Information Sharing
Insights Into the Musical Potential of Cognitively Impaired
Williams Syndrome
HOWARD M. LENHOFF
“Music is my favorite way of thinking. “This remark to music
researcher Dr. Audrey Don by a child having the condition
known as Williams syndrome may provide a key to the better
understanding and treatment of clients who can best learn and
perform music in non-traditional ways. In the past few years,
a number of music therapists have encountered congenitally
cognitively impaired individuals having Williams syndrome
(WS). Most likely in the near future music therapists will have
more Williams clients as a growing number of parents of chil­
dren having WS seek their aid.
Why? For at least four reasons. First, these parents are no­
ticing that their Williams children,* although cognitively im­
paired, show signs of having unusual musical abilities. Sec­
ond, cognitive scientists currently are interested in the appar­
ent unique musicality of Williams people. Third, although Wil­
liams people show a special affinity towards music, the typical
music teacher will not take them as students because most
cannot read musical notation. Fourth, some parents are find­
ing that Williams people are able to compensate for a number
of their motor and cognitive deficits through music. For ex­
ample, Williams people often learn to tie their shoe laces rel­
atively late; some parents have composed songs to help their
child carry out this task.
Some Williams musicians are extremely gifted, but they are
not “savants” in the sense that they can play a complex clas­
sical piece after hearing it once. Nonetheless, there are re­
ports, until now mostly anecdotal, indicating that Williams
people possess a range of musical talents, with some ap­
proaching the abilities usually ascribed to savants. But unlike
the musical savants, those with WS need to work to develop
and improve their musical skills. They appear to learn music
in non-traditional ways. Perhaps by understanding how Wil-
Howard M. Lenhoff, Ph.D., is a Research Professor (Emeritus, in the Depart­
ment of Developmental and Cell Biology, University of California, Irvine. He
is co-founder of the Williams Syndrome Music Camp in Lenox, Massachu­
setts, and is currently Executive Vice-President of the Williams Syndrome
Foundation. He is the principal investigator of a National Science Foundation
grant to study music cognition in Williams syndrome, and is father of the
Williams musician, Gloria Lenhoff. More information can be obtained at
www.wsf.org and he can be reached at hmlenhof@uci.edu.
© 1998, by the American Music Therapy Association
* Dr. Oliver Sacks, in the EOPI video mentioned on page 35, raid that indi­
viduals having Williams syndrome have their own distinctive traits, and that
he calls them “Williams people,” Board members of the Williams Syndrome
Foundation agree with his perception, and also refer to individuals having
Williams syndrome as Williams people, Williams children, Williams musi­
cians, and Williams campers, depending upon the context in which the terms
are used.
33
People Diagnosed with
University of California, Irvine
liams people learn and respond to music, the music therapist
can devise new ways to help them, and by so doing also better
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help both “normal” children and other cognitively impaired
individuals involved in music therapy.
What is Williams syndrome?
Years ago children with WS were called “pixie kids” be­
cause they were small for their age and talkative, and their
faces and certain behaviors resembled those described in folk
legends and depicted in paintings of the “little people.” Ob­
serving a dozen of these “pixie kids” in one room is like
watching a group of brothers and sisters because they look
and behave more like one another than they do like their
parents and actual siblings.
In medical circles knowledge of the syndrome is relatively
new, having been identified less than forty years ago. In 1961,
the New Zealand cardiologist, J. C. P. Williams, after exam­
ining a number of young children with pixie-like facial fea­
tures, noted that all had similar heart problems and other med­
ical symptoms as well as cognitive impairments. According to
the Williams Syndrome Association in the United States and
the Williams Syndrome Foundation in the United Kingdom,
there are currently some 5300 known individuals in those
countries identified as having WS. They are thought to make
up 1 in 20,000 of the population throughout the world.
