Enhancing Joint Attention Skills in a Child with Tuberous Sclerosis Complex (TSC):
A Single-Case Study of Using Music Therapy Intervention
DOI:
https://doi.org/10.37134//mjm.vol13.1.4.2024Keywords:
joint attention skills, music therapy, Tuberous Sclerosis Complex (TSC)Abstract
Tuberous Sclerosis Complex (TSC) is a rare genetic disorder that causes benign tumors, or hamartomas, in various organs, including the brain. These tumors can lead to seizures and epilepsy, which impact the brain's neural circuits and are associated with neurodevelopmental disorders (TAND) such as autism spectrum disorder, intellectual disability, and various behavioral, academic, and psychosocial difficulties. Due to these neurodevelopmental challenges, children with TSC often experience social communication delays, particularly in joint attention skills. Music therapy has been found to improve joint attention in children with autism spectrum disorder (ASD), but its effectiveness in children with TSC has not been studied. This study aimed to investigate the effectiveness of music therapy on joint attention skills in an 8-year-old child with TSC, using an ABAB single-case design. The study involved six baseline sessions and eleven music intervention sessions, which included singing, instrumental playing, and movement with music. Joint attention skills were assessed using the SCERTS Model, specifically the SAP-Report Form (SAP-R) and SAP-Observation Form (SAP-O). The results showed that during the baseline phases, the child’s joint attention skills had a mean score of 1.57 in the first baseline and 1.64 in the second. During the intervention phases, these scores increased to 1.85 and 1.93, respectively. The findings suggest that music therapy interventions effectively improve joint attention skills in children with TSC.
Downloads
References
Adamek, M. & Darrow, A. A. (2010). Music in special education. American Music Therapy Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
American Psychiatric Publishing.
American Psychological Association. (2023). Joint attention definition. https://dictionary.apa.org/joint-attention
Amonkar, N., Su, W. C., Bhat, A. N., & Srinivasan, S. M. (2021). Effects of creative movement therapies on
social communication, behavioral-affective, sensorimotor, cognitive, and functional participation
skills of individuals with Autism Spectrum Disorder: A systematic review. Front Psychiatry, 12, 722874.
https://doi.org/10.3389/fpsyt.2021.722874
Bland, M., & Altman, D. G. (2003). Applying the right statistics: Analyses of measurement studies. Ultrasound in Obstetrics & Gynecology, 22(1), 85-93. https://doi.org/10.1002/uog.122
Bolton, P. F., Clifford, M., Tye, C., Maclean, C., Humphrey, A., le Maréchal, K., Higgins, J. N., Neville, B. G.,
Rijsdjik, F., & Yates, J. R. (2015). Intellectual abilities in Tuberous Sclerosis Complex: Risk factors and correlates from the Tuberous Sclerosis 2000 Study. Psychol Med, 45(11), 2321-2331. https://doi.org/10.1017/s0033291715000264
Carpente, J., Casenhiser, D. M., Kelliher, M., Mulholland, J., Sluder, H. L., Crean, A., & Cerruto, A. (2022).
The impact of imitation on engagement in minimally verbal children with autism during improvisational music therapy. Nordic Journal of Music Therapy, 31(1), 44-62. https://doi.org/10.1080/08098131.2021.1924843
Chiengchana, N., & Trakarnrung, S. (2014). The effect of Kodály-based music experiences on joint attention in children with autism spectrum disorders. Asian biomedicine, 8, 547-555. https://doi.org/10.5372/1905-7415.0804.326
Claudia, S., & Lucia, L. (2022). Social skills, autonomy and communication in children with autism. In Technium Social Sciences Journal, 30, pp. 442-456.
Corey, G. (2009). Theory and practice of counselling and psychotherapy (8th ed). Thomson.
Corsini, R. J. & Wedding, D. (1995). Current psychotherapies (5th ed). Cengage Learning.
Curatolo, P., Moavero, R., & de Vries, P. J. (2015). Neurological and neuropsychiatric aspects of tuberous sclerosis complex. The Lancet Neurology, 14(7), 733-745.
https://doi.org/https://doi.org/10.1016/S1474-4422(15)00069-1
Davis, W. B., Gfeller, K. E. & Thaut, M. H. (2008). An introduction to music therapy: Theory and practice. Silver Spring MD: American Music Therapy Association.
