The Effects of Signed and

Spoken Words Taught with Music on

Sign and Speech Imitation by
Children with Autism

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Evelyn M. Buday, M.A.
University of Illinois at Chicago

The intent of this study was to explore the use of music as

a strategy to promote better memory for manual signs with
children with autism, who have been exposed to simulta­
neous communication. The 10 children tested were taught a
total of 14 signs under two conditions. One condition involved
signs taught in conjunction with music and speech. The other
condition involved signs taught in conjunction with rhythm
and speech. The number of correctly imitated signed words
and correcly imitated spoken words out of 7 total, were
measured under both conditions. Results from 2 factorial
ANOVAs indicated significant main effects for condition type
(music vs. rhythm) for both the number of imitated signed
words (F = 6.54, p < .05) and the number of imitated spoken
words (F = 6.33, p < .02). In each case, correct imitation
favored music condition training over rhythm condition train­
ing. The results are discussed in terms of representing a
potential first step in using music within a simultaneous com­
munication context to promote better pragmatic skills with
children with autism.

For much of the past 15 years, research concerning children

with developmental disabilities has attempted to address spe-

I would like to thank Dr. Laurence Grimm for providing much in terms of
unsolicited guidance with this project, and Partricia Herendeen for her expertise
and for permission to disrupt her normal classroom schedule. As well, I thank
Hattie Willis for the use of her video equipment, and Patricia Hays for her
attention and patience while scoring the hours of video tape.
Correspondence concerning this article should be addressed to Evelyn M.
Buday, Department of Psychology (M/C 285), University of Illinois at Chicago,
1009 Behavioral Sciences Building, 1007 West Harrision Street, Chicago, Illinois
60607-7137. Electronic mail may be sent via internet to [U54600@uicvm.cc.
uic.edu].
190 Journal of Music Therapy

cific deficiencies of language through intervention programs

designed to promote the development of better language skills.
Taken from mainstreaming techniques used with deaf children
to facilitate speech acquisition, the method of simultaneous

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communication has found much success as a viable augmen­
tative method for speech and language training with children
with mental retardation, autism, and language deficits (Fristoe
& Lloyd, 1978; Layton, 1988; Reich, 1978; Yoder & Layton,
1988). The technique itself involves the incorporation of a man­
ual or gestural system of communication (usually American Sign
Language or Exact English) paired concurrently with speech.
When compared to speech alone methods of training, a great
deal of the empirical research seems to indicate that simulta­
neous communication is superior in terms of faster acquisition
and more spontaneous use of target words with children ex­
periencing severe language deficits (Clarke, Remington, & Light,
1988; Reich, 1978; Schaeffer, Kollinzas, Music, & McDowell,
1977).
In terms of cognitive and linguistic development, it has long
been recognized that many children with mental retardation
or autism exhibit substantial deficits in the area of memory and
other cognitive processes as compared to normal children (My­
ers, 1979). Theorists account for these memory deficits as re­
sulting from one of two possibilities. The first involves a me­
diation deficiency where the children are unable to make use
of any type of memory strategy, even with assistance. The
second view, involves a production deficiency where the chil­
dren may be capable of utilizing the strategies, but fail to do
so (Butterfield & Warnbold, 1973; Myers, 1979; Spitz, 1973).
The literature concerning short-term memory and manual
versus vocal techniques, tends to focus on the cognitive pro­
cessing differences and similarities which occur with the distinct
modalities. Work by Morris (1975) and Reid (1984), suggest
that some mentally handicapped subjects may exhibit what they
refer to as a “preference” for visual spatial coding over au­
diosequential coding, in that they tend to show a greater facility
for remembering signs than for remembering words in short­
term memory tasks.
Music, and its connection with memory and attention, has
been of profound interest to the cognitive sciences, both with
Vol.XXXII,No.3, Fall, 1995 191

normal and developmentally delayed populations. Music’s not­

ed effects with normal populations are numerous, ranging any­
where from increased relaxation, to an increase in memory
capacity (Morton, Kershner, & Siegel, 1990). A study by Hoskins

