Music Therapy

1995, Vol. 13, No. 1, 47-73

The Musical Stages of Speech:

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A Developmental Model
of Pre-Verbal Sound Making

JOANNE V. LOEWY, DIRECTOR

THE ARMSTRONG PEDIATRIC MUSIC THERAPY PROGRAM,
BETH ISRAEL MEDICAL CENTER, NEW YORK CITY

The development of language has classically been under­

stood within a cognitive context. Yet the musical elements
of speech represent perhaps the most personal part of
human expression. Expressive sounds impact the content
of spoken words and characterize distinct feelings. This
article presents a rationale for the musical development of
speech and a means of understanding the level of vocal
activity that occurs in a pre-verbal context. The Model
identifies three Musical Stages of Speech: Stage I, Cry­
ing/Comfort Sounds; Stage II, Babbling, Lalling, and In­
flected Vocal Play; Stage III, Single­ and Double-Word
Utterances. At each stage of language acquisition, specific
techniques that enhance vocalizing are offered in order to
sequentially build upon each developmental level. The
Musical Stages of Speech integrate the cognitive, physical,
and emotional components of development through the
identification of musical elements that stratify levels of
pre-verbal speech.
48 Loewy

INTRODUCTION

The acquisition of language is a milestone that has been viewed

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as a major indicator of normal child development. Acquisition is
not simply a technical matter of how a child physically acquires
sounds and words; the importance of language acquisition often
is reflective of a child’s willingness to interact or communicate.
Linguistic markers can help predict problems. Researchers
have been focusing with new intensity on the earliest stages of
children’s language acquisition as key indicators of normal and
abnormal development (Brazelton, 1990; Hooper, Hynd, & Mat­
tison, 1992). Pediatric researchers Capute, Palmer, Shapiro,
Wachtel, Schmidt, and Ross (1986) were among the first to offer
physicians a means of detecting problems in language develop­
ment by evaluating the production and reception of sounds in
infants and young children. Their test offered the medical field a
means of measurement prior to a baby’s ability to speak in words.
The study of the emergence of language is no longer assessed
solely by speech pathologists. Pediatricians, psychiatrists, and
therapists from a wide variety of disciplines and orientations are
recognizing that the development of language is at the core of a
child’s physical, emotional, and cognitive growth.
The study of language acquisition is an area that could benefit
music therapists, since speaking is perhaps the most natural and
personal musical presentation that occurs in everyday life. Detec­
tion of deficits in sound receptivity and productivity is of primary
concern. The Musical Stages of Speech model presented in this
article utilizes aspects of Katharine Bridges’ (1932) study of emo­
tional development and body motion. Dr. Bridges’ important
work was one of the first studies to recognize a correlation be­
tween movement and specific emotions in infants and young
children. Her belief that stages of expressive development are
communicated through children’s sounds in conjunction with
body communication provides an integral and necessary basis for
the music therapist. The distinct emotions that Bridges noted in
babies, by studying their irregular, jerky movements and their
regular rhythmic movements as well, led researchers to acknow­
ledge that such variances were indicative of a broad range of
 The Musical Stages of Speech 49

emotions. This recognition of movement correlating to expression

sets a foundation for the understanding of conscious bodily ex­
pression of emotions and of contact movement that can be elicited
within a music-making process.

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Others have provided evidence that movement and sound are
an important meter of affect and communication. Thelan (1994)
studied the rhythmic behaviors of infants and connected move­
ment to an infant’s ability to explore affect. Briggs (1991) associ­
ated movement with rhythmic reflex, intention, control, and
integration. She saw rhythm as a major communicative compo­
nent of a child’s musical development.
The work of Charles Van Riper (1984) provides a foundation
for this Musical Stages of Speech model. Van Riper is considered
by many to be one of the grandfathers of speech theory and
development. In providing a rationale for developmental sound
production, he consistently viewed vocalizations as pre-verbal
behaviors, not as a means to an end in and of themselves, but as
indicators and integrators of mental, emotional, and physiological
systems.
The Van Riperian classic characteristics of speech and language
developmental levels begin with crying and comfort utterances,
signaling a period in which the child practices the basic synergies
of respiration and phonation. Babbling, the function that follows,
is thought of as a time in which the child explores articulation. The
third period involves the actual acquisition or comprehension of
words, which supersedes the child’s actual use of words. He saw
these phases of speech and language development as a context for
sounds that "... build the foundation for the true speech which is
still to come” (Van Riper, 1984, p. 87).
The Musical Stages of Speech model provides a means of
understanding the level of vocal activity that is occurring in a
pre-verbal context. The acquisition of sound and sound making
is viewed in consecutive phases within a developmental context
and presented as indicators of mental, physical, and emotional
development. At each stage of language acquisition, specific tech­
niques are offered in order to enhance vocalizing, sequentially
building upon each developmental level. The model also offers a
structure that inherently provides both order and spontaneity
50 Loewy

through rhythmic grounding and the exploration of melody and

improvisation.
Although the suggested techniques correspond to particular
stages of vocal development, they should not be thought of as

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mutually exclusive of one another. Some elements of one tech­
nique may be used in conjunction with another. For example,
Mirroring (Technique 6) is used to enhance socialized babbling.
Even though it is an important step that follows Sound/Breath
Organization (Technique 5) and is a prelude to the actual Dis­
crimination of Vowels (Technique 7), there are moments when
Mirroring is used in conjunction with other techniques.
These techniques have been developed from clinical experience
with children of varying populations ranging from mute to nor­
mal. Therefore, the Musical Stages of Speech model provides a
framework that is applicable to children with diverse needs. It has
been particularly beneficial to normal, autistic, emotionally­
handicapped, mentally-delayed, and speech-delayed children.

THE MUSICAL STAGES OF SPEECH

Stage I: Crying/Comfort Sounds

As early as 1877, Charles Darwin recognized the significance of
infant cries and connected them to motoric gesturing:

The wants of an infant are at first made intelligible by

instinctive cries, which after a time are modified in part
unconsciously, and in part, as I believe, voluntarily as a
means of communication, by the unconscious expres­
sion of the features, by gestures and in a marked manner
by different intonations, lastly by words of a general
nature invented by himself, then of a more precise
nature imitated from those which he hears. (Darwin,
1877, p. 24)

Darwin clearly supported the premise that a child’s emerging

nature is highly individualistic. In the above quote, Darwin is
alluding to the emotional (“unconscious expression”) and musical
 The Musical Stages of Speech 51

(“intonations”) elements of vocalization. His recognition seems to

support the inevitability of vocal improvisation (“words . . .
invented by himself”) and its importance during the first months
of life.

