Interview with Christine Barton, MM, MT-BC, Music Therapist

Linda Schreiber: Today I am visiting with an accomplished musician, Christine Barton, who also happens to be a board certified music therapist in private practice and a music consultant for the cochlear implant manufacturer, Advanced Bionics. Good morning, Christine. Christine Barton: Good morning,

Linda Schreiber: Today I am visiting with an accomplished musician, Christine Barton, who also happens to be a board certified music therapist in private practice and a music consultant for the cochlear implant manufacturer, Advanced Bionics. Good morning, Christine.

Christine Barton: Good morning, Linda.

Linda: Christine, you are a private music therapist who works with children who have a hearing loss, in particular those with cochlear implants. How did you become interested in using music to help children who have a hearing loss?

Christine: Well, I started working with Amy Robbins, a speech-language pathologist here in Indianapolis. We began seeing clients together; we would have dual sessions: music and speech. The sessions were a weaving together of all kinds of spoken language activities and music. And it worked so amazingly well, we ended up giving it a title: "The Tune-Up's Approach." The sessions would flow back and forth from music to language seamlessly one into the other. We found that whatever the moment needed is what we would use to approach our work with children. And then that approach just expanded and I started getting referrals from other people, including a group at St. Joseph's Institute for the Deaf. And now in my practice I see about 10 children a week. Out of those 10 kids, many have hearing loss, about 6 have cochlear implants, and the rest are kids who are on the autism spectrum.

Linda: So do you work mostly with school-age children?

Christine: Oh, I have very young ones. The littlest one is 9 months and I see kids all the way up to age 14. I have a boy with autism who is 14 but the majority of the children are preschool-age children. I see a number of kids who attend the First Steps Program here in our state, so I see them before they enter the school system.

Linda: You must recognize developmental milestones in children's musical awareness. How does musical awareness develop in children?

Christine: What got me interested in this was thinking about how children learn language. You know the goal of music therapy is not really to teach music to kids who have special needs, but to use music as a tool to bring about some nonmusical goals, for instance language acquisition.

Linda: So language development is a purposeful outcome of music therapy?

Christine: There are patterns that typically hearing children go through when they are learning music, as well as when they learn language. Language development has been pretty well-documented and music development is also becoming better documented. Children start earlyactually even before birththey are able to hear sounds in the womb, particularly sounds of the mother's voice. When I was 9 months pregnant, I played a banjo in a bluegrass band and every time I played the banjo, my son would just go absolutely bonkers inside of me so access to music starts very, very early.

And then think about what happens right after birth when babies are really new, and all mothers and daddies and anybody who has any kind of communication with the baby, communicates with that little lovely voicewhat we call "motherease" or "infant-directed singing." And that really is the first communication we have with children. It's interesting because it's both musical and speech at the same time. That's where it starts and then different elements break off. Language goes in one direction, and what happens with music then is that babies become aware of the difference between music and speech; so when they hear music, the response is very different than when they're listening to someone talk. When they listen to somebody talk, they hear "Da da, Ma ma," or repeated syllables. When they're listening to music, they're hearing things like "Ahh, ohhh" [sung] where the speaker is really changing the character of his or her voice.

We know that children with hearing loss respond pretty well to steady beats or the pulse of a piece of music. That's also one of the very first things that hearing kids respond to. When they hear music, they may start to do this little singing and the next thing they do is start kicking their legs or waving their arms or moving their bodies or their heads. There's a real strong physical response to hearing music. And after that they become actual participants in the music and they start clapping or patting or later actually marching and walking around as they hear music. And then little bits and pieces of familiar songs start entering their world like, "Twinkle, Twinkle," and "Mary Had a Little Lamb" and maybe some lullabies. One of the things I ask my parents (who have children with hearing loss) is to note whether their children sing when they play. That behavior is something all hearing children do at about age 2, 3, or 4; when they're playing at home, they're singing. And that's really important.

Linda: Yes, all kids do that don't they?

Christine: I really encourage my parents to be on the lookout for when their child starts singing when playing because that signals to me that we're moving along the developmental continuum.

