Download Quenching a Desire for Power: The Role of Music

Quenching a Desire for Power:
The Role of Music Therapy
for Adolescents With ADHD
Katrina McFerran
Faculty of Music, University of Melbourne, Australia
here is a growing body of literature that investigates the value of
music therapy for people with emotional and behavioural disorders
such as attention deficit disorder. These studies often focus on overt
behavioural change as the indication of successful outcomes. The
instrumental case study reported here challenges this focus and
provides a description of music therapy for one young man that
emphasises the importance of power in his experience. A grounded
theory analysis of this single case reveals that both individual and
small-group music therapy provided important opportunities for the
young man to express himself and to control what he and others did.
This example is intended to stimulate the contemplation of different
understandings of the potential role for music therapy, with an
emphasis on emotional needs and quality of life as the primary focus.
T
Keywords: music, empowerment, ADHD, pre-adolescent, grounded theory
The practice of music therapy is increasingly popular in special education settings in
Australia with many school principals being familiar with its purpose and methods
(Booth, 2004). In the United States, Jackson (2003) identified 1,116 board certified
music therapists as working with school populations. Many of these therapists are
serving youth who have mild, moderate, and severe behaviour disorders. Although
variously defined, a common conception of music therapy for young people with
behavioural disorders is provided by the author as follows.
Music therapy is the planned and intentional use of the properties of music to
achieve nonmusical goals. The relationship between the therapist and child or group
is primary to the process of assessment, treatment and evaluation that occurs.
Shared music making is frequently the basis of this relationship, with instrument
playing, song writing and singing, and movement all being used to address
presenting developmental needs.
Although there is a substantial body of literature describing music therapy
practice in special education (see systematic reviews by Jackson, 2003; McFerran,
Lee, Steele, & Bialocerkowski, 2009; Wigram, 1993; and a Cochrane review by Gold,
Wigram, & Elefant, 2006), this material is particularly focused on children with
disabilities such as cerebral palsy and children on the autistic spectrum. In the
following rationale the sparse literature directly relevant to Attention Deficit Disorder
Address for correspondence: Katrina McFerran, PhD RMT, Faculty of Music, University of
Melbourne VIC 3010, Australia. E-mail: [email protected]
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Empowerment and Music Therapy
and Emotional Behavioural Disorders will be canvassed and gaps in knowledge will be
highlighted. This literature will be presented in terms of models of intervention (group
compared to individual), as well as research outcomes monitored (primarily behaviour),
and various approaches to music therapy practice (behavioural compared to humanistic).
The contrast between the focus of this literature and the author’s clinical experiences was
her main motivation in undertaking a systematic investigation of one young man’s
experience of individual music therapy from within a humanistic framework. The purpose
of the investigation was therefore to further explore the use of music therapy in addressing
the needs of young people with emotional and behavioural disorders with a focus on the
emotions, rather than the behaviours. An individual case study has been used to stimulate
this discussion and promote the need for further research.
Literature Review
The music therapy literature specific to young people with Attention Deficit Disorders
(including ADD and ADHD) or Emotional Behavioural Disorders (EBD) reports almost
exclusively on group work. This stands in stark contrast with data from a recent survey
of American music therapists working with elementary school children who have
ADHD (Jackson, 2003). In this survey of 500 music therapists, n = 98 identified working
with young children with ADHD, of which 41% worked both individually and in
groups. Although only 20% worked exclusively in individual formats (and 29% only in
groups), this figure is a much more useful representation of music therapy work with
this population. Gardstrom’s (2004) work is the only published exception to this
overwhelming bias towards reporting group work, and her article is focused on
individual improvisation work with troubled adolescents outside the special education
sector. The heavy emphasis on music therapy group work in the literature may well be
influenced by positivist values, where greater numbers is seen as equivalent to greater
validity, given the dominance of quantitative designs apparent in the literature.
A further misrepresentation of the clinical application of music therapy is found in
the intervention methods reported in studies. The most frequently quoted study in the
field (Montello & Coons, 1998) describes contrasting approaches of active and passive
music therapy sessions based on the hypothesis that active music therapy sessions would
be more effective. The ‘active’ music therapy sessions in this study involved a highly
structured session format through which students learned to read and play rhythmic
patterns on drums, in contrast to a music listening focus in the ‘passive’ sessions. Results
indicated that both interventions were equally effective in achieving improvements in
attention and motivation, and to a significant degree, hostility. Nonetheless, the learning
of music reading and performance is not a typical strategy of music therapy sessions,
even within the behavioural models dominant in some parts of the United States.