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The crying sound at birth marks a child’s first vocal expression
in a new environment. Spectrographic analysis reveals that the
early cries of a newborn are composed of patterns of rhythms,
including crying, resting, inhaling and resting (Ziajka, 1981).
Characteristically, these sounds include three vowels /aa/, /E/,
and /aI/. Such vocalizations are typically characterized as cries
that provide the child with reflexive motoric release. As the infant
explores functions of tone and air, the larynx is exercised.
Langlois, Baken, and Wilder (1980) studied crying and meas­
ured patterns of cries with a focus upon fundamental frequencies.
Crying involves tone and dynamics, which can be thought of as a
precursor to melody and the ‘sing-song’ qualities of speech. Cry­
ing facilitates respiration. Crying is also defined by Boukydis
(1985) as communicative. He studied infant crying and noted that
the enrichment of the crying sounds occurs within the context of
a “mutually, regulated, dynamic relationship” (p. 213). Ostwald
(as cited in Katsch & Merle-Fishman, 1985) defined the infant cry
as a “remarkably efficient sound signal, which indicates that the
baby is hungry, cold, lonely, or in distress” (p. 19). The cry
represents an infant’s first audible expression of emotional need.
The comfort sounds develop soon after the crying sounds.
These vocalizations are generally more passive and include an
infant’s gurgles, sighs, and coos. The sighs and coos, although
they may include a pitch, ultimately are indicative of an infant’s
physiological response to her own bodily functions. The comfort
sounds have a relief-like, percussive quality. These sounds enable
the child to gain control of the rhythmic patterning of the breath.
Hollien (1980) defines comfort sounds as vegetative. Vegetative
sounds can be thought of asinternal, reflecting the body’s physical
manifestations, in contrast to crying sounds that are tonal and
expressive and therefore thought to be communicative in nature
(see Table 1).
52 Loewy

Table 1:
Communicative vs. Vegetative Sounds

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Communicative Vegetative
Cry coo
Scream Chuckle
Rasp Gurgle
out cry Grunt
Struggle grunt Suck
Whine Sigh
Sob Snort
Whimper Smack
Gasp
Sneeze
Yawn
Cough
(Hollien, 1980, p. 23) Hiccoughs

In general, the sounds that infants release within the Cry­

ing/Comfort Stage have a pitch pattern that at first rises and then,
toward the end, falls. Research on infants’ crying has been useful
in the identification of disease or neurological abnormalities (III­
ingworth, 1955; Ostwald, Phibbs, & Fox, 1968). For example, a
weak whine could indicate Tay Sachs, a disease involving lipid
storage difficulties (Ostwald et al., 1968); a hoarse, guttural cry
with a gruff sound could indicate a thyroid deficiency or cretin­
ism; a high, piercing, staccato cry could indicate brain defects or
severe brain damage, meningitis, or hydrocephalus (Illingworth,
1955). Lind, Vuorenkoski, Rosberg, Partanen, and Wasz-Hockert
(1970) noted that the cries of Down’s Syndrome babies were rather
flat and low in pitch. Perhaps the most significant disease to be
identified and named for its unique cry is the Cri Du Chat syn­
drome. The cry of the victims of this chromosomal disorder is
reminiscent of the mewing of a cat (Vuorenkoski, Lind, Partanen,
Lejeune, Lafourcade, and Wasz-Hockert, 1966). Indeed the crying
of infants has been explored by many in terms of dynamics, pitch,
 The Musical Stagesof Speech 53

timbre, rhythm, and tone. It is a crucial milestone of primary

importance to neonatal specialists.
For the music therapist, an understanding of the Crying/Com­

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fort Stage can be particularly helpful when working with infants
and children who, whether suffering from trauma, mutism, cere­
bral palsy, or asthma, are anxious, fearful, or reluctant to make
vocal sounds. The following techniques grant the child permis­
sion through blanketing, holding, matching the timbre, in order
to stabilize the child’s release of air, tone, and impulse.

Technique 1: Tonal/Vocal Holding

The music therapist can begin by listening to any sounds that
are elicited from the infant or child. At this early stage, the cry is
a primal release. The pitch and timbre of the cry can be taped and
analyzed. The therapist will then have an orientation to the tonal­
ity and quality of the child’s primal expression.
The therapist can seek to elicit or strengthen the child’s sound
response by matching the child’s cry with a long, steady blanket
of vocal holding tones. Such tones are best established within the
key of the child’s tones. In most circumstances, Tonal/Vocal
Holding is not accompanied by any pitched instruments. The
child’s perception of tone should not be over-stimulated by the
unfamiliar. The easy flow of the therapist’s voice, presented as
close to the tone and timbre of the child’s voice, can both stimulate
and comfort the child, as well as invite vocal exploration.
The emotional tone of the therapist may vary. Although the
tone needs to be steady in air flow and plentiful in deep breaths,
the timbre may reflect the timbre of the child. Typically, glissandi
are useful in this phase, reflecting the child’s voice that is not yet
mature enough to phrase the release of air into steady, separate,
consecutive tones.
In addition, the therapist’s tones should be as pure as possible,
avoiding excessive vibrato. The tone itself can provide a setting
for a growing musical relationship by giving the child a sense of
acoustical resonance. In this way, the emotional receptiveness
between the therapist and child is enhanced.
54 Loewy

Eventually, the therapist can offer the child’s name to provide

further familiarity and comfort. The melodic themes that are
developed by the therapist and child through this reciprocal

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process should be kept simple. The therapist’s role in Tonal/Vocal
Holding is to frame and elongate the child’s tonal release by
holding and framing her response.

