Music Therapy for Autism | Interview with Music Therapist Marlene

Transcript for Podcast Episode: 077
Music Therapy for Autism with Music Therapist Marlene
Hosted by: Dr. Mary Barbera

Mary: You're listening to The Turn Autism Around podcast episode number 77. Today, I am welcoming Dr. Marlene Sotelo, who is both a music therapist as well as a board-certified behavior analyst at the doctoral level. I found her just last week. I found her. And the fact that she had both credentials to be super fascinating. So I wanted to have her on the show to talk more about the power of music therapy and the research behind it. Dr. Sotelo is the chief operating officer for the Els for Autism Foundation. In addition to her background as a music therapist and as a BCBAD, she's also a regular education teacher and a special education teacher. And she has worked with individuals with autism for over 25 years and now is doing amazing work and amazing research down in Florida. So please help me welcome Dr Marlene Sotelo.

Mary: So thanks so much for joining us today. Marlene.

Dr. Sotelo: Hi. It's great to be here.

Mary: Yeah, you have such a great background being a music therapist and a behavior analyst that I just had to interview you. So, first of all, why don't you tell our listeners how you got started and describe your fall into the autism world?

Dr. Sotelo: And that's exactly what it was. It was a bit of a fall. I would say autism found me and I never left after that. So I was doing my internship in music for music therapy at a hospital. And in my work, I became friends with one of the nurses there. And eventually she left and contacted me and asked me to come and play my guitar for her child. He had just been diagnosed with autism and I told her I don't know anything about autism. And she said, it doesn't matter. Just bring your guitar. And just sing to him the way you do to the kids in the hospital. And I said, OK. And so that's where my journey started. And after that, she referred me to other families. And before I knew it, I had a full caseload and went on to continue seeing clients that have autism using music therapy.

Mary: And what year was your internship?

Dr. Sotelo: That was in ninety eighty-nine.

Mary: Nineteen eighty nine.

Dr. Sotelo: Nineteen eighty nine. Long time ago.

Mary: Wow. Oh yeah. That is a long time ago. Well, I'm, I'm viewing you on video and you don't look old enough to be doing your internship in nineteen eighty nine. So you got started way long time ago. OK. So OK. So you a music therapist who started working with kids with autism back in eighty nine.

Mary: And then at what point did you move on to becoming a behavior analyst or how was that journey?

Dr. Sotelo: Sure. Well I really love to learn and I always feel wherever the pinball goes, that's where I head. And after my journey as a music therapist, I ended up getting the opportunity to get my masters degree paid for by the hospital I was working for. And so I went on to get a degree diagnostic teaching. So I actually worked in the school system, public school system, as a special education teacher, of very exceptionalities.

Dr. Sotelo: So that was my first opportunity to be part of the education world. And then I went on to work for the University of Miami Center for Autism and Related Disabilities and got a further opportunity to get another degree. And so I'm all about free. And so I said, gosh, I'm going to get my doctorate paid for. Let's go. And so I went on to get my doctorate in education. And I studied. I took courses necessary to become a behavior analyst at the same time. And so I was able to accomplish both of those and become a behavior analyst in 2010.

Mary: Wow. So, yeah, I'm the same way I got my master�s degree from University of Pennsylvania because I was working at the University of Pennsylvania Hospital. And that was prepaid tuition at Penn. And I got my master's degree. And then I did my PhD and leadership and finished in 2011. So not that far off from your journey. So what did the behavioral approach and becoming a behavior analyst do for your role as a music therapist or your interest in music therapy for kids?

Dr. Sotelo: So to me, it really was a journey of using what I already was using to motivate students to learn to participate and to be engaged. But in a more formal way to really put labels to what I was already doing because of my background as a music therapist and a special education teacher, I have knowledge of the strategies that we use as behavior analyst. But I didn't call them what we as behavior analysts call them. And so it was really great to be able to learn further about the terminology that's used by behavior analysts and also the data collection. So that I could really measure the results of the work that I was doing. Because as a music therapist, we weren't directed to collect data. We had our goals and objectives. But it wasn't as systematic as it was in the science that we know we're all supposed to be collecting data. So this helped to structure my sessions and it helped to be able to guide me in creating very specific goals for my clients.

Mary: Yeah, I have, way back when Lucas was three years old, one of the first moms I met after his diagnosis. One piece of advice she gave me, and this is back in the late nineties, nineteen ninety nine, she told me that her son, who was, I don't know, eight at this time, really benefited from music therapy and was learning to play the violin. And she recommended that I get a music therapist and start music therapy. And I went and bought Lucas a drum at this local drum store. And there I met his music therapist, somebody who came to be his music therapist for over two decades now. Her name is Cindy and she's a certified music therapist and she is a special ed teacher. And because she works with Lucas, both in our home, when he was little, she worked.

