Difusión e Incorporación del Conocimiento

Before the video analysis could be conducted, it was necessary to reduce data by selecting music therapy sessions and then session excerpts from these selected sessions. This procedure has been described in detail in the methodology chapter (4.6.1). The excerpt selection followed a strength-based approach informed by resilience theory. The most pertinent moments according to individual clinical aims related to resilience were extracted from each session. I decided to explore which events and activities occurred during these session excerpts. If certain instruments or activities appeared often, they might be especially suited to promoting positive interactions that foster resilience in young children with ASD. To investigate this, each selected excerpt was labelled using short descriptions, such as ‘improvisation on two guitars’ or ‘making up a song while playing with pieces of colourful material’. Four to five excerpts were chosen per session, resulting in a total of 1,135 fragments of 30 to 180 seconds each. Once this process was completed, I created broader categories under which the activities in the extracts could be subsumed. These categories were naturally influenced by my personal therapy style. As the sessions predominantly included improvisations, I decided to use the instruments on which the improvisations were played as defining categories. In addition, recurring pre-composed or original songs played an important role in most sessions and they thus lent themselves to making up categories as well. Further activities, such as listening to music or body percussion, were combined in the category ‘other’. If several instruments were played in an excerpt or if the attribution was unclear, the video extract was assigned to the category that best described the focus of the child’s attention. The following categories were devised: ‘hello songs’, ‘action songs’, ‘drums’, ‘guitar’, ‘objects’, ‘piano’, ‘tuned percussion’, ‘untuned percussion’, ‘wind instruments’, ‘other’, and ‘goodbye songs’. I decided not to make up separate categories for singing or moving because these behaviours occurred in almost every excerpt. In these therapy sessions, singing or moving did not seem to be discrete activities, but rather they seemed to be integral elements of most interactions.

After all the video excerpts were assigned to a category, the proportion of session extracts falling under the respective categories was calculated for each child. Mean scores were computed for the whole music therapy treatment group and for the subgroups low-intensity music therapy and high-intensity music therapy. Table 7 provides an overview of the occurrences of activities. The first column lists the categories with clarifying examples. In addition to the group mean scores, the range of individual child mean scores is reported for each category and group.

Table 7: Activities in selected excerpts

Activities Treatment group

(Low + High) Low-intensity group High-intensity group

Category (Examples) Mean

% (Range) Mean % (Range) Mean % (Range) Hello songs (greeting song

at the beginning of each session) 10% (6-17%) 10% (7-14%) 11% (6-17%) Action songs (wheels on the bus, head and shoulders)

4% (0-14%) 5% (0-14%) 3% (0-9%)

Drums (bongo, drum, djembe)

10% (0-22%) 11% (7-16%) 9% (0-22%)

Guitar (guitar, ukulele)

12% (4-22%) 12% (5-17%) 11% (4-22%)

Objects (blanket, toys, colourful material) 6% (0-19%) 7% (0-19%) 5% (0-12%) Piano (keyboard, piano) 10% (1-25%) 5% (1-13%) 13% (6-25%) Tuned percussion (boomwhacker, chime bar, glockenspiel, triangle, bell, xylophone) 12% (3-22%) 13% (3-18%) 12% (7-22%) Untuned percussion (egg shaker, maraca, ocean-drum, tambourine) 10% (1-20%) 12% (4-20%) 9% (1-14%) Wind instruments (horn, kazoo, recorder, saxophone, whistle) 6% (0-13%) 5% (0-13%) 8% (1-12%) Other (body percussion, dancing, role play, listening) 5% (0-16%) 6% (0-15%) 4% (0-16%) Goodbye songs (farewell song at the end of each session) 15% (8-20%) 14% (8-19%) 15% (9-20%) Total 100% 100% 100%

Each of the eleven devised categories accounted for 4% (‘action songs’) to 15% (‘goodbye song’) of the selected excerpts. When the related activities ‘hello songs’ and ‘goodbye songs’ are combined, they form by far the biggest category (25%), with one quarter of all selected session excerpts having been classified as hello or goodbye songs. For all 13

children, the selected video excerpts included the following six categories: ‘hello songs’, ‘guitar’, ‘piano’, ‘tuned percussion’, ‘untuned percussion’, ‘goodbye songs’. The categories ‘drums’ and ‘wind instruments’ comprised session excerpts from twelve children. For nine children, video excerpts further appeared in the category ‘objects’, and session extracts from eight children occurred in the categories ‘action songs’ and ‘other’. Overall, the two subgroups of children who received low- or high-intensity music therapy had very similar mean percentage scores, with the mean mostly differing by only 1 or 2 percentage points. Exceptions were the three categories ‘piano’ (M = 5% and M = 13%), ‘untuned percussion’ (M = 12% and M = 9%), and ‘wind instruments’ (M = 5% and M = 8%).

The proportion of time spent on an activity varied enormously between children. For example, while 25% of the excerpts selected from Leanne’s sessions included piano playing as the main activity, only 1% of the excerpts selected from Fiona’s sessions focused on the piano. Drums played an important role in music therapy with Eric, which is reflected by the fact that 22% of his excerpts featured drum playing. In contrast, Leanne was not interested in drums, and, thus, no single excerpt from her sessions was grouped under this category. Even though the overall mean score for the category ‘objects’ was relatively low (6%), 19% of excerpts from Denise’s sessions showed how we used toys and material to play and make up songs. For Arjun, Henry, Jahnu and Kyle, on the other hand, playing with non- musical objects was not important, so this category accounted for 0% of their selected excerpts. The following figure provides a graphic representation of the proportions with which activity categories occurred in selected excerpts of the music therapy treatment group. In this pie chart, hello and goodbye songs are combined to one category.

This diagram illustrates the importance of hello and goodbye songs to generate positive and resilience-enhancing interactions in music therapy sessions with children with ASD. In the sessions that were included in this analysis, hello and goodbye songs had a very similar function. They were original compositions with a high recognition value. The songs were repeated at the beginning and end of every single session so that they became rituals that gave shape to the sessions. Many children seemed to feel reassured by the predictability and familiarity of these activities. Especially for very anxious or fidgety children, these rituals seemed highly important, as they allowed them to feel safe, to relax and to engage. At the same time, the structure of the hello and goodbye songs provided room for great flexibility. Depending on the needs and preferences of the child on the day, they could take a more passive or active role. Sometimes I played and sang the song to the child just once before he or she wanted to move on. In other sessions, the hello or goodbye song was the starting point for a long interaction during which the child played on chosen instruments, joined in singing, or invented expressive dance movements. The song provided the structure for a free exploration of the theme during which we changed dynamics, speed, lyrics, the rhythm, or harmonics. Many familiar songs could be used in music therapy sessions in this way but the hello and goodbye songs seemed to be especially appealing to the children as they addressed them directly and referred to their individual experience in this particular session. The ritualised repetition further enabled children to try out their own ideas and new roles. The ever-changing and mutually developed songs were part of our shared history of musical interactions. As described above, the excerpt selection was informed by resilience theory. Welcome and farewell rituals accounted for 25% of the most significant moments in the analysed music therapy sessions. This indicates that these activities might be especially suited to promoting resilience-enhancing interactions in young children with ASD.