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By Zach Giordano
| May 31, 2017
Hannah Silva wasn’t even two years old when she was diagnosed with autism. Her mother, Emanuella, tried to be patient with her daughter’s treatment, but, like so many parents whose children fall on the autism spectrum, she grew increasingly frustrated with the progress Hannah was making at school.
It was when she turned to Franciscan Children’s in Brighton, which offered a broad range of therapies to help Hannah’s speech and development delays, that Emanuella felt her first twinges of hope. Shortly after, they met someone who would change both their lives.
After one of Hannah’s weekly speech therapy appointments, she and her mother bumped into Jessica Triana, one of Franciscan’s music therapists. They both noticed Jessica’s cart, overflowing with musical instruments, but Hannah seemed particularly transfixed. In that moment, Emanuella considered a question she’d never thought to ask: Since Hannah loved music so much, could one of her passions actually become a core component of her treatment?
Jessica assured Emanuella that music therapy would not only help Hannah with her communication skills, but it would also help her focus and interactions with others. Emanuella wasted no time requesting to have this treatment added to her daughter’s care, and Hannah and Jessica have been best friends ever since.
“Hannah has a big heart,” Jessica says. “She’s very compassionate, and she loves music—especially singing, dancing, and getting other people to participate with her.”
The sounds of serendipity
Now five years old, Hannah walks into her music therapy sessions ready to play. She’s an adorable, dark-haired little girl who wears cat t-shirts and speaks with a broad vocabulary, but if you study her behavior for a few moments you’ll begin to see signs of her challenges.
Autism Spectrum Disorder, the country’s fastest growing developmental disability, according to the Centers for Disease Control, can be an invisible condition, where at first only those closest to the person can truly see its effects. For Hannah, it means she has a tendency to avoid eye contact, often looking around the room and down instead of at the person she’s talking with. And while she first appears to be shy, as time passes she becomes more distant. She can be engaged one moment, and distracted the next.
But when she is engaged, she lights up the room, with both her sneakers and her smile. The music room is packed with instruments, from tiny pink guitars and bongo drums to keyboards and maracas—all there to help her practice skills that transcend making music.
Jessica, whose bond with Hannah has grown increasingly tight, is focused on teaching her how to verbalize her thoughts and feelings appropriately with other children and adults. And even though Hannah has only been working with Jessica since last August, she’s made enormous strides in less than a year, showing emotion in more appropriate and controlled ways.
“When she was little, Hannah would have trouble making friends because many of the kids were scared of her,” says Emanuella. “She would get in their faces and not respect people’s personal space. She’s not that kid anymore.”
A holistic approach to young health
Jessica sees big changes, too. One of her ongoing focuses has been helping Hannah control her emotions when she doesn’t get her way—which can be a struggle for children with autism—and instead learn to problem solve when things change unexpectedly. Through the music that they make together, Hannah is learning that by working hard at something, she’ll become more flexible and understanding.
“The biggest change I’ve seen in Hannah is her willingness to be challenged to do some really difficult work,” Jessica says. “She knows that even though music therapy is fun, there’s also a lot of hard work that comes with it. She’s definitely become a lot more open to that and willing to take on those challenges.”
That willingness to be patient is a vital skill, especially for a child as young as Hannah. And those lessons don’t just apply to her music therapy. She also receives speech therapy, occupational therapy, expressive therapy, and nutrition services at Franciscan Children’s.
Normally, juggling multiple therapies, in addition to the specialized dental care Hannah requires, would be a herculean act for a parent. But as Emanuella has learned, when all of the care takes place under one roof, and sometimes in one day, it’s much more manageable.
“Hannah is a great example of the success of coordinated, integrated care,” said Dr. Paul Geltman, who oversees all outpatient services at Franciscan Children’s, including medical, dental, day surgery, behavioral health, diagnostic services and rehabilitation therapies, and makes sure they are all collaborating to provide a seamless experience for patients like Hannah.
“She comes here for different services and we’re able to provide them for her all in a single afternoon in coordination. The clinical staff involved with her talk to each other, coordinate care plans, walk her down the hall to the next provider’s office, and do a little curbside update. Her care demonstrates how the team approach to care, the integration and collaboration, can work.”
Bonding through bongos
After an afternoon of therapies, Hannah looks forward to the end of her day, when she gets to sit and make music with Jessica. But one day recently, a new face appeared in the room: Madeleine Brown, a music therapy student at Berklee College of Music.
Hannah warms to Madeleine quickly, which is unusual, but Madeleine doesn’t simply let Hannah bang on the drums or strum a guitar playfully. She prompts Hannah to repeat her name when she forgets and make eye contact when she grows distracted. This is both work and play for Hannah, but she doesn’t mind.
Madeleine asks Hannah to choose a subject for a song they’ll perform together, and Hannah suggests pets. One of the only things Hannah loves more than music and her mom is her cat, Munchy.
Hannah and Madeleine play a duet of “Old MacDonald,” with Hannah giving voice to the farm animals and house pets, while Madeleine strums along on her guitar. They soon move on to their own song, complete with more animals and animal sounds.
Even though they just met, Hannah shows certain behaviors with Madeleine that reflect the progress she’s made working with Jessica and all the therapists at Franciscan. She offers Madeleine the microphone so they can take turns singing and lets Madeleine share the keyboard with her, behaviors that are often hard for young children with autism to grasp and practice.
“Hannah’s distress tolerance was amazing,” Jessica explained later. “When Hannah becomes overwhelmed or challenged, she can withdraw or become aggressive and/or defiant. We didn’t see any behaviors like this despite the many social demands she was presented with. This tells me that Hannah was working very hard to keep her body and mind calm and be respectful of others.”
Hannah’s bright future
For their next session, Madeleine prepared a song that incorporated some of Hannah’s favorite things (animals and the sounds they make), and also encouraged behaviors she thought might be beneficial for Hannah, like call-and-response participation and memory recall.
During their duet, Madeleine jumped back on the guitar and Hannah played the drums. They sang about pandas, monkeys, elephants, and, of course, kitty cats. After each stanza, Madeleine asked Hannah to repeat all the animals that came before—and she succeeded almost every single time.
The bond that formed between two strangers—a college student and a five-year-old girl with autism—was remarkable in how quickly it blossomed. But it was no accident. It was the result of Hannah’s various therapies shining through and turning her into a more confident young girl who is learning to be more comfortable in her surroundings.
But her work has only just begun. As Hannah grows up, aspects of her autism will still be present, and she’ll have to manage all of the challenges it throws at her, in school, at home, and throughout her life. But the lessons she’s taking away from her time at Franciscan are already proving to be invaluable.“I have seen so much progress,” Emanuella says of her daughter. “She is calmer, more polite, and able to transition from one thing to another more easily. Her time at Franciscan has made all the difference.”
To learn more about children like Hannah and the services that Franciscan Children’s provides, please visit franciscanchildrens.org.
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