How can we use strengths to increase efficacy of musical interventions for individuals with Autism Spectrum Disorder or Williams Syndrome?
We live in a world made for neurotypical people, and one of the ways it manifests is in the way we approach neurodevelopmental disorders from a perspective and model of disease and deficit. Identification of deficits are valuable as they help individuals explicitly identify and name their difficulties, therefore bringing them closer to a solution or relief, isn’t that right? Before we answer that question, I want you to flip through the DSM-5 first, the psychopathology diagnostic manual equivalent to the bible. The diagnostic manual is full of criteria that are centered around a deficit model, with verbiage like “impairment,” “limited capacities,” and “persistent deficits.” Identification of deficits and grouping together of symptom clusters may be useful for forming a treatment plan, but should we define these disorders solely based on deficits? Should treatments for these disorders only target deficits, rather than using strengths to help uplift and achieve treatment goals?
The pushback on the deficit model of psychology has been a topic of discussion in recent decades, which eventually led to the development of a whole new subfield in psychology — the field of positive psychology. Positive psychology is the study of psychology from a perspective of strengths and protective factors. It refocuses the field of psychology from a “disease model” to “building strength and resilience,” as eloquently stated by Dr. Martin Seligman, the founder of positive psychology. In this article, we shed light on the long-overdue conversation of the strengths commonly shared by individuals with Autism Spectrum Disorder and Williams Syndrome.
For a brief background, Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is commonly associated with repetitive patterns in behavior or interests and difficulty with social interaction and interpersonal communication. ASD has a CDC-reported prevalence rate of 1 in 44 children, with higher rates of impact for males than females. On the other hand, ASD is starkly juxtaposed with Williams Syndrome (WS), which has a much lower prevalence rate of 1 in 10,000–20,000 children and is characterized by a common social phenotype of overt friendliness and socially disinhibited behavior. ASD and WS each have distinctly different social traits, with individuals with ASD typically facing difficulty with socio-communicative engagement while individuals with WS have an exaggerated propensity for social engagement. Therefore, it is possible that the difference in vocal processing and communication signals that lead to observable differences in socio-communicative engagement profiles in individuals with ASD and WS may lead to differences in other domains. One specific domain where these differences may arise is a domain that is directly linked to vocal processing and communication, which is vocal memory. Previous studies conducted with a sample population of typically developing children have demonstrated that children have better memories of vocal melodies over instrumental melodies, the reason being linked to evolutionary psychology. The reason for this pattern has been hypothesized to be because vocal melodies can serve as conspecific signals involved in communication, which leads humans to respond with greater arousal and better ability to remember vocal melodies over instrumental melodies. While melodies can be generated using either voice or instruments, only vocal melodies are communicative signals that are inherent and biological to humans; therefore, humans have evolved to respond to vocal melodies with greater arousal and better memory, as compared to instrumental melodies, to survive and communicate more effectively within a group. However, enhanced memory of vocal melody over instrumental melody has never been specifically tested in a sample population with neurodevelopmental disorders that impact socio-communicative engagement. Given that the evolutionary advantage of better memory of vocal melody over instrumental melody is specifically linked to social engagement and communication, it is possible that populations with neurodevelopmental disorders that impact socio-communicative engagement would display a memory pattern that differs from what is seen in typically developing children. Therefore, the researchers sought to determine whether children with ASD and adolescents and adults with WS demonstrate stronger memory of vocal melody over instrumental melody, as previously demonstrated by children and adults with typical development (TD).
To compare memory of vocal melody and instrumental melody between a sample with ASD, a sample with WS, and a TD sample, Weiss and colleagues recruited three sample groups. The three sample groups consisted of one sample group that included 26 children that met the DSM-5 diagnosis for ASD, a second sample group that included 26 adolescents and adults that were diagnosed with WS via genetic testing, and a third sample group of 26 participants that were initially screened for neurodevelopmental symptoms and concluded to be of typical development. While the birth age of the participants in the WS group were significantly older than the TD and ASD groups, the verbal mental age of the WS group was matched to the birth age of the TD group.
For the experiment, Weiss and colleagues used instrumental melodies and vocal melodies. The instrumental melodies consisted of 24 different unfamiliar melodies, with each melody having two different instrumental timbral versions of piano and marimba, while the vocal melodies consisted of the same 24 different melodies that were sung by a female vocalist. During the experimental procedure, each of the ASD, WS, and TD participant groups played two different games in succession, with a short break in between the first and the second games. In the first game, the participants were played 12 of the 24 different melodies, with four of the 12 melodies played in the timbre of piano, another four of the 12 melodies played in the timbre of marimba, and the last four of the 12 melodies played in the timbre of voice. All three groups were assessed for engagement during the first game by being asked to answer how much they liked each of the 12 melodies, on a four or five point scale. To help better understand the task, below are three YouTube videos of the same song, “Happy Birthday To You,” in three different timbres of the voice, piano, and marimba.
