Music Therapy To Promote Prosocial Behaviors in Aggressive Adolescent Boys-A Pilot Study

Journal of Music Therapy, XL (4), 2003, 283-301
© 2003 by the American Music Therapy Association
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Music Therapy to Promote Prosocial
Behaviors in Aggressive Adolescent
Boys—A Pilot Study
Daphne J. Rickson
Halswell Residential College, New Zealand
William G. Watkins
Otago University, New Zealand
This pilot study was undertaken to investigate whether music

therapy is effective in promoting prosocial behaviors in ag
gressive adolescent boys who have social, emotional, and
learning difficulties. Fifteen subjects (aged 11-15 years), en
rolled at a special residential school in New Zealand, were
randomly assigned to music therapy treatment groups (r\ - 6,
n = 5), and a waitlist control group (n = 4). Examination of
demographic data identified differences between groups for
diagnosis (p = .044), with Group 1 all having Attention Deficit
Hyperactivity Disorder (ADHD), and for age (p = .027), with
Group 2 having a mean age 1.38 years older. Measures in
cluded parent and teacher versions of the Developmental
Behaviour Checklist (DBC-P & DBC-T) (Einfeld & Tonge,
1994; Einfeld, Tonge, & Parmenter, 1998). While no definite
treatment effects could be detected, results suggest that a
music therapy program promoting autonomy and creativity
may help adolescents to interact more appropriately with
Daphne J. Rickson, Halswell Residential College, Christchurch, New Zealand;

William G. Watkins, Department of Psychological Medicine, Christchurch School of
Medicine & Health Sciences, Otago University, New Zealand.
Daphne Rickson is now at College of Design, Fine Arts & Music, Massey Univer
sity, Wellington.
Daphne Rickson undertook this study towards the qualification of Master of
Health Science (Mental Health), Otago University. William G. Watkins provided su
pervision and assistance with editing for publication. The authors would like to ac
knowledge Isobel Stevens, Research Facilitator, Christchurch School of Medicine for
assistance with data organization; and Associate Professor Chris Frampton, Biostatis
tician, Christchurch School of Medicine for statistical analysis.
Correspondence concerning this article should be addressed to Daphne Rick
son, Music Therapy Tutor, College of Design, Fine Arts and Music, Massey Univer
sity, P.O. Box 756, Wellington, New Zealand. E-mail: ricksons@xtra.co.nz
284 Journal of Music Therapy
others in a residential villa setting, but might also lead to a
temporary mild increase in disruptive behavior in the class
room. A more highly structured program and smaller group
numbers may be advantageous for boys who have ADHD.
This pilot study was undertaken to investigate the hypothesis that