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(1988) with preschool language delayed children found signif­
icant expressive language improvement in the Peabody Picture
Vocabulary Test after using antiphonal singing paired with
picture cards when teaching vocabulary. The positive effects
for music in this study were largely attributed to increased
attention factors.
The contention that many autistic and mentally retarded
children respond positively to music has been strongly sup­
ported in the literature (Hairston, 1990; Nelson, Anderson, &
Gonzales, 1984). Ricks and Wing (1975) studied the specific
role of music with autistic children and their tendency to recall
simple patterns of sounds with great accuracy. They accounted
for this effect in terms of the music drawing attention to a
regularly repeated pattern which could be easily recalled. When
other stimuli were paired with the melodic pattern, they were
remembered significantly more if the original musical pattern
was recalled first. Nelson, Anderson, and Gonzales (1984) stated
this pattern effect in terms of easier transfer of learning from
musical situations to other, more difficult learning situations.
Moreover, Kolko, Anderson, and Campbell (1980) suggested
that most children with mental retardation and autism are more
likely to attend to an auditory rather than a visual stimulus
when the auditory stimulus is musical in nature.
A key element often discussed with music-induced ability,
especially in connection with children and people with learning
disabilities, is the reported reduced distractibility effect (Mor­
ton, Kershner, & Siegel, 1990; Shehan, 1981). It has been sug­
gested that music focuses attention to on-task behaviors and
decreases the emotional arousal related to stress. For children
with mental retardation and autism, this observable focus of
attention to music is believed to be reinforcing. Watson (as cited
in Nelson, Anderson, & Gonzales, 1984) and Paul (as cited in
Nelson, Anderson, & Gonzales, 1984) state that the positive
affective responses that often occur to music with children with
autism can augment the child’s participation in activities that
will help them achieve goals in social and language domains.
192 Journal of Music Therapy

Likewise, Myers (1979) noted that the children with mental

retardation in her study exhibited positive behavioral effects to
musical stimuli. Specifically, they engaged in overt foot tapping,
smiling, and singing behaviors. Although no significant differ­

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ences were concluded on a retention task given music and
nonmusic conditions, Myers maintained the importance of mu­
sic as a paired stimulus in memory tasks, in that at the very
least, it exposed the child to a unique and more enjoyable
learning situation.
Since the 1950s, music’s specific role as an aid in developing
functional speech and communication with children with men­
tal retardation and autism has been of great interest, especially
in terms of its stimulating and motivating effects. Bensberg (as
cited in Walker, 1972), stated that besides mental retardation,
a second factor in the underdeveloped or delayed language
observed with some children, can be attributed to environ­
mental deprivation due to lack of stimulation. Likewise, Schlan­
ger (1954) postulated that one of the major causes of inferior
language development with the institutionalized children in his
studies was loss of speech motivation. With these stimulating
and motivational aspects of music as a primary focus, Talking­
ton and Hall (1970) reported that using music as a reinforcer
increased verbal production in low verbalizing subjects with
mental retardation.
To date, there have been few studies incorporating music
and sign stimuli pairings, and their subsequent effects on vo­
cabulary development. Even less of the literature pertains di­
rectly to mentally retarded populations. Madsen (1991) looked
at this specific pairing in the learning and transfer of nonsense
words with normal children. Sixty first graders were randomly
assigned to three treatment groups and were taught nonsense
words which were paired with either music and gesture, just
gesture, or no contact at all. In this study, the number of correct
verbal nonsense words recalled was measured, and results in­
dicated a significant increase in the number of words learned
and transferred for the music and gesture treatment group over
the gesture group and the no contact group. Madsen discusses
these results in terms of being a significant first step in the area
of music and vocabulary research, adding that of pertinent
Vol. XXXII, No. 3, Fall, 1995 193

interest is whether this effect is observed with language delayed

or developmentally delayed children.
The intent of this study was to explore the specific area of
memory for signed words in children with autism. Of central

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interest was a test of the success of music cues added to the
simultaneous communication framework which may benefit
vocabulary learning and short-term memory recall. Given the
success of the musical cues applied to signed vocabulary and
memory discussed by Madsen (1991), it seemed appropriate to
test its effect with populations other than normal children, es­
pecially when considering that children with mental retardation
and autism are frequently taught some method of manual com­
munication. It was hypothesized that signs taught in connection
with music would be acquired faster by children with autism,
than signs connected with rhythmic speech. Based on the Mad­
sen study, the primary focus of the present study was to measure
the number of signs and spoken words correctly imitated in a
story verse context given two testing conditions. In one condi­
tion, seven signed and spoken words paired with music were
presented to each child. In the other condition seven signed and
spoken words were paired with rhythmic speech without music.
It was hypothesized that the signed words taught with music
would result in more signs correctly imitated, and more spoken
words correctly imitated than when the signed words were
taught with just rhythmic speech.

