Esra GÜNEY, Elvan İŞERİ, Banu ÇAYCI, Mehmet Fatih CEYLAN, Rahmi Oruç GÜVENÇ, Azize Andrea GÜVENÇ, Ersan ÇIRAK, Burak BAHAR, Şahnur ŞENER

Music therapy and hormonal responses in autism

Amaç: Müzik terapisi çeşitli psikiyatrik ve fiziksel hastalıkların tedavisinde kullanılmaktadır. Bu çalışmada, otistik bozukluk tanısı almış çocuklarda müzik terapisinin etkinliğinin ve müzik terapisine nörohormonal yanıtların araştırılması amaçlanmıştır. Yöntem: Otistik bozukluk tanısı almış 10 çocuk ve ergene ayda bir kez, beş saat uygulanan müzik terapi seanslarının otizmin şiddeti ve sözel iletişim, sosyal etkileşim, davranış alanlarına yönelik etkinliği ve terapiye nörohormonal yanıtlar araştırılmıştır. Otizmin şiddeti Çocukluk Otizmi Değerlendirme Ölçeği (ÇODÖ) ile ölçülmüştür. Müzik terapisinin stres hormonları üzerine etkisinin incelenmesi amacıyla terapi öncesi ve sonrası plazma kortizol, ACTH, adrenalin ve noradrenalin düzeyleri incelenmiştir. Bulgular: Çalışma sonuçları, müzik terapisinin hiperkinezik hareketliliği ve basmakalıp-yineleyici davranışları azalttığını; karşılıklı sosyal etkileşimi ve sözel iletişimi arttırdığını ortaya koymaktadır. Terapi sonrasında ÇODÖ ile değerlendirilen otistik belirtilerin şiddetinde de anlamlı azalma saptanmıştır. Terapi öncesi ve sonrası hormon düzeyleri karşılaştırıldığında; kortizol, ACTH, adrenalin ve noradrenalin düzeyleri arasında istatistiksel açıdan anlamlı fark bulunmamıştır. Tartışma: Müzik terapisi otistik bozukluğu olan çocuk ve ergenlerde sözcüklerin kullanılmadığı bir iletişim aracı ve otistik bozukluğun tedavisinde özel eğitim desteği ve bireysel psikoterapilere eklenebilecek etkili ve önemli bir terapi seçeneğidir.

Otizmde müzik terapisi ve hormonal yanıtlar

Objective: Music therapy is used in the treatment of various psychiatric and physical disorders. This study aims to explore the efficiency of, and neurohormonal responses to, music therapy in children with autism. Methods: The effect of music therapy sessions of five hours a month on the severity of autism, verbal and social communication, behavior, and neurohormonal responses were explored in 10 children and adolescents. Autism severity was assessed using the Childhood Autism Rating Scale (CARS). Results: The results of the study indicate that music therapy decreases hyperkinetic activity and stereotypical-repetitive behaviors while increasing mutual social interaction and verbal communication. In addition, the severity of autistic symptoms assessed by CARS significantly decreased following the therapy. When pre- and post-therapy hormone levels were compared, cortisol, ACTH, adrenaline, and noradrenaline levels were not significantly different. Conclusion: Music therapy is a means of communication without words in children and adolescents with autism, and is an effective and important treatment option when accompanied by special educational support and individual psychotherapy in the treatment of autistic disorder.

