Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Alicia Clair, PhD, MT-BC
American Music Therapy Association
AMTA E-course producers:
Cathy Knoll, MA, MT-BC
Dwight Knoll
2013, American Music Therapy Association, Inc.
8455 Colesville Rd., Ste. 1000
Silver Spring, MD 20910 USA
All rights reserved.
No part of this e-course, the workbook or the audio,
may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, sharing links,
recording, or by any information storage and retrieval system,
without prior written permission from the Executive Director
of the American Music Therapy Association.
Produced in the United States of America
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
AMTA E-courses
Welcome to this AMTA E-course from the American Music Therapy Association. The user-friendly format of the self-study AMTA E-courses allows participants to listen and learn at their leisure. The core of the AMTA E-courses is the audio presentation, topical segments where the e-course instructor talks about various aspects of the e-course subject matter. AMTA E-course workbooks include additional references, links, supplementary materials, and other valuable resources for the participants. AMTA E-course participants will follow a two-step process to earn five CMTE credits: (1) listen to the audio discussion and review workbook, then (2) submit a CMTE Evaluation electronically.
AMTA Clinical Practice E-course Series
Music therapy clinicians share their experience and expertise about music therapy interventions, applications, strategies, protocols, group management,program and service-delivery models, research, and other issues related to delivering quality music therapy services to a variety of populations in various settings.
AMTA Professional Issues E-course Series
The self-study e-courses in this series provide in-depth, practical information about the “business” of music therapy, e.g., standards of clinical practice, ethics, career enhancement, supervision, leadership, job development, copyright, and other high-priority career and business issues.
The AMTA Music Therapy Intro E-course Series
This series features E-courses for continuing education credit for professionals in medicine, adjunct therapies, education, and other related fields, providing basic information about music therapy research and services. The series also includes accessible resources introducing music therapy to consumers and parents, career counselors, and other interested parties.
An up-to-date listing of available AMTA E-courses and pending self-study e-courses is on the AMTA website, Questions about the AMTA E-course series or about this particular AMTA E-course can be addressed via email <>
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Dementia E-course
Introduction
Individuals who have a dementia, particularly dementia of the Alzheimer’s type, can display behaviors problematic to family members, caregivers, and music therapists. In the context of dementia, problem behaviors are typically manifestations of progressive deterioration of the brain that impacts cognitive, behavioral, social, psychological, emotional, and communication functions. When individuals cannot adequately interpret and respond to stimuli in their environment, their behavior can become aberrant in attempts to cope.
This self-study AMTA E-course provides detailed information for music therapists about managing problem behaviors in late stage dementia. The e-course begins with detailed descriptions of behavior issues commonly encountered by families in private homes and by care staff in residential facilities. In chapters 5 and 6, we look at the theoretical framework and operating principles for music therapy interventions addressing problem behaviors resulting from dementia. The second half of this e-course provides step-by-step details about music therapy protocols to facilitate predictable outcomes. The protocols are tested through clinical experience and are typically effective. However, each situation is different, and each individual has unique characteristics and needs that must be considered. The music therapist can use these protocols as a basis for interventions that disrupt or prevent behaviors, relieve stress, enhance procedural memory, facilitate cooperation, allow for choices, and maintain personal dignity.
My experiences with dementia and interest in dementia care began when I was a young child, and continue in my professional music therapy career. My best wishes to my music therapy colleagues as you spend time with individuals with dementia and introduce protocols that improve the quality of life for each person.
Alicia Clair
Alicia Ann Clair, Ph.D., MT-BC, is a Professor and Director of Music Education and
Music Therapy at the University of Kansas and served 20 years as a research associate at the Eastern Kansas VA Medical Center in Topeka, KS. She will become Professor Emeritus at the University of Kansas on August 2, 2013. Dr. Clair has a long career of active involvement in clinical research and has published outcome studies with music and therapeutic music interventions for older adults includingthose who are well and those who are physically frail.
Dr. Clair has specialized in clinical protocols for persons in dementia and their families, persons in rehabilitation for chronic pulmonary obstructive disease, and rehabilitation for persons with movement disorders due to injury or disease. Her book, Therapeutic Uses of Music for Elderly Adults, is widely used as a text in music therapy training programs and is available in Japanese and Korean translations. Dr. Clair is the recipient of many awards and honors including the University of Kansas Chancellor's Award for Teaching Excellence, University of Kansas Motor Board Society's Award for Teaching Excellence, and the American Association for Music Therapy (AMTA) national awards for research, professional practice, service, and the AMTA Presidential Award for service on the Commission for Education and Training. In addition she received the highest distinction the AMTA conveys, the Lifetime Achievement Award. She has served on the editorial boards of research journals including the Journal of Music Therapy, and Music Therapy Perspectives. Contact Information: 448 Murphy Hall, 1530 Naismith Dr., The University of Kansas, Lawrence, 66045. Phone:(785) 864-9636. email:.
