There are numerous approaches and techniques in music therapy for children with Pervasive Developmental Disorders (PDD). Not all children with exceptionalities will respond to the same model in the same manner. However, regardless of the technique, model, or approach chosen, one common difficulty when working with children with PDD is the transition period between activities. Most young children with PDD live in the present time with little or no considerations for the past or the future. They usually focus on one thing at a time. Over time, the child gets to know you and the expectations and this would not be a problem. But during the first year of therapy, this can be a very trying time for both the child and the therapist.
When using structured activities such as a song or a dance, the child anticipates the ending and prepares himself somehow for the transition. However, this is not necessarily an easy transition for the child.
When using an improvisational model or improvisational activity during a more structured session, the transition can be even more difficult. As the child does not know exactly when the activity will end, s/he cannot prepare her or himself for the transition period. Perseveration and emotional responses at that time can escalate rapidly and it might be difficult to draw the child to another focus. As an activity progresses, the therapist must determine if the child is fully participating or is plainly perseverating. For some observers or inexperienced therapists, the child may appear to be fully participating in the activity. If perseveration persists, the activities must be quickly shifted, refocused or changed, thus bringing a rapid transition period to the session.
Some early indicators of signs of perseveration could be to repeat the same musical pattern over and over again with no musical or interpersonal contact with the therapist, puffing of cheeks, self-stimulating with fingers, rocking, repeatedly saying some words, muscle tension, rapid breathing, giggling, and musical dynamic increasing. Of course some of these signs do appear as well when the child is excited. Frequency and intensity must be constantly assessed to determine accurately the level of perseveration.
Numerous techniques can be used to redirect the child smoothly and to offer an easy transition period between activities. Following are some examples of how to redirect young children with PDD during a difficult transition period.
For a child using pictures to communicate, always have in hand or in a specific place in your room the picture symbols. Quickly end the activity and offer another choice to the child. If the child is not capable of making a choice, gently suggest a picture and, taking the card with you, walk towards the new activity. Children must be able to match the picture to the activity before making a choice. I would only assume that the music therapist worked on this several sessions before offering the child to make a choice. One cannot make a choice if they do not know what the pictures really represent.
Repetitive motor pattern can have a self-calming effect. Repetitive motor patterns could be to walk around the room playing on a tambourine, swinging in a parachute, rocking on a bass drum turned on its side.
For some children becoming a passive participant can also have a calming effect: listen to a song with pictures associated to the verse of the song, listen to a storybook on a CD, or play an ocean drum above the child’s head.
Distract the child by offering him an object associated with the next activity. My pockets are usually full of props such as visual cards, a piece of a puzzle, a small ball, etc. The music therapist must learn to anticipate the next two upcoming activities or alternatives to improvisation. For example, if the child and I are going to the piano to sing a song, I will discreetly take four mallets in my hand and put them on top of the piano. When the song is over I will hand the mallets to the child saying: “That was great, let’s go play the drum.” The use of humour can also interrupt the perseveration and the difficult moment in the transition period. Knocking over a few books “accidentally” or “tripping” over your chair can be useful techniques. The child must never perceive that you are “faking it”. If you cannot pull it off, use other techniques. There is security and comfort in the predictable and this is a key element in helping young children with PDD going through transition period. The above mentioned techniques are only a few ideas on how to avoid persevaration and facilitate transition period during music therapy session.
Confrontation, overstimulation, getting in his personal space, lack of preparation for transition, fear of failure and repeated verbal reminding can only trigger a difficult transition period. Keep the anxiety level to a minimum, observe carefully the signs of distress and perseveration in the child and make sure both, you and the child, enjoy every moment of your session.