music therapy is effective in promoting prosocial behaviors in ag
gressive adolescent boys, in classroom and residential villa settings.
While there appears to be considerable anecdotal evidence point
ing to the potential advantage of group music therapy with adoles
cents, there is an extreme paucity of recent music therapy litera
ture relating to the use of music therapy with adolescents who have
social and emotional difficulties.
Children and adolescents who have learning disabilities are
thought to exhibit a certain amount of internal arrhythmia or dys
rhythmia (Evans, 1986). Those with Attention Deficit Hyperactivity
Disorder (ADHD) (APA, 1994) are often unable to inhibit their
motor responses to the sights and sounds around them, are not
guided by internal instructions, and therefore find it difficult to in
dependently restrict their inappropriate behaviors. Self-control is
the precursor to the development of higher 'executive functions'
and therefore provides a critical foundation for the performance of
basic tasks. It has been suggested that rhythm activities can facilitate
internal organization (Gaston, 1968), the co-ordination of mind
and body (Montello, 1996), and, by providing a sense of internal se
curity, can help with the control of impulses (Bruscia, 1987).
Eidson (1989) examined the effects of a behavioral music ther
apy treatment program on emotionally handicapped middle
school students (N= 25), aged 11-16. Experimental subjects' scores
for classroom behavior were almost twice as stable as scores for con
trol subjects. In the same year Haines compared two active treat
ments (music vs. verbal) in a small sample of subjects identified by
their school systems as emotionally disturbed adolescents, and
found no treatment effects over the short term, that is, after six
half-hour sessions (Haines, 1989).
In a single case study with an adolescent boy who had a diagno
sis of Conduct Disorder, Kivland (1986) documented an increase of
prompted positive self-statements following individual music ther
apy sessions. Similarly, although significance was not achieved,
Henderson (1983) found that hospitalized adolescent psychiatric
Vol. XL, No. 4, Winter 2003 285
patients in music therapy programs had a trend towards improving
more than controls, on measures of self-esteem. Thaut (1989) mea
sured self-perceived changes in states of relaxation, mood/emo
tion, and thought/insight in psychiatric prisoner-patients before
and after music therapy. The three different music therapy tech
niques used in this study all proved to be successful in changing the
prisoner-patients' self-perceived states of relaxation, mood/emo
tions, and thoughts about self and one's own life.
Montello and Coons (1998) set out to evaluate the effects of active
rhythm-based versus passive listening-based group music therapy
treatment on young adolescents with emotional, learning, and be
havioral disorders, using 24 items relating to attention, motivation,
and hostility selected from the Child Behavior Checklist Teacher
Report Form (CBCL-TRF) (Achenbach, 1991). They found that
subjects improved after receiving either the passive or active inter
vention, particularly on the aggression/hostility scale. They there
fore argued for future research to discriminate between external
izing or internalizing behaviors in inclusion criteria. However while
in that study overall improvements in the three groups were
recorded, Group A increased their score for hostility problems dur
ing the treatment (active therapy) phase and returned to baseline
during the control (passive therapy) phase, which suggests between
group differences. Montello and Coons proposed that the treat
ment approach might have to be more structured for adolescents
who have more fragile ego development.
This pilot study aimed to confirm and add to the research of
Montello and Coons by targeting students who have identified ex
ternalizing behaviors. Further, the music therapy treatment ses
sions included active music making as well as listening activities,
which are described in more detail later in this paper, and the
study utilizes multi-informant data gathering. In summary, it aimed
to investigate the hypothesis that music therapy is effective in re
ducing aggressive behaviors.
Method
Population Sample
The subjects were drawn from a population of 88 adolescent
boys who have intellectual, social, and emotional deficits, who were
enrolled in a special education residential facility in New Zealand.
From students enrolled at the school in April 2001, those who
started before May 2000 and after March 2001 (i.e., 49 boys) were
excluded to control for historical effects and the likelihood of their
leaving before the study was completed. Remaining students (39)
were screened for aggressive behaviors using the Child Behaviour
Checklist (CBCL) data held by the school for all students. Eighteen
students were excluded because of insignificant aggression, and 3
were excluded because they were, or had been previously involved
in music therapy programs.
After exclusions, the potential research sample consisted of boys
(N= 18) ranging in age from 11 years 6 months to 15 years 3 months
(average of 13 years 2 months, and median age of 13 years) with
clinically significant measures on the CBCL Aggression/Hostility
scale. Twelve of the boys in this study had previous diagnoses of At
tention Deficit Disorder (ADD) or Attention Deficit Hyperactivity
Disorder (ADHD), four of General Developmental Delay, and one
each of Head Injury and Depression. Five of the boys with ADD or
ADHD had a dual diagnosis including Oppositional Defiant Disor
der (ODD) or Conduct Disorder (CD) according to DSMIV criteria
(APA, 1994). Half of the boys (n= 9) were taking psychotropic med
ication, most commonly stimulants. Nine of the boys were of Maori
ethnicity (50%) and nine were New Zealand European (50%).
Research Sample
From the initial research sample (N = 18), students were ran
domly assigned to two music therapy groups (n = 6, n = 6), and one
waitlist control group (n = 6). One of the boys in the control group
was indefinitely suspended shortly before the therapy program be
gan. A second withdrew after attending only 10 minutes of one ses
sion and a third was suspended after one music therapy session
only, because of severely disruptive and aggressive behavior in the res
idential villa environment. Fifteen subjects therefore completed mu
sic therapy treatment (Group 1, n = 6, Group 2, n = 5, Control Group
3, n = 4). Music therapy treatment was the same for all groups.
Measures
Developmental Behaviour Checklist (DEC). The potential effects of
the music therapy program on aggressive behavior were measured
using the subscales of disruption and antisocial behavior in the De
velopment Behaviour Checklist (DEC), (Einfeld & Tonge, 1994).
Although the Child Behavior Checklist 'CBCL' was used for initial
inclusion criteria, the more recently developed DBC, which has
been derived from the CBCL, was deemed a more appropriate
measure for this study as it is normed for children and adolescents
who have mild mental retardation. Residential social workers, act
ing as 'key workers' for students in their villa accommodation,
scored the parent version. Other subscales measured by the DBC
included Self-absorption, Communication Disturbance, and Anxi
ety. A further category on the parent version relates to autistic-type
behaviors, while the teacher version measures social relationships.
Converting scores to percentiles gives information about how
normal or abnormal that score is, which is useful for comparison.
It needs to be noted that while the Teacher version clinical cutoff
point is the 30th percentile, the Parent version is set at the 60th
percentile. The DBC was administered to all boys at the end of
Terms 1 and 3, 2001, (as a pre and posttest for treatment groups,
and a baseline for controls), and again at the end of Term 4, 2001
(as a posttest for controls and follow-up for treatment groups).
Video Analysis. Video data were analyzed to measure within-session
change. The process involved writing a thorough description of
group activity and each individual subject's specific behavior in that
context, during a 10-minute allocated period. Descriptions were
coded according to the quality of each interaction. The video data
were analyzed by recording the number of positive or negative
'events' that occurred for each individual during the 10-minute
data segment. Group totals were then calculated and the data pre
sented as a percentage of total number of events for each session. To
assess rater reliability a second rater was employed to view the video
tape of one randomly selected individual in each videotaped session.
Statistical Analysis. Because music therapy treatment was the same
for all boys, data were pooled for Groups 1 and 2. However, early
observations of dissimilarities between these two groups led to ad
ditional analysis to determine the extent of the differences be
tween all three groups. DBC data were tested using analysis of vari
ance for repeated measures (ANOVA) to look at treatment effects,
consistent difference between groups, and difference in changes
between groups over time. Confidence levels were set at 95%.
Music Therapy Treatment
Music therapy intervention consisted of 16 sessions of approxi
mately 30-45 minutes, twice a week, during Term 3, 2001. A wait
listed group of control subjects were offered music therapy inter
vention of 16 sessions of approximately 30-45 minutes twice a week
during Term 4, 2001.
Because the music therapist uses a client-centered humanistic
model of psychotherapy as her framework, the program and activi
ties were varied from the initial planning documents according to
client responses. Early sessions provided clear structure and con
trol to meet the needs of subjects. However, by session 4 onwards
they were gradually invited to take more responsibility for them
selves and others and were increasingly given opportunities for
choice making and creative expression. A program goal was to use
the process of group music to increase students' awareness of the
existence and feelings of self and others. Further, it was intended
that by experiencing success through contributing to group ac
tivity, recognition of themselves as valuable group members would
increase. Finally, the groups were to provide a setting for peer rela
tionships to develop based on respect and trust.
The activities included:
1. Bringing self selected music. During initial sessions, each stu

