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Music Therapy, Sensory Integration and the Autistic Child

br2002_021FSBerger, Dorita S. (2001). Music Therapy, Sensory Integration and the Autistic Child. London: Jessica Kingsley Publishers.

Reviewed by Dagrun Agnes Vikesland

The subject of Dorita S. Berger’s book, as stated by her in the preface, is music. Her goal with the book is to describe how music can “order the senses to integrate and induce cenesthesia – a sense of sensory balance and physical well-being” (p.13). She describes the difficulty people with autism experience as understanding and integrating sensory experiences and if and how music therapy can be a way of working through these difficulties.

All of the eleven chapters in the book are relatively short. For those of us who still prefer our mother tongue to English, this makes the book’s contents more available and the book easier to read. After each chapter there is a list of references and a list of recommended reading, and at the end of the book there is a full bibliography. Donna Williams, who seems to be a central inspiration to Berger, has written the foreword. The book also includes an index and two appendices. One contains examples of assessment and progress reports written by Berger. The other is an article published earlier in IEEE Engineering in Medicine and Biology Magazine. Berger writes the article in cooperation with Daniel J. Schneck, who is one of Berger’s most important sources throughout the book.

As far as I understand, Berger regards problems with “sensory information processing, coding and interpretation by the brain” (p.28), to be the central issue behind autistic functioning. Both the “autistic aloneness” and the “desire for sameness” is described to be caused by the constant bombardment upon the senses by the environment and the lacking capability by the autistic brain to sort, process and interpret this information: “the first important goal to achieve for that autistic system is a sense of calm, a stress-free type of information processing” (p.47).

It is not quite clear how Berger places herself in relation to other authors and authorities in the field of autism, but it is obvious that she considers autism to be a physiological problem. This is also visible in her definition of music therapy as “an approach to solving a physiological or psychological problem through understanding possible causes creating the problem and considering how music, through its elements, can be applied as a targeted intervention to alter the issue.” (p.15).

As a music therapist working with children with autism and Asperger’s syndrome I was really looking forward to reading this book. Though the literature about children with autism is vast, there are not many books about music therapy with this population. In addition, the theme of sensory integration seemed interesting and relevant. I know from my own work that many children with autism have an issue with perception and this is also one of the commonalities in several biographies written by people with autism and Asperger’s syndrome. The case study material, or rather case examples, from Berger’s own work is interesting and provide new dimensions to music therapy with children with autism. Berger describes the difficulties individuals with autism may experience or endure and how and why they experience the world in different ways than many others. At the same time she stresses that each and every human being is individual and special, and that a word like “appropriate” regarding behaviour is defined differently by different people under different conditions. She also discusses concepts like “aloneness” and “desire for sameness”, concepts that might describe autistic ways of functioning, but that at the same time describe common, human ways of functioning in some situations. What might seem like aloneness, desire for sameness or inappropriate behaviour from the teacher’s point of view, might well be the only sensible reaction from the child with autism’s point of view. I recognise and sympathise with Berger’s opinion in this case. Working with and being with children with autism, really places a great demand upon our ability to imagine and understand a totally different way of being and at the same time recognising our commonalities as human beings.

Still, I am a bit disappointed, both on my own behalf and on behalf of music therapy as a scientific profession. There seems to be a lot of claims in the text that very often is not substantiated by references to research done by Berger herself or by others. References to case material also seem to be anecdotal rather than research material. Berger writes “Scientists assume that some auditory information comes back from the brain to the ear” (p.85). Who are these scientists? This might be widespread knowledge, but even so I think it ought to be substantiated by references. In chapter two, named “Aspects of Autism”, Berger gives a short description of autism and its characteristics. She lists ten, as she calls them, “general characteristics of autism” like for instance “inability to formulate normal affective relationships” and “disturbed or inappropriate affect; visual avoidance” (p.27). She doesn’t explain why she selected these for her list and not describing autism by using diagnostic manuals, Wings triad or any other description earlier or commonly used in the literature.

Afterwards my conclusion must be that the book was an inspiring “read” which I have found to be useful in my daily work. The theme is interesting and I do believe that there is something to be learned from Berger’s work. However, the lack of references in the text and thereby the questionable scientific value limits the potential of the book.

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