ADDRESS

Dear ______,

Introduction and the purpose of you writing this letter

Reported on the Straits Times 2016, there were an increase number of children diagnosed with
developmental issues. There were 2500 children in 2010, and an increased of 76 percent to
4,400 such children in 2014 (Goy, 2016). These include children with autism, speech and
language delays, behavioral problems and development delays. Hence, I, Jennifer Darmadi, a
music therapist at the National Hospital in Indonesia writing this letter to introduce you about
the music therapy and the benefits of the music therapy for children with developmental
disabilities, focusing on children with Autism Spectrum Disorder (ASD). Also, I would like to
introduce you the Social Communication Emotional Regulation Transactional Supports (SCERTS)
model which was used to assess and identify treatment goals and objectives for children with
Autism Spectrum Disorder (Walworth, 2007, p.2)

Music is a universal means of communication. It has been called a non-verbal language. What
has yet to be more clearly recognized is the range of expression that is possible in this
“language”. The variety of human expression that can be communicated through music is highly
diversified and virtually unlimited. Because of this, music becomes vitally important as therapy
for exceptional children (Nordoff & Robbins, 2004, p.49). Music is use as a tool to promote
relaxation, improve self-expression, enjoyable, and facilitate physical, cognitive development
and social skills. Music can also be a tool for communication and interaction with babies and
toddlers. Also, music can have great effect on children’s growth and development. Music has
the power to change one’s attitudes, calm emotion, relax the body, promote cognitive
development and offer a sense of security during uncertainty. Music drive electrical networks
within the brain and can help the organization and reorganization of brain network, cortical
network particularly that maybe a fundamental aspect of recovery of function (Joseph Commented [1]: In particular, cortical network which is a
fundamental aspect of recovery of function.
Arezzo, 1996). I as a music therapist hope that music will play an important role in helping the
cells in the brain to interpret with sound and to help them learn again.

Words seem so indefinable, so inexact, so easy to misunderstand compared with real music,
which fills the soul with a thousand better feelings. What is expressed to me by music that I
love is not too vague to be put into words, but on the contrary, too precise.
Felix Mendelssohn (letter to Marc-Andre Souchay, 2842) Commented [2]: Harus ada kalimat pengantar sebelum ini.
Contohnya : Prior to explaining further on the subject; below is
an excerpt from Felix Mendelssohn regarding the comparison
of words and music.
What are music therapy and the benefits?
Music therapy is a systematic process of intervention wherein the therapists helps the client to
promote health, using musical experiences and the relationships that develop through them as
dynamic forces of change (Bruscia, 1998, p. 20). According to the American Music Therapy
Association (AMTA), music therapy is the use of music in the accomplishment of therapeutic
aims which are the restoration, maintenance, and improvement of mental and physical health
(peters, 2000, p. 2, citing AMTA, 1998, p.43). Music therapy is a planned and goal directed
process of intervention based on the evaluation of client’s condition and their needs. This
process takes time which involves growth, change, and development. Music therapy is
conducted by a professional therapists who believe may influence clients to a positive change in Commented [3]: Buang.

an individual's condition, thoughts, skills, attitudes and feelings.

Music therapy in early childhood promotes the development of verbal and non-verbal
communication skills through the musical activities. Throughout the process, children will be
able to express themselves, improve their physical and cognitive development. During the
music therapy sessions, therapists will involve musical activities such as listening, singing,
dancing, playing instruments. Commented [4]: During the musical therapy sessions,
therapist will engage the client to be involved in musical
activities such as......

What is Autism? And the role of music therapy for autistic children.
The "autism spectrum" describes a set of developmental delays and disorders which affect
social and communication skills and, to a greater or lesser degree, motor and language skills
(Lisa Jo Rudy, 2018). Autism syndrome will continue to be present until adulthood. Only a small
number of individuals with patients can be able to live independently. Commented [5]: Only a small number of patients are able to
live independently

The American Psychiatric Association (APA) classifies autism as one of the pervasive
developmental disorders (Peters, 2000, p. 189). Children with autism have trouble
communicating and interacting with others. They have trouble understanding what other
people think and feel. This makes it very hard for them to express themselves either with words
or through gestures, facial expressions, and touch. Autism children will react differently to
sensory stimuli and have difficulty handling sensory input. They might be very sensitive towards
sounds, touches, smells and sights which seem normal to others. During the music therapy
sessions, therapists will involve musical activities. Music will be use as a tool to stimulate both
hemispheres of the brain. To deal with their deficiency, therapists will interact with them
through introducing an instrument, as autistic children have more tendencies to be attracted to
object as compared to people. Instruments can serve as intermediary objects between client
and therapist. The use of music will encourage them to have a better communication and social
interaction.

Despite their disabilities, “Almost all individuals who have autism respond positively to music,
often showing unusual interests and abilities in music” (Peters, 2000, p.196, citing DeMyer,
1974; Edgerton, 1994; Euper, 1968; Snell 1966; Thaut, 1992d).

