Florida State University Libraries

2016 Music Therapy and Music Medicine Assessment in Mental Health and Medical Research with Children and Adolescents: An Integrative Review Dawn M. Pufahl

Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] FLORIDA STATE UNIVERSITY

COLLEGE OF MUSIC

MUSIC THERAPY AND MUSIC MEDICINE ASSESSMENT IN

MENTAL HEALTH AND MEDICAL RESEARCH WITH CHILDREN AND

ADOLESCENTS: AN INTEGRATIVE REVIEW

By

DAWN M. PUFAHL

A Thesis submitted to the College of Music in partial fulfillment of the requirements for the degree of Master of Music

2016 Dawn M. Pufahl defended this thesis on April 15, 2016. The members of the supervisory committee were:

Lori F. Gooding Professor Directing Thesis

Jayne M. Standley Committee Member

Dianne Gregory Committee Member

The Graduate School has verified and approved the above-named committee members, and certifies that the thesis has been approved in accordance with university requirements.

ii TABLE OF CONTENTS

List of Tables ...... iv List of Figures ...... v Abstract ...... vi

1. INTRODUCTION ...... 1

2. METHODS ...... 7

3. RESULTS AND DISCUSSION ...... 13

APPENDICES ...... 42

A. DATA COLLECTION FORM ...... 42

References ...... 43

Biographical Sketch ...... 47

iii LIST OF TABLES

Table 1. Electronic Search Strategy for Studies on Music Therapy and Music Medicine Assessments used in the Treatment Mental Health Symptoms of Children and Adolescents, 2000 – 2015...... 9

Table 2. Assessment used by Music Therapists with Children ...... 15

Table 3. Assessment used by Music Therapists with Children and Adolescents ...... 17

Table 4. Assessment used by Music Therapists with Adolescents ...... 22

Table 5. Assessment used with Children and Adolescents in Music Medicine Research ...... 23

Table 6. Assessment Type used by Music Therapists with Children ...... 25

Table 7. Assessment Type used by Music Therapists with Children and Adolescents ...... 28

Table 8. Assessment Type used by Music Therapists with Adolescents ...... 34

Table 9. Assessment Type used with Children and Adolescents in Music Medicine Research ... 36

Table 10. Number of Assessments used by Type ...... 38

iv LIST OF FIGURES

Figure 1. Database search results ...... 12

Figure 2. Types of Assessment used ...... 37

Figure 3. Number of Standardized Assessments used ...... 37

Figure 4. Number of Times each Assessment Design was used...... 38

v ABSTRACT

The purpose of this review was to identify and describe assessments used in music therapy and music medicine used with children and adolescents with mental health symptoms. After database searches were completed and studies screened for inclusion a total of 28 studies were included in this review. Of the studies meeting inclusion 6 examined the use of assessments used to assess mental health symptoms exhibited by children in music therapy treatment. In addition, there were 12 studies that addressed assessments used with both children and adolescents, and 7 that assessed only adolescents. Music medicine studies meeting criteria for inclusion in the review were 3 in total. Some commonalities in the assessment design employed within specific population groups were found. In addition, commonalities were found within the types of assessment used within each population group, and in some cases, across different population groupings. While findings from this review indicate some commonalities one should be hesitant in making the decision to use them in clinical practice due to the small number of participants included in most of the studies. Further research or researchers may want to further limit the scope of review in order to focus primarily one diagnosis or set of symptoms. In addition, they may want to look at the use of one specific type of assessment used within mental health settings.

vi CHAPTER 1

INTRODUCTION

An assessment can be defined as a systematic approach to determining a person’s strengths and weaknesses which involves observation within specific parameters (Hanser, 1999). Cohen and Gericke (1972) defined a true therapeutic assessment as one that is not developed through trial and error, but is specific, goal oriented, and comprehensive (as cited in Crowe, 2007, Chapter 2). In addition, Hanser (1999) conveys the need for a discriminating assessment tool which will (a) identify a client’s strengths and weaknesses, (b) give evidence that coincides with the suitability of the goal, (c) helps to determine target behaviors as well as specific objectives needed to guide therapy (d) to uncover other potential therapy goals, (e) to identify information regarding the target behavior and any prerequisite skills needed, and (f) to identify what a person can and cannot do. A music therapy assessment judges functioning not only in musical behaviors, but also non-musical behaviors that occur outside of music therapy (Crowe, 2007). Assessment is an integral part of music therapy treatment. As such, client assessment is included as part of the American Music Therapy Association’s (AMTA) professional competencies (American Music Therapy Association Professional Competencies, 2013). AMTA standards of practice state that clients will be assessed for music therapy services by a Music Therapist (American Music Therapy Association Standards of Clinical Practice, 2013). The standards of practice then go on to specify that a music therapy assessment will include these general categories: (a) psychological; (b) cognitive; (c) communicative; (d) social; (e) physiological functioning in alignment with a client’s needs as well as their strengths (AMTA, 2013). In addition to these general categories an assessment will “determine the client’s responses to music, music skills and music preferences” (AMTA Standards of Clinical Practice, 2013). Assessment is further specified in that it must not only explore a client’s culture, including but not limited to race, ethnicity, religion/spirituality, socioeconomic status, family experiences, sexual orientation, gender identity or expression, and social organizations, but must also be a method appropriate for the client’s chronological age, diagnoses, and functioning level (AMTA Standards of Clinical Practice, 2013). Music therapy assessments not only measure a client’s need for music therapy, but may also indicate a need for other services, which according

1 to the AMTA Standards of Clinical Practice (2013), must be addressed by referral to the appropriate service. In the most recent workforce survey by AMTA 19% of music therapists’ state that they work within the mental health population and 12% stated that they work in a mental health setting (American Music Therapy Association, 2015), and as such music therapists working within these settings require the use of assessments that take into account the needs of individuals with mental health issues. Music therapy assessments for clients with mental disorders should utilize multiple methods (informal, formal, and standardized) of assessment Chase, 2002 (as cited in Crowe, 2007, Chapter 2). Chase emphasized that informal processes of music therapy assessment do not have written accountability (as cited in Crowe, 2007, Chapter 2). Formal music therapy processes are systematic processes, and therefore, require the assessment be administered in a similar manner each time it is given (Crowe, 2007). Types of assessments that can be used in the assessment process include: (a) interviews with clients and/or family members; (b) observation; (c) review of client records; (d) standardized assessments (Crowe, 2007, Chapter 2). Music therapy assessments within the mental health population should include a client’s current diagnoses and history, and will address these specific areas: (a) motor functioning; (b) sensory processing, planning and task execution; (c) substance use or abuse; (d) emotional status; (e) vocational status; (f) educational background; (g) client’s use of music; (h) developmental level; (i) coping skills; (j) infection control precautions (AMTA, 2013). In addition to the previous assessment criteria on mental health assessments in music therapy it is important to note two additional concerns when assessing children and adolescents with mental health symptoms. Music therapy assessments of children and adolescents should also take into account side-effects of medication on the client’s cognitive, motor, and energy level (Crowe, 2007, Chapter 13). It is also important to assess the client’s musical skills, music preference, and personal history with music as music, especially with adolescents (Crowe, 2007, Chapter 13).

