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The Effect of a Music Therapy Social Skills Training Program on Improving Social Competence in Children and Adolescents with

Social Skills Deficits


Gooding, Lori F, PhD, MT-BC. Journal of Music Therapy 48. 4 (Winter 2011): 440-62. Turn on hit highlighting for speaking browsers Hide highlighting

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Translate Abstract Three separate studies were conducted in school, residential and after-school care settings to test the effectiveness of a music therapy-based social skills intervention program on improving social competence in children and adolescents. A total of 45 children (n = 12; n = 13; n = 20) aged 6-17 years with social skills deficits participated in a group-based five session intervention program. The same curriculum, adapted to be age appropriate, was used at all 3 sites. Specific deficits within the social skills areas of peer relations and selfmanagement skills were targeted. Active interventions like music performance, movement to music and improvisation were used. Cognitive-behavioral techniques like modeling, feedback, transfer training and problem soMng were also incorporated. Data on social functioning were collected before, during, and after the music therapy intervention from participants, appropriate adult personnel and via behavioral observations. Resutts indicated that significant improvements in social functioning were found in (a) school participant pre and post self-ratings, (b) researcher pre and post ratings of school participants, (c) case manager's pre and post treatment ratings for the residential participants, (d) after-school care participants' pre and post self-ratings, and (e) behavioral observations at all three settings. Additional changes, although not significant, were noted in teacher ratings, residential participant self- and peer ratings, and after-school case manager ratings. Results from these studies suggest that the music therapy intervention was effective in improving social competence in children and adolescents with social deficits. More research is warranted to provide additional guidance about the use of music therapy interventions to improve social functioning. [PUBLICATION ABSTRACT]

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Headnote Three separate studies were conducted in school, residential and after-school care settings to test the effectiveness of a music therapy-based social skills intervention program on improving social competence in children and adolescents. A total of 45 children (n = 12; n = 13; n = 20) aged 6-17 years with social skills deficits participated in a group-based five session intervention program. The same curriculum, adapted to be age appropriate, was used at all 3 sites. Specific deficits within the social skills areas of peer relations and selfmanagement skills were targeted. Active interventions like music performance, movement to

music and improvisation were used. Cognitive-behavioral techniques like modeling, feedback, transfer training and problem soMng were also incorporated. Data on social functioning were collected before, during, and after the music therapy intervention from participants, appropriate adult personnel and via behavioral observations. Resutts indicated that significant improvements in social functioning were found in (a) school participant pre and post self-ratings, (b) researcher pre and post ratings of school participants, (c) case manager's pre and post treatment ratings for the residential participants, (d) after-school care participants' pre and post self-ratings, and (e) behavioral observations at all three settings. Additional changes, although not significant, were noted in teacher ratings, residential participant self- and peer ratings, and after-school case manager ratings. Results from these studies suggest that the music therapy intervention was effective in improving social competence in children and adolescents with social deficits. More research is warranted to provide additional guidance about the use of music therapy interventions to improve social functioning. Review of Literature Social skills are those skills that enable individuals to function competendy at social tasks (Cook, Gresham, Barreras, Thornton, & Crews, 2008). Social skills can be defined as "a complex set of skills that include communication, problem-solving and decision making, assertion, peer and group interaction, and self-management" (KoIb & Hanley-Maxwell, 2003, p. 163). These skills impact academic success, peer and family relationships, employment, and extra-curricular/ leisure activities. In fact, children and adolescents who display academic, social and behavioral deficits are at risk for both short term and long term negative outcomes (Lane et al. 2004) . Research has indicated that children with poor social skills have (a) high incidences of school maladjustment, (b) increased expulsions and/or suspensions from school, (c) high dropout rates, (d) high delinquent rates, (e) high incidences of childhood psychopathology and (f) adult mental health issues (Gresham & Elliot, 1993). Furthermore, longitudinal studies have shown a connection between behavioral and social difficulties and academic achievement as children mature, as well as linked lower social competence in children to increased incidences of depression, conduct problems, anxiety and antisocial behavior (Lane et al., 2004; Rockhill et al., 2008; Spinrad et al., 2005). In order to be socially competent, individuals must interpret social situations correctly, identify the most appropriate skills to use for the given situation and be motivated to use them (Elksnin & Elksnin, 1995). Social competence is important for a variety of reasons. It can positively impact (a) child development and school readiness, (b) having positive regard for school, and (c) academic achievement (Spinrad, et al., 2005). In fact, research has shown that enhanced social competence can lead to the prevention of many negative outcomes in Ufe (Catalano et al., 2004). Research has also shown that social skills can be taught, with learning most likely to occur when evidence-based programs are utilized (Durlak & Weissberg, 2007). According to Gresham and Elliot (1993), social skills training involves observation learning, operant learning and classical learning. Successful training programs provide instruction, rehearsal and reinforcement for appropriate social skills. In general, social skills training programs have been shown to be effective, producing improvement ranging from 60 to 70% (Ang & Hughes, 2001; Beelman et al., 1994; Durlak et al., 1991; Losel & Beelman, 2003; Schneider & Byrne, 1985). In an analysis of social skills training literature, Gresham, Cook, Crews, and Kern (2004) found that approximately two-thirds of children with emotional and behavioral disorders demonstrated successful outcomes as a result of social skills training in