Thaut (1992d) also concluded that the evidence indicated that individuals, who have autism
often perform much better in musical areas than in other areas of behavior, often perform
better in musical areas than many normal children do and usually respond to music more
frequently & more appropriately than their response to other auditory stimuli. This proves that
children with autism has high tendency to respond well in music.

The symptoms of autism are usually visible above the age of two. Autism children before the
age of three will probably make more progress if they begin their intervention than children
after age five. There are several symptoms of autism children. One of the symptoms is the lack Commented [6]: Firstly, the lack of social skills......

of social skills and impairments in development of language. The appropriate musical activity
are singing and dancing to the greeting and also learning actions or movements according to
lyrics of the music. These activities are able to improve social skills by interaction between
children and therapists and peers, decrease echolalia and improve clients in language
comprehension or verbal commands. Another symptom is inability or difficulty in making eye Commented [7]: Secondly, the inability or difficulty in.....

contact. To improve this difficulty, passing and sharing of instruments activity are effective in
making the children to look at you first and then try to reach out the instruments. This activity is
suitable to increase ones’ attention and eye contact. Another symptom is stereotypical Commented [8]: Thirdly, having a stereotypical movement.

movement. To tackle this, the therapist will train them by playing instruments, doing
improvisation and also, when therapists put “stop” or “now we’re done” on V-I cadence, helps
autistic children to increase self-control. Another symptom is lack of self expression. The use of Commented [9]: . This helps autistic children to increase
self-control.
contrasting music to convey different feeling is to encourage more self-expression in autistic Commented [10]: Fourthly, the lack of self expression.
children. Last symptom is fail of doing the activities of daily living. By practicing the structured Commented [11]: Last but not least, the inability to carry out
daily activities.
songs that consist of activities of daily living, clients may be able to remember the sequence of
the steps in each task.

Stages of severity
ASD ranges in severity from a handicap that somewhat limits a normal life to a devastating
disability that may require institutional care.

Children with level one autism have slight issues with communication skills and socializing with
others. According to DSM-5, children who are diagnosed with level one autism require support. Commented [12]: Requires
Music therapy will help them to improve their social and communication skills. The symptoms
that will show are decreased interest in social interactions and activities, obvious signs of Commented [13]: The symptoms of a level one autism
are....
communication difficulty, trouble adapting to changes in routine or behavior and also difficulty
planning and organizing.

Children with level two autism have deficit in verbal and nonverbal social communication skills.
According to DSM-5, children who are diagnosed with level two autism require more support
than the children with level one autism. Even with support, children with level two autism often
have hard time in daily activities. Music therapy can be paired with sensory integration therapy Commented [14]: Often have a hard time doing their daily
activities.
(help to deal with sensory input) and occupational therapy (help to complete daily tasks). The Commented [15]: therapy, which helps in dealing with
symptoms that will show in this stage are difficulty in adapting with change, lack of verbal and sensory input, and occupational therapy, which helps in
completing daily tasks.
nonverbal communication skills, inflexibility of behaviors, repetitive or restricted behaviors and
severe behaviors issues that is obvious to observe

Children with level three autism have a more severe lack of communication skills and also
display stereotypical behaviors (repeating the same physical actions and speaking the same
phrase over and over). This is the most severe level of autism. According to DSM-5, children
who are diagnosed with level three require very substantial support. Children with level three
autism need frequent and intensive therapy. They also need a caregiver who will help them in
learning basic skills that will allow them to be independent in home, school and work. At this
stage, children might show high level of lacking verbal and nonverbal communication skills,
limited desire in engaging in social environment, difficulty in changing behaviors and extreme
difficulty in coping with changes

Next, I would like to introduce the use of Music Therapy within the SCERTS Model for children
with Autism Spectrum Disorder. SCERTS model is a four hours long ongoing assessment tool Commented [16]: Harus dipikirkan transisi antara paragraf
diatas tentang various symptoms dan level or severity dri
that was designed to observe children in two natural settings by several professionals. Autism dgn Scerts. How are they connected. Apakah scerts
itu adalah system utk mengdiagnosa seorang pasien berada
Furthermore, an extended observation will be held to capture the responses and di autism level berapa?

communicative intentions of a child in a different environment to better understand their Kalau iyah brrt tulisnya.
Normally, to assess the severity of the symptoms and to
strengths and weakness. As quoted above from the Peters, autism children tend to respond diagnose the level of the autism patients, SCERTS Model for
positively to music. The music therapists will provide an additional unique setting during the children with Autism spectrum is used. SCERTS model is......
Commented [17]: Kenapa the Peters?
observation to observe the children’s communication abilities.
Commented [18]: Buang

SCERTS Assessment Process Observation Form

Firstly, during the observation, therapist will observe the child communication abilities and
identify the language stage of the child. There are three different language stages (Social Commented [19]: There are three different language
stages, namely Social Partner........... . Under each stages
Partner Language Stage, Language Partner Stage, Conversational Partner Stage) under each there are three major development domains, namely....
stages there are three major development domains (social communication, emotional
regulation, and transactional support). Then, under the three domains, it is divided into two
different developmental domains for every stage with objectives assigned in each part. Each
language stage has its own assessment-scoring sheet. Secondly, once the observation
assessment is completed, it will show the child's strengths, weakness and also his/her social
emotional growth. Thirdly, the professionals will generate goals and discuss the three months
treatment that is suitable for the child.

