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Case study
Date: 16th February 2024
When it’s time for his music therapy session, Nathaniel will often spot me first from afar in the playground, sometimes with a big smile stretched across his face.
Nathaniel is a 14-year-old, non-verbal young man with Autism which impacts on his ability to learn and interact with people around him. Although he can walk, his anxiety stops him from walking around school, which is busy and unpredictable in nature. When I first met him, I didn’t see him walk at all. Staff said that he would only stand when getting on and off the minibus, after which he would hastily sit in his wheelchair.
Nathaniel often bangs his head against his hand on objects, mostly on the arm of his wheelchair, possibly as a way of self-regulating or an impulse. However, Nathaniel’s mum has mentioned that he does not do this as frequently at home, so I wondered whether this could be addressed in music therapy.
Around school, he presents as calm but withdrawn. On my observations of him in class, he seems to struggle to engage with learning activities and sometimes even physically pushes himself away from the rest of the class during their circle time. My therapeutic aims for Nathaniel initially were to offer him a way to express himself creatively and meaningfully in a 1-1 setting, but also to see if there was anything music therapy offer him that might help him to experience school life out of his chair.
I’ve been working with Nathaniel for just over a year now. At the beginning of our sessions together, he would keep his head down, banging it lightly against his hand on his padded chair. Initially I tried to match his overall presentation and body language, using music, to see if I could meet him where he was. It wasn’t clear whether he knew that I was responding to him musically or not, as he did not seem to respond. When I invited him into the music more directly through an improvised song ‘where is Nathaniel?’ with a tremolo bass line on guitar to evoke anticipation, he began to lift his head and look at me. He opened up physically, sitting up straight and breathed in and out deeply.
There was a real brightness to him that suggested to me he was aware of me trying to connect with him musically. I responded by singing ‘there he is!’, changing the music by using louder, triumphant chords to acknowledge and celebrate his change in body language. We continued in this way, and he seemed to begin using this upwards movement as a way of initiating a change in the music, laughing, and smiling in response.
Over time, Nathaniel began to respond and engage more readily and enthusiastically, sitting upright in his chair more frequently and engaging with a variety of instruments such as piano, guitar, table tubes and drums. He particularly seemed to enjoy upbeat and energetic minor key music on the guitar, where he would use one of his hands to make a rapid moving gesture that looked like he was strumming, perhaps to ask me to play faster.
One day, I offered an improvised song ‘we’re sitting down and standing up’ where I would model standing up as I sang. The song was upbeat and playful in nature, and Nathaniel responded by laughing whilst holding eye contact. I held my hand out for him to invite him to stand with me and he stood up and began to jump to the beat of the music, seeming very excited before returning to his chair. From then, Nathaniel began to walk to and from the music therapy room whilst holding both of my hands. I remember some members of staff becoming tearful because they were so pleased to see him walking down the corridor.
Nathaniel continues to walk more around school and stands up in the playground for longer periods of time. I am liaising with staff at the school as well as Nathaniel’s mother to find a more suitable chair for him at school. Music therapy has not only been a space for Nathaniel to be heard, understood, and valued but it has also helped to reduce anxiety and develop his confidence.
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