It’s a simple question most shrug off with “fine,” whether we are or not.
But what if we can’t find the word? What if we can’t speak words at all?
A music therapy program in the Triangle is helping young people with autism and other developmental disabilities answer the question by setting it to music.
In a room at Chapel Hill nonprofit Extraordinary Ventures last week, seven young men sat horseshoed around therapist Freddy Perkins at an electric keyboard.
“Andrew, Andrew, how do you feel?” they chanted, sing-song.
“How do you feel, Andrew?” Perkins asked the client to his right.
“Let’s say I’m feeling ... excited,” said Andrew.
“What did he say? He said he feels excited,” Perkins chanted to the group, then turned back to Andrew and said, “Now play it on the drums.”
Andrew tapped a few beats and passed the drum to the next person.
It was a simple exercise. But for these clients there was nothing simple about it. When they joined the Voices Together therapy group, some could barely sit still, much less communicate. One stood in the doorway his whole first meeting, then sat in the back of the room his second meeting, before slowly joining the group weeks later.
Today the members sing, express their feelings and even joke. The hope is they will take the skills they’re gaining in therapy into real-life relationships and the workplace.
“For people who struggle with language, there’s been an assumption that nothing’s going on,” said Voices Together founder Yasmine White, a music therapist for 30 years.
But people with autism and other developmental delays have plenty going on, White said. They just process things differently and sometimes lack the communication and social tools to respond as others do.
Music creates a structure – “a safety net,” Perkins said – that therapists can use to help clients express themselves, some perhaps for the first time.
White saw it early in her career with an 8-year-old who had not spoken since age 2.
“We sat at the piano; he was so excited,” she recalls. She began playing a children’s song.
“The wheels on the bus go round and round
“Round and round
“Round and round
“The wheels on the bus go round and round
“All through the ...”
And she stopped.
“Town,” the little boy said, his first words in six years.
There would be more such children, White said, including a 6-year-old boy whose mother stopped White in the supermarket and said, “You started him speaking!”
“It’s an amazing thing,” White said. “That’s one of those moments you can really hang on to.”
The ancient philosophers wrote about the healing power of music. Success with injured soldiers returning from World Wars I and II led some hospitals to begin music therapy programs.
Voices Together is taking it further, working with university researchers and enlisting support from education leaders to spread its model and train teachers in its methods.
State Superintendent June Atkinson visited one of the program’s groups in the Alamance-Burlington School System, one of five Triangle districts the nonprofit worked in this past year.
“I saw students excited to connect with their peers and motivated to communicate,” she said. “It was obvious they were committed to interacting, learning and were gaining essential skills.
“This program model should be in every classroom in North Carolina.”
Asking someone how they feel can be a landmine if the person thinks a four-letter word starting with S is funny.
But when one of the young men in the Chapel Hill group responds to the question with the word, Adam, another client, quickly calls him out.
“It’s very important not to curse,” he says. “If you keep cursing you’re never going to get a girlfriend.”
The young man smiles sheepishly. “I think those words are funny,” he says.
The moment passes, but not without the program staff’s notice. The interaction – the cuss word, the admonition and the response – would not have happened a few years, maybe a few months earlier.
For people who sometimes don’t look one another in the eye, to talk to one another, to have a simple back and forth conversation is “huge,” White said.
The Voices Together program is like conventional group therapy, Perkins said, but with music playing in the spaces between words where these clients might feel especially vulnerable.
“Silence can get kind of awkward,” the certified music therapist explained. “In talk therapy that (silence) can be very scary for someone. In music therapy you can share and there’s music underneath it, so you’re not so exposed.”
And rather than an interruption, Perkins said the young man’s “funny word” becomes an opportunity.
“I know he’s doing it because he thinks it’s funny. What’s the point of getting mad? That’s not going to help him,” Perkins said. “What’s going to help him is someone (else in the group) saying, ‘It makes me feel uncomfortable when you curse.’ It means more to come from someone else.”
Voices Together is working with students and faculty from Duke University and other institutions to evaluate its music therapy model.
Music therapy has long been used by clinicians to help people with autism or who have had strokes. But few studies have been conducted to evaluate its effectiveness, said Dr. Geraldine Dawson, the director of the Duke Center for Autism and Brain Development, who was part of the research team.
In neurotypical people, language – using words to express thoughts and feelings – is carried out by the left hemisphere of the brain, she said.
People with autism, however, tend to process language in the right hemisphere of the brain, the same side responsible for processing music, she said.
It’s like art. The music, the notes, the way it flows, it’s more calm and ... very good for me.
In the Voices Together program, the therapist uses singing as a way of stimulating language. The thinking is that perhaps music therapy helps spur language by creating right hemisphere pathways in a process called neuroplasticity.
To study Voices Together’s model, the researchers observed 37 students in four special education classes in the Durham Public Schools and later another group in the Alamance school system.
A paper under review for publication compared verbal responsiveness in groups of students undergoing weekly 45-minute therapy sessions for seven weeks and for 15 weeks.
The researchers found both groups increased their verbal responses – they spoke more – to prompts during three songs.
The study also found that members of the long-term therapy group also spoke significantly more within the group itself.
And that makes sense, Dawson said.
“One of the things we’re learning is children learn best – whether it’s a child with autism or a typical child – when they’re really emotionally engaged in what they’re doing.”
Call it social engagement or what Perkins calls it: fun.
In last week’s session he had the group sing Glen Campbell’s “Rhinestone Cowboy.”
I’ve been walkin' these streets so long
Singin’ the same old song
Each client took a line, and then the group sang a line, reading off a handout sheet.
But when Perkins flubbed the lyrics, adding words not on the handout, Adam spoke up.
“You actually messed up a few lines,” he told the therapist.
“He’s got a point,” Andrew chimed in.
Perkins rolled with it, more proof the group that sings together can learn to interact and affirm one another.
He admitted his goof and the group continued singing.
“Good thing I caught that,” Adam said.
Voices Together founder and CEO Yasmine White has spent nearly three decades as a music therapist, working with children, teens and adults with developmental disabilities such as autism. The techniques and methods that form the core of the Voices Together program are the product of those years of hands-on work. She is a board-certified music therapist, has a degree from the University of Maryland and has taken advanced studies in music therapy.