Examples of Tonal/Vocal Holding

(AUDIO EXCERPT #1, SIDE B)
Example A: Sam, age3 months, comfort sounds. This first example
illustrates Sam’s exploration of air patterns. Sam is an unusually
receptive, healthy infant, and, since this is his 2nd session, I am
already somewhat familiar with his vocal range. As I provide the
tonic, Sam immediately sings the fifth. As I reflect this and sing
the tonic, Sam sings the third, offering balance. These are comfort
sounds. The microphone is close to his mouth, and his air exhala­
tion can be easily heard. Sam’s sounds are vegetative; he is work­
ing with his mouth and body functions that seem to have sporadic
patterns of percussive grunts and gurgles. His sounds include
glissandi, and he explores various timbres. My holding of tones
on Sam’s third of the tonic invite him to move his air; he is gaining
incentive and breathing at a faster pace. The high octave gives him
impetus to breathe faster and with greater force. Sam’s sensitivity
to tone is notable as his vocalizations are contained and held
within the third and fifth of a major triad. He is constantly seeking
to affirm the tonic.

Example B: Sum, age 3 months, crying sounds. In contrast to the

comfort sounds, Sam’s cries in this example convey an expressive,
needy sound. There is more tone, with accented attacks of vocali­
zation The timbre reflects fluctuation in mood as the dynamics
shift from crescendo to diminuendo. For a moment, Sam ex­
presses his needs by singing on the dissonant major second. As I
hold the tonic, minor third, and fifth, reflecting the coarse mood
of Sam’s timbre, his crying becomes more accented and then shifts
from crying to comfort sounds. Sam is comforted by the holding
tones I offer.
 The Musical Stages of Speech 55

Technique 2: Primitive Drum Grounding

According to Catherine McHugh (1989), a developmental spe­
cialist who has studied the use of music with the profoundly

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handicapped, there is a hierarchy of sound that evokes primitive
responses. Rattles, tambourines, and drums, for example, often
provide a further catalyst for eliciting a crying/comfort sound.
The rhythm of such percussive instruments can offer a kind of
primitive grounding, neurologically connecting a child to his or
her own body and inducing the physical release of tone. The
grounding technique utilizes a broad range of rhythms.
Initially, the rhythms should not be consistent in meter, but
rather should reflect the patterning of breath, vocalizations, and
body movements of the child. After reflecting the child’s innate,
nonmetrical rhythms, the music therapist can gradually exagger­
ate the rhythms of sound and movement that are offered by the
child. Rider (as cited in Maranto, 1991) refers to this type of
reflection as “entrainment” and has used it in music treatment in
pain reduction. He has found entrainment to be effective when
the therapist is “synchronized with the listener’s physiology in
some way-such as respiration rate” (p. 94).
Eventually, when the child’s response begins to form a pattern,
the therapist may offer periods of meter but should still avoid
imposing order before exploration has occurred. Repetitive yet
unbound freedom--such as found in African rhythms-can often
serve as a catalyst that will help to integrate a child’s sound and
movement.
Primitive Drum Grounding encourages a child’s inner rhythm
to emerge and stabilize. It fosters self-control because rhythm is
the motion of instinct and drive. This is especially the case in
Primitive Drum Grounding because the child’s physiological,
innate body rhythms are being activated and reflected. Through
the eventual use of consistent rhythms, with or without the voice,
the therapist may join the child’s rhythms to reinforce and extend
the child’s crying/comfort sounds.
56 Loewy

Examples of Primitive Drum Grounding

(AUDIO TAPE EXCERPT #2, SIDE B)

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Example A: Jonathan, age12 months. Due to an up coming medical
procedure, Jonathan had not been not permitted to eat for twelve
hours. As I enter his room, I notice that he is biting his blanket and
silently sobbing. He appears to be holding his frustration of
hunger in. The rhythm of the toned tongue drum seems to offer
Jonathan permission to release and express his anger and need in
a communicative way. Although there are brief periods of meter
(shorter than two measures), the predominant rhythm of the
drum is undefined and entrained to the respiration sequences
(inhalations and exhalations) and motion of Jonathan’s body. The
patterns of rhythm reflect his inner feeling of chaos that is suscep­
tible, for brief moments through reflective grounding and toning,
to order. The Middle Eastern mode tonally grounds the release.
Jonathan’s sounds indicate a tremendous sensitivity to tone. His
willingness to express his needs through tonal communication is
powerful. A shaker egg is provided to further hold and acknow­
ledge his need for releasing tension and the discomfort that cannot
be avoided.

Example B: Stephanie, age 4 years. Since the age of 1 year,

Stephanie has carried with her, from setting to setting, the diag­
nosis of “autistic,” as well as “mute.” She has attended 5 different
programs in the past 3 years. Having seen her in a group for 1
year, and being acutely aware of her “mutism,” I am taken by
surprise, at this 2nd individual music therapy assessment session,
when she begins to point at the instruments and cry out loud, with
tone, for the first time. In this example, Stephanie is responsive to
the offered grounding. The syncopated drum rhythm seems to
elicit her cry response. As I reflect the mood of her tentative
tonality, it does not take her long to sense that I am imitating her
sounds. She becomes more easily able to let me do this within a
rhythmic context. Her vocal tone sequences become more pro­
nounced and accented when the drum is underneath her voice. I
continue to reflect the accent of her rhythms that go in and out of
meter. Although she is 4 years old, her cries reflect elements
 The Musical Stages of Speech 57

similar to an infant’s glissando and timbre. Stephanie uses the

common rise and fall of pitches that typify a baby’s cry.

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Example C: Theron, age 5 years.The steady African rhythm on the
Djimbe drum strengthens Theron’s breath and motivates him to
move his body. He is ready to begin organizing his sounds. This
is indicated in his tendency to pull away from entrained rhythms.
He seeks a steady order and defined rhythmic structure to provide
a sense of security as he explores his own inner melodies. During
this session, which occurs during his 2nd year of music therapy,
Theron begins to make direct eye contact with me, which is
unusual for him. He initiates a melody line that is syncopated with
the pattern of our drumming. His movements are connected to
his vocalizations, which are firm and accented. Through the
drumming, Theron begins to internalize the pulse of our meter.
This is evidenced by the fact that his improvised patterns begin to
have their own steady, internal meter. He no longer needs me to
hold the background beat pattern; he is able to hold it internally.
As you can hear in the audio excerpt, Theron is also beginning to
explore the rhythmic and tonal possibilities of his voice.