Williams people are missing a group of specific genes from
one of their chromosomes. Because of this “microdeletion,”
Williams people lack one gene from each of about fifteen
pairs of genes. One is the gene pair controlling the synthesis
of the stretchy protein, elastin, a protein found in large
amounts in aortas, intestines, lungs, and skin. Because they
share these same gene losses, people with WS are born with
a range of similar physical, behavioral, and cognitive impair­
ments regardless of their parental or ethnic background.
Researchers are now finding that Williams people also share
a number of abilities which are remarkable considering their
other cognitive and physical problems. It is these asymmetries
in their cognitive abilities and behavior that make Williams
people intriguing to scholars, the public, their families, and
music therapists.
First, although they have extreme difficulties with simple
additions and subtractions, spatial relations, logical reasoning,
and abstract ideas, they show a high level of language devel­
opment for individuals with cognitive impairments. Second,
as a group, many show a great love, appreciation, and talent
for music. Third, they have the condition called “hyperacusis,”
 34
allowing them to hear the faintest of sounds. Finally, Williams
individuals are people oriented and aim to please. They have
extremely warm and kind personalities and show a great deal
of empathy in understanding the feelings of others (Lenhoff,
Wang, Greenberg, & Bellugi, 1997).
Anecdotal Reports of Musical Ability in WS
Mounting anecdotal evidence regarding the innate musical
abilities of those with WS is quite compelling. Those obser­
vations come primarily from music therapists and private mu­
sic teachers working with WS children, from the teaching staff
of the Belvoir Terrace music camp in Lenox, Massachusetts
(see Stambaugh, 1996; Warshaw, 1996), independent observ­
ers such as Dr. Oliver Sacks, and parents. Research by Don,
Schellenberg, and Rourke (1996) confirms some of the obser­
vations. Consider the following:
l Whereas Williams children have short attention spans for
most subjects, their attention span for listening to and par­
ticipating in musical activities appears to be surprisingly
long.
0 Although most cannot read musical notation, many seem
to have absolute and relative pitch.
l A number have uncanny rhythm, being able to learn com­
plex drum beats, such as 7/4, in a short session.
l They seem to have an excellent sense of timing; for ex­
ample, two experienced vocalists were able to perform a
complex duet nearly perfectly at their first practice together.
0 Many are able to retain complex music (some in a variety
of languages), including both the words of many verses of
long ballads and the melodies, for periods of years.
0 Those who learn to sing in foreign languages have near
perfect accents.
l Experienced Williams musicians have a facility with har­
mony.
0 A number can improvise and compose lyrics with great
facility.
l Virtually all WS performers lack stage fright.
Current Status of Research on Music and WS
The brain volume of WS individuals is smaller than that of
most other individuals. Recently, however, there has been ev­
idence that the planum temporale, the part of the brain shown
to be enlarged in professional musicians with perfect pitch
(Schlaug, Jancke, Huang, & Steinmetz, 1994), occupies a rel­
atively higher proportion of brain volume in a small random
population of Williams people than their typical peers (Hick­
ok, Bellugi, & Jones, 1995).
Research defining and comparing the musical abilities of
Williams people is just beginning. Music psychologist Audrey
Don reports in a preliminary abstract that the music abilities
of her sampling of Williams people are commensurate with
their enhanced language abilities (Don, Schellenberg, &
Rourke, 1996). Funded by the National Science Foundation
at the University of California, Irvine, cognitive scientists
Gregory Hickok and Oligario Perales, psychologists Linda
Music Therapy Perspectives (1998), Vol. 16
Levine and Beverly Sandeen, and biologist Howard Lenhoff
are in the midst of two independent studies. One compares
the ability of Williams people to recognize relative pitch with
that skill in other populations. The other is an extensive survey
of parents asking them to compare the musical interests and
abilities of their Williams child with those of the sibling closest
in age. In a third project at the university, Dr. Gordon Shaw
and Dr. Amy Graziano are examining how providing musical
training to Williams toddlers may affect certain cognitive func­
tions dealing with spatial relationships.