dent was asked to bring favorite music to share and to stimulate
discussion (listening-based activity). One student per week
would play their chosen piece to the group and then be invited
to talk about why they chose that music. Other group members
would then be asked individually to make a positive comment
about their peer's choice. Boys were initially instructed not to
talk until invited.
2. Personalized song, where boys were asked to greet each other in
song and to shake hands with a peer.
3. Active rhythm-based activities where each student was encour
aged to support other group members, as well as to 'solo.' En
gagement was achieved through call and response rhythm
games, rhythm ensembles, and creative improvisation using a
range of percussion instruments.
4. Opportunities to experience and care for musical instruments,
and to share these with group members in appropriate ways.
Subjects were encouraged to explore unfamiliar sounds, to lis
ten to the creative sounds of their peers, to ask for and to re
ceive instruments in a respectful manner, to offer, pass and re
spond to requests for instruments from peers.
5. Group song writing activities in 'blues' form, which enabled the
group to build on and support each individual student's small
personal contribution to lyrics. The familiar 12-bar blues pat
tern provided a useful structure for the song writing as this
form accommodates short repetitive ideas that can be built on
or be 'resolved' in the final phrase. The short phrases encour
aged boys to take the risk of sharing a simple idea. Further, the
blues framework invited echoing of short phrases sung by peers
thereby leading to affirmation and support within the group.
Once the subjects were familiar with what each experience en
tailed, they were encouraged to make their own group decisions re
garding which activities they would undertake in a session. How
ever, on occasions when group negotiations were at risk of
breaking down, the therapist would intervene with more support
and direction. By the completion of the program it was anticipated
that students would be more able to attend, to offer a simple ap
propriate verbal response to a question, to wait for their turn and
take a turn when it was offered, to offer a creative idea and accept
and work with someone else's idea. It was also considered likely
that they would learn to keep a steady beat and to play instruments
with some self-control (e.g., play quietly when requested).
Results
Age of Subjects
While the average age of students in both Group 1 and Group 3
was 12.42 years, the average age for Group 2 was 13.8 years. Analy
sis of Variance between group tests (ANOVA) revealed statistical
differences between groups (p = .027). However repeating the test
with Groups 1 and 2 combined revealed no significant differences
(£=.299).
Diagnosis
Despite randomization, all six boys in Group 1 had a diagnosis of
Attention Deficit Hyperactivity Disorder, whereas in Group 2 only
three of five, and in Group 3, one of four had that particular diag
nosis. Statistical analysis (Pearson Chi-Square) revealed a signifi
cant difference (p = .044) between groups. When the test was re
peated with Groups 1 and 2 combined, the difference was nearing
significance (p = .077).
TABLE i
Raw Data far DEC Parent Version
Subscale Group Baseline Music Follow-up Baseline 2 Music
Disruptive i 21.000 22.000 20.333