Method
Participants
Ten children were selected from a local Chicago public school
with a special program for autistic children. Each child was
diagnosed with autism by their own health care provider. In
most cases the diagnosis was made by a pediatric psychologist.
Assessments of IQ made six months prior to testing yielded a
range of 91 to 20 points (M IQ = 56.4). According to the DSM
III-R criteria for mental retardation, 3 subjects were classified
as having no mental retardation, 4 subjects were classified as
mildly mentally retarded, 2 subjects were classified as moder­
ately mentally retarded, and 1 subject was classified as severely
mentally retarded.
194 Journal of Music Therapy

Of the 10 children comprising the sample, there were 2

females and 8 males; 1 subject was Caucasian and 9 were Af­
rican-American. The subjects ranged in age from 4 years, 4
months to 9 years (M age = 5.3). The Childhood Autism Rating

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Scale (CARS) was used to determine levels of functioning: 5
subjects were classified as mildly to moderately autistic and 5
were classified as severely autistic.
Prior to participation, all potential subjects were screened on
a number of different attributes which were fundamental to
the nature of the study. First, only those children possessingno
severe visual, hearing, or motor deficits were considered. Visual
and hearing tests were conducted on all of the subjects by a
staff nurse one month prior to the initial screenings. Second,
each subject was evaluated in terms of his or her attention to
music. Subjects were retained for the study only if they exhib­
ited an obvious attention to (as measured by affective behavior,
clapping, and/or vocalizations) and enjoyment of music. Third,
rough assessmentsof vocal and motor imitation ability, as well
as social readiness were determined. Each child was requested
to imitate some vocal words and manual gestures requiring one
and two hands, and specific finger placement. Of the 16 children
originally screened, 10 were retained for testing based on their
motor imitation abilities, and willingness to interact with the
experimenter on the required tasks. Most of the children who
were not retained failed to exhibit adequate attention to music,
or motor imitation abilities. One child was excused from further
testing for failing to demonstrate a willingness to interact with
the experimenter.

Materials
The signs trained for each subject totaled 14, with 7 signs
incorporated into verses representing the two levels of treat­
ment, music versus rhythm. The signs chosen for each condition
were matched in terms of:
(1) Difficulty (number of hands used, positioning, touching,
and visibility of hands) as specified in Fristoe and Lloyd (1978).
(2) Familiarity (the signs represented common words in the
child’s natural environment) as specified in Rosenberg and Ab­
beduto (1993).
Vol. XXXII, No. 3, Fall, 1995 195

(3) Reinforcement value (i.e., the signs chosen did not appear
to be inherently reinforcing to the subjects).
(4) Iconicity, as recommended by Fristoe and Lloyd (1978),
and Klein (1988), all of whom incorporated specific techniques

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used to match sign dimensions with use with children with
mental retardation and learning disabilities; one ASL sign (bell)
was modified from a two handed sign to a one handed sign for
easier use.
Matching of the target signs of these dimensions for both
conditions was done in place of complete condition counter­
balancing. Once the signs were selected and modified the two
conditions were considered to be equally matched.
The music selected was “Goldilocks Returns,” written and
performed by Dennis Hysom (1992). The tune itself was un­
familiar to the subjects and incorporated words that were ap­
propriate to sign and easy to match in terms of difficulty. The
music condition of the study involved the first verse of “Gold­
ilocks Returns”. The seven words tested in this condition were:
bears, girl, bell, door, table, bacon, and cold. All but two of the
signs required two hands to imitate. The one handed signs were
girl and bell. Each child was presented with this verse once
during each trial, for a total of 20 trials.
The rhythm condition involved the second verse of “Goldi­
locks Returns”. The audio portion consisted of a replication of
the exact rhythm and speed of the original music with the words
spoken (not sung) by the experimenter. Seven additional words
were tested during this condition including: chairs, three, laughs,
broke, rest, jumps, and soft. All but one of the signs required
two hands to imitate. The one handed sign was three, although
chair was scored as having been correctly imitated when the
child used either one or two hands to make the gesture. Each
child was presented with this verse once during each trial, for
a total of 20 trials.
The music and rhythm audio portions were transferred to
two separate audio cassette tapes with five trials (representing
one day’s testing) on each. During testing, the tapes were played
on a cassette player in the background. The total time for five
trials to be played for either the music or rhythm audio con­
dition was three minutes.
All testing sessions were video taped for scoring purposes
196 Journal of Music Therapy

using a small camcorder which was nearly inconspicuous to the

subjects. Other materials included, a small table, two chairs,
and a large screen to shield the children being tested from
distractions.

