specialized kindergarten in the Czech Republic. The observations reveal that the child uses a variety and combination of nonverbal communication from every category, which expands during the intervention. These carry meanings of relation, self-awareness, awareness of the others, and sharing. The IMT context thus provides a unique method for dialogues and reciprocity in a protected and comfortable environment. In conclusion, IMT presents promising opportunities for the care of children with ASD, bringing the aspect of individualization intrinsic in a non-directive approach into comprehensive treatment. IMT, therefore, empowers children to learn, and further develop their own expressive channels for the regulation of SI. Future research could compare SI development inside and outside the intervention. Multiple observers and interpretations, along with cross-observer agreement checks, present another possibility for future study-design.
Zuzana Vlachová studied social education and music therapy in Czech Republic and Italy and has a personal experience as a music therapist for children with ASD, working for schools and non-profit organizations in Czech Republic for eight years.
The author has professional interest in the studied material. No other conflict of interest is reported.