Technique 3: Reflexive, Motoric Solo Play

Bridges’ (1932) rationale for connecting movement to emotion
is an important concern because the two systems cannot be
viewed as separate, especially in the child who is not using
language actively. It is necessary for clinicians to consider the
emergence of sound and language in conjunction with a child’s
reflexes, movement, and coordination.
The sounds a child creates in the pre-verbal stages of develop­
ment are often a direct expression of how the reflexes are synthe­
sizing within the body. A child’s motion can provide the therapist
with insight about levels of synchrony and a child’s growing
connection to the surrounding world.
Beating a drum offers a person of any age or diagnosis a sense
of reflexive motion that enhances solo play and a sense of stability.
The release of tension strengthens a person’s ability to relax and
focus upon his own means of action. As a child beats, the therapist
can strengthen and support the movement by harmonically fram-
58 Loewy

ing the sound. The motions that a child extends upon the drum
can be heard as free downbeats. Contextualizing the drawn-out
instinct too quickly may prematurely pull the child into a struc­

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ture that is externally limited rather than internally driven. The
meter need not be rigidly defined. Rather, the child’s instinct and
drive should be encouraged. One of the most powerful means of
accomplishing this is for the therapist to extend the resonance of
the child’s impulse by meeting her in her desired release, precisely
on the down beat, accenting the quality of sound that she is
choosing to create.
A child can beat the drum with a mallet or bare hand. This
decision will depend on the child’s developmental level and
diagnosis. The tone of a drum is central to a child’s experience of
freedom. The action of creating a sound that is harmonically
framed instills a sense of safety that in turn promotes rhythmic
exploration. The harmonic power of the piano can affirm the
motoric strength and intensity that the child is offering. The drum
is perhaps the instrument most conducive to encouraging the
externalization of reflexive action because it is percussive and
easily permits the therapist to meet the child in her own beat. At
the same time, the therapist’s use of harmonies at the piano can
suggest and/or frame vocal melodies that might emerge from the
child in response to the recognizable resonance created between
the toned drum and piano (i.e., child and therapist).
The Dorian and Middle Eastern modes have often been used to
empower a child’s sense of exploration (Carol Robbins, personal
communication, 1991). These modes seem to induce a state of
inner charge or anticipatory readiness. They can help to create a
feeling of activation.
As the therapist joins the child in the downbeat, there often is
a dependency that evolves. This can strengthen the bond and
build upon the context for future musical exploration.

Example of Reflexive, Motoric Solo Play

(AUDIO EXCERPT #3, SIDE B)
Jason, age 2 ½ years. The Phrygian mode seems to offer a firm
frame that holds Jason in the moment. It is a challenge to meet him
in his beat because Jason has trouble standing or sitting still. He
 The Musical Stages of Speech 59

has been rejected from schools because of “hyperactivity,” and

most often he avoids contact of any kind. He is language-delayed
and, in many of our improvisations, he tends to become over­
stimulated when he plays the hand instruments. This particular

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example (taken from his 16th session in individual music therapy)
is a rare moment for Jason in that he is pulling together the control
of his body movements and blending his impulse energy with his
voice and emotional intent in order to release himself. The drum
tuned to the fifth of the tonic contributes to a sense of unity
existing between himself and his own music-making, as well as
in the growing musical connection between the two of us. As his
sense of collaborative momentum rises, his rhythms creatively
expand.

Technique 4: Organized Beating with the Child’s Name

Following Reflexive Play, this final phase of the Crying/Com­
fort Sound stage involves organization of the child’s beating. The
music therapist can use themes taken from earlier sessions to
ground both the strong and weak beats presented in order to draw
the child into the position of rhythmic synchrony (Loewy, 1994).
As this synchrony develops, singing the child’s name can acclaim
his sense of purpose and further enhance the process. It also can
implicitly provide support during a time of primary integration.
By establishing a basic beat for the child (Robbins, 1977) that
includes organized rests (pauses) within the accompaniment, a
child can begin to feel a sense of organization. This organization
will inform the therapist of the child’s readiness to proceed to
Stage II (Babbling). There must be a trust that has developed so
that the child feels safe enough to play within the therapist’s beat
meter. Furthermore, the child must trust that, when the therapist
organizes two beats of rests, there can be stability in playing alone
and in knowing that the therapist will come in and support again
within the basic beat.
In addition to leaving rests within the harmonic support beat,
the therapist can also begin to explore the absence of the vocal
cadence note that resolves a phrase, to see if the child can antici­
pate a sense of resolution. The use of this music therapy technique
known as “music minus one” can inform the therapist of the
60 Loewy

child’s sense of completeness (Hesser, 1984). It can provide the

therapist with insight about a child’s awareness, as well as how
well the child is able to organize her own sounds amidst an

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ever-changing environment.

Example of Organized Beating with the Child’s Name

(AUDIO EXCERPT #4, SIDE B)
Theron, age6 years.Playing together, exactly on Theron’s down­
beat, seems to affirm his sense of control. Theron fills in the pauses
of the music, which indicates that he is gaining awareness of the
rests and breath points between phrases, much like pauses in the
sentences of speech during a conversation. As the music pro­
gresses, Theron replaces the sound of the drum cadence with his
voice. He fills in the end of my sung sentence with his own
musically sung phrase, “the drum,” indicating awareness and
understanding of his action. The refrain strengthens and harmoni­
cally expands the understanding of the action that is the subject
of the lyrics. The tonic-dominant relationship created in this sim­
ple song structure seems to offer Theron a coherent form. The
harmony invites him to use his voice, and our collaboration
extends through the music. The guitar harmonically and percus­
sively provides an accurate and visually immediate synchroniza­
tion of our two sounds. I strum my fingers downward on the
guitar at precisely the same time that Theron beats his Tar drum.
This enhances our ability to organize our created sounds together.