Further educational and research programs regarding music
and WS are being planned at the Belvoir Terrace music camp
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in Lenox, Massachusetts, and the University of Texas, San An­
tonio, Texas. At Belvoir Terrace, the Williams Syndrome Foun­
dation expects to open its first Academy of Musical Arts for
the cognitively impaired in September of 1999. In addition,
through the leadership of Professor Don Hodges, the Regents
of the University of Texas have allocated to the Williams Syn­
drome Foundation an acre of land adjacent to the Department
of Music to develop a research center and a second Academy
of Musical Arts.
Activities Regarding Music and WS
Although currently involved in these research projects, as
an experimental biologist I am trained neither as a musician
nor as a cognitive scientist. My years of experience as an ob­
server and experimental investigator, however, have influ­
enced my work with Gloria, our 43-year-old daughter with
WS. Through my experience with her I have gained a grasp
of the limitations and potentials of Williams musicians and
have learned how to develop teaching methods that match
their cognitive abilities.
Gloria, like many Williams people, has perfect pitch. She
also has a lovely lyric soprano voice, great skill at playing the
large piano accordion, and a repertoire of over 2000 pieces
in 25 languages. She does not read musical notation and only
recently has been able to identify the white notes on the key­
board. Her first long-time voice teacher was an understanding
and talented music therapist, who remains her friend to this
day, although he now lives two thousand miles away.
But neither we nor her teacher had ever heard of WS until
an award-winning PBS documentary, “Bravo Gloria,” which
described her outstanding musical talents, was aired in 1988.
In response to that documentary, we received a number of
letters and phone calls suggesting that Gloria had WS. In ad­
dition, the film also piqued the interest of a number of parents
in training their Williams children in music. We often won­
dered if had we learned when Gloria was a child that she had
WS, would we have been discouraged by counselors and
teachers and not given her a good musical education?
Other parents have also noticed musical abilities in their
Williams children, some before the children were diagnosed
and others after, and provided them with either private lessons
and/or music therapy sessions as well as encouragement. [For
example, see the story by B. Krasean (1997) about Meghan
Music and Williams Syndrome
Finn, a student in the School of Music at Western Michigan
University.]
By 1994, a group of Williams parents, together with camp
director Nancy Goldberg, started a week-long special WS mu­
sic camp at Belvoir Terrace in Lenox, Massachusetts, which
for decades has been offering an outstanding summer music
camp for high functioning young women.
The Williams camp, which completed its fourth year in
1997, has attracted much attention from the press and media.
Two documentaries have been made, one by the Dutch Amer­
ican subsidiary, EO Productions, Inc., and the other by the
BBC and Dr. Oliver Sacks. On October 19, 1997, Sixty Min­
utes of CBS aired a segment on WS. In addition, two of the
camp music teachers have published their experiences teach­
ing Williams people (Stambaugh, 1996; Warshaw, 1996) [To
obtain a VHS copy of the EOPI video, copies of audio-cas­
settes by Gloria Lenhoff, and the article by Stambaugh, check
www.wsf.org. An edited version of the article by Warshaw can
also be found on that web site.]
Even more importantly, not only has the camp brought out
the musical abilities of those attending, but news of the camp
through the internet (www.wsf.org) has stimulated interest in
music in Williams families throughout the world, with many
fine Williams musicians “coming out of the closet” and being
identified.
In hindsight, we believe that Gloria, by perfecting her skills
and performing widely, has helped stimulate this growing in­
terest in music among Williams families, has offered hope to
the families, and has served as a peer model for many aspiring
Williams musicians.
How do People with Williams Syndrome Learn to Sing, Play
Instruments, and Perform?
Four generalizations apply to teaching Williams people.
First, they do better in one-on-one situations with the teacher,
rather than in group classes. Second, most of their learning
takes place through hearing and imitating. Third, they find it
difficult to read and follow musical notation and to grasp mu­
sic theory (the few who do read music still prefer playing by
ear and improvising). Fourth, because of motor limitations,
they do best with voice, keyboard instruments, and drums,
although a number do well with wind instruments and a few
handle the guitar with varying degrees of dexterity.
