Saying Something Else: Improvisation and Music-Play Facilitation in a Medical Ethnomusicology Program for Children on the Autism Spectrum
Studies of social and interactive processes in music improvisation constitute an important dimension of contemporary ethnomusicological research.1 The range of topics, issues, and traditions addressed is vast, yet one may identify across this literature a shared interest in the fundamental interconnectedness that exists between improvisational processes and the modes and values of communication, interaction, and community that reflect, embody, and inform these processes. The following passage from the book Saying Something: Jazz Improvisation and Interaction, by Ingrid Monson, captures something of the collective spirit of much scholarship in this area:
When a musician successfully reaches a discerning audience, moves its members to applaud or shout praises, raises the energy to dramatic proportions, and leaves a sonorous memory that lingers long after, he or she has moved beyond technical competence, beyond the chord changes, and into the realm of "saying something" [. . . ] this verbal aesthetic image underscores the collaborative and communicative quality of improvisation. A moment of community, whether temporary or enduring, can be established in such moments through the simultaneous interaction of musical sounds, people, and their cultural histories.2
The purpose of this article is to explore both processual dynamics of music improvisation and philosophical and pragmatic dimensions of music-play facilitation through a study of the "saying-something" practices, motivations, and values of two music improvisers operating within a specific musicultural3 setting and context. The musicians are Michael Bakan (henceforth Bakan, in contradistinction to Megan Bakan) and Benjamin Koen, ethnomusicologists and improvisers of diverse background who share a foundational grounding in jazz and its myriad of global extensions. The setting is the Exploratory World Music Playground, or E-WoMP, at Florida State University (FSU), a specially designed music-play facility featuring safety-modified Balinese gamelan instruments and other instruments from various parts of the world.4 The context is the Music-Play Project (MPP) at FSU, a medical ethnomusicology program for young children on the autism spectrum and their families. It brings the participant children and parents, and the project's two music-play facilitators to the E-WoMP, where they collectively take part in exploratory music-play sessions that are centered in free improvisation. The goal of these sessions is to foster positive experiences that increase emotional well-being, self-confidence, social and cultural agency, and what the philosopher of education Nel Noddings has termed "response-ability"—"the ability to respond positively to others and not just to fulfill assigned duties"5—in children diagnosed or provisionally diagnosed with an ASD, or autism spectrum disorder.
The central questions we address relate to how Bakan and Koen, in their roles as the MPP music-play facilitators, have redefined themselves as music improvisers—and have been redefined by others in the process—for the sake of facilitating enabling and response-able experiences of collaboration, communicative interaction, and the building of community in the unique musicultural environment of E-WoMP music-play sessions. We ask: If the goals of "saying something" through the medium of improvisation in the E-WoMP are not the same as those described by Monson relative to jazz, but rather are directly tied to effecting more fulfilling social-emotional experiences for people with ASD—and in turn to paving the way toward better understandings and ways of relating to people with ASD on the part of others—then how are the discursive priorities of a "saying-something"-based improvisational dialectic transformed? Put more simply, how are the values and practices of music improvisation affected when engagement with the priorities of autistic, rather than artistic, sensibilities are of primary concern?
These issues are treated both as subjects of ethnomusicological inquiry in the study of improvisation per se and as points of departure for broader considerations regarding research on and treatment of autism spectrum conditions, the dialectics of music and community-making in the collective co-creation of culture, epistemological challenges to conventional understandings of autism and people on the autism spectrum, and the very meaning of culture itself. Moreover, these considerations highlight a facilitative, child-directed, and success-oriented pedagogical/therapeutic approach for working with people on the autism spectrum. While unique to the specific project under discussion, this approach may have broader implications for educational and intervention paradigms involving music, play, or both, whether in music education or music therapy, or in other areas such as education for children with special needs. Agreeing with John Blacking that the "function of music is to enhance in some way the quality of individual experience and human relationships,"6 we consider the methodology of music-play facilitation employed in this project to be conducive to that function, both in our own work with children on the autism spectrum and their families and more broadly through its potential adaptation to other contexts.
Regarding the modes of presentation in this essay, it should be noted that personal accounts of, reflections on, and commentaries about our own experiences figure prominently in several sections. This approach accords to established narrative and reflexive strategies in contemporary ethnomusicology and related disciplines, including ones that have been employed in previous published work by the article's lead author.7 Moreover, it is reflective of our stance that in this particular study of improvisation and music-play facilitation, we are both researchers and research subjects, a dual identity that applies most especially to Bakan and Koen.
One evening in September 2003, Benjamin Koen, his wife Saba, and their baby daughter arrived at the home of Megan and Michael Bakan for dinner. Koen had just recently joined Bakan as a member of the ethnomusicology faculty at FSU, and this was the first time the two families had socialized. A three-year old boy named Mark8 was in the house, but he was nowhere to be seen. Mark, a member of the Bakan family, found the prospect of meeting new people overwhelming. He seemed to live in his own world much of the time and avoided communicating with others, at least in socially conventional ways. Though he was intelligent and possessed a large vocabulary for his age, Mark rarely spoke in English, even to members of his family. When he did speak, he preferred to use a language of his own invention called "Skoofie," which others could not understand. Bakan had previously informed Koen that Mark had recently been diagnosed with an ASD called Asperger's syndrome. Mark was much happier by himself in the safety of a bedroom located at the rear of the Bakan's home than he was facing the stressful social demands of dealing with company. He was in his bedroom when the Koens arrived and he would almost surely stay there throughout the evening.
After dinner, Bakan and Koen pulled out some drums and began to improvise. Bakan felt a light tap on his knee a few minutes into the session. He was surprised to see Mark staring up at him, with Mark's other hand resting on a pair of unused bongo drums on the floor. Mark seemed to be asking if he could join in; Bakan smiled approvingly and Mark started to play. Immediately, he locked in with the groove. Then he took the rhythm in a whole different direction and Bakan and Koen followed him there. Mark smiled playfully. It looked like he was having fun. His two new musical partners beamed back in return. Mark continued drumming, but now he started singing, too, and what he sang was beautifully in-sync and creative and moving, taking the music on an entirely new journey from where it had begun.
Then, very abruptly, it was all over. The baby began to cry and the Koens bundled her up and beat a hasty retreat to their car. The Bakans ran out the door for a quick goodbye and then returned to their living room, where Mark was still seated on the floor. Bakan went over to Mark and told him that he had enjoyed playing music with him very much, that it had been a lot of fun, but Mark did not show any sign of response. He sat on the floor for a minute or two, staring off into the distance. Then something quite remarkable happened. Mark stood up and faced the Bakans, who were now sitting on the couch. He looked directly at them, making eye contact, and began to speak. "I don't even remember what he said," Bakan recalls, but he "was speaking real English, and he was speaking lucidly, and expressively, and using appropriate gestures." The chronic tension that Mark had habitually carried in his shoulders seemed to have melted away. He looked truly relaxed and there was a flow in the way he was moving and carrying himself that was, in Bakan's experience, unprecedented. The next morning, Bakan called Koen. "I have an idea, something I think we should work on together," he said, and from this conversation the Music-Play Project emerged.
Background: Rethinking Autism from a Medical Ethnomusicology Perspective
It has been estimated that one out of every 150 children in the United States is affected by an autism spectrum disorder.9 The autism spectrum encompasses a range of conditions—autistic disorder (autism), Asperger's syndrome (Asperger's disorder), and PDD-NOS (pervasive developmental disorder, not otherwise specified)—that are collectively characterized by pervasive and heterogeneous developmental challenges in the areas of verbal and non-verbal communication, social interaction, and social reciprocity.10 All of the children who participate in the Music-Play Project carry either a diagnosis or provisional diagnosis of one of these conditions, and are recruited for the study from the Center for Autism and Related Disabilities (CARD) at FSU.11
"Individuals with ASD have neurological differences that impact their ability to predict the intentions of others, comprehend social cues and share their interactions with others," explain ASD researchers Emily Rubin and Amy Laurent.12 These challenges, combined with a lack of awareness and understanding in respect to them on the part of others, create a state in which "social experiences become threatening, anxiety provoking, and worthy of avoidance."13 Such problems may result in difficulties making friends, maintaining friendships, and participating in leisure and play activities. They can also cause strained family relationships, learning difficulties affecting school and work performance, and a wide range of psychological and emotional issues, including stress, anxiety, and depression. Individuals on the autism spectrum may have sensory integration, motor coordination, and cognitive flexibility challenges as well; and repetitive or ritualized behaviors (stereotypy) may occur.
Despite abundant research on ASD, consensus remains elusive about causal factors as well as the best practices for intervention and treatment. Biomedical and behavioral-science research has been central to ASD studies,14 but research across numerous other disciplinary lines has been significant as well. A considerable amount of research and clinical work has been done in the field of music therapy, which has been shown to be effective in work with people on the autism spectrum.15 Techniques and methods from music therapy have influenced the present project. These include improvisation-based approaches, music-play strategies premised on following the child's lead, and the use of particular types of instruments and musical devices (e.g., steady-beat rhythmic grooves) to facilitate desired behavioral outcomes (e.g., emotional regulation). Research promoting both spontaneous and directed approaches to play in the treatment of autism is also relevant,16 as are studies from within ethnomusicology and in related disciplines that explore the interrelationships of music, social performance, health, and healing in a wide range of cultural contexts.17 The influence of these latter studies on the present work is twofold: first, they provide descriptions and analyses of extant social-musical models with rich potential for adaptation to ASD intervention programs incorporating music; and second, they offer valuable methodological and theoretical models for describing, analyzing, and interpreting E-WoMP music-play sessions as cultural (musicultural) events that may be productively conceived of in principally ethnomusicological terms.
