Music, Arousal and Self-Injurious Behaviour

285 Pages·2016·4.83 MB·English

School of Psychology and Speech Pathology

Music, Arousal and Self-Injurious Behaviour: A Three-Stage
Mediating Model for Children with Low Functioning Autism

Jeremy Kent Marriott

This thesis is presented for the Degree of
Doctor of Philosophy
of
Curtin University

October 2015
DECLARATION

To the best of my knowledge and belief this thesis contains no material
previously published by any other person except where due acknowledgment has been
made. This thesis contains no material which has been accepted for the award of any
other degree or diploma in any university.
The research presented and reported in this thesis was conducted in accordance
with the National Health and Medical Research Council National Statement on Ethical
Conduct in Human Research (2007) – updated March 2014. The proposed research
study received human research ethics approval from the Curtin University Human
Research Ethics Committee (EC00262), Approval Number HR138/2011.

Signature: ………………………………………
Date: ………………………………………

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ACKNOWLEDGEMENTS
Thank you to my primary supervisor, Emeritus Professor Jan Piek, for her steadfast
guidance, knowledge, perseverance and astute reviews. Thank you to my co-
supervisor/statistical advisor, Dr Robert “The Man” Kane, for his statistical brilliance,
patience and hard work. Thank you to my co-supervisor/clinical biochemist, Dr Cyril
Mamotte, for his commitment to science, teaching and collaboration.

Thank you to David and Gillian Helfgott, for their expertise, support, and philanthropy.
Thank you to senior laboratory technician, Mrs Sophie Wylde, for her pleasant and
effective methods of supervising/guiding my lab work. Thank you to Dr John Wray
for his support, direction, towering clinical expertise and endearing passion for
improving the lives of children with LFA.

Thank you to Professor Andrew Whitehouse for his most valuable time, interest and
encouragement. Thank you to audio visual expert Mr Dale Towner for his expertise
and unrelenting enthusiasm for this project. Thank you to Qualtrics Survey Software
representative in Mrs Alison Lynton for her technical knowledge and timely responses.
Thank you to Dr Melissa Davis for her input and Dr Trevor Mazzuchelli for his
enthusiasm and review.

Thank you to music teachers Graeme and Andrea Stimson for their musical expertise.
Thank you to Mr Tristian Senycia for designing and Mr Joshua Brett for fabricating
the school bus seat pair sub-frame used in Study 2. Thank you to Arlina Suliman for
her drawings of the school bus ride simulator and Ms Lynda Monkhouse for her
formatting of this thesis.

Thank you to the participating schools, teachers and bus drivers. Thank you to the staff
at the Public Transport Authority - School Bus Services and Department of Education
Western Australia for their support, open mindedness and ethical guidance. Thank you
to the Child and Adolescent Health Service of Western Australia and Curtin University
for funding the saliva collection tubes, swabs and assay kits. Thank you to the
Scholarships Office at Curtin University for supporting me through to completion.
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Thank you to my family and friends, past and present for their understanding and
encouragement: especially Howard Arthur Brett. Thank you to Chrissie Herbert for
her understanding, commitment and support. Thank you to my fellow doctoral
candidates who have undertaken and completed research designed to truly make a
difference, Dr Petra Skeffington especially.

Thank you to the boys with LFA and their families for participating in this research.
Thank you to those who have afforded me the privilege of acquiring the experience
and knowledge required to identify and investigate a genuine area of need.