Problem Identification

While the AMTA standards of practice indicate that assessment is an integral part of music therapy practice, few research articles have addressed the assessments used and focus

2 primarily on the types of therapy used. Gold, Voracek, and Wigram (2004) conducted a meta- analysis on the uses of music therapy with children and adolescents with psychopathology in order to evaluate the efficacy of its use with this specific population. This meta-analysis focused on the case studies of 75 children and adolescents with psychopathology and the effects of individual music therapy treatment (Gold, Voracek, & Wigram, 2004). Conclusions from the meta-analysis indicated that the children and adolescents benefited from music therapy interventions that were music therapy specific (Gold, Voracek, & Wigram, 2004). While this study evaluates the use of music therapy treatment with children and adolescents it does not discuss the assessments used in music therapy treatment. There is also some disagreement on the need for assessment. Hanser (1999) emphasized the importance of having an assessment representative of the client’s behavior within the music therapy environment and in the presence of the music therapist. In this way skills that may be better evaluated in a musical context can be assessed (Hanser, 1999). Music therapy specific assessment can also further demonstrate the necessity of music therapy as a treatment method (Hanser, 1999). While it is important to evaluate the effectiveness of music therapy it is also important, as stated previously by Crowe (2007) that music therapy assessment measure behaviors in the music therapy setting as well as outside of the music therapy setting. In order to explore the types of assessments being used by music therapists in the treatment of children and adolescents with mental health symptoms the integrative review format was chosen. Like the meta-analysis and systematic review formats an integrative review involves a systematic process in which the reviewer sets criteria to determine what studies will be evaluated. “Integrative reviews are the broadest type of research review methods allowing for the simultaneous inclusion of experimental and non-experimental research” (Whittemore and Knafl, 2005). Due to the broad nature of the integrative review format case studies could be included to allow the survey of more types of assessment. The purpose of this study is to review the assessments being used by music therapy clinicians and researchers with children and adolescents with mental health symptoms. Before determining methodology it is important to define and clarify the terms that will be used in this review to evaluate and classify each music therapy and music medicine assessment used by clinicians and researchers.

3 Defining Music Therapy

Music Therapy as defined by AMTA is the “clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, 2015). Music therapy by definition is a health care profession in which music therapists use music to develop therapeutic relationships in order to attend to the physical, emotional, cognitive, and social needs of individuals (Yinger and Gooding, 2014). A credentialed music therapist, MT-BC, is and individual who has completed undergraduate or equivalency coursework at an AMTA approved college or university degree program, and has passed the Certification Board for Music Therapists (CBMT) exam (Yinger & Gooding, 2014). Once a music therapist has become board certified they must at minimum continue to train in advanced music therapy competencies through continuing education courses (Yinger & Gooding, 2014). Coursework in the music therapy curriculum consists of not only music foundations such as music theory, music history, and functional music skills, but on clinical foundations encompassing therapeutic applications, therapeutic relationships, and therapeutic principles (AMTA Professional Competencies, 2013). Music therapists are also trained in the foundations and principles of music therapy, client assessments, treatment planning, implementation, evaluation, and documentation (AMTA Professional Competencies, 2013). For the purposes of this integrative review music therapy assessments were only considered music therapy assessments when they were conducted by or in the presence of a music therapist, or in correspondence with a credentialed music therapist and were conducted in medical or mental health settings.

Defining Music Medicine

Due to the degree of study involved to become a credentialed music therapist it is important to differentiate it from music medicine. Music medicine can be defined as “passive listening to prerecorded music provided by medical personnel” (Yinger & Gooding, 2014). Often music medicine treatment is conducted by a medical professional who has gone through much different training than a music therapist (Yinger & Gooding, 2014). Another distinction to make

4 between music therapy and music medicine is the way in which music-based interventions are used. Music medicine treatments or studies often uses headphones as the tool to administer music (Yinger & Gooding, 2014). Also, the music used during the intervention may or may not have been chosen by the study participant (Yinger & Gooding, 2014). For the purposes of this review studies in which a music therapist did not author and/or was not involved in the development were termed music medicine.

Defining Mental Illness

The Diagnostics and Statistics Manual of Mental Disorders fifth edition (DSM-5) defines a mental disorder as “a syndrome characterized by clinically significant disturbances in an individuals’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (DSM – 5, 2013). By this definition anything that alters an individual’s mental functioning whether it be in regard to cognition, emotion, or behavior is considered a mental disorder. Gold, Wigram, and Berger (2001) compared mental illness and mental health to a continuum in which each state is not entirely disctinct. When looking specifically at children and adolescents, it is important to remember that “children and adolescents with behavioral and emotional difficulties have associated maladaptive qualities in their social information processing (Kendall, 2012). Accordingly, the reviewer has decided to include only those studies addressing attention, or social skills including the development of speech.

Definition of Assessment and Assessment Terminology

There are many types of assessments. Hanser (1999) placed assessments into three categories. One type of assessment mentioned is an initial assessment, which is an assessment taken as a baseline measure at the beginning of treatment to guide therapeutic goals and objectives (Hanser, 1999). The second type of assessment is a comprehensive assessment. This type of assessment is often used when an individual is referred only for a music therapy assessment (Hanser, 1999). In music therapy practice comprehensive assessments are often used to determine the appropriateness of music therapy services, determine an individual’s current

5 level of functioning, and/or be used in place of standard assessments when an individual has difficulty complying with those forms of assessment (Hanser, 1999).The last type of assessment defined is an ongoing assessment that continues to be measured through the duration of music therapy (Hanser, 1999). For the purposes of this review assessments will be classified as being administered pre, post, or ongoing throughout the duration of treatment. These terms will be used to refer to the assessment design used in each study included in the review. Assessments administered before treatment or implementation of music therapy or music medicine will be categorized as pre assessments. Post assessments will be used to refer to assessments conducted after music therapy of music medicine treatment or implementation. Ongoing assessments will be studies that included assessments used throughout the course of treatment that were re- assessed at specific intervals. In addition to assessment design there are also different methods of assessment. These different methods can include, but are not limited to, (a) standardized assessments, (b) clinician created assessments, (c) facility specific assessments, (d) self-report, (e) rating scale, (f) checklist, (g) questionnaire, (h) interview, and (i) direct behavioral observations. For the purposes of this review standardized assessments are those assessments that have evaluated norms and are generally available through purchase via a test publishing company. Clinician created assessments are, as the name suggests, assessments made by a clinician or researcher. Facility specific assessments are those assessments exclusive to a specific therapy practice. Self- report assessments can be questionnaires, checklists, rating scales, etc. that are completed by the participant, and/or a parent, teacher, clinician if the assessment requires additional individuals report on the participants symptoms/behaviors. For the purposes of this review assessment methods used will be classified as assessment types. In addition to the assessment terminology and criteria only assessments that fall within the realm of music therapy or music medicine will be included. Assessments will be categorized as music therapy or music medicine in accordance with the previous definitions of both music therapy and music medicine. Studies that meet inclusion for this review will be further scrutinized and summarized in tables by either assessment design or assessment type as defined in this section.

6 CHAPTER 2

METHODS

Identification of Relevant Studies

This review examined assessments within the scope of both music therapy practice and music medicine. The assessments reviewed specifically addressed their use in the treatment of children and adolescents exhibiting symptoms associated with mental illness. Prior to beginning the integrative review process the reviewer first consulted literature relevant to the integrative review structure which included the works of Burns (2012), Yinger and Gooding (2014), and Whittemore and Knafl (2015). Studies included in this review met the following criteria: Article inclusion Criteria: 1. Either an initial, comprehensive, or ongoing assessment was used to determine progress made during treatment. 2. Population assessed consisted of children and/or adolescents between the ages of 3-21 years. 3. Study measured the effectiveness of Music Therapy or Music Medicine Music on symptoms related to mental health. 4. Study was an unpublished dissertation, thesis, or article published in a Peer Reviewed journal. 5. Was not a meta-analysis, systematic review, or review of literature. 6. Published between the years 2000-2015. 7. Published in English. Article exclusion Criteria: 1. Music Therapy or Music Medicine Music was not used during treatment of symptoms related to mental health. 2. No assessment was used during the course of treatment to determine progress made. 3. Study was not an unpublished dissertation, thesis, or article published in a Peer Reviewed journal. 4. Was a meta-analysis, systematic review, or review of literature.

7 5. Article was published before the year 2000. 6. Published in a Language other than English. 7. Population assessed included participants younger than 3 years of age. 8. Population assessed included participants older than 21 years of age.

Search Strategies

Potential studies for inclusion were found using the PsycINFO, CINAHL Plus, ERIC (EBSO), PubMed, and ProQuest databases. Independent searches by the reviewer and reliability partner were conducted. Prior to conducting the reliability database search the reviewer and reliability partner met to clarify search terms and database specific instructions. Due to discrepancies in the number of studies found between the reviewer search and the reliability search an additional search was conducted to resolve the discrepancy. Table 1 shows the electronic search strategy. Terms used in the search were relevant to the assessment of children and adolescents in regards to symptoms related to mental health within the scope of music therapy and music medicine.