Linda: And what is the next stage to watch for?

Christine: Then after that, they start picking up first words or phrases of little nursery rhymes and they will sing these little spontaneous songs. They're actually able to sing, maybe a song all the way through, perhaps not on pitch at first, but eventually they can sing a whole song all the way through with what is known as a tonal center. We start in one place and we end kind of in the same place. And after that, they can learn to sing a song all the way through. Then, if they can conserve it in their minds, they can actually hear it in their minds; and they can think it. Then we can start doing rounds like "Row, row, row your boat."

Linda: That's tough singing.

Christine: And that leads to harmony. And from there we go into learning how to read music, just like children do when they progress from learning to speak and then learning to read and then finally learning to write. It's kind of a similar progression in music.

Linda: So what you have just described is that music awareness starts prenatally and then develops in stages up to about 7, 8, or 9 years of age.

Christine: That's right. So really by the time kids are going off to kindergarten, the typical child should be able to sing a song on pitch all the way through start to finish. They should be able to find a steady pulse, either by patting their knees or clapping their hands to a piece of music and have it be pretty well-matched to the music they are listening to. That's where they should be developmentally by the time they start school.

Linda: That's interesting developmental information. Christine, how is knowing these milestones relevant to children who are not hearing?

Christine: Well, I want to know why the child is not at a certain developmental level. Is it because he or she is not actually hearing the kinds of things that should be heard? Or is it because he or she hasn't been exposed to it? Exposure is critical; if you don't expose children to language, they're never going to learn it. The same is true with music.

We know that so much of language learning happens incidentally and it is that way also with music. But perhaps because a child has a hearing loss, it maybe never even occurred to a parent that music should continue to be a part of their child's life.

Linda: I can see how that would happen.

Christine: I want to know whether the child can or cannot hear a certain frequency range. Some kids have difficulty with really high-pitched sounds, others do just fine with the low, lower-ranged instruments. I have instruments that run the whole gamut from very, very low-sounding instruments called contrabass all the way up to really high-pitched glockenspiels. I try to find and match the child with an instrument that seems to be really appealing to him or her and then see where it lies on the spectrum of pitch. That gives me a clue such as, she's not really hearing that or he's hearing it but doesn't know what to make of it. I spend a lot of time working on what's that sound (just like you do when you are working with a child in an auditory or verbal way)? You know, "Oh, hear the drum goes boom, boom, boom" or "The rattle goes shake, shake, shake," or something like that. I pair the sounds with the instrument. And then we do discrimination kinds of things too, just like you would do in a language setting, only using the musical instruments to do that.

Linda: And how do you tie what you do to language development?

Christine: My approach is to gain meaningful language ability. We start with songs, because they're motivating for most children. Then maybe I'll work on repeated syllables, so we might sing a song all the way through on particular syllables, like "Ba, ba, ba, ba, ba, ba, ba" [sung to the melody of Mary Had a Little Lamb]. Or maybe the child is working on a particular word and I find a way to insert the word and make it really repetitive, for instance, "Boom, boom goes the great big, great big drum. Boom, boom, goes the great big drum." The hope is that the child can do the boom-boom part, and at the least then they can anticipate when it is that they need to jump in and say those two words; that's the language development.

Linda: So you're complementing the stage of language they are at, such as at a one-word stage or a two-word, etc.

Christine: Or phrases. So then the next step might be to leave off the last word of a phrase of a song. So for instance, "Twinkle, twinkle, little. . . ." and have the child fill that in. Then you back it up. "Twinkle, twinkle . . ." maybe he or she can do "little star" this time.

Linda: And would any of what you have said be different for children with cochlear implants?

Christine: What I tend to see among my kids with implants is that their music development is particularly delayed in the area of pitch. Being able to sing a song on pitch is going to be more difficult for themeven more so than for a child with a mild-to-moderate hearing loss who may be wearing aids. And the reason is that music is pretty complex spectrally and so it's represented less faithfully through the implant than it would be through a hearing aid. And one of the other things I am noticing is that with early training on pitch using their voice to sing up and down, high and low that their pitch starts coming. And so by the time they are 3