A more accurate representation of a highly structured group music therapy session is
provided by Sausser & Waller (2006) who outline the goals for individual and group
music therapy sessions as:
• create structured, safe musical experiences for students to achieve success and
increase self-esteem
• establish group cohesion and cooperation through welcome activity
• provide organised and planned sessions focused on achieving a group goal
• encourage on-task and appropriate behaviour
• provide musical experiences to encourage self-expression, communication skills and
socialisation
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• facilitate group movement to music activities
• provide musical experiences that reinforce cognitive and language skills.
Early studies in the field frequently employed a behavioural orientation to music
therapy practice, with music being provided as a positive reinforcement for positive
outcomes. Cripe’s (1986) study used rock music to this end and identified decreased
motor activity in response. Eidson’s (1989) participants achieved improvements in
interpersonal skills that were identified as transferring into the classroom setting.
Although the motivational effects of music have been well documented within
applied behavioural analysis designs, a recent meta-analysis (Gold, Voracek, & Wigram,
2004) of the effects of music therapy for children and adolescents with psychopathology
provides another perspective. This rigorous evaluation of the literature claims that
effects tended to be higher for eclectic, psychodynamic and humanistic approaches than
for behavioural approaches. Within the field of music therapy, ‘psychodynamic practice’
is understood as approaches informed by understandings of unconscious dynamics
originating with Freudian thought but more currently based on the work of Stern
(1985) and Winnicott (1975). ‘Humanistic practice’ involves a focus on unconditional
positive regard for each individual (Rogers, 1951) based on the assumption that all
people have the capacity to achieve their full potential given a supportive context
(Maslow, 1968). The Gold, Voracek and Wigram study (2004) calculated highly
significant results on clinically relevant outcomes based on 11 studies incorporating 188
subjects, including both the Eidson (1989) and Montello & Coons (1998) studies noted
above. These findings highlight a more common model of music therapy practice,
where an eclectic approach is adopted to suit individual client needs that may best be
approached through a combination of humanistic, psychodynamic and behavioural
strategies. Decisions about choice of approach are typically based on a context-aware
assessment of the individual’s needs, including acknowledgement of what other support
services are being accessed, as well as identifying appropriate goals for a music therapy
intervention. For example, if a client already accesses music classes, the intervention
strategy described by Montello & Coons (1998) would be redundant and a more
psychodynamic approach would be warranted to address personal developmental goals.
In contrast, if a child is receiving ample psychosocial support through psychologists,
social workers and counsellors, then music therapy may well focus on enhancing selfesteem through successful learning experiences facilitated in a therapeutic framework.
Nonetheless, a body of evidence is growing in the music therapy literature that
challenges psychodynamic approaches to clients with ADHD. This is exemplified in the
work of Rickson in New Zealand. Her initial investigation (Rickson & Watkins, 2003)
studied the prosocial behaviours of aggressive adolescent boys, only to discover that the
outcomes of the two intervention groups were heavily influenced by the dominant
presence of an ADHD diagnosis in one of the groups. A mild increase in disruptive
classroom behaviours post music therapy was discovered for this group, in contrast to
the non-ADHD group where an increase in appropriate social interactions was noted
within their residential setting. In a follow-up study (Rickson, 2006), the humanistic
approach to music therapy explained by Rickson was contrasted with a more
instructional approach to music therapy similar to the Montello & Coons (1998) model,
using a multiple contrasting treatment and experimental control design for two groups
of boys diagnosed with ADHD. No significant difference was identified between the two
models of intervention, however classroom behaviour appeared to be slightly more
improved in response to the highly structured intervention.