Data Collection

Inclusion and exclusion criteria were applied to studies found during the database search. Each study was evaluated for inclusion by both the reviewer and reliability partner using a data collection form created by the reviewer. The data collection form can be found in Appendix A. Information collected from each study included (1) age of population assessed and symptoms related to mental health; (2) distinction between music therapy and music medicine; (3) use of an assessment during treatment; (4) type of assessment used; (5) whether the assessment was completed as part of a pre and/or post measure, or was an ongoing measure taken throughout the duration of treatment; (6) whether the document was a journal article, dissertation, and/or thesis; (7) was not a meta-analysis, systematic review, or review of literature. When discrepancies in the data collection were found both parties met in order to discuss the study in question in order to find agreement on inclusion.

8 Table 1.

Electronic Search Strategy for Studies on Music Therapy and Music Medicine Assessments used in the Treatment Mental Health Symptoms of Children and Adolescents, 2000 – 2015

Articles Date Database Search Terms Found February PsycINFO Music therapy and assessment AND children and adolescents AND 2000 – 2015 55 27, 2016 Music therapy and assessment AND children and adolescents AND 2000 – 2015 AND 22 Scholarly Journals Music therapy and assessment AND children and adolescents AND 2000 – 2015 AND 3 Dissertations and Theses Music therapy and assessment AND children and adolescents AND mental health AND 2000 25 – 2015 Music therapy and assessment AND children and adolescents AND mental health AND 2000 9 – 2015 AND Scholarly Journals and Dissertations and Theses Music therapy and assessment AND children and adolescents AND mental health AND 2000 6 – 2015 and Scholarly Journals Music therapy and assessment AND children and adolescents AND mental health AND 2000 3 – 2015 AND Dissertations and Theses

February CINAHL Music therapy and assessment AND children and adolescents 6 27, 2016 Plus Music therapy AND assessment AND children AND 2000 – 2015 42 Music therapy AND assessment AND children AND 2000 – 2015 AND Full Text 27 Music therapy AND assessment AND adolescents AND 2000 – 2015 AND Full Text 8

9

Table 1. Continued Articles Date Database Search Terms Found February CINAHL Music therapy AND assessment AND children and adolescents 6 28, 2016 Plus Music22+ AND assessment AND children and adolescents 18 Music AND assessment AND children and adolescents AND 2000 – 2015 17 Music AND assessment AND children and adolescents AND 2000 – 2015 AND Full Text 9 February ERIC Music therapy and assessment AND children AND adolescents AND 2000 – 2015 4 29, 2016 (EBSCO) Music therapy and assessment AND children AND adolescents AND 2000 – 2015 AND 1 Academic Journal Music therapy AND children AND adolescents AND 2000 – 2015 14 Music therapy AND children AND adolescents AND 2000 – 2015 AND Full Text 7 Music therapy AND children AND adolescents AND 2000 – 2015 AND Full Text AND Peer 5 Reviewed Music therapy AND assessment AND adolescents AND 2000 – 2015 AND Full Text 1 Music therapy AND assessment AND children AND 2000 – 2015 AND Full Text 4

February PubMed Music therapy and assessment AND children and adolescents 19 29, 2016 Music therapy and assessment AND children and adolescents AND 2000 – 2015 16

March 5, PsycInfo Music therapy and assessment AND children and adolescents NOT adults OR infants AND 35 2016 2000 – 2015 Music therapy and assessment AND children and adolescents NOT adults OR infants AND 19 2000 – 2015 AND Peer Reviewed

March 5, CINAHL Music therapy and assessment AND children and adolescents NOT adults NOT infants AND 6 2016 Plus Full Text AND 2000 – 2015 Music therapy AND assessment or evaluation or test AND adolescent: 13 – 18 years AND 73 child: 6 – 12 years AND Full Text AND 2000 – 2015

10

Table 1. Continued Articles Date Database Search Terms Found March 7, ProQuest Music therapy and assessment AND mental health AND children and adolescents NOT 493 2016 adults NOT infants AND 2000 – 2015 AND Full Text AND Dissertations & Theses AND Scholarly Journals AND Article “Music therapy” and assessment AND mental health AND children and adolescents NOT 95 adults NOT infants AND 2000 – 2015 AND Full Text AND Dissertations & Theses AND Scholarly Journals AND Article “Music therapy” and assessment AND mental health AND children and adolescents NOT 29 adults NOT infants AND 2000 – 2015 AND Full Text AND Dissertations & Theses AND Scholarly Journals AND Article AND music therapy AND music “Music therapy” and assessment AND mental health AND children and adolescents NOT 24 adults NOT infants AND 2000 – 2015 AND Full Text AND Dissertations & Theses AND Scholarly Journals AND Article AND music therapy

March 7, PsycINFO Music medicine and assessment AND children and adolescents AND 2000 – 2015 10 2016 Music medicine and assessment AND children and adolescents AND 2000 – 2015 AND 7 Scholarly Journals

March 7, CINAHL Music medicine AND assessment AND children and adolescents AND Full Text AND 2000 1 2016 Plus – 2015

March 7, PubMed Music medicine AND children and adolescents AND 2000 – 2015 85 2016 Music medicine AND children and adolescents AND mental health AND 2000 – 2015 10

March 7, ERIC Music medicine AND children and adolescents 1 2016 (EBSCO)

11 Search and Inclusion Results

Figure 1 summarizes the results of the data collection process. As seen in the illustration, of the 487 sources located through the database search 173 were duplicates. Another 145 studies were excluded through screening the titles and abstracts to determine inclusion in the review. The articles screen by the reviewer and reliability partner totaled 169 studies. Of the 169 studies screened an additional 141 studies were excluded due to not meeting inclusion criteria. In total 28 studies were included in this review that met all criteria for inclusion.

487 sources identified through database search

173 duplicates removed 145 studies excluded through abstract and title screening

169 studies screened with data 141 studies excluded collection form

28 studies included in review

Figure 1. Database search results

12

CHAPTER 3

RESULTS AND DISCUSSION

Results

Of the articles screened for inclusion in this review, twenty-eight met inclusion criteria. Studies classified as only assessing children included participants eleven years of age and younger. Participants in studies identified as having included both children and adolescents included individuals who were twelve years of age as well as individuals who were older or younger than twelve years of age. Studies classified as only having assessed adolescents included participants twelve years of age and older. Six studies included assessments used to address mental health symptoms exhibited by children, twelve studies addressed assessments used with both children and adolescents, and seven assessed only adolescents. In addition to the music therapy studies three studies meeting criteria for music medicine were included in this review. Two of the music medicine studies addressed adolescents only and one study addressed both children and adolescents. Based upon the previous definitions of mental health only articles targeting specific symptoms versus diagnoses were included. Included below is a list of the assessments and their accronyms used in the studies reviewed.  Adolescent Coping Scale (ACS-Short Form)  Autism Diagnostic Interview, Revised (ADI-R)  Autism Diagnostic Observational Schedule(ADOS)  Behavior Assessment System for Children (BASC)  Box and Block Test of Manual Dexterity (BBT)  Child Abuse Checklist (CAC)  Child Behavior Checklist (CBCL)  Child Depression Inventory (CDI)  Childhood Autism Rating Scale (CARS)  Childhood Autism Rating Scale High Functioning Version (CARS-HF)  Early Social-Communication Scales, abridged (ESCS)