Mary: Then I had her introduced her to the private school that Lucas was going to for a short time. So she got a contract there and she got a contract with the local Autism Society to provide group music classes. And he still participates in in the music therapy even as a young adult. And I've seen his progression over the years. And also with my clients, they have different age groups. So if I'd have a client, I don't see one to one clients anymore. But when I did have local clients, I would encourage them to go to sign up for the free music therapy groups through the Autism Society locally because it was a chance for their children to practice group responding and invitation.

Mary: And I knew how good Cindy was. It was also a chance for them to meet as moms, and they became friends because they all met each other at music groups. So there was several, several benefits from it. But I am so pro music therapy and using music and I don't see that same enthusiasm with many behavior analysts. So when I found out about you and your background recently, two being combined music therapists as well as a BCBAD, I was very interested in talking to you because I want to know, you know, many BCBAs don't think that music therapy has enough evidence, is empirically supported enough to be using it. And so I just want to put that out there and have you educate me and my audience in terms of what is the research on music therapy.

Dr. Sotelo: Sure. Well, the National Clearinghouse had put out their recommendations for evidence-based practices years back, and they're about to by the end of this month, they're going to be publishing their new results. And from what I understand, it might be that music therapy is now listed as an evidence-based intervention. In the previous report, it was listed as an emerging evidence-based intervention. The reason being is that there wasn't sufficient research from various researchers. So one of the one of the criteria that this organization looked for was that it wasn't the same group of people doing the research to demonstrate the efficacy of that intervention. So they needed more variation. And so I'm hoping that the results that I've heard are going to come true and demonstrate that it really is an evidence based practice.

Dr. Sotelo: But even putting that aside, let's just think about from a commonsense standpoint and really from what the research says about brain's neuroplasticity and the impact of music. We know that people who have had traumatic brain injury, people who have Alzheimer's, those who have been affected by a brain trauma, are very receptive and responsive to music. So why is that? Because music provides structure to the brain. It provides the rhythmic patterns that are necessary to support motor movements by having rhythm. Rhythm is processed in the brain, on the left side. And the melody of music is processed in the right side. So if you have a traumatic brain injury that's affected your motor skills and your language skills. The music is giving you a tool to support the rehabilitation of those neural pathways. And it's actually affecting multi-modal areas of the brain. So you get double bang for your buck.

Dr. Sotelo: So instead of just doing, let's say, the physical therapy exercises that you would have to engage in for rehabilitation, you insert music into it. And now the brain has something to hold on to, to be able to have better progress. So let's bring that to autism. We know that our kids demonstrate motor difficulties. Many of them have motor coordination, motor planning issues. So when we use music to help facilitate that, we're enhancing the neural connections in that child's brain to be able to process the motor movements that they are required to engage in. So by using drumming, by having rhythmic marching, instead of just walking, if we're doing it to a beat, it's going to help them to be able to produce better results. If we move to the language part, which is a core deficit of children with autism.

Dr. Sotelo: When we're using melodies, we are enhancing the language processing in the right side of the brain. So if we were just looking at brain research, we can see the support for the utilization of music as an enhancement to behavior analytic intervention, because it's going to be a support system to helping that child to be able to learn and progress.

Mary: Yes. And I like the way you're breaking that down for me and my listeners, because everything doesn't have to be a multiple baseline design study published in JABA four to be effective. It does make common sense if you just look at the benefits of music and the right and the left hand side of the brain in terms of looking at people that have had strokes or people that, like you said, have had traumatic brain injuries and for autism. Is there research on autism and music therapy there?

Dr. Sotelo: There is. There is quite a bit of research, and which is why they're hopefully now going to be able to officially make it an evidence-based intervention for individuals with autism. So there has been research on the use of music for manding or tacks. So all of the verbal operands, there was a comparative study by Lynn in 2011 where they looked at the comparison of the, apologize for stumbling on my words, for gaining more vocabulary through direct speech and language therapy versus the addition of music. And although both made gains, the group that was in the music therapy group actually made greater gains. And I, just like all was telling you now, the facilitation of the melody and the rhythm that comes with music is going to enhance that individual's learning. And not only the learning, but the maintenance, which we know is difficult for children with autism to maintain and generalize many of the skills we teach them. And we know that music is a tool for memory. So it's going to help to allow that child to maintain the skills that we've learned.