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The literature appears to provide a number of warnings about possible contraindications for group music therapy models that use an open-ended structure in line with
humanistic/psychodynamic approaches. However this literature has typically focused on
measuring behavioural variables that are seen as intrinsic to ADHD, such as impulsivity
and motor activities. The emotional needs of this group of young people have been largely
ignored in the literature, as has the obvious value of individual interventions that contrast
with the child’s daily experience of classroom groups. The qualitative investigation
conducted by Gardstrom (2004) identified a number of meaningful elements in individual
music therapy sessions with troubled adolescents, suggesting benefits related to emotional
expression, connection and sustained engagement. These descriptions closely matched the
author’s clinical experiences and provided the inspiration for this position paper. A case
study investigation was conducted that sought to illustrate the discussion points through
the experiences of one 12-year-old male with ADHD.
The Case Study
Method
Design
A qualitative case study design was selected in order to both illustrate and investigate the
less overt elements at play in a typical music therapy session. A rigorous approach to the
investigation of a single case has been increasingly documented in the research
literature, with Stake’s model of instrumental case study being applied here in order to
‘gain insight into an issue’ and to advance understanding of an issue beyond the case
itself (Stake, 2005, p. 445).
Throughout the 9 months of intervention, data was collected from multiple sources
including:
• interviews with the young man and his peer who attended sessions
• interviews with the classroom teacher and teacher’s aide based on their observation of
video footage as well as their perceptions of the return of the young man to the
classroom
• progress notes recorded by the researcher at the conclusion of each session
• lyrics of original songs written in sessions
• lyrics of pre-composed songs selected for singing in sessions.
The Participant
The 12-year-old boy (referred to by the pseudonym Ben for the remainder of this article)
had recently commenced individual music therapy sessions on a weekly basis. The school
psychologist who referred Ben to music therapy was familiar with his case and functioned
in a consultative role to the classroom. The classroom teacher described Ben’s behaviour as
aggressive, estimating that he would hit people on a daily basis and persistently provoke
others to engage in negative interactions with him using threatening behaviour and
tormenting language. In contrast, both the psychologist and the classroom teacher had
observed his pleasure in participating in creative therapies groups and believed that he
would benefit from the focused therapeutic relationship available in individual music
therapy. Ben had been diagnosed with ADHD in his first year at school and commenced a
standard dose of Ritalin at that time; however, after approximately 2 years his mother
ceased medications because she felt it was impacting on his learning in a negative way.
Later that year Ben was diagnosed with a mild intellectual disability (IQ score of 65) at
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Katrina McFerran
which point he transferred to the special school where the case study took place. After a
number of years without medication, he recommenced in the middle of the year being
described, on an initial dose of 1.5 tablets, 2 × daily, that was reduced to 1 tablet, 2 × daily
because it impacted his ability to wake up in the mornings. Ben’s mother described the
decision to recommence medication as being related to his increasingly aggressive
behaviour that had led to a number of suspensions from school.
Ethics approval was achieved (Department of Education, Victoria #SOS003325) and
consent was provided by Ben and his primary caregiver, as well as two staff members and
another student involved in the project. Sessions were run for 45 minutes on a weekly basis
at the beginning of the day for two school terms (approximately 5 months), until another
student was introduced into the sessions (approximately 3 more months). Music therapy
methods included song writing, improvisation, song singing, and working towards the
performance of a song composed by Ben for the school. Goals of the sessions initially
focused on providing Ben with opportunities for choice and control and facilitating active
creative engagement that represented authentic self expression. In response to the
extremely positive experiences within sessions, more far-reaching goals were then set that
focused on transferring the strengths demonstrated within sessions into behaviour outside
of music therapy — specifically in the classroom and schoolyard. At this point, another
student diagnosed with ADHD who had also been receiving individual sessions was
invited to join music therapy with Ben. The purpose of this inclusion was to increase the
social requirements of the session and to focus on interactions with same aged peers rather
than therapeutically oriented adults.
Data Analysis
Data from the sources noted above were compiled as text within NVivo7©, a program
designed for managing and analysing qualitative research data.
A conventional grounded theory analysis was undertaken of the data, based on the
techniques and procedures detailed by Strauss & Corbin (1998) and adapted to a single
case study design. This process began with an inductive analysis that categorised similar
information together, described as open coding. The coding process was then
approached again with a more conceptual orientation that aimed to cluster the open
codes around identified axes, described as axial coding. A storyline memo was
constructed based on a number of prominent categories that had emerged, resulting in
the identification of a single central category, with dimensions and properties being
attributed to this based on the coded material. A descriptive storyline was then
developed with a final descriptive result statement being articulated.