An important new line of research with especially strong implications for the Music-Play Project has emerged within anthropology. Scholars including Elinor Ochs and Olga Solomon have applied ethnographic and linguistic approaches to their studies of autism.18 These anthropological perspectives have combined with other progressive approaches in multiple disciplines19—and also with a rapidly growing literature on autism being created by people on the autism spectrum20—in establishing new and innovative perspectives on ASD that privilege the person over the "disorder" and ability over disability.
Despite the advances of such progressive work, however, the dominant discourse on autism, in the medical-scientific literature and beyond, remains largely "deficit-centric," as is evident from the opening sentences of the introductory paragraph, "About Autism," at the website of the Centers for Disease Control and Prevention (CDC) Autism Information Center:
Autism spectrum disorders (ASDs) are a group of developmental disabilities defined by significant impairments in social interaction and communication and the presence of unusual behaviors and interests. Many people with ASDs also have unusual ways of learning, paying attention, or reacting to different sensations.21
The emphasis rests heavily on disability, impairment, and the unusual, and this functionally eliminates the possibility that we might engage with persons so described as equal partners in social and communicative interaction. This ostensibly benign, descriptive-diagnostic language has great potential for damage, for it sabotages the fundamental rights of being to which all persons ought to be entitled.22 "In order to feel real," argues Stephen Cope, "we all need to be recognized and affirmed. We need to be accepted and appreciated. Most of all, we need to be seen with loving eyes, and reflected back with warmth and enthusiasm."23
We find it crucial to affirm and nurture the essential human experience of real-ness among the children who participate in the Music-Play Project. Indeed, it is the foundation from which "response-ability" and cultural agency derive their potential growth. It is, moreover, consistent with the priorities of the academic discipline in which this broadly interdisciplinary project is anchored, medical ethnomusicology, which is defined by Koen, Barz, and Brummel-Smith as
. . . a new field of integrative research and applied practice, which explores holistically the roles of music and sound phenomena and related praxes in any cultural and clinical context of health and healing. Broadly, such roles and praxes are viewed as being intimately related to and intertwined with the biological, psychological, social, emotional, and spiritual domains of life, all of which frame our experiences, beliefs, and understandings of health and healing, illness and disease, life and death.24
The E-WoMP, in which all MPP music-play sessions are held, is at once a cultural and a clinical context for promoting healthful well-being and intersubjective understanding and reciprocity, both through and in relation to children on the autism spectrum. It provides a context in which personhood and agency, as opposed to diagnostic descriptors of disability, are privileged in ways that compel us to reconsider the nature of autism and to rethink our conceptions of, and relationships with, individuals on the autism spectrum.
The Music-Play Project at Florida State University
The Music-Play Project was launched in the summer of 2005 as a pilot study funded by the Florida State University Council on Research and Creativity. (The original name was the Children's Happiness Integrative Music Project.) The program is ongoing to the present (Spring, 2009), and so far has included a three-stage pilot study, with the aforementioned original pilot run in the summer of 2005, and two follow-up studies run concurrently in the spring of 2006. A fourth, more extensive program is currently in progress. In addition to Bakan and Koen, the project was founded and developed by Fred Kobylarz, a family physician/geriatrician and former faculty member of the FSU College of Medicine; Lindee Morgan, director of the Center for Autism and Related Disabilities (CARD) at FSU; Rachel Goff and Sally Kahn, former undergraduate students in the university's Speech-Language Pathology program; and Megan Bakan, a cognitive psychologist specializing in learning disabilities.25 A music therapist, Melanie Harms, was involved as a consultant in the early development stages of the project.
The project fosters an approach to improvisatory group music-play that is ethnomusicologically informed, ability nurturing, success oriented, and free of task-based requirements and demands—musical, social, or otherwise (i.e., beyond basic safety considerations). It is committed to:
- Enhancing the quality of individual experience and relationships for children on the autism spectrum;
- Contributing to person- and ability-centered understandings of children on the autism spectrum (rather than disorder- and disability-centered understandings);
- Providing a model of the rich potential for social and communicative reciprocity that exists within communities comprised of children on the autism spectrum, their parents/caregivers, and other individuals;
- Disempowering trenchant perceptions of division and difference with respect to individuals on the autism spectrum, while promoting mutual appreciation and comprehension, patience and acceptance, the realization of socio-communicative potential, and the joyful and mutually meaningful experience of building and sharing community.
The E-WoMP is housed in a multipurpose ethnomusicology ensembles room at FSU. Its core line-up of IRB-approved safety-modified music instruments,26 which are drawn from the university's extensive instrument collection, consists of several Balinese gamelan instruments—reyong and trompong gong-chimes, ugal and jegogan metallophones, two very large gongs, and kendang drums—plus a Sundanese angklung (bamboo idiophone), a powwow drum, and a Ghanaian gyil (xylophone-type idiophone)(See Figure 1).
Selected E-WoMP instruments, clockwise from rear (perimeter): gongs, ugal metallophones (2), gyil, kendang drums (2), angklung, powwow drum, and jegogan metallophones (2); the reyong (left) and trompong (right) are in the center. (Note: Safety modifications not shown.) Photo credit: Christian Gomez.
Additional instruments used in the project include a didjeridu and a Chinese xiao flute (these instruments are played mainly by Koen, not the children). We focus on instruments that offer high yield for low input, that is, which produce satisfying sounds with little effort and virtually no requirement of technical competence.27 Rubber swimming-pool dive-sticks and large, padded gong beaters serve as the main striking implements (mallets) for all E-WoMP percussion instruments. Traditional types of gamelan mallets, with their hard wooden beating surfaces and pointed ends, are not used, as these would present safety risks for the children in the form of possible physical injury and the production of sounds that could be disturbingly loud for them, and could even cause hearing damage in extreme instances.
The use of modified gamelan instruments as the foundational element of the E-WoMP is based on several considerations. First and foremost, these instruments were readily available (since Bakan directs the gamelan program at FSU) and the members of the research team believed that they would be conducive to the project's desired outcomes. Bakan relates that he had seen "up close and personal in Bali," often as an active musical participant, how gamelan instruments "seemed to have an almost innate capacity to get people in touch with themselves and with one another in all kinds of diverse settings." Moreover, a gamelan is a quintessential high-yield-for-low-input instrument. It is easy to get a satisfying sound out of a gamelan metallophone, gong, or drum without any special training or technique. This is advantageous in terms of facilitating enjoyable (and not frustrating) experiences for program participants. Finally, since the timbres and tunings of the gamelan instruments are for the most part entirely unfamiliar to the children and parents who participate in MPP, there are, in Bakan's words, "no expectations going in about what the music should sound like or how the instruments should be played." This, in his estimation, "really levels the playing field and opens the door to exploration and non-judgmental acceptance of whatever emerges during music-play."
Each MPP program thus far has covered a six-week period, with one music-play session in the E-WoMP each week. Prior to their first group music-play session, each participating family (child and parent) meets individually with Bakan and with other members of the MPP research team for a one-hour orientation in the E-WoMP. All of the participant children have been boys between five and seven years of age. Our efforts to recruit girls as participants have so far been unsuccessful (thus the generic use of male pronouns in this article); the incidence of ASD among boys is disproportionately higher than among girls.28 The music-play sessions last approximately forty-five minutes and never exceed one hour. Three children with ASD, a co-participating parent/caregiver of each child, and the two music-play facilitators (Bakan and Koen) participate in each session, for a total of eight players in all. Three videographers move about the facility as unobtrusively as possible, each documenting the activities of a single child from the beginning to the end of the session. The video recordings serve as the primary repository of project data for analysis and interpretation. Music-play sessions in the E-WoMP are designed to be nurturing and supportive of each child's unique creative and social agency, while placing as few demands and expectations on the child as possible. Our primary goal is to foster an environment in which the children can feel comfortable and find motivation and confidence to engage playfully with the other children, their own parents, and the other play session participants (parents of the other participating children and Bakan and Koen).
In their role as music-play facilitators, Bakan's and Koen's function is neither to teach the children nor to lead the play activity. Rather, their designated purpose is to provide the other play-session participants—children and adults alike—with some musical/social inspiration and "glue" that will motivate and nurture creative agency, social investment, and the collaborative creation of an inclusive E-WoMP cultural community. Moreover, through their encouragements and musical responses to what emerges in the playground environment, Bakan and Koen endeavor to recognize and valuate supportively—rather than assess and evaluate instructionally—the musical/playful expressions and ideas of their E-WoMP collaborators. Toward these ends, they operate in accordance with a set of guiding priorities in their improvisational music-play approach, with the following six priorities being of primary importance:
- To recognize each child as an inherently good and whole person who makes valuable contributions to social environments and can express and convey his or her thoughts and emotions.
- To let the children direct the course and flow of play, without judgment of its musical value or quality.
- To accept, nurture, and support the children's expression and creativity at all times—following rather than leading, responding rather than directing,
- integrating rather than teaching.
- To accept all expressions and actions of the children as socially and musically meaningful, and to recognize that what they create is music of meaning and inherent value.
- To encourage the co-participating parents of the children to be actively involved in the music-play activities, and to provide them with appropriate guidance on how to do so.
- To use their improvisational skills, in combination with their knowledge of social-musical models and improvisatory music traditions of diverse world cultures, to nurture and support musical/social interactions where such interactions exist, may be emerging, or seem to have the potential to emerge.