PDF

___

1. Filipek PA, Accardo P, Baranek GT, Cook EH Jr, Dawson G, Gordon B, et al. The screening and diagnosis of autistic spectrum disorders. J Autism Dev Disord 1999; 29: 439- 84.
2. Mitchell S, Brian J, Zwaigenbaum L, Roberts W, Szatmari P, Smith I, et al. Early language and communication development of infants later diagnosed with autism spectrum disorder. J Dev Behav Pediatr 2006; 27: 69-78.
3. Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children. JAMA 2001; 285: 3093-99.
4. Fombonne E. The epidemiology of autism: A review. Psychological Medicine 1999; 29: 769-786.
5. Gold C, Wigram T, Elefant C. Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews 2006; 2: CD004381.
6. Corbett BA, Shickman K, Ferrer E. Brief Report. The Effect of Tomatis Sound Therapy on Language in Cildren with Autism. J Autism Dev Disord 2008; 38: 562-6.
7. Wigram T, Gold C. Music therapy in the assesment and treatment and teratment of autistic spectrum disorder: clinical application and research evidence. Child: care, health and development 2006; 32: 535- 42.
8. Bruscia KE. Defining music therapy. 2nd Edition. Gilsum NH, Barcelona Publishers, 1998, p. 20.
9. Ledger AJ, Baker FA. An investigation of long-term effects of group music therapy on agitation levels of people with AlzheimersDisease. Aging Ment Health 2007; 11: 330-38.
10. Boso M, Politi P, Barale F, Enzo E. Neurophysiology and neurobiology of the musical experience. Fuct Neurol 2006; 21:187-91.
11. Myskja A, Lindbaek M. Examples of the use of music in clinical medicine. Tidsskr Nor Laegeforen 2000; 120: 1186-90.
12. Escher J, Höhmann U, Anthenien L, Dayer E, Bosshard C, GaillardRC. Music during gastroscopy. Schweiz Med Wochenschr 1993; 123: 1354-58.
13. Kumar AM, Tims F, Cruess DG, Mintzer MJ, Ironson G, Loewenstein D, et al. Music therapy increases serum melatonin levels with Alzheimers disease. Altern Ther Health Med 1999; 5: 49-57.
14. Yıldırım S, Gürkan A. Müziğin, kemoterapi yan etkilerine ve kaygı düzeyine etkisi. Anadolu Psikiyatri Dergisi 2007; 8: 37-45.
15. Kim J, Wigram T, Gold C. The effects of improvisational music therapy on joint attention behaviors in autistic children: A randomized controlled study. J Autism Dev Disord 2008; 38: 1758- 66
16. Boso M, Emanuele E, Minazzi V, Abbamonte M, Politi P. Effect of long-term interactive music therapy on behavior profile and musical skills in young adults with severe autism. The Journal of Alternative and Complement Medicine 2007; 7: 709-12.
17. Bode M, Meyberg W. Music therapy in a child and adolescent psychiatry department. Prax Kinderpsychol Kinderpsychiatr 1992; 41: 293-97.
18. Smith JC, Joyce CA. Mozart versus new age music relaxation states, stress and ABC relaxation theory. J Music Ther 2004; 41: 215-24.
19. Khalfa S, Bella SD, Roy M, Peretz I, Lupien SJ. Effects of relaxing music on salivary cortisol level after psychological stress. Ann N Y Acad Sci 2003; 999: 374-76.
20. Möckel M, Röcker L, Störk T, Vollert J, Danne O, Eichstädt H, et al. Immediate physiological responses of healthy volunteers to differe nt types of music:cardiovasculer, hormonal vand mental changes. Eur J Appl Physiol Occup Physiol 1994; 68: 451-59.
21. Leardi S, Pietroletti R, Angeloni G, Necozione S, Ranalletta G, Del Gusto B. Randomized clinical trial examining the effect of music therapy in stress response to day surgery. British Journal of Surgery 2007; 94: 943-47.
22. Gerra G, Zaimovic A, Franchini D, Palladino M, Giucastro G, Reali N, et al. Neuroendocrine responses of healthy volunteers to techno- music: relationships with personality traits and emotional state. Int J Psychophysiol 1998; 28: 99-111.
23. Migneault B, Girard F, Albert C, Chouinard P, Boudreault D, Provencher D, et al. The effect of music on the neurohormonal stress response to surgery under general anesthesia. Anesth Analg 2004; 98: 527-32.
24. Hirokawa E, Ohira H. The effects of music listening after a stressful task on immune functions, neuroendocrine responses, and emotional states in college students. J Music Ther 2003; 40: 189-211.
25. Schopler E, Reichler J, De Vill R, Daly K. Towards objective classification of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev Disorder 1980; 10: 91-103.
26. Saemundsen E, Magnusson P, Smari J, Sigurdardottir S. Autism diagnostic interview-revised and childhood autism rating scale: convergence and discrepancy in diagnosis autism. Journal of Autism and Developmental Disorders 2003; 33: 319-28.
27. Sucuoğlu B, Öktem F, Gökler B. Otistik çocukların değerlendirilmesinde kullanılan ölçeklere ilişkin bir çalışma. Psikiyatri, Psikoloji, Psikofarmakoloji 1996; 4: 117-21.
28. Odell WD, Horton R, Pandian MR, Wong J. The Use of ACTH and Cortisol Assays in the Diagnosis of Endocrine Disorders. Nichols Institute Publication, 1989.
29. Tunn S, Pappert G, Willnow P, Krieg M. Multicentre evaluation of enzyme-immunoassay for cortisol determination. J Clin Chem Clin Biochem 1990; 28: 929-35.
30. Edgerton CL. The effect of improvisational music therapy on the communicative behaviours of autistic children. Journal of Music Therapy 1994; 31: 31-62.
31. Buday EM. The effects of signed and spoken words taught with music on sign and speech imitation by children with autism. Journal of Music Therapy 1995; 32: 189-202.
32. Brownell MD. Musically adapted social stories to modify behaviours in students with autism: four case studies. Journal of Music Therapy 2002; 34: 117-44.
33. Aldridge D, Gustorff D, Neugebauer L. A preliminary study of creative music therapy in the treatment of children with developmental delay. The Arts In Psychotherapy 1995; 22: 189- 205.