comparison to controls. Furthermore, Payton et al. (2008) found that children involved in social skills training programs showed improvement in socialemotional skills, attitudes about self and others, connection to school, positive social behavior and academic performance as well as a reduction in conduct problems and emotional distress. Music and Social Skills Hargreaves, Marshall, and North (2003) noted that "most musical activity is carried out with and for other people - it is fundamentally social - and so can play an important part in promoting interpersonal skills, teamwork, and cooperation" (p. 160). Some of the social aspects of the music making process include but are not limited to: (a) cooperation, (b) communication (both verbal and non verbal) , (c) positive peer interactions, (d) peer collaboration, (e) recognizing and supporting the rights of others, (f) dependability, (g) responsibility, (h) focus of attention, (i) impulse control, (j) delayed gratification, and (k) accepting consequences (Hargreaves et al., 2003; McClung, 2000). By taking advantage of these social aspects, musical experiences can be used to facilitate social development by establishing and maintaining interpersonal relationships. Indeed, there is increasing evidence of a relationship between social interaction and learning the arts, including music (Hargreaves et al., 2003). Because music is nonthreatening and allows for successful participation by individuals with varying ability levels, music activities can be used to teach social and leisure skills simultaneously while also improving an individual's esthetic quality of life (Humpal, 1991). In fact, research indicates that not only can music be used to teach non-musical skills, but that it should be used to teach those skills (Sharer, 1994). Musical experiences have been shown to: (a) teach positive changes in social behaviors, (b) structure positive peer interactions, (c) stimulate nonverbal expression, (d) facilitate self-expression, (e) develop interpersonal skills, (e) facilitate social play, (f) develop group cohesion and (g) improve on-task behaviors (Eidson, 1989; Gunsberg, 1988; Humpal, 1991; Reid et al., 1975; Steele, 1977). Moreover, music can even facilitate group cohesion and increase on-task behavior (Eidson, 1989). Music can also play a role in managing mood, influencing choices and changing attitudes; diese behaviors strongly influence social interactions. In fact, research indicates that music can be actively used to manage mood states or manage levels of arousal (Hargreaves & North, 1999; Magee & Davidson, 2002; North & Hargreaves, 2000; Pelletier, 2004; Waldon, 2001). Furthermore, the research literature also suggests that music has been used effectively to focus attention, structure and/ or reinforce learning, increase awareness, facilitate non musical learning and promote social interaction (Cavallin & Cavallin, 1968; Standley, 1996). It appears that music can, as Cavallin and Cavallin (1968) noted, be a "particularly effective tool for social interaction" (p. 218). Music Therapy and Social Skills The use of music therapy-based interventions to improve social skills has been well documented in die literature. In a survey of music therapy practices in psychiatric settings conducted by Silverman (2007), socialization was the most cited treatment objective. Likewise, Jackson (2003) found that 89% of music therapy survey respondents reported working on psychosocial goals with children with ADHD in elementary school settings. Early research on the use of music therapy interventions to improve social skills noted increased interpersonal skills for individuals involved in music therapy (Cavallin & Cavallin,

