admin@inclusionaustralia.org.au
1300 312 343
PO Box 336, Nunawading, Victoria 3131
6 February 2025
Re: Independent Review of NDIS music and arts therapy supports
Dear Dr. Duckett,
Thank you for the invitation to provide information to inform your thinking for the Independent Review of NDIS Art and Music Therapy Supports.
Inclusion Australia is the national peak organisation representing the rights and interests of Australians with an intellectual disability and their families. Founded 70 years ago in 1954, our mission is to work with people with an intellectual disability, their families and our members to make positive change. Our strength is in our national representation and our connection to our community. We have a member organisation in every state and territory across Australia:
- ACT Down Syndrome and Intellectual Disability (ACT DSID)
- Council for Intellectual Disability (NSW)
- Developmental Disability WA (DDWA)
- Inclusion Northern Territory (Inclusion NT)
- Parent to Parent (P2P, Queensland)
- South Australian Council on Intellectual Disability (SACID)
- Speak Out Advocacy (Tasmania)
- Victorian Advocacy League for Individuals with Disability (VALID).
We invited our member organisations to share the views of people with an intellectual disability and their families. The key message that we heard is that music and arts therapy funded by NDIS enhances the lives of people with an intellectual disability and enables them to build important capacities and skills. These include developing social skills through interaction with the therapist, fine motor skills, through playing instruments or creating art, communication and self-regulation skills, and importantly, opportunities for increased informal supports and safety. In this letter, we include quotes and a case study from people we spoke to.
Research supports that music therapy positively impacts people with intellectual disabilities^1,2 and co-occurring diagnoses such as autism through improving their capacity to
^1 Cameron, H.J. (2017). Long term music therapy for people with intellectual disabilities and the National Disability Insurance Scheme (NDIS). Australian Journal of Music Therapy, 28, 1-15. ^2 Jacob, U.S., Pillay, J., Oladipupo, O.O., Eni-Olorunda, T., Asiru, A.B. (2022). Music therapy for individuals with intellectual disability: a systematic review. Int J Early Childhood Special Education 14(2):49–59.
communicate,^3 improving auditory processing skills which can positively affect academic achievement^4 and improving stress regulation thereby contributing to overall well-being.^5 Moreover, the relationships formed between people with an intellectual disability in long-term music therapy provide a context for increased interpersonal interactions and community participation which can contribute to higher quality of life; improved socioemotional well-being while strengthening social skills; and opportunities to build informal supports through increased visibility and participation in the community.^6,7
We also heard that arts therapies offered opportunities for increased capacity building for decision-making, personal safety and visibility in the community, as demonstrated by the following quotation from the art mentor of an adult with an intellectual disability and communication support needs:
“I have made videos around road safety where [the drawings the person made] talk back to deliver messages, which has helped understandings about safely getting around. I also painted a pair of [the person’s] boots with the shoelaces he made in them, and it contributed in quite a large way in his decision to start wearing boots—this encouraged safety by wearing boots, but also safety on lots of different levels because some people have judgements about people who don’t wear shoes, so that helped. Also, his work has been seen in exhibitions in the council areas where he walks, and the community knows him more fully now by seeing his artwork and knowing more about him.”
Similarly, there is evidence for positive effects of other forms of arts therapies, including dance, drama and expressive arts, for people with an intellectual disability. These therapies can enhance communication skills, self-esteem, social skills, self-expression and management of emotions.^8,9 Importantly, music and other arts therapies are accessible to
^3 Gold, C. & Wigram, T. (2006). Music therapy for ASD. Cochrane Database of Systematic Reviews 2006 April 19. ^4 Senkal, O. A., & Muhtar, Z. (2021). Role of Orff music therapy in improving auditory processing skills in children with intellectual disability. Nigerian journal of clinical practice, 24(7), 1005-1014. ^5 Poquérusse, J., Azhari, A., Setoh, P., Cainelli, S., Ripoli, C., Venuti, P., & Esposito, G. (2018). Salivary α‐amylase as a marker of stress reduction in individuals with intellectual disability and autism in response to occupational and music therapy. Journal of Intellectual Disability Research, 62(2), 156-163. ^6 Lee, J. (2014). You light up my life: a phenomenological study of interpersonal relationships between music therapists and adults with profound intellectual and multiple disabilities. PhD thesis, The University of Melbourne. ^7 Thompson, G. A., & McFerran, K. S. (2015). Music therapy with young people who have profound intellectual and developmental disability: Four case studies exploring communication and engagement within musical interactions. Journal of Intellectual and Developmental Disability, 40(1), 1-11. ^8 Mino‐Roy, J., St‐Jean, J., Lemus‐Folgar, O., Caron, K., Constant‐Nolett, O., Després, J. P., & Gauthier‐Boudreault, C. (2022). Effects of music, dance and drama therapies for people with an intellectual disability: A scoping review. British Journal of Learning Disabilities, 50(3), 385-401. ^9 Ho, R. T., Chan, C. K., Fong, T. C., Lee, P. H., Lum, D. S., & Suen, S. H. (2020). Effects of expressive arts–based interventions on adults with intellectual disabilities: A stratified randomized controlled trial. Frontiers in Psychology, 11, 1286.