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Design and Procedure
Following a within-subject design, each child was tested in­
dividually for a series of four consecutive days (five trials each
day) for two weeks. Five of the subjects were randomly assigned
to be tested on the music condition during the first week, while
the other five were tested on the rhythm condition. During the
second week the conditions were reversed for both groups. All
sessions were videotaped for scoring purposes.
The dependent measures of interest included, the number of
signs correctly imitated out of seven and the number of words
correctly spoken out of seven. It was determined by the ex­
perimenter that the presentation of 20 trials for each condition
was sufficient exposure to potentially enable correct imitation
for each of the seven target words.
During the music condition training, each child sat behind
a screen in a small chair facing the experimenter. The exper­
imenter would begin by first securing the child’s attention,
usually with the words “Are you ready?” or “Copy me”. Once
initial attention was achieved, the experimenter would begin
playing the audio cassette for the music condition. During each
trial, the experimenter would sign and speak to only those seven
target words (bear, girl, bell, door, table, bacon, cold) incor­
porated in the music verse. Each child was presented with five
trials per day for a total of 20 trials tested. Following one day’s
testing, each child was praised for his or her participation and
given a small eatable as a reinforcer.
During the rhythm condition training, the same basic pro­
cedure was enacted as in the music condition. The audio portion
consisted of the cassette with the replicated speed and rhythm
of the second verse of “Goldilocks Returns”. The experimenter
would sign and speak to only those seven words (chair, three,
laugh, broke, rest, jump, soft) corresponding to that condition.
Each child was presented with five trials per day for a total of
20 trials tested, and following one day’s testing each child was
praised and given a small eatable.
Vol. XXXII, No. 3, Fall, 1995 197

Scoring
The scoring of the two dependent measures (number of signs
imitated and number of spoken words imitated) was performed
by a person who was blind to the nature of the hypothesis. The

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scorer was taught the correct placement for each sign and ob­
served the video tapes for every child. Correct signing (sign
labeling) was scored on a random trial-by-trial basis for each
word and was defined as the proper positioning and movement
of the child’s hands. Simultaneously, correct speaking was scored
on the same random trial-by-trial basis for each word and was
defined as any vocalization (whether sung or spoken) which
closely approximated the appropriate word. Although imitation
scoring was determined for each word over 20 trials, correct
imitation of each target word was ultimately scored if the subject
correctly imitated a target word at least once in those 20 trials.
The maximum possible scores for each condition therefore, were
seven signs and seven spoken words.
Throughout the scoring, the experimenter was present only
to address questions by the scorer involving the reviewing of a
particular trial and to provide interobserver reliability measures
for 25 percent of each subject’s individual target word perfor­
mance. Reliability measures yielded 98% agreement for sign
and speech production between scorer and experimenter. Al­
though interobserver measures were obtained, only the scorer’s
ratings were considered for analysis.

Results
Two, 2 x 2 factorial within-subject analyses of variance
(ANOVA) were performed, one for each dependent variable
(number of signs imitated and number of spoken words imi­
tated). Both dependent variables were subjected to a two-way
analysis having 2 levels of condition type (music or rhythm)
and 2 levels of order type (music condition presented first or
rhythm condition presented first). In each analysis there were
no significant main effects for order, indicating that correct
responding was not dependent on whether the subject was pre­
sented with the music condition first or second. As such, none
of the condition type/order type interactions were significant.
A significant main effect for condition type (music or rhythm)
199 Journal of Music Therapy

TABLE 1
Main Effect Mean and Standard Deviation Numbers of Correct Sign Imitation

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Condition*
Music 10 5.10 7.89
Rhythm 10 4.00 2.83
Orderb
Music First 10 4.1” 2.92
Rhythm First 10 5.00 2.83
Note. Maximum score = 7.
* Significant main effect for condition type p < .05.
b Nonsignificant main effect for order type p > .05

was found with the number of signs correctly imitated out of

seven. The effect was such that the average number of signs
correctly imitated during the music condition (M = 5.1) was
significantly higher than the average number of signs imitated
during the rhythm condition (M = 4), (F(1, 8) = 6.54, p < .05).
An additional significant main effect for condition type (mu­
sic or rhythm) was found with the number of spoken words
correctly imitated out of seven. The effect was such that the
average number of spoken words correctly imitated during the
music condition (M = 4.2) was significantly higher than the

Table 2
Main Effect Mean and Standard Deviation Numbers ofCorrect Speech Im­
itation