1968). Later research pointed to the effectiveness of music therapy in promoting interpersonal behaviors and increasing appropriate interactions (Eidson, 1989; Humpal, 1991). More current research indicates that music therapy-based interventions are effective in (a) improving attention, motivation and reducing hostility (Montello & Coons, 1998), (b) increasing responsiveness to social cues and social approaching behaviors (Reitman, 2005), (c) increasing appropriate interactions with peers (Rickson 8c Watkins, 2003), (d) in reducing resdessness and impulsivity (Rickson, 2006) , (e) increasing sustained attention towards peers (Sussman, 2009), and (f) increasing positive social behaviors for both premature and full term infants less than two years of age (Walworth, 2009). While music therapy has been shown to be effective in combating a variety of social skills deficits, to date there has been no research on the use of a music therapy-based intervention program designed specifically to improve social competence. Therefore, the purpose of the present investigation was to examine the effect of a music therapy-based intervention program on improving social skills functioning in children and adolescents with social skills deficits. Three separate studies were conducted in (a) school, (b) residential and (c) afterschool care settings to test the efficacy of a five-session social skills training curriculum. The total number of participants for all three studies was 45; however, only 44 participants completed all forms of data collection. Specific deficits in the areas of peer relations and selfmanagement skills were targeted; these areas were chosen because they were the most frequently addressed in the social skills research literature (Caldarella & Merrell, 1997). Active, music-based interventions targeting the objectives were presented in a cognitivebehavioral group format at all three settings. Interventions included a variety of techniques such as music performance, movement to music and improvisation. Cognitive behavioral techniques included: (a) adult instruction to increase direct learning, (b) modeling, (c) role playing, (d) feedback, (e) transfer training, (f) opportunities for skill rehearsal, (g) problem solving techniques, (h) opportunities for interaction with peers and (i) social reinforcement. Data were collected from the participants, from appropriate adult personnel and via behavioral observations before, during and after music the therapy intervention. Experiment 1 Participants Participants (n = 12) in the first study were children and adolescents aged 11-16 years who attended a school designed to meet the academic, social and emotional needs of students with dyslexia and ADHD. All of the children and adolescents had been diagnosed with one or more of the following: specific learning disabilities, dyslexia, ADHD and/or Asperger's Syndrome. While all of the participants demonstrated average or above average intelligence, tiiey also displayed language and perceptual difficulties, attention and/or concentration deficits, organizational difficulties, and/or poor self-concept (Woodland Hall Academy, n.d.). Design A one-group pretest-posttest design was used in the school setting in order to accommodate space and participation requirements dictated by the facility. Due to facility-placed constraints, use of a two- group randomized design was not possible. Measures