Stage II: Babbling, Lalling, and Inflected Vocal Play

In the second Musical Stage of Speech, both vocal and motoric
sound-making are used as explorative processes to encourage the
vocal expression of sound. The connection to the body is strength­
ened through inhaling and exhaling, and through the motoric
release and structuring of physical body movements. The begin­
nings of the Babbling Stage appears as the child’s solo cries and
movements have been supported and appear to gain frequent
patterns. The child’s eager organization of vocal expression and
 The Musical Stages of Speech 61

the extension of outward rhythmic patterns alert the therapist that

the child will soon be babbling.
It is during this period of babbling that a child begins, seem­
ingly, to consciously experiment with the musical elements of

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speech. This “music of speech,” or prosody, is the earliest dimen­
sion of language that is used and understood by children. Re­
search on the prosodic features of language indicate that the
babbling period may be crucial to a child’s mastery of the intona­
tion and stress of spoken language (Wood, 1976).Nakazima (1980)
studied babbling and found it important in the development and
organization of phonatory, articulatory, and auditory mecha­
nisms. He found that phonemicization (the organization of single
consonant/vowel sounds, e.g., “ba, ba” or “me, me”) enhanced
children’s ability to begin to symbolize and reorganize the under­
standing of their environment through symbolization.
Landahl (l982) reminds us of the importance of listening dur­
ing this period. In his study at Brown University called “The onset
of structural discourse: A developmental study on the acquisition
of language,” he observes that human beings:

have some innate mechanisms that facilitate the

acquisition of speech and language and enable children
to filter out the linguistically salient aspects of speech
and language from the various other sounds they en­
counter. (p. 69)

The first phase of babbling is characterized by the chaining of

sounds together on one exhalation. These sounds may initially
have no more semantic meaning than did the infant’s cry­
ing/comfort sounds, yet they shape the child’s musical contour
into what is called a “phoneme” stage.
According to Bruner (1977), early patterns of interaction be­
tween infants and adults are vocally defined and learned in
infancy. Bruner studied the depth of vocal exchanges between
adults and their children. He stressed that vocal interchanges
represent a child’s developing ability to be able to read others’
signals, especially with regard to the beginnings and ends of
turns. He referred to “socialized” babbling as the beginnings of
the “intuiting of new exchanges” (as cited in Ziajka, 1981, p. 132).
62 Loewy

Bruner taught that pre-verbal exchange is a prototype for later

mutual linguistic communication and that it enables infants to
possess sophisticated vocalization patterns.
As children learn to explore the effect that their vocalizations

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have upon those around them, they begin to take greater risks in
their expression of tone and vocal release. During this phase, the
music therapist can encourage the child to make his own expres­
sive sounds. Then, through the therapist’s mirroring of socialized
babbling, the child can come to understand that voices can create
a variety of tones and that variances of pitch indicate differing
needs. Whereas an infant’s cries are reflexive and indicative of
basic needs, the babbles of an older child encapsulate a greater
sense of interaction, and the expression of needs becomes more
consciously controllable and expressive.
The following techniques focus on the elicitation and explora­
tion of vocalized play between the child and therapist. The thera­
pist’s music within this stage is playful and seeks to invite and
extend interaction.

Technique 5: Sound/Breath Organization

As the child vocalizes, the music therapist can begin to assess
the repetition of stress patterns and intonations that occur. New
instruments with tones can be offered. The idea is to encourage
the child’s breath flow and mouth movements in an effort to
expand and extend vocalization.
Slide whistles are one means of encouraging vocal expansion
of the breath because they encourage children to explore pitch and
intonation. This is congruent with Wood’s (1976) findings that
support the notion that the babbling period is a time in which
children exercise their vocal apparatus. Lieberman (1966, 1988)
electronically analyzed recorded babbling of l-year-olds and
found that infants are able to control pitch because of their acute
perceptions of the fundamental frequency differences in the
voices of their caretakers. In terms of the onset of babbling, the
controlling of pitch through the manipulation of the airways is
essential. This is exaggerated through the use of a slide whistle.
Since the movement of the slide changes the pitch, it implies a
synchrony between an action that affects the breath. This simple
 The Musical Stages of Speech 63

technique can come between the stages of vocalizing and speak­

ing because it encourages a child to explore the musical elements
that are contained in both of these activities.

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Examples of Sound/Breath Organization
(AUDIO EXCERPT #5, SIDE B)

Example A: Jennifer, age 6 years. Jennifer is a stutterer who has

had language difficulties that result from her anxiety about com­
municating. For her, a “slide whistle conversation” seems to offer
a clear, connected means of interchange that removes the anxiety
of content from the act of communicating. In this improvisation,
which took place during her 10th session, Jennifer asks me a
musical question by establishing a melody that ascends at the end
of her line. As I “answer” by descending my line, her confidence
increases. Her next “question” is faster, uses more air and accents.
This time, as I answer, she interrupts with an even faster and
longer phrase. Our conversation develops into a duet as we
spontaneously sequence the rhythms and tones.
Our phrases are contrapuntal. There is a sense of mystery and
fun that Jennifer works toward as she risks expressing herself on
the slide whistle. Unlike her verbal language experience, she is
communicating in a full musical discourse at a rapid, expressive,
chatty pace.

Example B, Jennifer, age 6 years. This example is taken from our

16th session. Jennifer’s slow slide whistle melody, supported by
the piano’s harmonies, reveals how much emotion Jennifer is
capable of expressing. She is used to holding onto her emotions.
The piano’s progression of diatonic seventh chords encourages
Jennifer’s musical lines to become more fluid as she releases air
and tone. This fluidity can and eventually will be directly trans­
lated into singing. The slide whistle can offer an intermittent step
between singing and speaking.