Davis, M. (2016). The effect of music therapy on join attention skills in children with Autism Spectrum Disorder. (Master’s Thesis).
de Vries, P. J., Hunt, A., & Bolton, P. F. (2007). The psychopathologies of children and adolescents with Tuberous Sclerosis Complex (TSC): A postal survey of UK families. European Child & Adolescent
Psychiatry, 16(1), 16.
https://research.ebsco.com/linkprocessor/plink?id=9794459c-2686-330a-a161-0ab021d37247
de Vries, P. J., Whittemore, V. H., Leclezio, L., Byars, A. W., Dunn, D., Ess, K. C., Hook, D., King, B. H., Sahin,
M., & Jansen, A. (2015). Tuberous Sclerosis associated neuropsychiatric disorders (TAND) and the
TAND Checklist. Pediatric Neurology, 52(1), 25–35. https://doi.org/10.1016/j.pediatrneurol.2014.10.004
Eren, B. (2015). The use of music Interventions to improve social skills in adolescents with Autism Spectrum Disorders in integrated group music therapy sessions. Social and Behavioral Sciences,197, 207-213. https://www.researchgate.net/publication/282599606
Geretsegger, M., Holck, U., & Gold, C. (2012). Randomised controlled trial of improvisational music therapy’s effectiveness for children with autism spectrum disorders (TIME-A): Study protocol. BMC
Pediatrics, 12(1), 2. https://doi.org/10.1186/1471-2431-12-2
Ghasemtabar, S. N., Hosseini, M., Fayyaz, I., Arab, S., Naghashian, H., & Poudineh, Z. (2015). Music therapy: An effective approach in improving social skills of children with autism. Advanced Biomedical Research, 4(157). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550953/
Gim, J.-a., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism: The International Journal of Research and Practice, 13(4), 389-409. https://research.ebsco.com/linkprocessor/plink?id=3b2f8e73-d48c-35c9-bf8c-eb9699fb5a88
Gross, W., Linden, U., & Ostermann, T. (2010). Effects of music therapy in the treatment of children with delayed speech development: Results of a pilot study. BMC Complement Altern Med, 10, 39.
https://doi.org/10.1186/1472-6882-10-39
Holck, U. (2007). An ethnographic descriptive approach to video microanalysis. In T. Wosch, & T. Wigram
(Eds.), Microanalysis in music therapy: Methods, techniques and applications for clinicians, researchers, educators and students (pp. 29-40). Jessica Kingsley Publishers.
Jeste, S., Wu, J. Y., Senturk, D., Varcin, K., Ko, J., McCarthy, B., Shimizu, C., Dies, K., Vogel-Farley, V., Sahin,
M., & Nelson, C. A., 3rd (2014). Early developmental trajectories associated with ASD in infants with
Tuberous Sclerosis Complex. Neurology, 83(2), 160–168.
https://doi.org/10.1212/WNL.0000000000000568
Jeste, S., Sahin, M., Bolton, P., Ploubidis, G., & Humphrey, A. (2008). Characterization of autism in young
children with Tuberous Sclerosis Complex. Journal of Child Neurology, 23(5), 520-525. https://doi.org/10.1177/0883073807309788
Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy
study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554-563. https://doi.org/10.1037/a0039080
Kearney, A. J. (Ed.). (2015) Understanding applied behavior analysis, 2nd Ed. An introduction to ABA for
parents, teachers, and other professionals. Jessica Kingsley Publishers.
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on Joint Attention Behaviors in Autistic Children: A randomized controlled study. Journal of Autism &Developmental Disorders, 38(9), 1758-1766. https://doi.org/10.1007/s10803-008-0566-6
Kopp, C. M. C., Muzykewicz, D. A., Staley, B. A., Thiele, E. A., & Pulsifer, M. B. (2008). Behavior problems in children with tuberous sclerosis complex and parental stress. Epilepsy and Behavior, 13(3), 505-510. https://doi.org/10.1016/j.yebeh.2008.05.010
Lau, W. C. M. (2005, May). Can children's social skills be enhanced through singing games in music lesson? Paper presented at Redesigning Pedagogy International Conference: Research, Policy, Practice, Singapore.
LaGasse, A. B. (2014). Effects of a music therapy group intervention on enhancing social skills in children with autism. Journal of Music Therapy, 51(3), 250-275. https://doi.org/10.1093/jmt/thu012
Leclezio, L., & de Vries, P. J. (2015). Advances in the treatment of tuberous sclerosis complex. Current Opinion in Psychiatry. https://doi.org/10.1097/YCO.0000000000000136
McDonald, N. M., Varcin, K. J., Bhatt, R., Wu, J. Y., Sahin, M., Nelson, C. A., 3rd, & Jeste, S. S. (2017).
