Journal of Music Therapy, XLVII (1), 2010, 2-26

© 2010 by the American Music Therapy A.ssoclatlon

Effect of "Developmental Speech and

Language Training Through Music"
on Speech Production in Children
with Autism Spectrum Disorders
Hayoung A. Lim, PhD, MT-BC, NMT

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Sam Houston State University

The study compared the effect of music training, speech

training and no-training on the verbal production of children
with Autism Spectrum Disorders (ASD). Participants were 50
children with ASD, age range 3 to 5 years, who had
previously been evaluated on standard tests of language and
level of functioning. They were randomly assigned to one of
three 3-day conditions. Participants in music training (n =
18) watched a music video containing 6 songs and pictures
of the 36 target words; those in speech training (n = 18)
watched a speech video containing 6 stories and pictures,
and those in the control condition (n -- 14) received no
treatment. Participants' verbal production including seman-
tics, phonology, pragmatics, and prosody was measured by
an experimenter designed verbal production evaluation
scale. Results showed that participants in both music and
speech training significantly increased their pre to posttest
verbal production. Results also indicated that both high and
low functioning participants improved their speech produc-
tion after receiving either music or speech training; however,
low functioning participants showed a greater improvement
after the music training than the speech training. Children
with ASD perceive important linguistic information em-
bedded in music stimufi organized by principles of pattern
perception, and produce the functional speech.

Introduction
One criterion for the diagnosis of" Autism Spectrum Disorders
(ASD) which has remained constant since Leo Kanner's first
description of infantile autism in 1943 is difl~iculty in the
development of social communication (American Psychiatric
Association [APA], 2000). In particular, speech and language
Vol. XLVII, No. 1, Spring 2010 3

impairment has been regarded as one of the most significant

deficits in ASD (Lord & Paul, 1997; Prizant & Wetherby, 2005;
Rapin & Dunn, 2003). Many studies which focused on the
language of verbal children with ASD identified aberrant speech
features, such as unusual word choice, pronoun reversal,
echolalia, incoherent discourse, unresponsiveness to questions,
aberrant prosody, and a lack of drive to communicate (Rapin &

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Dunn, 2003). Researchers have concluded that children with ASD
frequently have various kinds of language deficits, however,
semantic, pragmatic and prosody deficits are the most pervasive
(Lord & Paul, 1997; Rapin & Dunn, 2003; Tager-Flusberg, 1997,
2003). In spite of these deficits, more than h ~ f of all children with
ASD show an intact ability to perceive and produce speech
sounds, and do develop some level of functional speech (Paul &
Sutherland, 2005; Prizant & Wetherby, 2005; Schuler, 1995; Tager-
Flusberg, 1997). Therefore, providing effective intervention to
develop communication skills and language in children with ASD
by utilizing their intact capacity is a high priority in efforts to treat
ASD (Prizant & Wetherby, 2005).
Music has been used for autism treatment for decades because
of the beneficial effects of musical stimuli and the positive musical
responses in children with ASD (Thaut, 1999). In fact, many
clinicians have utilized music for development in various areas
such as? fine and gross motor coordination, attention span, social-
interpersonal skills, concept of self, and verbal and nonverbal
communication (Kaplan & Steele, 2003; Thaut, 1999). Whipple
(2004) indicated that all types of music intervention have been
effective for children and adolescents with autism. In particular,
the u~e of music was effective on increased communicative
behaviors including vocalization, verbalization, gestures, vocabu-
lary comprehension, echolalia with communicative intention
(Whipple, 2004).
While previous research indicated that music therapy is
effective across ' o f a number of functioning domains for
individuals with ASD, the benefits of music were not differentiated
by treatment intervention, age of participants, selection of music
or goal areas (Kaplan & Steele, 2005; Whipple, 2004). In addition,
the positive effects for music on language development of
children with ASD in the previous studies were largely attributed
to increased attention, enjoyment, and optimal social context
4 Journal of Music Therapy

(Brownell, 2002; Buday, 1995; Hoskins, 1988). Many previous

studies did not consistently have experimental control with
proper statistical methods and sample size. In result, those
studies did not provide the rational connection between music
interventions and the positive outcomes in language development
in ASD.
Music is composed of many separate yet interconnected

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components such as pitch, melody, rhythm, harmony, form,
timbre, and dynamics. These elements are typically arranged in
patterns and perceived as "music" (Berger, 2002; Radocy & Boyle,
2003). These musical patterns are organized in such a way so as to
bring anticipation of incoming patterns over a temporal order.
The perception of the musical pattern is commonly ruled by
Gestalt laws of perception with a number of organizational
principles including: proximity, similarity, common direction,
simplicity, and closure (Eysenck, 2001; Lipscomb, 1996; Radocy &
Boyle, 2003). Essentially, the Gestalt perceptual principles as
applied to melodic perception suggest that listeners are likely to
perceive musical tones close together in time and auditory space
as a melodic unit (i.e., proximity), perceive similar or repeated
tones as a unit (i.e., similarity), and hear a melodic sequence as
moving in a common direction toward completion (i.e., common
direction and closure) b~sed on what they heard previously. In
addition, listeners are likely to perceive and organize the Gestalt,
the melodic contour or pattern, in its simplest form (i.e.,
simplicity).
Musical pattern perception is observed in children with ASD
(Berger, 2002; Heaton, Hermelin, & Pring, 1999; Orr, Myles &
Carlson, 1998). Heaton and colleagues (1999) reported that
children with ASD who had affective and interpersonal deficits
perceived and processed affective patterns in musical stimuli.
Furthermore, they appeared to have an intact perceptual ability to
connect the melody patterns in music, such as a key or melodic
mode with a corresponding visual affective pattern. Results of the
several studies indicated that children with ASD perceive and
recognize the different characteristics or organizations of musical
patterns (Berger, 2002; Heaton et al., 1999; Orr et al., 1998;
Thaut, 1987).
Children with ASD are also able to produce well-organized
musical patterns including melodic and rhythmic patterns. Thaut
Vol. XLVII, No. 1, Spring 2010 5

