4. 4
Can’t Kids Play Together?
Music Therapy for Autism and ADHD
Alice Hui-ju Lee, Taiwan
Kaohsiung Chang Gung HospitalObjective:
This abstract intends to present the effectiveness of music therapy for a duet of a child with autism and a child
with ADHD in discussion of selective attention and joint attention.
Case Reports:
Six years old male client Payton and six years old male client Mike were referred to music therapy requested by
both moms separately approximately one year ago. Mike started his music therapy alone for his ADHD/autism half
year before their duet music therapy session. Payton was diagnosed of autism at the age of three and he started
music therapy at the age of five for his self-play.
According to the different diagnoses of these two clients, the individual goals for each one of them were different.
For Payton, the three main goals in music therapy were: a) maintaining eye contact while talking b) being able to
understand/follow verbal direction c) being able to communicate. For Mike, the three main goals in music therapy
were: a) emotional control b) maintaining eye contact while talking c) being able to stay with music.
The pair were able to come to music therapy at the same time for four consecutive sessions. In the duet, the
main music therapy goal was for them to work together. The social interaction between Payton and Mike increased
over time measured by the parts of the songs and the time the pair played together.
Discussion:
Attention is the key to the path of learning. Researches have pointed out that attention is a critical skill to
develop social and language skills in children with autism and children with ADHD(Charman, 2003;Cohen, 2003).
While these children with various impairments have difficulty in the realm of the society world, music therapy
provides them with a common playground. This paper is going to discuss selective attention (concentration on a
stimulus or event with attendant disregard for other stimuli or events), and joint attention (using cues to identify
and share the attentional focus of another), and how ADHD child could help the autistic child.
Reference:
Charman, Tony (2003) Why is Joint Attention a Pivotal Skill in Autism? The Royal Society. Behavioural and Brain Sciences Unit, Institute of
Child Health
Geurts, l., Luman, M. & Catharina S.(2008) What’s in a game: the effect of social motivation on interference control in boys with ADHD and
autism spectrum disorder. Journal of Child Psychology & Psychiatry. 49(8):848-857
6. 0
5
1 0
1 5
2 0
2 5
3 0
s u b j e c t 1 s u b j e c t 2 s u b j e c t 3 s u b j e c t 4 s u b j e c t 5 s u b j e c t 6
M M S E 1
M M S E 2
M M S E 3
C D R 1
C D R 2
C D R 3
憂 鬱 1
憂 鬱 2
憂 鬱 3
焦 慮 1
焦 慮 2
焦 慮 3
A D A S - C o g 1
A D A S - C o g 2
A D A S - C o g 3
b e h a v e - A D 1
b e h a v e - A D 2
Objective
Currently, there are about fourteen hundred thousand Alzheimer's patients in Taiwan and each year the prevalence is increased
at about 0.1%. Past researches have shown that music elements stimulate various brain areas and arouse memory. The
purpose of the research was to study music therapy both quantitatively and qualitatively in maintaining health and promoting
quality of life for the people with dementia.
Materials and Methods
The pilot study co-lead by two accredited music therapists and one psychologist included two sections each last ten weeks
separated by a two-week break. Four male and four female elderly (average MMSE=17.13, SD=4.291; average age=77.8,
SD=2.9;CDR=1) referred from the clinic. The first period the elderly participants participated in the music therapy group once a
week. The second period the seven elderly participants participated in the music therapy group twice a week. MMSE, CDR,
ADAS-Cog and behave-AD and interviews were collected before the study, during the two-week break, and after the study. The
sessions included song reminiscence, song writing, and musical games, etc.
Music Therapy in Dementia Care
音樂治療
Alice Hui-ju Lee
Kaohsiung Chang Gung Memorial Hospital Taiwan Alzheimer's Disease Association
Result
The number of the participants was limited to the
study space and the design of the study.
Quantitatively, the MMSE collected after the first
period was average at 17.17 (SD=4.07) and
collected after the second period was 17.20
(SD=5.63). Qualitative, family feedback and
participants' presentation were both positive and
recorded.
Conclusion
The scores did not reveal prevalent difference partly limited to the time space of the research; however, the qualitative results
were all positive. Seven out of the eight participants has never received official music training but all were musically inclined.