These priorities situate the Music-Play Project in the facilitative category of approaches to working with children on the autism spectrum. They are of specific relevance to this project and also have potential transferability to other musicking, educational, interactional, and/or play-centered settings that privilege child-directed group improvisation. In contrast to the highly prescriptive, directive, and discrete task-oriented approaches that have conventionally been dominant, facilitative approaches "base their goals and teaching practices primarily on following a child's preferences and motivations, and accepting a child's behavioral responses through imitation or positive emotional reactions. For these approaches [. . . ] the goals tend to be more focused on building social relationships and trust, rather than providing direct instruction in specific social-communicative, cognitive or self-help skills."29
Given the priorities of flexibility and openness, child-directed activity, and limited directivity that characterize music-play in the E-WoMP, it is not possible to generate a profile of a typical MPP music-play session or of a standard methodology of music-play facilitation. Nevertheless, certain procedures and practices do unify the music-play protocol overall, providing an at least somewhat predictable format for sessions. The first five-ten minutes of a music-play session are normally unstructured; the children and parents are left on their own to reacquaint themselves with the E-WoMP, one another, and the environment as a whole. We have found that allowing the children to ease into the E-WoMP in this way is productive in generating a smooth transition from their prior activities of the day, as well as in stimulating curiosity and interest in music-play and social interaction generally. Next, Bakan calls for all of the children and parents to congregate and then he introduces a relatively structured activity for the whole group. This may feature the integration of a novel instrument into the E-WoMP, or it may center on the playing of a new or pre-existing music-play game (e.g., everyone singing drone tones together, or following louder-softer hand signals while playing on instruments). This activity continues for as long as some or all of the children remain engaged by it, which is rarely more than ten minutes. It is allowed to organically disintegrate as the children move on to other activities or interests, musical or otherwise, of their own choosing.
The inevitable dissolution of the opening group activity—sometimes gradual, sometimes abrupt—marks a natural, undirected transition to the main, central portion of the play session, which normally lasts for 25-30 minutes. This period may feature several sequential and/or overlapping episodes of music-play (or music/play, since music per se is not always involved) involving multiple combinations of children, parents, and facilitators. Some children may elect to play by themselves for part or even most of this period. While the facilitators may attempt to interact with these children or try to foster their engagement with other children or parents, they do not press the matter. Allowing the children to play and explore on their own terms during this mid-session time is the goal, and following their lead is given highest priority.
The portion of a music-play session that requires the most explicit direction by the facilitators is its conclusion, comprising five-ten minutes. Transitions are challenging for all children, and are all the more so for children with ASD. In order to facilitate a smooth transition to life beyond the E-WoMP, a relatively structured closing group activity is consistently employed. Its goal is to generate an atmosphere in which the children can get themselves feeling calm and centered. The closing activity is initiated by Bakan. He calls the group together and instructs everyone to sit or lie down close to one another on the floor. The parents are now encouraged to hold their children on their laps or otherwise contain them in a nurturing way, so that the children can focus their energies and get settled down after the stimulation and excitement of the preceding play period. Bakan or Koen then leads the group in a relaxing, centering activity. This may involve asking the children to breathe deeply with eyes closed while listening to Koen play soft music on his Chinese flute (xiao) or, alternatively, while "listening to the silence." Group vocal toning is another closing exercise that has proven successful on several occasions.
The session closes with the children, parents, and facilitators tidying up the E-WoMP then joining hands in a circle in the open area of the room. Everyone thanks one another through the medium of a special thank-you song and hugs are often exchanged with farewells.30
Research Methods and Outcomes
The principal research methods employed in the MPP pilot research program included detailed videographic analysis, ethnographic documentation and interpretation of music-play session events, and analysis of parental responses in the form of parent journals and other response media (e-mail, interviews, questionnaires, in-person and telephone conversations).31 These have provided the primary data for the analysis and interpretation of music-play session programs discussed in this article, as well as for our ongoing assessments and developments of project methodology and outcomes overall. Preliminary quantitative research based on coding and statistical analysis of the approach and avoidance behaviors and social-emotional behavioral indicators of child participants in music-play sessions represented a second dimension of the pilot research program.32
The next stage of this research, to be developed in conjunction with more extended and intensive music-play programs, will incorporate a randomized controlled trial integrating the MPP music-play protocol with the SCERTS model for ASD assessment. (SCERTS is an acronym for Social Communication [SC], Emotional Regulation [ER], and Transactional Support [TS], which the model's creators identify as the primary domains that should be targeted in programs designed to support the development of individuals with ASD and their families.) SCERTS entails "a comprehensive, multidisciplinary approach to enhancing communication and social-emotional abilities of individuals with ASD and related disabilities."33 The integration of MPP with SCERTS offers great potential for facilitating a convergence of qualitative/ethnographic and quantitative data streams in this research, and is therefore key to the continued evolution of this project.34 We already have begun to implement elements of the SCERTS model program into MPP, and some of the perspectives advanced in the ensuing discussion of this article are indicative of our progressive movement in this direction.
Parental response to MPP programs has been especially instructive and encouraging. Our analysis of parent journals and other parent response media indicates that the parents, collectively, believe that their participation in the project has helped them in the following ways:
- To better understand their child on the child's own terms.
- To engage with their child, and with the other children in the program, more meaningfully, playfully, and interactively.
- To better perceive their child as a unique individual with particular abilities, interests, and modes of interaction, rather than in terms of that child's ASD condition.
- To be more confident, creative, resourceful, and fun when playing and interacting with their child in other contexts (at home and in other social situations).
- To feel more hopeful and optimistic—and in turn less anxious and prone to hyper-vigilance—relative to their child's life prospects generally (social, academic, and in terms of capacity for self-sufficiency in adult life).
All of the parents have indicated that participating in the Music-Play Project was a positive and enjoyable experience for their child. Most stated that the expectation-free, nurturing environment of the E-WoMP helped their child to gain confidence and discover that being with and interacting with others could be fun rather than stressful. Some parents reported that the play sessions were the first occasions on which they had ever seen their child actually enjoying play and interaction in a social context. Others noted that friendships between participating children were emerging from the program, leading to follow-up play dates and explicit expressions of excitement on the part of their children at the prospect of returning to the E-WoMP to play with their new friends. One mother commented in her journal that, "For the first time, my son has a friend!" The opportunity to "hang out" with their child in a supportive and enjoyable environment was identified as a major strength of the program by all parents. So too was the opportunity to see their child participating in a fun and stimulating activity, E-WoMP music-play, that was not only free of the task- and goal-oriented requirements that comprise most other activities of social involvement with their child (school work, speech therapy sessions, formal music lessons, sports), but was also success-oriented rather than testing- and assessment-oriented. All of the parents commented that this was something their child needed much more of: the opportunity to simply play, to have fun, and to experience success on his own terms. And they stated, unequivocally, that getting to see their child in such a context was something they themselves needed much more of as well. "They're fun," commented one of the mothers in her journal in reference to the E-WoMP sessions. "[My son] is enjoying himself. I don't get to spend much time with him when he's with other children. When I have, I haven't liked what I've seen—at school, at summer camp. He gets in fights, doesn't make friends. So this has been good. He's not fighting. He's making friends." Parent responses have also been useful in identifying areas for program improvements. Suggestions to organize smaller music-play groups (two child-parent units rather than three), use instruments that are not "breakable," and provide more information for the parents about the instruments used and conventional techniques of playing them have been especially constructive as we envision future MPP programs.
What is the specific role and value of music in E-WoMP music-play facilitation? And, on the other hand, how are the goals, priorities, and outcomes of such facilitation relevant for broader (non-musical) issues and concerns relating to the study and treatment of ASD? These are matters to which we now turn our attention. Regarding the specific role and value of music in MPP, our experiences and findings thus far indicate that the possibilities for improvisatory exploration and social interaction furnished by a "world-music" instrument-centered playground environment can be highly beneficial to children on the autism spectrum. Ideally suited for fostering curiosity and experiences of success are instruments that give high yield for low input, produce attractive yet largely unfamiliar timbres and tunings, have both visual and tactile appeal, and offer the potential for experimentation with highly varied forms of both music/sound-based play and "non-music" play styles (staging "sword fights" with dive-stick mallets, creating elaborate sculptures with bamboo angklung tubes, or using makeshift didjeridus constructed from wrapping paper tubes as elephant trunks in an impromptu "elephant dance"). These may serve to build confidence, agency, and response-ability in a supportive and largely demand-free environment such as the E-WoMP. Moreover, the fact that the medium of music offers compelling opportunities for creative exploration and social engagement through play, but without requiring that verbal communication or eye contact occur during the play process, is an important asset in terms of meeting our facilitative aspirations. Verbal communication challenges are a primary characteristic of ASD, and "face-to-face interaction is often anathema" to persons with autism.35 Since meaningful, enjoyable music-making eliminates from the communicative equation the necessity of speaking and interacting face-to-face to an extent that other forms of communal experience cannot, music offers powerful advantages in working with people on the autism spectrum.
In some musicultural traditions, such as Balinese gamelan, a cultivated detachment ("awayness") from explicit verbal and visual contact with one's fellow music players is considered both desirable and normative.36 This is a potentially valuable social-musical model to consider in the context of a project such as MPP. But is it a dangerous model? After all, if we are using music to afford children with ASD the "luxury" of avoiding verbal and face-to-face interactions in their communications, are we not then actually enabling their autistic proclivities for self-isolation as well? We think not. If these children can be provided with opportunities to feel satisfied and efficacious in social interaction of any type, then we believe—and we have seen—that this will inspire them to feel more motivated and confident as social actors, even in areas of challenge such as interactive dialogue and eye contact.