(1988) analyzed improvised musical tone sequences produced by

three groups of children: those with and without autism; and
those with mental retardation. The results suggested that the
children with autism scored significantly higher than the children
with mental retardation in terms of rhythm, restriction, originality
and total performance score, and no significant differences were
found between typical children and children with autism (Thaut,

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1988). The communicative and interactive behaviors of children
with autism are commonly presented through their musical
behaviors. Edgerton (1994) indicated that children with ASD are
able to produce various rhythmic patterns, vocal responses to
varied pitches, and vocalize in a steady tempo and match the
tempo of their improvisation to other's varied tempo. Edgerton
(1994) also found a significant positive correlation between
musical vocal behavior and nonmusical speech production such
as verbal communication with gestures. In addition, Wigram
(2000) reported that children with ASD are able to produce
different rhythm patterns and imitate changes in scales on the
keyboard.
Perception of musical elements such as rhythmic and melodic
p~/ttems is similar in many ways to the perception of speech/
language information. Trehub and Trainor (1993) indicated that
pitch-contour processes in music perception and prosodic pro-
cesses in speech require a common auditory perceptual strategy.
Rhythm perception is similar to perception of numbers in a metric
organization (i.e., counting) (Clarke, 1987; Radocy & Boyle, 2003;
Sloboda, 1985). Memory of melody contour or rhythmic figure is
similar to processing sequential linguistic information such as
sentence structure (Radocy & Boyle, 2003). Both music and speech
perception follows the same, principles of general perceptual
organization: pattern recognition and grouping information into
categorical units (McMullen & Saffran, 2004; Prizant, 1983, 1987;
Radocy & Boyle, 2003; Thaut, 2005). McMullen and Saffran (2004)
explained that both music and language are organized temporally,
with pattern structures unfolding in time. Furthermore, both
speech and music reach the perceptual system as frequency spectra
arrayed as pitches, which are generated from a selected finite set of
sounds (i.e., notes or phonemes). , :
Researchers also indicated that general auditory processing
mechanisms responsible for pattern analysis are involved in the
6 Joumal of Music Therapy

perception of both speech and music (Patel, 2003). Researchers

have found common neuro-anatomical structures and similar
patterns of cortical activation of Broca's area, the primary and
secondary auditory cortices (i.e., bilateral temporal and right
inferior frontal lobe), and the primary motor cortex that are
involved in processing both music and speech, particularly
prosody in speech (Brown, Martinez, Hodges, Fox, & Parsons,

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2004; Brown, Martinez & Parsons, 2006; Patel, Peretz, Tramo, &
Labreque, 1998). Similarities between music and speech/lan-
guage suggest a link between the two domains in terms of their
evolution and development as well, because both music and
language development in children are heavily influenced by their
capacity for pattern perception and production (McMullen &
Saffran, 2004; Peters, 1980; Prizant, 1983; Prizant, Schuler,
Wetherby, & Rydell, 1997). Therefore, it is possible to postulate
that a closer link between music and language, in particular the
common mechanism of pattern perception and production
between the two domains might exist in the development of
children with ASD.
Researchers have suggested that language development in
children with ASD is heavily influenced by the capacity for pattern
perception and production based on Gestalt perceptual-pattern
processing called 'the Gestalt style of language acquisition'
(Prizant, 1987; Prizant et al., 1997). In contrast to analytic style,
Gestalt style of language acquisition refers to unanalyzed language
forms or unanalyzed "chunks" with little appreciation of their
internal structure or specific meaning (Prizant, 1983, 1987).
Researchers have agreed that most typical children use the
analytic style, or may use both analytic and Gestalt forms, whereas
children with ASD demonstrate primarily Gestalt processing in
their language acquisition, as observed in speech characteristics
such as echolalia (Barrett, 1999; Eysenck, 2001; Peters, 1980, 1983;
Prizant, 1987). Gestalt language forms in autism, such as echolalia
and other unconventional verbal behaviors are unanalyzed units
of speech including multiword utterances that are learned as
memorized forms or whole units, but may appear to be the result
of productive linguistic processes and functional speech in
interacting with others (Prizant, 1987). It has been suggested
that to enhance speech and language development for children
with ASD, intervention should utilize the intact function of their
Vol. XLVII, No. 1, Spring 2010 7

language acquisition--Gestalt perceptual processingmwith apprc~

pilate contexts containing communicative exchanges and activ-
ities of high motivation and interest.
Researchers indicated that children with ASD have intact
auditory areas and functions that can process various patterns in
sounds, including musical and speech sounds. In addition, they
follow the same principles of Gestalt pattern perceptual organiza-