A. One-on-One Teaching
Although Williams people enjoy singing and striking rhythm
instruments in a group setting, and this may be the way to
begin with very young children, it is not the way they learn
best. A major incentive for Williams people to accomplish any
task given them is to please someone-a parent, a teacher, a
friend, and even strangers. This desire to please carries over
into teaching them musical skills. If the Williams student likes
the teacher and feels that by doing well he or she will please
the teacher, half the battle is won. The rest depends upon the
skills of the teacher and how teaching techniques are modified
35
to fit the cognitive abilities and limitations of the Williams
students.
As Stambaugh (1996) points out, expect every lesson to be­
gin with a hug. Likewise, Williams people seem to need a
great deal of reinforcement, with praise offered at every im­
provement and criticism kept at a minimum.
B. Learning Through Hearing
Williams people learn music best through hearing. Whether
or not this trait is related to their increased sensitivity to sound
(hyperacusis) is not known. What is known, however, is that
Williams people have a sensitive ear and rapidly learn melody
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and lyrics simply by hearing a piece a number of times. And
usually once they learn a piece, they rarely forget it. In ad­
dition to Gloria, who knows more than two thousand musical
pieces, other Williams musicians have large repertoires, some
retaining verse after verse of such sixties ballads as “American
Pie” and “Puff the Magic Dragon.”
The most successful music lessons for Williams people in­
volve those in which the lesson is recorded on a cassette tape,
with the student practicing daily while listening to the record­
ed lesson. For more complex music, like songs in a variety of
unfamiliar foreign languages, some special recording tech­
niques work extremely well. For example, to teach a folk song
in an unfamiliar foreign language, record a native speaker
singing a new song, then enunciating slowly a two or three
word phrase of the song, and next singing that same phrase,
and so on until the verses of the song are completely record­
ed. After inserting a few silent periods on the tape to allow
time for the student to repeat those phrases, give the student
a copy of that tape. By listening and practicing to such tapes,
some Williams students can learn songs in a foreign language
rapidly and retain those songs in their repertoire virtually in­
definitely.
It is intriguing that some Williams musicians seem to know
when a piece, particularly a classical one, must be performed
in a manner close to the music as recorded, whereas often
they will improvise on pieces from the folk and pop reper­
toires.
C. Musical Notation Gets in the Way
Although Williams people may be capable of reading mu­
sical notation, and some can sight read, they feel more com­
fortable returning to learning by ear and playing without read­
ing the notes. It appears that the cognitive processing of the
information involved in reading musical notes interferes with
their desire to produce music. If musical notation serves as a
means for musicians to communicate with each other, then
Williams people apparently find it unnecessary because with
their sensitive ear and facility in retaining musical information
they can simply skip that step.
Their facility in learning by listening and repetition often
confounds music teachers who believe that learning to read
musical notation and to understand music theory is essential
to becoming a good performer. Because of that widespread
misconception, parents of Williams children often find it dif-
36
ficult to recruit teachers. To open the door to Williams people,
music therapists and teachers might consider forgoing the goal
of teaching these children how to read musical notation. Not
only would this be a great service to the Williams families,
but is also would afford the therapist or teacher a rewarding
and enlightening experience.
Do Williams people have “absolute pitch”? Many teachers
and parents believe so. But how do you detect absolute pitch
when most Williams musicians (with Gloria and a few others
being the exception) cannot tell you the name of the note they
are singing or playing? The answer? Researchers will need to
devise tests for absolute pitch that do not require knowledge
of musical notation. Until then, the investigators at the Uni­
versity of California, Irvine are focusing on learning about rel­
ative pitch in WS adults. Why? First, relative pitch can be mea­
sured without the participant knowing musical notation. Sec­
ond, the ability to recognize relative pitch may be a truer
indication of musical ability.