(Dis) 2 23.400 16.400 17.800
3 26.250 20.250 17.500
Self-absorbed 1 7.000 5.333 6.833
(SA) 2 6.200 3.000 4.600
3 7.500 3.750 2.500
Communication 1 5.333 3.500 3.333
disturbance 2 4.200 2.000 2.800
(CD) 3 3.500 1.500 1.500
Anxiety 1 8.333 6.500 7.167
(Anx) 2 6.000 3.400 4.400
3 9.000 5.750 4.750
Autistic R. 1 5.000 2.833 3.000
(AR) 2 5.000 3.400 4.200
3 5.250 4.750 3.250
Antisocial 1 2.667 1.833 2.167
(And) 2 3.000 2.200 2.000
3 1.750 2.000 1.000
Key to Reading Data & Graphs

The DBC measures negative behaviors, and treatment aims to fa
cilitate a decrease in scores over time. A downward trend in the
graphs therefore represents an improvement. Groups 1 and 2 had
music therapy between Test 1 and Test 2. Waitlist controls, Group
3, had music therapy between Tests 2 and 3. The solid lines on the
line graphs, therefore, represent time in treatment, while the dot
ted lines represent pretreatment for Group 3, and posttreatment
period for Groups 1 and 2.
DBC Data as Mean Scores
The mean scores across subscales for the three music therapy
groups are shown in Table 1 (Parent Version) and Table 2 (Teacher
Version). Apart from a small increase in disruptive behavior sub
scale for Group 1 and 'no change' in Communication Disturbance
subscale for Group 3, residential social workers, scoring the parent
version, rated all three groups consistently improving during treat
ment across all six subscales. Teachers, however also rated Group 1
boys as more disruptive during music therapy treatment, and further,
TABLE 2
Raw Datafor DEC Teacher Version
Subscale Group Baseline Music Follow-up Baseline 2 Music
Disruptive 1 12.333 15.167 7.833

(Dis) 2 14.400 12.600 15.200
3 13.250 12.250 10.750
Self-absorbed 1 3.333 2.667 1.500
(SA) 2 2.600 2.400 4.200
3 1.500 1.250 1.500
Communication 1 1.333 1.833 0.667
disturbance 2 2.800 3.400 3.400
(CD) 3 0.500 1.250 .500
Anxiety 1 3.833 4.333 2.000
. (Anx) 2 2.400 2.600 5.800
3 2.250 2.500 2.750
Social relatmg 1 3.667 2.167 1.000
(SR) 2 1.800 3.200 4.000
3 3.250 4.250 5.250
Antisocial 1 0.833 1.333 0.333
(Anti) 2 2.400 2.000 1.400
3 0.500 1.500 0.500
noted an increase in Communication Disturbance in Groups 1 and

