Novel Music Intervention Model and Its Effects on Transition from Minimally Verbal to Verbal in Autism Spectrum Disorders

Background: According to the Centers of Disease Control estimates of 2014, every 42^nd boy and 189^thgirl in the United States has an Autism Spectrum Disorder. Every third child affected fails to develop functional language despite early intensive interventions, and will require life-long care. Tager-Flusberg and Kasari (2013) have suggested that particularly around the age of 4-5 years, there may be specific developmental changes that place a child on a path to becoming verbal, or remaining minimally verbal, and that development of novel interventions that target this transitional stage may be important. Despite general lack of knowledge about minimally verbal autism, affinity to music activities and exceptional pitch perception have been described. Taking advantage of preserved musical abilities in these children coupled with the knowledge from neuroscience research of shared neural systems of music and language, may offer a novel, music-based way to target the transition from minimally verbal to verbal in these children.

Objectives: To identify the mechanism by which, and evaluate effectiveness of, the role of musical stimuli, based on shared characteristics between music and speech, in development of meaningful spoken language in a 5 1/2 year old girl with minimally verbal autism with severe behavioral disturbances, and high nonverbal intelligence quotient (IQ) score, who failed to respond to any known intensive intervention modes; to characterize developmental trajectories and timeline of language acquisition in minimally verbal autism. 

Methods: A single subject design with short and long-term follow up. The novel intensive intervention model consisted of hierarchically designed active musical multicomponent system as primary intervention, 60 hours per week for two years, supported by operant conditioning to: (1) target the development of cognitive skills necessary for language acquisition and auditory scene analysis; (2) build access to spoken language development via shared features of music and speech (e.g., pitch, infra-pitch, timbre, prosody, patterns, accents, sequences); (3) enhance perception of basic meaningful vocabulary and construction of word combinations, sentences, and overcoming echolalia. Musical/speech stimuli incorporated the full range of sound frequencies of the human auditory system. Traditional and novel behavioral, cognitive, and linguistic assessments and observations at multiple time points, and adult outcome served as primary outcome measures. 

Results: Substantial decrease in frequency and intensity of undesired behaviors, and improvement in attention to auditory scene information was noted within the first month. Subsequent gradual development of cognitive skills necessary for language acquisition, sound/meaning equation, auditory memory, meaningful verbalization, and mathematical/musical cognition enabled to incorporate the least restrictive educational environments after 2-year long intensive intervention, and ultimately led to an optimal adult outcome. The developmental trajectories and timeline of language development displayed unique characteristics.

Conclusions: The novel music intervention model proved to be an effective method for transition from minimally verbal to verbal, and may have potential to serve as a modifier to current early intensive interventions to benefit a subgroup of children with minimally verbal autism who would otherwise remain minimally verbal.