Improving the Performance of a Young Child with Autism during Self-Care Tasks Using Embedded Song Interventions: A Case Study

ABSTRACT: The collaboration of music therapists, occupational therapists, and classroom teachers can provide innovative, effective, and evidence-based interventions that support independence in basic self-care tasks for young children with autism. This case study investigated the effectiveness of adding songs embedded in ongoing classroom routines as structural prompts to increase the independence of a 3-year-old boy with autism during multi-step self-care tasks (i.e., hand-washing, toileting, and cleaning up). The effectiveness of the musical versus verbal presentations of the task sequence were compared using an alternating treatment design replicated across three tasks. The teacher effectively embedded both forms of the presented sequencing in the ongoing classroom routines and results indicated that the implementation of both forms of the intervention were successful in increasing the child's independent performance for each task though task-specific differences were noted. When considered from a purely technical perspective, the performance of basic self-care tasks seems concrete and selfexplanatory (Frank & Stein, 2000). These tasks are embedded in everyday routines, follow a relatively predictable sequence to completion, and typically require few materials or tools. However, examined contextually and from the perspective of the performer, these same tasks take on individual meaning and importance and are orchestrated to meet the unique needs of the individual in terms of habits, preferences, and social roles. The performance of self-care tasks facilitates both the independence of the individual (Christiansen, 2000; Kellegrew, 1998) and the inclusion of that individual in a social context or group. In a Western culture in which independence is highly valued, the ability to perform self-care tasks, indeed, reflects an important aspect of the "self" as separate and sufficient. At the same time, our society has cultural norms about cleanliness and appearance, and while those norms may vary within smaller segments of that society, adherence to those norms is among the expectations people have for others in order to attain or maintain group membership or acceptance (Christiansen & Baum, 2005). In addition, health standards for child care, preschool, and school are provided by state and national licensing bodies. For instance, teaching proper handwashing techniques is part of the National Health Education Standards and consequently part of the preschool health and hygiene curriculum (Fanjul & Ball, 1995; Joint Commission on Health Education Standards, 1995). Therefore, the ability of a child to learn and refine performance of simple self-care tasks holds meaning not only for the child but also for the adults who provide care for that child, including parents, other family members, and teachers. Children express unique aspects of their identity in the way in which they enact preferences within the performance of self-care tasks (e.g., "I only want the blue toothpaste! "), and in the outcomes (e.g., the striped t-shirt with the flowered shorts). As the child develops skills and independence in the performance of self-care tasks, the patterns of activity and social participation change not only for that child but for the adults as well (Kellegrew, 1998, 2000). Adults change their roles, their use of time, the type and amount of assistance they offer, and their own perception of meaning in the activity. For the adults, the independence of the child not only reflects valued learning but also frees the adult to engage in other activities during the time that previously had been spent in assisting the child. For many children and adults, the changes in a child's self-care performance typically follow a natural process from being an occupation primarily of the adult as caregiver to a co-occupation as the child begins to perform tasks with less help to an event which is largely the occupation of the child. Each step toward independent self- care represents a milestone, which is expected and valued (Rogoff, 1993). …