2, and Anxiety across all three groups. Scores were higher post
treatment on Self Absorbed Subscale for Group 3, and Social Re
lating Subscales for Groups 2 and 3. The DEC subscales that are of
particular relevance to this study are those measuring 'Disruptive'
and 'Antisocial' Behavior.
DEC Disruptive Behaviour Subscales
On the Disruptive subscales (Figure 1), percentile scores re
corded by teachers show slight deterioration in classroom behavior
for treatment Groups 1 and 2 during the period of the music ther
apy, while 'controls' in Group 3 continued a trend toward im
provement which had begun prior to music therapy intervention.
Residential social workers who completed the parent version of the
DEC also noted a reduction in the disruptive behavior of subjects
in Group 3 prior to treatment, which continued when the music
therapy program commenced. Contrasting with the teacher view,
the residential staff also recorded a reduction of disruptive behav
iors for Groups 1 and 2, which levelled off posttreatment.
DISRUPTIVE BEHAVIOUR SUBSCALE. DISRUPTIVE BEHAVIOUR SUBSCALE,
TEACHER VERSION PARENT VERSION
T1 T2 T3
TESTS OVER TIME TESTS OVER TIME
FIGURE i.
Disruptive subscales, teacher and parent versions.
DEC Antisocial Subscale

Mean scores for the Antisocial Subscale are shown in Figure 2.
Teacher version scores for Groups 1 and 2 show a slight increase in
antisocial behavior during the music therapy treatment period,
while a much sharper 'improvement' was noted posttreatment.
Conversely, the parent version scores by residential social work
ers show a stronger improvement trend for Groups 1 and 2 while in
treatment, which levelled off when the music therapy program fin
ished. Despite deterioration prior to treatment, Group 3 also
showed a trend for improvement while in therapy, as recorded by
both teachers and residential social workers.
Assessment of 'Disruptive' and 'Antisocial' data using Analysis of
Variance (ANOVA) multiple comparisons revealed no statistical
differences.
ANTISOCIAL S U B S C A L E . TEACHER ANTISOCIAL SUBSCALE. PARENT

VERSION VERSION
T2 T3
TESTS OVER TIME TESTS OVER TIME
FIGURE 2.
Antisocial subscales, teacher and parent versions.
Groups One & Two - Total Scores Group Three, Total Scores as
as Percentile Data -Teacher Percentile Data - Teacher Version
Version
100
E] Baseline
R 1 80 .
60 60 rj Baseline
=5=
d Music
40 —— Therapy 40
Q Music
20 Q Post Music 20
Therapy
A
Therapy
0 0 .
FIGURE 3.
Total scores for DEC, Teacher Version.
DBC Total Problem Behaviour Scores

Figures 3 and 4 demonstrate mean DBC Total Problem Behavior
Scores for Groups 1 and 2, and Group 3 as percentile data. Note
that the clinical cut-off for the DBC-T is the 30th percentile, while
the DBC-P is set at the 60th percentile. Overall, teachers noted no
improvement in the boys during the music therapy period, but for
Groups 1 and 2 they recorded a posttreatment improvement. Resi
dential social workers noted improvement for Groups 1 and 2
while in music therapy which levelled off posttreatment, while the
improvement in the control period for Group 3 also continued
during music therapy treatment. Residential social worker scores
show boys improving to below clinical cut-off point.
Groups One & Two. Total Scores Group Three, Total Scores as
as Percentile Data - Parent Version Percentile Data - ParentVersion
90 o Baseline 80 0 Baseline
> ;
40 Therapy
v QPostMT
20 20 '
Therapy
FIGURE 4.
Total scores for DBC, Parent Version.
Mean Number of Negative Events
FIGURE 5.
Mean number of negative behaviors recorded within sessions.
Aggression Within Sessions