Figure 1
SCERTS MODEL

*Under each of three language stages, the tree branches are identical.

Many of the joint attention and symbol use areas under the social communication objectives of
the SCERTS assessment can be observed during the music therapy sessions. Schuler, Prizant, Commented [20]: Confusing. Mksdnya apa?

and Wetherby (1997) and Wetherby, Prizant and Schuler (2000) recommend the following
communication assessment areas for children with ASD during the intervention: use of eye gaze
and facial expression for social referencing and to regulate interaction, range of communicative
functions expressed, rate of communicating, use of gestures and vocal/verbalizations, use of
repair strategies, understanding conventional meanings and ability to engage in conversation
(Walworth, 2007, p.7). The use of eye gaze and facial expressions during activities are required
to provide participation and interaction. All the activities during a music sessions also provide
opportunities for gestures, verbalizations, communicative functions and repair strategies. For
example, music activity using boomwhackers, therapists will assigned each child with different
sections of the music to play with a visual cue to start and stop playing. This activity helps
children to improve their skills of attention and also train the children to observe the
surrounding. Another activity that helps children to improve in gaze, turn-taking and attention
for ASD children is the activity that imitates a child’s musical and non-musical action. For
example, during the cue of each movement songs, the therapists will ask the child to be the
leader of the movement and other participants imitate his or her movements. This activity will
provide an opportunity for assessing the symbol use in SCERTS objectives. Peer to peer learning Commented [21]: Symbil use itu apa? Apakah udah
dijelaskan sebelumnya?
is effective intervention. In addition, it will be more successful if ASD children also go through
individual intervention involving parents and siblings. The combination of peer to peer
intervention and individual intervention will encourage generalization of skills.

CONCLUSION YG KONEK SCERTS WITH MUSIC THERAPY

The SCERTS model helps to guide music therapists to observe ASD children’s condition
regarding their communication skills. It helps the music therapists to understand their strengths
and weaknesses better and also helps to assist music therapists to identify the appropriate
musical activities for the children so that it meets their needs and goals. This observation has
brought great impact on most of the ASD children. Most of them will improve in their language
and communication. However, if there is no improvement or progress, the strategy should be
changed.

Goals
Music therapy is expected to improve one’s quality of life and help children with developmental
disabilities to reach their goals in terms of academic, motor, music, self-help, social, speech. In
academic, children are expected to have basic concepts, decision making, cognitive processing,
sequential thinking and specific education goals. In motor, children should have fine motor
skills, gross motor skills, coordination, hands and eye coordination. In music, children are
expected to be able to have the basic skills of playing an instrument and improvisation. Self
help means that the children no longer require help from others, they are independent enough
for their activities of daily living. In social, students need to be able to have interaction with
others, making eye contacts, express their feeling, social/emotional development, engage in
activity, joint attention and following verbal directions. In speech, they should be able to speak
clearly, communication and breath support.
As long as the therapy was held by a professional therapist who knows how to amply different Commented [22]: Apply

techniques for specific students and also support from his/her surrounding, I believe music
therapy will bring ability where there’s been disability.
This is extraordinary modality, which they should use because that can bring ability where
there’s been disability. And also freedom and gives delight to people and something
enthusiastically joyful about music (Oliver Sacks, 1996) Commented [23]: Ini confusing juga knp tb2 kluar terms.
Extraodinary modality, di akhir.
2349 words

Reference:
● Nordoff, R. & Robbins, C. (2004). Therapy in Music for Handicapped Children. Gilsum,
New Hampshire: Barcelona Publishers.
● Peters, J. S. (2000) An Introduction to Music Therapy. Springfield, Illinois: Charles C.
Thomas. Publishers Ltd.
● Pavlicevic, M. (1997). Music Therapy in Context. London, England: Jessica Kingsley
Publishers Ltd.
● Schneck, D. J. & Berger, D. S. (2006). The Music Effect. London, England: Jessica Kingsley
Publishers.
● Walworth, D. D. (2007). The Use of Music Therapy within the SCERTS Model for Children
with Autism Spectrum Disorder. Journal of Music Therapy, XLIV (1), 2007, 2-22
● N.A.K Production Associates for the American Music Therapy Association (producer).
Music Therapy and Medicine: Partnership In Care [CD]
● Bruscia, K (1982).
● Goy, P. (2016, Dec 24). Rate is higher than global average; better diagnosis. Older
parents are some reasons. The Straits Times. Retrieved from
https://www.straitstimes.com/singapore/health/1-in-150-children-in-singapore-has-autism
● Rudy, L. J. (2018). Making sense of the 3 levels of Autism. Very Well Health. Retrieved
from https://www.verywellhealth.com/what-are-the-three-levels-of-autism-260233
● Holland, K. (2018). Understanding the 3 levels of Autism. Health Line. Retrieved from
https://www.healthline.com/health/levels-of-autism#level-2

(https://nursejournal.org/community/the-benefits-of-music-therapy-for-autistic-children/).