The independent variable was music therapy interventions targeting specific social skills deficits and the dependent variables were: (a) teacher ratings of social skill functioning, (b) researcher ratings of social functioning, (c) participant self-ratings of social functioning, and (d) behavioral observations of social on-task behaviors. Data were collected from the teachers using a researchercreated social skills ratings scale. Likert-type questions were used to assess each individual's ability to demonstrate specific social skills, as well as assess each individual's overall social functioning. The same teacher completed die ratings scales for each individual both pre and post music therapy interventions. The researcher completed Likert-type ratings of participant social functioning after the first and fifth sessions, with a trained observer also rating social functioning. Reliability was then computed for 33% of the researcher ratings; the reliability rate was determined to be 93%. Participants completed Likert-type self-ratings after the first and fifth sessions using a researcher-created rating form. Additionally, behavioral observations of on-task, prompted and off-task social behaviors were collected during the first and fifth sessions at the school setting by the researcher, with reliability calculated on 20% of the observations by an independent, trained observer. The reliability rate was determined to be 87%. On-task social skills were operationally defined by the researcher as demonstrating the following behaviors during the observation period: (a) active listening (looking at person speaking), (b) demonstration of appropriate verbal communication (taking turns in conversation, asking appropriate questions) , (c) following directions, (d) active participation, (e) demonstration of impulse control, and (f) demonstration of appropriate nonverbal communication for the given situation (makes eye contact, uses appropriate personal space for situation, uses appropriate facial expressions/gestures, uses appropriate tone of voice) . Procedure School participants took part in five, 50-minute group music therapy sessions across approximately a five week period. Sessions occurred during regular facility programming. Social skills covered in the program were divided into two categories, peer relations and self management skills; these skills were further subdivided into specific objectives and presented in hierarchical format. Table 1 shows both the scope and sequence of the social skills covered during the 5 week program. All skills were targeted using music dierapy interventions presented in a cognitivebehavioral format; interventions included (a) movement to music, (b) drumming, (c) instrument playing, (d) improvisation activities, (e) singing and (f) music combined with poetic techniques. Skills were defined and modeled, and participants were provided with practice opportunities as well as opportunities to develop problem solving abilities. Feedback was provided for all of the skills addressed, and transfer training was also incorporated. Participants were given "assignments" to work on the skills outside of the music therapy sessions and skills were reviewed repeatedly throughout the program. Results School participant teacher ratings, participant self-ratings, researcher ratings, and behavioral observations were all analyzed using an alpha level of .05 in order to determine changes in social functioning. Means and p values can be seen for teacher, self- and researcher ratings in Table 2. Differences in teachers' pre and post intervention ratings on the researcher-created social skills rating scale were calculated using a Wilcoxon Matched Pairs Test. Results were

not significant at the .05 alpha level; however, as can be seen in Table 2, results approached significance. Differences in participant self-report ratings for Sessions 1 and 5 were also calculated using a Wilcoxon Matched Pairs Test for Small Sample Sizes. Results for the selfreport ratings were significant, with self-ratings increasing by 25% (see Table 2 for data). Finally, differences in researcher ratings taken after Sessions 1 and 5 were calculated using a Wilcoxon Matched Pairs Test. Results were again significant. Behavioral observations of (a) on-task, (b) on-task prompted and (c) off-task behaviors were calculated separately using Wilcoxon Matched Pairs tests. As shown in Table 3, significant differences in the mean observations taken during the first and fifth sessions were found for all three sets of behaviors. Furthermore, the table shows that die occurrences of participant self- initiated on-task social behaviors increased while the occurrences of both researcher prompted behaviors and off- task behaviors decreased. Experiment 2 Participants Participants in the second study (n = 13) were children aged 8-17 years in a residential treatment program who had been diagnosed with a variety of disorders including Post Traumatic Stress Disorder, ADHD, and/or anxiety disorders. Individuals in die facility displayed a variety of emotional, behavioral and psychological problems; these problems included adjustment issues, oppositional behavior, attention deficit disorder, poor school motivation, impulse control problems, verbal aggression, poor coping skills, depression, and poor interpersonal skills. The majority of the residents, many of whom were in state custody, had been victims of physical abuse, sexual abuse, neglect, abandonment, and/ or unresolved trauma. All of the participants were unable to successfully function in their homes and communities (Vashti, 2004). Design A one-group pretest-posttest design was used in die residential setting in order to accommodate participation requirements dictated by the facility. Due to facility-placed constraints, use of a two-group randomized design was not possible. Measures The independent variable was music therapy interventions targeting specific social skills deficits and the dependent variables were: (a) case managers' ratings of social competence and antisocial behaviors, (b) participant self-ratings of social functioning, (c) participant ratings of peer social functioning and (d) behavioral observations of social on-task behaviors. Case manager social skills ratings were collected using the Home and Community Social Behavior Scales (HCSBS) - Social Competence and Antisocial Subscales (Merrell, 2002; Merrell & Caldarella, 2002). Like the researcher-created scale in Experiment 1, the HCSBS uses Likert-type questions to determine participant social functioning. In order to rate selffunctioning, participants at the residential setting completed either the Social Skill Assessment - Adolescent or the Social Skill Assessment - Elementary Age (Children's Services of Broward County, 2006). Participants at the residential setting also completed Likert-type peer sociometric ratings. Additionally, behavioral observations of ontask social