Technique 6: Mirroring
The crucial element of the Mirroring technique lies in “answer­
ing back” to the child (Van Riper, 1984,p. 91). The music therapist
64 Loewy

can start by providing chords of a familiar musical context and a

faint hum of a theme that is so familiar that the child will feel
moved to expand the sounds in a playful way. Whatever sounds
the child creates should be mirrored, that is, repeated back to the

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child as accurately as possible. This reinforces the child’s creation
of her own sounds while at the same time allows room for the
response, awakening the child’s awareness of the response of
another human being.
This technique can enhance the playful exchange of what are
called the “front vowels”­ /a/, /e/, /i/ -through duplication
and turn-taking. As the child presents a range of different sounds,
the therapist can use these sounds in a familiar musical theme by
setting front vowels to the theme, hence encouraging further use
and exploration with these front vowels. Eventually musical
movements should be included. Encouraging the child to clap,
stamp, or shake various body parts may help him begin to chan­
nel, invest, and direct his sense of energy and intention into the
music.
It should be noted that, unlike the therapist’s response to the
child, the child’s answering back to the therapist within the music
need not be the same exact sound response that the therapist has
offered. The therapist provides the child with exposure to the
vowels based upon familiar themes. The important aspect within
the socialized babbling phase is that the child is looking, listening,
and moving in response to the therapist.
Within this beginning period of expressive contact, it is typical
for the child to touch or notice new features in the environment
or on the therapist. This contact can be encouraged and prolonged
through musical call and answering. For example, the child may
gain the awareness that the sound is coming from the therapist’s
mouth and may touch the therapist’s mouth. In turn, the therapist
may touch the child’s mouth or place the child’s hand over his
own mouth. This kind of new and growing awareness offers the
therapist rich material with which to build future preliminary
songs upon. The content of these first songs may consist of one or
two words that recognize the child (his/her name, a body part, or
action).
 The Musical Stages of Speech 65

Example of Mirroring
(AUDIO EXCERPT #6, SIDE B)
Edward, age 5 ½ years. This well-known example of Edward is
taken from the work of Paul Nordoff and Clive Robbins (1977).

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Edward’s emotional difficulties have been dramatically altered by
this, his 9th, music therapy session. An important contributor to
his developing ability to communicate is the therapist’s offering
of a musical give-and-take experience. Listen to the infectious
repetition and playfulness of the musical game as you play this
audio excerpt. Edward’s Mirroring is described by Nordoff and
Robbins (1977):

Edward initiates vocal play, singing “ee-ee” on three

ascending tones. The therapist answers, playing and
singing, and a give and take in 2/4 develops. Edward
adds “hello” to the game. The leading of play passes
from one to the other. Edward’s sound patterns are
tonally defined and melodically responsive to the thera­
pist’s phrases. (p. 33)

Technique 7: Discrimination of Vowels through Structure

Discrimination of Vowels is a critical technique, since vowel

sounds are one of the most essential elements of speech. The most
simple means in which a child can learn vowel sounds is for the
therapist to playfully enhance and extend the child’s own sounds
within a structured melodic content. Using a pitch range from five
tones (the pitch range of newborns) to ten tones (the pitch range
of a child of seven) (McGlone, 1966), the music therapist can
organize and shape the vowels in a simple melodic line. By asking
the child to mirror the sounds, the child and therapist can explore
phonemes within a reciprocal play framework.

* “Edward” tape excerpt from Creative Music Therapy, © 1977 by Paul Nordoff and
Clive Robbins. Used by permission from Clive Robbins.
66 Loewy

In contrast to the socializedbabbling phase, where only the front

vowels are recognized through the therapist’s mirroring, in this
phase both front and back vowels - /u/, / v /, /o/, and /> /
- are organized into themes that are familiar. Simple songs,

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including simple three- to four-note ascensions that resolve in a
clear cadence, can assist the child in the organization of all the
vowel sounds. Such musical play that organizes the elements of
music within a language phonemic framework will also help the
child to discriminate between varying vowel sounds.
The child’s musically expressive inflections can be further ex­
plored through the therapist’s use of a variety of harmonic accom­
paniments on an assortment of instruments that offer varying
modes. Within such an improvisatory inflective sound explora­
tion, the dynamic level of vocalizing can be connected with mood
and affect. Silly sounds, intense sounds, quiet sounds, etc. can be
explored and ignited through the monitoring of the child’s vary­
ing responses. As children continuously explore their tones, espe­
cially through pitch exploration, they can differentiate
communicative meanings.
When a child brings forth a tone or sound, his whole
organism is actually involved and what takes place in
the song or speech organ is only the final culmination
of what goes on within the entire human being. (Steiner,
1922, p. 33)

Example of Discrimination of Vowels through Structure

(AUDIO EXCERPT #7, SIDE B)
Theron, age61/2years.The structure and thematic line of the song
form in this example offers clarity for Theron and encourages him
to distinguish between a variety of vowel sounds. He is aware of
the cadence and easily fills it in with a vowel. Through the
therapist’s tone modeling, Theron is able to deepen his constricted
and somewhat nasal resonance by opening his chest register.
Eventually, we add his name to the song. Rather than using his
full name, Theron modifies the situation by breaking his name
into two phonemes; “No T-t-t-the-ran.” He is eager to sing his
own name and seemingly understands how phonemes within a
musical context express meaning.
 The Musical Stages of Speech 67

Technique 8: Phoneme Expansion

through Rhythmic Consonant Play
The first consonants to be introduced within a phonemic con­

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text are typically /d/, /t/, /n/, and /1/. These can be enhanced
through the use of the drum and other percussive instruments.
The first competency that provides ameans for eliciting consonant
sounds should connect rhythm and action. Toned drums, for
example, can invite the pitched tone of vowels to be blended with
the consonant sounds encouraging phonemes. A Danish speech
therapist, Svend Smith (as cited in Van Riper, 1984), has devised
a set of simple rhythmic patterns based on drum chants of South
African natives that he uses on the bongo drums to elicit plosive
sounds.
Turn-taking within a rhythmically metered context can be en­
hanced by adding vocal accentuation to the elicited rhythms. The
child’s repertoire of sounds can be expanded through the elicita­
tion and framing of specific rhythms offered motorically and
vocally by the child. This could occur by improvising on a phrase
spontaneously. Perhaps the child and therapist will choose to
accent every other note, or every three notes. No matter the
decided meter, vocal and motoric accents provide phoneme risk­
taking experiences.
Another aspect of this technique is the use of the musical rest,
or pause, that the therapist can introduce within the sound struc­
ture. It allows the child to discriminate between “sound” and “no
sound.” According to Lieberman (as cited in Wood, 1976), normal
infant babbles contain “sound patterns that contain pausal fea­
tures of language” (p. 211). Developmentally, children must be­
come aware of these pauses in speaking. Lieberman connects the
breathing mechanisms to the prosodic features of children’s
speech and thinks of the pauses that occur in language as an innate
mechanism of breath need. Just as the air connects the body to the
acoustic events that are yet to come, the musical silence further
organizes the sounds by the creation of phrases.
68 Loewy