13  Electroencephalogram (EEG)  Giessen Complaint List for Children and Adolescents (GCL-CA)  Goldman-Fristoe Test of Articulation, 2nd ed. (GFTA-2)  Grief Process Scale (GPS)  Harter Self Perception Profile for Adolescents (SPPA)  Hertlingshausen Satisfaction Questionnaire (HZFB)  Home and Community Social Behavior Scales (HCSBS)  Individual Music-Centered Profile for Neurodevelopmental Disorders (IMCAP-ND)  Internal health locus of contol (IHLC)  Inventory of Life Quality in Children and Adolescents (ILC)  Khan-Lewis Phonological Analysis, 2nd ed. (KLPA-2)  Munich Questionnaire on Health-Related Quality of Life in Children (KINDL)  Music Therapy Coding Scheme (MTSC)  Music Therapy Diagnostic Assessment (MTDA)  Musical Cognitive/Perception Scale (MCPS)  Musical Emotional Assessment Rating Scale (MEARS)  Musical Responsiveness Scale (MRS)  Nursing Assessment of Pain Index (NAPI)  Pervasive Devlopmental Disorder Behavior Inventory-C (PDDBI)  Psychoeducational Profile – Revised Edition (PEP-R)  Raven’s Coloured Progressive Matrices for Children (CPM)  Schedule for Affective Disorders and Schizophrenia for Schoolage Children–Present and Lifetime Version (KIDDIE-SADS)  Social Phobia Inventory for Children (SPAI-C)  Speech Production Test (SPT)  State-Trait Anger Expression Inventory – 2 (STAXI-2)  State-Trait Anxiety Inventory (STAI-C)  Test of Everyday Attention for Children (TEA-CH)  The MacArthur-Bates Communicative Developmental Inventories, Words and Gestures (MBCDI-W&G)

14  The Parent-Child Relationship Inventory (PCRI)  The Social Responsiveness Scale Preschool Version (SRS-PS)  Vineland Social-Emotional Early Childhood Scale (VSEECS)  Visual Analogue Scales (VAS)

Assessments used by Music Therapists with Children

Six of the twenty-eight studies concerning mental health assessment included participants eleven years of age and younger. Many of the participants were assessed to identify impairments in social skills. In addition to the prominence of studies concerning social skills deficits, all of the studies except Robb et al. (2008) and Lagasse (2012) assessed participants with autism. Ongoing assessments were the most common assessments used, but were paired with pre assessments in the Lagasse (2012) and Sandiford, Mainess, and Daher (2013) studies. Exceptions to the combination of pre and ongoing assessments were Kim, Wigram, and Gold (2008), who used only ongoing assessments, as well as Thompson, McFerran, and Gold (2013) who employed a pre and post assessment design. Table 2 summarizes the data collected from the studies in regard to assessment design.

Table 2. Assessment used by Music Therapists with Children. Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 10 Kim, Wigram, Joint attention, PDDBI Ongoing (male only) and Gold social skills 3 – 5 years (2008) ESCS, abridged Ongoing

N = 83 Robb et al. Coping behaviors Behavioral Interval Ongoing (no gender (2008) Recording demographics given) 4 – 7 years

15 Table 2. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 1 Raglio, Impaired social PEP-R Pre (male only) Traficante, and interaction 7 years Oasi (2011) CARS Pre

MTSC Ongoing

N = 2 Lagasse (2012) Developmental GFTA-2 Ongoing (male only) Apraxia of 5 – 6 years Speech (DAS) KLPA-2 Ongoing

SPT Ongoing

N = 12 Sandiford, Social interaction ADOS Pre (11 male, 1 Mainess, and female) Daher (2013) Criterion refernced Ongoing 5 – 7 years vocabulary test

N = 23 Thompson, Social VSEECS Pre (no gender McFerran, and engagement demographics Gold (2013 SRS-PS Pre given) 3 – 6 year MBCDI-W&G Pre

PCRI Pre

MTDA Pre

Semi-Structured Post Interview

16 Assessments used by Music Therapists with Children and Adolescents

In total there were twelve articles that included both children and adolescent participants. Studies placed in this category included participants who were both older and younger than twelve years of age. With the exception of the Chong, Cho, and Kim (2014) study which assessed the use of music therapy for the hand rehabilitation of adolescents with brain damage, all of the remaining studies addressed behavioral symptoms of mental illness. More variety was found in the assessment tools with this population than was found in the assessments used with children. Whitehead – Pleaux et al. (2007), Baker and Jones (2002), and Layman, Hussey, and Laing (2002) employed the used of ongoing assessments throughout the duration of treatment. Five studies used both pre and post assessments, and Kim (2013) used both pre and ongoing assessments. One study, Goldbeck (2012), used only post assessments which were completed at

Table 3. Assessment used by Music Therapists with Children and Adolescents Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 7 Gold, Wigram, Behavioral – CBCL (German Pre/Post (5 male, 2 and Berger internalized, Version) female) (2001) externalized 4 – 11 years KINDL Pre/Post

HZFB Post

N = 20 Layman, Hussey, Severely The Beech Brook Ongoing (13 male, 7 and Laing (2002) emotionally Music Therapy female) disturbed Assessment 3 – 15 years

17 Table 3. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 43 Baker, and Jones Hyperactivity, BASC Ongoing Mean age (2006) aggression, Group 1 = 13.8 ± conduct 2.21 years problems, Group 2 = 14.06 anxiety, ± 1.91 years somatization, attention problems, etc.

N = 9 Whitehead – Pain and anxiety The Wong Baker Ongoing 7 – 16 years Pleaux et al. FACES Pain (2007) Rating Scale

NAPI Ongoing

Fear Thermometer Ongoing

Heart Rate Ongoing

Blood Ongoing Oxygentation

N = 75 Gold, Wigram , Predictors of KINDL Pre/Post (52 male, 23 and Voracek change female) (2007) 3.5 – 19 years CBCL Pre/Post

HZFB Pre/Post

VAS Post

Modified HZFB Post satisfaction scale

18 Table 3. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 12 Katagiri (2009) Emotion Clinician Created Pre/Post 9 – 15 years regulation, emotional understanding

N = 24 Gattino et al. PDD, impaired CARS (Brazilian Pre/Post (2011) communication, Version) Experimental social interaction, Group (n = 12) and repetetive behaviors ADI-R (Brazilian Pre Control Group Version) (n = 12)

(no gender CPM Pre demographics given) 7 – 12 years

N = 45 Gooding (2011) Social skills, peer Exp 1. Exp 1. n = 12 relations, self- Social Skills Pre/Post 11 – 16 years management. Rating Scale Exp 2. n = 13 8 – 17 years Exp 2. Exp 3. n = 20 HCSBS Pre/Post 6 – 11 years

Exp 3. Social Skills Pre/Post Assessment- Elementary Age

HCSBS Pre/Post

19 Table 3. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 36 Goldbeck (2012) Anxiety KIDDIE-SADS Post Intervention Group (6 male, 12 CBCL Post female) (German Version) Control Group (no gender demographics STAI-C Post given) 8 – 12 years SPAI-C Post (German Version

CDI Post (German Version)

GCL-CA Post

ILC Post

N = 26 Kim (2013) Aggression, CBCL Ongoing (no gender deliquent (Korean Version) demographics behavior Teacher Report given) Forms/ 7 – 12 years Youth Self - Report

CAC Pre

Interview Pre

20 Table 3. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 6 Layman, Hussey, Emotional Beech Brook Ongoing (4 male, 2 and Reed (2013) disturbances Group Therapy female) Assessment Tool 9 – 12 years

N = 8 Chong, Cho, and Brain damage Grip and Pinch Pre/Post 9 – 18 years Kim (2014) Power Test (no gender demographics BBT Pre/Post given) Jebsen Taylor Pre/Post Hand Function Test

Assessments used by Music Therapists with Adolescents

Of the seven studies meeting inclusion for this group, the majority assessed participants pre and post treatment. Many of the symptoms addressed in this population involved the identification and utilization of coping skills. In addition to the increased assessment of coping skills, Kim et al. (2006) assessed psycho-social and interpersonal relationships. In relation to assessments with children and/or adolescents in the previous sections, fewer studies assessed participants with Autism Spectrum Disorder. Parent self-report measures were not used with this population most likely due to the age of the participants. Instead the clinicians used participant self-report measures, and relied heavily on the responses given by participants in surveyed responses and interviews. In general, mainly pre and post assessments were conducted with this population. This could be related to the assessments used, as well as due to the symptoms being assessed. Kim et al. (2006) was the only study that did not use pre and post measures. This could be due to the interpersonal skills being assessed. Table 4 summarizes the assessment designs used with adolescents.