behavior were collected during all five sessions by independent, trained observers. On-task behaviors were judged using the operational dfinition outiined in Experiment 1. Reliability observations were calculated for a minimum of 20% of the behavioral observations, with a reliability rate of 83% obtained for the residential setting. Procedure Residential participants took part in five, 50-min group music therapy sessions across approximately a five week period. Sessions occurred during regular facility prograrrrming. Social skills covered in die program were divided into two categories, peer relations and self management skills; these skills were further subdivided into specific objectives and presented in hierarchical format Table 1 shows bodi the scope and sequence of the social skills covered during the 5 week program. While the same scope and sequence was used in Experiments 1 and 2, individual activities were adapted as needed to ensure diat all activities were age appropriate. All other elements, including types of music interventions (i.e., movement to music, dmmming, etc.) and specific cognitive behavioral techniques (e.g., modeling, feedback, transfer training, etc.) were identical to Experiment 1. Results Residential participant case manager ratings, participant selfratings, participant peer sociometric ratings, and behavioral observations were all analyzed using an alpha level of .05 in order to determine changes in social functioning. Differences in the pre and post test measurements on the HCSBS social competence subscale and the HCSBS antisocial subscale were analyzed separately using Wilcoxon Matched Pairs tests. Results for the social competence subscale ratings were not significant, T (13) = 16, p > .05. In fact, as shown in the mean scores provided in Table 4, the case manager ratings of social competence actually decreased from pre to post treatment. However, results for the antisocial behaviors subscale were significant, T (13) = 63, p = .03. As can be seen in Table 4, the mean decrease in antisocial behaviors was 10.6 points. A Wilcoxon Signed-Ranks Test was used to analyze participant self-ratings on the Social Skill Assessment pre and post music dierapy intervention. Likewise, participant peer sociometric ratings pre and post music therapy intervention were also analyzed using a Wilcoxon Signed-Ranks Test. Participant self-ratings on the Social Skills Assessment were not significant, G (11) = - 16, p > .05, nor were participant sociometric ratings significant, T(9) = - 23, p > .05. A Friedman Two-Way analysis of Variance was used to analyze the behavioral observations of social on-task behavior across all five sessions. Results indicated that die five sessions were significantly different from one another, (?2 (8, 4) = 14.3, p = .006) . Figure 1 further shows an increase in on-task behavior of 8% from Session 1 to Session 5. Experiment 3 Participants Participants (n = 20) in the third study were children aged 6-11 years who attended an innercity after-school care program. Individuals in the program ranged from typically developing children to individuals with generalized social, conduct and/ or behavioral deficits. Deficits