Reminiscence and all participants' presentations were videotaped for future reference. The prevalence of Alzheimer's Disease and
related dementia has increased globally. The mission of all aligned professional is to aim at maintaining the patient's condition,
promoting communication among all related personnel, and improving the patient's quality of life.
7. 7
Music Therapy in Palliative Care:
A Case Study of the Palliative Ward at a Teaching Hospital in Southern Taiwan
Alice Hui-Ju Lee1
and Yung Han Chang2
1
Kaohsiung Chang Gung Memorial Hospital
2
University of Kang NingIntroduction
The Hospice Palliative Care Act was passed by the Ministry of Health and Welfare in Taiwan in 2000. There are currently 74 hospitals
providing palliative care. At a palliative care ward of the biggest teaching hospital insouthern Taiwan, music therapy was launched in 2013.
Music Therapy& Palliative Care
As a complementary and alternative therapy in palliative care, music therapy is expected to work cohesively with the medical team to
achieve the palliative goal. Given a scarcity of research in this subject in Taiwan. The application of music therapy in palliative care may help
patients cope with:
Aim
Given a scarcity of research in this subject in Taiwan, this study aims to understand the functions and contributions of music therapy in the
palliative care ward in southern Taiwan.
Methods
The data was collected in the palliative care ward. From January 1st
to April 30th
in 2014, the total number of patients referred to the music
therapist was 18. At the end of each therapy session, designed questionnaires were administered to the patients or family helpers to understand
patients’ responses to music therapy.
Results
The average score of the Likert scale questions was 8.5 in a 10-point scale. Regarding the functions of music therapy in easing pain, relieving
depression, and helping patients relax, respondents overall affirm the contributions of music therapy with an average score of 8.5. Among all,
helping patients relax received the highest score (9.1) while reducing physical discomfort scored the lowest (7.4).
8. 8
Music Therapy in Palliative Care:
A Survey Study of the Palliative Ward at a Teaching Hospital in Southern Taiwan
[1]
Alice Hui-Ju Lee [2]
Ting-Yu Lai
Kaohsiung Chang Gung Memorial Hospital
1) difficulty orwithdrawal 2) depression
3) pain problem 4) persistent unexplained nausea or
vomiting
5) anxiety and fear 6) insomnia
7) extreme physical tension 8) disorientation and confusion
9)difficult medical and nursing
interventions
10) cultural and language barriers
Music Therapy& Palliative Care
As a complementary and alternative therapy in palliative care, music therapy is expected to work cohesively with the medical team to
achieve the palliative goal. Given a scarcity of research in this subject in Taiwan. The application of music therapy in palliative care may
help
patients cope with:
Methods
The data was collected in the palliative care ward. From January 1st
to December 31st
in 2015, the total number of patients referred to
the music therapist was 30. At the end of each therapy session, designed questionnaires were administered to the patients or family
helpers to understand patients’ responses to music therapy.
Results
The average score of the Likert scale questions was 8.8 in a 10-point scale. Regarding the functions of music therapy in easing pain,
relieving depression, and helping patients relax, respondents overall affirm the contributions of music therapy with an average score of
8.8.
Among all, patient’s view on need for MT, easing depression, and patient’s perspective on music therapy suitable for wider application
received the highest average score (8.9) while reducing physical discomfort and easing pain scored the lowest (8.7).
22. 期刊 年份 方法 結論
International
Journal of Geriatric
Psychiatry
2016 Meta-
analysis
statistical significance in
reducing depressive
symptoms among older
adults (95%CI=0.87,1.17)
Plos One 2013 Systematic
Review
4 or more music therapy
sessions proved effect
Brain Topogram 2013 RCT EEG alpha changed
continuously, but theta
changed most significantly
after 3 months. Music
therapy is helpful for
reducing anxiety and
depression.