Example of Phoneme Expansion through Rhythmic Consonant Play

(AUDIO EXCERPT #8, SIDE B)
Jeremy, age 8 years. The spontaneous rhythms created on the

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bongos by Jeremy, who has Down’s Syndrome, lead him into
expanding the range and dynamics of his vocalizations. In this,
his 29th session, his phonemes have extended into a full explora­
tion of plosive sounds. Jeremy is eager to try new rhythms as he
percussively creates a dotted-eighth beat for the first time. In
doing so he connects his body (drumming) to his voice (singing);
the improvised rhythm is exactly the same, indicating full integra­
tion The use of melodies within a harmonic structure stimulates
his vocal improvisation. Jeremy’s sense of phrase structure and
melodic sequencing is notable. In feeling the apparent joy of being
mirrored, he extends his cadence, seemingly inviting the therapist
to join him in a grand vocal resolution.

Stage III: Single­ and Double-Word Utterances

The use of music within the third stage of the Musical Stages of
Speech involves the implementation of beginning concepts that
pose the additional feature of content. Ideally, at this stage, the
therapist is familiar with the child’s own musical themes as well
as the child’s growing interest in the environment. The expansion
of prior musical themes into words will enhance the child’s sense
of what is occurring in the moment of music making. The Single­
and Double-Word Utterances should utilize the phonemic
strengths that the child has already developed during the Bab­
bling Stage (Stage II). It is at this point that the child first feels,
understands, integrates, and expresses her first word. This aware­
ness will eventually unfold in the music as a sung proclamation
by the child.
In order to stir a child’s sense of understanding about the world
around her, the first word of content that a child might be exposed
to is his or her own name. The child’s name, although it may have
inevitably been used prior to this final stage, merits a discussion
of rationale for it being the first word of introduction for the
pre-verbal child in music therapy.
 The Musical Stages of Speech 69

The name represents a child’s being. It is best to incorporate the

name into a song with a simple melody that integrates prior
commonly used intervals with a rhythm that is applicable to a
speech rhythm. For example, “Melanie” could be sung as a triplet

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with an accent and higher stepped tone on the first syllable; “Tom”
could be sung as a half note on one tone.
This type of “name song” can be structured in the context of a
greeting. A welcoming that incorporates the child’s name pro­
vides the most direct, sensical meaning for the child. Steiner (1983)
suggests that the interval of a third represents a person’s oneness
or wholeness. Nordoff and Robbins (1977) suggest melodies with
stepwise passages and intervals no larger than an octave, at best
thirds, fifths, or sixths.
The child’s name/greeting song can be strengthened by a con­
tact movement that includes the therapist. This allows the experi­
ence of exchange to be a connected, outside awareness of contact.
Edith Boxill (1985) emphasizes the value of what she has termed
the “contact song” (p. 80). Interestingly, her definition of contact
not only includes “reciprocal musical expression” but also “overt
musical indication initiated by the client of an awareness of the
existence of another” (p. 80).
Contact movement using this technique may be as simple as a
wave (side to side) or a handshake (up and down), or the contact
may be as complex as a hug (sway) or repetitive “high five”
(clapping together). If the child is unable to move, the therapist
may simply touch the child in the rhythm of the song and to the
beat of the child’s name.

Technique 9: Content and Action-Words

Stimulated by Music Making
Music is a medium conducive to the developing of phonemes
into words because sound-making is an active, outward process.
It is not a difficult task to listen to a child’s phoneme and to
structure it into a musical action. For instance,

be ---------> beat
(phoneme) (musical action word)
70 Loewy

Step 1: Within a familiar melodic context (based upon

prior themes offered by the therapist), the child
vocally explores the “be” sound freely.

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Step 2: The therapist, using a drum to associate the “be”
phoneme sound with the word “beat,” sings the
phoneme sound and then the word “beat” sev­
eral times in a theme, while playing steady beats
and framing the action in a meter.
Step 3: As the child signals and/or vocally indicates his
own desire to perform the action, the melodic
context (theme) from Step 1 is recapitulated,
incorporating the child’s beat pattern and en­
couraging him to sing the word “beat.”
Step 4: The child and therapist sing and play the drum
together. The therapist continues to offer the
familiar theme, a cappella (since speech is a
toned process, which, in actuality is unaccom­
panied).
Step 5: The action word “beat” is connected with the
child’s name in a short sentence within the
theme.
In addition, the therapist can create moments of playing together
and moments in which the child plays alone. Eventually, the child
will want to direct who is to play and when. It is not unusual for
children to begin to implement words to indicate what they desire
to happen in the music. It may evolve that, once they have under­
stood the action meaning of words through the music making, they
will then want to focus upon objects. This is not uncommon. Chil­
dren begin language by using nouns to identify desired actions. This
can be encouraged in the music therapy sessions. New songs may
be developed aseveryday objects are identified, conceptualized, and
integrated through the use of music.

Example of Action-Words Stimulated by Music Making

(AUDIO EXCERPT #9, SIDE B)
Theron, age 8 years. The “o-oh” serves as a recitative that pro­
vides Theron with the momentum to take initiative in determin­
ing the kind of action that he wants taken in the music. This
 The Musical Stages of Speech 71

example is taken from his 5th year of individual music therapy.

Theron’s natural sense of the pitch contour parallels his sense of
understanding the content embedded within the phrasing. He is
aware of his actions, which are affirmed by the strength in his own

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voice. His phonemes are developing into morphemes (complete
words), and he understands the meaning of what he is singing.
The structural component of melody seems to guide his cognitive
understanding of the action words that he chooses to use.

CONCLUSION
Virtually each and every sound that infants make from the
moment of their birth up until the time in which they express their
first morphemes can be understood in a musical context. The
Musical Stages of Speech model provides an overview of this
context for the music therapist working with children or adults of
any population. The suggested techniques for each stage of lan­
guage acquisition offer therapists a working focus that integrates
cognitive, physica1, and emotional aspects of growth
For the “normal” infant or toddler, the model and suggested
techniques can be used as preventative. For children or adults of
varying diagnoses, the model allows the clinician to identify the
level of arrested development and subsequently provide a means
for activating vocalization within the context of a given stage.
It is this author’s hope that future research will focus upon
pre-verbal sound making and the significant role that music
therapy plays in the development of children’s self-awareness,
language acquisition, and ease of expression.