Condition
Music 10 4.2” 3.36
Rhythm 10 3.20 2.94
Orderb
Music First 10 2.80 3.29
Rhythm First 10 4.60 2.68
Note. Maximum score = 7.
s Significant main effect for condition type p < .02
h Nonsignificant main effect for order type p > .05
Vol. XXXII, No. 3, Fall, 1995 199

average number of spoken words imitated during the rhythm

condition (M = 3.2), (F(1, 8) = 8.33, p < .02).
Subsequent omega-squared calculations conducted on the two
significant effects’ for condition type on sign imitation, and

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speech imitation yielded values of .35 and .42 respectively.
These values indicate the proportion of variability with sign
imitation and speech imitation that was associated with con­
dition type According to Cohen (1977) a large effect exists
when the omega-squared value exceeds 15%.

Discussion
In support of the main research hypothesis, the results in­
dicated that music did have a positive effect on the number of
signs subjects were able to correctly imitate. As such, the same
positive effect was found for music in terms of the number of
spoken words correctly imitated.
A noted influential aspect of music’s positive effect on sign
and speech imitation concerns aspects of attention, or what
Shehan (1981) and Morton, Kershner, and Siegel (1990), refer
to as music’s reduced distractibility effect. Their contentions
are that music enables a child to focus more intently to on-task
behaviors by reducing boredom. This was evident with a num­
ber of subjects in the present study. One child, who was pre­
sented with the music condition first, refused to sit beyond the
second trial of the rhythm condition. Another child would con­
sistently lose eye contact by the third trial presented each day
in the rhythm condition. The experimenter also observed less
hand flaying and head movements during the music conditions
as well as less incoherent babbling.
Another aspect about music that was important to this study
catered specifically on short-term memory recall. Ricks and
Wing (1975) noted that music helps a child to recall, when
important information to learn is paired to a simple pattern of
sound. If this aspect of music was the most important factor in
correct sign or speech imitation, then the children tested should
have performed just as well in the rhythm condition as they
did in the music condition. Given that this was not the case,
one possible conclusion is that had they not been so distracted
during rhythm condition training, they may have been able to
200 Journal of Music Therapy

imitate just as many signed and spoken words as they did during
music testing.
Another factor to logically account for the inducing effects
of music observed in this study, is that it made for a more

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enjoyable learning situation for many of the children. Watson
(as cited in Nelson, Anderson, & Gonzales, 1984) and Paul (as
cited in Nelson, Anderson, & Gonzales, 1984), mentioned that
positive affect was much more pronounced with their autistic
or mentally handicapped subjects during music learning situ­
ations, than in situations where music was not used. The ex­
perimenter noted, in particular, that a number of the children
would sing or speak to many, (and in some cases all), of the
words in the music verse in addition to the tested target words.
One child was observed to be singing the entire verse by the
last trial. In addition, it was evident that the children who spoke
frequently during music testing would often stop talking alto­
gether during rhythm testing, or their voices would become
dramatically softer.
Due to the specific nature of this design, a few cautions
regarding conclusions about language acquisition and com­
municative ability should be noted. As discussed in Rosenberg
and Abbeduto (1993), conclusions regarding language acqui­
sition and pragmatic ability are limited in the sense that this
extremely basic augmentative form of didactic intervention
measured only specific aspects of short-term memory. Although
the stimuli employed were linguistic in nature, there is no ev­
idence to suggest that the children tested, correctly utilized the
signs for communication purposes outside of the testing situation
or even during testing itself. The conclusions regarding music’s
effects are limited in the sense that it appeared to improve
learning and attention only in this specific context and only in
terms of stimulus imitation.
It should be noted as well, that the stimuli used in both
condition verses involved rhyming phrases. Because rhyme may
have a potentially positive facilitating effect with music that is
different from any effects with rhythmic phrases, the conclusion
about music’s positive effects could be limited even further. It
would be interesting to see if future research would result in a
significant effect for music with prose used in place of, or as
compared to verse.
Vol. XXXII, No. 3, Fall, 1995 201

Despite the limitations regarding communicative ability, this

study could function as a potential first step to a number of
larger and more complex studies which employ simultaneous
communication methods. Given the noted lack of research in­

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corporating music with manual language learning and children
with autism, the significant effects for music on sign and speech
imitation found in this study could be taken a step further. More
didactic based augmentative forms of intervention could assess
the spontaneous sign production and generalizability outside of
the test setting in order to achieve a better indication if music
actually promotes better utilization or more appropriate prag­
matic skills.
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