Melodic Intonation Therapy (MIT) has long been used to promote functional speech in persons who have had a cerebral vascular accident. Studies on MIT date back more than 30 years and many studies have looked at child populations including children with apraxia (Helfrich-Miller, 1994; LaGasse, 2004), children with Down syndrome (Carroll, 1996), and now children with autism.
MIT for Verbal Responses in Autism
First, what is MIT? This is a technique that is commonly used with persons who have left-side damage to the speech areas of the brain, yet retain the ability to sing due to unimpaired networks involved in singing. MIT is a specific technique that aims to reroute or strengthen networks for speech communication through the systematic application of singing.
What are mirror neurons and what do they mean for autism? Many areas of need in persons with autism (emotional relating, social interaction, communication) have been suggested to be related to dysfunction in the mirror neuron system. Mirror neurons are networks that respond to the actions of others and the self. For instance, mirror neurons fire in response to observed actions of others and in response to one’s own actions. Should the mirror neuron system be impaired, then learning from others would be difficult, especially in the areas of communication and emotions.
Wan et al. (2010) provide evidence that music making engages brain regions that include the mirror neuron (MN) areas, and therefore could be used to engage the MN system for learning. This combined with evidence that children with autism often sing despite not using verbal communication, led to the use of MIT to improve verbal communication.
The researchers state that MIT is a form of Auditory-motor mapping training (AMMT). Fort the purpose of this study, MIT was adapted from the standard procedure to include visual cues (picture cards or objects) and instruments (for tapping while saying the words). Within the MIT protocol the researchers combined singing, imitation, and motor activity in order to promote speech.
This is exciting; however, there are no data presented in this paper. I would want to see empirical evidence supporting the use of this technique before making any claims of efficacy.
There are also many components of the modified MIT technique, including the use of instruments and visual cues. From a therapeutic perspective, the procedure described sounds very similar to what would be done for developmental learning of speech and language, rather than the typical MIT protocol. The researchers postulate that language learning occurs through auditory-motor mapping using a protocol that includes singing (for shared networks), imitation (MN systems), and paired motor activity. These are things that I typically include in interventions with persons with autism (although have never called it MIT). In fact, I find that the use of visual cues (written word or objects) and/or movement when used with this population can make a big difference in verbal communication.
Although I like the overall idea presented in this article (engaging the mirror neuron system to increase verbal communication), further research is needed to determine if the presented protocol leads to intentional and self-generated verbal communication. The researchers do consider the many different aspects of the protocol and propose future research studies that look at the different components of the protocol to determine the contribution made by the different features of the treatment.
References:
Carroll, D. (1996). A study of the effectiveness of an adaptation of melodic intonation therapy in increasing the communicative speech of children with Down syndrome. Unpublished doctoral dissertation, McGill University, Montreal, Quebec, Canada.
Helfrich-Miller, K. (1994). A clinical perspective: Melodic intonation therapy for developmental apraxia. Clinics in Communication Disorders, 43, 175-182. PMID: 7994292
LaGasse, A. B. (2004). The effect of modified melodic intonation therapy on speech production of children who have developmental apraxia of speech. Unpublished master’s thesis, Colorado State University, Fort Collins, Colorado.
Wan, C.Y., Demaine, K., Zipse, L., Norton, A., & Schlaug, G. (2010). From music making to speaking: engaging the mirror neuron system in autism. Brain Research Bull, 82(3-4), 161-168. PMID: 20433906
Thanks for posting this, Blythe! Everything about MIT is amazing. I am intrigued with the idea of using instruments for the MIT tapping. A speech therapist I work with says they (speech therapists) modify the MIT all the time. I tried instruments (paddle drum, and big drum with mallet) with a woman with aphasia/apraxia. She would also have the visual picture with the word(s). Holding the mallet and maintaining the rhythm of that motor movement seemed like one more difficult thing for her to target and do. The apraxia would affect the initiation and the continuity of her work, and hitting a targeted surface with a held mallet seemed too much for her to channel. It seemed easier to get positive verbal results by using hand over hand for each syllable. Of course, every case is different. With children, playing a drum or another instrument can be a motivating factor for the developmental learning process, and
I am fascinated with a woman I am working with who has Alzheimer’s/dementia. She loves to play a paddle drum in our group music therapy sessions. Everyone is singing the words of the song. Instead of playing straight time, she matches each mallet attack with every syllable of every word. She is not vocalizing with this. I like to theorize that this may help her in the future, should she lose her words with the progression of the dementia or even a stroke. She will already have a motor map/memory of tapping with each syllable!
Thanks for this review. I had a parent contact me asking for MIT for a child with Autism. I was a bit wary of this, but the parent had communicated with an author of that study. I completed the assessment and am certain that MIT is not the right technique for this client.
Thanks for plugging the show on Podcast #5!