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people who are non-verbal and have complex communication needs. One parent of an adult with complex needs told us:
“Engaging in activities which are stimulating, enjoyable, sociable and have a creative purpose but where the person is not required to speak can be a great outlet for many people with disability. Music and art are languages that are understood across abilities, languages and cultures and therefore the most inclusive of endeavours. My daughter says she feels alive and free when she is dancing. That says it all really.”
The evidence that music and arts therapies build capacity for a range of forms of communication has specific importance and impact for people with an intellectual disability with complex communication needs. Today, there are many adults and older adults with an intellectual disability with communication support needs who did not receive communication support as children or young people. This is because of the ‘candidacy model’, which dominated approaches to delivering communication support up until the early 2000s.^10
This model was based on a range of ‘criteria’ it was believed a person needed to fulfil to demonstrate ‘candidacy’ for communication support. Because of these ideas, many children with an intellectual disability were denied communication support based on perceptions they were too ‘young’, too ‘socially withdrawn’, too ‘intellectual disabled’ or ‘too linguistically delayed’.^11
This model has since been replaced with a strengths-based approach premised on the use of early, ongoing communication support.^12 Yet this is a relatively recent shift, meaning many people with complex communication needs (especially if they are older) may have never had access to communication supports. As such, opportunities to access supports that have a demonstrated positive impact on communication capacity-building, such as music and arts therapies, are therefore crucial for this cohort particularly, due to historical denial of communication supports.
We also heard through our member organisations an acknowledgement that while the NDIS has been misused by bad actors, people with disability who benefit from arts and music
^10 Kangas, K., & Lloyd, L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4(4), 211–221. https://doi.org/10.1080/07434618812331274817; and Romski, M. A., & Sevcik, R. (1988). Augmentative and alternative communication systems: Considerations for individuals with severe intellectual disabilities. Augmentative and Alternative Communication, 4(2), 83–93. https://doi.org/10.1080/07434618812331274667 ^11 García JC, Díez E, Wojcik DZ, Santamaría M. (2020). Communication Support Needs in Adults with Intellectual Disabilities and Its Relation to Quality of Life. Int J Environ Res Public Health. 17(20):7370. doi: 10.3390/ijerph17207370. PMID: 33050216; PMCID: PMC7601275. ^12 Romski, MaryAnn PhD, CCC-SLP; Sevcik, Rose A. PhD. Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children 18(3):p 174-185, July 2005.
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therapy and choose these therapies as part of exercising choice and control should not be penalised or targeted for cost reductions.
The following case study was shared with Inclusion Australia by a parent of an adult with an intellectual disability and other complex needs, with details changed for confidentiality. This case study demonstrates the way music therapy may reduce dysregulation and build the capacity of other supports in a person’s life to enhance emotional regulation and socialisation.
Case study
Elena is a 42-year-old woman who has multiple and complex disabilities, including physical and intellectual disability, and is non-verbal with complex communication needs. The highlight of her week is her music therapy. She has been attending music therapy for four years with the same therapist and they have good rapport and a trusted relationship. Elena becomes visibly excited when she is preparing to attend music therapy, and her interest in music therapy is greater than any other activities in her week. While participating in music therapy, she smiles and moves her body to dance to the music. Following music therapy, her affect and behaviour are more regulated and settled. Her primary support worker attends music therapy and has been trained to ingrate music therapeutically into her daily schedule. This includes encouraging Elena to utilise her drum for rhythmic drumming when she is feeling dysregulated, which helps her to calm down.
Given Elena’s complex needs and challenges with self-regulating in a group environment, group-based music therapy would not meet her needs. The loss of her one-to-one music therapy would remove her most important opportunity to work towards her NDIS goals related to self-regulation and socialisation skills. This has a significant negative impact on her quality of life.
In line with the NDIS goals of improving the life of people with disabilities through choice and control and funding reasonable and necessary supports, it is our firm belief that research evidence alongside the lived experience of people with an intellectual disability demonstrates the value of music and other art therapies and the importance of continuing to fund these therapies under the NDIS.
Please feel free to reach out if we can provide any additional information to support this independent review, including facilitating the opportunity for direct input from people with an intellectual disability.
Kind regards,
Catherine McAlpine
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Catherine McAlpine
CEO, Inclusion Australia
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