Music has been integral to the human experience since the earliest civilizations, greatly influencing humanity across cultures, generations, and individuals. Whether it is through listening to music for motivation during a workout, the nostalgic feeling triggered by a song from childhood, or the comfort found in a familiar playlist after a stressful day, music supports and resonates with humanity on a deeply personal and universal level. These everyday encounters with music lay the foundation for music therapy, as music at its core can promote significant healing and growth where other forms of communication may dissipate. Music can also facilitate more profound development beyond everyday encounters, especially for children and adolescents navigating critical developmental milestones. Childhood and Adolescence are times of rapid growth and change, as well as delicate stages of life that music therapy can harness to support. Missed milestones might indicate underlying challenges and can profoundly impact that child’s future. Music therapy helps overcome these obstacles by aiding children and adolescents in keeping up and thriving in their developmental journey.
What are Music Therapy and Developmental Milestones? How do they relate?
Music therapy can be complex to define due to its dependence on vastly different contexts and the needs of each client (Edwards, 2017). Because of this, the work is very personalized and includes various approaches, models, and populations (clients). Music therapy is the clinical and evidence-based use of music intervention designed to accomplish individualized goals within a therapeutic relationship (AMTA, 2005).
Music therapists often work with many different populations of people and needs at one given time, emphasizing the importance of a clear understanding of developmental milestones (Knight et al., 2018). Many consider milestones as achieving simple skills, such as taking one’s first step or smiling for the first time. However, milestones go beyond the earliest parts of early childhood; milestones change throughout life. The definition of developmental milestones consists of the growth and development of not only the physical changes that occur from infancy to adolescence but also the changes in emotions, cognition, personality, and speech that develop in children as they begin to comprehend and interact with the world around them (Choi, 2021a).
Professionals examine developmental milestones through the achievement of Physical Gross and Fine Motor skills, Language/Communication skills, Cognitive skills, Social/Emotional skills, and combinations of each (Centers for Disease Control and Prevention, 2023).
Music therapists typically use a wide range of techniques, approaches, methods, and interventions to assist with each client’s goals. Through intervention and established goals, a music therapist develops music interventions designed to produce and facilitate change desired by or for the client. Each session and technique will vary based on the client’s age and functional level (Knight et al., 2018). Music therapy can help produce and correct developmental milestones for young children and be adaptable to many situations.
In general, a music therapist may utilize four types of music-based methods. These methods include a Receptive Method in which clients listen to live or recorded music, often including a form of a verbal, musical, or nonverbal response; a Recreative method in which clients perform music such as singing, instrumental play, learning, or performing a musical work; a Compositional Method which entails a client writing musical material such as lyrics, instrumental works, or any other form of musical product, and lastly, an Improvisational Method which includes the client and therapist singing or playing an unprepared musical work (Knight et al., 2018).
Stages of Development Can Help Define Appropriate Milestones and Techniques Used in Music Therapy
The stages of development are a core foundation of developmental milestones. Although individual children and adolescents may develop and meet milestones at different rates, the stages of development often assist professionals with a generalized spectrum of appropriate milestones and age markers to ensure a healthy progression of development. The ages associated with each stage can vary across cultures, purposes, and theories, but the typical progression is as listed.
The First 2 Years
The first stage of development after birth is typically analyzed through the first two years, ranging from infancy to toddlerhood (Berger, 2021). Music therapy can be a beneficial tool during these years in many ways, though most notable is its work with newborns, a highly specialized population in music therapy (Edwards, 2017). The description for the key milestones one looks for in newborn development is as follows: within physical skills, newborns movements include motor skills that are involuntary and consist mainly of reflexes including but not limited to the Suck reflex, the Startle reflex, the Tonic Neck reflex, and the Grasp reflex. Within language/communication skills, crying is a newborn’s only form of communication, making it essential for caregivers to respond to cries to earn a baby’s trust and love. Cognitively, newborns may react to loud noises, look at faces and pictures, pay attention to voices, and show hints of smiling, especially in their sleep. Lastly, social/emotional milestones are focused primarily on building the foundation for future emotions and social developments, best achievable when caregivers tend to the newborn’s basic needs, such as soothing cries by touch and voice, ensuring healthy attachment formation (Choi, 2021b).
Music Therapy Intervention
At this stage, a significant priority for music therapists is giving infants the proper stimulation to support emotional regulation and manage stress (Edwards, 2017). Music therapists can help the population of infants in the Neonatal Intensive Care Unit, otherwise known as the NICU, but first must go through specialized training as they are by far the most fragile and delicate population to exist in music therapy; music therapy and other forms of intervention have the potential to harm fragile newborns if not practiced in the proper manners (Knight et al., 2018). Too much stimulation and sound can be harmful to infants. Infants may be in the NICU for various reasons, but it is important to note that babies born prematurely may reach milestones much later than the typical development of others (Choi, 2021b).