Jimmy and the Gyil: Toward Agency and Response-Ability through Music-Play
The experiences of six year-old Jimmy, a participant in the MPP 2005 pilot study, support of our view. Jimmy was almost entirely non-communicative and averse to interaction of any kind during his first music play-session in the E-WoMP. He cuddled anxiously in his mother's lap throughout the session and frequently covered his eyes and ears with his hands in an apparent effort to shut out the world around him. He showed little interest in the instruments, except for a couple of egg shakers and dive-stick mallets that he would twist around in his hands and stare at for long periods of time. Through the first half hour of Jimmy's second session in the E-WoMP, his behavior remained essentially unchanged from the first session. Something interesting occurred mid-way through the session, however, and viewing this on video brings it vividly into present-tense experience, that is, into the ethnographic present.
We begin at the thirty-minute point of the video that documents Jimmy's second E-WoMP session. First we see Jimmy's mother, Hannah, walking across the E-WoMP and sitting down behind the gyil "xylophone" to join one of the other children and his mother in a music game of their own invention. Jimmy predictably follows Hannah to the gyil for fear of being separated from her. She encourages him to join in the game; he obliges to some extent, dutifully banging out a couple of notes on the instrument with his dive-stick mallet before shrinking back a moment later with an expression of distress on his face. A few seconds later, Jimmy picks up his dive-stick and throws it violently at the gyil in apparent protest. It lands on the sloped playing surface of the instrument and rolls downward across the wooden keys, yielding an ascending glissando effect that surprises him. His distressed facial expression immediately changes to one of curiosity. "It makes a noise when I roll it across!" Jimmy exclaims with evident excitement, though seemingly to no one in particular.
Bakan immediately responds to Jimmy's newfound interest in the gyil by walking over to the instrument and sitting down gently on the floor next to him. Jimmy does not acknowledge Bakan, but he allows him to stay without protesting, which Bakan interprets as an encouraging sign. Bakan picks up a dive-stick and rolls it down the sloping gyil, reproducing the same musical effect as Jimmy's original dive-stick throw. Jimmy does not look at Bakan or say anything, but he imitates his action, rolling the mallet down the gyil rather than throwing it. His facial expression registers happiness; both the sound and the back-and-forth mallet-roll game seem to please him. Hannah gets in on the act and rolls a dive-stick, too. This really seems to make Jimmy happy. He smiles, still looking downward. For about a minute the game continues between the three players in this fashion, gaining nice momentum. Then Jimmy decides to add a new element to it. He trots to the back of the E-WoMP (notably leaving Hannah behind with no apparent concern about the momentary separation) and gathers up a handful of dive-sticks. He returns to the gyil and initiates a series of experiments, rolling dive-sticks in different directions across the keys, wedging them between the wooden slats, stacking them up at one end of the instrument and then the other. His experiments generate several new and satisfying sounds as well as new possibilities for interacting with his fellow players around those sounds. Bakan and Hannah imitate everything he does. Jimmy is receptive both to their enthusiastic participation and their bids to assist him. For example, when Bakan looks over at and points to a cluster of dive-sticks that are out of Jimmy's view, Jimmy follows his gaze and responds by gathering up those mallets and incorporating them into the game.
Jimmy does not go so far as to share leadership of the game at this stage. When Bakan tries to introduce a new variation on the mallet stack-and-roll game theme, Jimmy does not respond, instead continuing to direct the play activity. Bakan proves to be sufficiently well in tune with the social dynamic of the moment to immediately back off, realizing that his bid for a higher level of music-play exchange with Jimmy is too advanced, or at least premature. Bakan returns to the follow-and-assist mode of playful interaction and the game evolves successfully for several more minutes under Jimmy's capable and quite enthusiastic direction.
The session eventually draws to a close, and Jimmy surprises everyone by taking part actively in the clean-up effort. He scampers energetically about the room, gathering up egg shakers and dive-stick mallets and placing them in the appropriate plastic bags. At one point, he and one of the other kids, seven year-old Frederick, inadvertently come face to face in the middle of the room on their way to other places. Jimmy has never spoken to Frederick, or to Christopher, the other boy in their group. Nor has he ever made eye contact with either of them.
"Here you go," Jimmy says matter-of-factly, looking directly at Frederick with a nice, calm expression as he hands him a pair of egg shakers to put in the bag. It is a pivotal moment of social response-ability for Jimmy, indeed for both boys, and a friendship between the two will grow in its aftermath. Music seems to have paved the way for Jimmy's social agency in this music-play episode. His wondrous discovery of the gyil glissando effect has served as a gateway to new kinds of playful, meaningful interaction, first with the sound itself, then with his mother, and finally with Bakan. And through this gateway, a door has opened to new levels of confidence and joy in the general social domain that makes saying "Here you go" to Frederick not just possible, but satisfying and purposeful.
Frank and the Didjeridu: Facilitating Emotional Regulation in the E-WoMP
The acoustical and physical properties of certain E-WoMP music instruments, as well as the tonal and rhythmic properties associated with performance on those instruments, have yielded beneficial outcomes in the area of "emotional regulation" for some children in our program. This is another domain where music has been a great asset to the achievement of MPP's music-play driven facilitative priorities. Emotional regulation is defined as "adapting to and coping with the inevitable and uniquely individual challenges" people face "in maintaining optimal states of arousal most conducive to [. . .] relating to others, and experiencing positive emotions."37 Given the inherent social difficulties that define autism spectrum conditions, challenges relating to emotional regulation are pervasive and often severe. The emotion-regulating capacities of two types of instruments used in the E-WoMP have been especially profound. These are the large gongs (gong ageng) of the Balinese gamelan and the didjeridu that Koen plays during most sessions, both of which produce sustained and deeply resonant tones of very low pitch. Steady-beat rhythmic grooves played on low-pitched, resonant drums (usually in interlocking style by Bakan and Koen) have been effective in facilitating emotional regulation among some of our child participants as well,38 though in some instances such drumming seems to have had an emotionally dysregulating effect, resulting in negative behavioral outcomes for certain children.39
Frank, a child who participated in one of the two MPP programs conducted in 2006 (and whose experiences in that program are the main focus of another publication40), was particularly receptive in the emotional-regulation domain to E-WoMP instruments with sustained, low-pitched, resonant tones, including the large gongs and most especially the didjeridu. The relationship that emerged between Frank and Koen with the aid of the sonic, physical, and musical mediation of Koen's didjeridu provides an interesting case study of musical affect in the E-WoMP. It also offers a good example of applied practice in E-WoMP music-play facilitation methodology.
Frank was six years old at the time of his MPP program. He had been diagnosed with autistic disorder at age three. His autism-related challenges were severe in comparison with those of most of the other children who have participated in our program, including the two other boys in his own music-play group. He had developmental delays in communication (mainly speech) from early childhood and had very limited verbal communication skills for a child of his age. The few words he did speak were difficult to comprehend due to his unique enunciation ("Ah be gu" for "I'll be good"). Non-verbal communication and interaction were also challenging for Frank and he rejected eye contact. He was prone to high levels of anxiety and would habitually grind his teeth, the volume level of the grinding escalating as his anxiety level increased.
Frank's first two sessions in the E-WoMP were difficult and stressful, to say the least, both for him and everyone else involved. He was constantly on the go, attacking instruments with near-destructive force, rattling the kettle-gongs and bronze bars of the gamelan instruments to produce jarringly abrasive sounds, trying to pull the large gongs down to the floor (which, fortunately, were secured in place by heavy sandbags), and occasionally attempting to escape the E-WoMP altogether. He proved to be a test case par excellence for the safety-modified instrumental apparatus of the facility.
Frank usually refused to interact with any of the other players during these first two sessions. The one partial exception was Koen. It was immediately evident that low-pitched, resonant sounds appealed to Frank, and those of the didjeridu most of all. Bakan, Koen, and Frank's mother, Kathleen, all commented on Frank's attraction to this instrument, as well as to the large gongs, in their journal entries for these early sessions.41 Throughout his program, Frank exhibited a quite consistent pattern of becoming more relaxed and less restless when embraced by the low, resonant, sustained tones of the didjeridu, which turned out to be an effective facilitator of emotional regulation for him. This instrument became, quite literally, a physical and sonic bridge between Frank and Koen, and the connection continued to grow during his six weeks. The emotionally-regulating impact of the didjeridu on Frank is most clearly evident in the video recording documenting his third session in the E-WoMP, which represented a breakthrough for him on many levels. A key element in Frank's quite remarkable gains in social agency and emotional control during this session was Koen's effective use of music-play facilitation methods centered on the didjeridu. In the following account, present-tense voice is again used to capture the experience of viewing this session on video.
We begin at a point just a few minutes into the video recording, where we observe Frank suddenly and dramatically shifting from a state of relative calm and control to one of severe agitation and apparent confusion. He darts around the room and destructively assaults instruments, tries to escape into an off-limits closet, and covers his eyes and ears in apparent response to overstimulation. Kathleen grabs him and squeezes him in a tight bear hug."What's wrong?" she asks. "Gaw home," he appeals to her. "Gaw home!" Koen observes what is happening and responds by beginning to play his didjeridu. Frank hears the welcome sound, wriggles free of his mother, and rushes over to Koen. He lies down and stares up into the bell of the instrument with interest as Koen plays. Almost immediately, the visible tension in his body releases and he becomes quite calm and relaxed. Later in the session, after a highly successful music-play episode initiated by Bakan, in which Frank for the first time becomes a truly engaged and interactive E-WoMP participant, he again begins to unravel. He crashes face-first to the floor in apparent distress, his body rigid with tension. Now Koen intervenes, sitting quietly next to Frank, placing the bell end of his didjeridu on the floor next to Frank's feet, and beginning to play. The tension in Frank's body seems to melt away almost immediately, as before. Kathleen joins Frank and Koen on the floor. There is a nice moment of mutual nurturance between the three of them as Koen continues to play long, droning tones on the didjeridu. Then Frank calmly walks over to the gongs and joins Bakan in a game of call-and-response gong strokes for a couple of minutes, after which he returns to Koen and the didjeridu, becoming more playful and adventurous. He inserts a large gong beater into the bell end of the didjeridu (which Koen allows), then he and Koen engage in some "didjeridu wrestling"—a silly, spontaneous tug-of-war game with the didjeridu as the prize. It is fun for a while, but then Frank begins to show signs of agitation and overstimulation again. This time, however, Frank knows just what he has to do. He lies down on the floor and positions himself so that the didjeridu rests across his body. This is clearly a non-verbal cue to Koen to play again. Koen honors the request, and as the low, resonant vibrations wrap around Frank's body we once again witness him returning to a state of calmness and emotional balance.