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ABSTRACT
Reports suggest that listening to calming music can reduce arousal. Reports
also suggest that reducing arousal can reduce self-injurious behaviour (SIB). Prior to
the present research, these reports had not been investigated amongst school-aged boys
with autism spectrum disorder (ASD) and an intellectual disability (ID) known as low
functioning autism (LFA). The following research investigated the potential for
biological arousal to mediate a relationship between music listening and SIB amongst
school-aged boys with LFA.
Study 1 incorporated musical factors, form, segment and expert musical
consultations into the selection of a calming music playlist. Thirty-two primary carers
of males with LFA rated the calming properties of 6 two-minute musical segments
based on how calming they would be for their son with LFA. A generalised linear
mixed model (GLMM) identified the second movement of Ludwig van Beethoven’s
sonata No. 8 in C minor, Op. 13 adagio cantabile known as his Sonata Pathetique and
the first movement of Beethoven’s sonata no. 14 en do dièse mineur, Op.27, No. 2
adagio sostenuto known as his Moonlight Sonata as significantly more calming than
the other segments in the playlist but not more calming than each other. Beethoven’s
Sonata Pathetique was then selected via expert musical consultation for application in
Study 2 and Study 3.
Study 2 assessed whether school-aged boys with LFA who listened to
Beethoven’s Sonata Pathetique would record lower biological arousal after being
exposed to an adapted trier social stress test for children (TSST-C) in the form of a
morning school bus ride simulation. Fifteen boys with LFA were randomly allocated
to a music listening group and 15 boys, matched by school-age and LFA diagnosis,
were randomly allocated to a no music group. Saliva samples were collected from the
boys before, and at 4 time-points after the simulation. The samples were analysed for
biomarkers of arousal: salivary cortisol (sCort) concentration as a hypothalamic-
pituitary-adrenocortical (HPA) axis biomarker and salivary alpha-amylase (sAA)
activity as an autonomic nervous system (ANS) biomarker. The music group recorded
significantly lower sCort across the collection time-points compared with the no music
group. This result suggested that music could reduce arousal for boys with LFA in a
controlled and demanding environment.
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A single-case design comprising two conditions with repeated trials, Study 3
assessed the sCort, sAA and SIB frequencies of three school-aged boys with LFA
ranging in age from 14 to 16 years (M = 15.3 years, SD = 1.1 years), on the same day
each week over four consecutive weeks. Two of the boys (named Bill and Harry)
exhibited ear-blocking SIB and one (named George) with pica SIB. Treatment Day 1
and Day 3, administered during weeks one and three, required the boys to take their
usual morning school bus ride, provide saliva samples across five time-points and have
video footage of their behaviour recorded by the researcher. Treatment Day 2 and Day
4, administered during weeks two and four, were identical to Day 1 and Day 3 with
the addition of the Sonata Pathetique for the final 14 minutes and 35 seconds of the
morning bus ride. The saliva samples were analysed for sCort and sAA as per Study
2. In addition, video footage collected on the school bus and at school was analysed
for SIB frequencies using a partial interval recording (PIR) analysis. Motivation
Assessment Scale (MAS) ratings provided by primary carers were recorded then
analysed to identify possible SIB motivating factors.
Study 3 assessed the validity of seven hypotheses using two distinct statistical
stages. Stage 1 tested Hypotheses 1 to 3 and stage 2 assessed Hypotheses 4 to 7.
Hypothesis 1 aimed to determine if listening to calming music could reduce the
frequency of SIB (ear-blocking or pica) compared to non-exposure. Hypotheses 2 and
3 assessed whether listening to calming music was associated with reductions in sCort
concentrations and sAA activity respectively when compared non-exposure.
Hypotheses 4 and 5 aimed to determine if reductions in sCort and sAA would be
associated with reductions in SIB frequencies respectively. Hypothesis 6 assessed if
changes in sCort were associated with changes in sAA. Lastly, Hypothesis 7 assessed
if increases in SIB frequencies were associated with either a symmetrical association
or an asymmetrical association between sCort and sAA (Bauer et al., 2002).
Hypotheses 1 through 3 were tested using a conventional single-case design
visual analysis. Hypotheses 4 through 7, used an unconventional single-case analytic
technique by conducting series of Fisher’s Exact tests to determine potential
associations between sCort concentration, sAA activity and SIB frequencies. sCort
concentration and sAA activity means and standard deviations (SDs) for each
participant were converted to z-scores and analysed across the four treatment days of
the study. SIB frequency data were gathered via 10-second PIRs as rated by the
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researcher and two independent inter-raters based on video footage recorded on the
bus and at school.
In relation to Bill and Harry, stage 1 of the analysis revealed no support for
Hypotheses 1, 2, or 3. Further, stage 2 of the analysis revealed no support for
Hypotheses 4, 5, 6, or 7. In relation to George, listening to calming music reduced the
frequency of his pica SIB on Day 2 (Music); supporting Hypothesis 1. However, this
was not replicated at Day 4 (Music). The remainder of George’s stage 1 analysis
revealed no support for Hypotheses 2, or 3. In addition, his stage 2 analysis revealed
no support for Hypotheses 4, 5, 6, or 7.
Of interest, the significant sCort reduction detected in the controlled school bus
simulation environment of Study 2 did not generalise to the naturalistic morning school
bus ride setting of Study 3. Key findings, theoretical implications, clinical
implications, strengths, limitations and recommendations for future research are
discussed.
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TABLE OF CONTENTS