Music therapy interventions that are reported to be especially helpful in the NICU include but are not limited to Multimodal Stimulation, which is the introduction of sensory stimulation done by a music therapist that follows the natural developmental pattern, including auditory stimulation such as humming or singing, tactile stimulation such as massage or soothing strokes, vestibular stimulation such as rhythmic rocking, and visual stimulation such as eye contact (Knight et al., 2018). Another technique could be live singing, which includes Continuous singing and Song of Kin. Contingent Singing is when a music therapist adapts and reacts to an infant’s cues by modifying musical elements such as tempo, rhythm, and timbre. Song of kin refers to a parent-chosen or composed song meaningful to the family’s history or culture and sung to the infant (Knight et al., 2018). These songs usually entail the musical characteristics of a lullaby, as lullabies help soothe infants and create bonds between baby and caregiver. Last but certainly not least, Instrumental Womb Sounds may also be implemented in intervention as they are intended to replicate the sounds of a womb when in utero or to match and cultivate healthy breathing patterns or heart rates for infants, usually created with an ocean disk or gato box instrument (Belluck, 2013).
Early Childhood
Early Childhood is another typically specialized area in music therapy and may be called Early Intervention. This stage usually ranges from birth to age 3 or ages 2 to 5 (Berger, 2021). In this case, at the beginning of the stage, around age 2, the key milestones in physical skills include walking and running, beginning to throw, kick, catch, climb, and showing dominance in hands. Within language/communication, speech becomes more apparent, and the child starts to form sentences; vocabulary is around 200-300 words, and they may start to identify and name body parts. In terms of cognition, 2-year-olds may understand the concept of possession, recognize their names and ages, begin counting, and may start developing problem-solving skills. In social/emotional milestones, children typically parallel play but do not quite understand the concept of sharing. They might even begin to mask their emotions in social situations, and temper tantrums are common (Tills, 2021).
At the end of this stage, around age 5, the milestones in physical skills include jumping rope, walking backward, using scissors, learning how to tie shoes, and drawing shapes. In language/communication: 5-year-olds’ vocabulary is between 1,000-2,000 words, though sound errors and stuttering are common in speech. In terms of cognition, a distinctive part of this age includes Perspective Theory, in which children begin to understand other people’s perspectives (and not meeting this milestone can be a component of Autism). Social/emotional milestones include having a group of friends and becoming more attached to parents as they enter school (Mody, 2021).
Music Therapy Intervention
During this stage of development, music therapy can assist in many of the fundamental milestones essential for schooling and meeting future milestones. Early Childhood is often the stage in which developmental disabilities present themselves, making early intervention crucial to recognize and help the child so they do not suffer later in life. Specific to early childhood populations, music therapy is efficacious in improving young children’s social skills by enhancing speech and language development (Knight et al., 2018).
The music therapy interventions seen in this stage of development include singing exercises and rhythmic chants, which can help develop expressive and receptive language. For example, Hello/Goodbye Songs help familiarize children with transitions within the music therapy process, their names, and social greetings such as waving, shaking hands, and cooperating with others (Florida State University College of Music, n.d.). Another intervention can include Instrumental Play, which focuses on hand-eye coordination and fine motor skills aided by playing instruments such as the triangle and drums, which require particular finger and grasp patterns and control (Florida State University College of Music, n.d.). As well as Song phrases/Sound Effects, which are songs that utilize sound effects and techniques such as leaving space at the end of a phrase for a child to fill in with their own words, which in turn can help form speech patterns for children, even for children who have never spoken a word before (Knight et al., 2018).
Middle Childhood
Middle Childhood usually ranges from ages 6-12 (Berger, 2021). Toward the beginning of this stage, regarding physical developmental milestones, 6-year-olds are expected to adequately run, jump, catch, and coordinate their upper and lower body in exercise. Within language/communication skills, children typically have a vocabulary of between 2,500 and 7,000 words, ask what unfamiliar words mean, and may increase their literacy in word meaning and sentence phrasing. Cognitively, 6-year-olds understand numbers, daytime, and nighttime; can read age-appropriate books; and can understand commands with three separate instructions. Within social/emotional milestones, they create “best friends,” want to be like friends and please them, like to copy adults, and can get jealous of others and siblings (Villa, n.d.).
At the end of this stage, around age 12, the milestones in physical skills include beginning puberty; schools also usually recommend at least 1 hour of substantial physical activity per day, and organized sports may be present. Within language/communication, pre-teens typically enjoy writing stories, talking on the phone, and texting; reading well is typical of this age, and sarcasm in conversation may be apparent. In cognitive milestones, children’s attention span is growing, they have an increased memory capacity, as seen in working memory, and they have a better problem-solving ability. Within social/emotional milestones: a new level of desire to be socially accepted is apparent, friendships are valued, and pre-teens may begin to develop innocent romantic interests and pave the way for independence (Villa, n.d.).
Music Therapy Intervention
As opportunities for more independence and academic challenges present themselves in middle childhood, many issues may arise as well, including but not limited to behavioral disorders and, perhaps most surprisingly, the onset of several mental health issues in some cases. Mental health is an essential part of the well-being of people at any age, but this is a crucial aspect of the development of the health of children and adolescents. Approximately 1 in 5 children and adolescents in the U.S. experience mental and behavioral health challenges (AMTA, 2019). Childhood behavioral health conditions that music therapists work with may include behavior disorders, mood and anxiety disorders, ADHD, Autism Spectrum Disorder (ASD), trauma, and emotional dysregulation (AMTA, 2019).