included: difficulty appropriately interacting with peers, difficulty staying on-task, difficulty following directions, etc. According to the program director, one in ten children in the afterschool program had been placed in foster care, and four in ten children had been diagnosed with either a mental illness, developmental disability or learning disability (M. Bardes, personal communication, September 10, 2009). Due to confidentiality restrictions, die research staff was not allowed access to participant history or diagnosis information. Design A pretest-posttest control group design was used in the afterschool care setting, with participants randomly assigned to the control and experimental groups. Measures The independent variable was music therapy interventions targeting specific social skills deficits and the dependent variables were: (a) case managers' ratings of social competence and antisocial behaviors, (b) participant self-ratings of social functioning, and (c) behavioral observations of social on-task behaviors. Case manager social skills ratings were collected using the Home and Community Social Behavior Scales (HCSBS) - Social Competence and Antisocial Subscales (Merrell, 2002; Merrell 8c Caldarella, 2002) . As stated previously, the HCSBS uses Likert-type questions to determine participant social functioning. In order to rate selffunctioning, participants at the after school setting completed the Social Skill Assessment - Elementary Age (Children's Services of Broward County, 2006) . Due to die age of die participants, no peer data was collected. Behavioral observations of on-task social behavior were collected during all five sessions at die after-school facility by independent, trained observers. Again, on-task behaviors were judged using the operational definition outlined in Experiment 1 . Reliability observations were calculated for a minimum of 20% of the behavioral observations, with a reliability rate of 85% obtained for the after-school care setting. Procedure After-school participants took part in five, 50-min group music therapy sessions across approximately a five week period. Sessions occurred during regular facility programming. As was the case with Experiments 1 and 2, social skills covered in the program were divided into two categories, peer relations and self management skills; these skills were further subdivided into specific objectives and presented in hierarchical format. Table 1 shows both the scope and sequence of the social skills covered during the 5-week program. Once again, individual activities were adapted as needed to ensure that all activities were age appropriate. All other elements, including types of music interventions (i.e., movement to music, drumming, etc.) and specific cognitive behavioral techniques (e.g., modeling, feedback, transfer training, etc.) were identical to those found in Experiments 1 and 2. Results After-School case manager ratings, participant self-ratings and behavioral observations were all analyzed using an alpha level of .05 in order to determine changes in social functioning. Data were collected pre and post music therapy intervention for the afterschool control and experimental groups using the program assistant director's ratings of social competence and

antisocial behaviors on the HCSBS. Pretest scores for the two groups were analyzed using a Mann Whitney U test, with no significant difference found between the two groups for the Social Competence Subscale, ( U = 66; p > .05) , or for the Antisocial Subscale, (U = 46.5, p > .05). Posttest scores for the two groups were also analyzed using Mann Whitney U tests, with results again indicating no significant difference for the Social Competence Subscale, ( U = 42.5, p > .05) or the Antisocial Subscale, ( U = 50.5, p > .05). As can be seen in the increasing mean scores found in Table 5, case manager ratings for both the control and experimental groups improved across time. Changes in the control and experimental after-school participants' pre and post self-rating scores on die Social Skill Assessment - Elementary Age (Children's Services of Broward County, 2006) were analyzed using a Mann-Whitney U test. A total of 20 participants completed the self-ratings forms; one participant, however, was removed from the statistical analysis. Because this participant's change score was out of the parameters of all other participants' scores, it was determined that the accuracy of this participant's scores could not be verified and therefore should be removed from the participant pool (see Table 6 for individual participant scores. Participant EE was removed from statistical analysis). Results from the analysis of the remaining 19 participant scores indicated a significant difference (U = 68; p (one-tailed) = .032) . As can be seen in Table 6, seven participants' scores in the experimental group increased compared with only four participants' scores in the control group. Furthermore, Table 6 shows that only one experimental participant's scores decreased from pre to post intervention as compared to decreases in five participants in the control group. Mean scores for both groups' pre and post intervention self-ratings are shown in Table 5. A Friedman Two-Way analysis of Variance was used to analyze the behavioral observations of social on-task behavior across all five sessions. Results of the analysis indicated a significant difference between the five sessions, ?2 (12, 4) = 23.5, p = .000. The mean on-task behavior for each session can be found in Figure 2, which shows an overall increase of 10% in on-task behavior. Discussion Music therapy interventions have been shown to be highly effective with children, and the successful use of music therapy interventions to address social skills deficits has been well documented in the music therapy literature (Eidson, 1989; Humpal, 1991; Standley, 1996; Sussman, 2009; Walworth, 2009). While much of the music therapy literature addresses social skills in addition to other client needs, the current investigation examined the use of music therapy interventions to specifically address social skills deficits. The curriculum designed for this investigation was not intended to be population or disability specific; instead it was designed to address specific social deficits common among individuals with a variety of diagnoses. By incorporating a variety of activities that addressed the same objectives, the program was intended to be both developmen tally and age appropriate for all participants. Previous research suggests that the use of a variety of data sources leads to a more accurate assessment of children across environments (Achenbach et al., 1987; Barkley, 1990; Brandenburg et al., 1990; Cantwell et al., 1997; Costello, 1989; Murray et al., 2009; Rutter, 1989). In fact, some researchers have argued specifically for the use of multiple assessments,