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Course Contents
Chapter 1: Issues related to pacing, wandering, sundowing, crying, crying out for help,
and screaming
Chapter 2: Issues related to hoarding, asking to go home, lack of cooperation,
physical and verbal aggression
Chapter 3: Sleep disturbances, routines, procedural memory, delusions, validation,
and withdrawal
Chapter 4: Moodiness, irritability, sexual issues, withdrawal from family,
ambulation issues, and late stage agitation
Chapter 5: Theoretical framework for music therapy protocols
Chapter 6: Operating principles and guidelines
Chapter 7: Protocols to remediate problem behaviors in dementia
Chapter 8: Protocols for pacing, aimless wandering, and sundowning
Chapter 9: Protocols addressing crying out for help, repetitively asking to go home,
screaming, and hoarding
Chapter 10: Protocols addressing physical and verbal aggression
Chapter 11: Protocols addressing sleep disturbances, delusions, and withdrawal
Chapter 12: Protocols addressing irritability, sexual issues, interaction with family,
ambulation, and agitation
Chapter 13: CMTE Information – step-by-step instructions for earning CMTE credits
Note: If you have any questions about this AMTA E-course or about CMTE credits, contact us via email <>
For further information about music therapy and dementia, click on the website of the American Music Therapy Association
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
What do I do next?
Step 1: Find materials and resources on the E-course Landing Page.
The link below leads to the Landing Page for this AMTA E-course.
The E-course Landing Page includes access to all the resources necessary for sharpening professional knowledge and skills and for earning CMTE credit. The Landing Page materials for this AMTA E-course includes:
Links to the audio segments of Alicia Clair’s discussion about music therapy protocols for managing problem behaviors related to dementia. The audio discussion is the core of this AMTA E-course.
A copy of the MT and Dementia E-course workbook in Word format, allowing participants to take notes while listening to the audio discussion if they like for their own reference.
The CMTE Evaluation for this AMTA E-course with step-by-step instructions for earning 5 CMTE credits from AMTA, a CBMT pre-approved provider.
Step 2: Listen to audio discussion.
Download the audio to any device and listen to each chapter at your leisure. You can refer back to any chapter - or chapter segment - at any time now and in the future. Note: AMTA E-course participants are not required to follow the written discussion outline of thee-course while listening to the audio segments, but, if you choose to do so, you will find the chapter outlines in this e-course workbook.
Step 3: Submit CMTE Course Evaluation for CMTE credits.
If you want to earn 5 CMTE credits from AMTA – a CBMT Approved Provider – you will submit the CMTE Course Evaluation found on the E-course Landing Page. Just as with any CMTE course, the AMTA Continuing Education Committee will process your CMTE Evaluation and send you a Certificate of Completion for 5 CMTE credits via email. Complete CMTE information and step-by-step instructions are in the back of this workbook.
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 1
Issues related to pacing, wandering, sundowing,
crying, crying out for help, and screaming
Listen to the audio segment for Chapter 1.
Discussion Outline
1. Pacing or aimless wandering
2. Sundowning
3. Crying or crying out for help
4. Screaming
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 2
Issues related to hoarding, asking to go home, lack of cooperation, and physical and verbal aggression
Listen to the audio segment for Chapter 2.
Discussion Outline
1. Hoarding
2. Asking to go home
3. Uncooperative with bathing and other daily living
4. Physical aggression
5. Verbal aggression
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 3
Sleep disturbances, routines, procedural memory,
delusions, validation, and withdrawal
Listen to the audio segment for Chapter 3.
Discussion Outline
1. Sleep disturbances for the individual and for the family
2. Attempts to conduct familiar routines of the past
3. Procedural memory
4. Delusions, reality orientation, and delusions
5. Withdrawal, lack of response, and attempts to hide from others
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 4
Moodiness, irritability, sexual issues, withdrawal from family,
ambulation issues, and late stage agitation
Listen to the audio segment for Chapter 4.
Discussion Outline
1. Moodiness, irritability, and short temper
2. Sexual acting out
3. Lack of interaction with family
4. Ambulation transition
5. Late stage agitation
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 5
Theoretical framework
for music therapy protocols
Listen to the audio segment for Chapter 5.
Discussion Outline
1. Need for theoretical framework for protocols for individuals with dementia
2. Purpose of and objectives for music therapy interventions for behavior issues
3. Optimal arousal as a basis for successful outcomes
4. Overarching goal of music therapy intervention focusing on arousal levels
5. Music therapy used throughout the day to achieve optimal arousal
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 6
Operating principles and guidelines
Listen to the audio segment for Chapter 6.