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tion for music and speech. The capacity of musical pattern
perception in children with ASD, and the effects of music stimuli
on enhancing their speech production should be investigated.
Research is also needed to explore the effect of a systematic
intervention on speech/language skills in children with ASD, and
such an intervention should be based on scientific evidence
regarding the unique ways in which children with ASD perceive
and produce music and speech. Therefore, the present study
explored how the perception of organized musical patterns
impact the perception and production of speech in children with
ASD, and examined the effect of music as part of developmental
speech-language training for the children. The following research
questions were addressed: (a) Do levels of speech production in
children with ASD differ by training conditions: music versus
speech? (b) Do levels of speech production in children with ASD
differ by level of functioning? (c) Does speech production in
children with ASD differ by presence of echolalia? (d) Does any
interaction exist between level of functioning, type of training
condition, language age, presence of echolalia, and overall speech
production in children with ASD? (e) Does any relationship exist
between training conditions: music versus speech and various
aspects of speech production, including: semantics, phonology,
pragmatics, and prosody, in children with ASD?

Method
Participants
Diagnosis of ASD and age range. A total of 51 children who met
the diagnostic criteria for ASD were recruited from various local
treatment facilities for children with ASD. One child was screened
with her parents' consent; however the child did not participate in
the study due to the dual diagnosis of Autism Spectrum Disorder
and Down syndrome. The exclusion of this volunteer resulted in
8 Joumal of Music Therapy

50 participants, ages 3 to 5 (M = 4 years, 8 months), all o f whom

had previously been diagnosed with ASD by their own health care
provider. T h e particular chronological age range (3-5) appears to
be a critical time for language development in children with
autism (Schopler, Van Bourgondien & Bristol, 1993). In this
study, 6 participants were 3 years old, 20 participants were 4 years
old, and 24 participants were 5 years old.

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Level of functioning. The determination of level o f functioning
was based on scores on either the Childhood Autism Rating Scale
(CARS) (Schopler, Reichler, & Renner, 1988), or the Autism
Diagnostic Interview Revised (ADI-R) (Rutter, Le Couteur, &
Lord, 1994). In this study, children who are categorized "age-
appropriate" and "mildly impaired" on the CARS were classified
as participants o f high functioning level. Children who were
identified "moderately impaired," and "severely impaired" on the
CARS were considered to be at a low functioning level. Elevated
scores o f the ADI-R indicate problematic behavior in a particular
area. A score o f 0 is given when "behavior of the types specified in
the coding is not present;" a score of 1 is given when "behavior o f
the type specified is present in an abnormal form, but not
sufficiently severe or f r e q u e n t to m e e t the criteria;" a score o f 2
indicates "definite abnormal behavior" meeting the criteria
specified, and a score o f 3 is reserved for "extreme severity" of
the specified behavior. In this study, children who obtained an
average score o f 0 or 1 on the ADI-R were considered to be at a
high functioning level. Children who obtained an average score of
2 or 3 on the ADI-R were considered to be at a low functioning
level. In this study, 25 children were considered to be at a high
functioning level and 25 children were considered to be at a low
functioning level.
Language age and echolalia. The investigator used previously-
administered test scores o f language from the recruiting sites in
o r d e r to d e t e r m i n e each participant's language age. Test scores
used for the present study included: the Preschool Language
Scale (Zimmerman, Steiner, & Pond, 2006), the Peabody
Picture Vocabulary Test (Dunn & Dunn, 1997), and the
Expressive and Receptive One Word Picture Vocabulary Test
(Gardner, 2000a, b). In this study, 10 participants had language
age o f 4, 8 participants had language age of 3.5, 5 participants
had language age of 3, 7 participants had language age o f 2.5, 6
VOI. XLVII, No. 1, Spring 2010 9

participants had language age of 2, 5 participants had language

age of 1.5, and 9 participants had language age of 1. The
presence of echolalic behavior was obtained from reports from
both speech/language pathologists and teachers at the recruit-
ing sites. In this study, 32 participants produced echolalia and
18 participants did not produce echolalia; however they were
verbal. In terms of speech-language training through music, it is

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not known how echolalia interacts with learning of words and
the speech production. Therefore, the participants' echolalic
behavior was used in the present study as an independent
variable for the analysis.