Within session aggression was rarely observed. From a total of
4243 behavioral 'events' categorized during video analysis, only 13
were coded as 'aggressive'.
Nevertheless, evidence from video data and therapist's session
notes indicate that total number of negative behaviors (Impulsive,
Uncooperative, Interfering, Aggressive, Inattentive/Restless, and
Antisocial/Avoidant) increased around Session 9 for all groups.
Further, Groups 1 and 2 did not reduce the total number of nega
tive behaviors they exhibited. On the other hand, despite an over
all increase in negative behaviors, predominantly in the impulsivity
category, Group 1 boys were more attentive, and were contributing
more to group activity. In contrast, while Group 3 also demon
strated more negative behaviors around Session 9, they reduced
negative behaviors in subsequent sessions and showed overall im
provement in their 'within session' interactions, particularly on
measures of impulsivity. Differences between the three groups in
respect to levels of impulsivity over time were significant (p = .014).
Tests for difference in levels of attention also achieved significance
(/>= .014) on mean scores of 5.470 (Group 1), 6.775 (Group 2), and
7.895 (Group 3). Figure 5 demonstrates the mean number of nega
tive behaviors recorded across four sessions. Note the overall num
ber of negative behaviors exhibited by Group 1 subjects is more
than double the number recorded for Groups 2 and 3.
Discussion
A notable feature of the results of this study was the difference
between 'Teacher' and 'Parent' reported change. This adds weight
to the evidence in the literature that indicates that agreement be
tween different sources is often minimal. Research suggests that
'externalizing' behaviors are more accurately reported by the par
ent(s) (Rapoport & Ismond, 1996). Children and adolescents do
have a tendency to present differently across settings, which this
study reinforces.
The results of this study are likely to have been significantly af
fected by three other factors, namely, the age and diagnostic dif
ferences between subjects in each group, and the small sample size.
Group outcomes appear to be influenced by major events for indi
viduals.
While the results from the Teacher version of the DBC indicate
few consistent trends across subscales, the Parent version recorded
consistent improvement across all subscales for treatment (Groups
1 & 2) and waitlist control (Group 3) groups. For the students in
this study, it is likely that variations in scores between the two ver
sions of the DBC can be attributed, at least partly, to the level of
structure provided in different environments.
A highly structured behavioral approach is employed in the
classroom, and the boys are given more direction and supervision.
In the residential villa environment the boys naturally have consid
erably more 'free' time, and opportunity to interact with peers
without adult direction. The consistent improvement across subscales
of the Parent Version DBC recorded by residential villa staff suggests
the music therapy program may have contributed positively to the
boys' ability to cooperate with peers in a less structured setting.
However, any such generalization was not so apparent for Group
1 boys, who all had a diagnosis of ADHD. In the classroom setting,
teachers noted an increase in disruptive behaviors during the pe
riod of music therapy treatment only (see Table 2) and this finding
is supported by the results of within session measures. Montello
and Coons (1998), using the CBCL-T (Achenbach, 1991), which is
a similar measurement tool for teachers, also found that the group
which had the highest attentional problems became more disrup
tive after each active music therapy session. This writer would con
cur with their suggestion that a highly-structured approach may be
more appropriate than encouraging spontaneity and creativity with
boys who have ADHD, and that groups be kept small. The impres
sion gained was that boys with ADHD might become overstimu
lated in a less structured situation.
Although the early music therapy sessions were highly structured,
the program had intended to support the boys' individual growth
by gradually encouraging more freedom of choice, spontaneity,
and creativity. Increased autonomy meant participants needed to
take more individual responsibility for self and for other group
members. However, the active nature of the sessions is likely to
have resulted in physiological arousal, making transition back to
the classroom more difficult for some boys. They possibly re
mained over-aroused after sessions and in their excitement were
less able to cope with formal classroom work. Zillman's 1991 re
search into the arousal of aggressive subjects (Cumberbatch &
Humphreys, 2000, pp. 404-405) may help to explain some of the
'deterioration' recorded by teachers in this study. He found that
physical exercise 'energized' aggression in a group of subjects who
had been previously angered, and argued that similar effects were
likely to occur with a wide variety of arousing stimuli such as loud
noise and vigorous music.
Improvement Trend, Prior to and Posttreatment
It is possible that the improvement noted for Group 3 following
their introduction to the study and signing of permission forms was
related to awareness of the special attention being paid to them. It
is feasible that the attention and anticipation of an enjoyable expe
rience had some positive effect on their behavior. While behavioral
theory would not predict this, as music participation was not con
tingent on good behavior, the suggestion does fit broadly within a
humanistic framework. Being chosen for what might have been
perceived to be a 'special' study, and discussing and signing infor
mation sheets and permission forms, may have facilitated the stu
dents' early recognition of acceptance and unconditional regard
from the therapist, resulting in an increase in self-esteem.
Inclusion criteria for the study required boys to have attended
the school for at least a term in what may have been a spurious at
tempt to have them accommodated to the environment and pro
gram expectations. A continuous trend for improvement could be
expected from the placement of boys into a stable and secure envi
ronment with consistent behavioral programs. The residential
school environment is in effect an active treatment in itself, and it
is difficult to attribute change to any particular program within the
school. The teachers did record a general improvement in boys'
behavior post-music-therapy treatment, and while one might con
sider whether a delayed treatment effect was being observed, it is
also conceivable that the music therapy sessions were in fact height
ening arousal and contributing to an increase in disruptive behav
ior in the classroom during the treatment period. These results
also imply that it could be advantageous to schedule music therapy
programs to finish prior to school break times. At the same time
there was no suggestion of any negative long term carryover effect.
If the decrease in disruptive and antisocial behaviors recorded by
villa staff was replicated in a comparable larger study, then it could
be argued that such benefits would outweigh the short-term class
room disturbance. Perhaps, by the time the boys in this study re
turned home after school, the villa staff were able to observe effects
of the music therapy treatment once arousal had settled—for ex
ample, the ability of the boys to get along with their peers in a less
structured environment.
Treatment and Follow-up Period
The results suggest that apart from an increase in disruptive be
haviors for Group 1 and no change in Communication Distur
bance for Group 3, residential social workers rated all three groups
as consistently improving during treatment across all six subscales.
Further, there is a tendency for the improvement to level off or to
be lost posttreatment, adding weight to the possibility that the mu
sic therapy sessions were having a positive effect on students during
the period of participation in the program.
Aggression Within Sessions
For all three groups, within-session aggression was rarely ob
served and subjects did appear to be developing positive relation
ships with peers. The overall increase in negative behaviors exhib