21 Table 4. Assessment used by Music Therapists with Adolescents Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 20 Dalton and Grief, GPS Pre/Post (7 male, 13 Krout (2005) bereavement, female) coping 12 – 18 years

N = 35 Kim et al 2006 Psycho-social, Clinician Created Ongoing (all female) interpersonal 11 – 12 years relationships

N = 16 McFerran et al. Bereavement, Group 1 = (2010) coping SPPA Pre/Post Group 1: n = 8 (6 male, 2 female) Group 2 = 13 – 16 years ACS-Short Form Pre/Post

Group 2: n = 8 (1 male, 7 female) 13 – 16 years

N = 23 Groene and Aggression STAXI-2 Pre 16 – 17 years Barrett (2012) Six item multiple Pre choice test

Opinion Survey Post

N = 8 Kleiber and Pain, anxiety Interview Post 13 – 17 years Adamek (2012)

22 Table 4. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design N = 1 Carpente Sustained IMCAP-ND Post (1 male) (2014) attention and 12 years engagement Scale I: MEARS Scale II: MCPS Scale III: MRS

N = 9 Pasiali et al. Attention CARS2-HF Pre (4 males, 5 (2014) females) TEA-CH Pre/Post 13 – 20

Assessment Design used with Children and Adolescents in Music Medicine Research

There were only three studies that met inclusion criteria in this category. None of the studies addressed only children, but two studies addressed adolescents specifically. A study by Kristjánsdóttir and Kristjánsdóttir (2011) assessed pain and anxiety through the use of music played via headphones and self-report measures. Nilsson et al. (2009) used standardized assessments to evaluate the use of postoperative music medicine. A study on judgment and emotional attributions by Altenmuller et al. (2002) used EEG readings. In addition to the EEG measures the researchers also required the participants to have studied at least one instrument for at least three years. The findings for this category can be found in Table 5.

Table 5. Assessment used with Children and Adolescents in Music Medicine Research Participant Publication Assessment Assessment Characteristics Information Symptoms Design Adolescents Altenmuller et Judgment, Physiological Ongoing N = 16 al. (2002) emotional measures: EEG 12 – 15 years attributions (all had played at least 1 instrument for at least 3 years)

23 Table 5. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Design Children and Nilsson et al. Pain, distress, Morphine Post Adolescents (2009) anxiety Consumption N = 80 7 – 16 years

Adolescents Kristjánsdóttir Pain, anxiety, Self-reported Pre N = 118 and and coping background 13 – 15 years Kristjánsdóttir behaviors questionnaire (2011)

VAS Pre/Post Anxiety Pre Fear Pre Pain Pre Pain intensity Post

IHLC Pre

Coping behavior Ongoing

Assessment Type used by Music Therapists with Children

All of the studies but the Robb et al. (2008) study used at least one standardized assessment, and four studies included a clinician created assessment. Due to the age of the population being assessed those assessments involving a self-report measure were mostly completed by the parent using either a rating scale or checklist that recorded the parent’s perceptions of their child’s current functioning level. In addition to a parent self-report measure, Raglio, Traficante, and Oasi (2011) included a clinician rating scale as dictated by the directions for use of the Childhood Autism Rating Scale (CARS). Many of the assessments also used direct behavioral observation to determine progress made by participants, or to determine participants’ current functioning levels. This information is further summarized in Table 6.

24 Table 6. Assessment Type used by Music Therapists with Children Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 10 Kim, Wigram, Joint attention, PDDBI Standardized (male only) and Gold social skills Parent and 3 – 5 years (2008) Observer Report/ Direct Behavioral Observation/ Rating Scale

ESCS, abridged Standardized Direct Behavioral Observation

N = 83 Robb et al. Coping Behavioral Direct (no gender (2008) behaviors interval Behavioral demographics recording Observation given) 4 – 7 years

N = 1 Raglio, Impaired social PEP-R Standardized (male only) Traficante, and interaction 7 years Oasi (2011)

CARS Standardized/ Clinician Rating Scale/Parent Self-Report Questionnaire

MTSC Direct Behavioral Observation

25 Table 6. Continued N = 1 Raglio, Impaired social PEP-R Standardized (male only) Traficante, and interaction 7 years Oasi (2011)

CARS Standardized/ Clinician Rating Scale/Parent Self-Report Questionnaire

MTSC Direct Behavioral Observation

N = 2 Lagasse (2012) Developmental GFTA2 Standardized (male only) Apraxia of 5 – 6 years Speech (DAS) KLPA2 Standardized

SPT Clinician Created

N = 12 Sandiford, Social ADOS Standardized (11 male, 1 female) Mainess, and interaction 5 – 7 years Daher (2013) Criterion Clinician referenced Created vocabulary test

26 Table 6. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 23 Thompson, Social VSEEC Standardized/ (no gender McFerran, and engagement Parent Self- demographics Gold (2013) Report/Semi- given) Structured 3 – 6 years Interview

SRS-PS Standardized/ Parent Self- Report

MBCDI-W&G Standardized/ Parent Self- Report

Standardized/ PCRI Parent Self- Report/Rating Scale/Checklist

Clinician MTDA Created/Direct Behavioral Observation

Semi-Structured Semi-structured Interview/ interview Parent Self- Report

Assessment Type used by Music Therapists with Children and Adolescents

In contrast to the types of mental health assessments used by music therapists to assess children, a number of the assessments being used with children and adolescents included self- report measures. The majority of studies used a standardized assessment of some sort during the course of treatment. Whitehead – Pleaux et al. (2007) used short assessments that could be evaluated quickly and repeated multiple times. This study also used heart rate and blood

27 oxygenation as physiological measures to evaluate intervention effectiveness during procedural support. Two studies, Layman, Hussey, and Laing (2002) and Layman, Hussey, and Reed (2013) evaluated assessment tools created to determine the effectiveness of music therapy interventions on children and adolescents with emotional disturbances. The first study used an individual assessment whereas the latter study included a group assessment form. Three studies, including the previously mentioned studies and a study by Katagiri (2009) used clinician created assessments. Many of the studies in this category also used standardized assessments. Of the assessments used, the Child Behavior Checklist, German Version, the Munich Questionnaire on Health-Related Quality of Life in Children (KINDL), and Hertlingshausen Satisfaction Questionnaire (HZFB) were used in multiple studies by the same primary author. In addition to the German Version of the CBCL being used in multiple studies, the Korean Version of the CBCL was used in a study by Kim (2013). Further details on the types of assessments used with this population are summarized in Table 7.

Table 7. Assessment Type used by Music Therapists with Children and Adolescents Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 7 Gold, Wigram, Behavioral: CBCL Standardized/ (5 male, 2 female) and Berger internalized, (German Version) Parent Self- 4 – 11 years (2001) externalized Report/ Checklist

KINDL Standardized/ Parent Self- Report/ Checklist

HZFB Parent Self- Report Questionnaire

28 Table 7. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 20 Layman, Severely The Beech Brook Clinician (13 male, 7 female) Hussey, and emotionally Music Therapy Created Rating 3 – 15 years Laing (2002) disturbed Assessment Scale

N = 43 Baker, and Hyperactivity, BASC Standardized/ Mean age Jones (2006) aggression, Teacher Direct conduct Behavioral Group 1 = 13.8 ± problems, Observation 2.21 years anxiety, Rating Scale somatization, Group 2 = 14.06 ± attention 1.91 years problems, etc.

