Music in Speech Therapy with Children Who Are Bilingual: What Works?
Dr. Ruth Crutchfield, SLP.D., CCC-SLP
University of Texas-Pan American, Edinburg, TX
Dr. Ruth Crutchfield is a lecturer and clinical supervisor at the University of Texas-Pan American. Dr. Crutchfield graduated with her master’s degree in Communication Disorders Bilingual/Bicultural from UTPA in December of 1997 and has held the Certificate of Clinical Competence from the American Speech and Hearing Association since then. Dr. Crutchfield received her Doctor of Speech Language Pathology in May of 2010. She practiced for seven years in the public school system and for four years as the director of speech-language pathology at a pediatric outpatient rehabilitation center. For the last three years, Dr. Crutchfield has been a clinical instructor and supervisor at the University of Texas-Pan American where she teaches language disorders in children, speech science and clinical report writing. Her experiences range from working as an SLP in the school system, working with the geriatric population in a nursing home and outpatient facility, and working with the pediatric population in all scopes in an outpatient rehabilitative facility. She has attended various workshops (i.e. SI for SLP’s, M.O.R.E., Beckman Oral Motor, Visual Phonics, Therapeutic Listening, Autism, Feeding Strategies, Dysphagia, Apraxia Kids, Fluency Therapy – Efficient Strategies, PROMPT, Carbone’s Verbal Behavior Therapy to name a few) from which knowledge she is able to draw from when forming a prescriptive treatment plan.
It is important to acknowledge that music is used in the area of speech therapy largely due to the influence that has been received by the field of music therapy itself. Music therapy is a profession that is delving on its own to provide proof of its effectiveness in rehabilitation of individuals with various disabilities. For speech therapy, speech-language pathologists (SLP’s) have been using music to enhance their treatment plan. At times, music is used to mark the beginning or ending of a session, or to enhance a certain activity that the SLP has prepared where a specific song emphasizes the language concept that the therapist is targeting in a private setting. SLP’s in the schools work with the special education units where music may be utilized throughout the day. The effectiveness of its use is evident in the manner in which the students successfully transition, or that morning routine is beginning. These are all examples of how music is naturally utilized in therapeutic settings. Molnar-Szakacs and Overy (2006), recently found through functional magnetic resonant imaging evidence suggesting that “music, like language, involves an intimate coupling between the perception and production of hierarchically organized sequential information, the structure of which has the ability to communicate meaning and emotion” (p. 235). Molnar-Szakas and Overy (2006) provide more of a substantial basis for using music in speech therapy. However, the question is posed: Is there evidence to prove that music therapy is effective for the specific purposes of speech and language therapy and what specifically can be done that is effective in promoting treatment outcomes?
In order to provide evidence to answer these questions, a search was completed in the following databases: CINAHL (2001-2011), ERIC (2001-2011) and all ASHA journals (2001-2011) with the search terms of music and speech therapy. As a selection criteria, only randomized controlled clinical studies comparing music and its effect on speech therapy in normal hearing children were selected. Additionally, attempts were made to find controlled studies that were focused on Spanish-dominant children, but this search provided no results. Two studies were found that met the aforementioned criteria.
Thompson, Schellenburg and Hussein (2004) completed a study where 43 six-year olds were randomly selected to participate in keyboard, drama, vocal or no classes at all. The purpose of the study was to investigate if enhancing a particular musical skill would increase the children’s ability to identify prosodic changes in their speech such as anger or fear. The findings revealed that the children who participated in the music group (e.g. keyboarding and voice lessons) were able to identify the prosodic changes in speech at an equivalent level to the drama group and outperformed the group of children that received no lessons. The significance in this study was that the drama group was being taught how to act out emotion specifically. However, the music group increased awareness of prosody, naturally, due to the increased exposure to musical concepts.
Lim (2010) completed a study where 50 children with Autism Spectrum Disorder from the ages of 3 to 5 were randomly selected to participate in a study that included a group in music training, a group in speech training and a control group with no intervention. The music group watched music videos of a story of 9 minutes in length while the speech group watched a video of a story being told over about 5 minutes in length via six training sessions. Results via pre and post-testing revealed that the children in the music and speech groups presented with increases in verbal production. The higher functioning children in both groups did increase verbal production; however, the lower functioning children in the music group had significantly more verbal productions than the speech group.
What works for bilingual children?
Knowing that there is some evidence of how effective the use of music can be in speech therapy provides SLP’s with the ability to utilize music as a modality with more assurance. What are the components of music that help children increase in verbalizations, in prosody awareness, and in clarity of speech (Crutchfield, 2010; Lim, 2010; Thompson, Schellenburg& Hussein, 2004)? Key practices noted were the repeated use of music in a structured and consistent manner, the type of music that was selected, the selection of terms for intervention targets, and the use of movement to enhance the musical experience.
Music was used in a structured manner before, during or after the sessions (Crutchfield, 2010; Lim, 2010; Thompson, Schellenburg & Hussein, 2004). It is feasible that if music is going to be used as part of the speech therapy session, a specific structure needs to be implemented. For example, the session can be opened or closed with music, or a specific part of the therapy room can be allotted the music center where the child will complete the center at the midpoint of the session. Also, music can be used as a parent/home program. The parent can be given a CD with the music that is being used in therapy to play at home to the child during an optimal learning time. The focus of this would be to provide the child with repeated exposure to the music; therefore, providing repeated exposure to the targets of speech therapy.
The music that was selected contained the therapy targets (Crutchfield, 2010; Lim, 2010); therefore, it is imperative that the music is carefully selected. For example, the SLP needs to verify that the music being used contains the target vocabulary for the language concept that is being targeted, or the target words for the phonological pattern present, or of the phoneme that the child is producing in error. There are options for selection in the use of music in Spanish. The SLP needs to research and locate the music that is available. Some SLP’s venture forth and write their own music and lyrics in order to assure that the concepts targeted are embedded in the music experience.
Additionally, movement was used throughout the studies found (Crutchfield, 2010; Lim, 2010; Thompson, Schellenburg & Hussein, 2004). In one study, keyboarding allowed the engagement of the hands. In the same study, singing allowed for the engagement of the whole body. It is the natural inclination of one to sway, clap, and move when listening to music. Because of this, it is to the SLP’s benefit to implement kinesthetic or movement cues to enhance the music experience such as clapping, tapping, waving, nodding of the head, and body motion in order to bring the child into the musical experience all together.
Is there efficacy in the use of music as a modality in speech therapy? The evidence is pointing towards a resounding, “Yes!”
Crutchfield, R. (2010). Music Therapy Efficacy on Increasing Word Length in Spanish
Dominant Phonological Process Disordered Children. Nova Southeastern University Dissertation Database.
Lim, H.A. (2010). Effect of “Developmental speech and language training through music” on
speech production in children with autism spectrum disorders. Journal of Music Therapy,
Molnar-Szakacs, I. &Overy, K. (2006). Music and mirror neurons: from motion to ‘e’motion.
SCAN,1, 235-241, doi:10.1093/scan/ns1029.
Thompson, W.F., Schellenberg, E.G., & Husain, G. (2004). Decoding speech prosody: Do
music lessons help? Emotion,4(1), 46-64, doi: 10.1037/1528-35188.8.131.52.