Beyond the Music of Music-Play
Our examples thus far have centered specifically on how the music and instruments of the E-WoMP contribute to the project's facilitative goals in valuable ways. The music of music-play is certainly a key component of our program, but extra-musical factors relating to the social environment of the E-WoMP in a general sense are at least as significant for our goals of promoting emotional well-being, self-confidence, social and cultural agency, and response-ability in children with ASD. MPP research team psychologist Megan Bakan explains:
I don't think the musicor the instruments are the main thing at all. It's the E-WoMP environment itself that matters most. These kids are constantly being defined by other peoples' agendas—at school, in therapy sessions, on the playground, even at home. They're under so much pressure; there are so many demands on them. And the parents, they're under that constant weight, too [. . . .] But in the E-WoMP that all goes away for a while. It's just about play and exploration and this place where nobody's telling you what you're supposed to do, or who you're supposed to do it with, or how to do it, or what it's supposed to sound like. Half of the games these kids are coming up with have nothing to do with music at all, as far as I can tell [. . . .] They [get to] have some fun, and the parents see that—even get to be part of it—and that helps make everybody feel good.
Megan Bakan's comments express a view shared by the entire MPP research team, namely, that however important the music piece of the Music-Play Project may be, it is another element—a community element, a culture element—that probably matters even more. Beyond their experiences and abilities as musicians and improvisers, what Bakan and Koen brought to the project was, as Bakan states, "an ethnographic perspective, an ethnomusicological sensibility regarding what we were up to." About the analogy between the music-play facilitation context of MPP and the ethnomusicological field research context of his work in Indonesia, Bakan comments:
You know, when I go off to Bali to do fieldwork, I don't start telling the musicians there how they should play gamelan or how they should behave themselves. I'm there to learn from them about what they do and how they do it, and what I'm really hoping is that if I listen and learn carefully enough they'll give me the chance to really play with them. If I can get to that place, I'm going to learn a lot more—andhave a lot more fun—than if I don't.
Bakan asserts that the same kind of ethnomusicological "mindset" should apply in the E-WoMP, and indeed far beyond it as well. The E-WoMP, he explains,
needs to be a place where these kids can have the same sense of ownership of theirmusic culture that folks in Bali—or wherever—have of theirs. Everything else flows from that, because in that situation ASD ways of being can become normal and empowering, not marginal and in need of "fixing" and "improvement." These children deserve that kind of respect, that acceptance of who they are, and not just in the E-WoMP, truth be told. It should be there in as many situations and contexts as possible.
Improvisation, Musicultural Experience, and the Making of Culture in the E-WoMP
The improvisational medium that defines music-play praxis in the E-WoMP is not jazz, but it does similarly partake of "the collaborative and communicative quality of improvisation" and "moment[s] of community" invoked by Ingrid Monson's phrase "saying something." The E-WoMP, like the jazz club or the jazz bandstand, is a place where individual and social transformations are enacted and acted upon through the "somethings" that are said there, in this case the musical and playful "utterances" made by and between the participating music-playerschildren, parents, and facilitators. The E-WoMP is also a fully cultural placeand more specifically a musicultural place42despite conventional epistemologies of culture that may lead one to think otherwise. It could be argued that whenever research subjects are isolated from their everyday settings of interaction, for example, in a "play-lab" environment such as the E-WoMP, their normative social networks and cultural practicesof home, school, work, and other culture-defining situationsare bracketed and set aside. By this logic, the E-WoMP is apart from, rather than a part of, the cultural realities of those who inhabit it; it is a bracketed environment where culture does not, and cannot, exist.
It is our contention, however, that the E-WoMP is a place where culture not only exists, but where culture is actively made and continually negotiated by all of the individuals who collectively occupy the space during their music-play sessions. The E-WoMP is not an everyday place; it is, rather, more akin to a ritual space in the anthropological sense, meaning that it is the locus of a separate, bracketed reality that can help make ordinary reality make more sense.43 That the E-WoMP is set aside from everyday life does not negate its cultural possibilities, but rather enriches them, for it is well established in anthropological and ethnomusicological theory that ritual place/space/time is not detached from culture, but, instead, is the manifestation of a super-saturated distillation of cultural essence, a locus for the performance of culture in highly concentrated form, and a context for experiencing mind and culture alike at deep-structure levels.44 When John Blacking reports that
the Balinese speak of "the other mind" as a state of being which can be reached through dancing and music [. . . and] refer to states in which people become keenly aware of the true nature of their being, of the "other self" within themselves and other human beings, and of the relationship with the world around them [through access to this "other mind"],45
he is implicitly projecting us into the realm of Balinese ritual experience, and by extension into the core realm of Balinese cultural experience.
Through their music, their playing, their dancing, and their interactions and non-interactions in the ritual space of the E-WoMP, the children who participate in the Music-Play Project take us into the ritual, and in turn cultural, experiences of their own being. The cardinal symptom of autism is usually characterized as a fundamental disability on the part of the autistic individual to connect socially with others, and this has been equated with an essential "inability to co-create culture" by some behavioral scientists. "If human beings do not 'make contact,' there can be no normal socialization, no co-construction of culture," write psychologists Penelope Vinden and Janet Astington.46 And if people with autism do indeed lack the capacity to be culture makers, then they "are in some senses individuals without a culture [. . . ,] since culture is by its very nature dialogic."47 Yet our own research and that represented in a growing body of ASD literature indicates that people on the autism spectrum, even purportedly "low-functioning" individuals, can and do "make contact" and thus do have the capacity to be culture makers. The problem they face is that their everyday settings of interaction—at home, at school, at work— tend to inhibit and discourage their cultural agency, rather than inspire it. As we have written elsewhere, where autism is concerned, "it is often not social interaction per se but rather the conventional expectations and demands associated with social interaction that impede social joy and investment."48
Thus, paradoxically, a constructed cultural environment such as the E-WoMP may provide the optimal type of context for the children with ASD who participate in our program to explore both the experience and the making of culture. Dedicated to the unequivocal nurturance and acceptance of their actions and the core values that underlie them—and concomitantly to the elimination (to the greatest extent possible) of the normative, everyday social expectations and demands that they find challenging—the E-WoMP is a ritual space in which these children can safely and confidently take part in the rich possibilities and pleasures of active social and cultural agency—perhaps for the first time in their lives ("For the first time, my son has a friend!"). And since such cultural agency is being promoted within a music-play atmosphere, they are becoming engaged through improvisatory exploration with their fellow E-WoMP players in a process of not only cultural, but also musicultural, co-creation. This is a process, to paraphrase Blacking's earlier gloss on Balinese experience, which can facilitate the ability of children with ASD to become attuned to aspects of themselves, of others, and of their relationship with the world around them in ways that might otherwise elude them. From there, it can lead to the development of skills in key areas that define their competence as culture makers generally. As R. Keith Sawyer observes, "the group collaborations of improvisation can potentially make it beneficial in a wide range of skills, not only musical skills, but social skills like collaboration, group problem-solving, and collective creativity"49—in other words, the skills of cultural agency. As facilitators of free improvisational music-play, Bakan and Koen do not remove the children from their everyday culture; rather, they are contributing to an environment in which these children can receive support to be more actively cultural, hopefully in ways that will have transferable potential beyond the E-WoMP ritual space itself. They are facilitating a cultural conversation that is "improvised, collectively created, and collaboratively emergent,"50 and in which all the participants, and the children most especially, "have creative freedom and the potential to negotiate their status in interaction"51 on their own terms and in the absence of judgment.
Saying Something Else, Letting Something Be Heard
For Michael Bakan and Benjamin Koen, the ability to "say something" of value as improvisers in the E-WoMP has developed mainly from learning to listen better and become more effectively attuned to the "somethings" that are said by the children with whom they play, and learning also to respond to what is communicated by the children with due sensitivity and care. An abiding commitment to a person-first mode of engagement, in all instances and at all times, has been of fundamental importance to their progress. As Tom Kitwood teaches us through his innovative work on dementia, respect for the personhood of the individual must trump all else.52 The relationship into which we enter, in the E-WoMP or anywhere else, is with a child with autism, not a child with autism; it is with a child who has abilities, not a disability.
Bakan and Koen came to the Music-Play Project as improvisers whose saying-something discursive strategies had been honed mainly in the musicultural domain of professional jazz performance, the same domain invoked by Ingrid Monson, as cited at the outset of this article.53 According to Megan Bakan, that brand of saying something largely defined their improvisational strategies when they began the project—even if they themselves did not recognize this—but it did not endure. It was transformed into something else in response to what the situation itself required. "I'd say that wanting to 'say something' in that [jazz-based] way was your mode going into this project, because that's what you went into it with," Megan Bakan told Michael Bakan during a conversation about MPP at their home in March 2007. "But I think that in the process [as the project progressed], it became less about saying something than letting something be heard." This alternative mode of being musical and interacting musically in the E-WoMP required a self-conscious attempt by Bakan and Koen—sometimes successful, sometimes not—to resist their deeply entrenched tendencies toward leading and toward striving for their own self-expression through musical performance. According to Megan Bakan, the two MPP facilitators "had to acknowledge that the children were really the leaders, and even question whether `the music' would be the focus of the activity at all" before the program could begin to achieve its potential. "That realization," she adds, "was the first step in the process, I think: that it might not be music; that it might, rather, be 'instrument play' or something else."