Mary: Yeah, that's great. And if you want to send me a couple of the studies that you refer to, we can put that in the show notes and that might help people, both parents and professionals, who want to take a look more at the research. But and in addition, just from using my example, especially with the little clients that I sent to music therapy and groups, there's additional benefits for group responding, for imitation, for even parental support within group music therapy if the parents are staying there. Are there other benefits that I'm not mentioning besides all the ones we did mention?

Dr. Sotelo: Well, as you mentioned, in regards to appropriate social behavior, especially in a group setting your, you know, we have difficulty in teaching greetings. And if you think about a preschool or kindergarten classroom, why do they have circle time? Why do they use music in circle time? They're using it. First of all, it provides a routine. It's the same repetition of the information. So we have the weather song. We have the days of the week song. It's ingrained in these kids' heads because of repetition. And then the music helps to enhance the memory. And so it's going to help with those social behaviors. Also about greeting each other. So usually my music therapy groups, I always have a hollow song and I have a goodbye song. And when I have a new group, we always have to say hello to each of the people that are in our group.

Dr. Sotelo: So it also helps to promote eye contact because you're looking towards the other individuals in the group as you're singing hello to them passing along the drum. So we're sharing materials. We're working on that socialization skill. It also allows for body awareness. So when we're playing instruments fast or slow or loud or soft. So that's sensory experiences also enhance with the individuals when you're using music. And most importantly, it enhances learning. So when I when I'm working with my individual clients, which I don't get the opportunity to work as a music therapist as much as I used to know in my new role.

Dr. Sotelo: But when I do see my clients, I use songs that I need to either written myself or the ones that are fantastic ones that are out there to teach concepts, whether it's about multiplication or if it's a, you know, vocabulary, the planets, the states. If you think about do you remember that Saturday morning? It's called Schoolhouse Rock. Right. Remember? Now, still to this day, remember the song Conjunction Junction, What's your function? I mean, that was so many years ago. They knew what they were talking about when they put music to such difficult, difficult concepts, even like a bill. When they're talking about the government and how bills are passed through. Is music to teach kids these difficult concepts? So music really helps to enhance learning of complex concepts.

Mary: Yeah. I think all of those skills are super important. Even just sitting, sitting on a mat, sitting on a chair, keeping your hands to yourself. And then following along. I mean, those are just some of the basic requirements to learning that I've seen. You know, sometimes when my little clients would come the first day for music group, it wouldn't go so well because they weren't used to the routine. And, you know, I would meet them there to ensure that we were delivering enough reinforcement. But then those behaviors of sitting and attending, sitting on a mat or a chair, would then go to preschool where they would be introduced more to sitting or sitting at the table for learning at home. So I just think there's so many benefits that that's why a couple of years ago, you know, I posted some little study on music therapy and some behavior analysts like commented like, how dare you?

Mary: You know, this isn't evidence base. I'm like, well, hold on a second, buddy, because evidence based is partially your clinical experience for sure. Just because it doesn't have double blind placebo effect studies, which very few things actually do, doesn't mean it's not beneficial. Plus, as a parent, there are at least 100 hours a week where you need to keep your kid busy and stimulated. And even if it didn't have all the benefits you listed, which are just so huge, it would if the child is happy and sitting and enjoying and clapping and imitating and sharing instruments. Then it's a win, right?

Mary: And it would make it that, you know, even just to fire new neurons. You know, I'm actually during the COVID shutdown, I decided that I was I'm going to learn to play the piano. So I started taking piano lessons from Lucas's music therapist online and bought an online course, which is going really well. And so at any age, music can be very beneficial. Even if you're super busy just developing a new skill on something like piano or guitar or singing can really help you hopefully stop some of the aging process and keep your memory sharp. I mean, I know there's research on that.

Dr. Sotelo: Yes. Oh, absolutely. Like I mentioned, we're able to use music to help to stimulate different pathways in the brain. And so with the brain being so, so neuroplastic that it can create these new pathways, if we use that music as a vehicle to be able to make those connections, we're going to get better results. And another point I want to make sure to bring up is that as behavior analyst, we know that we are always seeking out reinforcements. We need to set the stage to motivate that individual to want to engage with us because we don't want to sit at a table with a child that's crying and wants to leave or we're working with a young adult and they're bigger than us and they don't want us to tell them what to do. Well, what I have found is that music is the easiest way to pair myself and formulate that relationship with my client and to motivate them to engage in learning.