Materials
Target words. The target words were selected from functional
vocabularies that typically developing 3-year-old children can use
effectively in everyday interactions. The selection of vocabulary
words in this study was based on a number of criteria, including
meanings and intentions that are commonly expressed in early
language communication and that can be practiced often. A total
of 36 words were used in the present study. The specific criteria
for vocabulary selection and target words for this study are
presented in Table 1
Testing materials. The pre and posttest used the 36 target words
as listed in Table 1 and both tests were in the same format. The
pre and posttests were a form of fill-in-the-blank, intraverbal
communication. Intraverbal communication is a type of expres-
sive language in which a word or phrase evokes another word or
phrase by cuing or prompting, but the cue is not identical to the
response (target word) (8undberg & Partington, 1998). For
example, a child's tendency to say "farm" when cued by ~Old
MacDonald had a..." is a form of intraverbal communication. The
first phrase, "Old MacDonald had a..." evokes, but is not identical
to the response "farm." Each pre and posttest included 36 phrases
that were structured so as to end with one particular target word.
The investigator said the first part of each phrase, and then left off
the target word. A corresponding picture was also presented with
each target word. The pictures were selected from The Picture
Exchange Communication System (PECS) (Frost & Bondy, 1994).
Each picture was used only one time with its corresponding target
word. The objective of the procedure in the pre and posttest was
10 Journal of Music Therapy

TABLE l
Criteriafor Vocabulary Word &leaion and Target Words

Criteria for vocabulary words Target words

Words that express early semantic functions:

Nonexistence or cessation "all gone" "all done"
Recurrence "more" "again"

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Action "stop" "go"
Locative action "down" "out"
Words to request motivating things:
Food "apple" "banana"
Animals "brown bear" "pink pig"
Objects "key" "shoe"
Activities "sing" "story"
Words for routine independent living activities "eat" "sleep"
Words for expressing agreement of affirmation "yes" "ok"
Names (calling) of significant people "mommy" "baby"
Words to request:
Assistance "help" "here"
Affection or comfort "kiss" "hug"
Interaction "play" "come on"
Words for common environment "home" "school"
Action words of general application "point" "look"
Words of attribution "pretty" "dirty"
Words to express feelings or internal states "happy" "fun"

to p r o m p t the participant to p r o d u c e a target word at the e n d of a

p h r a s e u p o n hearing the first part o f the phrase.
M u s i c stimuli. In the present study, a music therapy technique
called developmental speech and language training t h r o u g h
music (DSLM) was used to address acquisition of the target words.
"Developmental Speech a n d Language Training t h r o u g h Music
(DSLM) is designed to utilize musical as well as related materials
to e n h a n c e a n d facilitate speech a n d language d e v e l o p m e n t in
children with developmental speech and language delays"
(Thaut, 2005, p. 173). Six songs c o m p o s e d by the investigator
were used for the study, a n d the songs included the 36 target
words. Each song lyric included six target words, and each lyric
line e n d e d with a target word a n d an a p p r o p r i a t e musical
Vol. XLVII, No. 1, Spring 2010 11

cadence. For example, "Hello, hello, brown bear. What do you eat?.
I'd like to eat an app/e. After eating apples, he is happy. Brown bear
says more. Daddy bear says the apples are a//gone.
The six songs in the music condition were composed in a
simple song structure with a limited n u m b e r - o f vocabulary
words. Each song was composed in a distinctly different style. For
example, the songs varied by key (i.e., C Major, d minor, &

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E Major), tempo, and meter (i.e., 4/4, 2/4, 3/4, 6/8, &
12/8 meter). The pitches of the melodies in each song were
relatively close together. The step-wise pitch movement was
perceived as a pattern; thus, the Gestalt perceptual law of
proximity was utilized. For example, two adjacent pitches
associated with target words (i.e., E and D for "Brown Bear")
helped the grouping of the words. The pitches and rhythmic
figures were also organized by the law of proximity and
similarity, and were matched to the syllables of each target
word. The combination of musical elements and target words
was perceived as a whole unit as well. All of the melodic
sequences in each song moved in a typical direction toward
completion; the Gestalt perceptual law of common direction
(i.e., good continuation) a n d / o r completion was utilized. All of
the target words in the six songs were placed at the end of each
phrase with a proper cadence indicating perceptual completion
of each phrase. The predictable harmonic progression of each
cadence and the relatively longer note duration or subde
changes in timing (i.e., rubato) on the last note of each phrase
emphasized the target word. All of the six songs were composed
of simple and repetitive combinations of musical pattern that are
symmetrical and parallel in form. The described organization of
musical stimuli (pattern) might enhance participants' musical
anticipation and prediction, and support their perceptual
process of the target words presented within the musical
patterns.
All of the songs were recorded on to video tape and presented
to participants through a television monitor. A female music
student sang all six songs, and the investigator played the guitar as
an accompaniment. Pictures from the PECS for each of 36 target
words were also presented by the singer as she sang the congruent
target word. Each song was presented two times consecutively in
the music video.
12 Journal of Music Therapy

Speech stimuli. T h e same texts for the six songs used in the music
sdmuli were used for the six stories in the speech stimuli. T h e
texts included 36 target words. Each story included six target
words, and each sentence o f a story e n d e d with a target word. T h e
same female music student in the music condition spoke the
stories. Pictures for each o f 36 target words in the stories were also
presented by the vocalist as she spoke the corresponding target

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word. All o f the stories were recorded on to video tape and
presented to participants through a television monitor. Each story
was presented two times consecutively in the speech video.