A few music therapy interventions that may assist some of these disorders include Song Parodies, which may help social milestones in the case of listening and following instructions. The lyrics of song parodies reinforce and cue the child to recall and perform a particular action, for example, a “good talking tips” song for school-aged children." (Edwards, 2017). Another approach is Top-Down and Bottom-Up Learning, which targets emotion-based goals like emotional regulation. The “Top-down” approach involves conscious awareness, learning emotional skills such as labeling and identifying others’ emotions, and learning and practicing coping strategies (Edwards, 2017). This approach includes playing music that elicits certain feelings (such as a minor key representing someone sad or a happy and bouncy rhythm to reflect someone happy). The “Bottom-up” approach involves managing emotional experiences in the moment and self-regulation, as practiced through the example of musically led alterations of stimulating and calming music experiences in which children learn to control their feelings (Edwards, 2017). Listening to music, playing instruments, and composing are all interventions that can aid all milestones, primarily cognitive and social milestones, and present opportunities to improve attention span, executive functioning, and academic skills (Edwards, 2017).
Adolescence
Adolescence usually includes ages 13-18 (Berger, 2021). A more extensive range of key milestones during adolescence includes puberty and growth spurts. At the same time, fine motor skills are efficient through activities such as driving, playing an instrument, and sports; coordination and endurance are all examples of physical milestones. Within language/communication, teenagers’ language is very reflective of adults; grasping word meanings and contexts is expected, explanations become more figurative and less literal, and social media might be a more prominent source of communication at this stage. Cognitively, complex thinking is apparent, and one typically begins to think about long-term goals, forms a code of ethics, develops individual identity, opinions, and thoughts, and may develop intolerance of opposing views. Within social/emotional milestones, adolescents seek independence and self-identity apart from their families, compare themselves to their peers, romantic relationships become important, and emotional regulation is more controlled. Self-esteem often fluctuates (Kennedy, 2021).
Music Therapy Intervention
Adolescence provokes many changes in development, mood, and identity. Many mental health concerns and factors may align with this stage of development, such as eating disorders and depression, which are some of the most common mental health disorders among adolescents. Music can enhance an adolescent’s health, including identity formation, resilience, competence, and connectedness. (Edwards, 2017).
The music therapy interventions that may aid this stage of development include songwriting, a beneficial means of psychotherapy. Through songwriting, adolescents can express their individuality, emotions, and personal experiences (Knight et al., 2018). Songwriting may help adolescents decipher their thoughts and feelings and encourage self-reflection. Another approach may be Group Music Therapy, which can be a positive intervention among adolescents. Group Music Therapy includes several individuals coming together with a music therapist and working on goals through a community. Group music therapy may be a non-confrontational way for members to share their problems, feelings, and issues with the therapist and others suffering from similar problems. Discussions about important songs to the individual, lyric analysis, and relatable experiences can be shared, bringing a sense of community and identity to the group (Edwards, 2017).
Who Does This Regard?
Music Therapy Services can benefit many people at any age, skill level, or condition. Music therapists can see the client for a vast number of reasons. In many cases, children’s ECI services (Early Childhood Intervention), IEPs (Individualized Education Plan), and treatment plans require the collaboration of many doctors, therapists, professionals, parents, and educators. It is a team effort. It is very common for music therapists to work in teams with other professionals for each client. Pediatricians usually identify red flags in developmental milestones, and although music therapists cannot diagnose disorders, they can refer families for assessments and evaluations and advocate for early intervention. Because of this, they must be aware of developmental milestones and red flags in healthy development. Certain professionals and specialists are called upon to aid different disabilities, whereas music therapy can help assist each of these milestones and lessen the symptoms of chronic disabilities.
Conclusion
Music therapy can offer many different, individualized, and impactful ways to support and achieve developmental milestones crucial to childhood and adolescence. Whether a music therapist is helping the delicate needs of infants in the NICU, helping children battle the cognitive and social symptoms of ADHD and Autism, or the complex social needs of teenagers struggling with mental health, music therapy can be a suitable intervention for meeting children and adolescents where they are in their development. Though some of the techniques of a music therapist may seem effortless, such as singing, chanting lyrics, or playing rhythms on an instrument, music therapy is much more than keeping a simple beat; it can impact the physical, language, cognitive, and social/emotional growth of a person who might not otherwise be able to achieve fundamental developmental tasks. Beyond this, children and adolescents are not the only populations for whom music therapy can cultivate change; music therapy has the tools to impact many people’s lives, ranging from those who are taking their first breath and need a little guidance in doing so, to those who are taking their last. Though the application of music therapy may be new to some, the power of music is not a new concept to humanity; through music therapy, positive change and prosperity can be cultivated in the lives of children, adolescents, and even populations beyond traditional developmental years.