NDIA Accountability Project

Submission 2 — Australian Music Therapy Association (AMTA) — Interventions for Children on the Autism Spectrum (NDIA Consultation Paper, 2021)

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Australian Music Therapy Association

Consultation response: Interventions for children on the autism spectrum

About the Australian Music Therapy Association

The Australian Music Therapy Association (AMTA) is the peak body for music therapy in Australia. AMTA represents Registered Music Therapists (RMTs), music therapy students and advocates for access to music therapy on behalf of the community. Our mission is to enable, advance and advocate for excellence in music therapy.

AMTA is the regulating body responsible for registering music therapists, accrediting music therapy courses, and maintaining professional standards and ethics. A member organisation of Allied Health Professions Australia (AHPA) and National Alliance for Self-Regulating Professions (NASRHP), AMTA supports Registered Music Therapists (RMTs) to use research-based practice that actively promotes the health, wellbeing and functioning of Australians.

RMTs work in private practice and in allied health teams in hospitals, residential facilities, community services and schools. They use evidence-based music therapy techniques to promote better health outcomes for vulnerable and unwell Australians.

AMTA welcomes the opportunity to respond to the Interventions for children on the autism spectrum consultation paper. AMTA has answered the questions asked throughout the consultation on the webform; this document provides additional information.

Summary

  • AMTA welcomes the focus on evidence-based interventions delivered by appropriately qualified and experienced professionals. Music therapy is a research-based practice and allied health profession, like occupational therapy and social work. Registered music therapists use evidence-informed music-based interventions to deliver successful outcomes for children with autism.
  • AMTA strongly supports the role of parents and caregivers as fundamental to a child’s development. Family-centred interventions that support active engagement, decision-making, self-efficacy and empowerment are central to building capacity in families and carers1-3 and achieving positive outcomes for children with autism.
  • AMTA strongly rejects the notion that only one professional can address a family-centred goal at a time. Team approaches to early intervention are central to achieving positive outcomes for children; multidisciplinary care is not duplication.
  • AMTA welcomes the focus on inclusion in community and mainstream activities and the capacity building supports required to achieve these aims.
  • AMTA asserts the importance of clinical evidence from participants’ therapy reports when establishing funding allocations for therapeutic supports.

Interventions for children on the autism spectrum – Consultation response Australian Music Therapy Association 1

  • AMTA questions the diagnosis-specific nature of this document. A specific focus on children on the autism spectrum seems to be at odds with other recent consultation papers focussing on functional capacity as a basis for assessment and funding allocations.
  • AMTA strongly rejects the paper’s assumption that as capacity increases, professional supports reduce. Supports for people on the autism spectrum should take a lifespan approach.
  • AMTA welcomes participants’ flexible use of funding when implementing their plan, including to access music therapy.

General comments in response to the consultation

Overlap and duplication? Or person and family-centred goals

AMTA draws attention to the consultation paper (page 19), suggesting denying therapeutic support needs due to perceived duplication. AMTA strongly rejects denial of the NDIS participant’s requested support needs because therapeutic supports address the same or similar goals. A well-planned multidisciplinary team approach is considered best practice in early intervention, where a child’s developing behavioural, cognitive, social and communication systems are inextricably intertwined4. Team approaches to early intervention are central to achieving positive outcomes for children. Multidisciplinary care, where professionals and families work together to address shared goals, is not duplication; it is best practice.

For children on the autism spectrum, working on goals across a range of contexts is also vitally important as many have difficulties generalising skills across contexts5. Providing for generalisation of skills across contexts represents high-quality, individualised planning and interprofessional collaboration, with providers working together to achieve critical goals identified by the child, their family or carer. Working together toward shared goals across professional boundaries has significant potential benefits for children and families. AMTA firmly rejects any moves to undermine, lessen or eradicate positive interprofessional, family centred team approaches to care.

Function-focussed or diagnosis-based

AMTA is questions the diagnosis-specific approach in this paper, which seems to be at odds with other recent consultation papers discussing function-focussed assessments and funding allocations. The paper does not represent the breadth and range of disability experienced by people on the autism spectrum. Co-occurring diagnoses are common for children on the autism spectrum and may include (but are not limited to) intellectual disability, ADHD, behavioural difficulties and language disorder6. While AMTA supports approaches that improve consistency of access to NDIS, focussing on a specific diagnostic group may be seen to be inequitable and even discriminatory.

Interventions for children on the autism spectrum – Consultation response Australian Music Therapy Association 2

Evidence-based interventions

The Australian Music Therapy Association (AMTA) has repeatedly voiced concerns about the Australian Government commissioned report, Interventions for children on the autism spectrum: A synthesis of research evidence (known as the Autism CRC report). The report attempts to summarise the value of a whole profession’s work and methods by reviewing a small number of studies and referring to music therapy as a ‘technique’.

Music therapy is not a technique. Music therapy is a research-based practice and allied health profession, like occupational therapy and social work1, and in Australia is delivered by registered music therapists. In a study investigating music therapy practices, Kern7 found most music therapists were incorporating eleven evidence-based practices in their music therapy sessions with children and young people with autism.

