In my private practice, I have encountered only a handful of clients/patients who are non-verbal. Sometimes they are toddlers who haven’t learned to speak yet or older children who are 99% non-verbal and rely on other methods of communication. We will focus on the child with autism who is also non-verbal.
When faced with a client who may never learn to use their voice to communicate through language, this can be a challenge for a therapist. As therapists, we create goals that the client works toward. When working with a non-verbal child, it is necessary to be flexible in our session planning or lack of session planning (aka IMPROV!). Some of the goals I have used in this situation are: “Client will make eye contact” “Client will hum along” “Client will sit still” “Client will allow touch”
As a student, I was immersed in behavioral music therapy. We learned about all of the other music therapy disciplines enough to understand them, but our foundation was behavioral. I planned everything and waited for the client response. It worked sometimes and other times not. Planning is comfortable for many of us. It feels good to know what is coming next! I still consider myself a behavioral therapist, but I have made some attempts to dabble in a little improv. When I say improv, I am not referring to the NYU method specifically. It is very loosely based on that method. For this blog, improv will be defined as an unplanned intervention that follows the client’s lead.
Working with a non-verbal child can be difficult when they give little feedback. A therapist can often wonder if they are “getting through” to them. So let’s return to improv. Because working with a non-verbal child presents some barriers to overcome, many of those can be diffused by being unconventional during our sessions. In the ideas below that use touch, keep in mind that many autistic children have sensory processing disorder (SPD) and stray away from touch. Use your discretion with the following suggestions while keeping in mind your client’s tolerance level. When using touch, be sure to use some pressure. Light touches can feel like bugs crawling on their skin and children with SPD will pull away. Follow the lead of the child and enjoy these alternative ways to communicate with them!
1) Get on their level physically: This may be different for each client due to the wide spectrum of autism and non-verbal children. Some children need more space than others, so it is important to respect that and slowly work on getting closer to them. Getting to their eye level while singing is a great place to start. Making eye contact, even occasional eye contact is one way to communicate. I have found that doing this helps the therapist to connect to the non-verbal child who may rarely offer a response.
2) Movement: If they are comfortable with touch, sit side by side with your client and put your arm around them while singing. Sway back and forth and see if they will do so without your physical prompting.
3) Hands: Since many autistic children have repetitive hand movements, this is a great way to quiet their repetitions for a short time. Hold their hands and slowly dance to the music. If touch is accepted, this will give their brains a rest from the repetitive movements and may allow for a few seconds of eye contact and focus.
4) Avoid the guitar: I have always been quite attached to my guitar, but it can sometimes be a barrier that separates us from our clients. I found that when I put down my guitar and used a cappella singing with a non-verbal client, I was able to focus on the client and they were more responsive while giving me more eye contact. So try it! You may be surprised at the increased response. In addition, the combination of a guitar and voice may be too much aural stimulation for these children and taking away one of those elements can at times eliminate their agitation.
5) Noise level: A non-verbal client SPD may also have sensitivities to sound. Observe them closely for signs of agitation. Some may use their hand to stop yours from playing the guitar and some others may just cover their ears. Be observant and simplify when they ask for it.
6) Instruments?: Even though we are music therapists, guess what? We don’t HAVE to give our clients instruments to play. Sometimes all that is needed for communication is the voice. Be creative in using your voice. Sing really high or really low. Sing like a man or like a mouse. This can elicit a fun response when the client isn’t expecting it.
7) Be respectful: These wonderful clients are non-verbal but can usually understand what we are communicating to them. Ask them questions. Talk to them. Ask them how school was that day. Even though they won’t answer, they will appreciate you treating them with respect and value.
These are all suggestions to jump start your own interventions. Working with a non-verbal child is a challenge but it will certainly help you to grow in your work as a music therapist. Enjoy these children. They are precious!