Results
In the following section the results of the analysis are provided in several formats that
match the explanation of methodology offered above. The order of presentation is
slightly different from the process of data analysis in order to provide the reader with
the main result of the study first, thus promoting a more informed scrutiny of the indepth results offered subsequently. This use of transparency is a standard qualitative
strategy used for enhancing the validity of results so that the reader can determine
whether they consider the interpretations to be biased or valid.
Descriptive Result
This succinct final descriptive result is presented first in order to provide a focus for the
more detailed results presented after it. In this single case study the grounded theory
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methodology has not been used to develop a theory, but rather to identify a specific
theme that may be used as the basis for further investigation.
The process of music therapy was empowering for this young man as he used the opportunities
to express himself and to control what he and others did.
Storyline Memo
The Storyline Memo was created in response to the axial coding process. This lengthy
memo provides insight into the content of sessions based on four conspicuous axial codes
that had been identified — self-perception, interpersonal relations, energy and power. It was
from the development of this storyline that the dominance of the category of ‘Power’
emerged as central, with far reaching consequences across all of the axes identified.
Power was the central issue in Ben’s experience of music therapy. Beginning before he entered
the music therapy room for session 1, Ben associated music therapy with playing out his
fantasies through identifying as a musician, despite his lack of musical training. This expectation often resulted in enthusiastic participation with displays of sustained attention as he participated in his preferred musical activity on a given day. Examples include the composition of
songs titled ‘Best Friend’ and ‘Bam went the gate’, which incorporated fantasy stories presented
as truth to the music therapist, and assisted in building up of an image of being tough and
powerful. This contributed to developing an improved perception of self, although it was not
necessarily based on a realistic evaluation of his musical skills.
Music therapy offered Ben the opportunity to be in control of others as well as of his own selfperception. This was experienced interpersonally by communicating his desires to others about
how they should play in order to best represent his songs or to suit him. When this occurred in
individual sessions it was directed at the music therapist and music therapy students in training
and provided evidence of his commitment to the music. In the shared sessions, it was expressed
initially as a reluctance to mentor his younger classmate because this detracted from his desire
to be focused entirely on himself. This developed into a more generous attitude towards his
peer, who kindly embraced his role as junior and dutifully admired Ben’s musical ability.
Music therapy was not always a positive experience for Ben, and he was sometimes flat
within sessions. His fluctuating energy levels had a significant impact on the content of
sessions, as he would engage in different ways with the music. Singing songs from the
songbook seemed to be a safe activity for Ben, and his teacher described him as having a
vast repertoire of known songs. At these times, a more vulnerable side of his nature would
emerge, as he elected to sing songs by James Blunt, Guy Sebastian, and Shannon Noll —
popular Australian male singers who frequently address topics related to emotions in their
lyrics. This was also reflected in the composition of a love song, as well as the final song
composed with his peer and called Don’t Worry, which was based around a repeating phrase
of ‘Don’t worry, it’s OK, I’ll be coming over to see you today’.
This vulnerability was also seen in Ben’s response to hearing himself after being recorded.
In contrast to the false bravado often used in describing himself, he was highly critical of
himself in this reflective stance. He was frequently unfocused when listening to himself on a
recording, and needed to play along or talk during listening rather than pay attention. His
perfectionist standards also resulted in an emphasis on any errors that had been made, and
despite a self-reported desire to record himself and share his music with his peers; he did not
seem to share any of the CDs he made with family or friends. This level of insight (realistic
evaluation) seemed to increase with the commencement of Ritalin, and it was observed that
his level of lyric contribution dropped markedly at this point.
Central Category: Power
The properties and dimensions of the central category of power are captured in Table 1.
These features were distinguished by moving repeatedly between the data and the
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Katrina McFerran
TABLE 1
Properties and Dimensions of the central category of ‘Power’
Dimension
Properties
Dimension
Intrapersonal
Fantasy
Generous
Sustained
Enthusiastic
Vulnerable
Singing
Performing
Direction
Perception
Communication
Attention
Energy
Degree
Music making
Musical involvement
Interpersonal
Critical
Self-focused
Unfocused
Flat
Confident
Playing
Listening
prominent codes identified previously. The use of bold and italic serves to highlight the
relationship between the central category and its narrative explanation in both the table
and the following storyline.