More than listening to or learning music, music therapy is the intentional use of music by a registered music therapist. Registered music therapists draw on an extensive body of research and a range of therapeutic techniques and practices. Music therapy differs from music education and entertainment; music therapy uses music to actively support people as they strive to improve their health, functioning and wellbeing.

Benefits of music therapy for children with autism and their families include:

  • improved social interaction, verbal communication8-12
  • more initiating behaviours8,10
  • improved social-emotional reciprocity and social adaptation skills8,10,12
  • improved family relationships8
  • caregiver social and emotional wellbeing9.

Music therapy is a cost-efficient and effective therapy for children on the autism spectrum. Registered music therapists develop individualised music-based interventions that support social, communicative, sensory, emotional, cognitive, behavioural and music skills in children.

1 We note this quote from the Autism CRC report: “…by focusing on intervention practices and categories – which is the typical method through which interventions are evaluated in the research literature – the umbrella review will not provide evidence regarding holistic service provision. Accordingly, terms such as occupational therapy, speech pathology/therapy, and psychology which are commonly used in the community do not feature, because these are clinical services that draw on a range of techniques and practices.” (p. 29)

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Capacity building and support

AMTA strongly rejects the paper’s assumption that as capacity increases, professional supports reduce. Developing capacity in one area does not result in a reduction in professional supports but may result in a shifting of resources from one area or priority to another. The provision of intensive supports in early intervention has significant and lifelong impacts for children on the autism spectrum4. The World Health Organisation’s acknowledgement of autism spectrum disorders as “developmental disorders and conditions that emerge in early childhood and, in most cases, persist throughout the lifespan” 13 reinforces the need for a lifespan approach to autism. Different stages of development and life stages present unique challenges. Support needs will likely increase, not decrease, over key transition periods for people on the autism spectrum4.

Naturalistic settings

AMTA supports the value of delivering interventions in naturalistic settings. Children on the autism spectrum have difficulty generalising skills; working in partnership with families and carers (a child’s primary ‘environment’) is invaluable and impactful. Allied health interventions designed for early childhood participants are developmentally-informed and age-appropriate, with play used as the natural setting. These play-based interventions may be delivered across environments, including the home, early childhood settings and clinical environments.

References

  1. Kuhaneck HM, Madonna S, Novak A, Pearson E. Effectiveness of Interventions for Children With Autism Spectrum Disorder and Their Parents: A Systematic Review of Family Outcomes. American Journal of Occupational Therapy. 2015;69(5):6905180040p6905180041-6905180040p6905180014.
  2. Althoff CE, Dammann CP, Hope SJ, Ausderau KK. Parent-Mediated Interventions for Children With Autism Spectrum Disorder: A Systematic Review. American Journal of Occupational Therapy. 2019;73(3):7303205010p7303205011-7303205010p7303205013.
  3. McConkey R, Cassin M-T, McNaughton R. Promoting the Social Inclusion of Children with ASD: A Family-Centred Intervention. Brain Sciences. 2020;10(5):318.
  4. The Royal Australasian College of Physicians. Position Statement. Early Intervention for Children with Developmental Disabilities. [Online]2013.
  5. Swan AJ, Carper MM, Kendall PC. In Pursuit of Generalization: An Updated Review. Behav Ther. 2016;47(5):733-746.
  6. Soke GN, Maenner MJ, Christensen D, Kurzius-Spencer M, Schieve LA. Prevalence of Co-occurring Medical and Behavioral Conditions/Symptoms Among 4- and 8-Year-Old Children with Autism Spectrum Disorder in Selected Areas of the United States in 2010. Journal of autism and developmental disorders. 2018;48(8):2663-2676.
  7. Kern P, Rivera NR, Chandler A, Humpal M. Music Therapy Services for Individuals with Autism Spectrum Disorder: A Survey of Clinical Practices and Training Needs. Journal of Music Therapy. 2013;50(4):274-303.
  8. Geretsegger M, Elefant C, Mössler KA, Gold C. Music therapy for people with autism spectrum disorder. Cochrane Database of Systematic Reviews. 2014(6).
  9. Whitehouse A, Varcin K, Waddington H, et al. Interventions for children on the autism spectrum: A synthesis of research evidence. Brisbane: Autism CRC;2020.
  10. LaGasse AB. Social outcomes in children with autism spectrum disorder: a review of music therapy outcomes. Patient Relat Outcome Meas. 2017;8:23-32.

Interventions for children on the autism spectrum – Consultation response Australian Music Therapy Association 4

  1. Sandiford GA, Mainess KJ, Daher NS. A pilot study on the efficacy of melodic based communication therapy for eliciting speech in nonverbal children with autism. J Autism Dev Disord. 2013;43(6):1298-1307.
  2. Sharda M, Tuerk C, Chowdhury R, et al. Music improves social communication and auditory–motor connectivity in children with autism. Translational Psychiatry. 2018;8(1):231.
  3. World Health Organisation. World Health Assembly resolution WHA67.8: Comprehensive and coordinated efforts for the management of autism spectrum disorders. In. [Online]2014.

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