Procedure
Each child's parents learned about the purpose of the study by
reading a prewritten document, and then signed the informed
consent form to give permission for h i s / h e r child to be part o f the
study. T h e informed consent form gave permission to the
investigator to use the participant's standardized test scores and
to ask the participant's speech/language pathologists or teachers
a b o u t the child's use o f echolalic behaviors. All screening
procedures were completed by the investigator. T h e investigator
arranged to meet the participant in a room at the recruiting site
for all subsequent research procedures.
Each o f the 50 participants was randomly assigned to one o f three
training conditions: music, speech or no-training. T h e music
training was 9 minutes long, and the speech video was 5 minutes
and 40 seconds long. Each was tested individually. On the day o f
the pretest, the investigator met the participant and showed the
appropriate video. Participants in the music condition (n = 18)
watched the music video, while participants in the speech condition
(n = 18) watched the speech video. Each participant watched the
same video presentation two times per day (i.e., morning and
afternoon) for three days. Participants in the control group (n =
14) did not watch the music or speech video for three consecutive
days. O n the next day after completing six training sessions o f the
music or speech training condition, the investigator administered
the posttest. T h e same posttest was administered individually to
participants in all conditions. All o f the pre and posttests were
video-taped, and each test took approximately 10 minutes.
Data collection. During the pre and posttests, data were collected
in regard to each child's production o f the target words. A correct
Vol. XLVII, No. 1, Spring2010 13

verbal response consisted of four components, including:

semantics, phonology, pragmatics, and prosody. A verbal produc-
tion evaluation scale (VPES) designed by the investigator
measured participants' productions of the target words according
to the four speech components.
In the present study, semantics refers to the meaning of each
spoken target word, and indicates whether the child produced the

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correct target word. If a child produced the correct target word, he
received one point. Phonology refers to correct pronunciation of
the target word. For correct pronunciation, the word produced will
have no articulation errors or phonetic errors in vowels or
consonants (Barrett, 1999). If a child produced the word free of
errors, he received one point. Pragmatics refers to the relationship
between language and particular behavior, social, or linguistic
contexts (Barrett, 1999). In this study, pragmatics were measured by
the temporal and sequential aspect of the verbal production. The
latency of the child's verbal response ranged from an immediate
response to 10 seconds after seeing the corresponding picture
(Braithwaite & Sigafoos, 1998). If a target word was produced within
the designated period of time, the child received one point. In
addition, the prosody of each target word was measured. Prosody
refers to the variation of tone used when speaking (i.e., intonation)
and vocal stress, which is the relative emphasis given to certain
syllables in a word (McCann & Peppe, 2003). The functions of
prosody are to provide an indication of the identity of words.
Prosody can indicate syntax, turn-taking in conversational interac-
tions, types of utterance such as question versus statement, and the
speaker's attitudes, or intention and feelings. The elements of
prosody are derived from the acoustics of speech; they include the
pitch accent on stressed syllables, loudness (i.e., dynamic accent,
volume, & intensity), and full vowel length (i.e., duration) of sound
production (McCann & Peppe, 2003; Peppe & McCann, 2003).
Each of the three prosodic elements; pitch accent, length of vowel
sounds, and intensity was worth one point. The maximum prosodic
score for one target word was three points. The highest overall score
for the verbal production of each target word was 6 points, and the
lowest score was 0 points. Total score possible for pre or posttest was
216 (see Appendix A for the VPES and scoring system).
Two speech/language pathologists who specialize in treating
young children with language impairment and who were blind to
14 Journal of Music Therapy

the purpose o f the study were trained for data coding. T h e two
s p e e c h / l a n g u a g e pathologists watched all video tapes one time
and completed the coding o f the four speech components on the
VPES simultaneously. The level of interrater reliability on the
VPES was .999, and the composite o f the two raters was used for
analysis o f the collected data.

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Results
A 3 × 2 × 2 analysis of covariance (ANCOVA) was conducted to
evaluate the effect o f training condition, level of functioning, and
echolalia on the posttest scores of the VPES. The analysis indicated
a significant effect of the treatment condition on the participants'
verbal productions after controlling for the pretest score and
language age, F (2, 37) = 21.54, p < .001, partial I"12 -- .54.
T h e results indicated that both music training (d = 1.275) and
speech training (d = 1.141) had a large effect on the speech
p r o d u c t i o n c o m p a r e d to the no training condition. T h e r e was no
significant difference between two training conditions (music vs.
speech) on speech production in the children with ASD (see
Table 2).
T h e large effect size (partial rl 2 = .54) and the significant p
value o f the mean differences led to an examination o f the
individual effect size for each training condition (see Table 3).
T h e same 3 × 2 × 2 ANCOVA indicated a significant main effect
for level o f functioning, F (1, 37) = 25.61, p < .001, partial .q2 =
.41. T h e effect size (Cohen's d) was calculated by hand to
c o m p a r e differences in level o f functioning on verbal production.
T h e effect o f high level of functioning versus low level of
functioning had a large effect size (d = 1.605). The results
indicated a significant difference between high and low level of
functioning on the speech production in children with ASD. T h e
participants with a high level o f functioning improved their verbal
p r o d u c t i o n to a greater degree (M o f changes = 76.08 points)
than participants with a low level o f functioning ( M o f c h a n g e s =
27.26 points). Level o f functioning in children with ASD might be
a significant factor to indicate the level of performance and
i m p r o v e m e n t in their speech production regardless o f the
training condition.
T h e analysis further indicated that participants with echolalia
achieved a higher score on the posttest than participants without
VOI. XLVII, No. 1, Spring 2010 15