D. Motor Limitations May Affect the Kind of Musical
instrument Played
Williams people are born with a number of motor prob­
lems. Consequently, to carry out the fine motor coordination
required to play stringed instruments, including guitars, is
quite difficult. Yet, by sheer determination, a number of Wil­
liams musicians have learned to play a range of chords suffi­
cient to accompany themselves singing, and one has devised
his own system of tuning his guitar to play chords by using
his fingers strictly as a bar while he strums the strings. One
Williams guitarist at the music camp does fingering more
complex than simple chords. More recently a young adult,
just diagnosed as having WS, demonstrated significant skill as
a violinist, much to the surprise of parents and professionals.
Stambaugh (1996) writes that because of the structure of
their mouths and lips, Williams students found instruments
such as the transverse flute difficult to play, whereas a number
of students became quite proficient in playing wind instru­
ments such as the clarinet and the trumpet.
The favorite musical instruments at the WS music camp at
Belvoir Terrace are the keyboards and drums. On the key­
boards (piano, organ, accordion, and keyboard synthesizers)
a number of Williams people excel, and others are doing quite
effectively. Yet, although many are able to play these instru­
ments well, it appears unlikely that they will be able to master
complex pieces requiring extreme finger dexterity and speed.
Some Williams drummers play exceptionally well and are
able to learn complex rhythms quickly and incorporate them
into their repertoire. As more and more young Williams mu­
sicians study the drums, reports by both parents and teachers
point out their exceptional aptitude in learning and perform­
ing on full drum sets. The drum instructor at the music camp,
himself a professional musician in a leading U.S. band, in
1996 reported that two of the drummers were outstanding and
could compete in the music industry, while another handful
showed great promise.
Congenital motor problems also affect the limbs of a good
Music Therapy Perspectives (1998), Vol. 16
number of Williams people. Many have an unusual gait, and/
or scoliosis, thereby affecting their ability to participate in
rhythmic dance movements. Some have a fused radius and
ulna in their forearms, making certain movements impossible
or difficult. Consequently, some Williams musicians devise
their own motor patterns for playing their musical instrument.
For example, it is physically difficult for Gloria, who has the
fused forearm condition, to play the accordion with her right
hand positioned horizontally to the accordion piano keyboard
and use all five fingers. Instead, she moves her right hand
vertically along the keyboard using three fingers most of the
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time.
Voice does not require manual dexterity; hence, more and
more Williams people are studying voice and are being found
to have naturally strong vocal abilities. Although Williams
people, including females, are often reported to have low, or
“hoarse” voices, there are a number of excellent Williams
sopranos. Early voice training may play a role. Some Williams
singers are being trained by professional voice teachers and
coaches and have attended university and community college
classes in voice and choir. Williams singers show and enjoy
a range of styles, from operatic and art songs, to country, re­
ligious, and popular. When asked which kind of music they
like most, the usual reply is “I like them all.”
The Challenge
Will music therapists and teachers, who do such a fine job
of involving younger special education students in elementary
music and rhythm classes, modify their methods and give a
higher challenge to older special education students? If the
answer is yes, then they will gain much satisfaction from their
efforts, and, to boot, may find new ways to help their “nor­
mal” clients and students.
References
Don, A., Schellenberg, E. G., &Rourke, B. P. (1996). Auditory pattern perce
inchildren with Williams Syndrom (WS): Preliminary findings. Paper presented at
the seventh International Professional Conference on Williams Syndrome: Philadel­
phia, PA.
Hickok, G., Bellugi, U., & Jones, W. (1995). Asymmetrical abilities. Science, 270,
219-220.
Krasean, B. (1997, July 1). Music feeds my soul. Kalamazoo Gazette, pp. D1, D3
Lenhoff, H. M., Wang, P., Greenburg, F., & Bellugi, U. (1997). Williams Syndrome
and the brain. Scientific American, 277(6), 68-73.
Schlaug, G., Jancke, L., Hauang, Y., and Steinmetz, H. (1995). In vivo evidence of
structural brain asymmetry in musicians. Science, 267, 699-701.
Stambaugh, L. (1996). Special learners with special abilities. Music Educators'
Journal, 83(3), 19-23.
Warshaw, D. (1996). Williams Syndrome: Pondering the complexities of a musical
gift. The Juilliard Journal, XII(3), 10-11.