N = 9 Whitehead – Pain and The Wong Baker Standardized/ 7 – 16 years Pleaux et al. anxiety FACES Pain Self- Report/ (2007) Rating Scale Rating Scale

Direct NAPI Behavioral Observation

Fear Self-Report/ Thermometer Rating Scale

Heart Rate Physiological

Blood Physiological Oxygenation

29 Table 7. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 75 Gold, Wigram, Predictors of KINDL Standardized/ (52 male, 23 and Voracek change Parent Self- female) (2007) Report/ 3.5 – 19 years Checklist

CBCL Standardized/ Parent Self- Report/ Checklist

HZFB Self- Report/Parent Self-Report Questionnaire

VAS Standardized/ Rating Scale

Modified HZFB Parent Self- satisfaction scale Report

N = 12 Katagiri (2009) Emotion Identifying facial Clinician 9 – 15 years regulation, expressions Created emotional understanding

30 Table 7. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 24 Gattino et al. PDD, CARS (Brazilian Standardized/ (2011) impaired Version) Direct Experimental communicatio Behavioral Group (n = 12) n, social Observation interaction, Control Group and repetetive ADI-R (Brazilian Standardized/ (n = 12) behaviors Version) Interview

(no gender demographics CPM Standardized/ given) Intelligence 7 – 12 years Test

N = 45 Gooding (2011) Social skills, Exp 1: Exp 1: Exp 1. n = 12 peer relations, Social Skills Researcher 11 – 16 years self- Rating Scale Created/Rating Exp 2. n = 13 management Scale/Direct 8 – 17 years Behavioral Exp 3. n = 20 Observation 6 – 11 years Exp 2. Exp 2: HCSBS Standardized/ Rating Scale/Direct Behavioral Observation

Exp 3. Exp 3: Social Skills Rating Scale/ Assessment- Direct Elementary Age Behavioral Observation

HCSBS Standardized/ Rating Scale/Direct Behavioral Observation

31 Table 7. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 36 Goldbeck Anxiety KIDDIE – Standardized/ Intervention (2012) SADS Interview Group (German Version) (6 male, 12 female) Control Group CBCL Standardized/ (no gender (German Version) Parent Self- demographics Report given) 8 – 12 years STAI-C Standardized/ (German Version) Self-Report

SPAI-C Standardized/ (German Version) Self-Report

CDI Standardized/ (German Version) Self-Report Standardized/ GCL-CA Self-Report

ILC Standardized/ Parent Self- Report/Self- Report/ Questionnaire

N = 26 Kim (2013) Aggression, CBCL Standardized/ (no gender deliquent (Korean Version) Checklist demographics behavior Teacher Report given) Forms 7 – 12 years Youth Self - Standardized/ Report Checklist/Self- Self-Report Report

CAC Self-Report

Interview Interview

32 Table 7. Continued Participant Publication Symptoms Assessment Assessment Characteristics Information Type N = 6 Layman, Emotional Beech Brook Clinician (4 male, 2 female) Hussey, and disturbances Group Therapy Created/Direct 9 – 12 years Reed (2013) Assessment Tool Behavioral Observation/ Rating Scale

N = 8 Chong, Cho, Brain damage Grip and Pinch Standardized 9 – 18 years and Kim (2014) Power Test

BBT Standardized

Jebsen Taylor Standardized Hand Function Test

Type used by Music Therapists with Adolescents

The assessments used with this population tended to involve a self-report element in the form of a rating scale, questionnaire, or interview. Due to the age of the participants in the adolescent category (twelve years of age or older) it is to be expected that more self-report measures than parent self-report measures would be taken. Again, many of the studies used involved a standardized assessment to evaluate effective treatment or improvements made over the course of treatment. Studies by Dalton and Krout (2005) and Kim et al. (2006) both used a clinician created assessment, but the latter study did not evaluate the assessment used. In contrast the Dalton and Krout (2005) evaluated the used of their assessment tool and its use with the population being assessed. Direct behavioral observation was less commonly used in assessments with adolescents. The studies that used direct behavioral observation, Kim et al. (2006) and Carpente (2014) both videotaped sessions to be reviewed and assessed to identify areas of improvement. Table 8 on the following page summarizes the types of assessments found to be used with this population.

33 Table 8. Assessment Type used by Music Therapists with Adolescents Participant Publication Symptoms Assessment Assessment Type Characteristics Information N = 20 Dalton and Grief, GPS Clinician (7 male, 13 Krout (2005) bereavement, Created/Self- female) coping Report/Rating Scale 12 – 18 years

N = 35 Kim et al Psycho-social, Clinician Clinician Created/ (all female) (2006) interpersonal Created Direct Behavioral 11 – 12 years relationships Observation/ Narrative

N = 16 McFerran et Bereavement, Group 1 = Standardized/ al. (2010) coping SPPA Self-Report/ Group 1: n = 8 Questionnaire (6 male, 2 female) 13 – 16 years Group 2 = Standardized/ ACS-Short Self-Report/ Group 2: n = 8 Form Questionnaire (1 male, 7 female) 13 – 16 years

N = 23 Groene and Aggression STAXI-2 Standardized/Self- 16 – 17 years Barrett Report (2012) Six item Self-Report/ multiple choice Questionnaire test

Opinion Survey Self-Report/Rating Scale/Questionnaire

N = 8 Kleiber and Pain, anxiety Interview Interview 13 – 17 years Adamek (2012)

34 Table 8. Continued Participant Publication Symptoms Assessment Assessment Type Characteristics Information N = 1 Carpente Sustained IMCAP-ND Direct Behavioral (1 male) (2014) attention and Observation/Rating 12 years engagement Scale Scale I: MEARS

Scale II: MCPS

Scale III: MRS

N = 9 Pasiali et al. Attention CARS2-HF Standardized/ (4 males, 5 (2014) Rating Scale females) 13 – 20 TEA-CH Standardized/ Checklist

Music Medicine Mental Health Assessment Type used with Children and Adolescents

Music medicine assessments used with this population generally used physiological measures. The only study that did not use physiological measures to assess participants was the Kristjánsdóttir and Kristjánsdóttir (2011) study that used pre and post measures which employed both self-report and direct behavioral observation assessments. The use of self-report measures seemed to fit the design of the study due to it being focused on participants’ anxiety, fear, pain, pain perception, and their effect on whether or not music was chosen as coping skill during immunizations. Due to the low number of studies included classified as music medicine a table comprised of assessments used with adolescents specifically have been identified as such in the participant characteristics column so that they are distinguished from the Nillson et al. study that included children and adolescent participants. Table 9 on the next page summarizes the studies included in this category of assessment.

35 Table 9. Assessment Type with Children and Adolescents in Music Medicine Research Participant Publication Symptoms Assessment Assessment Type Characteristics Information Adolescents Altenmuller et Judgment, EEG Physiological N = 16 al. (2002) emotional Measures 12 – 15 years attributions (all had played at least 1 instrument for at least 3 years)

Children and Nilsson et al. Pain, distress, Morphine Physiological Adolescents (2009) anxiety Consumption N = 80 7 – 16 years

Adolescents Kristjánsdóttir Pain, anxiety, Self-reported Self-Report/ N = 118 and and coping background Questionnaire 13 – 15 years Kristjánsdóttir behaviors questionnaire (2011) VAS Self-Report/Rating Scale

IHLC Self-Report/ Questionnaire

Coping Direct Behavioral behavior Observation

Assessment and Clinical Evaluation in Music Therapy: An Overview from Literature and Clinical Practice

The purpose of this study was to examine the types of assessments used by music therapists, both clinicians and researchers to assess children and adolescents with symptoms of mental illness. Based upon the number of standardized assessments used by music therapists in comparison to the number of clinician created assessments used in the studies reviewed, it appears as though music therapists are using standardized assessments more often than assessments created by clinicians. Figure 2 displays the number of studies using at least one clinician or standardized assessment.

36 Type of Assessment Used by Music Therapists

Standardized 17 Clinician Created 9

Figure 2. Type of Assessment used

The totals found in Figure 2 show that music therapists were using standardized assessments 61% of the time. Additionally, many studies used more than one standardized assessment during the course of treatment. Figure 3 summarizes the amount of standardized assessments used in studies conducted by music therapists.

Music Therapy Studies Using:

One Standardized Assessment 5

Two Standardized Assessments 7

Three Standardized Assessments 3

Four or More Standardized Assessments 2

Figure 3. Number of Standardized Assessments used

Findings from this review suggest that many clinicians and researchers are using standardized tools when assessing children and adolescents participating in music therapy services. In their feature on the use of standardized assessments by music therapists in the managed care environment, Scalenghe and Murphy (2000) stated that music therapists used standardized assessments from other disciplines. Findings from this review support their conclusion. The assessment design used within each population grouping tended to have some commonalities between studies. An example of this was the use of ongoing, pre/post, or post assessment designs in many of the studies assessing children and adolescents in comparison to the limited number of studies using only a pre assessment design when assessing children and adolescents with symptoms of mental illness receiving music therapy. Totals of the number of pre, post, ongoing, and pre/post assessments used are summarized in Figure 4.

