How Registered Music Therapists may use music as a structured, motivating medium to support communication access, AAC use and self-expression.
Communication is more than speech
For some people, spoken language is not their main or most reliable way to communicate. Augmentative and alternative communication, often called AAC, may include low-tech communication books, symbol systems, communication apps, devices, gestures, signs, facial expression and other ways of expressing thoughts, choices, needs and preferences.
In music therapy, AAC is not treated as an add-on or afterthought. When it is clinically appropriate, a Registered Music Therapist may intentionally build AAC access into music-based experiences so that a person can make choices, initiate communication, respond to others, express opinions, explore ideas and participate more fully.
What might this look like?
A music therapy session might include familiar songs, songwriting, shared music-making, lyric choices, pauses in songs, turn-taking, improvisation or technology-supported music listening. The therapeutic focus is not on performing music correctly. The music provides a meaningful structure in which communication can happen.
For example, a therapist might leave a predictable pause in a song so the person has time to select a word, symbol or phrase. They might offer real choices about songs, instruments, volume, tempo or lyrics. They might use a person’s special interests as a starting point for songwriting, conversation or shared decision-making. Over time, these musical experiences may provide repeated, purposeful opportunities to practise communication in a way that feels relevant to the person.
What is happening therapeutically?
Musical activity becomes therapeutic when it is connected to clinical reasoning, individual goals and a responsive therapeutic relationship. A Registered Music Therapist may use the predictability of a song to support timing, anticipation and initiation. They may use preferred music to increase motivation and attention, while still carefully balancing choice, flexibility and tolerance of other people’s preferences. They may use songwriting to create a structured context for self-expression, literacy, emotional exploration, decision-making or conversation.
In this kind of work, the pathway might be: a musical activity, such as choosing a song or completing a lyric; a therapeutic process, such as initiating a request, using a symbol, answering a question or expressing an opinion; and a therapeutic goal, such as increasing functional communication, participation, autonomy or shared interaction.
The music is not the outcome. It is the medium through which therapeutic work can happen.
Why music?
Music can offer structure, repetition, emotional meaning and shared attention. For some people, music may also be a strong interest area, which can make it a useful context for engagement and communication practice. A song has a beginning, middle and end. It can include predictable pauses, repeated words and clear opportunities for choice-making. These features can help create communication opportunities without relying only on spoken prompts.
However, music itself does not treat a diagnosis, and a diagnosis alone does not determine whether music therapy is appropriate. Intervention selection depends on the person’s strengths, needs, communication access, sensory preferences, goals, family priorities and broader support team. Music therapy may sit alongside speech pathology, occupational therapy, psychology, education, medical care and other supports as part of a coordinated plan.
An illustrative practice example
The following example is illustrative and does not describe an individual QPAH client.
A young person who uses AAC is referred to music therapy because music is a strong interest and communication practice has been difficult to extend in other contexts. At first, the therapist works with familiar songs and a low-tech communication system. The therapist pauses at predictable moments, offers meaningful choices and creates repeated opportunities for the young person to select words, request songs and complete short phrases.
As the person’s AAC access develops, the therapist collaborates with the broader team. Communication opportunities are gradually expanded from requesting preferred songs to making choices about shared music-making, answering questions about personally meaningful topics, contributing ideas to songwriting and expressing opinions. Technology may be used where appropriate, such as selecting music through a device or practising functional communication that can be used outside the therapy room.
The therapeutic goal is not to become a better singer, musician or performer. The goal is to support communication access, participation and self-expression in ways that may become useful across daily environments.
What does the evidence tell us?
Research into music therapy for autistic people suggests that music therapy may support some areas such as overall improvement, quality of life and total autism symptom severity immediately after therapy, but evidence about effects on social interaction and verbal or non-verbal communication remains uncertain in the current Cochrane review. The review included studies with children, young people and young adults, and rated the certainty of evidence from very low to moderate, meaning findings should be interpreted carefully and may change as further research emerges.
Research and practice literature also discuss the integration of AAC within music therapy. Clinical writing in this area highlights how AAC may be incorporated into music therapy with neurodivergent children and young adults, while more recent position work argues for disability-affirming AAC use, interdisciplinary collaboration and accessible communication practices within music therapy.
Importantly, evidence about AAC instruction more broadly should not be treated as proof that music therapy causes communication gains. Studies of AAC interventions show that strategies such as modelling, prompting, time delay, reinforcement and naturalistic intervention have been used in AAC teaching, including for autistic people using mobile AAC technology. In music therapy, these strategies may be considered within a person-centred, interdisciplinary plan when they are clinically appropriate.
What this means in practice
For families, educators and referrers, the key question is not simply whether a person enjoys music. The more useful question is whether music therapy may provide a clinically appropriate context for working towards identified goals. These might include communication access, participation, social interaction, emotional expression, choice-making or collaboration.
When AAC is involved, collaboration is especially important. A Registered Music Therapist may work alongside speech pathologists, families, support workers, educators and other clinicians so that communication approaches are consistent, respectful and transferable beyond the therapy session. Music therapy should not be seen as replacing speech pathology or other supports. Rather, it may provide another purposeful environment in which communication can be practised and supported.
Learning more about QPAH music therapy
Queensland Premium Allied Health provides music therapy services delivered by Registered Music Therapists. Families, referrers and support teams are welcome to contact QPAH to learn more about music therapy and discuss whether it may be appropriate for a person’s goals, needs and circumstances.
Evidence & Further Reading
- Devlin, K., & Meadows, A. (2021). Integrating Alternative and Augmentative Communication into Music Therapy Clinical Practice: A Clinician’s Perspective. Music Therapy Perspectives, 39(1), 24–33.
This article provides general information about music therapy practice and is not individual clinical advice. Examples are illustrative and do not describe an individual QPAH client unless explicitly stated otherwise. Music therapy is individualised, and approaches and outcomes vary according to each person’s needs, goals and circumstances.
The post Beyond the Notes: Supporting Communication Through AAC and Music Therapy appeared first on QPAH.
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