stating that differences in ratings reflect differences in behaviors that are context or situation specific (Bishop & Baird, 2001; Murray et al., 2009; Renk & Phares, 2004) . Therefore, it was determined that the use of multiple measurements would lead to the most accurate picture of participant functioning. Thus, self-report, adult report, and behavioral observations were collected from children ages 6 through 17 in three different settings during the course of this research. Of the 13 individual measures collected, seven indicated significant improvement for those participating in the music therapy-based intervention, and one approached significance. Significance was found in self-ratings, adult ratings and behavioral observations; however, only behavioral observations were consistently significant at all three sites. One dependent variable, the residential case manager ratings for the HCSBS Social Competence Subscale, indicated a decrease in functioning. The remaining participant and adult ratings (a total of 4) suggest improved social functioning during the music therapy intervention, though not at the level of significance. Therefore, even though results were mixed, the fact that the majority of the measures indicated improvement in social functioning that was at the level of significance or approached significance appears to provide initial support for the use of this type of music therapybased program as a vehicle for social skills training. Of particular interest in the current investigation is the fact that behavioral observations of on-task social behavior showed significant improvement at all three sites. This suggests that observation was the most consistent measurement of social functioning. This is not to imply that the teacher/ case manager and participant measurements were not valid forms of data; rather it indicates that these methods should be approached with more caution. It is possible that the consistency in the behavioral observation results was due to the welldefined operant definition of on-task participant behavior combined with training in evidenced-based procedures. In other words, this combination ensured that all raters were "seeing" the same behaviors, which allowed consistent and effective judgment of the treatment to occur. Perhaps by providing well-defined parameters combined with training in evidenced-based procedures for all practitioners participating in social skills training programs, treatment could be made more effective by ensuring that the same skills and behaviors are addressed and analyzed. This could then potentially lead to greater improvements in social skills functioning for those children and adolescents involved in social skills training programs. Though the majority of the dependent variables indicated improvement, one dependent variable, residential case manager ratings of participants' social competence, demonstrated a decrease in participant functioning. At the same time, however, the case manager also noted a decrease in antisocial behaviors, which would seem to imply an improvement in functioning. Research suggests that observers are sensitive to different behaviors, rating participants differently based on contextual differences in their interactions (Murray et al., 2009; Rapin et al., 1999). Perhaps the incongruence in results suggests that die rater viewed die participants with a preconceived bias not altered by participation in the intervention, even when actual behaviors changed. Or perhaps the results indicate that the rater may have based her ratings on her own interactions with the participants, and not the peer to peer interactions that were the focus of the intervention. This then suggests that adult-pleasing behaviors may need to be incorporated into the program in order for adults to "see" changes in social interactions.