ited by Group 1 seemed to be in part related to their enthusiasm
for the music making tasks. They were increasingly being chal
lenged to interact with each other, to negotiate and make group
decisions without direct instruction from the music therapist.
Groups were at times very busy and noisy as boys choose what the
focus of their musical activity might be, and this almost certainly
contributed to the higher number of impulsive behaviors displayed
by the boys who have ADHD. However, they did not resort to using
the aggressive responses that might be anticipated from this popu
lation. This suggests that the music therapy group is a positive en
vironment for these adolescent boys, and the motivation to be in
volved enables them, to a certain extent, to regulate and manage
their own behavior. Scores on the Parent version of the DEC, and
direct observation of prosocial interactions between subjects in the
playground raise the possibility that skills learned in a clinical set
ting might be transferred to other environments, particularly
within a residential school.
While resident, these boys did not have the same difficulties with
peer relationships encountered by other 'mainstream' pupils, as
the boys in this study were all'in the same boat.' This may have
facilitated the development of empathy and friendships within the
music therapy setting that could be generalized to villa (i.e., home
like environments). Further study would be required to determine
whether any effects could be detected when boys return to their lo
cal communities, which is, realistically, where any skills that they
have attained are most put to the test.
Summary and Conclusion
This study suggests that a music therapy program might help to
increase adolescents' awareness of the existence and feelings of
others and to assist in the development of positive relationships
with peers, at least for boys without severe attentional deficits. The
trends found in this research suggest that rhythm activities may fa
cilitate internal organization and help with impulse control, in
boys who are able to attend to the stimuli. However, the within ses
sion observations and outcomes as measured by teachers, also sug
gest that adolescents who have ADHD may become over aroused in
a creative music therapy group setting. This implies that individu
alized and highly structured treatment might be more effective for
this population, which is in keeping with the findings of Montello
and Coons (1998).
On the other hand, the additional evidence obtained from the
DBC-P provides some support for the premise that music therapy
might be effective in improving interpersonal relationships in less
structured settings. The consistent 'improvement' trend recorded
by residential villa staff, raises the possibility that music therapy
helps adolescents with aggressive behaviors interact more appro
priately with others in a less formal environment, such as a resi
dential villa setting. This in turn suggests that, for this population,
some generalization of skills to other environments might be pos
sible. The importance of using multiple informants across settings,
and multiple measures, was strongly reinforced by this research.
While there are indications that the music therapy program may
temporarily lead to some deterioration in classroom behavior for
some boys during the period of the music therapy treatment, no
carry-over effect was observed.
Although the randomization process did not produce the de
sired group equivalency, differences between groups and the vary
ing responses of the groups adds weight to what is reported about
the influence of ADHD on group processes. On the other hand,
differences between groups with respect to age, diagnosis, numbers
of participants, and other concurrent treatments raises further
questions about which variables could be affecting outcomes.
No significant statistical differences were found; therefore no
firm conclusions can be drawn from this study. However, social
workers did record consistent improvement trends that are of clin
ical interest and merit further study. In addition, future study,
which takes into account specific diagnoses of subjects, is also war
ranted.
Future Study
The total number of participants, and size of the groups is par
ticularly relevant to the results of this research, as only a large treat
ment effect could have been identified in a study of this size. De
tecting smaller effects would require larger numbers of subjects
and, given the limits on the school roll, would inevitably take some
years to complete.
When exclusion criteria are applied, the maximum numbers of
eligible participants in any such residential settings could be ex
pected to be small. Although this study utilized the maximum num
ber of students who met the criteria for inclusion, the remaining
small number of participants (N= 18), was problematic.
A design that utilizes multiple sites would enable greater num
bers of participants, and would have the likely advantage of reduc
ing the study period. However, a multisite-study of this type can be
confounded by the variability in populations across settings, as well
as differences in the way group music therapy treatment is deliv
ered. The alternative design, making use of the same site and mea
suring change in several groups of participants over time in 'waves,'
lessens the problems with regard to environmental and treatment
delivery consistency, but inevitably takes much longer to complete.
The difficulties associated with the small size of this study could be
addressed by a larger study incorporating a cluster design, thereby
enabling allocation of subjects to more evenly matched groups. For
example, it would have permitted students with ADHD to be ran
domly assigned across groups. However the current study, and that
of Montello and Coons (1998), also suggests that music therapy treat
ment for students who have ADHD may need groups of smaller size
and programs that are highly structured where participants are given
less autonomy. This raises two questions. Firstly, do diagnostic differ
ences influence the mode of participation in group therapy? To in
vestigate this would require contrasting groups based, for example,
on inclusion and exclusion criteria for ADHD. And secondly, how
much does group size matter? Such subsidiary questions would re
quire more complex designs and larger numbers. However, stricter
inclusion criteria would limit the generalizability of any findings.
A much larger study would also be required to determine
whether the number of therapy sessions provided is a variable that
significantly influences outcome. Data from the parent version of
the DBC indicated a possible trend toward improvement during
treatment, which levelled off when music therapy finished. How
ever, longer-term treatment risks being confounded by multiple
other variables. While randomization is the most effective way of
addressing this problem a large sample size is still required. Fur
ther, it would be important to consider the cost effectiveness of
longer-term interventions in any such study.
Marked differences in individual scores provide some indication
that group outcomes were influenced by major events for individu
als. The consistent trend towards improvement recorded by resi
dential social workers who completed the Parent Report form of
the DBC raises the possibility of a Type II error, that is, while the re
sults show no major treatment effect, a modest undetected effect
may be present.
A series of single-case studies using a multiple baseline design
might be particularly suitable for assessing music therapy outcomes
for individual boys, and provide support for the effectiveness of
music therapy for this population. The single case allows more in
depth study of individual responses, and measurement of within
session change.
The variability of multi-informant data found in this work indi
cates the importance of utilizing a multi-informant approach in fu
ture study. The results of this study suggest that subjects' behavior
varied across residential villa and school settings, which allowed a
more complex, but fuller, picture of the boys' overall functioning
to emerge.
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Music Therapy To Promote Prosocial Behaviors in Aggressive Adolescent Boys-A Pilot Study