Dr. Sotelo: A lot of times in the music therapy session, the client doesn't even realize that they're learning that they're actually engaging in the therapeutic skills that I need them to do because they're just having fun. They're singing, they're playing instruments. They're dancing. And so that's the funnest part about using music in there, is that it makes your job easier as a behavior analyst because who doesn't like music? Some people now have asked me, well, what about those kids who cover their ears because of sensory issues? That gives us a great opportunity to desensitize them and to slowly help them to be accepting of music, to make choices of what types of songs. So they're there practicing their independent skills and making those choices. They're given the independence to make it really loud or make it really soft so that they have volume control. So we're giving them that opportunity as well. It also helps them to be able to get out their frustrations. You give these guys some drums and some amounts. And you say, let's go and just bang it out. It's a great sensory experience for them and it's using that energy in a positive way.

Dr. Sotelo: So that also in regard to the drums, I had this one child that was always engaging in these stereotypies, these hand movement stereotypies. So I was able to reduce those during the sessions to be able to get him to learn more rapidly by using the drum mallets. So he loved to make sounds on the drums. So I was able to engage his hands in an appropriate activity so that he wouldn't be engaging the self-stimulatory behaviors. So, again, non-compatible behavior was taking place in order for him to be able to play the drums safely with the xylophones or any other music instrument that you can imagine.

Mary: Yeah, the friend who initially recommended music therapy to me, I said her son was about eight or 10 when I met her and Lucas was first diagnosed and her son went on and he had his pretty moderate to severe autism. He needs supervision and everything. He went on to play first chair, violin in high school and went on to like County Chorus and statewide chorus. And I know kids with, you know, autism who are in musical theater production. So sometimes it also provides an outlet for a real talent, for a skill, even for a job long term. And so that is also some of the benefits. So how does music therapy differ from music class or private music lessons?

Dr. Sotelo: Sure. So if you're taking it, you're doing a music class that's for education, like let's say you're a music teacher at school, at a school, or you're a private guitar instructor. Your primary goal is to teach the instrument, is to teach music theory or reading music. That's what you're focused on as a music therapist, that's secondary. So if I'm teaching an individual how to play piano as a music therapist, my goal is not for him to necessarily learn how to play piano. It's to follow instruction. It's to pay attention. It's to isolate their fingers for motor planning. Fine motor skills. It's to be able to manage their sensory system, to know the pressure that they have to press on each key. But in a functional way. So the instrument learning how to play that instrument is secondary to the therapeutic goals that I'm trying to achieve as a music therapist and also music certified music therapists don't just work with kids with autism or developmental disabilities, too.

Mary: They can work in hospitals, they can work on pediatric units, they can work with pain and those sorts of things. Anything else I'm missing with you.

Dr. Sotelo: So end of life. A lot of music therapies work in hospice. They also work with the elderly, with dementia patients. My mom has Alzheimer's and we've been able to have a music therapist work with her and to see her light up when the woman has gone in with her guitar and sings to her. It really is incredible to see her light up like that. So that also in the end, I see you there are music therapists that work with infants as well. And when I when I did my internship, I actually worked in the surgical unit for part of my rotation. And I did music relaxation before, during and after surgery. So I work with patients that were going to have the metal rods put in their back for scoliosis. And so I would prepare them in advance with music specific selected for them. And I work with them through guided imagery.

Dr. Sotelo: And I'd actually go into the operating room with them until the moment that they were completely under anesthesia and they were listening to music. That music continued on as soon as they recovered out of ICU and I was with them there. So it was used for pain management and to be able to relax them in this anxious state of knowing that they were going to have major surgery on their back.

Mary: So we've talked all about the benefits and all the success with music therapy. So what are specifically to kids and adults with autism?

Mary: What are the obstacles or struggles that parents and professionals might face if their child receives music therapy?

Dr. Sotelo: Well, the key obstacle for the families at this time is that most insurance carriers do not cover music therapy. So it's all private pay. There is one carrier that has now started to offer to some degree, but it's just in the early stages. So that is one of the biggest barriers because financially where are you going to put your money? Right. Are you going to put your money in this therapy, speech therapy, behavior therapy with all the co-pays. Right. Because that could be become very financially draining or are you going to pay out of pocket for it? The other obstacle is that just like in the field of education, you have teachers that teach in one way, very structured, very organized. And then there's other teachers that fly by the seat of their pants. You know, they're coming up with a lesson on the go.