Early autism symptoms in infants with tuberous sclerosis complex. Autism Res, 10(12), 1981-1990.
https://doi.org/10.1002/aur.1846
McDonald, N. M., Hyde, C., Choi, A. B., Gulsrud, A. C., Kasari, C., Nelson, C. A., 3rd, & Jeste, S. S. (2020). Improving developmental abilities in infants with Tuberous Sclerosis Complex: A pilot behavioral intervention study. Infants Young Child, 33(2), 108-118. https://doi.org/10.1097/iyc.0000000000000160
Mcleod, S. (2023, March 17). Humanistic approach in psychology (Humanism): Definition & examples. Simple Psychology. https://simplypsychology.org/humanistic.html
Mundy, P., & Newell, L. (2007). Attention, joint attention, and social cognition. Current Directions in Psychological Science, 16(5), 269–274. https://doi.org/10.1111/j.1467-8721.2007.00518.x
National Institute of Neurological Disorders and Stroke. (28, November 2023). Tuberous Sclerosis Fact Sheet. https://www.ninds.nih.gov/tuberous-sclerosis-fact-sheet
National Organization for Rare Disorders, Inc. (2021). Tuberous Sclerosis.
https://rarediseases.org/rare-diseases/tuberous-sclerosis/
National Health Service. (09, August 2021). Treatment-Tuberous Sclerosis.
https://www.nhs.uk/conditions/tuberous-sclerosis/treatment/
Northrup, H., Aronow, M. E., Bebin, M., Bissler, J., Darling, T. N., Vries, P. J. de., Frost, M. D., Fuchs, Z.,
Gosnell, E. S., Gupta, N., Jansen, A. C., Jozwiak, S., Kingswood, J. C., Knilans, T. K., McCormack, F.
C., Pounders, A., Roberds, S. L., Buritica, D. F. R., Roth, J.,Krueger, D. A. (2021). Updated International
Tuberous Sclerosis Complex diagnostic criteria and surveillance and management recommendations.
Pediatric Neurology, 123, 50-66. https://doi.org/10.1016/j.pediatrneurol.2021.07.011
Northrup, H., & Krueger, D. A. (2013). Tuberous Sclerosis Complex diagnostic criteria update: Recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatric Neurology, 49(4), 243-254. https://doi.org/10.1016/j.pediatrneurol.2013.08.001
Oldfield, A. (2011). Parents’ perceptions of being in music therapy sessions with their children: What is our role as music therapists with parents? in Jane Edwards (ed.), Music Therapy and Parent–Infant Bonding (Oxford, 2011; Online edn, Oxford Academic, 22 Sept. 2011).
Oldfield, A. (1991). Preverbal communication through music to overcome a child's language disorder. In
Bruscia, Kenneth E. Case studies in music therapy. Published by: Barcelona, Phoenixville, PA, 1991. Pages: 163-174. (pp. 163-174). Barcelona. https://research.ebsco.com/linkprocessor/plink?id=eb64725c-7ccb-38c8-a51c-aaa42ebcd820
Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS model: A
comprehensive educational approach for children with Autism Spectrum Disorders. Paul H. Brookes Publishing Co., Inc
Schoenberger, A., Capal, J. K., Ondracek, A., Horn, P. S., Murray, D., Byars, A. W., Pearson, D. A., Williams, M. E., Bebin, M., Northrup, H., Wu, J. Y., Sahin, M., & Krueger, D. A. (2020). Language predictors of Autism Spectrum Disorder in young children with Tuberous Sclerosis Complex. Epilepsy Behavior, 103(Pt A), 106844. https://doi.org/10.1016/j.yebeh.2019.106844
Scholtens, M. C. (2019). Using music to encourage joint attention for students with Autism Spectrum Disorder: Attention as a reciprocal relationship. Music Educators Journal, 105, pp. 45-51.
Tomasello, M., & Carpenter, M. (2007). Shared intentionality. Developmental Science, 10(1), 121-125.
Vaiouli, P. (2012). Promoting social engagement for young children with autism: A music therapy approach. Proceedings of the 12th International Conference on Music Perception and Cognition Volume.http://icmpc-escom2012.web.auth.gr/sites/default/files/papers/1044_Proc.pdf
Vaiouli, P., Grimmet, K., & Ruich, L. (2013). "Bill is now singing": Joint engagement and the emergence of social communication of three young children with autism. Autism: The International Journal of Research and Practice, 19. https://doi.org/10.1177/1362361313511709
Wheeler, B. L. (2017). Music Therapy Handbook (ed). The Guilford Press.
Wigram, T., Pedersen, I., & Bonde, L. (2002). A comprehensive guide to music therapy: Theory, clinical practice, research, and training. Jessica Kingsley Publishers.
Wigram, T., & Elefant, C. (2008). Therapeutic dialogues in music: Nurturing musicality of communication in children with Autistic Spectrum Disorder and Rett Syndrome. Oxford University Press.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Nikie Wong Zhi Qin, Asst. Prof. Dr. Natee Chiengchana, Asst. Prof. Dr. Ni-on Tayrattanachai
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