TABLE 2
Mean, and Standard Deviations of the Pretest, Posttest, and Change Scores for the Total
Scores on the Verbal Production Evaluation Scale by Training Condition

Pretest score Posttestscore Change so,re

M ~D M SD M SD

Music 55.64 58.06 133.11 77.23 + 77.47 43.09

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Speech 60.50 67.53 125.83 81.03 + 65.33 56.89
No-Training 42.14 60.89 43.07 63.98 + 0.93 9.84

echolalia. Participants with echolalia also p r o d u c e d a higher

change score (M o f change = 64.33 points) than participants
without echolalia (M o f change = 29.17 points). T h e results o f
the ANCOVA indicated that the presence o f echolalia did n o t
have a significant effect after controlling for pretest score and
language age, F (1, 37) = 0.064, p = .802, partial TI2 = < .01.
Although the participants with echolalia and without echolalia
produced different scores on the pretest and different mean
changes from the pre to posttest, the difference was not
statistically significant. However, the results o f a one-way ANOVA
evaluating only the two variables o f training condition and
echolalia on the posttest scores after controlling for the pretest
score indicated that a main effect o f echolalia on speech
production in children with ASD approached significance, F
(1,43) = 3.907, p = .055.
Correlation coefficients for the i n d e p e n d e n t variables and
covariates were conducted (see Table 4). According to the correla-
tion analysis, the training condition did not appear to relate to any o f
the other i n d e p e n d e n t variables or covariates. In fact, training
condition was an external variable, whereas other i n d e p e n d e n t
variables and covariates were internal variables acquired from the
participants. This particular analysis indicates that a participant's
high score on the pretest o f the VPES was strongly related to h i s / h e r

TABLE 3
Analysis of Training Conditions on Change Scores: Dunnett's t Test (2-sided)

Tnunmg conditions Mean difference SE Sig.

Music vs. No-Training 76.544 * 12.973 .00

Speech vs. No-Training 64.405 * 12.973 .00

Note. * The m e a n difference is significant at the .05 level.

16 Journal of Music Therapy

TABLE 4
Pearson Produa-Moment Correlation Coefficient 2-tailed for Type of Training, Level of
Functioning, Echolalia, Language Age, and Pretest Total Score

Training Level of Language Pretest

conchtton funcUonmg Echolalm age total

Training
condition 1 -.05 -.18 -.121 -.081

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Level of
functioning -.50 1 .417"* .797** .699**
Echolalia -.180 .417"* 1 .596** .378**
Language age -.121 .797** .596** 1 .722**
Pretest total -.081 .699** .378** .722** 1
N =50.
** Correlation is significant at the 0.01 level (2-tailed).

high language age, high level o f functioning, and the presence of

echolalia.
T h e same 3X2X2 ANCOVA was also used to examine the
interaction of training condition, level o f functioning, and echolalia
on verbal production in children with ASD. The analysis indicated
n o significant interaction between training condition and the
presence o f echolalia after controlling for the pretest score and
language age, F(2, 37) = 2.52, p = .0.94. The analysis also indi-
cated n o significant interaction between training condition and
level o f functioning after controlling for pretest score and language
age, F(2, 37) = 0.65, p = .528. Lastly, the results o f the ANCOVA
indicated no significant three-way interaction between training
condition, echolalia, or level of functioning after controlling for the
pretest score and language age, F(I, 37) = .41, p = .524. T h e r e is
n o interaction between type o f training condition, levels of
functioning, language age, presence o f echolalia, and speech
production in children with ASD. All mean differences between the
speech production in children with ASD are therefore explained by
the main effects of training condition a n d / o r level o f functioning.
A two-way ANOVA was conducted to examine the relationship
between the effects of training condition and level o f functioning
o n change scores for the VPES (see Table 5). This particular
analysis was c o n d u c t e d in o r d e r to further analyze and interpret
the main effects which were found to be significant in the initial
3 × 2 × 2 ANCOVA. The results o f this analysis indicated that an
interaction between training condition and level of functioning
Vol. XLVII, No. 1, Spring 2010 17

T Am~ 5
ANOVA for Between-SubjectsEffect of Training Condition and Level ofFunctioning on Ire to
Posttest Changes

Source 55 df MS F Sig Partial ~

Training Condition 45304.558 2 22652.279 17.013 .000 .436

Level of Functioning 18499.103 1 18499.103 13.894 .001 .240
TC X LF* 8367.135 2 4183.567 3.142 .053* .125

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Total 272726.750 50
Corrected T o t a l 139237.305 49

may in fact exist in the population, since the statistical results of

this interaction approached significance (p = .053).
The analysis showed that the low functioning participants
produced greater changes on the verbal production scores in the
music training than in the speech training. In contrast, high
functioning participants produced positive changes in verbal
production in response to both music and speech training
conditions. The mean difference in verbal production between
the low functioning and high functioning participants in the
music training was 38.08 points. The mean difference in verbal
production between the low functioning and high functioning
participants in the speech training was 75.25 points. Low
functioning participants produced greater changes on the VPES
after the music training than after the speech training.
An independent samples t-lest was conducted to determine the
relationship existing between the training conditions: music
versus speech, and the various aspects of speech production in
children with ASD. The researchers used the participant's
separate posttest scores for each of the four speech components:
semantics, phonology, pragmatics, and prosody, as a d e p e n d e n t
variable. The results indicated that no statistically significant
difference exists between participants in the music and speech
conditions on the semantics, t (34) = 0.38, p = .709; on the
phonology, t (34) = .01, p = .995; on the pragmatics, t (34) =
0.38, p = .709; and on the prosody, t (34) = 0.30, p = .768.