Cochrane Review 2011 Review Improve global state, mental
state (including negative
symptoms) and social
functioning 95% CI
心理領域
34. 訪談對象訪談對象
34
受訪人員代碼 已設立 / 未設立 服務機關 受訪人員
A 已設立 高雄凱旋醫院 音樂治療師
B 已設立 臺北榮民總醫院 音樂治療師
C 已設立 臺北醫學大學附設醫院 音樂治療師
D 未設立 成功大學附設醫院 精神科主任
E 未設立 埔里基督教醫院 復健科主任
F 已設立 阮綜合醫院 音樂治療師
G 已設立 台東基督教醫院 音樂治療師
H 已設立 童綜合醫院 音樂治療師
I 已設立 新竹希望種子職能治療所 音樂治療師
J 未設立 台灣大學附設醫院 復健科主任
K 已設立 桃園療養院 音樂治療師
L 已設立 中國醫藥大學附設醫院 音樂治療師
M 已設立 高雄長庚紀念醫院 音樂治療師
O 未設立 高雄醫學大學附設中和醫院 復健科主任
最早由鋼琴家Margaret Anderson 於1918年在哥倫比亞大學(Columbia University)開設第一門音樂治療課程。西元1944年，密西根州立大學(Michigan State University)亦提供音樂治療的課程，由學校開設專業性音樂治療課程提供給學生修課，但必未建立培養音樂治療人才的系統[1]。真正將音樂治療成為完整的音樂治療養成課程，乃是由Gaston於1946年堪薩斯大學(Kansas University)成立第一個音樂治療訓練場所，使音樂治療更有組織與系統的發展，Gaston並於1968年出版《治療中的音樂》(Music in Therapy)，使音樂治療的地位更為明確[1]。
根據國際專業管理亞太年會(International Professional Management Assembly-Asian Pacific Regions, IPMA-ASIA) ATS國際認證協定，對證照所下的解釋與定義。「執照」是特定被規範的行業或業務所應具備的資格，一般都有被立法來規範，或受業界團體要求需符合的資格或檢定，所核發之證明文件，用來規範或要求行使該業務或行為的資格。
最早發表音樂治療的研究是在1789年在美國發行的哥倫比亞雜誌，標題為“Music Physically Considered”，該文章主要介紹音樂治療使用的基本原則，並提供了音樂治療在歐洲執行佐證資料，其理論主要是利用笛卡兒(Descartes) 認為音樂和人的心靈健康有關的想法。在19世紀，音樂治療相關研究的文章陸續出現在音樂期刊、醫學期刊、精神病期刊和醫療論文。這一時期最早的研究為Atlee及Mathews。Atlee及Mathews利用文學、醫學和學術資源共同討論音樂在疾病的治療效果之影響性。主要訴求之目的乃以用音樂強大的影響力對於人類心靈產生影響。首先Atlee及Mathews先定義一些音樂治療專有名詞，並提出音樂可喚起並影響多種情緒，包括喜悅和悲傷的能力，並在最後部份討論音樂是有利於影響各種精神和身體疾病。並舉例三種個案中，成功地治療患者的音樂。其中一種樂器產生的樂符是以長笛為例子，也因此鼓勵可繼續吹長笛以產生療效。Mathews概述了音樂的好處在治療身心疾病，並引述聖經。例如，為了緩解憂鬱症，他建議使用符合病人的情緒的音樂，可能將曲調音律提高，產生更多活潑性及自然性。1915年，Burdick博士在American Yearbook of Anesthesia and Analgesia的研究報告指出，不論是在手術房或是輔助睡眠上，95%的病人表示音樂確實有治療成效(Burdick, 1915)。1929年，Duke大學針對病患的音樂，不僅僅用於手術房和恢復室，也已經涵蓋在病房中的兒童和成人(Taylor, 1981)。因此，有關於音樂治療的國際期刊創立於1977年，至今最主要的音樂治療期刊領域包含了音樂治療，音樂治療觀點，與北歐音樂治療雜誌。
Cochrane Review (2014) A limited number of studies suggest there may be a benefit of music therapy on the quality of life of people in end-of-life care.
本研究實證結果可符合Wigram, Pedersen, and Bonde (2004)的研究利用音樂經驗來激發或促進病患表達其內心的情感及Hanser (1999)所提出教育取向音樂治療當藉由音樂功能幫助個案產生改變，以達到治療成效，比對本研究實證結果，醫療院所設立音樂治療以提供多元化治療為目的。
