We observed condition-related differences in RBs/problem behaviors within each group. We believe that the nature of the activities practiced in the conditions and the types of supplies used within each condition might have led to condition-related differences in RBs/problem behaviors. The music and robot groups showed similar trends in RBs across conditions; hence, results from these two groups will be discussed together. The results of the academic group are discussed thereafter.
Children demonstrated greater sensory behaviors during the music-making and drumming conditions in the music and robot groups, respectively, compared to all other conditions (see Figures 2A &2B). In both conditions, children played with objects including musical instruments such as drums in the robot group and xylophones, cymbals, drums, maracas, or shakers in the music group. Children were usually seated on the floor or on a stool and were in a relatively more constrained setting while playing instruments
compared to other conditions that involved gross motor movements during standing. Given the easy access to objects within a relatively constrained environment, children had plenty of opportunities to engage in preferred manipulation of objects. Our findings within the music-making and drumming conditions mimic our overall results of greater sensory behaviors in the academic group, suggesting that when children were given access to objects in their proximal space, they engaged in persistent and primitive sensorimotor exploration of objects. Our observations of attention patterns of children also suggest that children directed maximum attention to objects during these two conditions compared to all other conditions. Along the same lines, children engaged in maximum self-injurious/negative behaviors during the music-making condition (music group), and action game and drumming conditions (robot group), compared to all other conditions. The music-making, action, and drumming conditions were based on themes such as start and stop, slow and fast, and turn taking where children were asked to practice complex motor sequences to the beat of music. In the music group, as a part of the music-making condition, we taught children unilateral and bilateral xylophone patterns corresponding to songs such as “Jingle bells” or “Twinkle twinkle little star”. Similarly, in the robot group, children practiced
combinations of quarter and eighth patterns to music during the drumming game. They practiced dual and multilimb gross motor actions during the action game. Overall, all these conditions in both groups were very challenging for children since they required imitation, praxis, and bilateral coordination skills. As discussed previously, children demonstrate greater RBs when faced with difficult tasks. Given the greater task-difficulty of the music-making, action, and drumming conditions, children might have engaged in negative behaviors to either escape from the task or to communicate their frustration to their caregivers.
Children in the movement groups engaged in greater stereotypical behaviors during the beat keeping and action game conditions compared to other conditions (see Figures 2A & 2B). In contrast to the relatively more stationary music-making and drumming game conditions, the beat-keeping and action games provided children with multiple opportunities to move freely. Both games involved children practicing upper and lower body actions to music. We believe that the unconstrained nature of the contexts allowed children to engage in whole body stereotypies. Moreover, the trainers and the coder observed that children frequently engaged in stereotypies as they moved to the beat of music, for example, nodding or turning their heads, swaying their bodies, shaking or waving their arms, and jumping or bouncing their bodies rhythmically to the beat. We argue that in contrast to non-purposeful, repetitive movements, these stereotypies are in fact “functional” in nature in that children moved rhythmically to explore the music through their bodies and to demonstrate their enjoyment and engagement with the context. This is not surprising, given the evidence from music education literature that music is in fact a multimodal active experience that involves the whole body (Findlay, 1971; Juntunen & Hyvonen, 2004; Overy & Molnar- Szakacs, 2009; Toiviainen, Luck, & Thompson, 2010). Even typically developing 2-year old toddlers attempted to synchronize their bodily movements and vocalizations to music that they heard (Gruhn, 2002). Similarly, when we hear a musical performance, we do not simply perceive it or think about it, but we rather participate actively in the experience using our bodies (Bowman, 2000). Hence, listening to music is automatically accompanied by bodily movements that are synchronized to the music rhythm (Lesaffre et al., 2008; Overy & Molnar-Szakacs, 2009) and in fact vary depending on the nature of the music and the biomechanical constraints of our bodies (Toiviainen et al., 2010). For example, faster musical pieces evoked movements of the lighter and easier to move extremities whereas slower beats led to movements of the heavier trunk in adults (Toiviainen et al., 2010). In fact, bodily enactment of music seems to enhance the musical understanding of individuals (Juntunen & Hyvonen, 2004). Children with ASDs enjoy music (Blackstock, 1978) and have heightened music perception abilities compared to TD children (Bonnel et al., 2003; Heaton, Pring, & Hermelin, 1999). We believe that the music-based beat
repetitive nature were coded as “stereotyped” movements according to our coding scheme. However, we argue that these “functional” movements reflect children’s exploration of the music using their bodies as well as their engagement in the context.