Discussion
The results of the present study showed that participants in
both music and speech training increased their scores on the
18 Journal of Music Therapy

Level of funcbonlng
10000-
• Low
[ ] High

7500-

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5000"

G
ot-

J 2500-

000-
F-1

i i !
Mus¢ Speech no treatment

Treatment Condition

F [ o u ~ 1.
T h e effects o f training condition and level of functioning on mean changes in
verbal production.

VPES from pretest to posttest. This finding suggests that both

music and speech training are effective for enhancing speech
production, including semantics, phonology, pragrnatics, and
prosody in children with ASD; however, the difference between
music and speech training was not statistically significant. Music
training is as effective as speech training for improving speech
production in children with ASD. The results of the present study
suggest that children with ASD perceive and produce the
linguistic information from music as they do from speech. This
finding is consistent with conclusions from previous research
indicating that the mechanism of music perception is similar to
the perceptual/cognitive mechanisms of speech/language infor-
mation (Radocy & Boyle, 2003; Thaut, 2005). In the present study,
the musical patterns and the speech patterns were organized
temporally in six songs and six stories, and the verbal information
in both music and speech conditions utilized a common Gestalt
Vol. XLVII, No. 1, Spring 2010 19

law of perception; the law of good continuation, which involves

perceptual completion. The target word in both the music and
speech stimuli was placed at the end of each phrase, which
allowed the children to anticipate the location and time of the
target words to be produced.
Results of the present research also suggests that children with
ASD appear to have an intact ability to perceive musical and

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speech patterns, and utilize the same principle of Gestalt pattern
perceptual organization to produce speech. The results indicate
that children with ASD improved their speech production after
receiving a short-term (i.e., 3 days) speech-language intervention.
This finding agrees with previous research indicating that
although children with ASD clearly have language impairments,
they may also have an intact ability to perceive and produce
speech sounds, and may be able to develop some level of
functional speech (Paul & Sutherland, 2005; Schuler, 1995; Tager-
Flusberg, 1997). Familiarity from repetition of stimuli presenta-
tion in both training conditions might be a critical factor for
maintaining attention and producing positive changes in their
speech production.
Results also suggest that music is an effective tool for improving
functional vocabulary acquisition and speech production in
children with ASD. Children with ASD in this study were able to
respond music stimuli attentively and perceive a good amount of
linguistic information organized by musical patterns. Children who
received music training perceived musical stimuli from six songs;
however, they produced speech as the outcome, which is a non-
musical, functional behavior. This result indicates that children
with ASD are able to transform the information perceived within
musical patterns into speech patterns. This particular result
suggests that the children with ASD have a certain degree of intact
perceptual association between music and speech.
The findings from this study support a close integrating
relationship between music and language in early childhood
development (Hafteck, 1997; McMullen & Saffran, 2004).
Previous studies indicated that during the early stages of
development in children, music and speech are highly integrated;
therefore the close link between the two domains can be utilized
for a child's language development. The present study found that
3 to 5 year-old children with ASD perceived the organized musical
20 Journal of Music Therapy

patterns in songs and subsequently produced functional speech.

They perceived the speech information that was attached to the
musical patterns in songs, and produced only speech patterns
without producing musical patterns during the pretest. This
finding indicates similarities a n d / o r associations between music
and speech perception for early childhood development in ASD,
and the effects of music on their speech production. The findings

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of the present study also support previous studies that suggest a
parallel neural process of the two domains, and reflect neural
processing by musical stimuli (Brown et al., 2006; Patel et al.,
1998; Patel, 2003). Previous research has shown that the
perception of musical stimuli involves cortical activation of many
different areas in the child's brain including the primary and
supplementary motor cortex, lateral premotor cortex, anterior
insula, frontal operculum, primary and secondary auditory cortex,
right and superior temporal pole, and basal ganglia (Brown et al.,
2006). The activation of multiple brain areas might allow for
integrated processing of the perceived music stimuli, thus
contributing to enhanced speech production.
Results of the present study indicate music training resulted in
greater improvement in speech production compared to speech
training, in particular for low functioning children with ASD.
High functioning children produced a positive outcome after the
speech training. Low functioning children did not produce much
of a change in their verbal production scores after the speech
training, possibly due to poor comprehension of the procedures
and a lack of concentration during the training. After the music
training; however, both high and low functioning participants
produced increased number of target words. Speech training
might be an effective training tool to improve verbal production
for children with a high level of functioning, but not for children
with a low level of functioning. Music training might be an
effective training tool for children with either a high or a low level
of functioning. These findings suggest that music provides more
predictable temporal patterns than speech does, making it easier
to perceive by low functioning children with ASD. The superior
performance on speech production as well as enhanced attention
in low functioning children who received music training is
explained by the characteristics and inherent structure of music
stimuli and their response to the music stimuli.
Vol. XLVII, No. 1, Spring 2010 21