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Music Therapy To Promote Prosocial Behaviors in Aggressive Adolescent Boys-A Pilot Study

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Journal of Music Therapy, XL (4), 2003, 283-301

© 2003 by the American Music Therapy Association

This pilot study was undertaken to investigate whether music

Daphne J. Rickson, Halswell Residential College, Christchurch, New Zealand;

This pilot study was undertaken to investigate the hypothesis that

1. Bringing self selected music. During initial sessions, each stu­

Subscale Group Baseline Music Follow-up Baseline 2 Music

Disruptive i 21.000 22.000 20.333

Key to Reading Data & Graphs

Subscale Group Baseline Music Follow-up Baseline 2 Music

Disruptive 1 12.333 15.167 7.833

noted an increase in Communication Disturbance in Groups 1 and

TEACHER VERSION PARENT VERSION

TESTS OVER TIME TESTS OVER TIME

Disruptive subscales, teacher and parent versions.

DEC Antisocial Subscale

ANTISOCIAL S U B S C A L E . TEACHER ANTISOCIAL SUBSCALE. PARENT

TESTS OVER TIME TESTS OVER TIME

Antisocial subscales, teacher and parent versions.

Vol. XL, No. 4, Winter 2003 293

DBC Total Problem Behaviour Scores

Total scores for DBC, Parent Version.

294 Journal of Music Therapy

Mean number of negative behaviors recorded within sessions.

Aggression Within Sessions

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1. Bringing self selected music. During initial sessions, each stu