A final point to consider when looking at residential participants' reported decrease in social functioning is that the fact that the decrease occurred in individuals who demonstrated die most interfering issues. According to quantitative meta-analyses of social skills intervention programs, traditional intervention programs have demonstrated minimal effectiveness in teaching social skills to children and adolescents (Bellini et al., 2007; Gresham et al., 2001; Quinn et al., 1999). Issues that interfere with the effectiveness of these programs include: oppositional behavior, conduct problems, negative influences from peer groups, substance abuse, family difficulties, and limited cognitive abilities (Bremer & Smith, 2004). Participants included in this research demonstrated all of these issues, as well as others not mentioned. As a result, the program itself may not have been enough to elicit significant changes for those individuals with considerable interfering issues. Thus, as is suggested in the social skills research literature (Spense, 2003) , it may be necessary to incorporate social skills training into a broader range of treatment objectives like cognitive restructuring, training in social perception and social perspective taking, self-regulation skills training, modification of environmental contingencies, and affect regulation methods (such as relaxation training). Given that traditional social skills intervention programs have demonstrated minimal effectiveness, the mixed but primarily positive results of the current investigation show potential for the use of music therapy interventions to ameliorate social skills deficits, as well as provide initial support the use of a music therapy-based curriculum specifically targeting impaired social functioning. While the results are mainly positive, they should be considered with some caution. Limitations to the current research include small sample size, differing experimental designs and differing data measurements. Sample availability, though exhaustive in terms of local resources, was limited. Moreover, logistical issues like space, inconsistent attendance, and difficulty obtaining participant permission contributed to small sample sizes in some of the settings. In terms of experimental design, facility constraints i.e., the requirement that all facility attendees participate prevented the use of a true experimental design at two of the three sites. While the use of the one-group pretest- posttest design is recognized when use of true experimental designs are not possible (Campbell & Stanley, 1963), use of this quasiexperimental design cannot rule out confounding variables. However, it is important to note that significance was also obtained at the site that involved use of a true experimental design. Furthermore, the significant results at all three sites suggest promise for the use of a structured music therapy intervention program to address social skills deficits. Finally, in terms of differing data measurements, differences in ages and settings necessitated the use of slightly different data measurements at each site. Therefore, even though data for each of the three sites were factored independendy, results could have been strengthened by using more consistent measures at all three sites. More research is necessary to better determine the efficacy of this type of intervention. The results of the current investigation indicate potential for the general use of music therapy interventions to ameliorate social skills deficits, as well as support for the use of a music therapybased curriculum specifically targeting impaired social functioning. Again, it is suggested that further research be conducted to verify the results of the current studies. Sidebar

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Indexing (details)
Cite Subject Music therapy; Children & youth; Intervention; Social interaction; Training MeSH Adolescent, Asperger Syndrome -- rehabilitation, Attention Deficit Disorder with Hyperactivity -- rehabilitation, Autistic Disorder -- rehabilitation, Child, Combined Modality Therapy, Female, Humans, Interpersonal Relations, Male, Mental Disorders -- psychology, Music -- psychology, Reinforcement (Psychology), Social Behavior Disorders -- psychology,

Social Environment, Acoustic Stimulation -- methods (major), Behavior Therapy -- methods (major), Education of Intellectually Disabled -- methods (major), Mental Disorders -rehabilitation (major), Self Efficacy (major), Social Behavior Disorders -- rehabilitation (major) Title The Effect of a Music Therapy Social Skills Training Program on Improving Social Competence in Children and Adolescents with Social Skills Deficits Author Gooding, Lori F, PhD, MT-BC Publication title Journal of Music Therapy Volume 48 Issue 4 Pages 440-62 Number of pages 23 Publication year 2011 Publication date Winter 2011 Year 2011 Publisher American Music Therapy Association Place of publication Silver Spring Country of publication United States Journal subject Education--Special Education And Rehabilitation, Music ISSN 00222917 CODEN JMUTAZ Source type Scholarly Journals Language of publication English Document type Feature, Journal Article Document feature Tables;Graphs;References Accession number 22506299 ProQuest document ID 916999904 Document URL

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