37 MT & Children MT & Children/Adolescents MT & Adolescents MM Pre 8 4 3 3 Post 1 10 3 1 Ongoing 8 9 1 2 Pre/Post 0 14 4 1

Figure 4. Number of Times each Assessment Design was used

The assessment design was also seemingly relative to the length or type of assessment used. Assessments that used multiple types of assessment generally varied more in their use and design than studies utilizing one specific assessment or assessment type. An example of this can be found in studies using self-report measures. These studies tended to employ some variation of pre and post assessment unless the assessments used were short rating scales such as the Wong Baker FACES pain rating scale that took only a few minutes to employ and could be used multiple times within a treatment intervention. Additionally, the age of participants seemed to influence the type of assessment used. In general, assessments involving a self-report measure were often completed by a parent, observer, clinician, or researcher when being used to assess symptoms of mental illness in children. In comparison, self-report assessments used with adolescents tended to be completed by the participants. A summary of the types of assessment used as well as the number of times they were used within the studies reviewed can be found in Table 10.

Table 10. Number of Assessments used by Type Type of Assessment MT and MT and MT and Music Children Children/Adolescents Adolescents Medicine Parent/Observer/ 7 9 0 0 Clinician/Researcher Self-Report 0 10 5 3 Checklist 1 6 1 0 Rating Scale 2 8 3 0

38 Table 10. Continued Type of Assessment MT and MT and MT and Music Children Children/Adolescents Adolescents Medicine Direct Behavioral 5 8 3 0 Observation Interview 2 3 1 0 Intelligence Test 0 1 0 0 Questionnaire 1 3 4 3 Physiological 0 2 0 2 Narrative 0 0 1 0

Implications for Clinical Practice

This review focused primarily on when assessments were administered and the types of assessments used. Based upon the findings of this review one can attempt to make associations between the assessments used in these studies and their potential for use within music therapy practice. Some caution should be taken when making these associations due to the small number of participants assessed within each setting. What can potentially be gleaned from the findings of this study are the types of assessment being used, and when they are used within the constructs of the assessment design. In general, studies that used quick assessments that inventoried behavioral observations were used as ongoing assessments. In contrast, studies using extensive checklists or self-report assessments tended to use a combination of pre and post measures. Based upon the use of standardized assessments within a large number of the assessment designs one may look at this as a means to collaborate or communicate across different therapies especially when treating clients as part of an interdisciplinary setting. Standardized or commonly used assessments across different treatment modalities may make it easier to communicate with other members of an interdisciplinary team in regard to looking at which methods are perhaps more effective, as well as common symptoms and/or behaviors being seen across disciplines. This is in agreement with the Scalenghe and Murphy (2000) feature in which the authors state that a large number music therapists are either using or adapting assessments from other disciplines. The use of common assessments may also identify improvement by the patient or client in treatment within one discipline, but not another, and could therefore identify a more appropriate setting or lead clinicians to evaluate why a specific behavior or symptom is or is not

39 present during treatment across disciplines within an interdisciplinary setting. While the use of standardized assessments may be beneficial for communication between disciplines it is also important to be cautious when adapting these assessments due to the effect these adaptations may have on the reliability and validity of the assessment used (Scalenghe and Murphy, 2000).

Limitations of this Review and Further Research

This review like others is not immune to limitations. Studies included in this review were located through the use of database searchers. While database searches allow researchers to find a copious amount of articles, the articles found are not guaranteed to include original articles, or include articles relative to a specific topic. In addition to the amount of relevant studies identified search terms and phrasing, while consistently searched across databases, may not return as many usable studies based upon the structure of the database searched. Limits of the study in regard to the search terms used to locate articles also apply. Search terms used were chosen by the reviewer and thus may not have looked into every possible word combination to increase the likelihood of articles found that met inclusion criteria. In alignment with these limitations further researchers may want to look at the specific tools used for assessment as far as common assessments, tests, or evaluations used across treatment modalities are concerned. Other researchers may also want to identify one specific symptom or diagnosis to focus on to further identify common assessments and/or types of assessments used within even more specific population parameters. In addition, future research on this topic may want to alter or change the terms used to locate studies through the use of databases. On a similar note, hand searches for articles may want to be included in addition to the database searches to allow for the inclusion of articles that may meet inclusion, but were not found using the terms the researcher used to locate articles via the database search. In conclusion, this review identified the types of assessment used in the treatment of children and adolescents with symptoms of mental illness within the scope of music therapy practice, music medicine, and medical research. Additionally, points at which assessments were administered were also identified. While this review does give some insight into the assessments used with this population, it is by no means representative of all the assessments being used due to the previously mentioned limitations. Though transfers may be made to clinical practice, one

40 should be cautious when adapting standardized assessments to music therapy practice so that they do not significantly alter the reliability and validity of the assessments being used.

41 APPENDIX A

DATA COLLECTION FORM

Data Collection Article: Author(s):

Check the appropriate box:

☐Music Therapy ☐Music Medicine ☐ Other ☐Assessment ☐No Assessment

Document Type:

☐ Journal Article ☐ Dissertation ☐ Thesis ☐ Other

Population Assessed:

☐ 0-2yrs ☐ 3-6yrs ☐ 7-9yrs ☐ 10-12yrs ☐ 13-15yrs ☐ 16-18yrs ☐ 19-21yrs ☐ 22yrs+

Symptoms:

Type of Assessment:

☐ Self-Report ☐ Rating Scale ☐ Interview ☐ Intelligence Test ☐ Direct Behavioral Observation ☐ Checklist ☐ Narrative ☐ Questionnaire ☐ Physiological Measures: ☐ Clinician Created ☐ Standardized ☐ Facility Specific

When was assessment given/administered?

☐ Pre ☐ Post ☐ Ongoing

Reliability: Validity:

Citation:

☐ Include ☐ Exclude

Researcher Signature:______Date:______Reliability Observer Signature:______Date:______

42 REFERENCES

(References included in the integrative review are indicated by an asterisk)

*Altenmuller, E., Schurmann, K., Lim, V. K., Parlitz, D. (2002). Hits to the left, flops to the right: different emotions during listening to music are reflected in cortical lateralization. Neuropsychologia, 40, 2242 – 2256.

American Music Therapy Association. (2013). AMTA professional competencies. Retrieved from: http://www.musictherapy.org/about/competencies/

American Music Therapy Association. (2013). AMTA standards of clinical practice. Retrieved from http://www.musictherapy.org/about/standards/

American Music Therapy Association (2015). 2015 AMTA member survey and workforce analysis. Retrieved from: https://netforum.avectra.com/public/temp/ ClientImages/ AMTA2/8fb8556a-6df1-47908485-ea0959f79a2e.pdf

American Music Therapy Association. (2015). Scope of music therapy practice. Retrieved from: http://www.musictherapy.org/about/scope_of_music_therapy_practice/.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

*Baker, F., Jones, C. (2006). The effect of music therapy services on classroom behaviours of newly arrived refugee students in Australia – a pilot study. Emotional and Behavioural Difficulties, 11, 249 – 260. doi: 10.1080/13632750601022170

Burns, D. S. (2012). Theoretical rationale for music selection in oncology intervention research: and integrative review. Journal of Music Therapy, 49, 7 – 22.

*Carpente, J. A. (2014). Individual music-centered assessment profile for neurodevelopmental disorders (IMCAP-ND): New developments in music centered evaluation. Music Therapy Perspectives, 32, 56 – 60. doi: 10.1093mtp/miu005

*Chong, H. J., Cho, S. R., Kim, S. J. (2014). Hand rehabilitation using MIDI keyboard playing in adolescents with brain damage: a preliminary study. NeuroRehabilitation, 34, 147 – 155 doi: 10.3233/NRE-101026

Crowe, B. J. (2007). Chapter 2: Assessment. In Crowe, B. J. & Colwell, C. (Eds.), Effective practice in music therapy: music therapy for children, adolescents, and adults with mental disorders (pp. 14 – 23). Silver Spring, MA: American Music Therapy Association, Inc.