Linked to that realization was the developing willingness by Bakan and Koen to take "more of a passive, observing role" in E-WoMP music-play. "There was a time [early on] when if a child started doing something, you [as improvisers] both wanted to immediately join in with that, but with time you learned to lay back for just a few minutes," Megan Bakan continued. In her view, these were the instances in which the richest and most meaningful social and play interactions between participating children tended to occur, and she also observed that when Bakan or Koen would allow themselves to be "accepted by the children first just as an observer, then [afterwards] you could join in with their way of playing and they'd let you in." Bakan's and Koen's ability to yield leadership responsibilities to the children and maintain an accepting attitude toward virtually all of their modes of sound-making and play in the E-WoMP was perceived as an important feature of MPP not only by Megan Bakan, but also by several of the participating parents. One mother involved in a 2006 MPP program commented in her journal that having an environment in which "the children get to create and be silly and make noise" and where "there is no `messing up' or wrong notes" was a great asset of the program. She specified, too, that the willingness "to let the kids lead" was another of its primary strengths.
For Michael Bakan, the experience of ethnographically documenting and analyzing roughly forty hours of MPP music-play session videos has been crucial for him to be able to perceive a shift in his own (and Koen's) behavior from the "saying-something" mode of music-play facilitation to the "letting-something-be-heard" mode. The videographic analysis has been both enlightening and humbling for Bakan. In the videos, he has witnessed himself and Koen struggling, often quite self-consciously, to unlearn their proclivities for "saying something" in the conventional terms familiar to them as improvisers. He explains that they have had to "learn to listen with new ears" and acknowledges that the learning curve has been steep and not always well navigated. In particular, Bakan notes that the children in MPP display creative tendencies with respect to music that are often very far removed from his own, and that this presents challenges to his improvisational—as well as social—sensibilities. He explains that the children can seem "completely oblivious" to what is going on around them one moment, then turn around and do something "incredibly musical and interactive" the next. Additionally, there is a comfort that many of them appear to have with long silences that he does not share, leading him to sometimes feel awkward and compelled to "fill up the space," sometimes inappropriately.
In his role as a facilitator, Bakan aspires to maintain a truly acceptingattitude toward whatever transpires in the E-WoMP, even in the face of such challenges. He recognizes, however, that there have been many instances in which he has fallen well short of his own standards. He cites episodes from the videos in which he sees himself unintentionally interfering with a child's ability to truly explore the E-WoMP on his own terms. In mistaking his own desire to "make something happen" with one of the children for an invitation from that child to interact with him, musically or otherwise, Bakan claims that he has at times inadvertently interrupted a child's creative flow or caused that child to close in on himself and retreat from a potentially positive social interaction. Despite these and other shortcomings evidenced by the video analysis, Bakan concludes that the results of the music-play sessions in the E-WoMP are, on the whole, very positive and encouraging. He finds this to be the case both in terms of the response-able individual achievements of the children and the response-able facilitation efforts of Koen, the participating parents, and himself:
There is a great rapport and sense of community in the E-WoMP, and you see that growing from week to week in the videos. There's real progress. And the most incredible thing you see—with every one of these kids—is that they really wantto connect with others. It doesn't always work out, so maybe they get frustrated, or they withdraw, but sometimes it does, and you see the kid's face light up and it's a magical thing. To claim that these children are socially unaware or lack the desire for social connection and experience doesn't make sense, and people need to start seeing that. Maybe we can help generate that kind of awareness with this project. I truly hope so.
Benjamin Koen takes a more spiritual, philosophical view on the matter of "saying something." His remarks provide a fitting conclusion to this essay:
One of our key features of the E-WoMP is to listen to the children's musicand sometimes we have to repeat, 'yes, music.' We must listen, hear, feel, and respond, not just with preconceived and learned models of listening, but more in the [Sufi] spirit of samá', the sacred and holistic listening/hearing with ear, heart, mind, body, and soul—where there is always a connection to be made, at times in silence, at times in sound. If [these children] are indeed "saying something," and we believe that they are—perhaps the language is different, perhaps not—our goal is to hear what is being said and strike up a conversation, and participate in the creation of a space in and beyond the E-WoMP where a different type of awareness, attention, and perception can pervade the space between people, even in the silence.
Aigen, Kenneth. "An Aesthetic Foundation of Clinical Theory: An Underlying Basis of Creative Music Therapy." In Listening, Playing, Creating: Essays on the Power of Sound, edited by C.B. Kenny, 233-57. New York: SUNY Press, 1995.
_____. Playin' in the Band: A Qualitative Study of Popular Music Styles as Clinical Improvisation. New York: Nordoff-Robbins Center for Music Therapy (Steinhardt School of Education, NYU), 2002.
Akombo, David Otieno. Music and Healing Across Cultures. Ames, IA: Culicidae Press, 2006.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th ed., Washington, D.C.: American Psychiatric Association, 1994.
Bakan, Michael B. Music of Death and New Creation: Experiences in the World of Balinese Gamelan Beleganjur. Chicago: University of Chicago Press, 1999.
_____. World Music: Traditions and Transformations. New York: McGraw-Hill, 2007.
_____. "Preventive Care for the Dead: Music, Community, and the Protection of Souls in Balinese Cremation Ceremonies." In The Oxford Handbook of Medical Ethnomusicology: Music, Medicine, and Culture, edited by B. Koen, 246-64. New York: Oxford University Press, 2008.
Bakan, Michael B., Benjamin Koen, Fred Kobylarz, Lindee Morgan, Rachel Goff, Sally Kahn, and Megan Bakan. "Following Frank: Response-Ability and the Co-Creation of Culture in a Medical Ethnomusicology Program for Children on the Autism Spectrum." Ethnomusicology 52, no. 2 (2008): 163-202.
Baker, Mary Joy. "Incorporating Children with Autism's Thematic Ritualistic Behaviors into Games to Increase Social Play Interactions with Siblings." Ph.D. diss., University of California at Santa Barbara, 1999.
Barz, Gregory. Singing for Life: HIV/AIDS and Music in Uganda. New York: Routledge, 2006.
Becker, Judith. "Music, Trancing, and the Absence of Pain." In Pain and Its Transformations, edited by S. Coakley and K. Shelemay, 166-94. Cambridge, MA: Harvard University Press, 2007.
Berliner, Paul. Thinking in Jazz: The Infinite Art of Improvisation. Chicago: University of Chicago Press, 1994.
Blacking, John. Music, Culture, and Experience: Selected Papers of John Blacking. Chicago: University of Chicago Press, 1995.
Borgo, David. Sync or Swarm: Improvising Music in a Complex Age. New York: Continuum, 2005.
Bruscia, Kenneth E. Improvisational Models of Music Therapy. Springfield, IL: Charles C. Thomas, 1987.
Campbell, Patricia Shehan. Songs in Their Heads: Music and Meaning in Children's Lives. New York: Oxford University Press, 1998.
Capps, Lisa, Molly Losh, and Christopher Thurber. "The Frog Ate the Bug and Made his Mouth Sad: Narrative Competence in Children with Autism." Journal of Abnormal Child Psychology 28, no. 2 (2000): 193-204.
CDC—Centers for Disease Control and Prevention. "Autism Information Center." http://www.cdc.gov/ncbddd/autism/index.htm (accessed May 24, 2007).
Coakley, Sarah, and Kay Kaufman Shelemay, eds. Pain and its Transformations: The Interface of Biology and Culture. Cambridge, MA: Harvard University Press, 2007.
Darrow, Alice-Ann, ed. Introduction to Approaches in Music Therapy.Silver Spring, MD: American Music Therapy Association, 2004.
Darrow, Alice-Ann, and Tammy Armstrong. "Research on Music and Autism: Implications for Music Educators." Update: Applications of Research in Music Education 18, no. 1 (1999): 15-20.
Donnelly, Julie, and Jean-Paul Bovee. "Reflections on Play: Recollections from a Mother and Her Son with Asperger Syndrome." Autism 7, no. 4 (2003): 471-76.
Edgerton, Cindy Lu. "The Effect of Improvisational Music Therapy on the Communicative Behaviors of Autistic Children." Journal of Music Therapy 31, no. 1 (1994): 31-62.
Friedson, Steven. Dancing Prophets: Musical Experience in Tumbuka Healing. Chicago: University of Chicago Press, 1996.
Goff, Rachel A., Sally Kahn, Lindee Morgan, Megan Bakan, Benjamin Koen, Fred Kobylarz, and Michael Bakan. "A Hands-on World Music Applied Research Program for Children with ASD and Their Families." Poster presented at the American Speech-Language Hearing Association (ASHA) Convention, Miami, FL, November 2006.
Gouk, Penelope, ed. Musical Healing in Cultural Contexts. Aldershot, UK: Ashgate, 2000.
Grandin, Temple, and Sean Barron. Unwritten Rules of Social Relationships: Decoding Social Mysteries through the Unique Perspectives of Autism. Arlington, TX: Future Horizons, 2005.
Greenspan, Stanley I. "Children with Autistic Spectrum Disorders: Individual Differences, Affect, Interaction, and Outcomes." Psychoanalytic Inquiry 20 (2000): 675-703.