In the present study, structurally and functionally organized

music experiences of DSLM may enhance speech production and
vocabulary acquisition in children with ASD. In particular, the
arrangement of musical elements was developmentally appro-
pilate for preschoolers; all six songs included melodies within a
limited pitch range, adjacent intervals and repetitive melodic
contour. Syllabic production (i.e., pronunciation) of the target

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words was emphasized by the rhythmic and harmonic structure as
needed to preserve prosody and speech rhythm. Collectively, the
musical stimuli in the present study were carefully organized by
the Gestalt laws of pattern perception including simplicity,
similarity, proximity, common direction (i.e., good continuation),
and completion. The researcher of the present study predicted
that the inherent musical structures and organized musical
patterns in the six songs would provide a perceptual Gestalt to
facilitate processing of both musical and speech information.
Each phrase or segment of a phrase of the six songs was composed
with a melodic contour combined with a ,simple rhythmic
configuration, and the phrase served as a musical Gestalt or a
pattern which was repeated in each song. As a result of the
repetition and similarity in musical patterns, the listeners might
have developed familiarity with the music stimuli which could
support learning new vocabulary words.
Results of the present study indicate that echolalia and level of
functioning in children with ASD were positively related to each
other. This finding suggests that children with ASD who produce
echolalia are likely to also have a high level of functioning;
conversely, children with ASD who do not produce echolalia may
have a low level of functioning. Logically, if echolalia is positively
related to high level of functioning, which is a critical factor for
improved speech production, echolalia might be related to
children's speech production as well. The results also indicate
that participants with echolalia achieved a much higher score on
the posttest of speech production than participants who did not
produce echolalia. This finding agrees with previous studies which
indicated that children with echolalia'are more likely to have
higher functional language development than children without
echolalia (Lord & Paul, 1997; Paul & Sutherland, 2005; Prizant &
Wetherby, 2005; Prizant & Wetherby, 1993; Sundberg & Parting-
ton, 1998). Findings from both previous studies and the present
22 Journal of Music Therapy

study suggest that echolalia serves a communicative function, and

that echolalic behavior can evolve into functional speech. The
present study in particular suggests that echolalic speech is related
to the production of functional speech patterns and to acquisition
of further functional language in children with ASD.
Several limitations of the present study need to be noted
including the variability in the diagnostic criteria, duration of the

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training video (i.e., 9 minutes long for music video vs. 5 minutes
and 40 seconds long for speech video), and validity of the VPES.
The sample size of the present study (N = 50) runs the risk of
being too small, and thus the statistical results might be
vulnerable to Type I error; even though the sample size is
substantially larger than that found in most previous research
involving music therapy interventions and their effects on the
communication skills of children with ASD. Therefore, it is
suggested to increase the sample size in future research, to reduce
further risk of Type I error, and to also increase external validity.
Future studies could examine the training effects on retrieval of
newly learned vocabulary words versus words which already be
known to participants. In light of the wide range of language
abilities among children with ASD, future investigators could
design interventions which are individualized to the language
level of each participant. Future studies could expand the
duration of the developmental speech-language training and
increase the number of target words in each category of
functional vocabulary words. Replications of the study could
divide participants' level of functioning into more levels or
categories and echolalia could be evaluated on a scale with more
than two levels. Future studies could compare the effects of
recorded music/stories versus live music/stories on speech
production in children with ASD. More various combinations of
musical components can be explored for future studies. Future
research could examine whether or not the speech-language skills
acquired from training could transfer to a functional setting such
as daily conversation.
Music training (i.e., DSLM) is as effective as speech training for
improving acquisition of functional vocabulary words and speech
production in children with ASD. Children with ASD respond
attentively to music stimuli, and perceive important linguistic
information (i.e., target words) embedded in the music stimuli. As
Vol. XLVII,No. 1, ,~ng 2010 23

a result, they can a c q u i r e a n d p r o d u c e f u n c t i o n a l v o c a b u l a r y

words. T h e positive c h a n g e s i n s p e e c h p r o d u c t i o n m i g h t h e l p
c h i l d r e n with ASD to e x p e r i e n c e i m p r o v e d c o m m u n i c a t i o n , m o r e
c o n v e r s a t i o n s a n d e n h a n c e d i n t e r a c t i o n s with others.

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Appendix A

Verbal Production Evaluation Scale

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Instructions: Please answer each question by circling 'Yes' or
'No.' Each item answered 'Yes' is scored as 1 point.

Participant Code: Date:

Target word: Pretest ( ) Posttest ( )

Semantics
1. Does this verbal production include the correct target word?
Yes No

Phonology
2. Is the target word pronounced free of any articulation or
phonetic errors?
Yes (free of error) No (with error)

Pragmatics
3. Is the target word produced at the right time, defined as
ranging from immediate to within 10 seconds? Yes (produced
in time) No (not produced in time)

Prosody
4. Is the target word produced with proper pitch accent, given the
context of the cue phrase? Yes No
5. Is the target word produced with proper length of vowel sounds
given the context of the cue phrase? Yes No
6. Is the target word produced with proper intensity (volume)
given the context of the cue phrase? Yes No

Total score: points