43 Crowe, B. J. (2007). Chapter 13: Diagnostic categories for children and adolescents with mental disorders classified as emotionally/behaviorally disturbed. In Crowe, B. J. & Colwell, C. (Eds.), Effective practice in music therapy: music therapy for children, adolescents, and adults with mental disorders (pp. 14 – 23). Silver Spring, MA: American Music Therapy Association, Inc.

*Dalton, T. A., Krout, R. E. (2005). Development of the Grief Process Scale through music therapy songwriting with bereaved adolescents. The Arts in Psychotherapy, 32, 131 – 143. Doi: 10.1016*j.aip.2005.02.002

*Gattino, G. S., Riesgo, R. S., Longo, D., Leite, J. C. L., Faccini, L. S. (2011). Effects of relational music therapy on communication of children with autism: a randomized controlled study. Nordic Journal of Music Therapy, 20, 142 – 154. Doi: 10.1080/08098131.2011.566933

*Gold, C., Wigram, T., Berger, E. (2001). The development of a research design to assess the effects of individual music therapy with mentally ill children and adolescents. Nordic Journal of Music Therapy, 10, 17 – 31. doi: 10.1080/08098130109478014

*Gold, C., Wigram, T., Voracek, M. (2007). Predictors of change in music therapy with children and adolescents: the role of therapeutic techniques. The British Psychological Society, 80, 577 – 589. doi: 10.1348/147608307X204396

Gold, C., Voracek, M., Wigram, T. (2004). Effects of music therapy for children and adolescents with psychopathology: a meta-analysis. Journal of Child Psychology and Psychiatry, 45, 1054 – 1063.

*Goldbeck, L. (2012). A randomized controlled trial of multimodal music therapy for children with anxiety disorders. Journal of Music Therapy, 49, 395 – 413.

*Gooding, L. F. (2011). The effect of a music therapy social skills training program on improving social competence in children and adolescents with social skills deficits. Journal of Music Therapy, 48, 440 – 462.

*Groene, R., Barrett, S. (2012). The effect of music and suggestion on defensive driving responses of high school students: implications for music therapy. Music Therapy Perspectives, 30, 56 – 64.

Hanser, S. B. (1999). Assessment. In The new music therapist’s handbook (pp. 75 – 97). Boston, MA: Berklee Press.

*Katagiri, J. (2009). The effect of background music and song text on the emotional understanding of children with autism. Journal of Music Therapy, 46, 2009.

Kendall, P. C. (2012). Guiding theory for therapy with children and adolescents. In Kendall, P. C. (Ed), Child and adolescent therapy: cognitive-behavioral procedures (pp. 3 – 24). New York, NY: Guilford Press.

44 *Kleiber, C., Adamek, M. S. (2012). Adolescents’ perceptions of music therapy following spinal fusion surgery. Journal of Clinical Nursing, 22, 414 – 422. doi: 10.1111/j.1365- 2702.2012.04248x

*Kim, J. (2013). The effects of group music therapy on aggressive and delinquent behaviors in children who experienced on-going child abuse and poverty: a randomized controlled study. Journal of Convergence Information Technology, 8, 447 – 453. doi: 10.4256/jcit.vol.8.issue12.56

*Kim, J., Wigram, T., Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders, 38, 1758 – 1766. doi: 10.1007/s10803-008-0566-6

*Kim, S., Kverno, K., Lee, E. M., Park, J. H., Lee, H. H., Kim, H. L. (2006). Development of a music group psychotherapy intervention for the primary prevention of adjustment difficulties in Korean adolescent girls. Journal of Child and Psychiatric Nursing, 19, 103 – 111.

*Kristjánsdóttir, Ó., Kristjánsdóttir, G. (2011). Randomized clinical trial of musical distraction with and without headphones for adolescents’ immunization pain. Scandinavian Journal of Caring Sciences, 25, 19 – 26. doi: 10.1111/j.1471-6712.2010.00784.x

*Lagasse, B. (2012). Evaluation of melodic intonation therapy for developmental apraxia of speech. Music Therapy Perspectives, 20, 49 – 55.

*Layman, D. L., Hussey, D. L. (2002). Music therapy assessment for severely emotionally disturbed children: a pilot study. Journal of Music Therapy, 39, 164 – 187.

*Layman, D. L., Hussey, D. L., Reed, A. M. (2013). The beech brook group therapy assessment tool: a pilot study. Journal of Music Therapy, 50, 155 – 175.

*McFerran, K., Roberts, M., O’Grady, L. (2010). Music therapy with bereaved teenagers: a mixed methods perspective. Death Studies, 34, 541 – 565. doi:10.1080/0748118003765428

*Nilsson, S., Kokinsky, E., Nilsson, U., Sidenvall, B., Enskar, K. (2009). School-aged children’s experiences of postoperative music medicine on pain, distress, and anxiety. Pediatric Anesthesia, 19, 1184 – 1190. Doi: 10.1111/j.1460-9592.2009.03180.x

*Pasiali, V., LaGasse, A. B., Penn, S. L. (2014). The effect of musical attention control training (MACT) on attention skills of adolescents with neurodevelopmental delays: a pilot study. Journal of Music Therapy, 51, 333 – 354. doi: 10.1093/jmt/thu030

*Raglio, A., Traficante, D., Oasi, O. (2011). Autism and music therapy. Intersubjective approach and music therapy assessment. Nordic Journal of Music Therapy, 20, 123- 141. doi: 10/1080/08098130903377399

45 *Robb, S. L., Clair, A. A., Watanabe, M., Monahan, P. O., Azzouz, F., Stouffer, J. W., … Hannan, A. (2008). Randomized controlled trial of the active music engagement (AME) intervention on children with cancer. Psycho-Oncology, 17, 699 – 708. doi: 10.1002/pon.1301

*Sandiford, G., Mainess, K. J., Daher, N. (2013). A pilot study on the efficacy of melodic based communication therapy for eliciting speech in nonverbal children with autism. Journal of Autism and Developmental Disorders, 43, 1298 – 1307. doi: 10.1007/s10803-012-1672-z

Scalenghe, R., & Murphy, K. M. (2000). Music therapy assessment in the managed care environment. Music Therapy Perspectives, 18, 23-30. doi:10.1093/mtp/18.1.23

*Thompson, G. A., McFerran, K. S., Gold, C. (2013). Family centered music therapy to promote social engagement in young children with severe autism spectrum disorder: a randomized controlled study. Child: care, health and development, 40, 840 – 852. doi: 10.1111/cch.12121

*Whitehead-Pleaux, A. M., Zebrowski, N., Baryza, M. J., Sheridan, R. L. (2007). Exploring the effects of music therapy on pediatric pain: phase 1. Journal of Music Therapy, 44, 217 –241.

Whittemore, R., Knafl, K. (2005). The integrated review: updated methodology. Journal of Advanced Nursing, 52, 546 – 553.

Yinger, O. S., & Gooding, L. (2014). Music therapy and music medicine for children and adolescents. Child & Adolescent Psychiatric Clinics of North America, 23, 535 – 553. doi: 10.1016/j.chc.2013.03.003

46 BIOGRAPHICAL SKETCH

Dawn Pufahl, MT-BC is currently pursuing her MM in Music Therapy from Florida State University (FSU). Prior to her studies at FSU she received an MM in Music performance from Kent State University in 2012, and a BM in Music performance from Florida Southern College in 2010. While at FSU she has worked with diverse populations such as senior adults with Alzheimer’s disease, homeless individuals, at risk teenagers, and elementary school students implementing music therapy goals and objectives under the supervision of Board Certified Music Therapists (MT-BC). In June of 2015 she completed her internship in music therapy at Chris Evert Children’s Hospital in Fort Lauderdale, FL. While there she was supervised by Laura Cornelius, MT-BC. At the hospital she interacted with pediatric patients and their families assisting in the provision of music therapy services. During her internship she often collaborated with practitioners from other fields to develop treatment goals, and to assist during medical procedures.

47