Descriptive Storyline
A more succinct descriptive storyline was created using the properties and dimensions
from the central category, and grounded in the open and axial codes created previously
from the multiple sources of data.
The process of music therapy was empowering for Ben as he used the opportunities to express
himself and to control what he (intrapersonal), and others (interpersonal) did. Part of feeling
powerful for Ben involved the use of fantasy as he enthusiastically presented himself as confident
by identifying as a musician and making music — either through playing drums or performing
known or self-composed songs. When the degree of power experienced was lower, Ben
expressed his vulnerability through more passive forms of musical involvement. In these states he
would often sing rock ballads from the song book or listen to CDs he had bought to engage with
his perception of himself as musician, but his energy levels were lower at these times. Ben’s
desired perception of himself was challenged by the reality of his musical abilities and he was
critical in listening to himself on recordings, often being unfocused during this time. Ben was
unfocussed when feeling out of control, and presented as flat, either due to external circumstances, or happenings within the music therapy session. In contrast, when his desire for power
was fulfilled it often resulted in sustained attention and commitment to music making. Ben’s
communication of power was usually self-focused, and songs chosen from the songbook, or
written in therapy, always focused on ‘Me’. However, he became increasingly generous in his
interpersonal relations, and feeling powerful often resulted in higher levels of communication,
particularly when the power-balance was well understood by the other.
The results suggest that power is an important element of the experience for this young man
with ADHD. The results show that many of the behaviours typically associated with ADHD
were diminished by creative opportunities to be in control. His response to these
opportunities was immediate and in direct contrast with his presentation in the classroom
and in the schoolyard. In relating these responses to the role of behavioural inhibition in the
performance of executive functions (Barkley, 1997, p. 73), this young man was able to:
• inhibit task-irrelevant responses in order to focus on playing drums and performing
songs
• execute goal-directed responses and display persistence in directing others to play in
ways that would achieve his desired outcomes for the performance of self-composed
songs
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•
•
execute novel/complex motor sequences in playing drums (nontraditionally)
display sensitivity to response feedback when others were playing with him and also
upon hearing recordings of himself playing
• re-engage with tasks after periods of disruption due to the needs of others in the
group or after becoming distracted
• control his behaviour in line with his internally represented identity as a musician.
None of these achievements occurred miraculously, as the music therapist’s focus was
on promoting the young man’s strengths by providing creative opportunities that
engaged his interest. In this sense, the session was highly facilitated, although entirely
unstructured. Unlike the majority of music therapy literature noted earlier, the sessions
were informed by humanistic philosophy, engaging the student with a stance of
unconditional positive regard (Rogers, 1951). As used in this project, a humanistic
orientation frequently results in an open-ended session structure that relies on the
interest and request of clients, a model called Free Music Therapy (Alvin, 1978). The
young man’s response to this freedom was highly enthusiastic and his teacher
commented frequently on his happy demeanor while viewing video footage of Ben in
sessions as part of data collection. The teacher was immediately inspired to recall other
situations where ‘that beaming smile’ had been present, such as horse-riding.
The positivity of this experience was an important feature of the session for the young
man. He described the sessions as ‘fun’, further articulating this by saying it was fun to ‘use
our minds’ and ‘be a leader’ as well as play drums, make CDs and sing/rap into the
microphone. His peer described music therapy as being ‘calming’ and making him feel good
so that he ‘doesn’t get that much anger’, and suggested that this might be the same for Ben.
It is worthy of note that the musical expectations of a therapist differ distinctly from
that of a music teacher in the special education setting. The young man did not play the
drums in time or even in the style one would expect, mostly using his upper two limbs to
beat on the drum kit in a style modelled casually on a rock drummer. However, he did
frequently play for 10-minute intervals, accompanied by the music therapist who
improvised a musical framework1 on guitar or keyboard. He would also sit behind the
drums, or on a chair holding his guitar, for long periods of time without needing to move
around the room. The teacher’s aide described his behaviour as surprisingly ‘calm and
focused’, where he would normally be much more verbally demanding and ‘fiddly’.