Greenspan, Stanley I., and Serena Wieder. Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, MA: Da Capo Press, 2006.
Gunsberg, Andrew. "Improvised Musical Play: A Strategy for Fostering Social Play Between Developmentally Delayed and Nondelayed Children." Journal of Music Therapy 25, no. 4 (1998): 178-91.
Hollander, Fred M., and Patricia D. Juhrs. "Orff-Schulwerk, an Effective Treatment Tool with Autistic Children." Journal of Music Therapy 11, no. 1 (1974): 1-12.
Kaplan, Ronna, and Anita Louise Steele. "An Analysis of Music Therapy Goals and Outcomes for Clients with Diagnoses on the Autism Spectrum." Journal of Music Therapy 42, no. 1 (2005): 2-19.
Kasari, Connie, Sabrina Freeman, and Tanya Paparella. "Joint Attention and Symbolic Play in Young Children with Autism." Journal of Child Psychology and Psychiatry and Allied Disciplines 47, no. 6 (2006): 611-20.
Keil, Charles, and Steven Feld. Music Grooves. Chicago: University of Chicago Press, 1994.
Kern, Petra. "Making Friends in Music: Including Children with Autism in an Interactive Play Setting." Music Therapy Today 5, no. 4 (2004): 1-43.
Kitwood, Tom. Dementia Reconsidered: The Person Comes First. New York: Open University Press, 1997.
Koen, Benjamin D., "Medical Ethnomusicology in the Pamir Mountains: Music and Prayer in Healing." Ethnomusicology 49, no. 2 (2005): 287-311.
_____. "Musical Healing in Eastern Tajikistan: Transforming Stress and Depression through Falak Performance." Asian Music 37, no. 2 (2006): 58-83.
_____. Beyond the Roof of the World: Music, Prayer, and Healing in the Pamir Mountains. New York: Oxford University Press, 2008.
Koen, Benjamin D., ed. The Oxford Handbook of Medical Ethnomusicology: Music, Medicine, and Culture. New York: Oxford University Press, 2008.
Koen, Benjamin D.,Gregory Barz, and Kenneth Brummel-Smith. "Introduction: Confluence of Consciousness in Music, Medicine, and Culture." In The Oxford Handbook of Medical Ethnomusicology, edited by B. Koen, 3-17. New York: Oxford University Press, 2008.
Koen, Benjamin D., Michael B. Bakan, Fred Kobylarz, Lindee Morgan, Rachel Goff, Sally Kahn, and Megan Bakan."Personhood Consciousness: A Child-Ability-Centered Approach to Sociomusical Healing and Autism Spectrum `Disorders'." In The Oxford Handbook of Medical Ethnomusicology, edited by B. Koen, 461-81. New York: Oxford University Press, 2008.
Laderman, Carol, and Marina Roseman. The Performance of Healing. New York: Routledge, 1996.
Lord, Catherine, Michael Rutter, Pamela C. DiLavore, and Susan Risi. Autism Diagnosis Observation Schedule. Los Angeles: Western Psychological Services, 2002.
Loth, Helen. "How Gamelan Music Has Influenced Me as a Music Therapist—A Personal Account." Voices: A World Forum for Music Therapy, 2006. http://www.voices.no/mainissues/mi40006000201.html.
MacDonald, Raymond A.R., and Dorothy Miell. "Music for Individuals with Special Needs: A Catalyst for Developments in Identity, Communication and Musical Ability." In Musical Identities, edited by R. MacDonald, D. Hargreaves, and D. Miell, 163-78. New York: Oxford University Press, 2002.
Minor, Lavada M. "The Developmental Progression of Play in Children with Autism." Ph.D. diss., University of California, Los Angeles, 2003.
Monson, Ingrid. Saying Something: Jazz Improvisation and Interaction. Chicago: University of Chicago Press, 1996.
Moreno, Joseph. "Multicultural Music Therapy: The World Music Connection." Journal of Music Therapy 25, no. 1 (1988): 17-27.
Nettl, Bruno, ed. In the Course of Performance: Studies in the World of Musical Improvisation. Chicago: University of Chicago Press, 1998.
Noddings, Nel. Happiness and Education. New York: Cambridge University Press, 2003.
Nordoff, Paul, and Clive Robbins. Creative Music Therapy: Individualized Treatment for the Handicapped Child. New York: John Day, 1977.
Ochs, Elinor, and Olga Solomon. "Introduction: Discourse and Autism." Discourse Studies 6, no. 2 (2004): 139-46.
_____. "Practical Logic and Autism." In A Companion to Psychological Anthropology, edited by C. Conerly and R. Edgerton, 140-67.Oxford: Blackwell, 2004.
Ochs, Elinor, Olga Solomon, and Laura Sterponi. "Limitations and Transformations of Habitus in Child-Directed Communication." Discourse Studies 7, nos. 4-5 (2005): 547-83.
Ochs, Elinor, Tamar Kremer-Sadlik, Karen Gainer Sirota, and Olga Solomon. "Autism and the Social World: An Anthropological Perspective." Discourse Studies 6, no. 2 (2004): 147-83.
Oldfield, Amelia. "Communicating through Music: The Balance between Following and Initiating." In The Art & Science of Music Therapy: A Handbook, edited by Tony Wigram, Bruce Saperston, and Robert West. Chur, 226-37. Switzerland: Harwood Academic Publishers, 1995.
Olsen, Dale A. Music of the Warao: Song People of the Rain Forest. Gainesville: University Press of Florida, 1996.
Pavlicevic, Mercedes, and Gary Andsell, eds. Community Music Therapy. London and Philadelphia: Jessica Kingsley Publishers, 2004.
Prizant, Barry M., Amy M. Wetherby, Emily Rubin, Amy C. Laurent, and Patrick Rydell. "The SCERTS Model: Enhancing Communication and Socioemotional Abilities of Children with Autism Spectrum Disorders." Jenison Autism Journal 14, no. 4 (2002): 2-19.
_____. The SCERTS Model: A Comprehensive Educational Approach for Children with Autism Spectrum Disorders. Vol. 1 (Assessment). Baltimore, MD: Paul H. Brookes, 2006.
_____. The SCERTS Model: A Comprehensive Educational Approach for Children with Autism Spectrum Disorders. Vol. 2 (Program Planning & Intervention). Baltimore, MD: Paul H. Brookes, 2006.
Prizant, Barry M., Amy M. Wetherby, Emily Rubin, and Amy C. Laurent. "The SCERTS Model: A Transactional, Family-Centered Approach to Enhancing Communication and Socioemotional Abilities of Children with Autism Spectrum Disorder." Infants and Young Children 16, no. 4 (2003): 296-316.
Rohrbacher, Michael. "The Ethnomusicology of Music Therapy." Ph.D. diss., Univer- sity of Maryland, Baltimore County, 1993.
_____. "Potential Applications of Clinical Music Therapy at RSJ Bangli Hospital, Bali, Indonesia." Paper presented at the Society for Balinese Studies Conference, Denpasar, Bali, Indonesia, July 1-3, 1993.
Roseman, Marina. Healing Sounds from the Malaysian Rainforest: Temiar Music and Medicine. Berkeley, CA: University of California Press, 1991.
Rubin, Emily, and Amy C. Laurent. "Implementing a Curriculum-based Assessment to Prioritize Learning Objectives in Asperger's Syndrome and High Functioning Autism." Topics in Language Disorders 24, no. 4 (2004): 298-315.
_____. "Implementing the SCERTS Assessment Process to Design Educational Programming." Power Point handout, SCERTS training, Tallahassee, FL, April 16-18, 2008.
Rutter, Michael. "Autism Research: Lessons from the Past and Prospects for the Future." Journal of Autism and Developmental Disorders 35, no. 2 (2005): 241-57.
Ruud, Even. Music Therapy: Improvisation, Communication, and Culture: Gilsum, NH: Barcelona Publishers, 1998.
Sanger, Annette, and James Kippen. "Applied Ethnomusicology: The Use of Balinese Gamelan in Recreational and Educational Music Therapy." British Journal of Music Education 4, no. 1 (1987): 5-16.
Sawyer, R. Keith. "Improvised Conversations: Music, Collaboration, and Development." Psychology of Music 27 (1999): 192-216.
_____. Improvised Dialogues: Emergence and Creativity in Conversation. Westport, CT, and London: Ablex Publishing, 2003.
Shore, Stephen M. "The Language of Music: Working with Children on the Autism Spectrum." Journal of Education 183, no. 2 (2002): 97-108.
_____. Beyond the Wall: Personal Experiences with Autism and Asperger Syndrome, 2nd ed. Shawnee Mission, KS:Autism Asperger Publishing Company, 2003.
Solomon, Olga. "Narrative Introductions: Discourse Competence of Children with Autistic Spectrum Disorders." Discourse Studies 6, no. 2 (2004): 253-76.
Standley, Jayne M. "A Meta-analysis on the Effects of Music as Reinforcement for Education/Therapy Objectives." Journal of Research in Music Education 44, no. 2 (1996): 105-33.
Stige, Brynjulf. Culture-Centered Music Therapy. Gilsum, NH: Barcelona Publishers, 2002.
Trevarthen, Colwyn, Kenneth Aitken, Despina Papoudi, and Jacqueline Robarts. Children with Autism: Diagnosis and Interventions to Meet Their Needs, 2nd ed. London and Philadelphia: Jessica Kingsley Publishers, 1998.
Turner, Victor. The Forest of Symbols: Aspects of Ndembu Ritual. Ithaca: Cornell University Press, 1967.