Following a short break that lasted under 10 minutes, the participants began the second game, which was the unexpected recognition test. Recall that there were 24 melodies in total, each of them in three different timbral versions of piano, marimba, and voice. In the first game, the participants were exposed to 12 of those 24 melodies, with a third of those 12 melodies being played in the piano version, another third of those 12 melodies being played in the marimba version, and the last third of those 12 melodies being played in a vocal version. In the second game, the participants were played a mix of the 12 old melodies from game 1, intermixed with the 12 new melodies that they had not heard previously, with the new melodies being equally divided amongst the three different timbral versions again. In this game, participants answered whether they had ever heard the song before; below is a picture of what the participants’ screens displayed during the second game.
After analyzing the collected data, Weiss and colleagues concluded that children with ASD and adolescents and adults with WS were able to remember vocal melodies better over instrumental melodies, and that the magnitude of this memory enhancement for vocal melodies was similar to that of the TD group. Overall, Weiss and colleagues concluded that memory enhancement for vocal melodies over instrumental memories applies to both typical populations and atypical populations of individuals with ASD and individuals with WS. Weiss and colleagues conclude the discussion by discussing the clinical implications for music therapies for children with neurodevelopmental disorders, with recommendations to incorporate vocal music in music therapy, as vocal melodies are more memorable and engaging than instrumental music.
In this study, Weiss and colleagues demonstrate that despite the vastly different socio-communicative profiles of individuals with ASD and individuals with WS from TD individuals, the ability to remember vocal melodies over instrumental melodies is universal among both typical and atypical populations. This study by Weiss and colleagues identifies a way to use an existing strength to further build upon a more effective treatment plan and to tackle the voice processing difficulties that individuals with ASD face, consistent with concepts of positive psychology, rather than following a typical disease model of psychopathology. It’s time for us to reconsider the disease model perspective we use to view neurodevelopmental diagnoses — it alienates neurodivergent people from neurotypical people, increases stigma, and instills the belief in neurodivergent individuals that something is inherently wrong with them. As demonstrated by Weiss and colleagues, we can find ways to help individuals with neurodevelopmental disorders by utilizing their strengths, rather than focusing on their deficits.
References
Centers for Disease Control and Prevention. (2022, March 2). Data & statistics on autism spectrum disorder. Centers for Disease Control and Prevention. Retrieved May 12, 2022, from https://www.cdc.gov/ncbddd/autism/data.html
Centers for Disease Control and Prevention. (2022, March 28). Signs and symptoms of autism spectrum disorders. Centers for Disease Control and Prevention. Retrieved May 12, 2022, from https://www.cdc.gov/ncbddd/autism/signs.html
Järvinen, A., Korenberg, J. R., & Bellugi, U. (2013). The social phenotype of Williams syndrome. Current Opinion in Neurobiology, 23(3), 414–422. https://doi.org/10.1016/j.conb.2012.12.006
Mental age vs Chronological age: What is our education system designed to assess? Konshius. (n.d.). Retrieved May 12, 2022, from https://konshius.com/mental-age-vs-chronological-age-what-is-our-education-system-designed-to-assess/#:~:text=Chronological%20age%20is%20the%20number,intelligence%20and%20the%20learning%20quotient.
Mills, J. (2020, October 29). Focus on finding solutions. Medium. Retrieved May 12, 2022, from https://jnmills-36798.medium.com/focus-on-finding-solutions-a2b0446b4fac
University of Pennsylvania, School of Arts and Sciences. (n.d.). Positive psychology center. Positive Psychology Center. Retrieved May 12, 2022, from https://ppc.sas.upenn.edu/
Weiss, M. W., Sharda, M., Lense, M., Hyde, K. L., & Trehub, S. E. (2021). Enhanced memory for vocal melodies in autism spectrum disorder and Williams syndrome. Autism Research, 14(6), 1127–1133. https://doi.org/10.1002/aur.2462
Williams syndrome. NORD (National Organization for Rare Disorders). (n.d.). Retrieved May 12, 2022, from https://rarediseases.org/rare-diseases/williams-syndrome/#:~:text=Williams%20syndrome%20is%20a%20rare,births%20in%20the%20United%20States.
YouTube. (2013). Happy Birthday Song | Happy Birthday To You Song for Kids | The Kiboomers. YouTube. Retrieved May 15, 2022, from https://www.youtube.com/watch?v=90w2RegGf9w.
YouTube. (2014). Happy Birthday on Marimba. YouTube. Retrieved May 15, 2022, from https://www.youtube.com/watch?v=esFqv-5wdtA.
YouTube. (2017). Happy Birthday on piano | Learn with Notation. YouTube. Retrieved May 15, 2022, from https://www.youtube.com/watch?v=6QxYUU4FSeQ.