Discussion Outline
1. Basic guidelines to consider when developing music therapy interventions
2. Familiar music
3. Positive and negative associations with music
4. Therapeutic singing and singing cues
5. Participation in active singing
6. Structured and predictable routine
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 7
Protocols to remediate problem behaviors
Listen to the audio segment for Chapter 7.
Discussion Outline
1. Definition of protocols
2. Considering individual needs
3. Considering the music therapist’s scope of practice
4. Recommended equipment and instruments
5. Use of an accompanying instrument
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 8
Protocols for pacing,
aimless wandering, and sundowning
Listen to the audio segment for Chapter 8.
Discussion Outline
1. Music therapy protocol for pacing or aimless wandering
A. Impact of this protocol on pacing or aimless wandering
B. Systematic steps in music therapy protocol
C. Indicators of progress as a result of the protocol
2. Music therapy protocol for sundowning
A. Evaluating the individual’s needs
B. Systematic steps in music therapy protocol
C. Notes for optimizing the therapeutic experience
D. Benefits of the protocol related to agitation
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 9
Protocols addressing crying out for help,
repetitively asking to go home, screaming, hoarding
Listen to the audio segment for Chapter 9.
Discussion Outline
1. Music therapy protocol for crying, crying out for help, and repetitively asking to go home
A. Similarities in these three issues
B. Systematic steps in the music therapy protocol
C. Transition to the next activity
2. Music therapy protocol for screaming
A. Systematic steps in music therapy protocol
B. Interaction with the person once screaming stops
2013, American Music Therapy Association, Inc.
3. Music therapy protocol for hoarding
A. Music therapist’s role in dealing with hoarding
B. Considerations for interrupting or eliminating the triggers of hoarding
C. Systematic steps in the music therapy exercise protocol
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 10
Protocols addressing physical and verbal aggression
Listen to the audio segment for Chapter 10.
Discussion Outline
1. Issues related to physical and verbal aggression, including pushing, hitting, combativeness,
lack of cooperation, yelling, and arguing loudly
2. Potential triggers of physical and/or verbal aggression
3. Safety issues and procedures when responding to aggressive behaviors
4. Systematic steps in the music therapy protocol for calming aggression
5. Considerations related to daily tasks, such as toileting, bathing, eating, and medical procedures
6. Systematic steps in music therapy protocol related to activities of daily living
7. Systematic steps in music therapy protocol related to bathing
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 11
Protocols addressing sleep disturbances,
delusions, and withdrawal
Listen to the audio segment for Chapter 11.
Discussion Outline
1. Music therapy protocols for sleep disturbances
A. Strategies for sleep hygiene beginning early in the day
B. Systematic steps for music therapy protocols to encourage sleep
C. Responses if a person awakens in the night
2. Music therapy protocol for progressive muscle relaxation
3. Music Time Out protocol to prevent or decrease agitation
4. Music therapy protocol in response to delusional behaviors
5. Music therapy protocol in response to withdrawal
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 12
Protocols addressing irritability, sexual issues,
interaction with family, ambulation, and agitation
Listen to the audio segment for Chapter 12.
Discussion Outline
1. Music therapy protocol in response to moodiness, irritability, and short temper
2. Options for responses to inappropriate touching and sexual aggression
3. Music therapy protocols for people who do not interact with their family
4. Music therapy protocols for facilitating ambulation transition
5. Music therapy protocols for late stage agitation
2013, American Music Therapy Association, Inc.
Music Therapy and Dementia:
Protocols for Managing Problem Behaviors
Chapter 13
CMTE Information
This AMTA E-course,Music Therapy and Dementia, provides detailed examples of challenging behaviors commonly encountered in dementia care, and provides protocols for addressing those behaviors effectively in music therapy, while, at the same time,giving music therapists the option to earn 5 CMTE credits from the American Music Therapy Association (AMTA), an approved provider (#P-051)of the Certification Board of Music Therapists (CBMT), and giving other professionals the option of earning continuing education credits.
E-course description. The instructor of this AMTA E-course, Dr. Alicia Clair, provides detailed information for music therapists about managing problem behaviors in late stage dementia, beginning with detailed descriptions of behavior issues commonly encountered by families in private homes and by care staff in residential facilities. Dr. Clair discusses the theoretical framework and operating principles for music therapy interventions addressing problem behaviors resulting from dementia. The second half of the e-course provides step-by-step details about music therapy protocols to facilitate predictable outcomes. The protocols are tested through clinical experience and are typically effective. However, each situation is different, and each individual has unique characteristics and needs that must be considered. The music therapist can use these protocols as a basis for interventions that disrupt or prevent behaviors, relieve stress, enhance procedural memory, facilitate cooperation, allow for choices, and maintain personal dignity.