Van Weelden, Kimberly, and Jennifer Whipple. "Preservice Music Teachers' Predictions, Perceptions, and Assessment of Students with Special Needs: The Need for Training in Student Assessment." Journal of Music Therapy 44, no. 1 (2007): 74-84.
Vinden, Penelope G., and Janet W. Astington. "Culture and Understanding Other Minds." In Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience, 2nd ed., edited by S. Baron-Cohen, H. Tager-Flusberg, and D. Cohen, 503-20. New York: Oxford University Press, 2000.
Walworth, Darcy DeLoach. "The Use of Music Therapy within the SCERTS Model for Children with Autism Spectrum Disorder." Journal of Music Therapy 44, no. 1 (2007): 2-22.
Wagner, Roy. Symbols That Stand for Themselves. Chicago: University of Chicago Press, 1986.
Warwick, Auriel. "Music Therapy in the Education Service: Research with Autistic Children and their Mothers." In The Art & Science of Music Therapy: A Handbook, edited by Tony Wigram, Bruce Saperston, and Robert West, 209-225. Chur, Switzerland: Harwood Academic Publishers, 1995.
Whipple, Jennifer. "Music in Intervention for Children and Adolescents with Autism: A Meta-Analysis." Journal of Music Therapy 41, no. 2 (2004): 90-106.
Wimpory, Dawn, Paul Chadwick, and Susan Nash. "Brief Report: Musical Interaction Therapy for Children with Autism: An Evaluative Case Study with Two-Year Follow-Up." Journal of Autism and Developmental Disorders 25, no. 5 (1995): 541-51.
Wing, Lorna. "Reflections on Opening Pandora's Box." Journal of Autism and Developmental Disorders 35, no. 2 (2005): 197-203.
Wolfberg, Pamela, and Adriana Schuler. "Integrated Playgroups: A Model for Promoting Social and Cognitive Dimensions of Play in Children with Autism." Journal of Autism and Developmental Disorders 23, no. 3 (1993): 467-89.
1Berliner, Thinking in Jazz; Borgo, Sync or Swarm; Campbell, Songs in Their Heads; Keil and Feld, Music Grooves; Monson, Saying Something; Nettl, In the Course of Performance.
2Monson, Saying Something, 1-2.
3Bakan, World Music.
4For discussion of the use of gamelan instruments in other projects of related orientation, see Akombo, Music and Healing Across Cultures; Loth, "How Gamelan Music Has Influenced Me"; MacDonald and Miell, "Music for Individuals with Special Needs"; Moreno, "Multicultural Music Therapy"; Rohrbacher, "Potential Applications of Clinical Music Therapy"; Sanger and Kippen, "Applied Ethnomusicology."
5Noddings, Happiness and Education, 35; Bakan et al., "Following Frank."
6Blacking, Music, Culture, and Experience, 31.
7Bakan, Music of Death and New Creation.
8Pseudonyms are used for all of the children mentioned in this article, and for the parents of the children who have participated in the Music-Play Project as well.
9CDC, "Autism Information Center."
10American Psychiatric Association, Diagnostic and Statistical Manual.
11CARD is a state-funded program that provides direct service and consultative support to children with autism spectrum disorders and related disabilities, their families, and the professionals that work with them. CARD personnel completed a database search for potential project participants and distributed an invitation-to-participate letter to prospective participant families. Eligibility requirements included diagnosis of an autism spectrum disorder including administration of the Autism Diagnostic Observation Schedule (ADOS) (see Lord et al., Autism). Participant families received a small honorarium for taking part in the program (see Bakan et al., "Following Frank,"197 [n.2], for further details on participant selection).
12Rubin and Laurent, "Implementing a Curriculum-based Assessment," 2.
14Rutter, "Autism Research"; Wing, "Reflections on Opening Pandora's Box."
15See Darrow and Armstrong,``Research on Music and Autism", Edgerton, "The Effect of Improvisational Music Therapy"; Hollander and Juhrs, "Orff-Schulwerk"; Kaplan and Steele, "An Analysis of Music Therapy Goals"; Kern, "Making Friends in Music"; Oldfield, "Communicating through Music"; Standley, "A Meta-analysis on the Effects of Music"; Walworth, "The Use of Music Therapy within the SCERTS Model"; Warwick, "Music Therapy in the Education Service"; Whipple, "Music in Intervention for Children"; Wimpory, Chadwick, and Nash, "Brief Report: Musical Interaction Therapy." For research in music therapy that is theoretically and methodologically related to the present study, though not necessarily related to ASD, see Aigen, "An Aesthetic Foundation of Clinical Theory," Playin' in the Band; Bruscia, Improvisational Models; Gunsberg, "Improvised Musical Play"; Pavlicevic and Andsell, Community Music Therapy; Rohrbacher, "The Ethnomusicology of Music Therapy," "Potential Applications of Clinical Music Therapy"; Ruud, Music Therapy; and Stige, Culture-Centered Music Therapy, as well as pioneering works by Nordoff and Robbins (e.g., Creative Music Therapy). For very different perspectives on the diverse approaches used in music therapy research and practice generally, see Darrow, Introduction to Approaches in Music Therapy, and Stige, Culture-Centered Music Therapy.
16Baker, "Incorporating Children"; Donnelly and Bovee, "Reflections on Play"; Kasari, Freeman, and Paparella, "Joint Attention"; Minor, "The Developmental Progression"; Wolfberg and Schuler, "Integrated Playgroups."
17Bakan, "Preventive Care for the Dead"; Barz, Singing for Life; Becker, "Music, Trancing"; Coakley and Shelemay, Pain and its Transformations; Friedson, Dancing Prophets; Gouk, Musical Healing in Cultural Contexts; Koen, "Medical Ethnomusicology," "Musical Healing in Eastern Tajikistan," The Oxford Handbook of Medical Ethnomusicology, Beyond the Roof; Olsen, Music of the Warao; Roseman, Healing Sounds from the Malaysian Rainforest.
18Ochs and Solomon, "Practical Logic and Autism," "Introduction: Discourse and Autism"; Ochs et al,. "Limitations and Transformations," "Autism and the Social World"; Solomon, "Narrative Introductions"; see also Capps et al., "The Frog Ate the Bug."
19See, for example, Greenspan, "Children with Autism Spectrum Disorders"; Greenspan and Wieder, Engaging Autism; MacDonald and Miell, "Music for Individuals with Special Needs"; Prizant et al., "The SCERTS Model: Enhancing Communication," "The SCERTS Model: A Transactional, Family-Centered Approach," and The SCERTS Model: A Comprehensive, Educational Approach (Vols. 1 and 2).
20See, for example, Grandin and Barron, Unwritten Rules of Social Relationships; Shore, "The Language of Music," Beyond the Wall.
21CDC, "Autism Information Center."
22Though not a study of ASD per se, Van Weelden and Whipple, "Preservice Music Teachers' Predictions," which focuses on instructors' predictions and perceptions of the music education achievement levels and test scores of students with emotional and/or behavioral disorders (EMBD) and acute cognitive delays (ACD), is highly revealing. The study found that students in both groups exceeded the teachers' expectations in both the mastery of music education concepts and in related test scores. Based on this finding, the authors suggest on page 81 that "...the [low] predictions given by the preservice teachers are due to a lack of much prior knowledge or hands-on contact with students with special needs before the field experience, which may lead teachers to infer stereotype associations based on general beliefs (e.g., the use of labels to describe the students' disabilities) about the possible achievement level between the two classrooms of students. However, these beliefs were challenged over the course of the field experience as teachers were given the opportunity to work with and observe what students with these disabilities can achieve, which accounts for the higher perception scores."
23c.f. Prizant et al., "The SCERTS Model: Enhancing Communication," 11.
24Koen, Barz, and Brummel-Smith, "Introduction," 3-4.
25Kobylarz is currently (2009) on the faculty of the Robert Wood Johnson Medical School in New Brunswick, New Jersey, while Goff and Kahn are now graduate students at the University of North Carolina, Chapel Hill, and Vanderbilt University, respectively.
26See Bakan et al.,"Following Frank," 198 [n.8], regarding safety modifications.
27See Hollander and Juhrs, "Orff-Schulwerk," on similar qualities of Orff instruments.
28Rutter, "Autism Research."
29Prizant et al., "The SCERTS Model: Enhancing Communication," 17.
30The original "thank-you song" was created by Bakan; variant versions and new songs have since been created by Koen and by children participating in the program.
31See Bakan et al., "Following Frank," for more detailed discussion.
32Goff et al., "A Hands-on World Music."
33Prizant et al., The SCERTS Model(Vol. 1), 1.
34See also Bakan et al., "Following Frank."
35Ochs and Solomon, "Practical Logic and Autism," 141.
36Bakan, Music of Death, 23.
37Prizant et al., "The SCERTS Model," 9.
38See also Gunsberg, "Improvised Musical Play."
39Bakan et al., "Following Frank," 190.
41Kathleen wrote about the first session that Frank "love[s] the gong; [it] seems to be his safe haven; vibrations of gong and didjeridu appeal to him"; and following the second session, she stated that he is "especially fond of the didjeridu" and enjoys "the vibration [of the instrument] against his legs, back, and arms" when Koen is playing it.
42Bakan, World Music, 10.
43See, for example, Turner, The Forest of Symbols; Wagner, Symbols That Stand For Themselves.
45Blacking, Music, Culture, and Experience, 34.
46Vinden and Astington, "Culture and Understanding," 515.
48Bakan et al., "Following Frank," 175; see also Koen et al., "Personhood Consciousness."
49Sawyer, "Improvised Conversations," 193.
50Sawyer, Improvised Dialogues, 241.
52Kitwood, Dementia Reconsidered.
53Monson, Saying Something.