DECLARATION ............................................................................................. I
ACKNOWLEDGEMENTS .......................................................................... II
ABSTRACT .................................................................................................. IV
TABLE OF CONTENTS ........................................................................... VII
LIST OF TABLES ..................................................................................... XIV
LIST OF FIGURES ................................................................................... XV
LIST OF ABBREVIATIONS ................................................................... XIX
CHAPTER 1: INTRODUCTION ............................................................... 20
CHAPTER 2: LITERATURE REVIEW ................................................... 22
2.1 Autism Spectrum Disorder from Past to Present ................................... 22
2.2 ASD Prevalence: Global, National and Local........................................ 25
2.3 ASD Causal Theories and Factors ......................................................... 25
2.4 Defining Low Functioning Autism ........................................................ 27
2.5 Self-Injurious Behaviour: A Definition .................................................. 28
2.5.1 SIB: Possible causes ....................................................................... 30
2.5.2 SIB: Possible treatments ................................................................ 32
2.5.2.1 SIB: ABA behavioural techniques for children with LFA ....... 32
2.5.2.2 SIB: Pharmacological therapies for children with LFA ........... 35
2.6 Music Therapy ....................................................................................... 38
2.6.1 Active music therapy ...................................................................... 40
2.6.2 Passive music therapy: Music listening ......................................... 41
2.7 Arousal ................................................................................................... 43
2.7.1 The hypothalamic-pituitary-adrenal axis and cortisol .................... 43
2.7.2 The autonomic nervous system and alpha-amylase ....................... 46
2.7.3 sCort and sAA ................................................................................ 47
2.7.4 The HPA Axis and ANS ................................................................. 48
2.8 The Trier Social Stress Test.................................................................... 48
2.9 The Trier Social Stress Test for Children ............................................... 50
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2.10 The Kagan et al. (1994) and Bauer et al. (2002) Models of Child
Behaviour ..................................................................................................... 50
2.11 Summary .............................................................................................. 55
CHAPTER 3: RATIONALE ....................................................................... 58
3.1 Why Treat SIB for Children with LFA? ................................................. 58
3.2 Music Listening ..................................................................................... 59
3.3 Music Listening and Arousal ................................................................. 60
3.4 The Hypothalamic-Pituitary-Adrenocortical Axis and Cortisol ............ 61
3.5 The Autonomic Nervous System and Alpha-Amylase .......................... 61
3.6 Group or Single-Case Research ............................................................. 62
3.7 The Three-Stage Mediating Model ........................................................ 63
3.7.1 Study 1............................................................................................ 64
3.7.2 Study 2............................................................................................ 65
3.7.3 Study 3............................................................................................ 65
CHAPTER 4: STUDY 1 .............................................................................. 67
4.1 The Problem: An Absence of Music Selection Methods ....................... 67
4.2 Selecting Music by Period and Composer for Music-Based Interventions
...................................................................................................................... 69
4.3 Common Musical Forms of the Classical Period .................................. 70
4.4 Method ................................................................................................... 71
4.4.1 Participants ..................................................................................... 71
4.4.1.1 Study 1: A ................................................................................. 71
4.4.1.2 Study 1: B ................................................................................. 72
4.4.2 Procedure ........................................................................................ 72
4.4.2.1 Study 1 - A ............................................................................... 72
4.4.2.2 Study 1 - B ............................................................................... 75
4.5 Data Analysis ......................................................................................... 77
4.5.1 Statistical assumptions and power.................................................. 78
4.6 Results .................................................................................................... 78
4.7 Discussion .............................................................................................. 80
4.8 Summary ................................................................................................ 82
CHAPTER 5: STUDY 2 .............................................................................. 83
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5.1 Method ................................................................................................... 83
5.1.1 Participants ..................................................................................... 83
5.1.2 Apparatus ........................................................................................ 84
5.1.2.1 Saliva sampling and assays ...................................................... 84
5.1.2.2 Morning school bus ride simulator .......................................... 85
5.2 Procedure ............................................................................................... 91
5.2.1 Saliva assays ................................................................................... 96
5.3 Data Analysis ......................................................................................... 98
5.3.1 Statistical assumptions ................................................................... 98
5.4 Results .................................................................................................... 98
5.5 Discussion ............................................................................................ 102
5.6 Summary .............................................................................................. 106
CHAPTER 6: STUDY 3 ............................................................................ 107
6.1 Method ................................................................................................. 108
6.1.1 Participants ................................................................................... 108
6.1.2 Apparatus ...................................................................................... 109
6.2 Procedure ............................................................................................. 112
6.2.1 Ethics ............................................................................................ 116
6.2.2 Participant recruitment via special educational schools ............... 116
6.2.3 Participant recruitment via the PTA-SBS ..................................... 117
6.3 Design .................................................................................................. 118
6.4 Data analysis ........................................................................................ 118
6.4.1 Hypotheses ................................................................................... 118
6.4.2 Stage 1 .......................................................................................... 119
6.4.3 Stage 2 .......................................................................................... 120
6.5 Single-case presentation: Bill .............................................................. 120
6.5.1 Family and developmental history ............................................... 121
6.5.2 Accommodation and schooling .................................................... 121
6.5.3 Physical attributes and demeanour ............................................... 121
6.5.4 Communication ............................................................................ 122
6.5.5 Nutrition ....................................................................................... 122
6.5.6 Music ............................................................................................ 122
6.5.7 Behaviour ..................................................................................... 122
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