Dr. Sotelo: I found that there's a lot of music therapists as well. And there are, in order for it to be successful, you have to understand autism and you have to know what are the strategies that help people with autism to be engaged. So you need to structure your session. You need to use visual supports. You need to have clear beginning and end repetition so that they know what's expected. You need to have communication tools so that if the individual can't verbalize, they still have their commenting on board, or they have a device that they could use. A Big Mac. I don't know if you're familiar with that or the audience is a big red button. Like the Staples button. And I can program individual messages so that my kids in the group that can't say hello. They can use the device to be able to do that. So if you have a music therapist that doesn't know autism. They may run into difficulties in managing behaviors that might appear during their sessions.

Mary: Yeah, yeah. I think that's probably the biggest thing, especially when you're talking about groups, because not only do you have to if you're doing individual music therapy at the you know, be aware of that person, but then you add groups and some of these nonprofits, like the local Autism Society, would fund music therapy and allow anybody to sign up. And then you might get a child in the group that you don't know. And now they've got, you know, a lot of challenging problem behaviors. I see that as being an obstacle. Certainly the pay, hopefully, if it if it does get on the list of more evidence based practices, maybe insurance companies would then start to fund more of it. Hopefully. And I know in private autism schools, they tend to have music therapy in groups once a week or something like that. So people might be exposed that way. But I think we definitely covered some of the main benefits. And hopefully as the years progressed, we will get more and more funding for music therapy. Are you involved with any research on music therapy now?

Dr. Sotelo: I'm not at this time, as the chief operating officer of the Els for Autism Foundation, I am quite busy in running our our big campus here in Jupiter, Florida.

Mary: Yeah. Tell us a little bit about your role there and what you do there.

Dr. Sotelo: Sure. I oversee all the operations of the campus. We serve individuals with autism spectrum disorder as well as other developmental disabilities. We have two public charter schools on our campus and we serve over 300 individuals with autism a day on it. On any given day between the two schools and the services that the foundation provides. And one of the first programs that I launched when we opened in 2015 was Music Therapy Group. So we had our signature golf program that we had developed. And then the other program that we started was music therapy because that's my baby andI knew how to do it.

Dr. Sotelo: And I knew that we could get it started right away. And so we offer music therapy, dance therapy, all different types of recreational programs. And we see children as young as 18 months and adults as old as 65 at our center. So I'm busy with that. We are engaged in research studies at the center. So we have a partnership with the Seiver, the Seiver Center, Seiver Autism Center at Mount Sinai in New York. And we're doing some genetic study with them. We're also doing an early intervention study program that we develop called Spring into Action Together. It's a parent and child dyad. And within that program, they're using music for the parent and child to engage in to really work on joint attention and eye contact vocalizations. And we've also done some studies on the use of exercise and golf and other sports to engage individuals with autism.

Mary: Wow. It sounds like an awesome center and an awesome foundation. So we will put the link to that in the show notes as well. Do you have an easy Web site for people to find you?

Dr. Sotelo: Yes, it's Els for autism dot org. And ls it spelled ELS for Mr. Ernie Els, World Hall of Famer golf legend.

Mary: And so he is responsible for funding the initial start of the organization because he has a child with autism, is that right?

Dr. Sotelo: Yes. Yes, he has son with autism. And so he and his wife Liesel started the foundation and they went on this journey to build a campus that would serve people with autism and also reach out to the rest of the world on best practices. So we also have a foundation in Canada, in England and in South Africa. Wow. Yes, very busy.

Mary: Yeah, that sounds. It sounds. And I've heard of him, obviously. And we will definitely link that in the show. Notes ls ELS for Autism Foundation dot org.

Dr. Sotelo: ELS for autism dot org.

Mary: OK. Els for autism dot org. OK, great. So before we leave for today, it's been really enlightening and great information about music. I love that part of my podcast. Goals are for parents and professionals to be less stressed and lead happier lives. So I'm wondering if you have any two or three tips on what helps you with stress reduction or management or self-care tips.

Dr. Sotelo: Absolutely. I exercise in some way, shape or form every day. And of course, with that I have my music in my ears as I'm exercising to keep me motivated. So I highly suggest everybody keep on moving to reduce the stress. I also highly encourage listening to calming music and meditating. There's a lot of great apps out there. There's a lot of things that are free right now that are available to families. And lastly is remember what's most important? That's what I always think about each morning. Is it worth it or can I put it aside? Because what we need now is to be with our families and be grateful for what we have. And so just having gratitude and remembering what we're grateful for is my way of also staying healthy in my heart and in my mind and in my soul.

Mary: Well, I think that's an excellent way to leave us today. Thanks so much for your time and explaining the benefits of music therapy. And thanks for all you do for the autism community. It's been a real pleasure to interview you.

Dr. Sotelo: Thank you so much, Mary. Thanks for having me.