Children in the academic group engaged in greater sensory behaviors during the building and art & crafts conditions compared to the reading and social interaction phases (see Figure 2C). In the building and art and crafts conditions, children made projects during each session using supplies such as Play-Doh®, Duplos®, Zoob (Infinitoy®), crayons, construction paper, scissors, and glue. In contrast, the reading and social interaction conditions did not involve interactions with supplies. As discussed previously, our aim was to promote social interactions within a stationary setting as children engaged in academic activities, to mimic the standard of care for children with ASDs. We encouraged verbal and non-verbal
communication by prompting children to ask for help, by requesting their help to complete creations or read out steps of the task, by providing them with choices, by asking them to comment on their creations, and by promoting collaborative work. However, we believe that the proximity of objects/supplies in the building and art-craft conditions might have allowed children to engage in repetitive sensory exploration of the supplies. Along the same lines, children also engaged in maximum negative behaviors during the building and art & crafts conditions. Children were provided with a visual instruction guide that broke down the steps for each building and art & craft project. These projects required cognitive and problem- solving skills as well as proficiency in fine motor skills such as cutting, coloring, pasting, and drawing. Children with autism have difficulties in planning and executing their actions (Hughes, Russell, & Robbins, 1994; Ozonoff, Pennington, & Rogers, 1991). They also have significant motor difficulties in manual dexterity and in the use of two hands for fine motor manipulation, which could have implications for performance of academic activities (Bhat et al., 2011; Fuentes et al., 2009; Ghaziuddin et al., 1994; Manjiviona & Prior, 1995; Miyahara et al., 1997; Provost et al., 2007). For example, young children with ASDs demonstrated significant impairments in object manipulation, grasping, and visuomotor integration as measured on the Peabody Developmental Motor Scales (Provost, Lopez, & Heimerl, 2007). Similarly,
children with ASDs also demonstrated poor handwriting skills compared to age-matched controls
(Fuentes et al., 2009). Overall, we believe that the fine motor difficulties in autism made the building and art & crafts conditions challenging for children, leading to greater negative behaviors during these conditions compared to other conditions.
6.5. Clinical Implications
We think that novel music and movement-based interventions are valuable contexts to promote critical skills in the motor and social communication domains in children with ASDs. Although movement contexts were initially challenging for children given their motor impairments and the novelty of the training activities, children learned the required motor skills over training and in fact began to enjoy music-based gross motor games. In addition, children began to functionally explore music through their bodies as seen in the music and robot groups but not in the academic group. Our observations also suggest that movement-based contexts provided children with multiple opportunities to engage in shared attention bids with their social partners. Moreover, children increased their rapport and spontaneous verbal
communication with trainers across weeks. Although the academic setting promoted responsive verbal communication in children, our results suggest that the easy access to supplies in this context allowed repetitive and restricted sensorimotor play with objects. Such stationary contexts are ideal for promoting academic skills, since children are relatively constrained and their limited mobility makes it easier for teachers to ensure on-task behaviors. However, if the aim is to promote social interactions, movement- based games within group settings provide a natural context for children to learn imitation, turn-taking, social monitoring, joint attention, and communication skills. We recommend that children engage in diverse experiences that facilitate both structured and free exploration within social contexts to enhance learning. Our results suggested that music-based contexts were more engaging and enjoyable for children compared to robotic contexts. Although technology is a predilection for children with ASDs, robotic contexts quickly lose their initial novelty and appeal as children become bored with the limited movement
monitoring of the child’s behavior and subsequent dynamic adaptation and contingent responding by the robot. We also experienced several technical issues with the robotic technology. We recommend that robots be used with caution as adjuncts in therapeutic settings, since they do not seem to be a feasible technology to reduce caregiver burden at present. Overall, our findings suggest the potential value of novel, music and movement-based contexts as treatment tools to broaden the social communication, behavioral, and motor repertoire of children with ASDs. In the future, we plan to explore the effects of other socially-embedded movement-based therapies such as creative yoga and dance to remediate the core impairments in autism.