Discussion
The descriptions provided by this case study challenge the dominant focus of the music
therapy literature on group work to achieve behavioural improvements by highlighting
the value of individual work. The following discussion will debate the potential role of
music therapy within the special education system for young people with ADHD and
emotional behavioural disorders. The inclination to focus on attentional and physical
outcomes across the music therapy literature will be considered and contrasted with the
less prominent emphasis on the quality of life or happiness of the young people
grappling with behavioural disorders.
Focusing on Behaviour: Vital or Outdated?
The ADHD literature is dominated by a focus on behavioural outcomes as a measure of
success for intervention. DuPaul (2007) notes that ADHD is typically treated with a
mixture of medication and behavioural strategies, and countless studies have focused on
measuring physical activity and disruptiveness as key indicators. Forness (2005) strongly
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advocates for evidence-based practice to inform the strategies used in schools, which
effectively cements this focus on overt behaviour that can be purported as objective
evidence within the positivist paradigm.
The music therapy literature described previously dutifully supports this approach with
research, typically measuring improvements in attention and physical activity. The case
study reported here also provides anecdotal support for behavioural outcomes, captured
through descriptions made by the music therapist, the young man, his peer, teacher and
teacher’s aide. All adults involved in the study reported a conspicuous increase in length of
attention span, as captured in the code of sustained attention. Interestingly, this was not
only related to events during which the young man felt empowered, as he also exhibited
extended focus on selecting songs from the song book, a task he frequently chose when his
energy levels were flat. Although the reduction in motor activity evidenced during these
‘flat’ sessions is typically regarded as a positive outcome in the literature, within the music
therapy sessions this was usually a point of concern that indicated an unhappy emotional
state. On questioning, the young man would sometimes note that he had stayed up late,
had a fight with a family member, or been in trouble with the school principal.
Another behavioural measure captured in this study was the young man’s
communication of the power he experienced in sessions, as seen by either generous or
self-focused social behaviours at different times. The poor social skills exhibited by
young people with ADHD is commonly noted, and DuPaul (2007) underlines the
challenges this group experience in developing and maintaining social relationships
with peers. Given that antisocial behaviours are seen as a risk factor for externalising
disorders such as ADHD, the importance of ‘positive play activities with peers’ has been
noted (Crews et al., 2007, p. 73). Within music therapy sessions the young man
exhibited a number of behaviours indicative of positive social interactions. He smiled
frequently, engaged with enthusiasm, and was willing to take turns on instruments with
his peer and the music therapist. This was sometimes heavily facilitated by the therapist,
but as sessions progressed, was more frequently initiated by the young man himself.
However these improvements in overt behavioural changes were grounded in the
context of the music therapy sessions; sessions focused on empowerment and creative
expression. Barkley (2007) provocatively argues that the adoption of behavioural
approaches is greatly outdated in the field of ADHD treatment, and that they are, in effect,
prosthetic aids akin to a wheelchair that once taken away is no longer useful. ‘No one
should rightly claim that several months of contingency management produces sustained
benefits once treatment is withdrawn’ (p. 281). This is a logical argument given that the
implementation of such strategies is based on outdated theories that ADHD has social
learning origins. Research by Greene and Ablon (2001) has also highlighted that
behavioural treatment in isolation does not improve treatment outcomes, instead
emphasising the need for individually tailored, multidimensional strategies for improving
psychosocial outcomes. In relation to the application of music therapy, this reignites the
question of best practice. There is no doubt that the motivational effect of music can
achieve positive behavioural responses, as reported throughout the history of music
therapy and music psychology research. But is this focus really addressing the needs of
young people with ADHD?
The Value of Empowerment for Young People With ADHD
Although behaviour is the focus of the vast majority of literature in the field of ADHD,
the common occurrence of comorbid states is routinely acknowledged. These
psychological ‘side-effects’ do not receive the same amount of attention in treatment
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designs as behavioural outcomes however, particularly treatments that are
nonpharmacological. Treuting & Hinshaw (2001) noted that boys with ADHD
(aggressive type) showed more depressive symptoms than those with nonaggressive
subtype ADHD or the control group. Self-esteem was also significantly lower. Quality of
life was only found to be investigated in one article in the ADHD literature (Topolski et
al., 2004), despite its obvious relevance to this population. The ADHD group in that
study (n = 55) reported significantly lower perceived quality of life scores than a control
group, although scores were equivalent to their mobility impaired comparison group. In
one of the few qualitative investigations reported in the literature an important finding
is highlighted (Whalen et al., 2006). The young men with ADHD were three times more
likely to report feeling sad/discouraged, as well as experiencing higher levels of stress. It
was also conspicuous that ‘good moods’ were reported less frequently both in the
perception of parents and the young people themselves.