References
Boukydis, Z. (1985). Infant crying: Theoretical and research perspectives. New York:
PlenumPress.
Boxill, E. (1985). Music therapy for the developmentally disabled. Rockville, MD:
Aspen.
Brazelton, B. (1990). The earliest relationship: Parents, infants, and the drama of early
attachment. Reading, MA: Addison-Wesley.
Bridges, K. (1932). Emotional development in early infancy. Child Development,
III, 324-41.
72 Loewy

Briggs. C. (1991). A model for understanding musical development. Music

Therapy, 10(l); l-21.
Bruner. J. (1977). Early social interaction and language acquisition. In H.R.
Scaffer (Ed.) Studies mother-infant interaction (pp. 271-289). London: Aca­

Downloaded from https://academic.oup.com/musictherapy/article/13/1/47/2757105 by guest on 19 February 2021

demic Press.
Capute, A., Palmer, F., Shapiro, B., Wachtel, R., Schmidt, S., & Ross, A. (1986). A
clinical linguistic and auditory milestone scale: Prediction of cognition in
infancy. Developmental Medicine and Child Neurology, 28, 762-771.
Darwin. C. (1877). A biological sketch ofan infant. New York: Appleton.
Hesser, B. (1984). Applications of the minus one technique in music therapy.
Lecture presented at aMethod IISeminar at New York University, New York,
NY.
Hollien, H. (1980). Developmental aspects of neonatal vocalizations. In T. Mur­
ray & J. Murry (Eds.), Infant communication: Cry and early speech (pp. 20-85).
Houston, TX: College Hill Press.
Hooper, S., Hynd, G. & Mattison, I. (1992). Developmental disorders: Diagnostic
criteria and clinical assessment. London: Lawrence Erlbaum Associates.
Katsch, S., & Merle-Fishman, C. (1985). The music within you. New York: Simon
and Schuster.
Illingworth, R.S. (1955). Crying in infants and children. Biomed Journal, I, 75-78.
Landahl, K. (1982). The onset of structural discourse: A developmental study
of the acquisition of language. Unpublished doctoral dissertation. Brown
University, Providence, RI.
Langlois. A.. Baken. R.. & Wilder. C. (1980). Pre-speech respiratory behavior
during & first year of life. In T: Murray & J. Murry (Eds.), ‘Infant comnunica­
tion: Cry and early speech (pp. 56-84). Houston, TX: College Hill Press.
Lieberman, P. (1966) Intonation, perception, and language Cambridge, MA: M.I.T.
Press.
Lieberman, P. (1985). The physiology of cry and speech in relation to linguistic
behavior. In B. Lester & C.F.Z. Boukydis (Eds), Infant crying: Theoretical and
research perspectives (pp. 29-58) New York: Plenum Press.
Lind, J., Vuorenkoski, V., Rosberg, G., Partanen,T., & Wasz-Hockert, O. (1970).
Spectrographic analysis of vocal response to pain stimuli in infants with
Down’s Syndrome. Developmental Medicine and Child Neurology, 12, 478-486.
Loewy,]. (1994). A hermeneutic panel study of music therapy assessment with
an emotionally disturbed boy. (Doctoral Dissertation, New York University,
1994.) University Microfilms No. #9502432
Maranto, C. (Ed.) (1991). Applications of Music in Medicine. Washington D.C.:
NAMT.
McGlone, R. (1966). Vocal pitch characteristics of children aged one to two years,
Speech Monographs, XXXIII, 178-181.
McHugh, C. (1989). Music
in special education. New York: McGraw Hill.
Nakazima, S.(l980). The reorganization process of babbling. In T Murray & J.
Murry (Eds.), Infantcommunication: Cry and early speech (pp. 272-283). Hous­
ton, TX: College Hill Press.
Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day &
CO.
Nordoff, P., & Robbins, C. (1971). Therapy in music for handicapped children (2nd
ed.). London: Victor Gollancz Ltd.
 The Musical Stages of Speech 73

Oshwald, P., Phibbs, R., & Fox, S. (1968). Diagnostic use of infant cry. Biology of
the Neonate, 13, 68-82.
Robbins, C. (1991). Verbal and musical communication from private course in piano
improvisation: New York.
Steiner, R. (1983). The inner nature ofmusic and the experience oftone.

Downloaded from https://academic.oup.com/musictherapy/article/13/1/47/2757105 by guest on 19 February 2021

New York:
Anthroposopbic Press.
Thelan, E. (1994). A dynamic systems approach to the development ofcognition and
action. Cambridge, MA: M.I.T. Press.
Van Riper, C. (1984). Speech correction: An introduction to speech pathology and
audiology. Englewood Cliffs, NJ: Prentice Hall.
Vuorenkoski, V., Lind, J., Partanen, T., Lejeune, J., Lafourcade, J., & Wasz-Hock­
ert, O. (1966). Spectrographic analysis of cries from children with maladie du
cri du chat. Annales Paediatriae Fenniae, 12, 174-180.
Wood, B. (1976). Children and communication: Verbal and non-verbal language
development. Englewood Cliffs, NJ: Prentice Hall.
Ziajka, A. (1981). Prelinguistic communication in infancy. New York: Praeger
Publishers.

Joanne Victoria Loewy, D.A., ACMT-BC, developed the Pediatric

Music Therapy Program at Beth Israel Medical Center, New York City,
in 1994, thanks to a generous five-year rant from The Louis Armstrong
Foundation. She has co-directed Pre-K Music Play, a parent-infant/tod­
dler musical bonding group, since 1991. Dr. Loewy earned her doctorate
from New York University, where she is faculty and research scientist
to the Dean in the The National Arts Education Research Center’s project
“Changing the Nature of Special Education through the Arts. ” She
current serves on the Boar of Directors for the Certification Board for
Music Therapists (CBMT). ’

The author would like to thank Alan Turry for his assistance in the preparation of this
manuscript