The creative arts therapies are particularly well placed to provide supportive
treatment for young people with ADHD. Henley (1998) found that ‘aggressive or
impulsive behaviour related to hyperactivity can be channelled and transformed into
socially constructive forms of self regulation through facilitated creative endeavour’ (p.
10). The young man himself anticipated such a result as he described his personal
musical identity whilst walking with the music therapist to the first session. This
association between music and power was represented in data analysis with the initial
development of axial codes that identified self-perception and self-representation as
core to this young man’s experience. He would often draw on fantastical
representations of himself as a rock musician within sessions, moving between tough
and vulnerable versions of his fantasised identity as needed on a given day. This wishful
thinking was challenged by the inclusion of a peer into sessions, but this change
facilitated a more realistic adoption of this self-representation. It was difficult for Ben
to maintain this bravado while listening back to songs, and he tended to be dissatisfied
or disinterested in this ‘deepening’ therapeutic procedure. A similar outcome was also
noted in Gardstrom’s (2004) study, where listening back challenged participants’
perceptions of musical confidence and evoked feelings of inadequacy that were then
processed.
Recent music therapy literature has seen an increase in the discussion of
empowerment as a critical element of treatment. Daveson (2001) has detailed the role of
empowerment as both intrinsic to, and a consequence of, music therapy practice, while
Procter (2002) has explicated a philosophical approach that guides music therapy work.
Rolsjvord (2006) has further articulated this tendency in music therapy practice,
defining empowerment as a focus on the client’s strengths and potentials. Here
empowerment is seen as political because it challenges the assumptions of medical and
institutional models that focus on deficits. This article potentially does the same.
Cautionary Notes on Empowerment and ADHD
As anticipated by the music therapy literature, empowerment within sessions sometimes led
to an unsuccessful experience on return to the classroom. Although not discussed in the data
collection interviews, the young man’s behaviour on return to the classroom did begin to
deteriorate in the second term of the music therapy intervention. This was communicated to
the music therapist and strategies were put in place to resolve the situation. An extended
closure activity was incorporated into sessions that involved sitting and listening to music
while discussing the session and considering the imminent departure. The session time was
also adjusted so that the young man did not return to the quiet and highly structured
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classroom environment, but finished the session before the recess break. In this way he was
able to transition more easily back to the classroom, and staff noted that the situation
resolved itself. The movement between the two contrasting worlds of free creative expression
and structured cognitive work was clearly a dramatic juxtaposition. Barkley (2007) notes
that there is a tendency in the literature to avoid documentation of these side-effects to
psychosocial interventions, called ‘adverse events’ in the psychopharmacological literature.
Although not readily apparent in the results of this study, this side-effect was apparent in the
clinical setting and is anticipated by previous music therapy studies. As Rickson (2003)
notes, the resultant state of physical arousal can cause challenges on the return to the
classroom, but no negative long term carryover effect is suggested.
Conclusion
In the search for mediators and moderators of ADHD, this position paper suggests that a
sense of control, paired with creative expression, may facilitate the development of executive
functions such as inhibition. The sense of frustration and disempowerment experienced by
young people within structured settings may even contribute to their poor performances in
these everyday situations. Whilst it is neither possible nor desirable to avoid the nature of the
classroom, it is important to recognise that the context itself plays a role in the expression of
disordered behaviour. Armstrong (1998) notes that most approaches to ADHD explore
phenomena from an ‘external control perspective’. That is, researchers trying to control the
behaviours known to be intrinsic to a diagnosis of ADHD. A wellness paradigm may
provide an alternative for further explorations of this disorder, with a focus on when young
people with ADHD perform best being useful to develop understandings. In the meantime,
individual interventions that are grounded in creative expression and take into account
transitions back to structured classroom settings may have an important place in treatment.
As this young man stated simply:
‘Yeah, it’s just all been good’.
Endnote
1
This is a standard music therapy intervention (Wigram, 2005).
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